The United States is the first country to implement DRG payment in the world, and its MS-DRG(medical severity DRG)version has been used for reference by many countries and regions. In order to ensure the universal applicability of DRG grouping scheme and adapt to the clinical reality, the MS-DRG grouping scheme should follow such grouping rules as similarity of resource consumption, clinical similarity and easy management of DRG groups. This paper presented the evolution of MS-DRG and expounded on its grouping rules in detail, for reference in the amendment and improvement of grouping rules in CHS-DRG.

Objective: To conduct a preliminary evaluation for the usability of Carelink remote monitoring system by clinical physician. Methods: A total of 215 patients received cardiovascular implantable electronic devices (CIED) with Carelink remote monitoring function from 12 hospitals in China between 2012-01 and 2013-10 were prospectively enrolled. The patient's mean age was (62.3±14.3) years including 108 male and 107 female. There were 54 physicians completed questionnaire survey. Based on the type of CIED, the patients were divided into3 groups: PM (pace maker) group,n=110, ICD (implantable cardioverter defibrillator) group,n=54 and CRT (cardiac resynchronization therapy) group,n=51. The patients received routine hospital visit at 3 months of CIED implantation and meanwhile, they performed device data transmission at 3 and 6 months of Carelink remote monitoring. The time physician spent to evaluate data was collected at 3 months and the questionnaire survey was completed by physician at 6 months after CIED implantation. Results: All 54 physicians felt that Carelink remote monitoring system was simple to operate and easy to use. There were 147 patients ifnished hospital visit at 3 months after CIED implantation, the mean time for physician to evaluate data was (14.8±8.4) min; 150 patients ifnished Carelink remote monitor at 3 months after CIED implantation, the mean time for physician to evaluate data was (8.2 ±4.6) min,P<0.0001.Conclusion: Carelink remote monitoring system was easy to use, it may save time in follow-up study which with high satisfaction in clinical practice.

Objective To explore the effects of the new melatonin nonselective agonists Neu-P11 on intraocular pressure (IOP) and glial fibrillary acid protein (GFAP) expression in the retina of acute high IOP rat.Methods Twenty-four male Sprague-Dawley rats were randomly divided into 4 groups (6 cases in each group):Normal IOP with local treatment (NIL) group,high IOP with local treatment (HIL) group,HILwith melatonin treatment (HIL-M) group,HIL with Neu-P11 treatment (HIL-N) group.10 μL normal saline was instilled in NIL group and HIL group,while 10 μL 100 μmol · L-1 Mel/Neu-P11 treated in HIL-M group and HIL-N group.After 2 hours of rest,rats were placed in the Trendelenburg position duration 45 minutes.And then,IOP was measured every hour for 6 hours,and repeated it for a week.The excessive sodium pentobarbital was injected to SD rats at the end of the experiment.The rat eyeballs were took out to perform HE and immunohistochemical staining to detect retina GFAP protein expression.Results After a week,IOP in HIL group was (41.26 ± 1.73) mmHg (1 kPa =7.5 mmHg),NIL group was (13.61 ± 0.55) mmHg,which mean the Trendelenburg could induce high IOP in SD rats.Compared with the NIL group,the retinal becoming thick,the level of organization was not clear and the expression of GFAP protein was quite high in HIL group.At the same time,the GFAP protein expression and IOP were significantly weakened in HIL-M group and HIL-N group compared with HIL group.Conclusion Neu-P1 1 can reduce IOP,inhibit the activation of gliocyte,and decrease the expression of GFAP to protect the retina.

OBJECTIVETo observe the results of remote home monitoring for cardiac implantable electronic devices (CIED).

METHODSFrom November 2009 to July 2014, 37 patients implanted with home monitoring system CIED were enrolled, and 31 cases were implanted with dual chamber pacemakers, 2 with cardiac resynchronization therapy(CRT) and 4 with implantable cardioverter defibrillator (ICD). All patients received clinical routine follow-up.Data was automatic transmitted daily by remote home monitoring system, while special alarm events were transmitted at any time.The success rate of data transmission, abnormal events monitoring and pacing parameter changes were analyzed.

RESULTSA total of 37 patients (24 males, mean age (70.0±9.6) years) were enrolled.Average follow-up time was (902±404) days.Success rate of data transmission was 97.6% (32 574), failed data transmission rate was 2.4% (801). Ninth-nine alerts were transmitted from 28 patients (75.7%), including 80 (80.8%) disease-related alerts and 19 (19.2%) system-related alerts.Average detection time of atrial fibrillation by remote home monitoring system to last clinical routine follow-up was 62 (19-120) days.There was no significant change in ventricular threshold, atrial and ventricle sensing during acute, subacute and chronic phases post the application of the steroid-eluting leads(all P>0.05).

CONCLUSIONSThe success rate of data transmission for CIED with remote home monitoring system is efficient, abnormal events can be timely detected.Meanwhile, remote home monitoring system also verified the stability of pacing parameters during acute, subacute and chronic phases post the application of the steroid-eluting leads.

Aged ; Atrial Fibrillation ; Cardiac Resynchronization Therapy ; Defibrillators, Implantable ; Electrocardiography ; Equipment Failure ; Female ; Humans ; Male

Objective To study the correlation between serum bilirubin and restenosis after stent implantation of coronary heart disease (CHD).Methods Two hundred and fourtynine patients with CHD were divided into Instent-restenosis (ISR) of CHD group and non-ISR of CHD group according to their angiography findings.Theirserum bilirubin levels were compared and correlation between serum bilirubin level and ISR of CHD was studied.Results The serum bilirubin level was significantlylower in ISRof CHD group than in non-ISR group (P ＜ 0.05),in TBIL (9.9322 ± 3.8748μmol/L) to (12.08 ±4.6679μmol/L)、DBIL (3.1744 ± 1.60μmol/L) to (3.8949 ± 1.825μmol/L)、IBIL (6.757 ±2.822μmol/L) to (8.174 ± 3.388μmol/L).Conclusions The serum bilirubinlevel is lower in CHD patients with ISR than in CHD patients with non-ISR,which is an indepent risk factor for ISR of CHD.

OBJECTIVETo evaluate the efficacy of intravascular ultrasound guided tranradial rotational atherectomy (RA) followed by drug eluting stent (DES) implantation in treating patients with heavily calcified coronary lesions.

METHODSClinical characteristics, coronary angiogram, intravascular ultrasound images, peri-procedure and follow-up data (including death , myocardial infarction and target lesion revascularization) of 44 patients treated with RA and DES implantation under the guidance of IVUS in our department from March 2011 to March 2013 were retrospectively analyzed. IVUS examination was carried out before RA, after RA and stent implantation to guide whether further RA or post dilatation was needed. According to the arc of calcification, the patients were divided into group A (90°-270°, 18 cases) and group B (271°-360°, 26 cases).

RESULTSIn A and B group, the arc of calcification was (195 ± 71)° in group A and (345 ± 23)° in group B (P < 0.01) , length of calcification was (34.4 ± 11.8) mm in group A and (20.0 ± 6.6) mm in group B (P < 0.05). Number of burrs used and size of largest burr used were similar between 2 groups (both P > 0.05). Acute cross sectional area gain after RA was (0.43 ± 0.32) mm in group A and (0.53 ± 0.38) mm² in group B (P > 0.05). After RA, there was significant decrease in the arc of calcification in group B compared with baseline ((324 ± 52)° vs. (345 ± 23)°, P < 0.05). The minimal lumen area and diameter were significantly increased after RA resulting in significant decrease in the plaque burden in both groups (all P < 0.05). The final minimal lumen area after stenting were similar between 2 groups (P > 0.05). Procedure success rate was 100% (44/44) without any major complications such as death, acute myocardial infarction and coronary perforation. During the (16.6 ± 6.3) months follow-up, there was 1 death in group A, 1 target lesion revascularization in group B and there was no acute myocardial infarction in the 2 groups.

CONCLUSIONHeavily calcified coronary lesions can be effectively and safely treated by transradial RA under the guidance of IVUS.

Atherectomy, Coronary ; Coronary Angiography ; Coronary Artery Disease ; therapy ; Drug-Eluting Stents ; Humans ; Myocardial Infarction ; Retrospective Studies ; Stents ; Treatment Outcome ; Ultrasonography, Interventional ; Vascular Calcification ; therapy

Objective To evaluate the efficacy of intravascular ultrasound guided tranradial rotational atherectomy ( RA) followed by drug eluting stent ( DES) implantation in treating patients with heavily calcified coronary lesions.Methods Clinical characteristics , coronary angiogram , intravascular ultrasound images , peri-procedure and follow-up data ( including death , myocardial infarction and target lesion revascularization ) of 44 patients treated with RA and DES implantation under the guidance of IVUS in our department from March 2011 to March 2013 were retrospectively analyzed.IVUS examination was carried out before RA , after RA and stent implantation to guide whether further RA or post dilatation was needed.According to the arc of calcification , the patients were divided into group A (90°-270°,18 cases) and group B (271°-360°,26 cases).Results In A and B group, the arc of calcification was (195 ±71)°in group A and (345 ±23)°in group B(P<0.01), length of calcification was (34.4 ±11.8)mm in group A and (20.0 ±6.6) mm in group B ( P<0.05).Number of burrs used and size of largest burr used were similar between 2 groups (both P>0.05).Acute cross sectional area gain after RA was (0.43 ±0.32)mm2 in group A and (0.53 ±0.38)mm2 in group B (P>0.05).After RA, there was significant decrease in the arc of calcification in group B compared with baseline ( ( 324 ±52 ) °vs.( 345 ±23 ) °, P <0.05 ).The minimal lumen area and diameter were significantly increased after RA resulting in significant decrease in the plaque burden in both groups ( all P<0.05 ).The final minimal lumen area after stenting were similar between 2 groups (P>0.05).Procedure success rate was 100%(44/44) without any major complications such as death , acute myocardial infarction and coronary perforation.During the ( 16.6 ±6.3 ) months follow-up, there was 1 death in group A , 1 target lesion revascularization in group B and there was no acute myocardial infarction in the 2 groups.Conclusion Heavily calcified coronary lesions can be effectively and safely treated by transradial RA under the guidance of IVUS.

OBJECTIVETo investigate the efficacy and safety of intravenous ibutilide for conversion of atrial fibrillation (AF) and flutter (AFL) to sinus rhythm.

METHODSNinety-nine consecutive patients aged 18-75 y with AF/AFL were included. The duration of arrhythmia was <90 d (1 h-90 d) and ventricular rate was >60 beats/min. Patients were assigned randomly into two groups: 49 patients in ibutilide group received ibutilide 1 mg, then repeated if AF/AFL was not converted after 10 min; 50 patients in propafenone group received propafenone 70 mg, then repeated if AF/AFL persisted after 10 min. Two drugs were diluted by 50 ml of 5% glucose and injected intravenously within 10 min.

RESULTSVentricular rates were decreased in both groups. AF/AFL were converted in 34 of 49 patients (69.4 % ) in ibutilide group and in 22 of 50 patients (44.0 %) in propafenone group (P <0.05). The converting time of ibutilide was significantly shorter than that of propafenone [(16.79 ± 12.31) min compared with (36.92 ± 11.38)min, P <0.01]. The most serious adverse effect of ibutilide was non-sustained monomorphic ventricular tachycardia (3/49,6.12 %). Transient hypotension and heart pause were the main adverse events in patients who received propafenone, acute left heart failure occurred in one patient of propafenone group.

CONCLUSIONIntravenous ibutilide is a safe and effective agent for cardioversion of recent-onset AF/AFL. Furthermore,strict processing under electrocardio-monitoring is important.

Adolescent ; Adult ; Aged ; Atrial Fibrillation ; drug therapy ; Atrial Flutter ; drug therapy ; Female ; Humans ; Male ; Middle Aged ; Propafenone ; therapeutic use ; Sulfonamides ; therapeutic use ; Treatment Outcome ; Young Adult

ObjectiveThe purpose of this study was to determine whether fQRS is associated with increased ventricular arrhythmic event in patients with Acute ST- elevation Myocardial Infarction.Methods 12-lead ECG, 24h-Holter monitoring and biochemical markers detection were performed in sixty cases with acute ST-elevation myocardial infarction, which were divided into two groups[fQRS group and nonfQRS group]according to Fragmented QRS (fQRS) on 12-lead ECG.Then ventricular arrhythmic events were analyzed.ResultsVentricular premature beats (24 h, 3140 +555 vs 1226 + 142, P ＜0.01) and the incidence of complex ventricular arrhythmic events(34.4％ vs 10.7％, P ＜0.05) in fQRS group were significantly higher than that in non- fQRS group.ConclusionsFragmented QRS may be used to predict ventricular arrhythmic events in patients with acute ST- elevation myocardial infarction.

AIM: The aim of the present study was to clarify the mechanism of intracellular signal transduction in Ang Ⅱ- induced proliferation of vascular smooth muscular cells (VSMC) by observing the effect of c- Src on Ang Ⅱ- mediated mitogen- activated protein kinase (MAPK) activation and c- Fos protein expression in cultured VSMC of rats. METHODS: Cultured aortic VSMCs from SD rats were transfected with anti-sense c-Src oligodeoxynucleotides (ODNs) wrapt with lipofectin to inhibit c- Src activity and protein production. Untransfected VSMCs were used as control. We observed the role of Ang Ⅱ stimulation in MAPK activation and c- Fos protein expression. c- Src kinase activity was measured by protein immunoprecipitation and kinase autophosphorylation. The phosphorylation rate of the substrate myelin basic protein (MBP) was employed to assess MAPK activity.Western immunoblot was used to detect protein expression of c- Src and c-Fos. RESULTS: c-Src protein expression in VSMC transfected with different concentrations of anti- sense ODNs significantly decreased in a negative dose- effect manner. c- Src kinase activity was also markedly inhibited. Following the stimulation of Ang Ⅱ on transfected VSMCs with anti-sense ODNs, the increase rate of c- Src activity was 8.7% of that in control, the activity of MAPK was 1.6% compared with control and c- Fos protein expression was as 30.0% as that of control. CONCLUSION: Ang Ⅱ induces c- Src activation. MAPK activation and c - Fos protein expression by Ang Ⅱ is dependent on c- Src activation. These findings indicate that c- Src is an important signal factor in Ang Ⅱ-induced VSMC proliferation.