Through analyzing domestic medical service payment method and day surgery payment method in USA and Australia, combine the current domestic progress of day surgery and its main prevailing payment to explore the future day surgery payment system in China.

Objective To investigate the risk factors of portal venous thrombosis ( PVST) following laparoscopic splenectomy ( LS) in cirrhotic patients with hypersplenism .Methods The clinical data of 62 patients with secondary hypersplenism due to cirrhotic portal hypertension admitted to the Clinical Medical College of Yangzhou University were retrospectively analyzed .These patients underwent LS from January 2013 to April 2014.Based on whether the patients had PVST on postoperative day (POD) 7 or not, the pa-tients were categorized into the non-PVST and PVST groups .Fifteen perioperative variables were analyzed in these two groups .Results On univariate analysis , age and portal vein diameter in the PVST group were significantly higher and velocity of portal blood flow in the PVST group were significantly lower than those in the non-PVST group, (all P<0.05).Bivariate correlation analysis performed for the relationship between these variables and occurrence of PVST on POD 7 showed age >50 years, portal vein diameter >13 mm and velocity of portal blood flow >18 cm/s were significantly correlated .Multivariate logistic regression showed that age >50 years and portal vein diameter >13 mm were significantly independent risk factors of PVST, and velocity of portal blood flow >18 cm/s was an independent protective factor .Conclusion Age>50 years and portal vein diameter >13 mm were independent risk factors , while velocity of portal blood flow >18 cm/s was an independent protective factor of postoperative PVST .

BACKGROUND:Percutaneous vertebroplasty for vertebral fractures can effectively relieve acute pain and has the advantages of smal trauma, good curative effect and less complications, but for patients with osteoporotic compression fractures, there were varying degrees of osteoporosis after surgery, which have a longer course of disease and cannot be easy to cure. So the effectiveness of percutaneous vertebroplasty cannot be ful y evaluated based on the pain relief. OBJECTIVE:To study the curative effect of percutaneous vertebroplasty for patients with fresh osteoporotic thoracolumbar vertebral compression fractures. METHODS:We selected 24 patients undergoing percutaneous vertebroplasty and 24 patients receiving conservative treatment at the same time who had fresh osteoporotic compression fractures as research objects;and compared pain degree, vertebral body height and the kyphosis Cobb angle, function activity of the lower lumbar before and after treatment, the quality of life and clinical incidence of complications within 6 months after treatment in the two groups. RESULTS AND CONCLUSION:The degree of pain, the vertebral body height, kyphosis Cobb angle, function activity of the lower lumbar were al improved in the two groups after treatment (P<0.05), and these indexes in the percutaneous vertebroplasty group were better than those in the conservative treatment group (P<0.05). The quality of life and incidence of complications within 6 months after treatment were improved better in the percutaneous vertebroplasty group than the conservative treatment group (both P<0.05). These results suggest that the percutaneous vertebroplasty for fresh osteoporotic thoracolumbar vertebral compression fractures can effectively reduce the pain of patients, improve vertebral deformity and activities of the lower lumbar, and has obvious role in promoting the postoperative quality of life of patients.

Objective: To systematically investigate the prevalence of anxiety among healthcare professionals during the COVID-19 pandemic, so as to provide the development of evidence-based psychological interventions among healthcare professionals. Methods: The publications pertaining to the prevalence of anxiety among healthcare professionals during the COVID-19 pandemic were retrieved in national and international electronic databases from January 1, 2020 through November 30, 2021, including CNKI, Wanfang Data, VIP, SinoMed, PubMed and Web of Science. The quality of publications was evaluated using the United States Healthcare Research and Quality (AHRQ) quality assessment of included cross-sectional studies, and the pooled prevalence of anxiety was estimated among healthcare professionals using the software Open Meta Analyst version 3.0. The publication bias were evaluated with funnel plots and Begg rank correlation test. Results: Totally 598 publications were retrieved, and 36 eligible publications were enrolled in the final analysis, including 33 Chinese publications and 3 English publications. There were 5 high-quality, 29 moderate-quality and 2 low-quality publications. All investigations pertaining to the prevalence of anxiety among healthcare professionals were conducted in 2020. Totally 19 872 healthcare professionals were investigated, and the prevalence of anxiety was 28.8% (95%CI: 24.0%-33.6%). Subgroup analysis showed that the prevalence of anxiety was 31.9% (95%CI: 17.6%-46.2%) among healthcare professionals from western China, 29.6% (95%CI: (17.8%-41.4%) from central China, and 25.3% (95%CI: 20.2%-30.3%) from eastern China. The prevalence of anxiety was 4.9% (95%CI: 3.3%-6.4%) among male healthcare professionals and 22.9% (95%CI: 17.7%-28.0%) among male healthcare professionals, and the prevalence of anxiety was 21.6% (95%CI: 13.2%-29.9%) among nurses, 5.2% (95%CI: 2.8%-7.5%) among doctors and 4.8% (95%CI: 2.2%-7.4%) among other healthcare professionals. The prevalence of mild, moderate and severe anxiety was 18.6% (95%CI: 14.0%-23.2%), 5.5% (95%CI: 4.1%-6.8%) and 1.9% (95%CI: 1.3%-2.5%), respectively. No publication bias was detected as revealed by funnel plots and Begg rank correlation test, and stable meta-analysis results and heterogeneity test were observed. Conclusions The prevalence of anxiety is 28.8% among healthcare professionals during the COVID-19 pandemic, and mild anxiety is predominant. A high prevalence rate of anxiety is seen female healthcare professionals and nurses, who should be given a high priority and timely psychological interventions

Objective To explore the feasibility and effect of spleen-preserving distal pancreatectomy in patients with distal pancreatic injures and its outcome.Methods Retrospectively analysed the follow up results of 18 patients undergoing spleen-preserving distal pancreatectomy in Clinical Medical College of Yangzhou University from March 2008 to November 2012.Results The operations were successful in all of these 18 patients,B-mode ultrasonography and CT scan follow-up revealed that there were no significant changes in the size and structure of the spleens.The operation time was 152 to 188 minutes (mean,172 minutes),and the intraoperative blood loss was 155 to 356 mL (mean,191 mL).The length of postoperative hospital stay was 13 to 19 days (mean,15 days).No bleeding after operation,no pancreatic leakage,and no intraabdominal infection occurred.Conclusions Distal pancreatectomy with spleen and supply vessel preserving is effective and feasible methods for the patients with distal

Objective To analysis the modified Gleason scoring system for predicting the prognosis after radical prostatectomy.Methods A total of 242 patients who received radical prostatectomy from April,2006 to October 2011 were recruited.The patients who lost follow-up or had adjuvant radiation or hormonal therapy or had visceral or bone metastasis were excluded,the remaining 168 patients were evaluated in the present study.The patients' age ranged from 53 to 85 years old (mean age 69 years old).The mean PSA level was 13.31ng/ml (ranging from 4.59 to 36.12 ng/ml).According to the traditional Gleason scoring system,there were 50 patients in Gleason ≤ 6 group,86 patients in Gleason 7 group and 32 patients in Gleason≥8 group.Patients were divided in five groups according to the modified Gleason scoring system.There were 50 patients in Gleason ≤6 group,67 in Gleason 3 + 4 group,19 in Gleason 4 + 3 group,15 in Gleason 8 group and 17 in Gleason 9-10 group.The biochemical-free-survival curve was drawn by Kaplan-Meier method and the multivariate Cox regression models were used to evaluate the clinical and pathological variables for the development of biochemical recurrence.ROC curve analysis was used to determine the predicted value for 5-year BCR of modified and traditional Gleason scoring.Results Significant differences were noted between the modified Gleason scoring groups and traditional Gleason scoring groups in PSA value (P =0.005),pathological stage (P =0.002),extraprostatic extension (P =0.003),seminal vesicle invasion (P =0.004),lymph node involvement (P =0.049) and positive surgical margin (P =0.006).With a median follow-up of 68 months(ranging from 7 to 98 months),5-year BFS rates for men with Gleason grade ≤6,3 + 4,4 + 3,8 and 9-10 tumours on RP pathology were 84.0％ (42/50),76.1％ (51/67),57.9％(11/19),40.0％ (9/15),29.4％ (5/17),respectively.On multivariate analysis,the HR value of Gleason 3 + 4 group and Gleason 4 + 3 group were 1.736 and 2.075 (P ＜ 0.05).The area under the curve in modified and traditional Gleason scoring were 0.698 (95％ CI 0.609-0.788) and 0.674 (95％ CI O.584-0.764),respectively.Conclusions The modified Gleason scoring system is related to the prostate cancer grade and its survival rate.Therefore,it can predict prognosis accurately in patients with prostate cancer.It can potential to reduce overtreatment in patients with Gleason 3 +4 prostate cancer.

Objective To evaluate the diagnostic value of 64-slice VCT reconstruction techniques in the diseases of joints of foot and hand.Methods 50 patients with diseases of joints of foot and hand underwent MSCT scans,the data were reconstructed,including multiplanar reconstruction(MPR),maximum intensity projection(MIP),shaded surface display(SSD)and volume rendering(VR),the results were analysed.Results 33 patients with fractures,40 and 51 fractures were found by X-ray and MPR,VR,respectively.The joint surface involved in 7 fractures,which was best with VR and MPR to show the whole fractures.SSD was better to demonstrate the soft tissue and the vessels of the skin.3D bone reconstruction with MIP was better than plain film in showing the fractures in 4 patients with plaster external fixation.Conclusion 64-slice VCT reconstruction techniques are effective in diagnosis of the diseases of joints of foot and hand.

Objective To investigate the feasibility and safety,and short-term therapeutic effect of laparoscopic azygoportal disconnection without splenectomy for cirrhotic portal hypertension (PLT count ＞ 50 × 109/L).Methods Clinical data of 48 patients with bleeding portal hypertension and secondary hypersplenism (PLT count ＞ 50 × 109/L) undergoing laparoscopic splenectomy and azygoportal disconnection (LSD,n =26) vs.laparoscopic azygoportal disconnection (LD,n =22) between January 2014 and August 2015 were analyzed.Results Operative time (82 ± 29) min,intraoperative blood loss 20(10-50) ml,days of postoperative fever 0(0-3) d,rate of postoperative fever 10/22,postoperative hospital stay (7.0 ± 1.3) d,and WBC counts (3.8 ± 1.6) × 109/L,PLT counts 64 (49-88) × 109/L,and the incidence of portal vein thrombosis on POD 7 (14％),were significantly less in LD group than in LSD group [(180±41) min,80(20-500) ml,2(0-4) d,(22/26),(10.8 ±3.0) d,(9.1 ±3.1) × 109/L,156 (78-630) × 109/L,(42％)],(t =9.637,Z =-4.746,Z =-2.314,x2 =8.224,t =5.794,t =7.785,Z=-5.508,x2 =4.742,all P ＜ 0.05).Immune function was better in LD group than in splenectomy group at postoperative month 3.The serum proportion of CD4 + (58 ± 11) and the CD4 +/CD8 + ratio (1.9 ±0.7) at postoperative month 3 were significantly higher after LD than after LSD [(43 ± 14),(1.2 ± 0.9)],(t =-3.755,t =-2.509,all P ＜ 0.05).Conclusion Laparoscopic azygoportal disconnection without splenectomy is safe and effective for esophagogastric variceal hemorrhage and moderate hypersplenism (PLT ＞ 50 × 109/L) secondary to portal hypertension.

Objective To investigate the safety and clinical efficacies of synchronous laparoscopic hepatectomy combined with splenectomy for the treatment of hepatocellular carcinoma (HCC) associated with cirrhotic portal hypertensive hypersplenism.Methods The clinical data of 5 patients with HCC associated with cirrhotic portal hypertensive hypersplenism who were admitted to the Clinical Medical College of Yangzhou University between January 2015 and April 2015 were retrospectively analyzed.Five patients underwent synchronous laparoscopic hepatectomy combined with splenectomy and intraoperative autologous blood transfusion.The operation time,volume of intraoperative blood loss,time for diet intake,postoperative drainage tube removal time,duration of hospital stay and occurrence of complications were observed.Patients were followed up by outpatient examination and telephone interview till June 2015.Measurement data with normal distribution were presented as x ± s.Results Of the 5 patients without conversion to open surgery,3 patients underwent synchronous laparoscopic hepatectomy combined with splenectomy,1 patient underwent laparoscopic hepatectomy + splenectomy + cholecystectomy and 1 patient underwent laparoscopic hepatectomy + splenectomy + devascularization.The operation time and volume of blood loss were (225 ± 41)minutes and (221 ± 81)mL.All the patients received intraoperative autologous blood transfusion without homologous blood transfusion.Two patients were complicated with abdominal effusion including 1 patient associated with pleural effusion,and symptoms of 2 patients disappeared after conservative treatment.All the patients took fluid diet at postoperative day 1 and out-of-bed activity at postoperative day 2,and drainage tubes were removed at postoperative day 3,with good recovery and without perioperative death.The duration of postoperative hospital stay was (7.8 ±0.8)days.All the 5 patients were followed up and survived well up to the end of follow-up.Conclusion Synchronous laparoscopic hepatectomy combined with splenectomy is safe and feasible for the treatment of HCC associated with cirrhotic portal hypertensive hypersplenism with an exact curative effect.

Objective To investigate the feasibility and safety of elective synchronous laparoscopic splenectomy plus portaazygous disconnection and hepatectomy for cirrhotic portal hypertension patients with hypersplenism, esophageal and gastric variceal bleeding and hepatocellular carcinoma.Methods Two hepatocellular carcinoma patients with a history of upper gastrointestinal hemorrhage and secondary hypersplenism underwent one stage, non-emergency laparoscopic splenectomy plus portaazygous disconnection and hepatectomy between April 2015 and May 2015 in our department.Autologous red cell salvage was used during the operation.Liver resection was performed after splenectomy, portaazygous disconnection and the use of cell saver.Results The two operations were performed successfully.The operative time was 190 min and 205 min respectively, Volume of intraoperative bleeding was 180 ml and 260 ml.There was no intraoperative homologous blood transfusion.The two patients recovered smoothly, without major complications and postoperative hospital stay was 8 d and 9 d.Conclusions The procedure of synchronous laparoscopic splenectomy and azygoportal disconnection with hepatectomy for cirrhotic patients with hepatocellular carcinoma, hypersplenism and esophageal and gastric variceal bleeding is safe and feasible.