Objective: On the basis of typical cases, the objective of this study is to assess the service quality of primary healthcare institutions under the vertically integrated model from the perspective of demanding side.Methods: The vertical model between Renhe Hospital and Lixian Township Health Center was selected as the case study.Quantitative data were collected by exit review using Primary health-Care quality service Assessment Tool (PCAT)-Chinese version from the patients seeking services in Lixian.Quantitative data were analyzed by descriptive statistics and multiple linear regression equations while qualitative data were analyzed by thematic framework analysis.Results: Under the vertical model, the PCAT total score was 20.09.The scores on the first diagnosis, continuity of care, and comprehensiveness of care and coordination of care were 6.59, 3.27, 4.58 and 5.62 respectively.The scores on the three dimensional extensions, family-centered, community-oriented, medical culture were 3.07, 1.86 and 2.67 respectively.The difference was significant for the PCAT total score between a number of visits and the length of waiting time for services in Lixian.Conclusions: Under the vertical model, primary healthcare institutions did better in the first diagnosis while weaker in continuity and the three dimensional extensions.With the development of the integration, the primary healthcare institutions need to strengthen the continuity and downward referral in the future.Future researches and follow-up, analysis is needed to track the impact of the vertically integrated model.

Lack of biocompatibility and bioactivity is a big problem for the synthetic materials that have been generated for neural tissue engineering. To get around the problem and generate better scaffold for neural tissue repair, we intended to generate nano-fibers by self-assembly of polypeptide IKVAV. Bioactive IKVAV Peptide-Amphiphile (IKVAV-PA) was first synthesized and purified, the property of which was analyzed and determined by high-performance liquid chromatography (HPLC) and mass spectrometry (MS). Then, by addition of hydrogen chloride (HCl), self-assembly of IK-VAV-PA was induced in vitro and nano-fibers formed as shown by transmission electron microscopy (TEM). The effect of IKVAV nanofibers on adherence of PC12 cells was assayed in cell culture and the results showed that the rates of adherence of PC12 increased significantly when the density of IKVAV was within a certain range (0.58 microg/cm2 to 15.6 microg/cm2). However, its effect on the rates of adherence did not significantly alter with time, whether after 1 hour or 3 hours of culture. In general, we showed that IKVAV-PA can successfully self-assemble to form nanofiber, and promote rapid and stable adherence of PC12 cells, and the effect of the self-assembled IKVAV to promote PC12 cells adherence is dosage-dependent within a certain range of densities.

The primary importance of magnetic resonance (MR) imaging in evaluating anal fistulas lies in its ability to demonstrate hidden areas of sepsis and secondary extensions in patients with fistula in ano. MR imaging is relatively expensive, so there are many healthcare systems worldwide where access to MR imaging remains restricted. Until recently, computed tomography (CT) has played a limited role in imaging fistula in ano, largely owing to its poor resolution of soft tissue. In this article, the different imaging features of the CT and MRI are compared to demonstrate the relative accuracy of CT fistulography for the preoperative assessment of fistula in ano. CT fistulography and MR imaging have their own advantages for preoperative evaluation of perianal fistula, and can be applied to complement one another when necessary.
Adult ; Anal Canal/anatomy & histology ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Rectal Fistula/diagnosis/*radiography/surgery ; Tomography, X-Ray Computed ; Young Adult

Objective To investigate the safety and efficacy of laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopy-assisted technique in the treatment of ureteral strictures secondary to Holmium laser lithotripsy.Methods The clinical data of 26 cases of ureteral strictures secondary to Holmium laser lithotripsy performed by laparoscopic ureteroureterostomy from December 2013 to January 2016 in our hospital were analyzed retrospectively.The patients included 15 men and 11 women,with an average age of 39.5 years (range 24-71 years).The ureteral strictures secondary to holmium laser lithotripsy were found on average follow-up of 5.2 months (range 1-22 months).There were 12 cases of mild hydronephrosis before surgery,moderate hydronephrosis in 11 cases,severe hydronephrosis in 3 cases.Preoperative serum creatinine was 102.0 μ mol/L on average (range 53.3-201.4 μmol/L),and ureteral stenosis length was 15.0 mm on average (range 8.0-26.0 mm).The upper ureteral strictures in 6 cases,the middle strictures in 13 cases,and the lower strictures in 7 cases.Results All the operations were completed successfully without conversion to open and no intraoperative death.The average operation time was 121.4 min(range 90-155 min);the estimated blood loss was 92.3 ml (range 30-200 ml);the mean recovery time of gastrointestinal function after operation was 1.4 d(range 0.5-2.5 d);the mean hospital stay was 6.2 d(range 4-9 d)with indwelling double J;the Foley catheter was removed 14.5 d(range 12-16 d)postoperatively;the mean time of double J withdrawal was 76.3 d(range 61-86 d).Postoperative fever occurred in two patients and were successfully treated by re-indwelling catheter and antibiotic administration.Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management 5 days later.After a period of 11 to 22 months of follow-up,no patient had ureteric re-stenosis.Conclusions Laparoscopic ureteroureterostomy with intraoperative retrograde ureteroscopyassisted technique could accurately locate and cure the ureteral strictures.It might be safe and effective with short operation time,less injury and quick recovery.

Lack of biocompatibility and bioactivity is a big problem for the synthetic materials that have been generated for neural tissue engineering. To get around the problem and generate better scaffold for neural tissue repair, we intended to generate nano-fibers by self-assembly of polypeptide IKVAV. Bioactive IKVAV Peptide-Amphiphile (IKVAV-PA) was first synthesized and purified, the property of which was analyzed and determined by high-performance liquid chromatography (HPLC)and mass spectrometry (MS). Then, by addition of hydrogen chloride (HCl), self-assembly of IKVAV-PA was induced in vitro and nano-fibers formed as shown by transmission electron microscopy (TEM). The effect of IKVAV nanofibers on adherence of PC12 cells was assayed in cell culture and the results showed that the rates of adherence of PC12 increased significantly when the density of IKVAV was within a certain range (0.58 μg/cm2 to 15.6 μg/cm2). However, its effect on the rates of adherence did not significantly alter with time, whether after 1 hour or 3 hours of culture. In general,we showed that IKVAV-PA can successfully self-assemble to form nanofiber, and promote rapid and stable adherence of PC12 cells, and the effect of the self-assembled IKVAV to promote PC12 cells adherence is dosage-dependent within a certain range of densities.

Objective To evaluate the efficacy and safety of preoperative intra-aortic balloon pump(IABP) insertion in acute myocardial infarction(AMI) without cardiogenic shock(CS) patients receiving off-pump coronary artery bypass grafting ( OPCABG).Methods 444 consecutive AMI patients who underwent isolated OPCABG from January 2009 to December 2016 were enrolled.158 patients who underwent preoperative IABP placement(IABP group) and the other of 286 patients who did not have IABP placement(control group).The in-hospital mortality rate, postoperative complications, mechanical ventilation time, ICU stay and hospital length were compared between the two groups.Results The overall mortality was 5.0%.135 pairs of patients were matched.The preoperative IABP insertion showed benefits in postoperative survival rate compared with the control group(0 vs.5.9%, P＝0.004).However, patients with preoperative IABP were more likely to prolong duration of mechanical ventilation and ICU stay.The postoperative length of stay in hospital didn't show significant difference between the two groups.Conclusion Survival advantage was observed from preoperative IABP insertion in AMI patients without CS under-going OPCABG.

Objective:To investigate the safety and the efficacy of percutaneous and surgical approach in femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation.Methods:All consecutive patients implanted with femoro-femoral VA-ECMO between January 2018 and December 2020 in Beijing Anzhen Hospital, Capital Medical University. Propensity score matching was used to compare outcomes of percutaneous and surgical groups while controlling for confounders.Results:Among the 276 patients who received femoro-femoral VA-ECMO (62 surgical and 214 percutaneous), propensity-score matching selected 52 pairs of patients with similar characteristics with mean age of(59.6±13.0)years old, in which 26 patients were female. There were a lower ECMO cannulation-associated complication (28.8% vs. 48.1%, P=0.044) and a lower hospital mortality (42.3% vs. 67.3%, P=0.010) in the percutaneous group. The circuit blood flow after ECMO initiation was similar in both groups[(3.3±0.8)L·min -1·kg -1 in percutaneous group vs. (3.2±0.7)L·min -1·kg -1 in surgical group, P=0.738]. The serum lactate was declined in both group after ECMO initiation[(5.4±5.8)mmol/L vs. (9.2±6.9)mmol/L, P<0.001 in percutaneous group; (6.3±6.2)mmol/L vs. (10.5±7.0)mmol/L, P=0.003 in surgical group]. Conclusion:Percutaneous approach is a safe and efficient technique in emoro-femoral VA-ECMO cannulation. Compared with surgical cannulation, percutaneous approach is associated with lower ECMO cannulation-associated complication and lower hospital mortality.

To investigate the feasibility and clinical effects of the laparoscopic urinary tract reconstruction with intraoperative retrograde ureteroscopy-assisted technique for the treatment of complex ureteral stricture. 
 Methods: The clinical data of 16 patients with complicated ureteral stricture treated by the laparoscopic urinary tract reconstruction with intraoperative retrograde ureteroscopy-assisted technique from February 2016 to June 2018 were retrospectively analyzed. All 16 patients were iatrogenic stenosis. There were 4 cases of severe hydronephrosis in the affected side, 7 cases of moderate hydronephrosis, and 5 cases of mild hydronephrosis. According to the specific location and length of the ureteral stricture, the corresponding surgical method was selected. 
 Results: All patients successfully completed the operation without conversion to open surgery and organ injury. After the operation, the patients were followed up for 8-18 months. The hydronephrosis of all patients was relieved to varying degrees, and no ureteral restenosis occurred. 
 Conclusion: The laparoscopic urinary tract reconstruction with intraoperative retrograde ureteroscopy-assisted technique can accurately locate the stenosis segment, test the anastomosis effect, expand the inflammatory stenosis, and improve the end-to-end anastomosis of the distal ureteral stricture, which is a new and effective technique for the treatment of complex ureteral strictures.
Constriction, Pathologic ; Humans ; Laparoscopy ; Retrospective Studies ; Ureteral Obstruction ; diagnostic imaging ; Ureteroscopy