Objective:To analyze the characteristics of local histological damage in patients with Mycobacterium abscessus infection caused by facial drug injection, and propose a treatment. Methods:The patients of Mycobacterium abscessus infection caused by facial injection of unknown drugs ( "osteolytic needles" ) admitted to Shaanxi Provincial People’s Hospital from September 2021 to June 2022 were analyzed retrospectively. Secretions were collected from the infected site for smear examination before surgery, and perform ultrasound, CT, MRI, and other related examinations. Surgical debridement was performed on the infected site under the assistance of endoscope and the guidance of B-ultrasound. During the operation, the infection was demonstrated to affect the facial superficial musculoaponeurotic system, even the deep muscle and bone tissue. The necrotic and degenerative tissue was completely removed and then the secretion was sent to bacterial culture and drug susceptible test, and the resected tissue was sent to pathological examination for HE staining. After debridement, the wound was not sutured. The vacuum sealing drainage (VSD) technique was used to treat the wound. The cavity was irrigated with 50 ml of normal saline+ 100 000 U of amikacin, and the wound was sutured after the wound was completely healthy and the secretion culture was negative. Drug treatment: first, according to the results of secretion smear examination (positive acid-fast bacteria), empirically apply cefoxitin or amikacin injection. After the infection was confirmed by bacterial culture, oral clarithromycin and minocycline were added, and bicyclol tablets were orally administered to protect liver function. Intravenous drip of cefoxitin or amikacin injection during hospitalization according to the results of drug susceptible test. After discharge, clarithromycin or minocycline and bicyclol tablets were used for 3-6 months, and the blood routine test and liver and kidney functions were examined every 2 weeks. Regular outpatient re-examination was carried out to observe whether there is a recurrence of infection and the recovery of facial appearance in the wound. Results:A total of 10 patients were included, including 1 male and 9 females, aged 19-28 years, with an average age of 25.3 years. The clinical manifestations were local redness and swelling in the zygomatic, buccal, periocular, or anterior temporal regions, low skin temperature, skin ulceration, purulent secretions, and palpable induration. CT and MRI results showed varying degrees of swelling and fluid accumulation in facial soft tissues, as well as locally structural and bone destruction. The results of secretion culture showed all patients were infected with Mycobacterium abscessus. Drug susceptible test results: sensitive to minocycline, cefoxitin, amikacin. HE staining showed exudative, proliferative and necrotic lesions, chronic suppurative inflammation and mixed granuloma lesions. Ten patients were hospitalized for 12-28 days, and their facial infections were well controlled. The wound healing was good. After 6 months of follow-up, there was no recurrence of facial infections and their appearance was generally normal. Conclusion:The local tissue damage caused by facial injection of unknown drug Mycobacterium abscessus infection is characterized as multiple layers, multiple sinuses, and bone destruction. Based on external debridement during treatment, drugs that are sensitive to Mycobacterium abscessus and have relatively small adverse reactions can be selected based on drug susceptible test results. Adherence to long-term and standardized treatment can achieve good results.

Objective:This study focuses on Na +-taurocholate cotransporting polypeptide (NTCP) deficiency to analyze and investigate the value of the serum bile acid profile for facilitating the diagnosis and differential diagnosis. Methods:Clinical data of 66 patients with cholestatic liver diseases (CLDs) diagnosed and treated in the Department of Pediatrics of the First Affiliated Hospital of Jinan University from early April 2015 to the end of December 2021 were collected, including 32 cases of NTCP deficiency (16 adults and 16 children), 16 cases of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD), 8 cases of Alagille syndrome, and 10 cases of biliary atresia. At the same time, adult and pediatric healthy control groups (15 cases each) were established. The serum bile acid components of the study subjects were qualitatively and quantitatively analyzed by ultra-high performance liquid chromatography-tandem mass spectrometry. The data were plotted and compared using statistical SPSS 19.0 and GraphPad Prism 5.0 software. The clinical and bile acid profiles of children with NTCP deficiency and corresponding healthy controls, as well as differences between NTCP deficiency and other CLDs, were compared using statistical methods such as t-tests, Wilcoxon rank sum tests, and Kruskal-Wallis H tests.Results:Compared with the healthy control, the levels of total conjugated bile acids, total primary bile acids, total secondary bile acids, glycocholic acid, taurocholic acid, and glycochenodeoxycholic acid were increased in NTCP deficiency patients ( P < 0.05). Compared with adults with NTCP deficiency, the levels of total conjugated bile acids and total primary bile acids were significantly increased in children with NTCP deficiency ( P < 0.05). The serum levels of taurochenodeoxycholic acid, glycolithocholate, taurohyocholate, and tauro-α-muricholic acid were significantly increased in children with NTCP deficiency, but the bile acid levels such as glycodeoxycholic acid, glycolithocholate, and lithocholic acid were decreased ( P < 0.05). The serum levels of secondary bile acids such as lithocholic acid, deoxycholic acid, and hyodeoxycholic acid were significantly higher in children with NTCP deficiency than those in other CLD groups such as NICCD, Alagille syndrome, and biliary atresia ( P < 0.05). Total primary bile acids/total secondary bile acids, total conjugated bile acids/total unconjugated bile acids, taurocholic acid, serum taurodeoxycholic acid, and glycodeoxycholic acid effectively distinguished children with NTCP deficiency from other non-NTCP deficiency CLDs. Conclusion:This study confirms that serum bile acid profile analysis has an important reference value for facilitating the diagnosis and differential diagnosis of NTCP deficiency. Furthermore, it deepens the scientific understanding of the changing characteristics of serum bile acid profiles in patients with CLDs such as NTCP deficiency, provides a metabolomic basis for in-depth understanding of its pathogenesis, and provides clues and ideas for subsequent in-depth research.

Objective:To analyze the characteristics of local histological damage in patients with Mycobacterium abscessus infection caused by facial drug injection, and propose a treatment. Methods:The patients of Mycobacterium abscessus infection caused by facial injection of unknown drugs ( "osteolytic needles" ) admitted to Shaanxi Provincial People’s Hospital from September 2021 to June 2022 were analyzed retrospectively. Secretions were collected from the infected site for smear examination before surgery, and perform ultrasound, CT, MRI, and other related examinations. Surgical debridement was performed on the infected site under the assistance of endoscope and the guidance of B-ultrasound. During the operation, the infection was demonstrated to affect the facial superficial musculoaponeurotic system, even the deep muscle and bone tissue. The necrotic and degenerative tissue was completely removed and then the secretion was sent to bacterial culture and drug susceptible test, and the resected tissue was sent to pathological examination for HE staining. After debridement, the wound was not sutured. The vacuum sealing drainage (VSD) technique was used to treat the wound. The cavity was irrigated with 50 ml of normal saline+ 100 000 U of amikacin, and the wound was sutured after the wound was completely healthy and the secretion culture was negative. Drug treatment: first, according to the results of secretion smear examination (positive acid-fast bacteria), empirically apply cefoxitin or amikacin injection. After the infection was confirmed by bacterial culture, oral clarithromycin and minocycline were added, and bicyclol tablets were orally administered to protect liver function. Intravenous drip of cefoxitin or amikacin injection during hospitalization according to the results of drug susceptible test. After discharge, clarithromycin or minocycline and bicyclol tablets were used for 3-6 months, and the blood routine test and liver and kidney functions were examined every 2 weeks. Regular outpatient re-examination was carried out to observe whether there is a recurrence of infection and the recovery of facial appearance in the wound. Results:A total of 10 patients were included, including 1 male and 9 females, aged 19-28 years, with an average age of 25.3 years. The clinical manifestations were local redness and swelling in the zygomatic, buccal, periocular, or anterior temporal regions, low skin temperature, skin ulceration, purulent secretions, and palpable induration. CT and MRI results showed varying degrees of swelling and fluid accumulation in facial soft tissues, as well as locally structural and bone destruction. The results of secretion culture showed all patients were infected with Mycobacterium abscessus. Drug susceptible test results: sensitive to minocycline, cefoxitin, amikacin. HE staining showed exudative, proliferative and necrotic lesions, chronic suppurative inflammation and mixed granuloma lesions. Ten patients were hospitalized for 12-28 days, and their facial infections were well controlled. The wound healing was good. After 6 months of follow-up, there was no recurrence of facial infections and their appearance was generally normal. Conclusion:The local tissue damage caused by facial injection of unknown drug Mycobacterium abscessus infection is characterized as multiple layers, multiple sinuses, and bone destruction. Based on external debridement during treatment, drugs that are sensitive to Mycobacterium abscessus and have relatively small adverse reactions can be selected based on drug susceptible test results. Adherence to long-term and standardized treatment can achieve good results.

Objective To investigate the efficacy and safety of intravesical instillation with Sufuning (SFN) lotion for prevention of postoperative recurrence of bladder cancer. Methods A total of 240 bladder cancer patients who were diagnosed as bladder cancer and accepted trans-urethral resection of bladder tumor from January 2010 to June 2016 in Shanxi Provincial Cancer Hospital were randomly divided into the experimental group (120 cases) and the control group (120 cases) according to the envelope method. The patients in the experimental group were treated with SFN lotion for immediate intravesical instillation(250 mg for once), and the patients in the control group were treated with pirarubicin (THP) for immediate intravesical instillation (30 mg for once). The patients of two groups were treated with intravesical chemotherapy once a week for 8 times, and the chemotherapy was performed once a month for 1 year. The recurrence rate, progression-free survival (PFS) rate, overall survival (OS) rate and recent side effects were compared between the two groups. Results The patients were followed up for 6 to 60 months. The median follow-up time was 36.5 months.In the experimental group,6 patients were lost and 8 patients were lost in the control group.The experimental group, the total recurrence rate was 26.3 % (30/114). The control group, the overall recurrence rate was 25.0 % (28/112) (χ2= 0.142, P = 0.781). Five years of PFS rate in the experimental group and the control group was 73.7 % (84/114) and 75.0 % (84/112) respectively, and there was no significant difference between the two groups (χ2= 2.011, P= 0.615). Five years of OS rate in the experimental group and the control group was 95.6 % and 92.9 % respectively, and there was no significant difference between the two groups (χ 2= 1.611, P= 0.425). The major side effects included chemical cystitis and hematuria. The incidence of chemical cystitis and hematuria in the experimental group was significantly lower than that in the control group(χ2=5.991,P=0.018;χ2=4.925,P=0.036).There was a statistically significant difference of the hematological side effects (blood routine changes) between the two groups (χ 2= 4.891, P= 0.032). Conclusion It is safe and effective for intravesical instillation of SFN lotion to prevent the recurrence of bladder cancer.

Objective To observe the clinical effect of percutaneous vertebroplasty(PVP) in the treatment of elderly patients with thoracolumbar vertebral compression fractures.Methods From September 2014 to September 2015,70 elderly patients with vertebral compression fractures in Cilin Hospital were selected and randomly divided into two groups according to the digital table,with 35 cases in each group.The control group received conservative treatment,the study group was given PVP treatment.Before and after treatment,the visual analogue scale (VAS),functional independence measure(FIM) score were compared between the two groups.The loss of vertebral height,vertebral height restoration of anterior and posterior margin,Cobb angle correction and quality of life(SF-36) score changes were compared between the two groups.Results After treatment,the VAS score,FIM score of the study group were (3.46 ± 0.25) points,(67.94 ± 5.48) points,which of the control group were (5.02 ± 0.13) points,(51.49 ± 3.84) points,there were statistically significant differences between the two groups (t =32.75,14.54,all P ＜ 0.05).The vertebral height lost,vertebral height restoration and margin,Cobb angle correction in the study group were (4.90 ± 0.23) mm,(93.84 ± 1.12) ％,(11.21 ± 0.24) °,respectively,which were better than those in the control group (t =34.67,101.31,190.57,all P ＜ 0.05).The SF-36 scores between the two groups had statistically significant differences(all P ＜ 0.05).Conclusion PVP in the treatment of elderly patients with thoracolumbar compression fractures has good effect,it can help to relieve the pain,improve the quality of life of patients.

Objective To evaluate the efficacy of preoperative and postoperative intravesical instillation of pirarubicin for the prevention of postoperative recurrence of non-muscle invasive bladder cancer (NMIBC). Methods From September 2012 to March 2014, 120 patients who were diagnosed as NMIBC and accepted trans-urethral resection of bladder tumor (TUR-Bt) were collected and randomly divided into two groups, including treatment group (60 cases) and control group (60 cases). 30 minutes before the operation, instillation of pirarubicin (40 mg) was performed in the treatment group, then pirarubicin perfusion was given within 24 h after operation, once a week for 8 weeks, and once a month for 10 months after operation. In control group, instillation of pirarubicin (40 mg) was given within 24 h after operation, and other treatments were the same as the treatment group. The differences of lesion detection probability, the 2-year recurrent rate and the adverse reaction rate were compared between the two groups. Results The lesion detection rates were 42.70 % (38/89) and 1.85 % (2/108) in the treatment group and control group, respectively (χ2=50.303, P<0.05). 119 patients were follow-up for 24 months. The 2-year recurrence rates were 8.47%(5/59), 21.67% (13/60) in treatment group and control group respectively (χ2= 4.033, P< 0.05). The adverse reactions mainly included hematuria (3 cases in treatment group, 3 cases in control group), urinary tract irritation (3 cases in treatment group, 2 cases in control group) and urethral stricture (1 case in treatment group, 1 case in control group). The difference of the adverse reaction incidence between the two groups was not significant statistically [11.86 % (7/59) vs. 10.00 (6/60), χ 2 = 0.106, P > 0.05]. Conclusions The preoperational intravesical instillation of pirarubicin can fix and diagnose malignant lesions in the bladder without adverse reactions, which will improve the rate of tumor resection and prevent postoperative recurrence of tumors.

Objective To investigate the efficacy of 125I radioactive particle implantation combined with surgery and chemotherapy in the treatment of locally advanced urinary tract urothelial carcinoma (UTUC).Methods The clinical data of 128 patients of locally advanced (T3,T4) UTUC treated with surgery with radioactive particle implantation plus postoperative GC chemotherapy (experimental group) and surgery plus postoperative GC chemotherapy (control group) were retrospectively analyzed.All the patients underwent complete resection of the tumor.The postoperative pathology was urinary tract epithelium cancer.In the experimental group,there were 45 (69.2％) males and 20 (30.8％) females,with median age 56.5 years.There were 39 (60.0％) patients diagnosed with renal pelvic cancer,including 13 (33.3 ％) patients with local lymph node metastasis;26 patients (40.0％) with ureteral cancer,11 patients (42.3％) with local lymph node metastasis.In the control group,there were 46 males (73.0％) and 17 females (27.0％),with median age 57.1 years.There were 40 (63.5％) patients with renal pelvic cancer,including 12 (30％) cases of local lymph node metastasis;23 patients with ureteral carcinoma (36.5％),including 10 patients (43.4％) with local lymph node metastasis.There was no significant difference in basehne data between the two groups (P ＞ 0.05).The recurrence and distant metastasis,recurrence-free survival,distant disease free survival(DDFS),disease-specific survival(DSS),overall survival (OS) and comphcations of two groups were compared.Results The follow-up time was 50.5 months (ranged 5 to 62 months).In experimental group,there were 2 cases,5 cases,11 cases,16 cases and 21 cases occurred recurrence and distant metastasis in 6 months,1 year,2 years,3 years and 5 years respectively,and the 5-year cumulative recurrence and distant rate was 32.3％ (21/65).In control group,there were 3 cases,5 cases,17 cases,21 cases and 32 cases,occurred recurrence and distant metastasis in 6 months,1 year,2year,3 year,5 year respectively,and the 5-year cumulative recurrence and distant rate was 50.8％(32/63).There was significant difference between the two groups (P =0.034).In the experimental group and the control group,the 5-year non-metastatic survival rates were 61.5％ (40/65)and 41.3％ (26/63),respectively.There was significant difference in 5-year non-metastatic survival rate between the two groups (P =0.033).The 5-year DSS rates were 69.2％ (45/65) and 50.8％ (32/63),respectively.The 5-year DSS rate of the two groups was significantly different (P =0.033).The 5-year OS rates were 53.8％ (35/65) and 36.5％ (23/63) respectively.There was significant difference in the 5-year OS rate between the two groups (P =0.049).Condusions Compared with surgery and chemotherapy,the use of 125I radioactive particle implantation combined with surgery and chemotherapy in the treatment of locally advanced stage (T3-T4) UTUC could achieve the total survival benefit,and less adverse reactions.

Objective To prepare a kind of Gelsolin-targeted ultrasound contrast agent (GSN-PLGA) and to explore its targeting and imaging effection in vitro.Methods The high molecular PLGA-COOH ultrasound contrast agents were prepared by a modified double emulsion technique and then conjugated with Gelsolin monoclonal antibody by carbodiimide technique.The physical property of contrast agent was determined.And the connectivity condition of ultrasound contrast agent with Gelsolin monoclonal antibody was estimated.The targeting ability and the effect of enhancing ultrasound imaging in vitro were explored.Results The average diameter of GSN-PLGA was (575.67 ± 4.71) nm.The potential was (-11.46±1.19) mV.And the binding rate of Gelsolin monoclonal antibody was 96.93％.In vitro experimentshowed more GSN-PLGA could be intaked by Hca-F cells and the ultrasound imaging cloud be enhanced greatly.Conclusion The GSN-PLGA nanoparticle can bind to Hca-F cells specifically and can enhance the ultrasound imaging greatly.

Objective: To explore the entry points and monitoring points of individualized treatment for fracture surgery patients with ARDS.Methods: Clinical pharmacists comprehensively assessed the patient's conditions and looked up lots of literatures.Some suggestions on the anti-infection treatment efforts, glucocorticoid use dispute and rational use of ambroxol were offered.The efficacy and adverse reactions of drugs in the treatment process were monitored using some subjective and objective indicators.Results: The consensus about the pros and cons, dosages, as well as the possible dosage decrease of glucocorticoid therapy, the dosages of antimicrobial agents, and the dosages and treatment course of ambroxol was achieved between clinical pharmacists and doctors.As a result, the maximum benefits were obtained for the patient.Conclusion: Clinical pharmacists can explore the treatment and monitoring for specific diseases and find out intervention entry points of clinicians and patients to play a certain role in clinics, and accumulate treatment experience gradually.

Objective: To investigate the feasibility of one-stage thinning of latissimus dorsi muscle, rectus abdominis muscle and gracilis flap in reconstruction of the hand and foot defects. Methods: From June 2009 to April 2015, 24 free muscle flaps were thinned during transfer operation by removing their superficial muscle layers on the basis of their vessel pedicles running in the deep surface of flaps. The surface of the muscle flaps were covered by split-thickness skin grafts. There were 16 latissimus dorsi muscle flaps, 4 gracilis flaps and 4 rectus abdominis muscle flaps. Flap size ranged from 6 cm×4 cm to 20 cm×12 cm. Thinned muscle flaps were used to resurface 7 hand defects and 17 foot defects. Results: All muscle flaps survived the thinning procedures without any circulation problems except for one case which suffered total flap necrosis due to venous thrombosis. Skins grafts on muscle flaps also took well. One patient experienced partial skin loss. Two patients underwent secondary debridement and thinning procedure for infection and bulkiness. During the 0.3-20 months follow-up, the contour of thinned muscle flaps matched well with the recipient areas. Reconstructed feet are able to wear regular shoes. Conclusions Intraoperative immediate thinning of free muscle flaps can be safely accomplished during the primary reconstruction procedure. This procedure prevents the limitations of muscle flap bulkiness and may provide an alternative for surface coverage.