Objective To assess the changes of medical institutions before and after the Diagnosis-Intervention Packet (DIP) payment method reform,analyze the challenges faced by medical institutions,and provide reference for further improvement.Methods Data were obtained through literature analysis,key informant interviews,and statistically analyzed using chi-square test,wilcoxon rank sum test and t-test,focusing on the four dimensions of medical institutions'service capacity,service efficiency,quality and safety,and cost control.Results After the implementation of the DIP payment method reform,the Case Mix Index in terms of service capacity did not change significantly,although the percentage of tertiary and quaternary surgeries in the pilot hospitals increased compared to the pre-reform period;in terms of service efficiency,the differences in average hospitalization days and bed utilization rate were not statistically significant compared with the pre-reform period;in terms of quality and safety,the mortality rate and the rate of surgical site infections of Class Ⅰ incisions in the low-risk group were significantly reduced;and in terms of cost containment,the average inpatient hospitalization cost increase trend has slowed down,and the proportion of drug costs decreased.Conclusion In order to further improve and implement the DIP payment method reform,the relevant departments of health insurance need to improve the medical quality evaluation system and pay attention to the participation of medical institutions;ensure the quality of medical care to regulate medical behavior and strengthen the refined management of clinical pathways;and implement a dynamic and flexible management strategy and set up DIP implementation rules according to local conditions.

The receptor-binding region(RBD)of the spike protein(S)on the surface of porcine epi-demic diarrhea virus(PEDV)is a critical structural domain mediating viral invasion of host cells and serves as a key target for inducing neutralizing antibodies.In order to prepare antibodies that can be used to study the biological function of PEDV RBD and develop novel diagnostic and thera-peutic methods,recombinant RBD protein expressed in Sf9 insect cells was utilized as an immuno-gen to immunize BALB/c mice.Monoclonal antibodies(mAbs)were generated via hybridoma tech-nology,and positive hybridoma clones were screened using indirect ELISA.The reactivity of the mAbs was subsequently characterized.The results of ELISA,Western blot,and indirect immuno-fluorescence assay(IFA)showed that three monoclonal antibodies screened(3E5,4F9 and 5A5)had good reactivity with the virus and RBD protein.Antibody subtype results showed that 3E5 and 4F9 were of IgG1 subtypes and 5A5 was of IgM subtype.Neutralization assay further revealed that 3E5 monoclonal antibody had viral neutralizing activity.In this study,three monoclonal antibodies against PEDV RBD proteins were successfully prepared,providing the basis for the study of the bi-ological function of RBD proteins,PEDV serologic detection and vaccine development.

The receptor-binding region(RBD)of the spike protein(S)on the surface of porcine epi-demic diarrhea virus(PEDV)is a critical structural domain mediating viral invasion of host cells and serves as a key target for inducing neutralizing antibodies.In order to prepare antibodies that can be used to study the biological function of PEDV RBD and develop novel diagnostic and thera-peutic methods,recombinant RBD protein expressed in Sf9 insect cells was utilized as an immuno-gen to immunize BALB/c mice.Monoclonal antibodies(mAbs)were generated via hybridoma tech-nology,and positive hybridoma clones were screened using indirect ELISA.The reactivity of the mAbs was subsequently characterized.The results of ELISA,Western blot,and indirect immuno-fluorescence assay(IFA)showed that three monoclonal antibodies screened(3E5,4F9 and 5A5)had good reactivity with the virus and RBD protein.Antibody subtype results showed that 3E5 and 4F9 were of IgG1 subtypes and 5A5 was of IgM subtype.Neutralization assay further revealed that 3E5 monoclonal antibody had viral neutralizing activity.In this study,three monoclonal antibodies against PEDV RBD proteins were successfully prepared,providing the basis for the study of the bi-ological function of RBD proteins,PEDV serologic detection and vaccine development.

Objective To explore the bronchoscopic manifestations of invasive pulmonary fungal disease(IPFD)and evaluate the safety and efficacy of interventional therapy effect.Methods A retrospective analysis was conducted on the clinical data of 35 patients with IPFD who underwent bronchoscopy from May 12,2018 to May 12,2025 to observe the bronchoscopic manifestations and interventional therapy of IPFD.Results 35 patients' clinical data were collected,including 22 males and 13 females,with an age of(53±14)years.The underlying diseases included:10 cases of hematological malignancies,5 cases of long-term use of glucocorticoids,4 cases of type 2 diabetes,2 cases of lung malignancies,and 1 case of organ transplant patient.Chest CT showed that there were 19 cases of lung lesions involving a single lobe and 16 cases involving multiple lobes.The main manifestations under bronchoscopy were 29 cases with mucosal hyperemia and edema(82.9％),22 cases with necrotic substances blocking the lumen(62.9％),17 cases with a large amount of viscous purulent secretions(48.6％),16 cases with partial bronchial stenosis or occlusion(45.7％),9 cases with mucosal necrosis(25.7％),5 cases with mucosal hemorrhage(14.3％),and 3 cases with fungal globules(8.6％).Among them,32 cases(91.4％)received systemic antifungal treatment,17 cases(48.6％)received local amphotericin B perfusion treatment by bronchoscopy,10 cases(28.6％)had the lesion removed by biopsy forceps,6 cases(17.1％)had the lesion frozen by cryoprobe,and 4 cases(11.4％)received argon plasma coagulation treatment.The clinical symptoms of 28 cases(80.0％)improved significantly,and the lung imaging lesions shrank or regressed.Four cases(11.4％)had stable lesions.Three cases(8.6％)did not complete the treatment.Conclusion IPFD is more common in immunosuppressed hosts,bronchoscopy often presents with necrotic substances blocking the lumen,accompanied by purulent secretions,bronchial lumen stenosis,local mucosal hyperemia,edema or necrosis.Systemic antifungal drugs combined with interventional therapy under bronchoscopy have high safety and good therapeutic effects.

Objective To explore the bronchoscopic manifestations of invasive pulmonary fungal disease(IPFD)and evaluate the safety and efficacy of interventional therapy effect.Methods A retrospective analysis was conducted on the clinical data of 35 patients with IPFD who underwent bronchoscopy from May 12,2018 to May 12,2025 to observe the bronchoscopic manifestations and interventional therapy of IPFD.Results 35 patients' clinical data were collected,including 22 males and 13 females,with an age of(53±14)years.The underlying diseases included:10 cases of hematological malignancies,5 cases of long-term use of glucocorticoids,4 cases of type 2 diabetes,2 cases of lung malignancies,and 1 case of organ transplant patient.Chest CT showed that there were 19 cases of lung lesions involving a single lobe and 16 cases involving multiple lobes.The main manifestations under bronchoscopy were 29 cases with mucosal hyperemia and edema(82.9％),22 cases with necrotic substances blocking the lumen(62.9％),17 cases with a large amount of viscous purulent secretions(48.6％),16 cases with partial bronchial stenosis or occlusion(45.7％),9 cases with mucosal necrosis(25.7％),5 cases with mucosal hemorrhage(14.3％),and 3 cases with fungal globules(8.6％).Among them,32 cases(91.4％)received systemic antifungal treatment,17 cases(48.6％)received local amphotericin B perfusion treatment by bronchoscopy,10 cases(28.6％)had the lesion removed by biopsy forceps,6 cases(17.1％)had the lesion frozen by cryoprobe,and 4 cases(11.4％)received argon plasma coagulation treatment.The clinical symptoms of 28 cases(80.0％)improved significantly,and the lung imaging lesions shrank or regressed.Four cases(11.4％)had stable lesions.Three cases(8.6％)did not complete the treatment.Conclusion IPFD is more common in immunosuppressed hosts,bronchoscopy often presents with necrotic substances blocking the lumen,accompanied by purulent secretions,bronchial lumen stenosis,local mucosal hyperemia,edema or necrosis.Systemic antifungal drugs combined with interventional therapy under bronchoscopy have high safety and good therapeutic effects.

ObjectiveTo investigate the processing technology of calcined Haematitum based on the concept of quality by design（QbD） and to assess its health risk. MethodsTaking whole iron content， Fe²⁺ dissolution content and looseness as critical quality attributes（CQAs）， and calcination temperature， calcination time， spreading thickness and particle size as critical process parameters（CPPs） determined by the failure mode and effect analysis（FMEA）， the processing technology of calcined Haematitum was optimized by orthogonal test combined with analytic hierarchy process-criteria importance through intercriteria correlation（AHP-CRITIC） hybrid weighting method. The contents of heavy metals and harmful elements were determined by inductively coupled plasma mass spectrometry， and the health risk assessment was carried out by daily exposure（EXP）， target hazard quotient（THQ） and lifetime cancer risk（LCR）， and the theoretical value of the maximum limit was deduced. ResultsThe optimal processing technology for calcined Haematitum was calcination at 650 ℃， calcination time of 1 h， particle size of 0.2-0.5 cm， spreading thickness of 1 cm， and vinegar quenching for 1 time［Haematitum-vinegar（10：3）］. The contents of 5 heavy metals and harmful elements in 13 batches of calcined Haematitum were all decreased with reductions of up to 5-fold. The cumulative THQ of 2 batches of samples was>1， while the cumulative THQ of all batches of Haematitum was>1. The LCR of As in 1 batches of Haematitum was 1×10^-6-1×10^-4， and the LCR of the rest was<1×10^-6， and the LCRs of calcined Haematitum were all<1×10^-6， indicating that the carcinogenic risk of calcined Haematitum was low， but special attention should still be paid to Haematitum medicinal materials. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg were formulated as 1 014， 25， 17， 27， 7 mg·kg^-1. ConclusionThe optimized processing technology of calcined Haematitum is stable and feasible， and the contents of heavy metals and harmful elements are reduced after processing. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg are formulated to provide a scientific basis for the formulation of standards for the limits of harmful elements in Haematitum.

ObjectiveTo investigate the processing technology of calcined Haematitum based on the concept of quality by design（QbD） and to assess its health risk. MethodsTaking whole iron content， Fe²⁺ dissolution content and looseness as critical quality attributes（CQAs）， and calcination temperature， calcination time， spreading thickness and particle size as critical process parameters（CPPs） determined by the failure mode and effect analysis（FMEA）， the processing technology of calcined Haematitum was optimized by orthogonal test combined with analytic hierarchy process-criteria importance through intercriteria correlation（AHP-CRITIC） hybrid weighting method. The contents of heavy metals and harmful elements were determined by inductively coupled plasma mass spectrometry， and the health risk assessment was carried out by daily exposure（EXP）， target hazard quotient（THQ） and lifetime cancer risk（LCR）， and the theoretical value of the maximum limit was deduced. ResultsThe optimal processing technology for calcined Haematitum was calcination at 650 ℃， calcination time of 1 h， particle size of 0.2-0.5 cm， spreading thickness of 1 cm， and vinegar quenching for 1 time［Haematitum-vinegar（10：3）］. The contents of 5 heavy metals and harmful elements in 13 batches of calcined Haematitum were all decreased with reductions of up to 5-fold. The cumulative THQ of 2 batches of samples was>1， while the cumulative THQ of all batches of Haematitum was>1. The LCR of As in 1 batches of Haematitum was 1×10^-6-1×10^-4， and the LCR of the rest was<1×10^-6， and the LCRs of calcined Haematitum were all<1×10^-6， indicating that the carcinogenic risk of calcined Haematitum was low， but special attention should still be paid to Haematitum medicinal materials. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg were formulated as 1 014， 25， 17， 27， 7 mg·kg^-1. ConclusionThe optimized processing technology of calcined Haematitum is stable and feasible， and the contents of heavy metals and harmful elements are reduced after processing. Preliminary theoretical values of the maximum limits of Cu， As， Cd， Pb and Hg are formulated to provide a scientific basis for the formulation of standards for the limits of harmful elements in Haematitum.

Objective:To identify risk factors for mucus plug formation and to construct a nomogram-based predictive model in children with adenovirus pneumonia.Methods:In this retrospective cohort study, 149 pediatric patients diagnosed with adenovirus pneumonia were included. All patients underwent bronchoscopy at the Department of Respiratory Tianjin Children′s Hospital Machang District, between January and December 2024. Their demographic characteristics, clinical manifestations, laboratory findings, imaging features, and treatment details were analyzed.The information of patients were collected about clinical manifestations, laboratory findings, imaging features, and treatment information. Patients were divided into a mucus plug group and a non-mucus plug group based on bronchoscopic findings. Independent risk factors were determined using multivariable Logistic regression. And a predictive nomogram was subsequently developed. Model performance was evaluated using the area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test.Results:Of the 149 enrolled patients (84 boys, 65 girls), 49 cases were classified into the mucus plug group and 100 cases into the non-mucus plug group. Compared with their counterparts, children in the mucus plug group were older on admission ( P<0.05), more likely to have a recent history of lower respiratory tract infection, and exhibited a higher prevalence of consolidation or bronchiolitis patterns on chest imaging (all P<0.05), while preoperative corticosteroid use was less frequent ( P<0.05). Multivariable Logistic regression identified age on admission ( OR=1.14, 95% CI 1.01-1.29, P=0.031), lower respiratory tract infection ( OR=5.23, 95% CI 2.15-13.56, P<0.001), radiographic consolidation ( OR=2.64, 95% CI 1.10-6.61, P=0.032), and bronchiolitis pattern ( OR=2.39, 95% CI 1.04-5.60, P=0.042) as independent risk factors, whereas pre-bronchoscopy corticosteroid use was a protective factor ( OR=0.26, 95% CI 0.10-0.63, P=0.004). The nomogram predictive model demonstrated strong discriminative ability (area under the curve=0.83) and good calibration (Hosmer-Lemeshow P=0.358). Conclusions:The independent risk factors for mucus plug formation include older age, a recent history of lower respiratory tract infection, and chest imaging features of consolidation or bronchiolitis in pediatric adenovirus pneumonia. Pre-bronchoscopy corticosteroid therapy is a protective effect. The developed nomogram demonstrates favorable predictive performance and may facilitate early identification and timely intervention.

Objective:To identify risk factors for mucus plug formation and to construct a nomogram-based predictive model in children with adenovirus pneumonia.Methods:In this retrospective cohort study, 149 pediatric patients diagnosed with adenovirus pneumonia were included. All patients underwent bronchoscopy at the Department of Respiratory Tianjin Children′s Hospital Machang District, between January and December 2024. Their demographic characteristics, clinical manifestations, laboratory findings, imaging features, and treatment details were analyzed.The information of patients were collected about clinical manifestations, laboratory findings, imaging features, and treatment information. Patients were divided into a mucus plug group and a non-mucus plug group based on bronchoscopic findings. Independent risk factors were determined using multivariable Logistic regression. And a predictive nomogram was subsequently developed. Model performance was evaluated using the area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test.Results:Of the 149 enrolled patients (84 boys, 65 girls), 49 cases were classified into the mucus plug group and 100 cases into the non-mucus plug group. Compared with their counterparts, children in the mucus plug group were older on admission ( P<0.05), more likely to have a recent history of lower respiratory tract infection, and exhibited a higher prevalence of consolidation or bronchiolitis patterns on chest imaging (all P<0.05), while preoperative corticosteroid use was less frequent ( P<0.05). Multivariable Logistic regression identified age on admission ( OR=1.14, 95% CI 1.01-1.29, P=0.031), lower respiratory tract infection ( OR=5.23, 95% CI 2.15-13.56, P<0.001), radiographic consolidation ( OR=2.64, 95% CI 1.10-6.61, P=0.032), and bronchiolitis pattern ( OR=2.39, 95% CI 1.04-5.60, P=0.042) as independent risk factors, whereas pre-bronchoscopy corticosteroid use was a protective factor ( OR=0.26, 95% CI 0.10-0.63, P=0.004). The nomogram predictive model demonstrated strong discriminative ability (area under the curve=0.83) and good calibration (Hosmer-Lemeshow P=0.358). Conclusions:The independent risk factors for mucus plug formation include older age, a recent history of lower respiratory tract infection, and chest imaging features of consolidation or bronchiolitis in pediatric adenovirus pneumonia. Pre-bronchoscopy corticosteroid therapy is a protective effect. The developed nomogram demonstrates favorable predictive performance and may facilitate early identification and timely intervention.

Objective:To characterize and compare the polysaccharide components of Panax japonicus with its common counterfeits (Dysosma versipellis, Lycopus lucidus and Dysosma pleiantha); To provide a scientific basis for the quality evaluation of polysaccharides of Panax japonicu.Methods:Crude polysaccharides were extracted using water and subsequently precipitated with ethanol. Three batches of total polysaccharides from Panax japonicus, Dysosma versipellis, Lycopus lucidus and Dysosma pleiantha were prepared using the savage deproteinization method. The molecular weight distribution, functional group characteristics and monosaccharide composition of each batch were analyzed using high performance gel filtration chromatography (HPGFC), fourier-transform infrared spectroscopy (FT-IR) and derivatization of 1-phenyl-3-methyl-5-pyrazolinone with high performance liquid chromatography (PMP-HPLC). Using DEAE column chromatography purification and specific enzymolysis, combined with high performance thin layer chromatography and carbohydrate gel electrophoresis, the saccharide profiles of polysaccharides of Panax japonicus and its counterfeits were analyzed and compared.Results:The molecular weight distribution of total polysaccharides from three batches of Panax japonicus exhibited high similarity, with a concentrated distribution ranging from 2.05×10 4 - 1.87×10 3 Da. However, the molecular weight distribution of total polysaccharides from Dysosma versipellis was scattered in regions 5.08×10 6-6.47×10 5 Da and 6.47×10 5-2.05×10 4 Da, while Lycopus lucidus and Dysosma pleiantha was scattered in regions 6.47×10 5-2.05×10 4 Da and 2.05×10 4-1.87×10 3 Da; the infrared spectra of all samples exhibited similarity, indicating that the sugar chains of each polysaccharide were predominantly linked by α-glycosidic bonds, with no significant differences was observed. In terms of monosaccharide composition, the polysaccharides from Panax japonicus, Dysosma versipellis and Dysosma pleiantha were mainly composed of glucose, galactose, arabinose, galacturonic acid, rhamnose and mannose. In contrast, the polysaccharides from Lycopus lucidus were distinct, primarily consisting of galactose and glucose; glycosidic linkage analysis revealed that the polysaccharides purified by DEAE column chromatography from Panax japonicus and its counterfeits were resistant to hydrolysis by β- galactosidase, but could be hydrolyzed by α-amylase and pectinase (except for Lycopus lucidus). The oligosaccharides produced by α-amylase hydrolysis of three batches of Panax japonicus polysaccharides were similar, showing clear differences from those of the counterfeits. The results of pectinase hydrolysis were correlated with the content of uronic acids. Conclusions:The total polysaccharides from Panax japonicus, Dysosma versipellis, Lycopus lucidus and Dysosma pleiantha exhibit significant differences in their molecular weight distributions. The monosaccharide composition of Lycopus lucidus polysaccharides is notably distinct, making it easily distinguishable from other species; purification using DEAE column chromatography, combined with HPTLC and polysaccharide analysis using carbohydrate gel electrophoresis (PACE), effectively differentiates the polysaccharides of Panax japonicus from its counterfeits. This approach provides a valuable reference for the quality analysis of polysaccharides in TCM. Additionally, it lays a foundation for the development and utilization of Panax japonicus polysaccharides.