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The authors discussed the meaning of smart hospital and the importance of Internet, cloud computing, supercomputer and other related technologies on the construction of smart hospital, summarized the construction status of smart hospital in China, and pointed out the problems such as lack of long-term planning for information construction, obvious island effect of information system, insufficient data processing capacity, and slow development of intelligent medical care. Based on the construction practice of smart hospital in Beijing Tiantan Hospital, the authors believe that the innovation and application of artificial intelligence technology will support intelligent medical treatment, supercomputer will become the standard configuration of high-level smart hospitals, and hospital infrastructure will affect the level of smart hospitals.
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Objective:To compare the incidence of intraoperative neurological complications during correction surgery of spinal deformities in patients with or without rotatory subluxation (RS), and to analyze the correlation between RS and intraoperative neurological complications.Methods:From January 2012 to August 2017, a total of 37 patients with RS undergoing correction surgery, whom was excluded with preoperative spinal traction or three-column osteotomy during operation were retrospectively reviewedin our hospital. Thirty-seven patients without RS undergoing correction surgery were included asthe control group. The radiographic parameters included Cobb angle of main curve, coronal trunk balance (CTB) which was the distance between C 7 plumb line and center sacral vertical line, global kyphosis (GK), sagittal vertical axis (SVA), RS at coronal plane (CRS), RS at sagittal plane (SRS) and axial rotation (AR). The abnormal intraoperative neurophysiological monitoring events and positive wake-up test were recorded. Results:The mean age was 42.4±17.9 years (12-74 years) in the RS group and 42.7±18.3 years (12-74 years) in the control group( t=0.0713, P=0.943). The mean preoperative Cobb angle of main curve, CTB, GK, and SVA was 75.4°±29.7°, 38.4±28.4 mm, 52.8°±25.2°, and 40.3±36.8 mm respectively in the RS group, which was 75.1°±27.6°( t=0.045, P=0.964), 34.8±24.4 mm( t=0.584, P=0.560), 49.8°±22.5°( t=0.540, P=0.591), and 38.7±25.3 mm ( t=0.219, P=0.828) respectively in the control group. There was no significant difference between the two groups among the above preoperative index. Significant improvements in Cobb angle of main curve, CTB, GK, SVA,CRS, SRS and ARA were found between preoperation and postoperation ( P<0.05 for all), while no significant correction loss was observed during follow-up ( P>0.05 for all). There were 6 patients (16.2%) in the RS group and 4 patients (10.8%) in the control group with preoperative neurological deficit of Frankel grade D ( F=0.463, P=0.496). The abnormal intraoperative neurophysiological monitoring events were observed in 5 patients (13.5%) of the RS group and 1 patient (2.7%) of the control group ( F=2.902, P=0.088). Positive wake-up test was found in 2 patients of RS group (5.4%) ( F=2.056, P=0.493). Conclusion:Patients with RS had higher risks of preoperative neurological deficit, abnormal intraoperative neurophysiological monitoring events and deteriorative neurological deficit at postoperation. The RS at preoperation may be a risk factor for intraoperative neurological deficit.
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Objective@#To evaluate the efficiency of preoperative Halo-gravity traction (HGT) in the treatment of severe kyphoscoliosis secondary to neurofibromatosis type Ⅰ (NF1).@*Methods@#A retrospective review was conducted on patients with severe kyphoscoliosis secondary to NF1 at Department of Spinal Surgery, Drum Tower Hospital, Medical School of Nanjing University between July 2007 and May 2016. A total of 29 patients including 17 males and 12 females were finally enrolled and the age was (13.7±2.9) years. The Cobb angle of major coronal curve and global kyphosis were measured before and after HGT. The forced vital capacity (FVC)and forced expiratory volume in 1 second (FEV1) before and after traction were also recorded. The paired t test was used for comparison analysis.@*Results@#The average maximum traction weight of HGT was (12.2±2.8) kg and the traction duration was (10.2±6.6) weeks. The coronal Cobb angle before HGT was (87.5±36.5)°, which improved to (68.4±25.9)° after HGT with a correction rate of (21.9±12.1)% (t=9.14, P<0.001); the average global kyphosis before HGT was (79.1±27.1)°, which improved to (59.9±19.4)° after HGT and the correction rate was (20.2±14.1)% (t=8.55, P<0.001). One patient had transient brachial plexus palsy which resolved completely after reducing the traction weight. After HGT treatment, FVC increased from (0.83±0.16) L to (0.89±0.19) L (t=1.48, P=0.12) and FEV1 increased from (0.72±0.16) L to (0.78±0.20) L (t=0.49,P=0.63). FVC predicted and FEV1 predicted improved from (42.9±20.1)% and (40.6±19.6)% to (46.9±20.5)% (t=0.98,P=0.33) and (43.6±25.8)% (t=1.24,P=0.22), respectively.@*Conclusion@#Preoperative HGT in the treatment of severe kyphoscoliosis secondary to NF1 can improve spinal deformity and pulmonary function to some extent, which can further benefit the patients by improving their surgical tolerance.
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The application of 3D printing technology in medicine may greatly affect the surgical methods of spinal surgery.Currently,3D printing technology has been applied to preoperative and intraoperative.Before surgery,3D printing can be used to create precise anatomical models of spinal deformities.In addition,these anatomical models can be used to plan and simulate complex spinal lesions.3D printed anatomical models can provide better understanding of anatomy than CT or MRI.During surgery,3D printing has been used to create surgical guidance systems,create templates and customize specific shapes of implants.Although 3D printing technology still faces the challenge of expensive equipment and materials,this technology has many advantages such as improving patient prognosis and reducing the radiation dose of patients.This article mainly introduces the clinical application and future development of 3D printing technology in spine surgery.
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Objective@#To evaluate the radiographic and clinical outcomes of Scoliosis Research Society(SRS)-Schwab Grade IV osteotomy in type I congenital kyphosis.@*Methods@#All of 28 patients with type I congenital kyphosis who underwent SRS-Schwab Grade 4 osteotomy from June 2015 to June 2017 were retrospectively reviewed,including 21 males and 7 females aged 10 to 28 years old, with an average of 13.6±8.5 years. On standing wholespinal X-rays at pre-operation, post-operation and each follow-up, global kyphosis(GK), thoracic kyphosis(TK), lumbar lordosis(LL) and sagittal vertical axis(SVA) were measured. The intra-operative and post-operative complications were recorded for each patient. The Scoliosis Research Society-22 questionnaires(SRS-22) and visual analog scale(VAS) for back pain were collected from patients elder than 12 years old at pre-operation and last follow-up. The comparison analysiswasperformed by paired samples t test.@*Results@#At pre-operation, the GK, TK, LL and SVA were 47.0°±4.9°, 16.8°±3.7°, 36.6°±7.7°, (-31.9±13.6) mm, respectively. At 3 months post-operation, the average values improved to 3.7°±2.3°, 36.8°±4.0°, 46.5°±4.4°, 4.0±19.1 mm, respectively. Significant differences were found in all parametersbetween pre- and post-operation. The post-operative follow-up was 12 to 24 months, with an average of 13.2±5.2 months. At the last follow-up, the GK, TK, LL and SVA were 4.0°±2.4°, 38.0°±6.0°, 45.9°±5.4°, 7.6±15.3 mm, and no significant correction loss was found during follow-up. The scores of each domain of SRS-22 questionnaire improved at different level during follow-up, of which the improvement in self-imagewas statistically significant (P<0.001). The scores of VAS for back pain improved significantly after operation (P<0.001). One patient hadabnormal intra-operative monitoringwhile no neurological defectwas detected at post-opera tion. Proximal junctional kyphosis occurred in 2 patients at 3 months follow-up while no patients needed revision surgery. There wereno implant-related complicationsduring follow-up.@*Conclusion@#The SRS-Schwab Grade 4 osteotomycould provide satisfying correction with relatively low rates of complications in type I congenital kyphosis. Thus, the SRS-Schwab Grade IV osteotomy is a safe strategy for type I congenital kyphosis.
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Objective@#To illustrate the surgical strategy of sequential correction in degenerative lumbar scoliosis (DLS) with type C coronal imbalance, and to evaluate the clinical outcomes and advances of sequential correction technique.@*Methods@#Twelve patients (2 males and 10 females) applying sequential correction technique from January 2015 to August 2017 were retrospectively reviewed. The ages of the cohort ranged 48-74 years and the average value was 52.3±8.4 years. The sequential correction technique was mainly applied in 3 steps: correction of local kyphoscoliosis with satellite rod on convex side of lumbar spine; correction of lumbosacral curve with L 4-S1 Intervertebral fusion and satellite rod on convex side of lumbosacral spine; correction of global deformity with bilateral long rods. The coronal parameters including Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL), and the sagittal parameters including global kyphosis (GK) and sagittal vertical axis (SVA) were assessed at pre-operation, post-operationand last follow-up. The quality of life was evaluated using SF-36 questionnaire, and paired t test was used for the statistical analysis.@*Results@#The average follow-up period was 16.7±4.8 months. The Cobb angles at pre-operation and post-operation were 59.6°±18.7° and 25.6°±12.4° (t=3.705, P<0.001), respectively. At last follow-up, the average Cobb angle was 27.5°±13.0°, and there was no significant loss of correction (t=0.366, P=0.718). Post-operative C7PL-CSVL changed from 48.5±17.2 mm to 9.7±4.3 mm (t=5.842, P<0.001), of which the average value was 10.1±4.5 mm at last follow-up (t=0.223, P=0.826). At post-operation, 11 patients were with type A coronal imbalance, and 1 patient was still with type C coronal imbalance. The scores of bodily pain, general health, and social functioning were 8.4±1.9, 78.1±9.4 and 76.7±8.4 at pre-operation, 10.2±2.0 (t=2.260, P=0.034) , 89.5±7.6 (t=3.267, P=0.004) and 84.5±9.3 (t=2.156, P=0.042) at post-operation. In addition, there was no implant-related complications during follow-up.@*Conclusion@#The sequential correction technique could be well used in adult degenerative lumbar scoliosis patients with type C coronal imbalance, which can simplify the surgical procedure, decrease the rates of post-operative coronal imbalance, and obtain rigid internal fixation.
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The application of 3D printing technology in medicine may greatly affect the surgical methods of spinal surgery. Currently, 3D printing technology has been applied to preoperative and intraoperative. Before surgery, 3D printing can be used to create precise anatomical models of spinal deformities. In addition, these anatomical models can be used to plan and simulate complex spinal lesions. 3D printed anatomical models can provide better understanding of anatomy than CT or MRI. During surgery, 3D printing has been used to create surgical guidance systems, create templates and customize specific shapes of implants. Although 3D printing technology still faces the challenge of expensive equipment and materials, this technology has many advantages such as improving patient prognosis and reducing the radiation dose of patients. This article mainly introduces the clinical application and future development of 3D printing technology in spine surgery.
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OBJECTIVE@#To establish a novel method to isolate endothelial progenitor cells（EPC） from cryopreserved umbilical cord blood (cryoUCB), to investigate the biological characteristics of EPC and to improve the rate of EPC obtained from cryoUCB.@*METHODS@#Twelve cryoUCB samples during 2000 to 2001 years were collected from allogeneic cord blood bank, cryoUCB was thawed rapidly in a water bath at 37 ℃, total nucleated cells (TNCs) were washed by phosphate-buffered saline (PBS). TNCs were seeded onto fibronectin-coated dishes to isolate EPC. Flow cytometry and immunofluorescence were used to identify EPC. The function of EPC was identified in vitro, such as the incorporation of Dil-Ac-LDL and FITC-UEA-I, the formation of capillary-like structure in matrigel, and the release of VEGF by ELISA.@*RESULTS@#One to five cluster of cobble stone-like cells appeared at 2-3 weeks after seeding. Flow cytometric analysis showed that positive rates of CD31, CD34, CD144, and VEGFR (CD309) were（92.91±5.20）%, （30.0±23.27）%, （88.55±3.83）% and （67.21±12.12）% in passage 1 to passage 3 of EPC. EPC could uptake Dil-Ac-LDL and FITC-UEA-I, form capillary-like network on Matriget and release VEGF.@*CONCLUSION@#EPC had been successfully isolated from cryopreserved umbilical cord blood by this method with high stability and reproducibility. EPC can be obtained in 85% frozen umbilical cord blood. This method may lay a foundation to supply abundant EPC for clinical application.
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Cell Differentiation , Cells, Cultured , Endothelial Progenitor Cells , Fetal Blood , Reproducibility of Results , Stem CellsABSTRACT
Objective To investigate the incidence and risk factors for rod fracture after correction surgery with satellite rod in severe spinal deformity.Methods A retrospective analysis was made including 234 cases who underwent correction surgery using satellite rod technique for severe spinal deformity in our hospital from July 2012 to June 2017.At the last follow-up,a total of 6 patients were found to have rod fracture.All the patients had complete clinical and imaging data at the time of preoperation,postoperation,rod fracture occurring,post-revision and the last follow-up.The Cobb angle,the Global kyphosis (GK),the coronal balance (distance between C7 plumb line and center sacral vertical line,C7PL-CSVL) and the sagittal vertical axis (SVA) were measured respectively in the 6 patients with rod fracture during the follow-up process.The time,incidence and position of the broken rod were recorded,and the reasons of rod fracture were analyzed for each patient.Results The incidence of rod fracture was 2.6％ (6/234) in the current study.The 6 patients included 3 males and 3 females with an average age of 34.5±15.4 years at initial surgery.The mean time of rod fracture was 24.0±17.7 months,of which 3 cases (50％) occurred within 1 years after operation.A total of 7 rods were broken,including 4 (57％) rods located at the single-rod-fixed side with stress concentration and 3 (50％) rods at the adjacent segment of the satellite rod.The average loss of correction was 20.8°±29.4° for Cobb angle and 34.0°±21.4° for GK.The potential reasons for rod fracture were listed as follows:3 cases for residual kyphosis;2 cases for pseudarthrosis;3 cases for long fusion construct crossing lumbosacral junction;1 case for trauma.Of the 6 patients with rod fracture,3 (43％) patients underwent revision surgery by replacing the broken rods,adding satellite rod at the opposite side of pre-existing satellite rod and bone graft at the rod-breakage area.The other 3 patients underwent observation and no deterioration was found during follow-up.Conclusion The incidence of rod fracture after correction for severe spinal deformity with satellite rod is 2.6％.The broken rods are mainly located at the single-rod-fixed side with stress concentration or the adjacent segment of the satellite rod.Residual kyphosis,pseudarthrosis,long fusion construct crossing lumbosacral junction and trauma are the significant risk factors of rod fracture.
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Objective To explore the clinical effect of 3D printing in vitro modeling for minimally invasive treatment of complex pelvic fractures.Methods From April 2016 to June 2017, 18 cases of complex pelvic fractures were treated by 3D printing in vitro modeling were selected.The operation time and intraoperative bleeding volume were recorded.Fracture reduction was evaluated by X-ray, CT and Matta scores, and functional recovery was assessed by Majeed score.Results All 18 patients were followed up for 12 to 24 months, with an average of 15.8 months.The operation time of 18 patients was 80～160 minutes, with an average of (120±23.1) minutes;the amount of bleeding was75～160 m L, with an average of (113.6±29.1) m L;the length of incision was 7～14 cm, with an average of (9.3±1.8) cm.According to the Matta score, the fracture reduction was excellent in 12 cases, good in 4 cases, fair in 2 cases, the excellent and good rate was 88.9％.Majeed score was used to evaluate functional recovery 6 months after operation, the results showed that 13 cases were excellent, 4 cases were good and 1 case was fair, the excellent and good rate was 94.4％.No complications such as internal fixation loosening or breakage occurred during the follow-up period.Conclusion For complex pelvic fractures, 3D printing in vitro modeling assisted minimally invasive surgery can make the operation more precision with less trauma, reduce the incidence of complications, and speed up the recovery of patients.
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Objective To investigate the fall efficacy of elderly people in nursing homes and its influencing factors. Methods A total of 174 elderly people in 8 nursing homes in Fujian province were recruited by convenience sampling method. They were investigated with a self-designed questionnaire about the demographic data, the Modified Falls Efficacy Scale (MFES) and the Kessler Psychological Distress Scale (K10). Results The mean score of fall efficacy was 7.81±1.15, which revealed a middle level. The score of get dressed and undressed scored 9.04 ±1.42, which was the highest, while the score of using public transport scored 5.80 ±3.21, which was the lowest. Multiple regression analysis showed that the mental health status, degree of self care, age were influencing factors of fall efficacy of elderly people. Conclusions The fall efficacy level of 174 elderly people is at medium level, which is different among fall efficacy with mental health status, degree of self care, age. Individualized interventions should be designed and provided for them.
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<p><b>OBJECTIVE</b>This study was to expand the cytotoxic T lymphocytes (CTL) through inducing the differentiation of umbilical blood monomuclear cells (UBMNC) by using various combination of cytokines, and to investigate the functions of expanded CTL.</p><p><b>METHODS</b>The MNC were isolated by ficoll density gradient centrifugation. Then, the PHA-P, IFN-γ combined with IL-2, IL-15 and other cytokines were used for induction and expansion of the cord blood-derived CTL. The biological function of CTL was examined by phenotype analysis, cytotoxic tests and real-time fluorescence quantitative PCR.</p><p><b>RESULTS</b>After expansion for 15 days, the cell number increased by 1522% ± 137%. The content of CD3(-)CD8(-) cells in uncultured cord blood MNC was 95%, and the CD3(+)CD8(+) CTL cells reached 82.77% in cultured cord blood MNC after expansion for 15 days. The expanded CTL cell showed the cytotoxic activity against K562 and HeLa cell line. The killing rate of MNC was 61.88 ± 1.08%. After expansion, the killing rate could reach to 90% with the average value of 90.33 ± 2.02%. The expanded CTL cells highly expressed some key cytokines, such as granzyme A, granzyme B, GM-CSF, granulysin, IFN-γ, TGF-β, TNF-α and perforin. Compared with the control group, the expression of IFN-γ and TGF-β significantly increased (P < 0.05), and the other factors dramatically increased (P < 0.01).</p><p><b>CONCLUSION</b>The cord blood-derived CTL can be expanded by different combinations of cytokines. These protocols may provide alternative choices for CTL cell expansion in tumor adoptive immunotherapy.</p>
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Humans , Cytokines , Fetal Blood , Granulocyte-Macrophage Colony-Stimulating Factor , Granzymes , Histocompatibility Antigens Class I , Histocompatibility Antigens Class II , Immunotherapy, Adoptive , Perforin , Phytohemagglutinins , T-Lymphocytes, CytotoxicABSTRACT
Objective To investigate that the relationship of serum concentration of copeptin ,procalcitonin(PCT )and early diagnosis ,prognosis in patients with cerebral hemorrhage‐associated pulmonary infection .Methods One hundred and twenty pa‐tients with acute cerebral hemorrhage ,acute cerebral hemorrhage‐associated pulmonary infection and 60 healthy individuals (the control group) admitted in our hospital from January 2012 to December 2013 were selected and detected for serum copeptin and procalcitonin .The differences of serum copeptin ,procalcitonin levels were compared in controls ,in patients with cerebral hemor‐rhage and cerebral hemorrhage‐associated pulmonary infection and their correlation was analyzed .Results The levels of serum copeptin in the cerebral hemorrhage‐associated pulmonary infection were significantly higher than that in control group and the cer‐ebral hemorrhage (P<0 .05) .The levels of serum procalcitonin in control group and the cerebral hemorrhage were significantly lower than that in the cerebral hemorrhage‐associated pulmonary infection ,the levels of serum C‐reactive protein ,copeptin ,procalci‐tonin and the APACHEⅡ scores of the patients with survival group were significantly lower than those with non‐survival group (P<0 .05) .Conclusion The levels of serum copeptin and procalcitonin are correlated intimately with cerebral hemorrhage‐associat‐ed pulmonary infection .They are important clinical parameters to reflect the early diagnosis and prognosis of cerebral hemorrhage‐associated pulmonary infection .
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Objective To investigate the relationship of plasma concentration of NT-proBNP,copeptin and glasgow coma scale(GCS)scores,hematoma volumes in patients with acute cerebral hemorrhage.Methods 109 patients with acute cerebral hem-orrhage(the cerebral hemorrhage group)and 32 healthy individuals (the control group)admitted in our hospital from December 2011 to June 2013 were selected and detected for plasma NT-proBNP and copeptin.The levels of NT-proBNP,copeptin,glasgow co-ma scale(GCS)scores and hematoma volumes were compared between the two groups.Results The levels of plasma NT-proBNP and copeptin in the cerebral hemorrhage group were significantly higher than that in control group(P <0.05).The levels of plasma NT-proBNP and copeptin were significantly increased with the severity and the hematoma volume of the acute cerebral hemorrhage. The levels of NT-proBNP and copeptin are positively correlated with hematoma volumes(r=0.63,r=0.58,P <0.01)and negative-ly correlated with Glasgow Coma Scale(GCS)scores(r=-0.52,r=-0.46,P <0.01).Conclusion The levels of NT-proBNP and copeptin are positively correlated with hematoma volumes and negatively correlated with glasgow coma scale(GCS)scores.They are important clinical parameters to reflect the severity and hematoma volumes of the acute cerebral hemorrhage.
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This study was objective to explore the effect of IFN-γ on immunosuppressive capability of mesenchymal stem cells (MSC) derived from umbilical cord. The immunomodulating capability of MSC was changed by stimulating cell surface receptors like Toll-like receptors (TLR). The inhibition of T-lymphocyte proliferation by MSC was tested via cell co-cultures. Further RT-PCR and ELISA were performed to examine the expression changes in gene and protein level. The results showed that the IFN-γ could promote the immunosuppressive effect of umbilical cord derived MSC. IFN-γ-stimulated MSC could suppress the proliferation of T cells more effectively. IFN-γ stimulation up-regulated the expression of immunosuppressive genes like IDO1, COX2, HLA-G, and soluble suppressive proteins such as HLA-G, KYN, IL10, PGE2 of MSC. And the immuno suppression capability of IFN-γ-stimulated MSC was 2-7 folds higher than control in MSC and lymphocyte co-culture tests. It is concluded that IFN-γ can effectively enhance the immunosuppressive capability of MSC.
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Humans , Cells, Cultured , Immunosuppression Therapy , Interferon-gamma , Pharmacology , Mesenchymal Stem Cells , Cell Biology , Allergy and Immunology , Umbilical Cord , Cell BiologyABSTRACT
Objective To compare the differences between college students and undergraduate students in terms of the evaluation of demonstration experimental teaching and analyze the influencing factors.Methods A questionnaire survey was conducted among 272 college students and 344 undergraduate students doing experimental study.Both stratified sampling and convenience sampling methods were used.Results The results showed that compared to the undergraduate students,the total score level of the evaluation,the teaching way,the teaching effect and the comprehensive evaluation of the college students was much lower.However,there were no significant differences between them in the evaluation of curriculum.Conclusions A few corresponding measures should be adopted by nursing schools and teachers to improve the quality of nursing experimental teaching.
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Objective To evaluate the quality of life and care needs of hospitalized AIDS patients and analyze the relationship between them to provide basis for clinic nurses' helping patients to improve the quality of life. Methods We adopted the general information questionnaire, patient care needs assessment questionnaire, as well as the World Health Organization Quality of life Scale (WHOQOL)and used cluster sampling method to make face to face interviews with 36 hospitalized AIDS patients. Results The care needs of the 36 AIDS patients were at a high level,all areas of quality of life were lower than the norm. The quality of life of hospitalized AIDS patients was negatively correlated with the care needs. Conclusions Clinic nursing staffs should understand and assess the care needs of patients initiatively and take appropriate measures to improve quality of life of hospitalized AIDS patients.
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Objective To investigate the clinical characteristics of the wounded in Wenchuan earthquake transported to our hospital and summarize therapeutic experiences. Methods Clinical data of 92 patients resulted from Wenchuan earthquake admitted into our hospital were reviewed and analyzed in aspects of general data,injury severity,therapeutic methods and clinical results. Results All pa-tients were free from infection,reamputation and fracture-related complication. Conclusion After the arrival of large number of the wounded in the station hospitals.efficient organization of station hospitals,comprehensive evaluation of the patients'condition,effective detailed therapeutic plans and careful man-agement of the medical complications can attain sound results.