OBJECTIVES: To investigate the risk factors of overall postoperative complications in elderly patients undergoing gastrointestinal surgeries. METHODS: This study was conducted among a total of 1388 elderly patients, who underwent elective gastrointestinal surgeries at 17 centers across China between April, 2020 and April, 2022. The primary outcome was the incidence of postoperative complications within 30 days, including procedure-related, neuropsychiatric, respiratory, cardiovascular, and gastrointestinal complications as well as acute kidney injury. Baseline characteristics, preoperative psychological and functional status, intraoperative anesthesia and surgical factors, intraoperative medication, use of nerve block, and postoperative analgesia methods were compared between the patients experiencing one or more postoperative complications and those without complications. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors for postoperative complications. The relationship between postoperative acute pain and each type of complication were explored. RESULTS: The incidence of overall postoperative complications was 50.8% (705/1388) in these patients. Multivariate analysis showed that age (OR: 1.026; 95% CI: 1.006-1.046), prognostic nutritional index (OR: 0.998; 95% CI: 0.997-1.000), preoperative EuroQol-5 dimensions score (OR: 0.094; 95% CI: 0.018-0.500), blood loss (OR: 1.002; 95% CI: 1.001-1.003), and acute postoperative pain (OR: 1.308; 95% CI: 1.033-1.657) were significantly associated with the occurrence of postoperative complications. Specifically, patients experiencing severe postoperative pain had a significantly higher incidence of neuropsychiatric (27.2% vs 19.8%), procedure-related (17.3% vs 10.2%), and cardiovascular complications (3.6% vs 1.7%). CONCLUSIONS An advanced age, a low preoperative nutritional index, a poor quality of life score, a greater volume of intraoperative blood loss, and acute postoperative pain are independent risk factors for postoperative complications in elderly patients undergoing gastrointestinal surgeries. There is a significant association between acute postoperative pain and multi-system complications.
Humans ; Postoperative Complications/etiology* ; Aged ; Risk Factors ; Digestive System Surgical Procedures/adverse effects* ; Male ; Female ; China/epidemiology* ; Pain, Postoperative/epidemiology* ; Incidence ; Aged, 80 and over

Health think tanks serve as a crucial intellectual support for the Healthy China strategy. The authors systematically analyzed the definitions, classifications, and operational status of health think tanks, categorizing them into five types: government-affiliated think tanks, university and research institute think tanks, social think tanks, hospital think tanks, and corporate think tanks. It was indicated that current health think tanks had significant room for improvement in both quantity and influence, particularly concerning deeper integration with policy decision-making and interdisciplinary collaboration. Although these think tanks played a unique role in supporting government decision-making, issues such as lagging institutional development, insufficient collaborative effectiveness, and difficulties in translating research findings into practice remained prominent. To enhance the ability of think tanks to serve the Healthy China strategy, this study proposed strategies including strengthening top-level design, improving participation mechanisms, optimizing management and evaluation systems, establishing data-sharing platforms, and deepening collaborative governance, with the aim of fostering the healthy development of China′s health think tanks.

Health think tanks serve as a crucial intellectual support for the Healthy China strategy. The authors systematically analyzed the definitions, classifications, and operational status of health think tanks, categorizing them into five types: government-affiliated think tanks, university and research institute think tanks, social think tanks, hospital think tanks, and corporate think tanks. It was indicated that current health think tanks had significant room for improvement in both quantity and influence, particularly concerning deeper integration with policy decision-making and interdisciplinary collaboration. Although these think tanks played a unique role in supporting government decision-making, issues such as lagging institutional development, insufficient collaborative effectiveness, and difficulties in translating research findings into practice remained prominent. To enhance the ability of think tanks to serve the Healthy China strategy, this study proposed strategies including strengthening top-level design, improving participation mechanisms, optimizing management and evaluation systems, establishing data-sharing platforms, and deepening collaborative governance, with the aim of fostering the healthy development of China′s health think tanks.

Objective To analysis the current situation of clinical pathway implementation and management of 53 public general hospitals in 16 cities in Anhui Province from 2018 to 2021,so as to provide a basis for further strengthening the management of clinical pathways in Anhui Province.Methods From December 2022 to March 2023,questionnaire stars were used to conduct a questionnaire survey on the implementation status of clinical pathway management.Results In 2021,53 public general hospitals implemented an average of 23.56 clinical pathways,228.75 diseases,88.58％ of the average admission rate,69.08％ of the average coverage rate,and 92.85％ of the average completion rate,meeting the national requirements. However,the number of departments,coverage and completion rate showed a small increase over the past four years.The hospital level,the time of information system implementation,the position of the clinical pathway leader,whether it is linked to departmental and individual bonuses,and the integration of clinical pathways with DRG/DIP payment methods all have statistically significant effects on the implementation effectiveness of clinical pathways(P<0.05).Conclusion Since the establishment of the Clinical Pathway Management Center in 2015,Anhui Province has promoted the implementation of clinical pathway management in the province's second-level and above public hospitals every year,but it has entered management after 2018.It is suggested that Anhui Province should strengthen the attention of hospital leaders,information management and the integration of clinical paths and medical insurance payment methods in the future,so as to achieve a balance between cost control and reasonable diagnosis and treatment.

Objective To analysis the current situation of clinical pathway implementation and management of 53 public general hospitals in 16 cities in Anhui Province from 2018 to 2021,so as to provide a basis for further strengthening the management of clinical pathways in Anhui Province.Methods From December 2022 to March 2023,questionnaire stars were used to conduct a questionnaire survey on the implementation status of clinical pathway management.Results In 2021,53 public general hospitals implemented an average of 23.56 clinical pathways,228.75 diseases,88.58％ of the average admission rate,69.08％ of the average coverage rate,and 92.85％ of the average completion rate,meeting the national requirements. However,the number of departments,coverage and completion rate showed a small increase over the past four years.The hospital level,the time of information system implementation,the position of the clinical pathway leader,whether it is linked to departmental and individual bonuses,and the integration of clinical pathways with DRG/DIP payment methods all have statistically significant effects on the implementation effectiveness of clinical pathways(P<0.05).Conclusion Since the establishment of the Clinical Pathway Management Center in 2015,Anhui Province has promoted the implementation of clinical pathway management in the province's second-level and above public hospitals every year,but it has entered management after 2018.It is suggested that Anhui Province should strengthen the attention of hospital leaders,information management and the integration of clinical paths and medical insurance payment methods in the future,so as to achieve a balance between cost control and reasonable diagnosis and treatment.

Objective To study effect of bufalin on invasion and metastasis of gastric cancer cells and related mechanism.Methods AGS human gastric cancer cell line was used for in vitro experiments.Cultured cells were treated by negative control group,bufalin group and oxaliplatin group.Cell proliferation was determined by MTT.Invasion and metastasis were observed by Wound-Healing Assay and Transwell Assay.Expression levels of E-cadherin,matrix metalloproteinases (MMP)-2,MMP-9 were detected by Western blotting.Results Bufalin was found to significantly inhibit the proliferation of AGS cells in a dose and time dependent manner.Wound-Healing Assay and Transwell Assay showed that as compared with the blank control group,bufalin inhibited invasion and metastasis of AGS cells (P＜ 0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞0.05).Western blotting showed the expression of E-cadherin was increased in bufalin group as compared with the blank control group while the expression levels of MMP-9 and MMP-2 were down-regulated (P＜0.05),but there was no statistically significant difference between bufalin group and oxaliplatin group (P＞ 0.05).Conclusion Bufalin has anti-cancer activity on gastric cancer cells,and it has the ability of inhibiting cancer cell invasion and metastasis,and regulating the expression of some related gene.

Aim To investigate the protective effect of flavonoids from Radix tetrastigmae (RTFs)on lipopo-lysaccharide (LPS)induced acute lung injury (ALI) of aged mice and the mechanism.Methods Aged C57BL/6J mice were bronchially instillated LPS to in-duce ALI.RTFs were orally administered to treat ALI. After 3 days,bronchoalveolar lavage fluid (BALF) was collected to enumerate leukocytes with Wright-Gi-emsa staining,and to detect inflammatory cytokines with ELISA.ELISA and Western blot methods were al-so used to detect the expression of MAPKs and NF-κB in lung tissues.The activity of NF-κB in nucleic pro-tein extract was detected with TransAMkit.Results
ALI models were successfully induced through LPS in-stillation.RTFs significantly reduced leukocyte,espe-cially neutrophil infiltration in BALF,inhibited IL-1 β, IL-6,IL-1 2p40,TNF-αand sTNF-R1 secretion,and improved pathohistological change of lung tissues.Be-sides,RTFs significantly attenuated the phosphoryla-tion of p38MAPK,NF-κB and the activity of NF-κB. Conclusion RTFs inhibits LPS-induced ALI through p38MAPK and NF-κB pathway and exhibits significant anti-inflammation effect on aged mice.