Objective:To investigate personal exposures to nitrogen oxides(NOX)and nitrogen di-oxide(NO2)and the influence of baseline personal characteristics,living environment and daily activity patterns of the participants on the exposures among adults over 35 in Tianjin and Shanghai.Methods:In this panel study,91 healthy nonsmoking adults aged over 35 from Tianjin and Shanghai participated in our study.The study was conducted in summer and winter.The participants were followed for three times with an interval of at least two weeks.Only participants in Shanghai were followed once in winter because of the COVID-19 pandemic.Twenty-seven participants completed follow-up visits in both seasons.We measured their 24 h personal exposures to NOX and NO2and collected their baseline and time-activity in-formation through questionnaire/diary.The linear mixed model was used to analyze the associations be-tween potential influencing factors and personal NOX and NO2 exposure levels.Results:There were 349 follow-up visits with valid 24 h personal NO2 and NOX exposure measurements in the two cities.The ave-rage 24 h personal exposures to NO2 and NOX(volume fraction)in Tianjin participants were 18.0 x 10-9 and 26.2 × 10-9 in summer,and 31.0 x 10-9 and 54.9 x 10-9in winter,respectively;and the average 24 h personal exposures to NO2 and NOX in Shanghai participants were 38.7 x 10-9and 100.0x10-9in summer,and 45.5 x10-9 and 139.2 x 10-9 in winter,respectively.The results of univariate regression analysis showed that their personal NOX exposure levels were significantly associated with city,season,gender,average daily cooking times,and ambient NO2 concentrations measured at fixed-site monitoring stations.In addition to the above factors,the personal NOX exposure levels were also significantly associ-ated with educational level and the personal NO2 exposure levels were also significantly associated with passive smoking,average daily home time,cooking energy type,residential distance from main traffic road,and use of kitchen ventilators.Multivariate regression analysis showed that the personal exposure levels of NO2 and NOX were significantly lower in Tianjin than that in Shanghai,were significantly lower in summer than that in winter,and were significantly and positively associated with ambient NO2 concen-trations measured at fixed-site monitoring stations.In addition,personal NOX exposure levels were signifi-cantly lower in females than in males,and personal NO2 exposure levels were significantly positively asso-ciated with average daily cooking times and significantly inversely associated with average daily home time.For every interquartile range(IQR)increase(12.7 × 10-9)in ambient NO2,the personal NO2 exposure levels increased by 27.5％(95％CI:17.0％-38.9％),and personal NOX exposure levels in-creased by 16.1％(95％CI:7.1％-25.8％).Conclusion:Season,city and ambient NO2 concentra-tions are significant influencing factors of personal exposure levels of NO2and NOX At the same time,the personal exposures levels of NO2 are also affected by lifestyle factors.Our study provides scientific evi-dence for making precise air pollution control decisions and reducing the exposure levels of NOX in the population.

Objective:To evaluate the diagnostic accuracy of the convolutional neural network（CNN） in diagnosing nasopharyngeal carcinoma using endoscopic narrowband imaging. Methods:A total of 834 cases with nasopharyngeal lesions were collected from the People's Hospital of Guangxi Zhuang Autonomous Region between 2014 and 2016. We trained the DenseNet201 model to classify the endoscopic images, evaluated its performance using the test dataset, and compared the results with those of two independent endoscopic experts. Results:The area under the ROC curve of the CNN in diagnosing nasopharyngeal carcinoma was 0.98. The sensitivity and specificity of the CNN were 91.90% and 94.69%, respectively. The sensitivity of the two expert-based assessment was 92.08% and 91.06%, respectively, and the specificity was 95.58% and 92.79%, respectively. There was no significant difference between the diagnostic accuracy of CNN and the expert-based assessment （P=0.282, P=0.085）. Moreover, there was no significant difference in the accuracy in discriminating early-stage and late-stage nasopharyngeal carcinoma（P=0.382）. The CNN model could rapidly distinguish nasopharyngeal carcinoma from benign lesions, with an image recognition time of 0.1 s/piece. Conclusion:The CNN model can quickly distinguish nasopharyngeal carcinoma from benign nasopharyngeal lesions, which can aid endoscopists in diagnosing nasopharyngeal lesions and reduce the rate of nasopharyngeal biopsy.
Humans ; Nasopharyngeal Carcinoma ; Narrow Band Imaging ; China ; Neural Networks, Computer ; Nasopharyngeal Neoplasms/diagnostic imaging*

Objective :To explore difference of blood lipid levels among patients with retinal vein occlusion (RVO) from department of ophthalmology , those with hyperlipidemia from department of cardiology and healthy people .Methods :Blood lipid levels were compared among 35 RVO patients who visited department of ophthalmology for the first time ,35 patients with hyperlipidemia who visited department of cardiology for the first time and 35 healthy people undergoing physi—cal examination from Jun 2017 to Jan 2018. Results : (1) Compared with healthy group ,there were significant rise in blood levels of total cholesterol (TC) and triglyceride (TG) ,and significant reduction in blood level of high density lipoprotein cholesterol (HDL—C) in RVO group and hyperlipidemia group (P＜0.05 or ＜0.01) ,and significant rise in blood level of low density lipoprotein cholesterol (LDL—C) in hyperlipidemia group , P＝ 0.001 ; (2 ) Compared with hyperlipidemia group ,there were significant reductions in levels of TC [ (5.73 ± 0.91) mmol／L vs.(5.09 ± 0.83) mmol／L] ,TG [ (2.31 ± 1.37) mmol／L vs.(1.81 ± 1.89) mmol／L] and LDL—C [ (3.11 ± 0.79) mmol／L vs.(2.55 ± 0.42) mmol／L] in RVO group , P＜0.01 all.Conclusion : Blood lipid levels of RVO patients are significantly higher than those of healthy people , but those were reduced than hyperlipidemia group indicated that blood lipid levels rise is a pathogenic factor ,but not only one ,its other pathogenic factor should be investigate .

Objective To propose a CT classification of die-punch fragments in posterior pilon fracture and to explore its significance in helping the surgery.Methods ACT scan classification of die-punch fragments in posterior pilon fracture into 5 types was proposed according to their size and location.A retrospective study was conducted of the 48 posterior pilon fractures which had been treated at Department of Orthopaedics,Huashan Hospital from January 2013 to December 2015.They involved 16 men and 32 women,aged from 20 to 87 years (average,46.5 years).According to the preoperative CT scan classification of die-punch fragments,16 cases (33.3％) belonged to type Ⅰ,2 (4.2％) to type Ⅱ,18 (37.5％) to type Ⅲ,10 (20.8％) to type Ⅳ and 2 (4.2％) to type Ⅴ.Choice of operative approach,reduction and internal fixation and removal of the fragments were guided by the CT classification of die-punch fragments.Their postoperative ankle functions were evaluated with American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) scoring systems.Results All the 48 cases were followed up for 11 to 21 months (average,13.7 months).Their AOFAS scores for ankle-hindfoot at the final follow-up ranged from 77 to 92 points,averaging 84.3 points;their VAS scores ranged from 0 to 1 point,averaging 0.2 point.There were no significant differences in their postoperative AOFAS scores for ankle-hindfoot or in their postoperative VAS scores between the types of die-punch fragments (P ＞ 0.05).No complications were recorded except superficial infection at the posteromedial wound of the ankle in 2 cases,tarsal tunnel syndrome in 2 cases,and sural nerve irritation in 2 cases.Conclusion It is feasible and effective to classify the die-punch fragments in posterior pilon fracture according to their size and location on the CT scan,because the classification can help choose an appropriate operative approach and manage the die-punch fragment,leading to fine clinical outcomes.

Objective To explore how to overcome the difficulties during two paddle anterolateral thigh flap harvest. Methods From January, 2009 to December, 2015, the harvest of two paddle anterolateral thigh flap was encountered difficulties during surgery in 8 cases, which were 7 males and 1 female. The age was ranged from 16 to 48 years old, with averaged of 32.8. Six patients presented with one defect, and 2 patients presented with two defects. The skin defects ranged from 60-247 cm2. The number of the flap perforator, vascular source, flap pattern and out-comes was recorded. All patiants were followed-up at regular intervals. Results All of 8 flaps were converted suc-cessfully during surgery. Only 1 perforator was found in 4 cases. The flap was converted to sigle perforator flap. The dornor site was covered by skin graft. Two perforators from different origins were found in 2 cases, and the flap was converted to sequential chimeric flap. Two perforators from descending branch and transverse branch respectively were found in 1 case, and the flap was converted to combined anterolateral thigh and tensor fascia lata flap. Only 1 perfora-tor was found in 1 case, which the distal defect was small sized, the flap was converted to deepithelialized two paddle flap. The flap ranged from 78-288 cm2. Venous compromise was happened in 1 case, and the flap survived after reex-ploration surgery. Local infection was found in 2 cases, and cured with wound dressing. Other flaps were survived un-eventfully. At donor site, 1 case wound dehiscence and 1 case local infection, both of which underwent debridement and healed. All patiants were followed-up for 7-21(mean, 11.5)months. The flaps had satisfactory appearance and soft texture. Conclusion When it is difficult to harvest two paddle anterolateral thigh flap during surgery, the flap need to be converted rationally based on the characteristics of the defect, the number of the flap perforator, and the vascular origins.

BACKGROUND: Operative correction of hallux valgus is one of the most procedures in foot and ankle department, but postoperative plaster slab immobilization often brings great inconvenience and pain. Off-loading forefoot shoes can theoretically help them to do activities off bed early, and prevent loading on the forefoot during walking. But its advantages and disadvantages compared with plaster slab are still unknown.OBJECTIVE: To compare the clinical effects of over-the-toe plaster slab and off-loading forefoot shoes after hallux valgus correction.METHODS: Patients with hallux valgus undergoing distal Chevron osteotomy or Scarf osteotomy in the Huashan Hospital of Fudan University between May 2012 and October 2013 were retrospectively reviewed. Group A patients had a below-knee and over-the-toe plaster slab while Group B had an off-loading forefoot shoe applied after surgery.Radiological assessment was done at 6 weeks postoperatively. Immobilization was removed once bone union was indicated. Clinical scales and subjective satisfaction investigation were performed at final follow-up, and complications during follow-up were noted. All values between groups were analyzed statistically.RESULTS AND CONCLUSION: Totally 125 patients (157 feet) were completely followed up, including 83 patients (95 feet) in Group A and 42 patients (62 feet) in Group B. There was no significant difference in demographics, pre-and-post operative radiological assessments, clinical scale, union time or general satisfaction rates between two groups. However,Group B patients had less chance to suffer metatarsophalangeal joint or inter-phalangeal joint stiffness, restricted ankle motion and supra-ankle pains of operated side in comparison with Group A (P < 0.05), and were more willing to accept the same treatment if they could choose again (P < 0.05). Compared with the plaster slab, the application of off-loading shoes not only maintains correction level, but also reduces such complications as stiffness or restricted motion of the joint, limb pains and so on, which makes patients more likely to accept, and should be given priority to in the rehabilitation following hallux valgus correction.

Objective Purpose of this research is to biomechanically compare the screw-fixed and plate-fixed posterior malleolus fracture in osteoporosis patients with fatigue loading system and space motion system in simulation gait cycle,and to give a theory evidence on how to choose an internal fixation in osteoporosis patients with posterior malleolus fracture.Methods 72 osteoporotic cadaveric lower limbs were prepared to simulate Haraguchi Ⅰ posterior malleolus fracture and randomized into 2 groups with 36 each.Screw group were fixed with 2 paralleled 4.0 mm titanium partial thread cancellous screws from posterior to anterior.Plate group were fixed with plate.Based on the ratio of fracture area on sagittal plane to distal tibial articular surface (S),the two groups were subdivided into three subgroups,named as screw group A,plate group A,screw group B,plate group B,screw group C,plate group C.S (screw group A,plate group A)=l/4;S (screw group B,plate group B)=1/3;S (screw group C,plate group C)=1/2.According to the height of fracture fragments,these 6 subgroups were further divided into subgroup "a" with height 19.3mm and subgroup "b" with height 39 mm.Furthermore,4 different conditions of gait cycle were simulated as follows:1) specimen was loaded with 3.2 body weight (BW) at dorsiflexion angle of 12°;2) Start-up phase:dorsiflexion angle of 5°,3 BW;3) neutral position,3.6 BW;4) maximum plantar flexion,angle of 12°,4.5 BW.At the end of repeated loading,the displacement of fracture fragment was measured with space motion system.Results At dorsiflexion 12° and plantar flexion 15°,there was a significant difference of displacement between screw and plate group with a larger displacement in screw group,whatever S or H was.When ankle was at dorsiflexion of 5°,the displacement showed significant difference between screw group Aa and plate group Aa,screw group Ba and plate group Ba,screw group Bb and plate group Bb,screw group Cb and plate group Cb,with a larger displacement in screw group.In neutral position,the differences were significant with a larger displacement in screw group,except between screw group Bb and plate group Bb.Conclusion Plate can provide stronger fixation for osteoporosis patients with posterior malleolus fracture in most situations,but both of the two methods cannot provide stable fixation when posterior malleolus fragment was in a too big area or height.

Objective To assess preliminary clinical efficacy of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of forefoot or midfoot.Methods From March 2013 to December 2015,eight patients with degloved injury of forefoot or midfoot were retrospectively analyzed by case series study.They were seven males and one female,with age range of 18-51 years (mean,34.5 years).The foot skin defect area ranged from 18 cm × 12 cm to 13 cm × 10 cm.All patients underwent computed tomography angiography (CTA) in lower extremities preoperatively.The CTA data were entered into Mimics 15.0 software in DICOM format.Based on perforating condition of descending branch of lateral fenoral circunflex artery and the size of foot defect,one thigh was chosen for three dimensional reconstruction of anterolateral thigh flap.The flap size ranged from 24 cm× 9 cm to 19 cm × 7 cm.All reconstructive surgeries were performed secondarily.Patients were all at Ⅱ stage recovery.The survival of flaps and healing status of flap donor sites were observed in one month after surgery.The number of debulking flaps was recorded.The appearance of flaps,shoe wearing,gait and related complications were recorded.Results The follow-up was 10-21 months (mean,15.5 months.All flaps survived uneventfully,and all donor sites were sutured directly.Three patients had twice debulking procedures,three patients had one debulking procedure,and two patients had no debulking.At the last visit in follow-up,the color and texture of flaps were good.All patients were able to wear shoes normally,two patients remained mild abnormal gait,and one patient presented superficial ulcer at the medial of the forefoot.Conclusions Double skin paddle anterolateral thigh flap for reconstruction of degloved injury of forefoot or midfoot can prompt wound healing and decrease complications.Digital assisted technology is an excellent supplementary method in double skin paddle anterolateral thigh flap for reconstruction of degloved injury of foot,which makes precise preoperative planning and intraoperative accurate cutting.

BACKGROUNDA causal link between the metatarsus adductus and hallux valgus is not clear. The aim of this study was to investigate the configurations of the metatarsus adductus deformity by radiological measurements and reappraise the relationship between hallux valgus and metatarsus adductus.

METHODSThe first step was evaluation of the relationship between metatarsus adductus and hallux valgus on 143 dorsoplantar weight-bearing radiographs diagnosed as hallux valgus which was also known as bunions. Measurements including the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the Kilmartin angle (KA), the tibial sesamoid position (TSP), and metatarsus adductus angle were taken. The metatarsus adductus angle is defined by Sgarlato's angle (SMA) and Engel's angle (EMA) respectively.

RESULTSThe metatarsus adductus angle positively correlates with the HVA (r = 0.590, P = 0.000) and KA (r = 0.601, P = 0.000), yet negatively correlates with the grade of TSP, (r = -0.348, P = 0.000). Contradiction of diagnosis existed in 22 (22/100) subjects diagnosed as metatarsus adductus by SMA yet normal by EMA. In this group, the correlation between HVA and metatarsus adductus angle was negative (r = -0.472, P = 0.027).

CONCLUSIONSEMA and SMA defined metatarsus adductus by different deformity apexes. Metatarsus adductus configurations in that the apex of the deformity lay in either the base of metatarsals or tarsus. They respectively correlate positively or negatively to the HVA.

Adult ; Aged ; Aged, 80 and over ; Female ; Foot Deformities, Congenital ; diagnostic imaging ; physiopathology ; Hallux Valgus ; diagnostic imaging ; physiopathology ; Humans ; Male ; Metatarsus ; abnormalities ; diagnostic imaging ; Middle Aged ; Radiography ; Young Adult

Objective To evaluate the ankle stability on lateral malleolar rotational models based on three-dimensonal CT reconstruction and volume rendering technique.Methods Eighteen cadaveric specimens were utilized in the study (male 11;female 7; 68.2 years in average) and were divided into 2 groups in which the first group only cut the anterior tibiofibular ligament and defined as intact deltoid ligament group.Another group additionally cut the deltoid ligament and defined as deltoid ligament injured group.Fibular transverse osteotomy was performed at 3 cm proximal to the ankle joint and lateral malleolar rotational malunion model of 5°,10°,15° and 30° were built in every specimen.CT scanning was performed for each model then and all CT data were imported into Mimics 10.01 software.The structures of distal syndesmosis,ankle mortise as well as talus in the mortise were outlined by automatic dense identifying and manually modified later.Three-Dimensional models of these structures and their volume were outputted in the software.The volume of ankle clear space was calculated as the difference value of ankle mortise and talus in the mortise.Ankle stability was reflected by comparison of these volumes to the normal condition.Results With the rising of malrotational degree,the volume of inferior syndesmosis and mortise were increased and the volume of talus in the mortise was reduced.In the deltoid ligament intact group,10° of malrotation would significantly enlarged the volume of distal syndesmosis and ankle clear space when compared to normal condition.However,in the deltoid ligament injured group,5° of rotational deformity would significantly enlarge the volume of ankle clear space and distal syndesmosis.Conclusion The condition of deltoid ligament has significant impact on ankle stability in cases of lateral malrotional deformity.Distal syndesmosis and ankle clear space were significantly enlarged at 10° malrotation deformity.However,additional deltoid ligament injury can significantly reduce ankle stability at just 5° of distal fibular rotational deformity.