Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures (version 2023) / 中华创伤杂志

Hip fractures are among the most common fractures in the elderly, presenting to be a leading cause of disability and mortality. Surgical treatment is currently the main treatment method for hip fractures. The incidence of perioperative malnutrition is increased after hip fractures in the elderly due to the comorbidities, decreased basal metabolic rate, accelerated protein breakdown, weakened anabolism and surgical stress. However, malnutrition not only increases the incidence of postoperative complications, but also leads to increased mortality, indicating an important role of perioperative nursing management of nutrition for the elderly patients with hip fractures. At present, there still lacks scientific guidance and application standards on perioperative nursing management of nutrition for the elderly patients with hip fractures. Therefore, the Orthopedic Nursing Committee of Chinese Nursing Association and the Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Expert consensus on perioperative nursing management of nutrition for elderly patients with hip fractures ( version 2023) according to evidence-based medical evidences and their clinical experiences. Fourteen recommendations were made from aspects of nutrition screening, nutrition assessment, nutrition diagnosis, nutrition intervention and nutrition monitoring to provide guidance for perioperative nursing management of nutrition in elderly patients with hip fractures.

Investigation and analysis of individual iodine nutrition among students aged 8 to 15 in Dongtai City, Jiangsu Province in 2021 / 中华地方病学杂志

Objective:To analyze the individual iodine nutrition status and its influencing factors among students aged 8 to 15 in Dongtai City, Jiangsu Province.Methods:From May to August 2021, a total of 905 students aged 8 to 15 were selected as survey subjects in Dongtai City based on the sampling method in the "National Monitoring Plan for Iodine Deficiency Disorders" (2016 version). Salt samples from students' homes were collected for salt iodine testing. Urine samples of students were collected for urinary iodine and creatinine testing. The creatinine correction method was used to estimate individual 24 h urinary iodine excretion and calculate iodine intake. At the same time, basic information (age, gender, height, weight, etc.) and consumption frequency of iodine rich foods (seafood, eggs, meat, milk, solid snacks) of students were collected through questionnaires and actual measurements.Results:The coverage rate of iodized salt in Dongtai City was 98.2% (889/905), the qualified rate of iodized salt was 97.9% (870/889), and the consumption rate of qualified iodized salt was 96.1% (870/905). The median estimated 24 h urinary iodine excretion was 179.7 μg/d. The median estimated iodine intake was 195.4 μg/d, the constituent ratio of estimated iodine intake < recommended nutrient intake (RNI) was 16.2% (147/905), RNI-tolerable upper intake level (UL) was 63.4% (574/905), and > UL was 20.3% (184/905). The medians estimated 24 h urinary iodine excretion of students aged 8-10, 11-13 and 14-15 were 157.4, 193.0 and 236.5 μg/d, respectively, and the difference was statistically significant ( H = 55.42, P < 0.001). The median estimated 24 h urinary iodine excretion of boys was higher than that of girls (222.6 vs 148.6 μg/d), and the median estimated 24 h urinary iodine excretion of urban students was higher than that of township students (215.6 vs 162.7 μg/d), the differences were statistically significant ( Z = - 8.41, - 5.66, P < 0.001). There were statistically significant differences in the median estimated 24 h urinary iodine excretion between students with different body mass index (weight loss, overweight, obesity, normal; H = 56.15, P < 0.001) and iodine rich foods consumption frequencies (seafood, meat, milk, eggs, solid snacks; H = 23.15, 21.20, 60.77, 20.01, 24.47, P < 0.001). Conclusion:Iodine deficiency or excess exists in students aged 8-15 in Dongtai City, and girls aged 8-10 who are physically emaciated are the focus of attention for iodine deficiency.

Ten-day tegoprazan-based concomitant therapy as a first-line treatment for Helicobacter pylori eradication

Background/Aims@#Tegoprazan, a novel potassium-competitive acid blocker, has shown rapid action and gastric acid inhibition. In this study, we evaluated the efficacy of a tegoprazan-based, nonbismuth-containing quadruple (concomitant) therapy for the primary eradication of Helicobacter pylori. @*Methods@#We conducted a prospective, single-arm, single-center, primitive study to verify the efficacy of a 10-day tegoprazan- based (50-mg dose) concomitant therapy, including amoxicillin (1,000-mg dose), clarithromycin (CLA; 500-mg dose), and metronidazole (MET; 500-mg dose) twice daily as a first-line treatment for H. pylori eradication. @*Results@#We tested consecutive cultures for antibiotic susceptibility and minimum inhibitory concentrations. We enrolled 84 participants; 79 (94.0%) completed first-line therapy. The overall intention-to-treat and per-protocol eradication rates were 90.5% (95% confidence interval [CI], 82.1−95.8) and 96.2% (95% CI, 83.4–97.6), respectively. Of the 73 participants evaluated for antibiotic resistance, 19 (26.0%), 32 (42.5%), and 8 (11.0%) exhibited CLA, MET, and CLA and MET dual resistance, respectively. Of these, 39 participants (66.1%) exhibited successful eradication after the therapeutic regimen despite antibiotic resistance. @*Conclusions@#The 10-day tegoprazan-based concomitant therapy may be an effective first-line treatment for eradicating H. pylori.

The Influence of Human Factors in Flight Training / 항공우주의학회지

Purpose@#Most aviation accidents are caused by human factors, and in recent years in Korea, human factors have been identified as the cause of 70% of aviation accidents.Human factors that influence pilots in the aviation field are closely linked to judgment ability and are crucial factors directly impacting flight proficiency. @*Methods@#To explore the human factors that may affect student pilots during flight training, a survey was conducted among flight instructors holding pilot certificates. @*Results@#The results aim not only to identify the human factors that can influence flight performance during training but also to establish a direction for safety by addressing the human factors related to student pilots, with the goal of maintaining safety. @*Conclusion@#Understanding the human factors that affect student pilots, who will be responsible for transporting hundreds of passengers in the future, is essential for cultivating safety knowledge and risk management skills, making it a highly important matter for accident prevention.

Analysis of the use of insulin products in our hospital after centralized volume-based procurement / 中国药房

OBJECTIVE To analyze the implementation of insulin centralized volume-based procurement policy （hereinafter referred to as “centralized procurement”） in our hospital and its effect on the use of insulin products in clinical. METHODS The manufacturer， specifications， usage， sales amount and agreed purchase volume of insulin products in our hospital before （July 4， 2021 to January 3， 2022） and after （July 4， 2022 to January 3， 2023） the centralized procurement were collected. The defined daily dose （DDD） method was used to calculate defined daily doses （DDDs）， defined daily cost （DDC）， the progress of procurement completion and actual cost saving. RESULTS After the centralized procurement， the number of insulin products had increased from 20 to 29 in our hospital； except for the Insulin degludec/aspart injection in our hospital’s original insulin catalog that had not been centrally purchased， all other existing varieties had been included in centralized procurement catalog. The use of Insulin aspart 30 injection produced by Novo Nordisk （China） Pharmaceutical Co.， Ltd. always ranked the first place in the list of usage and DDDs before and after the centralized procurement. The sales amount of Insulin glargine injection produced by Ganli Pharmaceutical Co.， Ltd. and Tonghua Dongbao Pharmaceutical Co.， Ltd. increased significantly due to the significant increase in usage. The centralized procurement of Degu insulin injection from Novo Nordisk （China） Pharmaceutical Co.， Ltd. had achieved a relatively high completion rate in our hospital’s original insulin catalog， while the completion rate for new varieties was low. After the centralized procurement， our hospital actually saved a total of 1 388 582.66 yuan in expenses. CONCLUSIONS After the centralized procurement， the selection and usage of insulin varieties in our hospital are reasonable， which saves patients’ insulin treatment costs， and reduces economic pressure on patients and society.

Hotspots and prospects of esophageal cancer research in China / 中华胃肠外科杂志

Esophageal cancer is a malignant tumor with a high incidence in China. At pesent, advanced esophageal cancer patients are still frequently encountered. The primary treatment for resectable advanced esophageal cancer is surgery-based multimodality therapy, including preoperative neoadjuvant therapy, such as chemotherapy, chemoradiotherapy or chemotherapy plus immunotherapy, followed by radical esophagectomy with thoraco-abdominal two-field or cervico-thoraco-abdominal three-field lymphadenectomy via minimally invasive approach or thoracotomy. In addition, adjuvant chemotherapy, radiotherapy, or chemoradiotherapy, or immunotherapy may also be administered if suggested by postoperative pathological results. Although the treatment outcome of esophageal cancer has improved significantly in China, many clinical issues remain controversial. In this article, we summarize the current hotspots and important issues of esophageal cancer in China, including prevention and early diagnosis, treatment selection for early esophageal cancer, surgical approach selection, lymphadenectomy method, preoperative neoadjuvant therapy, postoperative adjuvant therapy, and nutritional support treatment.

Relationship between cadmium exposure and pulmonary function level and chronic obstructive pulmonary disease / 中华劳动卫生职业病杂志

Objective: To analyze the levels and distribution characteristics of blood cadmium and urinary cadmium in American adults, to analyze the relationship between blood cadmium and urinary cadmium and pulmonary function dose response, and to explore the effect of this index on the risk of chronic obstructive pulmonary disease. Methods: In March 2022, 3785 patients from 2007 to 2012 in NHANES database were selected as the subjects. Collect demography data such as gender and age, and test data such as lung function, blood cadmium concentration and Urine cadimium concentration. The relationship between blood and urine cadmium levels and lung function and pulmonary function and chronic obstructive pulmonary diease (COPD) was analyzed by Mann-Whitney U test or Kruskal-Wallis H test, multivariate linear regression and restricted cubic spline method. Results: The geometric mean of blood cadmium and urine cadmium in American adults was 0.37 g/L and 0.28 g/L, FEV(1) and FEV(1)/FVC among different cadmium exposure groups was statistically significant, and there was a negative linear dose-response relationship between serum Cd and urine Cd concentrations and FEV(1)/FVC levels (P(overall)<0.001, P(non-linear)=0.152; P(overall)<0.001, P(non-linear)=0.926). Compared with the lowest quartile concentration (Q1), the highest quartile blood cadmium concentration (Q4) (OR=1.934, P(trend)=0.000) and urinary cadmium concentration (OR=1.683, P(trend)=0.000) may increased the risk of chronic obstructive pulmonary disease. Conclusion: There is a negative correlation between blood cadmium, urinary cadmium levels and lung function in American adults, and cadmium may increase the risk of chronic obstructive pulmonary disease.

Predictive Value of Exercise Blood Pressure Changes for Orthostatic Hypotension in Patients With Parkinson’s Disease

Background@#and Purpose Orthostatic hypotension (OH) is common in patients with Parkinson’s disease (PD). Early recognition OH is required with sensitive assessments. The purpose of this study was to determine whether blood pressure (BP) changes during exercise can predict the occurrence of OH in PD. @*Methods@#This prospective cohort study included 80 consecutive patients with PD. All patients agreed to participate in a baseline evaluation and cardiopulmonary exercise test (CPET).According to the initial active standing test (AST), those without OH (PD-nonOH) at baseline had their AST results followed up for 6 months. The main outcome was defined as whether patients without OH at baseline would develop OH after 6 months. Logistic regression analysis was applied to identify the relevant variables. A nomogram was constructed based on clinical features and identified variables. The concordance index (C-index) and area under the receiver operating characteristic curve (AUC) were used to evaluate the accuracy and predictive ability of the nomogram, respectively. @*Results@#CPET results indicated that peak load, peak heart rate, heart rate recovery at 1 min, and systolic BP change (ΔSBP) were lower in those with OH than in the PD-nonOH group (p<0.05) at baseline. Logistic regression analysis indicated that peak load and ΔSBP during CPET had significant effects on OH (p<0.05). Age, sex, peak load, and ΔSBP were used to construct the nomogram model (C-index=0.761). The prediction model had an AUC of 0.782 (95% confidence interval=0.649–0.889) and a specificity and sensitivity of 70.0% and 81.8%, respectively. @*Conclusions@#This study has identified predictive factors for OH development in patients with PD. CPET could be used as a complementary examination to identify patients at a high risk of OH.

Acute Necrotizing Myelitis Associated with COVID-19

Acute ascending hemorrhagic longitudinally extensive transverse myelitis is a rare inflammatory demyelinating disorder, which invades several vertebral segments and progresses rapidly and manifests severe symptoms. We present a case of acute necrotizing myelitis associated with COVID-19 infection. A 10-year-old female, with no previous medical history and no prior administration of COVID-19 vaccination, contracted COVID-19 in early April 2022. Two weeks later, she suffered from severe posterior neck pain and also presented with motor weakness and numbness in both lower extremities, making it difficult to walk independently and spontaneously void urine. Initial spinal cord MR showed longitudinally segmental extensive T2 hyperintensities. Cerebrospinal fluid (CSF) analysis revealed elevated red blood cell, normal white blood cell, and elevated protein levels and absence of oligoclonal bands. CSF culture and viral polymerase chain reaction were negative. Autoimmune work-up was negative. She was started on intravenous methylprednisolone 1g/day for 5 days and immunoglobulin (Ig) 2 g/kg for 5 days. She was also treated with six courses of therapeutic plasma exchange. Nevertheless, her pain and motor weakness persisted. She eventually developed respiratory failure. Follow-up MR presented a newly noted small hemorrhagic component. She was consequently treated with two additional courses of methylprednisolone and Ig. At 6-months follow-up, neurological examination showed improvement with normal sensory function and motor grade IV function in both upper extremities. We present the case of acute necrotizing myelitis associated with COVID-19 infection. Multiple courses of methylprednisolone and Ig showed mild improvement in motor and sensory function. However, poor prognosis was unavoidable due to rapid progression of the disease.

Nusinersen for Spinal Muscular Atrophy Type I with Chronic Respiratory Failure: A Retrospective Study in South Korea

Purpose@#To analyze the efficacy and safety of nusinersen in patients with spinal muscular atrophy (SMA) type I with chronic respiratory failure. @*Materials and Methods@#We retrospectively reviewed seven patients diagnosed with SMA type I and chronic respiratory failure who were on permanent ventilation and treated with nusinersen at Gangnam Severance Hospital between January 2018 and July 2023. Patient demographics and clinical characteristics were recorded, and treatment progress was evaluated according to Hammersmith Infant Neurological Examination (HINE-2) and Children’s Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) scores. @*Results@#Patients initially developed hypotonia at a mean age of 3.7 months. Mean age at start of nusinersen was 7.3 years; the mean duration of follow-up after starting nusinersen was 46.2 months. At 6-, 18-, 38-, 58-, and 74-month follow-up, the mean changes in CHOP-INTEND scores were 1.0, 2.9, 1.8, 1.5, and 1.5, respectively, and the proportions of patients who showed disease amelioration were 28.6%, 71.4%, 75.0%, 100%, and 100%, respectively. @*Conclusion@#Nusinersen is safe and effective in patients with SMA type I, even those with chronic respiratory failure and those on permanent ventilation. No significant adverse effects of nusinersen were observed.

Laboratory and clinical characteristics of patients with different SF3B1 genotypes in myelodysplastic syndromes / 中华检验医学杂志

Objective:To analyze the distribution of different SF3B1 genotypes in patients with myelodysplastic syndromes (MDS) and its prognostic value.Methods:Totally, 377MDS patients who were initially diagnosed in the First Affiliated Hospital of Nanjing Medical University from January 2014 to January 2022 were included in the retrospective analysis.The patients were divided into three different groups according to mutation stcote of SF3B1, including 317 patients with SF3B1 wild type (SF3B1 WT) (214 males and 103 females, 63(49, 71) years old),39 patients with SF3B1 K700E mutation(SF3B1 K700E(17 males and 22 females, 65(52, 73)years old)) and 21 patients with SF3B1 non-K700E mutation(SF3B1 non-K700E)(13 males and 8 females, 67(63, 73) years old). MDS-related 20 gene mutations were detected using targeted sequencing technology; Survival curves were constructed by the Kaplan-Meier method; Cox proportional hazards model was established to evaluate different factors at diagnosis on survival by univariate and multivariate analyses.. Results:Compared with SF3B1 non-K700E patients, SF3B1 K700E patients had a higher median absolute neutrophil count ( P=0.002) and were likely to be in the low/int-1 International Prognostic Scoring System (IPSS) categories ( P=0.023). A 20-gene targeted sequencing analysis showed that, compared with SF3B1 WT patients, SF3B1 K700E patients were associated with lower frequency of ASXL1 and U2AF1 mutations ( P=0.018 and P=0.003); while compared with SF3B1 non-K700E patients, the frequency of ASXL1 mutation was significantly lower in SF3B1 K700E cases ( P=0.029). Patients with SF3B1 K700E had better overall survival (OS) in comparison with SF3B1 WT and SF3B1 non-K700E in MDS patients ( P<0.001 and P=0.045, respectively). In comparison with SF3B1 WT patients, SF3B1 MUT patients had more favorable OS and progression-free survival (PFS) in MDS without excess blasts ( P<0.001 and P<0.001, respectively), but no significant difference was found in MDS with excess blasts ( P>0.05). Compared with SF3B1 WT patients, SF3B1 K700E patients had superior OS and PFS in the int-1 IPSS category ( P=0.010 and P=0.013, respectively). By multivariable analysis, the presence of SF3B1 K700Ewas an independent predictor of superior OS ( HR=0.461,95% CI 0.262-0.811, P=0.007). Conclusion:SF3B1 K700E and SF3B1 non-K700E patients had significantly improved OS in comparison with SF3B1 WT MDS patients. Furthermore, SF3B1 K700E patients were associated with a better OS compared with SF3B1 non-K700E MDS patients. SF3B1 mutation could not overcome the poor prognostic effect of excess blasts, which highlights the importance of the SF3B1 mutation subtype in risk assessment of MDS without excess blasts.

Exploring the application of inquiry-based defensive teaching based on the internet and clinical resources during probationary teaching of dermatovenereology / 中华皮肤科杂志

As a clinical compulsory course, dermatovenereology is characterized by various diseases, complex etiology, and distinct morphological characteristics, and its teaching during the probation period is faced with many challenges. Based on today′s rich educational resources on the internet, and combined with rich clinical resources in large hospitals, the traditional teacher-led lecturing during the probation period needs to be changed, and the adoption of inquiry-based defensive teaching mode has obvious advantages over the traditional teacher-led teaching mode. In the inquiry-based defensive teaching mode, clinical teachers design a series of clinical questions based on clinical topics, then introduce network teaching videos to students to change classroom teaching into students′ after-class learning, induce students to actively explore issues, encourage them to work together in groups to excavate clinical resources, make presentations and organize defense. This teaching mode turns the traditional teacher-led probationary class into a student-led and teacher-assisted speculative defense session, thereby improving learning efficiency and quality, and promoting the cultivation of students′ core literacy and comprehensive ability. Undergraduates are the main target group of this teaching mode, and this mode can also be adopted in the teaching of postgraduates and resident doctors in the standardized training program for the organization of teaching activities and optimization of assessment modes.

Effects of persistent isolated hypothyroxinemia in the first and second trimester of pregnancy on complications and adverse outcomes of pregnancy / 中华内分泌代谢杂志

Objective:To investigate the effects of persistent isolated hypothyroxinemia in the first and second trimester of pregnancy on complications and adverse outcomes of pregnancy.Methods:A retrospective analysis was conducted in 784 pregnant women including 111 cases of persistent isolated hypothyroxinemia in the first and second trimester of pregnancy and 673 pregnant women with normal thyroid function as control group. All women were registered and delivered in the Department of Obstetrics of our hospital from April 2016 to April 2017. The complications and adverse outcomes of pregnancy in the two groups were analyzed.Results:Age, body weight before pregnancy, body mass index(BMI), 1 h plasma glucose and 2 h plasma glucose during oral glucose tolerance test in persistent isolated hypothyroxinemia group were higher than those in control group( P<0.05), with increased incidence of anemia during pregnancy( P<0.05). However, there were no significant differences in the incidences of gestational diabetes mellitus and gestational hypertension between the two groups( P>0.05). No significant statistical differences were found in macrosomia, stillbirth, neonatal malformation, postpartum hemorrhage, acute delivery, premature delivery, fetal intrauterine development delay, and small full-term infants between the two groups( P>0.05). Logistic regression analysis showed that age( OR=1.1, 95% CI 1.0-1.1, P=0.002) and pre-pregnancy body weight( OR=1.0, 95% CI 1.0-1.1, P=0.046) were risk factors for the occurrence of persistent isolated hypothyroxinemia in the first and second trimesters of pregnancy. Persistent isolated hypothyroxinemia in the first and second trimesters was associated with anemia during pregnancy( OR=1.9, 95% CI 1.1-3.2, P=0.024). Conclusions:Pregnant women who are older and heavier before pregnancy should pay more attention to their thyroid function. Pregnant women with persistent isolated hypothyroxinemia in the first and second trimesters should be concerned for anemia.

Application effect of intelligent education model in the health management of the smokers with high-risk of chronic obstructive pulmonary disease / 中华健康管理学杂志

Objective:To explore the application effect of the intelligent interactive health education model in the health management of the smokers with high-risk of chronic obstructive pulmonary disease (COPD).Methods:From September 2019 to January 2020, 72 smokers with high-risk of COPD were recruited from Health Management Center, the First Affiliated Hospital of Nanjing Medical Universit y. The subjects were randomly divided into traditional group (35 cases) and intelligent group (37 cases) according to the intervention model. The traditional group used the method of mailing health education materials, while the intelligent group sent health education materials with the help of mobile intelligent platform for interactive feedback and intervention. After 12 weeks of intervention, the subjects′ nicotine dependence, international physical activity, population satisfaction, time consumption for follow-up and other indicators were compared. Results:After the intervention, the score of nicotine dependence in the intelligent group was lower than that in the traditional group [(1.86±1.48) vs (3.77±1.66), P<0.05], the number of smoking cessation cases was more than that in the traditional group (11 vs 1, P<0.05), the number of cases with significant improvement in the score of international physical strength scale was significantly improved than that in the traditional group (15 vs 0, P<0.01), and the satisfaction was higher than that in the traditional group (97.30% vs 42.85%, P<0.01), and the time consumption was less than that in the traditional group [(18.03±2.96) vs (25.14±2.64) min, P<0.01]. Conclusion:The intelligent interactive health education model can improve the health education effect of the smokers with high risk of developing COPD, and improve the health behavior of the population.

Clinical phenotype and gene mutation analysis of 12 patients with hereditary protein C deficiency in different families / 中华血液学杂志

Objective: To investigate the molecular pathogenesis and clinical features of unrelated 12 patients with inherited coagulation protein C (PC) deficiency in Chinese population. Methods: The PC activity (PC:A) and PC antigen (PC:Ag) were detected by chromogenic substrate and enzyme linked immunosorbent assay, respectively. The nine exons and flanking sequences of the protein C (PROC) gene were amplified by polymerase chain reaction with direct sequencing, and the suspected mutations were validated by reverse sequencing (clone sequencing for deletion mutations) . Results: The PC:A of the 12 probands decreased significantly, ranging from 18% to 55%, and the PC:Ag of the 10 probands decreased significantly. Eleven mutations were found, out of which four mutations [c.383G>A (p.Gly128Asp) , c.997G>A (p.Ala291Thr) , c.1318C>T (p.Arg398Cys) , and c.532G>C (p.Leu278Pro) ] were discovered for the first time. Six mutations were in the serine protease domain, four mutations were located in epidermal growth factor (EGF) -like domains, and one mutation was located in activation peptide. There were two deletion mutations (p.Met364Trp fsX15 and p.Lys192del) , and the rest were missense mutations. Mutations p.Phe181Val and p.Arg189Trp were identified in three unrelated families. All mutations may be inherited, and consanguineous marriages were reported in two families. Among the probands, nine cases had venous thrombosis, two cases had poor pregnancy manifestations, and one case had purpura. Conclusion: Patients with PC deficiency caused by PROC gene defects are prone to venous thrombosis, especially when there are other thrombotic factors present at the same time.

Clinical significance of monitoring parathyroid hormone in drainage fluid and serum after total thyroidectomy / 中华内分泌外科杂志

Objective:To observe the effect of different clinical factors on the level of parathyroid hormone (PTH) and to predict the possibility of permanent hypothyroidism (PHP) after total thyroidectomy (TT) by monitoring the levels of PTH in serum and drainage fluid after TT.Methods:Retrospective analysis was made on 150 patients who underwent TT for papillary thyroid carcinoma (PTC) in the Department of Thyroid Head and Neck Surgery in Jilin Cancer Hospital from Jan. 2020 to Aug. 2021. The changes of serum PTH were recorded at 1, 3, 7, 30 days and 6 months after surgery. The risk factors of postoperative hypoparathyroidism (HP) were investigated by single factor and multi factor methods. The impairment of parathyroid function was predicted combined with the level of PTH in the drainage fluid 1 day after operation.Results:After TT, serum PTH returned to normal value in most patients 1 month after operation. The proportion of PHP was 3.33% (5/150). Univariate analysis showed that bilateral central lymph node dissection, Hashimoto’s thyroiditis, tumor diameter ≥2 cm and intraoperative selective parathyroid autologous transplantation were risk factors for temporary hypoparathyroidism (THP). Multivariate analysis showed that BCND ( OR=0.322, P=0.001) , intraoperative selective parathyroid autograft ( OR=5.442, P=0.001) and tumor diameter ≥2 cm ( OR=2.247, P=0.003) were independent risk factors for THP. ROC curve was used to compare the predictive effect of postoperative serum and drainage PTH levels on postoperative PHP. The statistical results showed that the highest predictive effect of postoperative PHP was found on the first day of drainage PTH level within 1 week after operation (AUC 0.81) . 54 cases whose serum PTH was lower than normal value on the first day after operation were divided into 4 groups according to the level of PTH in drainage fluid from high to low. The results showed that the lower the level of PTH in drainage fluid, the greater the possibility of PHP ( P<0.05). Conclusions:Most of the patients with low PTH one month after operation develop PHP, while bilateral central lymph node dissection, intraoperative selective parathyroid transplantation, tumor diameter ≥2 cm are risk factors for THP after TT. If the serum PTH is lower than the normal value on the first day after operation, there is a possibility of PTH. The lower the PTH in the drainage fluid, the greater the possibility of PHP, which should be paid attention to in clinical practice.

Development of Fucosterol Certified Reference Material / 中国实验方剂学杂志

Objective:According to the GB/T 15000.3-2008， to develop a fucosterol certified reference material based on the project approved by Standardization Administration. Method:Fucosterol was isolated from <italic>Laminaria japonica</italic> dried thallus via 95% ethanol extraction， vacuum concentration， repeated column chromatography separation， recrystallization in petroleum ether-ethyl acetate， and residual solvent removal. Its chemical structure was identified by elemental analysis （EA）， infrared spectrum （IR）， mass spectrometry （MS）， nuclear magnetic resonance （NMR） and X-ray diffraction （XRD）. Its homogeneity， stability， and cooperative certification conducted by 8 laboratories were carried out by high performance liquid chromatography with evaporative light scattering detector. Result:For the fucosterol reference material， the certified value of purity was 99.54% with expanded uncertainty of 0.16% in confidence interval of 95%， the stability was good within 24 months storage period at 2-4 ℃， which met the technical requirements of reference material and passed the acceptance organized by Standardization Administration. Conclusion:The national standard materials of fucosterol has been successfully developed， which can be used for the determination of this component， the evaluation of detection methods， and the detection and quality control of related products.

A preliminary study on the surgical timing of spinal tuberculosis / 中国骨伤

OBJECTIVE@#To observe the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery, explore the timing of surgical intervention, and evaluate its influence on surgical safety.@*METHODS@#A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017, including 278 males and 109 females, aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis, 86 cases of thoracic tuberculosis, 76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvementand 90 patients with multiple segmental involvement. Among them, 62 cases presented neurological damage, and preoperative spinal cord neurological function depended on ASIA grade, 5 cases of grade A, 8 cases of grade B, 39 cases of grade C, and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment, the patients were divided into group A (256 cases, receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases, receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender, age, preoperative complicated pulmonary tuberculosis, lesion site, lesion scope, surgical approach, drug resistance and other general clinical characteristics. ESR, CRP, visual analogue scale(VAS), Oswestry Disability Index (ODI), Frankel grade and postoperative complications were observed.@*RESULTS@#All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender, age, preoperative pulmonary tuberculosis, lesion site, lesion range, surgical approach, preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery, with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery (@*CONCLUSION@#After 2-4 weeks of anti tuberculosis treatment before operation, patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle, patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery.

Expert consensus on clinical application of Wangbi Tablets in treating rheumatoid arthritis and knee osteoarthritis / 中国中药杂志

Wangbi Tablets are widely used in the treatment of rheumatoid arthritis, knee osteoarthritis and other diseases at pre-sent. Long-term clinical application and research have shown that this drug has a good effect in reducing the pain of related diseases and improving symptoms. Due to the lack of guidance in the instructions and currently no relevant norms to guide the clinical application of Wangbi Tablets, in order to further improve clinicians' understanding of the drug and fully tap the clinical advantages of the drug, the Professional Committee of Orthopedics and Traumatology Drug Research of China Association of Chinese Medicine organized experts in the fields of rheumatism, orthopedics, pharmacy and methodology in Chinese and western medicine to develop expert consensus on Chinese patent medicines in accordance with the relevant requirements of the consensus methodology. Based on full consideration of clinical research evidence and expert experience, the clinical issues were summarized in the consensus, and for those clinical problems supported by evidences, the internationally recognized recommendation evaluation and formulation method GRADE was used to evaluate the evidence and form recommendations; for those clinical issues not supported by evidences, a consensus was reached through the nominal group method to form consensus recommendations. The consensus adopted a concise and clear format to form re-commendations or reach consensus suggestions on the medication regimen, medication characteristics, intervention timing, usage and dosage, course of use and safety issues for the treatment of rheumatoid arthritis and knee osteoarthritis with Wangbi Tablets. It is suggested that its application will better improve the efficacy of Wangbi Tablets in the treatment of rheumatoid arthritis and knee osteoarthritis, at the same time provide a reference for clinicians to use Wangbi Tablets in a standardized, reasonable and safe manner.

Comparative analysis of binding multi-fold rib graft, iliac bone graft and titanium mesh graft during surgery of tuberculosis of thoracic vertebra / 中国骨伤

OBJECTIVE@#To compare the clinical effects of three different methods of binding multi-fold rib graft, iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process.@*METHODS@#A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients, after thoroughly remove the necrotic tissue of tuberculosis, three different bone grafts were used respectively including iliac bone graft (36 cases, group A), binding multi-fold rib graft (35 cases, group B), titanium mesh bone graft (36 cases, group C). Perioperative indexes, the time required for bone graft during operation, intraoperation blood loss, the loss rate of the anterior edge of the lesion, Cobb angle, postoperative bone graft fusion time, spinal nerve recovery and Oswestry Disability Index were compared among three groups.@*RESULTS@#All the patients were followed up for 13 to 24 months, and the operation time required for bone graft was (23.2±4.1) min in group A, (23.8± 4.4)min in group B, and (25.5±4.2) min in group C, with no statistically significant difference among three groups (@*CONCLUSION@#The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft, iliac bone graft and titanium mesh graft, but binding multi-fold rib graft can effectively avoid iliac bone donor complications, and is an effective alternative to iliac bone graft, which is worth popularizing.