Adoption of network and plan-do-check-action in the international classification of disease 10 coding

BACKGROUND with the widespread application of computer network systems in the medical field,the plan-do-check-action(PDCA)and the international classification of diseases tenth edition(ICD-10)coding system have also achieved favorable results in clinical medical record management.However,research on their combined application is relatively lacking.Objective:it was to explore the impact of network systems and PDCA management mode on ICD-10 encoding.Material and Method:a retrospective collection of 768 discharged medical records from the Medical Record Management Department of Meishan People’s Hospital was conducted.They were divided into a control group(n=232)and an observation group(n=536)based on whether the PDCA management mode was implemented.The two sets of coding accuracy,time spent,case completion rate,satisfaction,and other indicators were compared.AIM To study the adoption of network and PDCA in the ICD-10.METHODS A retrospective collection of 768 discharged medical records from the Medical Record Management Department of Meishan People’s Hospital was conducted.They were divided into a control group(n=232)and an observation group(n=536)based on whether the PDCA management mode was implemented.The two sets of coding accuracy,time spent,case completion rate,satisfaction,and other indicators were compared.RESULTS In the 3,6,12,18,and 24 months of PDCA cycle management mode,the coding accuracy and medical record completion rate were higher,and the coding time was lower in the observation group as against the controls(P<0.05).The satisfaction of coders(80.22%vs 53.45%)and patients(84.89%vs 51.72%)in the observation group was markedly higher as against the controls(P<0.05).CONCLUSION The combination of computer networks and PDCA can improve the accuracy,efficiency,completion rate,and satisfaction of ICD-10 coding.

Problems and Effective Measures of Enhancing Medical Record Coders’ Professional Qualities

Medical record coding plays an important role in hospital management and the improvement of medical record coding quality is quite important to hospital management.The professional qualities of medical record coders significantly affect the improvement of coding quality.At present,Medical record coders lack in professional knowledge,clinical knowledge and disease classification knowledge.In order to improve the quality of medical record coding,medical record coders should receive regular professional training,and hospital management departments should strengthen the monitoring of the quality of medical record coding.When encountering problems in the process of coding,medical record coders should take the initiative to consult and learn from clinicians.At the same time,medical record coders should cultivate a sense of responsibility,which can continuously improve their professional qualities and achieve the objective of improving the quality of medical record coding.

Real-world 10-year retrospective study of the guidelines for diagnosis and treatment of primary liver cancer in China

BACKGROUND Hepatocellular carcinoma(HCC) is a common malignant tumor worldwide. Many regions across the world have issued various HCC diagnosis and treatment protocols to improve the diagnosis and targeted treatment of patients with HCC. However, real-world studies analysing the practice, application value, and existing problems of the China Liver Cancer(CNLC) staging system are scarce.AIM To analyze the current situation and problems associated with the Guidelines for Diagnosis and Treatment of Primary Liver Cancer in China.METHODS We collected the medical records of all patients with HCC admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2011 to December 31, 2019, and recorded the hospitalization information of those patients until December 31, 2020. All information on the diagnosis and treatment of the target patients was recorded, and their demographic and sociological characteristics, CNLC stages, screening situations, and treatment methods and effects were analyzed. The survival status of the patients was obtained from follow-up data.RESULTS This study included the medical records of 3022 patients with HCC. Among these cases, 304 patients were screened before HCC diagnosis;their early-stage diagnosis rate was 69.08%, which was significantly higher than that of patients with HCC who were diagnosed without screening and early detection(33.74%). Herein, patients with no clinical outcome at discharge were followed up, and the survival information of 1128 patients was obtained. A Cox model was used to analyse independent risk factors affecting overall survival, which were revealed as age > 50 years, no screening, alpha-fetoprotein > 400 ng/mL, Child–Pugh grade B, and middle and late CNLC stages. Based on the Cox model survival analysis, in our study, patients with HCC identified via screening had significant advantages in overall and tumorfree survival after hepatectomy.CONCLUSION Early diagnosis and treatment can be achieved by screening groups at high risk for HCC based on the guidelines;however, real-world compliance is poor.

Promotion effect of TGF-β-Zfp423-ApoD pathway on lip sensory recovery after nerve sacrifice caused by nerve collateral compensation

Resection of oral and maxillofacial tumors is often accompanied by the inferior alveolar nerve neurectomy,resulting in abnormal sensation in lower lip.It is generally believed that spontaneous sensory recovery in this nerve injury is difficult.However,during our follow-up,patients with inferior alveolar nerve sacrifice showed different degrees of lower lip sensory recovery.In this study,a prospective cohort study was conducted to demonstrate this phenomenon and analyze the factors influencing sensory recovery.

Correlation between the triglyceride glucose index and the degree of steatosis and liver fibrosis in nonalcoholic fatty liver disease

Objective:To investigate the relationship between triglyceride glucose index(TyG)and the degree of steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease(NAFLD).Methods:Totally 2054 patients hospitalized in the second affiliated hospital of Xinjiang Medical University from September 2020 to September 2021 were retrospectively selected.According to abdominal ultrasound were divided into NAFLD group and non-NAFLD group.In accordance with the degree of steatosis,NAFLD patients were separated into mild group,moderate group and severe group.According to the liver stiffness,NAFLD patients were divided into liver fibrosis group and non-liver fibrosis group.We used the logistic regression to examine the correlation between TyG index and the the degree of steatosis and liver fibrosis.ROC curve was drawn to evaluate the diagnostic value of TyG index for NAFLD and liver fibrosis.Results:The prevalence of NAFLD increased with the increase of the interquartile of TyG index(Q_(1)44.1%,Q_(2)58.7%,Q_(3)71.9%,Q_(4)84.6%,P<0.001);The prevalence of liver fibrosis increased with the increase of the interquartile of TyG index(Q_(1)25.8%,Q_(2)30.2%,Q_(3)38.6%,Q_(4)44.3%,P<0.001).After adjusting for confounders,there was a correlation between TyG index and the degree of steatosis in NAFLD patients(the OR values of mild,moderate and severe groups were 1.383,2.450 and 3.070,P<0.001).TyG index was associated with liver fibrosis(OR=1.132,P<0.001).The ROC curve of TyG index predicted NAFLD was 0.701,with an optimal cutoff value of TyG is 8.57.However,the ROC curve of TyG index predicted liver fibrosis was 0.595.TyG index may not be a reliable predictor of liver fibrosis.Conclusion:TyG index was positively correlated with the degree of steatosis and liver fibrosis in NAFLD.

Prognostic significance of preoperative platelet count in patients with gallbladder cancer

AIM:To investigate the prognostic value of preoperative platelet count(PLT) in patients with primary gallbladder cancer(GBC).METHODS:The clinical data of 223 GBC patients after surgery was retrospectively reviewed.A receiver operating characteristic(ROC) curve was plotted to verify the optimum cutoff point for PLT.Univariate and multivariate survival analyses were performed to identify the factors associated with the prognosis.RESULTS:The ROC curve showed that the optimum cutoff point for PLT was 178 × 109/L,and the entire cohort was stratified into group A with PLT > 178 × 109/L and group B with PLT ≤ 178 × 109/L.Group A had a better survival than group B(P < 0.001).There was an obvious difference between the two groups in terms of the differentiation degree,advanced tumor stage,lymph node metastasis(P < 0.001) and pathological type(P < 0.05).The univariate analysis demonstrated that tumor location,differentiation degree,TNM stage,Nevin stage,lymph node metastasis and PLT were associated with overall survival(P < 0.001).In the multivariate analysis,PLT(P = 0.032),lymph node metastasis(P = 0.007),tumor location(P < 0.001) and TNM stage(P = 0.005) were independent prognostic factors.CONCLUSION:PLT is closely correlated with GBC prognosis and could be used to identify the population with a poorer prognosis after surgery.

Clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma

Objective： To assess the clinical features, survival and prognostic factors of primary testicular diffuse large B-cell lymphoma （DLBCL）. Methods： A retrospective study of 37 patients with primary testicular DLBCL was carried out from November 2003 to May 2012. Their clinical features, survival and prognostic factors were analyzed. Results： During a median follow-up period of 39.8 months （5.4-93.0 months）, the median progression-free survival （PFS） was 26.2 months （95% CI：0-65 months） and the 3-year overall survival （OS） rate was 78.4%. Within the whole cohort, the factors significantly associated with a superior PFS were limited stage （stage Ⅰ/Ⅱ）, lactate dehydrogenase （LDH） ≤245 U/L, international prognostic index （IPI） ≤1, primary tumor diameter 〈7.5 cm, and patients who had complete response （CR） and received doxoruhicin-contained chemotherapy （P〈0.05）. There was a trend toward superior outcome for patients who received combined therapy （surgery/ chemotherapy/radiotherapy） （P=0.055）. Patients who had CR, primary tumor diameter 〈7.5 cm and IPI score ≤1 were significantly associated with longer PFS at multivariate analysis. Conclusions： Primary testicular DLBCL had poorer survival. CR, primary tumor diameter and IPI were independent prognostic factors. The combined therapy of orchectomy, doxorubicin-contained chemotherapy and contralateral testicular radiotherapy （RT） seemed to improve survival.

Hyperthyroid heart disease in pregnancy: Retrospective analysis of a case series and review of the literature

BACKGROUND Hyperthyroidism in pregnancy may pose a great threat to maternal and fetal health.The risk of hyperthyroid heart disease(HHD),even heart failure,is significantly elevated in pregnant women.AIM To investigate the clinical characteristics,prognosis,and therapy of HHD in pregnant women.METHODS We searched the patient registry data at West China Second University Hospital of Sichuan University in Chengdu,China,following the approval by the Ethics Committee.We retrospectively analyzed the clinical characteristics of pregnant women diagnosed with HHD.The medical records of women with HHD during pregnancy from January 2012 to December 2017 were obtained from the electronic medical records system.All the included patients were followed in outpatient clinics and by telephone interviews until October 2018.RESULTS A total of 155 patients were diagnosed with thyrotoxicosis,of whom six were diagnosed with HHD.Three of them had regular antenatal care.Two patients were complicated with acute heart failure attacks,and one of them had a stillbirth.Both of these patients had a long history of Graves’disease with poor treatment compliance.Treatments of precipitating factors such as the control of infection could relieve the symptoms and prolong gestation for a better prognosis.Hyperthyroid heart failure could be controlled with aggressive diuretics and management of the coexisting complications.Intense monitoring and timely anti-heart failure treatment were crucial in patients with severe cardiac damage.Our findings indicated the importance of regular antenatal care and treatment adherence in patients with hyperthyroidism.CONCLUSION The timely and accurate diagnosis of HHD and the implementation of effective management are important for a better prognosis in pregnant women with HHD.Improvement in patients’awareness of thyrotoxicosis is needed.

Addition of rituximab is not associated with survival benefit compared with CHOP alone for patients with stage I diffuse large B-cell lymphoma

Background： The role of rituximab in combination with CHOP regimen in patients with stage I diffuse large B-cell lymphoma （DLBCL） remains to be defined. We aimed to compare CHOP plus rituximab （R-CHOP） with CHOP alone and determine the value of radiotherapy in these patients. Methods： Between 2003 and 2009, 140 untreated patients with stage I DLBCL were retrospectively analyzed in this study. Results： Seventy-eight patients were treated in R-CHOP group and 62 in CHOP group. Ninety-one patients received additional radiotherapy at the end of chemotherapy. The different treatment groups were well-balanced with respect to baseline characteristics. Complete response （CR） rate was 77% both in R-CHOP and CHOP groups （P=0.945）. After a median follow-up period of 56 months, patients received R-CHOP regimen had similar 5-year progression-free survival （PFS） （76% vs. 85%; log-rank P=0.215） and 5-year overall survival （OS） （90% vs. 96%; log-rank P=0.175） compared with those with CHOP alone. Patients with radiotherapy had significantly increased 5-year PFS compared with those who had chemotherapy alone （86% vs. 71%; log-rank P=0.005）. At multivariate analysis, patients who had CR （P=0.008） and received radiotherapy （P=0.003） were significantly associated with superior PFS. Conclusions： CHOP alone could be as effective as R-CHOP regimen and additional radiotherapy would be necessary for stage I or stage I non-bulky DLBCL patients.

Clinicopathological parameters predicting recurrence of pT1N0 esophageal squamous cell carcinoma

AIM To identify the clinicopathological characteristics of pT1 N0 esophageal squamous cell carcinoma(ESCC) that are associated with tumor recurrence. METHODS We reviewed 216 pT1 N0 thoracic ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy without preoperative chemoradiotherapy. After excluding those cases with clinical follow-up recorded fewer than 3 mo and those who died within 3 mo of surgery, we included 199 cases in the current analysis. Overall survival and recurrencefree survival were assessed by the Kaplan-Meier method, and clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence(≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.RESULTS Forty-seven(24%) patients had a recurrence at 3 to 178(median, 33) mo. The 5-year recurrence-free survival rate was 80.7%. None of 13 asymptomatic cases had a recurrence. Preoperative clinical symptoms, upper thoracic location, ulcerative or intraluminal mass macroscopic tumor type, tumor invasion depth level, basaloid histology, angiolymphatic invasion, tumor thickness, submucosal invasion thickness, diameter of the largest single tongue of invasion, and complete negative aberrant p53 expression were significantly related to tumor recurrence and/or recurrence-free survival. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence(Hazard ratios = 3.26, 3.42, and 2.06, P < 0.001, P < 0.001, and P = 0.002, respectively), and a nomogram for predicting recurrence-free survival with these three predictors was constructed. Upper thoracic tumor location and angiolymphatic invasion were independent predictors of distant recurrence. Upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and diameter of the largest single tongue of invasion were independent predictors of early recurrence.CONCLUSION These results should be useful for designing optimal individual follow-up and therapy for patients with T1 N0 ESCC.

Associations between Lesion Locations and Stroke Recurrence in Survivors of First-ever Ischemic Stroke:A Prospective Cohort Study

Summary:Several studies have indicated that stroke survivors with multiple lesions or with larger lesion volumes have a higher risk of stroke recurrence.However,the relationship between lesion locations and stroke recurrence is unclear.We conducted a prospective cohort study of first-ever ischemic stroke survivors who were consecutively enrolled from January 2010 to December 2015.Stroke recurrence was assessed every 3 months after post-discharge via telephone interviews by trained interviewers.Lesion locations were obtained from hospital-based MRI or CT scans and classified using two classification systems that were based on cerebral hemisphere or vascular territory and brain anatomical structures.Flexible parametric survival models using the proportional hazards scale(PH model)were used to analyze the time-to-event data.Among 633 survivors,63.51%(n-402)had anterior circulation ischemia(ACI),and morc than half of all ACIs occurred in the subcortex.After a median follow-up of 2.5 years,117(18.48%)survivors developed a recurrent stroke.The results of the multivariate PH model showed that survivors with non-brain lesions were at higher risk of recurrence than those with right-side lesions(HR,2.79;95%CI,1.53,5.08;P-0.001).There was no increase in risk among survivors with left-side lesions(HR,0.97;95%CI,0.53,1.75;P=0.914)or both-side lesions(HR,1.24;95%CI,0.75,2.07;P-0.401)compared to those with right-side lesions.Additionally,there were no associations between stroke ecurrence and lesion locations that were classified based on vascular territory and brain anatomical structures.It was concluded that first-ever ischemic stroke survivors with non-brain lesion had higher recurrence risk than those with right-side lesion,although no significant associations were found when the lesion locations were classified by vascular territory and brain anatomical structures.

Combined superposition effect of hypertension and dyslipidemia on left ventricular hypertrophy

Background : Hypertension and dyslipidemia are considered reversible risk factors for cardiovascular disease. The purpose of this study was to explore the impact of traditional and nontraditional blood lipid profiles on the risk of left ventricular hypertrophy(LVH) and to explore the superposition effect of dyslipidemia combined with hypertension.Methods : Data on 9134 participants(53.5 ±10.3 years old) from the Northeast China Rural Cardiovascular Health Study(NCRCHS) were statistically analyzed. The blood lipid profile was measured by total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), total glyceride(TG), and calculated nontraditional blood lipid indices including non-HDL-C, atherosclerosis index(AI), TC/HDL-C, and residual cholesterol(RC).Results : After the adjustment of age and gender, the odds ratios(ORs) of LVH in patients with hypertension, high LDL-C, high non-HDL-C, high AI, and high TC/HDL-C were 3.97(3.31– 4.76), 1.27(1.02– 1.59), 1.21(1.04– 1.39), 1.33(1.15– 1.53), and 1.42(1.22– 1.65), respectively. After full adjustment of potential confounding factors, high AI and TC/HDL-C were associated with LVH rather than traditional blood lipid indices.The combination of hypertension and nontraditional dyslipidemia(defined by high AI and TC/HDL-C) was associated with the highest risk of LVH, especially in participants under 45 years of age. The risk was more significant in men, 5.09-fold and 6.24-fold,respectively, compared with 3.66-fold and 4.01-fold in women.Conclusions : People with dyslipidemia defined by nontraditional blood lipid indices(high AI and high TC/HDL-C) and hypertension were more likely to develop LVH.

Release of myocardial noradrenaline during acute hibernation in the isolated rat heart

Objective： To explore the release of myocardial noradrenaline during acute hibernation. Methods： The hearts were gained from rats and set up as modified Langendorf preparations beating isometrically. They were perfused with modified Krebs-Henseleit buffer under controlled pressure. Mechanical measurements and coronary effluent were recorded simultaneously at 30min intervals for 150min. Lactate dehydrogenase in coronary effluent was assayed at the beginning, 60min and 120min low-flow ischemia. Noradrenaline in coronary effluent was determined at the beginning of low-flow and 120min of low-flow ischemia and also in control, during hibernation and after 30min reperfusion during stimulation, myocardial noradrenaline response on tyramine was investigated in absence or presence of desipramine after 30min reperfusion. Results： In the control, there was nosignificant chant in noradrenaline overflow during 120min perfusion; In the acute myocardial hibernation group, there was also nosignificant difference in noradrenaline overflow between the beginning and 120min low-flow ischemia. The electrical field stimulation-induced overflow of noradrenaline during hibernation myocardium was significantly less than preischemia or after reperfusion, but there was nosignificant difference between preischemia and reperfusion group. Tyramine induced significant noradrenaline release in absence of desipramine after 30min reperfusion, but this increase in noradrenaline release had nosignificant in the presence of desipramine. These studies indicated that there was not significant spontaneous noadrenaline overflow during acute myocardial hibernation in isolated rat hearts, the stimulation-induced noradrenaline overflow decreased during hibernation and restored to the level of preischemia after reperfusion, myocardial noradrenaline response to tyramine remained after 30min reperfusion. Conclusion： Myocardial noradrenaline overflow may not contribute to the development of acute myocardial hibernation and the function of sympathetic nerve may also maintain in hibernation as myocardium does during acute myocardial hibernation, reperfusion of myocardium may contribute to restoring the function of sympathetic nerve.

Changed trends of major causes of visual impairment in Sichuan,China from 1987 to 2006

AIM: To study the trends of major causes of visual impairment(VI) in adults in Sichuan,China and evaluate the effect of aging on the trends. ·METHODS: We used data from the National Sample Survey on Disabilities(NSSD) in Sichuan province conducted in 1987 and 2006. The age-adjusted prevalence of major causes of VI and the prevalence stratified by age in each cause were calculated and compared. The association between age and each cause of VI was also analyzed.·RESULTS: Retinal disease increased and became the second leading cause of VI in 2006 while blinding trachoma decreased markedly. Cataract and non-trachomatous corneal diseases were among the leading causes of VI in both years. We found associations between age and causes of VI,with age showing the strongest association with cataract and relatively lower associations with other causes. · CONCLUSION: In the last two decades,dramatic changes occurred in the major causes of VI with significantly increased retinal disease and decreased blinding trachoma. Aging of the population might be an important factor accounting for the changed trends of VI. Understanding the prevalence of VI,its major causes and trends over time can assist in prioritizing and developing effective interventional strategies and monitoring their impact.

Comparison of Obesity Prevalence among Middle and High School Graduates before and after the COVID-19 Lockdown

The world has been engulfed in a COVID-19 pandemic that has significantly affected the health and economics of the population.The Chinese authorities imposed lockdown measures to limit the spread of COVID-19 and stopped school programs for children and adolescents.Such measures have been associated with increased sedentary time and reduced physical activity[1-3].An online questionnaire study of youth in China compared activity patterns before and after the COVID-19 lockdown.

Research Progress of Geraniol in Tumor Therapy

Geraniol is an acyclic monoterpenoid compound,which exists widely in aromatic plants.Geraniol has antibacterial and anti-inflammatory effects.Recently,it has been found that geraniol has a strong effect on improving immune function and anti-tumor.Many experimental evidences support that geraniol has a good effect on the treatment or prevention of different types of tumors,such as breast cancer,lung cancer,liver cancer,pancreatic cancer,colon cancer,prostate cancer,etc.it also has a synergistic anti-cancer effect with many anti-cancer drugs,revealing the mechanism of its more complex anti-tumor pharmacological action System.In this review,we summarized a variety of anti-cancer signaling pathways and targets.Geraniol is considered to be a safe,effective and promising multi-target anti-cancer drug,which is expected to become an important force in the anti-cancer of traditional Chinese medicine.

Development and validation of a preoperative prediction model for all-cause mortality in patients following abdominal aortic aneurysm repair

To the Editor:Abdominal aortic aneurysm(AAA)is a life-threatening vascular disease.Surgical intervention is typically recommended when the maximum AAA diameter reaches a threshold of 5.5cm for men and 5.0cm for women,or when an AAA experiences a rapid expansion of greater than 1.0cm/year.[1]Survival after AAA repair is inuenced by various factors,and the identication of independent prognostic factors and the development of accurate prediction models are crucial for optimal treatment planning,counseling,and postoperative follow-up.Although several scoring systems with varying degrees of accuracy have been developed to predict the risk of mortality after intervention for patients with ruptured AAA.

Hepatocellular carcinoma and hepatitis B surface protein

The tumorigenesis of hepatitis B virus(HBV)-associated hepatocellular carcinoma(HCC) has been widely studied. HBV envelope proteins are important for the structure and life cycle of HBV, and these proteins are useful for judging the natural disease course and guiding treatment. Truncated and mutated pre S/S are produced by integrated viral sequences that are defective for replication. The pre S/S mutants are considered "precursor lesions" of HCC. Different pre S/S mutants induce various mechanisms of tumorigenesis, such as transactivation of transcription factors and an immune inflammatory response, thereby contributing to HCC. The pre S2 mutants and type Ⅱ "Ground Glass" hepatocytes represent novel biomarkers of HBVassociated HCC. The pre S mutants may induce the unfolded protein response and endoplasmic reticulum stress-dependent and stress-independent pathways. Treatments to inhibit hepatitis B surface antigen(HBs Ag) and damage secondary to HBs Ag or the pre S/S mutants include antivirals and antioxidants, such as silymarin, resveratrol, and glycyrrhizin acid. Methods for the prevention and treatment of HCC should be comprehensive.

Coronavirus Disease 2019 versus Influenza A in Children: An Observational Control Study in China

This study aimed to understand the differences in clinical,epidemiological,and laboratory features between the new coronavirus disease 2019(COVID-2019)and influenza A in children.Data of 23 hospitalized children with COVID-19(9 boys,5.7±3.8 years old)were compared with age-and sexmatched 69 hospitalized and 69 outpatient children with influenza A from a hospital in China.

Lung injury after cardiopulmonary bypass:Alternative treatment prospects

Although the lung injury caused by cardiopulmonary bypass(CPB)has been extensively investigated,the incidence and mortality of lung injury after CPB remain a prominent clinical problem.The poor outcome has been attributed to multifactorial etiology,including the systemic inflammatory response and ischemia reperfusion(I/R)injury during CPB.Lung injury after CPB is a complex pathophysiological process and has many clinical manifestations of mild to severe disease.Which is associated with prognosis.To alleviate this lung injury,interventions that address the pathogenesis are particularly important.This review summarizes the pathogenesis,mechanism and treatment options of lung injury after CPB,such as lung protection with intralipid.