OBJECTIVE: To explore the implementation effect of hour-1 bundle for sepsis patients based on crisis resource management (CRM) system. METHODS: A historical control study was conducted. The hour-1 bundle for sepsis based on CRM was used to train 24 nurses in the emergency department from October 2022 to March 2023. Clinical data of sepsis patients admitted to the emergency department of the First People's Hospital of Zunyi from April 2022 to September 2023 were collected. The patients were divided into three groups based on different stages of CRM system construction: control group (before construction, from April to September in 2022), improvement group (during construction, from October 2022 to March 2023) and observation group (after construction, from April to September in 2023). The baseline data, implementation rate of hour-1 bundle [including blood culture, antibiotic usage, blood lactic acid (Lac) detection, fluid resuscitation, hypertensors usage], identification and diagnosis time, and prognosis parameters [including correction rate of hypoxemia, intensive care unit (ICU) occupancy rate, and 28-day survival rate]. Sepsis cognition survey and non-technical skill (NTS) evaluation of nurses in emergency department were conducted before and after training. RESULTS: Finally 43 cases were enrolled in the control group, improvement group and observation group, respectively. There was no statistically significant difference in baseline data including the gender, age, primary site, heart rate, systolic blood pressure, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, mechanical ventilation ratio among the three groups with comparability. With the gradual improvement of the CRM system, the implementation rate of 1-hour bundle was gradually increased, and the implementation rate in the control group, improvement group and observation group were 65.12% (28/43), 74.42% (32/43) and 88.37% (38/43), respectively, with statistically significant difference (P < 0.05). It was mainly reflected in the completion rate of blood culture, antibiotic usage rate, Lac detection rate and hypertensors usage rate within 1 hour, which were significantly higher in the observation group than those in the control group [completion rate of blood culture: 90.70% (39/43) vs. 62.79% (27/43), antibiotic usage rate: 88.37% (38/43) vs. 60.47% (26/43), Lac detection rate: 93.02% (40/43) vs. 72.09% (31/43), hypertensors usage rate: 88.37% (38/43) vs. 60.47% (26/43), all P < 0.05]. The fluid resuscitation rates within 1 hour in the three groups were all over 90%, with no statistically significant difference among the three groups. The recognition and diagnosis time in the observation group was significantly shorter than that in the control group and the improvement group (hours: 0.41±0.15 vs. 0.61±0.21, 0.51±0.18, both P < 0.05), the correction rate of hypoxemia and 28-day survival rate were significantly higher than those in the control group [correction rate of hypoxemia: 95.35% (41/43) vs. 74.42% (32/43), 28-day survival rate: 83.72% (36/43) vs. 60.47% (26/43), both P < 0.05], and ICU occupancy rate was significantly lower than that in the control group [72.09% (31/43) vs. 93.02% (40/43), P < 0.05]. After training in the CRM system, the score of the sepsis awareness survey questionnaire for emergency department nurses was significantly increased as compared with before training (60.42±5.29 vs. 44.17±9.21, P < 0.01), and NTS also showed significant improvement. CONCLUSION CRM plays a significant role in promoting the implementation of sepsis hour-1 bundle, which can improve the implementation rate of hour-1 bundle and NTS of medical staff, effectively improve patients' hypoxemia, reduce patients' ICU occupancy rate and 28-day risk of death.
Humans ; Sepsis/therapy* ; Emergency Service, Hospital ; Patient Care Bundles ; Intensive Care Units ; Female ; Male ; Middle Aged

Objective To investigate the hepatic hemodynamic characteristics of cirrhotic patients with splenectomy using iodine map of dual-source computed tomography(DSCT).Methods Twenty-four cirrhotic patients with splenectomy were selected as a study group,41 cirrhotic patients without splenectomy as a cirrhosis group and other 32 patients with normal liver as a control group.The iodine concentration(IC)in hepatic arterial and venous phases was measured on the iodine map,and the arterial iodine fraction(AIF)and portal venous iodine concentration(PVIC)were calculated.Receiver operating characteristic(ROC)curves were plotted and the area under the curve(AUC)was recorded to evaluate the diagnostic efficacy of each parameter using the DeLong test.Results IC in arterial phase and AIF were significantly higher,and IC in venous phase and PVIC were significantly lower in study group(P<0.05).The AUC values of the four parameters between study group and cirrhosis group were 0.735,0.992,0.943,and 0.994,respectively.Conclusion DSCT iodine map is helpful for clinical quantitative assessment of hepatic hemodynamic characteristics in cirrhotic patients with splenectomy,and the PVIC has optimal independent diagnostic performance.

Objective:To investigate the safety and effectiveness of the laparoscopic hepatectomy guided by three-dimensional visualization technology for treating hepatolithiasis in military flying personnel and to discuss the aeromedical assessment.Methods:The diagnosis and treatment of a military flying personnel with hepatolithiasis admitted to the Air Force Medical Center in December of 2021 and the conclusions of aeromedical assessment were analyzed. The literature was reviewed in combination with the progress of new technologies.Results:This case, a 40-year-old male helicopter aerial machinist, had been found gallbladder stones for 12 years, hepatolithiasis for 8 years, and intermittent right upper abdominal pain for more than 3 months. Ultrasound and CT examination showed multiple gallbladder stones, intrahepatic bile duct stones in the right posterior lobe of the liver with bile duct dilatation. Under the guidance of three-dimensional visualization technology, laparoscopic liver segment 6 precise resection, cholecystectomy, common bile duct exploration and stone removal, and T-tube drainage were performed. The patient was well recovered and waivered to flight after 6 months of the operation. As of the submission date, he has safely flown for 50 h.Conclusions:Laparoscopic anatomical hepatectomy guided by three-dimensional visualization technology in the military flying personnel with hepatolithiasis shows good safety and effect, and those who recover well after surgery can be waivered to flight.

Scoliosis is a common deformity in neuromuscular disease, which usually has the characteristics of early onset age, severe degree of deformity, and rapid progression.Neuromuscular scoliosis often leads to serious damages to the quality of life, and results in the loss of walking, standing and sitting, and cardiopulmonary insufficiency.Surgical treatment can improve the quality of life for children with neuromuscular scoliosis, but surgical treatment is still challenging due to the complex surgery and many complicated diseases.The complications are much higher than those of idiopathic scoliosis.A multidisciplinary team is necessary in the surgical treatment of neuromuscular scoliosis to promptly and effectively reduce the complications.

Objective:To investigate the safety and effectiveness of the laparoscopic hepatectomy guided by three-dimensional visualization technology for treating hepatolithiasis in military flying personnel and to discuss the aeromedical assessment.Methods:The diagnosis and treatment of a military flying personnel with hepatolithiasis admitted to the Air Force Medical Center in December of 2021 and the conclusions of aeromedical assessment were analyzed. The literature was reviewed in combination with the progress of new technologies.Results:This case, a 40-year-old male helicopter aerial machinist, had been found gallbladder stones for 12 years, hepatolithiasis for 8 years, and intermittent right upper abdominal pain for more than 3 months. Ultrasound and CT examination showed multiple gallbladder stones, intrahepatic bile duct stones in the right posterior lobe of the liver with bile duct dilatation. Under the guidance of three-dimensional visualization technology, laparoscopic liver segment 6 precise resection, cholecystectomy, common bile duct exploration and stone removal, and T-tube drainage were performed. The patient was well recovered and waivered to flight after 6 months of the operation. As of the submission date, he has safely flown for 50 h.Conclusions:Laparoscopic anatomical hepatectomy guided by three-dimensional visualization technology in the military flying personnel with hepatolithiasis shows good safety and effect, and those who recover well after surgery can be waivered to flight.

It is still at the initial stage for basic-level military doctors to participate in the standardized residency training. While, their professional backgrounds and training objectives are significantly different from those civilian residents, it is necessary to explore the standardized training methods in line with the military career demands for those basic-level military doctors. Based on the actual needs of grass-roots troops and military medicine, this study makes significant progress in the integration of standardized residency training and field surgery training methods, making the basic-level military doctors achieve the goal of field surgery training in the course of clinical practice of residents. Not only the surgical capability of basic-level military doctors, but also the medical support capability in grass-roots troops has been improved. This article summarizes the application methods and experience of field surgery teaching in the standardized residency training of military medical residents at the grass-roots level.

Objective:To investigate the clinical efficacy of zoledronic acid combined with calcium in the treatment of primary osteoporosis (OP).Methods:A total of 180 patients with OP were selected and randomly divided into study group and control group. The two groups of patients were given oral calcium carbonate D3 tablets (Ⅱ), on this basis, the patients in the study group were given zoledronic acid injection. The clinical efficacy was observed after 12 months of the treatment, and the total effective rate was calculated. The bone mineral density, visual analog scale (VAS) of pain, and bone biochemical indexes, including blood calcium (Ca), blood phosphorus (P), bone γ-carboxyglutamate protein (BGP), calcitonin (hCT), collagen type I amino-terminal peptide (P1NP) and collagen type I cross-linked carboxy-terminal peptide (β-specific sequence) (β-CTX) were collected before and after the treatment.Results:The clinical efficacy of the study group was better than that of the control group ( P<0.05). After the treatment, the bone mineral density in the study group was higher ( P<0.05), and the VAS score was lower than that in the control group ( P<0.05). After the treatment, there was no significant difference in serum calcium, serum phosphorus and BGP between the control group and the study group (all P>0.05), the hCT and P1NP levels in the study group were significantly higher than those before the treatment (all P<0.01), and the β-CTX level was significantly lower than that before the treatment ( P<0.01). Conclusions:Zoledronic acid combined with calcium has a good therapeutic effect on OP.

Objective:To explore the clinical diagnosis and treatment of common bile duct stones (CBDS) in military pilots and the aeromedical assessment.Methods:The detailed diagnosis and treatment process, as well as the aeromedical assessment of 3 military pilots diagnosed as CBDS in Air Force Medical Center, PLA from June 2009 to March 2015 were collected. Then it was analyzed by the new technology.Results:Three pilots were diagnosed as CBDS and obstructive jaundice due to long term cholecystolithiasis or calculus of intrahepatic duct. Case 1 was secondary to cholecystolithiasis, and received laparoscopic cholecystectomy and common bile duct exploration. Case 2 was secondary to intrahepatic cholelithiasis and underwent left lateral lobectomy and common bile duct exploration. Case 3 recurred after cholecystolithotomy and then underwent open cholecystectomy, choledochoplasty and T-tube drainage because of biliary stricture. All 3 cases recovered well. The aeromedical assessment conclusions were as follows: case 1 was qualified to flight 5 months after operation, case 2 was grounded due to hypertension after the operation, case 3 was qualified after 6 months of the operation.Conclusions:CBDS of military pilots is often secondary to cholecystolithiasis or intrahepatic bile duct stones. The operation should be performed as early as possible, and minimally invasive methods should be adopted. The pilots with proper treatment and good postoperative recovery can be qualified to flight.

Objective:To explore the clinical diagnosis and treatment of common bile duct stones (CBDS) in military pilots and the aeromedical assessment.Methods:The detailed diagnosis and treatment process, as well as the aeromedical assessment of 3 military pilots diagnosed as CBDS in Air Force Medical Center, PLA from June 2009 to March 2015 were collected. Then it was analyzed by the new technology.Results:Three pilots were diagnosed as CBDS and obstructive jaundice due to long term cholecystolithiasis or calculus of intrahepatic duct. Case 1 was secondary to cholecystolithiasis, and received laparoscopic cholecystectomy and common bile duct exploration. Case 2 was secondary to intrahepatic cholelithiasis and underwent left lateral lobectomy and common bile duct exploration. Case 3 recurred after cholecystolithotomy and then underwent open cholecystectomy, choledochoplasty and T-tube drainage because of biliary stricture. All 3 cases recovered well. The aeromedical assessment conclusions were as follows: case 1 was qualified to flight 5 months after operation, case 2 was grounded due to hypertension after the operation, case 3 was qualified after 6 months of the operation.Conclusions:CBDS of military pilots is often secondary to cholecystolithiasis or intrahepatic bile duct stones. The operation should be performed as early as possible, and minimally invasive methods should be adopted. The pilots with proper treatment and good postoperative recovery can be qualified to flight.

Objective:To perform 3D modeling based on CT images of human stomach-esophagus structure and provide 3D models of normal and reflux forms of gastroesophagus.Methods:Based on CT images of stomach-esophagus structure, 3D models was established using Mimics 10.01, Geomagic Studio 2012 and SolidWorks 2018 software. In the modeling process, the Mimics software was used to coarsely and finely divide the model to export stomach-esophageal point cloud data. On the basis of the point cloud data, Geomagic Studio software was used to simplify and repair the model, and complete the operations of filling holes and smooth surfaces. SolidWorks software was used to process the structure of the cardia and establish a normal model of stomach-esophagus and a model of cardiac disease. Finally, the model was replicated using soft 3D printing technology.Results:The geometric parameters of the established stomach-esophagus model were within the actual range, which proved that the model has certain practicality.Conclusions:The model can be used as a basic material for gastric surgery simulation training, to help doctors or medical students to be proficient and improve the operation skills and surgical level of gastric surgery.