Objective:To investigate the safety and short-term efficacy of laparoscopic Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD).Methods:The clinical data of 61 patients underwent laparoscopic Nissen fundoplication from March 2018 to March 2022 in Jiangyin People′s Hospital were retrospectively analyzed. Among them, 14 patients had significant symptom relief after using proton pump inhibitor (PPI) before operation (group A), 30 patients had partial symptom relief after using PPI (group B), and 17 patients had persistent symptoms despite regular treatment with double-dose PPI for more than 8 weeks (group C). The surgical outcomes and recovery were compared among the three groups.Results:For the 61 patients, the surgical time was (117.46 ± 28.50) min, the intraoperative blood loss was 23.00 (8.00, 34.00) ml, and the postoperative hospital stay was 3.00 (2.00, 5.00) d. There were no statistically significant differences in surgical time, intraoperative blood loss, postoperative hospital stay, concurrent hiatal hernia repair and mesh placement among the three groups ( P>0.05). No short-term severe complications such as abdominal bleeding, abdominal infection and gastrointestinal perforation occurred in any group. There were no statistical differences in satisfaction score, subjective relief of overall postoperative symptoms, reflux symptoms, PPI usage, dysphagia, abdominal distention, diarrhea or constipation among the three groups ( P<0.05). No upper abdominal pain, recurrence and reoperation occurred in the three groups. Conclusions:Laparoscopic Nissen fundoplication has a definite therapeutic effect on rGERD, with significant anti reflux effects. There are no serious complications after surgery, and there are no recurrence or reoperation.

Objective:This study aims to analyze the provincial policy text of separate payment for National medical insurance negotiated drugs,summarize the key measures and characteristics,and provide reference for the formulation and improvement of separate payment policies in various provinces.Methods:The retrieved policy texts were analyzed by searching the websites of the medical security bureaus of various provinces,municipalities,and autonomous regions.Results:There are differences in the separate payment policies of different provinces in terms of catalogue publishing,catalogue selection,drug management,policy treatment level and policy cohesion.Conclusion:The separate payment policy is the key driver of Joint Reformation for Public Health Services,Medical Insurance,and Medical Production-Circulation.And all provinces should balance the various policy elements of the separate payment catalogue,deal with the control of medical insurance funds and patients'sense of gain,and clarify the relationship between the separate payment policy and support the development of innovative drugs,so as to reduce the obstacles of Joint Reformation for Public Health Services,Medical Insurance,and Medical Production-Circulation.

AIM To explore the clinical effects of Supplemented Buzhong Yiqi Decoction on patients with HP-positive chronic atrophic gastritis of Spleen-Stomach Deficiency Pattern.METHODS One hundred and thirty-two patients were randomly assigned into control group(66 cases)for 12-week intervention of conventional treatment,and observation group(66 cases)for 12-week intervention of both Supplemented Buzhong Yiqi Decoction and conventional treatment.The changes in clinical effects,HP clearance rate,miR-32,TGF-β1,IL-6,PGⅠ,PGⅡ,EGF,somatostatin,gastrin,motilin,gastroscopy pathological score and TCM symptom score were detected.RESULTS The observation group demonstrated higher total effective rate and HP clearance rate than the control group(P<0.05).After the treatment,the two groups displayed decreased miR-32,TGF-β1,IL-6,gastroscopy pathological score,TCM symptom score(P<0.05),and increased PGⅠ,PGⅡ,EGF,somatostatin,gastrin,motilin(P<0.05),especially for the observation group(P<0.05).CONCLUSION For the patients with HP-positive chronic atrophic gastritis of Spleen-Stomach Deficiency Pattern,Supplemented Buzhong Yiqi Decoction can alleviate inflammation,regulate gastrointestinal hormone levels,improve symptoms,and enhance efficacy.

Objective To observe the clinical efficacy of lesion removal,bone grafting,fusion,and external fixation in the treatment of late-stage wrist tuberculosis.Methods From October 2015 to May 2019,25 patients with late-stage wrist tubercu-losis were treated using lesion removal,bone grafting,fusion,and external fixation.Among these patients,there were 14 males and 11 females,aged from 40 to 74 years old,with an average age of(60.72±8.45)years old.The duration of the disease ranged from 5 to 24 months,with an average of(11.52±7.61)months.There were 11 cases of left wrist tuberculosis and 14 cases of right wrist tuberculosis,with 5 cases accompanied by sinus formation.Postoperative regular anti-tuberculosis treatment was continued.Visual analogue score(VAS),inflammatory indicators,Gartland-Werley wrist function score,and upper limb function score were observed before and after treatment.Results All 25 patients were followed up for ranging from 12 to 36 months with an average of(19.7±6.3)months.At the latest follow-up,all wounds were healed satisfactorily,and there was no recurrence of tuberculosis or infection.VAS at one week before operation and three months after operation were(5.16±1.14)score and(1.68±0.80)score respectively.One week before operation and three months after operation,erythrocyte sedimenta-tion rate(ESR)was(44.20±20.56)mm·h-1 and(14.44±1.14)mm·h-1,and C-reactive protein(CRP)was(12.37±7.95)mg· L-1and(4.3±3.37)mg·L-1.The differences in all three data sets were statistically significant(P＜0.01).According to Gartland-Werley wrist function scoring,the scores at one week before operation and one year after operation were(21.32±3.44)and(14.96±1.37)respectively,showed a statistically significant difference(P＜0.01).According to the upper limb function score(disabilities of the arm,shoulder,and hand,DASH),the score was(70.52±7.95)at one week before operation and(28.84± 2.30)at one year after operation.The difference was statistically significant(P＜0.01).At the latest follow-up,no patient had a recurrence of tuberculosis.Conclusion The short-term clinical efficacy of treating wrist tuberculosis with lesion removal,bone grafting,fusion,and external fixation is satisfactory.

Objective:To explore the clinical characteristics, diagnosis, treatment, and follow-up of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 Omicron variant infection.Methods:A retrospective analysis was conducted on clinical data of 11 children with MIS-C, who were admitted to the Department of Pediatrics of Peking University First Hospital from December 2022 to January 2023. Clinical characteristics, treatment, and follow-up of MIS-C were summarized in this study.Results:The 11 cases contained 7 boys and 4 girls, with an age of 4.4 (2.0, 5.5) years on admission. All the patients had fever, with a duration of 7(5, 9) days. Other clinical manifestations included rash in 7 cases, conjunctival hyperemia in 5 cases, red lips and raspberry tongue in 3 cases, lymphadenopathy in 3 cases, and swollen fingers and toes in 2 cases. There were 8 cases of digestive symptoms, 8 cases of respiratory symptoms, and 3 cases of nervous system symptoms. Eight patients had multi-system injuries, and one of them had shock presentation. All 11 patients were infected with SARS-CoV-2 Omicron BF.7 variant. The laboratory examination results showed that all cases had elevated inflammatory indicators, abnormal coagulation function and myocardial damage. Six patients had elevated white blood cell counts, 5 cases had liver function abnormalities, 3 cases had kidney function abnormalities, and 8 cases had coronary artery involvement. All 11 patients received anti-infection treatment, of which 3 cases received only 2 g/kg intravenous immunoglobulin (IVIG), while the remaining 8 cases received a combination of IVIG and 2 mg/(kg·d) methylprednisolone. Among the 8 cases with coronary artery disease, 6 cases received low molecular weight heparin anticoagulation therapy. All patients were followed up in 2 weeks after being discharged, and their inflammatory markers had returned to normal by that time. The 8 cases with coronary artery disease and 3 cases with pneumonia showed significant improvement or back to normal at the 4-week follow-up. All patients had no new complications or comorbidities during follow-up of more than 3 months.Conclusions:MIS-C may present with Kawasaki disease-like symptoms, with or without gastrointestinal, neurological, or respiratory symptoms. Elevated inflammatory markers, abnormal coagulation function, and cardiac injury contribute to the diagnosis of MIS-C. IVIG and methylprednisolone were the primary treatments for MIS-C, and a favorable short-term prognosis was observed during a follow-up period of more than 3 months.

Objective We aimed to compare the efficacy and prognosis of percutaneous coronary intervention(PCI)in complex and high-risk patients with coronary heart disease(CHD)treated with extracorporeal membrane oxygenation(ECMO)combined with intra-aortic balloon pump(IABP)assistance,and explore the application value of combined use of mechanical circulatory support(MCS)devices in complex PCI.Methods A total of patients who met the inclusion criteria and underwent selective PCI supported by MCS at the Department of Cardiology,the First Affiliated Hospital of the Air Force Medical University from January 2018 to December 2022 were continuously enrolled.According to the mechanical circulatory support method,the patients were divided into ECMO+IABP group and IABP group.Clinical characteristics,angiographic features,in-hospital outcomes,and complications were collected.The intra-hospital outcomes and major adverse cardiovascular events(MACE)at one month and one year after the procedure were observed.The differences and independent risk factors between the two groups in the above indicators were analyzed.Results A total of 218 patients undergoing elective PCI were included,of which 66 patients were in the ECMO+IABP group and 152 patients were in the IABP group.The baseline characteristics of the two groups of patients were generally comparable,but the ECMO+IABP group had more complex lesion characteristics.The proportion of patients with atrial fibrillation(6.1％vs.0.7％,P=0.030),left main disease(43.9％vs.27.0％,P=0.018),triple vessel disease(90.9％vs.75.5％,P=0.009),and RCA chronic total occlusion disease(60.6％vs.35.5％,P＜0.001)was higher in the ECMO+IABP group compared to the IABP group.The proportion of patients with previous PCI history was higher in the IABP group(32.9％vs.16.7％,P=0.014).There was no statistically significant difference in the incidence of in-hospital complications between the two groups(P=0.176),but the incidence of hypotension after PCI was higher in the ECMO+IABP group(19.7％vs.9.2％,P=0.031).The rates of 1-month MACE(4.5％vs.2.6％,P=0.435)and 1-year MACE(7.6％vs.7.9％,P=0.936)were comparable between the two groups.Multivariate analysis showed that in-hospital cardiac arrest(OR 7.17,95％CI 1.27-40.38,P=0.025)and after procedure hypotension(OR 3.60,95％CI 1.10-11.83,P=0.035)were independent risk factors for the occurrence of 1-year MACE.Conclusions Combination use of ECMO+IABP support can provide complex and high-risk coronary heart disease patients with an opportunity to achieve coronary artery revascularization through PCI,and achieve satisfactory long-term prognosis.

Objective: To compare the effects of the China Children's Asthma Action Plan (CCAAP)-based remote joint management model with traditional management model on the control of childhood asthma. Methods: A retrospective cohort study was conducted to analyze the general data and asthma control assessment data of 219 children with asthma who attended the respiratory department of Guangzhou Women's and Children's Medical Center from April 2021 to October 2021 and were followed up for 1 year or more. According to the follow-up management model, the CCAAP-based remote joint management model was used in the observation group and the traditional management model was used in the control group, and the propensity score matching method was applied to match the data of children in the two management models for comparison. Paired-samples t-test, Wilcoxon signed-rank test, McNemar χ²-test or χ²-test or nonparametric tests were used to compare the general data and asthma control assessment data between the two matched groups of children. Results: Among 219 children with asthma, 145 were male and 74 were female, aged at consultation (7.2±2.4) years. There were 147 cases in the observation group and 72 cases in the control group, and 27 cases in each of the observation and control groups were successfully matched. The number of asthma exacerbation aura, acute exacerbations, and emergency room visits or hospitalizations for asthma exacerbations were lower in the observation group than in the control group after pairing (1 (0, 2) vs. 3 (1, 5) times, 0 (0,0) vs. 0 (0, 1) times, 0 (0,0) vs. 1 (0, 1) times, Z=-3.42, -2.58, -3.17, all P<0.05). The use of peak flowmeters was higher in children aged 5 years and older in the observation group than in the control group after pairing (100% (22/22) vs. 13% (3/23), χ²=54.00,P<0.001). The ratio of actual to predicted 1st second expiratory volume of force after follow-up in the observation group after pairing was higher than that before follow-up in the observation group and after follow-up in the control group ((95±11)% vs. (85±10)%, (95±11)% vs. (88±11)%, t=-3.40, 2.25, all P<0.05). The rate of complete asthma control after follow-up was higher in both the observation and control groups after pairing than before follow-up for 12 months in both groups (93% (25/27) vs. 41% (11/27), 52% (14/27) vs. 41% (11/27), H=56.19, 45.37, both P<0.001), and the rate of complete control of asthma in children in the observation group was higher than that in the control group at 3 and 12 months of follow-up management (56% (15/27) vs. 25% (5/20), 93% (25/27) vs. 52% (14/27), χ²=47.00, 54.00, both P<0.001). The number of offline follow-up visits, inhaled hormone medication adherence scores, and caregiver's asthma perception questionnaire scores were higher in the observation group than in the control group after pairing (6 (4, 8) vs. 4 (2,5), (4.8±0.3) vs. (4.0±0.6) score, (19.3±2.6) vs. (15.2±2.7) score, Z=6.58, t=6.57, 5.61, all P<0.05), and the children in the observation group had lower school absences, caregiver absences, asthma attack visit costs, and caregiver PTSD scores than the control group (0 (0,0) vs.3 (0, 15) d, 0 (0,0) vs. 3 (0, 10) d, 1 100 (0, 3 700) vs. 5 000 (1 000, 10 000) yuan, 1.3 (1.1, 1.9) vs. 2.0 (1.2, 2.7) score, Z=-2.89, -2.30, 2.74, 2.73, all P<0.05). Conclusion: The CCAAP-based joint management model of asthma control is superior to the traditional management model in the following aspects: it can effectively improve asthma control, self-monitoring, and lung function in children; it can improve treatment adherence and caregivers' asthma awareness; and it can reduce the duration of absenteeism from school, the cost of asthma exacerbation visits, and caregiver's negative psychology.
Humans ; Child ; Female ; Male ; Retrospective Studies ; Asthma/therapy* ; China ; Hospitalization ; Hospitals