Objective:To explore grouping methods of subdividing adjacent diagnosis related groups(DRGs) by introducing patient clinical complexity level(PCCL) principle and provide references for exploring DRG grouping method in line with context in China.Methods:Clinical complexity level of each complication was assigned by clinicians.PCCL model was selected to calculate the scores of clinical complexity cases.Each adjacent DRG was subdivided into DRG groups by classification and regression trees(CART) model.The rank-sum test was applied to test the statistical significances of the grouping results.Results:9 surgical adjacent DRGs were subdivided into 18 DRG groups.There were statistical significances in the differences of hospitalization expenses and length of stay among different DRG groups in each adjacent group.Conclusion:PCCL model showed high performance in DRG subdivision.The unification of the quality of medical records and coding were the key factors to ensure the reasonable grouping results.

Objective To investigate the effects of direct peritoneal resuscitation (DPR) with sodium pyruvate from hemorrhagic shock (HS) on intestinal injury in rats.Methods Fifty SPF male Sprague-Dawley rats,weighing 200-250 g,were used in this study.The animals were anesthetized with 1％ pentobarbital sodium 40 mg/kg,tracheostomized and mechanically ventilated.Femoral artery was cannulated for mean arterial pressure (MAP) monitoring,blood-letting,blood sampling and fluid infusion.HS was induced according to the method described by Wiggers.MAP was maintained at 35-40 mm Hg for 60 min.The animals were then randomly and equally divided into 5 groups:sham operation group (group S) ; conventional resuscitation group (group CR) ; DPR with different fluid groups (DPRt-3 groups).In group CR,at 1 h after HS,the animals were resuscitated with infusion of the blood withdrawn and normal saline (the volume was 2 times volume of blood loss).In DPR1-3 groups,conventional resuscitation was performed,at the same time,1.5 ％ glucose-based peritoneal dialysis solution containing lactate,1.5％ glucose-based peritoneal dialysis solution containing lactate (40.00 mmol/L),and 1.5％ glucosebased peritoneal dialysis solution containing high lactate (80.00 mmol/L) 20 ml were infused intraperitoneally over 30 min,respectively.MAP was recorded before blood letting,at 5,30 and 60 min of HS,and at 5,30,60,90 and 120 min after the end of resuscitation.At 120 min after the end of resuscitation,the lactate level in the arterial blood was measured.The animals were then sacrificed.Small intestinal samples were obtained for determination of malondialdehyde (MDA) content,myeloperoxidase (MPO) activity and tumor necrosis factor-α (TNF-α) expression,and for microscopic examination.The damage to the small intestinal mucosa was assessed and scored.Results Compared with MAP before blood letting,MAP during HS was significantly decreased,and no significant change in MAP was found after resuscitation in CR and DPR1-3 groups (P ＜ 0.05).The lactate level in the arterial blood,MDA content,MPO activity,TNF-α expression and intestinal mucosal damage scores were significantly higher in CR and DPR1-3 groups than in S group (P ＜ 0.05 or 0.01),while lower in DPR1-3 groups than in CR group (P ＜0.01),and in DPR2,3 groups than in DPR1 group (P ＜ 0.05 or 0.01).The lactate level in the arterial blood,MDA content and TNF-α expression were significantly lower in DPR3 group than in DPR2 group (P ＜ 0.05 or 0.01).Conclusion Direct peritoneal resuscitation with sodium pyruvate can reduce the intestinal injury induced by HS and inhibition of lipid peroxidation and inflammatory responses is involved in the mechanism in rats.

Vitamin D participates in a variety of biological processes. 1,25-dihydroxyvitamin D [1,25-(OH)2D]is the active form of vitamin D. Besides its classical role in bone and calcium homeostasis, 1,25-(OH)2D has many non-classical functions such as regulating proliferation and differentiation of cells in various tissues, including tumor cells as well. However, the role of 1,25-(OH)2D in thyroid cancer is not clear yet. There are three integral components of the vitamin D pathway in thyroid cells. These components are the vitamin D receptor, 1α-hydroxylase (CYP27B1), and 24-hydroxylase (CYP24A1). Differences in the expression levels of these components in normal thyroid tissue and thyroid cancer tissue may offer clues and lay the foundation for study of the inhibitory function in the pathogenesis of thyroid cancer.This review focuses on the insights gained in the elucidation of the role of 1,25-(OH)2D pathway in thyroid cancer, one of the most common endocrine malignancies.

Objective To evaluate the effect of multidisciplinary intervention on antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection.Methods By standardizing preoperative disinfection and surgical procedures, training and education of antimicrobial use, conducting quality control activities, and performing periodic feedback of supervised results, efficacy of improvement of antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection in a hospital was observed.Results In 2013 and 2014, incidences of surgical site infection(SSI) were 7.66%(17/222)and 6.80%(27/397) respectively,there was no significant difference between two groups(X2 =0.158,P>0.05).Prophylactic use of antimicrobial agents in surgical patients were as follows: cefuroxime(n=495), cefazolin(n=103), cefathiamidine(n=9), clindamycin(n=8), and cefotaxime(n=4), types of used antimicrobial agents were rational.In 2014, the implementation rate of necessary intra-operative antimicrobial adding was 95.02%, which was higher than 87.66% in 2013(X2=7.969,P<0.05), 30.73% of patients received antimicrobial prophylaxis for>48 hours, which was lower than 57.66% in 2013, difference was significant(X2=42.88,P<0.05).Conclusion Multi-intervention measures, including standard preoperative disinfection and surgical procedures, education and training, quality control circle, and feedback of supervised results can improve standard antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection.

OBJECTIVE:To measure and analysis the related costs of drug-induced liver injury (D1LI) from different decision makers,and to provide reference for reducing related costs of DILI,improving medical insurance system and realizing effective health resource distribution.METHODS:In retrospective study,60 cured or recovered DILI inpatieuts were randomly selected as subjects from medical record management system of 4 hospitals in Henan province during Jun.2014-Jun.2015.Demographic character istic,clinical characteristic and related cost of DILI were analyzed retrospectively and the cost structure was also analyzed from different decison makers (patient,society,medical insurance payer).RESULTS:The total direct medical cost of 60 cases was 584 113.05 yuan,and total direct non-medical cost was 31 093.15 yuan and total indirect cost was 169 379.95 yuan.The total cost of DILI of fered by patients was 616 296.38 yuan;the total cost of DILI offered by society was 784 586.15 yuan;the total cost of DILI offered by medical insurance was 168 289.77 yuan.CONCLUSIONS:DILI results in serious economic damage for patients and society,deserving attracting extensive attention worldwide.The study provide reference for reducing patient's medical burden and improving medical insurance system,and contribute to optimize medical resource distribution.

Objective To investigate the impacts of γ-ray radiation on gene expressions of peripheral blood lymphocytes in SD rats,and to screen differential expression genes and biological pathways closely related to radiation injury.Methods The differential gene expression of peripheral blood lymphocytes in SD rats was selected by microarray at 6 h after 2 Gy 60Co γ-ray exposure in vitro and in vivo.Bioinformatics analysis of the differentially expressed genes was performed by using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) databases.Real-time quantitative PCR was applied to verify the screen results of the microarray.Results Fifty-five genes with three times over-expressed level were screened out from the radiation groups both in vitro and in vivo and they were involved in 6 signaling pathways.There were two differentially expressed genes of microarray assay were verified by PCR assay.Conclusions Differential expressed genes in the peripheral blood lymphocytes of SD rats could be induced by γ-ray radiation and they cooperatively contributed to a variety of biological processes.

Objective To study the effect of combining recombinet interferon α -2b gel and loop electrosurgical excision procedure (LEEP) to treat cervical intraepithehal neoplasia (CIN). Methods Prospective, randomly and control study was progressed in 80 patients with CIN Ⅱ-Ⅲ. Before carrying out LEEP, all women were performed high-risk HPV DNA detection by the method of HC2. Among them, forty women were. assigned to be the study group, in which the patients were added to use recombinet interferon α -2b gel for three courses of treatment before and after LEEP, the other forty women who carried out LEEP simply were assigned to be the control group. All patients were examined by hquid-based thinprep cytology test (TCT) and colposcopic site-specific biopsies to doubtful focus of infection in the 3rd, 6th, 9th and 12th month after treatment, and judged the effect by using HC2 in the 6th and 12th month after treatment. Results Eighty patients were not detected residue and recidivafion of CIN diagnosed by coiposcopic site-specific biopsies to doubtful focus of infection. In the study group, 3 women were abnormal detected by TCT, 37 women were negative detected by HC2, the negative rate was 92.5% when LEEP ended 6 months. The cure rate was 100.0% when LEEP ended 12 months. In the control group, 21 women were abnormal detected by TCT, 19 women were negative detected by HC2, the negative rate was 47.5% when LEEP ended 6 months, 8 women were negative detected by TCT, 25 women were negative detected by HC2, the cure rate was 62.5% when LEEP ended 12 months.In the 6th and 12th month after LEEP, the difference was distinguished in the cure rate between two groups. Conclusions There is double interrupted effects by combining recombinets interferon α -2b gel and LEEP to treat CIN. It can raise the one-time cure rate of the patients with CIN.

Objective:To introduce our experience on treatment of melanoma metastasis to lymph nodes by percutaneous radiofrequency ablation combined with microwave coagulation therapy under contrast-enhanced ultrasound guidance and to assess the subsequent clinical efficacy. Methods: The 64 years old male patient with right sole melanoma had an enlarged right inguinal lymph node and received surgical resection twice within 9 months. During the following 2-7 months, more than 20 enlarged lymph nodes appeared along the right iliac artery and right lower limb, complicated with lower limb swelling. Surgical resection was ruled out due to the involvement of the iliac artery and the great number of the enlargements. Chemotherapy and Chinese herb medication were proven to be less effective, then a combined thermotherapy by radio frequency ablation (CelonLab-ENT, Germany) and microwave coagulation (YWY-2T, China) was employed percutaneously under the guidance of contrast-enhanced ultrasound for the treatment. The patient was followed up for 6 months. Results: Intra-and post-operation contrast-enhanced ultrasound scanning and biopsy pathology showed avascularity, necrosis, and atrophy in all the treated lymph nodes, with no obvious complications. The general condition of the patient was good and there was no new lesion found in other sites, except a few ones still receiving ablation in the right lower limb. Conclusion: Percutaneous radiofrequency ablation combined with microwave coagulation therapy under the guidance of contrast-enhanced ultrasound shows a stable killing effect for melanoma metastasis to lymph nodes in this patient, without obvious complications, and should be considered for more clinical applications.

Objective To investigate the clinical efficacy of conventional treatment combined with flupentixol and melitracen in patients with reflux esophagitis (RE).Methods From June 2012 to March 2015, a total of 182 patients were selected as study subjects from newly diagnosed RE patients.The anxiety and depression scores were evaluated according to Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD).And then patients were divided into HAMA and HAMD negative conventional treatment group and combined treatment group, HAMA and HAMD positive conventional treatment group and combined treatment group.Rabeprazole and mosapride were administrated in conventional treatment group.For patients in combined treatment group, on the base of conventional treatment flupentixol and melitracen were added.The treatment course was eight weeks.The degree of anxiety and depression, RE symptoms and mucosal healing under gastroscope were evaluated before and after treatment.Adverse drug reaction was observed.Chi square test or t test was performed for statistical analysis.Results Eight weeks after treatment, the scores of HAMA and HAMD in HAMA and HAMD positive combined treatment group were 7.930 ±3.832 and 9.630 ± 3.650, which were both lower than those of conventional treatment group (11.660 ± 4.108 and 12.170 ± 4.459), and the differences were statistically significant (t=3.683 and 2.233;both P＜0.05).The symptom scores of heartburn, regurgitation, chest pain of HAMA and HAMD positive combined treatment group were 0.700±0.591,0.780± 0.629 and 0.720±0.621, respectively, which were lower than those of conventional treatment group (1.280 ± 0.502, 1.370 ± 0.610 and 1.040 ± 0.842), and the differences were statistically significant (t =5.133, 4.413 and 2.114, all P＜0.05).There were no statistical significance in symptoms scores between HAMA and HAMD negative combined treatment group and conventional treatment group (all P＞0.05).After treatment, the mucosal healing rate of HAMA and HAMD positive combined treatment group was 91.3％ (42/46), which was higher than that of conventional treatment group (71.7 ％, 33/46), and the difference was statistically significant (x2 =5.845, P =0.016).The incidence of adverse events of HAMA and HAMD negative combined treatment group was 4.8％ (2/42), and that of HAMA and HAMD positive combined treatment group was 2.2％(1/46).Conclusions The conventional treatment combined with flupentixol and melitracen in RE patients accompanied with anxiety and depression was remarkable and safe.RE patients without obvious anxiety or depression, preventive use of antianxiety and antidepressant medicine can not improve the efficacy.

Objective:To investigate the pharmacokinetics of mycophenolic acid( MPA)and its metabolites in different stages af-ter the administration of enteric-coated mycophenolate sodium( EC-MPS)tablets in Chinese liver transplant recipients. Methods:The blood samples of 24 patients were collected in 0-12h of the 1st and 3rd week after the administration of EC-MPS. The concentrations of MPA,AcMPAG and MPAG in plasma were measured by LC-MS/MS developed in our lab. The pharmacokinetic parameters of MPA and its metabolites were estimated by non-compartmental method. Results:After 1-and 3-week therapy with EC-MPS,Cmax ,AUC0-12 and t1/2 was(18. 1 ± 8. 75)and(20. 7 ± 16. 0)μg ml-1 ,(42. 7 ± 17. 5)and(47. 1 ± 23. 9)μg·h·ml-1 ,(3. 33 ± 2. 81)and (3.30 ±1.89)h for MPA;(2.50 ±1.86)and(1.78 ±1.72)μg·ml-1,(14.5 ±11.7)and(6.97 ±6.57)μg·h·ml-1, (4. 48 ± 2. 53)and(3. 76 ± 1. 8)h for AcMPAG;(171. 6 ± 135. 4)and(152. 2 ± 115. 9)μg·ml-1 ,(1299 ± 1 204)and(1 051 ± 561)μg·h·ml-1 ,(8. 73 ± 4. 25)and(7. 75 ± 2. 87)h for MPAG,respectively. There was no significant difference in the PK parameters of MPA after the 1-and 3-week therapy. The Cmax ,Tmax and t1/2 of MPA in the patients received EC-MPS were significantly higher than those in the patients received MMF(P<0. 05). Cmax and AUC0-12 of MPAG in the patients received EC-MPS were signifi-cantly higher than those in the patients received MMF after the 3-week therapy(P<0. 05). Conclusion:There is no significant accu-mulation of MPA after the therapy with EC-MPS at different stages. The absorption of MPA is delayed after the therapy with EC-MPS compared with that with MMF. There is no difference in MPA exposure between EC-MPS and MMF in Chinese liver transplant patients.