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Objective:To analyze the health development plans of the provinces in China during the " 14th Five-Year Plan" , and explore the key tasks, similarities and differences of health informatization construction in each province.Methods:Using the website of local people′s government and the official website of the provincial Health Commission, 27 copies of health development plans of various provinces during the " 14th Five-Year Plan" period were retrieved and collected from February 16 to June 5, 2022. The relevant statements of health information in the plan were extracted, content analysis was used to reveal the structural characteristics of the policy in the form of word frequency statistics, and discourse analysis was used to study the policy content.Results:The health information policies of 27 provinces during the " 14th Five-Year Plan" period could be summarized as 10 major themes, such as accelerating the construction of hierarchical diagnosis and treatment system, promoting the high-quality development of public hospitals, and deepening the reform of medical security system. The health information policy in the eastern, central and western regions was relatively clear, and there were certain differences in the construction points according to their own characteristics.Conclusions:During the " 14th Five-Year Plan" period, the policies of each province around the field of health information are well defined, and the core structure and content are similar. The distribution of key points in the eastern region is relatively balanced; the construction of health information in the central region is more prioritized and prominent; the construction of health information in the western region is focused on complementing the weak links and weaknesses.
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Objective:To evaluate the safety and effectiveness of Kangduo endoscopic surgical robot system for partial nephrectomy.Methods:Consecutive patients with stage T 1 renal tumor meeting the inclusion criteria from the Department of Urology, Peking University First Hospital from December 2020 to February 2021 were prospectively enrolled. All patients underwent partial nephrectomy with the Kangduo endoscopic surgical robot system after signing the informed consent. Clinical data including preoperative, perioperative and postoperative pathology and follow-up were collected. Results:Among the 26 patients, there were 16 males and 10 females, with a median age of 53(33-74) years, and a median body mass index of 25.99(20.90-32.91) kg/m 2. There were 12 cases of left kidney tumor and 14 cases of right kidney tumor. The median tumor diameter was 2.2(1.0-3.5) cm. The median time of warm ischemia was 17.7(7.1-29.2) minutes, and all of them were less than 30 minutes. The median docking time was 4.7(2.3-9.9) minutes, and the median time of robotic arm operation was 65.0 (37.0-155.0) minutes. The median National Aeronautics and Space Administration Task Load Index (NASA-TLX) score was 5.3 (2.0-28.0), and no instrument-related adverse events occurred intraoperatively. The median postoperative hospital stay was 4 (4-5) days. All tumor margins were negative on pathologic reports. No Clavien Ⅱ stage operative complications occurred in all patients during perioperative period and 1 month after the surgery. Conclusions:The partial nephrectomy using the kangduo endoscopic surgical robot system were completed successfully, and no instrument-related adverse events and complications occurred, showing that this surgical system used for partial nephrectomy is safe and effective.
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Objective: To investigate the short-term effectiveness of three-dimensional (3D) printed trabecular metal pads for Paprosky type Ⅲ acetabular defect in hip revision. Methods: Between August 2014 and December 2015, the 3D printed trabecular metal pads were used to repair Paprosky type Ⅲ acetabular defects and reconstruct the annular structure of the acetabulums in 5 cases of primary hip revision. There were 3 males and 2 females, aged from 50 to 72 years, with an average age of 66 years. The time from initial replacement to revision was 10 to 18 years, with an average of 14.4 years. The types of prostheses in primary replacement were non-cemented in 3 cases and cemented in 2 cases. The types of acetabular bone defects were Paprosky type ⅢA in 3 cases and Paprosky type ⅢB in 2 cases. The preoperative Harris score was 34.23±11.67. The height of rotation center of affected hip was (38.17±8.87) mm and the horizontal position was (35.62±9.12) mm. Results: The operation time was 120-180 minutes, with an average of 142 minutes. The intraoperative bleeding volume was 800-1 700 mL, with an average of 1 100 mL. Five patients were followed up 18-24 months (mean, 21 months). At last follow-up, the Harris score was 79.82±8.70, which was significantly higher than that before operation (t=16.991, P=0.000). At 1 week after operation, the abduction angle of acetabular cup was 38-42° (mean, 39.4 °) and the anteversion angle was 13-18 ° (mean, 14.6°). The height and horizontal position of rotation center of affected hip were (22.08±8.33) mm and (29.03±6.28) mm, respectively, showing significant differences when compared with those before operation (P0.05). During the follow-up, there was no complication such as prosthesis loosening, dislocation, or periprosthetic fracture. Conclusion: In hip revision, 3D printed trabecular metal pads can repair Paprosky type Ⅲ acetabular defect, reconstruct the structure of acetabulum, provide a stable supporting structure for the acetabular cup, reconstruct the relatively normal rotation center of the hip joint, avoid iatrogenic bone loss, and achieve satisfactory functional recovery of the hip. The long-term effectiveness needs further follow-up.
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Objective To investigate the relationship between serum 10-hydroxycarbazepine (MHD, the main active metabolite of oxcarbazepine) concentration and oxcarbazepine efficacy and safety, and to optimize rational use of oxcarbazepine. Methods A total of 553 patients were enrolled in a self-controlled and open-label trial to assess the efficacy and safety of oxcarbazepine as monotherapy. The steady state serum MHD trough concentrations after dose were determined by SPE-HPLC. The relationship between MHD level and efficacy were evaluated by logistic regression model and receiver operating characteristic (ROC) curve. Results A total of 498 patients (90.1%) were effective and 404 patients (73.1%) were seizure free after oxcarbazepine monotherapy in this study. The clinical therapeutic range of steady state serum MHD trough concentrations observed in this study was 5 - 20 mg ? L-1 , and the corresponding 95% distribution interval of oxcarbazepine daily dose was 9. 0 -34.5 mg?kg-1?d-1 . Logistic regression results indicated a positive correlation of antiepileptic efficacy with serum MHD trough concentration within 0.9-30.0 mg?L-1 . The ROC area (95% confidence interval) of MHD trough concentration as the predictor for efficacy was 0.964 (0.938- 0.990), which showed accurate predictions. Most of patients whould have good antiepileptic efficacy while the steady-state serum MHD trough concentration remains above 8 mg?L-1 . Adverse effects were observed in 104 patients (18.8%) during oxcarbazepine dose escalation phase, and 23 patients (4.2%) during maintenance phase. There were no severe adverse effects associated with oxcarbazepine in this study. Patients with serum MHD concentrations >20 mg?L-1 were at greater risk of developing adverse effects. Conclusion Oxcarbazepine therapeutic efficacy and safety are associated with MHD trough level closely, so it is necessary to monitor MHD concentration.
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Objective To evaluate the probability that strong ion gap was selected as predictive factor of mortality in patients with a -cute respiratory failure.Methods SIG was calculated with the Stewart -Figge model, after determination of blood gas ,blood pH,serum electrolytes.Results ①The incidence of acute respiratory distress syndrome and source pulmonary edema was 26% respectively in pa-tients with ARF.②There was a significant difference in the values of K +、Cl-、HCO3-、AG、pH、ALB、SIG、Cr,lactic acid,PaCO2 and PaO2 between group T 1 and control .However , there was no significant difference between recovery group T 2 and control .③There was a signifi-cant difference in the value of AG and SIG between the recovery group T 1 and death group T 1 from the patients with ARF .④SIG was a better predictor than AG by the evaluation of ROC curve .Conclusions AG and SIG can reflect the worse condition of acid -base disturb-ance in patients with ARF sensitively at the first beginning .Meanwhile , SIG may be served as a predictor for risk of mortality in patients with ARF better than AG .
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Objective To investigate the clinical application value of strong ion gap(SIG)generated by the third generation equa-tion following pH and the anion gap(AG)in critically ill patients.Methods On the basis of the determination results of blood gas and blood biochemistry,the equation in the Stewart-Figge methodology was adopted to calculate SIG.Results (1)There were sta-tistically significant differences in K+ ,Na+ ,HCO3 - ,AG,pH,PO4 3 - ,ALB,SIG and Cr between the critical illness groups and the control group(P <0.05).(2)The SIG mean value ratio the death group to non-death group was 3.04,the difference was the big-gest,P <0.05,AG and Cr took the second place.Conclusion SIG as a new indicator in combination with other biochemical and blood gas indicators,such as the HCO3 - ,AG,pH,PO4 3 - ,Cr and lactic acid can reflect the situation of the acid-base disorders in critically ill patients and plays a strong indicative role in predicting the disease development trends.
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In September 2012, the Assessment for Ethics Review of Traditional Chinese Medicine (TCM) Re-search with Human Participants (named CAP, Chinese medicine assessment human research protection system) was officially commissioned to the World Federation of Chinese Medicine Societies to organize by the State Ad-ministration of TCM. Through the assessment of 20 medical institutions, a comprehensive analysis on ethical re-view platform was conducted. Combined with current regulatory system of ethics in the U.S., this article discussed independent assessment on important CAP features of local brands, the practice and benefit of construction pro-motion based on assessment and continuous improvement, as well as the importance of vigorously promote CAP assessment .
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Objective To evaluate the early kindney injury by means of urinary protein/creatinine ratio(TPCR,200mg/g Cr)through group-discrimination in mellitus diabetes patients. Methods Qualitative analysis was carried out with urine 5~6 item indexes in 113 cases of diabetes mellitus ,61 cases of heallthy people and other 67 cases of diabetes mellitus patients. 2 groups were divided by means of urinary protein/creatinine ratio(TPCR,200mg/g Cr).Results In 113 cases of diabetes mellitus ,urine TPCR,mAlb,?2-MG,LAP and AFU of 38 cases in TPCR≥200mg/g Cr group were significantly higher than those of 75 cases in TPCR
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Objective To Investigate the application value of strong ion gap(SIG),anion gap(AG)and other four indicators in the trauma disease.Methods Blood was taken from trauma patients admitted to hospital immediately,with the heparin anticoagulation,misce bene.Blood gas was measured.Creatinine(Cr),phosphorus and albumin(ALB)was measured simultaneously.Results Betwean traumatic group and control group,there was signifrcant difference in SIG,AG,potential HCO3-,and other 5 item(P4mmol/L.
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Objective To discuss the feasibility of minimally invasive drainage tube placement and tee-junctions irrigation for the treatment of chronic subdural hematoma. Methods Transcranial drainage and closed tee-junctions irrigation was carried out under local anesthesia in 31 cases of chronic subdural hematoma by using self-made trocar and osteotome. Results All the patients had been completely freed of the disease, without pneumocephalus. Follow-up for 3～6 months revealed no recurrence. Conclusions Minimally invasive tube placement and tee-junctions irrigation for chronic subdural hematoma is feasible. It not only clears away the lesions thoroughly, but also prevents the pneumocephalus effectively.
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Researching and discussing the significance,principle,method and ethical conception of triage of casualties during earthquake.In particular,explaining the relationship between triage efficiency and aid impact;Pointing principles in Triage.At last,affirming the exigent importance of education of triage and giving some advie.
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This paper affirms that physician-patient relationship is the most important and fundamental relationship in medical activities.But nowadays there are some unpleasant factors arising in the physician-patient relationship,which have become severe intractable problems and heated social issues to be resolved as soon as possible in the development of Chinese society and healthcare career.Traditional Chinese Medicine contains a lot of information about medical ethics and humanism spirit of medicine.There are also many theories on how to build up a harmonious physician-patient relationship and many viable methods to solve the problems.Analysis of the physician-patient relationship nowadays and exploration of the T.C.M quintessence will help to build up a harmonious physician-patient relationship with Chinese characteristics for the construction of a harmonious society.