Efficiency and scale effect of county public hospitals in Shandong Province, China: a cross-sectional study.

OBJECTIVE: To evaluate the efficiency of county public hospitals in Shandong Province following China's new medical reform and compare the efficiency of hospitals with different bed sizes for improving efficiency. DESIGN AND SETTING: This was a cross-sectional study on the efficiency and size of 68 county public hospitals in China in 2017. OUTCOME MEASURES: Data envelopment analysis was used to calculate the efficiency scores of hospitals and to analyse the slack values of inefficient hospitals. The actual number of open beds, doctors, nurses and total expenditure were selected as inputs, and the total number of annual visits, discharges and total income were selected as outputs. The Kruskal-Wallis H test was employed to compare the efficiency of hospitals with different bed sizes. The χ2 test was used to compare the returns to scale (RTS) of hospitals with different bed sizes. RESULTS: Twenty (29.41%) hospitals were efficient. There were 27 hospitals with increasing returns to scale, 23 hospitals with constant returns to scale and 18 hospitals with decreasing returns to scale (DRS). The differences in technical efficiency (p=0.248, p>0.05) and pure technical efficiency (p=0.073, p>0.05) were not statistically significant. However, the differences in scale efficiency (p=0.047, p<0.05) and RTS (p<0.001) were statistically significant. Hospitals with DRS began to appear at 885 beds. All sample hospitals with more than 1100 beds were already saturated and some hospitals even had a negative scale effect. CONCLUSIONS: The government and hospital managers should strictly control the bed size in hospitals and make hospitals resume operating in the interests of public welfare. Interventions that rationally allocate health resources and improve the efficiency of medical workers are conducive to solving redundant inputs and insufficient outputs.

[miRNA-148b-3p Influences Glucose Metabolism of Offspring with Maternal Cholestasis by Regulating GLUT1 Expression in Placental Trophoblast Cells].

OBJECTIVE: To investigate the expression of miRNA-148b-3p and its target gene in the placenta between normal pregnant women and pregnant women with intrahepatic cholestasis of pregnancy (ICP) and to explore the possible mechanism of glucose metabolism of offspring with maternal cholestasis. METHODS: There were 30 cases of normal pregnant women and 30 cases of pregnant women with ICP recruited in the study, all of whom underwent cesarean delivery from Mar. 2017 to Jan. 2018. Placenta tissues, maternal blood and cord blood were collected in each case. Maternal blood and cord blood were sent for biochemical detection. miRNA of placenta tissues was extracted and qRT-PCR was used to measure the expression of miR-148b-3p in the placenta. Normal HTR-8 cells were transfected with miR-148b-3p inhibitor/mimics wrapped with lipofectaine3000. qRT-PCR was used to measure the expression of miR-148b-3p, and Western blot was used to measure the expression of glucose transporter 1 (GLUT1) after transfection. RESULTS: Maternal fasting blood glucose (FPG) and its fetal cord blood insulin levels in the ICP group were significantly higher than those of control. The expression of miR-148b-3p in the placenta of ICP group was lower than that of control group ( P<0.05). Compared with inhibitor control group, the expression of miR-148b-3p was decreased in HTR-8 cells transfected with miR-148b-3p inhibitor ( P<0.05), while the expression of GLUT1 was increased ( P<0.05). Compared with mimics control group, the expression of miR-148b-3p was increased in HTR-8 cells transfected with miR-148b-3p mimics ( P<0.05), while the expression of GLUT1 was decreased ( P<0.05). CONCLUSION: miR-148b-3p might participate in glucose metabolism of offspring with maternal cholestasis through the negative regulation of GLUT1 expression in placental trophoblast cells.

Cost-benefit analysis of enhanced recovery after hepatectomy in Chinese Han population.

BACKGROUND: Enhanced recovery after surgery (ERAS) programs have been proved effective for enhancing the clinical healing rate and reducing hospitalization cost in most countries of the world. It's a multi-model approach that designed to optimize perioperative pathway, attenuate the surgical stress response, and decrease postoperative complications. OBJECTIVE: The economic benefit from the application of ERAS to colorectal surgery has been demonstrated in China. However, such economic benefit of ERAS programs for hepatectomy hasn't been clarified yet. This study was carried out to explore the clinical efficacy and cost effectiveness of ERAS in Chinese Han population after hepatectomy. METHODS: ERAS program was implemented in our department for hepatectomy in December 2016. In total, 79 consecutive patients after hepatectomy were chosen as ERAS group (ERAS protocol) in coming half year while 121 consecutive patients after hepatectomy were chosen as Pre-ERAS group (traditional protocol) in past half year. The operation time, intraoperative blood loss, length of hospital stay (LOS), complication, readmission, and hospitalization cost of 2 groups were compared. RESULTS: The LOS of ERAS group was 5.81 ±â€Š1.79 days, significantly shorter than that of Pre-ERAS group (8.06 ±â€Š3.40 d) (P = .000). The operation time was 168.03 ±â€Š46.20 minutes for ERAS group and 175.41 ±â€Š64.64 minutes for Pre-ERAS group respectively (P = .417). The intraoperative blood loss was 166.58 ±â€Š194.13 mL (ERAS group) and 205.45 ±â€Š279.63 mL (Pre-ERAS group) (P = .293). It should be noted that the hospitalization cost of ERAS group was 51556.18 ±â€Š8926.05 Yuan (7835.05 ±â€Š1355.45 US dollars), significantly less than that of Pre-ERAS group 60554.66 ±â€Š15615.31 Yuan (9202.56 ±â€Š2371.24 US dollars) (P = .000). The application of ERAS effectively saved 8998.48 Yuan (1367.51 US dollars) for each patient. CONCLUSIONS: ERAS implementation for hepatectomy surgery is safe and feasible for Chinese Han population. It eventually enhanced the clinical healing rate. The benefits from such programs include a reduction of the LOS, complication, and readmission rates. So each patient has access to better medical service. It effectively relieved the financial burden of patients. The benefits from such programs include a reduction of the hospitalization cost, especially in medication cost. So each patient can afford the diseases.

Unusual Uptake of Radioiodine in a Subcutaneous Lipoma in a Patient With Differentiated Thyroid Cancer.

A 68-year-old man underwent adjuvant radioiodine therapy for follicular variant papillary thyroid carcinoma. Post-therapeutic whole-body I scan showed abnormal radioiodine uptake on the right side of back. SPECT/CT localized this abnormal activity from a small subcutaneous lesion with fat density between the right 10th and 11th rib. Under ultrasound-guided autopsy, the lesion was confirmed as lipoma.

Primary glioblastoma of the cerebellar vermis: A case report.

Cerebellar glioblastoma is a rare adult tumor. The accurate diagnosis of cerebellar glioblastoma is important for establishing a suitable therapeutic schedule. However, it is occasionally difficult to diagnosis these tumors. Clinical presentation, computed tomography (CT) and magnetic resonance imaging can provide useful information, but they may not lead to a definitive diagnosis. Positron emission tomography/computed tomography (PET/CT) may provide a novel way of forming a differential diagnoses. The lesions of glioblastoma multiforme (GBM) rarely occur in the cerebellum, with prior studies reporting that only 0.4-3.4% of all GBM tumors occur here. In the current study, a case of primary cerebellar glioblastoma is presented and the physiopathology, clinical presentation, diagnosis, differential diagnosis, treatment and general outcome of this disease are discussed. A 61-year-old female presented with nausea, vomiting, balance problems and cerebellar signs. Cranial magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) examination demonstrated one regular contour of a mass lesion in the cerebellar vermis. Following surgery, glioblastoma was histologically confirmed. The outcome of the patient was favorable after 18 months of follow-up. Cerebellar GBM should be considered in the differential diagnosis of a cerebellar mass lesion, and PET/CT may provide a novel identification method for different cerebellar mass lesions.