Objective To observe the clinical efficacy of lesion removal,bone grafting,fusion,and external fixation in the treatment of late-stage wrist tuberculosis.Methods From October 2015 to May 2019,25 patients with late-stage wrist tubercu-losis were treated using lesion removal,bone grafting,fusion,and external fixation.Among these patients,there were 14 males and 11 females,aged from 40 to 74 years old,with an average age of(60.72±8.45)years old.The duration of the disease ranged from 5 to 24 months,with an average of(11.52±7.61)months.There were 11 cases of left wrist tuberculosis and 14 cases of right wrist tuberculosis,with 5 cases accompanied by sinus formation.Postoperative regular anti-tuberculosis treatment was continued.Visual analogue score(VAS),inflammatory indicators,Gartland-Werley wrist function score,and upper limb function score were observed before and after treatment.Results All 25 patients were followed up for ranging from 12 to 36 months with an average of(19.7±6.3)months.At the latest follow-up,all wounds were healed satisfactorily,and there was no recurrence of tuberculosis or infection.VAS at one week before operation and three months after operation were(5.16±1.14)score and(1.68±0.80)score respectively.One week before operation and three months after operation,erythrocyte sedimenta-tion rate(ESR)was(44.20±20.56)mm·h-1 and(14.44±1.14)mm·h-1,and C-reactive protein(CRP)was(12.37±7.95)mg· L-1and(4.3±3.37)mg·L-1.The differences in all three data sets were statistically significant(P＜0.01).According to Gartland-Werley wrist function scoring,the scores at one week before operation and one year after operation were(21.32±3.44)and(14.96±1.37)respectively,showed a statistically significant difference(P＜0.01).According to the upper limb function score(disabilities of the arm,shoulder,and hand,DASH),the score was(70.52±7.95)at one week before operation and(28.84± 2.30)at one year after operation.The difference was statistically significant(P＜0.01).At the latest follow-up,no patient had a recurrence of tuberculosis.Conclusion The short-term clinical efficacy of treating wrist tuberculosis with lesion removal,bone grafting,fusion,and external fixation is satisfactory.

Objective To investigate the protective effect of dexmedetomidine(Dex)pretreatment on myocardial ischemia-reperfusion mice and the effect of Nod-like receptor protein 3(NLRP3)inflammatory signaling pathway.Methods C57BL/6J mice were randomly divided into sham group(only threading without ligation),model group(recovery after ligation of left anterior descending coronary artery),positive group(modeling after intraperitoneal injection of 1 mg·kg-1 trimetazidine),Dex group(modeling after intraperitoneal injection of 20 μg·kg-1 dexmedetomidine),MCC950 group(modeling after intraperitoneal injection of 10 mg·kg-1 NLRP3 inhibitor MCC950),12 mice in each group.Cardiac function indexes were detected at 24 h after reperfusion,the expression level of related proteins in myocardial tissue was detected by Western blot,enzyme-linked immunosorbent assay(ELISA)was used to detect the expression level of serum factor,myocardial antioxidant index was detected by kit method,and apoptosis was detected by Tunel method.Results The NLRP3 protein expression levels of sham group,model group,positive group,Dex group and MCC950 group were 0.31±0.05,1.06±0.07,0.52±0.05,0.65±0.07 and 0.39±0.04,respectively;the expression levels of apoptosis-associated granuloid protein(ASC)were 0.27±0.08,0.88±0.09,0.46±0.05,0.59±0.07 and 0.34±0.04,respectively;CK-MB levels were(25.64±2.94),(102.08±7.04),(49.61±7.70),(60.86±5.24)and(63.24±5.38)U·L-1,respectively;IL-6 levels were(104.78±10.73),(231.54±15.56),(158.20±16.54),(165.10±14.77)and(141.17±14.08)pg·mL-1,respectively;Tunel positive cell rates were(4.34±0.16)％,(25.98±1.58)％,(8.74±0.93)％,(11.06±1.07)％and(9.19±0.88)％,respectively.Sham group were compared with model group;Dex group and MCC950 group were compared with model group,the above indexes were statistically significant(all P＜0.05).Conclusion Dexmedetomidine preconditioning may prevent ischemia-reperfusion myocardial injury by inhibiting NLRP3/ASC/caspase-1 inflammatory pathway,inflammatory response and myocardial cell apoptosis.

The abuse and irrational use of antibiotics in human veterinary medicine has seriously endangered the ecological environment and human health.In this study,a fully automatic solid-phase disk extraction-stable isotope dilution-ultra-high performance liquid chromatography-mass spectrometry method for determination of 17 kinds of sulfonamides antibiotics(SAs)in water was established,which was then applied to determination of SAs in real samples including tap water,river water and seawater,respectively.Meanwhile,the residual characteristics were discussed and the ecological risks were assessed.With this method,1.0 L water sample with 0.5 g/L Na2EDTA(pH=3)was extracted and enriched by 3M SDB-XC disk,and eluted by 10 mL of mixture of methanol and acetone(1:1,V/V),and the pretreatment time of the sample was about 60 min per six samples.Under the optimized conditions,the linearity of the method for detection of 17 kinds of SAs ranged from 0.05 to 100 μg/L,with correlation coefficients(R2)>0.999.In addition,the detection limits(S/N=3)were as low as 0.012-0.052 ng/L,and the recoveries were in the range of 76%-110%,with relative standard deviations of 0.5%-9.6%(n=5).The results showed that no SAs was detected in tap water,while 3 and 9 kinds of SAs were detected in river water of Zhoushan,and seawater of Wenzhou Sea area in Zhejiang province,respectively.The total concentrations of the detected SAs were 0.875-21.826 ng/L and 1.024-20.768 ng/L in river water and seawater,respectively,and among which,sulfamethoxazole(SMX)was the predominant compound in river water and seawater,accounting for 81%and 74%of the total SAs,respectively.The ecological risk assessment showed that the risk quotients of the detected SAs in the river water and seawater in the study area for the three kinds of trophic organisms(algae,Daphnia and fish)were far less than 0.01,meaning that the ecological risk was low.

Post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is one of the most common complications after endoscopic retrograde cholangiopancreatography(ERCP).Numerous PEP prediction models have been established based on different statistical methods at home and abroad.The PEP prediction model,as a tool for evaluating and screening high-risk populations,can provide a basis for medical staff to find high-risk PEP patients early and take effective preventive measures.In recent years,new PEP prediction models have appeared one after another,but there is still a lack of recognized reliable prediction models in clinic.This article reviews the research status of PEP risk prediction models,aim to provide a direction for establishing a more reliable,accurate,and practical PEP risk prediction model in the later period.

Purpose/Significance To achieve safe and efficient open sharing of health and medical data,and to stimulate the value of health and medical data elements.Method/Process Aiming at the current situation and problems of open sharing of health and medical data,an open sharing system of health and medical data is designed based on data integration governance,data asset management,data product supermarket,data sampling analysis and online sandbox analysis.Result/Conclusion The practice has proved that the system can effectively realize the collection,analysis,management and utilization of health and medical data.

Patients with severe trauma require an extremely timely treatment and transfusion plays an irreplaceable role in the emergency treatment of such patients. An increasing number of evidence-based medicinal evidences and clinical practices suggest that patients with severe traumatic bleeding benefit from early transfusion of low-titer group O whole blood or hemostatic resuscitation with red blood cells, plasma and platelet of a balanced ratio. However, the current domestic mode of blood supply cannot fully meet the requirements of timely and effective blood transfusion for emergency treatment of patients with severe trauma in clinical practice. In order to solve the key problems in blood supply and blood transfusion strategies for emergency treatment of severe trauma, Branch of Clinical Transfusion Medicine of Chinese Medical Association, Group for Trauma Emergency Care and Multiple Injuries of Trauma Branch of Chinese Medical Association, Young Scholar Group of Disaster Medicine Branch of Chinese Medical Association organized domestic experts of blood transfusion medicine and trauma treatment to jointly formulate Chinese expert consensus on blood support mode and blood transfusion strategies for emergency treatment of severe trauma patients ( version 2024). Based on the evidence-based medical evidence and Delphi method of expert consultation and voting, 10 recommendations were put forward from two aspects of blood support mode and transfusion strategies, aiming to provide a reference for transfusion resuscitation in the emergency treatment of severe trauma and further improve the success rate of treatment of patients with severe trauma.

Objective:To carry out cytogenetic and molecular genetic analysis for two infertile patients carrying rare small supernumerary marker chromosomes (sSMC).Methods:Two infertile patients who received reproductive and genetic counseling at CITIC Xiangya Reproductive and Genetic Hospital on October 31, 2018 and May 10, 2021, respectively were selected as the study subjects. The origin of sSMCs was determined by conventional G banding, fluorescence in situ hybridization (FISH) and copy number variation sequencing (CNV-seq). Microdissection combined with high-throughput whole genome sequencing (MicroSeq) was carried out to determine the fragment size and genomic information of their sSMCs. Results:For patient 1, G-banded karyotyping and FISH revealed that he has a karyotype of mos47, XY, del(16)(p10p12), + mar[65]/46, XY, del(16)(p10p12)[6]/48, XY, del(16)(p10p12), + 2mar[3].ish mar(Tel 16p-, Tel 16q-, CEP 16-, WCP 16+ ). CNV analysis has yielded a result of arr[GRCh37]16p12.1p11.2(24999364_33597595)×1[0.25]. MicroSeq revealed that his sSMC has contained the region of chromosome 16 between 24979733 and 34023115 (GRCh37). For patient 2, karyotyping and reverse FISH revealed that she has a karyotype of mos 47, XX, + mar[37]/46, XX[23].rev ish CEN5, and CNV analysis has yielded a result of seq[GRCh37]dup(5)(p12q11.2)chr5: g(45120001_56000000)dup[0.8]. MicroSeq results revealed that her sSMC has contained the region of chromosome 5 between 45132364 and 55967870(GRCh37). After genetic counseling, both couples had opted in vitro fertilization (IVF) treatment and preimplantation genetic testing (PGT). Conclusion:For individuals harboring sSMCs, it is vital to delineate the origin and structural characteristics of the sSMCs for their genetic counseling and reproductive guidance. Preimplantation genetic testing after microdissection combined with high-throughput whole genome sequencing (MicroSeq-PGT) can provide an alternative treatment for carrier couples with a high genetic risk.

Purpose::With the increasing level of automation in automobiles, the advent of autonomous vehicles has reduced the tendency of drivers and passengers to focus on the task of driving. The increasing automation in automobiles reduced the drivers' and passengers' focus on driving, which allowed occupants to choose a more relaxed and comfortable sitting position. Meanwhile, the occupant's sitting position went from a frontal, upright position to a more relaxed and reclined one, which resulted in the existing restraint systems cannot to keep occupants safe and secure. This study aimed to determine the effects of different reclining states on occupants' lumbar and neck injuries.Methods::This is an original research on the field of automotive safety engineering. Occupants in different initial sitting positions (25°, 35°, 45°, and 55°) were adapted to changes in seat back angle and restraint systems and placed in the same frontal impact environment. Neck injury indexes, lumbar axial compression force and acceleration, as well as occupant dynamic response during the impact, were compared in different sitting positions. The injury response and kinematic characteristics of occupants in different reclining positions were analyzed by the control variable method.Results::As the sitting angle increased, the occupant's head acceleration decreased, and the forward-lean angle decreased. Occupants in the standard sitting position had the greatest neck injury, with an N ij of 0.95, and were susceptible to abbreviated injury scale 2+ cervical medullary injuries. As the seatback angle increased, the geometric position of the lumbar spine tended to be horizontal, and the impact load transmitted greater forces to the lumbar spine. The occupant's lumbar injury was greatest in the lying position, with a peak axial compression force on the lumbar region of 5.5 KN, which was 2.3 KN greater than in the standard sitting position. Conclusion::The study of occupant lumbar and neck injuries based on different recline states can provide a theoretical basis for optimizing lumbar evaluation indexes, which is conducive to the understanding of the lumbar injury mechanism and the comprehensive consideration of occupant safety protection.

Objective:To investigate the surgical situations and perioperative outcome of pancreaticoduodenectomy in Jiangsu Province and the influencing factors for postoperative 90-day mortality.Methods:The retrospective case-control study was conducted. The clinicopathological data of 2 886 patients who underwent pancreaticoduodenectomy in 21 large tertiary hospitals of Jiangsu Quality Control Center for Pancreatic Diseases, including The First Affiliated Hospital of Nanjing Medical University, from March 2021 to December 2022 were collected. There were 1 732 males and 1 154 females, aged 65(57,71)years. Under the framework of the Jiangsu Provincial Pancreatic Disease Quality Control Project, the Jiangsu Quality Control Center for Pancreatic Diseases adopted a multi-center registration research method to establish a provincial electronic database for pancrea-ticoduodenectomy. Observation indicators: (1) clinical characteristics; (2) intraoperative and post-operative conditions; (3) influencing factors for 90-day mortality after pancreaticoduodenectomy. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(IQR), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or constituent ratio, and comparison between groups was conducted using the chi-square test, continuity correction chi-square test and Fisher exact probability. Maximal Youden index method was used to determine the cutoff value of continuous variables. Univariate analysis was performed using the corresponding statistical methods based on data types. Multivariate analysis was performed using the Logistic multiple regression model. Results:(1) Clinical characteristics. Of the 2 886 patients who underwent pancreaticoduodenectomy, there were 1 175 and 1 711 cases in 2021 and 2022, respectively. Of the 21 hospitals, 8 hospitals had an average annual surgical volume of <36 cases for pancreaticoduodenectomy, 10 hospitals had an average annual surgical volume of 36-119 cases, and 3 hospitals had an average annual surgical volume of ≥120 cases. There were 2 584 cases performed pancreaticoduodenectomy in thirteen hospitals with an average annual surgical volume of ≥36 cases, accounting for 89.536%(2 584/2 886)of the total cases. There were 1 357 cases performed pancrea-ticoduodenectomy in three hospitals with an average annual surgical volume of ≥120 cases, accounting for 47.020%(1 357/2 886) of the total cases. (2) Intraoperative and postoperative conditions. Of the 2 886 patients, the surgical approach was open surgery in 2 397 cases, minimally invasive surgery in 488 cases, and it is unknown in 1 case. The pylorus was preserved in 871 cases, not preserved in 1 952 cases, and it is unknown in 63 cases. Combined organ resection was performed in 305 cases (including vascular resection in 209 cases), not combined organ resection in 2 579 cases, and it is unknown in 2 cases. The operation time of 2 885 patients was 290(115)minutes, the volume of intra-operative blood loss of 2 882 patients was 240(250)mL, and the intraoperative blood transfusion rate of 2 880 patients was 27.153%(782/2 880). Of the 2 886 patients, the invasive treatment rate was 11.342%(327/2 883), the unplanned Intensive Care Unit (ICU) treatment rate was 3.087%(89/2 883), the reoperation rate was 1.590%(45/2 830), the duration of postoperative hospital stay was 17(11)days, the hospitalization mortality rate was 0.798%(23/2 882), and the failure rate of rescue data in 2 083 cases with severe complications was 6.529%(19/291). There were 2 477 patients receiving postoperative 90-day follow-up, with the 90-day mortality of 2.705%(67/2477). The total incidence rate of complication in 2 886 patients was 58.997%(1 423/2 412). The incidence rate of severe complication was 13.970%(291/2 083). The comprehensive complication index was 8.7(22.6) in 2 078 patients. (3) Influencing factors for 90-day mortality after pancreaticoduodenectomy. Results of multivariate analysis showed that age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment were independent risk factors for 90-day mortality after pancreaticoduodenectomy ( odds ratio=2.403, 2.609, 16.141, 95% confidence interval as 1.281-4.510, 1.298-5.244, 7.119-36.596, P<0.05). Average annual surgical volume ≥36 cases in the hospital was an independent protective factor for 90-day mortality after pancreaticoduodenectomy ( odds ratio=0.368, 95% confidence interval as 0.168-0.808, P<0.05). Conclusions:Pancreaticoduodenectomy in Jiangsu Province is highly con-centrated in some hospitals, with a high incidence of postoperative complications, and the risk of postoperative 90-day mortality is significant higher than that of hospitallization mortality. Age ≥ 70 years, postoperative invasive treatment, and unplanned ICU treatment are independent risk factors for 90-day motality after pancreaticoduodenectomy, and average annual surgical volume ≥36 cases in the hospital is an independent protective factor.

OBJECTIVE: No consensus exists on the relative risk ( RR) of lung cancer (LC) attributable to active smoking in China. This study aimed to evaluate the unified RR of LC attributable to active smoking among the Chinese population. METHODS: A systematic literature search of seven databases was conducted to identify studies reporting active smoking among smokers versus nonsmokers in China. Primary articles on LC providing risk estimates with their 95% confidence intervals ( CIs) for "ever" "former" or "current" smokers from China were selected. Meta-analysis was used to estimate the pooled RR of active smoking. RESULTS: Forty-four unique studies were included. Compared with that of nonsmokers, the pooled RR (95% CI) for "ever" "former" and "current" smokers were 3.26 (2.79-3.82), 2.95 (1.71-5.08), and 5.16 (2.58-10.34) among men, 3.18 (2.78-3.63), 2.70 (2.08-3.51), and 4.27 (3.61-5.06) among women, and 2.71 (2.12-3.46), 2.66 (2.45-2.88), and 4.21 (3.25-5.45) in both sexes combined, respectively. CONCLUSION The RR of LC has remained relatively stable (range, 2-6) over the past four decades in China. Early quitting of smoking could reduce the RR to some extent; however, completely refraining from smoking is the best way to avoid its adverse effects.
Male ; Humans ; Female ; Smoking/epidemiology* ; Smoking Cessation ; Smokers ; Risk ; Lung Neoplasms/etiology* ; Risk Factors