Abstract On August 11, 2022, Tongxiang Center for Disease Control detected a case of brucellosis, and the case was not engaged in related work. Case finding and risk factor investigation were immediately conducted to trace the source of infection. It was revealed that the case sold aquatic products at a farmer's market and frequently picked up goods at a seafood warehouse adjacent to a lamb slaughtering site. There was a potential risk of infection due to indirect contact with slaughtered lambs or contaminants. Serological tests were conducted on 9 employees of the slaughtering site and 48 residents nearby, and the brucellosis cases diagnosed in hospitals in the same area were searched. A total of 11 brucellosis cases were identified, including 9 confirmed cases and 2 asymptomatic infections. There were 2 cases of slaughtering workers and 9 cases of non-occupational individuals from the surrounding area of the slaughtering site. Brucella melitensis biovar 3 were isolated from a slaughtering worker and a non-occupational individual. The slaughtered lambs primarily came from northern regions such as Inner Mongolia and Heilongjiang. It was concluded that it was a cluster caused by Brucella melitensis biovar 3 and spread through direct or indirect contact with imported infected lambs or contaminated environments from a lamb slaughtering site. It is suggested to strengthen the quarantine of imported sheep, legally shut down non-compliant lamb slaughtering sites, implement designated slaughtering and enhance occupational protection.

BACKGROUND:The traditional view is that proximal fibular fractures do not require fixation.Others and our research suggest that the proximal fibular structure plays an important role in the stability of the posterolateral structure of the knee joint,and its mechanism of action is worth studying. OBJECTIVE:To investigate the biomechanical effects of proximal fibular fractures on various structures of the knee joint in an extended state. METHODS:Finite element method was used to conduct simulated biomechanical experiments.A healthy young male volunteer was selected to establish a finite element model of the knee joint in an extended state using MRI and CT image data,and four proximal fibular shapes were simulated(Model A:intact,Model B:1 cm fracture below the fibular head,Model C:1 cm tip defect fracture from the proximal end of the fibula to the distal end,and Model D:2 cm bone defect from the proximal end of the fibula).A longitudinal concentrated load of 1 500 N was applied to the femoral shaft to compare and analyze the distribution and changing trend of the maximum equivalent stress and maximum first principal stress of each structure of the knee joint in an extended state under four working conditions. RESULTS AND CONCLUSION:(1)In Model A,the maximum equivalent stress in the tibial cartilage and lateral compartment of the meniscus was greater than that in the medial compartment,while the maximum first principal stress in the tibial plateau and medial compartment of the meniscus was greater than that in the lateral compartment.The maximum equivalent stress of the medial condyle of the femoral cartilage was greater than that of the lateral condyle,and the maximum first principal stress of the medial condyle of the femoral cartilage was greater than that of the medial condyle.(2)Compared to Model A,there was no significant difference in the magnitude and distribution of the maximum equivalent stress and maximum first principal stress in the cartilage and meniscus of Model C.(3)Compared to Model A,the maximum equivalent stress increase amplitude of Model B was in the order of medial tibial cartilage(14.9％),medial condyle of femoral cartilage(13.6％),and medial meniscus(6.6％).The maximum first principal stress increase amplitude was the medial meniscus(11.06％),the medial tibial cartilage(8.65％),and the medial condyle of the femoral cartilage(7.46％).The maximum equivalent stress increase amplitude of the ligament was as follows:popliteal arch ligament(33.2％)>anterior cruciate ligament(21.3％)>fibular collateral ligament(17％)>posterior cruciate ligament(14.3％)>anterior lateral collateral ligament(13.2％)>medial collateral ligament(10.1％).(4)Compared to Model A,the maximum equivalent stress increasing trend of Model D followed the medial tibial cartilage(19.5％),femoral cartilage medial condyle(17.9％),and medial meniscus(9.9％).The maximum first principal stress in sequence was the medial meniscus(14.04％),the medial tibial cartilage(13.03％),and the medial condyle of the femoral cartilage(11.37％).The increasing trend of maximum equivalent stress in ligaments was as follows:anterior cruciate ligament(25.2％)>posterior cruciate ligament(18.9％)>medial collateral ligament(18.5％)>anterior lateral collateral ligament(12.7％).(5)It is suggested that when the knee joint is extended,a 1 cm fracture below the fibular head and a 2 cm fibular tip bone defect have a significant impact on the structure of the medial ventricular cartilage,anterior cruciate ligament,and posterior lateral ligament complex.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Objective To analyze the current situation and factors influencing post-doctoral training in medical colleges and universities in Liaoning.Methods Convenience sampling was used to investigate 716 post-doctoral personnel at post-doctoral mobile stations of four medical colleges and universities in Liaoning.A cross-sectional study was conducted.A general information questionnaire,post-doctoral training questionnaire,interdisciplinary development questionnaire related to post-doctoral training,research burnout questionnaire,and postdoctoral research innovation ability questionnaire were distributed.A total of 780 copies were distributed and 716 copies were collected,with a response rate of 91%.A ttest or one-way ANOVA was used to compare the differences in post-doctoral training scores by age,sex,current status,and post-doctoral training type.Pearson's correlation analysis was used to analyze the scores for interdiscipli-nary development,research burnout,research innovation ability,and post-doctoral training in medical colleges.Indicators with statistical significance(P<0.05)in the single factor and correlation analyses were included in the multifactorial analysis of the factors influencing post-doctoral training.Results The score of post-doctoral training in medical colleges and universities in Liaoning(184.859±21.908)were at a high level.The results of the univariate analysis showed that the scores of post-doctoral training were statistically signifi-cant differences for the indicators of perceptions of post-doctoral status,reasons for joining the station,knowledge of post-doctoral training related policies,consistency of post-doctoral experience with initial expectations,satisfaction with post-doctoral work,and whether the research during the post-doctoral training had a disciplinary crossover nature(all P<0.05).The results of the correlation analysis showed that the interdisciplinary development scores,research burnout score,and research innovation ability score were positively correlated with post-doctoral training scores(all P<0.001).The results of the multifactorial analysis showed that consistency between experience and expectations(i.e.,relatively consistent,average,not very consistent,not consistent at all),job satisfaction(i.e.,unchanged,slightly improved,significantly improved),knowledge of relevant policies(no knowledge at all),interdisciplinary development,and research burnout were influential factors for post-doctoral training(all P<0.05).Conclusion The management of post-doctoral training in medi-cal colleges and universities in Liaoning is moderately high level,but there are still some problems.Relevant management methods and strategies should be established to alleviate post-doctoral research burnout,improve the level of cross-disciplinary development,and pro-mote the cultivation of research and innovation abilities to strengthen the cultivation of a first-class medical talent team.

Outpatient humanistic care refered to providing a full process of caring medical services to outpatients. In order to standardize the human caring services for outpatients in medical institutions, promote the comprehensive service level of outpatient services, and improve the patient′s medical experience, Chinese Association for Life Care issued the group standard of Management Norms for Human caring of Outpatients in April 2023. This standard clarified the relevant terms and definitions of human caring for outpatients, specified the basic requirements for human caring, the humanistic quality and care responsibilities of outpatient staff, the outpatient care environment and facilities, the outpatient care process and measures, and quality management. It designed standardized and personalized full process care service norms, providing references for medical institutions at all levels to promote the development of human caring for outpatients.

Objective:To explore the application and clinical efficacy of an innervated arterialised venous flap of the first dorsal metacarpal in reconstruction of thumb and finger pulp defects.Methods:From December 2021 to August 2022, 17 patients received surgery for reconstruction of thumb and finger pulp defects in the Department of Hand Surgery of Sichuan Modern Hospital. All were carried out in emergency surgery. The affected digits included: 3 thumbs, 4 index fingers, 6 middle fingers, 1 ring finger and 3 little fingers. After emergency debridement, a flap of the first dorsal metacarpal carrying superficial radial nerve and arterialised vein was taken for reconstruction of the defect. Donor site of the flap was directly closed with sutures. The survival and functional recovery of the digits and flaps were evaluated through postoperative follow-ups via outpatient visit and telephone and WeChat interviews.Results:Seven flaps developed blisters after surgery, which gradually subsided and healed after dressing change. The rest of 10 flaps survived smoothly, without any vascular compromise. All of the 17 patients(17 digits) had postoperative follow-up for 3-15 months, with 8 months in average. Appearance of thumb and finger pulps were good, with sensation restored to S 1-S 3+, according to the sensory function evaluation criteria of the British Medical Research Council(BMRC). According to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, all 17 patientswere in excellent of total active movement(TAM). Conclusion:Innervated arterialised venous flap of the first dorsal metacarpal is reliable in reconstruction of the defects of digit pulps with good function and appearance. The flap is easy to take and with a satisfactory recovery of sensation.

Objective:To evaluate the clinical effects of adjustable traction skin stretchers used in repair of wounds at the lower leg, foot and ankle.Methods:A retrospective study was performed to analyze the clinical data of 56 patients who had been treated for skin defects at the lower leg, foot and ankle from August 2016 to September 2022 at The First Affiliated Hospital of Zhengzhou University, Honghui Hospital, Affiliated to Xi'an Jiaotong University Medical College, The First Affiliated Hospital of Henan Polytechnic University, and Yunnan Zhongde Orthopedic Hospital. There were 35 males and 21 females, aged (39.9±18.7) years. There were 43 traumatic wounds, 3 burns, 6 inflammatory wounds, 3 relief incisions due to osteofascial compartment syndrome, and 1 scar. The areas of skin defect ranged from 2.5 cm × 2.0 cm to 20.0 cm × 10.0 cm. The duration of wounds was (8.6±7.8) d. All the wounds were repaired with adjustable traction skin stretchers. The row-hook type of skin stretchers was used in 28 cases, the single-rod type in 20 cases, the single-rod type combined with an external fixator in 5 cases, and a combination of the row-hook type and the single-rod type in 3 cases.The time for wound traction closure, color of wound skin margin, skin swelling around the wound, functional recovery of affected limb and complications were recorded.Results:The time from skin stretching to wound closure was (7.8±3.8) d in the 56 patients. The color of wound skin edge after stretching was normal in 16 cases, dark red in 38 cases, and dark in 2 cases; the skin swelling around the wound was degree 1 in 21 cases, degree 2 in 33 cases, and degree 3 in 2 cases. The 56 patients were followed up for (8.9±4.1) months. Primary wound closure was achieved in 48 patients, and secondary wound closure in 8 patients after repair with an autologous skin graft. Partial skin necrosis occurred due to tension blisters after skin stretching in 2 patients, one of whom was repaired with an autologous skin graft and the other of whom by dressing change. Deep bone infection recurred in 2 patients whose wounds healed after their bone defects were repaired using Ilizarov technique of bone transfer. In the 56 patients, the muscle strength of the lower extremity beyond the wound was recovered to normal, and the range of motion of the joints adjacent to the wound also recovered to normal.Conclusion:In repair of wounds at the lower leg, foot and ankle, adjustable traction skin stretchers can lead to fine clinical effects and limited complications, because the stretchers can control the tension of skin digitally and precisely.

Objective : To evaluate the effects of low temperature plasma modification on the surface morphology and bonding durability of zirconia ceramics. Methods: 180 pieces of zirconia ceramic(Y-TZP) were randomly divided into 5 groups(n= 36). Group A:blank group; Group B:sandblast group; Group C:nitrogen( N2) plasma group; Group D:oxygen(O2) plasma group; Group E:argon(Ar) plasma group. The surface hydrophilicity and microstructure of zirconia ceramics were observed,and the changes of surface elements and functional groups were detected. Each group of bonded specimens was randomly divided into two subgroups(n= 15). After receiving 0 and10 000 cycles of heat and cold,the shear strength was measured. The measured results were statistically analyzed and the fracture mode was analyzed. Results: The surface contact angles of groups B,C,D and E were significantly lower than those of group A,with statistically significant differences(P<0. 001). Compared with group A,the surface morphology of group C,D and E did not significantly change,while that of group B significantly changed. XPS showed that the surface carbon decreased,oxygen increased and carbon/oxygen ratio decreased after plasma treatment. SBS results showed that the immediate shear bonding strength of group A was lower than that of the other four groups(P<0. 001),and there was no significant difference in the immediate shear bonding strength of groups B,C,D and E(P>0. 05);After artificial aging,the shear bonding strength of group A was significantly lower than that of the other four groups,and the difference of shear bonding strength between groups A and B before and after artificial aging was statistically significant(P<0. 001). Conclusion The zirconia ceramics achieves better bonding strength and durability with resin cement through three kinds of low temperature plasmas,without changing the surface morphology.

Objective:To investigate the application value of fixation mesh with suture anchor in the repair of parailiac hernia.Methods:The retrospective and descriptive study was conducted. The clinical data of 5 patients with parailiac hernia who were admitted to Shaoxing People′s Hospital from March 2016 to February 2019 were collected. There were 4 males and 1 female, aged from 23 to 67 years, with a median age of 49 years. Patients underwent repair of parailiac hernia, in which mesh with suture anchor was fixed on the outside of the defect to the inner side of the ilium. Observation indicators: (1) surgical and postoperative conditions; (2) follow-up. Follow-up using outpatient examination or telephone interview was conducted at postoperative 1 week, at postoperative 2 weeks, at postoperative 1, 3, 6 months, at postoperative 1 and 2 years, respectively. The follow-up was up to July 2019. During the follow-up, the conditions about drainage tube removal, incision infection, hernia recurrence, and chronic pain were observed. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M (range). Results:(1) Surgical and postoperative conditions: 5 patients underwent surgeries successfully, without blood transfusion. The volume of intraoperative blood loss was 100 mL(range, 20-300 mL). The operation time and duration of drainage tube placement were (129±13)minutes and (13.8±1.9)days. Patients were discharged from hospital, without postoperative complications during the hospital stay. The duration of hospital stay was 13 days(range, 8-19 days). (2) Follow-up: patients were followed up for 4-39 months, with a median follow-up time of 16 months. One of the 5 patients was removed drainage tube during the hospital stay and other 4 patients were removed at the outpatient after discharge from the hospital. One patient felt numbness in the surgical site at postoperative 1 month without aggravation during the follow-up, and received no specific treatment. Four patients completed computed tomography examination at postoperative 6 months, without hernia recurrence. There was no incision infection or chronic pain.Conclusions:It is safe and effective to use fixation mesh with suture anchor in the repair of parailiac hernia.

Objective To study the relationship of serum UA level with coronary heart disease (CHD) and cerebral stroke in elderly female essential hypertension (EH) patients. Methods Four hundred and seventy-two female EH patients admitted to our hospital from February 2014 to June 2018 were divided into normal UA group (n = 389) and hyperuricemia group (n = 83) according to their serum UA level. The clinical characteristics, blood pressure, incidence of CHD and cerebral stroke were compared between the two groups. The relationship of serum UA level with CHD and cerebral stroke was analyzed by logistic regression analysis. Results The age was significantly older, the course of hypertension was significantly longer, the SBP and BMI were significantly higher, the circumstances of lumber and buttock were significantly longer, the serum FPG,TB, UA levels and the incidence of grade 2 hypertension and grade 3 hypertension were significantly higher while the serum HDL-C level was significantly lower in hyperuricemia group than in normal UA group (P＜0.05, P＜0.01). Multivariate logistic regression analysis showed that serum UA level was positively related with CHD and cerebral stroke in elderly female EH patients after adjustment for risk factors such as age (OR = 1.003, 95％CI:1.000-1.007, P=0.045;OR = 1.006, 95％CI:1.000-1.012,P = 0.042). Conclusion Hyperuricemia is closely related with CHD and cerebral stroke in elederly EH patients.