Diagnosis related groups (DRGs)have been widely used in many countries and regions.The versions of DRGs in different regions are modified according to the local circumstances and conditions.Beijing version DRGs (BJ-DRGs)is the first DRGs system in Chinese,which was developed locally based on the conditions of medical information system and health relative policies in Beijing.This paper introduced the grouping principles,logic and methodology of BJ-DRGs.Taking“ear,nose,mouth and throat disorders”for example,this paper demonstrated the grouping process of BJ-DRGs.

Objective To investigate the imaging manifestations and clinical features of hepatic and renal angiomyolipoma. Meth-ods The clinical data and imaging findings of hepatic and renal angiomyolipoma in a 51-year-old woman was retrospectively ana-lyzed with literature review. Results CT scan showed a large polymorphous hypodense mass in the right lobe of liver. After contrast -enhanced CT scan, the mass was enhanced gradually from periphery to ceritre. Bilateral kidneys obviously enlarged and appeared as alveolate appearance mixed density with spotty and stripped fat structures. At contrast-enhanced scan, the normal structures of cor-tex and medulla were disappeared, the alveolate walls were enhanced obviously. The arteries and veins of bilateral kidneys were com-pressed and displaced. Conclusion The imaging features of liver and kidney are of certain characteristic compared with other benign and malignant masses,but the final diagnosis of it is still depending on pathology mostly.

Objective To analyze the serum level of 25-hydroxy vitamin D [25-(OH) D] in pregnant women in Nanjing and its relationship with age,gestational week,pre-pregnancy body mass index (BMI) and season,so as to provide some guidance on clinical application of vitamin D measurement and supplementation.Methods 880 pregnant women (in 21-36 gestational weeks) regularly visiting antenatal clinic in Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University were selected from January to December 2015.Their serum 25-(OH)D concentrations were measured by enzyme-linked immunosorbent assay (ELISA).Results The mean serum 25-(OH) D concentration in these pregnant women was (42.03 ± 19.22) nmol/L and sufficient in only 42 (4.77％).Vitamin D levels showed seasonal variation (P =0.0164),with the levels in summer [(44.61 ±23.57) nmol/L] and autumn [(43.43 ± 19.31) nmol/L] being higher than spring [(39.68 ± 16.91) nmol/L] and winter [(39.65 ± 13.36) nmol/L].There was no statistically significant difference in serum vitamin D level among different gestational weeks (P =0.929 4).There was statistically significant difference in serum vitamin D level among different age groups (P =0.038 3).Vitamin D level was not associated with pre-pregnancy BMI.Conclusions Vitamin D deficiency is highly prevalent among pregnant women in Nanjing.We suggest vitamin D testing be carried out more actively.

Objective To investigate the effect of vascular endothelial growth factor (VEGF) on the leukocyle function in a rat denervated infect flap model and to investigate the action mechanison of VEGF in the flap anti-infection .Methods An island pedicle flap measured 2 cm × 2 cm was raised on the right abdomen of sixty wister rats ,which were divided into three groups .All flaps re-ceived intradermal inoculation of 107 Staphylococcus aureus ,and the animals were observed for 96 h .The indexes of the leukocyte count ,leukocyte vitality ,hemiluminescence of neutrophils ,tissue bacterial count ,naked eyes observation of falptissue and the light microscope observation were detected .Results The leukocyte count in the exudation at postoperative 96 h had no statistical differ-ences among 3 groups(P>0 .05);while in the indexes detection of the leukocyte vitality ,chemiluminescence of neutrophils ,tissue bacterial count ,etc .,the comparison between the chronic denervated group and the control group showed very significantly differ-ences(P<0 .01);the differences between the VEGF treatment group and the chronic denervated group was very significant (P<0 .01) .The falp pathological change in the control group and the VEGF treatment groups was slight .Conclusion The soft issue af-ter losing the innervation decreases the leukocyte function .VEGF might improve the flap micro circulation and play an important role in improving the leukocyte function .

Objective To study the accuracy and the clinical significance of sentinel lymph node biopsy (SLNB)after neoadjuvant chemotherapy for breast cancer.Methods A total of 90 patients with StageⅡorⅢbreast cancer and negative axillary node after neoadjuvant chemotherapy were enrolled in the study.Mapping proce- dure and SLNB were performed using methylene blue injected at the site of the primary breast cancer,followed by the axillary lymph node dissection.Results The sentinel lymph node(SLN)was successfully identified in 82 out of 90 patients(91.1%).The number of sentinel harvested nodes ranged from 1 to 4(average 1.6).The accuracy of SLNB to predict the axillary lymph node status was 93.9 %(77/82),the sensitivity,positive predictive value,nega- tive predictive value and false negative rate were 87.5 %(40/45),100 %,88.1% and 11.1%(5/45),respectively. The SLN identification rate tended to be higher and false negative rate tended to be lower in patients with T2 prima- ry tumor before neoadjuvant chemotherapy.Conclusion Our study indicated that SLNB after neoadjuvant chemotherapy in patients with StageⅡorⅢbreast cancer had a similar effect as SLNB in non-neoadjuvant studies. SLNB was considered to be able to accurately predict the axillary lymph node status in patients with T2 primary tu- mor before neoadjuvant chemotherapy.

Objective To observe the effect of human umbilical cord-derived mesenchymal stem cells (hMSCs) on type 2 diabetic rats, and to explore the possible mechanism. Methods Type 2 diabetic rats were induced by high-fat diet combined with a low dosage of streptozotocin ( STZ, 25 mg/ kg). After 3 × 106 hMSCs suspended in 1 ml PBS or 1ml 10-fold concentrated hMSC supernatant were intravenously infused into the rats via the tail vein, the blood glucose levels were measured every day. One week later, intraperitoneal glucose tolerance test and insulin tolerance test were performed to evaluate the effects of hMSCs on diabetic rats. Pancreatic tissues were collected for insulin/ glucagon immunofluorescence staining. Results After hMSCs infusion, blood glucose level and homeostasis model of assessment for insulin resistance index were significantly decreased in type 2 diabetic rats(both P<0. 01). The glucose tolerance and insulin tolerance were greatly alleviated by hMSCs(all P<0. 01). Intravenously infused 1ml 10-fold concentrated hMSC supernatant showed a similar result to hMSCs. Conclusion In type 2 diabetic rats, hMSCs are able to effectively lower the blood glucose level, improve insulin sensitivity, and increase the number of β cells, which seems to be mediated by their secreted molecules.

Objective To investigate the effects of N-acetylserotonin (N-AS) on the expression of active caspase-3,Bcl-2 and Bax in rat retinas induced by retinal ischemia-reperfusion injury (RIRI).Methods Adult male Sprague-Dawley rats were randomly divided into the normal control group (6 cases),RIRI group (30 cases) and NAS group (30 cases),RIRI models in NAS group were established after giving NAS,the groups were sub-divided into 6 hours,12 hours,24 hours,48 hours and 72 hours group based on the time of RIRI.Morphologic changes were evaluated by HE staining.The expression of active caspase-3,Bcl-2 and Bax protein in the retina of rats was detected by immunohistochemistry.Results HE staining showed that the retinal structure in the normal control group was clear,and the cells in each layer were tightly packed;Each layer of retina was edema in the RIRI group after 6 hours and 12 hours,the edema gradually alleviated after 24 hours,the ganglion cells decreased gradually,the distribution was in disorder,with the prolongation of time,the retinal ganglion cells were defected;drug group of as Compared with RIRI group,the cell edema in the NAS group at 6 hours and 12 hours were obvious reduced,the cells in 24 hours,48 hours,72 hours group arranged regularly,the loss number of ganglion cells were reduced.The number of active caspase-3 positive cells in RIRI group increased at 6 hours after peffusion,the number was (561.15 ±37.19) cell ·mm-2,and reached the high level at 24 hours,the number was (1522.61 ±84.36) cell · mm-2,and then decreased gradually.The number of active caspase-3 positive cells in NAS group was significantly lower than that in RIRI group,the difference was statistically significant (all P ＜ 0.05).The expression of Bcl-2 positive cells in RIRI group began to decrease after 6 hours,and decreased to a low level at 24 hours,and the number of Bcl-2 positive cells in NAS group was significantly higher than that in RIRI group at each time point,the differences were statistically significant (all P ＜ 0.05).There were almost no Bax positive cells in the retina of the control normal group,and the Bax positive cells were found to be higher of the RIRI group at the 6 hours after RIRI,and reached the higher level at 24 hours,and decreased at 48 hours.The Bax positive cells of NAS group were significantly less than those in the RIRI group at different time points,and the differences were statistically significant (all P ＜0.05).Conclusion NAS can promote the expression of Bcl-2 protein in rat retina after RIRI,inhibit the expression of Bax protein,decrease the expression of active caspase-3 protein,alleviate cell apoptosis,and have neuroprotective effects.

AIM: To evaluate the diagnostic accuracy of macular ganglion cell - inner plexiform layer ( GCIPL ) measurements using high- definition optical coherence tomography ( Cirrus HD - OCT ) ganglion cell analysis algorithm for detecting early and moderate to severe glaucoma.
METHODS:Twenty normal control persons, 26 patients with early glaucoma and 29 patients with moderate to severe glaucoma were enrolled in this study. Macular GCIPL, optic nerve head ( ONH ) parameters and peripapillary retinal nerve fiber layer ( RNFL ) thickness were measured in each subject. Then all measured results of each parameter were calculated using SPSS17. 0. Areas under the receiver operating characteristic curves ( AUC) of each parameter were calculated to compare the diagnostic accuracy for detecting early and moderate to severe glaucoma.
RESULTS: For detecting early glaucoma, AUC of average RNFL and seven clock value of RNFL were the biggest ( 0. 871 and 0. 896 respectively ), the AUC of parameters in GCIPL were also significant, among them,
the average GCIPL showed bigger AUC(0. 847) than the minimum GCIPL (0. 812). For diagnosing moderate to severe glaucoma, the AUC of rim area was 0. 992, which was bigger than that of average RNFL ( 0. 991 ). The minimum GCIPL showed bigger AUC ( 0. 983 ) than the average GCIPL (0. 967). For early glaucoma diagnosis, the sensitivity of average RNFL was the highest (76. 9%), while the average GCIPL has the highest specificity (93. 5%).
CONCLUSION: AS a new diagnostic parameter for detecting glaucoma, GCIPL shows similar diagnostic potential compared with RNFL. For early glaucoma diagnosis, average RNFL is the most important parameter, while screening early glaucoma, average GCIPL should be paid more attention.

Glaucoma is a group of diseases which can threaten and damage the optic nerve and its visual pathway, leading to visual impairment as a result. Glaucomatous optic neuropathy is a chronic disease accompanied by apoptosis of retinal ganglion cells ( RGCs ) , visual field defect and cupping of optic nerve head. The gold standard in functional glaucoma evaluation is standard automated perimetry ( SAP) , but it is often limited to the subjective feelings of the patients. Still, visual electrophysiological techniques cannot replace the conventional inspection, but with its rapid development, it has provided a new strategy for the early diagnosis of glaucoma as a supplement because it can show changes in amplitude and latency before visual field defect. Here we review three special electroretinograms and multifocal focal visually evoked potentials in the early diagnosis of glaucoma.

Introduction：Neonatal tetanus is a major cause of neonatal mortality in many developing countries and remains a major public health problem. This study aimed to determine risk factors associated with neonatal tetanus in Wenzhou, China.Methodology：Medical records of neonatal tetanus cases from 17 hospitals over a 13-year period (2000–2012) were reviewed for potential risk factors. Controls were selected from neonates with diseases other than tetanus who were admitted to the same facility during the same period. The potential risk factors of the neonatal tetanus group were compared with the control group using univariate analysis and an unconditional logistic regression model.Results：A total of 246 neonates with tetanus and 257 controls were included in this study. Univariate analysis showed that having untrained birth attendants, home delivery, an unsterile method of delivery and being a migrant to Wenzhou were significantly different between the two groups (P < 0.001). Logistic regression analysis revealed that the odds of having an untrained birth attendant, home delivery and an unsterile method of delivery were significantly higher in the tetanus group than the control group (odds ratio: 1371.0; 95% confidence interval: 206.0, 9123.5).Conclusion：This study identified that the main risks of neonatal tetanus in cases from Wenzhou were having an untrained birth attendant, home delivery and an unsterile method of delivery. Preventive measures directed to these risk factors may reduce the occurrence of neonatal tetanus in the studied area.