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Objective To evaluate the application effect of mini-clinical evaluation exercise (Mini-CEX) in the clinical teaching of orthopedics. Methods A total of 60 students who finished their orthopedics internship in Renji Hospital of Shanghai Jiao Tong University from January 2017 to July 2017 were in-volved and randomly divided into the experimental group and the control group with 30 students in each group. The experimental group received Mini-CEX while the control group received traditional lessons. Sur-veys and tests were conducted after the internship and the results were recorded. All statistical analyses were performed with the independent sample t test and Chi-square test using SPSS software (version 21.0). Results Except for communication skills, the medical counseling skills, physical examination skills, humanistic qualities, clinical diagnosis, organization and overall clinical competence were higher in the experimental group than in the control group and the difference was statistically significant (P<0.05). The improvements in clinical diagnosis ( χ2=6.674, P=0.036), professional knowledge and skills ( χ2=6.455, P= 0.040), clinical practice skills ( χ2=6.673, P=0.036) and satisfaction ( χ2=6.881, P=0.032) were greater in the experimental group than in the control group and the difference was statistically significant (P<0.05). No significant difference was observed in the inspiration of learning interest(χ2=4.025, P=0.134) and the improve-ments in language proficiency ( χ2=4.993, P=0.085), medical history acquisition ability ( χ2=1.564, P=0.458), humanistic qualities ( χ2=2.982, P=0.255) and teamwork ( χ2=2.651, P=0.266) between the two groups. Conclusion Mini-CEX not only achieves higher satisfaction but also helps students to improve their pro-fessional knowledge and skills, clinical diagnosis and clinical practice skills. Besides, Mini-CEX in the clinical teaching of orthopedics can effectively improve the quality of teaching and the satisfaction of students, thus providing a new teaching mode worthy of popularization.
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Objective To evaluate the application of scenario-based training and medical simulator in the orthopedics education. Methods A total of 60 students from Shanghai Jiao Tong University School of Medicine who finished their orthopedics internship from January 2016 to July 2016 were involved. They were randomly divided into the study group and control group with 30 students each. The study group re-ceived 2 classes of scenario-based training and medical simulator assisted education during their internship in the orthopedics department while the control group received 2 classes of traditional lessons instead. Sur-veys were conducted after the internship and the scores of internship were also recorded. Result The overall satisfaction was higher in the study group than the control group [(8.6±0.6) vs. (8.1±0.5), P=0.001]. On the part of learning interest, clinical thinking, clinical practice and group working, the study group also received better evaluation (P<0.05). The study group achieved better scores in the final examination than the control group [(84.4±2.6) vs. (82.5±3.4), P=0.018]. Conclusion The combination of scenario-based training and medical simulator can improve the ability of medical students in the orthopedics education, and receive higher satisfaction.
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Objective:To explore therapeutic effect of felodipine combined atorvastatin on aged patients with isolated systolic hypertension (ISH).Methods:A total of 176 aged ISH patients were selected from our hospital from Mar 2012 to Jan 2014. They were randomly and equally divided into felodipine group (only received felodipine and other routine therapy)and combined treatment group (received atorvastatin based on treatment of felodipine group),both groups were treated for 12 weeks.Levels of systolic blood pressure (SBP),diastolic blood pressure (DBP),pulse pressure (PP),fore brachial artery endothelium dependent diastolic-systolic function (FMD),nitric oxide (NO), high sensitive C reactive protein (hsCRP)and interleukin (IL)-6 were measured and compared between two groups before and after treatment.Results:Compared with before treatment,after treatment there were significant reductions in levels of SBP,PP,hsCRP and IL-6,and significant rise in FMD and NO level in both groups (P<0.01 all).Compared with felodipine group after treatment,there were significant reductions in levels of SBP [(134.64 ±9.64)mmHg vs.(130.86±9.75)mmHg],PP [(68.57±6.01)mmHg vs.(57.84±5.79)mmHg],hsCRP [(11.94±2.95)mg/L vs.(7.47±1.97)mg/L]and IL-6 [(10.64±3.85)mg/L vs.(5.84±3.11)mg/L],and sig- nificant rise in DBP [(72.64±7.95)mmHg比 (77.94±8.13)mmHg]and FMD [(9.75±2.56)% vs.(12.54± 4.65)%]and NO [(53.74±8.65)μmol/L vs.(86.48±6.84)μmol/L]in combined treatment group,P<0.05 or<0.01. Conclusion:Felodipine combined atorvastatin possesses good therapeutic effect in aged patients with isolated systolic hypertension.It' s help to recovering vascular function and lower inflammatory reactions.
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OBJECTIVE:To provide reference for rational use of antibiotics in the clinic. METHODS:The study quarterly count the dosage of carbapenems,the department distribution of cultured K. pneumonia (271 strains) during Oct. 1st 2013-Sept. 30th 2014,and it’s resistant rates to carbapenems and then investigate the correlation of dosage of carbapenem and drug-resistance of K. pneumoniae. RESULTS:Carbapenem drugs are mainly used in these departments,such as neurosurgery department,ICU and the departments of transplantation and respiratory. Carbapenem-resistant K. pneumonia was also detected in these departments. More-over,with the usage of carbapenem increased by from 64.24% to 360.63%,and the resistant rates of K. pneumonia increased by nearly 10%. CONCLUSIONS:The resistance rates of K. pneumonia is positively related to the amount of carbapenem;the amount control of carbapenems can delay the generation of K. pneumonia.
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Objective To compare differences of SRS-22 scores between male and female AIS patients.Methods From October 2007 to April 2009,298 AIS patients from 7 spine centers completed simplified Chinese edition of SRS-22 questionnaire,including 62 males and 236 females with an average age of 15.7 years old,and the average Cobb angle was 52.8°.Of 62 male patients,34 were from urban areas and 28 rural areas.Among 236 female patients,132 were from urban areas and 104 rural areas.A comparison was conducted in terms of age,Cobb angle,the ratio of urban population to rural population,and the scores of all domains and the subtotal scores of SRS-22 questionnaire between male and female patients.Results There was no difference of age,Cobb angle and the ratio of urban population to rural population between male and female patients(P＞0.05).The scores of four domains and subtotal scores of SRS-22 questionnaire were significantly higher in male patients when compared with female patients(P＜0.05).Conclusion Gender difference should be taken into the consideration when estimating the quality of life in AIS patients by SRS-22 questionnaire.The quality of life in male patients with AIS was better than that of female patients.
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Objective To establish a paraspinal neural pathway of quadriceps femoris by end-to-end anastomoses between the spinal ventral root after spinal cord injury(SCI) in rats. Methods Twenty-fourweek old SD rats, with the weight of 120 g to 150 g, were included. The left side was the experimental side, while the right side served as a control. Electrostimulating of L1-L5 ventral root was done respectively to decide the predominant nerve of quadriceps femoris. The lumbar 1 ventral root was reveal to little innervation of quadriceps femoris, and the lumbar 3 ventral root was predominant innervation. End-to-end anastomosis between the left L1 and L3 ventral root was done. After axona regeneration, the new paraspinal neural pathway of quadriceps femoris was established. At 6 months postoperatively, the early function of the new pathway was observed by electrophysiological examinations, hindlimb locomotion and BBB (basso, beattie and bresnahan)scale at 1,3,7, 14,21,28 d after SCI. Results Sixteen rats survived for 6 months after operation and only ten rats got good results because of tissue adhesion postoperatively. Single stimuli (2.5 mA,0.2 ms, 1 Hz) of the left anastomoses nerve resulted in action potential recorded from the left quadriceps femoris before and after the spinal cord hemisection horizontally between L2 segmental levels. The amplitudes of the action potentials were (7.63 ± 1.86) mV and (6.00 ± 1.92)mV, respectively, and there was no significant difference (P ＞ 0.05). The left quadriceps femoris contraction was initiated by single stimuli (2.5mA, 0.2 ms, 1 Hz) of the left anastomoses nerve. After paraplegia, when the right L3 ventral root was stimulated, the amplitude of the action potential was (15.87 ± 1.16) mV. Locomotion of the left hindlimb was partially restored after spinal cord hemisection while creeping and climbing. According to BBB scale, there was significant difference at 1, 3, 7 d, and little difference at 14, 21, 28 d after SCI. Conclusion Spinal ventral roots cross-ananstomosis to reconstruct the paraspinal pathway of quadriceps femoris after SCI is efficient reinnervation of hindlamb muscles in a rat model and may have potential in clinical application.
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BACKGROUND: Traditional anterior release followed by posterior correction and fusion is frequently used to treat severe and rigid adolescent idiopathic scoliosis, which is considered as Cobb angle of the major curve > 65° and flexibility < 34.5%; however, there are a great majority of complications. Whether isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion may provide better effects on severe and rigid adolescent idiopathic scoliosis needs to be further studied.OBJECTIVE: To evaluate isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion for the treatment of severe and rigid adolescent idiopathic scoliosis. DESIGN: Case analysis.SETTING: Department of Orthopaedics, Renji Hospital, Medical College of Shanghai Jiao Tong University.PARTICIPANTS: Twenty patients with severe and rigid adolescent idiopathic scoliosis, including 8 males and 12 females, were selected from Department of Orthopaedics, Renji Hospital, Medical College of Shanghai Jiaotong University from June 1999 to August 2005. They were 12-18 years old, and the mean age was 14.6 years. All patients were finally diagnosed as X-ray of whole spine. According to King-Moe criteria, patients were classified into type Ⅰ(n =4), type Ⅱ(n =6), type Ⅲ (n =5), type Ⅳ(n =3) and type Ⅴ(n =2). Before surgery, mean Cobb angle of the major curve was 82° (75°-92°), mean flexibility was 30% (20%-40%), and mean shoulder height difference was 15 mm (5-35 mm). Moreover, according to Risser syndrome, patients were classified into degree 1 (n =3), degree 2 (n =5), degree 3 (n =6), degree 4 (n =5) and degree 5 (n =1). All patients and their relatives provided the informed consents, and the experiment was approved by the local ethical committee. Artificial bone was Osteoset provided by Wright Company, USA.METHODS: Patients underwent isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion, and spinous process, lamina of vertebra, zygapophysial joints and transverse process were exposed in a preconcerted fusion area. Pedicle screw was inserted into strategy vertebra using free hand technique according to the anatomic landmark of entry point. Six patients underwent fixation with TSRH system, and the other patients with CDH M8 system. Operative time and blood loss were evaluated after surgery. At 7 days after operation, Cobb angle was measured with X-ray, and correction rate of major curve was calculated. While shoulder height difference and admission duration were evaluated simultaneously. Complications and recovery states were followed up in the next 4 years.MAIN OUTCOME MEASURES: ① Operative time and blood loss; ② Cobb angle and correction rate of major curve; ③ shoulder height difference and admission duration; ④ follow-up results.RESULTS: All 20 patients were included in the final analysis. ① Operative time and blood loss: Operative time lasted from 3.2 to 4.3 hours, and the mean time was 3.5 hours. Blood loss ranged from 660 to 1 070 mL, and the mean loss was 865 mL. ② Cobb angle and correction rate of major curve: Cobb angle of the major curve ranged from 82° (75°-92°) before surgery to 31° (22°-37°) after surgery, and the mean correction rate was 62%. ③ Shoulder height difference and admission duration: Mean should height difference before surgery was 15 mm (5-35 mm). Postoperative lateral film of spine indicated that thoracic and lumbar vertebra generally suffered from normal posterior and anterior convexity, and mean shoulder height difference after surgery was 7.5 mm (0-11 mm). The admission duration lasted from 8 to 11 days, and the mean duration was 9 days. ④ Follow-up results: All patients were followed up in the next 4 years after surgery. The cobb angle correction of major curve remained unchanged, and the instrumented segments were completely fused without instrumentation failure.CONCLUSION: Isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion may effectively cure severe and rigid adolescent idiopathic scoliosis, which is considered as Cobb angle of the major curve between 75° and 92° and flexibility ≥ 20%.
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This study was aimed to develop the personalized finite element model (FEM) of spine of a scoliotic adolescent. We derived the data of spine of a scoliotic adolescent using spiral computed tomography. Then by using a series of computer aided design (CAD) software, the patient-specific 3D finite element model of spine of a scoliotic adolescent was developed. Results show the 3-D FEM of spine of AIS adolescent was established according to patient-specific geometric parameters. The model had an appearance similar an reality. We concluded that the way in this study is an exact and effective one to develop the FEM of spine of scoliotic adolescent. It is possible to analyze and research the biomechanical behavior of the scoliotic spine using the personalized FEM.
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Adolescent , Humans , Male , Biomechanical Phenomena , Finite Element Analysis , Image Processing, Computer-Assisted , Methods , Imaging, Three-Dimensional , Models, Anatomic , Scoliosis , Diagnostic Imaging , Pathology , Spine , Diagnostic Imaging , Pathology , Tomography, Spiral ComputedABSTRACT
At present, doctors discuss the situation of scoliosis patients mainly through their x-ray photograph. Because of the complexity of human spine structure, it is very difficult for doctors to plan & simulate operation or instruct design of scoliosis bracket only through the x-ray photograph of patient. In this paper, the technology of forming an STL file from CT data was introduced. The solid model of a scoliosis patient was reconstructed and transferred to RPM system. A human scoliosis model with all spine anatomical structure was manufactured using laminated object manufacturing (LOM). It has important clinical value for doctors to plan & simulate operation, and it is significant for the development of integration of medicine and engineering.
Subject(s)
Humans , Computer Graphics , Computer Simulation , Computer-Aided Design , Imaging, Three-Dimensional , Models, Anatomic , Scoliosis , Diagnostic Imaging , General Surgery , Tomography, X-Ray ComputedABSTRACT
OBJECTIVE: To study the quality of Shuanghuanglian oral solutions from different manufactures. METHODS: The contents of baicalin, chlorogenic acid and forsythin in Shuanghuanglian oral solution on the market were determined by HPLC. The determination was performed on Agilent ZORBAX 80A Extend-C18 (150 mm?4.6 mm,5 ?m) column with column temperature set at 30 ℃. The mobile phase for baicalin consisted of methanol-water-acetic acid (50 ∶ 50 ∶ 1, V/V) at flow rate of 1.0 mL?min-1 and detection wavelength of 274 nm. The mobile phase for chlorogenic acid consisted of methanol-water-acetic acid (20 ∶ 80 ∶ 1, V/V) at flow rate of 0.8 mL?min-1 and detection wavelength of 324 nm. The mobile phase for forsythin consisted of acetonifrile-water (25 ∶ 75, V/V) at flow rate of 1.0 mL?min-1 and detection wavelength of 278 nm. RESULTS: Shuanghuanglian oral solutions from different manufactures conformed to the requirements of the first column of Chinese Pharmacopeia (2005 edition). The content differences of chlorogenic acid in Shuanghuanglian oral solutions were almost 3 times, which may be the cause of the difference of clinical efficacy. CONCLUSION: The minimum detection limit only has been established for the quality standard of Shuanghuanglian oral solution. It is suggested to improve the quality standard of Shuanghuanglian oral solution.
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0.70,and the Cronbach's ? value for satisfaction of management domain was 0.44.The ICC of the SRS-22 questionnaire,0.94,0.86,0.77,0.74,0.84,showed a satisfactory reproducibility.Five public factors were obtained by factor analysis compared with the five domains of SRS-22 questionnaire.For the concurrent validity,5 domains had excellent correlation,9 had good correlation,and 26 had correlation.CONCLUSION:The adapted simplified Chinese version of the SRS-22 questionnaire has satisfactory reliability and concurrent validity,and might be suitable for post-operative clinical evaluation of Chinese adolescent scoliosis patients.
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[Objective]To discuss the diagnosis and treatment method of scoliosis associated with Chiari malformation.[Method]Twelve patients were suffered from scoliosis associated with Chiari malformation,in which there were 7 patients also complicated with syringomyelia.Firstly,posterior suboccipital craniectomy to enlarge foramen occipital magnum was performed,then the patients underwent the scoliosis correction with instrumentation.[Result]Preoperatively,the mean Cobbs angle on the coronal plane was 71?,and 24? postoperatively,with an average correction of 66%.During a follow-up from 1 year to 4 years,there were no release of the hook,no breaking of pedicle screw,no false articulation and no new nervous lesion,while few improving was found about the sensory disability and superficial abdominal hyporeflexia.[Conclusion]We should first consummate the examination and make a definite diagnosis for the patients who were suffered from scoliosis associated with Chiari malformation and syringomyelia;posterior suboccipital craniectomy to enlarge foramen occipital magnum or syrinx-subarachnoid space shunting should be performed firstly to reduce nervous lesion during scoliosis correction surgery.
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BACKGROUND: Most of the scoliolosis patients with Marfan syndrome are young, and in the growth and development period. Scoliosis develops rapidly, so a great number of patients need operation. Many patients accompanied with severe cardiorespiratory disfunction, which brings about a great difficulty for operation.OBJECTIVE: To observe the effect of CD orthosis on spinal function of patients with Marfan syndrome.DESIGN: A self-control observation.SETTING: Department of Orthopaedics, Renji Hospital Affiliated to Medical College, Shanghai Jiao Tong University (i.e. Shanghai Second Medical University).PARTICIPANTS: A total of 8 severe scoliolosis patients with Marfan syndrome who were treated at Department of Orthopaedics, Renji Hospital Affiliated to Medical College, Shanghai Jiao Tong University (i.e. Shanghai Second Medical University) were enrolled from May 1999 to July 2003. Of them, there were 2 one-side curvatures, 6 two-side curvatures; 4 cases of cardiorespiratory function lost lightly, 2 cases midrange lost. Mean Cobb angle was 88°.METHODS: The patients were at prone position under general anesthesia.Incision was made at middle posterior after fixing the position. Erector spinal muscle beneath periosteum was stripped and vertebral plate to transverse process root was revealed. Claws or nails were used in multiple segments of vertebrae by CD orthosis such as CD, CD-Horison, TSRH, USS and so on.MAIN OUTCOME MEASURES: Changes of Cobb angle, height, grafting bone fusion and cardiorespiratory function of patients after operation.RESULTS: After 12-month follow-up, 8 patients were involved in the result analysis. The incision of 8 patients was healed, no infection. Scoliolosis was corrected effectively, and the height increased by 5-8 cm. Cardiorespiratory function recovered satisfactorily after operation. Grafting bone was fused. The lost Cobb's angle was less than 25° after correction.CONCLUSION: CD orthosis can correct the lateral curvature and effectively correct that of patients combined with rotational deformity, consisting of large distraction, multiple segment frame style fixation, average distributed force placement, so it is not easy to have the complications such as release, broken stick and so on. Selective multiple segment fixation and derotation are adopted, so good three-dimension correction is gained, which can reconstruct satisfactorily trunk balance, prevent post-operative loss,with less complication, high fusion rate, less correction lost. External fixation is not needed after operation, which is helpful for early rehabilitation.
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Objective The purpose of this study was to evaluate the relationship between the initial X-ray display and prognosis of intracapsular fractures of the proximal humerus, and to probe a new criterion which can accurately predict the prognosis of the fracture. Methods Between April 1999 and February 2004, 459 cases of intracapsular fractures of the proximal humerus were treated conservatively, among which 211 cases had completed at least 9 months of follow-up and their complete data were available(mean age, 54.2 years; minimum, 17 years; maximum, 81 years; 82 males, 129 females), all the patients were followed up for 1.7 years on the average (ranging from 9 months to 3 years). According to the original X-ray, the fractures were classified by Neer classification. There were 68 cases of one part fractures, 39 cases of two parts fractures, 59 cases of three parts fractures and 45 cases of four parts fractures. The original X-ray and that of at least 9 months postoperatively of every case were assessed by seven structured standards and studied the relationship between the standards and prognosis. The seven standards are listed as follow: Neer classification; the length of the medial side of proximal humerus; displacement between humeral head and shaft; displacement of greater tuberculosis relative to shaft; displacement of medial cortex in fracture site; glenohumeral dislocation and humeral head split. Results 79% of the cases with a length of the medial side of proximal metaphyseal less than 8 mm, and 84% case with medial cortex displacement over 2 mm and 68% of Neer four-part fractures have a poor prognosis. The prognostic significance of predictors were listed as follow: the medial cortex displacement more than 2 mm (accuracy, 0.85), the length of the medial proximal metaphyseal less than 8 mm (accuracy, 0.83), Neer four-part fractures (accuracy, 0.76), Neer three-part fractures (accuracy, 0.72), glenohumeral dislocation (accuracy, 0.64), head-split components (accuracy, 0.64), displa-cement of the head more than 10 mm (accuracy, 0.54). Conclusion The new criterion provides a precise pr-ognosis prediction for intracapsular fractures of the proximal humerus thus it may be helpful in selecting a proper procedure.
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Objective: To study the effects of TCFC on proliferation and osteogenic action of osteoblast in neonatal rat calvaria cultures in vitro. Methods: Osteoblasts were isolated from neonatal rat calvaria through trypsin and collagenase digestion. The proliferation and collagen synthesis were assayed by 3H TdR and 3H proline incorporation. The activity of ALP was measured by p nitrophenyl sodium phosphate assay. The ipriflavone was used as positive control drug.Results: TCFC significantly promoted bone cell proliferation, alkaline phosphatase activity and collage synthesis.Conclusion: TCFC had the anti osteoporosis action by promoting osteoblast proliferation, ALP activity and collage synthesis.