Objective Describes the use of homemade simple bedside bracket of children supracondylar fracture closed reduction and percutaneous pin fixed surgical methods and clinical effects.Methods 16 cases of children supracondylar fractures Gartland type Ⅱ cases,15 cases Gartland type Ⅲ,13 males and 3 females,with an average age of 6 years old,all patients used our hospital homemade simple bedside shelf assisted closed reduction,percutaneous pin fixation,and fixed with plaster immobilization.Results 16 patients were followed-up,in addition to the two cases of pin tract infection,fracture all were healed smoothly.Without iatrogenic nerve injury and internal fixation loosening,and also no volkmann contracture,and myositis ossificans etc complications.The average fracture healing time for three weeks,no bone delayed union or nonunion occurred.According to Flynn clinical function evaluation,there were excellent in 7 cases,good in 9 cases.Conclusion Useing homemade simple bedside shelf to children supracondylar fractures closed reduction and percutaneous Kirschner wire fixed can ensure the efficacy,and also simplify the surgical procedure,reduce radiation intake,which is the worthy of clinical practice.

Objective To explore whether albumin corrected anion gap (ACAG) is associated with long-term mortality of sepsis patients.Methods Adult patients with a diagnosis of sepsis within the first 24 hours (from December 2013 to December 2014) admitted to the intensive care unit (ICU) were included via the Sepsis database of West China Hospital Sichuan University. To record their long-term survival, patients were followed up by telephone interview one year after enrollment. ACAG was calculated according to the anion gap (AG) level within the first 24 hours admitted to ICU, and patients were divided into normal ACAG group (ACAG 12-20 mmol/L) and high ACAG group (ACAG > 20 mmol/L), and clinical characteristics and 1-year mortality were compared between groups. Patients were also divided into survivors and non-survivors according to the 1-year survival outcome, and multivariate logistic regression analysis was conducted to find independent risk factors for long-term mortality of sepsis patients.Results A total of 296 sepsis patients were enrolled in the study, with 191 (64.5%) in the high ACAG group and 105 (35.5%) in the normal ACAG group. There were no significant differences in age, gender, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA), Charlson cormobidity index (CCI) and other background variables between groups. Compared with the normal ACAG group, patients who suffered from multiple organ dysfunction syndrome (MODS) in the high ACAG group were more prone to develop renal and gastrointestinal injury (43.5% vs. 25.7%, 52.9% vs. 33.3%, respectively), had significantly higher serum creatinine [SCr (μmol/L): 89.0 (61.0, 148.0) vs. 67.1 (48.0, 86.0)], greater need for continuous renal replacement therapy (CRRT, 16.8% vs. 6.7%), and significantly shorter length of ICU stay and hospital stay [days: 11 (5, 22) vs. 16 (18, 31), 21 (14, 39) vs. 28 (20, 47)], with statistically significant differences (allP < 0.05). It was shown by Kaplan-Meier survival analysis that 1-year cumulative survival for the high ACAG group was significantly lower than that of the normal ACAG group (55.0% vs. 67.7%,P = 0.046). It was shown by multivariate logistic regression that ACAG [odds ratio (OR) = 1.201, 95% confidence interval (95%CI) = 1.115-1.293,P = 0.000], APACHE Ⅱ (OR = 1.053, 95%CI = 1.011-1.098, P = 0.014), the incidence of septic shock (OR = 2.203, 95%CI = 1.245-3.898,P = 0.007), fungus infection (OR = 3.107, 95%CI = 1.702-5.674,P = 0.000), acute renal failure (OR = 2.729, 95%CI = 1.134-6.567,P = 0.025) and complicated with malignancy (OR = 2.929, 95%CI = 1.395-6.148,P = 0.005) were independent risk factors contributing to increased 1-year mortality among sepsis patients.Conclusion ACAG was an independent risk factor for 1-year mortality of sepsis patients.

ObjectiveTo evaluate the primary effect of granulocyte-monocyte colony stimulating factor (GM-CSF) as an immunotherapy option for treatment of residual disease after alloHSCT.Methods Immunotherapy was performed on two patients with blood malignancy to treat residual disease after allo-HSCT. The patient one,who was diagnosed as having MDS-RAEB Ⅱ,showed bone marrow displasis and incomplete chimerism 6 months after unrelated donor HSCT.Immunosuppressive drug was withdrawn without induction of graft-versus-host disease (GVHD).The patient two B-ALL demonstrated a residual disease at molecular level 30 days post-transplantation.Both of them were given GMCSF (300 μg) subcutaneously once every two days for totally three weeks.During the whole period,skin itch and rash,liver function,subgroups of lymphocytes,and MDSCs and DCs in peripheral blood were investigated.Results In case one,grade Ⅰskin acute GVHD (aGVHD) appeared as early as one week after GM-CSF administration,as well as grade Ⅱ (skin and liver) by the end of the third weeks,and GM-CSF injection was withdrawn.One month later since the start of GM-CSF,the patient showed normal bone marrow morphology and full donor type chimerism. Cyclosporine A (CsA), mycophenolate mofetil and methylprednisolone were administered for two weeks to control GVHD.In the other case,grade Ⅰ aGVHD occurred 9 days after GMCSF administration,and whole blood CsA maintained at 0.134-0.472 μmol/L.Prednisone (30mg per day for 5 days) was used to control grade Ⅱ GVHD from the 11th day after GM-CSF,and grade Ⅰ GVHD continued without any intervention.On the 30th day after GM-CSF treatment,bone marrow aspiration showed complete molecular remission.In both of the two cases,no differences in lymphocytic subtypes were revealed before and after GM-CSF administration,while there were trends of increased DC number and decreased MDSCs in peripheral blood.ConclusionThe administration of GM-CSF as an immunotherapy option for blood malignancy may contribute to the clearance of residual disease after Allo-HSCT.

Objective: To detect varicella-zoster virus ( VZV ) antibody levels among children aged 1 to 12 years in Lu'an City, Anhui Province, so as to provide insights into perfection of the varicella immunization strategy. Methods: Children aged 1 to 12 years were recruited from Lu'an City using the stratified random sampling method from July 2018 to February 2019, and subjects' demographics were collected using questionnaires. The inoculation of varicella vaccines was retrieved through the Anhui Immunization Information Management System or review of preventive immunization certificates, and the serum VZV IgG antibody was detected using enzyme-linked immunosorbent assay ( ELISA ). The seroprevalence and geometric mean concentration of the VZV-IgG antibody were estimated, and the changes of serum the VZV-IgG antibody levels were analyzed at different time intervals following varicella vaccination. Results: Totally 734 children were surveyed, with a mean age of ( 6.94±2.95 ) years, and the subjects included 412 boys ( 56.13% ) and 322 girls ( 43.87% ). There were 514 children ( 70.03% ) with a history of varicella vaccination, including 501 children ( 68.26% ) with one dose of varicella vaccine and 13 children ( 1.77% ) with two doses. There were 297 children ( 40.46% ) positive for VZV-IgG antibody, with seroprevalence of 40.46%, and the GMC of VZV-IgG antibody was 74.97 ( 95%CI: 65.55-85.75 ) mIU/mL. The seroprevalence of the VZV-IgG antibody were 34.55%, 42.91%, and 46.15% among the unvaccinated children and children receiving one dose and two doses of varicella vaccine, with the GMCs of 53.04, 86.31 and 114.46 mIU/mL, respectively. The mean time interval between inoculation of the last dose of varicella vaccine and blood sample collection was ( 5.21±2.79 ) years, and the lowest seroprevalene (31.48%) and GMC of the VZV-IgG antibody (49.96 mIU/mL) were found 4 years after inoculation of varicella vaccine. Conclusions The serum VZV-IgG antibody level is low among children aged 1 to 12 years in Lu'an City, and the seroprevalence of the VZV-IgG antibody is affected by age and doses of varicella vaccine. A 2-dose schedule of varicella vaccine is recommended for children.

Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair, and evaluate the value of real-time three-dimensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation of valveplasty ring. A 4-0 Goretex sutures was used for reconstruction of artificial chordae. Realtime three-dimensional transesophageal echocardiography was performed in all the patients during the preoperative, intraoperatire, and postoperative periods. The length of the chordae tendineae under the A1 section of the anterior leaflet and the P1 section of the posterior leaflet were measured and considered the normal length of chordae tendineae by real-time three-dimensional transesophageal echocardiography preoperatively. These pre-determined normal chordal lengths helped intraoperatively to approximate the length of the artificial chordae used and postoperatively to gauge the success of the procedures. The same values were used again postoperatively to gauge the success of intervention. Full flexible valveplasty rings were used in all the patients.Results There was no operative death. The mean cardiopulmonary bypass (CPB) and aortic cross clamp time were ( 142. 0 ±31.2 ) min and (98.0 ± 22.5 ) min, respectively. One patient' s intraoperative echocardiography upon termination of CPB showed persistent severe mitral regurgitation and was converted to mitral valve replacement. This patient was not included in the study group. The mean number of artificial chordae per patient was (2.0 ± 1.5 ) , range from 1 to 3. The mean preoperatively measured normal chordal length was ( 21.0 ± 2.5 ) mm, and the mean postoperative artificial chordal length was ( 20.0 ± 2.2 )mm. The difference was not significant. The follow-up interval was from 3 to 30 months and the follow-up rate was 98%. During the follow-up period, there was no late death. Trace mitral regurgitation (MR) was detected in 15 patients, mild and moderate MR were detected in 1 for each. No severe MR was detected. The freedom from reoperation was 100% during follow-up.There were no documented artificial chordae ruptures. Conclusion Conclusion Artificial chordal replacement with Gore-tex suture in mitral valve repair in this group of patients with mitral valve prolapse appears to have satisfactory early and mid-term results. Real-time three-dimensional transesophageal echocardiography plays a critical role in this technique. Real-time threedimensional transesophageal echocardiography can exactly predict the length of artificial chordae, which is helpful to improve the outcomes of mitral valve repair. However, longer term follow-up and larger series are required to validate our findings.

0.05 ). The average enhancement rate of LV endocardial border was 96.6 %. The myocardial contrast agent perfusions of left ventricular walls were clearly visualized in 30 patients. CONCLUSION: Clinical application of intravenous left heart contrast echocardiagraphy with perfluoropropane-albumin microsphere is feasibility and effective.

Objective To evaluate the collateral circulation after canine acute coronary artery occlusion with contrast real-time three-dimensional echocardiography (RT-3DE). Methods Left anterior descending coronary artery was ligated in 12 healthy mongrel dogs. All dogs underwent myocardial contrast echocardiography (MCE) before ligation, immediately after ligation, at 30 min and 180 min after ligation respectively, and myocardial mass with collateral supply was calculated. Results Different degrees of collateral circulation were established in all dogs after left anterior descending coronary artery ligation. At 30 min after ligation, the myocardial mass with collateral supply was (9.65±2.90) g, while at 180 min after ligation were (12.58±3.98) g (P<0.01). Conclusion The coronary collateral circulation can be observed clearly and myocardial mass with collateral supply can be quantified accurately with contrast RT-3DE.

Objective To determine the utility of single energy CT value and spectrum energy curve in identifying different cause of diffuse spleen enlargement.Methods 43 patients confirmed by either surgical pathology,aspiration biopsy or clinical comprehensive diagnosis and follow-up were assessed,including lymphoma with spleen infiltration(lymphoma group,n=18) and cirrhotic splenomegaly(liver cirrhosis group,n=25).All patients underwent upper abdomen CT scans in GSI mode and the GSI data were transferred to the Workstation AW 4.6 to acquire single energy CT value(40-140 keV,10 keV's interval) and spectrum energy curve of the spleen on the venous phase.All single energy CT values and the slope of curves were comparatively analyzed through independent-samples t test.The diagnostic efficiency were evaluated by ROC analysis.Results Under 40-140 keV energy range,single energy CT values were significantly lower in the lymphoma group than in the liver cirrhosis group(all P＜0.05).The spectrum energy curve were both types of decreasing.Under 40-90 keV,100-140 keV energy range,the slop of curves in the lymphoma group(2.42 ± 0.70,0.27± 0.08) were also significantly lower than in the liver cirrhosis group (3.11 ± 0.62,0.34± 0.07),respectively(all P ＜0.05).When the slope of curve under 40-90 keV energy range was selected as a diagnostic indicator,the area under the curve(AUC) would reach 0.77.If threshold value of 1.39 was taken,the sensitivity and specificity would be equal to 86 ％ and 64 ％,respectively.Conclusion Single energy CT value and spectrum energy curve are helpful for differentiation of lymphoma with spleen infiltration from cirrhotic splenomegaly.

OBJECTIVE: To investigate the effectiveness of "hybrid" suture with en masse combined with double-layer repair under arthroscopy in repair of delaminated rotator cuff tear by comparison with en masse suture. METHODS: Fifty-six patients with delaminated rotator cuff tears met selection criteria between June 2020 and January 2022 were included in the study. Patients were divided into two groups ( n=28) using a random number method. The patients in trial group underwent arthroscopic "hybrid" suture with the combination en masse and double-layer suture. The patients in control group underwent en masse suture under arthroscopy. There was no significant difference between the two groups ( P>0.05) in terms of gender, age, rotator cuff tear side, tear size, cause of injury, disease duration, and preoperative American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, visual analogue scale (VAS) score, and shoulder range of motion (forward flexion and lateral external rotation). The operation time, the difference of ASES score, UCLA score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) between pre- and post-operation were recorded and compared between the two groups ( P>0.05). The rotator cuff healing was examined by MRI and evaluated based on the classification criteria of rotator cuff healing proposed by Sugaya et al. RESULTS: Three cases (1 case in the trial group and 2 cases in the control group) were excluded from the study due to loss of follow-up. Twenty-seven cases in the trial group and 26 cases in the control group were included in the final study analysis. All operations of the two groups were completed successfully. There was no significant difference in the operation time between groups ( P>0.05). The follow-up time was 10-12 months (mean, 10.9 months) in the trial group and 10-13 months (mean, 11.4 months) in the control group. All incisions healed by first intention. No surgery-related complications occurred. The UCLA score, ASES score, VAS score, and shoulder range of motion (forward flexion and lateral external rotation) of both groups at 9 months after operation were significantly superior to those before operation ( P<0.05). The difference of UCLA score, ASES score, and VAS score between before and after operation in the trial group were significantly better than those in the control group ( P<0.05). There was no significant differences between the two groups in the difference of shoulder range of motion (forward flexion and lateral lateral rotation) ( P>0.05). At 9 months after operation, according to the classification criteria of rotator cuff healing proposed by Sugaya et al, MRI showed that the rotator cuff healing of the trial group was significantly better than that of the control group ( P<0.05). CONCLUSION Compared with en masse suture, arthroscopic "hybrid" suture for the repair of delaminated rotator cuff tear has advantages in relieving pain and improving shoulder joint function, and the rotator cuff healing is better.
Humans ; Rotator Cuff Injuries/surgery* ; Prospective Studies ; Shoulder Joint/surgery* ; Treatment Outcome ; Arthroscopy/methods* ; Sutures ; Range of Motion, Articular ; Magnetic Resonance Imaging

Objective:This study aims to reveal the special immune infiltrating environment and possible immune escape mechanism of giant cell tumor of bone through single-cell sequencing data.Methods:The fresh samples obtained from 4 patients with primary giant cell tumor of bone from January 2018 to December 2021 were collected, and single-cell transcriptome sequencing was performed on the 10X platform to explore the characteristics and immune environment of giant cell tumor of bone by using t-distributed stochastic neighbor embedding ( t-SNE). The main cell types and signal pathways of immune cell regulation and function in giant cell tumor of bone were observed by cell communication analysis. Results:Cell clustering, the definition of basic cell types, the classification of immune cells, and the mutual regulatory relationship between cell types were analyzed for 35 643 single-cell data from 4 giant cell tumor samples of bone. It was found that giant cell tumor of bone was composed of 9 basic cell types, in which the immune cells were mainly CD8 + T cells (51%) and the non-immune cells were mainly fibroblast like spindle stromal cells (74%). The immune infiltration of giant cell tumor of bone is dominated by cytotoxic CD8 + T cells and lacks exhausted CD8 + T cells. CD4 + T cells are characterized by high expression of immune checkpoint genes CTLA4 and TIGIT. In giant cell tumor of bone, immune cells mainly act on multinucleated osteoclast like giant cells through PARs and CCL signaling pathways, but not stromal cells. Conclusion:This study defined the main cell types of giant cell tumor of bone through single cell sequencing data, and further revealed the composition characteristics of its immune infiltration, and found that the target of its immune cells was mainly multinuclear osteoclast like giant cells, which provided effective information for further understanding the occurrence and development of giant cell tumor of bone.