Maternal inulin supplementation ameliorates prenatal methamphetamine exposure-induced hepatotoxicity and restores gut microbiota in mouse offspring.

Prenatal exposure to methamphetamine (METH) is an issue of global concern due to its adverse effects on offspring, particularly its impact on liver health, an area still not fully understood. Inulin, a recognized prebiotic, is thought to potentially ameliorate these developmental disorders and toxic injuries in progeny. To investigate the effects of prenatal METH exposure on the liver and the role of gut microbiota, we established a murine model, the subjects of which were exposed to METH prenatally and subsequently treated with inulin. Our findings indicate that prenatal METH exposure causes liver damage in offspring, as evidenced by a decreased liver index, histopathological changes, diminished glycogen synthesis, hepatic dysfunction, and alterations in mRNA profiles. Furthermore, it impairs the antioxidant system and induces oxidative stress, possibly due to changes in cecal microbiota and dysregulation of bile acid homeostasis. However, maternal inulin supplementation appears to restore the gut microbiota in offspring and mitigate the hepatotoxic effects induced by prenatal METH exposure. Our study provides definitive evidence of METH's transgenerational hepatotoxicity and suggests that maternal inulin supplementation could be an effective preventive strategy.

Wave Propagation Characteristics and Compaction Status of Subgrade during Vibratory Compaction.

Vibratory compaction status has a significant influence on the construction quality of subgrade engineering. This study carried out field experiments to study the propagation characteristics of the vertical vibration wave in the soil field along the traveling direction of the vibratory roller. The propagation coefficients of the peak acceleration at different positions and compacting rounds are compared in both the time and frequency domains. The compaction status is estimated in the form of dynamic modulus of deformation (Evd) obtained by plate load tests. The experiment results show that the propagation coefficient of peak acceleration is affected by the traveling speed, excitation amplitude, and frequency of the vibratory roller, as well as the compacting rounds. An exponential relationship between the wave amplitudes of the fundamental mode and higher-order modes is revealed. The amplitude of the fundamental wave is maximum at the speed of 3 km/h, whereas the amplitudes of higher-order waves have a maximum of 1.5 km/h. The influences of compaction rounds on the average value of Evd are also investigated to provide a practical reference for engineering construction.

[Clinical Value of White Light Image, Endoscopic Ultrasonography and Magnifying Endoscopy with Narrow Band Imaging in Evaluation of Indications for Endoscopic Treatment of Early Gastric Cancer].

OBJECTIVE: To explore the application value of white light image (WLI), endoscopic ultrasonography (EUS) and magnifying endoscopy with narrow band imaging (ME-NBI) in the endoscopic treatment of early gastric cancer (EGC), and to provide basis for decision-making in clinical diagnosis and treatment. METHODS: The clinicopathological data of EGC patients who underwent endoscopic submucosal dissection (ESD) at West China Hospital, Sichuan University between December 2013 and October 2020 were included. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EGC invasive depth were compared between WLI and EUS. The role of ME-NBI in predicting the differentiation types of EGC was analyzed. RESULTS: A total of 280 patients (291 lesions) were enrolled in the study. Among them, 199 patients (207 lesions) received EUS and 160 patients (168 lesions) received ME-NBI. The overall accuracy of WLI in diagnosing the invasive depth of EGC was 87.0%, significantly higher than that of EUS (46.4%, P<0.001). When WLI was combined with EUS, the diagnostic accuracy (87.4%) was not significantly improved. The overall accuracy of determining the differentiation degree of EGC with ME-NBI was 92.3% (155/168), and the accuracy of determining undifferentiated EGC with ME-NBI was significantly lower than that of differentiated EGC (41.2% vs. 98.0%, P<0.001). CONCLUSION: In the evaluation of indications for endoscopic treatment of EGC, WLI showed better performance in predicting the invasive depth of EGC, while EUS demonstrated limited value. ME-NBI showed better accuracy for predicting the differentiation degree of most EGC, especially for differentiated EGC.

Surgical Protocol in a West China Day Surgery Center During the COVID-19 Pandemic: Practice and Experience.

Background. Despite the danger of infection during the outbreak of the 2019 novel coronavirus (COVID-19) in Wuhan, many patients still need surgical treatment. Most elective surgeries were delayed because of the public health emergency. However, when patients have life-threatening emergencies or illnesses, surgeries are often needed as soon as possible. Moreover, due to hospital overcrowding during the COVID-19 outbreak, healthcare professionals initially struggled to address the issue due to a lack of experience. This is especially true for day surgery centers with higher patient mobility. Methods. We remodeled pathways to separate patients and medical personnel to minimize the COVID-19 infection rate. Further, strategies for medical staff education and potential patient education, ward disinfection and maintenance, setup with 3 more screening stations, patient and companion management, medical staff management, and perioperative management were implemented before starting elective day surgery. Results. From February 11 to March 11 in 2020, 202 day surgeries were performed. These were all elective surgeries and included ultrasound-guided Mammotome biopsy, endoscopic polypectomy, hernia repair, pediatric surgeries, cholecystectomy, choledochoscopy, radical mastectomy, percutaneous transhepatic cholangial drainage, liver biopsy, video-assisted thoracoscopic surgery, laparoscopic resection of colon cancer, colostomy apotheosis, and varicose vein surgery. On days 7, 14, and 30 after discharge, no postoperative complications were reported or infection of COVID-19 cases was reported. Conclusions. Using scientific and well-designed protocols, day surgery can ensure quality surgical care with while ensuring medical safety during the COVID-19 outbreak. These protocols may also be applied to other surgical departments in China.

[Endoscopic Dilation to Treat One Case of Severe Intestinal Stenosis Caused by Endometriosis].

A 46-year-old woman was admitted for repeated abdominal distention and constipation for more than 10 years and further deterioration for 5 years. Colonoscopy showed, in the sigmoid colon, nodular neoplasm protruding into the cavity, resulting in local intestinal stenosis, through which the endoscopy could not pass. Pathological findings of the biopsy sample revealed changes caused by intestinal endometriosis. The patient underwent multiple endoscopic dilatation treatments in our hospital and the interval between recurrences of intestinal stenosis was extended from 6 months to 4 years. Intestinal endometriosis can cause repeated intractable stenosis caused by the infiltration of ectopic glands in the intestinal wall, which usually requires surgical intervention. Herein, we report a case of severe intestinal stenosis caused by endometriosis in the sigmoid colon. Good results have been achieved through endoscopic dilatation treatment. This case suggests that endoscopic dilation has good application value in the treatment of this kind of disease, which needs further exploration and promotion.

The role of endoscopic dilation and stents in refractory benign esophageal strictures: a retrospective analysis.

BACKGROUND: The outcomes of patients with refractory benign esophageal strictures (RBES) are unclear, and the clinical efficacy of dilation versus stent placement is lacking. Our objective was to explore the role of endoscopic dilation and stents placement in the management of RBES. METHODS: RBES patients treated with dilation and stents in our hospital between January 2009 and December 2017 were included in this study. The primary outcomes were to assess clinical effectiveness and adverse events. The secondary outcome was to identify factors that predicted the dysphagia-free period. RESULTS: Among 75 RBES patients (54 male; median age 59 years), 39 (52%), 20 (26.7%), 3 (4%), 10 (13.3%), and 3 (4%), were postsurgical, post-ESD, achalasia of cardia, caustic and mixed etiology, respectively. The median number of endoscopic therapy was 5 times (range 3, 21). Endoscopic therapy was successful in 46 patients (61.3%). Patients treated with dilation showed a higher success rate (70.9%, 39/55) than that treated with stents (35%, 7/20). Fifteen patients died during follow-up. Nineteen patients had adverse events after endoscopic therapy. In total, the mean dysphagia-free period was 3.4 months (95% CI, 2.5-4.3). The patients treated with dilation demonstrated a dysphagia-free period of 3.7 months (95% CI, 2.7-5), while patients treated with stents displayed a dysphagia-free period of 2.3 months (95% CI, 1.5-3). The dysphagia-free period had a linear growth trend over time, with an increase of 12 days per endoscopic therapy. CONCLUSION: The dysphagia-free period increased by 12 days per endoscopic therapy, so the endoscopic therapy tended to be effective in patients with RBES by increasing the dysphagia-free period. However, compared to dilation therapy, stent therapy was not effective in increasing the dysphasia-free period and reducing the times and frequency of dilation. In addition, univariate and multivariate analyses also indicated that etiology may predict the endoscopic therapy outcome. TRIAL REGISTRATION: This study was retrospectively registered and approved by the Ethics Committee of West China Hospital of Sichuan University (IRB number: ChiCTR1800016321 ).

[Accuracy of EUS and ME-NBI for Evaluating the Invasion Depth of Early Esophageal Cancer].

OBJECTIVE: To assess the accuracy of endoscopic ultrasound (EUS) and magnifying endoscopy with narrow-band imaging (ME-NBI) in evaluating the invasion depth of early esophageal carcinoma. METHODS: Patients who underwent endoscopic resection for early esophageal cancer from March 2013 to October 2017 were enrolled. The EUS and ME-NBI results were compared with the pathology results. RESULTS: A total of 392 lesions from 333 patients were assessed, including 83 mild and moderate dysplasia, 72 severe dysplasia, 235 squamous cell carcinoma, and 2 adenosquamous carcinoma. About 308 lesions were given EUS only, 7 had ME-NBI only, 77 underwent both EUS and ME-NBI. EUS resulted in a 43.9% accuracy for the 385 lesions, with poor consistency (Kappa=0.1) with the pathology results. But higher accuracy (68.2%) was found for lesions infiltrating into the submucosa of the lesions, compared with 40.5% for lesions contained within the mucosa (P=0.001). ME-NBI resulted in a 72.6% accuracy for the 84 lesions, with a medium consistency (Kappa=0.4). The accuracy for lesions contained within the mucosa was 91.0%, compared with 16.7% for lesions infilrtrating into the submucosa (P=0.001). EUS and ME-NBI for the 77 lesions demonstrated an accuracy of 42.9% for the EUS and 84.3% for the ME-NBI (P=0.001). CONCLUSIONS: ME-NBI has higher accuracy than EUS in evaluating the invasion depth of early esophageal carcinoma.

Skin healthcare protection with antioxidant and anti-melanogenesis activity of polysaccharide purification from Bletilla striata.

In this study, we investigated the structural characterization and biological activities of Bletilla striata polysaccharides (BSPs) for their role as antioxidants and anti-melanogenesis agents in skin healthcare protection. Three neutral polysaccharides (BSP-1, BSP-2, and BSP-3) with molecular weights of 269.121 kDa, 57.389 kDa, and 28.153 kDa were extracted and purified. Their structural characteristics were analyzed by ion chromatography, GC-MS, and 1D/2D NMR. The results showed that BSP-1, which constitutes the major part of BSPs, was composed of α-D-Glcp, ß-D-Glcp, ß-D-Manp, and 2-O-acetyl-ß-D-Manp, with the branched-chain accompanied by ß-D-Galp and α-D-Glcp. BSP-1, BSP-2, and BSP-3 can enhance the total antioxidant capacity of skin fibroblasts with non-toxicity. Meanwhile, BSP-1, BSP-2, and BSP-3 could significantly inhibit the proliferative activity of melanoma cells. Among them, BSP-1 and BSP-2 showed more significance in anti-melanogenesis, tyrosinase inhibition activity, and cell migration inhibition. BSPs have effective antioxidant capacity and anti-melanogenesis effects, which should be further emphasized and developed as skin protection components.

[Expression and its clinical significance of AMP-activated protein kinase in esophageal squamous cell carcinoma].

OBJECTIVE: To investigate the expression and its possible function of AMP-activated protein kinase (AMPK) in the occurrence of esophageal squamous cell carcinoma (ESCC). METHODS: The tissue samples were collected from 40 fresh ESCC and 40 normal esophagus, and the expression of AMPK downstream substrates p-ACC and ACC were tested by Western-blot, then the correlations of p-ACC and ACC expression to the clinicopathologic characterisics were analyzed. RESULTS: The expression of p-ACC in ESCC was lower than that in normal tissues, with significant statistical difference (P < 0.05). The down-regulation ratio of p-ACC in poorly-differentiated ESCC was 81.8% (9/11), which was significantly higher than that in moderately and well-differentiated ESCC (3.5%, 1/29). There was no correlation of p-ACC down-regulation with age, gender, TNM stage and lymph node metastasis (P > 0.05). CONCLUSION: The expression of p-ACC was down-regulation in ESCC, and the down-regulation is associated with tumor cell differentiation.

MiR-192-5p-Modified Tumor-Associated Macrophages-Derived Exosome Suppressed Endometrial Cancer Progression Through Targeting IRAK1/NF-κB Signaling.

Tumor-associated macrophages (TAMs) are a major regulator in the development of endometrial cancer (EC). It was indicated that TAMs could crosstalk with cancer cells via transferring exosomes which carrying microRNAs (miRNAs). Firstly, we found that TAMs could promote the epithelial-mesenchymal transition (EMT) of EC cells and inhibit its apoptosis. Next, we further found that TAMs regulated the EMT and apoptosis of EC cells through transferring exosomes into EC cells. Then, lowly expressed miR-192-5p in TAMs-derived exosomes was proved. Moreover, our data demonstrated that upregulation of miR-192-5p in TAMs-derived exosomes could significantly promote the apoptosis of EC cells and impede its EMT. IRAK1 was proved to be a downstream target of miR-192-5p. Importantly, we indicated that miR-192-5p-overexpressed TAMs-derived exosomes regulated the EC cells apoptosis and EMT through inhibiting IRAK1/NF-κB signaling pathway. In addition, we also revealed that overexpression of miR-192-5p in TAMs-derived exosomes obviously limits the growth of tumors. Overall, in TAMs-derived exosomes, our data demonstrated that overexpression of miR-192-5p could effectively suppress the progression of EC. Our data provid a new target for EC treatment.

Evaluating the Performance and Stability of the Highway Subgrades in Seismic Events, a Case Study of the Changning Earthquake, Sichuan.

On 17 June 2019, an M6.0 earthquake occurred in Changning County, Sichuan Province, China. Considerable highway subgrades were damaged in this earthquake. By investigating seismic damage of these subgrades, a systematical analysis of influence factors and failure mode of the damages on highway subgrade have been given. There is a close relationship between the damaged degree of subgrade and the distance of epicenter, fault distance, and structure type of subgrade. The seismic hazard investigation shows that the seismic damage of the cut-and-fill subgrade was more severe than that of the fill subgrade. Taking the Changning earthquake ground motion record as input, 3D dynamic finite element analyses were performed. The seismic damage mechanisms of cut-and-fill subgrade and fill subgrade were revealed. The numerical simulation confirmed that the cut-and-fill subgrade was more easily damaged by earthquakes compared with the fill subgrade. The fill-and-cut interface of the cut-and-fill subgrade had a notable plastic strain band after the earthquake, and the permanent displacement of the slope top was significant. In this manner, the numerical results are consistent with seismic investigation data. Considering the seismic investigation data for highway subgrades are rare, this paper may provide effective references for aseismic design and deformation control of highway subgrades.

An Automated Method of Causal Inference of the Underlying Cause of Death of Citizens.

It is of great significance to correctly infer the underlying cause of death for citizens, especially under the current worldwide situation. The medical resources of all countries are overwhelmed under the impact of coronavirus disease 2019 (COVID-19) and countries need to allocate limited resources to the most suitable place. Traditionally, the cause-of-death inference relies on manual methods, which require a large resource cost and are not so efficient. To address the challenges, in this work, we present a mixed inference method named Sink-CF. The Sink-CF algorithm is based on confidence measurement and is used to automatically infer the underlying cause of death of citizens. The method proposed in this paper combines a mathematical statistics method and a collaborative filtering and analysis algorithm in machine learning. Thus, our method can not only effectively achieve a certain accuracy, but also does not rely on a large quantity of manually labeled data to continuously optimize the model, which can save computer computing power and time, and has the characteristics of being simple, easy and efficient. The experimental results show that our method generates a reasonable precision (93.82%) and recall (90.11%) and outperforms other state-of-the-art machine learning algorithms.

Day Surgery Scheduling and Optimization in Large Public Hospitals in China: A Three-Station Job Shop Scheduling Problem.

Day surgery scheduling allocates hospital resources to day surgical cases and decides on the time to perform the surgeries in the day surgery center (DSC). Based on the day surgery service process of large public hospitals in China, we found that the service efficiency of the process depends on the utilization of hospital resources efficiently and could be optimized through day surgery scheduling. We described it as a flexible flow shop owing to the three-station nature of surgery. Allocating all types of hospital resources to the three stations and determining the length of time for each stage during surgery are crucial to improving the efficiency of DSC. This paper integrates a three-station job shop scheduling problem (JSSP) into the day surgery scheduling and optimization problem. The JSSP was formulated as a mixed-integer linear programming model, and the elicitation of the model for scheduling surgeries with different priorities in the DSC is discussed. The model illustrated a case study of the DSC within West China Hospital (WCH). Numerical experiments based on the genetic algorithm design were conducted. Compared to the other optimization strategies, we proposed that the three-station job shop scheduling strategy (TSJS) could not only improve the efficiency and reduce the waiting time of the patients of the DSC in large public hospitals in China but also allow for timely scheduling adjustments during the advent of emergency surgeries.

Recent advances in theoretical studies on transition-metal-catalyzed regioselective C-H functionalization of indoles.

Indole compounds are widely found in natural products and drug candidates. The transition-metal-catalyzed regioselective C-H bond functionalization of indoles as the most efficient method for the synthesis of various functionalized indoles has been extensively studied in the past two decades due to its advantages of step economy and atom economy. In general, the catalysts included the transition-metals (Pd, Rh, Ru, Cu, Co, Fe, Zn, and Ga) and these reactions were accomplished with a remarkably wide range of coupling reagents for construction of various C-C and C-X (X = N, O, S) bonds. However, the general and important rules of the regioselectivity are not clear to date. Therefore, a comprehensive analysis through previous reported theoretical studies on transition-metal-catalyzed regioselective C-H bond functionalization of indoles was crucial and significant. In this review, we found that when the C-H bond activation process was the rate-determining step, the regioselectivity ordinarily occurred at the C7 or C4 positions (on benzene ring), and otherwise, the regioselectivity often occurred at C2 position (on pyrrole ring). For indoline substrates, the C-H bond functionalization occurred at the benzene ring. General rules of the regioselectivities for transition-metal-catalyzed C-H bond functionalization of indoles. This review collects major advances in the transition-metal-catalyzed C-H bond functionalization of indoles and indolines.

Theoretical studies on the mechanism of Pd2+-catalyzed regioselective C-H alkylation of indole with MesICH2CF3OTf.

The reaction mechanism of Pd2+-catalyzed regioselective C-H alkylation of indole with MesICH2CF3OTf has been investigated by the density functional theory calculations. The reaction mechanism mainly contains four steps: C-H activation, oxidative addition, reductive elimination, and ligands substitution. From our calculations, we find that the C-H activation step was realized by the acetate anion (-OAc) assisted concerted metalation deprotonation (CMD) process and the transition state of C-H activation process is a square planar configuration. Moreover, the calculation results suggest that the regioselectivity of C-H bond alkylation of indole with MesICH2CF3OTf can be ascribed to the different stability of the CMD transition states in C-H activation step and the relative stabilities of deprotonated intermediates.

Pivotal role of video-assisted thoracoscopic surgery in improving survival outcome of stage I non-small cell lung cancer in day surgery patients.

BACKGROUND: Lung cancer, the leading cause of cancer-related deaths worldwide, has high morbidity rates. Video-assisted thoracoscopic surgery (VATS) as day surgery makes surgical treatment ideally in time with the same quality of medical care. This study aimed to assess the safety of stage I NSCLC patients who underwent VATS at a day surgery center. METHODS: We retrospectively analyzed the clinical characteristics and tumor features of VATS patients at a single center, West China Hospital, from June 1, 2019, to December 31, 2020. Patients fulfilled all inclusion criteria, did not meet any exclusion criteria and underwent wedge resection, segmentectomy, or lobectomy with systematic lymph node dissection. RESULTS: The median patient age was 43 (range, 19-67) years. Of the 209 patients, most were women. A total of 108 (51.7%) patients underwent segmentectomy, 87 (41.6%) lobectomy, and 14 (6.7%) wedge resection with systematic lymph node dissection. According to the AJCC/UICC eighth edition of lung cancer stage grouping, stages IA, IA1, IA2, and IA3 were 195 (93.3%), 122 (58.4%), 50 (23.9%), and one (0.5%), respectively. A total of 36 (17.2%) patients were stage 0. Adenocarcinoma was predominantly the postoperative pathological diagnosis, as only 14 (6.7%) were benign. A total of 201 (96.17%) patients were discharged without a chest tube. The most common chief complaints were cough, incisional pain, and shortness of breath. No severe complications or life-threatening emergencies were observed. CONCLUSIONS: The day surgery mode of VATS for stage I NSCLC is safe and feasible, which makes surgical treatment ideally in time for stage I NSCLC patients with the same quality of medical care.

A rare case of synovial sarcoma with lung, heart and adrenal gland metastasis: a caution for patients and clinicians.

A 68-year-old man presented to the Urology Clinic, West China Hospital, Chengdu, with a suspected right adrenal gland mass that had persisted for two months. He had no associated lumbodynia, dizziness or palpitation. Abdominal computed tomography (CT) revealed an uneven density and contrast-enhanced oval-like mass with smooth edges in the right adrenal gland. Laparoscopic right adrenal gland resection followed by histopathology confirmed a diagnosis of metastatic synovial sarcoma. The patient had a history of synovial sarcoma on the right upper leg 3 years previously that was surgically treated, but he had not undergone further treatment. Approximately 1.5 years later, he had undergone surgery for heart and lung metastasis from the synovial sarcoma of the thigh. At 5 months following laparoscopic right adrenal gland resection, abdominal CT showed a significant sign of right adrenal recurrence, and targeted therapy of 12 mg oral anlotinib, daily, was initiated. This relatively rare but alarming case highlights the importance of patient understanding and compliance to treatment.

Safety and Feasibility of Video-Assisted Thoracoscopic Day Surgery and Inpatient Surgery in Patients With Non-small Cell Lung Cancer: A Single-Center Retrospective Cohort Study.

Background and Objective: This study was undertaken to evaluate how safe and viable the use of video-assisted thoracoscopic day surgery (VATDS) is for individuals diagnosed with early-stage non-small cell lung cancer (NSCLC). Methods: Data obtained from the selected patients with NSCLC who underwent video-assisted thoracoscopic surgery (VATS) in the same medical group were analyzed and a single-center, propensity-matched cohort study was performed. In total, 353 individuals were included after propensity score matching (PSM) with 136 individuals in the day surgery group (DSG) and 217 individuals in the inpatient surgery group (ISG). Results: The 24-h discharge rate in the DSG was 93.38% (127/136). With respect to the postoperative complications (PPCs), no difference between the two groups was found (DSG vs. ISG: 11.76 vs. 11.52%, p = 0.933). In the DSG, a shorter length of stay (LOS) after surgery (1.47 ± 1.09 vs. 2.72 ± 1.28 days, p < 0.001) and reduced drainage time (8.45 ± 3.35 vs. 24.11 ± 5.23 h, p < 0.001) were found, while the drainage volume per hour (mL/h) was not notably divergent between the relevant groups (p = 0.312). No difference was observed in the cost of equipment and materials between the two groups (p = 0.333). However, the average hospital cost and drug cost of the DSG were significantly lower than those of the ISG (p < 0.001). Conclusion: The study indicated that the implementation of VATDS showed no difference in PPCs, but resulted in shorter in-hospital stays, shorter drainage times, and lower hospital costs than inpatient surgery. These results indicate the safety and feasibility of VATDS for a group of highly selected patients with early-stage NSCLC.

Breakthrough in breast reconstruction in the context of COVID-19: safety and efficiency of endoscopic breast reconstruction at a day surgery center.

BACKGROUND: In recently years, breast endoscopic reconstruction surgery is becoming increasingly popular. And we have explored a series of endoscopic breast reconstruction procedures and applied it to our day surgery under the epidemic control of the novel coronavirus. METHODS: The present study was a retrospective analysis. Patients who underwent unilateral breast endoscopic reconstruction surgery in the West China Hospital from April 2017 to February 2021 were included in the study. Patients were divided into the following three groups: ward exploration period (WEP), ward maturation period (WMP), and day surgery period (DSP), respectively. We compared the results of postoperative complications, hospitalization costs, operation time, and BREAST-Q (a patient-reported outcome instrument measuring health-related quality-of-life and patient satisfaction in breast surgery) scale scores among the three groups of patients. RESULTS: A total of 66 patients were included (WEP n=30, WMP n=14, DSP n=22). Four people refused to complete the BREAST-Q scale, and five patients missed complication record sheets. Patients in the DSP and WMP groups had slightly higher postoperative satisfaction with their breasts than WEP, but there was no statistically significant difference (3 months postoperatively: WEP vs. WMP =0.515, WEP vs. DSP =0.418, WMP vs. DSP =0.982). On the postoperative BREAST-Q scale scores of psychosocial, sexual life and chest well-being, patients with DSP scored slightly higher than those with WEP versus WMP, but there was no statistically significant difference. The incidence of postoperative complications was generally higher in the WEP group than in the WMP and DSP groups, but there was no statistically significant incidence of either major or minor complications (P=1.000). With the use of prostheses and mesh, patients in the DSP group had lower hospitalization costs than other two groups. In terms of operative time, patients in the WMP and DSP groups had shorter operative times compared with the WEP group, and the results were statistically significant (WEP vs. WMP =0.000, WEP vs. DSP =0.000, WMP vs. DSP =0.243). CONCLUSIONS: We believe that performing our newly developed endoscopic breast reconstructive surgery at a day surgery center is safe and reliable.

Day Surgery Program at West China Hospital: Exploring the Initial Experience.

Healthcare facilities in China are facing increasing demands as the country has the fastest aging populations in the world. Day surgery can be utilized to address some of these demands. Benefits of day surgery include shortened hospital stay, decreased risk of hospital-associated infections, and increased cost efficiency. We present a retrospective study of eight years of day surgery data from West China Hospital, one of the largest hospitals in China, with an emphasis on an examination of the growth in day surgeries. We examined patterns of utilization of day surgery versus inpatient surgery (including types of surgeries performed in the Day Surgery Center and the ratio of day surgery versus elective surgery), as well as unplanned readmission and return to inpatient department rates, and a comparison of average costs and length of stay for day surgery versus hospital surgery. Day surgery has a safe and cost-effective way to alleviate the soaring healthcare demands in West China. There is potential opportunity to further address the ever-increasing demands on the healthcare system in this area by performing more complex surgeries as day surgeries. This article presents an effective organizational protocol and proposes a reliable medical quality assurance system, which prioritizes safety of the growing day surgery program; furthermore, it describes the factors and lessons learned from the successful implementation of a day surgery system.