Objective To learn the impacts of major diagnosis, other diagnoses, major surgery and other surgeries on the grouping of DRGs, and to optimize the DRGs data grouping quality by analyzing the main influencing factors of DRGs.Methods Based on regrouping results of the 1 940 questionable cases which have been corrected, using SPSS 13.0 to study the impacts of the questions found on the grouping of DRGs.Results 438 Patient records affecting DRGs grouping were regrouped according to major diagnosis, other diagnoses, major surgery and other surgeries.Influences of the above four groups on the grouping vary in general For comparison between two groups, P＞0.007 1 between main surgery and other surgeries;while P＜0.007 1 for comparison between other groups.Conclusion The highest influence of grouping was found in questionable major diagnosis, much higher than such other factors as other diagnoses, major surgery and other surgeries.This conclusion conforms to the steps of basic DRGs grouping logic-sorting the eases according to major diagnosis first of all Correct naming of surgery influences DRGs grouping, but the influence extent of major surgery and other surgeries is close.

Objective To retrospectively analyze the cardiac systolic synchrony and cardiac function in patients with chronic heart failure (CHF） by gated SPECT myocardial perfusion imaging (GSMPI). Methods (1) From January 2010 to February 2015, 123 cases including 82 CHF patients (57 males, 25 females, age (59.5±11.0) years) and 41 healthy people (control group; 27 males, 14 females, age (33.8±5.2) years) were enrolled in this retrospective study. According to the New York Heart Association (NYHA) classification, the CHF patients were classified into grade Ⅰ-Ⅳ groups. The systolic synchrony and cardiac functional parameters including PHB, PSD, LVEF, EDV, summed rest scores (SRS) were acquired by Emory Cardiac Toolbox software. Differences of PHB, PSD and LVEF were compared between the CHF group and the control group using two-sample t test. The difference among the four CHF groups was compared by one-way analysis of variance. The difference of some clinical factors was compared between the two groups with and without damage of systolic synchrony. The relationship between the cardiac synchrony and myocardial perfusion was analyzed by Pearson correlation analysis. Results There was no obvious difference of PHB and PSD between the grade Ⅰ CHF patients and the control group (t=-1.502 and -0.448, both P>0.05), while LVEF was significant different (t=10.419, P<0.05). Significant difference of PHB, PSD and LVEF existed between the grade Ⅱ-Ⅳ CHF patients and the control group (t values: from -27.250 to 32.723, all P<0.05). There were significant differences of PHB, PSD and LVEF among the 4 CHF groups (F=118.05, 4.13 and 154.37; all P<0.05). The differences of LVEF, EDV and SRS were significant between the patients with and without damage of systolic synchrony (t=9.57, 10.85, 18.87, all P<0.05). The ratios of damage in systolic synchrony in grade Ⅰ-Ⅳ CHF patients were 8.7% (2/23), 60.0%（12/20）, 15/18 and100% (21/21), respectively. PHB and PSD were both positively correlated with SRS (r=0.808 and 0.773, both P<0.05). Conclusions The damage of systolic synchrony are getting severer from patients with NYHA grade Ⅱ to patients with NYHA grade Ⅳ. The damage could be accompanied by the heart failure progression. Diabetes mellitus, LVEF, EDV, ESV, and SRS are related to the damage. The myocardial perfusion damage is positively correlated with the damage of cardiac systolic synchrony. GSMPI is useful to early diagnosis and treatment of heart failure.

To develop a cell-penetrating chimeric apoptotic peptide AVPI-LMWP/DNA co-delivery system for cancer therapy, we prepared the AVPI-LMWP/pTRAIL self-assembled complexes containing a therapeutic combination of peptide drug AVPI and DNA drug TRAIL. The chimeric apoptotic peptide AVPI-LMWP was synthesized using the standard solid-phase synthesis. The cationic AVPI-LMWP could condense pTRAIL by electrostatic interaction. The physical-chemical properties of the AVPI-LMWP/pTRAIL complexes were characterized. The cellular uptake efficiency and the inhibitory activity of the AVPI-LMWP/pTRAIL complexes on tumor cell were also performed. The results showed that the AVPI-LMWP/pTRAIL complexes were successfully prepared by co-incubation. With the increase of mass ratio (AVPI-LMWP/DNA), the particle size was decreased and the zeta potential had few change. Agarose gel electrophoresis showed that AVPI-LMWP could fully bind and condense pTRAIL at a mass ratio above 15:1. Cellular uptake efficiency was improved along with the increased ratio of W(AVPI-LMWP)/WpTRAIL. The in vitro cytotoxicity experiments demonstrated that the AVPI-LMWP/pTRAIL (W:W = 20:1) complexes was significantly more effective than the pTRAIL, AVPI-LMWP alone or LMWP/pTRAIL complexes on inhibition of HeLa cell growth. Our studies indicated that the AVPI-LMWP/pTRAIL co-delivery system could deliver plasmid into HeLa cell and induce tumor cell apoptosis efficiently, which showed its potential in cancer therapy using combination of apoptoic peptide and gene drugs.

Objective To investigate the anti-tumor activities of cell-penetrating peptide ( CPP) - mediated trichosanthin ( TCS) , which is a recombinant protein obtained from Radix Trichosanthis. Methods Cysteine residue was introduced to the C-terminus of TCS by protein recombinant technique, and then with the newly-formed terminal as the modification site, TCS was coupled with CPP. As a target protein, CPP-mediated TCS was isolated and purified by affinity chromatography. The expression of the target protein and its responsiveness to reducing substances were detected by using the sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The cellular uptake rate of CPP-mediated TCS was determined by using cell uptake test, and its anti-tumor activity was measured by using methyl thiazolyl tetrazolium (MTT) assay. Results The TCS-CPP compound had been successfully developed in this study, and showed certain reducing responsiveness. After modified with CPP, TCS had higher cellular uptake rate and stronger anti-tumor effect on HeLa and MCF-7 cells. Conclusion TCS modified by CPP can enhance the anti-tumor activities of TCS.

Objective To explore the relationship between the expression of transcription factor ⅡB-related factor 1 (Brf1) and the prognosis of non-small cell lung cancer (NSCLC).Methods Collected 96 cases of NSCLC Surgical specimens and clinical data of patients from January 2013 to August 2015 in our hospital.First of all,we compared the expression of Brf1 in NSCLC tissues and adjacent lung tissues by Western blot and RT-qPCR.Then,Immunohistochemistry was used to detect the expression of Brf1 in NSCLC tissues,and analysis of the relationship between Brf1 expression level and clinical case characteristics.Survival curves were plotted using the Kaplan-Meier method and Log-rank test and multivariate Coxv regression analysis were performed.Results Western blot and RT-qPCR results showed that the expression of Brf1 in NSCLC tissues was significantly higher than that in adjacent lung tissues (P ＜0.01).The positive expression rate of Brf1 in 96 cases of NSCLC was 72.9％.The Brf1 expression level was higher in the poorly differentiated group than in the moderately-highly differentiated group(Mean Rank 62.33 ＞ 43.89,Z =-2.914,P =0.004),and the lymph node metastasis group was higher than the non-metastasis group(Mean Rank 60.34 ＞ 42.58,Z =-3.055,P =0.002),which was independent of patient gender,age,smoking status,tumor size,TNM stage,and pathological type (P ＞0.05).Single-factor survival analysis by Log-rank test showed that the survival rate of Brf1 positive expression group was lower than that of the negative group (x2 =7.560,P ＜0.01).Multivariate analysis of Cox regression model found that Brf1 positive expression (HR =2.043,95％ CI:1.082-3.860) was an independent observational index that affects the prognosis of patients with NSCLC.Conclusion Brf1 is overexpressed in NSCLC tissues,and Brf1 negative expression has a good clinical prognosis,suggesting that Brf1 may be one of the indicators of malignant degree and prognosis of NSCLC.

Objective To retrospectively analyze the cardiac systolic synchrony and cardiac function in patients with chronic heart failure (CHF) by gated SPECT myocardial perfusion imaging (GSMPI).Methods (1) From January 2010 to February 2015,123 cases including 82 CHF patients (57 males,25 females,age (59.5±11.0) years) and 41 healthy people (control group;27 males,14 females,age (33.8±5.2) years) were enrolled in this retrospective study.According to the New York Heart Association (NYHA)classification,the CHF patients were classified into grade Ⅰ-Ⅳ groups.The systolic synchrony and cardiac functional parameters including PHB,PSD,LVEF,EDV,summed rest scores (SRS) were acquired by Emory Cardiac Toolbox software.Differences of PHB,PSD and LVEF were compared between the CHF group and the control group using two-sample t test.The difference among the four CHF groups was compared by one-way analysis of variance.The difference of some clinical factors was compared between the two groups with and without damage of systolic synchrony.The relationship between the cardiac synchrony and myocardial perfusion was analyzed by Pearson correlation analysis.Results There was no obvious difference of PHB and PSD between the grade Ⅰ CHF patients and the control group (t =-1.502 and-0.448,both P＞0.05),while LVEF was significant different (t =10.419,P＜0.05).Significant difference of PHB,PSD and LVEF existed between the grade Ⅱ-Ⅳ CHF patients and the control group (t values:from-27.250 to 32.723,all P＜0.05).There were significant differences of PHB,PSD and LVEF among the 4 CHF groups (F=118.05,4.13 and 154.37;all P＜0.05).The differences of LVEF,EDV and SRS were significant between the patients with and without damage of systolic synchrony (t =9.57,10.85,18.87,all P＜0.05).The ratios of damage in systolic synchrony in grade Ⅰ-Ⅳ CHF patients were 8.7％ (2/23),60.0％(12/20),15/18 and 100％ (21/21),respectively.PHB and PSD were both positively correlated with SRS (r=0.808 and 0.773,both P＜0.05).Conclusions The damage of systolic synchrony are getting severer from patients with NYHA grade Ⅱ to patients with NYHA grade Ⅳ.The damage could be accompanied by the heart failure progression.Diabetes mellitus,LVEF,EDV,ESV,and SRS are related to the damage.The myocardial perfusion damage is positively correlated with the damage of cardiac systolic synchrony.GSMPI is useful to early diagnosis and treatment of heart failure.

Objective To investigate the clinical manifestations and imaging modality for the diagnosis of hepatic fasciola gigantica disease.Methods Thirty eight patients with abdominal pain were admitted in our hospital and underwent investigations with different imaging modalities.Thirty-eight cases underwent abdominal CT scan,among which 5 cases underwent follow-up with abdominal ultrasonography,10 patients with routine MRI scan and CT scan examination,and 2 cases with liver biopsy.Results Thirty-eight cases with CT scan showed the hepatomegaly,with decreased attenuation of the hepatic parenchyma,unclear boundaries.Thirteen cases showed decreased densities (suggesting hydroperitonium),including 10 cases with enhanced CT showed mild inhomogenous enhancement.Five cases with color doppler ultrasound showed inhomogenous hepatic echogenicity,and multiple liver parenchyma echogenecity showedirregular,cluttered cystic dark areas and spleenomegaly,among which two cases had evident hydroperitonium.Ten cases with MRI scan showed liver enlargement,abnormal diffuse signal of hepatic parenchymal lesions and splenomegaly.Two cases who underwent needle biopsy showed parasitic granulomas and necrosis,surrounded by a large number of monocytes andeosinophilic infiltration.Clinical manifestations:All cases were presented with fever,abdominal pain,liver tenderness,etc.Twenty-five cases presented with nausea,vomiting,loss of appetite,15 cases presented with ascites,5 cases presented with pericardial effusion,5 cases with lung parenchymal changes on CT,others showed generalised systemic edema and malena,very few patients had utricaria,itching and other symptoms.Conclusion CT and MRI scanning in patients suspected with human fasciola hepatica showed multiple small hepatic subcapsular abscess,of which some were clustered or tunnel-like.Combined with parasites,imaging manifestations are helpful for the early diagnosis.

Objective: To explore the biodistribution and quantitative value of ¹⁸F-Flurpiridaz in mini-swine, and compare with ¹³N-NH₃·H₂O. Methods: Ten Bama mini-swine were divided into normal group and myocardial infarction group (n=5 in each group). Normal group was not treated and myocardial infarction group was modeled by thoracotomy and coronary artery ligation. Both groups were preceded by ¹³N-NH₃·H₂O imaging, followed by ¹⁸F-Flurpiridaz imaging (time interval >40 min). Injection dosage of 2 tracers was the same (185-370 MBq). ¹⁸F-Flurpiridaz whole-body PET/CT imaging was also performed in normal group. Biological distribution of ¹⁸F-Flurpiridaz was observed, and the ratio of radioactive uptake of ¹⁸F-Flurpiridaz between myocardium and adjacent tissues or organs was calculated. Image quality score and rest myocardial blood flow (rMBF) of 2 imaging tracers in normal group were measured and compared. MPI image quality score, cardiac function parameters such as summed rest score (SRS), myocardial infarction area percentage, total perfusion defect (TPD), and left ventricular ejection fraction (LVEF) of 2 imaging tracers were compared in myocardial infarction group. Data was analyzed by paired t test. Results: In normal group, ¹⁸F-Flurpiridaz in the myocardium was clearly observed, with high radioactive uptake maintaining within 2 h postinjection. The radioactivity count ratios of left ventricular myocardium to cardiac pool, the lungs and liver were high (5.19-12.87, 4.17-50.51, 2.08-6.92). The quality of ¹⁸F-Flurpiridaz MPI images in both groups was excellent (10/10). The rMBF (ml·g^-1·min^-1) in different regions of left ventricle measured by ¹⁸F-Flurpiridaz and ¹³N-NH₃·H₂O imaging were not significantly different (left anterior descending: 0.98±0.06 vs 0.92±0.13; left circumflex: 0.98±0.05 vs 0.88±0.12; right coronary artery: 0.95±0.07 vs 0.88±0.15; left ventricle: 0.96±0.07 vs 0.90±0.13; t values: from -1.70 to -0.90, all P>0.05). There was no significant difference in SRS, myocardial infarction area percentage, TPD, rMBF or LVEF between ¹⁸F-Flurpiridaz and ¹³N-NH₃·H₂O (SRS: 10.6±4.1 vs 9.2±4.6; myocardial infarction area percentage: (15.2±9.0)% vs (12.6±6.6)%; TPD: (11.6±6.3)% vs (9.6±3.9)%; LVEF: (68.6±11.1)% vs (71.4±11.3)%; t values: -2.33-2.75, all P>0.05). Conclusions Comparing with ¹³N-NH₃·H₂O, ¹⁸F-Flurpiridaz has the advantages of good MPI image quality, accurate measurement of cardiac function parameters and quantitative potential of myocardial blood flow, which make it as a promising positron myocardial perfusion imaging agent.

Objective:To investigate the efficacy of the posterior axillary approach combined with the deltoid pectoralis major approach in the treatment of proximal humeral fracture combined with lower glenoid fracture.Methods:From July 2019 to September 2021, 7 patients were treated at Department of Traumatic Othopeadics, The Sixth Hospital of Ningbo for proximal humeral fracture combined with lower glenoid fracture by internal fixation via the posterior axillary approach combined with the deltoid pectoralis major approach. They were 2 males and 5 females, aged from 51 to 78 years (average, 62.9 years). All fractures were closed ones. According to the Neer classification for the proximal humeral fractures, there were one case of type Ⅱ, one case of type Ⅲ, 3 cases of type Ⅳ and 2 cases of type Ⅵ. According to the Ideberg classification for the glenoid fractures, 5 cases were type Ⅰ and 2 cases type Ⅱ. The anteroposterior, lateral and axillary X-ray films of the affected shoulder were taken at 6 and 12 weeks, and 6 and 12 months after operation to follow up fracture healing and occurrence of complications. The Constant-Murley shoulder joint scores and the Disability of Arm Shoulder and Hand (DASH) scores for the upper limb dysfunction were recorded at the last follow-up for all patients.Results:All the 7 patients were followed up for 8 to 15 months (mean, 11.9 months). Bone union was achieved after an average of 4.3 months (from 3 to 6 months) in all patients. None of the functional activities was affected in all by postoperative shoulder joint instability, incision infection or axillary scar hyperplasia. At the last follow-up, their Constant-Murley scores averaged 83.4 points (from 55 to 92 points), and their DASH scores 13.5 points (from 4.2 to 33.3 points).Conclusion:In the treatment of proximal humeral fracture combined with lower glenoid fracture, the posterior axillary approach combined with the deltoid pectoralis major approach can lead to fine early curative efficacy due to their advantageous possibilities to allow for easy fracture reduction, reliable fixation and early rehabilitation.

Objective:To explore the method and effect of endovascular treatment to innominate artery stenosis or occlusion.Methods:The data of 11 patients with stenosis or occlusion of innominate artery from January 2014 to November 2019 at Xuanwu Hospital of Capital Medical University were collected. All patients received endovascular treatment. We summarized the changes of clinical symptoms, surgical methods, perioperative complications, stent patency, and analyzed the changes in systolic blood pressure and peak blood flow velocity on the involving side.Results:All 11 patients underwent endovascular treatment. The surgical technique success rate was 100%. All patients were followed up. The follow-up time was 4-69 months, with an average of (30.1±23.4)months. 2 patients used cerebral umbrella during the operation. 1 patient was performed ipsilateral carotid endarterectomy, 1 patient underwent contralateral carotid stent implantation, 1 patient was diagnosed as severe stenosis of the innominate artery and left common carotid artery, and an innominate artery stent implantation was performed at one stage, left common carotid artery stent implantation was performed after half a year. We done operation from the femoral artery puncture approach (6 patients), brachial artery puncture approach (2 patients), axillary artery and femoral artery puncture approach (1 patients), and right common carotid artery and the femoral artery puncture approach (2 patients). 3 patients had in-stent restenosis at 6, 7and 12 months after stenting, respectively. 1 patient underwent balloon dilatation, and 2 patients underwent re-stent implantation. We have not do further intervention to 1 case of in-stent occlusion occurred 14 months after the stenting, for the clinical symptoms did not improve significantly. The clinical re-intervention rate in this group was 3/11, and the primary patency rate was 7/11. The secondary patency rate was 10/11. The symptoms of 10 patients were relieved and the weakness of right upper extremity was not significantly changed in 1 patient. No puncture point complications occurred in all patients, and no cerebral infarction occurred during the perioperative period. There were statistically significant differences in systolic blood pressure, blood pressure difference and peak blood flow velocity before and after the operation ( P<0.05). Conclusions:Endovascular treatment of innominate arterial stenosis or occlusion was safe and effective, and the appropriate surgical approach and plan should be selected according to the lesion characteristics and the whole body conditions.