The intensive care unit (ICU) is a highly equipment-intensive area with a wide variety of medical devices, and the accuracy and timeliness of medical equipment data collection are highly demanded. The integration of the Internet of Things (IoT) into ICU medical devices is of great significance for enhancing the quality of medical care and nursing, as well as for the advancement of digital and intelligent ICUs. This study focuses on the construction of the IOT for ICU medical devices and proposes innovative solutions, including the overall architecture design, devices connection, data collection, data standardization, platform construction and application implementation. The overall architecture was designed according to the perception layer, network layer, platform layer and application layer; three modes of device connection and data acquisition were proposed; data standardization based on Integrating the Healthcare Enterprise-Patient Care Device (IHE-PCD) was proposed. This study was practically verified in the Chinese People's Liberation Army General Hospital, a total of 122 devices in four ICU wards were connected to the IoT, storing 21.76 billion data items, with a data volume of 12.5 TB, which solved the problem of difficult systematic medical equipment data collection and data integration in ICUs. The remarkable results achieved proved the feasibility and reliability of this study. The research results of this paper provide a solution reference for the construction of hospital ICU IoT, offer more abundant data for medical big data analysis research, which can support the improvement of ICU medical services and promote the development of ICU to digitalization and intelligence.
Intensive Care Units ; Internet of Things ; Humans ; Internet ; Data Collection

Objective:In order to meet the needs of building Internet of Things(IoT)of medical equipment for mobile deployment,rapid deployment,high-speed and stable data transmission,a wireless IoT acquisition terminal for medical equipment on the basis of Wi-Fi 6 was developed.Methods:Wi-Fi 6 technique was adopted to construct IoT of medical equipment,and the data acquisition terminal included Wi-Fi 6-based customer premises equipment(CPE)and intelligent wireless access point(AP).The CPE adopted a domestic main control chip and Wi-Fi chips,which included two 2.4G and 5G antennas,and was compatible with multiple interfaces such as RS232 and RJ45.The data of medical equipment were converted into wireless transmission through wired communication interfaces.The security access and data traceability of medical equipment were supported through secure secondary authentication with security control enhanced by"white list plus certificate".The intelligent wireless AP was compatible with various RF devices such as Wi-Fi,bluetooth,radio frequency identification,etc.(included 2.4G and 5G antennas).CPE and AP jointly apply dual-transmitter selection technique to ensure stable data transmission.Results:The key performance of wireless IoT acquisition terminals has been tested,and the results indicated that the integrity of acquisition data of intelligent acquisition terminal was consistent with that of output data,with a maximum latency of 9 ms and an average latency of 2 ms.The tested results can meet the expected requirements.Conclusion:The wireless IoT data of medical equipment that based on the acquisition terminal can stably and quickly collect data of equipment to IoT platform,providing paradigm for the construction of wireless IoT of medical equipment.

Objective To investigate the correlation between the level of platelet autophagy related factors and the neurological impairment and prognosis of the patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods From July 2020 to March 2023,90 aSAH patients admitted to the intensive care unit of neurosurgery department of our hospital were analyzed retrospectively.Based on mRS score 3 months after discharge,patients with aSAH(n=46,mRS 0-2)were divided into the good prognosis group,while those with mRS 3-5(n=44)as the poor prognosis group.Platelets of all the participants were collected,and the levels of autophagy-associated protein 7(ATG7),benzalkonium chloride 1(BECN1),microtubule-associated protein 1 light chain 3(LC3)and sequestosome 1(p62)were determined by enzyme-linked immunosorbent assay(ELISA).Results Compared with the good prognosis group,the mechanical ventilation time,ICU stay,cases of early brain injury,vasospasm and delayed cerebral ischemia in the poor prognosis group increased significantly(P<0.05).Compared with the good prognosis group,the ΔPLT in the poor prognosis group decreased significantly(P<0.05),and ΔLC3-Ⅱ and ΔATG7 increased significantly(P<0.05).Spearman correlation analysis showed that ΔPLT was positively correlated with ΔATG7,ΔLC3-Ⅱ and ΔBECN1(r=0.239,0.389 and 0.487,all P<0.05).Platelet ΔLC3-Ⅱ in patients with vasospasm and delayed cerebral ischemia was higher than that in patients without vasospasm and delayed cerebral ischemia(P<0.05).ICU stay(OR=1.187,95%CI=1.045～1.349,P=0.008),ΔPLT(OR=0.972,95%CI=0.947～0.998,P=0.034)and ΔLC3-Ⅱ(OR=2.840,95%CI=1.049～7.694,P=0.040)were independent influencing factors for the poor prognosis of aSAH patients.The combination of ICU stay,ΔPLT and ΔLC3-Ⅱ had the greatest ability to predict the poor prognosis of aSAH patients,with AUC of 0.921,sensitivity of 86.4%and specificity of 84.8%.Conclusion The decrease of platelet count and LC3-Ⅱ improvement in early treatment of aSAH patients can be regarded as the independent influencing factors of adverse outcomes.

Background and Aims:Radical resection is the only potentially curative treatment for intrahepatic cholangiocarcinoma(ICC),yet the high recurrence rate results in poor prognosis.In recent years,"textbook outcome"(TO)has been proposed as a comprehensive quality metric,but its association with prognosis remains unclear.This study aimed to analyze the risk factors influencing the achievement of TO after radical resection of ICC and to explore the relationship between TO and survival.Methods:A retrospective analysis was conducted on the clinical data of 180 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA between February 2018 and February 2023.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with TO,and survival analysis was carried out using the Kaplan-Meier method and Log-rank test.Results:Of the 180 patients,66 achieved TO.Multivariate Logistic regression analysis indicated that preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,microvascular invasion(MVI),and lymph node metastasis were independent risk factors for failing to achieve TO(all P＜0.05).Survival analysis demonstrated that patients who achieved TO had a significantly longer median survival compared with those who did not(36 months vs.16 months,P＜0.001).Conclusion:Preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,MVI,and lymph node metastasis are independent risk factors for not achieving TO after radical resection of ICC.Patients who achieved TO exhibited markedly longer survival,suggesting that TO not only reflects perioperative treatment quality but also serves as an important prognostic indicator.Greater attention to these risk factors and optimization of perioperative management may improve the likelihood of achieving TO and enhance long-term outcomes.

Background and Aims:Radical resection is the only potentially curative treatment for intrahepatic cholangiocarcinoma(ICC),yet the high recurrence rate results in poor prognosis.In recent years,"textbook outcome"(TO)has been proposed as a comprehensive quality metric,but its association with prognosis remains unclear.This study aimed to analyze the risk factors influencing the achievement of TO after radical resection of ICC and to explore the relationship between TO and survival.Methods:A retrospective analysis was conducted on the clinical data of 180 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA between February 2018 and February 2023.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with TO,and survival analysis was carried out using the Kaplan-Meier method and Log-rank test.Results:Of the 180 patients,66 achieved TO.Multivariate Logistic regression analysis indicated that preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,microvascular invasion(MVI),and lymph node metastasis were independent risk factors for failing to achieve TO(all P＜0.05).Survival analysis demonstrated that patients who achieved TO had a significantly longer median survival compared with those who did not(36 months vs.16 months,P＜0.001).Conclusion:Preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,MVI,and lymph node metastasis are independent risk factors for not achieving TO after radical resection of ICC.Patients who achieved TO exhibited markedly longer survival,suggesting that TO not only reflects perioperative treatment quality but also serves as an important prognostic indicator.Greater attention to these risk factors and optimization of perioperative management may improve the likelihood of achieving TO and enhance long-term outcomes.

Objective:In order to meet the needs of building Internet of Things(IoT)of medical equipment for mobile deployment,rapid deployment,high-speed and stable data transmission,a wireless IoT acquisition terminal for medical equipment on the basis of Wi-Fi 6 was developed.Methods:Wi-Fi 6 technique was adopted to construct IoT of medical equipment,and the data acquisition terminal included Wi-Fi 6-based customer premises equipment(CPE)and intelligent wireless access point(AP).The CPE adopted a domestic main control chip and Wi-Fi chips,which included two 2.4G and 5G antennas,and was compatible with multiple interfaces such as RS232 and RJ45.The data of medical equipment were converted into wireless transmission through wired communication interfaces.The security access and data traceability of medical equipment were supported through secure secondary authentication with security control enhanced by"white list plus certificate".The intelligent wireless AP was compatible with various RF devices such as Wi-Fi,bluetooth,radio frequency identification,etc.(included 2.4G and 5G antennas).CPE and AP jointly apply dual-transmitter selection technique to ensure stable data transmission.Results:The key performance of wireless IoT acquisition terminals has been tested,and the results indicated that the integrity of acquisition data of intelligent acquisition terminal was consistent with that of output data,with a maximum latency of 9 ms and an average latency of 2 ms.The tested results can meet the expected requirements.Conclusion:The wireless IoT data of medical equipment that based on the acquisition terminal can stably and quickly collect data of equipment to IoT platform,providing paradigm for the construction of wireless IoT of medical equipment.

Intelligent medical devices are flourishing with the deep integration of modern information and artificial intelligence technologies into healthcare.Testing is an important means of performance evaluation and quality control for intelligent medical devices.Compared with traditional medical devices,the testing methods and technologies of intelligent medical devices are still immature,and need active research to promote the progress in this area.Intelligent medical devices are classified according to their characteristics as artificial intelligence medical devices in the form of software and medical robots based on a general discussion of their development.The medical-device Internet of Things(IoT)system has also been included due to its close relation to the construction of smart hospitals.For each type of intelligent medical device,testing indexes and testing plans are discussed.It is suggested that specific test rules should be further developed for various specific devices.Besides,the evaluation method of complex intelligent systems should be introduced and real-world data should be used for evaluation.This paper aims to accelerate the development of intelligent medical device testing,laying the foundation for quality control and performance evaluation of intelligent medical devices.

Objective:To Compare perioperative indicators of open pancreaticoduodenectomy (OPD), laparoscopic pancreaticoduodenectomy (LPD), and robotic pancreaticoduodenectomy (RPD) using propensity score matching (PSM).Methods:A retrospective analysis of the clinical data of 167 patients with periampullary lesions who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Zhengzhou University from January 2018 to March 2022. The cohort included 100 males and 67 females, with age of (58.92±11.47) years. Based on the surgical approach, patients were divided into three groups: OPD group ( n=67), LPD group ( n=58), and RPD group ( n=42). Clinical data such as gender, age, operation time, and postoperative complications were collected. PSM was employed to eliminate confounding factors and evaluate the effect of different surgical methods on perioperative outcomes. Results:After PSM, there were 42 cases in the OPD group, 29 cases in the LPD group, and 25 cases in the RPD group. The baseline characteristics of the three groups were compared, and no statistically significant differences were found (all P>0.05). The operation time in the LPD group was longer than that in the OPD group [6.0 (5.1, 7.1) h vs. 4.8 (4.1, 5.3) h, Z=221.50, P<0.001] and the RPD group [6.0 (5.1, 7.1) h vs. 5.3 (4.5, 6.0) h, Z=222.00, P=0.015], with statistically significant differences. The intraoperative blood transfusion volume in the OPD group was higher than that in the RPD group [0 (0, 600.0) ml vs. 0 ml], with a statistically significant difference ( Z=368.50, P=0.011). The length of hospital stay in the OPD group was longer than that in the LPD group [15.5(12.8, 22.3) d vs. 11.0(9.5, 16.0) d, Z=354.50, P=0.003] and the RPD group [15.5(12.8, 22.3) d vs. 11.0(8.5, 15.5) d, Z=289.00, P=0.002], with statistically significant differences. The duration of intravenous analgesic use in the OPD group was longer than that in the RPD group [1.5(0, 3.0) d vs. 0(0, 1.0) d], with a statistically significant difference ( Z=310.50, P=0.004). Additionally, the time to gastric tube removal after surgery in the OPD group was longer than that in the LPD group [3.0(2.0, 4.0) d vs. 2.0(2.0, 3.0) d, Z=392.50, P=0.009] and the RPD group [3.0(2.0, 4.0) d vs. 2.0(1.0, 3.5) d, Z=297.50, P=0.003], with statistically significant differences. There were no statistically significant differences in postoperative complications among the three groups. Conclusion:Compared with LPD, RPD had a shorter operation time; compared with OPD, both LPD and RPD were able to reduce hospital stay and intravenous analgesic use, and decrease intraoperative blood transfusion.

BACKGROUND:Scaphoid fractures are common wrist fractures.The percutaneous screw is used to treat scaphoid fractures.The closed reduction of the fracture site,the precise placement of the hollow compression screw in the scaphoid axis and the compression fixation of the fracture site can promote fracture healing and achieve the better function of the wrist. OBJECTIVE:To evaluate the efficacy of percutaneous hollow compression screw fixation of scaphoid fractures using a novel Kirschner wire guide. METHODS:Between January 2015 and December 2020,clinical data from 15 patients with scaphoid fractures selected at the Department of Hand Surgery,Third Hospital of Hebei Medical University were retrospectively analyzed.All patients underwent percutaneous hollow compression screw fixation by a novel Kirschner wire guide.Fracture healing time,operation time,number of intraoperative fluoroscopies,time to return to work and complications were collected.According to the modified Mayo wrist scoring system,the functional outcomes of wrists were assessed 12 months after surgery.Wrist flexion,extension,ulnar deviation,radial deviation and grip strength were measured. RESULTS AND CONCLUSION:All patients were followed up for 12 months.The compression screw was located in the axial position of the scaphoid by routine immediate postoperative radiographs.All scaphoid fractures united at an average of 10.0 weeks.The average operation time was 55.7 minutes.The number of intraoperative fluoroscopies was 10.9.The average time to return to work was 10.3 weeks.The results of wrist joint function were excellent in 9 cases,good in 5 cases,and average in 1 case,with an excellent and good rate of 93.3%.No significant differences in wrist flexion,extension,ulnar deviation,radial deviation and grip strength were found between the affected and healthy sides(P＞0.05).None of the patients had wound infection,malunion,screw displacement,or screw breakage.These findings indicate that the application of a novel guide can shorten the operation time,reduce the number of intraoperative fluoroscopies,improve the accuracy of screw insertion,and shorten the time to return to work.The function of the wrist was satisfactory after the operation.The novel Kirschner wire guide made percutaneous hollow compression screw fixation easier for scaphoid fractures.

Objective:To Compare perioperative indicators of open pancreaticoduodenectomy (OPD), laparoscopic pancreaticoduodenectomy (LPD), and robotic pancreaticoduodenectomy (RPD) using propensity score matching (PSM).Methods:A retrospective analysis of the clinical data of 167 patients with periampullary lesions who underwent pancreaticoduodenectomy at the First Affiliated Hospital of Zhengzhou University from January 2018 to March 2022. The cohort included 100 males and 67 females, with age of (58.92±11.47) years. Based on the surgical approach, patients were divided into three groups: OPD group ( n=67), LPD group ( n=58), and RPD group ( n=42). Clinical data such as gender, age, operation time, and postoperative complications were collected. PSM was employed to eliminate confounding factors and evaluate the effect of different surgical methods on perioperative outcomes. Results:After PSM, there were 42 cases in the OPD group, 29 cases in the LPD group, and 25 cases in the RPD group. The baseline characteristics of the three groups were compared, and no statistically significant differences were found (all P>0.05). The operation time in the LPD group was longer than that in the OPD group [6.0 (5.1, 7.1) h vs. 4.8 (4.1, 5.3) h, Z=221.50, P<0.001] and the RPD group [6.0 (5.1, 7.1) h vs. 5.3 (4.5, 6.0) h, Z=222.00, P=0.015], with statistically significant differences. The intraoperative blood transfusion volume in the OPD group was higher than that in the RPD group [0 (0, 600.0) ml vs. 0 ml], with a statistically significant difference ( Z=368.50, P=0.011). The length of hospital stay in the OPD group was longer than that in the LPD group [15.5(12.8, 22.3) d vs. 11.0(9.5, 16.0) d, Z=354.50, P=0.003] and the RPD group [15.5(12.8, 22.3) d vs. 11.0(8.5, 15.5) d, Z=289.00, P=0.002], with statistically significant differences. The duration of intravenous analgesic use in the OPD group was longer than that in the RPD group [1.5(0, 3.0) d vs. 0(0, 1.0) d], with a statistically significant difference ( Z=310.50, P=0.004). Additionally, the time to gastric tube removal after surgery in the OPD group was longer than that in the LPD group [3.0(2.0, 4.0) d vs. 2.0(2.0, 3.0) d, Z=392.50, P=0.009] and the RPD group [3.0(2.0, 4.0) d vs. 2.0(1.0, 3.5) d, Z=297.50, P=0.003], with statistically significant differences. There were no statistically significant differences in postoperative complications among the three groups. Conclusion:Compared with LPD, RPD had a shorter operation time; compared with OPD, both LPD and RPD were able to reduce hospital stay and intravenous analgesic use, and decrease intraoperative blood transfusion.