The Pathway of China's Integrated Delivery System: Based on the Analysis of the Medical Consortium Policies.

With the deepening of China's health-care reform, an integrated delivery system has gradually emerged with the function of improving the efficiency of the health-care delivery system. For China's integrated delivery system, a medical consortium plays an important role in integrating public hospitals and primary care facilities. The first medical consortium policy issued after the COVID-19 pandemic apparently placed hope on accelerating the implementation of a medical consortium and tiered health-care delivery system. This paper illustrates the possible future pathway of China's medical consortium through retrospection of the 10-year process, changes of the series of policies, and characteristics of the policy issued in 2020. We considered that a fully integrated medical consortium would be a major phenomenon in China's medical industry, which would lead to the formation of a dualistic care pattern in China.

Machine Learning for the Prediction of Synchronous Organ-Specific Metastasis in Patients With Lung Cancer.

Background: This study aimed to develop an artificial neural network (ANN) model for predicting synchronous organ-specific metastasis in lung cancer (LC) patients. Methods: A total of 62,151 patients who diagnosed as LC without data missing between 2010 and 2015 were identified from Surveillance, Epidemiology, and End Results (SEER) program. The ANN model was trained and tested on an 75/25 split of the dataset. The receiver operating characteristic (ROC) curves, area under the curve (AUC) and sensitivity were used to evaluate and compare the ANN model with the random forest model. Results: For distant metastasis in the whole cohort, the ANN model had metrics AUC = 0.759, accuracy = 0.669, sensitivity = 0.906, and specificity = 0.613, which was better than the random forest model. For organ-specific metastasis in the cohort with distant metastasis, the sensitivity in bone metastasis, brain metastasis and liver metastasis were 0.913, 0.906 and 0.925, respectively. The most important variable was separate tumor nodules with 100% importance. The second important variable was visceral pleural invasion for distant metastasis, while histology for organ-specific metastasis. Conclusions: Our study developed a "two-step" ANN model for predicting synchronous organ-specific metastasis in LC patients. This ANN model may provide clinicians with more personalized clinical decisions, contribute to rationalize metastasis screening, and reduce the burden on patients and the health care system.

Incidence and survival outcomes of secondary liver cancer: a Surveillance Epidemiology and End Results database analysis.

BACKGROUND: The global incidence and mortality rates of liver cancer, which is the second leading cause of cancer-related deaths worldwide, are increasing. However, information on its epidemiology and clinical prognosis is limited. This study aimed to characterize the epidemiology and prognostic factors of secondary liver cancer to aid in the pretreatment evaluation of the disease. METHODS: Patients diagnosed with secondary liver cancer between 2010 and 2014 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively included. Kaplan-Meier analysis and Multivariate Cox regression analysis were performed to screen for significant factors associated with secondary liver cancer. RESULTS: A total of 85,738 secondary liver cancer patients were identified; in this population, the first primary site was the lung (25.9%), followed by the colorectum, pancreas, stomach, breast, and cecum. Patients with primary tumors of the colorectum, cecum and breast had longer median survival time. Advanced age, male gender, black race, poor differentiation or lack of differentiation, regional lymph node metastases, and presence of distant metastasis were associated with poor prognosis. CONCLUSIONS: In this study, novel findings on the role of the primary site and synchronous distant metastasis to specific organs in patients with secondary liver cancer were described. These findings have significant implications in clinical diagnosis and treatment, and provide a better understanding of secondary liver cancer in the general population.

Analysis of Monitoring, Early Warning and Emergency Response System for New Major Infectious Diseases in China and Overseas.

In recent years, the impact of new major infectious diseases on people's normal life is becoming more and more frequent, which has brought great impact on people's life safety and social economy, especially the corona virus disease 2019, which has been sweeping the globe. Public health and disease prevention and control systems in different countries have different performances in response to the pandemic, but they all have exposed many shortcomings. Countries around the world urgently need to improve the monitoring, early warning and emergency response systems for new major infectious diseases. As the outpost and main part of medical rescue, the hospital urgently needs to establish a set of scientifically advanced emergency response mechanism that is suitable for the business process of the medical system and unified standards in order to improve the response efficiency and quality of emergency treatment.

Association between Gout and Erectile Dysfunction: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to assess the possible association between gout and erectile dysfunction (ED). METHODS: Studies were identified by extensively searching EMBASE, Pubmed, CENTRAL and ISI Web of Science. Four electronic databases were searched from their inception date to the latest issue (March 2016), without language restriction. Each reviewer screened articles independently and was blinded to the findings of the other reviewer. Data was extracted in adherence to the predetermined data collection form and meta-analysis was conducted via RevMan 5.3. RESULTS: Five studies involving 56465 patients (mean age: 49.11 years) with gout and 155636 non-gout subjects (mean age: 48.76 years) were selected. The combination of unadjusted odds ratio (OR) showed that patients with gout were 1.44 times more likely to be diagnosed with ED when compared with control (95% confidence interval (95%CI) 1.20, 1.72). After adjustment for age and comorbidities, the heightened risk to develop ED was still present (1.18, 95%CI 1.02, 1.38). Subgroup-analysis by age showed statistically significant association of gout and ED in all age groups. However, evidence supporting a causal effect of gout on ED was insufficient. CONCLUSION: The findings of this review indicated a positive association of gout and ED, but this work is hampered by the heterogeneity among included studies, to some extent. Future studies with larger community-based homogeneous population and randomized controlled trials aimed to evaluate the effect of gout treatment on ED associated outcomes are needed at this point.

Minimally invasive transforaminal lumbar interbody fusion aided with computer-assisted spinal navigation system combined with electromyography monitoring.

BACKGROUND: Minimally invasive techniques are gaining wide-spread application in lumbar fusion surgery, because they may have advantage over conventional open surgery in approach-related morbidity. This research was aimed to evaluate the safety and accuracy of the techniques of minimally invasive transforaminal lumbar interbody fusion by using a computer-assisted spinal navigation system combined with electromyography monitoring. METHODS: Sixteen patients underwent minimally invasive transforaminal lumbar interbody fusion. A computer-assisted spinal navigation system and electromyography were used for guiding pedicle screw placement. The operative duration, blood loss, complications, and fluoroscopic time were recorded. Clinical outcome was assessed by Visual Analog Scale and Oswestry Disability Index. Radiographic images were obtained to evaluate the accuracy of pedicle screw placement and fusion rates. RESULTS: The Visual Analog Scale and Oswestry Disability Index scores were vastly improved postoperatively. A total of 64 pedicle screws were implanted and three were regarded as misplacement by post-operative CT scan. Three screw trajectories were adjusted according to intra-operative stimulus-evoked electromyography monitoring. The average fluoroscopy time in each patient was 31.8 seconds, which equals to 7.9 seconds per pedicle screw. No patients had instrument related neurological complications, infection, implant failure or revision. Successful fusion was found in all patients. CONCLUSIONS: The combination of navigation system and real-time electromyography monitoring can make the minimally invasive operation more safe and accurate while decreasing radiation exposure time of the medical staff and patient and minimizing the chance and the degree of the pedicle screw misplacement.