Objective: To explore the effects of the bi-directional referral system from the perspective of the medical service consumer.Methods: A balanced panel data which was adjusted by Propensity Score Matching was employed to evaluate the effects of two-way referral system using difference-in-difference (DID) for the 2013 and 2015 data.The evaluation indicators including actual cost sharing ration, out-of-pocket cost per unit, the possibility of high cost, annual inpatient visits and length of hospital stay per unit were used.Results: Compared with the control group, the two-way referral system resulted in an 11.3% (P<0.001) increase in actual cost sharing ratio and an increase of 0.710 (P<0.001) annual inpatient visits in the intervention group.However, the policy did not significantly reduce the possibility of high-cost medical expenses and reduce the length of hospitalization and the annual cost hospitalization.Conclusion: Based on the key findings of the analysis of this study, the two-way referral system has beneficial effects on reducing inpatient financial burden and optimizing resource allocation.

OBJECTIVE To study the expression of Toll-like recptor2(TLR2)and Toll-like receptor4(TLR4) in the fungal rhinosinusitis tissues,and to explore the role of TLR2 and TLR4 in the pathogenesis of fungal rhinosinusitis.METHODS The mRNA and protein expression of TLR2 and TLR4 were detected by reverse transcription polymerase chain reaction(RT- PCR)and immunohistochemistry(IHC)in 24 fungal rhinosinusitis tissues,24 chronic rhinosinusitis tissues,and 15 normal mucosa of inferior turbinate. RESULTS The mRNA expression of TLR2 and TLR4 in fungal rhinosinusitis tissues(0.208?0.063,0.159?0.059)was significantly decreased compared with that in chronic rhinosinusitis(0.505?0.097,0.406?0.102)and normal inferior turbinate tissues(0.327?0.047;0.232?0.088).The protein expression rates of TLR2 and TLR4 in fungal rhinosinusitis tissues (3/24,4/24)were significantly lower than that in chronic rhinosinusitis(20/24,21/24)and normal inferior turbinate tissues(7/15,8/15)by IHC study. CONCLUSION The lower expression of TLR2 and TLR4 in fungal rhinosinusitis tissues indicates that the declined role of TLR-mediated innate immune responses in the defensive reaction of anti-fungal in sinonasal mucosa,which may be one of the reasons for dropped clearance rate and increased susceptibility to fungi.

Methotrexate (MTX)has dual effects of anti-inflam-matory and immune suppression,and its pharmacological mecha-nism is complex,diverse and synergistic.This paper summari-zes the main anti-inflammatory mechanism of low-dose MTX,in-cluding inhibition of JAK/STAT pathway,inhibition of inflam-matory reaction and immune response,increasing the accumula-tion of adenosine and the function of intracellular metabolites (methotrexate polyglutamate).In addition,low-dose MTX can inhibit oxidation by decreasing the level of lipid peroxidation, suppress the inflammatory response to secondary spinal cord in-jury,reduce spinal cord ischemia reperfusion injury and neuro-pathic pain,thus playing a neuroprotective role by a series of pharmacological mechanism.The anti-inflammatory mechanism of low-dose MTX and its application in spinal cord injury were reviewed,to guide the further research on the anti-inflammatory effect of MTX,and provide a theoretical basis for new drugs for clinical treatment of spinal cord injury.

Objective To explore the effect of Shenqi Fufang (参芪复方,SF) on skeletal muscle damage of type 2 diabetes mellitus (T2DM) and its possible mechanism.Methods Eighteen rats with spontaneous type 2 diabetes mellitus (GK) were randomized into the model group,SF group and sitagliptin group with six rats in each group,and six more Wistar rats were selected as the control group.Each group was given high fat diet for 8 weeks to build T2DM model except for the control group.At the same time,the control group and the model group were given normal saline 5 ml/(kg-d) by gastric perfusion,the SF group was given SF extract 1.44g/(kg · d) by gastric perfusion,and sitagliptin group was given sitagliptin phosphate suspension 16ml/(kg · d) by gastric perfusion.Eight weeks later,the levels of serum insulin-like growth factor 1 (IGF-1),tumor necrosis factor-αr (TNF-a) and interleukin-1β (IL-1β)were measured in each group,the gastrocnemius muscle was taken out to get the wet weight and observe the pathological changes,and the expression of p70s6k1 protein was detected.Results Compared with the control group,the wet weight of the gastrocnemius muscle,the serum IGF-1 level and p70s6k1 protein expression in the model group significantly decreased (P ＜ 0.05),while the levels of serum TNF-α and IL-1β significantly increased (P ＜ 0.05).Through pathological observation,there existed gastrocnemius muscle cells atrophy,a larger area of edema and interstitial lymphocyte infiltration.Compared with the model group,the wet weight of the gastrocnemius muscle,IGF-1 content and p70s6k protein expression in the sitagliptin group and the SF group significantly increased,the contents of TNF-α and IL-l β significantly decreased (P ＜0.05),and there were no obvious muscle cell atrophy and edema,and also little inflammatory cell infiltration.There was no significant difference between the sitagliptin group and SF group (P ＞ 0.05).Conclusion SF could reduce the diabetic skeletal muscle injury;the potential mechanism seems to reduce the inflammatory factor content,improve IGF-1 resistance and maintain the skeletal muscle mass.

Diabetes mellitus(DM),as a common and frequently-occurring disease,has become a huge burden of chronic diseases worldwide,whose pathogenesis is very complex and has not yet been fully elucidated.Small intestine is one of important immune organ in body,and relationship between its innate immune function and DM has become forefront of research in medical field.In this paper,role of intestinal innate immunity in pathogenesis of DM is reviewed,including tissue barrier dysfunction of small intestine,dysfunction of intestinal innate immune cells and imbalance of proportion of intestinal innate immune molecules,in order to provide references for future research on related mechanisms.

Objective:To explore the molecular mechanism of Danggui Niantong Decoction in the treatment of gouty arthritis (GA) based on network pharmacology and molecular docking.Methods:By selecting for the active components and targets of Danggui Niantong Decoction with TCMSP, and retrieving the GeneCards, OMIM, PharmGKB and DrugBank databases to obtain GA related targets. The potential targets of Danggui Niantong Decoction in the treatment of GA were obtained by the intersection of mappings. The regulation network of Chinese medicine compound and protein-protein interaction network of Danggui Niantong Decoction were constructed by Cytoscape software, and the targets of Danggui Niantong Decoction in the treatment of GA were analyzed by GO and KEGG enrichment by David Database. Finally, molecular docking was performed by using Autodock software.Results:There are 198 active components that could treat GA in Danggui Niantong Decoction. The key active components are Quercetin and Kaempferol. There are 46 key targets, the core targets are NFE2L2, HMOX1, PPARA, PTGS2, IL1β, CXCL8. GO enrichment suggests that the key genes are primarily involved in many biological processes such as Inflammatory response regulation, response to oxidative stress, Fatty acid metabolism process, steroid metabolism, lipopolysaccharide response and reactive oxygen species metabolism. KEGG pathway indicates that Danggui Niantong Decoction mainly acted on IL-17 signal pathway, HIF-1 signal pathway, TNF signal pathway and AGE-RAGE signal pathway. Molecular docking shows that the active components of Danggui Niantong Decoction and action target of GA can combine toghether with high efficiency, and the structure is stable.Conclusion:Danggui Niantong Decoction has multi-component, multi pathway and multi-protein characteristics. Danggui Niantong Decoction can treat GA by regulating immune inflammatory reaction and oxidative stress reaction.

Otorhinolaryngology is a high-risk department of a hospital, where there are many emergency critical diseases, common multiple diseases and major malignant diseases. Therefore, it is easy to cause many medical ethical problems. This paper analyzed the clinical status and characteristics of various otolaryngology diseases systematically, and expounded the related medical ethical issues in the diagnosis and treatment of otorhinolaryngology, including doctor-patient trust, safety and informed consent. Finally, the paper put forward a number of measures to do well the psychological evaluation and nursing care of patients, improve the professional skills of medical and nursing care, formulate the treatment plan of diseases, enhance the supervision and management of the network, and promote the social support of patients. The aim was to alleviate the "doctor-patient conflict" and create a harmonious medical environment.

Animals ; Asian Continental Ancestry Group ; Chickens ; China ; epidemiology ; Cytokines ; metabolism ; Genetic Variation ; Genotype ; Humans ; Influenza A Virus, H7N9 Subtype ; classification ; genetics ; pathogenicity ; Influenza A Virus, H9N2 Subtype ; genetics ; Influenza in Birds ; transmission ; virology ; Influenza, Human ; ethnology ; transmission ; virology ; Mice, Inbred BALB C ; Molecular Sequence Data ; Orthomyxoviridae Infections ; metabolism ; mortality ; virology ; Phylogeny ; Seasons ; Survival Rate ; Virulence ; genetics

Objective:To investigate the possible mechanism of rubbing abdomen to regulate intestinal homeostasis in irritable bowel syndrome with constipation (IBS-C) mouse models.Methods:IBS-C mouse models of intestinal immune dysfunction were established using trinitrobenzene sulfonic acid (TNBS)-induced C57BL/J6 male mice. Thirty C57BL/J6 mice were randomly divided into three groups: the control group, the model group, and the mogul group. After 7 days of modeling, mice in the mogul group were given a mogul mechanical stimulation intervention once per day for 2 weeks, while mice in the control and model groups were not given any intervention. Changes in serum levels of interleukin-6 (IL-6) and IL-17A were detected by enzyme-linked immune sorbent assay (ELISA) and immunohistochemistry. The gene expression and protein levels of IL-17A and IL-23 were detected by quantitative real-time fluorescence PCR (qRT-PCR) and Western Blot, respectively. The morphological changes were observed by HE staining. The CD44 and CD62L expression changes were observed by immunofluorescence staining.Results:Compared with the model group, the levels of IL-6 and IL-17A in the serum of mice in the mogul group were decreased, and the expression of IL-6 and IL-7A in the tissues was down-regulated (all P<0.001). In addition, the gene expression and protein expression levels of IL-17A and IL-13 in the tissues of mice in the mogul group were decreased (all P<0.001). HE staining results showed that the mogul mechanical stimulation intervention could repair colonic tissues and reduce the inflammatory response. Immunofluorescence staining results showed that mogul mechanical stimulation intervention could downregulate the expression of CD44 but had no modulating effect on the expression of CD62L. Conclusions:Rubbing abdomen can improve intestinal homeostasis in IBS-C model mice by regulating changes in Th17 cell function.

BACKGROUND:The pathogenesis of osteoporosis is complex,and its essence is the weakening of bone formation and the enhancement of bone absorption caused by various reasons,resulting in the imbalance of bone metabolism.In recent years,N6-methyladenosine has been found(N6-methyladenosine,m6A)methylation can prevent and treat osteoporosis by regulating bone metabolism. OBJECTIVE:Taking the regulation of bone metabolism by m6A methylation as an entry point,to systematically sort out and summarize the research progress of m6A methylation in osteoporosis,so as to provide certain theoretical reference bases for the search of new therapeutic targets for osteoporosis. METHODS:CNKI,WanFang,VIP,PubMed,MEDLINE,Nature,and Cochrane databases were retrieved for relevant literature published from database inception to 2023.The keywords were"osteoporosis,m6A methylation,bone metabolism,bone marrow mesenchymal stem cells,osteoblasts,osteoclasts"in Chinese and English.Duplicates and obsolete non-referenced documents were excluded,and a total of 73 standard papers were included for further review. RESULTS AND CONCLUSION:m6A methylation can affect the activity and differentiation of bone marrow mesenchymal stem cells,osteoblasts,and osteoclasts through various pathways to regulate bone metabolism and prevent osteoporosis.The regulatory process of m6A methylation is extremely complex,and its related proteins play different roles in different cells.Even in the same kind of cells,the same type of proteins may have radically different roles,regulating different physiological and pathological processes.