Objective To explore the risk factors of hip fracture in elderly patients from Yongkang.Methods From August 2014 to August 2016,468 elderly patients with hip fracture admitted to Department of Orthopedics, Orthopedics Hospital of Yongkang were prospectively collected as study group,and 150 elderly people admitted to Orthopedics Hospital of Yongkang and Community Health Service Center for health examination were randomly selected as control group.The complications,daily living habits,bone density and menstruation of the female were observed between the two groups.Results Compared with the control group,the incidence rate of diabetes in the study group increased significantly(28.63% vs.12.67%,χ2 =15.544,P =0.000),the rate of height decreased more than 3cm increased significantly (16.88% vs.8.00%,χ2 =7.134,P =0.008),the proportion of long -term use of hormone significantly increased (18.59% vs.10.00%,χ2 =6.082,P =0.014),the rate of physical exercise decreased signif-icantly (14.32% vs.22.67%,χ2 =5.793,P =0.016),the rate of bed ridden increased significantly (5.34% vs 1.33%,χ2 =4.369,P =0.037),the bone density of femoral neck decreased significantly[(0.99 ±0.12)g/cm2 vs. (1.10 ±0.12)g/cm2 ,t =10.139,P =0.000].When it came to the females,the rate of menopause before the age of 45 years in the study group was higher than that in the control group (33.23% vs.22.22%,χ2 =4.299,P =0.038).Conclusion Diabetes,height decrease >3 cm,long -term use of hormones,lack of physical exercise,bed ridden and bone density decrease are risk factors of hip fracture in elderly people from Yongkang,and menopause before the age of 45 is a risk factor for hip fracture in elderly women.

Objective To investigate the etiological, clinical and neuroimaging features of symmetric corpus callosum lesions. Methods The clinical data of 27 patients with symmetric corpus callosum lesions were analyzed including the etiological, clinical and neuroimaging data retrospectively. Results In 27 patients, 16 patients suffered from chronic alcoholic encephalopathy, 5 patients suffered from viral encephalitis, 2 patients suffered from disturbance of water and electrolyte, 1 patient suffered from acute disseminated encephalomyelitis(ADEM), 2 patients suffered from brain trauma, and the etiology of 1 patient was unknown. Clinical manifestation: 8 patients had conscious disturbance, 5 patients had psychological and behavior disorder, 5 patients had epileptic seizure, 4 patients had ataxia, 3 patients had dysarthria and 2 patients had headache. There were abnormalities in CT scans and MRI. Manifestations in CT scans were symmetric low-density focus with clear boundary in corpus callosum. The performance in MRI was low-signals on T1WI but high signals on T2WI and DWI images, and there might be other intracranial lesions. In the follow-up period, foci disappeared in 15 patients, and foci persisted in 7 patients. Four patients lost in follow-up periods, and 1 patient was not followed up because of death. Conclusions The causes of symmetric corpus callosum lesions include chronic alcoholic encephalopathy, infections, disturbance of water and electrolyte and demyelination. And in some patients the cause is unknown up to now. The etiological treatment and symptomatic treatment are the common treating ways in clinic.

OBJECTIVE: To provide prenatal diagnosis, pedigree analysis and genetic counseling for a pregnant woman who had given birth to a child featuring global developmental delay. METHODS: A pregnant woman who underwent prenatal diagnosis at the Affiliated Hospital of Southwest Medical University in August 2021 was selected as the study subject. Peripheral blood samples were collected from the woman, her husband and child, in addition with amniotic fluid sample during mid-pregnancy. Genetic variants were detected by G-banded karyotyping analysis and copy number variation sequencing (CNV-seq). Pathogenicity of the variant was predicted based on the guidelines from the American College of Medical Genetics and Genomics (ACMG). Candidate variant was traced in the pedigree to assess the recurrence risk. RESULTS: The karyotypes of the pregnant woman, her fetus, and affected child were 46,XX,ins(18)(p11.2q21q22), 46,X?,rec(18)dup(18)(q21q22)ins(18)(p11.2q21q22)mat and 46,XY,rec(18)del(18)(q21q22)ins(18)(p11.2q21q22)mat, respectively. Her husband was found to have a normal karyotype. CNV-seq has revealed a 19.73 Mb duplication at 18q21.2-q22.3 in the fetus and a 19.77 Mb deletion at 18q21.2-q22.3 in her child. The duplication and deletion fragments were identical to the insertional fragment in the pregnant woman. Based on the ACMG guidelines, the duplication and deletion fragments were both predicted to be pathogenic. CONCLUSION The intrachromosomal insertion of 18q21.2-q22.3 carried by the pregnant woman had probably given rise to the 18q21.2-q22.3 duplication and deletion in the two offspring. Above finding has provided a basis for genetic counseling for this pedigree.
Child ; Female ; Humans ; Pregnancy ; DNA Copy Number Variations ; East Asian People ; Pedigree ; Prenatal Diagnosis/methods* ; Chromosomes, Human, Pair 18/genetics* ; Male ; Fetus ; INDEL Mutation

Objective:To explore the application and choice of trunk perforator flaps in chest wound repair.Methods:From May 2015 to December 2019, clinical data of 14 patients using trunk perforator flap for chest soft tissue defect repair were reviewed. They were 8 males and 6 females, aged from 17 to 74 years. 5 patients had wound after scar surgery. 6 patients had benign lesions, and 3 patients had malignant tumors. The size of tissue defects ranged from 6.0 cm×8.0 cm-20.0 cm×21.0 cm. The perforator flaps were designed to repair different wounds. Preoperatively, the perforators are identified by ultrasound or CTA, and the flap scope and surgical approach are designed according to the perforator alignment and the perforated muscle point. Postoperatively, the survival of the flap was observed and followed up for at least 6 months.Results:All 17 flaps of 14 patients survived. The flap area was 7.0 cm × 8.0 cm-22.0 cm × 22.0 cm, and the length of the pedicle was 2.0-6.0 cm. All patients were followed up for 6 to 26 months with satisfied result . Recurrence occurred in one of the patients with thoracic dermatofibrosarcoma protuberans.Conclusions:The perforator artery of the trunk is densely and easy to obtain. The combined flaps could be used to repair large chest defects. The first-stage suture of the donor area, so it meets the organization transplantation principle of "the repair is perfect, the damage is small" .

Objective:To examine the effect of surgical treatment in children with pulmonary artery sling and the surgical treatment strategy.Methods:Relevant data of 110 children with pulmonary artery sling admitted to the Department of Cardiac Surgery, Children′s Hospital Affiliated to Shandong University from February 2017 to July 2022 were retrospectively analyzed. There were 55 males and 55 females, aging ( M(IQR)) 9.0 (10.6) months (range: 1 to 96 months). The weight was 7.8 (3.5) kg (range: 2.5 to 25.0 kg). Of the 110 patients, 108 had different degrees of tracheal stenosis and 2 had normal trachea. Left pulmonary artery transplantation and tracheoplasty were performed in 78 patients. Left pulmonary artery transplantation was performed in 30 patients (11 in our hospital and 19 in other hospitals) due to the lack of an early tracheoplasty technique, in which 24 patients needed stage Ⅱ tracheoplasty due to obvious respiratory symptoms and limited activity endurance, and 6 cases did not intervene. Two children with normal trachea only underwent left pulmonary artery transplantation. Results:Among the 78 children who underwent surgery in the same period, 70 cases recovered smoothly after surgery, of whom respiratory symptoms were significantly reduced or disappeared during the 1 to 65 months follow-up, with similar activity endurance to normal children of the same age. Eight cases died, including 4 cases of postoperative multi-drug resistant bacteria infection, died from tracheal anastomotic opening or septic shock, 1 cases with severe congenital heart disease died from postoperative low cardiac output syndrome difficult to correct, 1 case died from blood pressure could not be maintained due to the compressed left pulmonary artery after transplantation, 2 cases of postoperative digestive system diseases (adhesive intestinal obstruction, gastrointestinal bleeding, etc.). The 24 patients in the staging group were followed for 1 to 84 months. All patients needed stage Ⅱ tracheoplasty due to respiratory symptoms and decreased endurance to activity. Eight cases of the non-intervention tracheal group were successfully separated from the ventilator, cured and discharged in a short period of time.Conclusions:Most children with pulmonary artery sling have tracheal stenosis. Children with low degree of tracheal stenosis and inconspicuous respiratory symptoms can only undergo left pulmonary artery transplantation by lateral thoracotomy. For patients combined with severe tracheal stenosis or obvious respiratory symptoms, a simultaneous left pulmonary artery transplantat and tracheoplasty is recommended.

Objective:To examine the treatment strategy of congenital tracheal stenosis associated with non-vascular ring cardiac malformations.Methods:This is a retrospective case series study. Clinic data from 24 children with tracheal stenosis who underwent surgical treatment in the Department of Cardiac Surgery, Children′s Hospital Affiliated to Shandong University from February 2017 to March 2023 were retrospectively collected. There were 16 males and 8 females, aged ( M(IQR)) 6.5 (19.6) months (range: 2.2 to 66.3 months) and weighted 5.95 (4.76) kg (range: 3.2 to 20.0 kg). All patients had obvious respiratory symptoms. Eighteen patients underwent cardiac malformation correction and tracheoplasty at the same time (simultaneous group). Six patients in the staged operation group were treated with cardiac malformation correction in the first stage operation and tracheoplasty in the second stage operation due to missed diagnosis or delayed diagnosis of tracheal stenosis or no condition for tracheoplasty. Slide tracheoplasty was used to correct tracheal stenosis in both groups. The recovery of the children was followed. Wilcoxon sign rank test was used for comparison between the two groups. Results:There was no death during the perioperative period and hospitalization. In the simultaneous group, 1 case with delayed chest closure underwent bedside chest closure after 52 hours, 2 cases were intubated again after operation, and 1 case was implanted with an endotracheal stent. The duration of mechanical ventilation was 40.5 (39.6) hours (range: 19.0 to 438.8 hours). In the staged group, there was 1 case of re-intubation after operation, combined with left vocal cord paralysis and respiratory multidrug-resistant bacterial infection ( Acinetobacter baumanii). One patient underwent 3 times of bronchoscopic balloon dilatation of the right middle bronchus, and heart rate returned to normal range. The duration of mechanical ventilation was 19.0 (21.4) hours (range: 17.1 to 96.7 hours). During follow-up, a patient in the simultaneous group was prone to respiratory infection and had good exercise tolerance, 1 case in the staged group still had sputum stridor in the throat 3 months after the operation, and symptoms improved significantly 6 months after the operation. The other children didn′t have obvious respiratory symptoms. Conclusions:The diagnosis of tracheal stenosis may be delayed or missed when tracheal stenosis is complicated by non-vascular ring cardiac malformations. One-stage correction of tracheal stenosis and cardiac malformation can achieve a good outcome.

Objective:To examine the effect of surgical treatment in children with pulmonary artery sling and the surgical treatment strategy.Methods:Relevant data of 110 children with pulmonary artery sling admitted to the Department of Cardiac Surgery, Children′s Hospital Affiliated to Shandong University from February 2017 to July 2022 were retrospectively analyzed. There were 55 males and 55 females, aging ( M(IQR)) 9.0 (10.6) months (range: 1 to 96 months). The weight was 7.8 (3.5) kg (range: 2.5 to 25.0 kg). Of the 110 patients, 108 had different degrees of tracheal stenosis and 2 had normal trachea. Left pulmonary artery transplantation and tracheoplasty were performed in 78 patients. Left pulmonary artery transplantation was performed in 30 patients (11 in our hospital and 19 in other hospitals) due to the lack of an early tracheoplasty technique, in which 24 patients needed stage Ⅱ tracheoplasty due to obvious respiratory symptoms and limited activity endurance, and 6 cases did not intervene. Two children with normal trachea only underwent left pulmonary artery transplantation. Results:Among the 78 children who underwent surgery in the same period, 70 cases recovered smoothly after surgery, of whom respiratory symptoms were significantly reduced or disappeared during the 1 to 65 months follow-up, with similar activity endurance to normal children of the same age. Eight cases died, including 4 cases of postoperative multi-drug resistant bacteria infection, died from tracheal anastomotic opening or septic shock, 1 cases with severe congenital heart disease died from postoperative low cardiac output syndrome difficult to correct, 1 case died from blood pressure could not be maintained due to the compressed left pulmonary artery after transplantation, 2 cases of postoperative digestive system diseases (adhesive intestinal obstruction, gastrointestinal bleeding, etc.). The 24 patients in the staging group were followed for 1 to 84 months. All patients needed stage Ⅱ tracheoplasty due to respiratory symptoms and decreased endurance to activity. Eight cases of the non-intervention tracheal group were successfully separated from the ventilator, cured and discharged in a short period of time.Conclusions:Most children with pulmonary artery sling have tracheal stenosis. Children with low degree of tracheal stenosis and inconspicuous respiratory symptoms can only undergo left pulmonary artery transplantation by lateral thoracotomy. For patients combined with severe tracheal stenosis or obvious respiratory symptoms, a simultaneous left pulmonary artery transplantat and tracheoplasty is recommended.

Objective:To examine the treatment strategy of congenital tracheal stenosis associated with non-vascular ring cardiac malformations.Methods:This is a retrospective case series study. Clinic data from 24 children with tracheal stenosis who underwent surgical treatment in the Department of Cardiac Surgery, Children′s Hospital Affiliated to Shandong University from February 2017 to March 2023 were retrospectively collected. There were 16 males and 8 females, aged ( M(IQR)) 6.5 (19.6) months (range: 2.2 to 66.3 months) and weighted 5.95 (4.76) kg (range: 3.2 to 20.0 kg). All patients had obvious respiratory symptoms. Eighteen patients underwent cardiac malformation correction and tracheoplasty at the same time (simultaneous group). Six patients in the staged operation group were treated with cardiac malformation correction in the first stage operation and tracheoplasty in the second stage operation due to missed diagnosis or delayed diagnosis of tracheal stenosis or no condition for tracheoplasty. Slide tracheoplasty was used to correct tracheal stenosis in both groups. The recovery of the children was followed. Wilcoxon sign rank test was used for comparison between the two groups. Results:There was no death during the perioperative period and hospitalization. In the simultaneous group, 1 case with delayed chest closure underwent bedside chest closure after 52 hours, 2 cases were intubated again after operation, and 1 case was implanted with an endotracheal stent. The duration of mechanical ventilation was 40.5 (39.6) hours (range: 19.0 to 438.8 hours). In the staged group, there was 1 case of re-intubation after operation, combined with left vocal cord paralysis and respiratory multidrug-resistant bacterial infection ( Acinetobacter baumanii). One patient underwent 3 times of bronchoscopic balloon dilatation of the right middle bronchus, and heart rate returned to normal range. The duration of mechanical ventilation was 19.0 (21.4) hours (range: 17.1 to 96.7 hours). During follow-up, a patient in the simultaneous group was prone to respiratory infection and had good exercise tolerance, 1 case in the staged group still had sputum stridor in the throat 3 months after the operation, and symptoms improved significantly 6 months after the operation. The other children didn′t have obvious respiratory symptoms. Conclusions:The diagnosis of tracheal stenosis may be delayed or missed when tracheal stenosis is complicated by non-vascular ring cardiac malformations. One-stage correction of tracheal stenosis and cardiac malformation can achieve a good outcome.

Biological age (BA) is a marker to accurately assess aging, facilitating the prediction of age-related diseases and promoting healthy aging. In recent years, first- and second-generation organ-system-specific BA has been developed using chronological age (CA) or aging-related outcomes (mortality) as training phenotypes and data from questionnaires, physical examinations, clinical biochemistry, imaging, and multi-omics to investigate the specificity of organ systems aging. Here, we review the methodologies for constructing BA, current efforts to assess organ system-specific BA, and related genome-wide association studies (GWAS). Previous studies predominantly used the first-generation BA method, using CA as training phenotypes. Organ-system-specific BA can accurately predict the disease risk of corresponding organ systems. We propose the development of organ system-specific BA through second-generation BA models and conducting GWAS and Mendelian randomization studies to explore organ system-specific aging processes, which will provide a theoretical foundation for the clinical application of organ system-specific BA.

Objective:To explore the application and choice of trunk perforator flaps in chest wound repair.Methods:From May 2015 to December 2019, clinical data of 14 patients using trunk perforator flap for chest soft tissue defect repair were reviewed. They were 8 males and 6 females, aged from 17 to 74 years. 5 patients had wound after scar surgery. 6 patients had benign lesions, and 3 patients had malignant tumors. The size of tissue defects ranged from 6.0 cm×8.0 cm-20.0 cm×21.0 cm. The perforator flaps were designed to repair different wounds. Preoperatively, the perforators are identified by ultrasound or CTA, and the flap scope and surgical approach are designed according to the perforator alignment and the perforated muscle point. Postoperatively, the survival of the flap was observed and followed up for at least 6 months.Results:All 17 flaps of 14 patients survived. The flap area was 7.0 cm × 8.0 cm-22.0 cm × 22.0 cm, and the length of the pedicle was 2.0-6.0 cm. All patients were followed up for 6 to 26 months with satisfied result . Recurrence occurred in one of the patients with thoracic dermatofibrosarcoma protuberans.Conclusions:The perforator artery of the trunk is densely and easy to obtain. The combined flaps could be used to repair large chest defects. The first-stage suture of the donor area, so it meets the organization transplantation principle of "the repair is perfect, the damage is small" .