Abstract： Objective To compare individualized protamine with protamine based on weight in terms of postoperative bleeding and blood transfusion dose, in order to reduce postoperative bleeding complications. Methods Forty adult patients scheduled to elective open heart surgery under cardiopulmonary bypass （CPB） were randomly divided into two groups. For patients in the experimental group, we gave them protamine based on heparinprotamine titration result, while patients in the control group received the same amount of protamine as the heparin administered before operation. Pleural drainage and required transfusion were recorded at 1, 2 and 24 hours after surgery. Results Protamine dose given to the experimental group was significantly higher than the control group (Plt;0.05), while pleural drainage was significantly lower at 1 h(180±83 ml vs. 285±156 ml,P=0.012), 2 h (74±31 ml vs. 114±44 ml，P=0.002), and 24 h (465±167 ml vs. 645±207 ml，P=0.004) than that in the control group after surgery, and the required red blood cell suspension was also significantly lower than the control group (0.15±0.27 U vs.0.80±0.96 U,P=0.018). Conclusion Compared with protamine dose based on heparin administered before CPB, individualized protamine based on titration can reduce postoperative pleural drainage (blood loss) and red blood cell suspension requirement.
ObjectiveTo explore the clinical phenotype of patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) by cluster analysis and provide a basis for individualized treatment.MethodsA total of 515 patients with acute exacerbation of COPD admitted to this department from January 2014 to December 2016 were enrolled. The age, duration, smoking index, number of hospitalizations in the past 1 year, hospitalization days, treatment costs and other information were collected for cluster analysis.ResultsThe patients were divided into three categories of phenotype: " mild-glucocorticoid resistance-antibiotic dependent”," mild-glucocorticoid sensitive”, and " serious complication”. The patients with the first two phenotypes had a milder condition and lower hospitalization costs. There were differences in the time and cumulative dose of glucocorticoids in different pathways, antibiotic use time and usage rate. The third phenotype was the most serious, with the highest cost of hospitalization, and may merge or co-exist with other diseases such as cardiovascular disease and digestive tract disease.ConclusionCluster analysis may identify different phenotypes of acute exacerbation of COPD to provide a reference for clinical individualized treatment.
ObjectiveTo explore the effectiveness of transplantation of engraved autologous costal cartilage for individualized surgical management in secondary rhinoplasty for cleft lip. MethodsBetween September 2009 and January 2014, 350 patients with secondary nasal deformity of cleft lip were treated, including 160 males and 190 females with a mean age of 18.2 years (range, 16-56 years). Nasal deformity was caused by unilateral cleft lip in 200 cases and by bilateral cleft lip in 150 cases. The interval of lip repair and nasal deformity correction was 2-50 years (mean, 12 years). About a 2-6 cm cartilage was harvested from the 6th or 7th costal cartilage, and was engraved to the shape of "ge" in Chinese. The upper part was strengthened on both sides of the alar cartilage; the lower part was fastened to columella and nasal septum cartilages. The rest of cartilages was diced into 0.1 mm×0.1 mm×0.1 mm cubes. The columella incision was designed to "Z"-plasty, and was stretched to the nasion along alar edge. The engraved autologous costal cartilage was transplanted and fixed to the collapse of nostril. The cartilage cube was transplanted and filled into the collapse of nasal root to achieve the aesthetic effect of nasal augmentation. The effectiveness was evaluated according to the grade of secondary rhinoplasty for cleft lip by ZHANG Li et al. at 1, 6, and 12 months after operation. ResultsAll incisions were primary healing. All patients were followed up 1-12 months (mean, 6 months). After rhinoplasty, the collapse of nostrils was lifted, and the shape and height of collapse of nostrils were symmetrical to normal side. The deflection of columella nasi was corrected. A beautiful shape of nose was achieved. The excellent and good rates were 98.6% at 1 month, 97.4% at 6 months, and 97.1% at 12 months after operation, showing no significant difference (χ2=0.545, P=0.761). ConclusionThe technique of transplantation of engraved autologous costal cartilage for individualized surgical management in secondary rhinoplasty for cleft lip can achieve excellent surgery effect.
Objective To evaluate the efficacy of multiple minimally invasive therapy and individualized treatments combination in severe acute pancreatitis. Methods The data of sixty-seven patients with severe acute pancreatitis between September 1998 and October 2008 undergoing multiple minimally invasive therapy and individualized treatments were analyzed retrospectively. The changes of APACHE Ⅱ score, CT score, WBC count, total bilirubin, AST, blood glucose, amylase, lypase, C-reactive protein, tumor necrosis factor-α, blood urea nitrogen, creatinine, and oxygenation index (PaO2/FiO2) were observed and compared between before and after treatment. Time of abdominal pain relieved, laparotomy rate, mortality rate, recovery rate, hospital stay, and cost of hospitalization were also observed. Results All the detected indexes improved significantly after treatments compared with those before treatments （Plt;0.001）. Time of abdominal pain relieved was (20.17±14.16) h. Laparotomy rate was 6.0% （4/67）. Mortality rate was 7.5% （5/67）. Recovery rate was 92.5% （62/67）. Hospital stay was (30.85±28.37) d and cost of hospitalization was (59 295.78±34 564.44) yuan. Conclusions Multiple minimally invasive therapy and individualized treatments for cases of severe acute pancreatitis with different causes, course, severity of disease, and complications, could significantly improve the clinical indexes and recovery rate of severe acute pancreatitis.
To aim directly at the individualized character and tendency about clinical assessment of Traditional Chinese Medicine (TCM), we draw off a new pathway which is evidence-based goal attainment scale(EBGAS) in the text. i.e., we will develop clinical individualized assessment method of TCM on account of GAS by the approach of evidence based medicine.
ObjectiveTo compare the effectiveness of single-bundle and double-bundle anterior cruciate ligament (ACL) reconstruction by two methods. MethodsQualified for the selective standard, 120 patients with ACL injury between May 2010 and April 2013 were divided into 4 groups: double-bundle reconstruction was performed by the conventional procedure in 30 cases (group A); anatomic double-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group B); single-bundle reconstruction was performed by the conventional procedure in 30 cases (group C); and anatomic single-bundle reconstruction was performed in the original ACL residual footprints in 30 cases (group D). There was no significant difference in gender, age, disease duration, pathogenesis, injury side, Lysholm scores, International Knee Documentation Committee (IKDC) ratings, Lachman test, anterior drawer test, and pivot shift test among groups (P>0.05). The impingement between the ACL implants and intercondylar notch was evaluated with postoperative immediate MRI scan and the three-dimensional digital model. Lachman test, anterior drawer test, and pivot shift test results, Lysholm scores, and IKDC ratings were used to compare the effectiveness among groups after operation. ResultsThree-dimensional digital model after operation showed impingement in 11 cases (36.7%) of group A, 1 case (3.3%) of group B, 9 cases (30.0%) of group C, and no impingement in group D. The impingement rates of groups A and C were significantly higher than that of groups B and D (P<0.05), but no significant difference was found between groups A and C, and between groups B and D (P>0.05). All incisions healed by first intention, and no early complication was found. The patients were followed up 24-30 months (mean, 26 months). Lysholm scores, Lachman test, anterior drawer test, and pivot shift test results at 24 months after operation were significantly better than preoperative ones in 4 groups (P<0.05), but no significant difference was shown among groups (P>0.05). The IKDC ratings of groups B and D were significantly better than that of groups A and C (P<0.05); but there was no significant difference between groups A and C, and between groups B and D (P>0.05). ConclusionCompared with the conventional procedure, the individual anatomic single- and double-bundle reconstruction in the original ACL residual footprints has decreased impingement rate and increased IKDC rating.
ObjectiveTo suggest the importance of taking notice of oral chemotherapy drugs in cancer patients, and the importance of drug-use evaluation in patients with insufficient kidney functions, by reporting one death case caused by multiple organ failure because of myelosuppression after oral tegafur, gimeracil and oteracil potassium (S-1) capsules for 10 days in a patient with insufficient kidney functions. MethodsThrough the analysis of one patient who died of multiple organ failure due to degree-Ⅳ myelosuppression and the related literature review, we discussed the necessity of individualized administration of clinical chemotherapy. ResultsThe patient had grade-Ⅱ renal insufficiency before chemotherapy and did not undergo dihydropyrimidine dehydrogenase (DPYD) gene test. Myelosuppression occurred 10 days after oral chemotherapy drugs. The white blood cells, neutrophils and platelets decreased progressively, and then developed into degree-Ⅳ suppression. Finally the patient died of multiple organ failure. Conclusions Genetic variation and renal insufficiency may cause differences in drug metabolism. The reduced urinary excretion of guimet pyrimidine (CDHP), the inhibitors of dihydropyrimidine dehydrogenase which is the 5-fluorouracil (5-FU) metabolic enzyme, may lead to elevated plasma concentration of 5-FU, thereby increasing myelosuppression and other adverse reactions. If DPYD gene detection results show low enzyme activity, it can cause lethal toxicity through deceleration of 5-FU metabolism and high concentration of blood. DPYD gene dzetection should be performed if allowed, and individualized treatment plan should be formulated after comprehensive evaluation. The overall situation of the patients should be considered before treatment, and then individualized drugs should be administered.
ObjectiveTo investigate the classification and treatment strategies of symptomatic severe osteoporotic vertebral fracture and collapse. MethodsBetween August 2010 and January 2014, 42 patients with symptomatic severe osteoporotic vertebral fracture and collapse were treated, and the clinical data were retrospectively analyzed. According to clinical symptom and imaging materials, 23 cases were classified as type I (local pain, limitation of motion, no neurological symptom, and no obvious deformity), 12 cases as type II (slight neurological symptom and kyphotic Cobb angle ≤ 30°), and 7 cases as type III (severe neurological symptom and kyphotic Cobb angle <30°). In 23 type I patients, 17 underwent percutaneous vertebral augmentation, 6 underwent posterior pedicle screw fixation strengthened with bone cement combined with percutaneous vertebral augmentation. In 12 type II patients, they were treated with local spinal decompression and internal fixation strengthened with bone cement. In 7 type III patients, 5 underwent posterior osteotomy, and 2 underwent one stage posterior approach of vertebral resection and reconstruction. The visual analogue scale (VAS), Oswestry disability index (ODI), and local kyphotic Cobb angle were used to evaluate the neurological function. The complications were recorded. ResultsThe operation was successfully completed in all patients. Wound infection and ketoacidosis secondary to stress blood glucose rise occurred in 1 case of type III patients respectively, and were cured after corresponding treatment; primary healing of wound was obtained in the other patients. The patients were followed up from 6 to 36 months (mean, 11.6 months). The nerve function was improved in 17 cases, and micturition disability was observed in 2 cases. Asymptomatic cement leakage occurred in 13 cases (30.95%) (7 cases in type I, 4 cases in type II, and 2 cases in type III). No bone cement dislocation and internal fixation failure were found during follow-up. The VAS score, ODI, and the local kyphotic Cobb angle at 1 week and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). ConclusionIn order to improve the effectiveness and reduce the risk and complications of operation, individualized strategies should be performed according to different types of severe osteoporotic vertebral fracture and collapse.
During transfer tasks, the dual-arm nursing-care robot require a human-robot mechanics model to determine the balance region to support the patient safely and stably. Previous studies utilized human-robot two-dimensional static equilibrium models, ignoring the human body volume and muscle torques, which decreased model accuracy and confined the robot ability to adjust the patient’s posture in three-dimensional spatial. Therefore, this study proposes a three-dimensional spatial mechanics modeling method based on individualized human musculoskeletal multibody dynamics. Firstly, based on the mechanical features of dual-arm support, this study constructed a foundational three-dimensional human-robot mechanics model including body posture, contact position and body force. With the computed tomography data from subjects, a three-dimensional femur-pelvis-sacrum model was reconstructed, and the individualized musculoskeletal dynamics was analyzed using the ergonomics software, which derived the human joint forces and completed the mechanic model. Then, this study established a dual-arm robot transfer platform to conduct subject transfer experiments, showing that the constructed mechanics model possessed higher accuracy than previous methods. In summary, this study provides a three-dimensional human-robot mechanics model adapting to individual transfers, which has potential application in various scenarios such as nursing-care and rehabilitating robots.
The iodine-125 (125I) seeds interstitial implantation has the advantages of minimal invasiveness, high local control rate, and few complications; it has attracted worldwide attention. With the application of 3D printing technology in medicine, individualized 3D templates are gradually applied to clinical practice. Individualized 3D templates combining with CT-guided 125I seeds implantation are easy to operate and can not only effectively ensure the consistency and accuracy of preoperative and postoperative dose, but also minimize complications to achieve optimal efficacy. This paper reviews the application of CT-guided implantation of 125I seeds for malignant tumors assisted by individualized 3D template, and further demonstrates the safety and effectiveness of clinical application in 125I seeds implantation to provide a reliable basis for the standardization of 125I seeds implantation.