Objective:To evaluate the medical service quality of psychiatric hospitals in Beijing based on diagnostic related group (DRG), analyze the evaluation effect, for refences to constructe a DRG performance evaluation system suitable for psychiatric hospitals.Methods:This study extracted data such as the number of DRG groups, etc. of hospitalized patients in 14 tertiary and secondary psychiatric hospitals in Beijing from 2018 to 2020 from the Beijing inpatient medical performance evaluation platform, and analyzed data on DRG performance evaluation indicators, as well as the average length of hospital stay and average cost of DRG enrolled cases. All data were analyzed using descriptive research methods, and inter group comparisons were conducted using the Mann Whitney U-test. Results:From 2018 to 2020, the average number of DRG groups in tertiary hospitals (28) was higher than that in secondary hospitals (10) ( P<0.05), and the average CMI values of both were the same(1.79); The average cost consumption index (1.15) of tertiary hospitals was higher than that of secondary hospitals (0.65) ( P<0.05), while the average time consumption index (1.11) was slightly lower than that of secondary hospitals (1.30); The mortality rate of the low-risk group in tertiary hospitals (0.01%) was generally lower than that in secondary hospitals (0.88%), and the average percentage of DRG admitted inpatients (82.8%) was significantly higher than that in secondary hospitals (27.3%) ( P>0.05). The average length of stay and cost per case for DRG enrolled inpatients in tertiary and secondary hospitals were lower than the overall hospital discharge cases ( P<0.05). Conclusions:The number of DRG groups, CMI value, and low-risk mortality rate could be used for evaluating the medical service capacity and safety of psychiatric hospitals, but the cost and time consumption index could not objectively reflect the efficiency of hospital medical services. DRG performance evaluation indicators are more suitable for evaluating short-term hospitalization of psychiatric patients. The proportion of DRG enrolled cases might be a potential indicator for evaluating the service quality of psychiatric hospitals.

Objective:To explore the feasibility and clinical effectiveness of preoperative positioning grid combined with CTA assisted design of anterolateral thigh perforator flap (ALTPF) in reconstruction of soft tissue defects around foot and ankle.Methods:From May 2018 to December 2021, a total of 18 cases with soft tissue defects around foot and ankle were admitted to the Department of Plastic and Reconstructive Surgery, First Affiliated Hospital of Ningbo University. The patients were 11 males and 7 females, aged from 32 to 78 years old, with an average age of 57.5 years old. Among them, 10 had chronic ulcer wounds, 6 had traumatic wounds, and 2 had postoperative wounds after malignant tumor resection. The sizes of soft tissue defect ranged from 6.0 cm×8.0 cm to 9.0 cm×13.0 cm, and the flap sizes ranged from 8.0 cm×10.0 cm to 11.0 cm×15.0 cm. Preoperative positioning grid combined with CTA three-dimensional reconstruction were used to mark the exit point of the perforator vessels in digital format, in order to restore the course of vessels and calculate the length of the vascular pedicles. ALTPFs were accurately designed based on the digitally reconstructed images, and then the ALTPFs were used to repair the soft tissue defects around the ankle. The flap donor sites were directly closed in stage Ⅰ. After the operation, all the patients were included in scheduled follow-ups at the outpatient department to observe the appearance of the recipient flaps and donor sites. The functional evaluation of the affected feet were assessed according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results:All 18 flaps survived, and the wounds in both the recipient and donor sites healed in stageⅠ. Postoperative follow-up for the 18 patients were 5 to 36 months, with an average of 13 months. At the last follow-up, the appearances of the flaps were good without swelling, the donor sites had good recovery, and there was no obvious scar hypertrophy. The function evaluation of the affected feet were found at excellent in 10 cases, good in 6 cases, and fair in 2 cases.Conclusion:Preoperative position grid combined with CTA three-dimensional reconstruction can digitally mark the exit points and running courses of the perforator vessels. It is an effective method for accurate position of perforator vessels before surgery. It can effectively reduce the operation time, lower the surgical risks, and achieve a high survival rate of the flap, thus holding considerable clinical value.

The incidence of spinal tuberculosis ranks the first place among the bone and joint tuberculosis, and surgery is an important method of therapy, which can shorten the course of spinal tuberculosis, reduce treatment time and disability rate, and improve the quality of life. One-stage posterior debridement, interbody fusion with instrumentation is a safe and effective surgical approach that conforms to the " minimally invasive" concept, and has gradually become the mainstream surgical method for the treatment of spinal tuberculosis. In addition, radical debridement is relative, and strong internal fixation can better correct deformities and increase the stability of the spine.

Alfalfa(Medicago sativa L.)is the most important legume forage crop worldwide with high nutritional value and yield.For a long time,the breeding of alfalfa was hampered by lacking reliable information on the autotetraploid genome and molecular markers linked to important agro-nomic traits.We herein reported the de novo assembly of the allele-aware chromosome-level genome of Zhongmu-4,a cultivar widely cultivated in China,and a comprehensive database of genomic variations based on resequencing of 220 germplasms.Approximate 2.74 Gb contigs(N50 of 2.06 Mb),accounting for 88.39％of the estimated genome,were assembled,and 2.56 Gb contigs were anchored to 32 pseudo-chromosomes.A total of 34,922 allelic genes were identified from the allele-aware genome.We observed the expansion of gene families,especially those related to the nitrogen metabolism,and the increase of repetitive elements including transposable elements,which probably resulted in the increase of Zhongmu-4 genome compared with Medicago truncatula.Population structure analysis revealed that the accessions from Asia and South America had rela-tively lower genetic diversity than those from Europe,suggesting that geography may influence alfalfa genetic divergence during local adaption.Genome-wide association studies identified 101 sin-gle nucleotide polymorphisms(SNPs)associated with 27 agronomic traits.Two candidate genes were predicted to be correlated with fall dormancy and salt response.We believe that the allele-aware chromosome-level genome sequence of Zhongmu-4 combined with the resequencing data of the diverse alfalfa germplasms will facilitate genetic research and genomics-assisted breeding in variety improvement of alfalfa.

Objective:To investigate the clinical value of totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization for portal hypertension com-plicated with splenic aneurysm.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 17 patients with portal hypertension complicated with splenic aneurysm who were admitted to 2 medical centers (15 cases in Shenzhen University General Hospital and 2 cases in Wuhan First Hospital) from January 2013 to May 2020 were collected. There were 7 males and 10 females, aged (59±14)years. All patients underwent totally laparoscopic exoclusion of splenic artery aneurysm combined with pericardial devascularization. Observation indicators : (1) surgical and postoperative conditions; (2) complications; (3) follow-up. Follow-up was conducted by out-patient examiantion and telephone interview to detect the effect of exclusion of arterial tumor, and blood re-flow, portal vein thrombosis and survival of patients 3 months after operation. The follow-up was up to December 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Results:(1) Surgical and postoperative conditions. All 17 patients successfully completed the operation, without perioperative death. The operation time, volume of intraoperative blood loss of 17 patients were (181±30)minutes, 187(range, 90?420)mL. The white blood cell count, red blood cell count, hemoglobin, serum albumin were (9±4)×10 9/L, (3.5±0.9)×10 12/L, (86±17)g/L, (36±7)g/L on the postoperative day 3. Time to postoperative abdominal drainage tube removal and duration of post-operative hospital stay were (7±4)days and (11±4)days. (2) Complications. All 17 patients had ascites after surgery, which were improved after oral treatment with diuretics. There was no complication such as intra-abdominal hemorrhage, gastrointestinal fistula, pleural effusion, infection, abscess formation, fever and vascular embolism. (3) Follow-up. All the 17 patients were followed up for 28.6(range, 7.0?84.0)months. During the follow-up, the splenic aneurysm cavity of all patients was completely isolated, no blood re-flow and no portal vein thrombosis was observed, and no patient died. Conclusion:Totally laparoscopic exclusion of splenic artery aneurysm combined with pericardial devascularization is safe and feasible in the treatment of portal hypertension complicated with splenic aneurysm.

AIM: To establish an ultra-performance liquid chromatography-mass spectrometry (UPLC-MS/MS) method to determine the distribution of deuterosuccinylcholine chloride (

Objective To observe the effect of different hypoxic time on hydrogen sulfide (H2S), nitric oxide (NO) and Ras homolog gene family,member A/Rho associated coiled coil-forming kinase(RhoA-ROCK) pathway in rat cerebrovascular endothelial cells(EC),and investigate the effect of dermatogenous H2S on the RhoA-ROCK pathway. Methods Rat brain vascular EC was cultured by collagenase digestion. The EC was measured for H2S and NO after hypoxia for 1,2,4,8 and 24 h respectively. G-LISA was used to detect RhoA activity. Proteins expression changes were detected by Western blot. Results After 1 hour of hypoxia,the content of H2S decreased significantly, the NO content decreased significantly after hypoxia of 4 hours,the activity of RhoA increased significantly after hypoxia of 8 h. The expression of CSE protein decreased significantly after 4 h of hypoxia,the expression level of eNOS protein decreased significantly after 8 h of hypoxia,and the expression of ROCK1 and ROCK2 increased significantly at 8 h of hypoxia. Both endogenous and exogenous H2S inhibited RhoA activity. Conclusion During the hypoxic injury of rat cerebrovascular endothelial cells. The decrease of endogenous H2S occurred first, followed by NO,and the activation of RhoA-ROCK pathway occurred later,which may be secondary to the decrease of H2S.

Objective To investigate the total flavones of rhododendra(TFR) on contractility of rat myocardial cells and its possible mechanism. Methods The contraction amplitude and contraction frequency of primary cultured rat myocardial cells were observed by image analysis system. The intracellular free Ca2 + content was measured by calcium ion imaging system. Results 10 and 100 nmol /L hU Ⅱ significantly accelerated the contraction frequency of myocardial cells,and 10 nmol /L hU Ⅱ increased the contraction amplitude of myocardial cells,but 100 nmol /L hU Ⅱ reduced the contraction amplitude of myocardial cells. TFR 300 mg /L significantly slowed the contraction frequency of rat myocardial cells and increased the contraction amplitude. TFR in the range of 33. 3 ～ 300 mg /L could significantly inhibit the increase of contraction frequency,the decrease of contraction amplitude and the increase of intracellular free Ca2 + content induced by 100 nmol /L hU Ⅱ. Conclusion TFR can slow down the contraction frequency of myocardial cells and increase its contractility,which may be related to the decrease of free Ca2 + content in myocardial cells.