OBJECTIVE: To compare minimally invasive and traditional Chevron osteotomy in treating patients with mild to moderate hallux valgus. METHODS: Clinical data of 36 patients (36 feet) with mild to moderate hallux valgus from January 2019 to February 2021 were retrospectively analyzed, and divided into minimally invasive osteotomy(minimally invasive group) and traditional Chevron osteotomy(traditional group). There were 16 patients in minimally invasive group, including 1 male and 15 females, aged from 36 to 60 years old with an average of(49.0±9.5) years old;9 were mild and 7 were moderate according to Mann classification;treated with minimally invasive osteotomy with hollow screw fixation. There were 20 patients(20 feet) in traditional group, including 2 males and 18 females, aged from 38 to 65 years old with an average of(50.0±9.2) years old;11 were mild and 9 were moderate according to Mann classification;treated with traditional Chevron osteotomy. Hallux valgus angle (HVA), intermetatarsal angle (IMA) before and after operation at 12 months bewteen two groups were observed and compared, and American Orthopedic Foot and Ankle Society (AOFAS) forefoot score and visual analogue scale (VAS) before and after operation at 6 weeks and 12 months between two groups were compared. RESULTS: Thirty-six patiens were followed up from 14 to 30 months with an average of (21.00±5.77) months. All incisions were healed well at stageⅠwithout infection. There were no significant differences in HVA, IMA, AOFAS forefoot scores and VAS before and after operation at 12 months between two groups(P>0.05). However, AOFAS forefoot scores and VAS of minimally invasive group was significantly better than that of traditionl group at 6 weeks after operation (P<0.05). Postoperative HVA, IMA, AOFAS forefoot scores and VAS at 12 months bewteen two groups were improved better than that of preoperation(P<0.05). CONCLUSION Compared with traditional Chevron osteotomy, minimally invasive osteotomy has less trauma and quicker recovery. Both of them has similar clinical effects, and could receive satisfactory clinical effects, while treatment of minimally invasive osteotomy should pain attention to learning curve.
Adult ; Aged ; Bunion ; Female ; Hallux Valgus/surgery* ; Humans ; Male ; Middle Aged ; Osteotomy ; Retrospective Studies ; Treatment Outcome

Asian Continental Ancestry Group/genetics* ; Charcot-Marie-Tooth Disease/genetics* ; China ; Genetic Profile ; Humans ; Pedigree

BACKGROUNDData on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease (CKD) patients are limited. The aim of the present study was to investigate the prevalence, awareness, treatment, and control of hypertension in the non-dialysis CKD patients through a nationwide, multicenter study in China.

METHODSThe survey was performed in 61 tertiary hospitals in 31 provinces, municipalities, and autonomous regions in China (except Hong Kong, Macao, and Taiwan). Trained physicians collected demographic and clinical data and measured blood pressure (BP) using a standardized protocol. Hypertension was defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, and/or use of antihypertensive medications. BP < 140/90 mmHg and < 130/80 mmHg were used as the 2 thresholds of hypertension control. In multivariate logistic regression with adjustment for sex and age, we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.

RESULTSThe analysis included 8927 non-dialysis CKD patients. The prevalence, awareness, and treatment of hypertension in non-dialysis CKD patients were 67.3%, 85.8%, and 81.0%, respectively. Of hypertensive CKD patients, 33.1% and 14.1% had controlled BP to < 140/90 mmHg and < 130/80 mmHg, respectively. With successive CKD stages, the prevalence of hypertension in non-dialysis CKD patients increased, but the control of hypertension decreased (P < 0.001). When the threshold of BP < 130/80 mmHg was considered, the risk of uncontrolled hypertension in CKD 2, 3a, 3b, 4, and 5 stages increased 1.3, 1.4, 1.4, 2.5, and 4.0 times compared with CKD 1 stage, respectively (P < 0.05). Using the threshold of < 140/90 mmHg, the risk of uncontrolled hypertension increased in advanced stages (P < 0.05).

CONCLUSIONSThe prevalence of hypertension Chinese non-dialysis CKD patients was high, and the hypertension control was suboptimal. With successive CKD stages, the risk of uncontrolled hypertension increased.

Adult ; Aged ; Awareness ; Female ; Humans ; Hypertension ; complications ; epidemiology ; therapy ; Male ; Middle Aged ; Prevalence ; Renal Insufficiency, Chronic ; complications

Objective To explore the effect of methylprednisolone combined with HBO on acute lung injury (ALI) induced by rush decompression.Methods Twenty-six male healthy rabbits were randomly divided into the normal control group (n =6),the model group and the combined therapy group.Four animals in the model group and the combined therapy group died,following development of the ALI model by rush decompression by using vacuum pumps.Then,the remaining 24 animals were randomly divided into the model group and the combined therapy group,each consisting of 12 animals.The moment after the animals were surfaced from the chamber,4 animals in each group were sacrificed for the detection of wet/dry ratio of the lung tissue.The remaining animals in the model and control groups were given normal feeding for 3 days,without any treatment.Following injection of methylprednisolone (1 mg/kg),the animals in the combined therapy group were exposed to HBO (0.1 MPa gauge pressure,breathing oxygen for 2 hours),one session a day for a succession of 3 days.Three days later,observations were made on the wet/dry ratio of the lung tissue,pathologic morphology,concentrations of TNF-α and IL-1β,and the expressions of NF-κB p65 mRNA.Results The moment and 3 days after rush decompression,the wet/dry values of the animals in the model group were (5.29 ±0.26,3.20 ±0.21),which were higher than those of the animals in the control group (2.32 ±0.54,2.15 ±0.40) (P ＜0.01).Significant pulmonary exudation and inflammatory infiltration could obviously been seen.Three days after treatment with methylprednisolone combined with HBO therapy,the wet/dry value of the animals in the treatment group decreased significantly (2.34 ± 0.49),without statistical significance,when compared with that of the control group.However,statistical significance could be noted,when compared with that of the model group.Three days later,concentrations of TNF-α and IL-1β of the model group increased [(9.53 ± 1.28),(20.34 ± 1.87) ng/L)],which were significantly higher than those of the control group [(6.42 ±0.95),(15.63 ± 1.85) ng/L)] (P ＜ 0.05 or P ＜ 0.01).The expressions of NF-κB p65 mRNA (1.32 ± 0.48) also increased,when compared with those of the control group (0.35 ± 0.07) (P ＜ 0.05).After 3 days of combined treatment with methylprednisolone and HBO,acute lung injury score of the treatment group was(4.43 ± 0.93),which showed a significant improvement,when compared with that of the model group (8.56 ± 1.73) (P ＜ 0.01).Nevertheless,it was still rather high,when compared with that of the control group(0.97 ± 0.17)(P ＜ 0.01).The concentrations of TNF-α and IL-1β in the homogenates decreased [(7.17 ±0.65),(16.63 ± 0.57)ng/L],which were significantly lower than those of the model group [(9.53 ± 1.28),(20.34 ± 1.84) ng/L) (P ＜ 0.05).In the meantime,the expression of N F-κB p65 mRNA also declined markedly (0.43 ±0.15),when compared with that of the model group(1.32 ±0.48) (P ＜ 0.05).Conclusions The combined treatment of methylprednisolone and HBO could produce positive effects on acute lung injury induced by rush decompression,the inhibition in the expression of NF-κB p65 might be one of the mechanisms involved.

Objective To explore the effect of methylprednisolone combined with HBO on acute lung injury (ALI) induced by rush decompression.Methods Twenty-six male healthy rabbits were randomly divided into the normal control group (n =6),the model group and the combined therapy group.Four animals in the model group and the combined therapy group died,following development of the ALI model by rush decompression by using vacuum pumps.Then,the remaining 24 animals were randomly divided into the model group and the combined therapy group,each consisting of 12 animals.The moment after the animals were surfaced from the chamber,4 animals in each group were sacrificed for the detection of wet/dry ratio of the lung tissue.The remaining animals in the model and control groups were given normal feeding for 3 days,without any treatment.Following injection of methylprednisolone (1 mg/kg),the animals in the combined therapy group were exposed to HBO (0.1 MPa gauge pressure,breathing oxygen for 2 hours),one session a day for a succession of 3 days.Three days later,observations were made on the wet/dry ratio of the lung tissue,pathologic morphology,concentrations of TNF-α and IL-1β,and the expressions of NF-κB p65 mRNA.Results The moment and 3 days after rush decompression,the wet/dry values of the animals in the model group were (5.29 ±0.26,3.20 ±0.21),which were higher than those of the animals in the control group (2.32 ±0.54,2.15 ±0.40) (P ＜0.01).Significant pulmonary exudation and inflammatory infiltration could obviously been seen.Three days after treatment with methylprednisolone combined with HBO therapy,the wet/dry value of the animals in the treatment group decreased significantly (2.34 ± 0.49),without statistical significance,when compared with that of the control group.However,statistical significance could be noted,when compared with that of the model group.Three days later,concentrations of TNF-α and IL-1β of the model group increased [(9.53 ± 1.28),(20.34 ± 1.87) ng/L)],which were significantly higher than those of the control group [(6.42 ±0.95),(15.63 ± 1.85) ng/L)] (P ＜ 0.05 or P ＜ 0.01).The expressions of NF-κB p65 mRNA (1.32 ± 0.48) also increased,when compared with those of the control group (0.35 ± 0.07) (P ＜ 0.05).After 3 days of combined treatment with methylprednisolone and HBO,acute lung injury score of the treatment group was(4.43 ± 0.93),which showed a significant improvement,when compared with that of the model group (8.56 ± 1.73) (P ＜ 0.01).Nevertheless,it was still rather high,when compared with that of the control group(0.97 ± 0.17)(P ＜ 0.01).The concentrations of TNF-α and IL-1β in the homogenates decreased [(7.17 ±0.65),(16.63 ± 0.57)ng/L],which were significantly lower than those of the model group [(9.53 ± 1.28),(20.34 ± 1.84) ng/L) (P ＜ 0.05).In the meantime,the expression of N F-κB p65 mRNA also declined markedly (0.43 ±0.15),when compared with that of the model group(1.32 ±0.48) (P ＜ 0.05).Conclusions The combined treatment of methylprednisolone and HBO could produce positive effects on acute lung injury induced by rush decompression,the inhibition in the expression of NF-κB p65 might be one of the mechanisms involved.

OBJECTIVETo investigate the etiology, pathology, and clinical characteristics of cryptogenic liver diseases in order to develop a pathogenic profile for clinical diagnosis and therapeutic design.

METHODSThe data of the 566 patients diagnosed with abnormal liver function and who had undergone liver biopsy at our institute between January 2006 to March 2010 were retrospectively analyzed. The Chi-squared (x²) test was used to assess disease correlation with sex and the rank sum test was used to assess disease correlation with continuous data since all data had asymmetric distribution.

RESULTSAmong the 566 patients, abnormal liver function was attributed to alcoholic liver disease (n=175; 30.92%), drug-induced or environmentally-induced liver disease (n=101; 17.84%), hereditary and metabolic disease (n=93; 16.43%), infectious hepatitis disease (n=84; 14.84%), fatty liver disease (n=53; 9.36%), and autoimmune liver disease (n=30; 53.00%). Thirty patients had unknown etiology, despite liver biopsy analysis. Among these disease subgroups, there were distinct correlations with sex, age, and levels of alanine transaminase (ALT) and gamma-glutamyltransferase (GGT). The autoimmune liver disease group was correlated with sex (q=9.14, 7.435, 5.071, 9.529, and 12.5, respectively; P less than or equal to 0.01). The alcoholic liver disease group and autoimmune liver disease group were correlated with age (vs. genetic metabolic disease group: q=17.254 and 10.302; infectious hepatitis group: q=17.523 and 10.697); drug/environmentally-induced liver damage group: q=9.170 and 5.266); fatty liver group: q=7.118 and 4.661) (P less than or equal to 0.01). In addition, the alcoholic and autoimmune liver disease groups were correlated with GGT levels (vs. genetic metabolic disease group: q=8.003; infectious hepatitis group: q=4.793; drug/environmentally-induced liver damage group: q=4.404) (P less than or equal to 0.01).

CONCLUSIONLiver pathology is important for the diagnosis of cryptogenic liver diseases. Patient age, sex, and biochemistry index may facilitate diagnosis and treatment in the absence of pathology.

Adolescent ; Adult ; Biopsy ; Child ; Child, Preschool ; Female ; Humans ; Liver ; pathology ; Liver Diseases ; classification ; diagnosis ; pathology ; Male ; Middle Aged ; Young Adult

OBJECTIVETo investigate the changes and development of surgical treatment for breast cancer from 1999 to 2008 in China, and compare the differences between the surgical methods used in high-resource and low-resource areas.

METHODSClinicopathological data of surgical treatment for female primary breast cancer was collected via medical chart review at hospitals in seven geographic areas in China. Chi-square test and chisqure test for linear trends were used to analyze the changes and development of the surgical methods used for breast cancer in the 10 years.

RESULTSA total of 4211 primary breast cancer patients were selected from the 10-year database, including 4078 women (97.5%) treated by surgical operation. Among 3271 women (80.21%) treated with modified radical mastectomy, the surgical rate was rising from 68.89% in 1999 to 80.17% in 2008, ascending by 11.28% (χ(2) = 31.143, P < 0.001). In high-resource areas, the surgical rate of modified radical mastectomy was rising from 45.64% in 1999 to 76.13% in 2008, ascending by 30.49% (χ(2) = 89.393, P < 0.001), while in low-resource areas it kept a steady rate at 80% in the ten years (χ(2) = 2.113,P = 0.146). Among 231 women (5.66%) treated with breast-conserving surgery, the surgical rate was rising from 1.29% in 1999 to 11.57% in 2008, ascending by 10.28% (χ(2) = 102.835, P < 0.001). In high-resource areas, the surgical rate of breast-conserving surgery was rising from 2.68% in 1999 to 16.87% in 2008, ascending by 14.19% (χ(2) = 69.544, P < 0.001), while in low-resource areas it was rising from 0.42% in 1999 to 6.22% in 2008, ascending by 5.80% (χ(2) = 30.003, P < 0.001). Among 469 women (11.50%) treated with Halsted radical mastectomy, the surgical rate was declining from 28.28% in 1999 to 4.96% in 2008, descending by 23.32% (χ(2) = 206.202, P < 0.001). In high-resource areas, the surgical rate of Halsted radical mastectomy was declining from 50.34% in 1999 to 3.29% in 2008, descending by 47.05% (χ(2) = 274.830, P < 0.001), while in low-resource areas it was declining from 14.58% in 1999 to 6.64% in 2008, descending by 7.94% (χ(2) = 8.166, P = 0.004). Among 3786 women treated with breast mastectomy (including modified radical mastectomy and Halsted radical mastectomy), the surgical rate was declining from 98.46% in 1999 to 86.36% in 2008, descending by 12.10% (χ(2) = 95.744, P < 0.001). In high-resource areas, the surgical rate of breast mastectomy was declining from 96.64% in 1999 to 80.66% in 2008, descending by 15.98% (χ(2) = 53.446, P < 0.001), while in low-resource areas it was declining from 99.58% in 1999 to 92.12% in 2008, descending by 7.46% (χ(2) = 36.758,P < 0.001).

CONCLUSIONSThe main primary surgical treatment for breast cancer is modified radical mastectomy during the period 1999 - 2008. Halsted radical mastectomy is gradually replaced by modified radical mastectomy and breast-conserving surgery. The rate of changes for breast-conserving surgery and mastectomy is higher in high-resource areas than that in low-resource areas. Breast-conserving surgery will become the main treatment for early-stage breast cancer.

Breast Neoplasms ; economics ; pathology ; surgery ; Carcinoma, Ductal, Breast ; economics ; pathology ; surgery ; Chi-Square Distribution ; China ; Female ; Humans ; Mastectomy ; methods ; trends ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Neoplasm Staging ; Retrospective Studies ; Socioeconomic Factors

Objective To establish a rat model of decompression sickness induced by simulated deep fast buoyancy ascent of submariners.Methods Eighty male SD rats were randomly divided into 4 groups,each consisting of 20 animals:the control group,the 2-min exposure group,the 4-min exposure group,and the 8-min exposure group.The latter 3 groups were compressed to 150 m at an exponential rate of 2 t/8s in the air chamber,stayed at the said pressure respectively for 2,4 and 8 mins.Then,they were decompressed to atmospheric pressure at a linear speed of 3 m/s.Behavior and pathological changes in lungs,brain,spinal cord of all the animal groups were closely observed.Results After they came out of the chamber,the animals of all the groups displayed the following behaviors:hair erection,scratching and slow reaction.Pathological examination indicated that there were edema and hemorrhage in the alveolar and pulmonary interstitial tissue,and in the spinal cord as well.However,no significant pathological changes in the brain tissue could be noted.Mobidity of 2,4,8-min profile SD rats were 20.07％,55.0％ and 10.0％,respectiuely,At the same time,mortality of which were 0,20.0％ and 85.0％,respectively.Significant differences could also be seen in the morbidity and mortality of the animals in various exposure groups with different exposure time(P＜0.01).As the exposure time of the 8-min profile was too long,mortality 3 of the developed rat model was relatively higher,when they came out of the chamber.Nevertheless,the exposure time of the 2-min profile was obviously inadequate,morbidity of the developed rat model was relatively lower.Thus,the 4-min profile with a low mortality and high morbidity of decompression sickness might be appropriate for submarine escape.Conclusions The experiment has successfully established 4-min exposure profile was the animal model of decompression sickness induced by deep fast buoyancy ascent of submariners.

Objective To establish a rat model of decompression sickness induced by simulated deep fast buoyancy ascent of submariners.Methods Eighty male SD rats were randomly divided into 4 groups,each consisting of 20 animals:the control group,the 2-min exposure group,the 4-min exposure group,and the 8-min exposure group.The latter 3 groups were compressed to 150 m at an exponential rate of 2 t/8s in the air chamber,stayed at the said pressure respectively for 2,4 and 8 mins.Then,they were decompressed to atmospheric pressure at a linear speed of 3 m/s.Behavior and pathological changes in lungs,brain,spinal cord of all the animal groups were closely observed.Results After they came out of the chamber,the animals of all the groups displayed the following behaviors:hair erection,scratching and slow reaction.Pathological examination indicated that there were edema and hemorrhage in the alveolar and pulmonary interstitial tissue,and in the spinal cord as well.However,no significant pathological changes in the brain tissue could be noted.Mobidity of 2,4,8-min profile SD rats were 20.07％,55.0％ and 10.0％,respectiuely,At the same time,mortality of which were 0,20.0％ and 85.0％,respectively.Significant differences could also be seen in the morbidity and mortality of the animals in various exposure groups with different exposure time(P＜0.01).As the exposure time of the 8-min profile was too long,mortality 3 of the developed rat model was relatively higher,when they came out of the chamber.Nevertheless,the exposure time of the 2-min profile was obviously inadequate,morbidity of the developed rat model was relatively lower.Thus,the 4-min profile with a low mortality and high morbidity of decompression sickness might be appropriate for submarine escape.Conclusions The experiment has successfully established 4-min exposure profile was the animal model of decompression sickness induced by deep fast buoyancy ascent of submariners.

Objective To determine the adherence to and its determinants of methadone maintenance treatment (MMT) among heroin addicts in Dehong prefecture in Yunnan province from 2005 to 2009. Methods A dynamic cohort analysis was conducted with the time of treatment initiation as the time of cohort entry, to calculate the proportion of adhering to the treatment at different time points after initiation of the treatment, and to study the determinants of adherence.Results A total of 3758 had been treated. Among them, 95.8% were males, 75.8% aged between 20-39 years, 90.4% were peasants or unemployed, 57.0% were ethnic minorities, 35.0% were single and 55.5% were married with spouses, 43.9% were illiterate or educated at most primary school. The age of first using drugs averaged at 23.93 years. About 96.3% of the study subjects had used heroin and 21.7% were HIV-infected. The minimum time under MMT was less than 1 month and the maximum 61 months. The median methadone dose at first delivery was 25 ml, with the minimum 1 ml and the maximum 330 ml. By the end of the study or observation period, a total of 1798 patients had withdrawn from treatment and 1960 were still under treatment. The proportions of adherence to or still being under the treatment after 1,3,6,9, 12,24, 36,48 and 60 months treatment were 0.919,0.847,0.756, 0.690, 0.637, 0.519, 0.417, 0.360 and 0.321, respectively. Multiple regression analysis using Cox proportional hazard model indicated that withdraw from the methadone maintenance treatment was significantly associated with location of the treatment clinics, year of treatment initiation, marital status, HIV infection status, methadone dose of first delivery and the result of last urine test for heroin use. Conclusion MMT attendants in Dehong prefecture had a relatively high withdraw rate and low adherence rate. More efforts are needed to provide tailored counseling and education to MMT attendants, to provide family and community support, appropriate methadone dose at first delivery, and to better coordinate with local police department.