摘要:醫院有效事前監測、管控醫療不良事件，是保障患者安全、提高醫療質量的管理措施之一。超大型醫院對醫療不良事件管理的實戰中，建立、實施醫療安全隱患事件關鍵監測指標、醫療安全隱患事件篩查程序指標，積極開展醫療不良事件后臺監管工作，切斷醫療安全隱患事件向醫療風險事件演變、醫療風險事件向醫療糾紛事件演變的環節，保障患者安全。Abstract: Effective supervision in advance to the medical adverse event, is one of measures which hospital adopt to guarantee patient safety and enhance medical quality. The actual combat of supervision to the medical adverse event in super sized hospital, set up and put in practice on the key target of supervising the medical adverse event and the key target of ridding procedure, remain in the background and work actively on supervision on the medical adverse event, shut off the road from the medical safety issue to the medical risk issue and the road from the medical risk issue to the medical dissension in order to guarantee the patient safety.
Objective To investigate the effect of myoblast transplantation on duchenne muscular dystrophy (DMD) and to explore the method and feasibil ity of applying gene therapy to DMD. Methods Myoblast of C57/BL10 mice were cultured using multiple-step enzyme digestion method and differential velocity adherent technique. The morphology of the cells was observed with inverted phase contrast microscope. The cells at passage 4 were labeled with 5-BrdU. Twenty-four DMDmodel mice (mdx mice: aged 4-6 weeks, male, 13.8-24.6 g) were randomly divided into two groups (n=12 per group): group A, 1 × 106/mL labeled myoblast were injected via ven caudal is twice at an interval of 2 weeks; group B: 1 mL DMEM/F12 was injected in the same manner serving as a control group. The mice were killed 4 weeks after operation and the motor abil ity of the mice was detected by one-time exhaustive swimming before their death. HE staining and immunohistochemistry staining observation for 5-BrdU, desmin, and dystrophin (Dys) were preformed, and the imaging analysis was conducted. Results The primary myoblast could be sub-cultured 5-7 days after culture, providing stable passage and sufficient cells. The time of onetime exhaustive swimming was (60.72 ± 5.76) minutes in group A and (47.77 ± 5.40) minutes in group B, there was significant significance between two groups (P lt; 0.01). At 4 weeks after injection, HE staining showed that in group A, there were round and transparent-stained myocytes and the percentage of centrally nucleated fibers (CNF) was 67%; while in group B, there were uneven muscle fiber with such pathological changes as hypertrophia, atrophia, degeneration, and necrosis, and the percentage of CNF was above 80%. Immunohistochemistry staining revealed that the expression of 5-BrdU, desmin, and Dys was positive in group A; while in group B, those expressions were l ittle or negative. Image analysis result displayed that integral absorbency (IA) value of desmin was 489.70 ± 451.83 in group A and 71.15 ± 61.14 in group B (P lt; 0.05) and the ratio of positive area to thetotal vision area was 0.314 3 ± 0.197 3 in group A and 0.102 8 ± 0.062 8 in group B (P lt; 0.05); the Dys IA value was 5 424.64 ± 2 658.01 in group A and 902.12 ± 593.51 in group B (P gt; 0.05) and the ratio of positive area to the total vision area was 0.323 7 ± 0.117 7 in group A and 0.035 2 ± 0.032 9 in group B (P lt; 0.05). Conclusion Myoblast transplantation has certain therapeutic effect on DMD of mice.
ObjectiveTo analyse the microsurgical treatment and facial nerve preservation of giant acoustic neuromas. MethodsUnder the conditions of facial nerve monitoring, 400 patients with giant acoustic neuromas underwent microsurgical removal via suboccipital retrosigmoid approach between January 2005 and January 2013. There were 186 males and 214 females, with the age ranged from 15 to 74 years (mean, 41.6 years). The disease duration was 2-13 years (mean, 2.4 years). The lesions were located at the left cerebellopontine angle region (CPA) in 191 cases, right CPA in 200 cases, bilateral CPA in 9 cases. The clinical manifestations included unilateral hearing loss and tinnitus as first symptoms in 389 cases, facial numbness in 373 cases, unilateral facial paralysis in 370 cases, headache in 269 cases, lower cranial nerve symptoms with drinking cough and dysphagia in 317 cases, and unstable gait in 342 cases. Preoperative skull base thin layer CT showed varying degrees of horn-like expansion in ipsilateral internal auditory canal opening. MRI showed cysts in 78 cases and solid masses in 322 cases; with hydrocephalus in 269 cases. Postoperative cranial MRI or CT was taken to observe the extent of tumor resection. The preservation of facial nerves in anatomy was assessed by intraoperative microscope video and electrophysiological monitoring; the facial nerves function was assessed according to House-Brackmann (HB) classification on the first day after operation; and the rehabilitation of facial nerve function was also assessed at discharge and at 1 year postoperatively by using HB grade. ResultsTotal tumor removal was achieved in 372 cases (93.00%), and subtotal removal in 28 cases (7.00%). One case died of delayed brainstem ischemia at 14 days after operation, and 1 case died of lung infection at 20 days after operation; 398 cases were followed up 6 months to 8 years (mean, 3.5 years). Recurrence occurred in 1 case because of neurofibromatosis at 5 years after operation. The rate of anatomical preservation of the facial nerve during operation was 91.75% (367/400), and the functional preservation rate at the first day after operation was 62.75% (251/400). The HB grade of facial nerve function showed significant difference aomng 3 time points (at the first day, at discharge and at 1 year after operation) (χ2=23.432, P=0.000). Complications included postoperative intracranial infection in 11 cases (2.75%), cerebrospinal fluid leakage in 29 cases (7.25%), aggravated lower cranial nerve symptoms in 18 cases (4.50%), subcutaneous effusion in 13 cases (3.25%), second operation to remove hematoma in 9 cases (2.25%), postoperative circumoral herpes simplex virus infection in 25 cases (6.25%), and all complications were cured after symptomatic treatment. Postoperative hydrocephalus disappeared in 261 cases. ConclusionSurgical operation is the first choice in the treatment of giant acoustic neuromas. Under the auxiliary of neural electrophysiological monitoring, the microsurgery operation via suboccipital retrosigmoid approach for giant acoustic neuromas has extremely low mortality and high preservation rate of facial nerve function.
According to the characteristics of the diversified employment system of general hospitals, we have independently developed a set of personnel information platforms suitable for our hospital's operating model and work-flow which achieved establishing a novel big data management model for big personnel. After a year of trial operation, the big data management of personnel has completely covered the target management and requirements of the hospital, covering basic quality, public services, teaching work, medical work, scientific research, and other dimensions of information, which helped the hospital constructed a systematically networked and full-coveraged, personnel information system with strong early warning functions and incentives, enabling the reasonable utilization rate of human capital and continuous improvement of the quality of talent training.
Microsurgery has always been the main treatment for large vestibular schwannomas. With the progress of microsurgical technique and neuroimaging, the application of the intraoperative physiological monitoring technology, as well as the popularization of the concept of minimally invasive neurosurgery, the current development trend of surgery for vestibular schwannomas is to realize both the maximal tumoral resection and the maximal preservation of facial nerve function, which puts more emphasis on the improvement of quality of life. It is still a challenge for neurosurgeons to resect the tumor to the maximum extent and preserve the nerve function as well. In view of this background, the strategy of " near-total resection” and " subtotal resection” combined with stereotactic radiotherapy has been more and more accepted in the past years. However, as a neurosurgeon, the ultimate goal should be " gross-total resection of tumor” and preservation of the nerve function as well. For those tumors severely adherent to neurovascular structure, " near total resection” might be a rational choice. Meanwhile, long-term follow-up should be conducted to clarify the biological behavior of tumor residues, as well as the necessity and long-term effect of stereotactic radiotherapy.
ObjectiveTo understand the current status of healthcare human resources (HHR) in a large public hospital, predict the HHR demand aligned with the development of the hospital, and provide reference basis and feasible solutions for HHR planning for high-quality development of the large public hospital. MethodsBased on grey model and auto regressive integrated moving average model, a variance reciprocal method for weight allocation was applied to set up the combination forecasting model. Different types of HHR demand of the large public hospital from 2024 to 2026 were predicted and the accuracies of the three different model predictions were compared. ResultsThe numbers of total personnel, health technical personnel, physicians, nurses, and technicians predicted by the combination forecasting model for 2026 were 17654, 13041, 4389, 6198, and 2264, respectively. The corresponding average annual growth rates from 2024 to 2026 were 5.54%, 5.55%, 5.37%, 4.27%, and 5.60%, respectively. Compared with the two single forecasting models, the combination forecasting model had the smallest average absolute errors, mean squared errors, and mean absolute percentage errors for predicting the numbers of total personnel, nurses, and technicians. It also had the smallest average absolute error and mean absolute percentage error for predicting the number of health technical personnel, and the smallest average absolute error for predicting the number of physicians. ConclusionsCompared with the single forecasting model, the combination forecasting model shows fewer system errors and better predictive results. The demand for total personnel, health technical personnel, physicians, nurses, and technicians of this large public hospital will continue to increase, so planning and reserving staff in advance is a key to high-quality development of the hospital.
目的 探討內鏡反轉黏膜切除術治療超低位直腸大型側向發育型腫瘤的價值。 方法 回顧性分析四川大學華西醫院消化內鏡中心2010年1月－2011年12月間38例內鏡反轉黏膜切除術治療超低位直腸大型側向發育型腫瘤病變殘留、治療效果。 結果 38例患者，男18例，女20例，年齡8～80歲；病變下緣距肛門齒狀線1～4.0 cm24例，侵及齒狀線14例。病變大小（按病變最大徑分類）：1.5～3.0 cm 12例，3.1～4.0 cm 8例，4.1～5.0 cm4例，5.1～7.0 cm 10例，10 cm 4例。病變直徑在5.0 cm以下的24例患者，經首次手術治療腫瘤完整切除，術后2例灶性癌變，追加外科手術；其余22例2個月復查，病變無殘留，6個月復查，2例復發，經再次手術病變完整切除。隨訪1年，全部未見復發，治愈率為100%，無殘留。病變直徑5.1～7.0 cm的10例患者，經首次手術治療腫瘤分次切除，2個月復查，6例病變完整切除無殘留，6個月復查，其中2例復發，經再次內鏡下手術切完病變，隨訪1年，無復發；另4例有殘留，經再次內鏡下手術切完病變，6個月復查無復發，隨訪1年，4例均未見復發。病變直徑10 cm 的4例患者，經多次手術后復查均有病變殘留，無法完全切除，患者拒絕外科手術。5.1 cm以上病變治愈率71.43%，殘留率高達57.14%。本組術后出血16例，感染1例，直腸狹窄1例，肛門墜脹3例，無穿孔發生。 結論 內鏡反轉黏膜切除術治療超低位直腸大型側向發育型腫瘤有效，對5.0 cm以下病變能一次完整切除，5.1 cm以上病變殘留率高，需再次內鏡下手術，10 cm以上病變切除不完全。應慎重選擇病例，術后密切隨訪。
ObjectiveTo investigate the difference between four transforaminal endoscopic approaches in the treatment of serious lumbar disc herniation.MethodsBetween October 2010 and February 2015, a total of 122 patients with serious lumbar disc herniation were enrolled and treated with discectomy under transforaminal endoscope. The patients were divided into 4 groups according to the different approaches. The transforaminal endoscopic spine system (TESSYS) technology was used in group A (31 cases), Yeung endoscopic spine system (YESS) technology was used in group B (30 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (31 cases), and interlaminar dorsal access (IDA) technology was used in group D (30 cases). There was no significant difference in gender, age, disease duration, lesion segment, and preoperative visual analogue scale (VAS) score of low back pain, VAS score of bilateral lower extremities pain, Oswestry disability index (ODI), intervertebral height, lumbar curvature index (LCI), and disc degeneration grading between groups (P>0.05). The removal volume of nucleus pulposus was compared; after operation, VAS score, ODI score, LCI, intervertebral height, and disc degeneration grading were used to evaluate the effectiveness.ResultsThe removal volumes of nucleus pulposus in groups A, B, C, and D were (3.6±0.9), (3.5±0.7), (4.6±1.0), (3.1±1.1) cm3, respectively. There were significant differences between groups (P<0.05). All incisions healed by first intention, and no early postoperative complications was found. All cases were followed up 12-35 months, with an average of 24 months. During follow-up, there was no recurrence of nucleus pulposus herniation, infection of intervertebral space, cerebrospinal fluid leakage, epidural hematoma, or other complications. At last follow-up, the VAS scores of low back pain and bilateral lower extremities pain, and ODI scores in each group significantly improved when compared with those before operation (P<0.05); there was no significant difference in the scores and improvements between groups after operation (P>0.05). At last follow-up, the disc degeneration grading in group B significantly improved when compared with that before operation (P<0.05); there was no significant difference between groups (P>0.05). At last follow-up, there was no significant difference in LCI of each group when compared with that before operation (P>0.05); and there was no significant difference in LCI and loss value between groups (P>0.05). There was no significant difference in the intervertebral height of the 4 groups at immediate after operation and last follow-up when compared with preoperative value (P>0.05), and there was no significant difference between groups at immediate after operation and last follow-up (P>0.05).ConclusionApplication of transforaminal endoscope in the treatment of serious lumbar disc herniation has great clinical outcomes. The ITEA technology can obtain a wider field of view and be more convenient to find and remove the degenerative nucleus pulposus. However, the appropriate approach should be selected according to the symptoms and characteristics of lumbar disc herniation.