As the reform of the medical and health system continues to advance,cost accounting plays a crucial role in the efficient operation of public hospitals.In the context of the full-cost accounting implementation,it takes the work practice of a hospital as case study,in constructing an integrated system of full-cost accounting as a reference to explore the specific implementation path of full-cost accounting in public hospitals under the background of the new health care reform,and to provide new ideas and methods for public hospitals in China to carry out full-cost accounting work.The implementation of full-cost accounting in public hospitals promotes the transformation of public hospitals from the original revenue-centered episodic scale development to the connotative development centered on refined cost management,promotes the improvement of the overall operational efficiency of hospitals,helps to enhance the management effectiveness and comprehensive competitiveness of hospitals,and finds a new way out of the reform in order to promote the high-quality development of public hospitals.

As the reform of the medical and health system continues to advance,cost accounting plays a crucial role in the efficient operation of public hospitals.In the context of the full-cost accounting implementation,it takes the work practice of a hospital as case study,in constructing an integrated system of full-cost accounting as a reference to explore the specific implementation path of full-cost accounting in public hospitals under the background of the new health care reform,and to provide new ideas and methods for public hospitals in China to carry out full-cost accounting work.The implementation of full-cost accounting in public hospitals promotes the transformation of public hospitals from the original revenue-centered episodic scale development to the connotative development centered on refined cost management,promotes the improvement of the overall operational efficiency of hospitals,helps to enhance the management effectiveness and comprehensive competitiveness of hospitals,and finds a new way out of the reform in order to promote the high-quality development of public hospitals.

Objective:To analyze the screening results for chronic obstructive pulmonary disease (COPD) among residents aged 40 years and above in Shanghai Jiading Town, and to explore the influencing factors of COPD.Methods:The study was a cross-sectional study. Four hundred residents aged 40 years and above in Jiading Town were selected to attend COPD screening by multi-stage stratified random sampling method from 10 to 18 July, 2023. Information on demographic characteristics, disease history and family history, disease behavior and risk factors were collected by a questionnaire survey. Physical examination and pulmonary function tests were performed for all participants. Patients showing<70% FEV 1/FVC in pulmonary function and excluded of other cardiorespiratory diseases were diagnosed as the COPD. The SPSS 25.0 software was used for statistical analysis; and logistic regression was used to analyze the related factors of COPD. Results:There were 166 (41.5%) males and 234 (58.5%) females in the participants. The results of screening showed that 181 (45.3%) individuals were identified as high risk of COPD and 32 cases of COPD was diagnosed with a prevalence rate of 8.0%. The prevalence rate of COPD in males were significantly higher than that in females ( P<0.05). There were no significant differences in the age ( P=0.993), education level ( P=0.158), body mass index ( P=0.776), and waist-to-hip ratio ( P=0.833) between COPD patients and non-COPD participants. Logistic regression analysis showed that frequent coughing at 14 years of age and before ( OR=7.763, 95% CI: 2.898-20.791, P<0.05), Hospitalization for pneumonia or bronchitis at or before 17 years of age ( OR=4.359, 95% CI: 1.343-14.1462, P<0.05), asthma ( OR=11.800, 95% CI: 2.001-69.573, P<0.05), chronic bronchitis ( OR=72.748, 95% CI: 20.501-258.144, P<0.05), emphysema ( OR=23.600, 95% CI: 1.407-395.756, P<0.05),and other respiratory diseases, immediate family members with chronic bronchitis ( OR=6.112, 95% CI: 1.960-19.058, P<0.05) and family history of COPD ( OR=100.920, 95% CI: 14.625-696.390, P<0.05), smoking behavior ( OR=7.017, 95% CI: 2.605-18.906, P<0.05), living with daily smokers ( OR=35.481, 95% CI: 1.609-782.310, P<0.05), and second-hand smoking ( OR=3.448, 95% CI: 1.271-9.352, P<0.05) were independent risk factors for the development of COPD. Conclusion:The study shows the prevalence of COPD and related risk factors in residents over the age of 40 in Shanghai Jiading town, indicating that more attention should be paid for high risk population in COPD screening.

Objective:We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods:This was a multicenter, retrospective, observational cohort study, including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1, 2015 to June 30, 2018. Baseline characteristics, histopathological data and nutritional status, as assessed using Nutrition Risk Screening 2002 (NRS 2002) score and the scored Patient-Generated Subjective Global Assessment, were collected. The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model. Internal and external validations were performed.Results:There were 681 and 127 patients in the training and validation cohorts, respectively. A total of 188 deaths were observed over a median follow-up period of 59 (range: 58 to 60) months. Two independent predictors of NRS 2002 and Tumor-Node-Metastasis (TNM) stage were identified and incorporated into the prediction nomogram model together with the factor of age. The model's concordance index for 1-, 3- and 5-year overall survival was 0.696, 0.724, and 0.738 in the training cohort and 0.801, 0.812, and 0.793 in the validation cohort, respectively.Conclusions:In this study, a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer. This model has good differentiation, calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

Objective:To investigate the effect of cesarean scar defect and endometrial cavity fluid on the pregnancy outcomes of infertility patients with previous cesarean scar uterus undergoing in vitro fertilization-embryo transfer (IVF-ET). Methods:This was a retrospective cohort study. Totally 732 cases of patients with previous cesarean scar uterus were selected from frozen-thawed embryo transfer (FET) cycles in the Fertility Center, Shenzhen Zhongshan Urology Hospital from January 2019 to March 2020. They were divided into four groups: group A ( n=39) including patients with previous cesarean scar defect and without endometrial cavity fluid; group B ( n=82) including patients with previous cesarean scar defect and with endometrial cavity fluid; group C ( n=495) including patients without previous cesarean scar defect and without endometrial cavity fluid; group D ( n=116) including patients without previous cesarean scar defect and with endometrial cavity fluid. The general data and pregnancy outcomes were compared among these groups. Multivariate logistics regression analysis of pregnancy outcome indexes was performed. Results:The transplantation age of group A was higher than that of group B [(38.33±3.55) years vs. (36.93±3.59) years, P=0.045], the endometrial thickness of luteal transformation day and the rate of good-quality embryo transplantation of group C were higher than those of group D [(9.40±1.56) mm vs. (9.03±1.59) mm, P=0.025; 75.76% (375/495) vs. 65.52% (76/116), P=0.024]. The egg retrieval age of group A was higher than that of group C [(37.72±3.55) years vs. (36.25±4.52) years, P=0.049], but the endometrial thickness of luteal transformation day was thinner [(8.74±1.58) mm vs. (9.40±1.56) mm, P=0.012], and the differences were statistically significant. The implantation rate, the biochemical pregnancy rate and the clinical pregnancy rate of group C were higher than those of group D [34.23% (230/672) vs. 22.58% (35/155), P=0.007; 48.28% (239/495) vs. 37.93% (44/116), P=0.044; 42.83% (212/495) vs. 30.17% (35/116), P=0.012]. The early abortion rate in group D was higher than that in group B [40.00% (14/35) vs. 17.24 % (5/29), P=0.047], the difference was statistically significant. Multivariate logistics regression analyses were used with adjustment for possible confounders: the maternal age at embryo transfer, the maternal age at egg retrieval, anti-Müllerian hormone (AMH),antral follicle count (AFC), basic follicle-stimulating hormone (FSH), endometrial CD138 results, FET protocol, and embryo attributes, the number of embryos transferred, embryo quality, the endometrial thickness and the progesterone value on the day of luteal transformation, the result showed that the implantation rate, the biochemical pregnancy rate and the clinical pregnancy rate of group D were lower than those of group C [22.58% (35/155) vs. 34.23% (230/672), P=0.006; 37.93% (44/116) vs. 48.28% (239/495), P=0.047; 30.17% (35/116) vs. 42.83% (212/495), P=0.022] and the differences were statistically significant. The implantation rate, the biochemical pregnancy rate and the clinical pregnancy rate of group B were higher than those of group D [29.52% (31/105) vs. 22.58% (35/155), P=0.049; 48.78% (40/82) vs. 37.93% (44/116), P=0.012; 35.37% (29/82) vs. 30.17% (35/116), P=0.030] and the differences were statistically significant. Conclusion:Endometrial cavity fluid is the main factor that obviously affects the pregnancy outcome of infertility patients with previous cesarean scar uterus undergoing FET cycles.

Objective:To investigate the effect of cesarean scar defect and endometrial cavity fluid on the pregnancy outcomes of infertility patients with previous cesarean scar uterus undergoing in vitro fertilization-embryo transfer (IVF-ET). Methods:This was a retrospective cohort study. Totally 732 cases of patients with previous cesarean scar uterus were selected from frozen-thawed embryo transfer (FET) cycles in the Fertility Center, Shenzhen Zhongshan Urology Hospital from January 2019 to March 2020. They were divided into four groups: group A ( n=39) including patients with previous cesarean scar defect and without endometrial cavity fluid; group B ( n=82) including patients with previous cesarean scar defect and with endometrial cavity fluid; group C ( n=495) including patients without previous cesarean scar defect and without endometrial cavity fluid; group D ( n=116) including patients without previous cesarean scar defect and with endometrial cavity fluid. The general data and pregnancy outcomes were compared among these groups. Multivariate logistics regression analysis of pregnancy outcome indexes was performed. Results:The transplantation age of group A was higher than that of group B [(38.33±3.55) years vs. (36.93±3.59) years, P=0.045], the endometrial thickness of luteal transformation day and the rate of good-quality embryo transplantation of group C were higher than those of group D [(9.40±1.56) mm vs. (9.03±1.59) mm, P=0.025; 75.76% (375/495) vs. 65.52% (76/116), P=0.024]. The egg retrieval age of group A was higher than that of group C [(37.72±3.55) years vs. (36.25±4.52) years, P=0.049], but the endometrial thickness of luteal transformation day was thinner [(8.74±1.58) mm vs. (9.40±1.56) mm, P=0.012], and the differences were statistically significant. The implantation rate, the biochemical pregnancy rate and the clinical pregnancy rate of group C were higher than those of group D [34.23% (230/672) vs. 22.58% (35/155), P=0.007; 48.28% (239/495) vs. 37.93% (44/116), P=0.044; 42.83% (212/495) vs. 30.17% (35/116), P=0.012]. The early abortion rate in group D was higher than that in group B [40.00% (14/35) vs. 17.24 % (5/29), P=0.047], the difference was statistically significant. Multivariate logistics regression analyses were used with adjustment for possible confounders: the maternal age at embryo transfer, the maternal age at egg retrieval, anti-Müllerian hormone (AMH),antral follicle count (AFC), basic follicle-stimulating hormone (FSH), endometrial CD138 results, FET protocol, and embryo attributes, the number of embryos transferred, embryo quality, the endometrial thickness and the progesterone value on the day of luteal transformation, the result showed that the implantation rate, the biochemical pregnancy rate and the clinical pregnancy rate of group D were lower than those of group C [22.58% (35/155) vs. 34.23% (230/672), P=0.006; 37.93% (44/116) vs. 48.28% (239/495), P=0.047; 30.17% (35/116) vs. 42.83% (212/495), P=0.022] and the differences were statistically significant. The implantation rate, the biochemical pregnancy rate and the clinical pregnancy rate of group B were higher than those of group D [29.52% (31/105) vs. 22.58% (35/155), P=0.049; 48.78% (40/82) vs. 37.93% (44/116), P=0.012; 35.37% (29/82) vs. 30.17% (35/116), P=0.030] and the differences were statistically significant. Conclusion:Endometrial cavity fluid is the main factor that obviously affects the pregnancy outcome of infertility patients with previous cesarean scar uterus undergoing FET cycles.

Objective To analyze the prognostic factors in patients with initially diagnosed bone-only metastatic nasopharyngeal carcinoma (NPC). Methods We collected the data of 68 patients with initially diagnosed bone-only metastatic NPC admitted to The Affiliated Tumor Hospital of Shantou University Medical College from 1997 to 2015. Forty-nine patients received chemoradiotherapy. The Kaplan-Meier method was used to calculate the overall survival rate;the log-rank test was used for univariate prognostic analysis;the Cox model was used for multivariate prognostic analysis. Results The median follow-up was 953 months. The 1-, 2-, 3-, and 5-year overall survival ( OS) rates were 53%, 38%, 21%, and 15%, respectively. The median OS time was 134 months. The univariate prognostic analysis showed that spinal metastases, the number of bone metastases, lactic dehydrogenase level before treatment, the radiotherapy technology and dose for primary tumor, and the short-term outcome of primary tumor were associated with OS ( P=002, 001, 000, 002, 002, 001 ) . The multivariate prognostic analysis showed that ≤3 bone metastases, dose to primary tumor>65 Gy, and intensity-modulated radiotherapy ( IMRT) were favorable prognostic factors for OS ( P=003,002,004) . Conclusions For patients with initially diagnosed bone-only metastatic NPC, active treatment ( IMRT, dose to primary tumor>65 Gy) should be considered for those with ≤3 bone metastases to achieve a complete response of primary tumor.

OBJECTIVE To study the morphology, immunology, cyto- and molecular genetics of a patient with lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM), deletion of P53 gene and rearrangement of clonal T cell receptors-delta (TCR-delta) gene. METHODS The cell morphology and immunocytochemistry were analyzed by bone marrow testing and biopsy. Cellular immunology was analyzed by flow cytometry. Genetic analysis was carried out by chromosome karyotyping, fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR). Immunoglobulin M (IgM) in serum and urine was assayed by immunofixation electrophoresis. And the effect of chlorambucil therapy was evaluated. RESULTS Bone marrow biopsy suggested that the patient was of B lymphocyte type and had abnormal increase of lymphocytoid plasma cells, which were CD38 and CD138 positive. The patient had a normal male karyotype. FISH and PCR analysis of peripheral blood samples suggested deletion of P53 gene and rearrangement of TCR-delta gene. Immunofixation electrophoresis has detected IgM-kappa in both serum and urine. The patient showed partial response to chlorambucil. CONCLUSION In addition to typical clinical features, bone marrow examination, flow cytometry, histochemistry and immunophenotyping, testing for P53 gene deletion and lymphocyte gene rearrangement can facilitate the diagnosis and treatment of LPL/WM.
Aged ; Gene Rearrangement, delta-Chain T-Cell Antigen Receptor ; Genes, p53 ; Humans ; In Situ Hybridization, Fluorescence ; Male ; Polymerase Chain Reaction ; Waldenstrom Macroglobulinemia ; drug therapy ; genetics

Objective To investigate the influential factors on congenital gastrointestinal malformation and to provide evidences for prevention.Methods A hospital-based case-control study was conducted among infants with or without congenital gastrointestinal malformation at Children's hospital of Hunan province,from April 2011 to August 2012.Parents of 120 cases with congenital gastrointestinal malformation and another 170 controls were asked to fill in a questionnaire.Data was analyzed using SPSS 18.0 software.Results Congenital gastrointestinal malformation was associated with intakes of maternal medication (OR=3.35,95％CI:1.51-7.41) and folic acid (OR=0.28,95％CI:0.15-0.52),exposure to paints (OR=5.05,95％CI:1.32-19.29) and pesticides (OR=15.20,95％CI:1.55-148.99) prior to or during pregnancy,and also associated with medication intake of the father (OR=3.70,95％CI:1.13-12.10),smoking (OR=2.39,95％CI:1.24-4.62),drinking alcohol (OR=2.47,95％CI:1.20-5.07),exposure to the agents for indoor cleaning (OR=16.42,95％ CI:1.71-157.92) and exposure to paints (OR=9.92,95％ CI:2.66-36.98) before conception.Conclusion Congenital gastrointestinal malformation was affected by multiple factors.Potential risk factors for congenital gastrointestinal malformation would include intakes of medication by the pregnant mother,exposure to paints exposure and pesticide exposure before or during pregnancy,and medication intake by the father,smoking,drinking alcohol,exposure to indoor cleaning agents/paint before conception.The amount of folic acid intake by mother before or during pregnancy was likely to reduce the risk for congenital gastrointestinal malformation.