Objective Probing into the rationale of DRGs payment standards for references to making DRGs payment standards.Methods Based on the DRGs grouping results of circulatory diseases cases admitted by a tertiary hospital from 2003 to 2005,two typical combinations were selected to determine the payment standard for each DRGs combination.Unnecessary medical expenses were excluded.Results According to the percentage of unnecessary medical expenses,Angina,non-special nursing,and class 1 nursing were in a group,with unnecessary medical expenses per ease of 758.00 yuan;CAG,single stent implantation,acute myocardial infaction as the main diagnose were in a group,with medical expenses per case of 2814.03 yuan;such expenses account for 6.20% of the total hospitalization expenses of both groups.Conclusions If the average expenses with unnecessary medical expenses excluded are set as the combined payment standard,hospitals will be restrained from unnecessary medical behaviors and expenses so incurred.

Equipment department plays an important role in medical consumables management. Institutionalized management and practical medical consumable purchase are key to medical consumables management.

Transpedicular screw and rod internal fixation system is the common implants in spinal surgery. Multi-slice spiral CT and magnetic resonance imaging can generate section image, become routine imaging modality in the assessment of the postoperative spinal patients. Magnetic resonance imaging can evaluate the bone marrow and soft tissue, which is the first choice for examination. However, to the patients with metal implants, the existed metal artifacts can decrease the imaging quality. Therefore, multi-slice spiral CT is an important evaluation method for inserted material, os integumentale and anatomy. This article reviewed the production mechanism of metal-related artifacts, influencing factors and decreasing technique.

Object to define defects of drug accurately and to initially discuss its law responsibility. Method With comparative study and system thinking,we acquired few scientific recognition of drug’s defects. Result & Conclusion Defects of drug are not equal to negative drug reaction. The former one should be an unreasonable and potential risk which induces no expectant therapeutic efficacy to provide. And its law responsibility could be no-fault liability accompanied by state compensation.

OBJECTIVE:To establish the gas chromatography (GC) fingerprint for the petroleum ether part of Areca peel and provide reference for the quality evaluation. METHODS:GC was conducted to establish the fingerprint for the petroleum ether part of Areca peel from 10 different areas,the cluster analysis and similarity of fingerprint data were conducted to study the similarity of GC fingerprint of Areca peel. RESULTS:There were totally 8 common peaks. All the medicine materials had the characteristics,but there were differences among the relative peak area. CONCLUSIONS:The GC fingerprint has high importance and precision and can be used for the quality control of Areca peel.

AIM: To establish the quality standard for Yanqingsong Granule (Radix P uerariae, Rhizoma Chuanxiong, Radix Paeoniae Alba, Radix Angelicae Dahuricae, et c.). METHODS: Radix Puerariae; Rhizoma Chuanxio ng; Radix Paeoniae Alba; Radix Angelicae Dahuricae. in Yanqingsong Granule were identified by TLC, and the content of puerarin was determined by HPLC. RESULTS: Radix Puerariae; Rhizoma Chuanxio ng; Radix Paeoniae Alba; Radix Angelicae Dahuricae could be identified by TLC. P uerarin showed a good linear relationship at a ran ge of 0.1716～0.8580?g,r=0.9999. The average recovery was 97.49% (RSD= 1.77% and n=6). CONCLUSION: The methods are available with a reproducibility and ca n control the quality of this granule effectively.

Objective The aim of this study is to address learning curve and clinical outcomes of totally robotic atrial septal defect repair on the basis of a single - center experience.Methods 54 cases of atrial septal defect (ASD) were repaired using “da Vinic S surgical system on arrested ( group Ⅰ,54 cases) or beating heart ( group Ⅱ,40 cases) from January 2007 to December 2010.Learning curves were assessed by means of regression analysis with logarithmic curve fit.The effect of operative variables on clinical outcome was analyzed by linear by regression using the Spearman's rho coefficient.Results All cases were accomplished successfully without complications.No residual shunt was detected at intraoperative or postoperative echocardiography.Significant learning curves were noted for corss clamp time in group Ⅰ:y (min) =68.741 -8.283 (n) (x)( r2 =0.489 ; P ＜ 0.01 ) ; the operation time in group Ⅱ:y (min) =355.51 - 56.29 (n) (x) ( r2 =0.581 ; P ＜ 0.01 ).No correlation was detected between operation time,cardiopulmonary bypass time,or cross clamp time and intubation time,intensive care unit stay,or total length of stay.Conclusion The robotic atrial septal defect repair can be performed safely.The learning curves is steep and the longer cardiopulmonary bypass times,operation time or cross clamp time had no negative impact on intraoperative and postoperative outcome.

Objective To evaluate the operative treatment of nonunion of humeral shaft fracture with in- ternal plate fixation and autogenous cancellous hone graft.Methods Forty-one cases of nonunion of humeral shaft fracture operatively treated from February 2002 to December 2004 were analyzed retrospectively.There were 32 males and nine females.Their average age was 37.5 years(range,17 to 67 years).Sixteen nonunions were defined as hypertrophic and 25 as atrophic.We followed all the patients and obtained their complete medical information. Results Our average follow-up was 22.6 months(range,8 to 42 months).Forty fractures(97.6%)were united within an average of 5.8 months(range,3 to 12 months).Complications included iatrogenic radial nerve injury in three patients,wound infection in one patient and fracture nonunion in one patient.At the final follow-up,shou]der and elbow functions were found to be satisfactory.Conclusion Open reduction and plate internal fixation sup- plemented with autogenous cancellous bone graft is an effective treatment for nonunion of humeral shaft fracture.

Objective To evaluate the differences of the lower extremity atherosclerosis between patients with and without type 2 diabetes using dual-source CT angiography.Methods Dual-source CT angiography of lower extremity was performed in 87 patients with (n=30)or without (n= 57 )diabetes.Extent of luminal stenosis,and the type,distribution and range of the plaques were compared.Results 342 plaques in 540 segments (63.3%)in diabetic patients,and 500 plaques in 1 026 segments (48.7%)in non-diabetic ones were detected respectively.Compared with non-diabetic patients,the diabetic ones had a higher overall incidence of plaques (P <0.05).Calcified plaques were the most common in both kinds of patients,and the incidence of mixed plaques was high-er in diabetic patients than that in non-diabetic ones (35.6 % vs.28.4%,P <0.05).Light to moderate stenosis occurred in most diabetic patients,and fewer occlusion was found compared with non-diabetic ones (9.1% vs.1 7.0%,P <0.05).The most common sites of the plaques in diabetic patients were located at distal small arteries below the knee.However,those were located at proximal arteries above the knee for non-diabetic ones.The involvement of atherosclerosis in diabetic patients was more diffused,and the de-gree of Ⅳ (75%-100%)was higher than that in non-diabetic ones (P <0.05).Conclusion Atherosclerosis in lower extremity on dual-source CT angiography is very common in diabetic patients with multi-segmental,diffused,non-obstructive involvement of dis-tal small arteries below the knee.

Objective To explore how to improve the sensitivity and specificity of CT cisternography (CTC) examination.Methods The clinical data of 20 cases of CTC in detecting cerebrospinal fluid rhinorrhea were analyzed,and the influence of continuous dripping of fluid and the filling time of subarachnoid space upon the image quality were observed.Results Nineteen cases of active cerebrospinal fluid rhinorrhea were found with CTC,and the fistula sites were determined by CTC.Eighteen cases received operation which confirmed the fistula sites.One case was found with no active fistula site.According to the image of ethmoid sinus leaks results,7 cases had better image quality in 9 cases whose subarachnoid space filling time was longer than or equal to 10 min.One case had better image quality in 6 cases whose subarachnoid space filling time was shorter than 10 min.There was significant difference (P =0.0406).Conclusion To raise the positive rate of CTC,the position of active fistula should be maintained and keep the time between the injection and scan longer than or equal to 10 min,which help to get better image quality.