The rotary left ventricular assist device (LVAD) has been an effective option for end-stage heart failure. However, while clinically using the LVAD, patients are often at significant risk for ventricular collapse, called suction, mainly due to higher LVAD speeds required for adequate cardiac output. Some proposed suction detection algorithms required the external implantation of sensors, which were not reliable in long-term use due to baseline drift and short lifespan. Therefore, this study presents a new suction detection system only using the LVAD intrinsic blood pump parameter (pump speed) without using any external sensor. Three feature indices are derived from the pump speed and considered as the inputs to four different classifiers to classify the pumping states as no suction or suction. The in-silico results using a combined human circulatory system and LVAD model show that the proposed method can detect ventricular suction effectively, demonstrating that it has high classification accuracy, stability, and robustness. The proposed suction detection system could be an important part in the LVAD for detecting and avoiding suction, while at the same time making the LVAD meet the cardiac output demand for the patients. It could also provide theoretical basis and technology support for designing and optimizing the control system of the LVAD.
ObjectiveTo summarize the risk factors of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury and to provide reference for the prevention and treatment of postoperative voice quality damages.MethodThe research progress of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was reviewed by reading the related literatures at home and abroad.ResultsEven if there was no obvious recurrent laryngeal nerve injury during the operation, the voice quality may change after the operation for the patients undergoing thyroidectomy. The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was associated with various risk factors such as dysfunction of superior laryngeal nerve, injury of anterior laryngeal band muscles, endotracheal intubation, surgical methods, age, gender and special occupations.ConclusionsThe change of voice quality is a common complication after thyroidectomy, which seriously affects the quality of life of patients. In the absence of significant recurrent laryngeal nerve injury, many patients will still experience problems with voice quality. Understanding the related risk factors of voice quality change after thyroidectomy is helpful to optimize postoperative voice function, to prevent possible secondary injuries, and to improve the quality of life of patients.
Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1st to December 31th, 2015 were selected in this study, including 59 with ambulatory surgery mode (the ambulatory group) and 65 with special in-hospital surgery mode (the special group). The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was (1.03±0.18) and (6.35±0.74) days, respectively, and the difference was statistically significant (P<0.05). The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8% (4/59) in the ambulatory group and 6.2% (4/65) in the special group, without significant difference (P>0.05). The satisfaction score in the ambulatory group and the special group was 96.48±0.23vs. 96.53±0.18 without significant difference (P>0.05). The differences in direct medical cost [(17 738.28±1 027.85)vs. (21 307.67±554.41) yuan], direct non-medical cost [(103.39±18.25) vs. (630.76±78.90) yuan], indirect cost[ (266.93±47.12) vs. (1 640.44±190.55) yuan], and total cost [(18 128.10±1 037.76) vs. (23 558.29±619.20) yuan] between the ambulatory group and the special group were all statistically significant (P<0.05). The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group (16 629.64) was still lower than that in the special group (20 534.91). Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.
ObjectiveTo explore and analyze the current situation of discharge readiness and delayed discharge for patients undergoing ambulatory thyroid malignancy surgery.MethodsBy convenient sampling, 284 thyroid malignancy patients who were admitted to the day surgery ward of Xiangya Hospital, Central South University from September 1st to December 30th, 2018 were selected as the research objects. The general information questionnaire and Readiness for Hospital Discharge Scale (RHDS) were used as the research tools. Descriptive statistical analysis was used to analyze the demographic statistics of the patients, and the differences of different dimension scores and total scores of RHDS were analyzed based on the basic information of patients.ResultsThe total score of RHDS was 8.66±0.60 for patients, including 6.31±0.74 for dimension of physical condition, 9.49±0.87 for dimension of disease knowledge, 9.20±0.99 for dimension of coping ability after discharge, and 9.63±0.74 for dimension of expected social support. The delayed discharge rate was 2.1%. There was no significant difference in the scores of different dimensions or total scores in RHDS of patients undergoing ambulatory thyroid malignancy surgery with different gender, age, education level or whether there was a special person to take care of them (P>0.05). There were differences between patients with delayed discharge and the ones without delayed discharge in the three dimensions namely physical condition, disease knowledge, and coping ability, as well as the total scores (P<0.05), while there was no statistically significant difference in the scores of expected social support dimension (P>0.05).ConclusionsThe discharge readiness for patients undergoing ambulatory thyroid malignancy surgery is good. The medical staff should provide health intervention measures according to the specific situation of patients, so as to improve the quality of discharge guidance, and ensure the safety of patients.
The subpulmonary ventricular exclusion (Fontan) could effectively improve the living quality for the children patients with a functional single ventricle in clinical. However, postoperative Fontan circulation failure can easily occur, causing obvious limitations while clinically implementing Fontan. The cavopulmonary assist devices (CPAD) is currently an effective means to solve such limitations. Therefore, in this paper the in-silico and in-vitro experiment coupled model of Fontan circulation failure for the children patients with a single ventricle and CPAD is established to evaluate the effects of CPAD on the Fontan circulation failure. Then a sensorless feedback control algorithm is proposed to provide sufficient cardiac output and prevent vena caval suction due to CPAD constant pump speed. Based on the CPAD pump speed-an intrinsic parameter, the sensorless feedback control algorithm could accurately estimate the cavopulmonary pressure head (CPPH) using extended Kalman filter, eliminating the disadvantage for pressure sensors that cannot be used in long term. And a gain-scheduled, proportional integral (PI) controller is used to make the actual CPPH approach to the reference value. Results show that the CPAD could effectively increase physiological perfusion for the children patients and reduce the workload of a single ventricle, and the sensorless feedback control algorithm can effectively guarantee cardiac output and prevent suction. This study can provide theoretical basis and technical support for the design and optimization of CPAD, and has potential clinical application value.
Objective To evaluate the disease burden of acne vulgaris in China from 1990 to 2019 and to provide references for the prevention and control of acne vulgaris in China. MethodsThe quantity of incidences/illnesses, age-standardized incidence/prevalence rates, disability-adjusted life years (DALYs), and DALY rate of acne vulgaris in China from 1990 to 2019 which were derived from the Global Burden of Disease (GBD) 2019 were evaluated. The epidemiological trends, age-birth-cohort trends, and the relationship between the incidence and sociodemographic index (SDI) were also analyzed. Results In 2019, the prevalence and incidence of acne vulgaris in China were higher than the global average. The quantity of patients was slightly higher in 2019 than that in 1990 (3.91%), and the prevalence, incidence, and DALY rate showed a continuous growth trend. The incidence of acne vulgaris peaked at 10 to 14 years old. Acne vulgaris mostly affected young males, and its prevalence peaked at approximately 15 to 19 years old. With these two age groups as the boundary, there was a trend of the prevalence of acne vulgaris increasing initially and then decreasing. Obvious gender differences existed for acne vulgaris diagnoses, and most of the above indicators were shown at a higher level in females than in males. The age period cohort analysis showed that the incidence rate of acne vulgaris in China from 1990 to 2019 was significantly different from the net drift, age effect, period effect and cohort effect. As the SDI value increased, the incidence of acne vulgaris showed a linear growth trend. Conclusions From 1990 to 2019, the burden of acne disease in China increases significantly.
Objective To investigate the spectrum of diseases and the current situation of antibiotic use in rural hospitals and community health service centers in Chengdu, so as to provide evidence for selecting essential medicines and promoting rational use of antibiotics. Method We selected 7 township/community health institutions, from which we collected inpatient and outpatient information. Information about antibiotic use was also collected, including categories, cost, and dosage. A standard questionnaire was used to investigate physicians’ prescription behavior for principal diseases. Result Urban and rural areas had different spectrums of diseases. The major diseases in urban areas included diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and respiratory tract infection; while those in rural areas were infectious diseases of the respiratory system, digestive system, and urinary system. The physicians’ prescription behavior was mainly based on their personal experience. Antibiotics accounted for 30-50% of the total medicine cost. The top four types of antibiotics with the highest cost were cephalosporins, penicillin, quinolones, and macrolides. Conclusion Based on the different spectrums of diseases, essential drug lists and standard treatment guidelines appropriate for rural health care should be developed to improve the rational use of drugs. Factors such as the average cost of daily dose and the course of treatment should be taken into consideration to reduce the overall cost of medicine. An antimicrobial resistance monitoring system and special training courses on rational use of antibiotics should be utilized in the rural health institutions.