Objective:To explore the consistency of peripheral whole blood and venous serum procalcitonin (PCT) levels, and the value of peripheral whole blood PCT in evaluating pediatric bacterial infection.Methods:This multicenter cross-sectional parallel control study was conducted in 11 children′s hospital. All the 1 898 patients older than 28 days admitted to these hospitals from March 2018 to February 2019 had their peripheral whole blood and venous serum PCT detected simultaneously with unified equipment, reagent and method. According to the venous serum PCT level, the patients were stratified to subgroups. Analysis of variance and chi-square test were used to compare the demographic characteristics among groups. And the correlation between the peripheral blood and venous serum PCT level was investigated by quantitative Pearson correlation analysis.The PCT resultes were also converted into ranked data to further test the consistency between the two sampling methods by Spearman′s rank correlation test. Furthermore, the ranked data were converted into binary data to evaluate the consistency and investigate the best cut-off of peripheral blood PCT level in predicting bacterial infection.Results:A total of 1 898 valid samples were included (1 098 males, 800 females),age 27.4(12.2,56.7) months. There was a good correlation between PCT values of peripheral whole blood and venous serum ( r=0.97 , P<0.01). The linear regression equation was PCT?venous serum=0.135+0.929×PCT peripheral whole blood. However, when stratified to 5 levels, PCT results showed diverse and unsatisfied consistency between the two sampling methods ( r=0.51-0.92, all P<0.01). But after PCT was converted to ordinal categorical variables, the stratified analysis showed that the coincidence rate of the measured values by the two sampling methods in each boundary area was 84.9%-97.1%. The dichotomous variables also showed a good consistency (coincidence rate 96.8%-99.3%, Youden index 0.82-0.89). According to the severity of disease, the serum PCT value was classified into 4 intervals（<0.5、0.5-<2.0、2.0-<10.0、≥10.0 μg/L）, and the peripheral blood PCT value also showed a good predictive value (AUC value was 0.991 2-0.997 9). The optimal cut points of peripheral whole blood PCT value 0.5、1.0、2.0、10.0 μg/L corresponding to venous serum PCT values were 0.395, 0.595, 1.175 and 3.545 μg/L, respectively. Conclusions:There is a good correlation between peripheral whole blood PCT value and the venous serum PCT value, which means that the peripheral whole blood PCT could facilitate the identification of infection and clinical severity. Besides, the sampling of peripheral whole blood is simple and easy to repeat.

OBJECTIVE：To provide refe rence for inte lligent managemen t of central pharmacy. METHODS ：The construction experience of intelligent central pharmacy management mode were introduced ，including the use of information technology ，the introduction of automation equipment ，the rational layout of the central pharmacy ，as well as the optimization of work flow ，and the establishment of integrated management mode ，etc. The workload of intelligent central pharmacy in our hospital before construction（2016），during construction （2017-2018）and after operation （2019）were collected from our hospital information system（HIS），including the number of injection doctor ’s orders ，the number of doctor ’s orders reviewed ，the number of PIVAS deployment，the number of oral medical orders ，the number of medical orders discharged with medicine ，etc. The pharmacist scheduling before and after the operation of intelligent central pharmacy in our hospital was counted. The average daily quantity of injection prescription ，average dispensing speed ，timely delivery rate and dispensing errors were calculated. In addition ，the satisfaction of medical staff in 39 wards of our hospital were investigated every quarter to evaluate the implementation effect of intelligent central pharmacy management model. RESULTS ：From 2016 to 2019，the workload of the central pharmacy in our hospital showed an overall upward trend ，and the average daily prescription amount increased year by year ，and the average daily prescription amount in 2017-2019 was significantly more than that in 2016（P＜0.05）. Average dispensing speed ，timely delivery rate and dispensing errors of central pharmacy during 2018-2019 were significantly lower than 2016（P＜0.05）. The daily number of pharmacists in dispensing posts in the central pharmacy was reduced from 22 in 2016 to 18 in 2019，with 4 pharmacists saved. During the 4 years，867 questionnaires were distributed and 862 valid questionnaires were recovered. The effective recovery rate was above 99％. The average satisfaction of medical staff in the ward to the central pharmacy was high relatively ，being 96.8％， 98.4％ ，99.1％ and 99.1％ respectively from 2016 to 2019. CONCLUSIONS ：The integrated intelligent center pharmacy management mode established in our hospital has realized the information and automatic management of inpatient medication order dispensing；reasonable arrangement of the work contents of professional and technical personnel with different professional titles can not only save the labor cost ，but also increase the content 09304021） of pharmaceutical care ，broaden the work depth ，so as to improve the work efficiency and ensure the quality of 126.com pharmaceutical care.

Objective To investigate the surgical outcomes of one-stage repair of the ankle fracture combined with grade Ⅲ injury to the lateral ligament.Methods From April 2015 to December 2017,23 patients with ankle fracture and lateral ligament injury were treated at Department of Traumatic Reconstruction Surgery/Foot and Ankle Surgery,Zhongnan Hospital.There were 15 males and 8 females,aged from 18 to 65 years (average,37.8 years).After intraoperative treatment of their fractures,22 ruptures of the ligamentous insertion were repaired with suture anchor and one rupture of the middle ligament with Internal Brace.Routine postoperative X-rays,physical examination and Sefton grading system were used to evaluate the stability of the ankle joint and the subtalar joint.The Karlsson-Peterson and American Orthopedic Foot and Ankle Society (AOFAS) scores were used to evaluate the function and pain of the ankle.Results The follow-up for this cohort ranged from 12 to 24 months (average,13.9 months).The bone union time ranged from 6 to 24 weeks,averaging 10.1 weeks.There was no chronic instability of lateral ankle or subtalar joint in all the cases.Two cases developed osteochondral lesion of the medial talus which was treated with micro-fracture surgery one year after injury;one case suffered subtalar arthritis which was treated by subtalar arthrodesis 14 months after injury.Their Karlsson-Peterson scores averaged 84.6 points and AOFAS ankle-hindfoot scores 93.7 points with 19 excellent and 4 good cases.The Sefton grading system gave 9 cases of grade Ⅰ and 14 ones of grade Ⅱ.Conclusion One-stage repair of the ankle fracture combined with grade Ⅲ injury to the lateral ligament can lead to the stability of the ankle joint and the subtalar joint and improved function of the ankle.

OBJECTIVE:To promote the realization of intelligent management for narcotic and first type psychotropic drugs (narcotic and psychotropic drugs for short)in hospital. METHODS:With the aid of fingerprint identification technology and hardware devices such as intelligent storage cabinet,intelligent management for narcotic and psychotropic drugs were designed and developed in our hospital,including prescription dispensing,cardinal drug supplement,empty bottle recycling,changing shifts, etc. The effects of the system were evaluated 30 d before and after the implementation of the system through comparing related indexes. RESULTS:The application of intelligent management system for narcotic and psychotropic drugs realized intelligent dispensing of narcotic and psychotropic drugs,automatic checking during cardinal drug supplement,automatic information record during empty bottle recycling,automatic record during changing shifts,intelligent and information management on"five specific management"for narcotic and psychotropic drugs. Compared with before the implementation of the system,the duration of daily changing shifts was shortened from(13.62±0.40)min to(8.67±0.33)min,shortening by 4.95 min in average(n=30).The time of prescription dispensing was shortened from(30.36±0.48)min to(10.56±0.46)min,shortening by 19.80 min(n=30). The collecting time of cardinal drug supplement was shortened from(12.72±0.97)min to(0.13±0.03)min,shortening by 12.59 min (n=30). No drug dispensing error was found after the implementation of the system. CONCLUSIONS:The system is stable and convenient,which promotes that intelligent management for narcotic and psychotropic drugs is in line with the requirements of"five specific management". It also realizes intelligent and information operation,improves work efficiency and error prevention ability.

Objective To investigate the clinical efficacy of three-stage Masquelet technique in the treatment of infective bone defects of foot and ankle.Methods A retrospective case series study was conducted on the clinical data of 19 patients with infective bone defects of foot and ankle admitted to Zhongnan Hospital of Wuhan University from December 2014 to October 2017.There were 15 males and four females,aged 18-68 years [(39.6 ± 12.3)years].Among the patients,16 patients were infected with bacteria and three patients were infected with Mycobacterium tuberculosis.The infection involved humeral end,talus and surrounding joints in 14 patients,internal hemorrhoids in two patients,midfoot and interphalangeal joints in one patient,and humerus and metatarsophalangeal joints in two.The operation included three stages:the first stage was thorough debridement,supplemented with negative pressure closed drainage (VSD) and continuous washing to clarify the pathogenic bacteria;the second stage was to fill the bone defect with targeted antibiotic bone cement to prevent or treat infection;in the third stage,after filling the antibiotic bone cement for 3 months with no sign of local wound infection,the bone cement was taken out,and the bone reconstruction operation was performed by means of internal fixation and bone grafting.The flap survival and wound healing were observed,and the time of fracture healing was recorded.The American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Score (VAS) were used to evaluate the improvement of the function of the foot and ankle before operation and at the last follow-up,and the bone healing was evaluated according to the radiographic union scale in tibial (RUST) fractures.Results The patients were followed up for 9-12 months [(11.1 ±1.0) months].Two patients with soft tissue defects caused by preoperative infection and necrosis received posterior tibial artery perforator flap and anterolateral thigh flap repair in the second stage,and the flaps all survived.The postoperative bone healing time was 3 7 months [(3.5 ± 1.4)months].Nineteen patients underwent three-stage surgery,and the ankle and foot wound or sinus tract were all healed,with no infection recurrence during follow-up.At the last follow-up,the AOFAS score was improved significantly from preoperative (36.3 s-12.1) points to (71.4 ± 5.7) points (P ＜ 0.05).The VAS was decreased significantly from preoperative (5.3 ± 1.2) points to (1.4 ± 0.9) points (P ＜ 0.05).The RUST bone healing score at the last follow-up was 8-12 points [(10.2 ± 1.1) points].Conclusion In treating the infective bone defects of foot and ankle,the three-stage Masquelet technique can effectively control infection,facilitate wound healing,promote bone union,and improve foot and ankle function.

Objective To investigate the clinical effectivity of the muscular flap transposition and induced membrane technique in the emergency treatment for the limb salvage of Gustilo type Ⅲ B/C open fracture of lower leg. Methods From July, 2015 to December, 2017, 10 cases of Gustilo type Ⅲ B/C fracture of lower leg with bone defects were performed limb salvage surgery. Induced membrane technique was used to fill the bone defects in the emergency room.The gastrocnemius and/or soleus muscular flaps were transposed to cover the bone cement or ex-posed bone simultaneously in emergence treatment. After the wound healed completely, traditional bone grafting was used to repair the bone defects. There were 4 cases of Gustilo type Ⅲ B and 6 cases of Gustilo type Ⅲ C. The aver-age length of bone defect was (5.25±1.70) cm ranging from 3.0 cm to 11.0 cm. The gastrocnemius medial head flaps were performed in 5 cases, the combined application with the gastrocnemius medial head flaps and the medial hemimuscular flaps of soleus were performed in 2 cases, and medial hemimuscular flaps of soleus were transposed in 3 cases. Results The wounds in 6 cases were healed at one stage, but 2 cases healed by dressing because the exudate after skin grafting.In 1 case, the cross-leg flap was used to cover the exposed bone cement due to the necro-sis of soleus flap. The other 1 was performed the transposition of the lateral gastrocnemius flaps because the exposure of bone cement after the necrosis of the upper and lateral muscles in lower leg. In the second-stage, the bone defects were reconstructed by traditional bone grafting. The average healed time of bone was 7.2 months ranging from 5 months to 9 months. At the last followed-up time, all patients recovered their function of weight-bearing. The Paley's score of the adjacent joints: excellent in 8 cases and good in 2 cases. Conclusion The combination with induced membrane technique and local muscular flap transposition in emergency surgery is an effective method to limb salvage for the Gustilo type Ⅲ B/C open fracture of lower leg.

The pivot shift test is the most specific physical examination to assess the rotatory laxity of knee joint following anterior cruciate ligament injury.It is also one of the most important physical examinations to assess the stability and recovery of the knee joint after anterior cruciate ligament reconstruction.The following anterior lateral structures of knee joint contribute to the grade of the pivot shift,including the lateral meniscus,anterolateral capsule,iliotibial band and the morphology of tibial plateau.Lateral meniscus is a secondary stabilizer to rotatory loads in the anterior cruciate ligament deficient knee.Anterolateral capsule controls anterior tibial translation and internal rotation.Iliotibial band is an important secondary restraint to anterior tibial translation and internal rotation at high flexion angles.Posteroinferior slope of the tibial plateau results in increased anterior tibial translation during pivot shift.The size of the lateral tibial plateau is also associated with the grade of poivt shift.The integrity destruction of the anterolateral soft tissue in the anterior cruciate ligament deficient knee leads to higher grade of poivt shift.The morphological features of the tibial plateau can also affect the stability of the knee joint.However,there is still a paucity of knowledge about the anatomical and morphological features responsible for a high grade pivot shift.Higher grade pivot shift indicates the injury of anterolateral structures and the abnormality of tibial plateau.In order to restore the integrity of anterolateral soft tissue,the injury of lateral meniscus and iliotibial band should be repaired via anterior cruciate ligament reconstruction surgery with an addition of a lateral extraarticular reconstruction when the anterior cruciate ligament deficiency combined with injuries to anterolateral capsule.

OBJECTIVE:To provide reference for the informational and automatic management in Pharmacy intravenous admix-ture service (PIVAS). METHODS:The composition and practical application of PIVAS automatic management system developed in our hospital were introduced,and ratio of irrational medical order,drug dispensing efficiency and the numbers of error before and after application were compared to evaluate its effect. RESULTS & CONCLUSIONS:The work process was intelligently opti-mized,PIVAS automatic management system developed in our hospital composed by automatic prescription audit system,intelli-gent drug dispensing system,intelligent liquid preparation system,automated sorting system and automatic transportation system, which respectively achieved the automated audit of prescription,intelligent drug dispensing and labeling,responsibility traced in drug dispensing,intelligent mixed deployment of intravenous infusion,automated sorting and transportation of finished products of transfusion liquid. The ratio of irrational medical order decreased from 2.07%to 1.73%,time of drug dispensing and labeling short-ened from(3.15±0.53)h to(1.55±0.27)h,numbers of error within daily dispensing decreased from 0.26±0.78 to 0.06±0.13, numbers of error within daily sorting of finished products of transfusion liquid decreased from 6.57 ± 1.76 to 0.07 ± 0.17. The con-struction of the system achieves the information and automation of major work in PIVAS and improves the management level of PI-VAS.

Objective To investigate the application value of Calot triangle hollowing-out maneuver in laparoscopic cholecystectomy (LC) for preventing bile duct injury.Methods The retrospective cross-sectional study was conducted.The clinical data of 537 patients who underwent LC in the Dexing People's Hospital between January 2011 and December 2015 were collected.The tissues in Calot triangle were hollowed out,and cystic ducts were cut off and then gall bladders were resected.Observation indicators:(1) operation situations:anatomy of the Calot triangle and operation time;(2) postoperative recovery situations:postoperative complications and bile duct injury;(3) follow-up situation.The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and occurrence of cholangitis up to May 2016.Results (1) Operation situations:of 537 patients with LC,anatomical relation among cystic duct,common hepatic duct and common bile duct (three-duct relation for short) could be seen in 165 patients without dissection,and three-duct relation cannot be seen in other 372 patients.Of 372 patients,16 were operated on with the gallbladder open due to the difficult dissection of Calot triangle,7 were converted to open surgery due to local severe adhesion and unclear structure,1 was converted to open surgery due to intraoperative varices induced bleeding in Calot triangle,and other 348 patients underwent successful LC using Calot triangle hollowing-out maneuver.Operation time was 15-190 minutes,with an average time of 28 minutes.(2) Postoperative situations:2 patients were complicated with biliary colic pain,showing stones in the distal common bile duct via magnetic resonance imaging scans,and then received endoscopic sphincterotomy (EST);3 had subxyphoid puncture hole infection,1 had a small amount of postoperative bleeding due to hepatocirrhosis,3 had pulmonary infection,and they were improved by symptomatic treatment;1 had chylous fistula and were improved through drainage and low fat diet intake for 1 week;2 with mild bile leakage was improved through peritoneal drainage.No bile duct injury was detected.(3) Follow-up situation:348 patients were followed up for 12-18 months,with a median time of 16 months.During the followup,348 patients with follow-up had survival without manifestation of cholangitis.Conclusion Calot triangle hollowing-out maneuver could effectively prevent bile duct injury in LC.

Aim To investigate the effects of diterpene ginkgolides meglumine injection (DGMI ) on amino acids and monoamine neurotransmitters in rats with cerebral ischemia/reperfusion injury.Methods In-traluminal suture was applied to establish middle cere-bral artery occlusion (MCAO/R)model with ischemia for 1.5 h and reperfusion for 24 h.After the adminis-tration of DGMI (i.v.),the levels of amino acid and monoamine neurotransmitters in brain tissue were de-tected through HPLC-ECD.Results DGMI down-reg-ulated the concentrations of aspartic acid, glutamic acid,glycine and γ-aminobutyric acid which were in-creased in MCAO/R group.DGMI also reduced the levels of norepinephrine epinephrine,glyoxylic acid, serotonin and 5-HIAA in cortex and hippocampus,and increased adrenaline content compared to the model group.Conclusion DGMI exhibits a protective role in rats with cerebral ischemia /reperfusion injury through regulating amino acids and monoamine neuro-transmitters.