OBJECTIVE: To explore the methods, fixation points, and effectiveness of staged therapy using external fixation frame in treatment of infectious nonunion near knee joint. METHODS: A retrospective analysis was conducted on the clinical data of 60 patients with infectious nonunion near knee joint, who underwent staged therapy using external fixation frame between June 2021 and June 2024 and were followed up. There were 48 males and 12 females with an average age of 47.9 years (range, 16-70 years). The disease duration ranged from 9 months to 20 years, with a median of 14 months. Among them, 21 cases of infectious nonunion located in the distal femur, 36 cases in the proximal tibia, and 3 cases in the patella; 12 cases exhibited segmental bone defects (≥4 cm), while 48 cases presented with localized bone defects (<4 cm). Osteomyelitis was classified using the Cierny-Mader system, with 3 cases classified as type Ⅰ, 6 cases as type Ⅱ, 35 cases as type Ⅲ, and 16 cases as type Ⅳ. Preoperative C-reactive protein levels ranged from 15.1 to 55.8 mg/L (mean, 36.4 mg/L). The erythrocyte sedimentation rate was 35-80 mm/1 h (mean, 56.9 mm/1 h). The Hospital for Special Surgery (HSS) score for knee joint was 69.3±17.7 and the range of motion was (70.61±40.60)°. After debridement and placement of antibiotic carriers at the first-stage operation, unilateral orbital frames ( n=14), combined frames ( n=27), or Ilizarov frames ( n=19) were used for cross joint fixation ( n=9) or joint preservation fixation ( n=51). After 6-8 weeks of infection control, the bone grafting or bone transport was performed at the second-stage operation based on the type of bone defect, with internal fixation employed as an adjunct if necessary. After operation, the infection control and fracture healing were observed and the bone healing time was recorded. The knee joint function was assessed using the HSS score, and the knee joint range of motion was measured as well as the angle of motion loss. Patients were grouped according to the site of nonunion, type of external fixation frame, and fixation method. The bone healing time, change value of HSS score, and knee joint range of motion loss (difference between pre- and post-operation) were compared between groups. RESULTS: All infection markers returned to the normal range within 6 weeks after the first-stage operation. All patients were followed up 12-48 months (mean, 22.0 months) after the second-stage operation. There were 5 cases of needle tract infection during the external fixation period, and 3 cases of infection recurrence after the second-stage operation, all of which were cured after symptomatic treatment. The bone healing time was 6-18 months (mean, 11.0 months). At last follow-up, the HSS score was 88.5±7.9 and the range of motion was (61.84±40.59)°, with significant differences compared to preoperative values ( P<0.05); the knee joint range of motion loss was (8.77±11.07)°. The bone healing time was significantly longer in the distal femur group than in the proximal tibia group ( P<0.05), and in the unilateral orbital frames group than in the Ilizarov frames group and the combined frames group ( P<0.05). The angle of motion loss was significantly larger in the Ilizarov frames group than in the unilateral orbital frames group and the combined frames group ( P<0.05). The change value of HSS score was significantly higher in the cross joint fixation group than in the joint preservation fixation group ( P<0.05). CONCLUSION During the first-stage operation, debridement is performed and antibiotic carriers are placed to control infection. External fixation frames are then precisely positioned based on the distance between the lesion and the joint surface, avoiding the infected wound while ensuring mechanical balance. During the second-stage operation, bone grafting options are selected according to the extent of bone defects to enhance the bone union. Postoperative early functional exercises of the knee joint are permitted to improve joint function.
Humans ; Male ; Female ; Middle Aged ; Adult ; Fractures, Ununited/surgery* ; Retrospective Studies ; External Fixators ; Aged ; Knee Joint/surgery* ; Adolescent ; Young Adult ; Treatment Outcome ; Osteomyelitis/surgery* ; Fracture Fixation/instrumentation* ; Bone Transplantation ; Tibial Fractures/surgery*

Objective To analyze the efficacy of vascularized lymph node transplantation(VLNT)combined with lymphatic venous anastomosis(LVA)in the treatment of secondary lower extremity lymphedema assisted by super microsurgical techniques.Methods A retrospective analysis was performed for 15 patients with secondary lower limb lymphedema who underwent VLNT+LVA surgery in the Department of Reconstructive and Reconstructive Microsurgery of Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from July 2021 to July 2023,and compared the circumference and volume of each segment of the lower limb between the preoperative and postoperative 90 days.LVA according to the results of ICG examination,3-5 parts of the lower limb were selected for"Z"shaped surgery,and the lymphatic vessels and venules were anastomosed under the microscope in the subcutaneous fat layer.VLNT confirmed and labeled the saphenous branch of the descending knee artery and its accompanying veins in the popliteal fossa,and the latissimus dorsi lymph node flap was incised,and the flap vessels were anastomosed with the saphenous branch of the descending knee artery and its accompanying veins.Postoperative observation of flap vascularization.The circumference and volume of the affected limb were measured before surgery and 90 days after surgery.Results A total of 15 patients with lower extremity lymphedema were included without serious complications.Statistical analysis showed that the circumference of all levels of the affected limb and the volume of the affected limb were improved 90 days after operation compared with those before surgery.Among them,the limb circumference and volume at each level from the highest point of the dorsum of the foot to 52 cm above the ankle improved 90 days after the operation compared with those before the operation.Conclusion LNT+LVA treatment for secondary lower extremity lymphedema can effectively control edema and improve the function of the affected limb.

Objective:To explore the mediating effect of self-rated health status between living space and social frailty of the elderly in community, and to provide reference for intervention strategies.Methods:From December 2023 to March 2024, 550 community elderly in Yandun Community, Yicheng Community and Binhu Community in Baohe District of Hefei City were selected as the research objects by convenient sampling method. The general information questionnaire, self-rated health questionnaire, social frailty index and living space assessment scale were used to investigate a cross-sectional survey. Spearman correlation analysis was used to explore the correlation between self-rated health, living space and social frailty of community elderly. Bootstrap method was used to test the mediating effect.Results:A total of 542 valid questionnaires were collected. Among the 542 elderly residents in the community, aged 65-94 (71.69 ± 6.54) years, there were 267 males and 275 females. Among the 542 community elderly, the self-rated health score, living space score and social frailty index were (2.52 ± 0.95), (73.39 ± 16.77) and 0.0 (0.0, 3.0), respectively. Spearman analysis showed that the total score of living space was negatively correlated with the scores of self-rated health and social frailty ( r=-0.477, -0.538, both P<0.01), and the score of self-rated health was positively correlated with the score of social frailty ( r=0.711, P<0.01).The mediating effect results showed that the living space could play a partial mediating effect on social frailty through the mediating variable of self-rated health (-0.028), accounting for 49.12% of the total effect. Conclusions:The self-rated health status of the elderly in the community has an indirect mediating effect between living space and social frailty. Medical workers should take the improvement of the living space mobility of the elderly as the starting point, and improve their self-rated health level through diversified intervention means, so as to reduce the occurrence of social frailty and promote active aging.

Objective:To explore the latent categories and influencing factors of health activation among community-dwelling older adults with chronic diseases.Methods:Older patients with chronic diseases attending three community health centers in Hefei City from August to December 2023 were selected for the study using the convenience sampling method. The survey utilized the General Information Questionnaire, Consumer Health Activation Index, Chinese version of the Life-Space Assessment, Social Support Rating Scale, and Simplified Coping Style Questionnaire. Mplus 8.3 software was applied for latent profile analysis to examine patients' health activation, and unordered multicategory Logistic regression was used to explore the factors influencing different categories of health activation.Results:A total of 382 questionnaires were distributed, and 368 valid questionnaires were recovered, with a valid recovery rate of 96.34%. Three latent categories of health activation existed in community-dwelling older adults with chronic diseases, which were named as low health activation-high efficiency-coping inability group (16.85%, 62/368) , medium health activation group (27.99%, 103/368) , and high activation perception-action group (55.16%, 203/368) . Multicategory logistic regression analysis indicated that place of residence, age, self-rated health status, life space, social support, and active coping strategies were significant factors influencing the health activation of different latent categories of community-dwelling older adults with chronic diseases (all P<0.05) . Conclusions:The health activation of community-dwelling older adults with chronic diseases can be classified into three latent categories. Primary healthcare providers should identify the characteristics of patients in different categories and implement targeted nursing interventions to enhance their health activation levels.

Objective To analyze the efficacy of vascularized lymph node transplantation(VLNT)combined with lymphatic venous anastomosis(LVA)in the treatment of secondary lower extremity lymphedema assisted by super microsurgical techniques.Methods A retrospective analysis was performed for 15 patients with secondary lower limb lymphedema who underwent VLNT+LVA surgery in the Department of Reconstructive and Reconstructive Microsurgery of Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from July 2021 to July 2023,and compared the circumference and volume of each segment of the lower limb between the preoperative and postoperative 90 days.LVA according to the results of ICG examination,3-5 parts of the lower limb were selected for"Z"shaped surgery,and the lymphatic vessels and venules were anastomosed under the microscope in the subcutaneous fat layer.VLNT confirmed and labeled the saphenous branch of the descending knee artery and its accompanying veins in the popliteal fossa,and the latissimus dorsi lymph node flap was incised,and the flap vessels were anastomosed with the saphenous branch of the descending knee artery and its accompanying veins.Postoperative observation of flap vascularization.The circumference and volume of the affected limb were measured before surgery and 90 days after surgery.Results A total of 15 patients with lower extremity lymphedema were included without serious complications.Statistical analysis showed that the circumference of all levels of the affected limb and the volume of the affected limb were improved 90 days after operation compared with those before surgery.Among them,the limb circumference and volume at each level from the highest point of the dorsum of the foot to 52 cm above the ankle improved 90 days after the operation compared with those before the operation.Conclusion LNT+LVA treatment for secondary lower extremity lymphedema can effectively control edema and improve the function of the affected limb.

Objective:To explore the latent categories and influencing factors of health activation among community-dwelling older adults with chronic diseases.Methods:Older patients with chronic diseases attending three community health centers in Hefei City from August to December 2023 were selected for the study using the convenience sampling method. The survey utilized the General Information Questionnaire, Consumer Health Activation Index, Chinese version of the Life-Space Assessment, Social Support Rating Scale, and Simplified Coping Style Questionnaire. Mplus 8.3 software was applied for latent profile analysis to examine patients' health activation, and unordered multicategory Logistic regression was used to explore the factors influencing different categories of health activation.Results:A total of 382 questionnaires were distributed, and 368 valid questionnaires were recovered, with a valid recovery rate of 96.34%. Three latent categories of health activation existed in community-dwelling older adults with chronic diseases, which were named as low health activation-high efficiency-coping inability group (16.85%, 62/368) , medium health activation group (27.99%, 103/368) , and high activation perception-action group (55.16%, 203/368) . Multicategory logistic regression analysis indicated that place of residence, age, self-rated health status, life space, social support, and active coping strategies were significant factors influencing the health activation of different latent categories of community-dwelling older adults with chronic diseases (all P<0.05) . Conclusions:The health activation of community-dwelling older adults with chronic diseases can be classified into three latent categories. Primary healthcare providers should identify the characteristics of patients in different categories and implement targeted nursing interventions to enhance their health activation levels.

Objective:To explore the mediating effect of self-rated health status between living space and social frailty of the elderly in community, and to provide reference for intervention strategies.Methods:From December 2023 to March 2024, 550 community elderly in Yandun Community, Yicheng Community and Binhu Community in Baohe District of Hefei City were selected as the research objects by convenient sampling method. The general information questionnaire, self-rated health questionnaire, social frailty index and living space assessment scale were used to investigate a cross-sectional survey. Spearman correlation analysis was used to explore the correlation between self-rated health, living space and social frailty of community elderly. Bootstrap method was used to test the mediating effect.Results:A total of 542 valid questionnaires were collected. Among the 542 elderly residents in the community, aged 65-94 (71.69 ± 6.54) years, there were 267 males and 275 females. Among the 542 community elderly, the self-rated health score, living space score and social frailty index were (2.52 ± 0.95), (73.39 ± 16.77) and 0.0 (0.0, 3.0), respectively. Spearman analysis showed that the total score of living space was negatively correlated with the scores of self-rated health and social frailty ( r=-0.477, -0.538, both P<0.01), and the score of self-rated health was positively correlated with the score of social frailty ( r=0.711, P<0.01).The mediating effect results showed that the living space could play a partial mediating effect on social frailty through the mediating variable of self-rated health (-0.028), accounting for 49.12% of the total effect. Conclusions:The self-rated health status of the elderly in the community has an indirect mediating effect between living space and social frailty. Medical workers should take the improvement of the living space mobility of the elderly as the starting point, and improve their self-rated health level through diversified intervention means, so as to reduce the occurrence of social frailty and promote active aging.

Objective:To investigate the relationship between walking speed, life-space mobility (LSM), cognitive function and mild cognitive impairment (MCI) in elderly patients with type 2 diabetes mellitus in community, and compare the predictive value of walking speed and LSM alone and combined in elderly patients with type 2 diabetes mellitus.Methods:This was a cross-sectional study. Using the convenient sampling method, a total of 448 elderly patients with type 2 diabetes mellitus from three communities in Hefei City were selected as the research objects from September 2022 to May 2023. Daily walking speed was measured using the 4-Meter Walking Speed, LSM was assessed using the Chinese version of Life-Space Assessment (LSA), and cognitive function was evaluated using the Chinese version of Montreal Cognitive Assessment (MoCA). Participants were divided to the MCI group and non-MCI group. Spearman correlation analysis was used to explore the relationships between walking speed, LSM and cognitive function. Logistic regression analysis was used to analyze the relationship between walking speed, LSM and MCI. Area under the curve ( AUC) of receiver operating characteristic (ROC) curve analysis was performed to compare the effects of walking speed and Chinese version LSA score on the prediction of MCI alone and in combination. Results:The walking speed and the Chinese version LSA score were both positively correlated with the Chinese version MoCA score ( r=0.598, 0.543; P<0.05). Chinese version LSA score ( OR=0.942) and walking speed score ( OR=0.490) were influencing factors for MCI in elderly patients with type 2 diabetes mellitus ( P<0.05). The AUC for walking speed in predicting MCI was 0.875, with a cutoff value of 3 points. Chinese version LSA score in predicting MCI had an AUC of 0.887 with a cutoff value of 59 points. When used in combination, they achieved an AUC of 0.915, with cutoff values of 55 points for Chinese version LSA scores and 3 points for walking speed scores. Conclusions:The combination of walking speed and LSM can more accurately predict the occurrence of MCI in elderly patients with type 2 diabetes mellitus than the single application, which provide a reference for improving the cognitive function of elderly patients with type 2 diabetes mellitus.

Objective:To explore the chain mediating effect of self-rated health and aging attitudes on the relationship between life space and psychological distress of community-dwelling older adults.Methods:From August to November 2023, convenience sampling was used to select older adults from three communities of Baohe District in Hefei City as subjects. General Information Questionnaire, Life Space Assessment (LSA), Self-Rated Health (SRH), Attitudes to Aging Questionnaire (AAQ), and 10-item Kessler Psychological Distress Scale (K10) were used for the survey. Spearman correlation was used to analyze the correlation between life space and self-rated health, aging attitudes, and psychological distress. Process macro program of SPSS 25.0 software was used to test for mediating effects.Results:A total of 700 questionnaires were distributed and 669 valid questionnaires were collected, with a valid response rate of 95.57%. Among 669 community-dwelling older adults, the LSA, SRH, AAQ, and K10 scores were (74.35±19.39), (3.23±0.96), (80.66±13.43), and (19.29±6.26), respectively. Spearman correlation analysis showed a positive correlation between life space and attitudes to aging ( rs=0.568, P<0.01) and negative correlations between life space and self-rated health and psychological distress ( rs=-0.334 and -0.455; both P<0.01). The mediating effect test showed that self-rated health and aging attitudes had chain mediating effects on life space and psychological distress, with a mediating effect value of -0.053, accounting for 11.60% of the total effect. Conclusions:Life space can not only directly affect the psychological distress of community-dwelling older adults but also indirectly predict psychological distress through the mediating effect of self-rated health and aging attitudes.

ObjectiveTo study the effect of Jianpi Xiaoai prescription on the protein expression of metastasis-related factors in tumor microenvironment such as chemokine receptor 4 （CXCR4）， transformation growth factor-β （TGF-β）， integrin a_v β₅ （ITGα_v β₅）， serum calcium-binding protein A4 （S100A4）， serum calcium-binding protein A8 （S100A8）， and serum calcium-binding protein A9 （S100A9） in the liver tissue of the nude mouse model of liver metastasis of colon cancer， and to explore the possible mechanism of its anti-liver metastasis of colon cancer. MethodBALB/c nude mice were randomly divided into blank group， model group， and Jianpi Xiaoai prescription low， medium， and high-dose groups. A nude mouse model of liver metastasis of human colon cancer was established. Jianpi Xiaoai prescription low， medium， and high-dose groups were given 5.4， 10.8， 21.6 g·kg^-1 liquid medicine， respectively， and the model group and the blank group were given the same volume of distilled water by gavage， once a day for 3 consecutive weeks. 24 h after the last administration， the nude mice were sacrificed by neck removal， and the liver metastasis of each group was observed. Western blot was used to determine the protein expression of metastasis-related factors in the tumor microenvironment， such as CXCR4， TGF-β， ITGα_v β₅， S100A4， S100A8， and S100A9. ResultThe proportion of metastatic tumor area was 73% in the model group， 72% in the low-dose group， 55% in the medium-dose group， and 42% in the high-dose group. The high-dose group was significantly lower than the model group （P<0.05）. As compared with the model group， the expression of CXCR4， TFG-β， ITGα_v β₅， S100A8， and S100A9 in the Jianpi Xiaoai prescription high and medium-dose groups were significantly decreased （P<0.05）. As compared with the model group， the expression of S100A4 in the Jianpi Xiaoai prescription high， medium， and low-dose groups was significantly decreased （P<0.05）. The expression of CXCR4， TFG-β， ITGα_v β₅， S100A8， and S100A9 in the Jianpi Xiaoai prescription low-dose group was not significantly different from that in the model group. ConclusionJianpi Xiaoai prescription can inhibit liver metastasis of colon cancer， and its mechanism may be related to the reduction of the expression of metastasis-related factors such as CXCR4， TGF-β， ITGα_v β₅， S100A4， S100A8， and S100A9 in tumor microenvironment.