BACKGROUND: There are disputes concerning limb salvage and reconstruction in treating pelvis malignant tumor.OBJECTIVE: To study the surgical treatment following resection of tumor at acetabular region in order to restore pelvic stability with less damage or recurrence.METHODS: Thirty-three patients diagnosed with pelvic tumor at Department of Orthopaedics, First Affiliated Hospital of Second Military Medical University from April 2002 to June 2008 were selected. All patients were received tumor resection and computer-aided prosthetic replacement, 18 patients (8 cases with chondrosarcoma, 2 cases with Ewing sarcoma, 2 cases with osteosarcoma, and 6 cases with malignant fibrous histiocytoma) were combined with antitumor drug treatment. Functional assessment of therapeutic efficacy was divided into 4 levels: excellent, good, moderate, and inferior.RESULTS AND CONCLUSION: Two patients died at months 4 and 6 after prosthetic replacement; 31 cases were followed-up for 8-32 months, mean 12.5 months. Seven cases were recurred chondrosarcoma, the recovery of other patients were as follow: 18 cases were excellent, 4 cases were good, 2 cases were moderate and no case was inferior. Most of limb function and pelvic stability was preserved. The results suggested that malignant fibrous histiocytoma and Ewing sarcoma can receive a high rate of limb preservation if treated by effective chemotherapy with low recurrence; the recurrence of chondrosarcoma was high. Tumor resection combined with computer-aided prosthetic replacement can maximatily reserve limb function and raise life quality.

Objective Toinvestigateserumalanineaminotransferase(ALT)andtotalbilirubin(TB)concentrationsofchildrenin Panyu district of Guangzhou ,and establish the reference ranges for ALT and TB tests for healthy children of different gender and different age .Methods 4 065 children were chosen randomly ,and their serum ALT and TB were determined .After excluding the outliers ,the results were analyzed statistically .Results After excluding outliers ,a total of 4 000 children were enrolled in the stud-y ,including 2 241 males ,1 759 females ,aged 2- <9 years old .According to statistical analysis ,reference ranges were established . For male the ALT reference ranges were as follows ,2- <3 years old :5 .0-36 .0 U/L ,3- <4 years old :7 .0-21 .0 U/L ,4- <8 years old :6 .0-21 .0 U/L ,8- <9 years old :5 .0-24 .0 U/L ;TB reference ranges of male were as follows ,2- <3 years old :3-12μmol/L ,3- <7 years old :4-15 μmol/L ,7- <8 years old :4-16 μmol/L ,8- <9 years old :7-12 μmol/L .ALT reference range of female were as follows ,2- <3 years old :6 .0-30 .0 U/L ,3- <4 years old:7 .0-22 .0 U/L ,4- <9 years old :6 .0-19 .0 U/L ;female TB reference range ,2- <3 years old :3 .0-12 .0 μmol/L ,3- <4 years old :3 .0-13 .0 μmol/L ,4- <9 years old:4 .0-16 . 0 μmol/L .Conclusion Established the reference ranges of ALT and TB test for healthy children in Panyu district .

Objective: To understand the trends in malnutrition among primary and middle school students of Han nationality in Hainan Province from 2005 to 2019, so as to provide a basis for improving nutrition intervention measures for children and adolescents. Methods: A sample of 32 949 Han nationality primary and middle school students aged 7-18 years old in Hainan Province were investigated in 2005, 2010, 2014 and 2019 based on national survey on student physical fitness and health. The Malnutrition Screening Standard of Schoolage Children and Adolescents was used to screen malnutrition. Statistical analysis was performed using the χ2 test and the χ2trend test. Results: In the four surveys conducted during 2005 to 2019, the prevalence of malnutrition among primary and middle school students were 22.12%, 18.80%, 15.89% and 9.56%, respectively, with an increase of -12.56% and an average annual increase of -5.82%. The decreasing trend of malnutrition by year was statistically significant (χ2trend=600.72, P<0.01), and the proportion of emaciation type was the highest (8.87%-20.15%). The detection rates of malnutrition among all students aged 7 to 18 showed a decreasing trend from 2005 to 2019 (χ2trend=56.44, 60.04, 61.48, 42.49, 51.81, 50.81, 72.86, 101.34, 86.38, 24.81, 17.72, 10.38, P<0.01). From 2005 to 2019, the detection rates of malnutrition in boys were higher than that of girls (in 4 surveys), and that in rural students from 2005 to 2014 of 3 surveys were higher than that in towns (χ2=92.07, 35.16, 25.29, 29.98; 64.35, 4.26, 6.32, P<0.05). Conclusions The malnutrition of Han nationality primary and middle school students aged 7-18 years in Hainan Province show a trend of improvement year by year from 2005 to 2019, despite the overall high detection rate. Wasting is the most common type of malnutrition. The epidemic of malnutrition varies by age, sex and areas. Further targeted measures should be taken to strengthen intervention in the diet of primary and middle school students, to improve the nutritional status of children and adolescents.

Objective:To determine the influences of structural changes after valgus impacted femoral neck fracture on hip range of motion (ROM) so as to provide evidence for clinical judgment of whether reduction is necessary or not in the internal fixation of such fractures.Methods:1. 3D reconstructions of the CT hip scans were performed for the 73 patients who had been treated at Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University for valgus impacted femoral neck fractures from January 2019 to April 2019.The femoral neck-shaft angle, anteversion angle, femoral offset, axial alpha angle, lateral center edge angle (LCEA), anterior center edge angle (ACEA) and center displacement were measured and compared between the affected and healthy sides to determine the influences of the fracture on the above indexes. 2. Hip motions (flexion and MIR-90°) were simulated on bilateral sides to determine the influences of structural changes after fracture on hip ROM using stepwise regression and Logistic regression. 3. The distribution of femoral-acetabular contact points on the femoral side was observed in simulation of hip flexion to detect the potential area for femoracetabular impingement (FAI) induced by the fracture displacement.Results:1. The valgus impacted femoral neck fractures had significant influences on femoral neck-shaft angle, anteversion angle, femoral offset and axial alpha angle. Compared with the healthy side, on average, the femoral neck-shaft angle increased by 5.1°, anteversion angle decreased by 6.5°, femoral offset decreased by 8.2 mm and axial alpha angle increased by 9.7° on the affected side, showing significant differences ( P<0.05).The displacements of the femoral head center averaged 9.2 mm. There was no significant difference in LCEA or ACEA between the affected and healthy sides ( P>0.05). 2. Compared with the healthy side, on average, the simulated hip flexion decreased significantly by 27.0° and the hip MIR-90° decreased significantly by 20.3° on the affected side after fracture ( P<0.05). Regression analysis showed that femoral anteversion angle, ACEA and displacement of the femoral head center had a significant influence on hip ROM, especially the anteversion angle. When the anteversion angle decreased by more than 7.1°, the hip flexion would decrease by at least 20%. 3. The points of FAI distributed more widely on the fracture side. Compared with the healthy side, the impact points extended outward and upward in hip flexion and extended inwardly in hip MIR-90° on the affected side. Conclusions:After a valgus impacted femoral neck fracture, if the femoral anteversion angle has been decreased by more than 7.1°, the hip ROM can be greatly influenced and the points of FAI can be distributed more widely. Therefore, reduction should be recommended before internal fixation of the fracture.

Objective To analyze the CT signs of acute blunt or penetrating intestinal injury,and to improve the diagnostic accuracy of multi spiral CT for intestinal injury.Methods The CT and clinical data of 63 patients with intestinal injury confirmed by clinical surgical exploration who underwent emergency CT scan were collected,and the CT findings and surgical findings were comparatively analyzed.Results There were 63 cases of intestinal injury,of which 26 cases were complicated with mesenteric injury.The direct CT signs of intestinal injury included intestinal wall thickening sign and intestinal discontinuity sign,which accounted for 64%(40/63)and 17%(10/63),respectively.The indirect CT signs of intestinal injury included intraperitoneal/retroperitoneal gas sign,intraperitoneal/retroperitoneal effusion sign,intramural air,and portal venous gas,which accounted for 72%(45/63),88%(55/63),7%(5/63)and 5%(3/63),respectively.Conclusion Recognizing the CT signs of intestinal injury,such as intestinal wall thickening sign,intestinal discontinuity sign,intraperitoneal/retroperitoneal gas sign,intraperitoneal/retroperitoneal effusion sign,intramural air,and portal venous gas can help to make the early and correct diagnosis of intestinal injury if combined with clinical practice.

ObjectiveTo explore the current status and issues regarding the application of ancient books in clinical practice guidelines and expert consensus of traditional Chinese medicine （TCM） published in China， and to provide methodological recommendations for the incorporation of ancient books in the development of TCM guidelines. MethodsWe searched China National Knowledge Infrastructure （CNKI）， WanFang Data， VIP， SinoMed， PubMed， Embase， as well as six industry websites including China Association of Chinese Medicine， National Group Standards Information Platform， and Chinese Association of the Integration of Traditional and Western Medicine，etc. TCM clinical practice guidelines or expert consensus issued during January 1st， 2017， to November 26th， 2022 were searched. Clinical practice guidelines or expert consensus that explicitly referred to ancient books were included， and the content regarding the searching for ancient books， sources of access to ancient books， methods of evaluating the level of evidence， methods of evaluating the level of recommendation， and methods of evaluating the evidence for the ancient books were analysed. ResultsA total of 1,215 TCM clinical practice guidelines or expert consensus were retrieved， with 442 articles explicitly mentioning the application of ancient books， including 300 （67.87%） clinical practice guidelines and 142 （32.13%） expert consensus. Sixty of the 442 publications explicitly reported that ancient books searching had been conducted （13.57%）； among these 60 publications 27 （45.00%） explicitly reported ancient books searching strategies， and the most frequent method was manual searching with a total of 24 articles （40.00%）. The most popular search source was Chinese Medical Dictionary， a TCM classics database， with a total of 18 articles. 197 articles （44.57%） explicitly reported the evaluation criteria for the level of evidence， of which 141 articles （71.57%） involved the evaluation criteria for the ancient books； 413 articles （93.44%） mentioned ancient books in the recommendations， and only the source of formula name was mentioned in 409 （99.03%） of the publications. ConclusionThe current application of ancient books in TCM clinical practice guidelines and expert consensus is limited， with issues of non-standard searching and evaluation methods. Standar-dization and uniformity are needed in evidence grading and recommendation standards. Future research should clarify the scope and methods of applying ancient book， emphasize their integration with modern research evidence， and enhance their value and quality in the development of TCM clinical practice guidelines.

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.