With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

OBJECTIVE To observe the clinical efficacy of donafenib combined with programmed death-1 （PD-1） inhibitors and vascular intervention therapy in the treatment of unresectable hepatocellular carcinoma （HCC）. METHODS This retrospective study included 165 patients with unresectable HCC who were treated at the Fourth and First Affiliated Hospitals of Soochow University between June 2022 and March 2023. Among them， 89 patients received PD-1 inhibitors （tislelizumab or sintilimab， similarly hereinafter） plus vascular intervention （control group） and 76 patients received donafenib in combination with PD-1 inhibitors and vascular intervention （observation group）. Short-term efficacy （3 months after treatment）， long-term efficacy （2 years after treatment）， the levels of liver function indexes [serum alanine amino-transferase （ALT）， aspartate transferase （AST）， and total bilirubin （TBil）] and tumor biomarkers [alpha fetoprotein （AFP）， carcinoembryonic antigen （CEA）， carbohydrate antigen 19-9 （CA19-9）， and des-gamma-carboxy prothrombin （DCP）] before treatment and after 3 months of treatment， as well as the occurrence of adverse drug reaction （ADR） during treatment， were compared between the two groups. In addition， overall response rate （ORR） stratified by PD-1 inhibitor type was analyzed. RESULTS After treatment， the ORR was significantly higher in the observation group than in the control group （P＜0.05）； although the disease control rate was higher in the observation group compared to the control group， the difference was not statistically significant （P＞0.05）. The median overall survival of patients in the observation group was 16.9 months [95% confidence interval （CI）： 14.2 to 19.1 months]， which was significantly longer than that in the control group （12.4 months， 95%CI： 10.1 to 15.3 months） （P＜0.05）. Subgroup analysis result indicated that therapeutic advantage was consistent across both sintilimab and tislelizumab subgroups， with no significant heterogeneity （P＞0.1， I 2＜0.001%）. Before treatment， there were no significant differences in liver function indexes or tumor marker levels between 2 groups （P＞0.05）. After treatment， both groups showed significant declines in these indicators compared with baseline （P＜0.05）， with greater reductions observed in the observation group （P＜0.05）. There were no statistically significant differences in overall incidence of ADR and grade ≥3 ADRs between the two groups （P＞0.05）. CONCLUSIONS For patients with unresectable HCC， the combination of donafenib， PD-1 inhibitors and vascular intervention therapy may achieve superior clinical outcomes without increasing the risk of treatment-related ADR.

The Diagnosis-Intervention Packet(DIP)payment exerts notable effects on hospitals' economic operations.As centralized hubs of high-quality medical resources,tertiary hospitals face a functional mismatch with the provision of services for primary care diseases.By analyzing the admission and payment practices for primary care diseases in sample hospitals in Henan Province,it identifies key challenges,including inadequate alignment between healthcare payment reform policies and management systems,weak foundational capabilities in hospital health insurance informatization,and insufficient awareness of health insurance policies among medical staff.It is recommended that hospitals should strengthen communication and coordination with health insurance administration agencies to foster positive interactions between healthcare providers and insurers;continuously advance in-house health insurance informatization and enhance data governance capabilities;improve strategic awareness and innovate value-based health insurance management models.

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: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.

The Diagnosis-Intervention Packet(DIP)payment exerts notable effects on hospitals' economic operations.As centralized hubs of high-quality medical resources,tertiary hospitals face a functional mismatch with the provision of services for primary care diseases.By analyzing the admission and payment practices for primary care diseases in sample hospitals in Henan Province,it identifies key challenges,including inadequate alignment between healthcare payment reform policies and management systems,weak foundational capabilities in hospital health insurance informatization,and insufficient awareness of health insurance policies among medical staff.It is recommended that hospitals should strengthen communication and coordination with health insurance administration agencies to foster positive interactions between healthcare providers and insurers;continuously advance in-house health insurance informatization and enhance data governance capabilities;improve strategic awareness and innovate value-based health insurance management models.

Objective:To construct a self-management behavior intervention scheme for diabetic patients based on Health Action Process Approach (HAPA) and to explore its application effects in patients with diabetes mellitus.Methods:By the convenient sampling method, patients with type 2 diabetes mellitus who were hospitalized in the First Hospital of Jilin University were selected as research objects. According to the random number table method, they were divided into the control group ( n=61) and the experimental group ( n=67) . Patients in the control group were given conventional nursing methods while patients in the experimental group were given the intervention scheme based on HAPA. Summary of Diabetes Self Care Activities (SDSCA) and Chinese version of Diabetes Distress Scale (DDS) were used to assess the self-management level and distress before and after intervention. Results:Before intervention, there were no statistically significant differences in SDSCA scores in all dimensions between the two groups ( P>0.05) . After intervention, SDSCA scores in all dimensions were higher in the experimental group than in the control group, and the differences were statistically significant ( P<0.05) . Before intervention, there were no statistically significant differences in DDS scores in all dimensions between the two groups ( P>0.05) . After intervention, DDS scores in all dimensions in the experimental group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . Conclusions:The self-management intervention scheme based on HAPA can improve the self-management behavior of diabetic patients and reduce their psychological distress.

BACKGROUND:With the development and improvement of liver transplantation technology, patients waiting for or undergoing liver transplantation have continued to increase in number. Due to their fears and concerns about post-transplantation rehabilitation, patients are under physical and mental stress, most of whom are shown to have a variety of mental disorders that affect rehabilitation. At present, mental problems of liver transplant patients are more concentrated in post-transplantation research, while patients waiting for liver transplantation do not get enough mental assessment and intervention.
OBJECTIVE:To investigate the suitable mode of cognitive-behavioral therapy for liver transplant recipients waiting for donor liver and to evaluate the effect to improve patient’s physical and mental state.
METHODS:Twelve liver transplant patients who underwent pre-transplantation assessment were randomly divided into experimental group and control group, each group with six cases. The control group received conventional treatment. The experimental group received cognitive-behavioral therapy in addition to conventional treatment. Self-rating anxiety scale (SAS) and vital signs were measured in the two groups on admission, 1 week and 3 weeks after admission.
RESULTS AND CONCLUSION:The SAS score of the experimental group was lower than that of the control group at 1 and 3 weeks after admission, and SAS score decreased as the intervention extended. The systolic blood pressure of the experimental group was lower than that of the control group at 3 weeks after admission, but there was no significant difference in diastolic blood pressure between two groups. The heart rate of the experimental group was lower than that of the control group at 1 and 3 weeks after admission. The respiratory rate of the experimental group was lower than that of the control group at 3 weeks after admission. Cognitive-behavioral therapy can reduce the level of anxiety and keep vital signs stable with good feasibility and effectiveness in patients waiting for liver transplantation.

The transcriptional factor Oct-4 and Survivin are the key regulatory factors in cancer cell proliferation and mitosis. A dual cancer-specific shRNA adenovirus vector, Ad5-Dual-shRNA, targeting Oct-4 and Survivin genes was constructed by molecular cloning and recombination. After cells were infected with virus, hepatocellular carcinoma cell line EHBH-H1 was used for detecting the expression of Oct-4 and Survivin proteins by Western blotting. The viral cytotoxic effect on cancer cells was detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) reduction assay in vitro, and the inhibition effect on tumor xenografts was observed in nude mice. The results showed that the expression of Oct-4 and Survivin in cancer cell line EHBH-H1 could be silenced markedly by Ad5-Dual-shRNA. In MTT and animal experiments, Ad5-Dual-shRNA also represented much stronger anti-tumor effect on tumor growth than Ad5-Surv-shRNA and Ad5-Oct4-shRNA. From this research we can draw a conclusion that the cancer-specific adenovirus vector expressing dual-shRNA targeting Oct-4 and Survivin genes may provide us a more effective, specific and convenient gene therapy method.
Adenoviridae ; genetics ; metabolism ; Animals ; Apoptosis ; genetics ; Carcinoma, Hepatocellular ; pathology ; therapy ; Cell Line, Tumor ; Genetic Therapy ; Genetic Vectors ; genetics ; HEK293 Cells ; Humans ; Inhibitor of Apoptosis Proteins ; biosynthesis ; genetics ; Liver Neoplasms ; pathology ; therapy ; Mice ; Mice, Nude ; Octamer Transcription Factor-3 ; biosynthesis ; genetics ; RNA, Small Interfering ; genetics ; Recombinant Proteins ; biosynthesis ; genetics ; Transfection

Objective Among the various components of metabolic syndrome(MS),this investigation attempt to find the most important one.Furthermore,to verify the feasibility of using waist circumference(WC)for assessing the diagnostic criteria for MS proposed by the CDS in 2004.Methods Among 163 cases recruited,80 patients met the criteria of MS and 83 cases were diagnosed as non-metabolic syndrome group(non-MS).Age,WC,body mass index(BMI),fasting plasma glucose,lipid profile,blood pressure were compared between patients of MS and non-MS.Logistic regression analysis and area under curve(AUC)of receiver-operating characteristic(ROC)were used to study the predictive value of WC.Results Patients with CDS-defined MS showed a significantly higher age,WC,SBP,DBP,fasting plasma glucose,triglycerides(TG),1/HDL-C when compared with non-MS group.After adjusting for age,the family history of diabetes and hypertension,smoke,multiple logistic regression analysis revealed WC was the most important predictive factor for MS group.ROC analysis showed that the AUC of WC was 0.92 in the males,the cut-off value is 89.5 cm,the sensitivity was 0.84,the specificity was 0.93;the AUC of WC was 0.93 in the females,the sensitivity was 0.97,the specificity was 0.81 when cut-off value is 80.8 cm.This investigation has shown that smoking was also a component of MS.The relative risk of MS in current smokers and sustained smoker was higher than that of abstinence(6.88 vs 1.00 and 3.96 vs 1.00).Conclusion Central obesity is the riskest indicator for the diagnostic criteria for MS proposed by the CDS,WC is verified to be the accuracy and satisfactory predictive indicators for MS.Smoking may be a novel component of MS.