In 2021, China launched a national pilot project of diagnosis-intervention packet (DIP) in 71 cities, which is an important measure of medical insurance payment system reform. DIP was originated in Guangdong. This paper summarizes the reform experience and effectiveness of Guangzhou and Shenzhen, discusses how to promote the reform of DIP in the national pilot cities from the medical insurance agencies aspect and the hospitals aspect, so as to provide a reference for the national pilot cities.
Objective To evaluate the correlation between mycoplasma genitalium and HIV infection. Methods Databases including MEDLINE, ScienceDirect, EMbase, WanFang Data, and CNKI were searched from inception to March 2012, so as to identify the independent cohort studies, case-control studies and cross-sectional studies. Moreover, the references of relevant studies were also retrieved. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the methodological quality of the included studies was assessed. Then meta-analysis was performed using RevMan 4.2 and SAS 9.1.3 softwares. Results A total of 19 studies were included, including 3 430 HIV infected patients and 7 656 controlled participants. The results of meta-analyses showed that the HIV infection group was more likely to infect mycoplasma genitalium than the control group (OR=2.34, 95%CI 1.68 to 3.28, Plt;0.000 01). The same results were found in both subgroup and sensitivity analyses. Conclusion Mycoplasma genitaliuman infection is closely related to HIV infection. However, detailed pathogenesis is still unknown. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to prove the above.
ObjectiveTo explore the effectiveness of dual-pedicle abdominal flap for unilateral breast reconstruction.MethodsBetween March 2014 and March 2018, a clinical data of 19 female patients underwent dual-pedicle abdominal flap reconstruction because of unilateral mastectomy defect was reviewed retrospectively. The median age was 45 years (range, 32-51 years), including 3 immediate breast reconstruction and 16 delayed breast reconstruction, and left side in 7 cases and right side in 12 cases. Unilateral breast reconstruction were performed for 8 patients with unilateral pedicle transverse rectus abdominis musculocutaneous (TRAM) flap and contralateral free TRAM flap, for 3 patients with pedicle TRAM flap and contralateral deep inferior epigastric perforator (DIEP) flap, for 7 patients with bilateral DIEP flaps, for 1 patient with free muscle-sparing TRAM flap and contralateral DIEP flap. The size of abdominal flap ranged from 24 cm×7 cm to 43 cm×13 cm. The donor sites were closed directly.ResultsVascular crisis ocuurred in 1 flap and relieved after surgical exploration. The other flaps survived. Poor wound healing in abdominal incision occurred in 1 patient and was successfully treated with debridement. The other donor sites healed without any other complication. The patients were followed up with a median period of 12 months (range, 4-42 months). Four patients received reparative operation of their reconstructive breast, and 2 patients received mamopexy of the contralateral breast due to mastoptosis. The abdominal BREAST-Q score was 84.1±11.7, chest score was 86.5±8.9, and breast score was 67.6±16.4 at last follow-up.ConclusionThe dual-pedicle abdominal flap for unilateral breast reconstruction provides adequate soft tissue volume and good blood supply. It is a reliable and effective breast reconstructive method for patients who need large tissue volume to make symmetric with the contralateral breast, or slim patients with few tissue in the donor site, or patients with scars in the donor site, especially vertical abdominal scars.