Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Objective To analyze and investigate the correlation between the CYP2C19 gene polymorphism and clopidogrel cura-tive effect in the patients with coronary heart disease (CHD) to provide valuable reference information for the future clinical work. Methods A total of 128 cases of CHD undergoing PCI in our hospital from January 2015 to January 2016 were selected as the re-search subjects.All of them were treated with clopidogrel ,the loading dose was 300mg ,and the maintenance dose was 75mg.The subjects were divided into the clopidogrel resistance group and response group.The drug-metabolizing CYP2C19 genotype was com-pared between the two groups and the effect of CYP2C19 genotype on the clopidogrel response was observed.Results Among the subjects ,27 cases were clopidogrel resistance.A total of 16 cases of CYP2C19 slow metabolic gene carriers were detected.There was statistically significant difference between the patients with chronic metabolic genotype VASP-PRI with fast metabolic geno-type and intermediate metabolic genotype(P<0.05).The incidence rate of adverse end point events had statistical difference be-tween the clopidogrel resistance group and clopidogrel response group(P<0.05).Conclusion In the risk factors of clopidogrel re-sistance ,slow metabolism CYP2C19 genotype and clopidogrel resistance will increase the risk of clinical adverse endpoint events oc-currence ,clinic should give adequate attention.

Background and purpose:Myelosuppression is the most common dose-limiting toxicity of tumor chemotherapy in which leukocytopenia and neutropenia are the most common conditions. Not only are up-titrations of the doses of chemotherapeutic drugs limited, but also normal process of the chemotherapy is affected. Filgrastim-Recombinant Human Granulocyte Colony-Stimulating Factor (rhG-CSF) has the activity of stimulating the formation of granulocyte colony and promoting the growth, proliferation and differentiation of granulocytes which can be signiifcantly effective on leukocytopenia and neutropenia induced by chemotherapy. In this study, we observed the leukogenic effects, toxic and side effects of low, medium, and high doses of rhG-CSF used prophylactically after chemotherapy in patients with advanced non-small cell lung cancer (NSCLC), to explore a rational application strategy for rhG-CSF..Methods:One hundred and twenty six patients with pathologically proved advanced non-small cell lung cancer (NSCLC) under chemotherapy were digitally randomized to A, B and C groups. Filgrastim was given to patients of the three groups 24h after the end of chemotherapy. The dosages are: Group A (low dose): 300 μg of Filgrastim, s.c., qd × 1 day; Group B (medium dose): 300 μg of Filgrastim, s.c., qd × 2 days; Group C (high dose): 300 μg of Filgrastim, s.c., qd × 3 days. Then the signs and symptoms as well as toxic and side effects of Filgrastim after medication were observed.Results:Prophylactic usage of medium and high dosages of rhG-CSF could maintain WBC count at no less than 4.0×109/L in nearly 60% of patients. In patients with Grade III leukopenia, more days were needed for recovery of white blood cell (WBC) count with the low dose, while signiifcantly (P<0.05) less days were needed with the high dose. In view of the dynamic changes of neutrophil(ANC), additioning of the high dose of rhG-CSF after chemotherapy could increase the average level ofANC, notably shortening the duration of lowANC caused by chemotherapy. The incidence of infections was 4.76% for the 126 patients as a whole, 9.52% for the low dose group, and 4.76% for the middle dose group. The patients could tolerate the slight side effects incurred during treatment with Filgrastim.Conclusion:All of the three doses (low, medium, and high) of prophylactic administration of Filgrastim after chemotherapy can promote recoveries of WBCs and neutrophil granulocytes and reduce opportunities of infections. High doses of rhG-CSF can be faster and safer in increasing WBCs and neutrophil granulocytes.

OBJECTIVE: To analyze the pre-conception factors for intrauterine growth retardation. METHODS: A nested case-control study was conducted in a cohort of 1368 women from 14 Child and Maternity Health Care Departments by cluster sampling method in Liuyang City, Hunan Province. Following-up until delivery, we collected their medical records and maternal health care manual materials. All neonates with intrauterine growth retardation were detected in the follow-up (the case group) and another 186 neonates without intrauterine growth retardation, matched with gender and mother's age, were randomly selected from the cohort as controls. χ2 test and multiple conditional logistic regression were used to investigate the determinants of intrauterine growth retardation. RESULTS: Intrauterine growth retardation was associated with BMI (OR=64.775), waist circumference (OR=0.166), abortion (OR=6.997), level of total cholesterol (OR=0.045), folic acid (OR=0.077), and cortisol (OR=9.164). CONCLUSION Intrauterine growth retardation is associated with BMI, waist circumference, abortion,level of total cholesterol, folic acid, and cortisol. Effective measures to reduce intrauterine growth retardation in children include strengthening the detection of pre-pregnancy blood biochemical indicators to guide health care during pregnancy, and increasing nutrition during pregnancy according to pre-pregnancy BMI and waist circumference.
Case-Control Studies ; Female ; Fetal Growth Retardation ; Humans ; Logistic Models ; Pregnancy ; Risk Factors

OBJECTIVE: To describe the incidence and to discuss the risk factors of premature birth in rural areas of Liuyang. METHODS: We collected subjects from villages and towns in Liuyang through cluster sampling method. Before enrolling in this cohort, all of them had established health records from January 2010 to December 2011. We followed up the early, middle and late stages of pregnancy until delivery, and collected medical records and maternal health care manual of this cohort as our data materials. We explored the main influence factors of premature delivery by χ2 test and unconditional logistic regression analysis for single factor and multivariate analysis. RESULTS: Among 6270 women who enrolled in our cohort, 259 were diagnosed as premature birth. The incidence (4.13%) was lower than the national average level. Non-conditional logistic regression analysis showed that the risk factors of premature birth were as follows: OR of placental abruption was 7.678 (95% CI: 2.249-26.215), that of premature rupture of fetal membranes (PROM) was 5.177 (95% CI: 3.945-6.793), that of uterine abnormal and deformity was 2.675 (95% CI: 1.007-7.107), that of placenta anomaly was 2.633 (95% CI: 1.666-4.162), that of hypertension in pregnancy was 2.172 (95% CI: 1.044-4.521), that of pregnancy complications was 1.806 (95% CI: 1.033-3.157), that of male fetus was 1.429 (95% CI: 1.086-1.881). Protective factors of preterm birth were too frequent prenatal examination (OR=0.502, 95% CI: 1.033-3.157) and single pregnancy (OR=0.155, 95% CI: 0.075-0.319). CONCLUSION Preterm delivery is caused by complicated factors, such as placental abruption, PROM and male fetus. Comprehensive measures should be taken to reduce preterm birth.
Abruptio Placentae ; etiology ; Adult ; China ; epidemiology ; Female ; Fetal Membranes, Premature Rupture ; etiology ; Humans ; Incidence ; Logistic Models ; Pregnancy ; Premature Birth ; epidemiology ; etiology ; Risk Factors ; Rural Population ; Sampling Studies ; Young Adult

Objective To evaluate the safety and efficiency of combined finasteride and metformin on benign prostatic hyperplasia (BPH) with type 2 diabetes mellitus(T2DM).Methods Totally 106 patients with BPH plus T2DM received finasteride and metformin treatment for over 12months.Before and after treatment,the side effects and following parameters were measured:prostatic volume (PV),prostate-specific antigen(PSA),international prostate symptom score (IPSS),quality of life (QOL),the maximum flow rate of urinary (Qmax),residual urine(RU),body mass index (BMI),cholesterol (TG).Results There were obvious changes in the following:PV decreased from (56.40±18.75)ml to(42.40± 19.68) ml,PSA decreased from(3.65± 1.08) μg/L to (1.76±0.66)μg/L,IPSS decreased from(22.58±9.45)to(16.67±7.56),QOL decreased from(4.22± ±0.87) to (2.36 ± 0.74),Qmax increased from(8.32±2.42)ml/s to(15.48±3.61)ml/s,RU decreased form(68.36±19.25)ml to(36.42±13.91)ml,BMI decreased from(28.52±3.73)kg/m2 to (19.76± 1.88)kg/m2,TG decreased from (2.52 ± 0.43) mmol/L to (1.38 ± 0.52) mmol/L.The changes of PV,PSA,IPSS,QOL,Qmax,RU,BMI and TG were statistically significant (all P＜0.05).Conclusions Long term combined finasteride and metformin treatment for BPH plus T2DM is effective and safe.And the two drugs may be improve the efficacy each other.

Objective To explore the appliacation value of FPSAR between the serum f-PSA and t-PSA in hyperplasia of prostate by YAG Laser.Methods 150 cases with benign prostate hyperplasia(BPH)and 24 cases with prostate pcaancer were selected.The value of f-PSA、t-PSA、FPSAR was determined by TRFIA.Results The tPSA,f-PSA after treatment were significantly lower than before treatment in the two groups(t =2.984,2.701,P ＜0.05).The FPSAR after treatment was significantly higher than before treatment in the two groups(t =2.335,P ＜0.05);The patients of FPSAR≤0.05 in the overlapped field(t-PSA 4～45.5μg/L),the sensitivity of diagnosing PCa is 91.7％(22/24)[t-PSA ＞ 45.5 μg/L(17/24)+(t-PSA 4～45.5 μg/L,FPSAR ≤ 0.15)(5/24)].To examine the PCa with high sensitiveity,it provided the reliable basis for selecting BPH correctly.The patients of BPH group after TUEP was followed up for 6～12 months.The t-PSA is(2.13 ± 0.45)μg/L、f-PSA is(0.85 ± 0.26)μg/L、FPSAR is (0.39 ± 0.06)μg/L.There is no significant difference compared with that after treatment for a month.The international prostate symptom score,(I-PSS)is from(28.3 ± 5.8)points dropped to(12.5 ± 2.1)points.The quality of life,(QOL)is from(4.1 ± 0.6)points dropped to(1.3 ± 0.1)points.The residual urine volume(RUV)is form(93 ±61)ml reduced to(15 ±9)ml.The urination after operation have improvedsignificantly.The Qmax is from average 6.3(2.6～9.5)ml/s before operation raise to 18.4(14.6～22.3)ml/s after operation.Campared with the pre-operation,there is significant difference.Conclusion The application of serum PSA was impoetantin case selection hyperplasia of prostate,comparison of the level changing before and after operation and following up the patients after operation by YAG Laser.