Objective To analyze the characteristics of femoral neck fractures in young and middle-aged adults by means of medical image analysis and fracture mapping technology to provide reference for fracture treatment. Methods A clinical data of 159 young and middle-aged patients with femoral neck fractures who were admitted between December 2018 and July 2019 was analyzed. Among them, 99 patients were male and 60 were female. The age ranged from 18 to 60 years, with an average age of 47.9 years. There were 77 cases of left femoral neck fractures and 82 cases of right sides. Based on preoperative X-ray film and CT, the fracture morphology was observed and classified according to the Garden classification standard and Pauwels’ angle, respectively. Mimics19.0 software was used to reconstruct the three-dimensional models of femoral neck fracture, measure the angle between the fracture plane and the sagittal plane of the human body, and observe whether there was any defect at the fracture end and its position on the fracture surface. Through reconstruction, virtual reduction, and image overlay, the fracture map was established to observe the fracture line and distribution. Results According to Garden classification standard, there were 6 cases of type Ⅰ, 61 cases of type Ⅱ, 54 cases of type Ⅲ, and 38 cases of type Ⅳ. According to the Pauwels’ angle, there were 12 cases of abduction type, 78 cases of intermediate type, and 69 cases of adduction type. The angle between fracture plane and sagittal plane of the human body ranged from –39° to +30°. Most of them were Garden type Ⅱ, Ⅳ and Pauwels intermediate type. The fracture blocks were mainly in the form of a triangle with a long base and mainly distributed below the femoral head and neck junction area. Twenty-six cases (16.35%) were complicated with bone defects, which were mostly found in Garden type Ⅲ, Ⅳ, and Pauwels intermediate type, located at the back of femoral neck and mostly involved 2-4 quadrants. The fracture map showed that the fracture line of the femoral neck was distributed annularly along the femoral head and neck junction. The fracture line was dense above the femoral neck and scattered below, involving the femoral calcar. Conclusion The proportion of displaced fractures (Garden type Ⅲ, Ⅳ) and unstable fractures (Pauwels intermediate type, adduction type) is high in femoral neck fractures in young and middle-aged adults, and comminuted fractures and bone defects further increase the difficulty of treatment. In clinical practice, it is necessary to choose treatment plan according to fracture characteristics. Anatomic reduction and effective fixation are the primary principles for the treatment of femoral neck fracture in young and middle-aged adults.
The diagnosis and management of congenital heart disease (CHD), the most common inborn defect, has been a tremendous success of modern medicine. With the development of diagnostic techniques, surgical procedures and interventional techniques, more than 90% of CHD children can survive to adulthood. Consequently, the prevalence of patients with CHD has shifted away from infancy and childhood towards adulthood. Adult CHD cardiology is now encompassing not only young or middle-aged adults but also patients aged above 60 years. Standardized guidelines can provide good theoretical support for the comprehensive management of adult CHD. Ten years after the European Society of Cardiology guidelines for the management of grown-up CHD released in 2010, the new version was officially released in August 2020. The new version of guidelines updated the classification and stratification of diseases, comprehensive intervention methods and intervention timing, and put forward some new concepts, new intervention standards and methods. For adult CHD that has not been repaired or needs to be repaired again, the indication and mode of surgical intervention and perioperative management have a great impact on the prognosis. The new version of the guidelines provides a detailed description of the surgical and intervention indications and methods for different diseases, and clarifies the management methods for high-risk groups. This article attempts to interpret this newly updated guideline from the perspective of a surgeon, sort out several key diseases introduced by the guideline, and strives to provide a concise and actionable guideline for domestic counterparts.
Objective To identify the clinical features and risk factors for mortality associated with severe influenza B pneumonia of adults admitted to respiratory intensive care unit (ICU). Methods Patients with confirmed influenza B infection and respiratory failure between February 2020 and February 2022 who were admitted to the ICU were sequentially included. Demographic features, clinical data, microbiological data, complications, and outcomes were collected. Univariate logistic regression analysis was performed to identify risk factors associated with hospital mortality. A comparison with severe influenza A pneumonia was made to explore the characteristics of influenza B virus-associated pneumonia. Results A total of 23 patients with influenza B pneumonia were included. The survival group included 18 patients and the death group included 5 patients, with an ICU mortality of 21.7%. The median age in the death group was 64 (64, 72.5) years, which was significantly older than the survival group, with a median age 59 (30.25, 64.25) years (P=0.030). Univariate logistic regression analysis indicated that SOFA score [odds ratio (OR) 1.307, 95% confidential interval (CI) 1.013 - 1.686, P=0.039], decreased hemoglobin (OR 0.845, 95%CI 0.715 - 0.997, P=0.046), and high blood urea nitrogen (BUN) (OR 1.432, 95%CI 1.044 - 1.963, P=0.026) were independent risk factors for hospital mortality. Compared with influenza A pneumonia, patients with severe influenza B pneumonia had more complications (60.0% vs. 87.0%, P=0.023). Conclusions The mortality of severe influenza B virus-associated pneumonia with was high. Increased SOFA score, anemia, and high BUN were risk factors for ICU mortality of severe influenza B infection in adults.
ObjectiveTo summarize the experience of diagnosis and treatment of a case of adult hepatic fibrohistiocytoma with recurrent rupture and hemorrhage.MethodsRetrospective analysis on this case of recurrent adult fibrohistiocytoma with rupture and hemorrhage admitted to Shengjing Hospital Affiliated to China Medical University in May 2018 was conducted, discussion on MDT was conducted before surgery, and the causes of recurrent rupture and hemorrhage, as well as the experience of diagnosis and treatment were summarized and analyzed.ResultsThis patient was generally in good condition. After MDT discussions among the imaging department, oncology department, interventional department, and hepatobiliary surgeons, it was considered that surgical treatment was the best treatment scheme. After full communication with the patient and his family, the patient had chosen open tumor resection and the operation was smooth. The operation time was 278 min, intraoperative bleeding was about 100 mL, and no blood transfusion was performed. No bleeding, abdominal infection, gastroparesis, and other complications occurred after the operation, and the patient was discharged successfully on the 13th day after the operation. The patient had been interviewed for 8 months and the tumor recurred again 1 month ago. Currently, oral apatinib had been targeted for treatment for more than 1 month, and the follow-up treatment continued.ConclusionsRecurrent adult fibrous histiocytoma with rupture and hemorrhage is rare in clinical practice, and the treatment is mainly based on surgical resection. Postoperative comprehensive treatment combined with radiotherapy, chemotherapy, molecular targeting, and immunotherapy is the main treatment. Its short-term efficacy is satisfactory, but long-term efficacy still needs to befurther observed.
ObjectiveTo investigate the effect of anterior chest wall depression on the cardiac function and the effectiveness of minimally invasive surgery for pectus excavatum by comparing cardiac function and morphology between pre- and post-operation. MethodsBetween August 2009 and December 2010, 102 adult patients with pectus excavatum were treated with minimally invasive surgery, including the primary operation in 95 cases and the reoperation in 7 cases. There were 84 males and 18 females, aged 18-57 years (mean, 23.4 years). The haller index (HI) was 4.59 ± 1.51. Of 102 patients, 59 were classified as pectus excavatum type I and 43 as type II; 42 had clinical symptoms and 19 had the physical sign of heart. The preoperative chest CT examination showed cardiac compression in all patients and heart displacement in 74 patients. The left ventricular ejection fraction (LVEF) was 68.9% ± 6.2%. ResultsThe procedure was successful in all patients, and no death or serious complication occurred. The patients were followed up 12-28 months (mean, 21 months). The clinical symptoms and cardiac physical sign of the patients disappeared after operation. HI was 2.70 ± 0.33 at 12 months after operation, showing significant difference when compared with preoperative HI (t=5.83, P=0.00). According to Nuss’s evaluation method, the results were excellent in 99 patients and good in 3 patients. CT examination showed complete relief of cardiac compression in 101 patients and mild cardiac compression in 1 patient; the heart position was normal at 12 months after operation. Electrocardiogram returned to normal in 4 patients having abnormal electrocardiogram. LVEF was 70.5% ± 4.8% after operation, showing no significant difference when compared with preoperative LVEF (t=1.08, P=0.30). ConclusionThe main effects of pectus excavatum in adults on heart are compression and displacement. Cardiac compression may be relieved efficiently and the patient’s clinical symptoms can be abated by minimally invasive surgery.
Objective To discuss venous drainage types of median hepatic lobe and their guiding significances on the selection of grafts. Methods Between April 2005 and March 2009, 109 potential living donors underwent 3-dimensional reconstruction of computed tomography (CT) and the volume of graft was determined in the center of organ transplantation of Ruijin Hospital. The venous drainage types of median hepatic lobe of each donor were analyzed by the computer-based liver operation-planning system in detail to assign middle hepatic vein (MHV) types according to Marcos classification and venous types of Ⅳb segment according to Nakamura classification. Results The branching pattern of MHV was divided into 3 types: Type Ⅰ and Ⅱwere relatively more accounting for 44.0% （48/109）, 37.6% （41/109）, and type Ⅲ was fewest 〔18.3% （20/109）〕. There were no significant differences in volume of whole liver, volume of left liver or left liver/total liver volume ratio among various types of MHV of the donor (Pgt;0.05). Ⅳb vein was also divided into 3 types: The most common was type Ⅰ, accounting for 72.4% (79/109); Type Ⅱ 〔12.8% （14/109）〕, type Ⅲ 〔14.7% （16/109）〕 were relatively fewer. At last, 37 donors provided right liver, for Marcos Ⅰ, Ⅱ, and Ⅲ type of donors, donors remained with MHV was 12/17, 8/11, and 5/9; for Nakamura Ⅰ, Ⅱ, and Ⅲ type of donors, those number were 16/26, 4/6, and 5/5. Conclusion In adult-to-adult living donor liver transplantation, there may be great significances in accordance with Marcos and Nakamura typing results to harvest right lobe liver graft with or without MHV.
Objective To investigate the differentiation of theadipose-derived adult stem cell (ADASC) induced by the recombinant adenovirus’s containing fibers derived from B-group serotype 35 (rAd5/F35)mediated human bone morphogenetic protein 7 (hBMP-7) gene and to explore a new cell sourcefor the bone tissue engineering. Methods The hBMP-7 gene wasamplified with the pcDNA1.1/AMP-hBMP-7 plasmid as a formwork. After the purification, the gene fragment was cloned into the pDC316 carrier for the recombination of the plasmid of pDC316-hBMP-7. The 293 cells were cotransfected by the skeleton plasmid of pBHG-fiber5/35 and the shuttle plasmid of pDC316-hBMP-7, and the recombinant plasmid of Ad5/F35-hBMP-7 was obtained; the recombinant plasmid of Ad5/F35enhancd green fluorescent protein(EGFP) was obtained by the similar method. The rat ADASCs were cultured and transfected by the Ad5/F35-hBMP-7plasmid and the Ad5/F35-EGFP plasmid, respectively; the remaining untransfected ADASC were used as the controls. The morphology and the growth pattern of the transfected cells were evaluated. The transcription and the expression of the transfected genes and the steogenic phenotypes such as calcium nodules and osteocalcin were evaluated by ELISA. Results The identification of PCR and enzyme cutting showed that the construction of the recombinant Ad5/F35-hBMP-7 plasmid could be confirmed. The transfection rate of the ADASC by the Ad5/F35-EGFP plasmid was determined to be greater than 90%. The hBMP-7 gene in thetransfected ADASC could express the corresponding protein, and the formation ofthe calcium nodules could be found in the induced group. The electron microscopy showed that there was a calcium element in the cytoplasm, the alkaline phosphatase result was positive, and the expression of osteocalcin was increased. Conclusion The rAd5/F35-hBMP-7 gene can promote the differentiation of the adiposederived adult stem cells to the osteoblasts in the bone tissue engineering.
Sarcopenia, characterized by the progressive loss of muscle mass and function, predominantly afflicts older adults. This condition is a notable risk factor for functional impairments, increased incidence of falls and fractures, and can escalate to mortality. Timely intervention is crucial to mitigate disability and minimize complications during hospitalization. The development of these guidelines adhered to an internationally recognized standard protocol. This involved framing clinical queries, pinpointing key outcomes, systematically gathering evidence, and appraising this evidence through the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Subsequently, a consortium of experts convened to deliberate over the evidence, culminating in the formulation of these recommendations.
Objective To explore the effect of low-load resistance training on physical fitness in aged adults. Methods Select the aged adults who will go to the outpatient Department of Rehabilitation Medicine of Peking Union Medical College Hospital between June 1, 2020 and May 31, 2021. The aged adults were randomly divided into three groups by using the method of random number table: medium intensity aerobic training group (aerobic training group), standard-load resistance training group (standard-load group) and low-load resistance training group (low-load group). The basic information, exercise endurance (peak power, peak oxygen uptake), exercise cardiopulmonary function [peak heart rate, predicted peak heart rate, peak minute ventilation (VE), ventilatory equivalent for carbon dioxide at anaerobic threshold (EqCO2 during AT)], muscle strength, and muscle oxygen related indexes were collected blindly before the first exercise and after 12 weeks of training, respectively. To compare the differences of the indexes before and after training. Results A total of 90 patients were enrolled, 30 in each group. There was no significant difference in age, sex, height, weight and body mass index among the three groups (P>0.05). There was no significant difference in cardiopulmonary endurance, cardiopulmonary function, muscle strength, muscle oxygen related indexes between the groups before and after training (P>0.05). Except for the indexes related to cardiac function (peak heart rate, predicted peak heart rate) and resting muscle oxygen level (P>0.05), other indexes related to pulmonary function, cardiopulmonary endurance, muscle strength, and time of muscle oxygen falling to the valley in the three groups were statistically significant compared with those before training (P<0.05). Except for peak power, peak oxygen uptake and time of muscle oxygen falling to the valley (P>0.05), the difference of muscle strength before and after training in the three groups was statistically significant (P<0.05), including grip strength, chest push, sitting rowing, leg extension, hip abduction, body bending and horizontal push and push, and the low-load group was better than the aerobic training group (P<0.05), but the improvement of body bending and horizontal push and push in the standard-load group was better than the low-load group (P<0.05). Conclusions Low-load resistance training, standard-load resistance training and aerobic training have almost the same effect on improving the physical fitness of the elderly. Low-load resistance training is superior to medium intensity aerobic training in improving muscle strength, which is an effective method to improve the physical fitness of the aged adults.
Anemia and coagulopathy are frequently presented in critically ill patients on the intensive care unit. Scientific use of blood products assist the treatment of critically ill patients. However, life-threatening adverse effects are also a risk. In 2020, the European Society of Critical Care Medicine (ESICM) published a clinical practice guideline on transfusion strategies for non-bleeding critically ill adults in an attempt to resolve the transfusion strategy problems of relevant critically ill patients. This paper interprets the key contents in order to assist Chinese clinicians for better understanding and using of the guideline.