The Balanced Score card ( BSC) is a new set of performance measurement and strategic management tools. Based on the basic theory of BSC, and on the basis of establishing the basic framework for performance evaluation of four dimensions, namely satisfaction, financial, internal operation, and growth and development, this paper systematically designs specific evaluation indexes from the 4 dimensions in order to construct the performance evaluation index system for catastrophic disease insurance. The objective of this study is to provide a more scientific and reasonable reference for the operational performance evaluation of catastrophic disease insurance offered to urban and rural residents.

Objective To systematically evaluate the efficacy of acupotomy treatment for the stenosing tenovaginitis of flexor digitorum.Methods Articles about RCTs of acupotomy treatment and local blocking for the treatment of stenosing tenovaginitis of flexor digitorum were retrieved from CBM, CNKI, VIP, Wanfang database, PubMed, Embase, and Cochrane library. And then according to the requirement of Cochrane Handbook for Systemetic Reviews 5.1.0, two reviewers independently chose tests, extracted data, had a cross check, accessed methodological qualities and finally used RevMan 5.3 software for Meta analysis. The total effective rate, cure rate and improvement rate of acupotomy treatment and local blocking in treating stenosing tenovaginitis of flexor digitorum were assessed by using odds ratio (OR).Results Totally 10 articles involving 1426 cases were included. The cure rate in acupotomy treatment group was higher than that of local blocking group [OR=13.11 (95% CI: 8.23–20.89),Z=10.83 (P<0.000 01)], funnel plot Begg’s testP=0.858, Egger’s testP=0.579; the improvement rate of local blocking rate was higher than that of acupotomy treatment group [OR=0.14 (95% CI: 0.10–0.19),Z=11.60 (P<0.000 01)], funnel plot Begg’s test P=1.000, Egger’s testP=0.926; the total effective rate of acupotomy treatment group was higher than that of local blocking group [OR=18.26 (95% CI: 9.95–33.50),Z=9.38 (P<0.000 01)], funnel plot Begg’s testP=0.592, Egger’s testP=0.936.Conclusion Acupotomy treatment for stenosing tenovaginitis of flexor digitorum is superior to local blocking injection. However, the quality of the RCTs is low, so more large-sample, multi-center, and high-quality clinical RCTs are required for further verification.

Objective To evaluate a combination of open surgery and multiple interventional methods in the treatment of DVT of the lower extremities. Methods 521 cases (521 limbs,356 male and 165 female) were studied in this group. Age ranged from 16 to 86 years with the mean age of (46 ±9)years. All 521 cases with DVT were treated by Fogarty embolectomy catheter. Among them,348 cases underwent percutaneous transluminal angioplasty (PTA), 135 cases received PTA and ultrasound ablation,stent-grafts were implanted in 108 cases. Results Based on angiography during operation, the obstructed iliofemoral vein received complete recanalization in 511 cases. Among them, the postoperative luminal diameter was more than 90% in 38 cases after Fogarty embolectomy, the average stenosis rate was reduced from 90% ±5% to 24% ±5% in 365 cases after PTA and stent-grafts were implanted in 108 cases with the stenosis rate still over 50% after PTA. Only partial recanalization was achieved in the entrance of common iliac vein to inferior vena cava in 10 cases. Of the 521 cases,472 cases were followed-up with mean time of (53 ± 26) months, ranging from 8 to 108 months and 462 cases reported satisfactory results with normal life,the unsuccessful 10 cases still felt swelling pain especially in erect position. Complications occurred in 33 cases. Conclusions Open surgery combining with multiple interventional methods is a safe and effective method in the treatment of DVT.

Objective To explore the change of serum insulin-like growth factor-2 (IGF-2) and its relationship with clinical characteristics in patients with schizophrenia. Methods Fifty-one schizophrenic patients were recruited in the present study and 50 healthy volunteers served as controls. The serum IGF-2 level was measured using enzyme linked immunosorbent assay (ELISA). Positive and Negative Syndrome Scale (PANSS) was used to evaluate the psychotic symp?toms of patients. Trail Making Test-A (TMTA), Digit-Symbol Coding Test (DSCT), Continuous Performance Test (CPT) and Stroop Color-Word Test (SCWT) were used to evaluate the cognitive function of both groups. Results There were sig?nificant differences in the results of TMTA, DSCT, CPT and SCWT between patient and control groups. The serum levels of IGF-2 were significantly lower in patients than that in controls [(202.7±40.7) ng/mL vs. (365.9±65.5) ng/mL, P<0.01]. The levels of serum IGF-2 were not significantly different between first-episode and recurrent schizophrenic patients (P>0.05). Furthermore, significant correlations were found between the serum IGF-2 level and the negative symptom sub?scale of PANSS (r=-0.397, P=0.004), CPT score (r=0.378, P=0.006), SCWT-word number (r=0.289, P=0.040), SC? WT-color number (r=0.327, P=0.019) and SCWT-word/color number (r=0.386, P=0.005) in schizophrenic patients. Con?clusion The serum IGF-2 levels of patients with schizophrenia are significantly lower than that of healthy controls, and the IGF-2 level is associated with the severity of negative symptoms and cognitive impairments in patients, indicating that serum IGF-2 might be an indicator of the severity of schizophrenia.

Objective To study the risk factors of acute bilirubin encephalopathy (ABE) in neonates with severe hyperbilirubinemia (total serum bilirubin ≥ 427.5 μmol/L).Method Clinical information of neonates with severe hyperbilirubinemia admitted to the Neonatal Department of Baoan Maternal and Child Health Hospital in Shenzhen from December 2013 to October 2017 were collected.The enrolled cases were grouped as ABE and the control group (without ABE).The risk factors for ABE were compared between the two groups and the Logistic regression analysis was used to evaluate the independent risk factor.Result A total of 104 neonates were recruited.There were 32 cases in the ABE group and 72 cases in the control group.The level of total serum bilirubin and indirect bilirubin,the ratio of total bilirubin/albumin,the incidence of glucose-6-phosphate dehydrogenase deficiency and metabolic acidosis and sepsis,the rate of using traditional Chinese medicine and the failure of treatment in other hospitals and non-resident population were all significantly higher in the ABE group than the control (P ＜ 0.05).Logistic regression analysis showed that total serum bilirubin (OR =1.013,95％ CI 1.007 ～ 1.020) and sepsis (OR =6.343,95％ CI 1.801 ～22.338) were the independent risk factors for ABE.Conclusion The severe hyperbilirubinemia infants,particularly with sepsis,are at higher risk of developing acute bilirubin encephalopathy.

Objective To explore the effects of aripiprazole on clinical symptoms and neurotrophic factor levels in patients with schizophrenia. Methods Forty patients with schizophrenia and 40 normal controls were included in the study. The clinical symptoms of patients receiving aripiprazole only for 12 weeks were evaluated by using the Positive and Negative Syndrome Scale (PANSS). Stroop Color-Word Test (SCWT), Continuous Performance Test, Digit-Symbol Coding Test and Trail Making Test-A were used to evaluate the cognitive function both in patients and controls. Serum levels of Nerve Growth Factor (NGF), Brain Derived Neurotrophic Factor (BDNF) and Neurotrophin 3 (NT-3) were measured using enzyme linked immunosorbent assay. Results The clinical scores, cognitive function and levels of neurotrophic factors were different before and after treatment (P<0.01). And those were significantly lower in patients than in control group (P<0.05). Before treatment, BDNF was negatively correlated with PANSS negative symptom score (r=-0.362, P=0.022);NGF was related to the total score of PANSS (r=0.332, P=0.037) and positive symptoms (r=0.401, P=0.010); NT-3 was associated with negative symptom scores (r=-0.376, P=0.017) and SCWT-color words (r=0.332, P=0.037) in patient group. After treatment, the increase in BDNF was correlated with the reduction in PANSS total score (r=0.371, P=0.018), negative symptom score (r=0.345, P=0.029) and general pathology score (r=0.342, P=0.031). There was a correlation of the increase of NGF with the decrease of PANSS total scores (r=0.437, P=0.005) and with positive symptom scores (r=0.357, P=0.024). Conclusion Treatment with Aripiprazole can improve the clinical symptoms and cognitive functiona impairments in patients with schizophrenia, which may be related to the increase in serum levels of BDNF, NGF and NT-3.

Objectives:To study the clinical significance of time to positive (TTP) of blood culture for neonatal sepsis.Methods:From August 2016 to June 2019, a retrospective study was conducted in patients with positive blood cultures admitted to the Neonatology Department of our hospital. The patients were assigned into different groups according to the species of pathogen, types of neonatal sepsis and the samples contaminated or not. TTP of different groups were analyzed.Results:A total of 307 cases with positive blood cultures were identified from 10 035 cases with blood culture specimens. Among the 307 cases, 162 were contaminated (the contaminated group) and 145 (1.4%) were diagnosed of neonatal sepsis (the pathogenic group). The proportion of TTP <24 h, 24~<48 h, 48~<72 h and ≥72 h in the 145 sepsis cases were 90.3% (131/145), 7.6% (11/145), 1.4% (2/145) and 0.7% (1/145), respectively. The median TTP was 9.0 h in early-onset sepsis (EOS) group and 11.5 h in late-onset sepsis (LOS) group. The median TTP of the contaminated group was 24.5 (19.9, 30.5)h, which was longer than 11.1 (8.1,16.2)h of the pathogenic group ( P<0.05). The median TTP of Gram (+) group was 14.0 (9.4,18.8)h, which was longer than 9.6 (7.5,11.3)h of Gram (-) group ( P<0.05). The median TTP of fungi group was 32.5 (25.5, 39.0) h, which was longer than 10.6 (8.1, 15.5)h of bacteria group ( P<0.05). Conclusions:Different pathogens has different TTP for neonatal sepsis. If blood culture maintains negative for more than 72 h, empiric use of antibiotics may be discontinued for patients of suspected sepsis without specific clinical manifestations or other lab results.

OBJECTIVETo investigate changes in clinicopathological features and survival of patients with gastrectomy at a single institution in China.

METHODSFrom January 1990 to December 2009, clinicopathological data of 2518 cases of gastric cancer patients who underwent surgical resection in the Sun Yat-sen University Cancer Center were analyzed retrospectively. The overall survival rate was determined using Kaplan-Meier method and log-rank test was used to determine significance. The prognosis was analyzed using univariate analysis and multivariate analysis by Cox proportional hazards model. Clinical features, pathological findings and survival differences were compared in this cohort between two consecutive periods(1990-1999 and 2000-2009).

RESULTSThe 5-year survival rates for the whole cohort and those undergoing radical resection was 48.1% and 53.7%, respectively. In the first period, the 5-year survival rate for the whole cohort and for patients undergoing radical resection was 40.1% and 45.7%. In the second period, the 5-year survival rates for whole cohort and for patients undergoing radical resection was 51.5% and 57.1%, respectively. For those who underwent radical resection, the mean number of lymph node dissection was significantly higher in the recent period (20.1±8.3 vs. 9.5±6.0, P<0.01). On multivariate analysis by means of the Cox proportional hazard model, age, location, tumor size, histological type, radical resection, lymphatic/venous invasion, depth of invasion, nodal status, number of retrieved lymph nodes, and treatment period were independent factors (P<0.05). The constitution, number of retrieved lymph nodes, and survival rate were all improved between the two intervals (P<0.05).

CONCLUSIONThe overall survival rate has gradually increased in gastric cancer patients over the past 20 years.

Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Stomach Neoplasms ; pathology ; surgery ; Survival Rate

Objective:Differences between randomized controlled trial (RCT) results and real world study (RWS) results may not represent a true efficacy-effectiveness gap because efficacy-effectiveness gap estimates may be biased when RWS and RCT differ significantly in study design or when there is bias in RWS result estimation. Secondly, when there is an efficacy- effectiveness gap, it should not treat every patient the same way but assess the real-world factors influencing the intervention's effectiveness and identify the subgroup likely to achieve the desired effect.Methods:Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31 st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results:Ten articles were included to discuss how to use the RCT research protocol as a template to develop the corresponding RWS research protocol. Moreover, based on correctly estimating the efficacy-effectiveness gap, evaluate the intervention effect in the patient subgroup to confirm the subgroup that can achieve the expected benefit-risk ratio to bridge the efficacy-effectiveness gap.Conclusion:Using real-world data to simulate key features of randomized controlled clinical trial study design can improve the authenticity and effectiveness of study results and bridge the efficacy-effectiveness gap.

Objective:Randomized controlled trials (RCT) usually have strict implementation criteria. The included subjects' characteristics of the conditions for the intervention implementation are quite different from the actual clinical environment, resulting in discrepancies between the risk-benefit of interventions in actual clinical use and the risk-benefit shown in RCT. Therefore, some methods are needed to enhance the extrapolation of RCT results to evaluate the real effects of drugs in real people and clinical practice settings.Methods:Six databases (PubMed, Embase, Web of Science, CNKI, Wanfang Data, and VIP) were searched up to 31 st December 2022 with detailed search strategies. A scoping review method was used to integrate and qualitatively describe the included literature inductively. Results:A total of 12 articles were included. Three methods in the included literature focused on: ①improving the design of traditional RCT to increase population representation; ②combining RCT Data with real-world data (RWD) for analysis;③calibrating RCT results according to real-world patient characteristics.Conclusions:Improving the design of RCT to enhance the population representation can improve the extrapolation of the results of RCT. Combining RCT data with RWD can give full play to the advantages of data from different sources; the results of the RCT were calibrated against real-world population characteristics so that the effects of interventions in real-world patient populations can be predicted.