The inherent clinical uncertainties, substantial costs, and small patient cohorts of orphan drugs limit the applicability of randomized controlled trial (RCT)-based health technology assessments (HTAs) in guiding coverage criteria, sustainable financing models, and equitable reimbursement frameworks for medical financial assistance policies for rare diseases.The digital transformation in healthcare system leads to solutions to the challenges in designing the policy by using data-driven decision-making. This article summarizes the decision-making issues in policy design, discusses the current status and trends of digital transformation, and analyzes the important new opportunities for AI-driven policy design for medical financial assistance policies for rare diseases. Decision-making that is digital intelligence driven and using techniques such as big data analytics and real-world research methods will enhance targeting efficiency, improve the quality of financing, and realize the performance-based reimbursement in the medical financial assistance, providing significant value in facilitating the policy reform and development for rare diseases healthcare.

General anesthesia, pivotal for surgical procedures, requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments. Traditional assessment methods, relying on physiological indicators or behavioral responses, fall short of accurately capturing the nuanced states of unconsciousness. This study introduces a machine learning-based approach to decode anesthesia depth, leveraging EEG data across different anesthesia states induced by propofol and esketamine in rats. Our findings demonstrate the model's robust predictive accuracy, underscored by a novel intra-subject dataset partitioning and a 5-fold cross-validation method. The research diverges from conventional monitoring by utilizing anesthetic infusion rates as objective indicators of anesthesia states, highlighting distinct EEG patterns and enhancing prediction accuracy. Moreover, the model's ability to generalize across individuals suggests its potential for broad clinical application, distinguishing between anesthetic agents and their depths. Despite relying on rat EEG data, which poses questions about real-world applicability, our approach marks a significant advance in anesthesia monitoring.
Animals ; Machine Learning ; Electroencephalography/methods* ; Ketamine/administration & dosage* ; Rats ; Male ; Propofol/administration & dosage* ; Rats, Sprague-Dawley ; Anesthesia, General/methods* ; Brain/physiology* ; Intraoperative Neurophysiological Monitoring/methods*

Objective To investigate the mechanism by which blue light irradiation-activated microglia mediate immune cell recruitment and exacerbate retinal damage,and to explore the role of microglial depletion in inhibiting immune infiltration and protecting the retina.Methods SPF-grade C57BL/6J mice were randomly divided into control group,blue light irradiation group,and PLX5622 pretreatment blue light irradiation group.A retinal injury model was established by continuous LED blue light irradiation for 2 days.In the PLX5622 pretreatment group,microglia were specifically depleted before blue light irradiation.After modeling,HE staining and OCT examination were used to examine retinal histomorphological changes;ERG examination was performed to evaluate retinal function;DHE staining and RT-qPCR were used to detect oxidative stress and inflammatory responses,and Iba1,CD68,CD11b immunofluorescence staining and flow cytometry were used to analyze microglial activation status and immune cell infiltration.Results After blue light irradiation,the retinal outer nuclear layer thickness was significantly reduced;ERG a-wave and b-wave amplitudes decreased;expression of oxidative stress-related genes Nrf2,Sod2,and HO-1 was upregulated;expression of inflammatory factors IL-1β,TNF-α,and ICAM-1 increased;the number of Iba1-positive microglia increased and migrated extensively to the outer nuclear layer;the proportion of CD68+cells and CD11b+immune cells was elevated;and activated microglia aggregated around blood vessels to mediate immune cell infiltration.After PLX5622 pretreatment to deplete microglia,immune cell infiltration was significantly reduced;inflammatory responses were alleviated;retinal structural damage was markedly improved,and visual function was protected.Conclusions Blue light irradiation activates microglia and promotes their migration to the injury area.Activated microglia mediate immune cell recruitment and infiltration,exacerbating retinal inflammatory damage.Microglial depletion can effectively inhibit immune infiltration,rescue retinal structure and function,and provide new therapeutic strategies for the prevention and treatment of blue light-related ocular diseases.

Objective:To explore the effect of companion robot therapy in dementia patients through Meta-analysis.Methods:Randomized controlled trials of companion robot therapy in patients with dementia were searched in both English and Chinese databases with a search period from database establishment to April 30, 2024. Two researchers used the Risk of Bias ROB 2 software to evaluate the quality of the included literature and analyzed it using Stata 17.0 software.Results:A total of 10 papers were included. Meta-analysis showed that the effect of the companion robot on depression in dementia patients was statistically significant when comparing experimental group with control group [ SMD=1.09, 95% CI (0.02, 2.17), P=0.047], and that the improvement of agitated behavior [ SMD=-0.28, 95% CI (-0.53, -0.04), P=0.02] and anxiety [ WMD=2.80, 95% CI (2.70, 2.90), P<0.01] in experimental group were better than those in control group, and the differences were all statistically significant. However, the differences in the effects on quality of life and neuropsychiatric symptoms in experimental group compared with control group were not statistically significant ( P>0.05) . Conclusions:Companion robots have positive effects on improving depression, agitated behavior, and anxiety in dementia patients, and are not yet effective in improving quality of life and neuropsychiatric symptoms, which need to be validated by high-quality studies in the future.

Objective To analyze the current status of medical services in secondary and tertiary hospitals in Shandong Province based on DRG,and to provide effective support for the implementation strategies of bidirectional referral.Methods The DRG group was used to analyze 42.348 3 million cases from 75 secondary hospitals and 69 tertiary hospitals in Shandong Province from 2019 to 2023.Experts were organized to establish standards for bidirectional referral of diseases.Results(1)35 high-frequency DRG disease groups with diagnosis,treatment ability and medical resources in secondary hospitals were selected,(2)The medical expenses and medical quality in the high-frequency DRG disease groups within secondary hospitals were lower than those in tertiary hospitals,(3)To develop standardized referral standards and programs with esophageal cancer as an example.Conclusion It is urgent to triage patients gradually and accurately through disease classification management,and formulate disease diagnosis and treatment plans and bidirectional referral standards to improve the medical quality of secondary hospitals.

Objective To investigate the mechanism by which blue light irradiation-activated microglia mediate immune cell recruitment and exacerbate retinal damage,and to explore the role of microglial depletion in inhibiting immune infiltration and protecting the retina.Methods SPF-grade C57BL/6J mice were randomly divided into control group,blue light irradiation group,and PLX5622 pretreatment blue light irradiation group.A retinal injury model was established by continuous LED blue light irradiation for 2 days.In the PLX5622 pretreatment group,microglia were specifically depleted before blue light irradiation.After modeling,HE staining and OCT examination were used to examine retinal histomorphological changes;ERG examination was performed to evaluate retinal function;DHE staining and RT-qPCR were used to detect oxidative stress and inflammatory responses,and Iba1,CD68,CD11b immunofluorescence staining and flow cytometry were used to analyze microglial activation status and immune cell infiltration.Results After blue light irradiation,the retinal outer nuclear layer thickness was significantly reduced;ERG a-wave and b-wave amplitudes decreased;expression of oxidative stress-related genes Nrf2,Sod2,and HO-1 was upregulated;expression of inflammatory factors IL-1β,TNF-α,and ICAM-1 increased;the number of Iba1-positive microglia increased and migrated extensively to the outer nuclear layer;the proportion of CD68+cells and CD11b+immune cells was elevated;and activated microglia aggregated around blood vessels to mediate immune cell infiltration.After PLX5622 pretreatment to deplete microglia,immune cell infiltration was significantly reduced;inflammatory responses were alleviated;retinal structural damage was markedly improved,and visual function was protected.Conclusions Blue light irradiation activates microglia and promotes their migration to the injury area.Activated microglia mediate immune cell recruitment and infiltration,exacerbating retinal inflammatory damage.Microglial depletion can effectively inhibit immune infiltration,rescue retinal structure and function,and provide new therapeutic strategies for the prevention and treatment of blue light-related ocular diseases.

Objective To analyze the current status of medical services in secondary and tertiary hospitals in Shandong Province based on DRG,and to provide effective support for the implementation strategies of bidirectional referral.Methods The DRG group was used to analyze 42.348 3 million cases from 75 secondary hospitals and 69 tertiary hospitals in Shandong Province from 2019 to 2023.Experts were organized to establish standards for bidirectional referral of diseases.Results(1)35 high-frequency DRG disease groups with diagnosis,treatment ability and medical resources in secondary hospitals were selected,(2)The medical expenses and medical quality in the high-frequency DRG disease groups within secondary hospitals were lower than those in tertiary hospitals,(3)To develop standardized referral standards and programs with esophageal cancer as an example.Conclusion It is urgent to triage patients gradually and accurately through disease classification management,and formulate disease diagnosis and treatment plans and bidirectional referral standards to improve the medical quality of secondary hospitals.

Objective:To explore the effect of companion robot therapy in dementia patients through Meta-analysis.Methods:Randomized controlled trials of companion robot therapy in patients with dementia were searched in both English and Chinese databases with a search period from database establishment to April 30, 2024. Two researchers used the Risk of Bias ROB 2 software to evaluate the quality of the included literature and analyzed it using Stata 17.0 software.Results:A total of 10 papers were included. Meta-analysis showed that the effect of the companion robot on depression in dementia patients was statistically significant when comparing experimental group with control group [ SMD=1.09, 95% CI (0.02, 2.17), P=0.047], and that the improvement of agitated behavior [ SMD=-0.28, 95% CI (-0.53, -0.04), P=0.02] and anxiety [ WMD=2.80, 95% CI (2.70, 2.90), P<0.01] in experimental group were better than those in control group, and the differences were all statistically significant. However, the differences in the effects on quality of life and neuropsychiatric symptoms in experimental group compared with control group were not statistically significant ( P>0.05) . Conclusions:Companion robots have positive effects on improving depression, agitated behavior, and anxiety in dementia patients, and are not yet effective in improving quality of life and neuropsychiatric symptoms, which need to be validated by high-quality studies in the future.

Oral cancer represents a serious public health problem affecting oral and system health with a high global incidence.Treatment strategies for oral cancer vary in different disciplines and are likely to be limited to certain doctor's personal experience.While clinical practice guidelines are considered to enable doctors to determine the most appropri-ate and consistent treatment strategy according to the patient's situation.National Comprehensive Cancer Network(NCCN)clinical practice guidelines have become the most prevalent in global clinical oncology practice.This article mainly focuses on cases to discuss the normalized treatment strategy for oral cancer in different stages based on the NCCN Clinical Practice Guidelines in Oncology(NCCN Guidelines):Head and Neck Cancers,Version 3,2024.

The relationship between glycolysis and viral infectious diseases is close,and the inter-action between viral and host glycolysis is a common mechanism found in a wide range of viruses.Therefore,the regulation of glycolysis may be an important antiviral strategy.The coronavirus diseases 2019 pandemic has brought about a tremendous disaster to humanity,compelling us to seek effective solutions from various perspectives.Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection can induce an increase in host glycolysis,the level of which plays an important role in virus replication and infection,associated with the progression of the disease and a variety of clinical symp-toms and complications.The study on the interaction between host glycolysis and SARS-CoV-2 infec-tion can shed light on the pathogenic mechanism of SARS-CoV-2 and promote the research on related drugs.This article reviews the interactions between SARS-CoV-2 infection and host glycolysis in the hopes of providing a new perspective to understand the relationships between viral infections and disease in terms of metabolic regulation and formulate countermeasures.