Objective: To investigate the efficacy，safety and feasibility of regional lymph node dissection in laparoscopic radical surgery for bladder cancer under the guidance of indocyanine green fluorescence imaging. Methods: A total of 30 patients with muscle invasive bladder cancer (T2/T3NxM0) who volunteered to enter the clinical trial were randomly divided into the indocyanine green imaging guided laparoscopic regional lymph node dissection group (n=15) and the standard pelvic lymph node dissection group (n=15).The number of positive lymph nodes，operation time，intraoperative bleeding volume，incidence of lymph leakage，and tumor recurrence and metastasis rate 2-year after surgery were collected. Results: The number of positive lymph nodes was (4.20±1.66) and (4.60±1.72) respectively in the indocyanine green and standard groups，with no statistically significant difference (P>0.05).There were no statistically significant difference in the tumor recurrence and metastasis rates 2-year after surgery between the two groups (P>0.05).However，the indocyanine green group had shorter operation time，less intraoperative bleeding volume，and lower incidence of lymphatic leakage than the standard group (P<0.05). Conclusion: Indocyanine green fluorescence imaging guided laparoscopic lymph node dissection has comparable clinical efficacy to standard lymph node dissection，but with fewer complications.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To evaluate the impact of bladder volume on dosimetric parameters of clinical target volume (CTV) and organs at risk (OAR) of intensity modulated proton therapy (IMPT) for localized prostate cancer during the treatment planning and daily treatment.Methods:Clinical data of 25 patients with localized prostate cancer admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 and enrolled in the "Proton Therapy System" (SAPT-PS-01) registered clinical trial were retrospectively analyzed. All patients were male and the median age was 72 years old. A total of 30 sets of IMPT plans were obtained. Based on the planning CT (30 sets) and weekly verification CT during treatment (172 sets), bladder volume, CTV and OAR dose parameters were collected. Spearman correlation analysis was used to evaluate the correlation between bladder volume in CT and the dosimetric parameters of CTV and OAR during IMPT plans, and Wilcoxon-Mann-Whitney test was adopted to compare the dosimetric parameters of CTV and OAR among different bladder volume change groups.Results:The V 95% of CTV1 and CTV2 were both 100.0%±0.0% in IMPT plans. Bladder volume was significantly negatively correlated with D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder ( P<0.001, 0.003, <0.001, <0.001,<0.001), and D mean, V 50 Gy(RBE) of the small intestine (both P<0.001). During treatment, bladder D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE)( P<0.001, 0.001, <0.001, <0.001, <0.001), rectal D mean, V 50 Gy(RBE), V 40 Gy(RBE) (all P<0.001), small intestine D mean, V 50 Gy (RBE) (both P<0.001) of patients with bladder volume increase >20% compared to baseline were significantly decreased compared to those in IMPT plans. But CTV1 V 100%, and CTV2 V 95% were significantly decreased too( P=0.029, 0.020). In the bladder volume decreased>20% patients, the D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder were significantly increased compared to those in IMPT plans (all P<0.001). However, a bladder volume reduction of ≤20% and increase of ≤20% from baseline had no significant impact on CTV and OAR dosimetric parameters during treatment. Conclusions:For patients with localized prostate cancer undergoing proton therapy, a certain bladder volume should be ensured during planning CT scans. During the daily treatment, the bladder volume should be maintained between 80%-120% of the baseline level to ensure CTV coverage and good dose sparing to OAR.

Objective To investigate the application value of single nucleotide polymorphism(SNP)linkage analysis based on next-generation sequencing(NGS)technology in preimplantation genetic testing(PGT)of families with autosomal recessive polycystic kidney disease(ARPKD).Methods A family with ARPKD was selected,where the female member had a pregnancy ultrasound revealing polycystic kidney in the fetus.Genetic testing showed compound heterozygous mutations of the polycystic kidney/polycystic liver disease 1 gene(PKHD1),c.10444C>T(paternal)and c.4303del(maternal),with the c.4303del mutation being reported for the first time.Targeting the coding region of the PKHD1 gene,335 high-density tightly linked SNP sites were selected in the upstream and downstream 2M regions using multiplex polymerase chain reaction(PCR)and NGS.The couple′s SNP risk haplotypes carrying gene mutations were constructed.After in vitro fertilization,blastocyst culture was performed.Trophoblastic cells obtained from the biopsy were subjected to whole-genome amplification,and NGS was used for linkage analysis and low-depth chromosomal aneuploidy screening of the embryos.Sanger sequencing was used to verify the results of embryo linkage analysis.Results Among the 6 biopsied embryos,4 were mutation-free and euploid,1 exhibited heterozygous for the mutation and mosaic while another unstable sequencing data,making it impossible to judge.One of the mutation-free and developmentally healthy euploid embryos was implanted into the maternal uterus,resulting in the full-term delivery of a healthy baby.Conclusion Application of NGS-based SNP linkage analysis in PGT can effectively blocking the vertical transmission of ARPKD within families,while avoiding abortion issues caused by aneuploid embryos.This study is also the first PGT report target-ing the PKHD1 gene c.4303del mutation.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.

Objective:To study the time evolution of financing burden and discuss the feasibility of provincial pooling by analyzing the panel data of"individual contribution burden ratio"and"government subsidy burden ratio"of residents'medical insurance in Shandong Province from 2015 to 2022.Methods:Spatial auto-correlation was used to analyze the spatial agglomeration and heterogeneity pattern;convergence analysis was used to analyze the inter-annual trends in the economic burden.Results:The"out-of-pocket ratio"increased year by year and the difference among cities was significant,the Moran's I value decreased year by year,and the geographical distribution pattern showed a random distribution pattern;the"government subsidy burden ratio"had little difference among cities,the global Moran's index value increased year by year,and the spatial agglomeration pattern was enhanced;both of them had σ convergence and absolute β convergence,showing a trend of balanced development.Conclusion:In order to promote provincial-level coordination,safeguard fund security and reduce the burden on residents,economic synergistic development strategies have been adopted to raise residents'incomes;emphasis has been placed on cutting back on income and expenditure,fine-tuning fund supervision;and reforming the financing mechanism,formulating fine-tuning financing standards and focusing on the increase in the cost of disease prevention and control have been adopted,so as to provide references for the improvement of the health insurance system and the promotion of the sustainable development of the health insurance cause.