Objective To investigate the operative treatment of Sanders' type Ⅲ displaced intra-articular fractures of the calcaneus using a small dorsolateral incision.Methods From October 2006 to April 2012,90 patients with displaced intra-articular calcaneal fracture of sanders' type Ⅲ were treated by open reduction and internal fixation through a small dorsolateral incision at our department.The skin incision was made from the distal tip of the fibula to the base of the fourth metatarsal.They were 69 men and 21 women,aged from 17 to 61 years (average,39 years).On the right side were 49 cases and on the left side 41 cases.According to Sander's classification,26 fractures were of type Ⅲ AB,36 of type Ⅲ AC and 28 type Ⅲ BC.The displacements of articular facet were all larger than 1 mm.The foot functions were evaluated before and after operation by the American Orthopedic Foot and Ankle Society (AOFAS) scoring system.Results For each patient,4 to 6 calcaneal cannulated screws of 4.0 mm and 2 full threaded screws of 6.5 mm were used.No incision infection,skin necrosis or injury to the posterior tibial nerve or vessels occurred after surgery.Seventy-six patients were followed up for 10 to 56 months (average,20.5 months).Clinical union was achieved after 8 to 12 weeks (average,9.5 weeks).The lateral and axial X-ray films of the calcaneus at the last follow-up showed fine reduction and fixation of the fracture fragments and significant improvements in the length,width,height,and B(o)hler and Gissane angles of the calcaneus compared with the preoperation (P ＜ O.05).The ankle and hindfoot scored 70 to 100 AOFAS points at the last follow-up.Forty-five cases were excellent,24 good,5 fair and 2 poor (excellent to good rate of 90.8％).Follow-up observed no infection,nonunion or osteomyelitis.Conclusion Open reduction and internal fixation through a small dorsolateral incision is a good option for Sanders' type Ⅲ calcaneus fractures with a displacement of more than 1 mm,because it leads to minimal soft tissue damage,excellent exposure and convenience for later removal of internal fixators and subtalar arthrodesis.

OBJECTIVE：To overview t he s ystematic revi ews on JAK inhibitors in the treatment of rheumatoid arthritis （RA）， and to provide evidence-based basis for the treatment of RA with these drugs. METHODS ：The Cochrane Library ，PubMed， Embase，CNKI，Wanfang database and VIP were electronically searched to collect systematic reviews of JAK inhibitors in the treatment of RA from inception to Dec. 2020. After data extraction of included systematic review ，PRISMA statement ，AMSTAR2 scale and GRADE were used to evaluate the report quality ，methodological quality and the level of evidence for outcome indicators. RESULTS ：A total of 12 systematic reviews involving 103 outcomes were included. PRISMA score of systematic reviews was between 17.5 and 22.5，and the reported quality defects were mainly reflected in scheme ，registration and other aspects. AMSTAR 2 evaluation results showed that there were 6 studies of low quality and 6 studies of very low quality ，without high-quality study and medium-quality study. GRADE assessment results for outcome indicators showed low to medium quality of evidence. The summary of evidence showed that compared to placebo ，JAK inhibitor could alleviate various indicators of RA ； compared to adalimumab ，the advantage was not obvious. JAK inhibitors did not increase the incidence of serious adverse events ， but the systematic reviews were inconsistent in their effects on the incidence of total adverse events and liver injury. CONCLUSIONS：The efficacy of JAK inhibitors in the treatment of RA has certain advantages over placebo ，but more studies are needed to demonstrate the efficacy of JAK inhibitors in the treatment of RA compared to other drugs ；the advantage of safety is uncertain.

OBJECTIVE To identify Ginseng Flos and their confounds by using the high-throughput sequencing technology, and to verify the accuracy of high-throughput sequencing technology in species identification by using ITS2 sequencing technology. METHODS High-throughput sequencing was performed on the amplified products of Ginseng Flos adulterated samples, use cutadapt, PEAR, PRINSEQ, Usearch, RDP classifier, SINTAX software to obtain operational taxonomic unit(OUT) sequences, remove fungi, unclassified and other non-green plant sequences. To avoid false positives, delete OTU sequences with a sequence number <100 or base numbers <200 bp. The ITS2 amplification products of Ginseng Flos, Quinquefolii Flos, and Notoginseng Flos were sequenced. To verify the accuracy of high-throughput sequencing technology for species identification, MEGA 11.0 was used to construct neighbor joining system cluster tree, genetic distance, interspecific information loci and Blast analysis of ITS2 and OTU base sequences of Ginseng Flos, Quinquefolii Flos, and Notoginseng Flos. RESULTS A total of 54 653 valid sequences were obtained by high-throughput sequencing, the serial numbers of Ginseng Flos, Quinquefolii Flos, and Notoginseng Flos were OTU1, OTU2, OTU3, respectively, and the corresponding effective sequences were 31 325, 857 and 442, respectively. By performing a Blast search of ITS2 and OTU base sequences of each species, each species was supported. The genetic distance between Ginseng Flos and Quinquefolii Flos and Notoginseng Flos was 0.010 and 0.033, respectively. Ginseng Flos and Quinquefolii Flos, Notoginseng Flos had 2 and 7 information sites, respectively. The neighbor join system cluster tree showed that the species were clustered independently into one branch, with Ginseng Flos, and Quinquefolii Flos clustered as a large branch and juxtaposed with Notoginseng Flos. Ginseng Flos was the same as Quinquefolii Flos secondary structure, but with Notoginseng Flos there were three different positions but there were A, B and C differences between arm Ⅳ and arm Ⅰ of Notoginseng Flos. CONCLUSION The high-throughput sequencing technology can accurately identify Ginseng Flos, Quinquefolii Flos and Notoginseng Flos, and has a strong ability to identify adulterated samples, which provides a certain idea for the identification of commercial Ginseng Flos.

OBJECTIVE: To analyze relationship of debilitating and nutritional risk on complications of primary hip replacement, and risk factors of influence of complications of primary hip replacement. METHODS: Totally 100 patients who underwent hip replacement from January 2019 to January 2021 were retrospectively analyzed, including 36 males and 64 females, aged from 18 to 85 years old with an average of (73.82±4.04) years old. Postoperative frailty status was evaluated by modified frailty index, and nutritional status was evaluated by clinical biochemical indexes and NRS2002 nutritional risk assessment scale. One hundred patients were divided into frailty group and non-frailty group according to modified frailty index, 100 patients were divided into normal nutrition group and nutritional risk group according to nutritional status, and relationship between frailty, nutritional risk and complications after primary hip replacement was analyzed. RESULTS: There were significant differences in age, body mass index (BMI), complications and ASA grade between frailty group and non-frailty group(P<0.05). There were statistically significant differences in age, BMI, complications and ASA grade between normal nutrition group and nutritional risk group (P<0.05). Thirty-five patients occurred at least one postoperative complications, and the incidence of pulmonary infection was the highest, accounting for 34.29% (12/35). The second was urinary infection, accounting for 22.86%(8/35). Univariate Logistic regression analysis showed that age, BMI, ASA grade, complications, frailty and nutritional risk were the risk factors for postoperative complications. Multivariate Logistic regression analysis showed that complications, frailty and nutritional risk were independent factors affecting postoperative complications. CONCLUSION Patients with comorbidities, frailty and nutritional risk could increase the incidence of complications. Timely assessment and identification of these patients in time, and formulation of targeted intervention measures have great clinical significance.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Young Adult ; Incidence ; Postoperative Complications/etiology* ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Arthroplasty, Replacement, Hip

Objective: To investigate the mechanism of sodium houttuyfonate (SH) against Pseudomonas aeruginosa (PA) targeting quorum sensing system. Methods: The microdilution method was adopted to determine the minimal inhibitory concentration (MIC) of SH and azithromycin (AZM) for PA; The effects of SH on LasA proteases activity and pyocyanin production were detected by UV spectrophotometry; The semi-quantitative PCR and qRT-PCR were used to detect the expression changes of quorum sensing regulatory genes (lasI, rhlI, lasR, rhlR, phzM, pqsA, pslA, lasA, lasB, and toxA). Results: The MIC of P. aeruginosa for SH and AZM was 512 μg/mL and 64 μg/mL, respectively; SH could significantly inhibit the activity of LasA proteases, and pyocyanin of bacteria; The morphology of P. aeruginosa was observed by agar plates; Furthermore, semi-quantitative PCR and qRT-PCR results indicated that the expression of lasI, rhlI, lasR, lasA, pslA, and phzM was significantly impact by SH. Conclusion: The results of present study suggest that SH possesses anti-quorum sensing properties and plays a role against infection by anti-quorum sensing activity.

Objective:To identify 24 Rana species such as Rana dybowskii by mitochondrial cytochrome C oxidase subunit I （COⅠ） gene-based DNA barcoding and build the neighbour-joining （NJ） tree for hierarchical cluster analysis， so as to provide a basis for the identification and classification of Rana species as well as the discovery of new species. Method:R. dybowskii， R. chensinensis， R. amurensis， R. culaiensis， and R. huanrenesis， ten for each species， were collected for DNA extraction and polymerase chain reaction （PCR） amplification and sequencing. A total of 50 COⅠ gene sequences were obtained. Then 163 COⅠ gene sequences for 24 species of Rana and one COⅠ gene sequence for Pelophylax， Odorrana， Nidirana， Hylarana， and Amolops were harvested from GenBank. After sequence alignment by MEGA X， the parsimony-informative sites of COⅠ gene sequences were analyzed and the intraspecific and interspecific genetic distances were calculated， followed by the built of NJ tree and hierarchical cluster analysis. Result:The COⅠ gene sequences of 24 Rana species including R. dybowskii were 554 bp in length and there were 210 parsimony-informative sites in total. The intraspecific genetic distance of each species was smaller than 2%. Except that the interspecific genetic distance between R. sangzhiensis and R. zhengi was 0.004， the genetic distances between the other species ranged from 0.024 to 0.228. R. sangzhiensis and R. zhengi were clustered into one branch and some R. dybowskii and R. uenoi into one branch. There were two separate branches for R. chensinensis and the other species were all clustered independently. Conclusion:COⅠ-based DNA barcoding enabled the identification of 24 species of Rana including R.dybowskii. The findings supported that R. sangzhiensis， R. zhengi， R. coreana， and R. kunyuensis were the same species. One branch of R. chensinensis might be one of the four undownloaded species in Ranidae or a new species. The results have demonstrated that COⅠ-based DNA barcoding allows not only the identification of 24 species of Rana including R. dybowskii but also the classification of ranidae species and the discovery of new species or subspecies.

ObjectiveTo investigate the condition of liver injury in different populations of patients with coronavirus disease 2019 (COVID-2019), and to further understand the pathogenic characteristics of COVID-2019. MethodsA total of 28 patients with COVID-2019 and liver injury who were admitted to the designated hospitals for COVID-2019 in Bozhou, China from February 1 to 12, 2020 were enrolled, and they were divided into male group（n=15） and female group（n=13） according to sex or young group（n=10） and middle-aged and elderly group（n=17） according to age. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were measured on admission. The Wilcoxon rank-sum test was used for comparison of continuous data between two groups, the Fisher exact test was used for comparison of categorical data between two groups. ResultsVarying degrees of liver injury were observed in the 28 patients. There were no significant differences in the levels of ALT, AST, GGT, ALP, and LDH between the male group and the female group and between the young group and the middle-aged and elderly group (all P＞0.05). There was no significant difference in abnormal rate of ALT, AST, GGT and LDH between male group and female group (all P＞0.05); There was no significant difference in abnormal rate of ALT, AST, GGT between the young group and the middle-aged and elderly group (all P＞0.05); there was a significant difference in abnormal rate of LDH between the young group and the middle-aged and elderly group(P＜0.05). ConclusionPatients with COVID-2019 may experience different degrees of liver injury with the development of the disease, middle-aged and elderly patients tend to develop liver injury.There was no significant correlation with gender and age in mild and general patients. Therefore, liver function should be monitored in patients with COVID-2019, and the treatment method should be selected carefully to prevent liver injury.

To investigate the relationship between red blood cell distribution width （RDW） and poststroke depression in patients with acute ischemic stroke. Methods Continuous collection of patients with acute cerebral infarction admitted to our hospital from May 2017 to May 2020.All cases were divided into the non PSD group and PSD group according to whether they were diagnosed with depression at 3 months. The clinical data of the patients were recorded，and RDW was detected by automatic five-classification blood cell analyzer in the morning of the second day after admission. Multivariate Logistic regression analysis were used to screen the risk factors of PSD.The ROC curve analysis was performed to evaluate the predictive value. Results A total of 413 eligible patients were included，with an average age of 65.89 years（aged 40 to 86 years） and 169 males （40.92%）.During the follow-up 3 months after onset，the total number of patients diagnosed with depression was 88例（21.31%）.Multivariate Logistic regression analysis showed that the admission NIHISS score（OR=1.134，95%CI1.049～1.225，P<0.001）and infarction of key areas（OR=1.363，95%CI 1.205～1.641，P<0.001），Female（OR=1.888，95%CI1.097～3.249，P=0.022）RDW（OR=3.730，95%CI 2.229～6.051，P<0.001）were independent risk factors for PSD. The area under the ROC curve （AUC） of RDW for predicting poor prognosis was 0.709（95%CI 0.656～0.763，P<0.001），the optimal cut-off value was 13.01%，the sensitivity was 77.6% and the specificity was 55.7%.Conclusion RDW was an independent risk factor for post stroke depression at 3 months in acute ischemic stroke patients.

OBJECTIVE：To establish the eva luation criteria for the rationality of tumor nutritional standardized treatment ，and to provide reference for nutritional standardized treatment in tumer patients . METHODS ：Based on domestic and foreign guidelines or expert consensus ，the rationality evaluation standard of tumor nutritional standardized treatmentwas formulated in our hospital （Bozhou Municipal People ’s Hospital ）. 50 nutritional treatment medical records in our hospital from Jan. to Jun. 2019 were evaluated by weighted TOPSIS ；according to the evaluation results ，nutritional intervention was carried out ，and 50 nutritional treatment medical records （group B ）from Aug. to Dec. 2019 were re-evaluated by the same method after intervention. RESULTS ： The established evaluation criteria for the rationality of tumor nutritional standardized treatment in our hospital included 18 indicators，such as malnutrition diagnosis ，description of the nature of malnutrition ，nutrition screening and evaluation ，etc. After analysis ，the rational rate of nutritional treatment was only 18％ in group A （Ci of ideal solution with 9 medical records≥0.6），and 78％ in group B （Ci of ideal solution with59 medical records ≥0.6）. There was statistical significance in the rationality of nutritional treatment before and after nutritional intervention （Ci≥0.6）（P＜0.05）. CONCLUSIONS ：The established rational evaluation method of tumor nutritional standardized treatment is feasible ，and the evaluation results are intuitive and reasonable. Nutrition intervention is helpful to reduce the irrational rate of nutritional treatment.

Objective To verify the feasibility and maneuverability of fast bare-handed vertical slicing method for dry Chinese herbal medicine, and to provide reference of this method for different types of medicinal materials. Methods Several representative medicinal herbs were randomly selected in the market to make micro-slices using the top-slicing method to observe its cutting effect. Results Experiments showed that microscopic slices can be obtained for most herbs in a few minutes, which can be used for identification and quality testing. Conclusion This method is fast, effective, simple and practical. It meets the requirements of pharmacopoeia for microscopic identification. This method deserves for promotion.