Objective To explore the impacts of 24-hour medical records archiving on the DRGs grouping ratio and payment.Methods Retrospective survey was made in a tertiary hospital in Beijing during its pilot from November 18,2011 to May 31,2012.The study covered such categories as the 24-hour medical records archiving ratio,48-hour medical records archiving ratio,DRG grouping ratio and payment for discharged patients prior to and after the practice of such archiving requirement.The data were subject to a multilinear regression analysis.Results The practice of 24-hour archiving,since in place,has significantly raised the 24-hour ratio,48-hour ratio,DRG grouping ratio and payment ratio,with the differences statistically significant (averaging P＜0.0001).DRGs payment amount is positively correlated to the number of DRGs grouping (regression coefficient 0.75284,P＜0.0001).DRGs grouping amount is positively correlated to the number of 24-hour medical records archiving (regression coefficient 0.44233,P＜0.0001).Conclusion The 24-hour archiving practice has significantly raised DRGs grouping and payment ratio,making it one of requisites for hospitals to successfully carry out DRGs payment system.

Objective To evaluate the middle and long term effects of the two-stage procedures of drilling for hydroxyapatite orbital implant and inserting a motility peg, and to investigate the pathogenesis and treatment of the various complications during the procedure. Methods This retospective study included 68 patients who had underwent the drilling of the hydroxyapatite and motility peg placement for over 3 years. Mean age at operation was 30.7 years (range from 17～60 years). All patients were placed plastic peg. Information recorded included pre-and post-operative facial appearance, motility of the artificial eye, conjunctival sac discharge and other complications. Results No secondary infection occured in 36～72 months of follow up. All patients felt that there had been an improvement in the motility of their artificial eye. And their cosmetic appearance was acceptable. The most frequent complication encountered was discharge from conjunctiva sac, which occurred in 31 patients. Extrusion of the motility peg was found in 6 patients. 5 patients had exuberant granulation in conjunctiva sac. Conclusion Drilling of the hydroxyapatite implant improves both the appearance and the motility of the artificial eye. Complications are minor and can be easily prevented and treated. The vascularization of HA sphere with good motility should be drilled at relatively larger conjunctival sac in the patients who can cooperate under local anesthesia.

Objective To evaluate the clinical effect of the procedure that involves drilling and inserting a motility peg at the time of hydroxyapatite orbital implant.Methods 89 patients who needed hydroxyapatite orbital implant were divided into groups A and B.The patients in group A were drilled and inserted a motility titanium peg when hydroxyapatite implantation.The patients in group B were drilled and inserted a motility titanium peg 6 months after hydroxyapatite implantation.Data were recorded.including the rate of postoperative pain and conjunctive edema,postoperative facial appearance,motility of the artifieial eye,the rate of hydroxyapatite exposure,excursion and extrusion of titanium peg and other complications.Results The mobility of the prosthesis was 44.97%in group A,and 45.34%in group B.There was no difference in appearance and the motility of their artificial eye between the two groups.The rate of excursion of titanium peg was 4.2% in group A and 7.3%in group B and no statistical difference was found between the two groups.There were no prosthesis exposure,extrusion of titanium peg,secondary infeetion and other complication in one-year follow-up.There were no difference in the rate of postoperative pain and eonjunctive edema in first operative stage.The postoperative reaction in group A was lighter than that in group B in secondary operanve stage.Conclusion The hydroxyapatite orbital implant primary procedure drilling is simple,safe,convenient and effective.It is worth to recommend that procedure that involves drilling and inserting a motility peg at the time of hydroxyapatite orbitaI primary implant.

Objective To evaluate the application of the polymethyl methacrylate (PMMA) artificial eye in acquired ophthalmostewesis. Methods We summarized the experience in the application of PMMA in prosthesis for 8 years. 1155 patients were involved in the artificial eye custom-made program. The artificial eye was individually prepared based on the patient's condition and characters of the healthy eye.Results PMMA artificial eye associated with hydroxyl apatite implantation gave good cosmetic results with good motility, and there was no rejective reaction. The artificial eye was almost same to the real one in color and transparency. Conclusion It is suggested that PMMA is one of the best materials for manufacture of artificial eye at present.

Background　Culture of retinal pigment epithelium(RPE) cells is very important for establishment of proliferative vitreoretinopathy (PVR) model,prevention and treatment of PVR as well as RPE cell transplantation.Isolation of animal RPE cells by trypsinization is a critical step.ObjectiveThe present study is to establish the methods of isolation and culture of retinal pigment epithelium (RPE) cells in rabbit and comparied with that of pig RPE culture.MethodsRPE cells were isolated by trypsinization in pigmented rabbit and pig and cultured in DMEM containing 20% fetal bovine serum.Cultured RPE cells were identified by immunochemistry.The fourth generations of cells were used in this experiment.Morphology and characteristics of cultured RPE cells from rabbit and pig were examined and compared under the light microscope.ResultsIsolated RPE cells from pig were obtained by once trypsin digestion,but two times of trypsinization were needed in rabbit RPE cells isolation.The differentiation in response to trypsinization was related to anatomic difference between the two types of cells .The adherence time of pig RPE cells was 24 hours ,however,the rabbit RPE needed 48-72 hours after culture.Proliferation and vitality of cultured cells were gradually attenuated and melanin decreased after several times subculture.The morphology of culture RPE cells was obviously different between rabbit and pig because species difference.Immunohistochemistry demonstrated the positive response of RPE cells for keratin.ConclusionRPE cells can be acquired from both rabbit and pig by trypsinization and culture.The culture process of RPE cells of pig is simpler than that of rabbit.Cells within the fourth generations are suitable for experimental application.

Objective To evaluate the effects of exercise therapy for patients with difficult weaning using mechanical ventilation.Methods A total of 63 patients with difficult weaning using mechanical ventilation were randomly divided into the experimental group(33 cases) and the control group(30 cases).The patients in the control group received routine respiratory care,however,the patients in the experimental group received gradual and individualized exercise therapy according to patients' condition and physical strength.The items such as the tidal volume,respiratory rate,PaO2/FiO2 were compared between two groups.Results Compared with the control group,the tidal volume,respiratory rate,PaO2/FiO2 and the score of APACHE Ⅱ were better in the experimental group on the 21th and 28th day after mechanical ventilation,the heart rate was better in the experimental group on the 28th day after mechanical ventilation.In addition,the duration of mechanical ventilation and ICU hospitalization was shorter in the experimental group.But the rate of complications showed no significant difference.Conclusions Exercise therapy has a positive effect on patients with difficult weaning using mechanical ventilation.

Background Proliferative vitreoretinopathy (PVR) is a common cause of vision loss clinically,and retinal pigment epithelium (RPE) cells play a major part in this disease.Studying the effect of traditional Chinese medicine on RPE cells are of great importance to reveal the pathogenesis and prevention of PVR,which were rarely reported.Objective This study was to study and compare the inhibition effect among curcumin,salvia miltiorrhiza and matrine on IL-1β-induced proliferation of rabbit RPE cells.Methods RPE cells at passages 3-4 were enrolled for the research and identified by transmission electron microscope.The proliferation effect of IL-1 β (2.5,5.0,10.0,20.0 μg/L) and inhibitory effect of curcumin (5,10,20 μg/ml),salvia miltiorrhiza (5,10,20 μg/ml)or matrine (100,200,400 μg/ml) on RPE cells 24,48 and 72 hours after cultivation were studied by MTT assay.The 50％ inhibitory dose (IC50) of the three medicines were analyzed by regression analysis.The use and feeding of the experimental animals were followed by the ARVO Statement.Results RPE cells isolated from the rabbit eye were in round shape and abundant in melanin;The melanin significantly decreased in the fourth generations of RPE cells.Immunohistochemistry showed that the RPE cells was positive for keratin (AE1/AE3).The proliferation rates of RPE cells were statistically different among different concentrations of IL-1β 24,48 and 72 hours after cultivation (Ftime =30.33,P =0.00;Fconcentration =9.37,P =0.00);The proliferation rates of RPE were significantly different among different time points or different concentrations of IL-1β (all at P ＜ 0.05).And the proliferation rate run up to maximum at 10 μg/L after 72 hours of cultivation.The inhibitory rates of the three medicines were statistically different among different time points or different concentrations (curcumin:Ftime =128.75,P =0.00;Fconcentration =334.05,P=0.00.salvia miltiorrhiza:Ftime =39.32,P=0.00;Fconcentration =165.57,P=0.00.matrine:Ftime =267.76,P =0.00;Fconcentration =912.34,P =0.00).The three medicines dose-dependently and time-dependently inhibit IL-1β-induced proliferation of RPE cells,with significant differences between the adjacent time points and concentrations (all at P＜0.05).The IC50 were 26.77,19.01 and 9.45 μg/ml for curcumin;33.72,23.47 and 12.56 μg/ml for salvia miltiorrhiza,570.96,352.25 and 97.50μg/ml for matrine 24,48 and 72 hours after cultivation.Conclusions The proliferation of RPE cells can be stimulated by IL-1β,and the maximal proliferation occurred with a concentration of 10.0 μg/L IL-1β.Curcumin,salvia miltiorrhiza and matrine dose-dependently and time-dependently inhibit proliferation of RPE cells induced by IL-1β.Curcumin is the best medicine to inhibit the proliferation of RPE cells.

Objective To assess the value of magnetic resonance angiography (MRA) and arterial proton spin labeling (ASL) in the internal carotid artery transient ischemic attack. Methods According to TIA seizure frequency, 58 patients clinical diagnosed as TIA were divided into single group (n=12) and the frequent group (n=46). All patients underwent MRA and ASL, then intracranial arterial stenosis and cerebral perfusion were evaluated. Results Vascular stenosis with abnormal ASL were detected in 33 (71.74%) of 46 frequent TIA patients and 1 (8.33%) single TIA patient. The incidence of vascular stenosis with abnormal ASL was higher in frequent TIA than that in single TIA (P＜0.05). Conclusion Vascular stenosis with perfusion abnormality is one of the most risk factors of TIA frequent seizures. Combination of MRA and ASL can make judgment for stenosis and abnormality of cerebral blood flow, being helpful to understand the onset causes and prognosis of TIA.

Objective To investigate the prognostic value of lymph node status evaluated by computed tomography (CT) in cervical carcinoma treated with radical chemoradiation therapy.Methods 209 patients with FIGO stage Ⅰ B-ⅣA uterine cervical carcinoma treated with radical chemo radiation therapy were enrolled.Lymph node status was evaluated based on site,number and size respectively by CT.Kaplan-Meier method was used to analyze the impact of lymph node status as well as other pathoclinical factors on overall survival (OS).Cox regression model was used to explore the relationship between independent prognostic factors and OS.Results Lymph node metastasis rates for stage Ⅰ B,Ⅱ,Ⅲ and ⅣA patients were 16.7 ％ (1/6),48.2 ％ (68/141),57.4 ％ (31/54) and 87.5 ％ (7/8),respectively.Variate analysis showed that FIGO stage,anemia before treatment,para-aortic lymph node metastasis,and the number (≥3) and size (maximum diameter ≥ 2.0 cm) of CT positive lymph node were significant unfavorable prognostic factors for OS (P ＜ 0.05).FIGO stage,the number of lymph nodes metastasis,pathologic diagnosis and treatment regimen were identified to be independent prognostic factors in multivariate analysis.Conclusion Under current therapeutic strategy of concomitant chemoradiotherapy,lymph node metastatic status evaluated by pretreatment CT is still a significant and independent prognostic factor for cervical cancer.

Objective To explore the efficacy of triple therapy and sequential therapy in the eradication of Helicobacter pylori (Hp) in patients receiving long-term non-steroidal antiinflammatory drugs (NSAID) treatment.Methods Patients receiving long-term NSAID treatment were enrolled in this study.Patients diagnosed as Hp infection were divided into triple therapy and sequential therapy groups.The patients in triple therapy group received omeprazole,clarithromycin and amoxicillin theray for 10 days.The patients in sequential group received esomeprazole with amoxicillin for five days,and then esomeprazole with clarithromycin and metronidazole for another five days.All patients were given mucosal protective therapy as maintenance treatment after eradication therapy and followed up for 12 weeks.Patients underwent endoscopy examination and Hp testing before and after follow-up.Hp eradication rates were compared with the intention-to-treat (ITT) and per protocol (PP) analysis.Results According to ITT analysis,the eradication rates of Hp in triple therapy group and sequential therapy group were 78.4 ％ (40/51) and 80.0 ％ (40/50) respectively,there was no significant difference between these two groups (x2 =0.038,P=0.846).According to PP analysis,the eradication rates of Hp in triple therapy group and sequential therapy group were 84.4％ (38/45) and 87.0％ (40/46) respectively,there was no significant difference between these two groups either (x2=0.117,P=0.732).Conclusion There was no significant difference in Hp eradication between triple therapy and sequential therapy in patients receiving long-term NSAID treatment.