This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015-2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ⩾15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%xnosocomial infection management + 17.97%xcompliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.
Humans ; China/epidemiology* ; Cross Infection/epidemiology* ; Intensive Care Units/statistics & numerical data* ; Quality Control ; Quality Indicators, Health Care/statistics & numerical data* ; Sepsis/therapy* ; East Asian People/statistics & numerical data*

Objective:To study the image features in direction and quantity on CT scans of the axial safety target area of Sawbone femoral neck screw tunnels and possibility of establishing a stable spatial cartesian coordinate system.Methods:After three-dimensional reconstruction of CT data of 40 Sawbone femoral necks, the real axial CT images (perpendicular to the surgical central axis) of each femoral neck were superimposed respectively to get the intersection, called axial safe target area(ASTA). With the anterior cortex of femoral neck basilar seen as a landmark, the spatial rectangular coordinate system ( x, y, z) was established to measure superior-inferior diameters (D-SI), anterior-posterior diameters (D-AP) and the oblique angles. Each intersection was overlapped to the original axial CT images to find coronal position of ASTA boundaries. In addition, coronal CT union (equivalent to anteroposterior X-ray) and sagittal CT union (equivalent to lateral X-ray) were obtained by images in situ superposition method, from which the coronal positions of the isthmus of the perspective boundary (D-SI and D-AP) were determined. The coincidence of the boundary positions of ASTA and those of the perspective isthmus was compared. Pearson correlation coefficients were calculated for the left and right sides respectively to analyze the correlation between D-SI and D-AP. Results:Every ASTA presented an oblique rounded quadrilateral, whose front base was flat and coincided with anterior cortex of femoral neck basilar (FNB). In this coordinate system, D-SI were 35.13±0.51 mm on the left and 30.98±0.82 mm on the right, while D-AP were 26.66±0.39 mm on the left and 27.53±0.72 mm on the right. There was no significant correlation between D-SI and D-AP (left: R=0.43, P=0.060, right: R=0.32, P=0.176, respectively). All the isthmus of X-ray boundary fell at the corresponding ASTA boundary. The oblique angles ranged from 8° to 29°, and all parameters were within the range of normal femoral neck (the anterior cortex of the femoral neck basilar is flat, with a D-SI range of 26-38 mm, a D-AP range of 17-29 mm, and an oblique angle range of 5°-53°). Conclusion:The intersection method can be used to conveniently acquire directional-quantitative-stable individualized ASTA of Sawbone femoral neck. Thus, a stable spatial cartesian coordinate system can be established based on the anterior cortex of femoral neck basilar.

Objective To study the feasibility,efficacy and safety of ultrasound-guided percutaneous radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) in the caudate lobe.Methods From November 2006 to June 2017,31 patients with 31 HCCs located in the caudate lobe were treated with percutaneous RFA at the First Affiliated Hospital of Sun Yat-sen University.The treatment efficacy,complications,and the local tumor progression (LTP),disease-free survival (DFS) and overall survival (OS) rates were analyzed.Results Residual tumors were detected in 5 patients after the first treatment.Complete necrosis was achieved in all the patients after the second treatment.The mean number of ablation sessions was 1.16±0.37.At a follow-up period which ranged from 3 to 65 months,19 patients had died,10 patients were still alive,and 2 patients were lost to follow-up.The 1-,2-,3-,and 5-years OS rates were 78.4％,48.5％,12.1％ and 12.1％,respectively.On follow-up,9 caudate lobe HCC lesions were detected to have LTP.The 1-,2-,and 3-years LTP rates were 21.5％,41.6％ and 41.6％,respectively;while the 1-,2-,and 3-years DFS rates were 22.3％,11.2％ and 11.2％,respectively.Ablationrelated complications were detected in 4 patients.Conclusions Ultrasound-guided percutaneous RFA was safe and effective for patients with HCC in the caudate lobe.These patients should be followed-up closely to detect LTP.

Objective: To report the operation methods and clinical effects of repairing finger tip defect with the free tibial dorsal nerve flap of the second toe. Methods: 13 patients with finger tip defects were repaired by the tibial dorsal nerve flap of the second toe. The area of finger tip defect was 2.5 cm×1.5 cm-1.3 cm×1.0 cm, and the area of cutting flap was 2.7 cm×1.7 cm-1.5 cm×1.1 cm. All donor site defects on the second toe were covered with full-thickness skin graft. Results: There were 13 cases in this group, and all the flaps and skin grafts were survived. Postoperative follow-up ranged from 6 to 18 months, with an average of 13 months. The appearance of the fingers was satisfied and the sensory recovery was good. Two-point discrimination of the flaps returned to 7-13 mm, with an average of 9 mm. According to the total active move(TAM)scale, results were excellent in 11 fingers, good in 1 finger, and fair in 1 finger. The donor site skin graft was well healed, the second toe pulp was full, and the two-point discrimination of the toe pulps were 6-10 mm, with an average of 8 mm. Conclusions Compared to the traditional method of repairing finger tip defect with the tibial inherent nerve flap of the second toe, our new method can reduce the damage to the donor site, and we can repair finger tip defect as well as the traditional one at the same time. So it was a better operative method to repair finger tip defect with the tibial dorsal nerve flap of the second toe.

Glucocorticoid receptor (GR),a member of the steroid receptor superfamily,can mediate the signal pathway of ligands like glucocorticoids,regulate the transcription of target genes,and exert biological activity.GR is expressed in different degrees in three major kinds of urological malignant tumors including renal cancer,bladder cancer and prostate cancer.It also affects the metabolism of tumor cells,and is closely related to the occurrence,development and prognosis of tumors.GR provides an important clue for targeted therapy and endocrine therapy of urological malignant tumors.

Objective To evaluate the effect of SiO2-ZrO2 slurry coating on surface performance of zirconia ceramic.Methods Seventy pre-sintered zirconia discs were randomly divided into seven groups with 10 discs per group.Sample discs in each group received one of the following seven different surface treatments, namely, sintered(group AS), sand blasting after sintered(group SB), coated with slurry of mole ratio of SiO2 to ZrO2 2: 1(group 2SiO2-1ZrO2), coated with slurry of mole ratio of SiO2 to ZrO2 1: 1(group 1SiO2-1ZrO2), coated with slurry of mole ratio of SiO2 to ZrO2 1 : 2(group 1SiO2-2ZrO2), coated with slurry of mole ratio of SiO2 to ZrO2 1 : 3(group 1SiO2-3ZrO2), coated with slurry of mole ratio of SiO2 to ZrO2 1:4(group 1 SiO2-4ZrO2).Profilometer, X-ray diffractometer(XRD), energy dispersive spectrometer, scanning electron microscopy(SEM) were used to analyze surface performance.Results The surface roughness of the discs in group AS was lower than those in the other groups[(0.33 ± 0.03) μm] (P＜0.05), there was no statistically significant difference(P＞0.05) among group 2SiO2-1ZrO2[(3.85±0.38) μm], group 1SiO2-1ZrO2[(3.78±0.56) μm] and group 1SiO2-2ZrO2[(4.06 ± 0.48) μtm], and no difference(P＞0.05) was observed between group 1SiO2-3ZrO2 [(1.02±0.09) μm] and group 1SiO2-4ZrO2[(1.53±0.23) μm] either.However, surface roughness in all coating groups was higher than those in group SB[(0.86 ± 0.05) μm] (P＜0.05).According to the XRD pattern, group AS and all coating groups consisted of 100％ tetragonal airconia and monoclinic zirconia was detected at surface of group SB.Contents of surface silicon of coating groups increased significantly,however, no silicon was detected at sample surface of group AS and group SB.SEM showed that zirconia grains of coating exposed since part of silicon was etched by hydrofluoric acid, a three-dimensional network of intergrain nano-spaces was created.Conclusions SiO2-ZrO2 slurry coating could make surface of zirconia rough and increase Si content without creating monoclinic zirconia.

OBJECTIVETo investigate the influence of parathyroid hormone and estrogen on alveolar bone metabolism of castrated female rats.

METHODSSixty-six female Wistar rats which were healthy and 4 months old were divided into two groups, with group SHAM (n = 18) and group ovariectomy (OVX) (n = 48). After 8 weeks of ovariectomy, the osteoporosis model was confirmed by examing 8 ovariectomized and sham-operated rats. The rest 10 rats in group SHAM were the control group (group A). The rest 40 rats in group OVX were divided into ovariectomized group (group B), ovariectomized and treated with estrogen (group C), ovariectomized and treated with parathyroid hormone (group D), ovariectomized and treated with estrogen and parathyroid hormone (group E) at random with 10 in each group. Group A and B injected physiological saline (1 mL x kg(-1)), group C injected estradiol benzoate (10 microg x kg(-1)), group D injected parathyroid hormone (20 microg x kg(-1)), group E injected parathyroid hormone (20 microg x kg(-1)) and estradiol benzoate (10 microg x kg(-1)). The intraperitoneal injection were maken every other day to rats in each group, which continued for 8 weeks. The bone mineral density (BMD), bone histomorphology and serum Ca, P, alkaline phosphatase (ALP) were measured after therapy.

RESULTSAfter 8 weeks of ovariectomy, the lumbar BMD of ovariectomized rats were significantly declined compared with those of the sham-operated rats (P < 0.05). Eight weeks later after the drug use, the BMD, %Tb.Ar, Tb.Th, Tb.N in group C, D, E were slightly elevated compared to group B, especially the group E (P < 0.05). Serum calcium and phosphorus values did not change significantly (P > 0.05). ALP values in group B was significantly higher than that in group A (P < 0.05).

CONCLUSIONIntermittent application of parathyroid hormone in small doses can increase alveolar BMD of castration rats and improve their bone structure. And it can have synergy effects on the treatment of osteoporosis if it is used combining with estrogen.

Alkaline Phosphatase ; Animals ; Bone Density ; Estradiol ; analogs & derivatives ; Estrogens ; Female ; Osteoporosis ; Ovariectomy ; Parathyroid Hormone ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar

Increasing evidence has proved that inflammation plays an extremely important role in tumorigenesis.As the most representative biomarker for inflammation,C-reactive protein (CRP) has been considered to be critically associated with the prognosis of a variety of malignant tumors,like renal cancer.Numerous studies have shown that CRP is a significant prognostic factor for renal cancer patients treated with surgery,cytokine therapy or molecular-targeted therapy,and CRP has been incorporated into some prognostic algorithms for renal cancer.

Objective To investigate the influence of parathyroid hormone and estrogen on alveolar bone metabolism of castrated female rats. Methods Sixty-six female Wistar rats which were healthy and 4 months old were divided into two groups, with group SHAM (n=18) and group ovariectomy (OVX) (n=48). After 8 weeks of ovariectomy, the osteoporosis model was confirmed by examing 8 ovariectomized and sham-operated rats. The rest 10 rats in group SHAM were the control group (group A). The rest 40 rats in group OVX were divided into ovariectomized group (group B), ovariectomized and treated with estrogen (group C), ovariectomized and treated with parathyroid hormone (group D), ovariectomized and treated with estrogen and parathyroid hormone (group E) at random with 10 in each group. Group A and B injected physiological saline (1 mL·kg-1), group C injected estradiol benzoate (10 μg·kg-1), group D injected parathyroid hormone (20 μg·kg-1), group E injected parathyroid hormone (20 μg·kg-1) and estradiol benzoate (10 μg·kg-1). The intraperitoneal injection were maken every other day to rats in each group, which continued for 8 weeks. The bone mineral density (BMD), bone histomorphology and serum Ca, P, alkaline phosphatase (ALP) were measured after therapy. Results After 8 weeks of ovariectomy, the lumbar BMD of ovariectomized rats were significantly declined compared with those of the sham-operated rats (P<0.05). Eight weeks later after the drug use, the BMD, %Tb.Ar, Tb.Th, Tb.N in group C, D, E were slightly elevated compared to group B, espe-cially the group E (P<0.05). Serum calcium and phosphorus values did not change significantly (P>0.05). ALP values in group B was significantly higher than that in group A (P<0.05). Conclusion Intermittent application of parathyroid hormone in small doses can increase alveolar BMD of castration rats and improve their bone structure. And it can have synergy effects on the treatment of osteoporosis if it is used combining with estrogen.

With the continuous development of tumor immunology,cancer vaccines have become a hot spot of tumor immunotherapy.Companion member antigen peptide tumor vaccine attracts widely attention because of its chemical stability,easy preparation and no carcinogenic potential advantage.Companion member antigen peptide tumor vaccine may work through many kinds of ways including the function of antigen presenting,enhancing the body's non-specific line of anti-tumor mechanisms and activating the tumor-specific immune mechanism.Its different anti-tumor mechanisms merits and so on will have positive function in the tumor clinical immunity treatment.