Objective To investigate the clinical effect of anterograde percutaneous screw fixation under robot navigation in the treatment of acetabular anterior column fractures.Methods A retrospective analysis was made on 7 cases of anterior acetabular column fractures from April 2021 to January 2023.The traction reduction was conducted by using pelvic"double reverse"traction table,the orthopedic robot-assisted design was carried out to plan the screw entry point and direction,and the antegrade channel cannulated screw was used for internal fixation.Results The operation time was 60-95 min(mean,78 min).The intraoperative blood loss was 5-20 ml(mean,8.6 ml).The number of fluoroscopy was7-11(mean,8.7).The guide needle was unadjusted in 3 cases and adjusted for 1-2 times in 4 cases(once in 2 cases and twice in 2 cases).The actual path deviated from the planned by 0.65-1.50 mm(mean,0.98±0.30 mm).The excellent and good rate of screw position was 100%.X-ray and CT examinations were performed at 48 h after the operation.According to the Matta reduction standard,anatomical reduction was achieved in 6 cases and satisfactory reduction in 1 case.All the 7 cases were followed up for 6-28 months(mean,15 months).At the last follow-up,the Harris score of the hip joint was85-96 points(mean,91.6 points)and the pain of visual analogue scale(VAS)was0.There were no complications such as infection,loosening of internal fixation,or neurological dysfunction.Conclusion Anterograde percutaneous screw fixation under robot navigation in the treatment of acetabular anterior column fractures is safe,effective,and satisfactory.

Objective To explore the learning curve of Bikini incision direct anterior approach total hip arthroplasty(Bikini-THA).Methods Clinical data of 80 cases of Bikini-THA initially completed by an operator skilled in posterolateral approach and direct anterior approach total hip arthroplasty from March 2020 to March 2023 were retrospectively analyzed,and the learning curve was observed by scatter plots of operative time and intraoperative bleeding.They were divided into groups A to D according to the order of surgery,with 20 cases in each group.The operative time,intraoperative bleeding,acetabular abduction angle,anteversion angle,angle between stem and femoral axis,postoperative hip Harris score and complications were compared among the 4 groups.Results After about 40 cases,the decreasing trend of operative time and intraoperative bleeding slowed down and stabilized.The operative time and intraoperative bleeding in the 4 groups were group A＞group B＞groups C and D(P＜0.05),and the differences between the group C and group D were not statistically significant(P＞0.05).The acetabular prosthesis was well-positioned in the 4 groups(abduction angle of 30°-50°,anteversion angle of 5°-25°).The femoral prosthesis center fixation rate(angle between stem and femoral axis ≤3°)was group A＜groups C and D(P=0.003,0.003).The differences in the Harris scores of the hip joints at 2 weeks,1 month,3 months,and 12 months postoperatively of the 4 groups were not statistically significant(P＞0.05),and the efficacy evaluations of the hip joints at 12 months postoperatively were all excellent.There were 5 cases of complications in the group A(2 cases of greater trochanter fracture and 3 cases of lateral femoral cutaneous nerve injury),3 cases of complications in the group B(1 case of greater trochanteric fracture,1 case of lateral femoral cutaneous nerve injury,and 1 case of incision infection),1 case of complications in the group C(lateral femoral cutaneous nerve injury),and no complications in the group D.The follow-up period lasted for 12-26 months,with a mean of(19.4±4.7)months.There were no complications such as dislocation or loosening of the prosthesis.Conclusion The Bikini-THA learning curve was approximately 40 cases.

Objective To describe the changing trend and related factors of prevalence rates of healthcare-associa-ted infection(HAI)in a tertiary hospital in the past 10 years,and analyze the influencing factors for HAI.Methods A cross-sectional survey on HAI was conducted for 10 consecutive years from 2013 to 2022(one day was selected as the survey day each year),data were collected.The distribution and related factors of prevalence rates of HAI were analyzed by trend-x2 test and Pearson correlation coefficient.Multivariate logistic regression and multilayer percep-tron(MLP)models were constructed to analyze the independent effect and significance of factors.Results From 2013 to 2022,the prevalence rates of HAI ranged from 4.66％to 8.07％in this hospital,showing a linear upward trend.The proportions of ICU patients and utilization rate of central venous catheters within 2 days before the sur-vey showed linear upward trends,while the proportion of patients with urinary catheters within 2 days before the survey and proportion of patients undergoing surgery within 30 days before the survey decreased.The MLP model revealed that the top 3 important factors for HAI were length of hospital stay＞10 days,admission in ICU,and in-dwelling central venous catheters within 2 days before the survey.Multivariate logistic regression model indicated that length of hospital stay＞10 days,indwelling central venous catheters or urinary catheters within 2 days before the survey,surgery within 30 days before the survey,and admission in ICU were independent influencing factors for HAI.Conclusion The incidence of HAI in this hospital presents a linear increase in recent 10 years,the causes should be further analyzed and the direction of intervention should be determined through targeted surveillance.Adopting trend test statistical analysis method,logistic regression,MLP multi-factor model can further explore the data value of HAI prevalence survey.

Immmunosuppressants are mainly used to reduce rejection after solid organ transplantation,so as to improve the success rate of organ transplantation.However,long-term use of immunosuppressants can also serious-ly impair the immune function of patients,thereby increasing the risk of viral infection and postoperative complica-tions,leading to transplant failure.Therefore,patients need to use both immunosuppressants and antiviral agents.If some immunosuppressants with antiviral effects are found,the patient's burden of taking medicines will be greatly reduced.Currently,the immunosuppressants with antiviral effect have been focused by researchers.The gradual re-vealing of the antiviral mechanism of these immunosuppressants will help to optimize the treatment plan of postope-rative rehabilitation of organ transplant recipients.Based on the mechanism of rejection of transplanted organ,this paper systematically describes the types of viruses which closely related to infection of organ transplant patients and the molecular mechanism of some immunosuppressants in antiviral aspects,which further provides a new idea for clinical prevention and treatment of viral infection due to organ transplantation.

Objective To study the clinical characteristics and bacterial antimicrobial susceptibility testing results of patients with clinically isolated Ralstonia pickettii(R.pickettii),and provide basis for the rational use of antimi-crobial agents.Methods Inpatients with R.pickettii infection who were treated at the Tianjin First Central Hospi-tal from January 2014 to December 2023 were analyzed retrospectively.Clinical characteristics and antimicrobial sus-ceptibility testing results were analyzed.Results A total of 80 strains of Ralstonia spp.were isolated over 10-year period,including 42(52.5％)non-repetitive strains of R.pickettii.Among 42 R.pickettii strains,64.3％were isolated from male patients.The strains isolated from sputum,catheter,blood,throat swabs,and drainage fluid specimens accounted for 38.1％,28.6％,19.0％,4.8％,and 2.4％,respectively.The clinical distribution of R.pickettii was highest in the intensive care unit(ICU),with a proportion of 52.4％.The number of infected patients first increased and then decreased with the years,followed by a slight fluctuation.There was no statistically signifi-cant difference in the number of infected patients in each department over the years(P＞0.05).R.pickettii had higher susceptibility rates to doxycycline,levofloxacin,ciprofloxacin,and minocycline,susceptibility rates were 78.3％-90.9％,but was completely resistant to compound sulfamethoxazole and cefazolin(100％),it also had higher resistance rates to aztreonam,colistin,cefotetan,tobramycin,amikacin,ceftazidime,and gentamicin(80.0％-97.4％).There was no statistically significant difference in the resistance rates to 21 antimicrobial agents among different years(all P＞0.05).Conclusion R.pickettii is mainly from ICU,and the majority of the infected population are adult males.Most strains are isolated from sputum and catheter.R.pickettii presents multidrug re-sistance.Attention should be paid to the changes in the resistance rates of antimicrobial agents,strengthen the dy-namic monitoring of bacterial resistance and guide the rational selection of antimicrobial agents in clinic,implement early and effective treatment to improve the prognosis of the patients.

Objective To understand the current situation and influencing factors of kindergarten teach-ers'participation in training for preschool sex education in Luzhou city,and provide a basis for improving the sex education literacy of kindergarten teachers in the future.Methods A multi-stage stratified cluster sampling meth-od was adopted,and a questionnaire survey was conducted from December 2021 to January 2022 on the knowl-edge,attitude,and practice of preschool sex education among all the teachers in 24 kindergartens in Luzhou city.Results Among the 461 teachers,43.0％had participated in lectures/courses/training activities related to pre-school sex education;99.1％hoped to participate in lectures/courses/training activities related to preschool sex education;82.6％learned about child sexual knowledge through school education;75.5％expressed the hope to learn about child sexual knowledge through expert training.The results of multivariate Logistic regression showed that except private kindergartens as an inhibiting factor(OR=0.57,95％CI=0.37-0.87,P=0.008),high monthly income(OR=3.52,95％CI=1.13-9.30,P=0.011),more ways to know about sex education knowledge(OR=2.87,95％CI=1.76-4.70,P＜0.001),and social support(OR=1.58,95％CI=1.04-2.38,P=0.030)were promoting factors for teachers to participate in the training for preschool sex educa-tion.Conclusions The kindergarten teachers presented a participation rate but a high demand for the training for preschool sex education.They mainly obtain the sex education knowledge from school education.The nature of kindergarten,monthly income of teachers,social support situation,and ways of understanding sex education knowledge are the key factors influencing the teachers'participation in the training for preschool sex education.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective : Objective To investigate the demand for health management and influencing factors among occupational population at high risk of stroke, so as to provide insights into the development of stroke health management strategies among occupational population. Methods: Occupational population aged 40 to 60 years who participated in health examination were sampled from three tertiary hospitals in Luzhou City, Sichuan Province using a quota sampling method in the ratio of 4∶1∶1, from August to December 2020. Participants' blood biochemistry tests and health examination were collected through the examination reports, and the participants at high risk of stroke were screened using the assessment criteria for high-risk of stroke. Participants' general information and demand for health management were collected using questionnaire surveys. In addition, factors affecting the demand for health management were identified using a multivariable logistic regression model. Results: A total of 3 003 people who participated in health examination were investigated, and 1 062 participants met the assessment criteria for high risk of stroke, accounting for 35.36%. There were 1 000 men (94.16%) and 62 women (5.84%), with a mean age of (49.26±4.97) years. There were 414 professional and technical staff (39.50%). There were 709 participants (66.76%) with demand for health management, with the top three in the demand as health checkups (915 participants, accounting for 86.16%), health consultation (601 participants, accounting for 56.60%) and exercise guidance (560 participants, accounting for 52.73%), and 210 participants (19.77%) received health management. Multivariable logistic regression analysis showed that occupational population at high risk of stroke who received health management were more likely to have the demand for health management (OR=2.158, 95%CI: 1.479-3.149). Conclusions The occupational population at high risk of stroke have the demand for health management. Having received health management may affect the demand for health management among occupational population at high risk of stroke.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.

【Objective】 To objectively evaluate the quality control level of blood testing process in blood banks through quantitative monitoring and trend analysis, and to promote the homogenization level and standardized management of blood testing laboratories in blood banks. 【Methods】 A quality monitoring indicator system covering the whole process of blood collection and supply, including blood donation service, blood component preparation, blood testing, blood supply and quality control was established. The questionnaire Quality Monitoring Indicators for Blood Collection and Supply Process with clear definition of indicators and calculation formulas was distributed to 17 blood banks in Shandong province. Quality monitoring indicators of each blood bank from January to December 2022 were collected, and 31 indicators in terms of blood testing were analyzed using SPSS25.0 software. 【Results】 The proportion of unqualified serological tests in 17 blood bank laboratories was 55.84% for ALT, 13.63% for HBsAg, 5.08% for anti HCV, 5.62% for anti HIV, 18.18% for anti TP, and 1.65% for other factors (mainly sample quality). The detection unqualified rate and median were (1.23±0.57)% and 1.11%, respectively. The ALT unqualified rate and median were (0.74±0.53)% and 0.60%, respectively. The detection unqualified rate was positively correlated with ALT unqualified rate (r=0.974, P<0.05). The unqualified rate of HBsAg, anti HCV, anti HIV and anti TP was (0.15±0.09)%, (0.05±0.04)%, (0.06±0.03)% and (0.20±0.05)% respectively. The average unqualified rate, average hemolysis rate, average insufficient volume rate and the abnormal hematocrit rate of samples in 17 blood bank laboratories was 0.21‰, 0.08‰, 0.01‰ and 0.02‰ respectively. There were differences in the retest concordance rates of four HBsAg, anti HCV and anti HIV reagents, and three anti TP reagents among 17 blood bank laboratories (P<0.05). The usage rate of ELISA reagents was (114.56±3.30)%, the outage rate of ELISA was (10.23±7.05) ‰, and the out of range rate of ELISA was (0.90±1.17) ‰. There was no correlation between the out of range rate, outrage rate and usage rate (all P>0.05), while the outrage rate was positively correlated with the usage rate (r=0.592, P<0.05). A total of 443 HBV DNA positive samples were detected in all blood banks, with an unqualified rate of 3.78/10 000; 15 HCV RNA positive samples were detected, with an unqualified rate of 0.13/10 000; 5 HIV RNA positive samples were detected, with an unqualified rate of 0.04/10 000. The unqualified rate of NAT was (0.72±0.04)‰, the single NAT reaction rate [(0.39±0.02)‰] was positively correlated with the single HBV DNA reaction rate [ (0.36±0.02) ‰] (r=0.886, P<0.05). There was a difference in the discriminated reactive rate by individual NAT among three blood bank laboratories (C, F, H) (P<0.05). The median resolution rate of 17 blood station laboratories by minipool test was 36.36%, the median rate of invalid batch of NAT was 0.67%, and the median rate of invalid result of NAT was 0.07‰. The consistency rate of ELISA dual reagent detection results was (99.63±0.24)%, and the median length of equipment failure was 14 days. The error rate of blood type testing in blood collection department was 0.14‰. 【Conclusion】 The quality monitoring indicator system for blood testing process in Shandong can monitor potential risks before, during and after the experiment, and has good applicability, feasibility, and effectiveness, and can facilitate the continuous improvement of laboratory quality control level. The application of blood testing quality monitoring indicators will promote the homogenization and standardization of blood quality management in Shandong, and lay the foundation for future comprehensive evaluations of blood banks.