【摘要】 探討日間手術模式的運行流程及效果，并對日間手術的管理及優勢予以總結。2009年10月-2011年2月，我中心采用日間手術模式對普外、兒外、泌尿、耳鼻喉、眼、消化、腎臟等疾病患者施行手術治療。順利完成日間手術約5 900余例，日間手術成功率100%，未發生1例因為遲發并發癥而重新入院治療事件，患者及家屬對各自的治療方案滿意。合理的日間手術模式和流程，可以最大限度地減少醫療費用，縮短患者等待入院和行手術時間，提高床位周轉率和利用率，符合醫患雙方的利益。【Abstract】 This article discusses the operating process and results of ambulatory surgery, and to summarize the management and advantages of ambulatory surgery. From October 2009 to February 2011, the mode of ambulatory surgery was used in our department to treat patients. General, pediatric, urological, otolaryngological, ophthalmological surgeries and surgeries for digestive system and kidney were completed in this mode. About 5 900 surgeries were completed successfully with a mission success rate of 100%. No rehospitalization event occurred because of late onset complications. Both patients and families were satisfied with the treatment. Reasonable mode and process of ambulatory surgery can decrease cost of the patients, shorten waiting time of being admitted and operated, and improve the turnover and using rates of beds. It will bring benefits for both hospitals and patients.
Objective The Global Burden of Diseases (GBD) data were used to analyze the trend of the burden of disease of tracheal, bronchial, and lung cancer (TBL Cancer) caused by tobacco in China and globally from 1990 to 2021, and to predict the future development trend. Methods We performed descriptive analysis of the indicators of death and disability-adjusted life years (DALY) in the GBD 2021 database; The Joinpoint regression model was used to calculate the average annual percent change (APCC); The age-period-cohort (APC) model was used to estimate the effect of three independent factors, age, period and cohort, on disease mortality; and the BAPC model was used to project the burden of disease for TBL Cancer from 2022 to 2036. Results From 1990 to 2021, the disease burden of TBL Cancer attributable to tobacco showed an increasing trend in both China and globally, with a much higher burden of disease in men than in women, and a much higher burden of disease attributable to smoking than to secondhand smoke. The APC model showed that the net drift values of mortality in China and globally were ?0.1982% and ?1.5921%, respectively, from 1992 to 2021; the age effect showed that the mortality rate of both China and the world increased with age; the period effect model showed that the mortality rate of China increased and then decreased, and the global mortality rate generally decreased; the cohort model showed that the mortality rate of China and the world increased and then decreased; the BAPC model showed that the mortality rate of China declined slowly in the period of 2022-2036, and the global mortality rate declined even more dramatically. Conclusion The burden of TBL Cancer attributable to tobacco was higher in China than in the world from 1990 to 2021. Tobacco control measures in China have begun to bear fruit in recent years, and we should continue to strengthen our tobacco control initiatives and popularize health knowledge in order to make progress towards the goal of the "Healthy China 2030" plan.
ObjectiveTo investigate the relationship between the expression of programmed cell death ligand-1 (PD-L1) and the maximal standardized uptake value (SUVmax) in 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the correlation of clinical factors between SUVmax values and PD-L1.MethodsThe clinical data of 84 patients with invasive lung adenocarcinoma diagnosed pathologically in West China Hospital, Sichuan University from August 2016 to November 2018 were analyzed retrospectively, including 38 males and 46 females, aged 60 (32-85) years. The tumor was acinar-predominant in 37 patients, papillary in 20, lepidic in 19, solid in 5 and micropapillary in 3. Multivariate analysis of the relationship between SUVmax value and other clinicopathological features was performed by linear regression. Logistic regression analysis was used to analyze the relationship between PD-L1 protein expression and other pathological features.ResultsThe SUVmax of the PD-L1 expression group was significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group (P=0.002) and intermediate-grade histologic subtype (P=0.016). The SUVmax cut-off value of PD-L1 expression in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype was 5.34 (AUC: 0.732, P=0.002) and 5.34 (AUC: 0.720, P=0.017), respectively. Multivariate analysis showed that pleura involvement, vascular tumor thrombus and the increase of tumor diameter could cause the increase of the SUVmax value, while the SUVmax value decreased in the moderately differentiated tumor compared with the poorly differentiated tumor. The SUVmax cut-off value between low-grade histologic subtype and intermediate-grade histologic subtype, intermediate-grade histologic subtype and high-grade histologic subtypes was 1.54 (AUC: 0.854, P<0.001) and 5.79 (AUC: 0.889, P<0.001), respectively. Multivariate analysis of PD-L1 expression showed pleura involvement (P=0.021, OR=0.022, 95%CI 0.001 to 0.558) and moderate differentiation (opposite to poor differentiation) (P=0.004, OR=0.053, 95%CI 0.007 to 0.042) decreased the expression of PD-L1.ConclusionThe SUVmax of the PD-L1 expression group is significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype. The level of SUVmax and the expression of PD-L1 in invasive lung adenocarcinoma are related to many clinical factors.
Objective To analyze retrospectively the 875 procedures of earthquake related patient in West China Hospital of Sichuan University after the Wenchuan earthquake, so as to provide reference for the improvement of medical rescue for the disaster of earthquake and the establishment of state-level regional medical centers. Methods The analysis was based on the data provided by the Department of Information of the Hospital up until July 11. The software of Microsoft EXCEL was used for data input and statistical analysis. Results Up to July 11, 1 265 operations in earthquake injuries have been performed in the hospital, of which 875 were done in operating rooms. Initial peak of admission to hospital was positively correlated to peak of surgery performed, which the type of the operation was all emergency operation and most of which were amputation (43%). Second peak of surgery was 2 days delayed following admission to hospital. The type of operation mainly was elective surgeries. Most patients received second stage procedure-open reduction and internal fixation (61%). Conclusion Our hospital played a key part in rescue effort following such huge natural disaster. Our prompt response and effective leadership demonstrated our hospital’s flexibility and capability in the state-level hospital near the epicenter.
Objective To analyze the correlation between frailty syndrome and lower limb motor function in hospitalized elderly patients. Methods Convenience sampling method was used to select inpatients aged 65 and above from the Center of Gerontology and Geriatrics of West China Hospital, Sichuan University between December 2022 and May 2023. The FRAIL Scale, Short Physical Performance Battery (SPPB), and Timed Up and Go Test (TUGT) were used to evaluate the degree of frailty and lower limb motor function, and to explore the correlation between frailty and lower limb motor function. Results A total of 501 elderly patients were included, including 325 males (64.9%) and 176 females (35.1%); 256 cases of frailty (51.1%), 161 cases of pre-frailty (32.1%), and 84 cases of non-frailty (16.8%). The incidence of frailty in hospitalized elderly male patients was higher than that in female patients (P<0.05); The incidence of frailty in patients aged 80-99 was higher than that in patients aged 65-79 (P<0.05). The Spearman correlation analysis results showed that all dimensions of SPPB were negatively correlated with frailty (P<0.001), while TUGT was positively correlated with frailty (r=0.776, P<0.001). The results of multiple linear regression analysis showed that the worse the motor function of the lower limbs, the higher the debilitation score. Conclusions Frailty syndrome in hospitalized elderly patients is closely related to lower limb motor function. Lower limb motor function assessment can be used to predict the onset of frailty in clinical practice, and interventions to improve lower limb motor function can be used to improve the frailty of elderly patients.
