Objective To explore the medication closed-loop management of huangshi central hospital based on electronic medical records.Methods Diversified pharmaceutical information platform was constructed.The full coverage of all aspects of medication information,such as ordering/prescribing,transcribing,distributing,preparing,dispensing,administering,documenting,and monitoring was realized.Results The medication management and use had no information gap,and bias could be controlled to form a closed-loop management.Conclusion Application of the new information technology in the field of pharmaceutical care can improve work efficiency,reduce medication errors,broaden the vision of clinical pharmacists and scope of work,and improve the overall level of pharmaceutical care.

Objective Discussed the efficacy of applying standardized patient in clinical surgical practice teaching.Method Twenty eight-year-medical students in our college were enrolled and students' theoretical knowledge mastering ability,students' evaluation on the teaching and students'clinical ability were surveyed.Result Students' score significantly increased compared to last year scores (P ＜0.01).100％ of the participants found the SP teaching methods can increase the interest in learning; 90％ of students found the SP as a guide to better grasp the teaching content; 95％ of students found the SP teaching methods can improve the ability to communicate with patients.Conclusions The class atmosphere was improved,students' enthusiasm was activated,students' clinical ability was promoted and satisfactory teaching effect was obtained after applying standardized patient.

Objective To explore the impact of ischemic stroke on intestinal barrier changes in dogs.Methods Totally 20 mongrel dogs were divided into 2 groups by random number table with 10 in each.Double silicone cylinders measuring 1.1 mm in diameter and 8 mm in length were placed into their internal carotid arteries in all dogs of group A.Group B served as a control group and received sham operation.Light microscopy was performed for morphological measurement of intestinal epithelial cell.Immunohistochemistry was used to analysis the changes of protein zonula occludens-1(ZO-1)localizing at tight junction of intestinal epithelial cells.Results Ischemic stroke was confirmed by cranial CT scanning in all dogs of group A.Compared with the test results in group B,the occludin and Zo-1 protein levels in group A were significantly lower than those in group B(occludin:0.20 ±0.01 vs 0.22 ±0.01,P =0.007; ZO-1:0.20 ±0.01 vs 0.22 ±0.02,P =0.008).The apoptotic index in group A was significantly higher than in group B(29.04 ± 3.79 vs 6.44 ± 1.24,P =0.002).There was a positive correlation between occludin and ZO-1(R =0.71,P =0.02),and the apoptotic index was negatively correlated with levels of occludin,ZO-1(R =-0.91,P =0.00; R =-0.77,P =0.01).Light microscopy showed that the dogs in group A had intestinal mucousal injuries while no obvious change was detected in group B.Conclusions Dogs with ischemic stroke tend to develop intestinal barrier dysfunction,during which the destruction of tight junction plays a key role.The up-regulated apoptosis of intestinal epithelial cell constitutes one of the cellular bases of intestine injury.

Objective: To evaluate the accuracy of transarticular screw fixation using intraoperative three-dimensional fluoroscopy-based navigation (ITFN) and to evaluate the clinical outcomes of this treatment method. Methods: Data of 56 patients(26 males and 30 females) with atlantoaxial instability who were treated by C_{1, 2} transarticular screw fixation using ITFN from November 2005 to October 2015 were retrospectively analyzed. The mean age of the patients was 44.5 years (range, 9-68 years). There were 44 cases with congenital malformation, 4 with old odontoid fracture, 7 with spontaneous dislocation, and 1 with rheumatoid arthritis. C₂ isthmus width and height were measured on preoperatively obtained CT scans, and screw positioning was evaluated on postoperatively obtained CT scans, and classified into three types: ideal position (type I), acceptable position (type II) and unacceptable position (type III). A novel grading system is proposed based on previous study and grading system, and the difficulty of placing C_{1, 2} transarticular screw using ITFN was classified into three types: easy (total score 0), median (total score 1) and hard (total score 2, 3). Pain scores were assessed using the visual analogue scale. Myelopathy was assessed using the Nurick scale and Odom’s criteria. Results: The isthmus width was 5.46±1.86 mm on the right side and 5.38±1.36 mm on the left side. The isthmus height was 4.89±1.33 mm on the right side and 4.97±1.17 mm on the left side. According to the grading system, 78, 11, and 23 of the sides were classified into easy, median and hard groups respectively. One hundred and seven transarticular screws were placed in 56 patients, and 71.03% of which were ideal screws, and 28.97% were acceptable screws. Five patients had unilateral screws placed. There was no significant difference in screw positioning among the three groups (χ²=0.46, 0.54, 1.18; P=0.50, 0.46,0.28). The mean follow-up period was 44.7 months (range, 6-120 months). At the latest follow-up, according to Nurick score, there are 30 patients scoring 0, 25 patients scoring 1, and 1 patient scoring 2. According to Odom’s criteria, outcomes were as follows: excellent, 66.1%; good, 26.8%; fair, 7.1%; and poor, 0%. All patients with preoperative neck pain had symptom relief or improvement, with more than 89.33% improvement in visual analogue scale scores. No dural laceration, injury to the vertebral artery, spinal cord, or hypoglossal nerve were noted. Conclusion ITFN is a safe, accurate, and effective tool for transarticular screw placement in patients with atlantoaxial instability.

Objective: To investigate the relationships of intracranial compartment volumes with the severity of clinical symptoms before surgery, and the degree of symptom improvement one year after cerebrospinal fluid(CSF)shunt surgery in patients with idiopathic normal pressure hydrocephalus(iNPH). Methods: Twenty-one patients meeting the diagnosis criteria of international guidelines of iNPH and undergoing CSF shunt surgery in Department of Neurosurgery in our hospital from 2016 to 2017 were included.All patients underwent brain MRI measurement before surgery, and were evaluated by using 3-meter timed up and go test(TUG), minimum mental state examination(MMSE), idiopathic normal pressure hydrocephalus grading scale(iNPHGS)and modified Rankin scale(mRS)before and one year after CSF shunt procedures.The ventricular volume, brain volume, pericerebral CSF volume, total intracranial volume and Evans' index were measured in the pre-operative imaging of the brain.The following four pre-operative intracranial compartment volumes were calculated: the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume. Results: The scores of gait, cognitive function and urinary function were improved after surgery in iNPH patients(all P<0.05). There were no significant difference in the correlation of intracranial compartment volumes(the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index with the severity of clinical symptoms including gait, cognitive function and urinary function before surgery, and with the degree of symptom improvement one year after surgery in iNPH patients(all P>0.05). There was no significant difference in intracranial compartment volumes between patients having improvement in mRS, TUG, MMSE and iNPHGS and patients having no improvement one year after surgery in iNPH patients(all P>0.05). Conclusions Patients with iNPH can benefit from CSF shunt surgery and have improvements of clinical symptoms including gait, cognitive function and urinary function.Preoperative intracranial compartment volumes(the relative ventricular volume, brain volume ratio, pericerebral CSF volume ratio and the ratio of ventricular volume to pericerebral CSF volume)and Evans' index have no correlations with the severity of clinical symptoms before surgery, and have no correlations with the degree of symptom improvement one year after surgery in iNPH patients.For this reason, preoperative intracranial compartment volumes and Evans' index cannot be used to predict whether or not CSF shunt surgery can improve specific clinical symptoms.

Objective To evaluate the efficacy and the safety of Ulinastatin in treatment of severe acute pancreatitis.Methods A systematic review of randomized controlled trials (RCT) of Ulinastatin treatmen for severe acute pancreatitis was performed.The databases included Cochrane library controlled clinical trials database,PUBMED,EMBASE,China Biology Medicine disc,Wanfang Data were searched to date.Retrieval words were acute pancreatitis and Ulinastatin.Statistical processing using Review Manager 5.3 software provided by the Cochrane collaboration network.Results A total of 33 trials involving 1 786 patients were included,and all patients of the trials were not followed up at the end of the treatment.In the trials of Ulinastatin plus routine treatment vs routine treatment or placebo plus routine treatment,and 5 trials reported the fatality rate.Meta-analysis showed that the mortality rate in Ulinastatin group was lower than that in control group(RR =0.29,95％CI:0.17-0.52,P ＜ 0.01),and 16 trials used the total efficiency of treatment as outcome criteria.Meta-analysis results showed the total effective rate in the Ulinastatin group was significantly higher than that in control grouIn the trials of Ulinastatin plus routine treatment vs octreotide plus routine treatment,9 trials used the total efficiency of treatment as outcome criteria.Meta-analysis results showed there was no statistically significant difference in total effective rate between Ulinastatin group and octreotide group.Conclusions Ulinastatin treatment was superior to conventional therapy in improving the short-term clinical efficacy of severe acute pancreatitis,and the mortality rate was lower than that in conventional treatment.But no obvious advantage was found in ulinastatin treatment compared with octreotide treatment.

OBJECTIVE: To explore the relationship between hypoxia-inducible foctor-1α (HIF-1α) and neovascularization in early atherosclerosis plaques by establishing rabbit carotid atherosclerosis models, and to observe the value of contrast-enhanced ultrasound in the detection of neovascularization. METHODS: We provided high-fat diet combined with the implantation of silicone rubber ring to establish carotid atherosclerosis in rat models. On the 14th and 28th days, we detected neovascularization in the carotid atherosclerotic plaques by contrast-enhanced ultrasound, obtained the peak intensity (PI) of the contrast agent in the plaques by time-intensity curve (TIC) and analyzed the difference. We also tested the level of HIF-1α, vascular endothelial growth factor (VEGF), cluster of differentiation 31 (CD31), α-actin, and RAM-11 by immunohistochemical method in each group, analyzed their correlation, and the correlation between PI and CD31 expression. RESULTS: On the 14th day, contrast-enhanced ultrasound showed the neovascularization in the carotid atherosclerotic plaques. On the 14th and 28th days, the intensity of contrast-enhanced ultrasound showed significant difference, the mean optical density of HIF-1α, VEGF, CD31, RAM-11, and α-actin within the carotid atherosclerotic plaques also showed statistical difference. The expressions between HIF-1α and VEGF, HIF-1α and CD31, HIF-1α and RAM-11, HIF-1α and α-actin, as well as PI and CD31 showed highly positive correlations. CONCLUSION During the process of atherosclerosis evolution, neovascularization in the atherosclerotic plaques has come into being in the early period, and HIF-1α in early atherosclerosis can promote the formation of neovascularization. Contrast-enhanced ultrasound can detect the dynamic changes of neovascularization within early atherosclerotic plaques.
Animals ; Carotid Artery Diseases ; complications ; metabolism ; pathology ; Disease Models, Animal ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Male ; Neovascularization, Pathologic ; etiology ; metabolism ; pathology ; Rabbits

Legg-Calvé-Perthes disease (LCPD) is an idiopathic necrosis of the femoral head in childhood, the deformities of the femoral head occurring in the progress of disease could result in osteoarthritis. Treatment can be surgical or nonsurgical, but the timing and indications remain unclear. Understanding of the prognostic factors of LCPD is helpful to predict the outcome and guide the clinical management. This study reviewed the literatures about the prognosis of LCPD since 2000, the prognostic factors were summarized from three categoriesas general factors, disease factors and intervention factors. The general factors were the characteristic information of patient that can be obtained at the first time clinically. The age of onset is the most definite prognostic factor, the younger the age, the better the prognosis, and 6-8 years is an important watershed. Disease factors refer to the disease characteristic information obtained through evaluation. The modified Waldenstr?m stage of the disease needs to be confirmed first, early treatment can ensure better prognosis. Then the severity was evaluated, including the involvement of necrosis, morphological changes and extrusion of the femoral head. The more severe the disease, the worse the prognosis. Most predicters, such as Catterall grading and Herring lateral column typing, have to be used in late-stage of LCPD. The degree of femoral head perfusion evaluated in enhanced MRI or DWI-MRI is an early predictor of LCPD, but it is still in the preliminary exploratory. Intervention factors are the effects of different methods of treatment on prognosis, including the comparison of surgery or non-surgery, different non-surgical and different surgical methods. The determination of surgical or non-surgical treatment mainly depends on the age of onset and severity of disease, and the younger and milder cases tend to be non-surgical treatment, but the specific indications are still controversial.

Objective:To explore the clinical efficacy of periosteum-covered iliac crest autografts for treatment of severe osteochondral lesions of talus （OCLTs）.Methods:A retrospective case series study was used to analyze the clinical data of 26 patients with severe OCLTs treated at Zhejiang Armed Police Corps Hospital from January 2013 to October 2019. There were 21 males and 5 females，aged 17-49 years ［（36.3 ± 10.9）years］. All patients were treated using periosteum-covered iliac crest autografts. The visual analogue scale （VAS），American Orthopedic Foot and Ankle Society （AOFAS） ankle-hindfoot score and ankle joint range of motion （ROM） were assessed before operation，6 months after operation and at the last follow-up （≥ 12 months）. The area of talus injury with MRI at the same level was recorded before operation and at the last follow-up. The healing of talus and joint surface was detected with CT at the last follow-up. The healing of the incision and osteotomy site and complications were observed.Results:All patients were followed for 12 to 22 months［（15.1 ± 3.2）months］. The VAS was （2.4 ± 0.9）points and （1.7 ± 0.6）points at postoperative 6 months and at the last follow-up，significantly lower than the preoperative （5.4 ± 1.2）points （ P < 0.01）. Meanwhile，the VAS at the last follow-up was significantly lower than that at postoperative 6 months （ P < 0.01）. The AOFAS ankle-hindfoot score was （71.7 ± 7.8）points and （87.8 ± 6.2） points at postoperative 6 months and at the last follow-up，significantly lower than the preoperative （66.5 ± 7.5） points （ P < 0.01）. Meanwhile，the AOFAS ankle-hindfoot at the last follow-up was significantly lower than that at postoperative 6 months （ P < 0.01）. The ankle ROM was （58.4 ± 5.5）° and （70.0 ± 4.9）° at postoperative 6 months and at the last follow-up，significantly improved when compared to the preoperative （42.3 ± 8.1）° （ P < 0.01）. Meanwhile，the ankle ROM at the last follow-up was significantly improved when compared to that at postoperative 6 months （ P < 0.01）. The area of talus injury with MRI at the same level was 0.67（0.55，0.89）cm 2 at the last follow-up，significantly improved when compared to preoperative 2.64（1.98，3.68）cm 2 （ P < 0.01）. The transplantation had neither obvious defects nor joint surface steps based on CT findings. All surgical incisions were healed by first intention. There were no complications such as incision infection，skin necrosis，nonunion of osteotomy，malunion or severe ankle joint disorder except that 8 patients had residual local subchondral bone?marrow?edema-like?signal?and 2 patients showed delayed healing of medial malleolus osteotomy. Conclusion:For patients with severe OCLTs，periosteum-covered iliac crest autografts can effectively relieve ankle pain，improve ankle function，and reduce the area of injury.

Objective To propose a new rib fracture detection network Rib-Net to automatically and accurately detect and locate rib fracture and address the issue of missed diagnosis of rib fractures. Methods The public data set RibFrac Dataset was used to evaluate the performance of the Rib-Net, and the data set was divided into training set (420 cases), validation set (80 cases), and test set (160 cases). The Rib-Net was composed of the object detection integrated network Ensemble Detection Net (ED-Ne), Complete Box Fusion (CBF) module and the segmentation network 3D Unet. Firstly, Retina Unet, UFRCNN+ and Mask RCNN were integrated to form ED-Net to predict rib fracture candidate boxes. Secondly, a new CBF module was designed to fuse overlapping fracture candidate boxes to generate candidate boxes with accurate positioning and accurate confidence. Finally, Unet was used for rib fracture segmentation to achieve further precise localization of rib fractures. Results On the “MICCAI 2020 RibFrac Challenge: Rib Fracture Detection and Classification challenge”, our proposed Rib-Net’s detection results reached the best performance, and its recall rate, free-response receiver operating characteristic curve(FROC) value and Dice were 92.3%, 0.859 and 0.61, respectively. Conclusion The Rib-Net network can efficiently and accurately detect and locate rib fractures on chest CT images, effectively assisting doctors in making accurate diagnosis.