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Abstract Diagnosis-related groups (DRGs), designed to reflect the complexity of grouped cases and the consumption of medical resources, has been utilized for evaluating hospital specialty capabilities and assessing performance. A provincial tertiary hospital in Zhejiang Province has developed a management model based on DRGs performance evaluation with strengthening the medical record quality control, optimizing disease admission structures, and refining data analysis. This article introduced the application of DRGs performance evaluation in this hospital, and proposed suggestions for improvement, including leveraging artificial intelligence and big data and integrating clinical pathway management to further enhance medical care quality. These insights provided the reference for high quality development of hospitals.

Aim To study the inhibitory effect of gast-rodin (GSTD) on oleic acid (OA)-induced fat accu-mulation in HL-7702 cells and explore possible cellular signaling pathways. Methods The MTT method was used to study the impact of GSTD on cell viability in HL-7702 cells. Cellular steatosis was induced by 1 mmol·L-1 of OA administration for 24 h, and differ-ent concentrations of GSTD were added at the same time. Oil red O ( ORO) staining was used to determine fat accumulation in cells, and intracellular triglyceride ( TG) contents were assayed. Western blot was used to determine the phosphorylation levels of AMPKα and ACC in cells after GSTD administration. Compound C was used to treat the cells in order to study its influ-ence on the efficacies of GSTD. Results GSTD had no obvious toxicity in HL-7702 cells when its concen-tration was≤3 386. 5 μmol · L-1 . After 24 h of OA administration, there were large amounts of lipid drop-lets accumulated in HL-7702 cells, and intracellular TG contents greatly increased as well. However, when 169. 3 or 338. 7 μmol · L-1 of GSTD was added to-gether with OA, fat accumulation in cells was greatly inhibited, and intracellular TG contents were reduced averagely by 35% and 43 . 6%, respectively ( P<0. 01 vs OA alone ) . After administration, GSTD could in-crease the levels of p-AMPKα and p-ACC in HL-7702 cells time and dose dependently. Compound C could completely abolish the stimulating activity of GSTD on AMPK pathway and block its reducing effect on hepatic TG accumulation. Conclusions GSTD greatly inhibits OA-induced fat accumulation and reduces intracellular TG contents in HL-7702 cells;the efficacy of GSTD is dependent on the activation of cellular AMPK pathway.

Objective To research the role of matrix metalloproteinase-9(MMP-9), transforming growth factor ?1(TGF-?1) in viral myocarditis(VM) and their relationships with myocardial fibrosis, and to explore the forensic significance on sudden death due to viral myocarditis. MethodsSelected 30 cases of VM as experimental group,there cases were divided into definite VM group(n=18) and borderline VM group (n=12);Non-VM(n=10) were selected as control group. Collagen hyperplasia was observed by Masson staining. The expression and localization of MMP-9 and TGF-?1 in viral myocarditis were quantified by immunohistochemical method. Image analysis systems and statistical methods were used for quantitative analysis. ResultsThe amount of collagen fibre in the viral myocarditis group was more than that in the control group. The expression of MMP-9 and TGF-?1 were increased obviously. MMP-9、TGF-?1 expression were positively correlated with the collagen hyperplasis. ConclusionsThe MMP-9 and TGF-?1 may contributes to myocardial fibrosis, and may act as the assistant diagnostic indexes of sudden death due to viral myocarditis.

Objective To investigate the correlation of social capital and professional burnout in nursing staff. Methods Totally 1329nursing staff were recruited from 6 hospitals in China. They were investigated with the social capital scale and nursing personnel professional burnout scale. Results The mean score of social capital was 13.37±1.30;the mean score of 3 Scales of professional burnout was 24.39± 9.98, 6.24 ± 4.78, 23.37 ± 10.12. The 4 Scales scores of social capital were negative correlated with emotional exhaustion scale, the lack of human individual scale(r=-0.564 to-0.211,P<0.05). Besides with trust and security dimension, low sense of achievement were positively correlated with the total score of social capital (r=0.281-0.281, P<0.05). Conclusion Social capital of nursing staff have important effects on nurse's professional burnout. Nursing managers should take effective measures to reduce nurse's professional burnout.

Objective To explore the molecular mechanism of hypophrenia induced by Down syndrome (DS).Methods Ts65Dn mice were used as DS animal model.Three female mice and three male mice of three to twelve weeks old were mated.Among the 17 first-generation mice alive,five mice remained Ts65Dn trisomy and 12 mice were normal.Five Ts65Dn mice and five normal mice were selected randomly as Ts65Dn group and control group,and bred till 16 to 18 weeks old for experiments.Differential proteins in hippocampus of mice were tested by isobaric tags for relative and absolute quantitation (iTRAQ).Expressions of the differential proteins in Ts65Dn group were detected compared with those in control group.Results A total of 2805 proteins were identified in hippocampus of Ts65Dn group and control group,and significant differences were observed in the expressions of 374 proteins.Compared with those in control group,expressions of 195 proteins increased and 179 reduced in Ts65Dn group.Sorted by P value from low to high,the seven proteins with the lowest P value were uncharacterized protein C2orf47 homolog,isoform 2 of filamin A-interacting protein 1-like,zinc finger protein,isoform 1 of pericentriolar material 1 protein,SEC23 interacting protein,BAG family molecular chaperone regulator 3 and serpin H1.Conclusions Differential proteins are observed in hippocampus of Ts65Dn mice,perhaps closely correlating to neurological defects.The new technology of iTRAQ helps to screen and identify differential proteins in hippocampus.

Objective To detect point mutations of TAC1 gene in fluconazole-resistant Candida albi-cans isolates with rolling circle amplification (RCA), develop an accurate, rapid and specific assay to detect single nucleotide polymorphisms (SNPs), and to estimate the relationship between mutations of TAC1 gene and resistance to fluconazole. Methods A total of 33 fluconazole-resistant Candida albicana isolates, including 8 strains from America and 25 from Australia, were collected. Four TAC1-specific padlock probes were designed according to previously reported mutations. DNA was extracted from these tested strains, subjected to amplification of three targeted fragments of TAC1 gene with PCR. Then, RCA was performed to detect point mutations of TAC1 gene in resistant Candida albicans strains. At the same time, the target fragments underwent sequencing analysis, and the results of RCA were compared with those of sequencing. Results Two types of resistance-associated mutations were found in 5 out of the 33 fluconazole-resistant strains. Among the 5 strains, 4 were from America, 1 harbored T225A mutation and 4 carried A736V mutation. No related mutation was found in TAC1 gene of 4 fluconazole-sensitive isolates. Conclusions RCA assay could accurately and rapidly detect point mutations of genes. Further studies are required to clarify the relationship between TAC1 point mutations and fluconazole resistance.

Objective To prospectively study the main risk factors of variceal bleeding in cirrhotic patients. Methods Fifty-seven patients with liver cirrhosis and esophageal varices who had never experienced variceal bleeding were followed up for 12 months. The patients underwent measurements of esophageal variceal pressure by non-invasive endoscopic balloon technique. The endpoint of the study was the presence of a variceal hemorrhage. The relationship between variceal hemorrhage and endoscopic findings including varices, variceal pressure, Child-Pugh status, ascites, and etiology of cirrhosis was studied. Results Thirty-four patients (59.6% ) developed a variceal hemorrhage. In univariate analysis, the level of variceal pressure (P= 0. 001), the size of varices (P=0. 006), and the endoscopic red color sign on the variceal wall (P=0. 012) predicted higher risks of variceal hemorrhage. The multiple logistic regression revealed that variceal pressure was a major predictor of the risk for a first variceal bleeding (OR=2. 817, P=0. 003). The area under the receiver operating characteristic (ROC) of variceal pressure for predicting variceal bleeding was 0. 98, and the variceal pressure cutoff value was 25.3 mm Hg (1 mm Hg=0. 133 kPa) with both specificity and sensitivity of 91 %. Conclusion The level of variceal pressure is a major predictor for variceal bleeding in cirrhotic patients.

Objective To investigate effect of dexmedetomidine on postoperative analgesia pump dose and effect.Methods 50 cases of patients with abdominal surgery under general anesthesia were selected.According to the postoperative analgesic drugs were divided into control group and experimental group, 25 cases in each group were given corresponding drug treatment.After treatment, the visual analogue scale, comfort score, adverse reaction rate and dosage of analgesic drugs were detected and compared.Results Compared with the control group,the VAS score were lower(P <0.05),the BCS score were higher(P<0.05),the adverse reaction rate were lower(P<0.05),the dosage of analgesic pump were lower(P<0.05). Conclusion Dexmedetomidine can significantly reduce postoperative pain degree of patients, reduce the incidence of adverse reaction, reduce analgesic dosage of the drug pump.

Objective To explore the forensic identification points of deaths caused by secondary dam-ages of road traffic accidents. Methods Seventeen deaths caused by secondary dam ages of road traffic accidents were collected. Through scene investigation and necropsy, the basic inform ation of the acci-dents, distribution and property of the injuries, and other inform ation were collected. A ccording to the collected data, the scene was reconstructed in order to confirm the injury process, analyze the way, mechanism and severity of injury, distinguish antem ortem injury from postm ortem injury, and determ ine the cause of deaths. Results C ertain features such as serious injuries, multiple traum as, com bined in-juries, co-existence of antem ortem and postm ortem injuries, multiple causes of wounds, com plex injury mechanism , as well as the mutual dam aging and overlapping injuries were quite characteristically noted in these secondary traffic accident cases. Conclusion Forensic assessment of deaths caused by secondary dam ages of road traffic accidents should be synthetically analyzed and judged through scene investigation and necropsy.