Objective To quantitatively evaluate the structure and content of the long-term care insurance(LTCI)policy in China's deeply aging areas.Methods Using the Policy Modeling Consistency(PMC)index model indicator design method,a LTCI policy evalua-tion index system was constructed,consisting of nine primary indicators and 34 secondary indicators.A total of 123 provincial-level LTCI policies issued in deeply aging regions of China between June 1,2014,and October 1,2024 were analyzed.High-frequency word extraction was performed using ROSTCM 6.0,and a social network diagram of LTCI policies was created.The policy structure and content were quantitatively evaluated and ana-lyzed based on the established policy evaluation index system.Results The main content of LTCI policies in deeply aging areas of China covered services,institutions and assessment.The highest policy score was 7.28,and the lowest was 2.20,with an average score of 5.00.There were 25 perfect policies,63 excellent policies,28 good policies and seven qualified policies.In the dimension of policy content,the indexes of five primary indicators of policy evaluation,policy target groups,policy nature,policy perspective and policy tools were 0.60 or more;while the indexes of four primary indicators of policy content,incentives and constraints,policy timeliness,and policy level were 0.50 or less.Conclusion LTCI policies issued in China's deeply aging areas provide comprehensive coverage in aspects such as poli-cy evaluation,policy target groups and policy nature,and need to be improved in policy tool selection and the construction of incentive and constraint mechanisms.

Objective To quantitatively evaluate the structure and content of the long-term care insurance(LTCI)policy in China's deeply aging areas.Methods Using the Policy Modeling Consistency(PMC)index model indicator design method,a LTCI policy evalua-tion index system was constructed,consisting of nine primary indicators and 34 secondary indicators.A total of 123 provincial-level LTCI policies issued in deeply aging regions of China between June 1,2014,and October 1,2024 were analyzed.High-frequency word extraction was performed using ROSTCM 6.0,and a social network diagram of LTCI policies was created.The policy structure and content were quantitatively evaluated and ana-lyzed based on the established policy evaluation index system.Results The main content of LTCI policies in deeply aging areas of China covered services,institutions and assessment.The highest policy score was 7.28,and the lowest was 2.20,with an average score of 5.00.There were 25 perfect policies,63 excellent policies,28 good policies and seven qualified policies.In the dimension of policy content,the indexes of five primary indicators of policy evaluation,policy target groups,policy nature,policy perspective and policy tools were 0.60 or more;while the indexes of four primary indicators of policy content,incentives and constraints,policy timeliness,and policy level were 0.50 or less.Conclusion LTCI policies issued in China's deeply aging areas provide comprehensive coverage in aspects such as poli-cy evaluation,policy target groups and policy nature,and need to be improved in policy tool selection and the construction of incentive and constraint mechanisms.

Objective To investigate the impact of phase Ⅱ cardiac rehabilitation on the rehabilitation needs and physical activity status of patients after coronary heart disease intervention.Methods A total of 90 patients with coronary heart disease who underwent percutaneous coronary intervention(PCI)in the Coronary Heart Disease Center of the hospital from August 2023 to August 2024 were selected as the research subjects.They were subjected to a 12-week standardized phase Ⅱ cardiac rehabilitation training.General data survey forms,cardiac rehabilitation scales,and the International Physical Activity Questionnaire were used for scale surveys to understand the patients' needs before and after rehabilitation and their weekly physical activity en-ergy expenditure.The cardiopulmonary exercise test gold standard,which reflects exercise capacity through three indicators-maximum oxygen uptake(VO2 max),anaerobic threshold(AT),and metabolic equivalents(MET),were used to compare the physical activity status before and after cardiac rehabilitation.Results Compared with before the implementation,after the implementation of cardiac rehabilitation,the autonomy score in-creased(21.36±1.85 vs.16.73±3.28),the process anxiety(12.60±3.87 vs.14.27±2.12)and outcome anxiety scores(2.31±1.76 vs.4.56±3.56)decreased,the level of low-intensity physical activity decreased[(2 711.62±1 487.09)min/week vs.(3 845.97±2 083.71)min/week],the levels of moderate-intensity[(1 314.67±783.54)min/week vs.(686.22±126.79)min/week],high-intensity[(1 861.33±798.27)min/week vs.(112.00±40.77)min/week],and total physical activity increased[(5 887.62±2 843.54)min/week vs.(4 644.19±2 287.16)min/week].The levels of VO2 max[(28.11±14.28)mL·min-1·kg-1 vs.(23.82±12.34)mL·min-1·kg-1],AT[(16.06±5.41)mL·min-1·kg-1 vs.(13.53±4.56)mL·min-1·kg-1],and MET[(6.89±1.59)mL·min-1·kg-1 vs.(5.78±1.21)mL·min-1·kg-1]all in-creased,with statistically significant differences(P＜0.05).Conclusion Phase Ⅱ rehabilitation after PCI can effectively improve patients' physical activity levels.

INTRODUCTION: Paediatric sexual assault (SA) victims should be assessed for post-exposure prophylaxis (PEP) to mitigate the risk of sexually transmitted infections (STIs). We describe the clinical characteristics of children and young persons (CYPs) presenting with SA at KK Women's and Children's Hospital in Singapore, viral PEP (human immunodeficiency virus [HIV] and hepatitis B virus [HBV]) prescribing practices, and STI evaluation at follow-up. METHOD: Medical records of CYPs ≤16 years who presented with SA between January 2022 and August 2023 were reviewed, including assault and assailant characteristics, baseline and follow-up STI screening, PEP prescription, adherence and follow-up attendance. CYPs with SA in the preceding 72 hours by HIV-positive or HIV-status unknown assailants with high-risk characteris-tics were eligible for HIV PEP. RESULTS: We analysed 278 CYPs who made 292 SA visits. There were 40 (13.7%) CYPs eligible for HIV PEP, of whom 29 (82.9%) received it. Among those tested at baseline, 9% and 34.9% of CYPs tested positive for Chlamydia trachomatis and Gardnerella vaginalis, respectively. None tested positive for Neisseria gonorrhoeae, Trichomonas vaginalis, HIV, HBV or hepatitis C. Majority of CYPs tested were HBV non-immune (n=167, 67.6%); only 77 (46.1%) received the vaccine. Out of 27 CYPs eligible for HBV PEP with immunoglobulin, only 21 (77.7%) received immunoglobulin. A total of 37 CYPs received HIV PEP, including 8 who were retrospectively deemed ineligible. Only 10 (27%) completed the course. Overall, 153 (57.7%) CYPs attended follow-up, and none seroconverted for HIV or HBV. CONCLUSION We report suboptimal rates of HBV post-exposure vaccination, and low compliance to HIV PEP and follow-up among paediatric SA victims. Factors contri-buting to poor compliance should be examined to optimise care for this vulnerable population.
Humans ; Post-Exposure Prophylaxis/methods* ; Female ; Child ; Adolescent ; Singapore/epidemiology* ; HIV Infections/prevention & control* ; Male ; Sexually Transmitted Diseases/epidemiology* ; Retrospective Studies ; Hepatitis B/prevention & control* ; Follow-Up Studies ; Child, Preschool ; Sex Offenses/statistics & numerical data* ; Child Abuse, Sexual

Immunotherapy represents the third revolution in the pharmacological treatment of tumors and has demonstrated considerable efficacy in the management of malignant solid tumors, including melanoma and lung cancer. By contrast, breast cancer is frequently categorized as a “cold tumor” because of its limited immunogenicity and immunoreactivity, which hinder research progress and clinical outcomes in immunotherapy. Only a small proportion of patients derive benefits from immunotherapeutic interventions, and the development of drug resistance remains a concern. In this regard, novel strategies should be explored for converting immunologically inert “cold tumors” into immunologically active “hot tumors”, thereby expanding the population that will benefit from breast cancer immunotherapy. This study reviews new strategies to transform breast cancer from “cold tumor” to “hot tumor”. Strategies include enhancing the expression of tumor antigens, promoting immune infiltration, and reversing the immunosuppressive microenvironment. Results also emphasize the importance of comprehensive treatment to enhance systemic immunity.

Objective:To analyze the impact of changes in cardiovascular and cerebrovascular diseases mortality on the gender gap in life expectancy among Tianjin residents from 2004 to 2020.Methods:This is a cross-sectional study. The data sources included all-cause death surveillance data collected by the Tianjin Centre for Disease Control and Prevention, covering the entire population of Tianjin from 2004 to 2020, and the number of urban and rural residents by age, sex, and urban and rural areas from the Population Management Office of the Tianjin Public Security Bureau during the same period. The abbreviated life table and Arriaga′s decomposition method were applied to analyze the cause-of-death surveillance data of Tianjin residents from 2004 to 2020, and to calculate the impact of changes in mortality rates of cardiovascular and cerebrovascular diseases on gender differences in life expectancy by age, subcategory, and urban and rural areas.Results:In 2004, there were 56 189 deaths among Tianjin residents, including 31 233 males and 24 956 females. In 2020, there were 79 782 deaths among Tianjin residents, including 44 829 males and 34 953 females. The gender difference in life expectancy attributable to cardiovascular and cerebrovascular diseases among Tianjin residents increased from 1.52 years in 2004 to 2.02 years in 2020, with females having a longer life expectancy than males. The cumulative impact rate was higher among residents aged 40-74 years, increasing from 26.41% to 33.48%, while the cumulative impact rate among residents aged≥75 declined from 12.66% to 8.54%. The impact rates of intracerebral hemorrhage and cerebral infarction decreased significantly during the observation period, with intracerebral hemorrhage impact rate decreasing from 13.21% to 6.12% and cerebral infarction impact rate decreasing from 11.32% to 5.02%. The impact rate of acute myocardial infarction decreased but remained at a high level, from 9.70% to 6.99%. The impact rate of sequelae of cerebrovascular disease and other coronary heart diseases increased significantly, with the impact rate of sequelae of cerebrovascular disease increasing from 0.54% to 14.42% and the impact rate of other coronary heart diseases rising from 1.35% to 6.34%. The impact of sequelae of cerebrovascular disease deaths on the gender difference in life expectancy was greater in urban areas compared to rural areas, with an increase of 2 101.41% in urban areas and 1 898.51% in rural areas.Conclusions:The gender difference in life expectancy attributable to cardiovascular and cerebrovascular diseases among Tianjin residents is widening. Attention should be paid to the prevention of cerebrovascular disease sequelae and other coronary heart diseases among males aged of 40-74 years in urban areas.

Objective:To analyze the impact of changes in cardiovascular and cerebrovascular diseases mortality on the gender gap in life expectancy among Tianjin residents from 2004 to 2020.Methods:This is a cross-sectional study. The data sources included all-cause death surveillance data collected by the Tianjin Centre for Disease Control and Prevention, covering the entire population of Tianjin from 2004 to 2020, and the number of urban and rural residents by age, sex, and urban and rural areas from the Population Management Office of the Tianjin Public Security Bureau during the same period. The abbreviated life table and Arriaga′s decomposition method were applied to analyze the cause-of-death surveillance data of Tianjin residents from 2004 to 2020, and to calculate the impact of changes in mortality rates of cardiovascular and cerebrovascular diseases on gender differences in life expectancy by age, subcategory, and urban and rural areas.Results:In 2004, there were 56 189 deaths among Tianjin residents, including 31 233 males and 24 956 females. In 2020, there were 79 782 deaths among Tianjin residents, including 44 829 males and 34 953 females. The gender difference in life expectancy attributable to cardiovascular and cerebrovascular diseases among Tianjin residents increased from 1.52 years in 2004 to 2.02 years in 2020, with females having a longer life expectancy than males. The cumulative impact rate was higher among residents aged 40-74 years, increasing from 26.41% to 33.48%, while the cumulative impact rate among residents aged≥75 declined from 12.66% to 8.54%. The impact rates of intracerebral hemorrhage and cerebral infarction decreased significantly during the observation period, with intracerebral hemorrhage impact rate decreasing from 13.21% to 6.12% and cerebral infarction impact rate decreasing from 11.32% to 5.02%. The impact rate of acute myocardial infarction decreased but remained at a high level, from 9.70% to 6.99%. The impact rate of sequelae of cerebrovascular disease and other coronary heart diseases increased significantly, with the impact rate of sequelae of cerebrovascular disease increasing from 0.54% to 14.42% and the impact rate of other coronary heart diseases rising from 1.35% to 6.34%. The impact of sequelae of cerebrovascular disease deaths on the gender difference in life expectancy was greater in urban areas compared to rural areas, with an increase of 2 101.41% in urban areas and 1 898.51% in rural areas.Conclusions:The gender difference in life expectancy attributable to cardiovascular and cerebrovascular diseases among Tianjin residents is widening. Attention should be paid to the prevention of cerebrovascular disease sequelae and other coronary heart diseases among males aged of 40-74 years in urban areas.

Background::In vitro fertilization (IVF) has emerged as a transformative solution for infertility. However, achieving favorable live-birth outcomes remains challenging. Current clinical IVF practices in IVF involve the collection of heterogeneous embryo data through diverse methods, including static images and temporal videos. However, traditional embryo selection methods, primarily reliant on visual inspection of morphology, exhibit variability and are contingent on the experience of practitioners. Therefore, an automated system that can evaluate heterogeneous embryo data to predict the final outcomes of live births is highly desirable. Methods::We employed artificial intelligence (AI) for embryo morphological grading, blastocyst embryo selection, aneuploidy prediction, and final live-birth outcome prediction. We developed and validated the AI models using multitask learning for embryo morphological assessment, including pronucleus type on day 1 and the number of blastomeres, asymmetry, and fragmentation of blastomeres on day 3, using 19,201 embryo photographs from 8271 patients. A neural network was trained on embryo and clinical metadata to identify good-quality embryos for implantation on day 3 or day 5, and predict live-birth outcomes. Additionally, a 3D convolutional neural network was trained on 418 time-lapse videos of preimplantation genetic testing (PGT)-based ploidy outcomes for the prediction of aneuploidy and consequent live-birth outcomes.Results::These two approaches enabled us to automatically assess the implantation potential. By combining embryo and maternal metrics in an ensemble AI model, we evaluated live-birth outcomes in a prospective cohort that achieved higher accuracy than experienced embryologists (46.1% vs. 30.7% on day 3, 55.0% vs. 40.7% on day 5). Our results demonstrate the potential for AI-based selection of embryos based on characteristics beyond the observational abilities of human clinicians (area under the curve: 0.769, 95% confidence interval: 0.709–0.820). These findings could potentially provide a noninvasive, high-throughput, and low-cost screening tool to facilitate embryo selection and achieve better outcomes. Conclusions::Our study underscores the AI model’s ability to provide interpretable evidence for clinicians in assisted reproduction, highlighting its potential as a noninvasive, efficient, and cost-effective tool for improved embryo selection and enhanced IVF outcomes. The convergence of cutting-edge technology and reproductive medicine has opened new avenues for addressing infertility challenges and optimizing IVF success rates.

Objective To develop and validate a deep learning model for automatic identification of liver CT contrast-enhanced phases.Methods A total of 766 patients with liver CT contrast-enhanced images were retrospectively collected.A three-phase classification model and an arterial phase(AP)classification model were developed,so as to automatically identify liver CT contrast-enhanced phases as early arterial phase(EAP)or late arterial phase(LAP),portal venous phase(PVP),and equilibrium phase(EP).In addition,221 patients with liver CT contrast-enhanced images in 5 different hospitals were used for external validation.The annotation results of radiologists were used as a reference standard to evaluate the model performances.Results In the external validation datasets,the accuracy in identifying each enhanced phase reached to 90.50%-99.70%.Conclusion The automatic identification model of liver CT contrast-enhanced phases based on residual network may provide an efficient,objective,and unified image quality control tool.

OBJECTIVE To investigate the effect of Huangqi-Ezhu-Chonglou combination on macrophage polarization and its mechanism of inhibiting colorectal cancer(CRC)cells proliferation and migration.METHODS THP-1 cells were stimulated with phorbol 12-myristate 13-acetate(PMA)and interleukin-4(IL-4)to establish M2 macrophage polarization model.The experiment was divided into M0 group(PMA treatment),M2 group(PMA+IL-4 treatment),and M2+ Huangqi-Ezhu-Chonglou combination group(PMA+IL-4+Huangqi-Ezhu-Chonglou combination treatment).The effect of Huangqi-Ezhu-Chonglou combination freeze-dried powder on the viability of macrophage was detected by CCK-8 method.The expression of macrophage polarization markers,glu-taminase(GLS)mRNA and protein was detected by qPCR and Western blot.The levels of interleukin-10(IL-10),transforming growth factor-β(TGF-β)and tumor necrosis factor-α(TNF-α)in cell supernatant were detected by ELISA.CCK-8 method and Tr-answell assays were used to detect the proliferation and migration of HCT116 cells intervened by the supernatant of macrophage culture treated with Huangqi-Ezhu-Chonglou combination,namely conditioned medium(CM).RESULTS Compared with the M0 group,the expression levels of IL-10,mannose receptor(CD206),arginase 1(ARG1),and GLS mRNA and protein in the M2 group were significantly increased(P<0.01,P<0.001),the levels of IL-10 and TGF-β secreted by macrophages were significantly increased(P<0.01,P<0.001);compared with the M2 group,the M2+ Huangqi-Ezhu-Chonglou combination group had significantly reduced IL-10,CD206,ARG1,and GLS mRNA and protein expression(P<0.05,P<0.01),the mRNA and protein levels of TNF-α and in-ducible nitric oxide synthase(iNOS)were significantly increased(P<0.05,P<0.01,P<0.001),the interleukin-1β(Interleukin-1β,IL-1β)mRNA expression significantly increased(P<0.01),and the contents of IL-10 and TGF-β in the cell supernatant sig-nificantly decreased(P<0.05,P<0.01),while TNF-α content significantly increased(P<0.01).CCK-8 and Transwell results showed that compared with the M0-CM group,the M2-CM promoted the proliferation and migration of HCT116 cells(P<0.01,P<0.001),the M2+ Huangqi-Ezhu-Chonglou-CM group significantly inhibited HCT116 cell proliferation and reduced cell migration compared to the M2-CM group(P<0.01,P<0.001).CONCLUSION Huangqi-Ezhu-Chonglou combination can inhibit colorectal cancer cells proliferation and migration by regulating macrophage polarization,and its mechanism may be related to the changes in the expression of GLS,a key enzyme in glutamine metabolism.