Objective:To explore potential predictors of refractory Mycoplasma pneumoniae pneumonia (RMPP) in early stage. Methods:The prospective multicenter study was conducted in Zhejiang, China from May 1 st, 2019 to January 31 st, 2020. A total of 1 428 patients with fever >48 hours to <120 hours were studied. Their clinical data and oral pharyngeal swab samples were collected; Mycoplasma pneumoniae DNA in pharyngeal swab specimens was detected. Patients with positive Mycoplasma pneumoniae DNA results underwent a series of tests, including chest X-ray, complete blood count, C-reactive protein, lactate dehydrogenase (LDH), and procalcitonin. According to the occurrence of RMPP, the patients were divided into two groups, RMPP group and general Mycoplasma pneumoniae pneumonia (GMPP) group. Measurement data between the 2 groups were compared using Mann-Whitney U test. Logistic regression analyses were used to examine the associations between clinical data and RMPP. Receiver operating characteristic (ROC) curves were used to analyse the power of the markers for predicting RMPP. Results:A total of 1 428 patients finished the study, with 801 boys and 627 girls, aged 4.3 (2.7, 6.3) years. Mycoplasma pneumoniae DNA was positive in 534 cases (37.4%), of whom 446 cases (83.5%) were diagnosed with Mycoplasma pneumoniae pneumonia, including 251 boys and 195 girls, aged 5.2 (3.3, 6.9) years. Macrolides-resistant variation was positive in 410 cases (91.9%). Fifty-five cases were with RMPP, 391 cases with GMPP. The peak body temperature before the first visit and LDH levels in RMPP patients were higher than that in GMPP patients (39.6 (39.1, 40.0) vs. 39.2 (38.9, 39.7) ℃, 333 (279, 392) vs. 311 (259, 359) U/L, both P<0.05). Logistic regression showed the prediction probability π=exp (-29.7+0.667×Peak body temperature (℃)+0.004×LDH (U/L))/(1+exp (-29.7+0.667×Peak body temperature (℃)+0.004 × LDH (U/L))), the cut-off value to predict RMPP was 0.12, with a consensus of probability forecast of 0.89, sensitivity of 0.89, and specificity of 0.67; and the area under ROC curve was 0.682 (95% CI 0.593-0.771, P<0.01). Conclusion:In MPP patients with fever over 48 to <120 hours, a prediction probability π of RMPP can be calculated based on the peak body temperature and LDH level before the first visit, which can facilitate early identification of RMPP.

The incidence of osteoporotic thoracolumbar vertebral fracture (OTLVF) in the elderly is gradually increasing. The kyphotic deformity caused by various factors has become an important characteristic of OTLVF and has received increasing attention. Its clinical manifestations include pain, delayed nerve damage, sagittal imbalance, etc. Currently, the definition and diagnosis of OTLVF with kyphotic deformity in the elderly are still unclear. Although there are many treatment options, they are controversial. Existing guidelines or consensuses pay little attention to this type of fracture with kyphotic deformity. To this end, the Lumbar Education Working Group of the Spine Branch of the Chinese Medicine Education Association and Editorial Committee of Chinese Journal of Trauma organized the experts in the relevant fields to jointly develop Clinical guidelines for the diagnosis and treatment of osteoporotic thoracolumbar vertebral fractures with kyphotic deformity in the elderly ( version 2024), based on evidence-based medical advancements and the principles of scientificity, practicality, and advanced nature, which provided 18 recommendations to standardize the clinical diagnosis and treatment.

Objective:To explore the intervention effects of an Internet-based blood pressure monitoring and management platform in a prehypertensive population.Methods:One hundred and fifty-eight prehypertensive patients who were examined at the Third Xiangya Hospital in Changsha, China, from August to December 2019 were randomly divided into either the experimental or control groups using the random number table method. The experimental group utilized an Internet-based blood pressure monitoring and management platform, whereas the control group utilized regular telephone and SMS health management routines. The intervention duration was 12 months for both groups. Data were analyzed using descriptive analysis, t-tests, chi-square tests, χ 2 tests, and rank-sum tests. Results:Post intervention systolic blood pressure (124.79±9.71 mmHg) (1 mmHg=0.133 kPa) and diastolic blood pressure measurements (77.41±8.21 mmHg) of the participants in the experimental group were significantly lower than those before the intervention (128.29±5.10 mmHg and 79.99±6.01 mmHg, respectively), and significantly lower than those of the control group′s measurements after the intervention (130.00±7.78 mmHg and 80.33±7.90 mmHg, respectively) (all P<0.05). The blood pressure goal attainment rate was significantly higher in the experimental group (23.08%) than that of the control group (8.75%), with statistically significant differences within the experimental group before and after intervention, as well as between the groups post intervention ( P<0.05). Positive lifestyle changes, such as prehypertension knowledge score, active restriction and control of salt and oil intake, reduction of smoking, and exercising weekly, were significantly higher than those in the control group before the intervention (all P<0.05). Conclusion:The use of an Internet-based blood pressure monitoring and management platform can effectively help patients with prehypertension control their blood pressure levels, improve their knowledge about the condition, and improve their lifestyle choices.

Clinical data of 12 patients with gastric cancer, in whom the Roux and Y space hernia developed after gastrectomy with Roux-en-Y anastomosis in our hospital from June 2010 to December 2018, were retrospectively analyzed. The clinical symptoms of patients were abdominal pain, distension and ileus. The main CT findings were torsion of mesentery with whirlpool sign, intestinal obstruction and exudants around the small bowels. During the operation it was found that small bowels herniated into the Roux and Y space in all 12 patients, the necrotic small intestines were resected in 4 patients. Ten patients were recovered, and 2 died. No recurrence was observed in all 10 patients during 3 month-follow up. The postoperative Roux and Y space hernia is a internal hernia and difficult to be diagnosed. The CT scan is valuable for diagnosis of Roux and Y space hernia; the main CT signs were swirled appearance of mesentery and small bowel obstruction. Once diagnosis is made the emergency operation is necessary.

Sixty two patients with low anal fistula were treated by anal fistulectomy (fistula group) and 82 patients with mixed hemorrhoids were treated by automatic ligation of hemorrhoids (RPH group) and 38 patients with anal fistula plus mixed hemorrhoids were treated by the RPH and anal fistulectomy (fistula plus RPH group),the clinical data of patients were retrospectively analyzed.The complication rate,the degree of pain and,the urination disorders,the postoperative recurrent rate,scar area and the anal functions were observed and compared.There were no differences in pain degree at d1 and d3 among three groups(P ＞ 0.05).There was significant difference in urination disorders between the fistula group and anal fistula plus RPH group (8％ vs.32％,P ＜ 0.05),but no differences between the RPH group and anal fistula plus RPH group (11％ vs.32％,P ＞ 0.05).There were significant differences in scar area and the anal functions between anal fistula group and anal fistula plus RPH group(P ＜ 0.05).There were no postoperative massive hemorrhage,proctenclisis and infection in all three groups.

Objective    To investigate the effect of low-flow inhaling NO for short time on postoperative cardiac and pulmonary functions in infants with congenital ventricular septal defect complicated with severe pulmonary hypertension. Methods    Forty-five patients with congenital ventricular septal defect complicated with severe pulmonary hypertension from May 2014 to May 2016 in our hospital were enrolled. There were 19 males and 26 females, whose age ranged from 1 to 22 months (average age: 7.2±14.4 months) and weight ranged from 2.7 to 10.5 kg (average weight: 6.8±3.6 kg). The patients were randomly divided into three groups (n=15 in each): the blank group, the prior inhalation group and the posterior inhalation group. The blank group did not inhale NO, and the prior inhalation group inhalated NO for 10 min after tracheal and intubation. After the opening of the aorta, the posterior inhalation group inhaled NO for 10 min. The concentration of NO was 20 × 10–6. The pressure ratio of pulmonary circulation/systematic circulation, heart index and oxygenation index were calculated and the troponin value of the three groups was monitored 10 min after returning to intensive care unit (ICU) and postoperatively 1 h, 3 h and 24 h. Differences among above indicators between three groups were compared. Results    The troponin value of the posterior inhalation group within 3 h increased most, followed by the blank group and the prior inhalation group. Postoperatively 1 h and 3 h, the troponin value of the prior inhalation group was significantly less than that of the blank group and posterior inhalation group (P<0.01) and the value on postoperative 24 h in each group was lower than that on postoperative 3 h. The cardiac index of prior inhalation group was higher than that of the blank group and the posterior inhalation group at each time point. Postoperatively 3 h and 24 h as well as 10 min after returning to ICU, the cardiac index in prior inhalation group was significantly higher than that of the posterior inhalation group (P<0.05). The pressure ratio of pulmonary circulation/systematic circulation of posterior inhalation group increased more than that of blank group; the differences in two groups were significant between postoperative 3 h and 10 min after returning to ICU (P<0.01). There was no statistical significance in the pressure ratio on postoperative 24 h and 10 min after returning to ICU (P>0.05) in three groups. The index of oxygenation of the prior inhalation group was higher than that of the blank group and the posterior inhalation group and statistically different from that of posterior inhalation group (P<0.05). Conclusion    Inhaling NO 10 min preoperatively can reduce the injury to the heart and lung function effectively, but the result is the opposite when inhalating NO 10 min after aorta opening.

Objective To investigate the clinical efficacy of arthroscopy with anchor treatment on acute patellar dislo?cation. Methods Retrospective analysis of patient with acute patellar dislocation cases who visited our hospital from March 2010 to June 2013 and were followed up for 10 months or more after being discharged. Patients all underwent physical exami?nation and imaging examination before operations. All operations were performed under arthroscopy. Joint hematoma were first drained, then articular cartilage injury were explored and repaired. Corresponding relationship between patella and femo?ral condyle were observed. After that, lateral retinaculum was released and medial patellofemoral ligament was repaired by suture anchors. Finally patellar reduction and its corresponding relationship with femur were observed after operation. Re?sults Medial patella cartilage injury and bone contusion of femoral condyle were all observed under arthroscopy. Medial patellofemoral ligament damage and tensed lateral patellar retinaculum were combined. By the time of follow-up at 10~18 months later, no dislocation was found and fear test are all positive. No recurrence of patellar dislocation was observed. Compared the conditions before operation and the last follow-up, Lysholm score(91.38±1.65 vs 60.04±3.93), Kujala score (90.62±2.08 vs 55.27±3.00),patellar camber angle(11.96°±1.43° vs 25.15°±2.13°)were all imporved(P<0.01). Conclu?sion Arthroscopy with suture anchors present good clinical effect in the treatment of acute patellar dislocation, which in?cludes alleviating keen pain, stabilizing joint instability and restoring knee stretching. It also present with less recurrence of patellar dislocation.

Objective To review the clinical diagnosis and treatment of acute focal renal infarction. Methods Three cases of focal renal infarction were reported and the literature was reviewed.The patients aged from 45 to 63 years with mean age of 54. Two cases had low back pain, 1 case with abdominal pain. Based on clinical history, B-ultrasonography and CT scan, focal renal infarction was diagnosed in 3 patients. There were 2 cases on left kidney and 1 case right. All cases were applied digital subtraction angiography (DSA) and thrombolytic anticoagulant therapy. Results Two cases received DSA and thrombolytic therapy. The other one case received pethidine 50 mg, progesterone 20 mg treatment, the salvia infusion and low molecular heparin 6000 U anticoagulant therapy. All patients had symtoms relieved after 1 d. A week later CT scan, 3 cases of renal infarction were apparently disappeared. Serum creatinine and urea nitrogen were normal. Three patients were followed, mean follow-up time was 1. 5 (0. 5-2) years. Conclusions The diagnosis of acute focal renal infarction mainly depends on B-ultrasound and CT. Early diagnosis and treatment is important for achieving recovery of the compromised renal function. Renal infarction should be suspected in the presence of abdominal pain of sudden onset.

BACKGROUND:There are many studies concerning rat bone marrow mesenchymal stem cells for immune tolerance following transplantation and tissue repair.However,there are no reports on umbilical cord mesenchymal stem cells(UCMSCs).OBJECTIVE:To establish a method of separating mesenchymal stem cells(MSCs)from rat umbilical cord,and to study its biological characteristics.METHODS:MSCs were separated from rat umbilical cord with enzyme method and tissue mass method,and then incubated in DMEM-LG medium.Cell morphology was observed under an inverted microscope.Growth curves of cells were drawn using cell counting.Cell cycle and surface antigen were detected with flow cytometry.Adipogenic differentiation and osteogenic differentiation were tested by immunohistochemistry.RESULTS AND CONCLUSION:Both of the two methods could obtain plenty of MSCs from rat umbilical cord.Primary culture showed that the efficiency of enzyme method was higher than tissue mass method.Passage time of the former was about 10 days and the latter was 14 days.The passage time of latter except primary culture was the same.Immunophenotype analysis showed that MSCs from rat umbilical cord expressed adhesion molecule and stromal cell markers,CD90 and CD106,but did not express hematopoietic cell markers,CD34 and CD45.In vitro induction test verified that rat UCMSCs have the potentials of adipogenic and osteogenic differentiation.