The reform of payment based on disease diagnosis related grouping (DRG) is an important measure to deepen the medical security system. Its implementation will have a profound impact on the operation and management of public TCM hospitals from four aspects: medical service efficiency, cost, quality, and medical resource allocation. At the same time, there are also difficulties in reform, such as the contradiction between personalized diagnosis and treatment in TCM and standardized payment in DRG 2.0, compatibility issues between TCM medical record data and DRG 2.0 grouping system, limitations of special case negotiation mechanism, and difficulty in cost control and accounting. In response, this study formulated targeted strategies and recommendations intended to facilitate the effective implementation of the DRG 2.0 payment system, and bolster the operational and administrative efficacy of public TCM hospitals, culminating in a favorable scenario of tripartite synergy among "healthcare providers, insurers, and patients".

OBJECTIVE To observe the changes of cardiac function,local inflammation level and macrophage M2 polarization in mice with acute myocardial infarction(AMI after electroacupuncture preconditioning at the Neiguan point,and to explore the possible mechanisms from the perspective of regulating the DNA-PK/Rictor/Myc signaling pathway.METHODS Male C57BL/6J mice were randomly divided into sham group,model group and electroacupuncture group,with 10 mice in each group.The electroacupuncture group received bilateral electroacupuncture interventions at the Neiguan points,sparse-dense wave,2/15 Hz,1 mA,20 min/time,once a day for 3 consecutive days,and AMI models were performed 0.5 h after the electroacupuncture interventions.The myocardial ischemia model was prepared by ligating the left anterior descending branch.Echocardiography was used to detect cardiac ejection frac-tion(EF and fractional shortening(FS to evaluate cardiac function;HE and TUNEL staining were used to observe the pathological morphology of myocardium and apoptosis of cardiomyocytes,and immunohistochemistry and ELISA were used to detect IL-1β,TNF-α and NLRP3 in infarcted myocardium and peripheral blood to evaluate the level of inflammation;flow cytometry was used to detect cardiac macrophage polarization status,and Western blot method to detect the protein expression levels of DNA-PK,p-DNA-PK,Rictor and Myc in infarcted myocardium.RESULTS Compared with the sham group,the model group showed significantly lower EF and FS(P<0.000 1,significant inflammatory cell infiltration,significantly higher cardiomyocyte apoptotic index(P<0.001,up-regulated expression of IL-1β,NLRP3 and TNF-α in the myocardium and serum(P<0.01,P<0.001,a significant increase in the percentage of macrophages(P<0.001,a decrease in the percentage of cardiac M2-type macrophages(P<0.000 1,and a significant decrease in the expression levels of p-DNA-PK,Rictor and Myc proteins in myocardium(P<0.05,P<0.000 1.Compared with the model group,EF and FS were significantly higher in the electroacupuncture group(P<0.000 1,inflammatory cell infiltration was re-duced,cardiomyocyte apoptotic index was decreased(P<0.01,and the expression of IL-1β,NLRP3 and TNF-α was down-regula-ted in myocardium and serum(P<0.05,P<0.01,P<0.001;the macrophage percentage was decreased(P<0.05,cardiac M2-type macrophage percentage was increased(P<0.01,and p-DNA-PK,Rictor and Myc protein expression was enhanced in myocardium(P<0.05,P<0.01,P<0.000 1.CONCLUSION Electroacupuncture preconditioning may promote macrophage M2 polarization,attenuate local inflammation,and reduce cardiomyocyte apoptosis by modulating the DNA-PK/Rictor/Myc signaling pathway,thus im-proving cardiac function and achieving myocardial protective effects.

Objective To evaluate the level of clinical treatment in severe stable double COPD noninvasive positive pressure ventilation (BiPAP) + tiotropium + Symbicort regimen effect. Methods 210 patients with moderate to severe COPD patients as the research object, divided into group I, group II, group III, 1 BiPAP + group with tiotropium bromide in the treatment scheme, group II Implementation of tiotropium + Symbicort treatment group enabled BiPAP + tiotropium + Symbicort. Results Group comparison indexes of pulmonary function level and lung function indexes were found in the three groups after treatment showed a rising trend comparison between groups after treatment, the levels of the indicators of lung function showed the most significant increases in group I, group II indexes of pulmonary function approximation. In group 6-MWD group with the longest distance difference index (P<0.05), group II and group I but the difference between does not have statistical significance Conclusion BiPAP + tiotropium bromide + Cr is an effective treatment for moderate and severe stable COPD, which is beneficial to improve the quality of life of patients.

Objective To investigate the effect of budesonide in the treatment of COPD and nursing intervention. Methods 200 cases of COPD patients in our hospital during the period from January 2015 to December 2016 as the object of this study, all patients were randomly divided into control group and study group, 100 patients in each group. The control group the patients using conventional methods of treatment, patients in the study group is to use budesonide treatment on the basis of conventional treatment, while giving appropriate nursing intervention were observed and compared. Results The study group patients in the treatment of lung function improvement after (P<0.05); the average hospitalization time and cough symptoms time were significantly better than the control group, and the difference is significant; the study group after nursing intervention, nursing satisfaction of patients was significantly higher than control group (P<0.05). Conclusion The use of budesonide and implement corresponding nursing intervention on the patients with COPD were treated with remarkable effect, the clinical symptoms of the patients were obviously relieved, can improve the patients' recovery and quality of life.

Objective To evaluate the toe flap repair of finger pulp defect of the clinical effects.Methods Of finger pulp defect using the first or second toe in 25 cases of free flaps, the flaps were cut size of 2.0 cm x 3.0 cm-3.5 cm x 4.5 cm, to toe at the end of artery-means the artery, subcutaneous veins-ve-nous anastomosis reconstruction of dorsal skin flap blood circulation, plantar digital nerve-refers to the inherent sensory nerve reconstruction.Results Twenty-five patients with flaps all survived, after vascular crisis occurred in 2 cases,surgical exploration and re-anastomosis of vascular survival, 3 months after flap reconstructive surgery in 12 cases.All patients were followed up for 2 months to 2 years, an average of 10 months,the fingers were satisfied with function and appearance, pulp full, two- point discrimination was 4-6 mm.Conclusion The toe plantar free flap repair of finger pulp defect may be a better clinical effects.

Objective To discuss and popularise the necessarity of no shaving-skin methoed before operation in clinical praltsce.Methods 3331 patients were divide randomly into experimental Group(1824cases) and contradistinguishly Group(1507cases).Analysis the difference betweenⅠkind kerf infectional rate of two groups after operation.Results Two groups’rate are both in normal range and below 0.5,by statistic it shows no difference. Conclusion clinical application tfter analysising for longtime and the no shaving-skin methoed before operation is considered to be both scientical and greatly practical,which could be used mdinical practice.