Objectives:To explore the urban-rural differences in the association between the Life's Essential 8(LE8)scores and the risk of new-onset cardiometabolic diseases(CMD)among adult Chinese.Methods:A total of 4 719 adults aged 18 years or older without CMD from the China Health and Nutrition Survey(CHNS)cohort from 2009 to 2015 were enrolled,including 1 909 in urban areas and 2 810 in rural areas.CMD included myocardial infarction,stroke,and diabetes.The LE8 score included diet,physical activity,sleep,nicotine exposure,body mass index(BMI),non-high-density lipoprotein cholesterol(non-HDL-C),blood glucose,and blood pressure.The score of each LE8 factor ranged from 0 to 100 points,and the average of the sum of the eight scores was the final score.The final LE8 score was divided into a low group(<67.5 points),a medium group(67.5-77.5 points),and a high group(>77.5 points)according to the tertile of the final LE8 score.There were 780,564,and 565 cases in the low,medium,and high LE8 score groups in urban areas,respectively.There were 838,934,and 1 038 cases in the low,medium,and high LE8 score groups in rural areas.The primary outcome was the number of participants newly diagnosed with diabetes,stroke,and/or myocardial infarction during the follow-up period.The Cox proportional hazards regression model was used to analyze the urban-rural difference in the association between LE8 and the risk of new-onset CMD.Results:The total cardiovascular health LE8 scores in rural areas was higher than that in urban residents(72.9 points vs.70.2 points,P<0.01).During the average follow-up period([5.86±0.74]years),there were 176 new cases of CMD,including 67 cases in urban areas and 109 cases in rural areas.Multivariate Cox analysis showed that in the fully adjusted model,compared with the urban-higher group,the rural-lower group(HR=1.65,95%CI:1.27-2.15,P=0.001)had the greatest increased risk of new CMD,followed by the urban-lower group(HR=1.49,95%CI:1.01-2.21,P=0.046),the rural-middle group(HR=1.42,95%CI:1.06-1.90,P=0.020),and the rural-higher group(HR=1.16,95%CI:1.01-1.33,P=0.032).Multivariable Cox regression results showed that in urban areas,compared with those with LE8 scores≥70 points,those with LE8 scores<70 points and with unfavorable BMI score(HR=2.70,95%CI:1.51～4.84,P<0.01),blood glucose scores(HR=2.09,95%CI:1.24-3.51,P<0.01),and blood pressure score(HR=3.73,95%CI:1.69-8.24,P<0.01)faced increased risk of CMD;in rural areas,compared with≥70 points group,<70 points group with unfavorable BMI score(HR=3.92,95%CI:2.43-6.30,P<0.01),non-HDL-C score(HR=2.96,95%CI:1.94-4.52,P<0.01),blood glucose score(HR=2.59,95%CI:1.71-3.94,P<0.01)and blood pressure score(HR=1.85,95%CI:1.18-2.92,P<0.01)faced increased risk of CMD.The risk of CMD associated with BMI,blood glucose,and non-HDL-C scores<70 points was higher in rural areas than in urban areas.Conclusions:Although rural residents have slightly higher LE8 scores than urban residents,the risk of CMD associated with lower LE8 scores is particularly significant in rural areas.Strengthening the monitoring and primary prevention of cardiovascular health among rural residents is of great significance to reduce the burden of CMD in China.

Objectives:To explore the urban-rural differences in the association between the Life's Essential 8(LE8)scores and the risk of new-onset cardiometabolic diseases(CMD)among adult Chinese.Methods:A total of 4 719 adults aged 18 years or older without CMD from the China Health and Nutrition Survey(CHNS)cohort from 2009 to 2015 were enrolled,including 1 909 in urban areas and 2 810 in rural areas.CMD included myocardial infarction,stroke,and diabetes.The LE8 score included diet,physical activity,sleep,nicotine exposure,body mass index(BMI),non-high-density lipoprotein cholesterol(non-HDL-C),blood glucose,and blood pressure.The score of each LE8 factor ranged from 0 to 100 points,and the average of the sum of the eight scores was the final score.The final LE8 score was divided into a low group(<67.5 points),a medium group(67.5-77.5 points),and a high group(>77.5 points)according to the tertile of the final LE8 score.There were 780,564,and 565 cases in the low,medium,and high LE8 score groups in urban areas,respectively.There were 838,934,and 1 038 cases in the low,medium,and high LE8 score groups in rural areas.The primary outcome was the number of participants newly diagnosed with diabetes,stroke,and/or myocardial infarction during the follow-up period.The Cox proportional hazards regression model was used to analyze the urban-rural difference in the association between LE8 and the risk of new-onset CMD.Results:The total cardiovascular health LE8 scores in rural areas was higher than that in urban residents(72.9 points vs.70.2 points,P<0.01).During the average follow-up period([5.86±0.74]years),there were 176 new cases of CMD,including 67 cases in urban areas and 109 cases in rural areas.Multivariate Cox analysis showed that in the fully adjusted model,compared with the urban-higher group,the rural-lower group(HR=1.65,95%CI:1.27-2.15,P=0.001)had the greatest increased risk of new CMD,followed by the urban-lower group(HR=1.49,95%CI:1.01-2.21,P=0.046),the rural-middle group(HR=1.42,95%CI:1.06-1.90,P=0.020),and the rural-higher group(HR=1.16,95%CI:1.01-1.33,P=0.032).Multivariable Cox regression results showed that in urban areas,compared with those with LE8 scores≥70 points,those with LE8 scores<70 points and with unfavorable BMI score(HR=2.70,95%CI:1.51～4.84,P<0.01),blood glucose scores(HR=2.09,95%CI:1.24-3.51,P<0.01),and blood pressure score(HR=3.73,95%CI:1.69-8.24,P<0.01)faced increased risk of CMD;in rural areas,compared with≥70 points group,<70 points group with unfavorable BMI score(HR=3.92,95%CI:2.43-6.30,P<0.01),non-HDL-C score(HR=2.96,95%CI:1.94-4.52,P<0.01),blood glucose score(HR=2.59,95%CI:1.71-3.94,P<0.01)and blood pressure score(HR=1.85,95%CI:1.18-2.92,P<0.01)faced increased risk of CMD.The risk of CMD associated with BMI,blood glucose,and non-HDL-C scores<70 points was higher in rural areas than in urban areas.Conclusions:Although rural residents have slightly higher LE8 scores than urban residents,the risk of CMD associated with lower LE8 scores is particularly significant in rural areas.Strengthening the monitoring and primary prevention of cardiovascular health among rural residents is of great significance to reduce the burden of CMD in China.

Objective:To investigate the clinical curative effect of hyperbaric oxygen（HBO）combined with total arthroscopy in the treatment of popliteal cyst.Methods:From June 2015 to January 2020，the clinical data of 85 patients with popliteal cyst who received total arthroscopic minimally invasive surgery in Department of Orthopedics，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Department of Adult Orthopedics，Xinhua Hospital Chongming Branch were collected. According to different treatments，patients were divided into observation group（ n=45）and control group（ n=40）. The control group received total arthroscopic minimally invasive surgery while the observation group was additionally treated by hyperbaric oxygen therapy. Visual analogue scale（VAS）was used to evaluate the pain during the 72 hours after operation. Postoperative ambulation time and length of hospital stay were also recorded. Lysholm scoring system was used to evaluate knee function. The therapeutic efficacy was assessed by Rauschning-Lindgren grading. All the patients were followed up for one year to record the recurrence of cysts. Results:After treatment，the postoperative ambulation time and length of hospital stay of the observation group were obviously reduced compared with those of the control group，and its VAS score was lower than that of the control group，with significant statistical differences（ P<0.05）. The Lysholm scores of the two groups seven days after treatment were significantly higher than that before treatment，and the Lysholm score of the observation group markedly was higher than that of the control group after treatment，with significant statistical difference（ P<0.05）. After treatment，the total effective rate of the observation group（93.3%）was remarkably higher than that of the control group（77.5%），with significant statistical difference（ P<0.05）. The recurrence rate of popliteal cyst in the observation group（6.7%）was significant different from that in the control group（17.5%）（ P<0.05）. Conclusion:HBO combined with total arthroscopic minimally invasive surgery in the treatment of popliteal cyst has the advantages of small incision，light pain，rapid recovery，which can quickly restore the function of knee joint with low recurrence rate and significant curative effect.

Objective:To study the morphologic features of the fusion site of proximal tibial epiphysis in normal adults and analyze its potential clinical value based on Mimics three-dimensional (3D) reconstruction.Methods:CT images of knee joint of 68 patients without obvious abnormalities of lower limbs were retrospectively analyzed in electronic database of our hospital from June 2020 to June 2021, including 41 males and 27 females. The mean age of the patients was 38.7±8.4 years (range, 25-55 years), and the mean body mass index (BMI) was 25.3±4.0 kg/m 2 (range, 18.75-41.8 kg/m 2). Mimics 3D reconstruction technique was used to reconstruct the 3D model of the proximal tibia and epiphyseal fusion site. The relationship between the surface area of epiphyseal fusion site and age and BMI was studied, and the changes of cortical thickness and density at epiphyseal fusion site were also explored. Results:The fusion site of adult epiphyseal reconstructed by Mimics 3D reconstruction is a complex wavy surface structure in 3D space. The surface area of the epiphyseal fusion site was 2,994.7±645.3 mm 2 (range, 1,704.0-4,650.0 mm 2) obtained by 3-Matic Research 12.0. The fusing area of male epiphysis was 3 269.3±533.9 mm 2 than that of female 2,577.6±578.7 mm 2, the difference was statistically significant ( t=5.06, P<0.001). However, there was no significant correlation between the epiphyseal fusion site surface area and age ( R2=0.02, P=0.268) and BMI ( R2=0.04, P=0.125). Mimics software was used to obtain the CT values of bone cortex at the epiphysis line and the distal end of the epiphysis line at 10 mm and 20 mm levels as 451.059±74.953 Hu, 1,018.412±125.732 Hu and 1,414.162±107.848 Hu, respectively. The thickness of bone cortex was 1.814±0.090 mm, 2.511±0.089 mm and 3.189±0.185 mm at 10 mm and 20 mm layers of epiphysis line and distal epiphysis line, respectively. Conclusion:In this study, Mimics 3D reconstruction technique was used to visualize the fusion site of the proximal tibial epiphysis in normal adults. The epiphyseal fusion site of adult is a undulating plate-like structure, and the cortical bone density of epiphyseal fusion site is low and thin, theoretically, it is easy to fracture under indirect violence.

Objective:To investigate the clinical curative effect of hyperbaric oxygen（HBO）combined with total arthroscopy in the treatment of popliteal cyst.Methods:From June 2015 to January 2020，the clinical data of 85 patients with popliteal cyst who received total arthroscopic minimally invasive surgery in Department of Orthopedics，Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and Department of Adult Orthopedics，Xinhua Hospital Chongming Branch were collected. According to different treatments，patients were divided into observation group（ n=45）and control group（ n=40）. The control group received total arthroscopic minimally invasive surgery while the observation group was additionally treated by hyperbaric oxygen therapy. Visual analogue scale（VAS）was used to evaluate the pain during the 72 hours after operation. Postoperative ambulation time and length of hospital stay were also recorded. Lysholm scoring system was used to evaluate knee function. The therapeutic efficacy was assessed by Rauschning-Lindgren grading. All the patients were followed up for one year to record the recurrence of cysts. Results:After treatment，the postoperative ambulation time and length of hospital stay of the observation group were obviously reduced compared with those of the control group，and its VAS score was lower than that of the control group，with significant statistical differences（ P<0.05）. The Lysholm scores of the two groups seven days after treatment were significantly higher than that before treatment，and the Lysholm score of the observation group markedly was higher than that of the control group after treatment，with significant statistical difference（ P<0.05）. After treatment，the total effective rate of the observation group（93.3%）was remarkably higher than that of the control group（77.5%），with significant statistical difference（ P<0.05）. The recurrence rate of popliteal cyst in the observation group（6.7%）was significant different from that in the control group（17.5%）（ P<0.05）. Conclusion:HBO combined with total arthroscopic minimally invasive surgery in the treatment of popliteal cyst has the advantages of small incision，light pain，rapid recovery，which can quickly restore the function of knee joint with low recurrence rate and significant curative effect.

Objective:To investigate the clinical efficacy of minimally invasive surgery combined with hyperbaric oxygen in the treatment for moderate to severe carpal tunnel syndrome.Methods:The clinical data of 86 patients with moderate to severe carpal tunnel syndrome admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of the Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2016 to December 2019 were retrospectively analyzed. According to the treatment method, they were divided into observation group ( n=42) and control group ( n=44). The control group was treated with modified Okutsu method of endoscopic carpal tunnel release (ECTR), and the observation group was given hyperbaric oxygen on the basis of the treatment in the control group. The clinical efficacy of the two groups three months after operation was assessed by using carpal tunnel syndrome evaluation criteria, and their excellent and good recovery rates were compared. The median nerve sensory conduction velocity (SCV), motor nerve conduction velocity (MCV), sensory nerve action potential (SNAP) amplitude, and motor nerve distal motor latency (DML) of the two groups were measured by electromyography before operation, and 14 d, 30 d, and 90 d after operation. The disabilities of arm, shoulder, and hand (DASH) questionnaire was used to evaluate the upper-extremity function of the two groups before operation, and 14 d, 30 d, and 90 d after operation, and the pinch strength and grip strength of the two groups before operation, and 14 d, 30 d and 90 d after operation were measured by Jamar Pinch Gauge and Jamar Hand Dynamometer. Results:After three months of follow-up, the excellent and good recovery rate of the observation group (85.71%) was significantly higher than that of the control group (70.45%), with a significant statistical difference ( P<0.05). The DASH scores of the observation group were significantly lower than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The SCV and MCV of the observation group were significantly faster than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The DMLs of the observation group were significantly shorter than those of the control group at 14 d, 30 d, and 90 d after operation, while the SNAPs were significantly bigger than those of the control group ( P<0.05). The grip strength and pinch strength of the observation group were significantly stronger than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). Conclusion:Modified Okutsu method of ECTR combined with postoperative hyperbaric oxygen treatment can improve the clinical excellent and good recovery rate of carpal tunnel syndrome, which can enhance the electrophysiological function of their median nerves, and their daily functioning, to provide reference for treating chronic injuries caused by carpal tunnel syndrome and other peripheral nerve entrapment syndromes.

Objective:To investigate the clinical efficacy of minimally invasive surgery combined with hyperbaric oxygen in the treatment for moderate to severe carpal tunnel syndrome.Methods:The clinical data of 86 patients with moderate to severe carpal tunnel syndrome admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of the Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from March 2016 to December 2019 were retrospectively analyzed. According to the treatment method, they were divided into observation group ( n=42) and control group ( n=44). The control group was treated with modified Okutsu method of endoscopic carpal tunnel release (ECTR), and the observation group was given hyperbaric oxygen on the basis of the treatment in the control group. The clinical efficacy of the two groups three months after operation was assessed by using carpal tunnel syndrome evaluation criteria, and their excellent and good recovery rates were compared. The median nerve sensory conduction velocity (SCV), motor nerve conduction velocity (MCV), sensory nerve action potential (SNAP) amplitude, and motor nerve distal motor latency (DML) of the two groups were measured by electromyography before operation, and 14 d, 30 d, and 90 d after operation. The disabilities of arm, shoulder, and hand (DASH) questionnaire was used to evaluate the upper-extremity function of the two groups before operation, and 14 d, 30 d, and 90 d after operation, and the pinch strength and grip strength of the two groups before operation, and 14 d, 30 d and 90 d after operation were measured by Jamar Pinch Gauge and Jamar Hand Dynamometer. Results:After three months of follow-up, the excellent and good recovery rate of the observation group (85.71%) was significantly higher than that of the control group (70.45%), with a significant statistical difference ( P<0.05). The DASH scores of the observation group were significantly lower than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The SCV and MCV of the observation group were significantly faster than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). The DMLs of the observation group were significantly shorter than those of the control group at 14 d, 30 d, and 90 d after operation, while the SNAPs were significantly bigger than those of the control group ( P<0.05). The grip strength and pinch strength of the observation group were significantly stronger than those of the control group at 14 d, 30 d, and 90 d after operation ( P<0.05). Conclusion:Modified Okutsu method of ECTR combined with postoperative hyperbaric oxygen treatment can improve the clinical excellent and good recovery rate of carpal tunnel syndrome, which can enhance the electrophysiological function of their median nerves, and their daily functioning, to provide reference for treating chronic injuries caused by carpal tunnel syndrome and other peripheral nerve entrapment syndromes.

Objective:To investigate the clinical efficacy of hyperbaric oxygen (HBO) therapy combined with arthroscopic minimally invasive treatment on sports traumatic ankle arthritis (STAA) during perioperative period.Methods:The clinical data of 138 patients with STAA admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were collected. According to the treatment methods adopted, they were divided into 3 groups, 46 cases were treated with conventional surgery (group A), 43 cases were treated with arthroscopic minimally invasive treatment (group B), and 49 cases received HBO (HBO was started 3 days before the operation and restarted the second day after the operation) combined with arthroscopic minimally invasive treatment (group C). The clinical efficacies in the 3 groups of patients were observed. The Mcguire scores and the scores of visual analogue scale (VAS) for pain before and after operation were recorded. The postoperative ankle function recovery time, postoperative recovery treatment time, postoperative joint swelling and pain symptoms subsiding time, as well as the operation time, intraoperative blood loss, and length of hospital stay, were recorded.Results:After treatment, the Mcguire scores of the patients in group B and C were significantly higher than those of the group A, and the VAS scores were significantly reduced; after treatment, the Mcguire scores of the patients in group C were significantly higher than that of the group B, and the VAS scores was significantly reduced, with significantly statistical differences ( P<0.05, or P<0.01). After treatment, the total effective rates of the group B (86.0%) and the group C (95.9%) were significantly higher than that of the group A (71.7%), and the total effective rate of the group C was significantly higher than that of the group B, all were with significantly statistical differences ( P<0.05, or P<0.01). The operation time, intraoperative blood loss, and length of hospital stay of the group B and C were significantly lower than those of the group A ( P<0.05, or P<0.01); the length of hospital stay of the patients in the group C was significantly lower than that of the patients in the group B ( P<0.05), but their operation time and intraoperative blood loss were no significant difference ( P>0.05). The postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group B and C were significantly lower than those of the patients in the group A ( P<0.05, or P<0.01); the postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group C were significantly lower than those of the patients in the group B, with significantly statistical differences ( P<0.05). Conclusion:HBO combined with arthroscopic minimally invasive treatment on STAA can significantly improve the clinical efficacy and help restore ankle joint function.

Objective:To investigate the clinical efficacy of hyperbaric oxygen (HBO) therapy combined with arthroscopic minimally invasive treatment on sports traumatic ankle arthritis (STAA) during perioperative period.Methods:The clinical data of 138 patients with STAA admitted to the Department of Adult Orthopedics of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the Orthopedics Department of Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were collected. According to the treatment methods adopted, they were divided into 3 groups, 46 cases were treated with conventional surgery (group A), 43 cases were treated with arthroscopic minimally invasive treatment (group B), and 49 cases received HBO (HBO was started 3 days before the operation and restarted the second day after the operation) combined with arthroscopic minimally invasive treatment (group C). The clinical efficacies in the 3 groups of patients were observed. The Mcguire scores and the scores of visual analogue scale (VAS) for pain before and after operation were recorded. The postoperative ankle function recovery time, postoperative recovery treatment time, postoperative joint swelling and pain symptoms subsiding time, as well as the operation time, intraoperative blood loss, and length of hospital stay, were recorded.Results:After treatment, the Mcguire scores of the patients in group B and C were significantly higher than those of the group A, and the VAS scores were significantly reduced; after treatment, the Mcguire scores of the patients in group C were significantly higher than that of the group B, and the VAS scores was significantly reduced, with significantly statistical differences ( P<0.05, or P<0.01). After treatment, the total effective rates of the group B (86.0%) and the group C (95.9%) were significantly higher than that of the group A (71.7%), and the total effective rate of the group C was significantly higher than that of the group B, all were with significantly statistical differences ( P<0.05, or P<0.01). The operation time, intraoperative blood loss, and length of hospital stay of the group B and C were significantly lower than those of the group A ( P<0.05, or P<0.01); the length of hospital stay of the patients in the group C was significantly lower than that of the patients in the group B ( P<0.05), but their operation time and intraoperative blood loss were no significant difference ( P>0.05). The postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group B and C were significantly lower than those of the patients in the group A ( P<0.05, or P<0.01); the postoperative pain subsiding time, postoperative joint function recovery time, and postoperative recovery treatment time of the patients in the group C were significantly lower than those of the patients in the group B, with significantly statistical differences ( P<0.05). Conclusion:HBO combined with arthroscopic minimally invasive treatment on STAA can significantly improve the clinical efficacy and help restore ankle joint function.

BACKGROUND:With the increasing incidence of distal tibial fractures, locking plate fixation has become the preferred internal fixation method. OBJECTIVE:To analyze the biomechanical performance of distal tibial fractures, and to study the difference between medial and lateral locking plate methods for internal fixation of distal tibial fractures. METHODS:Articles concerning the biomechanics of the internal fixation of distal tibial fractures were col ected by literature search. The articles that met the criteria were analyzed in depth. In this paper, a biomechanical comparison between locking plate fixation and intramedul ary nail fixation was done as wel as the stress distribution and mechanism of the ankle joint. Meanwhile, 60 patients with distal tibial fractures who had received medial or lateral locking plate fixation at the Department of Orthopedics, Chongming Branch, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China from January 2009 to January 2012 were enrol ed for efficiency comparison. RESULTS AND CONCLUSION: For patients with distal tibial fractures, it is easy to cause posterior mal eolus fractures, Y-shaped fractures and anterior tibial compression, respectively, in the plantar flexion position, neutral position, and dorsiflexion position. Locking plate is better than the intramedul ary nail in the torsional force, and the intact fibula contributes to the improvement of fixed effects of these two internal fixation methods. When the fibula cannot be effectively fixed, the locking plate fixation has a better stability than the intramedul ary nail. Moreover, there is no difference in the fracture healing after fixation with medial and lateral locking plates. However, a lower incidence of complications and better function recovery of the ankle joint can be realized after lateral locking plate fixation.