Simulation and evaluation of a bone sawing procedure for orthognathic surgery based on an experimental force model.

Bone sawing is widely used in orthognathic surgery to correct maxillary deformities. Successful execution of bone sawing requires a high level of dexterity and experience. A virtual reality (VR) surgical simulator can provide a safe, cost-effective, and repeatable training method. In this study, we developed a VR training simulator with haptic functions to simulate bone-sawing force, which was generated by the experimental force model. Ten human skulls were obtained in this study for the determination of surgical bone-sawing force. Using a 5-DOF machining center and a micro-reciprocating saw, bone specimens with different bone density were sawed at different feed rates (20, 40, and 60 mm/min) and spindle speeds (9800, 11,200 and 12,600 cycles per minute). The sawing forces were recorded with a piezoelectric dynamometer and a signal acquisition system. Linear correlation analysis of all experimental data indicates that there were significant positive linear correlations between bone-sawing force and bone density and tool feed rate and a moderate negative linear correlation with tool spindle rate. By performing multiple regression analysis, the prediction models for the bone-sawing procedure were determined. By employing Omega.6 as a haptic device, a medical simulator for the Lefort I osteotomy was developed based on an experimental force model. Comparison of the force-time curve acquired through experiments and the curve computed from the simulator indicate that the obtained forces based on the experimental force model and the acquired data had the same trend for the bone-sawing procedure of orthognathic surgery.

Expression and diagnostic value of serum miR-483-3p in patients with essential hypertension / 中华老年心脑血管病杂志

Objective To investigate the level and diagnostic value of microRNA(miR)-483-3p in the serum of patients with essential hypertension(EH).Methods A total of 180 EH patients ad-mitted in Department of Cardiology of Sanya Central Hospital from January 2021 to March 2023 were enrolled as the study group,and another 160 healthy volunteers matched in general clinical data and taking physical examination during the same period were subjected as the control group.RT-qPCR was used to detect miR-483-3p levels in the sera of the 2 groups.Results The levels of TC,TG,LDL-C,SBP,and DBP were significantly higher(P＜0.01),so was the serum miR-483-3p level(2.15±0.57 vs 1.00±0.05,P＜0.01)in the study group than the control group.The serum miR-483-3p level was in an obvious upward trend in the patients with hypertension of grades 1,2,and 3(1.44±0.45 vs 1.79±0.58 vs 3.35±0.64,P＜0.05).The level was positively correlated with hypertension grade in the study group(r=0.745,P=0.000),and the levels of TC,TG,LDL-C,SBP and DBP(P＜0.01).miR-483-3p,TC,LDL-C,SBP and DBP were independent influencing factors for EH(P＜0.05,P＜0.01).The AUC value of serum miR-483-3p level for predicting EH was 0.923(95％CI:0.890-0.949).Conclusion Serum miR-483-3p level is increasing with severi-ty of EH,and has a high diagnostic value for the disease.

The application of social support and information motivation behavior model in pregnant women with gestational diabetes mellitus / 中国现代医生

Objective To explore the clinical effect of nursing intervention program based on social support and information motivation behavioral model for pregnant women with gestational diabetes mellitus(GDM).Methods A total of 104 pregnant women with GDM admitted to Linping District,the Second Affiliated Hospital of Zhejiang University School of Medicine from February 2020 to February 2022 were selected as study objects,and were divided into experimental group and control group by random number table method,with 52 cases in each group.The pregnant women in control group were given routine nursing intervention,and the pregnant women in experimental group were given social support and information motivation behavioral model nursing intervention based on routine nursing.The depression-anxiety-stress scale,disease cognition and health behavior,blood glucose control during pregnancy,perinatal maternal and infant complications and delivery mode were compared between two groups.Results After the intervention,the scores of depression,anxiety,stress,fasting blood glucose,2-hour postprandial blood glucose and glycosylated hemoglobin of pregnant women in experimental group were significantly lower than those in control group,and the scores of disease cognition,health promoting lifestyle profile and vaginal delivery rate were significantly higher than those in control group(P<0.05).The complication rate of pregnant women and perinatal infants in experimental group was significantly lower than that in control group(P<0.05).Conclusion The nursing intervention program based on social support and information motivation behavioral model has good effect on pregnant women with GDM,which can enable pregnant women to obtain more social support,reduce negative emotions,improve health behaviors,promote blood glucose control,and increase the rate of natural childbirth.

Seroprevalence of the specific antibody against Toxoplasma gondii among patients with hematological diseases / 中国血吸虫病防治杂志

Objective To investigate the seroprevalence of Toxoplasma gondii infections among patients with hematological diseases, so as to provide insights into improving the prognosis and quality of life among patients with hematological diseases. Methods A total of 240 patients with hematological diseases (including 170 patients with hematological tumors and 70 patients with non-tumor hematological diseases) admitted to The Affiliated Hospital of Putian University during the period from January 1, 2021 through October 10, 2023 and 500 healthy volunteers in the hospital during the same period were enrolled. Subjects’ demographics and serum samples were collected, and serum specific IgG and IgM antibodies against T. gondii were detected using the chemiluminescence assay, with any of a positive IgG or IgM antibody defined as a positive T. gondii infection. The seroprevalence of specific IgG and IgM antibodies against T. gondii was compared between patients with hematological diseases and healthy volunteers. Results The mean age (F = 2.034, P > 0.05) and gender distribution (χ2 = 0.462, P > 0.05) were comparable among patients with hematological tumors, patients with non-tumor hematological diseases and healthy volunteers, and there was no significant difference in the proportion of history of cat or dog contacts between patients with hematological diseases and healthy volunteers (χ2 = 0, P > 0.05). The seroprevalence of anti-T. gondii antibody was significantly higher among patients with hematological diseases than among healthy volunteers (15.8% vs. 0.6%; χ2 = 71.902, P < 0.01), and there was a significant difference in the seroprevalence of anti-T. gondii antibody among patients with hematological tumors (18.2%), patients with non-tumor hematological diseases (10.0%) and healthy volunteers (χ2 = 78.327, P < 0.01). The seroprevalence of anti-T. gondii antibody was significantly higher among patients with hematological tumors and non-tumor hematological diseases than among healthy volunteers (both P values < 0.05), while no significant difference was seen in the seroprevalence of anti-T. gondii antibody between patients with hematological tumors and non-tumor hematological diseases (P > 0.05). In addition, the proportion of history of cat or dog contacts was significantly higher among patients with hematological diseases that were positive for serum anti-T. gondii anti-body than among those negative for serum anti-T. gondii antibody (21.1% vs. 5.4%; χ2 = 8.653, P < 0.05). Conclusions There is a high seroprevalene rate of T. gondii infections among hematological diseases, which is significantly greater than that among healthy volunteers.

Diagnosis and treatment of chronic exertional compartment syndrome of the lower extremities: a review / 中华创伤杂志

Chronic exertional compartment syndrome (CECS) of the lower extremities is a common clinical condition characterized by exercise-induced pain in the extremities, which is predominantly observed in people who take an active part in sports, such as athletes. It is mainly presented as post-exercise pain in the lower extremities, probably accompanied by numbness and limb weakness, etc., affecting the patients′ life and work. The symptoms of CECS in the lower limbs are usually present after physical activities of a certain intensity, making them difficult to be identified through routine outpatient physical examination, and likely to be misdiagnosed and underdiagnosed. Furthermore, the absence of universally accepted and unified treatment standards for CECS of the lower extremities complicates the decision-making process regarding the necessity of surgical intervention and choice of surgical approach in the clinical practice. For this purpose, recent developments in the diagnosis and treatment of CECS of the lower extremities were reviewed to provide reference for its standardized diagnosis and treatment.

Dosimetric effect of customized 3D-printed headrest in radiotherapy for head and neck tumor / 中国医学物理学杂志

Objective To evaluate the dosimetric effect of three-dimensional(3D)printed headrests made of different materials in radiotherapy for head and neck tumor,and to evaluate whether the existence of customized 3D-printed headrest can be neglected during planning phase by comparing differences in target area doses,homogeneity index(HI),conformity index(CI),monitor units(MU),and organ-at-risk(OAR)dose.Methods Ten patients with head and neck tumors,including 5 cases with nasopharyngeal carcinoma and 5 with other head and neck tumors,were enrolled.The headrest contours were outlined using Monaco treatment planning system,and with the same calculation parameters,treatment plans were generated for scenarios without a headrest,with a standard headrest,and with 3D-printed headrests made of 10%filled polylactic acid and thermoplastic polyurethane.The target area doses,OAR dose,MU,and other results were recorded and subjected to statistical analysis.Results No significant differences were observed among the 4 groups(ignoring headrest,standard headrest,3D-printed headrests with 10%filled polylactic acid and thermoplastic polyurethane)in parameters such as D95,D5,Dmean,HI,CI,MU,and OAR dose(the maximum dose to the spinal cord)(P>0.05).Considering the presence of the headrest,significant differences were found in CI for nasopharyngeal carcinoma and other head and neck tumors(P<0.05).Conclusion During the planning phase,the existence of customized 3D-printed headrest can be ignored,but it should be noted that the presence of a headrest may reduce the MU in radiotherapy plans.When considering the headrest,the average CI of patients with other head and neck tumors is significantly higher than that with nasopharyngeal carcinoma.

Clinical and pathological features of 52 patients with glomerulonephritis with dominant C3 / 中南大学学报(医学版)

Objective:With the in-depth study of complement dysregulation,glomerulonephritis with dominant C3 has received increasing attention,with a variety of pathologic types and large differences in symptoms and prognosis between pathologic types.This study analyzes the clinical,pathological,and prognostic characteristics of different pathological types of glomerulonephritis with dominant C3,aiming to avoid misdiagnosis and missed diagnoses. Methods:The clinical,pathological,and follow-up data of 52 patients diagnosed as glomerulonephritis with dominant C3 by renal biopsy from June 2013 to October 2022 were retrospectively analyzed.According to the clinical feature and results of pathology,15 patients with post-infectious glomerulonephritis(PIGN)and 37 patients with of non-infectious glomerulonephritis(N-PIGN)were classified.N-PIGN subgroup analysis was performed,and 16 patients were assigned into a C3-alone-deposition group and 21 in a C3-dominant-deposition group,or 27 in a C3 glomerulopathy(C3G)group and 10 in a non-C3 nephropathy(N-C3G)group. Results:The PIGN group had lower creatinine values(84.60 μmol/L vs 179.62 μmol/L,P= 0.001),lower complement C3 values(0.36 g/L vs 0.74 g/L,P<0.001)at biopsy,and less severe pathological chronic lesions compared with the N-PIGN group.In the N-PIGN subgroup analysis,the C3-dominant-deposition group had higher creatinine values(235.30 μmol/L vs 106.70 μmol/L,P=0.004)and higher 24-hour urine protein values(4 025.62 mg vs 1 981.11 mg,P=0.037)than the C3-alone-deposition group.The prognosis of kidney in the PIGN group(P=0.049),the C3-alone-deposition group(P=0.017),and the C3G group(P=0.018)was better than that in the N-PIGN group,the C3-dominant-deposition group,and the N-C3G group,respectively. Conclusion:Glomerulonephritis with dominant C3 covers a variety of pathological types,and PIGN needs to be excluded before diagnosing C3G because of considerable overlap with atypical PIGN and C3G;in addition,the deposition of C1q complement under fluorescence microscope may indicate poor renal prognosis,and relevant diagnosis,treatment,and follow-up should be strengthened.

Study of genetic profiles and haematological phenotypes of δ-thalassemia in Guangdong population / 中华检验医学杂志

Objective:To investigate genetic variation profiles of δ-globin (HBD gene) and hematological phenotypes in Guangdong population.Methods:Retrospective case analysis was performed in this study. Blood samples of 11 616 couples who participated in free thalassemia screening in Guangzhou from July 2020 to December 2022 were collected which underwent blood routine tests and hemoglobin (Hb) capillary electrophoresis. According to the results, 154 samples were enrolled in this study: (1)group of 35 cases with HbA 2 <2.0% but no HbF band; (2)group of 64 cases with HbA 2 < 2.0% and HbF band; (3)group of 25 cases with HbA 2 <2.0% and suspected HbA 2 variants; (4) group of 25 cases with HbA 2 ≥2.0% and <3.5% and HbF band, as well as abnormal blood routine report [mean corpuscular volume (MCV) <82 fl and/or mean corpuscular hemoglobin (MCH) <27 pg]; (5)group of 5 cases with HbA 2 ≥2.0% and <3.0% accompanied with β thalassemia gene carriers Sanger sequencing was used to detect single nucleotide variants of δ-globin. Results:(1) A total of 22 genetic variations were detected, including 6 de novo variations, and the top 3 genetic variations were respectively c.-127T>C (57.02%, 65/114), c.-80T>C (9.65%, 11/114), c.349C>T (7.89%, 9/114). (2) In group of patients with HbA 2 <2.0% but no HbF band, 22 cases (62.85%, 22/35) had HBD gene variation, including 7 cases with MCV and MCH lower than reference values, 4 cases with α thalassemia; 13 cases had no HBD gene variation, including 12 cases with lower MCV and MCH. Among 19 cases with abnormal blood routine test results, levels of HbA 2 in patients (7 cases) with HBD gene variation were lower compared with those without HBD gene variation (12 cases) ( P<0.01%). (3)In group of patients with HbA 2<2.0% with HbF band, 59 cases (92.18%, 59/64) had HBD gene variations whose mutations all occurred in promoter region, and the HbF were all lower than 5.0%; 5 cases with HbF >5.0% had no HBD gene variation. (4) In group of patients with HbA 2 <2.0% and suspected HbA 2 variants, the detection rate was 100% (25/25) and δ-globin variants <1.0%. (5) In group of patients with HbA 2 ≥2.0% and <3.5% and HbF band accompanied with abnormal blood routine results, no HBD gene variation was found. (6) In group of 5 patients with HbA 2 ≥2.0% and <3.0% with β thalassemia gene carriers, HBD gene variation were found in all cases, and the level of HbA 2 was (2.62±0.17)% and HbF was (3.62±2.22)%. Conclusions:There are various genotypes of HBD gene variation, among which HBD: c.-127T>C is the most common in Guangdong population in China. Mutations in the promoter region may cause decrease in HbA 2 and increase in HbF which is mostly less than 5% but exceeds 5.0% when combined with β thalassemia. Our study enriched the gene mutation profiles of HBD gene in Guangdong population.

Construction of fixed asset bubble management mode in public hospitals from an integrated perspective / 中华医院管理杂志

Fixed assets management is an important part of hospital operation management. At present, the fixed asset management of public hospitals in China lacks integrity and needs further improvement. In May 2022, a tertiary public hospital in Shanghai explored a fixed asset bubble management mode from an integrated perspective based on a bubble management strategy. The main approach included building a hospital′s fixed asset management organizational structure, equipping it with fixed asset sorting cards, setting up large, medium and small fixed asset bubbles respectively, implementing such management measures as bubble flow management, bubble rupture plans, and bubble internal and external environmental risk control mechanisms.In March 2023, the hospital had constructed 104 fixed asset management bubbles, including 17 large bubbles, 58 medium bubbles and 29 small bubbles. The fixed asset bubble management mode effectively reduced the loss rate of hospital fixed assets and achieved a preliminary success, providing reference for improving the efficiency and quality of fixed asset management in public hospitals in China.

Comparison of the effect of oral megestrol acetate with or without levonorgestrel-intrauterine system on fertility-preserving treatment in patients with early-stage endometrial cancer: a prospective, open-label, randomized controlled phase II trial (ClinicalTrials.gov NCT03241914) / 부인종양

Objective@#To evaluate the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) plus oral megestrol acetate (MA) as fertility-preserving treatment in patients with early-stage endometrial cancer (EEC). @*Methods@#In this single-center, phase II study with open-label, randomized and controlled design, young patients (18–45 years) diagnosed with primary EEC were screened, who strongly required fertility-preserving treatment. Patients were randomly assigned (1:1) into MA group (160 mg oral daily) or MA (160 mg oral daily) plus LNG-IUS group. Pathologic evaluation on endometrium retrieved by hysteroscopy was performed every 3 months. The primary endpoint was complete response (CR) rate within 16 weeks of treatment. The secondary endpoints were CR rate within 32 weeks of treatment, adverse events, recurrent and pregnancy rate. @*Results@#Between July 2017 and June 2020, 63 patients were enrolled and randomly assigned. Totally 56 patients (26 in MA group; 28 in MA + LNG-IUS group) were included into primary-endpoint analyses. The median follow-up was 31.6 months (range, 3.1–94.0). No significant difference in 16-week CR rate were found between MA and MA + LNG-IUS groups (19.2% vs. 25.0%, p=0.610; odds ratio=1.40; 95% confidence interval=0.38–5.12), while the 32-week CR rates were also similar (57.1% and 61.5%, p=0.743), accordingly. More women in MA + LNG-IUS group experienced vaginal hemorrhage (46.4% vs. 16.1%; p=0.012) compared with MA group. No intergroup difference was found regarding recurrence or pregnancy rate. @*Conclusion@#Compared with MA alone, the addition of LNG-IUS may not improve the early CR rate for EEC, and may produce more adverse events instead.

PTEN mutation predicts unfavorable fertility preserving treatment outcome in the young patients with endometrioid endometrial cancer and atypical hyperplasia / 부인종양

Objective@#This study aimed to investigate the impact of molecular classification and PTEN, KRAS and PIK3CA gene mutation on the outcome of fertility-preserving treatment in the patients with endometrioid endometrial cancer (EEC) and endometrial atypical hyperplasia (EAH). @*Methods@#This is a single-center retrospective study. A total of 135 patients with EEC and EAH receiving fertility-preserving treatment and molecular classification were reviewed. The distribution of the four types of molecular classification was described. The impact of non-specific molecular profile (NSMP), mismatch repair-deficiency (MMRd), and PTEN, KRAS and PIK3CA gene mutation on the outcome of fertility-preserving treatment was analyzed. @*Results@#Of the patients analyzed, 86.7% (117/136) were classified as having NSMP; 14 (10.4%), MMRd; 1 (0.7%), POLEmut EAH; and 3 (2.2%), p53abn EEC. The patients having NSMP and MMRd achieved similar 16-, 32-, and 48-week complete response rates. The patients harboring tier I and tier II PTEN mutations (PTENmut-Clin) achieved lower cumulative 32-week CR rates than those with PTEN-others (without PTENmut-Clin) (22/47, 46.8% vs. 50/74, 67.6%; p=0.023; odds ratio=0.422; 95% confidence interval [CI]=0.199–0.896). Insulin-resistance (hazard ratio [HR]=0.435; 95% CI=0.269–0.702; p=0.001) and PTENmut-Clin (HR=0.535; 95% CI=0.324–0.885; p=0.015) were independent negative predictors for lower 32-week CR rates. @*Conclusion@#PTENmut-Clin is an independent risk factor for unfavorable fertility-preserving treatment outcomes in the patients with EEC and EAH. The patients with MMRd receiving fertility-preserving treatment achieved outcomes similar to those of the patients with NSMP. The molecular profiles might guide fertility-preserving treatment in the prognosis and clinical decisions.

Application of the “virtual-real combination” experimental teaching model in Human Parasitology teaching: a case study of comprehensive schistosome experiments / 中国血吸虫病防治杂志

Information technology has become an important driver to facilitate higher education developments in the context of new medical sciences. A new “virtual-real combination” experimental teaching model was designed and created through integrating information technology with experimental teaching by Experimental Teaching Center of Basic Medical Sciences and Department of Pathogen Biology, Nanjing Medical University and was applied in Human Parasitology teaching, which achieved satisfactory teaching effectiveness. This new model showed effective to deepen the understanding of the basic human parasitology knowledge, improve the operative skills, and cultivate the moral literacy and comprehensive capability among medical students. This report presents the teaching protocols and implementation, teaching effectiveness and evaluation, and experiences of comprehensive schistosome experiments.

Efficacy of lymph node dissection on stage IIICr of cervical cancer before CCRT: study protocol for a phase III, randomized controlled clinical trial (CQGOG0103) / 부인종양

Background@#Cervical cancer is still present a major public health problem, especially in developing countries. In International Federation of Gynaecology and Obstetrics 2018, allowing assessment of retroperitoneal lymph nodes by imaging and/or pathological findings and, if deemed metastatic, the case is designated as stage IIIC (with r and p notations). Patients with lymph node metastases have lower overall survival (OS), progression free survival (PFS), and survival after recurrence, especially those who have unresectable macroscopical positive lymph nodes. Retrospective analysis suggests that there may be a benefit to debulking macroscopic nodes that would be otherwise difficult to sterilize with standard doses of radiation therapy. However, there are no prospective study reporting that resecting macroscopic nodes before concurrent chemoradiation therapy (CCRT) would improve PFS or OS of cervical cancer and no guidelines for surgical resection of bulky lymph nodes. The CQGOG0103 study is a prospective, multicenter and randomized controlled trial (RCT) evaluating lymph node dissection on stage IIICr of cervical cancer. @*Methods@#Eligible patients are histologically confirmed cervical squamous cell carcinoma, adenocarcinoma, adeno-squamous cell carcinoma. Stage IIICr (confirmed by computed tomography [CT]/magnetic resonance imaging/positron emission tomography/CT) and the short diameter of image-positive lymph node ≥15 mm. 452 patients will be equally randomized to receive either CCRT (pelvic external-beam radiotherapy [EBRT]/extended-field EBRT + cisplatin [40 mg/m2] or carboplatin [the area under curve=2] every week for 5 cycles + brachytherapy) or open/minimally invasive pelvic and para-aortic lymph node dissection followed by CCRT. Randomization is stratified by status of para-aortic lymph node. The primary endpoint is PFS. Secondary endpoints are OS and surgical complications. A total of 452 patients will be enrolled from multiple hospitals in China within 4 years and followed up for 5 years.

A prospective randomized multicenter trial for lymphadenectomy in early-stage ovarian cancer: LOVE study / 부인종양

Background@#The Lymphadenectomy in Ovarian Neoplasms (LION) study revealed that systemic lymphadenectomy did not bring survival benefit for advanced ovarian cancer patients with clinically normal lymph nodes and was associated with a higher incidence of operative complications. However, there is no consensus on whether lymphadenectomy has survival benefit or not in early epithelial ovarian cancer (EOC). @*Methods@#We designed the LOVE study, a multicenter, randomized controlled, phase III trial to compare the efficacy and safety of comprehensive staging surgery with or without lymphadenectomy in stages IA-IIB EOC and fallopian tube carcinomas (FTC). The hypothesis is that the oncological outcomes provided by comprehensive staging surgery without lymphadenectomy are non-inferior to those of conventional completion staging surgery in early-stage EOC and FTC patients who have indications for post-operative adjuvant chemotherapy. Patients assigned to experimental group will undergo comprehensive staging surgery, but lymphadenectomy. Patients assigned to comparative group will undergo completion staging surgery including systematic pelvic and para-aortic lymphadenectomy. All subjects will receive 3–6 cycles of standard adjuvant chemotherapy. Major inclusion criteria are pathologic confirmed stage IA-IIB EOC or FTC, and patients have indications for adjuvant chemotherapy either confirmed by intraoperative fast frozen section or previous pathology after an incomplete staging surgery. Major exclusion criteria are non-epithelial tumors and low-grade serous carcinoma. Patients with severe rectum involvement which lead to partial rectum resection will be excluded. The sample size is 656 subjects. Primary endpoint is disease-free survival.

Construction and Evaluation of Metastatic Risk Model in Left and Right Colorectal Cancer / 肿瘤防治研究

Objective To identify the influence factors and construct a predicted model for liver, lung, bone, or brain metastasis among patients with left or right colorectal cancer. Methods Patients with colorectal cancer with information on liver, lung, bone, and brain metastasis were retrospectively filtered and analyzed from 2010 to 2018 from the SEER database. These patients were divided into three groups based on their primary tumor location. Multivariate logistic regression analysis was conducted to identify the influence factors on metastasis. A nomogram that could predict metastasis was established and further validated by the AUC of ROC curves. Results A total of 49335 eligible patients were chosen from the SEER database. N stage and CEA were identified as risk factors for all metastases, which were unrelated to primary tumor location. By contrast, race had varying effects on liver metastasis between different groups (P < 0.05). The nomogram model predicting liver metastasis was successfully established, and the AUCs based on the three groups were 0.821 (95%CI: 0.813-0.830), 0.841 (95%CI: 0.833-0.848), and 0.796 (95%CI: 0.782-0.811), respectively. Conclusion The influence factors and predictive models on liver metastasis were different in patients with colorectal cancer and different primary tumor locations.

Analysis of children's iodine nutrition and thyroid B-ultrasound examination results in Suqian City of Jiangsu Province / 中华地方病学杂志

Objective:To understand the iodine nutritional status and the prevalence of goiter and thyroid nodules among children in Suqian City, and to provide a basis for prevention and treatment of iodine deficiency disorders.Methods:From May 2019 to July 2020, the counties (districts) in Suqian City were divided into 5 areas according to east, west, south, north, and middle, each area selected 1 township (street) every year, and 40 non-boarding students aged 8 - 10 years were selected (balanced age and gender) from 1 primary school from each township (street). Children's urine samples and household salt samples were collected to detect urinary iodine and salt iodine contents, and some children were subjected to thyroid examination and height and weight measurements.Results:A total of 1 999 urine samples were collected from children aged 8 to 10 years, and the median urinary iodine was 221.0 μg/L. There was a statistically significant difference among different counties (districts, H = 147.89, P < 0.05). A total of 1 999 edible salt samples were collected from children's homes, and the salt iodine content was (24.01 ± 4.55) mg/kg. Among them, iodized salts was 1 979, the coverage rate of iodized salt was 99.00%; the qualified iodized salts was 1 910, and the iodized salt qualified rate was 96.51%, and the consumption rate of qualified iodized salt was 95.55%. A total of 1 000 cases of children's thyroid were examined, and 22 cases of goiter, 51 cases of solid thyroid nodules, and 54 cases of thyroid cyst were detected, and the detection rates were 2.20%, 5.10%, and 5.40%, respectively. There were significant differences in the detection rates of solid nodules and cysts beteen different counties (districts, χ 2 = 16.41, 37.66 , P < 0.05), but there was no significant difference in the detection rates of goiter (χ 2 = 8.65 , P > 0.05). According to Spearman correlation analysis, children's thyroid volume was positively correlated with height and weight ( r = 0.403, 0.315, P < 0.05). Conclusions:The iodine nutrition of children in Suqian City is at an excessively suitable level of iodine, and the salt iodine monitoring indicators meet the national iodine deficiency disorders elimination standards (the coverage rate of iodized salt ≥ 95%, and the consumption rate of qualified iodized salt > 90%). The children's thyroid volume is affected by factors such as height and weight.

Effects of tigacycline-based combination therapy onprocalcitonin, high sensitivity C-reactive protein and interleukin-6 in patients with multiple drug-resistant acinetobacterbaumannii post-operative abdominal infection in intensive care unit / 中国医师进修杂志

Objective:To explore the effects of tigacycline-based combination therapy on procalcitonin (PCT), high sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in patients with multiple drug-resistant acinetobacterbaumannii post-operative abdominal infection in intensive care unit (ICU).Methods:Seventy-five patients with multiple drug-resistant acinetobacter baumannii post-operative abdominal infection in ICU admitted to West Central Hospital of Hainan Prorvincefrom October 2015 to October 2018 were selected and divided into the control group (37cases) and the observation group (38 cases) according to random number table method. The control group was treated with cefoperazone-sulbactam on the basis of routine treatment, while the observation group was treated with tegacycline on the basis of the control group. Both groups were treated for 1 week. The clearance of acinetobacterbaumannii and clinical efficacy of the two groups were counted; the levels of serum PCT, hs-CRP and IL-6 and ummune function were compared.Results:The clearance rate of acinetobacterbaumannii in the observation group was significantly higher than that in the control group: 76.32%(29/38) vs. 54.05%(20/37), χ2 = 4.10, P = 0.043. Compared with before treatment, the levels of serum PCT, hs-CRP and IL-6 in the two groups were decreased after 1 week of treatment, and the levels of serum PCT, hs-CRP and IL-6 in the observation group were lower than those in the control group ( P<0.05). Compared with before treatment, the levels of peripheral blood CD 3+, CD 4+, CD 4+/CD 8+ were increased and peripheral blood CD 8+ was decreased in both groups, and the levels of peripheral blood CD 3+, CD 4+, CD 4+/CD 8+ in the observation group were higher than those in the control group ( P<0.05), while the level of peripheral blood CD 8+ in the observation group was lower than that in the control group ( P<0.05). The total effective rate in the observation group was significantly higher than that in the control group: 89.47% (34/38) vs. 67.57% (25/37), χ2 = 4.13, P<0.05. Conclusions:Tigacycline combined with cefoperazone-sulbactam in the treatment of intra-abdominal infection after surgery of acinetobacterbaumannii in ICU could reduce the levels of serum PCT, hs-CRP, IL-6, reduce the body′s inflammatory response and improve the immune function, and improve the treatment efficiency of intra-abdominal infection.

Pulp defect of thumb and finger repaired by the medial plantar artery flap: Report of 10 cases / 中华显微外科杂志

Objective:To investigate the effect of using the free medial planar artery flap(MPAF) pedicled by the superficial branch of the medial plantar artery in repair of pulp defect of thumb and finger.Methods:Ten patients with pulp defect of thumb and finger were repaired with MPAF of foot in the Department of Hand Surgery of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from November 2020 to January 2022. There were 3 cases of cutting injury, 2 cases of chainsaw injury, 2 cases of extrusion injury and 3 cases of avulsion injury. Digits injuried: 4 index fingers, 3 thumbs, 2 middle fingers, and 1 ring finger. After admission, Doppler ultrasound was performed to understand the running course of medial plantar artery. Emergency surgeries were performed to repair the pulp defects of thumb and finger with free MPAF, and donor sites were repaired by skin grafting. The area of soft tissue defects was 2.0 cm×2.5 cm-3.0 cm×4.5 cm, and the size of flap was 2.5 cm×3.0 cm-3.5 cm×5.0 cm after debridement. Postoperative effect was assessed over the follow-up at outpatient clinics by same group of surgeons. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All 10 free MPAFs pedicled by the superficial branch of medial plantar artery survived. After the transfer, the colour, texture and thickness of the flaps were matched with the digit with pulps realistic appearance. Secondary flap thinning surgery was not required. Two cases had blisters at the distal end of the flap, and healed after fluid extraction and dressing change. All patients had 3 to 18 months of follow-up. The TPD of the flap was 4-7 mm. The skin grafts in the donor sites survived well. At the last follow-up, the upper limb function was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, with the results of 8 cases in excellent and 2 in good.Conclusion:Free MPAF pedicled by the superficial branch of medial plantar artery can repair the pulp defect of thumb and finger with reliable blood supply, excellent texture and good appearance. And there is no damage to the main vessels in the donor site.

Application research on risk management of postoperative delirium in elderly patients with hip fragility fracture based on FMEA theory / 中国实用护理杂志

Objective:To explore the effect of postoperative delirium risk management in elderly patients with hip fragility fracture based on failure mode and effect analysis (FMEA) theory, and to provide a basis for reducing the incidence of postoperative delirium.Methods:A total of 50 patients admitted to the First Affiliated Hospital of Sun Yat-sen University due to hip fragility fractures from January to December 2019 were selected as the control group, and 50 patients admitted to the First Affiliated Hospital of Sun Yat-sen University for hip fragility fractures from January to December 2020 were selected as the observation group. The control group received routine care, and the observation group implemented risk control intervention measures based on FMEA theory on the basis of the control group. The risk priority number (RPN) value, incidence of delirium, duration of delirium, pain score, satisfaction, and average length of hospital stay were compared between the two groups of patients in each link of failure risk.Results:The RPN values of each link failure risk of the observation group were 100.80 ± 13.39, 103.96 ± 9.96, 103.76 ± 8.04, delirium duration was (36.33 ± 9.07) min, pain scores were 1.86 ± 0.76, 4.16 ± 1.17, average length of stay was (8.98 ± 4.64) days, and incidence of delirium was 6.0% (3/50), the RPN values of each link failure risk of the control group were 274.10 ± 8.48, 291.00 ± 10.10, 287.78 ± 11.64, delirium duration (78.70 ± 20.10) min, pain scores 2.26 ± 1.02, 4.74 ± 1.19, average length of stay was (11.50 ± 7.66) days, and incidence of delirium was 22.0% (11/50). The differences between two groups showed significant differences ( t values were 1.99-93.24, χ2=4.07, P<0.05). The patient satisfaction score of the observation group was 99.36 ± 1.01, which was higher than that of the control group 89.63 ± 2.62, and the difference was statistically significant ( t=24.50, P<0.05). Conclusions:The perioperative implementation of postoperative delirium risk management model based on FMEA theory in elderly patients with hip fractures can reduce the incidence of postoperative delirium, relieve pain, shorten hospital stay, and improve satisfaction degree. It is worthy of clinical promotion.

The SCIA-based conjoined flap for covering extremely large lower limb defects / 中华显微外科杂志

Objective:To investigate the results of the superficial circumflex iliac artery(SCIA)-based conjoined flap for covering extremely large lower limb defects.Methods:From February 2017 to June 2019, 15 patients were admitted, who suffered from severe degloved injury for the lower limb, including 9 males and 6 females with a median year of 45 (ranged, 36-67 ) years old. All were taken thorough and radical debridement and covered by the VSD device during the emergency operation. The dimension of defects was ranged from 25.0 cm ×8.0 cm to 50.0 cm ×15.0 cm. Using the lower abdominal wall or side chest wall as the donor site, the conjoined flap was dissected when the wound surface became granulating. The perforator match fashions included bilateral SCIA, and ipsilateral SCIA and thoracodorsal artery(TA). The donor sites were primary closure. The follow-up was accomplished by the same surgeon.Results:Fourteen flaps survived completely without significant complications, and distal necrosis was observed in one longitudinal flap, which was healed with the skin graft in the second stage. All flaps were available for a mean follow-up of 18 (ranged 16-24) months. The aesthetic outcomes were achieved on the recipient site without hairy appearance and hyper-pigmentation. A concealed line scare was left on the donor site, without the hernia and limited function. At the last follow-up, 7 cases were excellent and 1 case was good, evaluated with the LEFS criteria. And 6 cases were excellent and 1 case was good, assessed by the AOFAS criteria.Conclusion:The simultaneous reconstruction of extreme lower limb defects and better salvage treatment could be achieved by the SCIA-based conjoined flap. And as a versatile flap, it was blessed with concealed donor site, various design fashions, and larger dissection size in selected cases.