A history of eponym usage in hip and pelvis radiography part 1: the paediatric hip.

Eponyms, while inherently flawed, remain a constant in medical vernacular, especially in orthopaedic surgery. It is essential to understand how these eponyms came to be named and for whom they were named after in order to know the correct usage and definition of these eponyms. In this first part, we describe the history of eponym usage in paediatric hip radiography; who, when, what, where, and how. We hope to provide a historical perspective of interest, resolve any controversies in semantic definitions, and create a comprehensive library of eponymous terms related to paediatric hip radiography.

Tracking short-term health impacts attributed to ambient PM2.5 and ozone pollution in Chinese cities: an assessment integrates daily population.

Joint and synergistic control of PM2.5 and ozone pollution is an urgent need in China and a global-widely concerned issue. Health impact assessment could provide a comprehensive perspective for PM2.5-ozone coordinated control strategies. For a detailed understanding of the seasonality and regionality of the health impacts attributed to PM2.5 and ozone in China, this study extended the classic health impact function by daily population and assessed the short-term (daily) health impacts in 335 Chinese cities in 2021. Population migration indexes from Baidu were introduced to estimate the cities' daily population. Using this method, we quantitatively investigated the influence of population on short-term health impact assessment and identified which was significant in the Pearl River Delta (PRD) region and other populous cities. Although the annual sums of PM2.5- and ozone-related daily health impacts were close for all Chinese cities, the PM2.5-related health impact was equivalent to 333.96% and 32.07% of that ozone-related, during the cold and warm periods. The correlation and local spatial association analysis found significant city-specific and city-cluster associations of daily health impacts during the warm period and in Beijing-Tianjin-Hebei and surrounding regions (BTHS) and the Yangtze River Delta (YRD). Policymakers could promote period- and pollutant-targeted control actions for the major city groups, especially the BTHS, YRD, and PRD. Our methods and findings investigated the various influences of the population on short-term health impact assessment and proposed the PM2.5-ozone collaborative control idea for key regions and city groups.

Relevance between Proximal Humeral Migration and Rotator Cuff Tears.

Background: Proximal humeral migration is common in patients with rotator cuff tears. In this study, we aimed to evaluate the relevance between proximal humeral migration and some rotator cuff tear-related factors. Methods: A total of 75 patients with unilateral rotator cuff tears were retrospectively included from August 2016 to January 2018 who underwent magnetic resonance imaging and X-ray examinations before enrollment. We introduced the upward migration index (UMI) to stratify the patients into three groups, Group A: 1 < UMI ≤ 1.3; Group B: 1.3 < UMI ≤ 1.4; and Group C: UMI > 1.4. Pearson correlation analysis and logistic regression analysis were used to evaluate the relationship between UMI and age, sex, body mass index, pain, fatty degeneration grade, tear size, and thickness of ruptured tendon. Then, the χ 2 test and receiver operator characteristic curve were applied to measure the diagnostic value of UMI. Results: The average UMI was 1.34 ± 0.07, ranging from 1.16 to 1.48. For the Pearson correlation analysis, there was a negative correlation between UMI and tear size (R = -0.68, p < 0.01), and also, there was a negative correlation between UMI and the visual analogue scale score (R = 0.342, p < 0.01). What is more, there was a negative correlation between UMI and the fatty degeneration grade (R = -0.373, p < 0.01). Ordinal multinomial logistic regression analysis indicated that tear size (ß = -1.825, p < 0.001) was the independent predictor of UMI, which was a risk factor for humeral upward migration. The cutoff points of UMI were 1.38 and 1.3 to determine tears and distinguish large tears from small ones. Conclusions: UMI is a good predictor for humeral upward migration, which is related to the tear size of posterosuperior cuff tears. When the UMI is <1.3, a large tear should be alerted. Combining physical examination and X-ray is helpful for evaluating rotator cuff tears.

Evaluating the impact of the travel ban within mainland China on the epidemic of the COVID-19.

OBJECTIVES: The ongoing COVID-19 pandemic expanded its geographic distribution through the movement of humans and caused subsequent local outbreaks. Hence, it is essential to investigate how human mobility and travel ban affect the transmission and spatial spread while minimizing the impact on social activities and national economics. METHODS: We developed a mobility network model for spatial epidemics, explicitly taking into account time-varying inter-province and inner-province population flows, spatial heterogeneity in terms of disease transmission, as well as the impact of media reports. The model is applied to study the epidemic of the dynamic network of 30 provinces of mainland China. The model was calibrated using the publicly available incidence and movement data. RESULTS: We estimated that the second outbreak occurred approximately on February 24, 2020, and the cumulative number of cases as of March 15, 2020, increased by 290.1% (95% CI: (255.3%, 324.9%)) without a travel ban in mainland China (excluding Hubei and Tibet). We found that intra-province travel contributes more to the increase of cumulative number of cases than inter-province travel. CONCLUSION: Our quantitative and qualitative research results suggest that the strict travel ban has successfully prevented a severe secondary outbreak in mainland China, which provides solutions for many countries and regions experiencing secondary outbreaks of COVID-19.

Temporal and spatial analysis of COVID-19 transmission in China and its influencing factors.

OBJECTIVES: The purpose of this study was to explore the temporal and spatial characteristics of COVID-19 transmission and its influencing factors in China, from January to October 2020. METHODS: About 81,000 COVID-19 confirmed case data, Baidu migration index data, air pollutants, meteorological data, and government response strictness index data were collected from 31 provincial-level regions (excluding Hong Kong, Macao, and Taiwan) and 337 prefecture-level cities. The spatio-temporal characteristics of COVID-19 were explored using spatial autocorrelation, hot spot, and spatio-temporal scanning statistics. At the same time, Spearman rank correlation analysis and multiple linear regression were used to explore the relationship between influencing factors and confirmed COVID-19 cases. RESULTS: The distribution of COVID-19 in China tends to be stable over time, with spatial correlation and prominent clustering regions. Spatio-temporal scanning analysis showed that most COVID-19 high-incidence months were from January to March at the beginning of the epidemic, and the area with the highest aggregation risk was Hubei Province (RR=491.57) which was 491.57 times the aggregation risk of other regions. Among the meteorological variables, the daily average temperature, wind speed, precipitation, and new COVID-19 cases were negatively correlated. The air pollution concentration and migration index were positively correlated with new confirmed cases, and the government response strict index was strongly negatively correlated with confirmed COVID-19 cases. CONCLUSIONS: Environmental temperature has a certain inhibitory effect on the transmission of COVID-19; the air pollution concentration and migration index have a certain promoting effect on the transmission of COVID-19. The strict government response index indicates that the greater the intensity of government intervention, the fewer COVID-19 cases will occur.

The Impact of Spinal Fusion on Hip Displacement in Cerebral Palsy.

BACKGROUND AND STUDY AIMS: The aims of this study were to determine the risk of progressive hip subluxation in children with CP after spinal fusion for scoliosis and how frequent the hips follow-up should be scheduled. PATIENTS AND METHODS: Pelvis radiography [migration index (MI) and pelvic obliquity (PO)] of Gross Motor Function Classification System (GMFCS) levels IV and V children with CP who received spinal fusion and pelvic fixation were reviewed retrospectively. This population was categorized into three groups based on the MI at spinal fusion: G1 = 0-29%; G2 = 30-59%; and G3 = 60-100%. RESULTS: Fifty children (age 7.5-15.0 years) and categorized into 3 groups (G1 = 19, G2 = 23, G3 = 8; 100 hips in total). Preoperative and last follow-up MI were 22 ± 7% and 30 ± 20% (G1), 41 ± 9% and 43 ± 22% (G2), 92 ± 15% and 97 ± 10% (G3). The MIs at spinal fusion between groups were statistically different (p < 0.001). In G1, the mean MI progression was 5% and 25% at 12 months and 62 months, respectively. In G2, the mean MI progression was 9% and 25% at 12 months and 32 months, respectively. The progression more than 10% occurred within 2 years in G1 and within 1 year in G2. There was no difference between groups based on preoperative degree of PO (p = 0.653) and correction rate in PO (p = 0.421). CONCLUSIONS: In GMFCS IV and V children with the highest risk for progression occurred with increasing preoperative MI, especially over 50%. Hips should be monitored continuously after spinal fusion until hip stability is documented.

Regional infectious risk prediction of COVID-19 based on geo-spatial data.

After the first confirmed case of the novel coronavirus disease (COVID-19) was found, it is of considerable significance to divide the risk levels of various provinces or provincial municipalities in Mainland China and predict the spatial distribution characteristics of infectious diseases. In this paper, we predict the epidemic risk of each province based on geographical proximity information, spatial inverse distance information, economic distance and Baidu migration index. A simulation study revealed that the information based on geographical economy matrix and migration index could well predict the spatial spread of the epidemic. The results reveal that the accuracy rate of the prediction is over 87.10% with a rank difference of 3.1. The results based on prior information will guide government agencies and medical and health institutions to implement responses to major public health emergencies when facing the epidemic situation.

Derotational Subtrochanteric Osteotomy and External Fixation for the Treatment of Neurogenic Hip Dislocation in Children with Cerebral Palsy: Could This Be a Viable Method of Treatment?

Purpose The treatment of painful and chronic dislocated hip in children with severe cerebral palsy (CP) is particularly demanding and controversial. Numerous surgical techniques have been described, and their outcomes vary a lot. The purpose of the present study is to evaluate a new method, which combines varus derotational subtrochanteric osteotomy (VDSO) and external osteosynthesis: (VDSOEO). Methods Six non-ambulatory children with spastic quadriplegia and chronic dislocated painful hips were treated. The technique involved a small incision on the subtrochanteric site of the osteotomy, followed by retention with a single-sided external osteosynthesis with rotational correction capability [swiveling clamp (SC)] for the reduction of the femur head in the acetabulum, and finally by the osteotomy. Hardware was removed without a second intervention four-six months postoperatively and after the osteotomy was healed. Evaluation of the method was based on clinical, functional, and radiological criteria. Results  Four patients achieved improved radiological scores. Two patients demonstrated resubluxation during the period of the osteotomy's healing process. However, no patients experienced pain, and all were able to sit post-surgery, while caregivers reported improved capacity for nursing care. Conclusions It is our strong belief that this approach can improve the quality of life in children with severe CP and painful and chronic dislocated hips. It is a viable and definitely less invasive procedure than classic pelvic or femur osteotomies.

Epidemiological characteristics of confirmed COVID-19 in Guizhou province, China.

OBJECTIVE: To explore the epidemiological characteristics of COVID-19 associated with SARS-Cov-2 in Guizhou province, and to compare the differences in epidemiology with other provinces. METHODS: The data were extracted from National Health Commission of the People's Republic of China, Health Commission of Guizhou province, and Health Commission of Hubei province from January 20 to February 12, 2020. Information included such as general demographic indicators, population data and clinical outcome. RESULTS: A total of 135 cases were analyzed in the study. The average age was 39.46±18.95 years. The ratio of males to females was 0.985:1. Most of COVID-19 patients were 18-45 years old (52.27%). Close contact history was the most common (37.88%), followed by residence history in Hubei (34.85%). There was no difference between males and females in age (P=0.953) and exposure condition (P=0.186). Correlation analysis showed that there was a significant positive correlation between the migration index and the number of confirmed cases (r=0.816, P=0.007). CONCLUSION: Among the cases, most patients were young adults. Most epidemiological characteristics were no difference between males and females. Family-based transmission should not be ignored, as a close contact history was the top reason of exposure. Moreover, population movements also had significant impact on outbreaks.

Association Between the Elasticity of Hip Muscles and the Hip Migration Index in Cerebral Palsy.

OBJECTIVES: Cerebral palsy (CP) increases the risk of hip displacement during childhood. Abnormal hip muscle forces have been proposed as the predisposing factors. In CP, the amount of hip displacement is commonly evaluated by the Reimers hip migration index (MI) on an anteroposterior pelvic radiograph. To the best of our knowledge, the association between the elasticity of hip muscles measured by shear wave elastography and the MI has not been studied yet. Herein, we aimed to analyze the correlation between the elasticity of hip muscles and the MI. METHODS: Bilateral hips of 25 children with spastic CP were included prospectively in this study. Anteroposterior pelvic radiographs were used to measure the MI. Shear wave elastography was performed to evaluate the elasticity of muscles. The correlation between the MI and the elasticity of hip flexor and adductor muscle groups was assessed. Also, the association between the elasticity of agonist/antagonist muscles was analyzed. RESULTS: The MI showed fair to good correlations with hip flexors and adductors for both readers (0.71 ≥ r ≥ 0.52). The mean MIs of the patients ± SDs were 22.64% ± 7.79% for reader 1 and 21.55% ± 8.83% for reader 2. The elasticity of agonist/antagonist muscle groups showed little/no to a weak correlation for both readers (0.32 ≥ r ≥ -0.07). CONCLUSIONS: Although, hip flexor and adductor muscle elasticity showed a correlation with MI, it seems very hard to say that increased elasticity of hip flexor and adductor muscles causes hip dislocation.

The trilemma of trade, monetary and immigration policies in the United States: Accounting for environmental sustainability.

The United States like every other country across the globe, especially the developed nations, have consistently battled one of man's greatest challenge of the 21st century-saving and sustaining the dire environment. Being the largest emitter of carbon dioxide (CO2) after China, the United States is increasingly faced with an urgent policy drive toward environmental sustainability. Against the backdrop, this study employed the dynamic ARDL-bound testing approach to observing the tripartite impact of the trade policy, monetary policy, and migration index on carbon emissions over the period 1990:Q1-2018: Q2. The incorporated renewable energy consumption and the real GDP which controls for other unobserved factors are observed to have similar and significant impacts as in previous studies. The current study found that the trade policy, monetary policy, and migration index exerts positive and significant impacts on carbon dioxide emissions in the long-run. It implies that in the near future, the environmental sustainability of the United States is at the risk of the government policies on trade, monetary, and migration. However, such impact of the migration index on the carbon dioxide emissions is barely significant in the long-run and at the immediate time. Although the impact of the government's trade policy on carbon dioxide emissions is significant in the long-run, it immediate impact is negative and not significant. Hence, policy frameworks of the government should be designed such that it meets the Sustainable Development Goals 2030.

The relationship between the level of lesion and progression in Reimer's index of spina bifida patients.

AIM: We aimed to evaluate the influence of the lesion level and acetabular displasia on the progression of hip dislocation in patients with spina bifida. MATERIAL AND METHOD: Two hundred twelve hips of 106 cases with spina bifida were evaluated both clinically and radiologically. Their vertebral level of lesions, clinical examinations, radiological migration index, and acetabulum terms were noted and were evaluated in terms of their relations with the level of lesion-migration and dysplasia. Data analysis method was evaluated using SPSS 22.0 program. RESULTS: Deficiency of acetabulum was present in 33 % of the cases with spina bifida. Dysplastic floor was found to be as equally important as the level of lesion in the progression of hip dislocation (p = 0.002). Progression and dislocation incidences were observed to be higher in the thoracic level (p = 0.008). Reimer's progression index was seen to be a reliable way of assesment. CONCLUSION: The development of hip dislocation and progression are not solely connected with muscle imbalance. Encountered more frequently in these cases, acetabular dysplasia is a factor that is as important as the level of lesion in the formation of hip dislocation and progression. Hip dislocation is associated with more progression in the higher level lesions. Reimer's index is a reliable assessment criteria.

The effect of physician experience on the measurement reliability of the Reimers' hip migration percentage in children with cerebral palsy.

[Purpose] Reimers' hip migration percentage (MP) is commonly used to document the extent of hip displacement in children with cerebral palsy (CP). However, factors such as poor administration of pelvic radiographs, a lack of concentration, inexperience, or a busy clinical environment may result in variations in the MP measurements. The aim of this study was to compare the differences in the MP results of two physiatrists with varying levels of experience to determine the role of experience in the measurement's accuracy. [Subjects and Methods] This retrospective study included 62 hip radiographs of 31 children with spastic CP. Two physiatrists with different experience levels calculated the baseline MP on two occasions six weeks apart. Correlations, intra- and inter-rater reliabilities, and differences in the MPs were compared. [Results] Correlations and inter- and intra-rater reliabilities of the measurements were excellent. There were no statistically significant intra- or inter-rater differences for either of the two measurement points. Inter-rater correlations for each session were 0.94. [Conclusion] Experience does not appear to be a factor in the evaluation of MP, and inter-rater differences do not cause problems regarding patient follow-up. Therefore, repeated pelvic radiographs are not necessary in the evaluation of MP in children with CP unless indicated.

Reliability of hip migration index in children with cerebral palsy: the classic and modified methods.

OBJECTIVE: To determine reliability and clinical use of two methods of migration index (MI) in CP patients with or without hip dysplasia. METHOD: The materials included radiographs of 200 hips of children with cerebral palsy. Conventional anteroposterior radiographs of the pelvis were taken with the child in the supine position with standardized methods. Two rehabilitation doctors measured the migration index using two methods. In the classic method, the lateral margin of the acetabular roof was used as a landmark and in the modified method the lateral margin of the sourcil was used as a landmark. Each rater measured the migration index at three separate times with a time interval of at least one week. Intraclass correlation (ICC) was used to test the inter- and intra-rater reliability. RESULTS: MI shows excellent intra-rater reliability in both the classic and modified methods, but the inter-rater reliability was higher in the classic method than in the modified method. When categorized according to the sourcil classification, inter-rater reliability was higher in the normal sourcil type and lower in the dysplastic sourcil types. CONCLUSION: Generally, the classic method showed higher reliability than the modified method, even though the reliability of the MI measurement was relatively high with both methods.

Reliability of Hip Migration Index in Children with Cerebral Palsy: The Classic and Modified Methods

OBJECTIVE: To determine reliability and clinical use of two methods of migration index (MI) in CP patients with or without hip dysplasia. METHOD: The materials included radiographs of 200 hips of children with cerebral palsy. Conventional anteroposterior radiographs of the pelvis were taken with the child in the supine position with standardized methods. Two rehabilitation doctors measured the migration index using two methods. In the classic method, the lateral margin of the acetabular roof was used as a landmark and in the modified method the lateral margin of the sourcil was used as a landmark. Each rater measured the migration index at three separate times with a time interval of at least one week. Intraclass correlation (ICC) was used to test the inter- and intra-rater reliability. RESULTS: MI shows excellent intra-rater reliability in both the classic and modified methods, but the inter-rater reliability was higher in the classic method than in the modified method. When categorized according to the sourcil classification, inter-rater reliability was higher in the normal sourcil type and lower in the dysplastic sourcil types. CONCLUSION: Generally, the classic method showed higher reliability than the modified method, even though the reliability of the MI measurement was relatively high with both methods.

Early Subluxation of Hip in Children with Cerebral Palsy

OBJECTIVE: Hip deformity is one of the common problems in children with cerebral palsy. And it is important to detect hip subluxation or dislocation as early as possible. The purpose of this study is to find the incidence of hip subluxation in early childhood in patients with cerebral palsy. METHOD: We reviewed clinical and radiological records of children with cerebral palsy under 36 months of age. We measured migration index, acetabular index, center edge angle and neck shaft angle from hip X-ray of patients. RESULTS: Total 76 patients were included in this study. The mean of migration index was 4.5+/-7.5% at 8~12 months, 10.9+/-11.9% at 13~24 months, and 18.2+/-13.0% at 25~36 months (p<0.05). Twenty one patients (27.6%) were above 25% on the migration index. The neuromotor type of cerebral palsy in 21 patients with hip subluxation, were spastic in 20 (95.2%) except one child. The incidence of hip subluxation was 25.0% (8/32) for quadriplegia, 29.6% (8/27) for diplegia and 50.0% (4/8) for hemiplegia. The acetabular index was significantly higher and the center edge angle was lower in the subluxated hip group than in the non-subluxated hip group, though no significant difference in the neck shaft angle. CONCLUSION: We concluded that the hip subluxation in cerebral palsy can occur under 36 months of age with a relatively high incidence. Therefore, it is recommended to evaluate the hip of cerebral palsy with radiological as well as clinical examination in early childhood.

Legg-Calve-Perthes Disease: The Clinico-Radiological Analysis of 101 Hips of 89 Patients / 대한정형외과학회잡지

The object of treatment of Legg-Calve-Perthes disease (L.C.P.D.) is to shorten the clinical course and minimize, or prevent residual deformity, This is accomplished by placing the femoral head deeply within the acetabulum, so that its articular surface is completely contained and maintaining a full range of motion, thereby preventing lateral extrusion of head, concentrated vertical loads and collapse. The purpose of this study was to determine the predicting value of prognosis and correlation of three different evaluating methods, when examining an identical series of radiographs to assess the effect of treatments, and to determine whether the result obtained by femoral osteotomy gave better result than those by non-surgical means. During the past ten years prior to writing, 89 patients with L.C.P.D. were treated by authors. Seventy eight (87.6%) patients were boys and 11 (12.4%) girls. Their ages at the time of initial visit ranged from 2 to 13 years. Twelve (13.5%) patients had bilateral and 77 had unilateral involvement for a total of 101 hips. They were analysed according to Catteralls classification, and also comparative study was done for 32 patients who were followed up over 15 months. The longest follow-up was 5 years and 2 months. They were divided into 2 groups: clildren in group A were treated by rest and abduction brace,. followed over 3 years and 3 months in average, and children in group B were treated, by intertro-chanteric osteotomy, followed over 2 years and 6 months in average. End results for 32 cases were evaluated at each follow-up time by Length/Width Index (L/W.I.) of femoral neck (Robichon, 1974), Migration Index (M.I.) and Spherical quotient (S.Q.) of capital femoral epiphysis (Edsberg et al, 1979). L/W.I.,M.I, S.Q. were used not only as the method of evaluation, but also were used as a predicting the prospective clinical course during the treatment by regular measurement whether it takes the good course or not. Results obtained were as follows: 1. 21(20.8%) were classified as group I, 30(29.7%) as group Il. 31(30.7%) as group III and 19 (18.8%) as group IV. 43 children (42.6%) on their initial visit were found to have this diasbling hip condition at stage II (necrosis and early fragmentation stage). 2. Regardless of the type of treatment, good results were obtained in younger children under age of 7 years, and in mild form as in group I, and lI. Also good, results were obtained in the cases who had treatment at early stage of the disease. No difference was found in the end results between girls and boys when they had same degree of head involvement. 3. In 14 surgically-treated patients, the good results were obtained in 9(64.3%) when assessed by L/W I. 10(75.4%) by M.I., and 7(50%) by S.Q., while in 18 conservatively treated patients good results were obtained in 8(44.4%) when assessed by L/W I. in 6(33.3%) by M.I., and 7(38.7%) by S.Q.. This fact means that S.Q. under-estimates the results of well-treated cases, while M.I. seemingly over-estimates them. 4. when X-rays of the hips were taken in different position's, different L/W Indices were unexpectedly obtained; these deviations in assessment may be listed as a drawback. Migration Index can prognosticate the healing process of the disease during treatment, if the index together with medial joint space is measured repeatedly with certain intervals. Also it is difficult to obtain accurately the S. Q. by measurements because of difficulty locating the center of fragmentary head, but it is considered the best method assessing the end-result at the healed stage. S.Q. expresses the head spherocity, while the M. I. expresses the degree of head coverage and the neck L/W.I. expresses the indirectly amount of neck deformity. 5. When the clinical course is assessed by three evaluating methods, occasionally these three results contradict to each other and do not show similar prognostic tendency or trend. The reason is that neck L/W Index and Spherical quotient indicate directly the progress of the disease while Migration Inex receases only the state of femoral head containment and there by indirectly indicates ensuing prospective course when containment is good, and do not indicate the state of severity of the involved head. 6. In this study, the result of surgically treated patients were superior to those of conservatively treated patients.