Acute kidney injury (AKI) is one of the most common serious complications in critically ill patients, and it is an independent risk factor for death. In recent years, renal replacement therapy (RRT) has become one of the routine treatments for AKI patients, however there is no accepted consensus on the optimal timing of RRT over the world. This paper reviewed the clinical studies carried out by researchers in the field of critical care and nephrology, thereby summarized and analyzed the related parameters of the optimal time to carry out, with the exception of previously acknowledged classic RRT indications such as hyperkalemia, severe metabolic acidosis, volume overload and so on. The feasible parameters such as serum creatinine (SCr), blood urea nitrogen (BUN), urine volume, the time admitted in the intensive care unit (ICU) and several standards distinguished AKI stages are discussed in order to find out the cutoff points of those parameters which were best for the patients' outcome, and to provide guidance of decision making for the optimal timing of RRT for AKI patients.

There has still been controversy on selection of approapreate treatments for elderly patients with acetabular fracture who are rapidly increasing in number. Although the treatment principle for them is anatomical reduction, effective fixation and early mobilization, choice of a proper treatment has turned to be a new hot spot for clinical research because the physical status, bone quality and fracture type of the elderly population are special. With unceasing achievements in medicine, surgical techniques and implants, the management ideas and strategies for elderly acetabular fractures have become gradually mature and diversified. The current major protocols include conserverative treatment, open reduction and internal fixation and total hip arthroplasty. In order to enhance the surgeons'knowledge of elderly acetabular fractures and summarize the cilinical experiences in management of them, we present this review to illustrate the current achievements and new development trends.

Objective To develop a new ambulance aid on airport rescue of pilot and solve the difficult problems on medical staff, which carry the wounded from high aircraft cabin to the ground. Methods The device owned QG 0.85 trailer chassis. On the basis of it, self-made manual flexible extension-jib, flexible extension ladders and safety board were designed. The safety board was used to fix wounded pilots to protect secondary injury of backbone and C-spine. Results The maximal speed of equipment was 80km/h and spreading time is 3～7min, operating time is 4min and lifting height is 6 000mm. Conclusion The ambulance aid can be used in the location of flight accident quickly and rescued the pilots rapidly, adapted to any type fighters and met the needs of medical support in flight.

Objective To investigate the effect of exercise on the recovery of locomotor and neurological function in rats after incomplete spinal cord injury (SCI). Methods Ninety-five male Sprague Dawley rats were randomly divided into a control group, a training group (including subgroups which received training for 1 week, 2 weeks, 3 weeks and 4 weeks) and a sham operation group. The control and training groups were administered an SCI model at the T_(10) level by extradural compression using a modified Allen's stall with a damage energy of 40 g-cm. These rats were loosely restrained and given partial weight-bearing treadmill training 5min/time, twice a day for 1-4 weeks. Locomotor and neurological function were evaluated with inclined plane tests, modified Tarlov scores, the Basso-Beattie-Bresnahan scale and spinal cord somatosensory evoked potential (SCSEP) before injury and at different time points thereafter. Results Locomotor function improved significantly at different time points during the train-ing, and significantly better than in the control group. In the rats trained for 2-4 weeks, SCSEP latency shortened sig-nificantly compared to the control group. The latency shortened gradually with longer exercise. Conclusions Exer-cise with partial weight support may improve locomotor and neurological function. The improvements are correlated closely with the duration of the training.

Objective To investigate the systolic synchrony of the left ventricle in patients with left ventricular hypertrophy (LVH) or with heart failure but preserved ejection fraction (HF-PEF),and to evaluate the impact of systolic dyssynchrony on left ventricular function.Methods During June 2011 to May 2014,a total of 352 patients(160 males,192 females,average age:(67.6±7.8)years) with essential hypertension (EH) were enrolled in this retrospective study.Ultrasonic and G-MP1 were performed for assessment of left ventricular remodeling and systolic synchrony and the results were statistically analyzed by oneway analysis of variance and x2 test.Relationship between BNP and synchronic parameters as well as other clinical factors were analyzed by partial correlation analysis.Results The EH patients were divided into hypertension group (rt =182),LVH group (n =74) and HF-PEF group (n =96).In comparison to hypertension group,significant LVH developed in LVH and HF-PEF groups although the LVEF was still preserved.The LVMI of the 3 groups were (94.4±10.1),(121.1±9.8) and (123.2±10.9) g/m2,respectively(F=8.66,P＜0.05).The LVEF was (58.6±7.3)％,(60.8±10.4)％ and (55.1±4.6)％,respectively(F=2.89,P＞0.05).Diastolic dysfunction was identified in LVH and HF-PEF groups with significantly reduced E/A ratio (1.19±0.23,0.80±0.28,0.67±0.17;F=13.46,P＜0.05).Remarkable left ventricular systolic dyssynchrony with phase histogram bandwidth (PHB) of (88.4±8.6) ° and phase standard deviation (PSD) of (23.6±1.9)° and increased BNP of (228.4±69.7) ng/L were revealed in HF-PEF group.The BNP in HF-PEF group was significantly higher than that in LVH group((92.5±13.6) ng/L;q=8.63,P＜0.05).Positive correlation was found between BNP level and PHB,PSD,LVMI,respectively (r=0.277-0.331,all P＜0.05).Conclusion Left ventricular systolic dyssynchrony is concomitant with HF-PEF patients induced by EH,and this dyssynchrony might be one of the factors leading to diastolic dysfunction.

Objective:To investigate the clinical effects of antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap in the one-stage treatment of chronic calcaneus osteomyelitis plus skin and soft tissue defects.Methods:From January 2013 to September 2019, 48 patients were admitted to Department of Orthopedic Trauma, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University for chronic calcaneal osteomyelitis complicated with skin and soft tissue defects. They were divided into 2 groups according to different bone grafts. In group A of 26 patients treated at one stage by antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap, there were 16 males and 10 females with an age of (45.0±11.7) years and an area of skin defect of (56.0±16.7) cm 2. In group B of 22 patients treated at one stage by simple autologous iliac bone combined with sural neurocutaneous flap, there were 13 males and 9 females with an age of (43.6±9.6) years and an area of skin defect of (53.8±16.2) cm 2. The volume of the ilium harvested, fracture healing time, infection control, donor site complications, pain score of visual analogue scale (VAS) and function recovery of the ankle were compared between the 2 groups. Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The 48 patients were followed up for (15.3±6.0) months. Group A had a significantly smaller volume of the ilium harvested [(67.3±14.1) cm 3] than group B [(90.7±23.5) cm 3], a significantly lower rate of donor site complications [3.8% (1/26)] than group B [31.8% (7/22)], significantly lower VAS pain scores at 6, 12, 24, 48 and 72 hours than group B, and significantly lower WBC count, erythrocyte sedimentation rate and C-reactive protein at 2, 4, 8 weeks after operation than group B (all P<0.05). There was no statistically significant difference between the 2 groups in the infection control rate [96.2% (25/26) versus 77.3% (17/22)], the fracture healing time [(6.2±1.9) months versus (6.4±2.1) months], or the ankle-hindfoot score of AOFAS (The American Orthopaedic Foot and Ankle Society) (83.9±7.2 versus 82.5±8.7) at 6 months after operation (all P>0.05). Conclusion:In one-stage treatment of chronic calcaneal osteomyelitis complicated with skin and soft tissue defects, compared with simple autologous iliac bone combined with sural neurocutaneous flap, antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap can reduce the volume of the ilium harvested, pain score of VAS, and incidence of donor site complications, and improve the recovery of inflammatory indicators, leading to fine clinical effects.

Objective:To investigate the current situation of perioperative fasting management in patients with orthopaedic trauma waiting for elective surgery (those combined with diabetes mellitus included) and the surgeons' awareness in China.Methods:From November 1st to December 31st, 2021, the questionnaire forms were distributed through WeChat in the exchange group of National Enhanced Recovery Surgery (ERAS) and the exchange group of national training orthopaedists in Beijing Jishuitan Hospital. The survey contents included: time for preoperative water deprivation and for postoperative recovery of drinking in patients without diabetes mellitus, the rationales for orthopaedists to choose perioperative dietary management, the orthopaedists＇understanding of the existing guidelines, time for preoperative water deprivation and postoperative recovery of drinking and diabetes-related issues in patients with diabetes mellitus, and the time for postoperative recovery in all the patients (For the postoperative recovery of eating, there is no difference between patients with and without diabetes mellitus). The relationships were analyzed between some professional data of the orthopaedists and their rationales for choice of management strategies and their understanding of the guidelines.Results:A total of 565 valid questionnaires were collected. 12.92% (73/565) of orthopaedists required their patients without diabetes mellitus not to drink for at least 2 hours. In fact, the proportion of water prohibition from 0 o'clock on the day of operation was still the highest [24.07% (136/565)]. Respectively, 22.83% (129/565) and 42.12% (238/565) of the orthopaedists chose "water intake is allowed once awakened" and "water intake after at least 6 hours after operation" for their patients without diabetes mellitus. 33.98% (192/565) of the orthopaedists required all the patients fasted for at least 6 hours before surgery, and 44.25% (250/565) of the orthopaedists chose "eating can be resumed if there is no discomfort for 2 hours after water intake" .21.06% (119/565) of the orthopaedists demonstrated that they were quite familiar with the guidelines and carried out perioperative dietary management according to the guidelines. The management of water deprivation was more inconsistent for patients with diabetes mellitus, and more hospitals followed the traditional principles for water deprivation. The proportions of water deprivation starting at 0 o'clock on the day of operation, 8 hours before operation, 6 hours before operation and 4 hours before operation accounted respectively for 22.83% (129/565), 19.12% (108/565), 21.95% (124/565), and 18.94%% (107/565). The level of an orthopaedist's hospital and the professional rank of an orthopaedist were the factors related to the orthopaedist's understanding of the guidelines ( P<0.05). Conclusions:The current perioperative dietary management guidelines are not widely implemented or well known in Chinese faculties of orthopaedic trauma. The process of perioperative dietary management needs to be optimized for the patients combined with diabetes mellitus.

Papillary thyroid microcarcinoma(PTMC),which lacks lymph node metastasis,distant metastasis,extra-thyroid invasion,high-risk subtypes,and invasion of the trachea or recurrent laryngeal nerve,may be classified as low-risk PTMC based on clinical assessment.Surgical intervention such as lobectomy or total thyroidectomy is the primary treatment modality for PTMC.This study comprised 124 patients who underwent conformal thyroidectomy and revealed that this innovative surgical approach yielded long-term oncological outcomes comparable to those who received lobectomy or total thyroidectomy.The surgical intervention may play a significant role in the comprehensive management of PTMC,while the implementation of PTMC precision medicine necessitates the utilization of genetic testing,molecular typing,and other advanced technologies to detect early-stage high-risk factors like lymph node microinvasion and integrate biology-based surgery concept for optimal outcomes.

Purpose: Tamoxifen showed individual differences in efficacy under different CYP2D6*10 genotypes. Our study evaluated the prognosis of tamoxifen or toremifene in hormone receptor (HR)–positive breast cancer patients under different genotypes. Materials and Methods: CYP2D6*10 genotypes of HR-positive breast cancer patients were determined by Sanger sequencing, and all the patients were divided into tamoxifen group or toremifene group. Results: A total of 268 patients with HR-positive breast cancer were studied. The median follow-up time was 72.0 months (range, 5.0 to 88.0 months). Of these, 88 (32.9%), 114 (42.5%), and 66 (24.6%) patients had C/C, C/T, and T/T genotypes, respectively. Among patients who received tamoxifen (n=176), the 5-year disease-free survival (DFS) rate in patients with C/C and C/T genotype was better than that in patients with T/T genotype, and the difference was statistically significant (p < 0.001 and p=0.030, respectively). In patients receiving toremifene, CYP2D6*10 genotype was not significantly associated with DFS (p=0.325). Regardless of genotypes, the 5-year DFS rate was higher in patients treated with toremifene than in patients with tamoxifen (91.3% vs. 80.0%, p=0.011). Compared with tamoxifen, toremifene remained an independent prognostic marker of DFS in multivariate analysis (hazard ratio, 0.422; p=0.021). For all the 180 patients with CYP2D6*10 C/T and T/T genotypes, the 5-year DFS rate was significantly higher in the toremifene group than in the tamoxifen group (90.8% vs. 70.1%, p=0.003). Conclusion Toremifene may be an alternative adjuvant endocrine therapy for patients with CYP2D6*10 mutant genotypes.

Objective:To analyze the therapeutic effect of sural neurocutaneous flap combined with antibiotic-impregnated calcium sulfate and autogenous iliac bone graft of chronic calcaneal osteomyelitis.Methods:A retrospective analysis was peformed in 29 patients with chronic calcaneal osteomyelitis treated with sural neurocutaneous flap combined with antibiotic-impregnated calcium sulfate and autogenous iliac bone graft in the Xi′an Honghui Hospital Affiliated to Xi′an Jiaotong University from April 2013 to January 2020. There were 19 males and 10 females, with the age of (45.38±12.85) years, ranged from 22 to 67 years. The course of disease was (16.00±6.96) months, ranged from 6 to 36 months. The skin defect area was (41.9±15.9) cm 2, ranged from 11.8 to 86.8 cm 2. The causes of injury: 18 cases of high fall, 6 cases of traffic accidents, 3 cases of heavy rolling, the remaining 2 cases were machine strangulation and sharp stab wounds. The inflammatory markers [white blood cell (WBC), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), C reactive protein (CRP)] and bone healing time were recorded before operation, 2, 4, 8 weeks and 6 months after operation. During the follow-up period, the flap texture, survival were observed, and the ankle-posterior foot function recovery was evaluated by the American Association of Foot and Ankle Surgery (AOFAS) score were observed before and after the operation, and the incidence of complications were recorded. The measurement data were expressed as mean±standard deviation ( ± s), and the t-test was used for inter-group comparison; the levels of WBC, ESR, PCT and CRP at different time points before and after operation were compared by repeated measurement ANOVA, and the LSD t-test was used for pairwise comparison. Results:All the 29 patients were followed up for (14.51±6.10) months, ranged from 6 to 30 months. All the flaps survived without abrasion, ulceration, or skin protrusion, and all patients could walk normally with shoes. There were 28 cases of stage I bone healing, with an average of (5.87±2.07) months, ranged from 3 to 12 months. The inflammatory indexes was significantly decreased at different time points after operation ( P<0.05). There was no significant difference between 6 months and 8 weeks after operation ( P>0.05), while there was significant difference at other time points ( P<0.05). The ankle-posterior foot score of AOFAS at 6 months after treatment was significantly higher than that before treatment (83.44±7.93 vs 55.37±8.07), the differences was statistically significant ( P<0.05). The clinical efficacy of foot function recovery was excellent in 12 cases, good in 15 cases and fair in 2 cases among 29 patients .The excellent and good rate was 93.1% (27/29). One patient recurred 1 month after operation and was re-implanted with antibiotic-loaded calcium sulfate mixed autogenous iliac bone after debridement, no recurrence was found. The total complication rate was 31.0%, but there was no significant impact on the patient's life in the later period. All patients returned to daily life and work. Conclusion:The treatment of chronic calcaneal osteomyelitis with sural neurocutaneous flap combined with antibiotic-impregnated calcium sulfate and autogenous iliac bone graft can effectively control infection, reconstruct calcaneal and soft tissue structure, promote functional recovery of affected limb, and ultimately improve the patient′s quality of life.