Objective To analyze the impact of the basic medical insurance outpatient mutual aid policy on the utilization of medical services.Methods Data indicators related to the utilization of medical services from a tertiary hospital in Wuhan,Hubei Province,from January 2022 to December 2023 were collected.Interrupted time series analysis was used to examine the changing trends of outpatient visits,hospitalizations,and average cost per outpatient visit before and after the implementation of the outpatient mutual aid policy.The Granger causality test and vector autoregressive model were also used to analyze the association between outpatient and inpatient services.Results The outpatient mutual aid policy significantly increased the number of outpatient visits,hospitalizations,and day surgeries in the sample medical institutions(P＜0.05),but had limited impact on the average cost per outpatient visit and hospitalization.Conclusion Outpatient mutual aid can effectively promote the utilization of outpatient services,but attention needs to be paid to potential moral hazard issues and strengthen the supervision of medical insurance funds.

Next generation sequencing (NGS) technology is playing an increasingly important role in the diagnosis of genetic diseases. Whole exome sequencing (WES), which targets the coding regions of the genome, has been widely used in the diagnosis of genetic diseases for its low cost and high efficiency. However, compared to conventional methods, the Next Generation Sequencing (NGS) process is intricate, and there is variability in the expertise of data analysts and variant interpreters, which may lead to inconsistencies in the outcomes. To ensure the quality of testing and enhance the diagnostic rate of diseases, this consensus has provided recommendations regarding the laboratory setup, operational procedures, data analysis, result interpretation, and quality control for WES, with an aim to standardize its application in the detection of genetic disorders.

Objective:To investigate the risk factors and their predictive efficacy for postoperative premature epiphyseal closure in pediatric patients with distal tibial epiphyseal fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 216 pediatric patients with distal tibial epiphyseal fractures admitted to Zhengzhou Orthopedics Hospital from January 2018 to December 2023, including 136 males and 80 females, aged 2-16 years [11.8(9.8, 13.3)years]. Among them, 112 patients were affected on the left side and 104 on the right. According to the Salter-Harris fracture classification, the fracture was classified as type I in 14 patients, type II in 97, type III in 38, type IV in 64 and type VI in 3. According to the presence of premature epiphyseal closure after surgery, the patients were divided into premature epiphyseal closure group ( n=38) and normal epiphyseal group ( n=178). Age, gender, body mass index (BMI), injury mechanism, side of injury, Salter-Harris classification of fracture, initial displacement distance of the fracture end, medial malleolar involvement by the fracture line surgical fixation method, operation duration, reduction method, and reduction quality were recorded in the two groups. Univariate analysis and binary Logistic regression analysis were used to evaluate and determine the independent risk factors for postoperative premature physeal closure in pediatric patients with distal tibial epiphyseal fracture. The receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) was calculated to evaluate the predictive efficacy of each risk factor for the occurrence of premature physeal closure in pediatric patients with distal tibial epiphyseal fractures. Results:Univariate analysis showed the occurrence of postoperative premature epiphyseal closure of the distal tibia was associated with age, Salter-Harris fracture classification, medial malleolar involvement by the fracture line, surgical fixation method, reduction method, and reduction quality ( P<0.05), while it was not correlated with gender, BMI, injury mechanism, side of injury, initial displacement distance of the fracture end, and operation duration ( P>0.05). Multivariate binary Logistic regression analysis showed that medial malleolar involvement by the fracture line ( OR=0.18, 95% CI 0.04, 0.76, P<0.05) and reduction quality ( OR=43.18,95% CI 10.71, 174.05, P<0.01) were significantly correlated with the occurrence of postoperative premature epiphyseal closure of the distal tibia. The results of ROC curve analysis showed that medial malleolar involvement by the fracture line had limited predictive efficiency (AUC=0.53, 95% CI 0.43, 0.63), reduction quality had moderate predictive efficacy (AUC=0.81, 95% CI 0.72, 0.91), while their combination demonstrated even higher predictive efficacy (AUC=0.83, 95% CI 0.74, 0.91). Conclusions:Medial malleolar involvement by the fracture line and reduction quality are independent risk factors for postoperative premature epiphyseal closure in pediatric patients with distal tibial epiphyseal fractures. Reduction quality demonstrates good predictive efficacy, while medial malleolar involvement by the fracture line shows limited predictive value. The combination of both factors achieves even better predictive performance.

Objective To explore the mechanism by which cancer-associated fibroblasts(CAFs)regulate CD13-high expression neutrophil-like myeloid-derived suppressor cell(CD13hi-nMDSC)migration in pancreatic ductal adenocarcinoma(PDAC),so as to provide potential molecular targets and experimental evidences for immunotherapy in patients.Methods CAFs were isolated and purified from pancreatic cancer tissues of 5 PDAC patients.The phenotype and purity of CAFs were identified by immunofluorescence and flow cytometry.The expression of related factors in CAF was detected by quantitative polymerase chain reaction(qPCR)and enzyme-linked immunosorbent assay(ELISA).CAF conditioned medium and myeloid-derived suppressor cell(MDSC)migration system were constructed by Transwell to observe the migration of MDSCs and to study the specific mechanisms by which the aforementioned cytokines participate in regulating the migration of MDSCs.Results The isolated primary CAFs expressed activation biomarkers fibroblast activation protein(FAP)and α-smooth muscle actin(α-SMA),while the human foreskin fibroblasts(HFFs)of control cells did not express FAP and α-SMA.qPCR results showed that the mRNA expression levels of interleukin 6(IL-6),monocyte chemotactic protein 1(MCP-1),and stromal cell-derived factor 1(SDF-1)in CAFs were higher than those in HFFs(all P＜0.01).The contents of IL-6,MCP-1,and SDF-1 in the CAF culture supernatant were significantly higher than those in the HFF culture supernatant(all P＜0.01),and the secretion content increased with the prolongation of culture time.Compared with HFF conditioned medium and regular medium(RPMI 1640),CAF conditioned medium could recruit more total MDSCs and CD13hi-nMDSCs(all P＜0.01).The addition of SDF-1 recombinant protein alone in the culture system could induce the migration of total MDSCs and CD13hi-nMDSCs,and the addition of SDF-1 neutralizing antibodies or C-X-C motif chemokine receptor 4(CXCR4)blocking antibodies could significantly reduce the migration of CD13hi-nMDSCs induced by CAF conditioned medium(all P＜0.01).Although MCP-1 alone could also induce the migration of total MDSCs and CD13hi-nMDSCs,the number of CD13hi-nMDSCs migrating was significantly less than that of the SDF-1 experimental group.The IL-6 recombinant protein did not induce the migration of total MDSCs or CD13hi-nMDSCs.Conclusion CAFs can mediate the migration of total MDSCs and CD13hi-nMDSCs in PDAC through SDF-1/CXCR4 pathway.

Objective To establish a method for chiral analysis of dextromethorphan and levomethorphan in hair and urine by high performance liquid chromatography-triple quadrupole mass spectrometry.Methods Hair samples were extracted by grinding ultrasound,and urine samples were extracted by acetonitrile.The supernatant were separated using a Astec CHIROBIOTIC? V2 column(25 cm × 4.6 mm,5 μm)with 0.5 ‰ formic acid and 10 mmol/L ammonium acetate-methanol as mobile phases,then analyzed in scheduled-multiple reaction monitoring mode.Results The limits of detection and lower limits of quantitation of dextromethorphan and levomethorphan were 0.001 ng/mg and 0.005 ng/mg in hair samples,while they were 0.050 ng/mL and 0.200 ng/mL in urine samples.In the corresponding concentration range,there were good linearity for chiral isomers with correlation coefficients over 0.999.Besides,the recovery rates,accuracy and precision met analytical requirements,and no significant matrix effect were exhibited.In the actual case samples,dextromethorphan were detected in hair of 12 cases and in the corresponding urine of 3 cases.Conclusion This method is rapid,sensitive and reliable for chiral analysis of dextromethorphan and levomethorphan in hair and urine.

Objective To explore the application value of the deep learning image reconstruction algorithm(ClearInfinity,CI)combined with high tube voltage and low tube current low-dose computed tomography(LDCT)in lung screening.Methods A total of 216 patients underwent lung screening CT plain scan were selected.Patients were randomly divided into conventional-dose group(A group)and low-dose group(B group).Image reconstructed by using the iterative algorithm(ClearView+,CV)in group A,CV-60％,CI-30％,CI-60％,and CI-90％algorithms in group B.CT value,noise,image quality,and edge detail were conducted with both objective and subjective evaluations.Lung nodules were automatically detected by using computer-aided diagnosis software,and radiation doses were recorded.Results Images reconstructed with the CI showed significantly superior signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)than with the CV(P＜0.05).Additionally,there was a significant correlation in lung nodule detection performance between the CI and the CV(P＜0.05).The effective dose(ED)in group B was reduced by approximately 85.80％compared to group A(P＜0.01).Although the SNR and CNR were highest with CI-90％,the subjective image quality was lower than that of CI-60％.CI-60％and CI-90％showed same performance in lung nodule detection using artificial intelligence(AI)software.Conclusion The application of LDCT scanning protocol using the CI algorithm based on deep learning,combined with high tube voltage and low tube current is feasible for lung screening.It is recommended to use CI-60％in clinical diagnosis to improve the safety and diagnostic confidence of lung CT screening.

Objective To establish a method for chiral analysis of dextromethorphan and levomethorphan in hair and urine by high performance liquid chromatography-triple quadrupole mass spectrometry.Methods Hair samples were extracted by grinding ultrasound,and urine samples were extracted by acetonitrile.The supernatant were separated using a Astec CHIROBIOTIC? V2 column(25 cm × 4.6 mm,5 μm)with 0.5 ‰ formic acid and 10 mmol/L ammonium acetate-methanol as mobile phases,then analyzed in scheduled-multiple reaction monitoring mode.Results The limits of detection and lower limits of quantitation of dextromethorphan and levomethorphan were 0.001 ng/mg and 0.005 ng/mg in hair samples,while they were 0.050 ng/mL and 0.200 ng/mL in urine samples.In the corresponding concentration range,there were good linearity for chiral isomers with correlation coefficients over 0.999.Besides,the recovery rates,accuracy and precision met analytical requirements,and no significant matrix effect were exhibited.In the actual case samples,dextromethorphan were detected in hair of 12 cases and in the corresponding urine of 3 cases.Conclusion This method is rapid,sensitive and reliable for chiral analysis of dextromethorphan and levomethorphan in hair and urine.

Objective To analyze the impact of the basic medical insurance outpatient mutual aid policy on the utilization of medical services.Methods Data indicators related to the utilization of medical services from a tertiary hospital in Wuhan,Hubei Province,from January 2022 to December 2023 were collected.Interrupted time series analysis was used to examine the changing trends of outpatient visits,hospitalizations,and average cost per outpatient visit before and after the implementation of the outpatient mutual aid policy.The Granger causality test and vector autoregressive model were also used to analyze the association between outpatient and inpatient services.Results The outpatient mutual aid policy significantly increased the number of outpatient visits,hospitalizations,and day surgeries in the sample medical institutions(P＜0.05),but had limited impact on the average cost per outpatient visit and hospitalization.Conclusion Outpatient mutual aid can effectively promote the utilization of outpatient services,but attention needs to be paid to potential moral hazard issues and strengthen the supervision of medical insurance funds.

Objective To explore the application value of the deep learning image reconstruction algorithm(ClearInfinity,CI)combined with high tube voltage and low tube current low-dose computed tomography(LDCT)in lung screening.Methods A total of 216 patients underwent lung screening CT plain scan were selected.Patients were randomly divided into conventional-dose group(A group)and low-dose group(B group).Image reconstructed by using the iterative algorithm(ClearView+,CV)in group A,CV-60％,CI-30％,CI-60％,and CI-90％algorithms in group B.CT value,noise,image quality,and edge detail were conducted with both objective and subjective evaluations.Lung nodules were automatically detected by using computer-aided diagnosis software,and radiation doses were recorded.Results Images reconstructed with the CI showed significantly superior signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)than with the CV(P＜0.05).Additionally,there was a significant correlation in lung nodule detection performance between the CI and the CV(P＜0.05).The effective dose(ED)in group B was reduced by approximately 85.80％compared to group A(P＜0.01).Although the SNR and CNR were highest with CI-90％,the subjective image quality was lower than that of CI-60％.CI-60％and CI-90％showed same performance in lung nodule detection using artificial intelligence(AI)software.Conclusion The application of LDCT scanning protocol using the CI algorithm based on deep learning,combined with high tube voltage and low tube current is feasible for lung screening.It is recommended to use CI-60％in clinical diagnosis to improve the safety and diagnostic confidence of lung CT screening.