Reform of medical insurance payment methods,make DRG cost accounting an important part of hospi-tal management work.The choice of DRG cost accounting method affects the time of the accounting results to some extent,and also affects the accuracy of the accounting results,which turn affects the hospital's understanding of the surplus of medical insurance settlement and the corresponding control means.Taking a public hospital in Yunnan Province as an example,based on the theory of service unit superposition method,the DRG cost accounting method is improved,and the project cost accounting can be carried out synchron,which can produce the accounting results more simply and quickly,and lay the foundation for the further lean management of the hospital.

Reform of medical insurance payment methods,make DRG cost accounting an important part of hospi-tal management work.The choice of DRG cost accounting method affects the time of the accounting results to some extent,and also affects the accuracy of the accounting results,which turn affects the hospital's understanding of the surplus of medical insurance settlement and the corresponding control means.Taking a public hospital in Yunnan Province as an example,based on the theory of service unit superposition method,the DRG cost accounting method is improved,and the project cost accounting can be carried out synchron,which can produce the accounting results more simply and quickly,and lay the foundation for the further lean management of the hospital.

Objective To investigate the relationship between asymmetry of skin folds around the hip and developmental dysplasia of the hip(DDH).Methods A retrospective analysis was performed on 308 infants who underwent DDH screening at Xuzhou Children's Hospital Affiliated to Xuzhou Medical University from January 2017 to December 2022.According to screening reasons,they were divided into observation group(simple asymmetry of skin folds around the hip,n=116),clinical abnormality group(clinical manifestations such as hip snap,limited hip abduction,unequal length of lower limbs,n=92)and control group(simple hip screening,n=100).Clinical evaluation results and Graf hip ultrasonography results were analyzed,and the detection rate of pathological DDH in each group was compared.The positive predictive value,negative predictive value,sensitivity and specificity of pathological DDH were calculated.Results Five cases(4.31%)were detected as pathological DDH in observation group.Twenty-eight cases(30.43%)were detected as pathological DDH in clinical abnormality group.Four cases(4.00%)were detected with pathological DDH in control group.There was no significant difference in detection rate of pathological DDH between observation group and control group(χ2=0.909,P=0.592).The detection rate of pathological DDH in clinical abnormal group was significantly higher than that in control group(χ2=24.109,P<0.001).The positive predictive value,negative predictive value,sensitivity and specificity of asymmetry of skin folds around the hip for pathological DDH were 4.31%,96.00%,55.56%and 46.38%,respectively.The positive predictive value,negative predictive value,sensitivity and specificity of abnormal clinical manifestations for pathological DDH were 30.43%,96.00%,87.50%and 60.00%,respectively.Conclusion clinical signs to guide imaging screening of infants.

Objective:To analyze the duration of the second stage of labor without epidural anesthesia and its association with pregnancy outcome.Methods:This retrospective study involved 12 789 women who delivered without epidural anesthesia in the First Affiliated Hospital of Kunming Medical University from January 1, 2014 to December 31, 2017. These subjects were divided into primipara group (9 517 cases) and multipara group (3 272 cases). Demographic characteristics, maternal and neonatal outcomes and the duration of the second stage of labor were compared between the two groups using two independent samples t-test, Mann-Whitney U test and Chi-square test (Fisher's exact test). Differences in the maternal and neonatal outcomes were also analyzed among different subgroups in primiparae [length of second stage: <1 h group ( n=6 265), ≥1-2 h group ( n=2 305), ≥2-3 h group ( n=831) and ≥3 h group ( n=116)] and multiparae [length of second stage <1 h group ( n=3 144), ≥1-2 h group ( n=102) and ≥2 h group ( n=26)]. The association between second stage length and pregnancy outcomes was analyzed with Cramer's V. After adjusted for maternal age, gestational weeks at delivery, body mass index before pregnancy, complications during pregnancy and neonatal birth weight, the relationship between the duration of the second stage and adverse outcomes was analyzed by binary logistic regression analysis. Results:The 95 th percentile of the second-stage labor duration was 143 min for primiparae and 52 min for multiparae. The rates of vaginal delivery, forceps delivery, cesarean section in the second stage, episiotomy, third- or fourth-degree perineal laceration, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, transfusion, umbilical arterial blood gas pH<7.15 and transferring to neonatal intensive care unit (NICU) were all correlated with the duration of second stage in primiparae (Cramer's V values: 0.22, 0.23, 0.03, 0.22, 0.05, 0.10, 0.03, 0.03, 0.03 and 0.07, respectively, all P<0.05), and so did those of vaginal delivery, forceps delivery, episiotomy, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, transfusion and transferring to NICU in multiparae (Cramer's V values: 0.18, 0.19, 0.28, 0.14, 0.09, 0.13 and 0.06, respectively, all P<0.05). Logistic analysis showed that in primiparae, the duration of second stage >1 h was an independent risk factor for episiotomy, third- or fourth-degree perineum laceration, forceps delivery, postpartum hemorrhage, admission to NICU and umbilical arterial blood gas pH<7.15 [adjusted OR (95% CI): 2.080 (1.907-2.268), 1.773 (1.080-2.911), 1.625 (1.420-1.859), 1.365 (1.231- 1.514), 1.305 (1.165-1.462) and 1.246 (1.081-1.436), respectively], while second stage length >2 h was the independent risk factor for episiotomy, forceps delivery, third- or fourth-degree perineum laceration, postpartum hemorrhage, grade Ⅱ postpartum hemorrhage, blood transfusion, admission to NICU and umbilical arterial blood gas pH<7.15 [adjusted OR (95% CI): 4.844 (4.132-5.678), 4.223 (3.571-4.993), 3.289 (1.806-5.989), 1.952 (1.675-2.274), 1.781 (1.057-3.001), 1.654 (1.025-2.668), 1.682 (1.421-1.991) and 1.298 (1.039-1.620), respectively]. In multiparae, the length of second stage >1 h was an independent risk factor for episiotomy, blood transfusion, forceps delivery, postpartum hemorrhage and admission to NICU [adjusted OR (95% CI): 8.796 (5.717-13.534), 7.469 (2.874-19.411), 6.135 (3.217-11.699), 2.697 (1.624-4.477) and 1.814 (1.063-3.097), respectively], while the duration of second stage >2 h was the independent risk factor for episiotomy, third- or fourth-degree perineum laceration, blood transfusion, grade Ⅱ postpartum hemorrhage, forceps delivery and postpartum hemorrhage [adjusted OR (95% CI): 38.868 (14.948-101.063), 28.046 (2.780-282.490), 20.076 (5.384-74.866), 16.327 (3.406-78.274), 14.337 (5.351-38.411) and 9.036 (3.880-21.011), respectively]. Conclusions:The duration of the second stage of labor without epidural anesthesia is between that reported by Friedman and by Zhang. A prolonged second stage of labor may increase the risk of adverse pregnancy outcomes.

Objective:To generate the knowledge structure, emerging trends and frontier field from researches of female reproductive medicine by bibliometric analysis.Methods:Web of Science was used as the literature search engine. CiteSpace and VOSviewer were used to construct the knowledge map. Important countries were analyzed. Common key word and co-citation were used for analysis process.Results:A total of 19 759 bibliographic records were retrieved on the data source of Web of Science between 2009 and 2018 based on a topic search in titles, abstracts or indexing terms. Annual publication was from 1600 to 2000. The United States, China and France were the top countries that had published the most amount of papers with 6451 (32.65%), 1376 (6.96%), and 1072 (5.43%) papers respectively. The United States and its institutions played an important role both in number and influence of literatures, and a closer cooperation network has formed between the United States and European countries. American Journal of Obstetrics and Gynecology, Fertility and Sterility, and Obstetrics and Gynecology were the top-3 most important journals in female reproductive medicine. Etiology of endometriosis, gynecology cancer treatment, polycystic ovary syndrome diagnosis, fertility preservation, and assisted reproductive technology were the main topics in the field of reproductive medicine. In recent years, obesity-related reproductive endocrine disorders, prenatal diagnosis, infertility treatment, and neoadjuvant chemotherapy of gynecology cancer were becoming the hotspots. Conclusion:New concept and technological innovations in neoadjuvant chemotherapy and preimplantation genetic diagnosis are still hot topics in recent future. Multidisciplinary and multisectoral cooperation, such as further application of medical engineering and biotechnology in treatment of gynecological diseases, is important in further, as well as clinical practice or guidelines improvement through evidence-based research.

Objective:To generate the knowledge structure, emerging trends and frontier field from researches of female reproductive medicine by bibliometric analysis.Methods:Web of Science was used as the literature search engine. CiteSpace and VOSviewer were used to construct the knowledge map. Important countries were analyzed. Common key word and co-citation were used for analysis process.Results:A total of 19 759 bibliographic records were retrieved on the data source of Web of Science between 2009 and 2018 based on a topic search in titles, abstracts or indexing terms. Annual publication was from 1600 to 2000. The United States, China and France were the top countries that had published the most amount of papers with 6451 (32.65%), 1376 (6.96%), and 1072 (5.43%) papers respectively. The United States and its institutions played an important role both in number and influence of literatures, and a closer cooperation network has formed between the United States and European countries. American Journal of Obstetrics and Gynecology, Fertility and Sterility, and Obstetrics and Gynecology were the top-3 most important journals in female reproductive medicine. Etiology of endometriosis, gynecology cancer treatment, polycystic ovary syndrome diagnosis, fertility preservation, and assisted reproductive technology were the main topics in the field of reproductive medicine. In recent years, obesity-related reproductive endocrine disorders, prenatal diagnosis, infertility treatment, and neoadjuvant chemotherapy of gynecology cancer were becoming the hotspots. Conclusion:New concept and technological innovations in neoadjuvant chemotherapy and preimplantation genetic diagnosis are still hot topics in recent future. Multidisciplinary and multisectoral cooperation, such as further application of medical engineering and biotechnology in treatment of gynecological diseases, is important in further, as well as clinical practice or guidelines improvement through evidence-based research.

Objective: To analyze the molecular characteristics of Listeria monocytogenes strains from ready-to eat food in China. Methods: A total of 239 Listeria monocytogenes strains isolated from ready-to-eat food in 2017, all strains underwent whole-genome sequencing (WGS) , and comparisons uncovered population structure derived from lineages, clonal complex, serogroups, antimicrobial susceptibility and virulence, which were inferred in silico from the WGS data. Core genome multilocus sequence typing was used to subtype isolates. Results: All strains were categorized into three different lineages, lineage Ⅱ was the predominant types in food, and IIa was the main serogroups. CC8, CC101 and CC87 were the first three prevalent CCs among 23 detected CCs, accounting for 49.4%. Only 4.6% (11 isolates) of tested strains harbored antibiotic resistance genes, which were mostly trimethoprim genes (7 isolates, 2.9%). All strains were positive for LIPI-1, and only a part of strains harbored LIPI-3 and LIPI-4, accounting for 13.8% (33 isolates) and 14.2% (34 isolates), respectively. ST619 carried both LIPI-3 and LIPI-4. 51.5% (123 isolates) of strains carried SSI-1, and all CC121 strains harbored SSI-2. Different lineages, serogroups and CCs can be separated obviously through cgMLST analysis, and 24 sublineages were highly concordant with CCs. Conclusion Ⅱa was the main serogroups in ready-to-eat food isolates in China; CC8, CC101 and CC87 were the prevalent CCs, and CC87 isolates was hypervirulent isolates, cgMLST method can be adopted for prospective foodborne disease surveillance and outbreaks detection.

Objective Glucagon-like peptide-1 (GLP-1) has been reported to be effective in the treatment of nonalcoholic fatty liver disease (NAFLD). However, the molecular mechanism of GLP-1 on NAFLD is remained unclear. The present study was to detect whether the effect of GLP-1 on triglyceride (TG) content in hepatocytes is dependent on Foxos. Methods HepG2 cells were treated with palmitic/oleic acid for 24 h. The knockdown of Foxo1, Foxo3 was conducted through small interfering RNA (siRNA). Real time PCT (RT-PCR) was used to detect the changes of the SREBP1c and Acox2 genes in HepG2 cells after Foxo1/3 knockdown. Results As expected, palmitic/oleic acid increased TG concentration in HepG2 cells [(12.65 ± 1.32) μg/mg vs. (4.32 ± 0.54) μg/mg, P<0.05]. Addition of GLP-1 dose (10, 50, 100nmol/L) dependently lowered the TG content and reached plateau at 100 nmol/L of GLP-1 [TG(8.38±1.47) μg/mg]. The GLP-1 effect on TG remained after knocking down either Foxo1 [(9.09±1.34)μg/mg] or Foxo3 [(8.90± 1.60) μg/mg] alone, but not when knocking down Foxo1 and Foxo3 (Foxo1/3) together [(14.66±1.77)μg/mg]. Moreover, knocking down Foxo1/3 also abolished GLP-1 effect on SREBP1c and Acox2 expression. Conclusion GLP-1 can inhibit the synthesis of TG in hepatocytes depending on Foxo1 and Foxo3. Further studies are needed to explore the specific mechanisms.

Objective To observe the improvement of weight rebound in obese type 2 diabetes mellitus patients who underwent metabolic surgery after low-carbohydrate diet intervention.Methods 38 patients with obese type 2 diabetes mellitus who had underwent metabolic surgery in Changhai Hospital from Jan.2010 to Nov.2015,were randomly divided into two groups and intervened by low carbohydrate (LC) diet or diabetes mellitus (DM) diet.The blood glucose and body weight of the two groups were compared and analyzed.Results There was no statistical difference in fasting blood glucose,HbA1c,fasting C-peptide,body weight,waistline and BMI value(t=0.34,S=1.00-32.5,P＞0.05)in diabetes mellitus diet intervention group;while there was significant statistical difference in fasting blood glucose,body weight,waistline and BMI (t=2.38,S=17-24.5,P＜0.05)in low-carbo hydrate diet intervention group.There was significant differences in body weight difference (Z=2.31,P＜0.05),BMI difference(Z=2.36,P＜0.05),and weight rebound rate(P＜0.05) between the two groups,with the low carbohydrate diet intervention group displaying advantages.Conclusions Low carbohydrate diet intervention can improve fasting blood glucose,obesity indexes in obese type 2 diabetes mellitus patients who underwent metabolic surgery.Compared with diabetes mellitus diet intervention,low carbohydrate diet intervention can more greatly improve weight,weight rebound rate,rebound scale and have more advantages for maintaining the operation effects.

Objective:To investigate the expression and function of RIP3 in the liver of rats following ischemic postconditioning.Methods:The model of 70％ hepatic ischemia and reperfusion was established,then a total of forty healthy adult male Sprague-Dawley(SD) rats were divided randomly into four groups,ten rats in each group:a sham-operation group (Sham group);an ischemia reperfusion injury group(IR group);an ischemic postconditioning group(IPO group);an ischemic postconditioning and necrostatin-1 group (Nec-1 group).The blood samples and liver tissues were collected.The serum levels of ALT and AST were detected,and the liver histological examination was performed.Western-bolt was used to detect the TNF-α and RIP3 levels.Results:Compared with the IR group,ALT and AST in serum were significantly declined in the IPO group (P＜0.05);The liver damage after ischemia and reperfusion was improved obviously in the IPO group compared to which in the IR group;The Suzuki's scores was increased in the IR group compared to which in the IPO group (P＜0.05);There was a low grade of TNF-α and RIP3 in the Sham group,whereas the level of TNF-α and RIP3 significantly increased in the IR and IPO and Nec-1 group(P＜0.05);Compared with the IR group,the level of RIP3 was further decreased in the IPO group (P＜0.05);Compared with the IPO group,the level of RIP3 was further decreased in the Nec-1 group (P＜0.05).Conclusion:RIP3-mediated necroptosis was involved during hepatic ischemia postconditioning,and the protective effect of ischemia postconditioning may act as reducing necroptosis by cutting down the levels of RIP3.