Purpose To investigate the application value of diffusion weighted imaging (DWI) in differential diagnosis of common liver lipid-containing tumors.Materials and Methods Sixty patients with pathologically confirmed liver lipid-containing tumors from January 2011 to August 2015 were retrospectively analyzed,including 25 cases ofhepatocellular carcinoma (HCC),20 cases of hepatic adenoma (HA) and 15 cases of hepatic angiomyolipoma (HAML).Apparent diffusion coefficient (ADC) value and ratio of ADCtumor/ADCliver (rADC) of tumors were respectively measured.Routine MRI findings were analyzed.Results The MRI findings of these three common liver lipid-containing tumors were with their own characteristics.For HCC,HA and HAML,the average ADC value was (1.225±0.221)×10-3 mm2/s,(1.318±0.212)×10-3 mm2/s and (1.317±0.297)×103 mm2/s,respectively,(b=800 s/mm2);the average rADC value was 1.004± 0.151,0.984 ± 0.146 and 1.027±0.223,respectively.There was no significant difference in ADC and rADC among these three tumors (P＞0.05).Conclusion ADC and rADC had no differential diagnosis value in common liver lipid-containing tumors.Routine MRI signals and enhanced imaging features are the main diagnostic basis.

Objective To investigate the value of DWI in the evaluation of the therapeutic effect of cyber knife in the treatment of hepatocellular carcinoma.Methods Ninety patients who were clinically diagnosed with hepatocellular carcinoma (95 lesions) in the 5th Medical Center of General Hospital of PLA from February 2011 to December 2013 were retrospectively analyzed. All 90 patients underwent pre‐treatment dynamic contrast‐enhanced MRI scans of liver. Fourty six of them underwent liver MRI scan 3 months after treatment with cyber knife, and 49 patients underwent liver MRI scans 6 months after treatment. According to the evaluation criteria of solid tumor effect, complete necrosis tumor lesions and postoperative residual active lesions were determined. The ADC values of residual active tissue lesion, necrosis lesion in tumor and normal liver were measured. Paired sample t test was used to compare the difference of ADC values of tumor necrosis lesions and normal liver tissues between 3 and 6 months after treatment and before treatment, and ROC was used to evaluate the efficacy of ADC values in predicting complete tissue necrosis after treatment. Results In the 95 lesions, 91 lesions were completely necrotic, and active tissues were found in 4 lesions after treatment. There were statistically significant differences in the ADC values of the lesions at 3 and 6 months after treatment and before treatment (P<0.05),and the ADC values of the tissues after treatment were higher than those before treatment. There was no statistically significant difference in ADC values between 3 and 6 months after treatment and before treatment in normal liver tissue (P>0.05). The area under the ROC of using ADC value to predict the complete necrosis after treatment with cyber knife was 0.767, and the ADC value was 1.23×10‐3 mm2/s as the diagnostic cutoff value. The sensitivity and specificity of the diagnosis were 76.5% and 70.6%, respectively. Conclusion ADC values can distinguish the necrotic component from the active component of hepatocellular carcinoma after treatment, and can be used to evaluate the therapeutic effect of cyber knife in hepatocellular carcinoma.

Objective To discuss the diagnostic value of intravoxel incoherent motion(IVIM)DWI in the inflammation activity of chronic hepatitis B. Methods One hundred and seventy-five patients with chronic hepatitis B were prospectively collected as inflammation group, and 15 healthy volunteers with no history of hepatitis and normal liver function as control group.All subjects were performed MR plan scans for liver and IVIM tests.The liver apparent diffusion coefficient(ADC),the diffusion coefficient of the true water molecule (D), microcirculation perfusion coefficient (D*) and perfusion fraction (f) were measured. After MRI examination, the inflammation group received liver biopsy within two days, and obtained the pathological hepatitis activity grades.According to the degree of inflammation activity(G),the inflammation group was divided into G1,G2 and G3+G4 groups.The independent sample t test was used for the parameter values between the inflammation group and the control group.A single factor variance analysis was used to compare the parameters among different levels of inflammation group. Spearman correlation analysis was used to evaluate the correlation between inflammation activity grades and IVIM parameters.ROC curve was used to evaluate each parameter in the diagnosis of hepatitis activity pathology classification efficiency.Results The values of ADC, D, D*, f between control group and inflammation group were statistically significant(P<0.05).The results of pathological puncture showed that there were 61 cases of G1,62 cases of G2 level and 52 cases of G3+G4.The ADC,D*and f values in the G1,G2,G3+G4 groups decreased with the increase of the level of inflammation activity, and the difference was statistically significant (P<0.05). There was no statistically significant difference between D values (P>0.05). ADC, D* and f values were correlated negatively with low,moderate and low levels of inflammation activity(r=-0.377,-0.434,-0.226, P<0.05).There was no correlation between D value and inflammation activity(r=-0.076,P>0.05).Areas of ADC,D*and ADC combined with D*values under ROC curves to diagnose≥G2 grade inflammation activity were 0.732, 0.748, 0.837 respectively. Areas of f values under ROC curve to diagnose ≥G3+G4 grade inflammation activity was 0.600.Conclusion ADC and D*values help to identify≥G2 grade inflammation activity,and ADC combined with D*value has the highest diagnostic performance,and has certain reference value for clinical treatment.

In the COVID-19 epidemic prevention and control work, not only the safety management of in-hospital organ transplantation is facing severe challenges, but also a large number of patients at home after transplantation are in immunosuppressive state, and professional protection management is urgently needed. Since the outbreak of the epidemic, Shulan(Hangzhou)hospital fully identified the risks of transplant patients, established a special team, and formulated and implemented the control management plan for organ transplant patients based on the crisis leadership model. The control management plan has achieved staged results.From January 15 to March 2, 2020, 29 liver transplants and 31 kidney transplants were performed in our hospital. The remote health education of 1 002 patients after liver and kidney transplantation was completed. The goal of " zero infection" was achieved, and the protection management quality indicators were ideal.

In order to strengthen standardized residency training process management, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology combines informatization with teaching case library and establishes and improves the process of teaching case filling from the three aspects of the module for residency teaching case filling, the module for instructor feedback, and the module for functional department management, thereby establishing a teaching case system centered on residents and based on the standardized residency training process management and supporting the innovation of standardized residency training pattern with an integrated teaching platform, which provides new methods for the connotation construction of standardized residency training.

Objective Analyze the implementation effects of the specialized disease management policy(hereinafter re-ferred to as the policy)to provide reference for strengthening operational management and enhancing the integration of business and finance in public hospitals.Methods Patient information of inpatients from a large comprehensive tertiary hospital from Jan-uary 2022 to June 2023 was collected.Four out of ten single diseases focused on by the national tertiary public hospital perform-ance assessment were included in the study group for specialized disease management,while the remaining six were used as the control group.A difference-in-differences model was adopted to analyze the changes in relevant indicators such as per capita inpa-tient expenses,average length of stay,per capita drug expenses,per capita consumable expenses,and per capita examination and treatment expenses before and after the policy implementation.Additionally,the effects of policy implementation were further analyzed based on different medical insurance types.Results A total of 22 457 patients were included,with 5 879 patients in the study group(3 164 cases before policy implementation and 2 715 cases after policy implementation),and 19 741 patients in the control group.The difference-in-differences model analysis showed that after the policy implementation,per capita inpatient expenses for specialized disease management patients decreased by 32.7％,average length of stay decreased by 31.4％,drug ex-penses decreased by 49.5％,consumable expenses decreased by 24.2％,and examination and treatment expenses decreased by 29.2％.Moreover,compared to patients under non-Wuhan medical insurance,patients under Wuhan medical insurance experi-enced a greater reduction in related indicators.Conclusion The implementation of the policy effectively reduces the burden on patients seeking medical care,improves medical treatment efficiency,contributes to hospital refined management methods,deep-ens the integration of business and finance,and facilitates the transition towards leaner operations.

Objective To analyze the basic characteristics, drug features, prescription rules, and drug-symptom relationships of patients in the splenic deficiency and impairment stage, by data mining of medical records under the New Theory on Spleen Dampness Syndrome (Pi Dan Xin Lun, 《脾瘅新论》). Methods Medical records listed in the “New Theory on Spleen Dampness Syndrome – Understanding and Treatment of Metabolic Syndrome from the Perspective of Traditional Chinese Medicine”, and which were diagnosed with the spleen dampness syndrome at the splenic deficiency and impairment stage, during January 2004 and December 2016 were selected. These patients’ data, including basic information, clinical symptoms, laboratory examination results, traditional Chinese medicine (TCM) and western medicine diagnoses, treatment methods, prescriptions, etc., were collected. The collected data were subsequently compiled into a medical record database using the Epidata 3.1 data management software, followed by the use of Apriori algorithm provided in the SPSS Modeler 14.2 statistical software to investigate the association rules between drug-drug, drug-symptom, and drug-western medicine indices. Results (i) A total of 51 medical records were included, involving 17 types of syndromes. Among them, the top three with frequency ≥ 3 included “Phlegm and blood stasis, and thoracic obstruction” “Deficiency-weakness of the spleen Qi, and static blood blocking collaterals”, and “Deficiency-weakness of the spleen Qi, and static blood blocking collaterals”. Alternatively, of the 14 treatment methods, the top three treatments with frequency of ≥ 3 included “Activating Yang and eliminating turbidity, and removing phlegm and dredging channel blockage” “Strengthening the spleen and benefiting Qi, and eliminating phlegm to activate the channels”, and “Warming Yang and benefiting Qi, and expelling cold to remove obstructions”. Among the 15 prescriptions, the top three used with frequency ≥ 3 included Huangqi Guizhi Wuwu Tang (黄芪桂枝五物汤), Gualou Xiebai Banxia Tang (瓜蒌薤白半夏汤), and Ganjiang Huangqin Huanglian Renshen Tang (干姜黄芩黄连人参汤). Lastly, of the 83 drugs used for a total of 476 times, those with frequency ≥ 15 included Huanglian (Coptidis Rhizoma), Huangqi (Astragali Radix), Jiudahuang (Wine-processed Rhei Radix et Rhizoma), Jixueteng (Spatholobi Caulis), Shengjiang (Zingiberis Rhizoma Recens), Huangqin (Scutellariae Radix), and Guizhi (Cinnamomi Ramulus). (ii) For the drug-drug associations, under the criteria of support ≥ 15% and confidence = 100%, seven second-order association rules, seven third-order rules, and six fourth-order roles were identified. The top-ranking rule of each was “Huangqin (Scutellariae Radix) → Huanglian (Coptidis Rhizoma)” “Ganjiang (Zingiberis Rhizoma) + Huangqin (Scutellariae Radix) → Huanglian (Coptidis Rhizoma)”, and “Baishao (Paeoniae Radix Alba) + Guizhi (Cinnamomi Ramulus) + Jixueteng (Spatholobi Caulis) → Huangqin (Scutellariae Radix)”, respectively. Alternatively, the drug-symptom associations were analyzed under the criteria of support ≥ 5% and confidence = 100%, which derived eight second-order association rules, 31 third-order rules, and 30 fourth-order rules. The top-ranking association rule of each order was “Huangqi (Astragali Radix) → Limb edema” “Guizhi (Cinnamomi Ramulus) + Jixueteng (Spatholobi Caulis) → Limb numbness and pain”, and “Guizhi (Cinnamomi Ramulus) + Jixueteng (Spatholobi Caulis) + Huangqi (Astragali Radix) → Limb numbness and pain”, respectively. Similarly, the drug-western medicine index associations were investigated under the criteria of support ≥ 5% and confidence = 100%, and five second-order association rules, 16 third-order rules, and 16 fourth-order rules were identified. In this category, the top-ranking association rule of each order was “Qinpi (Fraxini Cortex) → Uric acid” “Huanglian (Coptidis Rhizoma) + Ganjiang (Zingiberis Rhizoma) → Glycated hemoglobin”, and “Huanglian (Coptidis Rhizoma) + Ganjiang (Zingiberis Rhizoma) + Huangqin (Scutellariae Radix) → Glycated hemoglobin”, respectively. Conclusion Through association rule mining, this study objectively and quantitatively demonstrated the drug-drug, drug-symptom, and drug-physicochemical index associations of patients with the spleen dampness syndrome at the splenic deficiency and impairment stage treated by Academician TONG Xiaolin. The results indicated that treatment for these patients adopted the “state-target” syndrome differentiation method. The drug combination was characterized by “small prescriptions”, targeting both the patient’s symptoms and signs (syndrome target) and western medicine indices (treatment target). This study could provide references for future research on the academic thoughts and medical experience of Academician TONG Xiaolin.

Objective:To analyze the risk factors of bronchopulmonary dysplasia(BPD)in very preterm infants(VPI), and to provide scientific basis for the prevention and treatment of BPD in VPI.Methods:A prospective multicenter study was designed to collect the clinical data of VPI in department of neonatology of 28 hospitals in 7 regions from September 2019 to December 2020.According to the continuous oxygen dependence at 28 days after birth, VPI were divided into non BPD group and BPD group, and the risk factors of BPD in VPI were analyzed.Results:A total of 2 514 cases of VPI including 1 364 cases without BPD and 1 150 cases with BPD were enrolled.The incidence of BPD was 45.7%.The smaller the gestational age and weight, the higher the incidence of BPD( P<0.001). Compared with non BPD group, the average birth age, weight and cesarean section rate in BPD group were lower, and the incidence of male infants, small for gestational age and 5-minute apgar score≤7 were higher( P<0.01). In BPD group, the incidences of neonatal respiratory distress syndrome(NRDS), hemodynamically significant patent ductus arteriosus, retinopathy of prematurity, feeding intolerance, extrauterine growth restriction, grade Ⅲ~Ⅳ intracranial hemorrhage, anemia, early-onset and late-onset sepsis, nosocomial infection, parenteral nutrition-associated cholestasis were higher( P<0.05), the use of pulmonary surfactant(PS), postnatal hormone exposure, anemia and blood transfusion were also higher, and the time of invasive and non-invasive mechanical ventilation, oxygen use and total hospital stay were longer( P<0.001). The time of starting enteral nutrition, cumulative fasting days, days of reaching total enteral nutrition, days of continuous parenteral nutrition, days of reaching 110 kcal/(kg·d) total calorie, days of reaching 110 kcal/(kg·d) oral calorie were longer and the breastfeeding rate was lower in BPD group than those in non BPD group( P<0.001). The cumulative doses of amino acid and fat emulsion during the first week of hospitalization were higher in BPD group( P<0.001). Multivariate Logistic regression analysis showed that NRDS, invasive mechanical ventilation, age of reaching total enteral nutrition, anemia and blood transfusion were the independent risk factors for BPD in VPI, and older gestational age was the protective factor for BPD. Conclusion:Strengthening perinatal management, avoiding premature delivery and severe NRDS, shortening the time of invasive mechanical ventilation, paying attention to enteral nutrition management, reaching whole intestinal feeding as soon as possible, and strictly mastering the indications of blood transfusion are very important to reduce the incidence of BPD in VPI.