BACKGROUND:Ilizarov bone transport is very effective in the treatment of open large tibial bone defects,but there are still complications,among which the difficulty of junction healing is one of the difficult points in treatment. OBJECTIVE:To investigate the effect of Ilizarov bone transport combined with antibiotic bone cement on junction healing after operation of open large tibial bone defect. METHODS:Totally 51 patients with open large tibial bone defect(bone defect>4 cm)admitted to Binzhou Medical University Hospital from August 2010 to January 2022 were selected,of which 28 received Ilizarov bone transport alone(control group)and 23 received Ilizarov bone transport combined with antibiotic bone cement treatment(trial group).External fixation time,bone healing time,bone healing index,visual analog scale score during bone removal,bone defect limb function,junction healing and complications at the final follow-up were statistically compared between the two groups. RESULTS AND CONCLUSION:(1)All the 51 patients were followed up for a mean of(22.53±5.77)months.External fixation time,bone healing time,bone healing index,postoperative infection rate,and non-healing rate of junction were less in the trial group than those in the control group(P<0.05).There was no significant difference between the two groups in visual analog scale scores at 6 months after the second surgery and in the functional excellence and good rate of limb with bone defect at the final follow-up(P>0.05).(2)These findings indicate that compared with the Ilizarov bone transport alone,Ilizarov bone transport combined with antibiotic bone cement treatment can promote the healing of open tibial fracture junction and increase the rate of bone healing.

Objective:Analyze the mediating and moderating effects of the relationship between food intake and blood glucose levels.Methods:This study uses data from the China Health and Nutrition Survey project in the survey 2018, involving 11 043 adults aged 18 years or older, who have complete dietary data, waist circumference (WC), glycated hemoglobin A1c (HbA1c) indicators, and other key variables. Food consumption data was gathered via three consecutive 24-hour dietary recalls and weighing accounting method, which included two weekdays and one weekend day. The average daily intake of various foods and total energy intake were calculated. The mediation effect and moderation effect analysis were conducted using simple mediation models, direct moderation effect models, and moderated mediation analysis theoretical models. The confidence interval method (bootstrap method) was performed for testing and analysis.Results:A total of 4 951 males and 6 092 females were included in the stratified analysis by gender. The mediating effects on the rice, wheat, and red meat→WC→HbA1c were all statistically significant in males. The standardized coefficients were -0.009 ( P<0.001), 0.013 ( P<0.001), and -0.005 ( P=0.008), respectively. In females, the mediating effect on the wheat→WC→HbA1c was statistically significant, and the standardized coefficient was 0.017 ( P<0.001); the impact of red meat intake on HbA1c is negatively regulated by the intake of dark vegetables, with a direct moderating effect; the standardized coefficient of the interaction term between red meat and dark vegetables was -0.024 ( P=0.008). Dark vegetables have a moderated mediator on the pathway from rice to WC and HbA1c ( a3b1=-0.003, P=0.041) in males. The mediating effect of WC is negatively regulated by the intake of dark vegetables (mediation effect difference U1/-1=-0.006, P=0.048). Dark vegetables showed a moderated mediator on the pathway from wheat to WC and HbA1c ( a3b1=-0.004, P=0.045) in females. The mediating effect of WC is negatively regulated by the intake of dark vegetables (mediation effect difference U1/-1=-0.009, P=0.049). Conclusions:Changes in WC indicators caused by rice, wheat, and red meat intake. WC could mediate between rice, wheat, red meat, and HbA1c. Dark vegetables directly or indirectly regulate HbA1c levels by interacting with rice, wheat, and red meat.

Objective To investigate the therapeutic effect of segmental decompression combined with corrective short-segment fusion surgery for the treatment of degenerative lumbar scoliosis.Methods In total,124 patients with degenerative lumbar scoliosis were selected and divided into short-and long-segment fusion groups using the random number table method,with 62 patients in each group.Posterior short-segment decompression,fixation,and fusion were performed in the short-segment fusion group;the fusion segment was the adjacent lumbar vertebra.Posterior long-segment decompression,fixation,and fusion were performed in the long-segment fusion group;the fusion segments included multiple adjacent lumbar vertebrae.At the 6th month after surgery,the coronal Cobb angle of lumbar convexity,sagittal Cobb angle of lumbar lordosis,intervertebral foramen height,intervertebral space height,intervertebral foramen area,spinal canal area,spinal canal diameter,Japanese Orthopedic Association(JOA)score,Oswestry Disability Index(ODI),degree of pain in the lower back and lower limbs,and postoperative complications were compared between the groups.Results The Cobb angle of the coronal lumbar scoliosis in the short-and long-segment fusion groups was significantly higher than that before surgery(P<0.05).At the 6th month after surgery,the intervertebral foramen height,intervertebral space height,intervertebral foramen area,spinal canal area,and spinal canal diameter in both groups increased,and those in the short-segment fusion group were higher than those in the long-segment fusion group(P<0.05);at the 6th month after the operation,the JOA scores of the short-segment and long-segment fusion groups were higher than those before surgery,and the JOA score of the short-segment fusion group was higher than that of the long-segment fusion group(P<0.05).The ODI score was lower than that before surgery in the short-and long-segment fusion groups,and the ODI score in the short-segment fusion group was lower than that in the long-segment fusion group(P<0.05).At the 6th month after surgery,the pain scores of the lower back and lower limbs in the short-and long-segment fusion groups were significantly higher than those before surgery(P<0.05).There were two cases of dural tears during decompression caused by lamina dura adhesion in the long-segment fusion group,and no serious complications were observed in the short-segment fusion group.Conclusions Both short-and long-segment decompression fixation fusion using a posterior approach can achieve good therapeutic effects for treating degenerative lumbar scoliosis.However,compared to the long-segment fusion group,the short-segment fusion group undergoing short-segment decompression fixation fusion through a posterior approach had a shorter surgical period,lower intraoperative blood loss,better recovery of lumbar function,and a lower risk of postoperative complications.

Objective:To investigate the predictive value of the combination of real-time three dimensional echocardiography of esophagus(RT-3D-TEE),computed tomography angiography(CTA)and congestive heart failure hypertension age diabetes mellitus prior stroke or transient ischemic attack vascular disease sex category(CHA2DS2-VASc)for left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.Methods:A total of 88 patients with non-valvular atrial fibrillation admitted to the department of cardiovascular medicine of Cangzhou People's Hospital from January 2022 to June 2023 were selected as the study subjects.They were divided into thrombus group(n=36)and non-thrombus group(n=52)based on whether occurred left atrial appendage thrombosis.All patients underwent RT-3D-TEE and CTA examinations,and underwent CHA2DS2-VASc scoring.Logistic regression was used to analyze the related factors of forming left atrial appendage in patients with non-valvular atrial fibrillation.Receiver operating characteristic(ROC)curve was used to analyze the predictive values of RT-3D-TEE,CTA and CHA2DS2-VASc on left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.And then,area under curve(AUC)value,sensitivity and specificity were calculated.Results:The maximum left atrial appendage emptying velocity(LAAeV)(51.48±5.87),the maximum left atrial appendage filling velocity(LAAfV)(48.36±5.49)and three-dimensional volume ejection fraction(3D-EF)(39.26±3.24)in the thrombus group were all significantly lower than those in the non-thrombus group,and the differences were statistically significant(t=5.933,6.767,4.605,P＜0.05),respectively.The opening diameter,short diameter and circumference,volume and area of left atrial appendage of the thrombus group were all larger than those of the non-thrombus group,while the ejection fraction was smaller than that of the non-thrombus group(t=6.581,3.410,9.220,3.178,4.453,4.162,P＜0.05),respectively.The ratios of cauliflower and cactus types of thrombus group were larger than those of non-thrombus group,and the ratios of wind vane type and chicken wing type were smaller than those of non-thrombus group,and the differences were significant(x2=3.771,7.132,1.003,5.455,P＜0.05),respectively.The CHA2DS2-VASc score of the thrombus group was significantly higher than that of the non-thrombus group,and the difference was statistically significant(t=12.269,P＜0.05).LAAeV,LAAfV,3D-EF,the long diameter of opening,the short diameter of opening,circumference of opening,volume,ejection fraction,spatial morphology and CHA2DS2 VASc score significantly correlated to the left atrial appendage thrombosis of patients with non-valvular atrial fibrillation(OR=4.323-19.562,P＜0.05).The sensitivity,specificity and AUC value of the combination of RT-3D-TEE,CTA and CHA2DS2-VASc were respectively 93.48%,90.83%and 0.895(0.654-0.963)in predicting left atrial appendage thrombosis of patients with non-valvular atrial fibrillation.Conclusion:The predictive values of RT-3D-TEE,CTA and CHA2DS2-VASc are higher for left atrial appendage thrombosis of patients with non-valvular atrial fibrillation.Among of them,the combinations of two or three indicators can effectively improve the predictive efficiency of individual test.The clinical practice should make choice on the basis of actual conditions.

Parkinson's disease (PD) is a chronic neurodegenerative disease commonly seen in middle-aged and elderly people, and aging is the largest risk factor for PD. With acceleration of the aging process in China, the wellbeing and life quality of the elderly are expected to be disturbed by increasing prevalence of PD. The Community-based Cohort Study on Nervous System Diseases (CCSNSD) has established community population-based cohorts of epilepsy, Alzheimer's disease, and PD, respectively; baseline survey and one round of follow-up have finished so far. The CCSNSD collected data on demographics, community environment, diet, lifestyle, cognition, history of chronic diseases, and PD-related risk factors and facilitated exploration of the relationship between dietary nutrition and PD-related outcomes. This special column described status on prodromal Parkinson's disease (pPD) risk and its demographic & economic differences among people aged 55 and above in four provinces of China, and investigated the associations of red meat and processed meat products intake , dairy products intake, and cognitive function with pPD risk, respectively. Furthermore, one paper reviewed previous studies on dietary nutrition, lifestyle, and PD risks. However, the follow-up time of CCSNSD was relatively short as of the publishing of this column, longer follow-ups are required to allow studying potential factors and risk of incident PD combined with clinical examination and diagnosis of PD.

OBJECTIVE: To compare the effectiveness of lower extremity axial distractor (LEAD) and traction table assisted closed reduction and intramedullary nail fixation in treatment of femoral subtrochanteric fracture. METHODS: The clinical data of 117 patients with subtrochanteric fracture of femur treated by closed reduction and intramedullary nail fixation between May 2012 and May 2022 who met the selection criteria were retrospectively analyzed. According to the auxiliary reduction tools used during operation, the patients were divided into LEAD group (62 cases with LEAD reduction) and traction table group (55 cases with traction table reduction). There was no significant difference in baseline data, such as gender, age, injured side, cause of injury, fracture Seinsheimer classification, time from injury to operation, and preoperative visual analogue scale (VAS) score, between the two groups ( P>0.05). Total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, closed reduction rate, fracture reduction quality, fracture healing time, weight-bearing activity time, and incidence of complications, as well as hip flexion and extension range of motion (ROM), Harris score, and VAS score at 1 month and 6 months after operation and last follow-up were recorded and compared between the two groups. RESULTS: There were 14 cases in the LEAD group from closed reduction to limited open reduction, and 43 cases in the traction table group. The incisions in the LEAD group healed by first intention, and no complication such as nerve and vascular injury occurred during operation. In the traction table group, 3 cases had perineal crush injury, which recovered spontaneously in 1 week. The total incision length, operation time, intraoperative blood loss, fluoroscopy frequency, and closed reduction rate in the LEAD group were significantly better than those in the traction table group ( P<0.05). There was no significant difference in the quality of fracture reduction between the two groups ( P>0.05). Patients in both groups were followed up 12-44 months, with an average of 15.8 months. In the LEAD group, 1 patient had delayed fracture union at 6 months after operation, 1 patient had nonunion at 3 years after operation, and 1 patient had incision sinus pus flow at 10 months after operation. In the traction table group, there was 1 patient with fracture nonunion at 15 months after operation. X-ray films of the other patients in the two groups showed that the internal fixator was fixed firmly without loosening and the fractures healed. There was no significant difference in fracture healing time, weight bearing activity time, incidence of complications, and postoperative hip flexion and extension ROM, Harris score, and VAS score at different time points between the two groups ( P>0.05). CONCLUSION For femoral subtrochanteric fracture treated by close reduction and intramedullary nail fixation, compared with traction table, LEAD assisted fracture reduction can significantly shorten the operation time, reduce intraoperative blood loss and fluoroscopy frequency, reduce incision length, effectively improve the success rate of closed reduction, and avoid complications related to traction table reduction. It provides a new method for good reduction of femoral subtrochanteric fracture.
Humans ; Fracture Fixation, Intramedullary ; Bone Nails ; Traction ; Blood Loss, Surgical/prevention & control* ; Retrospective Studies ; Treatment Outcome ; Femoral Fractures ; Hip Fractures/surgery* ; Lower Extremity ; Surgical Wound ; Fracture Fixation, Internal

Background Global dietary magnesium insufficiency is widespread and seriously harmful to human health. There are few studies on dietary magnesium intake in China, and associated dietary intervention lacks scientific support. Objective To explore the dietary magnesium intake level and food sources of Chinese adults aged 18-64 in 2018, and to identify the problems of dietary magnesium intake. Methods A total of 9181 residents in the 2018 "China Health and Nutrition Survey" were selected as the study subjects. Types and intake of food collected from consecutive 3-day 24-hour dietary recalls and by household condiment weighing and counting method. The average daily dietary magnesium intake and the composition of main food sources were calculated using the food composition table. Multiple logistic regression was used to analyze the relationship between socioeconomic factors and insufficient dietary magnesium intake. Results In 2018, the daily intake of magnesium in P₅₀ (P₂₅, P₇₅) of adults aged 18-64 in 15 provinces (autonomous regions and municipalities) of China was 252.28 (196.25, 326.27) mg. The proportion of residents with insufficient dietary magnesium intake was 60.9%. The proportions of women, adults aged 18-49, urban residents, southern region residents, and western regions residents with insufficient dietary magnesium intake were 66.4%, 63.4%, 62.4%, 65.2%, and 68.3%, respectively. The results of multiple logistic regression analysis showed that the risks of insufficient dietary magnesium intake were 64.6%, 24.6%, and 43.6% higher in women, urban residents, and southern region residents than those in men, rural residents, and northern region residents, respectively (OR=1.646, 95%CI: 1.509-1.794; OR=1.246, 95%CI: 1.126-1.379; OR=1.436, 95%CI: 1.311-1.573); the risk of insufficient dietary magnesium intake in residents aged 50-64 was 15.7% lower than that in residents aged 18-49 (OR=0.843, 95%CI: 0.771-0.921); the risks of insufficient magnesium intake in residents in middle and western areas were 1.202 times and 1.590 times of that in residents in eastern area (OR=1.202, 95%CI: 1.079-1.340; OR=1.590, 95%CI: 1.424-1.776). The effect of education level and income level on magnesium intake insufficiency was not observed (P>0.05). In addition, 41.4% of dietary magnesium of the subjects came from cereals and products (ranking first in food sources), and only 2.4% from dark vegetables with rich magnesium content (ranking sixth place). The top six dietary magnesium sources of men and women were the same. The proportion of dietary magnesium from cereals and products was 6.3% higher in rural residents than in urban residents, and 9.3% higher in residents living in northern regions than those in southern regions. The proportion of dietary magnesium from livestock meat and products was 1.3% higher in the 18-49 age group than in the 50-64 age group, 0.9% higher in urban residents than in rural residents, and 1.6% higher in western region residents than in eastern region residents. Conclusion The dietary magnesium intake of Chinese residents is generally insufficient, and the source of dietary magnesium is irrational. Women, residents aged 18-49, residents in southern, middle, and western areas are high-risk populations of dietary magnesium insufficiency. Chinese residents are encouraged to eat more dark vegetables and whole grain food; women should improve their dietary quality and intake diverse magnesium-rich food; southern region residents and urban residents should increase the intake of whole grains and avoid over refining food; residents aged 18-49, urban residents, and those in western regions should adjust their dietary structure and reduce meat intake.

Background Magnesium is an important nutrient, and participates in most metabolic processes. Many studies show an association between dietary magnesium intakes and nutrition-related diseases such as diabetes. However, the data of dietary magnesium intakes and secular trends among the whole life cycle of Chinese residents are not available. Objective To investigate the dietary magnesium intakes and associated secular trends over the past three decades in residents of all ages and China, to identify the high-risk residents of magnesium deficiency and plan nutritional interventions, and provide basic data support for the revision of dietary magnesium reference intake. Method The data came from the 10 rounds of the "China Health and Nutrition Survey" from 1991 to 2018, and the participants with complete sociodemographic and dietary data wereselected. The median intakes, insufficient rates, and secular trends of dietary magnesium intakes were analyzed in different survey years. Analysis of multiple linear regression was used to analyze the annual change characteristics of dietary magnesium intakes controlling gender, age, education, urban-rural stratum, and north-south region. Wilcoxon trend test was used to analyze the secular trends of dietary magnesium intakes in different characteristic groups. The trends of insufficient rate were analyzed by Cochran-Armitage trend test among different characteristic groups. Results A total of 127169 residents were included in the present study. The medians of dietary magnesium intakes in 1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011, 2015, and 2018 were 283.70, 283.38, 304.26, 285.50, 283.64, 275.49, 267.92, 242.93, 240.51, and 238.89 mg·d⁻¹, respectively, showing a significant downward trend (F=2931.81, P<0.001). Dietary magnesium intakes showed significant differences in gender, age, education level, income level, urban-rural stratum, and north-south region in almost all survey years, except that there was no significant difference among different income groups in 1991. Insufficient rate of dietary magnesium intake showed a significant upward trend (Z=62.62, P<0.001), approximate 60% of Chinese residents consumed insufficient magnesium. The insufficient rate was 53.94% for male and 65.35% for female, and the insufficient rate in the 14-17 age group was as high as 71.29%. Conclusion The dietary magnesium intake shows a significant downward trend and insufficient intake of dietary magnesium is prevalent among Chinese population. It is necessary to observe the high-risk population and conduct relevant nutritional interventions, as well as to further assess the recommended intake of magnesium.

Background Magnesium plays an important physiological role in human, but the association between dietary magnesium intake and the risk of hypertension is unclear. Few studies have reported the dose-response relationship in Chinese population. Objective To analyze the relationship between dietary magnesium intake and the risk of hypertension in Chinese adults aged 18-64 years, and to explore the dose-response relationship. Methods A total of 13082 adults aged 18-64 years who participated in at least two rounds of the China Health and Nutrition Survey (CHNS) from 2000 to 2018 were selected. Dietary data were obtained by consecutive 3-day 24-hour dietary recall and weighting & bookkeeping method. Blood pressure was measured with a standard mercury sphygmomanometer. Hypertension was diagnosed when systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg, or self-reported hypertension history or using antihypertensive drugs. The mean of dietary magnesium intake in all survey years (excluding the last survey) was used as the dietary magnesium intake of the subject, and the mean of dietary magnesium intake was divided into 5 equal groups. Cox proportional risk model with adjustments for socio-demographic factors, body mass index (BMI), smoking and drinking, sleep time, physical activity, and dietary factors, was used to analyze the association between dietary magnesium intake and the risk of hypertension. A sensitivity analysis was conducted by excluding baseline diabetes patients and adjusting for baseline blood pressure. In addition, a restricted cubic spline model was used to analyze the dose-response relationship between them. Results In this study, male participants accounted for 47.70%, and those aged 18-44 years accounted for 72.47%. The mean follow-up time was 12.56 years and the prevalence of hypertension was 13.86%. Dietary magnesium intake was inversely associated with the risk of hypertension at the 4^th quintile (median 333.56 mg·d⁻¹) and the 5^th quintile (median 420.07 mg·d⁻¹) compared with the 1^st quintile (median 189.06 mg·d^–1), and the hazard risk (HR) values and associated 95%CIs were 0.81 (0.67-0.97) and 0.81 (0.66-0.99) respectively. After eliminating baseline diabetes and adjusting baseline blood pressure, dietary magnesium intake remained negatively associated with the risk of hypertension, which was consistent with the population-wide HR. The association between dietary magnesium intake and the risk of hypertension was non-linear (χ²=11.07, P=0.01). When dietary magnesium intake was higher than 339 mg·d⁻¹, the risk of hypertension decreased, and the HR value was the lowest in 375-418 mg·d⁻¹ (HR=0.65, 95%CI: 0.45-0.94), and then gradually tended to 1. There was no statistically significant association at 467 mg·d⁻¹ and above. Conclusion Magnesium intake in the range of 339-467 mg·d⁻¹ is negatively associated with the risk of hypertension in Chinese adults, presenting a U-shaped dose-response relationship.