ObjectiveTo systematically review the clinical utilization of robotic bronchoscopes in diagnosis of pulmonary nodules, including MonarchTM and IonTM platforms, and then evaluate the efficacy and safety of the procedure. MethodsPubMed, EMbase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched by computer for literature about the biopsy of pulmonary nodules with robotic bronchoscope from January 2018 to February 14, 2022. The quality of research was evaluated with Newcastle-Ottawa Scale. RevMan 5.4 software was used to conduct the meta-analysis. ResultsFinally, 19 clinical studies with 1 542 patients and 1 697 targeted pulmonary nodules were included, of which 13 studies used the IonTM platform and 6 studies used the MonarchTM platform. The overall diagnostic rate of the two systems was 84.96% (95%CI 62.00%-95.00%), sensitivity for malignancy was 81.79% (95%CI 43.00%-96.00%), the mean maximum diameter of the nodules was 16.22 mm (95%CI 10.98-21.47), the mean procedure time was 61.86 min (95%CI 46.18-77.54) and the rate of complications occurred was 4.76% (95%CI 2.00%-15.00%). There was no statistical difference in the outcomes between the two systems. Conclusion Robotic bronchoscope provides a high efficacy and safety in biopsy of pulmonary nodules, and has a broad application prospect for pulmonary nodules diagnosis.
The mechanical properties of artificial intervertebral disc (AID) are related to long-term reliability of prosthesis. There are three testing methods involved in the mechanical performance evaluation of AID based on different tools: the testing method using mechanical simulator, in vitro specimen testing method and finite element analysis method. In this study, the testing standard, testing equipment and materials of AID were firstly introduced. Then, the present status of AID static mechanical properties test (static axial compression, static axial compression-shear), dynamic mechanical properties test (dynamic axial compression, dynamic axial compression-shear), creep and stress relaxation test, device pushout test, core pushout test, subsidence test, etc. were focused on. The experimental techniques using in vitro specimen testing method and testing results of available artificial discs were summarized. The experimental methods and research status of finite element analysis were also summarized. Finally, the research trends of AID mechanical performance evaluation were forecasted. The simulator, load, dynamic cycle, motion mode, specimen and test standard would be important research fields in the future.
ObjectiveTo study the effects of different penetration enhancers on the transdermal penetration of Miao medicine named Diploclisia affinis. MethodsImproved Franz diffusion cell was adopted as the apparatus for in vitro mouse' skin permeation. The kinetic parameters of percutaneous absorption, such as penetration rate, enhancing rate (ER), and lag time (Tlag) were determined by high performance liquid chromatography. Azone, oleic acid (OA) and borneol were investigated for percutaneous absorption effects. ResultsThe penetration rates of the medicine with 3% azone, OA and borneol added were respectively (214.1872±13.5690), (227.5544±9.8490), and (168.1187±21.5640) μg/(cm2·h), and the ER was 1.61, 1.71, and 1.26 compared with the penetration rate of that with nothing added. The Tlag was 2.1081, 1.8256, and 2.9655 hours. ConclusionAll the penetration enhancers can increase significantly the absorption of Miao medicine named Diploclisia affinis, especially 3% OA is the best, but 3% borneol may make the Tlag longer.
Aiming at the status of muscle and joint damage caused on surgeons keeping surgical posture for a long time, this paper designs a medical multi-position auxiliary support exoskeleton with multi-joint mechanism by analyzing the surgical postures and conducting conformational studies on different joints respectively. Then by establishing a human-machine static model, this study obtains the joint torque and joint force before and after the human body wears the exoskeleton, and calibrates the strength of the exoskeleton with finite element analysis software. The results show that the maximum stress of the exoskeleton is less than the material strength requirements, the overall deformation is small, and the structural strength of the exoskeleton meets the use requirements. Finally, in this study, subjects were selected to participate in the plantar pressure test and biomechanical simulation with the man-machine static model, and the results were analyzed in terms of plantar pressure, joint torque and joint force, muscle force and overall muscle metabolism to assess the exoskeleton support performance. The results show that the exoskeleton has better support for the whole body and can reduce the musculoskeletal burden. The exoskeleton mechanism in this study better matches the actual working needs of surgeons and provides a new paradigm for the design of medical support exoskeleton mechanism.
ObjectiveTo systematically review the efficacy of pay-for-performance (P4P) for primary care physicians (PCPs). MethodsThe Cochrane Library, Database of Abstracts of Reviews of Effects, EMbase, Web of Science, PubMed, Dissertations and Theses Database, EconLit, CNKI, WanFang Data, IDEAS, and POPLINE were searched to collect studies on the efficacy of P4P for PCPs from inception to May 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was then performed by using RevMan 5.4 software. ResultsA total of 10 studies were included. The results of meta-analysis showed that P4P incentives possibly improved child immunization status (RR=1.27, 95%CI 1.19 to 1.36, P<0.001), slightly improved primary care physicians’ prescribing of guideline-recommended antihypertensive medicines compared with existing payment method (RR=1.07, 95%CI 1.02 to 1.12, P=0.006), and improved a mixed outcome measure of service provision and patient health outcomes (RR=1.13, 95%CI 1.04 to 1.23, P=0.004). ConclusionsCurrent evidence shows that P4P possibly increases the quantity of health service provision and improve quality of service provision for targeted populations. The effects of P4P on health outcomes is uncertain. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
The high rotational speed of the axial flow blood pump and flow separation of the centrifugal blood pump are the main causes for blood damage in blood pump. The mixed flow blood pump can effectively alleviate the high rotational speed and the flow separation. Based on this, the purpose of this study is to explore the performance of the mixed blood pump with a closed impeller. A mixed flow blood pump with closed impeller was studied by numerical simulation in this paper. The flow field characteristics and the pressure distribution of this type of blood pump were analyzed. The hydraulic performance of the blood pump and the possible damages to red blood cells were also discussed. At last, pump performance was compared with the mixed flow blood pump with semi-open impeller. The results show that the mixed flow blood pump with close impeller studied in this paper can operate safely and efficiently with a good performance. The pump can reach the pressure head of 100 mmHg at 5 L/min mass flow rate. Flow in the blood pump is uniform and no obvious separation or vortex occurs. Pressure distribution in and on the impeller is uniform and reasonable, which can effectively avoid the thrombosis of blood. The average mean value of hemolysis index is 4.99 × 10?4. The pump has a good biocompatibility. Compared with the mixed flow blood pump with semi-open impeller, the mixed flow blood pump with closed impeller has higher head and efficiency, a smaller mean value of hemolysis index prediction, a better hydraulic performance and the ability to avoid blood damage. The results of this study may provide a basis for the performance evaluation of the closed impeller mixed flow blood pump.
Masticatory robots have a broad application prospect in the field of denture material tests and mandible rehabilitation. Mechanism type of temporomandibular joint structure is an important factor influencing the performance of the masticatory robot. In view of the wide application of elastic components in the field of the biomimetic robot, an elastic component was adopted to simulate the buffering characteristics of the temporomandibular joint disc and formed the elastic temporomandibular joint structure on the basis of point-contact high pair. Secondly, the influences of the elastic temporomandibular joint structure (on mechanism degree, kinematics, dynamics, etc.) were discussed. The position and velocity of the temporomandibular joint were analyzed based on geometric constraints of the joint surface, and the dynamic analysis based on the Lagrange equation was carried out. Finally, the influence of the preload and stiffness of the elastic component was analyzed by the response surface method. The results showed that the elastic temporomandibular joint structure could effectively guarantee the flexible movement and stable force of the joint. The elastic joint structure proposed in this paper further improves the biomimetic behavior of masticatory robots. It provides new ideas for the biomimetic design of viscoelastic joint discs.
ObjectiveTo establish an accurate and sensitive high performance liquid chromatography-mass spectrometric (HPLC/MS/MS) method for determination of vorinostat (SHA) and M2 metabolites in human serum, which was applicable for pharmacokinetic study of SHA. MethodsThe essay was conducted with an API 3000 HPLC-MS/MS system consisted of a Gemini C18 column (50 mm×3 mm, 3 μm), and the mobile phase consisted of methanol-acetonitrile-water-1 mol/L NH3-formic acid (25:15:60:0.1:0.05) at a flow rate of 0.23 mL/min. Acidulated serum samples were extracted by 3.5 mL diethyl ether which contains 3% isopropyl alcohol and was operated under the multiple reaction monitoring mode using the electrospray ionization technique. d5-SHA was used as the internal standard. ResultsThe retention time of SHA, M2 metabolite and internal standard were 4.1, 3.1 and 4.0 minutes, respectively. The linear range of SHA and M2 metabolite were in the range of 1-1 000 and 2-2 000 ng/mL, and the limit of quantity were 1.0 and 2.0 ng/mL; the method recovery were 93.0%-99.3% and 88.11%-104.12%, respectively. Matrixes effect of SHA and M2 metabolite were blow 9.0%. ConclusionThis method for the quantitative determination of SHA and M2 in human serum was proved to be simple, rapid, sensitive and accurate; it can be applied in the determination of SHA and M2 metabolite.
Objective To study the distribution and concentration of meropenem in rabbit bile. Methods The rabbits were cannulated with a silicone tube in the common bile duct and the blank bile was collected. The rabbits were then administered intravenously with meropenem. Multiple bile samples (1.5 ml) were collected at different phases after the administrations. According to requirement of the high performance liquid chromatography (HPLC), the specificity test was undertook. The blank bile was then mixed with meropenem and mobile phase, respectively, in order to obtain a series of bile samples at different concentrations ranging from 0.5 to 500 μg/ml. The samples were analyzed with HPLC and the chromatographic peak area of meropenem contents were quantitated through external reference method. The linear regression equation was used to analyzed the relationship between the drug concentrations and the chromatographic peak areas. The bile samples that were collected after drug administrations were pretreated and the chromatographic peak areas were assayed by the liquid chromatograph. The bile concentrations were then calculated according to the regression equation, and the concentration-time distribution of meropenem in the bile was obtained ultimately. Results The specificity test indicated the bile dopant peak and the meropenem chromatographic peak were well-separated under chromatographic condition of the mobile phase. The standard curve regression equation was S=2 209.10C-1 251.34, r=0.999 9, and minimum quantitation limit of meropenem was 0.5 μg/ml. After a single i.v. administration of 75 mg/kg of meropenem in each rabbit, drug concentrations reached (38.36±14.17) μg/ml immediately in bile， which significantly exceeded the minimum inhibitory concentrations (MIC90) for most gram negatives, which range from 0.031 to 2 μg/ml. The bile concentration of meropenem decreased quickly over time, and meropenem was eliminated completely in rabbit bile 3 hours after intravenous injection. Conclusion Meropenem could achieve adequate bile concentration for the treatment of biliary tract infection due to susceptible bacteria. However, because of its rapid biliary elimination, meropenem should be used in shorter interval time.
ObjectiveTo analyze the efficacy of promoting the development of day surgery in a municipal third-level public hospital under the guidance of national hospital performance appraisal system. MethodThe annual data relevant day surgery in the Yibin Second People’s Hospital were collected from 2016 to 2022, which were divided into three stages: 2016–2018, 2019–2020, and 2021–2022. The trend and correlation of the performance appraisal indicators were analyzed. ResultsThe day surgery in the Yibin Second People’s Hospital started in 2018, and its proportion in the elective surgery was only 1.2% in 2018, then increased continuously after the implementation of performance appraisal system, and was up to 34.7% in 2022. From 2016 to 2022, the proportion of discharged patients underwent surgery in the entire hospital increased continuously from 22.4% in 2016 to 35.7% in 2022, and the average hospital stay in the entire hospital gradually decreased from 10.9 d to 8.1 d, which both had a significant linear correlation with the proportion of day surgery in the elective surgery (rs=0.93, P=0.002; rs=–0.99, P<0.001, respectively). In the recent implementation of performance appraisal system, the re-operation rate after day surgery was less than 0.1%, the readmission rate of day surgery after discharge was 0%, and the satisfaction rate of day surgery patients was more than 95.0%, which reached 97.0% by 2022, higher than the average level of inpatient satisfaction in the entire hospital. Taking laparoscopic cholecystectomy, cataract phacoemulsification and intraocular lens implantation, internal fixation extraction, vocal cord polypectomy, and endoscopic gastric polypectomy as example, the average total hospitalization cost and average cost excluding drug and medical materials consumption of the day surgery all decreased compared to non-day-surgery mode, respectively. ConclusionUnder the guidance of national hospital performance appraisal system, day surgery has entered a rapid developing stage, but it is still necessary to promote the medical quality by standardized, precise, and informationized day surgery management.