BACKGROUND:The treatment of distal tibial fractures with soft tissue injury has always been challenging,and the new retrograde tibial nailing is a new choice.Up to now,there were few reports on the biomechanical properties between the new retrograde tibial nailing,anterograde intramedullary nailing and supercutaneous locking plate. OBJECTIVE:To explore the biomechanical stability of new retrograde tibial nailing,antegrade intramedullary nailing and supercutaneous locking plate in the treatment of distal tibial fractures with soft tissue injury using finite element analysis so as to offer a scientific foundation for clinical application. METHODS:The finite element model of transverse distal tibia fracture was established by relevant software utilizing the CT data of the tibia from a 42-year-old healthy male.Retrograde tibial nailing,antegrade intramedullary nailing and supercutaneous locking plate finite element models were assembled under the principle of fracture fixation.Finally,meshing,applying loads,and data processing were accomplished with the ANSYS 2019 software.Moreover,the stress distribution and displacement of the tibia and internal fixation of each model were compared. RESULTS AND CONCLUSION:(1)The displacement of fracture end in the three groups increased with the increase of load.In all mode loads,the average displacement of the fracture end was the least in the retrograde tibial nailing group,followed by the supercutaneous locking plate group,and the highest in the antegrade intramedullary nailing group.At 800 N vertical load,the displacement difference of the fracture end was statistically significant(P<0.05).There was no statistical significance in other load modes.(2)Under different loads,the tibial stress in the three groups was the highest in the middle of the tibia,and gradually decreased to the proximal and distal ends.The stress distribution of the tibial shaft was the highest in the retrograde tibial nailing group,followed by the supercutaneous locking plate group,and the least in the antegrade intramedullary nailing group.(3)Under different loads,the stress of the tibial stress raiser in the three groups was significantly higher in the supercutaneous locking plate group than in the other two groups,with statistical significance(P<0.05).(4)Under different loads,the stress of the fixators in the three groups was the largest in the supercutaneous locking plate group,followed by the retrograde tibial nailing group,and the minimum in the antegrade intramedullary nailing group.There were significant differences in the stress of fixator stress raiser among the three groups under different loading modes(P<0.05).(5)It is indicated that all three fixation methods have the good anti-rotation ability and axial stability.Retrograde tibial nail shows better biomechanical stability.

Objective:To evaluate the left ventricular diastolic function and pulmonary congestion in patients with acute myocardial infarction (AMI) with preserved left ventricular ejection fraction (LVEF) by cardiopulmonary ultrasound (CPUS), and to explore the value of CPUS in predicting the occurrence of heart failure with preserved ejection fraction (HFpEF) in AMI patients with preserved LVEF during hospitalization.Methods:A total of eighty-four patients with AMI with preserved LVEF (≥50%) who received optimal emergency reperfusion therapy on admission at Beijing Chaoyang Hospital Affiliated to Capital Medical University from August 2021 to March 2022 were enrolled. All patients completed comprehensive cardiopulmonary ultrasonography within 12 hours after reperfusion therapy and LVEF, left atrial maximum volume(LAV), peak flow velocity of tricuspid valve regurgitation (V TR), peak flow velocity of mitral valve in early diastole (E), peak velocity of mitral valve annulus on septal side and left ventricular lateral side in early diastole and other conventional echocardiography parameters were obtained, and then the left atrial volume index (LAVI), the mean peak velocity of the mitral valve annulus on the septal side and left ventricular lateral side in early diastole (e′) and E/e′ were calculated; lung ultrasound parameters(the number of B lines) were obtained; the left ventricular global long-axis strain (GLS) was obtained using speckle tracking imaging (STE). The predictive power of CPUS parameters for HFpEF during hospitalization in AMI patients with preserved LVEF were analyzed. Results:①The incidence of HFpEF during hospitalization was 40.4% (34/84). ②The number of B lines and LAVI were independently correlated with the occurrence of HFpEF during hospitalization( P<0.05). ③The ROC curve analysis showed that the area under the curve (AUC) of the number of B lines and LAVI for predicting the occurrence of HFpEF during hospitalization were 0.766 and 0.690, respectively. The number of B lines combined with LAVI had the best predictive performance in predicting the occurrence of HFpEF during hospitalization, with the largest AUC of 0.903, which was significantly better than the number of B lines and LAVI ( P<0.05). Conclusions:The number of B lines combined with LAVI can effectively predict the occurrence of HFpEF during hospitalization in AMI patients with preserved LVEF, which is helpful to further improve the clinical management of AMI patients at risk of HFpEF.

Objective:To assess the left ventricular myocardial function in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF) after percutaneous coronary intervention(PCI) by noninvasive myocardial work technology, and to explore the evolution of left ventricular myocardial function recovery.Methods:A total of 92 NSTE-ACS patients from July to December 2019 in Beijing Chao Yang Hospital with normal wall motion and LVEF (>55%) after PCI were recruited. Echocardiography was performed 1 day before PCI, 1 day, 2 weeks, 1 month, and 3 months after PCI. Global longitudinal strain (GLS) was analyzed, and Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. Global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW), global myocardial work efficiency (GWE) among groups were compared and their correlations with strain parameters were explored.Results:GWI, GCW, GWE were improved ( P<0.05) at 1 day after PCI, GLS improved ( P<0.05) and GWW decreased ( P<0.05) at 2 weeks, LVEF improved ( P<0.05) at 1 month. Baseline GWI and GCW had a moderately negative correlation with GLS ( r=-0.67, -0.66; both P<0.05); GWW had a moderately positive correlation with mechanical dispersion(MD) and postsystolic shortening index(PSI) ( rs=0.45, 0.50; both P<0.05); GWE had a moderately negative correlation with GLS, MD and PSI ( rs=-0.47, -0.55, -0.56; all P<0.05). Conclusions:Left ventricular myocardial function gradually improves in NSTE-ACS patients with normal wall motion and LVEF after PCI. Myocardial work parameters changes are more sensitive than GLS and LVEF, and can assess early left ventricular myocardial function changes after PCI.

Objective:To investigate the clinical characteristics and electron transfer flavoprotein dehydrogenase ( ETFDH) genetic mutations in patients with riboflavin responsive lipid storage myopathy (RR-LSM). Methods:A retrospective analysis was performed. The clinical data and muscular pathology of 26 patients with RR-LSM, admitted to our hospital from January 2009 to June 2021, were collected. Peripheral venous blood DNA was extracted, and the mutations of ETFDH gene were detected and analyzed by whole exome sequencing. Results:These 26 patients had onset of proximal limb myasthenia, 17 patients had difficulty in raising their head, 12 patients had mastication weakness, 6 had dysphagia, 5 had nausea and vomiting, and one was complicated with rhabdomyolysis and one was with reversible splenic lesion syndrome. Muscle biopsy indicated pathological deposition of lipid droplet, which type I fibers were involved mainly; degenerative necrotic muscle fibers were seen in a few cases. ETFDH gene mutations were detected in 26 patients; 23 patients had compound heterozygous mutation, two had single heterozygous mutation and one had homozygous mutation; 25 different mutation sites were found, mainly missense mutations; the C.770A>G frequency was the highest, accounting for 20% alleles (10/50); two novel mutation sites were found: c.1115A>G and c.1781T>C. Conclusion:RR-LSM is mainly characterized by proximal limb muscle weakness and fatigue intolerance, often accompanied by neck extensor and masticatory weakness; c. 770A>G is the hot site of ETFDH genetic mutations in RR-LSM patients.

Objective:To study the applicable value of personalized polyetheretherketone (PEEK) in maxillary reconstruction.Methods:6 patients with benign lesions in the maxilla and 7 patients with maxillary defects after tumor resection were repaired with personalized PEEK implant in our department from September 2018 to November 2020. In 6 patients with benign maxillary lesions, the maxillary defect models were obtained after the extent of tumor resection was established by virtual surgical design. Then, the individual PEEK was designed and produced on the base of mirroring technique. Cutting guide plates were also designed and printed according to virtual surgical planning. Then ablative surgery was performed under the guide of cutting guide, and PEEK was implanted. For 7 patients with maxillary defects, 3D models of maxillary defects were directly reconstructed in the computer based on the preoperative maxillofacial CT, then the individual PEEK was designed and produced based on mirroring technique. Afterwards PEEK was implanted associated with anterolateral thigh flap to repair palatal defects if necessary. All patients were followed up at regular intervals after surgical implantation of PEEK to observe postoperative complications. And postoperative appearance and function of the patients were evaluated by clinical and CT examinations one month after surgery.Results:PEEK implant operation was carried out with all of the patients according to the preoperative design. During implantation, PEEK did not match exactly with the defects in 2 patients. Then PEEK could be put into position after trimming and grinding. Three patients were performed anterolateral thigh flaps at the same time to restore the palatal defects to separate the oral and nasal cavity. The wound healed well after operation in all of the patients. All of the flaps survived, and the survival rate was 100%. Facial symmetry and eyeball location were well restored and mouth opening was recovered to normal after surgery. Image fusion showed the location of PEEK implant was accurate with an error of (0.68±0.12) mm. In 6 patients with benign lesions, postoperative orbital volume [(26.37±0.94) ml], eye vertical position [(0.98±0.48) mm] and the ratio of exophthalmos [(1.10±0.28) mm ]were significantly improved compared to pre-operation [(24.06±0.85) ml, (3.83±0.81) mm, (2.53±0.67) mm]. The difference were statistically significant ( P<0.05). In 7 patients with maxillary defects after tumor resection, postoperative eye verticalposition [(0.77±0.42) mm] and the ratio of exophthalmos [(0.61±0.31) mm] were significantly improved compared to pre-operation [(2.03±1.07) mm, (2.01±0.34) mm]. The difference were statistically significant ( P<0.05). The range of postoperative follow-up was 1-27 months [(12.0±7.6 ) months]. During follow-up, a PEEK implant was removed in one case because of implant extrusion and the other due to tumor recurrence. Conclusions:With the aid of virtual surgical planning, the personalized PEEK implant combined or not with hard/soft tissue flap can accurately restore the maxillary appearance and support the orbital floor, thus effectively improving the accuracy and safety of maxillary reconstruction.

Objective:To study the applicable value of personalized polyetheretherketone (PEEK) in maxillary reconstruction.Methods:6 patients with benign lesions in the maxilla and 7 patients with maxillary defects after tumor resection were repaired with personalized PEEK implant in our department from September 2018 to November 2020. In 6 patients with benign maxillary lesions, the maxillary defect models were obtained after the extent of tumor resection was established by virtual surgical design. Then, the individual PEEK was designed and produced on the base of mirroring technique. Cutting guide plates were also designed and printed according to virtual surgical planning. Then ablative surgery was performed under the guide of cutting guide, and PEEK was implanted. For 7 patients with maxillary defects, 3D models of maxillary defects were directly reconstructed in the computer based on the preoperative maxillofacial CT, then the individual PEEK was designed and produced based on mirroring technique. Afterwards PEEK was implanted associated with anterolateral thigh flap to repair palatal defects if necessary. All patients were followed up at regular intervals after surgical implantation of PEEK to observe postoperative complications. And postoperative appearance and function of the patients were evaluated by clinical and CT examinations one month after surgery.Results:PEEK implant operation was carried out with all of the patients according to the preoperative design. During implantation, PEEK did not match exactly with the defects in 2 patients. Then PEEK could be put into position after trimming and grinding. Three patients were performed anterolateral thigh flaps at the same time to restore the palatal defects to separate the oral and nasal cavity. The wound healed well after operation in all of the patients. All of the flaps survived, and the survival rate was 100%. Facial symmetry and eyeball location were well restored and mouth opening was recovered to normal after surgery. Image fusion showed the location of PEEK implant was accurate with an error of (0.68±0.12) mm. In 6 patients with benign lesions, postoperative orbital volume [(26.37±0.94) ml], eye vertical position [(0.98±0.48) mm] and the ratio of exophthalmos [(1.10±0.28) mm ]were significantly improved compared to pre-operation [(24.06±0.85) ml, (3.83±0.81) mm, (2.53±0.67) mm]. The difference were statistically significant ( P<0.05). In 7 patients with maxillary defects after tumor resection, postoperative eye verticalposition [(0.77±0.42) mm] and the ratio of exophthalmos [(0.61±0.31) mm] were significantly improved compared to pre-operation [(2.03±1.07) mm, (2.01±0.34) mm]. The difference were statistically significant ( P<0.05). The range of postoperative follow-up was 1-27 months [(12.0±7.6 ) months]. During follow-up, a PEEK implant was removed in one case because of implant extrusion and the other due to tumor recurrence. Conclusions:With the aid of virtual surgical planning, the personalized PEEK implant combined or not with hard/soft tissue flap can accurately restore the maxillary appearance and support the orbital floor, thus effectively improving the accuracy and safety of maxillary reconstruction.

Objective:High-flow nasal cannula (HFNC) is a new method to treat adult respiratory distress. This study aims to explore the early predictors of the inefficiency of HFNC in patients with respiratory distress.Methods:A total of 162 patients with respiratory distress were treated with HFNC oxygen therapy in the Department of Respiratory and Critical Care Medicine, Emergency and Critical Care Medicine. The age, sex, weight, history, diagnosis, vital signs, blood oxygen saturation/inhaled oxygen concentration (SpO 2/FiO 2, SF) ratio, and modified respiratory distress score (mRDAI) , duration of HFNC oxygen therapy, replacement of advanced oxygen therapy support time, adverse reactions and other data were extracted from the medical electronic medical records. Results:A total of 154 valid samples were included, with a median age of 55 (inter-quartile range 47-72), including 59 patients (38.3%) with acute bronchiolitis, 64 patients (41.6%) with bacterial pneumonia, 31 patients (20.1%) with atypical or viral pneumonia; 129 patients (83.8%) with effective HFNC oxygen therapy and 25 patients (16.2%) with ineffective HFNC oxygen therapy. SF ratio in ineffective HFNC oxygen therapy patients at admission was lower, pH value was lower, partial pressure of carbon dioxide was higher ( P values were 0.008, 0.012, 0.001). RR, mRDAI score and SF ratio in the first hour of effective HFNC oxygen therapy patients improved significantly ( t values were 1.732, 9.783, 37.591, P<0.05 or 0.01). SF ratio in the first hour of HFNC was lower than 195 (area under curve 0.842, 95% CI 0.743-0.942, P<0.01). It was the critical value for the ineffectiveness of oxygen therapy. Conclusions:When patients with respiratory distress are supported by HFNC oxygen therapy, the lower initial fingertip oxygen saturation, higher blood gas arterial partial pressure of carbon dioxide and lower SF ratio are the early predictors of failure of HFNC oxygen therapy.

Objective:To investigate the cognition of orthopedic nurses on perioperative nursing risk of orthopedic elderly patients in Beijing, and to understand its influencing factors.Methods:From August to October 2019, 171 orthopedic nurses from two Class Ⅲ Grade A hospitals and one Class Ⅱ Grade A hospital in Beijing were selected as research subjects. The self-designed questionnaire was used to conduct a questionnaire survey, and the survey content included the general information, nursing risk cognition and nursing risk management of the survey subject. The t-test and one-way ANOVA analysis were used for group comparisons, and multiple linear regression analysis was used for multivariate analysis. Results:Among 171 orthopedic nurses, the total score of nursing risk was (39.56±7.85) . In individual scores, two aspects of awareness of the cause and preventive measures of falls had the highest scores, respectively (3.62±0.76) and (4.04±0.72) , and the lowest postoperative delirium score was (3.00±0.99) and (3.06±1.02) respectively. Univariate analysis showed that there were statistical differences in the scores of nurses' cognition on perioperative nursing risk of orthopedic elderly patients among nurses with different education levels, positions, whether they were specialist orthopedic nurses, the proportion of elderly patients in the ward, the importance of nursing managers and the number of department training in the past two years ( P<0.01) . Multivariate analysis showed that the influencing factors of orthopedic nurses' cognition on perioperative nursing risk of orthopedic elderly patients included whether they were specialist orthopedic nurses, the proportion of elderly patients in the ward, the importance of nursing managers and the number of department training in the past two years with statistical differences ( P<0.05) . Conclusions:Orthopedic nurses have a moderate level of cognition on the nursing risk of orthopedic elderly patients, and their overall cognition needs to be improved. Nursing managers should focus on cultivating the risk awareness and risk assessment capabilities of orthopedic nurses, pay attention to the training and use of orthopedic specialist nurses, and improve the management system of orthopedic specialist nurses.

Objective: To investigate the incidence and risk factors of peripartum mood disorder (PPMD) in order to improve clinical prevention and intervention of this condition. Methods: This was a prospective cohort study recruiting first-trimester pregnant women (<13 gestational weeks) from Beijing Daxing Maternal and Child Care Hospital from October 1, 2016 to December 31, 2017. Zung Self-rating Anxiety Scale (SAS) and Zung Self-rating Depression Scale (SDS) were used to evaluate the anxiety and depression status in the second and third trimesters, respectively. Their life styles, social and environmental factors exposure during pregnancy were also collected. Statistical analysis was conducted using Chi-square test, student's t test, Mann-Whitney U test and multivariate logistic regression. Results: (1) A total of 478 subjects were enrolled in early pregnancy and 460 (96.2%) and 431 (90.2%) of them completed SAS and SDS assessment in the second and third trimesters, respectively, and 413 (86.4%) of the subjects finished both assessments on two occasions. (2) The prevalence of anxiety and depression was 7.1% (30/425) and 13.9% (59/425) in the second trimester, and 11.2% (44/392) and 21.5% (84/390) in the third. The incidence of anxiety and depression in the third trimester was 7.7% (26/336) and 9.6% (30/313). (3) Cross-sectional data analysis showed that prolonged television watching was a risk factor of anxiety in the second (OR=1.216, 95%CI: 1.055-1.402) and third (OR=1.166, 95%CI: 1.044-1.303) trimester, while exercise was a protect factor (OR=0.238, 95%CI: 0.105-0.541; OR=0.432, 95%CI: 0.212-0.879). Pregnant women with longer sleeping time had lower risks of depression in the second trimester (OR=0.725, 95%CI: 0.554-0.950); those who did exercise had lower risks of depression in the third trimester (OR=0.450, 95%CI: 0.252-0.803). (4) Longitudinal-data analysis revealed that longer television watching time in the second trimester was a risk factor for anxiety (OR=1.264, 95%CI: 1.117-1.432) and depression (OR=1.119, 95%CI: 1.005-1.246) in the third trimester. Conclusions The prevalence of anxiety and depression in the third trimester is higher than that in the second trimester. The incidence of depression is higher than that of anxiety in the third trimester. Prolonged television viewing time in the second trimester is a risk factor for both anxiety and depression in the third trimester.

The morbidity and mortality of stroke caused by large vessel occlusion are high,and its outcome is closely associated with emergency treatment.In order to receive treatment within the time window,the effective prehospital assessment is very important.The prehospital stroke scale simplifies emergency screening and assessment of such patients.Although the predictive value is good,its role remains controversial.This article reviews some of the prehospital stroke scales used to identify large vessel occlusions and analyzed the characteristics of different scales.