Objective:To construct a risk identification and early warning management model,and to explore its value in the risk control and management of active medical devices maintenance and repair. Methods:The risk identification and early warning knowledge base of active medical equipment maintenance and repair was constructed from three aspects:basic data,core data and auxiliary data. The risk evaluation index system was designed in combination with the equipment operating status,and the weight was assigned by coefficient of variation and the extension cloud algorithm was used to evaluate the risk level,so as to form a hierarchical early warning trigger path and a three-dimensional early warning intervention scheme of personnel,system and process. A total of 287 active medical devices in clinical use in the Second Hospital of Shanxi Medical University from 2022 to 2023 were selected,and 261 devices used in the period from January to December 2022 were managed by conventional management methods,270 active medical devices (including 244 in use under conventional management method) used from January to December 2023 were managed by active medical equipment maintenance and repair risk identification and early warning model (referred to as risk identification model management). The equipment maintenance and repair management effects of the two management methods were compared from the aspects of safety level assessment and risk hazard statistics,and business capability of personnel involved in equipment management were assessed and evaluated. Results:The risk rate of active medical equipment managed by risk identification model was 7.8％ (21/270),which was lower than that of conventional management method,and the difference was statistically significant (x2=8.773,P<0.05). Among the 2839 maintenance and repair activities carried out by the risk identification model management method,safety risk hazards of large medical equipment,ECG monitoring equipment,life support emergency equipment and medical testing equipment occurred 75,19,82 and 11 times,respectively,with the hidden danger rates of 2.6％,0.7％,2.9％ and 0.4％,which were all lower than those of the conventional management method,and the difference was statistically significant (x2=27.989,24.580,46.654,12.604,P<0.05). The pass rates of 92 medical equipment managers participating in the risk identification model management method in maintenance management,quality monitoring,fault handling and risk response were 95.7％ (88/92),98.9％ (91/92),92.4％ (85/92) and 97.8％ (90/92),respectively,which were higher than those of the conventional management method,the difference was statistically significant (x2=4.901,4.016,6.368,5.176,P<0.05). Conclusion:The risk identification and early warning model based on coefficient of variation weighting and extension cloud algorithm can reduce the risk level of active medical devices maintenance and repair,control the occurrence probability of potential safety hazards,and improve the support level of maintenance and repair management.

Objective:To construct a risk identification and early warning management model,and to explore its value in the risk control and management of active medical devices maintenance and repair. Methods:The risk identification and early warning knowledge base of active medical equipment maintenance and repair was constructed from three aspects:basic data,core data and auxiliary data. The risk evaluation index system was designed in combination with the equipment operating status,and the weight was assigned by coefficient of variation and the extension cloud algorithm was used to evaluate the risk level,so as to form a hierarchical early warning trigger path and a three-dimensional early warning intervention scheme of personnel,system and process. A total of 287 active medical devices in clinical use in the Second Hospital of Shanxi Medical University from 2022 to 2023 were selected,and 261 devices used in the period from January to December 2022 were managed by conventional management methods,270 active medical devices (including 244 in use under conventional management method) used from January to December 2023 were managed by active medical equipment maintenance and repair risk identification and early warning model (referred to as risk identification model management). The equipment maintenance and repair management effects of the two management methods were compared from the aspects of safety level assessment and risk hazard statistics,and business capability of personnel involved in equipment management were assessed and evaluated. Results:The risk rate of active medical equipment managed by risk identification model was 7.8％ (21/270),which was lower than that of conventional management method,and the difference was statistically significant (x2=8.773,P<0.05). Among the 2839 maintenance and repair activities carried out by the risk identification model management method,safety risk hazards of large medical equipment,ECG monitoring equipment,life support emergency equipment and medical testing equipment occurred 75,19,82 and 11 times,respectively,with the hidden danger rates of 2.6％,0.7％,2.9％ and 0.4％,which were all lower than those of the conventional management method,and the difference was statistically significant (x2=27.989,24.580,46.654,12.604,P<0.05). The pass rates of 92 medical equipment managers participating in the risk identification model management method in maintenance management,quality monitoring,fault handling and risk response were 95.7％ (88/92),98.9％ (91/92),92.4％ (85/92) and 97.8％ (90/92),respectively,which were higher than those of the conventional management method,the difference was statistically significant (x2=4.901,4.016,6.368,5.176,P<0.05). Conclusion:The risk identification and early warning model based on coefficient of variation weighting and extension cloud algorithm can reduce the risk level of active medical devices maintenance and repair,control the occurrence probability of potential safety hazards,and improve the support level of maintenance and repair management.

ObjectiveTo observe the recovery of proprioception of the affected ankle over time after lateral ankle sprain accepting routine rehabilitation. MethodsFrom June, 2020 to June, 2022, 18 patients with lateral ankle sprain in Kunshan Rehabilitation Hospital underwent routine rehabilitation for twelve weeks. They were measured active and passive position sense of bilateral ankles using an isokinetic dynamometer before treatment, and four, eight and twelve weeks after treatment, respectively. ResultsThe active presentation difference of affected ankle reduced after treatment (F = 22.533, P < 0.001), but it was more than that of the healthy ankle at the same time (t > 4.419, P < 0.001). No significant improvement was found in passive presentation difference of affected ankle after treatment (F = 1.175, P > 0.05), and it was not significantly different from those of the healthy ankle at the same time (|t| < 0.646, P > 0.05). ConclusionProprioception of affected ankle has been impaired after lateral ankle sprain, and it can be recovered after rehabilitation, but cannot achieve the healthy level even after three months of training. Passive position sense as an index of proprioception needs more researches.

Multiple myeloma is a plasma cell disease with the second highest incidence among hematological malignancies. Its risk of concurrent thrombosis is high, which greatly affects the quality of life and even endangers life of multiple myeloma patients. The pathogenesis of thrombosis in patients with multiple myeloma is complex, which is still unclear. However many mechanisms are considered to be related to hypercoagulable state in patients with multiple myeloma. Currently, there is a lack of thrombosis risk assessment model for multiple myeloma. Therefore, this paper reviews the research and the latest progress of venous thrombosis in patients with multiple myeloma, and provides a theoretical basis for the prevention and treatment of thrombosis.

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts′ expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig′s angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Objective To analysis the change of hip joint in healthy infants by ultrasound,and establish the normal reference value of the developmental dysplasia of the hip(DDH). Methods A total of 8 000 healthy infants from 0 to 24 weeks were collected from the Multi-center study of 10 children′s medical centers. Among them,3 855 infants(2 065 females and 1 790 males) with complete data and follow-up were included in this study. All subjects were divided into 6 groups ( ＜4,4～7,8～11,12～15,16～19 and≥20 weeks group). α angle,femoral head length and width,femoral head coverage ratio by acetabulum ( FHC) were measured in the coronal view on the neutral position;distance from pubis to femoral head ( P-H) and distance from ischium to femoral head ( I-H ) were measured in the transverse view on neutral position;distance from femoral head topubis ( H-P) was measured in the posterolateraltransverse view on the flexion position. The results of each group changes with age were analysised. Results ① The α angle of healthy infants from 0 to 20 weeks were increased with age,the difference among the groups were statistically significant( P ＜0.05),but there was no significant difference between 16～19 and ≥20 weeks group( P ＞0.05). ②The femoral head length and width of all age groups were increased with age,the difference among all the groups was statistically significant( all P ＜0.05). ③ FHC from 0 to 20 weeks were increased with age,the difference among the groups were statistically significant( P ＜0.05) except between 16～19 and ≥20 weeks group( P ＞0.05). ④ The P-H and I-H in all age groups showed no statistically significant ( all P＞0.05). ⑤The H-P of all age groups were increased with age,the difference between the groups were statistically significant(all P ＜0.05).Conclusions The development of hip joints have the certain regular developmental pattern in healthy infants less than 5 months of birth and are relatively constant after birth more than 5 months. The ultrasound normal reference value of the hip joints can be used for the early diagnosis of the DDH.

Objective To compare the clinical effect of simple volar or dorsal plate fixation of intra-articular distal radius fracture.Methods This retrospective study included 42 patients with closed intra-articular distal radius fracture treated surgically using the dorsal or volar plate.Out of the 15 patients in dorsal plating group 5 were males and 10 females at age of (55 ± 7)years (range, 48-62 years), 13 were injured from falls and 2 traffic accidents, 10 were classified as AO type C3 and 5 AO type C2.Out of the 27 patients in volar plating group 8 were males and 19 females at age of (56 ± 6)years (range, 50-62 years), 24 were injured from falls and 3 traffic accidents, 17 were classified as AO type C3 and 10 AO type C2.Between-group differences were compared with respect to wrist range of motion, postoperative radiographic parameters, postoperative complications, disabilities of the ann, shoulder and hand (DASH) score and Gartland-Werley score.Results All the patients were followed up for 11-25 months.There were no significant differences in the wrist range of motion and radiographic parameters between the two groups (P ＞ 0.05).Volar plating group resulted in a significantly better Gartland-Werley score compared to dorsal plating group [1 vs 4 points, P ＜ 0.05], but no significant difference was noted in DASH score (P ＞ 0.05).Four patients (27％) in dorsal plating group developed tendon adhesions and tenolysis was in demand, but one patients (4％) in volar plating group was complicated by median nerve symptoms (P ＜ 0.05).Conclusions Although the DASH score of the two methods was similar, volar plating yields better results in Gartland-Werley score and complication incidence.Thus the volar plating is recommended for intra-articular distal radius fracture.

Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; complications ; Spondylitis, Ankylosing ; complications

ObjectiveTo explore the biological features of colorectal adenoma with chicken-skin mucosa ( CSM ) and its clinical significance.MethodsExpression of cell proliferation markers ( Ki-67 and COX-2) and apoptosis-related factors ( survivin and caspase-3) in normal colorectal mucosa,colorectal adenoma without CSM,colorectal adenoma with CSM and colorectal adenocarcinoma were detected by immunohistochemistry SP method and enzyme-linked immunosorbent assay (ELISA).ResultsImmunohistochemical results revealed a decreased trend in expressions of Ki-67 and COX-2 from colorectal adenocarcinoma through colorectal adenoma with and without CSM to normal colorectal mucosa,while the expressions of survivin and caspase-3 showed an increased trend.By ELISA,the expressions of Ki-67,COX-2,surviving and caspase-3 showed no significant difference (P ＞ 0.05 ) between colorectal adenoma with CSM and coloreetal adenocarcima,while these variables were significantly different (P ＜ 0.05) between coloreetal adenoma with and without CSM,so as well between normal colorectal mucosa and other 3 groups.ConclusionThe biological characteristics of colorectal adenoma with CSM are different from those without,showing an activated cell proliferation and inhibited cell apoptosis with increased carcinogenesis risk.

Objective To evaluate the effect on treatment of multiple myeloma complicating femoral neck fracture by surgical intervention combined with drugs.Methods Twelve patients with multiple myeloma complicating femoral neck fracture were treated by cemented total hip arthroplasty femoral head shank.All of patients were received zoledronic acid treatment,at the same time,7 cases of them treated by MPT regimen (melphalan,methylprednisolone and thalidomide),3 by bortezomib combined with dexamethasone,and 1 by autologous peripheral blood stem cell transplantation.Results Twelve patients could tolerate surgery,postoperative pain was significantly reduced.Assessed by using Harris hip function score after 6 months operation,2 cases were excellent,7 cases were good,3 cases were common,excellent and good rate was 75％ (9/12).All patients were followed up for 8 months to 3 years,1 case of local recurrence after 13 months.1-year overall survival rate was 100％,2-year overall survival rate was 83％,and 3-year overall survival rate was 67％.Conclusions Multiple myeloma complicating femoral neck fracture,using bone cement in total hip arthroplasty femoral head shank to clear the local tumor lesions,receive reconstruction capability,rapid postoperative recovery,pain relief,and opportunities for further comprehensive treatments.The bisphosphonate can promote new bone formation and prevent further fractures.The surgical intervention combined with chemotherapy could relieve the symptoms,reduce tumor cell burden,improve quality of life and prolong survival time.