Objective:To compare the efficacy of whole blood (WB) versus component therapy (COMP) in the resuscitation of patients with traumatic shock.Methods:A systematic literature search was conducted using PubMed and Embase databases for English literature published from January 2006 to December 2023. Studies on the comparative efficacy of WB versus COMP in resuscitation of patients with traumatic shock were all included. Patients were categorized according to the initial transfusion strategies into WB group and COMP group. Primary outcome indicators were extracted and subjected to meta-analysis, including transfusion requirements after admission (4-hour red blood cell requirement, 4-hour plasma requirement, 4-hour total transfusion volume, 24-hour red blood cell requirement, 24-hour plasma requirement, and 24-hour total transfusion volume), length of hospital stay, length of ICU stay, and mortality rates (early mortality, 24-hour mortality, late mortality, and in-hospital mortality, and 24-hour mortality with multiple variables adjusted).Results:Twenty-seven studies involving 15 176 patients (4 692 patients in WB group and 10 484 in COMP group) were included. Meta-analysis results indicated that the 4-hour red blood cell requirement (SMD=-0.44, 95% CI -0.69, -0.19, P<0.01), 4-hour plasma requirement (SMD=-0.25, 95% CI -0.50, -0.01, P<0.05), 24-hour red blood cell requirement (SMD=-0.22, 95% CI -0.36, -0.09, P<0.01), and 24-hour mortality with multiple variables adjusted ( OR=0.78, 95% CI 0.68, 0.91, P<0.05) were significantly reduced in WB group. No significant differences were observed between the two groups regarding 4-hour total transfusion volume, 24-hour plasma requirement, 24-hour total transfusion volume, length of hospital stay, length of ICU stay, early mortality, 24-hour mortality, late mortality, and total in-hospital mortality ( P>0.05). Conclusions:WB demonstrates certain advantages over COMP in the resuscitation of patients with traumatic shock by reducing 4-hour red blood cell requirement, 4-hour plasma requirement, 24-hour red blood cell requirement, and 24-hour mortality with multiple variables adjusted. However, WB and COMP demonstrate comparable effectiveness in reducing 4-hour total transfusion volume, 24-hour plasma requirement, 24-hour total transfusion volume, early mortality rate, 24-hour mortality rate, late mortality rate, and in-hospital mortality.

Objective:To compare the efficacy of whole blood (WB) versus component therapy (COMP) in the resuscitation of patients with traumatic shock.Methods:A systematic literature search was conducted using PubMed and Embase databases for English literature published from January 2006 to December 2023. Studies on the comparative efficacy of WB versus COMP in resuscitation of patients with traumatic shock were all included. Patients were categorized according to the initial transfusion strategies into WB group and COMP group. Primary outcome indicators were extracted and subjected to meta-analysis, including transfusion requirements after admission (4-hour red blood cell requirement, 4-hour plasma requirement, 4-hour total transfusion volume, 24-hour red blood cell requirement, 24-hour plasma requirement, and 24-hour total transfusion volume), length of hospital stay, length of ICU stay, and mortality rates (early mortality, 24-hour mortality, late mortality, and in-hospital mortality, and 24-hour mortality with multiple variables adjusted).Results:Twenty-seven studies involving 15 176 patients (4 692 patients in WB group and 10 484 in COMP group) were included. Meta-analysis results indicated that the 4-hour red blood cell requirement (SMD=-0.44, 95% CI -0.69, -0.19, P<0.01), 4-hour plasma requirement (SMD=-0.25, 95% CI -0.50, -0.01, P<0.05), 24-hour red blood cell requirement (SMD=-0.22, 95% CI -0.36, -0.09, P<0.01), and 24-hour mortality with multiple variables adjusted ( OR=0.78, 95% CI 0.68, 0.91, P<0.05) were significantly reduced in WB group. No significant differences were observed between the two groups regarding 4-hour total transfusion volume, 24-hour plasma requirement, 24-hour total transfusion volume, length of hospital stay, length of ICU stay, early mortality, 24-hour mortality, late mortality, and total in-hospital mortality ( P>0.05). Conclusions:WB demonstrates certain advantages over COMP in the resuscitation of patients with traumatic shock by reducing 4-hour red blood cell requirement, 4-hour plasma requirement, 24-hour red blood cell requirement, and 24-hour mortality with multiple variables adjusted. However, WB and COMP demonstrate comparable effectiveness in reducing 4-hour total transfusion volume, 24-hour plasma requirement, 24-hour total transfusion volume, early mortality rate, 24-hour mortality rate, late mortality rate, and in-hospital mortality.

Objective:To compare the clinical effects of hip arthroplasty through direct anterior approach (DAA) in lateral decubitus in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia.Methods:The prospective study method was used to select the patients who needed hip arthroplasty in the Fourth Department of Orthopedics, the Second Affiliated Hospital of Harbin Medical University from January 2015 to December 2019. All of them were operated with lateral decubitus DAA. According to the inclusion criteria, they were divided into Kacshin-Beck disease hip osteoarthritis group (group A) and congenital acetabular dysplasia hip osteoarthritis group (group B). Hip Harris score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, visual analogue scale (VAS) score were conducted, and hip abduction angle and flexion angle were measured before surgery, 3, 14 days and 1, 3, and 12 months after surgery.Results:Nineteen and twenty-two patients were included in group A and group B, respectively. All patients successfully completed the surgery. There was no significant difference in Harris score between the two groups before surgery, 3, 14 days, and 1, 12 months after surgery ( P > 0.05). There were no significant differences in WOMAC score, VAS score, hip abduction angle and hip flexion angle between the two groups before surgery and each time point after surgery ( P > 0.05). In the same group, there were significant differences in Harris score, WOMAC score, VAS score, hip abduction angle and hip flexion angle at different time points ( P < 0.001). All postoperative indicators were significantly improved compared with those before surgery. Conclusions:There is no significant difference in the clinical effects of hip arthroplasty through lateral decubitus DAA in the treatment of hip osteoarthritis caused by Kaschin-Beck disease and congenital acetabular dysplasia. This surgical method has good therapeutic effect on both types of hip osteoarthritis.

Kashin-Beck disease (KBD) is a disabling osteoarthropathy of unknown cause, which occurs most frequently in children and adolescents and affects many regions in China. In adults KBD patients, the degeneration of weight-bearing joints is the most serious, especially the knee joint. Up to now, there are still a large number of adult patients with KBD arthritis of the knee, and they have not been systematically and effectively treated. The main manifestations are knee joint pain, thickening, deformation and restricted movement. In severe cases, it can lead to knee joint varus, valgus, flexion contracture, and rotational deformity, which seriously affects the quality of life and work ability of the patients. Early diagnosis of KBD arthritis of the knee is difficult and there is no effective treatment, so it needs to be differentiated from knee osteoarthritis (OA). KBD and OA have common pathological characteristics. According to the "Consensus of Four-stepladder Program of Knee 0steoarthritis" (2018), OA treatment is divided into four levels: basic treatment, drug treatment, restorative treatment and reconstruction treatment. In this paper, the treatment of KBD arthritis of adult knee joint is summarized, which is also divided into four steps. It is necessary to make stepwise treatments according to the severity of KBD arthritis of the knee and the differences of patient's own condition, so that the limited medical resources can be efficiently used. At the same time, this paper also systematically summarizes the epidemiological characteristics, pathological features and diagnostic criteria of KBD arthritis of the knee, aiming to provide effective reference and guidance for the treatment of KBD arthritis of the knee.

Objective:To analyze the distribution and drug resistance of wound pathogenic microorganisms in outpatients of wound healing center so as to provide a basis for the standardized construction of wound healing centers.Methods:A retrospective case series study was used to analyzed the data of 365 outpatients treated at Ruijin Hospital, Shanghai Jiaotong University School of Medicine from December 2017 to October 2019. There were 220 males and 145 females, aged (58.8±18.9)years (range, 18-98 years). The patients included 92 first-visit patients and 273 re-visit patients. The culture results (positive rate of pathogenic microorganisms, bacterial species, bacterial distribution) and drug sensitivity results of the wound secretions were compared and analyzed.Results:(1) Among 365 samples of wound secretions, 198 patients were positive for pathogenic microorganisms with a positive rate of 54.3%. A total of 107 strains (51.0%) of Gram-positive bacteria were detected, mainly Staphylococcus aureus (70 strains, 33.3%); 95 strains (45.2%) of Gram-negative bacteria were detected, mainly Escherichia coli (20 strains, 9.5%), followed by Pseudomonas aeruginosa (17 strains, 8.1%); 8 strains (3.8%) of fungi were detected. (2) A total of 26 (28.3%) first-visit patients were positive for pathogenic microorganisms, and 172 (63.0%) re-visit patients were positive for pathogenic microorganisms. The rate of positive microorganism detection had significant differences between first-visit and re-visit patients ( P<0.05). (3) A total of 29 strains were detected in first-visit patients, including 16 strains (55.2%) of Gram-positive bacteria, 11 strains (37.9%) of Gram-negative bacteria and 2 strains (6.9%) of fungi. A total of 181 strains were detected in re-visit patients, including 91 strains (50.3%) of Gram-positive bacteria, 84 strains (46.4%) of Gram-negative bacteria and 6 strains (3.3%) of fungi. The microbial distribution was significantly different between first-visit and re-visit patients ( P<0.05). (4) Compared with first-visit patients, the resistance of Staphylococcus aureus isolated from the re-visit patients to spenicillin, oxacillin, ciprofloxacin, tetracycline, clindamycin, moxifloxacin, erythromycin, and levofloxacin were increased variably. No vancomycin-resistant Staphylococcus aureus was detected, indicating that the staphylococcus aureus presented in the wound was highly sensitive to vancomycin. Conclusions:Staphylococcus aureus is the most common microorganism in wound secretions in outpatients of wound healing center. The rate of positive pathogenic microorganisms in wound secretions of re-visit patients is significantly higher than that of first-visit patients, and the distribution of pathogenic microorganisms of first-visited and revisited patients differs significantly. The Staphylococcus aureus detected in re-visit patients has a higher resistance to common antibiotics compared with first-visit patients. It is suggested that timely detection of pathogenic microorganisms in outpatients and effective control and supervision of outpatient infections are important contents that cannot be ignored in the construction of wound healing center.

Objective:The present study was aimed to determine the value of cone beam CT (CBCT) in predicting the risk of lingual bone plate injury during extraction of impacted mandible third molar (IMTM).Methods:The original CBCT data of 150 teeth (50 in vertical, 50 in angular and 50 in horizontal ) in January 2018 to December 2019 in Panzhihua Central Hospital of Sichuan Province were collected and analyzed. The thickness of lingual bone plate in enamel cementum boundary (ECB), root middle (RM) and root tip (RT) of each IMTM was measured by the software of CBCT system, and datas were analyzed by one-way ANOVA.Results:The average thickness of lingual bone plate in ECB of IMTM was (1.36±0.43)mm, (1.21±0.44)mm and (1.28±0.40)mm in vertical, horizontal and angular groups, respectively, with no significant difference ( F=1.07, P=0.35). The average thickness of lingual bone plate in RM of IMTM was (1.48±0.33)mm, (1.06±0.57)mm and (1.11±0.45)mm, respectively, with statistically significant difference ( F=8.78, P<0.01). The average thickness of lingual bone plate in RT of IMTM was (1.44±0.49)mm, (0.84±0.58)mm and (0.86±0.64)mm, respectively, with statistically significant difference ( F=12.35, P<0.01). Compared with the mandibular second molar, there were statistically significant differences in the average thickness of the lingual bone plate in ECB ( F=5.03, P<0.01), the RM ( F=15.13, P<0.01) and the RT ( F=33.12, P<0.01) of the IMTM among the three groups. In addition, the horizontal and angular IMTM, the thinness of lingual bone plate in RT region was more likely to occur than in vertical, and the absence of lingual bone plate was most likely to occur in patients with partial buccal crown. Conclusions:The doctor-patient communication and risk prediction should be sufficient before IMTM extraction when CBCT shows that the lingual bone plate of RT region is thin or absent. At the same time, we should avoid violent operation and thoroughly protect the lingual bone plate in the process of tooth extraction, and guard against serious complications such as perforation or fracture of lingual bone plate of mandible, and root displacement.

Objective:To analyze the clinical characteristics, cerebrospinal fluid (CSF) and other auxiliary examination results of febrile children with convulsions in order to provide the evidence for clinical recognition of central nervous system (CNS) infection and its etiology.Methods:The clinical data of 64 fever patients with convulsions admitted at the Department of Neurology, Shanghai Children′s Medical Center, Shanghai Jiaotong University School of Medicine were analyzed retrospectively.According to the results of the routine biochemical examination of CSF, they were divided into 2 groups as CSF normal group (44/64 cases, 69%) and CSF abnormal group (20/64 cases, 31%). Their age, gender, clinical manifestations, physical symptoms and auxiliary examination results were compared between the two groups. Logistic regression analysis was performed to explore the independent risk factors of abnormal CSF results.Twenty children with abnormal CSF results were divided into the normal glucose group (12/20 cases, 60%) and the glucose reduction group (8/20 cases, 40%) according to the glucose level of CSF.The fever duration, serum inflammation markers, CSF routine and biochemical indexes of the two groups were compared. Results:According to Logistic multivariate unconditional regression analysis, the mental state change ( OR=435.99, P=0.010), abnormal neurological signs ( OR=65.25, P=0.023) and vomiting ( OR=20.56, P=0.048) were the high risk factors of abnormal CSF results.Among the children with abnormal CSF results, in the glucose reduction and normal glucose groups, the fever duration was 12.50 (7.75-16.75) d and 4.00 (3.00-5.75) d, respectively; the level of CSF protein were 3 000 (1 745-3 000) mg/L and 648 (469-1 734) mg/L, respectively; the erythrocyte sedimentation rate (ESR) was 71.50(56.00-97.50) mm/1 h and 20.50 (12.00-26.00) mm/1 h, respectively; the procalcitonin level was 2.76(0.90-20.72) g/L and 0.23 (0.03-1.00) g/L, respectively; the C-reactive protein (CRP) level was 123.00 (33.00-177.75) mg/L and 12.50(4.25-57.75) mg/L, respectively.The fever duration, CSF protein level, ESR, procalcitonin level and CRP level were statistically different between the glucose reduction and normal glucose groups (all P<0.05). Conclusions:In fever children with convulsions, vomiting, the mental state change, and abnormal neurological signs are the high risk factors of abnormal CSF results, suggesting the possibility of CNS infections and the need of early diagnosis by CSF and other auxiliary examinations.In addition, a low level of CSF glucose in children with abnormal CSF results may be a potential and powerful clue for purulent meningitis.Timely etiological tests are required for confirmation, and antibiotics treatments should be applied as early as possible.

Objective:To investigate the effect of neoadjuvant chemotherapy on locally advanced rectal cancer.Methods:After collecting the clinical data of 180 rectal cancer patients diagnosed initially as cT3-4N0-2M0 stage, patients were divided into neoadjuvant chemotherapy group, neoadjuvant chemoradiotherapy group and control group. First-line chemotherapy regimen CAPEOX was used as neoadjuvant therapy. Second-line chemotherapy regimen FOLFIRI was used for the patients not sensitive to CAPEOX . Long-term radiotherapy (total dosage: 45-50 Gy)was used in the neoadjuvant chemoradiotherapy group. The compliance, anastomotic fistula , infection and incidence of anal dysfunction, effective rate of neoadjuvant therapy and tumor reduction rate were observed.Results:The compliance of neoadjuvant treatment was higher than that of the control group(90% vs.85% vs.73%, χ 2=6.16, P<0.05); The rate of adverse reaction in neoadjuvant chemoradiotherapy group was higher than that in the neoadjuvant chemotherapy group and control group(28% vs.6% vs.12%, χ 2=10.57, P<0.05); The anastomotic fistula(17% vs. 6% vs. 5%, χ 2=6.95, P<0.05), infection rate(16% vs. 5% vs. 3%, χ 2=6.89, P<0.05)and incidence of anal dysfunction(21% vs. 9% vs.7%, χ 2=6.42, P<0.05) in neoadjuvant chemoradiotherapy group were higher than that in the neoadjuvant chemotherapy group and control group. There was no significant difference between the neoadjuvant chemotherapy group and the control group( P>0.05) .Overall effective rate in neoadjuvant chemotherapy group and neoadjuvant chemoradiotherapy group was 40 % and 66%, respectively. Conclusions:Patients with locally advanced rectal cancer have better compliance with neoadjuvant chemotherapy and lower toxic side effects compared to neoadjuvant chemoradiotherapy. Neoadjuvant chemotherapy can be safely and effectively used in locally advanced rectal cancer.

Statistics show that 76.74% (4 688) of 6 109 patients with chronic wounds are those over 50 years of age; the proportion of patients with underlying diseases in all age groups above 50 years ranges from 78.25% to 100.00%; among the underlying diseases of chronic wound patients, the top four diseases are diabetes mellitus , cardiovascular and cerebrovascular diseases, hypertension, and respiratory diseases. The above underlying diseases and ages of patients are the susceptibility factors of corona virus disease 2019 released by National Health Commission of China. It is an unavoidable fact that patients with chronic wounds have to go to the hospital for treatment prescribed by the physician. At the same time, we found that there were not a few patients who go far afield because of various reasons when go to the hospital for treatment. During the period of epidemic prevention and control, this kind of "go far afield" style of seeking medical treatment may increase the exposure risk during transportation. Accordingly, we convened 36 wound care clinics in different regions in Shanghai to implement the "Five Measures" to encourage patients with chronic wounds to seek medical treatment proximately. The principle of this operation is that when seeking medical treatment, trying our best to reduce as much as possible the transportation distance for patients with chronic wounds to minimize the exposure risk during the epidemic period and eventually support the epidemic prevention and control campaign.

Objective To observe the heart protective effect of exercise preconditioning (EP) in the acute exhaustion exercise (EE) rats, and explore its action mechanism further. Methods Eighty healthy male Sprague-Dawley (SD) rats were divided into control group (C group), EP group, EE group, and EP+EE group randomly, with 20 rats in each group. The rats in EP and EP+EE groups were trained for 3 weeks according to the daily swimming for 60 minutes (swimming 15 minutes, resting 5 minutes, repeating 3 times) with 6 days each week. The rats in EE and EP+EE groups on the last 1 day after 3 weeks, 3% weight heavy weight was carried once for swimming EE. Two hours after the last EE, abdominal aortic blood and heart was harvested, the levels of serum MB isoenzyme of creatine kinase (CK-MB) and calcitonin gene related peptide (CGRP) were determined by enzyme linked immunosorbent assay (ELISA); the ultrastructure of myocardium was observed by optical microscopy; the levels of myocardial malondialdehyde (MDA) and superoxide dismutase (SOD) were determined by ELISA, the mRNA expression of myocardial CGRP was assayed by reverse transcription-polymerase chain reaction (RT-PCR), and the protein expression of myocardial CGRP was assayed by Western Blot. Results Compared with C group, the levels of serum CK-MB and myocardial MDA were significantly increased, serum CGRP content, myocardial SOD activity, and mRNA and protein expressions of myocardial CGRP were significantly decreased in EE group and EP+EE group. Compared with EE group, the levels of serum CK-MB and myocardial MDA in EP+EE group were decreased [CK-MB (U/L): 13.11±0.77 vs. 15.55±0.90, MDA (μmol/L): 389.57±49.60 vs. 709.08±160.49], the level of serum CGRP, and mRNA and protein expressions of myocardium CGRP were increased [serum CGRP (ng/L): 120.41±9.07 vs. 97.97±9.05, CGRP mRNA (2 -ΔΔCT): 0.45±0.09 vs. 0.14±0.02, CGRP protein (gray value): 0.78±0.08 vs. 0.41±0.04, all P < 0.05], the degree of myocardial injury was obviously alleviated. There was no significant difference in the indexes between the EP group and C group. Conclusion EP has the heart protective effect for the acute EE rats, and the mechanism is closely related to the endogenous protective substance CGRP.