Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.
Based on the current situation of patients with retinal diseases in China and the clear requirements of the "14th Five-Year Plan for Eye Health (2021-2025)" to strengthen the construction of the prevention and control system for retinal diseases, experts in the field of retinal diseases in China have conducted in-depth and comprehensive thematic discussions, and used the modified Delphi method for collective decision-making and opinion solicitation, ultimately forming consensus and consistent guidance suggestions for the management of chronic diseases of retinal diseases that are in line with China's national conditions. This consensus includes key content such as definitions, treatment plans, and follow-up frequency for the management of chronic diseases of the fundus. It clearly proposes relevant measures to improve the management process of chronic diseases of the fundus, and elaborates on the advantages and feasibility of establishing an online remote platform for the management of chronic diseases of the fundus, in order to assist doctors in formulating personalized treatment plans and ensure that patients receive standardized treatment and follow-up. This consensus will provide guidance and reference for the management of chronic diseases and long-term standardized diagnosis and treatment of major fundus diseases in China.
In recent years, three-dimensional (3D) technology has been more and more widely used in the auxiliary diagnosis and treatment of structural heart disease (SHD), and is also an important basis for the application of other technologies such as artificial intelligence. However, there are still some problems to be solved in the clinical application of 3D technology. In this paper, the application of 3D technology in SHD field is reviewed, and the future development of 3D technology is prospected.
American College of Cardiology (ACC) issued the updated expert consensus decision pathway on the management of mitral regurgitation in April 2020. The whole process in caring patients with mitral valve regurgitation from patient evaluation to treatment choice was discussed in the consensus. The main change from the 2017 version is the confirmation of the effect of transcatheter mitral valve repair on secondary mitral regurgitation. It standardized the process in this field. In this paper, we aimed to introduce the focus update of this consensus.
The misdiagnosis rate and mortality of mesenteric ischemia are high, but with the continuous updating of diagnosis and treatment techniques and treatment concepts in recent years, many patients can get timely and effective treatment. This article starts from the epidemiology, vascular anatomy, etiology, clinical manifestations and classification of mesenteric ischemia, and the progress of diagnosis and treatment under the multidisciplinary diagnosis and treatment mode, and details the research progress of mesenteric ischemia at home and abroad. This paper focuses on the significance of multidisciplinary diagnosis and treatment mode in the diagnosis and treatment of mesenteric ischemia, in order to strengthen the treatment consciousness of mesenteric ischemia and explore a more accurate and effective treatment system. The purpose of this study is to provide some reference for avoiding intestinal infarction and improving the survival rate of intestinal tract.
Objective To investigate the effectiveness of 5G remote robotic surgery in the treatment of pelvic fractures. Methods A retrospective analysis was conducted on the clinical data of 160 patients with pelvic fractures admitted between July 2023 and June 2024 who met the selection criteria. Among these patients, 80 underwent internal fixation surgery with the assistance of 5G remote robotic surgery (5G group), while 80 received local robotic surgical assistance (control group). Baseline characteristics, including gender, age, body mass index, disease duration, cause of injury, and fracture classification, were compared between the two groups, and no significant difference was found (P>0.05). The incision length, operation time, intraoperative blood loss, hospital stay, accuracy of screw placement, maximum residual displacement postoperatively, quality of fracture reduction, incidence of complications, Majeed pelvic function score and classification at last follow-up were recorded and compared between the two groups. Results In the 5G group, 180 screws were implanted during surgery, while 213 screws were implanted in the control group. The 5G group demonstrated significantly reduced intraoperative blood loss and shorter incision length compared to the control group (P<0.05). No significant difference was observed between the two groups in terms of operation time or hospital stay (P>0.05). Radiographic evaluation revealed excellent and good reduction rates of 98.8% (79/80) in the 5G group and 97.5% (78/80) in the control group, while excellent and good screw placement accuracy rates were 98.3% (177/180) in the 5G group and 95.8% (204/213) in the control group. No significant difference was found between the two groups in maximum residual displacement, reduction quality, or screw placement accuracy (P>0.05). All patients were followed up 7-16 months (mean, 11.3 months), with no significant difference in follow-up duration between the groups (P>0.05). No perioperative or follow-up complication, such as wound infection, iatrogenic fractures, iatrogenic neurovascular injury, screw loosening or breakage, or nonunion, were observed in either group. The control group exhibited a worse degree of gait alteration compared to the 5G group (P<0.05), while no significant difference was found in incidences of squatting limitation or persistent pain (P>0.05). At last follow-up, no significant difference was observed between the groups in Majeed pelvic function scores or grading (P>0.05). Conclusion Compared with the local surgery group, 5G remote robotic surgery supported by remote expert technical guidance demonstrated smaller incision lengths, less intraoperative blood loss, and fewer postoperative complications, and was shown to be a precise, minimally invasive, safe, and reliable surgical method.
ObjectiveTo explore the clinical characteristics, diagnosis, and treatment norms of gastrointestinal stromal tumor, so as to deepen clinicians’ understanding of the gastrointestinal stromal tumor and avoid misdiagnosis.MethodsThe clinical data of a patient with gastrointestinal stromal tumor who treated in March 2019 in The First Hospital of Kunming was retrospectively analyzed, and determining the methods of the treatment through MDT mode.ResultsThis patient was generally in good condition. After MDT discussions among the imaging department, cardiothoracic surgery department, oncology department, and anesthesia department, it was considered that surgical treatment was the best treatment scheme. The operation time was 120 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroesophageal reflux, and other complications occurred after the operation, and the patient was discharged successfully on the 10th day after the operation. Postoperative treatment was assisted by imatinib. Follow-up was conducted for more than 4 months, with no obvious complication occurred after discharge, so continued to follow-up.ConclusionGastrointestinal stromal tumor can be diagnosed and treated by multidisciplinary approach, and surgical resection is still the most important and effective treatment.
ObjectivesTo analyze the balance of medical human resource allocation in Chengdu and to discuss the impact of human resource allocation structure on the hospital’s medical service capabilities, so as to provide a theoretical basis for the hospital to optimize the talent team structure.MethodsThe Moran’s index and Gini coefficient were used to evaluate the spatial aggregation and grade distribution difference of human resources allocation, respectively. The case mix index (CMI), the length of hospital stay, and the difficulty of surgery were used as outcome variables, and a multiple regression analysis model was established to explore the impact of human resource indicators on the hospital’s medical service capabilities.ResultsThe distribution of doctors showed an obvious spatial aggregation in Chengdu, and there was a positive spatial correlation (Moran’s Idoctor=0.290); the distribution of nurses had no obvious spatial aggregation (Moran’s Inurse=0.102). Under different medical service capacity segments, the Gini coefficient of doctors was 0.518, and the Gini coefficient of nurses was 0.576, both exceeding 0.5, indicating that the distribution of medical human resources in different levels of hospitals was considerably different. The regression results showed that the expansion of the quantity of senior title doctors and the proportion of medical care both could improve the hospital’s CMI. The increase in the quantity of doctors with senior titles also had a certain impact on improving the hospital’s surgical capabilities. The expansion of the proportion of medical care could lead to a slight increase in the length of patients' hospital stay.ConclusionsOptimizing the allocation structure of medical human resources in different regions and hospitals with different levels is an important task in the construction of a hierarchical diagnosis and treatment system. It is necessary to further integrate medical human resources throughout the whole city and strengthen personnel training and team building in primary health institutions. Hospitals at different levels should implement their own development positioning and further optimize their human resource allocation structure according to development needs. Tertiary hospitals should pay more attention to the cultivation of senior professional doctors, optimize the proportion of medical care, and improve the hospital’s medical service capabilities. The primary health institutions should pay attention to the comprehensive construction of medical personnel, and strengthen the development of the team of general practitioners, so as to achieve a comprehensive improvement of the city’s medical service capabilities.
Objective To review the research progress of diagnosis and treatment system for knee dislocation (KD) based on the stage and classification of posteromedial structure and posterolateral corner injury, so as to provide guidance for clinical work. Methods The relevant literature on the classification, diagnosis and treatment was extensively reviewed. Results At present, the criterion of the stage and classification of KD mainly include classification based on the size of the injury energy, Kennedy classification, and the improved Schenck classification, but they are not perfect because of no stage and classification of multiple ligament injury and no standardized treatment of different injuries. Hua Xi Knee Dislocation and Multiple Ligament Injury (HX-KDMLI) has optimum plan for injury treatment of posteromedial structure and posterolateral corner injury in KD based on stage and classification. Conclusion At present, there is no unified opinion on stages and classifications of the posteromedial structure and posterolateral corner injury in KD as well as on diagnosis and treatment. HX-KDMLI has certain feasibility for the stage and classification of the posteromedial structure and posterolateral corner injury in KD, to a certain extent, it can be used as reference for the diagnosis and treatment of KD.
Liver cancer is one of the world’s most prevalent malignancies, and is also the third leading cause of cancer death in China. Hepatitis and cirrhosis background is a major feature of liver cancer patients in China, which makes specific requirements that suits the national conditions in many aspects of prevention and control like screening diagnosis, treatment options, and prognosis follow-up. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition), which is based on China’s practice, proposes liver cancer staging in line with China’s national conditions and forms a multi-disciplinary joint diagnosis and treatment model based on surgical treatment. Liver transplantation is included in liver cancer as one of the surgical treatments option. It also emphasizes the support of evidence-based medicine. The Specifications for Diagnosis and Treatment of Primary Liver Cancer (2017 Edition) may have laid a solid foundation for future diagnosis and treatment of liver cancer in China.