Objective:To analyze the operation data of inter-provincial direct settlement of patients with chronic diseases and special diseases in outpatient service, explore the effect of policy implementation and put forward corresponding suggestions.Methods:The descriptive analysis method was used to analyze the real-time settlement data of outpatients with chronic disease and special disease of a grade A tertiary cancer hospital in Beijing in 2022, including changing trend in medical visits, age distribution of the medical population, disease distribution of the medical population, medical departments, cost structure, and payment of medical insurance benefits.Results:In 2022, the hospital admitted a total of 12 812 outpatient patients with chronic and special diseases from 28 provinces and Xinjiang Production and Construction Corps, with an increase from 53 in January to 1 957 in December. The age of the patients was 11 to 88 years old, most of whom were 51 to 70 years old. The main disease was lung cancer, and the main visiting departments were internal medicine(chemotherapy) and radiotherapy(radiotherapy). The cost of diagnosis and treatment was relatively high, and the average proportion of medical insurance fund payment was 79.94%.Conclusions:The inter-provincial direct settlement policy for outpatients with chronic diseases and special diseases could further release the demand for medical treatment, greatly reduce the economic burden of cancer patients, and help to solve the problem of " difficult and expensive medical treatment" for patients with cancer and other major diseases.

Objective To propose on and improve direct settlements by medical insurance offices and hospital systems in their processing of medical treatment in allopatry (MTA), by analyzing such data as the homepages of medical records of such inpatients at a tertiary cancer hospital with their medical expenses settled directly. Methods Data of 6 379 MTA inpatients with direct settlements of in-hospital fees from April 2017 to March 2018 were included in this study. Such data were used to identify the change trend of their case counts and their regional distribution, and analyzed with hierarchical clustering to calculate the settlement counts of various provinces. Results Analyses found that the total cases of such patients remained stable at the hospital, yet the cases of direct settlement rose from five to 1 263, and the proportion of direct settlement among all MTA inpatients rose month by month from 0.14% to 29.26%. Most of MTA inpatients come from Hebei, Shandong, Inner Mongolia and Shanxi provinces in turn, yet the direct settlement counts and hospitalization case trends appear different. Clustering results indicate Hebei as the type-1 province with the highest proportion of direct settlement inpatients, accounting for 30. 41% ;Shandong, Inner Mongolia and Shanxi as the type-2 provinces, accounting for 15. 05% , 13. 45% and 11.00% respectively; Liaoning, Henan and Heilongjiang as the type-3 provinces, accounting for 6.79% , 4.81% and 4.42% respectively; while the rest provinces as the type-4, accounting for less than 3%. Conclusions Regional distribution varies distinctively among such inpatients, and the number of these inpatients keeps rising stably. In such circumstances, hospitals are recommended to enhance their management in strengthening medical insurance audit systems, speeding up settlement, and building regional medical alliances.

Objective To compare the effectiveness of controlling blood loss in the treatment of complex acetabular fracture between temporary occlusion of abdominal aorta by interventional balloon (TOAAIB),temporary occlusion of common iliac artery by interventional balloon (TOCAIIB) and internal iliac artery ligation (IIAL).Methods Included for this study were 113 complex acetabular fractures which had been treated at Department of Orthopaedic Trauma,Shaoguang Hospital Affiliated to Southern Medical University from January 2000 through January 2017.There were 68 males and 45 females,aged from 23 to 61 years (average,42.3 years).According to the Letournel classification,all of them belonged to complex fractures,including 10 T-type,24 double-column,16 posterior column & posterior wall,46 transverse & posterior wall and 15 anterior & posterior half-transverse ones.They were all treated by open reduction and internal fixation but differed in surgical hemostasis techniques:TOAAIB was used in 37cases,TOCAIIB in 31 and IIAL in 45.Fracture reduction was evaluated by Matta criteria.Intraoperative bleeding and postoperative wound drainage,fracture union and complications related to interventions were recorded.Hip function was evaluated by Modified d'Aubigne & Postal clinical grading system after fracture healing.Results The 3 groups (TOAAIB,TOCAIIB and IIAL) were comparable because there were no significant differences in gender,age,time from injury to surgery,Letournel classification or surgical approaches between the patients in the 3 groups (P ＞ 0.05).Anatomical reduction was achieved in 91.15％ of the patients (103/113) and satisfactory reduction in 8.85％ (10/113).Intraoperative hemorrhage was 1,631.5 ±675.5 mL in the HAL group,892.6 ±217.7 mL in the TOCAIIB group and 648.0 ± 170.2 mL in the TOAAIB group,showing significant differences between the 3 groups (P ＜ 0.05).One case of femoral artery thrombosis occurred in the TOAAIB group at the end of operation but was cured by symptomatic treatment of anticoagulation.There were no interventional complications in the other 2 groups.There were no significant differences between the 3 groups in postoperative wound drainage,fracture union time,hip function score or complications (P ＞ 0.05).Conclusions In controlling intraoperative bleeding in the surgery for complex acetabular fracture,TOAAIB may be the best,followed by TOCAIIB,and IIAL may be the worst.However,choice of a proper surgical hemostasis technique should also depend on the specific intraoperative condition of a specific patient.

Objective:To investigate the use of proton pump inhibitors (PPIs)in gynecological patients in a hospital and analyze the use rationality of PPIs for the prevention of stress ulcer so as to provide reference for the clinical application of PPIs. Methods:To-tally 1000 patients' medical records admitted to the gynecological department for the first time from January 1st to December 31st in 2016 were randomly selected to conduct a retrospective analysis,and the rationality of PPIs was evaluated. Results:The preventive use rate of PPIs was 90.72%(880/970). Among the 880 patients, 28.18%(248/880) of the patients were without indications for the preventive medication,95.68%(842/880) of the patients were with wrong administration time, and 91.46%(578/632) of the pa-tients were with wrong usage and dosage. Conclusion:When PPIs are used for the prevention of SU in gynecological surgery,irrational use such as without indications, unsuitable variety selection and wrong usage and dosage still exists. It is suggested that regulators should strengthen technical and administrative interventions and establish standard for the rational use of PPIs in hospitals so as to avoid the excessive use of PPIs and improve the situation of inappropriate application.

Objective:To establish the quality standard for Shule capsules. Methods: The microscopic characteristic identifica-tion of Figwort and Radix bupleuri was performed under a microscope. The qualitative identification of fritillary, andrographispaniculata and polygonumbistorta was studied by TLC. The content of salvianolic acid B in Salvia miltiorrhiza was determined by HPLC. The chro-matographic separation was carried out by using a phenomenex synergi 4 hydro-RP 80A (250 mm × 4. 6 mm) column. The mobile phase consisted of acetonitrile-methanol-formic acid-water(10 :30 :59 :1)with gradient elution at a flow rate of 1. 0 ml·min-1, and the injection volume was 10 μl . The detection wavelength and the column temperature was 286 nm and 20 ℃, respectively. Results:The microscopic characteristics were obvious. The spots in TLC were clear without any interference. The linear range was 10. 001-100. 007 μg·ml-1(r=1. 0000). The average recovery was 99. 3% with RSD of 1. 8% (n=6). Conclusion:The method is simple with high specificity and good repeatability, which can be used as the quality control method for Shule capsules.

Aim To research the protective effects of specnuezhenide, an active compound of traditional Chinese medicine, against CCl4-induced hepatic dam-age in mice. Methods The model of acute hepatic damage caused by CCl4 intraperitoneal injection on mice was obtained. The levels of ALT, AST, TNF-α, IL-1β, and IL-6 in serum, the activities of MDA, SOD, and GSH-Px in liver homogenates, and the his-topathological organization of liver sections were also examined to observe the protective effects of specnu-ezhenide. Results Specnuezhenide markedly de-creased the CCl4-induced elevation of serum ALT and AST activities, and improved hepatic histopathology changes. Specnuezhenide also significantly decreased the content of MDA in liver tissues, meanwhile in-creased the activities of antioxidant enzymes SOD and GSH-Px. In addition, specnuezhenide reduced the lev-els of TNF-α, IL-1β and IL-6 . Conclusions Specnu-ezhenide has significant protective effects against CCl4-induced hepatic damage in mice, and the possible un-derlying mechanisms of the activity could be due to its antioxidant and anti-inflammatory effects.

Erzhiwan includes two components of Chinese herbal medicines - Ligustri Lucidi Fructus and Herba Eclip-tae .Ligustri Lucidi Fructus ,Herba Ecliptae and their formulation have various hepatoprotective effects .There are many ac-tive ingredients in the formulation ,such as triterpenes ,iridoids ,phenethyl alcohol-glucosides ,coumarin ethers ,etc .They can resist various chemistry-induced hepatic injury ,ischemia reperfusion induced hepatic injury ,and hepatic fibrosis .The mecha-nisms of hepatoprotective effect include anti-oxidative stress ,anti-inflammatory ,inhibition of hyperplasia and activation of liver stellate cell ,motivating the apoptosis of liver stellate cell ,influencing the metabolic processes of liver cell ,ect .We reviewed and summarized the hepatoprotective effects of Erzhiwan and its components Ligustri Lucidi Fructus and Herba Ecliptae and explore the mechanisms of hepatoprotective effect in order to provide information for further research of pharmacodynamic ma-terial base .

Objective:To establish the quality standard for Shenyan Ⅱ granules. Methods:The characteristics of Folium Pyrrosiae were identified by microscopy. The three herbs in the preparation,rehmannia,madder and thistle were identified by TLC qualitatively. The content of ginsenoside in American ginseng was determined by HPLC. Chromatographic separation was carried out by using a WONDER CRACT ODS-2(150 mm × 46 mm,5 μm)column. The mobile phase consisted of acetonitrile-0. 1% phosphoric acid(28 ∶72)with gradient elution at a flow rate of 1. 0 ml·min -1 ,and the injection volume was 10 μl. The detection wavelength and the column temperature was 203 nm and 40 ℃,respectively. Results:The spots in TLC were clear without any interference. The linear range of ginsenoside was 38. 9- 194. 5 μg·ml -1(r = 0. 999 3). The average recovery was 98. 3% and RSD was 1. 9%(n = 6). Conclusion:The method is simple and highly specific with good repeatability,which can be used as the quality control method for Shenyan Ⅱ granules.

Objectives To investigate the inlfuence of polymorphisms of SLC19A1 80G>A, MDR1 exon26C>T and MDR1 exon21G>T/A on curative effect and adverse reaction of high-dose methotrexate in patients with acute lymphoblastic leukemia. Methods MALDI-TOF-MS technique was used to detect the polymorphisms of SLC19A1 80G>A, MDR1 exon 26C>T and MDR1 exon21G>T/A in 108 patients with acute lymphoblastic leukemia (ALL). The relationship of genetic polymorphism, survival rate and toxicity was analyzed. Results The 36-month event-free survival was not related to any polymorphisms of MDR1 and SLC19A1. Patients with mutant types of MDR1 exon26C>T and MDR1 exon21G>T/A showed a much higher MTX plasma levels at 24 hours and higher incidence of hepatic injury (P<0.05). Conclusions The genetic polymorphism of MDR1 exon26>T, MDR1 exon21G>T/A has a large inlfuence on hepatic toxicity and plasma concentra-tions of MTX.

Objective To evaluate the efficacy of laparoscopic Habib 4X (Habib 4X,Angio Dynamics US),a new bipolar radiofrequency (RF) device,in laparoscopic liver resection.Methods Thirty one patients who underwent laparoscopic liver resection using the laparoscopic Habib 4X from Sept 2009 to Apr 2012 were studied retrospectively.Results The laparoscopic Habib 4X was success fully used in 30 patients (malignant,n=18; benign,n=12).The procedures performed included left lateral sectionectomy (n=12),left hemi-hepatectomy (n=1),Ⅴ or Ⅵ segmentectomy (n=9),Ⅴ and Ⅵ bi-segmentectomy (n=2) and wedge exclusion (n=6).The time required for precoagulation and resection was 10～68 min (median 24 min).The mean intraoperative blood loss was 145±75ml (range 8-370 ml).Mild abnormal liver function which returned to normal in 3 to 5 days was detected postoperatively.The mean hospital stay was 7.8±2.6 d (range 3～12 days).There was no patient who developed postoperative bleeding,bile leakage or abdominal abscess.For cancer patients,there was no local recurrence on follow-up.Conclusion Laparoscopic Habib 4X,a device when used in laparoscopic liver resection,resulted in minimal blood loss and quick recovery.It had only mild effect on liver function and it had low morbidity.In addition,it might reduce the risk of local recurrence in malignant tumours.