The continuing medical education system of West China Hospital of Sichuan University is based on whole life cycle. We actively promote the continuing education, systematize and institutionalize the top-level design, and adopting flexible and diverse training methods. It is of great significance for a staff's entire career to continuously improve professional accomplishment, specialized knowledge and working skills, to adapt to the development of medical science and technology and the reform of health service, and to drive hospital innovation and high-quality development, so as to eventually achieve the goal of "double first-class" construction.
Objective A retrospective summary of the planning, organization, and implementation of the transprovince transfer of patients injured in Wenchuan Earthquake with an emphasis on experiences that may be helpful in future emergency rescue and patient transfer. Methods We collected the daily reports of a patient transfer team attached to the Sichuan Rescue Headquarters from May 12 through May 31, 2008. Results Under the guidance of policy made by the coordinating group of the Ministry of Health, and with the close cooperation of the railway and airline departments the transferring group transferred 10 373 patients in the period studied. The transfers were from 11 disaster areas, including Chengdu, Mianyang, and Deyang, to 20 cities and provinces, including Chongqing, Jiangsu, and Zhejiang. There were no casualties during transfer, and thus the biggest peacetime government-organized trans-province patienttransfer in China’s history achieved success. Conclusion Trans-province patient transfer is an effective measure to compensate for inadequate medical materials, relieve pressure on medical rescue, and guarantee quality of treatment. In the future, emergency plans for different types of disasters will be established, the information platform will be improved, and transfer procedures will be specified.
Objective To compare the biological characteristics of bone marrow mesenchymal stem cells (BMSCs) and anterior cruciate ligament derived mesenchymal stem cells (ACL-MSCs) from ratsin vitro. Methods Ten male SPF-level BN rats, weighing 200-220 g, were selected to obtain anterior cruciate ligaments and bone marrows, and ACL-MSCs and BMSCs were isolated for passage culture respectively under sterile condition. The cell morphology was observed, and the cells at passage 3 were used to detect the surface markers of CD34, CD45, CD90, and CD29 by flow cytometry, the ability of cell proliferation by cell counting kit 8 (CCK-8), and colony formation ability by clone forming test. The mRNA levels of differentiation related genes [alkaline phosphatas (ALP), bone gamma-carboxyglutamate protein, runt related transcription factor 2, bone morphogenetic protein 2 (BMP-2), secreted phosphoprotein 1 (Spp1), collagen type II α1 (Col2α1), Aggrecan (Acan), Sox9, peroxisome proliferator activated receptor γ2 (PPARγ2), and CCAAT-enhancer-binding protein-α] were also determined by real-time fluorescent quantitative PCR. Results BMSCs and ACL-MSCs had similar morphology, adherent cells displaying long fusiform. The immunoprofile of ACL-MSCs and BMSCs at passage 3 was positive for CD29 and CD90 and was negative for CD45 and CD34. The absorbance (A) value of ACL-MSCs (1.11±0.08) was significantly higher than that of BMSCs (0.78±0.05) (t=3.599,P=0.023); the number of colonies of ACL-MSCs [(53.00±5.51)/hole] was significantly more than that of BMSCs [(30.67±4.84)/hole] (t=3.045,P=0.038). The results of toluidine blue staining, alizarin red staining, and oil red O staining were positive in BMSCs and ACL-MSCs at 21 days after osteogenic, chondrogenic, and adipogenic induction. The mRNA expressions of BMP-2, Spp1, Col2α1, Acan, Sox9, and PPARγ2 in ACL-MSCs were significantly higher than those in BMSCs (P<0.01). Conclusion The proliferation potential of ACL-MSCs is greater than that of BMSCs, and the former is apt to differentiate into chondrocytes. ACL-MSCs are promising cells to promote tendon-bone healing.
Objective To compare diagnosis values of computed tomography (CT) and magnetic resonance imaging (MRI) in preoperative staging of rectal carcinoma. Methods The imaging data of 81 patients with rectal carcinoma from January 2013 to January 2017 in the Hefei Second People’s Hospital were retrospectively analyzed. Based on the postoperative pathological results, the diagnostic accordance rates of CT and MRI on the T staging and N staging were calculated. Results The sensitivities of the CT and MRI on the preoperative T staging of rectal carcinoma were 69.1% (56/81) and 82.5% (52/63), the difference was not statistically significant (χ2=3.396, P=0.065), the Kappa values was 0.521 and 0.371, respectively, the MRI on the T staging was in a good agreement with the pathological diagnosis. The sensitivitie of the T1-2, T3, and T4 stagings with CT was 70.0%, 66.7%, and 72.0%, respectively, with MRI was 83.3%, 83.3%, and 81.0%, respectively, which had no significant difference respectively between the CT and the MRI. The areas under the receiver operating characteristic curve of the T1-2, T3, and T4 stagings with the CT and MRI were 0.809, 0.689, 0.798 and 0.897, 0.826, 0.869, respectively. The sensitivities of the CT and MRI on the preoperative N staging of rectal carcinoma were 59.3% (48/81) and 65.1% (41/63), the difference was not statistically significant (χ2=0.509, P=0.476), the Kappa values were 0.371 and 0.463, respectively. The sensitivities of the N0, N1, N2 stagings with CT were 64.7%, 45.5%, 64.0%, with MRI were 70.3%, 63.2%, 72.5%, which had no significant difference respectively between the CT and the MRI. Conclusions Results of in this study show that MRI is superior to CT for judgment of tumor infiltration. Neither CT nor MRI is able to provide satisfactory assessment of lymph node metastasis.
ObjectiveThe aim was to summarize the seizure and video electroencephalogram (VEEG) characteristics of Dyke-Davidoff-Masson syndrome (DDMS). Methods The case data of four patients with Dyke-Davidoff-Masson syndrome (DDMS) who attended the Epilepsy Center of Hunan Provincial Brain Hospital from March 2022 to March 2023 were retrospectively analyzed to summarize the clinical manifestations of their seizures and the characteristics of their video electroencephalogram (VEEG). Results One case of symptomatic epilepsy with focal seizures; VEEG showed poor background activity alpha rhythmic modulation, amplitude modulation, and increased distribution of slow wave activity in the left frontal and temporal regions; bilateral frontal-central and anterior-temporal regions (more so on the left side), with sharp and slow composite wave issuance.Two cases of symptomatic epilepsy with focal seizures progressing to generalized seizures; in one case, the VEEG showed: background activity α-rhythmic modulation, amplitude modulation is possible, the left frontal, central, anterior temporal region slow wave increase; the left frontal central, parietal anterior temporal region spike-like slow wave activity mixed with spike wave, spike-slow complex wave short-medium-range issuance; the other VEEG showed: background activity α-rhythmic modulation, amplitude modulation is possible, the right frontal central, anterior temporal region slow wave increase; right frontal, central, and anterior temporal region for the famous medium-extremely high-high-amplitude slow wave activity mixed with spike wave, spike-slow complex wave short-medium-range issuance. One case of symptomatic epilepsy with generalized seizures; VEEG showed bilateral occipital alpha rhythm asymmetry, right occipital region <50% of the left side, poor regulation and amplitude modulation; bilateral frontal pole, frontal region, anterior temporal region spike and spiking slow complex wave discharges (right side was prominent), and right pterionic electrodes, anterior temporal and mesial temporal spike and spiking slow wave discharges. Conclusions Epileptic seizures are one of the main clinical manifestations of DDMS and most of them are consulted after a seizure, and their seizure types tend to be focal seizures or progress to generalized seizures, and most of them are drug-refractory epilepsies. The results of VEEG monitoring tend to be characterized by abnormal background activity, increased slow-wave activity, and the site of epileptogenic wave-like discharges tends to be in line with the site of cerebral softening foci or the site of the atrophic side of the brain as shown by cranial MRI.
Objective To investigate the effectiveness and biomechanical analysis of 3 fixation methods of screw anterior-posterior fixation (SAPF), screw posterior-anterior fixation (SPAF), and buttress plate fixation (BPF) in treatment of posterior Pilon fractures. Methods Fifteen fresh-frozen skeleto-ligamentous lower leg specimens were harvested to establish the models of posterior Pilon fracture, and then fracture was fixed with BPF (n=5), SAPF (n=5), and SPAF (n=5). Vertical force was loaded to internal fixation failure in a speed of 1 cm/minute with servohydraulic testing machine. The instantaneous loads of 1 mm and 2 mm steps and the failure modes were recorded. Between May 2008 and December 2011, 56 patients with posterior Pilon fracture were treated with SAPF (SAPF group) in 11 cases, or SPAF (SPAF group) in 26 cases, or BPF (BPF group) in 19 cases. There was no significant difference in age, gender, injury cause, side, disease duration, and complications among groups (P gt; 0.05). Clinical and radiographic examinations were used to assess the reduction and healing of fracture; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Results No breaking or bending was observed in all specimens, fixation failure was caused by cancellous bone compression. The instantaneous loads of 1 mm and 2 mm steps were the largest in BPF group, larger in SPAF group, and smallest in SAPF group, showing significant differences among 3 groups (P lt; 0.05). A total of 47 cases were followed up 16-54 months (9 in SAPF group, 22 in SPAF group, and 16 in BPF group), with a mean time of 35.2 months. Fixation failure was found in 2 cases of SAPF group; the other cases obtain bony union within 3 to 4 months (mean, 3.2 months) with no fixation failure. The AOFAS score was significantly lower in SAPF group than in SPAF and BPF groups (P lt; 0.05), but no significant difference was found between SPAF and BPF groups (P gt; 0.05). The VAS score was significantly higher in SAPF group than in SPAF and BPF groups (P lt; 0.05), but no significant difference was found between SPAF and BPF groups (P gt; 0.05). Conclusion SAPF could not reach enough fixation strength for the posterior Pilon fracture; both SPAF and BPF could reach rigid fixation, and have good effectiveness. And from the biomechanical points, BPF could reach better fixation strength than screw fixations.
Objectives About 12.9-50% patients of SARS (Severe Acute Respiratory Syndrome), require brief mechanical ventilation (MV) to save life. All the reported principles and guidelines for therapy SARS were based on experiences from clinical treatments and facts of inadequacy. Neither prospective randomized controlled trials (RCT) nor other high quality evidences were in dealing with SARS. Our objective is to seek safe and rational non-drugs interventions for patients with severe SARS by retrospectively reviewing clinical studies about MV all over the world, which include clinical guidelines, systematic reviews (SR), Meta-analysis, economic researches and adverse events. Methods To search MEDLINE and Cochrane Library with computer. According to the standards of inclucion or exclusion, the quality of the article which as assessed, and relevant data which were extracted double checked. The Meta-analysis was conducted if the studies had no heterogeneity. Results 14 papers were eligible. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and the authors’ conclusions were described only. Conclusions The outcome of PPV is better than that of VPV. Patients who underwent PPV had a significantly lower mortality than that of VPV. Of course, the volutrauma should be watched. With low tidal volume and proper PEEP, or decreased FiO2, even permissive hypercapnia, the mortality and length of stay were cut down. Non-invasive mechanical ventilation (NIMV) was effective in treating haemodynamical stable patients, minimizing complications and reducing medical staff infection. Patients with serious dyspnea with PaO2/FiO2lt;200, no profit of NIMV, or couldn’t tolerance hypoxaemia were unlikely to benefit from this technique and needed ventilation with endotracheal intubation. Prone position could improve PaO2/FiO2, NO maybe increased pulmonary perfusion, improved V/Q, and raised oxygenation. Furthermore, Inhaled NO sequentially (SQA) was better than Inhaled NO continuouly (CTA). Some studies implied that practice of protocol-directed weaning from mechanical ventilation implemented by nurses excelled that of traditional physician-directed weaning.
Objective To develop an evaluation tool for the screening of high risk population for oral complications in critically ill patients, which can be performed accurately and scientifically. Methods Basing on the related foreign oral assessment scale, combined with the method of brainstorming, expert consultation, method of clinical status and so on, the item pool of the assessment scale was determined. Five nursing experts and two oral experts assessed the content validity and 50 ICU nurses were tested. Then, the screening accuracy of the assessment scale was proved by application in 100 critically ill patients selected randomly. Results The Cronbach’s a coefficient of final version of the High Risk Assessment Scale for Oral Complications in Critically Ill Patients (including seven parts contents of oral health assessment and oral pH value test) was 0.815, the content validity index (Sr-CVI/Ave) was 0.932. The results of 50 nurses to the 91.2% assessment items of the assessment scale were very important and important. For screening related indicators of oral complications in high-risk patients, the sensitivity of the assessment scale was 97.53%, the specificity was 94.11%, the positive predictive value was 98.75%, the negative predictive value was 88.89%, and the crude agreement was 95%. Conclusion There are good reliability, validity and a high accuracy of screening test in the High Risk Assessment Scale for Oral Complications in Critically Ill Patients. It can be used for screening patients at high risk for oral complications in critically ill patients, and help clinical nurses to complete the oral health status of the critically ill patients quickly.
Objective To investigate the functional outcomes of buttress plate fixation and simple screws fixation for the treatment of supination-adduction type-II medial malleolar fractures so as to provide reference for selection of internal fixation. Methods Between March 2009 and December 2012, 53 patients with supination-adduction type-II medial malleolar fractures were treated with open reduction and internal fixation. Of them, buttress plate fixation was used in 30 cases (buttress plate fixation group), and screws fixation was used in 23 cases (screw fixation group). There was no significant difference in age, gender, injury cause, injury side, disease duration, and combined injuries between 2 groups (P>0.05). Complications and full weight-bearing time were recorded; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. Post-operative anteroposterior and lateral X-ray films were taken to evaluate fracture reduction and union condition. And the treatment failures were recorded. Results There was no significant difference in incision related complication rate and infection rate between 2 groups (P>0.05). The patients were followed up 46-91 months (mean, 64.5 months) in buttress plate fixation group and 44-86 months (mean, 59.5 months) in screw fixation group. The full weight-bearing time of the buttress plate fixation group was significantly shorter than that of screw fixation group (t=2.05,P=0.04). During follow-up time, malunion and nonunion occurred in 2 cases and 1 case of screw fixation group; anatomic reduction and bony union were observed in the other patients of 2 groups. The union time showed no significant difference between 2 groups (t=1.06,P=0.30). No significant difference was found in AOFAS score and good and excellent rate, VAS score, operation failure rate, and traumatic osteoarthritis rate between groups (P>0.05). Conclusion For patients with supination-adduction type-II medial malleolar fracture, the angle between fracture line and tibial axial line is too small to be fixed firmly with simple screws fixation, with a relatively higher failure rate. And buttress plate fixation can reach rigid fixation, and has better functional outcomes.
Objective To evaluate the short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus. Methods The clinical data of 30 patients (48 feet) who were diagnosised hallux valgus associated with mild to moderate metatarsus adductus and treated by Scarf osteotomy and Akin osteotomy combined with soft tissue procedures between February 2013 and May 2015 were analyzed retrospectively. There were 2 males (2 feet) and 28 females (46 feet) with an average age of 29.4 years (range, 18-50 years). The disease duration was 3-12 years (mean, 6.1 years). The degree of metatarsal adductus was assessed by Sgarlato’s measurement and Yu et al classification criteria, and the degree of metatarsal adductus was mild in 20 feet and moderate in 28 feet. Preoperative X-ray examination showed that the hallux valgus angle (HVA) was (39.4±5.6)°, the first-second intermetatarsal angle (1-2IMA) was (15.2±3.5)°, the metatarsus adductus angle (MAA) was (21.2±3.7)°. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 51.7±10.0, and visual analogue scale (VAS) score was 4.9±2.7 before operation. Postoperative complications and the union time of osteotomies were recorded. At last follow-up, the HVA, 1-2IMA, and MAA were measured on X-ray films, and the AOFAS scores and VAS scores were recorded, then compared them with preoperative ones. Roles - Maudsley score was used to investigate patients’ satisfaction. Results All the incisions healed by first intention. Thirty patients were followed up 24-27 months (mean, 26.4 months). Three patients (4 feet) occured metatarsalgia, and the pain relieved after treated by Custom-Made Orthotics. All the osteotomies were unoin, the healing time was 2-4 months (mean, 2.7 months). At last follow-up, the HVA and the 1-2IMA were (13.2±3.1)° and (5.1±2.3)°, respectively, showing significant differences when compared with preoperative ones (t=14.606, P=0.000; t=22.356, P=0.000); the MAA was (21.0±3.4)° and there was no significant difference when compared with preoperative one (t=0.789, P=0.434). The AOFAS and VAS scores were 91.8±7.5 and 1.1±1.0, respectively, showing signifiant differences when compared with preoperative ones (t=13.787, P=0.000; t=14.781, P=0.000). Satisfaction survey showed that 28 patients were very satisfied and satisfied (93.3%), and 2 cases were not satisfied (6.7%). Conclusion The short-term effectiveness of Scarf osteotomy and Akin osteotomy combined with soft tissue procedures for hallux valgus associated with mild to moderate metatarsus adductus is satisfactory, and no correction is required for metatarsal adductus.