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.

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.

Objective To explore the diagnostic performance of prostate imaging reporting and data system(PI-RADS)V2.1 score combined with prostate specific antigen(PSA)-related parameters in transition zone prostate cancer(PCa)in patients with PSA levels of 4-20 ng/mL.Methods The clinical data of 129 patients who underwent prostate biopsy were retrospectively analyzed,including age,total prostate specific antigen(tPSA),free prostate specific antigen(fPSA),f/t PSA,prostate volume(PV),and prostate specific antigen density(PSAD).Among 129 patients,52 were diagnosed with transition zone PCa and 77 with benign prostate hyperplasia.The MRI images of all patients were scored according to the PI-RADS V2.1 criteria.The clinical and imaging parameters between transition zone PCa and benign prostate hyperplasia were compared using univariate logistic regression analysis.Independent predic-tors were identified via multivariate logistic regression,and a combined predictive model was constructed.Diagnostic performance of the model was evaluated using the receiver operating characteristic(ROC)curves.Results Univariate logistic regression analysis showed that the transition zone PCa exhibited significantly higher PI-RADS V2.1 score,tPSA,and PSAD than the benign prostate hyperplasia(P＜0.05).Multivariate logistic regression analysis identified PI-RADS V2.1 score and PSAD were independent predictors for predicting transition zone PCa(P＜0.05).Optimal diagnostic thresholds were PI-RADS V2.1 score＞3 points and PSAD＞0.23 ng/mL2.The combined prediction model achieved an area under the curve(AUC)of 0.863,outperforming PI-RADS V2.1 score(AUC=0.821)and PSAD(AUC=0.779)alone(P＜0.05).Conclusion The combination of PI-RADS V2.1 score and PSAD has a high predictive value for transition zone PCa in patients with PSA levels of 4-20 ng/mL.Thresholds of PI-RADS V2.1 score＞3 points and PSAD＞0.23 ng/mLL2 significantly improve diagnostic accuracy.

Objective:To investigate the eosinophil-to-platelet ratio (EPR) in predicting the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Based on the prognosis within 3 months after discharge, 158 patients with AECOPD admitted to Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from February 2020 to February 2024 were divided into a good prognosis group and a poor prognosis group. General data, eosinophil count, platelet count, eosinophil-to-platelet ratio (EPR), procalcitonin (PCT) level, and neutrophil-to-lymphocyte ratio (NLR), were retrospectively collected from both groups. The factors influencing prognosis within 3 months after discharge were analyzed using a multivariate logistic regression model. The predictive value of these factors for poor prognosis was assessed through receiver operating characteristic curve analysis.Results:Among the 158 patients with AECOPD, 23 had a poor prognosis, 127 had a good prognosis, and 8 were lost to follow-up or died unexpectedly. The eosinophil count and EPR in the peripheral blood of patients with a poor prognosis were significantly lower than those in patients with a good prognosis ( t = 3.22, 4.11, both P < 0.05). The eosinophil count [ OR = 5.709, 95% CI: (2.653, 12.285)] and EPR [ OR = 19.747, 95% CI: (8.352, 46.686)] were independent risk factors for a poor prognosis in patients with AECOPD at 3 months after discharge (both P < 0.05). The results of the receiver operating characteristic curve analysis indicated that the area under the curve for eosinophil count and EPR in predicting a poor prognosis in patients with AECOPD at 3 months after discharge was 0.706 [95% CI: (0.596, 0.815)] and 0.730 [95% CI: (0.630, 0.829)], respectively. The cut-off values were 109.20 counts/μL for eosinophil count and 1.06 for EPR, with corresponding sensitivities and specificities of 43.48% and 88.19%, and 82.61% and 59.06%, respectively. Conclusions:EOS and EPR have good predictive value for the adverse prognosis of patients with AECOPD within 3 months after discharge, and EPR has better efficacy.

Objective To explore the effectiveness of the peripheral arterial calcification scoring system(PACSS)based on computed tomography angiography(CTA)in assessing renal function in patients with peripheral arterial disease(PAD).Methods The clinical data,CTA imaging data,and laboratory results from PAD patients who underwent lower limb artery CTA examination were retrospectively collected.The PACSS was utilized to score the calcification in both lower limb arteries.Participants were categorized into three groups based on their estimated glomerular filtration rate(eGFR)(normal group:eGFR≥90 mL/min;mild renal dysfunction group:eGFR 60-89 mL/min,and moderate to severe renal dysfunction group:eGFR＜60 mL/min).The demographic data,clinical symptoms,and comorbidities among the three groups were compared by analysis of variance(ANOVA).The Spearman correlation coefficient was employed to evaluate the relationship between eGFR,cystatin C,and PACSS score.Results The age(P＜0.001)and PACSS score(P＜0.05)of patients with renal dysfunction were significantly higher than those of patients with normal renal function.However,there were no significant differences in gender,prevalence of diabetes,hypertension,or severe limb ischemia.Spearman correlation analysis showed that eGFR was negatively correlated with PACSS score(r=-0.18 in the right lower limb,P=0.037,r=-0.24 in the left lower limb,P=0.006).In contrast,cystatin C was positively correlated with PACSS score(r=0.26 in the right lower limb,P＜0.001,r=0.22 in the left lower limb,P=0.002).Conclusion The PACSS score of lower limb artery in PAD patients is corre-lated with the severity of renal dysfunction.This finding may facilitate early warning and clinical intervention for PAD patients with renal dysfunction.

Objective To explore the clinical value of energy-spectrum CT single-energy imaging in enhancing the image quality and stent display of stent placement CT angiography(CTA)in lower extremity atherosclerotic occlusive disease.Methods Twenty patients[mean(65.61±9.65)years;male/female,16/4]who underwent stenting for chronic occlusive disease of the lower extremity arteries by lower extremity arterial energetic spectral CTA were retrospectively recruited at our hospital.The original images were reconstructed into seven sets of single energy(40-100 keV),120 kVp,virtual unenhanced images(VUE)and metal artifact reduction(MAR)technique images.Images were debossed and then scaffolded for display with volumetric reconstruction(VR),maximum density projection(MIP)and curve planar reconstruction(CPR),and were objectively and subjectively assessed and compared using one-way analysis of variance(ANOVA).Results The 80 keV and MAR images had the highest scores compared to the other reconstruction group images(P＜0.01).Conclusion 80 keV single-energy imaging and de-metallization artifacts MAR improve the image quality of lower extremity arterial stent lumen and structure display;therefore,they have higher diagnostic value for clinicians.

Objective:To explore the clinical efficacy of three different surgical timings of modified cervical cerclage in twin pregnant women with cervical insufficiency.Methods:The clinical data of 73 twin pregnant women who underwent modified cervical cerclage and had pregnancy outcomes in Qilu Hospital of Shandong University (Qingdao) from April 2014 to July 2023 were retrospectively analyzed. According to the different timings of surgery, they were divided into prophylactic cerclage group, ultrasound-indicated cerclage group (further divided into cervical length (CL)≤15 mm and 15 mm10 mg/L was a risk factor for preterm birth before 34 weeks of gestation ( OR=5.230, 95% CI: 1.616-16.929; P=0.006). Conclusions:In twin pregnant women with cervical insufficiency, prophylactic cerclage has the same surgical effect as ultrasound-indicated cerclage, while both prophylactic cerclage and ultrasound-indicated cerclage could significantly improve maternal and fetal outcomes compared with emergency cerclage. Twin pregnancies with CL≤15 mm might benefit from cervical cerclage. Postoperative CRP>10 mg/L is an independent risk factor for preterm birth before 34 weeks of gestation.

Objective To explore the clinical value of energy-spectrum CT single-energy imaging in enhancing the image quality and stent display of stent placement CT angiography(CTA)in lower extremity atherosclerotic occlusive disease.Methods Twenty patients[mean(65.61±9.65)years;male/female,16/4]who underwent stenting for chronic occlusive disease of the lower extremity arteries by lower extremity arterial energetic spectral CTA were retrospectively recruited at our hospital.The original images were reconstructed into seven sets of single energy(40-100 keV),120 kVp,virtual unenhanced images(VUE)and metal artifact reduction(MAR)technique images.Images were debossed and then scaffolded for display with volumetric reconstruction(VR),maximum density projection(MIP)and curve planar reconstruction(CPR),and were objectively and subjectively assessed and compared using one-way analysis of variance(ANOVA).Results The 80 keV and MAR images had the highest scores compared to the other reconstruction group images(P＜0.01).Conclusion 80 keV single-energy imaging and de-metallization artifacts MAR improve the image quality of lower extremity arterial stent lumen and structure display;therefore,they have higher diagnostic value for clinicians.

Objective:To explore how benzydamine (BA) improves brain edema in mice after cerebral ischemia-reperfusion.Methods:(1) One hundred and twenty 8 week-old male C57BL/6 mice were randomly divided into a sham-operated group, a middle cerebral artery occlusion (MCAO) group, a MCAO+low-dose BA group (L-BA group), and a MCAO+high-dose BA group (H-BA group), with 30 mice in each group. MCAO models in mice of the later 3 groups were established by suture method, while mice in the sham-operated group underwent the same surgical procedure without MCAO. At 6 hours after modeling, mice in the L-BA group and H-BA group were intraperitoneally injected with 5 mg/kg or 10 mg/kg BA, respectively, once daily for 3 days, while mice in the shamoperated group and MCAO group were intraperitoneally injected with same volume of normal saline instead. Dynamics of cerebral perfusion were monitored by laser speckle imaging in MCAO model mice at baseline, during occlusion, and following reperfusion. Three days after modeling, neurological deficits were assessed by modified neurological severity score (mNSS), neurological function was evaluated by forelimb grip strength and rotarod tests; cerebral infarct size was detected by 2,3,5-triphenyltetrazolium chloride (TTC) staining, and neuronal death was assessed by Fluoro-Jade B staining; cerebral edema was quantified by dry-wet weight method, blood-brain barrier (BBB) permeability was assessed by Evans blue dye extravasation, and expressions of tight junction proteins (Claudin-5, zonula occludens-1 [ZO-1]) were detected by immunofluorescent staining; expressions of neutrophil extracellular traps (NETs)-related proteins (citrullinated histone H3 [citH3], myeloperoxidase [MPO] and matrix metalloproteinase 9 [MMP-9]) were determined by Western blotting. (2) Bone marrow neutrophils were extracted from male C57BL/6 mice and randomly divided into a control group, a phorbol 12-myristate 13-acetate (PMA) group, and a PMA+BA group; neutrophils in the PMA group were stimulated with PMA (50 nmol/L), while neutrophils in the PMA+BA group were co-treated with 50 nmol/L PMA and 50 μmol/L BA; and those in the control group were given an equal amount of dimethyl sulfoxide. Sytox Green staining was used to detect the NETs proportion in neutrophils.Results:(1) Baseline cerebral perfusion was robust (1 237.75±98.16 PU), which was markedly reduced during occlusion (297.36±77.63 PU) in the ipsilateral middle cerebral artery territory, and improved following reperfusion (939.21±73.63 PU). Compared with the MCAO group, mice in the L-BA group and H-BA group had lower mNSS score, increased paw grip strength, prolonged rotarod retention time, reduced infarct size, fewer neuronal death, lower brain tissue water content, reduced blood-brain barrier permeability, increased fluorescent intensities of Claudin-5 (0.51±0.11, 0.71±0.04, and 0.83±0.05) and ZO-1 (0.43±0.09, 0.65±0.05, and 0.81±0.03), and decreased protein expressions of citH3 (2.33±0.15, 1.92±0.03, and 1.42±0.04), MPO (2.14±0.08, 1.71±0.06, and 1.37±0.03) and MMP-9 (2.62±0.09, 1.83±0.06, and 1.41±0.05), with significant differences ( P<0.05). All the above changes in the H-BA group were more significant than those in the L-BA group ( P<0.05). (2) Compared with that in the control group (10.00%±8.00%), the proportion of NETs formation per field in both PMA group (85.33%±2.08%) and PMA+BA group (58.46%±5.29%) was significantly increased ( P<0.05); the PMA+BA group showed a significant reduction in NETs formation compared with the PMA group ( P<0.05). Conclusion:BA can alleviate cerebral edema in mice after cerebral ischemia-reperfusion, and its mechanism may be involved in inhibiting NETs formation.

Objective:To investigate the effect of nefazodone on excessive activation of microglia and its regulatory mechanism, as well as its effect on neurological injury in mice subjected to middle cerebral artery occlusion (MCAO).Methods:(1) BV2 cell line was routinely cultured in vitro, and primary microglia from the cortex of neonatal C57BL/6J mice were cultured. Cell counting kit-8 (CCK-8) assay was employed to assess the effects of nefazodone (0, 10, 20, 30, 50 μmol/L) on viability of BV2 cells and primary microglia to determine the working concentration. BV2 cells and primary microglia were divided into a normal control group, a lipopolysaccharide (LPS) group, and a nefazodone group; cells in the nefazodone group were pretreated with 20 μmol/L nefazodone for 2 h; cells in the LPS group and nefazodone group were stimulated with LPS (0.5 μg/mL for BV2 cells and 0.1 μg/mL for primary microglia) for 24 h; cells in the normal control group received an equivalent volume of solvent. Immunofluorescent staining was used to detect the expressions of ionized calcium-binding adapter molecule 1 (Iba1) and CD68. Reverse transcription quantitative PCR (RT-qPCR) was performed to measure interleukin ( IL) -1β, IL-6, tumor necrosis factor-α ( TNF-α), nitric oxide synthase 2 ( Nos2), C-C motif chemokine ligand 2 ( CCL2), and β-hexosaminidase subunit β ( Hexb) mRNA expressions. ELISA was used to quantify the concentrations of supernatant IL-1β, IL-6, and TNF-α in BV2 cells. Western blotting was applied to detect the protein expressions of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in BV2 cells. Griess reagent assay was used to measure supernatant nitric oxide (NO) level in BV2 cells. Western blotting was also used to assess the protein expressions of extracellular signal-regulated kinase (ERK), phosphorylated (p)-ERK, c-Jun N-terminal kinase (JNK), p-JNK, p38, p-p38, nuclear factor kappa B p65 and p-p65 in BV2 cells. (2) Thirty male C57BL/6J mice were randomly divided into a normal control group, a MCAO group, and a nefazodone group, with 10 mice in each group. MCAO model in the MCAO group and nefazodone group was established using suture method; the nefazodone group received an intraperitoneal injection of nefazodone (15 mg/kg) 30 min after modeling, while the normal control group received an equivalent volume of solvent. Three days after modeling, neurological deficits were evaluated using modified neurological severity score (mNSS), and behavioral changes were evaluated by paw grip strength test and foot-fault test. Cerebral infarction volume was assessed by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Iba1 protein expression in the ischemic penumbra was detected by Western blotting. Results:(1) CCK-8 assay showed no significant difference in viability of BV2 cells between the normal control group and 10 or 20 μmol/L nefazodone groups ( P>0.05), and viability of BV2 cells in 30 and 50 μmol/L nefazodone groups was statistically lower than that of normal control group ( P<0.05). Immunofluorescent staining revealed that compared with the normal control group, the LPS group had significantly increased fluorescent intensities of CD68 and Iba1; compared with the LPS group, the nefazodone group had significantly decreased fluorescent intensities of CD68 and Iba1 ( P<0.05). RT-qPCR results indicated that compared with those in the normal control group, the Nos2, CCL2, IL-1β, IL-6, and TNF-α mRNA expressions in both BV2 cells and primary microglia of the LPS group were significantly increased; compared with the LPS group, the nefazodone group had significantly decreased CCL2, IL-1β, and IL-6 mRNA expressions in BV2 cells, and significantly decreased Nos2, CCL2, IL-1β, IL-6, and TNF-α mRNA expressions in primary microglia ( P<0.05). ELISA showed that compared with those in the normal control group, the supernatant IL-1β, IL-6, and TNF-α levels significantly increased in the BV2 cells of LPS group; compared with those in the LPS group, supernatant IL-1β, IL-6 and TNF-α levels statistically decreased in the nefazodone group ( P< 0.05). Western blotting demonstrated that compared with those in the normal control group, the iNOS and COX-2 protein expressions significantly increased in BV2 cells of the LPS group ( P<0.05); compared with those in the LPS group, the iNOS and COX-2 protein expressions in BV2 cells of the nefazodone group statistically decreased ( P<0.05). Griess assay showed that compared with the normal control group, BV2 cells in the LPS group had significantly increased supernatant NO concentration ( P <0.05); compared with the LPS group, BV2 cells in the nefazodone group had significantly decreased supernatant NO concentration ( P<0.05). Western blotting revealed that compared with those in the normal control group, the p-ERK/ERK and p-JNK/JNK ratios significantly increased in BV2 cells of the LPS group ( P<0.05); compared with the LPS group, the p-p65/p65, p-ERK/ERK and p-JNK/JNK ratios significantly decreased in BV2 cells of the nefazodone group ( P<0.05). (2) Behavioral tests showed that compared with the normal control group, the MCAO group had significantly decreased forelimb grip strength and increased foot-fault rate ( P<0.05); compared with the MCAO group, the nefazodone group had significantly decreased mNSS score, increased forelimb grip strength and decreased foot-fault rate ( P<0.05). The percentage of cerebral infarction volume in the nefazodone group was significantly lower than that in the MCAO group ([9.56±1.81]% vs. [21.71±12.26]%, P< 0.05). The MCAO group had statistically higher Iba1 protein expression in ischemic penumbra (7.27±2.88) than the normal control group (1.00±0.64), and the nefazodone group had significantly lower Iba1 protein expression in ischemic penumbra (1.75±0.86) than the MCAO group ( P<0.05). Conclusion:Nefazodone can improve neurological function impairment in MCAO mice by inhibiting the excessive activation of microglia; cytological experiments suggest that its mechanism may be related to the negative regulation of ERK/JNK/NF-κB p65 signaling axis.