Objective:To investigate the clinical effect of Ilizarov technique with compression and distraction osteogenesis in treatment of traumatic femoral shaft defects.Methods:A retrospective case series study was conducted to analyze the clinical data of 52 patients with traumatic femoral shaft defects admitted to West China Hospital of Sichuan University from September 2015 to September 2019，including 32 males and 20 females at age of 19-60 years［（40.3 ± 12.1）years］. There were 15 patients with fractures at the proximal 1/3，20 at middle 1/3 and 17 at distal 1/3 part of femoral shaft. Types of bone defects were bone defect after open fracture in 2 patients，infectious nonunion in 29 and atrophic nonunion in 21. Length of bone defects after debridement and osteotomy was 3.0-5.8 cm［（4.2 ± 0.8）cm］. A total of 24 patients underwent primary direct shortening and compression as well as re-lengthening of the broken ends；28 patients were operated by osteotomy and compression，and then by re-lengthening of the broken ends at Ⅱ stage with the average interval of 2.8 months. Postoperative wound healing，bone healing time，external fixation index（EFI）and complications were observed. Preoperative and postoperative levels of white blood cell count（WBC），C-reactive protein（CRP）and erythrocyte sedimentation rate（ESR）were measured. Association for the study and application of the method of Ilizarov（ASAMI）score was used to evaluate bone healing and functional recovery at the latest follow-up.Results:All patients were followed up for 20-60 months［（36.5 ± 10.3）months］. All wounds were healed at Ⅰ stage，with no infection or sinus tract recurrence. Bone healing time was 9-20 months［（14.5 ± 3.8）months］，and EFI was 1.2-1.9 months/cm［（1.5 ± 0.2）months/cm］. Nail tract infection was found in 14 patients，with the infection rate of 27%. Poor healing of broken ends fracture occurred in 4 patients，out of which 3 with infectious nonunion and 1 with atrophic nonunion. Axial deviation was observed in 2 patients and poor mineralization was observed in 1 patient. In 2 patients，the affected side was shortened by 1.8 cm and 2.0 cm when compared to the healthy side. At the latest follow-up，levels of WBC［（6.0 ± 1.4）× 10 9/L］，CRP［（6.8 ±1.7）mg/L］and ESR［（10.5 ± 6.1）mm/h］were lower than those before surgery［（9.2 ± 2.2）× 10 9/L，（31.7 ± 22.1）mg/L，（45.8 ± 31.3）mm/h］（ P < 0.01）. At the latest follow-up，bone healing rated on ASAMI score was excellent in 31 patients，good in 13 and fair in 8，with the excellent and good rate of 85%；limb function rated on ASAMI score was excellent in 28 patients，good in 14，fair in and good in 3，with the excellent and good rate of 81%. Conclusions:For traumatic femoral shaft defects，Ilizarov technique with compression and distraction osteogenesis can fully remove infection or ischemic bone lesions. Distraction osteogenesis technology can complete continuous compression of broken ends to further promote healing of broken ends and limb lengthening and attain limb reconstruction and bone healing and functional recovery.

Objective:To explore the perioperative management strategy for the elderly with hip fractures during the epidemic of corona virus disease 2019 (COVID-19) and evaluate its clinical effect.Methods:A retrospective case series study was conducted on 33 elderly patients with hip fractures admitted to Chongqing General Hospital, University of Chinese Academy of Sciences, from January 20 to February 29, 2020, including 14 males and 19 females, aged 65-92 years [(76.5±6.3)years]. There were 20 patients with intertrochanteric fractures and 14 with femoral neck fractures. In total, 15 patients were combined with hypertension and 9 with diabetes. A total of 19 patients were treated with open reduction and internal fixation and 14 with total hip/semi-hip replacement. The time from injury to admission was 2-14 hours. The temperature measurement, routine blood test and chest CT examination were performed to exclude COVID-19 in all patients, which showed 12 patients with pulmonary infection. The medical staff received different levels of protection: first level protection for those in the special ward, secondary level protection for the emergency isolation ward and tertiary level protection for those collecting the throat swab samples. The time from admission to operation, intensive care unit (ICU) stay time, hospitalization time, visual analogue score (VAS), perioperative complications as well as infection of patients and medical staff were observed and recorded.Results:The time from admission to operation was (3.18±0.19)days for all patients, with (2.24±0.28)days for 21 patients with no obvious pulmonary abnormality and (4.83±0.39)days for 12 with pulmonary infection. The hospitalization time was (10.97±0.31)days in all patients, with (9.71±0.27)days for 21 patients with no obvious pulmonary abnormality and (12.51±0.78)days for 12 with pulmonary infection. After operation, 12 patients were treated in ICU for 1-3 days, and the rest 21 patients were treated in general wards. The pain of all patients was effectively controlled. The time for exercise was (4.0±1.4)days after operation in all patients, among which 19 treated with fracture reduction and internal fixation started at (4.3±1.3)days after operation and 14 treated with total hip/semi-hip replacement started at (3.6±1.3)days after operation. VAS was (4.55±0.29)points at 12 hours before operation, (5.62±1.12)points at 6 hours, (3.54±0.39)points at 24 hours, and (2.42±0.11)points at 72 hours after operation ( P<0.05). Chest CT showed that the pulmonary inflammation was significantly improved one day before discharge. There was no indication of nucleic acid detection, with no urinary tract infection, pressure sore, deep vein thrombosis or other complications were found. No infection of patients or medical staff occurred. Conclusion:During pandemic of COVID-19, early surgical treatment for the elderly with hip fractures can be done in the general wards, based on strictly following the principle of infection prevention and control and carefully evaluating the perioperative risks, which can avoid the probability of infection of patients and medical staff without prolonging the hospitalization time or increasing the incidence of complications.

Objective: To analyze CYP2C9 and VKORC1 gene polymorphisms in Chinese Han population and their correlation with the maintenance dosage of warfarin. Methods: From October 2017 to April 2018, 458 Chinese Han patients (213 males and 245 females, aged from 26 to 94 years old) who underwent coagulation analysis in Peking University People′s Hospital were included in this retrospective study. PCR-Fluorescent probe method was applied to detect CYP2C9*3 and VKORC1-1639A>G gene polymorphisms in 458 patients, and among them, 130 patients who took warfarin for anticoagulant therapy and reached the international standard ratio of prothrombin time (INR) within the range of 2.0-3.0 were recorded. The basic information, dosage of warfarin and INR were also recorded. The statistical analysis data were compared with the reference table of recommended dosage of warfarin for different genotypes of patients recommended by FDA and the formula of predicted dosage of warfarin was simply verified by SPSS. Results: Among the 458 patients who took anticoagulant therapy, the genotype frequencies of CYP2C9*1/*1(AA), CYP2C9*1/*3(AC) and CYP2C9*3/*3(CC) were 90.8%, 8.5%, and 0.7%; the genotype frequencies of VKORC1-1639GG and VKORC1-1639AG were 0.9% and 14.2%; the genotype frequencies of VKORC1-1639AA was 84.9%. After INR was reached, the results showed that the variant CYP2C9*1/*3 and CYP2C9*3/*3 required lower daily maintain dosage [(2.92±1.29) mg] than wild-type CYP2C9*1/*1 patients did [(3.91±1.63) mg], with statistically significant difference (P=0.018). And variant VKORC1-AA required lower daily maintain dosage [(3.68±1.64) mg] than variant VKORC1-AG patients did [(4.54±1.29) mg], with statistically significant difference (P=0.001). The application dosage of warfarin in patients with different VKORC1+CYP2C9 genotypes was consistent with the recommended dosage of the FDA reference table. The prediction accuracy of miao 2007 formula was lower than that of IWPC formula, and 94.1% of patients′ dosages of warfarin were underestimated. Conclusion Patients with CYP2C9*3 or VKORC1-AA genotype required lower warfarin dosage. The CYP2C9 and VKORC1 gene polymorphisms had a certain correlation with maintenance dosage of warfarin.

Coicis Semen is widely used as a raw material which can be used as both medicine and food among people. According to the ancient monographs on materia medica and relevant documents on the processing specifications in various provinces and cities, herba logical study on the historical evolution of the processing methods of Coicis Semen was conducted in this paper from the aspects of collecting and processing methods of Coicis Semen, the processing methods in the past dynasties and the nature, flavour and efficacy of Coicis Semen. The results showed that the processing methods of Coicis Semen recorded in monographs on materia medica mainly included stir-frying, glutinous rice stir-frying, salt processing(including salt cooking and salt stir-frying), stir-frying with the earth scraped from the wall facing east, and ginger juice stir-frying, etc. Among them, stir-frying, and stir-frying with the earth scraped from the wall facing east are still used nowadays. The bran stir-frying is the improved version of glutinous rice stir-frying in order to be adaptive to the modern-day situation and the needs of the present. In addition, the ancient shell removal and kernel keeping method are also included in the processing procedures in modern local processing specifications, which are combined with frying to form a new method named "Fazhi" processing( "Fazhi" means a processing method of multiple procedures). The 2015 edition of Chinese Pharmacopoeia records that Coicis Semen is helpful to clear dampness and promote diuresis, strengthen the spleen and prevent diarrhea, eliminate impediment, discharge pus, resolve toxin and a mass, etc., which are consistent with those contained in ancient monographs on materia medica. After the "Fazhi" processing, the cold nature of Coicis Semen has been removed and its nature,flavour and meridian tropism have been changed, so its application scopes expanded. The results of this study clearly traced the history of the collecting and proces-sing of Coicis Semen, summarized the nature, flavour and efficacy of Coicis Semen contained in both ancient and modern literature, and provided a historical basis for the standardization of the subsequent processing technology of Coicis Semen, the clinical application of various processed products, and the further development and utilization of medicinal materials.
Coix ; Cooking ; Drugs, Chinese Herbal ; Ginger ; Materia Medica ; Medicine, Chinese Traditional ; Oryza

Objective To compare the clinical efficacy between absolute fixation and bridging fixation in plate osteosynthesis for simple distal tibia fracture.Methods A retrospective case control study was conducted to analyze 41 patients with simple distal tibia fracture admitted to the Chongqing People's Hospital from January 2013 to November 2016.There were 24 males and 17 females,aged 24-70 years [(46.3 ± 13.1)years].According to AO/OTA classification,fractures weres was AO/OTA type 42A1 in 29 cases,type 42A2 in nine cases,type 42A3 in two cases,and type 43A1 in one case.All patients were treated with plate and screw fixation.According to the method of plate fixation,the patients were divided into the locking compression plate (LCP) absolute fixation group (14 patients),the LCP bridge fixation group (12 patients) and the LCP + dynamic double thread locking screw (DDTL) bridge fixation group (15 patients).The patients were followed up by taking anteroposterior and lateral radiographs of tibia and fibula during outpatient visits 1,2,3,6 months and 1 year after operation.The operation time,time to radiological fracture union,time to full weight bearing,callus index and complications were analyzed.Results All the patients were followed up for 12-18 months [(14.5 ± 2.0)months].In the LCP absolute fixation,LCP and LCP + DDTL groups,the operation time was (74.3 ± 15.6) minutes,(78.6 ± 20.1) minutes and (82.5 ± 24.6) minutes,respectively;the time to radiological fracture union was (4.3 ± 1.5) months,(4.5 ± 1.3) months and (4.6 ± 1.4) months,respectively;the time to full weight bearing were (3.4 ± 0.7) months,(3.5 ± 0.6) months and (3.6 ±1.1) months,respectively (all P ＞ 0.05).There was no significant difference in complication incidence among the three groups (P ＞ 0.05).However,the callus index in the LCP + DDTL group (1.19 ±0.13) was significantly higher than that of the LCP absolute fixation group (1.08 ±0.06) and that of the LCP group (1.09 ± 0.09) (P ＜ 0.05).Conclusion For simple distal tibia fracture,both absolute and bridging fixation can attain good fracture union,and LCP combined with DDTL can better promote the formation of callus and facilitate the union.

Objective To determine the distribution of common deafness gene mutations by microarray-PCR in pregnant women of Beijing, then explore their prevalence and clinical significance. Methods Totally 1709 pregnant women were prospectively enrolled from the outpatients of Obstetrical Clinical from Peking University Peoples' Hospital in this study from June 2016 to April 2018. Peripheral blood samples were obtained and DNA templates were extracted from all subjects. The coding region of the GJB2 gene(35del G, 235delC, 176-191del16, 299-300delAT), SLC26A4 gene(IVS7-2 A>G, 2168A>G), 12sRNA gene(1494C>T,1555A>G) and GJB3 gene(538 C>T)were detected by microarray-PCR. Meanwhile,256 cases firstly recruited in this study were confirmed by Sanger sequencing. The analysis was performed to explore the distribution of deafness gene mutations and the subjects detected to be positive were further followed up until they had given birth to their babies.Results Among 1709 pregnant women, 89 cases were found to be carrying at least one mutation sites(5.21％).Among them,83 cases were heterozygous mutation(35 cases of GJB2235delC, 12 cases of GJB2299-300delAT mutation, one case of GJB2176-191del 16, 30 cases of SLC26A4 IVS 7-2 A>G, 3 cases of SLC26A42168 A>G and two cases of GJB3538 C>T). There were one case of 235delC homozygous mutation and 2 cases of double mutations(IVS7-2 A>G /GJB2299-300delAT, IVS7-2 A>G/GJB2235delC). The positive rate of 235delC, 299-300delAT and 176-191del16 was 2.17％, 0.76％and 0.06％, respectively. As to SLC26A4, 1.87％of the pregnant women were carrying IVS 7-2 A>G and 0.18％for 2168 A>G. Two cases were detected carrying GJB3 C>T mutation and three for 12s RNA1555 A>G mutation, respectively. The results of microarray-PCR were identical to those of Sanger sequencing, with the coincidence of 100％.26 spouses of the 56 cases were followed up. Two proved to be carrier of the same gene mutation. One of their babies was born with normal hearing until the end of this research, while another baby was born deafness and implant cochlear when three month old. Conclusions GJB2235delC and SLC26A4 IVS 7-2 A>G were the most prevalent mutations in pregnant women of Beijing, and it may provide guidance to eugenics and early clinical intervention.

Objective The single nucleotide polymorphisms (SNPs) of APOE and SLCO1B1 were examined to explore their association with the risk and severity of coronary heart disease(CAD). Methods A total of 1267 cases of consecutive coronary heart disease (CAD)-suspected inpatients visiting department of Cardiology in Peking University Peoples' Hospital from March 2017 to november were recruited into this case-control study, and then 391 CAD cases and 223 non-CAD controls were enrolled for final analysis after screening by coronary angiography and exclusion criteria. The severity of the CAD cases were evaluated according to Gensini scores. The SNPs of APOE(388T>C, 526C>T) and SLCO1B1(388A>G, 521T>C) were detected using Real-time PCR and further verified using Sanger sequencing. Environmental risk factors were collected, and the correlations between SNPs of APOE and SLCO1B1 and the risk and severity of CAD were performed by SPSS version 16.0. Results The SNPs of all the subjects included in CAD group and non-CAD group were successfully detected, with an accordance of 100％ to Sanger sequencing. The distribution of APOE and SLCO1B1 gene were subjected to Hardy-Weinberg. The distributions of APOE gene ε3/ε3 genotypes and ε3 allele were most commonly found in both CAD group and non-CAD group (ε3/ε3: 70.8％,73.1％;ε3: 83.5％,85.2％;respectively). APOE genotypes and alleles were comparable between the CAD cases and non-CAD controls (P>0.05). The frequencies of APOE gene ε4+genotype were more likely to be found in the subgroup of CAD with Gensini score≥72 (P<0.05). The distributions of SLCO1B1 gene *1b/*1b genotypes and *1b allele were most commonly found in both CAD group and non-CAD group (*1b/*1b: 37.3％, 36.8％; *1b: 60.1％, 61.7％; respectively). There was no significant difference in genotype and allele frequencies of SLCO1B1 between the two groups and among subgroups with different severity of CAD (P>0.05). Conclusion This study observed no association between SNPs of APOE, SLCO1B1 and the risk of CAD in this population. However, APOE gene ε4 +genotype may increase the severity of CAD.

Objective To investigate germline mutation of breast cancer susceptibility genes BRCA1/2,TP53 and PTEN in Chinese breast cancer patients. Methods All of128 female breast cancer patients in Peking University People′s Hospital from January 2016 to August 2018 were selected as objects. Among them,44 cases were sporadic breast cancer and 84 werebreast cancer patients with genetic high risks. Germline mutations of BRCA1,BRCA2,TP53 and PTENwere detected by NGS.χ2 test was used to analyze the difference of pathogenic mutation rates between sporadic breast cancer group and breast cancer with high genetic risks.Groups were divided according to the clinical features of the patients(family history, triple-negative breast cancer,age and bilateral breast cancer).Among them,there were 42 cases with family history of breast cancer,34 cases of triple-negative breast cancer,33 cases of early-onset breast cancer and 7 cases of bilateral breast cancer. Fisher′s exact probability test compared the relationship between pathogenic mutations of BRCA1/2 gene and clinical characteristics of breast cancer patients with hereditary risk factors. Results In 128 cases of breast cancer,30 germline mutations of BRCA1/2 were detected, including 13 pathogenic mutations and 3 newly discovered mutations(BRCA1:c. 4760C>G,BRCA2:c. 44134414del and BRCA2:c. 64826485del). The new mutations may be unique mutations of Chinese population. There were 3 cases of TP53 mutations,including 1 pathogenic mutation. All of the 3 mutations were found in early-onset breast cancer. Germline mutation of T53 has important detection significance for early-onset hereditary breast cancer. There were 5 cases of PTEN mutations,including 3 pathogenic mutations. Among 84 breast cancer patients with genetic high risks,the carry mutation rate was 40.5％(34/84)and the pathogenic mutation rate was 15.4(13/84). Among 44 sporadic cases,the carry mutation rate was 9％(4/44). The pathogenic mutation rate was 6.8％(3/44). Breast cancer susceptibility genes were carried at a higher rate in breast cancer patients with genetic high risks(P<0.001). BRCA1/2 mutations did not show statistical differences among groups of breast cancer patients with hereditary high risk factors . Conclusion Germline mutation detection of breast cancer susceptibility genes by next-generation sequencing is of great significance in breast cancer risk prediction and prognosis evaluation.

Objective To compare the pain management effects between painless wards with quality control circle mode and conventional pain management mode.Methods A retrospective case control study was conducted on the clinical data of 233 patients with lower limb fracture admitted from August 2015 to August 2016.There were 124 males and 109 females,aged 18-74 years [(48.3 ±3.3)years].The patients were divided into observation group (n =117) and control group (n =116) according to the pain management mode.The observation group followed the standard continuous quality improvement program and combined with professional team and patients Wechat group to implement pain management,and further measures were taken in accordance with the feedbacks.The control group adopted routine painless ward nursing model for perioperative analgesia nursing intervention.The pain score VAS,the start time of functional exercise,the compliance of rehabilitation activities,the length of hospital stay,and the healing time of fracture were compared between the two groups.Results There was no significant difference in VAS scores between the two groups at 12 hours before operation and 6 hours after operation (P ＞ 0.05).The observation group had lower VAS scores at 12 hours (3.2± 1.4),24 hours (2.8 ±0.9),48 hours (1.6 ± 0.7),and 72 hours (1.5 ± 0.8) after operation than the control group (P ＜0.05).The observation group started functional exercises earlier [(18.9 ± 0.4) hours after operation]than the control group earlier [(48.1 ± 1.7) hours after operation] (P ＜ 0.01).The observation group had a rehabilitation compliance rate of 62.6％,higher than that of the control group (17.6％) (P ＜0.05).The hospital stay [(12.18 ± 0.14) days] and fracture healing time [(97.86 ± 0.83) days] of the observation group were shorter than those of the control group (P ＜ 0.05).Conclusion The pain management model of standardized continuous quality improvement can significantly relieve pain in patients with lower limb fracture,shorten hospitalization time,bring forward the start time of functional exercise,improve the compliance of rehabilitation activities,and promote fracture healing.

Objective To investigate the clinical characteristics of the human Adenovirus (HAdv) infections in allogeneic hematopoietic stem cell transplantation ( allo-HSCT) patients and explore the clinical significance of HAdv monitoring .Methods A total of 845 cases underwent allo-HSCT were included retrospectively in Perking University People′s Hospital from October 2012 to August 2014.Peripheral blood HAdv load were monitored twice weekly within 100 days after allo-HSCT, or whenever necessary quantitatively by real-time PCR. Meanwhile, other clinical samples such as stool , urine, and bronchoalveolar lavage fluid ( BLAF ) were also detected qualitatively whenever necessary .The follow-up period was at least six months after allo-HSCT.All clinical data were collected and analyzed .Results The total positive rate of HAdv was 3.4% ( 29/845 ) .The incidence of HAdv infection was higher in children [3.8%(6/155), <18y] than that of adults [3.3%(23/690),≥18y].HAdv infection diagnosed within 100 days after allo-HSCT accounted for 72.4%(21/29) of the total number of positive cases .There were 19 cases detected positive in peripheral blood , 16 cases in stool , 9 cases in urine , and 1 cases in BLAF , respectively.One patient was positive in peripheral blood , stool and urine.The overall median time of HAdv was 69 (13-189) d.The median time was 56 (53 -144) d in stool ,which was earlier than that of in peripheral blood , urine and stool.Among 29 cases of HAdv positive patients , 17 patients were coinfected with Cytomegalovirus(CMV) and 11 casess with Epstein-Barr virus(EBV).Twenty-five cases of HAdv were diagnosed with acute graft-versus-host disease(aGVHD) before HAdv infection, and 4 cases were diagnosed with chronic graft-versus-host disease ( cGVHD ) . The most common clinical manifestation was HAdv enteritis (14 cases), followed by hemorrhagic cystitis (7 cases).Two cases complicated with multiple organ injury ( >2 ) clinically, 1 cases with pneumonia.There were 8 cases of death at the end of follow-up.Conclusions HAdv is an important pathogen causing infection in patients after allo-HSCT. The infenction is characterized with multiple organ involvement .CMV and EBV coinfection is common .HAdv monitoring was of great significance in allo-HSCT patients.