Risk factors for misdiagnosis in children with developmental dysplasia of the hip: a retrospective single centre study.

OBJECTIVE: To investigate risk factors of misdiagnosis at the first visit of children with developmental dysplasia of the hip (DDH) who did not participate in hip ultrasound screening. METHODS: A retrospective review was conducted on children with DDH admitted to a tertiary hospital in northwestern China between January 2010 and June 2021. We divided the patients into the diagnosis and misdiagnosis groups according to whether they were diagnosed at the first visit. The basic information, treatment process and medical information of the children were investigated. We made a line chart of the annual misdiagnosis rate to observe the trend in the annual misdiagnosis rate. Univariate and multivariate logistic regression analyses were used to identify significant risk factors for missed diagnosis. RESULTS: A total of 351 patients met the inclusion criteria, including 256 (72.9%) patients in the diagnosis group and 95 (27.1%) patients in the misdiagnosis group. The line chart of the annual rate of misdiagnoses among children with DDH from 2010 to 2020 showed no significant change trend. Multiple logistic regression analysis showed that the paediatrics department (v the paediatric orthopaedics department: OR 0.21, p<0.001), the general orthopaedics department (v the paediatric orthopaedics department: OR 0.39, p=0.006) and the senior physician (v the junior physician: OR 2.47, p=0.006) on the misdiagnosis at the first visit of children were statistically significant. CONCLUSION: Children with DDH without hip ultrasound screening are prone to be misdiagnosed at their first visit. The annual misdiagnosis rate has not been significantly reduced in recent years. The department and title of the physician are independent risk factors for misdiagnosis.

Quantification of femoral position on radiographic acetabular coverage in children.

An accurate assessment of the radiographic acetabular coverage is essential for clinical diagnosis or surgical decision-making in hip disorders. This study aimed to evaluate the effect of femoral position on acetabular coverage and to predict the actual acetabular coverage from nonstandard radiographs. A total of 21 children (34 hips) with normative acetabular coverage were screened in this retrospective study. The Mimics-based local-rotation fluoroscopy simulation method was used to tilt, incline, and rotate the femur in 4° increments within the range of femoral motion. The acetabular coverage, namely acetabular-head index (AHI) and center-edge angle (CEA), increased with femoral abduction but decreased with other motions. Compared to the femoral neutral position, no significant differences were identified in AHI with the rotation (range: 0°-16°) and in CEA with the tilt (range: -20°-4°), inclination (range: 0°-4°), or rotation (range: -8°-40°). The linear regression analysis showed that the CEA increased by about 0.20° for each 1° increase in femoral inclination and decreased by about 0.01°, 0.07°, 0.06°, or 0.07° for each 1° increase in internal rotation, external rotation, flexion, or extension, respectively. And a more significant change in AHI was observed. All femoral malpositions, especially the inclination, affected radiographic acetabular coverage in children. Therefore, each pelvic radiograph should assess potential femoral malpositioning before diagnosing hip disorders. This study will assist surgeons in predicting the acetabular coverage on nonstandard radiographs.

Closing-opening wedge osteotomy for the treatment of congenital kyphosis in children.

BACKGROUND: To evaluate the safety and effectiveness of posterior closed-open wedge osteotomy for treatment of congenital kyphosis in children. METHODS: Imaging and clinical data from January 2010 to December 2019 of posterior closed-open wedge osteotomy of congenital kyphosis with at least 2-year follow up was analyzed retrospectively. Perioperative indicators such as operation time, osteotomy site, osteotomy method and occurrence of complications, and imaging indicators were observed. The 3D printed models were used to measure the expanded distance of anterior edge vertebra and closed length of spinal canal line. The clinical effect was evaluated through SRS-22 questionnaires. RESULTS: There were 15 CK patients in this study. The osteotomy segments and details are as follows: 1 case each for T6-9 and L2, 2 cases at T11, 3 cases at T12, and 6 cases at L1. The average operation time was 314 min, the average blood loss was 970 mL, the average fusion range was 6.3 segments, and the average time of follow up was 70.5 months. The Cobb angle of local kyphosis was corrected from 65.6 ± 18.8° to 11.3 ± 7.1°(p < .001). The range of kyphosis correction was 40-90°, and average correction rate was 83.2% (67.7-95.7%). The correction was stable in follow-up, and the kyphotic angle was 11.0 ± 7.6 (p = .68). The preoperative SVA was 31.5 ± 21.8 mm, and the postoperative recovery was 18.0 ± 15.5, while the last follow-up was 9.1 ± 7.9. The p values were 0.02 and 0.07 respectively. By using 3D printed models, the expanded distance of anterior edge vertebra and closed length of spinal canal line were 14.5 ± 7.5 mm and 24.5 ± 8.0 mm respectively. Self-image and satisfaction in SRS-22 improved significantly. There was no recurrence of deformity and junctional kyphosis. CONCLUSIONS: The posterior closing-opening wedge osteotom for treatment of congenital kyphosis in children is satisfactory, if selected appropriately. During the longitudinal follow-up, the patients could achieve solid fusion and the correction could be well maintained.Evidence of Confidence: IVa.

Effects of a 4-week Omaha System transitional care programme on rheumatoid arthritis patients' self-efficacy, health status, and readmission in mainland China: A randomized controlled trial.

BACKGROUND AND AIM: To our knowledge, the practice of transitional care was not common in mainland China. This study was designed to test the intervention effects of a specific dose (4 weeks) of an Omaha-based system transitional care programme for Chinese patients suffering from rheumatoid arthritis. METHODS: The intervention group adopted a 4-week nurse-led transitional care intervention based on the Omaha System. The control group used a comparable length of routine care. The outcome indexes were a Chinese version of the Arthritis Self-Efficacy Scale-8, Health Assessment Questionnaire-Disability Index, and hospital readmission rates. Data were collected from June 2018 to December 2018. RESULTS: Finally, 88 patients (44 in the intervention group and 44 in the control group) entered the data analysis. Baseline sociodemographic data for both groups were not found to be statistically significant. The self-efficacy and HAQ-DI of the intervention group were significantly different from the control group. Although the readmission rates of the intervention group were lower than that of the control group, it was not statistically significant. CONCLUSIONS: This 4-week transitional care intervention dose is sufficient to provide evidence for improving self-efficacy to implement disease management and enhancing physical function of patients diagnosed with rheumatoid arthritis.

One-stage Surgical Treatment of Simultaneous Osteotomy and Asymmetric Lengthening on Short Femur with Severe Deformity of Genu Valgus.

This study aimed to discuss the effects of one stage surgical treatment by simultaneous osteotomy and asymmetric lengthening by Ilizarov external fixator on short femur with severe deformity of genu valgus. A total of 12 cases with unilateral deformities treated by simultaneous osteotomy and Ilizarov asymmetric lengthening on short femur with severe deformity of genu valgus were retrospectively analyzed from January 2006 to April 2015. The affected limbs were 2.5-11 cm (5.2 cm on average) short, the femorotibial angle was 135°-158° (146.3° on average), and the ankle interval was 15-43 cm (24.7 cm on average). The Paley method was used to determine the osteotomy plane (distal femur) of genu valgus. According to this standard, the bone union results were as follows: 11 had excellent and 1 had good, where 7 patients had excellent and 5 had good functional outcomes. One stage surgical treatment by simultaneous osteotomy and asymmetric lengthening on short femur with severe deformity of genu valgus was considered to be an effective and reliable method with better osteotomy union, less trauma and fewer complications.

Is meat consumption associated with depression? A meta-analysis of observational studies.

BACKGROUND: A number of epidemiological studies have examined the effect of meat consumption on depression. However, no conclusion has been reached. The aim of this study was to examine the relationship between meat consumption and depression. METHODS: The electronic databases of PUBMED and EMBASE were searched up to March 2017, for observational studies that examined the relationship between meat consumption and depression. The pooled odds ratio (OR) for the prevalence of depression and the relative risk (RR) for the incidence of depression, as well as their corresponding 95% confidence interval (CI), were calculated respectively (the highest versus the lowest category of meat consumption). RESULTS: A total of eight observational studies (three cross-sectional, three cohort and two case-control studies) were included in this meta-analysis. Specifically, six studies were related to the prevalence of depression, and the overall multi-variable adjusted OR suggested no significant association between meat consumption and the prevalence of depression (OR = 0.89, 95% CI: 0.65 to 1.22; P = 0.469). In contrast, for the three studies related to the incidence of depression, the overall multi-variable adjusted RR evidenced an association between meat consumption and a moderately higher incidence of depression (RR = 1.13, 95% CI: 1.03 to 1.24; P = 0.013). CONCLUSIONS: Meat consumption may be associated with a moderately higher risk of depression. However, it still warrants further studies to confirm such findings due to the limited number of prospective studies.

[Biodegradation of Pyrene by Intact Cells and Spores of Brevibacillus brevis].

Biodegradation characteristics of pyrene by intact cells and spores of Brevibacillus brevis were investigated. The results revealed that the degradation efficiency of 1 mg · L(-1) pyrene by B. brevis intact cells reached 53% within 5 d. Four hydroxy metabolites were detected by LC-MS/MS during the degradation of pyrene by intact cells and intracellular enzymes, including 1-hydroxy-pyrene, 9- phenanthrol, α-naphthol and ß-naphthol. The amount of products first increased and then declined in the degradation system with intact cells, while the macromolecular metabolites showed a continuous accumulation tendency in the degradation system with intracellular enzymes, proving that some degrading enzymes of B. brevis could be induced by the products generated during the degradation, and then the enzymes induced could further degrade these degradation products. The amount of cells germinated from spores in MSM containing pyrene was 1.5 x 10(9) cells · L(-1), and the degradation rate of pyrene (1 mg · L(-1)) within 5 d reached 15%.

[Influence of microcystin-LR on cell viability and surface characteristics of Pseudomonas putida].

In microcystin-LR (MC-LR) degradation system, the change in surface characteristics and cell viability of Pseudomonas putida was studied. The purpose of this study was to reveal the influence of MC-LR on P. putida and elucidate the toxicity of MC-LR on microorganisms. The result demonstrated that MC-LR enhanced the cytoplasmic membrane permeability, as well as affected the ion metabolism and protein release of P. putida. The soluble sugar and Na+, Cl-release increased with the rising concentration of MC-LR ranging from 0 mg x L(-1) to 2.0 mg x L(-1). Flow Cytometry Method(FCM) analysis revealed that MC-LR accelerated the death of P. putida, and the death rate increased with the ascending concentration of MC-LR. Compared with the control, the death rate on day 5 increased by nearly 30% when 2.5 mg x L(-1) MC-LR was added. Scanning electron microscopy (SEM) analysis showed that the cells were deformed under the toxicity of MC-LR. After 5-day exposure to 2.5 mg x L(-1) MC-LR, the majority of the cells were ruptured and the intracellular materials flew out. The cellular structure was severely damaged under this condition.

Clinical assessment of a CMC/PEO gel to inhibit postoperative epidural adhesion formation after lumbar discectomy: a randomized, control study.

PURPOSE: To evaluate effectiveness of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel in improving clinical outcomes after the first-time lumbar discectomy. METHOD: Ninety-three patients with herniated lumbar disc at L4-L5 or L5-S1 were enrolled and randomized into two groups: CMC/PEO gel treatment group and control group. All the patients underwent laminotomy and discectomy by posterior approach. The preoperative and postoperative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores for lower-back pain and leg pain were analyzed and compared between two groups at 30- and 60-day time points. RESULTS: No patient presented with any clinically measurable adverse event during surgery. There were no significant differences between the treated group and the control group on the preoperative ODI and VAS scores. In general, the ODI and VAS scores decreased in both groups at all the time points. At the 30-day time point, the VAS scores for back pain and leg pain and the ODI scores in treatment group were lower by 9.9 % (P = 0.0302), 27.0 % (P = 0.0002) and 16.3 % (P = 0.0007) than those in control group. And at the 60-day time point, the ODI and VAS scores further decreased in both groups. The VAS scores for leg pain in treatment group were lower by 4.5 % than that in the control group (P = 0.0149). However, no significant difference was detected between two groups on the ODI and VAS scores for back pain. CONCLUSIONS: The results demonstrated that CMC/PEO gel is effective in reducing posterior dural adhesions in the spine with no apparent safety issues. It can improve patients' postoperative clinical outcome.

In vivo study of pedicle screw augmentation using bioactive glass in osteoporosis sheep.

STUDY DESIGN: Augmentation of pedicle screws with bioactive glass (BG) was performed in osteoporotic ovine spine in vivo. Biomechanical tests, micro-computed tomography (CT) analysis, and histologic observation were performed. OBJECTIVE: To investigate the biomechanical stability of pedicle screws augmented by BG in osteoporotic sheep and observe the bone-screw interface histologically. SUMMARY OF BACKGROUND DATA: There is little information on the long-term biomechanical performance and screw-bone interfacial bonding of pedicle screws augmented with BG in osteoporotic spine in vivo. METHODS: Twelve months after ovariectomy combined with methylprednisolone injection, 8 adult female sheep were randomly divided into 2 groups (3- and 6-mo time point groups). In each time point group, pedicles were randomly selected from the lumbar spine (L1-L6) and implanted with (1) pedicle screw alone; (2) pedicle screw augmented by polymethylmethacrylate; or (3) pedicle screw augmented by BG. Three and 6 months after implantation, animals were labeled with tetracycline and calcein before being killed. Then vertebrae with pedicle screws were obtained, and a micro-CT scan, histologic analysis, and biomechanical tests were performed. RESULTS: Three months after implantation, micro-CT reconstruction showed that microstructural parameters of the BG group were significantly better compared with those in the other 2 groups (P<0.05). Histologic observation revealed that bone trabeculae around the screws in the BG group were more in number and denser than those in the control group. The average mineral apposition rate of the bone in the BG group was also higher than that in the other 2 groups (P<0.05). The mechanical properties in the BG group were also significantly higher than that in the control group. Six months after implantation, similar results except mineral apposition rate can be obtained among different groups. CONCLUSIONS: BG can significantly improve bone microstructure of the interface in osteoporosis condition and increase the hold strength of the pedicle screw.

[Stereotactic radiotherapy for multiple brain metastases].

BACKGROUND & OBJECTIVE: Stereotactic radiotherapy (SRT) has obvious advantages in treating intracranial tumors, but there are few reports about application of SRT to multiple intracranial tumors. This paper summarized the therapy outcome of patients with multiple brain metastases, and evaluated the efficacy and application of SRT. METHODS: Clinical data of 136 patients with multiple brain metastases received radiotherapy from Jun. 1996 to Dec. 2002 were reviewed. Of the 136 patients, 52(38.2%) received conventional radiotherapy alone (CR group), 84(61.8%) received SRT or SRT plus whole brain radiotherapy (SRT group). RESULTS: Clinical effective rate, and elimination rate of brain metastases (diameter of > 20 mm) were significantly higher in SRT group than in CR group (96.4% vs. 86.5%, P=0.02; 70.4% vs. 36.0%, P=0.007). Persistent brain edema rate was 8.3% in SRT group, and 9.6% in CR group (P=0.767). Intracranial tumor recurrence rate was 25.0% in SRT group, and 19.4% in CR group (P=0.653). Median survival time was significantly longer in SRT group than in CR group (10.5 months vs. 6.5 months, P=0.014); 1-year survival rate was significantly higher in SRT group than in CR group (40.5% vs. 21.2%, P=0.023). CONCLUSION: Reasonable application of SRT could improve life quality and treatment outcome of patients with multiple brain metastases, reduce intracranial tumor recurrence and radiation damage, and prolong patients'survival time.

[Clinical observation of hypoxic radiotherapy for nasopharyngeal carcinoma].

BACKGROUND & OBJECTIVE: The clinical application of hypoxic radiotherapy (RT) was developed at a high speed in China in recent years. The protective effect of hypoxic RT on normal tissues has been proved. However, there was not an affirmative answer whether hypoxic RT had any protective effect on tumor. This study was designed to analyze this question by comparing clinical results of hypoxic RT with regular RT in nasopharyngeal carcinoma (NPC) patients. METHODS: A series of 117 patients with NPC who underwent hypoxic RT or regular RT between March 1992 and June 2000 in PLA 309 Hospital was enrolled. The cancers were staged as I, II, III, and IV in 11, 30, 57, and 19 cases, respectively. Of these, 69 received hypoxic RT, and 48 received regular RT. There was no significant difference in age, sex, TNM staging, pathological type, adjuvant therapy between two groups (P>0.05). All patients underwent 6MV X-ray and 8-12 MeV electronic beam. The nasopharyngeal areas received dose of 72 Gy (range, 68 to 82 Gy), and neck positive lymph node regions received dose of 64 Gy (range, 60 to 70 Gy). RESULTS: The incidence rates of 2-3 degree early irradiation toxicity of oropharynx mucous membrane, salivary gland, and II- III degree late dry mouth were 23.2%, 26.1%, 37.7% in hypoxic RT group and 77.1%, 62.5%, 91.7% in regular RT group, respectively(P 0.05). The 1-, 3-, 5-, 7-year survival rates were 97.1%, 83.7%, 74.4%, 54.5% in hypoxic RT group and 97.9%, 86.8%, 70.2%, 54.7% in regular RT group, respectively (P>0.05). CONCLUSION: Hypoxia could alleviate irradiation toxicity and reduce complication rate of NPC patients. There is no significant difference between hypoxic RT and regular RT in tumor recurrence and metastasis and the survival rate of NPC. Further study is needed.