【Abstract】 Objective To review the progress of autologous fat grafting of the face and outline different arguments in this field. Methods Recent literature concerning autologous fat grafting of the face was reviewed and analyzed. Results The applications and techniques for autologous fat grafting have been matured increasingly. It not only can adjust the proportion of facial contours, restore tissue volume, but also can improve the local skin texture. Reliable clinical results have achieved in facial augmentation and rejuvenation. Although there are arguments about donor site, harvesting technique, processing technique, and grafting technique, the basic principle is the same. Conclusion From the perspective of evidence-based medicine, clinicians are rich in clinical experience, but objective evidence is insufficient. So further researches should be carried to look for scientific evidences.
ObjectiveTo investigate effect of coronal plane alignment of the knee (CPAK) phenotype alteration on patient-reported outcome measures (PROMs) and functional outcomes in patients undergoing robot-assisted total knee arthroplasty (RA-TKA). MethodsThe clinical data of 108 patients who underwent unilateral RA-TKA between December 2024 and June 2025 and met the inclusion criteria were retrospectively analyzed. The cohort included 34 males and 74 females, with an average age of 68.8 years (range, 54-83 years). General data including age, gender, body mass index (BMI), and operative side were collected. PROMs included the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and Forgotten Joint Score-12 (FJS-12). Functional outcomes included range of motion (ROM) and angle of knee extension lag. Based on full-length lower extremity X-ray films, the mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA) were measured, and the arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO) were calculated. The CPAK phenotype was determined according to the classification proposed by MacDessi et al. Patients were grouped into a CPAK consistent group and a CPAK changed group based on pre- and post-operative CPAK phenotypes, and the PROMs, functional outcomes, and radiographic parameters were compared. Multiple linear regression analysis was used to examine the independent association between CPAK phenotype change and the improvement in WOMAC scores. Results Among the 108 patients, the CPAK phenotype remained unchanged in 70 cases (64.8%, CPAK consistent group) and changed in 38 cases (35.2%, CPAK changed group). There was no significant difference between the two groups in age, gender, BMI, operative side, or preoperative WOMAC score, KSS score, ROM, and aHKA (P>0.05), whereas preoperative JLO showed a significant difference between groups (P<0.05). Univariate analysis demonstrated significant differences between groups at 3 months postoperatively in WOMAC, KSS, and FJS-12 scores, as well as in the changes of WOMAC score, KSS score, and ROM (P<0.05); moreover, the improvements in these parameters were superior in the consistent group compared to the changed group. There was no significant difference in postoperative ROM, angle of knee extension lag, mLDFA, mMPTA, JLO, aHKA, and the change of aHKA between groups (P>0.05). Multiple linear regression analysis revealed that CPAK phenotype change was a risk factor for improvement in WOMAC scores at short-term stage (P<0.05). ConclusionPreservation of the preoperative CPAK phenotype after RA-TKA is associated with superior improvement in PROMs at short-term stage.
Objective To investigate the incidence of Modic changes of lumbar endplate and its cl inical significances. Methods The imaging data of 562 patients (2 810 lumbar intervertebral discs) with lumbar degenerative disease undergoingposterior operation from June 2006 to June 2009 were retrospectively reviewed. There were 297 males and 265 femalesaged 26-77 years old (average 49 years old). The course of disease was 2 months to 40 years (median 10.4 years). Imaging examinations excluded the tuberculosis, cancer, infection, trauma, etc. The association of Modic changes with low back pain (LBP) and patients’ weight was analyzed according to the incidence and types of Modic changes as well as the distribution of gender, age and disc level through imaging data of MRI. Results Modic changes were observed in 106 patients (18.9%) of 113 intervertebral discs, including 40 (13.5%) males and 66 (24.9%) females. The difference between male proportion and female proportion had a significant difference (P lt; 0.05). Modic changes was distributed from age 26 to 77 years old (average 49 years old). Among all the patients, 33 cases (5.9%) were type I, 66 cases (11.7%) were type II, and 7 cases (1.2%) were type III. According to the segment, the lesions involved L5, S1 disc for 58 discs (51.3%), L4, 5 for 35 (31.0%), L3, 4 for 11 (9.7%), L2, 3 for 6 (5.3%), and L1, 2 for 3 (2.7%). The incidence of Modic change was 15.5% (41/264) in the normal body weight group, 16.3% (34/208) in the over-weight group, and 34.4% (31/90) in the obesity group. There was a significant association between obesity and the Modic change (P lt; 0.05). Preoperatively, there were 59 patients (55.7%) with LBP in the Modic group, including 27 cases of type I Modic change, 27 cases of type II Modic change, and 5 cases of type III Modic change. Postoperatively, the LBP of 40 patients (67.8%) were rel ieved, including 24 cases of type I Modic change, 14 cases of type II Modic change, and 2 cases of type III Modic change. In non-Modic change group, there were 126 patients (27.6%) with LBP preoperatively, and 96 patients (76.2%) eased the symptoms postoperatively. There was significant difference between two groups on incidence rate (P lt; 0.05),but no significant difference on the remission rate of LBP (P gt; 0.05). Conclusion The most common Modic change is typeII and the most frequently involved level is the L5, S1. Modic changes are more common in female than in male and mainly happen to the obesity group. The incidence of LBP is higher in the patients with Modic change.
Objectives To describe the factors determining choice of health financing systems. Methods Search words chosen by both health policy experts and the review search coordinators after discussion and pilot. 19 electronic databases, 2 international health institutes websites, 2 grey literature databases, and search engine Google were included in the databases. Any literature about health financing reforms on country level was included. Pre-designed data extraction form was used for collecting the information. The data was analyzed and described by pre-designed analytic framework.Result A total of 59 studies were included in this review. The driving forces included political, economic, social, and health systems factors. Development level of economy was the most crucial factor for transformation of health financing systems. The health system could directly led to the transition between different health systems, both Italy and France transform their financing system from social health insurance to national health system. The key persons such as premier of Thailand and Germany, leader of political and social organization in Israel and Korea are the driving forces of health financing reforms. Conclusion Developing countries can learn from the countries which have achieved universal coverage through health financing reform. Underlying factors influencing formulation of a health financing system need to be considered before taking actions in reforming the current system. Efforts in transforming the health financing systems need to be made from political, economic, and health systems sides.
Objective To review the research progress of rapid surgery for hip fracture in elderly patients. Methods The published studies, expert consensus, and guidelines at home and abroad were systematically summarized from the aspects of the characteristics of aging population, the benefits of rapid surgery, the disadvantages of delayed surgery, and the recommendations of current guidelines, so as to further guide clinical practice. Results Hip fracture is a common fracture type in the elderly population. As elderly patients generally have poor physique and often have a variety of underlying diseases, such as hypostatic pneumonia, bedsore, lower limb vein thrombosis, and other complications in conservative treatment, its disability rate and mortality are high, so surgical treatment is the first choice. At present, most relevant studies and expert consensus and guidelines at home and abroad support rapid surgery, that is, preoperative examination should be started immediately after admission, and adverse factors such as taking anticoagulant drugs, serious cardiovascular diseases, and severe anemia should be clearly and actively corrected, and surgery should be completed within 48 hours after admission as far as possible. Rapid surgery can not only significantly reduce the mortality of patients, but also reduce the length of hospital stay and the incidence of perioperative cognitive impairment, which is conducive to the recovery of patients with pain during hospitalization and postoperative function, and improve the prognosis of patients. Conclusion In order to avoid many problems caused by delayed surgery, the elderly patients with hip fracture should be operated as soon as possible under the condition of actively correcting the adverse factors. Comprehensive evaluation and preparation, the development of an individualized surgical plan, and the formation of a multidisciplinary medical team can reduce surgical risks and improve effectiveness.
Objective To review the progress of the mechanisms of Wnt/β-catenin and nuclear factor-kappa B (NF-кB) pathways in the process of the intervertebral disc degeneration. Methods The related literature about the mechanisms of Wnt/β-catenin and NF-кB pathways in the process of the intervertebral disc degeneration was reviewed, analyzed, and summarized. Results Wnt/β-catenin and NF-кB pathways are both activated in the process of the intervertebral disc degeneration, and exist interaction. However, the specific mechanisms and interactive mediums of Wnt/β-catenin and NF-кB pathways in the process of the intervertebral disc degeneration are still unclear. Conclusion The mechanisms of Wnt/β-catenin and NF-кB pathways in the process of the intervertebral disc degeneration have to be studied deeply.
ObjectiveTo compare the effect and safety of basiliximab in ABO incompatible pediatric liver transplant recipients.MethodsABO incompatible pediatric liver transplantation operated between January 2019 and August 2020 were studied. The patients were allocated randomized into two groups. Patients in experimental group were treated with basiliximab as immune induction therapy, but basiliximab was not used in patients of control group. Tacrolimus combined methylprednisolone were used after liver transplantation. The clinical characteristics, graft and recipient survival rate, rejection, infectious complications, and kidney functions after liver transplantation were observed. Donor specific antibody (DSA) was tested in 3 months after liver transplantation. The growth and development were assessed too after liver transplant.ResultsFourty-four patients were enrolled in the study, including 19 patients in the experimental group and 25 patients in the control group. The median follow-up time was 16.6 months (3.8–25.4 months), and there were no statistically differences between the two groups in terms of age, sex, weight, pediatric end-stage liver disease (PELD) score, and other basic conditions. There were no significant differences between the two groups in tacrolimus dose, tacrolimus trough concentration, kidney functions, height and weight growth after liver transplantation. There were no statistical differences in lung infection, blood stream infection within 3 months after liver transplantation, cytomegalovirus, EBV infection, graft/patient survival rate after liver transplantation (P>0.05). However, the acute rejection rate was lower and the DSA positive rate in 3 months after liver transplantation was lower in the experimental group (P<0.05).ConclusionsBasiliximab can be safely used in ABO incompatible pediatric liver transplant recipients. Acute rejection rate and DSA positive rate after transplantation can be decreased with the useof basiliximab.