Objective To explore the application effect of negative pressure sealing drainage combined with active factor dressing and flap transfer in Gustilo Ⅲ type tibiofibular fractures.Methods From March 2019 to March 2022,92 patients with Gustilo type Ⅲ tibiofibular fracture admitted to the Department of Orthopaedics of the Third People's Hospital of Zhangjiagang City were randomly divided into the experimental group(internal and external fixation+flap transfer+negative pressure sealing drainage+active factor dressing,n=46)and the control group(internal and external fixation+flap transfer+conventional dressing change+active factor dressing,n=46),and the clinical indexes,clinical efficacy,ankle joint function,lower limb function and complications were compared.Result The hospital stay time(25.32±8.36)d,the flap healing time(9.69±1.24)d,the fracture healing time(8.24±1.84)month and the wound healing time(14.24±3.84)d of the experimental group were shorter than those of the control group(43.44±11.84)d,(11.53±2.07)d and(9.12±2.50)month,(50.11±5.12)d(P＜0.05).The total effective rate of the experimental group(93.48％,43 cases/46 cases)was higher than that of the control group(71.74％,33 cases/46 cases,P＜0.05).The ankle pain scores of both groups after treatment were lower than before treatment,and the experimental group was lower than the control group,and the scores of ankle function and stability,the scores of American Association of Foot and Ankle Surgery(AOFAS)and the knee joint score of American Hospital for Special Surgery(HSS)after treatment were higher in both groups than before treatment,and the experimental group was higher than the control group(P＜0.05).The total complication rate of the experimental group(4.34％,2 cases/46 cases)was lower than that of the control group(17.39％,8 cases/46 cases,P＜0.05).Conclusion The application of negative pressure closed drainage combined with active factor dressing in Gustilo typeⅢ tibia and fibula fracture is effective,can promote postoperative wound recovery,improve ankle and lower limb function,and the incidence of complications is low.

Acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had caused a global pandemic since 2019, and posed a serious threat to global health security. Traditional Chinese medicine (TCM) has played an indispensable role in the battle against the epidemic. Many components originated from TCMs were found to inhibit the production of SARS-CoV-2 3C-like protease (3CLpro) and papain-like protease (PLpro), which are two promising therapeutic targets to inhibit SARS-CoV-2. This study describes a systematic investigation of the roots and rhizomes of Sophora tonkinensis, which results in the characterization of 12 new flavonoids, including seven prenylated flavanones (1-7), one prenylated flavonol (8), two prenylated chalcones (9-10), one isoflavanone (11), and one isoflavan dimer (12), together with 43 known compounds (13-55). Their structures including the absolute configurations were elucidated by comprehensive analysis of MS, 1D and 2D NMR data, and time-dependent density functional theory electronic circular dichroism (TDDFT ECD) calculations. Compounds 12 and 51 exhibited inhibitory effects against SARS-CoV-2 3CLpro with IC₅₀ values of 34.89 and 19.88 μmol·L^-1, repectively while compounds 9, 43 and 47 exhibited inhibitory effects against PLpro with IC₅₀ values of 32.67, 79.38, and 16.74 μmol·L^-1, respectively.
Flavonoids/chemistry* ; SARS-CoV-2 ; Rhizome ; COVID-19 ; Peptide Hydrolases ; Antiviral Agents/chemistry*

Objective:To develop a grading prediction model of traumatic hemorrhage volume based on deep learning and assist in predicting traumatic hemorrhage volume.Methods:A retrospective observational study was conducted based on the experimental data of pig gunshot wounds in the time-effect assessment database for experiments on war-traumatized animals constructed by the General Hospital of the Chinese People's Liberation Army. The hemorrhage volume data of the study population were extracted, and the animals were divided into 0-300 mL, 301-600 mL, and > 600 mL groups according to the hemorrhage volume. Using vital signs indexes as the predictive variables and hemorrhage volume grading as the outcome variable, trauma hemorrhage volume grading prediction models were developed based on four traditional machine learning and ten deep learning methods. Using laboratory test indexes as predictive variables and hemorrhage volume grading as outcome variables, trauma hemorrhage volume grading prediction models were developed based on the above fourteen methods. The effect of the two groups of models was evaluated by accuracy and area under the receiver operator characteristic curve (AUC), and the optimal models in the two groups were mixed to obtain hybrid model 1. Feature selection was conducted according to the genetic algorithm, and hybrid model 2 was constructed according to the best feature combination. Finally, hybrid model 2 was deployed in the animal experiment database system.Results:Ninety-six traumatic animals in the database were enrolled, including 27 pigs in the 0-300 mL group, 40 in the 301-600 mL group, and 29 in the > 600 mL group. Among the fourteen models based on vital signs indexes, fully convolutional network (FCN) model was the best [accuracy: 60.0%, AUC and 95% confidence interval (95% CI) was 0.699 (0.671-0.727)]. Among the fourteen models based on laboratory test indexes, recurrent neural network (RNN) model was the best [accuracy: 68.9%, AUC (95% CI) was 0.845 (0.829-0.860)]. After mixing the FCN and RNN models, the hybrid model 1, namely RNN-FCN model was obtained, and the performance of the model was improved [accuracy: 74.2%, AUC (95% CI) was 0.847 (0.833-0.862)]. Feature selection was carried out by genetic algorithm, and the hybrid model 2, namely RNN-FCN* model, was constructed according to the selected feature combination, which further improved the model performance [accuracy: 80.5%, AUC (95% CI) was 0.880 (0.868-0.893)]. The hybrid model 2 contained ten indexes, including mean arterial pressure (MAP), hematocrit (HCT), platelet count (PLT), lactic acid, arterial partial pressure of carbon dioxide (PaCO 2), Total CO 2, blood sodium, anion gap (AG), fibrinogen (FIB), international normalized ratio (INR). Finally, the RNN-FCN* model was deployed in the database system, which realized automatic, continuous, efficient, intelligent, and grading prediction of hemorrhage volume in traumatic animals. Conclusion:Based on deep learning, a grading prediction model of traumatic hemorrhage volume was developed and deployed in the information system to realize the intelligent grading prediction of traumatic animal hemorrhage volume.

Objective:To explore the effect of preoperative visit with Child Life mode in the management of preschool children′s anxiety.Methods:A total of 80 cases of children of pre-school age who were operated from September 2018 to February 2019 were selected by cluster sampling method. The children from September to November 2018 who were given the traditional mode of preoperative visit were set as the control group. Children from December 2018 to February 2019 who were given preoperative visit with Child Life mode were set as the experimental group. The Modified Yale Perioperative Anxiety Scale (m-YPAS) scores, Induction Compliance Checklist (ICC) scores and Pediatric Anesthesia Emergence Delirium (PAED) scores were compared between the two groups at 4 different perioperative time points (6 hours after admission, waiting for surgery, induction of anesthesia, and 6 hours after surgery).Results:Totally three patients were suspended from the study due to surgery. A total of 77 children were studied, 38 in the experimental group and 39 in the control group. The score of m-YPAS in the experimental group was significantly lower than that of the control group(17.57±16.64 vs. 42.04±27.46, t value was 3.85, P<0.01) while waiting for surgery. The score of m-YPAS in the experimental group was significantly lower than control group (31.64±27.95 vs. 62.22±25.13, t value was 4.26, P<0.01) at the anesthesia induction. Compare with the control group, the score of m-YPAS in the experimental group showed no significant difference at both time of 6 hours after admission (18.19±17.83 vs.19.85±17.92, t value was 0.87, P>0.05) and 6 hours after surgery(35.61±15.70 vs. 41.81±17.97, t value was 1.37, P>0.05). Compare with the control group the score of ICC in the experimental group was significantly decreased (1.40±1.39 vs. 3.78±2.60, t value was 4.88, P<0.01) at the anesthesia induction. The score of PEAD in the experimental group and control group, there was no significant difference between the two groups (7.18±2.45 vs. 7.85±3.05, t value was 0.91, P>0.05). Conclusions:Compared with the traditional preoperative visit mode, the preoperative visit mode of Child Life can effectively relieve the anxiety of preschool children undergoing general anesthesia surgery while they are waiting for surgery and during anesthesia induction, and can improve the degree of cooperation during anesthesia induction.

Objective:To observe the effect of remote exercise support on weight loss and maintenance in obese adolescents.Methods:From January 2018 to December 2018, a total of 118 adolescents with simple obesity who were treated in the Outpatient Department of Endocrinology and Metabolism in PKU Care Lu'an hospital were selected by the convenient sampling method. They were divided into the control group and the experimental group by the random number table method, with 59 cases in each group. The control group received a routine outpatient follow-up intervention for 6 months and the experimental group also received a 6-month outpatient intervention. The outpatient intervention included 3 months of intervention and 3 months of maintenance. During 3 months of intervention, the mobile wearable device was used to design the exercise scheme based on the internet, and the combination of the scheme and the supporting mobile APP monitoring system was used for remote exercise support. During the maintenance period of 3 months, the same intervention method as the control group was adopted. The study lasted for 6 months. The weight change and maintenance status were compared between the two groups at different intervention times.Results:In the intervention period (the first 3 months) , the weight showed a trend of weight loss in two groups, and the weight in the experimental group were lower than those in the control group. The differences were statistically significant ( P<0.05) . From the maintenance period (the last 3 months) , the weight of both groups rebounded, but the weight of patients in the experimental group were always lower than those of the control group, and the differences were statistically significant ( P<0.01) . By the end of the intervention period (the first 3 months) , there was no statistically significant difference in the standard-reaching rate of weight loss > 5% between the two groups ( P>0.05) . But the standard-reaching rates of weight loss >10% and weight loss >15% in the experimental group were higher than those in the control group, and the differences were statistically significant ( P<0.01) . During the maintenance period (the last 3 months) , the standard-reaching rates of weight loss >5%, weight loss >10% and weight loss>15% in the experimental group were all higher than those in the control group, and the differences were statistically significant ( P<0.01) . Conclusions:Remote exercise support can help obese adolescents further lose weight and delay body weight rebound.

Objective To evaluate the effect of laparotomy on cognitive function in rats with trau-matic brain injury and the relationship with calcium overload. Methods One hundred and fifty healthy male Wistar rats,aged 2~3 months,weighing 190~220 g,were assigned into 5 group ( n=30 each) using a ran-dom number table:blank group(group B),surgery group of blank rats(group BS),surgery group of sham rats (group SS),traumatic brain injury rats group( group T),surgery group of traumatic brain injury rats(group TS). TBI model was made in rats of group T and TS by Feeney method. Rats in group SS were only treated with cranial bone window without crainocerebral impact. Both group B and BS were normal rats. Then the rats in group BS,SS and TS group underwent laparotomy under sevoflurane anesthesia (the operation time was a-bout 3 hours) and the rats in group B and T inhaled pure oxygen for 3 hours after 20 days. One day before surgery,3 and 7 d after surgery,10 rats in each group were randomly selected for Morris water maze test. The hippocampus tissue of 10 rats were taken after the water maze test. The apoptosis rate and calcium concen-tration of hippocampal neurons were measured by flow cytometry,and the expression level of cleaved caspase-3 in hippocampal tissues was determined by Western blot. Results One day before surgery,compared with group B(the escape latency(9. 8±0. 8)s,the number of crossing platform (5. 8±0. 8),the apoptosis rate of hippocampal neurons ( 2. 5 ± 0. 9)%, calcium ion concentration ( 2. 3 ± 0. 2),the expression of cleaved caspase-3 (0. 22±0. 07) ),the escape latency of group T and group TS were prolonged (group T:(25. 5± 0. 7)s,P<0. 05;group TS:(25. 1±1. 1) s,P<0. 05),the number of crossing platform decreased (group T:(2. 7±0. 8),P<0. 05;group TS:(2. 8±0. 6),P<0. 05),the apoptosis rate of hippocampal neurons increased (group T:(5. 3±0. 6)%,P<0. 05;group TS:(5. 2±1. 0)%,P<0. 05),calcium ion concentration increased (group T:(3. 7±0. 4),P<0. 05;group TS:(3. 6±0. 5),P<0. 05) and the expression of cleaved caspase-3 increased (group T:(0. 45±0. 07),P<0. 05;group TS:(0. 44±0. 05),P<0. 05),the differences were statis-tically significant. Compared with the group SS,the escape latency ( 3 d after surgery:group SS:( 23. 8 ± 1. 3)s,group TS:(56. 4±2. 5)s,P<0. 05;7 d after surgery:group SS:(16. 6±1. 8)s,group TS:(38. 1±2. 1) s,P<0. 05)of the rats in group TS were prolonged,the number of crossing platform decreased (3 d after sur-gery:group SS:(2. 9±0. 6) ,group TS:(1. 1±1. 1) ,P<0. 05;7 d after surgery:group SS:( 4. 2± 1. 2) , group TS:(1. 7±1. 3),P<0. 05),the apoptosis rate of hippocampal neurons ( 3 d after surgery:group SS:(4. 8±0. 6)%,group TS:(14. 4± 0. 6)%,P<0. 05;7 d after surgery:group SS:(3. 8± 1. 1)%,group TS:(9. 6±1. 3)%,P<0. 05),calcium ion concentration ( 3 d after surgery:group SS:(3. 1± 0. 3),group TS:(6. 4±0. 5),P<0. 05;7 d after surgery:group SS:( 2. 6± 0. 3),group TS:( 4. 8± 0. 4),P<0. 05) ,the ex-pression of cleaved caspase-3 (3 d after surgery:group SS:( 0. 42± 0. 03),group TS:( 0. 88 ± 0. 08),P<0. 05;7 d after surgery:group SS:(0. 33±0. 05),group TS:(0. 63±0. 06),P<0. 05) in the hippocampus in-creased after surgery (P<0. 05). Compared with the T group,the escape latency (3 d after surgery:group T:( 18. 6±2. 0)s,group TS:(56. 4±2. 5)s,P<0. 05;7 d after surgery:group T:(13. 8±2. 6)s,group TS:(38. 1 ±2. 1)s,P<0. 05) of the rats in group TS were prolonged,the number of crossing platform (3 d after surger-y:group T:(3. 4±0. 5),group TS:(1. 1±1. 1),P<0. 05;7 d after surgery:group T:(4. 3±1. 2),group TS:(1. 7±1. 3),P<0. 05) decreased,the apoptosis rate of hippocampal neurons (3 d after surgery:group T:(4. 4±0. 7)%,group TS:( 14. 4 ± 0. 6)%,P<0. 05;7 d after surgery:( 3. 3 ± 1. 3)%,group TS:( 9. 6 ± 1. 3)%,P<0. 05),calcium ion concentration (3 d after surgery:group T:( 3. 4 ± 0. 4),group TS:( 6. 4 ± 0. 5),P<0. 05;7 d after surgery:group T:(3. 0±0. 3),group TS:(4. 8±0. 4),P<0. 05),the expression of cleaved caspase-3 (3 d after surgery:group T:(0. 40±0. 04),group TS:( 0. 88±0. 08),P<0. 05;7 d after surgery:(0. 35±0. 02),group TS:(0. 63±0. 06),P<0. 05) in the hippocampus increased after surgery(P<0. 05). Conclusion Laparotomy can aggravate the cognitive impairment of rats with traumatic brain injury and cause postoperative cognitive impairment,which may be related to the increased degree of calcium over-load and the increased rate of hippocampal neuron apoptosis.

Objective To evaluate the effect of an emollient containing Prinsepia utilis Royle oil extracts and other extracts on clinical symptoms and disease recurrence in children aged 2-12 years with atopic dermatitis (AD) in the remission period.Methods A multicenter,randomized,parallel-group,controlled clinical trial was conducted from December 2017 to September 2018.A total of 297 children aged 2-12 years with moderate AD were enrolled from 5 hospitals in China,and randomly divided into the test group (148 cases) and control group (149 cases).In the acute stage,the two groups were both topically treated with mometasone furoate cream once a day on the skin lesions,and with an emollient containing Prinsepia utilis Royle oil extracts and other extracts twice a day throughout the whole body for 2-4 weeks.The children would be enrolled into the remission stage if their Investigator's Global Assessment (IGA) score was ≤ 1 at following visits.In the remission stage,the test group was only topically treated with the emollient twice a day throughout the whole body,while mometasone furoate cream and the emollient were both withdrawn in the control group.At weeks 4,8 and 12 in the remission stage,the recurrence of AD,eczema area and severity index (EASI),children's dermatology life quality index (CDQOL) and adverse events were evaluated.Statistical analysis was carried out with SAS 9.4 software by using t test for comparison of normally distributed continuous data between two groups,chi-square test for comparison of unordered categorical data,Kaplan-Meier method for analysis of survival rates,Cox regression analysis for evaluating the effect of different therapies on AD recurrence in children in the remission stage,and Logistic regression analysis for analysis of odds ratio (OR) of EASI or CDQOL at week 4 in the remission stage between the test group and control group.Results Of the 297 children with AD,31 breached the clinical trial protocol,and 266 were included in the per protocol set (PPS),including 132 in the test group and 134 in the control group.In the PPS,114 and 106 patients completed the follow-up in the test group and control group respectively,and the recurrence rate was significantly lower in the test group (47,41.23％) than in the control group (84,79.25％;x2 =32.96,P ＜ 0.001).The time to recurrence was significantly longer in the test group(61.99 d ± 2.80 d)than in the control group(39.17 d ± 2.54 d,t =6.03,P ＜ 0.001),and the recurrence risk was significantly lower in the test group than in the control group (Log rank test,x2 =32.02,P ＜ 0.001).After adjustment for age and gender,Cox regression analysis showed that the recurrence risk in the test group was 0.35 times that in the control group (HR =0.35,95％ CI:0.24-0.51,P ＜ 0.01).At week 4 in the remission stage,the EASI score at P50-P75 and P75-P100 in the test group were 0.42,0.25 times that in the control group respectively (95％ CI:0.20-0.86,0.12-0.54 respectively;P =0.02,＜ 0.01respectively).Moreover,the CDQOL score at P75-P100 in the test group was 0.33 times that in the control group (95％ CI:0.17-0.65,P ＜ 0.01).No significant difference in the incidence of adverse events was observed between the two groups (P ＞ 0.05).Conclusion Maintenance treatment with the emollient containing Prinsepia utilis Royle oil extracts and other extracts can markedly reduce the recurrence risk in AD children,improve clinical symptoms,and enhance the quality of life.

Objective To evaluate the therapeutic outcome of horizontal bone augmentation by using the modified split crest technique of piezosurgery in mandible molar area. Methods The present study reviewed the record of 15 patients from 2016 January to 2017 March in the department of oral implantology center of Stomato-logical Hospital of Southern Medical University,who underwent the modified split crest technique of piezosurgery in mandible molar area. Preoperative CBCT was performed to determine the bone thickness of the toothless alveo-lar crest of the mandibular posterior region,and the bone thickness was less than 3 mm. The modified split crest technique of piezosurgery was performed for the horizontal bone augmentation at mandibular posterior region. Meanwhile,GBR and the postoperative CBCT were performed to determine the bone width increments,followed with 1-week anti-inflammatory therapy postoperation. Three months after the operations,the bone width incre-ment was examined by CBCT. SPSS13.0 software was used to analyze the collected data. Results The modified split crest technique of piezosurgery in mandible molar area was successfully established,resulting in the mini-mal operative wounds and the slight postoperative reaction,without obvious infection. The postoperative crest width increase achieved 6.05 ± 0.65 mm. At 3 months after operation,the crest width increase reduced to(5.81 ± 0.61)mm. There were significant differences of the alveolar ridge thickness between the preoperative and post-operative patients(P<0.05). There were significant differences between the preoperative crest width and the 3 months after treatment(P<0.05). Conclusion Horizontal bone augmentation of the modified split crest tech-nique of piezosurgery was efficient,which could be performed in very narrow alveolar ridge,and which was rela-tively safe and accurate,with less trauma. No damage was observed to the soft tissue,and the cutting direction can be well controlled.

Objective:To analyze the sleep quality before treatment and related risk factors of sleep disorder in patients with nasopharyngeal carcinoma (NPC). Methods: Totally 143 patients first diagnosed as nasopharyngeal carcinoma were selected [ average age (43 ± 10) years, 100 males and 43 females] in a NPC ward of one hospital, the Chinese version of Pittsburgh Sleep Quality Index (PSQI, total score ＞ 5 diagnosed as sleep disorder) was used to investigate the sleep quality before treatment, and the logistic regression analysis was used to analyze related factors of the sleep disorder before treatment Results: The rate of sleep disorder was 50.3％. The logistic regression analysis showed that age was a risk factor of sleep disorder before treatment in patients with NPC (OR = 1.04, 95％ CI: 1.01-1.08), while gender, culture degree, clinical stage, body mass index were not correlated with sleep disorder (Ps＞0.05). Conclusion: It suggests that patients with NPC may have a higher incidence of sleep disorder before treatment, and older patients may be more prone to pre-treatment sleep disorder.

Objective To explore how to reduce and quickly deal with all kinds of alarm in the dialysis process, to ensure the safety of dialysis, improve the coping ability of nurses, improve the quality of nursing and the satisfaction of patients. Methods Various kinds of alarm and nurse processing time in hemopurification center of our hospital from 2013 to 2014 were recorded and analyzed, the emergency treatment measures were found out, the coping methods were developed, the coping process were improved, and the training of nurses was strengthened. The various parameters were rerecorded and compared after training (2015 to 2016). Results The most common alarm in dialysis process was venous pressure alarm, accounting for 16.45%(15925/96831) of the total alarm, the lowest limit was 10.34%(10020/96831), and the highest limit was 6.11%(5905/96831). The total conductivity alarm was 10.33%(9969/968310), the nurse' s alarm processing time of the lowest limit was (53.11 ± 12.84) s, the highest limit was (136.77 ± 42.88 ) s, the conductivity alarm was (54.17 ± 33.55) s. After the training of nurses, the alarm frequency was reduced (χ2=3.164, P<0.05), the venous pressure alarm accounts for 14.69% (15415/104913) of the total alarm , the lowest limit was 9.52% (9985/104913),and the highest limit was 5.18%(5430/104913), the total conductivity alarm was 7.54%(7913/104913). The alarm processing time was shortened:the lowest limit was (40.94 ± 10.38) s, the highest limit was (119.15 ± 38.79) s (t=3.944, 3.304, P<0.05). The work efficiency and patient satisfaction degree were improved. Conclusions Through the summary and training of all kinds of alarm in the dialysis process, it can effectively reduce the alarm frequency of the dialysis process, improve the work efficiency of nurses, and improve the satisfaction degree of patients.