ABSTRACT
Objective:To investigate the role of cervical core muscle group exercise and massage in the change of cervical spine curvature during radiotherapy for head and neck tumors and the effect on set-up errors.Methods:A total of 40 patients with head and neck tumours receiving radiotherapy in the First Affiliated Hospital of Air Force Military Medical University from March 2020 to July 2021 were prospectively selected, and all of them underwent different degrees of changes in cervical spine curvature during radiotherapy. The cervical core muscle exercise and manual massage were used to do treatment intervention on the change in the cervical spine curvature. Changes in cervical spine curvature at the time of the curvature change of the cervical spine and at 1 d, 3 d and 5 d after the intervention were observed by using cone beam CT, and then data were recorded in 3 dimensions. The set-up error when cervical spine curvature changed was compared with that after the muscle group exercise and manipulation, and Pearson was used to analyze the linear correlation of set-up errors in each direction.Results:There were 23 males and 17 females, with a median age of 41 years (26-62 years). The significant improvement of cervical curvature at 1 d, 3 d and 5 d after the intervention could be found in 2 cases (5.0%), 20 cases (50.0%) and 39 cases (97.5%). Using the cervical 4 vertebrae as the matching standard, the set-up errors at the time of change in cervical spine curvature and at 1 d, 3 d and 5 d after treatment were (1.3±0.9) mm, (1.2±0.8) mm, (1.3±0.7) mm and (1.3±0.7) mm in the left-right direction respectively; (2.0±0.7) mm, (1.7±0.8) mm, (1.8±0.7) mm and (1.9±0.8) mm in the head-foot direction respectively; (4.9±0.7) mm, (4.6±0.7) mm, (3.4±0.7) mm, (1.7±0.6) mm in the anterior-posterior direction respectively. The set-up error in the anterior-posterior directions at 3 d and 5 d after treatment intervention was lower than that at the time of change in cervical spine curvature and at 1 d after treatment intervention (all P < 0.01), and that at 5 d after treatment intervention was lower than that at 3 d after treatment intervention ( P < 0.01). There were no statistically significant differences between the left-right direction and head-foot direction at each time point (all P > 0.05). There was no correlation between left-right direction and head-foot direction ( r = 0.049, P = 0.540), between left-right direction and anterior-posterior direction ( r = 0.041, P = 0.607), and between head-foot direction and anterior-posterior direction ( r = 0.003, P = 0.931) in terms of set-up errors. Conclusions:Core cervical muscle group training and massage could improve the change in cervical spine curvature, increase the repeatability of the set-up, which provides a favourable guarantee for accurate treatment.
ABSTRACT
Influenza is an infectious respiratory disease caused by the influenza viruses. Older people, infants and people with underlying medical conditions could have a higher risk of severe influenza symptoms and complications. The co-infection of Coronavirus Diseases 2019 (COVID-19) with influenza viruses could lead to the complication of prevention, diagnosis, control, treatment, and recovery of COVID-19. Influenza vaccine and COVID-19 vaccine overlapped in target populations, vaccination time, and inoculation units. Although there was insufficient evidence on the immunogenicity and safety of co-administration of influenza vaccine and COVID-19 vaccine, World Health Organization and some countries recommended co-administration of inactivated influenza vaccine and COVID-19 vaccine. This review summarized domestic and international vaccination policies and research progress, and put forward corresponding suggestions in order to provide scientific support for the formulation of vaccination strategy on seasonal influenza vaccine and COVID-19 vaccine.
Subject(s)
Aged , Humans , Infant , COVID-19 , COVID-19 Vaccines , China , Influenza Vaccines , Influenza, Human/prevention & control , Pandemics/prevention & control , SARS-CoV-2 , Seasons , VaccinationABSTRACT
Objective:To explore the diagnosis, surgical methods and therapeutic effect of primary duodenal malignant tumor.Methods:The clinical data of 116 patients with primary duodenal malignant tumor from January 2010 to December 2018 were retrospectively analyzed.Results:Among 116 patients, adenocarcinoma was in 74 cases, interstitial tumor was in 25 cases, carcinoid was in 9 cases, the others was in 8 cases. Before operation, duodenoscopy was performed in 107 cases, and CT examination was performed in 76 cases. There were 57 cases of pancreaticoduodenectomy, 15 cases of duodenal segmental resection, 13 cases of subtotal gastrectomy and duodenal bulbar resection, 13 cases of duodenal partial resection, and 18 cases of palliative short circuit operation. The total incidence of postoperative complication was 31.9% (37/116), including pancreatic fistula in 8 cases (grade B 5 cases, grade C 3 cases), biliary fistula in 6 cases, abdominal infection in 5 cases, pulmonary infection in 4 cases, intestinal fistula in 3 cases, delayed gastric emptying in 3 cases, and hemorrhage in 8 cases. Four cases (3.4%) died during the perioperative period. Single factor Cox regression analysis result showed that the postoperative survival time was related to the tumor differentiation degree, operation method, tumor infiltration degree and lymphatic metastasis ( P<0.05 or <0.01); multi-factor Cox regression analysis results showed that the operation method, tumor infiltration degree and lymphatic metastasis were the independent risk factors for the postoperative survival time of patients with primary duodenal malignant tumor ( P<0.05). The patients were followed up until June 2021, and 9 cases were lost to follow-up. Kaplan-Meier survival curve analysis result showed that the postoperative overall 1-,3- and 5-year survival rates were 82.11%, 57.56% and 33.11%, respectively. Conclusions:Adenocarcinoma is the main primary malignant tumor of duodenum. Duodenoscopy and CT are the main examination methods. Radical resection is the most effective treatment for primary duodenal malignant tumor, and pancreaticoduodenectomy is the first choice. Surgical method, tumor infiltration degree and lymphatic metastasis are the independent risk factors affecting the prognosis of patients.
ABSTRACT
Different from the traditional health technology assessment(HTA), hospital-based health technology assessment(HB-HTA) is mainly based on the perspective of the hospital to carry out economic analysis, commonly used cost-effectiveness analysis combined with budget impact analysis methods. It pays attention to the current medical costs and effects, and supports the hospital′s internal health technology access, purchase pricing, elimination and other decisions. In the context of deepening the reform of medical insurance payment mode in China, the hospital internal medicine decision-making based on HB-HTA is particularly important. Based on the economic characteristics of health technology, the authors analyzed the differences between HB-HTA and traditional HTA in carrying out economic evaluation, introduced the steps, contents, indicators and methods of HB-HTA economic evaluation, and put forward relevant strategic suggestions.
ABSTRACT
Objective:To analyze the differences in information needs of doctors, middle managers, and hospital leaders in tertiary public hospitals in the process of new technology access.Methods:From January to October 2018, 1 200 doctors and hospital administrators from 30 tertiary public hospitals in 8 provinces were selected. The importance scores of different positions for decision-making information demand of new technology introduction were collected through questionnaire survey, and the scores were analyzed by SPSS 25.0 software. Descriptive statistical analysis was performed.Results:1 032 valid questionnaires were obtained. Hospital-level leaders, middle-level managers, and doctors scored higher on the clinical application, safety, and effectiveness of technology at home and abroad(more than 4 points, maximum 5 points). Hospital-level leaders and middle-level managers had higher scores on effectiveness, evidence quality, possibility of being covered by medical insurance, ethics and relevant indicators of strategic level, while doctors had higher scores on health economics and organizational indicators.Conclusions:There are some differences in the information demand for new technology access among different positions in tertiary public hospitals. Understanding the decision-making needs of different positions is conducive to promoting the actual implementation of hospital-based health technology assessment standards in China′s public hospitals.
ABSTRACT
New " management measures and regulations for medical technology clinical use and research" was officially implemented on November 1, 2018. Under the background of the adjustment of the national medical technology clinical application management system, the authors collected and analyzed the research on the clinical application management and evaluation of medical technology from 30 tertiary public hospitals in 8 provinces, as well as other data, summarized the current status and problems, attempted to provide reference for the optimization and system construction of medical technology management and evaluation system in China.
ABSTRACT
Objective:To explore the mechanism of mitochondrial apoptotic pathway in rat degenerative intervertebral disc cells in improving intervertebral disc degeneration under the action of Bushen Zhuangdu recipe. Method:The 100 SD male rats were randomly divided into blank group, model group, low, medium and high dose Bushen Zhuangdu recipe group (0.38,0.77,1.53 g·kg-1).Histopathological changes of rat intervertebral discs were observed by hematoxylin-eosin(HE) staining after 4 weeks of continuous administration of Chinese medicine. The apoptotic rate of nucleus pulposus cells in degenerative intervertebral discs was detected by TUNEL(terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling), and the levels of active Cysteinyl aspartate-specific proteinase-3(active Caspase-3), B cell leukemia-2(Bcl-2), cytochrome C (cytC) and Bcl-2-associated X protein(Bax) protein in intervertebral discs were detected by Western blot. Result:Compared with blank group, the histopathological score of intervertebral disc in the model group was significantly increased, the apoptosis rate of nucleus pulposus was significantly increased (PPPPPPConclusion:Bushen Zhuangdu recipe may improve the degeneration of intervertebral disc by reducing the expression of active Caspase-3, cytC and Bax, increasing the expression of Bcl-2 and inhibiting the apoptotic pathway of mitochondria in a dose-dependent manner.
ABSTRACT
Objective To establish a scientific and comprehensive evaluation index for new technology access in tertiary public hospital, so as to provide a tool for new technology access management system and scientific basis for decision-making. Methods This study collected data from eight provinces nationwide including 30 tertiary public hospital based new technology access application, catalogued dimensions of application. It also referred to the European Union, Denmark, Canada and other countries in forming the hospital health technology assessment form, along with two rounds of Delphi expert consultation. Results The new medical technology access index system of China′s tertiary public hospitals was preliminarily formed, including 5 first-level indexes and 24 level-2 indexes. Conclusions The two rounds of expert advice have a high degree of consistency, indicating that the indicators are in line with the actual situation of hospital management in China, yet with rooms of constant improvement in practice.
ABSTRACT
BACKGROUND: Numerous studies focus on animal models of intervertebral disc degeneration (IDD), but criteria for establishing the animal models of IDD have not been confirmed, and there is a lack of systematic comparison among models. OBJECTIVE: To compare the rat models of IDD established by puncturing at annulus, endplate injection and their combination, thus providing reference for IDD model selection. METHODS: Eighty Sprague-Dawley rats were equivalently randomized into four groups: puncturing group (puncturing at the annulus), endplate injection group (endplate injected with ethyl alcohol), combination group (puncturing at the L5-6annulus and endplate injection at the same segment) and sham operation group. Three rats in each group were taken at postoperative 4, 8, and 12 weeks for X-ray examination to measure the disc height; and the discs were removed for histological observation and immunohistochemical staining. RESULTS AND CONCLUSION: The results of X-ray examination, hematoxylin-eosin staining and immunohistochemical staining all showed that the IDD degree was gradually aggravated in all groups except the sham operation group. At postoperative 4 weeks, compared with the sham operation group, in the endplate injection and combination groups, the percent disc height was significantly decreased, the pathological scores were significantly increased and the average gray value of collagen type I was significantly reduced (P ＜ 0.05). At postoperative 8 and 12 weeks, compared with the sham operation group, the percent disc height in the other three groups were all significantly decreased, the pathological score was significantly increased, and the average gray value of collagen type I was significantly decreased (P ＜ 0.05). Compared with the puncturing and endplate injection group, in the combination group, the percent disc height at postoperative 8 weeks was significantly decreased, and the average gray value of collagen type I at postoperative 12 weeks was significantly decreased (P ＜ 0.05). These results suggest that the rat IDD model can be successfully constructed by above three methods. Puncturing at the annulus is easy to operate and control IDD progression, which can be used to study different stages of IDD. Endplate injection is suitable for the etiological study of IDD, and induces IDD earlier than puncturing, but the final results are similar. The combination method can significantly accelerate IDD aggravation, and thus is not time consuming.
ABSTRACT
BACKGROUND: Deep venous thrombosis and blood loss are common complications after total hip arthroplasty in elderly patients. Thus, it needs to pick valid treatments to reduce the harm in the clinical treatment. OBJECTIVE: To compare and observe the effects of rivaroxaban and low molecular heparin on preventing deep venous thrombosis and blood loss after total hip arthroplasty in elderly patients. METHODS: 196 cases in Department of Orthopedics, General Hospital of Shuicheng Mining Group of Guizhou Province treated by unilateral total hip arthroplasty were enrolled between January 2015 and January 2017. They were randomly divided into observation group (98 cases) and control group (98 cases). The observation group was treated with oral rivaroxaban 6 hours after surgery for 2 consecutive weeks. The control group was subcutaneously injected with low molecular heparin injection 6 hours after surgery for 5 consecutive weeks. The coagulation index was measured by automatic coagulation analyzer at preoperative, 1 day, 1 and 2 weeks after surgery. Deep venous thrombosis was evaluated in the two groups. The caliber sizes of superficial femoral vein and popliteal vein were measured by color Doppler ultrasound before surgery, 1, 2, 3 and 4 weeks after surgery. Blood loss was recorded in the two groups. RESULTS AND CONCLUSION: (1) The difference in serum D-dimer levels was statistically significant 1 and 2 weeks after surgery in both groups (P < 0.05). Serum D-dimer levels were lower in the observation group than in the control group. (2) The incidence of deep venous thrombosis was lower in the observation group than in the control group (P < 0.05). (3) The caliber size of superficial femoral vein and popliteal vein was significantly different 1, 2, 3 and 4 weeks after surgery in both groups (P < 0.05). The caliber size of superficial femoral vein and popliteal vein was larger in the observation group than in the control group. (4) Hidden blood loss and total blood loss were significantly different between the two groups (P < 0.05). The hidden blood loss and total blood loss were higher in the observation group than in the control group. (5) Results suggest that rivaroxaban has a positive meaning for prevention of deep venous thrombosis after total hip arthroplasty in elderly patients. However, hidden blood loss is worthy of attention.
ABSTRACT
@#Objective This paper studied the status of community-based rehabilitation of rural disabled people in the process of ac-curate poverty alleviation and aimed to provide reference and reflection for promoting the community-based re-habilitation and development of rural disabled people and realizing a comprehensive well-off society. Methods Through combining and summarizing the literature,this paper elaborated the intrinsic relationship between ac-curate poverty alleviation and community-based rehabilitation, and analyzed the effectiveness and problems of community-based rehabilitation of rural disabled people in the process of accurate poverty alleviation based on field research. Results Aiming at the existing problems of community-based rehabilitation of disabled people in rural areas,some sug-gestions were put forward such as strengthening the top-level design and management and training of accurate employment skills in the process of accurate poverty alleviation so as to better realize the community-based reha-bilitation of rural disabled people. Conclusion The development of community-based rehabilitation for disabled people in rural areas is closely related to the process of precise poverty alleviation.They have the same purpose and promote each other.Simultaneously, they are both sustainable and inclusive development strategies.
ABSTRACT
Objective To apply the Baltimore Therapeutic Equipment (BTE), a kind of vocational training and evaluation system, in rehabilitaion of patients post traumatic upper extremity injury from work, and to observe the effects. Methods Inpatients from September, 2014 to August, 2015 for rehabilitation of traumatic upper extremity injury from work were selected as control group (n=42), and inpatients from September, 2015 to August, 2016 were selected as intervention group (n=36). Both groups received routine rehabilitation, while the control group received con-ventional work simulation training, and the intervention group received work simulation training with BTE, for four weeks. They were measured the standing lifting strength (elbow), squatting lifting strength, dynamic lifting strength (floor to waist), dynamic lifting strength (floor to shoulder), and grip strength of the injured hand and the healthy hand with BTE, before and after rehabilitation; while they were assessed with Disability of Arm Shoul-der and Hand (DASH). The incidence of return to work was investigated at six months of follow-up. Results The standing lifting strength (elbow) (t=4.290, P<0.001), squatting lifting strength (t=2.645, P=0.010), dynamic lifting strength (floor to waist) (t=2.639, P=0.010), dynamic lifting strength (floor to shoulder) (t=5.361, P<0.001), and grip strength of the injured hand (t=2.320, P=0.023) and the healthy hand (t=3.130, P=0.002) im-proved better in the intervention group than in the control group after rehabilitation. However, there was no sig-nificant difference between two groups in score of DASH (t=-0.851, P=0.398), as well as incidence of return to work (χ2=0.05, P=0.944). Conclusion BTE may help to improve the body function in patients post traumatic upper extremity injury from work. However, vocational rehabilitation should focus on the factors other than body function, to improve their return to work.
ABSTRACT
Objective: To understand the cognition and needs of medical personnel for the Horizon Scanning System(HSS)for emerging health technology based on the survey conducted in two provinces(municipalities)in some general public hospitals in eastern and western China,to provide a reference for establishing a proper,new HSS for emerging health technology in China.Methods:A total of 10 general public hospitals in Shanghai and Gansu were selected by convenience sampling method.The self-designed anonymous questionnaire survey was conducted on medi-cal staff.Results:There were 837 respondents,59.95%of which considered it of great necessity to establish a HSS for emerging health technology in China and 91.53%of which would use this system.The most expected functions of the HSS were identifying innovations in the field of health technology,and providing reference for decision-making of the introduction/distribution/use of the technology.The most expected feature of the HSS was involving clinicians and technical experts,and maintaining independence and justice.Conclusions:Medical personnel had a great demand for the HSS.The HSS was expected to identify new technologies efficiently and timely,and provide relevant information for decision makers.
ABSTRACT
Objective To study the compliance of medical care with corresponding national clinical pathways for inpatients of cholecystectomy for cholecystolithiasis with acute cholecystitis at public hospitals of China. Methods Thirty medical records of the inpatients with cholecystectomy admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding national clinical pathways. Results The average compliance rate of inpatient care of cholecystectomy at public hospitals was 67. 7%. The study found low compliance rates in both severity assessment and timely examinations/diagnosis within two days after admission ( 5. 8% and 35. 3%, respectively) . Conclusions Public hospitals in China should strengthen their supervision over the medical care process for inpatients of cholecystectomy with acute cholecystitis, and the clinical pathways in question should be updated and improved in time.
ABSTRACT
Objective To study the compliance of medical care at public hospitals in China with corresponding clinical pathway for inpatients of community acquired pneumonia ( CAP) . Methods Thirty medical records of inpatients with CAP admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding clinical pathways. Results The average compliance rate of inpatient care of CAP at public hospitals was 65. 1%. The study the lowest compliance rates in both timely examinations/diagnosis and severity assessment within three days after admission (0. 7% and 26. 6%, respectively). The compliance rate of reasonable initial antibiotic use was 48. 5%. Conclusions The compliance rate of inpatient care of CAP is low in China. Thus admission examinations, patient severity assessment and antibiotic utilization should be enhanced accordingly for their compliance.
ABSTRACT
Objective To study the compliance of medical care with corresponding national clinical pathways for inpatients of cholecystectomy for cholecystolithiasis with acute cholecystitis at public hospitals of China. Methods Thirty medical records of the inpatients with cholecystectomy admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding national clinical pathways. Results The average compliance rate of inpatient care of cholecystectomy at public hospitals was 67. 7%. The study found low compliance rates in both severity assessment and timely examinations/diagnosis within two days after admission ( 5. 8% and 35. 3%, respectively) . Conclusions Public hospitals in China should strengthen their supervision over the medical care process for inpatients of cholecystectomy with acute cholecystitis, and the clinical pathways in question should be updated and improved in time.
ABSTRACT
Objective To study the compliance of medical care at public hospitals in China with corresponding clinical pathway for inpatients of community acquired pneumonia ( CAP) . Methods Thirty medical records of inpatients with CAP admitted in 2014 were randomly sampled from 18 public hospitals in Shanghai, Hubei province and Gansu province, for assessment on their compliance with corresponding clinical pathways. Results The average compliance rate of inpatient care of CAP at public hospitals was 65. 1%. The study the lowest compliance rates in both timely examinations/diagnosis and severity assessment within three days after admission (0. 7% and 26. 6%, respectively). The compliance rate of reasonable initial antibiotic use was 48. 5%. Conclusions The compliance rate of inpatient care of CAP is low in China. Thus admission examinations, patient severity assessment and antibiotic utilization should be enhanced accordingly for their compliance.
ABSTRACT
Objective To investigate the diagnostic value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)in differentiating non-metastatic from metastatic mesorectal lymph nodes in rectal cancer.Methods IVIM-DWI and DCE-MRI were performed preoperatively in 38 patients with histologically proven rectal carcinoma.The short axis diameter,short-to-long axis diameter ratio,four IVIM-based parameters (ADC,D,D? and f) and six DEC-MRI semi-quantitative parameters (Slope,Maxslope,CER,Washout,TTP,iAUC90 and iAUC180 )were compared between the metastatic (n=28)and non-metastatic (n=27)lymph nodes.Results There were significant statistical significances between the metastatic and non-metastatic lymph nodes in mean short axis diameter (8.87 mm±2.829 mm vs 6.83 mm±1.075 mm),D value[(0.824±0.1 13)× 10 -3 mm2/s vs (1.033±0.244)× 10 -3 mm2/s],CER(1.588 ±0.664 vs 1.054 ±0.41 9),iAUC90 (22.89 ± 9.83 vs 13.59 ± 5.34)and iAUC1 80 (49.38±20.1 9 vs 30.31 ± 1 1.67)(P ≤0.001).The short-to-long axis diameter ratio,ADC,D? ,f,Slope,Maxslope,Washout and TTP values did not show significant differences between the two groups(P >0.05).The respectively optimal cut-off value (area under the curve,sensitivity and specificity)for distinguishing metastatic from non-metastatic lymph nodes were as follows:short axis diameter=7.1 mm(0.744,64.2%,85.1%),D=0.906×10 -3 mm2/s (0.821,81.5%,75.0%),CER=1.05(0.749,85.7%,62.9%), iAUC90 =13.42(0.780,85.7%,62.9%),iAUC180 =49.65 (0.770, 50.0%,100%)respecyively.Conclusion Both IVIM-DWI and DCE-MRI are useful for differentiating non-metastatic from metastatic mesorectal lymph nodes in rectal cancer.
ABSTRACT
Objective To analyze the key factors influencing the number of diseases or conditions in which clinical pathways ( CPs) were implemented at public hospitals of China. Methods Based on the questionnaire survey of 51 public hospitals that had implemented CPs in Shanghai, Hubei province, and Gansu province, a multivariate logistic model was used to analyze the factors that influenced the number of CPs implemented in hospitals. Results In terms of the 14 issues and difficulties found in CPs′implementation, the overall acceptance rate was 38. 8% on average among surveyed hospitals, yet with a great variation(from 7. 1% to 100. 0%). A multivariate logistic model showed that the recognition of public hospitals on the issues and difficulties in CPs′implementation did not affect the number of implemented CPs, and tertiary public hospitals had significantly higher number of CPs implemented than secondary hospitals. Conclusions The resources and management capabilities of public hospitals in China are the determinants of CPs′promotion.
ABSTRACT
Objective To investigate the role of self-made auxiliary device in pelvic tumor radiotherapy with phantom immobilization using Varian cone-beam CT (CBCT).Methods A total of 50 patients with pelvic tumor were enrolled and randomly divided into study group and control group according to the order of enrollment.The patients in the study group were immobilized with thermoplastic phantom and self-made auxiliary device,and those in the control group were immobilized with thermoplastic phantom.CBCT scan and online matching were regularly performed before radiotherapy to obtain the setup errors of the left-right (x),cranial-caudal (y),and anterior-posterior (z) directions.The independent-samples t-test was used for comparison between groups.Results The set-up errors in the x-,y-,and z-directions in the study group were 1.56± 1.00 mm,1.60± 1.29 mm,and 1.36± 1.00 mm,respectively,and those in the control group were 1.76±1.33 mm,2.76±1.69 mm,and 1.92±0.91 mm,respectively (P=0.551,0.009,and 0.043).Conclusions Self-made auxiliary device helps to eliminate the errors in the cranial-caudal direction and solve the problem of involuntary activities of the lower limbs.