Surgical operation is the main treatment of oral and maxillofacial tumors.Dysphagia is a common postoperative complication.Swal-lowing disorder can not only lead to mis-aspiration,malnutrition,aspiration pneumonia and other serious consequences,but also may cause psychological problems and social communication barriers,affecting the quality of life of the patients.At present,there is no systematic evalua-tion and rehabilitation management plan for the problem of swallowing disorder after oral and maxillofacial tumor surgery in China.Combining the characteristics of postoperative swallowing disorder in patients with oral and maxillofacial tumors,summarizing the clinical experience of ex-perts in the field of tumor and rehabilitation,reviewing and summarizing relevant literature at home and abroad,and through joint discussion and modification,a group of national experts reached this consensus including the core contents of the screening of swallowing disorders,the phased assessment of prognosis and complications,and the implementation plan of comprehensive management such as nutrition management,respiratory management,swallowing function recovery,psychology and nursing during rehabilitation treatment,in order to improve the evalua-tion and rehabilitation of swallowing disorder after oral and maxillofacial tumor surgery in clinic.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Spinal surgical site infection (SSI), especially deep SSI after internal fixation is difficult in treatment, with long course of disease and poor prognosis. At present, there are many controversies in the diagnosis and treatment of spinal SSI, with unsatisfactory overall efficacy of its diagnosis and treatment. Besides, no diagnosis and treatment guideline based on evidence-based medicine has been in existence. To this end, the Spinal Infection Group of the Orthopedic Branch of the Chinese Medical Doctor Association and the Spinal Infection Group of the Spinal Surgery Branch of the Chinese Rehabilitation Medicine Association jointly organized relevant experts to formulate Evidence-based clinical guideline for the diagnosis and treatment of surgical site infection in spinal trauma ( version 2024) based on an evidence-based approach. A total of 10 recommendations were proposed on the diagnosis and treatment of spinal SSI, so as to provide a clinical reference for the diagnosis and treatment of spinal SSI.

Objective:To analyze the clinical manifestations and laboratory features in patients with myeloid neoplasms complicated with clonal T large granular lymphocyte (T-LGL) proliferation.Methods:The clinical data of 5 patients with myeloid neoplasms complicated with clonal T-LGL proliferation from November 2017 to November 2018 in Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College were analyzed retrospectively.Results:The median age was 60 years old. All patients had a history of abnormal peripheral blood cell counts for over 6 months. The absolute lymphocyte count in peripheral blood was less than 1.0×10 9/L. In addition to the typical T-LGL phenotype, the immunophenotype was heterogenous including CD4 +CD8 - in 2 patients, the other 3 CD4 -CD8 +. Four patients were αβ type T cells, the other one was γδ type. STAT3 mutation was detected in 1 patient by next-generation sequencing, the other 4 cases were negative. Conclusions:Clonal T-LGL proliferation with myeloid neoplasm develops in an indolent manner, mainly in elderly patients. Hemocytopenia is the most common manifestation. The diagnosis of T-LGL proliferation does not have specific criteria, that it should be differentiated from other T cell proliferative disorders, such as T-cell clones of undetermined significance. STAT3 or STAT5b mutation may help distinguish.

Objective: To determine the clinical significance of nontuberculous mycobacteria (NTM) isolated from respiratory specimens. Methods: Clinical data of patients with NTM strains isolated from the respiratory tract between January 2014 and February 2017 were retrospectively analyzed. Clinical significance of NTM isolated strains was evaluated based on diagnostic criteria of NTM pulmonary diseases from American Thoracic Society (ATS). Quantitative data of two groups were analyzed by independent t test. Categorical data were analyzed by Pearson χ² test or Fisher exact test. Results: Totally 352 NTM strains from 257 patients had been isolated between January 2014 and February 2017. Among 15 identified NTM species, M. intracellular (51.7%, 182/352), M. abscessus (25.6%, 90/352), and M. avium (10.8%, 38/352) were predominant. Of the 157 patients with full clinical data involved in the analysis, 58 (36.9%) patients were determined to have definite disease, and 34 patients (21.7%) were designated as probable disease candidates, and 16 (10.2%) patients were regarded as uncertain disease, and 49(31.2%) patients were diagnosed as unlikely disease. The age of 58 patients with definite disease was (63.9±12.7) years, and 48.3% (28/58) were female. M. intracellulare (55.2%, 32/58) was the main cause of pulmonary NTM disease, followed by M. abscessus (25.9%, 15/58) and M. avium (12.1%, 7/58), while other NTM species only accounted for 6.8% (4/58). Definite cases with M. intracellulare, M. abscessus, M. avium, M. kansasii, M. marseillense, and M. columbia accounted for 35.2% (32/91), 57.7% (15/26), 7/15, 2/3, 1/3 and 1/2, respectively, among patients with corresponding isolations, while patients with other species of isolation did not meet the diagnostic criteria. Patients with clinical significant isolation of NTM were older than those without clinical significance (χ²=3.603, P=0.000), and proportion of anti-acid staining positivity of patients with clinical significance was higher than that of patients without clinical significance (χ²=18.815, P=0.000). The proportion of M. abscessus in patients with clinical significance was higher than that in patients without clinical significance (χ²=6.313, P=0.012). However, there was no significant difference between the two groups in the isolation of M. Gordon (Fisher exact test, P=0.028). The proportion of M. abscessus lung disease in women was 11/15, which was higher than that of M. intracellulare lung disease (41.5%, 17/41), and the difference between the two groups was statistically significant (χ²=4.462, P=0.035). There was no significant difference of clinical symptoms and underlying diseases in NTM lung disease among different groups (all P>0.05). In these patients with definite disease, 39.7% (23/58) of them manifested the upper lobe cavitary form, 53.4% (31/58) exhibited nodular bronchiectatic form, and only 6.9% (4/58) exhibited unclassified form. The upper lobe cavitary form (43.8%, 14/32) and the nodular bronchiectatic form (53.1%, 17/32) dominated in patients with M. intracellulare lung disease. M. abscessus lung disease was dominated by the nodular bronchiectatic form (11/15) while the upper lobe cavitary form only accounts for 3/15. There was no significant difference of image characteristics between NTM lung disease and other different groups (all P>0.05). Conclusions 36.9% of the patients with NTM isolates met the ATS diagnostic criteria for NTM lung disease. Different species have different clinical significance. M. intracellulare and M. abscessus are the most predominant NTM isolated species that cause NTM lung disease. Majority of patients manifest as the upper lobe cavitary form, followed by the nodular bronchiectatic form.

Heart specialists team has become one of the core concepts of diagnosis and treatment mode for cardiovascular diseases.Multidisciplinary collaboration has proved its beneficial effects on the diagnosis and treatment strategies, patient selection, follow-up and management of some cardiovascular diseases.At present,it is chiefly seen in the diagnosis and treatment of coronary artery revascularization and transcatheter aortic valve replacement.During implementation there still exist such problems as lack of awareness,attention and effective operation of the medical staff,and lack of an incentive mechanism, thus incurring controversies over such a model.Therefore further follow-up and improvements are expected in combination with the characteristics of China′s medical institutions.

Objective To elaborate the changes of the soluble B cell-activating factor of the tumor necrosis factor family (BAFF) in the peripheral blood of chronic human immunodeficiency virus (HIV)-infected patients ,and to study the correlation between the soluble BAFF in HIV-infected patients and the progressions of acquired immune deficiency syndrome (AIDS).Methods Fifty untreated HIV outpatients and 30 healthy controls were recruited .According to the counts of CD4+T lymphocytes ,HIV-infected patients were divided into three groups ,＜ 200 cells／μL group , (200 － 350 ) cells／μL group and ＞350 cells／μL group .B cell counts and the BAFF levels were compared among the three groups and the healthy controls .The correlation analysis was conducted for the levels of BAFF ,the counts of CD4+T lymphocytes and B cells ,and viral load in HIV-infected patients .The value of BAFF in staging of HIV disease was identified by receiver operating characteristic (ROC) curve.Results The B cell counts were (90.3 ± 43.1)cells／μL in ＜200 cells／μL group ,(114 .4 ± 28 .8) cells／μL in (200 －350) cells／μL group ,and (162 .1 ± 29 .5) cells／μL in ＞350 cells／μL group and (307.1 ± 97 .0) cells／μL in healthy controls ,which was significantly different among the four groups (F＝47.92 ,P＜0.05).The concentrations of BAFF in the four groups were (1 737.5 ± 719.7) ,(962.8 ± 341.1) ,(859.8 ± 270.4) ,and (456.9 ± 163.7) ng／L ,with significant difference among the groups (F＝36.72 ,P＜0.05).The level of BAFF was negatively correlated with both B cell counts and CD4+T lymphocyte counts (r＝ －0.722 and －0.568 ,respectively ;both P＜0.05) ,and positively correlated with viral load (r＝0.607 ,P＜0 .05).The area under the ROC curve was 0 .881.If the level of BAFF was 1 281.5 ng／L ,the sensitivity and specificity to predict the period of AIDS were 74 .1% and 87.0%,respectively .Conclusion The levels of soluble BAFF in HIV-infected patients are significantly increased and related with the reduction of B cell counts and disease progression.

Objective To investigate the resistance of second-line anti-TBdrugs to baseline strain in patients with multidrug-resistant pulmonary tuberculosis. Methods Atotal of 52 baseline strains in patients with multidrug-resistant pulmonary tuberculosis collected from March 2016 to May 2017 in our hospital were randomly selected. The sensitivity of the nine kinds of second-line anti-TBdrugs was tested, to analyze the proportion of different drug resistance and cross-resistance of similar drugs. Results Among the 9 second-line anti-TBdrugs, the ratio of drug resistance was ofloxacin =levofloxacin(59. 6％, 31/52)＞moxifloxacin(30. 8％, 16/52)＞ amikacin=kanamycin(both 9. 6％,5/52)＞paminosalicylic acid=cycloserine(both 7. 7％, 4/52)＞ capreomycin =prothionamide(both 9. 6％, 3/52). Ofloxacin was completely cross-resistant with levofloxacin, and its cross-resistant rate with moxifloxacin accounted for 51. 6％ (15/31). Amikacin was completely cross-resistant with kanamycin, and its cross-resistant rate with capreomycin accounted for 60％. Conclusion The baseline strains of patients with multi-drug resistant pulmonary tuberculosis are seriously resistant to fluoroquinolones. There is resistance to some extent for other second-line anti-tuberculosis drugs. Therefore, second-line drug susceptibility testing should be completed prior to establishing an effective MDR-TBtreatment regimen.

Objective To investigate the efficacy and safety of levofloxacin and rifapentine for elderly initial treatment pulmonary tuberculosis.Methods 120 cases of elderly initial treatment pulmonary tuberculosis patients January 2015 to January 2016 in our hospital were randomly divided into A,B,C three groups,with 40 cases in each group.Treatment regimen of group A: 2HRZE/4HR; treatment regimen of group B: 2Rft(rifapentine capsules)HZE/4HRft; treatment regimen of group C: 2Rft(rifapentine capsules)HELfx/4HRft.The clinical symptoms,signs and adverse drug reactions were compared between the three groups of patients,observation the changes of blood,urine,liver and kidney function,perform imaging and bacteriological examination to determine the treatment effect.Results Five cases in group A and one case in group B abandoned treatment because of liver damage and severe gastrointestinal reaction,but no one in the 40 cases of group C abandoned treatment.There was no statistically significant difference among three groups in sputum negative conversion rate and focus absorption.The number of cases presenting gastrointestinal reaction and liver damage in group C was significantly smaller than that in group A and group B(P<0.05).Rifampicin was replaced by levofloxacin in two cases of group A as a result of allergy,and no allergy occurred in the other two groups.Conclusion Levofloxacin and rifapentine have good efficacy and few side effects for elderly initial treatment pulmonary tuberculosis,initial treatment regimen for elderly pulmonary tuberculosis patients should be individualized,drugs with few side effects can be used to guarantee smooth proceeding of treatment.

Objective To investigate the isolation rate, distribution and trend of nontuberculous mycobacteria (NTM) in Wenzhou during 2014 to 2016.Methods Sputum or alveolar lavage specimens of patients with suspected pulmonary tuberculosis were collected for mycobacteria culture from January 2014 to December 2016.Mycobacterium culture positive strains were further identified by gene chip, 16S rRNA and hsp65 gene sequencing.SPSS 19.0 software was used to analyze the data.Results After excluding repetitive strains, 3 295 mycobacteria strains (MTB) were isolated from respiratory specimens, included 3 032 mycobacterium tuberculosis complex strains, 238 NTM strains, 20 Gordon genera strains, 3 Nocardia genera strains and 2 Tsukamurella genera strains.The proportion of NTM among confirmed mycobacteria was 8.5％ (86/1 006), 6.7％ (72/1 079) and 6.8％ (80/1 185) in 2014, 2015 and 2016, respectively (x2 =2.459,P ＞ 0.05).The overall prevalence of NTM was 7.3 ％ (238/3 270).There were 15 species of NTM, and the most common NTM strain was Mycobacterium intracellulare (52.5％,125/238), followed by Mycobacterium abscessus (22.7％, 54/238) and Mycobacterium avium (10.1％, 24/238), other species were only accounted for 14.7％ (35/238).The ranking of Mycobacterium avium went up rapidly from the fifth in 2014 to the second in 2016 (x2 =18.259, P ＜ 0.01), while proportion of Mycobacterium abscess, dropped from 34.9％ (30/86) in 2014 to 17.5％ (14/80) in 2016 (x2 =7.335, P＜0.01).Among patients from whom the NTM strains were isolated, 56.7％ (135/238) were male and most of them were aged 45 years or above (79.8％, 190/238).Conclusions In the past three years, the trend of NTM isolation rate in Wenzhou is steady.The most prevalent NTM species is Mycobacterium intracellulare, followed by Mycobacterium abscessus and Mycobacterium avium.Mycobacterium avium shows a continuously upward trend, while the separation of Mycobacterium abscessus shows a downward trend.