Diagnosis-related groups (DRG) payment is an important component of deepening the reform of medical insurance payment methods. In June 2023, a tertiary hospital launched an intelligent DRG grouping audit system to enhance grouping accuracy. By establishing a multi departmental collaborative organizational structure, building a standardized knowledge base and a rule base covering five categories (diagnosis, fees, testing, nursing, and pathology), and integrating electronic medical records, medical orders, testing, and imaging data throughout the entire diagnosis and treatment process, the intelligent DRG grouping audit system with data collection, identification, extraction, comparison, and output modules was constructed to achieve intelligent audit. At the same time, it was formed a closed-loop management system for pre reporting quality control, in-process group entry control, and post data analysis and assessment, which would prevent the risk of differentiated behaviors such as high coding and high sets, and ensure the reasonable use of medical insurance funds. By January 2024, the system had covered 89 ADRG groups, and improved the efficiency and quality of DRG grouping audit. Compared with February to May 2023, the monthly average rejection rate of medical records on the first page decreased by 9.4% after the system was put into operation (June to December 2023), and core medical indicators such as the number of DRG groups, medical insurance settlement cases, and time consumption index continued to improve. The practical experience could provide reference and inspiration for other hospitals in China.

Diagnosis-related groups (DRG) payment is an important component of deepening the reform of medical insurance payment methods. In June 2023, a tertiary hospital launched an intelligent DRG grouping audit system to enhance grouping accuracy. By establishing a multi departmental collaborative organizational structure, building a standardized knowledge base and a rule base covering five categories (diagnosis, fees, testing, nursing, and pathology), and integrating electronic medical records, medical orders, testing, and imaging data throughout the entire diagnosis and treatment process, the intelligent DRG grouping audit system with data collection, identification, extraction, comparison, and output modules was constructed to achieve intelligent audit. At the same time, it was formed a closed-loop management system for pre reporting quality control, in-process group entry control, and post data analysis and assessment, which would prevent the risk of differentiated behaviors such as high coding and high sets, and ensure the reasonable use of medical insurance funds. By January 2024, the system had covered 89 ADRG groups, and improved the efficiency and quality of DRG grouping audit. Compared with February to May 2023, the monthly average rejection rate of medical records on the first page decreased by 9.4% after the system was put into operation (June to December 2023), and core medical indicators such as the number of DRG groups, medical insurance settlement cases, and time consumption index continued to improve. The practical experience could provide reference and inspiration for other hospitals in China.

OBJECTIVE: To evaluate the positional relationship between protective channel and sural nerve while treating acute Achilles tendon rupture with channel assisted minimally invasive repair (CAMIR) technique based on anatomical observations of cadaver specimens. METHODS: Twelve adult cadaveric lower limb specimens (6 left, 6 right) were utilized. A CAMIR device was implanted at a distance of 4 cm from the proximal end of the specimen to the Achilles tendon insertion. The skin was incised along the tendon's medial side, the sural nerve was dissected, and the positional relationship with the protective channel was observed. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion, the vertical distance between protective channel and the calcaneal insertion, and the horizontal distance between the sural nerve and protective channel were measured by using vernier caliper. RESULTS: Anatomical examination demonstrated a variable positional relationship between the sural nerve and protective channel, with the sural nerve positioned above (8 specimens) or below (4 specimens) the protective channel. The distance from the sural nerve-Achilles tendon intersection to the calcaneal insertion was (105.67±14.94) mm, the vertical distance between protective channel and the calcaneal insertion was (93.20±9.57) mm, and the horizontal distance between the sural nerve and protective channel was (0.31±0.14) mm. CONCLUSION The use of CAMIR technique for the treatment of acute Achilles tendon rupture can effectively avoid iatrogenic injury to the sural nerve.
Humans ; Achilles Tendon/injuries* ; Sural Nerve/anatomy & histology* ; Cadaver ; Minimally Invasive Surgical Procedures/methods* ; Tendon Injuries/surgery* ; Rupture/surgery* ; Adult ; Male ; Calcaneus/injuries* ; Female ; Plastic Surgery Procedures/methods*

Objective: To explore the relationship between dieting and binge eating with non suicidal self-injury (NSSI) among secondary vocational school students, so as to provide a scientific basis for the development of effective interventions to prevent NSSI. Methods: From October to December 2023, 2 364 students were selected by stratified cluster random sampling method from nine secondary vocational schools in Guizhou Province to conduct a self administered questionnaire survey. Unconditional binary Logisitic regression was used to analyze the relationship between dieting, binge eating behaviours, and the co-occurrence of the two and NSSI among secondary vocational school students, and were stratified by sex. Results: The detection rate of NSSI among secondary vocational school students in Guizhou Province was 27.5%, 6.8% of secondary vocational school students reported dieting, 10.5% reported binge eating behaviour, and 2.9% showed both dieting and binge eating behaviours. The adjusted model of unconditional binary Logistic regression showed that the presence of dieting ( OR =2.37), binge eating behaviour ( OR =2.31), and the co-occurrence of both ( OR =2.60) were associated with higher risk of NSSI among secondary vocational school students; stratified analysis by gender showed that both males and females with dieting, binge eating and coexistence of dieting and binge eating behaviours were at increased risk of NSSI (females: OR =2.27, 2.26, 2.78 ; males: OR =2.15, 2.08, 2.02) ( P <0.01). Conclusions Dieting and binge eating behavior of secondary vocational school students will increase the risk of NSSI. When preventing and intervening NSSI problems of secondary vocational school students, it should pay more attention to eating habits.

Objective To understand the changing resistance proifle ofProteus,Serratia,Citrobacter,Morganella andProvidencia in hospitals across China according to the data from CHINET Antimicrobial Resistance Surveillance Program 2005-2014.Methods Antimicrobial susceptibility was tested by using Kirby-Bauer method or automatic minimum inhibitory concentration determination according to a uniifed protocol.Results A total of 21 663 clinical isolates were collected from January 2005 to December 2014. The proportion ofProteus andSerratia isolates increased with time from 1.41% in 2005 to 2.09% in 2014, and from 0.99% in 2005 to 1.28% in 2014 among all the isolates. No change was found for the proportion ofCitrobacter,Morganella, orProvidencia. Less than 10% of theProteus isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, ceftazidime, cefoxitin, amikacin and tigecycline. Less than 10% of theSerratia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, amikacin and tigecycline. Less than 20% of theCitrobacter isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 10% of theMorganella isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, amikacin and tigecycline. Less than 20% of theProvidencia isolates were resistant to cefoperazone-sulbactam, piperacillin-tazobactam, cefepime, cefoxitin and tigecycline.Conclusions The antibiotic resistance ofProteus,Serratia, Citrobacter,Morganella andProvidencia isolates in hospitals across China is growing during the period from 2005 to 2014. Strengthening infection control and rational antibiotic use are effective to slow the growth of drug resistance.

Objective To investigate the distribution and antibiotic resistance proifle of clinicalEnterobacter isolates using the data from CHINET during the period from 2005 through 2014.Methods A total of 20 558 clinical strains ofEnterobacter spp. were collected from 2005 to 2014 in CHINET Antimicrobial Resistance Surveillance Program. Antimicrobial susceptibility testing was performed with Kirby-Bauer or minimum inhibitory concentration method. The results were analyzed according to CLSI 2014 breakpoints.ResultsEnterobacter cloacae andEnterobacter aerogenes accounted for 71.1% (14 617/20558) and 20.1% (4 129/20 558) of all theEnterobacterisolates, respectively. The proportion ofEnterobacter spp. increased with time from 3.5% in 2005 to 4.3% in 2014. The main source of the isolates was respiratory tract, accounting for 55.2% (11 358/20 558). More than 90% of theEnterobacterisolates were resistant to cefazolin and cefoxitin, but less than 30% of the strains were resistant to cefepime, piperacillin-tazobactam, cefoperazone-sulbactam, amikacin, gentamicin, ciprolfoxacin, meropenem, imipenem and ertapenem. TheEnterobacterisolates showed a trend of declining resistance to most antibiotics except ertapenem and meropenem. The resistance proifle ofEnterobacterisolates varied with departments where they were isolated. The strains from ICU and Department of Surgery were relatively more resistant to antibiotics. The prevalence of multi-drug resistant (MDR) strains was decreasing, but the prevalence of carbapenem-resistantEnterobacter (CRE, resistant to any of imipenem, meropenem or ertapenem) was increasing. The MDR and CRE strains were primarily isolated from ICU and Department of Surgery. At least 30% of the MDREnterobacter strains were resistant to any of the antimicrobial agents tested except meropenem, imipenem and ertapenem and at least 35% of the CRE strains were resistant to any of the antimicrobial agents tested except amikacin and ciprolfoxacin.Conclusions TheEnterobacter isolates in CHINET Antimicrobial Resistance Surveillance Program showed decreasing resistance to most of the antimicrobial agents tested since 2011, but the prevalence of CRE strains increased progressively. Effective measures should be carried out to prevent the spread of CRE strains in hospitals.

Objective To evaluate the changing pattern of antibiotic resistance inKlebsiella strains isolated from the patients in 19 hospitals across China based on the data from CHINET Antimicrobial Resistance Surveillance Program during the period from 2005 through 2014.Methods Kirby-Bauer disk diffusion and automated susceptibility testing methods were used to test the susceptibility ofKlebsiella isolates to the commonly used antibiotics. The results were interpreted according to the criteria of the Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing (CLSI-2014).Results A total of 61 406Klebsiella strains were identified between 2005 and 2014, includingK. pneumoniae (56 281 strains), K. oxytoca(4 779),Klebsiella pneumoniae subsp.Ozaenae (300) and otherKlebsiella species (46). Most (89.0%, 54 664/61 406) of theKlebsiella strains were isolated from inpatients, and 60.0% (36 835/61 406) were from respiratory tract speciems. About 16.7% (10 248/61 406) of the strains were isolated from pediatric patients aged 0-17 years and 83.3% (51 158/61 406) from adult patients. The prevalence ofKlebsiella spp. increased with time from 10.1% in 2005 to 14.3% in 2014. Based on the surveillance data during the 10-year period, we found a marked increase of resistance to imipenem (2.9% to 10.5%) and meropenem (2.8% to 13.4%) inKlebsiella spp. The prevalence of ESBLs-producing isolates inK. pneumoniae andK. oxytoca decreased from 39.0% in 2005 to 30.1% in 2014. The resistance to amikacin, ceftazidime, ciprolfoxacin, pipracillin-tazobactam and cefoperazone-sulbactam was on decline. The resistance rate to cefotaxime remained high about 49.5%. Carbapenem resistantance was identiifed in 5 796 (9.4%) of the isolates, including 5 492 strains ofK. pneumoniae and 280 strains ofK. oxytoca. Overall, 4 740 (7.8%) strains were identiifed as extensively-drug resistant (XDR), including 4 520 strains ofK. pneumoniae and 202 strains ofK. oxytoca. The carbapenem-resistant strains showed high (>60%) resistance rate to majority of the antimicrobial agents tested, but relatively low resistance to tigecycline (16.8%), amikacin (54.4%), and trimethoprim-sulfamethoxazole (55.5%).Conclusions During the 10-year period from 2005 through 2014, carbapenem resistance amongKlebsiella isolates has increased dramatically in the hospitals across China. The level of resistance to other antibiotics remains stable.

Objective To study the clinical and immunologic features of 67 cases of patients with scrub typhus.Methods Epidemiological data,clinical manifestations,laboratory and image examination results and treatment of 67 cases of patients with scrub typhus hospitalized from January 2010 to December 2013 at the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.Results Autumn-winter type scrub typhus was predominant in the 67 patents.The main clinical manifestations included hyperpyrexia (100％,67/ 67),eschar or ulcer (91.0％,61/67),rash (52.2％,35/67),lymphadenopathy (46.3％,31/67) and other non-specific symptoms.Laboratory test results:①80.6％ (54/67) of the patients had normal or decreased white blood cell count,62.7％ (42/67) of them with elevated lymphocytes (＞ 40％),thrombocytopenia was detected in 34.3％ (23/67) of the patients,the lowest platelets count was 14 × 109/L.②14 of 17 cases (82.4％) had normal percentage of CD3+ T lymphocytes,CD8+ T lymphocytes increased in 16 of 17 cases (94.1％),while the percentage of CD4+ T lymphocytes (14 of 17,82.4％) and B lymphocytes (15 of 17,88.2％) decreased in most of the patients.③C reactive protein (CRP),ferritin and erythrocyte sedimentation rate (ESR) were elevated in 95.2％ (59/62),93.8％ (45/48) and 89.1％ (49/55) of the patients,respectively.④Elevated alanine aminotransferase (77.6％,52/67) and aspartate aminotransferase (80.6％,54/67) were frequent findings.⑤94.6％ (35/37) of the patients had increased adenosine deaminase.⑥ Antinuclear antibody was positive in 31.0％ (13/42) patients.⑦Epstein-barr virus DNA was detected in 15.6％ (7/ 45) cases,77.6％ (38/49) was accompanied with chest radiographic abnormalities.Two cases had tuberculosis.All the patients recovered after therapy with doxycycline,levofloxacin or moxifloxacin.Conclusion Autumn-winter scrub typhus has typical clinical manifestations in the 67 patients,and it can cause patients' immune disorders.

Objective To investigate the resistance of clinical Stenotrophomonas maltophilia isolates from 15 hospitals in several regions of China during 2011.Methods Fifteen repre-sentative general hospitals were involved in this program. Bacterial susceptibility testing was carried out by means of a unified protocol using Kirby-Bauer method and MIC determi-nation.Results were analyzed according to CLSI 2011 break-points.Results Majority (93.3%) of the 1 889 clinical strains of S.maltophilia were isolated from inpatients.On-ly 6.7% of the isolates were from outpatients.About 62.9% of these S .maltophilia strains were isolated from old patients whose age was 60 years or older.Only 8.2% of the strains were from the patients younger than 18 years old.Sputum and re-spiratory tract secretion were the most common specimen source,accounting for 82.6%.Another 4.2% isolates were from blood,abdominal fluid and other sterile body fluids.The percentage of the S .maltophilia strain resistant to trimethoprim-sul-famethoxazole,levofloxacin and minocycline was 16.6%,10.0% and 1.8%,respectively.The strains resistant to cefopera-zone-sulbactam accounted for 19.0%.About 37.1% of the strains isolated from blood or sterile body fluids were resistant to trimethoprim-sulfamethoxazole,significantly higher than the strains from urine or wound specimens (P < 0.01).Conclusions S.maltophilia strains are mainly isolated from inpatients.The most common source is sputum and other respiratory speci-mens.Most of the patients with S.maltophilia isolate are 60 years of age or older.The S.maltophilia strains are constitu-tively resistant to several antibacterial agents,but showed relatively lower resistance to trimethoprim-sulfamethoxazole,levo-floxacin and minocycline.Cefoperazone-sulbactam is still active against these strains.The antimicrobial therapy targeting S. maltophilia infections should be selected cautiously according to the results of antimicrobial resistance surveillance.

Objective To observe the relationship of viral load,serum cytokines and tissue damage after severe fever with thrombocytopenia syndrome virus (SFTSV)infection,and to explore the impact of SFTSV levels on tissue injury and prognosis.Methods Twenty-four ambulatory and hospitalized patients who were infected with SFTSV were enrolled between May 2011 and July 2012 at Department of Infectious Disease, First Affiliated Hospital with Nanjiang Medical University. According to their prognosis,they were divided into cure and death group,while 32 healthy blood donators were also enrolled from center blood station in Nanjing as control.The serum SFTSV load was detected using fluorescence quantitative polymerase chain reaction (PCR).The serum T helper (Th)1/Th2/Th17 cytokines in patients with severe fever with thrombocytopenia syndrome (SFTS)were determined dynamically and quantitatively by flow cytometry.The relationships between viral load,cytokines and serum enzymes, white blood cell (WBC),platelet (PLT)counts were analyzed.Comparisons among groups were achieved by rank sum test and correlation analysis among serum cytokines,blood cell counts and tissue damage was done by Spearman correlation test.Results All of the 24 patients showed a positive reaction to SFTSV RNA.The SFTSV loads of 21 cured cases,those of 2 were > 7.0 lg copy/mL,and those of 3 death patients were 6.7 lg copy/mL,8.8 lg copy/mL and 9.8 lg copy/mL,respectively.Serum level of interleukin (IL)-6 (21 .76 pg/mL in day 5 and 7.12 pg/mL in day 7)and IL-10 (14.33 pg/mL in day 5 , 14.13 pg/mL in day 7 and 3.01 pg/mL in day 9)of cured patients were significantly higher than those of healthy controls (IL-6:2.82 pg/mL and IL-10:1 .56 pg/mL)(P <0.05 ).At day 7 and day 9,serum levels of IL-6 of death cases were 137.61 pg/mL and 1 450.83 pg/mL,respectively and serum levels of IL-10 were 50.26 pg/mL and 49.43 pg/mL,respectively.Both of the indicators in the death group were significantly higher than those of cure group (P <0.05 ).However,serum levels of IL-2 and IL-4 were significantly lower than those in healthy control group (P <0.05 ).In the cure group,WBC and PLT counts were lowest during the early course of the disease,and serum alamine aminotransferase (ALT), aspartate aminotransferase (AST ), lactic dehydrogenase (LDH ) and creatine kinase (CK ) were significantly higher than their upper limits of normal.The correlation analysis showed that serum IL-6, IL-10 levels were negatively correlated with PLT count (r=-0.390 and -0.608,respectively;both P <0.01),and positively correlated with SFTSV load (r=0.560 and 0.758,respectively),ALT (r=0.412 and 0.390,respectively),AST (r = 0.686 and 0.764,respectively),LDH (r = 0.633 and 0.677, respectively)and CK (r =0.527 and 0.636,respectively)(all P <0.01 ).Conclusions SFTSV load, IL-6,IL-10 and serum enzyme levels are closely related to the severity of the disease.The inflammatory and anti-inflammatory cytokine storm after SFTSV infection may be involved in the immune pathological injury in patients with SFTS.