An ultra-short-acting benzodiazepine in thalamic nucleus reuniens undermines fear extinction via intermediation of hippocamposeptal circuits.

Benzodiazepines, commonly used for anxiolytics, hinder conditioned fear extinction, and the underlying circuit mechanisms are unclear. Utilizing remimazolam, an ultra-short-acting benzodiazepine, here we reveal its impact on the thalamic nucleus reuniens (RE) and interconnected hippocamposeptal circuits during fear extinction. Systemic or RE-specific administration of remimazolam impedes fear extinction by reducing RE activation through A type GABA receptors. Remimazolam enhances long-range GABAergic inhibition from lateral septum (LS) to RE, underlying the compromised fear extinction. RE projects to ventral hippocampus (vHPC), which in turn sends projections characterized by feed-forward inhibition to the GABAergic neurons of the LS. This is coupled with long-range GABAergic projections from the LS to RE, collectively constituting an overall positive feedback circuit construct that promotes fear extinction. RE-specific remimazolam negates the facilitation of fear extinction by disrupting this circuit. Thus, remimazolam in RE disrupts fear extinction caused by hippocamposeptal intermediation, offering mechanistic insights for the dilemma of combining anxiolytics with extinction-based exposure therapy.

Nomogram for the prediction of infected pancreatic necrosis in moderately severe and severe acute pancreatitis.

OBJECTIVES: As a serious complication of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP), infected pancreatic necrosis (IPN) can lead to a prolonged course of interventional therapy. Most predictive models designed to identify such patients are complex or lack validation. The aim of this study was to develop a predictive model for the early detection of IPN in MSAP and SAP. METHODS: A total of 594 patients with MSAP or SAP were included in the study. To reduce dimensionality, least absolute shrinkage and selection operator regression analysis was used to screen potential predictive variables, a nomogram was then constructed using logistic regression analysis. The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the discrimination, accuracy, and clinical efficacy of the model. External data were also obtained to further validate the constructed model. RESULTS: There were 476, 118, and 82 patients in the training, internal validation, and external validation cohorts, respectively. Platelet count, hematocrit, albumin/globulin, severity of acute pancreatitis, and modified computed tomography severity index score were independent factors for predicting IPN in MSAP and SAP. The area under the ROC curves were 0.923, 0.940, and 0.817, respectively, in the three groups. There was a good consistency between the actual probabilities and the predicted probabilities. DCA revealed excellent clinical utility. CONCLUSION: The constructed nomogram is a simple and feasible model that has good clinical predictive value and efficacy in clinical decision-making for IPN in MSAP and SAP.

Revealing the pharmacological mechanisms of nao-an dropping pill in preventing and treating ischemic stroke via the PI3K/Akt/eNOS and Nrf2/HO-1 pathways.

Nao-an Dropping Pill (NADP) is a Chinese patent medicine which commonly used in clinic for ischemic stroke (IS). However, the material basis and mechanism of its prevention or treatment of IS are unclear, then we carried out this study. 52 incoming blood components were resolved by UHPLC-MS/MS from rat serum, including 45 prototype components. The potential active prototype components hydroxysafflor yellow A, ginsenoside F1, quercetin, ferulic acid and caffeic acid screened by network pharmacology showed strongly binding ability with PIK3CA, AKT1, NOS3, NFE2L2 and HMOX1 by molecular docking. In vitro oxygen-glucose deprivation/reperfusion (OGD/R) experimental results showed that NADP protected HA1800 cells from OGD/R-induced apoptosis by affecting the release of LDH, production of NO, and content of SOD and MDA. Meanwhile, NADP could improve behavioral of middle cerebral artery occlusion/reperfusion (MCAO/R) rats, reduce ischemic area of cerebral cortex, decrease brain water and glutamate (Glu) content, and improve oxidative stress response. Immunohistochemical results showed that NADP significantly regulated the expression of PI3K, Akt, p-Akt, eNOS, p-eNOS, Nrf2 and HO-1 in cerebral ischemic tissues. The results suggested that NADP protects brain tissues and ameliorates oxidative stress damage to brain tissues from IS by regulating PI3K/Akt/eNOS and Nrf2/HO-1 signaling pathways.

[Imaging study on thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis].

OBJECTIVE: To observe the alteration of thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis(AIS) and the difference of physiological curvature between different types of scoliosis. METHODS: A retrospective analysis was conducted on 305 adolescent patients taken full spine X-ray in our hospital from January 2017 to December 2021. The patients were divided into normal group and scoliosis group. The normal group was composed of 179 patients, 79 males and 100 females, aged 10 to 18 years old with an average of (12.84±2.10) years old, with cobb agle less than 10 degrees. The scoliosis group was composed of 126 patients, 33 males and 93 females, aged 10 to 18 years old with an average of (13.92±2.20) years old. The gender, age, Risser sign, thoracic kyphosis(TK) and lumbar lordosis(LL) in 2 groups were compared, and the TK and LL were also compared between different genders, different degrees of scoliosis and different segments of scoliosis. RESULTS: The female ratio(P=0.001) and age (P<0.001) in scoliosis group were higher than them in normal group; the ratio of low-grade ossification was higher in normal group than in scoliosis group(P=0.038). TK was significantly smaller in scoliosis group than in normal group(P<0.001), but there was no significant difference in LL between the 2 groups(P=0.147). There were no significant difference in TK and LL between male and female. The TK was significantly bigger in mild AIS patients than in moderate AIS patients(P<0.05), but there was no significant difference in LL between mild and moderate patients(P>0.05). The TK and LL in different segments scoliosis were not found significant difference. CONCLUSION: The physiological curvature of thoracic and lumbar spine is independent of gender. The thoracic physiological curvature becomes smaller in AIS patients, but lumbar curvature remains unchanged. The thoracic physiological curvature in mild AIS patients is greater than that in moderate AIS patients, but the lumbar curvature is almost unchanged between mild and moderate scoliosis and is similar with that in normal adolescent. The alteration of thoracic and lumbar physiological curvature in AIS patients may be related to relative anterior spinal overgrowth, and the specific detailed mechanism needs to be further studied.

Correction: An E-selectin targeting and MMP-2-responsive dextran-curcumin polymeric prodrug for targeted therapy of acute kidney injury.

Correction for 'An E-selectin targeting and MMP-2-responsive dextran-curcumin polymeric prodrug for targeted therapy of acute kidney injury' by Jing-Bo Hu et al., Biomater. Sci., 2018, 6, 3397-3409, https://doi.org/10.1039/C8BM00813B.

Implantation of Adipose-Derived Mesenchymal Stromal Cells (ADSCs)-Lining Prosthetic Graft Promotes Vascular Regeneration in Monkeys and Pigs

BACKGROUND@#Current replacement procedures for stenosis or occluded arteries using prosthetic grafts have serious limitations in clinical applications, particularly, endothelialization of the luminal surface is a long-standing unresolved problem.METHOD: We produced a cell-based hybrid vascular graft using a bioink engulfing adipose-derived mesenchymal stromal cells (ADSCs) and a 3D bioprinting process lining the ADSCs on the luminal surface of GORE-Tex grafts. The hybrid graft was implanted as an interposition conduit to replace a 3-cm-long segment of the infrarenal abdominal aorta in Rhesus monkeys. @*RESULTS@#Complete endothelium layer and smooth muscle layer were fully developed within 21 days post-implantation, along with normalized collagen deposition and crosslinking in the regenerated vasculature in all monkeys. The regenerated blood vessels showed normal functionality for the longest observation of more than 1650 days. The same procedure was also conducted in miniature pigs for the interposition replacement of a 10-cm-long right iliac artery and showed the same long-term effective and safe outcome. @*CONCLUSION@#This cell-based vascular graft is ready to undergo clinical trials for human patients.

Development and application of key nursing technique training platform for nuclear,chemical and biological rescue / 医疗卫生装备

Objective To design a key nursing technique training platform for emergency response caregivers of nuclear,chemical and biological rescue.Methods The platform designed with B/S architecture used C# language for developing the server,HTML5 technology for building the user interface and JavaScript language for writing the logic of interaction,which was composed of three functional modules for video classroom,post-test and simulation training.Results The platform deve-loped realized training and assessment of key nursing techniques for nuclear,chemical and biological rescue without the restriction by time,space and teacher,and was of significance for enhancing the training efficacy.Conclusion The platform developed meets the needs of emergency response caregivers for key nursing techniques of nuclear,chemical and biological rescue.[Chinese Medical Equipment Journal,2024,45(1):37-41]

Bone morphogenetic protein 7 attenuates renal fibrosis in diabetic kid-ney disease rats by down-regulating Ajuba / 中国病理生理杂志

AIM:Bone morphogenetic protein 7(BMP7)reduces the expression of Yes-related protein 1(YAP1)by down-regulating Ajuba level and decreasing extracellular matrix(ECM)deposition.This study aimed to inves-tigate the influence of these factors on modifying the degree of renal fibrosis in rats with diabetic nephropathy.METH-ODS:Eighteen Sprague-Dawley(SD)rats were randomly divided into three groups:the normal control(NC)group,the diabetes mellitus(DM)group,and the DM group treated with BMP7 overexpressing adeno-associated virus(DM+rAAV-BMP7).Each group consisted of six rats.Diabetic kidney disease(DKD)was established in the DM and DM+rAAV-BMP7 groups by injecting 55 mg/kg streptozotocin(STZ)via the tail vein.NRK-52E cells were divided into three groups:the normal glucose(NG)group,the high glucose(HG)group,and the high glucose group treated with recombinant hu-man BMP7(HG+rhBMP7)group.Pathological changes in renal tissues were observed using hematoxylin and eosin(HE)and Sirius red staining.Immunohistochemical staining was performed to examine the expression sites of Ajuba and YAP1 in the renal cortex.Western blot analysis was conducted to determine the expression levels of BMP7,Ajuba,YAP1,colla-gen type Ⅲ(Col-Ⅲ),and fibronectin(FN)in the rat renal cortex and NRK-52E cells.RT-qPCR was used to measure the mRNA levels of Ajuba and YAP1 in the rat renal cortex.RESULTS:Biochemical indices revealed significantly ele-vated levels of blood glucose,serum creatinine,triglycerides,total cholesterol,and 24-hour urinary protein in the DM group compared to the NC group(P<0.05).In the DM+rAAV-BMP7 group,the levels of serum creatinine,24-hour uri-nary protein,triglycerides,and total cholesterol were lower than those in the DM group(P<0.05).Pathological staining demonstrated that the renal interstitium of the DM group exhibited inflammatory cell infiltration,fibrous tissue,collagen fi-ber deposition,disordered renal tubule arrangement,atrophy,and vacuolar degeneration,which were ameliorated in the DM+rAAV-BMP7 group.Immunohistochemistry revealed that Ajuba and YAP1 were mainly expressed in the cytoplasm and nucleus,with high expression in the cytoplasm of the DM group,which was significantly decreased in the DM+rAAV-BMP7 group.Western blot results indicated that the protein levels of FN,Col-Ⅲ,Ajuba,and YAP1 were up-regulated in the DM and the HG groups(P<0.05),but significantly down-regulated in the DM+rAAV-BMP7 group(P<0.05).RT-qP-CR results demonstrated that the mRNA levels of Ajuba and YAP1 were higher in the DM group and significantly lower in the DM+rAAV-BMP7 group(P<0.05).CONCLUSION:The overexpression of BMP7 can ameliorate renal fibrosis in rats with DKD.This effect is likely mediated by the down-regulation of Ajuba,reduction of YAP1 expression,and subse-quent inhibition of ECM deposition.

Risk factor research and risk prediction model establishment for early Q-T interval prolongation after acute myocardial infarction / 中国基层医药

Objective:To establish a prediction model of risk factors for early Q-T interval prolongation after acute myocardial infarction (AMI), which helps prevent and reduce the occurrence of acute malignant events.Methods:This is a case-control study. A total of 100 patients with Q-T interval prolongation after AMI who received treatment at Heilongjiang Provincial Hospital from January 2018 to December 2022 were included in this study. An additional 100 patients without Q-T interval prolongation after AMI who concurrently received treatment in the same hospital were also included in this study. Two model groups, including model group 1 (with Q-T interval prolongation, n = 50) and model group 2 (without Q-T interval prolongation, n = 50), and two test groups, including test group 1 (with Q-T interval prolongation, n = 50) and test group 2 (without Q-T interval prolongation, n = 50), were designated. Logistic regression analysis was performed to construct a prediction model of risk factors for Q-T interval prolongation. The area under the receiver operating characteristic curve was determined to evaluate the prediction model. The value of the prediction model was validated in the test groups. Results:Multivariate logistic regression showed that female gender ( OR = 2.307, 95% CI: 0.09-0.91, P = 0.041) and heart failure ( OR = 3.087, 95% CI: 1.15-8.27, P = 0.025) were independent risk factors for early Q-T interval prolongation after AMI. The area under the receiver operating characteristic curve of the prediction model was 0.770, with a sensitivity of 84.0%, a specificity of 66.0%, the Jordan index of 0.44, and the corresponding optimal critical value of 0.43. This indicates good fit of the model. Conclusion:Female gender and heart failure are independent risk factors for early Q-T interval prolongation after AMI. The model constructed based on the above-mentioned risk factors fits well and has a high predictive value, which helps reduce the occurrence of early Q-T interval prolongation after AMI.

Interaction of occupational and non-occupational noise exposure leads to high frequency hearing loss / 中国职业医学

ObjectiveTo explore the impact of the interaction between occupational and non-occupational noise exposure on the risk of high-frequency hearing loss (HFHL) in noise-exposed workers. Methods A total of 602 male workers with normal hearing, engaged in an automobile manufacturing company between 2016 and 2018, were selected as the study subjects using the retrospective cohort study method. Pure-tone audiometry and questionnaire surveys were conducted on the workers. The Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression model were used to analyze the interaction between occupational and non-occupational noise exposure and the risk of HFHL in these workers. Results The prevalence of HFHL of the workers was 34.1% in 2020, without any cases of speech frequency hearing loss. Kaplan-Meier survival analysis result showed that the risk of HFHL increased in workers with excessive national occupational noise exposure intensity, self-reported noisy living environments, and both excessive national occupational noise exposure intensity and self-reported noisy living environments (all P<0.01). The results of the Cox proportional hazards model showed that the combined effect of excessive national occupational noise exposure intensity and self-reported noisy living environments [relative risk (RR)=2.40, P<0.01] was higher than the individual effects of excessive national occupational noise exposure intensity (RR=2.09, P<0.01) and self-reported noisy living environments (RR=2.39, P<0.01). There was an antagonistic effect between excessive national occupational noise exposure intensity and self-reported noisy living environments (interaction index <1.00). Conclusion Both occupational and non-occupational noise exposure can increase the risk of HFHL in noise-exposed workers, and there is an interaction between them.

The ERF transcription factor LTF1 activates DIR1 to control stereoselective synthesis of antiviral lignans and stress defense in Isatis indigotica roots

Lignans are a powerful weapon for plants to resist stresses and have diverse bioactive functions to protect human health. Elucidating the mechanisms of stereoselective biosynthesis and response to stresses of lignans is important for the guidance of plant improvement. Here, we identified the complete pathway to stereoselectively synthesize antiviral (-)-lariciresinol glucosides in Isatis indigotica roots, which consists of three-step sequential stereoselective enzymes DIR1/2, PLR, and UGT71B2. DIR1 was further identified as the key gene in respoJanuary 2024nse to stresses and was able to trigger stress defenses by mediating the elevation in lignan content. Mechanistically, the phytohormone-responsive ERF transcription factor LTF1 colocalized with DIR1 in the cell periphery of the vascular regions in mature roots and helped resist biotic and abiotic stresses by directly regulating the expression of DIR1. These systematic results suggest that DIR1 as the first common step of the lignan pathway cooperates with PLR and UGT71B2 to stereoselectively synthesize (-)-lariciresinol derived antiviral lignans in I. indigotica roots and is also a part of the LTF1-mediated regulatory network to resist stresses. In conclusion, the LTF1-DIR1 module is an ideal engineering target to improve plant Defenses while increasing the content of valuable lignans in plants.

[Correlation analysis of Cobb angle and linear spinous process angle in adolescent idiopathic scoliosis].

OBJECTIVE: To analyze the correlation between Cobb angle and spinous process angle (SPA) on X-ray film and body surface in patients with mild to moderate adolescent idiopathic scoliosis(AIS). To explore the possibility of linear SPA to assess scoliosis. METHODS: Retrospective study for correlation of Cobb angle and linear SPA on X-ray film. AIS patients treated and taken full spine anteroposterior X-ray from January 2019 to December 2021 were analyzed correlation of Cobb angle and linear SPA on X-ray film. Prospective study for correlation of Cobb angle and body linear SPA. AIS patients treated and taken full spine anteroposterior X-ray from December 1 to December 9 this year were analyzed correlation of Cobb angle and body linear SPA. RESULTS: A total of 113 AIS patients with age an average of (14.02±2.16) years old(ranged from 10 to 18 years old) were recruited in retrospective study, involving 26 males and 87 females;there were 71 patients with mild AIS and 42 patients with moderate AIS. Cobb angle in AIS patients was significantly inversely associated with SPA(r=-0.564, P<0.001), the linear regression equation was:Cobb angle=169.444-0.878×SPA. Cobb angles in patients with mild scoliosis were significantly and inversely associated with SPA(r=-0.269, P=0.012), the linear regression equation was:Cobb angle=46.832-0.185×SPA. Cobb angles in patients with moderate scoliosis were also clearly correlated with SPA(r=-0.417, P=0.003), the linear regression equation was:Cobb angle=113.889-0.516×SPA. Thirty-eight patients were recruited in prospective study. The mean Cobb angle and body linear SPA were(18.70±6.98)°, ranged from 11.3° to 36.0° and (170.34±4.57)°, ranged from 162.1° to 177.7° respectively. There was significantly negative correlation(r=-0.651, P<0.001), the linear regression equation is:Cobb angle=187.91-0.99×SPA. CONCLUSION: Linear SPA on X-ray film or on the body was significantly negatively correlated with Cobb angles, but the regression equation fits poorly, so it's not suitable for diagnosis of scoliosis;however, linear SPA is appropriate for self-controlled assessment of scoliotic therapy or for dynamic assessment of spinal flexibility.

Narrowband Ultraviolet-B Persistent Luminescence in an Indoor-Lighting Environment through Energy Transfer from Host Excitons to Gd3+ Emitters in ScPO4.

Narrowband ultraviolet-B (NB-UVB) luminescent materials are characterized by high photon energy, narrow spectral width, and visible-blind emission, thus holding great promise for photochemistry and photomedicine. However, most NB-UVB phosphors developed so far are photoluminescent, where continuous external excitation is needed. Herein, we realize NB-UVB persistent luminescence (PersL) in an indoor-lighting environment by exploiting the interaction between self-trapped/defect-trapped excitons and Gd3+ emitters in ScPO4. The phosphor shows a self-luminescing feature with a peak maximum at 313 nm with a time duration of >24 h after ceasing X-ray irradiation, which can be clearly imaged by an UVB camera in a bright environment. Spectroscopic and theoretical approaches reveal that thermo- and photo-stimulations of energies trapped at intrinsic lattice defects followed by energy transfer to Gd3+ emitters account for the emergence of the afterglow. The present results can initiate more exploration of NB-UVB PersL phosphors for emerging applications in secret optical tagging and phototherapy.

Exploring the feasibility and safety of ropinirole combined with nerve growth factor for enhancing neurological health in football players

Objective: This study aims to investigate the viability and safety of utilizing ropinirole in combination with nerve growth factor for the management of neurological health in football players.Methods: A total of 92 athletic inpatients diagnosed with Parkinson's disease were enrolled in this study from December 2018 to December 2020. They were randomly divided into two groups: the control group and the research group, each comprising 46 athletic patients. The control group received nerve growth factor treatment, while the research group received a combination of ropinirole and nerve growth factor. Various serum markers, brain nerve factors, quality of life indicators, therapeutic outcomes, and safety profiles were evaluated and compared between the two groups.Results: Following treatment, both groups exhibited a significant increase in superoxide dismutase (SOD) levels compared to baseline, accompanied by substantial reductions in the levels of interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α), and nuclear factor-kappa B P65 (NF-κB P65). Moreover, the research group demonstrated significantly higher SOD levels and lower IL-1β, TNF-α, and NF-κB P65 levels compared to the control group (P<0.05). The levels of ciliary neurotrophic factor (CNTF), brain-derived neurotrophic factor (BDNF), dopamine (DA), and serotonin (5-HT) significantly increased in both groups post-treatment, with the research group exhibiting notably higher levels of these factors compared to the control group (P<0.05). Assessment of cognitive function (Montreal Cognitive Assessment - MoCA), balance (Berg Balance Scale - BBS), and activities of daily living (ADL) scores revealed significant improvements in both groups after treatment. However, the research group displayed higher MoCA and BBS scores and lower ADL scores than the control group (P<0.05). (AU)

Giant cyst in heterotopic pregnancy: A case report.

BACKGROUND: The coexistence of a heterotopic pregnancy with a giant ovarian cyst is an incredibly rare abnormal pregnancy in cases of natural conception. The incidence of this condition has increased significantly as a result of the continuous development of assisted reproductive technologies. When this type of pregnancy occurs, both the continuation of intrauterine pregnancy and the life of the pregnant woman are severely threatened. Early diagnosis and treatment using safe and effective methods are paramount in this situation. CASE SUMMARY: A 30-year-old primigravida at a gestation age determined as 8 wk 4 d by scan was admitted to the hospital with heterotopic pregnancy and a right ovarian cyst. Laparoscopic resection of the ectopic pregnancy was performed, but the intrauterine pregnancy and ovarian cyst were preserved. CONCLUSION: The approach to a patient with heterotopic pregnancy and a giant ovarian cyst is individualized base on the fertility requirements. We recommend the following: (1) If the patient satisfies parity and has no fertility requirement, a laparoscopic salpingectomy should be performed and the giant ovarian cyst and intrauterine pregnancy removed; (2) If the patient has fertility requirements wishes to have more children in the future, laparoscopic salpingectomy or salpingostomy should be performed and the intrauterine pregnancy preserved. Serial ovarian cyst aspiration can be performed under ultrasound and resection can be done after delivery; and (3) Heterotopic pregnancy should be diagnosed early by active surveillance during antenatal visits using ultra sound as this is important for the avoidance of catastrophic complications.

Autophagy-related tumor subtypes associated with significant gene expression profiles and immune cell infiltration signatures to reveal the prognosis of non-small cell lung cancer.

Autophagy plays an important role in non-small cell lung cancer (NSCLC). We aimed to establish novel autophagy-related tumor subtypes to distinguish the prognosis of NSCLC. In this study, gene expression profiles, mutation data and clinical information obtained from the Cancer Genome Atlas. Kaplan Meier-plotter could evaluate prognostic value of autophagy-related genes. Consensus clustering revealed autophagy-related tumor subtypes. Gene expression profiles, mutation data and immune infiltration signatures were identified, oncogenic pathways and gene-drug interactions were performed according to the clusters. Finally, a total of 23 prognostic genes were screened and consensus clustering analysis divided the NSCLC into 2 clusters. The mutation signature showed that 6 genes are special. Immune infiltration signatures showed that higher fraction of immune cells was associated with cluster 1. The oncogenic pathways and gene-drug interactions also showed different patterns. In conclusion, autophagy-related tumor subtypes have different prognosis. Understanding the subtypes of NSCLC are helpful to accurately identify the NSCLC and personalized treatment.

[Spatio-temporal Distribution Characteristics of Secondary Aerosol in Beijing-Tianjin-Hebei Urban Agglomeration in Winter].

The secondary component is an important factor causing PM2.5 pollution in the Beijing-Tianjin-Hebei urban agglomeration in winter. In this study, the CO tracer method was used to estimate the secondary PM2.5 concentration of the Beijing-Tianjin-Hebei urban agglomeration in the winter of 2017-2021. The temporal and spatial distribution characteristics were analyzed, and the influencing factors of regional secondary PM2.5 were discussed. The results showed that the decreasing trend of PM2.5 concentration in the Beijing-Tianjin-Hebei Region in the winter of 2017-2021 was obvious, and the cities with the largest decline were located in the central and southern part of Hebei Province, mainly contributed by primary PM2.5. There was a good correlation between secondary PM2.5 and PM2.5 in all cities of the Beijing-Tianjin-Hebei urban agglomeration, and the proportion of secondary PM2.5 in Beijing and Tianjin was significantly higher than that in other cities. With the aggravation of pollution degree, the mass concentration of primary PM2.5 and secondary PM2.5 increased in varying degrees, and the proportion of secondary PM2.5 increased significantly. Compared with the direct measurement results, the estimated value obtained by this method was lower as a whole. The selection of appropriate primary aerosol reference value was the key to improving this method and estimating the secondary PM2.5 concentration.

Does information disclosure among public hospitals stimulate medical cost change efforts? A pilot study in Shanghai.

BACKGROUND: In 2013, the Shanghai Hospital Development Center issued a policy to advocate public hospitals to report their information about costs on diseases. The objective was to evaluate the impact of interhospital disclosure of costs on diseases on medical costs and compare costs per case following information disclosure between hospitals of different rankings. METHODS: The study uses the hospital-level performance report issued by Shanghai Hospital Development Center in the fourth quarter of 2013, which covers quarterly aggregated hospital-level discharge data from 14 tertiary public hospitals participating in thyroid malignant tumors and colorectal malignant tumors information disclosure from the first quarter of 2012 to the third quarter of 2020. An interrupted time series model with segmented regression analysis is employed to examine changes in quarterly trends with respect to costs per case and length of stay before and after information disclosure. We identified high- and low-cost hospitals by ranking them on a costs per case basis per disease group. RESULTS: This research identified significant differences in cost changes for thyroid malignant tumors and colorectal malignant tumors between hospitals after disclosing information. A hospital's discharge costs per case for thyroid malignant tumors increased significantly among top-cost hospitals (1629.251 RMB, P = 0.019), while decreased for thyroid and colorectal malignant tumors among low-cost hospitals (-1504.189 RMB, P = 0.003; -6511.650 RMB, P = 0.024, respectively). CONCLUSION: Our findings indicate that information disclosure of costs on diseases results in changes in discharge costs per case. And low-cost hospitals continued to maintain their leading edge, whereas the high-cost hospitals changed their position in the industry by reducing discharge costs per case after information disclosure.

Impact of Diagnosis-Related Groups on Inpatient Quality of Health Care: A Systematic Review and Meta-Analysis.

The aim of this meta-analysis was to comprehensively evaluate the effectiveness of Diagnosis-related group (DRG) based payment on inpatient quality of care. A comprehensive literature search was conducted in PubMed, EMBASE, Cochrane Central Register of Controlled Trials and Web of Science from their inception to December 30, 2022. Included studies reported associations between DRGs-based payment and length of stay (LOS), re-admission within 30 days and mortality. Two reviewers screened the studies independently, extracted data of interest and assessed the risk of bias of eligible studies. Stata 13.0 was used in the meta-analysis. A total of 29 studies with 36 214 219 enrolled patients were analyzed. Meta-analysis showed that DRG-based payment was effective in LOS decrease (pooled effect: SMD = -0.25, 95% CI = -0.37 to -0.12, Z = 3.81, P < .001), but showed no significant overall effect in re-admission within 30 days (RR = 0.79, 95% CI = 0.62-1.01, Z = 1.89, P = .058) and mortality (RR = 0.91, 95% CI = 0.72-1.15, Z = 0.82, P = .411). DRG-based payment demonstrated statistically significant superiority over cost-based payment in terms of LOS reduction. However, owing to limitations in the quantity and quality of the included studies, an adequately powered study is necessary to consolidate these findings.

How do inpatients' costs, length of stay, and quality of care vary across age groups after a new case-based payment reform in China? An interrupted time series analysis.

CONTEXT: A patient classification-based payment system called diagnosis-intervention packet (DIP) was piloted in a large city in southeast China in 2018. OBJECTIVE: This study evaluates the impact of DIP payment reform on total costs, out-of-pocket (OOP) payments, length of stay (LOS), and quality of care in hospitalised patients of different age. METHODS: An interrupted time series model was employed to examine the monthly trend changes of outcome variables before and after the DIP reform in adult patients, who were stratified into a younger (18-64 years) and an older group (≥ 65 years), further stratified into young-old (65-79 years) and oldest-old (≥ 80 years) groups. RESULTS: The adjusted monthly trend of costs per case significantly increased in the older adults (0.5%, P = 0.002) and oldest-old group (0.6%, P = 0.015). The adjusted monthly trend of average LOS decreased in the younger and young-old groups (monthly slope change: -0.058 days, P = 0.035; -0.025 days, P = 0.024, respectively), and increased in the oldest-old group (monthly slope change: 0.107 days, P = 0.030) significantly. The changes of adjusted monthly trends of in-hospital mortality rate were not significant in all age groups. CONCLUSION: Implementation of the DIP payment reform associated with increase in total costs per case in the older and oldest-old groups, and reduction in LOS in the younger and young-old groups without deteriorating quality of care.