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OBJECTIVE To quantitatively evaluate the existing payment policies of diagnosis-related groups （DRGs）in China ， so as to provide reference for the formulation and improvement of policies. METHODS Totally 58 documents related to DRGs payment issued by the national and provincial medical security bureaus from 2017 to 2022 were processed by text mining method. PMC index evaluation model of DRGs payment policy was established. Nine typical DRGs payment policies were quantitatively evaluated and analyzed by 10 primary variables and 40 secondary variables. RESULTS Among the 9 policies，5 were excellent and 4 were acceptable. The average score of PMC index was 6.882. Generally ，there was still room for improvement because of the acceptable level. By comparing the two representative policies ，it was found that the main reasons was a lack of consideration in terms of supervision and management ，incentives and constraints when facing policy changes ，reason of the lower level of urban development. CONCLUSIONS Although DRGs payment policy in China is basically perfect ，there is still a lot of room for improvement in terms of extending the time limit of the policy ，summarizing and spreading the successful experience of pilot cities.
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Glucocorticoid pulse therapy is an important means to induce remission of neuroimmune diseases in acute attack stage. However, the specific programs of glucocorticoid pulse therapy in domestic hospitals are not standardized and unified at present. Here, glucocorticoid pulse therapy in acute attack of neuroimmune diseases in national and international guidelines in last decade are reviewed and summarized. Glucocorticoid pulse therapy follows the principle of large dosage and short course of treatment, and intravenous methylprednisolone 1 000 mg/d for three days to five days is the most common regimen. According to the characteristics of diseases, the dosage reduction regimens are different. Standardized glucocorticoid pulse therapy can not only maximize its curative effects, but also minimize its side effects, which deserves the attention of clinicians.
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Background:Malnutrition is common in patients with cancer, whichadversely affectsthesurvival and quality of life ofcancer patients.However, there is no national data on the prevalence of malnutrition inChinese cancer patients. Thisstudy aims to evaluate the prevalenceof malnutrition and quality of life(QOL)ofChinese patients with localregional, recurrentor metastatic cancer,to address the prognostic value of nutritional status and QOLon the survival of cancer patients in China and to validate the patient-generated subjective global assessment (PG-SGA) questionnaire in Chinese cancer patients.Methods:Thisisanobservational,multi-centered,and hospital-based prospective cohort study.We aimed to recruit 50,000 cancer patients (age 18and above)overan 8-year period.Data collection will occur within 48hrafter patientsare admitted to hospital, 30-days after hospital admission, and the follow-up will be conducted1-8years after enrolment. The primary outcomeisoverall survival, and secondaryoutcomes arelength of hospital stay and hospital costs. Factors measured are demographic characteristics, tumor characteristics, anthropometry measurements,hematological measurement, body composition, PG-SGAscores,Karnofsky performance status scores,and QLQ C30 scores. This protocol wasapproved by local ethical committees of all the participant hospitals.Conclusions: This multi-centered, large-scale, long-time follow-up prospective study will help diagnose malnutrition in cancer patients in China, and identify the related risk factors associated with the negative outcomes. The anticipated results will highlight the need for a truly scientific appraisal of nutrition therapy, and help to improve outcomes among cancer patients in China.Trial Registration: The trial has been registered with the Chinese Clinical Trial Registry, ChiCTR1800020329. Registered on 19 December 2018
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Objective@#To investigate the relationship between hope, mental suffering and quality of life in radiotherapy patients with cervical cancer, to provide the basis for the cancer patient′s psychological intervention.@*Methods@#A cross-sectional study of 120 cases of radiotherapy cervical cancer patients was conducted, using the psychological distress thermometer, Herth Hope Scale, Life Quality Measurement Scale for patients with cervical cancer to evaluate patients′ hope, quality of life and psychological distress.@*Results@#Radiotherapy cervical cancer patients′ psychological distress and hope were negatively correlated (r=-0.385, P <0.01), psychological distress and quality of life were negatively correlated (r=-0.602, P <0.01), hope and quality of life were positive correlation (r=0.711, P <0.01). Patients′ hope played partially mediated effect between psychological distress and quality of life, emotional status, functional status, played fully mediated effect between psychological distress and social family status. The Mediated effect sizes were 35.9%, 36.3%, 55.9% and 100.0%.@*Conclusions@#Psychological distress has not only a direct negative effect on the quality of life of cancer patients, but also an indirect negative effect through hope. During the Medical care, we should accurately assess of patient's psychological distress and hope, and take measures to help improve patients' hope and alleviate psychological distress, so as to improve patients′ quality of life.
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Objective@#To explore a predictive nomogram for the result of prostate biopsy based on Prostate Imaging Reporting and Data System version 2(PI-RADS v2)combined with prostate specific antigen (PSA) and its related parameters, and to assess its ability to diagnose prostate cancer by internal validation.@*Methods@#We retrospectively analyzed the clinical data of 509 patients who underwent transrectal prostate biopsy guided by ultrasound during the period from January 2014 to December 2018 in the Department of Urology, First Affiliated Hospital of Xiamen University. In 509 cases, the mean age was (68.1±7.2) years. The mean prostate volume(PV) was (55.8±30.7) ml. The mean tPSA value was (19.86±18.94) ng/ml. The mean value of fPSA was (2.63±3.60) ng/ml and the mean f/tPSA was 0.14±0.08. The mean PSAD was (0.46±0.52) ng/ml2. Based on the PI-RADS v2, score 1 point have 37 cases, score 2 point have 131 cases, score 3 point have 152 cases, score 4 point have 102 cases, score 5 point have 87 cases. Of these patients, we randomly selected 80% (407 cases) as development group, and the other 20% (102 cases) as validation group. Univariate and multivariate logistic regression analysis of the development group was performed to identify the independent influence factors that can predict prostate cancer (PCa), thereby establishing a predictive model for the result of prostate biopsy. In the development group, validation group and tPSA was between 4.1-20.0 ng/ml, the model was evaluated by analyzing the receiver operating characteristic (ROC) curve, calibration curve and decision curve, and compared to PSA, fPSA, f/tPSA, PSAD, PI-RADS v2.@*Results@#Among the 509 patients enrolled in the study, the detection rate of PCa was 43.0% (219/509). In the development group, the logistic regression analysis demonstrated that patient age (OR=1.113), f/tPSA (OR=0.004), PV (OR=0.986), PSAD (OR=11.023), digital rectal examination (DRE) texture (OR=2.295), transabdominal ultrasound (TAUS) with or without hypoechoic (OR=2.089), and PI-RADS v2 (OR=1.920) were independent factors for PCa (P<0.05). The nomogram based on all variables was established. In the development group, the area under the curve (AUC) of the model (0.883) was greater than those of tPSA (0.686), fPSA (0.593), f/tPSA (0.626), PSAD (0.777), PI-RADS v2 (0.761). In the validation group, the area under the curve of the model (0.839) was greater than those of tPSA (0.758), fPSA (0.666), f/tPSA (0.648), PSAD (0.832), PI-RADS v2 (0.803). In patients whose tPSA was between 4.1-20.0 ng/ml, the area under the curve of the model (0.801) was greater than those of tPSA (0.570), fPSA (0.426), f/tPSA (0.657), PSAD (0.707), PI-RADS v2 (0.701). The calibration curve of the nomogram indicated that the prediction curve was basically fitted to the standard curve, and the Hosmer-Lemeshow showed thatχ2=5.434, P=0.710, both suggested that the prediction model had better calibration ability. The decision curve showed that the model based on PI-RADS v2 had high clinical application value.@*Conclusions@#The nomogram based on PI-RADS v2 had a high predictive value for prostate cancer and could significantly improve the diagnostic performance. It had better diagnostic value than PSA and its related parameters. It also provided important guidance for the prostate cancer on clinical treatment of patients to some extent.
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Objective To explore a predictive nomogram for the result of prostate biopsy based on Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) combined with prostate specific antigen (PSA) and its related parameters,and to assess its ability to diagnose prostate cancer by internal validation.Methods We retrospectively analyzed the clinical data of 509 patients who underwent transrectal prostate biopsy guided by ultrasound during the period from January 2014 to December 2018 in the Department of Urology,First Affiliated Hospital of Xiamen University.In 509 cases,the mean age was (68.1 ± 7.2) years.The mean prostate volume (PV) was (55.8 ± 30.7) ml.The mean tPSA value was (19.86 ± 18.94) ng/ml.The mean value of fPSA was (2.63 ± 3.60) ng/ml and the mean f/tPSA was 0.14 ± 0.08.The mean PSAD was (0.46 ±0.52) ng/ml2.Based on the PI-RADS v2,score 1 point have 37 cases,score 2 point have 131 cases,score 3 point have 152 cases,score 4 point have 102 cases,score 5 point have 87 cases.Of these patients,we randomly selected 80％ (407 cases) as development group,and the other 20％ (102 cases) as validation group.Univariate and multivariate logistic regression analysis of the development group was performed to identify the independent influence factors that can predict prostate cancer (PCa),thereby establishing a predictive model for the result of prostate biopsy.In the development group,validation group and tPSA was between 4.1-20.0 ng/ml,the model was evaluated by analyzing the receiver operating characteristic (ROC) curve,calibration curve and decision curve,and compared to PSA,fPSA,f/tPSA,PSAD,PI-RADS v2.Results Among the 509 patients enrolled in the study,the detection rate of PCa was 43.0％ (219/509).In the development group,the logistic regression analysis demonstrated that patient age (OR =1.113),f/tPSA (OR =0.004),PV (OR =0.986),PSAD (OR =11.023),digital rectal examination (DRE) texture (OR =2.295),transabdominal ultrasound (TAUS) with or without hypoechoic (OR =2.089),and PI-RADS v2 (OR =1.920) were independent factors for PCa (P ＜0.05).The nomogram based on all variables was established.In the development group,the area under the curve (AUC) of the model (0.883) was greater than those of tPSA (0.686),fPSA (0.593),f/tPSA (0.626),PSAD (0.777),PI-RADS v2 (0.761).In the validation group,the area under the curve of the model (0.839) was greater than those of tPSA (0.758),fPSA (0.666),f/tPSA (0.648),PSAD (0.832),PI-RADS v2 (0.803).In patients whose tPSA was between 4.1-20.0 ng/ml,the area under the curve of the model (0.801) was greater than those of tPSA (0.570),fPSA (0.426),f/tPSA (0.657),PSAD (0.707),PI-RADS v2 (0.701).The calibration curve of the nomogram indicated that the prediction curve was basically fitted to the standard curve,and the Hosmer-Lemeshow showed thatx2 =5.434,P =0.710,both suggested that the prediction model had better calibration ability.The decision curve showed that the model based on PI-RADS v2 had high clinical application value.Conclusions The nomogram based on PI-RADS v2 had a high predictive value for prostate cancer and could significantly improve the diagnostic performance.It had better diagnostic value than PSA and its related parameters.It also provided important guidance for the prostate cancer on clinical treatment of patients to some extent.
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Objective To explore the efficacy and tolerance of adverse reactions of gene detection technique in guiding individualized targeted therapy for advanced metastatic renal cell carcinoma.Methods Retrospective analysis was performed on the clinical data of 62 patients with advanced metastatic renal cell carcinoma before and after receiving targeted drug treatment in our department from October 2015 to October 2017.Among the 62 patients,there were 36 males and 26 females,with an average age of (54 ± 13) years old.16 patients were treated with sunitinib,20 patients were treated with sorafenib and 26 patients were treated with pazopanib.A total of 28 patients (individualized group) were selected to receive targeted drug according to the results of gene detection,and 34 patients were treated with targeted drug empirically (empirical group).In individualized group,there were 17 males and 11 females with the average age of (51.3 ± 15.6) years old.20 patients accepted the operation.The distant metastasis included bone metastasis in 21 cases,lung metastasis in 7 cases,liver metastasis in 16 cases,epidermal metastasis in 4 cases and lymphatic metastasis in 14 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 15,7,6,respectively.7 patients were treated with sunitinib,8 patients were treated with sorafenib and 13 patients were treated with pazopanib.In empirical group,there were 19 males and 15 females with the average age of (56.3 ± 10.1) years old.22 patients accepted the operation.The distant metastasis included bone metastasis in 20 cases,lung metastasis in 5 cases,liver metastasis in 13 cases,epidermal metastasis in 3 cases and lymphatic metastasis in 15 cases.According to risk of MSKCC,the case number of low risk,moderate risk and high risk were 20,g,6,respectively.9 patients were treated with sunitinib,12 patients were treated with sorafenib and 13 patients were treated with pazopanib.The baseline characteristics of the two groups of patients,including gender,age,whether operation was performed,site of metastasis,and risk of MSKCC,didn't show significant difference.Patients in both groups received the standard treatment regimen and the follow-up duration was 4-26 months to observe the efficacy,progression-free survival and tolerance to adverse reactions of the targeted therapy.Results After 12 months of treatment,15 patients in the individualized group was recorded objective remission.7 patients in the empirical group was recorded objective remission,as well.The tumor control efficacy of the individualized group was significantly better than that of the empirical group (46.4％ vs.20.6％,P =0.03).Meanwhile,the median progression-free survival time (15.2 months,3.7-24.2 months) in the individualized group was significantly longer than that in the empirical group (12.1 months,2.8-22.1 months) (P =0.009).Compared with the empirical group,the higher incidence of targeted treatment-related adverse reactions occurred in the individualized group,including thrombocytopenia (46.4％ vs.17.6％ P =0.014),leukopenia (46.4％ vs.17.6％ P =0.005),hypertension (71.4％ vs.44.1％,P =0.031) and hypothyroidism(60.7％ vs.29.4％,P=0.013).Conclusions Compared with the patients with empirical drugs,the application of gene detection technique to select individualized targeted drugs for the treatment of advanced metastatic renal cancer is obvious curatively effective,and to a certain extent extends the progression-free survival time of patients.
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Objective To invcstigate the clinical effect of Bushenxuanfei decoction combined with salmon calcitonin on osteoporosis in COPD patients.Methods 60 COPD patients with osteoporosis were randomly divided into two groups:30 patients as controls were treated with calcium carbonate and vitamin D3 tablets and salmon calcitonin and another 30 patients in the treatment group with salmon calcitonim combined with Bushenxuanfei decoction.The two groups were compared in terms of pain,BMD and calcium concentration.Results The treatment group was significantly better than the control one in terms of indexes of pain BMD and calcium concentration (P＜0.05).Conclusion Bushenxuanfei decoction combined with salmon calcitonin is of significant effect in the treatment of osteoporosis in COPD patients.
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Objective To investigate the diagnostic value of serum MK (Midkine)and total bilirubin (TB)in diabetic retinopathy (DR). Methods A total of 148 patients with type 2 diabetes were divided into three groups:diabetes without retinopathy (NDR group,n = 50),diabetic with non proliferative retinopathy (NPDR group,n = 52 )and diabetic with proliferative retinopathy (PDR group,n = 46 ) according to whether retinal lesions were detected. The diagnostic value of serum MK and TB were investigated. Results Age,gender,body mass index (BMI),FPG,HbA1 c,TG,TC,LDL-C,HDL-C, SBP,DBP were not statistically different among the three groups (P >0.05).Duration,UAlb/Cr,SOD, MDA,AOPP,MK,TB and DB were statistically different among the three groups (P<0.05). Duration, ALB/CR,MDA,AOPP,and MK were higher,SOD,TB,DB were lower in PDR and NPDR group than in NDR group (P<0.05). Duration,UAlb/Cr,MDA,AOPP,and MK were higher,and SOD,TB,DB were lower in PDR group than in NPDR group (P <0.05).Logistic regression analysis showed that duration, ALB/CR,MDA,AOPP,and MK were risk factors (OR =1.36,1.71,1.27,1.65,2.35,P <0.05 )and SOD,TB,DB were protective factors for DR (OR =0.46,0.31,0.46,P <0.05). Diagnosis sensitivity, specificity,positive predictive value,negative predictive value and accuracy of TB combined with MK were higher than TB,MK alone(AUC=0.918,0.735,0.762,P <0.05). Conclusion DR may be associated with increased MK and decreased TB.Diagnostic efficacy of MK combined with TB is better than MK,TB alone.
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Objective To assess the safety and effectiveness of artificial ascites assisted thermal ablation for hepatic tumors adjacent to the gastrointestinal tract in patients with a history of abdominal surgery . Methods Thirty‐two patients (33 lesions located adjacent to the gastrointestinal tract) with a history of abdominal surgery were included in the study . Method ① :normal saline was injected into abdominal cavity to form water insulation band between liver and gastrointestinal tract . Method② :normal saline was injected with appropriate pressure to form local water insulation band between the liver and gastrointestinal tract . Method③ :normal saline was injected continuously at the interval between liver and gastrointestinal tract to flush away heat energy caused by ablation . All the patients were checked for gastrointestinal tract injury after ablation . During one month after ablation ,CT /MR was performed to evaluate whether the lesions were completely ablated . Results Respectively ,the numbers of lesion received method ① ,② and ③ were 27(81 .8% ) ,4(12 .1% ) and 2(6 .1% ) ,while the usage of normal saline were 400~2 000 ml ,600~800 ml and 1 000~1 500 ml . No gastrointestinal tract injury occurred . CT/MR scan during one month after ablation showed that all the 33 lesions had been completely ablated . Conclusions In patients with a history of abdominal surgery ,artificial ascites is a safe and effective method in assistance of thermal ablation for hepatic tumors adjacent to the gastrointestinal tract .
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Objective To explore the association between the CpG methylation level of positive regulatory domain containing 16(PRDM16)gene promoter and obesity or body mass index(BMI). Methods A total of 116 patients(91 female adults and 25 male adults) with abdominal operation in a municipal hospital of Henan province were enrolled in this study and they were divided into two groups:normal weight group(n=50), overweight or obesity group ( n=66 ) . Fasting plasma glucose, total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein were measured in peripheral blood. DNA was extracted from white blood cells in peripheral blood and modified by bisulphite. Then the CpG methylation level of PRDM16 gene promoter was detected by mass spectrometry. Finally, all data were analyzed by IBM SPSS Statistics 21. 0 at the 5% level. The essential features and biochemical indexes of research objects between two groups were compared by two independent sample t-test, except chi-square test for gender. The correlation between CpG methylation level of PRDM16 gene and BMI was analyzed by multiple linear regression. Results There were no significant differences ( P>0. 05 ) in the methylation levels of PRDM16 gene's effective CpG sites(including CpG5. 6, CpG8, CpG9, CpG12, CpG13. 14. 15, CpG26. 27, CpG28 and CpG29) between two groups. The methylation level of CpG26. 27 had positive linear relation with BMI in overweight or obesity group with the standardized coefficients of 46. 928(P=0. 015), which means the higher the methylation level is, the higher the BMI would be. Conclusion The CpG26. 27 methylation level of PRDM16 gene promoter region may have relationship with the risk of obesity.
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Objective To evaluate the feasibility and accuracy of three-dimensional ultrasound-ultrasound (3DUS-US)automatic image fusion technology based on electromagnetic positioning.Methods The experimental phantom was constructed to acquire ultrasonic images by agarose gel and additives,which was used as the experimental object.3DUS imaging with free-hand and real-time ultrasound imaging automatic registrations were performed based on electromagnetic positioning.To investigate the effect of 3DUS-US image fusion under different scanning speed by free-hand,the fast and slow groups were designed. In addition,a junior operator and a senior operator performed 3DUS-US automatic registrations,and recorded the operating time and registration error,respectively.The repeatability between two operators was analyzed.Results The macroscopic appearance,stability and ultrasonic image of the phantom met the demand of this research.The success rate of 3DUS-US automatic image fusion technology was 100%(40/40).The slow group's registration error distance was (1 .44 ± 0.64)mm,which was obviously lower than the fast group's (2.56±0.53)mm,the difference was statistically significant (P <0.001).There were no statistically differences of the registration error and operating time between the two operators (P =0.508,P = 0.5 1 7 ).Conclusions The technology of 3DUS-US automatic registration based on electromagnetic positioning was feasible and accurate,which is worth applying into the clinical treatment.
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Intensity-modulated radiotherapy (IMRT) is gradually replacing conventional radiation therapy and has become the mainstream radical treatment for patients with nasopharyngeal carcinoma (NPC). IMRT can conform and increase radiation doses to tu-mor-associated regions as well as decrease exposure doses and volumes on normal organs and tissues to avoid damage on critical or-gans. Aside from system and setup errors, other factors, such as the gradual reduction of the primary NPC lesion and the decrease in vol-ume of involved neck lymph nodes as well as body weight loss and changes in the head and neck shape during IMRT, may cause devia-tions in the radiation doses and volume delivered to the NPC targets and the organs at risk. These factors may affect the accuracy of IMRT. Several researchers have attempted to correct such deviations during IMRT for NPC patients by using adaptive radiotherapy (ART). The results indicate that ART is feasible to a certain degree and can correct the deviations, including decrease in tumor volume, body weight loss, and changes in head and neck shape of NPC patients.
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Objective: To explore the effect of parenteral nutrition support on immunity function in severe undernourished patients with chronic obstructive pulmonary disease. Methods: 36 cases of patients with severe chronic obstructive pulmonary disease were randomly assigned into experimental and control group.Control group was treated with normal regulation treatment.Experimental group was treated with normal regulation treatment and parenteral nutrition support for 2 weeks. Results: After the treatment,total lymphocyte,T cell population and OT test level in the experimental group were significantly higher than those in the control group( P
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Objectives:To explore the effect of total parenteral nutrition support on immunity funtion in critically ill patients . Metheds:60 Cases of critically ill patients were divided into two group(A and B).Group A was treated with the normal regulation treatment.Group B (30 patients) was treated with the normal regulation treatment and total parenteral nutrition support treatment for 2 weeks. Results:After the treatment,total lymphocyte and T cell population level in the B group were significantly higher than those in the A group ( P 0.05). Conclusions:Total parenteral nutrition support treatment can significantly improve the immunity function in the critically ill patients.