Objective:To investigate the protective effects of Mailuoning(MLN)against cisplatin(CP)-induced acute kidney injury(AKI)utilizing network pharmacology and to analyze the underlying mechanism of action related to anti-apoptotic pathways.Methods:Active components of MLN and targets related to AKI were identified using network pharmacology.The active components of MLN were sourced from the TCMSP and ETCM 2.0 databases.The targets of components were predicted using the Swiss Target Prediction tool,and subsequently the targets related to AKI were retrieved from the GeneCards database to identify intersecting targets.A protein-protein interaction network was constructed using the STRING database,and a topological analysis was performed using Cytoscape to identify core targets.Gene Ontology(GO)functional annotation and Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway en-richment analyses were conducted on these core targets.For the animal experiments,forty mice were randomly assigned to four groups:solvent control,MLN toxicity control,CP model,and CP+MLN groups.The MLN group received intraperitoneal injections of MLN at a dose of 15 mL/(kg·d)for ten consecutive days.The CP model and CP+MLN groups were administered a single intraperitoneal injec-tion of CP at 20 mg/kg on day 7.Three days after the CP treatment,plasma levels of blood urea nitrogen(BUN)and creatinine(Cre)were measured.The pathological injury of kidney tissues was as-sessed using hematoxylin-eosin staining.Western blot analysis was utilized to determine the expression of neutrophil gelatinase-associated lipocalin(NGAL)and apoptosis-related proteins in kid-ney tissues.Results:A total of 104 active components of MLN and 224 targets were identified using network pharmacology,and 2 465 targets were identified to be related to AKI,resulting in 117 intersecting targets,of which,17 targets were classified as core targets.KEGG and GO analyses indicated that the apoptosis-related signal transduction pathway might be a crucial pathway through which MLN provided protective effects against AKI.The results of animal experiments confirmed the successful establishment of CP-induced AKI models in mice.Compared with the CP model group,MLN treatment significantly reduced plasma levels of BUN and Cre(P<0.05),inhibited NGAL protein expression in the kidneys(P<0.05),and improved the pathological injury observed in kidney tissues.Furthermore,MLN markedly reduced the expression levels of p-P53(ser 15)and cleaved caspase-3 proteins,as well as the Bax/Bcl-2 ratio in kidney tissues of AKI model mice(P<0.05),while upregulating protein kinase B phosphorylation levels(P<0.05).Conclusion:MLN demonstrates protective effects against CP-induced AKI in mice,potentially through mechanisms related to its anti-apoptotic properties.

Objective This study aimed to investigate the factors influencing the personal burden rate incerebral ische-mic patients,compare the difference in the burden rate among the patients with varying degrees of cerebral ischemia,provide a reference for establishing a personal burden rate evaluation,and propose suggestions for control its increase.Methods The medi-cal insurance data were collected from 8164 discharged patients in a tertiary hospital in Tianjin between January and December 2022.With the data,the Generalized Linear Model was utilized to analyze the factors affecting the personal burden rate across different Diagnosis Related Groups(DRGs).Results Statistically significant differences were observed in the cost structure a-mong different DRGs.Age,length of hospital stays,total hospitalization cost,hospital admission mode,number of hospitaliza-tions,and type of medical insurance significantly impacted the personal burden rate.The personal burden rate was inversely cor-related with age and length of hospital stays,but directly correlated with the total hospitalization cost.The patients admitted from emergency,first-time hospitalization,and those covered by the basic medical insurance program for urban employees had a lower personal burden rate.Conclusion Hospitals should establish diverse personal burden rate performance evaluation standards for patients with different types of medical insurance,incorporating factors such as average length of hospital stays and average hospi-talization cost.A more equitable hospital internal assessment plan should be developed by considering patients admitted to differ-ent departments and aligning with the characteristics of clinical pathways.Medical institutions should minimize self-funded pro-jects under declared medical insurance,increase the enrollment of cases in DRGs,and promote tiered diagnosis and treatment to reduce the personal burden rate for patients.

Objective This study aims to investigate the application of the Plan-Do-Check-Act(PDCA)cycle in the Di-agnosis Related Group(DRG)payment system for oncological diseases.Methods We analyzed the factors influencing DRG pay-ment and incorporated the PDCA Cycle in the oncological diseases at a tertiary hospital in Tianjin.The baseline data of cases partic-ipating in DRG payment from April 2022 to September 2022 were compared with the settlement data of cases participating in DRG payment from October 2022 to March 2023.SPSS 20.0 was used to evaluate the impact of data quality in medical record documenta-tion on DRG admission rate,average hospitalization costs,average length of stay,Case Mix Index(CMI)value,and DRG settle-ment rate,so as to assess the effectiveness of the PDCA cycle in DRG payment within the oncological diseases at the hospital.Re-sults Following the PDCA cycle,the DRG admission rate increased from 84.03%to 89.98%,and the cases ineligible for inclu-sion decreased by 22.78%due to mismatched main diagnosis and procedures."Violations of the reporting and coding principles that do not require reporting"and"omission of primary surgical procedure codes"were no longer observed as reasons for failed DRG inclusion.Ambiguous cases with both average hospitalization costs and average length of stay higher than those of normal inclu-sion cases,leading to an increase in the average hospitalization cost from 22 496.56 yuan to 24714.92 yuan,and the average length of stay increased from 7.50 days to 8.13 days.The CMI value increased from 0.96 to 1.08,and the DRG settlement rate increased from 107.93%to 130.67%.Conclusion The PDCA cycle can effectively enhance the quality of medical record documentation,leading to improved quality in medical insurance settlement lists and DRG admission rates.It can help identify operational issues within the de-partment and promote the smooth implementation of DRG payment reform in the oncological department.

Objective To explore the application value of the Plan-Do-Study-Act(PDSA)cycle in reducing the occur-rence of decomposed hospitalization for stroke disease under the Diagnosis Related Group(DRG)payment model and validate the effectiveness of strategies to reduce decomposed hospitalization.Methods Taking stroke cases participating in DRG payment from January 2022 to December 2022 in a tertiary hospital in Tianjin as the baseline,the criteria for decomposed hospitalization were determined based on the"Implementation Rules for DRG/DIP Network Audit(Trial)"issued by the Tianjin Medical Insur-ance Fund Settlement Center.A PDSA cycle plan was developed according to the document content,and the PDSA cycle was im-plemented from January to December 2023.The relationship between the number of decomposed hospitalizations before and after the PDSA cycle was analyzed using SPSS 20.0 to determine the actual application effect.Results After the PDSA cycle,the number of decomposed hospitalizations decreased from1268 cases to26 cases,a total decrease of 97.95%.The number of cases in each target subgroup and the frequency of factors leading to decomposed hospitalization all showed a significant decrease.Con-clusion The PDSA cycle plays a significant role in addressing the problem of decomposed hospitalization for stroke disease under the DRG payment model.It can effectively reduce the occurrence of decomposed hospitalization,improve the quality of medical insurance settlement lists and medical records,and standardize clinical diagnosis and treatment behavior.

Marinesco-Sj?gren syndrome (MSS), also known as hereditary ataxia-dwarf-mental retardation syndrome, is a rare autosomal recessive ataxia syndrome. This article reviews the recent advance in clinic characteristics, pathogenic gene mutation sites, pathogenesis and clinic diagnosis and treatment of MSS, in order to improve clinicians' understanding of the disease and diagnosis and treatment level, and reduce the missed diagnosis and misdiagnosis of the disease.

OBJECTIVE：To study the heart protective effect of Panax quinquefolium extract of Zebra fish. METHODS ：The drug dosage of P. quinquefolium extract and the optimal modeling dose of terfenadine were determined by tolerance test ；24 hours post fertilization （24 hpf），Zebra fish were divided into control group （0.5％ dimethyl sulfoxide ），model group （2.5 μg/mL terfenadine），positive control group （2.5 μ g/mL terfenadine + 30 μ g/mL resveratrol） and different mass concentration P. quinquefolium extract groups （2.5 μg/mL terfenadine+5，10，25 μg/mL P. quinquefolium extract，by raw material ）. 48 h after incubation，the heart rate and sinus venous-bulbus arteriosus （SV-BA）interval of Zebra fish were used as indexes ，and the heart injury repair rate was calculated to investigate the heart protection of P. quinquefolium extract. Another 24 hpf Zebra fish were divided into blank control group ，model group ，positive control group ，20 batches of P. quinquefolium extract from different producing area groups （5 μg/mL，by raw material ），with same administration route and 48 h of incubation. The heart rate ，SV-BA interval of heart was determined ，heart injury repair rate and heart injury relative repair rate were calculated ；the heart protective effect of P. quinquefolium extract was further validated. RESULTS ：Compared with blank control group ，heart rate was decreased significantly（P＜0.01），while SV-BA interval was increased significantly in model group （P＜0.01）. Compared with model group，heart rate of Zebra fish was increased significantly in positive control group and 5，10，25 μg/mL P. quinquefolium extract groups（P＜0.01），while SV-BA interval of Zebra fish was shortened significantly in 5，10 μg/mL P. quinquefolium extract groups （P＜0.05 or P＜0.01）；heart injury repair rate of Zebra fish in 5 μg/mL P. quinquefolium extract group reached 73.77％. In validation test ，compared with model group ，heart rate was increased significantly （P＜0.01），while SV-BA interval of Zebra fish was decreased significantly in 20 batches of P. quinquefolium extract groups （P＜0.01）；heart injury repair rate ranged 70.45％-85.78％，and heart injury relative repair rate ranged 75.48％-98.12％. CONCLUSIONS ：P. quinquefolium extract has good heart protective effects.

Objective To study lymphocyte subsets changes in patients with malignant tumors during chemoimmunotherapy and the clinical significance. Metheds Fifty one cases were treated with chemotherapy and twenty six cases with chemoimmunotherapy. Lymphocyte subsets were determined by flow cytometry. Results Chemotherapy significantly decreased CD 3 +, CD 4 + and NK cells ( P 0 05). Chemoimmunotherapy elevated CD 8 + and NK cells ( P