Background It is imperative for public health to identify the factors that contribute to the progression of sarcopenia among middle-aged and older adults. Our study aimed to investigate the association between pain characteristics and the progression to sarcopenia and its subcomponents among middle-aged and older adults in China.Methods We included 5 568 participants from the China Health and Retirement Longitudinal Study. All participants completed assessments for pain characteristics and sarcopenia. Pain assessment included pain status (baseline pain, incident pain, and pain persistence) and pain distribution (single-site pain and multisite pain) using a self-report questionnaire. Diagnosis of sarcopenia followed The Asian Working Group for Sarcopenia 2019 consensus. The odds ratios (ORs) and 95% confidence intervals (CIs) were obtained by logical regression analysis.Results Participants who reported baseline pain, multisite pain, pain persistence, or multisite pain persistence were more likely to progress to sarcopenia than those without pain, with ORs of 1.33 (95% CI: 1.08-1.65), 1.44 (95% CI: 1.15-1.80), 1.63 (95% CI: 1.23-2.14), and 1.59 (95% CI: 1.19-2.11), respectively. Even after adjusting for other covariates such as gender, age, residential area, education level, marital status, smoking, alcohol consumption, comorbidities, and falls, these associations remained significant. Additionally, pain persistence and multisite pain persistence were significantly associated with low grip strength and clinically meaningful Short Physical Performance Battery decline, but not with low muscle mass.Conclusions Our study showed that pain, especially pain persistence, was closely correlated to the increased risk of progression to sarcopenia in Chinese middle-aged and older adults.

区块链技术可以在不安全的网络环境中建立节点之间的信任,具有公开透明、去中心化、不易篡改等特性,在加强医疗数据的安全性和保障患者数据隐私方面可以发挥重要作用.文章系统介绍了区块链的基本原理和关键技术,重点阐述了区块链技术在医疗数据管理方面的应用,包括数字签名在医患纠纷中的作用,基于医疗联盟链实现医疗大数据安全存储和共享的可行性,区块链技术在药品溯源方面的应用等.将区块链技术与医疗数据管理相结合,有助于推动医疗信息化体系的变革,加快医疗机构提升服务质量和效率.

目的 探索膀胱疾患的精细化病例组合方案和费用支付标准,为实施DRG医疗保险支付改革提供数据支持.方法 数据来源于浙江省某大型三甲综合医院2016—2019年收治的5848例膀胱疾患病例的病案首页信息,采用多重线性回归分析筛选对住院费用影响较大的因素,结合统计结果 和临床专家的意见确定分组变量.运用E-CHAID算法的决策树模型,建立膀胱疾患的DRG分组方案和费用标准.结果 决策树模型的结果 显示影响DRG分组的分类节点包括手术操作分类、住院日、合并症/并发症,共形成6个DRG,组内同质性良好,组间差异有统计学意义(P<0.0001).各组的费用测算对临床有一定指导意义.结论 运用决策树模型构建DRG分组方案科学合理,各省份可基于本土化的样本数据对DRG精细化分组方案及医保支付标准进行验证和优化.

Objective:To analyze the effect of diagnosis-related groups prospective payment system(DRG-PPS) on medical service quality.Methods:Literature on DRG-PPS impact on medical service quality was searched in Chinese and English databases, and inclusion and exclusion criteria were formulated. Meta analysis was performed on the average length of stay, mortality and readmission rate, and the results of other indicators were described and integrated.Results:A total of 33 articles were included for analysis. Meta analysis showed that the implementation of DRG-PPS could shorten the average length of stay, WMD=-0.67(95% CI: -0.91 to-0.43); the implementation of DRG-PPS had no significant impact on the readmission rate( OR=0.97, 95% CI: 0.87-1.08); the implementation of DRG-PPS did not have a significant impact on the death rate of patients( OR=0.98, 95% CI: 0.93-1.03). The results of narrative integration showed that DRG-PPS had no significant effect on the incidence of complications, patient satisfaction, quality of life, service and operation process indicators. Conclusions:DRG-PPS can shorten the average length of stay, but has no significant effect on mortality and readmission rate.

目的·系统评价机器人辅助腹腔镜下前列腺根治性切除术(RALP)和传统腹腔镜下前列腺根治性切除术(LRP)的疗效和术后功能恢复.方法·计算机检索PubMed、Web of Science、Cochrane图书馆、EMbase、EBSCO、CINAHL、CNKI、万方、维普文献数据库,查找RALP相关的临床对照研究,采用国际Cochrane协作网推荐的RevMan5.3软件进行系统评价.结果·最终纳入15篇文献,RALP组合计1 621人,LRP组合计1 894人.Meta分析结果显示:在前列腺根治性切除术方面,RALP较LRP能明显减少术中出血量[WMD=-120.29,95％ CI(-182.20,-58.39),P=0.000 1]和降低输血率[OR=0.44,95％ CI (0.25,0.79),P=0.006],术后第3、6、12个月的控尿率显著提高[OR=2.76,95％ CI(1.99,3.82),P＜0.00001;OR=2.50,95％ CI (1.72,3.63),P＜0.000 01;OR=2.28,95％CI (1.51,3.46),P＜0.0001].在手术时间、手术切口阳性率、术后并发症方面,RALP和LRP组之间差异无统计学意义(P＞0.05).结论·RALP在减少术中出血量和降低输血率方面有明显优势,术后功能恢复较好,远期疗效评价仍需要大规模长时间的随访研究数据.

本文结合实例探讨多水平Poison模型在公共卫生领域的应用,根据结核病患病数据资料的层次结构特征,采用多水平Possion模型拟合不同模型并分析比较.得出性别和年龄因素对于结核患病率有影响,不同地区问结核患病率也有差别.具有层次结构特征的数据适宜采用多水平模型进行分析,多水平Possion模型适合用于以人群为基础的公共卫生数据资料的分析.

Objective: To assess the effects and safety of sitagliptin (SITA) combined with metformin (MET) in treating type 2 diabetes mellitus (T2DM). Methods: The Cochrane Library, PubMed, EMbase, CNKI Database, WangFang Database, and VIP Database were searched to collect the randomized controlled trials (RCTs) on SITA combined with MET versus MET in treating T2DM. meta-analysis was performed using RevMan 5.2 software in accordance with the Cochrane Collaboration. Results: A total of 12 RCTs involving 3200 patients were included. The results of meta-analysis showed that, compared to MET alone, SITA combined with MET effectively improved glycosylated hemoglobin levels [WMD=-0.69%, 95%CI (-0.85, -0.53), P<0.00001] and fasting plasma glucose levels [WMD=-0.91%, 95%CI (-1.14, -0.69), P<0.00001], and increased insulin sensitivity and β-cell function [WMD=-0.54, 95%CI (-0.99, -0.10), P=0.02]. But there were no significant differences between the two groups in body mass index and the percentage of patients with adverse events (P>0.05). Conclusion: Compared to using MET alone, SITA combined with MET can improve glycemic control, and there is no statistical difference of adverse events.