OBJECTIVE: To compare the effectiveness of posterior axillary edge approach and arthroscopic assisted reduction in the treatment of Ideberg type Ⅰ and Ⅱ glenoid fracture of the scapula. METHODS: The clinical data of 26 patients with fresh Ideberg type Ⅰ and Ⅱ scapular fractures admitted between June 2021 and September 2024 who met the selection criteria were analyzed retrospectively. The patients were divided into two groups according to different treatment methods. Ten cases in the posterior axillary edge group were fixed by open reduction plate through the posterior axillary edge approach, and 16 cases in the arthroscopy group were treated with suture anchor fixation under arthroscopy. There was no significant difference in baseline data between the two groups ( P>0.05), such as gender, age, surgical side, Ideberg type, cause of injury, time from injury to operation, rotator cuff injury, and superior labrum anterior posterior (SLAP) injury, etc. The operation time and fracture healing time were recorded and compared between the two groups, and the shoulder pain was evaluated by visual analogue scale (VAS) score at 1 week, 1 month, and 3 months after operation. At 3 and 6 months after operation, the range of motion of shoulder joint in anteflexion, abduction, external rotation, internal rotation, and backward extension was evaluated, the upper limb dysfunction was evaluated by the Disability Assessment Scale of Arm, Shoulder, and Hand (DASH), and the shoulder joint function was evaluated by the Constant-Murley score. The differences between 6 months and 3 months after operation (changes) were statistically analyzed. RESULTS: Patients in both groups were followed up 11-13 months, with an average of 12.5 months. The operation time and fracture healing time in the posterior axillary edge group were significantly shorter than those in the arthroscopy group ( P<0.05). There was no complication such as wound infection, vascular and nerve injury, loss of reduction, bone nonunion, or glenohumeral instability in both groups. At 1 week after operation, the VAS score in the posterior axillary edge group was significantly higher than that in the arthroscopy group ( P<0.05); there was no significant difference in the VAS score between the two groups at 1 and 3 months after operation ( P>0.05). At 6 months after operation, the changes of shoulder joint in anteflexion, internal rotation range of motion and DASH scores in the posterior axillary edge group were significantly lower than those in the arthroscopy group ( P<0.05), while the changes of abduction, external rotation, backward extension range of motion and Constant-Murley scores were not significantly different between the two groups ( P>0.05). CONCLUSION For Ideberg type Ⅰ and Ⅱ glenoid fracture of the scapula, the posterior axillary edge approach for internal fixation has a short operation time, fast fracture healing, and is beneficial for early functional recovery; arthroscopic assisted reduction has minimal trauma and can handle joint injuries simultaneously. Both surgical procedures are safe and effective, and individualized selection should be made based on soft tissue conditions and combined injuries.
Humans ; Arthroscopy/methods* ; Scapula/surgery* ; Male ; Female ; Retrospective Studies ; Adult ; Fracture Fixation, Internal/instrumentation* ; Fractures, Bone/surgery* ; Middle Aged ; Treatment Outcome ; Bone Plates ; Suture Anchors ; Fracture Healing ; Range of Motion, Articular ; Young Adult ; Shoulder Joint/surgery* ; Operative Time

Objective:To explore the association between triglyceride-glucose (TyG) index and carotid artery plaque in patients with type 2 diabetic kidney disease (DKD).Methods:Clinical data of 620 DKD patients admitted in the Department of Endocrinology, the Affiliated Huai′an First People′s Hospital of Nanjing Medical University from August 2018 to August 2022 were retrospectively analyzed, including 366 cases with carotid artery plaque and 254 cases without carotid plaque. According to TyG index quartile patients were divided into Q 1,Q 2, Q 3 and Q 4 groups with TyG index<8.94,≥8.94 and<9.44,≥9.44 and<9.96, and≥9.96, respectively. The prevalence of carotid plaque in DKD patients with different TyG index levels was analyzed. The relationship between TyG index and carotid plaque occurrence in DKD patients were analyzed with Logistic regression analysis and restricted cubic lines (RCS). Results:The age, course of disease, smoking rate, SBP, HbA1c, TG, BUN, eGFR and TyG indexes in carotid plaque group were significantly higher than those in non-carotid plaque group (all P<0.05). Binary logistic regression analysis showed that age, disease course, smoking rate, SBP, HbA1c, TG, BUN, low eGFR and TyG index were independent influencing factors for carotid plaque ( OR=1.05, 1.05, 1.88, 1.01, 1.09, 1.11, 1.09, 0.99 and 1.28, all P<0.05). The risk of carotid plaque in DKD patients in Q 3 and Q 4 groups was 2.20 and 2.50 times higher than that in Q 1 group. After adjusting for age, sex, course of disease, smoking, BMI, blood pressure (SBP and DBP), blood lipids (TC, HDL and LDL) and renal function, the risk of carotid plaque in DKD patients in Q 3 and Q 4 groups was higher than that in Q 1 group ( OR=1.95 and 2.24). RCS analysis showed that the correlation between TyG index and the risk of carotid plaque in DKD patients was linear(χ 2=0.40, P=0.527), and DKD patients with TyG index>9.95 had a higher risk of carotid plaque. Conclusions:TyG index is significantly elevated in DKD patients with carotid plaque, and TyG index is an independent risk factor for the occurrence of carotid plaques in DKD patients.

ObjectiveTo observe the effect of hyperbaric oxygen therapy (HBOT) combined with repetitive peripheral magnetic stimulation (rPMS) on ankle motor function and balance of stroke patients. MethodsFrom April, 2022 to March, 2023, 96 patients in the First Affiliated Hospital of Bengbu Medical College were randomly divided into control group (n = 32), rPMS group (n = 32) and combined group (n = 32). The control group received conventional rehabilitation; rPMS group received rPMS on the basis of the control group; and the combined group received HBOT on the basis of rPMS group, for two weeks. Before and after treatment, the plantar weight-bearing ratio of the affected side, Berg Balance Scale (BBS), active range of motion (AROM) of ankle dorsiflexion of the affected side, and integrated electromyographic (iEMG) values during maximum isometric contraction of the tibialis anterior and gastrocnemius muscles were measured. ResultsTwo cases dropped out in each group, and 90 cases were finally included, and no adverse events occurred during treatment. Before treatment, there was no significant difference in plantar weight-bearing ratio of the affected side, BBS score, AROM of ankle dorsiflexion of the affected side, and iEMG of tibialis anterior and gastrocnemius among three groups (F < 2.070, P > 0.05). After treatment, all the indicators significantly improved in all the groups (|t| > 27.004, P < 0.001), and they were better in the combined group than in rPMS group and the control group (P < 0.001); except the proportion of plantar weight-bearing on the affected side, the other indicators were better in rPMS group than in the control group (P < 0.001). ConclusionrPMS can promote the recovery of ankle motor function and balance of stroke patients, and the effect combining with HBOT is better.

Objective:To explore the correlation between glycated hemoglobin variability index (HGI) and carotid artery plaque in patients with type 2 diabetic kidney disease (DKD).Methods:This cross-sectional study included 620 DKD patients admitted to the Department of Endocrinology in the First Affiliated Hospital of Nanjing Medical University from June 2019 to June 2022. Basic demographic and laboratory data, including age, disease duration, body mass index (BMI), blood pressure, fasting blood glucose (FBG), glycated hemoglobin (HbA 1c), lipid profile, and urinary albumin excretion rate (UAER), were collected for all participants. A linear regression equation was developed based on FPG and HbA 1c to calculate the HGI level of each patient. The patients were divided into low HGI group, medium HGI group, and high HGI group based on the tertiles of HGI. The detection rate of carotid artery plaque in the three HGI groups was analyzed. The patients were further divided into the non-plaque group (254 cases) and plaque group (366 cases) based on the presence or absence of carotid artery plaque. Binary logistic regression analysis was used to identify the risk factors for carotid artery plaque in DKD patients. Results:Among the DKD patients, the detection rate of carotid artery plaque was 59%. Compared with the non-plaque group, the patients in the plaque group had older age (60.52 years, t=-7.71), longer disease duration (10 years, Z=-4.17), higher systolic blood pressure (141.9 mmHg, t=-3.29), higher HbA 1c (9.2%, Z=-2.17), higher HGI (-0.20%, Z=-3.43), higher urea nitrogen (6.87 μmol/L, Z=-3.96), higher creatinine (77 mmol/L, Z=-4.05), and higher UAER (234.25 mg/24 h, Z=-5.59) (all P<0.05). The detection rate of carotid artery plaque in the low HGI group, medium HGI group and high HGI group was 50.5%, 57.9% and 68.5%, respectively, with a statistically significant difference among the three groups (χ 2=14.15, P=0.001). Age, UAER, and HGI were identified as risk factors for carotid artery plaque ( OR=1.051, 2.775 and 1.474, all P<0.05). The risk of carotid artery plaque in the high HGI group was 2.142 times of that in the low HGI group. After adjusting for confounding factors such as age, gender, disease duration, BMI, blood pressure, lipid profile and UAER, the risk of carotid artery plaque in the high HGI group was 2.558 times of that in the low HGI group. Conclusion:HGI is significantly elevated in DKD patients with carotid artery plaque, and the detection rate of carotid artery plaque increases with HGI level. Elevated HGI is an independent risk factor for carotid artery plaque in DKD patients.

Objective:To disclose the molecular genetic differences of Culex flavivirus among mosquitoes in Gansu province in 2011 and 2019.Methods:Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to obtain the nucleotide sequences of Culex flavivirus genomes from mosquitoes in Gansu province in 2011 and 2019, and viral molecular biology and bioinformatics method were used to analyze the genetic differences of the viruses.Results:Nucleotide sequences of 10 strains of Culex flavivirus were obtained, including 8 strains (all from Culex pipiens pallens) obtained in 2011 and 2 strains ( from Culex tritaeniorhynchus and Anopheles sinensis) in 2019. Homology analysis of nucleotide and amino acid sequences of virus E gene showed that the nucleotide sequence similarity and amino acid similarity of viruses isolated from Gansu in 2019 and 2011 ranged from 98.3%-100% and 95.4%-97.3%, respectively. Phylogenetic analysis of Culex flavivirus E gene sequence showed that two strains of Culex flavivirus isolated in Gansu province in 2019 (GS1975 and GS1976) and eight strains of Culex flavivirus isolated in 2011 all belonged to group B of genotype 1 of Culex flavivirus. Further analysis found that GS1975 virus isolated in 2019 was in a common evolutionary cluster with viruses isolated from Liaoning (2010 and 2011) and Inner Mongolia (2018), while GS1976 virus isolated in 2019 formed a coevolutionary cluster with viruses isolated from Inner Mongolia (2018) and Gansu (2011). Conclusions:Although both Culex flaviviruses isolated in Gansu province in 2011 and 2019 are genotype 1 virus, the two viruses isolated in 2019 distributed in two different evolutionary clusters, suggesting that the local mosquito virus genome changes over time, therefore, long-term monitoring of molecular differences is needed to carry out.

Objective:To perform virological and molecular biological identification of the virus (SX1943) isolated from specimens of Culex tritaeniorhynchus in Shaanxi province in 2019. Methods:Mosquito ground fluid was inoculated into tissue culture cells, and isolates were made virological and molecular genetic analysis.Results:A virus isolate (SX1943) was obtained from a specimen of Culex tritaeniorhynchus collected in Shaanxi province in 2019, which developed significant cytopathic effect (CPE) on day 3 after inoculation into C6/36 cells, manifested as cell pyknosis, aggregation and shedding, and the isolate could be stably passaged. However, no significant CPE was observed after three consecutive passages in BHK-21 cells. Electron microscopy (negative staining) of C6/36 cells inoculated with SX1943 virus showed a large number of round virus particles, about 25 nm in diameter. The result of amplification and sequencing of the SX1943 viral genome showed that the total length of the viral genome sequence was 3 594 nt, encoding a total of three proteins, which were non-structural proteins (NS1 and NS2) and capsid proteins (VP), and the gene lengths of the three proteins were 2 376 nt, 1 098 nt and 1 136 nt, respectively. Phylogenetic analysis of the virus revealed that the SX1943 virus were in the same evolutionary clade as Culex pipiens pallens Densovirus (CppDNV) in the genus Brevidensovirus in the subfamily Densovirus, and the above result suggested that SX1943 virus was CppDNV. Conclusions:CppDNV was isolated from Culex tritaeniorhynchus in Shaanxi province.

Objective:To investigate the clinical value of navigation assisted zygomatic implant technique in the repair of bilateral maxillary defects.Methods:Clinical data: from January 2013 to December 2019, patients underwent bilateral subtotal maxillectomy in the Department of Oral and Maxillofacial Head and Neck Oncology, the Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University. Inclusion criteria: James Brown’s class Ⅱ patients with bilateral maxillary defect, with oral nasal communication, without residual teeth. Exclusion criteria: patients with zygomatic pathologic involvement or requiring postoperative radiotherapy. The obturator was fitted with the defect by using digital technology and Simplant 3D software, and the implant direction and exposure position of the platform were determined. The bilateral zygomatic implants were implanted under the guidance of Brainlab platform navigation at the same time or in the second stage after tumor resection. Finally, the implant supported obturator was used to repair the maxillary defect. The patients were followed up for 1 year, and the clinical effect was evaluated by obturator functional scale(OFS).Results:A total of 20 patients, 13 males and 7 females, aged from 28 to 72 years, with an average of 53.6 years, were included in this study. A total of 68 zygomatic implants were implanted and 2 of them failed. The osseointegration rate was 97.06%. The repair rate of implant occluder was 90%. By the evaluation of OFS scale, the patients achieved satisfactory result in chewing, pronunciation and appearance.Conclusions:Zygomatic implant can provide decent repair effect for maxillary obturator, and navigation technology can make zygomatic implant accurately implanted into the ideal site.

Objective:To evaluate the use and effect of reconstruction with anterolateral thigh flap(ALTF)in orbitomaxillary defect resulting from oral maxillofacial oncology surgery.Methods:Patients with orbitomaxillary defects following enucleation of orbit were reconstructed with ALTF from January 2013 to September 2020 in Department of Oral & Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People’s Hospital and the data of the cases were collected. Based on the types of the defects, they were classified as orbit-nasal-oral defect, oronasal defect without defect of peri-orbit skin, nasal-orbit defect without defect of oral mucosa and peri-orbit skin defect. Based on the types of the defects and the number of the perforators of ALTF, the flaps were designed as tri-lobed, bi-lobed or mono-lobed flaps and oronasal fistula was determined to repair. Performance of maxillary prosthesis depended on the intraoral situation.Results:There were 19 male cases and 10 female cases and the age arranged from 23 to 82 years old. In terms of defect type, there were 8 cases of orbit-nasal-oral defect, 17 cases of oronasal defect without defect of peri-orbit skin, 1 case of nasal-orbit defect without defect of oral mucosa, 3 cases of peri-orbit skin defect. All the 29 cases of ALTF were successfully completed. Loculated flaps were designed in 16 cases, including 3 cases of tri-lobed flap and 13 cases of bi-lobed flaps. The oral-nasal fistula was repaired with ALTF in 11 cases and maxillary prosthesis was used in 7 cases after surgery. The oral-nasal fistula was not repaired in 14 cases and maxillary prosthesis was used in 6 cases in this group. Two cases were reconstructed with implant supported prosthesis with artificial eyes. The follow-up duration was 4 to 88 months. Eleven patients died of recurrence or metastasis and the other patients were alive without recurrence.Conclusions:In the reconstruction of the maxillary defects with intra-orbital loss following oromaxillofacial tumor resection, ALTF could be an ideal donor site because of flexible design, applicable in complicated defect repair and closure of oronasal fistula, improvement of facial appearance and sanitary maintenance of the oral and nasal cavities.

Objective:To investigate the clinical value of navigation assisted zygomatic implant technique in the repair of bilateral maxillary defects.Methods:Clinical data: from January 2013 to December 2019, patients underwent bilateral subtotal maxillectomy in the Department of Oral and Maxillofacial Head and Neck Oncology, the Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiao Tong University. Inclusion criteria: James Brown’s class Ⅱ patients with bilateral maxillary defect, with oral nasal communication, without residual teeth. Exclusion criteria: patients with zygomatic pathologic involvement or requiring postoperative radiotherapy. The obturator was fitted with the defect by using digital technology and Simplant 3D software, and the implant direction and exposure position of the platform were determined. The bilateral zygomatic implants were implanted under the guidance of Brainlab platform navigation at the same time or in the second stage after tumor resection. Finally, the implant supported obturator was used to repair the maxillary defect. The patients were followed up for 1 year, and the clinical effect was evaluated by obturator functional scale(OFS).Results:A total of 20 patients, 13 males and 7 females, aged from 28 to 72 years, with an average of 53.6 years, were included in this study. A total of 68 zygomatic implants were implanted and 2 of them failed. The osseointegration rate was 97.06%. The repair rate of implant occluder was 90%. By the evaluation of OFS scale, the patients achieved satisfactory result in chewing, pronunciation and appearance.Conclusions:Zygomatic implant can provide decent repair effect for maxillary obturator, and navigation technology can make zygomatic implant accurately implanted into the ideal site.

Objective:To evaluate the use and effect of reconstruction with anterolateral thigh flap(ALTF)in orbitomaxillary defect resulting from oral maxillofacial oncology surgery.Methods:Patients with orbitomaxillary defects following enucleation of orbit were reconstructed with ALTF from January 2013 to September 2020 in Department of Oral & Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People’s Hospital and the data of the cases were collected. Based on the types of the defects, they were classified as orbit-nasal-oral defect, oronasal defect without defect of peri-orbit skin, nasal-orbit defect without defect of oral mucosa and peri-orbit skin defect. Based on the types of the defects and the number of the perforators of ALTF, the flaps were designed as tri-lobed, bi-lobed or mono-lobed flaps and oronasal fistula was determined to repair. Performance of maxillary prosthesis depended on the intraoral situation.Results:There were 19 male cases and 10 female cases and the age arranged from 23 to 82 years old. In terms of defect type, there were 8 cases of orbit-nasal-oral defect, 17 cases of oronasal defect without defect of peri-orbit skin, 1 case of nasal-orbit defect without defect of oral mucosa, 3 cases of peri-orbit skin defect. All the 29 cases of ALTF were successfully completed. Loculated flaps were designed in 16 cases, including 3 cases of tri-lobed flap and 13 cases of bi-lobed flaps. The oral-nasal fistula was repaired with ALTF in 11 cases and maxillary prosthesis was used in 7 cases after surgery. The oral-nasal fistula was not repaired in 14 cases and maxillary prosthesis was used in 6 cases in this group. Two cases were reconstructed with implant supported prosthesis with artificial eyes. The follow-up duration was 4 to 88 months. Eleven patients died of recurrence or metastasis and the other patients were alive without recurrence.Conclusions:In the reconstruction of the maxillary defects with intra-orbital loss following oromaxillofacial tumor resection, ALTF could be an ideal donor site because of flexible design, applicable in complicated defect repair and closure of oronasal fistula, improvement of facial appearance and sanitary maintenance of the oral and nasal cavities.