Objective To evaluate the performance of Beckman Coulter Enhanced troponin Ⅰ immunoassay system (including the limit of detection and total imprecision) and establish the 99th percentile of Enhanced troponin Ⅰ in apparently healthy Chinese people in Kunming and Wuhan.Methods Evaluated the limit of detection and total imprecision of Beckman Enhanced troponin Ⅰ according to protocols EP of Clinical Laboratory Standards Institute; chose apparently healthy people from Wuhan (average altitude of 27 m) which represents plain regions,and Kunming (average altitude of 1895 m) which represents plateau regions.760 subjects from Wuhan were selected,aging from 30 to 91,included 400 males and 360 females.A total of 192 subjects from Kunming were selected,aging from 30 and 77,60 patients,which included 60 male and 132 female cases.To calculate the 99th percentile of Enhanced troponin Ⅰ by region,age,and gender.Results The limit of detection of Beckman Enhanced troponin Ⅰ is 0.013 μg/L,the cTnI concentration is 0.025 μg/L at 10％ CV.The 99th percentile of Enhanced troponin Ⅰ of the total population in Wuhan is 0.036 μg/L,the 99th percentile of men and women are 0.038 μg/L and 0.035 μg/L respectively,the 99th percentile in the 30-69 years group and over 70 years group are 0.038 μg/L and 0.035 μg/L respectively.The 99th percentile of Enhanced troponin Ⅰ of the total population in Kunming is 0.040 μg/L.To keep the 2nd digit after decimal point for results from Wuhan and Kunming,the 99th percentile of Enhanced troponin Ⅰ of the apparently healthy Chinese in 0.04 μg/L,where the CV is 8.23％.The percentage of positive samples detected below the 99th percentile in the normal reference population in Wuhan is 94％.Conclusions The 99th percentile of Beckman Enhanced troponin Ⅰ of the Chinese apparently healthy people is 0.04 μg/L,where the total imprecision is 8.23％,and the detection performance reach the acceptable levels per the guideline.

Objective:To compare the embrace fixation and screw fixation in the treatment of inferior tibiofibular syndesmosis injury.Methods:A retrospective study was conducted of the 125 patients who had been treated for ankle fractures and distal syndesmotic injuries at The Hospital Affiliated to Qingdao University from April 2018 to September 2021. They were 79 males and 46 females with an age of (25.4±11.2) years. The patients were divided into 2 groups according to their fixation methods: an observation group of 75 cases subjected to embrace fixation and a control group of 50 cases subjected to conventional screw fixation. Their reduction was evaluated by comparing the disparities between the affected and normal sides in the anterior and posterior syndesmotic distances, fibular translation distance, and fibular rotation angle between the 2 groups after surgery. Intraoperative immobilization time for the inferior tibiofibular syndesmosis, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Olerud-Molander ankle function score, and visual analog scale (VAS) for pain were also compared at the last follow-up between the 2 groups.Results:There was no statistically significant difference in the preoperative baseline data between the 2 groups of patients, indicating comparability ( P>0.05). There was no statistically significant difference between the 2 groups in intraoperative immobilization time for the inferior tibiofibular syndesmosis, disparity between the injured and normal sides in postoperative fibular translation distance, or VAS pain score at the last follow-up ( P>0.05). The anterior and posterior syndesmotic distances, disparity between the injured and normal sides in fibular rotation angle, AOFAS ankle-hindfoot score, and Olerus-Molander ankle function score in the observation group [0.1 (-0.2, 0.3) mm, 0.1 (-0.3, 0.5) mm, -0.5 (-1.1, 0.8)°, 96 (93, 100) points, and 95 (90, 100) points] were all significantly better than those in the control group [1.4 (0.6, 2.1) mm, 1.5 (0.9, 2.2) mm, 1.2 (-3.8, 3.7)°, 93 (89, 96) points, and 90 (85, 100) points] (all P<0.05). There was no major complication or nonunion in the observation group. Conclusion:The embrace technique can provide an accurate and effective fixation for the inferior tibiofibular syndesmosis in patients with ankle fracture and lead to better clinical and radiographic outcomes than conventional screw fixation.

Suture techniques for microvascular anastomoses have been clinically adopted for decades. However, there are still some limitations in microvascular anastomosis. Therefore, the improvement of suture techniques for microvascular anastomosis has become the focused topics in the research of microsurgery. With the development of science and technology in microsurgery, the suture techniques, anastomotic instruments and training models for microvascular anastomoses have been continuously improved. This article summarises the progress in microvascular anastomosis based on literatures published on PubMed, Embase, Medline, CNKI and Wanfang Data, and provides a theoretical basis for promoting the development in anastomosis of microvessels.

Objective:To investigate the clinical effect of bilateral anteriolateral thigh perforator flaps (ALTPF) pedicled with descending branch of lateral circumflex femoral artery in series on reconstruction of large soft tissue defects in lower limbs.Methods:A total of 9 patients with large soft tissue defects in lower limbs were selected in the study. The patients were 6 males and 3 females aged between 18 and 57 years old. They were treated in the Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University from June 2018 to January 2023. Causes of injury: 4 of traffic accident, 2 of crushing, 2 of falling from height and 1 of explosion. Five patients had combined defects in dorsal feet and 4 with tibia fractures and anterior-and-posterior-tibial soft tissue defects. All affected limbs had tissue necroses and infections in various degrees. Deep tissue defects such as tendons, nerves, bones and joints or orthopaedic implants were exposed. The areas of soft tissue defects were 30 cm×14 cm-42 cm×14 cm. All the defects were reconstructed by the bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series. The size of proximal flaps was 25 cm×8 cm-33 cm×13 cm and 20 cm×7 cm-29 cm×13 cm for the distal flaps. Scheduled postoperative follow-ups were conducted to observe the survival of the transferred flaps and functional recovery of calfs and feet. Sensory recovery was assessed against British Medical Research Council (BMRC) criteria. Puno scoring was used to assess the functional recovery and the effectiveness of treatment.Results:All flaps survived and the donor sites healed well. One patient developed vascular compromise within 24 hours after surgery, but it was rectified after timely surgical exploration, however it left with a small area of necrosis at distal end of the flap. The necrosis and wound healed after skin grafting in stage-two surgery. Postoperative follow-up lasted for 8.3 months in average. Two patients underwent flap thinning in stage-two surgery due to bloating appearance, 2 patients had slightly bloated flaps at the calfs, and the rest of 5 patients had satisfactory flap appearance. Two patients received nerve reconstruction by anastomosis of the lateral femoral cutaneous nerves. At the final follow-up, the sensory recovery in 9 patients achieved S 2-S 3+ according to BMRC. The average Puno score achieved 88.36 point±5.36 point, of which 4 patients in excellent, 3 in good and 2 in fair. Conclusion:The use of bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series to reconstruct a large soft tissue defect in lower extremity has a good clinical value, and it has become one of the effective methods.