Dynamic Body Weight Support (BWS) systems have gained attention in recent years for their potential in gait training. However, maintaining a natural gait and vertical unloading have been less explored. In our previous work, we developed a body Motion Tracking (MT) walker that can move with patients. In this study, we introduce a novel Motion Tracking Variable Body Weight Support (MTVBWS) system for overground walkers. This system utilizes Center of Mass (COM) tracking and gait phase detection to not only dynamically support the user's body weight in the vertical direction but also to facilitate movement in all directions. The system achieves this horizontal omnidirectional movement by employing active Mecanum wheels, guided by COM recognition. The validation experiments were implemented with the MT mode, passive mode, and BWS mode in "static," "fixed unloading ratio (FUR)," and "variable unloading ratio (VUR)" settings with unloading force of 20 and 30%. The result shows that, compared to other modes, the proposed system in the MTVBWS mode can reduce the dragging effect in the horizontal plane caused by the walker. Moreover, the unloading force can be adjusted automatically to minimize the fluctuations in the force experienced by each lower limb during the rehabilitation walking training process. In comparison to natural walk, this mode presents smaller force fluctuations for each lower limb.

目的 观察斜外侧入路腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)治疗后路腰椎椎间融合术后邻近节段退变(adjacent segment degeneration,ASD)的早期临床疗效.方法 回顾性分析18 例因腰椎融合术后ASD行OLIF治疗的患者资料.患者首次手术均行腰椎后路减压植骨融合术,术后24～240 个月发生 ASD,应用单纯OLIF或联合后路椎弓根螺钉内固定、或联合侧方内固定进行治疗.评估其手术情况,并评价术后疗效和相关影像学指标.结果 所有患者均顺利完成手术,术后随访14～30 个月,OLIF手术节段均骨性融合.手术方式采用stand alone 5 例,联合后路椎弓根螺钉内固定 5 例,联合侧方固定 8 例.手术时间为70(50,115)min,术中出血量为50(20,136)mL.所有患者末次随访时的腰腿痛VAS评分及ODI指数较术前均明显降低(P<0.05).影像学测量显示,患者术后手术节段的椎间隙腹侧和背侧高度、椎间孔高度较术前均明显增加(P<0.05).结论 OLIF是治疗后路腰椎椎间融合术后ASD的有效方式,具有良好的早期疗效.

四肢节段性骨缺损,尤其是临界尺寸节段性骨缺损的修复仍然是骨科最具挑战性的难题之一.人工骨材料逐渐取代自体骨及同种异体骨成为骨缺损修复的研究热点.为评价人工骨材料作为骨缺损修复替代物的发展前景,有必要建立可重复且有效的节段性骨缺损动物模型,但目前尚无一种理想的大动物节段性骨缺损模型能完美模拟人类骨结构和力学特征.因此本文对大动物节段性骨缺损模型的临界尺寸骨缺损大小的取值、常用建模动物的优缺点、节段性骨缺损模型的建立、骨材料的不同固定方法等方面进行综述,以促进大动物节段性骨缺损模型的优化改进.

目的 进一步完善现代医院制度下公立医院决策机制,以期医院更好地应对未来重大突发事件,提高科学决策能力和水平.方法 以某三甲医院为例总结分析现代医院决策机制构建及其在疫情防控中运行实践和启示.结果 根据疫情防控工作紧急、重要等特点,医院打破原有决策流程,建立了绿色通道进行同步决策的机制,确保决策质量和效率.结论 医院决策机制是现代医院管理制度的重要组成部分,对于重大突发事件,需要建立起应急决策机制,同时要充分利用互联网+大数据优势,提高医院决策效率和水平.

目的 探讨不同剂型氨甲环酸(tranexamic acid,TXA)对降低单侧初次全髋关节置换术(total hip arthroplasty,THA)围手术期失血量的有效性和安全性.方法 将2016年10月至2018年10月180例行单侧初次THA手术的患者按随机数表法分为粉剂氨甲环酸组(粉TXA组)、水剂氨甲环酸组(水TXA组)、单纯静脉注射组,每组60例.粉TXA组患者于切皮前10min静脉单次使用20 mg/kg的TXA,关闭关节腔前将2gTXA粉剂直接倒入腔内;水TXA组患者同样于切皮前10min静脉单次使用20 mg/kg的TXA,关闭关节腔前将2gTXA溶于20mL生理盐水局部浸泡手术部位.记录各组术中出血量及术后引流量;复查术后1、3d血常规,记录患者血红蛋白水平和红细胞比容,通过公式计算并比较患者术后绝对失血量;如患者血红蛋白低于70 g/L,则予以同型红细胞悬液2U静脉输入:术后5d复查双下肢静脉彩超,记录术后输血和深静脉血栓的发生率.结果 各组患者术中出血量无差异;粉TXA组患者术后引流量、绝对失血量均低于水TXA组、对照组,差异有统计学意义(P＜0.05);粉TXA组患者术后输血1例,水TXA组8例,对照组18例,各组间差异有统计学意义(P＜0.05);粉TXA组患者术后发现1例下肢深静脉血栓,水TXA组、对照组患者未发现术后下肢静脉血栓,三组患者术后深静脉血栓发生率无明显差异.结论 粉剂TXA局部关节腔内使用可以更加有效地减少THA围手术期的血液丢失及术后输血率,无需配药,减少操作环节,不增加下肢深静脉血栓的发生风险,粉剂TXA局部用于关节腔是THA围手术期控制血液丢失的安全、有效的方法.

目的:了解不同岗位住培人员组织支持感和住培制度满意度现况,比较不同特征人员的差异性,探讨组织支持感与住培制度满意度的关系.方法:对参加2017年住院医师规范化培训高峰论坛的住培人员进行问卷调查.结果:全科医师的组织支持感和对住培制度满意度最低,住培学员的组织支持感和对住培制度满意度也显著低于其他岗位.结论:组织支持感对住培制度满意度具有预测作用.建议给予年轻、低从业年限的住培人员更多关怀,提高住培各类人员的组织支持感,确保住培学员培训期间待遇水平及公平性,加快健全全科医学人才队伍培养、使用、激励机制,保障住培质量.

随着互联网和移动通信的快速发展,医院业务数据量以几何级数的速度增长,为了提高医院服务质量和服务能力,不断提高患者的满意度,就需要注患者体验感受,需要围绕以患者切身感受为核心建立一个完善的数据平台.广西医科大学第四附属医院利用信息化和移动医疗平台关注不同患者看病的“时间”和“空间”要素,进行了实践探索并提出建议.

目的:探讨骨水泥渗漏对经皮椎体成形术(PVP)远期疗效的影响.方法:收治单节段骨质疏松性椎体压缩性骨折(OVCFs)患者143例,分为渗漏组与正常组.在术前1 d,术后1～3 d、末次随访患者疼痛评分(VAS)、功能障碍评分(ODI),分析两组VAS、ODI评分及再骨折复发率的差异.结果:骨水泥渗漏组与无渗漏组的术前、术后及末次随访VAS、ODI评分差异无统计学意义(P>0.05),两组再发骨折发生率差异无统计学意义(P>0.05).结论:骨水泥渗漏对经皮椎体成形术的远期疼痛缓解及功能改善无明显影响,与椎体再发骨折无明显关联.

中国医疗卫生资源的不均衡分布,无法保证医疗服务供需的合理匹配.为推动各级医疗机构妥善分流、合理配置医疗资源,降低快速高涨的医疗费用及提高患者满意度,分级诊疗制度成为国家深化医药卫生体制改革的新举措.文章首先从供需匹配视角探讨了分级诊疗制度实施的阻碍因素,进而分析了医疗联合体建设对建立和完善分级诊疗制度的重要性,并以柳州市工人医院为例根据供需匹配理论,从人才建设、远程医疗和医疗协作等方面探索紧密型医疗联合体建设,落实分级诊疗制度,以期为卫生行政部门制定政策和其他医疗机构参与医疗联合体建设实践提供借鉴.

Objective To explore the effects of calcitonin gene-related peptide (CGRP) on proliferation of vascular endothelial cells (VECs) and osteogenic differentiation of bone mesenchymal stem cells (BMSCs) of osteoporotic rats in vitro,and cell/ molecular mechanism of promoting osteoporotic fracture healing.Methods 10 3-month-old SD rats were employed to make osteoporosis model by taking bilateral ovariectomy.Micro-CT analysis was used to determine the success of modeling at 6 months of postoperation.BMSCs and VECs were isolated from osteoporotic rats by blood adherence mcthod.10-7-10-10 mol/L CGRP were added to the culture medium.CCK-8 method was used to examine the cell proliferation.Effect of CGRP on osteogenic differentiation of BMSCs:Alkaline phosphatase (ALP) activity,and reverse transcription polymerase chain reaction (RT-PCR) were used to detect the expression of ALP,Collagen Ⅰ,BMP-2,Osteonectin and RunX2 gene.Effect of CGRP on vascularization of VECs:Vascular cell endothelial growth factor (VEGF) protein secretion and gene expression level were tested by ELISA and RT-PCR.Resuits BMSCs and VECs of osteoporotic rats were isolated successfully.The optical density (OD) values of CCK-8 method increased in a dose-dependent manner,for BMSCs at 7 d,the control group of OD value was 0.58±0.02,the CGRP group 10-7-10-10 mo]/L was to 0.80±0.03,0.79±0.03,0.74±0.03,0.69±0.03,difference was significant;for VECs,the control group of OD value was 2.20±0.01,the CGRP group 10-7-10-10 mol/L was to 4.12±0.04,3.90±0.02,3.56±0.04,3.12±0.04,difference was significant.Effect of CGRP on osteogenic differentiation of BMSCs:Alkaline phosphatase (ALP) activity,and reverse transcription polymerase chain reaction (RT-PCR) were used to detect the expression of ALP,Collagen Ⅰ,BMP-2,Osteonectin and RunX2 gene.Effect of CGRP on vascularization of VECs:Vascular cell endothelial growth factor (VEGF) protein secretion and gene expression level were tested by ELISA and RT-PCR,difference between the control group and CGRP group were all significant.Conclusion 10-7 mol/L,10-10 mol/L of CGRP can directly promote the proliferation of the BMSCs and VECs of osteoporotic rats,promote the osteogenic differentiation of BMSCs,improve the expression of VEGF gene and protein secretion,promote angiogenesis.

Objective To observe the clinic efficacy of open transforaminal lumbar interbody fusion (TLIF) compared with minimally invasive operation in treating lumbar spinal stenosis and instability among obese and non‐obese patients .Methods A ret‐rospective analysis was performed in these cases of mono‐segmental lumbar spinal stenosis and instability between January 2011 and January 2013 .Perioperative index ,clinical efficacy ,and imaging results were observed and compared between different groups .Re‐sults Thirty‐four obese cases and 105 non‐obese cases were divided into two groups ,including conventional posterior open TLIF and minimally invasive TLIF operation ,to compare the results .Perioperative indexes of obese patients were more than non‐obese patients undergone open TLIF operation way and there was significant difference(P<0 .01);while by minimally invasiveTLIF oper‐ation way ,comparing the results of the surgical blood loss and incision size between obese and non‐obese group ,there was signifi‐cant difference(P<0 .05) .However ,there was not significant difference in the operative time between two groups(P>0 .05) .No cases of slippage or breakage of implants were found among all these patients after 6 months of follow up .Postoperative VAS and ODI among these four groups were better than before(P<0 .01) .Undergoing open postoperative VAS in obese group and in non‐obese group ,there was significant difference(P< 0 .05);undergoing minimally invasive postoperative ODI in obese group and in non‐obese group ,there was significant difference(P< 0 .05) .But ,undergoing open postoperative ODI in obese group and in non‐obese group ,there was not significant difference(P>0 .05);undergoing minimally invasive postoperative VAS in obese group and in non‐obese group ,there was not significant difference(P>0 .05) .Conclusion Therefore ,obese may be risk factor in treating lumbar spinal stenosis and instability .

Objective:To explore a different recurrence after the treatment of eosinophilic granuloma of bone.Method:26 cases were treated in the hosp-tial,including 15 male and 11 female.Their age were from 3 years to 75 years.The locations were skull(6),femur(2),spine(5),carpal bones(2),rib(3), humerus(2),clavic(2),pevlic(3),fibula(1).Result:26 cases were diagnosised as eosinophilic granuloma of bone by biopsy.The follow -up time was from 6 month to 8 years.24 patienents were recover fully and had no recurrent or complication.The rest ones were in adult group and need radiotherapy when the dis-ease were replase after sugery produce.Conclusion:there is low recurrent rate of eosinophilic granuloma of bone in the patienent with immature bone.

OBJECTIVETo evaluate the effects a lithium chloride-doped calcium phosphate cement (Li/CPC) on promoting tibial defect repair in rats.METHODSTwenty 6-month-old female SD rats randomized into Li/CPC (n=10) and CPC control (n=10) groups. Surgery was performed to create bone defects at the bilateral tibia, which were filled with either of the cement. Five rats from each group were sacrificed at 1 and 2 months after the surgery for micro-CT examination and HE staining of the tibia.RESULTSMicro-CT showed better repair of bone defects in Li/CPC group, which had a significantly higher new bone volume fraction (BV/TV) and a lower trabecular separation/spacing (Tb.Sp) than the control group (P<0.05). HE staining showed an earlier appearance of fiber and osteoid callus in Li/CPC group than CPC control group. The number and quality of bone healing was significantly higher in Li/CPC group than in CPC group.CONCLUSIONLi/CPC possessed better osteoinductivity and can significantly promote bone defect repair in rats.

Calcium phosphate cement (CPC) has been widely used in bone tissue repairing due to its physical mechanical properties and biocompatibility. Addition of trace element to CPC has shown promising evidence to improve the physical properties and biological activities of CPC. Lithium (Li) has effect on osteoblast proliferation and differentiation. In this study, we incorporated Li to CPC and examined the physical properties of Li/CPC and its effect on osteoblast proliferation and differentiation. We found that Li doped CPC maintained similar setting time, pore size distribution, compressive strength, composition, and morphology as CPC without Li. Additionally, Li doped CPC improved osteoblast proliferation and differentiation significantly compared to CPC without Li. To our knowledge, our results, for the first time, show that Li doped CPC has beneficial effect on osteoblast in cell culture while keeps the excellent physical-mechanical properties of CPC. This study will lead to potential application of Li doped CPC in bone tissue engineering. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 944-952, 2017.

目的 观察双侧卵巢切除(OVX) SD大鼠不同时期血清骨生化标志物与骨小梁三维结构变化之间的关系.方法 分别于6月龄雌性SD大鼠假手术(Sham)组和双侧卵巢切除术(OVX)组术后2、4、8、12周随机取样,每组每个时间点处死4只,取血清测量雌二醇(E2)、骨碱性磷酸酶(BALP)、抗酒石酸酸性磷酸酶(TRAP)水平,取胫骨用显微CT(Micro-CT)和组织学HE染色观察胫骨骨小梁微结构变化.结果 术后2周,OVX组E2较Sham组开始下降,4周时差异有统计学意义(P＜0.05),一直持续到12周,Sham组E2水平随时间变化不大;OVX组血清BALP在术后2周达峰值,然后迅速下降,12周时降至术前水平;OVX组血清TRAP活性在术后迅速升高,术后4周达峰值,然后下降,术后12周时仍高于Sham组及术前水平;Micro-CT分析胫骨干骺端相对骨体积(BV/TV)、骨小梁数目(Tb.N)、骨小梁分离度(Tb.Sp)、Conn.Dn、骨密度(BMD)在2周时与Sham组比较差异无统计学意义,第4周开始出现明显差异,12周差异更加明显,骨小梁厚度(Tb.Th)始终无明显差异;Micro-CT重建显示术后12周OVX组骨小梁较Sham组稀疏,缺失严重;HE染色显示术后12周OVX组大鼠胫骨干骺端骨骺板下骨小梁变细且排列稀疏,骨小梁结构不成熟,骨小梁间连接差,部分断裂,出现大量骨小梁盲端,小梁壁厚度不一致.结论 OVX术骨质疏松模型建立过程中大鼠成骨及破骨细胞活跃度先增高后降低,破骨细胞相对而言上升周期更长且下降后能维持在更高水平,比成骨细胞更活跃,骨吸收大于骨生成导致骨质疏松,主要体现为骨小梁BV/TV、Tb.N、Conn.Dn、BMD下降,Tb.Sp升高,组织学表现为骨小梁结构不成熟,骨小梁间连接差,部分断裂,出现大量骨小梁盲端.

Objective To investigate the application of standardized treatment model in emergency treatment of patients with severe traffic injury in prehospital and hospital-based emergency care.Methods Clinical data of patients with severe traffic injury in a hospital of Liuzhou city before (control group) and after (project group) the application of standardized treatment mode were analyzed. The prehospital emergency time, time spent in emergency room, survival rate, and disability rate were compared between the two groups to appraise the significance of standardized treatment model in dealing with severe traffic injury.Results Survival rate of the project group was 84.5%, and 76.9% of the control group. There was a significant difference in survival rate between the two groups (χ2=5.857,P=0.016). Prehospital emergency time (t=-14.116,P<0.001) and time spent in emergency room (t=-17.835,P<0.001) of project group were significantly lower than that in control group, and the differences were statistically significance. There were 278 survival patients (30.2%) in project group ended up as the disabled, while 237 survival patients (37.1%) for the control group, and the difference was statistically significant (χ2=2.75,P=0.047). Conclusions Standardized treatment model could shorten prehospital emergency time and time spent in emergency room, reduce mortality and disability rate, which is worthy of clinical application.

OBJECTIVEThe aim of this study was to determine the application value of a trauma index (TI) to assess condition and likelihood of death in hospitalized patients with acute trauma (AT).METHODSTrauma index scores and injury severity scores (ISS) were assessed in 1,802 randomly selected cases of AT-hospitalized patients. The receiver operating characteristic (ROC) curve was used to compare the clinical values of TI and ISS values to predict outcomes in AT-hospitalized patients.RESULTSThe area under the ROC curve for TI scores was 0.896 (95% CI [0.881, 0.909]), while for ISS, it was 0.792 (95% CI [0.773, 0.811]). This difference was not statistically significant (z = 3.236, P = 0.001). Potentially critical disease conditions in AT-hospitalized patients were best identified when TI scores were ≥ 16 points and ISS values were ≥ 22 points.CONCLUSIONSTrauma Index scores exhibited a higher resolution for outcome prediction in AT-hospitalized patients compared to ISS values. The implementation of this scale was simple, reliable, easy to learn, and could quickly identify disease, which is vital for early detection and treatment of critical trauma patients.

It is a long last motivation for development to reform pub?lic hospital performance distribution and improve salary system. This article studies the reform of public hospital performance distribution incentive mechanism and outlines a comprehensive performance management system with hospital budget as the guidance, service as the core, medical efficien?cy , medical quality, scientific research and subject development, satisfac?tion , cost and medical fees control as the keys based on good information system.

2004年4月，世界卫生组织（world health organization ， WHO）在日内瓦发表的《世界预防道路严重交通伤害报告》中指出：道路严重交通伤害和死亡是一个全球范围内的主要公共卫生问题，除非立即采取适宜的行动，否则这一问题将在全球进一步恶化，在发展中国家更是如此［1］。严重交通伤是导致45岁以下人员死亡的首要原因，也是全人类非正常死亡的“第一杀手”［2］。因此，有效减少严重交通事故和降低严重交通伤患者的死亡率和伤残率是目前全社会所面临的重要研究课题之一。我院于2012年始进行柳州市严重交通创伤规范化救治模式的研究及推广，建立了一套适合柳州地区实情的严重交通伤规范化救治指南。通过2年的临床实践，认为能达到提高柳州市严重交通伤急救的效率和质量，降低死亡率和伤残率的目的。

Building high-quality service hospital and solving the issue of "narrow access to medical service and high cost for medical service" have always been the focus and difficulty of health care reform. Based on the problems in diagnosis and treatment of patients, constantly optimize the treatment process, innovate hospitalization and checking out services. Save patients' time on diagnosis and treatment, bring convenience to patients and continuously improve patients' satisfaction and service quality.