In 2021, China launched a national pilot project of diagnosis-intervention packet (DIP) in 71 cities, which is an important measure of medical insurance payment system reform. DIP was originated in Guangdong. This paper summarizes the reform experience and effectiveness of Guangzhou and Shenzhen, discusses how to promote the reform of DIP in the national pilot cities from the medical insurance agencies aspect and the hospitals aspect, so as to provide a reference for the national pilot cities.
Spanning two decades since the 1st generation spinal robotics inception, the robot-assisted spine surgery (RSS) technology has evolved through generations, culminating in the 4th generation characterized by real-time visual navigation and wire-free screw placement. The fundamental principles of RSS technology include surgical planning, tracking, image registration, and robotic arm control technologies. Currently, RSS technology is maturely employed in thoracolumbar procedures and is progressively being applied in cervical surgeries, spinal tumor resections, and percutaneous operations, offering advantages in reducing tissue trauma and exposure to radiation, thereby improving patient outcomes. Emerging research also focuses on the cost-effectiveness of clinical applications and robot-specific complications. With the integration of artificial intelligence into surgical planning, RSS technology is poised to further incorporate emerging technologies and expand its application across a broader clinical spectrum.
目的：探讨新生儿先天性肠闭锁患儿在围手术期间的护理措施。方法：分析26例新生儿先天性肠闭锁患儿术前、术后护理措施。结果：本组患儿除1例术后放弃治疗，5例术后因新生儿肺炎转入新生儿科继续治疗外，其余20例均痊愈，平均住院日为10天。结论：对本组患儿通过术前积极保暖，有效的胃肠减压，静脉补液，纠正水、电解质紊乱；术后采取加强气道湿化，胸部物理疗法等措施进行呼吸道管理，严格执行消毒隔离制度，预防感染，合理肠内联合肠外营养支持等护理措施，减少并发症的发生，提高了患儿的生存质量。
目的：探讨物理治疗在新生儿经会阴肛门形成术中的治疗效果，提高护理质量。方法：将103例新生儿肛门直肠畸形患儿，随机分为实验组和对照组，对照组实施常规护理治疗。实验组在常规护理治疗基础上，实施物理治疗。结果：物理治疗实验组患儿肛周的局部红肿情况明显低于对照组（P＜0.05），实验组患儿的平均住院日较对照组明显缩短（P＜0.05）。结论：物理治疗能降低新生儿经会阴肛门成形术术后并发症的发生率，缩短住院天数，降低医疗费用，提高护理质量。
Objective To investigate the characteristics of cognitive function and its correlation to neuroendocrine status in patients with refractory depression. Methods A total of 41 patients diagnosed by ICD-10 as depression onset who have been treated with more than two antidepressants drugs, fulfilled the criteria of refractory depression. Another 40 patients diagnosed by ICD-10 as depression onset but who have not been treated, or have been treated with only one antidepressant drug were selected as controls. Patients in both groups were evaluated by WAIS-RC, STROOP, VF, TRAILS A, B, TOH and M-WCST, and the concentrations of CORT, ACTH, T3, FT3, T4, FT4, TSH were also determined. Results A significant difference was found in VF between the refractory depression group and the control group. This showed that the damage to short-term memory, attention and interference rejection capability was much more serious in the refractory depression group. The ACTH concentration in the refractory depression group was significantly different from that of the control group, which indicated that the damage to the Hypothalamic-pituitary-adrenal axis was more serious in the refractory depression group. In particular in relation to memory and attention defect. Conclusion Changes in the levels of CORT, ACTH, TSH, FT3 and T4 may be correlated to cognitive function damage in patients with refractory depression.
目的 了解5.12汶川大地震24个月后震区小学生的心理健康状况，为进行震后长期心理危机干预提供依据。 方法 于2010年5月即汶川大地震发生后24个月，分别使用创伤应激量表儿童版（CRIES-13）、儿童抑郁障碍自评量表（DSRSC）、长处与困难问卷（SDQ）学生版，调查了553名来自于彭州灾区的小学生的心理健康状况及其影响因素。 结果 ① 灾区小学生CRIES-13总分为（22.98 ± 12.29）分，其中大于划界分（30分）者为143人，占总人数的25.9%；女性总分高于男性（Z=?2.031，P=0.042）；震后被转移至安全地点的时间越长（OR=1.025，P=0.012）、家人伤亡越严重（OR=1.141，P=0.021），其CRIES-13总分大于划界分的可能性越高。② 灾区小学生DSRSC总分为（11.07 ± 5.78）分，其中总分大于划界分（15分）者为120人，占总人数的21.7%；女性总分高于男性（Z=?2.508，P=0.012）；灾区小学生的年龄（r=0.098，P=0.021）、震后被转移至安全地点的时间（r=0.117，P=0.004）与DSRSC总分呈正相关。③ 灾区小学生SDQ总困难因子得分为（14.97 ± 5.44）分，62.9%的人报告自身存在主观困难；女性的情绪因子、亲社会因子得分高于男性（Z=?3.123，P=0.002；Z=?2.243，P=0.025）；年龄越大，品行因子（χ2=7.604，P=0.023）、亲社会因子（χ2=8.102；P=0.017）得分增加。 结论 震后灾区小学生的心理健康状况受到性别、年龄、震后被转移至安全地点的时间、家人伤亡程度的影响，震后长期心理危机干预应综合考虑这些相关因素以确定高危人群。
Objective To analyze the risk factors of prethrombotic state of obstructive sleep apnea and hyponea syndrome (OSAHS), providing basis and reference for the prevention of prethrombotic state of OSAHS. Methods Two hundred and thirty-eight patients excluding the presence of possible effects of coagulation factors from June 2014 to July 2016 were diagnosed as OSAHS by polysomnography (PSG) and underwent coagulation, thrombosis, fibrinolysis, and inflammatory factors testing. Fifty-six patients met the standard of prethrombotic state (prethrombotic state group) and 59 patients randomly selected from the remaining 182 patients did not meet the standard (non-prethrombotic state group). The age, sex, body mass index (BMI), sleep apnea and hypopnea index (AHI), interleukin-6 (IL-6), complicating chronic obstructive pulmonary disease (COPD) and hypertension were compared between two groups. Results Non conditional Logistic regression analysis showed that the risk factors of prethrombotic state of OSAHS were age (OR=1.202, 95%CI: 1.107 to 1.305), IL-6 (OR=1.127, 95%CI: 1.014 to 1.252), AHI (OR=1.151, 95%CI: 1.055 to 1.256), and complicating COPD (OR=4.749, 95%CI: 1.046 to 21.555). Conclusion Age, AHI, IL-6, and complicating COPD may be the risk factors of prethrombotic state of OSAHS, among which complicating COPD may be the most important risk factor.
Objective To analyze morbility，risk factors，etiology，treatment and outcome of nosocomial pulmonary fungal infections in respiratory intensive care unit（RICU）.Methods Forty-seven respiratory RICU patients with nosocomial pulmonary fungal infections between July 2000 and June 2005 were retrospectively analyzed.Results All of the 47 cases were clinically diagnosed as probable nosocomial pulmonary fungal infections，with the morbidity of 10.8% significantly higher than general wards（1.8%，Plt;0.005）.COPD and bacterial pneumonia were the major underlying diseases of respiratory system with a percent of 38.30% and 36.17%，respectively.Forty-one patients (87.2%) had risk factors for fungal infections.Compared with general wards，the proportion of Aspergillosis was higher in RICU without significant difference (Pgt;0.1)；the proportions of Candida glabrata and Candida tropicalis were higher too，but that of Candida krusei was relatively low.The effective rate of antifungal treatment was 79.1% and fluconazol was the most common used antifungal agents.The mortality of fungal infection in RICU was higher than that of general wards but without significant difference（Pgt;0.1）.Conclusion The morbidity of nosocomial pulmonary fungal infection in respiratory RICU is higher than that in general wards.The proportions of infection caused by Aspergilli and some Candida resistant to fluconazol is relatively high.Early and effective treatment is needed in these patients considering the poor prognosis.
目的 调查极重灾区某中学学生的创伤后应激障碍（PTSD）症状检出率及影响因素，为进一步开展灾后心理卫生服务提供依据。 方法 2008年9月下旬，对汶川地震的极重灾区都江堰某镇中学1 500名同学进行调查，获有效问卷1 498份。采用一般情况调查问卷、儿童事件影响量表（CRIES-13）中文版进行集体施测。 结果 某镇中学学生灾后4个月PTSD症状检出率29.71%（445/1 498）。经非条件逐步logistic回归筛选PTSD症状的影响因素有：地震时是否受伤（OR=1.995，P=0.000）、性别（OR=1.785，P=0.000）、绝望感（OR=1.597，P=0.000）、是否目睹死亡（OR=1.344，P=0.000）、年龄（OR=1.308，P=0.000）、是否目睹受伤（OR=1.262，P=0.000）、地震时是否被困（OR=1.209，P=0.011）、震后居住地点（OR=1.182，P=0.000）、是否目睹垮塌（OR=1.176，P=0.000）、家人情况（OR=1.104，P=0.000）、地震后是否住院（OR=0.828，P=0.041）12个因素。 结论 在灾后重建过程中，该中学的学生PTSD症状检出率较高，其与地震时是否受伤、性别、绝望感、是否目睹死亡、年龄、是否目睹受伤、地震时是否被困、震后居住地点、是否目睹垮塌、家人情况、地震后是否住院呈显著相关。
目的 探讨经转化生长因子-β1 ( TGF-β1) 基因修饰的未成熟树突状细胞(imDC) 预处理大鼠小肠移植受体后的外周血及移植肠浸润T 细胞的变化及意义。方法 选用近交系F344/ N 和BN 大鼠建立全小肠异位移植模型,实验分4 组(每组24 只) : 同基因移植组(BN-BN 组) 、异基因移植组( F344/ N-BN 组) 、异基因移植+ TGF-β1 基因转染imDC 组( F344/ N-BN + TGF2β1 组) 和异基因移植+ TGF-β1 基因转染imDC + FK506 组( F344/ N-BN + TGF-β1 + FK506 组) 。各组大鼠分别于术后3 、5 、7 d 各处死6 只,获取大鼠静脉血和移植肠。应用免疫组化SABC 法检测受体鼠外周血及移植肠CD4 + 、CD8 + 、CD25 + 细胞和IL-4 的表达。同时行移植肠组织病理学检查并观察大鼠生存情况。结果 TGF-β1 修饰的DC 细胞能显著抑制外周血及移植肠浸润淋巴细胞CD4 + 、CD8 + 及CD25 + 的表达,并提高IL-4 的表达; 显著延长受体大鼠的生存时间,但移植肠仍有排斥反应的病理组织学征象。结论 TGF-β1 修饰的DC 通过影响受体外周血及移植肠浸润T 细胞对大鼠小肠移植发挥免疫抑制作用。