Objective To analyze the clinical feasibility and effectiveness of the "G"-shaped surgical approach in robotic pancreatoduodenectomy. Methods The clinical data of 17 patients who were undergoing robotic pancreatoduodenectomy at the First Hospital of Shanxi Medical University from June 2017 to March 2018 was analyzed. Results All the 17 robotic pancreatoduodenectomy operations via the "G"-shaped surgical approach were successful. The operationtime was (499 ±146) min (350-825 min), and the blood loss was (119±38) ml (20-500 ml). All surgical margins were negative. All patients recovered well after surgeries, and the postoperative hospital stay was (21 ±6) (14-36 days). However, one patient experienced secondary surgery due to bilioenteric anastomosis fistula, fortunately the surgical process went successfully. This patient had pancreatic leakage (class B) after surgery and was discharged with tubes after a conservative treatment, another patient had gastroplegia and recovered completely after conservative treatment. Conclusion It is a safe and feasible procedure to use the robotic pancreatoduodenectomy with the"G"-shaped surgical approach.

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1％increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0～268 074 yuan,rhTPO has a 100％economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1％increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0～268 074 yuan,rhTPO has a 100％economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1％increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0～268 074 yuan,rhTPO has a 100％economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1％increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0～268 074 yuan,rhTPO has a 100％economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1％increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0～268 074 yuan,rhTPO has a 100％economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1％increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0～268 074 yuan,rhTPO has a 100％economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1％increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0～268 074 yuan,rhTPO has a 100％economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.

Objective:To evaluate the economy of recombinant human thrombopoietin(rhTPO)combined with conventional therapy compared with conventional therapy in the treatment of sepsis-associated thrombocytopenia(SIT)from the perspective of China's health service system.Methods:The decision tree model was constructed,and the minimum cost analysis and cost-effectiveness analysis were used to evaluate the economy based on the characteristics of sepsis.The economy was judged by two willingness to pay thresholds,and then the stability of the results was tested by sensitivity analysis.Results:rhTPO combined with conventional therapy can save 520.58 yuan for each 1％increase in survival rate compared with conventional therapy alone,which is an absolute advantage program.The single factor sensitivity analysis showed that the daily cost of ICU medical service and the duration of CRRT in the control group and the daily cost of ICU medical service in the experimental group had a great influence on the results,and the stability of the parameter outcome was good.The probability sensitivity analysis showed that when the willingness to pay threshold changes ranged 0～268 074 yuan,rhTPO has a 100％economical probability.Conclusion:Under the existing evidence,rhTPO combined with conventional treatment for SIT treatment is more economical on the basis of improving survival rate and equal safety.

Objective:To assess the impact of kidney damage on the progression and prognosis of coronavirus disease 2019 (COVID-19) patients.Methods:The databases including CNKI, Wanfang Chinese Academic Journal Database, Pubmed, EMBASE and Cochrane databases were searched. The data retrieval period was from December 2019 to June 2020. During this period, RevMan 5.2 was used to extract and analyze data from the literature.Results:In this study, 15 articles, covering 11 448 COVID-19-related cases, were selected from the target databases. Meta-analysis results indicated that, for COVID-19 patients with acute kidney injury (AKI), the proportion of COVID-19 patients with AKI who received intensive care unit (ICU) treatment was significantly higher than that of patients without AKI ( OR=10.83, 95% CI 9.43-12.45, Z=33.53, P<0.001). Among them, the Asian group of COVID-19 patients with AKI accounted for 3.4% of all COVID-19 patients. The Asian group of COVID-19 patients with AKI who received ICU treatment accounted for 74.1% of all COVID-19 patients with AKI. Meta-analysis showed that the proportion of COVID-19 patients with AKI in the Asian group receiving ICU treatment was significantly higher than that of COVID-19 patients without AKI ( OR=18.66, 95% CI 9.85-35.34, Z=8.98, P<0.001). COVID-19 patients with AKI in the European and American groups accounted for 36.5% of all COVID-19 patients, and the European and American groups of COVID-19 patients with AKI who received ICU treatment accounted for 53.3% of all COVID-19 patients with AKI. Meta-analysis showed that the proportion of COVID-19 patients with AKI in the European and American groups receiving ICU treatment was significantly higher than that of COVID-19 patients without AKI ( OR=10.58, 95% CI 9.18-12.21, Z=32.40, P<0.001). The death risk of COVID-19 patients with AKI was significantly higher than that of patients without AKI ( OR=56.46, 95% CI 15.86-200.96, Z=6.23, P<0.001). COVID-19 patients with renal impairment had a higher risk of worsening and death than those without renal impairment ( OR=6.40, 95% CI 4.14-9.90, Z=8.36, P<0.001). Subgroup analysis showed COVID-19 patients with positive urine protein had a higher risk of worsening and death than those without positive urine protein ( OR=6.27, 95% CI 3.88-10.14, Z=7.49, P<0.001), and COVID-19 patients with elevated serum creatinine had a higher risk of worsening and death than those without elevated serum creatinine ( OR=7.13, 95% CI 2.58-19.72, Z=3.79, P<0.001). Conclusions:Patients with COVID-19 combined with AKI or only with positive urine protein and elevated serum creatinine are the risk factors for aggravation and even death. It is recommended that, in the diagnosis and treatment of COVID-19 patients, an optimization plan should be adopted to avoid or reduce the burden on the kidneys, meanwhile the patients' kidney damage should be paid closely attention to for protection and treatment in the early stage to avoid the occurrence of AKI. For patients who already suffered from AKI, replacement therapy, which would prevent these patient's condition from getting worse or even death, should be promptly implemented to alleviate the impact of kidney damage.