Since the new medical reform,the scale of public hospitals at all levels and types in China has grown rapidly,resulting in a series of problems such as continued increase in financial burden,excessive growth in health expenses,and serious imbalance in the distribution of social basic medical insurance funds.Due to the ambiguous understanding of the connotation of the scale of China's public hospitals and the underlying driving forces of growth,and the traditional economic explanation of the growth of public hospital scale in China is not convincing.In view of this,revealing the essential driving framework for the scale growth of public hospitals in China from a new economic perspective has become a key theoretical issue to guide the next stage of high-quality development of public hospitals in China.It used the complex system modeling method to measure the growth of China's public hos-pitals since the new medical reform,and summarized the increasingly complex institutional spectrum of contempo-rary public hospitals.Drawing on the perspectives of the system's own costs and system change costs in new insti-tutional economics,starting from the analysis of system costs,it is proposed that under the premise of price regula-tion,it is the best strategy for public hospitals to compensate for institutional costs through scale growth.Finally,based on the three situations of prisoner's dilemma game,deer hunting game,and rule-abiding game experienced by public hospitals since the new health reform,the development path of public hospitals from single scale growth to extended scale growth,and then to collaborative scale growth was summarized.

Since the new medical reform,the scale of public hospitals at all levels and types in China has grown rapidly,resulting in a series of problems such as continued increase in financial burden,excessive growth in health expenses,and serious imbalance in the distribution of social basic medical insurance funds.Due to the ambiguous understanding of the connotation of the scale of China's public hospitals and the underlying driving forces of growth,and the traditional economic explanation of the growth of public hospital scale in China is not convincing.In view of this,revealing the essential driving framework for the scale growth of public hospitals in China from a new economic perspective has become a key theoretical issue to guide the next stage of high-quality development of public hospitals in China.It used the complex system modeling method to measure the growth of China's public hos-pitals since the new medical reform,and summarized the increasingly complex institutional spectrum of contempo-rary public hospitals.Drawing on the perspectives of the system's own costs and system change costs in new insti-tutional economics,starting from the analysis of system costs,it is proposed that under the premise of price regula-tion,it is the best strategy for public hospitals to compensate for institutional costs through scale growth.Finally,based on the three situations of prisoner's dilemma game,deer hunting game,and rule-abiding game experienced by public hospitals since the new health reform,the development path of public hospitals from single scale growth to extended scale growth,and then to collaborative scale growth was summarized.

Since the new medical reform,the scale of public hospitals at all levels and types in China has grown rapidly,resulting in a series of problems such as continued increase in financial burden,excessive growth in health expenses,and serious imbalance in the distribution of social basic medical insurance funds.Due to the ambiguous understanding of the connotation of the scale of China's public hospitals and the underlying driving forces of growth,and the traditional economic explanation of the growth of public hospital scale in China is not convincing.In view of this,revealing the essential driving framework for the scale growth of public hospitals in China from a new economic perspective has become a key theoretical issue to guide the next stage of high-quality development of public hospitals in China.It used the complex system modeling method to measure the growth of China's public hos-pitals since the new medical reform,and summarized the increasingly complex institutional spectrum of contempo-rary public hospitals.Drawing on the perspectives of the system's own costs and system change costs in new insti-tutional economics,starting from the analysis of system costs,it is proposed that under the premise of price regula-tion,it is the best strategy for public hospitals to compensate for institutional costs through scale growth.Finally,based on the three situations of prisoner's dilemma game,deer hunting game,and rule-abiding game experienced by public hospitals since the new health reform,the development path of public hospitals from single scale growth to extended scale growth,and then to collaborative scale growth was summarized.

Since the new medical reform,the scale of public hospitals at all levels and types in China has grown rapidly,resulting in a series of problems such as continued increase in financial burden,excessive growth in health expenses,and serious imbalance in the distribution of social basic medical insurance funds.Due to the ambiguous understanding of the connotation of the scale of China's public hospitals and the underlying driving forces of growth,and the traditional economic explanation of the growth of public hospital scale in China is not convincing.In view of this,revealing the essential driving framework for the scale growth of public hospitals in China from a new economic perspective has become a key theoretical issue to guide the next stage of high-quality development of public hospitals in China.It used the complex system modeling method to measure the growth of China's public hos-pitals since the new medical reform,and summarized the increasingly complex institutional spectrum of contempo-rary public hospitals.Drawing on the perspectives of the system's own costs and system change costs in new insti-tutional economics,starting from the analysis of system costs,it is proposed that under the premise of price regula-tion,it is the best strategy for public hospitals to compensate for institutional costs through scale growth.Finally,based on the three situations of prisoner's dilemma game,deer hunting game,and rule-abiding game experienced by public hospitals since the new health reform,the development path of public hospitals from single scale growth to extended scale growth,and then to collaborative scale growth was summarized.

Since the new medical reform,the scale of public hospitals at all levels and types in China has grown rapidly,resulting in a series of problems such as continued increase in financial burden,excessive growth in health expenses,and serious imbalance in the distribution of social basic medical insurance funds.Due to the ambiguous understanding of the connotation of the scale of China's public hospitals and the underlying driving forces of growth,and the traditional economic explanation of the growth of public hospital scale in China is not convincing.In view of this,revealing the essential driving framework for the scale growth of public hospitals in China from a new economic perspective has become a key theoretical issue to guide the next stage of high-quality development of public hospitals in China.It used the complex system modeling method to measure the growth of China's public hos-pitals since the new medical reform,and summarized the increasingly complex institutional spectrum of contempo-rary public hospitals.Drawing on the perspectives of the system's own costs and system change costs in new insti-tutional economics,starting from the analysis of system costs,it is proposed that under the premise of price regula-tion,it is the best strategy for public hospitals to compensate for institutional costs through scale growth.Finally,based on the three situations of prisoner's dilemma game,deer hunting game,and rule-abiding game experienced by public hospitals since the new health reform,the development path of public hospitals from single scale growth to extended scale growth,and then to collaborative scale growth was summarized.

Since the new medical reform,the scale of public hospitals at all levels and types in China has grown rapidly,resulting in a series of problems such as continued increase in financial burden,excessive growth in health expenses,and serious imbalance in the distribution of social basic medical insurance funds.Due to the ambiguous understanding of the connotation of the scale of China's public hospitals and the underlying driving forces of growth,and the traditional economic explanation of the growth of public hospital scale in China is not convincing.In view of this,revealing the essential driving framework for the scale growth of public hospitals in China from a new economic perspective has become a key theoretical issue to guide the next stage of high-quality development of public hospitals in China.It used the complex system modeling method to measure the growth of China's public hos-pitals since the new medical reform,and summarized the increasingly complex institutional spectrum of contempo-rary public hospitals.Drawing on the perspectives of the system's own costs and system change costs in new insti-tutional economics,starting from the analysis of system costs,it is proposed that under the premise of price regula-tion,it is the best strategy for public hospitals to compensate for institutional costs through scale growth.Finally,based on the three situations of prisoner's dilemma game,deer hunting game,and rule-abiding game experienced by public hospitals since the new health reform,the development path of public hospitals from single scale growth to extended scale growth,and then to collaborative scale growth was summarized.

Since the new medical reform,the scale of public hospitals at all levels and types in China has grown rapidly,resulting in a series of problems such as continued increase in financial burden,excessive growth in health expenses,and serious imbalance in the distribution of social basic medical insurance funds.Due to the ambiguous understanding of the connotation of the scale of China's public hospitals and the underlying driving forces of growth,and the traditional economic explanation of the growth of public hospital scale in China is not convincing.In view of this,revealing the essential driving framework for the scale growth of public hospitals in China from a new economic perspective has become a key theoretical issue to guide the next stage of high-quality development of public hospitals in China.It used the complex system modeling method to measure the growth of China's public hos-pitals since the new medical reform,and summarized the increasingly complex institutional spectrum of contempo-rary public hospitals.Drawing on the perspectives of the system's own costs and system change costs in new insti-tutional economics,starting from the analysis of system costs,it is proposed that under the premise of price regula-tion,it is the best strategy for public hospitals to compensate for institutional costs through scale growth.Finally,based on the three situations of prisoner's dilemma game,deer hunting game,and rule-abiding game experienced by public hospitals since the new health reform,the development path of public hospitals from single scale growth to extended scale growth,and then to collaborative scale growth was summarized.

Since the new medical reform,the scale of public hospitals at all levels and types in China has grown rapidly,resulting in a series of problems such as continued increase in financial burden,excessive growth in health expenses,and serious imbalance in the distribution of social basic medical insurance funds.Due to the ambiguous understanding of the connotation of the scale of China's public hospitals and the underlying driving forces of growth,and the traditional economic explanation of the growth of public hospital scale in China is not convincing.In view of this,revealing the essential driving framework for the scale growth of public hospitals in China from a new economic perspective has become a key theoretical issue to guide the next stage of high-quality development of public hospitals in China.It used the complex system modeling method to measure the growth of China's public hos-pitals since the new medical reform,and summarized the increasingly complex institutional spectrum of contempo-rary public hospitals.Drawing on the perspectives of the system's own costs and system change costs in new insti-tutional economics,starting from the analysis of system costs,it is proposed that under the premise of price regula-tion,it is the best strategy for public hospitals to compensate for institutional costs through scale growth.Finally,based on the three situations of prisoner's dilemma game,deer hunting game,and rule-abiding game experienced by public hospitals since the new health reform,the development path of public hospitals from single scale growth to extended scale growth,and then to collaborative scale growth was summarized.

Objective:To conduct a retrospective analysis of efficacy and safety of different conversion schemes of tacrolimus to slow-release dosage forms for recipients in stable phase after renal transplantation to provide rationales for the conversion strategy of tacrolimus.Methods:From January 2020 to June 2020, clinical data were reviewed for 101 kidney transplant recipients converting from common tacrolimus dosage form to tacrolimus sustained-release dosage form during postoperative stable period.There were 62 males and 49 females with an age range of 19 to 69 years.They were divided into two groups according to iso-dose and incremental-dose switching schemes.The common dosage form of tacrolimus was converted into a sustained-release dosage form with different conversion doses, They were divided into two groups of 1∶1 conversion( n=55)and >1∶1 conversion( n=46). The clinical parameters of serum creatinine(Scr), blood urea nitrogen(BUN), alanine aminotransferase(ALT)and aspartate aminotransferase(AST), alkaline phosphatase(ALP), serum albumin(ALB), white blood cell count(WBC), urinary white blood cell(UWBC), hemoglobin(Hb)and fasting blood glucose(Glu)were compared between two groups after conversion. Results:Regarding numerical change trend after switching to tacrolimus sustained-release dosage form, drug dose/variation trend was smaller and blood drug concentration more stabilized.In two subgroups converted by 1∶1 and 1>1 initial dose, change trend of dose/blood concentration in 1∶1 conversion group appeared to be more stable.However, no inter-group difference existed in long-term parameters.Scr was lower at 1 week and 3 months after switching to extended-release dosage form( P<0.05)and BUN was lower at 2 weeks( P<0.05). In addition, at 5 months after conversion, ALT and AST significantly improved as compared with common dosage form( P<0.05). Significant differences existed in urinary WBC(UWBC)at 2/3 weeks( P<0.05). After switching for 2 weeks, hemoglobin significantly improved compared with common dosage form( P<0.05). No significant differences existed in ALP, ALB or Glu at other timepoints and pre-conversion( P>0.05). In 1∶1 switch group, renal function tended to improve.At 2 weeks, BUN was lower than pre-conversion; at 1/3 weeks, Scr was lower than pre-conversion( P<0.05). In addition, there was also a trend of improvement in liver function in 1∶1 conversion group.At 1 week and 5 months, ALT was lower than pre-conversion( P<0.05). However, no significant differences existed in AST, ALB, ALP, Glu, UWBC and serum WBC count at each timepoint between two different dose conversion groups( P>0.05). After conversion, intra-individual variability of tacrolimus trough concentration significantly improved( P<0.05). Conclusions:With the same safety and efficacy as common dosage form, sustained-release dosage form of tacrolimus may improve drug variability of individuals.When converting common dosage form into sustained-release dosage form, individual differences should be considered.While monitoring trough concentrations, proper doses should be adjusted on the basis of various clinical parameters.

Objective:To summarize the clinical features and prognosis of acute kidney injury in patients with HBV related acute on chronic liver failure (ACLF).Methods:A total of 150 patients who developed acute kidney injury (AKI) in patients with HBV related ACLF from Sep. 2010 to Sep. 2019 were reviewed retrospectively, and the gender, age, laboratory examination, Child-pugh scores, and model for end-stage liver disease (MELD) were collected and the survival of the patients were followed up to analyze the prognosis.Results:Ninety-three percent of the patients were complicated with ascites, 81% with spontaneous peritonitis, 65% with hepatic encephalopathy and 58.7% with pulmonary infection; 60 patients (60.0%) were AKI stage 1, 44 patients (29.3%) were AKI stage 2, 16 patients (10.7%) were AKI stage 3. The patients with hyponatremia had lower albumin ( t=2.571, P=0.011), higher blood urea nitrogen, serum potassium and white blood cell levels than those without hyponatremia ( t=3.184, P=0.002; t=2.069, P=0.040; t=2.251, P=0.026); 74.7% of the patients died within 30 days, and the 90 days survival rate was 16.7%. The 30 days and 90 days mortality of patients with hyponatremia was higher than that of patients without hyponatremia ( χ2=4.11, P=0.044; χ2=3.901, P=0.049 7). Kaplan-Meier analysis revealed that the patients who had abnormal uric acid pre-diagnosis of AKI, hyponatremia when diagnosis of AKI, organ damage other than liver and kidney, metabolic acidosis, upper gastrointestinal tract bleeding, hepatic encephalopathy had a poor survival. Cox regression analysis showed that other organ function damage other than liver and kidney, metabolic acidosis, and the old age, were independent risk factors of death. Conclusions:Most of the AKI patients with HBV related ACLF had ascites and spontaneous bacterial peritonitis when AKI occurred, and AKI stage 1 was common. The mortality of patients with hyponatremia was high, and the risk of death was high in patients with severe organ damage other than liver and kidney, metabolic acidosis and the old age.