Objective Tho evaluate the outcomes of early percutaneous occlusion of these residual major aortopulmonary collateral arteries after heart surgery. Methods This was a retrospective review of children undergoing early percutaneous embolization of major aortopulmonary collateral arteries after cardiac surgery. From January 2013 to February 2017, 52 consecutive patients with postoperative residual major aortopulmonary collateral arteries were treated with percutaneous embolization (38 males, 14 females; median age of 10.0 months, interquartile range 14.0 months; median weight 8.6 kg, interquartile range 4.4 kg). Fifty-one patients were cyanotic and 1 patient was acyanotic. Forty-nine patients underwent corrective surgery and 3 patients underwent B-T shunt. Results Typical symptoms and signs of major aortopulmonary collateral arteries included: elevated left atrial pressure; focal lung infiltration, pink or blood-stained frothy sputum. The median time interval from cardiac surgery to percutaneous occlusion of major aortopulmonary collateral arteries was 5 (9) d, median duration of mechanic ventilation support since occlusion was 72 (159) h, mechanic ventilation support was 239 (480) h and median duration of intensive care unit was 19 (29) d. There was no death in this group. Conclusion Angiocardiography could be able to demonstrate the existence of postoperative major aortopulmonary collateral arteries. The early percutaneous occlusion appears to be simple, safe and effective.
According to the characteristics of the diversified employment system of general hospitals, we have independently developed a set of personnel information platforms suitable for our hospital's operating model and work-flow which achieved establishing a novel big data management model for big personnel. After a year of trial operation, the big data management of personnel has completely covered the target management and requirements of the hospital, covering basic quality, public services, teaching work, medical work, scientific research, and other dimensions of information, which helped the hospital constructed a systematically networked and full-coveraged, personnel information system with strong early warning functions and incentives, enabling the reasonable utilization rate of human capital and continuous improvement of the quality of talent training.
ObjectiveTo analyse the microsurgical treatment and facial nerve preservation of giant acoustic neuromas. MethodsUnder the conditions of facial nerve monitoring, 400 patients with giant acoustic neuromas underwent microsurgical removal via suboccipital retrosigmoid approach between January 2005 and January 2013. There were 186 males and 214 females, with the age ranged from 15 to 74 years (mean, 41.6 years). The disease duration was 2-13 years (mean, 2.4 years). The lesions were located at the left cerebellopontine angle region (CPA) in 191 cases, right CPA in 200 cases, bilateral CPA in 9 cases. The clinical manifestations included unilateral hearing loss and tinnitus as first symptoms in 389 cases, facial numbness in 373 cases, unilateral facial paralysis in 370 cases, headache in 269 cases, lower cranial nerve symptoms with drinking cough and dysphagia in 317 cases, and unstable gait in 342 cases. Preoperative skull base thin layer CT showed varying degrees of horn-like expansion in ipsilateral internal auditory canal opening. MRI showed cysts in 78 cases and solid masses in 322 cases; with hydrocephalus in 269 cases. Postoperative cranial MRI or CT was taken to observe the extent of tumor resection. The preservation of facial nerves in anatomy was assessed by intraoperative microscope video and electrophysiological monitoring; the facial nerves function was assessed according to House-Brackmann (HB) classification on the first day after operation; and the rehabilitation of facial nerve function was also assessed at discharge and at 1 year postoperatively by using HB grade. ResultsTotal tumor removal was achieved in 372 cases (93.00%), and subtotal removal in 28 cases (7.00%). One case died of delayed brainstem ischemia at 14 days after operation, and 1 case died of lung infection at 20 days after operation; 398 cases were followed up 6 months to 8 years (mean, 3.5 years). Recurrence occurred in 1 case because of neurofibromatosis at 5 years after operation. The rate of anatomical preservation of the facial nerve during operation was 91.75% (367/400), and the functional preservation rate at the first day after operation was 62.75% (251/400). The HB grade of facial nerve function showed significant difference aomng 3 time points (at the first day, at discharge and at 1 year after operation) (χ2=23.432, P=0.000). Complications included postoperative intracranial infection in 11 cases (2.75%), cerebrospinal fluid leakage in 29 cases (7.25%), aggravated lower cranial nerve symptoms in 18 cases (4.50%), subcutaneous effusion in 13 cases (3.25%), second operation to remove hematoma in 9 cases (2.25%), postoperative circumoral herpes simplex virus infection in 25 cases (6.25%), and all complications were cured after symptomatic treatment. Postoperative hydrocephalus disappeared in 261 cases. ConclusionSurgical operation is the first choice in the treatment of giant acoustic neuromas. Under the auxiliary of neural electrophysiological monitoring, the microsurgery operation via suboccipital retrosigmoid approach for giant acoustic neuromas has extremely low mortality and high preservation rate of facial nerve function.
ObjectiveTo understand the current status of healthcare human resources (HHR) in a large public hospital, predict the HHR demand aligned with the development of the hospital, and provide reference basis and feasible solutions for HHR planning for high-quality development of the large public hospital. MethodsBased on grey model and auto regressive integrated moving average model, a variance reciprocal method for weight allocation was applied to set up the combination forecasting model. Different types of HHR demand of the large public hospital from 2024 to 2026 were predicted and the accuracies of the three different model predictions were compared. ResultsThe numbers of total personnel, health technical personnel, physicians, nurses, and technicians predicted by the combination forecasting model for 2026 were 17654, 13041, 4389, 6198, and 2264, respectively. The corresponding average annual growth rates from 2024 to 2026 were 5.54%, 5.55%, 5.37%, 4.27%, and 5.60%, respectively. Compared with the two single forecasting models, the combination forecasting model had the smallest average absolute errors, mean squared errors, and mean absolute percentage errors for predicting the numbers of total personnel, nurses, and technicians. It also had the smallest average absolute error and mean absolute percentage error for predicting the number of health technical personnel, and the smallest average absolute error for predicting the number of physicians. ConclusionsCompared with the single forecasting model, the combination forecasting model shows fewer system errors and better predictive results. The demand for total personnel, health technical personnel, physicians, nurses, and technicians of this large public hospital will continue to increase, so planning and reserving staff in advance is a key to high-quality development of the hospital.
目的 探讨内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤的价值。 方法 回顾性分析四川大学华西医院消化内镜中心2010年1月－2011年12月间38例内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤病变残留、治疗效果。 结果 38例患者，男18例，女20例，年龄8～80岁；病变下缘距肛门齿状线1～4.0 cm24例，侵及齿状线14例。病变大小（按病变最大径分类）：1.5～3.0 cm 12例，3.1～4.0 cm 8例，4.1～5.0 cm4例，5.1～7.0 cm 10例，10 cm 4例。病变直径在5.0 cm以下的24例患者，经首次手术治疗肿瘤完整切除，术后2例灶性癌变，追加外科手术；其余22例2个月复查，病变无残留，6个月复查，2例复发，经再次手术病变完整切除。随访1年，全部未见复发，治愈率为100%，无残留。病变直径5.1～7.0 cm的10例患者，经首次手术治疗肿瘤分次切除，2个月复查，6例病变完整切除无残留，6个月复查，其中2例复发，经再次内镜下手术切完病变，随访1年，无复发；另4例有残留，经再次内镜下手术切完病变，6个月复查无复发，随访1年，4例均未见复发。病变直径10 cm 的4例患者，经多次手术后复查均有病变残留，无法完全切除，患者拒绝外科手术。5.1 cm以上病变治愈率71.43%，残留率高达57.14%。本组术后出血16例，感染1例，直肠狭窄1例，肛门坠胀3例，无穿孔发生。 结论 内镜反转黏膜切除术治疗超低位直肠大型侧向发育型肿瘤有效，对5.0 cm以下病变能一次完整切除，5.1 cm以上病变残留率高，需再次内镜下手术，10 cm以上病变切除不完全。应慎重选择病例，术后密切随访。
ObjectiveTo explore the application of pre-examination and triage service for outpatients in large general hospitals to improve the quality of service and increase the satisfaction of the patients. MethodsBy using convenience sampling, the outpatients from four third-class A level hospitals were investigated with self-designed questionnaire between July and August, 2013. The patients were differentiated according to the frequency of visiting doctors; the first and subsequent visit being the variables, the rank-sum test was used to investigate the demand and satisficing of the pre-examination and triage service in the two kinds of outpatients in large general hospitals. ResultsThe satisficing of the pre-examination and triage service was high; the demand of the service was high in the first-visit patients with high satisficing. The difference in out-patient consultation between the two kinds of patients were significant. ConclusionPre-examination and triage service has a great guiding effect on outpatients in large general hospitals, and its availability is related to the type of the patients, awareness rate of the service and satisfaction to nurses.
Microsurgery has always been the main treatment for large vestibular schwannomas. With the progress of microsurgical technique and neuroimaging, the application of the intraoperative physiological monitoring technology, as well as the popularization of the concept of minimally invasive neurosurgery, the current development trend of surgery for vestibular schwannomas is to realize both the maximal tumoral resection and the maximal preservation of facial nerve function, which puts more emphasis on the improvement of quality of life. It is still a challenge for neurosurgeons to resect the tumor to the maximum extent and preserve the nerve function as well. In view of this background, the strategy of " near-total resection” and " subtotal resection” combined with stereotactic radiotherapy has been more and more accepted in the past years. However, as a neurosurgeon, the ultimate goal should be " gross-total resection of tumor” and preservation of the nerve function as well. For those tumors severely adherent to neurovascular structure, " near total resection” might be a rational choice. Meanwhile, long-term follow-up should be conducted to clarify the biological behavior of tumor residues, as well as the necessity and long-term effect of stereotactic radiotherapy.
Based on the scientific research management experience for many years and the characteristics and advantages of the hospital, West China Hospital of Sichuan University develops an innovative scientific research management model relying on deepening the top-level design of scientific research management, strengthening the information management means, establishing the assessment and evaluation system of full-time scientific research personnel, and creating the benchmark of scientific research technician training industry. The “West China Model” of innovative scientific research management has achieved remarkable results. The comprehensive strength of scientific research has been strong, the management strength of scientific research has been greatly improved, and the scientific and technological research on the epidemic situation has been accurately deployed. The “West China Model” of innovative scientific research management not only provides a working path for research hospitals, but also lays a theoretical foundation for the exploration and establishment of the “scientific research management-scientific research team-scientific research project” trinity innovative hospital scientific research management system, which plays a positive role in effectively stimulating the vitality of scientific research and improving the core medical technology.
As pigs are similar to humans in anatomy, physiology and pathology, nutrition metabolism and disease characteristics, genetically modified pigs are already used for the studies of disease mechanism, pathology and toxicology and the evaluation of drugs. But the production of large modified animals is difficult, cumbersome, time-consuming and costly. With the breakthrough of gene editing technology, clustered regularly interspersed short palindromic repeat (CRISPR)/CRISPR-associated 9( Cas9)(CRISPR/Cas9) technology has greatly improved the mutation efficiency, reduced the cost and simplified the steps, and promoted the widespread application of genetically modified pigs. In this paper, the production methods of genetically modified pigs and the research progress of genetically modified pigs by CRISPR/Cas9 in the medical field were reviewed.