Objective To analyze the current status of medical services in secondary and tertiary hospitals in Shandong Province based on DRG,and to provide effective support for the implementation strategies of bidirectional referral.Methods The DRG group was used to analyze 42.348 3 million cases from 75 secondary hospitals and 69 tertiary hospitals in Shandong Province from 2019 to 2023.Experts were organized to establish standards for bidirectional referral of diseases.Results(1)35 high-frequency DRG disease groups with diagnosis,treatment ability and medical resources in secondary hospitals were selected,(2)The medical expenses and medical quality in the high-frequency DRG disease groups within secondary hospitals were lower than those in tertiary hospitals,(3)To develop standardized referral standards and programs with esophageal cancer as an example.Conclusion It is urgent to triage patients gradually and accurately through disease classification management,and formulate disease diagnosis and treatment plans and bidirectional referral standards to improve the medical quality of secondary hospitals.

Objective To analyze the current status of medical services in secondary and tertiary hospitals in Shandong Province based on DRG,and to provide effective support for the implementation strategies of bidirectional referral.Methods The DRG group was used to analyze 42.348 3 million cases from 75 secondary hospitals and 69 tertiary hospitals in Shandong Province from 2019 to 2023.Experts were organized to establish standards for bidirectional referral of diseases.Results(1)35 high-frequency DRG disease groups with diagnosis,treatment ability and medical resources in secondary hospitals were selected,(2)The medical expenses and medical quality in the high-frequency DRG disease groups within secondary hospitals were lower than those in tertiary hospitals,(3)To develop standardized referral standards and programs with esophageal cancer as an example.Conclusion It is urgent to triage patients gradually and accurately through disease classification management,and formulate disease diagnosis and treatment plans and bidirectional referral standards to improve the medical quality of secondary hospitals.

Objective Construct a scientific and reasonable evaluation index system for clinical specialties of tradi-tional Chinese medicine in Shandong Province to provide a scientific basis for improving the service capacity of clini-cal specia lties of traditional Chinese medicine.Methods Based on relevant policies and literature research,the analytic hierarchy process and Delphi expert consultation method were used to determine the index system and its weight,and 509 clinical specialties of traditional Chinese medicine capacity levels of 178 medical institutions in Shandong Province were evaluated.Results A scientific and effective evaluation index system for clinical specialty capacity of traditional Chinese medicine in Shandong Province was constructed,with 23 secondary indicators in 5 dimen-sions.It comprehensively evaluats the service capacity and management level of orthopedics and traumatology de-partments of traditional Chinese medicine class hospitals in Shandong Province,uses orthopedics and traumatology as an example.Conclusion Driven by the dynamic monitoring of the evaluation index system,improve the service ca-pacity for clinical specialties of traditional Chinese medicine,guide it to strengthen the internal construction of tradi-tional Chinese medicine,and give full play to the advantages of traditional Chinese medicine characteristics.Increase the support for clinical specialties of traditional Chinese medicine in Shandong Province,and then promote the high-quality development of traditional Chinese medicine.

Objective To investigate the influence of high + Gzenvironment on receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) messenger RNA (mRNA ) expression in the peri-implant bone tissue by an animal model. Methods Thirty New Zealand white rabbits were randomly and averagely divided into 3 control groups and 3 experimental groups corresponding to the investigation for 3 weeks ,5 weeks and 12 weeks respectively.Rabbits′ mandible incisors of both sides were extracted and im planted with 1 implant in each socket immediately.After 1 week of rest ,the experimental rabbits were exposed to high + Gzenvironment 3 times a week (Monday ,Wednesday ,Friday) ,The exposure scheme choose the + Gzprofile with 4～9 G for 10～45 s with 1 G/s onset rate and with the intervals of 1 min.The rabbits of control groups were not exposed to + Gzenvironment and normally fed.One control group and one experimental group rabbits were respectively sacrificed at the 3rd week (+Gzexposure for 2 weeks) , 5th week (+Gzexposure for 4 weeks) and 12th week (+Gzexposure for 4 weeks and normal feeding for 7 weeks) after the implanting surgery.The specimens were obtained to find the mRNA expression of RANKL and OPG by real-time polymerase chain reaction (RT-PCR) examination. Results The mRNA expression of RA NKL and OPG were the highest 3 weeks after the surgery in both groups , and then decreased gradually.The RANKL mRNA expression and the RANKL/OPG ratio of the experimental group were significantly higher than those of the control group 3 weeks after the surgery (P＜0.05).Five weeks after the surgery ,the OPG mRNA expression of the experimental group was significantlylowerthanthatofthecontrolgroup(P＜0.05),buttheRANKLmRNAexpressionand RANKL/OPG ratio were still higher than that of control group (P＜0.05).Twelve weeks after the surgery ,the differences on RANKL and OPG mRNA expressions was not obvious between two groups. Conclusions High +Gzexposure could increase the expression of RA N K L ,raise RA N K L/OPG ratio and promote bone resorption ,but may be not conducive to implant bone bonding.

Objective To investigate the influence of high + Gzenvironment on receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) messenger RNA (mRNA ) expression in the peri-implant bone tissue by an animal model. Methods Thirty New Zealand white rabbits were randomly and averagely divided into 3 control groups and 3 experimental groups corresponding to the investigation for 3 weeks ,5 weeks and 12 weeks respectively.Rabbits′ mandible incisors of both sides were extracted and im planted with 1 implant in each socket immediately.After 1 week of rest ,the experimental rabbits were exposed to high + Gzenvironment 3 times a week (Monday ,Wednesday ,Friday) ,The exposure scheme choose the + Gzprofile with 4～9 G for 10～45 s with 1 G/s onset rate and with the intervals of 1 min.The rabbits of control groups were not exposed to + Gzenvironment and normally fed.One control group and one experimental group rabbits were respectively sacrificed at the 3rd week (+Gzexposure for 2 weeks) , 5th week (+Gzexposure for 4 weeks) and 12th week (+Gzexposure for 4 weeks and normal feeding for 7 weeks) after the implanting surgery.The specimens were obtained to find the mRNA expression of RANKL and OPG by real-time polymerase chain reaction (RT-PCR) examination. Results The mRNA expression of RA NKL and OPG were the highest 3 weeks after the surgery in both groups , and then decreased gradually.The RANKL mRNA expression and the RANKL/OPG ratio of the experimental group were significantly higher than those of the control group 3 weeks after the surgery (P＜0.05).Five weeks after the surgery ,the OPG mRNA expression of the experimental group was significantlylowerthanthatofthecontrolgroup(P＜0.05),buttheRANKLmRNAexpressionand RANKL/OPG ratio were still higher than that of control group (P＜0.05).Twelve weeks after the surgery ,the differences on RANKL and OPG mRNA expressions was not obvious between two groups. Conclusions High +Gzexposure could increase the expression of RA N K L ,raise RA N K L/OPG ratio and promote bone resorption ,but may be not conducive to implant bone bonding.

Objective:Comparing the influence of colon cancer recurrence of laparoscopic and open operation to evaluate the safety and validity of operation.Methods:The cohort study includes 62 cases of laparoscopic and 83 cases of open colon cancer radical surgery from January 2010 to October 2012.The research aimed at comparing the effects of laparoscopic and open surgery for colon cancer recurrence by analyzing postoperative follow-up ending and GCC-mRNA & CEA.Results:There have no obvious differences in age,sex,BMI,tumor size,stage,grade,pathological types and resection range between laparoscopy and open group(P＞0.05).Postoperative 3-years recurrence of two groups have no difference (P＞0.05),but 1-year recurrence rate of laparoscopic was obviously lower than open operation (3.2％ vs 14.5％,P＜0.05).There have no obvious differences of postoperative overall survival rate and mortality(P＞0.05),but 1-year disease-free survival rate of laparoscopic group was obviously higher than laparotomy group (93.5％ vs 81.3％,P＜0.05).The postoperative GCC-mRNA and CEA positive rate of laparoscopic was significantly lower than laparotomy group.Univariable and Multivariable analysis reveals that laparoscopic colorectal cancer radical can obviously reduce the cancer recurrence within 1 year (P＜0.05).Addition,stage,aspirin and other amino acid drugs are independent risk factors of postoperative recurrence (P＜0.05).Conclusion:Laparoscopic colon cancer radical surgery is a safe and effective operation and can reduce short-term recurrence of colorectal cancer compared to open surgery.

OBJECTIVETo evaluate the clinical effectiveness and safety of Fangfeng Tongsheng Granule (FTG) in the treatment of upper respiratory infection (superficial cold and interior heat syndrome, exterior and interior excess syndrome).

METHODSA randomized, double-blinded, multi-centered, placebo-parallel-controlled clinical trial was adopted. Totally 324 patients were enrolled and assigned to two groups, 216 patients in the treatment group and 108 patients in the control group. Those in the treatment group took FTG at the daily dose of 3 g, twice per day, the therapeutic course being 3 days. Those with axillary temperature more than 37 degrees C took one more time before medication. Those in the control group took simulated agent granules the same dose and dosage as the treatment group. The effect of Chinese medical syndrome (ECMS), the rate of temperature-dropping-to-normal (RT), the time of temperature-dropping-to-normal (TT), the curative effect of single symptom (CESS) and adverse reactions were observed.

RESULTSTotally 203 completed the trial in the treatment group and 101 in the control group. In the treatment group, the cured-effective rate was 55.67% (113/ 101), the total effective rate was 93.10% (189/101), the ECMS score decreased by 9.24 +/- 4.46, while they were 5.94% (6/101), 36.63% (37/101), and 3.27 +/- 3.29, respectively in the control group (P < 0.01). The RT was 87.50% (98/112) in the treatment group and 58.49% (31/53) in the control group (P < 0.01). The TT in the treatment group was superior to that of the control group (P < 0.01). As for CESS, all of the three primary symptoms and nine secondary symptoms were improved more obviously in the treatment group than in the control group. The integral decreased obviously, showing statistical difference (P < 0.01). The decrease was more obvious in the treatment group than in the control group (P < 0.01). There was no adverse event related to FTG.

CONCLUSIONFTG was effective and safe in treating upper respiratory infection (superficial cold and interior heat syndrome, exterior and interior excess syndrome).

Adolescent ; Adult ; Aged ; Apiaceae ; Double-Blind Method ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Phytotherapy ; Respiratory Tract Infections ; drug therapy ; Treatment Outcome ; Young Adult

BACKGROUND: Skin defect is commonly repaired by autologous skin graft, but in which, it is required healthy skin provider and it probably results in scarring deformity to various extents. The successful construction and clinical application of tissue-engineered skin (TE skin) mark the major breakthrough in treatment of skin defect.OBJECTIVE: To analyze the relationship between operation method and healing rate, through repair of skin defect with TE skin, to provide experimental evidence on clinical application of TE skin.DESIGN: Randomized controlled observation was designed.SETTING: Department of Oral and Maxillofacial Surgery, Teaching-Research Room of Histology and Pathology and Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University of Chinese PLAMATERIALS: The experiment was performed in Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University, in which 6 healthy York pigs were employed, of clean grade,aged varied from 2.5 to 3 months. 3 groups were randomized, named TE whole-layer group, TE dermal and auto-epidermal group and auto-graft group, 2 pigs in each group. 8 wounds were prepared in each pig, round in shape and 50 mm in diameter, 16 wounds in each group, totally 48wounds.METHODS: ①Preparation of TE whole layer and TE true skin. ② In TE whole-layer group: The whole layer of skin was cut off from fat layeralong the drawn line. When bleeding stopped thoroughly and the wound was covered with wet physiological saline gauze, TE whole-layer skin was collected and windowing was done on the skin for drainage. Physiological saline was used to rinsed away the culture solution on the surface of TE skin, and then, the cuticular layer was upward-covered the wound, avoiding gas vacuole between cuticular layer and wound. Single-layer oleic gauze, physiological saline gauze, aseptic dry gauze and elastic sponge cushion were covered successively, about 3-5 mm in thickness each layer. After routine dressing, elastic bandage was wrapped with compression terminally. ③ TE dermal and auto-epidermal group: The whole- layer skin was cut off with same method. Thin split-thickness skin (TIS) 0.1-0.2 mm was collected with drum dermanuring machine and soaked in physiological saline. The same method was used to collect the managed TE true skin and cover it on the wound, covering immediately on autoTTS. The rest management was same as TE whole-layer group. ④ Autograft group: The whole-layer skin was cut off and the fat tissue was removed, afterwards, it was re-grafted on the auto-wound, covered with various layers of dressing and bandaged with compression. ⑤ The survival case was determined if it was discovered no infection, necrosis and scaling of grafted skin, less than 3 mm in diameter when the wound was opened for changing fresh dressing each time, otherwise, the failed case was recorded. The survival rate in each group was analyzed statistically in 4 weeks after operation.MAIN OUTCOME MEASURES: Survival situation of grafted skin in 4weeks after operation in each group.RESULTS: In 4 weeks after operation, the survival rate of grafted skin was 75% in TE whole-layer group was 87% in TE dermal and auto-epidermal group and was 94% in auto-graft group. The results were similar basically in comparison among 3 groups (x2=-2.34, P ＞ 0.05).CONCLUSION: The effect of TE skin graft on repair of skin defect is near to that of auto-epidermal graft, testifying that the repair of skin defect with TE skin is feasible.