Objective To analyze the hospitalization expenses of cancer patients covered with byitem payment and quota payment packages,and probe into the impacts on such expenses for the two payment packages.Methods Inpatient records of 600 cancer patients were sampled by random from the medical insurance databases of Zhengzhou and Fuzhou to learn their hospitalization expenses and impact factors.Results Under the by-item payment package,the expenses of urban workers’ medical insurance were found higher than those of urban residents' medical insurance,with a per capita expense of RMB 32747.70 ± 32035.01 and 23035.83 ± 22875.65 respectively.Under the quota payment package however,there were no significant differences between expenses of the two kinds of inpatients,with a per capita expense of RMB 66043.41±47562.09 and 66576.54±73417.29 respectively.Conclusion There are gaps of reimbursement level between the two basic insurance schemes,which may not disappear in a short time.Under the by-item payment package,the gap exists in the difference of perreimbursement amount; under the quota payment package,the gap is negligible between the two populations under different insurance schemes.It is recommended to make reasonable use of these different payment schemes to minimize the relative gaps in medical service accessibility caused by the difference in reimbursement level.

Objective: To evaluate the effect and safety of continuous veno-venous hemofiltration(CVVH) in the treatment of multiple organ failure(MOF) in senile patients.Methods: Sixteen patients with multiple organ failure,aged over 80 years,were divided into a survival group,who lived more than 20 days,and a non-survival group,less than 20 days after CVVH,and observed for such clinical indexes as of renal function,K+and blood gas analysis,APACHEⅡ scores and complications.Results: After CVVH,eleven of the patients survived for over 20 days,with 1 case up to 3 years.CVVH effected a significant improvement in BUN,Scr,K+and blood gas as well as a marked reduction in complications.APACHE Ⅱ scores decreased significantly after CVVH in the survival group though not in the non-survival group,as compared with those before CVVH,which were significantly lower in the former than in the latter.Conclusion: CVVH is a safe,effective and well-tolerated method for the treatment of MOF in senile patients.Patients with higher APACHEⅡscores have a poor prognosis.

Objectives:This study aims to provide a full picture of how Health Policy and Systems Research ( HPSR) in Chinese universities. Based on the current situation, analysis of problems and challenges of the HPSR capacity has been conducted and suggestions on personnel training have been proposed. Methods: Quantitative sur-veys and qualitative interviews have been conducted among personnel engaged in HPSR from 8 representative univer-sities. Results:Most HPSR researchers in the universities are young, of which 75. 26% have doctorates and the ma-jority is trained in health care management and public health sciences. Among the current HPSR projects, health in-formation and evidence is the main research direction in this field, and both the capital investment and attention of re-searchers are high. However, research resources and funding are still currently focused on senior researchers, with limited efforts to support young scholars. HPSR has interdisciplinary and multidisciplinary characteristics, but cur-rently the collaboration among institutions and individuals is relatively limited. In addition, only 5. 81% of undertak-en HPSR projects have been translated into health policy. Discussion and Suggestions:HPSR researchers in Chinese universities are not sufficient and have similar backgrounds, resulting in limited collaboration. Investment in HPSR projects is still shallow and young researchers are vulnerable in acquiring funding resources. The ability to translate research results into policy is weak. Therefore, this paper suggests to mainstream undergraduate and postgraduate teaching, enhance the training, funding and technical support for young researchers, and to establish the mechanism of dissemination of research findings and their translation into policy.

The severity of disease can be used to evaluate the current situation of patients as well as to predict the diseases outcome.In the meantime, the severity among different diseases has been more and more applied in the evaluation of the patients at hospital level.This study collected and summarized different types of international disea-ses grouping tools'characteristics and applications based on the severity of disease, and their suitability and practical values in hospital performance evaluation were compared and analyzed.

Two simple and sensitive high performance liquid chromatography–tandem mass spectrometry (HPLC–MS/MS) methods were developed and validated for the determination of fenticonazole in human plasma after percutaneous and intravaginal administration. Mifepristone was used as an internal standard (IS), and simple protein precipitation by acetonitrile containing 2%acetic acid was utilized for extracting the analytes from the plasma samples. Chromatographic separation was performed on a Kinetex XB-C18 column. The quantitation was performed by a mass spectrometer equipped with an electrospray ionization source in multiple reactions monitoring (MRM) positive ion mode using precursor-to-product ion transitions of m/z 455.2–199.1 for fenticonazole and m/z 430.2–372.3 for mifepristone. The validated linear ranges of fenticonazole were 5–1000 pg/mL and 0.1–20 ng/mL in plasma for the methods A and B, respectively. For the two methods, the accuracy data ranged from 85% to 115%, the intra- and inter-batch precision data were less than 15%, the recovery data were more than 90%, and no matrix interference was observed. The methods A and B were successfully validated and applied to the pharmacokinetic studies of fenticonazole gel in Chinese healthy volunteers after percutaneous and intravaginal administration, respectively.

This paper uses the data collected from 138,477 patient discharge records of 37 Shanghai tertiary public hospitals in December 2013 and classifies all the records into different groups by using a localized diagnosis re-lated group tool.The coefficient of variation index ( CV) of each group was used to analyze the dispersion of average hospital cost per inpatient day for each group, in order to evaluate the suitability of diagnosis related group systems and to set the coefficients of difficulty ( relative weights) for each disease.The study has found that severity-based di-agnosis related group systems are more suitable and consistent.However, future studies should collect more detailed information on health costs in order to reflect the value of health professionals and technologies and therefore further improve diagnosis related classification and develop new systems that can be adapted to local conditions by applying the weights of different groups.

Objective:To explore the pathogenesis of primary hemophagocytic syndrome with UNC13D and MYO5A gene mutations.Methods:A case of adult hemophagocytic syndrome with gene mutation of UNC13D and MYO5A admitted to The 940th Hospital of the Joint Logistic Support Force of the PLA on January 28, 2022 was retrospectively analyzed in terms of laboratory examination, gene atlas of its close relatives and prognosis, and related literature was reviewed.Results:The patient was finally diagnosed with primary hemophagocytic syndrome, and chemotherapy was performed twice with hemophagocytic lymphohistiocytosis(HLH)-2004 regimen. The HLA matching of his cytoplasm was semi-compatible. Considering that his cytoplasm carried blood-macrophage related genes, it was not suitable to be selected as a donor, and there were no other suitable relatives. He was transferred to another hospital for allogeneic hematopoietic stem cell transplantation, but failed to receive allogeneic hematopoietic stem cell transplantation during telephone follow-up, and died.Conclusion:The gene mutation of primary hemophagocytic syndrome is the gold standard for the diagnosis of primary HLH. There may be dual gene inheritance pattern in primary HLH, and the combination of immune disorder caused by viral infection and genetic factors may lead to the pathogenesis of primary HLH.

Objective To investigate the risk factors and improvement measures of thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients .Methods Case control studies were performed in this study . Totals of 100 maintenance hemodialysis patients with thrombosis in internal arteriovenous fistula from January 2009 to June 2015 in Lishui Central Hospital were included in observation group, while another 100 patients with maintenance hemodialysis who did not have thrombosis in internal arteriovenous fistula were involved as control group .The related clinical and nursing data were collected , and the correlation between the thrombosis in internal arteriovenous fistula and related factors were analyzed to improve targeted nursing .Results Prevalence of diabetes , puncture failure rate , hematoma occurrence rate , high intensity in site-directed oppression , tightly binding after hemodialysis rate , oppression time longer than 30 min after hemodialysis rate, ultrafiltration rate, hemoglobin, high-sensitivity C-reactive protein, fasting blood glucose, total cholesterol, low density lipoprotein cholesterol , calcium-phosphorus product and D-dimer in observation group were higher than those in control group .The differences were statistically significant ( P<0.05 ) .There were statistically significant differences in the systolic pressure and low molecular weight heparin usage between two groups (P<0.05).The multi-factor logistic regression analysis showed that the diabetes[OR=1.417, 95%CI (1.196 -1.803), P =0.001], puncture failure[OR=1.393, 95%CI (1.185 -1.638), P =0.000], tightly binding after hemodialysis [OR=1.249, 95%CI (1.101-1.416), P=0.001], oppression time longer than 30 min after hemodialysis[OR=8.369, 95%CI (1.725 -40.596), P=0.008], systolic pressure[OR=1.031, 95%CI (1.001 -1.061), P =0.040], ultrafiltration rate[OR =1.490, 95%CI (1.146-1.937), P=0.003], high-sensitivity C-reactive protein[OR=1.594, 95%CI(1.085-2.342), P=0.017], low-density lipoprotein cholesterol [OR=9.456, 95%CI (2.534 -55.040), P=0.007] and D-dimer[OR=11.711, 95%CI (5.310-69.231), P=0.005] were independent risk factors for thrombosis in internal arteriovenous fistula in maintenance hemodialysis patients .Usage of low molecular weight heparin [ OR=0.101, 95%CI (0.017 -0.590), P=0.011] was protective factor.Conclusions Thrombosis in internal arteriovenous fistula in patients with maintenance hemodialysis is not only related to metabolic factors , but also related to nursing factors .We should strictly control the ultrafiltration rate , improve puncture success rate , strengthen the health education and nursing observation post operation so as to early spot and prevent the thrombosis in internal arteriovenous fistula .

Objective To investigate the relationship of plasma albumin and hypersensitive C?reactive protein (Hs?CRP) with 5?year all?cause mortality among Chinese older adults aged 65 and older. Method Data was collected in 8 longevity areas of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) study conducted by Chinese Center for Disease Control and Prevention and Peking University at baseline survey in 2012 and 2014, the participants enrolled in 2012 was followed?up in 2014 and 2017, the participants enrolled in 2014 was followed?up in 2017 only. Finally, 3 118 older adults aged 65 and older with complete information on albumin, Hs?CRP and body mass index (BMI) were included in this study. Plasma samples of older adults were collected for the detection of albumin and Hs?CRP at baseline survey. Survival status and follow?up time was recorded for all participants. All older adults were divided into 4 groups according to the levels of plasma albumin and Hs?CRP, and Cox proportional hazard models were constructed to assess their influence on the risk of all?cause mortality. Results Among 3 118 older adults included, the prevalence of hypoalbuminemia was 10.1% (316/3 118), and was 22.8% (711/3 118) for elevated Hs?CRP. During 10 132 person?years of follow?up, 1 212 participants died. Participants with hypoalbuminemia had increased risk of all?cause mortality, with an hazard ratio (HR) and 95% confidential interval (CI) of 1.18 (1.01-1.38), compared to participants with normal plasma albuminemia; participants with elevated Hs?CRP had increased risk of all?cause mortality, with an HR (95%CI) of 1.18 (1.04-1.35), compared to participants with normal plasma Hs?CRP. Participants with normal plasma albumin and elevated Hs?CRP, with hypoalbuminemia and normal Hs?CRP, with hypoalbuminemia and elevated Hs?CRP also had increased risk of all?cause mortality when compared to those with normal plasma albumin and normal Hs?CRP, the HR (95%CI) were 1.16 (1.01-1.34), 1.11 (0.91-1.37) and 1.43 (1.11-1.83), respectively. Conclusion Hypoalbuminemia and elevated Hs?CRP were responsible for increased risk of 5?year all?cause mortality among Chinese older adults from 8 longevity areas.

Objective To explore the influence of different hardness surfaces on gait coordination in patients with functional ankle instability(FAI). Methods Qualisys Infrared Optical Motion Capture System was used to test the coordination and variability of 15 FAI patients on the right side at Nanjing Normal University from May to July,2023.The gait cycle data were collect-ed and intercepted,and coupling angle(CA)and standard deviation of coupling angle(SDCA)were calculated by Matlab to compare the differences on different hardness surfaces. Results On coronal plane,CA of hip-ankle joint was higher on the hard surface than on the soft surface during middle stage of support and early stage of swing,and lower on its rest stages and the gait stages of hip-knee joint and knee-ankle joint than on the soft surface(P<0.01).On sagittal plane,CA of hip-ankle joint and knee-ankle joint was smaller on the hard surface than on the soft surface during middle and late stages of support,and larger than on the soft surface during their rest stages,and the gait stages of hip-knee joint(P<0.01).On horizontal plane,CA of hip-knee joint was lower on the hard surface than on the soft surface during the late stage of support,and higher than on the soft surface during its early stage of swing and bearing stage of hip-ankle joint(P<0.01).Compared with the hard surface,SDCA was smaller on the soft surface than on the hard surface only in the hip-ankle on the sagittal plane and during bearing stage of hip-knee joint,and was greater than on the hard surface for the rest(P<0.01). Conclusion FAI patients showed more distal dominance on soft surface than on hard surface during most gait cycle on 3D plane,i.e.,advantage of ankle varus and plantar flexion increased,and advantage of hip joint decreased;the coordination variability was generally higher on soft surface than on hard surface.These findings suggested that FAI patients may increase the risk of recurrent lateral ankle sprain walking on soft surface.