Ruxolitinib， a small molecule inhibitor， selectively targets Janus kinase （JAK） by competitively binding to adenosine triphosphate on the catalytic site of the JAK1 and JAK2 domain， thereby inhibiting JAK activation and signal transducer and activator of transcription （STAT） phosphorylation and prevents the expressions of the JAK-STAT signaling pathway. Oral ruxolitinib has demonstrated promising efficacy for myelofibrosis and polycythemia vera. The topical Ruxolitinib cream， approved by the US FDA as the first non-segmental vitiligo home treatment drug， is set to be launched in domestic medical pioneer areas in August 2023 and is expected to bring about a breakthrough in the treatment of vitiligo. Clinical cases have also shown that Ruxolitinib cream has significant curative effects on atopic dermatitis， alopecia areata， and other conditions， indicating great application prospects.

Objective:To explore the efficacy of precise and empirical bismuth-containing quadruple therapy guided by clarithromycin sensitivity testing in the first eradication of Helicobacter pylori ( H. pylori) in Ningxia. Methods:From August 12, 2022 to March 22, 2023, 600 patients diagnosed as H. pylori-positive by 14C-urea breath test ( 14C-UBT) for the first time in People′s Hospital of Ningxia Hui Autonomous Region, Ningnan Hospital of People′s Hospital of Ningxia Hui Autonomous Region, Zhongwei People′s Hospital, Yanchi County People′s Hospital, and Pingluo People′s Hospital were selected, and divided into empirical treatment group (hereinafter referred to as the empirical group), genetic testing group (hereinafter referred to as the genetic group), and drug sensitivity testing group (hereinafter referred to as the drug sensitivity group) by using random number table with 200 patients in each group. The empirical group did not undergo drug sensitivity testing and genetic testing, while the genetic and drug sensitivity groups were confirmed to be sensitive to clarithromycin through genetic testing and drug sensitivity testing, and the patients with drug-resistant were excluded, respectively. All the patients of the 3 groups received the same clarithromycin bismuth-containing quadruple therapy. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed to compare the eradication rates of H. pylori among 3 groups. Cost-effectiveness ratio (CER) and incremental cost-effectiveness ratio (ICER) were used for cost-effectiveness and sensitivity analysis based on the ITT. Chi-square test was used for statistical analysis. Results:There were 200, 126, and 168 patients included in the empirical group, genetic group, and drug sensitivity group in ITT analysis, and 190, 123, and 164 patients were enrolled in the 3 groups in PP analysis, respectively. The results of ITT analysis showed that the eradication rates of H. pylori in the empirical group, genetic group, and drug sensitivity group were 80.5% (161/200), 94.4% (119/126), and 95.2% (160/168), respectively. The results of PP analysis indicated that the eradication rates of H. pylori in the 3 groups were 84.7% (161/190), 96.7% (119/123), and 97.6% (160/164), respectively, and the differences were statistically significant ( χ2=25.39 and 24.93, both P<0.001). The H. pylori eradication rates of genetic group and drug sensitivity group were both higher than that of empirical group in ITT and PP analysis( χ2=12.40, 17.80, 11.42, and 17.13; all P<0.001). The cost-effectiveness analysis showed that the direct treatment cost of the empirical group, genetic group, and drug sensitivity group was 400.8, 729.2, and 779.2 yuan, respectively, and the CER was 4.98, 7.72, and 8.18 yuan/%, respectively. Compared to the empirical group, the ICER of the genetic group and drug sensitivity group was 23.6 and 25.7 yuan/%, respectively. The sensitivity analysis demonstrated that, when the cost of genetic testing reduced or increased by 20%, the ICER of the genetic group compared to the empirical group was 21.8 or 25.5 yuan/%, respectively. When the cost of drug sensitivity testing reduced or increased by 20%, the ICER of the drug sensitivity group compared to the empirical group was 23.3 or 28.2 yuan/%. When the cost of gastroscopy reduced or increased by 20%, the ICER of the genetic group compared to the empirical group was 20.8 or 26.5 yuan/%, and the ICER of the drug sensitivity group compared to the empirical group was 23.0 or 28.4 yuan/%, respectively. Conclusion:In Ningxia, if the clarithromycin bismuth-containing quadruple regimen is applied as the first H. pylori eradication regimen, in order to achieve the clinical eradication efficacy of H. pylori, and the patients can accept an additional payment of 23.6 or 25.7 yuan for each 1% increasing in the H. pylori eradication rate, then the precision treatment after clarithromycin resistance test is recommended.

Balamuthia mandrillaris amoebic encephalitis （BAE） is a rare infectious disease with a high mortality rate and is caused by Balamuthia mandrillaris. The lack of specific clinical manifestations often leads to misdiagnosis. This article reports a case of BAE diagnosed by metagenomic next-generation sequencing， in order to improve the understanding of the disease.
Balamuthia mandrillaris

Objective:To evaluate the clinic efficacy of channel bone grafting [preservation of the sclerotic bone at the broken nonunion ends and fixation with limited contact dynamic compression plate (LC-DCP)] in the treatment of postoperative atrophic nonunion of middle clavicular fracture.Methods:The 41 patients were retrospectively analyzed who had been treated at Department of Orthopaedics and Traumatology, Xi'an Hong-Hui Hospital for atrophic nonunion after internal fixation of middle clavicular fracture from June 2015 to December 2019. They were 23 males and 18 females, with a mean age of 47.6 years (from 28 to 63 years). The left side was affected in 25 cases and the right side in 16 cases. The time interval between initial fracture surgery and nonunion surgery averaged 18.5 months (from 9 to 40 months). Thirty-six cases had undergone one operation and 5 cases 2 operations before admission. The length of bone defect was measured during operation. All nonunions were treated with construction of a graft channel, iliac bone graft and LC-DCP internal fixation above the clavicle. The upper limb function of the affected side was evaluated by the Disabilities of Arm, Shoulder and Hand (DASH) 12 months after operation.Results:The 41 patients were followed up for an average of 13.6 months (from 12 to 15 months). A bone defect ≤2.0 cm was found in 25 cases and that >2.0 cm in 16 ones. Nonunion healed in all patients after an average time of 14 weeks (from 12 to 16 weeks). One patient reported continuous pain in the donor area after operation and the other developed deep venous thrombosis at the right lower limb. The DASH upper limb scores at 12 months after operation averaged 14.7.Conclusion:Channel bone grafting is a feasible clinical treatment of postoperative atrophic nonunion of middle clavicular fracture, because it preserves the sclerotic bone at the broken nonunion ends, reduces the amount of iliac bone graft and leads to fine clinic efficacy.

【Objective】 To provide reference for fine management of blood donors by classifying and analyzing different types of blood donors from domestic blood stations. 【Methods】 The resident population of 15 regions in China from 2016 to 2019 were taken as the research object, among which the blood donors were divided into three categories: age-eligible citizens, registered donors and donated donors. The average value and proportion of the three categories were calculated and statistically analyzed. 【Results】 The resident population of the 15 regions varied greatly. The mean 95% CI of the proportion of age-eligible citizens to resident population from 2016 to 2019 was (60.16%, 67.84%); registered donors to age-eligible citizens and resident population was (2.21%, 2.86%) and (1.41%, 1.79%), respectively; donated donors to registered donors, age-eligible citizens and resident population was (84.63%, 91.68%), (1.93%, 2.55%) and(1.23%, 1.59%), respectively. 【Conclusion】 There were differences in the number and proportion of different types of blood donors in different regions. The fine management of blood donors can help blood stations carry out more effective recruitment and retention strategies.

Objective To analyze the status quo and existing problems of radiation protection for veterinary X-ray facilitiesin Beijing-Tianjin region, China, and to provide a basis for improving radiation protection management level. Methods According to the requirements of the Technical guidelines for status quo assessment of occupational hazard of the employing unit (AQ/T 4270—2015), the study performed status quo assessment on the workplaces of veterinary X-ray facilities in 16 pet hospitals in Beijing-Tianjin region, and comprehensively analyzed the impact of the workplaces on the health of radiation workers and the public. Results In terms of personnel management, the pass rates of occupational health management post setting, personnel training, personal protective equipment, individual monitoring of occupational external exposure, notification of occupational hazards, and occupational health surveillance were 100%, 81.3%, 100%, 75%, 37.5%, and 25%, respectively. In terms of workplace management, most workplaces had reasonable layout and zoning and complete protection and emergency devices. However, there were some problems in some places, such as non-standard radiation warning signs, no notice board of occupational hazards, and no radiation protection testing. In terms of document management, all institutions had imperfect system documents. Conclusion The workplaces of veterinary X-ray facilities in 16 institutions basically meet the requirements for radiation protection, but there are also some problems, such as inadequate management of personnel and workplace radiation protection, and imperfect system documents. Institutions should strengthen the study of radiation protection knowledge. The competent authorities should strengthen supervision, formulate corresponding standards for radiation protection, enhance training, and improve the professional level of staff.

Objective:To study the influence of anticoagulation timing on incidence of perioperative deep venous thrombosis (DVT) in elderly patients with hip fracture.Methods:A retrospective analysis was made of the 179 elderly patients with hip fracture who had been admitted to Department of Orthopedics and Traumaology, Hong-Hui Hospital from July 2017 to December 2018. They were 78 males and 101 females, aged from 62 to 91 years (mean, 79.5 years). There were 79 femoral neck fractures and 100 intertrochanteric fractures, 109 of which were treated by internal fixation and 70 by hip replacement. The patients were divided into 3 groups depending on the timing of anticoagulation after injury. In group 1 of 74 cases, anticoagulation started <24 h after injury; in group 2 of 36 cases, anticoagulation started 24 to 48 h after injury; in group 3 of 69 cases, anticoagulation started >48 h after injury. Anticoagulation continued until 12 h before surgery in all patients but was resumed 8 to 12 h after surgery. The 3 groups were compared in incidence of perioperative DVT.Results:The 3 groups were comparable due to insignificant differences between them in their pre-operative general data ( P>0.05). DVT occurred perioperatively in 84 patients, yielding an incidence of 46.9% (84/179). The incidences of perioperative DVT were 27.0% (20/74), 47.2% (17/36) and 68.1% (47/69) in groups 1, 2 and 3, respectively, showing significant differences ( χ2=24.206, P<0.001), between any 2 groups ( P<0.05). Conclusion:Since the earlier anticoagulation starts after injury the lower incidence of perioperative DVT in elderly patients with hip fracture, early standardized prophylactic anticoagulation after injury can effectively reduce incidence of perioperative DVT.

Objective:To characterize the biomechanical performance of our self-designed novel blocking screws in the treatment of distal tibial fractures.Methods:Thirty artificial composite tibial bones were used to create models of unstable distal tibial fracture (AO type 43-A3) which were randomized into 3 even groups ( n=10) according to modes of fixation. Group A was subjected to fixation with intramedullary nails only with merely preset holes reserved for the blocking screws, group B to fixation with intramedullary nails plus conventional anteroposterior blocking screws, and group C to fixation with intramedullary nails plus novel lateral blocking screws. In all the 3 groups, a lateral bending stress test was conducted to record the maximum transversal displacement of the intramedullary nail, a fatigue test to observe the structural abnormality in the model and an axial stress test to record the maximum axial displacement of the intramedullary nail-bone structure. The 3 groups were compared in structural abnormality, the maximum transversal displacement of the intramedullary nail and the maximum axial displacement of the intramedullary nail-bone structure. Results:The lateral bending stress tests showed the maximum transversal displacements were (5.02±1.03) mm; (4.19±0.64) mm and (4.18±0.65) mm in groups A, B and C; compared with group A, the maximum transversal displacement decreased by 16.6%( P=0.027) in group B and decreased by 16.8%( P=0.025) in group C, showing significant differences but there was no significant difference in the maximum transversal displacement between groups B and C ( P=0.978). In the fatigue test, all models showed no structural abnormality under cyclic loading. In the axial stress test, the maximum axial displacements of the intramedullary nail-bone structure were, respectively, (5.69±0.75) mm, (5.31±0.61) mm and (5.51±0.65) mm in groups A, B and C, showing no statistically significant difference among the 3 groups ( P>0.05). Conclusion:Our self-designed novel blocking screws can be a new means in clinical application, because they are similar to conventional blocking screws in increasing the stability of nail-bone construct and other biomechanical performance.

Objective To evaluate the current status of radioactive occupational hazards in the construction of some medical institutions in Tianjin, discover existingproblems and deficiencies, and provide a technical basis for radiation protection management. Methods Based on the requirements of relevant regulations and standards, we comprehensivelyevaluated the results of the pre-evaluation and control effect evaluation of 81 radioactive occupational hazards in Tianjin. Results Among the 35 proposed protective measures for pre-evaluation of radiation occupational hazards constructionprojects, the lowest compliance rate is warning signs and personal protective equipment. Among the 46 construction projects of radioactive occupational hazard control evaluation, the pass rate of protective measures was between 73.9% and 100%, with the lowest pass rate for personal protective equipment. Besides, the pass rate of radiation protectionmanagement evaluation was 95.7% ～ 100%, with the lowest pass rate for the protection management system.The initial inspectionpass rateof the equipment quality control acceptancewas 98.6%, while the pass rate was 97.1% for the relevant workplace radiation protection during the initial inspection. Conclusion The pre-evaluation completion rate of radiological occupational hazard evaluation in Tianjin medical institution construction project, unilateral and area of construction room, workplace layout and zoning, ventilation, shielding measures, personal dose management and occupational health inspection all meet the requirements of regulations and standards. However, there are still some deficiencies in the personal protective equipment, warning signs and the radiation protection management system. Therefore, the regulatory department should further strengthen the evaluation of medical institutions, especially the key supervision and management of non-conformities.

Objective:To explore the efficacy of our novel reduction technique in the surgical treatment of complicated tibial plateau fractures.Methods:From May 2016 to September 2018, 50 fractures of tibial plateau (Schatzker types Ⅴ and Ⅵ) were treated at Department of Orthopaedics and Traumatology, Hong Hui Hospital. They were 34 males and 16 females, aged from 27 to 56 years (average, 42.3 years). They were divided into 2 groups according to the reduction techniques. In the group of novel reduction ( n=23), bone fragments were reduced one by one from the distal to the proximal until the compression fracture was reduced and fixated. In the conventional reduction group ( n=27), the articular surface was reduced first before fixation of articular fragments with distal ends of tibial fracture. The 2 groups were compared in terms of intraoperative bleeding, operation time, tibial plateau angle (TPA) on the knee anteroposterior X-ray film taken on the second day after operation, and rate of acceptable TPA (±5°). Results:There were no significant differences between the 2 groups in general preoperative data, showing comparability ( P>0.05). There were no significant differences between the 2 groups in either operation time (2.7 h ± 0.4 h versus 3.0 h ± 0.6 h) or intraoperative bleeding (215 mL ± 56 mL versus 221 mL ± 52 mL) ( P>0.05). The novel reduction group had a significantly higher rate of acceptable TPA [78.2% (18/23)] than the conventional reduction group [48.1%(13/27)]( P<0.05). Conclusion:In the surgical treatment of complicated tibial plateau fractures, compared with conventional reduction technique, our novel reduction technique can increase the rate of acceptable reduction but not operation time nor intraoperative bleeding.