Analysis of the current status and influencing factors of cross-regional hospitalization services utilization by basic medical insurance participants in China − taking a central province as an example

BackgroundThe geographically uneven distribution of healthcare resources has resulted in a dramatic increase of cross-regional hospitalization services in China. The over-use of cross-regional hospitalization services may hinder the utilization and improvement of local hospitalization services. It is of great practical significance to study the utilization of cross-regional hospitalization services and its influencing factors in order to effectively allocate medical resources and guide patients to seek medical treatment rationally. Therefore, this study aims to analyze the current situation and influencing factors of the utilization of cross-regional hospitalization services by patients insured by basic medical insurance in China.MethodsA total of 3,291 cross-provincial inpatients were randomly selected in a central province of China in 2020. The level of medical institutions, hospitalization expenses and actual reimbursement rate were selected as indicators of hospitalization service utilization. Exploratory factor analysis was used to assess the dimensionality of influencing factors and reduce the number of variables, and binomial logistic regression analysis and multiple linear regression analysis to explore the influencing factors of the utilization of cross-regional hospitalization services.ResultsThe proportion of cross-provincial inpatients choosing tertiary hospitals was the highest with average hospitalization expenses of 24,662 yuan and an actual reimbursement rate of 51.0% on average. Patients insured by Urban Employees’ Basic Medical Insurance (UEBMI) were more frequently (92.9% vs. 88.5%) to choose tertiary hospitals than those insured by Urban and Rural Residents’ Basic Medical Insurance (URRBMI), and their average hospitalization expenses (30,727 yuan) and actual reimbursement rate (68.2%) were relatively higher (p < 0.001). The factor “income and security,” “convenience of medical treatment” and “disease severity” had significant effects on inpatients’ selection of medical institution level, hospitalization expenses and actual reimbursement rate, while the factor “demographic characteristics” only had significant effects on hospitalization expenses and actual reimbursement rate.ConclusionCross-provincial inpatients choose tertiary hospitals more frequently, and their financial burdens of medical treatment are heavy. A variety of factors jointly affect the utilization of cross-provincial hospitalization services for insured patients. It is necessary to narrow down the gap of medical treatment between UEBMI and URRBMI patients, and make full use of high-quality medical resources across regions

Efficient transfer of two large secondary metabolite pathway gene clusters into heterologous hosts by transposition

Horizontal gene transfer by transposition has been widely used for transgenesis in prokaryotes. However, conjugation has been preferred for transfer of large transgenes, despite greater restrictions of host range. We examine the possibility that transposons can be used to deliver large transgenes to heterologous hosts. This possibility is particularly relevant to the expression of large secondary metabolite gene clusters in various heterologous hosts. Recently, we showed that the engineering of large gene clusters like type I polyketide/nonribosomal peptide pathways for heterologous expression is no longer a bottleneck. Here, we apply recombineering to engineer either the epothilone (epo) or myxochromide S (mchS) gene cluster for transpositional delivery and expression in heterologous hosts. The 58-kb epo gene cluster was fully reconstituted from two clones by stitching. Then, the epo promoter was exchanged for a promoter active in the heterologous host, followed by engineering into the MycoMar transposon. A similar process was applied to the mchS gene cluster. The engineered gene clusters were transferred and expressed in the heterologous hosts Myxococcus xanthus and Pseudomonas putida. We achieved the largest transposition yet reported for any system and suggest that delivery by transposon will become the method of choice for delivery of large transgenes, particularly not only for metabolic engineering but also for general transgenesis in prokaryotes and eukaryotes

The effects of different dietary crude protein level on faecal crude protein and amino acid flow and digestibility in growing pigs

This study was conducted to evaluate the effects of dietary crude protein (CP) level on faecal CP and amino acid (AA) flow and digestibility, faecal and ileal digesta microbial AA composition. Eighteen Duroc × Landrace × Yorkshire barrows (60 ± 1.43 kg) were randomly divided into 3 groups with 6 barrows in each, and fed a maize–soybean meal diet at the 10% (L-CP), 13% (M-CP) and 16% (H-CP) CP levels. The results indicated the faecal total N, CP, total AA (TAA) flow increased linearly (P < 0.05) whereas dietary CP concentration increased from 10% to 16%. The DM digestibility, CP digestibility, TAA digestibility, essential amino acid and non-essential amino acid digestibility decreased linearly (P < 0.05), whereas dietary CP concentration increased from 10% to 16%. Compared with pigs in M-CP and L-CP groups, pigs in the H-CP group had higher Asp, Cys, His, Arg flow in the faeces (P < 0.05). Compared with pigs in the L-CP group, pigs in M-CP and H-CP groups had less faecal Glu, Ala, Tyr, Pro, Val, Ile, Leu and flow (P < 0.05). Faecal microbial N and AA in the L-CP group was the highest in three groups. Pigs fed a corn–soybean meal-based diet reduced in protein concentration have lower faecal N flow

Effect of Dietary Pomelo Peel Powder on Growth Performance, Diarrhea, Immune Function, Antioxidant Function, Ileum Morphology, and Colonic Microflora of Weaned Piglets

This trial evaluated how dietary-accommodated pomelo peel powder (PPP) affected average daily feed intake (ADFI) and average daily gain (ADG), diarrhea, antioxidation, and colonic microbial in weaned piglets. Thirty piglets weaned at 28 d were divided into three groups: a basal diet (CON); a CON containing 75 mg/kg chlortetracycline (CTC); and a CON containing 8 g/kg (PPP). This trial had a period of 28 days. Piglets supplemented with PPP had higher ADFI and ADG than piglets in CTC and CON (p &lt; 0.05). The diarrhea rate in PPP and CTC was lower than in CON in the 3rd and 4th weeks (p &lt; 0.05). Serum superoxide dismutase and glutathione peroxidase enzyme activities, and total antioxidant capacity in PPP were higher than those in CON (p &lt; 0.05). Serum interleukin (IL)-4, insulin-like growth factor-I, immunoglobulin (Ig)A, and IgG concentrations in the PPP and CTC groups were higher than those in the CON group (p &lt; 0.05). Serum IL-1&beta;, IL-8, IL-17, and interferon (IFN)-&gamma; concentrations and the cecal pH in PPP were lower than those in CON (p &lt; 0.05). Serum IL-1&beta;, IFN-&gamma;, and IgA concentrations of piglets in PPP were lower than in CTC (p &lt; 0.05). The villus height and villus height/crypt depth of the ileum of piglets in PPP and CTC were higher than those in CON (p &lt; 0.05), but there was no difference between PPP and CTC (p &gt; 0.05). The Firmicutes and Cyanobacteria relative abundances in PPP and CTC (p &lt; 0.05) were lower than those in CON, whereas the Bacteroidetes relative abundances in PPP and CTC were higher than those in CON. The Prevotellaceae relative abundance in CTC was higher than in CON (p &lt; 0.05), whereas the Lactobacillaceae relative abundance in CTC was lower than in CON (p &lt; 0.05). The Ruminococcaceae relative abundance in PPP was higher than in CON (p &lt; 0.05), whereas the Veillonellaceae relative abundance in PPP was lower than in CON (p &lt; 0.05). PPP can improve ADFI and ADG, relieve diarrhea, and enhance the colonic microflora of weaned piglets. Therefore, PPP is expected to replace CTC as a feed additive to alleviate weaning stress and ensure normal growth and development of piglets

Effects of Dietary Crude Protein Levels on Fecal Crude Protein, Amino Acids Flow Amount, Fecal and Ileal Microbial Amino Acids Composition and Amino Acid Digestibility in Growing Pigs

The purpose of this experiment was to evaluate the effects of low protein corn-soybean meal-based diets on fecal CP, amino acid (AA) flow amount, AA digestibility and fecal and ileal microbial AA composition in growing pigs. Eighteen pigs (initial body weight = 30 &plusmn; 1.35) were randomly divided into three groups and fed with basal diets with CP levels of 12%, 15% and 18%, respectively. The Lys, Met + Cys, Thr and Trp level in the 12% CP and 15% CP groups is the same as 18% CP group by the addition of four crystalline Lys, Met + Cys, Thr and Trp to the diet. The results showed that with the decrease of dietary CP level from 18% to 12%, the fecal total nitrogen (N), CP and total AA (TAA) flow amount decreased linearly (p &lt; 0.05). Dry matter (DM) digestibility, CP digestibility, TAA digestibility, essential amino acid (EAA) digestibility and non-essential amino acid (NEAA) digestibility increased linearly with the decrease of dietary CP concentration from 18% to 12%. Compared with 18% CP group, the flow amount of Asp, Ser, Glu, Gly, Tyr, Val, Leu and Phe in feces of pigs in the 15% CP group and 12% CP group decreased significantly, while the flow amount of Arg in the 15% CP group was lower than that in the 18% CP group and 12% CP group. The fecal microbial N and AA of the 15% CP group were higher than those of the 18% CP and 12% CP groups. Fecal TAA flow amount decreased linearly with the decrease of the dietary CP levels from 18% to 12%. Fecal TAA and NEAA flow amount also decreased linearly with the decrease of dietary CP level from 18% to 12%. Except for Glu, Gly, Met, Tyr, Thr and Phe, there were significant differences among the three groups in the composition of 17 kinds of AAs in fecal microorganisms. Among the 17 AA compositions of ileal microorganisms, except Tyr and Lys, the other AAs were significantly different among the three groups (p &lt; 0.05

Effect of High Efficiency Digestion and Utilization of Organic Iron Made by Saccharomyces cerevisiae on Antioxidation and Caecum Microflora in Weaned Piglets

Organic iron is expected to replace inorganic iron used in diets as an iron source. Organic iron possesses high absorption efficiency and low fecal iron excretion. This study aims to study the effect of organic iron produced by Saccharomyces cerevisiae (yeast iron) on digestion, utilization, antioxidation and caecum microflora in weaned piglets. In total, 20 piglets that had been weaned after 28 days were divided into 4 groups, each of which followed a different basal diet. The basal diet of each of these 4 groups contained, respectively, 104 mg/kg iron (ferrous sulfate, CON), 84 mg/kg iron (yeast iron, LSC), 104 mg/kg iron (yeast iron, MSC) or 124 mg/kg iron (yeast iron, HSC). This experiment lasted 35 d. The apparent digestibility of iron in LSC, MSC and HMS was higher than that in CON (p &lt; 0.01) and the fecal iron content in LSC, MSC and HMS was lower than that in CON (p &lt; 0.01). Serum iron contents in LSC, MSC and HMS were higher than that in CON (p &lt; 0.01). The iron contents of the heart, lungs, liver, kidney and left gluteus muscle in the MSC and HMS groups were higher than that in CON and LSC (p &lt; 0.05). Serum catalase, glutathione peroxidase, superoxide dismutase activity, superoxide anion, glutathione, hydroxyl free radical scavenging rate, total antioxidant capacity, and liver superoxide anion clearance rate and peroxidase in MSC and HMS were higher than that in CON and LSC (p &lt; 0.05). The contents of nitric oxide and peroxide of the weaned piglets in MSC and HMS were lower than that in CON and LSC (p &lt; 0.05). The abundance of Firmicutes, Blautia and Peptococcus in LSC, HSC and MSC was higher than that in CON (p &lt; 0.01). The abundance of Lactobacillus in CON and LSC was higher than that in MSC and HSC (p &lt; 0.01). The abundance of Acinetobacter, Streptococcus and Prevotella in LSC, MSC and HSC was lower than that in CON (p &lt; 0.01). The results suggested that a diet containing 84 mg/kg iron of yeast iron has the same effect as a diet containing 104 mg/kg iron of ferric sulfate, and that a diet containing 104 or 124 mg/kg iron of yeast iron is superior to a diet containing 104 mg/kg iron of ferric sulfate

Functional L-Arginine Derivative as an Efficient Vector for Intracellular Protein Delivery for Potential Cancer Therapy

The utilization of cytosolic protein delivery is a promising approach for treating various diseases by replacing dysfunctional proteins. Despite the development of various nanoparticle-based intracellular protein delivery methods, the complicated chemical synthesis of the vector, loading efficiency and endosomal escape efficiency of proteins remain a great challenge. Recently, 9-fluorenylmethyloxycarbonyl (Fmoc)-modified amino acid derivatives have been used to self-assemble into supramolecular nanomaterials for drug delivery. However, the instability of the Fmoc group in aqueous medium restricts its application. To address this issue, the Fmoc ligand neighboring arginine was substituted for dibenzocyclooctyne (DBCO) with a similar structure to Fmoc to obtain stable DBCO-functionalized L-arginine derivative (DR). Azide-modified triethylamine (crosslinker C) was combined with DR to construct self-assembled DRC via a click chemical reaction for delivering various proteins, such as BSA and saporin (SA), into the cytosol of cells. The hyaluronic-acid-coated DRC/SA was able to not only shield the cationic toxicity, but also enhance the intracellular delivery efficiency of proteins by targeting CD44 overexpression on the cell membrane. The DRC/SA/HA exhibited higher growth inhibition efficiency and lower IC50 compared to DRC/SA toward various cancer cell lines. In conclusion, DBCO-functionalized L-arginine derivative represents an excellent potential vector for protein-based cancer therapy

Effects of Multi-Bacteria Solid-State Fermented Diets with Different Crude Fiber Levels on Growth Performance, Nutrient Digestibility, and Microbial Flora of Finishing Pigs

This study aimed to investigate the effects of multi-bacteria solid-state fermented diets with different crude fiber (CF) levels on growth performance, nutrient digestibility, and microbial flora of finishing pigs. The multi-bacteria solid-state fermented diets were made up of Lactobacillus amylovorus, Enterococcus faecalis, Bacillus subtilis, and Candida utilis. According to a 2 (factors) × 2 (levels) design, with the two factors being multi-bacteria solid-state fermentation (fed non-fermented diet or multi-bacteria fermentation) or CF levels (fed a basal diet containing 2.52% CF or 7.00% CF), a total of 36 finishing pigs (70.80 ± 5.75 kg) were divided into 4 treatments with 9 barrows per group: (1) pigs fed a diet containing 7.00% CF (HF), (2) pigs fed a multi-bacteria fermentation diet containing 7.00% CF (HFM), (3) pigs fed a diet containing 2.52% CF (LF), and (4) piglets fed a multi-bacteria fermentation diet containing 2.52% CF (LFM). This experiment lasted 28 days. The multi-bacteria solid-state fermented diet increased the backfat thickness (p p p Lactobacillus, Oscillospira, and Coprococcus (p p p p Streptococcaceae (p p p p Clostridiaceae_Clostridium and Coprococcus (p p p p p Akkermansia and Oscillospira (p p < 0.05). The 7.00% CF had a negative effect on the digestion of nutrients, but multi-bacteria solid-state fermentation diets could relieve this negative effect and increase backfat thickness. High-fiber diets and multi-bacteria solid-state fermentation improved the diversity and abundance of fecal microorganisms in finishing pigs

Genome-wide identification and expression profile analysis of CCH gene family in Populus

Copper plays key roles in plant physiological activities. To maintain copper cellular homeostasis, copper chaperones have important functions in binding and transporting copper to target proteins. Detailed characterization and function analysis of a copper chaperone, CCH, is presently limited to Arabidopsis. This study reports the identification of 21 genes encoding putative CCH proteins in Populus trichocarpa. Besides sharing the conserved metal-binding motif MXCXXC and forming a βαββαβ secondary structure at the N-terminal, all the PtCCHs possessed the plant-exclusive extended C-terminal. Based on their gene structure, conserved motifs, and phylogenetic analysis, the PtCCHs were divided into three subgroups. Our analysis indicated that whole-genome duplication and tandem duplication events likely contributed to expansion of the CCH gene family in Populus. Tissue-specific data from PlantGenIE revealed that PtCCH genes had broad expression patterns in different tissues. Quantitative real-time RT-PCR (qRT-PCR) analysis revealed that PnCCH genes of P. simonii × P. nigra also had different tissue-specific expression traits, as well as different inducible-expression patterns in response to copper stresses (excessive and deficiency). In summary, our study of CCH genes in the Populus genome provides a comprehensive analysis of this gene family, and lays an important foundation for further investigation of their roles in copper homeostasis of poplar