ObjectiveTo understand the application of the Braden pressure ulcer risk-factor assessment scale in the nursing staff, in order to provide reference for clinical nurses to standardize the use of Braden assessment scale and facilitate the hospital to develop training programs on pressure ulcer related knowledge. MethodsStratified cluster sampling method was applied in February 2015. Using the self-designed questionnaire of “Application of Braden pressure ulcer risk-factor assessment scale in the nursing staff ”, we conducted a survey on 198 clinical nurses, and the survey results were scrutinized. The difficulty level of using Braden assessment scale in the nurses was analyzed based on their different demographic characteristics. We also analyzed the items which were most difficult to judge for the nurses and nurses’ learning needs for knowledge on Braden assessment scale. ResultsA total of 168 (84.85%) nurses found it difficult in using Braden scale for the evaluation of pressure ulcer. The most difficult items to judge for the nurses were friction force, shear force and feeling. Nurses in departments with pressure ulcer as a common symptom of the patients could better use the Braden pressure ulcer risk-factor scale, compared with those in departments where pressure ulcer was uncommon (P＜ 0.05) . A total of 189 (95.46%) nurses thought it necessary to carry out a unified quantitative standard analysis of six risk factors in the Braden scale. Conclusions The poor mastery of the assessment standards for Braden scale in the nurses causes various degrees of difficulty in applying the scale, which can influence the accuracy of assessment. It is important to train the nurses on pressure ulcer risk factor assessment in order to raise the clinical assessment accuracy.
【摘要】 目的 探讨t(8；21)急性髓系白血病(acute myeloid leukemia，AML)的临床特点及预后，提高对t(8；21)AML的认识。 方法 2010年5月收治1例t(8；21)AML患者，对其临床资料并复习相关文献进行分析。患者因乏力、皮下瘀斑入院，查体发现患者有胸骨压痛，脾肋下3 cm触及，血常规:白细胞80.37×109/L，异常细胞 23%，取患者骨髓液行形态学、流式细胞术检测及染色体核型检测。 结果 患者诊断为急性粒细胞白血病部分分化型(AML-M2b)，AML1/ETO融合基因阳性，染色体核型分析t(8；21)(q22；q22)。 结论 t(8；21)AML是一类较为特殊的急性髓系白血病，在诊断时需寻找疾病的预后因素并进行分层，实施个体化治疗。【Abstract】 Objective To obsrve the clinical features and prognosis of acute myeloid leukemia (AML) with t(8;21). Methods The clinical data of one patient with t (8; 21) AML diagnosed in May 2010 was retrospectively analyzed. The chief complaints of the patient were malaise and ecchymosis. The physical examinations revealed sternum pain and splenomegaly; blood routine examination showed that the peripheral WBC count was 80.37×109/L, and the abnormal cells were 23%. Bone marrow samples were collected to perform the morphologic test, flow cytometry analysis and chromosome analysis. Results The patient was diagnosed as AML with maturation (AML-M2) with positive AML1/ETO fusion gene and translocation (8; 21) (q22; q22). Conclusion AML with t (8; 21) is different with other types of AML; patients with AML with t (8; 21) need individualized treatment.
ObjectiveTo observe and analyze the accuracy of the optic disc positioning and segmentation method of fundus images based on deep learning.MethodsThe model training strategies were training and evaluating deep learning-based optic disc positioning and segmentation methods on the ORIGA dataset. A deep convolutional neural network (CNN) was built on the Caffe framework of deep learning. A sliding window was used to cut the original image of the ORIGA data set into many small pieces of pictures, and the deep CNN was used to determine whether each small piece of picture contained the complete disc structure, so as to find the area of the disc. In order to avoid the influence of blood vessels on the segmentation of the optic disc, the blood vessels in the optic disc area were removed before segmentation of the optic disc boundary. A deep network of optic disc segmentation based on image pixel classification was used to realize the segmentation of the optic disc of fundus images. The accuracy of the optic disc positioning and segmentation method was calculated based on deep learning of fundus images. Positioning accuracy=T/N, T represented the number of fundus images with correct optic disc positioning, and N represented the total number of fundus images used for positioning. The overlap error was used to compare the difference between the segmentation result of the optic disc and the actual boundary of the optic disc.ResultsOn the dataset from ORIGA, the accuracy of the optic disc localization can reach 99.6%, the average overlap error of optic disc segmentation was 7.1%. The calculation errors of the average cup-to-disk ratio for glaucoma images and normal images were 0.066 and 0.049, respectively. Disc segmentation of each image took an average of 10 ms.ConclusionThe algorithm can locate the disc area quickly and accurately, and can also segment the disc boundary more accurately.
ObjectiveTo investigate the factors of breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy when choosing surgical mode.MethodsA questionnaire survey was conducted on 228 breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy. Chi square test, nonparametric rank sum test and binary logistic regression were used to analyze the factors affecting the choice of surgical mode.ResultsUnivariate analysis showed that age, clinical stage, family history of cancer, molecular type, neoadjuvant chemotherapy effect, surgeon’s recommendation, chemotherapy side effects, and surgical complications were the factors affecting patient’s chose for breast-conserving surgery (P<0.05). Multivariate analysis showed that the effect of neoadjuvant chemotherapy [OR=0.312, 95%CI (0.255, 0.662), P<0.001] and the surgeon’s recommendation [OR=53.947, 95%CI (4.570, 6.239), P=0.002] were independent factors that affected the choice of surgery.ConclusionsThe decision of the surgical mode is a process in which doctors and patients participate together. Individualized neoadjuvant chemotherapy improves the remission rate and the progress of the surgeon’s comprehensive treatment strategy can play a role in improving the breast-conserving rate and the rate of breast-conserving success. Doctors should give positive guidance in accordance with the specific situation of the patient to make the best choice.
ObjectiveTo investigate the efficacy and safety of over-bending rod reduction and fixation technique via posterior approach in the treatment of unstable fresh thoracolumbar burst fracture.MethodsA clinical data of 27 patients with unstable fresh thoracolumbar burst fracture, who were met the inclusive criteria and admitted between January 2018 and October 2019, was retrospectively analyzed. There were 15 males and 12 females with an average age of 41.8 years (range, 26-64 years). The fractures were caused by falling from height in 14 cases, traffic accident in 8 cases, and crushing by a heavy objective in 5 cases. The interval between injury and operation was 1-7 days (mean, 3.2 days). The injured fracture was located at T10 in 1 case, T11 in 3 cases, T12 in 6 cases, L1 in 7 cases, L2 in 7 cases, and L3 in 3 cases. According to AO classification, there were 11 cases of type A3, 7 cases of type B, and 9 cases of type C. Neurological function was rated as grade A in 3 cases, grade B in 7 cases, grade C in 5 cases, and grade D in 12 cases according to the American Spinal Injury Association (ASIA) grading. All cases were treated by over-bending rod reduction and fixation technique via posterior approach, and 16 cases were combined with limited fenestration decompression. The evaluation indicators consisted of operation time, intraoperative blood loss, the compression ratio of the anterior vertebral height, the invasion rate of the injured vertebra into the spinal canal, the Cobb angle of segmental kyphosis, visual analogue scale (VAS) score, and Oswestry Disability Index (ODI).ResultsThe operation time was 67-128 minutes (mean, 81.6 minutes), and the intraoperative blood loss was 105-295 mL (mean, 210 mL). All patients were followed up 12-23 months (mean, 17.2 months). A total of 178 pedicle screws were implanted during operation, and the accuracy of the implantation was 98.9% (176/178). The compression ratios of the anterior vertebral height at the early postoperatively and last follow-up were significantly increased when compared with preoperative one (P<0.05), and the invasion rate of the injured vertebra into the spinal canal, Cobb angle, VAS score, and ODI were significantly lower than those preoperatively (P<0.05). Except that the ODI at last follow-up was significantly lower than that of the early postoperative period (P<0.05), there was no significant difference between the last follow-up and the early postoperative period for other indicators (P>0.05). At last follow-up, the neurological function was rated as grade A in 1 case, grade B in 2 cases, grade C in 4 cases, grade D in 9 cases, and grade E in 11 cases according to the ASIA grading, showing significant difference when compared with that before operation (Z=–3.446, P=0.001).ConclusionOver-bending rod reduction and fixation technique can effectively restore vertebral height, reset the invaded vertebral block, and selectively perform limited decompression and posterolateral bone grafting to ensure the completeness of intravertebral decompression and stability, which is one of the effective methods to treat unstable fresh thoracolumbar burst vertebral fracture.
ObjectiveTo evaluate the effectiveness of modified recapping laminoplasty preserving the continuity of supraspinous ligament in the treatment of intraspinal benign tumors in upper cervical vertebrae and its influence on the stability of the cervical vertebrae. MethodsThe clinical data of 13 patients with intraspinal benign tumors in upper cervical vertebrae treated between January 2012 and January 2021 were retrospectively analyzed. There were 5 males and 8 females, the age ranged from 21 to 78 years, with an average of 47.3 years. The disease duration ranged from 6 to 53 months, with an average of 32.5 months. The tumors located between C1 and C2. Postoperative pathology showed 6 cases of schwannoma, 3 cases of meningioma, 1 case of gangliocytoma, 2 cases of neurofibroma, and 1 case of hemangioblastoma. During operation the continuity of the supraspinal ligament were retained, the lamina ligament complex was lifted to expose the spinal canal via the approach of the outer edge of the bilateral lamina, and the lamina was fixed after the resection of the intraspinal tumors. Before and after operation, the atlantodental interval (ADI) was measured on three-dimensional CT; the effectiveness was evaluated by Japanese Orthopaedic Association (JOA) score, the neck dysfunction index (NDI) was used to evaluate the cervical function, and the total rotation of the cervical spine was recorded. Results The operation time was 117-226 minutes (mean, 127.3 minutes); the intraoperative blood loss was 190-890 mL (mean, 227.8 mL). The tumors were completely removed in all patients. There was no vertebral artery injury, aggravation of neurological dysfunction, epidural hematoma, infection, or other related complications. Two patients occurred cerebrospinal fluid leakage after operation, which were healed through electrolyte supplement and local pressure treatment of incision. All the patients were followed up 14-37 months, with an average of 16.9 months. Imaging examination showed no recurrence of tumor, displacement of vertebral lamina, loosening and displacement of internal fixator, and secondary reduction of vertebral canal volume. At last follow-up, JOA score significantly improved when compared with preoperative scores (P<0.05). Among them, 8 cases were excellent, 3 cases were good, and 2 cases were medium, with an excellent and good rate was 84.6%. There was no significant difference in ADI, total rotation of the cervical spine, and NDI between pre- and post-operation (P>0.05). ConclusionThe treatment of intraspinal benign tumors in upper cervical vertebrae with modified recapping laminoplasty preserving the continuity of the supraspinous ligament can restore the normal anatomical structure of the spinal canal and maintain the stability of the cervical spine.