Objective To investigate the radioprotection and management of yttrium-90 resin microsphere therapy based on the survey and monitoring of treatment institutions in Guangdong Province, China, and to provide technical reference and basis for the subsequent radiation management of this therapy. Methods Based on the technical data on yttrium-90 resin microsphere therapy collected from both domestic and international sources, an investigation was conducted on some yttrium-90 resin microsphere treatment institutions in Guangdong Province. Radiation level monitoring was carried out in the radioactive workplaces of three hospitals that had conducted yttrium-90 resin microspheres therapy. Environmental X-γ dose rate meters were used for detecting radiation dose equivalent rates, while α and β surface contamination monitors were used for detecting radioactive surface contamination. Additionally, urine samples from two patients were collected within 24 hours post-operation, and total radioactivity was analyzed using low-background α and β counters. Results During the yttrium-90 resin microsphere therapy, the radiation dose equivalent rates around the digital subtraction angiography rooms in the three hospitals ranged from 0.15 to 0.26 μSv/h, and the radiation dose equivalent rates around the observation wards ranged from 0.17 to 0.69 μSv/h. The β radioactive surface contamination values in the workplace control zones ranged from ＜0.07 to 18.7 Bq/cm², while the values in the supervised zones were all less than 0.07 Bq/cm². The total β radioactivity in the urine of the two patients within 24 hours post-operation accounted for approximately 0.0010% to 0.0013% of the yttrium-90 infusion dose. Conclusion The radiation levels at the monitoring sites in the workplaces of the three hospitals are below the national standard limits. The radioprotection and management of yttrium-90 resin microsphere therapy in the three hospitals in Guangdong Province are satisfactory.

Objective To investigate the radioprotection and management of yttrium-90 resin microsphere therapy based on the survey and monitoring of treatment institutions in Guangdong Province, China, and to provide technical reference and basis for the subsequent radiation management of this therapy. Methods Based on the technical data on yttrium-90 resin microsphere therapy collected from both domestic and international sources, an investigation was conducted on some yttrium-90 resin microsphere treatment institutions in Guangdong Province. Radiation level monitoring was carried out in the radioactive workplaces of three hospitals that had conducted yttrium-90 resin microspheres therapy. Environmental X-γ dose rate meters were used for detecting radiation dose equivalent rates, while α and β surface contamination monitors were used for detecting radioactive surface contamination. Additionally, urine samples from two patients were collected within 24 hours post-operation, and total radioactivity was analyzed using low-background α and β counters. Results During the yttrium-90 resin microsphere therapy, the radiation dose equivalent rates around the digital subtraction angiography rooms in the three hospitals ranged from 0.15 to 0.26 μSv/h, and the radiation dose equivalent rates around the observation wards ranged from 0.17 to 0.69 μSv/h. The β radioactive surface contamination values in the workplace control zones ranged from ＜0.07 to 18.7 Bq/cm², while the values in the supervised zones were all less than 0.07 Bq/cm². The total β radioactivity in the urine of the two patients within 24 hours post-operation accounted for approximately 0.0010% to 0.0013% of the yttrium-90 infusion dose. Conclusion The radiation levels at the monitoring sites in the workplaces of the three hospitals are below the national standard limits. The radioprotection and management of yttrium-90 resin microsphere therapy in the three hospitals in Guangdong Province are satisfactory.

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 observe the path and anatomic distribution of cutaneous branch of second dorsal metacarpal artery(SDMA) from the back of hand to the web of the fingers, and to explore the feasibility and clinical effect on the transfer of free flap of SDMA.Methods:Between June 2018 and September 2018, with perfusion of red latex, 22 hand specimens were dissected to explore the course, vessel calibre and distribution of cutaneous branches of SDMA, and to discover the existence of an innervation of cutaneous nerve in Department of Hand Surgery of Tangshan Second Hospital. Later on, from February 2019 to July 2020, 2 thumb pulp defects of 2 patients were reconstructed with the free flaps of SDMA. One defect was in the left thumb and the other in the right, both were male and compression injuries. Size of thumb pulp and a skin defect was at 3.5 cm×2.0 cm in 1 patient, and 2.0 cm×2.5 cm in the other. There was no neurovascular injury, but 1 patient had a distal phalangeal fracture and a nail bed laceration. The sizes of the flaps were 3.8 cm×2.3 cm and 2.8 cm×2.5 cm. Functional exercises started from 3 weeks after surgery. Patients attended postoperation follow up regularly by outpatient visit, telephone or internet interviews. Follow-up observations included the appearance, texture, sensory recovery of the flaps and thumb functions.Results:Multiple perforating branches (4-9 branches) were found from SDMA, which distributed in the distal 1/3 of SDMA in the anatomic study. It was found that the outer diameter of SDMA was 0.76 mm±0.25 mm at the intersection of extensor tendon of index finger and that of the digital web artery was 0.71 mm±0.12 mm. The length of digital web artery was 11.00 mm±1.27 mm. The 2 surgically transferred flaps were all survived. One patient showed the function of thumb in excellent with two-point discrimination (TPD) at 7.0 mm, at 18 months of follow-up. The other patient showed good thumb movement, soft and elastic skin of the flap and with a 7.5 mm in TPD, at 15 months of follow-up. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the results of the 2 flaps were all excellent.Conclusion:The flap of SDMA has a constant cutaneous nerve and a long vascular pedicle with an ideal vessel size. It is suitable for free transfer and can be used to reconstruct soft tissue defects of thumb.

Objective:To explore clinical results in reconstruction of finger C-shape soft tissue defect with the wrist crease free flap carrying cutaneous nerve.Methods:From June, 2017 to April, 2019, 7 fingers(7 patients) with C-shape defect were treated with the wrist crease free flap carrying cutaneous nerve. The size of defect ranged from 1.0 cm × 2.5 cm-2.2 cm × 4.0 cm; the flap sizes were 1.3 cm × 2.7 cm-2.5 cm × 4.5 cm. Five fingers had unilateral defect of proper palmar digital artery. Two fingers that had bilateral defect of proper palmar digital artery with poor blood circulation were re-established with blood supply by Flow-through flaps. Four fingers had unilateral defect of proper palmar digital nerves, and 3 had bilateral defect of proper palmar digital artery. Five of the fingers were repaired by the superficial branch of the radial nerve and 2 repaired by palmar cutaneous branch of median nerve. Regular outpatient follow-up was conducted after surgery for 8 to 15 (mean 11) months.Results:All the fingers and flaps survived with primary healing. Numbness existed in the areas of functional dominance of the cutaneous nerve. At the end of follow-up, the flaps showed good texture without significant bloated appearance with the recovery of protective sensation. The sensation of fingertip recovered to S 4 in 5 fingers and S 3+ in 2 fingers. Finger pulps were plump. All of the fingers moved freely. Linear scars were observed at donor sites and the wrists moved freely. Numbness feeling in the areas of cutaneous nerve disappeared at 6 to 8 weeks after surgery. According to the Functional Evaluation Criteria of the Finger Replantation published by the Hand Surgery Society of the Chinese Medical Association, the results were excellent in 6 fingers and good in 1 finger. Conclusion:The wrist crease free flap carrying cutaneous nerve is constant and can be dissected transversely to reconstruct and fit the C-shape defect of finger. It can re-establish the blood supply as well as to repair the proper palmar digital nerve defect at the same time.

Objective:To explore the application effect of BOPPPS teaching model and "Internet + WeChat" platform in the teaching of Clinical Pharmacology.Methods:Undergraduate students from two consecutive batches of clinical medicine in Wuhan University were selected as the control group and the experimental group. The control group adopted the traditional teaching method, and the experimental group adopted the BOPPPS teaching model combined with the "Internet + WeChat" platform. SPSS 12.0 was used for t test. Results:The scores of the final test in the experimental group and the control group were (86.34±7.36) and (80.77±9.21), respectively, with statistical significance ( P<0.05). For the questions of clinical case analysis, with a total score of 20 points, the scores of the experimental group students (13.31±2.25) were significantly higher than those of the control group (10.58±3.04), with significant difference ( P<0.001). Conclusion:The application of BOPPPS model and "Internet + WeChat" platform in the undergraduate teaching of Clinical Pharmacology could improve students' examination performance, and especially the ability of solving clinical problems comprehensively.

Objective To evaluate the outcomes of thumb reconstruction with dorsal thumb rotated single pedicel reverse island flap.Methods 49 thumb-tip defects cases with dorsal thumb rotated single pedicel reverse island flap were analyzed retrospectively.37 dorsal thumb reverse island flap were performed,and 12 ulnar-dorsal reverse island flaps were performed.Results The operation time was 40-60 minutes.The mean time was 45 minutes.All 49 cases survived completely.The color of the flaps was purple,and blisters in the surface of the flaps after 1-2 days in 2 cases.After took out stitches partly,the blisters were dried and crusted,the color of the flaps with better blood circulation was normal.The follow-up period was 3-24 months,all thumbs had satisfactory appearances and functions.The two-point discrimination was 6-9mm in flaps inosculated with nerve,that was 8-10 mm in flaps inosculated without nerve.The color,texture and elasticity of flaps were excellent,and the donor sites had not been defected.Conclusion Dorsal thumb rotated single pedicel reverse island flap is a reliable option to restore function as well as appearance,long vascular pedicle with skin strap,wide rotation angle,high rate of survival.It avoided damages to the well-known arteries and nerves.It is a relatively facile procedure that can be applied toward resurfacing thumb tip defects.

Objective To recognize the relationship between high cutantous artery branches and descending branch of lateral femoral circumflex artery artery,and to investigate the blood supply of anterolateral thigh flap in clinical.Methods Retrospective analysis 152 cases of anterolateral thigh flap from November,2003 to December,2016.It contains cutting with descending branchs in 99 cases,cutting with lateral branchs in 43 cases,the union of them in 8 cases and high cutantous artery branches in 2 cases.Results The flaps survival in 147 cases,cutting necrosis in 3 cases and partly necrosis in 2 cases.Descending and lateral branchs were both dominance neurovascular bundle of vastus lateralis muscle,independently or commonly dominate the skin of anterolateral thigh,occurrence rate was 33.5％.Conclusion The descending branch of lateral femoral circumflex artery include lateral branch,all of which are the neurovascular bundles,supply the anterolateral thigh muscle,and divid into some perforator branches crossing the musle to the anterolateral thigh skin subsequently,which constitute "the anatomical functional unit".High cutantous artery branche is the one of all of the branches,its origin lies hight and arise from lateral branch.

BACKGROUND:Recently, glucocorticoid-induced necrosis of femoral head has been much studied. However, the precise Wnt signaling pathway by which puerarin suppresses adipogenic differentiation of glucocorticoid-induced bone marrow mesenchymal stem cells adipogenic differentiation of glucocorticoid-induced bone marrow mesenchymal stem cells remains unconfirmed. OBJECTIVE:To investigate the expression of Wnt signaling pathway related genes and the key factor protein,β-catenin, during adipogenic differentiation of glucocorticoid-induced rat bone marrow mesenchymal stem cells treated by puerarin. METHODS:The third generation of bone marrow mesenchymal stem cells were cultured with Dulbecco’s modified Eagle’s medium containing blank serum (blank control group), dexamethasone (hormone group), dexamethasone with puerarin low dose group, the middle dose group and high dose group. After 6 days of culture, in the above five groups, the expressions of Wnt/β-catenin signaling pathway members, Wnt10b mRNA, GSK3βmRNA,β-catenin mRNA, were detected using RT-PCR assay, and the expression ofβ-catenin protein was detected using western blot assay.
RESULTS AND CONCLUSION:Compared with the control group, the Wnt10b mRNA,β-catenin mRNA andβ-catenin protein expressions were significantly higher in puerarin groups, but GSK3βmRNA expression was significantly lower in the puerarin groups. These findings suggest that puerarin effects on inhibition of adipogenic differentiation of glucocorticoid-induced bone marrow mesenchymal stem cells probably are realized through the activation of Wnt/β-catenin signal pathway and regulation of the key factor Wnt10b mRNA, GSK3βmRNA,β-catenin mRNA, andβ-catenin protein expressions. The mechanism by which puerarin prevents glucocorticoid-induced necrosis of femoral head not only improves local microcirculation of the femoral head, but also relates to its inhibitory effects on adipogenic differentiation of glucocorticoid-induced bone marrow mesenchymal stem cells.