BACKGROUND: As an essential part of health services, rehabilitation is of great significance to improve the health and quality of life of the whole population. Accelerating aging calls for a significant expansion of rehabilitation services in China, but rehabilitation needs remain unclear. We conducted the study to explore the rehabilitation needs in China and project the trend of rehabilitation needs from 2020 to 2034. METHODS: The data of health conditions that might potentially benefit from rehabilitation were obtained from Global Burden of Disease (GBD) study. Estimated annual percentage changes (EAPCs) were calculated to quantify the trends of the age-standardized rates. Projections of rehabilitation needs were made until 2034 using Bayesian age-period-cohort analysis (BAPC). RESULTS: Approximately 460 million persons (33.3% of the total population) need rehabilitation in China, contributing to 63 million years lived with disabilities (YLDs) in 2019. The number of prevalent cases that need rehabilitation increased from around 268 (95% uncertainty interval [UI]: 257-282) million in 1990 to almost 460 (95% UI: 443-479) million in 2019, representing an increase of 71.3%. The highest contribution to the need for rehabilitation was musculoskeletal disorders with about 322 (95% UI: 302-343) million persons in seven aggregate disease and injury categories, and hearing loss with over 95 (95% UI: 84-107) million people among 25 health conditions. Based on the projection results, there will be almost 636 million people (45% of the total population) needing rehabilitation services in China by 2034, representing an increase of 38.3%. The rehabilitation needs of neoplasms, cardiovascular diseases, and neurological disorders are expected to increase significantly from 2019 to 2034, with increases of 102.3%, 88.8% and 73.2%, respectively. CONCLUSIONS The need for rehabilitation in China substantially increased over the last 30 years. It is predicted that over two in five people will require rehabilitation by 2034, thus suggesting the need to develop rehabilitation services that meet individuals' rehabilitation needs.
Humans ; China/epidemiology* ; Global Burden of Disease ; Female ; Male ; Musculoskeletal Diseases/epidemiology* ; Rehabilitation/trends* ; Quality of Life ; Middle Aged ; Aged ; Bayes Theorem

ObjectiveTo observe the efficacy and safety of Uyghur medicine Yangxin Dawayimixike Honey Paste （养心达瓦依米西克蜜膏， YDMHP） in the treatment of stable angina pectoris （SAP） of qi stagnation and blood stasis syndrome. MethodsA randomized ， double-blind， positive-controlled，multi-center clinical trial was conducted， in which 370 patients with SAP of qi stagnation and blood stasis syndrome were randomly divided into treatment group（279 cases）and control group（91cases）at a ratio of 3∶1. The treatment group was orally administered with YDMHP， 3 g each time， and placebo of Xuefu Zhuyu Capsule （血府逐瘀胶囊）， 2.4 g each time， while the control group was treated with Xuefu Zhuyu Capsule， 2.4 g each time， and placebo of YDMHP， 3 g each time， both twice a day for a course of 12 weeks. The primary outcome was the effect of angina pectoris symptom. The secondary outcomes include single angina symptom scores such as number of attacks， duration of attacks， pain intensity and usae of nitroglycerin scores， the total angina symptom score before and after the treatment， the usage of nitroglycerin， the exercise duration in treadmill exercise test （TET） and the Duck treadmill score among patients，the scores of Seattle Angina Questionnaire （SAQ） on five dimensions including physical limitations， anginal stability， anginal frequency， treatment satisfaction， and disease perception， and efficacy of TCM syndrome and of each single TCM symptom after treatment. The safety were evaluated by examine blood routine， urine routine， liver and kidney function， fasting blood sugar， electrocardiogram， adverse events. ResultsThe total effective rate of angina symptom in the treatment group was 71.69% （200/279）， significantly higher than 51.64% （47/91） in the control group （P＜0.01）. The curative and markedly effective rate of TCM syndrome in the treatment group was 53.05% （148/279）， which was significantly higher than 25.27% （23/91） in the control group （P＜0.01）. After treatment， scores of the number as well as duration of angina attacks and pain severity， the total score of angina symptoms， and the usage of nitroglycerin significantly decreased in both groups， and more changes were seen in the treatment group than in the control group； the scores of physical limitations， anginal stability， anginal frequency， treatment satisfaction， and disease perception in both groups significantly increased， and more improvement were shown in the experimental group regarding the anginal stability， anginal frequency and treatment satisfaction （P＜0.05 or P＜0.01）. The effects of chest pain， chest tightness， palpitation， shortness of breath and fatigue in experimental group were significantly higher than those in control group （P＜0.05 or P＜0.01）. There was no significant difference in the exercise duration of treadmill test and Duke score among patients between the two groups either before or after treatment （P＞0.05）. Adverse events occurred in 66 cases （23.66%） of the experimental group and 16 cases （17.58%） of the control group， with no statistical significance between the two groups （P＞0.05）. ConclusionThe Uyghur medicine YDMHP can effectively improve symptoms of angina pectoris， reduce the number， duration， and intensity of attacks， decrease the dosage of nitrogly-cerin and improve the individual TCM symptoms and has good safety in the treatment of SAP patients of qi stagnation and blood stasis.

Objective:To compare our self-designed elastic syndesmosis hook plate (ESHP) and suture-button technique in treatment of injury to the distal tibiofibular syndesmosis.Methods:A retrospective study was conducted of the 53 patients who had been treated at Military Orthopaedic Center, 909 Hospital of Joint Service Support Force of PLA for ankle fractures complicated with syndesmosis injury by ESHP or suture-button technique from March 2013 to March 2017. Of them, 28 were treated by ESHP (ESHP group: 15 males and 13 females aged from 26 to 60 years) and 25 by suture-button technique (suture-button group: 14 males and 11 females aged from 24 to 59 years). The 2 groups were compared in terms of syndesmosis fixation time, postoperative incision bleeding, hospital stay, and ankle dorsiflexion and plantarflexion and ankle function by Baird-Jackson scoring at 3, 6, 12 months after surgery. Postoperative complications were observed.Results:The 2 groups were comparable because there was no statistically significant deference in general data between the 2 groups ( P>0.05). Surgery went on uneventfully in all the patients. The syndesmosis fixation time [(9.7±2.2) min] and postoperative incision bleeding [(49.3±10.4) mL] in the ESHP group were significantly less than in the suture-button group [(16.2±1.4) min and (62.4±6.3) mL] ( P<0.05); the maximum plantar flexion (29.9°±1.3°) and Baird-Jackson scores (87.2±2.9) at 3 months after surgery in the ESHP group were significantly greater than in the suture-button group (22.8°±1.3° and 78.7±4.1) ( P<0.05). There were no significant differences between the 2 groups in hospital stay, maximum plantar flexion at postoperative 6 or 12 months, maximum dorsiflexion at postoperative 3, 6 or 12 months, or Baird-Jackson scores at postoperative 6 or 12 months (all P>0.05). This cohort was followed up for 12 to 14 months (average, 12.5 months). All fractures united during follow-up and all the implants were removed around postoperative 12 months. Follow-up within 12 months observed internal fixation failure caused by metal fatigue in one case in the ESHP group, and internal fixation irritation in one case, internal fixation failure in 2 cases and internal fixation sinking and osteolysis in one case in the suture-button group. Conclusion:Compared with the suture-button technique, treatment of injury to the distal tibiofibular syndesmosis with ESHP may lead to shorter fixation time, less postoperative bleeding and complications, and faster functional recovery of the ankle.

Objective: To investigate the diagnosis and treatment for enterocutaneous fistula (ECF) in China, and to explore the prognostic factors of ECF. Methods: A multi-center cross-sectional study was conducted based on the Registration System of Chinese Gastrointestinal Fistula and Intra-Abdominal Infections to collect the clinical data of ECF patients from 54 medical centers in 22 provinces/municipalities from January 1, 2018 to December 31, 2018. The clinical data included patient gender, age, length of hospital stay, intensive care unit (ICU) admission, underlying diseases, primary diseases, direct causes of ECF, location and type of ECF, complications, treatment and outcomes. All medical records were carefully filled in by the attending physicians, and then re-examined by more than two specialists. The diagnosis of ECF was based on the clinical manifestations, laboratory/imaging findings and intraoperative exploration. Results: A total of 1521 patients with ECF were enrolled, including 1099 males and 422 females, with a median age of 55 years. The top three primary diseases of ECF were malignant tumors in 626 cases (41.2%, including 540 gastrointestinal tumors, accounting for 86.3% of malignant tumors), gastrointestinal ulcers and perforations in 202 cases (13.3%), and trauma in 157 cases (10.3%). The direct causes of ECF were mainly surgical operation in 1194 cases (78.5%), followed by trauma in 156 (10.3%), spontaneous fistula due to Crohn′s disease in 92 (6.0%), radiation intestinal injury in 41 (2.7%), severe pancreatitis in 20 (1.3%), endoscopic treatment in 13 (0.9%) and 5 cases (0.3%) of unknown reasons. All the patients were divided into three groups: 1350 cases (88.7%) with simple ECF, 150 (9.9%) with multiple ECF, and 21 (1.4%) with combined internal fistula. Among the patients with simple ECF, 438 cases (28.8%) were jejuno-ileal fistula, 313 (20.6%) colon fistula, 170 (11.2%) rectal fistula, 111 (7.3%) duodenal fistula, 76 (5.0%) ileocecal fistula, 65 (4.3%) ileocolic anastomotic fistula, 55 (3.6%) duodenal stump fistula, 36 (2.4%) gastrointestinal anastomotic fistula, 36 (2.4%) esophagogastric/esophagojejunal anastomotic fistula, 29 (1.9%) gastric fistula and 21 (1.4%) cholangiopancreatiointestinal. Among all the simple ECF patients, 991 were tubular fistula and 359 were labial fistula. A total of 1146 patients finished the treatment, of whom 1061 (92.6%) were healed (586 by surgery and 475 self-healing) and 85 (7.4%) died. A total of 1043 patients (91.0%) received nutritional support therapy, and 77 (6.7%) received fistuloclysis. Infectious source control procedures were applied to 1042 patients, including 711 (62.0%) with active lavage and drainage and 331 (28.9%) with passive drainage. Among them, 841 patients (73.4%) underwent minimally invasive procedures of infectious source control (replacement of drainage tube through sinus tract, puncture drainage, etc.), 201 (17.5%) underwent laparotomy drainage, while 104 (9.1%) did not undergo any drainage measures. A total of 610 patients (53.2%) received definitive operation, 24 patients died within postoperative 30-day with mortality of 3.9% (24/610), 69 (11.3%) developed surgical site infection (SSI), and 24 (3.9%) had a relapse of fistula. The highest cure rate was achieved in ileocecal fistula (100%), followed by rectal fistula (96.2%, 128/133) and duodenal stump fistula (95.7%,44/46). The highest mortality was found in combined internal fistula (3/12) and no death in ileocecal fistula. Univariate prognostic analysis showed that primary diseases as Crohn′s disease (χ²=6.570, P=0.010) and appendicitis/appendiceal abscess (P=0.012), intestinal fistula combining with internal fistula (χ²=5.460, P=0.019), multiple ECF (χ²=7.135, P=0.008), esophagogastric / esophagojejunal anastomotic fistula (χ²=9.501, P=0.002), ECF at ileocecal junction (P=0.012), non-drainage/passive drainage before the diagnosis of intestinal fistula (χ²=9.688, P=0.008), non-drainage/passive drainage after the diagnosis of intestinal fistula (χ²=9.711, P=0.008), complicating with multiple organ dysfunction syndrome (MODS) (χ²=179.699, P<0.001), sepsis (χ²=211.851, P<0.001), hemorrhage (χ²=85.300, P<0.001), pulmonary infection (χ²=60.096, P<0.001), catheter-associated infection (χ²=10.617, P=0.001) and malnutrition (χ²=21.199, P<0.001) were associated with mortality. Multivariate prognostic analysis cofirmed that sepsis (OR=7.103, 95%CI:3.694-13.657, P<0.001), complicating with MODS (OR=5.018, 95%CI:2.170-11.604, P<0.001), and hemorrhage (OR=4.703, 95%CI: 2.300-9.618, P<0.001) were independent risk factors of the death for ECF patients. Meanwhile, active lavage and drainage after the definite ECF diagnosis was the protective factor (OR=0.223, 95%CI: 0.067-0.745, P=0.015). Conclusions The overall mortality of ECF is still high. Surgical operation is the most common cause of ECF. Complications e.g. sepsis, MODS, hemorrhage, and catheter-associated infection, are the main causes of death. Active lavage and drainage is important to improve the prognosis of ECF.

In view of the pain points and difficulties in the current stroke service system, the Internet-plus model is merged into the stroke service process for exploration and practice. Mobile Internet technology bridged the process before and after the patient arrives at the hospital, thus extending the green path. This green path is under refined management by mobile applications and 2-dimensional bar code technologies, supporting sustained improvement of data-driven clinical quality. Benefited by"Internet-plus"stroke service management, the efficiency and key performance indicator of the stroke center are significantly elevated.

Objective: To investigate the effect of hypertensive disorder complicating pregnancy (HDCP) on the mortality and early complications of premature infants. Methods: The general clinical data of preterm infants with gestational age 24-36^{+ 6} weeks were collected from the cooperative units in the task group from January 1, 2013 to December 31, 2014.According to the severity of HDCP, the infants were divided into 4 groups: HDCP group, preeclampsia group, eclampsia group and non HDCP group, the mortality and major complications of preterm infants were compared, and the influencing factors were analyzed. Results: The mortality rate of preterm in the HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=9.970, P=0.019). Eclampsia had a highest fatality rate (4.8%) in the early stage, compared with non HDCP group (2.2%), and the difference was statistically significant.Comparison of HDCP group (1.8%) and eclampsia group (3.2%) suggested that there was no statistically significant difference.The incidence of respiratory distress syndrome (RDS) in preterm in HDCP group was significantly higher than that of non HDCP group, and there was statistical significance (χ²=13.241, P=0.004). Eclampsia group showed the highest incidence (35.4%), compared with non HDCP group (16.2%), the difference was statistically significant, but compared with HDCP group (19.9%), preeclampsia group (17.1%), there was no significant diffe-rence.The incidence of bronchopulmonary dysplasia (BPD) in preterm in HDCP group was significantly higher than that of non HDCP group (χ²=9.592, P=0.022), the highest incidence showed up in eclampsia group (9.7%), compared with non HDCP group (2.0%) and HDCP group (1.7%), the difference was statistically significant.But there was no statistically significant difference, compared with preeclampsia group.As the degree of HDCP aggravated, the incidence of BPD gradually rose.There was no significant impact on necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis of HDCP (χ²=7.054, 7.214, 0.358, 3.852; P=0.070, 0.065, 0.949, 0.278). Considering the overall outcome of the child, that was, whether the child died or survived, he had at least one complication, and HDCP had an effect on it (χ²=15.697, P=0.001), so the incidence increased while the degree of HDCP rose gradually.After adjusting gestational age, birth weight, sex, way of delivery, placental abruption and front placenta, prenatal hormonal, gestational diabetes, neonatal asphyxia and other factors, the results displayed that HDCP was the factor leading to the death of premature baby (OR=2.159, 95%CI: 1.093-4.266), and comparison between preeclampsia and eclampsia showed no statistical difference (P=0.714, 0.389); HDCP had no significant influence on RDS, BDP, ICH, NEC, ROP and sepsis. Conclusions HDCP leads to increased risk of premature death, but also leads to the increased incidence of RDS and BPD, but it had no obvious effect on NEC, ROP, IVH, sepsis and other complications.

Objective:To investigate the influence of chronic periodontitis on the clinic effect of implant restoration.Methods:Fifty-two cases of chronic periodontitis patients with 70 implants and forty-nine cases of periodontally healthy patients with 69 implants admitted into our hospital from July 2013 to June 2016 were named as observation group and control group respectively.The implants survival rates,marginal bone loss (MBL),modified plaque index (mPLI),modified sulcus bleeding index (mSBI),and peri-implant probing pocket depth (PD) as well as IL-1,IL-6 in peri-implant sulcular fluid of the two groups were detected and analyzed after loading of 1,3,6,12 months.Results:After 12 months of loading,no obvious difference was found in the implants survival rate between two groups (P＞0.05).After 1,3 months of loading,no remarkable change was found in mPLI,mSBI,PD,and MBL between two groups(P＞0.05),while mSBI,PD,and MBL in observation group were significantly higher than those of control group except of mPLI after 6 months of loading (P＜0.05).Additionally,after 1,3 months of loading,IL-β in control group was not detected,while IL-β in observation group was conspicuously higher than those of control group after 6 months of loading and IL-6 in observation group was significantly higher than that of control group after 3 months of loading (P＜0.05).Conclusion:Chronic periodontitis could decrease the clinical effect ofim-plant restoration,which was probably due to the occurrence ofperi-implantitis.

Objective:To investigate the curative effect of different restorations for deciduous teeth defect of children.Methods:67 children with teeth defecting seriously and being unable to fill restore were enrolled from January 2011 to January 2015 and randomly divided into three groups,one group of patients accepted metal crown restoration (Group A,n=22),one group adopted ceramic inlay restoration (Group B,n=22),and the last one accepted silver amalgam filling (Group C,n=23),the curative effect and incidence of adverse reactions among three groups in the period follow-up were compared.Results:In the period of 18-month follow-up,6 patients of toothache,5 patients of food impaction and crevices between restorations and teeth,3 cases of gingival congestion,2 cases of secondary caries were observed in group C;3 cases of toothache,1 case of food impaction,gingival congestion,crevices between restorations and teeth and secondary caries were observed in group B;2 cases of toothache and food impaction,1 case of gingival congestion were observed in group A.The incidence of adverse reactions in group A and group B was lower than those in group C (P＜0.05),which was lower in group A than that in group B,but no significant difference was found between group A and group B (P＞0.05).Conclusion:The restoration of metal crown and ceramic inlay deserved popularization had better curative effect and safety for deciduous teeth defect of children than silver amalgam filling.

Objective To explore the value of three-dimensional ultrasound (3D-US) gray scale median (GSM) in quantitative evaluation of the drug treatment of carotid plaques.Methods Eighty-one patients with 93 carotid plaques were enrolled from May 2015 to October 2015.Patients were received 3D-US,3.0T MRI and blood lipid examination including total cholesterol(TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),and high-density lipoprotein cholesterol(HDL-C) before drug treatment.After atorvastatin therapy with a daily dose of 20mg for 6-12 months,3D-US and blood lipid examination were repeated,and 55 patients were followed successfully with a total of 62 plaques obtained.According to data acquired by MRI and 3D-US before treatment,the patients were divided into low-risk group,medium risk group,and high-risk group.The differences of GSM value and blood lipid levels were compared among groups and the changes of these parameters before and after the treatment in each group were compared.Results There was no significantly difference in serum TC,TG,LDL-C and HDL-C levels among the groups before treatment.After treatment,the serum TC and LDL-C levels were significantly lower than those before(P ＜0.05),the differences of TG and HDL-C levels were not significant,and the LDL-C level in high-risk group was significantly lower than those in other groups(P ＜0.05).The GSM values in of high-risk and medium-risk group were significantly increased after drug treatment than those of before (33.87 ± 6.53 vs 27.50 ± 7.82,47.35 ± 5.42 vs 44.56 ± 4.36,P ＜0.05),and had no significantly change in low risk group(62.01 ± 10.68 vs 63.13 ± 10.41,P ＞0.05).The difference of GSM between before and after treatment in each group was negatively correlated with the difference of LDL-C (r =-0.28,P =0.03).Conclusions Three-Dimensional ultrasound (3D-US) gray scale median (GSM) can be a reliable parameter in clinic quantitative evaluation drug treatment of carotid plaques,and has a better value especially for high-risk and medium-risk plaques.

Objective To quantitatively evaluate the vulnerability of carotid plaques in patients with acute ischemic cerebral infarction by using Gray-scale median (GSM) based on Three-dimensional ultrasound (3D-US).Methods Totally 207 patients were examined with carotid plaques in the PLA Army General Hospital from December 2015 to August 2016,including 102 patients with acute cerebralischemic stroke (cerebral infarction group) and 105 patients without cerebral infarction (control group).The Vascular plaque quantification (VPQ) software was applied to acquire GSM value of carotid plaques automatically.Results The GSM value of carotid plaques in cerebral infarction group was significantly lower than that in control group (44.78± 11.58 vs 54.36± 11.99,t=7.70,P ＜ 0.01),and the low density lipoprotein in the cerebral infarction group was significantly higher than that in the control group [(3.51 ± 1.20) mmol/L vs (3.10± 1.07) mmol/L,t=1.58,P ＜ 0.05].There was no significant difference between the two groups in age,gender,body mass index,smoking,drinking,history of diabetes,history of hypertension,systolic blood pressure,diastolic blood pressure,triglyceride,total cholesterol,high density lipoprotein,plaque thickness,plaque area stenosis rate and plaque volume (all P ＞ 0.05).Conclusion The GSM value of carotid plaques based on 3D-US-VPQ technology can effectively reflect the vulnerability of carotid plaques,and may be valuable in the risk assessment of carotid plaques.