OBJECTIVE: To explore the safety and effectiveness of the "talus home technique (THT) " in the surgery of pronation open ankle fractures (POAF). METHODS: A retrospective analysis was conducted on 14 patients with POAF admitted between January 2023 and December 2023 who met the selection criteria. There were 7 males and 7 females; age ranged from 26 to 58 years, with a median age of 53 years. Injury causes included 9 cases of traffic accident injury, 3 cases of fall from hight injury, and 2 cases of crush injury. There were 5 cases of type Ⅱ, 6 cases of type ⅢA, and 3 cases of type ⅢB according to Gustilo classification; and 6 cases of pronation-abduction grade Ⅲ and 8 cases of pronation-external rotation grade Ⅳ according to Lauge-Hansen classification. Emergency first-stage debridement of the ankle joint was performed, followed by second-stage open reduction and internal fixation surgery. The THT was used through a limited incision on the lateral malleolus to restore the height of the lateral malleolus, rotational alignment, and anatomical relationship of the distal tibiofibular syndesmosis (DTFS). Wound healing was observed postoperatively. At 4 months postoperatively, weight-bearing anteroposterior, lateral, and mortise view X-ray films and CT scans of both ankles were reviewed to measure the medial clear space (MCS), tibiofibular clear space (TFCS), distal fibular tip to lateral process of talus (DFTL), and anterior/posterior syndesmosis distances of DTFS, and the quality of reduction of ankle fractures was evaluated. Ankle joint function was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and active dorsiflexion/plantar flexion range of motion were recorded at last follow-up. RESULTS: After second-stage internal fixation, 8 patients achieved wound healing by first intention, 1 case had skin edge necrosis, 2 cases had local skin necrosis, 1 case had extensive medial soft tissue defect, and 2 cases developed medial wound infection with sinus formation. All 14 patients were followed up 13-24 months (mean, 16.8 months). Postoperative X-ray films showed 1 case of delayed union of the lateral malleolus, which healed after bone grafting at 12 months; the remaining 13 cases achieved clinical union at 12-32 weeks (mean, 21.5 weeks). At 4 months postoperatively, X-ray films and CT examination showed no significant differences in MCS, TFCS, DFTL, and anterior/posterior syndesmosis distances of DTFS between the healthy and affected sides ( P>0.05), with no poor DTFS reduction. AOFAS ankle-hindfoot score ranged from 80 to 95, with an average of 87.7; ankle range of motion ranged from 10° to 25° (mean, 19.6°) in dorsiflexion and from 32° to 50° (mean, 41.2°) in plantar flexion. CONCLUSION THT is safe and effective in POAF surgery. It can restore lateral malleolar height and rotational alignment, enhance DTFS reduction quality, and obtain satisfactory short-term functional recovery of the ankle.
Humans ; Male ; Female ; Middle Aged ; Ankle Fractures/surgery* ; Adult ; Retrospective Studies ; Fracture Fixation, Internal/methods* ; Pronation ; Fractures, Open/surgery* ; Talus/surgery* ; Treatment Outcome ; Debridement/methods* ; Ankle Joint/surgery* ; Open Fracture Reduction/methods*

OBJECTIVE: To evaluate the safety and effectiveness of reducing posterior malleolar fractures via the modified Rammelt transfibular approach. METHODS: A retrospective analysis was conducted on 26 patients with ankle fractures who met the selection criteria and were admitted between September 2023 and May 2024. There were 13 males and 13 females, aged from 14 to 59 years (median, 43.5 years). Causes of injury included traffic accident (1 case), falls (7 cases), and sprains (18 cases). Time from injury to operation ranged from 1 to 13 days (mean, 3.9 days). According to the Lauge-Hansen classification, there were 5 supination-external rotation type Ⅲ fractures and 21 supination-external rotation type Ⅳ fractures. According to the Bartoníček classification for posterior malleolar fractures, there were 12 type Ⅱ fractures, 10 type Ⅲ fractures, and 4 type Ⅳ fractures. During operation, the fracture was exposed via the modified Rammelt transfibular approach; then, the fracture reduction was achieved under direct vision using techniques such as towel clip traction, posterolateral compression, and lifting with a posterior transverse periosteal elevator; finally, the fracture was fixed using anteroposterior cannulated screws or Kirschner wires. The incision healing was observed after operation. At 4 months after operation, X-ray film and CT were reviewed to evaluate the quality of fracture reduction. The medial clear space, tibiofibular clear space, and the anterior/posterior tibiofibular syndesmotic distances were measured. At last follow-up, the ankle function was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the range of motion. RESULTS: The marginal necrosis occurred in 2 lateral malleolar incisions, and superficial infection occurred in 1 lateral malleolar incision; the remaining incisions healed by first intention. All 26 patients were followed up 13-21 months (mean, 15.6 months). X-ray films showed that fractures in 25 patients achieved clinical union within 3-8 months (mean, 5.4 months); 1 case had delayed union of the lateral malleolus. At 4 months after operation, no significant difference was found between the injured and healthy sides in the medial clear space, tibiofibular clear space, or the anterior/posterior tibiofibular syndesmotic distances ( P>0.05). No malreduction of the posterior malleolus or the tibiofibular syndesmosis occurred. At last follow-up, the AOFAS score ranged from 80 to 100 (mean, 91.9). The range of motion ranged from 17° to 22° (mean, 21.0°) in active ankle dorsiflexion and from 40° to 49° (mean, 44.6°) in plantar flexion. Internal fixator was removed in 12 patients at 1 year after operation, with no ankle instability occurring. Ankle joint degeneration was observed in 1 patient at last follow-up. CONCLUSION The modified Rammelt transfibular approach is a safe and reliable technique. It enables precise reduction under direct vision, improves the quality of reduction for the distal tibial articular surface and the tibiofibular syndesmosis, and provides satisfactory ankle functional recovery in short-term follow-up.
Humans ; Male ; Female ; Adult ; Ankle Fractures/diagnostic imaging* ; Middle Aged ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Adolescent ; Treatment Outcome ; Young Adult ; Bone Screws ; Ankle Joint/surgery* ; Fibula/surgery* ; Range of Motion, Articular

OBJECTIVES: To explore the relevant protective and risk factors that affect spontaneous supratentorial large volume intracerebral hemorrhage. METHODS: Clinical data of hospitalized patients with spontaneous supratentorial intracerebral hemorrhage in Xiangya Hospital of Central South University from January 2014 to December 2018 were retrospectively analyzed. According to the amount of intracerebral hemorrhage (≥30 mL), the patients were divided into a large volume intracerebral hemorrhage group (255 cases) and a non-large volume intracerebral hemorrhage group (397 cases). Univariate and multivariate logistic regression analysis for the clinical data from the two groups of patients were performed. RESULTS: Systolic blood pressure, diastolic blood pressure, white blood cell count, neutrophil count, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, calcium ion concentration, and international standard ratio between the large volume intracerebral hemorrhage group and the non-large volume intracerebral hemorrhage group were significantly different (all CONCLUSIONS The occurrence of spontaneous supratentorial large volume intracerebral hemorrhage is the result of combination of multiple factors. The increased white blood cell count, the increased systolic blood pressure, the increased high-density lipoprotein cholesterol, and the increased international standard ratio may increase its risk, while the increased LDL cholesterol and calcium concentration may reduce its risk.
Blood Pressure ; Cerebral Hemorrhage ; Cholesterol, HDL ; Humans ; Retrospective Studies ; Risk Factors

Objective To explore the feasibility of tracking migration and distribution of SD-rat adipose derived stem cells (ADSCs) labeled with Polyethylene Glycol/Polyehthyleneimine modified superparamagnetic iron oxide (PEG/PEI-SPIO) in rats with chronic cerebral ischemia using MRI.Methods Thirty female SD rats underwent permanent occlusion of bilateral common carotid arteries 6 months were divided into PEG/PEI-SPIO labeled group and unlabeled group (each n =15).Labeled or unlabeled ADSCs suspension was injected into the right ventricle of rats in two groups,respectively.MR scans were performed at the 7th,14th and 21st day after transplantation for each 5 rats.T2 value of T2mapping sequence in hippocampus,cortex and cerebellum were measured.Then the rats were scarified,and the brains were obtained,and Prussia dyeing was performed.Under high magnification,blue dye cells at each time points and brain area were counted.T2 values and blue dye cells were statistically analyzed.Results Class round hypointensity areas were detected in temporol-parietal cortex and hippocampus in both groups on T2WI,T2* WI and SWI.T2 value of the right temporolparietal cortex and hippocampus in the labeled group was shorter than those of the unlabeled group on the 14th day after transplantation (P=0.013,0.045).T2 value of the right temporol-parietal cortex in the labeled group was shorter than that of the unlabeled group on the 21st day after transplantation (P=0.007).The number of blue dye cell of the right temporol-parietal cortex on the 14th and 21th day,hippocampus on the 14th day in the labeled group were more than those of the unlabeled group after transplantation (P=0.029,0.032,0.043).Conclusion ADSCs labeled with PEG/PEI-SPIO transplanted into lateral ventricle of SD rat could migrate to the damaged areas caused by chronic cerebral ischemia.It is possible to use quantitative MRI to track migration and distribution of ADSCs labeled with PEG/PEI-SPIO in rat brain.

Objective By using digital three-dimensional (3D) model of abdominal and pelvic vessels to investigate the relationship between the angle/position of the bifurcation of bilateral common iliac arteries and the length of the common iliac artery, thus to guide the endovascular interventional catheterization manipulation. Methods A total of 439 patients, who received abdominal and pelvic CTA at authors’ department during the period from Sep. 2011 to May 2013, were included in this study. By using digital 3D reformation technique, the 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae was established in all patients. With the help of mimics and geomagic software the angles between the left and right common iliac arteries and the lengths of common iliac arteries were determined, and the lumbar vertebra corresponding to the bifurcation of common iliac arteries was recorded. Using statistical software, the relationship between the bifurcation angle of bilateral common iliac arteries and the corresponding lumbar vertebra as well as the length of common iliac arteries was analyzed. Results The digital 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae was successfully reconstructed in all 439 patients. Both the angle between the left and right common iliac arteries and the corresponding lumbosacral level of bifurcation angle were clearly demonstrated on the model. The average angle was 49.1° ± 12.4°. The bifurcation was located at L3 -L4 level in 38 cases, at upper one-third level of L4 in 63 cases, at middle one third level of L4 in 89 cases, at lower one-third level of L4 in 135 cases and at L4 -L5 level in 114 cases. The average length of the left and right common iliac artery was (45.6 ± 15.6) mm and (43.3 ± 15.4) mm respectively. Pearson correlation analysis indicated that a negative correlation existed between the angle and the position level of the left and the right common iliac artery (r = -0.172, P< 0.05), and a negative correlation also existed between the angle and the length of the common iliac artery (left: r = -0.171, P<0.05; right: r = -0.164, P < 0.05). Conclusion The lower the opening position of the left and right common iliac artery is, and the bigger the intersection angle is, the shorter the length of corresponding common iliac artery will be. In this case, catheterization via femoral artery to contralateral iliac artery is a short path, and the catheterization procedure is easy to manipulate with higher success rate. On the contrary, the catheterization will be difficult, and the use of loop-technique will be needed. The digital 3D model of the abdominal and pelvic vessels as well as the lumbosacral vertebrae can help select the optimal catheterization path.

Objective To explore the application of 3D printing technology in individual pelvic structure of female and its value in obstetrics and gynecology based on the CT datasets of the pelvic structure and digital three-dimensional reconstruction. Methods CTA image dataset of a patient from gynecology department was obtained for constructing three-dimensional models of each organ using the digital three-dimensional reconstruction technology , then the digital 3D model with the same size as the model displayed was printed with Z510 3D printer. Results 3D models of patient′s lumbosacral vertebrae, aorta artery, common iliac artery, internal and external iliac artery , postcava , common iliac vein , internal and external iliac vein , pelvis ureter , uterus and uterine artery were printed out in the same size replica of the virtual reality model. Conclusion 3D printed model has all the features of 3D vision and can be touched and felt by people , which can provide new insights for medical education, clinical and medical research.

OBJECTIVETo investigate the epidemiological characteristics of human infections with avian influenza A (H7N9) in China and to provide scientific evidence for the adjustment of preventive strategy and control measures.

METHODSDemographic and epidemiologic information on human cases were collected from both reported data of field epidemiological investigation and the reporting system for infectious diseases.

RESULTSA total of 433 cases including 163 deaths were reported in mainland China before June 4, 2014. Two obvious epidemic peaks were noticed, in March to April, 2013 and January to February, 2014. Confirmed cases emerged in 14 areas of China. Five provinces, including Zhejiang, Guangdong, Jiangsu, Shanghai, and Hunan, reported about 85% of the total cases. Median age of the confirmed cases was 58 years (range, 1-91), with 70% as males. Of the 418 cases with available data, 87% had ever exposed to live poultry or contaminated environments. 14 clusters were identified but human to human transmission could not be ruled out in 9 clusters.

CONCLUSIONHuman infections with avian influenza A (H7N9) virus showed the characteristics of obvious seasonal distribution, with certain regional clusters. The majority of confirmed cases were among the elderly, with more males seen than the females. Data showed that main source of infection was live poultry and the live poultry market had played a significant role in the transmission of the virus.

Adaptation, Psychological ; Aged ; Animals ; China ; epidemiology ; Demography ; Environmental Pollution ; Female ; Humans ; Influenza A Virus, H7N9 Subtype ; Influenza, Human ; epidemiology ; prevention & control ; transmission ; Male ; Meat ; Poultry ; Research Design

Objective To explore the correlation between the incidence of abdominal and pelvic artery distortion and age using dig-ital three-dimensional reconstruction,in order to assess risk in uterine artery embolization surgical approach.Methods Collecting the CTA datasets of 475 patients,group A aged 11-27 (n=40),group B aged 28-44(n=218),group C aged 45-61(n=197), group D aged 62-78(n=20).The 3D model of pelvic arteries was reconstructed by mimics software,and the arterial distortion was recorded by rotating and observing the 3D model,which was further classified into three categories.One was the distortion of the aorta only,the second was the distortion of iliac artery,and the third being distortion of both sturctures.the number of cases appeared arterial distortion in every age group was calculated and the ratio of the total cases to each age group was counted.Results There were 128(26.9%)cases appeared arterial distortion,the last 347(73.1%)were not found distortion in any artery.Of the 128 cases,the occurrence rates of arterial distortion in each age group were 2.5%、11.9%、44.7%、65% for group A,B,C and D respec-tively.Pearson linear correlation analysis showed that the incidence of arterial distortion positively correlated with age (r=0.404,help of three-dimensional reconstruction.The occurrence rate of artery distortion is increased with age and the iliac artery distortion occurrence is higher than that of the aorta artery.

OBJECTIVE: To investigate the reliability of the Chinese version of Satisfaction with Amplification in Daily Life (SADL). METHOD: The cross-cultural adaption measures were used to translate the SADL into Chinese version. Thirty hearing aid users no younger than 18 years old were included. Test-retest analysis was administrated to the patients without significant changes in health and social status with an interval of two weeks between test and retest. RESULT: Test-retest reliability of the SADL was proved to be satisfactory. All subscales and global score had coefficients that exceeded 0.70 (P < 0.01). Except for "personal image", the score of other subscales and global score in this study are higher than the U. S. interim norms described by Cox and Alexander (1999) (P < 0.01). CONCLUSION This study completed the translation and test-retest analysis of Chinese version of SADL. We need further discussion about validation of Chinese version of SADL in order to meet basic psychometric criteria of a standard outcome measurement.
Activities of Daily Living ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Female ; Hearing Aids ; Humans ; Middle Aged ; Personal Satisfaction ; Reproducibility of Results ; Surveys and Questionnaires ; Young Adult

Objective The differences of von Willebrand factor(vWF),hypersensitive C-reactive protein(hs-CRP) and soluble P-selectin CD62P were observed in coronary heart disease(CHD) patients with different syndrome patterns,and the correlation of traditional Chinese medical(TCM) syndrome patterns with endothelial damage,inflammation and platelet activation in CHD patients was investigated.Methods One hundred and eighty-six CHD patients were differentiated as the syndromes of blockage of heart-blood-stasis,phlegm blocking heart vessels,deficiency of heart and kidney yin,deficiency of both yin and Qi,and deficiency of yang and Qi.Thirty healthy volunteers served as normal control.The blood levels of vWF,hs-CRP and CD62P were detected in the CHD patients and the normal controls.Results Blood vWF level in CHD patients was higher than that in the normal controls(P0.05).Blood CD62P in the syndrome pattern of deficiency of yang and Qi was higher than the other patterns(P