Cost analysis of radical resection of malignant breast tumors under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Breast cancer is one of the most common malignant tumors in women worldwide and poses a severe threat to their health.Therefore,this study examined patients who underwent breast cancer surgery,analyzed hospitalization costs and structure,and explored the impact of China Healthcare Security Diagnosis Related Groups(CHS-DRG)management on patient costs.It aimed to provide medical institutions with ways to reduce costs,optimize cost structures,reduce patient burden,and improve service efficiency.AIM To study the CHS-DRG payment system’s impact on breast cancer surgery costs.METHODS Using the CHS-DRG(version 1.1)grouping criteria,4073 patients,who underwent the radical resection of breast malignant tumors from January to December 2023,were included in the JA29 group;1028 patients were part of the CHS-DRG payment system,unlike the rest.Through an independent sample t-test,the length of hospital stay as well as total hospitalization,medicine and consumables,medical,nursing,medical technology,and management expenses were compared.Pearson’s correlation coefficient was used to test the cost correlation.RESULTS In terms of hospitalization expenses,patients in the CHS-DRG payment group had lower medical,nursing,and management expenses than those in the diagnosis-related group(DRG)non-payment group.For patients in the DRG payment group,the factors affecting the total hospitalization cost,in descending order of relevance,were medicine and consumable costs,consumable costs,medicine costs,medical costs,medical technology costs,management costs,nursing costs,and length of hospital stay.For patients in the DRG nonpayment group,the factors affecting the total hospitalization expenses in descending order of relevance were medicines and consumable expenses,consumable expenses,medical technology expenses,the cost of medicines,medical expenses,nursing expenses,length of hospital stay,and management expenses.CONCLUSION The CHS-DRG system can help control and reduce unnecessary medical expenses by controlling medicine costs,medical consumable costs,and the length of hospital stay while ensuring medical safety.

Surgical treatment of liver cancer and pancreatic cancer under the China Healthcare Security Diagnosis Related Groups payment system

BACKGROUND Data from the World Health Organization’s International Agency for Research on Cancer reported that China had the highest prevalence of cancer and cancer deaths in 2022.Liver and pancreatic cancers accounted for the highest number of new cases.Real-world data(RWD)is now widely preferred to traditional clinical trials in various fields of medicine and healthcare,as the traditional research approach often involves highly selected populations and interventions and controls that are strictly regulated.Additionally,research results from the RWD match global reality better than those from traditional clinical trials.AIM To analyze the cost disparity between surgical treatments for liver and pancreatic cancer under various factors.METHODS This study analyzed RWD 1137 cases within the HB1 group(patients who underwent pancreatectomy,hepatectomy,and/or shunt surgery)in 2023.It distinguished different expenditure categories,including medical,nursing,technical,management,drug,and consumable costs.Additionally,it assessed the contribution of each expenditure category to total hospital costs and performed cross-group comparisons using the non-parametric Kruskal–Wallis test.This study used the Steel–Dwass test for post-hoc multiple comparisons and the Spearman correlation coefficient to examine the relationships between variables.RESULTS The study found that in HB11 and HB13,the total hospitalization costs were significantly higher for pancreaticoduodenectomy than for pancreatectomy and hepatectomy.Although no significant difference was observed in the length of hospital stay between patients who underwent pancreaticoduodenectomy and pancreatectomy,both were significantly longer than those who underwent liver resection.In HB15,no significant difference was observed in the total cost of hospitalization between pancreaticoduodenectomy and pancreatectomy;however,both were significantly higher than those in hepatectomy.Additionally,the length of hospital stay was significantly longer for patients who underwent pancreaticoduodenectomy than for those who underwent pancreatectomy or liver resection.CONCLUSION China Healthcare Security Diagnosis Related Groups payment system positively impacts liver and pancreatic cancer surgeries by improving medical quality and controlling costs.Further research could refine this grouping system and ensure continuous effectiveness and sustainability.

General design of Sutong Bridge

The main span of Sutong Bridge is a double-pylon,double-plane cable-stayed bridge with steel box girder,which has the world's longest central span of 1 088 m within cable-stayed bridges.To overcome problems caused by severe meteorological conditions,perplexing hydrological conditions,deep buried bedrock and higher navigation level,many new technics and methods were created.Keys including structural system,steel box girder,stayed cable,tower,pier,tower foundation,collision avoidance system,wind-resistance,seismic-resistance,structural nonlinear response and structural static stability were presented individually in this paper.

Substructure isolation and damage identification using free responses

Structural health monitoring （SHM） has become a hot and intensively researched field in civil engineering. Thereinto, damage identification play an important role in maintaining structural integrity and safety. Many effective methods have been proposed for damage identification. However, accurate global identification of large real-world structures is not easy due to their com- plex and often unknown boundary conditions, nonlinear components, insensitivity of glohal response to localized damages, etc. Furthermore, global identification often requires lots of sensors and involves large number of unknowns. This is costly, rarely feasible in practice, and usually yields severely ill-conditioned identification problems. Substructuring approach is a possible solution： substructuring methods can focus on local small substructures; they need only a few sensors placed on the substruc- ture and yield smaller and numerically much more feasible identification problems. This paper proposed an improved sub- structure method using local free response for substructure damage identification. The virtual supports are constructed by Sub- structure Isolation Method （SIM） using the linear combination of the substructural responses. The influence of the global errors is isolated by adding the virtual supports on the main degree of freedoms （DOFs） of the substructure. Through the correlation analysis, the substructural modes are selected and used for damage identification of the substructure. A plain model of cable stayed bridge is used for the verification of the proposed method.

Key technology and innovation of Sutong Bridge

Sutong Bridge is a cable-stayed bridge across Yangtze River with the main span of 1 088 m. This article outlines technical challenges,key technology and innovation in the design and construction such as scour protection,lowering steel cofferdam,construction platform establishment,construction and control of pylons,fabrication and damping of long cables,erection and control of steel box girders.