Liver cancer is one of the world’s most prevalent malignancies, and is also the third leading cause of cancer death in China. Hepatitis and cirrhosis background is a major feature of liver cancer patients in China, which makes specific requirements that suits the national conditions in many aspects of prevention and control like screening diagnosis, treatment options, and prognosis follow-up. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition), which is based on China’s practice, proposes liver cancer staging in line with China’s national conditions and forms a multi-disciplinary joint diagnosis and treatment model based on surgical treatment. Liver transplantation is included in liver cancer as one of the surgical treatments option. It also emphasizes the support of evidence-based medicine. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) may have laid a solid foundation for future diagnosis and treatment of liver cancer in China.
This article discusses the new needs and development direction of medical testing technology under the hierarchical diagnosis and treatment system in China, outlines the principles and advantages of new medical testing technology based on smartphones, and briefly describes the development status and research results of smartphone testing technology in specific medical testing directions such as immune analysis, nucleic acid analysis, biochemical analysis and cell morphology analysis. In addition, the article also discusses the current problems of smartphone medical testing technology, such as poor compatibility with different models of smartphones, few detection indicators, low automation, lack of clinical verification. Finally, a prospect is made for the possible future development direction of smartphone medical examination technology, aiming to provide a certain reference for the promotion and more reasonable application of smartphone medical examination technology.
Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.
Objective To investigate the effectiveness of 5G remote robotic surgery in the treatment of pelvic fractures. Methods A retrospective analysis was conducted on the clinical data of 160 patients with pelvic fractures admitted between July 2023 and June 2024 who met the selection criteria. Among these patients, 80 underwent internal fixation surgery with the assistance of 5G remote robotic surgery (5G group), while 80 received local robotic surgical assistance (control group). Baseline characteristics, including gender, age, body mass index, disease duration, cause of injury, and fracture classification, were compared between the two groups, and no significant difference was found (P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, maximum residual displacement postoperatively, quality of fracture reduction, incidence of complications, Majeed pelvic function score and classification at last follow-up were recorded and compared between the two groups. Results In the 5G group, 180 screws were implanted during surgery, while 213 screws were implanted in the control group. The 5G group demonstrated significantly reduced intraoperative blood loss and shorter incision length compared to the control group (P<0.05). No significant difference was observed between the two groups in terms of operation time or hospital stay (P>0.05). Radiographic evaluation revealed excellent and good reduction rates of 98.8% (79/80) in the 5G group and 97.5% (78/80) in the control group, while excellent and good screw placement accuracy rates were 98.3% (177/180) in the 5G group and 95.8% (204/213) in the control group. No significant difference was found between the two groups in maximum residual displacement, reduction quality, or screw placement accuracy (P>0.05). All patients were followed up 7-16 months (mean, 11.3 months), with no significant difference in follow-up duration between the groups (P>0.05). No perioperative or follow-up complication, such as wound infection, iatrogenic fractures, iatrogenic neurovascular injury, screw loosening or breakage, or nonunion, were observed in either group. The control group exhibited a worse degree of gait alteration compared to the 5G group (P<0.05), while no significant difference was found in incidences of squatting limitation or persistent pain (P>0.05). At last follow-up, no significant difference was observed between the groups in Majeed pelvic function scores or grading (P>0.05). Conclusion Compared with the local surgery group, 5G remote robotic surgery supported by remote expert technical guidance demonstrated smaller incision lengths, less intraoperative blood loss, and fewer postoperative complications, and was shown to be a precise, minimally invasive, safe, and reliable surgical method.
ObjectivesTo analyze the balance of medical human resource allocation in Chengdu and to discuss the impact of human resource allocation structure on the hospital’s medical service capabilities, so as to provide a theoretical basis for the hospital to optimize the talent team structure.MethodsThe Moran’s index and Gini coefficient were used to evaluate the spatial aggregation and grade distribution difference of human resources allocation, respectively. The case mix index (CMI), the length of hospital stay, and the difficulty of surgery were used as outcome variables, and a multiple regression analysis model was established to explore the impact of human resource indicators on the hospital’s medical service capabilities.ResultsThe distribution of doctors showed an obvious spatial aggregation in Chengdu, and there was a positive spatial correlation (Moran’s Idoctor=0.290); the distribution of nurses had no obvious spatial aggregation (Moran’s Inurse=0.102). Under different medical service capacity segments, the Gini coefficient of doctors was 0.518, and the Gini coefficient of nurses was 0.576, both exceeding 0.5, indicating that the distribution of medical human resources in different levels of hospitals was considerably different. The regression results showed that the expansion of the quantity of senior title doctors and the proportion of medical care both could improve the hospital’s CMI. The increase in the quantity of doctors with senior titles also had a certain impact on improving the hospital’s surgical capabilities. The expansion of the proportion of medical care could lead to a slight increase in the length of patients' hospital stay.ConclusionsOptimizing the allocation structure of medical human resources in different regions and hospitals with different levels is an important task in the construction of a hierarchical diagnosis and treatment system. It is necessary to further integrate medical human resources throughout the whole city and strengthen personnel training and team building in primary health institutions. Hospitals at different levels should implement their own development positioning and further optimize their human resource allocation structure according to development needs. Tertiary hospitals should pay more attention to the cultivation of senior professional doctors, optimize the proportion of medical care, and improve the hospital’s medical service capabilities. The primary health institutions should pay attention to the comprehensive construction of medical personnel, and strengthen the development of the team of general practitioners, so as to achieve a comprehensive improvement of the city’s medical service capabilities.
Lung cancer is one of the leading causes of cancer deaths worldwide. Many options including surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy have been applied in the treatment for lung cancer patients. However, how to develop individualized treatment plans for patients and accurately determine the prognosis of patients is still a very difficult clinical problem. In recent years, radiomics, as an emerging method for medical image analysis, has gradually received the attention from researchers. It is based on the assumption that medical images contain a vast amount of biological information about patients that is difficult to identify with naked eyes but can be accessed by computer. One of the most common uses of radiomics is the diagnosis and treatment of non-small cell lung cancer (NSCLC). In this review, we reviewed the current researches on chest CT-based radiomics in the diagnosis and treatment of NSCLC and provided a brief summary of the current state of research in this field, covering various aspects of qualitative diagnosis, efficacy prediction, and prognostic analysis of lung cancer. We also briefly described the main current technical limitations of this technology with the aim of gaining a broader understanding of its potential role in the diagnosis and treatment of NSCLC and advancing its development as a tool for individualized management of NSCLC patients.
Sepsis is a critical condition. The key factor affecting the survival of patient is whether standard treatment can be obtained timely. Because of the complexity of its pathogenesis and high heterogeneity, there is no special diagnosis method currently. Early identification is difficult. Delayed diagnosis and treatment is closely related to the mortality of patients. With the continuous updating of the guidelines, sepsis has been included in the “time window” disease, putting forward a great challenge to the early screening and evaluation of sepsis. This article aims to review the application of Sepsis-Related Organ Failure Assessment, sepsis biomarkers and artificial intelligence algorithms in early screening and evaluation of sepsis, so as to provide guidance tools for timely starting standardized treatment of sepsis.
ObjectiveTo explore the clinical characters, diagnosis and treatment of Penicilliosis marneffei (PSM) in healthy hosts. MethodsThe clinical data of three cases of PSM involving the lung, bronchus and pleura in healthy hosts were retrospectively analyzed, and the case reports of Penicillium marneffei (PM) infection in healthy hosts were summarized by searching database for related articles, with "Penicilliosis marneffei" as key word both in English and Chinese literatures. ResultsThe main clinical manifestations of three PSM patients included fever, cough, lymphadenopathy, and elevated white blood cell counts.Series of chest computed tomography of three cases demonstrated atypical and extensive lung lesions.The fiberoptic bronchoscopy of the 2nd case showed several irregular nodules on the bronchial wall.The thoracoscopy of the 3rd case showed much pleural adhesions and small nodules on visceral and parietal pleura.Final diagnosis of PSM was confirmed by the fungal culture, and all patients received antifungal treatment.The symptoms relieved on medication but reoccurred on discontinuation.Literature review identified 36 cases of PSM in healthy hosts.The main clinical features were fever, cough/expectoration, skin rash/skin abscess and elevated white blood cell counts.The most common used antifungal drug was amphotericin B alone or combined with traconazole.The thoracic radiological imaging showed that roughly half of them had clearly thoracic lesions (20/36, 55.65%), and the pulmonary inflammatory infiltrate shadow was most common.Seventeen cases (47.22%) were misdiagnosed as tuberculosis. ConclusionsPulmonary involvement is common in healthy hosts with PSM and the thoracic radiological features are variable and unspecific, so PSM is easy to be misdiagnosed as tuberculosis.The PSM patients need a longer treatment than other fungal infections.
The misdiagnosis rate and mortality of mesenteric ischemia are high, but with the continuous updating of diagnosis and treatment techniques and treatment concepts in recent years, many patients can get timely and effective treatment. This article starts from the epidemiology, vascular anatomy, etiology, clinical manifestations and classification of mesenteric ischemia, and the progress of diagnosis and treatment under the multidisciplinary diagnosis and treatment mode, and details the research progress of mesenteric ischemia at home and abroad. This paper focuses on the significance of multidisciplinary diagnosis and treatment mode in the diagnosis and treatment of mesenteric ischemia, in order to strengthen the treatment consciousness of mesenteric ischemia and explore a more accurate and effective treatment system. The purpose of this study is to provide some reference for avoiding intestinal infarction and improving the survival rate of intestinal tract.
Day surgery is an important diagnosis and treatment modality to promote hierarchical diagnosis and treatment and form a “surgery in hospital, recovery in community” diagnosis and treatment mode. At the same time, the promotion and implementation of hierarchical diagnosis and treatment provides institutional support and promotion for the perfection of day surgery management. Based on the experience from the Day Surgery Centre of General Hospital of Eastern Theater Command, this paper investigates the role of “gate-keepers” and recovery guidance in community and secondary hospitals in the perfection of day surgery in tertiary hospitals. Taking orthopedic day surgery as an example, which accounts for the largest proportion in day surgery in General Hospital of Eastern Theater Command, this paper aims to explore a feasible model of hierarchical diagnosis and treatment of day surgery, which specifies the responsibilities and works of hospitals at all levels.