Objective:To compare the mid- to long-term clinical outcomes of arthrolysis versus revision arthroplasty for arthrofibrosis-related stiffness following total knee arthroplasty (TKA).Methods:A retrospective analysis was conducted of the 20 patients (26 knees) with post-TKA arthrofibrosis who had been treated at Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital between January 2004 and January 2020. The patients were divided into 2 groups based on their treatment: an arthrolysis group of 8 cases (10 knees) [1 male (2 knees)and 7 females (8 knees); median age: 44.0 (21.0, 62.0) years] and a revision arthroplasty group of 13 cases (16 knees) [4 males (6 knees)and 9 females (10 knees); median age: 41.5 (30.0, 56.0) years]. The knee range of motion (ROM) and the American Hospital for Special Surgery (HSS) knee score as well as their improvements were compared between preoperation and the last follow-up, as well as between the 2 groups; the satisfaction of the patients at the last follow-up was compared between the 2 groups.Results:No significant differences in the baseline characteristics were observed between the 2 groups, indicating comparability ( P>0.05). The preoperative knee ROM [55.0° (48.8°, 61.3°)] and HSS knee score [54.0 (47.0, 61.8) points] in the arthrolysis group were significantly higher than those in the revision group [27.5° (6.3°, 50.0°), 33.0 (27.3, 47.8) points] ( P<0.05). In the arthrolysis and revision arthroplasty groups, the knee ROMs [90.0° (65.0°, 100.0°), 90.0° (63.5°, 98.8°)] and HSS knee scores [(69.8±19.9) points, (77.6±11.3) points] at the last follow-up were significantly improved compared with those before operation ( P<0.05). In the revision arthroplasty group, the improvement in knee ROM (48.9°±21.7°) was insignificantly larger than that in the arthrolysis group (34.5°±13.2°) ( P>0.05), but the improvement in HSS knee score [39.5 (25.3, 57.0) points] was significantly larger than that in the arthrolysis group [16.0 (10.5, 25.3) points] ( P<0.05). Respectively, 14 and 3 knees in the revision arthroplasty group and the arthrolysis group resulted in patient satisfaction, showing a significant difference between the 2 groups ( P<0.05). Conclusions:Both arthrolysis and revision arthroplasty can significantly improve knee ROM and HSS knee score in post-TKA arthrofibrosis. However, since revision arthroplasty demonstrates superior improvements in HSS knee score and patient satisfaction, it is preferable for patients with lower preoperative knee ROM.

Objective:To compare the mid- to long-term clinical outcomes of arthrolysis versus revision arthroplasty for arthrofibrosis-related stiffness following total knee arthroplasty (TKA).Methods:A retrospective analysis was conducted of the 20 patients (26 knees) with post-TKA arthrofibrosis who had been treated at Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital between January 2004 and January 2020. The patients were divided into 2 groups based on their treatment: an arthrolysis group of 8 cases (10 knees) [1 male (2 knees)and 7 females (8 knees); median age: 44.0 (21.0, 62.0) years] and a revision arthroplasty group of 13 cases (16 knees) [4 males (6 knees)and 9 females (10 knees); median age: 41.5 (30.0, 56.0) years]. The knee range of motion (ROM) and the American Hospital for Special Surgery (HSS) knee score as well as their improvements were compared between preoperation and the last follow-up, as well as between the 2 groups; the satisfaction of the patients at the last follow-up was compared between the 2 groups.Results:No significant differences in the baseline characteristics were observed between the 2 groups, indicating comparability ( P>0.05). The preoperative knee ROM [55.0° (48.8°, 61.3°)] and HSS knee score [54.0 (47.0, 61.8) points] in the arthrolysis group were significantly higher than those in the revision group [27.5° (6.3°, 50.0°), 33.0 (27.3, 47.8) points] ( P<0.05). In the arthrolysis and revision arthroplasty groups, the knee ROMs [90.0° (65.0°, 100.0°), 90.0° (63.5°, 98.8°)] and HSS knee scores [(69.8±19.9) points, (77.6±11.3) points] at the last follow-up were significantly improved compared with those before operation ( P<0.05). In the revision arthroplasty group, the improvement in knee ROM (48.9°±21.7°) was insignificantly larger than that in the arthrolysis group (34.5°±13.2°) ( P>0.05), but the improvement in HSS knee score [39.5 (25.3, 57.0) points] was significantly larger than that in the arthrolysis group [16.0 (10.5, 25.3) points] ( P<0.05). Respectively, 14 and 3 knees in the revision arthroplasty group and the arthrolysis group resulted in patient satisfaction, showing a significant difference between the 2 groups ( P<0.05). Conclusions:Both arthrolysis and revision arthroplasty can significantly improve knee ROM and HSS knee score in post-TKA arthrofibrosis. However, since revision arthroplasty demonstrates superior improvements in HSS knee score and patient satisfaction, it is preferable for patients with lower preoperative knee ROM.

Objective:To monitor and investigate the long-term growth trend and nutritional status of very preterm infants (VPIs, born at gestational age between [28~31 +] weeks) with extrauterine growth restriction (EUGR) from birth to preschool period. Methods:VPIs who met with the following criteria were enrolled: infants born in Huai'an Maternity and Child Heath Care Hospital from January 1 to December 31, 2015; infants admitted to the Neonatal Medical Center and discharged alive; infants who received multi-disciplinary treatment in Child Care Division from discharge to preschool period. All of the VPIs were divided into the EUGR group and the non-EUGR group according to whether the weight at hospital discharge was below the 10 th percentile for corrected age in body weight. The weight for age Z score (WAZ), height for age Z score (HAZ), and head circumference for age Z score (HCZ) were calculated at each specified time point (at 40 weeks of age; at 1, 2, 3, 4, 5, 6 and 24 months of corrected age; and at 48 months of age). The growth trend and the nutritional status at 48 months of age were compared between the two groups. Results:1. A total of 53 VPIs were enrolled, among whom 35 cases were boys and 20 cases were with EUGR. The differences in the gestational age, birth weight, incidence of very low birth weight infants, neonatal respiratory distress syndrome (NRDS) and bronchopulmonary dysplasia (BPD) were all statistically significant between the EUGR group and the control group ( x 2= 2.306, 3.543, 10.852, 9.515, 0.001, respectively; all P<0.05). 2. The WAZ and HAZ of the EUGR group were lower at each time point. The WAZ at 40 weeks of age and the HAZ at 3 months of corrected age were significantly different between the two groups. From 40 weeks of age to 2 months of corrected age and from 6 months to 24 months of corrected age, the WAZ, HAZ and HCZ in both groups showed an increasing trend. However, the WAZ in the EUGR group and the WAZ, HAZ and HCZ in the non-EUGR group showed a declining trend from 24 months of corrected age to 48 months of age. 3. There was no significant differences in growth restriction incidence at each time point between the EUGR group and the control group. 4. The nutritional status showed no significant difference between the two groups, either ( P>0.05). Conclusions:Low gestational age, low birth weight, NRDS and BPD are the risk factors of EUGR. The growth trend of the EUGR VPIs shows an overall upward trend from hospital discharge to 24 months of corrected age but declined thereafter, while the nutritional status is good at 48 months of age. Thus, in addition to the integrated management, continuous monitoring of long-term growth and nutrient input after 24 months of age is required for VPIs.

Objective To evaluate the clinical manifestations, metal metabolism, imaging characteristics and treatment response in patients with delayed Wilson disease (WD). Methods Patients with untreated WD (40 with delayed onset and 40 with non?delayed onset) were enrolled. Twenty healthy people were included as normal controls. All patients were evaluated with modified Young scale neural symptom scores, grade of Child liver function and mental symptoms rating scale, magnetic resonance imaging (MRI) scan, magnetic sensitive imaging (susceptibility weighted imaging, SWI), metal metabolism. Corrected phase (CP) was measured at SWI. After 2 week treatment, neurologic symptoms, liver function, and metal metabolism were reviewed. Results The total score of neurological symptoms in WD patients with delayed onset was lower than that of non?delayed onset (13.00 ± 6.87 vs. 21.13 ± 5.53, P=0.033). The scores of SCL?90 and HAMA depression scales in patients with delayed onset were lower than those of non?delayed onset. On T2 weighted imaging, areas including substantia nigra and thalamus, the caudate nucleus, globus pallidus, putamen presented high signal rate in patients with delated onset than those with non?delayed (P=0.022, 0.037, 0.022, 0.037, 0.029 respectively). The SWI CP values of cangbai sphere and shell nucleus in patients with delayed onset were lower than those with non?delayed onset. Patients with delayed onset had higher urinary copper than those with non?delayed onset before and after treatment (P=0.040, 0.036). After treatment, the score of abnormal tremor and gait in patients with delayed onset was decreased (P=0.037, 0.044), while as the occurrence of neurological symptoms was increased by 10%, and the liver function level in patients with delayed WD was decreased in 3 cases. Conclusions The brain of WD patients with delayed onset is mainly composed of metal deposits, however the cell damage is not apparent. Clinical symptoms are characterized by significant liver injury, but relatively mild neurological and psychiatric symptoms. Patients with delayed WD have higher urinary copper excretion than those with non?delayed WD. Chelating agents improves the neurological symptoms in patients with delayed onset.

Objective To investigate the analgesic effect of methane rich saline (MS) on monoarthritis (MA) rat and its possible mechanism.Methods We utilized Complete Freund's Adjuvant (CFA) to induce MApain model,and observed the effect of MS on MA rats by behavior assess,western blot,enzyme linked immunosorbent assay(ELISA),and oxidative stress assay.Results Intraperitoneal injections of MS attenuated MA-induced mechanical allodynia.MS treatments inhibited the activation of microglia and astrocytes,decreased IL-1β and TNF-α production in the spinal cord on day 10 post-operation.Additionally,MS also suppressed MA-induced oxidative stress (MDA),and protected the antioxidant capacity (SOD and CAT) in spinal cord dorsal horn.Conclusions Our findssuggested the analgesic effect of MS on monoarthritis pain,and imply antineuroinflammation and anti-oxidative stress as the associated mechanisms.

Objective To investigate the analgesic effect of methane rich saline (MS) on monoarthritis (MA) rat and its possible mechanism.Methods We utilized Complete Freund's Adjuvant (CFA) to induce MApain model,and observed the effect of MS on MA rats by behavior assess,western blot,enzyme linked immunosorbent assay(ELISA),and oxidative stress assay.Results Intraperitoneal injections of MS attenuated MA-induced mechanical allodynia.MS treatments inhibited the activation of microglia and astrocytes,decreased IL-1β and TNF-α production in the spinal cord on day 10 post-operation.Additionally,MS also suppressed MA-induced oxidative stress (MDA),and protected the antioxidant capacity (SOD and CAT) in spinal cord dorsal horn.Conclusions Our findssuggested the analgesic effect of MS on monoarthritis pain,and imply antineuroinflammation and anti-oxidative stress as the associated mechanisms.

OBJECTIVE:To provide reference for formulating related provisions,guidelines and regulations for off-label drug use,standardizing medical behavior in medical health institutions. METHODS:According to the connotation of off-label drug use,Questionnaire for off-label drug use was developed for medical institutions,in which drug name,treatment disease,the type and use evidence ofoff-label drug usewere included. The questionnaires were delivered to pharmacists who participatedClinical phar-macist practice skills training in Sichuan province to collect the related information of off-label drug use for statistical analysis, and suggestions were put forward. RESULTS:Totally 150 questionnaires were sent out,124 were effectively received with effec-tively recovery of 82.7%;the surveyed pharmacists came from 22 medical institutions,including 18 tertiary hospitals and 4 second-ary hospitals;there were 128 information about off-label drug use,including 14 (10.9%) with incomplete reporting information. The another 114 information were major in“super indication”(61) and“super administration”(43),accounting for 53.5% and 37.7%,respectively,and there are 8 other drug overdose(7.0%),2 super object(1.8%). The relevant off-label drug use mainly included anti-infection drugs (34 information,29.8%),anti-tumor drugs (16 information,14.0%),TCM injections (8 informa-tion,7.0%),and etc.;the relative concentration of varieties were metronidazole,dexamethasone,gentamicin,methotrexate, azithromycin,irinotecan,vancomycin,nystatin,etc.. Some medical institutions were absence of effective regulatory measures. CONCLUSIONS:Off-label drug use is quite common in medical institutions of Sichuan province,some of them exist obvious med-ication risk. It is suggested that the state should be as soon as possible to develop related provisions,guidelines and regulations for off-label drug use,endowing legal force for off-label drug use;medical staff should avoid no evidence-based drug use,unreason-able or even unnecessary off-label drug use;pharmaceutical production enterprises should strengthen communication with medical institutions and pay attention to collect information related to the clinical medication,timely update the drug instructions to ensure the legitimate rights for patients and the interests for medical staff.

OBJECTIVETo investigate the situation and the influential factors of child neglect between left-behind children and living-with-parents children aged 6-17 years in the rural areas in western China.

METHODSStudents were randomly selected according to the principle of multi-stage stratified cluster sampling and they were from three cities in Shanxi and four districts in Chongqing. Among the 4,131 children, there were 1,874 students in the 6-11 years group and the left-behind children accounted for 50.21% (941/1,874) in this group. There were 2,257 students in the 12-17 years old group and the left-behind children accounted for 53.35% (1,204/2,257) in this group. The questionnaire named "Evaluation on Neglect for Elementary and Secondary School Students Aged 6-17 Years in Rural Areas in China" was used in the field investigation. The students' neglect frequency was described by neglect rate and the factors affecting students' neglect were analyzed by means of binary logistic regression.

RESULTSIn the 6-11 years old group, the neglect rates of left-behind children and living-with-parents children were 63.03% (474/752) and 43.87% (347/791), respectively (χ2=58.86, P<0.001). In the 12-17 years old group, the neglect rates of left-behind children and living-with-parents children were 60.64% (627/1 034) and 53.57% (495/924), respectively (χ2=9.96, P<0.001). For factors influencing left-behind children, compared to the factors about boys, younger mother (≤40 years old), presence of parents' income reduction within the last year and nuclear family, the factors about girls, elder mother (41-49 years), absence of parents' income reduction within the last year and three-generation family or single-parent family were associated with lower neglect risk, and OR values were 0.67, 0.68, 0.70, 0.73, and 0.43 (P<0.05); compared to the factors about Han nationality, only child, with separate room at home, and resident children, the factors about other nationalities, non-only child, no separate room at home, and non-resident children were associated with high neglect risk, and OR values were 1.85, 1.34, 1.46, and 1.32 (P<0.05); compared to the lower father's education background (primary school or uneducated), the higher father's education background (junior middle school, senior middle school, technical secondary school, college and above) was associated with lower neglect risk, and OR values were 0.66, 0.50, and 0.25 (P<0.05); compared to good relationship between children and parents as well as good relationship between parents, fair or poor relationship was associated with high neglect risk, and OR values were 1.57-3.79 (P<0.05). For factors influencing non-left-behind children, compared to the factors about younger mother (≤40 years old), changes of patient's work in the last year, presence of parents' income reduction within the last year and nuclear family, the factors about elder mother (41-49 years), no changes of patients' work in the last year, absence of parents' income reduction within the last year and three-generation family or single-parent family were associated with lower neglect risk, and OR values were 0.69, 0.71, 0.75, 0.82, and 0.56 (P<0.05); compared to the factors about Han nationality, only child and younger father (≤40 years old), other nationalities, the factors about non-only child, and elder father (41-49 years) were associated with high neglect risk, and OR values were 1.45, 1.56, and 1.57 (P<0.05); compared to lower father's education background (primary school or uneducated), higher father's education background (junior middle school, senior middle school, technical secondary school, college and above) was associated with lower neglect risk, and OR values were 0.65 and 0.49 (P<0.05); compared to good relationship between children and parents as well as good relationship between parents, fair or poor relationship was associated with high neglect risk, and OR values were 1.56-7.69 (P<0.05).

CONCLUSIONThe situation of child neglect among left-behind children aged 6-17 years in rural areas of the two provinces in western China was serious, their neglect rates were higher than those of living-with-parents children, and there were many risk factors affecting the neglect rates of the two group children.

Adolescent ; Child ; Child Abuse ; Child, Abandoned ; China ; Demography ; Female ; Humans ; Income ; Logistic Models ; Male ; Mothers ; Parents ; Research ; Risk Factors ; Rural Population ; Schools ; Students ; Surveys and Questionnaires

Objective To evaluate the role of interleukin-12 (IL-12) in the spinal cord in the maintenance of arthritic pain (AP) in rats.Methods Adult male Sprague-Dawley rats, aged 6-8 weeks,weighing 200-300 g, were randomly divided into 4 groups using a random number table: control group (group C, n=6);AP group (n=9);phosphate buffer solution (PBS) group (n=6);IL-12 antibody group (n =6).AP was induced by injecting 50 μl of complete Freund' s adjuvant into the ankle joint cavity of the left hindpaw of rats anesthetized with isoflurane.Goat anti-rat IL-12 antibody 1.50 μg (20 μl) was intrathecally injected on 9 days after establishment of the model in group IL-12 antibody, while 0.01 mol/L PBS (20 μl) was administered in group PBS.The mechanical paw withdrawal threshold to yon Frey filament stimulation (MWT) was measured before establishment of the model (baseline) and on 9 and 10 days after establishment of the model.The rats were sacrificed after the last measurement of pain threshold, and the L4 6 segments of the spinal cord were obtained for detection of IL-12 expression in the spinal dorsal horn (by immunofluorescence) , and the co-expression of IL-12 and glial fibrillary acidic protein (an astrocyte marker) was examined simultaneously in group AP.Results Compared with group C, the MWT was significantly decreased, and the expression of IL-12 was up-regulated on 9 and 10 days after establishment of the model in AP, PBS and IL-12 antibody groups.Compared with group AP, the MWT was significantly increased at 10 days after establishment of the model, and the expression of IL-12 was down-regulated in group IL-12 antibody, and no significant change was found in the MWT at 10 days after establishment of the model and expression of IL-12 in group PBS.IL-12 was co-expressed with glial fibrillary acidic protein in group AP.Conclusion IL-12 in the spinal cord is involved in the maintenance of AP in rats.

OBJECTIVETo understand the neglect situation of elementary and high school students aged 6-17 years in western rural areas of China.

METHODSUsing multi-stage stratified cluster sampling method, 4 131 students were recruited from 26 rural elementary and high schools of 7 districts in Shanxi province and Chongqing from September 2012 to April 2013. The investigation was conducted based on 'The Development of Neglect Evaluation Norms and Influence Factors for Primary and Middle School Students' in rural areas of China. SAS 9.21 software was used for analyzing neglect rate and neglect degree for groups of age, sex and neglect types (including neglect of physical, emotional, medical, educational, safety and social).

RESULTSThe total neglect rate and degree were 55.50% (1 943/3 501) and 49.96 ± 9.67; the neglect rates for males and females were 56.78% (1 018/1 793) and 54.16% (925/1 708) (P = 0.119); the neglect degrees were 50.08 ± 9.31 and 49.83 ± 10.02 (P = 0.479), respectively. The girls' medical neglect rate (18.25%, 348/1 907) was significantly higher than that in boys (14.72%, 294/1 997) (P < 0.01); the boys' neglect degrees of physical, educational and social neglect (50.05 ± 10.46, 49.99 ± 10.81, 57.63 ± 14.63) were significantly higher than that in girls (49.34 ± 10.70, 49.07 ± 11.30, 56.37 ± 14.80) (P < 0.05). The total neglect rates of 6-8, 9-11, 12-14 and 15-17 groups were 44.48% (310/697), 60.40% (511/846), 60.89% (601/987) and 53.66% (521/971) (P < 0.01), and the total neglect degrees among these groups were 46.89 ± 8.57, 51.88 ± 9.25, 51.88 ± 9.25 and 51.72 ± 8.89 (P < 0.01), respectively. Except the neglect rates of medical and social neglect, significant differences were found in other three neglect rates and neglect degrees. The rates of social, emotional and safety neglect in 9-11 group were higher than that in other groups (28.39% (264/930), 26.41% (239/905), 20.35% (187/919)). The 12-14 group has the highest educational neglect rate(29.41%, 317/1 078). While the physical and emotional neglect degrees in 12-14 and 15-17 group were higher than that in other groups(12-14 group: 51.59 ± 10.02, 53.43 ± 12.02, 15-17 group: 51.96 ± 9.80, 52.61 ± 11.59). The social, safety, educational and medical neglect degrees were the highest in 6-8, 9-11, 12-14 and 15-17 group (60.91 ± 13.13, 48.29 ± 11.34, 52.43 ± 10.55, 51.15 ± 17.25), respectively. The neglect rates and neglect degrees were significantly higher in minorities(68.88% (374/543) and 52.91 ± 9.14) than those in Han population (53.04% (1 569/2 958), 49.44 ± 9.67)(P < 0.01 in both indexes); and the neglect rates and neglect degrees were significantly higher in children with siblings group (58.20% (1 504/2 584), 50.58 ± 9.54) than those the in one-child group (47.87% (439/917), 48.27 ± 9.80) (P < 0.01 in both indexes); and the neglect rates and neglect degrees were significantly higher in left-hand students (61.65% (1 101/1 786), 51.41 ± 9.51) than those in living-with-parents students(49.10% (842/1 715), 48.56 ± 9.61) (P < 0.01 in both indexes).

CONCLUSIONThe children neglect situation is serious in western rural areas, close attention from families, schools and the society is in urgent need.

Adolescent ; Child ; Child Abuse ; ethnology ; statistics & numerical data ; China ; epidemiology ; ethnology ; Female ; Humans ; Male ; Minority Groups ; Parents ; Risk Factors ; Rural Population ; Safety ; Sex Factors ; Socioeconomic Factors ; Students