Evaluation of the impact of clinical pathway on medical efficiency and medical expenses of patients with two rheumatoid immune disease based on DRG data / 中国医师杂志

Objective:To evaluate the effect of clinical pathway implementation on medical efficiency and medical expenses of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" diseases by using diagnosis related group (DRG) related indicators.Methods:The data of patients with two common rheumatic immune diseases " rheumatoid arthritis" and " ankylosing spondylitis" included in the clinical pathway management from January 2017 to December 2019 in the Department of Rheumatology and Immunology of Jinhua Hospital, Zhejiang University School of Medicine were carried out. The impact of clinical pathway implementation on the average hospital stay, average cost and average drug cost of patients with the two diseases were analyzed and compared , so as to evaluate the effect of the implementation of the clinical pathway.Results:From the implementation of clinical pathway in 2017 to 2019, the number of patients admitted and total medical specialty services in the two groups of " rheumatoid arthritis" and " ankylosing spondylitis" increased year by year ( P<0.01). The average length of stay, average cost and average drug cost of patients in the " rheumatoid arthritis" disease group decreased year by year, with statistically significant differences between groups (all P<0.01). The average length of stay in the ankylosing spondylitis group was shortened year by year, and the difference was statistically significant ( P<0.01). Compared with 2017, the average cost in 2018 decreased significantly, and the difference was statistically significant ( P<0.01). There was no significant difference in average cost between 2018 and 2019 ( P>0.05). The average cost in 2018 was significantly higher than that in 2017 ( P<0.05). After analyzing the causes and optimizing the clinical pathway, the average cost in 2019 was significantly lower than that in 2018 ( P<0.01). Conclusions:Through the implementation of clinical pathways and continuous optimization of pathway connotation during use, the diagnosis and treatment efficiency of patients with " rheumatoid arthritis" and " ankylosing spondylitis" can be significantly improved, and medical costs can be reduced, which is in line with the current medical reform needs.

Complex glycerol kinase deficiency: two case report and literature review / 临床儿科杂志

Objective To explore the clinical and genetic characteristics of complex glycerol kinase deficiency (GKD). Methods The clinical data of 2 cases of complex GKD were analyzed and the related literatures were reviewed. Results Both cases were male onset in neonatal period, and had hypocorticalism (hyponatremia, hyperkalemia, dehydration), hypercreatine kinasemia, and pseudotriglyceridemia. Gene detection suggested that there was gene deletion in chromosome Xp21 region. In the follow-up, one case had good control of the disease and one died of infection. Conclusions Complex GKD is an X-linked recessive hereditary disease. It is rare and complicated, and is easily misdiagnosed. Early diagnosis and treatment are beneficial to improve the prognosis.

Design of portable integrated remote medical examination chest / 医疗卫生装备

Objective To design a portable integrated remote medical examination chest for telemedicine of the servicemen in remote areas.Methods The chest involved in a portable multi-parameter vital signs monitor,a 12-lead network ECG machine,an optical endoscope,an electrostethophone and etc,and applied medical information technology,biosensor technology,IOT,cloud technology and etc.The terminals for diagnosis and treatment,doctor as well as data uploading were developed,and the network storage,control and interaction of multi-type data were realized for the terminals.Results The chest implemented inter-connection and inter-communication between the elementary medical facilities and rear hospitals,and thus facilitated the telemedicine service for the troops in remote areas.Conclusion The chest executes integrated medical service of the central hospital and troops in remote areas,and thus is worthy promoting in the telemedicine system of the PLA.

Calycosin activates the protein kinase c/NF-E2-related factor 2 pathway to attenuate the oxidative stress and apopotosis induced by streptozotocin in RIN-m5F cell / 中国医师进修杂志

Objective To study the effects and mechanism of calycosin on oxidative stress andβ-cell apoptosis induced by streptozotocin (STZ). Methods RIN-m5F cells were divided into 5 groups:control group, STZ group, STZⅠgroup, STZⅡgroup and STZⅢgroup. The control group did not receive any treatment, while streptozotocin was added to the final concentration of 10 mmol/L in STZ group, STZⅠgroup, STZⅡgroup and STZⅢgroup. After the incubation with STZ for 6 h, calycosin was added to a final concentration of 10, 50 and 100 μmol/L in STZⅠgroup, STZⅡgroup and STZⅢgroup respectively. The cell viability and apoptosis was detected by CCK-8, LDH, caspase 3 and Tunel assay. The intracellular oxidative stress was measured using mitochondrial membrane potential, DCFH-DA, SOD activity and malondialdehyde levels assay. RIN-m5F cells were divided into control group, calycosinⅠgroup, calycosinⅡgroup and calycosinⅢgroup, which were treated with different concentrations (0,10, 50 and 100 μmol/L, respectively) of calycosin. The expression of NF-E2-related factor 2(Nrf2) in RIN- m5F cells was detected by Western blot. The translocation of Nrf2 was detected by immunofluorescence. In RIN-m5F cells were divided intoⅢgroup andⅣgroup,Ⅳgroup was pre-treated with protein kinase C(PKC) inhibitor. The effects of calycosin on Nrf2 translocation, oxidative stress and apoptosis were also observed. Results STZ could induce the accumulation of reactive oxygen species and apoptosis in RIN-m5F cells. Calycosin did not affect normal RIN-m5F cells, whereas it reduced the oxidative stress and apoptosis induced by STZ in a dose-dependent manner. The expression of Nrf2 in RIN-m5F cells was not affected by calycosin, whereas it promoted the translocation of Nrf2 into nucleus. The ability of calycosin promoting Nrf2 translocation was decreased after PKC inhibitor treatment, and PKC inhibitor could also significantly attenuate the anti-oxidant and anti-apoptotic ability of calycosin. Conclusions This study shows that calycosin may play an anti-oxidative and anti-apoptotic role by activating PKC to promote Nrf2 translocation, which is expected to be used as a new clinical drug for the prevention and treatment of diabetes mellitus.

Calycosin activates the protein kinase c/NF-E2-related factor 2 pathway to attenuate the oxidative stress and apopotosis induced by streptozotocin in RIN-m5F cell / 中国医师进修杂志

Objective To study the effects and mechanism of calycosin on oxidative stress andβ-cell apoptosis induced by streptozotocin (STZ). Methods RIN-m5F cells were divided into 5 groups:control group, STZ group, STZⅠgroup, STZⅡgroup and STZⅢgroup. The control group did not receive any treatment, while streptozotocin was added to the final concentration of 10 mmol/L in STZ group, STZⅠgroup, STZⅡgroup and STZⅢgroup. After the incubation with STZ for 6 h, calycosin was added to a final concentration of 10, 50 and 100 μmol/L in STZⅠgroup, STZⅡgroup and STZⅢgroup respectively. The cell viability and apoptosis was detected by CCK-8, LDH, caspase 3 and Tunel assay. The intracellular oxidative stress was measured using mitochondrial membrane potential, DCFH-DA, SOD activity and malondialdehyde levels assay. RIN-m5F cells were divided into control group, calycosinⅠgroup, calycosinⅡgroup and calycosinⅢgroup, which were treated with different concentrations (0,10, 50 and 100 μmol/L, respectively) of calycosin. The expression of NF-E2-related factor 2(Nrf2) in RIN- m5F cells was detected by Western blot. The translocation of Nrf2 was detected by immunofluorescence. In RIN-m5F cells were divided intoⅢgroup andⅣgroup,Ⅳgroup was pre-treated with protein kinase C(PKC) inhibitor. The effects of calycosin on Nrf2 translocation, oxidative stress and apoptosis were also observed. Results STZ could induce the accumulation of reactive oxygen species and apoptosis in RIN-m5F cells. Calycosin did not affect normal RIN-m5F cells, whereas it reduced the oxidative stress and apoptosis induced by STZ in a dose-dependent manner. The expression of Nrf2 in RIN-m5F cells was not affected by calycosin, whereas it promoted the translocation of Nrf2 into nucleus. The ability of calycosin promoting Nrf2 translocation was decreased after PKC inhibitor treatment, and PKC inhibitor could also significantly attenuate the anti-oxidant and anti-apoptotic ability of calycosin. Conclusions This study shows that calycosin may play an anti-oxidative and anti-apoptotic role by activating PKC to promote Nrf2 translocation, which is expected to be used as a new clinical drug for the prevention and treatment of diabetes mellitus.

Clinical Observation of Chaihu Shugan Powder Combined with Clonazepam in the Treatment of Liver Qi Stagnation Type Anxiety / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of Chaihu shugan powder combined with clonazepam in the treatment of liver qi stagnation type anxiety. METHODS:96 patients with liver qi stagnation type anxiety were randomly divided in-to observation group and control group,with 48 cases in each group. Control group was given Clonazepam tablet with initial dose of 0.5 mg,increasing to 4.0 mg gradually,tid;observation group was additionally given Chaihu shugan powder 300 ml,bid,on the basis of control group. Both groups were treated for 6 weeks. Clinical efficacy of 2 groups were observed,and HAMA and SAS were observed before and after treatment;the incidence of ADR were compared between 2 groups. RESULTS:The total effective rate of observation group(97.92%)was significantly higher than that of control group(83.33%),with statistical significance(P0.05);HAMA and SAS of 2 groups decreased significantly 1,3 and 6 weeks after treatment,and the observation group was lower than the control group, with statistical significance(P0.05). CONCLUSIONS:Chaihu shugan powder combined with clonazepam is effective,improve patient anxiety and safe in the treatment of liver qi stagnation type anxiety.

Clinical research advances for pacing in interatrial septum / 心血管康复医学杂志

Cardiac pacing site has an important impact on the activation sequence and systolic synchrony of heart , which is an important factor determining clinical effect of cardiac pacing .Along with expanding and use of active fixed electrode in clinic ,especially adjustable bending delivery sheath ,it makes right atrial pacing of non -tradition‐al site possible .But whether changing atrial pacing site can reduce atrial fibrillation load after pacemaker implanta‐tion is still controversial .Now the present article made a simple review about research progress of interatrial septum pacing .

Clustering analysis of anti-nuclear antibodies in systemic lupus erythematosus / 中华检验医学杂志

Objective To examine clusters of anti-nuclear antibodies (ANA) and their associations with clinical features in patients with systemic lupus erythematosus (SLE).Methods It was a retrospective study.113 SLE patients were reviewed from March 2010 to May 2012 in Department of Rheumatology,Jinhua Central Hospital.ANA and specific autoantibodies to 15 kinds of nuclear antigens were tested by indirect immunofluorescence assay (IIF) and line immunoassay (LIA) respectively.Hierarchical clustering method was performed to analyze specific clusters of ANA profiles in SLE.Chi-square tests were used to investigate relationship between antibody clusters and clinical features of SLE.Results The positive rate of LIA for ANA was 97.3％,consistent with IIF method,and the total accordance rate of the both methods was 98.2％.Thirteen kinds of antigen-specific antibodies were detected in SLE patients by LIA.Clustering analysis for these antibodies showed three specific clusters in SLE,Nuc/His/dsDNA cluster (C1),low-Ro/low-La cluster (C2),and Ro/Sm/RNP cluster (C3),accounting for 36.3％,24.8％,38.9％ of the total cases respectively.There were significant difference of AST levels among three clusters [(32.62 ± 21.92)U/L,(25.56 ± 16.63) U/L,(50.41 ± 60.86) U/L respectively for C1,C2 and C3].High incidences of chronic cutaneous lupus,abnormal renal indicators and inflammatory synovitis were found in all three clusters.Besides,there were significant differences among three clusters for the incidences of chronic cutaneous lupus (39.0％,39.3％,63.6％ respectively for C1,C2,C3) and leukopenia/lymphopenia (56.1％,25.0％,56.8％ respectively for C1,C2,C3) (P ＜ 0.05).Patients in Ro/Sm/RNP cluster showed higher incidences of lupus nephritis (43.2％/26.8％ or 39.3％); patients in low-Ro/low-La cluster showed low risk of hypertension (7.1％/19.5％ or 22.7％) ; patients in Nuc/His/dsDNA cluster showed high incidences of thrombocytopenia (41.5％/21.4％ or 25.0％) and high risk of lung or upper respiratory tract infection (46.3％/28.6％ or 29.5％),but low incidence of neurologic symptoms (0％/ 3.6％ ％ or 11.4％).Conclusion Three characterized ANA clusters are identified in SLE patients in this pilot study.Different clusters are associated with certain clinical features and complications ofSLE.However,the correlations found in this study need to be investigated further in larger populations.

Glycemic and blood pressure control in older patients with hypertension and diabetes: association with carotid atherosclerosis / 老年心脏病学杂志（英文版）

Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp)control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic vs. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure: tight control, 140 mmHg, and by their hemoglobin Alc (HbAlc) level: tight control, 7.5%, respectively. Results The mean CIMT was 8.20±0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥ 1.1 mm). The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ± 0.08 mm, and 8.60±0.12 nun, respectively, P = 0.03) but not between glycemic control categories (8.20 ± 0.10 ram, 8.1 ± 0.08 mm, and 8.40 ± 0.14 mm, respectively, P = 0.13) using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR = 1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1.17, 95% confidence interval (CI)1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.

Bile acids enhance proliferation and motility of hepatic stellate cell through regulation of p38/JNK signaling / 临床儿科杂志

Objective Bile acids (BA) facilitate cholesterol hepatic fibrosis. Although hepatic stellate cell (HSC) is one of the moot important cells during liver fibrogenesis, the effect of bile acids on HSC is rarely mentioned. Therefore,bile acids facilitate liver fibrosis through regulating activated HSC should be tested. Methods The amount of BrdU incor-poration was determined to assess the proliferation of HSC treated by bile acid. Wound-healing assay was used to determine the cellular motility. Meanwhile, the phoophorylation of p38 and JNK in HSC was detected by Western blotting. Results50 μmol/L GCDCA enhanced the HSC proliferation significantly (152.0% ± 7.1%, P < 0.05); 50 μmol/L GCDCA also induced phoophorylation of p38 and JNK (450.0% ± 12.2% of control in p38 (P < 0.01 ), 210.0% ± 15.2 % of control in JNK (P<0.05)). 50 μmol/L GCDCA aided wound healing (remaining wound area is 75.4% + 5.8% of original area, P<0.05), but this effect was inhibited by JNK (SP600125) or p38 (SB294002) inhibitor, respectively. Conclusions Bile acids enhance HSC proliferation and facilitate cellular motility through inducing phosphorylation of p38 and JNK, indicating bile acid aid liver fibrosis through regulation of p38 and JNK signaling.

The effect of TNF-α in intracellular Ca2+-overload associated cardiac dysfunction / 临床儿科杂志

Objective To explore the effect of TNF-α in intracellular Ca~(2+)-overload associated myocardial injury. Methods Thirty Wistar rats were randomly divided into three groups:control group,Ca~(2+)+-paradox group,and pentoxifylline treatment group. The intracellular Ca~(2+)-overload rat model was established by pre-filling the rats with Langendorff for 20 minutes,isolated rat hearts subjected to Ca~(2+)-depletion for 5 minutes and Ca~(2+)-repletion for 30 minites(Ca~(2+)-paradox). Changes in hemodynamics indexes were monitored continuously. TNF-α in cardiac tissues was tested by ELISA method,and nuclear factor-κB(NF-κB)in cardiac tissues was detected with Western blot. Results Dramatic depression in left ventricle contraction function was found in the Ca~(2+)-paradox hearts:significant decrease in left ventricular diastolic pressure(LVDP),markedly elevated left ventricular end diastolic pressure(LVEDP),decreased dP/dt ratio,increased TNF-α content,decreased cytosolic/homogenate NF-κB ratio. All these changes in Ca~(2+)-paradox group were significantly attenuated upon the treatment with 100 μmol/L pentoxifylline. Conclusions Activation of NF-κB and increased production of TNF-α may play important roles in cardiac injury associated with intracellular Ca~(2+)-overload.

Effect of oxidized low-density lipoprotein on endothelium-dependent relaxation in hyperlipidemic patients / 吉林大学学报(医学版)

Objective To study the effecet of oxidized low-density lipoprotein(Ox-LDL) on endothelium-dependent relaxation and mechanism of susceptibility to atherosclerosis(AS) in hyperlipdemic male patients.(Methods)LDL isolated from 13 normal patients and 29 hyperlipidemic patients were modified by CuSO_4.The amount of malondialdehyde(MDA) was measured by TBARS.The amount of lysophosphatidylcholine(LPC) was determined by the Bartlett.Endothelium-dependent relaxation was produced by acetylcholine.Results After LDL from normal and hyperlipidemic patients were modified by CuSO_4,the amount of MDA was increased(P

Pathologicd characteristics of osteoarthritis secondary to acetabular dysplasia and the short-term effects of total hip replacement / 中国矫形外科杂志

[Objective]To summarize the experiences of total hip replacement with cementless joint components in the treatment of osteoarthritis secondary to acetabular dysplasia in adults and to evaluate its early effect. [Method]From March 2000 to March 2007, thirty hips in 25 adult patients with osteoarthritis secondary to acetabular dysplasia undergoing total hip replacement with cementless joint components were included in this study. Of the patients, 5 were male and 20 were female.Their ages ranged from 35 to 55 years with an average age of 55 years. The patients mainly complained of pain and claudication. According to the Hartofilakidis classification , Semi-dislocation occurred in 21 hips and high-dislocation in 9 hips.Five patients underwent bilateral total hip replacements and twenty patients had unilateral total hip replacement.[Result]The duration of follow-up ranged from 8 months to 7 years ( average 3 years and 9 months ) . The average Harris score was increased from 36.09 to 88.21 points, They could take care of themselves and returned to their previous job. All the patients were pain-free and there was no sign of aseptic looseing or subsidence.[Conclusion]Total hip replacement with cementless joint components is an effective method for the treatment of osteoarthritis secondray to acetabular dysplasia in adults.The key point to the success for operation are appropriate cementless joint components, deepened medial wall of the acetabulum and improved the techniques of bone graft in the true acetabulum.

Implementation of sector imaging mode with high signal-to-noise ratio in the high frame rate ultrasonic imaging system / 生物医学工程学杂志

The high frame rate (HFR) ultrasonic imaging system, which is developed with limited diffraction beams, constructs images at a high frame rate. However the rectangular imaging area, to some extent, restricts the far field imaging information. At the same time, because of one transmission for constructing image, the system suffers from low SNR. In this paper we present a computationally efficient method to construct sector mode image and to increase the SNR in HFR system. The method uses Golay complementary sequence as excitation to realize two transmission events. Each event simultaneously transmits two plane waves with different transmission angle. Then the received echo signals related to different angle are separated according to orthogonality of Golay complementary sequence and used to construct two images of different area by HFR method. Finally the two images are synthesized to one frame of sector mode image.

Fungal Infection among Patients with Maintenance Hemodialysis:A Clinical Analysis / 中华医院感染学杂志

OBJECTIVE To investigate the risk factors,characteristics,measures of prevention and treatment of hospital fungal infection among maintenance hemodialysis patients.METHODS Clinical data of 128 maintenance hemodialysis patients between Jan 2002 and Dec 2006 were enrolled in this retrospective study of hospitalized infection cases.RESULTS During above period,36 infection episodes of 27 cases were occurred.The major infection site was lungs(69.4%).the Candida albicans was the main pathogen species(61.1%).The underlying and complicating diseases such as diabetes,chronic obstructive pulmonary disease and tumor,long antibiotics using,long hospitalization,poor nutrition status,inadequate hemodialysis,and venous indwelling catheter were the risk factors which led to fungal infection among maintenance hemodialysis patients.CONCLUSIONS The maintenance hemodialysis patients are easy to induce fungal infection.The C.albicans is the main pathogen species.The incidence of underlying diseases is rather high.Treatment of original diseases and complicating diseases,the standard using of antibiotics,adequate hemodialysis,the nutrition status and the reduction of the indwelling time of venous catheter are all the keys to decrease the fungal infection.