Role of TGF-β/Smad signaling pathway in diabetic kidney disease and research progress of traditional Chinese medicine intervention / 中国中药杂志

Diabetic kidney disease is an important microvascular complication of diabetes and the leading cause of end-stage renal disease. Its pathological characteristics mainly include epithelial mesenchymal transition(EMT) in glomerulus, podocyte apoptosis and autophagy, and damage of glomerular filtration barrier. Transforming growth factor-β(TGF-β)/Smad signaling pathway is specifically regulated by a variety of mechanisms, and is a classic pathway involved in physiological activities such as apoptosis, proliferation and differentiation. At present, many studies have found that TGF-β/Smad signaling pathway plays a key role in the pathogenesis of diabetic kidney disease. Traditional Chinese medicine has significant advantages in the treatment of diabetic kidney disease for its multi-component, multi-target and multi-pathway characteristics, and some traditional Chinese medicine extracts, traditional Chinese medicines and traditional Chinese medicine compound prescription improve the renal injury of diabetic kidney disease by regulating TGF-β/Smad signaling pathway. This study clarified the mechanism of TGF-β/Smad signaling pathway in diabetic kidney disease by expounding the relationship between the key targets of the pathway and diabetic kidney disease, and summarized the research progress of traditional Chinese medicine in the treatment of diabetic kidney disease by interfering with TGF-β/Smad signaling pathway in recent years, to provide reference for drug research and clinical treatment of diabetic kidney disease in the future.

The value of CXorf67 and H3K27me3 for diagnosing germ cell tumors in central nervous system / 中华病理学杂志

Objective: To investigate immunohistochemical patterns of CXorf67 and H3K27me3 proteins in central nervous system germ cell tumors (GCTs) and to assess their values in both diagnosis and differential diagnosis. Methods: A total of 370 cases of central nervous system GCTs were collected from 2013 to 2020 at Huashan Hospital of Fudan University, Shanghai, China. The expression of CXorf67, H3K27me3 and commonly-used GCT markers including OCT4, PLAP, CD117, D2-40, and CD30 by immunohistochemistry (EnVision method) was examined in different subtypes of central nervous system GCTs. The sensitivity and specificity of each marker were compared by contingency table and area under receiver operating characteristic (ROC) curve. Results: Of the 370 cases there were 282 males and 88 females with a mean age of 19 years and a median age of 17 years (range, 2-57 years). Among the GCTs with germinoma, the proportions of male patients and the patients with GCT located in sellar region were both higher than those of GCTs without germinoma (P<0.05), respectively. CXorf67 was present in the nuclei of germinoma and normal germ cells, but not in other subtypes of GCT. H3K27me3 was negative in germinoma, but positive in the nuclei of surrounding normal cells and GCTs other than germinoma. In the 283 GCTs with germinoma components, the expression rate of CXorf67 was 90.5% (256/283), but no cases were positive for H3K27me3. There was also an inverse correlation between them (r2=-0.831, P<0.01). The expression rates of PLAP, OCT4, CD117 and D2-40 were 81.2% (231/283), 89.4% (253/283), 73.9% (209/283) and 88.3% (250/283), respectively. In 63 mixed GCTs with germinoma components, the expression rate of CXorf67 was 84.1% (53/63), while all cases were negative for H3K27me3. The expression rates of PLAP, OCT4, CD117 and D2-40 were 79.4% (50/63), 79.4% (50/63), 66.7% (42/63) and 87.3% (55/63), respectively. The 6 markers with largest area under ROC curve in ranking order were H3K27me3, CXorf67, D2-40, OCT4, PLAP and CD117 (P<0.05). Conclusions: CXorf67 and H3K27me3 have high sensitivity and high specificity in diagnosing germinoma. There is a significant inverse correlation between them. Therefore, they can both be used as new specific immunohistochemical markers for the diagnosis of GCTs.

Comparison of Four-hook Needle and Memory Alloy Coil in Localization of Pulmonary Nodules / 中国肺癌杂志

BACKGROUND@#With the extensive development of minimally invasive surgery for pulmonary nodules, preoperative localization becomes more and more critical. There are some defects in traditional localization methods, so it is necessary to improve. The aim of this study was to compare and analyze the safety and effectiveness of two new methods, namely four-hook needle and memory alloy coil, in the localization of pulmonary nodules.@*METHODS@#A retrospective analysis of 152 patients was performed. 76 cases were in four-hook needle group, and 76 cases were in memory alloy coil group. Pulmonary nodules were located before operation, and then video-assisted wedge resection was performed. The average procedure time, localization complications and nodule resection time were counted.@*RESULTS@#The target pulmonary nodules were successfully removed in both groups. In four-hook needle group, 76 patients found localization devices, all the pulmonary nodules were successfully removed, and one case was transferred to open the chest for wedge resection of pulmonary nodules due to severe thoracic adhesion. All 76 patients in memory alloy coil group were successfully resected with pulmonary nodules, and one patient underwent compromising enlarged resection because no lesion was found after the specimen was removed during the operation. There was no significant difference in the incidence of pneumothorax and pulmonary hemorrhage, the success rate of localization and nodule wedge resection time between the two groups. The average time of localization in four-hook needle group was (13.66±3.11) min, lower than that of memory alloy coil group (15.51±3.65) min, and the difference was statistically significant (P=0.001). In memory alloy coil group, when the distance from the nodule to the pleura was ≥1.5 cm and <1.5 cm, the average localization time was (17.20±4.46) min and (14.91±3.15) min, respectively, and there was a statistical difference between the two distance (P=0.044).@*CONCLUSIONS@#Four-hook needle and memory alloy coil have good safety and effectiveness, and the localization time of four-hook needle is shorter. When using memory alloy coil, the effect of the method is better for pulmonary nodules with a distance less than 1.5 cm to pleura.

Multiple papillary adenomas (PA) coexisting with clear cell renal cell carcinoma (CCRCC):a case report / 复旦学报（医学版）

Papillary adenoma (PA) of kidney is defined as a lesion measuring less than 15 mm and featuring papillary or tubular architecture along with nuclei of low grade.Clear cell renal cell carcinoma (CCRCC) is the most common seen group of malignant neoplasms consists of cells with clear or eosinophilic cytoplasm.The coexistence of these two kinds of tumor is rare and was only reported in one piece of literature to date.We report a thought-provoking case in which CCRCC is coexisting with multiple PAs.The CCRCC shows no difference with other common cases while the PAs share the same clinical and pathological features with other ones and demonstrates no amplifying of 3,7 or 17 chromosome.However,the multiple PAs were neglected by imaging doctors and surgeons,and some tiny lesions were not found until the observation under microscope.This case reminds that patients accepting partial nephrectomy for CCRCC may have PAs,so attention should be paid to the image studies along with routine pathological examination of kidney for that there may exists two or more kinds of lesions.

Investigation of the outpatient and emergency diagnostic information standardization of a tertiary hospital / 中华医院管理杂志

Objective To investigate the status and present problems of standardization of outpatient and emergency diagnosis information of a hospital, and discuss the room of improvement. Methods The outpatient and emergency diagnosis information of a tertiary hospital was retrieved, and the data were inspected using tracking method over the whole process from diagnostic information input to data maintenance, for analysis of causes of the nonstandard diagnosis. Results The standard rate of the outpatient and emergency diagnosis of the hospital was 51. 07％ (15278/29915). Statistics by the departments visited found the traditional Chinese medicine department with the most nonstandard diagnosis;that by diagnosis names found the most nonstandard diagnosis in such common diseases as hypertension and diabetes. These nonstandard diagnosis may be contributed mainly to the system, the standard dictionary, the doctor and the imperfect maintenance mechanism. Conclusions It is suggested to improve the system maintenance mechanism, streamline the maintenance process, and train the doctors in dictionary use and input, to improve the outpatient and emergency diagnostic information standardization.

Analysis of Percutaneous Biopsy of 41 Small Lung Lesions / 中国肺癌杂志

BACKGROUND@#When lung cancer screening work extensively developed in recent years, more and more small lung lesions were found in clinic. The aim of this study is to analysis computed tomography (CT) guided percutaneous biopsy for lung small lesions (diameter<2 cm) on results, complications and prognosis.@*METHODS@#Choose CT guided percutaneous lung biopsy were performed in 41 cases of pulmonary peripheral lesions, single lesion in 39 cases, multiple lesions in 2 cases, 5-20 (13.1±5.2) mm in maximum diameter, depth from lung surface 1-45 (16.5±13.7) mm, ground-glass opacity (GGO) components 0%-100% (66.8%±35.2%).@*RESULTS@#41 patients and 43 biopsies successfully obtained pathological tissue. Atypical adenomatous hyperplasia in 3 cases, squamous carcinoma in 1 case, adenocarcinoma in 37 cases( carcinoma in situ in 7 cases, micro-invasive carcinoma in 5 cases, invasive adenocarcinoma in 25 cases, double primary lung cancer in 2 cases), inflammatory lesions in 2 cases. Except 2 cases of inflammatory lesions are in follow-up, biopsy and surgical pathology alignment (specificity) was 100%. 41 patients occurred complications related to percutaneous biopsy. Pneumothorax were in 22 cases, drainage required in 2 cases. There were 17 cases with hemoptysis, accounting for 39.5% incidence are self-limited. Intracranial air embolism occurred in 2 cases by 4.6% incidence. They were fully recovered.@*CONCLUSIONS@#For small lung lesions, CT guided percutaneous biopsy is technically feasible. However, for small lung lesions especially pure GGO biopsy, it is still need to be cautious.

Clinical application of thulium laser in thoracoscopic resection of pulmonary nodules / 中华胸心血管外科杂志

Objective The aim of the present study was to evaluate the clinical application of 2 μm thulium laser in pulmonary nodules resection under VATS.Methods 61 patients,undergoing thoracoscopic resection of pulmonary nodules in thoracic department of Xuanwu Hospital,were identified between January and December of 2016.Of those,30 underwent 2μm thulium laser dissection and 31 were treated with standard technique by using staplers.In terms of clinical characteristics,including gender,age and smoking history,there is no significant difference between the laser group and the stapler group,but the lesion size was slightly larger in the stapler group compared with the laser group.The lesions of the two groups were almost evenly distributed on the five lobes.Results All the procedures were performed successfully under VATS.The intraoperative evaluation of air leaks demonstrated that less than or equal to 2 grade air leaks were observed in 28 cases in the laser group and in 30 cases in the stapler group.Grade 3 air leaks requiring a rescue treatment were observed in 2 cases in the laser group and in 1 case in the stapler group.There were no significant differences in the postoperative hospital stay and total hospital stay between two groups.Chest tube duration was lower in the laser group compared with the stapler group even if it was not statistically significant (2.71 vs 3.55 days).Hospitalization costs was significantly lower for the laser group.Conclusion The use of 2um thulium laser to prevent intra-and postoperative air leaks and bleeding is effective and makes patients recover quickly,which allows a minimally invasive,accurate and safe application during thoracoscopic resection of pulmonary nodules.

Expressions of interleukin-11 and interleukin-11 receptorαin non-small cell lung cancer cell lines and their clinical significances / 肿瘤研究与临床

Objective To detect the expressions of interleukin-11 (IL-11) and interleukin-11 receptorα(IL-11Rα) in non-small cell lung cancer (NSCLC) cell lines, and explore their clinical significances. Methods The expressions of IL-11 and IL-11Rαin NSCLC cell lines A549, H2228, healthy lung small airway epithelial cell (SAEC) line cytoplasm, cell membrane and nucleus were detected by Western blot. Results The expressions of IL-11 and IL-11Rα were low in the cell membrance and nucleus (cell membrane: IL-110.04± 0.03, IL-11Rα0.05±0.03; nuclear: IL-110.45±0.19, IL-11Rα0.07±0.02;P<0.01); The expressions of IL-11 and IL-11Rα in A549 and H2228 cell lines were significantly increased compared with those of SAEC cell lines in the cell membrance and cytoplasm (P< 0.01); Among the A549 cell lines, the expressions of IL-11 and IL-11Rα in cell nucleus were much higher than those of the cell membrance and cytoplasm (P< 0.01). Among the H2228 cell lines, the expression of IL-11 in cytoplasm was the highest and the expression of IL-11Rα was the highest in the cell nucleus (P< 0.01). Conclusion The expressions of IL-11 and IL-11Rαare high in NSCLC cell lines, and it is good for the screening and early diagnosis of lung cancer by detecting the expressions of IL-11 and IL-11Rα.

Clinical study on the diagnostic value of plasma microRNAs in early stage non-small cell lung cancer / 肿瘤研究与临床

Objective To evaluate the diagnostic values of microRNAs (miRNAs) as plasma biomarkers for early diagnosis of non-small cell lung cancer (NSCLC). Methods The levels of 10 miRNAs in plasma of 59 patients with early stage (stage Ⅰ-ⅢA) NSCLC (lung cancer group) and 59 benign lesions (control group) were detected by real-time quantitative polymerase chain reaction (RT-PCR). The levels of serum cytokeratins antigen 21-1 (CYFRA21-1), carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) and other tumor markers were detected by electrochemiluminescence immunoassay (ECLIA), chemiluminescence immunoassay (CLIA) and immunoradiometric assay (IRMA). The early diagnostic value of miRNAs and other markers were evaluated by receiver-operating-characteristic (ROC) curve analysis. The sensitivity, specificity and area under the curve were calculated for the cut-off value. Results Plasma CYFRA21-1, miR-486 and miR-210 levels were significantly different in lung cancer group and control group (CYFRA21-1: 8.896±3.681 vs. 5.892±2.028, P= 0.020; miR-486:2.778±0.778 vs. 1.746±0.892, P< 0.001;miR-210: 4.836 ±1.374 vs. 2.829 ±1.503, P< 0.001). Area under ROC curve of CYFRA 21-1, miR-486 and miR-210 was 0.624 (sensitivity: 0.576, specificity: 0.797), 0.848 (sensitivity: 0.831, specificity: 0.780) and 0.751 (sensitivity: 0.746, specificity: 0.746), respectively. MiR-486, miR-210 combined with CYFRA21-1 had the highest diagnostic efficiency, and the area under the curve was 0.924 (sensitivity: 0.847, specificity:0.811), miR-486 combined with miR-210 had the highest diagnostic efficiency, and the area under the curve was 0.892 (sensitivity: 0.831, specificity: 0.780). Conclusions MiR-486 and miR-210 could be potential biomarkers for diagnosis of NSCLC. Plasma miRNAs combined with tumor markers can improve the diagnostic efficacy of early stage NSCLC.

Expression of hypoxia inducible factor 1αand glucose transporter 1 in lung adenocarcinoma and their clinical significances / 肿瘤研究与临床

Objective To investigate the expression of hypoxia inducible factor 1α (HIF-1α) and glucose transporter 1 (GLUT1) in lung adenocarcinoma and its correlation with tumor metastasis. Methods SP immunohistochemistry was used to detect GLUT1 and HIF-1α protein expression in 125 lung adenocarcinoma, including 41 cases without metastasis, 38 cases with lymphatic metastasis and 46 cases with brain metastasis. The correlation of GLUT1 and HIF-1α in lung adenocarcinoma metastasis was analyzed by using x 2 test and Pearson correlation analysis. Results Most lung adenocarcinoma were histologically heterogeneous, which contained more than one adenocarcinoma type. 73.2 % (30/41) cases were acinar predominant adenocarcinoma in lung adenocarcinoma without metastasis; 53.6 % (15/38) cases were acinar predominant adenocarcinoma and 26.3 % (10/38) cases were solid predominant adenocarcinoma in lung adenocarcinoma with lymphatic metastasis; 47.8 % (22/46) cases were papillary predominant adenocarcinoma and 34.8 % (16/46) cases were solid predominant adenocarcinoma in lung adenocarcinoma with brain metastases. The expression level of GLUT1 and HIF-1α in lung adenocarcinoma with lymphatic metastasis group was higher than that of the group without tumor metastasis (P< 0.05); the expression of GLUT1 and HIF-1α were positively correlated (r=0.407, P=0.000). Conclusions Papillary adenocarcinoma is the most histological type in lung adenocarcinoma with brain metastasis, suggesting that papillary adenocarcinoma is more prone to brain metastasis. The expression of GLUT1 and HIF-1α play an important role in lymph node metastasis and brain metastasis of lung adenocarcinoma.

Posteromedial peroneal tendon groove deepening treatment of the chronic subluxation of the peroneal tendons / 中华骨科杂志

Objective To investigate the clinical curative result of the new method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation.Methods From March 2006 to October 2012,21 patients (15 male,6 female) with chronic peroneal tendon subluxation via a novel method of postermedial deepen of the fibular groove.In this group:Ⅰ grade 5 cases;Ⅱ grade 9 cases;Ⅲ grade 5 cases;Ⅳ grade 2 cases.All patients were followed up for at least 24 months.The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score and visual analogue score (VAS) were used to evaluate the clinical outcomes.Operation time,time to heal and complications were also recorded.Results The average operation time was 50 minutes (30-70 minutes).The blood loss was 30-60 ml,average 40 ml.All incisions healed after operation,no case of incision infection,skin necrosis and sural nerve,vascular injuryed.Mean AOFAS score was significantly increased from (55.2±7.1) preoperative to (93.6±5.6) postoperative.15 patients with excellent,good for 1 cases.The excellent and good rate was 100％ (16/16).VAS score by an average of (5.3±2.1) points down to (1.2±1.1) points postperative.All the patients can wear normal shoes postoperative,waking with normal gait.No patients had peroneal tendon tenosynovitis,tendon adhesion,fracture of lateral malleolus and other serious complications,no dislocation recurrent,strength of the peroneal muscle returns to normal.Conclusion The novel method of postermedial deepen of the fibular groove in the treatment of chronic peroneal tendon subluxation was safe and effective for ankle instability with a relatively short time.

Treatment of Sanders' type Ⅲ intra-articular fracture of the calcaneus using a small dorsolateral incision / 中华创伤骨科杂志

Objective To investigate the operative treatment of Sanders' type Ⅲ displaced intra-articular fractures of the calcaneus using a small dorsolateral incision.Methods From October 2006 to April 2012,90 patients with displaced intra-articular calcaneal fracture of sanders' type Ⅲ were treated by open reduction and internal fixation through a small dorsolateral incision at our department.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.They were 69 men and 21 women,aged from 17 to 61 years (average,39 years).On the right side were 49 cases and on the left side 41 cases.According to Sander's classification,26 fractures were of type Ⅲ AB,36 of type Ⅲ AC and 28 type Ⅲ BC.The displacements of articular facet were all larger than 1 mm.The foot functions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.Results For each patient,4 to 6 calcaneal cannulated screws of 4.0 mm and 2 full threaded screws of 6.5 mm were used.No incision infection,skin necrosis or injury to the posterior tibial nerve or vessels occurred after surgery.Seventy-six patients were followed up for 10 to 56 months (average,20.5 months).Clinical union was achieved after 8 to 12 weeks (average,9.5 weeks).The lateral and axial X-ray films of the calcaneus at the last follow-up showed fine reduction and fixation of the fracture fragments and significant improvements in the length,width,height,and B(o)hler and Gissane angles of the calcaneus compared with the preoperation (P ＜ O.05).The ankle and hindfoot scored 70 to 100 AOFAS points at the last follow-up.Forty-five cases were excellent,24 good,5 fair and 2 poor (excellent to good rate of 90.8％).Follow-up observed no infection,nonunion or osteomyelitis.Conclusion Open reduction and internal fixation through a small dorsolateral incision is a good option for Sanders' type Ⅲ calcaneus fractures with a displacement of more than 1 mm,because it leads to minimal soft tissue damage,excellent exposure and convenience for later removal of internal fixators and subtalar arthrodesis.

Effectiveness of weight-bearing lateral radiographs in evaluation of ankle malunited fractures restoration / 中华骨科杂志

Objective To evaluate the significance of weight-bearing lateral radiographs in evaluation of malunited frac-tures of the ankle. Methods 17 patients with malunited fractures of the ankle were treated by different reconstructive operations be-tween March 2010 and October 2012, including 9 females and 8 males, aged from 17 to 64 years. According to the Takakura classifi-cation of ankle arthritis, there were 7 patients in grade 1, 4 in grade 2 and 6 in grade 3. Simple open reduction and internal fixation were performed in 5 patients, supramalleolar tibial osteotomy in 5, lengthening osteotomy of the fibula in 2, supramalleolar tibial and fibular osteotomy in 5. Tibiofibular clear space on the anteroposterior radiograph. Medial clear space, tibiofibular clear space and tib-iofibular overlap on ankle mortise radiographs were compared preoperatively and at last follow-up. Tibial lateral surface angle (TLS), the offset of the center of talar rotation from the tibial axis, and the displacement of tibiotalar articular surface center on weight-bear-ing lateral X-ray were also compared preoperatively and at last follow-up. AOFAS score was used to evaluate the function of the ankle. Results The duration of follow-up was 9 to 32 months. Bone healing was observed in all patients, and the average healing time was 11 to 14 weeks. Ankle joint degeneration grade had no exacerbation. The medial clear space, tibiofibular clear space and tibiofibular overlap had no significant difference between the pre and postoperative. Statistically significant change was seen postoperatively in the values of TLS (76.9°±4.1° vs 80.9°±5.2°). The offset of the center of rotation from the tibial axis and the displacement of tibiotalar articular surface center were changed from 10.8 ± 2.1 mm to 2.0 ± 0.5 mm and 4.5 ± 1.5 mm to 2.2 ± 1.0 mm, respectively. The average AOFAS score was improved from 45.7 ± 15.9 points preoperatively to 82.0 ± 9.9 points postoperatively. Conclusion Weight-bearing lateral radiographs can be used to judge the ankle restoration. Even if the mortise radiograph had relative good realignment, it may ap-pear obvious deformity on lateral radiographs. Good reduction of lateral radiographs requires that the mid axis of the tibia should pass through the center of talar rotation and tibiotalar articular surface be parallel on the lateral radiograph.

Comparison of semitendinosus tendon autograft and tendon allograft for reconstruction of the ligaments of the lateral ankle via minimally invasive method / 中华骨科杂志

Objective To study on the different results of a minimally invasive method to reconstruct the ligaments of the lateral ankle using semitendinosus tendon autograft and tendon allograft.Methods Data of 68 patients with chronic ankle instability who had undergone lateral ligament reconstruction from September 2006 to June 2011 were retrospectively analyzed.In the group of semitendinosus autograft,there were 32 patients (19 males,13 females) with an average age of 32.4 years old.Semitendinosus was harvested through 2 small knee incisions.While in the group of tendon allograft,there were 36 patients (22 males,14 females) with an average age of 34.2 years old.For the ankle reconstruction,4 small incisions of 5 mm each were made at the medial and lateral side of the fibular tip,the talar neck,and the middle of the calcaneus.Anatomical reconstruction of the anterior talofibular ligament and calcaneofibular ligament was then performed through these small incisions.AOFAS questionnaires were used to measure clinical outcomes,donor site morbidity and patients' satisfaction.Preoperative and postoperative stress tests were performed and radiographic parameters were measured.Results The average operation time of the autograft group 85.5 ± 11.5 min was significantly longer than that in the allograft group 58.1±10.2 min,but the fever days in the latter 5.5±1.5 d was significantly longer than in the former 2.5±1.2 d.In autograft group,23 patients got followed up,and the mean period of follow-up was 33.5±6.7 months.The mean AOFAS score increased from 62.3±8.2 to 95.1 ±7.5.In allograft group,26 patients got followed up,and the mean period of follow-up was 28.5±6.7 months.The mean AOFAS score increased from 60.2±8.4 to 94.8±5.5.There were 5 patients (3 of autugraft group and 2 of allograft group) with residual instability on uneven ground.One case of the autologous group had instability in daily life.No patient presented weakness or disability in the donor site.The satisfaction level of the autograft group was excellent in 16,good in 5 and bad in 2.Significant improvement in stress radiographic parameters was noted for the talar tilt angle,with reduction from a mean of 14.0° to 3.8°; anterior talar displacement reduced from a mean of 12.3 to 4.6 mm.The satisfaction level of the allograft group was excellent in 17,good in 5 and bad in 4.The talar tilt angle reduced from 13.0° to 3.6°; anterior talar displacement reduced from 11.5 to 4.3 mm.Conclusion There is no differences in efficacy could we found in using these 2 kinds of materials.The process of healing and rehabilitation of tendon autograft is slightly faster than the tendon allograft,but the allograft tendon has many advantages such as limited injury,simple procedure andavoiding of donor site morbidity.

Current medical education in UK and inspiration / 中华医学教育探索杂志

This paper discussed on current medical education situation in UK through introducing the concept,method and system.Medical education in UK takes students as the center of education,emphasizes humanistic education and cultivates medical students' eloquence,clinical skills and scientific research.Medical education in UK sheds light on how to mobilize students' subjective initiative,improve communication skills and clinical skills,which medical education in china can draw lessons from.

Surgical treatment of isolated fractures of the sustentaculum tali of calcaneus / 中华骨科杂志

Objective To evaluate the clinical results of surgical treatment of isolated fractures of the sustentaculum tali of calcaneus via medial approach.Methods The data of 23 patients with isolated fractures of the sustentaculum tali of calcaneus was retrospectively analyzed who were treated with open reduction and internal fixation with cannulated screw or Kirschner wire via medial approach from September 2006 to March 2011.There were 19 males and 4 females,with an average age of 26.3 years (range,17-41 years).Associated injuries included 4 cases of talus fracture,4 of metatarsal fracture,and 3 of cuboid fracture.The functions of hiudfoot were assessed by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores pre-operation and post-operation respectively.Results Fifteen patients got followed up with an average 20.5 months (10-56 months).Thirteen patients were rated as good,2 as excellent,and the excellent and good rate was 100％(15/15).All the fractures were stabilized reliably,and got clinical union with no obvious complications occurred.Time of fracture union was 8-10 weeks,with an average of 8.5 weeks.Three patients felt mild transient pain during the recovery of walking,but their pain disappeared quickly after physical therapy.No patients developed wound infection,nonunion and other complications.Conclusion For isolated fractures of the sustentaculum tali of caleaneus with articular surface displaced greater than 1 mm or involving the articular surface of middle subtalar joint,open reduction and internal fixation operation via medial approach under direct visualization is recommendable.

DRGs-based methodology for medical performance evaluation and case studies / 中华医院管理杂志

Authors described characteristics of medical service performance evaluation,and strategy options for scientifically evaluating such performance,and systematically presented the conditions and methodology of DRGs-based evaluation of medical service performance.Six evaluation indicators were cited in terms of the capacity,efficiency and medical safety of medical service providers,with detailed introduction to the computation process of such indicators.Cases in hand indicate that the first-page data completeness and accuracy of medical records are preconditions for using DRGs in medical service performance evaluation.

The introduction of AP-DRGs / 中华医院管理杂志

Prospective payment rates based on diagnosis related groups (DRGs)have been established as the basis of Medicare' s hospital reimbursement system.The purpose of the DRGs is to relate a hospital's case mix to the resource demands and associated costs experienced.The patient characteristics included in the definition of each DRG relate to a common organ system or etiology,and each DRG should contain patients,who are similar from a clinical perspective,with a similar pattern of resource intensity.DRGs were divided by principle diagnosis,major surgery,major complication and/or comorbidity,age,sex,birth weight etc.Using a grouping software(version 18)by DRG definitions used in the United Stated,we encoded the hospital discharge data of all secondary and senior hospitals in Beijing.After analyzing the DRG grouping,as well as rationality and weighting of these DRG groups,we concluded that it was feasible to encode Chinese data using US DRG definitions with specific adjustments accommodating to relevant conditions in China.

A study of resource consumption accounting and regulating of charge categorise / 中华医院管理杂志

Objective Beijing plans to run a DRGs-PPS pilot.Cost estimation of each DRG group needs a set of scientific reasonable standards for inpatient charge category.MethodsResource consumption accounting Classify charge item by practitioners,services,resources; medical consumables are singled out to emphasize the value of medical personnel's services; some of old categories are subdivided in order to be compatible with new categories.Results 19 old charge categories of patient discharge chart turn to 31 new items by dividing medical service into treatment,surgery,nursing,imaging,examination,management,paramedic,pharmacy,etc.ConclusionRegulating the charge categories of services,medical data is more consistent by using the same statistical coverage.Also it accurately present the incoming of all operationstreatment,surgery,nursing,imaging,examination,management,paramedic,pharmacy,etc.It gives government directions of decision-making to adjust the weight of DRG groups.

The stakeholder analysis of Beijing medical service payment system reform / 中华医院管理杂志

The medical service payment system reform is one of core issues in medical and health system reform.The payment system can directly affect behavior of stakeholders and indirectly affect medical expense,quality of care,efficiency of medical services and efficiency of medical insurance funds.Through behavior analysis of stakeholders in fee for service,DRGs-PPS,global budget,DRGs-PPS is the best payment system that can control the irrational increase of medical expenses and ensure the level of health service and meets interest of stakeholders among three payment systems.In DRGs-PPS,stakeholders continuously make progress in filling in the front sheet of medical records,clinical pathway,construction of information system,cost calculation and restructure costs.