Objective:To investigate the short-term clinical efficacy of implantation with a 3D-printed microporous titanium prosthesis in the treatment of large segmental infectious tibial defects.Methods:A retrospective analysis was conducted of the electronic medical records of the 47 patients with large segmental tibial defects who had been treated with 3D-printed microporous titanium prostheses at Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force from January 2019 to February 2024. The cohort included 36 males and 11 females, with an age of (46.2±11.8) years and a mean bone defect length of 12.3 (8.0, 16.8) cm. In the 19 patients complicated with soft tissue defects, the area of soft tissue defects ranged from 10.0 cm × 6.0 cm to 33.0 cm × 10.0 cm. For the 28 patients without soft tissue defects at the lower leg, the bone defects were filled with vancomycin-loaded calcium sulfate bone cement at the first stage; for the 19 patients complicated with soft tissue defects, the soft tissue defects at the lower limb were repaired using an anterolateral thigh flap with vascular anastomosis at the same time when bone defects were filled with vancomycin-loaded calcium sulfate bone cement at the first stage. After infection control at 2 to 8 months after surgery, individualized 3D-printed microporous titanium prostheses were implanted at the second stage to reconstruct the bone defects. Postoperative observations included the patients' first standing time, crutch walking time, full weight-bearing time, osseointegration of the tibial fracture and the prosthesis, and complications during follow-up.Results:The follow-up period for the 47 patients was (34.7±14.3) months. The first standing time was (2.2±0.6) months, crutch walking time (3.8±1.1) months, and full weight-bearing time (5.3±1.2) for this cohort. The evaluation by the Paley's bone healing score resulted in 25 excellent cases, 18 good cases, 1 medium case, and 3 poor cases, giving an excellent and good rate of 91.5% (43/47). One year after operation, the X-ray films showed that the tibial fractures and prostheses were well integrated in the 43 patients. Two patients developed recurrent tibial infection which was responded to replacement of the vancomycin-loaded calcium sulfate spacer. The fixation screws for tibial prosthesis were broken in one patient, but no recurrence of infection was observed after revision. The overall incidence of complications was 6.4% (3/47).Conclusion:In the treatment of large segmental infectious tibial defects, by facilitating rapid functional recovery and ensuring a low incidence of complications, implantation with a 3D-printed microporous titanium prosthesis demonstrates fine short-term clinical efficacy.

Objective To systematically evaluate the effect of inspiratory muscle training(IMT)on weaning outcomes in patients with weaning failure.Methods Literatures in Chinese and English were retrieved from databases such as PubMed,Cochrane Library,Web of Science,Embase,CNKI,VIP,Wanfang data and CBM for researches on the effect of IMT in mechanical ventila-tion weaning failure,from the inception of the databases to October 22,2024.The methodological quality of the researches was evaluated with PEDro scale,and data were extracted for a systematic review.Results Nine randomized controlled trials were included,published between 2011 and 2023,from Brazil,China,the United States,Iran and Australia,with a total of 499 patients.The scores of the PEDro scale ranged five to eight.The population included patients with prolonged weaning,difficult weaning and tracheostomy.The IMT methods included threshold load training and tapered flow resistance training.The training intensity was 30%to 80%of maximal inspiratory pressure(MIP),and some researches did not set the training intensity based on MIP.The pro-gression of intensity varied widely across researches.The intervention frequency ranged from five to 30 breaths per set,with at least one minute rest between sets,two to six sets per session,one to two sessions per day,and five to seven days per week.The duration of the intervention ranged from successful weaning,one week after weaning,extubation,or four days to eight weeks.Regarding the efficacy of the intervention,IMT was not benefi-cial for the duration of mechanical ventilation and intensive care unit(ICU)length of stay on weaning failure pa-tients.However,the effect of IMT on weaning successful rates,duration of weaning,MIP and mortality was in-consistent.Conclusion IMT can not improve the duration of mechanical ventilation and ICU length of stay for weaning failure pa-tients,and there is still debate regarding its effect on successful rate of weaning,duration of weaning,MIP and mortality.

Objective:To investigate the short-term clinical efficacy of implantation with a 3D-printed microporous titanium prosthesis in the treatment of large segmental infectious tibial defects.Methods:A retrospective analysis was conducted of the electronic medical records of the 47 patients with large segmental tibial defects who had been treated with 3D-printed microporous titanium prostheses at Department of Orthopaedics, 920th Hospital of Joint Logistics Support Force from January 2019 to February 2024. The cohort included 36 males and 11 females, with an age of (46.2±11.8) years and a mean bone defect length of 12.3 (8.0, 16.8) cm. In the 19 patients complicated with soft tissue defects, the area of soft tissue defects ranged from 10.0 cm × 6.0 cm to 33.0 cm × 10.0 cm. For the 28 patients without soft tissue defects at the lower leg, the bone defects were filled with vancomycin-loaded calcium sulfate bone cement at the first stage; for the 19 patients complicated with soft tissue defects, the soft tissue defects at the lower limb were repaired using an anterolateral thigh flap with vascular anastomosis at the same time when bone defects were filled with vancomycin-loaded calcium sulfate bone cement at the first stage. After infection control at 2 to 8 months after surgery, individualized 3D-printed microporous titanium prostheses were implanted at the second stage to reconstruct the bone defects. Postoperative observations included the patients' first standing time, crutch walking time, full weight-bearing time, osseointegration of the tibial fracture and the prosthesis, and complications during follow-up.Results:The follow-up period for the 47 patients was (34.7±14.3) months. The first standing time was (2.2±0.6) months, crutch walking time (3.8±1.1) months, and full weight-bearing time (5.3±1.2) for this cohort. The evaluation by the Paley's bone healing score resulted in 25 excellent cases, 18 good cases, 1 medium case, and 3 poor cases, giving an excellent and good rate of 91.5% (43/47). One year after operation, the X-ray films showed that the tibial fractures and prostheses were well integrated in the 43 patients. Two patients developed recurrent tibial infection which was responded to replacement of the vancomycin-loaded calcium sulfate spacer. The fixation screws for tibial prosthesis were broken in one patient, but no recurrence of infection was observed after revision. The overall incidence of complications was 6.4% (3/47).Conclusion:In the treatment of large segmental infectious tibial defects, by facilitating rapid functional recovery and ensuring a low incidence of complications, implantation with a 3D-printed microporous titanium prosthesis demonstrates fine short-term clinical efficacy.

Objective To systematically evaluate the effect of inspiratory muscle training(IMT)on weaning outcomes in patients with weaning failure.Methods Literatures in Chinese and English were retrieved from databases such as PubMed,Cochrane Library,Web of Science,Embase,CNKI,VIP,Wanfang data and CBM for researches on the effect of IMT in mechanical ventila-tion weaning failure,from the inception of the databases to October 22,2024.The methodological quality of the researches was evaluated with PEDro scale,and data were extracted for a systematic review.Results Nine randomized controlled trials were included,published between 2011 and 2023,from Brazil,China,the United States,Iran and Australia,with a total of 499 patients.The scores of the PEDro scale ranged five to eight.The population included patients with prolonged weaning,difficult weaning and tracheostomy.The IMT methods included threshold load training and tapered flow resistance training.The training intensity was 30%to 80%of maximal inspiratory pressure(MIP),and some researches did not set the training intensity based on MIP.The pro-gression of intensity varied widely across researches.The intervention frequency ranged from five to 30 breaths per set,with at least one minute rest between sets,two to six sets per session,one to two sessions per day,and five to seven days per week.The duration of the intervention ranged from successful weaning,one week after weaning,extubation,or four days to eight weeks.Regarding the efficacy of the intervention,IMT was not benefi-cial for the duration of mechanical ventilation and intensive care unit(ICU)length of stay on weaning failure pa-tients.However,the effect of IMT on weaning successful rates,duration of weaning,MIP and mortality was in-consistent.Conclusion IMT can not improve the duration of mechanical ventilation and ICU length of stay for weaning failure pa-tients,and there is still debate regarding its effect on successful rate of weaning,duration of weaning,MIP and mortality.

Objective:To investigate the feasibility of digital reconstruction technology in virtual planning of the free perforator flap of anterior tibial artery (ATA) for reconstruction of soft tissue defects in foot and ankle.Methods:From May 2018 to April 2023, 10 patients, including 7 males and 3 females, with foot or ankle defects were admitted in the Department of Orthopaedics Surgery, 920th Hospital of Joint Logistics Support Force. There were 5 defects in dorsal foot, 3 in plantar foot and 2 in medial malleolus. The sizes of defects ranged from 3.0 cm×2.5 cm to 5.5 cm×4.0 cm, all with exposed bones or tendons. Preoperative CTA scans from aorta abdominalis to feet were performed, and 3D digital models of bones, arteries and skin were reconstructed with Mimics. The most suitable perforators were selected to design the perforator flaps of ATA with the software, then the digital virtual flaps were superimposed onto the surfaces of donor sites and marked under a translucent image by Sina. During the surgery, flaps were harvested according to preoperative digital designs with the size of 3.5 cm×3.0 cm-6.0 cm×4.0 cm. The perforating branches were dissected along the way, and the origin, diameter, course, location and length of the perforators were recorded. The perforating branches of the flaps were anastomosed to the proximal vessels in the recipient sites, and the flaps were sutured to cover the wound. For the 10 donor sites, skin graft was used in 2 donor sites and direct suture were performed on 8 donor sites. After discharge of the patients, scheduled outpatient or online follow-ups were carried out to assess the progress of fracture healing as well as the appearance, texture and colour of flaps, and the recovery of donor sites. Ankle function was evaluated by Maryland foot scoring system.Results:Three-dimensional digital reconstructions of donor sites were successfully performed on all patients, enabling successful design and harvest of the free perforator flaps of ATA. The flaps were able to be used in complete reconstruction of the respective defects and made the anatomical parameters of perforators of the donor sites closely matching with those of preoperative modeling. Follow-up periods ranged from 6 to 19 months, apart from 1 flap experienced partial necrosis at distal endge, and another flap with partial exfoliation after blistering. The rest of 8 flaps were all survived smoothly, with appropriate thickness, aesthetic appearance, good texture and colour. Sensations in both donor sites and dorsal feet were all normal. Seven patients achieved excellent and 3 were good according to Maryland's ankle-foot function score. The donor sites healed well without scar hyperplasia.Conclusion:Digital reconstruction technology enables an accurate identification of perforators as well as individualised design and harvest procedures for perforator flaps of ATA, thereby it facilitates precise reconstructions of small-to-medium-sized defects in foot or ankle. It is a good method for vascular anatomy and flap harvesting.

Objective To verify the stability and accuracy of the made-in-China Quick TargSeq Fully Integrated Automated On-site Rapid DNA Detection Instrument(hereinafter referred to as Quick Targ-Seq DNA detection instrument)and evaluate its forensic application prospects.Methods A total of 74 blind samples provided by the expert group of Criminal Investigation Bureau of the Ministry of Public Security(4 individuals,20 samples)and five participating institutions(54 samples)were used to test on 5 Quick TargSeq DNA detection instruments and the accompanying microfluidic chip cartridges.The results were compared with the known genotypes to calculate the samples'detection rate and genotyping accuracy.Results The results of reproducibility obtained from 20 samples provided by the expert group on the 5 Quick TargSeq DNA detection instruments were all consistent with the known genotypes.The detection rate of the 74 samples was 100%,and the genotyping accuracy was 97.33%.Conclusion The Quick TargSeq DNA detection instrument has good stability and high genotyping accu-racy.

Objective To investigate the medication rules of tradition Chinese medicine for the treatment of ulcerative colitis(UC)at remission stage by data mining method,thus to provide reference for clinical prescription and medication.Methods The clinical research or medical case report of UC remission treated by Chinese medicine issued in CNKI,Wanfang Data and VIP from July 2000 to December 2022 were retrieved.Excel 2019 was used to analyze the frequency statistics,and the distribution of the nature,flavor and meridian tropism of the prescribed drugs in the included literature.Modeler 18.0 and SPSS Statistics 26.0 were used for association rules and cluster analysis,and Cytoscape 3.9.1 was used to construct the network diagram of the associated drugs.Results A total of 121 articles were included in the analysis,involving 167 drugs,of which 24 drugs were frequently used,mainly including Atractylodis Macrocephalae Rhizoma,Poria,Aucklandiae Radix,Coptidis Rhizoma,Codonopsis Radix,Paeoniae Radix Alba,Coicis Semen,Astragali Radix,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle,Angelicae Sinensis Radix,Citri Reticulatae Pericarpium,and Dioscoreae Rhizoma.According to the therapeutic actions,the drugs were mainly classified into deficiency-supplementing drugs,heat-clearing drugs,qi-regulating drugs,urination-promoting and dampness-percolating drugs,blood-stanching drugs,exterior-relieving drugs,interior-warming drugs,astringent drugs,dampness-resolving drugs,and blood-activating and stasis-resolving drugs.The medicinals were mainly warm,mild and cold in nature,and were sweet,bitter and pungent in flavor.Most of the drugs had the meridian tropism of the spleen,stomach,lung and liver.A total of 25 drug association rules were mined out,and five prescriptions were obtained after cluster analysis.Conclusion The Chinese medicine prescriptions for the treatment of UC remission usually deprive from the classical formulas such as Shenling Baizhu San,Sishen Pills,and Tongxie Yaofang.The compatibility of drugs reflects the thoughts of treating UC remission from the perspective of spleen,and embodies the therapies of strengthening the spleen and removing dampness,promoting qi and regulating blood,and focusing on tonifying ministerial fire and supporting yang in the later stage,which has the characteristics of treating both symptoms and root causes simultaneously by using multiple drugs through multiple methods.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To investigate the feasibility of digital reconstruction technology in virtual planning of the free perforator flap of anterior tibial artery (ATA) for reconstruction of soft tissue defects in foot and ankle.Methods:From May 2018 to April 2023, 10 patients, including 7 males and 3 females, with foot or ankle defects were admitted in the Department of Orthopaedics Surgery, 920th Hospital of Joint Logistics Support Force. There were 5 defects in dorsal foot, 3 in plantar foot and 2 in medial malleolus. The sizes of defects ranged from 3.0 cm×2.5 cm to 5.5 cm×4.0 cm, all with exposed bones or tendons. Preoperative CTA scans from aorta abdominalis to feet were performed, and 3D digital models of bones, arteries and skin were reconstructed with Mimics. The most suitable perforators were selected to design the perforator flaps of ATA with the software, then the digital virtual flaps were superimposed onto the surfaces of donor sites and marked under a translucent image by Sina. During the surgery, flaps were harvested according to preoperative digital designs with the size of 3.5 cm×3.0 cm-6.0 cm×4.0 cm. The perforating branches were dissected along the way, and the origin, diameter, course, location and length of the perforators were recorded. The perforating branches of the flaps were anastomosed to the proximal vessels in the recipient sites, and the flaps were sutured to cover the wound. For the 10 donor sites, skin graft was used in 2 donor sites and direct suture were performed on 8 donor sites. After discharge of the patients, scheduled outpatient or online follow-ups were carried out to assess the progress of fracture healing as well as the appearance, texture and colour of flaps, and the recovery of donor sites. Ankle function was evaluated by Maryland foot scoring system.Results:Three-dimensional digital reconstructions of donor sites were successfully performed on all patients, enabling successful design and harvest of the free perforator flaps of ATA. The flaps were able to be used in complete reconstruction of the respective defects and made the anatomical parameters of perforators of the donor sites closely matching with those of preoperative modeling. Follow-up periods ranged from 6 to 19 months, apart from 1 flap experienced partial necrosis at distal endge, and another flap with partial exfoliation after blistering. The rest of 8 flaps were all survived smoothly, with appropriate thickness, aesthetic appearance, good texture and colour. Sensations in both donor sites and dorsal feet were all normal. Seven patients achieved excellent and 3 were good according to Maryland's ankle-foot function score. The donor sites healed well without scar hyperplasia.Conclusion:Digital reconstruction technology enables an accurate identification of perforators as well as individualised design and harvest procedures for perforator flaps of ATA, thereby it facilitates precise reconstructions of small-to-medium-sized defects in foot or ankle. It is a good method for vascular anatomy and flap harvesting.

Objective: This cross-sectional investigation aimed to determine the incidence, clinical characteristics, prognosis, and related risk factors of olfactory and gustatory dysfunctions related to infection with the SARS-CoV-2 Omicron strain in mainland China. Methods: Data of patients with SARS-CoV-2 from December 28, 2022, to February 21, 2023, were collected through online and offline questionnaires from 45 tertiary hospitals and one center for disease control and prevention in mainland China. The questionnaire included demographic information, previous health history, smoking and alcohol drinking, SARS-CoV-2 vaccination, olfactory and gustatory function before and after infection, other symptoms after infection, as well as the duration and improvement of olfactory and gustatory dysfunction. The self-reported olfactory and gustatory functions of patients were evaluated using the Olfactory VAS scale and Gustatory VAS scale. Results: A total of 35 566 valid questionnaires were obtained, revealing a high incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain (67.75%). Females(χ2=367.013, P<0.001) and young people(χ2=120.210, P<0.001) were more likely to develop these dysfunctions. Gender(OR=1.564, 95%CI: 1.487-1.645), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), oral health status (OR=0.881, 95%CI: 0.839-0.926), smoking history (OR=1.152, 95%CI=1.080-1.229), and drinking history (OR=0.854, 95%CI: 0.785-0.928) were correlated with the occurrence of olfactory and taste dysfunctions related to SARS-CoV-2(above P<0.001). 44.62% (4 391/9 840) of the patients who had not recovered their sense of smell and taste also suffered from nasal congestion, runny nose, and 32.62% (3 210/9 840) suffered from dry mouth and sore throat. The improvement of olfactory and taste functions was correlated with the persistence of accompanying symptoms(χ2=10.873, P=0.001). The average score of olfactory and taste VAS scale was 8.41 and 8.51 respectively before SARS-CoV-2 infection, but decreased to3.69 and 4.29 respectively after SARS-CoV-2 infection, and recovered to 5.83and 6.55 respectively at the time of the survey. The median duration of olfactory and gustatory dysfunctions was 15 days and 12 days, respectively, with 0.5% (121/24 096) of patients experiencing these dysfunctions for more than 28 days. The overall self-reported improvement rate of smell and taste dysfunctions was 59.16% (14 256/24 096). Gender(OR=0.893, 95%CI: 0.839-0.951), SARS-CoV-2 vaccination status (OR=1.334, 95%CI: 1.164-1.530), history of head and facial trauma(OR=1.180, 95%CI: 1.036-1.344, P=0.013), nose (OR=1.104, 95%CI: 1.042-1.171, P=0.001) and oral (OR=1.162, 95%CI: 1.096-1.233) health status, smoking history(OR=0.765, 95%CI: 0.709-0.825), and the persistence of accompanying symptoms (OR=0.359, 95%CI: 0.332-0.388) were correlated with the recovery of olfactory and taste dysfunctions related to SARS-CoV-2 (above P<0.001 except for the indicated values). Conclusion: The incidence of olfactory and taste dysfunctions related to infection with the SARS-CoV-2 Omicron strain is high in mainland China, with females and young people more likely to develop these dysfunctions. Active and effective intervention measures may be required for cases that persist for a long time. The recovery of olfactory and taste functions is influenced by several factors, including gender, SARS-CoV-2 vaccination status, history of head and facial trauma, nasal and oral health status, smoking history, and persistence of accompanying symptoms.
Female ; Humans ; Adolescent ; SARS-CoV-2 ; Smell ; COVID-19/complications* ; Cross-Sectional Studies ; COVID-19 Vaccines ; Incidence ; Olfaction Disorders/etiology* ; Taste Disorders/etiology* ; Prognosis