Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Objective:To characterize the geriatric osteoporotic pelvic fractures using 3-D computed tomography (CT) fracture mapping.Methods:Retrospectively analyzed were the 79 elderly patients with pelvic fracture who had been admitted to Department of Orthopaedics, The 7th Medical Center of PLA General Hospital between January 2017 and December 2021. There were 24 men and 55 women, aged from 60 to 98 years (average, 74.3 years). The CT scan data of the pelvis from all patients were imported into the software (Mimics Medical 18.0, Geomagic Studio 2014, Rhinoceros 6.0, and Matlab) to create a 3-D pelvic fracture model. The fracture pieces were imported into a standard pelvic template to obtain the morphology of the fracture lines after fitting. A map of fracture line distribution frequency and a fracture heat map were created by fitting the fracture lines of all patients into a common pelvic template.Results:Of the 79 elderly patients with pelvic fracture, 69 (87.3%) had fractures of both the anterior and the posterior rings. The fracture map and heat map of geriatric pelvic fractures showed the following: the fracture lines of the anterior ring were concentrated in the junction of the cancellous bone and cortical bone of the superior and inferior pubic rami; the fracture lines of the posterior ring were concentrated in the middle and posterior 1/3 of the ilium and in the sacral wing; the fracture frequencies incurred by the pubic bone, sacrum, and ilium were from the highest to the lowest.Conclusions:Fracture mapping can visually characterize the distribution of fracture lines of the geriatric pelvic fractures. Simultaneous fractures of the anterior and posterior rings of the pelvis are the most typical kind of pelvic fractures in the elderly. The junction of the cancellous and cortical bones of the superior and inferior pubic rami and the area surrounding the sacroiliac joint are the most frequent locations for the fractures.

Objective:To determine the factors related to postoperative 1-year and 5-year mortalities in elderly patients with hip fracture plus chronic obstructive pulmonary disease (COPD).Methods:A retrospective study was conducted of the elderly patients with hip fracture who had sought medical attention at Department of Orthopaedics, The 7th Medical Center of PLA General Hospital from January 2012 to December 2016.Of them, 103 were complicated with COPD, and another 103 without COPD were selected as controls who were matched in age, gender and fracture site. The 2 groups were compared in terms of postoperative 30-day, 1-year and 5-year mortalities; the risk factors were explored for postoperative 1-year and 5-year mortalities in patients with hip fracture plus COPD.Results:The postoperative 30-day, 1-year and 5-year mortalities in the COPD group were 7.8%(8/103), 29.1%(30/103) and 48.5%(50/103), significantly higher than those in the control group except for the 30-day value [1.9%(2/103), 13.6%(14/103) and 31.1%(32/103)] ( P<0.05). Advanced age ( P=0.003), cardiovascular disease ( P=0.006), respiratory disease ( P=0.009), acute exacerbation of COPD (AECOPD) ( P<0.01), American Society of anesthesiologists (ASA) grades Ⅲ+Ⅳ ( P=0.001), delayed surgery (>48 h) ( P=0.015), pre-injury activities of daily living (ADL) score ( P=0.002) and mobility ( P=0.010) were related to an increased risk for 1-year mortality after operation. Advanced age ( OR=1.106, 95% CI: 1.016 to 1.210, P=0.021), AECOPD ( OR=5.053, 95% CI: 1.520 to 16.800, P=0.008), and ASA grades Ⅲ+Ⅳ ( OR=1.657, 95% CI: 1.072 to 3.912, P=0.040) were the risk factors for 5-year mortality in patients with COPD; pre-injury ADL ( OR=0.974, 95% CI: 0.987 to 0.967, P=0.043) was negatively correlated with 5-year mortality. Conclusions:COPD can significantly increase the short-term and long-term mortalities in elderly patients with hip fracture.Cardiovascular disease, AECOPD and ASA grades Ⅲ+Ⅳ are factors related to postoperative 1-year mortality in patients with hip fracture plus COPD. Advanced age, AECOPD and ASA grades Ⅲ+Ⅳ and delayed surgery (>48 h) are risk factors for postoperative 5-year mortality in patients with hip fracture plus COPD. ADL score before injury is negatively correlated with postoperative 1-year and 5-year mortalities.

Objective:To evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of elderly patients with fragility fracture of pelvis.Methods:Elderly patients with fragile pelvic fractures undergoing minimally invasive surgery and being followed up were retrospectively analyzed from January 2015 to December 2019.Based on the classification of pelvic fragile fractures(FFP), open reduction and internal fixation with pelvic anterior ring instability internal fixator(INFIX)plus posterior ring sacroiliac screw, or open reduction and internal fixation with iliac fossa approach, were performed for elderly patients with fragile pelvic fractures.The general data of all patients(age, sex, mechanism of injury)were recorded.Time from injury to operation, VAS(visual analogue scale)before and after operation, blood loss during operation, complications during hospitalization, time to ambulation, mortality, and Koval walking index at 2 year follow-up were recorded to evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of fragility fracture of pelvis.Results:Thirty-two patients were followed up, including 11 males and 21 females, aged 65-88 years(76.9±5.5)years.The mechanism of injury was fall on the ground as a percentage of 59.4%(19/32), fall in the sitting position as a percentage of 25.0%(8/32), and 15.63%(5/32)had unknown history of trauma.The time from injury to operation was 3-36 days(9.6±3.3)days.There were 50.0%(16/32)type Ⅱ, 31.3%(10/32)type Ⅲ and 18.8%(6/32)type Ⅳ cases according to FFP classification.The mean blood loss during operation was(65.9±35.2)ml(range, 20-200 ml). The preoperative VAS score was 5-9 scores, with an average of(6.41±1.07)scores.The postoperative VAS score was 1-4(1.71±0.63). Average time from injury to operation was(9.6±3.3)days(range, 3~36). The incidence of complications during operation was 9.4%(3/32), including 1 case of gastrointestinal bleeding, 1 case of lower extremity deep vein thrombosis, and 1 case of superficial wound infection.Ambulation was at 4 weeks post-operation in 56.3%(18/32)cases, at 6 weeks post-operation in 31.3%(10/32)cases and at 8 weeks post-operation in 12.5%(4/32)cases.6.25%(2/32)patients died within 2 year follow-up.Koval walking index of the rest 30 patients included grade 1 in 46.9%(15/32)cases, grade 2 in 18.8%(6/32)cases, grade 3 in 6.3%(2/32)cases, grade 4 in 18.8%(6/32)cases and grade 6 in 3.1%(1/32)case(1 year after surgery, hemiplegia after cerebral infarction).Conclusions:Minimal invasive surgery achieves significant pain relief and early mobilization in patients with fragility fracture of pelvis.

Moyamoya disease is a chronic progressive occlusive cerebrovascular disease characterized by progressive occlusion of the terminal internal carotid artery with formation of an abnormal vascular network at the skull base. The pathogenesis of the disease is not fully understood and is mainly thought to be associated with genetic factors, environmental factors and immune inflammatory response. The discovery of relevant biomarkers may provide hope for elucidation of pathogenesis of moyamoya disease and the early diagnosis and treatment of it. From the perspectives of coding gene, non-coding RNA and protein related to moyamoya disease, the possible molecular mechanisms involved in the occurrence and development of moyamoya disease are elaborated to further clarify their value as biomarkers of moyamoya disease.

Objective:To investigate the prognosis of severe hyperbilirubinemia in full-term infants who met the exchange transfusion criteria and were treated by blood exchange transfusion and phototherapy.Methods:A total of 168 full-term infants with severe hyperbilirubinemia who met the criteria for exchange transfusion and were hospitalized in the Neonatology Department of seven tertiary hospitals in Hebei Province from June 2017 to December 2018 were retrospectively included. According to the treatment protocol, they were divided into two groups: exchange transfusion group (38 cases) and phototherapy group (130 cases). Two independent sample t-test and Chi-square test were used to compare the clinical manifestations and follow-up results between the two groups. Multivariate logistic regression was used to analyze the risk factors for poor prognosis. Results:Neonatal severe hyperbilirubinemia in the exchange transfusion and phototherapy group were both mainly caused by hemolytic disease [42.1%(16/38) and 29.2%(38/130)], sepsis [28.9%(11/38) and 11.5%(15/130)] and early-onset breastfeeding jaundice [15.8%(6/38) and 11.5%(15/130)]. Total serum bilirubin level on admission in the exchange transfusion group was significantly higher than that in the phototherapy group [(531.7±141.3) vs (440.0±67.4) μmol/L, t=3.870, P<0.001]. Moreover, the percentage of patients with mild, moderate and severe acute bilirubin encephalopathy in the exchange transfusion group were higher than those in the phototherapy group [15.8%(6/38) vs 3.8%(5/130), 7.9%(3/38) vs 0.8%(1/130), 13.2%(5/38) vs 0.0%(0/130); χ2=29.119, P<0.001]. Among the 168 patients, 135 were followed up to 18-36 months of age and 12 showed poor prognosis (developmental retardation or hearing impairment) with four in the exchange transfusion group (12.9%, 4/31) and eight in the phototherapy group (7.7%, 8/104). Multivariate logistic regression analysis showed that for full-term infants with severe hyperbilirubinemia who met the exchange transfusion criteria, phototherapy alone without blood exchange transfusion as well as severe ABE were risk factors for poor prognosis ( OR=14.407, 95% CI: 1.101-88.528, P=0.042; OR=16.561, 95% CI: 4.042-67.850, P<0.001). Conclusions:Full-term infants who have severe hyperbilirubinemia and meet the exchange transfusion criteria should be actively treated with blood exchange transfusion, especially for those with severe ABE, so as to improve the prognosis.

Objective:To investigate the clinical effect of minimally invasive plate osteosynthesis (MIPO) through anterolateral approach in treatment of middle-distal humeral shaft fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with middle-distal humeral shaft fracture admitted to 7th Medical Center of Chinese PLA General Hospital from August 2015 to March 2018, including 12 males and 9 females, aged 18-68 years [(31.3±3.6)years]. All were closed fracture. According to AO classification, the fracture were classified as type A in 6 patients, type B in 10 and type C in 5. All patients were treated with anterolateral minimally invasive plate fixation. The operation time, intraoperative blood loss and hospital stay were recorded. The fracture healing was observed after operation. The visual analogue scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, and Mayo elbow performance score (MEPS) were used to evaluate the effectiveness before operation and at 2 weeks, 3 months and 12 months after operation.Results:All patients were followed up for 12-26 months [(18.2±2.4)months]. The operation time was 50-82 minutes [(68.2±19.4)minutes], with intraoperative blood loss of 40-95 ml [(60.2±21.3)ml]. The hospital stay was 6-16 days [(6.8±1.2)days]. There was no iatrogenic vascular or nerve injury during operation. The patients with radial nerve injury before operation were all adventitia contusion. The nerve function returned to normal within 3 months after operation. All fractures were healed within 5-10 months [(5.3±1.2)months]. At 2 weeks, 3 months and 12 months after operation, the VAS [(3.6±0.8)points, (2.1±0.4)points, (1.8±0.3)points] was lower than that before operation [(8.3±1.6)points] ( P<0.05); UCLA shoulder rating scale [(31.2±1.5)points, (33.6±0.8)points, (34.6±0.5)points] was higher than that before operation [(28.4±2.3)points] ( P<0.05); and MEPS [(80.2±3.4)points, (93.4±2.2)points, (96.4±3.5)points] was higher than that before operation [(60.5±4.5)points] ( P<0.05). At the last follow-up, the UCLA shoulder rating scale and MEPS showed excellent results. Conclusion:For middle and lower humeral shaft fracture especially for the fracture line relatively distal to the shaft, MIPO technique through anterolateral approach can attain satisfactory results in terms of pain, range of motion of shoulder and elbow joint, and joint function.

Objective:To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stage Ⅰa1 （lymph-vascular space invasion-positive, LVSI +）- Ⅰb1 cervical cancer patients with different tumor sizes. Methods:Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China (1538 project database), patients with stage Ⅰa1 （LVSI +）-Ⅰb1 cervical cancer who treated by laparoscopic or abdominal surgery were included. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) between the two surgical approaches were compared under 1∶1 propensity score matching (PSM) in different tumor diameter stratification. Results:(1) A total of 4 891 patients with stage Ⅰa1 （LVSI +）-Ⅰb1 cervical cancer who underwent laparoscopy or laparotomy from January 1, 2009 to December 31, 2016 were included in the 1538 project database. Among them, 1 926 cases in the laparoscopic group and 2 965 cases in the abdominal group. There were no difference in 5-year OS and 5-year DFS between the two groups before matching. Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS ( HR=1.367, 95% CI: 1.105-1.690, P=0.004). After 1∶1 PSM matching, 1 864 patients were included in each group, and there was no difference in 5-year OS between the two groups （94.1% vs 95.4%, P=0.151）. While, the inferior 5-year DFS was observed in the laparoscopic group (89.0% vs 92.3%, P=0.004). And the laparoscopic surgery was associated with lower 5-year DFS ( HR=1.420, 95% CI: 1.109-1.818, P=0.006). (2) In stratification analysis of different tumor sizes, and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size ≤1 cm, >1-2 cm and >2-3 cm stratification (all P>0.05). Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS ( P>0.05). In the stratification of tumor size >3-4 cm, there was no difference in 5-year OS between the two groups ( P>0.05). The 5-year DFS in the laparoscopic group was worse than that in the abdominal group (75.7% vs 85.8%, P=0.025). Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS ( HR=1.705, 95% CI: 1.088-2.674, P=0.020). Conclusions:For patients with stage Ⅰa1 （LVSI +）-Ⅰb1 cervical cancer, laparoscopic surgery is associated with lower 5-year DFS, and the adverse effect of laparoscopic surgery on oncology prognosis is mainly reflected in patients with tumor size >3-4 cm. For patients with tumor sizes ≤1 cm, >1-2 cm and >2-3 cm, there are no difference in oncological prognosis between the two surgical approaches.

OBJECTIVES: Cardiovascular disease (CVD) has a substantial financial impact on healthcare systems in the US. This study aimed to examine the impact of CVD on health insurance coverage and health service use under economic stress as indicated by the Great Recession in the US (December 2007–June 2009). METHODS: Data of 26,483 adults aged ≥ 20 years from the 2003–2012 National Health and Nutrition Examination Survey were analyzed. There were 9,479 adults assigned to the group “before the Great Recession” (2003–2006), 5,674 adults assigned to “during the Great Recession” (2007–2008), and 11,330 adults assigned to “after the Great Recession” (2009–2012). RESULTS: Patients with CVD from low-income families were more likely to have health insurance during the recession (OR:1.57, 95% CI: 1.01,2.45). Those participants without CVD, who were from low-income families or < 65 years, were more likely to use the emergency room rather than primary care facilities to gain access to routine healthcare (p < 0.05). Patients with CVD from high-income families were also more likely to use the emergency room (p < 0.05). Patients with CVD but not those without CVD, who reported a high family income or were ≥ 65 years old, were less likely to use mental health services during the recession than before the recession. CONCLUSION: Effective strategies need to be developed to promote primary care use among the general adult American population. In addition, use of mental health services among patients with CVD needs to be improved when financial stress occurs.
Adult ; Cardiovascular Diseases ; Chronic Disease ; Cost of Illness ; Delivery of Health Care ; Emergency Service, Hospital ; Health Services ; Humans ; Insurance, Health ; Mental Health Services ; Nutrition Surveys ; Primary Health Care

BACKGROUND: Tendon injury is common in clinic, which is mainly treated by surgical anastomosis. Postoperative tendon healing is usually assessed through surgeons' experience due to high cost and application restrictions of MRI examination. Thus there is still a lack of a convenient and objective imaging support. With the advancement and widespread application of high-frequency ultrasound, the diagnosis rate of tendon injury has been improved remarkably; thereafter, high-frequency ultrasound used for assessing tendon injury and repair has become an issuehas become an issue of concern.OBJECTIVE: To clarify the ultrasonic imaging features of tendon repair through high-frequency ultrasound scancombined with histological examination.METHODS: This was a single-central, preoperative and self-controlled animal experiment and finished in the Central People'sHospital of Siping, China. 130 adult male Highbrow chickens were selected and were then randomized into 13 groups (n=10per group). One side of each chicken hind foot was randomly selected as experimental limb to undergo achillotomy followedby repair using the modified Kessler method (groups 2-13) or no treatment (group 1); the contralateral limb served as control.Moreover, passive flexion-extension functional training targeting the experimental limbs was performed in the groups 8-13beginning at the 1st day after surgical anastomosis, several times a day. The high-frequency ultrasound and hematoxylineosinstaining were conducted before and after chillotomy (group 1), and at 3 (groups 2 and 8), 7 (groups 3 and 9), 14 (groups4 and 10), 21 (groups 5 and 11), 35 (groups 6 and 12) and 42 (groups 7 and 13) days after surgical anastomosis, respectively.RESULTS AND CONCLUSION: The primary measurement outcomes were the repair and healing of the injured tendonas assessed by high-frequency ultrasound; the secondary outcomes were the pathological manifestations of the injuredtendon detected by hematoxylin-eosin staining. Our findings will provide preclinical proof for high-frequency ultrasounduse in the assessment of tendon injury, repair and healing as well as for the rehabilitation therapy that promotes functionrecovery in the future.