BACKGROUND:Pedicle screw fixation has been used in children with thoracic injury. Conventional method is screw implantation by hand. This method can meet the needs of surgery, but its accuracy was low, and incidence of complications was high. The application of digital image navigation aid module is possible. OBJECTIVE:To study accuracy and safety of digital image navigation aid module in thoracic pedicle screw placement. METHODS:Eight thoracic vertebral bodies were equal y and randomly assigned to the manual insertion group and the digital image navigation aid module group. Manual insertion group received manual screw insertion. In the digital image navigation aid module group, navigation aid module was made according to CT scan results combined with principle of reverse engineering and rapid prototyping. Pedicle screw was placed using the digital image navigation aid module. RESULTS AND CONCLUSION:(1) Success rate of once screw set was significantly higher in the digital imaging navigation aid module group than in the manual insertion group (P<0.05). (2) Twenty-eight screws were implanted in the digital image navigation aid module group and manual insertion group separately. The excellent and good rate of screw placement was 96%in the digital image navigation aid module group and 75%in the manual insertion group (P<0.05). (3) These findings suggested that digital image navigation aid module can effectively improve the success rate of pedicle screw insertion. Moreover, this method is simple, easy to operate, and can make a personalized nail placement program for each child.

]. Conclusions The monoclonal-based ECLIA is a sensitive, specific, and rapid method and no radiocontamination. It can be used to detect hanum serum proinsulin in type 2 diabetes.

Objective To evaluate the diagnostic value of the aldosterone-renin ratio (ARR) for primary aldosteronism (PA). Methods Serum aldosteronos ( ALD ) and plasma renin activities (PRA)among 44 subjects with primary aldosteronism, 9 subjects with phecchromocytoma, 8 subjects with nonfunctional adrenal tumors, 12 subjects with Cushing syndrome, 4 subjects with stenosis of renal artery and 13 subjects with primary hypertension were retrospectively reviewed. ARR was calculated. The receiver operating characteristics (ROC) curves for every index were used to evaluate diagnostic value. Results The area under the curve(AUC) in the ROC curve of ALD in a supine position was 0. 947, the cut-off value of diagnosis of PA. The AUC for the ROC curve of ALD in upright position was 0. 889, the cut-off value of ALD diagnosis of PA. The AUC for the ROC curve of ARR in a supine position was 0. 978, the cut-off value of diagnosis of PA. The AUC for the ROC curve of ARR in upright position was 0. 981, the cut-off value of specificity. If ARR was combined with ALD in upright position was used, the diagnostic value was better than either index. When ALD > 275 ng/L and the AUC for the ROC curve in upright position was 0. 989,specificity. Conclusions The diagnostic value of ARR in diagnosis of primary aldosteronism is higher than ALD and PRA. ARR in upright position is better than that in supine position, especially when combined with ALD > 275 ng/L in upright position.

Objective:A three-dimensional (3D) finite element model of the ankle joint of marathon runners was constructed to simulate the changes of the lateral collateral ligament (LCL) injury on the stability of the ankle joint and the force distribution of talar talus cartilage during exercise.Methods:The 3D MRI images of the right ankle joint of one marathon runner were acquired and imported into Mimics software in DICOM format for preliminary 3D model reconstruction of the images. The boundary conditions and loads were loaded on the model using Ansys Workbench software, and the ankle joint forces were analyzed by Ansys Workbench for marathon runners in the sports condition, and four kinds of ankle LCL injury finite element models were established, i.e., the normal model of LCL, the injury model of anterior talofibular ligament (ATFL), the injury model of AFTL merged with the calcaneofibular ligament (CFL), and the injury model of AFTL merged with the CFL and the posterior talofibular ligament (PTFL). The peak talus slide cartilage stress and its distribution were observed under the four models, and one-way ANOVA was used to compare the values of talus advancement, and the SNK- q test was used for two-by-two comparisons. Results:In the LCL normal model, the maximum stress peak of the talar slide was 0.21 MPa, which was mainly distributed in the junction area of the anterior medial (MA) and anterior lateral (LA) parts and part of the LA region. In ATFL injury, the peak stress of talar cartilage increased compared with the normal model, with a maximum value of 0.65 MPa, which was mainly distributed in the MA region. In ATFL combined with CFL injury, the peak stress increased, and the peak was mainly distributed in the MA region, and was shifted from the MA to the LA region. In ATFL combined with CFL and PTFL injuries, the peak cartilage stress in the talus slide was up to 2.29 MPa, and the maximum stress was mainly distributed in MA and LA, which had a comparable range of distribution. The anterior talar displacement values were (3.2±0.4), (3.4±0.4), (3.7±0.5), and (6.5±0.7) mm for normal LCL, AFTL injury, AFTL combined with CFL injury, ATFL combined with CFL, PTFL injuries, respectively, with a statistically significant difference ( F=109.08, P<0.001). The anterior talar displacement of ATFL combined with CFL, PTFL injuries was larger than those of normal LCL, AFTL injury, and AFTL combined with CFL injury ( P<0.05). Conclusions:A 3D finite element model is successfully constructed based on 3D MRI of the ankle joint in marathon runners. The peak and range of cartilage stresses in the talar glide change during LCL injury, and the talar glide displaces anteriorly.

To carry out phylogenetic analysis for drug-resistance genes from clinical isolates of Helicobacter pylori (Hp) among patients with gastric diseases from Tibet, China.

METHODSHp strains were isolated and cultured from saliva and gastric mucosal tissues derived from patients with gastric diseases. Nine strains (including 5 isolated from oral tissues, 1 isolated from gastric tissues, and 3 representative strains of SS international standard strains used for animal models) were tested for common antibiotic resistance. Together with an ACTT 11637 international standard strain, these were subjected to re-sequencing to obtain drug-resistance genes. Such genes from various sources were compared with the resistance genes of Hp strains recorded by the NCBI website. Combined with results of drug-resistance experiments, correlation between molecular evolution and drug-resistance was analyzed.

RESULTSTesting of gastric mucosal tissues and salivary samples from 217 patients has found 89 Hp strains, which yielded a total infection rate of 41.01%. The resistance rates of 9 representative Hp strains for clarithromycin, amoxicillin, metronidazole, levofloxacin and tetracycline were 77.8%, 77.8%, 44.4%, 77.8%, and 77.8%, respectively. Compared with the reference strain, the similarity between clarithromycin-resistance genes was 99%, and that between amoxicillin- and metronidazole-resistance genes was 96%-97%. A2143G mutation was also found in clarithromycin-resistant genes of three Hp strains.

CONCLUSIONThe sensitivity of Hp to metronidazole is much higher in patients from Tibet region, and the sensitivity of Hp to clarithromycin, amoxicillin, levofloxacin and tetracycline is poor. Resistance mutations are consistent with drug resistance.

Objective:To analyze the effect of integrated care model on relocation stress and sense of coherence in caregivers of severe multiple injuries patients after ICU transfer.Methods:From January 2017 to October 2019, 102 caregivers of severe multiple injuries patients in ICU of Liuzhou Worker′s Hospital were selected and divided into control group and observation group by random digits table method,with 51 cases in each group. In the process of ICU transfer the control group received routine nursing, while the observation group carried out integrated care model based on the control group scheme. Before and after ICU transfer, the degree of relocation stress and sense of coherence of caregivers in two groups were evaluated by Family Relocation Stress Scale (FRSS) and Sense of Coherence Scale (SOCS) respectively.Results:The scores of migration preparation dimension, migration satisfaction dimension,caregiver stress dimension and the total scores of FRSS were 17.51 ± 3.46, 4.81 ± 0.48, 11.69 ± 1.82 and 49.91 ± 4.51 in the observation group, which were significantly higher than those in the control group after transfer (13.61 ± 2.83, 3.32 ± 0.53, 9.42 ± 2.17, 39.25 ± 4.01)( t values were 5.12-7.64, all P<0.05). The scores of manage ability dimension, comprehensibility dimension, meaningfulness dimension and the total scores of SOCS were 29.58 ± 4.96, 24.07 ± 2.72, 22.04 ± 3.64 and 75.52 ± 6.80 in the observation group, which were significantly higher than those in the control group (24.34 ± 4.13, 20.50 ± 2.99, 17.19 ± 3.96, 64.80 ± 6.12) after transfer ( t values were 4.51-7.01, all P<0.05). Conclusions:The integrated care model can significantly alleviate relocation stress and promote sense of coherence in caregivers of severemultiple injuriespatients after ICU transfer.

Objective:To investigate the changes of biventricular myocardial strain in amateur marathon runners using the cardiac MR feature tracking (CMR-FT) technique.Methods:Forty-one amateur marathon runners (marathon exercise group) and 20 age-matched healthy volunteers (control group) were recruited according to the inclusion criteria. After the kinematic parameters were obtained, all subjects underwent a CMR cine sequence imaging. The CMR images were post-processed using CVI42 software. The biventricular function parameters including end-diastole/end-systolic volume (EDV/ESV), end-diastole/end-systolic volume index (EDVI/ESVI), end-diastole/end-systolic myocardial mass (MMD/MMS), end-diastole/end-systolic myocardial mass index (MMDI/MMSI), stroke volume and index (SV/SVI), cardiac index (CI) and ejection fraction (EF), as well as the biventricular myocardial strain parameters including global radial/circumferential/longitudinal strain (GRS/GCS/GLS), global radial/circumferential/longitudinal diastolic strain rate (GRSDr/GCSDr/GLSDr) were measured and calculated. Demographic data, kinematic index, cardiac function and myocardial strain parameters were compared between the two groups.Results:Compared with the control group, the exercise group showed significant decrease heart rates ( P<0.001). It was found that the left ventricular function parameters (ESVI, MMD, MMDI, MMS, MMSI) and the right ventricular function parameters (EDVI, ESVI) of the exercise group were significantly higher than those of control group (all P<0.05); while the left ventricular strain parameters (GCS, GRSDr, GCSDr, GLSDr) and the right ventricular strain parameters (GRSDr, GLSDr) were of the exercise group were significantly lower than those of control group (all P<0.05). Conclusions:Amateur marathon runners have lower myocardial strain capacity and higher left ventricular myocardial mass. The ventricular diastolic strain rate may sensitively reflect the compensatory changes of ventricular function with the normal ejection fraction.