Objective:To summarize the tools and applications of functionality appreciation assessment.Methods:A computerized search was conducted in PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc for literature related to functionality appreciation assessment tools and their applications, with the time frame from database inception to May 12, 2024.Results:A total of 26 articles were included. Functionality appreciation was found to be associated with demographic, physiological, psychological, and social health factors. Functionality appreciation assessment tools demonstrated good psychometric properties across different cultural backgrounds and populations.Conclusions:Functionality appreciation exerts multidimensional benefits on physical and psychological health. However, the available functionality appreciation assessment tools are limited in variety. Future research should further explore the applicability of these tools in different populations in China.

Objective:To summarize the tools and applications of functionality appreciation assessment.Methods:A computerized search was conducted in PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine disc for literature related to functionality appreciation assessment tools and their applications, with the time frame from database inception to May 12, 2024.Results:A total of 26 articles were included. Functionality appreciation was found to be associated with demographic, physiological, psychological, and social health factors. Functionality appreciation assessment tools demonstrated good psychometric properties across different cultural backgrounds and populations.Conclusions:Functionality appreciation exerts multidimensional benefits on physical and psychological health. However, the available functionality appreciation assessment tools are limited in variety. Future research should further explore the applicability of these tools in different populations in China.

Objective:To investigate the effects of early enteral and parenteral nutrition support on the growth, development, and metabolomics of low-birth-weight newborns.Methods:Ninety low-birth-weight newborns admitted to Hangzhou Maternity and Child Health Care Hospital from April 2022 to April 2024 were included in this retrospective study. They were randomly divided into a control group ( n = 45) and an intervention group ( n = 45) according to different intervention methods. The control group received routine traditional nutritional support, while the intervention group received early enteral and parenteral nutrition support. Data were collected on the growth and development status of the newborns, as well as their feeding conditions. Gastric fluid pH value, frequency of bowel sounds, and level of direct bilirubin were recorded. Physical condition was also assessed. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate the neurobehavioral status of the newborns. Additionally, the incidence of complications was recorded for both groups, and metabolomic changes were analyzed. Results:After intervention, the control group exhibited a time to regain birth weight of (20.67 ± 8.31) days, a time to reach a body weight of 2.0 kg of (53.57 ± 12.51) days, a lowest recorded body weight of (1.32 ± 0.21) kg, a body weight loss percentage of (12.31 ± 5.52)%, and a body weight gain of (15.02 ± 2.30) g/(kg/d). In contrast, the intervention group demonstrated a time to regain birth weight of (14.31 ± 5.62) days, a time to reach a body weight of 2.0 kg of (39.21 ± 9.32) days, a lowest recorded body weight of (1.01 ± 0.17) kg, a body weight loss percentage of (7.84 ± 4.92)%, and a body weight gain of (17.74 ± 3.94) g·kg?1·d?1. All differences between the two groups were statistically significant ( t = 4.28, 9.96, 7.69, 4.05, 4.11, all P < 0.001). The difference in the lowest body weight day between the two groups of children was not statistically significant ( P > 0.05). After intervention, the control group had an initial oral feeding duration of (8.30 ± 1.37) days, with a vomiting frequency of (10.25 ± 2.20) times, a daily milk intake of (35.38 ± 3.94) mL, a gastric fluid pH value of (3.85 ± 0.20), bowel sounds of (4.94 ± 0.97) times/minute, and a direct bilirubin level of (41.98 ± 25.76) mmol/L. In contrast, the intervention group showed an initial oral feeding duration of (4.01 ± 0.76) days, a vomiting frequency of (5.61 ± 1.24) times, a daily milk intake of (43.54 ± 4.07) mL, a gastric fluid pH value of (3.41 ± 0.12), bowel sounds of (5.86 ± 1.11) times/minute, and a direct bilirubin level of (28.98 ± 18.10) mmol/L. The differences between the two groups were statistically significant ( t = 18.36, 12.32, 9.66, 12.65, 4.18, 2.77, all P < 0.05). After intervention, the control group had a body length of (40.32 ± 1.84) cm, a body weight of (1.47 ± 0.55) kg, and a head circumference of (29.21 ± 1.07) cm. The intervention group had a body length of (45.00 ± 2.16) cm, a body weight of (1.83 ± 1.03) kg, and a head circumference of (30.14 ± 1.35) cm. The differences between the two groups were statistically significant ( t = 11.06, 2.06, 3.62, all P < 0.05). At 40 weeks of corrected gestational age post-intervention, the control group had a NBNA score of (30.11 ± 2.41), whereas the intervention group had an NBNA score of (34.52 ± 2.82). The difference between the two groups was statistically significant ( t = 7.97, P < 0.05). The number of patients experiencing common complications in the intervention group was lower than that in the control group [8 (17.78%) vs. 28 (62.22%), χ2 = 18.51, P < 0.05]. The control group had glycine levels of (94.07 ± 19.78) μmol/L, valine levels of (99.53 ± 13.42) μmol/L, homocysteine levels of (10.87 ± 4.43) μmol/L, cystatin levels of (233.71 ± 35.02) μmol/L, and methionine levels of (20.54 ± 4.67) μmol/L. The intervention group had glycine levels of (79.21 ± 17.54) μmol/L,valine levels of (88.70 ± 12.96) μmol/L, homocysteine levels of (13.68 ± 7.66) μmol/L, cystatin levels of (256.54 ± 35.49) μmol/L, and methionine levels of (22.97 ± 5.49) μmol/L. The differences between the two groups were statistically significant ( t = 3.77, 3.89, 2.13, 3.07, 2.26, all P < 0.05). Conclusions:Early enteral and parenteral nutritional support for low-birth-weight infants can restore their growth and development status, improve feeding conditions, enhance gastrointestinal function, and improve levels of metabolomic-related indicators.

Objective:To investigate the effects of early enteral and parenteral nutrition support on the growth, development, and metabolomics of low-birth-weight newborns.Methods:Ninety low-birth-weight newborns admitted to Hangzhou Maternity and Child Health Care Hospital from April 2022 to April 2024 were included in this retrospective study. They were randomly divided into a control group ( n = 45) and an intervention group ( n = 45) according to different intervention methods. The control group received routine traditional nutritional support, while the intervention group received early enteral and parenteral nutrition support. Data were collected on the growth and development status of the newborns, as well as their feeding conditions. Gastric fluid pH value, frequency of bowel sounds, and level of direct bilirubin were recorded. Physical condition was also assessed. The Neonatal Behavioral Neurological Assessment (NBNA) was used to evaluate the neurobehavioral status of the newborns. Additionally, the incidence of complications was recorded for both groups, and metabolomic changes were analyzed. Results:After intervention, the control group exhibited a time to regain birth weight of (20.67 ± 8.31) days, a time to reach a body weight of 2.0 kg of (53.57 ± 12.51) days, a lowest recorded body weight of (1.32 ± 0.21) kg, a body weight loss percentage of (12.31 ± 5.52)%, and a body weight gain of (15.02 ± 2.30) g/(kg/d). In contrast, the intervention group demonstrated a time to regain birth weight of (14.31 ± 5.62) days, a time to reach a body weight of 2.0 kg of (39.21 ± 9.32) days, a lowest recorded body weight of (1.01 ± 0.17) kg, a body weight loss percentage of (7.84 ± 4.92)%, and a body weight gain of (17.74 ± 3.94) g·kg?1·d?1. All differences between the two groups were statistically significant ( t = 4.28, 9.96, 7.69, 4.05, 4.11, all P < 0.001). The difference in the lowest body weight day between the two groups of children was not statistically significant ( P > 0.05). After intervention, the control group had an initial oral feeding duration of (8.30 ± 1.37) days, with a vomiting frequency of (10.25 ± 2.20) times, a daily milk intake of (35.38 ± 3.94) mL, a gastric fluid pH value of (3.85 ± 0.20), bowel sounds of (4.94 ± 0.97) times/minute, and a direct bilirubin level of (41.98 ± 25.76) mmol/L. In contrast, the intervention group showed an initial oral feeding duration of (4.01 ± 0.76) days, a vomiting frequency of (5.61 ± 1.24) times, a daily milk intake of (43.54 ± 4.07) mL, a gastric fluid pH value of (3.41 ± 0.12), bowel sounds of (5.86 ± 1.11) times/minute, and a direct bilirubin level of (28.98 ± 18.10) mmol/L. The differences between the two groups were statistically significant ( t = 18.36, 12.32, 9.66, 12.65, 4.18, 2.77, all P < 0.05). After intervention, the control group had a body length of (40.32 ± 1.84) cm, a body weight of (1.47 ± 0.55) kg, and a head circumference of (29.21 ± 1.07) cm. The intervention group had a body length of (45.00 ± 2.16) cm, a body weight of (1.83 ± 1.03) kg, and a head circumference of (30.14 ± 1.35) cm. The differences between the two groups were statistically significant ( t = 11.06, 2.06, 3.62, all P < 0.05). At 40 weeks of corrected gestational age post-intervention, the control group had a NBNA score of (30.11 ± 2.41), whereas the intervention group had an NBNA score of (34.52 ± 2.82). The difference between the two groups was statistically significant ( t = 7.97, P < 0.05). The number of patients experiencing common complications in the intervention group was lower than that in the control group [8 (17.78%) vs. 28 (62.22%), χ2 = 18.51, P < 0.05]. The control group had glycine levels of (94.07 ± 19.78) μmol/L, valine levels of (99.53 ± 13.42) μmol/L, homocysteine levels of (10.87 ± 4.43) μmol/L, cystatin levels of (233.71 ± 35.02) μmol/L, and methionine levels of (20.54 ± 4.67) μmol/L. The intervention group had glycine levels of (79.21 ± 17.54) μmol/L,valine levels of (88.70 ± 12.96) μmol/L, homocysteine levels of (13.68 ± 7.66) μmol/L, cystatin levels of (256.54 ± 35.49) μmol/L, and methionine levels of (22.97 ± 5.49) μmol/L. The differences between the two groups were statistically significant ( t = 3.77, 3.89, 2.13, 3.07, 2.26, all P < 0.05). Conclusions:Early enteral and parenteral nutritional support for low-birth-weight infants can restore their growth and development status, improve feeding conditions, enhance gastrointestinal function, and improve levels of metabolomic-related indicators.

Objective:To design 3D printed prosthesis in an individualized way and explore the short-term clinical efficacy of reconstruction of segmental defect after resection of bone tumor in lower extremities with 3D-printed prosthesis.Methods:From January 2017 to June 2019, 6 patients with lower limb bone tumor who met the inclusion criteria were recruited, including 3 males and 3 females, aged 8.67±1.11 years (range 6-11 years). All 6 cases were primary bone tumors, and the Enneking stages were all IIB, including 3 cases of left tibial tumors, 2 cases of right tibial tumors, and 1 case of right femoral tumor. These 3D-printed prostheses were designed based on the preoperative imaging data. The mechanical stability of the prosthesis was evaluated by three-dimensional finite element analysis. After tumor resection, the 3D-printed prosthesis was installed and fixed to reconstruct the segmental bone defect. All patients were clinically followed up and evaluated by imaging regularly after operation. The functional status was assessed by the Musculoskeletal Tumor Society (MSTS) score. Oncology results and complications were recorded in detail.Results:All operations were successfully performed, including 3 cases underwent left tibial tumor resection, 2 cases underwent right tibial tumor resection, and 1 case underwent right femoral tumor resection. The length of the bone defect after tumor resection was 18.19±3.74 cm, the average operation time was 165.83±54.17 min, and the average intraoperative bleeding was 233.33±133.33 ml. These finite element analysis data show that the overall stress of these prostheses are lower than the maximum mechanical strength of the corresponding materials. These 3D printed prostheses match well with the excision defect and meet the expected effect. There were no adverse reactions during the operation. The mean follow-up period was 16.83±7.17 months. At the last follow-up, all patients survived without tumor recurrence or metastasis. Postoperative imaging results showed that all the implants were stable without complications such as peripheral infection, aseptic loosening, prosthesis fracture. These 3D-printed prostheses composite resulted in substantial bone integration at follow-up. The average MSTS score was 83.67%±9.11%.Conclusion:The individualized 3D printed prosthesis can be used to reconstruct the bone defect after the resection of osteosarcoma in the lower extremities, and the clinical efficacy was satisfactory in the short-term follow-up.

Objective To analyze clinical efficacy of artificial prosthesis in giant cell tumor in distal femur,and to investigate risk factors affecting prosthesis failure and functional outcomes.Methods 42 patients with giant cell tumor of bone in distal femur,who had undergo prosthesis replacement from January 2002 to May 2015,were enrolled in this study.There were 24 males and 18 females,with an average age of 38.53± 12.87 years.There were 28 primary patients and 14 relapsed patients,including 11 cases of recurrence once and 3 cases of twice.Three-dimensional finite element model was used to analyze the effect of different angles of deviation of the spinal needle on the deformation of the bone wall.The correlations between the factors such as age,sex,occupation,prosthesis type,and other factors on prosthesis loosening were compared.Biomechanical effect of lower limbs caused by prosthesis offset angle was analyzed through gait analysis.Analyzed the effects of primary tumor or recurrence,prosthesis service status,and length of surgical osteotomy on joint function.Results A total of 42 patients were followed up by 20-158 months,with an average of 68.7 months.The 3 year survival rate of prosthesis was 83.33％ for 3 years and 57.14％ for 5 years.The major reason of prosthesis failure was loose (18/42,42.8％).X-ray films showed 19 cases of prosthetic intramedullary nail and sagittal bias of medullary force line angle ＞ 3° in the first follow-up.Osteotomy length (OR=0.132,P=0.0027) and offset angle of needle (OR=25.000,P=0.000) were significantly correlated to prosthesis loose.A length more than 12 cm and angle more than 3° were easier to result in prosthesis loose.There were no significant correlation between prosthesis failure and patients age,gender,occupation and prosthesis type.Gait analysis shows that the unsuitable bias angle of the prosthesis can significantly change the joint force of the prosthesis.The average score of MSTS 93 function evaluation was 25.43±4.256,excellent in 33 cases,good in 7 cases and poor in 2 cases.Function of patients with primary GCT were better than that of recurrent ones.Patients with one 1 times recurrence were better than that of recurrence twice (P=0.003).Patients without prosthesis loosening and revision were better than that with loosening (P=0.001).Patients with an osteotomy length less than 12 cm had a poorer function than that with more than 12 cm (P=0.002).Conclusion The main factors affecting distal femoral prosthesis replacement therapy of GCT is loosening,which was caused by broach and medullary cavity mismatch,osteotomy length,prosthesis rotation,prosthesis position.The function of the prosthesis is mainly affected by operation times,prosthesis status,osteotomy length and low patella.

Objective To explore the feasibility and clinical efficacy of long-segmental bone defects after en bloc tumor resection of lower limb segment with composite of titanium alloy 3D printed prosthesis and vascularized fibular autograft and bioceramics.Methods 5 patients with lower extremity tumor (1 high grade chondrosarcoma,1 Ewing sarcoma,1 single metastatic tumor and 2 osteosarcoma) were treated by en bloc resection and precise reconstruction with segmental 3D-printed,custom-made prosthesis from August 2015 to November 2016,which composed of 1 male and 4 females,ranged from 16 to 56 years old,the average was 32± 19.3 years old.Three-dimensional computed tomography reconstructed images of patients' tumors were built before surgery.Custom-made prostheses were manufactured based on the patients' reconstructed images with micro-pores on the surface.After en bloc tumor resection with the help of osteotomy guide plate,the defects were reconstructed with 3D-printed,custom-made prostheses.Vascularized fibular autografts were put inside the prostheses,and the interval space among them was filled with bioceramics.Results All the 5 cases were performed surgical planning before the surgery with prosthesis and guide plate were designed at the same time.After verification of the finite element analysis SLM (2 cases) and the EBM (3 cases) were used to process prosthesis,and were designed into porous sharp with 210.98±66.16 mm in length and 26 901.76±12 903.96 mm3 in volume.Then the prosthesis would be cleaned and sterilized.All 5 operation were proceeded according to the plan of preoperative.The intra-operative guide plate were installed on the bone surface stably.The bone cutting was guided according to the plan of preoperative.By intra-operative frozen pathological examination,there were no malignant tissues in near and far marrow cavity.Unfolded fibular flap with 168.75±49.07 mm in length and porous tricalcium phosphate particle composite implants with 10±4.08 g were used in 4 cases and bone cement was used in 1 cases of metastatic tumor.The average operation time was 261±85 min and average blood loss was 540±182 ml.After a mean follow-up time of 6.4 months (1-15 months),all 5 cases survived with no local recurrence and pulmonary metastasis tumor.2 cases with vascular pedicle fibular transplant confirmed the survival of fibula via bone scan 3 months after operation.All cases were no infection,fractures,prosthesis loosening,except broken screw in 1 case.The Musculoskeletal Tumor Society (MSTS) 93 score was 17-26.Conclusion Long segment tubular titanium alloy 3D printed prosthesis with vascularized fibular autograft and bioceramics could reconstruct the segmental defects caused by tumor resection.

Objective To analyze the image and histological results of the combined use of allograft/extracorporeally frozen tumor-bearing bone and vascularized fibular flap for the reconstruction of bony defects following tumor resection,guiding clinical practice.Methods From March 2007 to June 2013,we enrolled 63 patients who had combinative biological reconstruction after bone tumor resection (11 in humerus,22 in femur,21 in tibia,4 in calcaneus).There were 36 male and 27 female in this series.The average age at time of operation was 20 years,ranging from 9 to 48 years.The follow-up ranged from 16 to 102 months with average of 48 months.We investigated the X-ray and CT images for all patients and histological findings of two patients.Patients were assessed functionally with the Musculoskeletal Tumor Society 93 score.Results Three patients with local soft tissue recurrence and one patient with infection underwent amputation.The survival of construct was 93.6％.Bone union achieved in all cases with the average MSTS score of 92.8％.Bone union ranged from 11 to 28 months in allograft group and 9 to 14 months in devitalized tumor bearing bone group.Significant difference of bone union time was found between two groups (Z=-3.638,P=0.000).Viability of the fibular grafts was verified in 58 of 63 patients (92％).Three types of images were observed in complex.Osteopenia and spongy change in fibula were found in 51 patients (81％) with stable fixation of the complex.Five complexes with failed blood supply of fibula and stable fixation revealed no density change of fibula,small amount of callous formation and relative delayed union.In seven complexes (11％) with unstable complex due to patients' incompliance,fibula reacted with dense hypertrophy and microfracture.Fusion of grafts with amount of callus was obviously observed.Union at allograft-host bone junctions occurred by residual host bone-derived external callus and fibular-derived internal callus that bridged the junction and filled the gap between abutting cortices.Callus from fibular graft was mature than that from periosteum of residual host bone.Internal repair was observed at the internal surface of the allografts.Fibula showed significant spongy changes.Conclusion Recycled tumor-bearing bone in combined with fibular flap is a reliable reconstruction as an alternative to traditional Capanna technique.The survival of the fibula is a cornerstone in success of complex reconstruction.Sponginess of fibula and internal repair of allograft compromise the intensity of complex,necessitating the strong instrumentation during reconstruction.

BACKGROUND:Infection is the catastrophic complication after total hip arthroplasty, moreover, its diagnostic criteria has not been unified, and treatment options were also controversial. The removal of the focus of infection was complete or not determines whether the joint could be reconstructed and the joint function could be restored. OBJECTIVE:To analyze the experience and efficacy of thorough debridement in two-stage revision surgery for treatment of infection after hip arthroplasty. METHODS:Total y 23 (24 hips) patients with infection after hip arthroplasty were treated at the Department of Orthopedics, Nanjing General Hospital of Nanjing Military Area Command of PLA from August 2008 to January 2013. The diagnostic criteria were in line with consensus. The repair options defined as two phrases:the first phrase was thorough debridement plus antibiotic-containing bone cement implanted with intervals;the second phrase was joint reconstruction. If the infection persisted in interval, debridement could be repeated, and then underwent joint reconstruction after the thorough control of infection. Harris scores of hip function were determined after revision during fol ow-up. Infection control condition was evaluated. RESULTS AND CONCLUSION:Al the patients were fol owed up, ranged from 1 to 5 years. The Harris scores increased from an average of 36.5 (27-45 scores) before treatment to an average of 88.6 (76-98 scores) after treatment. There was no infection recurrence. Infection control rates reached to 100%. These results suggest that two-stage revision is an effective method for treatment of infection after total hip arthroplasty. Thorough debridement plays a crucial role, and it can effectively control infection recurrence, improve prosthesis stability, so as to reconstruct joint function.

Objective To evaluate the prognostic effects of treatment of giant cell tumor of axis by tumor resection associated with biological reconstruction and internal fixation.Methods From 2009 to 2013,5 patients that had giant cell tumor of axis underwent combined anterior and posterior surgery program.The posterior use pedicle screw system to stabilize the cervical spine,then the anterior use stemocleidomastoid inner edge of the mandibular angle approach to reveal the axis.When the cortex of vertebrae was relatively complete,.When the cortical bone was destroyed,vertebra was resected and the ilium was taken to reconstruct the defect.Adjuvant radiotherapy and diphosphate treatment was used postoperatively.Regular follow-up for X-ray,3D CT and MRI examination were done to observe the tumor recurrence,healing of biological reconstruction and function of cervical vertebra.Results The follow-up time was 12-60 months.No recurrence of the tumor was observed in all patients.The 3 patients accepted beta-TCP implanting after curettage was observed with fuzzy internal structure 3 months after surgery,and the grafted bone fusion can be found 12 months after surgery.The 2 ilium grafted patients can be found with bone fusion with the adjacent vertebrae 6 months after surgery.The bend and stretch function of cervical vertebrae of the 5 patients returned to normal after 3months.The biological healing of bone graft,cervical stability and activity were satisfied.The local pain and neurological symptoms were relieved.Conclusion Anterior and posterior surgery program in combination with biological reconstruction and adjuvant radiotherapy provide an excellent option for treatment of giant cell tumor of axis.The dens could be retained to keep the function of occipital cervical when the odontoid bone cortex is not destructed.