Objective To offer decision support for reasonable allocation of medical resources by analysis of the present resources allocated.Methods Lorenz curve and Gini coefficient method were called into play.This paper studied such medical resources as the practicing doctors,registered nurses,medical institutions and hospital beds,from both the population distribution and geographical distribution aspects.The purpose is to compare the allocation in these municipalities (Beijing,Tianjin,Shanghai and Chongqing).Results If the Lorenz curve is drawn based on the total population served with such resources,the Gini coefficients indieate relatively balanced allocation of medical institutions,practicing physicians,and registered nurses in the municipalities,and highly balanced allocation of hospital beds.If the curve is drawn based on geographical distribution,the Gini Coefficient indicates relatively balanced allocation of medical institutions allocation in these municipalities,yet considerable difference in the allocation of practicing physicians,registered nurses,and hospital beds.Conclusion The study shows that medical resources allocation in China in these municipalities mirrors the condition of Priority to population density,and neglect of geographical distribution.It also reveals poor equity in the geographical distribution of medical resources,which plagues accessibility of medical resources.

ObjectiveTo investigate the dosimetric difference in the application of RapidArc using 6 and 15 MV X-rays for radiotherapy of multiple hepatic malignancy.MethodsA total of 12 cases with multiple hepatic tumors ( primary 5 cases and secondary 7 cases) were selected.All patients underwent the three dimensional CT simulation in free breathing.For each patient,RapidArc plans with single or two 358° arcs using 6 or 15 MV X-rays were designed respectively,the prescription dose was 2Gy per fraction × 25 fractions.The dosimetric differences were compared among RapidArc plans.ResultsAll of RapidArc plans could meet the clinicalrequirement.There were no significant differences in the conformity index ( CI ),homogeneity index ( HI),the maximum dose and the minimum dose of PTV among RapidArc plans ( P ＞ 0.05).All the CI could get to 0.91 and HI could get to 0.88.In the RapidArc plans with two 358° arcs,the Vs,V10,V15 of normal liver were higher than with single arc,while V20,V25,V30,V35,V40 were lower than with single arc.There were no significant differences in the different radiation dose of normal liver,stomach,duodenum and spinal cord among different plans ( P ＞0.05 ).The monitor units of RapidArc plans using 6 MV X-rays increased 12％ compared to 15 MV averagely.CondusionThe 6 MV X-ray would be selected chiefly in the radiotherapy of multiple haptic tumor using RapidArc with whole arc(s).

Objective To investigate the effects of insulin-like growth factor-1 (IGF-1) and oxidized low density lipoprotein (oxLDL) on expression of phosphatase PHLPP1 in vascular smooth muscle cells (VSMCs).Methods Rabbit aortic VSMCs were cultured.VSMCs proliferation ability was determined by measuring cell number and mitochondrial dehydrogenase (MD) activity with MTT assay.Western blot was used to detect the protein expression of phosphatase PHLPP 1.Results IGF-1 (100μg/L) increased cell number and MD activity to 3.02 and 3.59 times of that in control group.oxLDL(50μg/ ml) elevated the above two parameters to 2.03 and 2.91 times respectively.Western blot showed that IGF-1 and oxLDL inhibited the expression of PHLPP 1 to 39.27% and 40.26% of the control group (P＜0.01).Conclusion IGF-1 and oxLDL may enhance the proliferation of VSMCs by decreasing the expression of phosphatase PHLPP1 .

Objective To explore the effect of treating posterolateral tibial plateau fractures via the fibular osteotomy approach.Methods From August 2009 to August 2011,17 patients with posterolateral tibial plateau fractures,including 12 males and 5 females,aged from 24 to 76 years (average,37.8 years),were treated via the fibular osteotomy approach in our hospital.According to the Schatzker classification,8 cases were type Ⅱ,3 cases were type Ⅲ,6 cases were type V.After operation,X-rays were taken in all patients,and Rasmussen's radiological and functional gradings were used to evaluate radiological and functional outcomes of knees.Results All patients obtained follow-up,ranged from 9 to 35 months (average,18months).The healing time of the fracture ranged from 10.0 to 18.0 weeks (average,13.5 weeks).During the period of followed-up,there was no loss of reduction; one case presented with symptoms of common peroneal nerve injury,such as local hypesthesia in distal lateral lower leg and dorsi pedis,which recovered two weeks postoperatively.According to Rasmussen's radiological grading,the mean score of the knee joint was 17.5(range,14.0 to 18.0).The range of motion of the knee joint ranged from -5°to 135°(average,123.5o).According to Rasmussen's functional grading,the mean score of the knee joint was 26.9 (range,22 to 30).Conclusion Treating posterolateral tibial plateau fractures via the fibular osteotomy approach can obtain sufficient exposure,good reduction and fixation,and avoid flexion contracture of the knee and peripheral vascular nerve injury.Moreover,postoperative function and stability of the knee joint recover well.

Objective To explore the application of 3D-printing rapid prototyping in classification of acetabular fractures and education of young surgeons.Methods The data of 20 patients with acetabular fracture were reviewed in this study who had been treated between January and June 2016.Three junior orthopedic surgeons and 3 senior ones were chosen as observers.The conventional radiographs (X-ray films of the pelvis and acetabulum,CT scans and 3D reconstruction images of the pelvis) and 3D-printing rapid prototyping models of the 20 patients(1∶ 1) were randomly numbered.All the observers were asked to make Letournel-Judet classification of each radiograph and 3D-printing model independently in the first assessment.Four weeks later in the second assessment,all the observers were asked to make the same classifications after all the conventional radiographs and 3D-printing models were randomly numbered again.The kappa statistics was used to evaluate inter-and intra-observer agreements among the recorded results.Results At the first assessment,the inter-observer agreement was 0.887 and 0.962 respectively for conventional radiographs and 3D-printing models in senior surgeons while 0.659 and 0.849 in junior surgeons.The second assessment showed the intra-observer agreement was 0.906 for radiographs and 0.925 for 3D-printing models in senior surgeons while 0.696 and 0.849 in the junior ones.Conclusions Compared with conventional radiographs,since 3D-printing models can effectively enhance the reliability of acetabular fracture classification,they may be more helpful for young surgeons in understanding acetabular fractures.

Objective:To analyze the clinical outcomes of tibial bone transport over an intramedullary nail in combination with antibiotic-loaded calcium sulphate for treatment of segmental bone defect.Methods:A retrospective analysis was conducted by enrolling 11 surgically treated patients with tibial segmental bone defect after the debridement for tibial infection or osteomyelitis who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department, Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from Jan. 2018 to Jan. 2020. The collected clinical materials and data included gender, age, injury mechanism, smoke or alcohol, comorbidities, intraoperative bleeding loss, bone defect length, resorption time of calcium sulphate, bone transport time, external fixation time, external fixation index, complications and Paley bone and functional criteria. SPSS 24.0 software was used to analyze the data.Results:Eleven patients were followed up for 8 to 31 months (average 23.2 months). All patients achieved bone healing and the infection was eradicated with no sign of recurrence. The mean length of defect was (8.1±1.6) cm, mean resorption time of calcium sulphate was (6.6±2.6) months, bone transport time was (11.4±2.8) weeks, external fixation time was (4.7±1.2) months, external fixation index was (0.58±0.07) month/cm and full weight bearing time was (6.1±1.4) months. The complication rate was 36.4% including deep vein thrombosis, delayed union of the docking site, pin tract infection and sterile draining of the wound. Paley bone evaluation results were excellent and good in 10 patients (90.9%) and functional results were excellent and good in 11 patients (100%).Conclusion:Tibial bone transport over an intramedullary nail in combination with antibiotic-loaded calcium sulphate is a safe, reliable and successful method for segmental bone defect and eradication of infection which reduces external fixation time and complication rate, allows patients perform weight bearing and return to daily life earlier.

Objective:To investigate the effect of risk warning management mode on patients undergoing an emergency enhanced CT examination.Methods:This is a case-control study. A total of 40 patients who underwent emergency enhanced CT examination using routine management mode at No. 1 People's Hospital of Pinghu from January 2020 to June 2021 were included in the routine group. An additional 40 patients who underwent emergency enhanced CT examinations using risk warning management mode at the same hospital from July 2021 to December 2022 were included in the study group. The two groups were compared in terms of CT examination, image quality, adverse reactions, patient satisfaction, Self-rating Depression Scale score, and Self-rating Anxiety Scale score.Results:The Self-rating Depression Scale and Self-rating Anxiety Scale scores in the study group were significantly lower than those in the routine group ( t = -3.17, -2.90, both P < 0.05). The waiting time for CT examination, primary CT scan time, secondary CT scan time, and tertiary CT scan time in the study group were significantly shorter than those in the routine group ( t = 18.15, 4.89, 2.24, all P < 0.05). The completion rate of CT scans in the study group was 100% (40/40), which was significantly higher than that in the routine group [90% (36/40)], χ2 = 4.21, P < 0.05). The excellent and good image quality rate in the study group was 98% (39/40), which was significantly higher compared with the routine group [85% (34/40)], χ2 = 3.91, P < 0.05). The incidence of adverse reactions in the study group was 5% (2/40), which was significantly lower compared with the routine group [23% (9/40), χ2 = 5.17, P < 0.05]. Conclusion:The risk warning management mode for emergency CT enhanced examination can shorten the examination time, increase the completion rate of CT scans, enhance image quality, improve patients' psychological status, and reduce adverse reactions.

Child ; China ; Coronavirus ; Epidemiology ; Humans

Objective:To report our experience in the admission and perioperative management of 88 patients with lower extremity fracture in a mildly affected area in the epidemic of COVID-19.Methods:A retrospective analysis was conducted of the 88 patients with 97 lower extremity fractures who had been admitted to Department of Orthopedic Trauma, Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine from 23rd January, 2020 to 22nd February, 2020. They were 43 males and 45 females, aged from 15 to 95 years (average, 65.5 years). The patients underwent screening for COVID-19 infection before admission. Their fractures were located at the femoral neck in 33 cases and at the femoral trochanter in 26. Open reduction and internal fixation was performed for 29 cases, internal fixation with proximal femoral nail anti-rotation (PFNA) for 25 and hip replacement for 28. The time from injury to admission, time from admission to surgery, operation time, fracture reduction, hospital stay, and perioperative deep venous thrombosis (DVT) of lower limbs were recorded. COVID-19 infection was observed in the medical staff and patients as well.Results:All the 88 patients were COVID-19 negative in the screening before admission. The time from injury to admission averaged 4.5 days, the time from admission to surgery 3.7 days and hospital stay 6.6 days. The prostheses were all well located in the 28 patients undergoing hip replacement. The rate of functional and anatomic reduction was 94.2%(65/69) in the 69 patients undergoing internal fixation. Peri-operatively, DVT occurred in 25 cases (28.4%). High temperature was observed in 7 patients within 3 days after operation, which was diagnosed as absorption fever. No medical staff or patients were infected by COVID-19.Conclusion:In the epidemic of COVID-19, orthopedic surgeons in a medical institute in a mildly affected area can still provide effective and safe medical services for fracture patients and reduce nosocomial infection, as long as they comprehend the diagnosis and treatment guidelines for the epidemic, strictly screen the patients accordingly, stick to operative indications, protect against possible infection cautiously, and carry out the procedures in a standard manner.