Guideline for the diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients (version 2023) / 中华创伤杂志

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Epidemiological research progress on the relationship between children's dietary patterns and health / 中华预防医学杂志

As food preferences and eating habits form early in life, the development of healthy eating habits in early childhood is a way to prevent diet-related diseases. The dietary pattern approach examines the effect of an overall diet on health outcomes, instead of individual foods or nutrients, thereby presenting a comprehensive evaluation of children's dietary intake. This article reviews the current literature to summarize the main methods for assessing dietary patterns and explore relationships between children's dietary patterns and obesity, puberty onset, cardiovascular diseases, and neurodevelopment. The purpose of this review is to provide evidence-based support for reducing the risk of diet-related diseases in children and recommendations for future research directions.

Expert consensus on diagnosis, prevention and treatment of perioperative lower extremity vein thrombosis in orthopedic trauma patients (2022 edition) / 中华创伤杂志

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Characteristics and outcomes following transcatheter aortic valve replacement in China: a report from China aortic valve transcatheter replacement registry (CARRY) / 中华医学杂志(英文版)

BACKGROUND@#The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.@*METHODS@#CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan-Meier curve was used to estimate the risk of adverse events during follow-up.@*RESULTS@#The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7-8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%).@*CONCLUSIONS@#TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients.@*TRIAL REGISTRATION@#https://www.chictr.org.cn/ (No. ChiCTR2000038526).

Expert consensus on emergency surgery management for traumatic orthopedics under prevention and control of novel coronavirus pneumonia / 中华创伤杂志

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

Expert consensus on emergency surgery management for orthopedics trauma patients under prevention and control of corona virus disease 2019 / 中华创伤杂志

Since December 2019, corona virus disease 2019 (COVID-19) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of COVID-19. Based on the needs of emergency surgery for orthopedic trauma patients and review of the latest diagnosis and treatment strategy of COVID-19 and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of COVID-19 and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

Efficacy and safety of domestic dasatinib as second-line treatment for chronic myeloid leukemia patients in the chronic phase / 中华血液学杂志

Objective: To investigate the efficiency and safety of domestic tyrosine kinase inhibitor (TKI) dasatinib (Yinishu) as second-line treatment for patients with chronic myeloid leukemia in chronic phase (CML-CP). Methods: A retrospective analysis of clinical data of CML-CP patients who received domestic dasatinib as second-line treatment in the CML collaborative group hospitals of Hubei province from March 2016 to July 2018 was performed. The optimal response rate, the cumulative complete cytogenetic response (CCyR), the cumulative major molecular responses (MMR), progression free survival (PFS), event free survival (EFS) and adverse effects (AEs) of the patients were assessed at 3, 6 and 12 months of treatment. Results: A total of 83 CML-CP patients were enrolled in this study. The median follow-up time was 23 months. The optimal response rates at 3, 6 and 12 months in 83 CML-CP patients treated with dasatinib were 77.5% (54/71), 72.6% (61/75) and 60.7% (51/69), respectively. By the end of follow-up, the cumulative CCyR and MMR rates were 65.5% (55/80) and 57.1% (48/73), respectively. The median time to achieving CCyR and MMR was 3 months. During follow-up time, the PFS rate was 94.0% (79/83) and the EFS rate was 77.4% (65/83). The most common non-hematological AEs of dasatinib were edema (32.5%), rash itching (18.1%) and fatigue (13.3%). The common hematological AEs of dasatinib were thrombocytopenia (31.3%), leukopenia (19.3%) and anemia (6.0%). Conclusion: Domestic dasatinib was effective and safe as the second-line treatment of CML-CP patients and it can be used as an option for CML-CP patients.

The expression of CRLF2 in adult Ph negative acute B lymphocytic leukemia and its prognostic significance / 中华血液学杂志

Objective: To detect the expression of CRLF2 in adult Ph negative acute B lymphocytic leukemia (B-ALL) in newly diagnosed cases, and to investigate the relationship between CRLF2 and the general clinical characteristics, efficacy and prognosis. Methods: 103 cases of newly diagnosed adult B-ALL patients were investigated from Apr 2016 to Dec 2017 in the Department of Hematology, Henan Cancer Hospital. Bone marrow samples was used to detect the expression of CRLF2 in leukemic cells. The expression of CRLF2 ≥20% was defined as CRLF2-high group and <20% was defined as CRLF2-low group. The clinical characteristics and prognosis of the two groups were compared. Results: The Median overall survival (OS) and disease free survial (DFS) in CRLF2-high group were 9.0 months and 4.25 months, respectively. CRLF2-low group were 15.5 months and 10.25 months, respectively. There was a statistically significant difference in median OS and DFS between the two groups (P=0.007, P=0.000) . The 18-month OS and DFS in CRLF2-high group were 38.6% and 25.1%, respectively. CRLF2-low group were 57.8% and 42.3%, respectively. Multivariate analysis showed high expression of CRLF2 was an independent risk factor for OS (HR=2.991, 95% CI 1.429-6.261, P=0.004) and DFS (HR=2.374, 95%CI 1.146-4.960, P=0.041) in patients. Conclusion: Patients with high expression of CRLF2 had poor prognosis.

Synchronous lymphoma and carcinoma-clinical analyses of 17 patients / 中华血液学杂志

Objective: To explore the clinical features of patients with synchronous lymphoma and carcinoma. Methods: The clinical data of 17 patients with Synchronous lymphoma and carcinoma from February 2012 to October 2017 were analyzed retrospectively. Results: Among 17 patients of lymphoma, 1 case HL, 2 cases B-NHL, 6 cases MZBL, 3 cases DLBCL, 1 case mantle cell lymphoma (MCL) , 3 cases NK/T- cell lymphoma, 1 case anaplastic large cell lymphoma(ALCL). In terms of 17 patients with carcinoma, 3 cases esophageal carcinoma, 3 cases gastric carcinoma, 2 cases colorectal carcinoma, 7 cases thyroid carcinoma, 1 case hepatocellular carcinoma and lung cancer. Up to 15 patients received operation, and some of them combined with chemotherapy, radiotherapy and autologous transplant. Follow-up analysis showed that 3 cases was undergoing treatment, 2 cases lost follow-up, 4 cases died, 3 cases achieved CR, 3 cases remained to be at SD, and 2 cases assessed for progression or recurrence. Conclusion: The relationship between lymphoma and carcinoma was under discussion, patients with synchronous lymphoma and carcinoma were not unusual. We herein should raise awareness to avoid misdiagnosis.

3D printing technique combined with tibial lateral condyle osteotomy for complex tibial plateau fractures involving the posterolateral condyle / 中华骨科杂志

Objective To investigate the clinical efficacy of 3D printing technique combined with osteotomy in the treatment of complex tibial plateau fractures involving the posterolateral condyle.Methods The clinical data of 47 patients with complicated tibial plateau fractures involving the posterolateral condyle who were treated with 3D printing technology and tibial lateral condyle osteotomy from January 2012 to February 2015 were retrospectively analyzed.There were 19 males and 28 females aged from 21 to 69 years (mean 50.3 years).All of them were closed fractures without neurological and vascular injuries.The time between injury and operation was 4 to 19 days (average,6.7 days).All the patients were treated with tibial lateral condyle osteotomy and bilateral plate fixation with anterolateral approach and posteromedial approach.Three-dimensional CT scans were performed preoperatively and 1 ∶ 1 to mimics model was made by 3D printing technique based on the data after conversion.Refer to the 3D fracture model to accurately design the osteotomy line to improve the operation scheme.During the operation,anterior and lateral anterior combined with posterior medial incision were performed,and the tibia external condyle osteotomy was conducted to accurately expose the external posterior condyle fracture block of the tibia platform,and bilateral plate was applied after reduction.The fracture reduction was evaluated according to the Rasmussen score of the knee joint.The knee joint function was evaluated by the score of the hospital for special surgery (HSS).Results All 47 patients were followed up for 13.2 months (range,7-19 months).Immediate postoperative X-ray showed good fracture reduction.The union time of fracture was 14.3 weeks (range,12-18 weeks).The knee joint Rasmussen score one year after operation was 13-18 (average,15.73),including 33 cases excellent,12 cases good and 2 cases fair.The excellent and good rate was 95.7％ (45/47).HSS score was 67 to 94 (average,82.67),among which 31 cases were excellent,13 cases good,2 cases fair,and 1 case poor (postoperative refusal to rehabilitate exercise resulted in joint stiffness).The excellent and good rate of 89.9％ (44/47).Knee joint activity was-5°-0°-135°,with the average range of 125.5°.No common peroneal nerve injury,important vascular injury,postoperative infection,internal fixation failure and other serious complications was found.Conclusion 3D printing technology can help to accurately display the specific situation of the posterior tibial condyle fractures,which is conducive to the surgeon to develop a more intuitive plan of reduction.The method of tibial lateral condyle osteotomy can clearly reveal the tibial plateau posterolateral condylar fractures.With accurate osteotomy the surgical field can be fully exposed,and ultimately achieve a satisfactory result.Therefore,3D printing combined with tibial lateral condyle osteotomy is an effective method for complex tibial plateau fractures involving the posterolateral condyle.

Sinus tarsus mini incision approach with percutaneous reduction and fixation for Sanders Ⅱ、 Ⅲ calcaneal fractures / 中华骨科杂志

Objective To explore the methods and clinical effect of the sinus tarsus mini incision approach with percutaneous fixation technique in the treatment of Sanders Ⅱ,Ⅲ calcaneus fractures.Methods From January 2015 to May 2016,the clinical data of 64 cases with Sanders Ⅱ,Ⅲ calcaneus fractures who were treated by sinus tarsus mini incision approach with percutaneous reduction and fixation were analyzed retrospectively.The average age was 46.64±10.51 years (range,25-68) and 49 patients were males and 15 patients were females.According to Sander's classification,39 patients were Sanders Ⅱ and 25 were Sanders Ⅲ fracture.Calcaneal varus was corrected and the length,width and height of bone were reduced by sinus tarsus mini incision approach with percutaneous fixation technique.Calcaneal fracture was treated by calcaneal bone plate combined with percutaneous screw fixation.Complications and operation procedure were recorded post-operation.Anteroposterior,lateral and axial views of preoperative and postoperative X-ray and CT scan were taken to assess the classification,restoration and intertion status of fracture.Radiological assessment was performed using B(o)hler's angle and Gissane's angle.Functional outcome was assessed using the Maryland foot score (MFS).Results All of the sixty-four patients were followed up for 12-18 months (average,14.80± 2.03).After surgery,only 4 cases of superficial necrosis of the incision were found,and the incisions were all healed and no infection occurred after surgery.No tendon tenosynovitis was seen after surgery.There were no fracture displacement,internal fixation failure,and fracture deformity healing cases.The mean time of bone union was 9.44±1.38 weeks (8-12 weeks) without fracture deformity healing case.The mean time of bone union was 9.17±1.16 weeks for the 23 cases with bone graft.For the 41 cases without bone graft,the bone healing average time was 9.91 ± 1.62 weeks,and there is no statistically difference between cases with and without bone graft (t=1.936,P=0.061).B(o)hler's angle was 6.625°±4.904° (range,-5°-15°) preoperative,and improved to 31.031°± 4.660° (range,24°-40°),which had statistically significant difference (t=-28.863,P=0.000).Gissane's angle was from preoperative 76.094°±12.981° (range,55°-105°) to 127.328°±6.486° (range,115°-140°) at the time of the latest follow-up,and the difference had statistically significant (t=-28.246,P=0.000).Maryland Score:excellent 30 cases (22 cases of type Ⅱ,8 cases of type Ⅲ),good 27 cases (15 of type Ⅱ,12 of type Ⅲ),fair 7 cases (2 of type Ⅱ,5 of type Ⅲ).The overall good rate was 89.06％ (57/64).Conclusion The tarsal sinus minimally invasive small incision reduction and internal fixation combined with percutaneous reduction and fixation technique in the treatment of ealcaneal fractures,exerts the advantages of small trauma,clear surgical exposure for reduction,reliable fixation,and low incision complications,which is applicable to treat the Sanders Ⅱ,Ⅲ calcaneal fractures.

Euthyphoria reduction combined with percutaneous iliosacral screw fixation for irreducible sacroiliac dislocation / 中华创伤骨科杂志

Objective To evaluate euthyphoria reduction combined with percutaneous iliosacral screw fixation in the treatment of irreducible sacroiliac dislocation.Methods From March 2012 to May 2015,29 patients with irreducible sacroiliac dislocation were treated using euthyphoria reduction followed by percutaneous iliosacral screw fixation.They were 18 men and 11 women,aged from 25 to 68 years (average,37.9 years).According to the Tile classification,there were 7 cases of type Cl,9 cases of type C2,and 13 cases of type C3.The intervals from injury to surgery ranged from 6 to 32 days (average,11.3 days).Results The operation time for this cohort ranged from 40 to 125 minutes (average,76.2 minutes).The intraoperative bleeding ranged from 50 to 360 mL (average,148.6 mL).Their follow-ups ranged from 24 to 41 months (average,28.9 months).According to the Matta criteria for reduction,20 cases were rated as excellent and 9 as good,yielding an excellent to good rate of 100％.Their Majeed scores at the final follow-up averaged 90.1 points (range,from 67 to 100 points),giving 20 excellent,7 good and 2 fair cases (with an excellent to good rate of 93.1％).No screw loosening or lameness of the affected limb was observed during follow-ups.Conclusions Euthyphoria reduction combined with percutaneous iliosacral screw fixation can lead to satisfactory outcomes in the treatment of irreducible sacroiliac dislocation.Additionally it may improve operative safety.

Analysis of thigh pain after treatment of femoral trochanteric fractures by proximal femoral nail an-tirotation Ⅱ / 中华创伤骨科杂志

Objective To analyze the causes for the thigh pain after treatment of femoral trochanteric fractures by proximal femoral nail antirotation Ⅱ( PFNA Ⅱ) . Methods Included in this ret-rospective study were 236 patients who had been treated by us for femoral trochanteric fracture from October 2011 to December 2015. They were 103 men and 133 women, aged from 42 to 86 years (average, 50. 3 years) . According to AO classification, 13 cases belonged to type 31-A1. 2, 32 to type 31-A1. 3, 35 to type 31-A2. 1, 27 to type 31-A2. 2, 33 to type 31-A2. 3, 38 to type 31-A3. 1, 39 to type 31-A3. 2 and 19 to type 31-A3. 3. All the fractures were single, fresh and closed and treated with PFNAⅡinternal fixation. Results This cohort was followed up for 8 to 26 months (average, 13. 2 months). Nonunion occurred in one case who had to accept artificial hip replacement. The remaining 235 cases obtained bony union after 22 to 39 weeks (average, 29. 3 weeks). By the Harris evaluation at final follow-ups, the affected hips scored from 81 to 93 points (average, 85. 1 points) . Post-operative thigh pain was reported in 19 cases (8. 05％) . The causes included varied anatomic morphology of the proximal femur in 6 cases, distal defects of the intramadullary nails in 4, insufficient stability of internal fixation or uneven biomecanical distribution in 3, unskillful operation in 2, and severe oesteoporosis in 4. Avascular necrosis of femoral head was not observed during follow-ups. Conclusions Postoperative thigh pain is worthy of serious atention from orthopaedists following PFNA Ⅱtreatment of femoral trochanteric fractures. PFNA Ⅱshould be modified according to the specific Chinese features of the proximal femur, especially in the respects of anterior arch and distal structure of the main nail and lateral declination as well.

Comparison of locking compression plate distal ulna hook plate and cannulated screws for fractures of fifth metatarsal base at zones Ⅰ and Ⅱ / 中华创伤骨科杂志

Objective To compare the therapeutic effects of locking compression plate distal ulna hook plate (LCP-DUHP) and cannulated screws in the internal fixation for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ.Methods This retrospective study included 67 patients who had been treated for fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ from July 2013 through December 2015.Of them,29 were treated by internal fixation with cannulated screws,including 17 men and 12 women with an average age of 46.6 years.There were 13 zone Ⅰ fractures and 16 zone Ⅱ fractures according to the Lawrence-Botte partition.The other 38 patients were treated by internal fixation with LCP-DUHP,including 20 men and 18 women with an average age of 33.7 years.There were 20 zone Ⅰ fractures and 18 zone Ⅱ fractures according to the Lawrence-Botte partition.The therapeutic effects were evaluated at the final follow-ups using visual analogue scale (VAS) for the affected feet,American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scoring system,and incidence of postoperative complications.Results All this series were followed up for 51 to 87 weeks (average,57weeks).There were no significant differences between the cannulated screws group and the LCP-DUHP group in terms of fracture healing time (13.9 ± 1.6 weeks versus 14.2 ± 1.8 weeks),VAS scores (4.9 ± 1.3 versus 4.8 ± 1.O) or AOFAS midfoot scores (87.9 ± 3.4 versus 88.6 ± 2.5) (P ＞ 0.05).Bony union was achieved in all.No implant failure was observed in this series.Conclusion Both LCP-DUHP and cannulated screws can lead to satisfactory therapeutic effects in the treatment of fractures of the fifth metatarsal base at zones Ⅰ and Ⅱ.

Reliability and Validity of A Novel Hand-held Dynamometer for Muscles Strength of Lower Extremities / 中国康复理论与实践

Objective To investigate the reliability and validity of a novel hand-held dynamometer, OE-210, for muscles strength of low-er extremities. Methods From March 1st to August 30th, 2016, 38 young adults were tested the muscle strength of quadriceps and ham-strings with OE-210 dynamometer by 2 rators, and were retested by one of the raters three days later. The isokinetic test was also conducted on all the subjects one day afterwards. The intraclass correlation coefficient (ICC) of OE-210 test results and the Pearson's correlation coeffi-cient between results of OE-210 and isokinetic test were calculated. Results The ICC of test-retest were 0.718 to 0.924, and the ICC of in-ter-rater were 0.784 to 0.870. The correlation between muscle performance measured with 2 tools were significant (P<0.001), that was light to medium on quadriceps (r=0.270-0.413), and strong on hamstrings (r=0.582-0.668). Conclusion OE-210 dynamometer was reliable for muscle strength measurement on quadriceps and hamstrings, and the conditions for valid application need further research.

Surgical treatment of superior shoulder suspensory complex injury / 临床外科杂志

Objective To explore the method and effects of operative treatment of superior shoul-der suspensory complex(SSSC)injury.Methods A total of 18 patients with SSSC injury were enrolled. There were six cases of scapular neck fracture combined with comminuted clavicle fracture,five cases of scapular neck fracture combined with acromial fracture,and two cases of comminuted clavicle fracture com-bined with acromial and glenoid fracture.These patients were treated with open reduction and internal fixa-tion.Three patients had acromioclavicular joint dislocation combined with coracoclavicular ligament rupture and they were given hook plate fixation and ligament repair.One patient with scapular neck fracture com-bined with acromioclavicular joint dislocation,and one patient with comminuted clavicle fracture combined with coracoclavicular ligament rupture,were treated with the open reduction,internal fixation and the liga-ment repair.Results All patients were followed up for 3 to 14 months,with an average of 9 months.Ana-tomical reduction and healing were all achieved within 7 to 12 weeks,with an average of 8.6 weeks.Con-clusion Anatomical structure of SSSC is very complex and surgery is given priority to internal fixation, which restores the stability good therapeutic effect.

Antimicrobial resistance of bacterial isolated from different samples / 国际检验医学杂志

Objective To explore the differences in antimicrobial resistance of bacteria isolated from different samples ,and to guide antibiotic chemotherapy in clinic .Methods The sputum ,blood ,pus and urine specimens were collected from 2009 to 2013 in our hospital for bacterial identification and drug sensitivity tests by using automatic system .The drug resistance rate of Staphylo‐coccus aureus ,Escherichia coli ,Klebsiella pneumoniae isolated from different samples were compared .Results All isolates of E .co‐li ,Klebsiella pneumoniae were sensitive to imipenem ,ertapenem ,piperacillin/tazobactam and amikacin .All isolates of S .aureus were sensitive to vancomycin ,linezolid ,nitrofurantoin ,quinupristin/dalfopristin .The ESBLs positive rate of E .coli(71 .5% )and the MR‐SA detection rate(79 .9% ) of Staphylococcus aureus from sputum samples were significantly higher than that from other samples (P<0 .05) .The ESBLs positive rate(44 .4% ) of Klebsiella pneumoniae isolates from urine was significantly higher than that from other samples(P<0 .05) .Conclusion The same bacteria isolated from different samples have different antimicrobial resistance rates ,so the selection of antibiotics should based on drug sensitivity tests results for the treatment of the same pathogen infection confirmed by bacterial cultures from different samples .

Predicting early response to immunosuppressive therapy in severe aplastic anemia by soluble transferrin receptor assay / 中华血液学杂志

<p><b>OBJECTIVE</b>To evaluate the value of serum soluble transferrin receptor (sTfR) concentration in predicting early response to immunosuppressive therapy (IST) in severe aplastic anemia (SAA).</p><p><b>METHODS</b>Clinical data and hematologic responses of 140 SAA patients treated with rabbit antithymocyte globulin (rATG) combination with cyclosporine in our hospital were retrospectively analyzed. Correlation of pre-IST baseline of sTfR and IST responses was statistically analyzed and receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of sTfR in prediction of early responses.</p><p><b>RESULTS</b>Serum concentration of sTfR in very SAA (VSAA) patients were significantly lower than SAA and transfusion dependent non-SAA cases (P=0.001). The responders, especially at 3 months, had significantly higher pre- IST baseline of sTfR [median, 0.89 (range, 0.21-2.42) mg/L] than that [median, 0.58 (range, 0.13-1.88) mg/L] of non-responders (P=0.005). The cutoff level of 0.91 mg/L and 0.88 mg/L for predicting responses at 3 and 6 months were established based on the ROC curve, with the degree of accuracy of 65.0% and 60.7% respectively. Multivariate analysis showed that pre-IST baseline of sTfR was the independent factor of predicting response at 3 months (P=0.007) and at 6 months (P=0.021).</p><p><b>CONCLUSION</b>As a indicator of bone marrow failure severity, sTfR could predict early response to IST therapy in aplastic anemia.</p>

Finite element analysis of lumbar pelvic and proximal femur model with simulate lumbar rotatory manipulation / 中国骨伤

<p><b>OBJECTIVE</b>To study the changes of displacement and stress in the model of lumbar pelvic and proximal femur during lumbar rotatory manipulation.</p><p><b>METHODS</b>The date of lumbar pelvic and proximal femur CT scan by Mimics 10.01 software was established a lumbar pelvic and proximal femur geometric model, then the model was modified with Geomagic 9, at last the modified model was imported into hypermesh 10 and meshed with tetrahedron, at the same time,add disc and ligaments. According to the principle of lumbar rotatory manipulation,the lumbar rotatory manipulation were decomposed. The mechanical parameters assigned into the three-dimensional finite element model. The changes of displacement and stress in the model of lunbar pelvic and proximal femur under the four conditions were calculated with Abaqus model of Hypermesh 10.</p><p><b>RESULTS</b>1) Under the same condition,the displacement order of lumbar was L1>L2>L3>L5 L5, anterior column > middle column > posterior column. 2) Under the different conditions, the displacement order of lumbar,case 3>case 1>case 4>case 2. 3) Under the same conditions, the displacement order of lumbar inter-vertebral disc from L1,2 to L5S1 was L1,2>L2,3>L3,4>L4,5>L5S1, as for the same inter-vertebral disc, the order was: second quadrant>third quadrant>first quadrant>fourth quadrant. 4) Under the different conditions,the displacement order of the inter-vertebral disc was L1,2>L2,3>L3,4>L4,5>L5S1, but to same inter-vertebral disc: case 3>case 4>case 1 >case 2. 5) There were apparent displacement and stress concentration in pelvis and hip during the manipulation.</p><p><b>CONCLUSION</b>1) The principles of lumbar rotation manipulation closely related to the relative displacement caused by rotation of various parts of lumbar pelvic and proximal femur model; 2) During the process of lumbar rotatory manipulation, the angle of lateral bending and flexion can not be randomly increased; 3) During the process of lumbar rotatory manipulation, all the conditions of lumbar pelvic and proximal femur must be considered to determine indications and contraindications.</p>

Application of flexirigid thoracoscopy in the diagnosis of pleural disease with unknown etiology / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the diagnostic accuracy of flexirigid thoracoscopy for pleural diseases and the patients' compliance.</p><p><b>METHODS</b>Forty-seven patients with pleural effusion and thickening of unknown etiology underwent examinations with flexirigid thoracoscopy with subsequent pathological examination, and the diagnostic accuracy and the patients' compliance were observed.</p><p><b>RESULTS</b>Thoracoscopy identified lesions in the pleural and/or diaphragm in 42 patients and no lesions in 5 patients. Malignancy was confirmed in 21 (44.7%), tuberculosis in 17 (36.2%), idiopathic hypereosinophilic syndrome in 1 (2.1%), nocardiasis in 1 (2.1%), constrictive pericarditis in 1 (2.1%), chronic empyema in 2 (4.3%), splenic artery embolization in 1 (2.1%), and negative result in 3 (6.4%) of the cases. The diagnostic accuracy rate of flexirigid thoracoscopy reached 93.6%, and no serious complications in relation to the examination was found.</p><p><b>CONCLUSION</b>Flexirigid thoracoscopy is efficient and relatively safe for diagnosis of pleural diseases with or without hydrothorax.</p>