An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique (version 2023) / 中华创伤杂志

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Progress of chimeric antigen receptor in childhood acute T-lymphoblastic leukemia / 国际儿科学杂志

Acute lymphoblastic leukemia(ALL)is the most common malignant tumor in childhood, and T-ALL accounts for 10%~15% of all in children with ALL.Based on the application of MICM classification, risk stratification and multi-drugs intensive therapy, the prognosis of children with T-ALL has been improved, but the overall survival rate and event free survival rate are still less than 70%, and the overall survival rate of relapsed / refractory T-ALL is less than 10%.The treatment of T-ALL in children still faces great challenges.CDl9 targeted chimeric antigen receptor(CAR)modified T cells have shown impressive results in children with refractory B-ALL, with remission rate of 70%~90%.The emergence of CAR-T and CAR modified NK cells(CAR-NK)targeted therapy is expected to improve the prognosis of T-ALL in children.This article reviews the latest progress of CAR-T and CAR-NK in children with T-ALL.

Effect of IGF1Rβ Subunit Mutants on Proliferation, Migration and Apoptosis of Human Osteosarcoma Cells / 肿瘤防治研究

Objective To investigate the effect of IGF1R β subunit mutants sb-IGF1R and ma-IGF1R on the biological behavior of osteosarcoma 143B cells. Methods We designed and constructed sb-IGF1R and ma-IGF1R fragments. They were cloned into adenovirus AdEasy shuttle plasmid, to obtain Ad-sbIGF1R and Ad-maIGF1R. We observed the proliferation, migration and apoptosis of the osteosarcoma cells transfected with Ad-sbIGF1R, Ad-maIGF1R and Ad-IGF1R. The Ad-sbIGF1R, Ad-maIGF1R and Ad-GFP nude mouse models were constructed to evaluate the tumor growth in vitro. Results By plasmid PCR, IGF-1R β subunit mutant was overexpressed in osteosarcoma cells. Ad-sbIGF1R and Ad-maIGF1R significantly inhibited the proliferation and migration of osteosarcoma cells, and promoted cell apoptosis, and inhibited tumor growth in subcutaneous tumor-bearing nude mouse models. Conclusion IGF1R β subunit mutants inhibit the proliferation and migration of osteosarcoma cells and induce cell apoptosis.

Factors associated with the risk of violent behaviour in patients with acute mental disorders / 四川精神卫生

ObjectiveTo explore the factors associated with the risk of violent behaviour in inpatients with acute mental disorders， and to provide references for early detection and intervention of violent behaviour in patients with acute mental disorders. MethodsBased on the medical record system of the Affiliated Brain Hospital of Guangzhou Medical University， 1 107 inpatients with acute mental disorders from January to December 2016 were selected， all of whom met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10）. At admission， the risk assessment tools were used to assess the risk level of violent behaviour of inpatients， and 8 variables containing general demographic data and clinical data were selected to explore the factors associated with the risk of violent behaviour in inpatients with acute mental disorders. Thereafter， Logistic regression analysis was performed to screen the factors affecting the high risk of violent behaviour among inpatients. ResultsAmong the 1 107 inpatients with acute mental disorders， 357 （32.25%） patients were at high risk of violence. Regression analysis showed that gender of male （OR=1.747， 95% CI： 1.303~2.342）， manic episodes （OR=2.018， 95% CI： 1.310~3.108） and emergency admission （OR=4.244， 95% CI： 3.083~5.840） were risk factors affecting the high risk of violent behaviour of inpatients. Among different types of mental disorders， patients with depressive disorder had a relatively low risk of violent behaviour （OR=0.397， 95% CI： 0.233~0.677）. ConclusionAmong inpatients with acute mental disorders， patients of emergency admission， being male and manic episodes are more likely to be at high risk of violent behaviour.

Sleep characteristics and their impact on suicide risk among adolescents with depressive disorder and bipolar disorder / 四川精神卫生

ObjectiveTo compare the differences in sleep structure characteristics between adolescents with depressive disorder and adolescents with bipolar disorder， and to explore the impact of sleep indicators and other factors on the suicide risk of adolescents with affective disorder. MethodsThe medical records of adolescents with depressive disorder （n=97） and bipolar disorder （n=52） who met the International Classification of Diseases， tenth edition （ICD-10） and hospitalized in the Affiliated Brain Hospital of Guangzhou Medical University from January 1， 2019 to June 30， 2021 were retrospectively reviewed. Data including age， gender， body mass index （BMI）， psychiatric diagnosis， the Nurses' Global Assessment of Suicide Risk （NGASR） score and polysomnography （PSG） results of the patients were collected. Then patients were divided into two groups according to NGASR score， scored 0~5 were in the low risk group （n=32） and scored above 5 were in the high risk group （n=117）. Meantime， the PSG data of normal adolescents （n=80） in the previous literature were collected as the control group. Thereafter， a multiple linear regression model was established to explore the related factors affecting suicide risk in adolescents with affective disorder. ResultsThe sleep efficiency and the proportion of stage N2 sleep in high risk group were lower than those in low risk group （Z=-2.138， -2.520， P<0.05）. The total sleep time， N2 sleep duration and rapid eye movement （REM） sleep time in depression group were less than those in bipolar group （t=-2.822， -3.087， -2.277， P<0.05 or 0.01）. The proportion of REM sleep in depression group and bipolar group were lower than those in control group （t=-2.369， -2.069， P<0.05）. Linear regression analysis denoted that the factors affecting the suicide risk in adolescents with affective disorder included stage N1 sleep duration （β=0.019， P<0.05）， gender （male vs. female， β=-4.051， P<0.01） and psychiatric diagnosis （bipolar disorder vs. depressive disorder， β=-1.429， P<0.05）. ConclusionIn contrast to adolescents with bipolar disorder， the sleep structure of adolescents with depressive disorder is characterized by poor sleep continuity and less light sleep. Furthermore， the N1 sleep duration， female gender and diagnosis of depressive disorder are risk factors affecting the suicide in adolescents with affective disorder.

Risk factors of rehospitalization in psychiatric inpatients within one year after discharge / 四川精神卫生

ObjectiveTo explore the risk factors of rehospitalization of psychiatric inpatients within one year after discharge， so as to provide references for clinical evaluation and intervention. MethodsData of patients hospitalized in the Brain Hospital Affiliated to Guangzhou Medical University from 2013 to 2017 was collected through the electronic medical record system. Survival analysis was carried out to screen the risk factors for patient readmission. Cox risk regression and survival curve analysis were also performed， meantime， multiple linear regression was used to analyze the influencing factors of the time intervals between hospital discharge and subsequent readmission within one year. ResultsAmong the 22 807 hospitalized patients， 4 602 cases （20.2%） were readmitted within one year after discharge. Age， payment methods， disease diagnosis， number of hospitalizations and hospitalization days were risk factors for readmission （P<0.01）. The readmission rates of patients aged 21~30， 31~40， 41~50 and 51~60 were 0.706， 0.631， 0.610 and 0.693 times higher than those aged ≤20， respectively. The probability of readmission of patients with twice， three times and four times of hospitalization before was 3.015， 2.824 and 4.271 times higher than those with one time of hospitalization， respectively. The readmission rate of patients hospitalized for 21~40 days and above 101 days were 1.142 and 1.181 times higher than those hospitalized for less than 20 days， respectively. Age， hospitalization days and number of hospitalizations were the influencing factors of readmission within one year after discharge， and patients with older age had longer intervals between discharge and subsequent readmission （B=0.017， P<0.01）. The time intervals between discharge and subsequent readmission were significantly longer among patients who had been hospitalized for 61~80 days than among patients who had been hospitalized for less than 20 days （B=1.226， P<0.01）. Compared with patients with one time of hospitalization， the time intervals was significantly shorter among patients with twice of hospitalization （B=-1.386， P<0.01）. ConclusionPatients aged below 20 years old and those with two， four or more times of hospitalization before have a high rate of readmission within one year after discharge， and the readmission time may be earlier among patients with two times of hospitalization， and relatively later among patients who had been hospitalized for 61~80 days.

Mental health status among non-psychiatric inpatients in a general hospital / 四川精神卫生

ObjectiveTo analyze the mental health status of non-psychiatric inpatients in a general hospital， and to explore the relevant influencing factors， so as to provide references for the screening of mental health problems and the construction of intervention models among non-psychiatric inpatients. MethodsA cross-sectional study was conducted among 916 non-psychiatric inpatients in a third grade class A general hospital in Guangzhou， and all the inpatients were assessed using Patient Health Questionnaire-9 item （PHQ-9）， Generalized Anxiety Disorder-7 item （GAD-7）， Athens Insomnia Scale （AIS） and Columbia-Suicide Severity Rating Scale （C-SSRS） to detect their depression， anxiety， insomnia and suicide risk status. Thereafter， univariate and multivariate Logistic regression analysis were used to screen the risk factors affecting the mental health of inpatients. ResultsA total of 339 （37.0%） inpatients with positive mental health problems were screened， and the screening results for each dimension revealed 218 cases （23.8%） of depression， 141 cases （15.4%） of anxiety， 257 cases （28.1%） of insomnia， 42 cases （4.6%） of suicidal ideation and 7 cases （0.8%） of suicidal behavior. Binary Logistic regression analysis showed that female （OR=1.379， P<0.05） was a risk factor for positive screening of mental health problems. Ordinal Logistic regression analysis denoted that age above 60 years old （OR=1.542， P<0.05） and singlehood （OR=2.055， P<0.05） were risk factors affecting the severity of depression， while senior high school to junior college education （OR=0.524， P<0.05） was a protective factor of depression， meantime， female （OR=1.472， P<0.05） was a risk factor affecting the severity of insomnia. ConclusionMental health problems are quite common among non-psychiatric inpatients in general hospitals， and are mainly affected by factors such as gender， age， marital status and educational background.

Effects of ketamine on cardiovascular system and cognitive function in patients with depression receiving MECT / 实用医学杂志

Objective To investigate the effects of ketamine and propofol on cardiovascular system and cognitive function in the patients with depression during the modified electroconvulsive therapy (MECT). Methods A total of 60 patients with depression treated by MECT were randomly divided into 2 groups. Induced anesthesia with ketamine and propofol were performed respectively during MECT. The course of treatment was 8 times. The mean arterial pressure(MAP)was recorded before therapy and at 5 min after MECT.Depression and the cognitive function were evaluated by using the Hamilton Depression Scale(HAMD)and the Wisconsin Card Sorting Test(WCST)before treatment and 1 day after treatment. Results There was no significant difference in MAP between the two groups after MECT(P > 0.05). The HAMD scores of the two groups were lower than those before treatment(P 0.05). But in completing classification of WCST ,the ketamine group was better than the propofol group(P<0.05). Conclusion Propofol has no obvious influence on the cognition function and little influence on MAP,so it could be the first choice of anaesthetic for the induction of MECT.

Effect of modified electroconvulsive therapy with different anesthetics on efficacy of patients with treatment-resistant depression / 实用医学杂志

Objective To investigate the effect of modified electroconvulsive therapy (MECT) with different anesthetics on efficacy of patients with treatment-resistant depression (TRD). Methods Ninety patients with TRD were enrolled in this study to receive a standard 8 times MECT. The HAMD-17 scale was evaluated before MECT and after the completion of the first, second, third, forth, sixth and eighth MECT session. The TESS scale was evaluated before MECT and after the completion of the last MECT session. Results Scores of HAMD-17 after the completion of the first, second, third, fourth, sixth and eighth MECT session were significantly reduced (P<0.05). There were significant differences of HAMD scales among the three groups since the first MECT session (P < 0.05). The remission rate of ketamine group, propofol group and mixed group was 96.7%, 43.3%, and 73.3% (P < 0.05). Conclusion MECT of ketamine anesthetic might contribute to the best effect of TRD.

Establishment and practice of clinical diagnostics teaching system / 中华医学教育探索杂志

The improvement of diagnostics teaching system,including the establishment of curriculum system and evaluation system,is the base of promoting clinical- medicine teaching.Our study showed that the theoretical knowledge and clinical skill of medical students could be improved by constructing clinical diagnostics curriculum system and improving organization management and assessment system,which could pave the way for the transition from medical students to clinicians.

Transplantation of perforator flaps: Systematic review of 108 case series / 中华显微外科杂志

Objective To explore the clinical outcome of perforator flaps for reconstruction of limb soft tissue defects. Methods In this case series, from 2007 July to 2009 May, 108 cases of perforator flap to reconstruct the defects of the extremities were performed, of these, 98 were free perforator flaps, 10 were pedicled flaps. The perforator flaps included deep inferior epigastric artery perforator flap, anterolateral thigh perforator flap, thoracodorsal artery perforator flap, lateral thigh perforator flap, posterior interosseous artery perforator flap, collateral radial artery perforator flap, medial sural artery perforator flap, posterior tibial artery perforator flap, deep circumflex iliac artery perforator flap and peroneal artery perforator flap. The maximum size of the perforator flap was 44 cmx 9 cm, the minimum size of the perforator flap was 4 em x 2 cm.The donor defect was closed directly. Results Venous congestion occurred in 5 flaps, in 1 case venous congestion was overcomed after released the dressing, 4 flaps requiring reexploration for venous insufficiency,2 had a successful outcome, the other 2 flaps failed . The other 103 flaps were successful. The wounds healed without any infection complications. The follow-up ranges from 6-24 months( 10 months on average). The flaps were of good appearance and not bulky; there were only linear scars on the donor sites, the cosmesis and function of the donor sites were satisfying. Conclusion The muscle, deep fascia and motor nerve are not contained in the flap, the advantages of this type of flap is reducing morbidity of the donor site and its reliable blood supply and suitable thickness for resurfacing, no secondary debuiking is necessary. The perforator flaps can be chosen as the first option to deal with superficial extremity wounds.

Interventional therapy combined with multifactorial intervention in diabetes with lower-limb vascular disease / 中华内分泌代谢杂志

The effect of interventional therapy combined with multifactorial intervention on critical limb ischemia in patients with diabetes mellitus was investigated. The patency rate and limb salvage rate were followed up. Interventional therapy is effective in treating diabetic foot with critical limb ischemia. Multifactorial intervention was helpful for reducing amputation.

The deep inferior epigastric perforator flap for foot and malleolus reconstruction of child / 中华显微外科杂志

Objective To investigate the feasibility and the preliminary curative effect of the deep inferior epigagtrie perforator(DIEP)flap for child's foot and malleolus reconstruction.Methods A series of 5 child patients were treated with DIEP flap from August to December in 2007.All of them had foot and malleolus defects secondary to traumatic injuries and significant exposure of the tendons and skeleton.The maximum defect Wag 17 cm×6 em in size,the minimum defect Was 11 cm x 6 cm in size.In 2 eases,suture the inferior epigastric artery(vein)to the anterior tibial artery(vein).In 1 case,suture the inferior epigagtric artery(vein)to the dorsal artery (vein)of foot.In 2 cases,suture the inferior epigastric artery (vein)to the posterior tibial artery(vein).The minimum flap in size was 12 cm×7 cm.The maximum flap in size was 18 cm×7 cm.The donor site of the DIEP flaps Wag always closed primarily.Results Donorsite and receptor-site weIe primary healing in all patients.The mean follow-up was 3 months(range from 1to 5 months),all flaps survived with excellent color and quality,and no extremely fat contour.In 4 cases,a protective sensation Wag regained.The patient has obtained the good function of foot and malleohs.The abdomen contour resumes satisfaction, and the abdominal wall competency is preserved. Conclusion Abdominal wall competency is preserved because no muscle or fascia is included.DIEP flap is so thin that not required second-stage operation for debulking.In brief,it is believed that the DIEP flap is an ideal technique for foot and malleolus reconstruction of child patients, which meets the new concept of mieresurgery.

Cognitive Impairment in Alzheimer Disease / 中国心理卫生杂志

Objective:to study cognitive impairment of patients with Alzheimer disease (AD). Method:62 patients with AD and 159 normal elderly were tested with MMSE. Result:The patients group had lower scores in all subtests except that of naming. Level of education had positive correlation with the total score, subscores of attention and calculation, understanding, and describe graph. Conclusion:MMSE can be used in clinical assessment of cognitive function of patients with AD.