Objective: To investigate the clinical effects of en bloc resection and debridement combined with gluteus maximus muscle flap in the treatment of ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Methods: A retrospective observational study was conducted. From May 2018 to February 2020, 8 patients with pressure ulcers on the ischial tuberosity combined with chronic osteomyelitis who met the inclusion criteria were admitted to Fuyang Minsheng Hospital, including 5 males and 3 females, aged 38-69 years, with unilateral lesions in 6 patients and bilateral lesions in 2 patients. According to the anatomical classification of Cierny-Mader osteomyelitis, there were 6 patients (7 sides) with focal type, and 2 patients (3 sides) with diffuse type. The wound areas were 3 cm×2 cm to 12 cm×9 cm on admission. The pressure ulcer and chronic osteomyelitis lesions were completely removed by en bloc resection and debridement. The chronic infectious lesions were transformed into sterile incisions like fresh wounds by one surgical procedure, and the gluteus maximus muscle flaps with areas of 10 cm×6 cm to 15 cm×9 cm were excised to transfer and fill the ineffective cavity. The wounds of 5 patients were sutured directly, and the wounds of 3 patients were closed by local flap transfer. The intraoperative blood loss volume and blood transfusion, and length of hospital stay of patients were recorded. The incision healing and flap survival of patients were observed after operation. The recurrence of pressure ulcer and osteomyelitis, the appearance of the affected area, and the secondary dysfunction and deformity of the muscle flap donor site of patients were observed during followed up. Results: The intraoperative blood loss volume of the 8 patients was 220 to 900 (430±150) mL; 5 patients received intraoperative blood transfusion, of which 2 patients received 3 U suspended red blood cells and 3 patients received 2 U suspended red blood cells. The length of hospital stay was 18 to 29 (23.5±2.0) d for the 8 patients. In this group of patients, the incisions of 7 patients healed, while in one case, the incision suture was torn off during turning over and healed after secondary suture. The flaps survived well in 3 patients who underwent local flap transfer. During the follow-up period of 6-20 months, no recurrence of pressure ulcer or osteomyelitis occurred in 8 patients, the affected part had skin with good texture, mild pigmentation, and no sinus tract formation, and no secondary dysfunction or deformity occurred in the donor site. Conclusions: The en bloc resection and debridement combined with gluteus maximus muscle flap has good clinical effects on ischial tubercle pressure ulcer complicated with chronic osteomyelitis. Neither pressure ulcer nor osteomyelitis recurs post operation. The skin texture and appearance of the affected area are good, and the donor site has no secondary dysfunction or deformity.
Blood Loss, Surgical ; Debridement ; Female ; Humans ; Male ; Muscles/surgery* ; Osteomyelitis/surgery* ; Perforator Flap ; Pressure Ulcer/surgery* ; Reconstructive Surgical Procedures ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Treatment Outcome

Objective: To observe the short-term effectiveness of Endobutton plate in the reconstruction of Lisfranc ligament in tarsometatarsal joint injury. Methods: Between March 2015 and July 2018, 18 patients with tarsometatarsal joint injuries were treated with Lisfranc ligament reconstruction by Endobutton plate. There were 12 males and 6 females with an average age of 32.5 years (range, 16-55 years). The causes of injury were traffic accident in 8 cases, falling from height in 3 cases, crushing by a heavy objective in 4 cases, and spraining in 3 cases. There were 10 cases of Myerson type A, 4 of type B1, 2 of type B2, 1 of type C1, and 1 of type C2. The interval between injury and operation ranged from 3 to 9 days (mean, 4.9 days). X-ray examination was performed regularly after operation to measure the distance between the first and the second metatarsal joints, and the visual analogue scale (VAS) score was used to evaluate the pain relief. At last follow-up, the reduction of tarsometatarsal joint was evaluated by measuring and comparing the height of the affected and healthy arches. The foot function was evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: The average follow-up time was 15.8 months (range, 10-28 months). All incisions healed by first intention. X-ray reexamination showed that there was no screw loosening or plate fracture. There were significant differences in the distance between the first and the second metatarsal joints and VAS score at 3 months after operation, before removal of the internal fixator, and at last follow-up when compared with preoperative values ( P<0.05). There was no significant difference between the time points after operation ( P>0.05). At last follow-up, there was no significant difference in the arch height between affected foot [(5.3±0.2) mm] and healthy foot [(5.4± 0.3) mm] ( t=1.798, P=0.810). The AOFAS score of foot function was 89.5±7.3 with excellent in 12 cases, good in 4 cases, and fair in 2 cases. The excellent and good rate was 88.9%. Conclusion: The reconstruction of Lisfranc ligament with Endobutton plate can stabilize the tarsometatarsal joint and achieve satisfactory foot function at early stage.

BackgroundAtypical antipsychotics have been widely used in patients with chronic schizophrenia， and aripiprazole and risperidone are the most commonly used drugs. The mechanism of action of the two is different， while previous studies have provided insufficient credible evidence from multiple perspectives to support the comparative efficacy of the two drugs in improving symptoms in patients with chronic schizophrenia. ObjectiveTo compare the efficacy of aripiprazole and risperidone on the improvement of symptoms， prepulse inhibition （PPI）， cognitive functioning and neurotrophic factors in patients with chronic schizophrenia， so as to provide effective treatment regimens for these patients. MethodsA total of 86 patients with chronic schizophrenia attending the psychiatry department of the Third People's Hospital of Fuyang from March 2021 to March 2023 and fulfilling the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） were enrolled and grouped using random number table method， each with 43 cases. Aripiprazole group was given oral aripiprazole once daily at an initial dose of 5 mg for one week and then gradually increased to a maximum dose of 25 mg. Risperidone group received oral risperidone twice daily at an initial dose of 0.5 mg for one week and then gradually increased to a maximum dose of 3 mg. Treatment in both groups lasted 3 months. Before treatment and 3 months after treatment， Patients were required to complete Positive and Negative Symptom Scale （PANSS）， detection of both strong and weak PPIs in a startle modification passive attention paradigm， Wisconsin Card Sorting Test （WCST） and the measurement of neurotrophic factors at baseline and after treatment. The adverse reactions were recorded. Analysis of covariance was used to test the difference between the PANSS score， PPI， WCST and neurotrophic factor levels of the groups， with the pretest used as the covariate. Results3 months after treatment， no statistical difference was found in the scores of PANSS general psychopathology subscale， positive symptom subscale， negative symptom subscale and total score between two groups after treatment （F=0.621， 0.815， 0.743， 0.752， P>0.05）. There were no statistically significant differences between the two groups in PPI inhibition rate， single intense stimulus amplitude， single intense stimulus latency， prepulse inhibition amplitude， or prepulse inhibition latency （F=0.174， 0.001， 0.183， 0.171， 0.001， P>0.05）. There was no statistically significant difference in the total number of WCST tests between two groups （F=0.512， P>0.05）， whereas aripiprazole group reported significantly larger total numbers of categories completed and correct responses as well as smaller total numbers of random errors and perseverative errors compared to risperidone group （F=3.737， 4.621， 4.892， 5.130， P<0.05）. A significant increase in brain-derived neurotrophic factor （BDNF） and nerve growth factor （NGF） along with a reduction in glial fibrillary acidic protein （GFAP） were documented in risperidone group when compared to risperidone group （F=4.414， 3.781， 6.319， P<0.05）. No significant difference was demonstrated in the incidence of adverse reactions between the two groups （χ²=0.261， P>0.05）. ConclusionAripiprazole may be more beneficial than risperidone in improving cognitive functioning and neurotrophic factor levels in patients with chronic schizophrenia. ［Funded by Scientific Research Project of Fuyang Municipal Health Commission in 2021 （number， FY2021-147）］

Abstract To investigate the curative effects of modified submucosal tunnel endoscopic resection(STER) and endoscopic submucosal resection(ESE) in the treatment of paracardial submucosal tumors. Eighty-four patients with paracardial submucosal tumors diagnosed through digestive endoscopy and endoscopic ultrasonography signed informed consent forms, and they were randomly divided into observation group(n=42) and control group(n=42) with the help of the table of random numbers. Patients in the control group received ESE treatment. Patients in the observation group received modified STER surgery.The operation time, average hospitalization time and treatment cost of patients in STER group were(61.32±32.01) min,(8.11±2.42) d and(21.7±3.4) thousand Chinese Yuan respectively, which were better than those in ESE group(87.63±34.09) min,(10.05±2.84) d and(25.9±3.9) thousand Chinese Yuan. The difference was statistically significant(P<0.05). The average number of titanium clips used in the observation group was(5.00±1.37), and in the control group the average number was(4.68±1.25). The difference was not statistically significant. In the STER group, there were 2 cases of intraoperative perforation and 1 case of delayed bleeding. In the ESE group, there were 4 cases of intraoperative perforation and 3 cases of intraoperative uncontrollable bleeding. The incidence of postoperative complications in the STER group was lower than that in the ESE group. The postoperative pathological examination revealed that in both groups the tumors were mostly stromal tumor and leiomyoma. A few of the patients were suffering from lipomas and schwannomas. There was no significant difference in terms of the pathological composition of the patients between the two groups.

OBJECTIVETo evaluate the value of transforaminal approach single interbody fusion cage combining with fixation with pedicle screws in treating lumbar instability.

METHODSFrom 2006 to 2009, 36 patients (39 interspaces) with lumbar instability were retrospectively analyzed, included 14 males and 22 females; aged from 45 to 68 years with an average of 54 years; course of disease was from 6 months to 12 years with an average of 4 years. Of them, instability in lumbar disc herniation had 8 cases, lumbar spinal stenosis 5 cases, postoperative instability in lumbar disc herniation 3 cases, lumbar spondylolysis 20 cases; unstable segment in L3,4 had 2 cases, L4,5 18 cases, L5S1 13 cases, and double segment 3 cases (both L4,5 and L5S1). All patients underwent decompression, reduction, interbody fusion with single cage from transforaminal approach with pedicle screws and posterolateral fusion. The clinical effects were evaluated according to imaging results and JOA scoring system.

RESULTSAll the patients were followed up from 8 to 32 months with an average of 18 months. The results of 38 intervertebral fusion, suspicious fusion of a vertebral space, fusion rate was 97.4% (38/39). Segmental lordosis angle after operation was increased (4.09 +/- 0.13) degrees than before operation (P < 0.01), and final follow-up was reduced (3.83 +/- 0.17) degrees than after operation (P > 0.05). JOA scoring before operation and final follow-up were respectively 8.14 +/- 1.09 and 13.54 +/- 1.19, there was statistically significant between the two periods (P < 0.01); the JOA score improvement rate (RIS): 28 cases got excellent result, 6 good and 2 fair, the rate of excellent and good was 94.4%.

CONCLUSIONThe path through the transforaminal approach single-fusion cage, implantation of pedicle screw fixation fusion surgery can simplify operations, reduce complications, and can obtain satisfactory clinical efficacy, which is an effective method for the treatment of lumbar instability.

Aged ; Bone Screws ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; pathology ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Diseases ; diagnostic imaging ; surgery ; therapy ; Spinal Fusion ; methods ; Tomography, X-Ray Computed ; Treatment Outcome

ObjectiveTo investigate the correlation between plasma D-dimer level and severity of hepatitis B cirrhosis and its value in the diagnosis of portal vein thrombosis (PVT). MethodsA retrospective analysis was performed for the clinical data of 500 patients with hepatitis B cirrhosis who were hospitalized in The Fifth Medical Center of Chinese PLA General Hospital from January to December, 2018, and according to the plasma level of D-dimer, they were divided into normal group with 217 patients and elevated group with 283 patients. The correlations of plasma D-dimer level with Child-Pugh class and Model for End-Stage Liver Disease (MELD) score were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the Kruskal-Wallis H test was used for multiple groups comparison and further pairwise comparison. The chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was used to investigate correlation. The receiver operating characteristic (ROC) curve was used to evaluate the early warning performance of D-dimer level for PVT in patients with hepatitis B cirrhosis. ResultsThere were significant differences between the two groups in D-dimer level, alanine aminotransferase, aspartate aminotransferase, total bilirubin, albumin, Child-Pugh class, MELD score, and incidence rate of PVT (all P＜0.05). The correlation analysis showed that plasma D-dimer level was positively correlated with Child-Pugh class and MELD score in both groups (r=0.463, 0.455, 0.214, and 0.756, all P＜005). A total of 50 patients with hepatitis B cirrhosis were found to have PVT; the patients with PVT had a significantly higher D-dimer level that those without PVT ［1.96 (0.82-4.91) mg/L vs 0.61 (0.19-1.54) mg/L, Z=-6.02, P＜0.001］. The ROC curve analysis showed that D-dimer level had an area under the ROC curve of 0.758 (95% confidence interval: 0.719-0.796) at the optimal cut-off value of 0.76 mg/L. ConclusionPlasma D-dimer level is correlated with the severity of hepatitis B cirrhosis and can be used to predict the prognosis of patients with hepatitis B cirrhosis. The possibility of PVT should be considered in patients with an elevated D-dimer level.

OBJECTIVE: To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. METHODS: A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T ₁₀-L ₂, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. RESULTS: Except LL ( P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX ( P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated ( P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. CONCLUSION Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.
Male ; Female ; Humans ; Aged ; Fractures, Compression/surgery* ; Spinal Fractures/diagnostic imaging* ; Lumbar Vertebrae/surgery* ; Thoracic Vertebrae/surgery* ; Kyphosis/surgery* ; Osteoporotic Fractures/surgery* ; Lordosis ; Tomography, X-Ray Computed ; Retrospective Studies

OBJECTIVE: To explore the feasibility and early effectiveness of computer-simulated osteotomy based on the health-side combined with guide plate technique in the treatment of cubitus varus deformity in adolescents. METHODS: The clinical data of 23 patients with cubitus varus deformity who met the selection criteria between June 2019 and February 2023 were retrospectively analyzed. There were 17 males and 6 females, ranging in age from 4 to 16 years with an average of 8.5 years. The time from injury to operation was 1-4 years. The angle of distal humerus rotation was defined by humeral head posterior inclination angle using low radiation dose CT to scan the patient's upper extremity data at one time, and the preoperative rotation of the distal humerus on the affected side was (33.82±4.39)°. The CT plain scan data were imported into 9yuan3D digital orthopaedic system (V3.34 software) to reconstruct three-dimensional images of both upper extremities. The simulated operation was performed with the healthy upper extremity as the reference, the best osteotomy scheme was planned, overlapped and compared, and the osteotomy guide plate was prepared. The patients were followed up regularly after operation, and the formation of callus in the osteotomy area was observed by X-ray examination. Before and after operation, the carrying angle of both upper extremities (the angle of cubitus valgus was positive, and the angle of cubitus varus was negative) and anteversion angle were measured on X-ray and CT images. At the same time, the flexion and extension range of motion of elbow joint and the external rotation range of motion of upper extremity were measured, and Mayo score was used to evaluate the function of elbow joint. RESULTS: The operation time ranged from 34 to 46 minutes, with an average of 39 minutes. All patients were followed up 5-26 months, with a mean of 14.9 months. All the incisions healed by first intention after the operation; 2 patients had nail path irritation symptoms after Kirschner wire fixation, which improved after dressing change; no complication such as breakage and loosening of internal fixators occurred after regular X-ray review. Continuous callus formed at the osteotomy end at 4 weeks after operation, and the osteotomy end healed at 8-12 weeks after operation. At last follow-up, the carrying angle, anteversion angle, external rotation range of motion, and extension and flexion range of motion of the elbow joint of the affected side significantly improved when compared with preoperative ones ( P<0.05). Except for the extension range of motion of the healthy elbow joint ( P<0.05), there was no significant difference in other indicators between the two sides ( P>0.05). At last follow-up, the Mayo elbow score was 85-100, with an average of 99.3; 22 cases were excellent, 1 case was good, and the excellent and good rate was 100%. CONCLUSION Computer-simulated osteotomy based on health-side combined with guide plate technique for treating cubitus varus deformity in adolescents can achieve precise osteotomy, which has the advantages of short operation time and easy operation, and the short-term effectiveness is satisfactory.
Male ; Female ; Humans ; Adolescent ; Child, Preschool ; Child ; Elbow ; Humeral Fractures/surgery* ; Retrospective Studies ; Joint Deformities, Acquired/surgery* ; Elbow Joint/surgery* ; Limb Deformities, Congenital ; Osteotomy/methods* ; Humeral Head ; Range of Motion, Articular ; Computers ; Treatment Outcome

OBJECTIVE To investigate the clinical effect of Budigafol combined with Staphylococcus and neisseria tablets in maintenance treatment of patients with stable moderate to severe chronic obstructive pulmonary disease （COPD）. METHODS A total of 122 patients with stable moderate to severe COPD who were admitted to the infections diseases ward of the department of respiratory and critical care medicine in our hospital from October 1， 2021 to January 31， 2023 were divided into control group （n＝61） and observation group （n＝61） according to the random number table method. Patients in the control group were treated with Budigafol inhalation aerosol alone （2 presses each time， twice a day）， and patients in the observation group were treated with Staphylococcus and neisseria tablets （1.2 mg each time， 3 times a day） on the basis of the control group. The treatment course of both groups was 3 months. The quality of life， exercise tolerance， lung function， inflammatory indexes， immune function， as well as the number of acute attacks of COPD and the occurrence of adverse reactions were compared between the two groups before and after treatment. RESULTS Control group and observation group shed 12 and 9 patients， respectively. After treatment， the 6 minute walking distance of the two groups of patients was significantly prolonged compared with that before treatment （P＜0.05）. The COPD assessment test questionnaire score， St George’s respiratory questionnaire score， the ratio of residual volume to total lung capacity， the fractional exhaled nitric oxide， the serum levels of C-reactive protein and interleukin-6 were significantly E-mail：13956685295@163.com decreased compared with those before treatment （P＜0.05）. The forced expiratory volume in one second （FEV1）， the ratio E-mail：13966580920@163.com of FEV1 to forced vital capacity， the percentage of the measured value of carbon monoxide diffusion capacity to the predicted value， and the percentage of the measured value of FEV1 to the predicted value were significantly increased compared with those before treatment （P＜0.05）. The improvement of the above indicators in the observation group was significantly better than that in the control group （P＜0.05）. Compared with before treatment， there was no statistical significance in the immune function indexes of the control group or the serum levels of immunoglobulin A （IgA） and IgM in the observation group after treatment （P＞0.05）. The percentages of CD3+ ， CD4+ ， B lymphocytes and natural killer cells， the levels of CD4+/CD8+ and IgG were significantly increased in the observation group （P＜ 0.05）， the percentage of CD8+ cells was significantly decreased （P＜0.05）， and the improvement degree of the observation group was significantly better than that of the control group （P＜0.05）. There was no significant difference in the number of acute exacerbations of COPD during the follow-up period and the incidence of adverse events during treatment between the two groups （P＞0.05）. CONCLUSIONS Budigafol combined with Staphylococcus and neisseria tablets can effectively improve the immune function of patients with stable moderate to severe COPD， further reduce the level of inflammation， and improve their exercise tolerance and their quality of life with good safety.

Objective : To analyze the application value of metagenomic next-generation sequencing (mNGS) in the detection of pathogenic bacteria in pulmonary infection ，and to provide a theoretical basis for clinical diagnosis. Methods : A retrospective study was conducted on 161 patients with suspected pulmonary infection，and samples of bronchoalveolar lavage fluid ，sputum and lung tissue were collected specimens ，pleural effusion and blood were simultaneously subjected to routine culture，respiratory pathogen nucleic acid detection and pathogenic microorgan- ism mNGS detection．The sensitivity ，specificity，positive predictive value ，and negative predictive value of the three detection methods were calculated respectively to evaluate the clinical application value of mNGS. Results: Among 161 patients with suspected pulmonary infection，113 cases were finally confirmed as pulmonary infection. Among the 161 patients enrolled，the sensitivity and negative predictive value of mNGS were improved compared with routine culture and nucleic acid detection of respiratory pathogens，and the difference was statistically signifi- cant(P＜0. 001) ．Although the specificity of mNGS was higher than that of respiratory pathogen nucleic acid de- tection，the difference was not statistically significant．The positive predictive value of mNGS was the highest，and was higher than that of respiratory pathogen nucleic acid detection，but had no statistical significance compared with conventional culture． Conclusion The sensitivity of mNGS in the diagnosis of pathogenic microorganisms in pul- monary infection is higher than that of conventional culture and nucleic acid detection of respiratory pathogens， which reduces the false negative rate of diagnosis and has a better comprehensive evaluation ; conventional culture detection has low sensitivity，but high specificity ; respiratory pathogen nucleic acid detection compared with con- ventional culture，the sensitivity is improved，but the specificity decreased.