BACKGROUND: The use of potentially inappropriate medications (PIMs) is a major concern for medication safety as it may entail more harm than potential benefits for older adults. This study aimed to explore the prescribing rate, healthcare utilization, and expenditure of older adults using PIMs in China. METHODS: A cross-sectional analysis was conducted using a national representative database of all medical insurance beneficiaries across China, extracting ambulatory visit records of adults aged 65 years and above between 2015 and 2017. Descriptive analysis was conducted to measure the rate of patients exposed to PIM, prescribing rate of each PIM, average annual outpatient visits per patient, average total medication costs for each visit, average annual cost of PIMs for each patient, and average annual medication costs for each patient. Generalized linear model with logit link function and binomial distribution was used to examine the adjusted associations between PIMs and independent variables. RESULTS: In total, 845,278 (33.2%) participants were identified to be exposed to at least one PIM. Patients aged 75-84 years (38.1%, 969,809/2,545,430) and ≥85 years (37.9%, 964,718/2,545,430) were more likely to be prescribed with PIMs. Beneficiaries of the Urban Employee Basic Medical Insurance (UEBMI) and living in eastern and southern regions were more frequently prescribed with PIMs. Compared with patients without PIM exposure (7.5 visits, drug cost of RMB 1545.0 Yuan), patients with PIM exposure showed higher adjusted average annual number of outpatient visits (10.7 visits, β = 3.228, 95% confidence interval [CI] = 3.196-3.261) and higher annual drug costs (RMB 2461.8 Yuan, Coef. = 916.864, 95% CI = RMB 906.292-927.436 Yuan). CONCLUSIONS The results showed that the use of PIM among older adults was common in China. This study suggests that the use of PIM could be considered as a clear target, pending multidimensional efforts, to promote rational prescribing for older adults.
Humans ; Aged ; Cross-Sectional Studies ; Aged, 80 and over ; Male ; Female ; China ; Inappropriate Prescribing/economics* ; Patient Acceptance of Health Care/statistics & numerical data* ; Potentially Inappropriate Medication List/statistics & numerical data* ; Health Expenditures/statistics & numerical data*

Neurodegenerative diseases (NDDs) are a group of heterogeneous neurological disorders that can cause progressive loss of neurons in the central nervous system or peripheral nervous system, resulting in a decline in motor function. Motion capture, as a high-precision and high-resolution technology for capturing human motion data, drives NDDs motor assessment to effectively extract kinematic features and thus assess the patient's motor ability or disease severity. This paper focuses on the recent research progress in motor assessment of NDDs driven by motion capture data. Based on a brief introduction of NDDs motor assessment datasets, we categorized the assessment methods into three types according to the way of feature extraction and processing: NDDs motor assessment methods based on statistical analysis, machine learning and deep learning. Then, we comparatively analyzed the technical points and characteristics of the three types of methods from the aspects of data composition, data preprocessing, assessment methods, assessment purposes and effects. Finally, we discussed and prospected the development trends of NDDs motor assessment.
Humans ; Neurodegenerative Diseases/diagnosis* ; Machine Learning ; Biomechanical Phenomena ; Deep Learning ; Motion ; Motion Capture

Objective:To observe the effects of acupuncture and moxibustion on interleukin(IL)-9/IL-9 receptor(IL-9R)in the colon tissue of rats with ulcerative colitis(UC)and investigate the protective mechanism of acupuncture and moxibustion on the intestinal mucosal barrier in UC rats. Methods:Male Sprague-Dawley rats were randomly divided into a normal control(NC)group and a modeling group.UC models were prepared by giving 4%dextran sulfate sodium(DSS)water for 7 d.After the successful construction of the UC rat model,the modeling group was randomly divided into a UC group,a herb-insulated moxibustion(HM)group,and an electroacupuncture(EA)group.HM and EA interventions at bilateral Tianshu(ST25)were performed once a day for 7 d.Hematoxylin-eosin(HE)staining was used to observe the histopathological changes in the colon.The serum concentrations of IL-9,IL-6,IL-1β,and hemoglobin-H(HbH)were determined by enzyme-linked immunosorbent assay.The protein expression levels of IL-9,IL-9R,claudin-2,zonula occludens-1(ZO-1),and occludin in the colon tissue were measured by Western blotting or immuno-histochemistry.Immunofluorescence was used to detect the co-expression of PU.1 and CD4 with the IL-9 protein. Results:Compared with the NC group,the colon tissue of UC rats was severely damaged and ulcerated with congestion and edema,and the colonic histopathological score increased significantly(P<0.01).The serum HbH concentration decreased significantly(P<0.01),while the serum concentrations of IL-9,IL-6,and IL-1β increased(P<0.01).The protein expression of colonic ZO-1 and occludin decreased significantly(P<0.01),while the protein expression of colonic IL-9 and IL-9R increased(P<0.05).The positive co-expression levels of IL-9/PU.1 and IL-9/CD4 increased in the colon tissue(P<0.05).Compared with the UC group,the colonic mucosal structures were gradually repaired in both HM group and EA group,and healed ulcers could be observed,the colonic histopathological score decreased significantly(P<0.05).The serum concentration of HbH increased(P<0.01),while the serum concentrations of IL-9,IL-6,and IL-1β decreased(P<0.05).The protein expression levels of ZO-1 and occludin increased(P<0.05),while the protein expression levels of IL-9 and IL-9R decreased(P<0.01).The positive co-expression levels of IL-9/PU.1 and IL-9/CD4 decreased in the colon tissue(P<0.05). Conclusion:Both HM and EA can inhibit the protein expression levels of IL-9 and IL-9R in the UC colon by regulating the transcription factor PU.1,promote the repair of intestinal mucosal barrier,and down-regulate protein contents of proinflammatory factors IL-9,IL-6,and IL-1β in the serum,which may be one of the key mechanisms of acupuncture and moxibustion in reducing the inflammation of UC colonic mucosa and protecting the intestinal mucosal barrier.

Objective:To compare the antiplatelet effects of vicagrel and clopidogrel in patients with different cytochrome P450 (CYP) 2C19 genotypes.Methods:This is a post-hoc analysis of a phase Ⅱ clinical trial of vicagrel, which included patients with coronary heart disease who underwent percutaneous coronary intervention from August 2018 to June 2019 in 18 centers. Patients were categorized based on the presence of CYP 2C19 *2 or *3 loss-of-function (LOF) alleles into LOF carrier group ( n=111) and non-LOF carrier group ( n=90). Each group included patients received vicagrel 5 mg, 6 mg, 7.5 mg, or clopidogrel 75 mg for 28 days per study protocol. P2Y 12 reaction units (PRU) were measured using VerifyNow at baseline, 6 to 8 hours after loading dose, 7 to 10 days after randomization, and 28 days after randomization and the percentage inhibition of platelet aggregation (%IPA) was calculated. The primary endpoint was %IPA on day 28. Within the patients from the General Hospital of Northern Theater Command, 8 to 12 patients in each study arms were enrolled in a prespecified pharmacokinetic sub-study, measuring the time to reach maximum plasma concentration (T max), peak plasma concentration (C max), and area under the plasma concentration-time curve (AUC). Results:Among 201 patients, the age was (58.8±8.5) years, and 139 (69.2%) were male. In non-LOF carriers, there was no significant differences in PRU values and %IPA between the vicagrel 5 mg, 6 mg, 7 mg, and clopidogrel groups at all time points (all P>0.05). In LOF carriers, %IPA was significantly higher in the vicagrel-treated groups than in the clopidogrel group at 6-8 hours after loading dose (22.9 (14.2, 31.5)% vs. 19.8 (11.0, 28.6)% vs. 29.5 (20.9, 38.0)% vs. 12.9 (3.9, 21.9)%, P=0.038) and 7-10 days after randomization (22.4 (14.2, 30.5)% vs. 34.4 (26.1, 42.6)% vs. 39.8 (31.8, 47.9)% vs. 24.7 (16.3, 33.2)%, P=0.001), with a trend towards higher %IPA in the vicagrel-treated groups at day 28 (30.4 (21.3, 39.6)% vs. 36.5 (27.2, 45.7)% vs. 40.8 (31.8, 49.8)% vs. 30.7(21.2, 40.2)%, P=0.056). Pharmacokinetic results of 35 patients showed that the C max and AUC of the active metabolite M15-2 of vicagrel was similar to that of clopidogrel in non-LOF carriers, but AUC between vicagrel 5 mg, 6 mg, 7 mg and clopidogrel were significantly different in LOF carriers ((5.6±0.6) h·μg -1·L -1 vs. (6.8±2.7) h·μg -1·L -1 vs. (9.2±3.3) h·μg -1·L -1 vs. (4.2±1.9) h·μg -1·ml -1, P=0.020). Conclusion:Vicagrel and clopidogrel have similar antiplatelet effects in non-LOF carriers, but vicagrel exhibits superior antiplatelet effects in LOF carriers.

OBJECTIVE To provide reference and suggestions for dynamic adjustment of classification management lists for clinical use of antibiotics and the promotion of rational use of antibiotics. METHODS The latest version of provincial classification management lists for clinical use of antibiotics were aggregated into the “national list”， which was compared with 2021 WHO AWaRe classification list of antibiotics （hereinafter referred as to “AWaRe classification list”） to make a descriptive statistical analysis about the number of different classes of antibiotics in the two lists and their differences. RESULTS Based on the different classification principles， 262 kinds of antibiotic preparations in the national list were classified into non-restricted （84）， restricted （83） and highly-restricted classes （95）， and 258 kinds in the AWaRe classification list were classified into access （87）， watch （142） and reserve classes （29）； 182 kinds of antibiotic preparations were both included in the two lists. In the national list， among the non-restricted antibiotic preparations， 36 kinds belonged to access class， 30 belonged to watch class and 1 belonged to reserve class； among restricted antibiotic preparations， 7 belonged to access class， 46 kinds belonged to watch class and 3 belonged to reserve class； among highly-restricted antibiotic 82805019。E-mail：yyy211anne@163.com preparations， 9 belonged to access class， 35 belonged to watch class and 15 kinds belonged to reserve class. Among them， 91 kinds of antibiotic preparations were not recommended by WHO （20 kinds） or not included in the AWaRe classification list （71 kinds）. CONCLUSIONS The classification methods of two lists are different in classification principles and grading of some similar drugs. The classification management list of antibiotics is one of the key points of antibiotics management， more research is needed in the future to provide sufficient evidence for optimizing antibiotics classification management.

As a typical human pathogenic fungus,

Objective:To evaluate the enrollment rate, mutation rate and causes of variability the clinical pathway of bronchopneumonia.Methods:The enrollment rate, completion rate, variation and reasons of the clinical pathway in Beijing Children′s Hospital, Capital Medical University from January 2012 to December 2016 were retrospectively collected.Data of patients after the clinical pathway of bronchopneumonia in other tertiary class A hospitals were gathered by questionnaires, and the enrollment rate, completion rate, variation rate and reasons were analyzed.Results:(1)At the end of 2016, 11 of the 13 hospitals included in this study had implemented the clinical pathway for 5 years, 1 hospital for 3 years, and 1 hospital for 2 years.(2) Eleven hospitals provided their enrollment rates.The enrollement rate of 2 hospitals was<50%, and that of 9 hospitals was>80%.The annual completion rate of Beijing Children′s Hospital was ≥75%, and the completion rates offered by 8 hospitals were basically >70%.(3) Since the implementation of the clinical pathway for 5 years in Beijing Children′s Hospital, a total of 427 cases were enrolled of which 93 cases were mutated (variability 21.78%). The variability of 5 hospitals was maintained at <15%.The variability of 3 hospitals decreased with the implementation years, and became qualified.The variability of 1 hospital first rebounded and then controlled; 1 hospital increased by 27.65%; 1 hospital was first controlled and rebounded; 1 hospital was always >15%.The main cause of the mutation was coexisting diseases, complications, progression of the disease, or correction of the first diagnosis, etc.Conclusions:The completion rate of tertiary class A hospitals meets the requirements of national policy.However, the enrollment rate needs to be improved, and the variation rate among different hospitals differs a lot.Further implementation of the clinical pathway should be strengthened and monitored.

OBJECTIVE：To rapidly evaluate the effectiveness，safety and economics of rosuvastatin （RSV）in the treatment of dyslipidemia，so as to provide evidence-based support for clinical drug use. METHODS ：Retrieved from PubMed ，Embase， Cochrane Library ，CNKI，Wanfang database and CBM ，etc.，health technology assessment （HTA）related website and database were searched systematically to select HTA report ，Meta-analysis/systemic evaluation and pharmacoeconomics study about RSV versus placebo or other positive drugs in the treatment of dyslipidemia. According to the inclusion and exclusion criteria ，two researchers independently screened the literatures ，extracted and summarized the data ，then performed qualitative description of results. RESULTS ：Totally 11 Meta-analysis and 11 pharmacoeconomic studies were included ，and no relevant HTA report was retrieved. Results of the study showed that compared with the control group ，RSV could regulate dyslipidemia ，and reduce the levels of LDL-C ，TG，TC，C-reactive protein and sdLDL ；RSV could also reverse atherosclerotic plaque ，reduce all-cause mortality with good safety. In terms of economy ，compared with other statins or placebo ，RSV could prolong quality-adjusted life year，its incremental cost-effectiveness ratio is lower than the desired payment threshold ，which had more economic advantages. CONCLUSIONS：RSV is effective ，safe and economical in the treatment of hyperlipidemia.

OBJECTIVE: To investigate the effects of lead exposure and high fat diet on the hippocampal inflammatory factors and learning-memory in rats. METHODS: A total of 40 specific pathogen free male SD rats were randomly divided into control group,high fat diet group,lead exposure group,combine exposure group,10 rats in each group. Rats in control group were given regular diet and rats in high-fat diet group were given high-fat diet. Rats in lead exposure group were given regular diet and water with 400 mg/L lead acetate. Rats in combine exposure group were given high fat diet and water with 400 mg/L lead acetate. Body weight was measured every other week. The exposure period was 9 weeks. Morris water maze was applied to measure the learning-memory. The content of total cholesterol,triglyceride(TG),low density lipoprotein cholesterol(LDL) and high density lipoprotein cholesterol(HDL) in serum were detected by using microplate reader. The lead content of hippocampus was detected by inductively coupled plasma mass spectrometer. Enzyme-linked immuno sorbent assay was used to detect the content of tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-4,IL-6 and interferon-γ(IFN-γ). RESULTS: Beginning from the third week,the body weight of rats in high fat diet and combine exposure group were significantly higher than that in control group(P < 0. 05). In addition,the body weight of rats in combine exposure group were higher than that in lead exposure group(P < 0. 05). Escape latency and the frequency of crossing platform of rats in high fat diet group,lead exposure group and combine exposure group were significant changed compared with those in control group(P < 0. 05). The escape latency of rats in combine exposure group increased compared with those in high fat diet group and lead exposure group(P < 0. 05). In addition,serum TG and LDL content in high-fat diet group and combine exposure group increased and HDL decreased compared with the control exposure group and lead exposure group(P < 0. 05). Compared with the control group and high fat diet group,the content of lead in hippocampus of lead exposure group and combine exposure group substantially increased(P < 0. 05). The levels of TNF-γ,IL-6,IL-1β,IFN-γ of hippocampus in high fat diet group,lead exposure group and combine exposure group were significantly higher than those in control group(P < 0. 05). Besides,the levels of IL-4 of hippocampus in lead exposure group and combine exposure group were higher than that in control group(P < 0. 05). IL-1β content of rats hippocampus in combine exposure group was higher than that in high-fat diet group or lead exposure group(P < 0. 05). CONCLUSION: Combine lead and high-fat diet exposure can exert a synergy in decrease of learning-memory in rats. IL-1β might involved in the process of synergic neurotoxicity induced by lead and high fat diet.

Objective To investigate the invasion situation of cardinal ligaments(CL) in stage Ⅰ A2 - ⅡA2 cervical cancer and to find the high risk clinicopathological factors affecting its invasion .Methods The retrospective analysis was performed on the clinicopathological data in 2 982 patients with cervical cancer treated by operation extracted in 5 hospitals from January 2004 to De‐cember 2014 .Results (1) Totally 855 cases according with the research condition were included .The CL invasion was found in 20 cases(2 .3% ) .No CL invasion occurred in the stage ⅠA2 ,the CL invasion rate in the stage ⅠB1 was 1 .7% ,in the stage ⅠB2 was 1 .2% ,in the stage ⅡA1 was 5 .7% and in the stage ⅡA2 was 2 .9% .With the increase of FIGO staging ,the CL invasion rate had no significant increase(P=0 .269) .(2) The infiltration rate of left CL and right CL had no statistical difference among the stageⅠA2- ⅡA2(P=1 .000) .And the invasion rate of the left CL with different FIGO stages had no statistical difference(P=0 .286) , while the right one had statistical difference(P=0 .005) ,in which the highest was in the stage ⅡA1 (4 .3% ) .(3)The univariate a‐nalysis found that lymph‐vascular invasion ,cervical stroma infiltration depth ,pelvic lymph node metastasis ,uterus body infiltration and vaginal fornix infiltration were the risk factors of CL invasion(P<0 .01);the further multivariate analysis determined that the invasion of uterine body(OR=11 .858) ,pelvic lymph node metastasis(OR=6 .359 ,) ,vaginal fornix infiltration(OR=6 .012 ,) were the risk factors for CL invasion(P<0 .05) .Conclusion The invasion rate of CL invasion in early stage cervcial cancer is low .The invasion of uterine body ,pelvic lymph node metastasis and vaginal fornix filtration are the risk factors for CL invasion in the stageⅠA2- ⅡA2 cervical cancer .