ObjectiveTo explore the effect of Polygonati Odorati Rhizoma polysaccharides on hyperlipidemia in mice by modulating the gut microbiota. MethodsNinety male C57BL/6J mice were randomized into the following groups （n=15）： control， model， simvastatin， low- （100 mg·kg^-1）， medium- （200 mg·kg^-1）， and high-dose （400 mg·kg^-1） Polygonati Odorati Rhizoma polysaccharides groups. Other groups except the control group were fed with a high-fat diet for the modeling of hyperlipidemia， and drug interventions lasted for 12 weeks. Serum levels of total cholesterol （TC）， triglycerides （TG）， low-density lipoprotein cholesterol （LDL-C）， and high-density lipoprotein cholesterol （HDL-C） were measured by an automatic biochemical analyzer. The pathological changes in the liver and epididymal fat were observed by hematoxylin-eosin staining， and lipid accumulation in the liver was assessed by oil red O staining. The gut microbiota was analyzed by 16S rRNA gene sequencing. ResultsCompared with the control group， the model group exhibited an increase in body weight （P<0.01）， along with marked elevations in serum levels of TC， TG， and LDL-C （P<0.05，P<0.01）. Furthermore， the model group showcased increase in the liver index and epididymal fat coefficient （P<0.05）， increased liver fat accumulation， enlargement of adipocytes in the epididymal fat， decreases in both alpha and beta diversity of the gut microbiota， and an increase in the relative abundance of Allobaculum （P<0.01）. Compared with the model group， Polygonati Odorati Rhizoma polysaccharides suppressed the increase in body weight （P<0.01）， lowered the serum levels of TC， TG， and LDL-C （P<0.05，P<0.01）， reduced the liver index and epididymal fat coefficient （P<0.05）， alleviated liver fat accumulation， and decreased the size of adipocytes in the epididymal fat. Furthermore， it enhanced the alpha and beta diversity of the gut microbiota in mice， reduced the relative abundance of Allobaculum， Erysipelotrichaceae， and Clostridium （P<0.01）， and increased the relative abundance of Akkermansia and Blautia （P<0.01）. ConclusionPolygonati Odorati Rhizoma polysaccharides can ameliorate hyperlipidemia induced by a high-fat diet in mice by regulating the diversity and composition of the gut microbiota.

Objective To form the in vitro diagnostic reagents(IVD)selection and optimization management plan and management database,and optimize the IVD management work.Methods Through the analysis of the policy background and the current management status of the IVD clinical laboratory in Beijing Hospital,the selection and optimization management plan for existing and newly applied laboratory IVD was formulated based on clinical needs.The IVD of the whole hospital was selected and optimized by combing projects,open bidding,innovative quotation methods,on-site review and other steps.The IVD management database and qualification database of Beijing Hospital was formed,and the effect from the aspects of compliance,work efficiency and cost control was evaluated.Results The selection and optimization of 1 737 IVDs in the whole hospital were completed according to the formulated IVD selection and optimization management plan.The implementation of management plan improved the work efficiency.The content of review in an average meeting was increased by more than 10 times,and the frequency of new applications for IVD access was accelerated,while the IVD cost was reduced,and the average purchase amount of the whole hospital was reduced by about 15％.The prices of key IVD products were lower after selection than before selection,and the difference was significant(t=2.493,P=0.034).Conclusion The management scheme of IVD selection and optimization was feasible,and it could achieve the goal of ensuring compliance,improving efficiency and reducing costs.

Objective To establish in vitro diagnostic(IVD)reagents closed-loop management scheme for the whole process and implement,and optimize the IVD management.Methods Based on the status quo of IVD management in Beijing Hospital,the closed-loop management scheme of the whole IVD process was designed,such as IVD application,IVD selection,IVD subscription,IVD purchase,IVD receipt,IVD inbound and outbound,and IVD use.Key indicators were selected to establish an evaluation framework.Management data,procurement data and testing data before(2020)and after(2023)implementation of the program were collected and counted by means of interviews and consulting relevant information systems,and then process management,quality management and cost management were evaluated.Results The management process was optimized,the IVD purchase time was shortened by about 60％on average,the IVD purchase did not need manual processing,the order was split in real time and sent to the corresponding supplier,and the IVD collection time was shortened by about 75％on average.IVD and test quality management were satisfactory,supplier qualification perfection reached 100％,full marks were obtained in the inter-room quality assessment,and no IVD-related adverse events were observed.The cost management was effective,and the IVD procurement cost was reduced by about 15％.IVD cost fine management models were established for four items,namely,human immunodeficiency virus antibody assay,hepatitis C antibody assay,treponemal antibody assay and hepatitis B surface antigen quantitative assay.The average value of IVD loss was 0.07％～1.21％,and the standard deviation was 0.07％～0.66％.Conclusion The IVD whole process closed-loop management scheme is feasible,which can improve the efficiency of IVD management,ensure the quality of IVD and detection,reduce the cost of IVD,and refine the cost management work.

Objective To evaluate the professional competency of the clinicians with DRGs indexes. Methods The homepages of medical records of the hospital from January to June in 2018 were extracted, and the conventional evaluation indexes ( i. e. percentage of drug expenditure, percentage of medical consumables expenditure, and percentage of antimicrobials application ) of each clinician were obtained. " CN-DRGs" burster was used to calculate the DRGs indexes. The weighted RSR was applied to evaluate the professional competency of the resident physicians. Results A comprehensive evaluation of the professional competency of 438 resident clinicians was conducted. 218, 190, and 30 clinicians fell into excellent, medium and poor categories respectively. The results of ANOVA showed that the differences of the 3 categories were significant ( F =664. 863, P <0. 001 ). Conclusions The evaluation of clinicians′professional competency based on DRGs was reasonable, objective and feasible, proving its importance for the establishment of a scientific and standardized clinicians evaluation system.

Objective To explore the scientificity and feasibility of using weighted rank-sum ratio (RSR) method based on diagnosis-related groups ( DRGs) indicators in nursing performance evaluation. Methods Homepage data of medical records were extracted from inpatients discharged in 2017, and " CN-DRGs" burster was used to obtain the DRGs data. Data of medical safety were obtained from the nursing adverse event management system, while data of nursing grading information and medical expenses were obtained from the hospital information system, and the patient satisfaction was obtained in a questionnaire survey. Based on the indicators available, the weighted RSR was applied to evaluate the nursing performance from the 11 dimensions, namely workload, nursing competence, nursing quality, nursing personnel allocation, patient satisfaction, etc. Results The results of the weighted RSR showed that 43, 39, and 6 wards of total 88 wards of the hospital were rated as excellent, medium and poor grades respectively. The results of ANOVA showed that the difference of the 3 grades was significant (F=170. 391, P<0.001). The nursing performance evaluation results were consistent with the actual situation. Conclusions The evaluation of nursing performance with weighted RSR method based on DRGs indicators prove its practical application value, as this method can not only provide data support for nursing personnel allocation, but also provide reference for nursing quality evaluation and supervision.

Objective To evaluate the effect of ganglioside ( GM-1) preconditioning on endoplas-mic reticulum stress ( ERS)-dependent apoptosis during spinal cord injury induced by bupivacaine in rats. Methods One hundred and eight clean-grade healthy male Sprague-Dawley rats, aged 8 weeks, weighing 250-300 g, were divided into 3 groups ( n=36 each) using a random number table method: control group (group C), bupivacaine group (group B) and GM-1 pretreatment group (group G). In group B, 5％bupivacaine 0. 12 μl/g was intrathecally injected at 1. 5 h intervals, 3 times intotal. In group G, GM-120μl ( 30 mg/kg) was intrathecally injected, and 24 h later bupivacaine was intrathecally injected according to the method previously described in group B. Immediately after intrathecal injection and at 1, 3, 5, 7 and 14 days after intrathecal injection, the maximum percentage of anti-nociceptive effects (％MPE) was detected, the hindlimb motor function score ( BBB score) was evaluated, and spinal cord tissues were har-vested for determination of cell apoptosis ( using TUNEL) and expression of caspase-12 and CCAAT/enhan-cer-binding protein homologous protein ( CHOP ) protein and mRNA ( by Western blot or quantitative real-time polymerase chain reaction) . The apoptosis rate was calculated. Results Compared with group C, the％MPE and apoptosis rate were significantly increased, the BBB score was decreased, and the expression of CHOP and caspase-12 protein and mRNA was up-regulated in group B ( P＜0. 05) . Compared with group B, the ％MPE and apoptosis rate were significantly decreased, the BBB score was increased, and the ex-pression of CHOP and caspase-12 protein and mRNA was down-regulated in group G ( P＜0. 05) . Conclu-sion GM-1 preconditioning reduces bupivacaine-induced spinal cord injury possibly through inhibiting ERS-dependent apoptosis in rats.

Objective To investigate the clinical efficacy of sequential nasal flow ventilation after extubation in patients with acute respiratory failure (referred to as respiratory failure).First of all,before and after extubation in HFNCO group,the respiratory parameters (PaO2,PaCO2,pH,lactic acid value,oxygenation index,HR,RR and LVEF) were compared with each other.The circulatory parameters (PaO2,PaCO2,pH,lactate,oxygenation index,HR,RR),clinical outcomes at the end of treatment / comorbidities (delirium,diarrhea,reintubation,ICU stay after extubation).Methods PaO2,PaCO2,pH value,lactate value at 1 h,6 h,12 h and 24 h after extubation in HFNCO group were not significantly different from those before extubation (all P＞ 0.05) (P ＜0.05).The LVEF of patients after extubation was slightly higher than that before extubation (0.59 ± 0.09 vs.0.60 ± 0.09),and the difference was not statistically significant Significance (P＞ 0.05).PaO2,PaCO2,pH and lactate value in HFNCO group and NIV group at 1 h,6 h,12 h and 24 h after extubation showed no significant difference (all P＞ 0.05).The effect of HFNCO on improving the oxygenation index after extubation was better than that of NPV group (P ＜0.05).HR and RR before extubation were higher or higher in HFNCO group than those in NPV group lower HR,RR better (P ＜0.05).The incidence of diarrhea (33.33％ vs.38.89％) and reintubation rate (6.1％ vs 13.9％) in HFNCO group were lower than those in NIV group (38.89％),but the difference was not statistically significant (all P＞ 0.05).The incidence of delirium in HFNCO group (18.18％ vs.41.67％) and ICU stay time after extubation (2.00 to 3.50) were statistically significant (all P ＜0.05).Results There were no significant differences in the arterial blood gas analysis (PaO2,PaCO2,pH,lactate value),PaO2,PaCO2,pH value,lactate value and LVEF at 1 h,6 h,12 h and 24 h before and after extubation in HFNCO group (all P＞ 0.05) Slightly higher than before extubation (0.59 ± 0.09 vs.0.60 ± 0.09),the difference was not statistically significant (P＞ 0.05).PaO2,PaCO2,pH and lactate value in HFNCO group and NIV group at 1 h,6 h,12 h and 24 h after extubation showed no significant difference (all P＞ 0.05).The incidence of diarrhea (33.33％ vs.38.89％) and reintubation rate (6.1％ vs.13.9％) in HFNCO group were lower than those in NIV group (38.89％),but the difference was not statistically significant (all P＞ 0.05).The incidence of delirium (18.18％ vs.41.67％),and ICU stay time (2.00 to 3.50) in HFNCO group were significantly lower than those in NIV group (all P＜0.05).Conclusions For acute respiratory failure patients after mechanical ventilation extubation,sequential administration of HFNCO and NIV can provide stable and effective oxygen therapy support;relative to the NIV,HFNCO can effectively improve patients oxygenation index,improve patient comfort and reduce the incidence of delirium And ICU stay time.

Objective To evaluate the efficacy of one stage anterior debridement combined with posterior pedicle screw fixation in the treatment of cervical intervertebral space infection.Methods From June 2010 to June 2016,28 cases were fixed by anterior debridement combined with the posterior vertebral pedicle screws for the cervical intervertebral space infection,19 males and 9 females.The average age was 45-74 years (58±14.5 years old).21 cases (75％) were spontaneous infection,of which 6 cases were diabetes mellitus,15 cases were over 60 years old.The remaining 7 cases (25％) were intervertebral space infection after radiofrequency ablation of the cervical spine.All patients were excluded from tuberculosis and Brucella infection.All patients underwent hematological examination,with emphasis on WBC,ESP and CRP.All patients received JOA score before operation,applied antibiotic according to blood culture and drug sensitive test.All patients underwent one stage anterior debridement combined with posterior pedicle screw fixation,and the operative time and bleeding volume were recorded.After the operation,intravenous antibiotic therapy was continued,and the application of antibiotics was guided according to the results of ESP and CRP,and the time for the application of antibiotics was recorded.Follow up was performed at 3 months,6 months and 1 years after operation respectively.The JOA score and postoperative cervical lordosis Cobb angle were recorded.Results All operations were successfully completed in this group.The operation time was 130-225 min,with an average of 145.5±12.7 min.The intraoperative blood loss was 40-100 ml,with an average of 67±35.2 ml.The incision was healed in one stage.The time of application of antibiotics in 28 patients was 21-87 days,with an average of 30.8±8.7 days.The longest application time of antibiotics was 87 days,and no relapse was found during follow-up.The postoperative JOA score increased from 11.3± 1.2 to three months 14.9 ± 1.96 postoperatively and 6 months 15.1 ± 1.55 and 1 years 16.5±0.48 after operation.The JOA score was significantly higher than that before operation.No significant loss and change of the Cobb angle in the cervical spine surgery were found.All cases had good bone graft fusion at 1 years.Conclusion One stage anterior debridement combined with posterior pedicle screw fixation is a safe and effective method for the treatment of cervical vertebra instability and nerve function injury caused by cervical intervertebral space infection.It provides a new way for the treatment of cervical intervertebral space infection.

Objective To investigate the clinical efficacy of lumbar-sacurm-iliac screws fixation in the treatment of complicated sacral fractures.Methods From January 2012 to October 2012,18 complicated sacrum fracture patients with unstable pelvic fractures and cauda equina dysfunctionwere retrospectively studied,which Gibbons score were all 4 points.Surgical treatment was performed by posterior lumbar-sacurm-iliac screw fixation combined with sacral decompression.The fixation stage can be extended to L4,S2 level by fracture.According to the patient's nerve injury and fracture displacement surgery sacral decompression and observation of nerve root injury.Ater full decompression,correct the vertical displacement and rotate the displacement,and then place the cross further fixed.The first 3 months after surgery,the patient reviewed once a month,3 months after the patient review once every six months.Results 18 patients underwent surgery for 2-21 d after injury,with an average of 10.2 d.The operation time is 150-240 min,an average of 180 min.Intraoperative blood loss of 600-2 000ml,an average of 1 100ml.The time of follow-up was 13-34 months,with an average of 23.4 months.Gibbons score averaged 4 points from preoperative to 2.78 points,the difference was statistically significant.Preoperative patients with an average angle of 42.89,postoperative 21.94,the difference was statistically significant.Postoperative Majeed scores averaged 64.5 points.Excellent in 3 cases,good in 3 cases,can be 7 cases,poor in 5 cases,excellent rate was 33.33％.Preoperative visual analogue scale (VAS) score averaged from 8.78 points before surgery to 2.22 points,this difference was statistically significant.The results of Tometta and Matto method were excellent in 5 cases,3 cases were good,7 cases were available,5 cases were poor,excellent and good rate was 44.44％.Conclusion Lumbarsacurm-iliac screw fixation in the treatment of complex sacral fractures can achieve a good reduction of fracture and attain satisfied nerve decompression,and more conducive to oatients faster and better recovery.

With the continuously exploration,in recent years,further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation.In addition,pedicle screw implantation in cervical spine is considered as a technique with high safety and reliability,which can be widely used in cervical trauma fracture,cervical instability,degenerative,inflammatory,benign or malignant tumor,deformity and other neck diseases.Because of the tremendous differences between upper cervical spine (C1,C2) and lower cervical spine (C3-7) in anatomical morphology,cervical pedicle screw implantation in C1 and C2 differs from in lower cervical spine.Due to the similar structure of C3-7,pedicle screw implantation methods are based on the same principle and sharing a few points in common.The pedicle screw technique can be classified in two groups according to the practice methods:navigation technology and manual placement of cervical pedicle screw.Navigation nailing is considered as reliable,easy handing,and with clear operative vision,however,with disadvantages as complex procedures,highly cost operation equipment,and risk in navigation draft.Therefore,manual placement of pedicle screw is more reasonable and practical comparing with the former.In this study,it analyzed anatomical characteristics of lower cervical pedicle and the measurement of pedicle structure,discussed technique of manual placement of pedicle screw in lower cervical spine and biomechanical study of pedicle screw,and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.