Objective To explore the advantages of modified Paine point puncture for intraventricular intracranial pressure(ICP)monitoring probe implantation during decompressive craniectomy(DC)for severe traumatic brain injury.Methods The clinical data of 48 patients with severe traumatic brain injury admitted from April 2020 to April 2022 in Jiaxing Second Hospital were retrospectively collected.All patients underwent DC combined with ICP monitoring probe implantation.According to different ICP monitoring methods,they were divided into observation group(23 cases)and control group(25 cases).The observation group underwent the implantation of the intracerebroventricular ICP monitoring probe by puncture at the modified Paine point in the DC incision,while the control group underwent implantation of intracerebroventricular ICP monitoring probe by drilling of the skull through contralateral incision of DC at the Kocher point.The preoperative general data,operation time,postoperative mannitol dose and duration,ICP monitoring duration,postoperative rebleeding rate,intracranial infection rate and Glasgow outcome score(GOS)at 3 months after the operation were compared between the two groups.Results There was no statistical difference between the two groups in general data,mannitol dosage,mannitol duration and ICP monitoring duration(P>0.05).The operation time,postoperative rebleeding rate and intracranial infection rate in observation group were lower than those in control group(P<0.05).In the GOS score at 3 months after the operation,there was no statistical difference between the two groups(P>0.05).Conclusions Compared with the traditional implantation of intraventricular ICP monitoring probe through Kocher point through skull drilling with contralateral incision of DC,the implantation of intraventricular ICP monitoring probe through modified Paine point in the DC incision for severe traumatic brain injury can shorten the operation time and lower the postoperative rebleeding rate and intracranial infection rate.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

Since December 2019, novel coronavirus pneumonia (NCP) has been reported in Wuhan, Hubei Province, and spreads rapidly to all through Hubei Province and even to the whole country. The virus is 2019 novel coronavirus (2019-nCoV), never been seen previously in human, but all the population is generally susceptible. The virus spreads through many ways and is highly infectious, which brings great difficulties to the prevention and control of NCP. Based on the needs of orthopedic trauma patients for emergency surgery and review of the latest NCP diagnosis and treatment strategy and the latest principles and principles of evidence-based medicine in traumatic orthopedics, the authors put forward this expert consensus to systematically standardize the clinical pathway and protective measures of emergency surgery for orthopedic trauma patients during prevention and control of NCP and provide reference for the emergency surgical treatment of orthopedic trauma patients in hospitals at all levels.

With the outbreak of novel coronavirus pneumonia (NCP) induced by 2019 novel coronavirus (2019-nCoV) in Wuhan, Hubei Province in December 2019, more and more suspected or confirmed cases have been found in various regions of China. Although China has adopted unprecedented strict quarantine and closed management measures to prevent the spreading of the disease, Department of Traumatic Orthopedics may still have to manage NCP patients with open fractures or severe trauma that require emergency surgery. Therefore, the identification and management of 2019-nCoV infection as soon as possible as well as the protection of all medical staff involved in the emergency treatment of patients are the severe challenges faced by orthopedic traumatologists during the prevention and control of NCP. Based on the characteristics of such patients and related diagnosis and treatment experiences during the epidemic of NCP, the authors formulate the surgical management strategies for orthopedic trauma patients.

Resin-containing drugs in Dracaena from four different appearances were analyzed by headspace sampling-gas chromatography-mass spectrometry(HS-GC-MS) metabolomics technique and hierarchical clustering analysis(HCA) chemometrics method. This study was to analyze differential volatile components in resin-containing drugs in Dracaena from different appearance and metabolic pathways. The results of partial least squares discriminant analysis(PLS-DA) and HCA analysis indicated that there was little difference in volatile components between fiber-rich sample and hollow cork cambium sample, however, the volatile components in the two samples compared with whole body resin-containing sample and resin-secreting aggregated sample had a large metabolic difference. Twenty differential metabolites were screened by VIP and P values of PLS-DA. The content of these differential metabolites was significantly higher in whole body resin-containing sample and resin-secreting aggregated sample than in fiber-rich sample and hollow cork cambium sample. Sixteen significant metabolic pathways were obtained through enrichment analysis(P<0.05), mainly involved in terpenoids biosynthesis and phenylpropanoid metabolism. This result provided a reference for further study of resin formation mechanism of resin-containing drugs in Dracaena from different appearances. At the same time, it also provided a reference for establishing a multi-index quality evaluation system.
Cluster Analysis ; Discriminant Analysis ; Dracaena ; Gas Chromatography-Mass Spectrometry ; Resins, Plant

Objective: To evaluate Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin type Ⅱ in the youth. Methods: A retrospective analysis was conducted of the 16 patients who had been treated at Department of Orthopaedics, Union Hospital, Tongji Medical College for femoral head fractures of Pipkin type Ⅱ from August 2016 to June 2018. They were 9 men and 7 women, aged from 18 to 45 years (mean, 25.6 years). Of them, 10 cases who had been complicated with posterior dis-location of the hip received emergency hip reduction(<6 h) before surgical fixation. All the patients underwent Herbert screwing directly via the anterior approach. Their incision length, operation time, intraoperative blood loss, hospitalization time, Harris hip scores, therapeutic efficacy and complications were recorded. Results: In this series, the incision length averaged 10.4 cm, operation time 45.6 min, intraoperative blood loss 46.5 mL, and hospitalization time 4.0 d. All the 16 patients were followed up for 11 to 15 months (average, 12.7 months). Their Harris hip scores at preoperation, 3, 6 and 9 months postoperation and at the last follow-up were, respectively, 14.3±2.2, 64.8±2.4, 81.1±4.9, 88.1±4.6 and 91.9±3.4 points, showing a significant difference between any 2 time points (P<0.05). The therapeutic efficacy at the last follow-up by the Thompson-Epstein clinical evaluation was assessed as excellent in 9 cases, as good in 6 and as fair in one. No osteonecrosis of the femoral head or heterotopic ossification was observed by follow-up. Conclusion For young patients with femoral head fracture of Pipkin type Ⅱ, Herbert screwing directly via the anterior approach provides easy exposure and manipulation, does not aggravate the blood supply to the femoral head, decreases incidence of heterotopic ossification, and leads to shorter operation time and quick functional recovery of the hip.

Objective: To develop medical emergency support information system for large-scale social activities based on 5G communication technology to improve efficiency of emergency medical services. Methods: The project was completed in Hangzhou, China, from March 2016 to September 2019. Based on the medical service of large social activities, five information terminals are constructed, including on-site mobile terminal, on-board first aid terminal, expert remote consultation terminal, hospital terminal, and command dispatch center. The system can realize the real-time communication of medical information, patient's vital signs, audio, picture and video information, and can also make intelligent scheduling decisions for patients. Results: 5G Emergency Medical information System for Large-scale Social Activities has been completed, which consists of three parts: command and control platform, on-site rescue platform, and evacuation support platform. The command and monitoring platform displays the information of on-site medical teams, ambulances, hospitals and experts through web pages, and realizes multi-party video communication at any time, as well as text, voice and image information of patients' current condition, so as to realize command, dispatch and display statistical summary information. On-site rescue terminal includes patient information input, video signal acquisition and physiological information acquisition equipment. It realizes multiple methods of patient information input, vital signs and physiological information acquisition, multi-angle video acquisition and transmission to the command center. The evacuation support platform includes vehicle emergency terminal, remote expert consultation terminal, hospital terminal and UAV system. Vehicle terminal can scan and transfer with on-site ambulance team, record physiological information during transit, and also acquire and transmit monitor, electrocardiogram and ultrasound information. Hospital terminals can obtain patient information at the first time and prepare for first-aid in hospital. The remote expert terminal can be dispatched by the command center and the hospital terminal, and can join the remote consultation at any time. Unmanned aerial vehicle (UAV) system can transfer medical material between any locations. Conclusions This system can guarantee the patients to be transported from the scene to the ambulance and finally to the hospital during the large-scale social activities. In the whole process, the information transmission and dispatching decision-making are initially realized, and the statistical report forms can be made. However, to fully exert its advantages, it still needs the support of the complete 5G network and continuous optimization in real scenarios.

OBJECTIVE: To study the accuracy of 3D printing implant-guided anterior tooth implantation under flap or flapless surgery. METHODS: Twenty-one cases (32 teeth) with missing teeth were divided into two groups: tooth implantation on the maxillary models under flap surgery (FP group) and tooth implantation on the maxillary models under flapless surgery (FPS group). A dental implant guide was designed and used in the two groups. The actual position of the dental implants in the two groups was compared with the preplanned deviation values of implant top, bottom, vertical distance, and angle deviation. SPSS 19.0 software was used for statistical analysis. RESULTS: The deviation values of implant top, bottom, vertical distance, and angle were significantly lower in the FP group than in the FPS group (P<0.05). CONCLUSIONS High accuracy of tooth implantation can be realized by using the 3D printing implant guide. The different surgical methods influence the precision of tooth implantation. Clinicians can choose the surgery reasonably depending on the actual situation.
Cone-Beam Computed Tomography ; Dental Implantation, Endosseous ; Dental Implants ; Printing, Three-Dimensional ; Tooth

Objective To investigate the predictive values of Kwon's score,Chumbler's score,Age,Atrial Fibrillation,Dysphagia,Sex,Stroke Severity (A2DS2) score,the Preventive ANtibacterial THERapy in Acute Ischemic Stroke (PANTHERIS) score,Acute Ischemic Stroke-Associated Pneumonia Score (AIS-APS),and prestroke Independence,Sex,Age,NIHSS (ISAN) score for stroke-associated pneumonia (SAP) in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled retrospectively.They were grouped according to whether to be complicated with SAP or not.The demography and baseline characteristics were compared between the SAP group and the non-SAP group.Multivariate logistic regression analysis was used to identify the independent risk factors for SAP.Receiver operating characteristic (ROC) curves were used to compare the predictive values of the 6 kinds of scores for SAP.Results A total of 1 427 patients with acute ischemic stroke were enrolled.Three hundred ninety-five patients (27.7％) complicated with SAP within 7 d after onset.There were significant differences in age,gender,past history (pneumonia,atrial fibrillation,smoking),laboratory tests (white blood cell count ＞11 × 109/L,baseline blood glucose ≥ 11.1 mmol/L),Oxfordshire Community Stroke Project (OCSP) classification,falling at the time of onset,dysphagia,mechanical ventilation and the modifiel Rankin Scale (mRS) score before onset,baseline Glasgow Coma Scale (GCS) score,baseline National Institutes of Health Stroke Scale (NIHSS) score and 6 scores between the SAP group and the non-SAP group (all P ＜ 0.05).Multivariate logistic regression analysis showed that age (odds ratio [OR] 1.034,95％ confidence interval [CI] 1.019-1.049;P=0.001),white cell count ＞ 11 × 109/L (OR 4.386,95％CI 2.763-6.905;P=0.001),baseline blood glucose ≥ 11.1 mmol/L (OR 1.933,95 ％ CI 1.305-2.864;P =0.001),dysphagia (OR 7.839,95％ CI 4.892-12.563;P =0.001),baseline NIHSS (OR 1.120,95％ CI 1.077-1.165;P =0.001),and baseline GCS score (OR 1.132,95％ CI 1.019-1.257;P =0.021) were the independent risk factors for SAP.The areas under the ROC curves of SAP predicted by the Chumbler's,AIS-APS,A2DS2,ISAN,Kwon's and PANTHERIS scores were 0.830 (95％ CI 0.805-0.855),0.827 (95％ CI 0.802-0.852),0.818 (95％ CI 0.792-0.845),0.788 (95％ CI 0.762-0.814),0.774 (95％CI 0.774-0.803),and 0.727 (95％ CI 0.695-0.758),respectively.There were no significant differences in the area under ROC curves of Chumbler's,A2DS2 and AIS-APS scores between the pairwise comparisons.There were significant differences in the area under ROC curves of the Chumbler's,A2DS2,AIS-APS and ISAN scores between the pairwise comparisons (AIS-APS compared with ISAN:P =0.001;the rests P ＜ 0.001).Conclusions The accuracies of predicting SAP with the Chumbler's,AIS-APS and A2DS2 scores are superior to the ISAN,Known's and PANTHERIS scores,and have higher clinical application value.