Objective To study the biomechanical differences between hollow compression screws and shape-memory alloy staples in triple arthrodesis internal fixation and to provide references for the clinical application of shape-memory alloy staples.Methods Two-dimensional(2D)computed tomography(CT)foot data from a patient with severe horseshoe foot stiffness were selected,and a triple arthrodesis model was established using Mimics and Geomagic software.A geometric triple arthrodesis internal fixation model was established using SolidWorks 2021 software.Four fixation schemes(A,B,C,and D)were established according to the type and combination of fixed screws(hollow compression screws and shape-memory alloy riding nails).The biomechanical characteristics of models with different internal fixation schemes under neutral physiological loading were simulated and analyzed using ABAQUS software.Results The maximum end-face displacements of the fused surfaces of the talocalcaneal talonavicular and calcaneocuboid joints in the internal fixation model of scheme D were greater than those in schemes A,B,and C.The differences between the medial and lateral displacements of the fused surfaces of the talonavicular and calcaneocuboid joints in the internal fixation model of scheme D were 13.10％and 13.60％,respectively.The fused surface displacements were closer to the parallel displacements than those in the other three fixation schemes.The von Mises stresses were greater than those of schemes A,B,and C.Conclusions The application of scheme D(internal fixation at fusion surfaces of the talonavicular and calcaneocuboid joints with staples and at fusion surfaces of the talocalcaneal joints with compression hollow screws)provides stability at fusion surfaces of the internal fixation after triple arthrodesis surgery with near-parallel micromovement,which produces appropriate fusion stresses to make contact at the fusion end closer,promote the growth of bone scabs,and achieve better fusion results.

Twenty-three secondary and higher level hospitals in Nantong City were selected from June 3 to June 19, 2019, and the anesthesia safety and quality control surveys were conducted by using "Supervision and Evaluation Scale of Medical Quality Control Index System in a Department of Anesthesiology in Nantong City (2019 edition)" and "Special Supervision and Evaluation Scale of Perioperative Management and Information Construction in a Department of Anesthesiology in Nantong City (2019 edition)" . The results showed that the total score for medical quality control was 90.2±1.3, and the rate of reaching the standard was 87%.The department configuration score was (12.4±0.7), with the rate of reaching the standard 100%, 87% hospitals had anesthesia recovery rooms, but only 2 hospitals had anesthesia clinics.The staffing score was (15.50±0.23), with the rate of reaching the standard 74%, Nantong City had 0.67 anesthesiologists per 10 000 population, the ratio between the number of anesthesiologists and the number of operating rooms was (1.55±0.10), the ratio between the number of nurse anesthetists and the number of operating room was (0.30±0.04), and three hospitals even had no nurses in the department of anesthesiology.The department management and system score was (28.6±0.5), the rate of reaching the standard was 91%, and the operation safety verification system was not implemented in place in 87% hospitals.The medical technique score was (33.6±0.7), the rate of reaching the standard was 83%, and anesthesiology department was not equipped with anesthesia depth monitor, muscle relaxation monitor, body temperature monitor and other equipment in 35% hospitals.The perioperative management and information construction score was (40.2±1.7), the rate of reaching the standard was 48%, standardized post-operative ward round system was not carried out in 43% hospitals, and the surgical anesthesia information system was not used in 65% hospitals.In conclusion, the current status of anesthesia safety and quality control in secondary and higher level hospitals in Nantong City mainly manifests in the urgent need to improve the awareness of anesthesia safety and quality control, lack of doctors and nurses in a department of anesthesiology and lag of anesthesia information construction.

Background::Substantial progress in air pollution control has brought considerable health benefits in China, but little is known about the spatio-temporal trends of economic burden from air pollution. This study aimed to explore their spatio-temporal features of disease burden from air pollution in China to provide policy recommendations for efficiently reducing the air pollution and related disease burden in an era of a growing economy.Methods::Using the Global Burden of Disease method and willingness to pay method, we estimated fine particulate matter (PM 2.5) and/or ozone (O 3) related premature mortality and its economic burden across China, and explored their spatio-temporal trends between 2005 and 2017. Results::In 2017, we estimated that the premature mortality and economic burden related to the two pollutants were RMB 0.94 million (68.49 per 100,000) and 1170.31 billion yuan (1.41% of the national gross domestic product [GDP]), respectively. From 2005 to 2017, the total premature mortality was decreasing with the air quality improvement, but the economic burden was increasing along with the economic growth. And the economic growth has contributed more to the growth of economic costs than the economic burden decrease brought by the air quality improvement. The premature mortality and economic burden from O 3 in the total loss from the two pollutants was substantially lower than that of PM 2.5, but it was rapidly growing. The O 3-contribution was highest in the Yangtze River Delta region, the Fen-Wei Plain region, and some western regions. The proportion of economic burden from PM 2.5 and O 3 to GDP significantly declined from 2005 to 2017 and showed a decreasing trend pattern from northeast to southwest. Conclusion::The disease burden from O 3 is lower than that of PM 2.5, the O 3-contribution has a significantly increasing trend with the growth of economy and O 3 concentration.