Objective:To investigate the long-term outcomes of using 3D-printed preformed titanium meshes in repair and reconstruction of orbital region.Methods:A retrospective analysis was conducted on patients with tumors invading the naso-orbito-maxillary region who underwent surgical resection and repair/reconstruction with 3D-printed preformed titanium meshes. The patients were collected at three medical centers (the Third Affiliated Hospital of Sun Yat-sen University, Xijing Hospital of Air Force Military Medical University, and Shenzhen Longgang District Ear, Nose and Throat Hospital) from 2016 to 2023. Tumor extent was evaluated radiologically, and the surgical approaches, reconstruction outcomes, surgical complications, and long-term follow-up results were analyzed.Results:A total of 46 patients from the three centers were included in this study, comprising 27 males and 19 females, with an average age of 51 years (range: from 13 to 86 years). Among them, 4 patients had benign tumors, while the remaining 42 had malignant tumors. The median follow-up duration was 60.7 months (range: from 19.0 to 75.0 months). Postoperatively, symmetrical globe position was achieved in 38 cases without significant diplopia; 4 cases exhibited enophthalmos without diplopia, and 4 cases had enophthalmos with diplopia. Twelve patients received preoperative radiotherapy, and 30 patients received postoperative radiotherapy. Six patients developed enophthalmos, and 6 experienced titanium mesh exposure after radiotherapy. Following treatment completion, 3 patients underwent repair using frontal flaps, 1 using a superficial temporal artery island flap, and 2 using free flaps. All remaining patients showed no postoperative infections, and their wounds healed normally.Conclusion:The application of 3D-printed preformed titanium mesh enables precise repair of postoperative defects in patients with naso-orbital tumors, facilitating reliable reconstruction of the orbital and facial contours with straightforward operation and dependable outcomes.

Objective:To investigate the long-term outcomes of using 3D-printed preformed titanium meshes in repair and reconstruction of orbital region.Methods:A retrospective analysis was conducted on patients with tumors invading the naso-orbito-maxillary region who underwent surgical resection and repair/reconstruction with 3D-printed preformed titanium meshes. The patients were collected at three medical centers (the Third Affiliated Hospital of Sun Yat-sen University, Xijing Hospital of Air Force Military Medical University, and Shenzhen Longgang District Ear, Nose and Throat Hospital) from 2016 to 2023. Tumor extent was evaluated radiologically, and the surgical approaches, reconstruction outcomes, surgical complications, and long-term follow-up results were analyzed.Results:A total of 46 patients from the three centers were included in this study, comprising 27 males and 19 females, with an average age of 51 years (range: from 13 to 86 years). Among them, 4 patients had benign tumors, while the remaining 42 had malignant tumors. The median follow-up duration was 60.7 months (range: from 19.0 to 75.0 months). Postoperatively, symmetrical globe position was achieved in 38 cases without significant diplopia; 4 cases exhibited enophthalmos without diplopia, and 4 cases had enophthalmos with diplopia. Twelve patients received preoperative radiotherapy, and 30 patients received postoperative radiotherapy. Six patients developed enophthalmos, and 6 experienced titanium mesh exposure after radiotherapy. Following treatment completion, 3 patients underwent repair using frontal flaps, 1 using a superficial temporal artery island flap, and 2 using free flaps. All remaining patients showed no postoperative infections, and their wounds healed normally.Conclusion:The application of 3D-printed preformed titanium mesh enables precise repair of postoperative defects in patients with naso-orbital tumors, facilitating reliable reconstruction of the orbital and facial contours with straightforward operation and dependable outcomes.

【Objective】 To understand the prevalence of overweight/obesity among school-age children in Pudong New Area of Shanghai, and to explore the influence of gestational weight gain and pre-pregnancy body mass index (BMI) on weight status of school-age children. 【Methods】 From November to December 2020,a stratified cluster sampling method was adopted to select first-grade students from 13 primary schools in Pudong New Area of Shanghai.After matching with the birth monitoring database, 755 students with complete birth information were selected as the study subjects.The relevant information of mothers before and during pregnancy was retrospectively collected, and the effects of pregnancy weight gain combined with pre-pregnancy BMI on overweight/obesity in school-age children were analyzed. 【Results】 1) The prevalence rates of overweight and obesity of first-grade children were 15.89% and 18.41%, respectively.2) Maternal excessive weight gain during pregnancy (OR=1.678) and overweight/obesity before pregnancy (OR=2.315,2.412) were risk factors for overweight/obesity of the offspring at school age(P<0.05).3) For mothers who were underweight before pregnancy, excessive weight gain during pregnancy was associated with overweight/obesity in school-age children in their offspring (OR=7.436, 95%CI: 1.489 - 37.143,P<0.05).4) Excessive weight gain during pregnancy combined with overweight/obesity before pregnancy significantly increased the risk of overweight/obesity in offspring (OR=3.606, 95%CI: 2.030 - 6.405, P<0.05). Mothers who gained a moderate amount of weight during pregnancy and were emaciated before pregnancy had a significantly lower risk of overweight/obesity in their school-age children (OR=0.217, 95%CI: 0.049 - 0.967, P<0.05). 【Conclusion】 Excessive weight gain during pregnancy increases the risk of overweight/obesity in school-age children in their offspring, strengthening pregnancy health education and perinatal care to help pregnant women maintain appropriate weight gain during pregnancy may be an important and novel strategy to prevent childhood obesity.

Objective: To examine the association between serum vitamin D level and thyroid function indicators among elderly patients with type 2 diabetes mellitus (T2DM), so as to provide the evidence for the prevention and treatment of thyroid function abnormality among elderly patients with T2DM. Methods: Inpatients aged 60 years and older and admitted to the department of endocrinology of Zhejiang Hospital were selected as the study subjects. Gender, age, course of disease and other basic information were collected through questionnaire surveys. The serum 25-hydroxyvitamin D[25-(OH) D], thyroid stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), total triiodothyronine (TT3), and total thyroxine (TT4) were measured. The correlation between serum vitamin D level and thyroid function indicators in elderly patients with T2DM was evaluated by a multiple linear regression model. Results: A total of 402 elderly patients with T2DM were surveyed, including 210 males (52.24%) and 192 females (47.76%), and had a median age of 70.00 (interquartile range, 12.00) years and a median course of disease of 14.00 (interquartile range, 14.00) years. There were 162 patients with insufficiency of vitamin D (40.30%) and 182 patients with deficiency (45.27%). The levels of TSH and glycated hemoglobin in the vitamin D deficiency group were (2.34±1.66) μIU/mL and (8.83±2.14) %, respectively, which were higher than those in the normal group [(1.74±1.10) μIU/mL and (8.11±1.75) %; P<0.05]. The levels of FT3 and FT3/FT4 in the vitamin D deficiency group were (2.86±0.48) μIU/mL and 2.85±0.71, respectively, which were lower than those in the vitamin D insufficiency group [(3.09±0.47) pg/mL and 3.14±0.81, P<0.05]. Multiple linear regression analysis showed a negative correlation between 25- (OH) D and TSH (β'=-0.159, P=0.001). Conclusion The vitamin D deficiency may be associated with the increase of TSH level among the elderly patients with T2DM.

BACKGROUND:Lower limb peri-knee muscle strength training and neuromuscular electrical stimulation are generally safe and effective rehabilitation methods for patellofemoral joint pain,but the mechanism of their intervention is still unclear. OBJECTIVE:To determine the effect of muscle strength training combined with neuromuscular electrical stimulation on pain,lower extremity function and biomechanical characteristics in patients with patellofemoral pain. METHODS:Thirty-seven patients with patellofemoral pain were randomly divided into muscle strength training combined with electrical stimulation group(trial group,n=19)and muscle strength training group(control group,n=18).Both groups underwent intervention training for 6 weeks,three times a week.The visual analog scale and anterior knee pain scale were used to evaluate the pain level and functional level of the knee.Kinematic and kinetics data during running were collected by using an infrared motion capture system and a three-dimensional force platform simultaneously.A two-way analysis of variance with repeated measures(group*time)was applied to analyze the data. RESULTS AND CONCLUSION:(1)After the intervention,the visual analog scale scores of the trial group and the control group were significantly decreased(P<0.001),and the anterior knee pain scale scores were significantly increased(Ptrial group<0.001,Pcontrol group=0.001)in the trial group and control group.The anterior knee pain scale scores of the trial group were significantly higher compared to the control group after the intervention(P=0.001).(2)The peak knee flexion angle(P=0.011),peak knee extension moment(P<0.001),the peak knee internal rotation moment(P=0.008),the peak patellofemoral stress(P<0.001)and the peak patellofemoral contact force(P<0.001)were significantly decreased in the trial and control groups during running after the intervention compared with those before the intervention.(3)In conclusion,both muscle strength training and muscle strength training combined with electrical stimulation training are helpful to improve the subjective pain and lower limb function of patellofemoral pain patients,enhance the movement pattern during running and reduce the stress of the patellofemoral joint.Compared with muscle strength training alone,muscle strength training combined with electrical stimulation can improve lower limb function more significantly.

The rapid development of digital intelligence technologies is providing a powerful boost to the high-quality development of the healthcare system.Considering the current state of our healthcare services and guided by General Secretary Xi Jinping's insights on new quality productive forces and the directives from Third Plenary Session of Communist Party of China's 20th Central Committee,the high-quality development of the healthcare service system should focus on digital intelligence technologies such as cloud computing,big data,privacy computing,blockchain,Internet of Things(IoT),mobile computing,and AI.The key measures should include the optimization of production factors,services,and governance.Emphasis should be placed on enhancing the efficient and intensive development of the development model,ensuring the high-quality and continuous integration of the supply model,and transitioning to scientific and modern management methods.Herein,we analyzed the"factor optimization—service optimization—governance optimization"development mechanism driven by digital intelligence and proposed corresponding implementation pathways,intending to provide references for establishing a high-quality and efficient healthcare service system with Chinese characteristics.

Objective:To investigate the protective effects of Huoxue Rongluo Decoction on hypoxic-ischemic brain damage (HIBD) rats; To clarify the expression of AMPK signaling pathway during HIBD injury and repair.Methods:On the basis of the hypoxia ischemia reperfusion model, an improved hypoxia bottle was used to establish a full-term HIBD rat model. Totally 60 successfully modeled mice were divided into model group and TCM group using a random number table method, with 30 mice in each group and 30 mice in a control group. Two hours before surgery, TCM group was orally administered with Huoxue Rongluo Decoction 1.17 g/100 g (equivalent dose). The control group and model group were orally administered with equal volume of physiological saline. Two hours after surgery, it was orally administered again, twice a day, for consecutive 5 d. Behavioral tests (convulsion assessment, Longa score, suspension test, water maze test) were used to evaluate the motor nerve function and long-term learning ability of young rats in different groups. HE staining and electron microscopy were used to observe the pathological changes of brain tissue and mitochondrial damage. Evans blue (EB) staining and brain water content measurement were used to detect blood-brain barrier permeability and brain edema. The expression of AMPK signaling pathway related genes in brain tissues of different groups of young rats was detected by PCR array technique.Results:Compared with the model group, the convulsions of the rats in the TCM group were improved, the Longa score was significantly reduced, the grip strength test score and suspension time were significantly improved, the escape latency was significantly shortened, and the number of crossing platforms significantly increased ( P<0.05); the degree of neuronal and mitochondrial damage in the TCM group was reduced, and cerebral vascular permeability and brain water content were significantly reduced ( P<0.01). The results of PCR array showed that compared with the control group, 2 genes were significantly up-regulated and 12 genes were significantly down-regulated in the brain tissue of the model group; compared with TCM group, 15 genes were relatively down-regulated in the model group. Conclusion:Huoxue Rongluo Decoction can significantly reduce the degree of brain injury after HIBD, improve the motor nerve function and long-term learning and cognitive ability of model rats, and its damage repair mechanism is related to the expression regulation of AMPK signaling pathway related genes.

Venous thromboembolism (VTE) is a complication in children with acute lymphoblastic leukemia (ALL). The Chinese Children's Cancer Group-ALL-2015 protocol was carried out in China, and epidemiology, clinical characteristics, and risk factors associated with VTE were analyzed. We collected data on VTE in a multi-institutional clinical study of 7640 patients with ALL diagnosed in 20 hospitals from January 2015 to December 2019. First, VTE occurred in 159 (2.08%) patients, including 90 (56.6%) during induction therapy and 108 (67.92%) in the upper extremities. T-ALL had a 1.74-fold increased risk of VTE (95% CI 1.08-2.8, P = 0.022). Septicemia, as an adverse event of ALL treatment, can significantly promote the occurrence of VTE (P < 0.001). Catheter-related thrombosis (CRT) accounted for 75.47% (n = 120); and, symptomatic VTE, 58.49% (n = 93), which was more common in patients aged 12-18 years (P = 0.023), non-CRT patients (P < 0.001), or patients with cerebral thrombosis (P < 0.001). Of the patients with VTE treated with anticoagulation therapy (n = 147), 4.08% (n = 6) had bleeding. The VTE recurrence rate was 5.03% (n = 8). Patients with VTE treated by non-ultrasound-guided venous cannulation (P = 0.02), with residual thrombus (P = 0.006), or with short anticoagulation period (P = 0.026) had high recurrence rates. Thus, preventing repeated venous puncture and appropriately prolonged anticoagulation time can reduce the risk of VTE recurrence.
Humans ; Child ; Venous Thromboembolism/etiology* ; East Asian People ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/epidemiology* ; Risk Factors ; Thrombosis/chemically induced* ; China/epidemiology* ; Anticoagulants/adverse effects* ; Recurrence

Objective:To investigate the influence of muscle energy technology (MET) combined with Maitland joint mobilization surgery on the elbow joint flexion function in patients with deep burn of elbow joint.Methods:A retrospective controlled clinical trial was conducted. From January 2020 to January 2022, 53 patients with elbow joint flexion dysfunction after deep burns who met the inclusion criteria were treated in Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 32 males and 21 females, aged (37±12) years. According to the treatment method used, the patients were divided into conventional treatment alone group (15 cases), conventional treatment+joint mobilization surgery group (18 cases), and conventional treatment+joint mobilization surgery+MET group (20 cases). Before treatment and 2 months after treatment, the patient's elbow joint range of motion was measured using a protractor, the Mayo elbow joint function score was used to evaluate elbow joint function, a portable muscle strength tester was used to measure elbow extensor muscle strength, and visual analogue scale was used to evaluate pain degree. Data were statistically analyzed with one-way analysis of variance, least significant difference test, paired sample t test, Kruskal-Wallis H test, Wilcoxon signed rank-sum test, chi-square test, Fisher's exact probability test, and Bonferroni correction. Results:After two months of treatment, the elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery group and conventional treatment+joint mobilization surgery+MET group ((103±12)° and 60 (50, 66), (131±14)° and 73 (65, 80)) were significantly larger and higher than those in conventional treatment alone group ((77±15)° and 45 (35, 50), P values all <0.05), respectively. The elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery+MET group were significantly larger and higher than those in conventional treatment+joint mobilization surgery group ( P values all <0.05), respectively. After two months of treatment, the elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery+MET group were respectively significantly larger and lower than those in conventional treatment alone group and conventional treatment+joint mobilization surgery group ( P values all <0.05). The elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery group were similar to those in conventional treatment alone group ( P>0.05). The elbow joint range of motion and elbow extensor muscle strength (with t values of 9.37, 25.54, 28.71, 6.70, 7.20, and 7.01, respectively, P<0.05), elbow joint function scores and pain scores (with Z values of 3.15, 3.63, 3.93, 3.30, 3.52, and 3.84, respectively, P<0.05) of patients in conventional treatment alone group, conventional treatment+joint mobilization surgery group, and conventional treatment+joint mobilization surgery+MET group after two months of treatment were significantly improved compared with those before treatment. Conclusions:The combination of MET and Maitland joint mobilization surgery can effectively improve elbow joint range of motion, elbow joint function, elbow extensor muscle strength, and pain of patients with deep elbow joint burns, therefore it is worthy of promotion.

Objective:To explore the influencing factors of bowel preparation quality in hospitalized elderly patients, and to find the appropriate waiting time from the end of bowel preparation to the beginning of colonoscopy.Methods:Baseline and clinical data of elderly patients over 60 years old who underwent colonoscopy in the Tenth People′s Hospital, Tongji University from February 2021 to August 2021 were collected. Multivariate analysis was used to screen the factors that might affect the quality of bowel preparation in hospitalized elderly patients. Patients were grouped according to waiting time before colonoscopy. After eliminating confounding factors using propensity matching analysis, the difference of bowel preparation quality among groups was compared.Results:251 patients were included in the study. Multivariate analysis revealed that, hypertension ( OR=3.530, 95% CI 1.295-9.618), chronic constipation ( OR=3.302,95% CI 1.132-9.632), dietary compliance ( OR=0.161, 95% CI 0.070-0.371), medication and drinking water compliance ( OR=0.167, 95% CI 0.070-0.397), exercise compliance after medication ( OR=2.245, 95% CI 1.040-4.845), The frequency of defecation after medication ( OR=0.446, 95% CI 0.308-0.647) and waiting time ( OR=0.537, 95% CI 0.387-0.745) were important factors affecting the quality of bowel preparation in hospitalized elderly patients ( P<0.05). There were differences in bowel preparation quality between groups of waiting times. The overall quality of bowel preparation in 120-180 min group was significantly better than that in 241-300 min group, 301-360 min group and>360 min group ( P<0.05). The overall quality of bowel preparation in 181-240 min group was better than that in >360 min group ( P<0.05). There were no significant differences among other groups( P>0.05). The scores of cecum and ascending colon were the best in 120-180 min group, and the cleanliness of descending colon, sigmoid colon and rectum was significantly higher in 241-300 min group, 301-360 min group and > 360 min group. The scores of descending colon, sigmoid colon and rectum showed that the intestinal preparation quality of 181-240 min group was better than that of 301-360 min group and > 360 min group. Conclusions:The best examination time for elderly patients is about 180 minutes after bowelpreparation. Medical workers should flexibly guide the medication time to ensure that patients are in the best clean state of intestinal tract during examination.