OBJECTIVE To analyze the impact of the diagnosis-related groups （DRG） payment reform on the length of stay and medical costs in patients with chronic obstructive pulmonary disease （COPD） in Kashgar region， aiming to provide localized empirical evidence for the optimization of regional medical insurance payment methods. METHODS Based on the inpatient settlement database of the Xinjiang Uygur Autonomous Region Healthcare Security Administration， settlement data of COPD inpatients from 17 medical institutions in Kashgar region between January 1， 2022， and December 31， 2024， were extracted. The overall changes in patients’ length of stay and costs were compared before and after the reform. Subsequently， interrupted time series analysis （ITSA） was employed to explore the impact of the DRG payment reform on these variables. RESULTS Following the reform， both the average length of stay and various cost decreased significantly compared to the pre-reform period （ P ＜0.001）. At the overall sample level， the average length of stay， average total cost， average drug cost， average medical service cost， and average examination cost per admission all demonstrated significant long-term downward trends after the reform （ P ＜0.05）. However， the decrease in average out-of-pocket costs and the increase in average consumable costs per admission were not statistically significant （ P ＞0.05）. In tertiary medical institutions， the average length of stay and all categories of costs （except average consumable costs per admission） exhibited significant long-term upward trends after the reform （ P ＜0.05）； conversely， in secondary and lower-level medical institutions， the average length of stay， average total cost， average drug cost， average medical service cost， and average examination cost per admission showed significant long-term downward trends （ P ＜0.05）. CONCLUSIONS The DRG payment reform has achieved an overall effect of reducing the length of stay and controlling costs in COPD patients from Kashgar region. However， the effects vary across different levels of medical institutions： secondary and lower-level institutions show a long-term downward trend in length of stay and costs， whereas tertiary institutions exhibit a long-term upward trend. Furthermore， patients’ out-of-pocket financial burden does not show significant improvement.

ObjectiveTo explore the effects of Wumeiwan on liver metastasis and lung metastasis of colorectal cancer and its potential mechanism. MethodsFirstly， mice were randomized into control， low-dose （20 g·kg^-1） Wumeiwan， high-dose （40 g·kg^-1） Wumeiwan， and paclitaxel （10 mg·kg^-1） groups. Secondly， liver metastasis and lung metastasis models of colorectal cancer were established in mice. After 4 weeks of intervention， the body weight of each mouse was recorded， and the lung weight， liver weight， and survival time of mice with metastatic colorectal cancer were determined. Hematoxylin-eosin （HE） staining was employed to detect the effects of Wumeiwan on liver metastasis and lung metastasis. Real-time PCR was employed to determine the mRNA levels of M1 and M2 macrophage markers in the liver tissue. Finally， the content of M1 macrophage markers CD80 and CD86 in the liver tissue was measured by flow cytometry. ResultsCompared with the control group， Wumeiwan and paclitaxel reduced the body weight （P<0.01） and liver weight （P<0.01） and prolonged the survival of the mouse model of liver metastasis of colorectal cancer （P<0.01）. In the mouse model of lung metastasis of colorectal cancer， Wumeiwan and paclitaxel also reduced the body weight （P<0.01） and lung weight （P<0.01） and extended the survival time （P<0.01）. Histopathological results showed that compared with the control group， Wumeiwan inhibited the liver and lung metastases of colorectal cancer. Real-time PCR results showed that compared with the control group， Wumeiwan upregulated the mRNA levels of M1 macrophage markers IL-1β， IL-6， tumor necrosis factor-α （TNF-α）， inducible nitric oxide synthase （iNOS）， and prostaglandin-endoperoxide synthase 2 （PTGS2） in the liver and lung tissue of mice with liver metastasis and lung metastasis of colorectal cancer （P<0.01）. Meanwhile， Wumeiwan downregulated the mRNA levels of M2 macrophage markers Arg1， CD163， and CD206 （P<0.01）. Meanwhile， the flow cytometry results showed that compared with the control group， Wumeiwan increased the content of CD86 and CD80 （P<0.01）. In addition， immunohistochemical results showed that Wumeiwan promoted the expression of CD86 and inhibited the expression of CD206 in the liver and lung tissue of mice with liver metastasis and lung metastasis. ConclusionWumeiwan can inhibit the liver metastasis and lung metastasis of colorectal cancer by promoting the M1 polarization of macrophages in the liver and lung of the model mice.

OBJECTIVE To investigate the prevalence and influencing factors of potentially inappropriate medication （PIM） among the elderly in nursing homes in Urumqi based on three PIM screening tools， and to compare the applicability of different tools. METHODS A cross-sectional study design was adopted. Elderly individuals from six nursing homes in Urumqi were selected as the research subjects from May 2021 to September 2023. Demographic characteristics， disease burden and medication records of the elderly were collected. PIM screening was performed using the Chinese PIM criteria （2024 edition）， the American Geriatrics Society （AGS） Beers criteria （2023 edition）， and the Screening Tool of Older Person’S Prescriptions（STOPP）/Screening Tool to Alert to Right Treatment（START） （2023 edition）. Fleiss’s Kappa test was used to assess the consistency among the three screening tools， and multivariate Logistic regression was used to analyze the influencing factors of PIM. RESULTS The prevalence of PIM screened by the Chinese PIM criteria was 47.4% （323/682）， by the AGS Beers criteria was 43.4% （296/682）， and by the STOPP criteria was 50.9% （347/682）. The consistency among the three screening tools was low （Fleiss’s Kappa＝0.12， P ＜0.001）. Multivariate Logistic regression analysis showed that all three screening tools indicated that polypharmacy， aspirin use and psychotropic drug use were independent risk factors for PIM among elderly in nursing houses （all OR＞1， P ＜0.05）. CONCLUSIONS The prevalence of PIM among the elderly in nursing homes in Urumqi is relatively high. Polypharmacy， aspirin use and psychotropic drug use are common independent risk factors for PIM. There are differences in screening results among the three tools with low consistency. The Chinese PIM criteria can serve as a first-line tool for PIM screening in nursing homes.

AIM: To investigate the effect and potential mechanism of liraglutide(LIR)combined with neural stem cells(NSCs)in alleviating diabetic retinopathy(DR)in rats.METHODS:A DR rat model was established using a high-fat diet combined with a single intraperitoneal injection of streptozotocin(STZ). Rats in the control group were fed a normal diet and received an intraperitoneal injection of citric acid-sodium citrate buffer. After modeling, the rats were divided into the control group, DR group, DR+LIR group, DR+BMSCs group, DR+NSCs group, DR+BMSCs+LIR group, and DR+NSCs+LIR group. According to the grouping instructions, rats were given intraperitoneal injection of LIR at 200 μg/(kg·d)and intravitreal injection of bone marrow mesenchymal stem cells(BMSCs), or NSCs, or the combined therapy accordingly for 8 wk. Fasting blood glucose(FBG)and serum insulin levels, as well as retinal oxidative stress indexes and serum inflammatory indexes, were detected in each group. Retinopathy was evaluated by hematoxylin-eosin(HE)staining, retinal cell apoptosis was detected by TUNEL staining, SIRT1 expression in retinal tissues was detected by immunohistochemistry, and BDNF expression in retinal tissues was detected by immunofluorescence. The transcriptional levels of cZNF532, miR-29a-3p, SIRT1, TGF-β1, NRF2, Keap1, and BDNF in retinal tissues were detected by qRT-PCR, and the protein expression levels of SIRT1, TGF-β1, SMAD2/3, p-SMAD2/3, NRF2, Keap1, p65, and p-p65 in retinal tissues were detected by Western blot. RESULTS:Compared with the other groups of rats, the retinal morphology of rats in the DR+NSCs+LIR group was significantly improved, the levels of FBG, TNF-α, IL-1β, IL-6 and MDA were decreased(all P<0.05), the serum insulin level and the levels of SOD, CAT, and GSH-Px were increased(all P<0.05), the TUNEL-positive rate of retinal cells was reduced(all P<0.05). The expression levels of cZNF532, SIRT1, NRF2, and BDNF in retinal tissue were up-regulated(all P<0.05), whereas the expression levels of miR-29a-3p, TGF-β1, p-SMAD2/3, Keap1, and p-p65 were down-regulated(all P<0.05). CONCLUSION:LIR combined with NSCs alleviates DR by regulating the cZNF532-miR-29a-3p-SIRT1 network and its downstream TGF-β/SMAD, NF-κB, and Keap1/NRF2 signaling pathways.

OBJECTIVE To investigate the current status and existing problems in pretreatment of digestive endo-scopes in medical institutions of Jiangsu Province so as to optimize the pretreatment procedures.METHODS From Nov.7,2024 to Nov.17 2024,a questionnaire was preliminarily designed based on the current endoscope-related guidelines and standards by the infection control team of digestive endoscopy center of The Affiliated Drum Tower Hospital of Nanjing University Medical School.A cross-sectional survey was conducted for various levels of medi-cal institutions of Jiangsu Province by Wenjuanxing platform.The content of the survey covered basic information of the digestive endoscopy center,implementation status of pretreatment,operation status of pretreatment,quali-ty monitoring and management.RESULTS A total of 122 medical institutions were finally included in the survey,61 of which were tertiary hospitals,35 were secondary hospitals,and 26 were primary hospitals.97.54％of the medical institutions could implement the pretreatment procedures after every endoscopes use,while there was significant difference in the concrete details of pretreatment among the various grades of hospitals.64.75％of the medical institutions used dedicated buttons for pretreatment,however,there was significant difference in the cause for failed change of dedicated buttons among the various grades of medical institutions(x2=14.657,P＜0.001).76.23％of the medical institutions carried out the pretreatment for special sites of the endoscopes(pli-ers' pipelines,auxiliary water rinsing pipelines).Gas and water insufflation were maintained for over 10 seconds(77.87％).The suction duration was judged mainly based on subjective knowledge.The enzyme solution was the major pretreatment solution(94.26％).The changing frequency was dominated by'one use per change'(45.08％).There was significant difference in the time interval between pretreatment and cleaning among the va-rious grades of medical institutions(x2=10.032,P=0.012).57.38％of the medical institutions evaluated the quality of the pretreatment,and visual observation was the major method for quality assessment(53.28％).There was significant difference in the establishment of pretreatment system among the various grades of medical institu-tions(x2=7.033.P=0.030).CONCLUSIONS The pretreatment of the endoscopes is overall performed well in the 122 medical institutions of Jiangsu Province;however,the details of pretreatment procedure,quality monito-ring and management need to be improved.It is suggested that the related departments should accelerate the revi-sion of endoscope pretreatment-related standards so as to standardize professional behavior.

OBJECTIVE This study aims to investigate the epidemiological characteristics and influencing factors of skin diseases among soldiers performing duties and working in tunnel environments,and to propose targeted pre-ventive and therapeutic measures.METHODS A cross-sectional survey was conducted on 537 soldiers from multi-ple sites within a military unit from Nov.2022 to Oct.2023.The survey collected data on general information,liv-ing habits,and details of current skin diseases,including types,symptoms,duration and treatment status.Logis-tic regression analysis was applied to identify risk factors for the skin diseases observed.RESULTS A total of 21 types of skin diseases were identified,with dermatophyte infections being the most prevalent(59.96％,322/537),followed by acne(26.82％,144/537).Further analysis revealed that the incidence of dermatophyte infec-tions was closely associated with the region where the soldiers were stationed[OR(95％CI)=1.694(1.062,2.693),P=0.032]and the frequency of sock washing[OR(95％CI)=1.734(1.023,2.988),P=0.043],but no significant correlation was found between the prevalence of dermatophyte infections and the frequency of washing feet[OR(95％CI)=1.520(0.836,2.824),P=0.175].CONCLUSIONS This study highlights the epidemiological char-acteristics and key risk factors for skin diseases among soldiers in tunnel environments.Targeted prevention strategies are proposed,providing valuable scientific evidence for the prevention and control of skin diseases in similar environments.

Objective:To explore the effects of Baduanjin and brisk walking on the sleep quality among fe-male college students.Methods:Ninety female college students with poor sleep quality[Pittsburgh Sleep Quality Index(PSQI)≥ 8]were recruited randomly assigned to Baduanjin,brisk walking,and control groups,with 30 par-ticipants in each.The Baduanjin and brisk walking groups participated in 10-week intervention(five 45-minute ses-sions per week),while the control group did not receive any intervention.Baseline and post-intervention assessments were conducted using the PSQI,a lung capacity test,echocardiography,and the Fatigue Scale(FS-14).Results:Af-ter 10 weeks,participants in both the Baduanjin and brisk walking groups got significantly lower PSQI and FS-14 total scores compared to baseline(Ps＜0.001).Cardiopulmonary function indicators,including stroke volume(SV),forced expiratory volume in one second(FEV1.0),the vital capacity-to-body mass index(VC/W),and maximum voluntary ventilation per minute(MVV),also significantly improved(Ps＜0.001).Furthermore,the Baduanjin group had significantly lower PSQI and FS-14 scores than both the brisk walking and control groups(P＜0.001),along with superior improvements in cardiopulmonary function(P＜0.001).Conclusion:This study in-dicates that Baduanjin is particularly effective in improving sleep quality,cardiopulmonary function,and reducing fatigue among female college students,showing advantages over brisk walking.

Objective To explore the associations among smoking behavior,cognitive function,and personality traits in first-episode male patients with schizophrenia,thereby providing theoretical underpinnings for individualized treatment strategies in clinical settings.Methods A total of 140 first-episode male inpatients with schizophrenia admitted to the hospital from January 2022 to December 2023 were recruited.According to their smoking behavior,they were categorized into a smoking group(n=80)and a non-smoking group(n=60).Moreover,healthy controls were recruited and classified into a healthy smoking group(n=62)and a healthy non-smoking group(n=67)based on their smoking status.The Positive and Negative Syndrome Scale(PANSS)was employed to evaluate psychiatric symptoms in the schizophrenia groups.Nicotine dependence was measured using the Fagerstr?m Test for Nicotine Dependence(FTND)in the two smoking groups.Cognitive function and personality traits were assessed in all participants using the Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)and the Eysenck Personality Questionnaire(EPQ),respectively.Results Regarding cognitive function,the smoking group among schizophrenia patients demonstrated significantly higher scores than the non-smoking group in immediate memory,attention,and delayed memory(all P<0.05).Among schizophrenia patients,FTND scores were moderately negatively correlated with attention and delayed memory(r=-0.552 and-0.657 respectively;both P<0.001).Concerning personality traits,smokers had significantly higher scores in neuroticism and psychoticism compared to non-smokers(both P<0.001).Both patient groups had significantly lower lie scale scores when contrasted with healthy controls(P<0.01),while the healthy smoking group showed significantly higher extraversion scores than the other groups.Conclusions The smoking behavior of male patients during their first episode of schizophrenia exhibits specific characteristics in relation to cognitive performance and personality traits.Smokers demonstrate relatively superior performance in cognitive domains including attention,immediate memory,and delayed memory.However,higher degrees of nicotine dependence are associated with poorer cognitive function,especially in the aspects of attention and delayed memory.Regarding personality,smoking patients display elevated levels of neuroticism and psychoticism.These findings indicate that smoking behavior may be closely associated with cognitive functioning and personality traits,thus meriting clinical attention in the management of schizophrenia.

Objective:To explore the protective effects and mechanisms of an indole-3-acetaldehyde (I3A)-loaded inulin-based hydrogel against radiation-induced intestinal injury.Methods:The gelation properties and injectability of the I3A-loaded inulin-based hydrogel were detected using a rheometer, and its biocompatibility was assessed via a CCK-8 assay. Eighteen C57BL/6 mice (aged: 6-8 weeks) were stratified by body weight and randomly assigned into three groups with 6 mice in each group: blank control, irradiation-only, and irradiation+ hydrogel protection. Abdominal irradiation was administered using 137Cs γ-rays at 17 Gy. The irradiation+ hydrogel protection group received 200 μl/day of I3A-loaded inulin-based hydrogel for two days before and 2-3 days after irradiation. Meanwhile, the irradiation-only group was treated with an equivalent volume of sterile water via gavage. The mice were euthanized four days post-irradiation, and their intestinal tissues were harvested. Hematoxylin-eosin (HE) staining, Ki67 immunohistochemistry, and TUNEL immunofluorescence were performed to assess histopathological damage, epithelial cell proliferation, and apoptosis, respectively. Quantitative real-time PCR (qRT-PCR) was employed to measure mRNA levels of inflammatory and antioxidant factors. Gut microbiota composition was analyzed via 16S rRNA sequencing. Results:The test results of the rheometer confirmed successful hydrogel formation. CCK-8 assays demonstrated excellent biocompatibility. Compared with the irradiation-only group, the irradiation+ hydrogel protection group exhibited preserved intestinal histoarchitecture, a 1.5-fold increase in intestinal cell proliferation ( t = 8.35, P < 0.05), and a 2-fold reduction in radiation-induced apoptosis ( t = 7.94, P < 0.05). Moreover, the hydrogel group showed significantly elevated expression of the anti-inflammatory cytokine IL-10 and antioxidant factors NRF-2 and HO-1 ( t = 3.16, 24.83, 5.92, P < 0.05), alongside reduced levels of pro-inflammatory cytokines IL-1β, IL-6, and TNF-α ( t = 5.15, 3.82, 3.83, P < 0.05). Gut microbiota analysis revealed significant modulation in microbial composition and abundance in the hydrogel group. Conclusions:The I3A-loaded inulin-based hydrogel can significantly promote intestinal cell proliferation, reduce radiation-induced apoptosis, and enhance both anti-inflammatory and antioxidant responses. In addition, it regulates gut microbiota composition and abundance, protecting against radiation-induced intestinal injury.

OBJECTIVE To investigate the current status and existing problems in pretreatment of digestive endo-scopes in medical institutions of Jiangsu Province so as to optimize the pretreatment procedures.METHODS From Nov.7,2024 to Nov.17 2024,a questionnaire was preliminarily designed based on the current endoscope-related guidelines and standards by the infection control team of digestive endoscopy center of The Affiliated Drum Tower Hospital of Nanjing University Medical School.A cross-sectional survey was conducted for various levels of medi-cal institutions of Jiangsu Province by Wenjuanxing platform.The content of the survey covered basic information of the digestive endoscopy center,implementation status of pretreatment,operation status of pretreatment,quali-ty monitoring and management.RESULTS A total of 122 medical institutions were finally included in the survey,61 of which were tertiary hospitals,35 were secondary hospitals,and 26 were primary hospitals.97.54％of the medical institutions could implement the pretreatment procedures after every endoscopes use,while there was significant difference in the concrete details of pretreatment among the various grades of hospitals.64.75％of the medical institutions used dedicated buttons for pretreatment,however,there was significant difference in the cause for failed change of dedicated buttons among the various grades of medical institutions(x2=14.657,P＜0.001).76.23％of the medical institutions carried out the pretreatment for special sites of the endoscopes(pli-ers' pipelines,auxiliary water rinsing pipelines).Gas and water insufflation were maintained for over 10 seconds(77.87％).The suction duration was judged mainly based on subjective knowledge.The enzyme solution was the major pretreatment solution(94.26％).The changing frequency was dominated by'one use per change'(45.08％).There was significant difference in the time interval between pretreatment and cleaning among the va-rious grades of medical institutions(x2=10.032,P=0.012).57.38％of the medical institutions evaluated the quality of the pretreatment,and visual observation was the major method for quality assessment(53.28％).There was significant difference in the establishment of pretreatment system among the various grades of medical institu-tions(x2=7.033.P=0.030).CONCLUSIONS The pretreatment of the endoscopes is overall performed well in the 122 medical institutions of Jiangsu Province;however,the details of pretreatment procedure,quality monito-ring and management need to be improved.It is suggested that the related departments should accelerate the revi-sion of endoscope pretreatment-related standards so as to standardize professional behavior.