The influence of the national drug price negotiation policy reform on the medical expenses of patients in Xuzhou City: an interrupted time series analysis.

Background: To reduce the burden of patients' medical care, the Xuzhou Municipal Government has initiated an exploratory study on the supply model and categorized management of nationally negotiated drugs. This study aims to understand the extent to which Xuzhou's 2021 reform of the National Drug Price Negotiation (NDPN) policy has had a positive impact on the healthcare costs of individuals with different types of health insurance. Methods: The Interrupted Time Series Analysis method was adopted, and the changes in average medical expenses per patient, average medical insurance payment cost per patient and actual reimbursement ratio were investigated by using the data of single-drug payments in Xuzhou from October 2020 to October 2022. Results: Following the implementation of the policy, there was a significant decrease in the average medical expenses per patient of national drug negotiation in Xuzhou, with a reduction of 62.42 yuan per month (p < 0.001). Additionally, the average medical insurance payment cost per patient decreased by 44.13 yuan per month (p = 0.01). Furthermore, the average medical expenses per patient of urban and rural medical insurance participants decreased by 63.45 yuan (p < 0.001), and the average monthly medical insurance payment cost per patient decreased by 57.56 yuan (p < 0.04). However, the mean total medical expenditures for individuals enrolled in employee medical insurance decreased by 63.41 yuan per month (p < 0.001), whereas the monthly decrease was 22.11 yuan per month (p = 0.21). On the other hand, there was no discernible change in the actual reimbursement ratio. Conclusion: After the adoption of the NDPN policy, a noticeable decline has been observed in the average medical expenses per patient and the mean cost of the average medical insurance payment per patient, although to a limited extent. Notably, the reduction in employee medical insurance surpasses that of urban and rural medical insurance.

Chromosome-level genome assembly of the predatory stink bug Arma custos.

The stink bug Arma custos (Hemiptera: Pentatomidae) is a predatory enemy successfully used for biocontrol of lepidopteran and coleopteran pests in notorious invasive species. In this study, a high-quality chromosome-scale genome assembly of A. custos was achieved through a combination of Illumina sequencing, PacBio HiFi sequencing, and Hi-C scaffolding techniques. The final assembled genome was 969.02 Mb in size, with 935.94 Mb anchored to seven chromosomes, and a scaffold N50 length of 135.75 Mb. This genome comprised 52.78% repetitive elements. The detected complete BUSCO score was 99.34%, indicating its completeness. A total of 13,708 protein-coding genes were predicted in the genome, and 13219 of them were annotated. This genome provides an invaluable resource for further research on various aspects of predatory bugs, such as biology, genetics, and functional genomics.

Animal-and mineral-based medicines in Gansu-Ningxia-inner Mongolia region, P.R. China: a cross-cultural ethnobiological assessment.

Introduction: Traditional animal- and mineral-based medicines are widely used in the Gansu-Ningxia-Inner Mongolia junction zone, a region with diverse ethnic groups and cultures. This study aims to document, conserve, and explore the potential of these medicines for further research and sustainable development of ethnic medicine. Methods: We interviewed 56 informants from different ethnic backgrounds and analyzed their responses quantitatively. Additionally, a comparative analysis with adjacent regions was conducted, providing invaluable contextual insights. Results: The study unveiled a diverse array of traditional medicines in the Gansu-Ningxia-Inner Mongolia junction zone. A total of 47 animal-based medicines were identified, ranging from insects and scorpios to distinctive animal organs. Of notable significance was Moschus, emerging as a pivotal traditional Chinese medicine resource. In parallel, 12 mineral-based medicines were cataloged, procured both locally and from "pharmacies". Female informants, frequently local herbal practitioners, demonstrated broader knowledge of medicines. The analysis of 13 villages revealed varying perceptions of medicine importance, underscoring the wealth of traditional knowledge. Specific medicines, such as Feng-Mi and Xie-Zi, were widely used and valued in local healthcare practices for their cultural and medicinal benefits. Conclusion: This study provides a comprehensive overview of traditional animal- and mineral-based medicines in the Gansu-Ningxia-Inner Mongolia junction zone. It highlights the need for preserving and applying these practices in a sustainable manner. It also lays a solid foundation for future research on ethnic medicine, which can contribute to the holistic wellbeing of local communities.

Integrated widely targeted metabolomics and network pharmacology revealed quality disparities between Guizhou and conventional producing areas of Codonopsis Radix.

Introduction: With the internationalization of traditional Chinese medicine, the demand for medicinal and edible Codonopsis Radix (CR) has increased, and its medicinal resources have attracted attention. CR is a well-known traditional Chinese medicine with a long pharmaceutical and edible history. The Guizhou province in China has abundant CR resources, but in the absence of systematic studies on species identification and chemical compositions, the capacity of the capacity of the province to CR resource has not been fully utilized. Methodology: We used plant morphology and DNA barcoding techniques to identify Luodang (LD) and Weidang (WD) species. To investigate the differences in metabolites between LD and WD, as well as three Chinese Pharmacopeia CRs, and to predict pharmacological mechanisms of action for the dominant differential metabolites, we utilized widely targeted metabolomics and network pharmacology. The results also revealed the material basis for the excellent food properties of both LD and WD. Results: The plant traits and DNA barcoding molecular identification results indicated that Luodang and Weidang from Guizhou were Codonopsis tangshen and Codonopsis pilosula, respectively. Widely targeted metabolomics analysis revealed that a total of 1,116 metabolites from 14 categories, including phenolic acids, lipids, flavonoids, were found in five CRs and shared 1,054 (94.4%) metabolites. LD and WD each contained 3 and 10 dominant differential metabolites, respectively, which were primarily flavonoids and amino acids. Amino acids, phenolic acids, and organic acids play important roles in their excellent food attributes. In CR, eight dominant differential metabolites were discovered for the first time, including isoorientin-7-O-(6″-feruloyl) glucoside, N-formyl-L-methionine, and cyclo (Phe-Glu), among others. Network pharmacology analyses showed that, in LD, dominant differential metabolites were closely related to anti-tumor, cardiovascular disease improvement, nervous system protection, and metabolic disease treatment, whereas in WD, they were closely related to nervous system protection and cardiovascular disease improvement. Conclusion: The species of LD and WD were included in the Chinese Pharmacopeia, and their metabolite profiles were remarkably similar to CR from traditional producing areas. Therefore, LD and WD can be used and promoted medicinally as CR, and they have potential value for new drug development. This study enriched the database of CR compounds and provided a reference for quality control, resource development, and new drug development of CR.

Assessment of black soldier fly (Hermetia illucens) larvae meal as a potential substitute for soybean meal on growth performance and flesh quality of grass carp Ctenopharyngodon idellus.

A 90-day feeding trial was conducted to assess the effects of black soldier fly larvae meal (BSFLM) as a replacement for soybean meal (SM) on growth performance and flesh quality of grass carp. A total of 420 grass carp (299.93 ± 0.85 g) were randomly divided into 7 groups (triplicate) and fed 7 diets with SM substitution of 0% (SM, control), 15% (BSFLM15), 30% (BSFLM30), 45% (BSFLM45), 60% (BSFLM60), 75% (BSFLM75) and 100% (BSFLM100) by BSFLM. The growth performance of grass carp in the BSFLM75 and BSFLM100 groups were significantly lower compared to other groups (P < 0.05). The mid-gut villus height was the lowest in the BSFLM100 group (P < 0.05). Muscle nutritional value was improved due to increased DHA (docosahexaenoic acid), EPA (eicosapentaenoic acid), total HUFA (highly unsaturated fatty acids) and glycine levels, and reached the optimum in the BSFLM100 group (P < 0.05). According to the results of principal component analysis and weight analysis of muscle texture and body color, all the BSFLM diets except BSFLM15 could improve muscle texture and body color and reached the optimum level in the BSFLM100 group. Muscle drip loss and hypoxanthine content were the lowest and muscle antioxidant capacity was the highest in the BSFLM75 group, and water- and salt-soluble protein contents reached the optimum level in the BSFLM60 group (P < 0.05). Dietary BSFLM significantly reduced muscle fiber area and diameter, and increased muscle fiber density and the proportion of small fiber (diameter <20 µm) (P < 0.05). Additionally, sarcomere lengths in the BSFLM75 and BSFLM100 groups were significantly higher than that in the SM group (P < 0.05). The mRNA relative expression levels of MyoD, Myf5, MyHC and FGF6b were remarkably up-regulated at an appropriate dietary BSFLM level (P < 0.05). In conclusion, BSFLM could replace up to 60% SM without an adverse effect on growth performance and improve the flesh quality of grass carp. The optimum levels of dietary BSFLM were 71.0 and 69.1 g/kg diet based on the final body weight and feed conversion ratio. The flesh quality was optimal when dietary SM was completely replaced with BSFLM (227 g/kg diet).

Impacts of unifying urban and rural residents' medical insurance on the hospitalisation expenses of rural patients in eastern China: an interrupted time series analysis.

OBJECTIVES: This study evaluated the impact of the Urban and Rural Residents' Basic Medical Insurance scheme on hospitalisation expenses of rural patients in eastern China, which unified separate healthcare systems for urban and rural residents. DESIGN: Monthly hospitalisation data from municipal and county hospitals were collected from the local Medicare Fund Database, covering the period from January 2018 to December 2021. The unification of insurance between urban and rural patients was implemented at different times for county and municipal hospitals. An interrupted time series analysis was used to assess the immediate and gradual effects of the integrated policy on the total medical expenses, out-of-pocket (OOP) expenses and effective reimbursement rate (ERR) among rural patients. SETTING AND PARTICIPANTS: This study included 636 155 rural inpatients over 4 years in Xuzhou City, Jiangsu Province, China. RESULTS: In January 2020, the policy of urban and rural medical insurance was initially integrated in county hospitals, after which the ERR decreased at a monthly rate of 0.23% (p=0.002, 95% CI -0.37% to -0.09%) compared with the preintervention period. After the insurance systems were unified in municipal hospitals in January 2021, OOP expenses decreased by ¥63.54 (p=0.002, 95% CI -102.48 to -24.61) and the ERR increased at a monthly rate of 0.24% (p=0.029, 95% CI 0.03% to 0.045%). CONCLUSIONS: Our results suggest that the unification of urban and rural medical insurance systems was an effective intervention to reduce the financial burden of illness for rural inpatients, especially OOP expenses for hospitalisation in municipal hospitals.

The effect of China's leading officials' accountability audit of natural resources policy on provincial agricultural carbon intensities: the mediating role of technological progress.

China is one of the largest agricultural countries in the world. In the context of China's efforts to achieve dual carbon goals (carbon peak and carbon neutral), the need for carbon emissions reductions in the agricultural sector cannot be ignored. This study collected 2007 to 2018 data from 30 Chinese provinces and used a difference in differences (DID) model to investigate the relationships between China's leading officials' accountability audit of natural resources policy (LOAANR), agricultural technological progress, and agricultural carbon emissions intensities (CEI). A common trend test, placebo test, PSM-DID, and other test methods were used to verify the reliability of the results. The results show that (1) compared with the non-pilot areas, the policy implementation could significantly reduce CEI; (2) the LOAANR was able to stimulate patented technological progress (ATI) and mechanical technological progress (AMT), but different types of technological progress had different mediation effect sizes; and (3) the policy effects shows obvious regional heterogeneity, manifesting as west > east > central; and the policy effects were more obvious in the non-major grain-producing areas, but had no inhibition effects on the CEI in the major grain-producing areas; compared with low intensity market-based environmental regulation (MER) regions, high-intensity MER regions have stronger LOAANR emission reduction effects. Based on the study findings, policy suggestions are given to reduce agricultural carbon emissions and promote higher quality agricultural development.

Ethnobotanical study of the wild edible and healthy functional plant resources of the Gelao people in northern Guizhou, China.

INTRODUCTION: The Gelao people are a unique minority in Southwest China with a unique culture for the utilization of edible plants, including a large number of medicinal plants. They believe that at least 61 species are edible and have medicinal value. Ethnobotany research can reveal the local knowledge of the Gelao people regarding the traditional use of plants and the relationship between this minority and their living environment to help retain and pass on this traditional knowledge forever. METHODS: Edible wild plants and their applied ethnic knowledge were investigated in three counties in northern Guizhou. Gelao residents were the main informants, and literature search, village interviews, participatory observation and quantitative ethnobotany evaluation were used. RESULTS: A total of 151 species of wild plants in 67 families are collected and eaten by Gelao residents, among which 61 species were considered to have medicinal value, accounting for 40.4% of the total, and 43 were listed in the Chinese Pharmacopoeia. There were 57 plant species with fruits as their edible parts, which are consumed as snacks, followed by 54 species whose young seedlings and leaves are the edible parts, most of which are consumed cold or stir-fried. Other edible parts included roots or rhizomes (bulbs), flowers, whole plants, seeds, fruiting bodies and stems. There were two consumption modes: raw and cooked. Raw foods were mainly consumed as snacks, which mainly comprise fruits. Cooked foods were mainly vegetables consumed cold or stir-fried. Some plants were used as seasonings, infused wines, condiments and grains. The main medicinal functions were nourishing and reducing heatiness. Nourishing plants were mainly "shen" plants and Liliaceae, while plants able to reduce heatiness were mainly Asteraceae. Others functions included anti-hangover, anticancer and insecticidal. There were 38 species of important edible wild plants (CFSI > 500) in northern Guizhou, which had a high utilization rate. Houttuynia cordata Thunb. and Mentha suaveolens Ehrh. were the most representative edible wild plants in this area. The species, edible parts, edible categories, consumption modes and medicinal functions of edible wild plants in this area are diverse, and the traditional knowledge on their uses is rich. However, the number of wild plant species eaten by the informants and their related knowledge were positively correlated with age, which indicates that the rich traditional knowledge in this area is gradually disappearing with urbanization. CONCLUSIONS: The Gelao have a rich history of consuming wild plants. With the development of the social economy, the traditional knowledge passed from older generations is gradually being lost and its inheritance is facing great risks. This study collects, sorts and spreads this precious traditional knowledge, which is of great value to its protection and inheritance and fully demonstrates the value and importance of our work.

Assessment of the correlation between residual hearing and audiologic outcomes after cochlear implantation in patients with cochlear nerve deficiency.

Objective: This study aimed to assess the correlation between residual hearing and audiologic outcomes after cochlear implant (CI) surgery in patients with cochlear nerve deficiency (CND). Methods: This retrospective study included 57 patients with CND who underwent CI surgery. Patients were divided into four groups according to hearing level (80-95, 95-110, 110-120, and >120 dB) and three groups according to residual hearing (entire spectrum hearing, partial spectrum hearing, and no spectrum hearing) based on the measured response at each frequency. Auditory performance (categorical auditory performance [CAP], Infant-Toddler Meaningful Auditory Integration Scale [IT-MAIS]) and speech perception (speech intelligibility rating [SIR] and meaningful use of speech scale [MUSS]) were assessed before and 2 years after the surgery. Results: Forty-seven (82.5%) patients had complete or total hearing loss (≥95 dB) and 17 (29.8%) had no spectrum hearing before CI surgery. Twenty-nine (50.9%) patients did not exhibit residual hearing at 4 kHz. All patients demonstrated an improvement in auditory performance and speech perception: the CAP score in the 80-95 dB group was significantly higher than that in the 110-120 and >120 dB groups, and the entire spectrum hearing group showed significantly higher CAP, SIR, and IT-MAIS scores than the partial spectrum hearing group and significantly higher CAP, SIR, IT-MAIS, and MUSS scores than the no spectrum hearing group. Conclusion: For patients with CND, residual hearing, especially high-frequency residual hearing, was poor and postoperative audiologic outcomes were significantly associated with the range of residual hearing. Level of Evidence: 4.

Environmental regulation, market demand, and green innovation: spatial perspective evidence from China.

This paper used a dynamic spatial panel model to empirically analyze the effects of environmental regulation, market demand, and the associated spatial spillovers on regional green innovation in China, from which the following was found. (1) The environmental regulations had a positive "U-shaped" effect on local green innovation and a positive neighborhood spillover effect, and market demand had a significant positive effect on local green innovation and a "ripple effect." (2) The mechanism analysis found that the environmental regulations tended to inhibit regional green innovation input through a "cost compliance" effect, and market demand had a stronger incentive effect on innovation input than the environmental regulations, thus promoting the improvement of green innovation level. (3) The environmental regulation and market demand effects on green innovation had obvious spatial and temporal heterogeneity. The results of this study could help to promote regional green innovation by formulating reasonable environmental policies and stimulating the vitality of green technology market.

Can the Leading Officials' Accountability Audit of Natural Resources policy stimulate Chinese heavy-polluting enterprises' green behavior?

Under the pressure of environmental crisis caused by production and economic development, a policy for Leading Officials' Accountability Audit of Natural Resources (LOAANR) was issued in 2014 to reduce the environmental risks and gain high-quality economy. Taking LOAANR policy as the research object, and based on 2011 to 2018 panel data from Chinese heavy-polluting enterprises, this paper employed a two-way fixed difference-in-differences (DID) model to explore the relationship between the LOAANR, environmental costs (ECs) and green innovation (GI). It was found that the implementation of the LOAANR significantly promoted enterprise GI, with the regulating impact mechanism, EC. GI efficiency was measured by continuous DID method. A heterogeneity analysis revealed that non-state-owned enterprises (NSOEs) were more eager to environmentally innovate. A corporate life cycle heterogeneity analysis of the GI policy effect found that the policy effect was negative in the decline stages. Compared with the eastern Chinese enterprises, enterprises in other regions were found to be more prone to positively adopting GI to maximize benefits in the face of the LOAANR. The policy was observed to have inhibited GI in central Chinese enterprises. It was also demonstrated that the policy effect has time and regional dynamic effect. Common trend, placebo, PSM-DID tests, and another robustness regressions were applied to support the conclusions. All the findings are expected to provide basic theoretical guidance for more environmental policies and high-quality production.

Application of Multiplanar Volume Reconstruction Technique for the Assessment of Electrode Location and Analysis of the Correlation to Cochlear Programming and Performance in Common Cavity Deformity.

Purpose: Owing to the characteristic anatomy, cochlear implantation (CI) for common cavity deformity (CCD) has resulted in varied outcomes and frequent facial and vestibular nerve stimulation. The current study analyzed the correlation among the distance between each electrode and cavity wall (abbreviation, D), programming parameters, and performances outcomes. Materials and Methods: The current, retrospective study included 25 patients (27 ears) with CCD underwent CI. The multiplanar volume reconstruction (MPVR) techniques were employed to reconstruct and evaluate the postoperative temporal bone CT. The D and maximum comfortable level (MCL) 6 months after CI, facial and vestibular nerve stimulation, and outcomes 1, 2, and 3 years after CI pertaining to the questionnaires were documented and analyzed. Results: The patients were divided into symptomatic (10, 37%) and asymptomatic (17, 63%) groups according to with or without facial and vestibular nerve stimulation. The MCL pertaining to the symptomatic group was significantly lower than asymptomatic group, but Categories of Auditory Performance (CAP) scores 1 year after surgery was better (p < 0.05). The subjects were divided into flat (12, 44.4%) and curved (15, 55.6%) groups based on the contour of MCL map. The MCL and D were lower and shorter in the curved group than the flat group, and CAP score 1 year after surgery and Speech Intelligibility Rating (SIR) 3 years after surgery were better (p < 0.05). Conclusion: Although abnormal reactions such as facial and vestibular nerve stimulation were observed to be more frequent, lower MCL and better outcomes were observed in relation to the shorter D.

[An assessment of white matter development in preterm infants with bronchopulmonary dysplasia using diffusion tensor imaging].

OBJECTIVE: To assess white matter development in preterm infants with bronchopulmonary dysplasia (BPD) using fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of diffusion tensor imaging (DTI). METHODS: Ninety-six infants with a gestational age of ≤32 weeks and a birth weight of <1 500 g who were admitted to the neonatal intensive care unit within 24 hours after birth from August 2016 to April 2019 and underwent head MRI and DTI before discharge were enrolled. According to the discharge diagnosis, they were divided into BPD group with 48 infants and non-BPD group with 48 infants. The two groups were compared in terms of FA and ADC values of the same regions of interest on DTI image. RESULTS: There were no significant differences in the incidence rates of periventricular/intraventricular hemorrhage, periventricular leukomalacia, and punctate white matter lesions between the two groups (P>0.05). Compared with the non-BPD group, the BPD group had significantly lower FA values and significantly higher ADC values of the posterior limb of the internal capsule, the splenium of the corpus callosum, the occipital white matter, the cerebellum, and the cerebral peduncle (P<0.05). Compared with the non-BPD group, the BPD group had a significantly higher frequency of apnea, a significantly higher proportion of infants with pneumonia or mechanical ventilation, and a significantly longer duration of assisted ventilation (P<0.05). CONCLUSIONS: BPD may has potential adverse effects to white matter development in preterm infants, leading to delayed white matter development. Therefore, it is necessary to pay attention to the neurological function of these infants.

[The design and assessment of a novel simulated training system for cardiac surgery].

Simulations can mimic the environment that refers to the surgery operation to improve the technical skills of the trainees. In this paper, we designed a new cardiac surgery simulative training system. The isolated pig heart was selected as the heart model. A mechanical device was designed to achieve the beating of heart model. At the same time, adjusting frequencies of mechanical movement could change the rating of heartbeat. In order to validate the rationality of the system, 12 non-medical specialty students and 12 medical specialty students were divided into two groups, which consecutively accepted seven-days of training for off-pump coronary artery bypass grafting using the cardiac surgery simulative training system. The time for completing bypass grafting before and after training were recorded. And the bridging outcomes of each trainee were assessed by 3 surgery cardiac surgeons using the object structured assessments of technical skill (OSATS) criteria. After training, each trainee could finish the bypass suturing in a shorter time than before training, and the scores of each trainee assessed by OSATS criteria were also improved. The results showed that the cardiac surgery simulative training system had better training effect in improving the surgical techniques, operation skills and proficiency of surgical instruments of trainees.

Standard-Chinese Lexical Neighborhood Test in normal-hearing young children.

OBJECTIVE: The purposes of the present study were to establish the Standard-Chinese version of Lexical Neighborhood Test (LNT) and to examine the lexical and age effects on spoken-word recognition in normal-hearing children. METHODS: Six lists of monosyllabic and six lists of disyllabic words (20 words/list) were selected from the database of daily speech materials for normal-hearing (NH) children of ages 3-5 years. The lists were further divided into "easy" and "hard" halves according to the word frequency and neighborhood density in the database based on the theory of Neighborhood Activation Model (NAM). Ninety-six NH children (age ranged between 4.0 and 7.0 years) were divided into three different age groups of 1-year intervals. Speech-perception tests were conducted using the Standard-Chinese monosyllabic and disyllabic LNT. RESULTS: The inter-list performance was found to be equivalent and inter-rater reliability was high with 92.5-95% consistency. Results of word-recognition scores showed that the lexical effects were all significant. Children scored higher with disyllabic words than with monosyllabic words. "Easy" words scored higher than "hard" words. The word-recognition performance also increased with age in each lexical category. A multiple linear regression analysis showed that neighborhood density, age, and word frequency appeared to have increasingly more contributions to Chinese word recognition. CONCLUSION: The results of the present study indicated that performances of Chinese word recognition were influenced by word frequency, age, and neighborhood density, with word frequency playing a major role. These results were consistent with those in other languages, supporting the application of NAM in the Chinese language. The development of Standard-Chinese version of LNT and the establishment of a database of children of 4-6 years old can provide a reliable means for spoken-word recognition test in children with hearing impairment.

[Assessment of cochlear implant performance with Mandarin Hearing In Noise Test].

OBJECTIVE: To evaluate the abilities speech perception of post-lingual cochlear implant patients by Mandarin Hearing In Noise Test(MHINT), get the performance-intensity function (P-I function). METHOD: The material was MHINT adults' version, including 12 lists, 20 sentences per list. Twenty-two cochlear implant patients were the subjects, age from 14 to 56. Three adaptive rules were used during the test. Firstly Rule 3 would be done. If subject could finish the test, then Rule 2 and Rule 1 would be used. Got the Reception threshold of sentences and speech recognition score of subjects, then got performance-intensity function (PI function). RESULT: Among those 22 subjects, 5 of them could be tested in all three rules, 3 could be tested in Rule 2 and Rule 3, 7 of them could be tested with Rule 3, and 7 of the CI users could not be tested even with Rule 3. All of the PI functions for CI users are shifted 10 dB or more above the normal PI functions. Most CI users thought that MHINT was hard for them. CONCLUSION: When use new adaptive scoring rules for MHINT, most CI users could be tested with the modified HINT scoring rules, although three subjects could not be tested. Compared with normal hearing subjects, all CI users required positive S/N ratios to perform the HINT measures.