OBJECTIVE In order to inquire the methods of thumb reconstruction by transferring the index finger with incomplete conditions of nerve or blood vessels. METHODS From April 1987 to October 1997, 6 cases were treated by 3 kinds of operative methods according to the damage type of thumb and complications injures of the rest of hand: 1. transferring the index finger with pedicle without proximal phalanx, 2. transferring the index finger with palmar nerve and blood vessels, and dorsal skin pedicle, 3. transferring the index finger with compound pedicle. RESULTS All 6 cases of thumb reconstruction were successful. Followed up 6 months to 2 years, the pinching and gribing functions in 6 cases were completely recovered, and the sensation were partly recovered. CONCLUSION The operative method of thumb reconstruction had following advantages: Simple operation, high survival rate and certain function recovery. It can enlarge the indications of thumb reconstruction.
Osteosarcopenia (OS), which has become a global public health problem, is a geriatric syndrome in which sarcopenia and osteoporosis co-exist, leading to falls, fractures, and even varying degrees of disability in the elderly. The Dietary Inflammatory Index (DII) is a tool to measure the overall level of dietary inflammation in an individual, and the DII score is closely associated with the development of OS. This article reviews the basic concepts of DII and OS and their interrelationships, focusing on the associations between diet, inflammation, DII and OS, with the aim of providing a reference for dietary interventions in the prevention and control of OS patients.
ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
Objective To explore the effect of the first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps in repairing irregular wounds on thumbs and index fingers. Methods From December 2006 to March 2009, 15 patients with irregular wounds on thumbs and index fingers were treated, including 11 males and 4 femals, with an average age of 31 years (range, 18-48 years). Of them, 6 cases of hyperplastic scar of postburn had a 2-25 years course of disease (7.5 years onaverage) and 9 cases of machine injury had a 14-30 days course of disease (20 days on average). In 8 thumb wounds on palmaris, there were 3 cases of rhomboid wounds, 1 case of C-shape wound, and 4 cases of irregular wounds; the area of wounds ranged from 4.5 cm × 3.0 cm to 5.5 cm × 4.5 cm and wounds were treated by the first dorsal metacarpal artery-based proximate pedicle dictyo-pattern sublobe flaps (5 cm × 3 cm to 6 cm × 5 cm). In 7 index fingers wounds on dorsi-fingers, there were 3 cases of 2-wounds, 4 cases of irregular wounds; the area of wounds ranged from 1.0 cm × 0.5 cm to 2.2 cm × 2.0 cm and wounds were treated by the first dorsal metacarpal artery-based distal pedicle dictyo-pattern sublobe flaps (1.2 cm × 0.5 cm to 3.0 cm × 2.2 cm). The donor sites were covered with skin grafts or sutured directly. Results All of the flaps survived completely, the wound of recipient site healed at stage I. The free skin graft on donor site survived completely, the wound of donor site healed at stage I. All cases were followed up for 6-12 months (9 months on average). There was good appearance of flaps. The two point discrimination was 5-7 mm for the proximate pedicle flaps and 9-10 mm for the distal pedicle flaps. The thumbs had digital opposition, opposition function, the index fingers had no dysfunction. According to Hand Surgery Association Society of Chinese Medical Association Society standard for the part function evaluation trial-use of upper l imb, the results of the total active movement were excellent in 14 cases, and good in 1 case. The l ine-scar was existed at donor site of the case of direct suture, the function of thumb web had no dysfunction. Conclusion The first dorsal metacarpal artery-based pedicle dictyo-pattern sublobe flaps can repair the irregular wounds on thumbs and index fingers. It has rel iable blood supply and simple operation.
ObjectiveTo explore the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and interlaminar fenestration discectomy in the treatment of lumbar (L) 5-Sacral (S) 1 lumbar disc herniation (LDH).MethodsLDH patients were retrospectively included from January 2016 to Januray 2018. And the patients were divided into the PEID group and the fenestration group according to their choice of different surgical methods. The operation time, intra-operative blood loss, and bed rest time in the two groups were recorded. The preoperative and postoperative [1 week, 1 month, 3 months, and last follow-up (>12 months)] Visual Analogue Score (VAS) of the lumbago and leg pain between the two groups were compared; the preoperative and postoperative [1 week, and last follow-up (>12 months)] Oswestry Disability Index (ODI) and also the postoperative [(>12 months)] therapeutic effect (modified MacNab) between the two groups were compared.ResultsA total of 66 patients were included, with 31 in the PEID group and 35 in the fenestration group. There was no significant difference in age, gender and course of disease between the two groups (P>0.05). There were leakage of cerebrospinal fluid and transient lumbago, leg pain and numbness, which were worse than those before operation in the PEID group (1 and 1 patient, respectively) and the fenestration group (2 and 3 patients, respectively). There were statistically significant differences between the PEID group and the fenestration group, in the operative time [(90.65±9.98) vs. (66.23±16.50) minutes], intra-operative blood loss [(51.77±18.64) vs. (184.29±78.38) mL], and bed time [(2.87±0.92) vs. (7.49±1.20) d] (t=−7.365, t’=−9.697, t=−17.374, P<0.001). There was no significant difference in the preoperative VAS score (lumbar-leg pain) and ODI index, and the ODI index at each postoperative time point, between the two groups (P>0.05). VAS score (lumbago) and VAS score (leg pain) in the PEID group at each postoperative time point were lower than those in the fenestration group (P<0.05); VAS scores (leg pain) at other time points were not statistically significant between the two groups (P > 0.05). VAS (lumbar-leg pain) score and ODI index at each postoperative time point were lower than those before the surgery. The was no statistically significant difference in the PEID group (90.32%) and fenestration group (85.71%) in the excellent rate (χ2=0.328, P=0.713).ConclusionsPEID has less surgical trauma, less bleeding, short bed rest, fast recovery, and better relief of postoperative lumbago symptoms. It is worthy of further promotion in clinical work.
Objective To assess the appropriateness of Barthel Index (BI) and Modified Rankin Scales (MRS) used as long-term outcome measures in a stroke data register and to investigate the correlation between cutoff points of the two scales in different stroke patients with and without disability. Methods Nine hundred and twelve patients were registered prospectively. BI and MRS were evaluated at the end of 1, 3, 6 and 12 months after stroke onset. The distribution, ceiling effects and floor effects of the two scales were evaluated. A logistic regression model was established to investigate correlation of cutoff points of BI and MRS. Results There were a total of 2 829 evaluation points of BI and MRS. The percentages of patients reaching the maximum scores of BI at the end of 3, 6 and 12 months (54.8％, 62.2％ and 68.3％, respectively) were higher than those of MRS. There was significant correlation between the two scales (Spearman’s correlation coefficient 0.887, P＜0.05), when MRS scores of ≤1 and ≤2 were taken as cutoff points, the corresponding cutoff points of BI score were ≥90 and ≥85, respectively. Conclusions BI has significant ceiling effects when used as long-term outcome measurement in a stroke data register. There was significant correlation between BI and MRS scores. In future clinical studies, an MRS score ≤2 or BI score ≥85 could be used as cutoff points in predicting stroke patients with and without disability.
Objective To explore the effect of kidney transplantation on chronic prostatitis-like symptoms. Methods A total of 300 male renal transplant recipients between January 2015 and January 2017 were collected in the study. All recipients received the questionnaire survey of the National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) preoperatively and at 3 months after transplantation. The score and relevant risk factors were statistically analyzed. Results A total of 210 recipients (70.0%) completed questionnaire effectively, in whom 150 (71.4%) had preoperative and 90 (42.9%) had postoperative chronic prostatitis-like symptoms, respectively. In the 210 patients, the preoperative and postoperative pain score was 6.57±3.12 vs. 3.57±3.16 (P<0.001), voiding score was 3.71±2.38vs. 3.29±2.66 (P=0.116), quality of life score was 7.57±1.60 vs. 5.14±2.75 (P<0.001), and the total NIH-CPSI score was 17.86±3.81vs. 12.00±6.65 (P<0.001), respectively. The severity of chronic prostatitis-like symptoms was alleviated significantly after kidney transplantation. Conclusion Kidney transplantation can alleviate the chronic prostatitis-like symptoms significantly, and improve the quality of life in uremia patients.
Objective To explore the effect and evaluation criterion of the transplantation of autologous peripheral blood stem cells(PBSC)for blood flow remodeling in the critical limb ischemia (CLI).MethodsThirty six patients with 39 limbs suffered from CLI at Yunnan Provincial Center of Vascular Surgery and Department of Vascular Surgery of The First Affiliated Hospital of China Medical University from March 2003 to January 2007 were included in this study.These patients were divided into two groups. One groupconsisted of 20 cases in all 22 limbs used the transplantation of autologous PBSC,and another group included 16 cases in all 17 limbs were not use this technique.Multifunction monitoring device,dopplor ultrasound monitoring device,per cutem oxygen partial pressure monitoring device and digital subtraction angiography were used to measure effect degree of limbs regional blood flow from cutaneous covering,blood vessel and blood on the preoperative and postoperative days and the follow-up time was six months.ResultsThe effect indexes of limbs regional blood flow of the case by transplantation of autologous PBSC was as follows:skin temperature index(STI)was(1.5±0.3) ℃， per cutem oxygen partial pressure monitoring device(TcPO2)was(36.6±9.3)mm Hg,ankle-brachium index(ABI)was0.7±0.1,photoplethysmograpy index(PPGI) was0.8±0.1,saturation of blood oxygen(SaO2)was(78.3±15.9)%,digital subtraction angiography score was1.5±0.3,the rate of limbs salvage was 82%,the distance of intermittent claudication was(150.3±41.1)meters,and the change of index was consistent with ameliorative tendency of symptom(0.415＜r＜0.592, P＜0.05).ConclusionThe transplantation of autologous PBSC can promote blood flowremodeling in limbs ischemia,and the effect indexes of limbs regional blood flow can objectively reflect the degree of blood flow remodeling.
To achieve policy goals of new medical reform, a control line of drug proportion was delimited for hospitals by the Department of National Administration. However, to formulate criteria of drug proportion in a scientific and rational approach has been a challenge, which plagued numerous medical workers. This study aims to analyze the baseline data of drug proportion and its impact factors in clinical departments, and quality control charts are applied to explore an estimating method and process for rationally formulating an index criterion of pharmaceutical management, so as to provide a reference for hospital management practice.
ObjectiveTo systematically review the research status of competency evaluation systems of residents in China. MethodsThe CNKI, VIP, WanFang Data, PubMed, Embase and Web of Science databases were electronically searched to collect relevant literature on competency evaluation systems for residents in China from inception to December 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The descriptive analysis was then performed. ResultsA total of 15 studies were included. There were 9 index construction methods involved in the included studies, the Delphi method was the most widely used (7 papers, 46.7%), followed by the questionnaire method (3 papers, 20%) and the expert consultation method (2 papers, 13.3%). The most common reference model was the ACGME Milestones (10 articles, 66.7%). According to the construction of index systems, the number of first-level indicators was at least 4 and at most 8. The minimum number of entries (number of final grading indicators) was 15 and the maximum number was 116. The index systems included in the research had a wide range of contents, covering all aspects of resident competencies. The expert teams consisted of clinical experts, nurses, administrators, college teachers, patients, residents, etc. ConclusionThere are various research methods for the competency evaluation systems of residents in China, and the research content is in line with international standards.