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Objective:To analyze the impacts of the clinics-pharmacy separation reform on outpatient CT utilization and provide policy recommendations for the rational use, refined management and subsequent price adjustment for large-scale imaging equipments.Methods:The number of outpatient CT examinations of a tertiary public hospital in Beijing from January 1st, 2015 to April 30th, 2019 was collected. Data were analyzed using single-and multi-group interrupted time series analysis model(ITS), along with qualitative interviews.Results:The number of CT examinations increased by 0.216 per 100 visits after the reform( P<0.001). The trend of changes(slope)in the number of CT examinations increased by 0.012 person-times/month( P<0.001). There were no statistically significant differences in the slope change of CT examinations between patients under Urban Employee Basic Medical Insurance and those under Urban Resident Basic Medical Insurance( P=0.504). Conclusions:The reform has significantly increased the utilization of outpatient CT examinations. However, the impacts of the reform may be similar among patients covered by different insurance systems. The qualitative interviews imply it as necessary to pay attention to the overworking status of relevant practitioners and be alert to the excessive use of large-scale imaging equipments.
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Objective@#To observe the short-term clinical efficacy of wrist arthroscopy in the treatment of Palmer IB type triangular fibrocartilage complex(TFCC) injury.@*Methods@#From March 2016 to January 2017, 12 patients with Palmer IB TFCC were admitted to the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, including 5 males and 7 females, with an average age of 38.5 years.After examination and imaging examination, the diagnosis was confirmed.After full preoperative preparation, the patients underwent arthroscopic repair under wrist arthroscopy.The VAS score and modified Mayo wrist joint function score before and after surgery were tested to evaluate the clinical efficacy after 6 months.@*Results@#Twelve patients underwent successful operation and with no postoperative complications.The patients were followed up.The VAS scores before and after surgery were (4.08±0.90)points and (1.33±0.88)points, respectively, the difference was statistically significant(t=8.37, P=0.000). The modified Mayo wrist joint function scores were (48.33±7.48)points and (87.91±5.41)points before and after surgery, and the difference was statistically significant(t=12.05, P=0.000).@*Conclusion@#Arthroscopic repair of Palmer IB type TFCC has less trauma and quick recovery, and the clinical short-term result is satisfactory.
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Objective@#To explore the influence and mechanism of time effect of the controlled micromovement on fracture healing.@*Methods@#Forty-eight rabbit models of femoral fracture were prepared and fixed with unilateral two-bar external fixator. They were randomly divided into four groups: continuing immobilization group, instant micromovement group, 1-week micromovement group and 2-week micromovement group. Postoperative radiographs were taken at 1, 2, 3 and 5 weeks to observe callus growth. The maximum load, deflection and rigidity of callus at fracture end were measured 5 weeks after operation. At 1, 2 and 3 weeks after operation, the histological morphology of callus was observed, and the expression and distribution of osteocalcin (oc) in callus were detected.@*Results@#At 5 weeks after operation, the X-ray scores of fracture line in 1-week micromovement group and 2-week micromovement group were 10.384±0.744 mm, 10.412±0.482 mm, significantly higher than those in continuing immobilization group (7.518±0.536). The anteroposterior diameter and the exterior and interior diameter of the external callus in 1-week micromovement group and 2-week micromovement group were 14.3±3.2 mm, 14.0±2.8 mm and 14.6±2.1 mm, 15.2±3.1 mm, which were smaller than those in the continuing immobilization group 15.3±2.3 mm and 16.7±1.9 mm, but there was no significant difference. The bone mineral density value and proportion rate in the fracture site were 0.446±0.020 g/cm2, 0.416±0.021 g/cm2 and 1.171%±0.056%, 1.143%±0.040% in 1-week micromovement group and 2-week micromovement group, which were significantly higher than those in continuing immobilization group which were 0.376±0.022 g/cm2 and 0.912%±0.051%. The maximum load of callus in 1-week micromovement group and 2-week micromovement group was 415.6±27.2 N, 400.3±28.5 N, which was significantly higher than that in continuing immobilization group 329.2±18.4 N and instant micromovement group 272.8±22.7 N. There was no difference of the deflection of callus between groups. The rigidity of callus in 1-week micromovement group was 590.4±24.2 N/mm, which was significantly higher than that in other groups; the rigidity of callus in the 2-week micromovement group was 540.6±22.8 N/mm, which was significantly higher than those in the instant micromovement group and the continuing immobilization group (152.4±21.7 N/mm, 174.8±20.6 N/mm).@*Conclusion@#Micromovement begins from one or two weeks can significantly raise external callus formation and vagueness level of fracture line, accelerating bridging callus formation, and can significantly raise bone mineral density and rigidity of callus. It also accelerates the maturity, hypertrophy and mineralization of chondrocyte, resulting in the stimulation of the fracture healing through endochondral ossification; it seemingly can improve the amount and density of osteoclasts in callus to stimulate the maturity and mineralization of chondrocyte. The strengthening coupling of osteoblasts and osteoclasts can promote the transformation from soft callus to hard callus and the remolding of hard callus.
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Objective To observe the short-term clinical efficacy of wrist arthroscopy in the treatment of Palmer ⅠB type triangular fibrocartilage complex ( TFCC) injury.Methods From March 2016 to January 2017, 12 patients with Palmer ⅠB TFCC were admitted to the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine,including 5 males and 7 females,with an average age of 38.5 years.After examination and imaging exami-nation,the diagnosis was confirmed.After full preoperative preparation , the patients underwent arthroscopic repair under wrist arthroscopy.The VAS score and modified Mayo wrist joint function score before and after surgery were tested to evaluate the clinical efficacy after 6 months.Results Twelve patients underwent successful operation and with no postoperative complications.The patients were followed up.The VAS scores before and after surgery were (4.08 ±0.90)points and (1.33 ±0.88)points,respectively,the difference was statistically significant (t＝8.37,P＝0.000).The modified Mayo wrist joint function scores were (48.33 ±7.48)points and (87.91 ±5.41)points before and after surgery,and the difference was statistically significant ( t＝12.05,P＝0.000).Conclusion Arthroscopic repair of Palmer Ⅰb type TFCC has less trauma and quick recovery ,and the clinical short-term result is satisfactory.
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Objective To evaluate if mucinous subtype has a relevant impact on disease-free survival (DFS) of patients with rectal carcinoma.Methods The clinicopathological data of patients with rectal adenocarcinomas (ring cell carcinoma were excluded)undergoing radical surgery at Beijing Cancer Hospital from Jan 2010 to Jan 2012 were retrospectively studied,survival analysis was done to detect potential prognostic predictors.Results 353 patients with stage Ⅰ-Ⅲ rectal cancer were included in this study,of whom 28 (7.9％) had mucinous histology.The 3-year DFS for patients with a mucinous adenocarcinoma was 50.0％ and 83.4％ for patients with nonmucinous adenocarcinoma (P ＜ 0.001).Mucinous adenocarcinoma was associated with advanced pathologic T (T3/4,100％ vs 52.3％,P ＜0.001) and N stage (N1/2,64.3％ vs.32.6％,P =0.001).More patients were diagnosed under 40 years in mucinous adenocarcinoma group (21.4％ vs.5.5％,P =0.005).Conclusions Patients with mucinous adenocarcinoma more often present at a younger age,mucinous adenocarcinomas are associated with more advanced tumor stages,and should be regarded as a dismal prognostic factor for the survival of patients with rectal cancer.