OBJECTIVE To evaluate the clinical efficacy and safety of XELOX chemotherapy （oxaliplatin+capecitabine） combined with antiangiogenic agent （apatinib） and immunotherapy （camrelizumab） in patients with inoperable metastatic colorectal cancer （CRC）of microsatellite stable （MSS） type. METHODS Clinical medical records of 40 patients with inoperable metastatic CRC of MSS type treated in Lishui People’s Hospital from January 2020 to January 2021 were retrospectively collected. According to the treatment plan， the patients were divided into control group （20 cases） and observation group （20 cases）. Control group was given XELOX+apatinib regimen， while observation group was given XELOX+apatinib+camrelizumab regimen. Every 3 weeks was a treatment cycle， and the treatment lasted for 2 consecutive cycles. The objective response rate （ORR）， disease control rate （DCR）， progression-free survival （PFS）， overall survival （OS） and adverse events （AEs） were recorded for all patients. RESULTS The ORR and DCR of observation group were 65.0% and 85.0%， respectively； and the ORR and DCR of control group were 35.0% and 75.0%， respectively， with no statistical significance between 2 groups （P＞0.05）. The median PFS of observation group and control groups were 16.0 months and 8.0 months， respectively； and the median OS were 19.0 months and 12.5 months， respectively， with statistical significance between 2 groups （P＜0.05）. Each patient in both groups had at least one AEs， and the incidences of reactive skin capillary hyperplasia and hyperthyroidism in observation group （40.0%， 20.0%） were significantly higher than those in control group （both were 0） （P＜0.05）. The incidence of nausea and vomiting in control group （90%） was significantly higher than observation group （10%） （P＜0.05）. There were 14 cases （70.0%） of patients with grade 3 or above AEs in observation group， and only 5 cases （25.0%） in control group， with statistical significance between 2 groups （P＜0.05）. However， no severe AEs that could not be tolerated or fatal occurred in the two groups， which could be alleviated after drug withdrawal or treatment. CONCLUSIONS The efficacy of XELOX chemotherapy combined with apatinib and camrelizumab in inoperable metastatic CRC patients of MSS type is comparable to that of XELOX chemotherapy combined with apatinib， but it has certain advantages in ORR， PFS and OS， and controllable safety.

OBJECTIVE To investigate the incidence of bacteria colonization on lumbar epidural catheter tips in postoperative analgesia patients. METHODS The catheter tips were cultured in 100 patients with ASA grade Ⅰ-Ⅱ undergoing lower extremity osteoarticular operation.Lumbar epidural catheters were placed in the operating room with aseptic technique.Diluted local anesthetic and fentanyl infusions were used for postoperative analgesia.The epidural catheter was removed with aseptic technique and the tips sent for microbiological culture after 3 days. RESULTS From 100 patients,bacteriological examination revealed bacteria colonization in 9(9.0%),mainly Staphylococcus epidermidis(6;66.7%),followed by Enterococcus(1;11.1%),Gram-negative bacilli(1;11.1%),and yeasts(1;11.1%).No patient developd infectious complications. CONCLUSIONS Our results show that the risk of bacteria colonization associated with lumber postoperative analgesia in three days is low.No patient develops local or central nervous infection.Epidural postoperative analgesia can be routinely used without worry of infection in epidural space.But we recommend prophylactic measures should be applied in the high-risk groups.

Objective: To explore the clinical effect of Kangfu Xiaoyan suppository combined with moxifloxacin in the treatment of chronic pelvic inflammatory disease. Methods: From November 2016 to November 2018, a total of 216 patients with chronic pelvic inflammatory disease admitted to the Maternal and Child Health Care Hospital of Lishui were enrolled.The patients were divided into control group and observation group according to the digital table, with 108 cases in each group.The patients in the control group were treated with quinolone antibacterial agent moxifloxacin hydrochloride tablets.The patients in the observation group were treated with Kangfu Xiaoyan suppository and moxifloxacin hydrochloride tablets.The disappearance time of clinical signs, clinical treatment effects and adverse reactions in the two groups after treatment were observed and compared. Results: The disappearance time of fever[(5.15±2.46)h], lower abdominal pain[(7.62±2.77)h], leucorrhea abnormality[(9.16±3.13)h], and pain[(6.38±2.03)h] in the observation group were significantly shorter than those in the control group[(8.09±2.28)h, (10.45±2.68)h, (12.20±2.96)h, (9.49±2.27)h](t=8.231, 7.631, 7.334, 10.613, all P=0.000). The total effective rate of the observation group (93.51%) was significantly higher than that of the control group (86.11%), the difference was statistically significant (χ²=6.983, P=0.008). The overall incidence of adverse reactions of the observation group (3.70%) was significantly lower than that of the control group (11.11%), and the difference was statistically significant (χ²=4.32, P=0.038). Conclusion Compared with the simple use of moxifloxacin, Kangfu Xiaoyan suppository combined with moxifloxacin in the treatment of gynecological chronic pelvic inflammatory disease has a better clinical treatment effect and a lower incidence of adverse reactions.It is recommended to apply in clinical treatment in the future.

Objective: To investigate the reversibility of ischemic core defined by CT perfusion imaging in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis within different time windows and influencing factors. Methods: The data of AIS patients who received intravenous thrombolysis in the Department of Neurology of Lishui People′s Hospital from May 2016 to December 2018 were retrospectively reviewed. All patients had finished multi-model CT imaging before thrombolysis and multi-model MRI examination 24-48 hours after thrombolysis. The baseline ischemic core volume (hypoperfusion area with relative cerebral blood flow (rCBF)<30%) was quantitatively assessed based on CT perfusion images using MIStar software, and the final ischemic core volume was assessed based on diffusion weighted imaging acquired 24-48 hours after thrombolysis. The reversibility of ischemic core was defined as baseline ischemic core volume-the final infarct volume ≥5 ml. Then the clinical and imaging features of the patients between reversible group and irreversible group were compared, and the predictors of ischemic core reversibility were analyzed by binary Logistic regression analysis. Results: Finally, 97 patients were enrolled in the present study, of which 64 (66%) patients achieved successful recanalization, 51 (53%) patients with reversible baseline ischemic core. For patients with recanalization, the incidence of reversibility was 76% (26/34), 71% (17/24), 2/5 and 0 (0/1) in patients with time window from onset to thrombolysis (ONT) <3.0 h, 3.0-4.5 h, 4.6-6.0 h, and >6.0 h, respectively. In the non-recanalization group, six patients were also showed with ischemic core reversibility, including 4 (4/12) in the ONT<3.0 h group and 2 (2/12) in the ONT 3.0-4.5 h group. It was found that the reversible volume was positively correlated with baseline ischemic core volume (r=0.805, P<0.001) by Spearman correlation analysis. Finally, binary Logistic regression analysis revealed that the history of hypertension, ONT and recanalization were independent predictors of reversible changes of baseline ischemic core. Conclusions The ischemic core defined by CT perfusion imaging (rCBF<30%) was considerably inaccurate for patients with ONT<6.0 h. If recanalization could be achieved within this time window, most of the patients would manifest with ischemic core reversibility, the predictors of which also included hypertension history and ONT.

OBJECTIVE To establish an ultra-performance liquid chromatography-tandem mass spectrometry(UHPLC-MS/MS) method for determination and comparison of 26 components in different parts of two base plants of Shiliang tea(Chimonanthus salicifolius S.Y.Hu and Chimonanthus zhejiangensis M.C.Liu), and screen quality markers of different parts. METHODS The UHPLC method was performed on an Agilent RRHD Eclipse Plus C18 (2.1 mm×50 mm, 1.8 μm) column with a gradient elution of methanol and 0.1% formic acid in water at a flow rate of 0.3 mL·min−1, the column temperature was 35 ℃, and the injection volume was 0.5 μL; the multiple reaction monitoring mode was employed for the quantification of 26 components with electrospray ionization(ESI) source polarity in negative and positive mode. RESULTS Good linear relationship(r >0.999) were observed in the test ranges for 26 compounds, and the average recovery was 88.5%−111.7% with RSD was 3.4%−9.8%. There was no significant difference between the two base plants of Shiliang tea, and all of these samples were divided into two categories by hierarchical cluster analysis. The main components in leaves was flavonoids, among them, the content of kaempferol 3-O-rutinoside was the highest, reaching 12.902 mg.g−1; the main components in stems and roots was coumarins, and the content of alkaloids in roots was higher, relatively; 7 quality markers of difference were screened by OPLS-DA, which were kaempferol 3-O-rutinoside, chimonanthine, rutin, fraxetin, calycanthoside, scopolin, neochlorogenic acid. CONCLUSION These study elucidates the differences of chemical components in the different parts of two base plants of Shiliang tea, which providing basis for the research of pharmacodynamic substances and references for the comprehensive utilization of Chimonanthus salicifolius S.Y. Hu and Chimonanthus zhejiangensis M.C.Liu resources.

Objective: To observe the clinical effect of pelvic floor rehabilitation training on patients with pelvic floor dysfunction after delivery through vagina. Methods: From January 2017 to December 2017, 96 patients with pelvic floor dysfunction treated in the Maternal and Child Health Hospital of Lishui were randomly selected for clinical study.The patients were divided into observation group and control group by random number method, with 48 cases in each group.The control group was given pelvic floor dysfunction knowledge education, psychological counseling and general treatment methods such as guiding patients to perform functional exercises.The observation group received pelvic floor rehabilitation training on the basis of the treatment plan of the control group.The symptoms related to pelvic floor dysfunction, pelvic floor contraction ability before and after treatment, pelvic floor function and sexual quality of life were compared between the two groups. Results: The incidence rates of clinical symptoms such as organ prolapse, urinary incontinence, asexuality and sexual intercourse pain in the observation group were 8.33%, 6.25%, 8.33% and 10.42%, respectively, which were significantly lower than those in the control group (25.00%, 27.08%, 22.92% and 27.08%) (χ²=4.800, P=0.028; χ²=7.500, P=0.006; χ²=3.872, P=0.049; χ²=4.376, P=0.036). There was no statistically significant difference between the two groups in grade I-V before treatment(P>0.05). After treatment, there were 2 cases, 4 cases, 8 cases, 18 cases and 17 cases in the observation group with grade I-V, which were significantly better than those in the control group (8 cases, 7 cases, 10 cases, 16 cases and 7 cases), and there was statistically significant difference (χ²=8.102, P=0.044). After treatment, the pelvic floor muscle tension of the observation group was higher than that of the control group[(4.16±0.33)grades vs.(3.84±0.27)grades], the difference was statistically significant(t=5.200, P=0.000). The sexual life quality score of the observation group was (87.33±10.24)points, which was significantly higher than (78.62±8.29)points in the control group(t=4.580, P=0.000). The total effective rate of the observation group was 95.83%, which was significantly higher than that of the control group (83.33%, χ²=4.019, P=0.048). Conclusion Pelvic floor rehabilitation training has good clinical effect on pelvic floor dysfunction after vaginal delivery.It can significantly improve pelvic floor function and sexual life ability, improve pelvic floor muscle tension and reduce visceral prolapse.It has important clinical application value.

In the post-antibiotic era,the overuse of antimicrobials has led to a massive increase in antimicrobial resistance,leaving medical doctors few or no treatment options to fight infections caused by superbugs.The use of bacteriophages is a promising alternative to treat infections,supplementing or possibly even replacing antibiotics.Using phages for therapy is possible,since these bacterial viruses can kill bacteria specifically,causing no harm to the normal flora.However,bacteria have developed a multitude of sophisticated and complex ways to resist infection by phages,including abortive infection and the clustered regularly interspersed short palindromic repeats(CRISPR)/CRISPR-associated(Cas)system.Phages also can evolve and acquire new anti-defense strategies to continue predation.An in-depth exploration of both defense and anti-defense mechanisms would contribute to optimizing phage therapy,while we would also gain novel insights into the microbial world.In this paper,we summarize recent research on bacterial phage resistance and phage anti-defense mechanisms,as well as collaborative win-win systems involving both virus and host.

OBJECTIVETo evaluate the clinical effects of over 5 year follow up of unilateral pedicle screw fixation with transforaminal lumbar interbody fusion(TLIF) in treating lumbar degenerative diseases.

METHODSThe clinical data of 24 patients with lumbar degenerative disease underwent unilateral pedicle screw fixation with transforaminal lumbar interbody fusion from March 2007 to October 2009, were retrospectively analyzed. There were 13 males and 11 females, aged from 34 to 68 years old with an average of 52 years. Postoperative pain and functional results were analyzed by the visual analogue scale(VAS) and Oswestry Disability Index(ODI). Radiological examination was obtained for each patient to assess the height of intervertebral space, postoperative intervertebral fusion conditions and general complications.

RESULTSAll patients were followed up from 5 to 8 years with an average of 6.7 years. VAS scores of low back pain and leg pain decreased from preoperative 7.82±0.71, 8.42±1.24 to postoperative 1.87±0.81, 2.23±1.62, respectively(<0.05). ODI decreased from preoperative(53.42±8.26)% to postoperative(12.45±7.67)%(<0.05). Postoperative intervertebral space height in different segments were improved than preoperative(<0.05), but in final follow up it was decreased than 3 months after operation(<0.05). There was no significant difference in the postoperative intervertebral space height between the operated side and non operated side. But at final follow up, the intervertebral space height of non operated side was obviously loss. At final follow up, the fusion rate was 95.8%. The incidence of adjacent segment degeneration was 45.8%. The paraspinal muscle fibrosis incidence was 8.3%. No complications such as secondary scoliosis, intervertebral height loss, cage slippage, screw loosening and internal fixation breakage were found.

CONCLUSIONSUnilateral pedicle screw fixation with TLIF is a satisfactory method and can obtain good effects in treating lumbar degenerative diseases according to over 5 year follow up, however, its indications should be well considered. But the problems such as intervertebral space height of operated side loss and adjacent segment degeneration after unilateral pedicle screw fixation need further clinical study.

OBJECTIVETo investigate the clinical characteristics of Segond fracture and its operative method and opportunity.

METHODSFrom June 2008 to December 2011, arthroscopic exploration was performed in 16 patients with Segond fracture. Six patients were explored at 1 week after injury ,their anterior cruciate ligament were broken completely combined with meniscus injury. Ten patients were explored at 8-10 weeks after injury, 4 patients with anterior and posterior cruciate ligament breakage completely, 4 patients with anterior cruciate ligament breakage completely,and 2 patients with anterior cruciate ligament breakage incompletely,among 10 cases, 8 cases of anterior cruciate ligament breakage completely combined with meniscus injury, 1 case of anterior cruciate ligament breakage incompletely without obviously meniscus injury, 1 case combined with fibular head fracture and lateral collateral ligament injury. All broken cruciate ligaments were rebuilt after arthroscopic exploration and meniscus injuries were sutured in 5 cases. Clinical effects were evaluated according to Lysholm-Gillquist scoring of knee joint function.

RESULTSSix patients were operated at 1 week after injury,their knee joint swelled obviously at 3 days after operation,unloaded blood oozing by joint puncture,and out-of-bed activity with assistance at the I week after operation. Other 10 patients were operated at 8-10 weeks after injury,no knee joint obviously swelled,no blood oozing was found by joint puncture ,and out-of-bed activity with assistance at 3 days after operation. All patients were followed up from 12 to 50 months with an average of 24 months. Postoperative Lysholm-Gillquist scoring of all patients were higher than preoperative and recovered well.

CONCLUSIONSegond fractures often associated with anterior cruciate ligament breakage and meniscus injury,it is important that early detection for treatment. The best time of cruciate ligament rebuilding and meniscus repairing may be at 8-10 weeks after injury.

Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Humans ; Male ; Menisci, Tibial ; surgery ; Middle Aged ; Tibial Fractures ; diagnosis ; surgery ; Tibial Meniscus Injuries

Objective: To explore the application value of B-ultrasound examination in gynecological acute abdomen. Methods: From October 2015 to October 2017, 150 patients with suspected gynecological acute abdomen were selected in the People's Hospital of Lishui.The effect of B-ultrasound examination in diagnosis of gynecological acute abdomen was analyzed. Results: The sensitivity, specificity and total accuracy of abdominal ultrasound in the diagnosis of gynecological acute abdomen were 75.00%(99/132), 44.44%(8/18) and 71.33%(107/150), respectively.The sensitivity, specificity and total accuracy of transvaginal ultrasound in the diagnosis of gynecological acute abdomen were 87.12%(115/132), 72.22%(13/18) and 85.33%(128/150), respectively.The sensitivity, specificity and total accuracy of abdominal combined with transvaginal ultrasonography in the diagnosis of gynecological acute abdomen were 98.48%(130/132), 94.44%(17/18) and 98.00%(147/150), respectively.The sensitivity, specificity and total accuracy of abdominal combined with transvaginal ultrasound in the diagnosis of gynecological acute abdomen were significantly higher than those of abdominal ultrasound and transvaginal ultrasound(χ²=8.658, 10.699, 9.075, all P<0.05). The diagnosis of acute pelvic inflammation, ectopic pregnancy, rupture of luteal cyst and torsion of ovarian cyst by abdominal combined with transvaginal ultrasound was better than abdominal ultrasound(χ²=13.748, 5.984, 13.524, 6.874, all P<0.05). Conclusion Abdominal ultrasound and transvaginal ultrasound can be used to diagnose gynecological acute abdomen.However, abdominal combined with vaginal ultrasound is more effective in the diagnosis of gynecological acute abdomen, and it can effectively improve the accuracy of diagnosis.