10.3969/j.issn.2095-4344.2013.24.010

Objective To explore diagnosis-related groups(DRGs) case mixes and development approaches for medicare expense standard fitting patients with respiratory system diseases in Sichuan province.Methods 280 717 cases of respiratory system diseases were sampled from the homepages of medical records of general hospitals in Sichuan.These cases were grouped by means of the exhaustive chi-square automatic interaction detector in the decision tree model and the medicare costs standard was derived using the relative-ratio weighting coefficient.Results The main classification nodes of respiratory diseases were age and patient clinical complexity level (PCCL).Patients were classified into 158 disease diagnosis related groups, including 122 DRGs of internal medicine and 36 DRGs in surgical medicine.The max relative-ratio weighting coefficient was 14.04 and the min one was 0.29.And the extreme inpatients' expenses can affect the identification of classification nodes, calculation of relative weighting coefficient and medicare cost standard.Conclusions Large sample size is advantageous in establishing DRGs and calculating the medicare costs standard based on relative-ratio weighting coefficient.It is however imperative to strengthen monitoring on extreme inpatients' costs and control the homepage quality of medical records.

Objective To discuss whether it is necessary to integrate metabolic indices into diagnosis of polycystic ovary syndrome (PCOS).Methods Taking ESHRE/ASRM diagnosis as the gold standard,51 women with PCOS and 47 women without PCOS were selected and divided into the intervention group and control group respectively from the Department of Gynecology in the Second Affiliated Hospital of Kunming Medical University between January 2013 and July 2014.Logistic regression based on principal component analysis and significant variables chosen through single factor analysis were used to establish the new diagnostic model which combined reproductive indices and metabolic indices.We evaluated the validity and reliability of the new diagnostic model by using ROC curve analysis.Finally,we analyzed the consistence and difference between the new diagnostic model and the gold standard.Results Thirteen significant variables were chosen using single factor analysis.ROC analysis showed that an area under the curve was 0.976 (P＜0.001) and the optimal cut-off point was 0.526 with a sensitivity of 96.08％,a specificity of 93.62％ and a consistency of93.88％.The new diagnostic model had superior validity and reliability.The two diagnostic methods had strong consistence (Kappa=0.877,P＜0.001) and no difference (x2=0.167,P=0.688).Conclusion Considering that the integration of metabolic indices does not change the diagnosis result,we come to a conclusion that it is unnecessary to integrate metabolic indices into diagnosis of PCOS.

Objective To optimize the processing technology for Radix Puerariae simmered with wheat bran.Methods Orthogonal experiment L9(34) was chosen to optimize the technology. The external properties of Radix Puerariae simmered by wheat bran, the content of puerarin and the antidiarrheal effect on mice with diarrhea caused by folium sennae were used as indexes. Comprehensive weighted score was employed to optimize simmering Radix Puerariae with wheat bran technology.Results Processing time was the main affecting factor, while processing temperature had no significant effect. The optimum processing parameters were 100 g Radix Puerariae simmered with 30 g wheat bran at 160℃ for 2 minutes.Conclusion The optimum processing technology was simple and convenient, and with good reproducibility and operability. It is also helpful for the quality control of Radix Puerariae simmered with wheat bran.

Objective To explore the occurance and risk factors of recurrence and metastasis of gastric cancer after gastrectomy.Methods From January 2001 to December 2004, the clinic pathological data of 141 patients with recurrence and metastasis after radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively.The possible clinic pathological factors which may affect tumor recurrence were analyzed.Results After the surgery, the 1, 2, 3 and 5-year cumulative recurrence rates were 58.2%(82/141) 、80.1%(113/141)、89.4%(126/141) 、97.9 % (138/141)respectively.The results of multivariate analysis indicated that the tumor size,invasive depth, lymph node metastasis were independent factors which affected recurrence and metastasis after radical gastrectomy (P = 0.017, 0.003, 0.000).Invasive depth, lymph node metastasis and tumor differentiation degree were independent factors which affected early recurrence and metastasis after radical gastrectomy (P=0.042, 0.000, 0.039).Conclusions The tumor size,invasive depth, lymph node metastasis are the independent risk factors to predict the recurrence and metastasis after radical gastrectomy.Most of the recurrences and metastasis is found within 2 years after radical gastrectomy.Invasive depth, lymph node metastasis and tumor differentiation degree are the independent factors to predict early recurrence after radical gastrectomy.

The ability of clinical teachers plays a key role in residents standardized training. The teachers should fully understand the relevant policies and improve the awareness of resident standardized training. The construction of clinical teaching ability is the essential ability for clinical teachers and is the focus of the teacher training, which can guarantee to guide the improvement of residents' clinical thinking ability and the training of their clinical skills. Establishing teacher training system, making a suitable train-ing plan, selecting applicable training content and participating in various types of teacher training should effectively improve the comprehensive teaching ability of clinical teachers for resident standardized training.

Objective:To study the effects of soybean isoflavone (SI) on metabolism of lipids and lipoprotein (a) [Lp(a)] in ovariectomized rats . Methods:Senventy female Sprague- Dawley (SD) rats were randomly divided into 7 groups according to the levels of total cholesterol (TC) in serum: high-lipid (HF) group, estrogen (EG) group, low-dose SI (L-SI) group, middle-dose SI (M-SI) group, high-dose SI (H-SI) group, sham group and normal control (NC) group. One week after bilateral ovaries were extirpated, except sham and NC group, estrogen, different doses of SI or deionized water were fed i.g. for 12 w. Except NC group, the other groups were fed high fat diet. Body weights were weighed every week and blood and heart were collected at the end of experiment. The serum TC, triglyceride(TG), high or low density lipoprotein-cholesterol (HDL-C, LDL-C), Lp (a), and antioxidative enzymes activities were assayed. Results:After SI intervention, the levels of LDL-C in SI groups were significantly lower than in HF group but higher than in NC group. The levels of Lp (a) were also changed, but there was almost no effect on HDL-C. Persistent intervention with SI can reduce TC, TG , and protect cadiocyte’s actin filament andmitochondrial ultramicrostructure from damage as shown in HF group. The ultramicroscopic pictures in EG and H-SI group almost resembled NC group. Conclusion:Persistent intervention of high-dose SI can reduce the levels of LDL-C, TC, TG and protect the myocardiac damages due to high fat diet in ovariectomized rats.

OBJECTIVE: To prepare bezafibrate osmotic pump tablets(BOPT) and optimize its formulation by central composite design-response surface methodology(CCDRSM).METHODS: The amount of polyoxyethylene(PEO) N80 which used as an adjuvant of Bezafibrate osmotic pump tablets(A),the amount of Na2CO3(B),and the coating weight increase(C) were used as 3 factors for investigation,and the cumulative release amount at 1 h and 6 h respectively,and the linear correlation coefficient(r) of the cumulative release amount versus time were taken as indexes.The formulation of BOPT was optimized by CCDRSM and the optimized formulation was verified.RESULTS: The optimized formulation obtained was as follows: A 40 mg,B 20 mg,and C 29 mg.The tablets prepared in optimized formulation demonstrated good release behavior,with the absolute value of deviation of each index being less than 5%.CONCLUSION: The CCDRSM can be applied to optimize the formulation of BOPT and the established model is of satisfactory predictive value.

Objective: To analyze influencing factors of percutaneous coronary intervention (PCI) on therapeutic effect in patients with coronary chronic total occlusions (CTO). Methods: Clinical data, lesion features and PCI therapeutic results of 65 patients with 72 CTO lesions, who received PCI in our hospital from Jan 2010 to Dec 2012, were retrospectively analyzed. Results: PCI success rate of CTO lesion was 91.67% (66/72); compared with patients with CTO occlusion 3~12 months, there was significant decrease in PCI success rate (97.78% vs. 81.48%) in those with CTO occlusion >12 months; compared with patients with occlusion length ≤15mm, there was significant decrease in PCI success rate (97.96% vs. 78.26%) in those with occlusion length >15mm; compared with patients with mouse tail-like broken ends, there was significant decrease in PCI success rate (96.55% vs. 71.43%) in those with knife cut-like broken ends, P<0.05 all; PCI failed in six lesions, in which four because guidewire failed to pass through lesions and two because balloon failed to pass through lesions; incidence rate of complications was 7.69% during PCI, there were no major adverse cardiovascular events during admission in all patients; symptoms relieving rate of angina pectoris was 90.16% after PCI. Conclusion: Success rate of percutaneous coronary intervention is related to lesion features, CTO occlusion duration etc.

Objective To investigate clinical and epidemiological features of pneumocystis jirovecii pneumonia (PJP) in kidney transplant recipients. Methods Clinical data of 68 kidney transplant recipients admitted from July, 2021 to December, 2021 were collected. All patients were divided into the PJP group (n=11), common pulmonary infection group (n=24) and non-pneumonia group (n=33) according to the status of pulmonary infection. The incidence and treatment of PJP after kidney transplantation were analyzed. Basic characteristics and laboratory parameters of the recipients were compared among all groups. The genotyping and transmission map of PJP patients were evaluated. Results Among 64 kidney transplant recipients, 11 cases were definitely diagnosed with PJP. The most common clinical manifestations included elevated body temperature, and dry cough complicated with progressive dyspnea. Chest CT scan showed diffuse interstitial inflammation and ground glass-like lesions of bilateral lungs in all patients. After diagnosis, all patients were orally given with compound sulfamethoxazole for 3-4 weeks. Two patients received non-invasive ventilator-assisted ventilation due to severe lung infection and dyspnea, and the remaining patients were given with nasal cannula oxygenation. One patient experienced elevated serum creatinine level upon discharge, and developed renal allograft failure. The remaining 10 recipients with PJP obtained normal renal allograft function, and no recipient died. Compared with the non-pneumonia group, the rejection rate was higher, the length of hospital stay was longer, the lymphocyte count was less, the lymphocyte proportion was lower, the levels of C-reactive protein, serum creatinine and lactate dehydrogenase were higher, and the levels of serum albumin was lower and CD4⁺T cell count was less in the PJP group (all P < 0.05). Compared with common pulmonary infection group, the lymphocyte count was less, the lymphocyte proportion was lower, the CD4⁺T cell count was less and 1, 3-β-D- glucan (BDG) level was higher in the PJP group (all P < 0.05). No new genotype was detected in 10 of the 12 testing samples. It was considered that PJP mainly depended on two transmission chains and two independent transmission individuals. Conclusions Kidney transplant recipients are prone to pneumocystis jirovecii (PJ) infection due to impaired cellular immune function. The most common clinical manifestations consist of elevated body temperature and dry cough complicated with progressive dyspnea, accompanied by headache and fatigue in partial patients. Chest CT scan shows diffuse interstitial inflammation and ground glass-like lesion of bilateral lungs. PJ may be transmitted through respiratory tract. Small-scale PJP might occur in the follow-up outpatient of kidney transplant recipients. Preventive measures should be delivered in a timely manner.