Objective To construct large medical model named by "Huaxi HongYi"and explore its application effectiveness in assisting medical record generation. Methods By the way of a full-chain medical large model construction paradigm of "data annotation - model training - scenario incubation", through strategies such as multimodal data fusion, domain adaptation training, and localization of hardware adaptation, "Huaxi HongYi" with 72 billion parameters was constructed. Combined with technologies such as speech recognition, knowledge graphs, and reinforcement learning, an application system for assisting in the generation of medical records was developed. Results Taking the assisted generation of discharge records as an example, in the pilot department, after using the application system, the average completion times of writing a medical records shortened (21 min vs. 5 min) with efficiency increased by 3.2 time, the accuracy rate of the model output reached 92.4%. Conclusion It is feasible for medical institutions to build independently controllable medical large models and incubate various applications based on these models, providing a reference pathway for artificial intelligence development in similar institutions.

OBJECTIVE To explore comprehensive management and potential issues associated with long-term prescriptions medications of psychiatry， in order to provide a reference for the comprehensive management of long-term prescriptions of psychiatry in psychiatric hospitals and other medical institutions’ pharmacies. METHODS Starting from the applicable principles for long-term prescriptions of psychiatry， this study introduced the standardized assessment and precautions before issuing long-term prescriptions， the formulation and adjustment of the drug list， as well as the rational management of the long-term prescriptions. It also analyzed potential issues that may arise in the comprehensive management of long-term prescription medications and proposed corresponding countermeasures and suggestions. RESULTS & CONCLUSIONS Prior to initiating long-term prescriptions， a standardized assessment should be conducted on patients from the aspects of their psychiatric condition and long-term potential risk factors， pharmacological treatment plans and other non-pharmacological therapies， physical illnesses. Additionally， healthcare providers should fulfill their obligation to inform patients or their family members. The comprehensive management of long-term prescription medications should be jointly established and improved by multiple departments， and the formulation of drug catalogs should avoid including drugs with potential social harm or medication risks while complying with policy requirements. Furthermore， measures such as adding special identifiers to long-term prescriptions， providing patients with reminders about （No.YGLX202537） prescription expiration， or offering online consultations can also effectively enhance the rationality of medication use under long-term prescriptions. Currently， the implementation of long-term prescriptions in psychiatry remains challenged by inconsistencies in prescription duration， incomplete coverage of diagnostic categories， poor patient adherence， and the risk of deviation in clinical assessments. In this regard， measures such as collaborating with multiple departments to strengthen long-term prescription information management， providing matching pharmaceutical services， ensuring the quality and rationality of long-term prescription implementation， and using modern methods to screen high-risk patients can be taken to improve patient medication compliance and safety.

OBJECTIVE: To explore the effect of chitosan (CS) hydrogel loaded with tendon-derived stem cells (TDSCs; hereinafter referred to as TDSCs/CS hydrogel) on tendon-to-bone healing after rotator cuff repair in rabbits. METHODS: TDSCs were isolated from the rotator cuff tissue of 3 adult New Zealand white rabbits by Henderson step-by-step enzymatic digestion method and identified by multidirectional differentiation and flow cytometry. The 3rd generation TDSCs were encapsulated in CS to construct TDSCs/CS hydrogel. The cell counting kit 8 (CCK-8) assay was used to detect the proliferation of TDSCs in the hydrogel after 1-5 days of culture in vitro, and cell compatibility of TDSCs/CS hydrogel was evaluated by using TDSCs alone as control. Another 36 adult New Zealand white rabbits were randomly divided into 3 groups ( n=12): rotator cuff repair group (control group), rotator cuff repair+CS hydrogel injection group (CS group), and rotator cuff repair+TDSCs/CS hydrogel injection group (TDSCs/CS group). After establishing the rotator cuff repair models, the corresponding hydrogel was injected into the tendon-to-bone interface in the CS group and TDSCs/CS group, and no other treatment was performed in the control group. The general condition of the animals was observed after operation. At 4 and 8 weeks, real-time quantitative PCR (qPCR) was used to detect the relative expressions of tendon forming related genes (tenomodulin, scleraxis), chondrogenesis related genes (aggrecan, sex determining region Y-related high mobility group-box gene 9), and osteogenesis related genes (alkaline phosphatase, Runt-related transcription factor 2) at the tendon-to-bone interface. At 8 weeks, HE and Masson staining were used to observe the histological changes, and the biomechanical test was used to evaluate the ultimate load and the failure site of the repaired rotator cuff to evaluate the tendon-to-bone healing and biomechanical properties. RESULTS: CCK-8 assay showed that the CS hydrogel could promote the proliferation of TDSCs ( P<0.05). qPCR results showed that the expressions of tendon-to-bone interface related genes were significantly higher in the TDSCs/CS group than in the CS group and control group at 4 and 8 weeks after operation ( P<0.05). Moreover, the expressions of tendon-to-bone interface related genes at 8 weeks after operation were significantly higher than those at 4 weeks after operation in the TDSCs/CS group ( P<0.05). Histological staining showed the clear cartilage tissue and dense and orderly collagen formation at the tendon-to-bone interface in the TDSCs/CS group. The results of semi-quantitative analysis showed that compared with the control group, the number of cells, the proportion of collagen fiber orientation, and the histological score in the TDSCs/CS group increased, the vascularity decreased, showing significant differences ( P<0.05); compared with the CS group, the proportion of collagen fiber orientation and the histological score in the TDSCs/CS group significantly increased ( P<0.05), while there was no significant difference in the number of cells and vascularity ( P>0.05). All samples in biomechanical testing failed at the repair site during the testing process. The ultimate load of the TDSCs/CS group was significantly higher than that of the control group ( P<0.05), but there was no significant difference compared to the CS group ( P>0.05). CONCLUSION TDSCs/CS hydrogel can induce cartilage regeneration to promote rotator cuff tendon-to-bone healing.
Rabbits ; Animals ; Rotator Cuff/surgery* ; Chitosan ; Hydrogels ; Rotator Cuff Injuries/surgery* ; Wound Healing ; Tendons/surgery* ; Collagen ; Stem Cells ; Biomechanical Phenomena

OBJECTIVE To explore the safety and efficacy of tocilizumab in the treatment of refractory anti-N-methyl-D-aspartate receptor encephalitis in children, and to provide reference for the treatment of this disease. METHODS The clinical manifestations, diagnosis and treatment, safety and efficacy of tocilizumab in a case of refractory anti-NMDAR encephalitis in Children’s Hospital, Zhejiang University School of Medicine were analyzed retrospectively, and the relevant literature was reviewed. RESULTS The clinical symptoms of the patient were not improved after 2 doses of methylprednisolone, immunoglobulin and 6 doses of rituximab. After 6 doses of tocilizumab, the modified Rankin scale(mRS) score was improved without adverse reactions. CONCLUSION Tocilizumab, as a escalation second-line immunotherapy, is effective and well tolerated in the treatment of refractory anti-NMDAR encephalitis. It is one of the potential therapeutic means.

Objective:To investigate the expression of nuclear matrix protein 4 (NMP4) in hepatocellular carcinoma (HCC), and its relationship with clinicopathological features and survival prognosis of patients.Methods:The clinical data of 100 HCC patients who were treated with radical resection of liver cancer in the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Wenzhou Medical University from July 1, 2014 to July 1, 2019 were retrospectively analyzed. There were 63 males and 37 females, aged (58.5±10.4) years old. Immunohistochemical method was used to detect the expression of NMP4 protein in HCC cancer tissue and the corresponding adjacent normal tissue. According to the expression of NMP4 in HCC tissues, 100 patients were divided into two groups: the NMP4-positive expression group ( n=62) and the NMP4-negative expression group ( n=32). Univariate analysis was performed on the relationship between NMP4 expression and clinical pathological features as well as overall survival of HCC patients. Cox multivariate analysis was performed on the factors influencing postoperative prognosis of HCC patients. Results:Immunohistochemistry results showed that NMP4 was primarily expressed in the nucleus, the positive expression rate of NMP4 in HCC tissues was higher than that in adjacent non-cancerous tissues [62.0% (62/100) vs. 8.0%(8/100)], and the difference was statistically significant ( χ2=2.12, P=0.003). Univariate analysis revealed that the overall survival of HCC patients was correlated with the degree of tumor differentiation, tumor length, BCLC stage, number of tumor foci, vascular tumor thrombus and expression of NMP4 (all P<0.05). Cox multivariate analysis revealed that low differentiation, high BCLC stage (stage C), number of tumor foci (≥3), and positive expression of NMP4 were independent risk factors affecting postoperative survival and recurrence-free survival of HCC patients. The median overall survival and median recurrence-free survival of HCC patients in the NMP4-positive expression group were 22.3 months and 11.5 months, respectively. In contrast, that in the NMP4-negative expression group were 40.6 months and 19.4 months, respectively. The cumulative survival rate and recurrence-free survival rate of HCC patients in the NMP4-positive expression group were lower than those in the NMP4-negative expression group, and the differences were statistically significant (both P<0.05). Conclusion:Positive NMP4 expression was closely correlated with malignant biological progression and poor prognosis of HCC patients.

Objective:To explore the cost control effect and cost-shifting effect of Diagnosis-Intervention Packet(DIP)payment reform on inpatient coronary heart disease patients.Methods:Z City,a national pilot city for DIP,is taken as a case study.It utilizes inpatient claims data and the propensity scoring matching-difference in differences method to evaluate the impact of DIP payment reform on total medical expenses,Out-of-Pocket(OOP),the OOP proportion,self-paid Category B expenses,the proportion of self-paid Category B expenses,Category C expenses,and the proportion of Category C expenses for coronary heart disease inpatients.Results:After the DIP reform,the total medical expenses per inpatient coronary heart disease patient significantly decreased(β=-0.127,P＜0.01).Regarding cost-shifting,the OOP expenses(β=0.108,P＜0.05),the OOP proportion(β=0.055,P＜0.01),self-paid Category B expenses(β=0.239,P＜0.01),the proportion of self-paid Category B expenses(β=0.030,P＜0.01),and the proportion of Category C expenses significantly increased(β=0.026,P＜0.01),while there was no significant change in Category C expenses.Conclusion:The DIP reform significantly reduced the total medical expenses per inpatient case of coronary heart disease.At the same time,the reform shifted costs from within the scope of the insurance policy to outside the policy's coverage,with a stronger shift observed from Category B to Category C expenses.

Objective:To explore the cost control effect and cost-shifting effect of Diagnosis-Intervention Packet(DIP)payment reform on inpatient coronary heart disease patients.Methods:Z City,a national pilot city for DIP,is taken as a case study.It utilizes inpatient claims data and the propensity scoring matching-difference in differences method to evaluate the impact of DIP payment reform on total medical expenses,Out-of-Pocket(OOP),the OOP proportion,self-paid Category B expenses,the proportion of self-paid Category B expenses,Category C expenses,and the proportion of Category C expenses for coronary heart disease inpatients.Results:After the DIP reform,the total medical expenses per inpatient coronary heart disease patient significantly decreased(β=-0.127,P＜0.01).Regarding cost-shifting,the OOP expenses(β=0.108,P＜0.05),the OOP proportion(β=0.055,P＜0.01),self-paid Category B expenses(β=0.239,P＜0.01),the proportion of self-paid Category B expenses(β=0.030,P＜0.01),and the proportion of Category C expenses significantly increased(β=0.026,P＜0.01),while there was no significant change in Category C expenses.Conclusion:The DIP reform significantly reduced the total medical expenses per inpatient case of coronary heart disease.At the same time,the reform shifted costs from within the scope of the insurance policy to outside the policy's coverage,with a stronger shift observed from Category B to Category C expenses.

Objective:To explore the cost control effect and cost-shifting effect of Diagnosis-Intervention Packet(DIP)payment reform on inpatient coronary heart disease patients.Methods:Z City,a national pilot city for DIP,is taken as a case study.It utilizes inpatient claims data and the propensity scoring matching-difference in differences method to evaluate the impact of DIP payment reform on total medical expenses,Out-of-Pocket(OOP),the OOP proportion,self-paid Category B expenses,the proportion of self-paid Category B expenses,Category C expenses,and the proportion of Category C expenses for coronary heart disease inpatients.Results:After the DIP reform,the total medical expenses per inpatient coronary heart disease patient significantly decreased(β=-0.127,P＜0.01).Regarding cost-shifting,the OOP expenses(β=0.108,P＜0.05),the OOP proportion(β=0.055,P＜0.01),self-paid Category B expenses(β=0.239,P＜0.01),the proportion of self-paid Category B expenses(β=0.030,P＜0.01),and the proportion of Category C expenses significantly increased(β=0.026,P＜0.01),while there was no significant change in Category C expenses.Conclusion:The DIP reform significantly reduced the total medical expenses per inpatient case of coronary heart disease.At the same time,the reform shifted costs from within the scope of the insurance policy to outside the policy's coverage,with a stronger shift observed from Category B to Category C expenses.

Objective:To explore the cost control effect and cost-shifting effect of Diagnosis-Intervention Packet(DIP)payment reform on inpatient coronary heart disease patients.Methods:Z City,a national pilot city for DIP,is taken as a case study.It utilizes inpatient claims data and the propensity scoring matching-difference in differences method to evaluate the impact of DIP payment reform on total medical expenses,Out-of-Pocket(OOP),the OOP proportion,self-paid Category B expenses,the proportion of self-paid Category B expenses,Category C expenses,and the proportion of Category C expenses for coronary heart disease inpatients.Results:After the DIP reform,the total medical expenses per inpatient coronary heart disease patient significantly decreased(β=-0.127,P＜0.01).Regarding cost-shifting,the OOP expenses(β=0.108,P＜0.05),the OOP proportion(β=0.055,P＜0.01),self-paid Category B expenses(β=0.239,P＜0.01),the proportion of self-paid Category B expenses(β=0.030,P＜0.01),and the proportion of Category C expenses significantly increased(β=0.026,P＜0.01),while there was no significant change in Category C expenses.Conclusion:The DIP reform significantly reduced the total medical expenses per inpatient case of coronary heart disease.At the same time,the reform shifted costs from within the scope of the insurance policy to outside the policy's coverage,with a stronger shift observed from Category B to Category C expenses.

Objective:To explore the cost control effect and cost-shifting effect of Diagnosis-Intervention Packet(DIP)payment reform on inpatient coronary heart disease patients.Methods:Z City,a national pilot city for DIP,is taken as a case study.It utilizes inpatient claims data and the propensity scoring matching-difference in differences method to evaluate the impact of DIP payment reform on total medical expenses,Out-of-Pocket(OOP),the OOP proportion,self-paid Category B expenses,the proportion of self-paid Category B expenses,Category C expenses,and the proportion of Category C expenses for coronary heart disease inpatients.Results:After the DIP reform,the total medical expenses per inpatient coronary heart disease patient significantly decreased(β=-0.127,P＜0.01).Regarding cost-shifting,the OOP expenses(β=0.108,P＜0.05),the OOP proportion(β=0.055,P＜0.01),self-paid Category B expenses(β=0.239,P＜0.01),the proportion of self-paid Category B expenses(β=0.030,P＜0.01),and the proportion of Category C expenses significantly increased(β=0.026,P＜0.01),while there was no significant change in Category C expenses.Conclusion:The DIP reform significantly reduced the total medical expenses per inpatient case of coronary heart disease.At the same time,the reform shifted costs from within the scope of the insurance policy to outside the policy's coverage,with a stronger shift observed from Category B to Category C expenses.