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Bone defects caused by trauma, tumour resection, infection and congenital deformities, together with articular cartilage defects and cartilage-subchondral bone complex defects caused by trauma and degenerative diseases, remain great challenges for clinicians. Novel strategies utilising cell sheet technology to enhance bone and cartilage regeneration are being developed. The cell sheet technology has shown great clinical potential in regenerative medicine due to its effective preservation of cell-cell connections and extracellular matrix and its scaffold-free nature. This review will first introduce several widely used cell sheet preparation systems, including traditional approaches and recent improvements, as well as their advantages and shortcomings. Recent advances in utilising cell sheet technology to regenerate bone or cartilage defects and bone-cartilage complex defects will be reviewed. The key challenges and future research directions for the application of cell sheet technology in bone and cartilage regeneration will also be discussed.
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Bone Regeneration , Bone and Bones , Cartilage, Articular , Regeneration , Tissue Engineering , Tissue ScaffoldsABSTRACT
Objective To compare simulated training of "45° tilting insertion" and the "dynamic scan" needling under B ultrasound.Methods Fifty volunteer residents and visiting physicians worked in the anesthesiology department in Peking Union Medical College Hospital were recruited to attend the simulated needling training.The insertion time,insertion attempts until success,numbers of success while advancing the needle and numbers of needle tip visible upon success were re corded.The degree of difficulty and safety of the techniques,the confidence of performing the techniques,the clinical usefulness of the techniques and the training effect were evaluated among the volunteers.Results There were no differences in the insertion time,numbers of successful insertion while advancing the needle and numbers of needle tip visible upon success between the two techniques.Compared with "45° tilting insertion" technique,"dynamic scan" resulted in less needle redirection times and a higher first-attempt successful rate,and got higher scores in terms of difficulty and safety (P＜0.05 or P＜0.01).The confidence scores of performing the two technique were similar.20 (40％) volunteers chose to use "dynamic scan",8 (16％) chose to use "45° tilting insertion" and 22 (440％) chose to use both technique in their clinical work.100％ of them considered the training was greatly helpful or helpful.Conclusion The technique of "dynamic scan" produced a higher first-attempt successful rate and was easier and safer than "45° angle insertion".The combination of the two techniques might be a new technique that is worth trying.
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Objective To summarize experience and characteristics of the perioperative anesthetic management of patients with active infective endocarditis (AIE) undergoing cardiac valve surgery under cardiopulmonary bypass (CPB).Methods A total of 117 patients of both sexes,aged 18-70 yr,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,undergoing cardiac valve surgery under CPB from January 2014 to June 2015 in Peking Union Medical College Hospital,were enrolled in the study and divided into AIE group (n =57) and non-AIE group (n =60).Anesthesia was induced by Ⅳ injection of midazolam 1-2 mg,etomidate 0.15-0.30 mg/kg,sufentanil 0.3-0.5 μg/kg and rocuronium 0.6-1.0 mg/kg.After orotracheal intubation,the patients underwent high-frequency volume-controlled ventilation with low tidal volume,and positive end-expiratory pressure was increased appropriately.Esophageal echocardiography was used for evaluation.Anesthesia was maintained by inhalation of 1.0％-1.5％ sevoflurane,intermittent Ⅳ boluses of sufentanil 0.2-0.3 μg/kg and Ⅳ infusion of piperium bromide 2 mg/h,and the bispectral index value was maintained between 40-60 during surgeDy.Sensitive antibiotics were given during surgery according to the results of preoperative blood culture in AIE group.The following data were collected:baseline patient characteristics,preoperative blood routine,erythrocyte sedimentation rate,concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide,operation time,CPB time,intraoperative consumption of vasoactive drugs,fluid intake and output,use of antibiotics,length of postoperative intensive care unit stay,extubation time,new invasive operation (intra-aortic balloon counterpulsation was performed),time for use of vasoactive drugs,postoperative 24 h drainage,length of hosptial stay,serious complications (postoperative bleeding,pericardial tamponade,severe arrhythmia,heart failure,acute lung injury,renal failure and other organ function failure,etc.) and development of death.Results Compared with non-AIE group,age,body mass index and preoperative Hb,Hct,systolic blood pressure and diastolic blood pressure were significantly decreased,the rate of preoperative hypertension,neutrophil count,erythrocyte sedimentation rate,concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide,body temperature and heart rate were increased,the intraoperative volume of allogeneic blood transfused and consumption of norepinephrine,phenylephrine and ephedrine after CPB were increased,the time for postoperative use of vasoactive drugs,extubation time and length of postoperative intensive care unit stay were shortened,and the length of hospital stay was prolonged in AIE group (P＜0.05).Conclusion For the patients with AIE undergoing cardiac valve surgery under CPB,comprehensive evaluation should be performed and heart failure be corrected actively before surgery;esophageal echocardiography should be used for evaluation,the application of vasoactive drugs could be increased appropriately and anesthetists should pay attention to respiratory management during surgery;cardiotonic and anti-shock therapy should be maintained,arrhythmia prevented and anti-infective therapy strengthened after surgery.
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Objective To investigate the resident performance on preoperative anesthetist visit in Beijing hospitals,thereby providing introduction for further training.Methods A self-designed questionnaire was distributed among the anesthesia residents who were receiving anesthesia residency training in Beijing through WeChat.The questionnaire covers geographic data of the residents,information on preoperative visit and existing training program.Results160 questionnaires were reclaimed.History-taking and physical examination were not comprehensive in many residents,the nature of surgery was not evaluated by most residents.The capacity of risk assessment and risk informing were not competent in many residents.The most desired training methods for preoperative visit were scenario simulation and bedside observation.Conclusions Scenario simulation with standard patient may have a promising prospect in preoperative anesthetist visit training.
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Objective To understand the content of discharge guidance for lung cancer patients ,and to provide evidence for improving the quality of lung cancer .Methods Using convenient sampling method ,a sample of 212 patients with lung cancer in the Department of Thoracic Oncology ,a third‐class hospital in Sichuan province was surveyed by general data questionnaire and dis‐charge guidance quality questionnaire .Results The total discharge guidance quality was (195 .93 ± 39 .98) points and was at a high level .The score of discharge guidance requirement(48 .69 ± 11 .51) was higher than that of discharge instruction (47 .35 ± 11 .34) , the difference was statistically significant(P<0 .05) .There was significant difference in the scores of different age ,educational lev‐el ,living style and the patients with central venous catheter (PICC/CVC) ,the difference was statistically significant (P<0 .05) . Conclusion Patients with lung cancer were discharged from the hospital with a higher level of guidance ,and the content of dis‐charge guidance from patients with lung cancer was far from meeting the requirements .It should be based on the age ,education and living style of patients with lung cancer ,especially for strengthening the guidance of discharged patients with PICC/CVC ,improving the quality of discharge guidance and promoting the rehabilitation of lung cancer patients .
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Objective:To investigate the expression of AEG-1 gene in NSCLC and its clinical significance. Methods:Selected our hospital cardiothoracic surgical resection of 83 cases of postoperative cancer tissues of NSCLC patients and 20 paracancer to study, immunohistochemical staining was used to detect the expression level of AEG-1 protein in two groups,the clinical and pathological of AEG-1 protein in patients with NSCLC was analyzed. Results:NSCLC tissues AEG-1 protein expression 46 cases ( 55. 42%) was sig-nificantly higher than 2 cases ( 10. 00%) of paracancer ( P0. 05 ) . AEG-1 high expression of NSCLC in patients with a median survival time of 15. 0 months was significantly lower than that of 19. 0 months (log-rankχ2=4. 119 P<0. 05,) in patients with low expression of AEG-1. Conclusion:AEG-1 gene expression has been up-regulated in NSCLC tissue,which was related to the clinical stage and distant metastasis of the patients.
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Objective To investigate the relationship of single nucleotide polymorphism (4G/5G) in the promoter of plasminogen activator inhibitor-1 (PAI-1) and plasma PAI-1 level with gastrointestinal bleeding in Henoch-Sch?nlein purpura (HSP). Methods A total of 524 children with HSP in acute phase were recruited, and divided into gastrointestinal bleeding group (bleeding group, n?=?186) and non-gastrointestinal bleeding group (control group, n?=?338). The genotype frequency of 4G/5G polymorphism, the plasma PAI-1 level, and other parameters related to coagulation and ifbrinolysis were measured and compared between two groups. Results The levels of platelet count (PLT), platelet distribution width (PDW), serum D dimer (DD), serum PAI-1 were signiifcantly higher in the bleeding group than those in the control group, and the levels of mean platelet volume (MPV) and plasma ifbronectin protein of ifbrinogen (FIB) were signiifcantly lower in the bleeding group than those in the control group (P?
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Objective:To study the impact factors of psychological distress in patients with first diag-nosed lung cancer.Methods:The cross-sectional study was applied to newly diagnosed lung cancer pa-tients who received treatments in Cancer Center of West China Hospital of Sichuan University in Chengdu from June 201 3 to March 201 5 by distributed questionnaires.The general information of the patients,the hospital anxiety and depression scale (HADS)and distress management screening measure (DMSM) were included in the questionnaire to evaluate the states of distress,pain and the factors related to the distress of the patients.Results:The survey investigated a total of 390 patients with first diagnosed lung cancer,including 291 male patients and 99 female patients.The proportion of the patients with positive anxiety symptom was 26.7% (1 04 /390),with positive depression symptom was 27.7% (1 08 /390), and with positive distress symptom was 30.0% (1 1 7 /390).On the top five problem list of DMSMwere worry,disease treatment,breathing,pain and sleep.The Spearman correlation analysis showed that an-xiety score,depression score,and the pain intensity were positively correlated with the distress.Multiple linear regression analysis showed that gender (β=-0.209,P =0.003),age (β=-0.098,P =0.042),chronic disease (β=0.378,P <0.001 ),and pain score (β=0.1 00,P =0.029)could affect the distress of the patients.Smoking (β=0.1 1 1 ,P =0.041 )could affect the anxiety of newly diagnosed lung cancer patients.Conclusion:The gender,age,chronic disease and pain score of the patients are the independent factors of the psychological distress of first diagnosed lung cancer patients.Smoking is the predictive factors of the patients with anxiety.Controlling the pain intensity and the clinical process of chronic disease of the patients actively,solving the sleep and breathing problem and helping the patients to quit smoking progressively could alleviate the psychological distress of the patients.
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Objective To explore the effect of cognitive behavioral intervention on quality of life and distress of cancer patients. Methods The research was a random control study, and computer randomized grouping, the experimental group and control group contained 64 cases, 66 cases, respectively. The control group only accepted health education, while experimental group accepted cognitive behavioral intervention twice a week. Before and after the research, the patients were investigated with quality of life and distress scale. Results After the study of cognitive behavioral intervention, quality of life of experimental group scored (71.7±17.5) points which showed greater improvement than the control group scored (63.9±18.3) points (t=2.2,P<0.05), the distress score of experimental group was (2.6±0.6) points which was significant lower than the control group scored (3.9 ±0.7) points (t=11.8, P<0.05), and the proportions of distress problems contained anxiety [42.2% (27/64)], pain [29.7% (19/64)], depression [35.9% (23/64)] and sleep [23.4% (15/64)] in the experimental group were all significant lower than the control group [60.6% (40/66), 47.0% (31/66), 53.0% (35/66), 39.4% (26/66)]( X2=4.4, 4.1, 3.9, 4.5, P<0.05). Conclusions Short-term group cognitive behavioral intervention can alleviate the distress and pain, improve their negative emotions and sleep, eventually improve the quality of life of cancer patients.
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Objective To compare the effectiveness of training with a digital video disc ( DVD)-based instruction ver-sus intubation model simulator in placement of endotracheal tube by video -laryngoscope .Methods Sixty patients un-dergoing elective gynecology surgeries and twenty residents of Dept .of anesthesiology were randomized to place a en-dotracheal tube by video-laryngoscope .Results Compared with intubation model simulator , intubation time [ (68 ± 14)s vs (69 ±7)s], score of performance (8.24 ±0.64 vs 8.31 ±0.58), failure rate (3 times/11 vs 1time/9 resi-dents), and instruction rate (5times/11 vs 4times/9 residents) were no statistic difference .Conclusions Digital video disc ( DVD)-based instruction is an alternative way to intubation model simulator in training .
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〔Abstract〕 The paper introduces the connotation of digital learning environment and digital scientific research environment, analyzes the strategies of constructing digital learning environment and digital scientific research environment in hospitals, including hospital librar-ians taking part in scientific research knowledge service, doctors, teachers and researchers participation, creating personalized scientific research information environment, etc.
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Objective To identify the risk factors for perioperative major adverse cardiac events (MACEs)in elderly patients with coronary heart disease (CHD) undergoing orthopedic surgery.Methods One hundred and twenty-nine patients with CHD,aged ≥65 yr,undergoing elective major orthopedic surgery in our hospital from January 2004 to December 2009,were selected.The patients were assigned into MACE group or non-MACE group according to the occurrence of MACEs during surgery and within 30 days after surgery.Age,sex,history of coronary reconstruction,myocardial infarction,heart failure,angina,systemic angionosis,cerebrovascular disease and diabetes,basic and preoperative blood pressure,routine blood test,serum creatinine,blood glucose,preoperative electrocardiography (ECG) and ultrasonic cardiography,ASA,intraoperative blood transfusion,operation and anesthesia time,entering ICU after surgery and postoperative volume of drainage were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factors for incidence of MACEs.Results Twenty-one patients developed perioperative MACEs (16.3 %).Logistic regression analysis showed that unstable angina within 6 months,preoperative haematocrit ≤ 35%,preoperative ECG arrhythmia and wall motion abnormality were risk factors for incidence of perioperative MACEs in this population (P ＜ 0.05),and the risk indexes of the factors were 5,3,3 and 4,respectively.Conclusion Unstable angina within 6 months,preoperative haematocrit ≤ 35 %,preoperative ECG arrhythmia and wall motion abnormality are risk factors for perioperative MACEs in elderly patients with CHD undergoing orthopedic surgery.
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Visiting doctors' training is a main part of medical education in general hospital,but it has not gained full attention.Based on the features of visiting doctors and the department,a new teaching method-tutorial system was applied to enhance the responsibility of tutors and the sense of belongings of visiting doctors.Individual teaching method was used to enhance the overall quality of visiting doctors and to guarantee the safety of anesthesia treatment for patients.The tutorial system clarified and enhanced the relationship between tutors and visiting doctors and it would be a new teaching mode for the visiting doctors' education in the department of anesthesiology.
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ObjectiveTo investigate the applicability and superiority of modified Seldinger technique (MST).MethodsTotally 108 patients receiving peripherally inserted central catheter (PICC) through vascular ultrasound combined with MST technology were enrolled as MST group and another 108 patients receiving PICC using traditional direct vision method as control group.The first puncture success rate,PICC succesa rate,catheterization time required,and early complication rate were compared between these two groups.ResultsThe first puncture success rate was 88.89％ in MST group and 72.22％ in control group (P=0.002) ; the catheterization success rate was 82.41％ in MST group and 57.41％ in control group ( P =0.000).In the MST group,there were two cases where the catheter within neck was ectopic ( P =0.003 ),two cases experienced bleeding at the puncture sites (P =0.017),three cases had phlebitis (P =0.001 ),and one case suffered from catheter blockage (P=0.010).In the eontrol group,the corresponding numbers were 13,10,18,and 9.However,the time required for PICC showed no significant difference between these two groups (P=0.685).In the MST group,15 cases were catheterized in less than 15 minutes,72 cases between 15 and 25 minutes,and 21 cases for more than 25 minutes.In the control group,12 cases were catheterized in less than 15 minutes,70 cases between 15 and 25 minutes,and 26 cases for more than 25 minutes.ConclusionPICC through MST can be more effective in positioning the targeting blood vessels,increasing the success rate of catheter insertion,reducing various tissue damages,and lowering potential complications.
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Objective To investigate the effect of bibliotherapy in soothing the postoperative pain in children and relieving the perioperative anxiety of children and their care givers. Methods Hospitalized children and their care givers from August 2007 to March 2009 were studied. 153 cases from August 2007 to May 2008 were assigned to the control group and the other 153 cases to the intervention group. Routine surgical nursing were applicated in the control group by introduction of perioperative nursing procedures.Bibliotherapy were applicated in the intervention group on the basis of the control group-using "bibliotherapy materials for hospitalized children" which was designed by ourselves and correspond with the theory of bibliotherapy to interfere in the 153 cases in the intervention group. The variance of preoperative anxiety of care givers and perceptions of postoperative pain of children between the two groups were compared with scales of mYPAS, STAI and FLACC and Wong- Baker Facial Scale. Results The scores of mYPAS in children of the intervention group and the control group was (35.875+4.441)and(46.796+8.606 )respectively and the variance was significant. The scores of STAI in care givers of the two groups was(38.125+4.371 )and (49.901 +7.420) respectively and revealed significant variance. The scores of Wong-Baker and FLACC in children of both groups 1 hour after operation were compared and revealed no statistical significance. The scores of Wong-Baker and FLACC in children at 6 hours and 24 hours postoperative were compared subjectively and objectively and revealed statistic significance. Conclusions Bibliotherapy can ameliorate the anxiety level of both children and their care givers, relieve the perception of postoperative pain in children and improve their comforts. Bibliotherapy thus conduces to the recovery of postoperative children.
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Objective To study the effect of low tidal volume ventilation in patients with respiratory failure due to neuromuscular disease. Methods Fifty-seven patients with neuromuscular disease and respiratory failure requiring mechanical ventilation were divided into low tidal volume ventilation group ( group A: 2 7 cases ) and routine tidal volume ventilation group (group B: 30 cases ). Indices of airway pressure and blood gas were recorded. The levels of TNF, IL-6, IL-8 in Bronchoalveolar Lavage Fluid (BALF) were measured after ventilation. The survival rates of 14 days and weaning success rates of 14 days were observed. Results The pH value in arterial blood gas at 0.5 and 24 hour after ventilation was 7.30 ± 0.08,7.40 ± 0.06 in group A,which were significantly lower than those of 7. 39 ± 0. 06,7.47 ± 0. 04 in group B at the same time point ( P ＜ 0. 05 ). The PaCO2 levels at0.5 and24 h were (60.4 ± 16.9)mm Hg and (38.2 ±7.3)mm Hg in group A,which were also significantly higher than those of (46. 6 ±8. 1 )mm Hg and (29.2 ±6.9)mm Hg at the same time point in group B (P ＜ 0.05 ). The airway peak pressure at 0.5 and 24 hour were (21.5 ± 4.5 ) mm Hg and ( 18.6 ± 3.8 ) cm H2O in group A,which were significantly lower than those of (29.4 ±5.1)cm H2O and (31.3 ±4.7)cm H2O at the same time point in group B (P ＜ 0. 05 ). The levels of TNF in BALF at 24 and 48 hour were ( 1385 ± 341 ) ng/L and (1345 ±411 )ng/L in group A,which were significantly lower than those of (1914 ± 501 )ng/L and (2214 ± 544)ng/L in group B at the same time point (P ＜0.01 ). The level of IL-6 in BALF at 24 and 48 hour were (249 ±64)ng/L and (209±49)ng/L in group A,which were significantly lower than those of (324 ±79) ng/L and (343 ±60)ng/L in group B at the same time point ( P ＜ 0. 01 ). The levels of IL-8 in BALF at 24 and 48 hour were (79. 4 ±23.6) ng/L and (92. 7 ± 32. 5)ng/L in group A,which were significantly lower than those of (143 ± 36)ng/L and (162 ±49)ng/L in group B at the same time point (P ＜0.01 ). No significant difference was found in the survival rates of these two groups (100% vs. 96. 7% ,P ＞0. 05). The higher weaning success rate was observed higher in group A (59. 3% ) than group B (33.3%, P ＜ 0. 05 ). Conclusions For patients with respiratory failure resulting from neuromuscular disease,low tidal volume ventilation can decrease ventilation-induced cytokine release, alleviate ventilator-induced lung injury, and increase the success rate of ventilator weaning.
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With clinical first-aid needs, it is necessary to develop and produce combined first-aid equipment box to meet needs of the battlefield and emergency treatment. The choice of medical devices should also be followed to change, so as to well realize the scene first aid and portable purpose, whose internal configuration of medical devices can also be set according to actual requirements and have met a case of multiple uses, to suit different applications require medical treatment.
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Equipment Design , First AidABSTRACT
Objective To analyze the causes of peripherally inserted central catheter (PICC) relat-ed infections, study the types of pathogens and their drug sensitivities in order to supply evidence for clini-cal medication. Methods 110 cancer patients were analyzed for PICC related infections and blood sam-pies underwent bacterial culture. Results Of 110 cases of cancer patients, catheter-related infections were found in 11 patients (10.00%), including 9 cases of local infection (8.18%), and 2 cases of hemato-ge-nous infection (1.82%). Catheter-related infections were not associated with gender, age, types of catheter, venous selection, and the inserted length of intravenous catheter. Catheter- related infections were likely to be associated with the indwelling time of catheters. Conclusions To avoid the infections related to long-term PICC, strict aseptic operation and standardized maintaining procedures are required.
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Fifteen patients with chronic renal failure(CRF)underwent laparoscopic cholecystectomy(LC)at carbon dioxide(CO2)pneumoperitoneum pressure of 10-12 mm Hg(Group A,n=9)or 13-15 mm Hg(Group B,n=6).Renal function and urinary volume(UV)of Group A showed no remarkable change following the operation.But in Group B,the levels of blood urine nitrogen(BUN)and serum creatine(Scr)were increased significantly,and creatinine clearance rate(Ccr)and UV were remarkably decreased(P＜0.05).These variants gradually retumed tO the preoperative levels after 1 week.The analysis showed that laparoscopic choleeystectomy at CO2 pneumoperitoneum pressure of 10-12 mm Hg in CRF patients might be safe.Higher CO2 pneumoperitoneum pressure could result in reversible renal Email:yuanhuizhong2000@yahoo.com.cnfunction change.
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Objective To demonstrate the correlation between heart rate and blood serum kalium in patients with clenbuterol poisoning.Methods From September 2005 to November 2005,146 patients with clenbuterol poisoning were divided into two groups for the correlations study.Group A was the patients with HR