BACKGROUND:At present,measurement osteotomy technique and gap balance technique are the two main surgical methods in total knee arthroplasty.Both methods have their advantages and disadvantages.By adjusting the osteotomy angle,the gap balance technique can reduce the release of soft tissue and obtain a more balanced flexion and extension space.The clinical efficacy of gap balance technique is superior,but this surgical method lacks tools and is easily influenced by the surgeon's surgical experience and subjective judgment,with more errors.Measurement osteotomy technique has a short learning curve,but it relies on anatomic markers and is prone to many complications due to inaccurate positioning.In recent years,many instrument companies have successively developed and launched tools that can improve the quality of surgery.However,there are still few reports about the tool. OBJECTIVE:To compare the clinical efficacy of gap balance technique and measurement osteotomy technique under Offset Repo-Tensor in total knee arthroplasty,and explore the value of Offset Repo-Tensor in total knee arthroplasty. METHODS:The medical records of 85 patients with total knee arthroplasty were collected and divided into two groups according to the operation method.Group A consisted of 44 patients who underwent total knee arthroplasty using a gap balance technique combined with Offset Repo-Tensor.Group B consisted of 41 patients who underwent total knee arthroplasty using measurement osteotomy technique.Surgical time,American Knee Society Score,knee range of motion,changes in lower limb alignment,and postoperative complications were compared between the two groups to evaluate the clinical efficacy of gap balance technique combined with Offset Repo-Tensors in total knee arthroplasty. RESULTS AND CONCLUSION:(1)All 85 patients were followed up.(2)Postoperative knee range of motion in both groups was higher than that before surgery(P<0.05),and the improvement in group A was more significant than that in group B(P<0.05).(3)American Knee Society Score in both groups after surgery was higher than that before surgery(P<0.05),and the American Knee Society Score in group A was higher than that in group B at 2 weeks,1,3 months,and the last follow-up(P<0.05).(4)The operation time of group A was slightly shorter than that of group B,but the difference was not significant(P>0.05).(5)The lower limb alignment in both groups was improved after operation,but there was no significant difference between the two groups(P>0.05).(6)The complication rate of group A(2%)was lower than that of group B(7%),but there was no significant difference between the two groups(P>0.05).(7)It is indicated that compared with the measurement osteotomy technique,the combination of Offset Repo-Tensor and gap balance technique can elevate the clinical effect and improve the function and motion range of the knee joint.

Objective:To describe the characteristics, etiology and patterns of outpatients and inpatients patients with moderate or severe valvular heart disease (VHD).Methods:This is a cross-sectional study. Outpatients and inpatients with moderate or severe VHD who underwent transthoracic echocardiography for first examination from 1 st January 2001 to 1 st January 2020 in Southwest Hospital, Army Medical University were enrolled. Data were collected from medical records and big data platform of Southwest Hospital. Characteristics of age and gender, etiology and types of VHD were descriptively analysed. Results:A total of 68 354 patients with moderate or severe VHD were enrolled. The age was 63 (50, 72) years. And 35 706 (52.24%) patients were female. (1) Age characteristics: There was similar age trend between male and female patients with moderate or severe VHD. The number of patients increased firstly and then decreased and reached its peak in the age group of 65-69 years old. The peak age of mitral stenosis patients was 45-49 years, which was earlier than that of whole patients with moderate or severe VHD. The median age of patients with bicuspid aortic valve was 42 years. (2) Gender characteristics: The proportion of tricuspid regurgitation, pulmonary regurgitation, mitral regurgitation, mitral stenosis and valve surgery in female patients with moderate or severe VHD were higher than those in male patients. The proportion of aortic regurgitation, aortic stenosis and bicuspid aortic valve in male patients with moderate or severe VHD were significantly higher than those in female patients (all P<0.05). (3) Etiology: The proportion of rheumatic VHD was 13.07% (8 934/68 354), which was higher than that of degenerative VHD (0.67% (458/68 354)). (4) Types of VHD: Tricuspid regurgitation made contribution to the largest proportion with 60.72% (41 503/68 354), followed by mitral regurgitation, aortic regurgitation, mitral stenosis, pulmonary regurgitation and aortic stenosis. Conclusions:There are certain regional characteristics in the prevalence of moderate or severe VHD in southwest China, suggesting different attention should be paid on the whole process of refined management of moderate or severe VHD.

Objective To analyze the spatial and temporal characteristics of hand, foot and mouth disease (HFMD) in Hunan Province from 2016 to 2020. Methods The data of HFMD in Hunan Province from 2016 to 2020 were collected from China's Disease Prevention and Control Information System. HFMD spatial autocorrelation analysis was conducted by ArcGIS 10.2 software at county level, and spatial-temporal scan statistical analysis was performed by SaTScan 9.7 software. Results A total of 714 157 cases was reported in Hunan Province during 2016-2020, with an average annual incidence rate of 208.36/100 000. Global spatial autocorrelation showed that HFMD had a positive spatial correlation on the county scale in Hunan Province during this period. Local spatial autocorrelation indicated that the hot spots were mainly concentrated in the north of central Hunan, the east of central Hunan and the west of Hunan. Spatial-temporal scanning analysis revealed the first class clusters (RR = 6.65, P< 0.001) covering 34 counties in northern and central Hunan, mainly distributed in Yueyang City, Changsha City, Zhuzhou City, Yiyang City and Xiangtan City from May 2018 to June, and the second class clusters (RR = 3.02, P < 0.001) covering 40 counties in western Hunan and central and southwest Hunan from April 2016 to June 2016. Conclusion HFMD incidence exhibits seasonal and regional characteristics in Hunan Province. The prevention and control of HFMD should be guided by combining the characteristics of spatial-temporal clustering.

Objective:To provide a promising and optimal laboratory susceptibility-testing method for the clinical usage of antibiotic (polymyxin), four susceptibility-testing methods were performed and the broth microdilution (BMD) was chosen as the gold standard.Methods:A total number of eighty-eight nonduplicate clinical Enterobacteriaceae specimes were collected from January to December of 2019 in the First Affiliated Hospital, Fujian Medical University. Among the clinical specimens, of which six strains were positive for mcr-1. The minimal inhibitory concentration (MIC) of polymyxin of the clinical specimens were examined by the following methods: (1) broth microdilution, (2) colistin broth disk elution, (3) Vitek-2?, (4)BD PhoenixTM,(5)commercial broth microdilution. With BMD as reference, essential agreement (EA), categorical agreement(CA), very major error(VME) and major error (ME) of polymyxins for different methods were analyzed. The Kappa-consistency testing, paired Chi-square testing and the Spearman-rank correlation testing were used to analyze the consistency between the four antimicrobial susceptibility testing methods and the gold standard.Results:Taking broth microdilution as reference, the EA of colistin broth disk elution, Vitek-2?, BD PhoenixTM, commercial broth microdilution were 94.32% (83/88), 92.05% (81/88), 90.90% (80/88), and 96.59%(85/88), respectively. The CA of all the four methods were 100% (88/88). No VME and ME were recorded for four methods. Moreover, the consistency between four susceptibility testing methods and the gold standard is acceptable (Kappa values=1, P<0.001, McNemar test P=1 and r>0.5, P<0.05). Conclusions:In the present work, four susceptibility testing methods all met the standards recommended jointly by the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing, of which the performance of the commercial broth microdilution and CBDE fared relatively well. Thus, these four methods could be routinely used in clinical microbiology laboratory of our hospital for colistin and polymyxin B susceptibility testing.

Objective:To evaluate the diagnostic efficacies of computed tomography (CT), clinical manifestations and 2019 novel coronavirus (2019-nCoV) nucleic acid test results for the screening and diagnosis of novel coronavirus pneumonia.Methods:The clinical data of suspected cases with corona virus disease 2019 (COVID-19) visited fever clinic or stayed in emergency room of the First Affiliated Hospital of Nanchang University from January 23 to February 9, 2020 were collected. Totally 274 cases who met the inclusion criteria were enrolled. Four screening schemes including chest CT screening, scoring, chest CT and scoring series screening, chest CT and scoring parallel screening were designed. The statistical analysis was performed by using chi-square test. The sensitivities, specificities and the areas under the receiver operator characteristic curve of the four screening schemes were calculated, and the diagnostic efficacies were evaluated.Results:Among the 274 cases, 93.80%(257/274) presented with typical clinical symptoms, 47.81%(131/274) had epidemiological history, and the blood routine examination results of 45.26%(124/274) cases met the positive criteria of the scoring , and chest CT results of 43.07%(118/274) cases met the positive criteria of chest CT screening. The 2019-nCoV nucleic acid test positive rate of cases with epidemiological history was 30.53%(40/131), which was higher than that of cases without epidemiological history (9.09%(13/143)), and that of cases with typical imaging performance on chest CT was 40.68%(48/118), which was higher than cases without typical imaging performance (3.21%(5/156)). The differences between the above groups were both statistically significant ( χ2=20.150、60.468, respectively, both P<0.01). The positive rates of viral nucleic acid detection in cases with positive findings of chest CT screening, scoring, series screening, and parallel screening were 40.68%(48/118), 23.74%(47/198), 44.68%(42/94) and 23.87%(53/222), respectively, while those in cases with negative findings of the four screening schemes were 3.20%(5/156), 7.89%(6/76), 6.11%(11/180) and 0(0/52), respectively. The positive rates of the four screening schemes were all significantly different from that of viral nucleic acid detection ( κ=0.402, 0.100, 0.431, 0.106, all P<0.01). The chest CT screening method had a sensitivity of 90.57%and a specificity of 68.33%, and an area under the operating characteristic curve of the subject was 0.794, which had higher diagnostic value than those of the other three screening schemes. Conclusions:For the screening and diagnosis of COVID-19 cases, epidemiological history, positive 2019-nCoV nucleic acid test with ≥2 typical clinical manifestations have highly diagnostic value. On the basis of the preliminary screening of chest CT examination, flexible analysis of the diagnostic results could improve the diagnostic value of each detection method.

Objective To compare the efficacy of erlotinib and pemetrexed in treatment of advanced non-small cell lung cancer (NSCLC) and its effect on the immunity of patients. Methods A total of 82 patients with NSCLC at the First Affiliated Hospital of Hainan Medical College from June 2014 to May 2018 were retrospectively analyzed. According to the different treatment methods, the patients were divided into erlotinib group (150 mg/d, oral administration, 2 hours after the meal) and pemetrexed group (500 mg/m2, intravenous drip, 21-day each cycle). There were 41 cases in each group. The clinical effects of the two groups were analyzed. Flow cytometry was used to detect the immune index. Results The objective effective rate in pemetrexed group was lower than that in erlotinib group [34.2％ (14/41) vs. 39.0％ (16/41), χ 2 = 0.210, P =0.647). There was no significant difference in T lymphocyte subsets between the two groups before and after treatment (both P > 0.05). The values of CD3+ T cells, CD4+ T cells, CD4+ / CD8+ in both groups after the treatment were decreased compared with the values before the treatment; CD8 + T cells was increased after the treatment compared with the value before the treatment (all P < 0.05). Quality of life questionnaire-C30 (QLQ-C30) score in erlotinib group was higher than that in pemetrexed group [(75.1±13.5) vs. (68.9±12.9), t = 2.158, P = 0.017]. Myelosuppression and gastrointestinal reactions were the main adverse events in pemetrexed group; rashes and diarrhoea were the main adverse reactions in erlotinib group. Grade Ⅰ-Ⅱ side effects occurred in both groups. There were statistical differences in the incidence of myelosuppression, gastrointestinal reactions, rashes and diarrhoea of both groups (all P < 0.05). Conclusions The efficacy oferlotinib and pemetrexed in treatment of advanced NSCLC is similar, and both of them could regulate the immune response. Erlotinib has a significant advantage in improving the quality of life.

Objective: To investigate the effect and safety of apatinib in the treatment of advanced gastric cancer. Methods: A total of 60 patients with advanced gastric cancer at the first Affiliated Hospital of Hainan Medical College from April 2015 to October 2018 were retrospectively analyzed, and all patients were divided into two groups according to the treatment method, each group of 30 cases. The control group was treated with conventional treatment, and the observation group was given the treatment of apatinib on the basis of the control group, and then the clinical curative effect and adverse reactions were compared between the two groups. Results: There were 2 cases (6.67%) of complete remission in the observation group, 14 cases (46.67%) of partial remission, 10 cases (33.33%) of stability and 4 cases (13.33%) of disease progression, and the total effective rate was 53.33% (16/30). The control group had no complete remission, 8 cases (26.67%) of partial remission, 11 cases (36.67%) of stability and 11 cases (36.67%) of disease progression, and the total effective rate was 26.67% (8/30). The difference of total effective rate between the two groups was statistically significant (χ ² = 4.444, P = 0.035). There was no significant difference in the level of tumor marker carcinoembryonic antigen (CEA), carbohydrate antigen (CA)199, CA125, cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) between the two groups before and after treatment (all P > 0.05). The incidence of hand-foot syndrome and hypertension in the observation group was higher than that in the control group [73.33% (22/30) vs. 43.33% (13/30), H = 5.554, P = 0.018; 76.67% (23/30) vs. 46.67% (14/30), H = 5.711, P = 0.017]. The incidence of proteinuria, bone marrow suppression and the cardiac adverse reactions in the observation group was higher than that in the control group [63.33% (19/30) vs. 33.33% (10/30), H = 3.300, P = 0.069; 60.00%(18/30) vs. 36.67% (11/30), H = 5.455, P = 0.071; 53.33% (16/30) vs. 30.00% (9/30), H = 3.360, P = 0.067]. Conclusion Apatinib is effective in the treatment of advanced gastric cancer, but the occurrence of hand-foot syndrome and hypertension should be paid close attention during the treatment.

Objective: To examine whether presepsin level can serve as a distinguishing marker between G- bacteria and G+ bacteria, fungal infection in sepsis patients. Methods: A prospective observation study was conducted on the consecutive patients with positive bacterial cultures in intensive care unit (ICU) from June 2017 to November 2018. The patients were divided into the G- group, G+ group and fungal group. Blood samples were collected upon admission to measure the levels of presepsin and procalcitonin (PCT). Results: (1) Of the 156 patients met the inclusion criteria. 96 (62% G- rods, 25 (16%) G+ microbes, and 35 (22%) fungi were detected. (2) Presepsin concentrations were significantly higher in the G- group compared with the G+ and fungal groups (P = 0.000). (3) Presepsin level has a higher accuracy in differentiating G- sepsis from Gram+ and fungal sepsis than PCT level [area under the curve (AUC): 0.809 vs 0.712]. The AUC value of a combination of presepsin and PCT level was significantly larger than that of presepsin level alone in differentiating G- sepsis from Gram+ and fungal sepsis (AUC: 0.866 vs 0.809). Conclusions In contrast to PCT, presepsin is a good discriminative biomarker in different infections.

In the development of oxidative stress-relevant diseases, reactive oxygen species (ROS) removal obstacle or excess production results in the damage of the body tissues and organs. Recent studies have demonstrated that nuclear factor E2-related factor 2/heme oxygenase-1 (Nrf2/HO-1) axis played a significant role in anti-oxidative stress. The Nrf2/HO-1 axis counteracts oxidative stress injury by its resistance to inflammation, oxidation, mitochondrial damage and calcium influx, apoptosis, pyroptosis, ferroptosis and autophagy, which provides a theoretical basis for its therapeutic effect on various oxidative stress-relevant diseases in multiple organs (respiratory, cardiovascular, nervous, digestive, urinary and blood systems). Therefore, effective regulation of the Nrf2/HO-1 signal axis can be an important strategy for treatment of oxidative stress-relevant diseases.
Heme Oxygenase-1 ; NF-E2-Related Factor 2 ; Oxidative Stress ; Reactive Oxygen Species ; Signal Transduction

Objective To compare the clinical outcomes of neuromuscular scoliosis(NMS)patients with pelvic obliquity who underwent spino-pelvic fixation utilized traditional iliac screw(IS),second sacral alar-iliac(S2AI)screw or iliac sacral screw. Methods All of 20 patients who met the inclusion were included in this study,with 14 cases of poliomyelitis,4 cases of spinal muscular atrophy, 2 cases of muscular dystrophy,with 11 patients utilizing IS, 6 patients utilizing S2AI,and 3 patients utilizing ISS.The radiographic parameters measured pre-and post-operation and at last follow up included coronal Cobb angle,pelvic obliq-uity,and regional kyphosis.The SRS-22 questionnaires and the Oswestry disability index(ODI)and complications were collected. Results There were no significant difference in age,Cobb angle,pelvic obliquity and regional kyphosis among three groups,the follow up times was significantly shorter in the ISS group(H=15.183,P<0.01).In the IS group,the Cobb angle at pre-or post-oper-ation and at last follow up measured 70°,35°and 40°,the pelvic obliquity measured 24°,11°and 12°,the regional kyphosis mea-sured 36°,12°and 14°.In S2AI group,the Cobb angle measured 70.5°,25.0°and 26.5°,the pelvic obliquity measured 20°,10° and 11.5°,the regional kyphosis measured 37°,12°and 12.5°,showing significant improvement compared to pre-operation(P<0.05).In the ISS group,the Cobb angle at pre or post operation and at last follow up measured 64°,25°and 27°,the pelvic obliqui-ty measured 24°,9°and 11°,the regional kyphosis measured 53°,8°and 8°,showing a decrease after surgery with P>0.05,which may attribute to the small sample size in ISS group.The pre-operative ODI score was 42%,45% in IS and S2AI group,improving significantly to 26%,25.5% at last follow up.The ODI score in ISS group improved from 36% to 24% after surgery(P=0.068).The SRS-22 score improved significantly in three groups,with P<0.05 in IS and S2AI group and P=0.066 in ISS group.In the IS group, one patient had rod breakage and underwent revision surgery,one patient had deep infection and recovered with conservative treat-ment.In the S2AI group,one patient had S2AI screw misplacement on the right side.Conclusion In the surgical management of neuromuscular scoliosis(NMS)patients with pelvic obliquity,the utilization of either iliac screw,S2AI screw or ISS fixation can ob-tain satisfied deformity correction and improvement in health-related quality of life,however,the utilization of S2AI and ISS could reduce the implant related complications.