Objective To investigate and analyze the surgical site infection rate,clinical characteristics,risk factors and pathogens in patients after type Ⅰ incision orthopedic foot and ankle surgery,which may provide a basis for preventing surgical site infection in foot and ankle surgery.Methods Patients undergoing type Ⅰ incision orthopedic foot and ankle surgery from Jun.2011 to Jun.2015 were investigated retrospectively.Clinical data of cases with surgical site infection were collected and analyzed.Incidence of surgical site infection,clinical features,risk factors and pathogen distribution were studied.Results Seven hundred and sixty-one patients were undergoing type Ⅰ incision orthopedic foot and ankle surgery,surgical site infection occurred in 42 patients with an infection rate of 5.5％.In terms of age,gender,anesthesia,smoking,drinking,rheumatoid arthritis,gout,number of incisions and recovery after open injuries,no significant difference of surgical site infection rate were found.Diabetes mellitus complicated with peripheral neuropathy increased the risk of surgical site infection compared with nondiabetic patients.Patients who had an operative time more than 3 hours had a greater risk of surgical site infection compared with those less than 1 hours.The presence of intra-operative implants increases the risk of surgical site infection compared with patients with external fixations or without implants.Conclusions Surgical site infection is a common complication for the patients after type Ⅰ incision orthopedic foot and ankle surgery.Diabetes mellitus complicated with peripheral neuropathy,long operation time and intra-operative implants may be the high risk factors for surgical site infection.

Objective To analyze the causes of under-staging in first transurethral resection of bladder tumor (TURBt) and find out solutions. Methods We retrospectively analyzed 118 cases (93 males and 25 females) of non-muscle invasive bladder cancer and compared the grade and stage between the first TURBt with the second transurethral resection (TUR) or partial cystectomy (PC) or radical cystectomy (RC) from January 2006 to March 2011.The mean patient age was 63.0 ±8.6 yrs.The tumors located in lateral,dome and posterior wall were 71,23,24 respectively; 75 of them were with single and 43 were with multifocal lesions; the sizes of tumor ranged from 0.5 -4.0 cm and 39 of them were ≥3.0 cm; The procedures performed by senior and junior urologist were 53 and 65 cases,respectively.In the study,we used the 2004 WHO/ISUP and 2002 TNM classification system for grading and staging.The data were analyzed with x2 and the logistic regression test to find out the causes of under-staging in first TURBt. Results There were 13 and 105 cases with high-grade Ta and T1 (low-grade T1 44 cases,high-grade T1 61 cases) in first TURBt,respectively.The finial stages were low-grade Ta(2),high-grade Ta(6),low-grade T1 (36),highgrade T1 ( 38 ),T2 (36) and 39 cases (33.1 ％ ) were under staged ( P ＜ 0.01 ).There were 17 and 22 under-staged cases compared with the second-TUR group (60 cases) and PC/RC groups (58 cases),respectively.The reasons of under-staging were related to tissue morphology changes (63 cases) and the absence of the detrusor muscle (56 cases) in specimens collected during the first TURBt.Multivariate analyses revealed that large tumors ( ≥3 cm),and lateral/dome/anterior wall tumors were independent risk factors to the absence of the detrusor muscle in the resected specimens with OR (95％ CI):3.766 ( 1.263 -11.225 ),and OR (95 ％ CI):5.951 (2.186 - 16.203 ),respectively.While surgery performed by senior surgeons was the protective factor to the presence of detrusor muscle,OR (95％ CI):0.274 (0.127 -0.593). Conclusions It is difficult for the first TURBt to completely avoid under-staging.The causes were related to tissues morphology changes and the absence of underlying detrusor muscle in specimens collected during the first TURBT procedure.Tissues morphology changes and the absence of detrusor muscle are related to the tumors location and size.A senior urologist and second-TUR can improve the under-staging.

Objective To explore the clinical value of dual-energy CT lung perfusion imaging and perfusion scintigraphy in acute pulmonary embolism (PE) rabbit models. Methods Acute PE models were established in 20 rabbits with femoral vein injection of sponge as embolus materials, and 4 rabbits were injected saline as control group. Two hours after embolization, dual-energy CT and perfusion scintigraphy imaging were performed respectively. Taking the pathologicall findings as the reference standards, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both imaging methods were compared. CT values and enhancement degree (overlay value) of the embolic areas and normal pulmonary parenchyma were measured in DEPI image after embolization. Results Normal lung was color-coded as homogeneously yellowish red, perfusion scintigraphy displayed rarefaction or absence. The sensitivity, specificity, PPV, NPV of DEPI was 100%, 97.50%, 95.24%, 100%, and of perfusion scintigraphy was 67.50%, 81.25%, 64.29%, 83.33%, respectively. Increased CT values and overlay values of embolism areas in DEPI images were lower than those of normal pulmonary parenchyma (P<0.05). Conclusion DEPI has higher sensitivity and specificity than perfusion scintigraphy for detection of pulmonary emboli in an acute PE rabbit models.

BACKGROUND:At present, biological agent-involved immunologic induction therapy gradual y became a key component in immunosuppression therapy of kidney transplantation. It can effectively prevent acute rejection and avoid the appearance of complications. OBJECTIVE:To evaluate the effect of different biological agents on immune state and functional status of transplanted kidney in immunologic induction therapy. METHODS:Clinical data of 110 recipients with kidney transplantation were retrospectively analyzed. In accordance with the conditions of immunologic induction therapy, recipients in the monoclonal antibody group (n=35) received basiliximab. Recipients in the polyclonal antibody group (n=43) underwent rabbit anti-human antithymocyteglobulin. Recipients in the control group (n=32) did not receive immunologic induction therapy. Absolute value of lymphocytes and the number of CD4+T lymphocyte subsets in peripheral blood were comparatively analyzed among three groups at 1, 4 and 12 weeks after kidney transplantation. Functional status of the transplanted kidney and complications of infection were evaluated at 12 weeks after transplantation.RESULTS AND CONCLUSION:The incidence of acute rejection was lower in the monoclonal antibody group and polyclonal antibody group than in the control group (P<0.05). The incidence of infectious complications was higher in the polyclonal antibody group than in the monoclonal antibody group and control group (P<0.05). The absolute value of lymphocytes was lower in the monoclonal antibody group and polyclonal antibody group at 1, 4 and 12 weeks after transplantation than in the control group (P<0.05). The number of CD4+T lymphocyte subsets in peripheral blood was lower in the polyclonal antibody group than in the monoclonal antibody group and control group at 1, 4 and 12 weeks after transplantation (P<0.05). These results suggested that biological agents participate in immunologic induction therapy of kidney transplantation, can effectively suppress the functional status of activated T lymphocytes, and decrease the occurrence of early acute rejection of the transplanted kidney. However, the incidence of infectious complications was higher after the use of rabbit anti-human antithymocyteglobulin.

Objective To report the therapeutic effects of transfer of flexor hallucis longus tendon on the treatment of obsolete Achilles tendon rupture with a defect greater than 5 cm.Methods The clinical data were retrospectively analyzed of the 39 patients with obsolete Achilles tendon rupture who had been treated at Department of Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University from September 2010 to January 2017.They were 33 males and 6 females,aged from 15 to 46 years(average,31.6 years).All the defects of Achilles tendon were greater than 5 cm.The duration between injury and operation ranged from 5 to 32 weeks(mean,16 weeks).All the 39 patients underwent transfer of flexor hallucis longus tendon to reconstruct their Achilles tendons.The tendons were harvested using double incisions in 23 patients and using a single incision in 16.The functional recovery of the ankle was evaluated according to ankle-hindfood score of American Orthopaedic Foot and Ankle Society(AOFAS),Achilles tendon total rupture score(ATRS),visual analogue scale(VAS),dorsal extension and plantar flexion of the ankle and patient's satisfaction as well.Results Healing by the first intention was achieved in 38 cases.Delayed healing occurred in one patient due to wound infection.One patient had postoperative numbness in the medial plantar region which disappeared 3 months later with no special treatment.All the 39 patients were followed up for 24 to 91 months(mean,32 months).None of the tendons was re-ruptured during the follow-up.The AOFAS scores at postoperative 3 months,one year and last follow-up were significantly higher than the preoperative one(P<0.05);the postoperative VAS scores were significantly lower than the preoperative one(P<0.05);the postoperative ranges of dorsal extension and plantar flexion of the ankle were all significantly larger than the preoperative ranges(P<0.05).At the last follow-up,31 patients expressed great satisfaction,7 satisfaction,and one neutral attitude.Conclusion Reconstruction of the Achilles tendon with transfer of flexor hallucis longus tendon is an effective surgical option for obsolete rupture of Achilles tendon with a defect greater than 5 cm.

Objective To explore the effects of open reduction and internal fixation plus primary subtalar arthrodesis for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ.Methods From January 2012 to December 2016,23 patients with severely comminuted calcaneal fracture of Sanders type Ⅳ were treated by open reduction and internal fixation plus primary subtalar arthrodesis at our department.They were 16 men and 7 women with an average age of 39.6 years (range,from 32 to 67 years).Auto-iliac bone graft was performed in 18 cases and allo-bone graft in the other 5 cases.B(o)hler and Gissane angles were measured preoperatively,postoperatively and at the last follow-up to evaluate anatomical morphology of the calcaneus;the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to evaluate the functional recovery.Results All the 23 cases were followed up successfully for an average time of 21 months (range,from 6 to 39 months).The operations lasted from 40 to 100 minutes with an average of 60 minutes;the intraoperative bleeding ranged from 10 to 40 mL with an average of 20 mL.No one suffered from wound infection but partial epidermal necrosis happened in only one case.Union and fusion of the fractures was achieved after 3 to 5 months with an average of 3.5 months.At the last follow-up,no failed fusion of the subtalar joint happened.Anatomical morphology of the calcaneus was improved obviously.The B(o)hler angles were respectively 12.47° ± 1.61°,30.58° ± 5.34° and 30.09° ± 5.78° preoperatively,postoperatively and at the last follow-up;the Gissane angles were respectively 86.21° ±7.70°,127.44°± 7.61° and 129.07°± 5.47° preoperatively,postoperatively and at the last follow-up.There were significant differences between preoperation versus postoperation and the last follow-up in the above 2 values (P ＜ 0.05);there were no significant differences between postoperation and the last follow-up in the above 2 values (P ＞ 0.05).The AOFAS ankle-hindfoot scoring at the last follow-up showed 8 excellent,11 good and 4 fair cases,giving an excellent to good rate of 82.6％.Conclusion Open reduction and internal fixation plus primary subtalar arthrodesis is a safe alternative for the treatment of severely comminuted calcaneal fractures of Sanders type Ⅳ.

Objective Toevaluateefficacyandsafetyoftwodifferentbiologicalsinimmunologic inductiontherapyonrenaltransplantrecipients.Methods Clinicaldataof78renaltransplantrecipientswho received biological immunologic induction therapy in Department of Urology of the 452nd Hospital of Chinese People's Liberation Army from June 2008 to April 2013,were retrospectively analyzed. According to different biological immunologic induction therapy,the recipients were divided into two groups,monoclonal antibody group (group A,n=35,received treatment of basiliximab)and polyclonal antibody group [group B,n=43, received treatment of antithymocyte globulin (ATG)]. And the other recipients who didn't receive immunologic induction therapy in the hospital during the corresponding period were chosen as control group (group C,n=32). The survival rates of recipient and kidney in 3 groups at 12th weeks after transplantation were analyzed.The levels of serum creatinine (Scr)of recipients in 3 groups were monitored at 7,14,30,60 d after transplantation. The occurrence rates of complications including acute rejection,delayed graft function and infectionwerecomparedamong3groups.Results At12thweeksaftertransplantation,thesurvivalratesof recipient and kidney in 3 groups were 100% and 100% in group A,97.7% and 97.7% in group B,100%and 96.9% in group C. There was no significant difference among 3 groups (all in P>0.05 ). Compared with group C,the Scr levels in group A and B decreased significantly at 7,14 d after transplantation (all in P<0.05 ). Compared with group C,the incidence rates of acute rejection decreased in group A and B(all in P<0.05 ). There was no significant difference in the incidence rates of delayed graft function among 3 groups (all in P>0.05 ). The incidence rate of infection in group B was significantly higher than those in group A and C (allinP<0.05).Conclusions Immunologicinductiontherapyissafeandeffectiveintheapplicationon renal transplant recipients.

Objective:Anterior cruciate ligament injury is the most common type of knee joint ligament injury.Anterior cruciate ligament reconstruction has a high failure rate,with bone tunnel abnormalities as the most significant factor in these failures.Digital orthopedic technology can effectively develop implementation plans for the revision,thus increasing the success rate.This study aims to develop a surgical plan for anterior cruciate ligament revision by employing multiplanar reconstruction(MPR)for measuring bone tunnel position and diameter,and simulating bone tunnel creation via 3D printing preoperatively. Methods:A total of 12 patients who underwent anterior cruciate ligament revision at the Third Xiangya Hospital of Central South University between 2014 and 2021 were retrospectively studied.The data included patient demographics,preoperative formulated knee joint 3D printing models,and preoperative knee CT scans.The study measured the bone tunnel's diameter and position to guide the establishment of revision bone tunnels during surgery,reassessed the postoperative bone tunnels,and evaluated knee joint functional scores[including International Knee Documentation Committee Knee Evaluation Form(IKDC)score,Lysholm score,and Tegner exercise level score]. Results:Preoperative measurements revealed suboptimal femoral tunnels positions in 4 patients and tibial tunnels positions in 2 patients.MPR and 3D printing technology were used to guide the establishment of a new bone canal during surgery,and postoperative measurements were satisfactory for all patients.Preoperative measurements demonstrated the interclass correlation coefficient for femoral tunnels and tibial tunnels diameters were 0.843(P<0.05)and 0.889(P<0.001),respectively.Meanwhile,the intraclass correlation coefficient were 0.811(P<0.05)and 0.784(P<0.05),respectively.The intraoperative diameter of femoral and tibial tunnels showed excellent correlation with postoperative CT measurements,with intraclass correlation coefficient values of 0.995(P<0.001)and 0.987(P<0.001),respectively.All bone tunnel positions were within the normal range.At the final follow-up,knee joint function scores in all 12 patients improved significantly compared to pre-surgery(P<0.001),and the reoperation rate was zero. Conclusion:MPR and 3D printing technology can accurately measure the parameters of reconstructed anterior cruciate ligament bone tunnels.Personalized revision plans for patients with reconstruction failure enhances the success rate of revision surgery and improves patient prognosis.

【Objective】 To investigate the safety and effectiveness of suctioning flexible ureteroscopy with intelligent pressure-control at different times after drainage for patients with urogenic sepsis complicated with upper urinary tract stones. 【Methods】 Clinical data of 59 patients treated in the Department of Urology, Affiliated Hospital of Nantong University during May 2022 and May 2023 were collected.The patients were divided into early lithotripsy (≤1 week) group (n=27) and late lithotripsy (>1 week) group (n=32).Baseline data, imaging data and postoperative data of the two groups were compared. 【Results】 There were no significant differences between the two groups in the stone-free rate, total incidence of complications, incidence of high-grade complications, length of stay after lithotripsy, hospitalization costs after lithotripsy and total hospitalization costs (P>0.05). 【Conclusion】 Both early lithotripsy (<1 week) and late lithotripsy (>1 week) are safe and effective in the treatment of urogenic sepsis after drainage.