Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

Objective To analyze the coding quality of multiple primary malignant tumors in a tertiary hospital,identify existing problems,and improve the accuracy of coding for multiple primary malignant tumors.Methods We collected 393 medi-cal records from a tertiary hospital from June 1,2021,to June 30,2023,with ICD-10 code C97 for the discharge diagnosis.By carefully reading the medical records,we analyzed the reasons for coding errors in multiple primary malignant tumors with code C97.Results Among the 393 medical records,there were 34 cases with coding errors in C97,including 11 cases where meta-static malignant tumors were erroneously coded as multiple primary malignant tumors,9 cases where malignant tumors of the same organ system with non-adjacent sites and the same histological type were erroneously coded as multiple primary malignant tumors,7 cases where distant metastasis or local invasion was erroneously coded as multiple primary malignant tumors,4 cases where be-nign tumors were mistakenly coded as malignant tumors,and 3 cases where suspected malignant tumors were coded as confirmed cases.Conclusion To improve the quality and efficiency of C97 coding,coders need to have a clear understanding of the defini-tion of multiple primary malignant tumors,read the medical records carefully and completely,determine the location and histolog-ical type of the tumors accurately,and strengthen communication with clinical physicians.

Coding malignant tumors in multiple sites within the digestive system involves some coding rules.When more than two malignant tumors present various pathologic types,they should be included in the code of C97,which indicates multiple primary malignancies,and should be categorized into a specific code under the category of C97 upon corresponding treatment pur-poses.For those malignant tumors in the digestive system presenting with the same pathological results but unidentified primary sites,which are diagnosed as more than two types of tumors and recorded on the first page of a medical record,they are coded ac-cording to their specific locations.The coding principles are as followed:① If a malignant tumor spans two or more adjacent sites with an unidentified primary origin,it should be classified as a cross-site malignant tumor and coded based on the tumor's ana-tomical location.② If more than two malignant tumors are located in the separate parts of the same location,they should be co-ded with".9"as a subheading of the three-digit category specific to the right location.③If more than two malignant tumors are not adjacent to each other in the digestive system,they should be classified to the code of C26.9.In the process of coding,cod-ers should review case data thoroughly,enhance the accumulation of clinical knowledge,and strengthen communications with doc-tors,thereby enhancing coding precision.

Objective To detect the expression of vacuolar protein sorting-associated protein 33A(VPS33A)in the peripheral blood of elderly patients with pulmonary tuberculosis,and explore its correlation with clinical prognosis.Methods A total of 95 elderly pulmonary tuberculosis patients admitted to Macheng City People's Hospital from February 2019 to February 2021 were collected as the research group,and 90 healthy subjects in the same period were selected as control group.The expression of VPS33A and Toll like receptor 2(TLR2)in peripheral blood was detected by real-time fluorescent quantitative PCR(qRT-PCR),and the level of interleukin-6(IL-6)in peripheral blood was detected by enzyme-linked immunosorbent assay.Patients with pulmonary tuberculosis were given standardized anti-tuberculosis regimen therapy(2HRZE/4HR)treatment,and they were followed up for 12 months.According to their prognosis,they were divided into good prognosis group(n=58)and bad prognosis group(n=37).The predictive value of VPS33A for poor prognosis was analyzed by ROC curve.The correlation between serum VPS33A,IL-6 and TLR2 in poor prognosis group was analyzed by Pearson method.Logistic regression analysis was used to explore the factors influencing poor prognosis in elderly patients with pulmonary tuberculosis.Results Compared with the control group,VPS33A level(0.87±0.22 vs 1.02±0.23)in peripheral blood was lower,but IL-6(22.13±5.36 pg/ml vs 18.53±4.68 pg/ml)and TLR2 levels(1.26±0.25 vs 0.99±0.21)were higher in the pre-treatment study group,with significant differences(t=6.170,6.682,11.241,all P＜0.05).Compared with the pre-treatment study group,VPS33A level(0.95±0.25)in peripheral blood was higher,but IL-6(19.66±5.44 pg/ml)and TLR2 levels(1.11±0.2)were lower in the post-treatment study group,with significant differences(t=3.336,4.648,6.331,all P＜0.05).The level of VPS33A(0.71±0.16)in peripheral blood of poor prognosis group was lower than that of good prognosis group(0.97±0.22),while the levels of IL-6(26.41±7.16 pg/ml)and TLR2(1.35±0.26)were higher than those of good prognosis group(19.40±4.21pg/ml,1.20±0.24),with significant differences(t=5.555,6.012,2.875,all P＜0.05).Pearson correlation analysis showed that VPS33A in the pre-treatment study group was negatively correlated with IL-6 and TLR2 levels(r=-0.649,-0.634,all P＜0.05).ROC curve analysis results showed that the AUCs of VPS33A,IL-6 and TLR2 for predicting the prognosis of tuberculosis in the elderly were 0.805,0.842 and 0.882,respectively.The combined AUC of the three was 0.971,which was higher than that predicted by the three alone(Z=4.010,3.136,2.285,P=0.001,0.002,0.022).Logistic regression analysis showed that VPS33A,IL-6 and TLR2 were the influencing factors for poor prognosis of elderly pulmonary tuberculosis patients(all P＜0.05).Conclusion The expression of VPS33A is down-regulated in the peripheral blood of elderly patients with pulmonary tuberculosis,which may be a good predictive value for the prognosis of elderly patients with pulmonary tuberculosis,and be a factor affecting bad prognosis.

Objective To observe the effect of cluster emergency nursing in treating patients with chlorfenapyr poisoning. Methods A retrospective analysis was performed for the treatment and nursing processes of 6 patients with chlorfenapyr poisoning. Results Among the 6 patients with chlorfenapyr poisoning, 5 cases were orally poisoned and one case was poisoned by respiratory tract and skin absorption of toxins. All of the 6 patients with chlorfenapyr poisoning were treated through the green channel for poisoning treatment, and multidisciplinary cooperation cluster treatment and nursing as well as toxicant detection were carried out. One patient was excluded because no chlorfenapyr component was detected in the toxicant detection; the remaining 5 patients had different degrees of fever, fatigue, nausea and vomiting and other symptoms in the early stage, and among them, 4 patients had high fever and aggravated degree of consciousness disturbance in the later stage of the disease, and died of ineffective treatment for 2 to 11 days after poisoning (one patient was out of contact and was expected to die), with a mortality rate of 80%. Conclusion There is no specific antidote for chlorfenapyr poisoning, and the mortality rate is extremely high. After poisoning, blood, urine and other specimens should be collected as soon as possible for toxic examination. At the same time, early gastric lavage (within 6 hours), intestinal adsorption, gastrointestinal catharsis, enema and other symptomatic treatments should be given. Continuous blood purification should be performed as soon as possible to remove blood toxins, and extracorporeal membrane oxygenation can be performed if conditions permit.

ObjectiveTo predict the targets and signaling pathways of Si Junzitang and Tongxie Yaofang in treating ulcerative colitis （UC） following the concept of "same disease with different treatments" based on the network pharmacology and explore the underlying mechanisms. MethodThe differentially expressed genes （DEGs） of UC were extracted from GeoChip. The active components and corresponding potential targets of Si Junzitang and Tongxie Yaofang were collected from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP）. The regulatory networks of Si Junzitang and Tongxie Yaofang were constructed and the protein-protein interaction （PPI） network was plotted. The core genes were predicted， followed by enrichment analysis. The UC model was induced in mice by dextran sodium sulfate （DSS） solution. Mice were randomly divided into a normal group， a UC group， a Si Junzitang group， a Tongxie Yaofang group， and a mesalazine group. Drugs were administered continuously for 14 days. The disease activity index （DAI） was scored for mice in each group. The characteristic values of hemorheology were measured. The serum levels of interleukin-6 （IL-6）， tissue factor （TF）， and hypoxia-inducible factor-1α （HIF-1α） in mice were detected. The relative mRNA expression levels of inhibitory kappa B kinase α （IKKα）， nuclear factor kappa B （NF-κB）， HIF-1α， and vascular endothelial growth factor （VEGF） were measured. ResultA total of 44 genes were obtained by network pharmacological analysis， including 17 common genes. HIF-1 pathway and hypoxia response were potential common targets of Si Junzitang and Tongxie Yaofang in the treatment of UC. The results showed that Si Junzitang and Tongxie Yaofang could significantly reduce DAI score， increase blood perfusion volume and blood cell movement speed， decrease the concentration of mobile red blood cells， reduce the levels of IL-6， TF， and HIF-1α， down-regulate the mRNA expression of IKKα， NF-κB， HIF-1α， and VEGF. ConclusionThe HIF-1 pathway and related targets may be the common targets of Si Junzitang and Tongxie Yaofang to exert different therapeutic effects on the same disease. Si Junzitang is potent in promoting Qi circulation to improve intestinal tissue hypoxia， and Tongxie Yaofang is effective in promoting blood circulation to facilitate intestinal mucosal microcirculation.

Objective: To investigate the effects of interleukin ( IL) -10 on the proliferation of HaCaT cells and CaCl2 induced expression of differentiation markers and its possible molecular mechanisms． Methods: HaCaT cells were treated with various concentrations of IL-10 (0，3，10，30 ng / ml) for different time (0，24，48，72 h) ，cell proliferation was measured using MTS，and cell cycle was determined by flow cytometry．HaCaT cells were pretreated with IL-10 (final concentration 10 ng / ml) for 1 h，then incubated with or without CaCl2 (final concentration 1. 2 mmol / L) for 24，48，72 h ，Western blot was performed to detect the effect of IL-10 on the expression of HaCaT keratinocyte differentiation markers．After pretreatment of HaCaT cells with PD98059，an inhibitor of mitogen-activated kinase-ERK1 /2，and LY294002，an inhibitor of phosphatidylinositol kinase-serine / threonine kinase (PI3K-AKT) ，the total RNA and proteins were extracted separately，real time quantitative polymerase chain reaction (RT-qPCR) and Western blot were used to examine the influence of IL-10 on the expression of differentiation markers (Keratin1，Keratin5，Involucrin) . Results : MTS results revealed that IL-10 (30 ng / ml and lower doses) did not alter the proliferation of HaCaT cells in 72 h．Flow cytometry analysis demonstrated that IL-10 had no significant influence on cell cycle progression．The results of Western blot showed that IL-10 upregulated the expression of differentiation markers Involucrin，while there was no significant effect on Keratin1 and Keratin5 ．Mechanism research analysis demonstrated that IL-10 could activate ERK1 /2 and AKT ，increase their phosphorylation levels ; RT-qPCR and Western blot results showed that PD98059 and LY294002 partially blocked IL-10 induced Involucrin expression． Conclusion At a particular concentration range，IL-10 has little effect on HaCaT proliferation ，but it partially upregulates the expression of differentiation marker Involucrin via the MAPKs-ERK1 /2 and PI3K-AKT pathways.

Objective:To solve international students' problems of learning difficulties and passive learning caused by language barriers in the process of biochemistry learning from the perspective of teachers in this specialty.Methods:Eighty international students were randomly divided into experimental group and control group. In the experimental group, the regional management mode was introduced in teaching, allowing students to speak mother tongues or English for group discussions on well-designed questions, and at the same time, classroom quizzes and stage tests were given, introducing formative evaluation to supervise students' learning and assess their learning performance. The control group received conventional teaching. The learning effects were assessed through a final exam and questionnaire survey. SPSS 25.0 was used to perform the Kruskal-Wallis H test and Nemenyi test. Results:Twenty-seven (75.00%) students believed that group discussion by region could deepen the discussion of questions; 27 (75.00%) no longer felt difficult, or even felt easy, to learn biochemistry; and nearly 90.00% of the students affirmed the formative evaluation mode, believing that it had positive effects on their learning attitude and behavior. In addition, the median exam score of the experimental group was 36.94% higher than that of the control class in the same year.Conclusions:Regional management combined with formative evaluation can promote international students' learning enthusiasm, improve their comprehensive achievement, and positively affect their learning behavior.

Adult ; Atherosclerosis ; Cardiovascular Diseases ; China ; Habits ; Humans ; Lipids

Objective To compare the success rate and complication rate between real-time ultrasound-guided and technique modified methods of right subclavian vein puncture in tumor patients during implantation of totally implanted port, and to evaluate their effectiveness and safety. Methods We randomly divided 260 tumor patients into ultrasound-guided group and technique modified group, and compared the success rate, pneumothorax, arterial injury, ectopic catheter, local hematoma, puncture times, pinch-off syndrome, etc. Results The success rate of primary puncture in the ultrasound-guided group was better than that in the technique modified group (96.92% vs. 86.15%, P=0.002). The overall complication of the ultrasound-guided group was lower than that of the technique modified group (0 vs. 9.23%, P < 0.001). The incidence of pneumothorax (0 vs. 3.85%, P=0.024) and accidental arterial injury (0 vs. 3.08%, P=0.044) in the ultrasound-guided group were lower than those in the technique modified group. There was no arteriovenous fistula and pinch-off syndrome in any group. Conclusion Compared with the technique modified group, the ultrasound-guided group has more advantages in puncture. Patients with vascular variability can be detected in time.