Determination of outcomes of complex upper end tibial fractures in squatting and cross leg sitting South Asian population

IntroductionTreatment of complex upper end tibial fractures has always been a challenge to orthopaedic surgeons. Though the roentgenogram results are satisfactory, the clinical and functional outcomes especially in terms of squatting/cross-leg sitting after long term follow-up are little known. Hence, we have done this study with a primary aim to assess the clinico-radiological and functional outcomes after operative fixation (mostly by locking plates) in complex upper end tibial fractures and a secondary aim to analyze correlation between functional outcome scores/range of motion (ROM) and the ability to squat & sit cross-legged in post-operative period.Materials and methodsThis prospective study included a total of 33 patients who were mainly treated with locking plates. In the follow-up, patients were assessed clinico-radiologically and outcome measurements were determined using the Tegner-Lysholm (T-L) Knee Score. Patients were categorized according to their ability to squat/sit cross-legged and a subgroup analysis was performed by comparing mean ROM and T-L score in each group.ResultsMajority of patients were in young and adult age group with a male to female ratio of 4.5:1. The average age was 42.39 ±14.64 years. Road traffic accident was the most common mode of injury. Average time interval between injury and surgery was 5.8±4.4 days. All the fractures united by 5-9 months. Mean ROM and T-L score at last follow-up were 120.94°±13.63° and 88.12±7.24 respectively. Average shortening, varus and valgus deformity were 0.43±0.09 cm, 2.12°±0.62° and 1.06°±0.45° respectively. 14 patients (42.42%) were able to squat and 15 (45.45%) were able to sit cross-legged postoperatively. Upon subgroup analysis, difference of mean ROM in those who could squat/sit cross-legged was found statistically significant (p≤0.05), however the difference in mean functional scores was not significant (p≥0.05).ConclusionComplex upper tibial fractures are a difficult entity to deal with. Anatomical locking plates take care of the alignment, articular congruity as well as ligamentous balancing thus giving good mid-term outcomes after ORIF/MIPO. However, applicability of the present functional outcome scores in assessing squatting/cross leg sitting remains doubtful. More weightage needs to be given to these activities to evaluate the outcome in South Asian population.     

Gender-related differences in concomitant articular injuries after acute lateral patellar dislocation

ObjectivesTo explore the gender differences in the concomitant articular injuries after acute lateral patellar dislocation (LPD).MethodsMagnetic resonance images were prospectively analyzed in 166 patients after an acute LPD. Concomitant articular injuries included bone contusion, medial patellofemoral ligament (MPFL) injury, articular cartilage lesion, and vastus medialis obliquus (VMO) lesion. Statistical analyses were performed between the patient's gender and the incidence of concomitant articular injuries in adolescent and adult subgroups.ResultsThe incidence of partial and complete MPFL tear in adolescent males and females were (45%, 50%) and (63.2%, 29.8%), respectively. Compared with adolescent females, adolescent males showed higher incidence of complete MPFL tear (P = 0.049). The incidence of articular cartilage lesion of patella in adolescent males and females were 40% and 21.1%, respectively. Compared with adolescent females, adolescent males showed higher incidence of articular cartilage lesion of the patella (P = 0.043). No correlations were identified in other injuries in the adolescent group. The incidence of partial and complete MPFL tear in adult males and females were (34.4%, 65.6%) and (56.8%, 37.8%), respectively. Compared with adult females, adult males showed higher incidence of complete MPFL tear (P = 0.036). The incidence of articular cartilage lesion of patella in adult males and females were 56.3% and 32.4%, respectively. Compared with adult females, adult males showed higher incidence of articular cartilage lesion of patella (P = 0.047). The incidence of VMO injury in adult males and females were 59.4% and 35.1%, respectively. Compared with adult females, adult males showed higher incidence of VMO injury (P = 0.044). No correlations were identified in other injuries in the adult group.ConclusionsCompared with females, males predispose to complete MPFL tear and articular cartilage lesion of patella after acute LPD. Compared with female adults, male adults predispose to VMO injury.     

基于HS-GC-IMS技术分析六神曲炮制前后（炒、焦）挥发性物质的变化

目的 分析六神曲Massa Medicata Fermentata炮制前后（炒、焦）的挥发性有机物特征及其变化规律。方法 采用顶空-气相色谱-离子迁移质谱（headspace-gas chromatography-ion migration mass spectrometry,HS-GC-IMS）测定六神曲生品、炒品和焦品的挥发性有机物,构建HS-GC-IMS指纹图谱,采用VOCal软件对检测到的成分进行定性和定量分析,运用主成分分析（principal component analysis,PCA）、偏最小二乘-判别分析（partial least squares-discriminant analysis,PLS-DA）、t检验等对样品进行差异性分析。结果 基于HS-GC-IMS技术从六神曲生品、炒品和焦品中共获得了80种挥发性有机物,定性鉴别出60种;构建了六神曲生品、炒品和焦品的HS-GC-IMS指纹图谱,通过PCA、PLS-DA、t检验等分析方法可将三者进行区分,己醛-D(hexanal-D)、乙醇（ethanol）2种物质可作为六神曲生品的特征性成分;丁醛（butanal）...     

基于指纹图谱和多指标含量测定的蜜远志质量评价

目的 建立指纹图谱和多指标定量的蜜远志质量评价方法。方法 Kromasil 100-5-C₁₈色谱柱（250 mm×4.6 mm,5 μm）为固定相,以乙腈（A）-0.2%磷酸水溶液（B）为流动相进行梯度洗脱,体积流量为1.0 mL/min,检测波长318 nm。对16批蜜远志建立指纹图谱,确定共有峰并进行相似度分析结合化学计量学分析。采用Waters Xbridge Shiled RP C₁₈色谱柱（250 mm×4.6 mm,5 μm）进行同时测定远志（口山）酮III、3,6''-二芥子酰基蔗糖、细叶远志皂苷、远志酸、远志皂苷元的含量。结果 在指纹图谱研究中,标定了27个共有峰,结合对照品和HPLC-Q-TOF-MS共指认8个成分,分别为西伯利亚远志糖A5、西伯利亚远志糖A6、远志（口山）酮IX、远志（口山）酮III、3,6''-二芥子酰基蔗糖、细叶远志皂苷、远志酸、远志皂苷元。聚类分析将16批样品分为3类;经主成分分析,主成分1～3是影响蜜远志质量评价的主要因子。多指标含量测定中远志（口山）酮III、3,6''-二芥子酰基蔗糖、细叶远志皂苷、远志酸、远志皂苷元的质量分数分别为0.027%～0.068%、0.074%～0.798%、1.1%～1.4%、0.15%～0.36%、0.15%～0.37%。经方法学验证,线性关系良好（r≥0.999 6）,平均加样回收率为97.15%～100.9%。结论 所建立的指纹图谱结合多指标含量测定方法准确、高效,特征性强,可为蜜远志饮片的质量评价和临床应用提供有效参考。     

基于预防接种异常反应补偿的山东省卡介苗淋巴结炎经济负担测算

目的了解山东省卡介苗(BCG)淋巴结炎经济负担情况。方法以2011年5月至2019年12月山东省304例申请省级补偿的BCG淋巴结炎病例为对象,收集患者基本情况、预防接种相关情况、门诊(住院)病历和收费票据等相关资料,对其直接经济负担(包括直接医疗费用和直接非医疗费用)、间接经济负担和总经济负担进行测算,比较不同特征病例经济负担的差异。结果304例BCG淋巴结炎患者月龄的M(Q1,Q3)为3(2,4)月,其中男性239例(78.6%),淋巴结破溃71例(23.4%),手术227例(74.7%)。单纯门诊、单纯住院和门诊后住院病例分别占25.7%(78例)、7.2%(22例)和67.1%(204例)。贴现后单例直接、间接和总经济负担的M(Q1,Q3)分别为9910(5713,16074)、2081(1547,3122)和12262(7694,18571)元。直接医疗费用占直接经济负担的89.4%,直接经济负担占总经济负担的84.9%,80.0%病例的总经济负担仅占其补偿金额的20.0%左右,只有2.3%的病例总经济负担占补偿金额的60.0%以上。单纯住院和门诊后住院病例的直接、间接和总经济负担高于单纯门诊病例,手术病例的直接、间接和总经济负担高于非手术病例,淋巴结未破溃病例的直接和总经济负担高于破溃病例(均P<0.05)。结论山东省BCG淋巴结炎病例经济负担受诊疗方式的影响,且以直接医疗费用为主。     

山东省2016-2017年人群烟草使用及其影响因素调查

目的 了解山东省人群烟草使用现状以及主要影响因素。方法 运用多阶段分层整群抽样方法,在山东省36个区（县）216个村（居委会）抽取调查对象,使用非条件logistic回归模型进行多因素分析。结果 有效调查6 271人,经过复杂加权计算后,≥ 15岁人群现在吸烟率为23.93%,其中男性为45.58%,女性为1.18%;不同年龄组人群现在吸烟率差别较大,45~64岁年龄组现在吸烟率最高（25.07%）;不同文化程度人群吸烟率不同,初中文化程度者现在吸烟率最高（28.94%）;农村现在吸烟率（24.98%）高于城市（23.08%）;现在每日吸烟率为20.23%,吸烟者开始吸烟平均年龄为21.21岁,日平均吸机制卷烟量为16.31支;在调查所有曾经和现在吸烟者中,戒烟率为20.79%。多因素logistic回归分析结果显示,性别、年龄、职业、地区、健康知识得分与吸烟行为存在关联。男性现在吸烟率高于女性（OR=49.625,95%CI：37.832~65.093）,45~64岁组现在吸烟率高于15~24岁组（OR=1.830,95%CI：1.048~3.194）,农林牧渔从业者现在吸烟率分别高于医务人员（OR=0.403,95%CI：0.187~0.866）和离退休人员（OR=0.648,95%CI：0.481~0.873）,中部地区居民现在吸烟率低于东部（OR=0.724,95%CI：0.606~0.865）,吸烟危害健康知识得分1~3分组现在吸烟率高于4~6分组（OR=1.432,95%CI：1.240~1.654）。结论 山东省人群吸烟率处于较高水平,应对吸烟者开展控烟健康教育等综合性干预措施,以降低人群吸烟率。     

2014-2018济南市522437例围产儿出生缺陷发生情况分析

目的 了解近5年济南市出生缺陷发生情况,为政府部门制定针对性的防控措施提供依据。方法 利用济南市妇幼信息平台收集出生缺陷相关信息,分析出生缺陷发生率、发生顺位变化趋势。结果 2014-2018年济南市出生缺陷平均发生率为136.02/万,发生率最高的年份为2017年（183.87/万）,发生率最低的年份为2014年（99.63/万）总体呈上升趋势（Z=185.153,P<0.05）。男性围产儿缺陷发生率为152.79/万,女性围产儿缺陷发生率为117.34/万。出生缺陷围产儿的母亲发生年龄分布呈“U”型,20岁以下低年龄段和35岁以上高年龄段发生率较高,其中2014年、2015年20岁以下年龄段发生率最高,2016、2017、2018年35岁以上年龄段发生率最高;主要出生缺陷病种为先天性心脏病、多指/趾、总唇裂、并指/趾、尿道下裂,其中先天性心脏病发病率逐年上升（Z=223.604,P<0.05）。结论 济南市出生缺陷发生率呈逐年上升趋势,应特别关注低年龄段人群,重点关注先天性心脏病的防控工作。     

山东省2019年中小学校教学环境调查

目的 调查山东省中小学教学环境卫生学现状。方法 2019年8月至12月,采用多阶段随机抽样方法随机抽取山东省16地市213所中小学校的1287间教室,对教学环境的教室人均面积、课桌/椅分配、黑板尺寸、教室采光、照明及噪声进行监测并计算各项指标的合格率。结果 合格率最低的是黑板面照度,为24.46%,小学、初中和高中分别为22.38%,26.24%和24.75%,差异无统计学意义。课桌椅分配符合率为31.46%,小学、初中和高中分别为25.06%,35.77%和33.59%,差异有统计学意义。教室人均面积合格率为43.52%,小学、初中和高中分别为31.32%,44.06%和55.48%,小学的合格率明显低于中学。其余项目的合格率在50%~77%之间。城区和郊县学校在教室人均面积、黑板、黑板面照度均匀度、课桌面照度和照度均匀度合格率的差异具有统计学意义,其中郊县学校的黑板面和课桌面照度均匀度合格率高于城区,其他项目合格率低于城区学校。结论 山东省中小学教学环境教室人均面积、课桌椅分配符合率和教室照明等方面还存在一些问题,需要相关部门采取措施来改善教学环境。     

山东省胶东半岛养殖海带部分元素含量水平分析及健康风险评估

目的 研究山东省胶东半岛养殖的140份海带中铅、镉、砷等10种金属及无机砷含量水平及分布特征,评估其对人体健康的潜在风险,以期为我国鲜海带制定卫生标准提供参考依据和数据支撑。方法 采用ICP-MS 法测定样品中铅、镉、砷等九种元素,原子荧光法测定汞,HPLC -ICP-MS联用法测定无机砷。采用目标危险系数评估鲜海带中金属对成人及儿童存在的潜在健康风险。结果 10种金属元素平均浓度依次递减为Al、As、Zn、Cu、Cr、Ni、Pb、Cd、Sn、Hg。 单个元素风险顺序为Cd> Cr> Al> Pb> Cu> Ni> Zn> Hg。单一元素的目标危险系数THQ值与多种金属的复合目标危险系数TTHQ值均小于1。虽然样品中总砷的含量非常高,但无机砷含量却很低,95%样品中无机砷未检出。结论 食用山东省胶东半岛养殖海带目前对人体不具有危险性。对人体健康危害最大的元素为镉,贡献率达32.4%（儿童）、32.2%（成人）。应关注海带中镉元素含量对人体健康造成的潜在威胁。对儿童来说多种金属的复合风险TTHQ值（0.877）已接近1,也应引起持续关注。