Distributions and trends of the global burden of COPD attributable to risk factors by SDI, age, and sex from 1990 to 2019: a systematic analysis of GBD 2019 data.

BACKGROUND: Global distributions and trends of the risk-attributable burdens of chronic obstructive pulmonary disease (COPD) have rarely been systematically explored. To guide the formulation of targeted and accurate strategies for the management of COPD, we analyzed COPD burdens attributable to known risk factors. METHODS: Using detailed COPD data from the Global Burden of Disease study 2019, we analyzed disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and deaths attributable to each risk factor from 1990 to 2019. Additionally, we calculated estimated annual percentage changes (EAPCs) during the study period. The population attributable fraction (PAF) and summary exposure value (SEV) of each risk factor are also presented. RESULTS: From 1990 to 2019, the age-standardized DALY and death rates of COPD attributable to smoking and household air pollution, occupational particles, secondhand smoke, and low temperature presented consistently declining trends in almost all socio-demographic index (SDI) regions. However, the decline in YLD was not as dramatic as that of the death rate. In contrast, the COPD burden attributable to ambient particulate matter, ozone, and high temperature exposure showed undesirable increasing trends in the low- and low-middle-SDI regions. In addition, the age-standardized DALY and death rates attributable to each risk factor except household air pollution and low temperature were the highest in the low-middle-SDI region. In 2019, the COPD burden attributable to smoking ambient particulate matter, ozone, occupational particles, low and high temperature was obviously greater in males than in females. Meanwhile, the most important risk factors for female varied across regions (low- and low-middle-SDI regions: household air pollution; middle-SDI region: ambient particles; high-middle- and high-SDI region: smoking). CONCLUSIONS: Increasing trends of COPD burden attributable to ambient particulate matter, ozone, and high temperature exposure in the low-middle- and low-SDI regions call for an urgent need to implement specific and effective measures. Moreover, considering the gender differences in COPD burdens attributable to some risk factors such as ambient particulate matter and ozone with similar SEV, further research on biological differences between sexes in COPD and relevant policy-making of disease prevention are required.

[Application of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion].

OBJECTIVE: To investigate the effectiveness of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion. METHODS: Between January 2017 and May 2020, 11 patients with pelvic fractures complicated with severe Morel-Lavallée lesions were treated with channel screw combined with skin-stretching technique. There were 8 males and 3 females, with an average age of 39.2 years (range, 28-58 years). Causes of injury included traffic accident in 9 cases and falling from hight in 2 cases. The time from injury to hospital admission ranged from 1 to 6 days (mean, 3.7 days). According to the Tile classification, the pelvic fractures were rated as type C1 in 7 cases, type C2 in 3 cases, and type C3 in 1 case. The sites of Morel-Lavallée lesions were buttocks in 8 cases, hips in 2 cases, and thigh in 1 case. There was 1 case of rectal injury, 1 case of splenic rupture, 3 cases of craniocerebral injury, 2 cases of chest injury, 4 cases of spinal fracture, and 6 cases of sacral nerve injury. X-ray films were performed to observe reduction and healing of fracture. The quality of fracture reduction was evaluated by Matta standard at 1 week after operation. Wound healing and complications were observed. Majeed scoring was used to evaluate hip function and Gibbons sacral nerve injury grading was used to evaluate neurological function recovery. RESULTS: The patients underwent 4-7 operations, with an average of 5.8 operations. The time of first operation (pelvic fracture fixation, debridement, and skin distractor installation) was 115-275 minutes, with an average of 186.5 minutes. The amount of intraoperative blood loss was 30-80 mL, with an average of 45.5 mL. All patients were followed up 6-12 months, with an average of 8.3 months. The quality of fracture reduction according to the Matta standard was excellent in 7 cases, good in 2 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. All fractures healed at 3-6 months after operation, with an average of 4.5 months. At last follow-up, the hip functions were excellent in 7 cases and good in 4 cases according to Majeed scoring, with an excellent and good rate of 100%. Among the 6 patients complicated with sacral nerve injury, the Gibbons sacral nerve injury grading reached gradeⅠ for 4 cases, gradeⅡ for 1 case, and grade Ⅲ for 1 case. The wounds of 9 cases were sutured directly after skin-stretching treatment for 25-32 days, with an average of 28 days. The dermal edge necrosis occurred in 1 case, and the defect was repaired by free skin grafting. The skin superficial dry necrosis of the wound occurred in 1 case, and healed by dressing change. CONCLUSION: In the treatment of pelvic fracture complicated with severe Morel-Lavallée lesion, the channel screw and skin-stretching technique showed their own advantages, which can obtain early fracture fixation and good wound healing.