Objective:Under the background of the"Healthy Shanxi 2030"strategy,it systematically analyzes the spatiotemporal evolution characteristics and equilibrium of health resource allocation in Shanxi Province,and explores the optimization path to promote the high-quality development of health care.Methods:Based on the health statistics of Shanxi Province from 2012 to 2023,it systematically analyzes the spatiotemporal evolution characteristics and equilibrium of health resource allocation in Shanxi Province by using Gini coefficient,Theil index and statistical description method.Results:The total number of health resources in Shanxi Province continues to grow steadily,and by the end of 2023,the total number of medical and health institutions in the province will reach to 37 838,the number of hospital beds will reach to 223 650,and the total number of health technicians will be 260 536.Despite this,the imbalance of regional allocation is still significant,showing a"core-periphery"structure.According to the calculation of the Gini coefficient and the Theil index,from 2011 to 2023,the overall equilibrium of the health resources allocation in Shanxi Province showed a gradual improvement trend,which was reflected in the fact that the Gini coefficient of the number of health institutions decreased from 0.287 to 0.268,and the Theil index decreased by 42.40％.However,the structural imbalance of key human resources such as registered nurses is still significant,and the Gini coefficient continues to be higher than 0.30.The regional differences are mainly due to the economic gradient differentiation,policy orientation and population aging pressure,among which the Gini coefficient in the Jinzhong region group is 0.33,and the contribution of regional differences to the overall imbalance is more than 51.00％.Conclusion:Promote the balanced allocation of health resources and help achieve the strategic goal of"Healthy Shanxi"by optimizing the spatial distribution of resources,strengthening the capacity of grassroots services,improving the talent training and mobility mechanism,and deepening the reform of the hierarchical diagnosis and treatment system.

Objective To evaluate the efficacy and safety of Jiawei Dihuang Decoction in the treatment of vascular dementia(VD);To explore its mechanism and the VD susceptibility genesby using whole exome sequencing.Methods A total of 75 patients with VD who were hospitalized or received outpatient treatment at The Second Affiliated Hospital of Shaanxi University of Chinese Medicine were included.They were divided into the control group(37 cases,treated with conventional Western medicine)and the experimental group(38 cases,treated with conventional Western medicine+Jiawei Dihuang Decoction)using random number table method.The treatment course was 3 months.The general data,TCM syndrome scores,MMSE scores,ADL scores,Blessed scores and adverse reactions of the two groups were compared.Peripheral blood samples from 36 patients with kidney-yin deficiency type VD were selected for whole exome sequencing.Susceptible genes were screened,and the targets of Jiawei Dihuang Decoction were analyzed by network pharmacology.A"drug-gene"network was constructed,and key pathways were enriched.Results There was no statistical significance in the baseline data between the two groups(P>0.05),and they were comparable.Compared with before treatment,the MMSE scores of patients in both groups significantly increased after treatment,while TCM syndrome scores and ADL scores significantly decreased(P<0.05).Compared with the control group,the TCM syndrome scores,MMSE scores,ADL scores and clinical efficacy of the experimental group were significantly better than those of the control group(P<0.05).Moreover,the Blessed score showed that the experimental group had more advantages in improving the patients'living ability and daily habits(P<0.05).No adverse reactions were observed in both groups during the treatment period.A total of 1 250 744 single nucleotide polymorphism(SNP)loci and 37 314 insertion and deletion(InDel)loci were detected by whole exome sequencing.After screening,3 041 VD susceptibility genes were obtained.It was found that they were involved in biological processes such as the response to nutrient levels,positive regulation of the MAPK cascade,vascular processes in the circulatory system,the response to nutrients,etc.And enriched in PI3K-Akt,cholinergic/glutamatergic synapses,lipid metabolism and atherosclerosis pathways.The potential targets of 854 of Jiawei Dihuang Decoction were intersected with the susceptibility genes to obtain 353 common targets.The top 10 key genes were analyzed and found to be involved in positive regulation of cytosine-serine phosphorylation,miRNA-mediated gene silencing regulation,and the response of cells to decreased oxygen levels,etc.They were enriched in PI3K-Akt,lipid and atherosclerosis signaling pathways.Conclusion Jiawei Dihuang Decoction can alleviate the symptoms of patients with VD,protect cognitive function,enhance their ability of daily living,and has good safety profile.Its mechanism may involve regulating susceptibility genes through PI3K-Akt signaling pathway and lipid atherosclerosis signaling pathway,and improving lipid metabolism,inflammatory response and oxidative stress.

Objective:Under the background of the"Healthy Shanxi 2030"strategy,it systematically analyzes the spatiotemporal evolution characteristics and equilibrium of health resource allocation in Shanxi Province,and explores the optimization path to promote the high-quality development of health care.Methods:Based on the health statistics of Shanxi Province from 2012 to 2023,it systematically analyzes the spatiotemporal evolution characteristics and equilibrium of health resource allocation in Shanxi Province by using Gini coefficient,Theil index and statistical description method.Results:The total number of health resources in Shanxi Province continues to grow steadily,and by the end of 2023,the total number of medical and health institutions in the province will reach to 37 838,the number of hospital beds will reach to 223 650,and the total number of health technicians will be 260 536.Despite this,the imbalance of regional allocation is still significant,showing a"core-periphery"structure.According to the calculation of the Gini coefficient and the Theil index,from 2011 to 2023,the overall equilibrium of the health resources allocation in Shanxi Province showed a gradual improvement trend,which was reflected in the fact that the Gini coefficient of the number of health institutions decreased from 0.287 to 0.268,and the Theil index decreased by 42.40％.However,the structural imbalance of key human resources such as registered nurses is still significant,and the Gini coefficient continues to be higher than 0.30.The regional differences are mainly due to the economic gradient differentiation,policy orientation and population aging pressure,among which the Gini coefficient in the Jinzhong region group is 0.33,and the contribution of regional differences to the overall imbalance is more than 51.00％.Conclusion:Promote the balanced allocation of health resources and help achieve the strategic goal of"Healthy Shanxi"by optimizing the spatial distribution of resources,strengthening the capacity of grassroots services,improving the talent training and mobility mechanism,and deepening the reform of the hierarchical diagnosis and treatment system.

Objective To evaluate the efficacy and safety of Jiawei Dihuang Decoction in the treatment of vascular dementia(VD);To explore its mechanism and the VD susceptibility genesby using whole exome sequencing.Methods A total of 75 patients with VD who were hospitalized or received outpatient treatment at The Second Affiliated Hospital of Shaanxi University of Chinese Medicine were included.They were divided into the control group(37 cases,treated with conventional Western medicine)and the experimental group(38 cases,treated with conventional Western medicine+Jiawei Dihuang Decoction)using random number table method.The treatment course was 3 months.The general data,TCM syndrome scores,MMSE scores,ADL scores,Blessed scores and adverse reactions of the two groups were compared.Peripheral blood samples from 36 patients with kidney-yin deficiency type VD were selected for whole exome sequencing.Susceptible genes were screened,and the targets of Jiawei Dihuang Decoction were analyzed by network pharmacology.A"drug-gene"network was constructed,and key pathways were enriched.Results There was no statistical significance in the baseline data between the two groups(P>0.05),and they were comparable.Compared with before treatment,the MMSE scores of patients in both groups significantly increased after treatment,while TCM syndrome scores and ADL scores significantly decreased(P<0.05).Compared with the control group,the TCM syndrome scores,MMSE scores,ADL scores and clinical efficacy of the experimental group were significantly better than those of the control group(P<0.05).Moreover,the Blessed score showed that the experimental group had more advantages in improving the patients'living ability and daily habits(P<0.05).No adverse reactions were observed in both groups during the treatment period.A total of 1 250 744 single nucleotide polymorphism(SNP)loci and 37 314 insertion and deletion(InDel)loci were detected by whole exome sequencing.After screening,3 041 VD susceptibility genes were obtained.It was found that they were involved in biological processes such as the response to nutrient levels,positive regulation of the MAPK cascade,vascular processes in the circulatory system,the response to nutrients,etc.And enriched in PI3K-Akt,cholinergic/glutamatergic synapses,lipid metabolism and atherosclerosis pathways.The potential targets of 854 of Jiawei Dihuang Decoction were intersected with the susceptibility genes to obtain 353 common targets.The top 10 key genes were analyzed and found to be involved in positive regulation of cytosine-serine phosphorylation,miRNA-mediated gene silencing regulation,and the response of cells to decreased oxygen levels,etc.They were enriched in PI3K-Akt,lipid and atherosclerosis signaling pathways.Conclusion Jiawei Dihuang Decoction can alleviate the symptoms of patients with VD,protect cognitive function,enhance their ability of daily living,and has good safety profile.Its mechanism may involve regulating susceptibility genes through PI3K-Akt signaling pathway and lipid atherosclerosis signaling pathway,and improving lipid metabolism,inflammatory response and oxidative stress.

Objective:To evaluate the prognostic value of the lung immune prognostic index (LIPI) combined with the prognostic nutritional index (PNI) for predicting immunotherapy response in patients with non-small cell lung cancer (NSCLC). Methods:A total of 106 patients with NSCLC who received immunotherapy in Zhumadian Central Hospital from January 2022 to December 2023 were selected and assigned into a response group (n=72) and non-response group (n=34) according to their response after immunotherapy. Clinical data,LIPI,and PNI of the two groups were compared to analyze the relationship between LIPI and PNI with clinicopathological features and treatment response and to analyze the predictive value of LIPI and PNI in the immunotherapy response of patients with NSCLC. The precision-recall (PR) curve was used to evaluate combined predictive values. Results:The TNM stage,lymph node metastasis,and distant metastasis were significantly different between the two groups (P<0.05). The proportion of patients with good LIPI in the non-response group was lower than that in the response group,the proportion of patients with poor LIPI was higher than that in the response group (P<0.05),and the PNI in the non-re-sponse group was lower than that in the response group (P<0.05). LIPI positively correlated with TNM stage,lymph node metastasis,distant metastasis,and treatment response,whereas PNI negatively correlated with TNM stage,lymph node metastasis,distant metastasis,and treatment response (P<0.05). Logistic regression analysis showed that LIPI and PNI were still significantly correlated with immunotherapy re-sponse in patients with NSCLC (P<0.05). The area under the curve (AUC) of the combined prediction of LIPI and PNI was 0.936,which was significantly higher than that of LIPI and PNI alone (P<0.05). The PR curve showed an AUC of 0.852,indicating that the combined prediction had high recall and accuracy rates. Conclusions:LIPI and PNI are closely related to TNM stage,lymph node metastasis,distant metastasis,and treatment response in patients with NSCLC. The combination of LIPI and PNI has a high reference value for predicting immunotherapy response in patients with NSCLC.

Objective:To evaluate the prognostic value of the lung immune prognostic index (LIPI) combined with the prognostic nutritional index (PNI) for predicting immunotherapy response in patients with non-small cell lung cancer (NSCLC). Methods:A total of 106 patients with NSCLC who received immunotherapy in Zhumadian Central Hospital from January 2022 to December 2023 were selected and assigned into a response group (n=72) and non-response group (n=34) according to their response after immunotherapy. Clinical data,LIPI,and PNI of the two groups were compared to analyze the relationship between LIPI and PNI with clinicopathological features and treatment response and to analyze the predictive value of LIPI and PNI in the immunotherapy response of patients with NSCLC. The precision-recall (PR) curve was used to evaluate combined predictive values. Results:The TNM stage,lymph node metastasis,and distant metastasis were significantly different between the two groups (P<0.05). The proportion of patients with good LIPI in the non-response group was lower than that in the response group,the proportion of patients with poor LIPI was higher than that in the response group (P<0.05),and the PNI in the non-re-sponse group was lower than that in the response group (P<0.05). LIPI positively correlated with TNM stage,lymph node metastasis,distant metastasis,and treatment response,whereas PNI negatively correlated with TNM stage,lymph node metastasis,distant metastasis,and treatment response (P<0.05). Logistic regression analysis showed that LIPI and PNI were still significantly correlated with immunotherapy re-sponse in patients with NSCLC (P<0.05). The area under the curve (AUC) of the combined prediction of LIPI and PNI was 0.936,which was significantly higher than that of LIPI and PNI alone (P<0.05). The PR curve showed an AUC of 0.852,indicating that the combined prediction had high recall and accuracy rates. Conclusions:LIPI and PNI are closely related to TNM stage,lymph node metastasis,distant metastasis,and treatment response in patients with NSCLC. The combination of LIPI and PNI has a high reference value for predicting immunotherapy response in patients with NSCLC.

Objective To explore the classification and changes of macrophage subsets in liver transplant rejection.Methods Rat liver transplantation model were established and divided into immune tolerance group(B-B),where the liver of BN rat donors was transplanted to BN rat recipients,and immune rejection group(L-B),in which the liver of Lewis rat donors was transplanted to BN rat recipients.Single-cell RNA sequencing and high-throughput RNA sequencing were used to distinguish the macrophage subsets of rat liver transplantation,and to find differential gene in rejection reactions.Immunohistochemistry was used to determine the changes and distribu-tion of protein expression and cell subsets.Results CD68 positive macrophages were higher in the rejection group than that in the tolerance group(P<0.05),and macrophages could be divided into 9 subsets.During the rejection reaction,the CXC chemokine ligand 9(CXCL9)in the 8th subsets of macrophages was significantly increased,while the gene for white blood cell differentiation antigen 74(CD74)in the 5th subsets was significantly increased(P<0.05).CD74 ranked first in the differential gene synthesis of macrophages during rejection,followed by CXCL9.Compared with the tolerance group,a large number of CD74 positive macrophages were observed in the hepatic portal area of the rejection group,and the infiltration of CD74 positive macrophages in the hepatic sinuses was also significantly increased(P<0.05),while a large number of CXCL9 positive macrophages were observed in the hepatic portal area and hepatic sinuses of the rejection group,especially in the portal area(P<0.05),and CD14 positive cells were significantly increased(P<0.05).Conclusions The CD74 positive macrophage subsets and CXCL9 positive macrophage subsets may be key subgroups in promoting liver transplant rejection,improving the mechanism of macrophage action in liver transplant rejection.

Objective:To compare the effect of age and gender on mastication efficiency between healthy volunteers and dysphagic stroke survivors and to document any correlation of mastication efficiency with mandible movements.Methods:Thirty-two stroke survivors with dysphagia and 84 healthy volunteers were asked to chew two-color gum. Their chewing efficiency was indicated by the degree of color mixing after chewing (SDHue). The SDHue value was evaluated using ViewGum software. The healthy volunteers were further divided into an age 20-40 years group, a 41-60 years group and an over-60 group. The SDHue values were compared among the 3 groups. The SDHue values were correlated with clinical mandibule movement scores.Results:Among the healthy volunteers, those older than 60 years had significantly higher SDHue values on average than those between 20 and 40 years. However, no significant gender difference was observed. The dysphagic stroke survivors had, on average, significantly higher SDHue results than the healthy volunteers, and those results were positively correlated with their mandible movement scores.Conclusions:Mastication efficiency tends to be age-related but not gender-related. Among those with post-stroke dysphagia mandible movement is positively correlated with mastication efficiency.

Background::Although existing mycological tests (bronchoalveolar lavage [BAL] galactomannan [GM], serum GM, serum (1,3)-β-D-glucan [BDG], and fungal culture) are widely used for diagnosing invasive pulmonary aspergillosis (IPA) in non-hematological patients with respiratory diseases, their clinical utility in this large population is actually unclear. We aimed to resolve this clinical uncertainty by evaluating the diagnostic accuracy and utility of existing tests and explore the efficacy of novel sputum-based Aspergillus assays. Methods::Existing tests were assessed in a prospective and consecutive cohort of patients with respiratory diseases in West China Hospital between 2016 and 2019 while novel sputum assays (especially sputum GM and Aspergillus-specific lateral-flow device [LFD]) in a case-controlled subcohort. IPA was defined according to the modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Sensitivity and specificity were computed for each test and receiver operating characteristic (ROC) curve analysis was performed. Results::The entire cohort included 3530 admissions (proven/probable IPA = 66, no IPA = 3464) and the subcohort included 127 admissions (proven/probable IPA = 38, no IPA = 89). Sensitivity of BAL GM (≥1.0 optical density index [ODI]: 86% [24/28]) was substantially higher than that of serum GM (≥0.5 ODI: 38% [39/102]) ( χ2 = 19.83, P < 0.001), serum BDG (≥70 pg/mL: 33% [31/95]) ( χ2 = 24.65, P < 0.001), and fungal culture (33% [84/253]) ( χ2 = 29.38, P < 0.001). Specificity varied between BAL GM (≥1.0 ODI: 94% [377/402]), serum GM (≥0.5 ODI: 95% [2130/2248]), BDG (89% [1878/2106]), and culture (98% [4936/5055]). Sputum GM (≥2.0 ODI) had similar sensitivity (84% [32/38]) (Fisher’s exact P = 1.000) to and slightly lower specificity (87% [77/89]) ( χ2 = 5.52, P = 0.019) than BAL GM (≥1.0 ODI). Area under the ROC curve values were comparable between sputum GM (0.883 [0.812-0.953]) and BAL GM (0.901 [0.824-0.977]) ( P = 0.734). Sputum LFD had similar specificity (91% [81/89]) ( χ2 = 0.89, P = 0.345) to and lower sensitivity (63% [24/38]) ( χ2 = 4.14, P = 0.042) than BAL GM (≥1.0 ODI), but significantly higher sensitivity than serum GM (≥0.5 ODI) ( χ2 = 6.95, P = 0.008), BDG ( χ2 = 10.43, P = 0.001), and fungal culture ( χ2 = 12.70, P < 0.001). Conclusions::Serum GM, serum BDG, and fungal culture lack sufficient sensitivity for diagnosing IPA in respiratory patients. Sputum GM and LFD assays hold promise as rapid, sensitive, and non-invasive alternatives to the BAL GM test.

Alkali-salinity exerts severe osmotic, ionic, and high-pH stresses to plants. To under-stand the alkali-salinity responsive mechanisms underlying photosynthetic modulation and reactive oxygen species (ROS) homeostasis, physiological and diverse quantitative proteomics analyses of alkaligrass (Puccinellia tenuiflora) under Na2CO3 stress were conducted. In addition, Western blot,real-time PCR, and transgenic techniques were applied to validate the proteomic results and test the functions of the Na2CO3-responsive proteins. A total of 104 and 102 Na2CO3-responsive proteins were identified in leaves and chloroplasts, respectively. In addition, 84 Na2CO3-responsive phospho-proteins were identified, including 56 new phosphorylation sites in 56 phosphoproteins from chloro-plasts, which are crucial for the regulation of photosynthesis, ion transport, signal transduction, and energy homeostasis. A full-length PtFBA encoding an alkaligrass chloroplastic fructose-bisphosphate aldolase (FBA) was overexpressed in wild-type cells of cyanobacterium Synechocystis sp. Strain PCC 6803, leading to enhanced Na2CO3 tolerance. All these results indicate that thermal dissipation, state transition, cyclic electron transport, photorespiration, repair of pho-tosystem (PS) Ⅱ, PSI activity, and ROS homeostasis were altered in response to Na2CO3 stress, which help to improve our understanding of the Na2CO3-responsive mechanisms in halophytes.