ObjectiveTo analyze the policy texts regarding the inclusion of 44 assisted reproductive medical service projects into basic medical insurance in China and to provide recommendations for the formulation and improvement of subsequent policies. MethodsMethods such as textual analysis， qualitative research， and descriptive statistics were employed. Based on the theory of policy instruments， a two-dimensional analytical framework integrating policy instruments with policy objectives was constructed to systematically examine the current status and existing issues in the inclusion of assisted reproductive medical service projects in basic medical insurance. ResultsDemand-based and environment-based policy instruments were more frequently utilized， accounting for 42.11% and 37.89%， respectively. Supply-based policy instruments accounted for only 20.00%， indicating limited use. In terms of policy objectives， standardized service management constituted the largest proportion （27.65%）， whereas integrating service resources accounted for the smallest share （10.00%）， showing an imbalanced and insufficient utilization of policy instruments. ConclusionTo better advance and implement the inclusion of assisted reproductive medical service projects in basic medical insurance and foster the construction of a fertility-friendly society， it is essential to strengthen the use of supply-based policy instruments， promote internal structural balance， expand the medical insurance catalog of assisted reproductive technologies， increase reimbursement rates， intensify publicity efforts， formulate scientific planning， establish rigorous qualification evaluations， enhance the synergy of policy instruments， and optimize the structure of policy instruments.

Objectives:To investigate the physical growth status of pediatric patients with transfusion-dependent thalassemia (TDT) and analyze the effects of treatment-related and socioeconomic factors on physical growth.Methods:Based on the specialized thalassemia database from gene therapy clinical research at the Institute of Hematology & Hospital of Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, we collected data on height and weight development, family economic status, and medical records of 338 pediatric patients with TDT from October 2023 to May 2024. The length/height-for-age and body mass index (BMI) -for-age were classified based on the Growth Standard for Children under 7 Years of Age, Standard for Height Level Classification among Children and Adolescents Aged 7-18 Years, and Dietary Guidelines for Chinese Residents. Logistic regression analysis was conducted to assess the effects of family economic status and disease-related treatment on length/height-for-age and BMI-for-age.Results:Among the 338 patients, 118 were children and 220 were adolescents (192 males and 146 females), with a median age of 12 years (range: 0.8-18) and a median diagnosis duration of 10.3 years (range: 0.5-17.9). Subtypes included α-thalassemia [21 cases (6.2%) ], β-thalassemia [288 cases (85.2%) ], and combined αβ-thalassemia[29 cases (8.6%) ]. The monthly household income of patients was concentrated in 3 000-5 000 yuan (39.9%) and 5 001-10 000 yuan (34.9%), whereas 67.2% of the families had monthly medical expenses of <3 000 yuan. Of the patients, 75.5% received their first transfusion before 1 year of age. The proportions of children and adolescents with pretransfusion hemoglobin (HGB) of ≤70 g/L were 4.2% and 6.4%, respectively. Adolescents demonstrated significantly higher rates of transfusion frequency of <4 weeks/session, monthly red blood cell infusion of >2 U, serum ferritin (SF) of ≥5 000 μg/L, iron chelation therapy, and splenectomy compared with children (all P<0.05). Of the 338 patients, 26.0%, 22.8%, and 8.9% demonstrated stunted growth, underweight, and concurrent stunted growth with underweight, respectively. No significant difference was observed in the stunted growth rates between children (22.9%) and adolescents (27.7%) ( P=0.402). However, the underweight rate in adolescents (26.8%) was significantly higher than that in children (15.3%) ( P=0.023). The multivariate analysis determined the following risk factors for stunted growth: monthly household income of <10 000 yuan (5 001-10 000 yuan: OR=5.49, 95% CI: 1.48-35.76; 3 000-5 000 yuan: OR=6.87, 95% CI: 1.88-44.60; <3 000 yuan: OR=9.29, 95% CI: 2.20-64.77), pretransfusion HGB of ≤70 g/L ( OR=3.25, 95% CI: 1.07-10.18), and SF of ≥5 000 μg/L ( OR = 3.04, 95% CI: 1.20-7.70). Longer diagnostic duration was associated with underweight ( OR=1.10, 95% CI: 1.01-1.20) . Conclusions:Children and adolescents with TDT with pretransfusion SF of ≥5 000 μg/L, HGB of ≤70 g/L, low monthly household income, or longer diagnosis duration were significantly more likely to experience delayed physical growth.

Objective To analyze the influencing factors of substandard steady state blood trough concentration of meropenem in the first monitoring.Methods Patients who were treated with meropenem and monitored steady-state blood trough concentration from July 2021 to June 2023 in the First Affiliated Hospital of Xi'an Jiaotong University were selected as the study subjects,and the patient's age,gender,and other medical history data were recorded.The steady-state blood trough concentration of meropenem was determined and the target was identified.According to the monitoring results,the patients were categorized into the standard group(2.0-16.0 mg·L-1)and non-standard group(＜2.0 mg·L-1 in the low concentration group and＞16.0 mg·L-1 in the high concentration group).Univariate and multivariate logistic regression analyses of relevant variables were performed for the low and high concentration groups,respectively,compared with the standard group to screen for risk factors for substandard steady-state trough concentration of meropenem.Results A total of 324 patients were included,there were 189 cases(58.33％)were reached the standard concentration,while 135 cases(41.67％)were failed to meet the standard(86 cases in low concentration group and 49 cases in high concentration group).The results of multivariate logistic regression analysis showed that glomerular filtration rate(P＜0.05),abumin(P＜0.05)and craniocerebral diseases(P＜0.05)were risk factors in the low concentration group compared with the standard group,the glomerular filtration rate of patients with brain injury was significantly higher than patients without brain injury;cystatin-C(P＜0.05)was a protective factor for the concentration of meropenem in both groups.The daily dose of meropenem(P＜0.05)and procalcitonin(P＜0.05)were risk factors for high meropenem blood concentrations in the high-concentration group compared with the standard group,whereas glomerular filtration rate(P＜0.05)was ta protective factor for the concentration of meropenem in the two groups.Conclusion Glomerular filtration rate,albumin and brain injury were risk factors for low steady-state blood trough concentrations of meropenem,whereas daily dose of meropenem and procalcitonin of meropenem were risk factors of high steady-state blood trough concentrations of meropenem.

Cardiac surgery patients often present with multiple comorbidities,the risk of periop-erative complications and the complexity of postoperative rehabilitation have significantly increased,posing higher demands on comprehensive perioperative management.Preoperative exercise pre-reha-bilitation,as a multidisciplinary collaborative intervention strategy,has been demonstrated to signifi-cantly improve the clinical prognosis of patients undergoing elective cardiac surgery by enhancing their cardiopulmonary function,muscle strength,and overall physiological functional reserve,thereby in-creasing the body's tolerance to surgical stress.Although phase-specific research achievements have been made domestically and internationally in the field of exercise pre-rehabilitation,its standardized implementation and clinical translation on a global scale still face numerous obstacles,necessitating systematic review and in-depth exploration.Therefore,this study aimed to conduct a systematic re-view of the intervention protocols,clinical efficacy,safety,and feasibility of preoperative exercise pre-rehabilitation in patients undergoing elective cardiac surgery,with the goal of providing theoretical evidence and practical references for optimizing perioperative management pathways and promoting the implementation of enhanced recovery after surgery concepts.

Objectives:To investigate the physical growth status of pediatric patients with transfusion-dependent thalassemia (TDT) and analyze the effects of treatment-related and socioeconomic factors on physical growth.Methods:Based on the specialized thalassemia database from gene therapy clinical research at the Institute of Hematology & Hospital of Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, we collected data on height and weight development, family economic status, and medical records of 338 pediatric patients with TDT from October 2023 to May 2024. The length/height-for-age and body mass index (BMI) -for-age were classified based on the Growth Standard for Children under 7 Years of Age, Standard for Height Level Classification among Children and Adolescents Aged 7-18 Years, and Dietary Guidelines for Chinese Residents. Logistic regression analysis was conducted to assess the effects of family economic status and disease-related treatment on length/height-for-age and BMI-for-age.Results:Among the 338 patients, 118 were children and 220 were adolescents (192 males and 146 females), with a median age of 12 years (range: 0.8-18) and a median diagnosis duration of 10.3 years (range: 0.5-17.9). Subtypes included α-thalassemia [21 cases (6.2%) ], β-thalassemia [288 cases (85.2%) ], and combined αβ-thalassemia[29 cases (8.6%) ]. The monthly household income of patients was concentrated in 3 000-5 000 yuan (39.9%) and 5 001-10 000 yuan (34.9%), whereas 67.2% of the families had monthly medical expenses of <3 000 yuan. Of the patients, 75.5% received their first transfusion before 1 year of age. The proportions of children and adolescents with pretransfusion hemoglobin (HGB) of ≤70 g/L were 4.2% and 6.4%, respectively. Adolescents demonstrated significantly higher rates of transfusion frequency of <4 weeks/session, monthly red blood cell infusion of >2 U, serum ferritin (SF) of ≥5 000 μg/L, iron chelation therapy, and splenectomy compared with children (all P<0.05). Of the 338 patients, 26.0%, 22.8%, and 8.9% demonstrated stunted growth, underweight, and concurrent stunted growth with underweight, respectively. No significant difference was observed in the stunted growth rates between children (22.9%) and adolescents (27.7%) ( P=0.402). However, the underweight rate in adolescents (26.8%) was significantly higher than that in children (15.3%) ( P=0.023). The multivariate analysis determined the following risk factors for stunted growth: monthly household income of <10 000 yuan (5 001-10 000 yuan: OR=5.49, 95% CI: 1.48-35.76; 3 000-5 000 yuan: OR=6.87, 95% CI: 1.88-44.60; <3 000 yuan: OR=9.29, 95% CI: 2.20-64.77), pretransfusion HGB of ≤70 g/L ( OR=3.25, 95% CI: 1.07-10.18), and SF of ≥5 000 μg/L ( OR = 3.04, 95% CI: 1.20-7.70). Longer diagnostic duration was associated with underweight ( OR=1.10, 95% CI: 1.01-1.20) . Conclusions:Children and adolescents with TDT with pretransfusion SF of ≥5 000 μg/L, HGB of ≤70 g/L, low monthly household income, or longer diagnosis duration were significantly more likely to experience delayed physical growth.

Objective To analyze the influencing factors of substandard steady state blood trough concentration of meropenem in the first monitoring.Methods Patients who were treated with meropenem and monitored steady-state blood trough concentration from July 2021 to June 2023 in the First Affiliated Hospital of Xi'an Jiaotong University were selected as the study subjects,and the patient's age,gender,and other medical history data were recorded.The steady-state blood trough concentration of meropenem was determined and the target was identified.According to the monitoring results,the patients were categorized into the standard group(2.0-16.0 mg·L-1)and non-standard group(＜2.0 mg·L-1 in the low concentration group and＞16.0 mg·L-1 in the high concentration group).Univariate and multivariate logistic regression analyses of relevant variables were performed for the low and high concentration groups,respectively,compared with the standard group to screen for risk factors for substandard steady-state trough concentration of meropenem.Results A total of 324 patients were included,there were 189 cases(58.33％)were reached the standard concentration,while 135 cases(41.67％)were failed to meet the standard(86 cases in low concentration group and 49 cases in high concentration group).The results of multivariate logistic regression analysis showed that glomerular filtration rate(P＜0.05),abumin(P＜0.05)and craniocerebral diseases(P＜0.05)were risk factors in the low concentration group compared with the standard group,the glomerular filtration rate of patients with brain injury was significantly higher than patients without brain injury;cystatin-C(P＜0.05)was a protective factor for the concentration of meropenem in both groups.The daily dose of meropenem(P＜0.05)and procalcitonin(P＜0.05)were risk factors for high meropenem blood concentrations in the high-concentration group compared with the standard group,whereas glomerular filtration rate(P＜0.05)was ta protective factor for the concentration of meropenem in the two groups.Conclusion Glomerular filtration rate,albumin and brain injury were risk factors for low steady-state blood trough concentrations of meropenem,whereas daily dose of meropenem and procalcitonin of meropenem were risk factors of high steady-state blood trough concentrations of meropenem.

Objective To explore the optimal ratio of Baitong decoction based on efficacy,clarify its spectrum-effect relationship,and identify its potential quality markers.Methods An ulcerative colitis(UC)model in mice was established using dextran sulfate sodium.The efficacy of Baitong decoction with varying drug ratios was assessed by evaluating the apparent score,pathological score and inflammatory factor changes of UC in each group of experimental animals.The fingerprints of Baitong decoction with different ratios were established by high performance liquid chromatography(HPLC),and the relationship between the content of each substance and its efficacy was analyzed by partial least squares regression to determine the potential quality markers of Baitong decoction.Results Baitong decoction was most effective in relieving ulcerative colitis when the mass ratio of Fuzi,Ganjiang and Congbai was 1∶2∶2.The fingerprinting identified 14 common peaks across 7 ratios,with 9 peaks were found to be associated with the remission of ulcerative colitis by partial least squares regression analysis.Conclusion The optimal ratio of Fuzi,Ganjiang and Congbai for treating UC is 1∶2∶2.The spectrum-effect relationship analysis suggested that the quality markers of Baitong decoction may be the substances represented by peak 2(benzoylaconine),3,5,6,8(mesaconine),9(aconitine),10(hypaconitine),13(10-gingerol)and 14.

Objective:To compare the efficacy of domestic and imported hemostatic clips in preventing delayed post-polypectomy bleeding (DPPB) after endoscopic resection of colorectal polyps ≥ 10 mm.Methods:Clinical data of 789 patients who underwent endoscopic resection of colorectal polyps (polyp diameter ≥10 mm) in Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2019 were collected. The patients were divided into DPPB group ( n=15) and non-DPPB group ( n=774). Univariate and multivariate logistic regression models were used to analyze the influential factors for DPPB. The patients using one type of hemostatic clip were divided into the domestic hemostatic clip group ( n=499) and the imported hemostatic clip group ( n=208). The efficacy of hemostatic clips in preventing DPPB in the two groups was compared. Results:Among the 789 patients undergoing endoscopic resection of colorectal polyps, 1.9% (15/789) suffered from DPPB. Multivariate logistic regression analysis showed that pedunculated polyp was an independent risk factor for DPPB ( OR=6.621, 95% CI: 2.278-19.241, P=0.001), and closure of mucosal defect was an independent protective factor for DPPB ( OR=0.169,95% CI: 0.050-0.570, P=0.004). Regardless of physician experience, there was no significant difference between the domestic and imported hemostatic clip group in preventing DPPB after endoscopic resection of colorectal polyps ≥10 mm [experienced physicians: 1.8% (7/385) VS 0.6% (1/175), χ2=1.314, P=0.445; common physicians: 2.6% (3/114) VS 3.0% (1/33), χ2=0.010, P>0.999]. The domestic hemostatic clip group paid for less medical expenses than the imported hemostatic clip group (experienced physicians: 1 433.51±889.02 yuan VS 3 033.97±1 686.87 yuan, t<0.001 , P<0.001; common physicians: 1 181.58±815.29 yuan VS 3 303.46±1 690.43 yuan, t<0.001 ,P<0.001). Conclusion:Pedunculated polyp is an independent risk factor for DPPB after endoscopic resection of colorectal polyp larger than 10 mm, and clipping can significantly reduce the risk for DPPB. There is no significant difference in the prevention of DPPB between domestic and imported clips, but domestic clips compared with imported clips yield less medical burden, which are suitable for promotion to primary hospitals and major clinical centers.

OBJECTIVES: The interaction between elderly people with disabilities and their caregivers and the improvement of caregiver burden is important for elderly people with disabilities and their caregivers. This study aims to explore the multiple mediating roles of caregiver's caring ability and resilience in depression in the elderly people with disabilities on caregiver burden. METHODS: A total of 246 elderly people with disabilities at home and their family caregivers from 5 regions were investigated by questionnaires, including the General Information Questionnaire, the Patient Health Questionnaire, the Family Caregiver Task Inventory, the Resilience Scale, and the Caregiver Burden Interview. A multiple mediation model was constructed and tested. RESULTS: Univariate analysis showed that the caregiver burden of disabled elderly men is higher than that of women; the lower the level of self-care of disabled elderly individuals, the greater the burden on their caregivers (both P<0.05). Correlation analysis showed that depression of the disabled elderly people was positively correlated with the caregiver burden (P<0.01). Caregiver's caring ability was positively correlated with caregiver's resilience (P<0.01), and both were negatively correlated with caregiver burden (both P<0.01). The multiple mediating effects of caregiver caring capacity and resilience between depression of the disabled elderly people and caregiver burden were significant, with the mediating effects of caregiver caring capacity and resilience accounting for 68.9% and 26.2% of the total effect, respectively. CONCLUSIONS Depression in the elderly people with disabilities can indirectly affect caregiver burden through the caregiver's caring ability and resilience. Families of older people with disabilities need to focus on both the elderly and their caregivers. It is possible to reduce the caregiver burden and improve the physical and mental health of the dyads by empowering the caregiver's caring ability and resilience.
Male ; Humans ; Female ; Aged ; Caregiver Burden ; Disabled Persons ; Caregivers ; Surveys and Questionnaires ; Mental Health

Objective:To observe the effect of astragaloside Ⅳ on lysophosphatidic acid(LPA)- induced neurite retraction of N1E-115 cells and its potential mechanism.Methods:N1E-115 cells were divided into blank group, model group, the low, medium and high dose groups of astragaloside Ⅳ. The blank group and model group was not intervened by astragaloside; while the low, medium and high dose groups were treated with 20,40 and 80 μg/ml astragaloside Ⅳ for 24 h. Each group was cultured with serum-free medium for 12 h. The model group and astragaloside Ⅳ groups were intervened by 40 μmol/L LPA for 10 min. Each group was observed and photographed with the inverted microscope, and the number of neurites in N1E-115 cells was counted by Image J software. The fluorescence expression of recombinant ras homolog gene family member A (RhoA), rho associated coiledcoil protein kinase 2 (ROCK2), phospho-rho associated coiledcoil protein kinase 2 (p-ROCK2) and phospho-myosin light chain 2 (p-MLC2) proteins was detected by immunohistochemistry. Real-time fluorescent quantitative polymerase chain reaction was used to detect the mRNA expression levels of RhoA and ROCK2 ; the protein expression levels of RhoA, ROCK2, p-MLC2 and myosin light chain 2 (MLC2) were detected by Western blotting.Results:Compared with 20 μg/ml astragaloside Ⅳ group, the inhibition rate of neurite retraction in 40 and 80 μg/ml astragalosideⅣ groups increased ( P<0.05). Compared with model group, the average fluorescence intensity of RhoA, p-ROCK2, p-MLC2 in 20, 40, 80 μg/ml astragaloside Ⅳ groups and the ROCK2 average fluorescence intensity in 40 μg/ml astragaloside Ⅳ group were decreased ( P<0.05, P<0.01); the expression of RhoA mRNA (0.89±0.09, 0.41±0.01, 0.09±0.03 vs. 1.50±0.01) and ROCK2 mRNA (0.89±0.09, 0.14±0.01, 0.20±0.01 vs. 1.62±0.17) decreased in 20, 40, 80 μg/ml astragaloside Ⅳ groups ( P<0.05, P<0.01); the ROCK2 protein (0.75±0.06, 0.57±0.02, 0.66±0.01 vs. 1.08±0.02), p-MLC2 protein (1.72±0.03, 1.40±0.04, 1.29±0.03 vs. 2.19±0.11), MLC2 protein (1.13±0.02, 0.68±0.03, 0.75±0.03 vs. 1.60±0.03) in 20, 40, 80 μg/ml astragaloside Ⅳ groups and the RhoA protein (0.35±0.01, 0.40±0.03 vs. 0.57±0.08) in 20, 40 μg/ml astragaloside Ⅳ groups were decreased ( P<0.05, P<0.01). Conclusion:Astragaloside Ⅳ can prevent LPA-induced neurite retraction and promote damaged nerve regeneration. The mechanism may down-regulae the protein expression levels of RhoA, ROCK2, p-ROCK2, p-MLC2 and MLC2 in RhoA-ROCK2 signaling pathway, and inhibite nerve growth cone collapse.