Objective:To quantitatively evaluate the level of the three medical linkage in China from 2009 to 2022,explore the influencing factors and driving paths of the three medical linkage in China,and provide a new perspective for promoting the development of the three medical linkage.Methods:An optimized coupling coordination degree model was used to calculate the coupling coordination degree between the trinity healthcare systems and different binary systems within the systems in 31 provinces of China(excluding Hong Kong,Macao and Taiwan),and the Fuzzy-set Qualitative Comparative Analysis method was used to explore the condition configurations of multi-factor-driven three medical linkage.Results:From 2009 to 2022,the coupling coordination degree between the trinity healthcare systems in each province of China generally showed an increasing trend year by year.Among the binary systems,the overall coordinated development situation between the medical and medical insurance systems was the best and the regional development was the most balanced.The coupling coordination degree gap between the trinity healthcare system and the internal binary systems among provinces gradually widened,and the multi-polarization trend intensified.The paths to promote high-level three medical linkage can be summarized into two types:internal and external balanced development type(H1)and government-led type(H2,H3),among which the H1 path with per capita GDP and health expenditure as core conditions was the most common.Conclusion:It is suggested to enhance institutional and technological innovation,and integrate resources through a cross-departmental collaboration mechanism and digital technology.Provinces should select high-level optimization paths by leveraging regional endowments to narrow the regional development gap.Meanwhile,under the impetus of high-level policies,the protection and supervision system continues to improve,thereby promoting the three medical linkage.

Objective To investigate the effects of meridian and tendon acupuncture on the mitochondrial apoptosis of quadriceps femoris muscle cells in model rats of knee osteoarthritis(KOA);To explore its mechanism for the treatment of KOA.Methods Totally 40 SPF healthy male Wistar rats were randomly divided into sham-operation group(10 rats)and modeling group(30 rats).The modified Hulth method was used to establish a KOA rat model.The model rats were randomly divided into model group,celecoxib group and meridian and tendon acupuncture group,with 9 rats in each group.Corresponding intervention measures were given to each group for 14 consecutive days.Improved Lequesne MG score was used for evaluating knee joint function in rats,measuring thigh circumference,quadriceps femoris wet weight,wet weight maintenance rate and wet weight ratio of the affected limb,HE staining was used to observe the morphology of quadriceps femoris tissue,TUNEL method was used to detect apoptosis of quadriceps femoris cells,immunofluorescence was used to detect the expressions of reactive oxygen species(ROS),superoxide dismutase(SOD),Caspase-3 and Caspase-9 in quadriceps femoris muscle tissue,fluorescence double staining method was used to detect the co-expression of ROS and Caspase-3 in quadriceps femoris tissue,Western blot was used to detect the expressions of apoptosis related proteins in quadriceps femoris tissue.Results Compared with the sham-operation group,the improved Lequesne MG score of the knee joint in the model group rats increased(P<0.05),the circumference of the thigh,wet weight of the quadriceps femoris,wet weight maintenance rate and wet weight ratio of the affected limb decreased(P<0.05),the arrangement of quadriceps femoris muscle fibers was disordered and loose,with some muscle fibers dissolved and necrotic,accompanied by a large amount of inflammatory exudate,an increase in lymphocytes,and an increase in cell apoptosis index(P<0.05),the expressions of ROS,Caspase-3 and Caspase-9 in quadriceps femoris tissue increased,while the expression of SOD decreased(P<0.05),the protein expressions of Bcl-2,Bcl-XL,Bax,Cytochrome C(CytC),Caspase-3 and Caspase-9 in quadriceps femoris tissue increased(P<0.05).Compared with the model group,the improved Lequesne MG scores of the knee joint in the celecoxib group and the meridian and tendon acupuncture group decreased(P<0.05),while thigh circumference,quadriceps femoris wet weight,wet weight maintenance rate,wet weight ratio increased(P<0.05),the structure of quadriceps femoris muscle fibers was normal,the muscle membrane was relatively intact,the apoptosis index decreased(P<0.05),the expressions of ROS,Caspase-3 and Caspase-9 in quadriceps femoris tissue decreased,while the expression of SOD increased(P<0.05),the protein expressions of Bcl-2,Bcl-XL,Bax,CytC,Caspase-3 and Caspase-9 in quadriceps femoris muscle tissue decreased(P<0.05),and the expression trend of ROS and Caspase-3 in fluorescent double staining was consistent.Conclusion Meridian and tendon acupuncture can reduce ROS in the quadriceps femoris tissue of KOA model rats,inhibit the expressions of mitochondrial apoptosis-related proteins,thereby improving skeletal muscle strength,and play a certain therapeutic role.

Objective To analyze and evaluate the early warning efficacy of D-dimer/albumin ratio(DAR)combined with interleukin-6(IL-6)and fibrin degradation products(FDP)in the postoperative treatment of acute Stanford type A aortic dissection(ATAAD).Methods A retrospective cohort study was conducted on 284 ATAAD patients who underwent the Sun's procedure at our hospital from July 2024 to March 2025.Patients were divided into a non-adverse outcome group(n=196)and an adverse outcome group(n=88)based on the occurrence of postop-erative complications within 30 days,including acute renal failure requiring dialysis,secondary thoracotomy for hemostasis,severe neurological complications,multiple organ failure,or all-cause mortality.Preoperative baseline data,perioperative parameters,and laboratory indicators were collected via the electronic medical record system.The Mann-Whitney U test was used to compare the differences between groups for continuous variables that did not conform to the normal distribution,and Chi-square test or Fisher's exact test was selected for statistical difference analysis according to the frequency distribution characteristics of categorical variables.On the basis of univariate analysis,multivariate logistic regression analysis was used to screen independent risk factors.Results Statistically significant differences were observed between the non-adverse and adverse outcome group in age,cardiopulmonary bypass time,lactate dehydrogenase(LDH),IL-6,D-dimer(D-D),FDP,and DAR levels(P<0.05).Multivariate analysis revealed that DAR,IL-6,D-D,FDP,and prolonged cardiopulmonary bypass time were independent risk factors for adverse postoperative outcomes(P<0.05).Combined detection analysis demonstrated that the combination of DAR,IL-6,FDP,and cardiopulmonary bypass time yielded the highest predictive efficacy,with an area under the ROC curve of 0.886(95％CI:0.846～0.927).Conclusion The combination of DAR,IL-6,FDP,and cardio-pulmonary bypass time effectively predicts adverse postoperative outcomes in ATAAD patients.This biomarker panel may serve as a robust predictive tool for postoperative risk stratification.

Objective To explore the mechanism of acupuncture protection of quadriceps muscle cells in knee osteoarthritis model rats based on Piezo1/YAP/Caspase3 axis.Methods 40 SPF grade Wistar rats were selected and adaptively fed for 7 days before being divided into three groups:sham surgery group,model group,western medicine group,and acupuncture group,with 10 rats in each group,according to a random control table.The model group,Western medicine group,and acupuncture group used the modified Hulth method to construct knee osteoarthritis models,while the sham surgery group only cut open the joint cavity and sutured it.After successful model replication,the sham surgery group was given physiological saline by gavage,the western medicine group was given celecoxib solution by gavage,and the acupuncture group was given acupuncture at the infrapatellar,crane top,and blood sea levels.Each group was intervened once a day for 14 consecutive days.During the treatment period,the rats continued to undergo treadmill training.After the intervention,the hematoxylin eosin staining method(HE)was used to detect the morphological changes of various rat quadriceps muscle tissues and articular cartilage;TUNEL method was used to detect apoptosis of quadriceps muscle cells,immunofluorescence method was used to detect the protein expression of Piezo1,YAP,and p-YAP in quadriceps muscle cells,Western blot method was used to detect the expression of anti apoptotic proteins CTGF,AREG,Gli2,AFP in quadriceps muscle tissue,as well as the protein expression levels of apoptosis related proteins Bcl-2,Bcl-xl,Bax,cytc,and Caspase3.Results Compared with the model group,the western medicine group and the acupuncture group had higher thigh circumference,quadriceps wet weight,wet weight maintenance rate,and wet weight to body weight ratio(P<0.05).Compared with the western medicine group,the acupuncture group had higher thigh circumference,quadriceps wet weight,wet weight maintenance rate,and wet weight to body weight ratio(P<0.05).Compared with the model group,the apoptosis index of the quadriceps muscle in the Western medicine group and acupuncture group rats was lower,and the apoptosis index of the quadriceps muscle in the acupuncture group was lower(P<0.05).Compared with the model group,the Western medicine group and acupuncture group showed higher expression of Piezo1 and p-YAP proteins in the quadriceps femoris muscle tissue,lower expression of YAP protein,higher expression of CTGF,AREG,Gli2,AFP proteins,higher expression of Bcl-2 and Bcl-xl proteins,and lower expression of Bax,cytc,and Caspase3 proteins(P<0.05).Compared with the Western medicine group,the acupuncture group showed higher expression of Piezo1 and p-YAP proteins in the quadriceps muscle tissue,lower expression of YAP protein,higher expression of CTGF,AREG,Gli2,AFP proteins,higher expression of Bcl-2 and Bcl-xl proteins,and lower expression of Bax,cytc,and Caspase3 proteins(P<0.05).Conclusion Acupuncture increases the expression of Piezo1 protein in the quadriceps femoris muscle of knee osteoarthritis model rats,promotes the phosphorylation of YAP into the nucleus,thereby promoting proliferation,anti apoptotic proteins CTGF,AREG,Gli2,and AFP protein expression,inhibiting Caspase3-dependent mitochondrial apoptosis,and protecting muscle cells.

Objective:To investigate whether malignant tumors affect the laboratory outcomes of patients in their first controlled ovarian hyperstimulation (COH) cycle.Methods:This study was a retrospective case-control study that analyzed the clinical and laboratory data of patients who underwent fertility preservation before chemotherapy and radiotherapy due to malignant tumors, as well as patients with infertility caused by tubal factors who first underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from January 2020 to May 2024. Patients who underwent fertility preservation were designated as the research group, while patients who underwent assisted reproduction due to tubal factors during the same period were designated as control group. After 1∶3 propensity score matching (PSM), 40 patients were included in the research group and 118 patients were included in control group. The ovarian response, oocyte retrieval outcomes, and embryonic development after fertilization in the first COH cycle were compared between the two groups. Results:After PSM, the research group and control group showed statistically significant differences in the gonadotropin (Gn) starting dosage [225.00 (162.50, 300.00) U vs. 193.75 (150.00, 225.00) U, P=0.002], duration of Gn used [10.00 (8.00, 11.00) d vs. 12.00 (10.00, 13.00) d, P<0.001], and average estradiol levels on human chorionic gonadotropin trigger day [2 487.00 (1 461.25, 4 090.25) pmol/L vs. 10 738.50 (8 400.00, 16 507.25) pmol/L, P<0.001]. However, no statistically significant difference was found in the total dosages of Gn used between the two groups ( P>0.05). There were no significant differences between the groups in terms of the number of oocytes retrieved, the number of metaphase Ⅱ oocytes, two pronuclei (2PN) rate, 2PN cleavage rate, available embryo rate, high-quality embryo rate, blastocyst formation rate, and available blastocyst formation rate (all P>0.05). Conclusion:Compared with infertility patients with tubal factors, there is no significant difference in the laboratory outcomes of malignant tumor patients undergoing COH for fertility preservation prior to chemotherapy and radiation.

Objective:To investigate the effects of male body mass index (BMI) on semen parameters and perinatal outcomes following artificial insemination by husband (AIH) treatment.Methods:A retrospective cohort study was conducted to analyze the clinical data of 5 053 patients underwent AIH treatment at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University, from January 2017 to February 2024. The study focused on factors such as male semen parameter abnormalities, male sexual dysfunction, female cervical factors, reproductive tract malformations, and unexplained infertility. Patients were classified into three groups based on male BMI: normal weight group (18.5-23.9 kg/m2, n=1 673), overweight group (24.0-27.9 kg/m2, n=2 078), and obese group (BMI≥28.0 kg/m2, n=1 302). The primary objective was to assess the differences in semen parameters and perinatal outcomes among the three groups. Multivariable logistic regression and linear regression analyses were applied to adjust for potential confounders that could influence semen parameters and perinatal outcomes. Results:Semen volume in the normal weight group and overweight group [4.00 (3.00, 5.50) mL, 4.00 (3.00, 5.50) mL] was higher than that in the obese group [4.00 (3.00, 5.00) mL], with a significant difference among the three groups ( P<0.001, a P<0.001). The total sperm count in the normal group and overweight group [207.60 (121.90, 341.75)×10 6, 211.80 (119.88, 334.83)×10 6] was higher than that in the obese group [188.40 (110.96, 323.41)×10 6], with a significant difference among the three groups ( P=0.007, a P<0.001). The total progressive sperm motility count in the normal group [88.18 (43.63, 163.80)×10 6] was higher than that in the obese group [75.30 (40.29, 147.86)×10 6], with a significant difference among the three groups ( P=0.001, a P<0.001). The percentage of forward motile sperm in the normal group [(45.37±17.16)%] was higher than that in the overweight group [(44.03±17.36)%] and the obese group [(43.80±17.21)%], with a significant difference compared among the three groups ( P=0.020, a P=0.016]. In terms of perinatal outcomes, after multivariate logistic regression analysis, only the overweight and obese groups had higher newborn birth weights [(3 389.53±472.65) g, (3 408.57±507.90) g] compared with the normal group [(3 271.32±532.02) g], with a significant difference among the three groups ( P=0.010, a P=0.009). Conclusion:Higher male BMI is associated with decreased semen quality and may increase newborn birth weight following AIH treatment.

Objective:To investigate the mediating role of serum β-human chorionic gonadotropin (hCG) levels on the relationship between embryo quality and pregnancy outcomes following single frozen-thawed blastocyst transfer 14 d post-transfer.Methods:This retrospective cohort study collected data from patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) frozen-thawed single blastocyst transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University between August 2017 and June 2021. Patients were grouped according to embryo quality into good-quality blastocyst group ( n=3 191) and available blastocyst group ( n=2 027). Differences in serum β-hCG levels and pregnancy outcomes at 14 d post-transfer were compared between the two groups. Mediation analysis and receiver operating characteristic (ROC) analysis were used to explore the mediating effect of β-hCG levels on the relationship between embryo quality and pregnancy outcomes and to evaluate the differences in the incidence of placental-related diseases between the two groups. Results:The good-quality blastocyst group had significantly higher serum β-hCG levels [1 177.0 (1.8, 2 278.5) U/L], clinical pregnancy rate [65.62% (2 094/3 191)], and live birth rate [52.55% (1 667/3 191)] compared with the available blastocyst group [54.4 (0.1, 1 453.5) U/L, P<0.001; 46.13% (935/2 027), P<0.001; 34.19% (693/2 027), P<0.001]. The early miscarriage rate in the good-quality group [13.47% (282/2 094)] was lower than that in the available blastocyst group [19.14% (179/935), P<0.001]. Serum β-hCG levels at 14 d post-transfer showed significant mediating effects on clinical pregnancy rate ( r=-0.126), live birth rate ( r=-0.122), and early miscarriage rate ( r=0.028) in both groups (all P<0.001). The cut-off values for β-hCG to predict live birth in the available and good-quality blastocyst groups were 366.9 U/L and 485.5 U/L, with positive predictive values of 76.28% (672/881) and 82.84% (1 628/1 965), respectively, and negative predictive values of 98.15% (1 114/1 135) and 96.14% (1 170/1 217). The cut-off values for predicting clinical pregnancy were 118.8 U/L and 226.5 U/L, with positive predictive values of 95.43% (919/963) and 98.45% (2 037/2 069), and negative predictive values of 99.72% (1 050/1 053) and 94.89% (1 059/1 116). The cut-off values for predicting early miscarriage were 1 337.0 U/L and 1 162.6 U/L, with positive predictive values of 32.75% (130/397) and 30.18% (150/497), and negative predictive values of 90.89% (489/538) and 91.73% (1 465/1 597). No differences were found in the incidence of placental-related diseases between the two groups (all P>0.05). Conclusion:This study indicates that both embryo quality and serum β-hCG levels at 14 d post-transfer significantly affect pregnancy outcomes. β-hCG levels play an important mediating role between embryo quality and pregnancy outcomes. ROC analysis demonstrates the good predictive efficacy of serum β-hCG levels for pregnancy outcomes, providing scientific evidence for optimizing embryo selection.

Objective:To evaluate the predictive role of ultrasound, genetic testing, and clinical features in the malignancy risk of Bethesda Ⅲ thyroid nodules, and to explore strategies for optimizing treatment decisions.Methods:This retrospective study included 227 Bethesda Ⅲ thyroid nodules from patients who underwent surgical treatment at the Thyroid Surgery Department of Nanjing Drum Tower Hospital between Jan. 2020 and Dec. 2023. All patients underwent ultrasound evaluation and fine-needle aspiration. For nodules diagnosed as ultrasound, genetic testing, and clinical features were analyzed using univariate and multivariate regression to assess their association with malignancy.Results:Among the 227 nodules, 214 were malignant, resulting in a malignancy rate of 94.2%. The malignancy rate of thyroid nodules was 94.2%. In univariate analysis, age ( P=0.016), BRAF V600E gene mutation ( P<0.001), nodule size ( P=0.002), and TIRADS ( P<0.001) were significantly associated with malignancy in Bethesda Ⅲ thyroid nodules. Multivariate analysis confirmed that age ( OR=0.939, P=0.049) and BRAF V600E gene mutation ( OR=24.641, P<0.001) were significantly associated with thyroid nodule nature and served as independent predictive factors for malignancy. Conclusions:Genetic testing is an important method for predicting the malignancy of Bethesda Ⅲ thyroid nodules, and ultrasound also has high clinical value in assessing the malignancy risk of nodules. While some clinical features are highly correlated with nodule characteristics, they may not be practical in clinical application. For nodules classified as TIRADS 3 through ultrasound evaluation and negative for BRAF mutations, continued observation may be considered, whereas TIRADS 5 nodules or nodules with BRAF mutations should be prioritized for surgical treatment.

Objective To analyze the imaging features of cerebral small vessel disease in patients with type 2 diabetes mellitus by multimodal MRI.Methods The clinical data of 160 patients with cerebral small vessel disease admitted to our hospital from January to December 2020 were retrospectively analyzed.According to whether they were complicated with type 2 diabetes mellitus,they were divided into the diabetic group and the non-diabetic group,with 80 cases in each group.Both groups underwent multimodal MRI scans.And the severity of lacunar infarction,the severity of subcortical and periventricular white matter lesions,white matter integral and cerebral microbleeds of patients in the two groups were compared.Results The severity of lacunar infarction(χ2=34.076,P=0.001),subcortical white matter lesions(χ2=25.000,P=0.001),periventricular white matter lesions(χ2=22.895,P=0.001)and white matter integral(t=12.370,P=0.001)of patients in the diabetic group were significantly higher than those in the non-diabetic group.No cerebral microbleeds were detected in either group of patients.Conclusion Patients with cerebral small vessel disease and type 2 diabetes mellitus show characteristic multimodal MRI changes.The increase in the number of lacunar infarction lesions and the aggravation of white matter lesions can be used as the characteristic imaging basis for the diagnosis of type 2 diabetes mellitus related cerebral small vessel disease.

Objective:To understand the tobacco use situation and related factors among the occupational population in Beijing in 2018.Methods:The data were obtained from a special survey on “Healthy Beijing People—Ten-year Action Plan for Health Promotion (2009—2018)”. From June to September 2018, 12 908 participants were recruited from 16 districts of Beijing using the stratified sampling method combined with the typical sampling method. Questionnaires were conducted to collect basic information, work situations, tobacco exposure in public places, and smoking cessation. The Chi-square test was used to compare the differences in current smoking rates, smoking cessation rates and second-hand smoke exposure rates among participants with different characteristics. Multivariate logistic regression analysis was used to analyze the related factors of tobacco use.Results:The present smoking rate of the occupational population in Beijing was 18.0% (95% CI: 17.3%-18.7%), and the passive smoking exposure rate of non-smokers was 61.0% (95% CI: 60.1%-61.9%). The smoking cessation rate among the working population was 22.2% (95% CI: 20.7%-23.7%), and the proportion of current smokers with the intention to quit was 63.9% (1 485/2 325). The present smoking rate of employees of different genders, ages, education levels and occupational nature showed statistically significant differences ( P<0.05). The results of multivariate logistic regression analysis showed that in males, compared with the age group of 16-29 years old, the risk of smoking increased in the age groups of 30-39 years old, 40-49 years old and over 50 years old [ OR (95% CI) values were 1.49 (1.27-1.74), 1.34 (1.13-1.59) and 1.30 (1.06-1.59)]. Compared with those with junior high school or lower education, participants with high school/vocational/college education group had a higher risk of smoking ( OR=1.38, 95% CI: 1.13-1.69), while those with master′s degree or above had a lower risk of smoking ( OR=0.30, 95% CI: 0.22-0.42). The physical workers ( OR=1.28, 95% CI: 1.11-1.47) had a higher risk of smoking than the mental workers. Conclusion:The current smoking rate among the occupational population in Beijing is lower than the national level during the same period, but the exposure rate to second-hand smoke is relatively high. Age, educational level, job nature and gender are related factors of smoking.