50.0%.CONCLUSION:The extensive use of antibacterials results in increased drug resistance,while rational use of antibiotics is the key of decreasing drug resistance and multidrug resistance.It is of great importance to analyze the variation of bacterial drug resistance in area hospital.

Objective To study the outcomes of autologous osteo-periosteal cylinder graft transplantation for Hepple V osteochondral lesions of the talus (OLT) with large subchondral cyst.Methods The data of 27 consecutive patients of OLT with subchondral cyst was retrospectively analyzed who were treated by autologous osteo-periosteal cylinder graft transplantation from October 2007 to September 2011.There were 26 males and 1 female with an average age of 35.8 years (range,22-53 years).Visual analogue score (VAS) for pain during daily activities,the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score,and subjective satisfaction were investigated.The plain radiographs,magnetic resonance imaging (MRI) of the ankle,and second look arthroscopy were analyzed.Results All the 26 patients were followed up for 22.4 months.At the last follow-up,the VAS score decreased from 5.4±1.0 points preoperatively to 0.8±0.8 points postoperatively,and the mean (50％) AOFAS score improved from 73.9±3.1 points preoperatively to 93.0±6.5 points postoperatively.In 26 cases,the radiolucent area of cysts disappeared on plain radiographs.The mean magnetic resonance observation of cartilage repair tissue (MOCART) score was 57.2,though small subchondral bone cyst was still found in 3 cases on postoperative MRI.The mean (50％) ICRS arthroscopic score of cartilage repair was 9.2 points according to second look arthroscopy of 18 cases.There were 16 cases receiving excellent effect,8 good and 2 fair.The excellent and good rate was 92.3％ (24/26).There were no major complications.Conclusion Autologous osteo-periosteal cylinder graft transplantation could repair the osteochondral defects.It yields satisfactory results,and is suitable for treating OLT with large subchondral cyst.

Objective:To explore the clinical efficacy of disease-modifying drug nusinersen on children with spinal muscular atrophy.Methods:The baseline and longitudinal clinical data of 15 children who were treated with nusinersen in the Children′s Hospital, Zhejiang University School of Medicine from October 2019 to October 2021 were retrospectively collected. The general data (gender, age, genotype, and clinical classification, etc.), motor function, nutritional status, scoliosis and respiratory function were analyzed. Wilcoxon rank-sum test was used for comparing multi-system conditions before and after treatment.Results:The age of 15 cases (7 males, 8 females) was 6.8 (2.8, 8.3) years, with 2 cases of type 1, 6 cases of type 2, and 7 cases of type 3 respectively, and the course of disease was 55.0 (21.0, 69.0) months. After 9.0 (9.0, 24.0) months of treatment, the motor function scale evaluations of the Hammersmith neurological examination section 2 (13.0 (7.0, 23.0) vs. 18.0 (10.0, 25.0) scores, Z=-2.67, P=0.018) of 15 children, the Hammersmith functional motor scale expanded (38.0 (18.5, 45.5) vs. 42.0 (23.0, 51.0) scores, Z=-2.38, P=0.018), and the revised upper limb module (27.0 (19.5, 32.0) vs. 33.0 (22.5, 35.5) scores, Z=-2.52, P=0.012) of children with type 2 and 3 had significantly improved. Thirteen patients achieved clinically significant motor function improvement, and 2 of them had kept stable scale scores. Subjective reports also indicated that the muscle strength and daily exercise ability of these children improved after treatment, and no serious adverse reactions were reported. Supplemented by the multi-disciplinary team management, the levels of some indicators such as Cobbs angle of scoliosis and forced vital capacity all had significantly improved (all P<0.05). Conclusions:Nusinersen can improve the motor function of patients with 5q spinal muscular atrophy, which is also proved safe to be used in children. The drug treatment supplemented by the multi-disciplinary team management is helpful to improve the multi-system function of the children with spinal muscular atrophy.