Long term follow-up evaluation of combined surgery for congenital tibial pseudarthrosis in children / 中华外科杂志

Objective: To explore the long-term effect of combined surgery for the treatment of congenital tibial pseudarthrosis in children. Methods: The clinical data of 44 children with congenital tibial pseudarthrosis who underwent combined surgery (tibial pseudarthrosis tissue resection, intramedullary rod fixation, Ilizarov external fixator fixation, wrapped autologous iliac bone graft) from August 2007 to October 2011 at the Department of Pediatric Orthopedics, Hunan Children's Hospital were collected retrospectively. There were 33 males and 11 females. The age at the time of surgery was (3.7±2.2)years (range:0.6 to 12.4 years), including 25 cases under 3 years old and 19 cases above 3 years old.Among them, 37 cases were complicated with neurofibromatosis type 1.The operation status, postoperative complications and follow-up results were recorded. Results: The follow-up time after surgery was (10.9±0.7)years (range:10 to 11 years).Thirty-nine out of 44 patients (88.6%) achieved initial healing of tibial pseudarthrosis, with an average healing time of (4.3±1.1)months (range:3 to 10months).In the last follow-up, 36 cases (81.8%) had unequal tibial length, 20 cases (45.4%) had refractures, 18 cases (40.9%) had ankle valgus, 9 cases (20.4%) had proximal tibial valgus, and 11 cases (25.0%) had high arched feet.Nine cases (20.4%) developed distal tibial epiphyseal plate bridging.17 cases (38.6%) had abnormal tibial mechanical axis.Seven cases (15.9%) developed needle infection, and one case (2.3%) developed tibial osteomyelitis. 21 patients (47.7%) had excessive growth of the affected femur.Five patients (11.3%) had ankle stiffness, and 34 patients (77.2%) had intramedullary rod displacement that was not in the center of the tibial medullary cavity.Among them, 8 cases (18.1%) protruded the tibial bone cortex and underwent intramedullary rod removal.18 children have reached skeletal maturity, while 26 children have not been followed up until skeletal maturity. Conclusion: Combined surgery for the treatment of congenital pseudarthrosis of the tibia in children has a high initial healing rate, but complications such as unequal tibia length, refracture, and ankle valgus occur during long-term follow-up, requiring multiple surgical treatments.

Extrapulmonary manifestations and complications of severe acute respiratory syndrome coronavirus-2 infection: a systematic review

INTRODUCTION@#We aimed to describe the extrapulmonary manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, including their frequency, onset with respect to respiratory symptoms, pathogenesis and association with disease severity.@*METHODS@#We searched the MEDLINE and Embase databases for SARS-CoV-2-related studies. Meta-analysis, observational studies, case series and case reports published in English or Chinese between 1 January 2020 and 1 May 2020 were included. Reports with only paediatric or obstetric cases were excluded.@*RESULTS@#169 articles were included. Early manifestations (preceding respiratory symptoms until Day 6 of onset) included olfactory and gustatory disturbance (self-reported in up to 68% and 85% of cases, respectively), gastrointestinal symptoms (up to 65.9%) and rash (up to 20.4%). From Day 7 onwards, hypercytokinaemia, paralleled multi-organ complications including acute cardiac injury (pooled incidence of 17.7% in 1,412 patients, mostly with severe disease and 17.4% mortality), kidney and liver injury (up to 17% and 33%, respectively) and thrombocytopenia (up to 30%). Hypercoagulability resulted in venous thromboembolic events in up to 31% of all patients. Uncommon disease presentation and complications comprised Guillain-Barré syndrome, rhabdomyolysis, otitis media, meningoencephalitis and spontaneous pneumomediastinum.@*CONCLUSION@#Although the systemic manifestations of SARS-CoV-2 infection are variegated, they are deeply interwoven by shared mechanisms. Two phases of extrapulmonary disease were identified: (a) an early phase with possible gastrointestinal, ocular and cutaneous involvement; and (b) a late phase characterised by multiorgan dysfunction and clinical deterioration. A clear, multidisciplinary consensus to define and approach thromboinflammation and cytokine release syndrome in SARS-CoV-2 is needed.

Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion / 대한뇌졸중학회지

Background@#and Purpose Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT. @*Methods@#This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0–3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH). @*Results@#Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not asComorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013). @*Conclusions@#Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.

Prevalence of abnormal glucose metabolism and dyslipidemia across different categories of body mass index among women with Polycystic Ovarian Syndrome

Background@#Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathies among reproductive aged women. It is associated with metabolic problems such as obesity, insulin resistance and dyslipidemia. Obesity in itself is associated with insulin resistance and dyslipidemia. However, it remains unclear whether lean and obese PCOS women share the same metabolic profiles. @*Objective@#The aim of this study was to identify the prevalence of abnormal glucose metabolism and dyslipidemia across different categories of body mass index among women with PCOS@*Methods@#A retrospective cross – sectional study included 160 PCOS patients covering the years 2015 to 2017 was performed. Fisher’s exact test, one-way analysis of variance using Fisher-Hayter multiple comparisons procedure and independent-test were used to compare the prevalence of disease among the different categories of body mass index (i.e. non-obese, overweight and obese).@*Results@#Among obese patients, the prevalence of pre-diabetes was 39.33% (35/89) and Type II diabetes mellitus was 8.99% (8/89). Among overweight, pre-diabetes patients were at 16.67% (5/30), while diabetics were only 6.67% (2). Among the non-obese population, only 17.07% (7/41) were classified as pre-diabetics while only 2.44% (1/41) were considered diabetic. For the prevalence of dyslipidemia, overweight and obese patients had the most proportion of affected individuals, at 90% (27/30) and 87.64% (78/89), respectively.@*Conclusion@#Abnormal glucose metabolism and dyslipidemia are more prevalent among obese and overweight women compared to non-obese PCOS patients.

Towards a digital solution: Predicting public take-up of Singapore's contact tracing application during the COVID-19 crisis

In the global outbreak of coronavirus disease 2019 (COVID-19), new digital solutions have been developed for infection control. In particular, contact tracing mobile applications provide a means for governments to manage both health and economic concerns. As public reception is paramount to success, we conducted a systematic examination of sociodemographic characteristics that predict downloads of a contact tracing application. Participants were 505 adults who completed a web-based survey in Singapore, the site of the first contact tracing application (TraceTogether). We found that persons who had already changed their lifestyles on account of the pandemic were more likely to download the application. Network analyses revealed that contact tracing downloads was associated with using hand sanitizers, avoiding public transport, and preferring outdoor over indoor venues during the pandemic. However, demographic and situational characteristics were not significant predictors of application downloads. Together, these findings provide a base for policy makers to promote the uptake of digital contact tracing. HighlightsO_LIWorldwide, digital contact tracing has been introduced to control the spread of coronavirus disease 2019 (COVID-19). C_LIO_LIIn a survey of 505 participants, we investigated sociodemographic factors predicting voluntary downloads of a contact tracing mobile application. C_LIO_LIUse of the contact tracing application was predicted by the extent to which an individual had modified his / her behaviors because of the outbreak. C_LIO_LINetwork analyses revealed that application usage was associated with using hand sanitizers, avoiding public transport, and preferring outdoor over indoor venues. C_LIO_LINo demographic factor significantly predicted application usage. C_LI