Objective: To observe the long-term efficacy and safety of autologous hematopoietic stem cell transplantation (AHSCT) for systemic sclerosis (SSc) patients. Methods: Between May 2007 and June 2009,4 patients with SSc were enrolled in the study. Peripheral blood stem cells were mobilized with cyclopho-sphamide (CTX) followed by granulocyte colony stimulating factor (G-CSF). Conditioning was performed with i.v. cyclophosphamide 50 mg·kg^-1·d^-1 for 4 days. The results of the modified Rodnan skin score (mRSS), thoracic high-resolution computer tomography and pulmonary function were collected after transplantation. Results: There was an improvement in mRSS, lung function and HRCT in the six months after AHSCT. Within six month to one year after transplantation, one patient had sustained and two patients recurred. After active treatments two patients were improved again. During the follow-up of 8.7 (4.1-9.8) years, three patients were stable and one patient died. Infection and hepatic function injury were the major complications. There was not transplant-related mortality. Conclusion AHSCT with CTX as a pre-conditioning regimen is safe and effective for SSc. The efficacy for patients with short course, rapid progress and edema is significant. However, long-term efficacy is poor, and long-term maintenance treatment is needed.

Objective:To evaluate the feasibility and accuracy of surgical template guides to assist mandibular osteotomies in craniofacial microsomia.Methods:Ten children diagnosed with craniofacial microsomia (Pruzansky Ⅱ) from May 2018 to November 2018, at the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, were selected for this study. First, pre-operative CT scans were prescribed, osteotomy plans were designed by Mimics 19.0, and individualized template guides were manufactured before surgery. Under the guidance of the surgical template, distraction osteotomy of craniofacial microsomia and distractor implantation surgeries were performed until the proposed length was reached. Then, another CT scan was performed. Based on the registration of pre- and post-surgery mandible statistics harvested by Geomagic Control, six points were randomly chosen on the osteotomy surface to estimate deviations, the mean value of which was calculated as distance deviation between the osteotomy surfaces. Meanwhile, the angle between the osteotomy surfaces was considered as angular deviation. Considering the deviation of 2 mm in distance and 5 degrees in angles as references, a single-sample t-test was conducted in SPSS 25.0 and it was considered as statistically significant when P<0.05. Results:A total of 10 children, six males and four females, diagnosed with craniofacial microsomia, with an average age of 4.9 years, were included in this study. The left-to-right ratio of the afflicted mandibles was 3∶7. The implantation surgeries were successfully conducted on all the patients and no complications were observed. All patients underwent follow-up visits for one year. The results were consistent with the pre-surgery designs, including satisfactory effects of distraction osteogenesis, obvious improvements of facial asymmetries, and corrections of occlusal surface inclinations. The deviation distribution before and after the surgeries could be distinctly visualized, in which the deviation of two matching groups of mandibles was (0.94±0.92) mm, the distance deviation between the osteotomy surfaces was (2.05±0.40) mm, and the angular deviation was (4.76±1.95)°. Compared with references, all the deviations were not statistically significant ( P>0.05). Conclusions:Metal surgical template guides are applicable to assist mandibular osteotomies of craniofacial microsomia with relatively high accuracy, which is beneficial to the intraoperative application of preoperative design so that satisfying effects could be achieved after surgeries.

Objective:To evaluate the feasibility and accuracy of surgical template guides to assist mandibular osteotomies in craniofacial microsomia.Methods:Ten children diagnosed with craniofacial microsomia (Pruzansky Ⅱ) from May 2018 to November 2018, at the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, were selected for this study. First, pre-operative CT scans were prescribed, osteotomy plans were designed by Mimics 19.0, and individualized template guides were manufactured before surgery. Under the guidance of the surgical template, distraction osteotomy of craniofacial microsomia and distractor implantation surgeries were performed until the proposed length was reached. Then, another CT scan was performed. Based on the registration of pre- and post-surgery mandible statistics harvested by Geomagic Control, six points were randomly chosen on the osteotomy surface to estimate deviations, the mean value of which was calculated as distance deviation between the osteotomy surfaces. Meanwhile, the angle between the osteotomy surfaces was considered as angular deviation. Considering the deviation of 2 mm in distance and 5 degrees in angles as references, a single-sample t-test was conducted in SPSS 25.0 and it was considered as statistically significant when P<0.05. Results:A total of 10 children, six males and four females, diagnosed with craniofacial microsomia, with an average age of 4.9 years, were included in this study. The left-to-right ratio of the afflicted mandibles was 3∶7. The implantation surgeries were successfully conducted on all the patients and no complications were observed. All patients underwent follow-up visits for one year. The results were consistent with the pre-surgery designs, including satisfactory effects of distraction osteogenesis, obvious improvements of facial asymmetries, and corrections of occlusal surface inclinations. The deviation distribution before and after the surgeries could be distinctly visualized, in which the deviation of two matching groups of mandibles was (0.94±0.92) mm, the distance deviation between the osteotomy surfaces was (2.05±0.40) mm, and the angular deviation was (4.76±1.95)°. Compared with references, all the deviations were not statistically significant ( P>0.05). Conclusions:Metal surgical template guides are applicable to assist mandibular osteotomies of craniofacial microsomia with relatively high accuracy, which is beneficial to the intraoperative application of preoperative design so that satisfying effects could be achieved after surgeries.

OBJECTIVE： To establish antibiotics use rationality evaluation model in type Ⅰ incision surgery patients， and to provide reference for prescription review of clinical pharmacists. METHODS： Totally 432 inpatients underwent type Ⅰ surgical incision in a hospital from Jan. 1st- Dec. 31st， 2017 were selected as the research objects. The information of diagnosis and treatment including age， nosocomial infection， the number of kinds of antibiotics used were extracted. Based on the results of clinical pharmacists’ comments on the antibiotics use rationality in patients’ prevention and treatment， non-conditional Logistic regression and support vector machine （SVM） in machine learning method were used to convert clinical pharmacists’ comments into objective index that can be recognized by the machine learning model， using categories of antibiotics （preventive or therapeutic use） as dependent variables and the patient’s diagnosis and treatment information as independent variables. Classification and identification model was established for antibiotics use rationality in type Ⅰ incision surgery patients. Using sensitivity， specificity and Youden index as indexes， established mode was validated on the other 61 samples of type Ⅰ incision surgery patients. The rationality of antibiotics prescriptions in type Ⅰ incision surgery patients before （by manual review， Jan.-Dec. 2017） and after （Jan.-Oct. 2018） using the model were collected， and the effects of the model were evaluated. RESULTS： The sensitivity， specificity and Youden index of non-conditional Logistic regression model were 65.63％， 75.00％ and 40.63％， respectively. Main parameters of the model established by SVM included gamma 0.01， cost 10， sensitivity 92.19％， specificity 87.50％， Youden index 79.69％. The model established by SVM was better than non-conditional Logistic regression. SVM was used to validate established mode， and sensitivity， specificity and Youden index were 100％， 88.57％ and 88.57％， respectively. Compared with before using the model， the evaluation ratio increased from 69.44％ to 100％， the rate of prophylactic use of antibiotics decreased from 23.84％ to 16.43％， the rate of rational drug type selection increased from 37.86％ to 54.39％， and treatment course shortened from 5.01 days to 3.26 days after using the model. CONCLUSIONS： Established antibiotics use rationality evaluation model in typeⅠincision surgery patients by SVM in machine learning method fully covers all the patients， promotes rational use of antibiotics in typeⅠincision surgery patients， and provides a new idea for pharmacist prescription comment.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult