Objective To achieve the goal of standardized use of surgical consumables and reasonable cost control by the diagnosis-intervention packet(DIP)total control combined with clinical pathways.Methods Four DIP clinical groups implementing clinical pathways were selected as pilot disease groups.Cases from 2019 to 2020 served as control group,develop a diagnosis and treatment plan based on clinical pathways and pathway form combined with the actual situation of the hospital.Cases from 2021 to 2023 formed experimental groups:experimental group 1(added control measures of the inventory of surgical consumables on the basis of the control group),and experimental group 2(added total DIP control measures to the experimental group 1).The average hospitalization costs and average costs of disposable surgical consumables were compared to evaluate the practical outcomes.Results There were significant differences in the average hospitalization costs and average costs of disposable surgical consumables among the three groups(P<0.05).Further pairwise comparisons showed that the average hospitalization costs and average costs of disposable surgical consumables in experimental group 2 were significantly lower than those in experimental group 1 and the control group(P<0.05).The average hospitalization costs in all pilot disease groups except the group undergoing transurethral ureteroscopic laser lithotripsy in the experimental group 1 were significantly lower than those in the control group(P<0.05),and the average costs of disposable surgical consumables in all pilot disease groups in the experimental group 1 were significantly lower than those in the control group(P<0.05).Conclusion The management plan based on DIP combined with clinical pathways can improve the management effect of surgery-related consumables and effectively reduce the costs.

Objective:To explore the value of MR elastography (MRE) and shear wave elastography (SWE) for staging liver fibrosis in a rabbit model.Methods:From March to November 2020, 200 healthy New Zealand white rabbits were randomly divided into control group ( n=40) and liver fibrosis group ( n=160) by random number table method. The volume ratio of CCl 4 and olive oil was 1∶1 to prepare 50% CCl 4 oil solution, and the experimental rabbits in the liver fibrosis group were subcutaneously injected with 50% CCl 4 olive oil solution. It was injected once a week at the dose of 0.1 ml/kg in the first to third weeks, once a week at the dose of 0.2 ml/kg in the 4th to 6th weeks. The dose of 0.1 ml/kg was injected twice a week from week 7 to 16. The control group were subcutaneously injected with an equal dose of normal saline. At the end of the 4th, 8th, 12th, and 16th week, 40 and 10 animals in the liver fibrosis group and the control group were randomly selected by random number table method for MRE and SWE, respectively, to obtain the liver elastic stiffness (LS), which were recorded as LS MRE and LS SWE. After the examination, the experimental rabbits were sacrificed and liver tissue of rabbits were taken for histopathological Scheuer staging, and they were divided into F0-F4 groups. One-way ANOVA was used to evaluate the differences of LS MRE and LS SWE in different stages of liver fibrosis. Spearman correlation was used to analyze the correlation between LS and pathological stages. The receiver operating characteristic curve was used to evaluate the efficacy of LS MRE and LS SWE in diagnosing liver fibrosis staging, and the area under the curve (AUC) was compared using the Z test. Results:Totally 162 rabbits were included, which covered F0 ( n=38), F1 ( n=33), F2 ( n=35), F3 ( n=31) and F4 ( n=25). Significant differences of LS MRE and LS SWE values were found among different stages of liver fibrosis ( F=295.29, 102.40, both P<0.001). LS MRE, LS SWE were both positively correlated with liver fibrosis stage ( r=0.93, 0.81, both P<0.001). The AUC of LS MRE for diagnosing liver fibrosis stages ≥F1, ≥F2, ≥F3, and ≥F4 were 0.955, 0.967, 0.996, and 0.980, respectively; the AUC of LS SWE were 0.856, 0.880, 0.974, and 0.953, respectively. The AUC of liver fibrosis stage ≥ F1, ≥ F2 for LS MRE value were greater than LS SWE value ( Z=2.93, 3.29, P=0.003, 0.001), and the AUC of ≥F3, ≥F4 had no significant differences ( Z=1.58, 1.68, P=0.115, 0.093). Conclusion:Both MRE and SWE can accurately predict the stage of liver fibrosis in experimental rabbits, and MRE is better than SWE in diagnosing early liver fibrosis.

Objective:To explore the application of peritoneal dialysis routine examination in reducing the incidence of peritonitis associated with peritoneal dialysis.Methods:From July 2018 to June 2019, 191 patients with peritoneal dialysis who were followed up regularly in the nephrology department were selected as the study subjects.Using convenient sampling method, outpatient follow-up on Tuesday were selected as control group(95 cases) and fixed outpatient follow-up on Thursday were selected as observation group(96 cases). Routine follow-up was performed in the control group, and routine examination of peritonitis was performed in the observation group during the follow-up.Intervention was given immediately when the problems were found to the naked eye and the examination results were abnormal.The incidence of peritonitis in the two groups was compared.Results:Peritonitis occurred in 24 cases in the control group(25.26%), and 9 cases in the observation group(9.38%). The incidence of peritonitis in the observation group was lower than that in the control group, and the difference was statistically significant(χ 2=5.972, P<0.05). Conclusion:The occurrence of peritoneal dialysis-related peritonitis is related to a variety of factors.Paying attention to the routine examination of peritonitis and observing the color of peritonitis, strengthening the aseptic fluid exchange operation, and following up the patients can effectively reduce the occurrence of peritonitis and improve the quality of dialysis.

Objective To investigate the value of susceptibility weighted imaging (SWI) with T1ρimaging in staging of hepatic fibrosis(HF) in rabbits. Methods Eighty selected white rabbits from New Zealand were randomly divided into the HF group (n=60) and the control group (n=20). Rabbits in the HF group were injected subcutaneously with 50％CCl4 oil solution to establish HF model,and the normal control rabbits were injected with saline solution subcutaneously.The HF group(n=15) and control group(n=5) were randomly selected at the 4th, 5th, 6th and 10th week after injection, to undergo liver MR scan. The liver signal intensity (SI liver), the muscle signal intensity (SI muscle),liver-to-muscle SI ratios (SIR) and liver T1ρvalues were measured. Scheuer was adopted to stage the rabbits in HF. One-way analysis of variance was used to compare the differences between SIR and T1ρ values in different stages of HF pathological. Spearman correlation was used to analyze the correlation between SIR and T1ρ values in the different stage of HF pathological.The ROC were used to compare the efficacy between SIR and T1ρvalues in the diagnosis of HF pathological stage. Results Among the final qualified 68 rabbits in the study, 17 in F0 phase, 11 in F1 phase, 16 in F2 phase, 11 in F3 phase, and 13 in F4 phase. The SIR were (0.977 ± 0.013), (0.960 ± 0.015), (0.802 ± 0.026), (0.786 ± 0.022), (0.541 ± 0.116); T1ρ values were (22.301 ± 1.849), (24.034 ± 0.867), (25.374 ± 1.309),(25.364±1.945),(30.948±2.925) ms.There were statistically significant in SIR between F0 and F2,F0 and F3, F0 and F4, F1 and F2, F1 and F3, F1 and F4, F2 and F4, F3 and F4 (P<0.01). There were statistically significant in T1ρvalues between F0 and F1,F0 and F2,F0 and F3,F0 and F4,F1 and F2,F1 and F4,F2 and F4, F3 and F4(P<0.05). SIR were negatively correlated with HF staging while T1ρ values were positively. ROC showed that the AUC of the T1ρvalues was slightly larger than SIR in the F4 group(0.992>0.966),and the AUC of the SIR was greater than T1ρvalues in the other groups. Conclusion SWI and T1ρvalues can provide an important objective basis in staging of HF. Both of them have great clinical application prospects but SIR diagnostic efficiency is slightly better than that of T1ρvalues.

Objective To compare the diagnostic values of magnetic resonance elastography (MRE) and T1ρ imaging in staging hepatic fibrosis (HF) in a rabbit model.Methods The institutional animal care and use committee approved all experiments.Sixty healthy rabbits were divided into HF group (n=44) and control group (n=16).Each eight rabbits in the HF group and 4 rabbits in the control group were randomly selected at the 4th,5th,6th week and the remaining rabbits at the 10th week after subcutaneous injection with 0.1 ml 50％ CCl4 oily solution per kilogram of body respectively,to undergo liver MR scan including axial liver MRE and T1ρ imaging.The values of liver stiffness (LS) and T1ρ were measured.Masson trichrome staining of liver tissue was used.According to the Scheuer scoring system,rabbits were classified into F0 to F4 group based on the percentage of hepatic fibrosis.The difference of LS values and Tip values among stage F0 to F4 were compared by the one-way ANOVA analysis.The correlations between pathological staging and LS,T1ρ values were performed by the Spearman correlation analysis.ROC curve analysis was performed to compare the value of MRE with T1ρ imaging.Results Forty three rabbits were included,there were 10,8,8,8,9 rabbits in F0,F1,F2,F3 and F4 stage,respectively.LS values were (1.051±0.155),(1.335±0.235),(1.401±0.163),(2.001±0.499) and (2.981±0.714) kPa in F0,F1,F2,F3 and F4,respectively,while T1 p values were (23.20±4.02),(24.28±2.93),(25.40± 1.82),(24.69± 1.85) and (31.54±3.39) ms (all P＜0.05).The correlation of LS values with hepatic fibrosis staging measured on MRE was stronger than T19 values (r values were 0.916 and 0.608,all P＜0.01).Area under ROC curve of LS value for differentiating hepatic fibrosis stage were 0.938 to 0.989,while the areas of T1ρ were 0.771 to 0.954.Conclusion MR elastography is an accurate technique for quantitatively staging hepatic fibrosis and superior to T1ρ imaging.

Objective To investigate the correlation between fatigue and coping strategies among peritoneal dialysis patients,to improve their health consciousness and reduce the fatigue.Methods A total 107 patients were surveyed with general data questionnaire,Multidimensional Fatigue Symptom Inventory-Short Form( MFSI-SF) ,and Medical Coping Modes Questionnaire,MCMQ.Results The score of fatigue was (83.32 ±1.54) points,which indicated the fatigue remained in high level.Scores from high to low were dialysis≥5years,dialysis<1year and 1year≤dialysis<5years.Patients mainly took the coping style with positive face.Pearson correlation analysis showed that fatigue was negatively correlated withface(r=-0.300,P<0.05),while it was positively correlated with withdrawand yield(r=0.227,0.300,all P<0.05).Conclusion Patiens should be encouraged to actively face the disease,pay more attention to their own state of dialysis and improve the effect of drain,reduce fatigue,then to reply for both mind and body health.

Objective To investigate the correlation of HBV DNA level with clinicopathological characteristics and prognosis of HBV-associated glomerulonephritis ( HBV-GN ) .Methods One hundred and two patients with HBV-GN admitted in Affiliated Hospital of Qingdao University during January 2009 and October 2012 were successively enrolled.Fluorescence quantitative polymerase chain reaction was used to determine the serum titer of HBV DNA.According to HBV DNA levels the patients were divided into three groups:low-replication group (HBV DNA <103 copies/mL), moderate-replication group (103 copies/mL ≤HBV DNA≤105 copies/mL) and high-replication group ( HBV DNA >105 copies/mL) .Renal biopsy was performed to determine the pathological type, and immunofluorescence assay was used for quantitative detection of HBV related antigens ( HBsAg, HBcAg and HBeAg ) in kidney. All patients received lamivudine (100 mg/d) plus adefovir dipivoxil (10 mg/d) combination therapy and followed up for 18 months.The renal function, biochemical and immunological indexes before and after the treatment were measured.One-way ANOVA was used to analyze the differences of above parameters among patients in three groups.Spearman correlation coefficient was used for correlation analysis between HBV DNA level and pathological stages in kidney.Results There were 20 patients in low-replication group, 51 in moderate-replication group and 31 in high-replication group.With the increase of serum level of HBV DNA, 24-h urine protein excretion, plasma cholesterol, and triglycerides increased (F=34.64, 40.10 and 31.72, P<0.01), plasma level of albumin decreased (F=24.04, P<0.01), and the immune complexes of HBV related antigens ( HBsAg, HBcAg and HBeAg) in kidney increased ( F=41.49, 15.64 and 10.41, P<0.01).For 78 patients with HBV-membranous nephropathy ( HBV-MN), the pathological injury was aggravated with the increase of serum level of HBV DNA (r=0.38, P<0.01).The level of 24-h urine protein excretion declined after treatment in three groups ( t =7.86, 19.28 and 16.74, P <0.01 );complement C3 increased, but no statistical significance was observed ( t =1.05, 1.04 and 1.94, P >0.05);no change in creatinine was found (t =0.14, 0.52 and 0.57, P >0.05).After 18-month treatment, clinical remission rates in three groups were 95.0% ( 19/20 ) , 70.6% ( 36/51 ) and 54.8%(17/31), respectively.The clinical remission rate was significantly lower in the high-replication group as compared with that in low-replication group (χ2 =9.44, P<0.01).Conclusion Serum level of HBV DNA is closely correlated with renal function, renal pathology and clinical remission rate in HBV-GN patients, which may be used for the evaluation of kidney biopsy, treatment and prognosis in patients with HBV-GN.

Objective To study the expression of RhoA and C-myc in gastric carcinoma , and to discuss the action in infiltration and metastasis of gastric carcinoma as well as their dependability. Methods RhoA protein expression and C-myc protein expression were detected by immunohistochemical method in 46 cases of gastric carcinoma and 20 cases of normal tissues..RhoA protein expression was compared with clinical pathologic parameters as related to C-myc. Results The positive rate of RhoA,C-myc were significantly higher in gastric carcinoma than in normal tissue (P < 0.05). The expression of RhoA and C-myc were associated with the loss of tumor differentiation, lymph node metastasis and deep invasion (P<0.05). There was a significant correlation between RhoA and C-myc (r=0.62, P<0.05). Conclusions The data suggests that the expression level of RhoA protein was closely related to biological behavior of gastric carcinoma. RhoA and C-myc were possibly both correlated with the infiltration and metastasis of gastric carcinoma.

Objective To determine whether mutation of Hepatitis B virus (HBV) X gene is associated with hepatitis B virus-associated glomerulonephritis (HBV-GN).Methods The venous blood was collected from 50 patients with HBV-GN and 60 patients with asymptomatic HBV carriers (control group).Serum HBV DNA was extracted to determine the serum titer of HBV-DNA and then polymerase chain reaction (PCR) was used to detect the HBV X gene mutation.Results (1)There were not statistical significance between age and gender in HBV-GN group and control group (P ＞0.05).There were not statistical significance of serum replication level of HBV DNA in HBV-GN with X gene mutation and control group (P ＞ 0.05).Urine protein excretion in HBV-GN group with or without X gene mutation was found with statistical significance (P ＜ 0.05).(2)Nucleotide mutations [84％ (42/50)] resulted in amino acid substitution in HBV-GN.Nucleotide mutations changed in transfunction control region of X gene,including position nt1653,nt1726,nt1727,nt1730,nt1753,nt1762 and nt1764.(3)Nucleotide mutations [8％(5/60)] resulted in amino acid substitution in control group.Nucleotide mutations changed in position nt1632 and nt1635,located in non-functional region.Conclusions HBV X gene mutations and the subsequent amino acid substitutions are found in HBV-GN.The urine protein excretion level increases in patients with X mutation,suggesting that these mutations may play an important role in the pathogenesis of HBV-GN.

Objective To evaluate the effect of MRI in reflecting the pathological changes of VX2 carcinoma in rabbits after radiofrequency ablation (RFA) . Methods RFA was performed in the livers of 24 rabbits with planted VX2 carcinoma. The rabbits were divided into 4 groups. After RFA, the rabbits were killed after MR imaging on 0, 1, 2, and 4 weeks, respectively. The correlation between MRI and pathological findings was analyzed. Results In the acute phase, coagulative necrosis of the ablated tumors and inflammatory reaction with hyperemia around were detected at microscopic examination. The ablated tumor showed as hypointensity on T1WI and hyperintensity on T2WI, while rim of high signal intensity on T1WI and low signal intensity on T2WI was found. Gadolinium-enhanced MRI showed a thin high signal rim surrounding the central coagulative necrosis. In the subacute phase, extensive coagulative necrosis and marked infiltration by neutrophils, lymphocytes, macrophages and a peripheral fibrous generation rim were observed microscopically on the ablated tumor. The ablated tumor showed iso-or hyperintensity on T1WI and hypointensity on T2WI, while the periphery of ablated lesions was hypointensity on T1WI and hyperintensity on T2WI. There was prominent rim enhancement along the ablated margin. In the chronic phase, peripheral fibrous rim became obvious, more regular and thicker than at subacute phase as hypointensity on T1WI and T2WI, and unenhancement was observed. Residual or recurrence of tumor was found in 17 rabbits as hypointensity on T1WI and hyperintensity on T2WI, and irregular, thicker rim or nodular enhancing abnormalities. Conclusion MRI can effectively show the histopathological tissue changes of rabbit VX2 carcinoma after ablation and demonstrate the residual or recurrence of tumor.