Objective To explore the feasibility and safety of systemic chemotherapy concurrent whole brain radiotherapy (WBRT) for non-small cell lung cancer (NSCLC) with brain metastases.Methods Eighty cases of NSCLC patients with brain metastases were divided into observation group (40 cases) and the control group (40 cases) according to random number table.Patients were given systemic chemotherapy synchronous WBRT or sequential WBRT.Results The Ⅰ-Ⅳ degree leukocytopenia incidences of the two groups were 12.5％,25.0％,25.0％,0.0 and 30.0％,25.0％,12.5％,15.0％,and there was statistical significance (x2 =12.12,P ＜ 0.05).In the observation group,the total remission rate was 20％ (8/40),and it was 22.5％ (9/40) in the control group,with no significant difference (x2 =1.79,P ＞ 0.05).The median progression free survival of the observation group and of the control group were (3.5 ± 2.3) months and (3.6 ±1.1) months,respec-tively,with no significant difference (t =5.23,P ＞ 0.05).But the 1-years survival rate in the observation group was 37.5％ (15/40),significantly higher than that in the control group (17.5％,7/40),which had statistical significance (x2 =9.11,P ＜ 0.05).Conclusion The safety of systemic chemotherapy synchronous WBRT for NSCLC patients with brain metastases is higher,with good curative effect and strong application feasibility.

Objective To explore protective effects of curcumin on lung injury in the early hepatic ischemia/reperfsion (reperfusion for 1 and 3 hour) inrats. Methods Wistarratswererandom]y divided into the fo]]owinggroups: GroupA (shamoperation), group B (control group) and group C (cureumin applied). Contents of superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), myeloperoxidase (MPO) in lung tissues were determined to evaluate the protective effect of eurcumin on lung injury in the injury of isehemia/ reperfusion. Results Curcumin relieved edema of diaphragmatic wall and exudation of blood cell and white cell in pulmonary alveoli. Curcumin increased the contents of SOD, CAT and decreased contents of MDA, MPO in lung tissue. Conclusion By repressing the generation of oxygen free radical and infiltration of polymorphonuclear leukocyte in lung tissue, curcumin can relieve lung injury in the early hepatic ischemia/repeffusion.

Objective To evaluate the long-term efficacy of vascularized pisiform transfer for patients with Kienb(o)ck's disease in Lichtman stages Ⅲ-Ⅳ. Methods Eleven patients were reviewed to analyze results after lunate resection and vascularized pisiform transfer for Lichtman stages Ⅲ and Ⅳ. There were six men and five women. Age ranged from 20 to 67 years with a average of 41.0±14.3 years. According to Lichtman stage. There were 4 cases in stage Ⅲa, 5 cases in stage Ⅲb, and 2 cases in stage Ⅳ. Assessment criteria included subjective assessment of pain, visual analogue scale (VAS), range of motion (ROM), grip power,Cooney wrist score and radiographic changes on each follow-up visit. The radiographic changes including pis iform bone location, shape, sclerosis change, osteoarthritis, carpal height ratio, Nattrass index, Radioscaphoid angle and ulnar variance were recorded. Results The follow-up periods of all of cases were 61-202 months,with an average of 104.1 months. Pain had improved in 10 patients and disappeared in 7 cases. The VAS score was 2.2±1.9 at follow-up visit. Range of motion of injured wristw as only 65.3% of opposite side. Grip power was 84.3% of the contralateral hand. According to Cooney score, the results were excellent in 1 case, good in 7cases, fair in 2 cases and poor in 1 case, with the excellent and good rate of 72.7%. Radiologically, 8 cases had normal position of the pisiform bone, 2 had volar displacement and 1 had ulnar displacement which leaded to widen scaphopisiform space. Six pisiform bones had normal trabecular structure, three had degenerative changes. Bone sclerosis was seen in 2 cases and osteoarthritis was found in 3 patients. Compared with radiographic parameter before surgery, carpal height ratio and Nattrass index significantly lowered and radioscaphoid angle significantly increased. Conclusion Lunate resection and vascularized pisiform transfer is an effective method for Kienb(o)k′s disease in stages Ⅲ-Ⅳ. Although carpal collapse appeared postoperatively,the results show high patient satisfaction and good function after vascularized bone transplantation.

Objective:To analyze the clinical phenotype and genetic basis of a Chinese pedigree affected with Otopalatodigital syndrome type 1 (OPD1).Methods:A pedigree which was evaluated at the Department of Endocrinology, General Hospital of the Central Theater Command on December 3, 2020 was selected as the study subject. Clinical phenotype and genetic features of the proband were analyzed. Whole exome sequencing was employed to screen for genetic variants in the proband, and Sanger sequencing was used to verify the candidate variants in the proband′s mother, uncle, maternal aunt, and paternal aunt. Pathogenicity analysis was also conducted for the candidate variants.Results:The proband, a 16-year-old male, had shown distinctive facial features including mildly prominent eyebrows, down-slanting palpebral fissures, hypertelorism, and depressed nasal bridge. Additionally, he had clubbing of bilateral thumbs and big toes, and central type diabetes insipidus. Genetic sequencing revealed that he has harbored a heterozygous c. 586C>T (p.R196W) missense variant of the FLNA gene (NM_001110556.2), which was also carried by his mother and uncle. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), this variant was classified as likely pathogenic (PM1+ PM2_Supporting+ PP2+ PP3+ PS4 Supporting). Conclusion:The heterozygous c. 586C>T (p.R196W) variant of the FLNA gene probably underlay the pathogenesis in this OPD1 family. The central type diabetes insipidus in the proband may represent a newly discovered phenotype of OPD1. Above finding has contributed crucial information for the comprehensive understanding of the clinical manifestations and pathogenic mechanisms of OPD1.

Objective To investigate the clinical characteristics and therapeutic methods of bac-terial colonization and infection of Acinetobacter baumannii on the wound of earthquake induced patients. Methods A retrospective study was done on 42 Wenehuan earthquake induced patients with positive wound germiculture of Acinetobacter baumannii. There were 24 males and 18 females, at mean age of 37 years (12-96 years). Open injury was located at the upper arm in one patient, at the forearm in four, at the thigh in 12, at the calf in 23 and at the trunk in two. The time between injury and treatment varied from 3 to 7 days. The clinical characteristics including the bacteria identification and drug sensitivity test were studied to compare drug resistance to 15 antibiotics. Results Bacterial colonization of Acineto-bacter baumannii was found in 31 patients (8.2%) and infection of Acinetobacter baumannii in 11 (2.9%). After debridement, pruphylactic antibiotics and nutrition support, 15 patients with bacterial colonization were managed with Ⅱ stage suture or skin grafting. The other 16 patients were transferred to hospitals of other provinces after germiculture turned negative. Through debridement and drainage, antibi-otic therapy and nutrition support, the infection was controlled and the wound eliminated in six patients through Ⅱ stage suture but four were concomitant with pulmonary infection and one with septicemia. Drug sensitivity test showed that sensitive rate to imipenem, amikacin, levofloxacin, ticarcillin-clavulanic acid, tobramycin were 59.5%, 21.4%, 21.4%, 19.5% and 19.0% respectively. Conclusions The risk factors of infection of Acinetobacter baumannii include severe tissue trauma, severe wound contamination, delayed treatment and weak body resistance. During treatment, the bacterial colonization and infection of Acinetobacter baumannii should be distinguished and treated respectively. Correct wound treatment, suit-able antibiotic therapy and increased body resistance are key to improvement of clinical curative effect.

Objective To understand the awareness of the emergency physicians for thrombolytic thera-py recommended by ST-segment elevation myocardial infarction(STEMI)guidelines and implementation sit-uation,and to analyze the related influencing factors.Methods Relying on Chengdu Emergency Quality Con-trol Center,the questionnaires were distributed to the hospitals of expert group members and the hospitals of the medical union from April to July 2023 to investigate the awareness,implementation status and training status of the emergency doctors in Chengdu area on the STEMI thrombolytic therapy.The causes affecting thrombolysis decision-making were analyzed.Results A total of 137 hospitals participated in the survey.Whether the treatment system and type of chest pain,chest pain center,percutaneous coronary intervention(PCI)qualified hospitals or departments carrying out the training and hospital grade were correlated to whether STEMI patients were thrombolyzed within 12 h before transport(P＜0.05).Whether the PCI quali-fied hospital,chest pain center,chest pain treatment system and type,carrying training,hospital grade,geo-graphical location,transport duration,and thrombolytic indication understanding situation were not related to whether thrombolytic therapy was recommended for the duration from the first medical contact(FMC)to PCI(FMC-PCI)≥120 min(P＞0.05).The multivariate logistic regression analysis showed that whether the de-partment carrying out the training was an influential factor for whether thrombolytic therapy was carried out within 12 h before transport in STEMI onset(P＜0.05).The hospital grade was a influencing factor for whether thrombolysis in non-chest pain treatment system was carried before transport within 12 h of the onset of STEMI.The main reason for STEMI patients being directly transfered treatment without thrombolysis within 12 h of onset was because they knew that thrombolysis was needed but did not know how to do it(50.00％).The awareness rate of thrombolytic indication in non-main urban area was higher than that in main urban area(P＜0.05).The carrying out department training rate of PCI qualified hospitals was higher than that of non-PCI qualified hospitals(P＜0.05).The receiving superior hospital training rate also had difference among different hospital grades and geographical locations.Conclusion Conducting the thrombolysis training and enhancing the learning of treatment processes directly affect the emergency physicians'choice of reperfu-sion strategies for the patients with STEMI.Continuous promotion of the construction of chest pain center or chest pain treatment unit could further increase the early reperfusion rate of STEMI.

BACKGROUND:Digital three-dimensional reconstruction technology is gradually applied to orthopedic diseases with the advantages of visualization,accuracy and non-invasiveness,but there is less evidence-based support for its use in artificial hip hemiarthroplasty for intertrochanteric fractures of the femur in the elderly. OBJECTIVE:To investigate the application value and economic effects of digital three-dimensional reconstruction techniques in artificial hip hemiarthroplasty of intertrochanteric fractures of the femur in the elderly. METHODS:One hundred and thirty elderly patients with intertrochanteric femur fractures admitted to Zunyi First People's Hospital from January 2019 to December 2022 were selected and randomly divided into a control group(n=65)and an observation group(n=65).Artificial hip hemiarthroplasty was performed in both groups.The control group adopted the film template measurement method for manual preoperative planning while the observation group adopted a digital three-dimensional reconstruction technique.Preoperative planning and intraoperative actual application of prosthesis compliance rate,fibrinogen,D-dimer,bilateral femoral eccentric distance difference,bilateral lower limb length difference,Harris hip function score,visual analog scale score,excellent and good rate of hip function,complications,and hospitalization cost were observed in both groups. RESULTS AND CONCLUSION:(1)The proportion of acetabular side and femoral side prosthesis in grade 0(fully compliant)was higher in the observation group than that in the control group(P<0.05).(2)Fibrinogen and D-dimer levels in the observation group were lower than those in the control group 3 days after surgery(P<0.05).(3)The difference in bilateral femoral eccentric distance and the difference in bilateral lower limb length in the observation group were smaller than those in the control group immediately after surgery(P<0.05).The differences in Harris and visual analog scale scores were not significantly different between the two groups preoperatively,6 and 12 months postoperatively(P>0.05).There was no significant difference in excellent and good rate of hip function between the two groups 12 months postoperatively(P>0.05).(4)There was no significant difference in the complication rate between the two groups(P>0.05).The hospitalization cost of the observation group was higher than that of the control group(P<0.05).(5)It is indicated that digital three-dimensional reconstruction technology applied in artificial hip hemiarthroplasty of intertrochanteric femoral fracture in the elderly can not only accurately determine the prosthesis type before surgery,but also accurately reconstruct the bilateral lower limbs offline,but its hospitalization cost is high.

Objective To analyze the statistical behavior of plantar pressure distribution, extract the characteristics of foot movement, and provide references for application of gait recognition in medical clinical diagnosis, rehabilitation training and public health. Methods The collected foot pressure data were prepossessed, statistical analysis on the data was performed, the footprint reconstruction was realized, and the pressure distribution rates of the footprints, segmented regions and each region were compared and analyzed, so as to decompose the foot motion characteristics. Results Based on the cross point of pressure peak curve in different regions, the plantar region was divided into toe region, metatarsal region, arch region and heel region, which could accurately extract the foot movement characteristics. Conclusions The peak plantar pressure is used to extract the characteristics of foot movement, which is divided into landing stage, whole foot contact stage, heel tiptoe stage and ground off stage.