After the monoclonal antibody drug come out,it has played an important role in the clinical treatment,especially in tumor therapy.With the further understanding of monoclonal antibody,it has been applicated in the food, transgenic animal and plants,plant virology aspect. However,rare research of natural medicine have been reported in China.The monoclonal antibody-based enzyme-linked immunosorbent assay method, which is sensitivity,accuracy,fastness and simpler,can be used in quantitative analysis of bioactive compound in the natural products. It also can be used in isolation and purify effective component of the natural medicine, the pharmacokintic study,the quanlity control, screening candidacate drug and expanding the resources of medicinal plant It is important to exploit and utilizate the natural medicine,and promote the progess of modern chinese medicine.

Objective To compare the pain management effects between painless wards with quality control circle mode and conventional pain management mode.Methods A retrospective case control study was conducted on the clinical data of 233 patients with lower limb fracture admitted from August 2015 to August 2016.There were 124 males and 109 females,aged 18-74 years [(48.3 ±3.3)years].The patients were divided into observation group (n =117) and control group (n =116) according to the pain management mode.The observation group followed the standard continuous quality improvement program and combined with professional team and patients Wechat group to implement pain management,and further measures were taken in accordance with the feedbacks.The control group adopted routine painless ward nursing model for perioperative analgesia nursing intervention.The pain score VAS,the start time of functional exercise,the compliance of rehabilitation activities,the length of hospital stay,and the healing time of fracture were compared between the two groups.Results There was no significant difference in VAS scores between the two groups at 12 hours before operation and 6 hours after operation (P ＞ 0.05).The observation group had lower VAS scores at 12 hours (3.2± 1.4),24 hours (2.8 ±0.9),48 hours (1.6 ± 0.7),and 72 hours (1.5 ± 0.8) after operation than the control group (P ＜0.05).The observation group started functional exercises earlier [(18.9 ± 0.4) hours after operation]than the control group earlier [(48.1 ± 1.7) hours after operation] (P ＜ 0.01).The observation group had a rehabilitation compliance rate of 62.6％,higher than that of the control group (17.6％) (P ＜0.05).The hospital stay [(12.18 ± 0.14) days] and fracture healing time [(97.86 ± 0.83) days] of the observation group were shorter than those of the control group (P ＜ 0.05).Conclusion The pain management model of standardized continuous quality improvement can significantly relieve pain in patients with lower limb fracture,shorten hospitalization time,bring forward the start time of functional exercise,improve the compliance of rehabilitation activities,and promote fracture healing.

Objective:To evaluate the outcomes of endoscopic resection of symptomatic talocalcaneal coalitions in adolescents using a posterior approach.Methods:A retrospective case-series study was performed to analyze the data of 15 adolescent patients (16 feet) with symptomatic talocalcaneal coalitions (TCC) who had been treated by posterior arthroscopy from February 2017 to December 2020 at Department of Orthopaedics, Xuzhou Central Hospital. There were 11 boys and 4 girls with an average of 14.3 years (from 11 to 17 years). The left side was affected in 9 and the right side in 5 patients, and both sides were involved in one. Ten patients had a history of ankle sprain. The clinical outcomes were evaluated by visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and 36-item short form health survey (SF-36) postoperatively.Results:The 15 patients were followed up for a mean time of 19.9 months (from 12 to 36 months). At the final follow-up, the VAS significantly decreased from preoperative 6 (6, 7) points to 1 (1, 3) point, the AOFAS ankle-hindfoot score significantly increased from preoperative (54.1±10.4) points to (90.0±16.6) points, and the SF-36 score significantly improved from preoperative (55.5±12.7) points to (88.7±6.5) points ( P<0.05). Follow-ups found such complications as infection, TCC recurrence or osteoarthritis in none of the patients. Conclusion:Endoscopic TCC resection using a posterior approach is an effective surgery for symptomatic TCC in adolescents, showing advantages of limited invasion, fast recovery, a low rate of postoperative complications and precise resection.

Objective:To understand the clinical manifestations and prognosis of severe bubonic plague, and to explore the treatment experience of severe bubonic plague.Methods:A retrospective analysis was conducted on the clinical data and treatment of a case of severe bubonic plague admitted to Huade County on November 11, 2019.Results:The case of bubonic plague was a 55-year-old male, and outbreak after hunting the hare at the foci. The clinical manifestations included fever, fatigue, left armpit skin hard, swelling, heat and pain, distinctness of lymph node enlargement in later stage, hiccups and pleural effusion. Laboratory tests showed diffuse intravascular coagulation (DIC), sepsis and multiple organ dysfunctions. Bubonic plague was confirmed by positive culture of Yersinia pestis and positive phage lysis test on the 3rd day after admission. After platelet, plasma, fluid resuscitation and streptomycin combined with moxixacin, DIC and multiple organ functions were restored to normal and the hard swelling subsided. The course of treatment lasted for 19 days, the body temperature returned to normal and the patient recovered. Conclusions:This patient is a severe case of bubonic plague characterized with lymphangitis, skin sclerosis and abnormal coagulation. Timely identification, evaluation, early and combined treatment is the key to successful treatment.

Objective:To explore the clinical effect of the application of intraoperative psoas major intramuscular block therapy on the complications related to the approach after multi-segmental crenel lumbar interbody fusion (CLIF).Methods:All of 68 degenerative lumbar scoliosis patients who had received multi-segmental crenel lumbar interbody fusion during January 2020 and June 2020 were retrospectively reviewed. Patients were divided into two groups according to whether the psoas major muscle was treated with block therapy during the operation. The psoas muscle inblock group were filled with gel sponge infiltrated with a mixture of Betamethasone and lidocaine for local block therapy before closing the incision while that in the control group were not filled with gel sponge. There were 33 patients in the control group, 7 males and 26 females with an average of 65.8±7.1 years old (range: 54-81 years old); 35 cases in the block group, 9 males and 26 females with an average of 68.0±6.5 years old (range: 54-85 years old). The complications related to the approach (mainly includes pain, numbness in the front of the thigh, as well as psoas major, quadriceps muscle strength) were recorded respectively 1 day, 1 week, 1 month and 3 months after surgery. The main indicators of outcome including visual analog scale (VAS) of pain, the visual analog scale (VAS) of numbness, muscle strength of psoas major and quadriceps femoris, and the incidence of complications related to the approach were compared between the two groups of patients at different time points after surgery. The clinical outcomes were assessed using the Oswestry disability index (ODI), VAS for low back pain. The radiological outcome was evaluated with Cobb angles and sagittal balance parameters (sagittal vertical axis, SVA).Results:There were no significant differences in age, gender, body mass index (BMI), number of fusion segments, operation time, and intraoperative blood loss between the two groups. The incidence of approach-related complications was 17.1% in the block group and 39.4% in the control group, with statistically significant difference between the two groups ( χ2=4.177, P=0.041). The incidence of postoperative pain, numbness in the front of the thighs, and muscle strength of psoas major in the block group (11.4%, 14.3%) were lower than those in the control group (33.3%, 36.4%) ( χ2=4.740, P=0.029; χ2=4.416, P=0.036). And for numbness in the front of thigh, the block group (14.3) was lower than control group (21.2%), but no significant difference was shown between two groups ( χ2=0.561, P=0.454). However, there was no quadriceps weakness in either group. The VAS scores of painof the block group were lower than those of the control group at 1 day, 1 week, and 1 month after surgery, and the difference was statistically significant ( t=2.220, P=0.031; t=2.235, P=0.031; t=2.086, P=0.044). The difference at 3 months was not statistically significant ( t=0.385, P=0.701). The muscle strength of psoas major of the block group, meanwhile, was higher than those of the control group on the 1day and 1 week after surgery, the difference was statistically significant as well ( t=2.208, P=0.032; t=2.171, P=0.034). The difference at 1 and 3 months was not statistically significant ( t=0.923, P=0.359; t=1.437, P=0.160). No statistically significant differences were found in VAS scores of numbness at 1 day, 1 week, 1 month, and 3 months after surgery. Postoperative low back pain and lumbar spine function were significantly improved in both groups, and there was no statistical significance between the two groups. Coronal Cobb angle and sagittal balance were significantly improved in both groups after surgery, and there was no statistical significance between the two groups. Conclusion:Psoas major intramuscular block therapy can reduce the incidence of early postoperative complications of multi-segmental CLIF. Furthermore, it was found to be effective to alleviate anterior thigh pain within 1 month, and improve psoas major muscle weakness within 1 week.

Objective:To explore the perioperative management strategy for the elderly with hip fractures during the epidemic of corona virus disease 2019 (COVID-19) and evaluate its clinical effect.Methods:A retrospective case series study was conducted on 33 elderly patients with hip fractures admitted to Chongqing General Hospital, University of Chinese Academy of Sciences, from January 20 to February 29, 2020, including 14 males and 19 females, aged 65-92 years [(76.5±6.3)years]. There were 20 patients with intertrochanteric fractures and 14 with femoral neck fractures. In total, 15 patients were combined with hypertension and 9 with diabetes. A total of 19 patients were treated with open reduction and internal fixation and 14 with total hip/semi-hip replacement. The time from injury to admission was 2-14 hours. The temperature measurement, routine blood test and chest CT examination were performed to exclude COVID-19 in all patients, which showed 12 patients with pulmonary infection. The medical staff received different levels of protection: first level protection for those in the special ward, secondary level protection for the emergency isolation ward and tertiary level protection for those collecting the throat swab samples. The time from admission to operation, intensive care unit (ICU) stay time, hospitalization time, visual analogue score (VAS), perioperative complications as well as infection of patients and medical staff were observed and recorded.Results:The time from admission to operation was (3.18±0.19)days for all patients, with (2.24±0.28)days for 21 patients with no obvious pulmonary abnormality and (4.83±0.39)days for 12 with pulmonary infection. The hospitalization time was (10.97±0.31)days in all patients, with (9.71±0.27)days for 21 patients with no obvious pulmonary abnormality and (12.51±0.78)days for 12 with pulmonary infection. After operation, 12 patients were treated in ICU for 1-3 days, and the rest 21 patients were treated in general wards. The pain of all patients was effectively controlled. The time for exercise was (4.0±1.4)days after operation in all patients, among which 19 treated with fracture reduction and internal fixation started at (4.3±1.3)days after operation and 14 treated with total hip/semi-hip replacement started at (3.6±1.3)days after operation. VAS was (4.55±0.29)points at 12 hours before operation, (5.62±1.12)points at 6 hours, (3.54±0.39)points at 24 hours, and (2.42±0.11)points at 72 hours after operation ( P<0.05). Chest CT showed that the pulmonary inflammation was significantly improved one day before discharge. There was no indication of nucleic acid detection, with no urinary tract infection, pressure sore, deep vein thrombosis or other complications were found. No infection of patients or medical staff occurred. Conclusion:During pandemic of COVID-19, early surgical treatment for the elderly with hip fractures can be done in the general wards, based on strictly following the principle of infection prevention and control and carefully evaluating the perioperative risks, which can avoid the probability of infection of patients and medical staff without prolonging the hospitalization time or increasing the incidence of complications.