Objective To evaluate curative effect and related prognosis factors of synchronous colorectal cancer with liver metastasis.Methods The clinicopathological and follow-up data of 47 patients undergoing surgical treatment with synchronous colorectal cancer with liver metastasis at Shanghai Jiaotong University Affiliated Sixth People's Hospital and Tongji University Affiliated Yangpu Hospital from Jun 2013 to Jan 2018 were retrospectively analyzed.Results All 47 patients were followed up and themedian followup time was 38 months (2-65 months),after simultaneous colorectal and hepatic neoplasm radical surgery,added in 41 patients by postoperative chemotherapy.There was no perioperative mortality and the postoperative complication rate was 34％.The 1-,3-,and 5-year overall-survival rates were 87％,53％,and 15％,respectively.The disease-free survival rates were 81％,43％,and 9％,respectively.Multivariate results showed tumor differentiation,serum CEA level and adjuvant chemotherapy are independent prognostic factors for patients with synchronous colorectal cancer liver metastasis (P ＜ 0.05).Conclusions Colorectal cancer with synchronous liver metastasis treated by simultaneous resection of colorectal cancer and liver metastases are the widerly adopted treatments.Long-term survival is closely related to the degree of primary neoplasm differentiation,serum CEA level at diagnosis,and postoperative adjuvant chemotherapy.

Objective To investigate the application value of spectral computed tomography venography(CTV)in the display and staging of deep venous thrombosis(DVT)in the lower extremity.Methods Eighty-two patients with CTV were selected and ran-domly divided into group A(42 patients)and group B(40 patients).Group A:tube voltage 120 kVp.Group B:gemstone spectral ima-ging(GSI)mode,reconstruction of 50 keV and iodine(water)maps.The CT and standard deviation(SD)values of the veins were measured,signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)were calculated in 120 kVp images of group A and in 50 keV images of group B.Two observers scored the image quality of the 2 groups subjectively,and Kappa test was used to examine the con-sistency.Based on the duration from the occurrence of clinical symptoms,the DVTs were classified.The CT values and iodine con-centration(IC)of DVT were measured in the 120 kVp images of group A and in the iodine(water)maps of group B,respectively.The receiver operating characteristic(ROC)curve was drawn to compare the effectiveness of CT values and IC in diagnosing DVT staging.Results CT values,SNR,and CNR of veins in group B were higher than those in group A(P<0.05).The subjective scores of the two groups were consistent(Kappa=0.926-0.955,P<0.05).The score for the display of veins and thrombus clarity in group B was 5(4,5),which was better than the score of 4(3,4)in group A(P<0.05).The efficiency of IC in diagnosing DVT staging[area under the curve(AUC)=0.973]was better than that of CT values(AUC=0.891).Conclusion The spectral CTV can improve the contrast of lower extremity deep veins and the clarity of thrombus,and can provide more objective indicators for the diagnosis of thrombus staging,which is conducive to accurate clinical diagnosis and treatment.

Objective:To study the changes of patient-related costs and the use of stents and other consumables before and after the centralized procurement of coronary stents.Methods:The inpatient medical insurance settlement case data of 1,973 patients with coronary stent implantation admitted to Daping Hospital of Army Medical University from December 2019 to October 2021 were selected.Among them,the data of 1,317 cases of percutaneous cardiovascular surgery and coronary stent implantation with serious or complications and accompanying disease group were slected according to disease diagnosis related groups(DRG),which were divided into the pre-centralized procurement group(667 cases)and the post-centralized procurement group(650 cases)according to the centralized procurement of coronary stents before and after.The costs of patients'medical consumables with the consumption of patients'medical consumables and the impact of the use of consumables such as coronary stents on the costs of medical consumables were compared.Results:There was no significant statistical difference in the hospitalization days and the average number of stents used in patients undergoing percutaneous cardiovascular procedures and coronary stent implantation with centralized procurement of coronary stents.There was a statistically significant difference in the total diagnosis and treatment cost,medical consumables cost,medicines and consumables cost and medicines cost between the pre-centralized procurement group and the post-centralized procurement group(Z=-22.316,-23.546,-22.917,-5.724,P<0.05).The cost of stents[16 260(13 300,32 272)yuan],the number of catheter guidewire balloon sheaths consumables[5(4,8)sets(pieces)],and the cost of catheter guidewire balloon sheaths consumables[8 719(5 805,15 372)yuan]in the pre-collection group were collected.There were statistically significant differences in the stent cost[1 059(590,1 770)yuan],the number of catheter guidewire balloon sheaths consumables[8(7,12)sets(pieces)],and the cost of catheter guidewire balloon sheaths consumables[5 708(3 392,12 871)yuan]between the two groups(Z=-30.452,16.582,-7.670,P<0.05).There was a statistical correlation between the cost of coronary stents and the cost of catheter guidewire balloon sheaths before and after centralized volume procurement on the cost of medical consumables for patients(r=0.903,0.473,0.785,0.953,P<0.05).The correlation coefficient between the cost of coronary stents and the cost of medical consumables for patients in the post-centralized procurement group decreased compared to the pre-centralized procurement group,the correlation coefficient between the cost of catheter guidewire balloon sheath and the cost of medical consumables for patients increased.Conclusion:The centralized procurement of coronary stents has a significant cost control effect on patients in the disease groups,and affects the cost structure of medical consumables.Combined with DRG reform,it can continuously improve the standardization and scientificity of clinical use of medical consumables.

OBJECTIVE To analyze the grouping effect and composition of hospitalization costs for cases of patients with malignant proliferative disease under the diagnosis-related group （DRG） payment system， as well as any changes， in order to provide a basis for medical institutions to improve DRG payment-related measures， control drug costs， and for relevant departments to make decisions. METHODS The data of patients with malignant proliferative disease cases were collected from a “Third Grade Class A” hospital in 2021 and 2022， and the variation coefficient （CV） was used to evaluate the grouping of DRG. The structural variation degree and the new grey correlation analysis were used to study the structural variation of hospitalization cost and the correlation degree between the hospitalization cost and the cost of other items. RESULTS The overall reduction in variance （RIV） for the DRG group of patients with malignant proliferative disease was 79.36%； the CV of other groups were all lower than one except that the RW21 group was 1.09. Compared with 2021， the hospitalization cost for patients with malignant proliferative disease in 2022 decreased by 17.80%， and the decreases in management fees and drug costs were 32.15% and 21.30%， respectively， while the per capita medical expenses increased by 17.26%. The new grey correlation degree of drug cost decreased， but that of medical expenses increased. CONCLUSIONS Under the DRG payment system， hospitalization costs for patients with malignant proliferative disease in the sample hospital decrease， but the grouping efficiency of RW21 and other disease groups needs improvement， and the cost structure needs optimization.

OBJECTIVE To explor e the effect of clinical pharmacists participatin g in fine management of pharmaceutical affairs among the inpatients in the department of gastroenterology based on diagnosis related groups （DRG）data. METHODS The discharged patients in the gastroenterology department of our hospital were selected as the research objects to compare the changes of DRG indicators and hospitalization related indicators before （from April to December 2019）and after （from April to December 2020 and from April to December 2021） pharmacists participating in fine management of pharmaceutical affairs in the gastroenterology department. The key DRG with the highest number of enrolled cases and DRG cases of the total cost overrun were analyzed to explore the deviation of various costs. The rationality of drug use was evaluated for the cases in each DRG that exceeded the benchmark hospital payment standard by three times ，with the help of prescription doctor ’s advice review. RESULTS In the first year of intervention ，the case combination index value of gastroenterology department was increased ，meanwhile，the cost consumption index ，time consumption index and average hospital stay were decreased significantly （P＜0.01）. In the second year of intervention ，total weight of the cases in gastroenterology department was increased ，while cost consumption index ，time consumption index ，hospitalization cost per time ，drug cost per time and average hospital stay were all decreased significantly ， compared with before intervention （P＜0.01）. Among the top five DRG ，the drug cost per time in the GZ 15，GZ13 and GJ 15 were all decreased significantly in the first year of intervention ；hospitalization cost per time and drug cost per time in the GZ 15，GZ13， GJ15 and GJ 13 were all decreased significantly in the second year of intervention （P＜0.01）；after the intervention of clinical pharmacists in DRG over-expenditure cases ，the over-expenditure rate decreased significantly （P＜0.001）. CONCLUSIONS The fine management of pharmaceutical affairs in our hospital has achieved certain results and promotes the rationality of clinical drug use，and provides a new entry point for the cost control and utilization of medical institutions under the background of 〔2020〕68号） DRG.

OBJECTIVE To investigate the effectiveness of clinical pharmacists’ participation in the refined pharmaceutical management for inpatients of oncology center based on diagnosis related groups （DRG）.　METHODS Patients who entered DRG and stayed in hospital for less than 60 days in oncology center of Daping Hospital， Army Medical University were selected as the research objects to analyze the changes of DRG indicators and related hospitalization indicators before the intervention of clinical pharmacists’ participation in the refined pharmaceutical management （Jan.-Dec. 2019）， the first year after the intervention （Jan.- Dec. 2020）， and the second year after the intervention （Jan.-Dec. 2021）； the key DRG groups were selected from the oncology center according to DRG enrollment and disease diagnosis and treatment methods， and related hospitalization indicators before and after the intervention and rational drug use after intervention were analyzed.　RESULTS Compared with before intervention， in the first and second years after the intervention， the number of DRG groups increased to 157 and 184， and the case mix index increased significantly （P＜0.05）， while costconsumption index， time consumption index， average hospital stay and average hospitalization expense per time were decreased or shortened significantly （P＜0.05）； drug cost per time was increased significantly （P＜0.05）， and there were no low- risk deaths and severe adverse drug reactions. Among the 4 key DRG groups， the average hospital stay in RE19 disease group and RU29 disease group in the first and second year after intervention and those of RU14 disease group in the first year after intervention were significantly lower than before （P＜0.05）； the average hospitalization expense per time of RE19 disease group in the first and second year after intervention and those of RU14 disease group， RV19 disease group and RU29 disease group in the second year after intervention were significantly lower than before （P＜0.05）； drug cost per time of RU14 disease group in the second year after intervention was significantly lower than before， while those of RE19 disease group and RU29 disease group in the first and second year after intervention were significantly higher than before （P＜0.05）. There was some irrational drug use in the DRG disease groups with a significant increase in the drug cost per time after the intervention， such as inappropriate selection of drugs， inappropriate usage and dosage， off-label drug use， etc.　CONCLUSIONS In the context of DRG， after the clinical pharmacists participated in the refined pharmaceutical management， the overall diagnosis and treatment service capacity of oncology center are improved， the efficiency of diagnosis and treatment are improved， and there are no low-risk deaths and severe adverse drug reactions， which promote the management of rational drug use in medical institutions.