Objective:Taking a tertiary public hospital in Tianjin as an example,to sort out the internal mechanism of the influence of the total budget management mode of regional points method on medical expenses,and to deeply study the effect of the adaptive management measures to be taken by medical institutions on cost control under the background of reform.It provides references for optimizing hospital management measures and development path.Methods:Based on CIMO framework,the overall situation of total budget management policy of regional points method in Tianjin was analyzed,and the system structure of the impact of reform on medical cost control in public hospitals was presented.Based on the system dynamics theory,the SD model of public hospital cost control under the method of regional points was further constructed.Different management measures were selected as targets and interventions were carried out to quantitatively study the control situation and development trend of medical expenses in medical institutions.Results:After targeted intervention,cost accounting,performance assessment,information construction,path standardization and medical record quality control,the decreasing trend of the amount of medical expenses and the actual burden of patients was strengthened to a certain extent,and the influence on the latter was stronger.Among them,information construction,path specification,cost accounting has a greater impact.Conclusions:Strengthen the consensus and cooperation of multi-department management,innovate the work flow and timely data feedback analysis,and adjust the performance management plan of medical staff according to the related indicators of medical insurance.

Objective To investigate the clinicopathologic features and clinical significance in mismatch repair (MMR) of deficient endometrial carcinoma. Methods A total of 108 endometrial carcinoma cases younger than 50 years of age who were underwent routine laparotomy in our hospital were included in this study. Immunohistochemistry staining was used for 4 MMR proteins (MLH1, MSH2, MSH6 and PMS2). Patients were divided into two groups (MMR deficiency group and MMR normal group) based on the results of immunohistochemistry staining. Results Thirty-three percent of cases (36 patients) showed at least one deletion of MMR protein expression. The clinicopathological features of 36 cases with deletion of MMR protein expression were analyzed. The 31% showed deep myometrium invasion and 25% were with intense lymphocyte infiltration around tumor cells. Thirty-five percent of endometrial carcinomas associated with mucinous, clear cell or other differentiations, and 14% with heterogeneity. Background endometrium of majority of the cases displayed proliferative endometrium. There were 20% cases complicated with ovarian carcinoma. Features included deep myometrium invasion, lymphocyte infiltration around tumor cells, multiple differentiations and complicated with ovarian carcinoma. There were significant differences in background endometrium between endometrial carcinoma combined with ovarian cancer group and control group. Conclusion MMR deficient endometrial carcinoma has characteristic features, which are different from both type I and type II endometrial carcinoma.

Objective To evaluate the efficacy of epidural analgesia in latent phase of labor for preeclamptic women undergoing vaginal delivery.Methods A prospective study was conducted on 80 nulliparae of singleton pregnancy with preeclampsia and cephalic presentation in Tianjin Central Hospital of Gynecology Obstetrics from August 2016 to July 2017.All subjects were randomly divided into two groups including labor analgesia in active phase group (labor analgesia was commenced at cervical dilation over ≥ 4 cm,n=40,group 1) and the whole labor analgesia in latent phase group (labor analgesia was comenced at the onset of labor,n=40,group 2).Visual analogue score (VAS) was used to evaluate pain intensity at different time points.Maternal venous blood samples were collected at the time of parturient and fetal delivery to determine the serum concentrations of cortisol (Cor) and adrenocorticotropic hormone (ACTH) by enzyme-linked immunosorbent assay (ELISA).Clinical data was statistically analyzed using t-test or Chisquare test.Results (1) Compared with group 1,the duration of the first stage of labor [(521.3±103.5) vs (570.3 ±116.2) min,t=0.366,P＜0.05],the VAS scores immediately after analgesic administration and at cervical dilation of 2 and 3 cm [4.1±1.1 vs 7.3±1.2,3.5±0.9 vs 7.6±1.7,3.7±0.7 vs 8.1±1.4;t=4.387,9.652,5.321;all P＜0.05],the mean arterial pressure at cervical dilation of 2 and 3 cm [(98.3±9.1) vs (125.3±10.6) mmHg (1 mmHg=0.133 kPa),(98.6±10.4) vs (127.5±9.6) mmHg;t=8.014,5.496;both P＜0.05] and the cesarean delivery rate [15.0％ (6/40) vs 27.5％ (11/40),x2=4.012,P＜0.05] were all lower in group 2.(2) The serum levels of Cor [(565±76) vs (231 ±64) nmol/L,(457±79) vs (233±55) nmol/L;t=6.028,5.126;both P＜0.05] and ACTH [(81 ± 14) vs (38±11) pg/ml,(71 ± 16) vs (39±10) pg/ml,t=5.984,6.028;both P＜0.05]in group 1 and group 2 were both increased significantly after delivery as compared with those at the time of parturient,and they also showed significant differences between the two groups after delivery (t=5.009,3.862;both P＜0.05).Conclusions Epidural analgesia in latent phase of labor can be implemented in preeclamptic women attempting vaginal delivery through alleviating labor pain as sooner and earlier as possible,reducing their stress responses and maintain hemodynamic stability.

Objective:To summarize the clinical characteristics and treatment effect of patients with acute oral 84 disinfectant poisoning, so as to improve the understanding, diagnosis and treatment of the disease.Methods:In January 2022, 25 hospitalized patients with acute oral 84 disinfectant poisoning admitted to our department from March 2016 to August 2021 were selected as the research objects, and their general conditions, poisoning reasons, poisoning time, dose of poisoning, clinical manifestations, blood routine and biochemical indicators, diagnosis, treatment and prognosis were selected.Results:A retrospective analysis was performed. Among the 25 patients, there were 4 males and 21 females, aged from 20 to 91 years, and M ( Q1, Q3) was 38.7 (27, 46) years; The poisoning time (from exposure to poison to treatment) was 1~72 h, and M ( Q1, Q3) was 10.5 (3, 11.5) h. The length of stay was 1~20 days, and M ( Q1, Q3) was 5.72 (2, 7) days.The dose was 40-500 ml, and the M ( Q1, Q3) was 219.6 (100, 330) ml. Chest CT showed exudative changes in both lungs in 4 patients, excessive decreased permeability in 1 case and pleural effusion in 1 case. Gastroscope showed 2 cases of erosive inflammation of gastric body and antrum, 1 case of esophageal ulcer and cardiac ulcer, 1 case of corrosive gastritis, gastric fundus ulcer and esophageal stenosis. Abdominal X-ray showed 1 case of abdominal intestinal dilatation and pneumatosis with multiple gas-liquid planes.There were 1 case of type I respiratory failure, 6 cases of gastrointestinal bleeding and 1 case of incomplete intestinal obstruction. There were 19 cases of nausea and vomiting, 9 cases of abdominal pain, 6 cases of pharyngeal pain and 6 cases of retrosternal burning pain, 1 case of cough and 2 cases of fatigue. Conclusion:Acute oral 84 disinfectant will cause varying degrees of damage to the human digestive tract and lungs. In severe cases, gastrointestinal bleeding, intestinal obstruction, hypoxemia, etc, and even life-threatening, should be paid attention to clinically. The treatment is mainly symptomatic support treatment, such as protecting gastrointestinal mucosa, controlling acute inflammatory reaction, protecting the functions of liver and kidney and other important organs.

Fat emulsion is a drug commonly used clinically for parenteral nutrition support in critically ill patients.With the development of the pharmaceutical industry, fat emulsion has formed a variety of different formulations, among which different types of fat emulsion have their own metabolic and body energy supply characteristics, and the application indications are also different. In addition to providing the supply of nutrients, the role of fat emulsion in anti-toxicity, immune regulation, anti-inflammatory, anti-shock, cardiopulmonary resuscitation and other aspects has gradually been discovered. This article reviews the existing evidence-based medical evidence and expounds the mechanism and therapeutic role of fat emulsion in the treatment of critically ill patients with poisoning. Its value in the treatment of critically ill patients with poisoning was discussed, and some references were provided for the application of non-nutritional functions of fat emulsion in the future.

Objective:To summarize the clinical characteristics and treatment effect of patients with acute oral 84 disinfectant poisoning, so as to improve the understanding, diagnosis and treatment of the disease.Methods:In January 2022, 25 hospitalized patients with acute oral 84 disinfectant poisoning admitted to our department from March 2016 to August 2021 were selected as the research objects, and their general conditions, poisoning reasons, poisoning time, dose of poisoning, clinical manifestations, blood routine and biochemical indicators, diagnosis, treatment and prognosis were selected.Results:A retrospective analysis was performed. Among the 25 patients, there were 4 males and 21 females, aged from 20 to 91 years, and M ( Q1, Q3) was 38.7 (27, 46) years; The poisoning time (from exposure to poison to treatment) was 1~72 h, and M ( Q1, Q3) was 10.5 (3, 11.5) h. The length of stay was 1~20 days, and M ( Q1, Q3) was 5.72 (2, 7) days.The dose was 40-500 ml, and the M ( Q1, Q3) was 219.6 (100, 330) ml. Chest CT showed exudative changes in both lungs in 4 patients, excessive decreased permeability in 1 case and pleural effusion in 1 case. Gastroscope showed 2 cases of erosive inflammation of gastric body and antrum, 1 case of esophageal ulcer and cardiac ulcer, 1 case of corrosive gastritis, gastric fundus ulcer and esophageal stenosis. Abdominal X-ray showed 1 case of abdominal intestinal dilatation and pneumatosis with multiple gas-liquid planes.There were 1 case of type I respiratory failure, 6 cases of gastrointestinal bleeding and 1 case of incomplete intestinal obstruction. There were 19 cases of nausea and vomiting, 9 cases of abdominal pain, 6 cases of pharyngeal pain and 6 cases of retrosternal burning pain, 1 case of cough and 2 cases of fatigue. Conclusion:Acute oral 84 disinfectant will cause varying degrees of damage to the human digestive tract and lungs. In severe cases, gastrointestinal bleeding, intestinal obstruction, hypoxemia, etc, and even life-threatening, should be paid attention to clinically. The treatment is mainly symptomatic support treatment, such as protecting gastrointestinal mucosa, controlling acute inflammatory reaction, protecting the functions of liver and kidney and other important organs.

Fat emulsion is a drug commonly used clinically for parenteral nutrition support in critically ill patients.With the development of the pharmaceutical industry, fat emulsion has formed a variety of different formulations, among which different types of fat emulsion have their own metabolic and body energy supply characteristics, and the application indications are also different. In addition to providing the supply of nutrients, the role of fat emulsion in anti-toxicity, immune regulation, anti-inflammatory, anti-shock, cardiopulmonary resuscitation and other aspects has gradually been discovered. This article reviews the existing evidence-based medical evidence and expounds the mechanism and therapeutic role of fat emulsion in the treatment of critically ill patients with poisoning. Its value in the treatment of critically ill patients with poisoning was discussed, and some references were provided for the application of non-nutritional functions of fat emulsion in the future.

Objective The study intended to investigate the effect and mechanism of endoplasmic reticulum stress on cisplatin resistance in ovarian carcinoma .Methods RT-PCR and Western blot were used to test the expression of mTOR and Beclin 1 mRNA and protein in ovarian cancer SKOV 3 cells after saquinavir induction .MTT assay was used to analyze the influence of saquinavir on cisplatin sensitivity in SKOV3 cells.Results The IC50 of SKOV3 cells was ( 5.490 ±1.148 ) μg/ml.After induced by Saquinavair 10μmol/L and 20μmol/L, the IC50 of SKOV3 cells was increased to (11.199 ±0.984) μg/ml and (14.906 ±2.015) μg/ml, respectively.It suggested that the sensitivity of ovarian cancer cells to cisplatin was decreased significantly (P=0.001).The expression of mTOR and Beclin1 mRNA and protein was significantly different among the five groups: the (Saquinavair +DDP) group of, Saquinavair group, LY294002 group, DDP group and control group(P<0.001).The expressions of mTOR and Beclin1 mRNA were highest in the ( Saquinavair +DDP ) group, 0.684 ±0.072 and 0.647 ±0.047, respectively;Secondly, the Saquinavair group , 0.577 ±0.016 and 0.565 ±0.037, respectively.The expressions of mTOR and Beclin1 proteins were also highest in the (Saquinavair+DDP) group, 0.624 ±0.058 and 0.924 ± 0.033, respectively, followed by the Saquinavair group , 0.544 ±0.019 and 0.712 ±0.024.3-MA inhibited the autophagy and restored cisplatin sensitivity in the SKOV 3 cells after Saquinavir induced ER stress ( P<0.001 ).Conclusions Saquinavir can effectively induce endoplasmic reticulum stress in SKOV 3 cells. Endoplasmic reticulum stress can decrease the sensitivity to cisplatin in SKOV 3 cells.The mechanism of the decrease of sensitivity to cisplatin in SKOV 3 cells may be that ERS regulates cell autophagy through the mTOR and Beclin1 pathways .ERS of tumor cells and autophagy may become a new target to improve the therapeutic effect of chemotherapy and to reverse the drug resistance in tumor treatment .

Objective The study intended to investigate the effect and mechanism of endoplasmic reticulum stress on cisplatin resistance in ovarian carcinoma .Methods RT-PCR and Western blot were used to test the expression of mTOR and Beclin 1 mRNA and protein in ovarian cancer SKOV 3 cells after saquinavir induction .MTT assay was used to analyze the influence of saquinavir on cisplatin sensitivity in SKOV3 cells.Results The IC50 of SKOV3 cells was ( 5.490 ±1.148 ) μg/ml.After induced by Saquinavair 10μmol/L and 20μmol/L, the IC50 of SKOV3 cells was increased to (11.199 ±0.984) μg/ml and (14.906 ±2.015) μg/ml, respectively.It suggested that the sensitivity of ovarian cancer cells to cisplatin was decreased significantly (P=0.001).The expression of mTOR and Beclin1 mRNA and protein was significantly different among the five groups: the (Saquinavair +DDP) group of, Saquinavair group, LY294002 group, DDP group and control group(P<0.001).The expressions of mTOR and Beclin1 mRNA were highest in the ( Saquinavair +DDP ) group, 0.684 ±0.072 and 0.647 ±0.047, respectively;Secondly, the Saquinavair group , 0.577 ±0.016 and 0.565 ±0.037, respectively.The expressions of mTOR and Beclin1 proteins were also highest in the (Saquinavair+DDP) group, 0.624 ±0.058 and 0.924 ± 0.033, respectively, followed by the Saquinavair group , 0.544 ±0.019 and 0.712 ±0.024.3-MA inhibited the autophagy and restored cisplatin sensitivity in the SKOV 3 cells after Saquinavir induced ER stress ( P<0.001 ).Conclusions Saquinavir can effectively induce endoplasmic reticulum stress in SKOV 3 cells. Endoplasmic reticulum stress can decrease the sensitivity to cisplatin in SKOV 3 cells.The mechanism of the decrease of sensitivity to cisplatin in SKOV 3 cells may be that ERS regulates cell autophagy through the mTOR and Beclin1 pathways .ERS of tumor cells and autophagy may become a new target to improve the therapeutic effect of chemotherapy and to reverse the drug resistance in tumor treatment .

Objective:To explore the correlation between the serum 25-(OH)D 3, adiponectin (APN), and chemerin levels of pregnant women with gestational diabetes mellitus (GDM) and insulin resistance. Methods:28 pregnant women with GDM were selected for the study group from May 2020 to December 2021, and 45 pregnant women with normal glucose tolerance were selected for the control group. 25-(OH)D 3, APN, chemerin, islet resistance index (HOMA-IR), fasting blood glucose, fasting insulin, and HbA1c were compared between the two groups. The correlation between 25-(OH)D 3, APN, chemerin, and GDM insulin resistance was analyzed. Results:Fasting blood glucose, fasting insulin, HOMA-IR, and chemerin in the GDM group were higher than those in the control group (all P<0.05), while 25-(OH)D 3 and APN were lower than those in the control group (all P<0.05). There was no statistical difference in HbA1c between the two groups. Logistic regression analysis showed that serum 25-(OH)D 3, APN, and chemerin were all related influencing factors of GDM (all P<0.05). Spearman's correlation analysis showed that serum 25-(OH)D 3 was negatively correlated with fasting blood glucose and HOMA-IR (all P<0.05), chemerin was positively correlated with fasting insulin and HOMA-IR (all P<0.05). ROC curve analysis showed that the AUC of 25-(OH)D 3 was 0.841 (95% CI: 0.746~0.967). AUC of APN was 0.678 (95% CI: 0.545~0.812). AUC of chemerin AUC was 0.360 (95% CI: 0.233~0.487). Conclusions:The levels of 25-(OH)D 3, APN, and chemerin have a certain correlation with the pathogenesis of GDM, which has a certain reference value for the prediction of GDM.