Objective:To explore the influence of outpatient co-ordination on the purchase of commercial medical insurance in China,enrich the research perspective of outpatient co-ordination.Methods:Based on the data of China Health and Retirement Longitudinal Study from 2011 to 2020,past outpatient co-ordination policies in pilot cities and the Digital Inclusive Finance insurance index,using staggered DID to empirically test the impact of outpatient co-ordination on employees'commercial medical insurance purchase.Results:Outpatient co-payment increases workers'willingness to purchase commercial health insurance,which increases by about 4％;heterogeneity analysis finds outpatient co-payment primarily affects individuals'commercial insurance purchasing behavior and that the extent of the effect is related to workers'age,health status,and the outpatient co-payment coverage model of the affiliation.Conclusion:Improving the outpatient co-payment guarantee mechanism at the national level and promoting the effective connection between basic medical insurance and commercial medical insurance.

Objective:To explore the influence of outpatient co-ordination on the purchase of commercial medical insurance in China,enrich the research perspective of outpatient co-ordination.Methods:Based on the data of China Health and Retirement Longitudinal Study from 2011 to 2020,past outpatient co-ordination policies in pilot cities and the Digital Inclusive Finance insurance index,using staggered DID to empirically test the impact of outpatient co-ordination on employees'commercial medical insurance purchase.Results:Outpatient co-payment increases workers'willingness to purchase commercial health insurance,which increases by about 4％;heterogeneity analysis finds outpatient co-payment primarily affects individuals'commercial insurance purchasing behavior and that the extent of the effect is related to workers'age,health status,and the outpatient co-payment coverage model of the affiliation.Conclusion:Improving the outpatient co-payment guarantee mechanism at the national level and promoting the effective connection between basic medical insurance and commercial medical insurance.

Objective:To explore the influence of outpatient co-ordination on the purchase of commercial medical insurance in China,enrich the research perspective of outpatient co-ordination.Methods:Based on the data of China Health and Retirement Longitudinal Study from 2011 to 2020,past outpatient co-ordination policies in pilot cities and the Digital Inclusive Finance insurance index,using staggered DID to empirically test the impact of outpatient co-ordination on employees'commercial medical insurance purchase.Results:Outpatient co-payment increases workers'willingness to purchase commercial health insurance,which increases by about 4％;heterogeneity analysis finds outpatient co-payment primarily affects individuals'commercial insurance purchasing behavior and that the extent of the effect is related to workers'age,health status,and the outpatient co-payment coverage model of the affiliation.Conclusion:Improving the outpatient co-payment guarantee mechanism at the national level and promoting the effective connection between basic medical insurance and commercial medical insurance.

Objective:To explore the influence of outpatient co-ordination on the purchase of commercial medical insurance in China,enrich the research perspective of outpatient co-ordination.Methods:Based on the data of China Health and Retirement Longitudinal Study from 2011 to 2020,past outpatient co-ordination policies in pilot cities and the Digital Inclusive Finance insurance index,using staggered DID to empirically test the impact of outpatient co-ordination on employees'commercial medical insurance purchase.Results:Outpatient co-payment increases workers'willingness to purchase commercial health insurance,which increases by about 4％;heterogeneity analysis finds outpatient co-payment primarily affects individuals'commercial insurance purchasing behavior and that the extent of the effect is related to workers'age,health status,and the outpatient co-payment coverage model of the affiliation.Conclusion:Improving the outpatient co-payment guarantee mechanism at the national level and promoting the effective connection between basic medical insurance and commercial medical insurance.

Objective:To explore the influence of outpatient co-ordination on the purchase of commercial medical insurance in China,enrich the research perspective of outpatient co-ordination.Methods:Based on the data of China Health and Retirement Longitudinal Study from 2011 to 2020,past outpatient co-ordination policies in pilot cities and the Digital Inclusive Finance insurance index,using staggered DID to empirically test the impact of outpatient co-ordination on employees'commercial medical insurance purchase.Results:Outpatient co-payment increases workers'willingness to purchase commercial health insurance,which increases by about 4％;heterogeneity analysis finds outpatient co-payment primarily affects individuals'commercial insurance purchasing behavior and that the extent of the effect is related to workers'age,health status,and the outpatient co-payment coverage model of the affiliation.Conclusion:Improving the outpatient co-payment guarantee mechanism at the national level and promoting the effective connection between basic medical insurance and commercial medical insurance.

Objective:To explore the influence of outpatient co-ordination on the purchase of commercial medical insurance in China,enrich the research perspective of outpatient co-ordination.Methods:Based on the data of China Health and Retirement Longitudinal Study from 2011 to 2020,past outpatient co-ordination policies in pilot cities and the Digital Inclusive Finance insurance index,using staggered DID to empirically test the impact of outpatient co-ordination on employees'commercial medical insurance purchase.Results:Outpatient co-payment increases workers'willingness to purchase commercial health insurance,which increases by about 4％;heterogeneity analysis finds outpatient co-payment primarily affects individuals'commercial insurance purchasing behavior and that the extent of the effect is related to workers'age,health status,and the outpatient co-payment coverage model of the affiliation.Conclusion:Improving the outpatient co-payment guarantee mechanism at the national level and promoting the effective connection between basic medical insurance and commercial medical insurance.

Objective:To explore the influence of outpatient co-ordination on the purchase of commercial medical insurance in China,enrich the research perspective of outpatient co-ordination.Methods:Based on the data of China Health and Retirement Longitudinal Study from 2011 to 2020,past outpatient co-ordination policies in pilot cities and the Digital Inclusive Finance insurance index,using staggered DID to empirically test the impact of outpatient co-ordination on employees'commercial medical insurance purchase.Results:Outpatient co-payment increases workers'willingness to purchase commercial health insurance,which increases by about 4％;heterogeneity analysis finds outpatient co-payment primarily affects individuals'commercial insurance purchasing behavior and that the extent of the effect is related to workers'age,health status,and the outpatient co-payment coverage model of the affiliation.Conclusion:Improving the outpatient co-payment guarantee mechanism at the national level and promoting the effective connection between basic medical insurance and commercial medical insurance.

Objective:To explore the influence of outpatient co-ordination on the purchase of commercial medical insurance in China,enrich the research perspective of outpatient co-ordination.Methods:Based on the data of China Health and Retirement Longitudinal Study from 2011 to 2020,past outpatient co-ordination policies in pilot cities and the Digital Inclusive Finance insurance index,using staggered DID to empirically test the impact of outpatient co-ordination on employees'commercial medical insurance purchase.Results:Outpatient co-payment increases workers'willingness to purchase commercial health insurance,which increases by about 4％;heterogeneity analysis finds outpatient co-payment primarily affects individuals'commercial insurance purchasing behavior and that the extent of the effect is related to workers'age,health status,and the outpatient co-payment coverage model of the affiliation.Conclusion:Improving the outpatient co-payment guarantee mechanism at the national level and promoting the effective connection between basic medical insurance and commercial medical insurance.

Objective To investigate the clinicopathological characteristics of radioactive Iodine-refrac-tory differentiated thyroid cancer(RAIR-DTC)to provide a clinical evidence for early prediction of the thyroid cancer patients with radioactive Iodine-refractory(RAIR).Methods The data of 84 patients with undergoing thyroidectomy and 131I therapy in PLA 960 hospital from January 2010 to December 2019 were retrospectively analyzed.Thirty-nine patients with diagnosed RAIR-DTC served as the study group and 45 cases of radioactive iodine-avid differentiated thyroid cancer(RAIA-DTC)served as the control group.The clinicopathological characteristics were compared between the two groups.The logistic regression was used to analyze the inde-pendent risk factors of RAIR-DTC,and the RAIR-DTC prediction model was established.Results Compared with the RAIA-DTC group,the RAIR-DTC group had more iodine treatment times,the proportions of the pa-tients with age ≥55 years old,total iodine therapeutic dose,distant metastasis,TNM stage Ⅳ,high-risk sub-types and focal calcification were higher,the tumor maximum diameter was greater,the number of lymph node metastases was more and the probability of Ⅱ,Ⅰ+Ⅱ and non-central lymph node metastases was higher(P＞0.05).The progression-free survival rate had statistical difference between the two groups(P＜0.05).The total survival rate had no statistical difference between the two groups(P＞0.05).The binary logistic re-gression analysis results showed that the distant metastasis,high-risk histological subtype and maximum tumor diameter ≥10.5 mm were the independent risk factors for RAIR-DTC.The obtained fitting equation logit(P)=-2.259+3.330X1+2.287X2+1.606X3,the ROC curve was used to calculate the truncation val-ue of the fitted equation as-0.312 5,when logit(P)＞-0.312 5,it might develop into RAIR-DTC.Conclusion The clinicopathological characteristics of the patients with differentiated thyroid cancer could ef-fectively predict RAIR.

ObjectiveTo investigate the mechanism of Ershiwuwei Guijiu pill in preventing and treating postmenopausal osteoporosis （PMOP） by activating the phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway and inhibiting excessive autophagy. MethodFemale SD rats were ovariectomized and randomly divided into the sham operation group （Sham）， the operation group （OVX）， the Ershiwuwei Guijiu pill （GJ） group， and the raloxifene hydrochloride （RLX） group， with 10 rats in each group. Enzyme-linked immunosorbent assay （ELISA） and colorimetric methods were used to detect the levels of estrogen， bone metabolism markers in serum， and total superoxide dismutase （T-SOD）， malondialdehyde （MDA）， and glutathione peroxidase （GSH-Px） in tibial tissue. Flow cytometry was used to detect reactive oxygen species （ROS） levels in bone marrow mesenchymal stem cells. Masson staining was used to observe pathological changes in the proximal tibia， and micro-computed tomography （Micro-CT） was used to observe changes in tibial microstructural parameters. Real-time fluorescence quantitative polymerase chain reaction （Real-time PCR） and Western blot were used to detect the expression of autophagy-related proteins Beclin1， microtubule-associated protein 1A/1B-light chain 3 （LC3）， autophagy-related 5 （Atg5）， as well as PI3K， Akt， and mTOR in tibial tissue. ResultCompared with the Sham group， the OVX group showed a significant decrease in serum levels of estradiol （E₂） and calcium ion （Ca²⁺）， and T-SOD， GSH-Px， PI3K， Akt， and mTOR mRNA levels in bone tissue （P<0.05， P<0.01）， significantly reduced bone mineral density （BMD）， bone surface/bone volume （BS/BV）， trabecular thickness （Tb.Th）， trabecular number （Tb.N）， and trabecular connectivity （Con） in the tibia （P<0.05， P<0.01）， thinner epiphyseal growth plate， and the bone marrow cavity filled with fat vacuoles. Moreover， the levels of phosphorus （P）， MDA， ROS， and mRNA and protein expression of Beclin1， LC3， and Atg5， as well as trabecular separation （Tb.Sp） were significantly elevated （P<0.05， P<0.01）. Compared with the OVX group， the GJ and RLX groups showed significant increases in serum E₂ and Ca²⁺， and bone tissue levels of SOD， GSH-Px， and the mRNA levels of PI3K， Akt， and mTOR （P<0.05， P<0.01）， significantly increased BMD， BS/BV， Tb.Th， Tb.N， and Con in the tibia， thickened epiphyseal growth plate， and significantly reduced fat vacuoles in the bone marrow cavity （P<0.05， P<0.01）. Additionally， the levels of P， MDA， ROS， Beclin1， LC3， Atg5 mRNA and proteins， and Tb.Sp were significantly decreased （P<0.05， P<0.01）. The ratios of p-PI3K/PI3K， p-Akt/Akt， and p-mTOR/mTOR， which were significantly reduced in the OVX group （P<0.01）， were significantly increased in the GJ and RLX groups （P<0.01）. ConclusionThe Ershiwuwei Guijiu pill reduces oxidative stress and inhibits autophagy， thereby preventing and treating postmenopausal osteoporosis. Its mechanism may be related to the activation of the PI3K/Akt/mTOR signaling pathway， which inhibits autophagy.