Objective To explore the viral pathogen spectrum characteristics of acute intestinal infection in Hanzhong from 2019 to 2022. Methods Fecal samples from patients with acute intestinal infection in the outpatient clinic of 3201 Hospital from January 2019 to December 2022 were collected. Common enteroviruses such as enterovirus 71 (EV-A71), coxsackievirus 16 (CV-A16), CV-A10, CV-A6, CV-A2, CV-A4, and CV-B3 were detected and analyzed by real-time fluorescence quantitative PCR. Results A total of 5 194 fecal samples were collected, and the positive rate of nucleic acid detection was 23.95%. In terms of the enteroviruses, the highest detection rate was 9.82% for EV-A71, followed by 4.58% for CV-A16 and 3.37% for CV-A6. The positive detection rate of common enteroviruses showed statistical difference among different age groups (P<0.05), with the highest detection rate of 41.49% in 0-4 years old group. There was no significant difference in the positive virus detection rate between different genders (P>0.05). EV-A71 infection showed no seasonal characteristics, whereas the detection of CV-A16 and CV-A6 infections was concentrated in summer and autumn. There were 106 cases of mixed infection, and the prevalence rate was 2.04%, with EV-A71 and CV-A6 mixed infections accounting for the majority of cases. Conclusion The main pathogens of acute intestinal infections in the Hanzhong area from 2019 to 2022 are EV-A71, CV-A16, and CV-A6. It is necessary to strengthen the monitoring of acute intestinal infections in children aged 4 years and below.

OBJECTIVE: To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose. METHODS: The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm. RESULTS: One patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any "cat ear" malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction. CONCLUSION The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Plastic Surgery Procedures ; Skin Transplantation ; Retrospective Studies ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Arteries/surgery* ; Cicatrix/surgery* ; Treatment Outcome ; Skin Neoplasms/surgery*

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Objective To investigate the risk factors of gastric cancer in Hanzhong area and establish a gastric cancer risk prediction model based on gastric function indexes. Methods A questionnaire survey was conducted on 227 patients with gastric and non-gastric cancer admitted to the Department of Gastroenterology of Hanzhong Central Hospital from January 2018 to January 2019. The diet, lifestyle habits, family history, and past history of the subjects were collected. Serological tests (including serum PGⅠ,Ⅱ, and G-17), gastroscopy and pathological examination of the samples were carried out. Multi-factor Logistic regression analysis was performed to analyze the high risk factors. The efficacy of serum gastric function for gastric cancer screening was assessed through ROC curve. Results There were no significant differences in the distribution of age (χ²=0.054, P=0.816), gender (χ²=3.823, P=0.051) and BMI (χ²=5.569, P=0.135) between the gastric cancer and non-gastric cancer groups, suggesting that the clinical data between the two groups was comparable. Multivariate logistic regression analysis showed that smoked food intake (P=0.031, 95% CI: 1.150 ~ 17.545) and hyperlipidemia (P=0.039, 95% CI:0.216~0.960) were high risk factors for gastric precancerous lesions, other factors did not show significant high risk (P>0.05). The results of ROC curve showed that the diagnostic efficacy of combined PG I, PG II, and G-17 was significantly higher than that of PG I, PGⅡ, or G-17 alone (P<0.05). Conclusion The risk factors of gastric cancer in Hanzhong area mainly included the intake of smoked food and hyperlipidemia. Patients can be advised to pay attention to diet during clinical treatment. Based on gastric function indexes PG, PGⅡ and G-17, the diagnosis of gastric precancerous lesions had a good prediction. The combined diagnosis is more effective, which provided a theoretical basis for the early diagnosis of clinical gastric cancer.

Objective:To investigate the effect of double steel plate internal fixation combined with autogenous iliac bone grafting on aseptic nonunion after femoral shaft fractures.Methods:Retrospective analysis of clinical data of 73 patients with aseptic nonunion after femoral shaft fracture treatment was performed in department of orthopedies, Honghui Hospital, Xi′an Jiaotong University from January 2017 to December 2018, there were 42 males and 31 females, aged 30 to 58 years, with an average age of 40.63 years. They were divided into control group ( n=33) and observation group ( n=40) according to different surgical methods, the control group was treated with intramedullary nail replacement, and the observation group was treated with double steel plate internal fixation combined with autogenous iliac bone grafting. The general indicators of perioperative period (intraoperative blood loss, duration of operation, postoperative drainage), bone nonunion healing, and surgical efficacy were compared between the two groups. The follow-up time in outpatient clinic was (15.24 ± 4.72) months, and the follow-up deadline was December 2019. At 6 months after surgery, joint function, joint mobility, visual analogue scale (VAS) and Oswestry disability index(ODI) were evaluated. Measurement data were expressed as mean ± standard deviation ( Mean ± SD), and comparison between groups was analyzed using independent sample t test. Count data were expressed as percentage (%), and comparison between groups was analyzed using χ2 test. Comparison of ordinal data was analyzed by Mann-whitney U non-parametric test. Results:The patients in both groups were followed up. The amount of intraoperative blood loss, duration of operation, and postoperative drainage [(201.6±38.4) mL, (138.7±22.7) min, (25.8±6.9) mL] in the observation group were significantly less than those in the control group [(278.5±40.6) mL, (171.4±20.1) min, (43.2±8.5) mL], the differences were statistically significant between the two groups ( P<0.05). Comparison of postoperative bone nonunion healing, the healing time of the observation group (5.15±0.42) months was significantly shorter than that of the control group (6.31±0.58) months, and the healing rate of the observation group (100%) was significantly higher than that of the control group (90.1%), the differences were statistically significant between the two groups ( P<0.05). After 6 months of follow-up, the excellent and good rate of joint function were compared between the two groups. The knee joint excellent and good rate (97.50%) and hip joint excellent and good rate (97.50%) in the observation group were significantly better than those of the control group (78.79%, 81.81%), the differences were statistically significant between the two groups ( P<0.05). Comparison of joint mobility between the two groups of patients, knee joint mobility [extension angle (0.64±0.14) °, flexion angle (138.72±6.37) °]and hip joint activity [adduction angle (35.13±9.44) °, the abduction angle (74.38±5.22) °] were significantly better than the knee joint mobility [extension angle (0.48±0.21) °, flexion angle (113.57±5.43) °] and hip joint motion [adduction angle (21.57±8.63) °, abduction angle (69.57±6.37) °], the differences were statistically significant between the two groups ( P<0.05). The VAS and ODI efficacy scores [(3.24±0.43), (23.45±4.77) scores]in the observation group were significantly better than those of the control group [(4.64±0.71), (27.25±4.38) scores] at 2 and 4 weeks after operation, the differences were statistically significant between the two groups ( P<0.05). Conclusions:The double steel plate internal fixation combined with autologous iliac bone grafting is ideal and significant in the treatment of aseptic nonunion after femoral shaft fracture. Meanwhile, it has the advantages of less trauma throughout the operation, quicker postoperative recovery, and significantly improved joint function. It is worthy of clinical application.

Fracture-related infection is one of the most feared complications for orthopedic surgeons and patients. What is more frightening than aseptic bone nonunion is the presence of deep or shallow bone tissue infection at the broken end of the fracture.The high rate of recurrence of bone infections, long treatment cycles and the risk of disability, amputation and death bring physical and mental suffering to patients.At the same time, the complexity of the disease puts forward higher requirements for the diagnosis and treatment of orthopedic doctors. This paper reviews the treatment methods of fracture related infections in recent years at home and abroad.

Objective:To evaluate the clinical efficacy and operative techniques of medullary external fixation with proximal femoral plate (PFP) and locking compression plate (LCP) assisted by double grafting (cancellous bone and allograft bone grafting in nail holes plus structural grafting at ununited fracture ends) for subtrochanteric femoral nonunions after intramedullary fixation.Methods:Between January 2018 and December 2008, 21 patients received secondary revision at Department of Orthopedics, Honghui Hospital for subtrochanteric femoral nonunion after intramedullary fixation. All of them obtained full follow-up. They were 15 men and 6 women, with an average age of 52.3 years (from 27 to 65 years). There were 18 cases of atrophic nonunion and 3 ones of ischemic nonunion. The intervals between primary operation and secondary revision averaged 10.3 months (from 9 to 13 months). All the fractures were treated by intramedullary fixation with closed reduction in 10 cases and open reduction in 11 cases (including 8 ones of wire binding). All the nonunions were managed with PFP and LCP assisted by double grafting (cancellous bone and allograft bone grafting in nail holes plus structural grafting at ununited fracture ends). Functional recovery of the hip was evaluated by Harris scoring 12 months after operation.Results:The 21 patients obtained an average follow-up of 11.4 months (from 10 to12 months).All the nonunions got united after an average time of 5.2 months (from 4 to 6 months). Postoperative subcutaneous haematomas occurred in only one patient which was treated by a secondary debridement. The mean hip Harris scores were 85.7 (from 84 to 92).Conclusions:As PFP can effectively correct varus deformity and strengthen fixation, LCP plus structural grafting can provide medial mechanical support, and cancellous bone and allograft bone grafting can increase the bone mass in nail holes, our composite method can greatly increase the healing rate of subtrochanteric femoral nonunions after intramedullary fixation with better functional recovery of the hip joint.

OBJECTIVE: To assess the geometrical matching of a new anatomical adaptive titanium mesh cage (AA-TMC) with the endplate and its effect on cervical segmental alignment reconstruction in single- and two-level anterior cervical corpectomy and fusion (ACCF) and compare the compressive load at the endplate between the AA-TMC and the conventional titanium mesh cage (TMC). METHODS: Twelve cervical cadaveric specimens were used to perform single- and two-level ACCF. The interbody angle (IBA), interbody height (IBH) and the interval between the AA-TMC and the endplate were evaluated by comparison of the pre- and postoperative X-ray images. The maximum load at the endplate was compared between the AA-TMC and TMC based on American Society for Testing and Materials (ASTM) F2267 standard. RESULTS: No significant differences were found between the preoperative and postoperative IBA and IBH in either single-level ACCF (11.62°±2.67° 12.13°±0.69° and 23.90±2.18 mm 24.23±1.13 mm, respectively; > 0.05) or two-level ACCF (15.63°±5.06° 16.16°±1.05°and 42.93±3.51 mm 43.04±1.70 mm, respectively; > 0.05). The mean interval between the AA-TMC and the endplate was 0.37 ± 0.3 mm. Compared to the conventional TMC, the use of AA-TMC significantly increased the maximum load at the endplate in both single-level ACCF (719.7±5.5 N 875.8±5.2 N, < 0.05) and two-level ACCF (634.3±5.9 N 873±6.1 N, < 0.05). CONCLUSIONS The use of AA-TMC in single-level and two-level ACCF can significantly increase the maximum load at the endplate to lower the possibility of implant subsidence and allows effective reconstruction of the cervical alignment.
Biomechanical Phenomena ; Cervical Vertebrae ; Humans ; Prostheses and Implants ; Spinal Fusion ; Surgical Mesh ; Titanium ; Treatment Outcome

Objective To investigate the influence of botulinum toxin A (BTX-A) injection in detrusor muscle region and detrusor muscle combined with bladder triangle region on the symptoms severity, bladder function and quality of life in patients with neurogenic detrusor overactivity (NDO) combined with urinary incontinence. Methods Sixty patients with NDO combined with urinary incontinence were chosen in the period from March 2011 to June 2017. The patients were divided into control group and observation group according to random digits table method with 30 cases each. The patients in control group were treated with detrusor muscle region BTX-A injection, and the patients in observation group were treated with detrusor muscle combined with bladder triangle region BTX-A injection. The number of urinary incontinence for every day, detrusor muscle overactivity (DO) duration, average urine volume, bladder detrusor muscle urine storage period of maximum pressure (Pdetmax), bladder compliance (BC), volume at first involuntary detrusor muscle contraction (VFIDC), quality of life of urinary incontinence (I-QOL) score and incidences of adverse reaction before and after treatment were compared between 2 groups. Results The number of urinary incontinence every day, DO duration, average urine volume, Pdetmax, BC, VFIDC and I-QOL score after treatment in observation group were significantly better than those in control group: (2.84 ± 0.56) times vs. (6.18 ± 1.22) times, (80.05 ± 9.49) s vs. (125.16 ± 12.72) s, (378.57 ± 91.03) ml vs. (255.88 ± 75.95) ml, (30.19 ± 5.47) cmH2O (1 cmH2O=0.098 kPa) vs. (47.33 ± 7.79) cmH2O, (10.04 ± 1.71) ml/cmH2O vs. (8.09 ± 1.32) ml/cmH2O, (249.60 ± 76.19) ml vs. (195.19 ± 60.72) ml and (63.17 ± 9.60) scores vs. (54.46 ± 6.29) scores, and there were statistical differences (P＜0.05). There was no statistical difference in incidence of adverse reaction (P＞0.05). Conclusions Detrusor muscle combined with bladder triangle region BTX-A injection in patients with NDO combined with urinary incontinence relieves the symptoms severity, improves the bladder function and quality of life and not increases the adverse reactions risk.

Objective To analyze the VP1-VP4 genetic region of enterovirus 71 ( EV71 ) strains isolated from children with severe or mild hand, foot and mouth disease ( HFMD) in Shenzhen in 2012. Methods EV71 strains were isolated from five children with mild HFMD and five children with severe HFMD in Shenzhen in 2012.Reverse transcription-polymerase chain reaction ( RT-PCR) method was used to amplify the sequence of VP1-VP4 genes of EV71 strains.The sequences of the amplified products were analyzed by comparing with those of the EV71 reference strains ( A, B and C genotypes) published in Gen-Bank using nucleotide alignment, amino acid alignment and phylogenetic tree analysis.Results The homo-geneity between the EV71 strains isolated from severe and mild cases was 95.1%-98.2% in nucleotides and 99.2%-100% in amino acids.The VP1-VP4 nucleotide sequences of 5 strains isolated from severe cases and 5 strains from mild cases in Shenzhen shared 87.9%-97.8% homologies in nucleotides and 97.3%-99.9% homologies in amino acids with the genotype C EV71 reference strain.The EV71 strains isolated from children in Shenzhen were highly similar with the EV71 strain (FJ439769) isolated in Fuyang in 2008 and the one isolated in Jingdezhen in 2011 (JQ806378, C4a subtype) in nucleotide sequences.Mutations at the residue 31 in the VP1 region ( N→D ) were detected in 3 strains isolated from children with severe HFMD.Conclusion All of the 10 EV71 strains isolated in Shenzhen in 2012 belonged to the sub-genotype C4a.The mutation ( aa31 N→D) in the VP1 region of EV71 might be related to the different clinical mani-festations of HFMD cases in Shenzhen area.