Objective:To evaluate our self-designed guide device for Kirschner-wire placement in the surgery for paediatric fractures of supracondylar humerus.Methods:A retrospective study was conducted of the 117 children who had been treated for fractures of supracondylar humerus at Department of Orthopedics, The First People's Hospital of Huaian Affiliated to Nanjing Medical University from March 2019 to January 2023. There were 64 boys and 53 girls with an age of (5.8±1.5) years. By the Gartland classification, there were 67 fractures of type Ⅱ and 50 fractures of type Ⅲ. The time from injury to operation averaged (48.5±10.8) hours. The children were divided into 2 groups according to how their Kirschner-wires were placed. In the control group of 58 cases, external percutaneous Kirschner-wire placement was assisted using a syringe needle; in study group of 59 cases, external percutaneous Kirschner-wire placement was assisted using our self-designed guide device for Kirschner-wire placement. The operation time, rate of one-time placement of disposable K-wire, intraoperative fluoroscopy frequency, Baumann angle, carrying angle, fracture healing time, Flynn score of elbow joint function at the final follow-up, and postoperative complications were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). The 117 pediatric patients were followed up for (15.3±3.2) months after operation. The operation time [(30.6±4.5) min] and intraoperative fluoroscopy frequency [(15.6±2.1) times] in the study group were significantly less than those in the control group [(40.6±7.3) min and (23.7±4.9) times], while the rate of one-time placement of disposable K-wire in the study group was significantly higher than that in the control group [84.2%(149/177) versus 32.2%(56/174)] ( P<0.05). There were no significant differences in Baumann angle, carrying angle, fracture healing time, or Flynn score of elbow joint function at the final follow-up between the 2 groups ( P>0.05). The incidence of complications in the study group (6.8%, 4/59) was significantly lower than that in the control group (20.7%, 12/58) ( P<0.05). Conclusions:Our self-designed guide device for Kirschner-wire placement is simple and convenient to use. In the surgery for paediatric fractures of supracondylar humerus, it can improve the rate of one-time placement of disposable K-wire, reduce intraoperative fluoroscopy, and decrease the incidence of complications.

Objective:To explore the reliability and validity of the International Classification of Functioning, Disability and Health′s 17-item Rehabilitation Set (ICF-RS-17) when used to evaluate multidisciplinary inpatients.Methods:A total of 359 inpatients in the departments of rehabilitation, orthopedics, neurology, and neurosurgery of three hospitals in Jiangsu province were assessed with the ICF-RS-17 at admission and at discharge, and the internal consistency of the tool was calculated. Inter-rater and intra-rater reliability were quantified using interclass correlation coefficients (ICCs). Structural validity was analyzed using factor analysis.Results:The tool′s Cronbach′s α was 0.945. The overall inter-rater ICC was 0.946 with the ICCs of all of the items except b280 sensation of pain within the range from 0.630 to 0.948. The overall intra-rater ICCs ranged from 0.471 to 0.947. The factor analysis found three factors with eigenvalues greater than 1, accounting for 74% of the variation, without double-loaded items. The three influential factors were exercise ability, sleep perception communication ability and self-care ability.Conclusion:The ICF-RS-17 has good internal consistency, inter-rater and intra-rater reliability and structural validity in the evaluation of multidisciplinary inpatients.

Objective    To review and analyze the clinical manifestations of common aortitis in cardiac surgery. Methods    We screened 41 552 patients who were hospitalized in the Department of Cardiac Surgery of Zhongshan Hospital, Fudan University from 2010 to 2020, analyzed the patients' clinical data, and classified according to the type of diseases. Then we summarized all their clinical manifestations. Results    In our center 145 patients were operated for aortitis diseases, including 75 males and 70 females, with the age of 24-76 (45.6±11.3) years. There were 61 patients of Takayasu's arteritis, 51 patients of Behcet's disease, 8 patients of syphilitic aortitis, 8 patients of systemic lupus erythematosus, 2 patients of Kawasaki disease, 4 patients of ankylosing spondylitis, 10 patients of dry syndrome, and 1 patient of scleroderma. Conclusion    Aortitis is not uncommon in cardiac surgery, and awareness of the disease should be enhanced. So that we can distinguish various types of aortitis and to make proper management to improve patients' prognosis.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.

Objective:To confirm items included in a tool for assessing clinical outcomes based on International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set.Methods:The item pool was established based on the ICF Rehabilitation Set. Then 15 experts were invited to participate in three rounds of expert Delphi consensus-building to choose items with high importance in assessing clinical outcomes. The reliability of the tool was examined by analyzing the experts′ positive coefficients, authority coefficients and degree of agreement.Results:The assessment tool which emerged from the three rounds comprised 17 items, including 8 Body Functions items (b130 Energy and drive functions, b134 Sleep functions, b152 Emotional functions, b280 Sensation of pain, b455 Exercise tolerance functions, b620 Urination functions, b710 Mobility of joint functions and b730 Muscle power functions), d230 Carrying out daily routine from General Tasks and Demands, 3 Mobility items (d410 Changing basic body position, d450 Walking and d465 Moving around using equipment), 4 Self-care items (d510 Washing oneself, d530 Toileting, d540 Dressing and d550 Eating) and 1 item of Interpersonal Interactions and Relationships (d710 Basic interpersonal interactions). All had 100% positive coefficients after the three rounds, with an authority coefficient of 0.81 and coefficients of variation between 0.054 and 0.412.Conclusion:The assessment tool constructed in this study provides a new direction for quality control in clinical practice and medical insurance assessments.

Objective:To explore the validity of a function assessing tool based on the International Classification of Functioning, Disability and Health′s (ICF′s) rehabilitation set in assessing aging-related disability.Methods:A total of 1610 elderly people from 15 nursing homes across China were assessed using the tool based on the ICF′s rehabilitation set and with the 12-item short form health survey (SF-12). The structural validity of the responses was analyzed using factor analysis, and criterion-related validity was also evaluated.Results:The factor analysis yielded three factors with eigenvalues greater than 1. Their cumulative explanatory power was 74.4%. Item d550 eating had double loading in the factor analysis. The item scores and the total scores of the disability assessment tool were significantly negatively correlated with the physiological function domain scores and the psychological function domain scores.Conclusion:The function assessment tool based on the ICF′s rehabilitation set when combined with a numerical rating scale has good structural and criterion-related validity in the assessment of disability due to aging.

Objective:To investigate the reliability of a tool based on the International Classification of Functioning, Disability and Health (ICF) in the assessment of functioning despite disability.Methods:A total of 371 patients were assessed using a tool based on the ICF rehabilitation set combined with a numerical rating scale ranging from 0 to 10. The internal consistency, inter-rater reliability and intra-rater reliability were analyzed.Results:The scale′s Cronbach′s alpha coefficient was 0.89. The inter-rater correlation coefficient was 0.85, and the correlations among the items ranged from 0.78 to 0.94. The intra-rater correlation coefficient with the scale was 0.95, with the item correlations ranging from 0.72 to 0.97. Only item b230 Hearing function did not correlate well.Conclusions:The functioning assessment tool based on the ICF rehabilitation set when combined with a numerical rating scale has internal consistency, inter-rater reliability and intra-rater reliability sufficient for use in clinical practice.

OBJECTIVETo study differential expression of microRNA (miRNA) in peripheral blood mononuclear cells (PBMNC) from patients with different types of aplastic anemia (AA) and explore the role of miRNA in the pathogenesis of AA.

METHODSmiRNA microarray were used to determine the differential expression profile of miRNA in PBMNC from patients with AA. Real-time quantitative polymerase china reaction (RQ-PCR) was used to verify the differential expression of miRNA. Candidate miRNA were analyzed with bioinformatics tools.

RESULTSCompared with the normal controls, 6 miRNAs were up-regulated and 10 were down-regulated in patients with severe aplastic anemia (SAA), while 24 miRNAs were up-regulated and 12 were down-regulated in patients with chronic non-severe aplastic anemia (CAA). Compared with CAA patients, 4 miRNAs were up-regulated and 11 were down-regulated in SAA patients. Compared with normal controls, 3 miRNAs were up-regulated and 4 were down-regulated in both SAA and CAA patients. As verified by RQ-PCR, expression of miR-155-5p and miR-1260b were increased in both CAA and SAA patients compared with the normal controls (P<0.01). The expression of miR-155-5p and miR-1260b of CAA patients were higher than that of SAA patients (P<0.01). Bioinformatics analysis showed that target genes of miR-155-5p and miR-1260b may be involved in regulation of cell metabolism, gene expression and transcription, TNF signaling pathway, B cell receptor signaling pathway, Fc gamma R-mediated phagocytosis and other signaling process.

CONCLUSIONThere are characteristic differential expression profiles of miRNA in PBMNC from CAA and SAA patients, in which miRNA-155-5p and miRNA-1260b are both up-regulated. The common target gene predicted for miRNA-155-5p and miRNA-1260b is ETS1. miRNA-155-5p and miRNA-1260b may act synergistically to inhibit the expression of ETS1 and promote differentiation of Th17, therefore play an important role in the pathogenesis of AA.

Objective To investigate the status quo of knowledge-attitude-practice in preventing venous thromboembolism (VTE) among medical staff in Shandong Province and analyze the influencing factors, so as to provide guidance for the prevention and treatment of VTE. Methods In November 2017, 1 987 medical staff from 52 hospitals in Shandong Province were investigated by filling out an electronic questionnaire with a self-designed questionnaire on knowledge, attitude and behavior related to VTE prevention among medical staff. Results The knowledge score on VTE prevention of medical staff was (19.49±2.33), attitude score (21.82±2.55), practice score (64.87±9.54), respectively accounted for 88.59%, 87.28% and 81.09%. The total scores of knowledge, belief and practice of VTE prevention among medical staff in different hospital grades, occupations, educational background, professional titles and departments were statistically significant (F=9.419, 8.418, 2.823, 6.852, 6.375; P＜ 0.05). Conclusions Medical staff have a higher level of knowledge and attitude towards prevention of VTE, but lack of behavioral knowledge. The hospital should establish a standardized VTE prevention and management system to raise the level of VTE prevention and control.

Objective To determine the effectiveness and medical cost-effectiveness of clinical rehabilitation for promoting the functional recovery of sub-acute cerebral infarction patients.Methods Totally 247 sub-acute patients with cerebral infarction were randomly divided into a clinical rehabilitation group of 129 and a routine rehabilitation group of 118.The clinical group received a standardized rehabilitation intervention and drug treatment,while the routine rehabilitation group received routine rehabilitation therapy and drug treatment.The Fugl-Meyer assessment (FMA) and the modified Barthel index (MBI) were used to compare the two groups after the treatment and 3 and 6 weeks later.The hospital cost for six weeks was also compared between the 2 groups.Results At 3 and 6 weeks,improvement in the average FMA and MBI scores was observed in both groups but the inter-group differences were not significant.The total hospital cost of the clinical group was,however,significantly less than that of the others.Conclusion Clinical rehabilitation can improve the motor function and ability in the activities of daily living of stroke patients.It also has economic benefits.