Objective To explore the diagnostic value of musculoskeletal ultrasound in patients with limb pain.Methods A total of 80 patients with limb pain admitted to the First Hospital of Nanchang from January 2021 to December 2022 were included in the study.All patients received magnetic resonance imaging(MRI)and musculoskeletal ultrasound on admission.The consistency and coincidence rate of musculoskeletal ultrasound and MRI in diagnosing the cause of limb pain were compared.Results In the 80 patients,MRI and musculoskeletal ultrasound detected positive results in 78 cases,accounting for 97.50%,and 2 cases had no clear disease type.According to the results of MRI,there were 75 cases in which musculoskeletal ultrasound diagnosis of the cause of limb pain was consistent with the MRI results,and total coincidence rate was 96.15%(75/78),with excellent consistency(Kappa=0.907).Conclusion Musculoskeletal ultrasound can clearly display the fine tissue structure,and the diagnosis accuracy of limb pain is high,and the diagnosis consistency with MRI is excellent.

Objective:To evaluate the role of minimal residual disease (MRD) monitoring during early induction therapy for the treatment of childhood acute lymphoblastic leukemia (ALL).Methods:This was a multicenter retrospective cohort study. Clinical data of 1 164 ALL patients first diagnosed between October 2016 and June 2019 was collected from 16 hospitals in South China Children′s Leukemia Group. According to MRD assay on day 15 of early induction therapy, they were divided into MRD<0.10% group, MRD 0.10%-<10.00% group and MRD≥10.00% group. According to MRD assay on day 33, they were divided into MRD<0.01% group, MRD 0.01%-<1.00% group and MRD≥1.00% group. Age, onset white blood cell count, central nervous system leukemia (CNSL), molecular genetic characteristics and other data were compared between groups. Kaplan-Meier method was used for survival analysis. Cox regression model was used to analyze prognostic factors.Results:Of the 1 164 enrolled patients, there were 692 males and 472 females. The age of diagnosis was 4.7 (0.5, 17.4) years. The white blood cell count at initial diagnosis was 10.7 (0.4, 1 409.0) ×10 9/L. Among all patients, 53 cases (4.6%) had CNSL. The follow-up time was 47.6 (0.5, 68.8) months. The 5-year overall survival (OS) and 5-year relapse-free survival (RFS) rates were (93.1±0.8) % and (90.3±1.1) %. On day 15 of early induction therapy, there were 466 cases in the MRD<0.10% group, 523 cases in the MRD 0.10%-<10.00% group and 175 cases in the MRD≥10.00% group. The 5-year OS rates of the MRD<0.10% group, MRD 0.10%-<10.00% group and MRD≥10.00% group were (95.4±1.0) %, (93.3±1.1) %, (85.4±2.9) %, respectively, while the RFS rates were (93.2±1.6) %, (90.8±1.4) %, (78.9±4.3) %, respectively ( χ2=16.47, 21.06, both P<0.05). On day 33 of early induction therapy, there were 925 cases in the MRD <0.01% group, 164 cases in the MRD 0.01%-<1.00% group and 59 cases in the MRD≥1.00% group. The 5-year RFS rates in the MRD 0.01%-<1.00% group was lowest among three groups ((91.4±1.2) % vs. (84.5±3.2) % vs. (87.9±5.1) %). The difference between three groups is statistically significant ( χ2=9.11, P=0.010). Among ALL patients with MRD≥10.00% on day 15 of induction therapy, there were 80 cases in the MRD <0.01% group on day 33, 45 cases in the MRD 0.01%-<1.00% group on day 33 and 45 cases in the MRD≥1.00% group on day 33. The 5-year RFS rates of three groups were (83.9±6.0)%, (67.1±8.2)%, (83.3±6.9)% respectively ( χ2=6.90, P=0.032). Univariate analysis was performed in the MRD≥10.00% group on day 15 and the MRD 0.01%-<1.00% group on day 33.The 5-year RFS rate of children with CNSL was significantly lower than that without CNSL in the MRD≥10.00% group on day 15 ((50.0±20.4)% vs. (80.3±4.4)%, χ2=4.13, P=0.042). Patients with CNSL or MLL gene rearrangement in the MRD 0.01%-<1.00% group on day 33 had significant lower 5-year RFS rate compared to those without CNSL or MLL gene rearrangement ((50.0±25.0)% vs. (85.5±3.1)%, χ2=4.06, P=0.044;(58.3±18.6)% vs. (85.7±3.2)%, χ2=9.44, P=0.002). Multivariate analysis showed that age ( OR=0.58, 95% CI 0.35-0.97) and white blood cell count at first diagnosis ( OR=0.43, 95% CI 0.27-0.70) were independent risk factors for OS. The MRD level on day 15 ( OR=0.55,95% CI 0.31-0.97), ETV6-RUNX1 fusion gene ( OR=0.13,95% CI 0.03-0.54), MLL gene rearrangement ( OR=2.55,95% CI 1.18-5.53) and white blood cell count at initial diagnosis ( OR=0.52,95% CI 0.33-0.81) were independent prognostic factors for RFS. Conclusions:The higher the level of MRD in early induction therapy, the worse the OS. The MRD levels on day 15 is an independent prognostic factor for RFS.The MRD in early induction therapy guided accurate risk stratification and individualized treatment can improve the survival rate of pediatric ALL.

Objective To evaluate the effect of the current immunization strategy for hepatitis B virus (Hepatitis B) in blocking mother-to-infant transmission in Hubei Province, and to explore the mechanism and possible influencing factors of failure of mother-to-infant blockade. Methods A multi-stage random sampling method was used to select 2 counties or districts in Hubei Province. Through maternity hospital health handbook, neonatal health record or hospital medical record system, hepatitis B virus (HBV) surface antigen (HBsAg)-positive pregnant women in 2012-2018 years were included to retrospectively investigate their delivery status and the HBV infection status of their children. Results Among the 302 newborns, 32 were positive for HBsAg, and the success rate of blockade of mother-to-infant transmission of hepatitis B was 89.45%. Further analysis showed that 68.21% (206 / 302) of newborns were delivered in township hospitals, 66.23% (200 / 302) were delivered by caesarean section and 41.72% (126 / 302) were breastfed, while 16.89% (51/302) were positive for hepatitis B virus e antigen (HBeAg), and 41.06% (124/302) were positive for anti-HBe. The vaccination rate of hepatitis B immunoglobulin (HBIG) during pregnancy was 3.31% (10/302), and the newborn HBIG vaccination rate was 94.37% (285/302). There were 84.11% (254/302) of pregnant women taking protective measures in daily life. Logistic regression analysis showed that township hospitals (OR=2.82, P<0.05), HBeAg positivity during pregnancy (OR=8.68, P<0.05), and HBIG vaccination during pregnancy (OR=12.62 , P<0.05) were risk factors for failure of mother-to-infant blockade, while anti-HBe positivity during pregnancy (OR=0.22, P<0.05), vaccination of newborns with HBIG (OR=0.20, P<0.05), and protective measures taken in daily life (OR=0.28, P<0.05) were protective factors for mother-to-infant interruption. Conclusion Deliveries in township hospitals and HBeAg-positivity during pregnancy are more likely to fail in blocking of mother-to-infant transmission of hepatitis B. HBIG vaccination during pregnancy does not reduce the risk of blockade failure. Neonatal HBIG vaccination, anti-HBe positivity during pregnancy, and protective measures in daily life can reduce the risk of blockade failure of mother-to-infant transmission of hepatitis B.

Objective To summarize the clinical characteristics of patients with occupational melanosis. Methods Diagnostic data of 69 patients with occupational melanosis was analyzed using retrospective analysis. Results The main occupational hazards for the 69 patients with occupational melanosis were coal tar, petroleum and its fractionated products, pigments and dyes and their intermediates, rubber additives and rubber products. The median length of occupational exposure and disease latency were 8.0 and 6.0 years, respectively, with a highly positive correlation between them (Spearman correlation coefficients=0.962, P<0.01). Skin lesions were mainly found on exposed areas such as the face-to-neck and limbs, prevalence of 94.2% and 75.4% respectively. And 78.3% of patients had skin lesion on more than two sites. The lesions were mostly in the form of irregular flakes (59.4%), with a gray-black color (44.9%). About 43.5% of patients experienced skin itching. Complete blood count, liver function, and kidney function were all within normal ranges. Skin biopsy results showed that epidermal hyperkeratosis, thinning of the spinous layer, liquefaction degeneration of basal cells, increased superficial dermal melanocytes, and infiltration of lymphocytes, histiocytes, and melanocytes around the blood vessels. Reflectance confocal microscopy (RCM) detection showed focal liquefaction degeneration of basal cells in the lesions, with a significant infiltration of melanocytes and inflammatory cells in the dermal papillae and superficial layers. Conclusion The primary target organ of occupational melanocytes is the skin, and no damage to other organs was identified thus far. Results from skin biopsies and RCM examinations can be used for differential diagnosis.

Ultrasound-guided serratus anterior plane block is one of the ways to provide analgesia to post thoractomy.It appears to be more easily performed compared with other techniques and is applied to be a postoperative analgesia for chest surgery such as breast cancer,ribs fracture and lung cancer.The review studies the using of serratus anterior plane block in clinical pain management.

Objective To investigate the effect of ultrasound-guided serratus plane block (SAPB) on efficacy of postoperative analgesia in patients undergoing video- assisted thoracoscopic surgery. Methods Sixty patients scheduled for video- assisted thoracoscopic radical resection of lung cancer under general anesthesia from October 2017 to April 2018 were divided into 2 groups by random digits table method with 30 cases each: SAPB group and control group. After induction of anesthesia, ultrasound-guided homolateral SAPB was performed, and 0.5％ ropivacaine 20 ml was injected in SAPB group, while the equal volume of normal saline was used instead in control group. The patients received intravenous analgesia after operation in 2 groups. The scores of visual analogue score (VAS) and Bruggrmann comfort score (BCS) were evaluated at 1, 2, 4, 6, 12, 24 and 48 h after operation. The consumption of additional pain medication within 48 h after operation and remifentanil during operation were recorded. The adverse effects were also recorded. Results The VAS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly lower than those in control group: (2.70 ± 0.92) scores vs. (5.10 ± 2.04) scores, (2.80 ± 1.00) scores vs. (5.13 ± 1.78) scores, (3.07 ± 1.17) scores vs. (4.93 ± 1.53) scores, (3.13 ± 1.07) scores vs. (4.63 ± 1.47) scores and (2.87 ± 0.73) scores vs. (3.83 ± 1.29) scores, P <0.05; the BCS scores at postoperative 1, 2, 4, 8 and 12 h in SAPB group were significantly better than those in control group: (1.90 ± 0.66) scores vs. (0.93 ± 0.91) scores, (2.03 ± 0.41) scores vs. (0.90 ± 0.80) scores, (1.90 ± 0.40) scores vs. (1.07 ± 0.69) scores, (1.97 ± 0.32) vs. (1.20 ± 0.66) scores and (2.03 ± 0.18) scores vs. (1.73 ± 0.45) scores, and there were statistical differences (P<0.05). The dose of remifentanil consumption of additional pain medication within 48 h in SAPB group were significantly lower than those in control group: (0.23 ± 0.03) mg vs. (0.34 ± 0.03) mg and (26.67 ± 25.37) mg vs. (40.00 ± 24.21) mg, and there were statistical differences (P<0.05). There was no significant difference in the incidence of adverse reactions between 2 groups (P > 0.05). Conclusions The SAPB can reduce the early pain after video-assisted thoracoscopic radical resection of lung cancer, improve the comfort of patients, enhance the effect of postoperative analgesia and reduce the use of postoperative analgesic drugs.

Objective To investigate the risk factors for childhood acute leukemia complicated with streptococcus mitis bacteriaemia and to explore a better therapeutic regimen of antibiotics.Methods Seventy-eight cases of childhood acute leukemia complicated with bacteriaemia hospitalized in Zhujiang Hospital of Southern Medical University from January 2012 to December 2016 were collected,among them there were 8 cases (10.26％) caused by streptococcus mitis.The susceptible factors,clinical manifestations,drug susceptibility,treatments and outcomes of 8 cases of streptococcus mitis bacteriaemia were summarized and analyzed.Results All of 8 cases were attacked during the agranulocytosis phase lasting for more than 1 week after chemotherapy for acute leukemia.Four cases of them had been exposed to the third-generation cephalosporins for more than 7 days,and 5 cases exposed to proton pump inhibitor (PPI) for more than 10 days.The incidence of remittent fever,shiver,stomatitis and pneumonia was 100.0％ (8/8 cases),62.5％ (5/8 cases),62.5％ (5/8 cases) and 62.5％ (5/8 cases),respectively.And severe pneumonia occurred at a rate of 37.5％ (3/8 cases).The sensitivity to Linezolid,Vancomycin,Penicillin and Cefotaxime was 100.0％,100.0％,37.5％ and 25.0％,respectively.Five of the 7 cases treated with Meropenem had a fever 3 days later and then they took Linezolid as a replacement according to the drug sensitivity.One case was treated with Cefoperazone-Sulbactam.The duration time of fever,positive blood culture,agranulocytosis and course of antibiotics therapy was 1-19 d(10.4 d on average),4-22 d(13.4 d on average),10-30 d (21.6 d on average),9-26 d (18.3 d on average),respectively.Among 3 patients with severe pneumonia,1 patient received the respirator assisted ventilation for 1 week.Conclusions Streptococcus mitis is one of the major causes of severe infection among children with acute leukemia.Agranulocytosis after chemotherapy,stomatitis,exposure to PPI and antibiotics may be the risk factors for streptococcus mitis infection.Fever,stomatitis,respiratory and digestive symptoms are the common clinical manifestations.Streptococcus mitis is resistant to Penicillin and Cefotaxime,but sensitive to Linezolid,which can shorten the course of infection and improve the outcomes.Thus,Linezolid may serve as an optional therapy for streptococcemia mitis bacteriaemia.

Acute Stanford type A aortic dissection with important branches involved is more complex, could lead to organ malperfusion syndrome even organ failure. The understanding of pathological anatomy, classification, staging, and the pathophysiological change has increasingly mature, but not complete. In addition, the treatment strategy for complex lesions is diversified, some questions may not reach consensus. Fully understanding of the anatomical and pathophysiology is very important for surgeons to choose reasonable treatment strategy. As the rapid development of the basic research, imaging techniques and the concept of surgery procedures, the manage technique of Stanfrod type A dissection and branch vessels at the same time is getting seriously, the related issues also need further discussions.

Objective To develop the Quality of Life Questionnaire with traditional Chinese medicine characteristics for patients with ulcerative colitis.Methods The pool of entries were initially formed by using literature review,theoretical analysis and interviews.Delphi technique was used to formulate.quality of life questionnaire for patients with ulcerative colitis through a two-round expert consultation among 22 experts in 9 provinces.Results In two-round surveys,the rates of questionnaire retrieve were 95.7％ and 100.0％,respectively.The authoritative coefficients was 0.85,the coordination coefficients were 0.288 and 0.290,respectively,P＜ 0.01.The preparation of the primary scale consisted of physical,psychological,independence and social function of 4 dimensions and 48 items.Conclusions A reliable and valid questionnaire with traditional Chinese medicine characteristics for evaluation of quality of life for patients with ulcerative colitis was developed.It can be used to provide reference for the evaluation of the quality of life for patients with ulcerative colitis in China.

Objective To explore the relationship between the MRI enhancement ratios of liver parenchyma in hepatobiliary phase with gadobenate dimeglumine (Gd-BOPTA)and liver function.Methods Fifty-nine patients who underwent Gd-BOPTA-enhanced MRI were retrospectively enrolled in the study.The enhancement ratio of signal to noise ratio and enhancement ratio of the contrast ratio were calculated.The relationships between the enhancement ratio and CTP grading and MELD score were analyzed.Results The signal enhancement ratios in hepatobiliary phase in patients with CTP A classification were higher than those with CTP B classi-fication (P <0.01).Meanwhile,the ratios in patients with MELD scores less than 10 points were higher than those with MELD scores more than 10 points (P <0.01).Conclusion The MR enhancement degree of liver parenchyma in the hepatobiliary phase with Gd-BOPTA may reflect the liver function.