Objective:To analyze the efficacy and safety of Minocycline for treating macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) in children aged 6-14 years, and to investigate the influencing factors of severe Mycoplasma pneumoniae pneumonia (SMPP). Methods:Retrospective cohort study.The clinical data of 247 children with MUMPP hospitalized in the Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University from August to December 2023 were analyzed.According to the medication 3 to 7 days after conventional macrolide treatment, the children were divided into an Azithromycin group (107 cases) and a Minocycline group (140 cases). Clinical indicators such as the length of hospital stay and chest radiograph absorption time were compared between the two groups.Multivariate Logistic regression analysis was performed on children with SMPP to explore the correlation of the incidence of severe cases with the initiation time of Minocycline, serum vitamin D, lactate dehydrogenase (LDH), C-reactive protein (CRP) levels.Results:In the Minocycline group, the median hospital stay was shortened by 1.0 d (4.0 d vs.5.0 d, P=0.008), the median time for cough improvement after hospitalization was reduced by 3.0 d (2.0 d vs.5.0 d, P<0.001), and the duration of coughing, time to normal body temperature, and the 1-2-week improvement rate of chest imaging [91.4%(128/140) vs.49.5%(53/107), P<0.001] were all significantly better, compared with those in the Azithromycin group.In addition, the Glucocorticoid use rate [35.7%(50/140) vs.49.5%(53/107), P=0.029] in the Minocycline group was significantly lower than that in the Azithromycin group.The incidence of drug-related adverse reactions was only 0.71%(1/140) in the Minocycline group.A longer duration of macrolide treatment before Minocycline administration [odds ratio ( OR)=1.386, 95% confidence interval ( CI): 1.038-1.850, P=0.027], lower serum vitamin D levels ( OR=0.841, 95% CI: 0.748-0.945, P=0.004), elevated LDH levels ( OR=1.023, 95% CI: 1.009-1.037, P=0.001), and elevated CRP levels ( OR=1.074, 95% CI: 1.035-1.114, P<0.001) were associated with SMPP.The area under the receiver operating characteristic curve of the combined model for predicting SMPP was 0.912 7. Conclusions:Minocycline shows better efficacy than Azithromycin in treating MUMPP children aged 6-14 years, with comparable safety.LDH and CRP levels are independent risk factors for SMPP, while the serum vitamin D level is a protective factor.Early initiation of Minocycline treatment can optimize the clinical outcome.

Objective:To analyze the efficacy and safety of Minocycline for treating macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) in children aged 6-14 years, and to investigate the influencing factors of severe Mycoplasma pneumoniae pneumonia (SMPP). Methods:Retrospective cohort study.The clinical data of 247 children with MUMPP hospitalized in the Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University from August to December 2023 were analyzed.According to the medication 3 to 7 days after conventional macrolide treatment, the children were divided into an Azithromycin group (107 cases) and a Minocycline group (140 cases). Clinical indicators such as the length of hospital stay and chest radiograph absorption time were compared between the two groups.Multivariate Logistic regression analysis was performed on children with SMPP to explore the correlation of the incidence of severe cases with the initiation time of Minocycline, serum vitamin D, lactate dehydrogenase (LDH), C-reactive protein (CRP) levels.Results:In the Minocycline group, the median hospital stay was shortened by 1.0 d (4.0 d vs.5.0 d, P=0.008), the median time for cough improvement after hospitalization was reduced by 3.0 d (2.0 d vs.5.0 d, P<0.001), and the duration of coughing, time to normal body temperature, and the 1-2-week improvement rate of chest imaging [91.4%(128/140) vs.49.5%(53/107), P<0.001] were all significantly better, compared with those in the Azithromycin group.In addition, the Glucocorticoid use rate [35.7%(50/140) vs.49.5%(53/107), P=0.029] in the Minocycline group was significantly lower than that in the Azithromycin group.The incidence of drug-related adverse reactions was only 0.71%(1/140) in the Minocycline group.A longer duration of macrolide treatment before Minocycline administration [odds ratio ( OR)=1.386, 95% confidence interval ( CI): 1.038-1.850, P=0.027], lower serum vitamin D levels ( OR=0.841, 95% CI: 0.748-0.945, P=0.004), elevated LDH levels ( OR=1.023, 95% CI: 1.009-1.037, P=0.001), and elevated CRP levels ( OR=1.074, 95% CI: 1.035-1.114, P<0.001) were associated with SMPP.The area under the receiver operating characteristic curve of the combined model for predicting SMPP was 0.912 7. Conclusions:Minocycline shows better efficacy than Azithromycin in treating MUMPP children aged 6-14 years, with comparable safety.LDH and CRP levels are independent risk factors for SMPP, while the serum vitamin D level is a protective factor.Early initiation of Minocycline treatment can optimize the clinical outcome.

Objective To investigate the indirect decompression effect of oblique lateral interbody fusion (OLIF) in the treatment of mild to moderate degenerative lumbar stenosis.Methods From October 2014 to November 2016,23 patients with mild to moderate lumbar spinal stenosis underwent OLIF combined with or without posterior pedicle screw fixation;9 males and 14 females with average age of 59.2±11.6 years old;8 cases at L3,4 segment and 15 cases at L4,5 segment.All cases were followed up for more than 6 months.Thin layer scanning of CT and two-dimensional reconstruction images were used to measure the vertical diameter and area of intervertebral foramen.Intervertebral disc height and spinal canal anteroposterior diameter were measured on median sagittal MRI sequence,and the anteroposterior diameter and the cross-sectional area of the spinal canal were measured on cross-sectional MRI sequence.The clinical effects were assessed by the visual analogue score (VAS) and the Oswestry disability index (ODI) for low back pain,lower limb pain and lower limb numbness.Results Compared with those measurements pre-operatively,the post-operative intervertebral disc height increased by 78.6％±13.4％.The post-operative left vertical diameter of intervertebral foramen increased by 36.7％±7.8％,and the post-operative left area of intervertebral foramen increased by 36.6％± 8.7％,and the post-operative right vertical diameter of intervertebral foramen increased by 40.7％±9.6％,and the post-operative right area of intervertebral foramen increased by 40.0％±8.9％.The post-operative anteroposterior diameter of sagittal spinal canal were increased 32.6％ ± 5.9％,and the post-operative anteroposterior diameter of cross-sectional spinal canal were increased 34.4％±6.8％,and the post-operative cross-sectional area of the spinal canal were increased 47.5％±7.2％.All of the differences were statistically significant between pre-operative and post-operative measurements.The VAS score for low back pain was 6.2± 1.7 pre-operatively,and 1.1±0.5 post-operatively.The ODI for low back pain was 81.2％± 18.2％ pre-operatively,and 6.1％±2.0％ post-operatively.The VAS score for lower limb pain was 5.6±1.4 pre-operatively,and 0.8±0.3 post-operatively.And the VAS score for lower limb numbness was 6.6±2.0 pre-operatively,and 3.4± 1.2 post-operatively.All of the differences were statistically significant between pre-operative and post-operative evaluations.Conclusion There were obvious radiological evidences and remarkable clinical effect of indirect decompression using OLIF technique in treatment of mild to moderate lumbar spinal stenosis at early post-operative stage.However further long-term follow-up studies with multicenter large sample were still needed.

Objective To investigate the effect of ultrasound-guided subcostal transverses abdominis plane (TAP) block with dexmedetomidine after laparoscopic radical operation. Methods 40 patients underwent laparoscopic radical operation for colorectal cancer were randomized into dexmedetomidine group (group DEX) and control group (group CON). All the patients received ultrasound-guided subcostal TAP block after operation, Group DEX with dexmedetomidine 1 μg/kg and 0.25% ropivacaine to 20 ml, and group CON with 0.25% ropivacaine 20 ml. All the patients were assessed with Ramsay scores and the pain at rest and on coughing were assessed with Visual Analogue Scale (VAS), 2, 6, 12, 24 and 24 hours after operation. The highest level and the duration of sensory blockade, the first time and the total times of pressing the analgesia pump in the first day after operation, and the requirements of sufentanil were recorded. First flatus time, first diet time and the length of hospital stay were compared. Results The scores of VAS were significantly less (P<0.001), and the Ramsay scores were more in the group DEX than in the group CON (P<0.01) 2, 6 and 12 hours after operation; with the longer time of sensory blockade (P<0.001), the later to first press the analgesia pump (P<0.001), the less frequence of pressing the analgesia pump (P<0.001), and less dosage of sufentanil (P<0.001). The first flatus time, first diet time were significantly earlier in the group DEX than in the group CON (P<0.001), with the less length of total hospital stay (P<0.001). Conclusion Dexmedetomidine can promote the anaesthesia of ultrasound-guided subcostal TAP block with ropivacaine and improve the recovery after laparoscopic radical operation.

Objective To study the relationship between spinal shifting and C5 palsy after posterior approach cervical decompression surgery (PACDS).Methods Twenty-four patients underwent PACDS were examined with MRI before and one month after operation.The spinal shifting were measured.Clinical and imaging characteristics of patients with post-operative C5 palsy were observed.Analyzed the correlation between C5 palsy and spinal shifting after operation.Results The average spinal shifting was (2.41 ± 0.46) mm.Three cases developed C5 palsy,whose spinal shifting at C5 level was significantly greatert han those without C5 palsy.Conclusion Excessive posterior spinal shifting after PACDS can drag C5 nerve root leading to C5 palsy.

Objective To summarize clinical experience in application of nail-bed lengthening operation for fingertip injuries.Methods From September 2003 to May 2007,36 patients (25 men and 11 women) aged 16 -45 years (26 in average) with nail defect by fingertip injuries underwent reconstruction operation using nail-bed lengthening at Orthopaedics and Traumatology Hospital of Taizhou,with the thumb involved in 15 cases,the index finger in 10 cases,the middle finger in eight eases and the ring finger in three case.A skin rectangle with thickness of 2 - 3 mm and width as that of the nail was resected at the skin edge 5 -6 mm distant from the epenychium,without damage to underlying subcutaneous vascular network, and U-shape skin flap was delicately slid proximally with its ends sutured.Results All surgical operations for nail lengthening were uneventful and clinically satisfactory,and the appearance of the thumb or other fingers was good during follow-up for six months to three years (19 months in average).Conclusions Nail lengthening for fingertip injuries with nail defect is a simple and effective surgical operation which could improve the appearance of the thumb and other fingers.

From September 2002 to May 2006, five patients ( age range, 24 to 46; mean, 32) with tibial defect underwent transplantation of free latissmus dorsi osteocutaneous flap using bridge-like vascular anastomosis. All the osteocutaneous flaps survived without any serious complications, and tibial defects were improved completely. After 1.5 to 4.5 years' follow-up ( mean, 2.6), no remarkable dysfunction was found at donor sites, and local injury was reduced. This study indicates that transplantation of free latissmus dorsi osteocutaneous flap using bridge-like vascular anastomosis might be useful in leg reconstructive surgery if only one vessel is remained.

In the item bank construction of medical microbiology examination questions,the accurate difficulty coefficient is an important parameter to guarantee the quality of the bank.Thus,the accurate difficulty estimate plays an important role in the item bank construction of examination questions.Methods of estimating the difficulty of medical microbiology test questions were explored,based on the knowledge points,the type of test questions,the structure of test questions and the degree of students’ familiarity with the questions and so on.Finally,the feasibility of methods was confirmed through the simulated tests.

The training of basic scientific research skills is very important for seven-year medical program students. Through various kinds of scientific research training in preclinical medical teaching stage, the students’ abilities of scientific thinking, performing experiments, and writing scientific papers have been improved.