Therapeutic antibodies have achieved ideal results in clinical practice,while the immunogenicity of antibody drugs may trigger anti-drug immune response in the body,thus inducing the formation of anti-drug antibody(ADA).ADA affects the clearance and bioavailability of drugs through neutralizing/non-neutralizing drug activities,and changes the pharmacokinetic and pharmacodynamic characteristics of drugs,which can interfere or block the therapeutic effect of drugs and may lead to adverse reactions to varying degrees in clinical practice,and can interfere with the effectiveness evaluation and screening of candidate molecules in preclinical studies.Therefore,this paper reviewed the factors affecting immunogenicity,the types and formation mechanism of ADA,the detection methods of ADA,the strategies to mitigate immunogenicity and the development of preclinical animal models for highly immunogenic drugs,so as to provide a reference for the development of therapeutic antibodies.

[Objective]To analyze the biodegradation properties and active osteogenesis features of implanted composites of gelatin microspheres(GMs) impregnated with calcium phosphate cement(CPC) and recombinant human bone morphogenetic protein-2(rhBMP-2) in bone defect.[Method]rhBMP-2 loaded gelatin microspheres was incorporated in rhBMP-2/CPC during setting.Thirty rabbits were divided into groups A,B and C(10 each).The rhBMP-2/GMs /CPC,GMs/cpc and rhBMP-2/cpc was implanted into the rabbits of group A,B and C,respectively.The biodegradation properties and active osteogenesis features of implanted composites bone substitute was evaluated by radiography,histology,bone mineral density(BMD)after the composites were implanted into the bone defects at rabbit radius for 6,12 weeks respectively.[Result]Significant implant resorption and bone ingrowth were observed in all rhBMP-2/GM/CPC treated defects while the defects treated with rhBMP-2/CPC implants showed slight resorption of CPC and the defects treated with GM/CPC implants showed slight formation of new bone.[Conclusion]The result of this study suggested that the rhBMP-2/GMs/CPC composite could be used as material for bone graft substitute.

Objective To investigate the requirement of health education for patients with spinal tuberculosis,making clinical education form,and determine the evaluation system.Methods 134 cases of spinal tuberculosis patients were surveyed with self-designed questionnaires.The questionnaire included 5 aspects,using the Likert 4 scoring method.Delphi method was applied in 16 experts.Results The health demand of patients showed high positive correlation in domains of cognition and operation.There was a moderate positive correlation between affective domain and cognition,operation domain.Two rounds of expert consultation showed that the expert opinion coordination coefficient was 100％,the average of authority was above 0.8,the expert opinion coordination coefficients of all the indexes were between 0.2～0.6.Conclusions The health education form for spinal tuberculosis patients can help to understand the needs of patients,it is pertinent and get the recognition of experts.

Objective? To evaluate the incidence of upper extremity deep venous thrombosis (UEDVT) after traumatic fracture using Meta-analysis. Methods? Chinese Biomedical Science Articles Database (CBMdisc), CNKI, Wanfang Medical Network Database were searched to collect studies about UEDVT after traumatic fracture from January 1st, 1990 to December 31st, 2018. After inclusion of exclusion criteria, literature was screened according to PICO principle, and literature quality was evaluated according to STROBE declaration. Qualified literature was used to extract data on the incidence of upper limb thrombosis, and data fusion was carried out using Meta-analysis method of single-arm study. Results? Finally, 9 articles of high quality were included in the study, including 14 425 patients. Data fusion result showed that the incidence of UEDVT after upper limb fracture was 0.83% (95%CI: 0.69% - 0.98%). Axillary vein thrombosis accounted for 19.99%, brachial vein thrombosis 46.66%, subclavian vein thrombosis 6.58%, subclavian vein-brachial vein thrombosis 14.84%, axillary vein-brachial vein thrombosis 11.93% in UEDVT after upper limb fracture. The incidence of UEDVT was 1.83% after humeral surgical neck fracture and 1.76% after humeral shaft fracture. Conclusions? The overall incidence of UEDVT after upper limb fracture was 0.83%. Brachial vein and axillary vein are the main sites, which should be paid attention to in postoperative nursing. The incidence of UEDVT in patients with proximal humeral fracture and peri-shoulder fracture is higher than that in patients with other upper limb fractures, which should be paid more attention.

Objectives:To investigate the genetic characteristics of the blaNDM-1-carrying plasmid of the multidrug resistant Enterobacter hormaechei subsp. hoffmannii clinical isolate C37, and constructing a phylogenetic tree of the 66 publicly available genomes of the Enterobacter hormaechei subsp. hoffmannii to explore its global epidemic situation. Methods:Carbapenem-resistant Enterobacter cloacae complex (CRECC) strains isolated from the First Affiliated Hospital of Sun Yat-sen University from August 2014 to August 2021 were collected. Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rDNA Sanger sequencing were used for species identification. Micro broth dilution method was used for antibacterial susceptibility test. The polymerase chain reaction (PCR) was used to detect the β-lactamase resistance gene and plasmid-mediated quinolone resistance (PMQR) gene carried by the C37 strain. The conjugation experiment was used to confirm the conjugative metastasis of the resistance genes in C37 strain. Whole genome of the C37 strain was sequenced. Core genome was extracted and the phylogenetic analysis of 66 publicly available Enterobacter hormaechei subsp. hoffmannii was performed. Results:Enterobacter hormaechei subsp. hoffmannii C37 strain is resistant to third-generation cephalosporins, carbapenems, aminoglycosides and quinolones, and carries blaACT-5, blaNDM-1, qnrA1, aac(6′)-Ib-cr, oqxAB, fosA, dfrA15 and other resistance genes, as well as IncX3, IncX4, IncFIB and IncFII plasmids. Multilocus sequence typing (MLST) analysis showed that C37 strain belongs to the ST78 type of Enterobacter cloacae complex (ECC). Conclusions:ST78 type Enterobacter hormaechei subsp. hoffmannii is closely related to the spread of carbapenem resistance genes. It is a potential high-risk clone to spread carbapenem resistance genes. The prevalence and trends of ST78 type Enterobacter hormaechei subsp. Hoffmannii should be monitored.

Objective:To compile the "Quick Psychological Assessment Scale for Military Training Injuries", analyze the psychological status and influencing factors of the wounded during military training, and propose intervention measures.Methods:Totally 105 wounded patients during military training who were treated in the Orthopedic Center at the Eighth Medical Center of Chinese PLA General Hospital from December 2018 to October 2019 were selected. The self-designed "Quick Psychological Assessment Scale for Military Training Injuries" was used to assess the anxiety and depression of the wounded 1-10 d post injury. The age, rank, injured part, injury type, interval from injury to surgical treatment, nature of the task performed, Barthel index, and the effects of Perceived Social Support Scale (PSSS) on the anxiety and depression of the wounded were observed, and CHISS2011 was used for statistical analysis.Results:The expert validity of the "Quick Psychological Assessment Scale for Military Training Injuries" was 0.893. The Cronbach's α coefficient, validity and norm of the rapid anxiety assessment scale was 0.754, 0.997 and (10.54±2.80) , respectively; the Cronbach's α coefficient, validity and norm of the rapid depression scale was 0.749, 0.997 and (11.60±3.22) , respectively. On the seventh day after injury, the rapid anxiety score of the wounded was (13.70±3.12) , which was statistically significantly different from the norm ( t=-10.588, P< 0.01) ; the rapid depression score was (11.83±2.99) , which was not statistically significantly different from the norm ( t=0.687, P> 0.05) . Cox regression analysis revealed that the interval from injury to surgical treatment, PSSS score and Barthel index were correlated with the anxiety of the wounded during military training ( P< 0.05) ; the nature of the tasks performed and the time of receiving surgical treatment were correlated with the depression after injury during military training ( P< 0.05) . Conclusions:The "Quick Psychological Assessment Scale for Military Training Injuries" has good performance. Mild and moderate anxiety is the focus of psychological intervention for the wounded during military training. Early implementation of effective treatment, recovery of self-care ability as soon as possible and effective social support can improve the mental state of the wounded during military training.

Objective? To explore the construction method and the effects of the orthopedic specialized nurse studio. Methods? The orthopedic specialized nurse studio included 4 working groups, which were intravenous therapy group, wound care group, chronic diseases management group and perioperative venous thromboembolism (VTE) management group. Each group were assigned 1 team leader and 10 to 12 team members. Nursing training, management and research were carried out. The professional competency of orthopedic nursing staff and the nursing quality were compared before (January to December 2016) and after (January to December 2017) the construction of the studio. Results? The scores of theoretical assessment, specialized nurses' performance and nursing quality in 2017 were (97.76±4.09), (82.25±6.60) and (99.06±0.91) respectively, which were higher than those of the same period in 2016. The differences were statistically significant (t=2.169, 3.327, 2.129; P＜ 0.05). Conclusions? The establish of the orthopedic specialized nurse studio can enhance the growth of specialized nursing team, improve the nursing quality and promote the development of multi-disciplinary integration.