Objective To identify the correlated factors of chronic hypercapnia in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS).Methods The study cohort consisted 56 patients with OSAHS.They were taken arterial blood gas analysis and pulmonary function tests.They were divided into two groups,hypercapnic(PaCO_2≥45 mm Hg)and normocapnic(PaCO_2

Objective To analyze the characteristics and influencing factors of sleep disorders and nocturnal hypoxemia of patients with different degrees of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Four hundred and twenty-five patients with snoring were scored by Epworth Sleepiness Scale ( ESS), and monitored by polysomnography (PSG). The possible correlations between sleep structure, hypoxia parameters, ESS and clinical features were analyzed and compared in those patients. Results Four hundred and twenty-five patients were divided into 4 groups according to the apnea-hypopnea index (AHI). There were 65 primary snoring patients (15.3%) and 360 OSAHS patients (84. 7% ) including 187 patients (44. 0% ) in severe OSAHS group. ESS was increased as aggravation of OSAHS. There were significant statistical differences in ESS among each group. Compared with primary snoring group, sleep efficiency, NREM1 + 2, oxygen desaturation index ( ODI), time with pulse oxygen saturation below 90% (T(SpO2 <90% ) ) were significantly higher in the OSAHS groups, and NREM3 +4, lowest pulse oxygen saturation level ( LSpO2 ) were lower. ESS was correlated positively with AHI (r= 0. 474,P <0. 01 ). They were both correlated positively with ODI, T (SpO2 <90% ) and NREM1 + 2( ESSr =0. 392, 0. 356,0. 194;AHI r = 0. 714, O. 682, 0. 365, all P < 0. 01 ), and correlated negatively with LSpO2, NREM3 + 4 ( ESS r = - 0. 414, - 0. 196; AHI r = - 0. 740, - 0. 385, both P < 0. 01 ). LSpO2, ODI and T (SpO2 < 90% ) were the primary influencing factors. Common clinical presentations and subjective symptoms were presented including daytime sleepiness, impaired memory, fatigue, dry mouth, oppressive wake and morning headache, etc. Percentage of individuals with daytime sleepiness in the severe OSAHS group was 73. 3% (137/187). These had serious impact on the patients' quality of life, leading to difficulty concentrating, poor memory and cognitive impairment. Conclusions Sleep disorders are found in the patients with different degrees of OSAHS. The excessive daytime sleepiness interrelated partly with the structure of sleep, and totally with hypoxia parameters. The more severity the patients have, the more nocturnal hypoxia, sleep disorders and higher ESS are found.

Objective To explore the operation opportunity of cholecystectomy for senile patients with acute cholecystitis combined with underlying disease.Methods 82 elderly patients with acute cholecystitis complicated with underlying diseases underwent cholecystectomy were selected,they were divided into two groups according to the different operation time:the early operation group and the delayed operation group,41 cases in each group.The patients in early operation group were given operation in 72h,while the delayed operation group was given operation more than 72h after attack.The operation time,intraoperative blood loss,intraoperative tissue adhesions,intraoperative exudation,hospitalization time,cost of hospitalization and complications of the two groups were observed and com-pared.Results The operation time of the two groups were (45.32 ±1 2.23)min,(50.89 ±1 3.34)min,there was no significant difference (P >0.05),the intraoperative tissue adhesions of the delayed operation group was more than the early operation group,and the intraoperative hemorrhage and exudation in the early operation group were significantly higher than those of the delayed operation group (P <0.05),and the hospital stay and cost of hospitalization were sig-nificantly lower than those of the delayed operation group (P <0.05).1 case in the early operation group occurred pulmonary infection,3 cases with incision infection,the incidence of complications was 9.76%;1 case in the delayed operation group underwent laparotomy operation,2 cases in the delayed operation group had pulmonary infection,inci-sion infection in 4 cases,the incidence rate of complication was 1 4.63%,there was no significant difference between the two groups (P >0.05).Conclusion The optimal operation timing of acute cholecystitis combined with basic dis-eases in the elderly patients underwent cholecystectomy is within 72h.For patients who can not be immediately given operation due to various reasons,delayed cholecystectomy is safe and feasible.

Objective To observe the efficacy and safety of endoscope and laparoscope in treatment of acutebiliary pancreatitis.Methods 84 patients with acute biliary pancreatitis from January 2010 to January 2014 in our hospital during treatment were randomly divided into the study group and control group according to the random num-ber table methods,42 cases in each group.The control group was treated with conservative treatment of department of internal medicine,while the study group was treated with duodenoscopy combined with laparoscopy.To observe and compare the efficacy and adverse reactions of two groups.Results Temperature returned to normal time,abdominal pain relief time,recovery time of amylase in urine,recovery time of biochemical index,hospitalization time and cost of hospitalization of the study group after treatment were (3.44 ±1.63)d,(4.73 ±1.12)d,(7.82 ±3.31)d,(9.81 ± 6.42)d,(12.43 ±4.61 )d,which were significantly lower than (5.94 ±2.43)d,(7.53 ±2.12)d,(11.72 ± 2.21)d,(18.41 ±8.62)d,(20.33 ±6.21)d of the control group(t =3.90,4.02,4.26,4.50,5.01,all P <0.05). 2 cases of the study group occured biliary tract bleeding,2 cases with pancreatic pseudocyst,1 case with wound infec-tion,there was no recurrence,the incidence rate of adverse reaction was 11.90%;3 cases of the control group after treatment occurred pancreatic pseudocyst,2 cases with abdominal cysts,5 cases with recurrence,1 case with acute respiratory distress syndrome (ARDS),1 case with renal failure,the incidence rate of adverse reactions was 28.57%, which of the control group was significantly higher than the study group (χ2 =4.21,P <0.05 ).Conclusion Duodenal endoscopy combined with laparoscopy has good clinical effect,shorter hospitalization time,less cost,less adverse reaction and the recurrence rate is low in treatment of acute biliary pancreatitis,which has high application value.

Objective To study the polymorphism of glucocerebrosidase ( GBA) gene of N370S, V394L, L444P, R120W, R359X, R496H, R353W and RecNcil in the patients with Parkinson's disease ( PD) in Han, Uygur and Kazak in Xinjiang and to investigate the relationship between GBA gene polymorphism and Parkinson's disease.Methods GBA gene polymorphism was analyzed by improved multiplex ligation detection reaction technique in 294 sporadic PD patients (100 cases of Uygur, 134 cases of Han, 60 cases of Kazak) and 305 healthy controls (109 cases of Uygur, 122 cases of Han, 74 cases of Kazak) in Xinjiang area.Results There were two L444P loci polymorphisms that were heterozygous mutations in 294 cases of PD patients and the mutation frequency was 0.7%.Three hundred and five cases of control group did not show L 444P polymorphism.There were no significant differences in L 444P genotype and allele frequency distribution between PD group and control group ( AA:99.3%vs 100.0%, GA:0.7%vs 0, P>0.05;G:0.3%vs 0, A:99.7%vs 100.0%, P>0.05);L444P genotype and allele frequency distribution in Han and Uygur patients with PD showed no significant differences ( AA:99.3% vs 99.0%, GA:0.7%vs 1.0%, P>0.05;G:0.4%vs 0.5%, A:99.6%vs 99.5%,P>0.05);N370S, V394L, R120W, R359X, R496H, R353W, RecNcil loci polymorphisms were not found in the PD and control groups.Conclusion The GBA gene of N370S, V394L, R120W, R359X, R496H, R353W, RecNcil showed no polymorphism in Xinjiang Han and Uygur population and there was no association of L 444P polymorphism with Parkinson's disease in Han and Uygur populations in Xinjiang .

Objective To construct an"Internet+TCM nursing service"talent cultivation model in Zhejiang Province and to evaluate its application effect.Methods Based on the literature review and expert panels,the"Internet+TCM nursing service"talent cultivation model was constructed in Zhejiang Province.A total of 63 trainees from 63 TCM and integrated traditional Chinese and Western medicine hospitals in the province were selected to carry out for 45 days of theoretical training and 9 days of clinical skills training.After the training,the training effect was evaluated by theoretical knowledge,TCM nursing skills,scenario simulation case assessment,trainees'satisfaction,as well as a survey on the results of practice.Results The constructed talent cultivation model contains course contents including theoretical learning,skill training and emergency home treatment management and corresponding assessment programs.Sixty-three trainees successfully completed the course with the theoretical score of(92.24±3.64),the skill score of(97.13±2.53),and the situational case score of(95.78±3.02).Fifty-five trainees(87.30％)were assessed as"excellent"and 8(12.70％)as"good".The trainees'satisfaction about the overall module design of the project was(4.93±0.23)and 415 cases of"Internet+TCM nursing service"were carried out.Conclusion The"Internet+TCM nursing service"talent cultivation model in Zhejiang Province has strong applicability and remarkable training effect,which can provide references for the implementation of"Internet+TCM nursing service"in other regions.

Taking the reform of payment methods based on diagnosis related groups as an opportunity, implementing performance management based on disease groups is an important lever to promote the improvement of hospital diagnosis and treatment level and high-quality development. In 2023, a tertiary comprehensive hospital introduced benchmarking management into performance management, using the average days of stay, drug costs, and consumables costs of the disease group as cost benchmark indicators. The cost benchmark values for each disease group was determined based on the big data of the disease group of the tertiary comprehensive hospital in the region and the clinical pathway management goals of the hospital. Through multidimensional and multi-level comparative analysis of the hospital′s historical values and regional big data distribution values of the benchmark indicators for each disease group, the cost benchmark values for each disease group was determined. The hospital has established a performance reward and punishment mechanism based on the benchmark value of disease group costs, and at the same time, established a performance management communication mechanism to promote relevant departments and medical groups to improve their management against the benchmark. In addition, with changes in the external environment and internal practices, the cost benchmark value of the disease group was dynamically optimized, forming a closed-loop management system that included establishing benchmarks, comparing benchmarks, achieving benchmarks, and optimizing benchmarks. Since the implementation of performance management based on disease group cost benchmarking in March 2023, the hospital′s case mix index has increased from 1.52 in March to 1.54 in September; The average days of stay decreased from 6.22 days to 5.90 days; The monthly payment weight has increased from 18 103 to 18 558; The average hospitalization cost has decreased from 16 724 yuan/person to 15 278 yuan/person, mainly due to the decrease in drug and consumables costs. The proportion of drug costs has decreased from 27.45% to 26.32%, the proportion of consumables costs has decreased from 28.75% to 26.85%, and the proportion of medical service revenue has increased from 24.64% to 26.08%; The proportion of low magnification cases decreased from 9.09% to 8.24%; The medical insurance payment rate has increased from 99.3% to 107.0%; The job satisfaction of physicians has increased from 70.00% in 2022 to 76.77% in 2023, which can provide reference for performance management practices in other hospitals.