ObjectiveTo explore the reliability and safety of continuous monitoring of vital signs in patients using wireless wearable monitoring devices after video-assisted thoracoscopic surgery (VATS) for lung cancer. MethodsThe patients undergoing VATS for lung cancer in West China Hospital, Sichuan University from May to August 2023 were prospectively enrolled. Both wireless wearable and traditional wired devices were used to monitor the vital signs of patients after surgery. Spearman correlation analysis, paired sample t test and ratio Bland-Altman method were used to test the correlation, difference and consistency of monitoring data measured by the two devices. The effective monitoring rate of the wireless wearable device within 12 hours was calculated to test the reliability of its continuous monitoring. ResultsA total of 20 patients were enrolled, including 15 females and 5 males with an average age of 46.20±11.52 years. Data collected by the two monitoring devices were significantly correlated (P<0.001). Respiratory rate and blood oxygen saturation data collected by the two devices showed no statistical difference (P>0.05), while heart rate measured by wireless wearable device was slightly lower (\begin{document}$ \bar{d} $\end{document}=−0.307±1.073, P<0.001), and the blood pressure (\begin{document}$ \bar{d} $\end{document}=1.259±5.354, P<0.001) and body temperature(\begin{document}$ \bar{d} $\end{document}=0.115±0.231, P<0.001) were slightly higher. The mean ratios of heart rate, respiratory rate, blood oxygen saturation, blood pressure and body temperature collected by the two devices were 0.996, 1.004, 1.000, 1.014, and 1.003, respectively. The 95% limits of agreement (LoA) and 95% confidence interval of 95%LoA of each indicator were within the clinically acceptable limit. The effective monitoring rate of each vital signs within 12 hours was above 98%. ConclusionThe wireless wearable device has a high accuracy and reliability for continuous monitoring vital signs of patients after VATS for lung cancer, which provides a security guarantee for subsequent large-scale clinical application and further research.
PurposeTo analyze the effect of medication withdraw (MW) on long-term electroencephalogram (EEG) monitoring in children who need preoperative assessment for refractory epilepsy.MethodsRetrospective analysis was performed on the data of preoperative long-term EEG monitoring of children with refractory epilepsy who needed preoperative evaluation in the Pediatric Epilepsy Center of Peking University First Hospital from August 2018 to December 2019. Monitoring duration: at least three habitual seizures were detected, or the monitoring duration were as long as 10 days. MW protocol was according to the established plan.ResultsA total of 576 children (median age 4.4 years) required presurgical ictal EEGs, and 75 (75/576, 13.0%) needed MW for ictal EEGs. Among the 75 cases, 38 were male and 37 were female. The age range was from 15 months to 17 years (median age: 7.0 years). EEG and clinical data of with 65 children who strictly obey the MW protocol were analyzed. The total monitoring duration range was from 44.1 h (about 2 days) to 241.8 h (about 10 days)(median: 118.9 h (about 5 days)). Interictal EEG features before MW were including focal interictal epileptiform discharge (IED) in 39 cases (39/65, 60%), focal and generalized IED in 2 cases (2/65, 3.1%), multifocal IED in 20 cases (20/65, 30.7%), multifocal and generalized IED in 2 cases (2/65, 3.1%), and no IED in 2 cases (2/65, 3.1%). After MW, 18 cases (18/65, 27.7%) had no change in IED and the other 47 cases had changes of IED after MW. And IEDs in 46 cases (46/65, 70.8%) were aggravated, and IED was decreased in 1 case. The pattern of aggravated IED was original IED increasement, in 41 cases (41/46, 89.1%), and 5 cases (5 /46, 10.9%) had generalized IED which was not detected before MW. Of the 46 patients with IED exacerbations, 87.3% appeared within 3 days after MW. Habitual seizures were detected in 56 cases (86.2%, 56/65) after MW, and within 3 days of MW in 80.4% cases. Eight patients (14.3%) had secondary bilateral-tonic seizure (BTCS), of which only 1 patient had no BTCS in his habitual seizures. In 56 cases, 94.6% (53/56) had seizures after MW of two kinds of AEDs.Conclusions① In this group, thirteen percent children with intractable epilepsy needed MW to obtain ictal EEG; ② Most of them (86.2%) could obtain ictal EEG by MW. The IED and ictal EEG after MW were still helpful for localization of epileptogenic zone; ③ Most of the patients can obtain ictal EEG within 3 days after MW or after MW of two kinds of AEDs;4. The new secondary generalization was extremely rare.
ObjectiveTo analyse the microsurgical treatment and facial nerve preservation of giant acoustic neuromas. MethodsUnder the conditions of facial nerve monitoring, 400 patients with giant acoustic neuromas underwent microsurgical removal via suboccipital retrosigmoid approach between January 2005 and January 2013. There were 186 males and 214 females, with the age ranged from 15 to 74 years (mean, 41.6 years). The disease duration was 2-13 years (mean, 2.4 years). The lesions were located at the left cerebellopontine angle region (CPA) in 191 cases, right CPA in 200 cases, bilateral CPA in 9 cases. The clinical manifestations included unilateral hearing loss and tinnitus as first symptoms in 389 cases, facial numbness in 373 cases, unilateral facial paralysis in 370 cases, headache in 269 cases, lower cranial nerve symptoms with drinking cough and dysphagia in 317 cases, and unstable gait in 342 cases. Preoperative skull base thin layer CT showed varying degrees of horn-like expansion in ipsilateral internal auditory canal opening. MRI showed cysts in 78 cases and solid masses in 322 cases; with hydrocephalus in 269 cases. Postoperative cranial MRI or CT was taken to observe the extent of tumor resection. The preservation of facial nerves in anatomy was assessed by intraoperative microscope video and electrophysiological monitoring; the facial nerves function was assessed according to House-Brackmann (HB) classification on the first day after operation; and the rehabilitation of facial nerve function was also assessed at discharge and at 1 year postoperatively by using HB grade. ResultsTotal tumor removal was achieved in 372 cases (93.00%), and subtotal removal in 28 cases (7.00%). One case died of delayed brainstem ischemia at 14 days after operation, and 1 case died of lung infection at 20 days after operation; 398 cases were followed up 6 months to 8 years (mean, 3.5 years). Recurrence occurred in 1 case because of neurofibromatosis at 5 years after operation. The rate of anatomical preservation of the facial nerve during operation was 91.75% (367/400), and the functional preservation rate at the first day after operation was 62.75% (251/400). The HB grade of facial nerve function showed significant difference aomng 3 time points (at the first day, at discharge and at 1 year after operation) (χ2=23.432, P=0.000). Complications included postoperative intracranial infection in 11 cases (2.75%), cerebrospinal fluid leakage in 29 cases (7.25%), aggravated lower cranial nerve symptoms in 18 cases (4.50%), subcutaneous effusion in 13 cases (3.25%), second operation to remove hematoma in 9 cases (2.25%), postoperative circumoral herpes simplex virus infection in 25 cases (6.25%), and all complications were cured after symptomatic treatment. Postoperative hydrocephalus disappeared in 261 cases. ConclusionSurgical operation is the first choice in the treatment of giant acoustic neuromas. Under the auxiliary of neural electrophysiological monitoring, the microsurgery operation via suboccipital retrosigmoid approach for giant acoustic neuromas has extremely low mortality and high preservation rate of facial nerve function.
Abstract: Objective To evaluate the effect on gastroesophageal reflux and gastric emptying in the different route of gastroesophageal anastomosis objectively after esophagectomy for patients with midesophageal carcinoma. Methods Forty patients with midesophageal carcinoma were randomly divided into two groups. Esophageal bed group (n=20): the gastroesophageal anastomosis were performed while the stomach were pulled on through the esophageal bed after esophagectomy; endothoracic group (n=20): gastroesophageal anastomosis were performed while the stomach were pulled on in the thoracic cavity. Ten persons had no disease of digestive system and healthy volunteers were recruited as normal control group. 24-hour esophageal pH monitoring and radioisotope gastric emptying checkup were carried out in all experimental subjects 3 months after operation, so as to observe the changes of gastroesophageal reflux and gastric emptying. Results All of the patients’s operation were success. And no anastomotic leakage and no anastomotic stenosis. Three months after operation, the patients in both operation groups were with different level of reflux. DeMeester total appraise score, the times of regurgitation of gastric juice in 24h, gt;5 min reflux frequency, the longest time of keep reflux, pHlt;4.00 total time and pHlt;4.00 of total time percent, these targets in both operation groups were higher than those in control group (Plt;0.01) DeMeester total appraise score, the times of regurgitation of gastric juice in 24 hours, the longest time of keeping reflux, pHlt;4.00 of total time and pHlt;4.00 of total time percent in esophageal bed group were lower than those in endothoracic group(Plt;0.01). The recent period of gastric emptying percentage (GE) in both operative groups were lower than that in normal control group. GE in esophageal bed group experimental meal in the stomach after entering the 30,60,90,120,180 and 240 min were higher than those in endothoracic group. Conclusion After the operation of esophagogastric anastomosis through esophageal bed in upper aortic site,gastroesophageal reflux and delayed gastric emptying exist objectively, However, the technique is superior to the traditional technique to reduce the extent of gastroesophageal reflux and delayed gastric emptying, its mechanism might be the result of mechanical factors.
Objective To explore the factors associated with clinic follow-up of old patients with colorectal cancer and provide more evidence to improve the efficiency and quality of clinic follow-up after sugery. Methods The data of 253 patients who were underwent sugery because of old colorectal cancer in our hospital from January 2009 to May 2010 were reviewed. Data about the rate and times of clinic follow-up within 6 months after operation were collected via Hospital Information Systerm, then the follow-up rate was calculated, and to analyse the possible factors associated with follow-up times and rate. Results The total follow-up rate was 84.2%（213/253）, and the total times of follow-up was between 0 to 24 times per one, （4.08±0.03）times on average. On the times of follow-up, patients inside the city was higher than that outside, patients with medical or postoperative complications were higher than those without, and patients with a stoma was lower than that without, and the differences were statistically significant （P＜0.05）.While on the follow-up rate, patients underwent a radical sugery or with a stoma were lower than those not or without, and the differences were statistically significant （P＜0.05）. Conclusions The clinic follow-up of old colorectal cancer patients is not satisfactory, and the possible factors associated with follow-up times or rate are the distance between residence and hospital, have medical complications or not, have postoperative complications or not, radical sugery or not, and with a stoma or without.
ObjectiveTo discuss the safety of dental extraction with electrocardiogram (ECG) monitoring for cardiovascular patients. MethodsWe summarized and analyzed the clinical data of 933 cases of dental extraction with ECG monitoring from May 2010 to May 2011. Analysis of the change of heart rate and blood pressure in the process of dental extraction was also carried out. ResultsAll patients underwent the tooth extraction successfully. The heart rate and blood pressure increased after local anesthesia and in the process of tooth extraction without any accident. ConclusionUnder the premise of strict control of indications, dental extraction with the implementation of ECG monitoring has a very high security for patients with cardiovascular diseases or other systemic disorders.
As a low-load physiological monitoring technology, wearable devices can provide new methods for monitoring, evaluating and managing chronic diseases, which is a direction for the future development of monitoring technology. However, as a new type of monitoring technology, its clinical application mode and value are still unclear and need to be further explored. In this study, a central monitoring system based on wearable devices was built in the general ward (non-ICU ward) of PLA General Hospital, the value points of clinical application of wearable physiological monitoring technology were analyzed, and the system was combined with the treatment process and applied to clinical monitoring. The system is able to effectively collect data such as electrocardiogram, respiration, blood oxygen, pulse rate, and body position/movement to achieve real-time monitoring, prediction and early warning, and condition assessment. And since its operation from March 2018, 1 268 people (657 patients) have undergone wearable continuous physiological monitoring until January 2020, with data from a total of 1 198 people (632 cases) screened for signals through signal quality algorithms and manual interpretation were available for analysis, accounting for 94.48 % (96.19%) of the total. Through continuous physiological data analysis and manual correction, sleep apnea event, nocturnal hypoxemia, tachycardia, and ventricular premature beats were detected in 232 (36.65%), 58 (9.16%), 30 (4.74%), and 42 (6.64%) of the total patients, while the number of these abnormal events recorded in the archives was 4 (0.63%), 0 (0.00%), 24 (3.80%), and 15 (2.37%) cases. The statistical analysis of sleep apnea event outcomes revealed that patients with chronic diseases were more likely to have sleep apnea events than healthy individuals, and the incidence was higher in men (62.93%) than in women (37.07%). The results indicate that wearable physiological monitoring technology can provide a new monitoring mode for inpatients, capturing more abnormal events and provide richer information for clinical diagnosis and treatment through continuous physiological parameter analysis, and can be effectively integrated into existing medical processes. We will continue to explore the applicability of this new monitoring mode in different clinical scenarios to further enrich the clinical application of wearable technology and provide richer tools and methods for the monitoring, evaluation and management of chronic diseases.
ObjectiveThe guideline is formulated to standardize the principles, procedures and methods of developing therapeutic drug monitoring (TDM) guidelines and to promote open, transparent, scientific and credibility of the TDM guidelines.MethodsDivision of Therapeutic Drug Monitoring, Chinese Pharmacological Society established guideline working groups, declared and managed conflict of interest. The guideline working groups used the Delphi method to formulate the purpose and scope of the guideline and questions in PICO format, searched and synthesized evidence, integrated with Chinese actual situation and TDM characteristics to preliminarily develop recommendations for the guideline for TDM guideline development in China. Through internal discussion of the guideline working groups and external peer review, the content has been improved, and we eventually formulated the guideline suitable for guiding TDM related guidelines development.ResultsThe guideline provide suggestions for problems to be identified and solved in the planning, development, publishing and updating stages of TDM guidelines including forming guideline wording groups, planning guidelines, declaration and management of interests, formulating questions and selecting outcomes, preparing the planning proposal, retrieval and synthesis evidence, evaluating evidence, developing recommendations, drafting guidelines, external review, publishing and spreading guidelines, evaluating guidelines, and updating guidelines.ConclusionsThis guideline can provide methodological guidance and reference for the development of TDM guidelines.
Objective To investigate the antihypertensive effects of continuous airway positive pressure( CPAP) plus antihypertensive drugs on patients with obstructive sleep apnea hypopnea syndrome ( OSAHS) and hypertension.Methods 82 OSAHS patients with hypertension were enrolled in this study. They were randomly divided into a CPAP treatment group( 44 patients, treated with antihypertensive drugs and CPAP) , and a control group( 38 patients, treated with antihypertensive drugs only) . All the patients were performed polysomnography and 24-hour blood pressure monitoring before and 12 weeks after the treatment. Results After 12 weeks treatment, except the systolic pressure in night time( nSBP) , all the parameters of 24-hour blood monitoring improved better in the CPAP group than in the control group( all P lt; 0. 05) . The blood pressure dropped to normal in 75. 0% ( 33/44) CPAP patients and in 52. 6% ( 20 /38) control patients. In the CPAP group, 8( 18. 2% ) cases were withdrawn from antihypertensive drugs, 13( 29. 5% )cases required single agents, and 9( 20. 5% ) cases required three agents to achieve blood pressure control.But in the control group, all the patients needed two or more antihypertensive agents, in which 23( 60. 6% )patients needed three agents to achieve blood pressure control. After the treatment, the patients with dipping pattern blood pressure increased from10 to 29( 22. 7% -65. 9% , P lt;0. 05) in the CPAP group, and from10to 14( 26. 3% -36. 8%, P gt;0. 05) in the control group. Conclusions Combination therapy with CPAP and antihypertensive drugs controls blood pressure better than antihypertensive medication only for OSAHS patients with hypertension with fewer types of antihypertensive agents or even withdrawal from antihypertensive medication in some patients.
ObjectiveTo develop a smart orthosis personalized management system for the treatment of patients with adolescent idiopathic scoliosis (AIS) and to evaluate the feasibility and efficiency through clinical preliminary applications.MethodsThe smart orthosis personalized management system consists of a wireless force monitor, a WeChat Mini Program, a cloud-based storage system, and a website backstage management system. Twenty-two patients with AIS who underwent orthosis treatment and met the selection criteria between March 2020 and December 2020 were enrolled. The follow-up time was 4 months. The parameters used to evaluate patients’ compliance were as follows (back and lumbar): baseline force value, measured force value, force compliance (measured force value/baseline force value×100%), measured wearing time (wearing time of force value was more than 0 N), and time compliance (measured wearing time/prescribed wearing time×100%), in which the prescribed wearing time was 23 hours/day. The baseline force values were measured at initiation, while the measured force value, measured wearing time, force compliance, and time compliance were measured during follow-up. The differences of these parameters between back and lumbar, and the differences among these parameters at 1, 2, 3, and 4 months after orthosis wearing were analyzed.ResultsThe average measured force value of 22 patients (back and lumbar) was (0.83±0.34) N, the average force compliance was 68.5%±17.9%, the average measured wearing time was (15.4±1.7) hours, and the average time compliance was 66.9%±7.7%. The baseline force value and measured force value of back were significantly higher than those of lumbar (P<0.05); the measured wearing time, force compliance, and time compliance between back and lumbar showed no significant difference (P>0.05). The measured force value, measured wearing time, force compliance, and time compliance at 1 month after wearing were significantly lower than those at 2, 3, and 4 months after orthosis wearing (P<0.05), no significant difference was found among 2, 3, and 4 months after orthosis wearing (P>0.05). At different time points after wearing, the measured force value of back were significantly higher than that of lumbar (P<0.05), while there was no significant difference between back and lumbar on the other parameters (P>0.05).ConclusionThe smart orthosis personalized management system has high feasibility to treat AIS, and can improve the compliance of such patients with orthosis wearing.