Epidemiological survey on pre-hypertension and hypertension prevalence among adolescents aged 11 to 17 years in Shanghai / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the prevalence of pre-hypertension and hypertension as well as the association with overweight/obesity in Shanghai adolescents.</p><p><b>METHODS</b>School children aged 11 - 17 years in four schools in Shanghai were included in this survey. All students were visited in May 2010 at school by trained nurses or physicians who administered a questionnaire and carried out anthropometric measurements. Anthropometric measurements included height, weight, heart rate and blood pressure. Repeat measurements were performed in school children with elevated blood pressure within one month. The pre-hypertension and hypertension was defined on the basis of the 2004 National High Blood Pressure Education Program Working Group definitions. The overweight and obesity was defined using cutoff points recommended by Working Group of Obesity, China (WGOC).</p><p><b>RESULTS</b>There were 4175 school children aged 11 - 17 years [mean (15.0 ± 1.9) years, 52.3% (n = 2183) girls and 47.7% (n = 1992) boys]. There were 72.5% (n = 3025) participants with normal blood pressure [ girls (n = 1666) 76.3% and boys (n = 1361) 68.3%], 18.0% (n = 750)participants with pre-hypertension [14.2% (n = 310) for girls and 22.1% (n = 440) for boys], 8.3% (n = 346) participants with stage 1 hypertension [8.2% (n = 179) for girls and 8.3% (n = 165) for boys] and 1.3% (n = 54) participants with stage 2 hypertension [1.3% (n = 28) for girls and 1.3% (n = 26) for boys]. The prevalence of overweight and obesity was 6.7% (n = 147) and 3.0% (n = 66) for girls and 13.7% (n = 273) and 6.3% (n = 125) for boys. After adjusting for gender, age, parental history of hypertension and physical activities, multivariable logistic regression analysis showed that the overweight [adjusted odds ratio and 95% confidence interval: 1.42 (1.16 - 1.75)] and obesity [adjusted odds ratio and 95% confidence interval: 2.35 (1.78 - 3.11)] were independent predictors of elevated blood pressure in this cohort.</p><p><b>CONCLUSIONS</b>The prevalence of elevated blood pressure is common in adolescents in Shanghai. Overweight and obesity are closely associated with the elevated blood pressure in this cohort.</p>

Axial and tangential views of the acromioclavicular joint: the introduction of new projections / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Routine anteroposterior radiographs of the acromioclavicular (AC) joint with or without weight bearing have limitations in demonstrating the AC joint. Transarticular fixation with Kirschner wire is a treatment choice for AC dislocations. However, percutaneous fixation of the AC joint is technically demanding. The C-arm fluoroscopy can be used as routine intraoperative guidance to facilitate this procedure. The current study aims to introduce new projections, the axial and tangential views of AC joint, to help evaluate the severity of the injury and facilitate the percutaneous procedure.</p><p><b>METHODS</b>Three shoulder specimens were used to find the projection directions of the axial and tangential views of the AC joint by using the digital radiography (DR) unit. The axial and tangential views were taken of 20 adult volunteers by referencing the projection directions determined in the shoulder specimens. The angles showed on the DR system and the angles between the coronal plane of the body and the vertical plane of the flat panel detector (FPD) during taking these radiographs were recorded. The C-arm fluoroscopy unit was used to take the axial and tangential views referencing the angles measured on the DR system. Routine anteroposterior radiographs of the AC joint were taken on the volunteers. The minimal distances from the distal clavicle to the acromion were measured on both tangential and anteroposterior radiographs. The data was statistically analyzed.</p><p><b>RESULTS</b>The clear axial and tangential radiographs of AC joints of the volunteers were obtained using both DR and C-arm fluoroscopy units. The angles demonstrated on the DR window are (20.8 ± 2.4)° for male and (18.3 ± 2.3)° for female. During taking the axial views, the angles between the coronal plane of the body and vertical plane of FPD are (23.3 ± 3.2)° for male and (20.1 ± 2.4)° for female. During taking tangential views, the corresponding angles are (117.5 ± 3.7)° for male and (113.1 ± 3.3)° for female. On the tangential radiographs, the minimal distance from the distal clavicle to the acromion is (6.1 ± 1.2) mm, wider than the same measurement on the anteroposterior radiographs (P < 0.05). Statistical analyses showed no significant differences in the above-mentioned angles and the minimal distances between the left and right AC joints (P > 0.05). There were no significant differences in the above-mentioned angles between DR and C-arm fluoroscopy units (P > 0.05).</p><p><b>CONCLUSIONS</b>The axial and tangential radiographs of the AC joint can demonstrate the joint clearly and they can be easily obtained with both DR system and C-arm fluoroscopy unit in similar projection directions.</p>

Comparison of two kinds of intramedullary nails in the treatment of femoral shaft fractures in adults / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intramedullary nails have been widely used in treating femoral shaft fractures. However, end caps falling into soft tissue intraoperatively may cause trouble to surgeons, prolong operative time and increase radiation exposure. Additionally, difficulties may be encountered when removing nails because of callus formation over the nail tip. We performed a prospective study to compare two types of nails in managing femoral shaft fractures.</p><p><b>METHODS</b>Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails. Group II consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires. The patients' ages, fracture severity, duration of operation, fluoroscopy time, blood loss and falls of end caps into soft tissue were recorded. Nails were removed after fracture healing. The duration of operation and blood loss during nail removal were recorded.</p><p><b>RESULTS</b>There were no significant differences between groups with respect to age and fracture severity (P > 0.05). End caps fell into soft tissue 17 times in 15 cases in group I and 21 times in 16 cases in group II. An average of seven minutes was spent recovering a lost cap in group I. In group II, all lost caps were recovered immediately. The duration of operation and fluoroscopy time in group II was significantly less than in group I (P < 0.05). Asymptomatic palpable nodules were detected in 4 cases in group II. Nail removals were performed on 58 patients in group I and 69 patients in group II. The duration of operation, blood loss and complications in group II were less than in group I (P < 0.05).</p><p><b>CONCLUSION</b>Intramedullary nails with tail wires facilitate both fracture fixation and nail removal, which can be used to treat femoral shaft fractures with less radiation exposure, shorter surgical time and fewer complications.</p>

Combination of medial patellofemoral ligament reconstruction with vastus medialis advancement for chronic patellar dislocation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The medial patellofemoral ligament (MPFL) reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.</p><p><b>METHODS</b>We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008: twenty eight cases with isolated MPFL reconstruction (group I), forty one cases with the combination of MPFL reconstruction with vastus medialis advancement (group C). All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.</p><p><b>RESULTS</b>Patients were followed up for a mean of 42 months (12 - 65 months) without a recurrent dislocation reported. Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group I and three in group C had patellar lateral shift exceeding 1.5 cm with a hard end point (P < 0.05). The Kujala score improved significantly from 51.3 ± 4.5 to 79.9 ± 6.2 in group I and from 53.7 ± 5.2 to 83.9 ± 6.5 in group C (P > 0.05). However, the subjective questionnaire revealed a significant difference (P < 0.05), including 12 excellent, seven good and nine fair in group I and 30 excellent, six good and five fair in group C.</p><p><b>CONCLUSION</b>The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.</p>