Surgical outcomes of proximal femoral bone cysts in pediatric patients: a retrospective study of 41 cases.

Purpose: The aim of this study was to evaluate the surgical outcomes of proximal femoral bone cysts in pediatric patients. Methods: We retrospectively analyzed 41 pediatric patients (31 males and 10 females, mean age 7.47 ± 2.67 years, range 2.03-14.67 years) diagnosed with proximal femoral bone cysts treated at a single institute between March 2009 and November 2021. Data included demographics, preoperative details, intraoperative conditions, surgical techniques, postoperative outcomes, recurrence, and complications. Results: Of the participants, 68% presented with simple bone cysts and 32% with aneurysmal bone cysts. Prior to surgery, 32% exhibited pathological fractures. Surgical methods included lesion curettage, defect filling using allograft bone and Minimally-Invasive Injectable Graft ×3, and varied fixation techniques. Postoperative recurrence (17%) was associated with cyst location between the capital femoral epiphysis and the linea intertrochanterica (P = 0.010). At the final assessment (mean follow-up: 26.51 ± 18.99 months), all showed radiological bony union with 93% rated as "good" and 7% as 'fair' based on Ratliff hip scores. Complications arose in 20% of patients, significantly correlated with prior pathological fractures (P = 0.007) and their association with the linea intertrochanterica (P = 0.004). Those with fractures reported higher intraoperative blood loss (P = 0.015) and longer surgery durations (P = 0.012) compared to those without. Conclusion: Treating pediatric proximal femoral bone cysts using techniques such as lesion curettage, defect filling, and selective internal fixation yields favorable outcomes. The presence of pathological fractures can prolong surgical time, increase intraoperative blood loss, and elevate postoperative complication risks. Hence, early surgical intervention for these cysts is recommended to prevent fractures.

Differential Game-Based Control for Nonlinear Human-Robot Interaction System With Unknown Desired Trajectory.

Differential game is an effective technique to describe the negotiation between the humans and robots, which is widely used to realize the trajectory tracking tasks in the human-robot interaction (HRI). However, most existing works consider the control-affine HRI systems and assume the desired trajectory is available to both the human and the robot, which limit the scope of applications. To overcome these difficulties, this work focuses on the nonaffine HRI system and supposes that the desired trajectory is not available to the robot. A novel differential game framework encoding the desired trajectory estimator is proposed, where the desired trajectory is estimated via the Gaussian process regression (GPR) technique. To address the challenge arising from the nonlinearity of the HRI system, we equivalently transform the original problem into the one in a differentially flat space, and seek the equilibrium strategies for the transformed problem substitutionally. We further prove that the trajectory tracking error satisfies a probabilistic bound, whose confidence interval tightens as the decrease of noise variance during the interaction. Comparative simulation results show that our method outperforms the learning-based method in terms of robustness, parameters setting, and time consumption. Experiment results further show that the tracking error under the proposed human-robot cooperative algorithm is reduced by 55% compared to the human direct control.

Indoleamine 2,3-dioxygenase 1 promotes osteosarcoma progression by regulating tumor-derived exosomal miRNA hsa-miR-23a-3p.

Background: Osteosarcoma (OS) is the most common primary malignant tumor originating in bone. Immunosuppressive enzyme indoleamine 2,3-dioxygenase 1 (IDO1) participates in tumor immune tolerance and promotes tumor progression, while the study of IDO1 in OS is limited. Methods: Immunohistochemistry analysis was performed to test the expression of IDO1 and Ki67. The relationship between IDO1 or Ki67 positive count and clinical stage of the patient was analyzed. Laboratory test indexes including serum alkaline phosphatase (ALP), lactate dehydrogenase (LDH), white blood cell (WBC) count and C-reactive protein (CRP) at diagnosis of OS patients were collected. The relationship between positive count of IDO1 and Ki67 or laboratory test indexes was analyzed by Pearson's correlation analysis. IDO1 stably overexpressed cell lines of these cells (MG63 OE, 143B OE and hFOB1.19 OE) were constructed and validated by Western blot and Elisa. Exosomes were isolated from conditioned culture media of these cells and were identified by Zetaview nanoparticle tracking analyzer. Next-generation sequencing was conducted to identify miRNAs enriched in exosomes. Differentially expressed miRNAs (DE miRNAs) were verified in clinical samples and cell lines by qPCR. Biological processes and cell components analysis of DE miRNAs was conducted by GO enrichment analysis using the protein interaction network database. Results: Immunosuppressive enzyme IDO1 was highly expressed in tumor tissues. 66.7% (6/9) of the tissues showed moderately or strongly positive immunostaining signal of IDO1, and 33.3% (3/9) were weakly positive. The expression of IDO1 was positively related to Ki67 and associated with prognostic-related clinical features of OS patients. Overexpression of IDO1 significantly affected the exosome-derived miRNA subsets from MG63, 143B and hFOB1.19 cells. A total of 1244 DE miRNAs were identified, and hsa-miR-23a-3p was further screened as key DE miRNA involved in the progression of OS. GO analysis of target genes of the DE miRNA results showed that target enrichment in the functions of immune regulation and tumor progression. Discussion: Our results indicate that IDO1 has the potential to promote the progression of OS that is related to miRNAs mediated tumor immunity. Targeting IDO1-mediated hsa-miR-23a-3p may be a potential therapeutic strategy for OS treatment.

Effective detection of Ag+, Hg2+ and dye adsorption properties studies of Ln-MOFs based on a benzimidazole carboxylic acid ligand.

Five new lanthanide metal-organic frameworks (Ln-MOFs), namely {[Ln(L)]·Cl}n, [Ln = Pr(1), Nd(2), Eu(3), Ho(4), Ce(5)], based on a benzimidazole carboxylic acid ligand [H2L = 2-(2-carboxyphenyl)-1H-benzo[d]imidazole-6-carboxylic acid] were synthesized by a solvothermal method. Ln-MOFs 1-5 have the same two-dimensional layered structures. Interestingly, 1-5 exhibit excellent adsorption performance to anionic dye Congo red (CR), with adsorption capacities of 2724 mg g-1, 2719 mg g-1, 2718 mg g-1, 327 mg g-1, and 2273 mg g-1, respectively. Adsorption kinetics experiments showed that this kind of adsorption belonged to chemisorption; the hydrogen bonding and π-π interactions between the 1-5 host and CR guest molecules resulted in a high adsorption capacity. Luminescence and sensing experiments showed that 5 can be considered a promising multifunctional fluorescent sensor with good reusability and a high sensitivity toward Ag+ and Hg2+ ions, with detection limits of 1.7 × 10-7 and 2.5 × 10-6 M, respectively.

A Novel Heterozygous Missense Variant in Parathyroid Hormone 1 is Related to the Occurrence of Developmental Dysplasia of the Hip.

Introduction: Developmental dysplasia of the hip (DDH) is one of the most common diseases in the pediatric orthopedics, with an incidence of 1-5%. Genetic factors are the bases of the pathogenesis of DDH, but the pathogenic variants and pathogenesis of DDH are still unknown. There are no key accurate diagnostic or prognostic molecular markers for DDH. The purpose of our study was to screen for genetic variant associated with DDH and explore its pathogenesis. Materials and Methods: The genetic variation of DDH was tested by variant NGS-based exome analyses, verified by the Sanger sequencing. Results: A four-generation family in which DDH was present in three generations was recruited. A novel heterozygous missense variant c.629C>T (p.(Ala210Val)) in exon 7/8 of the parathyroid hormone 1 receptor (PTH1R) gene was identified through screening of two affected and one unaffected family members. The candidate variant was validated in all available family members with all three affected members being positive for the PTH1R variant. Conclusion: Our results are highly supportive of PTH1R as a novel candidate gene for DDH and demonstrated that the combination of pedigree information and next-generation sequencing is an effective method for identifying pathogenic variants associated with DDH.

Finite Element Analysis of Mechanical Characteristics of Internal Fixation for Treatment of Proximal Femoral Osteolytic Lesions in Children.

OBJECTIVES: Clinically, it is very difficult to prevent pathological fracture caused by high recurrence rate of osteolytic disease of proximal femur in children. At present, there is no consensus in clinical studies of which internal fixation method can significantly reduce the probability of recurrence of pathological fracture. The study aims to research the mechanical properties of different internal fixations in the treatment of osteolytic lesions of proximal femur in children by finite element analysis, and to find out the optimal treatment. METHODS: Based on finite element analysis, the osteolytic disease models of the femoral neck and intertrochanter in a child (8-year-old, boy) were established respectively, and different internal fixation models (plate and titanium elastic intramedullary nails, TENs) were assembled. For the osteolytic lesion of the femoral neck: model A1 was assembled with a plate; model A2 with two TENs crossing the physis; model A3 with two TENs without crossing the physis. And for pertrochanteric osteolytic lesion: model B1 was assembled with a plate, model B2 with two TENs crossing the physis and model B3 with two TENs without crossing the physis. The Eccentric bearing load, torsional restraintal restraint of calcar femorale and composite load were analyzed for each models. RESULTS: When the yield strain of each model is reached, the stress concentration points are located in the proximal and distal femoral calcar. In the model of femoral neck lesions, the failure load of model A1 and model A2 are the same (1250 N), and the failure load of model A3 (980 N) is significantly lower than that of the former two; in the model of intertrochanteric lesions, the failure load of model B2 is the largest (1350 N), and the failure load of model B1 (1220 N) is lower than that of model B3 (1260 N), but both are smaller than that of model B2. CONCLUSION: Through finite element analysis, TENs through the epiphyseal plate, is found to be the better internal fixation method for femoral neck lesions and intertrochanteric lesions under two different working conditions. The results of clinical correlation study provide new biomechanical information for orthopedic doctors to consider different treatment options for osteolytic lesions of proximal femur.

Application of Noise Control Combined with Relaxation Training in Patients with Skin Laser Cosmetology: A Single-center Retrospective Study.

Objective: Noise pollution has been listed as one of the three major types of pollution, along with air and water pollution. Hospitals should pay attention to noise control, which is of great importance for the treatment and rehabilitation of patients. This study focuses on the application value of noise control and relaxation training. Methods: This study retrospectively collected and analyzed the clinical data of 184 patients who underwent skin laser cosmetology in Ningbo Yinzhou No. 2 Hospital from January 2021 to December 2022. Twelve patients who did not meet the criteria were excluded, and the remaining 172 patients were divided based on the type of intervention into the control group (CG, n = 82) and the study group (SG, n = 90). The CG received relaxation training and routine noise management, while the SG received noise control combined with relaxation training. The intervention effect was discussed from the aspects of noise, psychology, and satisfaction. Results: After the intervention, the SG had overtly lower noise levels and lower scores of anxiety and depression compared to the CG (all P < 0.001). Correlation analysis showed that noise levels were positively correlated with scores of anxiety and depression (r = 0.553, r = 0.592, P < 0.001). The two groups had no significant difference in total satisfaction (P > 0.05). Conclusion: Noise poses a significant threat to the human body. Strengthening noise control in hospitals is beneficial for patients' recovery. Combining noise control with relaxation training is an intervention method worthy of clinical application. It can improve the hospitalization environment and reduce the noise levels to a great extent, thereby improving the psychological state of patients and enhancing the medical satisfaction.

Single-port laparoscopy-assisted trans-scrotal hernia sac ligation for pediatric male inguinal hernia.

Objective: We report the introduction of a novel single-port laparoscopic-assisted trans-scrotal hernia sac ligation (LAT-HSL) technique for the treatment of inguinal hernias in pediatric males. In this article, we describe the LAT-HSL technique and the outcomes. Methods: Twenty-five male children with confirmed unilateral inguinal hernia who underwent surgical treatment from January 2020 to September 2021 were selected for this study. All children underwent surgical treatment with LAT-HSL, and the operative time, hospital stay, and postoperative results and complications were recorded. Results: All 25 cases underwent LAT-HSL with minimal perioperative complications, and all children were successfully discharged from the hospital postoperatively. At the postoperative follow-up, there was no retraction or atrophy of the testes, no incisional infection, no chronic pain, no urinary retention, and no recurrent hernias. Conclusion: Single-port LAT-HSL allows for rapid and accurate localization of the extra-abdominal hernia sac. The method is safe, easy to perform, and adaptable. Additionally, the scar is hidden, and the operation time is short.

Silencing LINC00665 inhibits cutaneous melanoma in vitro progression and induces apoptosis via the miR-339-3p/TUBB.

BACKGROUND: LncRNAs are closely related to cutaneous melanoma (CM) tumorigenesis and metastasis, and it can affect the progression of CM by regulating cell proliferation, migration, invasion, apoptosis, and other cellular mechanisms. This study investigated the role of LINC00665 in CM. METHODS: Expressions of LINC00665, miR-339-3p, and tubulin beta chain (TUBB) in CM cells were analyzed by qRT-PCR and/or Western blot. The LINC00665/miR-339-3p/TUBB targeting network was predicted by bioinformatics tools, screened out by Venn diagrams and analyzed by Pearson's correlation coefficients, followed by validation via dual-luciferase reporter assay and/or pull-down assay. Transfection of siLINC00665 or miR-339-3p inhibitor/mimic was conducted with CM cells whose viability, proliferation, migration, invasion, cell cycle progression, and apoptosis were measured by CCK-8 assay, colony formation assay, wound healing assay, Transwell assay, and flow cytometry. The associations of TUBB with tumor biological characteristics and other proteins were analyzed by CanserSEA and String, respectively. RESULTS: High-expressed LINC00665 was detected in CM cells. Silencing LINC00665 decreased CM cell viability; inhibited colony formation, cell cycle progression, migration and invasion; enhanced apoptosis; and upregulated miR-339-3p. LINC00665 targeted miR-339-3p which targeted TUBB. MiR-339-3p upregulation induced effects similar to the LINC00665-silencing-induced effects and could downregulate TUBB, which was associated with malignant behaviors and related to other five proteins. MiR-339-3p downregulation induced the opposite effects of what miR-339-3p upregulation induced, and the miR-339-3p downregulation-induced effects could be reversed by LINC00665 silencing. CONCLUSION: Silencing LINC00665 inhibits in vitro CM progression and induces apoptosis via the miR-339-3p/TUBB axis.

Establishment of pediatric developmental dysplasia of the hip biobank: Shanghai children's hospital experience.

Developmental dysplasia of the hip (DDH) is a debilitating condition that affects 1-7% of newborns. Children with DDH, not treated early and effectively, will easily lead to disability. A better understanding of the biology of DDH is critical to the development of prognostic biomarkers and novel therapies. The purpose of this study was to establish a biobank of DDH genetic resources, to facilitate clinical and basic scientific research. The biological specimen and clinical data of DDH were collected in Shanghai Children's Hospital from 2014 to 2021. The collection of blood samples was performed at definitive diagnosis and review, tissue specimens were performed at definitive surgery. The clinical data was collected at the whole stage of DDH patients at diagnosis, treatment and follow-up. A total of 528 patients with DDH were enrolled in this study, 90 were men and 438 were women, with the mean age of 4.67 years. The numbers of tissue and blood specimens reached 2172 and 1490, respectively. The quality test results showed that the DNA concentration decreased slightly with the extension of storage time, but the DNA purity did not change. Meanwhile, the extension of storage time slightly affected the stability of protein of tissue samples but did not affect the expression of the housekeeping gene. The DDH biobank built has the potential of monitoring disease pathogenesis and progress, which could provide specimens to the researchers improving the biological understanding and provide guidance of clinical treatment of this disease to clinicians.

Exponential Consensus of Linear Systems Over Switching Network: A Subspace Method to Establish Necessity and Sufficiency.

In this article, the consensus problem of linear systems is revisited from a novel geometric perspective. The interaction network of these systems is assumed to be piecewise fixed. Moreover, it is allowed to be disconnected at any time but holds a quite mild joint connectivity property. The system matrix is marginally stable and the input matrix is not of full-row rank. By directly examining the subspace determined by the network, we first establish convergence by resorting to an observability condition. Then, according to joint connectivity, we are able to extend this convergence uniformly to the entire orthogonal complement of the consensus manifold. In this way, we work out the necessary and sufficient condition for exponential consensus. It turns out that, with a suitably designed feedback matrix, exponential consensus can be realized globally and uniformly if and only if a jointly (δ,T) -connected condition and an observability condition relying only on the system and input matrices are satisfied. We also characterize the lower bound of the convergence rate. Simple yet effective examples are presented to illustrate the findings.

On Containment for Linear Systems With Switching Topologies: A Novel State Transition Matrix Perspective.

This article studies the containment control problem for a group of linear systems, consisting of more than one leader, over switching topologies. The input matrices of these linear systems are not required to have full-row rank and the switching can be arbitrary, making the problem quite general and challenging. We propose a novel analysis framework from the viewpoint of a state transition matrix. Specifically, according to the inherent linearity, we successfully establish a connection between state transition matrices of the above multileader system and a virtual leader-following system obtained by combining those leaders. This enlightening result relates the containment problem to a consensus one. Then, by analyzing the property of the state transition matrix, we uncover that each component of any follower's state converges to the convex hull spanned by the corresponding components of the leaders', provided some mild conditions are satisfied. These conditions are derived in terms of the concept of a positive linear system. A special case of the second-order linear system is further discussed to illustrate these conditions. Moreover, two different design methods of the feedback gain matrix are provided, which additionally require that the network topology contains a united spanning tree all the time.

Hierarchical Optimal Synchronization for Linear Systems via Reinforcement Learning: A Stackelberg-Nash Game Perspective.

Considering the fact that in the real world, a certain agent may have some sort of advantage to act before others, a novel hierarchical optimal synchronization problem for linear systems, composed of one major agent and multiple minor agents, is formulated and studied in this article from a Stackelberg-Nash game perspective. The major agent herein makes its decision prior to others, and then, all the minor agents determine their actions simultaneously. To seek the optimal controllers, the Hamilton-Jacobi-Bellman (HJB) equations in coupled forms are established, whose solutions are further proven to be stable and constitute the Stackelberg-Nash equilibrium. Due to the introduction of the asymmetric roles for agents, the established HJB equations are more strongly coupled and more difficult to solve than that given in most existing works. Therefore, we propose a new reinforcement learning (RL) algorithm, i.e., a two-level value iteration (VI) algorithm, which does not rely on complete system matrices. Furthermore, the proposed algorithm is shown to be convergent, and the converged values are exactly the optimal ones. To implement this VI algorithm, neural networks (NNs) are employed to approximate the value functions, and the gradient descent method is used to update the weights of NNs. Finally, an illustrative example is provided to verify the effectiveness of the proposed algorithm.

Prevalence and Clinical Significance of Occult Fractures in the Extremities in Children.

Objective: Diagnosis of occult fractures by initial plain radiographs remains challenging in children in the emergency room. This study was to assess the prevalence and distribution of occult fracture in children with acute extremities injuries (AEI) and clinical suspicion of fracture. Methods: We conducted a retrospective study to review the medical records of all pediatric patients with AEI in the orthopedic emergency room from January 1, 2017, to December 31, 2019. For patients with concerning history and physical examination but negative initial radiographs, we conducted the following three diagnostic strategies according to the choic of children's parents: immediate MRI scanning, [2] immediate CT scanning, or [3] empiric cast immobilization with orthopedic follow-up radiographs at 2 weeks post-injury (late radiographs). Prevalence and distribution of occult fracture were recorded. Results: A total of 43,560 pediatric patients meet the inclusion criteria. A total of 4,916 fractures of the extremities were confirmed by initial plain radiographs, and 550 occult fractures were confirmed by immediate MRI, immediate CT, or late radiographs. The prevalence of occult fracture in the extremities was 10.1% (550/5,466). Supracondylar fractures were the most prevalent (2,325/5,466, 42.5%) but had the lowest rate of occult fractures (117/2,325, 5.0%). The highest rate of occult fracture was distal epiphyseal fracture of the tibia and fibula (49/145, 33.8%), but these had a relatively lower prevalence of fractures (145/5,466, 2.65%). Conclusions: We should be aware of the relative high prevalence of occult fractures in the extremities in children, especially when the injured site is in the high incidence area of occult fracture such as ankle.

Identification of drug resistance genes and drug resistance analysis of Salmonella in the duck farm environment of Zhanjiang, China.

This study investigated and identified the distribution of drug resistance genes in feces, soil, and water of duck farms in Zhanjiang, China, and analyzed the drug resistance of Salmonella in the duck farm environment. PCR was used to assess the distribution of 25 resistance genes that are common in the duck farm environment. The isolation, biochemical identification, PCR identification of Salmonella, and the minimum inhibitory concentration (MIC) of 22 drugs were measured by micro-broth double dilution. In water, 25 drug resistance genes were detected, 24 in soil, and 23 in feces. Among them, the detection rate of the aadA1 gene in soil reached 100%, 13 drug resistance genes had a detection rate above 80%, and five species had a detection rate below 50%. In water, the detection rate of the floR and aadA1 genes was 100%, 12 drug resistance genes had a detection rate above 80%, and eight genes had a detection rate below 50%. In feces, nine drug resistance genes had a detection rate of 100%, nine genes had a detection rate above 80%, and one gene had a detection rate below 50%. In addition, 92 strains of Salmonella were isolated and identified, and their resistance rate to nine drugs was as high as 100%. All isolated Salmonella can tolerate at least nine drugs, 55.43% (51/92) of the strains can tolerate more than 16 drugs, and 4.35% (4/92) of the strains were resistant to up to 21 drugs. In conclusion, the present experiment suggested that drug resistance genes were ubiquitous in the duck farm environment in Zhanjiang and that these drug resistance genes may spread horizontally between feces, soil, and water. Moreover, drug resistance and multi-drug resistance were found for 92 isolated Salmonella strains from the duck farm environment. The government should consequently strengthen the regulation of antimicrobial drug use in duck farms.

Giant fibrous hamartoma of infancy: A case report.

RATIONALE: Fibrous hamartoma of infancy (FHI) is a rare benign soft-tissue tumor in children with a triphasic organoid histologic appearance. PATIENT CONCERNS: We here report a case with the largest FHI published so far. A 13-month-old boy with a rapidly growing tumor 45 cm in length and 69.3 cm in circumference of the left lower extremity was identified immediately at birth. DIAGNOSES: The diagnosis was uncertain before the operation, although biopsy was conducted. The postoperation histological examination showed arranged spindle cells, adipose tissue, and nests of immature small cells embedded in a myxoid background, which is the characteristic triphasic histology of FHI. INTERVENTIONS: Under general anesthesia, hip and lower extremity amputation was performed. OUTCOMES: The patient was followed-up for 6 years and no signs of recurrence were found, suggesting a favorable prognosis, although a part of the residual tumor was present after the surgery. LESSONS: FHI exhibits pathological and clinical characteristics. However, differential diagnosis of FHI from other soft-tissue tumors before operation remains a challenge. Thus, sometimes, aggressive therapy for the treatment of FHI might be a good choice to get a satisfactory.

Correlation between spinal coronal balance and static baropodometry in children with adolescent idiopathic scoliosis.

BACKGROUND: Scoliosis is accepted as a 3-dimensional deformity involving axial, sagittal and frontal planes. RESEARCH QUESTION: To evaluate the correlation between baropodometric parameters and coronal balance status for idiopathic scoliosis. METHODS: 44 patients (7 males and 37 females) of Adolescent Idiopathic Scoliosis (AIS) were recruited. All participants should have scoliosis confirmed by a spine X-ray performed less than one month ahead of the baropodometric study. Radiographic studies including Cobb angle, offset between Central Sacral Vertical Line (CSVL) and C7 Vertebra Plumb Line (C7PL) (considered as global coronal balance, GCB), Apical Translation of the major curve (AT, considered as regional coronal balance) as well as Lateral Pelvic Tilt (LPT) were examined. A static baropodometry was performed for each patient. The contact surface and load ratio (to the entire load of both feet) were measured. RESULTS: On both sides, the surface of the forefoot was significantly larger than that of the rearfoot (P < 0.001) and the load ratio of the forefoot was significantly smaller than that of the rearfoot (P < 0.001). On the major curve side, GCB showed a positive correlation with the contact surface of the forefoot (r = 0.36, P = 0.019), as well as the load ratio (r = 0.40, P = 0.008). AT also showed a positive correlation with the load ratio of the forefoot (r = 0.331, P = 0.03) but no correlation with contact surface. SIGNIFICANCE: In scoliosis, coronal balance is correlated to plantar pressure distribution. Apical translation of the major curve and offset between CSVL and C7PL are the best describers of coronal balance.

Elastic Stable Titanium Flexible Intramedullary Nails Versus Plates in Treating Low Grade Comminuted Femur Shaft Fractures in Children.

OBJECTIVES: To review the experience at our center with elastic stable titanium flexible intramedullary nails (ESIN) for pediatric femoral shaft unstable fractures. METHODS: From January 2015 to January 2017, 56 consecutive patients with femur shaft fractures were treated in our hospital. History and radiologic parameters were retrospectively reviewed. The inclusion criteria were: femur shaft fractures treated by ESIN or locking compressing plates (LCP); more than 2 years' follow-up care; and complete clinical information. A total of 51 patients were included according to the criteria: 16 girls and 35 boys. Ages at operation averaged 5.9 ± 2.8 years. OUTCOME: anteroposterior (AP) and lateral X-ray radiographs were performed every 2 weeks before the fracture healing, every 3 months until 1 year, then once a year after the surgery. Clinical examinations were recorded for any clinical deformity, hardware prominence, pain, and infection. ESIN were applied in either a retrograde or an antegrade fashion for 29 patients. For 22 patients, LCP were implanted. For the remaining 5 cases, instruments other than ESIN and LCP were applied. RESULTS: The average follow-up time was 29 months (range, 24-37 months). The average operation time was 78.2 min (range, 25-155 mins). The average blood loss in surgery was 69.6 mL (range, 3-700 mL). The average healing of fracture time was 2.2 month (range, 1-6 months). The average removal of implants time was 7.8 months (range, 3-20 months). The average expense for index operation was CNY 31 100 (CNY 17 500-142 200). Comminution grades were strongly correlated with time to fracture union (P < 0.001, r = 0.53) and time to implant removal (P = 0.006, r = 0.38). For comminuted pattern, the operation time and blood loss during operation in LCP were significantly higher than those in ESIN (P = 0.037 and P = 0.006, respectively). Other clinical parameters were similar between the two groups. No clinically detectable LLD, rotational or angular deformity was found. All patients recovered full knee range of motion. In this series, 30 patients (59%) had complications; 26 minor complications (51%) did not require unplanned surgery, most of which were prominence of hardware; 4 patients (8%) had a major complication and underwent an unplanned surgery. Of these, 2 were refractures distal to primary fracture and 2 were intolerable prominence of ESIN. CONCLUSIONS: Elastic stable intramedullary nails provide equivalent outcomes but decreased operative time and blood loss during surgery, and lower hospitalization cost in treating low-grade comminuted femur shaft fracture compared with plating techniques. The results of this study support the use of ESIN over plates in low-grade comminuted femur shaft fractures despite the fact that both options are indicated.

Screening for Developmental Dysplasia of the Hip in Infants in Tibet Identifies Increased Prevalence Associated with Altitude.

BACKGROUND Developmental dysplasia of the hip (DDH), also known as congenital hip dislocation or congenital hip dysplasia is usually diagnosed at birth. Studies on DDH at high-altitude are rare. Tibetans live mainly at altitudes above 3,500 m, and the prevalence of DDH in this population is not currently known. This cross-sectional epidemiological study aimed to identify the prevalence and associated risk factors for DDH in Tibet. MATERIAL AND METHODS Between 1st June 2015 and 30 June 2016, infants in Tibet aged between 0-6 months and from ten districts at different altitudes in Shigatse, Tibet were referred to our hospital for the assessment of DDH. All the infants underwent clinical evaluation for DDH and ultrasound testing using the Graf method. RESULTS There were 606 infants who met the study inclusion criteria, including 253 female infants and 353 male infants, of which 106 infants had DDH. The prevalence of DDH in Shigatse, Tibet was approximately 174.9/1000 infants (106/606). Altitude was strongly associated with increased risk of DDH in Tibet (r=0.82, P=0.004). CONCLUSIONS This is the first epidemiological study of DDH in the Tibetan population. The results showed that DDH is prevalent among native Tibetan people in Shigatse, and there was a significant correlation between altitude and the prevalence of DDH. Further studies are needed to investigate the mechanism of the association between altitude and the increased incidence of DDH in infants.

Coronal Balance vs. Sagittal Profile in Adolescent Idiopathic Scoliosis, Are They Correlated?

Background: Clinical evaluation of the postural balance in adolescent idiopathic scoliosis has been evaluated by coronal and sagittal parameters. The relationship between coronal and sagittal parameters has not been fully studied in adolescent idiopathic scoliosis. Objective: This study aimed to evaluate the relationship between coronal and sagittal parameters in idiopathic scoliosis. Methods: One hundred and three patients of Adolescent Idiopathic Scoliosis (AIS) were recruited. Radiographs were evaluated for the following spine and pelvic measurements. Coronal parameters including thoracic Cobb angle (TC), lumbar Cobb angle (LC), global coronal balance (GCB), apical translation of the major curve (AT), and coronal pelvic tilt (CPT) were analyzed. Sagittal parameters including thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were analyzed. A canonical correlation analysis was performed between all of the coronal parameters and sagittal parameters. Results: One hundred and three patients were recruited (male 15, female 88; aged 12.5 ± 1.5 years). Compared with the published age-matched normal population, TK, PI, LL, and SS were not statistically different in the normal group. However, PT was significantly increased in patent groups (P = 0.003). Canonical correlation analysis showed strong correlation between coronal parameters and sagittal parameters, F (20, 313) = 2.44, p = 0.001. SVA was not correlated with any coronal parameter. Conclusions: Children with AIS showed an increased pelvic tilt sign. In this study, TC, LC, GCB, AT, CPT, TK, LL, SVA, PI, PT, and SS contributed to the postural balance. In AIS, coronal balance is contributed to sagittal balance.