Gastric stump carcinoma (GSC) generally refers to the primary cancer in the remnant stomach,which occurs 5 years or latter after subtotal gastrectomy for gastric or duodenal ulcer,or 10 years or latter after gastric cancer resection.Laparoscopic radical gastrectomy for GSC is difficult with low resection rate.Although laparoscopic gastrectomy is technically mature in recent years,there is still few reports about laparoscopic resection for GSC.From January 2009 to June 2012,18 patients with GSC received laparoscopic radical gastrectomy at the General Hospital of Lanzhou Military Area of PLA.Laparoscopic gastrectomy for GSC is technically feasible and safe with satisfactory short-term outcome.Surgeons who have mastered laparoscopic D2 dissection could perform this procedure.

Objective:To evaluate the effect of coronary artery anatomical score(SYNTAX score) on in-hospital mortality of CABG patients.Methods:The clinical data of patients who were performed with a CABG surgery alone in the Department of Cardiovascular Surgery, Tianjin Chest Hospital from July 2017 to December 2018 were collected. The clinical end point was all-cause in-hospital death or against-advice discharge after surgery. Univariate analysis and multivariate logistic regression analysis were performed on the clinical data of the patients to obtain the risk factors affecting the in-hospital death of CABG in our center, to evaluate the influence of SYNTAX score on the in-hospital death of CABG. Results:Univariate logistic analysis showed that age, critical condition, creatinine level, serum albumin level, NT-proBNP level, NYHA grade, internal mammary artery use, SYNTAX score were correlated with in-hospital mortality. Multivariate analysis showed that age(≥75 years old), history of diabetes mellitus, critical state, creatinine clearance rate < 85 ml/min, albumin <35 g/L, NYHA Ⅲ-Ⅳ, SYNTAX score(≥29) were independent risk factors for in-hospital mortality after CABG. Conclusion:Coronary artery anatomy score - SYNTAX score(≥29) was an independent risk factor for in-hospital mortality in CABG patients in our hospital.

Objective:To investigate the efficacy and safety of prolonged dual antiplatelet therapy (DAPT) (aspirin + clopidogrel) after coronary artery bypass grafting (CABG) for more than 12 months.Methods:1 900 patients who received CABG treatment in Tianjin Chest Hospital from January 2019 to October 2020 were continuously included, and 1 528 patients were finally identified according to the inclusion and exclusion criteria. According to whether the patients continued to take DAPT treatment 12 months after discharge, they were divided into the extended DAPT group and the standard DAPT group. Cox multivariate regression and propensity score matching (PSM) analysis were performed on major cardiovascular and cerebrovascular adverse events (MACCE) and clinically related bleeding events in the two groups during 12-24 months after discharge to evaluate the efficacy and safety of extended DAPT treatment for more than 12 months. Results:Of the 1 528 patients, 624 (40.8%) continued to take DAPT 12 months after discharge. Compared with patients receiving standard DAPT, patients receiving extended DAPT had a lower incidence of MACCE within 12 to 24 months ( HR=0.597, 95% CI: 0.399-0.892, P=0.012); ( HR=0.519, 95% CI: 0.338-0.798, P=0.003), and there was no significant increase in clinically relevant bleeding risk ( HR=1.209, 95% CI: 0.522-2.798, P=0.658), ( HR=1.112, 95% CI: 0.452-2.737, P=0.817). At the same time, prolonged DAPT treatment also brought a good net benefit. Conclusion:Prolonged DAPT treatment after CABG for more than 12 months significantly reduced the risk of ischemia at 12-24 months after surgery, and did not significantly increase the risk of bleeding at 12-24 months after surgery. It may be beneficial for patients treated with CABG to continue DAPT (aspirin+ clopidogrel) on the basis of intensive DAPT therapy for 1 year.

Objective:To develop a deep learning model which can automatically and accurately detect osteoporotic vertebral compression fractures (OVCF) based on artificial intelligence.Methods:MRI images of 500 patients diagnosed with OVCF at The First People＇s Hospital of Guangzhou from January 2019 to October 2021 were collected retrospectively. There were 396 males and 204 females, with an age of (74.5±6.0) years. The T value of bone mineral density was -2.9±0.8. The fracture segments were L1 in 128 cases, L2 in 113 cases, L3 in 109 cases, L4 in 115 cases, and L5 in 108 cases. The multimodal layered converged network was used to train, test, and verify the robustness and generalization ability of a deep learning model based on MRI images of OVCF. The grad-cam was applied to visualize the results. The diagnostic value of the model for OVCF was assessed by comparing the diagnoses between the artificial intelligence model and 2 senior spinal surgeons on the MRI images of 30 OVCF patients randomized from the 500 ones.Results:Of the precise auxiliary diagnosis model for OVCF based on MRI images, the diagnostic accuracy was 96.7%, the sensitivity 93.5%, the specificity 88.9%, the positive predictive value 100.0%, and the negative predictive value 86.6%, all significantly higher than those of the 2 senior spinal surgeons (70.0%, 72.7%, 28.6%, 82.1%, and 28.6%) ( P<0.05). Conclusion:The present study has successfully established a deep learning model which can automatically and accurately diagnose OVCF based on MRI images, showing a high diagnostic efficiency than human spinal surgeons.

OBJECTIVE: To explore the level and influential factors for out-of-pocket (OOP) expenditure regarding Hunan Provincial Urban Employee Basic Medical Insurance (UEBMI) and to provide evidence for improvement of medical insurance payment system.
 METHODS: Stratified random sampling method was used to obtain 10 527 records of cancer inpatients from January 2011 to December 2014. Social demographic and expenditure information were collected from UEBMI information system. The proportion of OOP expenditure for inpatient and each part of the cost was described. Multiple linear regression was used to analyze main related factors of OOP expenditure.
 RESULTS: The median proportion of OOP for inpatients costs was 20.11%, and remained stable from 2011 to 2014. The main related factors for OOP expenditure were age, civil servant, retirment status, hospital level, cost of hospitalization, hospitalization duration, medicine cost, proportion of general medical service charges, treatment cost, expenses of examination and laboratory test, and cancer type.
 CONCLUSION OOP expenditure among UEBMI cancer inpatients was under control and stable. The level can well reflect the policy preferences. It could be further improved through the control of related factors, particularly the hospital level.
Health Care Costs ; Health Expenditures ; Hospitalization ; economics ; Humans ; Inpatients ; Neoplasms ; economics