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ObjectiveTo analyze the factors affecting the cost of hospitalization for patients and provide insights using the intrauterine lesion surgery group (DRG code NE19) as an example.MethodsThis study was a retrospective cross-sectional study, with data from the first page of medical records of patients enrolled under NE19 at a comprehensive tertiary hospital in Beijing from March 15, 2022 to November 30, 2023. Influence factor selection and multifactorial linear regression analysis were conducted with hospitalization cost as the dependent variable, and patient's basic information, treatment information and key concern factors as independent variables. The profit and loss of medical records containing key factors and differences in indicators of hospitalization cost structure were analyzed in the context of clinical practice.ResultsA total of 2213 valid medical records (all female patients) were included, with patients predominantly young and middle-aged women under 45 years of age (72.12%), and with 931 day surgery medical records (42.07%). The diagnosis records included 334(15.09%) multiple uterine leiomyomas, and 246(11.12%) pelvic adhesions. A total of 150(6.78%) medical records involved ovary- and tubal-related surgeries or manipulations, with 160(7.23%) main operations being laparoscopic hysterectomy of diseased uterine lesions and 38(1.72%) mechanical rotational excision of abnormal uterine tissue using transhysteroscopy. Linear regression analysis showed that whether or not ovarian and tubal surgical operations were involved (βi=0.30), whether or not the main operation was laparoscopic hysterectomy for uterine lesions (βi=0.30), and whether or not transhysteroscopic mechanical rotational excision of abnormal uterine tissue was used (βi=0.20) had a greater impact on hospitalization costs. In the analysis of the focal factors, the percentage of patients who experienced a deficit was higher for surgical operations involving the ovaries and fallopian tubes, whether the primary operation was laparoscopic hysterotomy for uterine lesions, multiple uterine leiomyosarcomas, and pelvic adhesions (all P < 0.05), and "whether or not transhysteroscopic mechanical rotational excision of abnormal uterine tissues was used" and "whether it was a day surgery" had a significant effect on several structural indicators of hospitalization costs (all P < 0.05).ConclusionsThe NE19 group of hospitals in the study had a high loss rate, and factors such as the severity of the patient's condition and the use of new technologies affected hospitalization costs, suggesting that there is room for further optimization of the existing grouping scheme. Tiered payment standards can be set up for different tiers of healthcare institutions, and a sound and optimized exclusion mechanism can be used to promote the development of new technologies. The internal management of hospitals should encourage the development of daytime surgery to improve the efficiency of medical services.

Introduction: The Dicranopteris dichotoma fern community plays vital roles in nutrient sequestration, succession regulation, and ecological threshold control. However, the mechanisms underlying the formation of the D. dichotoma –dominant community remain unclear. Methods: This study established four different community types to investigate the effects of environmental factors on the formation of a D. dichotoma –dominant community. Results: We found that climate was the primary factor affecting the formation of patches dominated by D. dichotoma at the regional scale. Specifically, higher annual mean temperature and annual mean precipitation were associated with larger single-dominant-species patches of D. dichotoma. Understory light intensity was the major factor affecting the formation of the D. dichotoma community at the community scale. Light intensity ranging from 200 to 500 µmol·m⁻²·s⁻¹ was most conducive to the development of a large D. dichotoma community. Additionally, understory light intensity enhanced the importance value of D. dichotoma in the herb community by decreasing its biomass proportion of support modules and increasing its biomass proportion of photosynthetic and reproductive modules. Soil properties and D. dichotoma characteristics showed interactions with each other. Acidic red-yellow soil was most suitable for the formation of single-dominant-species patches of D. dichotoma , and the growth of D. dichotoma further decreased the soil pH. Soil total phosphorus content was identified as a limiting factor for formation of the D. dichotoma community. Discussion: In summary, the formation of single-dominant-species patches of D. dichotoma is mainly influenced by a combination of climate, community, and soil. [ABSTRACT FROM AUTHOR]

Background Low sexual desire is the most prevalent female sexual health problem; however, national epidemiologic data on female sexual desire in China are absent. Understanding factors related to low sexual desire are essential in preparing educational and consultative programs and policies to improve women's sexual health.Methods: A national epidemiological survey on female sexual function was conducted from February 2014 to January 2016 in mainland China. Women were randomly selected using multistage, stratified, cluster sampling. The sexual functioning was assessed by using the Chinese version of the 19-item Female Sexual Function Index (FSFI) questionnaire.Results: The questionnaire on sexual dysfunction was completed by 25446 women who were aged 20-70 years. The prevalence of low sexual desire was 21.6% (domain score ≤4.28), and the declines in sexual desire started as early as 25-29 years. Sexual arousal was most closely related to sexual desire (Pearson's correlation = 0.760). Higher educational attainment was associated with a decreased risk of low sexual desire. Diabetes, non-gynaecological cancer, pelvic inflammatory disease and pelvic pain had negative effects on sexual desire (OR = 1.44, 99% CI = 1.11-1.87; OR = 1.92, 99% CI = 1.18-3.13; OR = 1.32, 99% CI = 1.07-1.63; OR = 1.77, 99% CI = 1.13-2.76 respectively).Conclusions: The prevalence of low sexual desire in females in China was modest. Low sexual desire is correlated with sexual arousal disorder. Biopsychosocial factors have overlapping effects on sexual desire. [ABSTRACT FROM AUTHOR]

Herlyn-Werner-Wunderlich syndrome (HWWS), also named as Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, is a rare female genitourinary malformation disease featured by uterine didelphys, obstructed hemivagina and ipsilateral renal anomaly. In addition to the abnormalities of the reproductive system, it's been reported that HWWS patients can present with other rare extragenital malformations, such as scoliosis, abnormal cardiac development and intestinal malrotation, which might need proper evaluation and intervention by other specialties (1,2). Due to the low incidence of HWWS, previous studies were limited to case reports. There is no clinical study with relative large sample size focusing on the extragenital malformations of HWWS patients so far. To analyze the proportion of extragenital malformations in a large cohort of Chinese patients with HWWS. This is a nationwide multicenter, retrospective study. Patients diagnosed with HWWS and treated at 19 centers from January 2015 to June 2021 were included. HWWS patients with complete medical history records and screening examinations for urinary system, skeletal system, cardiovascular system and other systems were included. Then the prevalence and types of concomitant extragenital malformations were analyzed.This study was approved by the Ethics Committee of Peking Union Medical College Hospital (Project No. ZS-1858). Among 307 HWWS patients, a total of 255 patients were included in this study. Among them, 206 patients (80.8%) presented with dysmenorrhea or periodic lower abdominal pain, and 116 patients (45.5%) complained of vaginal bloody/purulent discharge. In terms of combined deformities of skeletal system, 37 cases (14.5%) were combined with congenital or idiopathic scoliosis, 18 cases (7.1%) were combined with lumbar or sacral spina bifida, and a few cases with hip dysplasia and coccyx hypogenesis. As for urinary system, the vast majority (93%) of the patients presented with renal agenesis, other abnormalities such as ectopic ureter orifice, megaureter, ectopic kidney, renal dysplasia, duplication of the collecting system, and extrarenal pelvis can also be observed. As for cardiovascular system, a total of 8 patients (3.2%) had cardiac abnormalities, including redundant anterior leaflets of the mitral valve, bicuspid aortic valve, and atrial septal defect. In addition, 5 patients (2%) had malformations of other systems, including anal atresia, ectopic colon, congenital vaginal-rectal fistula, vaginal-vesical fistula, and congenital strabismus. It's reported that the prevalence of scoliosis is 0.5-1/1000 while that of congenital cadiovascular malformations is 19.93/10,000 live births (3,4). Compared with the existing epidemiological research data, the incidence of scoliosis in HWWS patients was significantly higher than that in the normal population, but there was no significant difference in the incidence of cardiovascular system malformations. Patients with a definite diagnosis of HWWS should complete the evaluation of the urinary system and skeletal system to screen possible developmental abnormalities and provide timely intervention. ▪ ▪ ▪ ▪ ▪ [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: This study aimed to explore gene expression and their regulatory mechanisms in etiology of stress urinary incontinence (SUI). Methods: Tissue samples were taken from the paraurethral vaginal wall from three pairs of postmenopausal, age/body mass index/parity-matched SUI, and continent women and subjected to microarray analysis using the Affymetrix GeneChip® Human Genome U133 Plus 2.0 oligonucleotide chip set. The significantly differentially expressed genes and their protein expression were confirmed by quantitative PCR and Western blot. Results: Seventy-five differentially expressed genes were listed; 31 genes were upregulated in SUI group, while 44 were downregulated. Gene metabolic pathway analysis showed that solutable N-ethylmaleimide-sensitive factor attachment protein receptor signaling pathway and neurodegenerative disorder pathway were the most predominant. Conclusions: Apolipoprotein E, growth factor receptor-bound protein 2, Golgi SNAP receptor complex member 1, and glucosidase, beta, acid may play a neurodegenerative role in SUI development. [ABSTRACT FROM AUTHOR]