OBJECTIVE To evaluate the impact of the specialized centralized procurement policy for insulin on daily cost and affordability of insulin， and provide data support for the enhancement of relevant policies. METHODS In this research， the insulin purchasing data were obtained from provincial centralized procurement platforms in provinces before and after the specialized centralized procurement of insulin （October-December 2021 and October-December 2022）， and the cost variations of insulin before and after the centralized procurement were analyzed by the defined daily dose cost （DDDc） of various types of insulins. The changes in the affordability of various types of insulins before and after the specialized centralized procurement were evaluated， using the percentage of annual expenditure on various types of insulins relative to annual per capita disposable income （i.e. the proportion of annual expenditure） as an indicator. RESULTS After the specialized centralized procurement， DDDc of various types of insulins decreased by 20.7%-71.8%， with an average reduction of 45.7%. Moreover， the reduction in DDDc for third-generation insulin exceeded that for second-generation insulin. The reduction in the proportion of annual expenditure on insulin ranged from 24.3% to 73.4%， with an average decrease of 48.5%. Premixed insulin analogs experienced the greatest reduction （73.4%）. Following the specialized centralized procurement， DDDc of insulin decreased in all provinces. Except for Guangxi （10.2%）， the average proportion of annual expenditure on insulin in the remaining provinces dropped to below 10%. CONCLUSIONS The specialized centralized procurement policy for insulin has significantly reduced insulin costs and improved affordability， thereby alleviating the economic pressure on patients with diabetes. There are notable cost disparities among provinces and among insulin categories， which require attention.

Objective To analyze the short-term clinical outcomes of emergency conversion to surgery during transcatheter aortic valve replacement (TAVR). Methods Clinical data of patients who underwent emergency surgical conversion from TAVR in the Department of Cardiovascular Surgery, the Second Hospital of Hebei Medical University, from 2018 to 2023 were collected. Postoperative follow-up results at 1 month were recorded. Results A total of 253 patients underwent TAVR, of whom 11 (4.3%) required emergency conversion to surgery. Among these 11 patients, 7 were male and 4 were female, with a mean age of (69.55±5.01) years. The primary cause for emergency surgical conversion was valve stent displacement (63.6%), followed by left ventricular perforation/rupture (18.2%) and significant perivalvular regurgitation persisting after a second valve implantation (18.2%). One (9.1%) patient died intraoperatively. Among the 10 surviving patients, postoperative complications included pulmonary infection in 8 patients, severe pneumonia in 7, pleural effusion in 3, liver dysfunction in 8, renal dysfunction in 3, upper gastrointestinal bleeding in 5, cerebrovascular complications in 1, atrial fibrillation in 1, ventricular premature contractions in 1, atrioventricular block in 1, and complete left bundle branch block in 3. At 1-month postoperative follow-up, one additional patient died, yielding a 30-day mortality rate of 18.2% after TAVR emergency surgical conversion. The quality of life improved significantly compared to preoperative status in 9 (81.8%) patients, and no patients were readmitted for cardiovascular diseases. Conclusion The incidence of emergency conversion to surgery during TAVR is low, but the rates of surgical complications and 30-day postoperative mortality are high. Nevertheless, when severe complications occur during TAVR, emergency conversion to surgery can still yield satisfactory short-term clinical outcomes for a majority of these patients.

Objective To investigate the frequency of therapy-oriented oral radiation in Nanping, China and its distribution, and to provide a basis for the rational application of therapy-oriented oral radiation and the effective allocation of resources in Nanping. Methods A questionnaire was designed to investigate the frequency of therapy-oriented oral radiation in all oral radiation diagnosis and treatment institutions in Nanping. Results In 2021, there were 54 oral radiation diagnosis and treatment institutions and 79 oral radiation machines in Nanping. The total frequency of therapy-oriented oral radiation was 61593 visits and the radiation frequency was 19.54 visits per thousand patients. The average annual frequency of medical institutions at all levels was 721.87 to 3713.25 visits per institution; the male-to-female composition ratio of frequency of therapy-oriented oral radiation in December 2021 was 50.5%:49.5%. The proportion of radiation frequency of different devices was as follows: 38.7% (intraoral dental film), 46.5% (oral panorama), 10.3% (oral computed tomography [CT]), and 4.5% (cranial photography). The proportion of radiation frequency in patients of different ages was as follows: 17.1% (0−15 years), 48.2% (15−40 years), and 34.7% (over 40 years). The frequency of therapy-oriented oral radiation grew by 77.43%, 35.18%, and 8.16% every two years from 2015 to 2021, respectively. Conclusion The frequency level of therapy-oriented oral radiation in Nanping is at the level of Class II health care. The distribution of therapy-oriented oral radiation is highly unbalanced and is related to the level of economic development. Private healthcare institutions are growing rapidly, and public healthcare institutions of grade two and above occupy the main healthcare resources. The oral panorama accounts for the most, cranial photography accounts for the least, and oral CT is the fastest-growing portion. Therapy-oriented oral radiation is predominantly performed in the young and middle-aged populations, regardless of sex. Except for intraoral dental films, the general trend is upward.

Objective To explore the efficacy of a new anti-heart failure drug,Entresto,in the prevention of cardiotoxicity caused by doxorubicin(DOX).Methods Male adult ICR mice were randomly divided into three groups(n = 8):control group,DOX group and DOX plus Entresto group.Cardiac function of mice was measured by echocardiography.H9c2 cells were pretreated with Entresto(0-48 μmol/L)for 24 hours in the presence or absence of DOX(1 mmol/L),and then cell viability,oxidative stress,apoptosis and mitochondrial function were evaluated.Results As compared with the control group,leakage of CK,CK-MB and LDH increased significantly in the DOX group(P<0.01),and left ventricular systolic dysfunction occurred.Entresto administration reversed these changes in the DOX group.The level of ROS and the number of apoptotic cells in cardiomyocytes in the DOX plus Entresto group were lower than those in the DOX group(P<0.05).As compared with the DOX group,the level of ROS and the number of apoptotic cells in H9c2 cells decreased significantly in the Entresto plus DOX group(P<0.05),and mitochondrial membrane potential increased significantly(P<0.05).Entresto reversed the inhibitory effect of DOX on SIRT1/PGC-1α/MFN2 signaling pathway.Conclusions Entresto improves DOX-induced cardiotoxicity by inhibiting ROS-mediated oxidative stress and apoptosis,and its mechanism may be related to SIRT1/PGC-1α/MFN2 signal transduction pathway.

Background::Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized immune-mediated disorder that can affect almost any organ in the human body. IgG4-RD can be categorized into proliferative and fibrotic subtypes based on patients’ clinicopathological characteristics. This study aimed to compare the clinical manifestations, laboratory findings, and treatment outcomes of IgG4-RD among different subtypes.Methods::We prospectively enrolled 622 patients with newly diagnosed IgG4-RD at Peking Union Medical College Hospital from March 2011 to August 2021. The patients were divided into three groups according to their clinicopathological characteristics: proliferative, fibrotic, and mixed subtypes. We compared demographic features, clinical manifestations, organ involvement, laboratory tests, and treatment agents across three subtypes. We then assessed the differences in treatment outcomes among 448 patients receiving glucocorticoids alone or in combination with immunosuppressants. Moreover, risk factors of relapse were revealed by applying the univariate and multivariate Cox regression analysis.Results::We classified the 622 patients into three groups consisting of 470 proliferative patients, 55 fibrotic patients, and 97 mixed patients, respectively. We found that gender distribution, age, disease duration, and frequency of allergy history were significantly different among subgroups. In terms of organ involvement, submandibular and lacrimal glands were frequently involved in the proliferative subtype, while retroperitoneum was the most commonly involved site in both fibrotic subtype and mixed subtype. The comparison of laboratory tests revealed that eosinophils ( P = 0.010), total IgE ( P = 0.006), high-sensitivity C-reactive protein ( P <0.001), erythrocyte sedimentation rate ( P <0.001), complement C4 ( P <0.001), IgG ( P = 0.001), IgG1 (P <0.001), IgG4 (P <0.001), and IgA ( P <0.001), at baseline were significantly different among three subtypes. Compared with proliferative and mixed subtypes, the fibrotic subtype showed the lowest rate of relapse (log-rank P = 0.014). Conclusions::Our study revealed the differences in demographic characteristics, clinical manifestations, organ involvement, laboratory tests, treatment agents, and outcomes across proliferative, fibrotic, and mixed subtypes in the retrospective cohort study. Given significant differences in relapse-free survival among the three subtypes, treatment regimens, and follow-up frequency should be considered separately according to different subtypes.Trial Registration::ClinicalTrials. gov, NCT01670695.

Objective To explore the effect of cluster nursing intervention in elderly patients with swallowing dysfunction. Methods A total of 105 elderly patients with a Water Swallowing Test (WST) score of ≥3 and a Fried Frailty Phenotype (FP) score of ≥33 admitted to the department of geriatrics in our hospital from August 2022 to December 2023 were selected as research subjects and randomly divided into study group (n=55) and control group (n=50). The control group received routine nursing care for swallowing dysfunction, while the study group received cluster nursing care. The frailty status, swallowing disorders, and quality of life were compared between the two groups after 1 month of intervention. Results Due to changes in the condition, 2 cases dropped out from the control group and 3 cases from the study group, leaving 52 cases in the study group and 48 cases in the control group. There was no statistically significant difference in general information between the two groups (P>0.05). Before the intervention, there was no statistically significant difference in the proportion of patients with different WST grades between the two groups (P>0.05). After 1 month of intervention, there was a statistically significant difference in the proportion of patients with WST grades 3, 4, and 5 compared to before the intervention (P < 0.05). After 1 month of intervention, there was a statistically significant difference in the proportion of patients with different WST grades between the two groups (P < 0.05). Before the intervention, the Swallowing-Quality of Life(SWAL-QOL) score of the study group was (108.47±19.99) points, and was (109.17±20.34) points in the control group. There was no statistically significant difference in SWAL-QOL scores between the two groups before the intervention (P>0.05). After 1 month of intervention, the SWAL-QOL score of the study group was (143.07±16.55) points, and was (133.52±21.06) points in the control group. The SWAL-QOL scores of both groups improved compared to before the intervention, and the study group had a higher score than the control group (P < 0.05). Conclusion Cluster nursing for elderly patients with swallowing disorders and frailty can effectively improve their frailty status, swallowing function, and quality of life.

Objective To investigate the effect of early postoperative activities on rehabilitation and discharge in hepatocellular carcinoma patients with portal hypertension.Methods A total of 423 patients who underwent surgical treatment for hepatocellular carcinoma with portal hypertension in The Third Affiliated Hospital of Naval Medical University from June 2019 to June 2021 were collected as research objects.There were 348 patients without early postoperative activity and 75 patients with early postoperative activity.The impacts of preoperative factors(age,gender,smoking history,etc.)and intraoperative factors(intraoperative hepatic portal block,perioperative blood transfusion,and tumor size)on postoperative recovery of patients were analyzed.In order to reduce the selection bias,75 patients were chosen from 348 patients without early postoperative activity by propensity score matching and taken as non-early activity group.Early postoperative complications,gastrointestinal function recovery(including first ventilation time,abdominal distension,and diarrhea),postoperative hospital stay,and total hospital stay were compared between non-early activity group and early activity group before and after propensity score matching.Results There was no significant difference in the incidences of serious postoperative complications,postoperative diarrhea,or total length of hospital stay between non-early activity group and early activity group before and after propensity score matching(P>0.05).But there were significant differences in the incidences of first ventilation time,postoperative abdominal distension,and postoperative hospital stay between the two groups(P<0.05).Conclusion Early postoperative activities can accelerate the recovery of gastrointestinal function in portal hypertension patients undergoing hepatectomy,promote the intake and absorption of nutrients,facilitate the recovery of postoperative liver function,shorten the postoperative hospital stay,and promote the early recovery of patients.

Objective To explore the relationship between serum lipoprotein(a),Apelin-13,and transforming growth factor beta 1(TGF-β1)and left atrial diameter(LAD)in patients with atrial fibrillation(AF).Methods A total of 100 patients who were admitted to Chuzhou First People's Hospital between December 2022 and January 2024 were selected as research objects.There were 50 patients with AF(AF group)and 50 patients without AF(NAF group).Serum levels of lipoprotein(a),Apelin-13,and TGF-β1 were detected,and LAD were measured by transthoracic echocardiography.Results Compared with those in the NAF group,lipoprotein(a),TGF-β1 and LAD were increased significantly in the AF group,while Apelin-13 was decreased significantly(P<0.05).Multivariable logistic regression revealed that lipoprotein(a),TGF-β1,diastolic blood pressure and LAD were risk factors of AF,while Apelin-13 was a protective factor of AF(P<0.05).Furthermore,lipoprotein(a),TGF-β1,LAD and Apelin-13 had predictive value for AF(P<0.05).Linear regression results showed that the coefficients of lipoprotein(a),TGF-β1 and Apelin-13 influencing on LAD were 0.01(P>0.05),-0.04(P>0.05)and-1.22(P<0.05),respectively.Conclusion Lipoprotein(a),TGF-β1 and LAD are independent risk factors of AF.However,lipoprotein(a)and TGF-β1 have no notable relation with LAD.As an independent protective factor of AF,Apelin-13 is significantly negatively correlated with LAD.

Objective: To explore the social functioning characteristics of children with co ocurrence of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) for intervention reference. Methods: The Chinese Version of Swanson Nolan and Pelham, Version IV Scale-Parent Form(SNAP-IV), the Chinese Version of Weiss Functional Impairment Scale-Parent(WFIRS-P), and the Questionnaire-Children with Difficulties (QCD) were applied to 192 children with ADHD, 243 children with co occurrence of ADHD and ODD, who firstly visited the Department of Children Psychological Health of Zhuhai Maternal and Child Health Care Hospital, and 118 healthy control children from a school in Zhuhai. Results: The scores of attention deficit factor in SNAP-Ⅳ scale of children in three groups were[1.9(1.7, 2.1), 1.8(1.6, 1.9), 1.0(0.6, 1.2)], the scores of hyperactive impulsivity were[1.8(1.4, 2.1), 1.6(1.1, 1.8), 0.7(0.2, 1.0)] the scores of oppositional defiant were[1.6(1.5, 1.9), 1.0(0.8,1.1), 0.8(0.5, 1.0)], the differences were statistically significant( H=268.44, 237.97, 418.66, P <0.01). The dimensions and total scores of the three groups of children s WFIRS-P scale were family[0.8(0.6, 1.1), 0.6(0.3, 0.8), 0.3(0.1, 0.6)]; learning and school[0.8(0.5, 1.1), 0.8(0.5, 1.0), 0.3(0.1, 0.5)]; life skills[1.0(0.7, 1.2), 0.8(0.6, 1.0), 0.6(0.4, 0.8)]; self management [1.0(0.3, 1.0), 0.7(0.3, 1.0), 0.3(0.0, 0.7)]; social activities [0.7(0.4, 1.0), 0.6(0.3, 0.9), 0.3(0.0, 0.4 )]; adventure activities[0.3(0.2, 0.5), 0.2(0.1, 0.4), 0.1(0.0, 0.2)]; the total score[0.8(0.6, 1.0), 0.6(0.5, 0.8), 0.4( 0.2 , 0.6)], the difference between the groups was statistically significant( H=108.82, 122.45, 60.17, 40.58, 96.17, 76.57, 138.30, P <0.01). The difference between the QCD scale scores of children in the three groups was statistically significant[30.0( 24.0 , 37.0), 32.0(27.0, 40.0), 47.0(37.0, 52.3), H=124.65, P <0.01). Multiple regression analysis showed that attention deficit, and oppositional defiant symptoms were associated with both the total WFIRS-P score and the QCD score of children( R 2= 0.40 , 0.25, P <0.05). Conclusion Children with co occurrence of ADHD and ODD have more severe deficits in all dimensions of social functioning than children with ADHD, which might be associated with attention deficit and oppositional defiant symptoms.