BACKGROUND:There is still no consensus on the optimal internal fixation for the treatment of Pauwels Ⅲ femoral neck fracture,and most of the related finite element analyses have been performed using a single simplified loading condition,and the biomechanical properties of commonly used internal fixation devices need to be further investigated. OBJECTIVE:To analyze the biomechanical characteristics of Pauwels Ⅲ femoral neck fractures treated with cannulated compression screw,dynamic hip screw,and femoral neck system by finite element method under different loading conditions of single-leg standing loads and sideways fall loads. METHODS:The DICOM data of healthy adult femur were obtained by CT scanning,imported into Mimics 15.0 software to obtain the rough model of bone tissue.The data exported from Mimics were optimized by Geomagics software,and then three internal fixation models were built and assembled with the femur model according to the parameters of the clinical application of the cannulated compression screw,dynamic hip screw,and femoral neck system by using Pro/E software.Finally,the three internal fixation models were imported into Ansys software for loading and calculation to analyze the stress distribution and displacement of the femur and the internal fixation under different working conditions of single-leg standing loads and sideways fall loads,as well as the stress characteristics of the calcar femorale and Ward's triangle. RESULTS AND CONCLUSION:(1)Under the single-leg standing load and the sideways fall load,the proximal femoral stress of the three internal fixation models was mainly distributed above the fracture end of the femoral neck.The peak stress of the proximal femoral end,fracture end,Ward triangle,and calcar femorale of the three internal fixation models were the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(2)Under the single-leg standing load and the sideways fall load,the peak displacement of the proximal femur of the three internal fixation models was all located at the top of the femoral head,and the peak displacement was the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(3)The peak displacement of the three internal fixation models was all located at the top of the internal fixation device under the single-leg standing and sideways fall loading conditions,and the peak displacement values were the smallest in the femoral neck system internal fixation model and the largest in the cannulated compression screw internal fixation model.(4)The internal fixation stress of the three internal fixation models was mainly distributed in the area near the fracture end of the internal fixation device under the single-leg standing and sideways fall loads,and the peak value of internal fixation stress was the smallest in the femoral neck system model and the largest in the cannulated compression screw model.(5)These results suggest that the mechanical stability of the femoral neck system is the best,but there may be a risk of stress shielding of the fracture end and calcar femorale.The stress of the internal fixation device of the femoral neck system is more dispersed,and the risk of internal fixation break is lower.

Objective:To analyze the effect of modified Banxia Baizhu Tianma Decoction combined with Nimodipine on cognitive dysfunction and changes on cerebral blood flows of the patients with chronic cerebral insufficiency (CCCI).Methods:A total of 91 patients with CCCI who received treatment in our hospital from March 2019 to March 2020 were selected and divided into the treatment group ( n=46) and the control group ( n=45), according to random number table method. The control group was treated with Nimodipine oral treatment, and the treatment group was treated with modified Banxia Baizhu Tianma Decoction on the basis of the control group treatment. Both groups were treated for 2 weeks. The Traditional Chinese Medicine (TCM) syndrome scores were performed before and after treatment, and transcranial Doppler ultrasound was used to detect the average blood flow of bilateral vertebral arteries (VA), basilar arteries (BA), internal carotid arteries (ICA) and middle cerebral arteries (MCA). The whole blood viscosity high shear (HS), whole blood low shear (LS), plasma viscosity (PV), fibrinogen (FIB) and hematocrit (HCT) were detected by automatic blood rheometerusing. The Montreal Cognitive Assessment Scale (MoCA) was used to assess the degree of cognitive impairment and evaluate the clinical efficacy. Results:The total effective rate was 91.3% (42/46) in the treatment group and 73.3% (33/45) in the control group, with a statistically significant difference between the two groups ( χ2=5.07, P=0.024). The scores of dizziness, headache, forgetfulness, insomnia and total scores in the treatment group were significantly lower than those in the control group after treatment ( t values were 8.59, 7.79, 3.92, 4.11, 5.01, all Ps<0.01), and the MoCA score (25.13±2.16 vs. 23.88±2.70; t=2.44, P=0.017) in the treatment group significantly higher than that in the control group. After treatment, VA [(35.49±4.08) cm/s vs. (32.17±4.25) cm/s, t=3.80], BA [(36.99±3.79) cm/s vs. (33.76±4.12) cm/s, t=3.89], ICA [(62.49±5.07) cm/s vs. (58.91±5.31) cm/s, t=3.29], MCA [(70.09±5.04) cm/s vs. (67.12±5.85) cm/s, t=2.60] in the treatment group was significantly higher than those in the control group ( P<0.01). After treatment, the levels of HS, LS, PV, Fg, and HCT in the treatment group were significantly lower than those in the control group ( t values were 2.37, 4.35, 2.23, 2.42, 2.20, P<0.05 or P<0.01). Conclusion:Modified Banxia Baizhu Tianma Decoction combined with Nimodipine tablets can relieve the clinical symptoms of CCCI patients, improve blood flow velocity, blood rheology level and cognitive function, and improve clinical efficacy.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Non-neonatal tetanus remains a serious public health problem, although neonatal tetanus has been eliminated in China since 2012. Non-neonatal tetanus is a potential fatal disease. In the absence of medical intervention, the mortality rate of severe cases is almost 100%. Even with vigorous treatment, the mortality rate remains 30%-50% globally. These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China, in order to improve medical quality and safety. These specifications introduce the etiology, epidemiology, pathogenesis, clinical manifestations and laboratory tests, diagnosis, differential diagnosis, grading and treatment of non-neonatal tetanus.

Objective: To investigate the effect of "工" type adhesive tape fixation method on tracheal tube fixation in children′s adenoids and tonsils surgery. Methods: Eighty children who underwent selective adenoids and tonsils surgery from January to June 2019 in Shengjing Hospital of China Medical University were selected. The children were divided into control group and experimental group by random digits table method with 40 cases each. The tracheal tube of control group was fixed by traditional double-adhesive tape fixation method, and the tracheal tube of experimental group was fixed by "工" type adhesive tape fixation method. The distance between tracheal tube and right corner of mouth at the time of tracheal tube fixation, mouth opener insertion and the end of surgery by a soft ruler were recorded as an index of tracheal tube displacement. The detubation and skin damage were also recorded. Results: The displacement distances of tracheal tube from tracheal tube fixation to mouth opener insertion and from tracheal tube fixation to the end of surgery in experimental group were significantly smaller than those in control group: (0.38 ± 0.16) cm vs. (0.74 ± 0.25) cm and (0.51 ± 0.20) cm vs. (1.69 ± 0.51) cm, and there were statistical differences (t = 7.67 and 13.62, P<0.05). There was no statistical difference in the incidence of detubation between 2 groups (P>0.05). The pressure ulcers did not occur in 2 groups; there was no statistical difference in the incidence of breakage between 2 groups (P>0.05); the incidences of redness and total skin damage in experimental group were significantly lower than those in control group: 20.0% (8/40) vs. 55.0% (22/40) and 20.0% (8/40) vs. 62.5% (25/40), and there were statistical differences (χ² = 13.07 and 14.90, P<0.01). Conclusions The "工" type adhesive tape fixation method is used for the fixation of tracheal tube in adenoids and tonsils surgery in children, which is easy to operate and fixes firmly, and can effectively reduce the displacement of tracheal tube and reduce the degree of skin damage. It is worthy of clinical application.

Tetanus consists of neonatal tetanus and non-neonatal tetanus.Non-neonatal tetanus remains a serious public health problem,although neonatal tetanus has been eliminated in China since 2012.Non-neonatal tetanus is a potential fatal disease.In the absence of medical intervention,the mortality rate of severe cases is almost 100％.Even with vigorous treatment,the mortality rate is still 30％-50％ globally.These specifications aim to regulate non-neonatal tetanus diagnosis and treatment in China,in order to improve medical quality and safety.These specifications introduce the etiology,epidemiology,pathogenesis,clinical manifestations and laboratory tests,diagnosis,differential diagnosis,grading and treatment of non-neonatal tetanus.

Tetanus consists of neonatal tetanus and non-neonatal tetanus. Although neonatal tetanus in China has been eliminated since 2012, non-neonatal tetanus remains a serious public health problem. Non-neonatal tetanus is a potential fatal disease, and the mortality rate of severe cases is almost 100% in the absence of medical intervention. Even with vigorous treatment, the mortality rate is still 30~50% globally. In order to standardize the diagnosis and treatment of non-neonatal tetanus in China, this specification is hereby formulated. This standard includes etiology, epidemiology, pathogenesis, clinical manifestations, laboratory tests, diagnosis, differential diagnosis, classification, grading and treatment of non-neonatal tetanus.

Objective To investigate the effect of high mobility group box-1 protein (HMGB1) on the permeability of human umbilical vein endothelial cells, and the protective effect of unfractionated heparin on HMGB1-mediated, endothelial cell tightly junction-related protein Claudin-5. Methods The human umbilical vein endothelial cells after trypsin digestion were subcultured in culture flasks and divided into 4 groups: blank control group (addition of PBS equivalent), rhHMGB1 treatment group (100 ng/mL), unfractionated heparin control group (UFH, 10 U/mL) and rhHMGB1+ unfractionated heparin-treated group (100 ng/mL rhHMGB1 + UFH 10 U/mL). After human umbilical vein endothelial cells were cultured: the viability of endothelial cells was determined by MTT assay; transwell method was used to measure the permeability of endothelial cells; the expression and distribution of Claudin-5 were determined by immunofluorescence; and Claudin-5 protein expression was detected by Western blotting. Results After treated with rhHMGB1 (100 ng/mL), the viability of endothelial cells was notsignificantly different from that of the blank control group (P> 0.05). After treated with rhHMGB1 (100 ng/mL) for 3 and 6 h respectively, the permeability of endothelial cells was not significantly different from that of the blank control group (P> 0.05). After 12 h and 24 h treatment of rhHMGB1, the permeability of endothelial cells was significantly increased compared with the blank control group (P< 0.05). However, after endothelial cells were incubated with unfractionated heparin and rhHMGB1 for 12 and 24 h, the permeability of endothelial cell was lower than that of rhHMGB1 treatment group (P< 0.05). Immunofluorescence and Western-blot showed that after treatment of rhHMGB1 for 24 h, the distribution and expression of claudin-5, a tightly junction-associated protein, was decreased. After incubation with unfractionated heparin and rhHMGB1, the expression of tightly junction-associated protein Claudin-5 was increased, as well as the fluorescence intensity of Claudin-5. Conclusions HMGB1 can increase the permeability of endothelial cells by mediating the abnormal distribution and decreased expression of Claudin-5. Unfractionated heparin can improve the expression and distribution of Claudin-5, improving the permeability of endothelial cells.

Objective To explore a new method for the reconstruction of defect after resection of hypopharyngeal and cervical esophageal cancer using pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis.Methods From June 2010 to June 2014,56 cases of hypopharyngeal or cervical esophageal cancer were treated with pharyngogastric anastamosis,in 5 cases of them,because the length of pulled-up stomach was limited and could not reach oral pharynx,free jejunal flap was used in 2 cases with laryngeal invasion and laryngotracheal flap was used in 3 cases without laryngeal invasion to reconstruct the defect between oral pharynx and stomach.Results Pharyngeal fistula occurred in 1 case with laryngotracheal flap reconstruction,but healed after 2 weeks of wound dressing.Other 4 cases had oral liquid diet two weeks after surgery and did not occur any complications such as infection or pharyngeal fistula.Follow-up showed 1 case died from mediastinal and lung metastases after 3 years,1 case had cervical lymph recurrence after 2 years and still survived,and other 3 cases were tumor free survival for 28,37,and 56 months respectively.Conclusions The defect after resection of hypopharyngeal and esophageal cancer can be reconstructed with pulled-up stomach combined with free jejunal flap or lanryngotracheal flap if pulled-up stomach can not reach the level of oral pharynx for ananstamosis.

Objective To evaluate the result of short-segment pedicle screw instrumentation plus pedicle screws inserted into the injury level for treatment of thoracolumbar burst fracture.Methods Fifty-six cases of thoracolumbar burst fracture treated from June 2008 to June 2011 were reviewed.There were 40 males and 16 females at mean age of 32.8 years (range,25-60 years).Twenty-four cases were injured from traffic accidents,19 cases from fall from the height,and 13 cases from fall of heavy objects.Fractured segments were T11 in 6 cases,T12 in 14 cases,L1 in 16 cases,L2 in 12 cases,L3in 5 cases,and L4 in 3 cases.Thirty cases underwent short-segment pedicle screw fixation through the level above the fracture to level below the fracture (Group A).Apart from this,26 cases were treated with additional transpedicular fixation at the fractured level (Group B).Anterior vertebral height ratio,sagittal Cobb' s angle,neurologic performance as evaluated by American Spinal Injury Association (ASIA) scale were assessed before operation,one week after operation,and one year after operation.Results Anterior vertebral height ratio and Cobb' s angle revealed no significant differences between the two groups before operation and one week after operation.At postoperative one year,anterior vertebral height ratio and sagittal Cobb' s angle were (87.2 ± 6.9)％ and (7.6 ± 3.2)°in Group A with significant differences from (93.3 5.7)％ and (5.7 ± 1.9) ° in Group B (P ＜ 0.05),but there was no statistical difference in ASIA scale of neurologic performance.Conclusion Short-segment pedicle screw instrumentation with stabilization at the level of fracture is an effective treatment for thoracolumbar burst fracture.