Objective:To evaluate the cost-effectiveness and impact on mortality of health management services for the elderly aged 65 years and older in national essential public health service project.Methods:Based on the data of county-level medical institutions in Henan Province from 2019 to 2024,the Random Forest Method was used to construct a counterfactual framework to predict the hospitalization expenses under the unmanaged scenario,and then the cost-benefit ratio(BCR)and net income were calculated.Time-dependent Cox proportional hazards model was used to evaluate the effect of health management on all-cause mortality and cardiovascular and cerebrovascular disease mortality in the elderly.Results:A total of 962 955 elderly patients were included,451 119(46.85%)were included in the management group.The average hospitalization cost of the management group was significantly lower than that of the non-management group(P<0.05).Except for 2020-2021,BCRS in 2019 and 2022-2024 were 6.34,2.05,4.45 and 6.60,respectively.The risk of all-cause death was reduced by 76.96%,and the risk of cardiovascular and cerebrovascular death was reduced by 75.57%in the elderly patients included in the management group compared with those not included in the management group.Suggestions:It is necessary to establish a health outcomes-based evaluation system and promote the transformation and upgrading of the service model from single chronic disease management to"integrated health services with multi-disease management".

Objective:To evaluate the cost-effectiveness and impact on mortality of health management services for the elderly aged 65 years and older in national essential public health service project.Methods:Based on the data of county-level medical institutions in Henan Province from 2019 to 2024,the Random Forest Method was used to construct a counterfactual framework to predict the hospitalization expenses under the unmanaged scenario,and then the cost-benefit ratio(BCR)and net income were calculated.Time-dependent Cox proportional hazards model was used to evaluate the effect of health management on all-cause mortality and cardiovascular and cerebrovascular disease mortality in the elderly.Results:A total of 962 955 elderly patients were included,451 119(46.85%)were included in the management group.The average hospitalization cost of the management group was significantly lower than that of the non-management group(P<0.05).Except for 2020-2021,BCRS in 2019 and 2022-2024 were 6.34,2.05,4.45 and 6.60,respectively.The risk of all-cause death was reduced by 76.96%,and the risk of cardiovascular and cerebrovascular death was reduced by 75.57%in the elderly patients included in the management group compared with those not included in the management group.Suggestions:It is necessary to establish a health outcomes-based evaluation system and promote the transformation and upgrading of the service model from single chronic disease management to"integrated health services with multi-disease management".

This study was aimed at creating an engineered strain of Bacillus subtilis for efficient expression of biologically active type 2 toxin B(TcdB2)derived from a highly virulent strain of Clostridium difficile.The TcdB2 gene was cloned from ST1/RT027 strain genome DNA,incorporated into the PHT01 vector,and then transformed into B.subtilis strain WB800N for prokaryotic expression.Cell toxicity assays revealed that the recombinant TcdB2 exhibited cytotoxic effects in various cells.The engineered B.subtilis strain effectively expressed biologically active TcdB2,thus providing a basis for further exploration of the pathogenic mechanisms of highly virulent strains of C.difficile and establishing a foundation for potential vaccine can-didate targets.

Cadaver ; Foramen Ovale ; Humans ; Punctures ; Robotics ; Tomography, X-Ray Computed

Objective A/H1N1(pdm09) viruses were the dominant strains in Shanghai during 2018-2019 influenza surveillance year.This study is to provide a scientific reference for clinical drug use by investigating the susceptibility of A/H1N1(pdm09) viruses to neuraminidase inhibitors(NAIs). Methods Sixty strains of A/H1N1(pdm09) viruses were randomly selected for testing the susceptibility and drug resistance to Oseltamivir and Zanamivir by means of neutaminidase inhibition and neuraminidase (NA) gene sequencing. Results The 60 epidemic strains all proved to be susceptible to Oseltamivir and Zanamivir and the susceptibility was not observed to be decreased or remarkably decreased.In genetic sequencing, NA was not observed to present amino acid mutation at the key sites and auxiliary sites in catalytic activity, which confirmed the results of the phototypic detection of neuraminidase inhibition. Conclusion The subtype influenza viruses A/H1N1(pdm09) circulating in Shanghai during 2018-2019 surveillance year are still sensitive to NAIs, which provides a scientific reference for clinical use of drugs.However, we monitored only a number of strains and think that the work monitoring antiviral susceptibility should be continued with the wide use of the drugs.

【Objective】 To compare the volumes of brain regions and the white matter hyperintensities(WMH) in Alzheimer's disease(AD) and vascular dementia(VaD) patients, and discuss values of magnetic resonance imaging (MRI) in the differential diagnosis of AD and VaD. 【Methods】 The clinical data and MRI images of 35 patients with VaD and 74 patients with AD were retrospectively analyzed. Volumes of different brain regions and WMH were measured by using AccuBrain^TM system and visual rating scale was used to assess WMH. We then compared the volumes of brain regions and the WMH between AD and VaD. The principal component analysis(PCA) and logistic regression analysis were adopted for differential diagnosis. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic efficiency of the indexes. 【Results】 ①Compared with VaD patients, AD patients showed statistically smaller volumes of total intracranial volume, brain parenchyma, gray matter, white matter, hippocampus, amygdala, hypothalamus, frontal lobe(left, right), occipital lobe(left, right), temporal lobe(left, right), parietal lobe(left, right), hippocampus (left, right), amygdala(left, right), hypothalamus(left, right) (P<0.05). ②There was statistically significant difference in the visual scores for deep WMH(DWMH) between AD and VaD patients(P=0.015). The absolute and relative volumes of WMH in VaDpatients were statistically larger than those in AD patients(P<0.05). ③PCA revealed eight important parameters including brain parenchyma, hippocampus, amygdala, hypothalamus, frontal lobe(left), occipital lobe(left), temporal lobe(left) and parietal lobe(left) .The identification model consisting of amygdala, occipital lobe (left) and absolute volume of WMH was established based on logistic regression analysis. ④Among all the indexes, the identification model had the best diagnostic performance to differentiate AD from VaD and its sensitivity and specificity were 81.1% and 74.3%, respectively. 【Conclusions】 There are significant differences in both volumes of certain brain regions and severity of WMH between VaD and AD patients. The cranial MRI is of great value for the differential diagnosis of VaD and AD.

OBJECTIVETo study the clinical characteristics and pathogenesis of hematidrosis.

METHODSDetailed clinical manifestations and natural history of a patient with hematidrosis were presented. A series of laboratory examinations were performed, and skin pathohistologic features and ultra microscopic structures were observed.

RESULTSThe episodes of skin bleeding occurred on any site of the body spontaneously and promptly. The skin surface bloody extravasation has identical cell components as that of peripheral blood. All the results of laboratory tests were normal except a positive Trousseau's test. Skin pathohistological study revealed some intradermal bleeding and emphraxised capillaries. No abnormality was found in sweat glands, hair follicles and sebaceous glands.

CONCLUSIONThe pathological basis for hematidrosis might be a distinctive vasculitis.

Child ; Female ; Hemorrhage ; pathology ; Humans ; Skin ; blood supply ; pathology ; Skin Diseases ; pathology