Objective Diagnosis related groups ( DRGs) is a system to classify hospital cases into groups , which is effective in the control of medical cost .The article was to explore the DRGs grouping method and quality control indexes of cerebrovascular dis -ease in Nanjing first-class hospitals at grade 3. Methods Polytomous logistic regression for ordinal response was used in the factor analysis of hospitalization cost .E -CHAID decision tree method was applied in the DRGs grouping of cerebrovascular patients . Results Totally 9095 cases were enrolled in this study with the average age was (64.52 ±14.85).The average of stay lengths and expenses were (11.77 ±9.26)d and (25921.04 ±23096.76)rmb respectively.Hospitalization expense was associated with neurologi-cal surgery, main diagnosis, interventional surgery, main complication and ICU days.Taking neurological surgery as the first forced variable, cerebrovascular cases could be divided into 14 DRGs groups. Conclusion The terminal quality control index , the step warning index and case maximum index of cerebrovascular disease established by the DRGs grouping method are suitable in the area .

Objective To study the perception of patients and nurses for the artificial airway suction,in order to provide theoretical reference for building the artificial airway suction clinical practice guidelines.Methods CNKI,Wanfang,VIP,Pubmed,Science direct databases were searched for papers of patients and/or nurses' perception over the limited period of 2005 to 2013.The retrieved papers were analyzed.Results Nineteen eligible papers were identified.Extract relevant contents found the majority of patients retained the memory of that airway suction,mainly for pain,choking,suffocation,and eager to get the relevant knowledge and information.There were few researches on nurses' subjective feeling about airway suction.Conclusion We should pay attention to the perception of patients,while strengthening the research on nurses' perception of artificial airway suction and improve communication with patients,in order to relieve their discomfort experience,and could be helpful for the building of airway suction clinical practice guidelines.

According to the infection characteristics of batches of patients with extensive burns in dust explosion, the article focused on the concept and mode of whole-range fine management.Based on the characteristics and rules of infection prevention in bat-ches of patients with extensive burns, the measurement and examination of infection management were refined, the infection monitoring indexes were designed scientifically, the infection prevention scheme and monitoring table were formulated.By early and whole-range intervention of infection prevention, quantitative evaluation, fine management and precise control at different times, all levels of infec-tion management teams could fully serve their purposes in order to realize effective infection prevention.

Objective To investigate the effect of Zhali Nusi Recipe ( ZNR) on hemorheological parameters, blood - lipid metabolism, the activities of superoxide dismutase ( SOD) and glutathione peroxidase ( GSH-Px) , and the content of malondialdehyde (MDA) in brain tissues of cerebral ischemia-reperfusion rats with the syndrome of phlegm blended with blood stasis. Methods Ninety rats were randomly divided into sham operation group, model group, nimodiping (10.8 mg/kg) group, high-, middle- and low-dose ZNR groups ( in the dosage of 30, 15, 7.5 g/kg, respectively) , 15 rats in each group. Except the sham operation group, the other groups were given intragastric administration of intralipid for 4 weeks, and then were induced into focal cerebral ischemia-reperfusion by middle cerebral artery occlusion with thread-obstruction method. After post-operation medication for 7 days, the rat general situations, the neurological deficiency symptoms, and the water content in brain tissues were observed. The morphological features of brain tissues were observed after HE staining. The blood was taken from the ab dominal aorta to detect the hemorheological parameters and blood lipid levels. Metabolic levels of free radicals in the brain tissue homogenate were also determined. Results Compared with the sham operation group, neurological deficiency scores of the rats and the water content in the brain tissues of model group were significantly enhanced. The hippocampal neurons of model rats presented typical ischemic changes. In the model group, the hemorheological parameters such as whole blood viscosity, plasma viscosity, hematocrit ( HCT) , and erythrocyte aggregation in dexes ( EAI) were significantly increased, and erythrocyte deformation indexes were significantly decreased; the serum levels of total cholesterol ( TC) , triglyceride ( TG) , low-density lipoprotein cholesterol (LDL-C) were significantly increased, and high-density lipoprotein cholesterol ( HDL-C) level was significantly decreased; the activities of SOD and GSH-Px in brain tissues were significantly decreased, and MDA content was increased significantly ( P<0.05 or P<0.01). Compared with the model group, high-, middle-and low-dose ZNR improved the general situations of the cerebral ischemia-reperfusion rats, increased the neurological deficiency scores, reduced the water content in brain tissues, improved the recovery of morphology of cells in cerebral ischemia tissues, reduced whole blood viscosity, plasma viscosity, HCT and EAI of the model rats, promoted erythrocyte deformation indexes, decreased serum TG, TC, LDL-C levels, increased the activities of SOD and GSH-Px in cerebral ischemic tissues, and sig nificantly decreased MDA content (P<0.05 or P<0.01). And high-dose ZNR had the best effect. Conclusion ZNR has certain protective effect on cerebral ischemia-reperfusion rats with the syndrome of phlegm blended with blood stasis, and the mechanism may be closely related with the improvement ofhemorheology, blood lipid and free radical metabolism in model rats.

Objective To study the applicability of unilateral and bilateral antegrade cerebral perfusion during deep hy-potbermia circulatory arrest (DHCT) surgery and to determine a better method of brain protection. Methods 60 patients un-derwent aortic arch surgery were random divided into either unilateral cerebral perfusion group with a cannula in the innominate artery (n = 30 ) , or bilateral cerebral peffusion gToup with an additional cannula in the left carotid artery ( n = 30 ). S-100β,neuron specific enolase (NSE) were assayed at the following time points: the beginning of cardiopulmonary bypass (T_1), the beginning of circulatory arrcst( T_2 ), antegradc cerebral perfusion (ACP) 25 min( T_3 ), the end of ACP( T_4 ), the end of car-diopulmonary bypass ( T_5 ) , 1h( T_6 ) , 6h ( T_7 ) and 24h( T_8 ) after operation. Neurological deficit incidence and mortality were also obtained. Results There is no statistical significance for S-100β and NSE plasma concentration among time points of T_1、T_2 and T_3. But every time point among T_4、T_5、T_6、T_7 ,Ts do have statistical significances. The incidence of central nervous system dysfunction in group unilateral ACP was higher than that in group bilateral ACP ( 33.33% vs. 10.00%, P = 0.028 ).But there is no significant difference between the two groups in mortality( 3.33% vs. 6.66% ,P = 1. 000 ). Conclusion There is no significant difference between unilateral ACP and bilateral ACP in 25 min during DHCA. But as the DHCA time extends, the effect of bilateral ACP will be better.

With the development of economy and society, the change of heath concept and increased demands for health care , the cultivation of postgraduates majoring in clinical medicine is facing a lot of problems which seriously affects the quality of culti-vation.The article analyzed the problems and reasons in the clinical medicine postgraduate cultivation.We stated the competency of clinical medicine postgraduates according to the transition of health demands, global medical development and practical requirements for clinical personnel in China.We elaborated the required post competence for clinical medicine postgraduates on the basis of its con-tent and characteristics.We proposed to strengthen the cultivation of clinical medicine postgraduates by the reform and support of the government, enhanced construction of teachers, improved course plan and cultivation process, perfected assessment system in order to make the students competent to their posts.

Objective To study the methodology and effect of auricle reconstruction with prefabricated expanded fascial flap in temporal and parietal area and skin flap in mastoid area, covered on the Medpor support. Methods Thirty cases of congenital vestigial auricle were involved in this study. The operations were divided into two stages: in the stage I,the temporal and parietal superficial fascia flap was cut with a vascular pedicle in the parietal and temporal superficial area, which was implanted under the skin of mastoid, and then both layers of those were expanded at the same time; in the stage II, this fascial skin flap was cut down and covered on the whole Medpor support to rebuild the man-made auricle. Results Thirty cases were successful after following-up for 6 months to 3 years. Their auricle shapes were vivid; their skin color was normal, and it had no any difference from all around skins, or no any appearance of the support. Conclusions With best understanding the biological characteristics of the Medpor support and choosing the suitable procedures and using the prefabricated expanded support, we could minimize the surgical complications in this operation. The results show that this procedure is satisfactory, without any necrosis of flap, swelling of contour, or appearance of the support. The combination of two flaps is the best method for the auricle reconstruction.

Objective Analyze current clinical practice guidelines related to pre-anesthesia as-sessment to provide a resource for healthcare providers (or institutions)seeking protocols of their own.Methods National and international guideline databases were searched along with healthcare or-ganizations and associations.Content analysis method was used to analyze clinical practice guidelines searched from internet and obtained in the database search.Results Five clinical practice guidelines were included.A total of 39 items related to pre-anesthesia assessment were identified and when divid-ed into 3 essential areas:1)past history and present medical,2)physical examination,and 3)labora-tory examination.There is no guidance to general anesthesia currently in China.Pre-anesthesia testing in the presence of specific clinical characteristics was recommended.Conclusion We should develop local clinical practice guidelines of preanesthesia assessment with consideration of the actual medical situations in China.

Abstract Cardiovascular disease is the leading cause of death and disease burden in China and worldwide. The state of cardiovascular health in childhood and adolescence has been shown to be a strong predictor of cardiovascular health in adulthood. The study summarizes current state of cardiovascular health evaluation methods in children and adolescents, including Life s Simple 7, Life s Essential 8, and the aggregation of cardiovascular risk factors; and relevant indicators include diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood pressure, blood glucose, and the application of evaluation methods, so as to provide insights for the development of cardiovascular health evaluation methods applicable to children and adolescents in China.

Background: To evaluate the feasibility of treating odontoid fractures in the Chinese population with two cortical screws based on computed tomography (CT) scans and describe a new measurement strategy to guide screw insertion in treating these fractures. Methods: A retrospective review of cervical computed tomographic scans of 128 patients (aged 18–76 years; men, 55 [43.0%]) was performed. The minimum external transverse diameter (METD), minimum external anteroposterior diameter (MEAD), maximum screw length (MSL), and screw projection back angle (SPBA) of the odontoid process were measured on coronal and sagittal CT images. Results: The mean values of METD and MEAD were 10.0 ± 1.1 mm and 12.0 ± 1.0 mm, respectively, in men and 9.2 ± 1.0 mm and 11.0 ± 1.0 mm, respectively, in women. Both measurements were significantly higher in men (p < 0.001). In total, 87 individuals (68%) had METD > 9.0 mm that could accommodate two 3.5-mm cortical screws. The mean MSL value and SPBA range were 34.4 ± 2.9 mm and 13.5°–24.2°, respectively, with no statistically significant difference between men and women. Conclusions The insertion of two 3.5-mm cortical screws was possible for anterior fixation of odontoid fractures in 87 patients (68%) in our study, and there was a statistically significant difference between men and women.