Objective To explore the application effect of negative pressure sealing drainage combined with active factor dressing and flap transfer in Gustilo Ⅲ type tibiofibular fractures.Methods From March 2019 to March 2022,92 patients with Gustilo type Ⅲ tibiofibular fracture admitted to the Department of Orthopaedics of the Third People's Hospital of Zhangjiagang City were randomly divided into the experimental group(internal and external fixation+flap transfer+negative pressure sealing drainage+active factor dressing,n=46)and the control group(internal and external fixation+flap transfer+conventional dressing change+active factor dressing,n=46),and the clinical indexes,clinical efficacy,ankle joint function,lower limb function and complications were compared.Result The hospital stay time(25.32±8.36)d,the flap healing time(9.69±1.24)d,the fracture healing time(8.24±1.84)month and the wound healing time(14.24±3.84)d of the experimental group were shorter than those of the control group(43.44±11.84)d,(11.53±2.07)d and(9.12±2.50)month,(50.11±5.12)d(P＜0.05).The total effective rate of the experimental group(93.48％,43 cases/46 cases)was higher than that of the control group(71.74％,33 cases/46 cases,P＜0.05).The ankle pain scores of both groups after treatment were lower than before treatment,and the experimental group was lower than the control group,and the scores of ankle function and stability,the scores of American Association of Foot and Ankle Surgery(AOFAS)and the knee joint score of American Hospital for Special Surgery(HSS)after treatment were higher in both groups than before treatment,and the experimental group was higher than the control group(P＜0.05).The total complication rate of the experimental group(4.34％,2 cases/46 cases)was lower than that of the control group(17.39％,8 cases/46 cases,P＜0.05).Conclusion The application of negative pressure closed drainage combined with active factor dressing in Gustilo typeⅢ tibia and fibula fracture is effective,can promote postoperative wound recovery,improve ankle and lower limb function,and the incidence of complications is low.

Objective:To analyze the clinical efficacy of treatment of cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures.Methods:A retrospective study was conducted to analyze the data of 13 patients who had been treated at Department of Orthopaedics, The First Affiliated Hospital of Soochow University for cement dislodgement after vertebral augmentation for osteoporotic vertebral fractures from July 2013 to July 2022. There were 4 males and 9 females, with an average age of (76.5±8.6) years and a T value of bone mineral density of -3.3±0.6. By the CT and MRI features of cement dislodgement, their conditions fell in 4 types: cement loosening in situ (4 cases), anterior cement moving (6 cases), anterior cement moving with posterior bone mass moving (2 cases), and posterior cement moving (1 case). They were treated by percutaneous vertebroplasty (3 cases), pedicle screw fixation combined with bone graft fusion and decompression (7 cases), and conservative therapy (3 cases). The curative effects for surgical patients were evaluated by comparing their visual analogue scale (VAS), Oswestry dysfunction index (ODI) and cobb angle of kyphosis at preoperation, 1 week and 1 month postoperation, and the last follow-up, and Frankel grading for nerve injury as well. The curative effects for patients undergoing conservative treatment were evaluated by observing their symptoms.Results:This cohort was followed up for 7 (5, 12) months after treatment. The VAS scores [5.0 (4.0, 5.0) points, 3.0 (2.0, 3.0) points, and 3.0 (2.0, 3.0) points] in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value [8.5 (8.0, 9.0) points] ( P<0.05); the VAS scores at 1 month postoperation and the last follow-up were also significantly improved compared with that at 1 week postoperation ( P < 0.05), but there was no significant difference between the last follow-up and 1 month postoperation ( P > 0.05). The ODIs (50.6%±4.2%, 37.8%±4.5%, and 29.3%±5.6%) in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value (93.2%±3.6%), showing significant differences in pairwise comparisons ( P<0.05). The cobb angles [10.0 (9.0, 11.0)°, 9.0 (9.0, 11.0)°, and 10.0 (9.0, 12.0)°] in the 10 surgical patients at 1 week and 1 month postoperation and the last follow-up were significantly improved compared with the preoperative value [12.5 (11.0, 14.0)°] ( P<0.05) , but there was no statistically significant difference between the time points after operation ( P>0.05). The Frankel grading was significantly improved in the 6 patients with nerve injury after operation. Of the 3 patients undergoing conservative treatment, the symptoms were cured in one, showed no change during follow-up in one, and aggravated in one. Conclusion:Surgical treatment can significantly relieve pain, improve spinal dysfunction and repair nerve injury in patients with bone cement dislodgement after vertebral augmentation.

ObjectiveTo validate the alleviating effect of Gegen Qinliantang （GGQLT） on insulin resistance in db/db diabetic mice by regulating the silent information regulator 1 （SIRT1）/forkhead transcription factor O1 （FoxO1） autophagy pathway. MethodSeventy-five SPF-grade spontaneous type 2 diabetic db/db mice and 15 control db/m mice were selected and maintained on regular feed for one week before measuring blood glucose. They were randomly divided into six groups， with 15 mice in each group. The groups included a normal group （physiological saline， 0.2 g·kg^-1）， a metformin group （0.2 g·kg^-1）， high-， medium-， and low-dose GGQLT groups （31.9， 19.1， 6.9 g·kg^-1）， and a model group （physiological saline， 0.2 g·kg^-1）. They were orally treated with corresponding drugs for eight weeks， once daily. Fasting blood glucose （FBG） was measured using a Roche glucometer. Serum levels of high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， triglyceride （TG）， and total cholesterol （TC） were measured using an automated biochemical analyzer. Fasting serum insulin （INS） levels were determined using enzyme-linked immunosorbent assay （ELISA）， and the homeostasis model assessment of insulin resistance （HOMA-IR） was calculated. Western blot was used to detect the expression of Beclin-1， microtubule-associated protein 1 light chain 3 （LC3）， and SIRT1/FoxO1 autophagy pathway-related proteins in liver tissues. Immunohistochemistry was performed to assess the expression of SIRT1， FoxO1， Beclin-1， and LC3B proteins in liver tissues. Transmission electron microscopy was used to observe the formation of autophagosomes in the liver. ResultCompared with the normal group， the model group showed significant increases in FBG， FINS， HOMA-IR， TC， TG， LDL-C， and HDL-C levels （P<0.01）， and significant increases in the expression of SIRT1， Beclin-1， LC3， and FoxO1 proteins in liver tissues （P<0.01）. Transmission electron microscopy revealed the highest number of autophagosomes in the model group. Compared with the model group， the metformin group and the low-， medium-， and high-dose GGQLT groups showed significant decreases in serum FBG， FINS， HOMA-IR， TC， TG， LDL-C， and HDL-C levels （P<0.05， P<0.01）， significant decreases in the expression of SIRT1， Beclin-1， LC3 （P<0.05， P<0.01）， and up-regulated FoxO1 protein （P<0.01）. Transmission electron microscopy showed a reduction in the degree of autophagy in the treatment groups. Compared with the metformin group， the medium- and high-dose GGQLT groups showed significant decreases in FBG， FINS， and TG levels （P<0.01）， significant decreases in the expression of SIRT1， Beclin-1， and LC3 in liver tissues （P<0.05， P<0.01）， and reduced FoxO1 protein （P<0.01）. The high-dose GGQLT group showed reduced HOMA-IR， TC， LDL-C， and HDL-C levels （P<0.05， P<0.01）. Transmission electron microscopy revealed a significant reduction in autophagosomes in the medium- and high-dose GGQLT groups. ConclusionGGQLT can significantly improve glucose and lipid metabolism disorders， alleviate insulin resistance in db/db mice， and prevent and treat type 2 diabetes by activating the SIRT1/FoxO1 autophagy pathway.

Objective:To establish a method which Nifedipine was used as an alternative control for determinating of three flavonoid glycosides in the tablets of Ginkgo biloba leaves by substitution method of reference substance.Methods:Make Nifedipine instead reference substance, the analysis was performed on a JADE-PAK C18 column (4.6 mm × 250 mm, 5 μm), with the mobile phase consisted of 0.5% phosphoric acid solution-methanol (adjusting pH value to 2.2) (50:50) at the flow rate of 1.0 ml/min, the column temperature was 35 ℃. The Nifedipine was selected as the reference substance of three flavonoid glycosides and the correction factor of Nifedipine. The content of total flavonoid glycosides was determined by relative correction factor f and substitute reference.Results:The linear ranges of Nifedipine, quercetin, kaempferide and isorhamnetin were 0.17-1.73 μg, 0.11-1.08 μg, 0.08-0.84 μg, 0.04-0.40 μg. The relative correction factor ( f) between Nifedipine and quercetin, kaempferide, isorhamnetin were 0.782 2, 0.768 5, 0.808 8, respectively. The average recovery ( n=6) were 98.48%, 98.03%, 94.55%. Conclusion:The results indicated that the HPLC method by substitute reference substance is economical, feasible and practical.

Objective:To compare the clinical efficacy and safety of surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope in cerebral basal ganglia hemorrhage. Methods:One hundred and five patients with basal ganglia cerebral hemorrhage admitted to our hospital from January 2017 to January 2020 were chosen in our study; 51 patients underwent surgeries via frontal keyhole approach assisted by neuro-endoscope (neuro-endoscopy group) and 54 patients underwent surgeries via temporal keyhole approach assisted by microscope (microscopy group). The clinical data of these patients were retrospectively analyzed; and the differences of hematoma clearance rate, intraoperative blood loss, duration of surgery, length of hospital stays, Glasgow Coma Scale (GCS) scores one week after surgery, incidence of postoperative complications, and activity of daily living (ADL) scores 6 months after surgery were compared between the 2 groups. Results:There were no significant differences in hematoma clearance rate and length of hospital stays between the 2 groups ( P>0.05). As compared with the microscopy group, the neuro-endoscopy group had significantly lower intraoperative blood loss, significantly shorter duration of surgery, and statistically higher GCS scores one week after surgery ( P<0.05). There were no significant differences in incidence of postoperative complications and ADL scores 6 months after surgery between 2 groups ( P>0.05). Conclusion:Both surgeries via frontal keyhole approach assisted by neuro-endoscope and via temporal keyhole approach assisted by microscope can effectively clear the intracranial hematoma in patients with cerebral hemorrhage in the basal ganglia and protect neurological function; however, surgeries via frontal keyhole approach assisted by neuro-endoscope has advantages of shorter duration of surgery and lower intraoperative blood loss, and earlier neurological function recovery.

Objective The HPLC-MS/MS is used to comprehensively monitor the feeding conditions of raw materials in Yuanhu analgesic capsules, and the content of the index components can be detected at the same time. Methods The Inertsil ODS-3 (4.6 mm×250 mm, 5 μm) was used with the column temperature 40 ℃, Flow phase: 0.1% formic acid-acetonitrile; the gradient elution program, active ingredients were separated by HPLC, and the Electrospray Ionization Mass (ESI) source was applied and operated in the negative ion mode, and reactions ion monitoring mode (MRM) for quantitative analysis were selected. Results Through analysis and contrast of the medicinal materials, reference substance of primary mass spectrogram showed the same characteristic peak, and the proprietary Chinese medicine can be judged by prescription feeding process. The tetrahydroxene and imperatorin had a good linear relationship in 5.08×10-5-30.45×10-5μg (r=0.999 4), 5.02×10-5-30.09×10-5μg (r=0.999 2). Precision test were 0.99% and 1.14%, the recovery rate were 97.02%-99.66%, 97.62%-99.94%. Conclusions The method is simple, accurate and reliable, high sensitive and fast. It is suitable to monitor the feeding condition and quality of yuanhu analgesic capsules.

Objective To establish a quantitative method for the simultaneous measurement of the residual level of three pesticides in Nelumbinis semen by GC-MS/MS. Methods The samples were extracted by acetonitrile and purify by Cleanert TPH column. The samples were then tested by GC-MS/MS. Information on relative retention time and mass charge ratio was used for qualitative analysis. The peak area obtained by secondary ion MS of bifenthrin (181.1/166.1)was used as the reference peak to calculate the relative correction factor for the peak area of fenpropathrin (265.1/210.1) and deltamethrin (252.9/93.0), to establish a method using bifenthrin as the reference substance to determinate there sidual quantity of three pesticides in Nelumbinis semen by GC-MS/MS. Results When the injection quantity of the sample containing bifenthrin,fenpropathrin and deltamethrin in the range of 0.01-0.1 ng , there was a good linear relationship between the injection quantity and peak are a Limitation of quantification (LOQ) of bifenthrin , fenpropathrin and deltamethrin were 4.321×10-4 ng, 3.435×10-4 ng, 8.913×10-3 ng, respectively. The average recovery rates of bifenthrin, fenpropathrin and deltamethrin were 93.5％, 93.5％ and 93.8％, respectively. Conclusions The method of quantitative analysis of multi-components with a single-marker is simple, quick and accurate. It suitable for the detection of residual quantity of bifenthrin, fenpropathrin and deltamethrin in Nelumbinis semen.

Objective To investigate the effect on occupational failure and psychological withdraw behavior of group occupational characteristics in nurses of Pearl River Delta. Methods Questionnaire approach including demographic variables, job autonomy of occupational characteristics, work routinization, occupational exposure risk, occupational stress, occupational failure and psychological withdraw behavior were investigated in clinical nurses in 20 hospitals of Pearl River Delta. Results Group occupational characteristics in nurses influence directly on the psychological withdraw behavior. Occupational failure was partly involve in the relationships such as job autonomy of occupational characteristics and psychological withdraw behavior, work routinization and psychological withdraw behavior, occupational exposure risk and psychological withdraw behavior, occupational stress and psychological withdraw behavior. Conclusions Relative to other professions, group occupational characteristics in nurses cause higher occupational failure rate, and the psychological withdraw behavior in nurses is obviously.Attention should be taken from organizational leadership level to personal level.It is eager to take appropriate measures to relieve the occupational failure in nurses.

Objective To develop a HPLC-MS/MS method for comprehensive monitoring and control of the raw material feeding (honeysuchle flowers extract and baikal skullcap root extract) , and simultaneous determination of chlorogenic acid and baicalin in Yinhuang capsules. Methods The separation was performed on an Inertsil ODS-3 (2.1 mm × 150 mm, 5 μm) analytical column with the mobile phase consisting of methanol- 10 mmol/L ammonium acetate solution by gradient elution program, and the column temperature was 40 ℃. Active ingredients were separated by HPLC, and the Electrospray Ionization Mass (API) source was applied and operated in the negative ion mode, and reactions ion monitoring mode (MRM) for quantitative analysis were selected. Results The samples and the mixed Extract have the same characteristic peak in MS and MS/MS. According to the prescription feeding process, the proprietary Chinese medicine wasdetermined. The results showed that the palladium residue of 6 batches samples were up to the standard by HPLC/MS/MS chromatographic peak areas. The calibration cruve of chlorogenic acid and baicalin were linear: 0.60-4.80 μg/ml (r = 0.9989),2.87-14.40 μg/ml (r = 0.9986), with the relative standard deviation of repeatability by 0.69% and 0.69% respectively, and the mean recovery rate were 95%-102%, 95%-103%, respectively. Conclusions The method was proven to be simple, accurate, reliable, high sensitive and can be used for determination and control of the raw material feeding (honeysuchle flowers extract and baikal skullcap root extract) and quality in Yinhuang capsules.

Objective The monitoring of the feeding situation of active pharmaceutical ingredient in Shendan-Chenpi tablet by HPLC-MS/MS,and the content of sodium taurocholate and hesperidin.Methods Using ZORBAX Eclipse Plus C18(4.6 mm×250 mm, 5 μm)Column temperature 40 ℃, Mobile phase with acetonitrile-10 mmol/sodium acetate solution, using gradient elution program. Active ingredients were separated by HPLC, and the Electrospray Ionization Mass (ESI) source was applied and operated in the negative ion mode, and reactions ion monitoring mode(MRM) for quantitative analysis were selected. Results The proprietary Chinese medicine is judged by the prescription feeding process, through analysis and contrast of the medicinal materials, reference substance of primary mass spectrogram, secondary mass spectrogram of peak. The aurocholic acid sodium and hesperidin had a good linear relationship in 0.242×10-2-1.45×10-2μg(r=0.996 0), 0.688×10-2-10.30×10-2μg(r=0.999 2), and the precision test were 0.78% and 1.56%, and the recovery rate were 102%-103%,96%-109%. Conclusions The method was simple, accurate and reliable, high sensitive and fast. The comprehensive monitoring was applied to the Shedan-Chenpi tablet in feeding analysis and quality.