Objective:To analyze the influencing factors of extremely high cost cases under disease diagnosis related grouping (DRG) payment, for references for further improving China′s medical insurance payment system.Methods:The inpatient medical record homepage and medical insurance settlement list data of medical insurance settlement cases in a tertiary hospital in 2022 were Collected; 19 potential influencing factors such as gender, age, and hospitalization status were used as independent variables, and extremely high cost cases as dependent variables. Single factor analysis and directed acyclic graphs were used to screen for independent variables; Logistic regression model was used to analyze the influencing factors of extremely high cost cases.Results:A total of 17 028 hospitalized patients were contained, including 815 cases with extremely high costs. After analysis, the older the age, the greater the positive impact on cases with extremely high costs ( P<0.001); Third/fourth level surgery had a positive impact on these cases ( P<0.05); Emergency/critical hospitalization negative impact on extremely high cost cases ( P<0.001); Coding downgrade, surgical, intensive care unit discharge, and death positive impact cases with extremely high costs ( P<0.001); The higher the proportion of drugs, the greater the positive impact on cases with extremely high costs ( P<0.001); Compared with treatment costs accounting for ≤10%, treatment costs accounting for (10%, 30%] had a positive impact on cases with extremely high costs ( P<0.001), while treatment costs accounting for >30% had a negative impact ( P=0.007); Complications and/or comorbidities negative impact on thses cases ( P<0.001); The higher the weight of the disease group, the greater the negative impact on cases with extremely high costs ( P<0.001). Conclusions:There were many influencing factors for extremely high cost cases, among which factors such as advanced age, emergency/critical hospital admission, third/fourth level surgery, code downgrade, and high drug proportion would increase the number of extremely high cost cases, accompanied by complications and/or comorbidities, and the high weight of disease group reduce the number of extremely high cost cases. Medical institutions should strengthen internal management by standardizing admission management and optimizing the structure of hospitalization expenses; The medical insurance management department should focus on improving the DRG grouping scheme, scientifically setting the weight of disease groups, and jointly promoting the reform of China′s medical insurance payment system.

Objective:To analyze the influencing factors of extremely high cost cases under disease diagnosis related grouping (DRG) payment, for references for further improving China′s medical insurance payment system.Methods:The inpatient medical record homepage and medical insurance settlement list data of medical insurance settlement cases in a tertiary hospital in 2022 were Collected; 19 potential influencing factors such as gender, age, and hospitalization status were used as independent variables, and extremely high cost cases as dependent variables. Single factor analysis and directed acyclic graphs were used to screen for independent variables; Logistic regression model was used to analyze the influencing factors of extremely high cost cases.Results:A total of 17 028 hospitalized patients were contained, including 815 cases with extremely high costs. After analysis, the older the age, the greater the positive impact on cases with extremely high costs ( P<0.001); Third/fourth level surgery had a positive impact on these cases ( P<0.05); Emergency/critical hospitalization negative impact on extremely high cost cases ( P<0.001); Coding downgrade, surgical, intensive care unit discharge, and death positive impact cases with extremely high costs ( P<0.001); The higher the proportion of drugs, the greater the positive impact on cases with extremely high costs ( P<0.001); Compared with treatment costs accounting for ≤10%, treatment costs accounting for (10%, 30%] had a positive impact on cases with extremely high costs ( P<0.001), while treatment costs accounting for >30% had a negative impact ( P=0.007); Complications and/or comorbidities negative impact on thses cases ( P<0.001); The higher the weight of the disease group, the greater the negative impact on cases with extremely high costs ( P<0.001). Conclusions:There were many influencing factors for extremely high cost cases, among which factors such as advanced age, emergency/critical hospital admission, third/fourth level surgery, code downgrade, and high drug proportion would increase the number of extremely high cost cases, accompanied by complications and/or comorbidities, and the high weight of disease group reduce the number of extremely high cost cases. Medical institutions should strengthen internal management by standardizing admission management and optimizing the structure of hospitalization expenses; The medical insurance management department should focus on improving the DRG grouping scheme, scientifically setting the weight of disease groups, and jointly promoting the reform of China′s medical insurance payment system.

Objective To investigate the clinical outcomes in the treatment of complex acetabular fractures through a single supra-ilioinguinal approach after the application of preoperative 3D printing and rapid prototyping simulating the operative procedure.Methods From January 2013 to January 2016,24 cases of complex pelvic and acetabular fractures in our hospital were retrospectively analyzed.Among them 18 cases were male and 6 were female.The average age was 39.2+±13.8 years (range,24-68 years).According to Letoumel-Judet's classification,there were 6 cases of transverse,4 cases of T shaped,4 cases of combined anterior column and posterior hemi-transverse (ACPHT) and 10 cases of 2-column fractures.The time from injured to operation averaged 9 days (range,4-18 days).Before operation,pelvic AP view,three-dimensional CT as well as CTA of iliac blood vessels was taken routinely in all cases.The CT and CTA scan data were then imported into Mimics software for 3D reconstruction.Surgical simulation and optimal placement of internal fixations were performed on computer.After that,the individual simulated model of the pelvis was printed by the use of 3D printing and rapid prototyping technique.The order of reduction,selection and optimal position of the implants were determined.The plates were bent before operation and the length and direction of the screws were recorded.A uniform supra-ilioinguinal approach was used in all cases.Results The length of incision averaged 9 cm (range,8-13 cm).The operative time average 130 min (range,90-220 min).The blood loss averaged 600 ml (range,300-1 500 ml).Once a satisfactory reduction was obtained,single placement of the plates was achieved.In accordance with the preoperative plan,the plates were perfectly fitted to the bone surface.The 24 patients were followed for an average time of 18.3 months (range,15-30 months).The fractures healed in all cases.The average healing time was 4.2 months (range,3-6 months).According to Matta criteria,there were 16 cases of excellent,6 cases of good,2 cases of poor and the excellent rate was 91.7％ (22/24).The average modified Merle d'Aubigne score was 16.5 (range,13-18).The functional outcome was excellent in 13 cases,good in 6 cases and poor in 5 cases.The excellent rate of hip functions was 79.2％ (19/24).There were 2 cases of femoral lateral cutaneous nerve injury (recovered one month later) and another 1 case of fat liquefaction of the incision happened three days postoperatively (the wound healed completely after several dressing changes).No inguinal hernia or abdominal wall hemias was found.No other postoperative complications was found.Conclusion The application of 3D printing and rapid prototyping technique allows preoperatively simulating reduction in vitro,determining the optimal position of the implants,bending the plates and measuring the length of the screws in advance,which could largely reduce the operative time,intraoperative blood loss and occurrence of postoperative complications.Adopting supra-ilioinguinal approach for the treatment of complex acetabular fractures with a small incision and less trauma,a full exposure could be obtained,so the reduction and fixation of the anterior,posterior and middle column (also named pubo-ischiatic column) could be completed in a direct visualization,resulting in a satisfactory clinical outcomes.

OBJECTIVETo explore the change pattern of hypothalamic-pituitary-adrenal (HPA) axis and related neurotransmitters under simulated weightlessness.

METHODSA total of 40 clean-grade male Wistar rats were randomly divided into a normal group, a tail-suspension group, an electroacupuncture (EA) at Neiguan (PC 6) group, an EA at Sanyinjiao (SP 6) group, 10 rats in each group. Rats in the tail-suspension group, EA at "Neiguan" (PC 6) group and EA at "Sanyinjiao" (SP 6) group were treated with tail suspension to simulate weightlessness effect. Rats in the normal group were treated with normal diet. Rats in the tail-suspension group were treated with tail suspension for 28 d. During the time of tail suspension, rats in the EA at "Neiguan" (PC 6) group were treated with EA at "Neiguan" (PC 6), 30 min per treatment, once every two days for 14 treatments, while rats in the EA at "Sanyinjiao" (SP 6) group were treated with EA at "Sanyinjiao" (SP 6), 30 min per treatment, once every two days for 14 treatments. Samples were all collected after 4 weeks. The contents of corticotropin releasing hormone (CRH) , adrenocorticotropic hormone (ACTH), corticosterone (CORT) in as well as 5-hydroxy tryptamine (5-HT), dopamine (DA), norepinephrine (NE) were measured by using radioimmunoassay.

RESULTSCompared with the normal group, in the tail-suspension group the content of ACTH in pituitary was significantly decreased (P< 0.05), and the content of 5-HT in hypothalamus was significantly decreased (P < 0.01); the content of CRH and 5-HT in hypothalamus was significantly decreased (P < 0.01, P < 0.05) in the EA at "Neiguan" (PC 6) group; the content of CRH and 5-HT in hypothalamus was significantly decreased (P < 0.01), and the content of CORT in serum was significantly decreased (P < 0.05) in the EA at "Sanyinjiao" (SP 6) group. Compared with the tail-suspension group, the content of ACTH in hypothalamus was significantly decreased (P< 0.05) in the EA at "Neiguan" (PC 6) group; the content of CRH, ACTH and CORT was significantly decreased (P < 0.01, P < 0.05) in the EA at "Sanyinjiao" (SP 6) group. Compared with the EA at "Neiguan" (PC 6) group, the content of CORT was decreased (P < 0.05) in the EA at "Sanyinjiao" (SP 6) group.

CONCLUSIONEA can regulate the content of 5-HT in hypothalamus in tail-suspension rats, inhibit the hyperactivity of the HPA axis, in which EA at "Sanyinjiao" (SP 6) had more significant effects than "Neiguan" (PC 6), but no obvious effects on NE and DA were observed.

Acupuncture Points ; Adrenocorticotropic Hormone ; metabolism ; Animals ; Corticotropin-Releasing Hormone ; metabolism ; Dopamine ; metabolism ; Electroacupuncture ; Hormones ; metabolism ; Hypothalamus ; metabolism ; Male ; Neurotransmitter Agents ; metabolism ; Norepinephrine ; metabolism ; Pituitary-Adrenal System ; metabolism ; Rats ; Rats, Wistar ; Serotonin ; metabolism ; Weightlessness

OBJECTIVETo analyze the results of pathogenic bacteria culture on chronic periprosthetic joint infection after total knee arthroplasty (TKA) and total hip arthroplasty (THA).

METHODSThe medical data of 23 patients with chronic periprosthetic joint infection after TKA or THA from September 2010 to March 2014 were reviewed. Fifteen cases of TKA and 8 cases of THA were included in this study. There were 12 male and 11 female patients with the mean age of 62 years (range from 32 to 79 years), and among them 9 patients with sinus. All patients discontinued antibiotic therapy for a minimum of 2 weeks before arthrocentesis, taking pathogenic bacteria culture and antimicrobial susceptibility test by using synovial fluid taken preoperatively and intraoperatively of revision. Common pathogenic bacteria culture and pathological biopsy were taken on tissues intraoperatively of revision. Culture-negative specimens were prolonged the period of incubation for 2 weeks.

RESULTSThe overall culture-positive rate of all 23 patients for 1 week before revision was 30.4% (7/23), and the positive rate of culture-negative samples which prolonged for 2 weeks was 39.1% (9/23). The overall culture-positive rate of patients for 1 week intraoperatively of revision was 60.9% (14/23), and the positive rate of culture-negative samples which prolonged for 2 weeks was 82.6% (19/23). The incubation results of 7 cases (30.4%) preoperatively conformed to that of intraoperation.

CONCLUSIONThe culture-positive rate of pathogenic bacteria culture can be increased evidently by discontinuing antimicrobial therapy for a minimum of 2 weeks prior to the definite diagnosis.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; Arthroplasty, Replacement, Knee ; Bacteria ; isolation & purification ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Prosthesis-Related Infections ; Reoperation