The whole-process tutor management system of residency training based on informatization / 中华医学教育探索杂志

The standardized residency training is an important stage in the training of physicians. Shanghai East Hospital has explored the system of the whole-process tutor management in the residency training. To explore the specific methods of carrying out the whole-process tutor training for residents in the whole hospital, gradually the whole-process tutor system is built with qualification certification, mutual selection of teachers and students, tutor empowerment, plan implementation and assessment and evaluation. Meanwhile, a supporting informatization platform is being developed to provide necessary tool support for the implementation and promotion of the whole-process tutor of residency training. And information tools are used to carry out implementation management, process optimization and quality monitoring, so as to form a closed management loop.

Combination pattern of internal fixation for periprosthesis fractures of the proximal femur after hip replacement / 中华骨科杂志

Objective:To investigate the combination of internal fixation for periprosthetic fractures of the proximal femur (PFFF) after hip arthroplasty.Methods:The data of 58 patients with periprosthetic fractures after hip arthroplasty from May 2008 to March 2022 were retrospectively analyzed, including 31 males and 27 females. The average age was 75.5±18.2 years (range, 35-95 years). There were 39 total hip arthroplasty and 19 hemiarthroplasty; 37 biological prosthesis and 21 cemented prosthesis. Intraoperative periprosthetic fractures occurred in 6 cases and 52 cases postoperatively. Unified classification system (UCS): UCS IV.3A1 type 2 cases, 3A2 type 1 case, 3B1.1 type 19 cases, 3B2.1 type 25 cases, 3B3 type 2 cases, 3C type 9 cases. Fracture site: 3 cases in zone A (greater trochanter), 46 cases in zone B (around the femoral stem), and 9 cases in zone C (distal to the tip of the femoral stem. Internal fixation is composed of primary and secondary fixation, the main fixation method was the cerclage of steel wire or titanium cable, locking compression plate, and locking attachment plate fixation. The secondary fixation method was the cerclage of titanium cable, which was required to cover three zones A, B and C to form an overall balanced fixation. The modified Harris hip scores (mHHS), plate length, working length and screw number of different internal fixation combinations were compared.Results:The follow-up time was 54.2±21.6 months (range, 11-86 months). All patients showed signs of fracture healing at 10.2±1.5 weeks (range, 7-13 weeks) after operation, and bony union was observed at 19.6±1.3 weeks (range, 17-22 weeks) after operation. No delayed union or nonunion was observed. After operation, one case had a stress fracture and was revised with double-plate internal fixation; one case had a failed internal fixation and was revised with double-plate internal fixation and a large allograft bone graft. The mHHS score of UCSIV.3B2.1 group (80.3±4.6) was the lowest at 6 months after operation, and the difference between the groups of different types was statistically significant ( F=256.72, P<0.001). The score of simple internal fixation group (91.6±4.2) was higher than that of revision combined with internal fixation group (81.9±4.1), and the difference was statistically significant ( t=8.32, P<0.001). The plate length and working length were 24.9±2.5 cm and 12.6±1.7 cm for UCS IV.3B1.1, 25.4±2.6 cm and 13.6±1.8 cm for 3B2.1 and 28.1±2.5 cm and 4.9±1.9 cm for 3C, respectively ( F=5.33, P=0.005; F=6.78, P<0.001). The number of screws in zone A was significant difference among different UCS types ( F=52.67, P<0.001); UCS IV.3B1.1 (6.5±2.3) and 3B2.1 (6.7±2.2) were more than 3B3 (3.5±1.5) and 3C (3.7±1.6). The number of screws in zone B was significant difference among different UCS types ( F=42.15, P<0.001); The number of UCS IV.3B1.1 (2.3±1.6) and 3B2.1 (2.8±1.9) were significantly more than that of 3B3 (1.0±0.5) and 3C (1.2±0.6). The number of screws in zone C was significant differences among different UCS types ( F=39.62, P<0.001); The number of UCS IV.3B1.1 (3.8±1.9) and 3B2.1 (3.9±1.7) were more than that of 3B3 (2.0±0.5), the difference was statistically significant ( P<0.05). Conclusion:The function of hip after simple internal fixation of proximal femoral periprosthetic fractures was better than that of those who underwent revision at the same time; the number of screws of UCSIV.B1 and B2 is more than that of B3.

Pedicle screw fixation combined with posterior-lateral fusion with autogenous bone for thoracolumbar burst fractures / 中国组织工程研究

BACKGROUND: Spinal reconstruction plays an important role in the treatment of thoracolumbar burst fractures, but wherther the vertebral fusion can effectively reduce the loss of correction still remains controversial. OBJECTIVE: To investigate the repair effect of pedicle screw fixation combined with posterior-lateral fusion with autogenous bone for thoracolumbar burst fractures.METHODS: Eighty patients with thoracolumbar burst fractures undergoing pedicle screw fixation from January 2011 to June 2015 were enrolled, and were then randomly divided into experimental (posterior-lateral fusion with autogenous bone) and control groups (n=40 per group). The clinical efficacy was assessed according to the operation time, intraoperative blood loss and postoperative drainage volume, wound scale scores, anterior vertebral height and Cobb angle, American Spinal Injury Association impairment scale, and Oswestry dysfunction index.RESULTS AND CONCLUSION: (1) All patients were followed up for 24 months. The operation time, intraoperative blood loss and postoperative drainage volum in the experimental group were significantly more than those in the control group (P 0.05). (3) The American Spinal Injury Association impairment scale and Oswestry dysfunction index scores were significantly improved in the two groups, but had no significant difference between two groups (P > 0.05). (4) These results suggest that pedicle screw internal fixation is effective and safe for thoracolumbar burst fractures. Posterior-lateral fusion with autogenous bone allograft holds a good histocompatibility, but cannot reduce postoperative correction loss, therefore, it is not recommended for vertebral burst fractures.

Application of total parathyroidectomy without autotransplantation in refractory secondary hyperparathyroidism / 中国现代普通外科进展

Objective:To analyze the clinical outcome and feasibility for patients who underwent total parathyroidectomy without autotransplantation (TPTX) for secondary hyperparathyroidism (SHPT).Methods:From April 2012 to December 2015,220 SHPT patients underwent TPTX in the department of Breast and Thyroid Surgery of China-Japan Friendship Hospital.The clinical data and effect were assessed retrospectively.Results:All the 220 patients were on permanent dialysis with mean duration of dialysis (7.93 ± 3.75) years.A durable reduction in mean PTH,Ca and P were observed after TPTX (P＜0.01).The mean hospital stay was (7.8 ± 2.8) days.TPTX produced a rapid improvement in clinical symptoms.Incidence of hypocalcemia was 73.46％.Severe complications such as recurrent laryngeal nerve palsy or inactive dynamic osteopathia,haven't been observed postoperatively.The rate of persistent status (PTH≥300 pg/mL) was 9.1％.One (0.45％) died of infectious shock perioperatively.Conclusions:TPTX was a safe and feasible surgical procedure for patients with SHPT.It was worth of being applied.Not missing the parathyroid during operation was the key point for successful TPTX.Intensive monitoring and maintaining stable normocalcemia were the key point to reduce complication.

First aid training of resident doctors based on case simulation teaching / 中华医学教育探索杂志

To increase the rescue competency of residents, also the critical thinking, team dynamics, and the capability to handle with emergencies, Shanghai East Hospital developed a rescue course integrated with 24 standardized simulation cases learning and medical simulation education for residents training pro-gram. The instructor candidates should complete the simulation training and pass the instructor certification. Every course was monitored by the course director to ensure the teaching quality. After two and a half years of practice, it is found that the teaching of case teaching and simulation teaching is better than traditional teaching, and it plays an important role in the security of medical security.

Treatment of papillary thyroid microcarcinoma / 国际肿瘤学杂志

The recent development and wide application of ultrasonography and ultrasonography-guided fine needle aspiration biopsy have greatly facilitated the detection of papillary thyroid microcarcinoma (PTMC).Currently, the occurrence, development and pathological features of PTMC are not clearly understood.Therefore, no consensus on the diagnosis and treatment has been reached.Patients with PTMC are suggested to be closely observed and periodically examined with ultrasonography in some countries such as Japan, and these patients are to be operated when the tumor enlarged or new lymphatic metastasis are found.Operation is the first choice in the European and American countries, and the long-term survival rates of these patients are nearly 100％.For the PTMC patients with the risk factors such as thyroid capsule invasion, lymphatic metastasis,multi-focal lesion, higher degree of malignancy, thyroid stimulating hormone suppression therapy was given after operation, which may reduce the local recurrence rate.In China, we should hold well thelimitation and choose the best way for different patients according to the personalized principle in clinical practice.

Clinicopathological features and treatment of postsurgical incidental papillary thyroid microcarcinoma / 中华内分泌外科杂志

Objective To analyze clinicopathologic features and treatment strategy of postsurgical incidental papillary thyroid microcarcinoma(PTMC).Methods A total of 305 patients undergoing surgery for thyroid diseases from Apr.2012 to Mar.2013 were retrospectively analyzed.Results Among the 305 patients,19 patients(18 females and 1 male)showed PTMC incidentally after surgery.The mean age was (43.2 ± 12.8)years (ranging from 23 to 67 years old).All patients underwent subtotal thyroidectomy,including 17 endoscopic surgery and 2 open surgery.All frozen sections were benign during operation while pathologic results were PTMC after surgery.The average size of tumors was(2.2 ± 1.5) mm which all was unicentric with no lymph node enlargement intraoperatively.Immunohistochemistry showed that the positive rate of cytokeratin 19,galectin-3,mesothelial cell,and CD56 was 87.5％,43.8％,81.3％ and 18.8％,respectively.There were 4 cases of B-raf V600E mutation found in 6 patients.All patients discharged 1 to 3 days after surgical treatment with no complication and received levothyroxine therapy with a suppressive dose of thyrotropin(TSH).131I therapy was not given.Conclusions PTMC is found more common in female and younger age under 45 years.Tumor is usually unicentric and less than 5 mm.Lymph node metastasis is rare.Immunohistochemistry and B-raf V600E mutant test can help the diagnosis.Initial endoscopic subtotal thyroidectomy is effective.There is no need of further surgery and 131I therapy.

Clinical significance of spiral CT three-dimensional reconstruction for measurement of Chinese calcaneal data / 中国组织工程研究

BACKGROUND:Calcaneus is a kind of irregular bone, with complicated three-dimensional structure. Calcaneus is often measured with X-ray plain film, while spiral CT three-dimensional imaging is a potent technology for anatomic measurement and has good application prospect. However, little is known about it. OBJECTIVE:To measure calcaneal anatomic data in Chinese peoples with spiral CT three-dimensional reconstruction and to explore its clinical significance. METHODS:Calcaneal spiral CT three-dimensional reconstruction in 100 Chinese adults (including 50 males and 50 females) were performed. The length, width, height of calcaneus, and Bohler’s and Gissane’s angles were measured after reconstruction, and compared with the data of westerners. RESULTS AND CONCLUSION:The mean length, width and height of the Chinese calcaneus were respectively (74.60±5.06) mm, (29.71±2.93) mm and (45.23±4.46) mm in male group, and (71.48±5.36) mm, (26.65±3.01) mm and (42.23±4.49) mm in female group. There were no significant differences between male group and female group in al the above parameters (P>0.05). There was no significant difference in the Gissane’s angle between the two groups (123.3±8.5° versus 122.7±8.9°;P>0.05). The Bohler’s angle in male group (35.98±4.34)° was significantly lower than that in female group (38.81±4.43)° (P0.05). Experimental findings indicate that, the length, width and height of Chinese calcaneus in female were lower than that in male, but Bohler’s angle is significantly higher than that in male, there was no significant difference in Gissane’s angle between males and females. Compared with the data of westerners, the length, width and height of Chinese adult calcaneus are significantly decreased, and no difference is found in Bohler’s angle and Gissane’s angle.

Adult bilateral Crowe type-IV developmental dysplasia of the hip:is the prosthesis an optimal therapeutic strategy? / 中国组织工程研究

BACKGROUND:Crowe type-IV developmental dysplasia of the hip presented complete dislocation of the femoral head, significantly shortening lower limb, serious adverse development of upper segment of acetabulum and femur, and even deformity. At present, there are no reports concerning its therapeutic strategy. OBJECTIVE:To explore the therapeutic strategy of adult bilateral Crowe type-IV developmental dysplasia of the hip. METHODA total of 12 cases of adult bilateral Crowe type-IV developmental dysplasia of the hip, who were treated in the Department of Orthopedics, The First People’s Hospital of Changzhou from January 2000 to January 2013, were col ected. There were 5 males and 7 females, at the age of 19-47 years old, averagely 33.5 years old. After two or three weeks of skeletal traction, they received bilateral total hip arthroplasty. Hip rotation center was reconstituted at the level of the“true”acetabulum. The subtrochanteric osteotomy was performed for patients with reduction difficulty. For patients with femoral neck anteversion>40°, subtrochanteric rotary osteotomy was performed. RESULTS AND CONCLUSION:Disappearance of hip pain, satisfied move function and normal gait were gained after operation. Lower limbs recovered to be isometric. The average leg lengthening was 3.1 cm (range, 2.5 to 4.8 cm). One patient affected sciatic nerve irritation. The average fol owed-up time was 3.5 years. No fracture, dislocation or loosening of the prosthesis appeared. The post-operative Harris Hip Score averaged 86.3. By reconstruction of the hip rotation center in the“true”acetabular level, correction of femoral neck anteversion, reconstruction of function of the abduction muscle and proper selection of prosthesis, total hip arthroplasty for adult bilateral Crowe type-IV developmental dysplasia of the hip could obtain good curative effects.

Analysis of Reasons for In-Hospital Mortality After a Surgical Resection for Esophageal and Cardial Cancer and Countermeasures / 中华胸心血管外科杂志

Objective To analyze the reasons for in-hospital mortality after a surgical resection for esophageal and cardial cancer and countermeasures.Methods From 1999.1 to 2010.12,7,225 patients with esophageal and cardial cancer were performed surgery in Cancer Institute and Hospital.Retrospectively analyzing the clinical datas of patients in-hospital mortality of these patients.Results 71 cases of 7,225 patients with a surgical resection for esophageal and cardial cancer died in-hospital after surgery.Conclusion Strictly mastering the operative indications,treating the acompaning diseases actively,choose the appropriate surgical approach,careful operation in surgery,reducing surgical time,intensice care after surgery and timely treatment of postoperative complications correctly may play a significant role in the decrease of in-hospital mortality after surgery.

Prevention of deep vein thrombosis after total knee replacement / 国际外科学杂志

Objective To investigate how to prevent deep-vein thrombosis(DVT) after total knee replace-ment(TKR).Methods Deep vein thrombosis in 87 patients after TKR from 2004 to 2007 in the Third Hospital Affiliated to Suzhou University was retrospectively analyzed.Results Amony the 87 patients,13 were found having deep vein thrombosis,5 of 38 using low-molecular-weight beparin after TKR having deep vein thrombosis,6 of 35 cases using aspirin after TKR having deep vein thrombosis,5 of the 10 eases using mechanical preventive measures having deep vein thrombosis.The difference between low-molecular-weight heparin and aspirin group was not statistically significant.Conclusion Using low-molecular-weight heparin before TKR can prevent the occurrence of deep-vein thrombosis.Using epidural anesthesia,and a low-molee-ular-weight heparin drugs or aspirin after TKR can better prevent the formation of deep-vein thrombosis.

Acute patella cartilage fracture: diagnosis and treatment / 国际外科学杂志

Objective To investigate the mechanism of acute patella bone cartilage fracture,and further study its diagnosis and treatment of clinical significance.Methods Collecting 21 cases of the acute patella bone cartilage fracture from July 2005 to December 2007.Eleven patients were male and ten were female,with the mean age of 31.6 (16～46) years.All the patients were treated using the arthroseopic microfracture technique after MR examination.Results All patients were followed up 6 to 18 months,did not show patellofemoral joint pain. Evaluated by Tagner rating,excellent outcomes were found in 17 cases,good in 4 cases,satisfactory results in 100% cases.Conclusion The arthroscopic microfracture technique in treatment of the patella cartilage fracture method is simple,easy to operate,can significantly improve knee function and pain,as well as the quality of life.

Treatment of old thoracolumber vertebrae fracture associated with incomplete paraplegia by using anterolateral decompression and internal fixation / 中华创伤杂志

Objective To evaluate the efficacy of anterolateral decompression and internal fixation on the treatment of old thoracolumbar vertebrae fracture with associated incomplete paraplegia. Method the clinical findings of 26 cases with old thoracolumber vertebrae fracture with associated incomplete paraplegia treated by anterolateral decompression and internal fixing were reviewed retrospectively. Results All cases were followed up for 6 months through 2.5 years. The angle of kyphosis was 23?preoperatively and 6?postoperatively. According to Frankel's grading, there were two cases at grade A, three at grade B, five at grade C, seven at grade D, nine at grade E before operation and one at grade A, three at grade B, four at grade C, six at grade D and 12 at grade E after operation. Conclusion Anterolateral decompression and internal fixation is the treatment of choice for the old thoracolumber vertebrae fracture associated with incomplete paraplegia, especially for spinal deficit generated by displacement of the middle column.