Emergency medical rescue system is an important part of public health and urban security system. Based on the emergency medical rescue practice of" 6·24”sudden high mountain collapse disaster in Diexi town of Mao county, this article mainly analyzes, summarizes and puts forward the countermeasures and suggestions for the emergency medical rescue system, which has been sharpened, explored and established in numerous disasters in Sichuan province.
Chest wall tuberculosis is a common extra-pulmonary tuberculosis, which often occurs in lung or pleura tuberculosis, or coexists with tuberculosis in other parts. The final manifestation of the disease is cold abscess on the chest wall, chronic sinuses with repeated exudation after the abscess is broken. At present, There were a series of problems in the diagnosis, treatment, and extremely prognosis of tuberculosis of the chest wall. Therefore, we reviewed the diagnosis of chest wall tuberculosis, including B-ultrasound, chest CT and positron emission tomography/computed tomography (PET/CT), tuberculous infectin of T cells spot test (T-SPOT TB), pathological examination. The related treatments including medical treatment, surgical treatment and other local treatment in order to better understand the chest wall tuberculosis.
Objective To investigate the effectiveness of trans-intervertebral space osteotomy (TIO) combined with cage implantation in treatment of old thoracolumbar compression fracture with kyphosis. Methods A clinical data of 59 patients with old thoracolumbar compression fracture and kyphosis, who met the selection criteria between January 2010 and August 2020, was retrospectively analyzed. Among them, 20 cases underwent TIO combined with cage implantation (group A), 21 patients underwent TIO (group B), and 18 patients underwent pedicle subtraction osteotomy (PSO; group C). There was no significant difference in gender, age, time from injury to operation, fracture segment, and preoperative Cobb angle, average height of functional spinal unit (FSU), sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score, and Oswestry disability index (ODI) between groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications were recorded. Imaging review was performed to observe the fusion of the bone graft. Cobb angle, average height of FSU, and SVA were measured. VAS score, JOA score, and ODI were used to evaluate the degree of low back pain and lumbar function. Frankel grading was used to evaluate neurological function. Results The operations of 3 groups were successfully completed. The operation time and intraoperative blood loss were significantly lower in groups A and B than in group C (P<0.05); there was no significant difference between group A and group B (P>0.05). All incisions healed by first intention. Patients in all groups were followed up 23-27 months, with an average of 24.8 months. There was no significant difference in follow-up time between groups (P>0.05). At last follow-up, VAS score, JOA score, ODI, and SVA of 3 groups significantly improved when compared with those before operation (P<0.05), there was no significant difference in the differences of pre- and post-operation between groups (P>0.05). The neurological function grading of 3 groups was Frankel grade E. The Cobb angle and the average height of FSU in 3 groups at immediate and last follow-up significantly improved when compared with preoperative ones (P<0.05), there was no significant difference between immediately after operation and last follow-up (P>0.05). And there were significant differences in above indexes between groups at each time point (P<0.05). At last follow-up, the osteotomy site fused without internal fixation failure or pseudarthrosis formation were observed in 3 groups. ConclusionFor patients with old thoracolumbar compression fractures with kyphosis, the effectiveness of TIO combined with cage implantation is satisfactory. Compared with TIO and PSO, it can obtain more deformity correction degree and less invasive.
Objective To investigate the status of the knowledge, attitudes and intervention behaviors in medical professionals in the prevention and treatment of deep vein thrombosis (DVT), and explore the weak links in knowledge-attitude-practice of DVT. Methods From December 2017 to February 2018, a convenient sampling method was used to extract 158 medical professionals out of 204 medical professionals from Department of Orthopedics, West China Hospital of Sichuan University. The questionnaire included the general information and basic situation of DVT learning, the knowledge of DVT, intervention attitude and implementation of preventive measures. The survey involved orthopedic doctors, nurses, rehabilitation therapists and nutrition managers. Results A total of 158 questionnaires were distributed and 150 valid questionnaires were completed. The effective questionnaire recovery rate was 94.9%. The mean score of basic knowledge of DVT was 6.45±1.83, the mean score of risk factors was 13.29±3.38, the mean score of intervention attitudes was 9.57±0.78, and the mean score of prevention implementation was 23.33±5.85. Conclusions The knowledge-practice of DVT intervention in orthopedic medical staff is moderate, and the attitude of DVT intervention is better among medical staff. There are various characteristics and weaknesses in knowledge-practice. It is necessary to regularly carry out knowledge about DVT among medical staff to improve the professional level of medical staff to prevent and treat DVT.
ObjectiveTo investigate the effectiveness of limited middle and posterior column osteotomy via transvertebral space approach in treatment of old thoracolumbar compression fracture.MethodsA clinical data of 47 patients with old thoracolumbar compression fractures, who met the selection criteria between January 2010 and March 2018, was retrospectively analyzed. Twenty-five patients (group A) underwent the limited middle and posterior column osteotomy via transvertebral space approach, and 22 patients (group B) underwent the pedicle subtraction osteotomy (PSO). There was no significant difference in gender, age, cause of injury, time from injury to operation, fracture segment, and preoperative Cobb angle, sagittal vertical axis (SVA), visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Oswestry disability index (ODI) between the two groups (P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as postoperative Cobb angle, SVA, VAS score, JOA score, ODI and the differences of all indexes between pre- and post-operation were recorded and compared between the two groups. The neurological function was evaluated by Frankel scale.ResultsThe operations of both groups were successfully completed. The operation time and intraoperative blood loss in group A were significant lower than those in group B (P<0.05). All incisions healed by first intetion. All patients were followed up 23-27 months (mean, 24.2 months) in group A and 24-28 months (mean, 24.8 months) in group B. At last follow-up, the VAS score, JOA score, ODI, Cobb angle, and SVA of the two groups were compared with those before operation, and the differences were significant (P<0.05). There was no significant difference between the two groups (P>0.05) in the indexes at last follow-up and the difference between pre- and post-operation. The lower extremity neurological symptoms (Frankel grade D) in 3 patients of group A before operation relieved (Frankel grade E) at last follow-up. The other patients were Frankel grade E. At last follow-up, CT showed bony fusion in the grafted area without any complications such as failure of internal fixation or pseudarthrosis.ConclusionFor patients with old thoracolumbar compression fractures, the limited middle and posterior column osteotomy via transvertebral space approach has a satisfactory effectiveness. Compared with PSO, it can reduce surgical trauma on the basis of achieving the same degree of deformity correction.
ObjectivesTo investigate the ability of emergency medical rescue personnel in Sichuan province to collect information and contact resources at rescue sites, and to provide evidence for emergency training and drills. MethodsThe rescue site of a batch of critically ill patients in public emergency was simulated. The cross-sectional survey was made on rescue personnel at the city (prefecture) and county level of Sichuan province. The rating scale of on-site information contact ability was used to evaluate their performance. Because the score distribution does not conform to the normal distribution, the space between the median and interquartile was used to describe the score, and multiple measurement data was compared by the rank sum test. ResultsA total of 287 rescue drill personnel were included. The overall score M (P25, P75) of information contact ability was 19.57 (13.04, 28.26). The scores of each dimension were as follows: the safety zone was set as 0 (0, 10), the on-site hazard identification was 0 (0, 16.67), external contact and coordination was 50 (0, 50), internal coordination and command was 50 (16.67, 50), the on-site disaster statistics was 40 (10, 70), the on-site resource status was 0 (0, 0), and the on-site reinforcement demand was 0 (0, 0). Hierarchy by occupation: 19.57 (12.50, 28.26) for clinicians, 19.57 (14.13, 34.78) for nurses, 25 (14.67, 32.61) for medical skills, 21.74 (14.13, 30.44) for public health doctors, and 17.39 (9.78, 21.74) for health management. Hierarchy by titles: 21.74 (13.04, 28.26) for intermediate level, and 17.39 (10.33, 23.91) for advanced level. Scores of different dimensions, occupations and titles were compared respectively, and the differences were statistically significant (P<0.05). ConclusionsThe results of this survey show that the emergency medical rescue personnel at the city (prefecture) and county level of Sichuan province have insufficient overall ability to contact information on site, so those with insufficient ability need to be trained. The training focuses on the on-site resource status, on-site reinforcement demands, safety zone setting and the ability to identify on-site hazards.
ObjectiveTo evaluate the correlation between the Mohawk (MKX) expression level and the collagen fiber diameter of autologous hamstring tendon graft during the stable graft remodeling phase after anterior cruciate ligament (ACL) reconstruction.MethodsBetween January 2018 and August 2018, patients who underwent arth-roscopic single-bundle anatomical ACL reconstruction with autologous hamstring tendons for at least 48 months and also underwent second-look arthroscopy were enrolled in study. During the second-look arthroscopic procedures, ACL graft biopsies were performed from the surface of central part of the ligament. MKX expressions of ACL grafts were analysed by real-time fluorescent quantitative PCR (qRT-PCR). The ultrastructure of collagen fibers of grafts were evaluated by transmission electron microscopy, which included average diameter of collagen fibers (Dc), average diameter of large-diameter collagen fibers (DL), average diameter of small-diameter collagen fibers (DS), and large-small collagen fibers ratio (RL/S). The correlation between MKX expression level and graft collagen fiber diameter was calculated.ResultsTwenty-six patients met the selection criteria and their ACL graft specimens were enrolled in the study. The interval between ACL reconstruction and second-look arthroscopy was 52-128 months, with an average of 78.6 months. Arthroscopic graft remodeling score was 3-6 (mean, 4.8). There were 17 cases of excellent remodeling and 9 cases of fair remodeling. All ACL grafts showed typical bimodal distributions of both large-diameter collagen fibers and small-diameter collagen fibers, but the ultrastructural characteristics of the graft collagen fibers were different according to different remodeling status under arthroscopy. The DC, DL, DS, and RL/S of the graft specimens were (65.2±9.3) nm, (91.6±10.5) nm, (45.7±8.6) nm, and 0.73±0.12, respectively. The relative expression level of MKX was 1.42±0.11, which was positively linearly correlated with DC, DL, and RL/S, and the correlation coefficient was statistically significant (r=0.809, P=0.000; r=0.861, P=0.000; r=0.942, P=0.000), while there was no significant correlation between DS and relative expression level of MKX (r=0.147, P=0.238). Regression analysis showed that the relative expression level of MKX could predict the DC, DL, and RL/S results of the ACL graft specimens (P<0.05).ConclusionAfter autologous hamstring tendon grafts stepped into stabilized remodeling phase, MKX expression level could predict the diameter measurement results of collagen fibers and be used as an important evaluation basis for graft collagen anabolic metabolism.
ObjectiveTo investigate the effect of isokinetic training of thigh muscle group on graft remodeling after anterior cruciate ligament (ACL) reconstruction, and summarize the relevant rules to guide the clinic.MethodsBetween August 2016 and December 2016, forty patients underwent arthroscopic ACL reconstruction using hamstring tendon were randomly divided into isokinetic group and control group (n=20). The two groups of patients underwent staged rehabilitation treatment. The isokinetic group replaced the traditional intervention with the corresponding isokinetic strength training from 3 to 6 months after operation, and the traditional rehabilitation intervention was used in the control group. Finally, 12 cases of isokinetic group and 12 cases of control group with complete follow-up were enrolled in study. There was no significant difference in gender, age, body mass index, side of injury, the interval between injury and operation, and preoperative International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The peak torque (PT) of knee extension and flexion and hamstring quadriceps ratio (H/Q) were measured at 3 months, 6 months, 12 months, and the second-look arthroscopy. The MRI examination was performed at the same time to evaluate graft remodeling. The shape, tension, and degree of vascularization of grafts were observed under arthroscopy. The grafts were harvested and observed by HE staining.ResultsThe invertal between ACL reconstruction and the second-look arthroscopy was (23.57±3.23) months in isokinetic group and (23.22±3.56) months in control group, showing no significant difference between the two groups (P>0.05). At the second-look arthroscopy, the IKDC score was 90.45±4.73 in isokinetic group and 89.32±4.54 in control group, showing significant differences when compared with preoperative scores in the two groups (P<0.05). But there was no significant difference between the two groups (t=0.868, P=0.404). At 3 months after operation, there was no significant difference in the PT of knee extension and flexion between the two groups (P>0.05). At 6 months, 12 months, and the second-look arthroscopy, the PT of knee extension and flexion in isokinetic group were higher than those in control group (P<0.05). The H/Q at 6 months and 12 months were higher in isokinetic group than in control group, and the differences were significant (P<0.05). There was no significant difference in MRI score between the two groups at 3 months, 6 months, and the second-look arthroscopy (P>0.05). The MRI score at 12 months was significantly higher in isokinetic group than in control group (P<0.05). At the second-look arthroscopy, there was no significant difference in the arthroscopic score between the two groups (P>0.05), and the histological score of the isokinetic group was superior to the control group (P<0.05).ConclusionOn the basis of regular rehabilitation training, using the isokinetic training system to develop a suitable post-surgical isokinetic rehabilitation training program is helpful in early muscle strength recovery, early graft remodeling, and even long-term histological results after ACL reconstruction.
To prevent and control 2019 novel coronavirus pneumonia diseases (COVID-19), hundreds of medical teams and tens of thousands of medical professionals throughout the nation were transferred to Hubei to assist COVID-19 control efforts. Medical professionals were at high risk of novel coronavirus pneumonia infections. To ensure the prevention and control of infection in medical teams and prevent cross-infection among medical staff at the medical station, this management standard includes routine management standards, resident disinfection, personnel entry and exit process, and logistics support management, so as to provide reference for medical teams combating COVID-19 in the future.