Objective To investigate the relationship between triglyceride glucose body mass index(TyG-BMI),high density lipoprotein cholesterol to Apolipoprotein A ratio(HAR),glycemic risk index(GRI)and diabetic retinopathy(DR).Methods A total of 159 patients with type 2 diabetes mellitus(T2DM)complicated with DR(the DR group)were divided into the non-proliferative retinopathy group(NPDR group,66 cases)and the proliferative retinopathy group(PDR group,93 cases)according to DR international clinical grading criteria,and 159 T2DM patients without DR were selected as the control group.Clinical information and baseline laboratory test results were recorded,and TyG-BMI,HAR and GRI were calculated.Multivariate Logistic regression analysis was conducted to analyze the related factors of the incidence of DR,and receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of TyG-BMI,HAR and GRI for DR.Results The duration of T2DM,the proportion of hypertension,diabetic nephropathy and diabetic foot,levels of HbA1c,homeostasis model insulin resistance index(HOMA-IR),total cholesterol(TC),C-reactive protein(CRP),TyG-BMI,HAR and GRI were higher in the DR group than those in the control group(P<0.05).TyG-BMI,HAR and GRI were higher in the PDR group than those in the NPDR group(P<0.05).Multivariate Logistic regression analysis showed that the longer course of T2DM disease[OR(95%CI):2.781(1.398-5.534)],high TyG-BMI[2.036(1.169-3.546)],high HAR[1.890(1.090-3.280)]and high GRI[1.836(1.065-3.167)]were risk factors for DR(P<0.05).ROC curve analysis results showed that,the area under the curve(AUC)of combined TyG-BMI,HAR and GRI diagnosis of DR was higher than that of single diagnosis[0.940(0.908-0.964),0.864(0.821-0.900),0.796(0.747-0.839)and 0.836(0.790-0.875),all P<0.05].Conclusion The increased TyG-BMI,HAR and GRI in T2DM patients is associated with the onset and severity of DR,and which can be used to assess the risk of DR.

Objective:This study empirically analyzes the relationship between outpatient and inpatient services under the impact of healthcare payment reform,and evaluates the effects of the reform.Methods:Data from healthcare services and basic medical insurance payments in eight districts of Jinhua City from 2020 to 2022 were used.A fixed-effects model for outpatient and inpatient services was constructed to analyze the impact of healthcare payment reforms and outpatient services on inpatient services.Results:The DRG-based payment had a significant positive effect on inpatient visits and a significant negative effect on employee basic medical insurance inpatient costs.The"capitation+APG"outpatient payment policy had a significant negative effect on inpatient visits and a significant negative effect on residents'basic medical insurance inpatient costs.The interaction between outpatient payment and outpatient visits had a significant negative effect on employee basic medical insurance inpatient visits,while the interaction between outpatient payment and outpatient costs had a significant negative effect on both overall and employee inpatient costs.Conclusions:The DRG payment reform led to an increase in inpatient visits and a reduction in employee basic medical insurance inpatient costs.The outpatient"capitation+APG"payment reform reduced inpatient visits and lowered residents'basic medical insurance inpatient costs,thereby slowing down the complementary effect between outpatient and inpatient services.

OBJECTIVE To construct an evaluation index system for the core competencies of ethics committee members of drug clinical trial institution,providing a basis for optimizing the training system for committee members,improving the quality of ethical review,and fully safeguarding the safety and rights of subjects.METHODS Using methods such as literature research and expert consultation,a preliminary core competency evaluation index system was constructed.The Delphi method was employed to revise and validate it,ultimately forming an evaluation index system for the core competencies of ethics committee members.Based on this system,a questionnaire survey was conducted among 90 ethics committee members from 29 drug clinical trial institutions nationwide,comparing their importance rating and self-assessment scores of the core competency indexes.RESULTS The evaluation system constructed included 4 primary indicators(ethics and professional knowledge,ethics review ability,communication and expression ability,moral integrity and work style)and 39 secondary indicators(familiarity with the content of clinical trial-related laws and regulations,ability to complete project ethics review and identify ethical defects in research protocols within a short period of time,ability to judge the scientific value of clinical research,etc.).The results of questionnaire survey showed that the interviewed ethics committee members had significant capability gaps in dimensions such as regulatory knowledge,ethical norms,review efficiency,risk judgment,and problem analysis.The differences between the importance rating scores of corresponding secondary indicators and the self-assessment scores were all no less than 0.38.CONCLUSIONS This study has developed a quantifiable and stratified core competency assessment tool for ethics committee members.It can provide a scientific framework for committee member training,qualification certification,and standardized management of ethics committees.

Objective:This study empirically analyzes the relationship between outpatient and inpatient services under the impact of healthcare payment reform,and evaluates the effects of the reform.Methods:Data from healthcare services and basic medical insurance payments in eight districts of Jinhua City from 2020 to 2022 were used.A fixed-effects model for outpatient and inpatient services was constructed to analyze the impact of healthcare payment reforms and outpatient services on inpatient services.Results:The DRG-based payment had a significant positive effect on inpatient visits and a significant negative effect on employee basic medical insurance inpatient costs.The"capitation+APG"outpatient payment policy had a significant negative effect on inpatient visits and a significant negative effect on residents'basic medical insurance inpatient costs.The interaction between outpatient payment and outpatient visits had a significant negative effect on employee basic medical insurance inpatient visits,while the interaction between outpatient payment and outpatient costs had a significant negative effect on both overall and employee inpatient costs.Conclusions:The DRG payment reform led to an increase in inpatient visits and a reduction in employee basic medical insurance inpatient costs.The outpatient"capitation+APG"payment reform reduced inpatient visits and lowered residents'basic medical insurance inpatient costs,thereby slowing down the complementary effect between outpatient and inpatient services.

Objective To investigate washing patterns in human simulated body fluids(SBF)by combining high doses of vancomycin,manuperenan and single compound with bone cement.The antibacterial effect of five common bacteria in orthopaedic infections were observed.Methods Vancomycin 2g and meropenem 3g were combined or alone mixed with ordinary bone cement 20g in aseptic operation.Six copies of antibiotic bone cement pellets were made,immersed in SBF,replaced with SBF buffer every 48 hours,sampled every 24 hours 2 μl drops in methicillin-resistant staphylococcus aureus(MRSA),petries of staphylococcus aureus,pseudomonas aeruginosa,E.coli,and extended-spectrum beta-lactamase(ESBL)-positive E.coli were observed for 24 hours and measured the size of the bactericidal rings of the washing fluid at each time point.The antibacterial effect of different ratios of antibiotic bone cement on 5 common orthopedic infections were compared.Results Compound antibiotic group had a better bactericidal effect,and the drug continues to be given for about 30 days.Wancomycin alone could not cover E.coli,ESBL positive E.coli,pseudomonas aeruginosa,and melopicillin alone had only a partial mild bactericidal effect on MRSA around 3 to 6 days after use.The effect on staphylococcus aureus and pseudomonas aeruginosa lasted only about 15 days.Conclusion The combined antibiotic bone cement has a more comprehensive,longer duration and better bactericidal effect than the alone antibiotic bone cement.

Objective To investigate the current situation of off-label use of immune checkpoint inhibitors(ICIs)in China and the cognition of medical staff.Methods From August 31 to September 9,2022,a nationwide survey questionnaire was sent to medical staff in the form of electronic questionnaire.The questionnaire included 13 questions,covering four dimensions:Drug allocation,current situation of medication beyond the instructions,cognition of medication beyond the instructions and current situation of medication beyond the instructions.Results A total of 745 questionnaires were collected.75.70％of respondents reported off-label use of ICIs in their hospitals,with the most common type being off-label indications.The primary reasons for such practices included support from authoritative domestic and international guidelines,clinical research data validation,and approved indications in foreign regulatory documents.85.37％of respondents believed off-label use could offer new hope for patients,while 68.86％considered it unlikely to increase adverse reactions.44.97％of respondents' hospitals had not established off-label use registration systems for ICIs.88.86％of respondents emphasized the need for stricter regulations governing off-label use of immunotherapeutic agents.Conclusion Off-label use of ICIs is common,and there is a lack of unified guidance in clinical practice.It is urgent to form norms and consensus on the management of off-label use of ICIs.

This paper summarizes the current situation of the cultivation of specialized Traditional Chinese Medicine (TCM) geriatric nursing talents under the background of the integration of medical care and elderly care, including the cultivation status, necessity, feasibility, and existing problems. Based on this, reflections and prospects are put forward, aiming to further promote the cultivation of specialized TCM nursing talents, facilitate the in-depth integration of TCM nursing and geriatric nursing, and drive the high-quality development of nursing.

Objective:To construct an exercise management program for inpatients with postmenopausal osteoporosis (PMOP) based on the health action process approach (HAPA) .Methods:Using HAPA as a theoretical basis, the literature on exercise management in PMOP inpatients was systematically searched and relevant evidence was extracted. On this basis, the first draft of an exercise management program for PMOP inpatients was constructed by combining the results of semi-structured interviews with 16 PMOP inpatients. The first draft of the exercise management program for PMOP inpatients was revised after two rounds of Delphi expert consultation.Results:A total of 15 experts were invited for two rounds of expert consultation. In the two rounds of consultation, the effective recovery rate of the questionnaire was 100.0% (15/15), the expert authority coefficient was 0.880, and Kendall's harmony coefficient was 0.156 and 0.208, respectively ( P<0.01). The final exercise management program for PMOP inpatients consisted of three first-level items, nine second-level items, and 48 third-level items. Conclusions:The exercise management program for PMOP inpatients is scientific and comprehensive, which can provide a reference for nursing staff.

Objective To investigate the protective effect of valeric acid on Doxorubicin-induced myocardial injury in mice.Methods C57BL/6J mice and AC16 cells were randomly divided into control group,injury group,and low-,medium-,and high-dose valeric acid groups.Doxorubicin was used to treat mice and myocardial cells to establish myocardial injury models.Hematoxylin-eosin(HE)staining was used to analyze the pathological changes of myocardial tissue in mice,and enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of myocardial injury markers and inflammatory factors in mice from each group.Cell counting kit was used to detect the viability of myocardial cells in each group,and spectrophotometry was used to detect the levels of superoxide dismutase(SOD)and malondialdehyde(MDA)in the serum and myocardial cells in mice from each group.Reactive oxygen species(ROS)fluorescence probe was used to detect the levels of reactive oxygen species in each group,and flow cytometry was used to detect the apoptosis rate of each group.Western blot was used to detect the expression levels of nuclear factor erythroid 2-related factor 2(Nrf2)and heme oxygenase 1(HO-1)proteins in myocardial tissue and myocardial cells of mice from each group.Results Compared with the injury group,the myocardial injury in the low-,medium-,and high-dose valeric acid groups was ameliorated,the levels of myocardial injury markers gradually decreased,the levels of SOD in the body,and the expression levels of Nrf2 and HO-1 proteins gradually increased,and the levels of inflammatory factors,MDA,and apoptosis rate gradually decreased(P<0.05).Compared with myocardial cells in the injury group,the viability of myocardial cells,the levels of SOD,and the expression levels of Nrf2 and HO-1 proteins in the low-,medium-,and high-dose valeric acid groups gradually increased,while the levels of inflammatory factors,MDA,and apoptosis rate gradually decreased(P<0.05).Conclusion Valeric acid can inhibit inflammation and oxidative stress to improve Doxorubicin-induced myocardial injury,which may be related to the activation of Nrf2/HO-1 signaling pathway by valeric acid.

This paper summarizes the current situation of the cultivation of specialized Traditional Chinese Medicine (TCM) geriatric nursing talents under the background of the integration of medical care and elderly care, including the cultivation status, necessity, feasibility, and existing problems. Based on this, reflections and prospects are put forward, aiming to further promote the cultivation of specialized TCM nursing talents, facilitate the in-depth integration of TCM nursing and geriatric nursing, and drive the high-quality development of nursing.