Jiangsu Provincial People's Hospital takes the reform of DRG payment method as an opportunity,based on the theory of incentive behavior,uses literature research,expert consultation,and key performance indicator methods to develop evaluation indicators,and applies PDCA management tools to establish a continuously improving medical insurance service quality evaluation system.It introduces the process of medical insurance service quality evaluation system construction and its application in medical insurance performance management,and analyzes the implementation effect:DRG operation is improving,disease group structure is optimized,medical quality and efficiency continue to improve,and medical service evaluation scores are improving.

Objective:To investigate the impact of donor human leukocyte antigen (HLA) -Bw4 expression on natural killer (NK) cell reconstitution and transplant outcomes in recipients undergoing haploidentical hematopoietic stem cell transplantation (HSCT) from maternal or related donors without ex vivo T-cell depletion.Methods:This study prospectively enrolled 32 patients who received T-replete haploidentical HSCT from maternal or collateral donors (cohort 1) to evaluate the facilitating effect of donor HLA-Bw4 expression on NK cell reconstitution. Furthermore, a retrospective analysis was conducted on 278 patients who underwent T-replete haploidentical HSCT from maternal or collateral donors (cohort 2) to analyze the impact of donor HLA-Bw4 expression on HSCT outcomes. Thus, a comparison was made between the effects of donor HLA-Bw4 expression on HSCT outcomes in patients receiving or not receiving post-transplant cyclophosphamide (PT-Cy) conditioning.Results:Donors expressing HLA-Bw4 alleles facilitated NK cell reconstitution and functional recovery, which remained unaffected by PT-Cy. Donors with HLA-Bw4 expression were associated with reduced transplant-related mortality (TRM), particularly mortality related to infections. The use of PT-Cy did not impact the ability of donor HLA-Bw4 to decrease TRM.Conclusion:In haploidentical HSCT from maternal or related donors without ex vivo T-cell depletion, the presence of donor HLA-Bw4 expression promotes rapid NK cell reconstitution and functional recovery and is significantly associated with lower TRM, especially infection-related mortality. These findings underscore the clinical significance of donor HLA-Bw4 expression in patients who underwent HSCT. Hence, the consideration of donor HLA-Bw4 in recipient selection and HSCT strategies holds important clinical implications.

OBJECTIVES: With the increasing detection rate of lung nodules, the qualitative problem of lung nodules has become one of the key clinical issues. This study aims to evaluate the value of combining dynamic contrast-enhanced (DCE) MRI based on time-resolved imaging with interleaved stochastic trajectories-volume interpolated breath hold examination (TWIST-VIBE) with T₁ weighted free-breathing star-volumetric interpolated breath hold examination (T₁WI star-VIBE) in identifying benign and malignant lung nodules. METHODS: We retrospectively analyzed 79 adults with undetermined lung nodules before the operation. All nodules of patients included were classified into malignant nodules (n=58) and benign nodules (n=26) based on final diagnosis. The unenhanced T₁WI-VIBE, the contrast-enhanced T₁WI star-VIBE, and the DCE curve based on TWIST-VIBE were performed. The corresponding qualitative [wash-in time, wash-out time, time to peak (TTP), arrival time (AT), positive enhancement integral (PEI)] and quantitative parameters [volume transfer constant (Ktrans), interstitium-to-plasma rate constant (Kep), and fractional extracellular space volume (Ve)] were evaluated. Besides, the diagnostic efficacy (sensitivity and specificity) of enhanced CT and MRI were compared. RESULTS: There were significant differences in unenhanced T₁WI-VIBE hypo-intensity, and type of A, B, C DCE curve type between benign and malignant lung nodules (all P<0.001). Pulmonary malignant nodules had a shorter wash-out time than benign nodules (P=0.001), and the differences of the remaining parameters were not statistically significant (all P>0.05). After T₁WI star-VIBE contrast-enhanced MRI, the image quality was further improved. Compared with enhanced CT scan, the sensitivity (82.76% vs 80.50%) and the specificity (69.23% vs 57.10%) based on MRI were higher than that of CT (both P<0.001). CONCLUSIONS T₁WI star-VIBE and dynamic contrast-enhanced MRI based on TWIST-VIBE were helpful to improve the image resolution and provide more information for clinical differentiation between benign and malignant lung nodules.
Adult ; Humans ; Retrospective Studies ; Magnetic Resonance Imaging ; Plasma ; Tomography, X-Ray Computed ; Lung

Background Occupational stress and depressive symptoms of disease prevention and control personnel are serious. Objective To investigate the relationship between occupational stress, psychological capital, and depressive symptoms of disease prevention and control personnel, and analyze the potential mediating effect of psychological capital on the relationship between occupational stress and depressive symptoms. Methods From July to September 2020, a cluster random sampling method was used to select 2201 employees from 21 centers for disease control and prevention as study subjects covering all levels of administrative divisions in Jiangsu Province. A total of 2036 valid questionnaires were collected with a recovery rate of 92.5%. The Core Occupational Stress Scale, Patient Health Questionnaire, and Psychological Capital Questionnaire were used to investigate their occupational stress, depressive symptoms, and psychological capital. Stratified regression analysis was used to explore the effects of occupational stress and psychological capital on depressive symptoms. A mediating effect model was used to analyze and verify the potential mediating effect of psychological capital on the relationship between occupational stress and depressive symptoms. Results The total scores in M (P₂₅, P₇₅) of occupational stress, depressive symptoms, and psychological capital in the target population were 42.0 (37.0, 48.0), 8.0 (4.0, 9.0), and 4.6 (4.0, 5.0) respectively. The positive rate of occupational stress was 31.0% (631/2036), and the positive rate of depressive symptoms was 22.0% (448/2036). The dimensional scores of organization and reward, and demand and effort of occupational stress were positively correlated with the total score of depressive symptoms [Spearman correlation coefficients (r_s) were 0.371 and 0.269, P<0.05]. The dimensional scores of social support and autonomy of occupational stress and the score of psychological capital were negatively correlated with the total score of depressive symptoms (r_s=−0.373, −0.112, −0.494, P<0.05). The organization and reward, and demand and effort had positive effects on depressive symptoms (b=0.188, 0.177, P<0.05), while social support and autonomy had negative effects on depressive symptoms (b=−0.290, −0.078, P<0.05), and associated with a 22.5% increase of explanatory variance. Psychological capital had a negative effect on depressive symptoms (b=−0.368, P<0.05), and associated with an 11.0% increase of explanatory variance. Psychological capital had mediating effects on the associations of social support, organization and reward, and autonomy with depressive symptoms, and the mediating effect values were −0.210 (95%CI: −0.253-−0.171), 0.096 (95%CI: 0.071-0.122), and −0.164 (95%CI: −0.229-−0.103), respectively. The corresponding mediating effect percentages were 40.23%, 26.97%, and 45.56%, respectively. Conclusion Occupational stress of disease prevention and control personnel can directly affect depressive symptoms, but also indirectly through psychological capital. Psychological capital plays a partial mediating role in the associations of social support, organization and reward, and autonomy of occupational stress with depressive symptoms. The occurrence of depressive symptoms can be reduced by decreasing occupational stress and increasing psychological capital.

Objective:To establish a multicriteria value assessment index system, so as to provide reference for hospitals access of medical consumables.Methods:In May 2021, based on the paper previously published, the expert consultation method was used to finalize the index structure, index definitions and scoring standards, along with an importance grading of the indexes. And the index weights were calculated using the analytical hierarchy process. Then the assessment scale was designed by way of multi-criteria decision analysis and mini-HTA. With the linear cutting stapler used as an example, six clinicians, three hospital administrators and the medical consumable management committee made an empirical analysis and evaluation of its general value. The coefficient of variation and Kendall coefficient of concordance were used to test the consistency of clinicians′ scores.Results:Three rounds of expert consultations finalized an index structure with 4 level-1 and 11 level-2 indexes, and on such basis a multicriteria value assessment index system for hospital access of medical consumables was established. This system comprised the clinician evaluation scale, hospital administrator evaluation scale and medical consumable management committee evaluation scale. The first two of which were used for preliminary screening, and the third for a full-scale, detailed and quantitative evaluation of those selected, hence a decision was made in the end according to the weighted sum of the three scales. This scale system was used to evaluate a foreign brand and a domestic brand of linear cutting staplers, while the former and the latter scored 90.5 and 75.4 respectively. Statistical analysis of the six clinicians found a coefficient of variation CV<0.25, and the Kendall coefficient of concordance W=0.833, proving good consistency of the evaluation criteria and results. Conclusions:The multicriteria value assessment index system proves highly scientific, comprehensive and practicable, serving a good reference for hospitals to build their value-based mechanism to select medical consumables.

Objective:To evaluate the use of serosa muscular layers circumferential incision combined with mucosal layer cutting and closure by laparoscopic or robotic surgery for gastrointestinal mesenchymal tumors at difficult sites of the stomach.Methods:From Jul 2019 to Apr 2021, 18 gastric mesenchymal tumor patients undergoing serosa muscular layers circumferential incision combined with mucosal layer cutting and closure by laparoscopic or robotic surgery at the Department of Surgery, the Fourth Hospital of Hebei Medical University were retrospectively analyzed.Results:All 18 patients had successful surgery, including 7 cases of robotic surgery, 11 cases of laparoscopic surgery, and there was no conversion to open surgery. Tumors were at the gastric in cardia, 8 cases at the gastric body and lesser curvature in 4 cases, and at the gastric antrum in 6 cases, respectively. Eleven cases were of endogenous and 7 cases were of dumbbell type. The average operation time was (99±29) min, the intraoperative blood loss was (10±5) ml, the first time taking food per mouth was (2.0±1.0) d, and the postoperative hospital stay was (4.9 ± 1.2) d. Pathology showed gastrointestinal stromal tumor in 11 cases, leiomyoma in 5 cases and schwannoma in 2 cases. All were with negative margins. The average tumor diameter was (4.7±1.4) cm. The median follow-up time was 16.5 months, and there was no sign of tumor recurrence or metastasis.Conclusion:The serosa muscular layers circumferential incision combined with mucosal layer cutting and closure technique in laparoscopic or robotic surgery is a safe and feasible procedure for treating gastrointestinal mesenchymal tumor at difficult sites of the stomach.

Motor imagery (MI) is an important paradigm of driving brain computer interface (BCI). However, MI is not easy to control or acquire, and the performance of MI-BCI depends heavily on the performance of the subjects' MI. Therefore, the correct execution of MI mental activities, ability evaluation and improvement methods play important and even critical roles in the improvement and application of MI-BCI system's performance. However, in the research and development of MI-BCI, the existing researches mainly focus on the decoding algorithm of MI, but do not pay enough attention to the above three aspects of MI mental activities. In this paper, these problems of MI-BCI are discussed in detail, and it is pointed out that the subjects tend to use visual motor imagery as kinesthetic motor imagery. In the future, we need to develop some objective, quantitatively visualized MI ability evaluation methods, and develop some effective and less time-consumption training methods to improve MI ability. It is also necessary to solve the differences and commonness of MI problems between and within individuals and MI-BCI illiteracy to a certain extent.
Algorithms ; Brain-Computer Interfaces ; Electroencephalography ; Humans ; Imagery, Psychotherapy ; Imagination

Objective:To explore the clinico-pathological characteristics and risk factors affecting prognosis in elderly patients with gastric cancer.Methods:A retrospective study was used to retrospectively analyze 2386 patients with gastric cancer undergoing radical surgery in Surgery Department of the Fourth Hospital of Hebei Medical University from 1 January 2012 to 1 January 2015.Patients aged 70 years and older were screened so as to analyze clinical characteristics and influencing factors for the prognosis.Results:A total of 2386 patients with gastric cancer were divided into the elderly group aged 70 years and older(342 of 2386 cases, 14.3%). There were statistically significant differences between the two groups in gender, number of concomitant diseases, NRS2002 score, PG-SGA score, tumor location, tumor diameter, histological type, Borrmann classification, tumor invasion depth staging(pT), lymph node metastasis staging(pN), the anatomic extent of tumor staging(TNM, pTNM), and Lauren classifications( P<0.05). The 981 of 2386 cases(41.4%)had postoperative complications, accompanied by 413 cases(17.3%)of surgery-related complications and 568 cases(24.0%)of non-surgery-related complications.A multivariate logistic analysis showed that the number of preoperative co-existing diseases ≥ 2 was an independent influencing factor for postoperative complications in elderly gastric cancer patients( HR=4.478, 95% CI: 1.121-7.918, P=0.006). The 5-year OS and DSS was 21.10% and 62.73% in the ≥70 years gastric cancer group, and was 54.1% and 70.0% in the <70 years gastric cancer group, respectively.The difference in the 5-year OS between the two groups was statistically significant( P<0.05), while the difference in the 5-year DSS between the two groups was not statistically significant( P>0.05). Multivariate analysis by the Cox proportional hazard model showed that the independent risk factors for the prognosis of elderly patients with gastric cancer included the low-undifferentiated histological type of the tumor( P=0.004), the depth of tumor invasion pT stage of pT4a-pT4b( P=0.007), lymph node metastasis( P=0.034), tumor pTNM stage ⅢA-ⅢC( P=0.002)and vascular tumor thrombus( P=0.034). Conclusions:Elderly patients with gastric cancer have many preoperative co-existing diseases, which increases the risk of postoperative non-surgical complications.Therefore, we should focus on the peri-operative management of their comorbid diseases so as to improve the safety and efficacy of surgery.The advanced age is not the independent risk factors for the prognosis.

Objective:To explore the correlation of cognitive impairment with abnormal brain regions having low-frequency fluctuation (ALFF) by resting-state blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) in patients with mild hepatic encephalopathy (MHE).Methods:Fifty-nine patients (28 patients with chronic cirrhosis and 31 patients with MHE, according to results of digital symbol test [DST] scores/digital connection test A [NCT-A] scores) admitted to our hospital from March 2018 to January 2020 were enrolled; 33 healthy control subjects matched in gender, age and years of education were chosen as controls. Resting-state BOLD-fMRI was performed in all subjects, and the original images were processed to obtain ALFF brain map. Statistical methods were used to obtain the brain regions with different ALFF values in the three groups, and the brain regions enjoying correlations between ALFF values and venous blood ammonia content/DST scores/NCFA scores in patients from the MHE group.Results:As compared with the control group, patients in the MHE group exhibited significantly lower ALFF values in the right central posterior gyrus, bilateral cuneiform lobe, left lateral occipital gyrus, left occipital gyrus, and left pars opercularis, and significantly increased ALFF values in the right thalamus, left parahippocampal gyrus and surrounding ventricle (bilateral caudate nucleus head)( P<0.05). Bivariate correlation analysis suggested that ALFF values were negatively correlated with blood ammonia in the left pars opercularis, left margin superior gyrus, bilateral precuneus, left superior temporal gyrus, right middle frontal gyrus and surrounding area, and right insula ( P<0.05); ALFF values were positively correlated with DST scores in left medial cingulate gyrus and right cerebellar hemisphere; ALFF values in the left frontal lobe and left posterior cerebellar lobe were positively correlated with NCT-A scores, and ALFF values in the left parahippocampal gyrus were negatively correlated with NCT-A scores ( P<0.05). Conclusion:The ALFF differences in multiple brain regions of patients with MHE may be related to cognitive impairment.

Objective To evaluate the association between vitamin D (VD) and vascular endothelial injury in hypertensive patients.Methods Ninety nine patients with hypertension and 126 healthy subjects (control group) from the same community in Nanjing were recruited in the study.The serum levels of fasting blood glucose (GLU),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were measured.Serum 25-hydroxy vitamin D (25-OH-D) and nitric oxide (NO) levels were determined by enzyme-linked immunosorbent assay.The level of plasma endothelial microparticles was measured by flow cytometry.The data were statistically analyzed with SPSS version 19.O.Results The serum 25-(OH)-D [(55.22 ± 11.92) nmol/L vs.(64.17 ± 21.52) nmol/L,t =-3.71],vitamin D binding protein (VDBP) [(257.32 ±141.31) ng/mlvs.(314.21±124.13) ng/ml,t=-3.21],NO levels [(39.35±13.33)μmol/L vs.(43.42 ± 11.83) μmol/L,t =-2.42] in hypertension group were significantly lower than those in control group.And the circulating endothelial cell particles (4.95 ± 1.78 vs.2.84 ± 2.07,t =8.05) in hypertension group was significantly higher than that in control group.In hypertensive patients,the circulating endothelial cell particles in VD deficiency group was significantly higher than that in low VD group and normal VD group [(6.42 ± 1.25)％ vs.(4.6 ± 1.68)％,(3.15 ±0.90)％,F =15.08].And the serum NO level in VD deficiency group was significantly lower than that in other two groups [(36.57 ± 10.52) μmol/L vs.(39.77 ± 13.01) μmol/L,(46.26 ± 25.90) mol/L,F =1.20].Multiple linear regression analysis showed that low serum 25 (OH) D(B =-0.189,SE =0.033,β =0.509,t =-5.72) and gender (B =-0.682,SE =0.351,β =-0.182,t =-2.054) were the risk factors of vascular endothelial injury.Conclusion The serum vitamin D levels in hypertensive patients is decreased,and vitamin D deficiency may be a risk factor for endothelial injury in hypertension.