Elderly patients are a crucial population for medical treatment and referral.The establishment of standardized and efficient referral channels is essential for enhancing the referral process, improving treatment outcomes for the elderly, and optimizing the allocation of medical resources.Referral network analysis examines the integrity, structure, and dynamics of referrals to infer the characteristics of the network.This can offer insights for enhancing referral policies and elevating medical service standards.While existing research predominantly concentrates on referral networks within the general population, there is a noticeable gap in studies focusing on elderly patients.This review article assesses domestic and international research on networks formed between medical institutions or physicians through patient referrals, aiming to inform and enhance referral policies in our country.

Objective To investigate the effects of neurotrophic factor Neuritin overexpression on the angiogenic effects of chicken embryonic allantoic membrane (CAM) and human umbilical vein endothelial cells (HUVECs),and to provide a new direction for the treatment of angiogenic diseases. Methods Thirty fresh yellow-skinned breeding eggs were selected to establish a CAM model,which were divided into three groups by randomized numerical table method:positive control group (bFGF),negative control group (NS) and experimental group (Neuritin),with 10 eggs in each group. The positive control group was loaded with 2500 U/mL of bFGF,the experimental group was loaded with 10 μg/mL of Neuritin protein,and the negative control group was loaded with NS. 10 μL loading volume was loaded into each group,and all CAMs were incubated at the same temperature,relative humidity,and time,and the vascular branching,number,and size of the CAMs in each group were recorded after 72 h of incubation. Fresh umbilical cords from healthy pregnant women were selected to produce primary HUVECs,which were divided into three groups:transfected with recombinant plasmid (HUVEC-neu group),transfected with empty vector (HUVEC-3.1 group),and untransfected (HUVEC group). Primary HUVECs in the HUVEC-neu group were transfected with the recombinant plasmid Neuritin,and those in the HUVEC-3.1 group were transfected with the empty vector. HUVEC-3.1 group was transfected with the empty vector plasmid,and HUVEC group was not given any special treatment,and all three groups received the same culture regimen. Western blot was used to detect the protein expression level of Neuritin in HUVEC-3.1 and HUVEC-neu groups. CCK-8 assay,cell scratch assay,Transwell assay,and tube formation assay were used to detect protein expression level of Neuritin in HUVEC-3.1 group and HUVEC-neu group,and HUVEC-neu groups for cell proliferation,migration and tube formation. Results (1) The number of CAM vessel branch points and microvessels in the experimental group was significantly increased compared with that in the negative control group (P<0.01),but there was no statistically significant difference in the number of large and medium-sized vessels between the two groups (P>0.05);(2) Neuritin was successfully overexpressed in HUVECs in the HUVEC-neu group. (3) Compared with the HUVEC-3.1 group,the proliferation vigor of cells in the HUVEC-neu group was decreased (P<0.05),but their migration and tube formation abilities were significantly enhanced (P<0.01). Conclusion Neuritin overexpression promotes angiogenesis and participates in the regulation of neovascularization by affecting cell prolif-eration,migration,and tube formation ability.

Objective To explore the detection rate and distribution characteristics of gene mutations in pa-tients with non-small cell lung cancer,and to analyze their relationship with clinicopathological characteristics.Methods The genetic testing results and clinicopathological data of 213 patients with non-small cell lung cancer who underwent high-throughput genetic testing at the Gene Detection Center,Changchun Cancer Hos-pital from April 2020 to December 2023 were collected.High-throughput sequencing technology was used to detect mutations in 26 genes,and the relationship between the mutation frequency and its distribution and the clinicopathological characteristics of patients was analyzed.Results Among 213 patients with non-small cell lung cancer,192 cases(90.14％)had at least one gene mutation detected.Among them,the genes with rela-tively high mutation frequencies were TP53(60.56％),EGFR(46.48％),KRAS(14.55％),ALK fusion(11.74％),and PIK3CA(8.92％).There were 132 cases(30.28％)of evidence level for Class 1 drugs and 11 cases(2.52％)of evidence level for Class 2 drugs.The incidence of EGFR gene mutations was higher in women,non-smokers and patients with lung adenocarcinoma(P＜0.05).TP53 mutations usually occured in women,smokers and patients with stage Ⅳ.ALK mutations were more common in young patients,while KRAS mutations were more frequently seen in male smokers.Conclusion Analyzing the distribution charac-teristics of gene mutations in non-small cell lung cancer and their relationship with clinicopathological charac-teristics can provide a scientific basis for further optimizing genetic testing for patients with non-small cell lung cancer and offer guidance for clinical treatment.

Objective:To establish a rapid and accurate duplex real-time fluorescent reverse transcription-recombinase polymerase amplification/recombinase-aided amplification（RT-RPA/RAA）detection method for identification and differentiation of Nipah virus（NiV），Langya virus（LayV），Mojiang virus（MoJV），and Cedar virus（CedV）.Methods:First，specific primers and probes were designed targeting the conserved L gene regions of NiV and LayV，as well as the conserved N gene regions of MoJV and CedV，respectively. The four viruses were divided into two groups for duplex detection. Subsequently，the optimal primer and probe combinations were screened by comparing the amplification efficiency of different primer pair combinations（F1/R1，F1/R2，F2/R1，F2/R2）. The reaction temperature was optimized through temperature gradient settings from 37 ℃ to 42 ℃，and the amounts of primers and probes were optimized to establish the duplex real-time fluorescent RT-RPA/RAA detection system. Finally，the detection performance was evaluated through specificity，sensitivity，and stability tests，as well as clinical sample validation.Results:The selected primer pairs（NiV primer pair F2/R1，LayV primer pair F1/R1，MoJV primer pair F2/R2，and CedV primer pair F2/R2）all demonstrated optimal amplification efficiency when combined with their corresponding probes. The optimal annealing temperature was 39 ℃，and the minimum detection limit was 101-102 copies/μl. The method could effectively distinguish target viruses from other non-target viruses，and repeated experiments showed good stability（ R2> 0.90）. Additionally，detection results for Malaysian NiV strains and various clinical samples were consistent with the Taqman multiplex qRT-PCR method. Conclusion:The duplex real-time fluorescent RT-RPA/RAA detection method successfully established in this study can rapidly and accurately identify and differentiate four important henipavirus-like viruses：NiV，LayV，MoJV，and CedV. It features simple operation，rapid reaction，high specificity，and good stability，providing an effective molecular detection tool for rapid field diagnosis，surveillance，and control of these zoonotic viruses.

Objective:To investigate the effects of metronidazole and vulvar cleaning with 0.1% benzalkonium bromide solution on vaginal environment, etiology, and interleukin-6 and Toll-like receptor 2 levels in lavage fluid of patients with bacterial vaginosis.Methods:A total of 114 patients with bacterial vaginosis who were admitted to Jinan 2 nd People's Hospital from February 2021 to February 2024 were included in this prospective study. These patients were randomly divided into a control group and an observation group, with 57 patients in each group, following a 1:1 ratio. The control group received treatment with metronidazole, while the observation group received metronidazole in combination with vulvar cleaning using a 0.1% benzalkonium bromide solution, for a total of 14 days. The clinical efficacy was evaluated by comparing the vaginal environment (including vaginal pH, cleanliness, and microbial density), microbiological outcomes (lactobacilli detection rate and pathogenic bacteria detection rate), and interleukin-6 and Toll-like receptor 2 levels in the vaginal lavage fluid between the two groups before and after treatment. Adverse drug reactions were recorded. Patients were followed up for 3 months after treatment to record recurrence rates. Results:The total response rate in the observation group was significantly higher than that in the control group [92.98% (53/57) vs. 78.95% (45/57), χ2 = 4.65 P < 0.05]. After treatment, improvements of vaginal pH, vaginal cleanliness, and bacterial density were greater in the observation group than those in the control group ( χ2 = 4.61, Z = 4.92, 4.29, all P < 0.05). After treatment, the detection rate of lactobacilli in the observation group was significantly higher than that in the control group [63.16% (36/57) vs. 42.11% (24/57), χ2 = 5.07, P < 0.05]. The detection rate of pathogenic bacteria in the observation group was significantly lower than that in the control group [5.26% (3/57) vs. 17.54% (10/57), χ2 = 4.25, P < 0.05]. After treatment, lavage fluid levels of interleukin-6 [(8.70 ± 2.13) ng/L vs. (13.52 ± 3.36) ng/L] and Toll-like receptor 2 [(5.06 ± 1.34) ng/L vs. (7.84 ± 1.22) ng/L] in the observation group were significantly lower than those in the control group ( t = 9.15, 11.58, both P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups ( χ2 = 1.37, P > 0.05). After 3 months of treatment, the recurrence rate of bacterial vaginosis in the observation group was significantly lower than that in the control group [4.55% (1/22) vs. 27.78% (5/18), χ2 = 4.19, P < 0.05]. Conclusions:The combination of metronidazole and vulvar cleaning with a 0.1% benzalkonium chloride solution is effective for treating bacterial vaginosis. This approach helps regulate the vaginal environment, increases the levels of lactobacilli, reduces the levels of pathogenic bacteria, and decreases the levels of interleukin-6 and Toll-like receptor 2 in the lavage fluid. Additionally, it decreases the risk of recurrence of bacterial vaginosis and is highly safe.

Objective To investigate the effects of neurotrophic factor Neuritin overexpression on the angiogenic effects of chicken embryonic allantoic membrane (CAM) and human umbilical vein endothelial cells (HUVECs),and to provide a new direction for the treatment of angiogenic diseases. Methods Thirty fresh yellow-skinned breeding eggs were selected to establish a CAM model,which were divided into three groups by randomized numerical table method:positive control group (bFGF),negative control group (NS) and experimental group (Neuritin),with 10 eggs in each group. The positive control group was loaded with 2500 U/mL of bFGF,the experimental group was loaded with 10 μg/mL of Neuritin protein,and the negative control group was loaded with NS. 10 μL loading volume was loaded into each group,and all CAMs were incubated at the same temperature,relative humidity,and time,and the vascular branching,number,and size of the CAMs in each group were recorded after 72 h of incubation. Fresh umbilical cords from healthy pregnant women were selected to produce primary HUVECs,which were divided into three groups:transfected with recombinant plasmid (HUVEC-neu group),transfected with empty vector (HUVEC-3.1 group),and untransfected (HUVEC group). Primary HUVECs in the HUVEC-neu group were transfected with the recombinant plasmid Neuritin,and those in the HUVEC-3.1 group were transfected with the empty vector. HUVEC-3.1 group was transfected with the empty vector plasmid,and HUVEC group was not given any special treatment,and all three groups received the same culture regimen. Western blot was used to detect the protein expression level of Neuritin in HUVEC-3.1 and HUVEC-neu groups. CCK-8 assay,cell scratch assay,Transwell assay,and tube formation assay were used to detect protein expression level of Neuritin in HUVEC-3.1 group and HUVEC-neu group,and HUVEC-neu groups for cell proliferation,migration and tube formation. Results (1) The number of CAM vessel branch points and microvessels in the experimental group was significantly increased compared with that in the negative control group (P<0.01),but there was no statistically significant difference in the number of large and medium-sized vessels between the two groups (P>0.05);(2) Neuritin was successfully overexpressed in HUVECs in the HUVEC-neu group. (3) Compared with the HUVEC-3.1 group,the proliferation vigor of cells in the HUVEC-neu group was decreased (P<0.05),but their migration and tube formation abilities were significantly enhanced (P<0.01). Conclusion Neuritin overexpression promotes angiogenesis and participates in the regulation of neovascularization by affecting cell prolif-eration,migration,and tube formation ability.

Objective:To investigate the effects of metronidazole and vulvar cleaning with 0.1% benzalkonium bromide solution on vaginal environment, etiology, and interleukin-6 and Toll-like receptor 2 levels in lavage fluid of patients with bacterial vaginosis.Methods:A total of 114 patients with bacterial vaginosis who were admitted to Jinan 2 nd People's Hospital from February 2021 to February 2024 were included in this prospective study. These patients were randomly divided into a control group and an observation group, with 57 patients in each group, following a 1:1 ratio. The control group received treatment with metronidazole, while the observation group received metronidazole in combination with vulvar cleaning using a 0.1% benzalkonium bromide solution, for a total of 14 days. The clinical efficacy was evaluated by comparing the vaginal environment (including vaginal pH, cleanliness, and microbial density), microbiological outcomes (lactobacilli detection rate and pathogenic bacteria detection rate), and interleukin-6 and Toll-like receptor 2 levels in the vaginal lavage fluid between the two groups before and after treatment. Adverse drug reactions were recorded. Patients were followed up for 3 months after treatment to record recurrence rates. Results:The total response rate in the observation group was significantly higher than that in the control group [92.98% (53/57) vs. 78.95% (45/57), χ2 = 4.65 P < 0.05]. After treatment, improvements of vaginal pH, vaginal cleanliness, and bacterial density were greater in the observation group than those in the control group ( χ2 = 4.61, Z = 4.92, 4.29, all P < 0.05). After treatment, the detection rate of lactobacilli in the observation group was significantly higher than that in the control group [63.16% (36/57) vs. 42.11% (24/57), χ2 = 5.07, P < 0.05]. The detection rate of pathogenic bacteria in the observation group was significantly lower than that in the control group [5.26% (3/57) vs. 17.54% (10/57), χ2 = 4.25, P < 0.05]. After treatment, lavage fluid levels of interleukin-6 [(8.70 ± 2.13) ng/L vs. (13.52 ± 3.36) ng/L] and Toll-like receptor 2 [(5.06 ± 1.34) ng/L vs. (7.84 ± 1.22) ng/L] in the observation group were significantly lower than those in the control group ( t = 9.15, 11.58, both P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups ( χ2 = 1.37, P > 0.05). After 3 months of treatment, the recurrence rate of bacterial vaginosis in the observation group was significantly lower than that in the control group [4.55% (1/22) vs. 27.78% (5/18), χ2 = 4.19, P < 0.05]. Conclusions:The combination of metronidazole and vulvar cleaning with a 0.1% benzalkonium chloride solution is effective for treating bacterial vaginosis. This approach helps regulate the vaginal environment, increases the levels of lactobacilli, reduces the levels of pathogenic bacteria, and decreases the levels of interleukin-6 and Toll-like receptor 2 in the lavage fluid. Additionally, it decreases the risk of recurrence of bacterial vaginosis and is highly safe.

Elderly patients are a crucial population for medical treatment and referral.The establishment of standardized and efficient referral channels is essential for enhancing the referral process, improving treatment outcomes for the elderly, and optimizing the allocation of medical resources.Referral network analysis examines the integrity, structure, and dynamics of referrals to infer the characteristics of the network.This can offer insights for enhancing referral policies and elevating medical service standards.While existing research predominantly concentrates on referral networks within the general population, there is a noticeable gap in studies focusing on elderly patients.This review article assesses domestic and international research on networks formed between medical institutions or physicians through patient referrals, aiming to inform and enhance referral policies in our country.

Objective:To establish a rapid and accurate duplex real-time fluorescent reverse transcription-recombinase polymerase amplification/recombinase-aided amplification（RT-RPA/RAA）detection method for identification and differentiation of Nipah virus（NiV），Langya virus（LayV），Mojiang virus（MoJV），and Cedar virus（CedV）.Methods:First，specific primers and probes were designed targeting the conserved L gene regions of NiV and LayV，as well as the conserved N gene regions of MoJV and CedV，respectively. The four viruses were divided into two groups for duplex detection. Subsequently，the optimal primer and probe combinations were screened by comparing the amplification efficiency of different primer pair combinations（F1/R1，F1/R2，F2/R1，F2/R2）. The reaction temperature was optimized through temperature gradient settings from 37 ℃ to 42 ℃，and the amounts of primers and probes were optimized to establish the duplex real-time fluorescent RT-RPA/RAA detection system. Finally，the detection performance was evaluated through specificity，sensitivity，and stability tests，as well as clinical sample validation.Results:The selected primer pairs（NiV primer pair F2/R1，LayV primer pair F1/R1，MoJV primer pair F2/R2，and CedV primer pair F2/R2）all demonstrated optimal amplification efficiency when combined with their corresponding probes. The optimal annealing temperature was 39 ℃，and the minimum detection limit was 101-102 copies/μl. The method could effectively distinguish target viruses from other non-target viruses，and repeated experiments showed good stability（ R2> 0.90）. Additionally，detection results for Malaysian NiV strains and various clinical samples were consistent with the Taqman multiplex qRT-PCR method. Conclusion:The duplex real-time fluorescent RT-RPA/RAA detection method successfully established in this study can rapidly and accurately identify and differentiate four important henipavirus-like viruses：NiV，LayV，MoJV，and CedV. It features simple operation，rapid reaction，high specificity，and good stability，providing an effective molecular detection tool for rapid field diagnosis，surveillance，and control of these zoonotic viruses.

Objective The aim of this study is to evaluate the effect of the payment reform of basic medical insurance on cost,medical behavior and patients′ burden.So as to provide a reference for improving the payment reform in Changsha.Methods Interrupted time-series method was used to analyze the changes of the same-day readmission rate,average hospitalization cost per time and the out-of-pocket proportion before and after the payment reform.Stakeholder interviews were used to investigate suggestions and possible reasons for the change.Results The average hospitalization cost per time and the out-of-pocket proportion of insured patients decreased significantly in early stage of the reform,and then showed an increasing trend.The growth rate of the total number of inpatients and the decrease of same-day readmission rate declined.The results of interrupted time-series analysis showed that the growth rate of total inpatients decreased from 600 per month to 20 per month after the payment reform.The same-day readmission rate increased by 0.237%in the short term after the reform,but showed a downward trend in the long term,with the rate decreasing from 0.014%per month before the reform to 0.003%per month.In the short term after the reform,the average hospitalization cost per time fell by 786.360,and the proportion of out-of-pocket decreased by 2.089%.Conclusion The effects of controlling cost and alleviating patients′ burden were obvious in the initial reform of the basic medical insurance for urban employees in Changsha,but the long-term supervision needs to be strengthened,especially for decomposition of hospitalization and patients′burden relief.