Objective To summarize the injury characteristics of the whole hand degloving injury and to explore its classification and treatment. Methods Between December 1999 and May 2010, 41 cases of the whole hand degloving injury were admitted for treatment. There were 28 males and 13 females with an average age of 35 years (range, 18-58 years). The causesof injury included mangled injury in 28 cases and crush injury in 13 cases. The interval between injury and surgery was 1-10 hours (mean, 3 hours). According to self-made classification standard for whole hand degloving injury, 11 cases were rated as type I, 5 cases as type II, 4 cases as type III, 8 cases as type IV, and 13 cases as type V. Type I injury was treated by replantation surgery with vascular anastomosis, type II by reconstruction with thumb flap and the second toe containing dorsal skin flap, type III by reconstruction with the second toe containing dorsal skin flap of both feet, type IV by replantation surgery with vascular anastomosis, and type V by reconstruction with thumb flap containing dorsal skin flap (8 cases) or repairing with abdominal flap (5 cases). The size of the dorsal flap was between 9 cm × 6 cm and 17 cm × 11 cm and the dorsal donor site was covered with free skin grafting. Results After surgery, partial necrosis occurred at fingers in 6 patients with type I injury, and at fingers and palm skin in 6 patients with type IV injury; the flaps, the reconstructed fingers, and replanted skin all survived in the others. The grafted skin at donor sites successfully healed. Forty cases were followed up from 6 months to 7 years (mean, 14 months). The skin color and texture were close to normal hand in the cases undergoing replantation, who had the best function restoration with S2-S4 sensory recovery; the hand function was basically restored with S2-S3 sensory recovery in the cases undergoing finger reconstruction with thumb and toe flaps; and the restoration of the hand function was not satisfactory with S1-S2 sensory recovery in the cases undergoing abdominal flaps. Conclusion Whole hand degloving injury can be classified into different types according to injury degree and this will help choose the cl inical treatment plan. The appropriate treatment based on these types can obtain better cl inical effectiveness.
To further enhance quality control in breast cancer diagnosis and treatment across Sichuan Province, Expert Committee of Sichuan Provincial Quality Control Center for Multidisciplinary Precision Diagnosis and Treatment of Breast Cancer has established 44 quality control indexes and suggested standards. These indexes were developed through evidence from multiple authoritative domestic guidelines and consensus, combined with clinical quality control experience within the province. By emphasizing the multidisciplinary nature of breast cancer care and identifying crucial control points, this quality control system promotes regional standardization of medical services and elevates the overall quality of breast cancer management throughout Sichuan province.
Based on the national 2020 and 2022 versions of Accreditation Standards for Tertiary Hospital, the Hospitals Accreditation Office of the Sichuan Provincial Health Commission organized to develop Implementation Rules for the Accreditation Standards for Tertiary Comprehensive Hospitals in Sichuan Province (2023 Edition). In order to guide the evaluated hospitals to comprehensively understand and master the content of hospital infection prevention and control (IPC), this article interprets the main evaluation points and scoring methods of hospital infection management in the detailed rules, emphasizes on organizational management, system implementation, monitoring/supervision, and connotation improvement for IPC. The purpose is to make the evaluated hospitals attach importance to the standardized implementation of daily work of IPC, focus on the routine, objective, and quantitative approach to accreditation work, and continuously achieve the effect of quality improvement in IPC.
ObjectiveTo analyze the status of scientific papers published by clinical medicine postgraduates during the "double-track integration" training period. MethodsData of publications of 634 clinical medicine postgraduate students who were been trained in the "double-track integration" system in West China School of Medicine, Sichuan University from 2015 to 2017 were collected. The data of the papers published during the concurrent training and residency were retrospectively analyzed. Results634 postgraduates with master degree in clinical medicine published 1 038 papers in total. Students from 3 grades published 1.606, 1.554 and 1.785 papers on average respectively, and the overall average number of publications was 1.637 per person. The composition ratios of the journal types of articles were: SCI, 37.96%; MEDLINE, 6.55%; Chinese core journals, 55.49%. Statistical differences were found in the types of journals published in the three grades. The composition ratios of article types were: case report, 24.56%; review, 34.01%; original study, 41.43%. There was no statistical difference in the composition of article types in 3 grades. All 634 graduate students met the requirements for thesis publication and succeeded in completing the training. ConclusionsIn the "double-track integration" training system, postgraduates with master degree in clinical medicine can meet the training requirements of publishing relevant articles prior to graduation.
Digital health technology implementation has grown rapidly in recent years. To standardize the quality of digital health implementation research and increase the transparency and integrity of reporting, Perrin published iCHECK-DH: guidelines and checklist for the reporting on digital health implementations in 2023. This article interprets the contents of the list with a view to improving the reporting quality of digital implementation studies to develop more effective digital health interventions and achieve better health outcomes.
In recent years, the field of cardiovascular surgery has undergone revolutionary changes and made rapid progress in various aspects, bringing more hope and possibilities for the health and well-being of patients. The constant emergence of new technologies brings new opportunities and hope, as well as constant challenges to past concepts. This article aims to provide a comprehensive overview of the latest developments in cardiovascular surgery in recent years, especially since 2023. It introduces cutting-edge knowledge and technologies in the field of cardiovascular surgery, including lifelong management of aortic valve disease, artificial valves, mitral valves, treatment options for hypertrophic obstructive cardiomyopathy, heart transplantation, left ventricular assist, coronary artery surgery, cardiac structural interventions for chronic heart failure, aortic dissection, and comprehensive surgical treatment of atrial fibrillation. It also analyzes and explores future development directions in depth, aiming to provide useful references and inspiration for cardiovascular doctors and jointly promote the continuous progress of cardiovascular surgery in China.
ObjectiveTo compare the short- and long-term efficacy of artery-first approach pancreatico-duodenectomy (AF-PD) and standard approach pancreaticoduodenectomy (S-PD).MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang, and CNKI databases were searched, relevant literatures were included, and relevant data were extracted for meta-analysis.ResultsA total of 30 articles were included, including 2 750 cases underwent pancreaticoduodenectomy. The results of meta-analysis showed that in terms of short-term efficacy when compared with S-PD group, the AF-PD group had less intraoperative blood loss (WMD=–175.87, P<0.001), lower intraoperative blood transfusion rate (OR=0.36, P=0.002), higher R0 resection rate (OR=1.83, P<0.001), lower postoperative pancreatic leakage rate (OR=0.71, P=0.005), and shorter postoperative hospital stay (WMD=–2.69, P=0.007). However, there were no statistically significant differences in the operation time and overall postoperative complication rate between the two groups (P>0.05). In terms of long-term efficacy when compared with S-PD group, the AF-PD group had lower tumor local recurrence rate (OR=0.43, P=0.004) and tumor liver metastasis rate (OR=0.60, P=0.010), but had higher 1-year (OR=1.95, P=0.007), 2-year (OR=2.04, P<0.001), 3-year (OR=2.09, P=0.001), and 5-year (OR=2.06, P=0.003) overall survival rates, and there were no significant differences in the rates of lung metastasis and peritoneal metastasis between the two groups (P>0.05).ConclusionsAF-PD is better than S-PD in some short-term and long-term outcome indicators such as R0 resection rate, pancreatic leakage rate, overall survival rate, and so on. However, due to the limited quality of the included literatures, more high-quality studies are still needed to verify in the future.
In order to improve the management of medical technology and ensure the safety, efficiency, and economy of medical devices, we introduce the current situation and future of clinical medical engineering technology evaluation from eight aspects: evaluation standard, evaluation of technical performance, evaluation of reliability, evaluation of clinical application, evaluation of health economy, evaluation of service system, technology maturity, and human factor engineering. The evaluation of clinical medical engineering technology is still in the initial stage, and it is necessary to speed up the establishment of standardization system and evaluation criterion for all kinds of equipment evaluation.
Objective To investigate the clinical characteristics of prepapillary and preretinal vascular loops. Methods The clinical manifestation, results of the fundus fluorescein angiography, and the prognosis of 20 cases(24 eyes) with prepapillary and preretinal vascual loops were analyzed retrospectively. Results 66.7% of prepapillary and preretinal vascular loops were involved in one eye, and 95.8% of vascular loops were located within one optic disc diameter. There were different configuration types of the vascular loops. Among 20 cases(24 eyes) of the vascular loops, 70.8%(17 eyes) were arterial, 12.5%(3 eyes) were venous, and 16.7%(4 eyes) were both arterial and venous. 62.5% of eyes with prepapillary and preretinal vascular loops were associated with other congenital and developmental anomalies of retinal vascular vessels. Conclusion Most PRVL are arterial and superior to the optic disc. The serious distortion of the vascular loops may result in disturbance of blood flow in artery and retinal hemorrhage, which cause visual loss. (Chin J Ocul Fundus Dis, 1999, 15: 9-11)
Basing on development of medical model, new national diagnostic standard is interpreted according to three aspects: classification, diagnostic standard, and diagnostic contents. Tracheobronchial tuberculosis and tuberculous pleurisy are added into the classification. The value of molecular and pathological techniques for diagnosis of the pulmonary tuberculosis is emphasized. The status of drug-resistance is included in the diagnostic content. Two opinions are suggested: some practical methods such as diagnostic chemotherapy are indicated in some grassroots areas, while new molecular techniques for detection of DNA/RNA of mycobacteria and resistant mutation are encouraged in some suitable institutions.