A severe crush injury to the hand is devastating to patients. Under conditions in which the crush force is too great, the digits are not viable candidates for replantation. We present two cases in which the patients suffered from loss of the thumb ray at the first carpometacarpal joint and skin defect at the radial side. The tendons, radial nerve and metacarpal bone of the index finger were injured, and the second metacarpal head was retained. There was a comminuted fracture of the trapezium in both patients. The treatment protocols consisted of the index finger pollicization and the free anterolateral thigh flap transfer. The procedure was performed in a single operation. The new thumb is able to provide a stable post for pinch and grip after six months follow-up. Both patients were satisfied with the function and appearance of the reconstructed thumb.

Objective:To investigate the clinical efficacy of injectable polymyxin B combined with tigecycline in pneumonia caused by pan-drug resistant Klebsiella pneumonia (PDR-KP). Methods:The retrospective analysis utilized clinical data of 71 patients with PDR-KP admitted to the Neurointensive Care Unit of Beijing Chaoyang Integrative Medicine Emergency Medical Center between September 2018 and August 2021. All patients received injectable polymyxin B combined with tigecycline. The response rate, bacterial clearance rate, and safety of this therapeutic option were evaluated according to the clinical symptoms and biochemical parameters before treatment (baseline), 7 days after the treatment, and at the end of the treatment.Results:The treatment time of 71 patients ranged from 8 to 14 days, with an average of 11 days. The symptoms, signs, laboratory tests, and chest CT findings of most patients significantly improved after the treatment using polymyxin B combined with tigecycline. On the 7th day after the treatment, 37 patients were clinically effective, with a total effective rate of 52.1%(37/71); 41 patients obtained bacteriological clearance, with a bacterial clearance rate of 57.7%(41/71). At the end of treatment, 51 patients were clinically effective, with a total effective rate of 71.8%(51/71); 56 patients obtained bacteriological clearance, with a bacterial clearance rate of 78.9%(56/71). Compared with the results on the 7th day after the treatment, the total effective rate ( χ2=5.86, P=0.016) and bacterial clearance rate ( χ2=7.32, P=0.007) of patients at the end of treatment were significantly increased. Skin pigmentation occurred in 39.4%(28/71) of patients during the treatment. Conclusions:Polymyxin B combined with tigecycline can be tried as a treatment option for pneumonia caused by PDR-KP, but more reliable clinical evidence is still needed.

Objective To establish an individual Nomgram model for predicting the risk of coronary heart disease complicated with pulmonary hypertension. Methods From January 2017 to December 2021 , 352 patients with coronary heart disease (CHD) complicated with pulmonary hypertension in our hospital were selected, and 352 patients with coronary heart disease but without pulmonary hypertension were selected as the control group. The clinical baseline data of the two groups were analyzed first, and then logistics multivariate analysis was performed. To explore the risk factors of coronary heart disease complicated with pulmonary hypertension, the Nomgram model was established to predict the risk, and the predictive value of the model was tested by receiver characteristic curve (ROC). Results Logistics multivariate analysis showed that alcoholism, smoking, stroke history, hypertension course, CHD course, PASP, HCT, PaCO₂, D-dimer, NIHSS score and low PaO₂ were all independent risk factors for CHD complicated with pulmonary hypertension. Nomgram model prediction results for patients with coronary heart disease showed that Alcohol abuse, smoking, stroke history, duration of hypertension (5.66 years), duration of coronary heart disease (2.12 years), NIHSS (12.33 points), PASP (75.22mmHg), HCT (33.22%), PaCO₂ (56.11mmHg), D-dimer (255.12μg/L), PaO2 (56.22mmHg) is a risk factor for coronary heart disease complicated with pulmonary hypertension. ROC curve showed that the area under the prediction curve of Nomgram model for coronary heart disease complicated with pulmonary hypertension was 0.675. Conclusion Nomgram model can predict pulmonary hypertension in patients with coronary heart disease to a certain extent.