In order to understand the influence of the free tendon graft and the tendon transfer on their blood supply, histological and biochemical changes during healing following repair of the damaged tendon after the alteration of the nourishing environment, an experiment was carried on 36 New Zealand white rabbits. In the front paws of the rabbits, the free tendon graft was sutured in the tendon defect of flexor of the fourth toe and the flexor tendon of the third toe was transferred to the second toe to reconstr...
Objective The rising medical expenditure is an international problem. By comparing theories and methods of medical expenditure control between China and the US, this paper aims to find out the medical expenditure strategies fitting for our country and to help with the new round of medical and health system reform. Methods This evidence-based research searched for literatures using the search strategy and screened literatures according to inclusion and excluding criteria. Useful information in the literatures was extracted through quantitative analysis of literature tables and descriptive statistical analysis. Results We found that the US academia showed a sustainable and steady trend of increased concern on the medical expenditure control, while the Chinese academia showed a larger volatility on it. There were some obvious differences such as reasons for expenditure increase, the reasonableness of the medical expenditure increase, and the specific methods and strategies of the medical expenditure control between Chinese and American authors. Conclusion On the one hand, the purpose of medical expenditure control is based on the different stages of development. On the other hand, the main interest group determines the main body who is responsible for the medical expenditure control. According to our national context, China should develop effective strategies and methods for medical expenditure control.
Objective To compare the effects of flap delay and vascular endothelial growth factor (VEGF) on the viability of the rat dorsal flap. Methods Thirty rats were divided into 3 groups: saline group, flap delay group and VEGF group. The rats in flap delay group underwent flap delay by keeping bipedicle untouched, and the cranial pedicle was cut 7 days later. The rats in VEGF group were given VEGF solution locally when the flaps were elevated in the operation. The ratsin saline group were given saline solution in the same way. Five days after thesingle pedicle flaps were performed, the flap survival rate was measured. Theflap tissues were collected to measure and analyze the microvascular density, diameter and sectional area by immunochemical method. Results The flap survival rate of flap delay group was similar to that of VEGF group andthere is no statistically significant difference(Pgt;0.05). The vascular diameter of flap delay group was much larger than that of saline group and VEGF group, showing statistically significant difference (Plt;0.05). The vascular density of VEGF group was much higher than that of saline group and flap delay group, showing statistically significant difference (Plt;0.05). The vascular sectional area of flap delay group was similar to that of VEGF group(Pgt;0.05). Conclusion The change in the flap after flap delayis manifested as obvious dilatation of microvessels, while the change in the flap after the injection of VEGF is manifested as obvious vascular proliferation. Both flap delay and VEGF can increase the vascular sectional area and the viability of the flap, but the mechanism is different.
Objective To compare administration of incidence reporting systems for healthcare risk management in the United Kingdom, the United States, Canada, Australia, and Taiwan, and to provide evidence and recommendations for healthcare risk management policy in China. Methods We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws, regulatory documents, research reports, reviews, and evaluation forms concerned with healthcare risk management and assessment. Descriptive comparative analysis was performed on relevant documents. Results (1) A total of 142 documents were included in this study. The United States had the most relevant documents (68). (2) The type of incidents from reporting systems has expanded from medication errors and hospital-acquired infections to near-misses, and now includes all patient safety incidents. (3) The incidence-reporting systems can be grouped into two models: government-led and legal/regulatory/NGO-collaborative. (4) In two cases, reporting systems were established for specific incident types: One for death or serious injury events (the sentinel events database in Britain, SIRL), and one for healthcare-associated infections (NHSN in America). (5) Compared to the four countries, Taiwan’s system put more emphasis on public welfare, confidentiality, and information sharing. The contents of reporting there covered every aspect of risk management to create a more secure environment. Conclusion (1) Britain’s national reporting and learning system was representative of a government-led model; (2) The United States was the earliest country to have a reporting system, which included a limited range of incident types. Management of incidents became more reliable with increased application of laws, regulations, and guidances; (3) Both the Canadian and the Australian systems drew from the American experience and are still developing; (4) The Taiwanese system was comprehensive and is an instructional case.
By comparing the diagnostic accuracy of two or more tests in the same study, the one with the higher diagnostic accuracy can be screened. Therefore, it is extremely important to conduct the comparative diagnostic test accuracy study. This paper introduced the concept of the comparative diagnostic test accuracy study, compared it with single diagnostic test accuracy study, and described its role, study design, statistical analysis, current status, and challenges.
Objective To compare the short-term result between the high-flex (HF) and conventional posteriorstabil ized (PS) prosthesis in total knee arthroplasty (TKA). Methods From April 2005 to October 2007, 23 cases (27 knees) underwent TKA by HF prosthesis (HF group), and 35 cases (41 knees) underwent TKA by PS prosthesis (PS group).In HF group, there were 2 males (3 knees) and 21 females (24 knees) aged (64.3 ± 5.6) years, including 20 cases (23 knees) of osteoarthritis and 3 cases (4 knees) of rheumatoid arthritis; body mass index (BMI) was 27.3 ± 3.9; the course of disease was (5.3 ± 5.6) years; the Hospital for Special Surgery Scoring System (HSS) score was 58.4 ± 7.9; the Western Ontario and McMaster universities osteoarthritis index (WOMAC) score was 49.4 ± 6.9; the maximum knee flex degree was (107.6 ± 8.3)°; and the range of knee motion was (103.5 ± 7.7)°. In PS group, there were 3 males (3 knees) and 32 females (38 knees) aged (65.1 ± 5.9) years, including 33 cases (39 knees) of osteoarthritis and 2 cases (2 knees) of rheumatoid arthritis; BMI was 27.1 ± 4.1; the course of disease was (5.1 ± 4.9) years; HSS score was 60.1 ± 10.4; WOMAC score was 47.9 ± 7.2; the maximum knee flex degree was (108.4 ± 9.7)°; and the range of knee motion was (105.9 ± 11.4)°. There were no significant differences in general data between two groups (P gt; 0.05). Results All incisions achieved heal ing by first intention. No compl ication of ankylosis, blood vessel and nerve injuries, and prosthesis loosening occurred. All patients were followed up for 24-54 months (average 32.8 months). There were no significant differences in the HSS score, WOMAC score, the maximum knee flex degrees, and the range of knee motion at 3, 12, and 24 months after operation between two groups (P gt; 0.05), but there were significant differencesbetween pre- and post-operation (P lt; 0.05). Anterior knee pain occurred in 1 case of HF group and 4 cases of PS group after 24 months, the incidence rates were 3.70% in HF group and 9.76% in PS group, showing significant difference (P lt; 0.05). The X-ray films showed that no lucent zone around prosthesis and no patella baja were observed, and the force l ine was excellent. Conclusion There is no significant difference in the range of knee motion and cl inical scores between the HF prosthesis and the PS prosthesis, but the former’s incidence rate of anterior knee pain is lower.
Objective To investigate the therapeutic effects of anterior approach set (AAS) versus posterior approach set (PAS) in treating multilevel cervical disc herniation of three or four segments. Methods Fifty-six cases of multilevel cervical disc herniation were retrospectively studied. Thirty-seven casesunderwent anterior approach, and discectomy, selectively partial corpectomy with bone grafting and plate fixing was performed (AAS group); 19 cases underwent posterior approach, and laminectomy with lateral cervical mass plate screw fixing was performed (PAS group).Results The followup periods were 6 months to 4 years and 5 months, averaging 2 years and 10 months in AAS group and 1 year and 5 months to 5 years and 1 month, averaging 3 years and 8 months in PAS group. JOA functional assessment and sagittal diameter of dural sac were not-statistically significant between two groups before operation (Pgt;0.05) andwere significantly larger in AAS group than in PAS group after operation (Plt;0.01). The improvement rate of AAS was significant higher than that of PAS (Plt;0.01). The number of complication in AAS were slight more than that in PAS.Conclusion AAS is obviously better than PAS in the therapeutic effects. The operation of anterior decompression with bone grafting and plate fixing is an indication of multilevel cervical disc herniation of three or four segments.
摘要:目的:探索区域文化、亚文化、经济水平、教育环境、家庭环境等因素对学龄儿童行为的影响。方法: 比较分析岳阳市与济宁市学龄儿童行为问题调查结果。结果:岳阳市与济宁市学龄儿童行为问题总体现患率分别为9.19%和10.7%(χ2=8.804, Plt;0.05),但与全国22个城市协作调查组报告结果(12.97±2.19)%基本相符;行为问题现患率和构成比存在性别与地区差异(Plt;0.05),男性儿童行为问题现患率高于女性儿童、男性儿童以“A行为”为主、女性儿童以“N行为”为主;行为问题现患率在8、9、12岁三个年龄段有地区差异(Plt;0.05)。结论:学龄儿童行为问题与区域文化、亚文化、经济水平、教育环境、家庭环境等因素有关联,与男女生物学特征的差异和不同环境的反应倾向及年龄等生物社会心理因素有关。Abstract: Objective: To explore the factors affect schoolaged children behavior by regional culture, subculture, economic level, educational environment, family environment and so on. Methods: Compared and analyzed the investigation results of schooleaged children behavior from Yueyang City and Jining City. Results: The prevalence rate of schoolaged children with behavior problems reflects respectively 9.19% and 10.7% (χ2 = 8.804, Plt;0.05), which is in collaboration with the National Investigation Unit report on the results (12.97 ± 2.19)%; the prevalence rate and composition exist gender and regional differences (Plt;0.05). The behavior problems prevalence rate of male child is higher than female children, male children in “A behavior” mainly, female children in “N behavior” mainly; The behavior problems prevalence rate at the age of 8,9,12 exist regional differences (Plt;0.05). Conclusion: Schoolaged children behavior problems are associated with regional culture, subculture, economic level, educational environment, family environment and other factors, and have something with biopsychosocial factor as the differences in male and female biological characteristics, different environments and age.
Objective To evaluate the effect of 27G pars plana vitrectomy (PPV) and 25G PPV on idiopathic epiretinal membrane (IMEM). Methods Thirty-eight eyes of 38 patients with IMEM were enrolled into this retrospective and comparative study. Eighteen eyes were treated with 27G PPV (group A), 20 eyes underwent 25G PPV (group B) voluntarily. The best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp microscope, indirect ophthalmoscopy, fundus color photograph, ocular coherence tomography (OCT) and counting of corneal endothelial cells (CEC) were examined before the surgery. BCVA results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. There was no statistically significant difference between two groups in terms of BCVA, IOP, foveal macular thickness (FMT), the counting of CEC and CEC hexagon rate before the surgery (t=1.627, 0.860, 0.293, 1.238, 0.697;P＞0.05). All operations were performed by the same doctor. Operation time for vitrectomy and peeling membrane was recorded. BCVA, IOP, OCT, FMT, counting of CEC and the improvement of metamorphopsia were observed on 1, 7 days and 1, 3 months after PPV. Results The mean operation time for vitrectomy in group A and B were (6.7±2.8), (10.5±3.3) min, respectively. The mean operation time for vitrectomy in group A was significantly longer than that in group B (t=3.084,P＜0.05). The mean operation time for peeling membrane in group A and B were (10.2±5.2), (11.0±5.9) min, respectively. There was no statistically significant difference between two groups in terms of the time for peeling membrane (t=1.970,P=0.187). On 1, 7 days and 1, 3 months after PPV, the difference of BCVA (t=1.463, 0.683, 0.961, 1.226;P=0.833, 0.509, 0.699, 0.744) and IOP (t=1.314, 1.262, 0.699, 1.116;P=0.763, 0.721, 0.534, 0.712) between two groups were not statistically significant. On 1 day after PPV, there were 2 eyes and 5 eyes with ＜9 mmHg (1 mmHg=0.133 kPa) IOP in group A and B. On 7 days and 1, 3 months after PPV, the difference of FMT between two groups were not statistically significant (t=1.257, 1.368, 1.437;P=0.735, 0.745, 0.869). On 3 months after PPV, the difference of CEC between two groups were statistically significant (t=2.276,P＜0.05); the difference of hexagon rate between two groups were not statistically significant (t=1.473,P=0.889). Conclusion The efficacy of 27G PPV for IMEM appears similar to 25G PPV. But 27G PPV has a shorter operating time for vitrectomy, a more stable IOP and a minimal damage to CEC.
Objective To study the influence of the pedicle length on the perforator flaps in hemodynamics. Methods Four mature swine (2 males, 2 females; weight, 23.0±2.0 kg) were applied to the experiment.Two transverse abdominal skin flaps, based on the superior epigastric pedicle orits rectus abdominal muscle perforators, were designed; each swine was used as its own control. At 2 hours and 1, 2, 3 weeks postoperatively, the skin paddle perfusion and the blood stream velocity in the superior epigastric artery were measured by the Laser Doppler Flowmeter and the Color Doppler Ultrasound, respectively. Flap survival percentages were calculated by the grid method at 1 week postoperatively. The swine were euthanatized, and they underwent angiography at 3 weeks postoperatively. Results At 2 hours and 1 week after operation, edema of the perforator flaps with the superior epigastric pedicle was more severe than that of the skin flaps with the rectus abdominal muscle perforator, and the skin perfusion had a statistical difference between the two kindsof flaps (Plt;0.05). The skin paddle viability and the skin perfusion had nostatistical difference after the first week postoperatively (Pgt;0.05). At 2hours and 1 week after operation, the blood stream velocity in the superior epigastric artery in the perforator flap with the superior abdominal artery pediclewas reduced, and there was a statistical difference between the two kinds of flaps (Plt;0.05); however, the velocity was almost the same after the first week postoperatively. Conclusion The excessively long pedicle of the perforator skin flap may have an unfavorable influence on the flap perfusion,especially during the first week after operation, because of the vascular compromise during the dissection of the long pedicle. The blood vessel anastomosis atthis level of the blood vessels may have no relationship with the perforator flap in hemodynamics. This study can also indicate that the ligation of the branches in the recipient vessels cannot make the perforator flaps overperfused.