OBJECTIVE To investigate the reasonable use of antibacterial in department of orthopedics.METHODS The patients in our department were registered according to the inventory of antibacterial use made by the hospital infection monitoring network of Medical Administration Bureau,Ministry of Health of the People′s Republic of China,the(operative) incision was classified according to Clinical Surgery.The data of reasonable use of antibacterial were(obtained) after evaluation and(analysis).RESULTS Of the 257 patients in our study,79.37% of them were used antibacterial,20.62% were not used antibacterial,24.50% were used antibacterial for therapy,75.49% were used antibacterial for infection(prevention);95.09% were used systematically;74.50% were reasonable(usage,) 25.49% were unreasonable usage;of the 204 patients who were used antibacterial,only 34 patients were tested by drug sensitivity trial,and the others were used by experience.CONCLUSIONS In order to use antibacterial reasonably,we suggest two points,one is that the medicine management department should workout a feasible antibacterial use institution and mass(evaluation) criterion,take mass examination regurally,and connect the bonus to the examination result;the other is that we should enhance the management of antibacterial market,avoid the improper competition,rise the morality view of the doctor,and suggest them to use antibacterial reasonably(according) to the scientific theory.

Objective To investigate insulin resistance in type 1 diabetes(T1DM)with euglycemic-hyperinsulinemic clamp.Methods Eight cases of newly diagnosed T1DM and 8 cases of newly diagnosed type 2 diabetes(T2DM)were selected.Their insulin sensitivity index(ISI)was evaluated with euglycemic-hyperinsulinemic clamp after 2 week insulin intensive treatment and compared with that of 10 heMthy volunteers(normal control group,NC group).Results Age,BMI,fasting insulin(Fins),fasting C-peptide in the TI DM group were significantly lower than those in the NC group.while waist-to-hip ratio (WHR),systolic blood pressure(SBP),diastolic blood pressure(DBP),TC,TG,LDL-C,HDL-C were not significantly different between the T1DM and NC groups.Age,BMI,WHR,Fins,fasting C-peptide,SBP,TC,TG in the T1DM group were significantly lower than those in the T2DM group.The ISI of the NC,TlDM and T2DM groups were 12.83±1.09,9.95±0.50,3.80±0.20,respectively.There was significant difference among the three groups(P＜0.05).Conclusion The ISI in T1DM Was significantly lower than that in NC group,but higher than that in T2DM.

Objective To investigate the role and potential mechanism of high mobility group box-1 protein (HMGB1) on improving the chemosensitivity of gemcitabine-resistant pancreatic cancer PANC1 ceils.Methods Gemcitabine-resistant pancreatic cancer PANC1 (PANC1-GR) cell line was established by using increased gradient concentration of gemcitabine.The si-HMGB1-PANC1 and si-HMGB1-PANC1-GR cells were established by the transfection with HMGB1 siRNA using liposome.The 50％ inhibitory concentration (IC50) and Resistance index (RI) of gemcitabine in 4 PANC1 cell lines with or without HMGB1 siRNA transfection were determined and calculated by CCK-8 assay.Western blot assay was used to detect the protein expression of HMGB1 in PANC1 and PANC1-GR cells and the expression of autophagy marker protein Beclin1 in the 4 PANC1 cell lines.Flow cytometry assay was used to evaluate the apoptosis rate of 4 pancreatic caner cell lines.Results The gemcitabine-resistant pancreatic cancer cell line PANC1-GR was successfully established,which could grow stably and passage in media with 100 μmol/L gemcitabine.The IC50 of gemcitabine in PANC1,PANC1-GR,si-HMGB1-PANC1,and si-HMGB1-PANC1-GR cells lines were (4.7 ±0.4) μmoL/L,(166.5 ± 13.6) μmol/L,(3.2 ± 0.3) μmol/L,and (52.4 ± 8.4) μmol/L,respectively.The IC50 in PANC1-GR wassignificantly higher than that in PANC1,while the IC50 in the transfected cells was significantly lower than that in untransfected cells,and the differences were both statistically significant (bothP ＜ 0.01).The RI value of gemcitabine in transfected and untransfected PANC1-GR cells was 35.4 and 16.4.The relative protein levels of HMGB1 in PANC1 and PANC1-GR were 0.17 ± 0.08 and 0.38 ± 0.11.The expression of HMGB1 in PANC1-GR was obviously higher than that in PANC1,and the difference was statistically significant (P＜0.01).The relative protein levels of Beclin1 in PANC1,PANC1-GR,si-HMGB1-PANC1 and siHMGB1-PANC1-GR cells were 2.68 ± 0.23,3.28 ± 0.15,0.68 ± 0.23 and 0.78 ± 0.11,which in two transfected cells was greatly lower than those in untransfected cells.The apoptosis level was (34.58± 3.14)％,(79.56±3.58)％,(19.41± 1.53)％,and (34.57±2.94)％.The apoptosis level in the 2 transfected cell lines were significantly higher than those in the 2 untransfected cell lines,and the differences were both statistically significant (P ＜ 0.01).Conclusions The inhibition of HMGB1 could improve the chemosensitivity of gemcitabine in pancreatic cancer PANC1 cells,which might be mediated by the activation of autophagy.

Objective:To explore the clinical effect of observation and psychological intervention, splint or brace fixation as well as surgical treatment on habitual dislocation of the hip (HDH) and to combine the authors' data with a compilation of the cases from the literature, evaluingating the epidemiological characteristics of HDH and the treatment scheme to maintain the stability of hip joint by systematic literature review in children.Methods:A retrospective analysis of the relevant data of 11 patients (12 hips) with HDH were treated from March 2007 to March 2021, including 2 boys and 9 girls. The age of the first dislocation was 2.25 (1.66, 3.75) years old and 4.33 (3.33, 6.17) years old at the age of diagnosis. At the same time, the relevant literature reports were searched from 1932 to 2022, and 24 HDH patients reports and clinical studies were confirmed to be included in this study according to the inclusion and exclusion criteria. The data of 33 patients (38 hips) with HDH who were obtained in the literature, including 5 boys and 28 girls. The age of the first dislocation was 2.00 (1.50, 2.00) years old and 4.00 (2.55, 5.00) years old at the age of diagnosis. A total of 44 patients (50 hips) with HDH who were analyzed, including gender, age of first dislocation, age of diagnosis, mode of stimulating dislocation, side and direction of dislocation, accompanying symptoms, family history, trauma history and imaging examination. The data of 41 patients with HDH (3 patients were excluded due to lack of treatment description) were treated with observation and psychological intervention in 19 patients, splint or brace fixation in 13 patients, and surgical treatment in 9 patients. The femoral neck-stem angle, acetabular index, central edge angle (CE angle) and Reimers instability index were measured by AutoCAD software, and the hip function was evaluated by Harris standard. Meantime, the disappearance time of dislocation was recorded.Results:The average follow-up time of 44 patients (50 hips) with HDH were 4.05±2.93 years old, and the time of disappearance of dislocation after treatment were 1.28±1.19 years old. Patients were diagnosed as 7 boys and 37 girls, 30 right and 8 left as well as 6 bilateral, the age of the first dislocation was 2.64±1.54 years old and 4.52±2.64 years old at the age of diagnosis. The data of 39 patients took hip flexion, adduction, internal rotation or hip flexion and adduction as the mode of stimulating dislocation. There were 43 patients with posterior dislocation, 41 patients with an audible "click" sound during dislocation, 36 patients with painless dislocation, and 37 patients with "vacuum phenomenon" were captured at the moment of dislocation. All patients with HDH had no specific family history and obvious history of trauma. There was no significant difference in general data between observation and psychological intervention group, splint or brace fixation group as well as surgical treatment group ( P>0.05). Harris standard to evaluate hip function, CE angle and Reimers instability index of the affected side were significantly different from those before and after treatment at the moment of dislocation ( H=127.51, P<0.001; H=55.70, P<0.001; H=54.69, P<0.001). Compared with the immediate disappearance of dislocation in the surgical treatment group, the disappearance time of dislocation in the observation and psychological intervention group and the splint or brace fixation group were significantly longer, and the difference was statistically significant ( H=20.83, P<0.001). Conclusion:Without specific family history and obvious trauma at young girls, painless posterior dislocation of hip with an audible "click" sound and "vacuum phenomenon" at the moment of dislocation are the significant epidemiological characteristics of HDH. Observation and psychological intervention, splint or brace fixation are recommended as the initial treatment scheme. When conservative treatment is ineffective, surgical treatment is needed to stabilize the hip joint quickly.

Objective:To investigate the treatment strategy for pediatric humeral supracondylar fractures with callus formation and displacement neglected for over 1 week.Methods:A retrospective analysis was made of the clinical data of 36 children who had been treated at Department of Pediatric Orthopaedics, Medical Center, The Second Affiliated Hospital, Inner Mongolia Medical University from January 2011 to January 2021 for humeral supracondylar fractures with callus formation and displacement neglected for over 1 week. There were 22 boys and 14 girls, with an age of (6.7±2.7) years (from 2.3 to 12.8 years). All fractures were Gartland type Ⅲ. The patients were divided into 2 groups according to their treatment methods: a closed reduction and percutaneous pinning (CRPP) group of 15 patients subjected to the CRPP treatment only, and a leverage group of 21 patients subjected to CRPP assisted by the "lever technique" with posterior elbow Kirschner wire prying and pulling. The 2 groups were compared in terms of operation time, fluoroscopy frequency, quality of reduction, and recovery time for elbow range of motion; the elbow range of motion, visual analogue scale (VAS), Mayo elbow performance score (MEPS) and complications were assessed at the last follow-up.Results:The 2 groups were comparable because there was no significant difference between them in the general information before operation ( P>0.05). All patients were followed up for (26.2±16.3) months (from 6 to 96 months). All the fractures obtained acceptable reduction and clinical union 4 to 6 weeks after operation. The operation time [(28.2±6.8) min] and fluoroscopy frequency [(27.0±6.0) times] in the leverage group were significantly less than those in the CRPP group [(40.8±10.8) min and (43.3±11.4) times] ( P<0.05). The CRPP group was significantly better than the leverage group in the intraoperative Baumann angle (78.1°±1.6° versus 73.7°±4.1°), lateral capitellohumeral angle (58.3°±2.6° versus 49.6°±5.2°) and horizontal rotation rate (109.5%±3.0% versus 103.2%±4.9%) ( P<0.05). The intraoperative reduction in the CRPP group was significantly closer to the normal mean value than that in the leverage group ( P<0.05). There was no significant difference in the recovery time for elbow range of motion between the CRPP and the leverage groups ( P>0.05). At the last follow-up, the Baumann angle (75.4°±2.8°) and the lateral capitellohumeral angle (53.2°±3.6°) in the leverage group were still significantly better than those in the CRPP group (78.3°±1.5° and 57.5°±2.3°) ( P<0.05). However, there was no significant difference in the elbow range of motion, VAS, MEPS or incidence of complications between the 2 groups ( P>0.05). Conclusion:To treat humeral supracondylar fractures with callus formation and displacement neglected for over 1 week in children, CRPP assisted by the "lever technique" with posterior elbow Kirschner wire prying and pulling is an efficient and accurate method, because it can lead to more satisfactory reduction than CRPP only.

Tumor immune microenvironment is a local external tumor environment composed of tumor immune cells and the cytokines secreted by these cells， and it plays a regulatory role in the development and progression of tumors. In the treatment of hepatocellular carcinoma， amino acid metabolism and its reprogramming of proliferating cell metabolism have attracted more and more attention， showing potential in regulating the tumor immune microenvironment. Although amino acid metabolic reprogramming is regarded as a novel approach for tumor therapy， its specific mechanism remains unclear in the regulation of tumor immunity in hepatocellular carcinoma. This article discusses the mechanism of action of amino acid metabolism in the tumor immune microenvironment of hepatocellular carcinoma and its application prospect in clinical practice， in order to provide new ideas for immunotherapy for liver cancer.