Objective:To investigate the correlation between heart rate variability (HRV) and the progression of Parkinson's disease (PD).Methods:A total of 78 patients with PD who received treatment at the Second People's Hospital of Lianyungang from January 2020 to May 2022 were included in this study. According to Hoehn-Yahr (H&Y) staging, patients with PD were divided into three subgroups: mild PD group (H&Y stage < 2), moderate PD group (2 ≤ H&Y < 3), and advanced PD group (H&Y ≥ 3). Another 66 healthy people who concurrently underwent physical examinations in the same hospital were included in the control group. A dynamic electrocardiogram examination was performed in each group for HRV analysis. The Spearman test was used to analyze the correlation between HRV parameters, disease course, and H&Y staging.Results:Standard deviation of all sinus R-R intervals during 24 hours (SDNN), root mean square of successive RR interval differences during 24 hours (RMSSD), percentage normal-to-normal interval deviation greater than 50 ms (PNN50%) during 24 hours, high frequency component (HF), and low frequency component (LF) in the PD group were (94.76 ± 21.65), (23.41 ± 8.67), (3.50 ± 4.32), (96.57 ± 53.84), and (124.92 ± 82.43), respectively, which were significantly lower than (115.65 ± 13.31), (32.48 ± 8.08), (5.61 ± 5.25), (109.11 ± 39.51), and (143.95 ± 72.77) in the control group ( Z = -6.17, -6.22, -3.90, -2.14, -2.53, all P < 0.05). Disease duration, H&Y staging, and the LED level in the mild PD, moderate PD, and advanced PD groups showed an upward trend (all P < 0.05). The Mini-Mental State Examination (MMSE) score in the advanced PD group was significantly higher than that in the mild PD group ( P < 0.05). There was no significant difference in MMSE score between the mild and moderate stages and between moderate and advanced stages ( P > 0.05). Both SDNN and LF in the mild PD group were (110.61 ± 18.53) and (192.02 ± 95.98), respectively, which were significantly lower than (91.97 ± 15.23) and (113.29 ± 56.71) in the moderate PD group ( t = 4.18, 3.55, both P < 0.01). SDNN and LF in the advanced PD group were (80.90 ± 21.03) and (68.10 ± 44.86) respectively, which were significantly lower than those in the moderate PD and advanced PD groups ( t = 4.88, 2.23, 5.54, 3.26, all P < 0.05). There were no significant differences in RMSSD, PNN50%, and HF among the mild PD, moderate PD, and advanced PD groups (all P > 0.05). SDNN and LF were negatively correlated with PD course ( r = -0.36, -0.37, both P < 0.05) and H&Y staging ( r = -0.46, -0.49, both P < 0.05). Conclusion:Sympathetic dysfunction in PD patients is closely related to the onset and progression of PD, and it can reflect the severity of the disease.

Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) on admission for early neurological deterioration (END) in patients with lacunar stroke.Methods Patients with acute lacunar stroke admitted to the Department of Neurology,the Second People's Hospital of Lianyungang from June 2015 to October 2017 were enrolled retrospectively.END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale (NIHSS) score within 72 h of admission.Multivariate logistic regression analysis was used to determine the independent risk factors for END.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for END in patients with lacunar stroke.Results A total of 309 patients with acute lacunar infarction were enrolled,including 180 males (58.2％),aged 59.7 ±7.3 years;65 patients (21.0％) in END group and 244 (79.0％) in non-END group.Multivariate logistic regression analysis showed that after adjusting for other confounders,NLR was an independent risk factor for END in lacunar stroke (odds ratio 4.508,95％ confidence interval 3.128-7.547;P＜0.001).ROC curve analysis showed that the area under the curve of NLR predicting END in patients with lacunar stroke was 0.725 (95％ confidence interval 0.671-0.776;P ＜ 0.001);the optimal cut-off value was 2.32,the sensitivity of predicting END was 61.21％,and the specificity was 72.54％.Conclusion The elevated NLR after admission is an independent risk factor for END in patients with lacunar stroke,which has certain value for early identification and prediction of END.

Adult ; Aged ; Coma ; physiopathology ; Consciousness ; physiology ; Consciousness Disorders ; physiopathology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Persistent Vegetative State ; physiopathology ; Photic Stimulation ; methods ; Recovery of Function ; physiology ; Treatment Outcome

Objeetive To investigate the associations of plasma homocysteine (Hcy) level and methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism with white matter lesion (WML) in a Chinese Han population.Methods A toal of 104 patients with WML and 74 controls were recruited.Hcy level and MTHFR gene C677T polymorphism were determined.The degree of severity of the WML was evaluated using a modified Scheltens scale.Results The plasma Hcy level (median and interquartile range,16.81 [11.33-18.92] μmol/L vs.11.40 [8.28-14.23] μmol/L;Z =5.415,P =0.001) and the proportion (85.6％ vs.54.1％;x2 =28.535,P ＜ 0.001) of patients with hyperhomocysteinemia (HHcy) in the WML group were significantly higher than those in the control group.However,there were no significant differences in the frequencies of C677T genotype (x2 =1.255,P =0.534) and allele (x2 =1.057,P =0.304).There are 89 patients with HHcy and 15 patient with normal Hcy in 104 patients with WML.The modified Scheltens scale score in the HHcy subgroup was higher that in the normal Hcy subgroup (8.06 ±5.61 vs.5.80 ±2.98;t =2.324,P=0.027).Multivariate logistic regression analysis showed that age (odds ratio[OR] 1.090,95％ confidence interval [CI] 1.049-1.133;P=0.001),hypertension (OR 1.719,95％ CI 1.645-2.307;P ＜ 0.001),and HHcy (OR 1.128,95％ CI 1.044-1.219;P =0.002) were the independent risk factors for white matter lesions.Conclusions HHcy is an independent risk factor for WML,whereas the MTHFR gene C677T polymorphism is not associated with WML.

This study summarized the experiences of disease-specific performance appraisal at tertiary hospitals in Shanghai,which was launched since year 2013 by Shanghai Hospital Development Center (SHDC). 38 tertiary hospitals in Shanghai were included in the study. A disease-specific performance appraisal system centering on quality and performance, by means of case-mix model, classified surgery management and typical disease screening, and leveraging disease and surgery difficulties analysis, and inter-hospital performance appraisal of typical diseases. This reform has established appraisal criteria of disease difficulty management,coding criteria and data norms,guiding such hospitals to consolidate their functional positioning of focusing on difficult,urgent and complicated cases in the medical service delivery system.All these efforts have paved the way for the reforms to build a hierarchical medical service system, pricing per disease, payment per disease, and consolidate performance appraisal of medical workers.

To sum up the reform of internal performance appraisal system and income allocation system of Shanghai municipal hospitals.The internal performance appraisal index system,evaluation methods and corresponding income allocation system,featuring two breaks,one change and eight elements.The reforms highlight public welfare nature of public hospitals,which is expected to create profound impacts on hospital operation and medical staff behavior.

Objective To explore methods for performance appraisal of directors of municipal hospitals in Shanghai.Methods To assess the management performance of directors of 24 tertiary hospitals each year,measured by five dimensions of social satisfaction,management efficiency,capital operation,development sustainability and staff satisfaction,and 23 indexes.Results Implementation of the performance appraisal has witnessed constant improvement of patient satisfaction and quality of medical care,as well as rational control of medical expenses and cost.In 2014 for example,the cost of emergency/outpatients per visit at such hospitals were 312 yuan and 1 5 600 yuan per hospitalization respectively,with 7.6 days of stay in average.Also improved were service efficiency,clinical research output and hospital business performance in general.Conclusion Performance appraisal of directors of public hospitals proves an important means for guiding the hospitals to adhere to public welfare, consistent with the government medical institution operation target, and to strengthen internal management of such hospitals.

This paper introduced the design ideas and general information of Shanghai in building theHospital-Link Project.Thanks to innovative information technology and service model,it achieved real-time connectivity and clinical information sharing between the 38 municipal hospitals,which enables the general reform of such hospitals citywide.

This paper uses the data collected from 138,477 patient discharge records of 37 Shanghai tertiary public hospitals in December 2013 and classifies all the records into different groups by using a localized diagnosis re-lated group tool.The coefficient of variation index ( CV) of each group was used to analyze the dispersion of average hospital cost per inpatient day for each group, in order to evaluate the suitability of diagnosis related group systems and to set the coefficients of difficulty ( relative weights) for each disease.The study has found that severity-based di-agnosis related group systems are more suitable and consistent.However, future studies should collect more detailed information on health costs in order to reflect the value of health professionals and technologies and therefore further improve diagnosis related classification and develop new systems that can be adapted to local conditions by applying the weights of different groups.

The public hospital reform is the main content of the new healthcare reform.Studying the diagnosis related group system and establishing a set of scientific and rational performance assessment, which is essential to strengthen the public hospitals'public and social benefits, improve the service capacity and enhance the specialized and delicacy management.The international diagnosis related group system localization and weight settlement have been proved suitable and consistent through the Shanghai Shenkang Hospital Development Centre.Hence, the severity-based DRGs should be introduced to reflect the actual hospitals operation and management outcome, which provides a proper guidance on the hospitals'specialized and delicacy management.