Liver cancer is one of the world’s most prevalent malignancies, and is also the third leading cause of cancer death in China. Hepatitis and cirrhosis background is a major feature of liver cancer patients in China, which makes specific requirements that suits the national conditions in many aspects of prevention and control like screening diagnosis, treatment options, and prognosis follow-up. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition), which is based on China’s practice, proposes liver cancer staging in line with China’s national conditions and forms a multi-disciplinary joint diagnosis and treatment model based on surgical treatment. Liver transplantation is included in liver cancer as one of the surgical treatments option. It also emphasizes the support of evidence-based medicine. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) may have laid a solid foundation for future diagnosis and treatment of liver cancer in China.
Objective By analyzing and summarizing the clinical characteristics of pulmonary capillary hemangiomatosis (PCH), to enhance clinical physicians’ recognition, diagnosis and treatment capabilities for PCH. Methods Clinical data of two cases of PCH, who were diagnosed in Nanjing Tower Hospital, were reported retrospectively. Simultaneously, by using “Pulmonary Capillary Hemangiomatosis” as keywords, a total of 227 relevant articles was retrieved from domestic and international databases and 113 articles of case report were analyzed. Results Two cases of PCH patients were diagnosed eventually in our hospital, which were initially misdiagnosed as other diseases. After follow-up, the first case underwent lung transplantation four months after diagnosis, and the second case had been regularly taking medication to decrease pulmonary arterial pressure. Currently, two patients were in stable condition with pulmonary artery pressure significantly reduced. In literature review, 93 patients’ medical records were included in this study. We summarized the diagnostic methods, clinical manifestations, genetic testing, function check results, imaging characteristics, histopathology, treatment and prognosis of these patients. Conclusions PCH is very rare. The extremely low incidence rate and nonspecific clinical manifestations lead to high risk of misdiagnosis and underdiagnosis. Therefore, fully understanding and grasping its clinical characteristics are crucial for reducing misdiagnosis and underdiagnosis in the future.
Objective To study the effect of training methods for hospital infection management that through the whole process of diagnosis and treatment. Methods We selected part-time hospital infection personnel from Panyu Central Hospital of Guangzhou to form a teaching staff between January 1 and October 31, 2022. The teaching staff was randomly divided into a control group and an experimental group using a random number table method. The control group received training using traditional theoretical training models, while the experimental group received training using a simulated hospital infection training teaching model that runs through the entire diagnosis and treatment process. The training effects of the two groups through theoretical knowledge assessment, operational skills assessment, and teacher satisfaction evaluation were compared. Results A total of 196 teachers were included, with 98 students in each group. There was no statistically significant difference between the two groups in terms of gender, age, education level, major category, professional title, and years of work experience (P>0.05). The total score of theoretical knowledge examination in the experimental group [(88.49±8.33) vs. (80.35±13.57) points, t=5.062, P<0.001] was higher than the control group. Among them, the scores of hand hygiene standards for medical personnel, principles of aseptic operation, occupational exposure disposal, classification and disposal of medical waste were significantly higher than those of the control group (P<0.05). The total score of the operational skills assessment in the experimental group was higher than that in the control group [(86.37±5.25) vs. (76.75±7.07) points, t=10.811, P<0.001], among which the scores during operation, after operation, and overall impression were significantly higher than the control group (P<0.05). The overall satisfaction in the experimental group was higher than that of the control group (94.90% vs. 72.45%, χ2=18.076, P<0.001), among which the satisfaction with training methods, textbook value, course attractiveness, and clinical applicability were higher than those of the control group (P<0.05). Conclusions Through the whole process of diagnosis and treatment training method for hospital infection management can significantly improve the training effectiveness of teachers. It is worth promoting in the teaching of hospital infection management for various levels and types of personnel.
Objective
To carry out the systematic clinical management to reduce the incidence of femoral pseudoaneurysm after interventional treatment.
Methods
A historical controlled study was used to compare the management effect before (from October 2012 to October 2013) and after (from March 2014 to March 2015) the application of doctor-nurse integrated systematic clinical management mode. This work mode enhanced cooperation between doctors and nurses, formed the clinical path for nursing workflows and contingency plans, and strengthened specialized education and training for nurses.
Results
After the implementation of systematic clinical management, the incidence of femoral pseudoaneurysm was significantly lower than before (1.0% vs. 2.7%), and the difference was statistically significant (P<0.05).
Conclusions
The systematic clinical management, carrying out in the doctor-nurse integration mode, can improve the quality of nursing and reduce the incidence of femoral pseudoaneurysm. And the management model has achieved remarkable results. So it is worth to be applied in the clinical practices.
Objective To investigate the number, distribution and characteristics of the treatment of epilepsy by vagus nerve stimulation (VNS) under China's three-grade diagnosis and treatment system from 2022 to 2023. Methods Researchers from the China Association Against Epilepsy (CAAE) conducted investigations on the number and distribution of epilepsy centers, as well as the number and distribution of VNS treatments for epilepsy from 2022 to 2023 through online and telephone surveys. Results A total of 435 epilepsy centers in China participated in the treatment of epilepsy by VNS under the three-grade system, among which 191 (43.91%) were in the eastern region. From 2022 to 2023, a total of 1 888 VNS procedures were carried out. Among them, 1 255 procedures (66.47%) were carried out in the eastern region; 1 253 procedures (66.37%) were carried out in third-level epilepsy centers, and 635 procedures (33.63%) were carried out in second-level epilepsy centers. Conclusions The promotion and application of VNS for the treatment of epilepsy under China's three-grade diagnosis and treatment system have achieved preliminary outcomes. However, there are still a regional imbalance in the VNS treatment and a shortage of abilities in primary epilepsy c enters.
Day surgery is an important diagnosis and treatment modality to promote hierarchical diagnosis and treatment and form a “surgery in hospital, recovery in community” diagnosis and treatment mode. At the same time, the promotion and implementation of hierarchical diagnosis and treatment provides institutional support and promotion for the perfection of day surgery management. Based on the experience from the Day Surgery Centre of General Hospital of Eastern Theater Command, this paper investigates the role of “gate-keepers” and recovery guidance in community and secondary hospitals in the perfection of day surgery in tertiary hospitals. Taking orthopedic day surgery as an example, which accounts for the largest proportion in day surgery in General Hospital of Eastern Theater Command, this paper aims to explore a feasible model of hierarchical diagnosis and treatment of day surgery, which specifies the responsibilities and works of hospitals at all levels.
Objective
To investigate the clinicopathological features and clinical subtypes of Peutz-Jeghers syndrome (PJS) in Chinese cases.
Methods
The clinical and pathological data of 295 patients with PJS who were treated in Air Force General Hospital from Nov. 1994 to Aug. 2017 were retrospectively analyzed and a multifactor statistical study was carried out on.
Results
Two hundreds and ninety-five patients with PJS belonged to 7 nationalities and came from 26 provinces and urban areas. 99.0% (292/295) of the patients had black spots on the lip and buccal mucosa, and the median occurrence time was 2 years old (0–33 years). The median age of inital diagnosis and treatment was 15 years old (1–45 years). The median interval time between the occurrence of black spots and abdominal symptoms was about 10 years (0–45 years). PJS hamartoma polyps were found in alimentary canals of 293 patients (99.3%), and 96.9% distributed in the duodenum and small intestine (n=284), 90.4% distributed in the colorectal (n=265), 79.9% distributed in the stomach (n=234). Patients of black spot appearing at age <3 years and (or) initial treatment at age <14 years were classified as early-onset subtype, otherwise they could be included in delayed-onset subtype.
Conclusions
The clinical features of PJS are prominent and the harm of PJS hamartoma polyps is serious. The black spots on the lip and buccal mucosa can be used as an early warning signal to divide the PJS patients into 2 clinical subtypes, which should be differentiated in clinical therapy and follow-up strategy.
Objective
To investigate the cause, treatment, and prognosis of the postpancreaticoduodenectomy hemorrhage (PPH) .
Method
A total of 779 patients who underwent pancreaticoduodenectomy at Fudan University Shanghai Cancer Center between January 2015 and December 2016 were enrolled, and the data of them were retrospectively analyzed.
Results
Sixteen patients (PPH group) suffered from PPH and 763 patients didn’t suffered from PPH (non-PPH group) of 779 patients. There was no significant difference in the age, gender, type of disease, operative time, blood loss, and ratio of blood transfusion between the 2 groups (P>0.05), but the incidences of pancreatic fistula and delayed gastric emptying, postoperative drainage time, hospital stay, and mortality were all higher or longer in PPH group compared with non-PPH group (P<0.001). Of the 16 PPH patients, early haemorrhage occurred in 3 patients (including 2 patients with gastrointestinal haemorrhage and 1 patient with intra-abdominal haemorrhage) and delayed haemorrhage occurred in 13 patients (including 6 patients with gastrointestinal haemorrhage and 7 patients with intra-abdominal haemorrhage). All the 3 patients with early haemorrhage were cured by surgery. Of the 13 patients with delayed haemorrhage, 5 patients were cured by radiological intervention, 2 patients were cured by endoscopic hemostasis, and 3 patients were cured by conservative treatment, but 3 patients with sentinel bleeding died after interventional embolization+surgery.
Conclusions
The mortality of PPH is high. Surgery is optimal to early haemorrhage and radiological intervention is optimal to delayed haemorrhage, including embolization or covered stent implantation. The sentinel bleeding should be given great attention.
ObjectivesTo analyze the balance of medical human resource allocation in Chengdu and to discuss the impact of human resource allocation structure on the hospital’s medical service capabilities, so as to provide a theoretical basis for the hospital to optimize the talent team structure.MethodsThe Moran’s index and Gini coefficient were used to evaluate the spatial aggregation and grade distribution difference of human resources allocation, respectively. The case mix index (CMI), the length of hospital stay, and the difficulty of surgery were used as outcome variables, and a multiple regression analysis model was established to explore the impact of human resource indicators on the hospital’s medical service capabilities.ResultsThe distribution of doctors showed an obvious spatial aggregation in Chengdu, and there was a positive spatial correlation (Moran’s Idoctor=0.290); the distribution of nurses had no obvious spatial aggregation (Moran’s Inurse=0.102). Under different medical service capacity segments, the Gini coefficient of doctors was 0.518, and the Gini coefficient of nurses was 0.576, both exceeding 0.5, indicating that the distribution of medical human resources in different levels of hospitals was considerably different. The regression results showed that the expansion of the quantity of senior title doctors and the proportion of medical care both could improve the hospital’s CMI. The increase in the quantity of doctors with senior titles also had a certain impact on improving the hospital’s surgical capabilities. The expansion of the proportion of medical care could lead to a slight increase in the length of patients' hospital stay.ConclusionsOptimizing the allocation structure of medical human resources in different regions and hospitals with different levels is an important task in the construction of a hierarchical diagnosis and treatment system. It is necessary to further integrate medical human resources throughout the whole city and strengthen personnel training and team building in primary health institutions. Hospitals at different levels should implement their own development positioning and further optimize their human resource allocation structure according to development needs. Tertiary hospitals should pay more attention to the cultivation of senior professional doctors, optimize the proportion of medical care, and improve the hospital’s medical service capabilities. The primary health institutions should pay attention to the comprehensive construction of medical personnel, and strengthen the development of the team of general practitioners, so as to achieve a comprehensive improvement of the city’s medical service capabilities.
Postmenopausal osteoporosis (PMOP) is a significant metabolic bone disease triggered by estrogen deficiency. Macrophages, as pivotal cells in bone metabolism regulation, participate in bone remodeling and inflammatory modulation through differentiation into osteoclasts and polarization phenotype switching. This article systematically reviews the mechanistic roles of macrophages in PMOP, encompassing their interactions with osteoclasts, polarization effects, immune-inflammatory responses, and impacts of oxidative stress. Furthermore, it explores the potential applications of macrophages in molecular diagnosis and pharmacological interventions for PMOP, while proposing future research directions.
