Objective:This study aims to investigate the spillover effects of the Diagnosis-Related Groups payment reform on medical expenditures.Methods:Based on the medical record data of inpatients in a tertiary Grade A hospital in Wuhan,Hubei Province,the Difference-in-Differences method was applied to estimate the impact of the DRG reform on medical expenditures for non-local patients.Results:After the implementation of DRG payment,the total medical expenses(β=-0.13),out-of-pocket expenses(β=-0.22),drug expenses(β=-0.25),consumable expenses(β=-0.26)decreased significantly.Meanwhile,the reduction ranges of the level and proportion of out-of-pocket expenses for non-local inpatients were significantly larger than those for local inpatients.However,the reduction range of the proportion of drug expenses for non-local inpatients was significantly smaller than that for local inpatients.The gaps between the two groups in terms of the level of out-of-pocket expenses and the proportion of drug expenses gradually narrowed.Conclusion:The DRG payment reform has produced a significant spillover effect,leading to a decrease in the medical expense level and an improvement in the expense structure for non-local inpatients.However,the medical expenses of non-local inpatients remain relatively high.It is suggested to accelerate the inclusion of non-local inpatients in disease-specific payment management and strengthen the coordination between the hospital's internal operation management and the reform of medical insurance payment methods.

Objective:This study aims to investigate the spillover effects of the Diagnosis-Related Groups payment reform on medical expenditures.Methods:Based on the medical record data of inpatients in a tertiary Grade A hospital in Wuhan,Hubei Province,the Difference-in-Differences method was applied to estimate the impact of the DRG reform on medical expenditures for non-local patients.Results:After the implementation of DRG payment,the total medical expenses(β=-0.13),out-of-pocket expenses(β=-0.22),drug expenses(β=-0.25),consumable expenses(β=-0.26)decreased significantly.Meanwhile,the reduction ranges of the level and proportion of out-of-pocket expenses for non-local inpatients were significantly larger than those for local inpatients.However,the reduction range of the proportion of drug expenses for non-local inpatients was significantly smaller than that for local inpatients.The gaps between the two groups in terms of the level of out-of-pocket expenses and the proportion of drug expenses gradually narrowed.Conclusion:The DRG payment reform has produced a significant spillover effect,leading to a decrease in the medical expense level and an improvement in the expense structure for non-local inpatients.However,the medical expenses of non-local inpatients remain relatively high.It is suggested to accelerate the inclusion of non-local inpatients in disease-specific payment management and strengthen the coordination between the hospital's internal operation management and the reform of medical insurance payment methods.

Objective To explore characteristics of clinical and imaging findings in patients with fat embolism syndrome.Methods From January 2021 to October 2022,clinical manifestations of 13 patients with fat embolism due to fracture or or-thopaedic surgery were retrospectively analyzed,including 11 males and 2 females,aged from 17 to 60 years old.Mental and respiratory abnormalities and changes in vital signs occurred after admission or after surgery,and patient's chest and brain imaging results were abnormal.The patient's mental and respiratory abnormalities,vital signs,chest and brain imaging results were continuously monitored.Results The main clinical manifestations of fat embolism syndrome were abnormal pulmonary respiration in 13 patients,abnormal central nervous function in 7 patients,and spotted rash in 2 patients.Chest CT showed dif-fuse distribution of ground glass shadows in 13 patients,and severe symptoms were"snowstorm".Nine patients with ground glass fusion consolidation,5 patients with multiple nodules and 4 patients accompanied by bilateral pleural effusion.Head CT findings of 5 patients were negative,and head MRI findings of 1 patient showed multiple T1WI low signal,T2WI high signal shadow,DWI high signal shadow,and"starry sky sign"in basal ganglia,radiative crown,hemioval center,thalamus,frontal parietal cortex and subcortex.Conclusion Fat embolism syndrome has a high mortality rate.Clinical manifestations of respira-tory system and nervous system are not specific,and the skin spot rash has a characteristic manifestation.The"blizzard"sign is the specific manifestation of chest X-ray and CT examination of fat embolism,and the"starry sky"sign is the typical manifesta-tion of diffusion-weighted sequence of brain MRI examination of fat embolism.

Our previous study demonstrated that phosphodiesterase 8 (PDE8) could work as a potential target for vascular dementia (VaD) using a chemical probe 3a. However, compound 3a is a chiral compound which was obtained by chiral resolution on HPLC, restricting its usage in clinic. Herein, a series of non-chiral 9-benzyl-2-chloro-adenine derivatives were discovered as novel PDE8 inhibitors. Lead 15 exhibited potent inhibitory activity against PDE8A (IC₅₀ = 11 nmol/L), high selectivity over other PDEs, and remarkable drug-like properties (worthy to mention is that its bioavailability was up to 100%). Oral administration of 15 significantly improved the cAMP level of the right brain and exhibited dose-dependent effects on cognitive improvement in a VaD mouse model. Notably, the X-ray crystal structure of the PDE8A-15 complex showed that the potent affinity and high selectivity of 15 might come from the distinctive interactions with H-pocket including T-shaped π-π interactions with Phe785 as well as a unique H-bond network, which have never been observed in other PDE-inhibitor complex before, providing new strategies for the further rational design of novel selective inhibitors against PDE8.

PURPOSE: To compare the diagnostic efficiency of ⁶⁸Gallium labelled prostate-specific membrane antigen positron emission tomography (⁶⁸Ga-PSMA PET) and magnetic resonance imaging (MRI) for staging the lymph node metastases (LNMs) in the prostate cancer.MATERIALS AND METHODS: A broad search of scientific databases including PubMed, EMBASE, Web of Science, Cochrane Database, and Chinese Biomedicine Literature Database (updated prior to November 1st, 2018) was conducted systematically by two reviewers. In this paper, we evaluated the methodological quality of each included article independently and performed a systematic review and meta-analysis to reveal the summary of the diagnostic performance of ⁶⁸Ga-PSMA PET and MRI in properly identifying LNMs of intermediate- and/or high-risk prostate cancer.RESULTS: Thirteen eligible articles comprising 1,597 patients were included. For LNMs detection, the pooled sensitivity and specificity of ⁶⁸Ga-PSMA PET were 0.65 (95% confidence interval [CI]: 0.49–0.79) and 0.94 (95% CI: 0.88–0.97), respectively, while the corresponding values of MRI were 0.41 (95% CI: 0.26–0.57) and 0.92 (95% CI: 0.86–0.95). The area under the symmetric receiver-operating characteristic (SROC) curve for ⁶⁸Ga-PSMA PET and MRI were 0.92 and 0.83, respectively.CONCLUSIONS: In intermediate- or high-risk pre-treatment prostate cancer, ⁶⁸Ga-PSMA PET had a higher sensitivity and a slightly different specificity in probing the LNMs when comparing with MRI. Moreover, the area under the SROC curve indicated that ⁶⁸Ga-PSMA PET was a more effective weapon for predicting the LNMs prior to radical surgery.

Ferroptosis is a newly discovered non-apoptotic form of regulated cell death driven by iron-dependent lipid peroxidation. The present studies have shown that many metabolic processes and homeostasis are affected by ferroptosis. It is related to many lung diseases, including acute lung injury, chronic obstructive pulmonary disease and pulmonary fibrosis, etc. Currently, the research on ferroptosis is still in its infancy. Previous studies have confirmed that ferroptosis is regulated by a variety of genes, and the mechanism is complex, mainly involving iron homeostasis and lipid peroxidation metabolism. This review summarizes some regulation networks of metabolic processes associated with ferroptosis and discusses the roles of ferroptosis in the pathophysiological progression of many lung diseases. We expected to provide new ideas and references for the treatment of these diseases.
Ferroptosis ; Humans ; Iron ; Lipid Peroxidation ; Metabolic Networks and Pathways ; Pulmonary Disease, Chronic Obstructive

Alzheimer' s disease (AD) is a chronic neurodegenerative disease, which is seriously affecting people' s lives. Until now, the pathogenesis of AD is still unknown which result in its worldwide difficulties in prevention and treatment. Some studies have shown that AD might be a metabolic disease associated with glucose, lipid and energy metabolisms. Traditional Chinese medicine (TCM) believes that the spleen is acquired foundation and the origination of Qi and blood. The function of spleen is not only closely related to the metabolism of substance and energy, but also related to the aging of human body. In this article, we summarized and analyzed the interrelationship of metabolism, AD and spleen, as well as the effect of spleen-invigorating prescription on AD. The purpose of the paper is to analyze the possible mechanism of TCM treating AD from the perspective of regulating metabolism, explore the potential value of spleen-strengthening TCM in the treatment or prevention of AD, and provide new ideas for exploring the drug development and TCM therapy of AD.

Objective To investigate the effect of environmental enrichment (EE) on lipopolysaccharide (LPS) induced cognitive dysfunction in mice. Methods A total of thirty six 3 weeks old Kunming mice experienced 8 weeks of EE or standard environment (SE) feeding. After 8 weeks, they were divided into three groups: standard environment+ normal saline (SE+NS) group, standard environment+lipopolysaccharide (SE+LPS) group, environmental enrichment+ lipopolysaccharide (EE+LPS) group. The open field test was used to measure the locomotive of mice, and the cognitive function was determined by novelty object recognition test. The expression of microglial marker ionized calcium binding adaptor molecule-1 (IBA-1) in hippocampus was determined by immunohistochemical staining. The expression of microglial activation marker CD68 and NOD-like receptor protein 3 (NLRP3) inflammasome related protein in the hippocampus was detected by Western blotting. Results In the open field test, there was no difference in the activity among the three groups. Compared with the SE + NS group, SE + LPS group showed decreased discrimination ratio in novelty object recognition task, with remarkably up-regulated expression of CD68 in the hippocampus (P< 0. 01) . In addition, SE+LPS group exhibited significantly enhanced expression of NLRP3, apoptosis associated speck-like protein (ASC), Caspase-1 and interleukin-1β(IL-1β) in the hippocampus compared with SE + NS group (P < 0. 05) . Compared with the SE + LPS group, EE+LPS group showed enhanced discrimination ratio in the object recognition task, with down-regulated expression of CD68, NLRP3, ASC, Caspase-1, IL-1β and IL-18 in the hippocampus (P < 0. 01) . Conclusion Environmental enrichment can alleviate LPS induced cognitive dysfunction, which might be attributed to the inhibiting of microglia and NLRP3 activation in the hippocampus.

As an important branch of traditional medicines,medicinal marine organisms have many advantages,including biological diversity,remarkable biological activity,especial for the treatment of anti-cancer,anti-virus,anti-coagulation,analgesia,anti-bacterial,cardiovascular and cerebrovascular diseases. In recent years,with the continuous exploration of marine organisms by human beings,many marine organisms with specific biological activities and medicinal prospects have been found,which have attracted great attention around the world and thus called " new hope" to solve human health problems. However,due to the rapid development of modern industry,heavy metal pollution not only poses a great threat to medicinal marine living resources,but also hinders the development of marine biomedical industry and threatens human health. In view of this,this paper introduced the development trend of medicinal marine organisms and the current situation of heavy metal pollution and focusing on the analysis technology and chemical removal technology of heavy metals in medicinal marine organisms,which is to provide reference for the heavy metals control in marine medicines and the development and utilization of marine medicines.
Aquatic Organisms ; China ; Environmental Monitoring ; Medicine, Chinese Traditional ; Metals, Heavy/analysis* ; Water Pollutants, Chemical/analysis*

In order to further improve the quality and safety evaluation standards of traditional Chinese medicine compound preparation,Xiaochaihu Tang compound preparations were selected to analyze the pollution level of heavy metals deeply,and the potential health risks were evaluated under taking such kind of compound preparations. In this study,the contents of copper( Cu),arsenic( As),cadmium( Cd),mercury( Hg),and lead( Pb) in different Xiaochaihu Tang compound preparations were determinated by the method of inductively coupled plasma mass spectrometry( ICP-MS). Moreover,combined with target hazard coefficient method and in vitro artificial system,the bioaccessibility and health risk level was investigated in three main consumption ways including powder,decoction and granule. The result was showed that,under the maximum residual limit set by International Standard Organization,only one batch of raw herb was eight times exceeded the Hg MRL,however,in water decoctions and granules,the heavy metal residue rate was reduced to 2. 02%( Hg in granules)-42. 85%( Cd in granules). So,the heavy metal pollutions and health risks can be reduced to safe region in spite of the serious pollution in raw herbs. Besides,the THQ and CR values of the three consumption methods were lower than the standard values of non-carcinogenic and carcinogenic risks of each heavy metal. It can be seen that even if the heavy metals in the raw herbs exceed the standard,the use of Xiaochaihu Tang decoction and granules can reduce the harm of heavy metals to the human body. Above all,the establishment of this health risk assessment model can be provided experimental basis and reference value for improving the safety evaluation standard of other heavy metals contained traditional Chinese medicine( TCM) compound preparations,and further improving the quality control methods of other different toxic compounds in clinical use.
China ; Drug Contamination ; Drugs, Chinese Herbal/analysis* ; Environmental Pollution ; Humans ; Metals, Heavy/analysis* ; Risk Assessment