Objective To investigate the effects of repeated shortischemia training on flap survival area, vascular endothelial growth factor and the microvascularsel density. Methods Seventy-two rabbits were divided into:the experimental group(n=64), the skin flaps were constructed in two sides of back, one side flap were given ischemia training for 15 minutes and 8 times one day at the pedicles from the 1st to 8th day after operation (group A), the other side flap was served as a control (group B), the corresponding site was only marked as a blank control group (group C).Then, 8 pedicles of group A and group Bwere isolated every day. The surviving area of all skin flaps were calculated on the5th day after isolating operation. The vascular endothelial growth factor(VEGF)and microvessel density(MVD) of the 3 groups were checked with immunohistologochemical staining. Results After the operation, all animalswere survival with normal vitality.The survival flap area of group A were significant more than that of group B after 3 days(Plt;0.05).The expressions of VEGF and MVD of group A and group B were higher than group C. The expression of VEGF of group A was significantly higher than that of group B(Plt;0.01). The counting of MVD of group A was also significantly higher than that of group B(Plt;0.05). There was positive correlation between flap survival area and MVD in group A. The relation of time point was n and n 2 respectively,correlation coefficient was 0.850. As well as MVD and VEGF were positive correlation,correlation coefficient was 0.801. Conclusion Early repeated shortischemia training can increase flap survival area, the mechanism maybe involve the increased expression of VEGF, which can increased skin flap microvascular density.
Robot rehabilitation has been a primary therapy method for the urgent rehabilitation demands of paralyzed patients after a stroke. The parameters in rehabilitation training such as the range of the training, which should be adjustable according to each participant’s functional ability, are the key factors influencing the effectiveness of rehabilitation therapy. Therapists design rehabilitation projects based on the semiquantitative functional assessment scales and their experience. But these therapies based on therapists’ experience cannot be implemented in robot rehabilitation therapy. This paper modeled the global human-robot by Simulink in order to analyze the relationship between the parameters in robot rehabilitation therapy and the patients’ movement functional abilities. We compared the shoulder and elbow angles calculated by simulation with the angles recorded by motion capture system while the healthy subjects completed the simulated action. Results showed there was a remarkable correlation between the simulation data and the experiment data, which verified the validity of the human-robot global Simulink model. Besides, the relationship between the circle radius in the drawing tasks in robot rehabilitation training and the active movement degrees of shoulder as well as elbow was also matched by a linear, which also had a remarkable fitting coefficient. The matched linear can be a quantitative reference for the robot rehabilitation training parameters.
Objective To investigate the effects of children’s crawling-promotion-training-robot on gross motor function and cognitive function in children with global developmental delay (GDD). Methods A total of 40 children with GDD admitted to the Department of Rehabilitation Medicine, Children’s Hospital of Nanjing Medical University were selected as the research subjects. By envelope method, the children were randomly and equally divided into experimental group and control group, with 20 cases in each group. The experimental group received children’s crawling-promotion-training-robot combined with conventional rehabilitation therapy, while the control group received manual crawling training combined with conventional rehabilitation therapy. Before and after treatment, the scores of Gross Motor Function Measure Scale-88 (GMFM-88) and Gesell Developmental Scale (GDS) were respectively used to evaluate gross motor function and cognitive function. Results There was no significant difference in gender (χ2=0.100, P=0.752) and age (t=0.053, P=0.962) between the two groups. Before treatment, there was no significant difference in GMFM-88 and GDS scores between the two groups (P>0.05). After treatment, there were statistically significant differences in GMFM-88 and GDS scores between the two groups (P<0.05). The comparison within the group showed that there were statistically significant differences in GMFM-88 and GDS scores between the two groups before and after treatment. Conclusion Children’s crawling-promotion-training-robot is more effective than manual crawling training in improving gross motor function and cognitive function in children with GDD.
Objective To understand the demands of residents in postgraduate medical education for faculty doctors and provide useful information to teaching hospitals. Methods Two hundred residents were interviewed through questionnaires. Results Demands for faulty doctors were consistent in the following 5 fields: faculty’s synthetic diathesis, adaptability to social and medical changes, information management and research, cooperation and teamwork, and innovation and continuous self-improvement (Pgt;0.05). However, with regard to the faculty doctors’ professionalism, teaching models and atmosphere, the demands of residents in the different stages of postgraduate medical education differed significantly (Plt;0.05). Conclusion Teaching hospitals continuously improve faculty doctors’ abilities and pay much attention to residents’ role transformation.
ObjectiveTo observe the effectiveness of core endurance isokinetic strength training on subacromial impingement syndrome (SAIS) rehabilitation.MethodsSAIS patients were selected from the Rehabilitation Department, Second Affiliated Hospital of Inner Mongolia Medical University from January 2018 to June 2019. The patients were randomly divided into observed group and control group by random number table method. The patients in control group were treated by keritherapy, cold, standard physiotherapy (PT) and exercise. At the same time, the patients in observed group were treated by core endurance isokinetic strength training combined with keritherapy, cold and standard PT. Both two groups were treated for 8 weeks. The patients were scored with visual analogue scale (VAS), Shoulder Pain and Disability Index (SPADI), Short Form 36 Healthsurvey Questionnaire (SF-36), flexor peak torque (FPT) and extensor peak torque (EPT) in pre and post treatment.ResultsA total of 59 patients with SAIS were enrolled. No exfoliating cases. There were 31 cases in the observed group and 28 cases in the control group. Pre-treatment, there were no significant difference in FPT, EPF, VAS, SPADI and SF-36 between the two groups (P>0.05). Post-treatment, there were no significant difference in EPT and VAS between the two groups (P>0.05); FPT [(62.65±10.17) N·m], SPADI [(53.18±10.25) points] and SF-36 [(35.54±11.39) points] in the observed group were significantly improved compared with the control group [(56.28±9.55) N·m, (61.05±9.41) points, (42.65±10.74) points] (t=2.473, 3.061, 2.460; P=0.014, 0.003, 0.017); FPT in both groups, and EPT in the observed group were improved compared with that of the pre-treatment (P<0.05); the EPT of the control group was improved compared with that of the pre-treatment, but the difference was not statistically significant (P>0.05); VAS, SPADI and SF-36 in the two groups were improved compared with those of the pre-treatment (P<0.05).ConclusionsCore endurance isokinetic strength training could improve the core stability of subacromial impingement syndrome patients. Satisfactory musculoskeletal dynamic chain plays a vital role in subacromial impingement syndrome rehabilitation.
ObjectiveTo discuss the influence of tutorial system in standardized emergency residency training. MethodWe reviewed the settings and management of tutorial system in the Emergency Department of West China Hospital since 2009, and summarized the achievements. ResultsThrough practice in these years, the clinical skills, teaching abilities and scientific research capability of standardized-training emergency residents were enhanced greatly. ConclusionsTutorial system facilitates standardized emergency residency training.
ObjectiveTo explore the effect of dynamic neuromuscular stabilization technique for chronic non-specific low back pain. MethodsFrom July 2019 to June 2020, 60 patients with chronic non-specific low back pain who underwent rehabilitation at the outpatient clinic of Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine were prospectively selected. All patients were divided into trial group and control group by random number table method. There were 30 cases in each group. The control group used rehabilitation education and core muscle strength training. The trial group used dynamic neuromuscular stabilization of chest and abdomen combined with breathing control training on the basis of the treatment plan of the control group. The Visual Analogue Scale (VAS) score, Oswestry Dability Index (ODI), abdominal pressure stability, xiphoid level thoracic mobility and axillary level thoracic mobility were compared between the two groups of patients. ResultsAll the 60 patients in this study completed the trial, and there was no recurrent case during treatment, after treatment or during follow-up. There was no statistically significant difference in age, gender, height, weight, body mass index, or course of disease between the two groups (P>0.05). Taking VAS score as the dependent variable, the result of generalized estimating equations showed that the difference in VAS score between the trial group and the control group was statistically significant (χ2=4.132, P=0.042), and the VAS scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment (χ2=1618.814, P<0.001; χ2=1573.419, P<0.001); the between-group comparisons at different time points showed that the difference in VAS score between the two groups at 12 weeks of follow-up was statistically significant (P<0.001), and the remaining between-group differences were not statistically significant (P>0.05). Taking ODI score as the dependent variable, the result of generalized estimating equations showed that the difference in total ODI score between the two groups was statistically significant (χ2=11.063, P=0.001), and the ODI scores at 12 weeks of follow-up and at 8 weeks of treatment differed significantly from that before treatment (χ2=524.694, P<0.001; χ2=717.236, P<0.001); the between-group comparisons at different time points showed that there were statistically significant differences between the two groups at 8 weeks of treatment and at 12 weeks of follow-up (P<0.001). After treatment, the improvement of stability value of abdominal pressure [(−4.93±8.14) vs. (−1.33±4.78) mm Hg (1 mm Hg=0.133 kPa)], the improvement of xiphoid level thoracic mobility [(1.87±0.62) vs. (1.52±0.70) cm] and the improvement of axillary level thoracic mobility [(1.78±0.62) vs. (0.92±0.45) cm] in the trial group were better than those in the control group (P<0.05).ConclusionThe dynamic neuromuscular stabilization technique can improve the dysfunction and relieve the symptoms of patients with chronic non-specific low back pain, and it is worthy of promotion.
Objective To provide scientific evidence for the establishment of medical specialist system in China by analyzing the current situation and problems, putting forward solution thoughts and countermeasures, from the angle of medical education system, residency training program and licensed physician management. Method Principle and method of evidence-based medicine were adopted. Retrospective investigation was conducted to gain information from 1996 to 2002 about enrollment and running form of medical education, current situation of residency and specialist training. Data was then extracted and analyzed for the benefit of corresponding countermeasures. Results By the end of 2001, there were totally 1 640 thousand physicians in China. The enrollment proportion of undergraduate and junior college student steadily increased from 1996 to 2002, while the situation quite the reverse as for medical secondary school. More than 300 thousand have taken part in the licensure exam, among whom less than 15% had university diploma. About 52 000 doctors have already completed the residency training program, and 65 700 are being trained. Standardized system of specialist training and admittance is not available in China. Conclusions It was three main tough problems that mainly account for the poor quality of doctor as a whole in China, which include diversity of educational system, insufficient software and hardware of residency training program, and absence of specialist training system. An allied funded program of "research on medical specialist training and admittance" has been on the way, and research outcomes will be published soon.
In the past two decades, adult cardiac surgery has developed by leaps and bounds in both anesthetic techniques and surgical methods, whereas the incidence of postoperative pulmonary complications (PPCs) has not changed. Until now PPCs are still the most common complications after cardiac surgery, resulting in poor prognosis, significantly prolonged hospital stays and increased medical costs. With the promotion of the concept of enhanced recovery after surgery (ERAS), pre-rehabilitation has been becoming a basic therapy to prevent postoperative complications. Among them, preoperative inspiratory muscle training as a very potential intervention method has been widely and deeply studied. However, there is still no consensus about the definition and diagnostic criteria of PPCs around the world; and there is significant heterogeneity in preoperative inspiratory muscle training in the prevention of pulmonary complications after cardiac surgery in adults, which impedes its clinical application. This paper reviewed the definition, mechanism, and evaluation tools of PPCs, as well as the role, implementation plan and challenges of preoperative inspiratory muscle training in the prevention of PPCs in patients undergoing cardiac surgery, to provide reference for clinical application.
Objective To explore a new teaching mode relying on the new media platform, aiming to stimulate residency standardized trainees’ interest in learning theories related to gynecology outpatient surgery, improve practical operation skills, and achieve better teaching effects. Methods The residency standardized trainees who rotate in the gynecology outpatient of West China Second University Hospital, Sichuan University between July 2021 and June 2022 were selected. According to the random number table method, the trainees were divided into the control group (using the traditional teaching mode) and the intervention group (using the teaching mode of combining the flipped classroom and simulated teaching relying on the new media platform). The assessment results, teacher evaluation, trainees self-evaluation and teaching satisfaction of the two groups were compared and analyzed. Results A total of 118 trainees were enrolled, 59 in each group. There was no significant difference in gender, age, years of training and education level between the two groups (P>0.05). The total scores of evaluation scores (87.59±4.54 vs. 85.17±3.70), teachers’ evaluation (87.05±3.79 vs. 85.14±3.75), and trainees’ self-evaluation (87.81±4.41 vs. 85.54±3.96) of trainees in the intervention group were better than those in the control group, and the differences were statistically significant (P<0.05). The clinical thinking ability [teachers’ evaluation (24.49±1.62 vs. 23.22±2.05), trainees’ self-evaluation (25.25±1.99 vs. 23.97±2.27) and operation skills [teachers’ evaluation (37.05±1.58 vs. 36.10±1.99), trainees’ self-evaluation (36.75±2.73 vs. 35.66±2.56)] of trainees in the intervention group were better than those in the control group, and the differences were statistically significant (P<0.05). The satisfaction rate of the trainees in the intervention group was 98.3%, and that of the trainees in the control group was 93.2%. The teaching satisfaction of the intervention group was better than that of the control group (P<0.05). Conclusion The teaching mode of combining flipped classroom and simulated teaching relying on the new media platform has effectively stimulated residency standardized trainees’ learning interest in gynecological outpatient surgery, improved trainees’ clinical practice ability, improved teaching satisfaction, achieved good teaching results, and can be promoted as a new teaching mode.