Objective:To investigate the clinical effect of free anterolateral thigh myocutaneous flap combined with oral repair membrane in the reconstruction of nasal mucosa defect after maxillary malignant tumor surgery. Methods:A total of 12 patients with maxillary gingival squamous cell carcinoma and maxillary sinus cancer who had been treated in Department of Oral and Maxillofacial Surgery, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, were selected from November 2020 to November 2023. Free anterolateral thigh musculocutaneous flap transplantation combined with oral repair membrane were used in all patients. Meanwhile, maxillary soft and hard tissue defects and nasal mucosa defects left after tumor operation were repaired and reconstructed. The clinical effect was evaluated after 6-12 months follow-up. Results:Subtotal maxillary resection was performed in 1 case, total maxillary resection in 9 cases and extended maxillary resection in 2 cases. The musculocutaneous flaps of all patients survived, the facial appearance was basically symmetrical, no obvious depression deformity, the swallowing and speech function recovered well, the mouth and nasal cavity were closed completely, the food could be eaten through the mouth, and the lower nasal passage was not blocked. Conclusion:The free anterolateral thigh musculoflap combined with oral repair membrane can be used to repair and reconstruct maxillary malignant tumor complicated with extensive maxillary tissue and nasal mucosa defect after operation, and the appearance and function can be recovered well after operation, which is a choice for maxillary malignant tumor complicated with nasal mucosa defect.
Humans ; Myocutaneous Flap ; Plastic Surgery Procedures/methods* ; Maxillary Neoplasms/surgery* ; Carcinoma, Squamous Cell/surgery* ; Male ; Middle Aged ; Female ; Nasal Mucosa/surgery* ; Maxilla/surgery* ; Thigh/surgery* ; Maxillary Sinus Neoplasms/surgery*

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 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 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.

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.