OBJECTIVE To introduce the technique of epiphysiolysis and epiphysis grafting in the treatment of early partial closure of the epiphysial plate in children, and evaluate its effect. METHODS Retrospective study was performed in 10 cases of cubitus varus and valgus, or genu varum and valgum due to early partial closure of the epiphysial plate, 6 cases received simple cuneiform osteotomy, and 4 cases received epiphysioloysis and epiphysis grafting. RESULTS Clinical outcoming after 6-month to 5-year’s follow-up showed 1 case deformity of recurrence and 2 cases of non-isometric limb after simple osteotomy, while no recurrence and isometric limb after epiphysiolysis and epiphysis grafting. CONCLUSIONEpiphysiolysis and epiphysis grafting may effectively prevent the recurrence of postoperative deformity, and restore the longitudinal growth of limb.
ObjectiveTo understand the levels of and influencing factors for knowledge of earthquake in the elderly population.
MethodPeople who were older than 60 years in the earthquake area of Sichuan Province were surveyed by self-designed earthquake knowledge scale composed of 6 items with a point of 1-5 for each item between October and November 2013. The total score ranged from 6 to 30 points.
ResultsUp to 1 509 elderly people participated the survey. The total score of earthquake knowledge was 13.33±4.85. The main resource for acquiring those knowledge was TV (76.87%). Occupation, education level, residency, marital status, residence, self-injury, health status, access to earthquake knowledge, and worrying about earthquake were related factors for their knowledge on earthquake (P<0.05). Regression analysis showed that the higher degree of education, having a spouse, living in city, more access to earthquake knowledge, worrying about earthquake were the promotion factors for earthquake knowledge preparedness. Self-injury, poor health were the factors that hindered the acquiring of earthquake knowledge preparedness.
ConclusionsIt is necessary to train knowledge of earthquake for elderly people individually because they lack enough resources and tend to be affected by many factors.
ObjectiveTo explore the applicability of early goal-directed sedation (EGDS) in intensive care unit (ICU) patients with mechanical ventilation.MethodsAn prospective double blind study was conducted. ICU patients with mechanical ventilation in the First Affiliated Hospital of Jinzhou Medical University were recruited as research objects by chester sampling from September 2015 to September 2017, and divided into an experimental group and a control group by stratified randomization. Two groups were sedated on the basis of adequate analgesia. The experimental group adopted the EGDS strategy that dexmedetomidin was the first choice to be infused at the rate of 1 μg·kg–1·h–1. And the patients were given Richmond agitation-sedation score (RASS) on the interval of 4 hours: used additionally propofol and midazolam if RASS>2, or reduced right metomomidin at the speed of 0.2 μg·kg–1·h–1 per 30 min if RASS<–3, and stopped sedation until RASS of –2 to 0. The control group adopted routine sedation strategy that propofol was the first choice to be infused and combined with dexmedetomidine and midazolam until RASS score in –2 to –3. The doses of sedative drugs, mechanical ventilation time, ICU-stayed time, total hospitalization time and the incidence of adverse events such as delirium, accidental extubation, and ICU death were compared between two groups.ResultsSixty-sis cases were selected in the experimental group and 71 in the control group. The baseline data such as gender, age, acute physiology chronic health evaluation Ⅱ (APACHEⅡ), or basic diseases in two groups had no significant differences. Compared with the control group, the per capita total doses of dexmedetomidine, propofol and midazolam in the experimental group were significantly less [right metopromicine (μg): 154.45±27.86 vs. 378.85±39.76; propofol (mg): 4 490.03±479.88 vs. 7 349.76±814.31; midazolam (mg): 255.38±46.24 vs. 562.79±97.26; all P<0.01], mechanical ventilation time, ICU-stayed time, total hospitalization time were significantly lower [mechanical ventilation time (d): 7.7±3.3vs. 11.7±3.6; ICU-stayed time (d): 10.2±3.9 vs. 19.2±4.1, total hospitalization time (d): 29.9±4.6 vs. 50.4±9.1; all P<0.01]. The Kaplan-Meier survival curves showed that the incidence of delirium in the experimental group was significantly lower than that in the control group (log-rankχ2=5.481, P<0.05). The accidental extubation rate and accidental fatality rate in two groups had no significant differences (log-rankχ2=0.078, 0.999, P>0.05).ConclusionEGDS can not only reduce the dose of sedative drugs, shorten the mechanical ventilation time, the ICU-stayed time and the total hospitalization time, but also reduce the incidence of delirium, so it has a positive impact in ICU patients with mechanical ventilation.
Objective To investigate the development and significance of the expression of early growth response gene-1 （EGR-1） in autogenous vein graft in rats and detect the role of it in intimal hyperplasia. Methods Autogenous vein graft model was established in 90 Wistar rats, transplanting the right jugular vein to infra renal abdominal aorta by microsurgical technique. The vein graft samples were harvested at hour 1, 2, 6 and 24, day 3, 7,14, 28 and 42 after procedure. Normal vein as control group. Egr-1 mRNA was measured by reverse transcription-PCR and in situ hybridization. Western blot and immunohistochemistry were used to detect the protein expression of Egr-1. Results Intimal hyperplasia reached peak at day 28 after autogenous vein graft surgery. Egr-1 mRNA and Egr-1 protein hadn’t been found in the normal vein. The expressions of Egr-1 mRNA and Egr-1 protein had biphasic changes. By reverse transcription-PCR and in situ hybridization, we found that the level of Egr-1 mRNA rose at 1 hour after graft, the expression of Egr-1 mRNA was (35±7)%. Decline at hour 6， 24 and day 3, the positive rates of Egr-1 mRNA were (8±2)%, (8±6)% and (8±4)% respectively. Reincrease at day 7, a peak at day 28, the positive rate of Egr-1 mRNA was (45±6)% (compared with other phase, P＜0.01). At day 42, the expression of Egr-1 mRNA declined again. Immunohistochemical staining and Western blot revealed Egr-1 protein had expressed at hour 2 early phase, the expression of Egr-1 protein was (30±5)%, and until to hour 6. The level of Egr-1 protein was decrease at hour 24 and day 3, the positive rates were (7±3)% and (7±8)% respectively. A peak at day 28, the positive rate of Egr-1 protein was (40±9)% (compared with other phase, P＜0.01). We found that immu-noreative Egr-1 located vascular smooth muscle cells （VSMCs） and monocytes/macrophages in tunica media at the early phase of day 7 and 14, and in neointimal and medial VSMCs at later phase of day 28. Egr-1 was also present in the endoluminal endothelial cells. Conclusion In autogenous vein graft, Egr-1 plays an important role in the proliferation of VSMCs. Egr-1 may become a new target for the prevention and therapy of intimal hyperplasia, stenosis and emphraxis after vein graft.
Objective To provide a disaster triage method by analyzing the data of the hospital transferring casualties after Wenchuan earthquake. Method The data of the patients’ admission and hospital transferring in the West China Hospital were collected after the earthquake in two weeks. Moreover, the reason and the method of the hospital transferring were analyzed. Result In the first two weeks since the earthquake struck Wenchuan, the number of the available bed for earthquake patients in West China Hospital was 124 per day, but in the 2 227 earthquake patients treated, 1 181 patients were admitted. Comparing with the number of the total hospitalized, the percentage is 53.03%. The hospital was overloaded. After a reasonable hospital transference, the daily number of inpatients was stable and all the patients were treated sufficiently. Conclusion After a natural disaster, an effective administration transferring patients to suitable medical recourse should be performed, so that more right treatments should be given to more right patients in the right time and right place.
ObjectiveTo explore the effect of rehabilitation training focusing on early exercise on the time of first getting out of bed after surgery, pain during early activities, postoperative infection rate and the length of hospital stay for renal transplant recipients.MethodsThe clinical data of patients undergoing allogeneic renal transplantation in West China Hospital of Sichuan University from June to August 2020 were analyzed retrospectively. According to the time of multidisciplinary postoperative management and the time of early rehabilitation intervention, the patients were divided into the conventional group (from June 2020 to the beginning of multidisciplinary postoperative management) and the rehabilitation group (after multidisciplinary postoperative management). The time to get out of bed for the first time after surgery, the Visual Analogue Score (VAS) during weight monitoring on the second day post operation, the number of days required to complete an independent walk of 100 meters, postoperative complications, the incidence of postoperative infection and the length of hospital stay were compared between the two groups.ResultsA total of 79 patients were included. There were 46 cases in the conventional group and 33 cases in the rehabilitation group. Among the included patients, 14 patients had postoperative infection, 1 patients in the conventional group developed thrombosis, no catheter shedding or bleeding after exercise occurred. The differences between the rehabilitation group and the conventional group in the time to get out of bed for the first time after surgery [(1.1±0.2) vs. (2.2±0.4) d; t=13.224, P<0.001], the VAS during weight monitoring on the day post operation (2.5±0.9 vs. 3.4±1.4; t=3.267, P<0.001), the number of days required to complete an independent walk of 100 meters [(2.2±0.4) vs. (4.0±0.8) d; t=11.312, P<0.001], and the incidence of postoperative infection (6.1% vs. 26.1%; χ2=5.285, P=0.022) were statistically significant. There was no significant difference in the length of stay between the rehabilitation group and the conventional group [(19.8±5.8) vs. (20.7±7.4) d; t=0.584, P=0.561].ConclusionEarly postoperative rehabilitation training reduces the time required for renal transplant recipients to get out of bed for the first time post operation and to walk 100 meters independently, reduce the pain response during early activities, and reduce the incidence of postoperative infection.
In the hospital where centralized treatment was applied for the victims after Yiliang earthquake (on 7th September, 2012), a holistic rehabilitation service mode which centred on supportive psychological intervention promoting was developed by the Yiliang psychological crisis intervention team designated by the National Health and Family Planning Commision of the People’s Republic of China. The pattern takes psychological nurses as liaison, bases on the integrity and continuity of medical service, roots in comprehensive health assessment and key assessment of mental trauma stress, emphasizes on solving realistic problems for patients and their caregivers, provides supportive psychological intervention, and encourages psychological nurses to offer psychological support for earthquake victims with the help of quantitative self-assessment of social psychological support service. In practice, the mode of psychological services, which could be contiuously conducted, is welcomed by hospital managers, work staff, and earthquake victims and their caregivers.
Objective To investigate the recovery status of people wounded in the Wenchuan earthquake. Method Data were retrospectively collected from administrative documents in the Bureau of Medical Affairs, Sichuan Provincial Health Department. The severity of injury was assessed by Injury Severity Score (ISS). The data were recorded by EXCEL software and descriptive analysis was conducted. Results Our analysis results of rehabilitation treatment through Feb. 5, 2009 shows that 27,080 of the 28,008 patients had been treated and discharged, for a discharge rate of 97.8%. There were 928 patients still in hospitals at that time, including 55 cases of traumatic brain injury, 163 cases of paraplegia, 260 amputees, and 449 cases of severe spine, pelvis and other fractures. Some amputees needed to receive replacement of artificial limbs or stump dressing operation and rehabilitation; most patients who were installed internal fixation needed to removal and post-rehabilitation. Conclusions The effectiveness of rehabilitation is significant. Our work in the next stage should focus on (1) continuing to improve the establishment of province’s rehabilitation capabilities and increasing capital investment; (2) enhancing training for medical rehabilitation practitioners in order to improve operational standards and service capabilities; (3) developing the wounded rehabilitation standards in later stages, conducting follow-up and functional training in order to maximize recovery and return to society; (4) increasing employment opportunities for disabled persons.
Abstract: Objective To determine the effects of early enteral nutrition (EEN) on postoperative recovery in elderly patients with esophageal cancer. Methods We included 100 elderly patients with esophageal cancer who were admitted at the PLA 100 Hospital between January 2006 and April 2010, and whose diagnoses were confirmed by pathological examination. The patients were divided into an early enteral nutrition (EEN) group and a parenteral nutrition (PN) group, with 50 patients in each group. There were 32 males and 18 females with an average age of 72 years in the EEN group. There were 30 males and 20 females with an average age of 69 years in the PN group. We analyzed the effect of the nutrition administration method on bowel function recovery, hospital stay, complication rate, and nutritional status one week after surgery. Results The anal exhaust time (45.3±12.7 h vs. 73.6±11.7 h), time until anal defecation (80.5 h±15.6 h vs. 140.1±13.2 h), and hospital stay (13.0±1.8 d vs. 15.2±3.3 d) in the EEN group were all shorter than those in the PN group (Plt;0.05). The rates of lung infection, anastomotic leakage, and cardiac complications in the EEN group were significantly lower than those of the PN group (Plt;0.05). One week after the operation, the serum albumin (ALB), peripheral blood lymphocytes, transferrin, and 24 h urea nitrogen (BUN) in the EEN group were higher than those in the PN group (Plt;0.05). Conclusion Compared with parenteral nutrition, enteral nutrition can promote metabolic function in elderly patients after recovery, reduce morbidity, and promote recovery.
ObjectiveTo compare the clinical effects of early dynamic brace passive activity program and average delay activity program after the repair of extensor tendon.
MethodsSeventy-eight patients undergoing repair of the extensor tendon during the period from December 2008 to October 2011 in our hospital were randomly divided into two groups.The treatment group had 36 patients who were treated with early dynamic brace passive activity program,and the other 42 patients belonged to the control group and they accepted delay activity program.TAM and FIM were used to evaluate their clinical effects six and eight weeks after surgery,respectively.
ResultsThe results of TAM and FIM of the treatment group were significantly better than those of the control group (P<0.01).
ConclusionThe early dynamic brace passive activity after extensor tendon injury repair can improve the clinical effect and is worth popularizing.
