This study was designed to establish methods to measure partition coefficients of inhaled anesthetics at 1 atmosphere and 37 C by using syringe-flask double equilibration technique. Olive oil/gas (O/G), saline/gas (S/G), and water/gas (W/G) partition coefficients of isoflurane were 90.20?2.01, 0.6256?0.109, and 0. 741?0.025, respectively. Even though O/G was 150 folds of S/G,coefficients of variation for both O/G and S/G were less than 3%. The results indicate that the established double-equilibration technique has a very high repeatability and is applicable to wide ranges of inhaled anesthetics' solubilities.

Objective:To evaluate the treatment strategy of primary shortening plus secondary lengthening for Gustilo ⅢC open fractures in the lower limb.Methods:From January 2010 to January 2018, 12 patients (8 males and 4 females) with complex Gustilo ⅢC open fracture in the lower limb received emergency treatment at Department of Orthopaedic Surgery, Wuhan Fourth Hospital. Their ages ranged from 22 to 67 years (average, 41.2 years). All patients were complicated with bone and soft tissue defects associated with nerve and vascular injury in the lower limb. The sizes of soft tissue defects ranged from 4 cm × 2 cm to 17 cm × 12 cm; the main arteries were shortened after debridement by an average of 4.2 cm (from 1.2 cm to 8.3 cm); the broken nerves were shortened after debridement by an average of 4.0 cm (from 1.0 cm to 8.1 cm); the tibial shaft defects averaged 6.3 cm in length (from 2.0 to 9.6 cm). All cases were treated at the first stage by emergency debridement and shortening at the fracture site to directly repair the damaged bone, blood vessels and nerves before the wound was covered. After the limb survived and the wound completely healed, an Ilizarov external fixator was installed to lengthen the limb by bone transport. Recorded were speed of bone lengthening, time with external fixation and complications. The lower limb functions were evaluated at the last follow-up by Paley criteria.Results:The 12 patients were followed up for 14 to 32 months (average, 19.1 months). All the limbs survived with no serious infection. The shortening ranged from 2.0 to 8.2 cm (average, 3.6 cm); the mean speed of bone transport was 0.87 mm/day; the time with external fixation ranged from 11 to 16 months (average, 13.2 months); the bony union was achieved after 10 to 14 months (average, 11.2 months). Postoperative horseshoe inversion was reported in 7 patients, and needle tract infection below Dahl grade 3 in 2 cases. According to Paley criteria, the function of lower limb was rated as excellent in 8 cases, as good in 3 cases, and as fair in one.Conclusion:The treatment strategy of primary shortening plus secondary lengthening using Ilizarov technique has lowered the risk for limb salvage and the surgical difficulty, leading to fine clinical outcomes.

Objective:To evaluate the efficacy of arthroscopic minimally invasive reduction in the treatment of talus posterior process fractures.Methods:The clinical data were retrospectively studied of the 42 patients with talus posterior process fracture who had been admitted to Department of Orthopedics, The Fourth Hospital of Wuhan from January 2010 to June 2021. There were 25 males and 17 females, aged from 21 to 60 years (average, 40.5 years). They were assigned into 2 groups according to their different treatments. In the arthroscopic group of 15 cases, arthroscopic reduction and internal fixation (ARIF) were conducted via the posteromedial and posterolateral approaches; in the open reduction group of 27 cases, open reduction and internal fixation (ORIF) were conducted via the posteromedial para-Achilles approach. The 2 groups were compared in terms of operation time, blood loss, hospital stay, fracture clinical healing time, postoperative complications, and the American Society for Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at one year postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P> 0.05). The arthroscopic group incurred significantly less blood loss [(32.0±11.5) mL], hospital stay [(5.3±1.8) d], and fracture clinical healing time [(4.6±1.0) months], and a significantly lower incidence of postoperative complications [20.0% (3/15)] than the open reduction group did [(80.0±15.2) mL, (8.4±2.4) d, (6.3±2.2) months, and 29.6% (8/27)], but significantly longer operation time [(74.0±8.9) min] than the open reduction group [(62.9±5.1) min] ( P<0.05). The AOFAS ankle-hindfoot scores at one year postoperation in both groups were higher than those before operation. The AOFAS ankle-hindfoot scores in the arthroscopic group [(83.0±13.0) points] were significantly higher than those in the open reduction group [(72.3±16.0) points] ( P<0.05). Conclusion:ARIF is a preferred minimally invasive treatment for talus posterior process fractures, because it leads to a smaller incision, less blood loss, shorter hospital stay, quicker clinical healing, a lower incidence of postoperative complications, and better functional improvement of the ankle and hindfoot than ORIF.

Objective To summarize risk factors for clinical outcomes in heart transplantation patients, evaluate the characters of Chinese patients by comparing with international data, and introduce new clinical strategies. Methods We performed 200 heart transplantations from Jun. 2004 to May 2010. The clinical information was recorded and all patients were followed up. By analyzing 160 patients with a follow-up period of more than one year, we summarized clinical outcomes and risk factors of early and late results of heart transplant patients. Results Of 160 patients, 8. 1 % received postoperative extracorporeal membrane oxygenation (ECMO) support and 10% continuous renal replacement therapy. In 550 cases/times of endomyocardial biopsies, the incidence of rejection with grades more than Ⅱ (concluding grade Ⅱ ) was 14. 9%. In-hospital mortality was 3. 8%. Smoking,preoperative diastolic pulmonary arterial pressure, PAWP, total serum protein level and albumin level were risk factors of peri-operative mortality, and preoperative diastolic pulmonary arterial pressure,primary heart diseases, pulmonary hypertension and implantations of ICD, MCS and ECMO were risk factors of late mortality. Postoperatively, 1-, 3- and 5-year survival rate was 94. 4%, 91.9% and 88. 8%, respectively. Compared with UNOS data, the rate of primary heart diseases, pulmonary hypertension, and implantation of ICD, MCS and ECMO were different, and the long-term survival rate of 160 patients was higher than that reported by ISHLT. Conclusion The risk factors of mortality of Chinese heart transplant patients are different with their counterparts from western countries. Our corresponding peri-operative treatments and clinical strategies have produced satisfactory clinical outcomes.

Objective:To explore the clinical efficacy of microsurgery combined with Ilizarov technique in the treatment of Gustilo ⅢC open tibiofibular fractures.Methods:From January 2014 to December 2016, 20 patients with Gustilo ⅢC open tibiofibular fracture were treated at Department of Hand Surgery 2, Repair and Reconstruction, Wuhan NO. 4 Hospital, Wuhan Puai Hospital. They were 13 men and 7 women, aged from 36 to 56 years (average, 42.6 years). The time from injury to operation ranged from 2 to 6 hours (average, 4.3 hours). The defects were at the proximal bone in 6 cases, at the middle bone in 9 cases and at the distal bone in 5 cases. The area of soft tissue defect ranged from 10 cm×6 cm to 12 cm×9 cm, and the lengths of bone defects averaged 10.3 cm. Microsurgery was conducted at the first stage to repair blood vessels and nerves and to reconstruct blood circulation, and an Ilizarov circular external fixator was installed at the second stage to repair bone and soft tissue defects by two-way bone transport. Bone transport time, wound healing time, bone transport distance, external fixation time, external fixation index, solidification time for the extended area and complications were recorded after operation. The curative efficacy was evaluated by Palay evaluation.Results:All patients were followed up for 12 to 30 months (average, 24 months). After the bone and soft tissue defects were well repaired, all the patients returned to daily life. The time from bone transport to apposition of fracture ends ranged from 50 to 160 days, averaging 75.8 days; the wound healing time ranged from 60 to 150 days, averaging 100.6 days; the bone transport distance ranged from 8 to 13 cm, averaging 10.3 cm; the external fixation time ranged from 12 to 20 months, averaging 14.0 months; the external fixation index was 1.6 months/cm; the solidification time for the extended area ranged from 5 to 16 months, averaging 10.9 months. No infection, malunion or re-fracture was observed; postoperative axis deviation was observed in 2 cases and ankle stiffness in 3 cases. According to the Palay evaluation, 5 cases were excellent, 12 cases good, and 3 cases fair.Conclusion:As microsurgery combined with Ilizarov technique can treat Gustilo ⅢC open tibiofibular fractures effectively by reconstructing limb blood circulation, it is worthy of clinical promotion.

OBJECTIVE To systematically analyze the status of health economic evaluation studies of influenza vaccination in Guangdong-Hong Kong-Macao Greater Bay Area （GBA） of China， and to provide a methodological reference for future scholars to carry out economic evaluations of influenza vaccine in GBA. METHODS Seven English databases such as PubMed and Embase and three Chinese databases such as CNKI and Wanfang database were searched. The economic evaluation studies of influenza vaccines with the study area of GBA were collected. The search time frame was from the inception to June 30， 2022. After screening the literature and extracting key information， descriptive analysis was conducted on the study design， evaluation methods， model settings， results and conclusions of these collected papers， and the quality of the papers was evaluated using Quality of Health Economic Studies. RESULTS A total of 12 papers were included， of which 7 had a study region of Hong Kong in China， 6 had an older target group， 5 had a society-wide perspective， and the study time frame ranged from 6 months to 9 years. Besides， 8 papers used cost-utility analysis， only 2 used an epidemic model； 8 papers conducted sensitivity analyses， and most of them conducted both one-way sensitivity analysis and probabilistic sensitivity analysis. Moreover， the results of the economic evaluation of 10 papers showed that （combined） vaccination or increased vaccination rates were more economical. In addition， 4 of the 12 papers had a quality score＞75， which were considered high-quality studies. CONCLUSIONS Although most of the included studies showed that vaccination was economical， the quality of the existing paper needed to be improved. It is recommended that subsequent studies on the economic evaluation of influenza vaccines in GBA may consider adding economic evaluations for Macau and other cities in Guangdong of China， prioritizing dynamic models and recent data from local residents， and referring to relevant tools and guidelines to improve thestandardization and scientificity of the study design.

Objective: To explore the role of miR-30b in the trigeminal ganglion( TG) of trigeminal neuralgia( TN) model rats. Methods: An infraorbital nerve-chronic constriction injury( ION-CCI) model of TN was produced in the rat. Von Frey hair was used to determine the time-course of changes in mechanical pain threshold.qRT-PCR and Western blot were used to detect the expression of miR-30b and activating transcription factor 3( ATF3) in the TG. In addition,miR-30b agomir and agomir NC were injected into ION-CCI rats by the infraorbital foramen injection. The mechanical pain threshold and the expression changes of ATF3 were determined after intervention. Results: Compared with the sham-operated group,the ION-CCI group had a decreased mechanical pain threshold 2 days after surgery,reached the lowest observed level by day 12,and this threshold reduction lasted more than 28 days( P<0. 05). Compared with the sham-operated group,the ION-CCI group had a lower miR-30b expression and a higher ATF3 expression in postoperative TG( P<0. 05). After the overexpression of miR-30b in ION-CCI group,the mechanical pain threshold increased,and the expression of ATF3 decreased in TG( P<0. 05). Conclusion These results suggest that miR-30b may participate in the regulation of TN. miR-30b may be a potential therapeutic target for TN.