Objective To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults. Methods Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing. Results All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results (Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results (P<0.05). Conclusion For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient’s knee joint function recovers well.
ObjectiveTo investigate the effectiveness of U-shape titanium screw-rod fixation system with bone autografting for lumbar spondylolysis of young adults.
MethodsBetween January 2008 and December 2011, 32 patients with lumbar spondylolysis underwent U-shape titanium screw-rod fixation system with bone autografting. All patients were male with an average age of 22 years (range, 19-32 years). The disease duration ranged from 3 to 24 months (mean, 14 months). L3 was involved in spondylolysis in 2 cases, L4 in 10 cases, and L5 in 20 cases. The preoperative visual analogue scale (VAS) and Oswestry disability index (ODI) scores were 8.0±1.1 and 75.3±11.2, respectively.
ResultsThe operation time was 80-120 minutes (mean, 85 minutes), and the blood loss was 150-250 mL (mean, 210 mL). Primary healing of incision was obtained in all patients without complications of infection and nerve symptom. Thirty-two patients were followed up 12-24 months (mean, 14 months). Low back pain was significantly alleviated after operation. The VAS and ODI scores at 3 months after operation were 1.0±0.5 and 17.6±3.4, respectively, showing significant differences when compared with preoperative ones (t=30.523,P=0.000;t=45.312,P=0.000). X-ray films and CT showed bone fusion in the area of isthmus defects, with the bone fusion time of 6-12 months (mean, 9 months). During follow-up, no secondary lumbar spondyloly, adjacent segment degeneration, or loosening or breaking of internal fixator was found.
ConclusionThe U-shape titanium screw-rod fixation system with bone autografting is a reliable treatment for lumbar spondylolysis of young adults because of a high fusion rate, minimal invasive, and maximum retention of lumbar range of motion.
Objective To investigate the possibility of differentiation of theisolated and cultured adipose-derived adult stem cells into chondrocytes, which is induced by the recombinant human bone morphogenetic protein 2 (rhBMP-2). Methods The rabbit adipose tissue was minced and digested by collagenase Type Ⅰ. The adposederived adult stem cells were obtained and then they were cultured inthe micropellet condition respectively in the rhBMP-2 group, the rhTGF-β1 group, the combination group, and the control group for 14 days. The differentiation of the adiposederived stem cells into chondrocytes was identifiedby the histological methods including HE, Alcian blue, Von kossa, and immunohistochemical stainings. Results After the continuous induction by rhBMP-2 and continuous culture for 14 days, the HE staining revealed a formation of the cartilage lacuna; Alcian blue indicated that proteoglycan existed in the extracellular matrix; the immunohistochemical staining indicated that collagen Ⅱ was in the cellular matrix; and Von kossa indicated that the adipose-derived stem cells couldnot differentiate into the osteoblasts by an induction of rhBMP-2. Conclusion In the micropellet condition, the adipose-derived adult stemcells can differentiate into the chondrocytes, which is initially induced by rhBMP-2. This differentiation can provide a foundation for the repair of the cartilage injury.
ObjectiveTo observe the abnormal clinical manifestations of retinal blood vessels and the characteristic image characteristics of optical coherence tomography (OCT) in young myopia. MethodsA case observation study. From July to December 2020, 523 young patients with different myopia refractive powers who were treated in Department of Ophthalmology of The Second Hospital of Hebei Medical University were included in the study. Among them, 277 were males and 246 were females; the median age was 19.0 (5.0) years. All the affected eyes underwent best corrected visual acuity (BCVA), frequency domain OCT (SD-OCT) examination and axial length (AL) measurement. The BCVA examination was performed using the Snellen eye chart. The median myopia refractive power of the affected eye was 5.00 (3.25) D. Among them, low myopia, moderate myopia, and high myopia were 227, 405, and 414 eyes, respectively. The average AL of the affected eye was 25.6±2.8 mm. The frequency domain OCT instrument was used to scan the temporal side of the retina, the upper and lower nasal vascular arches and the macular fovea radially. The images of retinal vascular cysts, microfolds, and lamellar hole were acquired and stored. The prevalence, composition ratio, distribution rule and OCT imaging characteristics of retinal paravascular abnormalities were observed and analyzed. The distribution of paravascular abnormalities in the retina was compared by the χ2 test; the age, refractive power, and AL of different paravascular abnormalities were compared by the K-W rank sum test. ResultsOf the 1046 different diopters of myopic eyes, there were 227 eyes in mild myopia, 405 eyes in moderate myopia and 414 eyes in high myopia. Retinal paravascular abnormalities were detected by SD-OCT in 40 eyes (3.8%,40/1046). The prevalence of retinal paravascular abnormalities in moderate myopia was 0.7% (3/405) and high myopia was 8.9% (37/414). No retinal paravascular abnormalities were observed in mild myopia.Retinal paravascular cysts in 40 eyes (3.8%, 40/1046), retinal paravascular microfolds in 28 eyes (2.7%, 28/1046) and retinal paravascular lamellar holes in 13 eyes (1.2%, 13/1046). Of 40 eyes with retinal paravascular abnormalities, retinal paravascular cysts in all 40 eyes (100.0%, 40/40), retinal paravascular microfolds in 28 eyes (70.0%, 28/40) and retinal paravascular lamellar holes in 13 eyes (32.5%, 13/40). Twelve eyes with simple cyst cavity (30.0%, 12/40); 15 eyes were with cyst cavity with micro-wrinkles (37.5%, 15/40); 13 eyes were with cyst cavity, micro-wrinkles and lamellar holes (32.5%, 13/40). The temporal vascular arch retinal paravascular cysts (χ2=25.664), microfolds (χ2=14.973), and lamellar holes (χ2=13.499) were significantly more than those on the nasal side, and the difference was statistically significant (P＜0.001). ConclusionsThe total prevalence of retinal paravascular abnormalities in young myopia is 3.8%; it can occur in both moderate and high myopia. The paravascular cyst may be the earliest pathology of paravascular abnormalities in the retina. The three paravascular abnormalities are mostly distributed along the temporal arch of the retina.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
Objective To explore the effect of low-load resistance training on physical fitness in aged adults. Methods Select the aged adults who will go to the outpatient Department of Rehabilitation Medicine of Peking Union Medical College Hospital between June 1, 2020 and May 31, 2021. The aged adults were randomly divided into three groups by using the method of random number table: medium intensity aerobic training group (aerobic training group), standard-load resistance training group (standard-load group) and low-load resistance training group (low-load group). The basic information, exercise endurance (peak power, peak oxygen uptake), exercise cardiopulmonary function [peak heart rate, predicted peak heart rate, peak minute ventilation (VE), ventilatory equivalent for carbon dioxide at anaerobic threshold (EqCO2 during AT)], muscle strength, and muscle oxygen related indexes were collected blindly before the first exercise and after 12 weeks of training, respectively. To compare the differences of the indexes before and after training. Results A total of 90 patients were enrolled, 30 in each group. There was no significant difference in age, sex, height, weight and body mass index among the three groups (P>0.05). There was no significant difference in cardiopulmonary endurance, cardiopulmonary function, muscle strength, muscle oxygen related indexes between the groups before and after training (P>0.05). Except for the indexes related to cardiac function (peak heart rate, predicted peak heart rate) and resting muscle oxygen level (P>0.05), other indexes related to pulmonary function, cardiopulmonary endurance, muscle strength, and time of muscle oxygen falling to the valley in the three groups were statistically significant compared with those before training (P<0.05). Except for peak power, peak oxygen uptake and time of muscle oxygen falling to the valley (P>0.05), the difference of muscle strength before and after training in the three groups was statistically significant (P<0.05), including grip strength, chest push, sitting rowing, leg extension, hip abduction, body bending and horizontal push and push, and the low-load group was better than the aerobic training group (P<0.05), but the improvement of body bending and horizontal push and push in the standard-load group was better than the low-load group (P<0.05). Conclusions Low-load resistance training, standard-load resistance training and aerobic training have almost the same effect on improving the physical fitness of the elderly. Low-load resistance training is superior to medium intensity aerobic training in improving muscle strength, which is an effective method to improve the physical fitness of the aged adults.
ObjectiveTo explore the regional and urban-rural disparities in the hypertension incidence of Chinese adults. MethodsBased on the data from the China Health and Nutrition Survey (CHNS), as well as the consumption level and altitude data from the National Bureau of Statistics and government official website, a robust multilevel Poisson regression was performed to explore the regional and urban-rural disparities in the hypertension incidence of Chinese adults, according to data and design types. ResultsAccording to the inclusion and exclusion criteria, 11 579 subjects and totaling 50 957 lines of data were enrolled. The 24 years follow-up results indicated that the crude incidence density of hypertension was 37.08/1 000 person years, with 40.51/1 000 person years for males and 34.13/1 000 person years for females. The robust multilevel Poisson regression results indicated that, by adjusting the high-level factors such as time, the proportion of the community mainly engaged in agricultural labor, and the consumption level of subjects, as well as sociodemographic characteristics such as age and gender, the Middle (RR=1.20, 95%CI 1.04 to 1.39), Northeast (RR=1.25, 95%CI 1.03 to 1.52), and Eastern (RR=1.25, 95%CI 1.05 to 1.48) China had a higher risk of developing hypertension than the Western China. The risk of hypertension in urban area was lower than that in rural area (RR=0.87, 95%CI 0.77 to 0.96). ConclusionThe incidence density of hypertension in China is relatively high, and male is higher than female. The incidence of hypertension in the Western China is lower than that in the Middle, Northeast and Eastern China, and urban area is lower than rural area.
Objective To explore and implement a systematic, case guided online interactive training course for neurologists to improve their diagnosis and treatment of rare genetic diseases. Methods Doctors who participated in the course investigation of the neurogenetic project of the Department of Neurology of Peking Union Medical College Hospital between January and September 2021 were selected. Based on andragogy theory, a genetics training course for neurologists was developed by applying Kern’s six steps of curriculum development. According to the time of participating in the doctor’s courses, they were divided into three groups: completed all courses (10.7 h group), completed more than 1/2 courses (5.3～10.7 h group) and completed less than 1/2 courses (<5.3 h). According to the length of service, they were divided into groups of less than 10 years, 10-20 years and more than 20 years. Analyze the benefit difference of different doctors’ training time, and collect their feedback scales on the curriculum for the improvement of follow-up courses. Results A total of 54 doctors were included. Among them, 17 (31.5%) completed all courses, 29 (53.7%) completed more than 1/2 courses, and 8 (14.8%) completed less than 1/2 courses. There was a statistically significant difference among the three groups in the self-assessment improvement score (H=12.341, P=0.002). The results of pairwise comparison between groups of self-assessment improvement score showed that the <5.3 h group was lower than that of the 10.7 h group (P=0.007), and the the <5.3 h group was also lower than that of the 5.3～10.7 h group (P=0.002). 33 (61.1%) in the less than 10 years group, 16 (29.6%) in the 10-20 years group, and 5 (9.3%) in the more than 20 years group. There was no correlation between participating in work and course time (rs=0.113, P=0.418). 54 (100.0%) believed that they had more than moderate help (≥3 points). Most doctors (>90%) had a good evaluation of the curriculum. Conclusion The periodic neurogenetic re-education project is helpful for clinical diagnosis and treatment of rare neurogenetic diseases.
ObjectiveTo summarize the research progress of femoral neck system (FNS) in the treatment of femoral neck fracture in young and middle-aged patients. Methods The literature on FNS at home and abroad in recent years was extensively reviewed, and the results of mechanical and clinical studies on FNS were summarized based on clinical experience. Results FNS has good mechanical stability, which can reduce complications such as femoral neck shortening, internal fixation failure, and varus caused by mechanical instability. At present, FNS is mainly selected for comparison with cannulated compression screws and dynamic hip screws in clinical research. The results show that FNS has the advantages of minimally invasive, short operation time, less intraoperative fluoroscopy, earlier postoperative weight-bearing and fracture healing, and better hip function recovery. Conclusion As a new internal fixator, FNS has achieved satisfactory results in the current research. FNS has good mechanical advantages, which is beneficial to fracture healing and the recovery of hip joint function after operation. However, whether FNS can reduce the incidence of nonunion and osteonecrosis of the femoral head remains to be further clarified.
Sarcopenia, characterized by the progressive loss of muscle mass and function, predominantly afflicts older adults. This condition is a notable risk factor for functional impairments, increased incidence of falls and fractures, and can escalate to mortality. Timely intervention is crucial to mitigate disability and minimize complications during hospitalization. The development of these guidelines adhered to an internationally recognized standard protocol. This involved framing clinical queries, pinpointing key outcomes, systematically gathering evidence, and appraising this evidence through the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Subsequently, a consortium of experts convened to deliberate over the evidence, culminating in the formulation of these recommendations.
