Objective To explore the challenges and reform strategies of price management in public hospitals under the background of high-quality development.Methods This study uses a tertiary hospital in Guangdong as a case study,analyzed the current situation and challenges of price management from an overall perspective,and proposed effective strategies.Results With the ongoing reforms in medical service prices and health insurance policies,and the increasing need to improve patient expe-rience and hospital operational efficiency,we have identified significant limitations in traditional price management models.These limitations include the inability to adapt to continuous changes in external pricing policies,inadequate organizational structure and professional knowledge,lack of regulatory systems and information platforms,and lagging development of medical service pro-jects.To address these issues,the hospital conducted comprehensive evaluations of the Price Management Committee,Price Man-agement Department,and relevant business departments,adopting a problem-oriented approach to fill institutional gaps and ac-tively respond to new challenges.Conclusion Through the implementation of institutionalized,standardized,intelligent and dy-namic reform measures for price management,the level and ability of hospital price management can be improved and meet the re-quirements of high-quality development.

In this paper, chemical derivatization-high performance liquid chromatography was used to determine the potential genotoxic impurities chloroacetyl chloride and chloroacetic acid, respectively, in the raw material of azintamide.Derivatization was carried out using 2-nitrophenylhydrazine followed by the determination.Separation was performed on a Thermo Syncronis C18 column (250 mm × 4.6 mm, 5 μm), with mobile phase consisting of 0.1% phosphoric acid in water (A) and acetonitrile(B) by gradient elution, at a flow rate of 1 mL/min.The column temperature was 40 °C and the detection wavelength was 226 nm.The blank solvent, derivatization reagent, and azintamide did not interfere with the peak of the test substance, and the target component was well separated from the others.For impurities chloroacetyl chloride and chloroacetic acid, the limits of detection (LOD) were 7.5 ng/mL and 15 ng/mL respectively. There was a good linear relationship between the integral area and the concentration in the range of 30-300 ng/mL.The sample recovery rate was in the range of 87.37% ~ 109.75%.The two methods established in this study have good specificity, good precision, high sensitivity and simple operation, which can be used for the trace determination of potential genotoxic impurities chloroacetyl chloride and chloroacetic acid in the raw material of azintamide.

ObjectiveTo study the mechanism of Shenbai Jiedu prescription inhibiting the proliferation of HCT116 colorectal cancer （CRC） cells by regulating the phosphatase and tensin homolog deleted on chromosome ten （PTEN）/phosphatidylinositol 3-kinase （PI3K）/ protein kinase B （Akt） signaling pathway. MethodShenbai Jiedu prescription was extracted by water extraction and alcohol precipitation to prepare freeze-dried powder. HCT116 cells were cultured in vitro， and treated with different concentrations of Shenbai Jiedu prescription （2， 4， 8， 16 g·L^-1）. The inhibitory effect of Shenbai Jiedu prescription on the proliferation of HCT116 cells was tested by methyl thiazolyl tetrazolium （MTT）. Real-time quantitative PCR was used to detect the mRNA expression levels of PTEN， PI3K， Akt， glycogen synthase kinase-3β （GSK-3β）， c-Myc， survivin and Cyclin D₁. Western blot was employed to measure the protein expression levels of PTEN， phosphorylated PTEN （p-PTEN）， PI3K， Akt， phosphorylated Akt （p-Akt）， GSK-3β， phosphorylated GSK-3β （p-GSK-3β）， c-Myc， survivin and Cyclin D₁， β-catenin nuclear import was explored by immunofluorescence assay. ResultCompared with the control group， Shenbai Jiedu prescription inhibited the proliferation of HCT116 cells in a dose-dependent manner （P<0.01）. Compared with the control group， the mRNA expression levels of PTEN and GSK-3β were up-regulated whereas those of PI3K， Akt， c-Myc， survivin and CyclinD₁ were down-regulated after treatment with Shenbai Jiedu prescription （P<0.01）. The protein expression levels of PTEN， p-PTEN and GSK-3β were up-regulated whereas those of PI3K， Akt， p-Akt， GSK-3β， p-GSK-3β， c-Myc， survivin and CyclinD₁ were down-regulated （P<0.05， P<0.01）. Immunofluorescence assay showed that Shenbai Jiedu prescription suppressed β-catenin nuclear import in HCT116 cells. ConclusionShenbai Jiedu prescription inhibited the proliferation of HCT116 cells via the mechanism of regulating the PTEN/PI3K/Akt signaling pathway.

Objective:To screen risk factors of postoperative venous thromboembolism (VTE) in patients in department of spinal surgery and establish a risk prediction model and conduct external validation.Methods:This study was a case-control study. Using the convenient sampling method, a total of 93 patients with VTE who underwent spinal surgery from May 2019 to April 2021 in the Second Xiangya Hospital of Central South University were selected as as the thrombosis group, while 100 patients who underwent spinal surgery without VTE during the same period were selected as the control group. A self-designed questionnaire about the risk factors of VTE in patients undergoing spinal surgery was used to investigate the patients. Binomial Logistic regression was used to analyze the risk factors of postoperative VTE in patients with spinal surgery and R software was used to establish a nomogram prediction model. A total of 46 patients (23 patient with VTE and 23 patients without VTE) from Department of Spinal Surgery from May and June 2021 were selected to verify the prediction model.Results:Age ( OR=1.603, 95% CI: 1.036-2.483) , operation time ( OR=0.253, 95% CI: 0.123-0.518) , use of internal fixation ( OR=0.128, 95% CI: 0.043-0.384) , application of bone cement ( OR=0.176, 95% CI: 0.048-0.652) , D-dimer ( OR=0.360, 95% CI: 0.147-0.884) and plasma fibrinogen degradation product ( OR=0.024, 95% CI: 0.006-0.091) were risk factors for VTE in spinal surgery patients. The prediction model was established according to the risk factors. The prediction agreement rate of the model was 0.865 and the sensitivity was 0.742. The model was externally validated with a sensitivity of 0.761, a specificity of 0.565 and an area under the receiver operating characteristic curve of 0.810. Conclusions:Age, operation time, use of internal fixation, application of bone cement, D-dimer and plasma fibrinogen degradation products are risk factors for postoperative VTE in patients with spinal surgery. Predictive models based on risk factors can predict the risk of VTE in spinal surgery patients.

Objective: To investigate the effect of intracoronary administration of nicorandil prior to primary percutaneous coronary intervention (PPCI) on myocardial perfusion and short-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 158 patients with STEMI undergoing PPCI from January 2014 to December 2015 in Fuzhou General Hospital were enrolled consecutively in this prospective controlled randomized trial. Patients were assigned into three groups with random number table: the nicorandil group (patients received intracoronary administration of 6 mg nicorandil after guide wire or balloon successfully crossed the target lesion, n=53), the nitroglycerin group (patients received intracoronary administration of 300 μg nitroglycerin after after guide wire or balloon successfully crossed the target lesion, n=52) and the control group(patients received routine treatment, n=53). The primary outcomes were myocardial perfusion, including the levels of corrected TIMI frame count (cTFC), and the incidence of no reflow or slow flow after PPCI. The secondary outcomes included the incidence of major adverse cardiovascular events (MACE) during hospitalization (all-cause death, reperfusion arrhythmia within 2 hours after PPCI, angina within 24 hours after PPCI, new heart failure or worsening cardiac function, and repeat revascularization) and within 3 months of follow-up (all-cause death, nonfatal myocardial infarction, repeat revascularization, post-infarction angina, and re-hospitalization for congestive heart failure). Results: The age of enrolled patients was (62.9±11.3) years old, and 130 cases (82.3%) of them were male. The median time of symptom-onset to balloon was 4.50 (3.20, 6.43) hours. There were significantly difference in cTFC immediately after PPCI((21.68±7.43)frames, (24.74±8.66)frames, and(27.06±10.40)frames), incidence of no reflow or slow flow after PPCI(5.7%(3/53), 13.5%(7/52), and 22.6%(12/53)), ST-segment resolution at 2 hours after procedure(90.6%(48/53), 84.6%(44/52), and 74.5%(38/53)), and reperfusion arrhythmia at 2 hours after procedure(15.1%(8/53), 36.6%(19/52), and 34.0%(18/53)) among the 3 groups(P<0.01 or 0.05). In the multivariate logistic regression models, intracoronary administration of nicorandil could lower the cTFC level (OR=0.17, 95%CI 0.10-0.41, P=0.001), acted as a protecting factor on lowering the incidence of no reflow or slow flow (OR=0.13, 95%CI 0.02-0.96, P=0.045) and reperfusion arrhythmia (OR=0.26, 95%CI 0.09-0.74, P=0.012), as well as facilitating the ST-segment resolution at 2 hours after procedure (OR=4.62, 95%CI 1.14-18.82, P=0.033). However, observed parameters were similar between intracoronary administration of nitroglycerin group compared with control group (all P>0.05). MACE within 3 months of follow-up were similar among the 3 groups(all P>0.05). Conclusion Intracoronary administration of nicorandil prior to balloon dilation can significantly improve the myocardial perfusion and reduce the occurrence of reperfusion arrhythmia during PPCI for STEMI, but does not affect the short-term prognosis in STEMI patients.

Objective To design and formulate a electronic preoperative preparation checklist for applying in the preoperative preparation,to reduce missing rate in preoperative preparation and transfer,to improve patient satisfaction,to avoid operation delay and medical accident caused by inappropriate preparation.Methods A total of 145 patients with surgery from March 2013 to February 2013 were as experimental group,and 158 patients with surgery from March 2012 to February 2012 were as control group.The experimental group was used electronic preoperative preparation checklist for preoperative preparation and transition,and the control group was used conventional methods.The incidence of mistake for preoperative preparation and transfer and both surgeon's and patient's satisfactory were compared between two groups.Results After applying the electronic preoperative preparation checklist,the incidence of mistake for preoperative preparation and transfer in experimental group reduced significandy to 1.37％(2/145) and 4.83％ (7/145),compared with the incidence of control group 6.33％(10/158),11.39％(18/158),and the differences between two groups were statistically different (x2=4.870,4.305,P ＜ 0.05).Both surgeon's and patient's satisfactory were improved dramatically,the satisfactory in experimental group improved to 100.00％(50/50)and 97.93％(142/145),compared with the satisfactory of control group 90.00％(45/50) and 90.51％(143/158),and the differences between two groups were statistically different(x2=5.263,7.459,P ＜ 0.05).Conclusions Implementing the electronic preoperative preparation checklist can reduce the incidence of mistake before operation and ensure patient operation schedule.Therefore,it could improve nursing care quality and efficiency.

Objective To study the risk factors of mortality in severe sepsis and septic shock patients. Methods 142 patients with severe sepsis and septic shock in ICU were observed and divided into alive group (98 patients)and dead group (44 patients)by using hospital mortality.The risk factors of mortality in severe sepsis and septic shock patients were assessed by binary logistic regression.Results Independent mortality risk factors were inotropic agents (OR =4.329,95%CI:1.045 -17.937,P =0.043),blood glucose >10 mmol/L (OR =3.771,95%CI:1.214 -11.710,P =0.022)and APACHE Ⅱ score (OR =3.098,95%CI:2.012 -4.760,P =0.000),while PaO2 /FiO2 after early goal -directed therapy (EGDT)was protective factor (OR =0.682,95%CI:0.500 -0.930, P =0.016).Conclusion Severe sepsis and septic shock patients with inotropic agents,blood glucose >10mmol/L, high APACHE Ⅱ score and decreased PaO2 /FiO2 after EGDT indicate poorly prognosis.

Objective To investigate the risk factors for the occurrence of cerebral infarction in patients with capsular warning syndrome (CWS). Methods Consecutive patients with transient ischemic attack (TIA) meeting the CWS clinical manifestations were col ected retrospectively. They were divided into either a cerebral infarction group or a non-cerebral infarction group according to the brain diffusion weighted imaging findings. The independent risk factors for patients with CWS were identified through the comparison of demographic and baseline clinical data. Results A total of 39 patients were enrol ed, including 25 males (64. 1%) and 14 females (35. 9%), and their mean age was 58. 9 ± 10. 3 years. There were 21 patients in the cerebral infarction group and 18 in the non-cerebral infarction group. Compared with the non-cerebral infarction group, the age of patients in the cerebral infarction group was older (62. 5 ± 9. 3 years vs. 54. 8 ± 10. 2 years;t=2. 470, P=0. 018). The constituent ratio of the patients with a history of previous stroke or transient ischemic attack was higher (33. 3% vs. 5. 6%; P=0. 049), the fasting blood glucose level was higher (8. 2 ± 3. 2 mmol/L vs. 6. 0 ± 1. 3 mmol/L; t=2. 748, P=0. 009), and ABCD2 score was higher (5. 2 ± 1. 1 vs. 3. 5 ± 1. 1;t=4. 734, P<0. 001). Multivariate logistic regression analysis showed that the ABCD2 score was an independent risk factor for cerebral infarction in patients with CWS (odds ratio, 4. 529, 95% confidence interval 1. 233-16. 627;P=0. 023). Conclusions The higher ABCD2 score was an independent risk factor for the occurrence of cerebral infarction in patients with CWS. It can be used as an evaluation tool for predicting the risk of cerebral infarction in patients with CWS.

Objective To evaluate the efficacy of oxycodone in preventing catheter-related bladder discomfort (CRBD) during recovery from anesthesia in the patients undergoing general anesthesia.Methods A total of 155 male patients, aged 18-60 yr, weighing 46-75 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective spinal surgery performed under general anesthesia, were randomly divided into 3 groups: control group (group C, n =52), oxycodone group (group O, n=51), and sufentanil group (group S, n=52).After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated.At 15 min before the end of surgery, oxycodone 0.07 mg/kg was injected intravenously in group O, sufentanil 0.10 μg/kg was injected intravenously in group S, and the equal volume of normal saline was given in group C.The emergence time and extubation time were recorded.Riker sedation-agitation scale (SAS) score was recorded at 5, 15 and 30 min, and 1, 2 and 4 h after extubation (T1-6).The occurrence and severity of CRBD within 4 h after surgery, and occurrence of nausea and vomiting and respiratory depression were observed and recorded.Results Compared with group C, the SAS score at T1-4 and incidence and severity of CRBD were significantly decreased, and the emergence time and extubation time were prolonged in group S, and the SAS score at T1-6 and incidence and severity of CRBD were significantly decreased (P＜0.05) , and no significant change was found in emergence time and extubation time in group O (P＞0.05).Compared with the group S, the SAS score at T1-4 was significantly increased, the SAS score at T5-6 and incidence and severity of CRBD were decreased, and the emergence time and extubation time were shortened in group O (P＜0.05).There was no significant difference in the incidence of nausea and vomiting and respiratory depression between the three groups (P＞0.05).Conclusion Oxycodone 0.07 mg/kg injected intravenously at 15 min before the end of surgery can prevent the occurrence of CRBD during recovery from anesthesia in the patients undergoing general anesthesia.

A total of 114 cases of femoral hernia undergoing 3D Prolene patching via femoral approach were examined for duration of surgery , length of stay , recurrence , postoperative pain and complications.Among them, 53 cases received both pre-and post-operative Doppler ultrasonic examinations.The vein thrombus ,diameter and flow rate of femoral vein were observed to compare with the pre-operative data to learn whether it had difference or not.The operative duration was 13.3 minutes.There was no event of recurrence ,compression,stricture or thrombosis of femoral vein.