Jiangsu Provincial People's Hospital takes the reform of DRG payment method as an opportunity,based on the theory of incentive behavior,uses literature research,expert consultation,and key performance indicator methods to develop evaluation indicators,and applies PDCA management tools to establish a continuously improving medical insurance service quality evaluation system.It introduces the process of medical insurance service quality evaluation system construction and its application in medical insurance performance management,and analyzes the implementation effect:DRG operation is improving,disease group structure is optimized,medical quality and efficiency continue to improve,and medical service evaluation scores are improving.

ObjectiveTo investigate the immunological characteristics of the patients with aplastic anemia （AA） and elevated hemogram parameters treated with Yiqi Yangxue prescription combined with Western medicine and the predictive effects of immunological indexes on elevated hemogram parameters， thus providing a reference for the prediction of the treatment efficacy and the adjustment of the treatment regimen. MethodA retrospective study was conducted， involving 77 AA patients treated with Yiqi Yangxue prescription combined with Western medicine for 6 months in 19 medical institutions including Xiyuan Hospital， China Academy of Chinese Medical Sciences from September 2018 to March 2021. The patients were assigned into two groups according to the elevations in hemogram parameters ［including hemoglobin （HGB）， white blood cell count （WBC）， platelet （PLT）， and absolute neutrophil count （ANC）］ after 6 months of treatment. One group had the elevation <50%， and the other group had the elevation ≥50% compared with the baseline. The clinical and immunological characteristics were compared between the two groups. Result① Compared with the group with HGB elevation<50%， the group with HGB elevation≥50% showed elevated level of CD3⁺ human leukocyte antigen-DR （HLA-DR）⁺ and increased proportion of patients with T-helper cell type 2 （Th2）<5%， CD8⁺≥50%， and CD3⁺HLA-DR⁺≥9% before treatment （P<0.05， P<0.01）. The multivariate Logistic regression analysis showed that CD8⁺≥50% before treatment was the independent influencing factor for HGB elevation ≥50% ［odds ratio （OR）=12.000， 95% confidence interval （CI） 2.218， 64.928， P<0.01］. ② Compared with the group with WBC elevation<50%， the group with WBC elevation≥50% showed increased proportion of patients with CD3⁺HLA-DR⁺<6% and T-box transcription factor （T-bet）≥200% before treatment （P<0.05）. The multivariate Logistic regression analysis showed that CD3⁺HLA-DR⁺<6% （OR=2.998， 95%CI 1.036， 8.680， P<0.05） and T-bet≥200% （OR=3.634， 95%CI 1.076， 12.273， P<0.05） before treatment were independent influencing factors for WBC elevation≥50%. ③ Compared with the group with PLT elevation<50%， the group with PLT elevation≥50% presented lowered Th1 and CD3⁺HLA-DR⁺ levels and increased proportion of patients with Th1<12%， CD4⁺≥6%， and CD3⁺HLA-DR⁺<5% before treatment （P<0.05， P<0.01）. The multivariate Logistic regression analysis showed that CD3⁺HLA-DR⁺<5% before treatment was the independent influencing factor for PLT elevation≥50% （OR=16.190， 95%CI of 3.430 to 76.434， P<0.01）. ④ Compared with the group with ANC elevation<50%， the group with ANC elevation≥50% showed no significant changes in the hemogram parameters before treatment. ConclusionAs for the AA patients with rapid elevation in HGB， Yiqi Yangxue prescription combined with Western medicine demonstrate significant effects in the patients with Th2<5% and CD3⁺HLA-DR⁺≥9%， especially those with CD8⁺≥50%. As for the AA patients with rapid elevation in WBC， the therapy was particularly effective in the patients with CD3⁺HLA-DR⁺<6% and T-bet≥200%. As for the AA patients with rapid growth in PLT， the therapy was particularly effective in the patients with Th1<12% and CD4⁺≥6%， especially those with CD3⁺HLA-DR⁺<5%.

Objective To explore the effectiveness of high-definition diffusion weighted imaging(DWI)sequence combined with T1 WI-fat suppression(FS)dynamic contrast enhancement(DCE)sequence for preoperative T-stage of rectal cancer by using 3.0T MRI standardized scanning.Methods A retrospective analysis was conducted on MRI images of 57 patients with rectal cancer confirmed by pathology.Before surgery,the patients underwent 3.0T MRI standardized rectal cancer scan methods,including routine sequence,high-definition DWI sequence,and T1 WI-FS DCE sequence,etc.Then two experienced physicians evaluated the T-stage of preoperative rectal cancer through high-definition DWI(transverse and sagittal sections)and T1 WI-FS DCE sequences in the double-blind method.Using the postoperative pathological results of rectal cancer as the"gold standard",two sequences were combined to evaluate the accuracy,sensitivity,and specificity of rectal cancer T-stage.Results Among the 57 cases,there were 9 cases of upper rectal cancer,39 cases of middle rectal cancer,and 9 cases of lower rectal cancer.The accuracy rates of preoperative T-stage diagnosis for rectal cancer by two evaluator were both 85.7％(6/7)in T1 stage,88.2％(15/17)and 94.1％(16/17)in T2 stage,96.9％(31/32)and 93.8％(30/32)in T3 stage,and both 100.0％(1/1)in T4 stage.For evaluator 1,the sensitivity and specificity of the rectal cancer T-stage diagnosis were 96.1％and 83.3％,and for evaluator 2 were 94.1％and 83.3％,respectively.For rectal cancer MRI diagnosis,the accuracy rates and sensitivity were higher when combining the high-definition DWI sequence and T1 WI-FS DCE sequence,compared with a single high-definition DWI sequence or T1 WI-FS DCE sequence,and the difference was statistically significant.The average preoperative apparent diffusion coefficient(ADC)value of rectal cancer was compared between the corresponding postoperative pathological T1 to T4 stage groups,and the difference was statistically significant.Conclusion The combination of high-definition DWI sequence and T1 WI-FS DCE sequence improves the accuracy of rectal cancer T-stage,providing assistance for personalized clinical treatment.

Objective To investigate the effect of SMAD family member 3(SMAD3) silenced by small interfering RNA (siRNA) on macrophage polarization and transforming growth factor β1 (TGF-β1)/ SMAD family signaling pathway in rheumatoid arthritis (RA). Methods RA macrophages co-cultured with rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS) were used as a cell model. TGF-β1 was used to stimulate macrophages, and SMAD3-specific siRNA (si-SMAD3) and negative control siRNA (si-NC) were transfected into human RA macrophages co-cultured in Transwell^TM chamber. The expression of SMAD3 mRNA was detected by real-time fluorescence quantitative PCR, and the expression of TGF-β1, SMAD3 and SMAD7 protein was detected by Western blot analysis. The contents of TGF-β1 and IL-23 in cell culture supernatant were determined by ELISA. Cell proliferation was detected by CCK-8 assay. Transwell^TM chamber was used to measure cell migration. Results Compared with the model group and the si-NC group, the expression of TGF-β1, SMAD3 mRNA and protein in RA macrophages decreased significantly after silencing SMAD3. In addition, the secretion of IL-23 decreased significantly, and the cell proliferation activity and cell migration were inhibited, with high expression of SMAD7. Conclusion Knockdown of SMAD3 can promote M2 polarization and SMAD7 expression in RA macrophages.
Humans ; Arthritis, Rheumatoid/genetics* ; Interleukin-23 ; Macrophages ; RNA, Messenger ; RNA, Small Interfering/genetics* ; Smad7 Protein/genetics* ; Transforming Growth Factor beta1/genetics* ; Smad3 Protein/genetics* ; Gene Silencing

Objective:To establish a multicriteria value assessment index system, so as to provide reference for hospitals access of medical consumables.Methods:In May 2021, based on the paper previously published, the expert consultation method was used to finalize the index structure, index definitions and scoring standards, along with an importance grading of the indexes. And the index weights were calculated using the analytical hierarchy process. Then the assessment scale was designed by way of multi-criteria decision analysis and mini-HTA. With the linear cutting stapler used as an example, six clinicians, three hospital administrators and the medical consumable management committee made an empirical analysis and evaluation of its general value. The coefficient of variation and Kendall coefficient of concordance were used to test the consistency of clinicians′ scores.Results:Three rounds of expert consultations finalized an index structure with 4 level-1 and 11 level-2 indexes, and on such basis a multicriteria value assessment index system for hospital access of medical consumables was established. This system comprised the clinician evaluation scale, hospital administrator evaluation scale and medical consumable management committee evaluation scale. The first two of which were used for preliminary screening, and the third for a full-scale, detailed and quantitative evaluation of those selected, hence a decision was made in the end according to the weighted sum of the three scales. This scale system was used to evaluate a foreign brand and a domestic brand of linear cutting staplers, while the former and the latter scored 90.5 and 75.4 respectively. Statistical analysis of the six clinicians found a coefficient of variation CV<0.25, and the Kendall coefficient of concordance W=0.833, proving good consistency of the evaluation criteria and results. Conclusions:The multicriteria value assessment index system proves highly scientific, comprehensive and practicable, serving a good reference for hospitals to build their value-based mechanism to select medical consumables.

Objective:To explore the clinical effect of dual triangular skin flaps for male nipple reconstruction.Methods:From October 2011 to March 2019, we admitted 4 male patients with flat or missing nipples, aged 29 to 45 years old, with an average of 37 years old in Jiangxi Provincial People’s Hospital. Among them, there was 1 case of congenital bilateral flat nipples, 1 case of bilateral nipple loss caused by drug corrosion, and 2 cases of exogenous injury with failure history of bilateral nipple reconstruction. According to the blood supply and elasticity of the skin of the nipple and areola, dual triangular flaps were designed for bilateral nipple reconstruction. The survival of the skin flap was observed and the sensation and shape of the nipple were followed up.Results:Among the 4 patients with 8 nipples, 7 nipples were fully survived symmetrically with no skin flap infection and necrosis. One nipple had local flap necrosis, resulted in wide and flat nipple appearance. During the 12-month follow-up, the reconstructed nipples were soft and felt good. The height of the nipple was 3-4 mm, the diameter was about 5 mm, 7 nipples were in good shape, 1 nipple was slightly small.Conclusions:Dual triangular skin flaps is a good choice for male nipple reconstruction with satisfactory symmetrical appearance and less complication.

Objective:To explore the clinical effect of dual triangular skin flaps for male nipple reconstruction.Methods:From October 2011 to March 2019, we admitted 4 male patients with flat or missing nipples, aged 29 to 45 years old, with an average of 37 years old in Jiangxi Provincial People’s Hospital. Among them, there was 1 case of congenital bilateral flat nipples, 1 case of bilateral nipple loss caused by drug corrosion, and 2 cases of exogenous injury with failure history of bilateral nipple reconstruction. According to the blood supply and elasticity of the skin of the nipple and areola, dual triangular flaps were designed for bilateral nipple reconstruction. The survival of the skin flap was observed and the sensation and shape of the nipple were followed up.Results:Among the 4 patients with 8 nipples, 7 nipples were fully survived symmetrically with no skin flap infection and necrosis. One nipple had local flap necrosis, resulted in wide and flat nipple appearance. During the 12-month follow-up, the reconstructed nipples were soft and felt good. The height of the nipple was 3-4 mm, the diameter was about 5 mm, 7 nipples were in good shape, 1 nipple was slightly small.Conclusions:Dual triangular skin flaps is a good choice for male nipple reconstruction with satisfactory symmetrical appearance and less complication.

Objective To explore the effects of nutritional status investigation combined with WeChat platform intervention on nutritional quality, weight and disease recurrence rate of ulcerative colitis (UC) children. Methods A total of 96 UC children were selected in Affiliated Hospital of Jining Medical University. From January to December 2017, 48 children were included in control group. From January to December 2018, 48 children were included in observation group. Control group carried out routine follow-up. On the basis of that in control group, observation group implemented nutritional status investigation combined with WeChat platform intervention. We compared the disease cognition, children's nutrition cognition, ratio of strictly implementing doctor's advice and correcting the habit of doting on children, family members' nursing satisfaction among children's patients between two groups before intervention and 6 months after intervention. Besides, we observed the nutritional biochemical indexes before intervention and three weeks after intervention, and dietary intake as well as nutritional status, body mass index (BMI), bone mineral density (BMD) before intervention and 6 months after intervention, and disease recurrence rate of children within 6 months. Results A total of 6 months after intervention, the disease cognition, children's nutrition cognition, ratio of strictly implementing doctor's advice and correcting the habit of doting on children, nursing satisfaction among children's patients, and daily protein, fat, sugar as well as energy intake, BMI and BMD in observation group were higher than those in control group with statistical differences (P＜ 0.05). Three weeks after intervention, serum albumin and prealbumin of children in observation group were higher than those in control group with statistical differences (P＜0.05). Conclusions Nutritional status investigation combined with WeChat platform intervention can improve the disease and children's nutrition cognition of UC children's patients, promote them to strictly implement doctor's advice, and improve UC children's nutritional status, weight and growth, and reduce the risk of disease recurrence, and enhance nursing satisfaction which is worth to be used widely in clinical application.

Objective To analyze the characteristics of epidemic situation of HIV/AIDS in Yongzhou from 1993 to 2014,and provide evidence for HIV/AIDS prevention and control strategy.Methods Descriptive epidemiological analysis was conducted on HIV/AIDS epidemic situation in Yongzhou from 1993 to 2014.Results A total of 2 917 HIV/AIDS cases were reported,the reported cases increased year by year;the ratio of male to female cases was 2.30∶1 ;52.04% were aged 20-49 years old,46.76% were aged ≥50 years old,the percentage of population ≥50 years old increased obviously in recent years;the major transmission route was sexual contact (88.48% ),gay transmission accounted for 2.64%.Conclusion The knowledge about AIDS in Yongzhou should be strengthened, intervention in high risk population should be implemented,scope of detection should be expanded,so as to prevent the transmission of AIDS effectively.

Objective To analyse characteristics of military pilot group sandplay work and reveal their psychological status.Methods Using the self-reporting 90-item Symptom Checklist (SCL-90) to test the validity of group sandplay work made by 87 groups of military pilots.Statistical analysis was used to analyse the characteristics of code data in group sandplay work.Results Positive and negative themes in group sandplay work showed negative and positive correlations(r=-0.59,0.59) with symptom factors of SCL-90,respectively.Positive and negative themes scores were 5.37±2.25 and 2.36± 1.85 ,respectively.The secondary theme scores in the positive theme were entirely higher than those in the negative theme.Scores of energy, connection, cooperation, integration, relaxation, and spirituality in the positive theme and threat,limitation, and aggression in the negative theme were relatively high.The overall evaluations of the work include power, integration, enrichment, and fluency.The theme names of the work include life, military, natural and abstract.Conclusion Group sandplay is an effective method in the study of military pilots' psychological health and military pilots are in good mental health.These pilots have strong intrinsic energy,teamwork and communication.However,some pilots have symptoms of anxiety,tension and insecure.