In the era of precision medicine,liquid chromatography-mass spectrometry(LC-MS)will continue to have significant impact on laboratory medicine in spite of the inherent challenges posed by the technology.It seeks to explain what is clinical mass spectrometry,and describes its basic framework and life cycle.It concludeds the key points of clinical LC-MS through the practical experiences of CLSI guideline and Cleveland health care clinical mass spectrometry laboratory.It then illustrates the challenges of appropriately applying LC-MS to clinical diagnostics through comparisons with research based LC-MS utilizations. Furthermore,It attempts to elucidate the challenges and endeavors It has made toward implementing clinical LC-MS in China.Finally,It discusses the prospective future of LC-MS in clinical diagnostics.

Objective To analyze the causes of the complications in the treatment of limb deformities with the Ilizarov technique and to discuss the management and prevention of these complications.Methods From January 2000 to October 2010,846 patients with limb deformities (16 upper limbs and 830 lower limbs) who had been treated with Ilizarov technique were retrospectively analyzed,including 508 males and 338 females with an average age of 25.7 years (range,1.2-72).Statistical analysis was used to compare the type,severity,treatment methods and results of complications.Results Postoperative follow-up lasted for 6 to 30 months,with an average of 18 months.There were 81 cases of pin tract infections,36 cases of restricted joint movements,6 cases of skin thermal damage,7 cases of nerves and vessels injury,8 cases of bone delayed union,2 cases of osteofascial compartment syndrome,7 cases of dislocation,5 cases of fixed needle breakage,8 cases of secondary joint deformities,5 cases of serious osteoporosis,6 cases of skin eruption,4 cases of femoral fractures near to proximal external fixator,3 cases of subsequent fracture after external fixator dismantled,11 cases of deformity recurrence and 1 case of the others.Combining with anti-infection,functional training,physiotherapy,and the second operation therapy and so on,a permanent disability was finally left in 13 patients.Conclusion If the Ilizarov technique was used improperly,there would be multiple complications during the preoperative preparation,surgical procedures and postoperative management.Effective preventive measures should be taken,such as following the principle of the Ilizarov technique,standardizing operation procedures,strictly postoperative observation,correcting postoperative rehabilitation exercise guidance,regular follow-up radiography and postoperative adaptability dynamic adjustment of the external technique.

30? in 2 cases. All these patients were treated using orthosis. CONCLUSION: Based on Ilizarov’s technique and principle, the individualized designed external distraction apparatuses are fixed around the knee and the ankle-foot by transcutaneous steel pins. Slow mechanical distraction gradually corrects the flexion deformities of the knee and clubfoot.

Background Choroidal thickness is closely associated with ametropia,and to study the influence of subfoveal choroidal thickness (SFCT) on refraction is very important for understanding the mechanism of refractive error more clearly.Objective This study was to investigate the relationship between SFCT and refraction.Methods A retrospective serial cases analysis was performed.Forty anisometrope patients were recruited in Zhongshan Ophthalmic Center from June 2012 to August 2012.The subjects were divided into 6-13 years group and 14-21 years group.Vision acuity was tested by the EDTRS visual acuity chart and ocular anterior segment was examined under the slit lamp microscope,and the fundus examination was performed by direct ophthalmoscope.Subjective and objective optometry was performed after pupils were dilated.EDI OCT was used to illuminate choroidal image.Ocular axial length (AL) was obtained by Lenstar 900.The difference in SFCT between myopic eyes and hyperopic eyes was compared using Student t test,and the correlations between SFCT and refraction were analyzed by Pearson linear analysis and linear regression analysis.Results The average SFCT was (307.82±88.47) μm in all the tested eyes,and the SFCT of myopic eyes and hyperopic eyes was (270.60±70.57) μm and (376.95±76.59) μm,respectively,with a significant difference between them (P =0.000).In the 6-13 years group,positive correlations were found between SFCT and diopters with the regression coefficient 18.60 and regression equation Y =18.60X +310.79 (r=0.345,F=21.110,P=0.000) as well as between SFCT and AL with the regression coefficient -31.76 and regression equation Y =-31.76X+1 039.97 (r=0.262,F=17.320,P=0.000).In the 14-21 years group,SFCT showed positive correlation with diopters,with the regression coefficient 23.38 and regression equation Y=23.38X+353.17 (r =0.430,F =27.210,P =0.000) and negative correlation with AL,with the regression coefficient-35.82 and regression equation Y =-35.82X+1 132.75 (r=0.237,F=15.650,P=0.000).Conclusions SFCT seems to be positive correlated with diopter.When the diopter shifts toward positive value,SFCT value increases,and whenever diopter increases-1 D,SFCT decreases 20 μm approximately.SFCT decreases with the increase of AL.

Objective:To investigate the effect of lateral tibial periosteum distraction on diabetic foot and vasculitis foot.Methods:A retrospective analysis of 13 patients (16 feet) who received lateral tibial periosteal distraction between June 2019 and May 2020 were included in the study. 9 males and 4 females; aged 39-77 years (average 66 years); left foot 7 cases, right foot 9 cases. 5 cases were patients with diabetic foot, 1 case was diabetic foot with arteriosclerosis obliterans, 2 cases were thromboembolic vasculitis, and 5 cases were arteriosclerosis obliterans. The tibial periosteum was dissected and a distraction device was placed. In the 3 patients with foot ulcers, tibial periosteum distraction devices were placed on the severer side. The periosteal distraction began on the third day after surgery, about 0.75 mm/d, the adjustment was done usually in two weeks. Two weeks later, the stretch plate was removed surgically. The followings were evaluated: visual analogue scale (VAS) pain score, foot peripheral oxygen saturation, foot capillary filling test, lower extremity arterial CT angiography (CTA), etc.Results:All 13 patients were followed up for 2-12 weeks, with an average of 3.85 weeks. VAS pain score: the average pain score of 13 patients with preoperative foot pain was 5.31±1.84 (range, 2-9) points, and 2 weeks after surgery, the average value was 2.46±1.39 (range, 1-6) points with statistical significance ( t=6.124, P<0.001) ; peripheral foot oxygen saturation: the average preoperative blood oxygen saturation of 12 patients was 87.83%±14.83% (range, 50%-98%), 1 patient was not detected before surgery, and 2 weeks after operation, the average blood oxygen saturation was 92.33%±7.91% (range, 75%-99%). There was no significant difference between them ( t=1.124, P=0.285). The foot skin temperature of 10 patients was 35.68±0.85 ℃ (range, 34.00-36.60 ℃) before surgery and 36.23±0.46 ℃ (range, 35.50-36.90 ℃) after surgery, and the difference was statistically significant ( t=3.197, P=0.008) . Capillary filling test: 2 weeks after operation, the capillary filling response was significantly improved. All 13 patients had improved CTA of both lower extremity arteries before operation, and 11 patients had CTA taken back after two weeks of operation. Compared with preoperative CTA, new vascular network was found in the operation limb. In addition to 1 patient with thromboangiitis obliterans (mainly suffering from foot pain, no wound symptoms), 2 of 12 patients with heart failure, renal failure and other basic diseases did not heal, and the wounds of the other 10 patients had improved significantly 1 month later. Conclusion:Lateral tibia periosteum distraction can be used to treat chronic ischemic diseases of lower extremities with satisfactory postoperative results.

Objective: To discuss the clinical application and effects of domestic external fixator in the treatment of patients with malformations of limbs. Methods: A total of 7 289 patients with malformation of limbs who had been operated in Qin Sihe orthopedic surgery team from January 1989 to June 2016 were retrospective analyzed. The patients were treated with domestic external fixator, including 4 033 males and 3 256 females, aging from 2 to 82 years with a mean age of 23.4 years. There were 2 732 patients using Ilizarov external fixator, 4 713 patients using hybrid external fixator, 57 patients using monobrachial external fixator, 232 patients using Ilizarov external fixator and hybrid external fixator. The Ilizarov, hybrid and monobrachial external fixator were used in 67, 65 and 0 patients on the upper limbs and in 2 665, 4 616 and 57 patients on the lower limbs. There were 3 028 patients operated on the left limbs, 3 260 patients operated on the right limbs and 1 001 patients operated on the bilateral limbs. The top three types of diseases were sequelae of poliomyelitis, cerebral palsy and post-traumatic stress disorder peromely. Deformity types inclued talipes equinovarus, knee flexion deformity, cavus foot and so on. Results: All the patients were followed up for a period of 2.5 months to 22.4 years, with an average follow-up time of 5.4 years. All of the external fixators were used for single once, and there was no substitute for external fixator quality problem. All the patients were completed surgery goal until removing external fixation except 1 patient gave up treatment and 1 removed the fixator because of metal allergy. The common complications included wire or pin infection and joint movement limitation and so on. Conclusions The domestic external fixator developed and produced based on the characteristics of Chinese limb deformity disability. The domestic external fixator can be used to treat kinds of limb deformities with the advantages of practical, economical, adjustable, universal and portable. The domestic external fixator could meet the clinical demand for fixation of the osteotomy end of the limbs, the correction of the deformity, the repair of the defects and the limb lengthening.

Objective To assess the clinical curative effect of accordion technique in the treatment of tibial delayed union or nonunion.Methods From February 2016 to December 2017,data of 11 patients with tibial delayed union (n=8) or non-union (n=3) who had been treated by accordion technique with an Ilizarov ring external fixator were retrospectively analyzed.10 males and 1 female were included in our study,with an average age of 41.9 years (range,21-63 years).There were 5 cases of docking site delayed union after Ilizarov transport for chronic tibial osteomyelitis.There were 3 cases of fracture site delayed union after external fixation for open tibia comminuted fracture.There were 3 cases of nonunion after tibia closed fracture,including 2 cases who had hybrid external fixation treatment,and 1 case who had conservative treatment.All the cases received accordion technique using Ilizarov ring external fixators.First,gradual compression at the fracture site was conducted until the bony contact was seen on a radiograph.After bony contact,compression was continued at a rate of 0.85 mm/d for a week,followed by distraction of 0.85 mm/d for 2-3 weeks.Afterward,a second compression was conducted using same rate and time with the distraction procedure.And there was a 7-day latent period between compression and distraction.One or two cycles of compression-distraction were needed before union was present radiographically.Results Bony union was obtained in all 11 patients after a mean time of 5.4 months (from 3 to 9 months).The mean follow-up for the 11 patients was 15.2 months (from 11 to 29 months).The mean duration of the accordion technique treatment was 50.2 d (range,35-67 d).The accordion technique was used 1 time for 8 patients,and 2 times for 3 patients.The mean duration of bone consolidation was 114.9 d (range,64-239 d).According to Paley evaluation criteria,osseous results were excellent in 8 cases,good in 3 cases,with a good to excellent rate of 100％(11/11);functional results were excellent in 7 cases,and good in 4 cases,with a good to excellent rate of 100％(11/11).Conclusion The accordion technique is a minimal invasive,safe and reliable treatment program for tibial delayed union or nonunion.

OBJECTIVE: To investigate the effectiveness of single Taylor external fixator combined with biplanar osteotomy on correction of tibial multiplanar deformities. METHODS: Between October 2016 and December 2021, 11 patients with tibial multiplanar deformities (20 sides) were treated with single Taylor external fixator and biplanar osteotomy. Of them, 4 were male and 7 were female; the average age ranged from 13 to 33 years (mean, 21.9 years). Diagnosis included rickets severe genu varum deformity (7 cases, 14 sides), rickets severe genu valgum deformity (2 cases, 4 sides), multiple osteochondromatosis calf deformity (1 case, 1 side), neurofibromatosis medial lower leg anterior arch deformity with short of leg (1 case, 1 side). After fibular osteotomy and tibial multiplanar osteotomy, a Taylor external fixator was installed. After operation, the deformities were corrected successively and fixed completely. The osteotomy healed, then the external fixator was removed. Before operation and at 12 months after operation, the full-length X-ray films were taken. The leg-length discrepancy, medial proximal tibial angle (MPTA), lateral distal tibial angle (LDTA), posterior proximal tibial angle (PPTA), anterior distal tibial angle (ADTA), and tibial rotation angle were measured. The degree of lower limb deformity was scored with reference to a customized tibial mechanical axis scoring table. RESULTS: Osteotomy was successfully completed without neurovascular injury and other complications. The external fixator was adjusted for 28-46 days, with an average of 37 days, and the external fixator was worn for 136-292 days, with an average of 169 days. Mild needle infection during the fixation period occurred in 3 sides, refracture at the distal tibial osteotomy in 1 side after removing the external fixator, and nonunion of the distal fibular osteotomy in 1 side. All patients were followed up 369-397 days (mean, 375 days). At 12 months after operation, the lower limb discrepancy decreased, but there was no significant difference ( P>0.05). MPTA, LDTA, PPTA, ADTA, and tibial rotation angle improved, and the differences in LDTA, ADTA, and tibial rotation angle were significant ( P<0.05). The score of lower limb deformity was significantly higher than that before operation ( P<0.05), and the results were excellent in 9 sides, good in 8 sides, fair in 3 sides, with the excellent and good rate of 85%. CONCLUSION Single Taylor external fixator combined with biplanar osteotomy is effective in the correction of tibial multiplanar deformities.
Humans ; Male ; Female ; Adolescent ; Young Adult ; Adult ; Tibia/surgery* ; Osteotomy/methods* ; Rickets ; External Fixators ; Retrospective Studies ; Treatment Outcome