Objective:To evaluate the early-to-mid-term efficacy of supramalleolar osteotomy (SMO) in the treatment of traumatic ankle arthritis secondary to peri-ankle fracture.Methods:A retrospective study was conducted to analyze the clinical data of 29 patients who had been treated for traumatic ankle arthritis secondary to old peri-ankle fracture by SMO from March 2018 to March 2023 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 14 males and 15 females, 39.0 (25.0, 49.0) years in age. Types of old fracture: 4 lower tibiofibular fractures, 19 ankle fractures, and 6 pilon fractures. Surgery was conducted for 16 cases and conservative treatment for the remaining 13 cases. The interval between the old fracture and the current surgery was 10.0 (2.0, 19.5) years. The clinical efficacy was evaluated using the ankle-hindfoot score of American Association of Foot and Ankle Surgery (AOFAS), foot function index (FFI), and visual analog scale (VAS) pain score. Imaging analysis was conducted and imaging comparisons were made between pre-surgery and post-surgery in terms of tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle, talar tilt (TT) angle, and changes in modified Takakura staging. Complications were recorded. Surgical satisfaction was investigated at the final follow-up.Results:The 29 patients were followed up for 17.0 (14.0, 23.5) months. The AOFAS ankle-hindfoot score [(84.2±9.6) points], FFI [7.0 (3.0, 10.9) points], VAS pain score [2.0 (1.0, 3.0) points], and TAS angle [90.84° (86.70°, 92.50°)] at the final follow-up for all patients were significantly better than the pre-surgery values [(68.0±16.7) points, 20.9 (6.1, 29.1) points, 5.0 (2.0, 8.0) points, and 78.63° (74.30°, 85.00°)] (all P<0.05). At the final follow-up, the ankle arthritis grading did not show any significant change ( P>0.05) and there were no significant differences in TT angle or TLS angle between pre-surgery and post-surgery ( P>0.05). Incision failed to heal in 1 case, incision healing was delayed in 3 cases, and ankle arthritis progressed on imaging in 6 cases. As for patient self-assessed satisfaction, 23 cases felt very satisfactory, 4 cases quite satisfactory, and 2 cases common, giving an overall satisfaction rate of 93.1% (27/29). Conclusions:SMO has led to good early-to-mid-term efficacy in the treatment of traumatic ankle arthritis secondary to peri-ankle fracture, showing obvious pain relief and functional improvement after correction of the ankle joint alignment, limited postoperative complactions and a high rate of patient satisfaction.

Objective To investigate the efficacy and safety of the Corheart 6 left ventricular assist system in patients with end-stage heart failure. Methods A retrospective study was conducted on patients with end-stage heart failure who were treated with Corheart 6 left ventricular assist system from March 2022 to June 2024 in 4 hospitals in Jiangsu Province. The efficacy of the device was evaluated by comparing changes in clinical indicators at preoperative, discharge, 3-month postoperative, and 6-month postoperative timepoints, including the New York Heart Association (NYHA) functional classification, left ventricular ejection fraction (LVEF), and left ventricular end-diastolic diameter (LVEDD). The safety of the device was assessed by analyzing the intraoperative position and orientation of the blood pump inlet cannula, as well as the incidence of adverse events. Results In this study, 39 patients were collected, including 34 males and 5 females with a mean age of (56.4±12.5) years, ranging from 20 to 75 years. There was no operative death. There was no death in postoperative 3 months with a survival rate of 100.0%. There were 3 deaths in 6 months postoperatively, with a survival rate of 92.3%. All patients had a preoperative NYHA cardiac function classification of class Ⅳ. The NYHA cardiac function class of the patients improved (P<0.05) at discharge, 3 and 6 months after surgery when compared to the preoperative period. LVEF was significantly higher at 3 months after surgery than that during the preoperative period (P<0.05). LVEDD was significantly smaller at discharge, 3 and 6 months after surgery than that during the preoperative period (P<0.05). The safety evaluation's findings demonstrated that all 39 patients' intraoperative blood pump inlet tubes were oriented correctly, the artificial blood vessel suture sites were appropriate, there were no instances of device malfunction or pump thrombosis, or instances of bleeding or hemolysis, and the rate of the remaining adverse events was low. Conclusion With a low rate of adverse events and an excellent safety profile, the Corheart 6 left ventricular assist system can efficiently enhance cardiac function in patients with end-stage heart failure. It also has considerable clinical uses.

Objective:To investigate the risk factors for recurrence after modified Chevron osteotomy for hallux valgus.Methods:A total of 86 patients (102 feet) with hallux valgus who underwent modified Chevron operation in Beijing Jishuitan Hospital from December 2018 to February 2021 were retrospectively analyzed. There were 12 males (14 feet) and 74 females (88 feet), aged 50±15 years (range, 18-74 years). There were 36 cases on the right side, 34 on the left side, and 16 on the bilateral side. 4 feet were treated with Chevron osteotomy, 74 feet with modified McBride's osteotomy, 61 feet with Weil osteotomy, 24 feet with Akin osteotomy, and 23 feet with gastrocnemius aponeurotic release. At the last follow-up, hallux valgus angle (HVA) ≤15° was defined as the non-recurrence group after hallux valgus operation, and HVA>15° was defined as the recurrence group after hallux valgus operation. Compare the age, gender, preoperative HVA, the first and second intermetatarsal angles (IMA) before and after operation, the metatarsus adductus angles (MAA) before and after operation, the Meary angles before and after operation, the distal metatarsal articular angles (DMAA) before and after operation, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores before and after operation, and the rotation of the first metatarsal head between the two groups of patients. Include the indicators with statistically significant differences in the binary variable logistic regression analysis to screen for the risk factors of recurrence after modified Chevron operation for hallux valgus.Results:All patients successfully completed the operation and were followed up for 30.3±16.4 months (range, 12-52 months). Postoperative recurrence occurred in 21 feet, and the recurrence rate was 20.6% (21/102). The HVA at the last follow-up was 8.48°±4.52° in the non-recurrence group and 20.68°±3.61° in the recurrence group. In the non-recurrence group, the AOFAS ankle-hindfoot score increased from 60.31±16.62 points preoperatively to 86.89±12.79 points postoperatively ( t=-13.644, P<0.001). In the recurrent group, the AOFAS ankle-hindfoot score increased from 61.71±15.68 points preoperatively to 84.33±18.84 points postoperatively ( t=-6.082, P<0.001). The proportion of patients with preoperative Meary angle> 4° in the non-recurrence group was 52% (10/21), which was lower than 79% (64/81) in the recurrence group, and the difference was statistically significant (χ 2=6.077, P=0.014). The proportion of patients with square type of metatarsal rotation (type A) in the recurrence group was 58%(47/81), which was higher than 33%(7/21) in the non-recurrence group, and the difference was statistically significant (χ 2=4.081, P=0.043). There was no significant difference in gender, age, preoperative HVA, pre- and post-operative IMA, pre- and post-operative DMAA, pre- and post-operative MAA, or preoperative metatarsal rotation type between the two groups ( P>0.05). The results of the logistic regression analysis showed that a preoperative Meary angle ≤ 4° ( OR=3.299, P=0.024) and a non-type A metatarsal rotation pattern after operation ( OR=4.183, P=0.041) were independent risk factors for recurrence after modified Chevron operation for hallux valgus. Conclusion:Hallux valgus patients with a preoperative Meary angle ≤4° and non-type A metatarsal rotation after operation have an increased risk of recurrence following modified Chevron operation.

Objective:To investigate application of the teaching method of problem-based learning(PBL)combined with neuronavigation technique in neurosurgical teaching,so as to improve further the teaching quality.Methods:The teaching method of PBL combined with neuronavigation technique adopted the same PBL teaching approach with conventional teaching method,and the neuronavigation technique was applied to reconstruct three dimensional(3D)graphics for patients'imaging documents.The neuronavigation technique was used to display intraoperative operation process for students,and guide their operation in surgery,and conduct teaching for them.A total of 30 medical students who conducted internship at department of neurosurgery of Beijing Tiantan Hospital,Capital Medical University during January and December 2023 were selected.A random-number table method was adopted to divide them into conventional PBL teaching method group(n=15)and PBL combined with neuronavigation technique teaching method group(n=15).The students'assessment results between two teaching methods were compared when they completed internship.A self-made survey questionnaire was adopted to investigate students'satisfaction for two kinds of teaching methods.Results:The assessment results of theory,technical ability and imaging of PBL combined with neuronavigation technique teaching method group were respectively(90.27±2.66),(90.73±2.71)and(90.13±2.77),all of which were higher than those of conventional PBL teaching method,and the differences were significant(t=13.82,7.95,13.93,P<0.05).The satisfactions about case,teacher performance,auxiliary teaching tools,learning initiative,learning efficiency,the mastery of theoretical,anatomical and imaging knowledge,the mastery of operational skills,and communication and interaction in PBL combined with neuronavigation technique teaching method group were all higher than those of conventional PBL teaching method,and the differences were significant(t=10.96,5.98,6.51,4.64,3.83,4.80,6.95,7.54,9.47,5.93,P<0.05).Conclusion:The application of the teaching method that PBL combined with neuronavigation technique in the teaching of neurosurgery for medical students can improve the teaching quality of neurosurgery,and enhance the satisfaction of students for teaching method.

Objective:To investigate application of the teaching method of problem-based learning(PBL)combined with neuronavigation technique in neurosurgical teaching,so as to improve further the teaching quality.Methods:The teaching method of PBL combined with neuronavigation technique adopted the same PBL teaching approach with conventional teaching method,and the neuronavigation technique was applied to reconstruct three dimensional(3D)graphics for patients'imaging documents.The neuronavigation technique was used to display intraoperative operation process for students,and guide their operation in surgery,and conduct teaching for them.A total of 30 medical students who conducted internship at department of neurosurgery of Beijing Tiantan Hospital,Capital Medical University during January and December 2023 were selected.A random-number table method was adopted to divide them into conventional PBL teaching method group(n=15)and PBL combined with neuronavigation technique teaching method group(n=15).The students'assessment results between two teaching methods were compared when they completed internship.A self-made survey questionnaire was adopted to investigate students'satisfaction for two kinds of teaching methods.Results:The assessment results of theory,technical ability and imaging of PBL combined with neuronavigation technique teaching method group were respectively(90.27±2.66),(90.73±2.71)and(90.13±2.77),all of which were higher than those of conventional PBL teaching method,and the differences were significant(t=13.82,7.95,13.93,P<0.05).The satisfactions about case,teacher performance,auxiliary teaching tools,learning initiative,learning efficiency,the mastery of theoretical,anatomical and imaging knowledge,the mastery of operational skills,and communication and interaction in PBL combined with neuronavigation technique teaching method group were all higher than those of conventional PBL teaching method,and the differences were significant(t=10.96,5.98,6.51,4.64,3.83,4.80,6.95,7.54,9.47,5.93,P<0.05).Conclusion:The application of the teaching method that PBL combined with neuronavigation technique in the teaching of neurosurgery for medical students can improve the teaching quality of neurosurgery,and enhance the satisfaction of students for teaching method.

Objective:To evaluate the early-to-mid-term efficacy of supramalleolar osteotomy (SMO) in the treatment of traumatic ankle arthritis secondary to peri-ankle fracture.Methods:A retrospective study was conducted to analyze the clinical data of 29 patients who had been treated for traumatic ankle arthritis secondary to old peri-ankle fracture by SMO from March 2018 to March 2023 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 14 males and 15 females, 39.0 (25.0, 49.0) years in age. Types of old fracture: 4 lower tibiofibular fractures, 19 ankle fractures, and 6 pilon fractures. Surgery was conducted for 16 cases and conservative treatment for the remaining 13 cases. The interval between the old fracture and the current surgery was 10.0 (2.0, 19.5) years. The clinical efficacy was evaluated using the ankle-hindfoot score of American Association of Foot and Ankle Surgery (AOFAS), foot function index (FFI), and visual analog scale (VAS) pain score. Imaging analysis was conducted and imaging comparisons were made between pre-surgery and post-surgery in terms of tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle, talar tilt (TT) angle, and changes in modified Takakura staging. Complications were recorded. Surgical satisfaction was investigated at the final follow-up.Results:The 29 patients were followed up for 17.0 (14.0, 23.5) months. The AOFAS ankle-hindfoot score [(84.2±9.6) points], FFI [7.0 (3.0, 10.9) points], VAS pain score [2.0 (1.0, 3.0) points], and TAS angle [90.84° (86.70°, 92.50°)] at the final follow-up for all patients were significantly better than the pre-surgery values [(68.0±16.7) points, 20.9 (6.1, 29.1) points, 5.0 (2.0, 8.0) points, and 78.63° (74.30°, 85.00°)] (all P<0.05). At the final follow-up, the ankle arthritis grading did not show any significant change ( P>0.05) and there were no significant differences in TT angle or TLS angle between pre-surgery and post-surgery ( P>0.05). Incision failed to heal in 1 case, incision healing was delayed in 3 cases, and ankle arthritis progressed on imaging in 6 cases. As for patient self-assessed satisfaction, 23 cases felt very satisfactory, 4 cases quite satisfactory, and 2 cases common, giving an overall satisfaction rate of 93.1% (27/29). Conclusions:SMO has led to good early-to-mid-term efficacy in the treatment of traumatic ankle arthritis secondary to peri-ankle fracture, showing obvious pain relief and functional improvement after correction of the ankle joint alignment, limited postoperative complactions and a high rate of patient satisfaction.

Objective:To investigate the risk factors for recurrence after modified Chevron osteotomy for hallux valgus.Methods:A total of 86 patients (102 feet) with hallux valgus who underwent modified Chevron operation in Beijing Jishuitan Hospital from December 2018 to February 2021 were retrospectively analyzed. There were 12 males (14 feet) and 74 females (88 feet), aged 50±15 years (range, 18-74 years). There were 36 cases on the right side, 34 on the left side, and 16 on the bilateral side. 4 feet were treated with Chevron osteotomy, 74 feet with modified McBride's osteotomy, 61 feet with Weil osteotomy, 24 feet with Akin osteotomy, and 23 feet with gastrocnemius aponeurotic release. At the last follow-up, hallux valgus angle (HVA) ≤15° was defined as the non-recurrence group after hallux valgus operation, and HVA>15° was defined as the recurrence group after hallux valgus operation. Compare the age, gender, preoperative HVA, the first and second intermetatarsal angles (IMA) before and after operation, the metatarsus adductus angles (MAA) before and after operation, the Meary angles before and after operation, the distal metatarsal articular angles (DMAA) before and after operation, the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot scores before and after operation, and the rotation of the first metatarsal head between the two groups of patients. Include the indicators with statistically significant differences in the binary variable logistic regression analysis to screen for the risk factors of recurrence after modified Chevron operation for hallux valgus.Results:All patients successfully completed the operation and were followed up for 30.3±16.4 months (range, 12-52 months). Postoperative recurrence occurred in 21 feet, and the recurrence rate was 20.6% (21/102). The HVA at the last follow-up was 8.48°±4.52° in the non-recurrence group and 20.68°±3.61° in the recurrence group. In the non-recurrence group, the AOFAS ankle-hindfoot score increased from 60.31±16.62 points preoperatively to 86.89±12.79 points postoperatively ( t=-13.644, P<0.001). In the recurrent group, the AOFAS ankle-hindfoot score increased from 61.71±15.68 points preoperatively to 84.33±18.84 points postoperatively ( t=-6.082, P<0.001). The proportion of patients with preoperative Meary angle> 4° in the non-recurrence group was 52% (10/21), which was lower than 79% (64/81) in the recurrence group, and the difference was statistically significant (χ 2=6.077, P=0.014). The proportion of patients with square type of metatarsal rotation (type A) in the recurrence group was 58%(47/81), which was higher than 33%(7/21) in the non-recurrence group, and the difference was statistically significant (χ 2=4.081, P=0.043). There was no significant difference in gender, age, preoperative HVA, pre- and post-operative IMA, pre- and post-operative DMAA, pre- and post-operative MAA, or preoperative metatarsal rotation type between the two groups ( P>0.05). The results of the logistic regression analysis showed that a preoperative Meary angle ≤ 4° ( OR=3.299, P=0.024) and a non-type A metatarsal rotation pattern after operation ( OR=4.183, P=0.041) were independent risk factors for recurrence after modified Chevron operation for hallux valgus. Conclusion:Hallux valgus patients with a preoperative Meary angle ≤4° and non-type A metatarsal rotation after operation have an increased risk of recurrence following modified Chevron operation.

Objective:To analyze the clinical data of patients with end-stage ankle and hindfoot ar-thropathy who underwent tibiotalocalcaneal(TTC)arthrodesis by the same surgeon,explore the short-and mid-term clinical results,complications and functional improvement,and discuss the clinical progno-sis and precautions of TTC arthrodesis.Methods:Retrospective analysis was made on the clinical data of 40 patients who underwent TTC arthrodesis by the same surgeon from March 2011 to December 2020.In this study,23 males and 17 females were included,with an average age of(49.1±16.0)years.All the patients underwent unilateral surgery.The clinical characteristics,imaging manifestations,main diagno-sis and specific surgical techniques of the patients were recorded.The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score and visual analogue scale(VAS)between pre-operation and at the last follow-up.The fusion healing time,symptom improvement(significant improvement,certain improvement,no improvement or deterioration)and postoperative complications were also recorded.Results:The median follow-up time was 38.0(26.3,58.8)months.The preoperative VAS score was 6.0(4.0,7.0),and the AOFAS score was 33.0(25.3,47.3).At the last follow-up,the median VAS score was 0(0,3.0),and the AOFAS score was 80.0(59.0,84.0).All the significantly improved compared with their preoperative corre-sponding values(P＜0.05).There was no wound necrosis or infection in the patients.One patient suf-fered from subtalar joint nonunion,which was syphilitic Charcot arthropathy.The median bony healing time of other patients was 15.0(12.0,20.0)weeks.Among the included patients,there were 25 cases with significant improvement in symptom compared with that preoperative,8 cases with certain improve-ment,4 cases with no improvement,and 3 cases with worse symptoms than that before operation.Con-clusion:TTC arthrodesis is a reliable method for the treatment of the end-stage ankle and hindfoot ar-thropathy.The function of most patients was improved postoperatively,with little impact on daily life.The causes of poor prognosis included toe stiffness,stress concentration in adjacent knee joints,nonunion and pain of unknown causes.

Objective:To analyze the relationship between health belief and the stages of parental decision-making on childhood 13-valent pneumococcal conjugate vaccine (PCV13) immunization in China.Methods:Cross-sectional multistage survey sampling method was used to select study subjects. The study subjects were parents who were aged 20-45 years and had one and more children ≤5 years old in three cities in China. A self-administered questionnaire designed based on health belief model was used to collect the information. Multinomial logistic regression analysis was used to assess the relationships between perceived susceptibility, perceived severity of illness, perceived effect of PCV13 and stages of parental decision-making on childhood PCV13 immunization.Results:A total of 1 716 valid questionnaires were returned (89.33%). The average age of the study subjects was (35.33±4.95) years, and 79.60% of them were women. In the study subjects, 48.31% had in action, 21.79% were in contemplation and 29.90% were in pre-contemplation. The multinominal logistic regression analysis indicated that high perceived susceptibility ( OR=0.14, 95% CI:0.09-0.22; OR=0.54, 95% CI:0.39-0.76), high perceived severity of illness ( OR=0.55, 95% CI:0.42-0.73), and high perceived effect of PCV13 ( OR=0.27, 95% CI:0.18-0.40; OR=0.51, 95% CI:0.32-0.81) were significantly lower in those who were in contemplation or pre-compared with those who had in action. For study subjects with low perceived susceptibility, high perceived effect of PCV13 might decrease the probabilities of contemplation ( OR=0.53, 95% CI:0.32-0.87) and pre-contemplation ( OR=0.27, 95% CI:0.18-0.41). For those with high perceived susceptibility, perceived severity of illness might decrease the probability of contemplation ( OR=0.43, 95% CI:0.23-0.82). Conclusions:Childhood PCV13 vaccination willingness and level is low in China. It is important to pay greater attention to the intervention on health belief in child parents, such as perceived effect of PCV13, perceived severity of illness, and perceived susceptibility, in health policy development and health promotion.

Objective     To investigate the clinical characteristics, risk factors and perioperative outcome of prolonged mechanical ventilation (PMV) in elderly patients undergoing coronary artery bypass grafting (CABG). Methods     The data of elderly patients receiving CABG in the Nanjing First Hospital from January 2013 to June 2019 were collected. All patients were divided into a control group and a PMV group according to whether ventilation time≥24 h. The clinical characteristics and risk factors of PMV were compared between the two groups. Variables were 1∶1 balanced through propensity score matching (PSM) and perioperative outcomes of two groups was analyzed. Results     Finally 956 patients were collected, including 187 in the PMV group and 769 in the control group. There were 586 males and 370 females aged 70-94 (74.3±3.5) years. Compared with the control group, the PMV group had higher rates of smoking,  preoperative renal impairment, intraoperative blood transfusion and intra-aortic balloon pump (IABP) implantation, worse cardiac function, lower glomerular filtration rate and ejection fraction, larger left atrial diameter, longer cardiopulmonary bypass time and aortic cross-clamping time (P<0.05). There was no statistical difference in other clinical data between the two groups (P>0.05). Binary multivariate logistic regression analysis showed that females, smoking, chronic obstructive pulmonary disease, left ventricular ejection fraction≤56.0%, cardiopulmonary bypass time>106.0 min, IABP implantation and intraoperative blood transfusion were independent risk factors for PMV in elderly patients. After PSM, there were 146 patients in the control group and the PMV group, respectively. The PMV group had longer ICU stay and length of hospital stay and more drainage volume compared with the control group (all P<0.05). There was no statistical difference in perioperative mortality or other complications between the two groups (all P>0.05). Conclusion    There are a lot of factors associated with PMV of the elderly patients undergoing on-pump CABG. In order to establish a complete and formal PMV prediction model, clinicians can make a further step of assessment according to perioperative elements, and improve the prognosis of such patients.