Objective:To investigate the application value of enhanced recovery after surgery (ERAS) in perioperative period of laparoscopic sleeve gastrectomy (LSG).Method:The retrospective cohort study was conducted. The clinical data of 1 181 patients undergoing LSG in the Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from January 2021 to December 2023 were collected. There were 242 males and 939 females, aged (31±8)years. Of 1 181 patients, 598 cases receiving routine perioperative care were divided into the control group, and 583 cases receiving perioperative care with ERAS were divided into the ERAS group. Measurement data with normal distribution were represented as Mean± SD, and the independent sample t test was used for comparison between the groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and the Mann-Whitney rank sum test was used for comparison between the groups. Count data were expressed as absolute numbers or percentages, and the chi-square test or Fisher exact probability were used for comparison between the groups. Repeated measurement data were analyzed using the repeated ANOVA, with baseline scores as covariates. Simple effects analysis was conducted in case of interaction, and multiple comparisons were adjusted using the Bonferroni method. Results:(1) Postoperative outcomes. The numerical rating scale (NRS) scores for pain at immediate return to the ward and on the third postoperative mornings changed from 5.35±0.93 to 2.57±0.83 in the control group, versus changed from 3.15±0.93 to 0.70±0.65 in the ERAS group, showing significant difference between the two groups ( Ftime=66.58, Fgroup=1 765.85, Finteraction=6.90, P<0.05). After adjusting NRS scores for pain at immediate return to the ward as the baseline, results of simple effects analysis showed that on the third postoperative mornings, the NRS scores in the ERAS group were lower by 1.89, 1.53, and 1.76 respectively compared to the control group ( P<0.05). Cases with nausea at immediate return to the ward and on the third postoperative mornings changed from 497 to 97 in the control group, versus changed from 198 to 11 in the ERAS group, showing signifi-cant difference between the two groups ( χ2=294.45, 398.76,209.39, 73.00, P<0.05). Cases with vomiting at immediate return to the ward and on the third postoperative mornings changed from 243 to 41 in the control group, versus changed from 51 to 2 in the ERAS group, showing significant difference between the two groups ( χ2=160.54, 149.37, 71.76, 35.69, P<0.05). The duration of postoperative hospital stay was (3.22±0.65)days in the control group, versus (2.17±0.49)days in the ERAS group, showing a significant difference between the two groups ( t=-11.89, P<0.05). (2) Complications. The incidence of cases with dehydration within postoperative 30 days was 0.50%(3/598) in the control group, versus 0.69%(4/583) in the ERAS group, showing no significant difference between the two groups ( P>0.05). None of patient in the control group and the ERAS group experienced bleeding, gastric leakage, intra-abdominal infection, and no patient had unplanned secondary surgery within postoperative 30 days. Conclusions:ERAS in perioperative period of LSG are safe and feasible. Compared to routine care, ERAS can significantly reduce postoperative pain, decrease the incidence of postoperative nausea and vomiting, shorten the postoperative hospital stay, and do not increase the rate of postoperative complications or unplanned secondary surgeries within postoperative 30 days.

Objective:To establish a set of scientific and reasonable indicator system of common prosperity in the field of health, so as to promote the construction and evaluation of the demonstration area of common prosperity with high quality of health.Methods:According to the requirements of promoting common prosperity demonstration area with high quality of health in Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis in July 2021, and experts were convened to carry out expert brainstorming to determine indicator system in the form of meetings. Delphi method was used to conduct two rounds of expert consultation on the indicator system.Finally, the analytic hierarchy process and percentage weight method were used to calculate the indicator weight value.Results:The final indicator system included 4 first-level indicators and 30 second-level indicators. Among the first-level indicators, the weight values of the development, equilibrium, inclusiveness, and sustainability were 0.326 4, 0.242 8, 0.245 8, and 0.185 0. There were 8 second-level indicators in developmental indicator dimension, of which the indicator with the highest weight was the per capita health expectancy. The balance indicator dimension included 6 second-level indicators, of which the indicator with the highest weight was the per capita financing difference of basic medical insurance between the urban workers with the urban-rural residents. The inclusive indicator dimension included 6 second-level indicators, and the proportion of personal health expenditure to total health expenditure had the highest weight. The sustainability indicator dimension included 10 second-level indicators, and the proportion of government health expenditure in fiscal expenditure had the highest weight.Conclusions:The indicator system constructed in this research could provide certain guidance and reference for promoting the construction of common prosperity in health, and provide some reference for follow-up research in this field.

During the 14th Five-Year Plan period, China′s public hospitals are facing important development opportunities as well as many difficulties and challenges. Using PEST model, this study analyzed the macro-environmental factors of the development of public hospitals in China from four aspects: political environment, economic environment, social environment and technological environment. The authors proposed relevant countermeasures and suggestions to promote the high-quality development of public hospitals, including implementing functional positioning and promoting differentiated and synergistic development, strengthening operation management and enhancing the capacity for high-quality development, and building smart hospitals and stimulating new efficiency in service management.

Objective:To explore the application value of transpancreatic precut sphincterotomy combined with pancreatic duct stent placement for difficult intubation of endoscopic retrograde cholangiopancreatography (ERCP).Methods:A total of 169 patients with difficult papilla intubation who underwent ERCP treatment in the Third Affiliated Hospital of Naval Medical University from January 2017 to December 2019 were included. Double guide wire intubation was used in 137 cases and transpancreatic precut sphincterotomy combined with pancreatic duct stent placement was used in 32 cases. The success rate of intubation, intubation time and postoperative complications of the two groups were compared.Results:The success rates of intubation in the double guide wire group and the transpancreatic precut sphincterotomy combined with pancreatic duct stent placement group were 98.54% (135/137) and 100.00% (32/32) ( P>0.05); the mean intubation time of the two groups were 15.69±9.07 min and 17.06±5.79 min ( P>0.05); the incidence of postoperative complications were 25.55% (35/137) and 9.38% (3/32) ( P<0.05), among which incidences of pancreatitis were 5.8% (8/137) and 0 respectively. Conclusion:During difficult ERCP papilla intubation, the transpancreatic precut sphincterotomy combined with pancreatic duct stent placement can yield higher safety and a similar success rate compared with the double-guide wire technique, which is worthy of clinical application.

Objective:To establish a set of evaluation indicator system of policy coordination of integrated county healthcare consortium based on the construction practice of integrated county healthcare consortium in Zhejiang province.Methods:Based on the guiding opinions and relevant supporting policy documents issued by Zhejiang province, the initial indicator pool was established through literature research and theoretical analysis, and the indicator system was modified and perfected in two rounds by Delphi method. The weight value of the indicators was calculated by the priority chart method.Results:The indicator system included 4 first-level indicators, 10 second-level indicators and 35 third-level indicators. Among the first-level indicators, the weight values of health insurance payment, personnel salary, price reform, fiscal and finance were 0.406, 0.281, 0.141 and 0.172, respectively.Conclusions:The indicator system established in this study has certain rationality and feasibility, which can provide reference for promoting the construction of integrated county healthcare consortium in China from the perspective of policy coordination, and provide reference for relevant scholars to carry out follow-up research.

Betacoronavirus ; isolation & purification ; pathogenicity ; Bile Acids and Salts ; metabolism ; Bile Ducts, Intrahepatic ; pathology ; virology ; Cell Culture Techniques ; Coronavirus Infections ; complications ; pathology ; Cytokine Release Syndrome ; etiology ; physiopathology ; Cytopathogenic Effect, Viral ; Epithelial Cells ; enzymology ; pathology ; virology ; Humans ; Hyperbilirubinemia ; etiology ; Liver ; pathology ; Organoids ; pathology ; virology ; Pandemics ; Peptidyl-Dipeptidase A ; analysis ; Pneumonia, Viral ; complications ; pathology ; Receptors, Virus ; analysis ; Serine Endopeptidases ; analysis ; Viral Load

The past ten years have witnessed China′s primary public health services making remarkable progress in the number of projects and funding subsidy standards, but such problems as the single nature of the main supplying entities, poor supply mechanism and low supply efficiency are still prominent. The authors comprehensively expounded the present situation of the supply of primary public health services in China from the aspects of implementation subject, service content, fund guarantee, human resources, supply mode and performance evaluation, studied and summarized the evolution process and characteristics of public health service supply model. On such basis, they recommended on improving the supply model from the perspective of tripartite subjects of government, market and social organization, so as to speed up the formation of the government-led public service supply model, in which the market, the society and other pluralistic subjects participate equally, construct the competitive supply pattern of medical and health services at county and township levels, strengthen the purchase from social organizations and improve the performance evaluation system and supervision mechanism.

Objective: Understanding mental health status of students with learning disabilities in Beijing to provide a basis for mental health promotion of students with learning disabilities. Methods: By means of random cluster sampling, 5 787 enrolled students in grade one and grade two of 11 public junior middle schools in Beijing were selected as the survey subjects. A self designed questionnaire was used to investigate the students’ learning disabilities and mental health status through anonymous self filling. Results: About 11.6% students self reported learning disabilities. The proportions of students with learning difficulty in mathematical reasoning and calculation were higher, 44.1% and 40.7% respectively. The reported rate of mental health problems was 38.3%. The top four of the 10 symptoms were obsessive compulsive symptoms, learning pressure, emotional instability and anxiety(2.19±0.77)(2.17±0.99)(2.09±0.90)(2.07±1.08). Compared with students without learning disabilities, students with self reported learning disabilities had poorer mental health status(OR=1.47), and learning disabilities were related to most factors of mental health. Different types of learning disabilities were associated with different mental health factors. Conclusion Mental health problems of students with learning disabilities are higher than that of students without learning disabilities. It is necessary to strengthen the mental health support for students with learning disabilities and improve their mental health.

Objective To investigate the expressions of miR-21 in clinical lung tissues,serum of lung cancer patients and X-ray irradiated A549 cells in vitro and in vivo.Methods A549 cells were irradiated with 2 and 4 Gy X-rays,and pulmonary metastasis model of lung cancer in nude mice was established to detect the expression of miR-21 in vitro and in vivo,as well as in clinical lung tissues of different pathological types serum sample of lung cancer patients and NSCLC patients whether or not received radiotherapy.The survival rate was further analyzed in the above mention NSCLC patients.Results The miR-21 expressions was up-regulated in 60.0％ of tissue samples of NSCLC patients,and it was up-regulated in 50.5％ serum samples of lung cancer patients (52 out of 103).The miR-21 expressions in lung adenocarcinoma and squamous cell carcinoma had significant difference (x2 =5.766,P ＜ 0.05).In the serum samples of 87 NSCLC patients,miR-21 was detected in 66.7％ samples from the patients of radiotherapy but only 39.6％ of patients without radiotherapy (x2 =6.321,P ＜ 0.05).Kaplan-Meier curves showed that the survival rate of patients with low miR-21 expression was higher than that with high miR-21 expression (P ＜ 0.05).Multivariate Cox regression analysis demonstrated that the miR-21 expression,regional lymph node metastasis and radiotherapy were independent prognostic factors for NSCLC patients.The expression of miR-21 was up-regulated significantly in X-ray irradiated A549 cells at different time-points after irradiation (t =-7.552--1.206,P ＜ 0.05).Furthermore,the expression of miR-21was up-regulated in the serum and lung of nude mice (t =-47.845--2.356,P ＜ 0.05).Conclusions The X-ray irradiation could up-regulate the expression of miR-21 in A549 cells in vitro and in vivo,which might be correlated with the enhanced metastasis of A549 cells.

Objective To examine the occupational stability,training needs and capacity building requirements of the general practitioners purposely trained to work in rural communities,for improvement of policies regarding their training and issues related. Methods There counties were selected by stratified random sampling, where general practitioners graduated from such training completed an anonymous questionnaire. Focus group interviews were made to officials of the local Health and Family Planning Commission,those of primary healthcare institutions,and general practitioners themselves. Results The of the 190 valid questionnaires recovered, male accounted for 34. 2% and female 65. 8%. These general practitioners were mostly satisfied with their working environment, social status, work stress and job achievement,yet with lower satisfaction with their salary and availability of medical devices. Consideration of resignation was reported by only 5. 3% of them,with more males than females. As high as 63. 2% of them prefer to work in hospitals of county level. 91. 1% of them held it as necessary to participate in standard resident training,and 98. 4% held it as necessary to have on-job training. 94. 7% of them have participated in further education to gain a bachelor degree in medicine. Conclusions These doctors were found with high stability to work in rural communities and low turnover intention. Further studies are required to encourage these general practitioners to serve rural communities in a long term, and to improve the standard resident training mechanism,and their career development.