Objective To explore the operative therapy of young and middle-age patients with femoral collum fracture to improve the therapeatic efficacy. Methods 25 cases of femoral collum fracture were treated with opening and internal fixation, and circumflex iliac vascular pedicle bone graft of ilium with monitoring skin flap. After operation, The blood supply of femoral collum was observed by the monitoring skin flap. Results The blood supply of the monitoring skin flap in 23 cases was good, and in 2 cases the monitoring skin flap's color chang indicated that the crisis occurred in the circulation of the grafted bone. The grated bone recovered the blood supply through removing thrombosis by operation. All the patients were cured early, and no femoral head nercosis occured. Conclusion The transplantation of iliac lamella of circumflex ilium profound artery with monitoring skin flap for the treatment of femoral collum fracture could monitor the blood supply of femoral head, improve the fracture healing, and decrease the incidence of femoral head necrosis.

Drug-resistant tuberculosis (DR-TB) has been a serious global public health problem. There is an urgent need in new drug development for drug-resistant Mycobacterium tuberculosis (MTB). Bedaquiline (Bdq) is a new antituberculous drug belonging to the diarylquinoline class that efficiently inhibits the adenosine triphosphate synthase enzyme of MTB, now is one of the core drugs for the treatment of DR-TB. Bdq can significantly improve the negative rate of sputum culture and reduce the mortality with good safety and tolerance, and it can also shorten the course of treatment for patients with tuberculosis and save costs. This article reviews the efficacy, safety, tolerability and treatment-related issues of Bdq-containing regimens for DR-TB.

Tuberculous meningitis is the most common and serious type of central nervous system tuberculosis, with high mortality and disability rate, which has attracted extensive attention of global public health. The high mortality rate and disability rate of tuberculosis meningitis may be related to its lack of specific clinical and imaging characteristics, insufficient attention from clinicians, lack of early sensitive and specific diagnostic testing techniques, delay in treatment, and restricted penetration of anti-TB drugs into the blood-brain barrier or/and MDR-TB, etc. This article reviews the disease burden of TBM, chemotherapy drugs and regimens, anti-inflammatory agents, aspirin, interventional and surgical treatment to provide reference for clinical management of this disease.

The global trends of nontuberculous mycobacteria (NTM) infection and disease are both rising. Nontuberculous mycobacterial disease(NTMD) is a worldwide health burden associated with increasing morbidity, mortality, and economic costs. Antibiotic therapy is the mainstay of treatment for NTMD.Mycobacterial pathogens are intrinsically resistant to many available antibiotics, making treatment extremely challenging, especially in immunocompromised individuals and patients with underlying chronic lung conditions. Even with lengthy therapy and the use of a combination of antibiotics, only less than half NTMD patients can achieve clinical treatment success, so it is urgent to develop novel anti-NTM antibiotics. This article reviews the research progress on the medication of nontuberculous mycobacterial diseases.

Objective:To investigate the intervention effect of decision aid on the fear of falling in elderly patients after total hip arthroplasty.Methods:This study was a quasi experimental research. From June 2021 to November 2021, 84 patients after total hip arthroplasty who were admitted to the Department of Orthopedics of Zhengzhou Central Hospital Affiliated to Zhengzhou University were selected as the research objects. According to the order of admission, they were divided into the control group (42 cases, 2 cases fell off ) and the observation group (42 cases). The control group was given routine nursing care and guidance for fear of falling, while the observation group was given a decision-making aid intervention program on the basis of the control group. The time to first getting out of bed, the scores of Modified Falls Efficacy Scale (MFES), Generalized Anxiety Disorder (GAD-7) and Harris Hip Score (HHS) were compared between two groups.Results:The time to get out of bed for the first time in the observation group was (42.71 ± 6.41) h, lower than that in the control group (49.95 ± 5.73) h, and the difference was statistically significant ( t=5.38, P<0.05). Twelve weeks after discharge, the GAD-7 score in the observation group was (4.64 ± 1.43), which was lower than that of the control group (6.85 ± 1.83), and the difference was statistically significant ( t=6.10, P<0.05). The score of the MFES in the observation group was [8.50(8.00,10.00)], which was higher than that in the control group [7.50(7.00,8.00)], and the difference was statistically significant ( Z=-6.26, P<0.05). The hip joint function score of the observation group was (81.74 ± 4.24), which was higher than that of the control group (74.30 ± 4.51), and the difference was statistically significant ( t=7.69, P<0.05). Conclusions:Decision support can advance the time of downward movement of elderly patients after total hip arthroplasty, reduce their anxiety and fear of falling, and improve hip function.

Objective: To investigate the feasibility of one-step coronary and carotid-cerebrovascular computed tomography angiography (CTA) using high-pitch Double Turbo Flash mode and to analyze the image quality and radiation dose in patients with heart rate variability using multi-slice detector dual-source CT. Methods: A total of 79 patients with heart rate variability higher than 3 beat/min (bpm) were retrospectively analyzed. They were grouped by the scanning methods. Group A (n=40) were performed double turbo flash mode for one-step coronary and carotid-cerebrovascular arteriesinjected with one injection of contrast agent.further divided into Single A (only the phase 1 image)and Double A(combined images of phases 1 and 2). Group B (n=39) were performed separately with twice injection of contrast agent. Subjective scoring was performed on the image quality of the group Single A, Double A and B using a 4-point. Then the objective parameters of image quality, CT attenuations, image noise, signal-to-noise (SNR), and contrast-to-noise (CNR), were evaluated. Then subjective scores, objective evaluation indicators, and radiation dose were compared with one-way ANOVA analysis among the three groups.Contrast agent were compared by using t test in group A and B. Results: No significant difference was found (F=2.093, P=0.128) for the subjective scores of the head and neck CTA among the three groups with (3.47±0.51), (3.53±0.51), (3.69±0.47). Significant difference was found (F=50.955, P<0.01) for the subjective scores of coronary CTA among the three groups with (2.70±0.76), (3.35±0.66), (3.58±0.50), and there was no statistically significant difference between Double A and B groups (P=0.104), met the requirements for diagnosis. The objective evaluation of the three groups compared the head and neck CTA images were statistically significant (P<0.05), of which the difference between the Single A and the Double A was not statistically significant (P>0.05), met the requirements for diagnosis; the differences in SNR and CNR of coronary CTA images are statistically significant (F=12.991, 12.236, P<0.01), and there was no statistically significant difference between Double A and B (P>0.05), met the requirements for diagnosis. Radiation dose in the group Double A was lower than group B (decreased by 46.15%,P<0.01).The amount of the contrast agent in the group Double A was lower than group B (decreased by 44.13%, t=-45.455;P<0.01). Conclusion The double turbo flash mode is feasibility for one-step coronary and carotid-cerebrovascular CTA in patients with the heart rate variability using multi-slice dual-source CT.This scan mode can maintain the diagnostic image quality with low contrast agent and radiation dose.