In the context of medical insurance payment reform,the sample hospital has implemented performance management optimization to effectively address the challenges posed by diagnosis-intervention packet(DIP)payment.Reform measures focused on disease quality,rational diagnosis and treatment,operational management,medical technological value,and policy orientation,and they have significantly optimized service ability and performance evaluation indexes of the hospital.Main achievements included a reduction in the cost consumption index and an increase in the clinical performance index,with the overall DIP payment rate increasing from 88.86%to 103.23%and a marked improvement in operational management.The quality control and operational efficiency of the hospital have been effectively enhanced by choosing proper DIP payment evaluation indexes and improving performance management,and provided strong support for the high-quality development of the hospital.

ObjectiveTo investigate the potential mechanisms of Zhimu （Anemarrhena asphodeloides）-Huangbai （Phellodendron amurense） medicinal pair in alleviating postmenopausal osteoporosis （PMOP）. MethodsSixty unpregnant female SD rats were randomly divided into five groups， blank group， model group， low-dose Zhimu-Huangbai group， high-dose Zhimu-Huangbai group， and estradiol group， with 12 rats in each group. Except for the blank group， all other groups had their ovaries removed to create PMOP rat models， while the blank group only had the fat tissue around the ovaries removed. One week after the ovarian removal， the low-dose and high-dose Zhimu-Huangbai groups received concentrated solution of Zhimu and Huangbai with 1.8， 7.2 g/（kg·d） via gavage， the estradiol group received estradiol solution 0.09 mg/（kg·d） via gavage， and the blank group and the model group received 10 ml/（kg·d） of normal saline via gavage， once daily for 12 weeks. Before sampling， the body mass of the rats was recorded， and uterine tissue was taken to calculate the uterine index. The levels of interleukin-1β （IL-1β）， interleukin-6 （IL-6） and tumor necrosis factor-α （TNF-α） in serum were detected by ELISA； micro CT was used to examine the parameters of femoral microstructure， including bone volume/tissue volume （BV/TV）， trabecular number （Tb.N）， trabecular thickness （Tb.Th）， bone mineral density （BMD）， trabecular separation （Tb.Sp）， and cortical bone area （Ct.Ar）. HE staining was used to observe pathological changes in the femur； RT-qPCR was used to detect the mRNA expression of osteogenic-adipogenic differentiation-related factors in femoral tissue， including Runt-related transcription factor 2 （Runx2）， bone morphogenetic protein 2 （BMP-2）， peroxisome proliferator-activated receptor γ （PPARγ）， chemerin and chemokine-like receptor 1 （CMKLR1）. ResultsCompared with the blank group， the model group showed a significant increase in body mass， a significant decrease in the uterine index， BV/TV， Tb.N， Tb.Th and BMD， a significant increase in Tb.Sp， and serum IL-1β， IL-6， and TNF-α levels， a significant reduction of mRNA expression of Runx2 and BMP-2 in bone tissue， and a significant increased mRNA expression of PPARγ， chemerin， and CMKLR1 （P＜0.01）. HE staining revealed that the femoral tissue showed a reduction and sparsity of trabeculae， a significant enlargement of the medullary cavity， and a large number of fat cells. Compared to the model group， the low-dose， high-dose Zhimu-Huangbai groups， and estradiol group showed significant improvements in all the above-mentioned indicators （P＜0.05 or P＜0.01）. HE staining revealed a significant increase in trabeculae， more organized arrangement， and a marked reduction in fat cells. Compared to low-dose Zhimu-Huangbai group， the high-dose Zhimu-Huangbai group exhibited a significant increase in the uterine index and BMD， and a significant reduction in body mass and PPARγ and Chemerin mRNA expression （P＜0.05 or P＜0.01）. Compared to high-dose Zhimu-Huangbai group， the estradiol group showed a decrease in uterine index， BV/TV， Tb.N， Tb.Th， BMD， and BMP-2 mRNA expression， while the levels of IL-1β， TNF-α， and IL-6， as well as Tb.Sp and the mRNA expressions of PPARγ， chemerin， and CMKLR1 increased （P＜0.05 or P＜0.01）. ConclusionThe Zhimu-Huangbai medicinal pair can alleviate PMOP bone loss， and its mechanism of action is related to reducing the levels of inflammatory factors， correcting the disorder of osteogenic-adipogenic differentiation of bone marrow mesenchymal stem cells （BMSCs）， and promoting the differentiation of BMSCs into osteoblasts.

Endangered animal medicine is an important part of traditional Chinese medicine， which is distinctive in the treatment of diseases. At present， the rare and endangered medicinal materials such as tiger bone， rhinoceros horn， pangolin， antelope horn， bear bile are listed as national key protected animals， so their clinical application is limited， the current solution is mainly based on the ideas and methods of similar pharmacological effects， close genetic relationships， artificial breeding， and artificial synthesis to find and develop alternatives for endangered animal medicinal materials. Although artificially cultured bear bile and musk， and artificially synthesized tiger bone， bezoar and musk can solve the shortage of endangered animal medicines to a certain extent， there are still some problems such as difficult breakthroughs in breeding technology and incomplete recognition in the substitute industry. According to this， based on summarizing the existing substitutes for endangered animal medicines， our group proposed the concept of homology， homogeneity and equivalent of substitutes， and constructed a new idea to develop and evaluate substitutes by combining frontier biotechnology with multi-omics detection， so as to provide some support for protecting rare and endangered animals and solving the shortage of endangered animal medicines.

Objective To analyze the efficacy of higher pressure recompression therapy (≥70 m) in the patients with decompression sickness (DCS),who displayed poor efficacy after initial recompression.Methods Forty patients with type Ⅱ DCS who received treatment in our hospital from September 2011 to June 2018 were selected as research subjects,and were designated as the study group (n =6) and the control group (n =34),in accordance with whether or not they had received recompression therapy before admission into hospital.The DCS patients of the study group were those transferred to our hospital after initial lower pressure recompression treatment with unsatisfactory results.These patients were treated with the Air Diving DCS Recompression Treatment Table (Table 5,Oxygen Breathing) developed by the Chinese Naval Medical Research Institute,at a pressure of 70 meters and with a total oxygen breathing time of 225 minutes.The patients of the control group were those with type Ⅱ DCS patients who received initial recompression treatment in our hospital within the same time span.Delayed time,application rate and treatment efficacy in the patients of the 2 groups were analyzed statistically.Results The delayed time (14.5 ± 4.9 h) of the secondary recompression group (or the study group) was obviously longer than that of the control group(4.3 ± 3.0 h) (P ＜ 0.001),and there was statistical significance when comparisons were made between them (P ＜ 0.001).The application rate of higher pressure treatment profile in the secondary recompression group (83.3％) was higher than that of the control group (5.9％),also with statistical significance (P ＜ 0.001).The treatment efficacy of the 2 group was identical,without statistical significance (P =0.585).Conclusion The higher pressure recompression profile could effectively treat those DCS patients who showed unsatisfactory treatment effects after initial recompression.For those DCS patients with delayed treatment,proper recompression profile could also achieve satisfactory treatment outcome.With the lack of low pressure oxygen-breathing treatment profile and other supplementary treatment methods,secondary higher pressure recompression treatment should be performed as early possible,in the treatment of the patients with type Ⅱ DCS.

Objective To construct an operational effectiveness evaluation system for submarine rescue medical team,so as to objectively evaluate its operational effectiveness.Methods AHP method combined with the Delphi method was used to determine the operational effectiveness evaluation index and weight of the submarine rescue medical team.Results The evaluation index system consisting of 3 first-class indexes and 11 second-class indexes was constructed.In the first-class indexes,the weight of the organizing and commanding ability,the weight of support ability of the medical system and the weight of the maritime medical treatment ability were respectively 0.121,0.293 and 0.586.Conclusion The construction of the operational effectiveness evaluation system for the submarine rescue medical team by AHP method was scientifically sound and practical,and the maritime medical rescue ability was the core of the operational ability of the submarine rescue medical team.

Objective To analyze the efficacy of higher pressure recompression therapy (≥70 m) in the patients with decompression sickness (DCS),who displayed poor efficacy after initial recompression.Methods Forty patients with type Ⅱ DCS who received treatment in our hospital from September 2011 to June 2018 were selected as research subjects,and were designated as the study group (n =6) and the control group (n =34),in accordance with whether or not they had received recompression therapy before admission into hospital.The DCS patients of the study group were those transferred to our hospital after initial lower pressure recompression treatment with unsatisfactory results.These patients were treated with the Air Diving DCS Recompression Treatment Table (Table 5,Oxygen Breathing) developed by the Chinese Naval Medical Research Institute,at a pressure of 70 meters and with a total oxygen breathing time of 225 minutes.The patients of the control group were those with type Ⅱ DCS patients who received initial recompression treatment in our hospital within the same time span.Delayed time,application rate and treatment efficacy in the patients of the 2 groups were analyzed statistically.Results The delayed time (14.5 ± 4.9 h) of the secondary recompression group (or the study group) was obviously longer than that of the control group(4.3 ± 3.0 h) (P ＜ 0.001),and there was statistical significance when comparisons were made between them (P ＜ 0.001).The application rate of higher pressure treatment profile in the secondary recompression group (83.3％) was higher than that of the control group (5.9％),also with statistical significance (P ＜ 0.001).The treatment efficacy of the 2 group was identical,without statistical significance (P =0.585).Conclusion The higher pressure recompression profile could effectively treat those DCS patients who showed unsatisfactory treatment effects after initial recompression.For those DCS patients with delayed treatment,proper recompression profile could also achieve satisfactory treatment outcome.With the lack of low pressure oxygen-breathing treatment profile and other supplementary treatment methods,secondary higher pressure recompression treatment should be performed as early possible,in the treatment of the patients with type Ⅱ DCS.

Objective To construct an operational effectiveness evaluation system for submarine rescue medical team,so as to objectively evaluate its operational effectiveness.Methods AHP method combined with the Delphi method was used to determine the operational effectiveness evaluation index and weight of the submarine rescue medical team.Results The evaluation index system consisting of 3 first-class indexes and 11 second-class indexes was constructed.In the first-class indexes,the weight of the organizing and commanding ability,the weight of support ability of the medical system and the weight of the maritime medical treatment ability were respectively 0.121,0.293 and 0.586.Conclusion The construction of the operational effectiveness evaluation system for the submarine rescue medical team by AHP method was scientifically sound and practical,and the maritime medical rescue ability was the core of the operational ability of the submarine rescue medical team.

Objective: To investigate the effects of EI injection on learning and memory ability and brain energy of two-way Meynert basal injection of Ibotenic acid (IBO) dementia model rats. Methods: A rat model of dementia wasestablished by bilateral meynert basal injection of IBO. After 8 weeks of EI injection, Morris water maze was used todetect the learning and memory ability of rats. Congo red staining was used to observe the deposition of Aβ plaque inhippocampal CA1 and cortical areas of rats. The changes of ATP, ADP and AMP in brain tissue of each group weredetermined by HPLC. The content of insulin in rat brain tissue was detected by ELISA kit. The expression of key proteinin PI3K/AKT signaling pathway was detected by Western blot. Results: Compared with the sham operation group, theescape latency of the model group was significantly prolonged, the number of entering the platform, the time andpercentage of crossing the platform quadrant decreased significantly (P ＜ 0.05); Aβ plaque deposition was observed inthe hippocampus and cortex; ATP/AMP ratio and insulin content were significantly decreased (P ＜ 0.05); brain tissue PI3 K and AKT protein were low expression (P＞ 0.05) . After intervention with EI injection, the escape latency of themodel rats was significantly shortened, the number of entering the platform and the time of crossing the platform quadrantincreased significantly (P ＜ 0.05); the hippocampus and cortex red staining was alleviated; the brain tissue ATP/AMPratio and insulin content increased significantly (P ＜ 0.05) . Conclusion: EI injection can improve the learning andmemory function of IBO-induced dementia model rats, which is related to the improvement of brain energy.

Objective: To investigate the effects of Kaixin Powder on learning and memory, ATP/AMP ratio, GABA andiNOS levels in rats with multiple infarct dementia. Methods: The rat model of multi-infarct dementia was established bymicro-thromboembolism. Morris water maze and opening experiment were used to evaluate learning and memoryfunction. The pathological changes of hippocampal CA1 area were evaluated by HE staining. The contents of ATP andAMP in brain tissue were determined by HPLC. The content of γ-aminobutyric acid and iNOS in peripheral blood weredetected by ELISA kit. Results: Compared with the rats of model group, rats of Kaixin Powder group can significantlyshorten the escape latency, increase the number of crossing platforms, Results: Compared with the model group, increasethe standing times in the opening experiment, prolong the exercise time, shorten the resting time, improve the nerve celldamage in the hippocampal CA1 area, and significantly increase the ratio of ATP/AMP of brain tissue, decreased brainGABA content and serum iNOS content (P ＜ 0.05) . Conclusion: Kaixin Powder has the effect of improving learning andmemory function and abnormal motor behavior in rats with multiple infarct dementia. The mechanism is related toreducing GABA and i NOS content in brain tissue, increasing ATP/AMP ratio in brain tissue and improving energysupply in brain tissue.

Integrins are cell adhesion receptors, which consists of several transmembrane glycoproteins. They are widely distributed on the cell surface and involved in signal transduction pathways. As a heterodimer, each integrin is composed of one α subunit and one β subunit. Integrins are mainly expressed on lepidopteran hemocytes and involved in cell immune response. The full-length cDNA sequence of BmIntegrin β2 was obtained by PCR and RACE, including 2 434 bp. BmIntegrin β2 was predicted to be a transmembrane protein. The BmIntegrin β2 expression profile was detected by qRT-PCR at L4D3 or L5D3 larval stage, and it was highly expressed in hemocyte and hematopoietic organ. Anti-BmIntegrin β2 polyclonal antibody was generated following prokaryotic expression, protein purification and animal immunization, which is highly specific and effective for recognizing BmIntegrin β2 protein through Western blotting. The results of plasmatocytes adhesion experiment showed that BmIntegrin β2 plays an important role on the adhesion and spreading of plasmatocytes to foreign surfaces. This study provides a foundation for further research of the biological function of BmIntegrin β2 gene.