Objective To investigate the cost and payment management of DRG group malignant tumor targeted therapy and immunotherapy(RG19)in medical institutions,and provide reference suggestions for further improving DRG related systems.Methods A questionnaire survey was conducted on clinical doctors and medical insurance staff from 96 comprehensive hospitals and oncology specialized hospitals in 22 DRG pilot cities in China.The questions included the hospital management of RG19 group,and special payment policies in different regions.Results A total of 148 valid questionnaires were collected.The survey results showed that 37％of hospitals in the RG19 group was in a loss state,mainly due to the use of innovative drugs and the high proportion of targeted therapy and immunotherapy combined cases.46％of respondents believed that the current payment standards for RG19 group did not fully reflect the value of doctor plan development,and the grouping rules needed to be further optimized.Factors such as line of treatment,and drug use types should be comprehensively considered.In addition,24％of hospitals RG19 group made profits due to the high proportion of clinical trial cases,but most regions did not have special policies for payment of clinical trial cases.Conclusion Medical institutions should further strengthen the management of hospital internal cost control for DRG patients,and regions should pay more attention to clinical practice in formulating DRG grouping rules and payment schemes.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

The number of patients with reduced blood volume due to haemorrhage, fractures, severe infections, extensive burns and tumours is increasing, and traditional blood products are no longer able to meet the increasing clinical demand. Therefore, plasma substitutes have become particularly important in fluid resuscitation, especially artificial colloidal solutions, which have a sustained volume expansion time and a good volume expansion effect, and can significantly improve the circulatory status of patients. This article aims to review the classification of artificial colloidal plasma substitutes and their research progress in clinical practice, in order provide a more rigorous, professional and standardized reference for medicine.

Objective To construct a high-precision statistical shape model of the humerus and systematically describe its anatomical variation patterns.Methods In this study,a statistical shape model of the humerus was constructed using the three-dimensional model data of 60 collected humerus cases.The principal component analysis method was adopted to reveal the main patterns of humerus anatomical variations and their contribution rates.Results The results showed that the first five principal components(PC01-PC05)collectively explained 96.6%of the total anatomical variations.Among them,PC01 and PC02 were the main components,contributing 66.6%and 23.5%of the variations respectively.PC01 mainly reflects the scaling effect of the overall size(length/width)of the humerus,while PC02 reveals the length variation characteristics independent of the overall scaling,which may reflect individualized differences.The subsequent principal components(PC03-PC05)depicted the local morphological characteristics and fine changes of the proximal and distal humerus.Conclusion The statistical shape model constructed in this study provides a reliable digital basis for personalized prosthesis design,surgical planning and biomechanical simulation.

Objective:To evaluate the performance of three mainstream large language models (LLMs) in the review of drug reimbursement indications in hospitals, and to explore their potential in improving audit quality and efficiency, thereby safeguarding the medical insurance fund.Methods:A total of 3 247 outpatient prescription records were retrospectively collected from a specialized oncology hospital between January 2, 2022, and June 30, 2023. Manual assessment of the consistency between clinical diagnoses and drug reimbursement indications was used as the gold standard. Three LLMs, Baidu′s ERNIE Bot, Alibaba′s Tongyi Qianwen, and OpenAI′s ChatGPT-4o, were evaluated on the same task. Performance metrics included accuracy, precision, sensitivity, specificity, F1 score, and area under the curve (AUC).Results:The ERNIE Bot model returned 3 242 valid data, which took 314 min; The Tongyi Qianwen model returned a total of 3 162 valid data, taking 384 min; The ChatGPT-4o model returned a total of 3 218 valid data, taking 150 min. ChatGPT-4o demonstrated the best performance, with an accuracy of 88.41%, precision of 60.48%, sensitivity of 78.75%, specificity of 90.24%, F1 score of 0.68, and an AUC of 0.88.Conclusions:LLMs demonstrate stable performance in determining whether prescriptions align with reimbursement indications, with ChatGPT-4o approaching human-level accuracy and exhibiting more conservative specificity. These findings suggest that LLMs have practical value as auxiliary tools in drug indication reviews, contributing to improved audit efficiency and more refined management of medical insurance funds.

Objective To construct a high-precision statistical shape model of the humerus and systematically describe its anatomical variation patterns.Methods In this study,a statistical shape model of the humerus was constructed using the three-dimensional model data of 60 collected humerus cases.The principal component analysis method was adopted to reveal the main patterns of humerus anatomical variations and their contribution rates.Results The results showed that the first five principal components(PC01-PC05)collectively explained 96.6%of the total anatomical variations.Among them,PC01 and PC02 were the main components,contributing 66.6%and 23.5%of the variations respectively.PC01 mainly reflects the scaling effect of the overall size(length/width)of the humerus,while PC02 reveals the length variation characteristics independent of the overall scaling,which may reflect individualized differences.The subsequent principal components(PC03-PC05)depicted the local morphological characteristics and fine changes of the proximal and distal humerus.Conclusion The statistical shape model constructed in this study provides a reliable digital basis for personalized prosthesis design,surgical planning and biomechanical simulation.

Objective To investigate the cost and payment management of DRG group malignant tumor targeted therapy and immunotherapy(RG19)in medical institutions,and provide reference suggestions for further improving DRG related systems.Methods A questionnaire survey was conducted on clinical doctors and medical insurance staff from 96 comprehensive hospitals and oncology specialized hospitals in 22 DRG pilot cities in China.The questions included the hospital management of RG19 group,and special payment policies in different regions.Results A total of 148 valid questionnaires were collected.The survey results showed that 37％of hospitals in the RG19 group was in a loss state,mainly due to the use of innovative drugs and the high proportion of targeted therapy and immunotherapy combined cases.46％of respondents believed that the current payment standards for RG19 group did not fully reflect the value of doctor plan development,and the grouping rules needed to be further optimized.Factors such as line of treatment,and drug use types should be comprehensively considered.In addition,24％of hospitals RG19 group made profits due to the high proportion of clinical trial cases,but most regions did not have special policies for payment of clinical trial cases.Conclusion Medical institutions should further strengthen the management of hospital internal cost control for DRG patients,and regions should pay more attention to clinical practice in formulating DRG grouping rules and payment schemes.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:To evaluate the performance of three mainstream large language models (LLMs) in the review of drug reimbursement indications in hospitals, and to explore their potential in improving audit quality and efficiency, thereby safeguarding the medical insurance fund.Methods:A total of 3 247 outpatient prescription records were retrospectively collected from a specialized oncology hospital between January 2, 2022, and June 30, 2023. Manual assessment of the consistency between clinical diagnoses and drug reimbursement indications was used as the gold standard. Three LLMs, Baidu′s ERNIE Bot, Alibaba′s Tongyi Qianwen, and OpenAI′s ChatGPT-4o, were evaluated on the same task. Performance metrics included accuracy, precision, sensitivity, specificity, F1 score, and area under the curve (AUC).Results:The ERNIE Bot model returned 3 242 valid data, which took 314 min; The Tongyi Qianwen model returned a total of 3 162 valid data, taking 384 min; The ChatGPT-4o model returned a total of 3 218 valid data, taking 150 min. ChatGPT-4o demonstrated the best performance, with an accuracy of 88.41%, precision of 60.48%, sensitivity of 78.75%, specificity of 90.24%, F1 score of 0.68, and an AUC of 0.88.Conclusions:LLMs demonstrate stable performance in determining whether prescriptions align with reimbursement indications, with ChatGPT-4o approaching human-level accuracy and exhibiting more conservative specificity. These findings suggest that LLMs have practical value as auxiliary tools in drug indication reviews, contributing to improved audit efficiency and more refined management of medical insurance funds.

BACKGROUND:The number of hip fracture patients with dementia is increasing with an aging population,posing challenges for surgical treatment. OBJECTIVE:To determine the effect of dementia on postoperative complications in older patients with hip fractures. METHODS:Patients aged over 60 years old with hip fractures from 2000 to 2019 at Chinese PLA General Hospital were included.Dementia patients with a preexisting diagnosis of dementia at admission were identified.Each dementia patient was matched,for age±5 years,gender,and fracture type with 10 non-dementia patients.The differences in postoperative complications were compared between the two groups,including pneumonia,respiratory failure,gastrointestinal bleeding,urinary tract infection,surgical site infection,deep venous thrombosis,pulmonary embolism,angina pectoris,arrhythmia,heart failure,myocardial infarction,stroke,and death.The impact of dementia on major complications was evaluated using multivariate conditional logistic regression. RESULTS AND CONCLUSION:A total of 2 887 patients were included,of whom 125(4.3%)were dementia patients and matched with 1 243 non-dementia patients.The average age of dementia patients was(80.6±7.4)years;64.8%were female;53.6%were intertrochanteric fractures,and 46.4%were femoral neck fractures.Major complications occurred in 25(20.0%)patients with dementia and 123(9.9%)patients without dementia(P<0.01).The risk of major complications was 200.0 per 1 000 persons(95%CI,139.3-278.6)in dementia patients and 99.0 per 1 000 persons(95%CI,83.6-116.9)in non-dementia patients.Multivariate conditional logistic regression showed that a 2-fold risk of major postoperative complications after hip fracture surgery was found in dementia patients than in those without dementia(adjusted OR,2.11;95%CI,1.08-4.10).The results show that dementia is an independent risk factor for postoperative complications in elderly patients with hip fractures.Appropriate preoperative risk assessment and corresponding preventive and therapeutic measures should be given to this vulnerable population to mitigate postoperative complications.