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.

Objectives:To investigate the clinical efficacy of bilateral mini-open Wiltse approach transforami-nal lumbar interbody fusion(MO-TLIF)in the treatment of degenerative lumbar diseases in the elderly.Meth-ods:A retrospective analysis was conducted on 62 elderly patients with single-segment degenerative lumbar diseases who underwent MO-TLIF or minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)inthe First Affiliated Hospital of Naval Medical University between September 2017 and August 2020.Among them,37 were male and 25 were female,aged 68.0±5.5 years.The patients were divided into the MO-TLIF group(32 cases)and the MIS-TLIF group(30 cases).There were no statistically significant differences between the two groups in terms of gender ratio,age,body mass index(BMI),surgical segment,disease duration,or follow-up time(P＞0.05).The differences between the two groups were compared in terms of operative time,in-traoperative blood loss,intraoperative fluoroscopy,postoperative wound drainage,time to ambulation,hospital stay,complications,and fusion rate.The visual analogue scale(VAS),lumbar Japanese Orthopedic Association(JOA)scores,and Oswestry disability index(ODI)before surgery,at 3 months postoperatively,and at the final follow-up were recorded and compared.Results:The two groups of patients all successfully completed the surgery without significant surgery-related complications.There were no statistically significant differences be-tween the MO-TLIF and MIS-TLIF groups in terms of intraoperative blood loss(80.3±25.1mL vs.72.3±21.8mL),postoperative wound drainage volume(30.7±10.2mL vs.29.3±9.0mL),or hospital stay(5.4±0.9d vs.5.4±0.8d)(P＞0.05).Compared with the MIS-TLIF group,the MO-TLIF group had shorter operative time(90.8±8.8min vs.98.3±8.0min,P=0.001)and fewer number of intraoperative fluoroscopy(4.7±0.7 times vs.7.2±1.4 times,P＜0.001).Both groups showed significant improvement in low back pain VAS score,lumbar JOA score,and ODI at postoperative 3 months and final follow-up compared with preoperative values(P＜0.001),but there were no statistically significant differences between the two groups at the same time points(P＞0.05).At the fi-nal follow-up,no internal fixation-related complications such as screw or rod breakage were observed in both groups,and all the cases achieved bone fusion.Conclusions:Bilateral MO-TLIF can achieve good therapeutic outcomes in treating single-segment degenerative lumbar diseases,which can reduce intraoperative fluoroscopy frequency and shorten operative time comparing with MIS-TLIF.

Objective:To investigate the role of YTHDF2 in cervical lesions and its potential molecular mechanism.Methods:Gene expression data of cervical tissue were obtained from the GEO database to analyze the expression of YTHDF2 mRNA and perform pathway enrichment analysis. Patients with cervical lesions diagnosed by thinprep cytologic test in Gynecological Outpatient Department of Maternal and Child Health Hospital in Jiexiu, Shanxi Province, were selected as the research subjects. Data of cervical lesions and cervical exfoliated cells were collected. HPV infection status was detected by flow-through hybridization, and the expression of YTHDF2 mRNA was detected by reverse transcription real-time polymerase chain reaction. The expression of YTHDF2 in cervical lesions and the mediating role of HPV infection in the relationship between YTHDF2 and squamous intraepithelial lesion (SIL) were evaluated. YTHDF2-related genes were screened from multiple datasets in the GEO and ENCORI databases, and their expression, immune infiltration, and survival analysis were performed to assess the association between YTHDF2 and prognosis. Results:Compared with normal cervical tissue, YTHDF2 was highly expressed in cervical lesion tissue ( P<0.05). A total of 3 672 differentially expressed genes were screened from the dataset GSE49339. Gene Ontology analysis showed that YTHDF2 was mainly involved in transcription regulation. Kyoto Encyclopedia of Genes and Genomes analysis showed that YTHDF2 might be related to HPV infection and other signaling pathways. In the mediation analysis, χ2 test results showed that the expression level of YTHDF2 was significantly different among groups ( χ2=22.47, P<0.001). Trend χ2 test further showed that the expression level of YTHDF2 was upregulated with the degree of cervical precancerous lesions (trend χ2=10.26, P=0.001). Multivariate logistic regression analysis indicated that high YTHDF2 expression increased the risk of low-grade squamous intraepithelial lesions ( OR=3.15, 95% CI: 1.93-5.15) and high-grade squamous intraepithelial lesions ( OR=1.85, 95% CI: 1.01-3.39). Mediation effect analysis revealed a partial mediating effect of HPV infection between YTHDF2 and SIL, accounting for 32.02% of the total effect. Twelve YTHDF2 related genes were screened by the intersection of multiple datasets. The immune infiltration analysis results showed that YTHDF2 and related genes KLF4, E2F3 and HOXC6 were associated with immune infiltration (all P<0.05). Multivariate Cox proportional hazard regression model analysis showed that low expression of KLF4 ( HR=0.53, 95% CI: 0.30-0.94) and high expression of RHOB ( HR=1.80, 95% CI: 1.04-3.13) were risk factors for the prognosis of cervical cancer. Conclusion:YTHDF2 is highly expressed in cervical lesions and may have been involved in the regulation of HPV infection-related pathways and its downstream related genes are related to immune infiltration and prognosis of cervical cancer, providing a theoretical basis for the study of mechanisms related to cervical lesions.

Objective:To investigate the detection status of pulmonary tuberculosis (PTB) among patients aged ≥65 years in China and provide evidence for improving PTB prevention and control in this population.Methods:The data were collected from the tuberculosis subsystem of Chinese Disease Control and Prevention Information System, and the case information of elderly PTB patients aged ≥65 years old who were registered in designated tuberculosis medical institutions nationwide from January 1, 2015 to December 31, 2023.Descriptive epidemiological methods were used to analyze trends in detection status, regional differences, and demographic characteristics.Results:From 2015 to 2023, 1 567 047 elderly PTB detection were identified, accounting for 25.1% of all PTB patients (1 567 047/6 243 215). The average registration rate for elderly PTB patients was 96.9 per 100 000, approximately twice that of the general population. The registration rate declined over the years ( Z=-2.61, P=0.009) but increased in 2018 and 2023. The proportion of elderly PTB patients rose annually, from 21.3% in 2015 to 32.4% in 2023 ( Z=2.30, P=0.022). Active case-finding accounted for only 3.0% (47 049/1 567 047) of patients on average during the study period, peaking at 7.3% (14 123/194 615) in 2018 before declining. The registration rates of elderly tuberculosis patients are relatively higher in central and western regions. In the central region, the average registration rate was 113.8 per 100 000, with a proportion of active case detection of 0.4% (2 532/570 059). In the western region, the average registration rate was 130.0 per 100 000, and the proportion of active case-finding was 7.6% (41 973/549 998). Subgroups with notably lower active detection proportions included males (2.5%, 27 443/1 101 091), those aged 80-84 years (2.2%, 2 978/133 855), and migrant populations (0.5%, 1 635/307 673). Conclusions:The burden of PTB among the elderly aged ≥65 years in China remains high, with a low proportion of active case-finding from 2015-2023. There is an urgent need to strengthen health education and active screening to improve the early diagnosis and prevention of tuberculosis in the elderly.

Objective:To investigate the relationship between glycated hemoglobin (HbA1c) level and the occurrence of diabetes complications in patients with type 2 diabetes mellitus in 11 provinces in China.Methods:A total of 4 832 patients with type 2 diabetes mellitus from 60 surveillance sites in 11 provinces where national surveillance for chronic diseases and risk factors was conducted in 2010 were selected as the study participants, and a follow-up survey was conducted in 3 516 persons from 2016 to 2017, finally 3 427 patients were included in the analysis after excluding those data exception and incomplete data. Cox proportional risk regression model was used to evalaute the association between HbA1c level and the risk for diabetes complications (macroangiopathy, microangiopathy and diabetic foot), and subgroup analyses were conducted according to the baseline characteristics of the study participants, such as age, gender and smoking status.Results:A total of 3 427 study participants were included in final analysis of the follow up for an average of 6.2 years, in whom 395 suffered from macroangiopathy, 226 suffered from microangiopathy, and 57 suffered from diabetic foot later during the follow-up period. After adjusting for relevant confounders, using the HbA1c <7.0% as a reference, there was no increased risk for macrovascular lesions in the those with HbA1c levels of 7.0%-, 7.5%-, 8.0%-8.4%, and the risk for macrovascular lesions increased by 38% in those with HbA1c ≥8.5% ( HR=1.38,95% CI:1.06-1.80); the risk for microangiopathies increased by 131% ( HR=2.31,95% CI:1.46-3.65), 206%( HR=3.06,95% CI:1.91-4.90) and 208% ( HR=3.08,95% CI:2.20-4.30) in those with HbA1c levels of 7.5%-, 8.0%-, ≥8.5%, respectively; and the risk for diabetic foot increased by 253% ( HR=3.53, 95% CI: 1.89-6.59) in those with HbA1c level ≥8.5%. Subgroup analyses revealed an effect modifying effect of different diabetes diagnosis situations (previously diagnosed and newly diagnosed) on HbA1c level and the risk for microangiopathy. Conclusions:HbA1c level ≥7.5% would increase the risk for microangiopathy in patients with type 2 diabetes mellitus, the higher the level, the higher the risk, and HbA1c level ≥8.5% would increase the risk for macrovascular lesions and diabetic foot. It is necessary to strengthen the health education in diabetic patients to improve their awareness of blood glucose management and the importance of HbA1c level control to effectively reduce or delay the diabetes complications.

Objective To analyze the significance of CT perfusion imaging combined with artificial intelli-gence (AI) in evaluating reperfusion injury after cerebral infarction. Methods 106 patients with cerebral infarc-tion admitted to the hospital from January 2019 to October 2023 were prospectively selected as the study objects. Patients were divided into reperfusion injury group and no perfusion injury group according to whether reperfusion injury occurred after 14 days of thrombolytic therapy. CT perfusion imaging and AI parameters were compared between reperfusion injury group and non-perfusion injury group. The factors affecting reperfusion injury in cerebral infarction patients after thrombolytic therapy were analyzed. The value of CT perfusion imaging parameters combined with AI in predicting reperfusion injury after thrombolytic therapy in cerebral infarction patients was analyzed. Results 31 cases had reperfusion injury,and the other 75 cases had no perfusion injury. CBF,average CT value and entropy level in the reperfusion injury group were lower than those in the non-perfusion injury group (P<0.05),CBV,MTT,TTP and kurtosis were higher than those in the non-perfusion injury group (P<0.05). Logistic regression analysis showed that NIHSS (OR=5.228,95％CI:2.151～12.705),CBF(OR=3.777,95％CI:1.554～9.180),CBV(OR=3.699,95％CI:1.522～9.989) and average CT value (OR=4.125,95％CI:1.697～10.024) were the influencing factors of reperfusion injury in cerebral infarction patients after thrombolytic therapy (P<0.05). ROC curve results showed that the sensitivity of CBF,CBV,average CT value and their com-bination in predicting reperfusion injury after thrombolytic therapy in cerebral infarction patients were 67.74％,70.97％,77.42％,87.10％,and the specificity were 70.67％,74.67％,77.33％,90.67％,AUC values were 0.665,0.667,0.744 and 0.908. Conclusion CT perfusion imaging combined with AI is effective in evaluating reperfusion injury after cerebral infarction.

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.

Objective:To investigate the role of YTHDF2 in cervical lesions and its potential molecular mechanism.Methods:Gene expression data of cervical tissue were obtained from the GEO database to analyze the expression of YTHDF2 mRNA and perform pathway enrichment analysis. Patients with cervical lesions diagnosed by thinprep cytologic test in Gynecological Outpatient Department of Maternal and Child Health Hospital in Jiexiu, Shanxi Province, were selected as the research subjects. Data of cervical lesions and cervical exfoliated cells were collected. HPV infection status was detected by flow-through hybridization, and the expression of YTHDF2 mRNA was detected by reverse transcription real-time polymerase chain reaction. The expression of YTHDF2 in cervical lesions and the mediating role of HPV infection in the relationship between YTHDF2 and squamous intraepithelial lesion (SIL) were evaluated. YTHDF2-related genes were screened from multiple datasets in the GEO and ENCORI databases, and their expression, immune infiltration, and survival analysis were performed to assess the association between YTHDF2 and prognosis. Results:Compared with normal cervical tissue, YTHDF2 was highly expressed in cervical lesion tissue ( P<0.05). A total of 3 672 differentially expressed genes were screened from the dataset GSE49339. Gene Ontology analysis showed that YTHDF2 was mainly involved in transcription regulation. Kyoto Encyclopedia of Genes and Genomes analysis showed that YTHDF2 might be related to HPV infection and other signaling pathways. In the mediation analysis, χ2 test results showed that the expression level of YTHDF2 was significantly different among groups ( χ2=22.47, P<0.001). Trend χ2 test further showed that the expression level of YTHDF2 was upregulated with the degree of cervical precancerous lesions (trend χ2=10.26, P=0.001). Multivariate logistic regression analysis indicated that high YTHDF2 expression increased the risk of low-grade squamous intraepithelial lesions ( OR=3.15, 95% CI: 1.93-5.15) and high-grade squamous intraepithelial lesions ( OR=1.85, 95% CI: 1.01-3.39). Mediation effect analysis revealed a partial mediating effect of HPV infection between YTHDF2 and SIL, accounting for 32.02% of the total effect. Twelve YTHDF2 related genes were screened by the intersection of multiple datasets. The immune infiltration analysis results showed that YTHDF2 and related genes KLF4, E2F3 and HOXC6 were associated with immune infiltration (all P<0.05). Multivariate Cox proportional hazard regression model analysis showed that low expression of KLF4 ( HR=0.53, 95% CI: 0.30-0.94) and high expression of RHOB ( HR=1.80, 95% CI: 1.04-3.13) were risk factors for the prognosis of cervical cancer. Conclusion:YTHDF2 is highly expressed in cervical lesions and may have been involved in the regulation of HPV infection-related pathways and its downstream related genes are related to immune infiltration and prognosis of cervical cancer, providing a theoretical basis for the study of mechanisms related to cervical lesions.

Objective:To investigate the detection status of pulmonary tuberculosis (PTB) among patients aged ≥65 years in China and provide evidence for improving PTB prevention and control in this population.Methods:The data were collected from the tuberculosis subsystem of Chinese Disease Control and Prevention Information System, and the case information of elderly PTB patients aged ≥65 years old who were registered in designated tuberculosis medical institutions nationwide from January 1, 2015 to December 31, 2023.Descriptive epidemiological methods were used to analyze trends in detection status, regional differences, and demographic characteristics.Results:From 2015 to 2023, 1 567 047 elderly PTB detection were identified, accounting for 25.1% of all PTB patients (1 567 047/6 243 215). The average registration rate for elderly PTB patients was 96.9 per 100 000, approximately twice that of the general population. The registration rate declined over the years ( Z=-2.61, P=0.009) but increased in 2018 and 2023. The proportion of elderly PTB patients rose annually, from 21.3% in 2015 to 32.4% in 2023 ( Z=2.30, P=0.022). Active case-finding accounted for only 3.0% (47 049/1 567 047) of patients on average during the study period, peaking at 7.3% (14 123/194 615) in 2018 before declining. The registration rates of elderly tuberculosis patients are relatively higher in central and western regions. In the central region, the average registration rate was 113.8 per 100 000, with a proportion of active case detection of 0.4% (2 532/570 059). In the western region, the average registration rate was 130.0 per 100 000, and the proportion of active case-finding was 7.6% (41 973/549 998). Subgroups with notably lower active detection proportions included males (2.5%, 27 443/1 101 091), those aged 80-84 years (2.2%, 2 978/133 855), and migrant populations (0.5%, 1 635/307 673). Conclusions:The burden of PTB among the elderly aged ≥65 years in China remains high, with a low proportion of active case-finding from 2015-2023. There is an urgent need to strengthen health education and active screening to improve the early diagnosis and prevention of tuberculosis in the elderly.

Objective:To investigate the relationship between glycated hemoglobin (HbA1c) level and the occurrence of diabetes complications in patients with type 2 diabetes mellitus in 11 provinces in China.Methods:A total of 4 832 patients with type 2 diabetes mellitus from 60 surveillance sites in 11 provinces where national surveillance for chronic diseases and risk factors was conducted in 2010 were selected as the study participants, and a follow-up survey was conducted in 3 516 persons from 2016 to 2017, finally 3 427 patients were included in the analysis after excluding those data exception and incomplete data. Cox proportional risk regression model was used to evalaute the association between HbA1c level and the risk for diabetes complications (macroangiopathy, microangiopathy and diabetic foot), and subgroup analyses were conducted according to the baseline characteristics of the study participants, such as age, gender and smoking status.Results:A total of 3 427 study participants were included in final analysis of the follow up for an average of 6.2 years, in whom 395 suffered from macroangiopathy, 226 suffered from microangiopathy, and 57 suffered from diabetic foot later during the follow-up period. After adjusting for relevant confounders, using the HbA1c <7.0% as a reference, there was no increased risk for macrovascular lesions in the those with HbA1c levels of 7.0%-, 7.5%-, 8.0%-8.4%, and the risk for macrovascular lesions increased by 38% in those with HbA1c ≥8.5% ( HR=1.38,95% CI:1.06-1.80); the risk for microangiopathies increased by 131% ( HR=2.31,95% CI:1.46-3.65), 206%( HR=3.06,95% CI:1.91-4.90) and 208% ( HR=3.08,95% CI:2.20-4.30) in those with HbA1c levels of 7.5%-, 8.0%-, ≥8.5%, respectively; and the risk for diabetic foot increased by 253% ( HR=3.53, 95% CI: 1.89-6.59) in those with HbA1c level ≥8.5%. Subgroup analyses revealed an effect modifying effect of different diabetes diagnosis situations (previously diagnosed and newly diagnosed) on HbA1c level and the risk for microangiopathy. Conclusions:HbA1c level ≥7.5% would increase the risk for microangiopathy in patients with type 2 diabetes mellitus, the higher the level, the higher the risk, and HbA1c level ≥8.5% would increase the risk for macrovascular lesions and diabetic foot. It is necessary to strengthen the health education in diabetic patients to improve their awareness of blood glucose management and the importance of HbA1c level control to effectively reduce or delay the diabetes complications.