BACKGROUND: As an essential part of health services, rehabilitation is of great significance to improve the health and quality of life of the whole population. Accelerating aging calls for a significant expansion of rehabilitation services in China, but rehabilitation needs remain unclear. We conducted the study to explore the rehabilitation needs in China and project the trend of rehabilitation needs from 2020 to 2034. METHODS: The data of health conditions that might potentially benefit from rehabilitation were obtained from Global Burden of Disease (GBD) study. Estimated annual percentage changes (EAPCs) were calculated to quantify the trends of the age-standardized rates. Projections of rehabilitation needs were made until 2034 using Bayesian age-period-cohort analysis (BAPC). RESULTS: Approximately 460 million persons (33.3% of the total population) need rehabilitation in China, contributing to 63 million years lived with disabilities (YLDs) in 2019. The number of prevalent cases that need rehabilitation increased from around 268 (95% uncertainty interval [UI]: 257-282) million in 1990 to almost 460 (95% UI: 443-479) million in 2019, representing an increase of 71.3%. The highest contribution to the need for rehabilitation was musculoskeletal disorders with about 322 (95% UI: 302-343) million persons in seven aggregate disease and injury categories, and hearing loss with over 95 (95% UI: 84-107) million people among 25 health conditions. Based on the projection results, there will be almost 636 million people (45% of the total population) needing rehabilitation services in China by 2034, representing an increase of 38.3%. The rehabilitation needs of neoplasms, cardiovascular diseases, and neurological disorders are expected to increase significantly from 2019 to 2034, with increases of 102.3%, 88.8% and 73.2%, respectively. CONCLUSIONS The need for rehabilitation in China substantially increased over the last 30 years. It is predicted that over two in five people will require rehabilitation by 2034, thus suggesting the need to develop rehabilitation services that meet individuals' rehabilitation needs.
Humans ; China/epidemiology* ; Global Burden of Disease ; Female ; Male ; Musculoskeletal Diseases/epidemiology* ; Rehabilitation/trends* ; Quality of Life ; Middle Aged ; Aged ; Bayes Theorem

Objective:To investigate the surgical technique and initial outcomes of distal derotational femoral osteotomy (DDFO) combined with knee extension device reconstruction in adolescents with habitual patellar dislocation and severe lower limb torsional deformity.Methods:A retrospective study was conducted on 10 adolescent patients (12 knees) treated at Beijing Jishuitan Hospital and its Guizhou branch from June 2016 to June 2022. There were 6 males and 4 females with an average age of 12.0±1.5 years (range: 10.0-14.5 years) Surgical treatment included DDFO and knee extension device reconstruction (lateral retinacular release, medial retinacular plication, Roux-Goldthwait distal realignment, and MPFL reconstruction). Clinical outcomes were assessed using Lysholm scores, incidence of redislocation and complications, and imaging parameters (lateral patellofemoral angle, Insall-Salvati index, TT-TG distance, and femoral anteversion angle) preoperatively and at 1 year postoperatively.Results:All 12 knees were successfully operated on, with an average surgery time of 2.0±0.5 h (range 1.0-2.5 h), intraoperative blood loss of 47.1±17.1 ml (range 20-80 ml), and follow-up time of 46.2±18.7 months (range 24-72 months). The Lysholm knee score improved from 58.25±8.80 preoperatively to 89.17±5.32 at final follow-up ( t=-9.096, P<0.001) with significant difference. The lateral patellofemoral angle improved from -64.92±4.68 preoperatively to 6.08±2.27 at final follow-up ( t=39.178, P<0.001) with significant difference. The femoral anteversion angle decreased from 34.08±3.06 preoperatively to 14.50±2.65 at final follow-up ( t=16.916, P<0.001) with significant difference. No patellar redislocation, skin necrosis, wound infection, or limited joint mobility occurred during follow-up. Conclusion:DDFO combined with knee extension device reconstruction is an effective and safe treatment for adolescent habitual patellar dislocation with severe torsional deformity, resulting in significant clinical and radiographic improvement with low complication rates.

Objective: To explore the intervention effects of high intensity interval training (HIIT) on glucose metabolism, cortisol (Cor), and sleep quality among college students with comorbid depressive symptoms and obesity, so as to provide a reference for improving sleep quality among college students with comorbid depressive symptoms and obesity. Methods: In March 2023, 45 college students with comorbid depressive symptoms and obesity were recruited and randomly assigned to an exercise group ( n =23) and a control group ( n =22) by random number table method. The exercise group received HIIT intervention for 12 weeks, three times a week, while the control group received no intervention. Blood samples were collected from participants to measure fasting insulin (FINS), fasting blood glucose (FBG), homeostatic model assessment of insulin resistance (HOMA-IR), Cor, and Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Statistical analysis was performed using t-test, repeated measures analysis of variance (ANOVA), simple effect analysis. Results: The repeated measures ANOVA revealed statistically significant time×group interaction effects for body composition (weight, body mass index, percentage of body fat, fat mass, waist to hip ratio), depressive symptoms, PSQI scores and its subdimensions (subjective sleep quality, sleep onset time, sleep efficiency, sleep disorders, daytime dysfunction), as well as FBG, FINS, and HOMA-IR between the exercise group and control group before and after intervention ( F =7.10-53.38, all P <0.05). Simple effect analysis showed that compared to the control group, the exercise group demonstrated significant improvements in body composition (body mass index, fat mass, waist to hip ratio), depressive symptoms, PSQI scores and its sub dimensions (subjective sleep quality, sleep onset time, sleep efficiency, sleep disorders, daytime dysfunction), FBG, FINS, HOMA-IR, and Cor (all P <0.05). Conclusion HIIT can improve the sleep quality of college students with comorbid depressive symptoms and obesity by enhancing glucose metabolism and regulating Cor levels.

We report a family with multiple endocrine neoplasia type 1(MEN1), in which the proband presented with primary amenorrhea and was diagnosed with both a pituitary prolactinoma and an ACTH-secreting adenoma. Genetic testing identified a heterozygous MEN1 gene c. 1449_1476del mutation in the proband, as well as in six additional family members, who exhibited variable clinical phenotypes. Following initial transsphenoidal pituitary surgery, the proband's symptoms and biochemical abnormalities persisted, with elevated ACTH and cortisol levels. Functional imaging using [ 68Ga]-DOTA-TATE PET/CT confirmed residual pituitary tumor tissue, and a second surgery resulted in biochemical remission.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Purpose To evaluate the long-term efficacy of radiofrequency ablation(RFA)for T1N0M0 papillary thyroid carcinoma(PTC)with rich blood supply and poor blood supply.Materials and Methods Clinical data,ultrasound and contrast-enhanced ultrasound(CEUS)images,RFA parameters,and postoperative follow-up indicators of 375 T1N0M0 PTC patients who received RFA from June 2014 to December 2018 were retrospectively collected.The propensity score matching method was used to match the baseline data of the two groups in a 1:1 ratio,finally a total of 212 patients were included in the study.The RFA parameters,volume,tumor disappearance,and local tumor progression(LTP)were compared between the groups.Besides,the correlation between rich blood supply and LTP was analyzed using multivariate COX regression.Results According to the peak intensity displayed by preoperative CEUS,all lesions were divided into a group with rich blood supply(n=129)and another with poor blood supply(n=246).After a mean follow-up time of(84.48±14.44)months,the tumor disappearance in the rich blood supply group was 87.74%,while in the poor blood supply group it was 88.68%,and there was no statistically significant difference(Z=0.05,P=0.831).There were 10 cases of LTP in the rich blood supply group(6 cases of residual cancer and 4 cases of new cancer),and 6 cases of LTP in the poor blood supply group(2 cases of residual cancer and 4 cases of new cancer).The LTP rates of the two groups were 9.43%and 5.67%,with no statistically significant difference(x2=1.08,P=0.298).The Kaplan-Meier survival curve showed no statistically significant difference in progression free survival between both groups(P=0.265).The adjusted multivariate COX proportional risk model analysis showed that rich blood supply was no association with LTP(HR=1.54,P=0.409).Conclusion RFA for T1N0M0 PTC with rich blood supply can achieve effective ablation,and its long-term efficacy is similar to that of poor blood supply.RFA can serve as an effective alternative treatment for T1N0M0 PTC patients with different blood supply.

Purpose To construct a nomogram model based on conventional ultrasound(US)and contrast-enhanced ultrasound(CEUS)features for predicting extrathyroidal extension(ETE)of papillary thyroid carcinoma,and to evaluate its diagnostic performance.Materials and Methods A retrospective analysis of clinical and ultrasound data from 715 papillary thyroid carcinoma patients in the First Medical Center of Chinese PLA General Hospital from January 2017 to December 2022 was conducted.The patients were divided into two groups based on the presence or absence of ETE.Univariate and Multivariate analyses was performed to identify independent risk factors associated with ETE.Three models were established:clinical,clinical+US and clinical+US+CEUS.The nomogram of the best model was constructed and validated.Results The model based on clinical+US+CEUS features performed the best,the area under the curve was 0.885.Multivariate analysis indicated that older age(OR=1.029,95%CI 1.011-1.047),higher body mass index(OR=1.108,95%CI 1.049-1.171),capsular contact<25%(OR=4.716,95%CI 2.079-10.701),capsular contact 25%-50%(OR=21.320,95%CI 8.240-55.160),capsular contact>50%(OR=24.045,95%CI 6.792-85.126),nodules adjacent to the lateral side(OR=4.265,95%CI 1.366-13.318),nodules adjacent to the medial side(OR=6.416,95%CI 2.067-19.920)and interrupted capsular enhancement(OR=6.044,95%CI 3.588-10.180)were independent risk factors for ETE(all P<0.05).Decision curve analysis and clinical impact curve indicated high net benefit and strong clinical utility of the model.Ten-fold cross-validation showed good model stability.Conclusion The nomogram model constructed based on US and CEUS features demonstrates good predictive performance and holds significant clinical utility.

Objective:To investigate the surgical technique and initial outcomes of distal derotational femoral osteotomy (DDFO) combined with knee extension device reconstruction in adolescents with habitual patellar dislocation and severe lower limb torsional deformity.Methods:A retrospective study was conducted on 10 adolescent patients (12 knees) treated at Beijing Jishuitan Hospital and its Guizhou branch from June 2016 to June 2022. There were 6 males and 4 females with an average age of 12.0±1.5 years (range: 10.0-14.5 years) Surgical treatment included DDFO and knee extension device reconstruction (lateral retinacular release, medial retinacular plication, Roux-Goldthwait distal realignment, and MPFL reconstruction). Clinical outcomes were assessed using Lysholm scores, incidence of redislocation and complications, and imaging parameters (lateral patellofemoral angle, Insall-Salvati index, TT-TG distance, and femoral anteversion angle) preoperatively and at 1 year postoperatively.Results:All 12 knees were successfully operated on, with an average surgery time of 2.0±0.5 h (range 1.0-2.5 h), intraoperative blood loss of 47.1±17.1 ml (range 20-80 ml), and follow-up time of 46.2±18.7 months (range 24-72 months). The Lysholm knee score improved from 58.25±8.80 preoperatively to 89.17±5.32 at final follow-up ( t=-9.096, P<0.001) with significant difference. The lateral patellofemoral angle improved from -64.92±4.68 preoperatively to 6.08±2.27 at final follow-up ( t=39.178, P<0.001) with significant difference. The femoral anteversion angle decreased from 34.08±3.06 preoperatively to 14.50±2.65 at final follow-up ( t=16.916, P<0.001) with significant difference. No patellar redislocation, skin necrosis, wound infection, or limited joint mobility occurred during follow-up. Conclusion:DDFO combined with knee extension device reconstruction is an effective and safe treatment for adolescent habitual patellar dislocation with severe torsional deformity, resulting in significant clinical and radiographic improvement with low complication rates.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Purpose To construct a nomogram model based on conventional ultrasound(US)and contrast-enhanced ultrasound(CEUS)features for predicting extrathyroidal extension(ETE)of papillary thyroid carcinoma,and to evaluate its diagnostic performance.Materials and Methods A retrospective analysis of clinical and ultrasound data from 715 papillary thyroid carcinoma patients in the First Medical Center of Chinese PLA General Hospital from January 2017 to December 2022 was conducted.The patients were divided into two groups based on the presence or absence of ETE.Univariate and Multivariate analyses was performed to identify independent risk factors associated with ETE.Three models were established:clinical,clinical+US and clinical+US+CEUS.The nomogram of the best model was constructed and validated.Results The model based on clinical+US+CEUS features performed the best,the area under the curve was 0.885.Multivariate analysis indicated that older age(OR=1.029,95%CI 1.011-1.047),higher body mass index(OR=1.108,95%CI 1.049-1.171),capsular contact<25%(OR=4.716,95%CI 2.079-10.701),capsular contact 25%-50%(OR=21.320,95%CI 8.240-55.160),capsular contact>50%(OR=24.045,95%CI 6.792-85.126),nodules adjacent to the lateral side(OR=4.265,95%CI 1.366-13.318),nodules adjacent to the medial side(OR=6.416,95%CI 2.067-19.920)and interrupted capsular enhancement(OR=6.044,95%CI 3.588-10.180)were independent risk factors for ETE(all P<0.05).Decision curve analysis and clinical impact curve indicated high net benefit and strong clinical utility of the model.Ten-fold cross-validation showed good model stability.Conclusion The nomogram model constructed based on US and CEUS features demonstrates good predictive performance and holds significant clinical utility.