Objective:To compare the clinical and radiological outcomes between the ankle dislocation exposure versus the traditional posterolateral approach exposure in the treatment of complex posterior ankle malunion.Methods:This retrospective study analyzed the 50 patients (50 feet) with posterior ankle malunion who had been treated at Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from May 2015 to June 2023. This cohort included 18 males and 32 females, with an age of (46.2±12.0) years. The duration from injury to surgery averaged 7.0 (4.0, 12.2) months. The patients were divided into 2 groups based on the surgical exposure methods: an ankle dislocation group (22 cases) in which the posterior ankle malunion was exposed by ankle dislocation before reduction and fixation, and a traditional posterolateral approach group (28 cases) in which the posterior ankle malunion was exposed by the traditional posterolateral approach before reduction and fixation. Evaluation indices included operative time, ankle arthritis grading, incidence of complications, as well as pre-operative and last follow-up recordings of distal tibial articular angle and joint step-off, visual analogue scale (VAS) pain score, and ankle-hindfoot score of American Orthopaedic Foot and Ankle society (AOFAS).Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). The average follow-up was (39.4±17.9) months. The operative time in the dislocation group [(95.8±9.9) min] was significantly shorter than that in the posterolateral approach group [(121.9±14.3) min] ( P<0.05). The step-off on the distal tibial articular surface at the last follow-up in the dislocation group [0.3 (0.0, 0.9) mm] was significantly lower than that in the posterolateral approach group [1.0 (0.3, 1.1) mm] ( P<0.05). The grading of ankle arthritis was significantly worse in the posterolateral approach group than that in the dislocation group ( P<0.05). There were no differences in distal tibial articular angle, VAS pain score, AOFAS ankle-hindfoot score, or postoperative complications between the 2 groups at the last follow-up ( P>0.05). Conclusions:Both ankle dislocation exposure and traditional posterolateral approach exposure yield satisfactory clinical and radiological outcomes in patients with complex posterior ankle malunion. However, the ankle dislocation exposure offers a novel method for direct visualization of the malunion on multiple planes, which is more advantageous for restoration of the anatomical consistency of the distal tibial articular surface.

Objective:To compare the effects of propofol and dexmedetomidine for sedation on the outcome in mechanically ventilated patients with severe pulmonary infection.Methods:Patients with severe pulmonary infection (Clinical Pulmonary Infection Score >7) requiring mechanical ventilation from the Medical Information Mart for Intensive Care Ⅳ database between 2008 and 2020 were selected and divided into propofol group and dexmedetomidine group based on the sedative agent used. The primary outcome was all-cause in-hospital mortality, and secondary outcomes included 90-day all-cause mortality and duration of mechanical ventilation. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounders, and logistic regression and linear regression were applied to analyze the effects of the two sedative drugs on the outcomes of mechanically ventilated patients with pulmonary infection. Kaplan-Meier survival curves were used to analyze survival outcomes.Results:A total of 6 204 critically ill patients with pulmonary infection requiring mechanical ventilation were included, with 3 439 cases in propofol group and 2 765 cases in dexmedetomidine group. The baseline characteristics between the two groups were well balanced (standardized mean difference < 0.1) after IPTW adjustment. In the IPTW-adjusted cohort, the in-hospital all-cause mortality and 90-day all-cause mortality were significantly lower in dexmedetomidine group than in propofol group (439.2[18.7%] vs 563.6[24.1%], 618.0[26.3%] vs 733.6[31.3%], P<0.001), the results of Further Kaplan-Meier survival curve analysis showed that the 90-day all-cause mortality was significantly lower in dexmedetomidine group than in propofol group ( P<0.01). Conclusions:Compared with propofol, dexmedetomidine can decrease the mortality rate and improve the prognosis in mechanically ventilated patients with severe pulmonary infection when used for sedation.

Objective To investigate the clinical value of serum mast cell carboxypeptidase(MC-CP),C-C motif chemokine 26(CCL26),and decoy receptor 3(DcR3)in the diagnosis of obstructive sleep apnea syndrome(OSAS)in chronic obstructive pulmonary disease(COPD).Methods Ninety COPD patients who visited the First Affiliated Hospital of Hebei North University from January 2021 to January 2023 were collected.Among them,48 patients with simple COPD were included in the COPD group,and 42 patients with COPD combined with OSAS were included in the COPD-OSAS group.During the same period,48 healthy volunteers who underwent physical examination in that Hospital of Hebei North collected as the control group.Enzyme linked immunosorbent assay(ELISA)was applied to detect serum level of MC-CP,CCL26,and DcR3.Receiver operating characteristic(ROC)curve was applied to analyze the clinical value of serum level of MC-CP,CCL26,and DcR3 in the diag-nosis of COPD complicated with OSAS.Multivariate Logistic regression was applied to analyze the influencing fac-tors of COPD complicated with OSAS.Results Compared with the control group,the smoking index,C-reactive protein(CRP)and white blood cell count(WBC)in the COPD and COPD-OSAS groups increased obviously in sequence,the ratio of forced expiratory volume in first second to forced vital capacity(FEV1/FVC)decreased obviously in sequence(P<0.05);Compared with the control group,the level of MC-CP,CCL26,and DcR3 in patients with COPD and COPD-OSAS increased significantly in sequence(P<0.05);The combination of serum MC-CP,CCL26 and DcR3 had a higher area under the curve(AUC)for the diagnosis of COPD complicated with OSAS compared to the individual diagnosis(Z=4.066,P<0.001;Z=2.391,P<0.05;Z=2.353,P<0.05).Multivariate Logistic regression analysis showed that smoking index,serum level of MC-CP,CCL26 and DcR3 were influencing factors for COPD complicated with OSAS(P<0.05).Conclusions The simultane-ously increased expression of MC-CP,CCL26 and DcR3 in the serum of COPD may support clinical diagnostic of COPD patients with OSAS.

Objective To analyze the current situation of the knowledge-attitude-practice among noise-exposed workers at an airport apron. Methods A total of 494 noise-exposed workers from an airport apron were selected as the study subjects using the judgmental sampling method. A self-designed "Occupational Protection Knowledge, Attitudes, and Practices Questionnaire" was used to assess the current situation of knowledge-attitude-practice on occupational protection. Results Regarding the awareness of noise hazards among the study subjects, the awareness rates of noise-induced impairment on digestive function and reproductive system were the lowest (44.9% and 37.7%, respectively). The awareness rate of noise-induced negative emotions increased with length of service (P<0.01). Regarding the occupational protection knowledge for noise, the awareness rate of occupational noise-induced deafness was “incurable” was the lowest (39.1%). The support rate for five kinds of occupational protection attitudes for noise was generally >85.0%, while only 58.3% of the study subjects consistently or frequently wearing earplugs during work. The most common source of noise hazard and protection knowledge was pre-employment training (76.9%), followed by occupational disease prevention and control campaigns (76.1%). Conclusion Noise-exposed workers in this airport apron have incomplete awareness of non-auditory system hazards caused by noise, and the awareness of knowledge of some occupational protection is relatively low. Although their attitudes toward occupational protection are positive, many workers still fail to consistently wear personal protective equipment at work.

With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

Objective:To compare the clinical and radiological outcomes between the ankle dislocation exposure versus the traditional posterolateral approach exposure in the treatment of complex posterior ankle malunion.Methods:This retrospective study analyzed the 50 patients (50 feet) with posterior ankle malunion who had been treated at Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from May 2015 to June 2023. This cohort included 18 males and 32 females, with an age of (46.2±12.0) years. The duration from injury to surgery averaged 7.0 (4.0, 12.2) months. The patients were divided into 2 groups based on the surgical exposure methods: an ankle dislocation group (22 cases) in which the posterior ankle malunion was exposed by ankle dislocation before reduction and fixation, and a traditional posterolateral approach group (28 cases) in which the posterior ankle malunion was exposed by the traditional posterolateral approach before reduction and fixation. Evaluation indices included operative time, ankle arthritis grading, incidence of complications, as well as pre-operative and last follow-up recordings of distal tibial articular angle and joint step-off, visual analogue scale (VAS) pain score, and ankle-hindfoot score of American Orthopaedic Foot and Ankle society (AOFAS).Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). The average follow-up was (39.4±17.9) months. The operative time in the dislocation group [(95.8±9.9) min] was significantly shorter than that in the posterolateral approach group [(121.9±14.3) min] ( P<0.05). The step-off on the distal tibial articular surface at the last follow-up in the dislocation group [0.3 (0.0, 0.9) mm] was significantly lower than that in the posterolateral approach group [1.0 (0.3, 1.1) mm] ( P<0.05). The grading of ankle arthritis was significantly worse in the posterolateral approach group than that in the dislocation group ( P<0.05). There were no differences in distal tibial articular angle, VAS pain score, AOFAS ankle-hindfoot score, or postoperative complications between the 2 groups at the last follow-up ( P>0.05). Conclusions:Both ankle dislocation exposure and traditional posterolateral approach exposure yield satisfactory clinical and radiological outcomes in patients with complex posterior ankle malunion. However, the ankle dislocation exposure offers a novel method for direct visualization of the malunion on multiple planes, which is more advantageous for restoration of the anatomical consistency of the distal tibial articular surface.

With the development of preimplantation genetic testing (PGT) technology, the application of third-generation sequencing technology in PGT has been increasing. This article reports the pregnancy outcome of a patient with autosomal dominant polycystic kidney disease who underwent PGT using the third-generation sequencing technology. It summarizes the technical characteristics of third-generation sequencing technology, as well as its significant advantages and limitations in PGT for families with de novo mutations.

Objective:To compare the effects of propofol and dexmedetomidine for sedation on the outcome in mechanically ventilated patients with severe pulmonary infection.Methods:Patients with severe pulmonary infection (Clinical Pulmonary Infection Score >7) requiring mechanical ventilation from the Medical Information Mart for Intensive Care Ⅳ database between 2008 and 2020 were selected and divided into propofol group and dexmedetomidine group based on the sedative agent used. The primary outcome was all-cause in-hospital mortality, and secondary outcomes included 90-day all-cause mortality and duration of mechanical ventilation. Inverse probability of treatment weighting (IPTW) was used to adjust for baseline confounders, and logistic regression and linear regression were applied to analyze the effects of the two sedative drugs on the outcomes of mechanically ventilated patients with pulmonary infection. Kaplan-Meier survival curves were used to analyze survival outcomes.Results:A total of 6 204 critically ill patients with pulmonary infection requiring mechanical ventilation were included, with 3 439 cases in propofol group and 2 765 cases in dexmedetomidine group. The baseline characteristics between the two groups were well balanced (standardized mean difference < 0.1) after IPTW adjustment. In the IPTW-adjusted cohort, the in-hospital all-cause mortality and 90-day all-cause mortality were significantly lower in dexmedetomidine group than in propofol group (439.2[18.7%] vs 563.6[24.1%], 618.0[26.3%] vs 733.6[31.3%], P<0.001), the results of Further Kaplan-Meier survival curve analysis showed that the 90-day all-cause mortality was significantly lower in dexmedetomidine group than in propofol group ( P<0.01). Conclusions:Compared with propofol, dexmedetomidine can decrease the mortality rate and improve the prognosis in mechanically ventilated patients with severe pulmonary infection when used for sedation.

Discipline construction is the power source to realize the high quality development of public hospitals,and high quality scientific research management is the inevitable path to realize the connotative development of public hospitals.The quality improvement of scientific research project process management is step-by-step,and mid-term inspection is a representative work.This paper applies PDCA cycle theory to the mid-term inspection of scientific research projects,analyzes the problems encountered in the mid-term inspection of scientific research projects from the four stages of plan,implementation,check and act,and develops effective intervention measures.The mid-term inspection mode,which combines publicity activities of scientific research norms with self-examination by researchers and on-the-spot inspection by the scientific research department,should be carried out to standardize the process of mid-term inspection of scientific research projects and promote the high-quality development of scientific research in hospitals.

Objective To investigate the incidence of anemia and evaluate the immune status among newly reported HIV/AIDS patients in Jiangsu Province in 2021, and to identify the risk factors of anemia among patients living with HIV infections. Methods Newly reported HIV/AIDS patients in Jiangsu Province from January 1 to December 31, 2021 that were registered in China’s National AIDS Comprehensive Control Information Management System were enrolled. Subjects’ fresh whole blood samples were collected, and hemoglobin levels, CD4 and CD8 cell counts and HIV viral loads were measured. Anemia was defined according to hemoglobin levels, and the immunological parameters and HIV viral loads were compared between HIV-infected patients with and without anemia. The risk factors of anemia were identified among individuals living with HIV infections using univariate analysis and multivariate logistic regression analysis. In addition, subjects’ CD4 cell counts one year following antiretroviral therapy (ART) were retrieved from China’s National AIDS Comprehensive Control Information Management System, and compared between subjects with and without anemia. Results A total of 635 newly diagnosed HIV/AIDS patients were reported in Jiangsu Province in 2021, including 544 males (85.67%) and 91 females (14.33%), and with ages of 15 to 83 years, and the overall incidence of anemia was 5.51% (35/635) among the study subjects. Men, individuals at ages of 45 years and lower and workers had relatively higher hemoglobin levels, with median hemoglobin levels of 156 (interquartile range, 22), 154 (interquartile range, 23) g/L and 162 (interquartile range, 19) g/L, respectively. The median baseline HIV viral load was 40 500.00 (interquartile range, 119 735.00) copies/mL among HIV-infected individuals with anemia and 29 754.00 (69 183.00) copies/mL among those without anemia (Z = -0.91, P = 0.31), and the median baseline CD4 and CD8 cell counts were significantly lower among HIV-infected individuals with anemia [166 (interquartile range, 143) cells/μL and 755 (653) cells/μL] than those without anemia [308 (253) cells/μL and 892 (638) cells/μL] (Z = -4.36 and -2.37, both P values < 0.05). The median CD4 cell counts remained lower among HIV-infected individuals with anemia than those without anemia [296 (interquartile range, 229) cells/μL vs. 457 (interquartile range, 313) cells/μL; Z = -3.71, P < 0.05] one year following ART, and the proportions of moderate and severe immunosuppression were significantly higher among HIV-infected individuals with anemia (40.00% and 17.14%) than those without anemia (21.00% and 9.33%) (χ² = 10.37 and 8.79, both P values < 0.01). Univariate analysis showed a higher detection rate of anemia among female HIV-infected individuals than among males [odds ratio (OR) = 4.528, 95% confidence interval (CI): (3.811, 5.245), P < 0.001], a higher rate among HIV-infected individuals at ages of 45 to < 60 years [OR = 3.415, 95% CI: (1.191, 9.788), P = 0.022] and 60 years and older [OR = 5.820, 95% CI: (2.013, 16.826), P < 0.001] than among those at ages of 15 to < 30 years, a higher rate among HIV-infected individuals through heterosexual transmission than among those through homogeneous transmission [OR = 3.015, 95% CI: (1.423, 6.387), P = 0.004], a lower rate among HIV-infected individuals with an educational level of college and above than among those with an educational level of primary school [OR = 0.103, 95% CI: (0.028, 0.386), P < 0.001], a higher rate among HIV-infected individuals with baseline CD4 cell counts of < 200 cells/μL than among those with baseline CD4 cell counts of 200 cells/μL and higher [OR = 4.340, 95% CI: (2.165, 8.702), P < 0.001], and lower detection rates among HIV-infected individuals with CD4/CD8 cell ratios of 0.208 to < 0.326 [OR = 0.232, 95% CI: (0.076, 0.711), P = 0.011] and 0.516 and higher [OR = 0.292, 95% CI: (0.104, 0.818), P = 0.019] than among those with CD4/CD8 cell ratios of < 0.208. Multivariate logistic regression analysis identified woman [OR = 4.945, 95% CI: (3.944, 5.946), P = 0.002], and CD4 cell counts of < 200 cells/μL [OR = 3.597, 95% CI: (1.448, 8.937), P = 0.006] as risk factors of anemia among newly reported HIV/AIDS patients. Conclusions The incidence of anemia was low among newly reported HIV/AIDS patients in Jiangsu Province in 2021, and the immune status was poorer among HIV-infected individuals with anemia than those without anemia at baseline and one year following ART. Female and CD4 cell counts of < 200 cells/μL are risk factors of anemia among individuals living with HIV infections, and intensified surveillance, follow-up and precision interventions are recommended targeting female HIV-infected individuals and HIV-infected individuals with low CD4 cell counts.