To offer insights for enhancing the hierarchical medical system and guiding patient healthcare-seeking behaviors systematically, this study analyzes referral willingness and influencing factors of tertiary public hospitals and primary healthcare institutionsamong chronic disease patients in Sichuan Province.

A questionnaire survey was conducted on 297 chronic disease patients. Descriptive statistical analysis of the data was performed using SPSS 26.0 software. Chi-square tests were employed to analyze the downward referral willingness of chronic disease patients from tertiary public hospitals and the upward referral willingness to primary healthcare institutions.

Patients in large public hospitals showed low downward referral willingness (44.2%). Rural residence, prior medical consortium services, and greater distance from tertiary hospitals increased willingness. Primary healthcare patients exhibited a 28.1% upward referral willingness, influenced by occupation, age, and use of outpatient special disease policy services.

Referral willingness is generally weak in large public hospitals and primary healthcare institutions. Enhancing the comprehensive capacity of primary healthcare institutions, strengthening collaborative mechanisms and the level of medical services within medical consortia, along with expanding reimbursement policies for chronic diseases, contributes to promoting bidirectional patient referrals and advancing the formation of a tiered diagnosis and treatment system.

To evaluate the impact of DRG medical insurance payment reform on the quality development of a tertiary comprehensive hospital in Guangxi.

This study selected data on all inpatient settlement cases in the hospital from 2020 to 2021, and calculated the DRG grouping of all cases according to the national CHS-DRG version 1.0 grouping plan. The interruption time series analysis method was further used to analyze the level and trend changes of indicators after the DRG policy reform in hospitals in December 2020. These indicators included total weight, case group index, cost consumption index, time consumption index, average length of stay, average hospitalization cost per visit, etc. They were used to evaluate the hospital’s medical service capacity, medical service efficiency, and medical safety, in order to understand the quality of the hospital.

A total of 72 089 cases were included in this study. Indicators such as cost consumption index (β=-0.242, P=0.001), time consumption index (β=-0.119, P=0.002), average length of stay (β=-1.543, P=0.011), proportion of high incidence cases (β=-0.028, P=0.026), and average cost of hospitalization (β=-3 669.366, P=0.026) showed an immediate decrease during the implementation of DRG policy.

After implementing the DRG policy reform, the hospital has significantly improved the efficiency of medical services, but still faces the challenge of adjusting structure and increasing quality.

To analyze the relationship between dietary intake of n-3 polyunsaturated fatty acids (n-3 PUFA) and the incidence of type 2 diabetes mellitus (T2DM) among residents in selected districts of Chongqing,and to provide recommendations for the prevention of T2DM.

Using cross-sectional survey data collected in Chongqing as part of the 2021 China National Nutrition and Health Survey (CNNHS), and in combination with energy and nutrient intake calculated from the Chinese Food Composition Tables, single-factor and multi-factor Logistic regression models were employed to investigate the association between n-3 PUFA intake and the incidence of T2DM.

This study included a total of 1 511 participants, of which 280 were diagnosed with T2DM, accounting for 18.80% of the total. When compared to participants in the lowest quartile of animal-derived n-3 PUFA intake, those in the highest quartile had a significantly lower risk of developing T2DM (OR=0.61, 95%CI: 0.42-0.88). The results from adjusted Model 1 were consistent with those of Model 2 (Model 1: OR=0.64, 95%CI: 0.44-0.94; Model 2: OR=0.66, 95%CI: 0.44-0.98). Notably, in Model 2, the risk of developing T2DM was even lower in the Q₄ group of plant-derived n-3 PUFA compared to Q₁ (OR=0.48, 95%CI: 0.24-0.98).

The dietary intake of animal-derived n-3 PUFA and plant-derived n-3 PUFA is negatively correlated with the incidence of T2DM. The association between animal-derived n-3 PUFA and T2DM weakens after adjusting for confounding factors, with the highest quartile of plant-derived n-3 PUFA showing the strongest protective effect against T2DM.

Using Mendelian randomization analysis to explore the immune cells involved in myocarditis(MC).

Genome-wide association study (GWAS) was used to mine the data, and the exposure factors were 731 immune cell traits, and the outcome factor was myocarditis. Regression models such as Inverse-Variance Weighted method (IVW), MR-Egger, Simple Mode, weighted median and Weighted Mode were used for Mendelian randomization analysis. At the same time, heterogeneity tests, horizontal multiple validity analyses, and sensitivity analyses were also conducted. Multivariate Mendelian randomization analysis of the relevant immune cell traits was performed by Inverse-Variance Weighted method (IVW) to correct the effect of seven positive immune cell traits on the outcome.

(1)The results of Mendelian randomization showed that there was a causal relationship between 7 immune cell traits that include CD39+resting Treg %resting Treg (OR=1.237, 95%CI:1.039-1.474), CD4+CD8dim %leukocyte (OR=0.737, 95%CI:0.543-0.100), CD28-CD8dim AC (OR=0.868, 95%CI:0.753-0.100), CD28-CD8br AC (OR=1.398, 95%CI:1.097-1.780), CD20 on CD20-CD38- (OR=1.295, 95%CI:1.012-1.659), CCR2 on monocyte (OR=1.010, 95%CI:1.000-1.208), CD11b on basophil (OR=0.852, 95%CI:0.727-0.998) and MC.(2)The results of multivariate Mendelian randomization showed that CD39+ resting Treg %resting Treg (OR=1.228, 95%CI:1.059-1.423), CD28-CD8dim AC (OR=0.629, 95%CI:0.428-0.924), CCR2 on monocyte (OR=0.661, 95%CI:0.488-0.895) were correlated with MC.(3)The results of reverse Mendelian randomization did not find a causal relationship between 7 positive immune signatures and MC.

This study confirm the close relationship between immune cells and MC through genetics, which will provide a reference for future research.

To investigate thejob satisfaction and analyze influencing factors of health workers in basic public health service projects.

164 primary medical institutions in Jiangxi Province were selected according to the method of phased cluster sampling. A questionnaire survey was conducted on the health personnel providing basic public health services in these institutions. Nonparametric test and ordered multiclass logistic regression were used to analyze the influencing factors of job satisfaction.

Among the 3 018 basic public health service workers, the average score of job satisfaction was 24.52±6.84 points. The proportion of very dissatisfied, relatively dissatisfied, average, fairly satisfied and very satisfied were 3.78%, 9.87%, 39.83%, 23.92% and 22.60%, respectively. Multiple linear regression analysis showed that educational background, job category, working years, income, overtime, training and performance reward mechanism had statistical significance on the overall job satisfaction score (P<0.05).

The job satisfaction of health worker in basic public health service projects in Jiangxi Province was above average. In order to improve the job satisfaction, we can improve the promotion and guarantee mechanism for grassroots talents, strengthen vocational training, and improve the assessment mechanism.

To explore the regulatory role of the NF-κB/NLRP3 signaling pathway in the anxiety and depressive-like behavior induced by acute sleep deprivation in mice.

Forty eight C57BL/6J mice aged 8 weeks were randomly divided into four groups: control group(CON), inhibitor group(LiCl), sleep deprivation group(SD), and inhibitor + sleep deprivation group (SD＋LiCl), with 12 mice in each group. The model of acute sleep deprivation in mice was established by modified multiple platform method(modified multiple platform method,MMPM), Elevated Plus Maze(EPM)、Open Field Test(OFT)、Forced Swim Test(FST) and Tail Suspension Test(TST)were used to evaluate the behavior of mice. HE staining was used to observe the pathological changes of hippocampal neurons. RT-PCR was used to detect the mRNA expression ofNF-κB and NLRP3 in hippocampal tissues.

Compared with the CON group, the body weight, hippocampal weight, and hippocampal organ coefficient of the SD group mice were significantly reduced (F=0.452, P=0.006; F=6.553, P=0.009; F=1.428, P=0.001).In OFT, Compared with the CON group, the LiCl group had no significant difference in the number of visits to the center(F=5.084,P=0.744), and the SD group significantly decreased(F=0.028,P=0.017). In EPM, the time of entering the open arm in the LiCl group was not significantly shorter than that in the CON group(F=0.09,P=0.113),but the SD group was significantly shorter(F=0.085,P=0.011). In FST,there was no significant difference in the immobility time between the LiCl group and the CON group(F=3.422,P=0.260). In TST, Compared with the CON group, the immobility time of the suspension tail increased in the SD group(F=11.218,P=0.005). HE staining results showed, Compared with CON group, pathological changes were found in hippocampus of SD group and SD+LiCl group. RT-PCR showed thatCompared with CON group, the mRNA expression of NF-κB and NLRP3 in LiCl group were not significantly different(F=4.629,P=0.147, F=15.555,P=0.107).However, the SD group were significantly increased (F=6.969,P<0.001,F=15.833,P=0.017).

NF-κB/NLRP3 pathway may play a regulatory role in the development of SD-induced anxiety-depression-like behavior in mice.

To explore the application value of a recombinant antigen-based capture enzyme immunoassay (RAg-CEIA) in detection of recent human immunodeficiency virus type 1 (HIV-1) infection in the sentinel surveillance population.

Among the HIV/AIDS sentinel surveillance population in Yunnan province in 2015, the confirmed HIV-1 antibodies positive plasma specimens matching the detection criteria for recent HIV-1 infection were tested by HIV-1 RAg-CEIA. The recent HIV-1 infection specimens were classified by the normalized optical density (ODn) values, and then the HIV-1 incidence in population were estimated. The detection and analysis data were compared with those by BED capture enzyme immunoassay (BED-CEIA) and limiting antigen avidity enzyme immunoassay (LAg-Avidity EIA), respectively.

A total of 51 313 plasma specimens were tested for HIV antibodies, in which 1 255 specimens were HIV-1 antibodies positive. 253 out of 373 specimens matching the detection criteria for recent HIV-1 infection were tested by the 3 assays, respectively. By RAg-CEIA, BED-CEIA and LAg-Avidity EIA, 88, 78 and 54 specimens were classified as recent HIV-1 infections, and the HIV-1 incidence in the sentinel surveillance population was 0.33% (95%CI: 0.26%~0.39%), 0.31%（95%CI: 0.24%~0.38%) and 0.31% (95%CI: 0.22%~0.39%), respectively. The differences between the HIV-1 incidence by the 3 assays were not statistically significant (P=0.927). Among the sub-populations, the HIV-1 incidence in men who have sex with men (MSM) were 3.50% (95%CI: 2.48%~4.52%), 3.92% (95%CI: 2.76%~5.08%）and 4.17% (95%CI: 2.79%~5.55%), respectively. The differences between the HIV-1 incidence by the 3 assays were not statistically significant (P=0.763). The ODn values by RAg-CEIA were linear correlation with those by BED-CEIA (Spearman’s rank correlation coefficient was 0.911), and those by LAg-Avidity EIA (Spearman’s rank correlation coefficient was 0.755), respectively.

HIV-1 RAg-CEIA can be effectively used in classification of recent HIV-1 infections and estimation of HIV-1 incidence, indicating that this approach has a good application prospect in detection of recent HIV-1 infection.

To analyze adverse outcomes and influencing factors of elderly pulmonary tuberculosis patients in Guizhou Province and to provide a scientific basis for effective treatment of elderly pulmonary tuberculosis patients.

The medical records information of elderly pulmonary tuberculosis patients aged 65 and above in Guizhou Province from January 1, 2011, to December 31, 2022, was extracted from the Tuberculosis Monitoring Report Management Information System. The time trend of adverse outcomes was analyzed using the chi-square trend test, inter-group comparison was conducted using the chi-square test, and binary logistic regression was employed to analyze influencing factors.

From 2011 to 2022, 10,820 elderly patients with pulmonary tuberculosis had adverse outcomes in Guizhou Province, with an adverse outcome rate of 12.91%. The rate of adverse outcomes increased from 2011 to 2015 (, P<0.001), and decreased from 2016 to 2022 (, P<0.001). Regarding regional distribution, Bijie City had the highest rate of adverse outcomes, and TongrenCity had the lowest rate (χ²=808.188, P<0.001)..The results of multivariate analysis showed that compared with the patients who were female, ethnic minorities, 65-69 years old, without comorbidities, newly treated, pathogenic negative, and without other tuberculosis, the patients were more likely to develop tuberculosis. Male (OR=1.323,95%CI=1.267-1.380), Han ethnic group (OR=1.168,95%CI= 1.117-1.222), 70-74 years old (OR=1.244,95%CI=1.181-1.310), 75-79 years old (OR=1.612,95%CI=1) 525-1.704), ≥80 years old (OR=2.322,95%CI=2.178-2.476), comorbidities (OR=1.261,95%CI=1.179-1.348), retreatment (OR=1.526,95%CI=1.423-1.636), positive pathogen (OR=1.244, 95%CI= 1.181-1.310) and other tuberculosis (OR=1.245,95%CI=1.161-1.336) were risk factors for poor outcomes.

Since the implementation of the "13th Five-Year Plan" for tuberculosis prevention and treatment, the adverse outcome rate of elderly tuberculosis patients in Guizhou Province has shown a gradual decreasing trend, but the distribution of the adverse outcome rate is uneven, which suggests that we need to continue to maintain a high degree of vigilance and strengthen preventive and control measures.

Different library construction methods, combined with high-throughput sequencing methods, were used to understand the genetic characteristics of the virus of the first confirmed imported monkeypox case in mainland China, and to compare the advantages and disadvantages of different library types.

The herpetic fluids and nasopharyngeal swabs of the first imported monkeypox case in the Chinese mainland were used as samples. After nucleic acid extraction and quantification, the library was directly constructed or the amplicon library was constructed using the monkeypox virus whole genome capture kit, and the whole genome sequence of the virus was obtained by high-throughput sequencing. Combined with 34 monkeypox virus sequences downloaded from the NCBI and GISAID databases, a phylogenetic evolutionary tree was constructed using vaccinia, variola, and cowpox sequences as out groups.

The whole genome sequence of the virus was obtained by both library construction methods, named hMpxV/China/CQ-CQCDC-001/2022, which belongs to the monkeypox virus branch IIb, located in the same branch as hMpxV/Germany/BE-ChVir28656/2022 belonging to the IIb B.1 branch. Metagenomic libraries have more uniform sequence coverage than amplicon libraries, but the sequencing depth is lower and the effective data volume accounts for less.

Clade IIb B.1 monkeypox viruses have already been introduced into the mainland China, and the sequencing of subsequently discovered monkeypox viruses should be based on the sample size and sequencing timeframe, sequencing cost-effectiveness ratio, and other factors to choose the appropriate library construction method.

To establish a depression prediction model for adolescents with Polycystic Ovary Syndrome (PCOS) and validate the model.

Patients’ data were collected from the gynecological clinic of Affiliated Hospital of Zunyi Medical University according to the item pool of risk factors for depression in adolescents with PCOS. Data collected between October 2021 and September 2022. In this study, R software (version 4.2.1) was used to perform regression analysis by the least absolute shrinkage and selection operator (LASSO), so as to screen out strong risk factors related to depression in adolescents with PCOS. These risk factors were then incorporated into logistic regression to develop a depression warning model in adolescents with PCOS. The model has been visualized by nomogram and has been verified both internally and externally. The predicted effect of the model was evaluated through discrimination, specificity and sensitivity. Decision curve analysis was used to analyze the clinical effect of the model.

The model was as follows: depression risk=1/(1+exp-(-4.055+0.221×sleep+0.729×hormonal contraceptive use+0.920 ×hirsutism+0.079×illness perception -0.058×social support+1.049×(luteinizing hormone/follicle stimulating hormone)≥2)). The area under the ROC curve for this model was 0.881. The optimal cut-off value on the ROC curve was 0.278, corresponding to a high specificity and sensitivity of 76.2% and 88.0%, respectively. The corrected area under the ROC curve obtained was 0.867. In addition, the result of decision curve analysis showed that the model could provide effective evidence support for clinical decision-making. The area under the ROC curve obtained from external validation was 0.871.

In this study, an early warning model of depression risk in adolescents with PCOS was constructed. It can effectively identify people at high risk of depression in adolescents with PCOS at an early stage, thus providing a theoretical basis for the implementation of comprehensive and effective risk prevention measures.