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Objective:To study the safety, validity and practicability of the modified trans-cricothyroid needle electrode method for neurmonitoring during thyroidectomy.Methods:115 patients from the Department of Thyroid Surgery in Peking University Shenzhen Hospital scheduled for thyroid surgery were recruited into the group. Two paired needle electrodes were obliquely inserted into the cricothyroid membrane from the angle between the rectus cricothyroid muscle and the inferior margin of thyroid cartilage. The function of recurrent laryngeal nerve (RLN) was localized, exposed and evaluated by standard four-step method (V1-R1-R2-V2) . The vocal cord movement was evaluated by electronic laryngoscope before and after operation, and t-test was used to compare the difference of EMG signal amplitude before and after operation.Results:A total of 130 RLN from 115 patients were recorded effective electromyographic (EMG) signals, including 12 cases of giant goiter with tracheal compression stenosis; 13 cases had repeated adjustments of the position of tracheal intubation electrode during operation, but EMG signals were not satisfactory; 15 cases were with of accidental findings during operation and requiring neurmonitoring, but tracheal intubation electrodes were not used in advance. 75 cases were volunteers. The signals of 3 RLN were lost during operation. On the second day after operation, electronic laryngoscope showed that 2 cases had normal vocal cord movement and 1 case had vocal cord paralysis and no recovery for 6 months follow-up. The EMG signals of other 127 nerves were V1/R1=1857±1718μV/2347±2323μV, V2/R2=1924±1705μV/2450±2345μV. There was no significant difference in EMG signals between pre-operation and post-operation ( t=0.31/0.35, P=0.755/0.725) . The electronic laryngoscope showed normal vocal cord movement before and after operation. During the operation, 2 patients had a little bleeding at the needle electrode insertion point, which stopped after 5 minutes of compression. No electro-acupuncture breakage, infection or local hematoma occurred. Conclusions:The modified trans-cricothyroid needle electrode method had been proved to be safe and feasible for evaluating the function of recurrent laryngeal nerve in thyroid surgery. Besides of unaffected by tracheal conditions, it has good stability, simple implantation and low cost. In thyroid surgery, it can be used as a useful supplement to endotracheal intubation electrode.
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Objective The policy of quota payment for specific diseases has been carried out at the hospital for several years, yet proven a failure. This paper aims at searching for a new way of management.Methods Since 2013,attempts have been made for classification of medical costs and the quota setting for specific diseases, and for development of a real-time supervision software for classification of disease-specific costs.The attempts prove a success with a new model for management of quota management for specific diseases.Results This practice has proved to be effective in 2014,and used in other likewise diseases,which has been embraced by administrators of medical insurance sector. Conclusion This model proves useful for reducing inpatient expenses and regulating medical behaviors. but also shorten the average hospitalization days,improve the satisfaction of patient.The method of management control can be expanded and imitated.
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BACKGROUND:Articular cartilage injuries can result from a variety of causes. Conventional therapy cannot obtain the optimal clinical results. Low-intensity pulsed ultrasound has been shown to promote the repair of injured articular cartilage. OBJECTIVE:To investigate the effects of low-intensity pulsed ultrasound on the repair of injured articular cartilage. METHODS:Twenty New Zealand white rabbits were used to establish knee arthritis models and equal y randomized into study and control groups, respectively. Rabbits in the study group received low-intensity pulsed ultrasound treatment, and sham low-intensity pulsed ultrasound treatment was given in the control group. At 8 weeks after treatment, pathological change and histological scores in articular cartilage tissue col ected from both groups were determined. Moreover, the ultrastructure and type II col agen expression of chondrocytes were determined. Matrix metal oproteinase-13 mRNA expression was detected by quantitative real-time PCR. RESULTS AND CONCLUSION:At 8 weeks after treatment, toluidine blue staining showed a disordered arrangement of cel s, decreased number of cartilage cel s in each layer and cluster in the control group. Light disordered arrangement of cel s, decreased appearance of the superficial layer cel s and the cluster phenomenon were observed in the study group. Articular cartilage tissue scores were significantly decreased in the study group compared with the control group (P<0.05). The chondrocytes were smal , enlarged intracel ular mitochondria and rough endoplasmic reticulum, cytoplasmic swel ing, col agen fibrils coarse, wel developed Golgi apparatus, and nuclear fragmentation were observed in the control group. In addition, the normal structure of organel es disappeared and cel degeneration was observed in the control group. In the study group, the size of chondrocytes and the Golgi complex and other organel es were normal, and the protein polysaccharide granules were observed in the cytoplasm and membrane. The mRNA expression of matrix metal oproteinase-13 in the study group was significantly lower than that in the control group (P<0.05). Type II col agen immunoreactivity in the study group was stronger than that in the control group. No incision infection, suppuration, red swel ing appeared in al rabbits. Our results suggest that low-intensity pulsed ultrasound can be used for the treatment of articular cartilage injury by al eviating the degradation of col agen type II and inhibiting the expression of matrix metal oproteinase-13.
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BACKGROUND:Current clinical studies seldom concern biomechanical properties of lateral plate combined with medial percutaneous lag screw. Moreover, effects of clinical application to distal tibial fractures are not investigated. OBJECTIVE:To explore biomechanical properties of lateral plate combined with medial percutaneous lag screw, and to analyze the repair effect on distal tibial fractures. METHODS:Six adult antiseptic tibia specimens were studied. Bone saw was used to make a bone defect in 1 cm length, which was fixed with lateral plate and lateral plate combined with medial percutaneous lag screw. Three point bending test, axial compression test and rotation test were performed. Clinical data of twenty cases of distal tibial fracture patients from the Department of Orthopedics of Hebei Medical University were analyzed and randomly divided into lateral plate groupand lateral plate combined with medial percutaneous lag screw group (n=10). Clinical repair effects were compared between the two groups. RESULTS AND CONCLUSION:(1) Biomechanical indexes of cadaver specimens: no significant difference in torsional strength was determined between the two groups (P> 0.05). Bending stress and axial displacement were significantly lower in the lateral plate combined with medial percutaneous lag screw group than in the lateral plate group (P< 0.05). (2) Repair surgery related indicators: operation time, intraoperative blood loss, length of stay and fracture healing time were significantly less in the lateral plate combined with medial percutaneous lag screw group than in the lateral plate group (P< 0.05). (3) Repair effects: There were nine cases of fracture healing in the lateral plate combined with medial percutaneous lag screw group 3 months after treatment. The total effective rate was significantly higher in the lateral plate combined with medial percutaneous lag screwgroup (90%) than in the lateral plate group (70%) (P<0.05). (4) These findings indicate that lateral plate combined with medial percutaneous lag screw has a unique advantage in resisting axial compression, torsion and bending. Its application to distal tibial fractures obtains ideal effects, can improve the clinical efficacy and stability.
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Objective: To investigate effective matching between computerized physician order entry and charging items in the hospital. Methods: Standard data of computerized physician order has been established, in which physician order items and charging items have been matched. It has effectively solved the problems in the process of computerized physician order entry. Results and Conclusion: The implementation of matching computerized physician and costs has effectively controlled the errors and missing of costs, which released the complaint of patients and received the good reputation and welcome, the compliance of doctors using computerized physician order entry has been obviously improved, meanwhile, it has provided new application experiences for implementing the following charging of national medical services prices in hospitals.
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BACKGROUND:Vertebral metastatic tumor often occurs in the thoracolumbar segment, and it is difficult for internal fixation due to the complex anatomical position. OBJECTIVE:To evaluate the stability of lumbar vertebra in the patients with single thoracolumbar vertebral metastases after treated with artificial vertebral placement and internal fixation. METHODS:Sixteen patients (9 male and 7 female) with single thoracolumbar vertebral metastases treated in the Department of Orthopedics, the Fourth Hospital of Hebei Medical University from January 2006 to January 2009 were selected, and the age ranged 40-74 years, averaged 52 years. Before treatment, al the patients were evaluated according to Frankel classification:A grade in two cases, B grade in three cases, C grade in three cases, D grade in five cases, and E grade in three cases. And the vertebral state of patients was detected with X-ray plain film examination, systemic radionuclide bone scanning, CT and MRI. The T11 vertebral metastases were treated with chest approach artificial vertebral placement and internal fixation, and T12-L2 vertebral metastases were treated with artificial vertebral placement and internal fixation via extrapleural and extraperitoneal space approach. RESULTS AND CONCLUSION:Al the 16 patients were fol owed up for 4-32 months, and the average survival time after treatment was 12 months. After treatment, Frankel classification was C grade in three cases, D grade in five cases and E grade in eight cases. The visual analog scale score was decreased from (6.22±1.31) before treatment to (3.25±0.94) after treatment, and there was significant difference between two groups (P<0.05). The artificial vertebral placement and internal fixation can restore the stability of lumbar vertebra in the patients with spinal metastases, and thus improving the symptoms and quality of life.
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AIM: Granulocyte colony-stimulating factor and stem cell factor are the important cell factor in the hematopoiesis. According to changes in the cell information conduction and obstruction of the expression of the stem cell adhesion molecule, they can increase the quantities of stem cells, restrain the apoptosis and alter the function of bone marrow mesenchymal stem cells. The experiment was to discover how to isolate and culture the granulocyte colony-stimulating factor and stem cell factor mobilized peripheral blood derived mesenchymal stem cells, and to explore the induction to the cartilage cells in the monolayer culture. METHODS: Experiments were performed at the Hebei Provincical Key Laboratory, Research Center, Fourth Hospital of Hebei Medical University from January 2005 to March 2006. ①The 4-6 weeks male BALB/c mice weighting 15-20 g were provided by Animal Experimental Center of Hebei Medical University. The lab procedure met the animal ethical standard. ②The density gradient centrifugation combined with the adherence method were adopted to isolate the mesenchymal stem cells from peripheral blood of BALB/C mice after granulocyte colony-stimulating factor and stem cell factor mobilization. Detections of colony forming unit-forming ability were preformed on grow well cells. Mesenchymal stem cells were identified by flow cytometry and immunohistochemical method. The 3rd passage mesenchymal stem cells were induced to differentiate into chondrocytes in high glucose DMEM medium containing transforming growth factor beta 1. The expression of type Ⅱ collagen was detected by immunohistochemical method. RESULTS: ①The peripheral blood derived mesenchymal stem cells possessed the similar phenotypes with bone marrow derived mesenchymal stem cells and could differentiate into chondrocytes. Flow cytometry showed that CD29 and CD44 were positive, while CD34 and CD45 of them were negative. ②The passage 3 mesenchymal stem cells did not express type Ⅱ collagen and laminin, expressed vimentin in immunohistochemical method. The differentiated mesenchymal stem cells expressed type Ⅱcollagen ③The passage 1,3,5 mesenchymal stem cells showed different ratios of colony forming unit. Pairwise comparison showed that with the passage increasing, the ratio of colony forming unit degraded gradually (21.32%,16.13%,9.63%,P
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Objective To apply cervical pedicle screw system (CPSS) to treat cervical disorders and discuss its surgical indications, techniques and clinical effectiveness. Methods A total of 52 patients with middle and lower cervical spine lesions who underwent cervical transpedicular fixation were analyzed retrospectively. There were 41 males and 11 females aging from 16 to 62 years. The diagnosis of the patients were fractures and dislocations of cervical spine accompanied by complete paralysis (28 cases) or incomplete paralysis (19 cases) in 47 cases, and metastatic bone tumor in 5 cases. Prior to surgery, anteroposterior and lateral radiographs, CT scan through bone windows, and/or magnetic resonance images were carried out in all patients. During surgery, all screws were inserted into the pedicle under the guidance of lateral or oblique image intensifier to confirm the direction and insertion depth of screws. In 7 to 14 days after surgery, physical examination and roentgenograms evaluations were performed in all patients, and CT scans were obtained in 31 patients, the location of screws were evaluated with the radiographic examinations and CT scan. The follow-up period averaged 13 months (range, 1 to 36 months) in 38 patients. The authors experiences in achieving accurate pedicle screw insertion was introduced, the clinical value of using cervical pedicle screw system to manage cervical lesions was summarized, the possible complications of CPSS were analyzed, the candidates of using CPSS were discussed as well. Results Pedicle screws were inserted successfully in all cases, 9 cases were found to have nerve irritating symptoms by 10 pedicle screws when which were introduced into pedicles, however, by changing the direction of the screws, all symptoms disappeared and screws were successfully inserted. Postoperative radiographic evaluation confirmed proper insertion of screws except 2 screws perforating the lateral pedicle wall but without injury of the vertebral artery demonstrated on CT scans. In the followed-up, no screw breakage and loosening was observed. By applying distractive force between the screws placed into pedicles, the space between the affected vertebrae and discs could be increased, displaced anterior fragments of bone or disc could also be indirectly reduced from the spinal canal, and additional anterior decompression interventions might be avoided. Conclusion CPSS can be considered as one of alternative in posterior cervical internal fixation systems. However, specific caution must be taken. The candidates of utilizing CPSS should be properly selected.