[Objective]On May 12,2008,an over 8.0-magnitude earthquake occurred in Wenchuan county,Sichuan province,China.The anthor's field hospital was deployed to An county,which arrived on the 3rd day after the disaster.During the first week of the deployment,284 victims with musculoskeletal injuries received orthopedic management.The objective of this article is to highlight the experience gained by this author's medical assistance team,focusing on the orthopedic care in the early part of the post-disaster relief activities.[Method]Records of 284 patients who underwent orthopedic management were reviewed retrospectively.[Result]There were a large number of musculoskeletal injuries amongst the survivors in the acute phase of the disaster,including spinal trauma,fractures and dislocations,peripheral nerve injuries and soft tissue injuries.The average age was 49.3 years(range,11 to 92 years) with 133 men and 151 women.The patients with upper extremity fracture were 85,with lower extremity fracture 73,with spinal fracture 23,with shoulder or hip dislocation 7.The patients with hand or foot injuries,peripheral nerve injuries and soft tissue injuries were 96.Open injuries were 67,the remaining were closed injuries.Totally 131 patients recovered,and the rest were transferred to the rear hospital for further management.The X-ray postoperatively showed that 21 open fractures were reduced functionally by means of external fixator,and the shoulder or hip dislocations were reduced anatomically.The wounds with primary suture had no infection.There were no other complications.[Conclusion]Correct diagnsis of the injuries,providing scientific and resonable therapeutic measures,and correct operative indication should be emphasized for early orllopedic care.Definitive surgeries such as open reduction and internal fixation are not recommended strongly.External fixation for post-earthquake open fractures is simple and effective,allowing simple approach to wound care and transferring to rear hospital during the whole period of fixation.

Objective To investigate the ultrasound characteristics of pseudothrombophlebitis.Methods The ultrasound characteristics of thirty-two popliteal cyst cases with pseudothrombophlebitis which were confirmed by MRI or puncture were retrospectively analyzed.The former group was matched with a case control group of sixty-four patients with asymptomatic popliteal cysts,the ultrasound images were comparative analysis between the two groups.Results Compared to the control group,both the length and width of the case group were larger [(12.4 ± 4.7) ×(2.5±0.4)cm vs (5.3±2.9) × (1.2±0.4)cm,P ＜ 0.001],and there were 18(43.8％) cases with the cysts extension into the calf.The case group were more prone to show cyst with poor ultrasound penetration or solid-cystic echo (78.1％ vs 9.4％,P =0.000),which were diagnosed as popliteal cyst with hematoma or infection.Six cases of case group showed irregular anechoic area surrounding the inferior border of the cysts,which were diagnosed as ruptured popliteal cyst,no similar imaging detected in the control group(P =0.001).Both the two group showed septation in the cyst,but it did not differ significantly(P ＞0.05).Conclusions Ultrasonography is helpful to the diagnosis of pseudothrombophlebitis,the ultrasound characteristics include large cyst extension into the calf,cyst with poor ultrasound penetration or solid-cystic echo and irregular anechoic area surrounding the inferior border of the cysts.

Objective: To investigate the detection of HIV/AIDS cases in medical institutions in Tianjin Municipality from 2005 to 2021, so as to provide insights into optimization of HIV antibody testing strategies in medical institutions. Methods: All data pertaining to individuals receiving HIV antibody tests in medical institutions in Tianjin Municipality from 2005 to 2021 were collected from the information systems in medical institutions and the HIV/AIDS Prevention and Control Information System of Chinese Disease Prevention and Control Information System. The positive rate of HIV antibody and epidemiological characteristics of HIV/AIDS cases in medical institutions were analyzed. Results: The number of HIV antibody tests increased from 86 102 person-times in 2005 to 1 369 345 person-times in 2021 in medical institutions in Tianjin Municipality, with annual increase by 18.88%. The positive rate of HIV antibody increased from 2.44/104 to 2.85/104 (P<0.05), with annual increase by 2.79/104. Both the proportion of the number of HIV antibody tests and the number of HIV/AIDS cases detected by medical institutions in the whole city appeared a tendency towards a rise (P<0.05). A high positive rate of HIV antibody was seen in sexually transmitted disease clinics (53.69/104) and other testing services (12.25/104), and the highest positive rate of HIV antibody was seen in individuals at ages of 20 to 39 years (5.40/104), while the positive rate of HIV antibody was higher in men (5.84/104) than in women (0.53/104) (P<0.05). A total of 3 610 HIV/AIDS cases were detected in medical institutions in Tianjin Municipality from 2005 to 2021, with a median age of 38 (interquartile range, 24) years. Of all HIV/AIDS patients, there were 3 277 men (90.78%), and men who have sex with men was the predominant transmission route (63.46%), while the proportion of late identification of HIV/AIDS cases was 65.60%. In addition, the proportion of timely detection for the first CD4+T lymphocyte count testing increased from 23.81% in 2005 to 71.54% in 2021 (P<0.05). Conclusions The number of HIV antibody tests and positive rate of HIV antibody appeared a tendency towards a rise in medical institutions in Tianjin Municipality from 2005 to 2021. The HIV/AIDS cases were predominantly identified in sexually transmitted disease clinics and other testing services, and were predominantly men.

ObjectiveTo investigate emergency diagnosis and treatment of pelvic fracture complicated with traumatic rupture of urethra and bladder,and to improve the success rate of treatment on pelvic fracture.MethodsClinical data of 52 cases of pelvic fracture complicated with traumatic rupture of urethra and bladder in department of emergency and urology from 2000 to 2010 was retrospectively analyzed.Results Among the 52 patients,there was 41 cases of pelvic fracture complicated with posterior urethral disruption,15 cases complicated with rupture of bladder and 4 cases complicated withtraumatic rupture of urethra and bladder at the same time.In 41 cases with posterior urethral rupture,6 individual's condition were relatively so severe that they onlyunderwent bladder puncture nephrostomy,and 29 cases underwent traction urethral realignment,the other 6 cases didn't undergo surgery; In 15 cases of patients with bladder rupture,2 patients were performed urethral realignment and bladder repair,11 patients underwent the bladder repair only and the other 2 patients were not performed surgery.There were 8 patients died and the mortality rate was 15.4％.Six died cases failed to conduct emergency surgery because of uncontrollable bleeding and another 2 cases died due to multiple organ failure.ConclusionPelvic fractures is a disease with more complications,it should be diagnosed as early as possible.Patients invalid for conventional anti-shock should be performed pelvic external fixation and emergency embolization to stop bleeding in the emergency department,and undergo associated processing after they are in stable condition.

Humans ; Pancreaticoduodenectomy ; Pathology, Clinical ; Perioperative Period ; Postoperative Period ; Preoperative Period

Objective:To investigate the value of BRAF V600E and multigene detection and stratified application for the diagnosis of thyroid nodules.Methods:A total of 1 117 patients with thyroid nodules resection at Nanjing Gulou Hospital from December 2020 to July 2022 were enrolled in the study. Fine needle aspiration (FNA) and core biopsy samplings were performed for cytopathologic examination and genetic testings; the findings were combined with BSRTC classification. The diagnostic performance of BRAF V600E and multigene detection were compared.Results:Among the 1, 117 patients who underwent thyroid nodules resection, 285 were male and 832 were female, with a median age of 46 years (range: 24-76 years). Postoperative histopathologic examination confirmed 1 040 cases of thyroid cancer and 77 cases of benign nodules. The sensitivity (87.0% vs. 80.8%, P<0.01) and diagnostic accuracy (87.9% vs. 82.1%, P<0.01) of multigene detection were significantly higher than those of BRAF V600E detection. The result of multigene detection showed that BRAF V600E mutation was the most common finding, followed by CCDC6-RET (E1-E12) fusion, ETV6-NTRK3 fusion, and KRAS mutation. Multigene detection had a higher sensitivity (81.9% vs. 72.8%, P<0.01) and lower cancer risk in wild-type (47.6% vs. 57.7%, P=0.069) than BRAF V600E detection in BSRTCⅠ-Ⅴ lesions. Compared with BRAF V600E detection, multigene had no significant difference of sensitivity in BSRTC Ⅰ lesions, but significantly higher sensitivity (86.3% vs 74.0%, P<0.01) in BSRTC Ⅲ lesions. Conclusions:Genetic detection can be used as an effective tool for the diagnosis of thyroid nodules. A stratified application of molecular markers in the diagnosis of thyroid nodules is proposed. Combined with FNA, single gene or multigene detection both can effectively assist in the diagnosis of thyroid nodules. Moreover, multigene detection is superior to single gene detection. For BSRTC Ⅲ lesion with wild-type BRAF, multigene detection can be considered with a repeated FNA.

OBJECTIVE: To explore the effect of rare synonymous variants of the ATP7B gene on the splicing of its precursor mRNA. METHODS: A total of 248 rare synonymous variants with allelic frequency of <0.005 were retrieved from the ExAc database. Human Splicing Finder (HSF) was used to predict their effect on the splicing of precursor mRNA. And ESE Finder 3.0 was used to predict the effect of such variants on the binding ability of SR protein family. Rare synonymous variants affecting the binding of two or more SR proteins were selected and verified with an in vitro mini gene splicing report system. RESULTS: HSF analysis indicated that 136 of the 248 rare synonymous variants may destroy the exonic splicing enhancer (ESE) motif. Analysis using ESE Finder 3.0 indicated that 19 of them may affect the binding of two or more SR proteins at the same time. In vitro mini gene experiment confirmed that the c.1620C>T (p.L540L) and c.3888C>T (p.A1296A) variants could lead to abnormal splicing of the corresponding exons, resulting in complete skipping of exon 4 and 25% increase in the skipping of exon 18, respectively. CONCLUSION Synonymous variants may affect the splicing of precursor mRNA in various ways, particularly the destruction of ESE motif. This study confirmed that the c.1620C>T (p.L540L) and c.3888C>T (p.A1296A) variants can affect the mRNA splicing of the ATP7B gene, resulting in skipping of corresponding exons, which may provide a basis for genetic diagnosis and consultation of carriers.
Alternative Splicing ; Copper-Transporting ATPases/genetics* ; Enhancer Elements, Genetic ; Exons ; Gene Frequency ; Humans ; RNA, Messenger/genetics*

Objective To explore the association between interleukin 28B (IL-28B),equilibrative nucleoside transporters 1 (ENT1) gene polymorphisms and spontaneous clearance of HCV in HIV/HCV co-infectors in Hunan province.Methods Genotypes of IL-28B and ENT1 (rs12980275,rs12979860,rs8099917 and rs760370) were analyzed in 107 HIV/HCV co-infectors in Hunan province and the distributions of gene polymorphisms were compared between chronic hepatitis and spontaneous clearance groups.Results The major genotypes in rs12980275,rs12979860 and rs8099917 of IL-28B were AA,CC and TT in HIV/HCV co-infectors,which accounted for 84.1％ of each.The three single nucleotide polymorphisms were highly linkage disequilibrium (r2＞0.94) and the differences of genotype distribution were statistically significant between chronic hepatitis and the spontaneous clearance groups (P＜0.05).Infectors which carrying the major genotypes were more susceptible to spontaneous clearance of HCV.Differences of the genotype distributions in rs760370 of ENT1 were not statistically significant between the two groups.Conclusion Genotypes AA,CC and TT of IL-28B were related to spontaneous clearance of HCV in HIV/HCV co-infectors.

In the online teaching of Biochemistry course, a variety of network resource platforms (such as Zhihuishu learning network, teleconference, WeChat, QQ, etc) were used to establish a learning community. The teaching content and teaching plan were carefully designed and implemented, enriching the knowledge system of the learning community. And then blending teaching was performed through the combination of live broadcasting and online interaction. In addition to teaching students the basic knowledge of biochemistry, it is also combined with clinical cases and life examples to interact and discuss with students in various forms, giving full play to the advantages of learning community and improving the quality and effect of online learning.