Objective To study the diagnostic value of 3T three-dimensional contrast-enhanced MR angiography (3D CE-MRA) of arteriosclerosis occlusive disease of lower extremities using a low dose of gadolinium.Methods 26 patients with arteriosclerosis occlusive disease of lower extremities were prospectively enrolled.DSA and 3D CE-MRA with a low dose of gadolinium were per-formed and directly compared by radiologists.Sensitivity,specificity,accuracy,positive and negative predictive values,Kappa val-ue of 3D CE-MRA were determined for significant stenoses and vessel occlusions (5 1%-100%).Results The diagnosis coincidence rate of 3D CE-MRA was 87.21%,over-and underestimation rates were 8.91% and 3.88%,respectively.Sensitivity,specificity, accuracy,positive and negative predictive values,Kappa value of 3D CE-MRA in the characterization of significant stenoses and oc-clusions were 91.67%,94.29%,93.22%,91.67%,94.29%,0.860,respectively,in aortoiliac arteries,and 90.63%,94.23%, 92.86%,90.63%,94.23%,0.849,respectively,in femoropopliteal arteries and 93.67%,75%,87.83%,89.1 6%,84.38%, 0.718,respectively,in infrapopliteal arteies.The overall sensitivity,specificity,accuracy,positive and negative predictive values, Kappa value in the lower extremity were 92.59%,88.62%,90.70%,89.93%,84.50% and 0.813.Conclusion 3T 3D CE-MRA with a low dose of gadolinium is an accurate method used to depict significant stenoses and occlusions comparable with that of DSA in lower extremity artery disease.

Objective To investigate the effectiveness of human insulin-like growth factor-Ⅰ(hIGF-Ⅰ) in transfecting adipose-derived mesenchymal stem cells (AdMSCs) and the expression of the transfected genes and find the possibility of differentiation of ADSCs to chondrocytes after hIGF-Ⅰ transfection. Methods AdMSCs were extracted from the fat tissue of the back of rabbits' neck and cultured in vitro by monolayer. Then, the recombinant eukaryotic expression plasmid poDNA3.1 + hIGF-Ⅰwas transfected into AdMSCs by Lipofectamine 2000. The growth of the ADSCs was observed by inverted microscope at 4-72 hours after transfection, at the end of passage and after stable transfection respectively, and the transfection efficiency was calculated. The hIGF-Ⅰ concentration in the supernatant was detected by enzyme-linked immnnosorbent assay (ELISA), the expression of collagen-Ⅱ by immunohistochemistry, the expression of hIGF-Ⅰ mRNA by reverse transcription polymerase chain reaction (RTPCR), the expression of hIGF-Ⅰ protein by Western blot and the cell cycle by flow cytometry. Results AdMSCs were shaped long shuttle and adhered to the disk at the 4th hour. AdMSCs were increased and distributed in cluster at 24th hour. After tranafection, AdMSCs were proliferated actively, with shortened doubling generation time. The concentration of hlGF-I in the supematant increased slowly after transfection and reached peak at 32.45 ng/ml at the 72nd hour. The hIGF-Ⅰ concentration remained at 28.36 ng/ml after stable transfectian. Immunohistochemistry affirmed a large number of collagen-Ⅱ in the endochylema and positive expression of hIGF-Ⅰ mRNA and hIGF-Ⅰ protein. The percentage of AdMSCs at stage S increased after transfection, which was significantly higher than that of AdMSCs without transfection, with statistical difference (P < 0.05). Conclusion After stable transfection, AdMSCs can secrete high concentration of hIGF-Ⅰ that can promote cell proliferation and differentiation of AdMSCs to chondrocytes.

Objective To study the technical details, clinical results and complication of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation. Methods Ninety cases of lumbar disc herniation were operated upon with MED, and followed up for 24-32 months. Under direct endoscopic manipulation, semi circular excision of the inferior part of lamina, removal of the lateral part of the ligamentum flavum and the medial part of the facet were performed. The annulus fibrosus was circularly excised and the nucleus pulposus was removed. Results After operation, the patients could walk in 1.9 days, resumed their daily activities in (2.4?1.9) weeks and went back to work in (4.3?3.8) weeks. The rate of improvement was 83.1%. Several technical problems could happen in the beginning of using MED, including wrong identification of the vertebral level, difficulty to enter into the spinal canal and to control the bleeding, as well as injury of nerve root, dura mater and facet joint. Conclusion The advantages of MED are removal of the annulus fibrosus, the calcified ligamentum flavum and osteophyte under direct vision. However, sometimes it is difficult to fix the tip of microendoscopic tube on the surface of the lamina. Improvement is needed for the instrument design in order to increase the safety and easier manipulation.

Objective To discuss the application of C-arm CT scanning technology in performing transcatheter arterial chemoembolization for hepatic cancer.Methods Seventy-seven patients of hepatic cancer were treated with selective transcatheter arterial chemoembolization(TACE),which was followed by C-arm CT scanning to observe the embolization effect.C-arm CT scanning was also performed before TACE in 13 cases.Three-dimension reconstruction of the images was carried out on Integris 3D-RA workstation.The therapeutic results were evaluated.Results The embolization state of both the peripheral margin and the body of the tumor could be clearly displayed on CT scans in all 77 patients.Some tiny liver lesions were also detected in 3cases.Conclusion C-arm CT scanning technology is a newly-developed high-tech examination.This examination is very helpful for making the proper operation scheme and for evaluating the curative effect of intravascular intervention.Compared to the traditional CT scanning,C-arm CT scanning can provide more accurate information and stereoscopic image of the lesions,therefore,the whole course of the interventional procedure can be entirely under the operator's control and the curative effect can be evaluated at any time during the operation.C-arm CT scanning can be effectively employed in interventional therapy for multisystemic disorders.

Objective To explore the endovascular therapeutic strategy for multiple occlusive lesions of aorta and iliac-femoral arteries, and to discuss the technical skill as well as the clinical significance. Methods A total of 8 patients with multiple occlusive lesions of aorta and iliac-femoral arteries were enrolled in this study. Preoperative CT angiography and MR angiography were performed in all the 8 patients. The lesions included complete occlusion of abdominal aorta below renal artery level (n = 2), distal abdominal aorta occlusion (n = 4), distal abdominal aorta stenosis (n = 1), distal abdominal aorta membranous occlusion (n = 1), and diseased iliac artery (n = 12), external iliac artery (n = 8), femoral artery (n = 1) and popliteal artery (n = 2). Endovascular interventional management, including opening channel, thrombolysis, balloon dilation, stent implantation, etc. was carried out via different routes. The results were analyzed. Results After endovascular interventional management the abdominal aorta was completely reopened in all the 8 patients. Of 12 diseased iliac arteries, 9 were successfully reopened by interventional treatment and the remaining 3 were not treated. All the diseased external iliac arteries were opened up. The involved femoral artery and popliteal arteries were not treated. The patients were followed up for 1 -12 months. During the follow-up period, ischemic symptoms of the lower limb disappeared in 5 patients and were obviously improved in 2 patients. Recurrence of thrombotic occlusion was observed in one case, which returned to normal after transcatheter thrombolysis therapy. Conclusion For the treatment of multiple occlusive lesions of aorta and iliac-femoral arteries, endovascular interventional management is safe, simple and effective with fewer complications. The ischemic symptoms of the lower limb can be significantly improved.

Objective:To explore the impact of the clinic-pharmacy separation reform in Beijing on the outpatients with medical insurance.Methods:A segmented regression model of interrupted time series(ITS)data was used, to analyze the changes from April 2017 to May 2019 in outpatient visits, average cost per visit, out-of-pocket burden, with a tertiary hospital in Beijing as an example before and after the reform.Results:Segmental regression analysis showed that since the reform, the out-of-pocket burden of outpatients fell by 5.2% in the first month. After the reform, the medicine expenses decreased 0.50 yuan monthly instead of increasing 0.24 yuan before, and the surgery expenses, examination and laboratory fees, and materials expenses have increased from an average monthly increase of 0.14 yuan, 0.64 yuan and 0.36 yuan to 0.15 yuan, 0.70 yuan and 0.17 yuan respectively. Meanwhile, the growth rate of outpatient services slowed down, with an increase number dropping from 855 visits/month to 523 visits/month.Conclusions:The reform had reduced the out-of-pocket expenses of outpatients.

Objective:To investigate the expression of long non-coding RNA (Lnc RNA) RP5-919F19 in gastric cancer tissues and its correlation with gastric cancer invasion and metastasis.Methods:Non-tumor gastric mucosa (more than 3cm away from the cancer tissue) and gastric adenocarcinoma tissues were collected from Jan. 2020 to Jan. 2022 in our hospital. TRIzol kit was used to extract total RNA from cells and tissues, and reverse transcription kit was used to reverse transcribed RNA into cDNA. Quantitative real-time PCR kit was used for quantitative analysis. SGC-7901 and AGS human gastric cancer cells were used to construct RP5-919F19 knockdown and overexpression models. CCK-8 assay was used to confirm cell proliferation, and Transwell invasion assay was used to confirm the invasion ability of gastric cancer cells.Results:The expression of RP5-919F19 was detected in 79 cases of gastric cancer tissues and adjacent normal tissues, and it was found that the relative expression of RP5-919F19 in gastric cancer tissues was 1.51±0.05 significantly higher than that of 0.82±0.04 in adjacent normal tissues ( P<0.05) . The levels of RP5-919F19 in patients with different pathological conditions were compared and analyzed. The results showed that there were statistically significant differences in RP5-919F19 expression in patients with different TNM stages, distant metastasis, lymph node metastasis and different depth of invasion ( P<0.05) . There was no significant difference in RP5-919F19 expression among patients with different tumor sizes, ages and genders ( P>0.05) . AGS gastric cancer cells were transfected with RP5-919F19 overexpression plasmid and control plasmid, and the efficiency of RP5-919F19 was detected. The results showed that the expression level of RP5-919F19 in the overexpression group was 1.83±0.14 higher than that of 0.82±0.05 in the control group ( P<0.05) . SGC-7901 gastric cancer cells were transfected with RP5-919F19 knockout vector and control vector, and the efficiency of RP5-919F19 was detected. The results showed that the expression level of RP5-919F19 in the knockout group was 0.42±0.07 lower than that of 0.89±0.08 in the control group ( P<0.05) . CCK-8 was used to detect the proliferation ability of gastric cancer cells. The results showed that the proliferation ability of AGS cells in RP5-919F19 overexpression group was significantly increased compared with that of the control group at 24 and 48h after culture ( P<0.05) . However, the proliferation ability of SGC-7901 cells in RP5-919F19 knockdown group was lower than that in the control group at 24 h and 48 h ( P<0.05) . Transwell invasion assay showed that the invasion and migration abilities of AGS cells in RP5-919F19 overexpression group were higher than those in the control group ( P<0.05) , and the invasion and migration abilities of SGC-7901 cells in RP5-919F19 knockout group were lower than those in the control group ( P<0.05) . Western blot showed that compared with control cells, the expression of MMP-2 and MMP-9COPS7A proteins in down-regulated Lnc RNA RP5-919F19 SGC-7901 cells was decreased. Conclusion:The expression of LncRNA RP5-919F19 is abnormally increased in gastric cancer tissues, and the increased expression of RP5-919F19 can promote the proliferation and metastasis of gastric cancer cells.

The construction of DRGs management information system proves conducive to hospital medical quality management .In order to better understand the status of the hospital′s DRGs, further improve the quality of medical care , and embrace the DRGs reform in medical insurance , the hospital built the DRGs management information system in 2015 , and integrated it with the electronic medical record management system, and the medical record management system .The system consists of such modules as inpatient medical service evaluation , disease surveillance , case analysis , and real-time dynamic monitoring , applied to homepage evaluation and performance management at both hospital and department levels .Such a system can provide practical data for decision support of clinicians , and enable decision makers , thus improving fine management of medical care in the full course .

The medical management department of individual hospitals varies with their organizational structure and operational mechanism, instead of following a general pattern. Inspired by the"super-ministry" system of government,the hospital has integrated successively the Medical Affairs Office, Patient Safety Office,Medical Quality Control Office,Hospital-acquired Infection Control Office and Medical insurance office. Through integration and innovation of duties, regulations, culture, decision-making progress,coordination and talent training mechanism, the " Five-in-One" super-ministry model of medical management came into being,achieving collaborative and efficient medical management as a result.