OBJECTIVE: To review the main fixation methods for proximal tibial extra-articular fractures based on clinical and biomechanical results, and to provide evidence for clinical application. METHODS: Extensive related literature at home and abroad was conducted in recent years, and external fixation systems such as external fixation braces and external locking plates, as well as internal fixation systems such as plates and intramedullary nails, were systematically reviewed regarding their application indications, clinical efficacy, and biomechanical results in proximal tibial extra-articular fractures. RESULTS: External fixation systems have advantages in fractures with open or severe soft tissue injury, facilitating wound management and maintaining stability of the fracture site to some extent. However, in proximal tibial extra-articular fractures with good soft tissue conditions, internal fixation systems such as plates and intramedullary nails are still the first choice. Some studies have found that intramedullary nails allow patients to bear weight early, with shorter fracture healing time and higher rate of malunion, while other studies have found that both intramedullary nails and plates have similar clinical efficacy and can achieve satisfactory treatment results. CONCLUSION The choice of fixation method for proximal tibial extra-articular fractures depends not only on the type of fracture, but also on the surgeon's habits and operational skills. Larger-scale studies are still needed to clarify the advantages and disadvantages of intramedullary nails and locking plates in the treatment of proximal tibial extra-articular fractures.
Humans ; Tibial Fractures/surgery* ; Bone Plates ; Fracture Fixation, Intramedullary/instrumentation* ; Fracture Fixation, Internal/instrumentation* ; Fracture Healing ; External Fixators ; Bone Nails ; Fracture Fixation/instrumentation* ; Treatment Outcome ; Biomechanical Phenomena

Objective:To investigate the clinical effect of Paris polyphylla var. yunnanensis oral care solution in the prevention of ventilator-associated pneumonia (VAP) in patients with endotracheal intubation in ICU, and to provide reference for continuing to explore the best oral care solution of traditional Chinese medicine for preventing VAP. Methods:Randomized controlled experiment was used. Fifty patients with tracheal intubation admitted to the ICU of the Affiliated Hospital of Yunnan University from May 2022 to February 2023 were selected by convenient sampling method. The patients were divided into control group and observation group with 25 cases in each group by random number table method. The control group was treated with Xipayi mouth rinse for oral care, and the observation group was treated with self-made Paris polyphylla var. yunnanensis oral care solution for oral care. The incidence of VAP, clinical efficacy of oral care, leukocyte and procalcitonin after 7 days of intervention were observed, the mechanical ventilation time and ICU hospitalization time were recorded in the two groups. Results:All patients completed the study. There were 19 males and 6 females in the control group with the age of (60.72±19.32) years old. There were 15 males and 10 females in the observation group with the age of (60.24±16.80) years old. The incidence of VAP after 7 days of intervention in the observation group was 12% (3/25), which was lower than that in the control group 36% (9/25). The difference between the two groups was statistically significant ( χ2=3.95, P<0.05). The total clinical effective rate of oral care after 7 days of intervention in the observation group was 88% (22/25), which was higher than that in the control group 68% (17/25). The difference between the two groups was statistically significant ( χ2=9.78, P<0.01). There was no significant difference in the level of the leucocyte and procalcitonin before and after 7 days of intervention between the two groups (all P>0.05). The mechanical ventilation time and ICU hospitalization time in the observation group were (6.92 ±3.89), (10.36±6.17) days respectively, which were lower than those in the control group (9.72±4.76), (12.12±4.87) days. The difference of mechanical ventilation time between the two groups was statistically significant (t=2.28, P<0.05). The ICU hospitalization time in the observation group was lower than that in the control group, but there was no significant difference between the two groups ( P>0.05). Conclusions:Paris polyphylla var. yunnanensis oral care solution can improve the oral condition of patients, reduce the incidence of VAP, shorten the time of mechanical ventilation, which has certain clinical value.

OBJECTIVE To understand the changing trends of use of antibiotics and etiological submission rates in medical institutions of Wuhan and find out the key points of management.METHODS The survey data of Wuhan were collected from the cross-sectional survey databases for nosocomial infections in China of 2016,2018,2020 and 2022,and the data were retrospectively analyzed.RESULTS From 2016 to 2022,a total of 141 284 hospital-ized patients from 117 medical institutions were enrolled in the survey,and the utilization rate of antibiotics was 32.36％;the utilization rate of antibiotics was 32.87％in 2016,31.74％in 2018,28.75％in 2020,34.56％in 2022,showing an upward trend(x2=13.941,P＜0.001).The utilization rates of antibiotics were relatively high in respiratory medicine department and comprehensive ICU,which showed upward trends(x2=16.377,P＜0.001;x2=5.581,P=0.018);the utilization rate of antibiotics showed a downward trend in non-neonates pediatrics de-partment(x2=11.886,P＜0.001).The rates of prophylactic use of antibiotics for type Ⅰ incision surgery were 31.54％,23.53％,28.44％and 13.24％,respectively,showing downward trends(x2=230.333,P＜0.001).The etiological submission rates were 59.98％,55.77％,65.69％and 59.16％,respectively,which were basically same(P=0.072);the etiological submission rates of the medical institutions with less than 300 beds and 300 to 599 beds showed upward trends,while the etiological submission rates of the medical institutions with 600 to 899 beds and no less than 900 beds showed downward trends(x2=42.019,P＜0.001;x2=4.599,P=0.032).The etiological submission rate was 44.87％in 2018 before the treatment with antibiotics,47.80％in 2020,44.45％in 2022,which were basically same(P=0.431);the etiological submission rate of the medical institutions with no less than 900 beds showed a downward trend(x2=14.464,P＜0.001).CONCLUSIONS The use of antibiotics of the hospi-talized patients is generally normalized in the medical institutions of Wuhan,the utilization rate shows an upward trend,the etiological submission rate is basically same,and the rate of prophylactic use of antibiotics for type Ⅰincision surgery shows a downward trend.It is necessary to attach great importance to the etiological submission of large scale metical institutions before the treatment with antibiotics and the use of antibiotic of some key departments.

Objective:To investigate the clinical effect of Paris polyphylla var. yunnanensis oral care solution in the prevention of ventilator-associated pneumonia (VAP) in patients with endotracheal intubation in ICU, and to provide reference for continuing to explore the best oral care solution of traditional Chinese medicine for preventing VAP. Methods:Randomized controlled experiment was used. Fifty patients with tracheal intubation admitted to the ICU of the Affiliated Hospital of Yunnan University from May 2022 to February 2023 were selected by convenient sampling method. The patients were divided into control group and observation group with 25 cases in each group by random number table method. The control group was treated with Xipayi mouth rinse for oral care, and the observation group was treated with self-made Paris polyphylla var. yunnanensis oral care solution for oral care. The incidence of VAP, clinical efficacy of oral care, leukocyte and procalcitonin after 7 days of intervention were observed, the mechanical ventilation time and ICU hospitalization time were recorded in the two groups. Results:All patients completed the study. There were 19 males and 6 females in the control group with the age of (60.72±19.32) years old. There were 15 males and 10 females in the observation group with the age of (60.24±16.80) years old. The incidence of VAP after 7 days of intervention in the observation group was 12% (3/25), which was lower than that in the control group 36% (9/25). The difference between the two groups was statistically significant ( χ2=3.95, P<0.05). The total clinical effective rate of oral care after 7 days of intervention in the observation group was 88% (22/25), which was higher than that in the control group 68% (17/25). The difference between the two groups was statistically significant ( χ2=9.78, P<0.01). There was no significant difference in the level of the leucocyte and procalcitonin before and after 7 days of intervention between the two groups (all P>0.05). The mechanical ventilation time and ICU hospitalization time in the observation group were (6.92 ±3.89), (10.36±6.17) days respectively, which were lower than those in the control group (9.72±4.76), (12.12±4.87) days. The difference of mechanical ventilation time between the two groups was statistically significant (t=2.28, P<0.05). The ICU hospitalization time in the observation group was lower than that in the control group, but there was no significant difference between the two groups ( P>0.05). Conclusions:Paris polyphylla var. yunnanensis oral care solution can improve the oral condition of patients, reduce the incidence of VAP, shorten the time of mechanical ventilation, which has certain clinical value.

OBJECTIVE To understand the changing trends of use of antibiotics and etiological submission rates in medical institutions of Wuhan and find out the key points of management.METHODS The survey data of Wuhan were collected from the cross-sectional survey databases for nosocomial infections in China of 2016,2018,2020 and 2022,and the data were retrospectively analyzed.RESULTS From 2016 to 2022,a total of 141 284 hospital-ized patients from 117 medical institutions were enrolled in the survey,and the utilization rate of antibiotics was 32.36％;the utilization rate of antibiotics was 32.87％in 2016,31.74％in 2018,28.75％in 2020,34.56％in 2022,showing an upward trend(x2=13.941,P＜0.001).The utilization rates of antibiotics were relatively high in respiratory medicine department and comprehensive ICU,which showed upward trends(x2=16.377,P＜0.001;x2=5.581,P=0.018);the utilization rate of antibiotics showed a downward trend in non-neonates pediatrics de-partment(x2=11.886,P＜0.001).The rates of prophylactic use of antibiotics for type Ⅰ incision surgery were 31.54％,23.53％,28.44％and 13.24％,respectively,showing downward trends(x2=230.333,P＜0.001).The etiological submission rates were 59.98％,55.77％,65.69％and 59.16％,respectively,which were basically same(P=0.072);the etiological submission rates of the medical institutions with less than 300 beds and 300 to 599 beds showed upward trends,while the etiological submission rates of the medical institutions with 600 to 899 beds and no less than 900 beds showed downward trends(x2=42.019,P＜0.001;x2=4.599,P=0.032).The etiological submission rate was 44.87％in 2018 before the treatment with antibiotics,47.80％in 2020,44.45％in 2022,which were basically same(P=0.431);the etiological submission rate of the medical institutions with no less than 900 beds showed a downward trend(x2=14.464,P＜0.001).CONCLUSIONS The use of antibiotics of the hospi-talized patients is generally normalized in the medical institutions of Wuhan,the utilization rate shows an upward trend,the etiological submission rate is basically same,and the rate of prophylactic use of antibiotics for type Ⅰincision surgery shows a downward trend.It is necessary to attach great importance to the etiological submission of large scale metical institutions before the treatment with antibiotics and the use of antibiotic of some key departments.

Objective To analyze the current situation of healthcare-associated infection (HCAI) management of fever clinics among different levels of medical institutions in Wuhan, and to provide a scientific basis for improving hospital infection management. Methods In January 2023, a network questionnaire survey was conducted on medical institutions with fever clinics in Wuhan. Results A total of 72 medical institutions were investigated, of which 58.33% had CT, and 48.61% had fever clinics for children. The total qualified rate of HCAI management was 78.28%. The qualified rates of four primary indicators, including hospital management, diagnosis and treatment environment protection, training and education, and implementation of infection control measures, were 82.27%, 71.49%, 75.93%, and 81.31%, respectively. There were statistical differences among different levels of medical institutions (all P<0.01). Among the 13 secondary indicators, the qualified rates of 7 indicators were more than 80%, with the highest being medical item management (93.06%), medical waste disposal (89.72%), and personnel management (83.33%), and the lowest being facilities and equipment (66.32%), and patients and accompanying personnel education (66.67%). Among the 65 tertiary indicators, 30 had a pass rate great than 80%. Conclusion Wuhan actively promotes the construction of fever clinics in medical institutions, and the overall situation of HCAI management is good. However, there are still some problems to varying degrees, especially in the layout procedures, hand hygiene, and staff training of fever clinics in secondary and lower medical institutions, which should be further strengthened.

Objective To investigate the disease progression and influencing factors of human immunodeficiency virus (HIV)-infected persons in Sanya area from 2010-2020. Methods Data of HIV infected cases reported in XX region from January 2014 to January 2020 were collected through the National AIDS Comprehensive Prevention and Control Information System. The incidence of AIDS was calculated by the life expectancy method, and the single factors influencing the progression of HIV infection were analyzed from the aspects of sex, age, BMI, nationality, marital status, educational level, highly active anti-retroviral therapy (HAART), anemia, route of transmission, CD4⁺ cell count, and co-infection of other viruses. Results A total of 761 HIV-infected cases were reported in Sanya areaFrom January 2010 to January 2020, of which 103 had progressed to AIDS (13.53%), the incidence of AIDS was 6.01/100 person-years, the average incubation period was 4.63 years; There were 31 death cases, and the all-cause mortality rate was 1.81/100 person years; Gender, age, HAART treatment status, anemia, CD4⁺ cell count, and other viral infections were single factors that affect the disease progression of HIV-infected persons (χ²=16.803, 13.362, 15.954, 20.119, 16.039, 15.711, P<0.05), meanwhile, age, HAART treatment status, anemia, CD4⁺ cell count, and other viral infections were independent risk factors that affect the disease progression of HIV-infected persons (P=0.014, 0.007, 0.017, 0.009, 0.001, 0.001). Conclusion The incubation period is an important stage of the disease progression of HIV-infected patients, moreover, age, HAART treatment status, anemia, CD4⁺ cell count, and other viral infections are all independent risk factors that affect the disease progression of HIV-infected patients.

Objective To evaluate the value of acoustic radiation force impulse (ARFI) elastography in assessment of nonalcoholic fatty liver disease (NAFLD) and hepatic fibrosis in rats.Methods Models with various degrees of NAFLD severity were conducted in 110 rats by feeding high fat emulsion.The right liver lobe of rat models were processed and embedded in a fabricated gelatin solution to measure the shear wave velocity (SWV) by ARFI.And the other liver lobes were used for histologic assessment.Based on NAFLD activity score (NAS),the final pathologic NAFLD diagnosis were considered as normal group (NAS=0),simple steatosis (SS) group (1≤NAS≤2),borderline (3≤NAS≤4) group and nonalcoholic steatohepatitis (NASH) group (NAS≥5).The diagnostic accuracy of the SWV parameters in evaluating NAFLD severity and fibrosis stages was studied using ROC curves.Results The difference of SWV values among normal group,SS group,borderline group and NASH group was statistically significant (F=31.53,P＜0.001).Taking SWV≥ 2.54 m/s as the diagnostic standard to differentiate normal rats from rats with SS,and SWV≥2.90 m/s to differentiate SS from NASH in rats,the area under ROC curve (AUC) was 0.922 (95％CI [0.871,0.973],P＜0.001) and 0.882 (95％ CI [0.807,0.956],P＜0.001) respectively.The sensitivity and specificity were 93.5 ％ and 100 ％ for differentiating normal and SS groups,83.3 ％ and 84.2 ％ for differentiating SS and NASH groups.Taking SWV≥3.48 m/s as cutoff to predict fibrosis (≥F2 stage),the AUC was 0.963 (95％CI [0.909,1.000],P＜0.001),the sensitivity was 92.9％ and the specificity was 97.6％.Taking SWV≥3.61 m/s as cutoff to predict severe fibrosis (≥F3 stage),the AUC was 0.997 (95％CI [0.990,1.000],P＜0.001),sensitivity was 100％ and specificity was 98.9％.The same high validity was maintained as in the prediction of cirrhosis (F4 stage) with the cutoff as SWV≥4.50 m/s,and the AUC was 0.993 (95％CI [0.982,1.000],P＜0.001),the sensitivity was 100 ％ and the specificity was 96.8％.Conclusion ARFI elastography is a promising method for differentiating the different severity of NAFLD and staging the degree of hepatic fibrosis with NAFLD in rat models.

OBJECTIVETo evaluate the validity and reliability of Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale (DSKAB).

METHODSWe selected 460 patients with diabetes in the community, used the scale which was after two rounds of the Delphi method and pilot study. Investigators surveyed the patients by the way of face to face. by draw lots, we selected 25 community diabetes randomly for repeating investigations after one week. The validity analyses included face validity, content validity, construct validity and discriminant validity. The reliability analyses included Cronbach's α coefficient, θ coefficient, Ω coefficient, split-half reliability and test-retest reliability.

RESULTSThis study distributed a total of 460 questionnaires, reclaimed 442, qualified 432. The score of the scale was 254.59 ± 28.90, the scores of the knowledge, attitude, behavior sub-scales were 82.44 ± 11.24, 63.53 ± 5.77 and 108.61 ± 17.55, respectively. It had excellent face validity and content validity. The correlation coefficient was from 0.71 to 0.91 among three sub-scales and the scale, P<0.001. The common factor cumulative variance contribution rate of the scale and three sub-scales was from 57.28% to 67.19%, which achieved more than 50% of the approved standard, there was 25 common factors, 91 items of the total 98 items held factor loading ≥0.40 in its relevant common factor, it had good construct validity. The scores of high group and low group in three sub-scales were: knowledge (91.12 ± 3.62) and (69.96 ± 11.20), attitude (68.75 ± 4.51) and (58.79 ± 4.87), behavior (129.38 ± 8.53) and (89.65 ± 11.34),mean scores of three sub-scales were apparently different, which compared between high score group and low score group, the t value were - 19.45, -16.24 and -30.29, respectively, P<0.001, and it had good discriminant validity. The Cronbach's α coefficient of the scale and three sub-scales was from 0.79 to 0.93, the θ coefficient was from 0.86 to 0.95, the Ω coefficient was from 0.90 to 0.98, split-half reliability was from 0.89 to 0.95.Test-retest reliability of the scale was 0.51;the three sub-scales was from 0.46 to 0.52, P<0.05.

CONCLUSIONThe validity and reliability of the Diabetes Self-management Knowledge, Attitude, and Behavior Assessment Scale are excellent, which is a suitable instrument to evaluate the self-management for patients with diabetes.

Objective To investigate the clinical efficacy and related factors of holmium laser lithotripsy under ureteroscopy in treating mid -upper ureteral calculi.Methods The clinical data of 65 patients with mid -up-per ureteral calculi were retrospectively analyzed.Results The overall stone -free rate was 90.7% (59 /65 ). 4 weeks after operation,the stone -free rate was 94.9%(56 /59).The incidence rate of complications was 3.3%(2 /59).Stone size,hydronephrosis,ureteral stricture and twist,complicated with ureteral polypus were related to the success of lithotripsy(P =0.028).Conclusion Holmium laser lithotripsy under ureteroscopy in treating mid -upper ureteral calculi is safe and effective,improve surgical techniques and pay attention to cases screening may improve the success rate.