The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Wild castor grows in the high-altitude tropical desert of the African Plateau,a region known for high ultraviolet radiation,strong light,and extremely dry condition.To investigate the potential genetic basis of adaptation to both highland and tropical deserts,we generated a chromosome-level genome sequence assembly of the wild castor accession WT05,with a genome size of 316 Mb,a scaffold N50 of 31.93 Mb,and a contig N50 of 8.96 Mb,respectively.Compared with cultivated castor and other Euphorbiaceae species,the wild castor exhibits positive selection and gene family expansion for genes involved in DNA repair,photosynthesis,and abiotic stress responses.Genetic variations associated with positive selection were identified in several key genes,such as LIG1,DDB2,and RECGI,involved in nucleotide excision repair.Moreover,a study of genomic diversity among wild and cultivated accessions revealed genomic regions containing selection signatures associated with the adaptation to extreme environments.The identification of the genes and alleles with selection signatures provides insights into the genetic mechanisms under-lying the adaptation of wild castor to the high-altitude tropical desert and would facilitate direct improvement of modern castor varieties.

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 application of ultrasound-guided fascia iliaca compartment block(FICB) and proximal popliteal sciatic nerve block(PPSNB) on patients undergoing total knee arthroplasty. Methods: From January 2015 to January 2018, 60 patients scheduled for total knee arthroplasty undergoing laryngeal mask airway(LMA) general anesthesia in the People′s Hospital of Langfang were divided into three groups by the random number table, with 20 cases in each group.Before general anesthesia, every patient received dezocine 5mg iv, group A received FICB, group B received FICB combined with PPSNB(extraparaneural), group C received FICB combined with PPSNB(subparaneural).40mL of 0.375% ropivacaine was injected guiding by ultrasound.The dosage of propofol and remifentanil, time of awake, awake visual analogue scale(VAS), mean arterial blood pressure(MAP) and heart rate(HR) at pre-block(T1), LMA insert(T2), skin incision(T3), femoral bone cutting(T4), LMA remove(T5), and awake stage(T6) were recorded.The incidence of using vasoactive drugs and adverse reaction were also recorded. Results: The dosage of propofol and remifentanil, the time of awake and awake VAS in group A, group B and group C were: group A (768.0±8.5)mg, (977±21)μg, (18.4±2.1)min, (4.2±0.7)points; group B (554.0±7.1)mg, (775±12)μg, (12.3±1.6)min, (2.4±0.6)points; group C (530±8.2)mg, (738±15)μg, (11.8±1.7)min, (1.3±0.5)points.The dosage of propofol and remifentanil, time of awake, awake VAS in group B and group C were significantly lower than those in group A (F=29.23, 42.56, 32.42, 19.31, all P<0.05). The awake VAS in group C was lower than that in group B (q=8.12, P<0.05). MAP and HR at T2, T3, T4, T5 and T6 in group B or group C were significantly lower than those in group A (MAP: F=85.66, 78.46, 86.04, 62.75, 61.31; HR: F=26.03, 42.75, 38.04, 29.31, 31.50, all P<0.05). The number of patients who required vasoactive drugs and adverse reaction in group B or group C were significantly lower than those in group A (χ²=11.32, 12.81, 15.24, 15.24, 10.15, all P<0.05). The incidence rates of incision pain at awake stage in group A, group B and group C were: group A(30%), group B(20%), group C(0%), that in group C was lower than group B (χ²=9.87, P<0.05). Conclusion The ultrasound-guided FICB and PPSNB(subparaneural) can obviously reduce the dosage of general anaesthetic and maintain the stability of hemodynamics in patients undergoing total knee arthroplasty.It has effective analgesia and less adverse reactions during sober.

Objective To prepare gemcitabine hydrochloride thermosensitive gel injection and to stablish the determina‐tion methods of its contents .Methods Gemcitabine hydrochloride thermosensitive gel injection was prepared using PLGA‐PEG‐PLGA as thermosensitive viecle .The contents of gemcitabine hydrochloride were determined by HPLC .Results The formulation contained 40 mg/ml gemcitabine and 20% (wt) PLGA‐PEG‐PLGA with phase‐transition temperature of (37 ± 0 .15) ℃ ,showing the best viscosity around human body temperature .Gemcitabine hydrochloride presented a good linearity in the range of 5‐500 μg/ml(r=0 .999 8) ,which had good precision and reproducibility .The recovery rate of low ,middle and high concentrations of gemcitabine hydrochloride were (99 .5 ± 3 .2)% ,(100 .4 ± 2 .4)% ,(102 .1 ± 2 .4)% ,n=3 ,respectively . The average contents of gemcitabine hydrochloride in three batches of sample were (101 .87 ± 2 .95)% ,(99 .4 ± 2 .73)% , (98 .98 ± 0 .71)% ,n=3 ,respectively .Conclusion The quality of gemcitabine hydrochloride thermosensitive gel injection with PLGA‐PEG‐PLGA as matrix could be controlled .It is a promising new drug for pancreatic cancer .

OBJECTIVE: To summarize the outcome of tricuspid valve replacement.
 METHODS: A total of 28 patients (15 males and 13 females) underwent tricuspid valve replacement from March 2000 to February 2015 in the First Affiliated Hospital of Zhengzhou University were recruited. Among them, 16 patients were Ebstein's anomaly, 7 had rheumatic valve heart disease, 3 and 2 suffered from infective endocarditis and degenerative tricuspid lesions, respectively.
 RESULTS: One patient died of multiple organ failure. Four patients were implanted permanent cardiac pacemaker because of third degree atrioventricular block occurring in the 5th day (2 patients) and in the 9th day (2 patients) after the operation, respectively. Twenty-seven patients were followed up from 1 month to 15 years. The prosthetic valves and permanent pacemakers worked well.
 CONCLUSION Third degree of atrioventricular block, mostly appearing in early postoperative period, is the most common and severe complication of tricuspid valve replacement. The key point for prevention of damage is to accurately identify the anatomical relationship among the tricuspid valve, atrioventricular node, and conduction bundle.
Ebstein Anomaly ; surgery ; Female ; Heart Valve Diseases ; surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Pacemaker, Artificial ; Rheumatic Heart Disease ; surgery ; Tricuspid Valve ; pathology ; surgery

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Fluorodeoxyglucose F18 ; Follow-Up Studies ; Humans ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphoma, Large B-Cell, Diffuse ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Neck ; diagnostic imaging ; pathology ; Positron-Emission Tomography ; Prognosis ; Young Adult

OBJECTIVETo compare the diagnostic value of ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and large-scale diffusion weighted imaging (DWI) for evaluation of non-Hodgkin lymphoma (NHL) bone marrow (BM) infiltration.

METHODSA total of 79 patients with pathologically diagnosed NHL underwent ¹⁸F-FDG PET/CT, large scale DWI and BM pathological examination. BM examination as the "gold standard", the performance (the sensitivity, specificity, accuracy, positive and negative predictive value) of ¹⁸F-FDG PET/CT and large scale DWI for evaluation of BM infiltration was compared and the risk of BM infiltration of different subtypes and sources of NHL was analyzed.

RESULTS25 of 79 cases were diagnosed as BM infiltration by pathological examination with 57 BM sites. Abnormal high BM metabolisms were identified in 22 cases with 56 BM sites by ¹⁸F-FDG PET/CT and 25 cases with 58 BM sites by large-scale DWI. The sensitivity, specificity, accuracy, positive and negative predictive value of ¹⁸F-FDG PET/CT were 80.0%, 96.3%, 91.1%, 90.9%, 91.2%, respectively. And they were 84.0%, 92.6%, 89.9%, 84.0%, and 92.6% by large-scale DWI, respectively. A receiver operating characteristic (ROC) analysis demonstrated that there was no statistical difference in ¹⁸F-FDG PET/CT and large-scale DWI (P>0.05). The area under ROC curve for ¹⁸F-FDG PET/CT and large-scale DWI were 0.911 and 0.883 respectively. The incidences of BM infiltration in aggressive NHL patients by ¹⁸F-FDG PET/CT (21/69, 30.4%) and large-scale DWI (23/69, 33.3%) were higher than those (PET/CT: 10.0%; large-scale DWI: 20.0%; P>0.05) in indolent NHL patients.

CONCLUSION¹⁸F-FDG PET/CT and large-scale DWI had important clinical value in diagnosing BM infiltration of NHL. A combination of ¹⁸F-FDG PET/CT, large-scale DWI and pathological examination could improve the positive rate of BM infiltration in NHL.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Marrow ; pathology ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymphoma, Non-Hodgkin ; diagnosis ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Positron-Emission Tomography ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Young Adult

BACKGROUND:Extraction of a wel fixed cementless femoral stem or a cemented stem is difficult during revision of total hip arthroplasty. The extended trochanteric osteotomy provides excellent methods, and combining with long-stem cementless prosthesis can better reduce postoperative complications.
OBJECTIVE:To retrospectively analyze the recent clinical curative effect after extended trochanteric osteotomy combined with long-stem cementless prosthesis in hip revision.
METHODA total of 25 patients undergoing hip revision were selected from the Department of Osteoarthrosis, Pingdingshan First People’s Hospital, China from May 2008 to May 2013. Of them, 17 patients were subjected to the extended trochanteric osteotomy combined with single-incision and double-approaches. The femurs were reconstructed with long-stem cementless prosthesis. Al patients were fol owed-up for 12 to 60 months. Pre-operative and post-operative Harris hip scores, the post-operative complications, the bone cutting length, the length of stem in contact with cortical bone, the length of the end of bone cutting to the end of the prosthesis were recorded.
RESULTS AND CONCLUSION:17 patients were fol owed-up. The mean length of bone was 17 cm (15-23 cm). The mean length of stem in contact with cortical bone was 6.4 cm (4-11 cm). The mean length of the end of bone to the end of the prosthesis was 11.5 cm (8-18.5 cm). After fol ow-up, the mean Harris hip scores were improved from (39.0 ± 13.6) scores preoperatively to (75.0 ± 14.9) scores postoperatively (P<0.01). Subsidence occurred in two hips. The cutting sites of 17 cases of extended trochanteric osteotomy were fixed wel . These data suggested that the operation through single-incision and double-approach to the hip, while preserving the attachment of the external rotators and posterior capsule, wil strength rear hip stability and prevent postoperative dislocations. Recent effects were satisfactory, but the long-term outcomes should be further investigated.

Objective: To analyze the regional differences of the health resource allocation in Guangdong Province from 2002 to 2011, and provide the scientific basis for regional health planning and health resource allocation optimizing. Methods: The Theil Index was used to analyze the regional differences of the health resource allocation in Guangdong Province. Results: The health resource per capital is consistent with the national level, while differences existed in different areas, and the gap of the differences has been broaden during this period. Conclusions: The differences are caused by the difference distribution of material resources, human resources, the faulty of system and mechanism. Therefore, the hygienic resources disposition should be balanced establish reasonable mechanism to improve the equity of health human resources, strengthen the community health service as a breakthrough during the health system reform, and promote the equal access to basic medical and health services to narrow the gap of the regional differences and promote the equity of health resource allocation.