Correctly grasping the International Classification of Diseases ICD-10 and surgical classification ICD-9-CM-3 encoding method to improve coding accuracy and professional level is increasingly important to the current hospital information management.Through systematic continuing education training,the relevant personnel should be familiar with ICD-10 and ICD-9-CM-3 encoding rules,and continue to accumulate the appropriate clinical knowledge to improve their own coding levels.Coders should be a basis,six fits,that is based on the international classification of diseases and operation classification coding rules,coders should rcad more medical records,have more communication with clinicians,understand clinical medical knowledge,do more book search query for [CD code,sum up coding experience and multiply track the latest development of medicine and ICD coding.

Objective To investigate the clinical and serological manifestations of the interstitial lung disease(ILD) resulting from the dermatomyositis(DM) or the polymyodsitis(PM),and the factors affecting the resulting of treatment for the purpose of providing necessary reference for clinical treatment and diagnosis.Methods The clinical manifestations and the findings of serological tests of 18 patients compared with only DM or PM.Results ILD was likely to strike 42.9 percent of patients with DM or PM,who were higher than those without ILD in the rate of positive Jo-1,LDH and Reynolds disease.Conclusion The patients with DM or PM,with their high probability to be stricken by ILD,need HR-CT scanning in order to be diagnosed as early as possible.

Objective Through the investigation of nurses'situation of fatigue and perceived social support, to know about the status of nurses' fatigue and the degree of perceived social support, and influenc-ing factors for a preliminary regression analysis of nurses in order to further the prevention of the occurrence of chronic fatigue for reference. Methods By using fatigue assessment scale (FAI), fatigue scale (FS-14)and perceived social support scale (PSSS) to investigate 200 female nurses in Jining city, 191 valid questionnaires were got, the reclaimed efficiency was 95.5%. The results underwent analysis. Results Nurses who had accounted for 69.11 percent of fatigue, had more severe fatigue than nurses who had less fatigue, and they had tense response to rest or sleep. Nurses' physical fatigue and mental fatigue were significantly higher than the general healthy population. Nurses received higher scores of social support. Age and other factors and perceived social support went through regression analysis: the degree of job tension exacerbated the severity of fatigue, however, social support to some extent, mitigated or alleviated the situation of nurses in the total fatigue. Conclusions Nurses are high-risk population for fatigue. The degree of job stress is the main influencing factor. And social support and care for nurses, especially home care support, adequate rest, in-creasing the number of nurses, good working environment can effectively reduce fatigue.

There are a lot of medical colleges which carry out foreign student medical education in our country. On the basis of clinical theory situation and problems of foreign students medical education,Xuzhou Medical College implemented a number of reform measures and achieved good teaching effect.These measures included writing new syllabus of oversea students and reforming multiform teaching methods and the pattern of examination and evaluation for clinical theory.

ObjectiveTo compare the therapeutic effect, adverse effects and safety of leflunomide (LEF)and cyclophosphamide(CTX) on lupus nephritis(LN). Methods43 patients with reactive LN were randomly divided into two groups. Based on hormone application,22 cases in LEF group were given LEF orally and 21 cases in CTX group were given CTX intravenous drip discontinuously. They were followed up for six months. The related indexes and possible concomitant adverse effects were detected. ResultsThe total effective rate in LEF group was 81.8％ and that in CTX group was 85.7％. The tolerance in LEF group was better and 3 cases had adverse effects. 13 cases in CTX group had adverse effects. ConclusionLEF had the same efficacy as CTX in the LN therapy, but the tolerance is better and the side effects are minor than CTX.

Objective To analyze the drug resistance genes and homology in nosocomial infection caused by carbapenem‐resistant Acinetobacter baumannii(CRAB) .Methods Forty strains of CRAB were collected and the minimal inhibitory concentration (MIC) was detected by the agar dilution method .The main carbapenemase genes were detected by PCR .The PCR products were performed the DNA sequencing .The enterobacterial repetitive intergenic consensus (ERIC)‐polymerase chain reaction(PCR) was performed to analyze the genotypes and homology of these strains .The plasmid conjugation experiment was carried out to investigate the trans‐mission of resistant genes .Results Forty strains of CRAB maintained the good sensitivity only to polymyxin B (100% ) and cef‐operazone/sulbactam(57 .5% ) .All of them had different degrees of resistance to other drugs .The OXA‐23 and OXA‐51genes were detected by PCR amplified in all of the CRAB strains .The homology analysis showed that the strains could be divided into 4 types according to 80% of cluster similarity coefficient ,the type A1 (19 strains) was the major epidemic strain ,moreover the various de‐partments had cross infection ;the plasmid conjugation experiment failed .Conclusion There is an endemic spread of CRAB in our hospital and its resistant mechanism is mainly related with OXA‐23 gene expression ;in the rational antibiotics use at the same time , the isolation and prevention measures should be done well for avoiding the hospital cross infection .

Objective To explore the cell frequency , phenotypes and in vitro cytotoxic effects of circulating CD56+T cells in the patients with chronic HCV infection .Methods Peripheral blood mononu-clear cells (PBMCs) were isolated from 33 patients with HCV chronic infection and 21 healthy subjects. Multi-color flow cytometry was used to analyze cell frequency , expressions of activating receptors ( NKG2C, CD16 and NKp46) and inhibitory receptors (NKG2A and CD158a) on CD56+T cells.The functional mark-er for cytotoxic effects (CD107a) on circulating CD56+T cells and their cytokines expression (IFN-γand TNF-α) with or without stimulation of K 562 human Leukemia cell line were also analyzed .Then the correla-tions among the expressing levels of CD 107 a, IFN-γand TNF-αwere investigated .Results The frequency of CD56+T cells in periphery lymphocytes were significantly decreased in the patients with chronic HCV in -fection as compared with that in healthy controls ( P=0.018 ).The expressions of activating receptors (NKG2C, CD16 and NKp46) on CD56+T cells from HCV infected patients were decreased (P=0.015 for NKG2C, P=0.036 for CD16 and P=0.001 for NKp46), while there was no significant change in the ex-pressions of inhibitory receptors (P>0.05 for both CD158a and NKG2A).The concentrations of IFN-γand TNF-αsecreted by CD56+T cells in the patients with chronic HCV infection were significantly decreased with or without K562 stimulation (P<0.0001).However, in the presence of K562 cells CD107a expression on CD56+T cells were sharply decreased in the patients (P<0.0001).In absence of K562 cells, there was no significant change in CD107a expression on CD56+T cells from patients and healthy controls (P>0.05). The expressions of CD107a, IFN-γand TNF-αwere closely related under the stimulation of K562(r>0.80, P<0.0001).Conclusion The frequency of CD56+T cells was reduced in patients with chronic HCV infec-tion.Moreover, cytotoxic effects and cytokines production mediated by CD 56+T cells were also significantly impaired, indicating that the dysfunction of circulating CD 56+T cells might be associated with the persist-ence of chronic HCV infection .

Combined with the practice of curriculum reform in Xuzhou Medical College for for-eign clinical medical students, this paper discussed its experiences in compiling the teaching syllabus, programming rational courses, increasing practical class hours, establishing corresponding elective courses, taking various teaching methods and using flexible testing mode.

Objective: To investigate the association between body mass index ( BMI ) and mortality risk among older Chinese based on the China Health and Retirement Longitudinal Study ( CHARLS ). Methods: The demographic features, BMI, prevalence of chronic diseases and mortality among the elderly at ages of 60 years and greater were captured from the CHARLS database from 2011 to 2018. A multivariable Cox proportional hazards regression model was used to examine the association between BMI and the risk of death. Results: Totally 6 023 subjects were enrolled, including 3 006 men ( 50.09% ) and 3 017 women ( 49.91% ), and 68.69% of the participants ( 4 137 subjects ) were at ages of 60 to 69 years. There were 637 subjects ( 10.58% ) with underweight, 1 544 ( 25.63% ) with overweight, and 557 ( 9.25% ) with obesity. During the follow-up period ( 35 091 person-years ), 1 035 subjects died. Multivariable Cox proportional hazards regression analysis revealed an increased risk of mortality among the underweight elderly ( HR=1.496, 95%CI: 1.261-1.775 ) and a reduced risk of mortality among the obese elderly ( HR=0.671, 95%CI: 0.511-0.881 ) relative to the elderly with normal weight, after adjustment for age, gender, smoking, household registration, administration of anti-diabetic drugs, administration of anti-dyslipidemia drugs, and administration of anti-hypertensive drugs. Conclusion It is found that the risk of mortality among the Chinese elderly correlatives with BMI through the analysis of CHARLS data.

Objective: To establish an optimized path for health management of HBV infections among pregnant and lying-in women based on a Delphi method, so as to provide the evidence for intensifying the interruption of the mother-to-child transmission of HBV. Methods: Based on literature review and previous studies, the preliminary framework and contents of the optimized path for health management of HBV infections were constructed. Experts from epidemiology, clinical medicine and maternal and children healthcare were invited to participate in two-round Delphi consultations, and the preliminarily designed indicators were screened and revised. The score for feasibility of each indicator was calculated, and the weight of each indicator was estimated using a proportional distribution method. Results: Sixteen experts participated in the consultation, including 13 women. The participants had a mean age of (45.69±5.71) years, and a mean employment duration of (23.06±7.05) years. All participants had a degree of bachelor and above, and there were 14 experts with vice senior professional titles. The mean positive coefficient was 96.88% and the mean authority coefficient was 0.790 during the two-round expert consultations. There were significant differences in the coordination coefficient of importance, necessity and feasibility of indicators at all levels (P<0.05), and the coefficient of variation of the feasibility was all less than 0.250. The final optimized path for health management of HBV infections among pregnant and lying-in women included 6 primary indicators, 17 secondary indictors and 73 tertiary indicators. Among the primary indicators, delivery management (0.173 4), screening and evaluation (0.172 8) and pregnancy management (0.172 7) had a high weight. Conclusion A scientific and reliable optimized path is created for health management of HBV infections among pregnant and lying-in women, which has a potential value for improving the interruption of mother-to-child transmission of HBV.