Objective To investigate the independent risk factors of cerebral white matter lesions (WML) of different degrees in the elderly aged 80 years and over,and provide the evidences for forecasting the prognosis of WML.Methods Brain magnetic resonance images (MRI) findings in 151 people aged 74 to 93 years were collected and analyzed.According to the severity of WML in brain MRI using the Fazekas Scale,the persons were divided into non-WML (control) group,mildWML (grade 1 WML) group and moderate-to-severe WML (grade 2 WML) group.The cognitive score,vascular risk factors,cerebral hemodynamic and arteriosclerotic index,and radiological features were compared among the three groups.Subsequent one-way ANOVA and multivariate logistic analysis were performed to determine the statistically significant factors and the independent risk factors among groups.Results The statistically significant factors with one-way ANOVA analysis among the three groups were cognitive performance (F = 48.595,P = 0.000),hypertension (x2 =7.052,P=0.029),cigarette history (x2 = 19.476,P= 0.000),cholesterol (TC) (F= 3.086,P=0.049),Crouse score (F=3.968,P=0.021) and multiple cerebral atrophy indexes.When compared with control group,cigarette history (OR 2.031,95%CI 1.244-1.317),lacunar infarction (LI)numbers (OR 2.031,95%CI 1.316-4.015) and cholesterol (OR 1.610,95%CI 0.972-2.668) were independent risk factors in grade 1 WML group (all P＜0.05).The independent risk factors between grade 1 and 2 WML group were cognitive performance (OR 0.276,95%CI 0.143-0.532),cigarette history (OR 2.262,95% CI 1.260-4.059),and sylvian fissure ratio (SFR) (OR 1.954,95% CI 1.013-3.768) (all P＜0.05).The independent risk factors between the grade 2 WML group and control group were cognitive performance (OR 0.091,95%CI 0.030-0.273),bicoudate ratio (BCR)(OR 2.511,95%CI 1.147-5.499),Crouse score (OR 2.304,95%CI1.127-4.712)and LI numbers (OR 2.200,95%CI 1.028-4.707) (all P＜0.05).Conclusions Mild WML patients have no significant abnormalities in cognition,brain atrophy and cerebral atherosclerosis.Moderate to severe WML patients manifest remarkable cognitive disorder,cerebral atherosclerosis and brain atrophy.Compared with the controls,cognitive performance,BCR,Crouse score,LI numbers were the independent risk factors for moderate-severe WML patients.

Objective To retrospectively study postoperative nonunion of femoral neck fractures so as to identify high risk factors for their nonunion.Methods A total of 965 patients with complete clinical data out of the 1 323 patients with femoral neck fractures treated by internal fixation with cannulated compression screws from January 2003 to January 2011 were included in the study.Logistic muhiple regression method was used to analyze five factors including patients' age,gender,injury mechanism (whether high energy injury or not),fracture type (with or without displacement) and medical comorbidities [American Society of Anesthesiologists Physical Score (ASAS) grade] and their correlation with fracture healing to investigate the high risk factors for the nonunion of femoral neck fractures.Results Quantitative assay of the factors affecting healing of femoral neck fractures was ranged as follows:medical comorbidities (ASAS grade),injury mechanism (whether high energy injury or not),fracturc type (with or without displacement),gender and age.Conclusion Age ＞ 50 years,females,displacement fracture,high energy injury,and ASAS grade above Ⅲ are high risk factors for nonunion of femoral neck fractures.

Objective To investigate the relationship among the late-life depression ( LLD ) , cognitive function and white matter lesions ( WML) , after excluding vascular risk factors and brain atrophy.Methods The depression and cognition status of 277 patients were assessed using a variety of neurological scales, and the actually enrolled patients were divided into LLD group ( 77 cases ) and the non-depressed group (103 cases).The independent samples t test and multivariate Logistic regression were used to analyze independent risk factors for depressive symptoms with the model Ⅰ of controlling age , sex, years of education and the model Ⅱof controlling age, sex, years of education, high blood pressure, diabetes and coronary heart disease.Under the premise of controlling mode Ⅱand brain atrophy , partial correlation was used to analyze the correlations of depressive symptoms and cognitive function and WML , and the correlation between depressive symptoms and cognitive items.Results The results showed that the proportion of high blood pressure (90.9%vs 74.7%, χ2 =6.342,P=0.046), cognitive scores (19.23 ±7.05 vs 22.99 ± 6.71, t=3.343,P=0.001), WML level 2 proportion (65.1% vs 34.9%, χ2 =7.373,P=0.025) and temporal lobe atrophy of hippocampal sulcus ratio (0.24 ±0.03 vs 0.22 ±0.03, t=-2.041,P=0.044) had statistically significant difference between the two groups.Multivariate Logistic regression showed that cognitive function was an independent risk factor for depression ( OR=1.63,95% CI 1.01 -2.80, P=0.030).Controlling for all risk factors , partial correlation analysis showed that depressive symptoms were correlated with cognitive function ( r=-0.239,P=0.004) and WML ( r=0.222,P=0.008) and the atrophy of temporal lobe and hippocampus ( r=0.173, P=0.040 ).Under the model Ⅱ, depressive symptoms correlated with attention (r=-0.175, P=0.040), memories (r=-0.140, P=0.050) and drawing clock test ( r=-0.186, P=0.029 ).Conclusions Excluding vascular risk factorts , brain atrophy and WML , cognitive impairment has significant correlation with depressive symptoms.Vascular risk factors are involved in the occurrence of depression , and WML may be the severity of cognitive impairment reserve marker.LLD patients showed hippocampal atrophy similar with early AD , manifesting the cognitive feature of memory and executive dysfunction and attention disorder .

Objective To introduce the operation method of a rotational support plate through a traditional anterolateral approach for posterolateral tibial plateau fractures and analyze the postoperative outcome.Methods From May 2016 to September 2017,10 patients with posterolateral tibial plateau fractures who underwent surgery with the rotational support plate were retrospectively analyzed.There were 6 males and 4 females,aged from 23-66 years (average,46.2 years).The causes of the fractures included traffic accident in 4 cases,fall from height in 5 cases and falling injury in 1 case.According to AO-OTA classification,there were 1 case of 41-B2,8 cases of 41-B3 and 1 case of 41-C3.According to Schatzker classification,there were 6 cases of type Ⅱ,1 was of type Ⅲ,2 were of type Ⅴ,and 1 was of type Ⅵ.Four cases suffered multiple fractures.One patient suffered pelvic fracture,ipsilateral femoral shaft and medial malleolus fracture;One patient suffered ipsilateral tibiofibular fracture;1 patient suffered ipsilateral fibular head and medial femoral epicondyle fracture;One patient suffered ipsilateral fibular head fracture.Fracture healing time,complications,knee range of motion,Hospital for Special Surgery (HSS) knee score were recorded to evaluate postoperative outcomes.Results All 10 patients were followed up for 15.25 months (range,12-27 months).The bony union time ranged from 3.0-4.5 months (average,3.2 months).The range of motion of the knee joint was 105°-161.4° (average,139.9°).According to the HSS system,the score was 64-98 (average,88),including 8 of excellent and 2 of fair.No skin necrosis,incision infections,or fixation failure occurred during follow-up.Conclusion Fixation of posterolateral tibial plateau fracture was successfully achieved using the newly designed plate through a traditional anterolateral approach.It has many advantages such as reliable fixation,satisfying recovery,simplicity of operator,and small tissue damage.

Objective To analyze biomechanical differences among quantity configurations of four common cannulated screws using three-dimensional finite element analysis.Methods The Dicom CT images of the right proximal femoral neck of a 65-year-old Chinese healthy volunteer were used to establish models of three kinds of different Pauwels types of femoral neck and four kinds of different quantity and configuration models (triangle,inverted triangle,rectangle,diamond) through three-dimensional virtual softwares.Models were imported into the finite element analysis software Ansys.After axial load application,the stress and displacement on the screws and femoral head were compared.The peak stresses on the screws,peak stresses on the femoral head break side and displacement peaks were observed.Results Four kinds of quantity and configuration models (triangle,inverted triangle,rectangle,rhombus) had different peak stress on the screws and femoral head break side and different displacement peak.Among Pauwels type Ⅰ fractures,the peak stresses on the screws were 46.382,32.159,43.985,and 24.342 MPa;the peak stresses on the femoral head break side were 5.840,7.440,3.731,and 6.311 MPa;the displacement peaks were 0.610,0.608,0.598,and 0.595 mm.Among Pauwels type Ⅱ fractures,the peak stresses on the screws were 46.763,39.979,49.619,and 25.692 MPa;the peak stresses on the femoral head break side were 4.971,7.332,3.161,and 5.734 MPa;the displacement peaks were 0.634,0.635,0.622,and 0.631 mm.Among Pauwels type Ⅲ fractures,the peak stresses on the screws were 51.432,39.477,51.515,and 26.949 MPa,and the peak stresses on the femoral head break side were 6.163,10.070,5.257,and 9.552 Mpa;the displacement peaks were 0.662,0.654,0.644,and 0.644 mm.Conclusion The fixation of femoral neck fractures with four screws in a diamond position can guide clinical application,for the procedure has better stress dispersion effects,ensure fracture stablility,provide effective sliding compression and anti-torsion and have biomechanical advantages.

Objective:Elderly patients with sarcopenia and cognitive impairment are prone to experiencing more severe adverse events.This study aimed to analyze body composition and gait characteristics in this population, as well as to identify sensitive gait indicators of sarcopenia in individuals with cognitive impairment.Methods:A total of 200 elderly individuals from 3 different nursing homes in Suzhou were recruited for this study.The participants' overall cognitive function was assessed using the Beijing version of the Montreal Cognitive Assessment(MoCA-BJ), body composition was evaluated through bioelectrical impedance analysis, and gait was assessed using a wearable gait analysis system.Gait predictors of sarcopenia with cognitive impairment were then identified and used to construct predictive models.Results:The study encompassed 83 participants, divided into three groups: 35 in the control group(cognitively normal, without sarcopenia), 24 in the sarcopenia with mild cognitive impairment(MCI)group, and 24 in the sarcopenia with dementia group.When compared to the control group, individuals in the sarcopenia with MCI group exhibited lower Skeletal Muscle Mass Index[(5.6±0.8)kg/m 2vs.(7.4±0.8)kg/m 2], Total Protein[(6.7±1.1)kg vs.(8.9±1.5)kg], and Arm Muscle Circumference[(21.4±1.7)cm vs.(24.1±2.3)cm](all P<0.05).Similarly, in comparison to the control group, those in the sarcopenia with dementia group displayed a shorter stride length[(0.45±0.17)m vs.(0.65±0.22)m], slower gait speed[(0.38±0.13)m/s vs.(0.55±0.18)m/s], smaller turn velocity[(89.8±23.4)degrees/s vs.(116.8±26.3)degrees/s], and longer turn duration[(3.2±0.5)s vs.(2.8±0.3)s](all P<0.05).Notably, turn duration was identified as having predictive value for sarcopenia with MCI[Area under the curve(AUC)=0.673, sensitivity 70.8%, specificity 68.6%], while a model incorporating age and turn velocity demonstrated strong predictive power for sarcopenia with dementia(AUC=0.87, sensitivity 83.3%, specificity 85.7%). Conclusions:Compared to the control group, the group with both sarcopenia and cognitive impairment exhibited lower levels of muscle strength, nutritional status, and gait performance.This study also introduced the concept that gait indicators associated with turns could be a significant predictor of sarcopenia in individuals with cognitive impairment.Furthermore, the use of wearable devices for gait assessment may offer a novel approach to identifying these at-risk individuals.

Objective To investigate the relationship between the expression of Wnt induced secreted protein-1 (WISP-1) and the fibrosis of renal biopsy tissue in IgA nephropathy (IgAN) patients.Methods Fifty-three patients firstly diagnosed as IgA nephropathy by renal biopsy were included and classified according to Oxford and Lee's classification.Sixteen patients with MCD entered the fibrosis negative control group,and fourteen healthy adults entered the normal control group.The expression of WISP-1 in renal tissues and serum of all subjects were detected by immunohistochemistry and ELISA respectively.Results Immunohistochemistry results showed that WISP-1 was not expressed in MCD patients and normal human kidney tissues,which was abundantly deposited in renal tissue of patients with focal proliferative IgAN with renal interstitial fibrosis.The serum level of WISP-1 in IgAN patients was significantly higher than that in normal subjects (P=0.015) and MCD patients (P=0.030).In the subgroup analysis of IgAN renal fibrosis,the serum concentration of WISP-1 of fibrosis grade between 0-10％ (F1 group) and fibrosis ＞ 25％ (F3 group) were significantly higher than that in the normal group and the MCD group (all P ＜ 0.05).There was no significant difference between F2 group (10％ ＜ fibrosis≤25％) and normal group or MCD group (P ＞ 0.05).Conclusions The expression of WISP-1 in serum and renal tissue of renal interstitial fibrosis IgAN patients is higher than that of normal and MCD patients without renal fibrosis,and the IgAN patients' serum level of WISP-1 is significantly increased in fibrosis lower score group.The expressions of WISP-1 in serum and renal tissue are related to the occurrence of IgAN renal interstitial fibrosis,in which WISP-1 may play an important role as an early precursor factor in the pathogenesis of IgAN renal interstitial fibrosis.

Objective To raise awareness of the late-onset meningitis caused by group B streptococcus (GBS) which was homogenous to the maternal colonization.Methods The clinical data of late-onset GBS meningitis in neonates twins whose pathogens were homogenous to their maternal colonization were collected from Department of Neonatology,Guangzhou Women and Children's Medical Center.The general conditions,clinical symptoms,laboratory tests and drug treatment of the twins and their mother were retrospectively analyzed,and the GBS homology during inpatient care was tested.And the progress of the twins' condition was investigated by telephone follow-up.Results The mother had two pregnancies without prenatal GBS screening or intrapartum antimicrobial intervention for GBS,everything was normal during pregnancy and delivery.Twins were born through cesarean section.The elder sister was discharged with Linezolid taken orally after 167 days in hospital without convulsions,shaking or other discomfort.The elder sister was followed up for every 2 weeks,and in the last time of follow-up,cerebrospinal fluid white blood cell counts were 45 × 106/L,protein level was 1.52 g/L and Linezolid was withdrawn.The younger brother was discharged after 58 days in hospital with follow-up for every 2 weeks,and in the last time of follow-up,cerebrospinal fluid white blood cell counts were 30 × 106/L,protein level was 0.66 g/L.During the hospitalization and follow-up without convulsions and irritation,and the cranial magnetic resonance imaging of the twin brother was normal.Test results showed that the GBS bacteria strain for twins and their mother were all serotype Ⅲ.The possibility of the GBS homology was more than 90％.Conclusions The toxicity of serotype Ⅲ GBS strain was strong.More proactive precautions should be considered to apply for the mother whose first birth already had GBS infection.Early identification and intervention of infection risk factors would help optimize the anti-infection treatment program and reduce nerve system damage and other adverse outcomes caused by invasive GBS infection.

Objective To explore the clinical features and risk factors of poor prognosis in neonatal necrotizing enterocolitis(NEC).Methods A retrospective study was carried out in the infants with NEC admitted to 6 cooperative hospitals in Guangdong Province between January 2005 and December 2014.The clinical features and risk factors of poor prognosis in preterm and full-term infants diagnosed NEC,early onset and late onset NEC were analyzed.Results A total of 449 cases who met the criteria were admitted during the study time.The mortality was 23.6％ (106/449 cases),of which the preterm group was 24.6％ (58/238 cases) while the full-term group was 22.7％ (48/211 cases),the early onset group was 22.1％ (45/204 cases) while the late onset group was 24.3％ (57/235 cases).The median number of NEC onset in preterm group was 11 d after birth while the number of the full-term group was 6 d.Full-term infants who diagnosed NEC were more likely to manifest themselves as abdominal distension (52.1％ vs.42.0％,x2 =4.597,P =0.032),vomiting(36.5％ vs.17.2％,x2 =21.428,P =0.000) and bloody stool(30.3％ vs.21.4％,x2 =4.653,P =0.031);but in the onset of NEC,preterm infants more likely to have feeding intolerance (21.0％ vs.12.8％,x2=5.309,P =0.021).The early onset group of full-term NEC was much common in twins or multiplets(9.4％ vs.1.1％,x2 =6.226,P =0.013),which rate of surgical therapy was much higher (41.0％ vs.27.0％,P =0.036) and the breast-feeding rate before NEC was lower than the late onset group(14.5％ vs.32.6％,x2 =9.500,P =0.002),the differences were statistically significant.The gestational age and birth weight were bigger in the early onset group of preterm NEC[(33.8 ±2.5) weeks vs.(32.2 ±2.8) weeks,t =4.261,P =0.000;(2.1 ±0.5) kg vs.(1.7 ± 0.5) kg,t =4.735,P =0.000)],but length of stay was shorter than the late onset group (18.0 d vs.26.5 d,P =0.000).Logistic regression analysis showed that the risk factors of poor prognosis of full-term NEC were shock,peritonitis and sepsis;while risk factors of poor prognosis of preterm NEC were small for gestational age infant,pulmonary hemorrhage,shock,intestinal perforation and sepsis;the risk factors of poor prognosis of the early onset group of full-term NEC was shock;while those of the late onset group were shock and peritonitis;the risk factors of poor prognosis in the early onset group of preterm NEC were shock and sepsis,while those in the late onset group were pulmonary hemorrhage,shock,intestinal perforation and sepsis.Conclusions Compared to the preterm NEC,the onset time of full-term NEC was earlier and the clinical manifestations were more typical.Early identification and management of shock,peritonitis,intestinal perforation,sepsis and pulmonary hemorrhage can reduce the risk of poor prognosis of neonate NEC.

BACKGROUNDAlthough the use of an intramedullary fibular allograft together with locking plate fixation can provide additional medial support and prevent varus malalignment in displaced proximal humeral fractures with promising results, the fibular autograft donor site often sustains significant trauma and cannot restore the articular surface of comminuted fractures. The aim of this study was to evaluate the clinical and radiographic outcomes of a locking plate and crest bone autologous graft for treating proximal humerus comminuted fractures.

METHODSWe assessed the functional outcomes and complication rates in 40 patients with proximal humerus comminuted fractures. Eighteen patients were treated with a locking plate and an autologous crest bone graft (experimental group), and 22 were treated with only the locking plate and no bone graft (control group). Postoperative assessments included radiographic imaging, range of motion analysis, pain level based on the visual analogue scale (VAS), and the SF-36 (Short Form (36) Health Survey), as well as whether patients could return to their previous occupation.

RESULTSAll fractures healed both clinically and radiologically in the experimental group. There was no more than 2 mm collapse of the humeral head, and no osteonecrosis or screw penetration of the articular surface. In contrast, two patients had a nonunion in the control group, and they eventually accepted total shoulder replacements. The average time from surgery to radiographic union was significantly shorter in the experimental group ((4.66±1.63) months) compared with the control group ((5.98±1.57) months) (P < 0.05). For the experimental versus controls groups, the mean shoulder active flexion (148.00±18.59 vs. 121.73±17.20) degrees, extension (49.00±2.22 vs. 42.06±2.06) degrees, internal rotation (45.00±5.61 vs. 35.00±3.55) degrees, external rotation (64.00±9.17 vs. 52.14±5.73) degrees, and abduction (138.00±28.78 vs. 105.95±15.66) degrees were all significantly higher (all P < 0.001). The median SF-36 in the experimental group ((88.00±5.71) points) was significantly higher than that of the control group ((69.45±9.45) points; P < 0.001). The median VAS pain level (mean rank, 10.50) in the experimental group was lower than that (mean rank, 47.19) of the control group (P < 0.001). All but one patient (17 of 18, 94.4%) in the experimental group returned to their previous activities or occupations, and that one patient changed to a different occupation because of slight restrictions to activities. On the other hand, four patients could not return to their previous activities or occupations in the control group.

CONCLUSIONLocking plate fixation combined with an iliac crest bone graft is an effective technique for treating proximal humerus comminuted fractures.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Shoulder Fractures ; surgery ; Transplantation, Autologous