Objective: To develop price framework of medical service price project and introduce the weights calculation method of the new edition medical service price project. Methods: According to the new instruction manuals of medical service price and the research of the resource costs based on the relative value(RBRVS)of the U.S. Health Care Financing Administration (HCFA) and the American Medical Association ( AMA ) , an analysis framework and dimension of medical service price was raised and authoritative international medical service project price methods w ere summarized. Results: Based on the percentages of constituted factors and the professional features, it found the weights calculation model could be constructed with the weights model, and it could calculate the weights of the elements. Conclusion: Medical service price can be measured and comprehensively researched from the different dimensions of the medical service price, so as to carry out the pricing work of medical service price project and provide better service for pharmaceutical reform.

Objective To explore the effect of rehabilitation training on self-care ability of patients with senile dementia. Methods One hundred and one senile dementia patients were divided into two groups with 53 cases in experimental group receiving targeted rehabilitation training besides routine nursing and 48 in control group only receiving routine nursing.Self-care ability of patients in the two groups was comparatively evaluated according to the activity of daily living scale (ADL).Result The ADL score and the total score of the experimental group were both higher than those of the control group (P<0.05).Conclusion Rehabilitation training according to the specific conditions of patients with senile dementia can improve their self-care ability in adapting to the society, delaying the progress of the disease and improving the quality of life.

Objective To translate the Eating Behavior Scale (EBS) into Chinese and test its reliability and validity. Methods The Chinese Version of the scale (C-EBS) was developed through translation, back-translation, cross-cultural adaption and pre-test. A convenient sample of 100 old people with dementia was investigated with C-EBS to test its reliability and validity. Results The Cronbach′s α, Guttman Spilt and test-retest reliability of C-EBS were 0.842, 0.865 and 0.840, respectively. The I-CVIand S-CVI of C-EBS were 1.00, and the score of C-EBS was negatively correlated to the total score of The Chinese Edinburgh Feeding Evaluation in Dementia scale(C-EdFED) (r = 0.727,P < 0.01). Conclusion The C-EBS is reliable and valid and can be used as a valid tool to measure the eating ability among the old people with dementia in China.

Objective: To analyze the association between non-school sedentary time and myopia among primary and secondary school students with different levels of physical activity, so as to provide data for precise measures to prevent and control myopia. Methods: From September to December 2019, stratified cluster sampling was used to select 7 872 primary and secondary students in grades 4 to 12, middle and high school students from Hefei, Suzhou, Chizhou and Wuhu Cities in Anhui Province. Face-to-face questionnaires and vision examinations were conducted to collect demographic information, physical activity time, sedentary study time and visual health status. Potential categories were analyzed for different types of physical activity time, and Logistic regression was used to assess the relationship between non-school sedentary time and myopia at different levels of physical activity. Results: A total of 2 976 primary and secondary school students were found with high physical activity levels and 4 896 primary and secondary school students with low physical activity levels. The proportion of low physical activity was higher in girls than in boys (68.7% vs . 55.6%), and the differences were statistically significant ( χ 2=143.97, P <0.01). The overall screening myopia rate was 48.2%, with statistically significant differences among female students (53.0%) compared with male students (43.3%), urban students ( 51.8 %) compared with rural students (44.5%), and longer non-school sedentary time students (60.6%) compared with average (45.1%) and shorter (42.1%) non-school sedentary time students, and the differences were statistically significant ( χ 2=73.15, 41.96 , 161.74, P <0.01). Adjusting for confounders such as residence, grade, gender, age, father s education, mother s education, and body mass index (BMI), multivariate Logistic regression analysis revealed that prolonged after-school sedentary study was positivety correlated with myopia among primary and secondary school students of low physical activity levels ( OR=1.52, 95%CI=1.27-1.83, P <0.01), and there was no statistical association between after-school sedentary time and myopia in primary and secondary school students with high physical activity levels ( P >0.05). Conclusion Attention should be paid to non-school sedentary time for primary and secondary school students with low physical activity levels. And students who spend a lot of time sitting outside of school should be encouraged to maintain high physical activity levels to reduce the risk of myopia.

Objective: To explore the association of vitamin D deficiency with anxiety and depressive symptoms as well as their comorbidity, so as to provide references for improving the mental health of children and adolescents. Methods: From October to December 2021, a total of 1 323 students from four middle schools in Shenzhen were selected by using convenience sampling method for a questionnaire survey and physical examination. Fasting blood samples were collected to detect vitamin D levels. The Chi square test and multiple Logistic regression model were used to analyze the association of vitamin D deficiency with anxiety and depressive symptoms and their comorbidity among middle school students. Results: The detection rates of anxiety, depressive, and thier comorbidities in middle school students were 33.0%, 21.5% and 16.3%, respectively. After adjusting for confounding factors, vitamin D deficiency was positively associated with the risk of anxiety symptoms ( OR=1.59, 95%CI =1.02-2.46), depressive symptoms ( OR=1.94, 95%CI =1.22-3.09) and anxiety depressive comorbid symptoms ( OR=1.75, 95%CI =1.06-2.90) in secondary school students ( P ＜0.05). Conclusion Vitamin D deficiency is associated with an increased risk of anxiety, depressive and their co morbidity symptoms in middle school students, and the directionality of the association should be further studied.

Objective: To explore two visual acuity standards for examining uncorrected visual acuity (UCVA) to define poor vision in lower grade elementary school students, and to compare the difference of screening myopia rates when combined with non cycloplegic auto refraction (NCAR), so as to provide a scientific basis for standardizing UCVA examination methods using CAR as the gold standard of authenticity and reliability. Methods: From March 22nd to April 9th, 2023, a total of 549 first and second grade students aged 7-8 years from a primary school in Hefei City were selected for the study by convenient cluster sampling method. Two methods were employed for UCVA examination:the first method involved charts where the student could not make mistakes in identifying at least half of the characters per line (V1), and the second method used charts with character sizes ranging from 4.0 -4.5, 4.6-5.0 and 5.1-5.3, without allowing 1, 2 and 3 errors per line (V2). While NCAR was performed, then 187 students underwent CAR examination. Paired Wilcoxon rank-sum test and McNemar test were used to compare the differences between V1 and V2 methods in defining poor vision and screening myopia rates. Using CAR as the gold standard, the authenticity and reliability of defining screening myopia rates through the combination of V1 and V2 methods along with NCAR were evaluated. Results: The UCVA examination results for V1 and V2 showed statistically significant differences in both the right eye [5.0(4.9,5.0), 4.9(4.8,5.0)] and the left eye [ 5.0 (4.9,5.0), 4.9(4.8,5.0)] ( Z=-13.95, -13.34, P <0.01). The detection rates of poor vision for the right eye were 43.53% for V1 and 63.21% for V2, and the left eye with 44.08% for V1 and 62.11% for V2, with statistically significant differences ( χ 2= 106.01 , 95.09, P <0.01). When screening myopia rates were assessed for UCNA methods combined with NCAR, the right eye rates were 21.49% for V1 and 24.59% for V2, and the left eye rates were 21.31% for V1 and 23.13% for V2, with statistically significant differences ( χ 2=15.06, 8.10, P <0.01). Using CAR as the gold standard, the detection rates in the right eye and left eye were 16.58 % and 17.11%, respectively. The Youden indices for defining screening myopia in the right eye were 0.80 for V1 and 0.79 for V2, and the left eye with 0.85 for V1 and 0.83 for V2. The agreement rates for the right eye were 91.98 % for V1 and 89.30% for V2, and the left eye with 94.12% for V1 and 91.98% for V2. The Kappa values for the right eye were 0.73 for V1 and 0.67 for V2, and the left eye with 0.81 for V1 and 0.75 for V2. Conclusions Authenticity and reliability of two UCVA examination methods combined with NCAR in defining screening myopia are higher in V1 than V2 methods. It is recommended to unify the visual acuity examination methods by requiring the correct identification of more than half of the total number of visual markers in a row.

Objective:To evaluate the relationship between preoperative serum bilirubin concentrations and postoperative delirium (POD) in the patients undergoing knee or hip replacement.Methods:Medical records from 413 patients undergoing knee or hip arthroplasty were selected from August 2020 to October 2023 at Qingdao Municipal Hospital using a nested case-control design based on the PNDABLE study cohort. The patients were divided into POD group ( n=77) and non-POD group ( n=336) according to whether POD occurred. Univariate analysis was used to analyze the influencing factors. Logistic regression was used to identify the risk factors for POD. The significance of mediation effect was tested. The receiver operating characteristic curve was drawn to evaluate the accuracy of risk factors in predicting POD. Results:There were significant differences in age, education time, ratio of diabetes history, Memorial Delirium Assessment Scale score, total bilirubin concentration, direct bilirubin concentration, indirect bilirubin concentration, Aβ 42 concentration, p-tau concentration, t-tau concentration, Aβ 42/p-tau ratio and Aβ 42/t-tau ratio between POD group and non-POD group ( P<0.05). The results of logistic regression analysis showed that preoperative serum total bilirubin, direct bilirubin and indirect bilirubin were risk factors for POD ( P<0.05). The results of mediation effects showed that the concentration of total tau protein in CSF partly mediated the relationship between high serum total bilirubin, direct bilirubin and indirect bilirubin concentrations and POD. The area under the receiver operating characteristic curve of total bilirubin, direct bilirubin and indirect bilirubin combined with CSF biomarker concentrations in predicting POD was 0.83 ( P<0.001). Conclusions:Preoperative elevated concentrations of total bilirubin, direct bilirubin and indirect bilirubin are risk factors for POD in the patients undergoing knee or hip replacement. CSF t-tau concentration has a partly mediating role in the association between serum total bilirubin, direct bilirubin and indirect bilirubin concentrations and the development of POD.

Objective:To analyze the abnormal vestibular function of Wernicke encephalopathy (WE) and to explore its diagnostic value.Methods:WE patients who visited the Vertigo Center of the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2021 were retrospectively collected. All patients were evaluated by clinical neurology. Before treatment, all patients completed video head impulse test (vHIT) and video nystagmusgraphy (VNG) in addition to cranial magnetic resonance and serum thiamine level examination.Results:All 12 patients had a history of eating defects, including 8 cases of alcoholism. All 12 patients had walking instability, 7 cases had dizziness and 8 cases had oscillopsia. Six cases had ophthalmoplegia. All 12 cases showed positive gaze nystagmus. The pathological saccades of bilateral horizontal semicircular canals were found in 12 patients by vHIT before treatment, but there was only 1 patient showing abnormality in vertical semicircular canals, the difference being statistically significant ( P<0.05). All patients could detect bilateral, horizontal, gaze-evoked nystagmus, including 3 cases with vertical nystagmus, 1 case with abnormal saccade test, 3 cases with abnormal smooth tracking test and 1 case with abnormal optokinetic test. There were abnormalities in the caloric test, including 6 cases of bilateral dysfunction and 2 cases of unilateral dysfunction. Conclusions:WE patients may have abnormal vHIT and bilateral, horizontal, gaze-evoked nystagmus, which is similar to the special abnormal signs of simultaneous damage of both peripheral and central vestibular dysfunction.Vestibular function test is valuable for diagnosis of WE, and it is suitable for patients with a history of nutritional disorders who have dizziness or walking instability and suspected WE.

Objective To explore the association of serum cytokine levels with disease activity in patients with dermatomyositis (DM) and clinically amyopathic dermatomyositis (CADM),especially their association with skin lesions and interstitial lung disease (ILD).Methods Enzyme-linked immunosorbent assay (ELISA) and cytometric beads array (CBA)were performed to detect the serum levels of interleukin (IL)-2,IL-4,IL-6,IL-10,IL-17A,IL-18,tumor necrosis factor (TNF) and interferon (IFN)-γin 40 patients with DM or CADM,as well as in 16 health checkup examinees (healthy control group).Then,the association of serum cytokine levels with skin lesions,inflammatory biomarkers and severity of ILD was analyzed.Results The patients with DM/CADM showed significantly higher serum levels of IL-6 (37.8 ±45.8 pg/ml),IL-10 (16.1 ± 7.2 pg/ml) and IL-18 (492.0 ± 193.1 pg/ml) compared with the healthy controls (12.0 ± 2.7 pg/ml,7.7 ± 1.4 pg/ml,191.1 ± 39.2 pg/ml,respectively,all P ＜ 0.001),and there were no significant differences in the serum levels of the other 5 cytokines between the above 2 groups.The serum level of IL-6 was significantly higher in patients with elevated erythrocyte sedimentation rate (ESR) than in those with normal ESR (49.7 ± 46.8 pg/ml vs.29.1 ± 45.4 pg/ml,P =0.008).The patients with raised C-reactive protein (CRP) levels showed significantly higher serum levels of IL-6 (68.7 ± 59.7 pg/ml) and IL-18 (635.1 ± 232.8 pg/ml) compared with those with normal CRP levels (IL-6:30.6 ± 40.3 pg/ml,P =0.013;IL-18:440.2 ± 164.7 pg/ml,P =0.020).Moreover,the patients with elevated levels of lactate dehydrogenase (LDH) showed significantly higher serum levels of IL-10 (18.4 ± 6.9 pg/ml),IL-17A (19.6 ±6.7 pg/ml) and IL-18 (529.4 ± 197.2 pg/ml) compared with those with normal LDH levels (IL-10:10.7 ±4.8 pg/ml,P ＜ 0.001;IL-17A:11.4 ± 6.6 pg/ml,P =0.001;IL-18:404.9 ± 158.0 pg/ml,P =0.037).No significant difference in the cytokine levels was observed between the patients with elevated creatine kinase (CK) levels and those with normal CK levels.The patients with Gottron's papules/sign showed significantly higher serum levels of IL-18 (513.7 ± 187.2 pg/ml) compared with those without Gottron's papules/sign (297.1 ± 140.4 pg/ml,P ＜ 0.05).The serum levels of IL-10 and IL-18 were significantly higher in the patients with DM/CADM complicated by ILD (18.0 ± 6.7 pg/ml,552.3 ± 192.8 pg/ml,respectively) than in those without ILD (11.6 ± 6.5 pg/ml,351.4 ± 101.0 pg/ml,respectively,both P =0.001).Conclusion Serum levels of IL-6,IL-10 and IL-18 are highly associated with inflammatory biomarkers,skin lesions and ILD in patients with DM/CADM.

Objective:To investigate the effect of inflation-free thyroid surgery on patient-specific immune function and inflammatory response.Methods:Sixty patients who underwent axillary endoscopic thyroid surgery at the First Affiliated Hospital of Bengbu Medical College from January 2021 to May 2023 were selected and randomly divided into an observation group and a control group using a random number table method, with 30 patients in each group. The control group underwent unilateral lobectomy and isthmus resection under transareola carbon dioxide inflation endoscopy, while the observation group underwent unilateral lobectomy and isthmus resection under transareola non inflation endoscopy. Compare the cellular immune related indicators, humoral immune related indicators, inflammatory response related indicators, as well as arterial blood partial pressure of carbon dioxide (PaCO 2) and end-expiratory carbon dioxide (PetCO 2) levels at T 1, T 2, and T 3 time points before anesthesia induction (T 1), during adenoidectomy (T 2), at the end of surgery (T 3), on the first postoperative day (T 4), and on the second postoperative day (T 5) in two groups of patients. The measurement data is represented by xˉ±s, and independent sample t-test is used for comparison between the two groups; The comparison between two groups at multiple time points was conducted using two factor analysis of variance, and the pairwise comparison was conducted using LSD- t test; Counting data is represented as an example (%), and inter group comparisons are made using χ 2 Inspection. Results:At time point T 1, there was no statistically significant difference between the two groups of patients in terms of cellular immune related indicators, humoral immune related indicators, and inflammatory response related indicators (all P>0.05). At time points T 2, T 3, T 4, and T 5, the CD3 +, CD4 +, CD4 +/CD8 + values and serum IgA, immunoglobulin A, immunoglobulin IgM The levels of immunoglobulin IgG were all lower than the T 1 time point in this group [control group: (31.49±5.37)%, (26.76±6.11)%, (34.75±5.99)%, (38.92±5.37)%, (51.78±5.90)%, (25.37±8.23)%, (19.12±7.13)%, (29.15±9.85)%, (33.49±8.03)%, (40.12±6.05)%, (0.97±0.28), (0.71±0.30), (1.11±0.36), (1.21±0.39)%, (1.69±0.41), (0.95±0.13), (0.91±0.14) (0.82±0.13), (0.96±0.16) g/L vs (1.21±0.20) g/L, (7.74±1.26), (7.33±1.31), (7.16±1.28), (7.82±1.31) g/L vs (9.18±1.52) g/L, (0.87±0.14), (0.86±0.13), (0.73±0.16), (0.88±0.15) g/L vs (1.16±0.22) g/L; Observation group: (35.82±5.71)%, (30.85±5.86)%, (39.43±5.68)%, (42.53±5.64)% vs (51.36±6.28)%, (30.39±9.76)%, (23.34±8.64)%, (34.68±11.37)%, (38.92±9.82)% vs (40.75±5.68)%, (1.15±0.35a), (0.89±0.38), (1.31±0.33), (1.52±0.37) vs (1.63±0.35), (1.04±0.17), (0.98±0.17) 0), (0.91±0.11a) (1.07±0.14) g/L vs (1.24±0.18) g/L, (8.51±1.35), (8.07±1.32), (7.93±1.34), (8.56±1.39) g/L vs (9.12±1.47) g/L, (0.95±0.11), (0.93±0.12), (0.83±0.18), (0.97±0.14) g/L vs (1.19±0.21) g/L], The CD8+values of both groups of patients were higher than those of the T 1 time point in this group, and at the T 4 time point, the control group was higher than the observation group [(29.89±8.99)% vs (25.70±6.91)%], with statistically significant differences (both P<0.05). At time points T 2, T 3, T 4, and T 5, both groups of patients had serum IL-interleukin-1 levels β、Interleukin IL-6, TNF tumor necrosis factor α The levels of CRP and CRPC reactive protein were higher than those at T 1 time point in this group [control group: (3.92±1.80), (4.16±1.86), (5.81±2.14), (4.46±1.87) ng/L vs (1.36±0.61) ng/L, (5.76±2.78), (6.68±3.12), (9.73±3.12), (4.65±2.78) ng/L vs (0.92±0.60) ng/L, (1.02±0.42), (1.30±0.61), (7.82±2.28), (6.65±2.16) mg/L vs (0.57±0.16) mg/L, (4.48±2.04) (4.48±2.04), (6.45±2.52), (5.33±2.15) ng/L vs (2.86±1.03) ng/L; Observation group: (3.04±1.09), (3.29±1.14), (4.56±2.01), (3.52±1.34) ng/L vs (1.65±0.63) ng/L, (4.12±2.11), (5.07±2.98), (8.07±3.15), (3.22±2.69) ng/L vs (0.98±0.53) ng/L, (0.81±0.34), (1.00±0.50), (6.65±2.03), (5.43±1.93) mg/L vs (0.56±0.12) mg/L, (3.39±1.81), (3.89±1.81) 4±1.93), (5.11±2.10) (3.96±2.03) ng/L vs (2.91±1.09) ng/L], and the control group was higher than the observation group, with statistically significant differences (all P<0.05). At time point T 1, there was no statistically significant difference in PaCO 2 and PetCO 2 between the two groups of patients (both P>0.05); At time points T 2 and T 3, the levels of PaCO 2 [(44.1±4.1), (45.8±4.0) mmHg] and PetCO 2 [(40.8±4.0), (42.1±3.5) mmHg] in the control group were higher than those at time points T 1 [(38.4±1.8), (36.3±1.9) mmHg] and observation group [PaCO 2: (38.3±2.0), (38.6±2.6) mmHg; PetCO 2: (36.3±1.9), (36.5±2.9) mmHg] (all P<0.05), There was no statistically significant difference between the observation group and this group at T 1 time point (all P>0.05). Conclusions:Inflation-free lumpectomy thyroid surgery is worthwhile as it has less suppressive effect on specific immunity and causes less inflammatory response compared to inflatable lumpectomy thyroid surgery.