Exploration and application of online teaching in first aid skill operation course / 中华医学教育探索杂志

Objective:To explore the teaching effect and novel ideas of online teaching applied in skill operation course.Methods:One hundred and fifty-one students studying in Sichuan University taking the First Aid in the Life: Basic Knowledge and Skills as an elective course in the autumn semester of 2019 and spring semester of 2020 were included as the research subjects in this study. Among them, 77 students in the spring semester of 2020 were selected as the experimental group and 74 students in the autumn semester of 2019 were selected as the control group. The students in the experimental group studied the first aid course by online platform, and the others in the control group studied through traditional teaching mode. The teaching effect of the two groups was compared and the teaching satisfaction of the two groups weas analyzed. SPSS 23.0 was used for Chi-square test and t-test. Results:There was no significant difference between the control group and the experimental group in the assessment scores of cardiopulmonary resuscitation, hemostatic bandaging, and fracture fixation [(8.65±0.81 vs 8.69±0.90, P=0.750); (8.10±0.50 vs 8.12±0.61, P=0.880); (8.21±0.89 vs 8.16±0.78, P=0.710)]. Among the students participating in the questionnaire survey in the experimental group, 59 (95.16%) students thought that this course was helpful in dealing with first aid in daily life, and 38 (61.29%) students did not want to change the traditional teaching method to online teaching. Conclusion:The application of online teaching in first-aid skill operation course is feasible and can achieve the similar teaching effect, which provides a novel idea for exploring the online teaching of first aid skills.

Development and clinical application of a new transverse process retractor based on computer-aided design and 3D printing technology / 中国骨伤

OBJECTIVE@#To manufacture a new type of transverse process retractor by using computer-aided design(CAD) combined with 3D printing technology and investigate its clinical application effect.@*METHODS@#A new type of transverse protrusion retractor was developed by CAD combined with 3D printing technology. From September 2018 to September 2019, the new transverse process retractor was applied in clinic. Sixty patients with lumbar single segment lesions who needed treatment by pedicle screw fixation, bone grafting and interbody fusion were divided into new transverse process retractor group and control group, with 30 cases in each group. There were 14 males and 16 females in new type transverse process retractor group, the age was (68.0±4.3) years old on average; lesion segment of 8 cases were L3,4, 9 cases were L4,5, 13 cases were L5S1;5 cases of lumbar disc herniation, 20 cases of lumbar spinal stenosis, 5 cases of degenerative lumbar spondylolisthesis;new transverse process retractor was used to pedicle screw placement. While there were 15 males and 15 females in control group, with an average age of (69.2±4.5) years old;lesion segment of 8 cases were L3,4, 10 cases were L4,5, 12 cases were L5S1;5 cases of lumbar disc herniation, 21 cases of lumbar spinal stenosis, 4 cases of degenerative lumbar spondylolisthesis;the traditional lamina retractor was used for soft tissue pulling and finished pedicle screw placement by freehand. The length of surgical incision, the time required for inserting a single screw, fluoroscopy times, the times of adjusting the positioning needle or screw in insertion process, and the visual analogue scale (VAS) of surgical incision 72 hours after operation were compared between two groups.@*RESULTS@#Using CAD and 3D printing technology, a new type of transverse protrusion retractor was developed quickly. The length of surgical incision, the time required for inserting a single screw, fluoroscopy time, and the times of adjusting the positioning needle or screw in insertion process in new transverse process retractor group were less than those in control group(P<0.05). There was no significant difference in VAS of lumbar incision pain at 72 hours after operation between two groups(P>0.05).@*CONCLUSION@#Using CAD combined with 3D printing technology to develop a new transverse protrusion retractor has the advantages of convenient design, short development cycle and low cost. It provides a new idea for the research and development of new medical devices. The new transverse process retractor has the advantages of easy operation, reliable fixation, less damage to paravertebral muscle, convenient pedicle screw placement, reducing fluoroscopy time and so on.

3D printing technology assisted the preoperative planning and application value in adult kyphoscoliosis deformity / 中国骨伤

OBJECTIVE@#To explore the application value of 3D printing technology in preoperative surgery plan and intraoperative auxiliary operation for adult kyphoscoliosis deformity.@*METHODS@#The clinical data of 12 adult patients with kyphoscoliosis deformity treated from September 2017 to January 2019 were retrospectively analyzed. There were 3 males and 9 females, aged from 21 to 63 years old with an average of (47.67±13.32) years old. Among them, 4 cases were congenital kyphoscoliosis, 2 cases were old tuberculosis thoracolumbar kyphosis ; 2 cases were idiopathic kyphoscoliosis, 4 cases were degenerative kyphoscoliosis. The CT scan data of the patient's spine was imported into Mimics17.0 software to establish the three dimensional model of the spine, and the spine model was produced by 3D printer. Using the spine model simulated operation, preoperative surgery program planning and formulated a precise surgery, and further analysed postoperative imaging parameters improvement. All the patients were followed up for more than 1 year. Before and after operation and at the last follow-up, the scoliosis Cobb angle, maximum kyphosis Cobb angle, and coronal plane balance (distance between C 7 plumbline and center sacral vertical line, CPL-CSVL), sagittal plane balance (sagittal vertical axis, SVA), pelvic parameters and other related imaging parameters were measured to further evaluate its orthopedic effect.@*RESULTS@#Twelve patients with spine deformity were treated with different osteotomy and internal fixation fusion methods under the guidance of a 1∶1 spine model (pedicle screw placement of 4 patients with severe deformity were assisted by pedicle screw guide plates), nail placement and osteotomy have good effects, no major tissue damage such as blood vessels, nerves and spinal cord during and after surgery, no complications such as cerebrospinal fluid leakage and infection. Preoperative Cobb angle of scoliosis was (56.5±22.5) °, Cobb angle of kyphosis was (65.2±19.5) °, C PL-CSVL was (45.8±16.9) mm, SVA was (48.7±25.4) mm. Postoperative at 4 weeks, Cobb angle of scoliosis was (20.8±11.5) °, and Cobb angle of kyphosis was (22.0±6.6) °, with correction rates of (65.1±9.7)% and (64.6± 10.6)%, respectively ; C PL-CSVL was (22.3±8.9) mm, and SVA was (23.3±13.1) mm, all of which were significantly improved compared with preoperative results. The mean follow-up time was (18.5±7.9) months in 12 patients. At the last follow-up, the Cobb angles of scoliosis and kyphosis were (22.2±10.8) ° and (23.6±7.7) °, respectively, C PL-CSVL was (23.5±10.8) mm, and SVA was (24.7±12.5) mm. The results were statistically significant compared preoperative (0.05).@*CONCLUSION@#The 3D print model can visually and clearly show the vertebral morphology and structure of adult kyphoscolisis and its spatial relationship with the adjacent vertebrae, blood vessels, and nerves, which provides a good and intuitive stereoscopic anatomical structure observation for the individualization of the surgical plan. Pre-simulation of operations to determine the internal fixation, fusion segment and osteotomy orthopedic way, may to provide a reference for actual clinical surgery, and can improve the accuracy and safety of surgery.

Significance of emergency observation time of measurement with high-sensitive troponin T in patients with chest pain / 实用医学杂志

Objective To investigate the value of emergency observation time of chest pain patients for ruling-out myocardial infarction by using high-sensitive troponin T. Method Total 1 687 patients with chest pain from December 2015 to August 2016 visiting Sichuan University Huaxi Hospital emergency department were en-rolled.We included 1082 patients who diagnose with AMI finally.We define the time from the start of the chest pain to visiting the emergency as the onset time.We analyzed the level of high-sensitive troponin T of AMI patients at dif-ferent onset time and calculated the rate of patients with hs-cTnT level lower than the conventional hs-cTnT thresh-old of 14 ng/L. Result Among 1082 cases of AMI patients,32 patients with hs-cTnT level below threshold(14 ng/L).The for whose The onset time over 5h was observed in AMI patients with hs-cTnT level over 14 ng/L.Con-clusion AMI can not be excluded in chest pain patients whose hs-cTnT levels below the conventional threshold value of 14 ng/L,and these people should be dynamically monitored for 5h in emergency department.The patients can exclude AMI if the hs-cTnT levels are below 14 ng/L after 5 hours.

Effect of ulinastatin on lung function in pediatric patients undergoing cardiopulmonary bypass:a meta-a-nalysis / 临床麻醉学杂志

Objective To systemically review the effect of ulinastatin on lung function in pediatric patients undergoing cardiopulmonary bypass.Methods PubMed,Embase,Cochrane Controlled Trials Reg-istry,China National Knowledge infrastructure,China Biology Medicine disc,VIP and Wanfang databases were searched from their inception to October 2015.Articles regarding the use of ulinastatin on lung function in patients undergoing cardiopulmonary bypass were searched.Studies were screened by two independent re-viewers and then the data were extracted.The methodological quality was evaluated according to the inclusion and exclusion criteria.Meta-analysis was then performed using RevMan 5.1 software. Results Nineteen eligible studies (n = 657 patients)were identified.The results of meta analysis showed that ulinastatin could improve the oxygen partial pressure(SMD=0.90,95%CI 0.52-1.28,P <0.01)and oxygenation index (SMD=1.01,95%CI 0.45-1.56,P <0.01),decrease the PA-a O2 (SMD= -0.87, 95%CI -1.70--0.03,P =0.04),reduce the respiratory index (SMD=-0.81,95%CI -1.51--0.11, P =0.02),Lower the airway peak pressure (SMD=-0.83,95%CI -1.18--0.48,P <0.01),improve the dynamic compliance (Cd)(SMD=1.10,95%CI 0.57-1.62,P <0.01),and shorten the breathing ma-chine ventilation time (SMD=-0.98,95%CI -1.59--0.36,P <0.01).Conclusion This meta-analysis showed that ulinastatin treatment had a certain degree of protective effects on lung function in pediatric pa-tients undergoing cardiac surgery with CPB,but further research was needed for all these studies which were not multicenter,strictly controlled.

Comparison of short-term effects by anterolateral deltoid approach or delto-pectoral approach for proximal humerus fractures / 重庆医学

Objective To compare the short-term effects of proximal humerus fractures by deltoid approach or delto-pectoral approach .Methods The clinical records of 53 patients with proximal humeral fracture for two kinds of different treatment were re-viewed :delto-pectoral approach with anatomical form plate(delto-pectoral group ,24 cases) or anterolateral deltoid approach with locking proximal humerus plate (anterolateral deltoid approach group ,29 cases) from May 2008 to May 2013 .The length of inci-sion ,bleeding volume ,postoperative painscores ,union of fracture time ,incidence of complications ,pain and function of shoulder score (Neer scores) were compared and recorded .Results All the patients were followed up for 6 - 24 months(mean 16 .3 month) , and all patients obtained bone union .The anterolateral deltoid approach was significantly higher than delto-pectoral approach in the operation fime ,the bleeding volume ,postoperative painscores ,union of fracture time ,pain and function of shoulder score(after a month)(P 0 .05) .By delto-pectoral approach ,there were 2 cases with delayed wound healing ,3 cases underwent the loosening of screw ,4 cases humerus head varus and 2 cases necrosis of head of humerus ,with the rate of complications of 45 .8% .On the other hand ,deltoid approach group were 2 cases underwent screw cutting and 2 cases humerus head varus ,with the rate of complications of 13 .8% (P< 0 .05) .Conclu-sion The clinical results of anterolateraldeltoid approach group with locking proximal humerus plate had the advantage of reliable fixation ,less suffering ,less surgical trauma and less complication ,which was better the short-term effects than delto-pectoral ap-proach with atomical from plate .