Objective To analyze the change of healthcare quality after the Diagnosis-Intervention Packet(DIP)payment system reform and provide evidence for improving payment system reform in China.Methods It collected discharge records of hospitalized patients with employee basic medical insurance scheme in first DIP pilot hospitals of a city from July 2017 to June 2021.It included three death-related measures and two readmission-related mea-sures,which were all risk-adjusted considering the patient mix.It used t test to compare their differences before and after the DIP reform in July 2019.Results After the risk-adjustment,mortality rate of surgical patients,mortality rate of patients in low-risk DIP groups,all-cause readmission rate within 30 days after discharge and readmission rate with the same principal diagnosis within 30 days after discharge declined 0.06 percentage points(P=0.031),0.15 percentage points(P=0.001),0.47 percentage points(P＜0.001)and 0.72 percentage points(P＜0.001),respectively.Conclusion No current evidences indicated negative impacts of the DIP payment reform on the quality of healthcare in the city.Case-based payment pilot cities should closely monitor the change of healthcare quality after the reform.

AIM: To describe and evaluate the clinical characteristics, treatment management and clinical outcomes of ceftazidime-avibactam (CZA) in the treatment of patients with multidrug-resistant gram-negative bacterial (MDR-GNB) infections. METHODS: A retrospective cohort study was performed on patients hospitalized in the Affiliated Hospital of Xuzhou Medical University from September 2019 to December 2021. Adult patients who received CZA for ≥ 72 hours consecutively were eligible for inclusion. The primary outcome was clinical failure, defined as a composite of 30-day all-cause mortality, microbiological failure and / or failure to resolve or improve signs and symptoms of infection during treatment with CZA. RESULTS: A total of 198 patients with MDR-GNB infections were described and evaluated, including 132 in the carbapenem-resistant Enterobatceriaceae (CRE) cohort and 66 in the Pseudomonas spp. cohort. The main infection sites were lung infection (92.42%), abdominal infection (10.61%), and intracranial infection (10.61%), among which 63 patients (31.82%) were positive for blood culture. Clinical failure, 30-day all-cause mortality and microbiological failure occurred in 61 (30.81%), 33(16.67%) and 11(5.56%) patients, respectively. Body mass index (BMI), acute physiology and chronic health evaluation scoring system (APACHE Ⅱ) and polymicrobial infections were positively associated with clinical outcome failureadjusted OR 1.109, 95%CI 1.017, 1.209; adjusted OR 1.071, 95%CI 1.015, 1.129; adjusted OR 2.844, 95%CI 1.391, 5.814, however, initiation of CZA within 48 hours of admission was protective (adjusted OR 0.424, 95%CI 0.205, 0.879). A total of 15 patients had adverse reactions possibly related to CZA, including 2 cases of rash, 6 cases of nausea and vomiting, and 7 cases of antibiotic-related diarrhea. CONCLUSION: CZA can be used to treat infections caused by a range of MDR-GNB, including Pseudomonas spp. and CRE.

The perception of motion is an important function of vision. Neural wiring diagrams for extracting directional information have been obtained by connectome reconstruction. Direction selectivity in Drosophila is thought to originate in T4/T5 neurons through integrating inputs with different temporal filtering properties. Through genetic screening based on synaptic distribution, we isolated a new type of TmY neuron, termed TmY-ds, that form reciprocal synaptic connections with T4/T5 neurons. Its neurites responded to grating motion along the four cardinal directions and showed a variety of direction selectivity. Intriguingly, its direction selectivity originated from temporal filtering neurons rather than T4/T5. Genetic silencing and activation experiments showed that TmY-ds neurons are functionally upstream of T4/T5. Our results suggest that direction selectivity is generated in a tripartite circuit formed among these three neurons-temporal filtering, TmY-ds, and T4/T5 neurons, in which TmY-ds plays a role in the enhancement of direction selectivity in T4/T5 neurons.
Animals ; Neurites ; Drosophila ; Neurons ; Connectome

The orbitofrontal cortex (OFC) is involved in diverse brain functions via its extensive projections to multiple target regions. There is a growing understanding of the overall outputs of the OFC at the population level, but reports of the projection patterns of individual OFC neurons across different cortical layers remain rare. Here, by combining neuronal sparse and bright labeling with a whole-brain florescence imaging system (fMOST), we obtained an uninterrupted three-dimensional whole-brain dataset and achieved the full morphological reconstruction of 25 OFC pyramidal neurons. We compared the whole-brain projection targets of these individual OFC neurons in different cortical layers as well as in the same cortical layer. We found cortical layer-dependent projections characterized by divergent patterns for information delivery. Our study not only provides a structural basis for understanding the principles of laminar organizations in the OFC, but also provides clues for future functional and behavioral studies on OFC pyramidal neurons.

Objective To analyze the correlation between thrombelastography(TEG)and coagulation, platelet count(PLT)in patients with malignant tumor.Methods Retrospectively analyzed the clinical data of 241 cases with tumor who were performed TEG,coagulation and blood test in the same day in Chongqing Cancer Institute from November 2016 to March 2017.Linear correlation and regression were carried out to an-alyze relationship among the parameters.The number of patients with positive blood clotting,PLT and TEG parameters were counted,and the χ2test was used to compare the difference between them.Using Mann-Whit-ney U test to compare the differences between multiple parameters of liver cancer,breast cancer,and pancreatic cancer.Results The R value of TEG parameters in patients with malignant tumor was positively correlated with APTT,negatively correlated with TT,DD and FDPs.K was positively correlated with APTT and TT, and negatively correlated with FIB and PLT.The relationship between α and FIB,PLT were positive,between APTT and TT were negative.MA was positively correlated with FIB and PLT,negatively correlated with TT, CI was positively correlated with FIB and PLT,and negatively correlated with APTT(P<0.05).The correla-tion between FIB,PLT and MA was the highest.And the linear regression equation of TEG parameters and coagulation indexes was obtained.The positive rate of TEG was lower than that of coagulation(P<0.05). Same certain differences of TEG and coagulation parameters were existed in liver cancer,breast cancer and pancreatic cancer patients.Conclusion TEG is significantly associated with PLT and conventional coagulation test,and the results of TEG and conventional coagulation test are consistent to a certain degree,but the overall agreement is generally not interchangeable.TEG might be play a complementary role with coagulation tests and platelet counts.And the TEG of different cancer types is not exactly the same as the coagulation parameters.

BACKGROUND: Studies have shown that OCT4, SOX2 and HIWI can express in tumor tissues. OBJECTIVE: To investigate the relationship between the expression of stem cell transcription factors SOX2 and OCT4 in esophageal squamous cell carcinoma and their clinical characteristics and prognosis. METHODS: Expression levels of SOX2 and Oct4 were detected using immunohistochemical SP method in 77 cases of esophageal squamous cell carcinoma and 40 cases of adjacent cancer tissues confirmed by pathological examination, and then the their relationship with prognosis and clinical characteristics of the patients was analyzed. RESULTS AND CONCLUSION: Significantly higher levels of SOX2 and Oct4 were found in the esophageal cancer tissues than the adjacent cancer tissues (P < 0.05). SOX2 and Oct4 were highly expressed in the esophageal cancer tissues isolated from poorly differentiated, lymph node metastasis patients (P < 0.05). During the 2-year follow-up, the median survival of patients positive for SOX2 and Oct4 was only 24 and 21 months, respectively, which was significantly lower than that of negative patients (30 and 33 months, respectively). These findings indicate that the highly expressed SOX2 and Oct4 in esophageal cancer tissues are associated with the differentiation, metastasis and prognosis of the patients with esophageal squamous cell carcinoma.

Objective:To observe the effect and influence of homocysteine and cystatin C in type 2 diabetes patients treated by Shuxuening injection combined with gliclazide. Methods: Type 2 diabetic patients were randomly divided into observation group and control group,and there were 30 cases in each group. The control group was given gliclazide hypoglycemic treatment, on the basis of the observation group to combined with Shuxuening injection. The course of treatment was 2 weeks. Efficacy , adverse drug reactions ,Ho-mocysteine ( Hcy) , Cystatin C ( CysC) and blood glucose ( FBG, PB) level change of two groups patients before and after treatment were compared. Results:The total effective rate of the observation group was 96. 67%, which was significantly higher than that of the control group (P<0. 05). After treatment,blood glucose and Hcy, CysC levels of the two groups of patients were significantly de-creased compared with before treatment (P<0. 05),and those of the observation group was much lower(P<0. 05). The incidence of adverse drug reactions between the two groups had no significant difference(P>0. 05). Conclusion:Shuxuening Injection on patients with type 2 diabetes mellitus has good curative effect, it can effectively reduce homocysteine and cystatin C levels, better control of blood glucose.

Objective To compare the effect of Acetate Sodium Potassium Magnesium Calcium and lactate ringers′ as priming solution in pediatrics with cardiopulmonary bypass (CPB) during congenital heart surgery. Methods Sixty children, aged 1-6 years, weighting 8 to 20 kg, with ASA Ⅱ to Ⅲ class and with ventricular or atrial septal defect elective , received heart surgery with CPB. They were randomly divided into two groups: the lactate ringers′ group (R) and the sodium acetate, potassium, magnesium and calcium glucose injection pre-filled group (L). Levels of artery blood gas, lactic, gluclose, electrolytes were detected at the time points of induction of anesthesia (T1), aortic cross damping (T2), stopping before (T3), and closing chest later (T4). Results Levels of the blood glucose and lactic acid in the two groups post-CPB were increased (P <0.01) at T2 and T3. Lactic acid level in group L was lower than that in group R (P < 0.05), and the blood glucose level in group L was higher than that in group R (P < 0.01). No significant difference was found in the lactic acid and blood glucose post-closing chestbetween the two groups (P > 0.05). Conclusion Sodium, potassium , magnesium , calcium and glucose injection as children CPB priming crystalloid fluid could provide energy substrate, reduce lactic acid concentration, with little effect on electrolyte and blood gas.

This paper summarized and analyzed the reforming trends in ideas,methods and contents of morphology laboratory education in basic medical school.In order to fulfill the education goals of imparting knowledge and fostering capability and quality education,we should combine the traditional and virtual methods effectively,transform the secondary status ( verifying lecture) of morphology laboratory teaching to independent subject,try to integrate the subjects of morphology,use bilingual education and cultivate scientific research ability.

This article analyzes and discusses histology's teaching mode and condition,to put forward a conceiving of altering classical modal to first experimental classes and then theoretical classes.The feasibility and expecting effect of new teaching model are concluded