OBJECTIVE To optimize the clinical drug list of diagnosis-related group （DRG）， reduce the drug cost of patients， and increase the DRG settlement rate. METHODS By selecting BR23 disease group in the department of neurology of a hospital as the research object， data mining technology was used to explore the medication rule of the disease group， and the key monitored drugs were scored by comprehensive evaluation of drugs， thus optimizing the clinical drug list of disease groups. The hospitalization information of patients enrolled in the disease group in December 2022 was selected as the pre-optimization data， and the hospitalization information of patients enrolled in the disease group in September 2023 was selected as the post-optimization data. The implementation effect of the optimized list was evaluated by comparing the medical quality and drug cost data between the two groups. RESULTS After optimizing the clinical drug list， the settlement rate of this disease group increased from 84.36% before optimization to 104.70%； there was significant reduction in hospitalization drug cost and total hospitalization cost （P＜ 0.05）； the consumption of key monitored drugs significantly decreased. CONCLUSIONS Data mining technology helps explore the clinical medication rules of disease groups， which can be used by pharmacists to improve the settlement rate of DRG through effective pharmaceutical intervention.

Objective To investigate the mechanism of circadian clock protein Bmal1(Bmal1)on renal injury with chronic periodontitis,we established an experimental rat periodontitis model.Methods Twelve male Wistar rats were randomly divided into control and periodontitis groups(n=6,each group).The first maxillary molars on both sides of the upper jaw of rats with periodontitis were ligated by using orthodontic ligature wires,whereas the control group re-ceived no intervention measures.After 8 weeks,clinical periodontal parameters,including probing depth,bleeding index,and tooth mobility,were evaluated in both groups.Micro-CT scanning and three-dimensional image recon-struction were performed on the maxillary bones of the rats for the assessment of alveolar bone resorption.Histopatholo-gical observations of periodontal and renal tissues were conducted using hematoxylin-eosin(HE)and periodic acid-Schiff(PAS)staining.Renal function indicators,such as creatinine,albumin,and blood urea nitrogen levels,and oxida-tive stress markers,including superoxide dismutase,glutathione,and malondialdehyde levels,were measured using bio-chemical assay kits.MitoSOX red staining was used to detect reactive oxygen species(ROS)content in the kidneys.The gene and protein expression levels of Bmal1,nuclear factor erythroid 2-related factor 2(Nrf2),and heme oxygenase-1(HO-1)in rat renal tissues were assessed using real-time quantitative polymerase chain reaction(RT-qPCR)and immuno-histochemical staining.Results Micro-CT and HE staining results showed significant bone resorption and attachment loss in the maxillary first molar region of the periodontitis group.Histological examination through HE and PAS staining revealed substantial histopathological damage to the renal tissues of the rats in the periodontitis group.The findings of the assessment of renal function and oxidative stress markers indicated that the periodontitis group exhibited abnormal levels of oxidative stress,whereas the renal function levels showed abnormalities without statistical significance.Mito-SOX Red staining results showed that the content of ROS in the renal tissue of the periodontitis group was significantly higher than that of the control group,and RT-qPCR and immunohistochemistry results showed that the expression levels of Bmal1,Nrf2,and HO-1 in the renal tissues of the rats in the periodontitis group showed a decreasing trend.Conclu-sion Circadian clock protein Bmal1 plays an important role in the oxidative damage process involved in the renal of rats with periodontitis.

Objective This study aims to explore changes in uncoupling protein 2(UCP2)in experimental periodonti-tis-associated renal injury induced by ligation and investigate the effect of UCP2 on renal injury induced by periodontitis.Methods Twelve Wistar male rats were randomly divided into two groups:control and periodontitis groups.A periodon-tal model was built by ligating the maxillary first molars area with 0.2 mm orthodontic ligature wire.After 8 weeks,the in-traoral condition of the rats was observed and periodontal clinical indices such as gingival bleeding index(BI),periodontal probing depth(PD),and tooth mobility(TM)were detected.The maxillary bone was scanned by Micro CT to observe the alveolar bone resorption.The tissue mineral density(TMD),bone mineral density(BMD),bone volume fraction(BV/TV),trabecular thickness(Tb.Th),trabecular bone separation(Tb.Sp)were recorded,and the distance from the enamel bone boundary to the alveolar crest(CEJ-ABC)of the maxillary first molar was measured.The oxidative stress indexes such as malondialdehyde,glutathione(GSH),and superoxide dismutase(SOD)were detected using frozen rat kidney tissue.The gene expression of UCP2,nuclear factor erythroid 2-related factor 2(Nrf2),and peroxisome proliferator-activated receptor gamma coactivator-1α(PGC-1α)was observed by quantitative real-time polymerase chain reaction(qRT-PCR)test.The gingival tissue of the rats was used for immunohistochemical staining to observe the expression of the UCP2 protein.The fixed rat kidney tissue was used for hematoxylin-eosin(HE),periodic acid-schiff(PAS),MitoSOX Red,JC-1,and immu-nohistochemical staining to observe the renal histopathology,the level of reactive oxygen species(ROS),the level of mito-chondrial membrane potential,and the expression of UCP2,Nrf2,and PGC-1α protein.Rat serum was collected to detect renal function indices,namely,blood urea nitrogen(BUN),creatinine(Cre),and albumin(Alb).Results Compared with the control group,the periodontitis group showed red,swollen,and soft gingival tissue,with gingival probing bleeding,periodontal PD increased,tooth loosening,alveolar bone resorption,decreased TMD,BMD,BV/TV,and Tb.Th indices,and increased Tb.Sp index,CEJ-ABC,and gingival UCP2 protein expression.Compared with the control group,the levels of MDA and ROS in the kidney tissue of periodontitis rats and the gene and protein expression of UCP2 increased,and the levels of MMP,GSH,and SOD and the gene and protein expression of Nrf2 and PGC-1α decreased.Renal functional indi-ces,namely,BUN,Cre,and Alb,were not significantly different between the two groups.Conclusion UCP2 may play a role in renal injury induced by periodontitis through oxidative stress.

Objective:To explore the effect of nursing interventions based on systematic concept in elderly patients with type 2 diabetes.Methods:From May 2018 to August 2019, 120 elderly patients with type 2 diabetes in Hangzhou Red Cross Hospital were selected by convenience sampling. The patients were randomly divided into observation group and control group with 60 cases each. Patients in each group were given nursing interventions based on systematic concept and routine nursing respectively. The anxiety, depression, benefit finding and coping modes of the two groups were compared before and after the intervention.Results:Before the intervention, there was no statistical difference between the two groups in the scores of anxiety, depression, benefit finding and behavior pattern ( P>0.05) . After intervention, the scores of anxiety and depression in the two groups decreased, and the scores in the observation group were lower than those in the control group, with statistically significant differences ( P<0.05) . After the intervention, the scores of benefit finding of the two groups increased, and that of the observation group was higher than that of the control group, and the differences were statistically significant ( P<0.05) . After intervention, the scores of confronting of the two groups increased, and that of observation group was higher than that of the control group, and the differences were statistically significant ( P<0.05) . After intervention, the scores of avoidance and resignation in the two groups decreased, and the scores in the observation group were lower than those in the control group, with statistically significant differences ( P<0.05) . Conclusions:Systematic concept nursing can reduce the anxiety and depression of elderly patients with type 2 diabetes, improve the benefit finding, increase the sense of benefit, and urge patients to adopt a positive coping style to deal with the disease.

Objective? To retrieve, assess and integrate the best evidence for diet management in cirrhosis and hepatic encephalopathy patients. Methods? The evidences involving guidelines, evidence summary, best practice information book, systematic review and expert consensus on diet management for cirrhosis and hepatic encephalopathy patients were retrieved in National Guideline Clearinghouse (NGC), National Institute for Health and Clinical Excellence (NICE), the Cochrane Library, Joanna Briggs Institute (JBI) Evidence-based Practice Database, ClinicalKey Database, EBSCO Database, Pubmed, China Biology Medicine (CBM) by computer. The quality evaluation of literatures and the evidence extraction were carried out. This study also determined the quality grade and recommendation level of extracted evidence. Results? A total of 13 literatures were included with 2 guidelines and 11 systematic reviews. There were 9 best evidences summarized from five aspects including nutrition assessment, diet frequency, choice of foot category, intake demand of energy and protein, and other nutritional intake in hepatic encephalopathy patients. Conclusions? Cirrhosis and hepatic encephalopathy patients usually are with malnutrition which plays a decisive role in prognosis. This study summarized the best evidence on diet management of cirrhosis and hepatic encephalopathy patients so as to provide an evidence-based basis for medical staff and cirrhosis and hepatic encephalopathy patients to carry out diet management.

Objective To explore the diagnostic value of serum lipoprotein(a)[Lp(a)]in cerebral infarction by a model of Logistic regression and receiver operating characteristic(ROC)curve.Methods A total of 316 patients with cerebral thrombosis from Foshan Hospital Affiliated to Southern Medical University were col-lected.According to the diagnostic criteria,the patients were divided into cerebral thrombosis group(196 ca-ses)and non-cerebral thrombosis group(120 cases).All the subjects were tested for Lp(a)by immune turbi-dimetry.To evaluate the diagnostic value of Lp(a)by applying logistic regression model,drawing ROC curves and calculating the area under the curve(AUC).Results The P25,P50,P75of Lp(a)in cerebral thrombosis group and non-cerebral thrombosis group were 97.23,238.22,430.01 and 29.80,92.27,233.86,the average rank were 185.42 and 114.52,the differences in the two groups were significant(P<0.05).Logistic regres-sion showed that the correlation between Lp(a)level and cerebral thrombosis was positive,the partial regres-sion coefficient(B)was 0.005,Wald value was 31.295.It suggested that when the levels of Lp(a)was higher the risk of cerebral thrombosis increased.The most valuable diagnosis level was 305.80 mg/L.And the area under the ROC curve(AUC)was 0.724,which has moderate diagnostic efficacy.Diagnostic specificity was 91.7%,misdiagnosis rate was 8.3%,negative predictive value was 48.7%,sensitivity was 40.8%,omission rate was 59.2%,positive predictive value was 88.9%.Conclusion The level of serum Lp(a)has high diag-nostic specificity for the diagnosis of cerebral thrombosis.

FimA has been characterized as an important virulence factor for Porphyromonas gingivalis (Pg). These structures play a major role in the mechanisms of adhesion and invasion of Pg to host cells, and can induce cellular activation and cytokines release. FimA can also promote biofilm formation and induce immuno-inflammatory response of host cells. Many studies have characterized FimA to be associated with periodontitis and cardiovascular disease. Pg strains are classified into six types based on divergent nucleotide sequences of the fimA gene (types Ⅰ、Ⅰb、Ⅱ、Ⅲ、Ⅳ andⅤ). The expression of fimbriae is regulated by the fimA gene, which may be the key factor that leads to virulence diversities of Pg, At present, the research on the pathogenesis of FimA mainly focuses on periodontitis and atherosclerosis, which is of great significance for the prevention and treatment of diseases. This paper reviewed the pathogenic effect of FimA in the development of above mentioned two diseases and its application in the prevention.

Objective To analyze the statistical correlation between 25-hydroxyl vitamin D and bone metabolism parameters in-cluding parathyroid hormone(PTH),N-terminal osteocalcin (N-MID),calcitonin(CT),bone alkaline phosphatase(BALP),and dis-cuss the significance in clinical diagnosis,prevention and treatment.Methods 411 cases of hospitalized patients were collected from January to September in 2014,including 316 women,95 men,age arranged from 37 to 96,the average age was(69.29±12.21).Use electro chemiluminescence immunoassay(ECLIA)method to detect the levels of 25-hydroxyl vitamin D,PTH,N-MID,CT,and BALP in hospitalized patients and explore the relationship of 25-hydroxyl vitamin D and serum bone markers in osteoporosis pa-tients.Results It was showed that vitamin D and PTH,BALP were negative correlation(P <0.05);There was no significant corre-lation between calcitonin and N-terminal osteocalcin(N-MID)(P >0.05 ).Regression analysis showed that regression equation for vitamin D and blood bone markers was:Y =19.02-0.066PTH-0.09BALP.Conclusion There was some correlation between 25-hydroxyl vitamin D and PTH,BALP in patients with osteoporosis.By taking a combination test of these markers,it can provide some basic data for clinical osteoporosis diagnosis,prevention and control.

Objective To explore the medication rules of State Medical MasterYan Zhenghua. Methods The prescriptions including Angelicae Sinensis Radix that built by Pro. Yan were collected to build a database based on Traditional Chinese Medicine (TCM) inheritance assist system(V2.0.1). After analyzed by the statistical reports module and the data analysis module which were from TCM inheritance assist system, and the methods of data-mining that including association rules and apriori algorithm, the frequency of single medicine, the frequency of drug combination, the association rules between drugs and core drug combinations which all were including Angelicae Sinensis Radix can be get from the database.Results The prescriptions including Angelicae Sinensis Radix were commonly used to treat stomach-ache, arthralgia syndrome, irregular menstruation and other syndromes. The highest frequency used drugs were Radix Paeoniae Rubra, Radix Paeoniae Alba, Radix Salviae Miltiorrhizae, Pericarpium Citri Reticulatae, Rhizoma Cyperi, and so on. The most frequency drug combinations were “Angelicae Sinensis Radix, Radix Paeoniae Rubra”, “Radix Paeoniae Alba, Angelicae Sinensis Radix”, and “Radix Salviae Miltiorrhizae, Angelicae Sinensis Radix”. The drug association rules that the confidence was more than 0.9 were “Fructus Jujubae-Angelicae Sinensis Radix”, “Fructus Amomi Villosi-Angelicae Sinensis Radix”, “Radix Codonopsis-Angelicae Sinensis Radix”, and “Os Draconis-Concha Ostreae”, and so on.Conclusion The drugs in the prescriptions containing Angelicae Sinensis Radix that built by Pro. Yan mostly had the effects of cooling blood, replenishing blood, and promoting blood circulation for removing blood stasis, which reflected the clear thought when making prescriptions.

Background Orbital fracture in children has its own characteristics.Choosing the suitable plastic materials is the effective measurement to improve the successful rate of surgery.Absorbable plate filling provides a new material for children with orbital fracture.However,few studies compare the effectivity and safety between absorbable plate filling and conventional filling.Objective The aim of this study was to compare the longterm efficacy and safety between absorbable plate and Medpor implants in the repair of pediatric orbital fracture.Methods Clinical data of 72 eyes of 72 pediatric patients with orbital fracture who received surgicals reconstruction in Beijing Tongren Eye Center from 2008 April to 2014 August were respectively analyzed,including 28 patients with absorbable plates filling and 44 patients with Medpor implants.Demography and preoperative clinical signs were matched between the two groups.Operative procedure was same except the implanted materials.The functional training of extraocular muscle was performed since the second day after surgery in both groups.The imaging findings of the orbit were evaluated by computed tomography (CT) before and after surgery.The patients were followed-up for avarage 12.7 months after operation.The therapeutic effectiveness and safety were compared between the different implants,such as incidence of enophthalmos,extraocular movement impairment and diplopia,and the sensory deficit of skin and complications were documented.Results Extraocular muscle movement improved and diplopia alleviated or disappeared in 92.9％ (26/28) in the absorbable plate group and 90.9％ (40/44) in the Medporgroup,without significant difference between the two groups (P=0.57).The sensory deficit of skin was found in 13 eyes (46.4％) and 20 eyes (45.5％ in the absorbable plate group and Medpor group,respectively,and there was no significant difference between the two groups (P =0.56).CT revealed that the anatomical reconstruction of orbits could be achieved in all patients in both groups without the shifting of implants and extrusion.No enophthalmos and postoperative infection were found in absorbable plate group,however,the residual enophthalmos or late infection was found in I eye for each in the Medpor group.Conclusions Both the absorbable plate and Medpor implants show good results for reconstruction of pediatric orbital fracture.Absorbable plate is an ideal material for pediatric orbital blowout fracture because of fewer postoperative complications.