Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

Objective:To evaluate the clinical value of three-dimensional(3D) printing-assisted fenestrated/branched endovascular aortic repair (F/B-TEVAR) for the treatment of endoleak after open surgery for type A aortic dissection.Methods:A multi-center retrospective case series analysis was conducted on 16 patients with anastomotic leakage following Stanford type A aortic dissection open repair, admitted to 12 medical centers between January 2019 and December 2023. All surgeries were led by the vascular surgery team from Department of Vascular Surgery, Nanjing Drum Tower Hospital. The study included 12 males and 4 females, with an age of (58.1±8.2) years (range: 42 to 75 years). Preoperative patient-specific 3D-printed models or 3D parametric surface topological guides were created based on aortic CT angiography data. These models assisted intraoperative external positioning of fenestration sites, combined with stent diameter selection and inner branch techniques to complete endovascular repair. Surgical procedures, complications, and clinical outcomes were evaluated, with follow-up CT imaging to assess efficacy.Results:All patients successfully underwent surgery without conversion to open repair. One patient had distal stent migration from a prior open repair, requiring intraoperative coverage of the main stent window and conversion to an in situ fenestration procedure. The mean operative time was (332.6±111.2)minutes (range: 80 to 460 minutes). No renal failure, paraplegia, or branch artery loss occurred. Postoperative follow-up ( M(IQR)) was 18(18) months(range: 6 to 36 months), with follow-up rates of 16/16 at 6 months, 10/16 at 12 months, 8/16 at 24 months, and 2/16 at 36 months. During follow-up, endoleak occurred in 3 patients, cerebral infarction in 1 patient, and death in 1 patient. The remaining patients demonstrated stable stent positioning, patent branches, and no endoleak. Conclusion:3D technology-guided F/B-TEVAR shows favorable mid-to short-term outcomes in treating anastomotic leakage after open repair of type A aortic dissection.

Objective:To explore the relationship between dietary pattern and sexual function in people of childbearing age.Methods:This study adopted a cross-sectional method and included all women and men who visited Reproduction Center of Maanshan Maternal and Child Health Hospital, Reproductive Medicine Center of the 901th Hospital of the Joint Logistics Support Force of People's Liberation Army and Reproduction Center of Anhui Wanbei Coal Power Group General Hospital from December 2020 to March 2022. The Female Sexual Function Index (FSFI) and International Index of Erectile Function-15 (IIEF-15) were used to assess sexual function. Factor analysis was used to establish dietary patterns, and multivariate logistic regression was used to analyze the association between dietary patterns and sexual function.Results:A total of 1 290 females and 1 331 males were included in the study, including 1 031 females and 899 males with sexual dysfunction. There were 289 women and 272 men with balanced dietary pattern, 473 women and 395 men with traditional dietary pattern, 272 women and 324 men with processed dietary pattern, and 256 women and 340 men with beverage dietary pattern. After adjusting for confounding factors such as residence and age, it was found that balanced dietary pattern was negatively correated with female sexual desire disorder ( OR=0.904, 95% CI: 0.820-0.995, P=0.039), sexual arousal disorder ( OR=0.840, 95% CI: 0.759-0.929, P=0.001), vaginal lubrication disorder ( OR=0.833, 95% CI: 0.710-0.979, P=0.026), orgasmic disorder ( OR=0.764, 95% CI: 0.680-0.858, P<0.001), low sexual satisfaction ( OR=0.887, 95% CI: 0.796-0.987, P=0.028), sexual dysfunction ( OR=0.805, 95% CI: 0.714-0.907, P<0.001), and male orgasmic disorder ( OR=0.859, 95% CI: 0.763-0.967, P=0.012). The traditional dietary pattern was negatively correlated with female sexual desire disorder ( OR=0.879, 95% CI: 0.786-0.983, P=0.024), sexual arousal disorder ( OR=0.884, 95% CI: 0.784-0.995, P=0.042), male erectile disorder ( OR=0.736, 95% CI: 0.634-0.855, P<0.001), sexual desire disorder ( OR=0.753, 95% CI: 0.648-0.876, P<0.001), and sexual dysfunction ( OR=0.769, 95% CI: 0.653-0.907, P=0.020). The processed dietary pattern was positively correlated with erectile disorder ( OR=1.162, 95% CI: 1.049-1.287, P=0.004), orgasmic dysfunction ( OR=1.207, 95% CI: 1.091-1.337, P<0.001), sexual desire disorder ( OR=1.199, 95% CI: 1.081-1.330, P=0.001) and sexual dysfunction ( OR=1.134, 95% CI: 1.020-1.261, P=0.002). Beverage dietary pattern was not associated with sexual dysfunction in men and women (all P>0.05). Conclusion:Balanced, traditional dietary patterns were related to the reduce risk of sexual dysfunction in both women and men of childbearing age, while processed dietary patterns were related to the increased risk of sexual dysfunction in men of childbearing age.

Objective:To explore the relationship between dietary pattern and sexual function in people of childbearing age.Methods:This study adopted a cross-sectional method and included all women and men who visited Reproduction Center of Maanshan Maternal and Child Health Hospital, Reproductive Medicine Center of the 901th Hospital of the Joint Logistics Support Force of People's Liberation Army and Reproduction Center of Anhui Wanbei Coal Power Group General Hospital from December 2020 to March 2022. The Female Sexual Function Index (FSFI) and International Index of Erectile Function-15 (IIEF-15) were used to assess sexual function. Factor analysis was used to establish dietary patterns, and multivariate logistic regression was used to analyze the association between dietary patterns and sexual function.Results:A total of 1 290 females and 1 331 males were included in the study, including 1 031 females and 899 males with sexual dysfunction. There were 289 women and 272 men with balanced dietary pattern, 473 women and 395 men with traditional dietary pattern, 272 women and 324 men with processed dietary pattern, and 256 women and 340 men with beverage dietary pattern. After adjusting for confounding factors such as residence and age, it was found that balanced dietary pattern was negatively correated with female sexual desire disorder ( OR=0.904, 95% CI: 0.820-0.995, P=0.039), sexual arousal disorder ( OR=0.840, 95% CI: 0.759-0.929, P=0.001), vaginal lubrication disorder ( OR=0.833, 95% CI: 0.710-0.979, P=0.026), orgasmic disorder ( OR=0.764, 95% CI: 0.680-0.858, P<0.001), low sexual satisfaction ( OR=0.887, 95% CI: 0.796-0.987, P=0.028), sexual dysfunction ( OR=0.805, 95% CI: 0.714-0.907, P<0.001), and male orgasmic disorder ( OR=0.859, 95% CI: 0.763-0.967, P=0.012). The traditional dietary pattern was negatively correlated with female sexual desire disorder ( OR=0.879, 95% CI: 0.786-0.983, P=0.024), sexual arousal disorder ( OR=0.884, 95% CI: 0.784-0.995, P=0.042), male erectile disorder ( OR=0.736, 95% CI: 0.634-0.855, P<0.001), sexual desire disorder ( OR=0.753, 95% CI: 0.648-0.876, P<0.001), and sexual dysfunction ( OR=0.769, 95% CI: 0.653-0.907, P=0.020). The processed dietary pattern was positively correlated with erectile disorder ( OR=1.162, 95% CI: 1.049-1.287, P=0.004), orgasmic dysfunction ( OR=1.207, 95% CI: 1.091-1.337, P<0.001), sexual desire disorder ( OR=1.199, 95% CI: 1.081-1.330, P=0.001) and sexual dysfunction ( OR=1.134, 95% CI: 1.020-1.261, P=0.002). Beverage dietary pattern was not associated with sexual dysfunction in men and women (all P>0.05). Conclusion:Balanced, traditional dietary patterns were related to the reduce risk of sexual dysfunction in both women and men of childbearing age, while processed dietary patterns were related to the increased risk of sexual dysfunction in men of childbearing age.

Objective: To investigate the factors influencing small intestinal ischemia in elderly patients with incarcerated hernia. Methods: The clinical data of 105 elderly patients admitted for surgical procedures of incarcerated hernia at Department of General Surgery, Huadong Hospital between January 2014 and December 2021 were retrospectively analyzed. There were 60 males and 45 females, aged (86.1±4.3) years (range: 80 to 96 years). They were divided into normal group (n=55) and ischemic group (n=50) according to intraoperative intestinal canal condition. The t test, χ² test and Fisher's exact probability method were used for the univariate analysis of the factors that influence intestinal ischemia in patients, and Logistic regression was used for multifactorial analysis. Results: In all patients, 18 patients (17.1%) had irreversible intestinal ischemia with bowel resection. Six patients died within 30 days, 3 cases from severe abdominal infection, 2 cases from postoperative exacerbation of underlying cardiac disease, and 1 case from respiratory failure due to severe pulmonary infection. The results of the univariate analysis showed that there were differences in gender, history of intussusception, duration of previous hernia, white blood cell count, neutrophil percentage, C-reactive protein, type of incarcerated hernia, and preoperative intestinal obstruction between the two groups (all P<0.05). The Logistic regression results showed that the short time to the previous hernia (OR=0.892, 95%CI 0.872 to 0.962, P=0.003), high C-reactive protein (OR=1.022, 95%CI 1.007 to 1.037, P=0.003), non-indirect incarcerated hernia (OR=10.571, 95%CI 3.711 to 30.114, P<0.01) and preoperative intestinal obstruction (OR=6.438, 95%CI 1.762 to 23.522, P=0.005) were independent risk factors for the development of intestinal ischemia in elderly patients with incarcerated hernia. Conclusions: The short duration of the previous hernia, the high values of C-reactive proteins, the non-indirect incarcerated hernia, and the preoperative bowel obstruction are influencing factors for bowel ischemia in elderly patients with incarcerated hernia. A timely operation is necessary to reduce the incidence of intestinal necrosis and improve the prognosis.
Male ; Aged ; Female ; Humans ; Retrospective Studies ; C-Reactive Protein ; Intestinal Obstruction/etiology* ; Hernia, Inguinal/surgery* ; Mesenteric Ischemia/surgery* ; Ischemia/surgery* ; Herniorrhaphy/adverse effects*

OBJECTIVE: To assess the efficacy and safety of Bushen Huoxue Formula (BSHXF) for the treatment of discogenic low-back pain (DLBP). METHODS: This was a parallel, double-blind, randomized, clinical trial performed between May 2019 and June 2020. Seventy patients were assigned by computerized random number table to the treatment group (lumbar traction and BSHXF, 35 cases) or the control group (lumbar traction and placebo, 35 cases). The patients received intervention for 3 weeks. Assessment was conducted before treatment and at week 1, 2, 3 during treatment. Primary outcome was the self-reported score of Oswestry Disability Index (ODI). Secondary outcomes included Visual Analog Scale (VAS), clinical efficacy rate by minimal clinically important difference (MCID) as well as lumbar tenderness, muscle tone and lumbar spine mobility. Adverse reactions were recorded. Follow-up was performed at 1 and 3 months after the end of treatment. RESULTS: In the treatment group, ODI score was significantly decreased compared with baseline (P<0.05) and the control group at 2- and 3- week treatment. Similarly, VAS score decreased compared with the baseline (P<0.05) and was lower than that in the control group at 2- and 3- week treatment (P<0.05). The clinical efficacy rate of the treatment group was higher than that of the control group after treatment [32.35% (11/34) vs. 3.13% (1/32), P<0.05). Moreover, the tenderness, and muscle tone, as well as the back extension and left flexion in lumbar spine mobility in the treatment group at 3-week treatment were significantly improved compared with the control group (P<0.05). Follow-up showed that at 1-month after treatment, the treatment group had better outcomes than the control group with regard to a total score of ODI and VAS scores, as well as clinical efficacy rate (all P<0.05). Moreover, VAS score was still significantly lower than the control group at 3-month follow-up (P<0.05). No adverse reactions were reported during the study. CONCLUSION BSXHF combined with lumbar traction can significantly improve the clinical symptoms including pain intensity, functionality, muscle tone, and lumbar spine mobility in DLBP patients. (Registration No. ChiCTR1900027777).
Humans ; Intervertebral Disc Degeneration/therapy* ; Low Back Pain/drug therapy* ; Lumbar Vertebrae ; Pain Measurement ; Treatment Outcome

BACKGROUND: Thyroid dysfunction is associated with cardiovascular diseases. However, the role of thyroid function in lipid metabolism remains partly unknown. The present study aimed to investigate the causal association between thyroid function and serum lipid metabolism via a genetic analysis termed Mendelian randomization (MR). METHODS: The MR approach uses a genetic variant as the instrumental variable in epidemiological studies to mimic a randomized controlled trial. A two-sample MR was performed to assess the causal association, using summary statistics from the Atrial Fibrillation Genetics Consortium (n = 537,409) and the Global Lipids Genetics Consortium (n = 188,577). The clinical measures of thyroid function include thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) levels, FT3:FT4 ratio and concentration of thyroid peroxidase antibodies (TPOAb). The serum lipid metabolism traits include total cholesterol (TC) and triglycerides, high-density lipoprotein, and low-density lipoprotein (LDL) levels. The MR estimate and MR inverse variance-weighted method were used to assess the association between thyroid function and serum lipid metabolism. RESULTS: The results demonstrated that increased TSH levels were significantly associated with higher TC (β = 0.052, P = 0.002) and LDL (β = 0.041, P = 0.018) levels. In addition, the FT3:FT4 ratio was significantly associated with TC (β = 0.240, P = 0.033) and LDL (β = 0.025, P = 0.027) levels. However, no significant differences were observed between genetically predicted FT4 and TPOAb and serum lipids. CONCLUSION Taken together, the results of the present study suggest an association between thyroid function and serum lipid metabolism, highlighting the importance of the pituitary-thyroid-cardiac axis in dyslipidemia susceptibility.
Lipid Metabolism/genetics* ; Mendelian Randomization Analysis ; Thyroid Function Tests ; Thyroid Gland ; Thyrotropin ; Thyroxine ; Triiodothyronine

OBJECTIVE: A3 intertrochanteric fracture is an extremely unstable fracture, which is often treated with intramedullary nail, but the implant failure is common due to the posterior medial fragment cannot be reconstructed. A new medial sustainable nail (MSN-Ⅱ) which can reconstruct the femoral medial support by sustainable screw was introduced in this study. The mechanical effect was verified by biomechanical experiment. METHODS: The loss medial support model of intertrochanteric fracture (A3) was made by artificial Sawbones model, fixed with MSN-Ⅱ and PFNA-Ⅱ, underwent axial loading and axial failure tests. The axial stiffness, yield load, displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences. The effect of early reconstruction of medial support with MSN-Ⅱ was determined. RESULTS: The axial stiffness, yield load, the displacement of head and neck fragment when the axial load was 1 800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱ were (222.76 ±62.46) N /mm, (4 241.71 ±847.42) N, (11.51 ±0.62) mm, (1.71 ±0.10)° respectively, while the PFNA -Ⅱ was (184.58±40.59) N /mm, (3 058.76±379.63) N, (16.15±1.36) mm, (2.52±0.26)°respectively. The difference between the two groups was statistically significant. CONCLUSION The axial stiffness of MSN-Ⅱ is better than that of PFNA-Ⅱ. The MSN-Ⅱ can bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability. It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture.
Biomechanical Phenomena ; Bone Nails ; Bone Screws ; Femur ; Fracture Fixation, Intramedullary ; Hip Fractures/surgery* ; Humans

BACKGROUND: The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis. METHODS: Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site. RESULTS: The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively. CONCLUSION Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.
Bone Nails ; Femur ; Finite Element Analysis ; Fracture Fixation, Intramedullary ; Hip Fractures/surgery* ; Humans ; Treatment Outcome