Objective:To evaluate the clinical outcomesof primary reverse total shoulder arthroplasty (RTSA) and revision procedure with RTSA after treatment failure of complex proximal humeral fractures in the elderly.Methods:A retrospective analysis was conductedon 24 elderly patients with Neer three- or four-part proximal humeral fractures who underwent RTSA revision after treatment failure (RTSA revision group) from January 2017 to June 2022. There were 7 males and 17 females included, with a mean age of 78.23±5.78 years (range, 67-86 years). Forty-eight patients who underwent primary RTSA (primary RTSA group) during the same time period were selected by propensity score matchingin a 1∶2 ratio as controls, based on age, dominanthand, etiology, Neer typing, glenohumeral joint dislocation, rotator cuff integrity, and osteoporosis T-score. The primary RTSA group included 12 males and 36 females, with a mean age of 76.38±6.15 years (range, 65-87 years). Clinical indicators including demographic characteristics, healing rate of the greater tuberosity, visual analogue score (VAS), Constant-Murley score, American Shoulder and Elbow Surgeons (ASES), shoulder range of motion (ROM), patient satisfaction, and complication rate were collected and analyzed.Results:The mean follow-up duration was 40(32, 60) months (range, 25-72 months) in the primary RTSA group and 38(30, 61) months (range, 24-68 months) in RTSA revision group. There was no significant difference (χ 2=5.058, P=0.168) in the healing rate of the greater tuberosity between the primary RTSA group (41/48, 85.4%) and the RTSA revision group (15/24, 62.5%). Compared with preoperative status, the ROM of anterior elevation, abduction supination, external rotation, VAS score, Constant-Murley score, and ASES score were significantly improved at the last follow-up (all P<0.05) in the RTSA revision group. The anterior elevation (123.74°± 16.57°), abduction supination (113.73°±16.42°), and external rotation (36.45°±10.36°) in the primary RTSA group were superior to those in the RTSA revision group (109.43°±18.75°, 98.64°±15.47°, 30.47°±10.64°, respectively), the difference was statistically significant ( P<0.05). No statistical difference of ROM of internal rotation between the two groups was found (χ 2=4.034, P=0.133). At the last follow-up, the Constant-Murley scores (75.47±11.66) and ASES scores (73.58±15.72) of the primary RTSA group were higher than those in the RTSA revision group (60.43±10.24 and 63.28±18.77, respectively), and the differences were statistically significant ( P<0.05). In terms of VAS (1.66±0.93 vs. 2.02±1.15) and patient satisfaction [83%(40/48) vs. 88%(21/24)], no statistical difference was identified ( P>0.05). The complication rate were 10.4% (5/48) in the primary RTSA group and 20.8% (5/24) in the RTSA revision group (χ 2=1.452, P=0.285), with no serious complications requiring revision surgery in either group. Conclusions:For elderly patients with proximal humeral fractures after failed operation, RTSA revision might effectively improve the limb function and alleviatepain. However, compared with RTSA revision, primary RTSA demonstrated superiorearly clinical outcomes in shoulder ROM and functional recovery.

Objective:To compare the clinical efficacy of a fixed exoskeleton robot with that of an exoskeleton walker in training the balance of stroke survivors in the subacute stage.Methods:Thirty persons with subacute stroke were divided at random into a fixed robot group (15 cases) and a walking robot group (15 cases). In addition to conventional rehabilitation treatment, the fixed robot group underwent daily 20-minute treadmill-based fixed exoskeleton robot training, 5 days a week for 2 weeks. The walking group was trained with an exoskeleton walking robot on the same schedule. Before and after the treatment, the Berg balance scale, the sitting modified functional stretch test (SMFRT), an isokinetic muscle strength test and the modified Barthel index (MBI) were used to evaluate the subjects′ global balance, self-dynamic balance, knee proprioception and ability in the activities of daily living (ADL).Results:After the treatment, both groups′ average Berg score, SMFRT extension difference, proprioceptive absolute error angle in the affected knee and MBI had improved significantly. The average SMFRT extension difference after treatment in the walker group was then significantly better than the fixed robot group′s average. However, the fixed robot group′s proprioception in the affected knee joint was then significantly better, on average, than among the walking robot group.Conclusions:Both fixed exoskeleton robot training and exoskeleton walker training can improve the balance, proprioception and ADL ability after a stroke. The former better improves dynamic balance; the latter better improves proprioception in the affected knee joint.

Objective:To evaluate the clinical outcomesof primary reverse total shoulder arthroplasty (RTSA) and revision procedure with RTSA after treatment failure of complex proximal humeral fractures in the elderly.Methods:A retrospective analysis was conductedon 24 elderly patients with Neer three- or four-part proximal humeral fractures who underwent RTSA revision after treatment failure (RTSA revision group) from January 2017 to June 2022. There were 7 males and 17 females included, with a mean age of 78.23±5.78 years (range, 67-86 years). Forty-eight patients who underwent primary RTSA (primary RTSA group) during the same time period were selected by propensity score matchingin a 1∶2 ratio as controls, based on age, dominanthand, etiology, Neer typing, glenohumeral joint dislocation, rotator cuff integrity, and osteoporosis T-score. The primary RTSA group included 12 males and 36 females, with a mean age of 76.38±6.15 years (range, 65-87 years). Clinical indicators including demographic characteristics, healing rate of the greater tuberosity, visual analogue score (VAS), Constant-Murley score, American Shoulder and Elbow Surgeons (ASES), shoulder range of motion (ROM), patient satisfaction, and complication rate were collected and analyzed.Results:The mean follow-up duration was 40(32, 60) months (range, 25-72 months) in the primary RTSA group and 38(30, 61) months (range, 24-68 months) in RTSA revision group. There was no significant difference (χ 2=5.058, P=0.168) in the healing rate of the greater tuberosity between the primary RTSA group (41/48, 85.4%) and the RTSA revision group (15/24, 62.5%). Compared with preoperative status, the ROM of anterior elevation, abduction supination, external rotation, VAS score, Constant-Murley score, and ASES score were significantly improved at the last follow-up (all P<0.05) in the RTSA revision group. The anterior elevation (123.74°± 16.57°), abduction supination (113.73°±16.42°), and external rotation (36.45°±10.36°) in the primary RTSA group were superior to those in the RTSA revision group (109.43°±18.75°, 98.64°±15.47°, 30.47°±10.64°, respectively), the difference was statistically significant ( P<0.05). No statistical difference of ROM of internal rotation between the two groups was found (χ 2=4.034, P=0.133). At the last follow-up, the Constant-Murley scores (75.47±11.66) and ASES scores (73.58±15.72) of the primary RTSA group were higher than those in the RTSA revision group (60.43±10.24 and 63.28±18.77, respectively), and the differences were statistically significant ( P<0.05). In terms of VAS (1.66±0.93 vs. 2.02±1.15) and patient satisfaction [83%(40/48) vs. 88%(21/24)], no statistical difference was identified ( P>0.05). The complication rate were 10.4% (5/48) in the primary RTSA group and 20.8% (5/24) in the RTSA revision group (χ 2=1.452, P=0.285), with no serious complications requiring revision surgery in either group. Conclusions:For elderly patients with proximal humeral fractures after failed operation, RTSA revision might effectively improve the limb function and alleviatepain. However, compared with RTSA revision, primary RTSA demonstrated superiorearly clinical outcomes in shoulder ROM and functional recovery.

Objective:To compare the clinical efficacy of a fixed exoskeleton robot with that of an exoskeleton walker in training the balance of stroke survivors in the subacute stage.Methods:Thirty persons with subacute stroke were divided at random into a fixed robot group (15 cases) and a walking robot group (15 cases). In addition to conventional rehabilitation treatment, the fixed robot group underwent daily 20-minute treadmill-based fixed exoskeleton robot training, 5 days a week for 2 weeks. The walking group was trained with an exoskeleton walking robot on the same schedule. Before and after the treatment, the Berg balance scale, the sitting modified functional stretch test (SMFRT), an isokinetic muscle strength test and the modified Barthel index (MBI) were used to evaluate the subjects′ global balance, self-dynamic balance, knee proprioception and ability in the activities of daily living (ADL).Results:After the treatment, both groups′ average Berg score, SMFRT extension difference, proprioceptive absolute error angle in the affected knee and MBI had improved significantly. The average SMFRT extension difference after treatment in the walker group was then significantly better than the fixed robot group′s average. However, the fixed robot group′s proprioception in the affected knee joint was then significantly better, on average, than among the walking robot group.Conclusions:Both fixed exoskeleton robot training and exoskeleton walker training can improve the balance, proprioception and ADL ability after a stroke. The former better improves dynamic balance; the latter better improves proprioception in the affected knee joint.

Objective:To evaluate direct and indirect costs for schizophrenia,major depressive disorder(MDD)and bipolar disorder,and to compare their differences of cost composition,and to explore the drivers of the total costs.Methods:A total of 3 175 inpatients with schizophrenia,MDD,and bipolar disorder were recruited.In-patient's self-report total direct of medical costs outpatient and inpatient,out-of-pocket costs,and direct non-medical costs were regarded as direct costs.Productivity loss and other loss caused by damaging properties were defined as indirect costs.The perspectives of this study included individual and societal levels.Multivariate regression analysis was applied for detecting the factors influencing disease costs.Results:The total cost of schizophrenia was higher than those of MDD and bipolar disorder at individual and societal levels.The indirect costs of three mental disorders were higher than the direct costs,and the indirect cost ratio of bipolar disorder was higher than those of schizophre-nia and MDD.Age,gender,working condition and marital status(P＜0.05)were the important drivers of total costs.Conclusion:The economic burden of the three mental disorders is relatively heavy.Schizophrenia has heaviest disease burden,and the productivity loss due to mental disorders is the driving force of the soaring disease cost

Objective:To synthesize a 68Ga-labeled oxalyldiaminopropionic acid (ODAP)-urea based prostate specific membrane antigen (PSMA) targeting probe, and evaluate its properties in vitro and in vivo. Methods:Ligand P151 was synthesized by solid-phase synthesis and its Ki value was determined. The ligand P151 was added into the mixture of 68GaCl 3 and NaOAc solution and was reacted at 95 ℃ for 10 min. The labeling yield and in vitro stability of 68Ga-P151 were determined by high performance liquid chromatography (HPLC). The lipid-water partition coefficient (log P) and cell binding ability were determined. The biodistribution of 68Ga-P151 in normal KM mice was determined. MicroPET imaging of 68Ga-P151 was carried out in prostate cancer 22Rv1 tumor-bearing mice and compared with 68Ga-PSMA 617. Independent sample t test was used to analyze the data. Results:P151 was successfully synthesized with the Ki of 0.58 nmol/L, the labeling yield more than 95% and the radiochemical purity more than 95%. After placement in saline or human serum albumin (HSA) solution at 37 ℃ for 2 h, the radiochemical purity of 68Ga-P151 was still more than 95%, indicating a good stability in vitro. The lipid-water partition coefficient (log P) of 68Ga-P151 was -2.65±0.17, indicating a good hydrophilicity. 68Ga-P151 specifically bound to PSMA in prostate cancer LNCaP cells with the uptake value of (0.83±0.04) percentage injection activity (%IA)/10 5 cells. Biodistribution of normal mice showed that 68Ga-P151 was mainly excreted through kidneys and other organs showed low uptake. MicroPET imaging of tumor-bearing mice showed the maximum standardized uptake value (SUV max: 0.79±0.23 vs 0.54±0.05; t=2.12), tumor/kidney ratio (2.04±0.65 vs 1.88±0.33; t=0.44) and tumor/muscle ratio (12.83±5.18 vs 6.95±1.63; t=2.17) between 68Ga-P151 and 68Ga-PSMA 617 were not significantly different (all P>0.05). Conclusions:68Ga-P151 can be prepared simply and labeled in high yield and show improved pharmacokinetic properties in vivo. The imaging of 68Ga-P151 on PSMA positive tumor is comparable to that of 68Ga-PSMA 617, making it a potential radiopharmaceutical for the diagnosis of prostate cancer.

Objective To analysis the change of hip joint in healthy infants by ultrasound,and establish the normal reference value of the developmental dysplasia of the hip(DDH). Methods A total of 8 000 healthy infants from 0 to 24 weeks were collected from the Multi-center study of 10 children′s medical centers. Among them,3 855 infants(2 065 females and 1 790 males) with complete data and follow-up were included in this study. All subjects were divided into 6 groups ( ＜4,4～7,8～11,12～15,16～19 and≥20 weeks group). α angle,femoral head length and width,femoral head coverage ratio by acetabulum ( FHC) were measured in the coronal view on the neutral position;distance from pubis to femoral head ( P-H) and distance from ischium to femoral head ( I-H ) were measured in the transverse view on neutral position;distance from femoral head topubis ( H-P) was measured in the posterolateraltransverse view on the flexion position. The results of each group changes with age were analysised. Results ① The α angle of healthy infants from 0 to 20 weeks were increased with age,the difference among the groups were statistically significant( P ＜0.05),but there was no significant difference between 16～19 and ≥20 weeks group( P ＞0.05). ②The femoral head length and width of all age groups were increased with age,the difference among all the groups was statistically significant( all P ＜0.05). ③ FHC from 0 to 20 weeks were increased with age,the difference among the groups were statistically significant( P ＜0.05) except between 16～19 and ≥20 weeks group( P ＞0.05). ④ The P-H and I-H in all age groups showed no statistically significant ( all P＞0.05). ⑤The H-P of all age groups were increased with age,the difference between the groups were statistically significant(all P ＜0.05).Conclusions The development of hip joints have the certain regular developmental pattern in healthy infants less than 5 months of birth and are relatively constant after birth more than 5 months. The ultrasound normal reference value of the hip joints can be used for the early diagnosis of the DDH.

Objective To analyze cause and preventative measures of neurological complications of spinal osteotomy for thoracolumbar and lumbar kyphosis in ankylosing spondylitis.Methods Data of 126 patients with kyphosis caused by ankylosing spondylitis,who had undergone spinal osteotomy in our hospital from January 2006 to January 2012,were retrospectively analyzed.Among them,18 patients developed neurological complications after spinal osteotomy,including 15 males and 3 females,aged from 25 to 56 years.The average preoperative Cobb angle of these patients was 76.3°.According to American Spinal Injury Association (ASIA) classification,all patients were rated as grade E.Results All 18 patients were followed up for 6 to 49 months (average,35 months).The postoperative Cobb angle ranged from 19° to 38° (average,27°).The average Cobb angle was corrected 49.3°.Neurological complications included spinal cord injury (3 cases) and nerve root injury (15 cases).The reasons of spinal cord injury consisted of sagittal migration of vertebra,spinal stenosis due to operation and iatrogenic cervical spine fracture and dislocation.The reasons of nerve root injury included compression injury (2 cases),malposition of screw (1 case) and excessive drag of nerve root during osteotomy (12 cases).Conclusion Nerve injury is one of the most serious complications of spinal osteotomy in the treatment of kyphosis in ankylosing spondylitis.The incidence of the neurological complications could be obviously reduced by fully decompressing,making patients in a proper surgical position,recognizing the pathological nature of ankylosing spondylitis and avoiding sagittal migration of osteotomy part.

Objective To evaluate the clinical effects of Anisodamine on neurological function as well as the safety of using it after cerebral resuscitation. Methods The data of CNKI (from January 1979 through January 2011 ) and Pubmed (from January 1978 through January 2011 ) were searched.The Cochrane Library was applied for identifying randomized controlled trials (RCTs) about effects of Anisodamine on neurological function after cerebral resuscitation.The methodological quality was assessed and the data were collected according to the criteria defined in Cochrane Reviewer' s Handbook for meta-analyses with RevMan 5.0.25 package.Results Data of 327 patients from 4 eligible studies were included in this analysis.The results of meta-analyses showed that Anisodamine used after cerebral resuscitation improved Glasgow coma scale (GCS) in the early stage [ MD =1.4,95％ CI (0.98,1.82),P ＜0.01 ] and lessen neurological deficit (ND) in the later stage [ MD =-4.38,95％CI ( -5.26, -3.51 ),P ＜0.01 ].Meanwhile,the reduction of long-term ND of patients was documented in two studies ; the improvement of ability of daily life of patients in 2 ～ 3 months after anisodamine used was reported in two studies; the improvement of patients' quality of life (QL) was recorded in one study and the inhibited release of excitatory amino acid (EAA) was reported in one study.All eligible studies did not report any serious adverse effects of Anisodamine used after cerebral resuscitation. Conclusions Anisodamine used after cerebral resuscitation can improve patients'status of neurological function with relative safety of administration.

OBJECTIVE: To evaluate changes in acoustic features of voice after tonsillectomy. METHOD: Thirty-three patients presenting for tonsillectomy were recruited. Voice recordings obtained from patients before and 1 month after surgery, were analyzed using the Kay Elemetrics, multi-dimensional voice processing software. The following parameters were estimated: the first formant (F1, B1), average of fundamental frequency (F0), Jitter percent (Jitter), Shimmer, noise-to-harmonics ratio (NHR). RESULT: There were significant difference in the first formant frequency and bandwidth before and 1 month after surgery. The larger the tonsil was, the more changes were seen in the formant frequency. No significant differences were found for F0, Jitter, Shimmer, NHR decreased after the surgery. CONCLUSION The modifications in the anatomical structure and volume of the vocal tract, induced by the tonsillectomy can change the formant frequency and bandwidth. The larger the tonsil was, the more changes were detected in the formant frequency.
Humans ; Organ Size ; Palatine Tonsil ; pathology ; Postoperative Period ; Preoperative Period ; Software ; Speech Acoustics ; Tonsillectomy ; Voice Quality