Objective:This study utilizes data from the 2021 Chinese Longitudinal Healthy Longevity and Happy Family Survey(CLHLS-HF)to examine the current status of Long-Term Care Insurance(LTCI)implementation and to identify the factors influencing whether disabled elderly individuals receive formal care services.The study aims to provide policy recommendations to enhance the effectiveness and equity of the system.Methods:In this cross-sectional study, a sample of 1 447 older participants with dependency, residing in LTCI pilot areas and meeting the inclusion criteria from the 2021 CLHLS-HF, was selected.Chi-square tests and binary logistic regression analyses were employed to explore the factors influencing the receipt of formal care by dependent older individuals.Results:Among the 1 447 participants, there were 496 males with an average age of 92 years(SD 9)and 951 females with an average age of 95 years(SD 9). Of these, 701 received formal care.The logistic regression analysis revealed that factors influencing the receipt of formal care included urban residence( OR=2.237, 95% CI: 1.675-2.987, P<0.001), residing in the eastern region( OR=2.907, 95% CI: 1.747-4.837, P<0.001), living in the western region( OR=3.132, 95% CI: 1.816-5.501, P<0.001), having no children( OR=2.478, 95% CI: 1.108-5.540, P=0.027), and the degree of disability, with severe disability being more likely to receive care compared to mild( OR=0.497, 95% CI: 0.388-0.637, P<0.001)and moderate disabilities( OR=0.589, 95% CI: 0.433-0.801, P=0.001). Conclusions:Dependent older individuals in the eastern and western regions, particularly those without children or with severe disabilities, are more likely to receive formal care through the LTCI system.However, there are substantial inequities in LTCI coverage among individuals with varying degrees of disability.To enhance the effectiveness of the LTCI system, greater efforts should be directed towards economically disadvantaged regions and older individuals with mild to moderate disabilities, thereby ensuring better protection for the disabled population.

Objective:This study utilizes data from the 2021 Chinese Longitudinal Healthy Longevity and Happy Family Survey(CLHLS-HF)to examine the current status of Long-Term Care Insurance(LTCI)implementation and to identify the factors influencing whether disabled elderly individuals receive formal care services.The study aims to provide policy recommendations to enhance the effectiveness and equity of the system.Methods:In this cross-sectional study, a sample of 1 447 older participants with dependency, residing in LTCI pilot areas and meeting the inclusion criteria from the 2021 CLHLS-HF, was selected.Chi-square tests and binary logistic regression analyses were employed to explore the factors influencing the receipt of formal care by dependent older individuals.Results:Among the 1 447 participants, there were 496 males with an average age of 92 years(SD 9)and 951 females with an average age of 95 years(SD 9). Of these, 701 received formal care.The logistic regression analysis revealed that factors influencing the receipt of formal care included urban residence( OR=2.237, 95% CI: 1.675-2.987, P<0.001), residing in the eastern region( OR=2.907, 95% CI: 1.747-4.837, P<0.001), living in the western region( OR=3.132, 95% CI: 1.816-5.501, P<0.001), having no children( OR=2.478, 95% CI: 1.108-5.540, P=0.027), and the degree of disability, with severe disability being more likely to receive care compared to mild( OR=0.497, 95% CI: 0.388-0.637, P<0.001)and moderate disabilities( OR=0.589, 95% CI: 0.433-0.801, P=0.001). Conclusions:Dependent older individuals in the eastern and western regions, particularly those without children or with severe disabilities, are more likely to receive formal care through the LTCI system.However, there are substantial inequities in LTCI coverage among individuals with varying degrees of disability.To enhance the effectiveness of the LTCI system, greater efforts should be directed towards economically disadvantaged regions and older individuals with mild to moderate disabilities, thereby ensuring better protection for the disabled population.

AIM: To analyze the diagnostic value of optical coherence tomography angiography(OCTA)in evaluating the parameters of foveal avascular zone(FAZ)in early diabetic retinopathy(DR).METHODS: Retrospective study. A total of 209 cases(209 eyes)of type 2 diabetes mellitus(T2DM)with DR admitted to our hospital from June 2019 to December 2022 were selected as DR group. The DR group was divided into three groups, with 115 cases(115 eyes)in mild group, 54 cases(54 eyes)in moderate group, and 40 cases(40 eyes)in severe group according to stage. Another 100 cases(100 eyes)of T2DM patients without DR were selected as No-DR group, and 70 cases(70 eyes)of healthy people were selected as control group for physical examination at the same time, all of whom underwent OCTA examination. The DR group was enrolled according to the disease degree, one eye was randomly taken for the study if the degree in both eyes was the same, while the control group and the No-DR group were randomly selected for one eye to be included in the study. The perimeter of the foveal avascular area(PERIM), FAZ transverse diameter, FAZ vertical diameter, FAZ area, macular fovea retinal thickness(MFRT), acircularity index(AI), full layer retinal blood flow density within a range of 300 μm around the FAZ(FD-300), and changes in FAZ vascular density(VD)levels among different groups of subjects were compared. Furthermore, Pearson correlation analysis was used to determine the correlation between general data and FAZ related indicators, and receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of macular FAZ indicators for DR.RESULTS: The levels of FBG, MFRT, FAZ area, and PERIM in patients with mild, moderate, and severe DR were significantly higher than those in the No-DR group and the control group, while the levels of AI and VD were significantly lower than those in the No-DR group(all P<0.05); patients in the No-DR group, mild DR group, moderate DR group, and severe DR group had significantly higher cystatin C, FAZ transverse diameter, and FAZ vertical diameter than the control group, while FD-300 vascular density was significantly lower than the control group(all P<0.05); the MFRT was positively correlated with age(r=0.295, P=0.001); The AI and VD was negatively correlated with age(r=-0.296, -0.235, all P<0.05); the area under the curve(AUC)of MFRT, FAZ area, PERIM, AI, and VD for the diagnosis of DR were 0.745, 0.738, 0.696, 0.792, and 0.847, respectively.CONCLUSION:The structure and microcirculation of FAZ can be changed in DM patients, and the related parameters of FAZ have certain value in the diagnosis of early DR.

Objective:To summarize the clinical characteristics of central nerve system (CNS) infection and grasp the necessity and possibility of early diagnosis and precise intervention of CNS infection after renal transplantation.Methods:This retrospective study enrolled consecutive recipients of renal transplantation with CNS infection after transplant between January 2000 and December 2020. Correlative factors for CNS infection after renal transplant were determined by comparing the clinical data between recipients with and without CNS infection. After screening 3, 199 consecutive renal transplant recipients, 12 patients with CNS infection post-transplant were identified and recruited. The median age-of-onset was 48.5 (23-65) years. And the median time to disease onset after transplant was 50.5(1-204) months. The most common symptoms of CNS infection after renal transplant included fever (75.00%), consciousness disorder (58.33%), headache (58.33%) and neck rigidity (41.67%).Results:Hepatitis B virus carrier and pulmonary infection were correlated with CNS infection after transplantation ( P<0.05). Nine patients failed to identify the pathogen and only received empirical anti-infective regimen. The outcomes were curing ( n=3) and death ( n=6). Metagenomic sequencing was performed for identifying the pathogen in three recipients and actively adjusting the anti-infective regimen. As a result, 2 were cured and 1 died. The overall mortality was 58.33%. The median time to death or curing from disease onset were 20(2-19) and 25(16-35) days respectively in surviving and non-surviving recipients. Conclusions:The progress of CNS infection after transplantation is rapid with a high mortality. HBV carrier and pulmonary infection are possible risk factors of CNS infection after renal transplantation. Early pathogenic identification and precise etiological intervention are vital for better clinical outcomes.

The hospital took the lead in the area to carry out stroke process improvement, including the accountability practice of the president, micro-videos for illness condition description, standardized language communication, CT-room thrombolysis, and interdisciplinary seamless corporation among others. The timespan from admission to thrombolysis ( door to needle time, DNT) has shortened significantly, scoring the median time of 25 minutes and the shortest of 8 minutes. The hospital is also the first in the area to initiate the program to bypass the emergency department and the thrombolytic treatment on the ambulance. Such bypass program keeps the DNT of emergency patients within 15 minutes.

Objective To investigate the related factors for the survival of the patients with pancreatic cancer.Methods A total of 1 620 patients confirmed as pancreatic cancer admitted in Sun Yat-sen Memorial Hospital affiliated with Sun Yat-sen University,Tumor prevention and treatment center affiliated with Sun Yat-sen University and People's Hospital of Guangdong Province from 2004 to 2016 were retrospectively analyzed,and the effects of TNM staging,surgical treatment,palliative chemotherapy and postoperative assisted chemotherapy on the survival of the patients with pancreatic cancer were examined by life table and Log-rank test.Results The median survival time of all 1 620 cases was 7.15 months.The median survival time of TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ was 12.50 months,10.12 months,9.56 months and 5.43 months,and there was statistically significant difference (P =0.001).The median survival time of cases who did not undergo surgery was 6.10 months,which of patients who underwent radical surgery was 13.67 months,and the difference was statistically significant (P =0.001).The median survival time of cases without chemotherapy was 5.55 months,which of patients who underwent palliative chemotherapy was 7.58 months,and the difference was statistically significant (P =0.001).The median survival time of cases with pure radical surgery without chemotherapy was 12.38 months,which of patients who underwent adjuvant chemotherapy was 14.50 months,and the difference was no statistically significant (P =0.561).Conclusions Early diagnosis followed closely by radical surgery is the key to prolong the survival of pancreatic cancer patients.And adjuvant chemotherapy for patients who lose surgery opportunity may improve clinical prognosis to a certain extent.

Objective To evaluate the effect of nodosin,as an effective element extracted from rabdosiae serrae, on hepatocyte regeneration after partial liver transplantation.Methods Wistar rats were used as donors and SD rats as recipients.Rat models with partial liver transplantation were established by modified two-cuff technique.Twenty-four recipient rats were randomly assigned into the nodosin and control groups.In the nodosin group,nodosin at a dosage of 1 00 μg/ml was administered via tail venous route after liver transplantation.Peripheral plasma and liver specimen were obtained at postoperative 3 and 7 d.The levels of alanine transaminase (ALT),aspartate aminotransferase (ALT)and albumin (ALB)in the peripheral plasma were measured by spectrophotometry.Hepatic histomorphological changes were observed under light microscope.The positive cell count of proliferating cell nuclear antigen (PCNA)antibody in the liver tissue was detected by immunohistochemistry. The expression levels of phosphorylated protein kinase (p-AKT ), phosphorylated mammalian target of rapamycin (p-mTOR),cyclin D1 and heme oxygenase (HO)-1 proteins were measured by western blot.The apoptosis of liver cells was detected by Annexin V method and TdT mediated-dUTP nick end labeling (TUNEL).Results Compared with the control group,the serum levels of ALT and AST were significantly lower at 3 d and 7 d after operation,whereas the ALB content was significantly higher in the nodosin group (all in P <0.05).And nodosin could alleviate the pathological injury of rat liver tissue after transplantation.The positive cell count of PCNA in the nodosin group was significantly higher than that in the control group (P <0.05).In the nodosin group,the expression levels of p-AKT,p-mTOR,cyclin D1 and HO-1 proteins were significantly higher than those in the control group (all in P <0.05).The quantity and percentage of apoptotic hepatocytes in the nodosin group were significantly lower than those in the control group (both in P <0.05).Conclusions Application of nodosin can decrease the quantity of apoptotic hepatocytes and accelerate hepatocyte proliferation after liver transplantation in rat models.

Bronchopulmonary Dysplasia ; therapy ; Humans ; Infant, Newborn

Diagnosis, Differential ; Echocardiography, Doppler, Color ; Heart Defects, Congenital ; diagnosis ; physiopathology ; Humans ; Infant, Newborn ; Male ; Pneumonia ; diagnosis ; physiopathology ; Pulmonary Artery ; abnormalities ; diagnostic imaging ; physiopathology ; Tomography, X-Ray Computed ; Trachea ; abnormalities ; diagnostic imaging ; Vascular Malformations ; diagnosis ; physiopathology

AIM:To synthesize a safe , efficient and targeted nanoparticulate carrier for siRNA delivery to pan-creatic cancer cells .METHODS: Iron oxide nanocrystal with carboxylic acid group-polyethyleneimine ( IONP-PEI ) was synthesized and investigated as a nonviral carrier of siRNA to the pancreatic cells .The size, surface and charge using zeta potential were characterized .The perfect charge ratio between amino groups of IONP-PEI and phosphate groups of siRNA ( N/P) was determined by the transfection efficiency detection , gel retardation assay and MTS assay .An antibody-directed nonviral vector , scFvCD44v6-IONP-PEI nanoparticle attaching to the cancer-associated CD44v6 single-chain variable frag-ment, was constructed as a cancer-targeting nanocarrier for siRNA delivery .Prussian blue staining and immunofluorescent staining were performed to detect the distribution of scFv CD44v6-IONP-PEI/siRNA complexes in the cells .The transfection efficiency , fluorescence intensity and the expression of KRAS at mRNA and protein levels in the cells transfected by IONP -PEI/siRNA and scFv CD44v6-IONP-PEI/siRNA were detected by flow cytometry , fluorescence microscopy , real-time PCR and Western blotting, respectively.RESULTS:The mass ratio of IONP to PEI was 0.75.The suitable ratio of N/P was 20. The averaged size and surface zeta potential of IONP-PEI/siRNA in deionized water were (51.3 ±2.2)nm (diameter) and (21.73 ±8.07)mV, respectively.Red fluorescence was seen in both targeting and nontargeting groups , which clearly re-vealed the intracellular distribution of siRNA and delivery agents .Transfection efficiencies in targeting and nontargeting groups were (89.75 ±1.81)%and (59.87 ±4.52)%, respectively.Down-regulation of the KRAS mRNA in Panc-1 cells transfected with siKRAS by scFvCD44v6-IONP-PEI and IONP-PEI was up to (34.02 ±6.15)%and (51.09 ±6.70)%, re-spectively .The protein level of KRAS was lower in targeting group than that in nontargeting group .CONCLUSION:scFvCD44v6-IONP-PEI is a safe and efficient nanoparticulate carrier for gene delivery .It is more effective to transfer siRNA into the cells and mediate gene silencing effect in vitro than the nontargeting group .