The article summarizes the differentiated effects of personal account reform on the satisfaction of different in-come groups in the reform of medical insurance outpatient mutual aid.This reform has significantly improved the mutual aid pro-tection offered by medical insurance funds through comprehensive measures such as adjusting the personal account accounting method,promoting coordination of medical treatment in different places,strengthening guidance for first visits at the grassroots level,and expanding the coverage of outpatient coordination.Satisfaction levels varied significantly across income groups,with high-income groups expressing lower satisfaction due to reduced personal account accumulation.The satisfaction of the middle-in-come group increased due to the reduced burden of outpatient expenses.While low-income groups benefited from higher reim-bursement rates,the satisfaction of the above groups was moderated by limited primary care capacity.Interdisciplinary research suggested that differences in economic utility,psychological expectations,and perceptions of social justice are the root causes of differences in satisfaction among different income groups.In the future,it is advisable to fully rely on the big data of medical in-surance electronic vouchers,conduct long-term queue research,construct innovative theoretical models,and establish regional collaborative policy frameworks.This article employed AI-driven predictive modelling to assess policy responsiveness under var-ying scenarios and explored the localization of advanced foreign models,and constructed a three-tier system of"basic protection+differentiated supplements+commercial insurance",so as to promote the precise and sustainable development of the medical in-surance system.

Objective: To genotype 50 RhD variant samples from Guangzhou, China, using our previously established genotyping strategy, thereby providing guidance for transfusion management and antenatal monitoring in RhD-variant individuals. Methods: Between June and August 2024, fifty samples identified as RhD variants during RhD-negative confirmation testing at Guangzhou Blood Center were collected. Serological testing for the D antigen was performed with two different anti-D reagents, and the epitope profiles of the D antigen were determined using a commercial panel of monoclonal anti-D reagents containing nine kinds of monoclonal anti-D. Genomic DNA was extracted, and high-resolution melting (HRM) analysis was applied to detect the Asian-type DEL (RHD 1227A). Subsequently, RHD genotyping was carried out using Multiplex Ligation-dependent Probe Amplification (MLPA) and Sanger sequencing. Results: Among the 50 D variant samples, 17 (34.0%) Asian type DEL samples were detected by HRM, including 13 cases with RHD DEL1/01N.01 genotype and 4 cases with RHD DEL1/DEL1 genotype. Eleven (11/50, 22.0%) samples were typed as DVI by the epitope profiles of D antigen. The epitope profiles of D antigen combined with Sanger sequencing of exon 6 identified 5 (5/50, 10.0%) cases of RHD weak partial 15/01N.01. MLPA combined with Sanger sequencing identified two cases of RHD DVI.3/DEL1, representing 4.0% (2/50) of the samples. Additionally, the following RHD genotypes were each detected in one case: RHD weak D type 18/01N.04, RHD weak D type 72/01N.01, RHD weak D type 95/DEL1, RHD weak D type 114/DEL1, RHD weak D type 136/DEL1, RHD weak D type 147/01N.01, RHD 496G/496G, RHD 536C/01N.01, RHD 689A/689A, RHD 689A/DEL1, RHD DEL32/DEL1, RHD DV.1/01N.01, RHD DV.5/01N.01, RHD 01.01/01N.01, and RHD 01/01N.01. Conclusion: Fifty D variant individuals were typed using our previously established serological and molecular approach. These findings provide guidance for precision transfusion therapy in RhD variant patients and inform evidence-based decisions regarding anti-D immunoglobulin prophylaxis for RhD variant pregnant women.

Objective To reveal the distribution patterns of dialysis equipment adverse event types and their seasonal characteristics,identify potential influencing factors,and provide a basis for developing scientific and effective equipment man-agement strategies in clinical practice.Methods A retrospective collection of 38 dialysis equipment adverse events from 2023 to 2024 in the hospital was conducted.Descriptive statistical methods were used to systematically analyze the events from dimensions such as event type,occurrence season,causes,and consequences.Results Among the 38 adverse events,equipment pressure sensor failures had the highest incidence(9 cases,23.68％),followed by tubing aging issues(7 cases,18.42％).Different types of failures corresponded to specific causes and consequences.The events showed significant seasonal differences:summer accounted for 31.6％of the total events,with high incidences of equipment pressure sensor failures and dialysate proportioning device failures;winter saw prominent tubing aging issues,accounting for 42.9％of such events.The number of events in spring and autumn was relatively balanced,with some failures exhibiting seasonal clustering.Equipment aging,lack of maintenance,procurement management defects,and non-standard personnel operations were the main causes of adverse events.Conclusion The findings of this study provide references for hospitals to develop dynamic and targeted maintenance management strategies for dialysis equipment,helping to reduce the risk of adverse events and ensure the safety of dialysis treatment.

Objective To reveal the distribution patterns of dialysis equipment adverse event types and their seasonal characteristics,identify potential influencing factors,and provide a basis for developing scientific and effective equipment man-agement strategies in clinical practice.Methods A retrospective collection of 38 dialysis equipment adverse events from 2023 to 2024 in the hospital was conducted.Descriptive statistical methods were used to systematically analyze the events from dimensions such as event type,occurrence season,causes,and consequences.Results Among the 38 adverse events,equipment pressure sensor failures had the highest incidence(9 cases,23.68％),followed by tubing aging issues(7 cases,18.42％).Different types of failures corresponded to specific causes and consequences.The events showed significant seasonal differences:summer accounted for 31.6％of the total events,with high incidences of equipment pressure sensor failures and dialysate proportioning device failures;winter saw prominent tubing aging issues,accounting for 42.9％of such events.The number of events in spring and autumn was relatively balanced,with some failures exhibiting seasonal clustering.Equipment aging,lack of maintenance,procurement management defects,and non-standard personnel operations were the main causes of adverse events.Conclusion The findings of this study provide references for hospitals to develop dynamic and targeted maintenance management strategies for dialysis equipment,helping to reduce the risk of adverse events and ensure the safety of dialysis treatment.

The article summarizes the differentiated effects of personal account reform on the satisfaction of different in-come groups in the reform of medical insurance outpatient mutual aid.This reform has significantly improved the mutual aid pro-tection offered by medical insurance funds through comprehensive measures such as adjusting the personal account accounting method,promoting coordination of medical treatment in different places,strengthening guidance for first visits at the grassroots level,and expanding the coverage of outpatient coordination.Satisfaction levels varied significantly across income groups,with high-income groups expressing lower satisfaction due to reduced personal account accumulation.The satisfaction of the middle-in-come group increased due to the reduced burden of outpatient expenses.While low-income groups benefited from higher reim-bursement rates,the satisfaction of the above groups was moderated by limited primary care capacity.Interdisciplinary research suggested that differences in economic utility,psychological expectations,and perceptions of social justice are the root causes of differences in satisfaction among different income groups.In the future,it is advisable to fully rely on the big data of medical in-surance electronic vouchers,conduct long-term queue research,construct innovative theoretical models,and establish regional collaborative policy frameworks.This article employed AI-driven predictive modelling to assess policy responsiveness under var-ying scenarios and explored the localization of advanced foreign models,and constructed a three-tier system of"basic protection+differentiated supplements+commercial insurance",so as to promote the precise and sustainable development of the medical in-surance system.

A 50-year-old female presented with bilateral cervical arteriosclerosis and right-sided plaque formation,after 25 d of treatment with rosuvastatin calcium tablets(20 mg,po,qn),the patient developed temporomandibular joint dislocation,the adverse reactions occurred again after giving manipulative repositioning.The patients were healthy,had no history of trauma and related diseases in stomatology,no history of drug allergy,patients did not open their mouth loudly at the onset of the disease,no external factors affecting the use of drugs during the combined use of other drugs.It was considered"very likely"that the dislocation of the jaw joint was caused by rosuvastatin calcium tablets.The patients were followed up for 3 months after the treatment of manipulative repositioning and other treatments,did not have any further dislocation of the temporomandibular joint dislocation.It is suggested that when using rosuvastatin calcium in clinical practice,attention should be paid to strengthening drug observation to ensure drug safety.

Objective:To analyze the bubble dynamic characteristics of shock wave enhanced emission photoacoustic streaming(SWEEPS)technique in free water region under different temporay delays.Methods:The Er∶YAG laser tip was activated in free water model with SWEEPS mode at 150-600 μs pulse delay.The bubble dynamic process during irrigation was recorded by a high-speed camera(200 000 Hz).Matlab was used to analyze the interaction between bubble made by the dual pulses frame by frame.The distance between bubble remnants and laser tip was measured before the bubble disappeared.The experimental data were statisti-cally analyzed by SPSS 19.0.Results:In free water region,different temporal delays caused different interaction between the bub-bles activated by the SWEEPS technique with a dual pulse modality.The interactions include bubble fusion,bubble collision and bubble separation.When the temporal delay between 360-440 μs,bubble collision was the most violent,and the farthest distance between bubble remnants and laser tip was reached.Conclusion:In free water region,the dual pulse of SWEEPS technique can lead to bubble interaction which may enhance the cavitation effect of Er∶YAG laser irrigation,and improve the debridement in clinic ap-plication.

Objective To summarize the current situation of the implementation of the death case discussion system in county-level medical institutions and analyze the existing problems,to attempt to make suggestions for improvement.Methods Judgmental sampling method was used in this study.A self-made questionnaire was used to conduct field investigation on the im-plementation of the death case discussion system in 16 county-level medical institutions in Chongqing,and semi-structured inter-views were conducted with medical staff.Results All county-level medical institutions have established death case discussion system,but there are many differences in connotative quality.There are many problems in system implementation,such as unclear scope of death case discussion,formality,irregular discussion,poor quality of connotation and lack of systematic supervision.Conclusion As a core medical system,the death case discussion system is an important tool for medical quality management.The medical quality management and medical staff must place a high value on the significance of death case discussion.In order to enhance medical quality and ensure patient safety,we must adhere to the principles of openness and honesty,systematic criti-cism,non-recrimination and non-punishment to conduct death case discussion in time and standardize,keep a record of death case discussions and enhance supervision.

The overall health condition of patients significantly affects the diagnosis,treatment,and prognosis of endodontic diseases.A systemic consideration of the patient's overall health along with oral conditions holds the utmost importance in determining the necessity and feasibility of endodontic therapy,as well as selecting appropriate therapeutic approaches.This expert consensus is a collaborative effort by specialists from endodontics and clinical physicians across the nation based on the current clinical evidence,aiming to provide general guidance on clinical procedures,improve patient safety and enhance clinical outcomes of endodontic therapy in patients with compromised overall health.

[Abstract] Objective: To investigate the relationship between expression of MICA/B (MHC class I chain-related proteinA/B) and disease-free survival (DFS) of patients with HER2+(human epidermal growth factor receptor 2) breast cancer tissue. Methods: Twenty six cases of corresponding para-cancerous tissue and 100 cases of HER2+ breast cancer tissue that preserved in wax at Zhengzhou People’ s Hospital Affiliated to Southern Medical University from January 2009 to June 2010 were collected for this study. Expression of MICA/ B in these tissue samples was detected by immunohistochemistry; and the relationship between MICA/B expression with clinicopathologic features as well as DFS was analyzed with Kaplan-Meier survival curve. Results: The expression of MICA/B in adjacent paracancerous tissues was negative (0/26), however, it was highly positive in cancer tissues (92/100), and the percentage with high expression was 65%(65/100), the difference was significant (P<0.05). High MICA/B expression rate in stage I was significantly higher than that in stage Ⅱ-Ⅲ (77.55% vs 52.94%， P<0.05), and the high expression rate in stage T1 was also significantly higher than that in stage T2-T4 (75.00% vs 52.27%， P<0.05). High MICA/B expression rate in ER+, PR+ group (with positive number≥1%) was significantly lower than that in ER- , PR-group (ER： 52.38% vs 74.14%，PR： 51.35% vs 73.02%， all P<0.05). MICA/B expression was correlated with clinical stages, the expression of ER, PR and tumor size (all P<0.05), but not associated with menopausal status, histological grade and lymph node metastasis (all P>0.05). Over-expression of MICA/B was closely associated with much better 6-year DFS rate in patients no matter with or without targeted therapy (the targeted group: 90.6% vs 72.2%; the untargeted group: 78.4% vs 58.8%, all P<0.05). Conclusion: Over-expression of MICA/B in HER2+ breast cancer tissue is closely related to DFS, which may be served as a potential prognosis indicator for patients with HER2+ breast cancer.