Research progress of the impact of payment by disease diagnosis-related group on nursing care / 中国实用护理杂志

The National Medical Insurance Administration launched a national pilot project based on diagnosis-related group (DRG) payment across the country in 2019. It optimizes and reuses limited resources from a clinical perspective, controls hospitalization expenses and medical costs, and reduces average hospital stays based on DRG payment. This article expounds the concept and application of DRG payment, from the perspective of clinical nursing, expounds the research progress of DRG payment at home and abroad, attempts to analyze the relationship between DRG payment and nursing, and further proposes the impact on the development of clinical nursing.

Four-dimensional analysis of wall thickness for judgment of femoral bone healing / 中华创伤骨科杂志

Objective:To explore the feasibility and effectiveness of four-dimensional analysis of wall thickness for judgment of femoral bone healing.Methods:The clinical data were retrospectively analyzed of the 29 patients who had been diagnosed with femoral bone malunion or bone nonunion at Department of Orthopaedics, Air Force Hospital of Eastern Military Theater of PLA from June 2014 to June 2019. They were 24 males and 5 females with an average age of 41.8 years (from 5 to 54 years). There were 25 cases of delayed union and 4 cases of nonunion (including 2 ones of hypertrophic nonunion and 2 ones of at-rophic nonunion). Mimics software 2.0 and the four-dimensional analysis of wall thickness were used to simulate and analyze the fracture bone healing of the patients at different time points. In comparison with the CT data of the contralateral healthy limb, the fracture bone healing was judged to assist the diagnosis of femoral union, delayed union and nonunion on the basis of the changing trends with time. The original clinical diagnoses were thus revised and the eventual clinical healing outcomes were observed.Results:All the patients were followed up for 1 to 4 years (mean, 14.9 months). Of them, bone union was clinically diagnosed in 13 (44.8%), delayed bone union in 12 (41.4%) and bone nonunion in 4 (13.8%). According to the judgment by four-dimensional analysis of wall thickness, the clinical diagnoses were modified as follows: 9 cases (31.0%) had bone union, 18 cases (62.1%) delayed bone union, and 2 cases (6.9%) bone nonunion. There were statistically significant differences between the 2 methods ( χ2=15.399, P=0.031). Conclusions:The four-dimensional analysis of wall thickness can be used to analyze quantitatively the femoral bone healing, providing a relatively objective basis for clinical diagnosis of bone nonunion and delayed bone union.

Clinical characteristics and their relationships with glucose metabolism in elderly patients with Guil-lain-Barré syndrome / 中国医师杂志

Objective To determine the clinical characteristics in elderly patients with Guillain-Barré syndrome ( GBS) and explore the relationship between glucose metabolism and severity and prognosis of disease. Methods Records of patients with GBS admitted between January 2004 and February 2017 from Affiliated Hospital of Jiangsu University were evaluated, including antecedent infection, initial symp-toms, cranial nerve palsy, subgroup analysis, Hughes score and Medical Research Council ( MRC) score at nadir and when discharged. Results The incidence of ocular palsy (6. 4％ vs 27. 0％, P=0. 02) and of facial palsy (18. 8％ vs 45. 8％, P =0. 016 ) were both lower in older group, compared to non-elderly group. MRC score at nadir (32 vs 44, P=0. 020), rate of severe type (80. 6％ vs 47. 9％, P=0. 004) and rate of poor prognosis when discharged (67. 7％ vs 29. 2％,P=0. 001) in elderly group were higher than non-elderly group. As to the distribution of subtype in these two groups, no significant difference was found (P=0. 691). Hyperglycemia wasn't prognostic factor of severe type (OR =0. 531,P =0. 321) or poor short-term prognosis (OR=0. 519,P=0. 261). Conclusions The clinical characteristics of elderly patients with GBS are distinct from non-elderly patients. Hyperglycemia wasn 't predictor of severe type or poor short-term prognosis of GBS.

Arginine vasopressin reverses fever induced by lipopolysaccharide in rats and its effect on hyperalgesia / 中国病理生理杂志

AIM: To investigate the effect of peripheral administration of arginine vasopressin (AVP) on lipopolysaccharide (LPS)-induced fever and hyperalgesia in rats and its relationship with interleukine-1β (IL-1β) and prostaglandin E2 (PGE2).METHODS: The core temperature (Tc), brown adipose tissue (BAT) temperature and activity were measured by telemetry in adult male Sprague-Dawley rats at an ambient temperature of 23 ℃ during a 12 h light/12 h dark photoperiod (lights on at 06:00 and lights off at 18:00).The rats were intraperitoneally injected with LPS (50 μg/kg), AVP (10 μg/kg) or V1a vasopressin receptor antagonist (V1a antagonist, 30 μg/kg) at 10:00 or 11:30.Hyperalgesia was assessed by measuring the latency to withdraw a hindpaw from radiant heat (Hargreaves test).The concentrations of IL-1β and PGE2 in the serum were tested by ELISA.RESULTS: Intraperitoneal administration of LPS induced periods of biphasic fever accompanied by hyperalgesia.AVP reversed LPS-induced fever, and decreased the hyperalgesia and BAT thermogenesis.Peripheral administration of V1a antagonist enhanced the fever produced by LPS, but did not affect the hyperalgesia.AVP significantly attenuated LPS-induced IL-1β and PGE2 production.CONCLUSION: Peripheral administration of AVP reverses LPS-induced fever and decreases hyperalgesia by reduction of BAT thermogenesis and inhibition of IL-1β and PGE2.Endogenous AVP attenuates the fever induced by LPS, but does not affect the nociceptive thresholds.

Influence of cardiac resynchronization on inflammation and ventricular remodeling in patients with chronic heart failure / 心血管康复医学杂志

Objective:To observe influence of cardiac resynchronization therapy (CRT ) on ventricular remodeling and inflammation in patients with chronic heart failure (CHF) .Methods :A total of 84 CHF patients treated in our hospital from Jun 2012 to Feb 2015 were selected , according to randam number table , they were randomly and e‐qually divided into routine treatment group (received routine medication ) and combined treatment group (received CRT based on routine treatment group) .Left ventricular ejection fraction (LVEF) ,left ventricular end -diastolic dimension (LVEDd) ,6min walking distance (6MWD) ,levels of high sensitive C reactive protein (hsCRP) ,inter‐leukin (IL)‐6 and tumor necrosis factor (TNF)–αwere compared between two groups before and three months after treatment .Results:Compared with before treatment ,three months after treatment ,there were significant rise in LVEF and 6MWD ,and significant reductions in LVEDd ,levels of hsCRP ,IL‐6 and TNF‐α in combined treatment group ( P<0.05 or < 0.01 ) ,while there were no significant improvements in above indexes in routine treatment group .Compared with routine treatment group ,there were significant rise in LVEF ± [(29.42 ± 4.32)%vs .(37.16 ± 4.72)% ] and 6MWD [ (232.66 ± 40.54) m vs .(304.12 ± 51.65) m] ,and significant reductions in LVEDd [ (64.35 ± 7.81) mm vs .(57.64 ± 6.12) mm] ,levels of hsCRP [ (23.21 ± 3.45)μg/ml vs .(16.31 ± 2.02)μg/ml] ,IL‐6 [ (22.08 ± 3.82)μg/ml vs .(15.79 ± 2.09)μg/ml] and TNF‐α[ (32.66 ± 5.66)μg/ml vs .(23.23 ± 3.12)μg/ml] in combined treatment group , P<0.05 or <0.01. Conclusion:CRT can significantly reduce levels of hsCRP ,IL‐6 and TNF‐αin CHF patients ,which may be the main mechanism delaying ventricular remodeling and improving cardiac function .

Clinical observation of brucea javanica oil combined with 125I and chemotherapy on Stage Ⅲ-Ⅳ Pa-tients with non-small cell lung cancer / 中国综合临床

Objective To investigate the clinical efficacy and side reaction of brucea javanica oil ( BJO) combined with 125I and chemotherapy on stageⅢ?Ⅳpatients with non?small cell lung cancer ( NSCLC) . Methods One hundred and twenty cases on stageⅢ?Ⅳpatients with NSCLC were randomly divided into two groups,60 cases received BJO combined with 125I and chemotherapy treatment(observation group),the other 60 cases received 125I combined with chemotherapy treatment(control group). Results The objective response rate(ORR) and disease control rate (DCR) were 71. 7%,86. 7% of observation group and 66. 7%,85. 0% of control group,there were no significant difference(χ2=0. 352,0. 069;P>0. 05) . The improvement rate of KPS score in observation group was significantly superior to that in control group, the difference was significant (76. 7% vs. 55. 0%;χ2=6. 261,P<0. 05) . The incidence of myelosuppression and gastrointestinal adverse e?vents in observation group was significantly lower that in control group ( 68. 3% vs. 83. 3%,41. 7% vs. 61. 7%;χ2=3. 883,4. 805;P<0. 05) . Conclusion BJO combined with 125I and chemotherapy for treating on stageⅢ?Ⅳ patients with NSCLC can reduce the toxicity and side effects caused by chemotherapy,and significantly im?prove the clinical symptoms and quality of life of patients.

Interleukin-23 strengthens the anti-apoptotic and drug resistance of human tongue squamous cell carcinoma through the Wingless-related integration site/β-catenin pathway / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aims to detect the expression level of interleukin-23 (IL-23) in tongue squamous cell carcinoma tissues and its relationship with clinical prognosis, as well as explore the anti-apoptotic and drug resistance of the tongue squamous cell line-SCC9 before and after treatment with IL-23.</p><p><b>METHODS</b>The expression of IL-23 in tumor tissues from 28 tongue cancer patients was analyzed by immunohistochemistry assay. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the mRNA expression of Wingless-related integration site (Wnt)1 and c-myc in SCC9 cells treated with different IL-23 concentrations. After interferencing the β-catenin with small interfering RNA (siRNA), the expression of β-catenin, B-cell lymphoma-2 (Bcl-2), ATP-binding cassette sub-family G member 2 (ABCG2), and permeability-glycoprotein (P-gp) in SCC9 was measured by Western blot analysis. The effect of IL-23 on the apoptotic resistance of SCC9 to cisplatin was examined by methyl thiazolyl tetrazolium test.</p><p><b>RESULTS</b>The expression of IL-23 in tongue cancer tissues was correlated with lymphatic metastasis, nerve invasion, and the recurrence after therapy (P<0.05). After dealing with IL-23, SCC9 showed the upregulation effect of Bcl-2, ABCG2 and P-gp expressions. IL-23 was closely related to the activation level of the Wnt pathway and significantly strengthened the resistance to cisplatin (P<0.01).</p><p><b>CONCLUSION</b>IL-23 activates the Wnt pathway in tongue squamous cell carcinoma, thereby enhancing its resistance to apoptosis and drug.</p>

Therapeutic effect of submental flap in repairing of approaching circumferential defects after hypopharyngeal cancer ablation with laryngeal function unpreserved / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To study the effectiveness of repairing nearly circumferential defect with the submental flaps after resection of laryngeal function unpreserved hypopharyngeal cancer.@*METHOD@#All the cases were treated with the submental flaps after resection of hypopharyngeal cancer with laryngeal function unpreserved.@*RESULT@#All 13 flaps were alive. Hypopharyngeal fistula occurred in 2 cases. All patients had normal swallowing function. The patients were followed up 6-42 months. Of 13 cases,3 had recurrence at neck Lymph node, but no local hypopharyngeal recurrence was found. Seven cases were followed up more than 3 years, and only 3 of them survived.@*CONCLUSION@#Submental flap is an ideal tissue flap submental flap in repairing of approaching circumferential defects after hypopharyngeal cancer ablation with laryngeal function unpreserved for the repairment of after approaching circumferential defects after hypopharyngeal cancer ablation with laryngeal function unpreserved, For it is close to the defect region, safe, easy-to-obtain and easy-to-survive.

Clinical analysis of hypocalcemia after thyroid cancer surgery / 中华内分泌外科杂志

Objective To investigate the related factors of postoperative hypocalcemia after thyroid carc-er surgery.Methods 346 cases of thyroid carcer patients undergoing surgery from Jan .2013 to Dec.2013 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed .Results 129 cases developed hepocalcemia after thyroid surgery .Among the related factors that may cause postoperative hypocalcemia , the scope of surgery , parathyroid injury and secondary surgery might play important roles .Conclusions The inci-dence of postoperative hypocalcaemia is high after total thyroidectomy .Patients with reoperation and lymph node dissection have an increased rate of postoperative hypocalcaemia .In order to reduce hypocalcaemia incidence ,sur-gons need to protect parathyroid blood supply in thyroid surgery and give calcium after surgery .

Construction and identification of CCDC67 gene lentiviral vector / 中华内分泌外科杂志

Objective To construct a]entiviral expression vector carrying CCDC67 and to obtain CCDC67 efficient and stable expression in mammalian cells.Methods The DNA fragment of CCDC67 coding sequence was amplified by PCR with designed primer from the cDNA library including CCDC67 gene,and then subcloned into GV208 vector with in-fusion technique to generate the lentiviral expression vector,GV208-CCDC67.The positive clones were screened by PCR and the correct CCDC67 was confirmed by sequencing.Recombinant lentiviruses were produced in 293T cells after the cotransfection of GV208-CCDC67,and packaging plasmids of pHelper 1.0 and pHelper 2.0 Green fluorescent protein (GFP)expression in 293T cells was observed to evaluate gene delivery efficiency.CCDC67 protein expression in 293T cells was detected by Western blot.Resuits The lentiviral expression vector carrying CCDC67 was successfully constructed and CCDC67 protein expression was detected in 293T cells.Conclusion The recombinant lentivirus GV208-GFP-CCDC67 is successfully constructed and it lays a foundation for further molecular function study of CCDC67.

The significances of monitoring urine NGAL and KIM -1 levels before and after coronary intervention in ;early predication of contrast-induced nephropathy / 中国基层医药

Objective To investigate the significances of monitoring urine neutrophil gelatinase -associated apolipoprotein (NGAL)and kidney injury molecule -1 (KIM-1)levels before and after coronary intervention in early predication of contrast -induced nephropathy.Methods The clinical data of 249 patients with coronary heart disease undergoing percutaneous coronary intervention were collected.All patients were divided into contrast -induced nephropathy group(n =21 )and non -contrast -induced nephropathy group(n =228)according to whether had contrast -induced nephropathy.Before surgery and 4h,12h,24h,48h,72h after surgery,the levels of serum creatinine were tested.Before surgery and 4h,12h,24h,48h after surgery,the levels of urinary NGAL and KIM-1 were detected by using enzyme -linked immunosorbent assay(ELISA).Results Compared with before surgery,the serum creati-nine level of contrast -induced nephropathy patients after surgery 48h[(101.7 ±20.3)μmol/L]was elevated,the difference was statistically significant(t =15.972,P <0.05).Compared with before surgery,the urinary NGAL levels of contrast -induced nephropathy patients after surgery 4h ~48h were (12.3 ±1.6)μg/L,(14.5 ±1.5 )μg/L, (14.1 ±1.2)μg/L and (14.3 ±1.4)μg/L,which were significantly elevated(t =8.672,11.817,15.942 and 17.641,all P <0.05),and the urinary KIM-1 levels after surgery 24h and 48h were (5.1 ±0.9)μg/L and (5.5 ± 1.3)μg/L,which were elevated,the differences were statistically significant(t =9.672,14.381,all P <0.05).The urinary NGAL levels of contrast -induced nephropathy patients after surgery 4h ~48h were higher than non -contrast-induced nephropathy patients,and the urinary KIM-1 levels after surgery 24h and 48h were higher than non -contrast -induced nephropathy patients,the differences were statistically significant(t =17.838,19.370,13.996, 18.172,2.792,3.307,all P <0.05).Pearson correlation analysis showed that the urinary NGAL levels after 4h and urinary KIM-1 levels after 24h were positively correlated with serum creatinine levels after surgery 48h(r =0.698, 0.576,all P <0.05).ROC curve analysis showed that urinary NGAL levels in predicting contrast -induced nephrop-athy,the area under the curve was 0.963 (95% CI:0.931 ~0.995 ),sensitivity was 85.7%,and specificity was 94.3%,for urinary KIM-1 levels,those were 0.839 (95%CI:0.768 ~0.909),81.0% and 72.8%.Conclusion The urinary NGAL levels of contrast -induced nephropathy patients after interventional treatment 4h were increased, and the urinary KIM-1 levels appeared increased after surgery 24h,which were earlier than serum creatinine.They were expected to be early indicators for determining acute kidney injury and predicting contrast -induced nephropathy after intervention treatment.

Changes of large-conductance calcium-activated potassium channel in gastric smooth muscle cells of diabetic gastroparesis rats / 中国病理生理杂志

[ ABSTRACT] AIM: To discuss the relevance between the pathogenesis of diabetic gastroparesis and the large-conductance calcium-activated potassium channels ( BKCa ) in gastric smooth muscle cells.METHODS:The SD rats were randomly divided into control group and model group.The gastric smooth muscle cells of the SD rats were enzymatically iso-lated in a low calcium solution containing papain.The current was recorded by patch clamp single channel recording tech-nique.The expression of KCNMA and KCNMB1 were observed by the method of immunohistochemistry.RESULTS:The value of BKCa single channel conductance was (220.10 ±10.90) pS;the channels had distinct voltage dependent and cal-cium dependent characteristics.In outside-out patch (Vm =+30 mV), the activation of BKCa was blocked by 200 nmol/L IbTX completely.Compared with control group, the open probability and amplitude of current in model group significant-ly increased, while the mean open time and mean close time significantly decreased.Compared with control group, the ex-pression of KCNMB1 in model group was significantly increased.CONCLUSION: Up-regulation of β1-subunit and in-crease in BKCa functional activities may be associated with diabetes gastroparesis in rats.

Carbon nanoparticles in central lymph node dissection in treatment of papillary thyroid carcinoma / 中华内分泌外科杂志

Objective To evaluate the curative effects of carbon nanoparticles on central lymphnode dis -section in papillary thyroid carcinoma ( PTC) .Methods 72 PTC patients were randomly divided into two groups:carbon nanoparticle group(n=32)and the control group(n=32).Patients in the carbon nanoparticle group were injected with carbon nanoparticles during surgery .Patients in the control group had conventional surgery .The number of lymph nodes being dissected ,lymph node metastasis , and the rate of hypoparathyroidism were compared between the two groups .Results The number of lymph nodes dissected in nanoparticle group ( n =312 ) was much bigger than that in the control group (n=189)(P0.01;χ2 =1.048).Conclu-sions The lymphatic tracer technique may improve the number of lymph nodes dissected in central region of PTC and reduce parathyroid gland damage .

Research progress of coiled-coil domain-containing in carcinoma / 国际外科学杂志

Coiled-Coil domain-containing has many important biological functions and can control the invasion and metastasis of malignant tumor cells and other biological behavior.The abnormal expression of the coiled-coil domaincontaining protein in nasopharyngeal carcinoma,gastric cancer,prostate cancer,pancreatic cancer,breast cancer,colorectal cancer,has a direct link with the phenotype of tumor cell migration,invasion and metastasis.Abnormal protein expression and inhibition of coiled-coil domain-containing related pathways can significantly affect the tumor invasion and metastasis,for the new targeted cancer medicine used in the treatment provides a theoretical basis.

Effects of pingyangmycin in the treatment of maxillofacial and infraoral hemangiomas / 医学研究生学报

Objectives:The effects of pingyangmycin(PYM) in the treatment of cavernous hemangioma, strawberry hemangioma and mixed hemangioma in the oromaxillofacial and intraoral regions is evaluated.　Methods:450 cases of hemangioma in the oromaxillofacial regions from January 1993 to January 1999 were reviewed. PYM was injected into the cavity or in the circumference of the hemangioma, and the injection may be repeated every 7～10 days for 3～5 times.　Results:450 patients were followed-up for 6 months～6 years. 86.89% were cured and nearlly cured,and 12% were improved. The total efficiency rate was 98.86%. The cure and elementary cure rates of cavernous hemangioma, strawberry hemangioma and mixed hemangioma were 91.04%, 86.08% and 78.01%, respectively, but the elementary cure rate of the wine color stainscapillary hemangioma was 14.29% only.　Conclusions:This method may be a safe, simple and effective therapy for cavernous hemangioma, strawberry hemangioma and mixed hemangioma in the oromaxillofacial regions.

Combination of multi-disciplinary techniques with ~(125)Ⅰ seeds in treating malignant obstructive jaundice / 介入放射学杂志

0.05).Conclusion Multi-disciplinary techniques combined with 125Ⅰ seeds implantation is effective in the management of the malignant obstructive jaundice.No significant difference for relief and liver function were found between CT-guided and during operation interstitial 125Ⅰ seeds implantations,but it seems more quickly relief or recovery was achieved in the latter.

The Value of 3D-Reconstruction Technique with Spiral CT in Acetabulum Fracture / 实用放射学杂志

Objective To evaluate the usefulness of the transect imaging and 3D-reconstruction with spiral CT in acetabulum fracture.Methods 23 cases of acetabulum fracture proved by clinical plain radiograph,transect imaging and 3D-reconsection were reviewed retrospectively.3D-reconsection were obtained on the basis of spiral transect imaging with use of 2~3 mm collimation.3 pitch and 1.2~2 mm reconstruction interval.Results Fractures were demonstrated definitely with transect imaging.3D-reconstruction in all patients the transect imaging displayed the fractures and the displacement of the burden opex of acetablulum,the disruption within joint,the direction of fracture.Displacement of detached bone fragments and capitis femoris were display stereoscopically by 3D-reconstruction.Conclusion The transect imaging and the 3D-reconstruction of spiral CT technique with spiral CT could afford the more valuable messages.Surgeon will benefit greathy from their usefulness in the choice of the surgical intervention and operative planning.