OBJECTIVE: To investigate the effectiveness of digital three-dimensional (3D) printing osteotomy guide plate assisted total knee arthroplasty (TKA) in treatment of knee osteoarthritis (KOA) patients with femoral internal implants. METHODS: The clinical data of 55 KOA patients who met the selection criteria between July 2021 and October 2023 were retrospectively analyzed. Among them, 26 cases combined with femoral implants were treated with digital 3D printing osteotomy guide plate assisted TKA (guide plate group), and 29 cases were treated with conventional TKA (control group). There was no significant difference in gender, age, body mass index, side, Kellgren-Lawrence classification, preoperative visual analogue scale (VAS) score, Hospital for Special Surgery (HSS) knee score, knee range of motion, and other baseline data between the two groups ( P>0.05). The operation time, intraoperative blood loss, incision length, postoperative first ambulation time, surgical complications; VAS score, knee HSS score, knee range of motion before operation, at 1 week and 3 months after operation, and at last follow-up; distal femoral lateral angle, proximal tibial medial angle, hip-knee-ankle angle and other imaging indicators at last follow-up were recorded and compared between the two groups. RESULTS: The operation time, incision length, intraoperative blood loss, and postoperative first ambulation time in the guide plate group were significantly lower than those in the control group ( P<0.05). In the control group, there were 1 case of incision rupture and bleeding and 1 case of lower limb intermuscular venous thrombosis, which was cured after symptomatic treatment. There was no complication such as neurovascular injury, incision infection, or knee prosthesis loosening in both groups. Patients in both groups were followed up 12-26 months, with an average of 16.25 months. The VAS score, HSS score, and knee range of motion improved at each time point after operation in both groups, and further improved with time after operation, the differences were significant ( P<0.05). The above indicators in the guide plate group were significantly better than those in the control group at 1 week and 3 months after operation ( P<0.05), and there was no significant difference between the two groups at last follow-up ( P>0.05). At last follow-up, the distal femoral lateral angle, the proximal tibial medial angle, and the hip-knee-ankle angle in the guide plate group were significantly better than those in the control group ( P<0.05). CONCLUSION The application of digital 3D printing osteotomy guide plate assisted TKA in the treatment of KOA patients with femoral implants can simplify the surgical procedures, overcome limitations of conventional osteotomy guides, reduce surgical trauma, achieve individualized and precise osteotomy, and effectively restore lower limb alignment and knee joint function.
Humans ; Arthroplasty, Replacement, Knee/instrumentation* ; Osteoarthritis, Knee/surgery* ; Osteotomy/instrumentation* ; Male ; Retrospective Studies ; Female ; Printing, Three-Dimensional ; Femur/surgery* ; Middle Aged ; Bone Plates ; Range of Motion, Articular ; Aged ; Treatment Outcome ; Surgery, Computer-Assisted/methods* ; Knee Prosthesis ; Knee Joint/surgery* ; Operative Time

Objective:To translate the Nurse Delirium Care Competency Scale (NDCCS) into Chinese and test the validity and reliability of Chinese version of NDCCS among ICU nurses.Methods:According to Brislin translation model, the Chinese version of NDCCS was developed by forward translation, back translation, cross-cultural adaptation and pre-survey. From October to December of 2023, 338 ICU nurses from Sir Run Run Shaw Hospital, Zhejiang University School of Medicine were selected by cross-sectional survey to test the reliability and validity of Chinese version of NDCCS.Results:A total of 329 valid questionnaires were collected. There were 50 males and 279 females, aged 20-53 years old. The Chinese version of NDCCS included 6 dimensions and 27 items. The scale-level content validity value was 0.985, and the item-level content validity value was 0.800-1.000. Exploratory factor analysis showed a six-factor structure, the cumulative variance contribution rate was 75.700%, the Cronbach′s α coefficients of the scale amount table were 0.952, and the Cronbach′s α coefficients of the dimensions were 0.811- 0.936,and the retest reliability was 0.932.Conclusions:The Chinese version of the NDCCS has good reliability and validity, and it is suitable for assessing the delirium care competence of ICU nurses in China.

Objective Comparative analysis of rule categories,key audit behaviors,and the degree of correspon-dence between rules and behaviors through intelligent auditing of key audit violations and monitoring of the rule base.To provide reference for the improvement of intelligent audit and monitoring rule library for key audit violations under DRG payment in medical insurance fund.Methods Searching and collecting policy documents such as DRG payment management methods issued by local health insurance bureaus from May 20,2019 to December 31,2023 and the literature related to DRG payment smart audit monitoring rules in the database,and targeting the rules therein that are related to the focus on auditing irregularities under the DRG payment.Literature analysis and comparative analysis were used to summarize and analyze the rules related to key audit violations under DRG payment.Results The intelli-gent audit rules for key audit violations under DRG payment can be divided into two major categories:logical judg-ment and parameter index,and the degree of correspondence between audit rules and key audit behaviors varies.Conclusion(1)Unify the key audit rules nationwide to ensure the universality and comprehensiveness of the rules;(2)Deepen the current situation of regional illegal activities and strengthen local characteristics;(3)Improve the quality of logical judgment rules and increase the quantity of parameter indicator rules;(4)Strengthen scientific re-search on new types of violations,and establish more targeted regulatory rules.

Objective Comparative analysis of rule categories,key audit behaviors,and the degree of correspon-dence between rules and behaviors through intelligent auditing of key audit violations and monitoring of the rule base.To provide reference for the improvement of intelligent audit and monitoring rule library for key audit violations under DRG payment in medical insurance fund.Methods Searching and collecting policy documents such as DRG payment management methods issued by local health insurance bureaus from May 20,2019 to December 31,2023 and the literature related to DRG payment smart audit monitoring rules in the database,and targeting the rules therein that are related to the focus on auditing irregularities under the DRG payment.Literature analysis and comparative analysis were used to summarize and analyze the rules related to key audit violations under DRG payment.Results The intelli-gent audit rules for key audit violations under DRG payment can be divided into two major categories:logical judg-ment and parameter index,and the degree of correspondence between audit rules and key audit behaviors varies.Conclusion(1)Unify the key audit rules nationwide to ensure the universality and comprehensiveness of the rules;(2)Deepen the current situation of regional illegal activities and strengthen local characteristics;(3)Improve the quality of logical judgment rules and increase the quantity of parameter indicator rules;(4)Strengthen scientific re-search on new types of violations,and establish more targeted regulatory rules.

Objective:To optimize the accuracy of the intelligent hand hygiene system to monitor the hand hygiene timing warning, and provide a reference basis for healthcare workers to apply the intelligent hand hygiene system.Methods:Using a single-sample diagnostic pilot study method, 62 clinical nurses wearing smart badges working in the intensive care unit of Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine in Hangzhou, from December 1, 2020 to December 31, 2021 were selected by convenience sampling methods. Direct observation was used as the gold standard. The accuracy of the warning timing of the intelligent hand hygiene monitoring system was optimized through adjusting the bed sensing rang,adjusting the time setting, adjusting the time settings according to the physical space of the ward and adding posture recognition.Results:The sensitivity of adjusting the bed sensing range was 0.935 (95% CI 0.918-0.949); the specificity was 0.008 (95% CI 0.001-0.074). The sensitivity of the temporal setting based on the physical space of the ward was 0.932(95% CI 0.915-0.946); the specificity was 0.205 (95% CI 0.087-0.410). The false positive rate with gesture recognition turned on was 86.1% higher than the false positive rate without gesture recognition which was 79.5%. The diagnostic OR based on the temporal setting of the physical space of the ward was the largest at 3.517(95% CI 1.213-10.193). Conclusions:The intelligent hand hygiene system exhibits high accuracy in monitoring hand hygiene timing. Adjusting the bed sensing range and individualizing the timing settings according to the physical space of the ward can improve the accuracy. Further optimization is needed for posture recognition to improve the accuracy.

Objective:To explore the application effect of womb-like bird's nest nursing and parent-child kangaroo nursing model in the developmental care of premature infants.Methods:A total of 80 premature infants admitted to our hospital from Aug 2021 to Feb 2023 were selected and divided into the control group and the observation group by random number table method.A total of 40 premature infants in the control group received routine nursing,and 40 premature infants in the observation group received womb-like bird's nest nursing combined with parent-child kangaroo nursing model.Both groups received continuous nursing for 2 weeks.The physiological indexes,growth and development,feeding intolerance,and parental satisfaction were compared between the two groups.Results:The physiological indexes and growth and development of the observation group were better than those of the control group(P＜0.05).The incidence of feeding intolerance in the observation group was lower than that in the control group(P＜0.05).The score of parental satisfaction in the observation group was higher than that in the control group(P＜0.05).Conclusion:In the developmental care of premature infants,the combination of womb-like bird's nest nursing and parent-child kangaroo nursing model can improve the physiological indexes,promote the growth and development,and reduce the risk of feeding intolerance of premature infants,and thus improve the satisfaction of parents.

Objective:To evaluate the clinical efficacy of modified endoscopic mucosal resection (EMR) in the management of early gastrointestinal lesions.Methods:Upon endoscopic identification of the lesion, normal saline is injected into the submucosa to establish a fluid cushion, which elevates the lesion's mucosa. Methylene blue may also be applied to improve visualization of the relationship between the submucosa and muscular layer. A snare with a tip diameter of 2-3 mm is utilized to circumferentially incise the mucosal layer at the lesion's edge, forming a circular groove. The snare is anchored within this groove, allowing for complete resection of the lesion in a single step. The procedure involves a slow and alternating technique of electrosurgical cutting and coagulation to minimize bleeding risks, while upward tension on the snare during cutting reduces perforation risks. Direct coagulation of exposed blood vessels is performed using the snare tip, and hemostatic clips are applied to larger defects; nylon sutures may be utilized for substantial wounds.Results:Between June 2015 and April 2024, modified EMR was performed on 65 patients with early gastrointestinal lesions at Dongguan Children's Hospital, Guangdong Medical University. The mean operative time was (15.2 ± 3.1) minutes, with a complete resection rate of 100% and negative margins confirmed. Postoperative complications included one case each of delayed bleeding and electrosurgical syndrome. The average cost of consumables was (1887.2±187.6) yuan. Follow-up colonoscopies at 3 and 6 months postoperatively indicated no recurrences.Conclusions:Modified EMR demonstrates a short operative time, high safety and efficacy, and reduced material costs in the treatment of early gastrointestinal mucosal lesions.

Background::Carotid intima-media thickness (IMT) and diameter, stiffness, and wave reflections, are independent and important clinical biomarkers and risk predictors for cardiovascular diseases. The purpose of the present study was to establish nationwide reference values of carotid properties for healthy Chinese adults and to explore potential clinical determinants.Methods::A total of 3053 healthy Han Chinese adults (1922 women) aged 18-79 years were enrolled at 28 collaborating tertiary centers throughout China between April 2021 and July 2022. The real-time tracking of common carotid artery walls was achieved by the radio frequency (RF) ultrasound system. The IMT, diameter, compliance coefficient, β stiffness, local pulse wave velocity (PWV), local systolic blood pressure, augmented pressure (AP), and augmentation index (AIx) were then automatically measured and reported. Data were stratified by age groups and sex. The relationships between age and carotid property parameters were analyzed by Jonckheere-Terpstra test and simple linear regressions. The major clinical determinants of carotid properties were identified by Pearson’s correlation, multiple linear regression, and analyses of covariance.Results::All the parameters of carotid properties demonstrated significantly age-related trajectories. Women showed thinner IMT, smaller carotid diameter, larger AP, and AIx than men. The β stiffness and PWV were significantly higher in men than women before forties, but the differences reversed after that. The increase rate of carotid IMT (5.5 μm/year in women and 5.8 μm/year in men) and diameter (0.03 mm/year in both men and women) were similar between men and women. For the stiffness and wave reflections, women showed significantly larger age-related variations than men as demonstrated by steeper regression slopes (all P for age by sex interaction <0.05). The blood pressures, body mass index (BMI), and triglyceride levels were identified as major clinical determinants of carotid properties with adjustment of age and sex. Conclusions::The age- and sex-specific reference values of carotid properties measured by RF ultrasound for healthy Chinese adults were established. The blood pressures, BMI, and triglyceride levels should be considered for clinical application of corresponding reference values.

Objective Comparative analysis of rule categories,key audit behaviors,and the degree of correspon-dence between rules and behaviors through intelligent auditing of key audit violations and monitoring of the rule base.To provide reference for the improvement of intelligent audit and monitoring rule library for key audit violations under DRG payment in medical insurance fund.Methods Searching and collecting policy documents such as DRG payment management methods issued by local health insurance bureaus from May 20,2019 to December 31,2023 and the literature related to DRG payment smart audit monitoring rules in the database,and targeting the rules therein that are related to the focus on auditing irregularities under the DRG payment.Literature analysis and comparative analysis were used to summarize and analyze the rules related to key audit violations under DRG payment.Results The intelli-gent audit rules for key audit violations under DRG payment can be divided into two major categories:logical judg-ment and parameter index,and the degree of correspondence between audit rules and key audit behaviors varies.Conclusion(1)Unify the key audit rules nationwide to ensure the universality and comprehensiveness of the rules;(2)Deepen the current situation of regional illegal activities and strengthen local characteristics;(3)Improve the quality of logical judgment rules and increase the quantity of parameter indicator rules;(4)Strengthen scientific re-search on new types of violations,and establish more targeted regulatory rules.

Objective Comparative analysis of rule categories,key audit behaviors,and the degree of correspon-dence between rules and behaviors through intelligent auditing of key audit violations and monitoring of the rule base.To provide reference for the improvement of intelligent audit and monitoring rule library for key audit violations under DRG payment in medical insurance fund.Methods Searching and collecting policy documents such as DRG payment management methods issued by local health insurance bureaus from May 20,2019 to December 31,2023 and the literature related to DRG payment smart audit monitoring rules in the database,and targeting the rules therein that are related to the focus on auditing irregularities under the DRG payment.Literature analysis and comparative analysis were used to summarize and analyze the rules related to key audit violations under DRG payment.Results The intelli-gent audit rules for key audit violations under DRG payment can be divided into two major categories:logical judg-ment and parameter index,and the degree of correspondence between audit rules and key audit behaviors varies.Conclusion(1)Unify the key audit rules nationwide to ensure the universality and comprehensiveness of the rules;(2)Deepen the current situation of regional illegal activities and strengthen local characteristics;(3)Improve the quality of logical judgment rules and increase the quantity of parameter indicator rules;(4)Strengthen scientific re-search on new types of violations,and establish more targeted regulatory rules.