Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

ObjectiveTo study the changes of body composition indexes reflecting muscle condition for stroke hemiplegic patients after isokinetic strength training. MethodsFrom January, 2021 to April, 2022, 30 stroke inpatients with hemiplegia in Beichen Hospital of Nankai University were randomly divided into control group (n = 15) and isokinetic group (n = 15). Both groups accepted routine rehabilitation training, while the isokinetic group accepted isokinetic strength training of shoulder and elbow on the affected side in addition. All patients were tested the lean body mass, affected upper arm muscle circumference, affected upper limb muscle mass, edema index, skeletal muscle index before, and two weeks and four weeks after training. ResultsCompared with the control group, the edema index decreased in isokinetic group after training (t > 2.536, P < 0.05); the affected upper limb muscle mass increased more in the isokinetic group four weeks after training (t = -2.750, P = 0.010). ConclusionIsokinetic training can reduce edema and muscular disuse atrophy of the affected side for stroke patients with hemiplegia.

Objective:To characterize the radial head fracture combined with capitulum cartilage injury (CCI).Methods:The data of 110 patients were analyzed retrospectively who had been treated for radial head fracture at Department of Orthopaedics, The Ninth People's Hospital of Wuxi from January 2011 to May 2020. They were 62 males and 48 females, aged from 17 to 74 years (average, 44.10 years). According to the finding of intraoperative exploration whether CCI was complicated or not, they were assigned into a CCI group and a CCI-free group. The diagnosis, location, size, type, operation method and postoperative recovery of CCI were observed in CCI group. The 2 groups were compared in terms of preoperative general data, range of forearm motion before and after operation and functional recovery of the limb by Mayo elbow performance score (MEPS).Results:CCI was complicated in 25 cases (type Ⅰ in 7 ones, type Ⅱ in 12 ones and type Ⅲ in 6 ones), involving all Mason types of radial head fracture, and located at the lateral capitellum in 13 cases, at the posterolateral capitellum in 9 cases and at the anterolateral capitellum in 3 cases. CCI was diagnosed before operation in 13 cases by physical examination after local anesthesia and imaging examination with a rate of 48% (12/25) for missed diagnosis. The preoperative flexion and extension (61.8°±13.7°) and rotation (60.0°±24.2°) in CCI group were significantly less than those in CCI-free group (77.7°±23.0° and 79.9°±21.9°) ( P<0.05); the Mason types of radial head fracture in CCI group were significantly more serious than those in CCI-free group ( P<0.05). There was no significant difference between the 2 groups in age, gender, combined injury, treatment of radial head fracture, follow-up time, range of forearm motion at the last follow-up or MEPS score ( P>0.05). Conclusions:CCI was complicated in 22.73%(25/110) of the radial head fractures in this cohort and found in all Mason types of radial head fracture, and mostly located at the lateral and posterolateral capitellum. CCI is likely to be missed by imaging examination. In patients with mild radial head fracture and suspected CCI, positive physical examination after local anesthesia is valuable for diagnosis of CCI complication and operative indication. Care should be taken to detect CCI complication by intraoperative exploration in surgery of radial head fracture.

Objective:To understand the current status of HIV self-testing reagent use in pre-exposure prophylaxis (PrEP) and related factors in men who have sex with men (MSM).Methods:From December 2018 to December 2019, "Gold data" online platform (www.jinshuju.com) was used to conduct multicenter PrEP studies in Shenyang, Beijing, Chongqing and Shenzhen of China.Results:A total of 1 222 MSM PrEP users were included in the multicenter study. The average age of the participants was (31.5±8.7) years, and the number of sexual partners in the past three months was 3 ( P 25, P 75:2,6). The proportions of those who did not use condoms in anal sex with fixed, casual and commercial partners were 62.7% (456/727), 56.3% (440/781) and 41.0% (16/39), respectively. Up to 74.5% (910/1 222) of participants had used HIV self-testing reagents, and the number of HIV self-testing during last year was 3 ( P 25, P 75:2,5). The multivariate logistic regression analysis indicated that compared with age group >40 years, those with education level of junior high school or below, those with psychological identity as female, event driven PrEP users, those never using new type drugs in past 3 months, the participants aged 18- years (a OR=2.06, 95% CI: 1.35-3.14), 26- years (a OR=2.72, 95% CI: 1.77-4.17), 31- years (a OR=1.76, 95% CI: 1.19-2.59), undergraduates (a OR=2.18, 95% CI: 1.35-3.49), graduate students and above (a OR=3.06, 95% CI: 1.69-5.54), those with psychological identity as male (a OR=3.22, 95% CI: 1.55-6.70), daily PrEP users (a OR=1.35, 95% CI: 1.03-1.78), and new type drug users in the past three months (a OR=1.72, 95% CI: 1.30-2.28) had higher proportions of HIV self-testing behaviors. Conclusions:The proportion of HIV self-testing in MSM PrEP users was high, while it was relatively low in older age group, event driven PrEP users and MSM never using new type drugs. To assess and improve the effectiveness and compliance of PrEPs, it is necessary to provide better HIV self-testing service for MSM with low HIV self-testing rate.

Acute pancreatitis (AP) is a common disease faced by clinicians. Severe acute pancreatitis (SAP) has a high mortality rate, so early identification of patients who may develop into SAP is of great significance for guiding treatment. Machine learning is a multi-layer representational learning algorithm that analyzes and obtains laws from existing data and uses these laws to make predictions on unknown data. This study established an SAP prediction scoring system based on machine learning, which can predict the SAP risk of patients within 24 hours. The prediction accuracy rate is as high as 87.36% and AUC 94.11%. The model can better assist clinical decision-making and treatment, and guide doctors to make relevant interventions earlier.

Objective:To investigate the efficiency of the Montreal cognitive assessment (MoCA) and international human immunodeficiency virus dementia scale (IHDS) in asymptomatic neurocognitive impairment (ANI) and human immunodeficiency virus-associated dementia (HAD) screening among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM).Methods:According to the exclusion criteria, 210 HIV-infected MSM and 84 HIV-negative MSM were recruited from the First Hospital of China Medical University in Shenyang from December 2016 to December 2018. In this cross-sectional study, the MoCA and IHDS were performed among all HIV-positive and HIV-negative MSM, and their efficiency in ANI and HAD screening were analyzed. Student t-test, one-way analysis of variance and chi-square test were used for statistical analysis. Results:HIV-positive MSM had lower total scores of MoCA and IHDS [(26.04±3.41) and (11.15±1.44)] than HIV-negative controls [(27.58±1.85) and (11.67±0.52)] ( t =-4.970 and -4.542, respectively, both P<0.01). The differences of MoCA and IHDS total scores of HIV-infected patients with different cognitive functions were statistically significant ( F=117.982 and 49.291, respectively, both P<0.05). The proportions of patients with MoCA<26 points and IHDS≤10 points were statistically significant ( χ2=115.917 and 70.155, respectively, both P<0.05). In ANI screening, the cut-off of MoCA<26 points showed a sensitivity of 79% and a specificity of 91%, Youden index was 0.70; and the cut-off of IHDS≤11 points showed a sensitivity of 74% and a specificity of 75% Youden index was 0.49. In HAD screening, the cut-off of MoCA<24 points showed a sensitivity of 88% and a specificity of 87%, Youden index was 0.75; and the cut-off of IHDS≤10 points showed a sensitivity of 68% and a specificity of 87%, Youden index was 0.55. Conclusion:The MoCA is prefered to the IHDS in HIV-associated neurocognitive disorders screening among MSM population, and its cut-off score should be set for the purpose to screen different degrees of cognitive impairment.

Objective:To discuss the the effects, indications and protective measures of tracheotomy for severe cases of coronavirus disease 2019 (COVID-19) patients.Methods:A retrospectively analysis was conducted to explore the clinical data of COVID-19 patients who received tracheotomy in February to March 2020, and descriptive statistics were used to analyze the indication of tracheotomy, particularity of intraoperative treatment and protective measures.Results:A total of 4 cases were included in this article. All patients were successfully operated. One case had postoperative incision continuous bleeding, there were not other complications and nosocomial infection among the medical staff. The patient′s condition was relieved in different degrees after the operation, who remained hospitalized.Conclusion:Tracheotomy for severe cases of COVID-19 can achieve certain curative effect, but the occurrence of tracheotomy related complications and nosocomial infection should be effectively controlled, and the risk benefit ratio of tracheotomy should be carefully weighed before surgery.

Objective To evaluate the clinical outcomes and prognosis of older human immunodeficiency virus (HIV )-infected patients under antiretroviral therapy (ART ) in China .Methods This study was carried out in a retrospective cohort of HIV-infected patients initiated ART between January 2004 and December 2012 at The First Affiliated Hospital ,China Medical University .The patients were enrolled and divided into two groups ,including <50 years group (young and middle-aged group) and≥50 years group (older group) .Immunological and virological responses and mortality were analyzed . Data were analyzed by t test ,chi-square test ,two-way analysis of variance and log-rank test .Results Totally 291 subjects were included ,among whom 97 subjects were older patients and 194 subjects were young and middle-aged patients .Male was predominate in both groups ,which accounted for 91 .8％ and 87 .6％ ,respectively .The CD4+ T lymphocyte count in the older group before treatment was (151 .9 ±96 .2) cells /μL ,which was significantly lower than that in the young and middle-aged group (183 .4 ± 93 . 5) cells/μL (t= 2 .657 , P=0 .009) .At month 12 of treatment ,the CD4+ T lymphocyte count in the older group was significantly lower than that in the young and middle-aged groups (t= 2 .120 , P=0 .035) ,while there was no statistically significant difference between the two groups at month 24 (t=1 .025 ,P=0 .299) .The percentage of CD4+ T lymphocyte count increasing to 500 cells/μL in the older and youth groups during follow-up were 11 .3％ and 16 .0％ ,respectively (χ2=1 .127 ,P =0 .376) .Log-rank analysis showed that the mean times of virus inhibition in older group and young and middle-aged group were 7 .9 (95％ CI:6 .8-8 .5) and 7 .6 (95％ CI:6 .5 -9 .3) ,respectively ,with no statistically significant difference (χ2 =0 .002 , P=0 .961) .Virological failure was reported in 4 patients (4 .1％ ) in older group and 11 patients (5 .7％ ) in young and middle-aged group . Chi-square test showed no statistically significant difference between the two groups (χ2 = 0 .15 , P= 0 .78) .During follow-up , 19 .6％ (19/97) in older group and 3 .6％ (7/194) in young and middle-aged group died .The former was significantly higher than the latter (χ2 = 21 .113 , P< 0 .01 ) .Conclusions Older patients show a poor immunologic response ,similar viral suppression and higher risk of mortality compared with young and middle-aged patients . Future research should be aimed at the feasible and specific strategy for early diagnosis and timely treatment for older patients to improve treatment efficacy and reduce mortality .

Publicly-accessible resources have promoted the advance of scientific discovery. The era of genomics and big data has brought the need for collaboration and data sharing in order to make effective use of this new knowledge. Here, we describe the web resources for cancer genomics research and rate them on the basis of the diversity of cancer types, sample size, omics data com-prehensiveness, and user experience. The resources reviewed include data repository and analysis tools;and we hope such introduction will promote the awareness and facilitate the usage of these resources in the cancer research community.