Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
The existing mazes are mainly used to study the learning and memory of animals. However, there is still a lack of corresponding maze and method in the aspect of the observation and test of aquatic animal robots. For this purpose, the authors have developed a three-dimensional water maze combined with bilayer multi-channel which equips with stratified lines and tick marks. This device is a rectangular structure composed of one square bottom and four rectangular side walls, and the channels of every side wall are composed of one upper channel and two lower channels. The center of the upper channels is in the vertical center line of every side wall, and the two uper channels of adjacent side walls are at 90° degrees with each other, and the two lower channels of adjacent side walls are at 45° degrees with each other. There are stratified lines and tick marks on the side wall to test the spatial location and movement trajectories of aquatic animals. The carp robot was put into the water maze for the underwater experimental detection. The success rates of left and right steering at 135, 90 and 45 degrees as well as forward motion of the carp robots (n = 10) were over 60%. This study showed that the device could be used to observe and test the motion of the carp robot.
To solve the safety problems caused by the restriction of interaction space and the singular configuration of rehabilitation robot in terminal traction upper limb rehabilitation training, a trajectory planning and tracking control scheme for rehabilitation training is proposed. The human-robot safe interaction space was obtained based on kinematics modeling and rehabilitation theory, and the training trajectory was planned based on the occupational therapy in rehabilitation medicine. The singular configuration of the rehabilitation robot in the interaction space was avoided by exponential adaptive damped least square method. Then, a nonlinear controller for the upper limb rehabilitation robot was designed based on the backstepping control method. Radial basis function neural network was used to approximate the robot model information online to achieve model-free control. The stability of the controller was proved by Lyapunov stability theory. Experimental results demonstrate the effectiveness and superiority of the proposed singular avoidance control scheme.
ObjectiveExplore the impact of a digital-intelligence-based quality control platform for thyroid cancer on the effectiveness of clinical diagnosis and treatment quality management. MethodsThe digital-intelligence-based quality control platform for thyroid cancer at Zhejiang Provincial People’s Hospital was launched at the end of July 2022. In its initial phase, six quality control indicators related to the standardized diagnosis and treatment of thyroid cancer were deployed. This study analyzed the changes in these six quality control indicators between January 2022 and November 2023, comparing data before and after the platform’s implementation. ResultsCompared with the period from January to July 2022 (prior to the platform’s launch), the rates of preoperative cytopathological examination (t=–8.490, P<0.001) and postoperative pTNM staging for thyroid cancer patients (t=–3.027, P=0.013) increased from July to November 2023 (one year post-launch). However, the proportion of minimally invasive surgeries among thyroid cancer patients (t=4.085, P=0.002) decreased. The linear regression model results indicated that, following the platform’s launch, there was a gradual increase over time in both the preoperative cytopathological examination rate for thyroid cancer (P=0.001) and the postoperative pTNM staging rate (P=0.049). ConclusionPreliminary results of this study suggest that the thyroid cancer digital-intelligence-based quality control platform developed by our team can effectively enhance the standardized quality control of clinical diagnosis and treatment for thyroid cancer.
ObjectiveTo investigate the current situation of orthopedic quality control and management in county-level regional general hospitals in Guangdong, and to provide a scientific basis for further standardizing the procedures of orthopedic quality control and management in county-level regional general hospitals and continuously improving the work of provincial orthopedic quality control center.MethodsFrom June 2019 to July 2020, online and offline questionnaire survey and field survey were used to investigate the quality control and management of orthopedic departments in 22 county-level regional general hospitals in Guangdong.ResultsAmong the overall scores of the surveyed hospitals, the highest score was 96.5, the lowest score was 72.0. There were 6 hospitals with a total score of “excellent” (accounting for 27.3%). The “facilities and equipment” and “medical quality” of the surveyed hospitals were relatively valued. Taking Guangzhou, the capital of Guangdong as the center, the districts and counties were divided into the east, the south, the west and the north regions, and the difference in overall scores of orthopedics among the four regions was statistically significant (F=6.299, P=0.004). The unqualified rates of department setting, key technology development, average hospitalization days of representative diseases, equipment allocation, personnel allocation, department management and building layout were relatively high, which were 77.3%, 63.6%, 45.5%, 40.9%, 40.9%, 36.4% and 36.4%, respectively. Most hospitals had set up special debridement rooms in orthopedic department (95.5%), and the management and monitoring of the use of antibacterial drugs was mostly reasonable (90.9%). In terms of the level of orthopedic medical treatment, only 3 hospitals with sufficient key technologies reached the standard, accounting for 13.6%, and only 7 hospitals reached the standard of scientific research capacity, accounting for 31.8%. In terms of quality control, the numbers of hospitals with qualified medical record sampling (72.7%), perfect management and supervision mechanism (86.4%) and quality management team in departments (77.3%) were the least. In addition, among the investigated hospitals, beds were in short supply in orthopedic departments, with 12 hospitals accounting for 54.5% being deducted; 16 hospitals (72.7%) were deducted for unqualified doctor-patient ratio and 11 hospitals (50.0%) were deducted for unqualified nurse-patient ratio.ConclusionsThe overall level of orthopedics construction and management in the surveyed hospitals is uneven. The medical professional and technical level is insufficient. It is difficult to meet the practical needs, and there is an imbalance in the ratio of medical personnel. In the future, it is necessary to strengthen the quality control of orthopedic medical care, strengthen the medical technology training of county-level regional general hospitals and increase the medical and health resources and capital investment, so as to improve the quality control of county-level regional general hospitals.
This paper presents a wearable exoskeleton robot system to realize walking assist function, which oriented toward the patients or the elderly with the mild impairment of leg movement function, due to illness or natural aging. It reduces the loads of hip, knee, ankle and leg muscles during walking by way of weight support. In consideration of the characteristics of the psychological demands and the disease, unlike the weight loss system in the fixed or followed rehabilitation robot, the structure of the proposed exoskeleton robot is artistic, lightweight and portable. The exoskeleton system analyzes the user's gait real-timely by the plantar pressure sensors to divide gait phases, and present different control strategies for each gait phase. The pressure sensors in the seat of the exoskeleton system provide real-time monitoring of the support efforts. And the drive control uses proportion-integral-derivative (PID) control technology for torque control. The total weight of the robot system is about 12.5 kg. The average of the auxiliary support is about 10 kg during standing, and it is about 3 kg during walking. The system showed, in the experiments, a certain effect of weight support, and reduction of the pressure on the lower limbs to walk and stand.
Objective The rising medical expenditure is an international problem. By comparing theories and methods of medical expenditure control between China and the US, this paper aims to find out the medical expenditure strategies fitting for our country and to help with the new round of medical and health system reform. Methods This evidence-based research searched for literatures using the search strategy and screened literatures according to inclusion and excluding criteria. Useful information in the literatures was extracted through quantitative analysis of literature tables and descriptive statistical analysis. Results We found that the US academia showed a sustainable and steady trend of increased concern on the medical expenditure control, while the Chinese academia showed a larger volatility on it. There were some obvious differences such as reasons for expenditure increase, the reasonableness of the medical expenditure increase, and the specific methods and strategies of the medical expenditure control between Chinese and American authors. Conclusion On the one hand, the purpose of medical expenditure control is based on the different stages of development. On the other hand, the main interest group determines the main body who is responsible for the medical expenditure control. According to our national context, China should develop effective strategies and methods for medical expenditure control.