With the development of economic globalization and the complication of enterprise management, the level of internal control has become an important part for measuring the quality of management, risk prevention, competitiveness and operational efficiency of modern enterprises. As a special economic organization, hospitals have some defects in terms of internal control environment, organization of control system, risk management and implementation system, supervision, control and evaluation system. Based on the “Medical Institutions Internal Control Provisions of Finance and Accounting (Trial)” and “A Lecture on Medical Institutions Internal Control of Finance and Accounting”, this article gives some suggestions on how to improve the management of hospital internal control.
The Department of Finance, West China Hospital, Sichuan University, Chengdu 610041, ChinaAbstract During the medical rescue of the earthquake, the Department of Finance of West China Hospital initiated emergency response plan, not only ensured the security of funds of hospital in the earthquake, but also opened a green channel of emergent finance to the wounded, so as to assure more than 2 600 wounded people of their registration for emergency treatment, emergent disposal, hospitalization, operation and medication, the comprehensive, precise and prompt record of which offered the government the basic data and references to work out the policy of financial subsidy for the treatment of the wounded. Furthermore, the financial supervision and management of materials and funds of disaster relief were reinforced.
Objective To compare the analgesic efficiency and safety of subacromial bursa continued ropivacaine analgesia with patient-controlled intravenous analgesia for arthroscopic rotator cuff repair. Methods A total of 64 patients undergoing rotator cuff repair surgery between October 2013 and February 2015 were randomly divided into the subacromial bursa group (JFX group, 32 cases) and the patient-controlled intravenous analgesia group (JM group, 32 cases). At the end of surgery, a catheter was inserted into the subacromial bursa of the patients in JFX group under arthroscopic visualisation and fixed properly, and analgesia pump was connected after surgery; in JM group, analgesia pump was connected to the vein channel after surgery. The pain Visual Analogue Scale (VAS) (motion and rest) scores 1 hour and 12, 24, 48, 72 hours after surgery, adverse reactions, use of analgesic pump, number of additional analgesia and patients satisfaction were recorded. Results There were no differences between the two groups in the number of additional analgesia, patients satisfaction, additional use of antiemetic drugs, motion and rest VAS scores 1 hour and 12, 72 hours after surgery, and the incidence of moderate-severe pain (VAS≥4) at each time point (P>0.05). The motion and rest VAS scores 24, 48 hours after surgery in JFX group were lower than those in JM group, the analgesia times and the incidence of nausea and vomiting in JFX group were lower than those in JM group, and the differences were statistically significant (P<0.05). Conclusion Efficiency of subacromial bursa infiltration of ropivacaine sustained analgesic is slightly better than that of patient-controlled intravenous analgesia, with lower incidence of adverse reactions.
ObjectiveTo review the research progress of intramedullary lengthening nail technology.MethodsThe foreign literature on the development history, types, advantages and disadvantages, indications and contraindications, complications, and effectiveness of intramedullary lengthening nail were reviewed and analyzed.ResultsThe intramedullary lengthening nail system mainly includes mechanical type, electric motor drive type, and magnetic drive type. Compared with traditional external fixation and lengthening technology, the intramedullary lengthening nail technology has certain advantages in incidence of complications, bone healing, postoperative functional rehabilitation, incision aesthetics, convenience, and patient satisfaction. However, there are also shortcomings, such as pain, uncontrollable distraction rate, device failure, etc. In the clinical application of intramedullary lengthening nails for limb lengthening, the indications should be grasped reasonably, and the related complications should be prevented and treated.ConclusionIntramedullary lengthening nails provide a new option for limb lengthening, and the initial effectiveness is good. It is one of the development direction of limb lengthening technology.
ObjectiveTo establish a prediction model for ipsilateral cervical lateral lymph node metastasis (LLNM) in stages T1–T2 unilateral papillary thyroid carcinoma (PTC) and to verify its efficacy. MethodsA retrospective case-control study was conducted to analyze the clinical information of 280 patients with unilateral PTC at stages T1–T2 who underwent ipsilateral cervical lateral lymph node dissection and were diagnosed postoperatively via pathological examination in the Department of Thyroid Surgery (General Surgery) at the First Hospital of Shanxi Medical University from February 2019 to February 2024. The patients were randomly allocated into a training set and a test set in a 7∶3 ratio. The general, clinical, laboratory, and imaging data were collected for all patients. The univariate and multivariate logistic regression analyses were used to compare the differences in data of the patients between with and without LLNM in the training set. Then the risk factors affecting on the LLNM were used to construct a nomogram prediction model. The receiver operating characteristic (ROC) curve was generated for both the training and test sets, and the area under the ROC curve (AUC) was calculated to evaluate model discrimination. The calibration curve was used to assess model calibration, and decision curve analysis (DCA) was conducted to evaluate the clinical utility of the nomogram prediction model. ResultsA total of 280 patients were included, including 196 in the training set and 84 in the testing set. There were no statistically significant differences in the clinical and pathological data between the training set and the testing set (P>0.05). There were 147 cases of LLNM in the training set and 63 cases of LLNM in the testing set. The results of multivariate logistic regression analysis showed that the patients with T1–T2 stage unilateral PTC who were male in gender, had cancer lesions located in the upper pole, had central lymph node metastasis, had larger cancer lesions, and higher serum thyroid stimulating hormone level had a higher probability of developing ipsilateral cervical LLNM (P<0.05). The AUC (95%CI) of the nomogram prediction model constructed based on these risk factors in the training and testing sets were 0.822 (0.747, 0.897) and 0.838 (0.743, 0.933), respectively. The calibration curves of the training and testing sets roughly overlapped with the reference curve. The DCA results indicated that the net benefit for patients was positive when the threshold probabilities were within the ranges of 15% to 92% for the training set and 10% to 100% for the test set. ConclusionsThe results of this study suggest that gender, maximum cancer lesion diameter, cancer lesion location, central lymph node metastasis, and serum thyroid stimulating hormone are risk factors affecting the occurrence of ipsilateral cervical LLNM in T1–T2 stages unilateral PTC. The nomogram prediction model developed based on these risk factors demonstrates good discrimination, accuracy, and clinical applicability for its prediction.
Objective To compare the vasoactive effects of norepinephrine( NE) and dopamine of different doses on isolated rabbit pulmonary and systemic arteries in septic shock. Methods Six paired pulmonary and systemic arterial rings were prepared fromsix rabbits, and matched randomly assigned into a normal group and a LPS group. The assigned groups were intervened by different doses of NE. Another six paired pulmonary and systemic arterial rings were prepared from another six rabbits. They were assigned to different groups as above and intervened by different doses of dopamine. The LPS groups were pre-incubated in RPMI mediumsupplemented with4 μg/mL LPS to simulate septic shock. The tension of arterial rings was measured and its response to NE and dopamine were studied. Results ( 1) In the normal groups, the contraction of the systemic arteries was ber than the pulmonary arteries in response to low,middle dose of NE, and high dose of dopamine ( all P lt; 0. 05) , and which was weaker in response to middle dose of dopamine and similar in response to high dose of NE( P gt;0. 05) . Both the pulmonary and systemic arteriesrelaxed in response to low dose of dopamine. ( 2) After LPS pre-incubation, the contraction of the systemic arteries was weaker than the pulmonary arteries in response to low dose of dopamine ( P lt;0. 05) , and which was similar in response to low,middle and high dose of NE, and middle, high dose of dopamine. ( 3) Comparing the LPS groups with the normal groups, the contraction in response to middle dose of dopamine increased in the systemic arteries and dreased in the pulmonary arteries ( P lt;0. 05) . Conclusions In septic shock, the vasoactive effect of different doses of NE is not different between pulmonary and systemic arteries. But middle dose of dopamine can increase the contraction of systemic arteries and decrease the contraction of pulmonary arteries.
Objective To investigate the effect of heme oxygenase-1 (HO-1) activity on rat liver transplantation model. Methods One hundred and thirty-seven rats were divided into 4 groups. Study control group (n＝44)： 24 h before operation, saline 5 ml/kg was infused into peritoneal cavity of donor rats; Hemin group (n＝44)： hemin 100 mg/kg was infused into peritoneal cavity of donor rats 24 h before operation, and hemin 100 mg/kg was infused into portal vein during the preserve time in 4 ℃ saline； ZnPP group (n＝44)： ZnPP 5 mg/kg was infused into peritoneal cavity of donor rats 24 h before operation, and ZnPP 5 mg/kg was infused into portal vein during the preserve time in 4 ℃ saline； Normal control group (n＝5)： normal rats as normal control group. Expressions of HO-1 protein and mRNA were detected with immunohistochemistry and RT-PCR technique respectively. The apoptosis rate of hepatocytes was analyzed by flow cytometry. Results Expression of HO-1 mRNA in the liver of hemin group after transplantation was higher than that in study control group obviously, serum ALT and AST levels were lower than those in study control group (P＜0.05); HO-1 mRNA expression in ZnPP group liver was lower than that in study control group, serum ALT and AST levels were higher than those in study control group (P＜0.05). About liver cell apoptosis rate 48 h after liver transplantation, ZnPP group was the highest, hemin group was the minimum, and there had a significant difference between two groups (P＜0.05). Seven days after transplantation, the survival ratios of control study group, hemin group and ZnPP group were 7/12, 9/12 and 4/12 in turn, the inter-group differences had statistical significance (P＜0.05). Conclusion Activity of HO-1 could be induced by the transplant operation. HO-1 increases the survival rate after liver transplantation which was related with reducing apoptotic ratio of hepatocyte and improve hepatic function.
Anemia and coagulopathy are frequently presented in critically ill patients on the intensive care unit. Scientific use of blood products assist the treatment of critically ill patients. However, life-threatening adverse effects are also a risk. In 2020, the European Society of Critical Care Medicine (ESICM) published a clinical practice guideline on transfusion strategies for non-bleeding critically ill adults in an attempt to resolve the transfusion strategy problems of relevant critically ill patients. This paper interprets the key contents in order to assist Chinese clinicians for better understanding and using of the guideline.
ObjectiveTo understand the research status of phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) signaling pathway in the thyroid cancer (TC), as well as its role in the occurrence, cell differentiation, invasion, and metastasis of the TC, so as to find potential targets for treatment of TC. MethodThe literature about the research of PI3K/AKT signaling pathway in the TC was searched and summarized. ResultsThe PI3K/AKT signaling pathway was abnormally activated directly or indirectly in the TC, resulting in inhibition of cell apoptosis, malignant proliferation, accelerated cycle progression, invasion, and metastasis, etc., which promoted the occurrence and development of the TC. There were also some tumor suppressor genes, microRNAs, long chain non-coding RNAs, etc., which indirectly inhibited the activation of PI3K/AKT signaling pathway, or directly acted on it inhibiting its activity to inhibit the occurrence and development of the TC. ConclusionsFor the TC, some proteins, genes, microRNAs, and long chain non-coding RNAs directly or indirectly activate the PI3K/AKT signaling pathway through different targets to promote the occurrence and development of TC. At the same time, many targets inhibit the activation of the PI3K/AKT signaling pathway, which inhibits the malignant proliferation, invasion, and metastasis of TC. At present, there have been studies trying to use PI3K/AKT signaling pathway as a breakthrough for the treatment of TC. In-depth exploration of the role of PI3K/AKT signaling pathway in different TC is of great significance to find new targets for the treatment of TC.