Background:The objective of our study was to investigate the willingness to pay (WTP) per quality-adjusted life year (QALY) among people with malignancies in China, and the associated factors that significantly affect WTP/QALY ratios.Methods:We conducted a cross-sectional survey using the contingent valuation method and employed the EuroQol-5 Dimensions (EQ-5D), European Organisation for Research and Treatment of Cancer Quality of Life Utility Measure-Core 10 Dimensions (QLU-C10D), and WTP questionnaires to extract information on demographic characteristics, health utility, and WTP for full recovery from the respondents. Furthermore, we conducted stepwise regression analyses to identify factors affecting the WTP/QALY ratios.Results:We received 1012 valid questionnaires, comprising 588 patients and 424 family members. The mean age of the patients was 57.05 (11.48) years. There were 483 male patients and 529 female patients; the numbers of urban and rural patients were 576 and 436, respectively. The mean scores of health utility (standard deviation) measured by EuroQol Five-Dimensional Five-Level Questionnaire and QLU-C10D were 0.75 (0.20) and 0.74 (0.16). For the overall sample, the mean and median WTP/QALY values based on the EQ-5D instrument were 336,236 renminbi (RMB) (4.67 times gross domestic product [GDP] per capita) and 177,814 RMB (2.47 times GDP per capita), and 344,233 RMB (4.78 times GDP per capita) and 152,386 RMB (2.12 times GDP per capita) for the QLU-C10D instrument. There was no significant difference between the WTP/QALY values based on different cancers. In stepwise regression models, the WTP/QALY value was significantly correlated with health utility, income level, employment status, regular physical examination, etc.Conclusion:This paper evaluated the monetary value of QALY among people with malignancies in China. Our analysis reveals an inverse relationship between national income levels and the ratio of WTP per QALY to GDP per capita, suggesting that lower-income countries may adopt relatively higher cost-utility thresholds in proportion to their GDP per capita. Additionally, the ratios of WTP/QALY to GDP per capita for patients with malignant tumors are similar to those of the general population with life-threatening conditions; patients with non-life-threatening diseases have comparable WTP/QALY to GDP per capita ratios with the general population in a quality-of-life improvement scenario, providing empirical reference for decision-making and resource allocation in the stratified disease management. Future studies with more representative samples across a broader range of countries are warranted to enable a more comprehensive and systematic discussion.

The internationalization of the Renminbi (RMB) is a crucial strategic objective for China. Currently, RMB internationalization faces constraints such as insufficient currency value stability, the need to enhance the influence of the Cross-Border Interbank Payment System (CIPS), weak network externalities, and the pressures of dollar hegemony and international currency competition. The issuance and circulation mechanisms of e-CNY, along with its inherent advantages, can help alleviate these issues and provide positive momentum to break through the bottlenecks of RMB internationalization. In the future, China should promote the development of e-CNY by expanding its cross-border application scenarios, enhancing the efficiency and security of cross-border payments, actively improving relevant legal and regulatory systems, seizing the opportunity of "de-dollarization" to encourage and support other countries in using the RMB, and leveraging initiatives like the Belt and Road Initiative (BRI) and the Regional Comprehensive Economic Partnership (RCEP) to guide e-CNY internationalization, thereby injecting fresh momentum into the RMB's global ascent.

ObjectiveTo evaluate the cost-effectiveness of the levonorgestrel intrauterine system (LNG-IUS) compared with hysteroscopic niche resection (HNR) for women with niche-related postmenstrual spotting.DesignEconomic evaluation from a healthcare perspective, conducted alongside a randomised controlled trial with 12 months of follow-up.SettingA single-centre study at a university hospital in Shanghai was carried out between October 2019 and January 2021.ParticipantsA total of 208 women aged 18–48 years with niche-related spotting who were suitable for a HNR, defined as a residual myometrium of at least 2.2 mm confirmed by MRI.InterventionParticipants were randomly assigned to LNG-IUS insertion (n=104) or HNR (n=104).Main outcome measuresThe primary outcome was reduction in postmenstrual spotting at 6 months, defined as ≥50% decrease in spotting days compared with baseline. Cost-effectiveness was expressed as incremental cost-effectiveness ratios (ICERs), calculated by dividing cost differences in effective rate and spotting days.Statistical analysesMean costs (diagnostic, examination, surgical) were compared between groups using Student’s t-test, standardised to 2019 price levels. Uncertainty around cost-effectiveness was assessed with non-parametric bootstrapping and cost-effectiveness acceptability curves.ResultsAt 6 months, 78.4% (80/102) of women in the LNG-IUS group and 73.1% (76/104) in the HNR group reported improvement in spotting symptoms (RR 1.07, 95% CI 0.92 to 1.25). Spotting reduction was greater with LNG-IUS (0.0 days, IQR 0.0 to 2.8) compared with HNR (2.0 days, IQR 0.8 to 4.3; p<0.001). Mean costs were significantly lower in the LNG-IUS group (￥2273.8 RenMinBi (RMB)) versus the HNR group (￥6318.0 RMB), with a mean cost difference of −￥4044.2 RMB (95% CI −4367.3 to −3721.1). The ICER of LNG-IUS over HNR was −￥763.2 RMB per one-percentage-point effective rate gained. Each day reduction in spotting was associated with cost savings of ￥1833.8 RMB. The probability of LNG-IUS being dominant was 0.99 at a willingness-to-pay (WTP) of ￥0 RMB and 0.97 at WTP ￥10 000 RMB per effective rate point, and 0.99 and 0.60, respectively, per spotting day reduced.ConclusionsLNG-IUS is highly cost-effective compared with HNR for the treatment of niche-related postmenstrual spotting at 6 months. These findings support LNG-IUS as first-line therapy for niche-related spotting in women with a residual myometrium ≥2.2 mm.Trial registration numberChiCTR1900025677.

Comparison of robotic and anterolateral minithoracotomy mitral valve repair: Experience in China.

ABSTRACT This paper develops a multi-country dynamic general equilibrium model to quantify how capital account liberalization influences the internationalization of the Chinese renminbi (RMB). The model features two major economies: the United States and China, and a continuum of small open economies. We incorporate two types of capital controls: price-based (e.g. transaction costs) and quantity-based (e.g. foreign ownership quotas) into household portfolio choices, along with frictions in trade finance that generate collateral demand. After calibration, we uncover three key findings. First, price-based controls exhibit nonlinearity effect: small reductions have little effect until a critical threshold is passed, after which RMB usage rises sharply—by about 20% in the baseline case, and up to around 27% with a larger bond market. Second, quantity-based controls also show threshold effects, with full liberalization raising RMB usage by 8–15%, depending on RMB bond market size. Third, expanding the supply of RMB-denominated bonds substantially boosts global adoption. Doubling bond supply increases RMB internationalization by roughly 30% points under tight capital controls, and around 55% when paired with full liberalization. These findings highlight the importance of jointly reducing cost frictions and expanding asset availability.

ABSTRACT This paper examines how U.S. monetary policy is transmitted to the renminbi (RMB) within China's onshore–offshore exchange‐rate structure. Using monthly data from 2012 to 2025 and a time‐varying parameter vector autoregression (TVP‐VAR) model, we identify how adjustments in three dimensions of U.S. policy—prices, interest rates, and liquidity—affect the onshore (CNY) and offshore (CNH) markets. The estimates show apparent differences across channels and between the two markets. Movements in the U.S. Dollar Index exert the most persistent influence and become more important when global uncertainty rises. Interest‐rate shocks also matter, but their effects depend on the policy environment, whereas liquidity shocks have limited explanatory power. CNH responds more quickly and more strongly than CNY, reflecting the contrast between a globally traded market and one constrained by domestic policy. Institutional changes, including the 2015 exchange‐rate reform and the later introduction of the counter‐cyclical factor, modify how external shocks influence RMB pricing by altering the interaction between onshore policy tools and offshore market behaviour. Overall, spillovers from U.S. policy to the RMB are neither constant nor uniform; they evolve with shifts in global financial conditions and changes in China's monetary policy. These insights contribute to a deeper understanding of monetary autonomy, exchange‐rate formation, and the evolving role of the RMB in global financial markets.

American Investment in Chinese Renminbi

With the vigorous development of China's economy, the internationalization level of Renminbi (RMB) is still improving, and the offshore RMB market is also expanding. Compared with onshore RMB, the price of offshore RMB is formed by free bidding of buyers and sellers. Market supply and demand are two extremely important factors affecting the exchange rate of offshore RMB, and the fluctuation of exchange rate is relatively free, so the offshore RMB exchange rate is relatively volatile. Under such circumstances, it is of great significance to forecast the offshore RMB exchange rate. This review focuses on the application of combinatorial models related to machine learning in offshore RMB exchange rate forecasting, and systematically combs the data types, modeling methods, and related forecasting performance involved in recent research. This paper evaluates the application effectiveness of the machine learning fusion Autoregressive Integrated Moving Average (ARIMA) model, supervised learning based on neural network and random forest, and the Long Short-Term Memory-Temporal Convolutional Network-Convolutional Neural Network (LSTM-TCN-CNN) hybrid model in offshore RMB exchange rate forecasting, compares and analyzes the advantages of each model, and summarizes the applicable scenarios of different models. The results show that the machine learning fusion ARIMA model is suitable for the prediction of time series with obvious rules and a small amount of data, the combination model of random forest and neural network is suitable for the prediction of structured data, and the LSTM-TCN-CNN model is suitable for the prediction of multivariate time series with a large amount of data and high dimension.

The United States dollar (USD) has long served as the cornerstone of the global reserve currency system, maintaining its dominance for several decades. Nevertheless, this preeminence is increasingly challenged by a landscape characterized by geopolitical strife, shifts in economic power, and advancements in monetary technology. This paper investigates the validity of USD supremacy in light of China’s ascendance as a formidable economic force and the rising discussions surrounding a potential reversion to the gold standard. The analysis focuses on China’s expanding role through initiatives such as the internationalization of the renminbi (RMB), which aims to transform global trade and financial frameworks. Additionally, the paper considers both the historical and modern ramifications of a gold-backed monetary system, assessing its viability as a substitute for the current reliance on fiat currencies. Employing a multidisciplinary perspective, the study examines the interactions among these elements, offering insights into the durability of USD dominance and the potential for a multipolar currency landscape.

In the 21st century, renminbi (RMB) has become an important currency in the world and this essay will exam the process of the RMB internationalization and its influence on the financial system. This essay will mix literature analysis and case-based analysis to evaluate that RMB in global using. including trade settlement, reserve currency status, and the emergence of digital currency innovations. First, this paper outlines the historical development of RMB’s internationalization and highlights the main key policies and economic factors that help RMB gradually integrate into global finance. Secondly, this paper examined the current statues of RMB usage in crossborder payments, global settlement, and financial markets, making sure the main channels that RMB using to utilises including the SWIFT network and digital RMB initiatives. And then, this research explores the challenges and risks associated with internationalization process including exchange rate volatility, capital flow management and uncertainties in the global political economy. So, with the development of RMB internationalization, it not only has opportunities, but also has risks and challenges. So, RMB internationalization is a double-edged sword. The research indicates that RMB internationalization makes a huge influence on multipolarity in the global currency system, providing an option for emerging market economies, at the same time it also affects the structure of international debt and investment. In the end, this paper conducts policy implications and provides strategies to strengthen the RMB’s role in the international financial system.

In the context of the development of the digital economy, the controllable anonymity mechanism of digital Renminbi (RMB) is gradually being promoted. The characteristics of small amount anonymity, large amount traceability, voluntary front-end, and real name back-end have had various impacts on the risks of small consumer credit. On the one hand, the safety and convenience of small-scale consumption have been improved, which, to some extent, solves the problem of information asymmetry and enhances the ability to manage credit risks. On the other hand, it is difficult to strike a balance between “anonymity” and “regulation”. Furthermore, it relies on a strict legal system and rigorous management institutions, as well as advanced technologies such as blockchain and distributed accounting. However, due to the limitations in the quantity and scope of market research, as well as the challenges brought by the continuous updates of digital RMB, the research results may have limitations. So it suggest considering the market environment and paying attention to the different impacts of digital RMB on credit risk under different conditions. And it can also pay attention to technological updates to make research results more in line with reality, and make more reasonable and effective research results in the future.

IntroductionIn China, real-world evidence on the burden and management of moderate-to-severe atopic dermatitis (AD) is needed. The ChinaSTAD study aimed to characterise the treatment and disease and health economic burden of patients with moderate-to-severe AD uncontrolled on topical therapy in China.MethodsThe ChinaSTAD national prospective registry study enrolled individuals aged ≥ 12 years with AD, with a SCORing Atopic Dermatitis (SCORAD) score of ≥ 25, at participating hospitals. At baseline (enrolment visit), clinical status (SCORAD, Patient-Oriented Eczema Measure [POEM], Peak Pruritus Numerical Rating Scale [PP-NRS], Atopic Dermatitis Control Tool [ADCT]), health-related quality of life (Dermatology Life Quality Index [DLQI] and Children’s DLQI [CDLQI]), AD treatment, and healthcare resource use in the previous year, were evaluated. Costs were estimated from the patient’s perspective. Baseline visit data are reported here for the subgroup of patients who had not received prior systemic AD therapy continuously up to the point of study enrolment. Data are expressed as mean ± standard deviation unless stated otherwise.ResultsOf 2962 patients enrolled at data cut-off (31 October 2022), 2550 were included in this analysis (aged 40.2 ± 21.0 years). The baseline SCORAD was 54.4 ± 15.7; 85.6% of patients had uncontrolled AD (ADCT score ≥ 7), and DLQI and CDLQI scores were 10.9 ± 7.1 and 9.9 ± 6.3, respectively. At enrolment, patients were being treated with antihistamines (62.1% of patients), topical corticosteroids (61.3%) and topical moisturising emollients (31.3%). In the year prior, 37.5% of patients had one to three outpatient visits (cost per visit 662.3 ± 1563.4 renminbi (RMB) and 12.9% had one to three hospital admissions (cost per hospitalisation 822.4 ± 3149.2 RMB).ConclusionsPatients in China aged ≥ 12 years with moderate-to-severe AD uncontrolled on topical therapy experience considerable disease burden.Clinicaltrial.gov identifierNCT05023668.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-025-01540-w.

BackgroundCesarean scar pregnancy (CSP) is an uncommon and potentially life-threatening form of ectopic pregnancy characterized by embryo implantation within the scar tissue of a prior cesarean delivery.ObjectiveThe aim of this study is to compare clinical outcomes between focused ultrasound ablation surgery (FUAS) combined with suction curettage under hysteroscopic guidance and transvaginal debridement and repair surgery (TDRS) in the treatment of CSP.MethodsA retrospective analysis was conducted on 78 patients with CSP and treated between 2017 and 2023. Among them, 25 received FUAS followed by hysteroscopic suction curettage, and 53 underwent TDRS. Key clinical indicators included intraoperative parameters, postoperative recovery, treatment costs, complications, and subsequent pregnancy outcomes.ResultsNo significant differences were observed between the two groups in terms of intraoperative blood loss, decline rates of β-human chorionic gonadotropin and hemoglobin, or menstrual recovery. FUAS was associated with a significantly shorter operative time (34.96 ± 28.90 vs 60.13 ± 22.87 minutes, p <0.001), but also with a longer hospital stay (7.92 ± 2.98 vs 5.38 ± 1.61 days, p < 0.001) and higher treatment costs (Ren Min Bi (RMB) 15,278 ± 3980 vs RMB 9443 ± 1570, p <0.001). The treatment success rate was 76.00% for FUAS and 96.23% for TDRS (p=0.078). Among patients seeking fertility, post-treatment pregnancy rates were 71.43% in the FUAS group and 76.47% in the TDRS group (p > 0.05). No procedure-related complications were reported in either group.ConclusionBoth FUAS combined with curettage and TDRS demonstrated safety and effectiveness in the treatment of CSP, with favorable post-treatment fertility outcomes. TDRS was associated with shorter hospitalization and lower medical costs and may be preferable for certain CSP subtypes, such as type III. Treatment selection should be individualized based on clinical characteristics.

In recent years, the growth of international trade has faced significant disruptions due to the COVID-19 pandemic, trade frictions, and geopolitical tensions, revealing the limitations of relying solely on trade to advance the internationalization of the Chinese renminbi (RMB).This study examines the role of China's Outward Foreign Direct Investment (OFDI) as a key driver of RMB internationalization by constructing a multiple regression model and a vector autoregression (VAR) model.Using quarterly data from 2012 to 2022 and the China RMB Internationalization Index (CRI) as the primary dependent variable, the empirical findings confirm a long-term relationship between OFDI and RMB internationalization(Johansen trace statistic = 404.89).The regression model demonstrates a strong explanatory power (R 0.79).A Granger-causality test(an econometric technique that checks whether past values of one variable improve forecasts of another) shows that CRI significantly influences subsequent OFDI flows.In contrast, OFDI does not predict changes in CRI.Furthermore, variance decomposition results show that the contribution of OFDI to the internationalization of the RMB increases steadily over time.RMB CRI variance explained by OFDI rises from 5 % at horizon 1 to 48 % at horizon 10, underscoring a steadily intensifying link.These findings imply that RMBdenominated OFDI can diversify global reserve portfolios, reduce emerging-market exposure to U.S. dollar volatility, and strengthen China's monetary influence in Belt-and-Road partner economies, highlighting its increasing strategic importance.The findings offer theoretical insights and practical implications for understanding the dynamic mechanism between capital outflows and currency internationalization under evolving global economic conditions.

Infertility, a widely prevalent condition globally, incurs high economic burdens. Assisted reproductive technologies (ARTs) are effective treatments, but public health financing in low- and middle-income countries (LMICs) rarely covers ART services. In China, where birth rates are declining, willingness to pay (WTP) can inform insurance reimbursement policies by reducing out-of-pocket expenses. However, there is no consensus on WTP thresholds for assessing the cost-effectiveness of fertility treatments in LMICs. This study aimed to assess WTP for ART among individuals with infertility in China. Data were obtained from a cross-sectional survey conducted at five hospitals across different geographical and socioeconomic regions in China. Individuals with infertility were recruited using a quota sampling method. A contingent valuation method was employed, with three hypothetical WTP scenarios developed to present detailed information on the success rates, costs, and the treatment processes of in vitro fertilization (IVF), artificial insemination (AI), and preimplantation genetic testing (PGT). A total of 570 individuals with infertility participated in the survey [94.4% female; mean (standard deviation) age: 33.0 (4.7) years]. The sampled respondents were willing to pay renminbi (RMB) 30 163 [$4259, 95% confidence interval (CI): RMB 29 650–30 675] for IVF, RMB 6046 ($854, 95% CI: RMB 5987–6106) for AI, and RMB 47 234 ($6669, 95% CI: RMB 46 435–48 033) for PGT. These WTPs were equivalent to 0.34, 0.07, and 0.53 times the GDP per capita in China, respectively. Older age and male-factor or unexplained infertility were significantly associated with lower WTP (P < .05), while higher education and patient-physician communication about costs were positively associated with WTP (P < .05). These findings suggest that public health insurance schemes should establish appropriate cost-effectiveness thresholds and reimbursement ceilings for ART to improve affordability and access. Incorporating patient-physician communication about cost into clinical practice may facilitate shared decision-making and potentially increase patients’ perceived value of ART.

Spatial distribution of typical persistent organic pollutants in South China Sea by economical solid phase microextraction with hierarchical porous biochar.

With the formal entry into force of the Regional Comprehensive Economic Partnership (RCEP), the use of Renminbi (RMB) for international trade settlement is becoming increasingly common, further accelerating the internationalization of the RMB. This trend is not only significant for the outward-oriented development of the Chinese economy but also provides a key driving force for the optimization of its internal economic structure. Against this backdrop, this paper examines the performance of RMB in international settlement, digital transformation, and financial markets under the RCEP framework in the post-pandemic era, while summarizing its current status and the challenges it faces. By offering optimized policy recommendations and forecasting future development paths, this study provides a new perspective for deepening regional economic cooperation and enhancing the global influence of RMB.

This paper examines the geopolitical dimensions of China's strategy to internationalise the renminbi (RMB) and reduce reliance on the U.S. dollar. Far from a purely financial initiative, RMB internationalisation is a strategic response to the geopolitical and economic risks of a dollar-centric order. Through instruments such as the petroyuan, bilateral currency swaps, the Cross-Border Interbank Payment System, and the digital yuan, China seeks to embed the RMB within global trade, investment, and payment infrastructures. Anchored in geopolitical frameworks such as the Belt and Road Initiative and BRICS+ cooperation, these efforts form part of a wider strategy to extend China's economic influence and reduce exposure to dollar weaponisation. While the RMB's role in global reserves remains limited, China's selective and incremental approach prioritises trade-based internationalisation over capital account liberalisation. Set against accelerating de-dollarisation and deepening multipolarity, the paper analyses how China's RMB strategy is reshaping global systems of exchange, across finance, trade, and payments.

BackgroundTraumatic Spinal Cord Injury (TSCI) exerts a profound negative impact on patients’ psychological well-being and daily life. The objective of this study is to dissect the comorbidity of Acute Stress Disorder (ASD) among TSCI patients, identify its contributing factors, and construct a predictive model to provide empirical support for clinical treatment and nursing care.MethodsPatients with TSCI admitted to our hospital between January 2022 and September 2024 were enrolled in this study. We collected and compared general demographic and disease-related data between patients who developed ASD and those who did not.ResultsA cohort of 224 individuals with TSCI was enrolled in the study, revealing an incidence rate of ASD to be 33.93%. Age (r=0.562), gender (r=0.489), monthly household income (r=0.585), and injury severity (r=0.722) were correlated with ASD. Age ≤45 years (OR=2.606, 95%CI: 1.985-3.215), female gender (OR=2.213, 95%CI: 2.004-2.612), monthly household income less than 5000 Renminbi (RMB) (OR=3.027, 95%CI: 2.677-3.431), and level A injury severity (OR=3.673, 95%CI: 3.115-4.066) were the independent predictors of ASD among patients with TSCI. The area under the ROC curve (AUC) and its 95% confidence interval (CI) were 0.788 (0.710, 0.852) for the predication model, indicating good sensitivity and specificity.ConclusionASD is a common occurrence in patients with TSCI, with a multitude of contributing factors. The predictive model established in this study aids in the risk assessment of ASD in patients with TSCI.

The dominant international role of the U.S. dollar has received renewed attention in recent years, but across many measures, the dollar's dominance in international finance has changed little.2However, there has been a notable change in one statistic. Dollar-denominated cross-border bank lending to emerging market economies (EMEs) declined almost 10 percent between the start of 2022 and early 2024.3According to our analysis using both public and restricted BIS banking statistics, this is largely because of a shift in the currency composition of lending abroad by Chinese banks. With both economic and geopolitical considerations supportive of the trend, Chinese banks have notably reduced their dollar lending to other emerging market economies (EMEs), increasing lending in renminbi (RMB).