Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Background With economic development and globalization, shift work has become prevalent across industries. Its relationship with type 2 diabetes mellitus (T2DM) attracts increasing attention. Objective To thoroughly explore the relationship between shift work and T2DM, and analyze the impacts of specific shift patterns on T2DM, so as to provide a basis for formulating reasonable shift schedules. Methods We conducted a 1:2 matched case-control study among adults (20-60 years) who ordered occupational health examinations at the Wuxi No.8 People's Hospital from November to December 2023. The case group comprised 200 T2DM patients, while the controls were 400 age-stratified matched non-diabetic individuals. General demographic characteristics, behavioral habits, medical history, and shift work exposure data (including shift patterns, frequency, and length of service) 5 years prior to diagnosis were collected through standardized questionnaires. Logistic regression adjusted for selected confounders was employed to evaluate the association between shift work and T2DM. Results The logistic regression analysis demonstrated that shift work was associated with an increased risk of T2DM. After adjusting for confounding factors, shift workers had a 3.55 times higher risk of being diagnosed T2DM compared to non-shift workers (OR=3.55, 95%CI: 1.026, 12.263). The risk varied across different shift patterns, and the three-shift two-rotation system showed the highest risk (OR=4.17, 95%CI: 1.921, 9.035), followed by the two-shift system (OR=2.94, 95%CI: 2.016, 4.281) and four-shift three-rotation system (OR=2.66, 95%CI: 1.611, 6.093). Workers with more than 3 monthly shift days had a 2.74-fold increased risk (95%CI: 1.658, 4.512) compared to non-shift workers. Additionally, working more than 8 h daily (OR=1.74, 95%CI: 1.185, 2.562) and having more than 20 years of service (OR=2.51, 95%CI: 1.581, 3.976) were both significantly associated with a higher T2DM risk. The trend tests revealed that each incremental increase in monthly shift days and length of service elevated T2DM risk by 2.61 times (95%CI: 1.813, 3.765) and 1.49 times (95%CI: 1.147, 1.931), respectively (P<0.05). Conclusion Shift work is an independent risk factor for T2DM, with three-shift two-rotation system posing the highest risk. Shift frequency, daily working hours, and length of service are all significant factors affecting the risk of T2DM. These findings support industry-specific shift policy reform and targeted glucose monitoring and health interventions are recommended for workers engaged in high-risk shift patterns (e.g., three-shift two-rotation system, frequent shifts) and those with prolonged shift work history (>20 years).

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To summarize the clinical characteristics and prognosis of acute hyperextension spinal cord injury (SCI) in children, and to provide some recommendations for the treatment and prevention of this disease.Methods:Reviewed the data of children of SCI after sustained or repeated hyperextension of the spine at Wuhan Union Hospital and Wuhan Children's Hospital from September 2010 to September 2020. According to the American Spinal Injury Association impairment scale (AIS grade), the patients were divided into complete SCI group and incomplete SCI group. The age, symptoms and evolution after injury, neurological level of injury, imaging data, laboratory examination data, prognosis and complications of the two groups were analyzed. Retrospectively summarize the characteristics of this type of injury.Results:Forty-four cases of acute hyperextension SCI in children were included. Their age ranged from 3 to 10 years old, 95% of them were under 8 years old and 95% of them were female. There was no significant difference in age at injury and time of dance training between children with complete SCI and incomplete SCI. Back and leg pain, lower limb weakness or paresthesia, and rapidly progress to complete or incomplete SCI in a short period were typical symptoms. All blood test results anddiagnostic analysis of cerebrospinal fluid were unremarkable or negative. There was no fracture or dislocation in the whole spine. Magnetic resonance imaging showed a longitudinally extended intramedullary high-intensity signal in the thoracolumbar spinal cord. Complete SCI accounted for 60% of all cases, and the prognosis was poor with spinal cord atrophy and various complications.Conclusion:Children younger than 10 years old after sustained or repeated hyperextension of the spine may suffer acute hyperextension SCI. Children with complete SCI have poor prognosis and serious complications. Therefore, prevention of this type of injury is the best strategy.

Objective:To explore the safety and efficacy of the minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire and 3D-printed external template technique.Methods:A retrospective study was conducted of the clinical data of 21 patients with unstable pelvic fracture who had undergone minimally invasive treatment at Department of Orthopaedics, Union Hospital from May 2016 to July 2018 using 3D-printed external templates and the blunt head technique of Kirschner wire. There were 7 males and 14 females with an age of 43.6 years (from 19 to 65 years). According to the Tile classification, there were 3 cases of B1, 7 ones of B2, 6 ones of C1 and 5 ones of C2. The intraoperative fluoroscopy, operation time, postoperative fracture reduction and functional recovery of the pelvis at the last follow-up were recorded.Results:The 21 patients were followed up for an average of 16.3 months (from 12 to 24 months). A total of 33 wires were inserted in the 21 patients, including 15 S 1 ones and 18 S 2 ones. The intraoperative fluoroscopy ranged from 13 to 27 times, averaging 21.8 times. The operation time ranged from 65 to 130 min, averaging 88.6 min. The anterior subcutaneous internal fixation was used to fix the anterior ring in 9 patients. No vascular injury occurred during the operation. By the Matta criteria, the postoperative fracture reduction was assessed as excellent in 14 cases, good in 5, and fair in 2, giving an excellent to good rate of 90.5% (19/21). By the Majeed scoring system, the pelvic function at the last follow-up was assessed as excellent in 10 cases, good in 8, and fair in 3, giving an excellent to good rate of 85.7% (18/21). Lateral femoral cutaneous nerve injury occurred in 2 patients but was recovered by the 3-month follow-up. No other complications were follwed up. Conclusion:The minimally invasive treatment of unstable pelvic fractures with the blunt head technique of Kirschner wire assissted by 3D-printed external templates is safe and effective, showing advatages of reduced fluoroscopic frequency and operation time.

Objective:To investigate the advantages and disadvantages and clinical effects of integrated acetabular quadrilateral surface buttress plate in the treatment of acetabular both column fractures.Methods:From September 2017 to March 2019, 14 patients with acetabular both column fractures were treated with integrated quadrilateral acetabular buttress plate and were followed up. The clinical data were retrospectively analyzed. There were 10 males and 4 females with an average age of 53.2 years (range, 26-75 years). Fracture classification were both column fractures according to the Letournel-Judet classification system, including 11 cases of combined posterior wall without posterior dislocation. The time from injury to operation was 8-19 days, with an average of 10.3 days. All operations were performed with a supra-ilioinguinal approach. After satisfactory reduction, the integrated acetabular quadrilateral surface buttress plate was used to fix the anterior and posterior column and quadrilateral fractures at the same time. After operation, Matta criteria was used to evaluate the quality of fracture reduction on postoperative images, and modified Merle d'Aubigné-Postel score to evaluate hip joint function.Results:The average operation time was 180 min (range, 120-320 min), and the intraoperative average blood loss was 980 ml (range, 700-1 600 ml). Operations were performed successfully with none intraoperative reshaping conducted, and the plate could fit into the bone surface well. All 14 patients were followed up with an average of 15.6 months (range, 9-20 months). During the follow-up, all fractures healed with an average of 3 months (range, 2.5-5 months). The reduction quality evaluated by the Matta criteria were 7 anatomical, 5 satisfactory, and 2 unsatisfactory, with an excellent and good rate of 85.7% (12/14). The hip joint function at the last follow-up was in accordance with the modified Merle d'Aubigné-Postel score was 12-18 points, with an average of 16.9 points, of which 8 excellent, 4 good, and 2 fair. The excellent and good function rate was 85.7% (12/14). During the operation, 1 patient had a rupture of about 1 cm of the peritoneum during the separation of the spermatic cord, which was immediately sutured and repaired. One patient had obturator nerve paralysis after the operation, without special treatment, and the paralysis symptoms were relieved during the 6th-month follow-up. There were no other operation-related complications.Conclusion:For both-column fractures characterized by central dislocation of the femoral head, the integrated acetabular quadrilateral buttress plate can simultaneously fix the anterior and posterior columns and quadrilateral surface at the same time. Satisfactory reduction and functional outcomes could be achieved by the novel plates.

Objective:To explore the feasibility, safety and clinical efficacy of using the self-developed acetabular posterior wall and column integrative anatomical plate to treat various types of posterior wall/column fractures.Methods:Between January 2016 and January 2019, 21 patients involving acetabular posterior wall and/or column were treated with the novel acetabular posterior wall and column integrative plate, the data were collected and retrospectively analyzed. There were 11 males and 10 females, with an average of 48 years old (range, 18-65 years old). According to the classification of AO/OTA, there were 6 simple fractures, 9 comminuted fractures, and 6 associated with joint surface compression of posterior wall; and there were 16 simple acetabular posterior wall fractures and 5 cases associated with acetabular posterior column fractures. Before operation, the CT data of each patient was collected and imported into Mimics software to reconstruct and print a 3D model of pelvis and injured and mirrored side to simulate operation. All patients were treated with a single Kocher-Langenbeck approach for posterior acetabular fractures, and fixed with the novel integrated anatomical plate after satisfactory reduction was achieved. Matta score was used to evaluate the quality of fracture reduction, and the modified Merle D'Aubigné-Postel score was adopted to evaluate functional recovery of hip joint.Results:21 patients involved in this study, the average time of plate insertion after successful reduction was 20 min (range, 15-30 min); the mean time of operation was 180 min (range, 90-300 min); the intraoperative mean bleeding volume was 700 ml (range, 300-1 500 ml). All the incisions healed by level 1 classification, and no incisions infection and sciatic nerve injury occurred. The patients included in the study have been followed up for at least one year and the imaging data was intact, the mean follow-up time was 19 month (range, 12-26 month). The fracture reduction was evaluated according to the Matta score: 16 cases were anatomical reduction, 3 cases were satisfactory reduction, 2 cases were unsatisfactory reduction, the satisfactory rate of reduction was 90.5% (19/21); the modified Merle D'Aubigné-Postel score at 3 month was 13.0±2.2 (range, 9-16), 6 month was 15.8±2.4 (range, 10-18) and last follow up was 17.0±1.8 (range, 13-18), respectively; the difference was statistically significant ( F=15.38, P < 0.001). At the last follow-up, 15 cases were excellent, 3 cases were good and 3 cases were fair, the total excellent and good rate was 85.7% (18/21). One case developed symptoms of sciatic nerve injury after operation, but the symptoms resolved after treating with neurotrophic drug by 6 months. 2 cases developed arthritis related pain after operation, receiving symptomatic treatment with oral painkillers. During the follow-up period, no complications such as plate broken and screw loosen occurred. Conclusion:The use of an integrative anatomical plate for treating posterior wall/column fractures of acetabulum achieved satisfactory fixation and postoperative functional recovery.

Objective To investigate the influence of job burnout on sleep quality of oilfield workers.Methods In January to August,2014,the Chinese Maslach Burnout Inventory (CMBI) and Pittsburgh Sleep Quality Index(PSQI) were used to conduct investigation on job burnout and sleep quality in 1180 oilfield workers.Results The scores on each subscale of CMBI showed significant differences between workers with different characteristics(marital status,working years,educational background,and type of work)(P＜0.05).The global PSQI score for oilfield workers was 5.55±3.26,which was significantly higher than the national norm (3.88±2.52)(P＜ 0.05),and the incidence of issues related to sleep quality was 32.54％.The PSQI score showed significant differences between workers with different characteristics (sex and working years)(P＜0.05).The multivariate logistic regression analysis showed that working years,sex,emotional exhaustion,and depersonalization were the major factors affecting sleep quality,and the workers with long working years,male workers with job burnout,and oilfield workers with issues related to sleep quality tend to have a high incidence of issues related to sleep quality.Conclusion Job burnout is the major factor influencing the sleep quality of oilfield workers,and reducing job burnout of such workers is an effective way to improve sleep quality.

Objective To investigate the influence of job burnout on sleep quality of oilfield workers.Methods In January to August,2014,the Chinese Maslach Burnout Inventory (CMBI) and Pittsburgh Sleep Quality Index(PSQI) were used to conduct investigation on job burnout and sleep quality in 1180 oilfield workers.Results The scores on each subscale of CMBI showed significant differences between workers with different characteristics(marital status,working years,educational background,and type of work)(P＜0.05).The global PSQI score for oilfield workers was 5.55±3.26,which was significantly higher than the national norm (3.88±2.52)(P＜ 0.05),and the incidence of issues related to sleep quality was 32.54％.The PSQI score showed significant differences between workers with different characteristics (sex and working years)(P＜0.05).The multivariate logistic regression analysis showed that working years,sex,emotional exhaustion,and depersonalization were the major factors affecting sleep quality,and the workers with long working years,male workers with job burnout,and oilfield workers with issues related to sleep quality tend to have a high incidence of issues related to sleep quality.Conclusion Job burnout is the major factor influencing the sleep quality of oilfield workers,and reducing job burnout of such workers is an effective way to improve sleep quality.

Objective To assess the safety and effectiveness of robotic-assisted laparoscopic radical cystcctomy and urinary diversion in the treatment of bladder cancer.Methods We collected the clinical data of one patient with bladder cancer who underwent RCRA with ileal neobladder from the Second Artillery General Hospital in Beijing on March,2010.Literature on this topic was analyzed.Results ( 1 ) Tbc operation duration of this procedure was 540 mins.The intra-operative blood loss was 200 ml,and no blood transfusion was needed.Postoperative pathologic examination indicated low-grade infiltrative urothelial carcinoma.The patient exhausted on the 3th post-operative day,had off-bed activities on the 4th post-operative day,and was discharged on the 28th post-operative day.(2) There were more than 400 patients underwent RARC worldwide.The RARC group had marginally lower complications rate (31％ vs.28％ ) and numbers of lymph node dissection ( 18.2 vs.13.0) than the LCR group.There were significant differences in the duration of operation (285.7 mins vs.372.0 mins),intraoperatie blood loss ( 286 ml vs.556.0 ml) and mean days of hospitalization ( 8.6 d vs.13.0 d) between the RARCA and the LCR groups.Conclusion RARC is a novel and effective procedure for the treatment of bladder cancer.As there is only a relatively small sample around the world and little experience on this procedure can be referred,more clinical practice with RARC and high quality research with long-term follow-up are needed to update the database and evaluate its effectiveness and safety.