Background: Endoscopic submucosal dissection (ESD) was commonly used for en bloc resection in gastric cancer and adenoma with the risk of delayed bleeding after ESD. We conducted a direct and indirect comparison meta-analysis to evaluate the best choice in preventing post-ESD bleeding among proton pump inhibitors (PPIs), histamine₂-receptor antagonists (H₂RAs), and the most widely used potassium-competitive acid blocker, vonoprazan. Methods: The Pubmed, Cochrane Library, and Embase were searched for randomized trials. We pooled odds ratios (OR) for preventing post-ESD bleeding using meta-analysis. Results: Sixteen randomized trials met the inclusion criteria including 2,062 patients. Direct comparisons showed slightly significant efficacy in PPIs rather than H₂RAs in preventing post-ESD bleeding [OR: 1.83; 95% confidence interval (CI): 1.10 to 3.05] and vonoprazan was better than PPIs (OR: 0.46; 95% CI: 0.25 to 0.86). The adjusted indirect comparison indicated vonoprazan was superior to H₂RAs (OR: 0.30, 95% CI: 0.12 to 0.74). In subgroup analysis, PPIs had similar efficacy as H₂RAs in 4 weeks, while PPIs were better than H₂RAs in 8 weeks’ treatment (OR: 1.91; 95% CI: 1.08 to 3.40). The superiority of vonoprazan than PPIs was more significant in combination therapy (OR: 0.18; 95% CI: 0.04 to 0.69). There was a significant difference in vonoprazan for 8 weeks of medication (OR: 0.44; 95% CI: 0.21 to 0.92). Conclusions: The effects of vonoprazan is better than PPIs than H₂RAs in preventing bleeding after ESD. When vonoprazan combined with mucosal protective antiulcer drug in treatment or used in 8 weeks of medication, the efficacy may be even better.

The cement industry’s intricate production process, including kiln heating and fossil fuel use, contributes 5–8% of global CO₂ emissions, marking it as a significant carbon emitter in construction. This study focuses on quantifying CO₂ capture potential in blended cement systems through the utilisation of phenolphthalein and thermalgravimetric methodologies. Its primary objective is to assess the CO₂ absorption capacity of these blended systems’ pastes. Initial evaluation involves calculating the carbon capture capacity within the paste, subsequently extended to estimate CO₂ content in the resultant concrete products. The findings indicate that incorporating ground granulated blast-furnace slag (GGBS) or an ettringite-based expansive agent did not notably elevate carbonation depth, irrespective of their fineness. Conversely, the introduction of fly ash (FA) notably augmented the carbonation depth, leading to a substantial 36.4% rise in captured CO₂ content. The observed distinctions in carbonation behaviour primarily stem from variances in pore structure, attributable to distinct hydration characteristics between GGBS and FA. Thermal analysis confirms the increased stabilisation of CO₂ in FA blends, highlighting the crucial influence of material composition on carbonation and emission reduction. Incorporating both GGBS and FA notably diminishes binder emissions, constituting almost half of PC-concrete emissions. Initially, 60% GGBS shows lower emissions than 50% FA, but when considering CO₂ capture, this emission dynamic significantly changes, emphasising the intricate influence of additives on emission patterns. This underscores the complexity of evaluating carbonation-induced emissions in cementitious systems.

Objective: To systematically estimate and compare the effectiveness and cost-effectiveness of the glucagon-like peptide-1 receptor agonists (GLP-1RAs) approved in China and to quantify the relationship between the burden of diabetic comorbidities and glycosylated hemoglobin (HbA1c) or body mass index (BMI).Methods: To estimate the costs (US dollars, USD) and quality-adjusted life years (QALY) for six GLP-1RAs (exenatide, loxenatide, lixisenatide, dulaglutide, semaglutide, and liraglutide) combined with metformin in the treatment of patients with type 2 diabetes mellitus (T2DM) which is inadequately controlled on metformin from the Chinese healthcare system perspective, a discrete event microsimulation cost-effectiveness model based on the Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) simulation model was developed. A cohort of 30,000 Chinese patients was established, and one-way sensitivity analysis and probabilistic sensitivity analysis (PSA) with 50,000 iterations were conducted considering parameter uncertainty. Scenario analysis was conducted considering the impacts of research time limits. A network meta-analysis was conducted to compare the effects of six GLP-1RAs on HbA1c, BMI, systolic blood pressure, and diastolic blood pressure. The incremental net monetary benefit (INMB) between therapies was used to evaluate the cost-effectiveness. China’s per capita GDP in 2021 was used as the willingness-to-pay threshold. A generalized linear model was used to quantify the relationship between the burden of diabetic comorbidities and HbA1c or BMI.Results: During a lifetime, the cost for a patient ranged from USD 42,092 with loxenatide to USD 47,026 with liraglutide, while the QALY gained ranged from 12.50 with dulaglutide to 12.65 with loxenatide. Compared to exenatide, the INMB of each drug from highest to lowest were: loxenatide (USD 1,124), dulaglutide (USD −1,418), lixisenatide (USD −1,713), semaglutide (USD −4,298), and liraglutide (USD −4,672). Loxenatide was better than the other GLP-1RAs in the base-case analysis. Sensitivity and scenario analysis results were consistent with the base-case analysis. Overall, the price of GLP-1RAs most affected the results. Medications with effective control of HbA1c or BMI were associated with a significantly smaller disease burden (p < 0.05).Conclusion: Loxenatide combined with metformin was identified as the most economical choice, while the long-term health benefits of patients taking the six GLP-1RAs are approximate.

Due to the popularization and development of new energy vehicles (NEVs) worldwide, power batteries that have been used are being retired and replaced. In China’s battery recycling industry, the legal NEV battery recycling enterprises are at a negative financial performance. Based on theory of organizational adaptation, the key to innovation performance and sustainable development is recognition of the environment and strengthening organizational flexibility. This study empirically explores the bidirectional dynamic relationships among heterogeneous environmental uncertainties, innovation activities, firm growth and strategic flexibility in Chinese NEV battery recycling firms. A total of 1040 sample data were collected from 2015 to 2021. The research results demonstrate that environmental uncertainty (EU), strategic flexibility (SF) and innovation activities (INNO) all had impacts on firm growth (FG). Specifically, INNO had strongly negative effects in the short term, and in the long term, it will bring a positive effect to FG; the impact of EPU was more important than market uncertainty (MU) to FG and innovation activities. This could be due to the dependence of the Chinese NEV battery recycling industry on government policy. However, MU has a strong impact on SF. Moreover, the levels of SF should be reasonable, otherwise it could be a burden to enterprises. There also exists the bidirectional dynamic relationships between FG and INNO. This study contributes a non-core perspective to strategic flexibility research by revealing the complex environmental mechanism, and to the Chinese NEV battery recycling industry we provide a theoretical basis and practical guidance for government and firms on how to apply SF to promote innovation and realize growth in the present business environment.

Background Levalbuterol is a short-acting β2-agonist (SABA) indicated for treating or preventing asthma exacerbation. It was included in the 2020 Chinese National Reimbursement Drug List (NRDL). This study estimates the economic impact of levalbuterol’s status change within and withdrawal from the NRDL in treating pediatric asthma from a publicly funded medical insurance perspective. Methodology A prevalence-based budget impact model was developed. The analysis compared a world with a levalbuterol scenario to a world without levalbuterol. Epidemiological data were obtained from the existing literature. Cost data were estimated based on the drug dosage in clinical trials, real-world settings, and expert opinions. Scenario analysis considered the same length of stay (LOS) in the two groups. One-way sensitivity analyses were carried out to show the impact of varying individual parameters. Results In the base-case analysis, compared to the world without scenario, the preservation of levalbuterol resulted in cost savings of ¥82.8 million in China over three years. In the scenario analysis, savings decreased to ¥76.1 million over three years. Sensitivity analysis showed that, for the most part, the results were robust to changes in input parameter values. Conclusions Using levalbuterol may lead to substantial cost savings for Chinese society.