摘要:目的:探讨临床教学的全程制度化管理及其效果。方法:通过健全组织,完善制度,加强教学、临床及实习生管理、建立激励机制等措施,进行全程制度化的规范管理。结果:教学质量显著提高,不良事件鲜见,无恶性事件发生。近来医院已有6篇教学论文公开发表,4个先进集体和8名先进个人受到医院表彰,5名优秀带教教师和8名实习生受到各学院奖励。结论:临床教学全程制度化管理是提高教学质量的切实有效途径。Abstract: Objective: To investigate system management during the entire clinical teaching process and its effect. Methods: To robust organization, perfect rules, strengthen management of clinical teaching and intern student, and establish encouragement mechanism,and other measures, so as to conduct standard system management during the entire process. Results: Quality of teaching improved notably, bad event was scarce, no malignant event occurred. There were six teaching articles issued publicly, four advanced collectives and eight advanced individuals had been praised by hospital, and five excellent teachers,eight intern students had been rewarded by each college. Conclusion: System management during the entire clinical teaching process is an effective way to improve teaching quality.
To explore the treatment of multi-segmental lumbar disc herniation and spinal canal stenosis by laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and general spine system(GSS) fixation. Methods From January 2004 to January 2006, 21 patients with multi-segmental lumbar disc herniation and spinal canal stenosis were treated by laminectomy, removal of nucleus pulposus and GSS pedicle screw spinal system. There were 14 males and 7 females with an average age of 53 years ranging from 46 to 61 years, and with an average disease course of 18 months ranging from 8 months to 15 years. All of the patients were examined by X-ray with AP position, lateral position and dynamic lateral position, CT and MRI, and all of them proved to be with multi-segmental lumbar disc herniation and different degrees of spinal canal stenosis. A total of 47 nucleuses were picked out, and 47 instable segments were filled in with granule selfbone. Results There were 21 patients who were followed up for 1 to 2 years with an average of 13 months. All patients achieved successful fusion and bony union postoperative from 8 to 12 months, and no artificial joint was formed. As to the cl inical results in 21 cases, according to the Macnab outcome criteria, 14 were excellent, 6 were good and 1 was poor, the excellent and good rate was 95.2%. Conclusion The methods of laminectomy, removal of nucleus pulposus, fusion of intra-transverse process and GSS system fixation are effective in treatment of multi-segmental lumbar disc herniation and spinal canal stenosis．
Objective To observe the affection of optic nerve under acute ocular hypertension and the effect of protection of bFGF on optic nerve. Methods BSS was perfused into anterior chamber of rabbits to increase the intraocular pressure to cause retinal ischemia. A computer image analysis system was used to count the optic nerve axons.Eyes were intravitreally injected with bFGF and then the number of optic nerve axons of the normal rabbits,and hypertension with and without bFGE treatment groups were counted respectively. Results The number of optic nerve axons in ocular hypertension eyes was less than the normal eyes(P=0.00003).The bFGF treated eyes had more optic nerve axons than the controls(P=0.0078). Conclusions The acute ocular hypertension may cause the loss of the nerve axons,and bFGF may be effective in protecting optic nerve in acute ocular hypertension. (Chin J Ocul Fundus Dis,2000,16:94-96)
ObjectiveTo analyze the association between the cultural level and hospitalization management process and length of hospitalization of the colorectal patients served by West China Hospital of Sichuan University as a regional center in the current version of the Database from Colorectal Cancer (DACCA). MethodAccording to the established screening criteria, eligible colorectal cancer patients were collected from the updated version of DACCA on June 29, 2022. The analyzed data items included gender, age, BMI, blood type, marriage, waiting time before admission, preoperative hospitalization time, postoperative hospitalization time, total hospitalization time, and management process, and patients were divided into illiterate group, primary education group, medium education group, and higher education group according to their educational level, then compared the hospitalization management process and length of hospitalization of each group. ResultsA total of 4 765 eligible data were screened, with secondary education being the most prevalent (2 792, 58.6%), followed by primary (1 337, 28.1%) and higher education (417, 8.7%), and illiteracy being the least prevalent (219, 4.6%). In the classification of management processes, “regular” account for the majority (4 219, 88.5%), followed by “enhanced”(274, 5.8%), “individual” was third (231, 4.8%), and “rapid” was the least (41, 0.9%). There was no statistically significant difference in the comparison of waiting time before admission, preoperative hospitalisation time and postoperative hospitalisation time among patients with different literacy levels (P=0.371, P=0.095, P=0.352), but there was a statistically significant difference in total hospitalisation time (P=0.021), with a significant difference in total hospitalisation length between illiterate patients and patients with medium education (P=0.041). There was no statistically significant difference in the comparison of inpatient management processes of patients in different literacy groups (χ2=15.2, P=0.085). ConclusionsAnalysis of the DACCA data revealed a statistically significant difference in total hospitalisation time between patients with illiteracy and those with medium education. However, the choice of hospitalisation management process was similar for patients with different literacy levels, which needs to be further analysed for the reasons.
ObjectiveTo summarize the experience of the whole process management of hepatocellular carcinoma (HCC) patients with high-risk of recurrence and metastasis based on the multidisciplinary team (MDT) mode, and to improve the clinicians’ understanding of the concept of whole process management, so as to improve the survival rate of patients with HCC. MethodThe clinicopathologic data of a HCC patient with high-risk of recurrence and metastasis admitted to the Division of Liver Surgery, Department of General Surgery, West China Hospital of Sichuan University were retrospectively analyzed. ResultsA 52-year-old male patient was diagnosed with HCC with intrahepatic metastasis (China liver cancer staging Ⅱ b, Barcelona Clinic Liver Cancer stage B) after admission due to “epigastric discomfort for 1+-month and liver occupying for 1+-week”. Through discussion by the MDT mode, the allogeneic liver transplantation was performed after successful downstaging following two conversion therapies. No serious complications occurred after operation, and the patient was discharged on the 23rd day after operation. Up to now, pulmonary bacterial and fungal infections and pulmonary metastases had been found during the postoperative follow-up. After anti-infective therapy and targeted therapy combined with radiotherapy, the patient was significantly relieved, had survived for 34 months after operation, and was still under regular follow-up. ConclusionsFor HCC patients with high-risk of recurrence and metastasis, MDT mode has a good clinical benefit for the whole process management of patient. Through the MDT model, the diagnosis, treatment, and follow-up of HCC are organically integrated, and the patient’ s diagnosis and treatment plans are dynamically adjusted to realize the whole process management of HCC patient, and to raise the survival rate and improve quality of life of HCC patient.
Multivariate time series problems widely exist in production and life in the society. Anomaly detection has provided people with a lot of valuable information in financial, hydrological, meteorological fields, and the research areas of earthquake, video surveillance, medicine and others. In order to quickly and efficiently find exceptions in time sequence so that it can be presented in front of people in an intuitive way, we in this study combined the Riemannian manifold with statistical process control charts, based on sliding window, with a description of the covariance matrix as the time sequence, to achieve the multivariate time series of anomaly detection and its visualization. We made MA analog data flow and abnormal electrocardiogram data from MIT-BIH as experimental objects, and verified the anomaly detection method. The results showed that the method was reasonable and effective.
Objective To evaluate the effectiveness of lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle screw fixation for lumbar degenerative instabil ity. Methods Between January 1998 and October 2010, 48 patients with lumbar degenerative instabil ity were treated by posterior decompression, lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous processand vertebral plate complex and pedicle screw fixation. There were 26 males and 22 females, aged 52-76 years (mean, 62.4 years). The disease duration was 7 months to 25 years (mean, 6.5 years). One segmental instabil ity was located at L3, 4 in 1 case, at L4, 5 in 10 cases, and at L5, S1 in 11 cases; multi-segmental instabil ity was located at L3, 4, L4, 5, and L5, S1 in 5 cases, at L2, 3 and L3, 4 in 2 cases, at L3, 4 and L4, 5 in 10 cases, and at L4, 5 and L5, S1 in 9 cases. Of 48 patients, 32 complicated by lumbar disc herniation, 46 by lumbar spinal stenosis, and 16 by degenerative scol iosis. The cl inical results were evaluated by the Japanese Orthopaedic Association (JOA) score, recovery rate, disc height, and lumbar lordosis angles. Results The incisions obtained healing by first intention after operation. No nerve injury, rod or screw breakage, and infection occurred during and after operation. All 48 patients were followed up 1 to 6 years. The fusion time was 12-18 weeks (mean, 16.2 weeks). Vertebra sl i pping or degenerative scol iosis was corrected, and spinal column series became normal. At preoperation, 6 months after operation, and last follow-up, the disc heights were (5.2 ± 2.3), (11.9 ± 2.0), and (11.6 ± 2.1) mm, respectively; the JOA scores were 3.2 ± 2.1, 12.8 ± 1.6, and 13.6 ± 1.2, respectively; and the lumbar lordosis angles were (—20.5 ± 10.5), (30.5 ± 8.5), and (31.2 ± 5.6)°, respectively. The JOA scores, disc heights, and lumbar lordosis angles were significantly improved at 6 months after operation and last follow-up when compared with preoperative ones (P lt; 0.05), but no significant difference was found between 6 months after operation and last follow-up (P gt; 0.05). The recovery rate of JOA was excellent in 36 cases, good in 10 cases, and fair in 2 cases at 6 months after operation, with an excellent and good rate of 95.8%. Conclusion Lumbar interbody fusion impacted bone grafts combined with regrafting in situ with spinous process and vertebral plate complex and pedicle crew fixation for lumbar degenerative instabil ity can restore and maintain the intervertebral disc height effectively with high fusion rate. It is a plasty close to anatomic reconstruction.
In order to solve the saturation distortion phenomenon of R component in fingertip video image, this paper proposes an iterative threshold segmentation algorithm, which adaptively generates the region to be detected for the R component, and extracts the human pulse signal by calculating the gray mean value of the region to be detected. The original pulse signal has baseline drift and high frequency noise. Combining with the characteristics of pulse signal, a zero phase digital filter is designed to filter out noise interference. Fingertip video images are collected on different smartphones, and the region to be detected is extracted by the algorithm proposed in this paper. Considering that the fingertip’s pressure will be different during each measurement, this paper makes a comparative analysis of pulse signals extracted under different pressures. In order to verify the accuracy of the algorithm proposed in this paper in heart rate detection, a comparative experiment of heart rate detection was conducted. The results show that the algorithm proposed in this paper can accurately extract human heart rate information and has certain portability, which provides certain theoretical help for further development of physiological monitoring application on smartphone platform.
To cure patients suffering from atlanto-axial instability following old fracture of odontoid process concomitant with stenosis of lower end of cervical spinal canal, a new operative method was designed. It included atlanto-axial fusion by Gallie technique and resection of right half of the laminae of C3-C7 spine at one stage. A female of 63 years old was treated. She was admitted with neck pain and numbness of the upper and lower limbs. A history of neck injury was noted in enquiry. In physical examination showed the sensation of pain of the upper limbs was decreased and the muscle power of the upper and lower limbs ranged from III degree to IV degree. The X-ray film and MRI suggested that there was instability of the atlanto-axial joint with stenosis of 4th-6th cervical spinal canal. The operation was satisfactory. After operation, the patient was followed up for 11 months. The physical examination indicated that sensation of the upper limbs had recovered to normal and the muscle power of the upper limbs reached IV degree and that the lower limbs reached V degree and X-ray showed bony fusion of the atlanto-axial joint. The conclusions were: 1. The stability of atlanto-axial joint was reconstructed with expanding of the spinal canal at the same time. 2. The duration, risk and cost of the therapy were reduced, and maintenance of the stability of the cervical spine throughout whole period of treatment was recommended.
OBJECTIVE: To explore the potential possibility of synaptic connection and 3D adhesion between fetal spinal cord cell suspension (FSCS) and host, and to observe the synapses developing process of FSCS transplantation. METHODS: Spinal cord injury model produced in 42 Wistar rats on T7 by use of modified Allen’s impact method (10 g x 5 cm); 3 days after injury, 20 microliters FSCS with a density of 1 x 10(5)/microliter prepared from E14 rat were injected into the epicenter of the traumatized cavity. Animals were sacrificed after 2, 4, 6, 8, 10 and 12 weeks of transplantation, the graft survival, its differentiation and integration with the host were observed by light and electronmicroscopic study as well as immunohistochemical assay (NF, GFAP, CGRP, 5-HT). RESULTS: In the transplantation area, the neuroblasts stretched out the terminal endings 4 weeks after implantation, followed by the presenting of the pre- and postsynaptic membrane. After 8 weeks, the dense or developed projections were observed in the pre- and postsynaptic membrane; the synaptic cleft filled with the high electron dense substance. All the spherical clear vesicles, granular vesicles, elliptical vesicles and flattened-f type vesicles were seen under the electronmicroscope. After 10 weeks, the axosomatic, dendrosomatic, dendro-dendritic, axo-axonic, dendro-axonic synapses coexisted. Light microscopy showed that the graft cell grew gradually. Immunohistochemical assay showed that NF, 5-HT, CGRP and GFAP positive fibers were in the graft. Synapses, gliafibers and blood brain barrier integrated each other. CONCLUSION: (1) The transplanted FSCS can develop mature synapses with miscellaneous synaptic vesicles in the acute injured spinal cord, host injury cavity wall may induce the FSCS into 3D adhesion. (2) Co-existence of different type of synapse and the immunohistochemistry findings indicate the possibility of synaptic connection between FSCS and host.