In order to meet the demand of the high-end medical market,some public hospitals have explored the establishment of specialized diagnosis and treatment centers,providing high-end customized medical services at special registration prices.The establishment of the International Medical Center is an effective supplement to public welfare healthcare and an important measure for public hospitals to innovate and enhance themselves under the concept of value based healthcare.It conducts pioneering research and exploration on the cost-benefit accounting of international medical centers in public hospitals,and compares it with the accounting situation of conventional departments.By analyzing and calculating cost-effectiveness,medical indicators,and DRG data,the key points and difficulties of lean operation in international medical centers are explored.Innovative methods and ideas for platform fine accounting are proposed,which have guiding significance for its development direction.

In order to meet the demand of the high-end medical market,some public hospitals have explored the establishment of specialized diagnosis and treatment centers,providing high-end customized medical services at special registration prices.The establishment of the International Medical Center is an effective supplement to public welfare healthcare and an important measure for public hospitals to innovate and enhance themselves under the concept of value based healthcare.It conducts pioneering research and exploration on the cost-benefit accounting of international medical centers in public hospitals,and compares it with the accounting situation of conventional departments.By analyzing and calculating cost-effectiveness,medical indicators,and DRG data,the key points and difficulties of lean operation in international medical centers are explored.Innovative methods and ideas for platform fine accounting are proposed,which have guiding significance for its development direction.

To investigate the correlation of different types of urinary abnormalities or different proteinuria and hematuria with the pathological injury of kidney in IgA nephropathy with isolated hematuria and/or mild proteinuria.
 Methods: Patients with primary IgA nephropathy, isolated hematuria and/or mild proteinuria were enrolled in the Department of Nephrology, the Second Xiangya Hospital, Central South University from January 2013 to January 2018. According to the difference of red blood cell count in urinary sediment and quantitative of 24-hour urinary protein (24 h-UP) during renal biopsy, the patients were grouped in 3 ways: a simple hematuria group, a hematuria and proteinuria group, and a simple proteinuria group; a proteinuria I group, a proteinuria II group, and a proteinuria III group; a hematuria I group, a hematuria II group, and a hematuria III group. The clinical parameters such as age, mean arterial pressure, blood urea nitrogen, serum creatinine, blood uric acid, 24 h-UP, and renal pathological damage were compared.
 Results: A total of 157 patients met the inclusion criteria, including 71 males and 86 females. The most common pathological type was focal and/or segmental glomerulosclerosis. The Lee's classification were dominated by grade III and IV, and the renal pathological injury was heavy. Immunoglobulin deposition was dominated by simple IgA deposition. The most common fluorescence intensity of IgA deposition was +++. 97 (61.78%) patients were accompanied by complement deposition and were mainly composed of simple complement C3 deposition. There were 18 patients (11.47%) in the simple hematuria group, 111 patients (70.70%) in the hematuria and proteinuria group, and 28 patients (17.83%) in the simple proteinuria group. Compared with the simple hematuria group, the proportion of patients with mild injury was lower in the simple proteinuria group, and the proportion of patients with moderate-to-severe injuries was increased (χ2=7.053, P=0.008). Compared with the hematuria and proteinuria group, the proportion of patients with mild injury was lower in the simple proteinuria group, and the proportion of patients with moderate-to-severe injury was increased (χ2=4.294, P=0.038). Compared with the proteinuria I group, the proportion of patients with mild injury was lower in the proteinuria III group, and the proportion of patients with moderate-to-severe injury was increased (χ2=5.433, P=0.020). There was no significant difference in the proportion of patients with renal pathological injury among different hematuria groups (P>0.05).
 Conclusion: The clinical manifestations of patients with IgA nephropathy with hematuria and/or mild proteinuria are inconsistent with renal pathological damage. Some patients with mild clinical manifestations have severe renal pathological damage and the renal pathological damage is more serious in simple proteinuria. The more proteinuria, the heavier the renal pathological damage.
Creatinine ; Female ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Kidney ; Male ; Proteinuria

Objective To explore the prognostic value of sarcopenia in patients undergoing pancreati-coduodenectomy.Method Clinicopathologic data and follow-up information of 116 patients undergoing pancre-aticoduodenectomy at Renmin Hospital of Wuhan University between March 2011 and August 2016 were collected for statistical analysis.Results Among the 116 patients,the prevalence of sarcopenia was 42.2％ (n =49).When compared to the rest of the patients who did not have sarcopenia,the sarcopenia group had longer recovery time [(17.33±6.54) d vs.(13.46±9.32) d,P=0.013] and increased risk of complications (complications in general,59.2％ vs.38.8％,x2 =4.714,P =0.030;Clavien-Dindo ≥ 3:26.5％ vs.10.4％,x2 =5.130,P=0.024).Both the Kaplan-Meier survival analysis (P＜0.05) and the Cox proportional hazard model (overall survival:hazard ratio =2.285,95％ CI =1.521-3.431;recurrence-free survival,hazard ratio =2.167,95％ CI=1.445-3.248) indicated sarcopenia as the risk factor for poorer overall survival and recurrence-free survival.Conclusions Sarcopenia was an independent predictor of poor prognosis for patients undergoing pancreaticoduodenectomy.Patients with sarcopenia had higher risk of developing complications after surgery and lower overall survival rate and recurrence-free survival rate.

As an important immune organ,spleen also plays a crucial role in stabilizing hematologic system.Previous reports support that splenectomy must be performed after the ligation of spleen vessels.At recent time,with the deep knowledge of the anatomy and function of spleen,the surgeons have tried to preserve this organ after the ligation of the vessels.From March 2012 to April 2016,five patients in our hospital have undergone the distal pancreatectomy with spleen preservation after the ligation of splenic vessels,and all the patients' outcomes were satisfactory in the follow-up.This essay aims to discuss the safety and feasibility of preserving spleen after the ligation of the vessels by reporting our own experience and reviewing related literatures on this topic.

Objective To explore the clinical characteristics and diagnosis of autoimmune pancreatitis(AIP) with the aim to raise awareness of AIP.Methods Clinical data of 32 patients with AIP were retrospectively analyzed,including clinical manifestations,imaging features,laboratory examination,histopathology and treatment from November 2009 to April 2013 in the First Affiliated Hospital of Medical School,Zhejiang University.Results All 32 AIP patients including 25 males and 7 females had a median age of (62.5 ± 12.6) years (27-84 years).The initial symptoms included obstructive jaundice in 50.0％patients (16/32),abdominal pain in 43.8％ (14/32),fatigue and weight loss in 12.5％ (4/32),and bloody stool in 6.3％ (2/32).Laboratory findings revealed abnormal liver function in 6.3％ (2/32)patients,increased immunoglobulins in 71.9％ (23/32)patients and elevated IgG4 in 8/10 patients.Computerized tomography(CT) scan and ultrasonography were performed in all patients.Diffusely enlarged pancreas were found in 62.5％ (20/32) patients and focally enlarged in 37.5％ (12/32),additionally main pancreatic duct stenosis in 62.5％ (20/32) patients.Nineteen patients obtained histopathological examination,indicating pancreatic interstitial fibrosis,and infiltration of lymphocytes and plasma cells.Conclusions Autoimmune pancreatitis is an autoimmune disease which may be misdiagnosed as pancreatic cancer.The clinical features,laboratory findings,imaging characteristics,and typical histopathologic presentation,as well as good response to glucocorticoids provide supportive evidence for the diagnosis of AIP.

OBJECTIVE To assess the relationship among the genes types ureA,cagA,vacA,gene vacA subtypes and Helicobacter pylori(Hp)-related upper gastrointestinal diseases in this study.METHODS Eighty-four Hp strains were identified from bacteria isolated and cultured from the gastric mucosa tissue.Genes ureA,cagA,vacA,and gene vacA subtypes were typed using PCR with specific primers.RESULTS In 84 identified Hp strains,the positive ratio of gene ureA was 100.00%,of gene cagA was 90.48%,and of gene vacA was 95.24%.The positive ratio of genes cagA and vacA was lower in gastric cancer than in gastritis and peptic ulcer(P0.05).CONCLUSIONS ure+,cagA+ and vacAm2 subtypes of Hp are predominant in patients with upper gastrointestinal diseases in Zhenhai District,Ningbo,Zhejiang Province.They are more common in patients with gastric ulcer and gastritis.