Objective: To examine the effect of diagnosis-related groups (DRGs) point payment on hospitalization costs of parturition among lying-in women, so as to provide the evidence for alleviating the burdens and saving medical resources among lying-in women. Methods: Lying-in women's age, gestational age, parity, duration of hospital stay, DRGs grouping and hospitalization costs were collected from the Inpatient Medical Record System and DRG Operation Analysis System in a tertiary women and children's hospital in Ningbo City from 2020 to 2021. The changes of hospitalization costs of parturition were compared among lying-in women before and after DRGs point payments, and the association between DRGs point payments and gross hospitalization costs of parturition was examined among lying-in women using a multivariable logistic regression analysis. Results: A total of 11 505 lying-in women after DRGs point payments, including 6 216 women at age of 30 years and below (54.03%), and 10 871 lying-in women before DRGs point payments, including 6 208 women at age of 30 years and below (57.11%), were enrolled. The median (interquartile range) gross hospitalization expenses, material expenses and laboratory testing expenses of parturition were 8 519.19 (2 456.61), 881.38 (816.16) and 939.00 (310.00) Yuan among lying-in women after DRGs point payments, which were significantly lower than those [9 123.13 (2 660.33), 915.57 (825.26), 1 036.00 (385.00) Yuan] among lying-in women before DRGs point payments (Z=-21.971,-16.061 and -27.199, all P<0.001). Multivariable logistic regression analysis showed that DRGs point payment was statistically associated with lower gross hospitalization expenses of parturition among lying-in women after adjustment for age, duration of hospital stay, gestational age, parity, type of delivery and development of complications (OR=0.462, 95%CI: 0.432-0.494). Conclusion DRGs point payment is beneficial to reduce the hospitalization cost of parturition among lying-in women.

Patient satisfaction reflects the patients' subjective feelings which are subject to several factors.The physician-patient relationship is the critical factor of patients' satisfaction with the hospital.Harmonious doctor-patient relationship is the bridge of promoting mutual understanding,trust,and communication,and also improves patients' satisfaction and loyalty with the hospital.The establishment of effective mechanisms for the management in improving patient satisfaction will be an important link with the harmonious doctor-patient relationship,at the same time raise the reputation of hospital to build up a harmonious society.

Objective Through adverse event reporting module in hospital nursing manage-ment system, research group screened out the fall incidence higher departments to explore the effect of workshop mode in tralning nurses' prevention of falls of hospitalized patients. Methods A tralning team was set up under the guidance of hospital nursing department, to determine the content of the project and implementation process. 176 registered nurses were received tralning of fall-prevention by workshop mode, compared the differences in fall prevention knowledge level of nurses before and after tralning. Likert's 5-points were used in the investigation for satisfaction of participants. Results Aver-age score of after tralning was (18.66 ±1.32). The previous increase was (2.42 ±2.06). The differences was statistically significant (P=0.000). The comprehensive evaluation of the tralning mode from the participants was over 92.00%, except for the tralner was 89.77%. Participants were satisfied with the workshop mode . Conclusion Application of workshop in tralning program can improve nurses' knowledge of fall-prevention and guarantee patient safety.

Adult ; Child ; Endoscopy ; Fibrous Dysplasia of Bone ; pathology ; surgery ; Humans ; Male ; Nose ; surgery ; Orbit ; pathology

Objective To analyze the clinical and immunological manifestations of antiphospholipid syndrome(APS)in a cohort of 100 patients.Methods The clinical and serologic features of APS(Sapporo preliminary criteria)in 100 patients were analyzed retrospectively.Results The cohort consisted of 79 female patients and 21 male patients witb a mean age of 36?13 years at diagnosis.Primary APS was presented in 37% of patients;APS was secondary to systemic lupus erythematosus(SLE)in 46%,lupus-like syndrome in 14%. Eighty percent of the patients had thrombosis,43(54%)patients had venous thrombosis,18(22%)had arterial thrombosis,15(19%)had both arterial and venous thrombosis.4(5%)had thrombosis of microcirculation. Forty-two(52%)patients presented thrombosis at a single site,26(32%)at two sites,12(15%)at three or more sites.Forty-five(56%)patients experienced one thrombotic episode,20(25%)patients had only one re- currence,and 15(19%)had more thrombosis.The most common manifestations of thrombosis were deep vein thrombosis(36%),pulmonary embolism(30%)and stroke(26%),with heart,kidney,gastrointestinal tract and other organs involvements.Thirty-four(51%)female patients had spontaneous fetal losses including intrauter- ine fetus death and recurrent spontaneous abortion.Seventy-one(71%)patients developed thromboeytopenia. The presence of antieardiolipin antibody(ACL)was detected in 84 patients(84%).Among 90 patients with APS,alone ACL was detected in 38 patients(42%),both ACL and lupus anticoagulant(LA)were detected in 36(40%),LA alone in 16(18%).Patients with APS associated with SLE or lupus-like syndrome had higher frequency of arthritis,leukopenia,antinuclear antibodies(ANA)and low complement levels.Female patients had a higher frequency of leukopenia,ANA and ACL.Male patients had a higher prevalence of deep venous thrombosis in the lower limbs and LA.Conclusion APS is an autoimmune disorder characterized by recurrent arterial and venous thrombosis,fetal loss,or thrombocytopenia with the presence of ACL and/or LA.In APS secondary to with SLE,the patient's sex can modify the disease expression and define specific subsets of APS.

Objective To learn the plague's host animals and parasitic flea composition, and to investigate the natural foci of plague in Xiji county in order to provide basic information for plague prevention and control. Methods The Citellus alaschanicus density, nocturnal rodents, the body flea, the burrow track flea, the nest flea were investigated in 8 townships (town) of Xiji county from June 11 2007 to July 25 2007. Specimens of small mammalian, fleas were collected for bacteriological and serological testing. Results The average density of the main host Citellus alaschanicus was 0.85 per hectare. The nocturnal mouse capture rate was 0.80%(24/2987).The survey found 16 species of small mammals that belonging to 3 orders, 9 families and 16 species with Citellus alaschanicus the dominant species. The Citellus alaschanicus had 2.84 fleas per body. Four families and 16 species of fleas were identified in the areas. The Citellus alaschanicus and Citellophilus Tesquorum Mongolicus were the dominant species. Plague bacteriology and serology tests were negative. Conclusions The study shows that the area is suitable for the formation of natural foci of Citellus alaschanicus plague. Surveillance is an important measure for prevention and control of the plague.

Objective To compare the changes of physiological parameters after cardiac arrest caused by asphyxia with that of cardiac arrest induced by ventricular fibrillation in rats and assess the values of the parameters on predicting ROSC and 24 h survival rate. Method Two groups of Sprague-Dwaley rats, which randomly (ramdom number) included 30 animals in each group, were investigated. Cardiac arrest were induced by asphyxia (AS group) or ventricular fibrillation(VF group). PETCO2, aortic pressure, left ventricular pressure and ECG of limb lead Ⅱ were recorded continuously, dP/dt4o was calculated with the windaq software. The parameters were compared between the two groups at baseline, precordial compression(PC) 10 s, PC 1 min, PC 3 min, ROSC 1 h and ROSC 2 h. The relations were explored between the parameters and ROSC/24 h survival rate. Results PETCO2,aortic pressure, left ventricular pressure and ECG have distinctive changes in the two groups. In group VF, PETCO2 of ROSC rats at BL, PC 1 min and PC 3 min were higher than those of Non-ROSC rats (P ＜ 0.05); PETCO2of 24 h survival rats at ROSC 1 h and ROSC 2 h were higher than those of 24 h death rats (P ＜ 0.05), which were not observed in the group AS. dP/dt40 and - dP/dt40 at ROSC 1 h and ROSC 2 h in group VF were higher than those in group AS (P ＜ 0.05). Conclusions Physiological parameters after cardiac arrest caused by asphyxia or that of cardiac arrest induced by ventricular fibrillation in rats have unique features respectively. PETCO2 in cardiac arrest caused by ventricular fibrillation may predict ROSC and 24 h survival rate. Researchers have to select the appropriate cardiac arrest model according their research purposes and clinical requirments.

Objective To study the effects of mild hypothermia on cardiomyocyte contractility improvement after ischemia-repeffusion injury and on the preservation of well-functioning mitochondrial respiratory capability.Methods A total of 50 newborn SD rats 1 ～ 2 days after delivery were sacrificed and their hearts taken to preserved in 4 ℃ cold D-hanks buffer solution with 0.12％ pancreatic proteinase and collagenase and then processed with 37 ℃ water bath to collect the cardiomyocytes cultured in DMEM medium with 10％ FBS for 5 days.The cardiomyocytes of rats were subjected to ischemia/reperfusion,in vitro,by oxygen and glucose deprivation(OGD)/oxygen and glucose restoration(OGR).The cardiomyocytes of rats after ischemia/reperfusion were divided into three groups:control group,hypothemia group and normothermia group.Contractile frequency and velosity were determined before OGD and 0 h,0.5h,1 h,1.5 h and 2 h after OGR.Ultrastructure changes of cardiomyocytes and mitochondrion were observed under transmission electron microscope(TEM)0 h and 2 h after OGR as well as assessment ot respiratory rate and respiratory control rate(RCR)with Clark oxygen electrode in each group.All data were analyzed with statistical software of SPSS 13.0.Results Contractile function of cardiomyocytes in hypothermia group and normothermia group declined to nadir at 0 h after OGR(P =0.000)and the contractile function of cardiomyocytes in hypothermia group was improved one hour later,compared with the normothermia group(P =0.000).Obvious swelling of mitochondrion was observed under TEM in normothermia group with little alteration after OGR.The RCR assessments indicated respiratory function in normothermia group was impaired after OGR(P =0.000)and this may be responsible for contractility dysfunction.Conclusions Mild hypothemia used after ischaemia can optimize the contractility of cardiomyocytes after a normothermia OGR,and the well-functioning respiratory capability of mitochondrion may be preserved in this process.

Objective:To describe the clinical characteristics , overall survival as well as to evaluate the prognostic factors in Chinese diffuse large B cell lymphoma ( DLBCL) patients.Methods: DLBCL pa-tients who were initially diagnosed and treated in Peking University Cancer Hospital from January 1995 to December 2008 were identified and analyzed ,retrospectively .The 5-year OS rates were estimated with Ka-plan-Meier.Log-rank test was used to compare the survival curves of the different groups .The multivari-ate analysis of prognostic factors was conducted with Cox regression model , which included all statistically significant prognostic factors in the univariate analyses .Results:A total of 525 DLBCL patients were in-cluded in this retrospective analysis , of whom , 294 were male and 231 female ( male∶female=1 .27∶1 ) . The median age at the initial diagnosis was 55 (range 16-90) years, and 37.0% (n=194) were 60 years and above .Regarding the clinical staging at the initial diagnosis , 54 patients (10.3%) were diag-nosed as Stage Ⅰ of the disease, 152 (28.9%) as Stage Ⅱ, 117 (22.3%) as Stage Ⅲ and 202 (38.5%) as Stage Ⅳ.The ‘B symptoms’ and increased serum LDH were presented in 206 (39.2%) and 192 (36.6%) patients, respectively.A total of 197 (37.5%) patients were treated with rituximab (R).The survival follow-up continued till 31 January 2014 with a median follow-up time of 77.5 ( range:0-205) months.A total of 267 patients (50.9%) died during the follow-up period.The medi-al overall survival ( OS) time was 84 months, and 5-year OS rate was 52.3%.There were six statistically significant prognostic factors that were identified in both univariate and multivariate analyses : gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment .The relative risk ( RR) of these prognostic factors in the multivariate analyses were: age >60 years /≤60 years=1.380 (95%CI 1.078 -1.765), male /female =1.315 (95%CI 1.025 -1.687), stage Ⅲ/stageⅠ=3.034(95%CI 1.667-5.522), stage Ⅳ/Ⅰ=3.748(95%CI 2.102 -6.681), with B symp-toms/without B symptoms=1.278(95%CI 0.999-1.636),serum LDH increased/LDH not increased=1.351(95%CI 1.057 -1.726), without R treatment /with R treatment =1.543(95%CI 1.182 -2 .015 ) .Compared with the IPI , age >50 years/≤50 years was a statistically significant factor in both univariate and multivariate analyses RR =1.478 (95%CI 1.148-1.902), P=0.002.Conclusion:Six factors were related to DLBCL survival:gender, Ann Arbor stage, B symptom, serum LDH, age at initial diagnosis and rituximab treatment .Compared with the IPI , several specific factors may predict a poor prognosis in Chinese DLBCL patients:male , age>50 years and the presence of ‘B symptoms ’ .But this result is not conclusive until these factors are further tested .

Objective To investigate the effect of low-dose glucocorticoid on prognosis of critical illness-related corticosteroid insufficient (CIRCI) patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods A total of 385 eligible patients met the criteria of AECOPD were admitted from January 2010 to December 2012.The AECOPD patients co-morbid with CIRCI screened by an adrenal corticotrophic hormone test within 12 hours after admission were randomly divided into treatment group (n =32) and control group (n =31) for prospective,randomized (random number) and controlled clinical study.Hydrocortison (150mg/d) for treatment group or normal saline instead for control group was injected intravenously for 7 days.The 28-day mortality,shock-free days,length of ICU stay within 28 days and ventilator-free days were evaluated.And the markers of inflammation C-reactive protein,tumor necrosis factor-α,interleukin 6 and procalcitonin were measured before and 7 days after treatment.The variables were analyzed by Student' s t-test,non-parametric statistical test,Chi-square test or KaplanMeier test with SPSS 18.0 statistic software.P ＜ 0.05 was considered statistically significant.Results A cohort of 385 patients with AECOPD was screened,and the prevalence rate of CIRCI was 16.4％.The shock rate was higher in the AECOPD patients co-morbid with CIRCI than that in the AECOPD patients without CIRCI (23.8％ vs 8.7％,P ＜0.01).Compared with the control group,the 28-day mortality was significantly lower in treatment group (2/32 vs 8/31,P ＜ 0.05),and shock-free days within 28 days longer in the treatment group (18.2 ± 9.5 vs 25.8 ± 4.1,P ＜ 0.05).However,there was no difference in the shock rate,days of ICU stay and ventilator-free days between the two groups.After treatment,the levels of infection markers were decreased and obviously lower than those in control group (P ＜ 0.01),such as Creactive protein (13.2 ± 5.5 mg/L vs 8.3 ± 3.1 mg/L for control group; 13.5 ± 5.9 mg/L vs 5.1 ± 2.3mg/L for treatment group),tumor necrosis factor-α (26.1 ± 16.2 μg/L vs 17.5 ± 11.7 μg/L for control group ; 25.0 ± 14.8 μg/L vs 10.4 ± 7.8 μg/L for treatment group) and procalcitonin [3.88 (0.25,8.5) μg/L vs 2.03 (0.15,5.1) μg/L for control group; 3.77 (0.21,8.0) μg/L vs 1.26 (0.10,3.2) μg/L for treatment group],furthermore,the levels of infection markers were decrease more obviously in the treatment group than those in the control group (P ＜ 0.01).Conclusions There was high prevalence rate of CIRCI in the patients with AECOPD in the department of critical medicine,and low-dose glucocorticoid reduced 28-day mortality,shock days and markers of infection and inflammation.