酒精性肝硬化患者不适当住院日影响因素分析

?????? 目的 测算酒精性肝硬化理论住院日,探究其影响因素,为制定临床路径提供依据。方法 收集418位患者资料,用住院日适当性评价方案对患者9 694个住院日进行逐一分析,测算酒精性肝硬化的理论住院日,然后用SPSS 20.0对不适当住院日进行单因素和多因素分析。结果 16.6%的住院日是不恰当的,等待检查报告和等待手术导致的不适当住院日占76.09%;术前等待日和肝功能Child-Pugh分级是影响不适当住院日的两大因素。结论 不适当住院日处于中间水平,应加强各科室之间的沟通协调,在医技科室和网络上加强管理是关键。     

周六手术在医院运行管理中的价值和意义

目的 通过开展周六手术,缩短病人平均术前等待日及平均住院日。在保证医疗质量的前提下,达到提高效率,增加产能的目的。方法 在多部门协作的基础上,开展周六手术,改变原有人力配置方式和手术流程,以配合周六手术的进行。结果 手术流程再造后,与之前同期相比术前等待日缩短25.00%, 月平均手术台次增加12.35%, 病人平均住院日降低9.22%。结论 开展周六手术,能缩短患者平均住院日和术前等待日,为患者节约宝贵的时间和金钱,在一定程度上解决了患者看病难、看病贵的问题,提高了医院的工作效率。     

DRGs IE15组在临床路径管理前后的费用影响分析

目的 探讨临床路径对DRGs付费IE15组费用的影响。方法 对某三级甲等医院骨关节科2012年DRGs试点IE15组146例病历实行临床路径管理,分析其平均住院费用和平均住院天数的情况,并与2011年166例病历未实行临床路径管理的结果进行比较。结果 某三级甲等医院骨关节科IE15组实行临床路径管理后的平均住院费用(10 463.65元)和平均住院日（4.03天）明显低于实行临床路径管理前的平均住院费用（11 373.27元）和平均住院日（4.90天）（分别有P＜0.05和P＜0.000 1）。结论 临床路径可以降低DRGs的费用和住院日。     

我院开展日间手术的效果评价与分析

目的 探索开展日间手术的临床应用价值。方法 对照分析开展日间手术前后相关学科和主要病种平均住院日、例均费用的变化。结果 日间手术使全院和相关科室、相应病种的平均住院天数明显缩短,例均住院费用明显下降。结论 开展日间手术可明显缩短人均住院天数、减少人均住院费用,是解决当前“看病难、看病贵”的一条非常有效的途径。     

临床路径管理系统对医院运营效率的影响研究

目的 以某综合性三甲医院2010—2011年普通外科7个住院病种为研究对象,探讨临床路径管理应用系统对医院运营效率的影响。 方法 采用病例对照研究方法。 结果 (1) 研究组住院日中位数为11天,明显低于对照组住院日中位数（P＜0.05）;(2) 研究组平均住院费用为30 826.90元,对照组平均住院费用与研究组平均住院费用相比无显著差异（P＞0.05）。结论 医院临床路径管理系统可以有效的缩短患者住院天数,对于控制住院费用有间接控制作用,但没有直接降低住院费用。     

某三甲医院高额住院费用构成及成本控制分析

?????? 目的 通过对高额住院费用病例的费用构成及基本特征进行统计分析,探询高额费用发生的主要原因,为控制成本、遏制医疗费用过快增长提供参考依据。方法 选取某三级甲等综合医院2011年单个病人1次住院费用10万元以上的病例297例进行统计分析。结果 297例高额住院费用病例主要以损伤类疾病为主;药品、材料构成主要费用;不同住院天数对医疗费用具有明显影响。结论 对常见高额住院费用病例实施重点监控,控制药品、高值耗材及高新技术准入,缩短平均住院日是控制高额医疗费用的主要途径。     

综合性医院平均住院日绩效指标集的构建与应用

目的 构建以平均住院日为核心的绩效指标集,在此基础上,制定绩效目标及关键控制举措,并跟踪实际的执行效果。方法 收集2008年12月—2013年6月共计55个月的重点科室平均住院日数据,运用相关性分析和多元线性回归提取影响平均住院日的显著因素,根据模型结论,研究分析绩效控制目标和举措并进行应用。结果 现阶段有效缩短平均住院日应主要解决“收容收治比及床位资源的利用效率”两对关键矛盾,模型应用后,医院院整体平均住院日由原来的15.7天降低为11.6天,重点科室平均住院日由19.2天降低为14.6天。结论 平均住院日绩效指标集的应用有助于优化医院资源配置,达到显著提高整体运营效率的目的。     

品管圈降低肝胆外科非计划再手术发生率的应用研究

??????? 目的 降低肝胆二科非计划再次手术发生率。方法 综合运用品管圈的管理方法,分析影响非计划再次手术的主要原因,制定针对性措施实施过程改进。结果 实施改进措施后,非计划再次手术发生率由1.12%降低至0.21%,达到目标值＜0.5%（P=0.045）,月平均住院日由14.32天缩短至10.52天（P<0.001）。结论 品管圈管理方法的应用显著降低非计划再次手术发生率,缩短患者平均住院日,有利于提升手术质量,减少不良事件发生,保障患者生命安全。     

超长住院日患者分布特征与影响因素分析

目的 分析新疆某三级甲等医院超长住院日患者分布情况及其影响因素。方法 采用Logistic回归模型。结果 费别、性别、病种、出院转归、是否转科与是否手术是住院日超长的影响因素。转科患者、手术患者以及病种是影响住院日超长的重要危险因素。结论 合理安排转科患者与手术流程,制定以病种为特点的平均住院日考核值能有效控制超长住院日,进而有效降低平均住院日。     

A Unique Protease Cleavage Site Predicted in the Spike Protein of the Novel Pneumonia Coronavirus (2019-nCoV) Potentially Related to Viral Transmissibility

正Dear Editor,In December 2019, a novel human coronavirus caused an epidemic of severe pneumonia(Coronavirus Disease 2019,COVID-19) in Wuhan, Hubei, China(Wu et al. 2020; Zhu et al. 2020). So far, this virus has spread to all areas of China and even to other countries. The epidemic has caused 67,102 confirmed infections with 1526 fatal cases     

Curcuminoids as inhibitors of thioredoxin reductase: A receptor based pharmacophore study with distance mapping of the active site

Curcumin is the yellow pigment of turmeric that interacts irreversibly forming an adduct with thioredoxin reductase (TrxR), an enzyme responsible for redox control of cell and defence against oxidative stress. Docking at both the active sites of TrxR was performed to compare the potency of three naturally occurring curcuminoids, namely curcumin, demethoxy curcumin and bis-demethoxy curcumin. Results show that active sites of TrxR occur at the junction of E and F chains. Volume and area of both cavities is predicted. It has been concluded by distance mapping of the most active conformations that Se atom of catalytic residue SeCYS498, is at a distance of 3.56 from C13 of demethoxy curcumin at the E chain active site, whereas C13 carbon atom forms adduct with Se atom of SeCys 498. We report that at least one methoxy group in curcuminoids is necessary for interation with catalytic residues of thioredoxin. Pharmacophore of both active sites of the TrxR receptor for curcumin and demethoxy curcumin molecules has been drawn and proposed for design and synthesis of most probable potent antiproliferative synthetic drugs.     

Comparative morphology of the carpel in the Liliaceae: Hewardieae, Petrosavieae, and Tricyrteae

The young pistils in the melanthioid tribes, Hewardieae, Petrosavieae and Tricyrteae, are uniformly tricarpellate and syncarpous. They lack raphide idioblasts. All are multiovulate, with bitegmic ovules. The Petrosavieae are marked by the presence of septal glands and incomplete syncarpy. Tepals and stamens adhere to the ovary in the Hewardieae and the Petrosavieae but not in the Tricyrteae. Two vascular bundles occur in the stamens of the Hewartlieae and Tricyrtis latifolia. Ventral bundles in the upper part of the ovary of the Hewardieae are continuous with compound septal bundles and placental bundles in the lower part. Putative ventral bundles occur in the alternate position in the Tricyrteae and putative placental bundles in the opposite. position in the Petrosavieae. The dichtomously branched stigma in each carpel of the Tricyrteae is supplied by a bifurcated dorsal bundle.     

Enterovirus 71 3C proteolytically processes the histone H3 N-terminal tail during infection

Highlights
1. The N-terminal tail of histone H3 is specifically cleaved during EV71 infection.
2. Viral protease 3C is identified as a protease responsible for proteolytically processing the N-terminal H3 tail.
3. Our finding reveals a new epigenetic regulatory mechanism for Enterovirus 71 in virus-host interactions.     

Detection of EBV and HHV6 in the Brain Tissue of Patients with Rasmussen’s Encephalitis

Rasmussen’s encephalitis (RE) is a rare pediatric neurological disorder, and the exact etiology is not clear. Viral infection may be involved in the pathogenesis of RE, but conflicting results have reported. In this study, we evaluated the expression of both Epstein-Barr virus (EBV) and human herpes virus (HHV) 6 antigens in brain sections from 30 patients with RE and 16 control individuals by immunohistochemistry. In the RE group, EBV and HHV6 antigens were detected in 56.7% (17/30) and 50% (15/30) of individuals, respectively. In contrast, no detectable EBV and HHV6 antigen expression was found in brain tissues of the control group. The co-expression of EBV and HHV6 was detected in 20.0% (6/30) of individuals. In particular, a 4-year-old boy had a typical clinical course, including a medical history of viral encephalitis, intractable epilepsy, and hemispheric atrophy. The co-expression of EBV and HHV6 was detected in neurons and astrocytes in the brain tissue, accompanied by a high frequency of CD8⁺ T cells. Our results suggest that EBV and HHV6 infection and the activation of CD8⁺ T cells are involved in the pathogenesis of RE.     

Perinatal Vertical Transmission of Chikungunya Virus in Ruili,a Town on the Border between China and Myanmar

正Dear Editor,Chikungunya virus (CHIKV), an arbovirus in the family of Togaviridae, genus Alphavirus, is transmitted by the A.aegyptii or A. albopictus mosquito, and causes disease in humans characterized by fever, rash, and arthralgia (Silva and Dermody 2017; Suhrbier 2019). It was first reported in 1953 in Tanzania, and caused only a few outbreaks and sporadic cases in Africa and Asia in last century. However, in the epidemic in 2004, CHIKV acquired mutations that conferred enhanced transmission by the A. albopictus mosquito(Schuffenecker et al. 2006). Since then, it has successively caused outbreaks in Africa, the Indian Ocean, South East Asia, the South America, and Europe (Zeller et al. 2016).     

Development of a Novel Reverse Transcription Loop-Mediated Isothermal Amplification Method for Rapid Detection of SARS-CoV-2

In conclusion, the novel visual RT-LAMP assay is a simple, rapid, and sensitive approach for detection of SARS-CoV-2, and it is ready for application in primary care and community hospitals or health care centers, and even patients' own houses in response to the current SARS-CoV-2 epidemic because the assay does not require sophisticated equipment and skilled personnel. Furthermore, it is also ready to be used in fields for screening samples from wild animals and environments to facilitate the identification of potential intermediate hosts that mediate the cross-species transmission of SARS-CoV-2 from bats to humans.