Objective To analyze the causes of high-rate DRG cases and to propose effective management countermeasures to address the challenges posed by high-rate cases to the economy of hospitals and the quality of medical services.Methods Data of 6 937 high-rate cases and 120 782 normal-rate cases were analyzed using Excel 2021,and the causes of high-rate cases were analyzed in conjunction with the results of medical quality inspections.Results High-rate cases exhibit significantly higher average benchmark points and per capital hospitalization costs compared to normal cases,especially those with benchmark points exceeding 300,where the average cost reaches up to 151 906.70 yuan.The high-rate cases were concentrated in the group of complex diseases such as invasive ventilator support ≥96 hours or ECMO or total artificial heart transplantation.Conclusion The main causes of high-rate cases include complex and severe cases,operational errors of doctors and coders,over-treatment,and the practice of"under-coding with over-charging".To effectively control the number of high-rate cases,improve the quality of medical services,and alleviate the economic pressure on hospitals,the following countermeasures were proposed:improving medical insurance supporting policies,strengthening the training of medical teams,promoting the construction of information technology,formulating clinical pathways,and reinforcing medical supervision.

Objective To analyze the causes of high-rate DRG cases and to propose effective management countermeasures to address the challenges posed by high-rate cases to the economy of hospitals and the quality of medical services.Methods Data of 6 937 high-rate cases and 120 782 normal-rate cases were analyzed using Excel 2021,and the causes of high-rate cases were analyzed in conjunction with the results of medical quality inspections.Results High-rate cases exhibit significantly higher average benchmark points and per capital hospitalization costs compared to normal cases,especially those with benchmark points exceeding 300,where the average cost reaches up to 151 906.70 yuan.The high-rate cases were concentrated in the group of complex diseases such as invasive ventilator support ≥96 hours or ECMO or total artificial heart transplantation.Conclusion The main causes of high-rate cases include complex and severe cases,operational errors of doctors and coders,over-treatment,and the practice of"under-coding with over-charging".To effectively control the number of high-rate cases,improve the quality of medical services,and alleviate the economic pressure on hospitals,the following countermeasures were proposed:improving medical insurance supporting policies,strengthening the training of medical teams,promoting the construction of information technology,formulating clinical pathways,and reinforcing medical supervision.

Objective:To explore the changes in serum advanced receptor for glycation end-products (sRAGE) and neuregulin-1 (NRG-1) in patients with different conditions of H-type hypertension combined with acute ischemic stroke (AIS) and their relationship with short-term prognosis.Methods:A total of 185 patients with H-type hypertension complicated with AIS admitted to the Linyi Central Hospital from January 2020 to December 2022 were selected and included in the AIS group. According to the National Institutes of Health Stroke Scale (NIHSS) score, there were 55 cases in the mild group (≤4 points), 86 cases in the moderate group (5-20 points), and 44 cases in the severe group (>20 points); According to the improved Rankin scale score, the patients were divided into a poor prognosis group (>2 points) and a good prognosis group (≤2 points). Another 100 healthy individuals who underwent physical examinations during the same period in our hospital were selected as the control group. Enzyme linked immunosorbent assay was used to detect serum sRAGE and NRG-1 levels in subjects. The correlation between serum sRAGE, NRG-1 levels and NIHSS score in patients with H-type hypertension complicated with AIS was analyzed through Spearman test. A multivariate logistic regression model was used to analyze the influencing factors of poor short-term prognosis in patients with H-type hypertension complicated with AIS. The receiver operating characteristic (ROC) curve analysis revealed the predictive value of serum sRAGE and NRG-1 levels for poor short-term prognosis in patients with H-type hypertension complicated with AIS.Results:The serum sRAGE level in the AIS group was higher than that in the control group, while the NRG-1 level was lower than that in the control group (all P<0.05). The serum sRAGE levels of patients in the mild, moderate, and severe groups increased sequentially, while the NRG-1 levels decreased sequentially (all P<0.05). Spearman correlation analysis showed that the NIHSS score was positively correlated with serum sRAGE levels ( rs=0.847, P<0.001) and negatively correlated with serum NRG1 levels ( rs=-0.810, P<0.001) in patients with H-type hypertension and AIS. After 90 days of follow-up, the incidence of poor prognosis in 185 patients with H-type hypertension and AIS was 37.84%(70/185). Multivariate logistic regression model analysis showed that increased age, diabetes, increased NIHSS score, increased homocysteine (Hcy) and increased sRAGE were independent risk factors for poor short-term prognosis of patients with type H hypertension combined with AIS, while increased NRG-1 was an independent protective factor (all P<0.05). ROC curve analysis showed that the combined detection of serum sRAGE and NRG-1 levels predicted a poor short-term prognosis in patients with H-type hypertension and AIS, with an area under the curve (AUC) of 0.876, which was higher than the predicted values of 0.795 and 0.791 for serum sRAGE and NRG-1 levels alone (all P<0.05). Conclusions:Elevated serum sRAGE levels and decreased NRG-1 levels are closely related to worsening of the condition and poor short-term prognosis in patients with H-type hypertension and AIS. The combined detection of serum sRAGE and NRG-1 levels has high predictive value for poor short-term prognosis in patients with H-type hypertension and AIS.

Objective Conduct routine microbiological monitoring of laboratory rats and mice from vendors to provide an important basis for the scientific management of laboratory animal facility and ensure the reliability of relevant experimental data obtained from laboratory animals.Methods Taking the Department of Laboratory Animal Science of Fudan University as an example, between April 2021 and April 2023, rats and mice purchased from 7 vendors were sampled for microbiological quality according to the principle of simple random sampling on the arrival days of animal delivery. Then, surveillance tests were conducted to examine the microbiological contaminations according to the national standards of SPF laboratory animals.Results The total qualified rate was 80.36%, with 52.63% in SD rat, 82.76% in inbred mice, 86.67% in outbred mice and 86.36% in immunodeficient mice in details. The most frequent bacteria isolated were Staphylococcus aureus, Pseudomonas aeruginosa, Klebsilla pneumoniae and Rodentibacter heylii, and their detection rates were 10.76%, 3.16%, 2.53% and 0.63%, respectively. Serological assays demonstrated the highest prevalence for virus was Sendai virus, and the detection rate was 2.53%. In addition to the pathogens those must be excluded from SPF rodents, Entamoeba muris and Enterobacter spp. were also detected in inbred mice, and Klebsiella oxytoca was detected in immunodeficient mice, with the detection rates of 1.15%, 2.30% and 4.55%, respectively.Conclusion There are certain incidences of pathogen infections in laboratory rats and mice from vendors, and an efficient microbiological monitoring of laboratory animals should be implemented in animal facilities, in order to eliminate pathogen infections in laboratory animals, which is required for improving the accuracy of research results and protecting the occupational health of laboratory animal practitioners as well.

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.

Objective To investigate the correlation between the early phase insulin secretion index and 72 h continuous glucose levels in patients of impaired glucose tolerance (IGT). Methods According to repeated 75 g oral glucose tolerance test (75 g OGTT) ,62 cases were divided into 2 groups: normal glucose tolerance group (NGT group, 30 cases) and isolated impaired glucose tolerance group (IGT group, 32 cases). Insulin levels were detected and HOMA-IR,HOMA-β , ΔI30/ΔG30,AUCI were calculated. The blood glucose levels were monitored by continuous glucose monitoring system for 72 h. The characteristics of postprandial glucose excursion were studied based on peak postprandial glucose (PPC) concentration, time to PPG (Δt) , postprandial glucose excursion (PPGE) and duration of postprandial glucose excursion (DPE). They were statistically analyzed by SPSS12.0. Results The levels of PPG and PPGE were significantly higher in IGT group (P < 0.05). Δt and DPE delayed obviously in IGT group (P < 0.05). HOM A-IR in IGT group was higher than that in NGT group (1.68 ± 1.03 vs 1.15 ± 0.90, P < 0.01), Δ I30/ΔG30 and HOMA- β was significantly lower in IGT group than that in NGT group (3.85 ± 1.04 vs 6.42 ±1.05,52.97 ± 2.02 vs 55.68 ± 12.45, P < 0.01 or < 0.05). Conclusions Higher postprandial glucose levels are characteristics of IGT patients,and the function of islet β cell after glucose load is impaired more severely. The levels of FPG and 2hPG are positively correlated with insulin resistance, and negatively correlated with islet β cell function.