Purpose To investigate the expression of POLR2M in colorectal cancer(CRC)and its effects on cell growth,apoptosis and invasion.Methods GEPIA2.0,TCGA and Kaplan-Meier Plotter databases were used to ana-lyze the differential expression of POLR2M in CRC tissues and normal adjacent tissues,and to evaluate its prognostic significance using the Log-rank test.Quantitative real-time PCR(qRT-PCR)was used to detect the expression of POLR2M in human colorectal cancer cell lines SW480,HCT-8,RKO,LOVO,DLD-1,HCT-116,SW620 and human normal colorectal cell line FHC.DLD-1 and RKO cells were stably transfected with lentivirus,and the POLR2M groups were up-regulated into the control group(LV-NC)and experimental group(LV-POLR2M),and the transient transfec-tion of SW620 and SW480 cells with interfering fragments of SiRNA was used to down-regulate the POLR2M groups into the control group(Si-NC)and experimental group(Si-POLR2M),and the transfection efficiency of each group was verified.CCK-8,plate cloning,Transwell and scratch healing assays were used to detect cell proliferation,invasion and migration.Flow cytometry was used to detect the effects of POLR2M on cell cycle and apoptosis.Results GE-PIA2.0,TCGA and Kaplan-Meier Plotter database analysis showed that the expression of POLR2M in colorectal cancer was significantly higher than in normal adjacent tissues(P＜0.05),and the expression of POLR2M was closely associ-ated with the histological type of colorectal cancer and lymph node metastasis(P＜0.05),but not with the age,gen-der,tumor grade and vascular invasion of patients(P＞0.05).The prognosis of patients with POLR2M overexpression was poor(P＜0.05).The results of qRT-PCR showed that compared with FHC cells,the mRNA expression of POLR2M in SW480,HCT-8,RKO,LOVO,DLD-1,HCT-116 and SW620 cell lines was increased(F=97.7,P＜0.05),and POLR2M stable overexpression and interference cell lines were successfully constructed.Compared with the LV-NC group,the viability,colony number,number of cells passing through the chamber and cell mobility of DLD-1 and RKO cells in the LV-POLR2M group were significantly increased(P＜0.05).Compared with the Si-NC group,the viability,colony number,number of cells passing through the chamber,and cell mobility of SW620 and SW480 cells in the Si-POLR2M group were significantly decreased(P＜0.05).Downregulation of POLR2M induced cell cycle arrest in G1 phase and promotes apoptosis(P＜0.05).Conclusion POLR2M may play a role as a pro-tumor gene in CRC,and its high expression can significantly promote the proliferation and invasion of CRC cells.

Objective To compare six existing Chinese standards related to visual disability,including Disability Assessment and Code for Life Insurance(Insurance Standard),Specification for Ability Assessment of Older Adults(Elderly Stan-dard),Grading of Disability due to Human Body Injury(Judicial Standard),Standard for Identify Work Ability—Gradation of Disability Caused by Work-related Injuries and Occupational Diseases(Work Injury Standard),Standard for Assessment of Disability Grades of Military Personnel(Military Standard),and Classification and Grading Criteria of Disability(Disability Classification Standard).Methods Based on the theoretical framework of International Classification of Functioning,Disability and Health(ICF)and International Classification of Diseases,the 11th Revision(ICD-11),and with reference to World Report on Vision(WRV),this study analyzed and compared five key dimensions of visual disability across the six stan-dards:definition,classification,grading,assessment methods and coding systems.Results In terms of definition,the insurance,work injury,military,and disability classification standards emphasized vi-sual structure and function,focusing on visual acuity and visual field;the insurance and elderly standards incor-porated activities and participation,reflecting the concept of functional vision;the judicial standard lacked a dedi-cated definition of visual disability.In terms of grading,each standard graded visual disability into different lev-els acoording to different functional indicators.In terms of coding,only the insurance standard adopted the ICF framework,while others used non-ICF numeric codes or lacked standardized coding.In terms of assessment tools,the elderly standard employed a customized perceptual and participation scoring system,while others re-lied primarily on vision charts.Conclusion Most current Chinese standards focus on impairments in visual function,with limited attention to activity limitations and participation restrictions.It is needed for incorporating the concept of functional vision,aligned with ICF and WRV,to establish a unified conceptual framework,terminology,coding system for visual disability,and comprehensive assessments that reflect not only impairments but also the impact on daily functioning and en-vironmental interaction.

Objective To explore the characteristics of high-frequency users of pediatric telemedicine outpatient services and analyze the factors influencing the frequency of use,providing theoretical support for the promotion and broader application of pediatric telemedicine outpatient services.Methods 197 parents of patients were randomly selected for telephone questionnaire survey by cross-sectional research method,and were divided into high frequency and low frequency users according to their frequency of use.Based on annual usage frequency,participants were divided into high-frequency and low-frequency groups.Mann-Whitney U test and x2 test or Fisher exact probability method were used for univariate analysis,and multiple logistic regression model was used to analyze the independent influencing fac-tors of the difference in the frequency of pediatric outpatient telemedicine use.Results A total of 165 questionnaires were completed.Among high-frequency users,the proportion of provinces outside Beijing was higher than that of low-frequency users,the overall knowledge level of information was better than that of low-frequency users,the overall satisfaction evaluation was better than that of low-frequency users,and the proportion of gastroenterology pa-tients was higher than that of low-frequency users.Conclusion Pediatric medical institutions need to strengthen the pub-licity of the platform,improve service quality,improve user experience by optimizing technical means,further pro-mote Internet outpatient services,and expand its application potential in children's health management.

OBJECTIVES: To investigate the effects of dihydroartemisinin (DHA) combined with doxorubicin (DOX) on proliferation and apoptosis of triple-negative breast cancer cells and explore the underlying molecular mechanism. METHODS: MDA-MB-231 cells were treated with 50, 100 or 150 μmol/L DHA, 0.5 μmol/L DOX, or with 50 μmol/L DHA combined with 0.5 μmol/L DOX. The changes in proliferation and survival of the treated cells were examined with MTT assay and colony-forming assay, and cell apoptosis was analyzed with flow cytometry. Western blotting was performed to detect the changes in protein expression levels of PCNA, cleaved PARP, Bcl-2, Bax, STAT3, p-STAT3, HIF-1α and survivin. RESULTS: The IC₅₀ of DHA was 131.37±29.87 μmol/L in MDA-MB-231 cells. The cells with the combined treatment with DHA and DOX showed significant suppression of cell proliferation. Treatment with DHA alone induced apoptosis of MDA-MB-231 cells in a dose-dependent manner, but the combined treatment produced a much stronger apoptosis-inducing effect than both DHA and DOX alone. DHA at 150 μmol/L significantly inhibited clone formation of MDA-MB-231 cells, markedly reduced cellular expression levels of PCNA, p-STAT3, HIF-1α and survivin proteins, and obviously increased the expression level of cleaved PARP protein and the Bax/Bcl-2 ratio, and the combined treatment further reduced the expression level of p-STAT3 protein and increased the Bax/Bcl-2 ratio. CONCLUSIONS DHA combined with DOX produces significantly enhanced effects for inhibiting cell proliferation and inducing apoptosis in MDA-MB-231 cells possibly as result of DHA-mediated negative regulation of the STAT3/HIF-1α pathway.
Humans ; STAT3 Transcription Factor/metabolism* ; Apoptosis/drug effects* ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism* ; Doxorubicin/pharmacology* ; Triple Negative Breast Neoplasms/metabolism* ; Cell Line, Tumor ; Artemisinins/pharmacology* ; Female ; Cell Proliferation/drug effects* ; Signal Transduction/drug effects* ; Survivin

Objective It analyzes the internal relationship between hierarchical diagnosis and remote medical treatment,explores the internal relationship state,and put forward collaborative suggestions.Methods Through the review of relevant policies and academic literature from 2009 to 2023,the magic policy tool platform of Peking University and CNKI are used to conduct visual analysis of policy documents and academic research trends.Results The included literature includes 1 119 hierarchical diagnosis and treatment policies,444 remote medical treatment policies and 16 dual-policy coordination.There were 10 224 articles related to hierarchical diagnosis and treatment,and 2 388 articles related to remote medical treatment.The number of paper of hierarchical diagnosis and treatment policies is higher than that of medical treatment in different places policies,and the main institutions are the National Health Commission and the National Healthcare Security Administration.The overall publication and academic discussion showed a trend of rising first and then decreasing.Conclution The implementation of hierarchical diagnosis and remote medical treatmentpolicies has caused friction due to departmental conflicts of interest.The government and academia should pay more attention to the coordinated development of the dual policies,and should consider more effective collaborative strategies in the future.

Objective:To investigate the clinical characteristics,contributing factors,and impacts of low-ratio cases under the Diagnosis-Intervention Packet(DIP)in tertiary hospitals,and propose actionable management strategies to promote the compliance and efficiency of medical insurance payment in tertiary hospitals.Methods:Based on retrospective analysis of 98 298 DIP-settled cases(January-October 2024)from a tertiary hospital in Henan,18 126 low-ratio and 80 172 normal-ratio cases were selected.Comparative metrics(demographics,hospitalization duration,primary care-sensitive conditions,medical insurance reimbursement ratios)were analyzed using non-parametric tests.Pareto analysis was applied to identify key diagnostic clusters.Results:Low-ratio cases exhibited distinct features:38.6％patients aged ≥61 years,32.5％hospital stays＜48 hours,l.0％primary care-sensitive conditions,Median reimbursement ratio was 0.69,with significant differences compared with general group.Seven diagnostic clusters(myeloproliferative disorders,poorly differentiated tumors,impact factors for health,medical treatment situation,etc.)accounted for 75.36％of low-ratio cases.Conclusion:It is suggested to optimize the medical service management under DIP payment through standardizing clinical pathways,enhanced coding quality,establishing policy feedback mechanisms,and promoting data governance.

Objective Based on the theoretical framework of International Classification of Functioning,Disability and Health(ICF),this paper compared the classification and grading methods of disability standards in four areas in China,focusing on definition,classification,grading,coding systems and assessment tools.Methods Four disability standards including Disability Assessment and Code for Life Insurance(insurance standard),Classification of Disability Degrees for Human Body Injury(judicial standard),Grading of Disability for Work-Related Injuries and Occupational Diseases(work-related injury standard),and Classification and Grading of Dis-abilities for Persons with Disabilities(disability eligibility standard)were systematically analyzed.Each standard was reviewed to identify core elements of disability definitions,classification,and grading methods.Content analysis was used to extract and compare the definitions,classification,grading,coding systems,and assessment tools.The strengths,weaknesses,and practical limitations of each standard were analyzed using the ICF frame-work.Results There were different in disability definitions,classification and grading,coding systems,and assessment tools across the standards.In terms of definitions,the insurance standard emphasized ICF's body structure and function impairments;the judicial standard defined disability as limitations in life and work capacity due to bodily injury,covering ICF's body structure and function,activity and participation;the work-related injury standard focused on loss of labor capacity due to work-related injuries,involving body structure and function,activity and partici-pation;the disability eligibility standard refered to the ICF model,defining disability as impairments in body function and structure,and activity limitations and participation restriction.Regarding classification and grading,the insurance standard divided disabilities into eight categories based on body structure and function,with ten grades of disability severity;the judicial standard first graded disabilities into ten levels and then classified as in-jury site;the work-related injury standard divided disabilities into five categories based on clinical disciplines,grading from one to ten;the disability eligibility standard divided disabilities into seven categories,each with four grades.For coding systems and assessment tools,the insurance standard used ICF coding system,while the disability standard for persons with disabilities used a numerical coding system other from ICF,and the other standards did not use coding systems.Assessment tools varied significantly.The use of World Health Organiza-tion Disability Assessment Schedule(WHODAS 2.0)was proposed but not applying it in grading.Conclusion This study has systematically compared and analyzed four typical disability-related standards in China using the ICF framework.Personal Insurance Disability Assessment and Coding,Grading of Disability Caused by Bodily Injury,and Classification and Grading of Disabilities for Persons with Disabilities are all promulgated af-ter 2011,and adopt ICF concepts and methods to define and classify disabilities,considering body function and structure,activity and participation,and environmental factors.However,due to different purposes,their grading methods and levels vary:except for Classification and Grading of Disabilities for Persons with Disabilities,which uses a four-level grading system,the other standards use a ten-level system,primarily based on body func-tion and structure.In disability assessment,the recommended methods differ by category,showing significant variability.Due to differing classification and grading methods,disability data from various standards are lack in comparability.The international trend advocates for a unified disability standard framework based on ICF and ICD-11 to enhance the comparability and exchangeability of disability data.

Objective Utilizing the International Classification of Functioning,Disability and Health(ICF)framework and Interna-tional Classification of Diseases,the 11th Revision(ICD-11)system,alongside evidence from World Health Or-ganization(WHO)global reports and technical reports from relevant countries,this study systematically exam-ines the definitions,classifications,grading,and assessment methods for visual,hearing,speech,physical,intel-lectual,and mental(psychiatric)disabilities.Methods Employing the ICF's biopsychosocial model,classification,and coding system and ICD-11,and referencing WHO global reports and national technical reports,this study systematically investigated the definitions,classifi-cations,grading and assessment approaches for six prevalent disabilities:visual,hearing,speech,physical,intel-lectual and mental.Results The ICF and ICD-11model and classification system offered a robust framework for defining,classifying,grad-ing and assessing disabilities.Disability definitions should address body function impairments,activity limita-tions,participation restrictions and environmental factors.The definitions,classifications and grading of visual,hearing,speech,physical,intellectual and mental disabilities aligned with ICF categories for body functions and structures,activities and participation and categories of ICD-11.Standardized tools like the WHO Disability As-sessment Schedule(WHODAS 2.0)effectively measured overall activity and participation levels.Conclusion Anchored in the ICF and ICD-11 framework,disabilities are defined,classified,graded and assessed across body functions and structure,activities and participation,and environmental factors.WHODAS 2.0 serves as a universal tool for assessing activities and participation,enabling both comprehensive functional evaluations and the conversion of results from other assessment tools.By analyzing WHO global reports and technical documents in some countries within the ICF and ICD-11 classifications framework,this study highlights global advance-ments in disability definitions,classifications,grading and assessments.Variations in disability statistics stem from differing definitions,diagnostic criteria and assessments.Disability service eligibility criteria should be tai-lored to the needs of recipients and the capacity of providers.

Objective It analyzes the internal relationship between hierarchical diagnosis and remote medical treatment,explores the internal relationship state,and put forward collaborative suggestions.Methods Through the review of relevant policies and academic literature from 2009 to 2023,the magic policy tool platform of Peking University and CNKI are used to conduct visual analysis of policy documents and academic research trends.Results The included literature includes 1 119 hierarchical diagnosis and treatment policies,444 remote medical treatment policies and 16 dual-policy coordination.There were 10 224 articles related to hierarchical diagnosis and treatment,and 2 388 articles related to remote medical treatment.The number of paper of hierarchical diagnosis and treatment policies is higher than that of medical treatment in different places policies,and the main institutions are the National Health Commission and the National Healthcare Security Administration.The overall publication and academic discussion showed a trend of rising first and then decreasing.Conclution The implementation of hierarchical diagnosis and remote medical treatmentpolicies has caused friction due to departmental conflicts of interest.The government and academia should pay more attention to the coordinated development of the dual policies,and should consider more effective collaborative strategies in the future.

Objective To explore the characteristics of high-frequency users of pediatric telemedicine outpatient services and analyze the factors influencing the frequency of use,providing theoretical support for the promotion and broader application of pediatric telemedicine outpatient services.Methods 197 parents of patients were randomly selected for telephone questionnaire survey by cross-sectional research method,and were divided into high frequency and low frequency users according to their frequency of use.Based on annual usage frequency,participants were divided into high-frequency and low-frequency groups.Mann-Whitney U test and x2 test or Fisher exact probability method were used for univariate analysis,and multiple logistic regression model was used to analyze the independent influencing fac-tors of the difference in the frequency of pediatric outpatient telemedicine use.Results A total of 165 questionnaires were completed.Among high-frequency users,the proportion of provinces outside Beijing was higher than that of low-frequency users,the overall knowledge level of information was better than that of low-frequency users,the overall satisfaction evaluation was better than that of low-frequency users,and the proportion of gastroenterology pa-tients was higher than that of low-frequency users.Conclusion Pediatric medical institutions need to strengthen the pub-licity of the platform,improve service quality,improve user experience by optimizing technical means,further pro-mote Internet outpatient services,and expand its application potential in children's health management.