Objective To investigate the profit-loss of the hospital's DRGs pilot and its reasons.Methods An investigation of the profit-loss situation of 9 225 cases of a hospital in Beijing,who have been discharged from December 2011 to December 2013 and grouped into 105 DRG pilot groups.Results As shown in the medical records of 9 225 cases,96.54％ are covered by urban employee basic medical insurance,and 3.46％ by urban residents' medical insurance; 78 DRGs groups were recorded as with profit(74.29 ％),while 27 recorded as with a loss(25.71％) ;average length of stay as 9.37 days,average expense per hospitalization per person as 18 032.27 yuan,average quota standard as 17 337.53 yuan,average out-of-pocket cost as 829.47 yuan,average second charge as 2 448.57 yuan,average profit as 2 583.29 yuan,average sum of out-of-pocket payment ratio and second charge ratio as 12.46％.Conclusion The current DRGs pilot model shows the hospital as profit making in general,with no significant impact on the hospital.

OBJECTIVE To learn the condition of nosocomial infection in our hospital,and enforce the prevention and therapy of nosocomial infection.METHODS A total of 8413 inpatients of our hospital in 2006 monitored prospectively and investigated retrospectively.RESULTS A total of 188 patients suffered from nosocomial infection.The rate of infection was 2.23%.The sites of infection were mainly in respiratory tract(30.30%),skin soft tissue(28.79%),gastrointestinal trackt(14.14%) and operative infection(10.10%).The pathogenic bacteria of hospital infection were mainly G+ bacteria(58.14%).CONCLUSIONS Analyzing the risk factors of nosocomial infection,monitoring the pathogens,aseptic manipulation,strictly proper antibiotics usage,and protecting the susceptible population in hospital,all the measures are effective to reduce nosocomial infection.

Objective To investigate the expression of P2X7 receptor (P2X7R) and the effect of P2X7R agonist 2'-3'-O-(4-benzoyl-benzoyl) ethane adenosine triphosphate three amine salt (BzATP) on cell growth and apoptosis in non-small cell lung cancer A549 cells,and to explore the related mechanism.Methods The expression of P2X7R in A549 cells was detected by immunofluorescence.Cells were treated with different concentrations (150,300,600 μmol/L) of BzATP.Cells untreated with BzATP were used as control group.3-(4,5-dimethyl-2-thiazoly)-2,5-diphenyl-2H-tetrazolium bromide (MTF) assay and Hoest33342 staining were respectively used to detect cell viability and apoptosis.Enzyme-linked immunosorbent assay (ELISA) was uesd to detect the concentration of tumor necrosis factor-α (TNF-α) of cell culture supernatants.The expressions of nuclear factor-κB (NF-κB) p65,inhibitor of α of NF-κB (IκBα) and the phosphorylation of inhibitor of α of NF-κB (phospho-IκBα) were detected by Western blotting.Results P2X7R was expressed on the cell membrane of A549 cells.Survival rate of A549 cell was significantly decreased with the concentrations of BzATP at 300 and 600 μmol/L [(67.87 ± 8.98) ％,(44.73 ± 6.92) ％],compared with the control group (98.60 ± 1.44) ％,the differences were statistically significant (t =4.481,P =0.027;t =3.920,P =0.038).BzATP promoted apoptosis,and increased the concentration of TNF-α of supernatant at 300 and 600 μmol/L [(57.35 ±6.41) pg/ml,(78.63 ± 11.33) pg/ml],compared with the control group (42.56 ±0.37) pg/ml,the differences were statistically significant (t =6.410,P =0.035;t =11.330,P =0.005).In addation,the expressions of NF-κB p65 and IκBα were respectively downregulated and upregulated by BzATP,while the expression of phospho-IκBα was not significantly altered.Conclusion P2X7R is expressed on A549 cell membrane.BzATP can inhibit cell proliferation and induce the apoptosis of A549 cells,and the mechanism of action may be related to promoting the release of TNF-α and inhibition of NF-κB pathway.

Afferent Pathways ; anatomy & histology ; Animals ; Female ; Ganglia, Spinal ; anatomy & histology ; Neurons, Afferent ; Rats ; Rats, Sprague-Dawley ; Urinary Bladder ; innervation

Objective To analyze the clinical effect of intravascular intervention for treating the severe stenosis of bilateral renal arteries (BRASS).Methods A total of 40 patients with BRASS admitted in Fuwai Hospital from September 2008 to December 2010 were retrospectively analyzed.These patients,23 males and 17 females,aged from 21 to 76 years with average age of (59.75 ± 17.59) years,with luminal narrowing over 70％ in bilateral renal arteries,met the criteria of BRASS evidenced by angiography of renal arteries,and were subjected to renal artery interventional therapy. The etiological factors included arteriosclerosis (34 cases),Takayasu arteritis (3 cases) and congenital fibromuscular dysplasia (3 cases).After percutaneous endovascular intervention,the therapeutic effects were evaluated by lowering the systemic blood pressure and serum creatinine level in 12-month follow-up in average after operation. The data were analyzed with SPSS 13.0 statistical software.ResultsAmong the 80 reual arteries in 40 patients,18 arteries were treated with percutaneous transluminal balloon angioplasty (PTBA),while the other 62 arteries were treated with percutaneous transluminal renal artery stenting (PTRAS).Mter endovascular intervention,the mean systolic blood pressure decreased from ( 165.0 ± 27.0) mm Hg to ( 135.7 ± 25.3 ) mm Hg on the second day after operation ( P ＜ 0.01 ) ; and the mean diastolic blood pressure decreased from ( 88.9 ±15.1 ) mm Hg to (74.8 ± 13.2) mm Hg on the second day after operation ( P ＜ 0.01 ).Accordingly,the kinds of anti-hypertension drug used decreased from ( 3.1 ± 0.9 ) to ( 2.3 ± 1.2) ( P ＜ 0.01 ).Only one patient died suddenly 3 months after intervention,and one died of acute myocardial infarction 7 months after operation.The other 38 patients were followed up for 12 months.At last,the mean systolic blood pressure of patients decreased from ( 165.0 ±27.0) mm Hg to ( 133.53 ± 15.94) mm Hg and the mean diastolic blood pressure decreased from (88.9 ± 15.1 ) mm Hg to (77.37 ± 13.47 )mm Hg. Of all 38 patients,2 were cured (5.3％),27 were improved (71.1％) and 9 failed to treatment (23.7％).Of all 38 patients,76.4％ got hypertension lowered.Moreover,renal function (Scr) was improved in 2 patients (6.3％ ),steady in 21 patients ( 65.6％ ),declined in 9 patients ( 28.1％ ) resulted in azotemia stage.Of 38 patients,71.9％ patients got overall benefit from endovascular intervention in respect of renal function improved.Conclusions The procedure of PTBA or PTRAS offered a minimally invasive,relatively safe and effective technique for BRASS patients to decrease blood pressure and stabilize renal function.

OBJECTIVE To learn the condition of nosocomial infection of lower respiratory tract,so as to take effective measures to prevent and control it. METHODS A total of 10351 inpatients of our hospital from Mar 2007 to Mar 2008 were monitored prospectively and investigated retrospectively. RESULTS Of 234 nosocomial infection events,the lower respiratory tract infection occupied 80 events which the infection rate was the highest (34.19%) and mainly happened in internal medicine (33.75%) and neurosurgery (25.0%) departments. The pathogenic bacteria of hospital infection were mainly G-bacteria (50.94%). CONCLUSIONS The primary affection should be actively treated with strictly aseptic manipulation,reasonable application of antibiotics and strengthening disinfection and management of wards. All the measures are effective,to prevent the lower respiratory tract infection.

Background:A recent perspective European study has shown that Chronic Liver Failure-Consortium Organ Failure score(CLIF-C OFs)is an effective diagnostic criteria for acute-on-chronic liver failure(ACLF)in alcoholic or hepatitis C virus patients with acute decompensation(AD). Aims:To assess the efficacy of CLIF-C OFs for distinguishing ACLF in non-hepatitis B virus(HBV)-related chronic liver disease patients with AD. Methods:A total of 274 consecutive non-HBV-related chronic liver disease patients with AD from Jan. 2005 to Dec. 2010 at Shanghai Ren Ji Hospital were enrolled. Patients were divided into three groups:ACLF at admission,ACLF developed within 28-day and non-ACLF according to CLIF-C OFs criteria. Clinical and biochemistry characteristics,severity of the disease and 28-day and 90-day mortality data between ACLF and non-ACLF groups were analyzed. Results:Of the patients assessed,40 had ACLF at admission,27 had ACLF developed within 28-day,207 remained not having ACLF. Patients in ACLF group had higher TB,Cr,INR,ALT,AST,ALB,WBC,score of Child-Pugh,CTP,MELD,MELD-Na than non-ACLF patients(P <0. 05),and were younger in age(P < 0. 01). Incidences of hepatic,renal,cerebral,coagulation,circulation and lung failure,28-day mortality,90-day mortality were significantly higher in ACLF group than in non-ACLF patients( P <0. 01). However,no significant differences were seen in the characteristics mentioned above between ACLF at admission group and ACLF developed at 28-day group(P > 0. 05). TB level at admission and infection occurred within 28-day were the risk factors for developing ACLF(P < 0. 05). Conclusions:ACLF constitutes a more severe subgroup in non-HBV-related chronic liver disease patients with AD,and CLIF-C OFs could help to distinguish ACLF patients out from non-HBV-related chronic liver disease patients with AD.

Objective To summarize the clinical characteristics of 15 cases of Poland's syndrome and to explore the suitable treatment strategies. Methods A retrospective study of 15 adult patients with Poland's syndrome was conducted and the related literature was reviewed. According to the development of pectoralis muscles and breast, chest deformities were classified into 2 grades: mild and severe. Mild form was limited to absence of partial pectoralis major muscle, with variable hypoplasia of other minor components (such as the size of breast and the size and position of the nipple-areola complex), leading to a mild chest wall asymmetry. Severe form was characterized by absence or severe hypoplasia of the pectoralis major muscle and mammary gland with an evident chest wall asymmetry. Combined with gender, adult patients were divided into 4 types: female mild, female severe, male mild, and male severe. Each type had its own treatment strategies based on its anatomic features: silicone implant insertion for female mild type;latissimus dorsi muscular flap transposition and silicone implant insertion for female severe type;fat injection for male mild type;latissimus dorsi muscular flap transposition for male severe type of the patients. From 2003 to 2008, 15 adult cases were admitted to our ward, aged from 16 to 34 years.The case number of each type was 6, 6, 2 and 1, respectively. One severe female patients rejected any surgical interventions;the others were all treated as the above. Results Follow-up periods ranged from 6 months to 4 years. This series had got satisfactory results with good breast symmetry and natural texture. All the latissimus dorsi muscular flaps survived well. No postoperative complications, such as implant capsular contracture or implant displacement, were observed. Conclusion The manifestations of Poland's syndrome are extremely varied. This classification method is simple but useful, which could effectively direct the individualized treatment for the complete and adequate rehabilitation. Latissimus dorsi muscular flap, pedicled or free transplanted, pulsing silicone implant in females, are the first choices for severe chest deformations of this syndrome.

BACKGROUND:Negative pressure wound therapy has been extensively used, but most people only knew the superiority of negative pressure wound therapy based on clinical experiences or subjective judgment.
OBJECTIVE:To observe the effects of negative pressure wound therapy on the wound on the body surface, and to compare with contemporaneous conventional method.
METHODS:A total of 45 patients with wound on the body surface treated in the Peking Union Medical Col ege Hospital from January 2006 to December 2011 were enrol ed in this study, including 25 patients undergoing negative pressure wound therapy and 20 patients undergoing conventional change dressing method. Al clinical data were recorded.
RESULTS AND CONCLUSION:Negative pressure wound therapy was better than conventional method (P<0.05), on terms of preoperative preparation period, wound granulation, bacterial scavenging, labor intensity of working staff and incidence of postoperative complications. However, no significant difference in therapy cost was detectable (P>0.05). These results suggested that compared with conventional method, negative pressure wound therapy positively contributed to the healing, obviously shortened preoperative preparation, accelerated the diminution of wound, decreased the incidence of complications of reconstruction, lessened patient’s distress, reduced their economic cost, and diminished labor intensity of working staff. Negative pressure wound therapy has been proven an excellent tool of to promote wound healing.

BACKGROUND:Negative pressure wound therapy has been widely recognized, the currently published papers are limited in academic value and lack of scientific, objective, qualified index to confirm the therapy effectiveness. OBJECTIVE:To systemical y evaluate the clinical effect of negative pressure wound therapy, provide more evidence for its clinical application, and guide clinical research.
METHODS:Fifteen articles were screened out of peer-reviewed publications (Cochran library, Embase, PubMed-Medline and Chinese BioMedical Literature Database). Scientific data were col ected and evaluated by two researchers. The data were statistical y analyzed with RevMan software.
RESULTS AND CONCLUSION:Only 15 random-control ed trials were final y preserved, including 10 as B-grade moderate bias risk and focused on the effect of negative pressure wound therapy on chronic wounds, and 5 as C-grade high bias risk and focused on the effect of negative pressure wound therapy on acute wounds. There were significant differences in the main outcome measures between negative pressure wound therapy and conventional wound therapy. As for chronic wound patients, no significant difference was observed in the operation-preparing period, reducing wound area, promoting wound granulation, and amputation rate between two therapies. As for acute wound patients, the differences were significant in the operation-preparing period, promoting wound granulation, wound infection rate, and cost materials between two therapies. However, no difference was significant in the healing of wound and hospitalization time. Our findings indicate that, negative pressure wound therapy is an effective means for both acute and chronic wounds, it can shorten operation-preparing period, promote wound granulation, and reduce amputation rate and infection rate, thus providing evidence for clinical application. The wel-designed study is needed to develop high-quality random control ed trails.