According to a guideline on promoting the high-quality development of public hospitals issued by the General Office of the State Council and a guideline on accelerating the development of medical rehabilitation, a high-quality and efficient rehabilitation system should be established, and efforts should be made to promote the high-quality development of rehabilitation services in public hospitals. We propose an action guideline for promoting the high-quality development of rehabilitation services in public hospitals, which is based on a Delphi method questionnaire on the opinions of front-line clinical rehabilitation experts, and integrated with relevant literature and evidences. This guideline introduces 31 specific action plans from 7 dimensions, including standardization of basic rehabilitation settings, standardization of clinical rehabilitation techniques, improvement of the tertiary rehabilitation system, standardization of emergency rehabilitation, standardization of rehabilitation education, standardization of rehabilitation management, and promotion of scientific and technological innovation in rehabilitation medicine.
The prevalence of developmental delay (DD) in children worldwide is still on the rise, and its causes are complex and diverse, causing varying degrees of impact on the development of the sensory nervous system in the brain of children. Sensory integration training is a treatment method that applies sensory stimulation and comprehensive activities. It is currently widely used in children with DD. This therapy can effectively improve the development and integration of the sensory system in children with DD. It also enhances the individual’s ability to adapt to external stimuli, promoting their development in language, motor, and cognitive functions. This article explores the relevant mechanisms of sensory integration training and DD, as well as the current status and effects of its application in DD children, in order to promote the development and progress of related research fields.
Severe psychomotor developmental delay resulting from early postnatal (within 3 months) seizures can be diagnosed as Early-Infantile Developmental and Epileptic encephalopathies (EIDEE). Its primary etiologies include structural, hereditary, metabolic and etc. The main pathogenesis may be related to the inhibition of normal physiological activity of the brain by abnormal electrical activity and the damage of the brain neural network. Ohtahara syndrome and Early Myoclonic Encephalopathy (EME) are typical types of EIDEE. The principle of treatment is to improve the cognitive and developmental function by controlling frequent seizures. When the seizure is difficult to control with drugs, surgical evaluation should be performed as soon as possible, and surgical treatment is the first choice for patients suitable for surgery. The types of surgery can be divided into excision surgery, dissociation surgery, neuromodulation surgery and etc. The current status of surgical treatment of EIDEE was described, and the curative effect of surgical treatment was explored, so as to help clinicians choose appropriate treatment methods.
Abstract From 1980 to 1985, 21 cases of free transplantation of fibula were performed. There were 6 children in this series, and 4 children were followed up for 9 to 12 years (average 10 years). The Xray showed that distal epiphysis of tibia had a normal width at the medial side and gradully tapered toward the lateral side in a "wedgeshaped" apperance. The articular space of the tibiotalar joint inclined to the fibularside. The hight of the talus was higher laterally, leading to eversion deformity of the ankle joint. The medial and lateral malleoli were smaller than normal, and thus the ankle joint mortise became shallow. The trabeculae of the tibia were irregularly arranged. The lateral cortex of the tibia was thicker than that of the medial one. In one case, the bone density of the lateral side of the "wedgeshaped" epiphysis had increased as high as that ofthe cortex with disappearance of trabeculae. The biomechanics of fibular boneand the mechanism of development of disturbance of ankle joint in childhood were analyzed. Close attention should be paid to this disturbance.
Objective To investigate the spatial and temporal regulation effect of VEGF on human fetal retinal vascularization and angiogenesis. Methods The posterior segmental retinas from 54 human fetuses of the 9th week to the 40th week were studied by immunohistodhemistry standing for the expressions of VEGF and PCNA. Results 1. The distribution of VEGF espression was spiking and the peaks were during the 9th-13th and around the 26th week. 2. PCNA immunoreactivity was localized in spindle cells and vascular endothelial cells. The expression level was fluctuated during the developmental process. The peaks were during the 9th-13th and around the 21st week. In these periods, the spindle cells kept proliferating and differentiating, and remodelled subsequently to form the inner side retinal vessels. From the 26th or 34th week, the PCNA immununoreactivity is fully expressed in the vascular endothelial cells of the inner and outer margin of inner nuclear layer(INL) and kept to full terms. 3. Significant positive correlation were shown between the content of VEGF in the retina and that of PCNA in spindle cells and vascular endothelial cells(r=0.736,p＜0.01). Conclusion VEGF was positively involved in modulating human fetal retinal vascularization and angiogenesis. (Chin J Ocul Fundus Dis,1999,15:12-15)
Objective To summarize the biomechanical characteristics, diagnosis, and hip arthroscopic treatment of borderline developmental dysplasia of hip (BDDH) with Cam-type femoroacetabular impingement (Cam FAI). Methods The literature on BDDH with Cam FAI at home and abroad in recent years was extensively reviewed and analyzed. Results In patients with BDDH and Cam FAI, the femoral neck anteversion angle and femoral neck shaft angle increase, the pelvis tilts, and the acetabulum rotates, resulting in instability of the hip joint. In order to maintain the stability of the hip joint, the direction of biomechanical action of the hip joint has changed, which further affects the anatomical structures such as the proximal femur and acetabular morphology. BDDH with Cam FAI can be diagnosed clinically by combining lateral center edge angle, anterior center edge angle, and acetabular index. BDDH with Cam FAI can be effectively treated through arthroscopic polishing of the edges of the acetabular proliferative bone, excision of Cam malformations, and minimally invasive repair of the glenoid lip and cartilage of the hip joint. Conclusion Currently, there is no unified standard for the diagnosis and treatment of BDDH with Cam FAI. Minimally invasive treatment of the hip under arthroscopy can achieve good early- and medium-term effectiveness, and has certain advantages in repairing and maintaining the integrity of the glenoid lip and suturing/compression joint capsule. However, the long-term effectiveness needs to be further followed up to determine. The timing of surgery, intraoperative bone edge depth polishing, and joint capsule suturing/compression techniques also need to be further explored.
Objective To develop a novel transcatheter tricuspid valve replacement device and test its performance. MethodsThe transcatheter tricuspid valve stent consisted of double-layer self-expanding nitinol stent, biotissue-derived bovine pericardial leaflets, and PTFE woven. The delivery system, mainly consisting of a handle control unit and a delivery sheath, was sent to the correct position via right atrium or jugular vein. The sheath had a visualization feature, and the handle control unit could realize the functions of stable release and partial recovery of the interventional valve. In addition, this study performed animal survival experiments on the basis of in vitro experiments. A large-white pig was used as the experimental animal. Cardiopulmonary bypass was established through median thoracotomy, then the right atrium was opened, and the interventional valve was released under direct vision without cardiac arrest. Approximately 1 month after interventional valve implantation, the maneuverability and stability of the interventional tricuspid device were evaluated by autopsy. ResultsThrough the animal experiment, the interventional valve was successfully released, and the anchoring was satisfactory. Postoperative transthoracic echocardiography showed that the interventional valve opened and closed well, the flow rate of tricuspid valve was 0.6 m/s, and there was no obvious tricuspid regurgitation. One month after the operation, we dissected the large-white pig and found the interventional valve was not deformed or displaced, the leaflets were well aligned, and there was thrombus attachment in the groove between the inner and outer layers of the interventional valve. ConclusionAnimal experiment shows that the novel device can stably and firmly attach to the tricuspid annulus, with good anchoring effect, and effectively reduce paravalvular leakage.
As subjects in drug clinical trials and participants in medical practice, patients can best understand their own conditions and needs. With this in mind, the FDA proposed "patient-centered drug discovery" and issued a set of guidelines to incorporate patient experiences, perspectives, needs, and preferences into the drug development and evaluation process. Guideline (2), methods for identifying important patient information, mainly describes methods and precautions for collecting and extracting patient experience data. This paper will focus on the characteristics, common methods and precautions of qualitative, quantitative and mixed research methods in the collection of patient experience data, in order to provide help for the comprehensive collection of patient experience data.
ObjectiveTo investigate revision reasons and prosthesis selection of Crowe Ⅳ developmental dysplasia of the hip (DDH) after total hip arthroplasty (THA). MethodsA clinical data of 14 patients (15 hips) with Crowe Ⅳ DDH, who underwent a revision hip arthroplasty between January 2008 and May 2018, was retrospectively reviewed. There were 1 male (1 hip) and 13 females (14 hips). The age ranged from 27 to 63 years (mean, 45.0 years). There were 7 cases of left hip, 6 cases of right hip, and 1 case of bilateral hips. The prosthetic interfaces of primary THA were metal-on-polyethylene (MOP) in 9 hips, ceramic-on-ceramic (COC) in 4 hips, ceramic-on-polyethylene (COP) in 1 hip, and ceramic-on-metal in 1 hip. The time from primary THA to revision was 3-204 months (mean, 65.0 months). The causes of revision included aseptic loosening in 7 hips, dislocation in 3 hips, periprosthetic joint infection in 2 hips, osteolysis in 1 hip, nonunion of osteotomy in 1 hip, and a small-angle of femoral anteversion in 1 hip. Preoperative Harris score was 54.1±17.8 and the range of motion (ROM) of flexion was (92.7±20.2)°. Preoperative X-ray films showed the acetabular bone defect in 11 hips and osteolysis of femoral side in 4 hips. During the revision, the prostheses with COP and COC interfaces were used in 5 hips and 10 hips, respectively. Both acetabular and femoral revisions were performed in 11 hips and only femoral revision was performed in 4 hips.ResultsThe mean operation time was 3.7 hours (range, 1.5-6.0 hours). The mean intraoperative blood loss was 940.0 mL (range, 200-2 000 mL). All patients were followed up 16-142 months (mean, 73.9 months). Postoperative X-ray films showed no difference in inclination and anteversion between primary THA and revision (P>0.05). The height of rotation center and offset after revision were higher than those after primary THA, and the difference in offset was significant (P<0.05). At last follow-up, the Harris score and ROM of flexion were 85.0±7.3 and (115.0±17.0)°, respectively, which were significantly higher when compared with those before revision (t=8.909, P=0.000; t=4.911, P=0.000). Three hips underwent a re-revision operation. All protheses were fixed well and no radiolucent line, loosening, or subsidence was observed at last follow-up.ConclusionThe most common reason for revision in patients with Crowe Ⅳ DDH after THA was aseptic loosening. Due to high activity demand of this population, the prosthesis with MOP interface should be prevented and the prosthesis with COC interface could be alternative. Metal block, cup-cage, and reinforcement ring were reasonable solutions for reconstruction of acetabulum with severe bone defects and have satisfactory effectiveness. S-ROM prosthesis should be the preferred stem for neither primary THA or revision.