Objective To investigate the clinical significance of visual identification and intraoperative neuromonitoring of recurrent laryngeal nerve (RLN) during thyroidectomy. Methods Totally 1 664 patients underwent thyroidectomy with RLN protection from January 2009 to December 2009 were included in this study, in which 1 447 cases were protected by visual identification only, and 217 complex thyroidectomy cases were protected by visual identification and intraoperative monitoring. Results By the “multisites, three steps” RLN exposure method, 1 417 cases （85.16%） were successfully recognized and the recognition time was (3.57±1.26) min. The recognition time in the rest 30 complex cases (2.07%) without intraoperative neuromonitoring was (17.02±5.48) min. By this method, the temporary RLN injury occurred in 23 cases (1.54%) and 15 cases (65.22%) recovered within 2 weeks. In patients undewent intraoperative neuromonitoring, the recognition rate was 100% (217/217) and recognition time was (2.18±0.67) min. The temporary RLN injury occurred in 4 cases (1.84%) and 3 cases (75.00%) recovered within 2 weeks. All temporary RLN injuries recovered within 1 month and no persistent RLN injury occurred. Conclusions Conventional visual identification can reduce the RLN injury, but not meet the needs of the RLN protection during complex thyroidectomy. The combination of visual identification and intraoperative neuromonitoring can further improve the recognition rate and shorten the recovery time of vocal cord dyskinesia.
Objective To propose a lightweight end-to-end neural network model for automated Korotkoff sound phase recognition and subsequent blood pressure (BP) measurement, aiming to improve measurement accuracy and population adaptability. Methods We developed a streamlined architecture integrating depthwise separable convolution (DSConv), multi-head attention (MHA), and bidirectional gated recurrent unit (BiGRU). The model directly processes Korotkoff sound time-series signals to identify auscultatory phases. Systolic BP (SBP) and diastolic BP (DBP) were determined using Phase Ⅰ and PhaseⅤdetections, respectively. Given the clinical relevance of phase Ⅳ for specific populations (e.g., children and pregnant women, denoted as DBPIV), BP values from this phase were also recorded. Results The study enrolled 106 volunteers with 70 males, 36 females at mean age of (40.0±12.0) years. The model achieved 94.25% phase recognition accuracy. Measurement errors were (0.1±2.5) mm Hg (SBP), (0.9±3.4) mm Hg (DBPIV), and (0.8±2.6) mm Hg (DBP). Conclusion Our method enables precise phase recognition and BP measurement, demonstrating potential for developing population-adaptive blood pressure monitoring systems.
ObjectiveTo explore the feasibility of organoid culture derived from the patients with gastric cancer by suspension culture. MethodsThe fresh gastric cancer tissues of the 3 patients with gastric cancer were selected, which were digested with mixed enzymes and then made into cell suspensions, and were inoculated into ultra-low attachment plates to culture organoid by suspension. When the organoid growth was dense, the passage and freezing were carried out. The formation process of organoid was observed under the inverted microscope (IM). Further the consistency between the organoid and primary gastric cancer tissue was evaluated by hematoxylin-eosin (HE) and immunohistochemical (IHC) staining. ResultsIn this study, an organoid that could be passaged and frozen was successfully established in one patient. The results under the IM showed that the organoid was initially spherical in shape (cultured on day 5), then gradually became short rod-shaped on day 10, showed a branching like change on day 15, and formed irregular glandular tubular structures on day 20. The structures between the organoids and primary gastric cancer tissues were highly similar by HE staining. The IHC staining results showed that the expressions of low molecular weight cytokeratin (CK-LMW), p53, and Ki67 in the organoid and its corresponding primary gastric cancer tissue were basically the same. That was, the CK-LMW and p53 expressions were positive in the organoid and primary gastric cancer tissue, and the Ki67 was highly expressed (with a positive rate of approximately 70%). ConclusionBased on the preliminary research results of this study, it suggests that the suspension culture can be used to establish organoid derived from patients with gastric cancer, which is in accordance with primary tumor tissue at the tissue and cellular levels.
ObjectiveTo investigate the status of knowledge, attitude, and practice of patient identification in nurses, and provide a basis for clinical managers to carry out targeted training.MethodsA total of 3 696 nurses of tertiary, secondary, and primary hospitals in Guizhou Province were recruited and investigated for the status of knowledge, attitude, and practice of patient identification with a questionnaire by using convenient sampling in May 2019.ResultsThe scores of identification knowledge, attitude, and practice of the 3 696 nurses were 47.87±6.10, 27.39±3.15, and 57.19±4.86, respectively. Logistic regression analysis showed that the higher the educational level was, the higher the score of nurses’ knowledge of patient identification was [odds ratio (OR)=1.592, 95% confidence interval (CI) (1.084, 2.338), P=0.018]; the higher the personal monthly income was, the more positive the nurses’ attitude towards patient identification was [OR=1.570, 95%CI (1.005, 2.453), P=0.048].ConclusionsThe general situation of patient identification in nurses is good, but there are still differences among nurses with different characteristics. It is suggested that managers should pay special attention to the training of nurses with low educational level and low income, make them master the knowledge of patient identification, at the same time, improve their enthusiasm and standardize their behavior, so as to ensure the safety of patients.
ObjectiveTo introduce a new method for identifying intersegmental planes during thoracoscopic segmentectomy using pulmonary circulation single-blocking in the target segment. MethodsTo retrospectively analyze the clinical data of 83 patients who underwent thoracoscopic pulmonary segmentectomy from January 2019 to March 2020 using the pulmonary circulation single-blocking method. There were 33 males and 50 females, with a median age of 54 (46-65) years, and they were divided into a single vein group (SVG, n=31) and a single artery group (SAG, n=52), and the clinical data of two groups were compared. ResultsThe intersegmental planes were identified successfully in both groups and there were no statistically significant differences between the two groups in terms of intersegmental plane management (P=0.823), operating time (P=0.786), intraoperative blood loss (P=0.775), chest drainage time (P=0.659), postoperative hospital stay (P=0.824) or the incidence of postoperative complications (P=1.000). ConclusionThe use of pulmonary circulation single-blocking for intersegmental plane identification during thoracoscopic segmentectomy is safe and feasible, and the intersegmental plane can be satisfactorily identified by the single-blocking of arteries or veins.
Carbapenemase producing Enterobacteriaceae (CPE) has emerged as a significant global public health challenge and placing infected patients at risk of potentially untreatable infections. When resistance to carbapenems occurs, there are often few alternative treatments available. Numerous international guidelines have performed systematic and evidence review to identify new strategies to prevent the entry and spread of CPE in healthcare settings. Several key strategies have been shown to be highly effective. Firstly a new strategy that is proven to be effective is the early identification of the CPE carrier patients through active surveillance cultures. While waiting for the screening results, suspected CPE carriers will be put on preemptive isolation in single room and healthcare worker will at the same time practice contact precautions. The active surveillance culture and prompt preemptive isolation will limit the entry and spread of CPE from getting into hospital. Secondly, it is of utmost importance to incorporate enforcement of the basic infection prevention and control best practices in the hospital including, full compliance to hand hygiene, appropriate use of personal protective equipment, execute antibiotic stewardship program to control abuse of antibiotics, effective environmental cleaning and decontamination, staff education and feedback, as well as surveillance of healthcare-associated infections. Such a holistic approach has been shown to be effective in inhibiting CPE from gaining foothold in the hospital.
In this paper, the research has been conducted by the Microsoft kinect for windows v2 for obtaining the walking trajectory data from hemiplegic patients, based on which we achieved automatic identification of the hemiplegic gait and sorted the significance of identified features. First of all, the experimental group and two control groups were set up in the study. The three groups of subjects respectively completed the prescribed standard movements according to the requirements. The walking track data of the subjects were obtained straightaway by Kinect, from which the gait identification features were extracted: the moving range of pace, stride and center of mass (up and down/left and right). Then, the bayesian classification algorithm was utilized to classify the sample set of these features so as to automatically recognize the hemiplegia gait. Finally, the random forest algorithm was used to identify the significance of each feature, providing references for the diagnose of disease by ranking the importance of each feature. This thesis states that the accuracy of classification approach based on bayesian algorithm reaches 96%; the sequence of significance based on the random forest algorithm is step speed, stride, left-right moving distance of the center of mass, and up-down moving distance of the center of mass. The combination of step speed and stride, and the combination of step speed and center of mass moving distance are important reference for analyzing and diagnosing of the hemiplegia gait. The results may provide creative mind and new references for the intelligent diagnosis of hemiplegia gait.
Acute respiratory distress syndrome (ARDS) is a serious threat to human life and health disease, with acute onset and high mortality. The current diagnosis of the disease depends on blood gas analysis results, while calculating the oxygenation index. However, blood gas analysis is an invasive operation, and can’t continuously monitor the development of the disease. In response to the above problems, in this study, we proposed a new algorithm for identifying the severity of ARDS disease. Based on a variety of non-invasive physiological parameters of patients, combined with feature selection techniques, this paper sorts the importance of various physiological parameters. The cross-validation technique was used to evaluate the identification performance. The classification results of four supervised learning algorithms using neural network, logistic regression, AdaBoost and Bagging were compared under different feature subsets. The optimal feature subset and classification algorithm are comprehensively selected by the sensitivity, specificity, accuracy and area under curve (AUC) of different algorithms under different feature subsets. We use four supervised learning algorithms to distinguish the severity of ARDS (P/F ≤ 300). The performance of the algorithm is evaluated according to AUC. When AdaBoost uses 20 features, AUC = 0.832 1, the accuracy is 74.82%, and the optimal AUC is obtained. The performance of the algorithm is evaluated according to the number of features. When using 2 features, Bagging has AUC = 0.819 4 and the accuracy is 73.01%. Compared with traditional methods, this method has the advantage of continuously monitoring the development of patients with ARDS and providing medical staff with auxiliary diagnosis suggestions.
Objective To establish a simple and efficient method to isolate and culture the umbilical vein vascular endothelial cells in canine. Methods Twelve umbilical cords [(13.0 ± 1.5) cm in length] were taken from 12 newborn pups of Beagles. And then the vascular endothelial cells were isolated from these umbilical cords digested by 1% collagenase type I for 5, 7, and 10 minutes respectively (4 umbilical cords in each group). After cultured, the vascular endothelial cells were identified by morphology, immunofluorescence, and flow cytometry. And the growth curvature of umbilical vein vascular endothelial cells was detected by MTT assay. Results Few vascular endothelial cells were collected at 5 and 10 minutes after digestion; many vascular endothelial cells were seen at 7 minutes, and became cobblestone with culture time, with a large nucleus; after passage, cell morphology had no obvious change. Fluorescence microscope results showed that positive von Willebrand factor (vWF) and CD31 cells were observed in most of cells. The flow cytometry test displayed that the positive cell rates of vWF and CD31 were 99.0% ± 0.7% and 98.0% ± 1.2%, respectively. The above results indicated that cultured cells were vascular endothelial cells. MTT assay showed that vascular endothelial cells proliferation increased significantly with culture time. Conclusion Enzyme digestion is a convenient method to isolate vascular endothelial cells from canine umbilical vein, and a large number of cells and high purity of cells can be obtained by the method.
ObjectiveTo explore value of ultrasound real-time elastography (RTE) technology for identification of benign and malignant solid thyroid nodules.MethodsA retrospective analysis was performed on 125 patients with thyroid nodules who underwent ultrasound RTE in this hospital from February 2018 to August 2019. All patients underwent RTE on the basis of conventional ultrasound. The ultrasound elasticity contrast index (ECI) was used as the evaluation index and the pathological examination result was used as the gold standard. The receiver operating characteristic (ROC) curve analysis was used to evaluate the value of ECI in the identification of benign and malignant solid thyroid nodules. Logistic regression analysis was used to analyze the influencing factors of ECI.ResultsAmong the 125 patients with solid thyroid nodules, 51 were malignant nodules, 74 were benign nodules. The ECI value of patients with benign thyroid nodules was lower than that of patients with malignant nodules (2.71±0.83 versus 3.42±1.14, t=–4.030, P<0.001). The result of ROC analysis showed that the cutoff value of ECI to distinguish benign and malignant solid thyroid nodules was 3.07, area under curve of ROC was 0.806 [95%CI (0.717, 0.894), P<0.001], sensitivity was 80.3%, specificity was 70.4%. The multivariate logistic regression analysis showed that the thyroid nodules with diffuse lesions, calcification, and maximum nodule diameter ≥1 cm were the risk factors for elevated ECI values (P<0.05). For the solid thyroid nodules without diffuse lesions, without calcification, and maximum nodule diameter <1 cm, ECI had the higher sensitivity, specificity, accuracy, and positive predictive value for the differential diagnosis of benign and malignant thyroid nodules (all exceed 80%), but these indexes were lower (under 60%) for the differential diagnosis of solid thyroid nodules with diffuse diseases, with calcification, and maximum nodule diameter ≥1 cm.ConclusionsECI obtained by ultrasound RTE can be used to differentiate solid thyroid nodules from benign ones. The presence or absence of diffuse lesions, calcification, and maximum nodule diameter are the influencing factors for ECI to differentiate solid thyroid nodules. In clinical diagnosis, it should be paid attention to the comprehensive analysis of the above factors.