【摘 要】
：
Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients\'quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirs
【机 构】
：
Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Center of
论文部分内容阅读
Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients\'quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(＞2,500),moderately concentrated(1,500-2,500),and unconcentrated(＜1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95％confidence interval(95％CI)=0.43-0.84,P=0.003;high:OR=0.57,95％CI=0.38-0.87,P=0.009;and very high:OR=0.33,95％CI=0.18-0.61,P＜0.001)and length of stay(high vs.low:p=-0.036,95％CI=-0.071-0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95％CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95％CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.
其他文献
目的 通过盆栽实验,综合评价不同钝化材料对土壤镉的钝化以及对川麦冬Cd含量降解的影响.方法 以一年生川麦冬为供试材料,采用土壤盆栽实验方法研究了钝化材料汉白玉(Ar)、秸秆生物炭(Br)、粉煤灰(Fh)、菌渣(Me)、硅藻土(Dm)对土壤总Cd、有效Cd和川麦冬各部Cd吸收累积的影响.结果 2种Cd污染程度土壤,不同钝化材料处理下均能提高土壤pH值;土壤阳离子交换量均极显著高于对照组,与土壤pH值成正相关;土壤总Cd含量和土壤有效Cd、麦冬地上部和地下部Cd含量较对照均极显著降低.综合各项指标发现,Ar对
吡咯里西啶类生物碱(pyrrolizidine alkaloids,PAs)是一类种类繁多、分布广泛的植物内源性毒性成分,具有不同程度的肝毒性、遗传毒性和致癌性.目前已在约3％的开花植物中鉴定出600余种PAs及其氮氧化物.对可能含有毒性PAs的中草药,尤其是《中国药典》2020年版收录的品种进行了详尽梳理,对PAs的基本结构、植物来源和各国监管机构对其风险评估和限值制定情况,以及近年来分析方法的最新进展进行综述,并对其定性和定量分析中的难点进行讨论,对毒性PAs的监控提出建议,旨在为毒性PAs的检测研究
目的 鉴定艾叶Artemisiae Argyi Folium中主要化学成分的结构并建立其含量测定方法.方法 利用UPLC-UV-Q/TOF进行艾叶分析条件的优化,在对21批艾叶分析的基础上,确定其中紫外和质谱上主要的色谱峰,利用精确相对分子质量和碎片离子鉴定其结构后,利用对照品比对确定结构;进一步采用Waters Acquity Ⅰ-Class?液相色谱系统,Waters Acquity HSS T3色谱柱(100mm×2.1 mm,1.8 μm),乙腈-0.2％磷酸水为流动相,体积流量0.5 mL/mi
与传统化疗药物相比,中药抗肿瘤活性成分具有多靶点、多层次及协同干预等独特的优势.然而,大部分中药抗肿瘤活性成分往往水溶性差、生物利用度低等,限制了其临床应用.纳米递送系统有望改善中药抗肿瘤活性成分的应用限制,与游离药物相比,纳米载药系统表现出改善的生物利用度、增强的组织靶向性、减轻的脱靶不良反应及更大的体内稳定性.综述了目前最常用的2种中药抗肿瘤活性成分纳米递送系统即包载递送系统和共价结合前药递送系统,并对其中存在的问题及未来发展进行讨论,旨在为促进中药抗肿瘤活性成分纳米递送系统在临床上的实际应用提供参考
艾滋病是严重危害人民健康和生命安全的重大疾病,加强艾滋病防治工作是实施健康中国战略的重要任务.党中央、国务院高度重视艾滋病防治工作,在各地、各部门和全社会的共同努力下,我国整体疫情持续控制在低流行水平[1].艾滋病尚无可以预防的疫苗,也没有可以彻底治愈的药物.因此通过宣传教育这个有效的“社会疫苗”普及艾滋病基本知识,避免易感行为、促进重点人群早检测早治疗,是控制艾滋病的首要环节.同时,宣传教育对于消除社会歧视,动员社会参与,营造良好社会氛围也发挥了重要作用.可以说,我国艾滋病防治取得的一系列成就与多年来持
Objective:Increasing evidence has demonstrated that ZNF292 plays a suppressive role in cancer,however,little is known about its function and exact mechanism in esophageal squamous cell carcinoma(ESCC).Methods:Bioinformatic analysis and immunohistochemistr
目的 建立闹羊花中闹羊花毒素Ⅱ、Ⅲ、Ⅴ的定量分析方法,并测定不同产地、花期闹羊花毒素含量,用于闹羊花药材的质量评价及产地、采收期的选择.方法 采用Waters C18色谱柱(250 mm×4.6 mm,5 μm)色谱柱,甲醇(A)-水(B)流动相,建立高效液相色谱联合电雾式检测器(HPLC-CAD)方法,并进行方法学验证,对17批不同产地、5批不同花期药材中3种闹羊花毒素进行含量测定,并聚类分析.结果 所建立的分析方法简便,准确度和精密度良好,能作为闹羊花药材常规定量评价方法;不同产地闹羊花药材可聚为3类
心血管疾病是心脏和血管方面相关的疾病,包括高血压、高脂血症、血栓栓塞、冠心病和心力衰竭等.心血管疾病严重危害人类健康,是全球范围内造成死亡的最主要原因.维护心血管系统健康的关键因素是对疾病的预防.植物精油及其部分成分能舒张血管、降血压、抗心肌缺血、预防和改善动脉粥样硬化、抗血小板聚集以及抗心律失常,从而对心血管系统具有保护作用.植物精油有益于人体的心血管系统,但需要更多的临床研究和安全性研究的证据.
Objective:This study aimed to develop and validate a risk scoring system to identify high-risk individuals carrying malignant lesions in stomach for tailored gastric cancer screening.Methods:A gastric cancer risk scoring system(GC-RSS)was developed based
Objective:Computer-aided diagnosis using deep learning algorithms has been initially applied in the field of mammography,but there is no large-scale clinical application.Methods:This study proposed to develop and verify an artificial intelligence model ba