As a practical carrier for promoting the tiered diagnosis and treatment model, the medical consor-tium is of great significance for balancing medical resources and boosting medical service efficiency. The construction of medical consortiums not only improves the accessibility of high-quality medical resources for patients, but also enhances the diagnostic and treatment level of member units. Meanwhile, it provides space for the leading hospital to adjust the structure of diseases and improve the level of discipline construction. As the core of medical insurance payment reform, DRG, through indicators such as the case mix index(CMI) and the number of diagnosis related group (DRG), provides objective and quantified data support for case management and disease structure optimization, thus effectively guiding the rational allocation of medical resources and the adjustmentof diseases and surgical types within the medical consortium. Comprehensive use of DRG evaluation indicators can construct a multidimensional medical consortium construction evaluation system, provides a clear direction for medical consortium cooperation, thereby promoting the overall healthy and sustainable development of medical consortiums and achieving a win-win situation for all parties involved. This paper, based on the "1+5+1" medical consortium cooperation model centered around Peking Union Medical College Hospital, utilizes DRG indicators to analyze the benefits for patients, member hospitals, and the leading hospital during the medical consortium construction process, with the hope of providing reference for the construction of a medical consortium evaluation system.

A 14-year-old male pediatric patient was admitted to the hospital mainly because of neck and back deformity, with limited activity for 7 yr, dysphagia and short of breath for more than 10 months.He was diagnosed with cervical lordosis deformity, RyR1 gene-related myopathy, high possibility of multi-minicore disease and being susceptible to malignant hyperthermia.Posterior cervical orthopedic internal fixation surgery was successfully performed under total intravenous anesthesia with propofol.The vital signs were stable during anesthesia and operation which lasted for 10 h. The patient was admitted to intensive care unit after the uneventful operation.When emerging from general anesthesia, the patient suddenly presented with symptoms of muscular fasciculation in the head, face, trunk and limbs, along with elevated body temperature as high as 39.4℃, severe acidosis and hypercapnia, meanwhile, the blood creatine kinase, blood myoglobin and urinary myoglobin gradually increased.The patient was diagnosed with malignant hyperthermia based on the clinical grading scale score of 63.Dantrolene sodium was infused intravenously, combined with multiple treatments such as physical cooling, correction of acidosis and electrolyte disturbance, alkalization of urine, intermittent hemofiltration and plasma exchange.The arrhythmia and delirium were treated symptomatically.The pediatric patient was fully recovered and discharged with good outcomes.

Objective:To compare clinical characteristics of orthopedic trauma patients between the patients during pandemic of corona virus disease 2019 (COVID-19) and those beyond the pandemic period and analyze the factors influencing fracture site changes during pandemic of COVID-19.Methods:A retrospective case-control study was made on data of 1 048 patients with fractures hospitalized in Third Hospital of Hebei Medical University treated from January 20, 2020 to February 25, 2020 (pandemic period group) and from January 31, 2019 to March 9, 2019 (beyond pandemic period group). There were 232 patients in pandemic period group, including 121 males (52.2%) and 111 females (47.8%), with age range of 1-100 years [(47.9±26.3)years]. There were 816 patients in beyond pandemic period group, including 454 males (55.6%) and 363 females (44.5%), with age range of 1-96 years [(47.3±23.9)years]. Fracture sites were compared between the two groups. Age, sex, occupation, cause of injury, history of basic medical diseases, location of fracture, residence, marital status and other factors among the patients with low limb fractures and other fractures in pandemic period group were analyzed using the Logistic regression analysis.Results:Incidence of limb fractures in pandemic period group (69.4%, 161/232) was significantly higher than that in beyond pandemic period group (59.8%, 488/816) ( P<0.05), while the incidence of whole-body multiple fractures in pandemic period group (8.2%, 19/232) was significantly lower than that in beyond pandemic period group (13.6%, 111/816) ( P<0.05). Univariate analysis showed that female, middle or older age, farmers, low-energy injury, basic medical disease, staying at home were risk factors for limb fracture during pandemic ( P<0.05). Multivariate Logistic regression analysis showed low-energy injury ( OR=8.264, P<0.01) was an independent risk factor for limb fracture during pandemic. Conclusions:Compared with the beyond pandemic period, some location of fracture is changed and incidence of limb fracture is increased during pandemic. Low energy injury is an independent risk factor of limb fracture during the pandemic.

Objective: To analyze the blood pressure changes of adults aged 18-59 years in rural area of Shanxi province based on a cohort study, and provide reference for the study of the blood pressure level of rural residents and hypertension prevention and control in rural areas in China. Methods: Data were obtained from Shanxi Nutrition and Chronic Disease Family Cohort from 2002 to 2015. Subjects aged <18 years or ≥60 years and individuals with hypertension at baseline survey in 2002, and those who had taken antihypertensive drugs for nearly two weeks during the follow-up survey in 2015 were excluded from the study. A total of 1 629 subjects aged 18-59 years were included in the analyses of the blood pressure level and its change from the baseline survey in 2002 to follow-up survey in 2015. Results: The systolic blood pressure (SBP) of the subjects increased from (122.7±10.4) mmHg in 2002 to (132.8±17.6) mmHg in 2015 and the diastolic pressure (DBP) increased from (72.7±6.9) mmHg in 2002 to (78.8±10.3) mmHg in 2015. The SBP in men and women increased with growth rates of 6.7% and 9.5%. While DBP in men and women increased with growth rates of 9.3% and 7.8%. The SBP levels of those aged 18-, 30-, 40- and 50-59 years increased with growth rates of 5.0%, 6.7%, 9.4% and 11.8%. While the DBP of these age groups increased with growth rates of 12.2%, 8.2%, 8.2% and 6.5%. Conclusions The blood pressure of adults aged 18-59 years old in rural area of Shanxi showed a substantially increasing trend. The mean increase level of SBP in women was higher than that in men, and increased with age. While the mean increase level of DBP in men is higher than that in women, and decreased with age.

Ultrasound-based measurement of relative blood volume can be used to assess patient's dry weight during hemodialysis. The results of relative blood volume were calculated from the ultrasonic transmission time measurement in the arteriol pot, and the accuracy of transmission time measurement is directly related to the reliability of the results of relative blood volume. There are various factors which influence the travel time, this article analyzed patients themselves, measuring device and the external factors, and advised appropriate counter measures.

Objective To observe the genetic predisposition of complement C5 gene polymorphisms in proliferative diabetic retinopathy (PDR) in Chongqing Han population.Methods 400 type 2 diabetes (T2D) patients (case group) and 600 age-and sex-matched healthy controls (control group) were enrolled in this study.There were 8 PDR patients in case group.All the subjects were Han ethnic people.The immune-related representative SNP locus of C5 gene including rs2269067,rs7040033,rs7027797 were screened by linkage disequilibrium analysis.Locus rs1017119 was selected by TagSNP and was around the above three loci.Subjects' peripheral venous blood was collected and DNA was extracted.Genotyping was examined by PCR-restriction fragment length polymorphism method.The level of C5 plasma protein was measured by enzyme-linked immunoabsorbent assay.Results The frequency of GG genotype of rs2269067 was significantly increased in PDR patients in cases group compared with controls (Pc=3.4 × 10-5,OR=1.87,95％CI=1.43-2.44;P=3.1 × 10-6).There was no differences in frequency of G,CC and CG genotype of rs2269067 between two groups (P=1.4 × 10-4,1.000,1.0 × 10-6).There were no differences in frequency of G,CC,CG,GG genotype of rs7040033,rs1017119,and rs7027797 between two groups (P＞0.05).The production of C5 plasma protein was significantly increased in case group as compare with control group (P=0.0004).An increased production of C5 plasma protein was observed in rs2269067 GG genotype cases compared to CG or CC cases (P=0.003,0.001).Conclusion C5 rs2269067 GG genotype may be associated with the PDR of T2D in Chongqing Han population.

Objective To evaluate the effect of ischemic postconditioning on myocardial injury in the patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Thirty patients of both sexes,aged 21-59 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ),with left ventricular ejection fraction ≥ 40％,scheduled for elective cardiac valve replacement under CPB,were divided into 2 groups (n=15 each) using a random number table:control group (C group) and ischemic postconditioning group (P group).In group P,ischemic postconditioning was induced by 3 cycles of 30 s aortic unclamping followed by 30 s cross-clamping starting from 5 min before complete opening of the ascending aorta.After induction of anesthesia and before operation (T1),at 1 h after opening of the ascending aorta (T2),at the end of operation (T3),and at 12,24 and 48 h after opening of the ascending aorta (T4-6),blood samples were taken from the radial artery for determination of plasma concentrations of heart-type fatty acid-binding protein (H-FABP),ischemia-modified albumin (IMA),and cardiac troponin Ⅰ (cTnI).Myocardial specimens in the right auricle were obtained at T2,and the pathological changes were examined using an optical microscope.Results The concentrations of plasma cTnI at T2-6 and H-FABP and IMA at T2-5 were significantly higher than those at T1 in the two groups (P＜0.05).Compared with group C,the concentrations of plasma cTnI at T2-6,H-FABP at T2-4,and IMA at T2,3 were significantly decreased (P＜0.05),and the pathological changes of myocardial tissues were significantly reduced in group P.Conclusion Ischemic postconditioning can reduce myocardial injury in the patients undergoing cardiac valve replacement under CPB.

Objective To explore the effects of hand hygiene management on hand washing compliance of staff members and infection rates in Burn Unit.Methods From April 201 5 to October 201 5,40 staffs in Burn Unit received the hand hygiene management intervention,including perfecting facilities of hand hygiene, carrying out propaganda and standardizing the supervision,and so on.The hand washing compliance of staffs and infection rates in burn unit were observed before and after interventions.Results Before interventions,the hand hygiene compliance of doctors,nurses,nursing assistants,cleaning workers were 41 .5%,45.7%, 31 .0%,29.0%,lower than 88.8%,91 .7%,74.9%,68.8% after the interventions,and all staffs improved the compliance of hand hygiene (P <0.01 ).Before and after interventions,the compliance in doctors and nurses was higher than that of caregiver and cleaner (P <0.01 ).The hospital infection rate was reduced from 1 3.2% before interventions to 6.8% after interventions(P <0.05 ).Conclusions To make effective hand hygiene management measures can improve the hand hygiene compliance of staffs in Burn Department and effectively reduce the hospital infection rate.

OBJECTIVE:To study the purification technology of total flavonoids from Nelumbinis receptaculum by macropo-rous resin. METHODS:Using adsorption rate and desorption rate of total flavonoids from Nelumbinis receptaculum as index,the type of macroporous resin was selected by static adsorption-desorption tests;With adsorption rate of total flavonoids as index,sin-gle factor test was used to investigate the effects of the concentration of total flavonoids,adsorption time,adsorption speed, drug-loading amount,water amount,volume fraction and amount of eluant and other factors on the purification technology. The op-timal technology was validated. RESULTS:Among 10 kinds of resin,HPD-400 macroporous resin was found to have the best ad-sorption and desorption effects. The optimal purification conditions was as follows as the concentration of total flavonoids 7.00 mg/ml, adsorption time of 3 h,flow rate for sampling of 3 column volume (BV)/h,drug-loading amount of 8 BV,water amount of 6 BV,50% ethanol elution amount of 4 BV. In validation test,mass fraction of total flavonoids from purified Nelumbinis receptacu-lum were 63.88%,62.50% and 63.44%(RSD=1.11%,n=3). CONCLUSIONS:HPD-400 macroporous resin could purify total flavonoids from purified Nelumbinis receptaculum,and established purification technology is stable and practical.

This paper reports the diagnosis and therapy of one case of Dipylidium caninum infection in an infant.