The burden of low back pain in adolescents and young adults.

BACKGROUND: Low back pain is highly prevalent and the main cause of years lived with disability, but data on the burden and trends of low back pain (LBP) in adolescents and young adults (AYAs) are sparse. OBJECTIVE: To assess trends in the burden of LBP among AYAs aged 15-39 years at the global, regional and national levels from 1990 to 2019. METHODS: Data from the Global Burden of Disease (GBD) 2019 were used to analyze incidence, prevalence and Disability-adjusted life year (DALY) due to LBP at global, regional, and national levels. Joinpoint regression analysis calculated the average annual percentage changes (AAPC). Then analyse the association between incidence, prevalence and DALYs and socioeconomic development using the GBD Socio-demographic Index (SDI). Finally, projections were made until 2030 and calculated in Nordpred. RESULTS: The incidence, prevalence and DALYs rates (95%UI) were 2252.78 (1809.47-2784.79), 5473.43 (4488.62-6528.15) and 627.66 (419.71-866.97) in 2019, respectively. From 1990 to 2019, the incidence, prevalence, and DALYs rates AAPC (95%CI) were -0.49 (-0.56 to -0.42), -0.58 (-0.65 to -0.51) and -0.57 (-0.64 to -0.5), respectively. Incidence, prevalence, and DALYs rates in South Asia, East Asia, High-income North America, Western Europe, and Australasia decreased with SDI. Incidence, prevalence, and DALYs rates in Central Asia, Central Europe, and Eastern Europe decreased and then increased with SDI. At the national level, the incidence, prevalence, and DALYs rates are high in the United States and low in India and China. From the 2020 to 2030, most regions is predicted to decline. CONCLUSION: LBP in AYAs is a major global public problem with a high burden. There are large differences in incidence, prevalence and DALYs across SDIs, regions and countries. there is still a need to focus on LBP in AYAs and tailor interventions to reduce the future burden of this condition.

IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch promotes angiogenesis in transplanted flap and inhibits inflammatory response.

Skin flap transplantation is one of the most common tissue transplantation methods for wound repair and organ reconstruction in plastic surgery. During the transplantation process, the inflammatory response of transplanted flap and angiogenesis are critical to the successful rate of skin flap transplantation. In recent years, to improve the biocompatibility and cell affinity of biomedical materials, the modified biomaterials have gradually become a popular subject in scientific researches. In our study, the IL-4 modified expanded polytetrafluoroethylene (e-PTFE) surgical patch IL4-e-PTFE was prepared, and the rat skin flap transplantation model was constructed. The results of cell experiment prove that IL-4 has potentiation in the angiogenesis of human umbilical vein endothelial cell (HUVEC) induced by monocyte, and IL-4 can also promote angiogenesis by inducing the M2 macrophages. According to the results of in vivo experiment, the apoptosis level of transplanted flap cells of rats in the IL4-e-PTFE group was lower than that in the e-PTFE group, and in the IL4-e-PTFE group, the expression levels of pro-inflammatory cytokines IL-1ß, IL-6 and TNF-α showed significantly decline compared to the e-PTFE group, while the expression levels of anti-inflammatory cytokines IL-1Ra, IL-10 and TGF-ß presented significant increase compared to the e-PTFE group; the immunofluorescence staining results show that the number of M2 macrophages in transplanted flap area of rats in the IL4-e-PTFE group was significantly higher than that in the e-PTFE group, and the angiogenesis level was remarkably improved. In this study, by preparing IL4-e-PTFE and carrying out the cell and in vivo experiments, a reference method is proposed, which can reduce the inflammatory response during skin transplantation process using e-PTFE and optimize the long-term effects of flap blood vessels, hoping to provide a broader space for the applications of e-PTFE in medicine.

Clinical Characteristics of COVID-19 Patients With Gastrointestinal Symptoms: An Analysis of Seven Patients in China.

Objectives: Patients with novel coronavirus disease 2019 (COVID-19) can present with gastrointestinal symptoms as their initial symptoms or as the main manifestations during disease progression, but the clinical characteristics of these patients are still unknown. Methods: We identified COVID-19 patients who admitted to Xiangyang No. 1 People's Hospital and presented with gastrointestinal symptoms as their initial or main symptoms. Their medical records were reviewed by two independent clinical scientists. The epidemiological and clinical characteristics as well as the clinical outcomes were analyzed. Results: Among 142 confirmed COVID-19 cases, 7 (4.9%) of them presented with gastrointestinal symptoms. Three patients had gastrointestinal symptoms as the initial symptoms and chief complaints, and 4 patients as the main symptoms during disease progression. Six patients had symptoms of diarrhea (3-16 days), 7 with anorexia (7-22 days), 6 with upper abdominal discomfort (1-7 days), and 4 with nausea (1-7 days), 1 with heartburn lasting 2 days, and 2 with vomiting symptoms (1 day). The chest CT scan showed typical COVID-19 imaging features, and associated with the progression of the disease. During treatment, 2 patients died due to organ failure. Discussion: COVID-19 patients with gastrointestinal symptoms are relatively rare and might be misdiagnosed. The clinical features include watery stools, anorexia, and upper abdominal discomfort. These patients may have severe disease and be associated with a poor prognosis. The underlying mechanisms of SARS-CoV-2 related gastrointestinal symptoms need to clarify in future studies.

Folic acid-tagged titanium dioxide nanoparticles for enhanced anticancer effect in osteosarcoma cells.

In this study, folic acid surface modified-Titanium dioxide nanoparticles (FA-TiNP) were prepared as a suitable alternative to conventional chemotherapeutic agents to treat human osteosarcoma. The particle size of TiNP increased marked after polymer assembly on the nanoparticles (NP) surface with a spherical morphology. FA-TiNP exhibited a superior anticancer effect in osteosarcoma cancer cells compared to that of bare TiNP. The reason might due to the specific interaction of FA with the folate receptor which is overexpressed in the cancer cells. Especially, FA-TiNP treated cells exhibited chromatin condensation, cell shrinkage and membrane blebbing. FA-TiNP showed significantly higher cancer cell apoptosis with nearly 38% of cells in apoptosis chamber (early and late) compared to only ~16% for TiNP. The higher proportion of Annexin V positive cells for FA-TiNP treated group was mainly attributed to the higher intracellular uptake of the TiO2. Importantly, FA-TiNP increased the sub-G0 population to ~25% indicating its superior anticancer effect. The results clearly indicated that FA-TiNP induced greater reactive oxygen species (ROS) generation that resulted in higher sub-G0 cell population with higher cell apoptosis. FA-TiNP showed a remarkably higher expression of cytochrome C (Cyt C) with a marked increase in the expression of cleaved caspase-3 and PARP. Overall, results suggest that surface modification of TiNP with a specific targeting moiety could enhance the chances of having successful therapies for cancer diseases.

The effectiveness of pressure therapy (15-25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis.

Although pressure therapy (PT) represents the standard care for prevention and treatment of hypertrophic scar (HS) from burns, its practice is largely based on empirical evidence and its effectiveness remains controversial. To clarify the effect of PT (15-25 mmHg) for HS, we performed the systematic review and meta-analysis. Several electronic databases were screened to identify related randomized controlled trials (RCTs). 12 RCTs involving 710 patients with 761 HS resulting from burn injuries were included. Compared with non/low-PT, cases treated with PT (15-25 mmHg) showed significant differences in Vancouver Scar Scale score (MD = -0.58, 95% CI = -0.78--0.37), thickness (SMD = -0.25, 95% CI = -0.40--0.11), brightness (MD = 2.00, 95% CI = 0.59-3.42), redness (MD = -0.79, 95% CI = -1.52--0.07), pigmentation (MD = -0.16, 95% CI = -0.32--0.00) and hardness (SMD = -0.65, 95% CI = -1.07--0.23). However, there was no difference in vascularity (MD = 0.03, 95% CI = -0.43-0.48). Our analysis indicated that patients with HS who were managed with PT (15-25 mmHg) showed significant improvements. Due to limitations, more large and well-designed studies are needed to confirm our findings and the side-effects of the PT may also need to be evaluated.

Association between angiotensin converting enzyme gene insertion/deletion polymorphism and renal scar risk in children vesicoureteral reflex: a reappraise meta-analysis.

Vesicoureteral reflex(VUR) is a common disease in children. Some studies indicated that the angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism associated with the renal scar in VUR, but not all researchers agreed with it. To clarify the effect of ACE I/D polymorphism on renal scar risk in children with VUR, we performed the present meta-analysis. PubMed, CNKI, CBM, and Embase databases were searched for studies that examined the relationship between ACE I/D polymorphism and renal scar risk in children with VUR. The Stata 12.0 software was used for statistical analyses. 11 case-control studies with 1,032 VUR patients were analyzed. The results showed that the DD genotype and D allele were associated with renal scar risk in overall VUR patients, DD vs. DI + II: OR = 1.61, 95% CI = 1.04-2.49, P = 0.03; DD vs. II: OR = 1.78, 95% CI = 1.20-2.65, P < 0.01; D vs. I: OR = 1.38, 95% CI = 1.02-1.86, P = 0.04. Similar results were revealed in Turks, but not in Caucasians and Asians. Our meta-analysis indicated that the ACE DD genotype may increase the risk of renal scar in children with VUR.

Angiotensin Converting Enzyme Gene Insertion/Deletion Polymorphism and Vesicoureteral Reflux in Children: A Meta-Analysis of 14 Case-Control Studies.

Vesicoureteral reflux (VUR) is a common and serious urinary disease in children. It usually causes renal scar, urinary tract infection, and chronic renal failure. Previous studies showed the angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism might be associated with VUR; however, the conclusions were inconsistent. Therefore we used the meta-analytic approach to clarify the effect of ACE I/D polymorphism on VUR risk.We systematically searched the PubMed, CNKI, and EMBASE databases to identify all the potentially related studies published up to February 4, 2015. Two reviewers independently selected studies and extracted data. The strength of the association was assessed using odd ratio (OR) with its 95% confidence interval (CI) based on fixed or random effects model. The STATA 12.0 software was used for data analysis.A total of 14 case-control studies involving 1197 VUR patients and 1320 healthy controls met the eligibility criteria. Results of meta-analysis showed significant association between ACE I/D polymorphism and VUR risk (D vs. I: OR = 1.28, 95% CI = 1.06-1.54, P = 0.01; DD vs. II: OR = 1.44, 95% CI = 1.12-1.85, P = 0.01; DD vs. DI + II: OR = 1.49, 95% CI = 1.23-1.79, P < 0.01; DD + DI vs. II: OR = 1.20, 95% CI = 0.84-1.72, P = 0.31). Subgroup analyses revealed varied results. In Turkish people, results of all the genetic models other than DI vs. II showed statistical significance; in Caucasians, DD vs. DI + II showed statistical significance; and in Asians, DI versus II showed statistical significance.Our meta-analysis indicated that the ACE I/D polymorphism might be associated with increased risk of VUR in children. However, due to the limitations, we suggest conducting additional studies with larger sample size and adjustment for various risk factors, in the future for further clarification.

[Relationship between initial stability and infected loosening of total hip arthroplasty prosthesis].

OBJECTIVE: To investigate the relationship between the initial stability and infected loosening of the total hip arthroplasty (THA) prosthesis. METHODS: From January 2000 to December 2008, 110 cases (110 hips) were treated with THA revision. Among them, 15 cases (15 hips) were confirmed infected loosening. There were 8 males and 7 females with an average age of 62 years (range 42-75 years). The infected signs were found from 6 months to 2 years after initial THA. All of them had Tsukayama type IV and late infection, including 6 cases of acetabular infected loosening (5 cases of one-stage and 1 case of two-stage acetabular revision), 7 cases of simple infected loosening of femoral prosthesis (4 cases of one-stage and 3 cases of two-stage femoral prosthesis revision), and 2 cases of joint capsule infection and sinus without prosthesis loosening (debridement and continuous irrigation). RESULTS: All incisions healed by first intention. Fifteen patients were followed up for 12 to 36 months (average 24 months). In 13 cases of revision, postoperative X-ray films showed that femoral acetabular prostheses were in good position, and had no clinical and imaging infective signs of loosening. In 2 cases of joint capsule infection, sinus recurred 6 months postoperation without hip joint pain, the function of weight-bearing and walking of hip joint was normal. Harris score increased from preoperative average of 42 to postoperative average of 85; the results were excellent in 4 cases, good in 7 cases, and fair in 4 cases. CONCLUSION: The infection of THA may occur in the whole joint, half-joint or just in joint capsule. The initial stability of the prosthesis would affect the long-term survival of the prosthesis. If the prosthesis initial stability is obtained, even if there are infective factors, infections would also be limited.

[Treatment of osteoarthritis secondary to acetabular dysplasia by total hip arthroplasty].

OBJECTIVE: To evaluate the flexibility of the treatment of osteoarthritis secondary to acetabular dysplasia by total hip arthroplasty (THA), in which the acetabular component is placed in the true acetabulum and femoral osteotomy is not performed. METHODS: From January 1999 to December 2005, 35 THA procedures were performed in 32 patients with 35 hips, including 6 males with 7 hips and 26 females with 28 hips, with the average age of 53 years (ranging from 28 years to 72 years). On the basis of Crowe classification, type I included 10 patients with 11 hips, type II included 14 patients with 15 hips, type III included 5 patients with 6 hips, and type IV included 3 patients with 3 hips. All patients experienced severe pain and dysfunction. In 19 cases, the leg length discrepancy was from 3 cm to 6 cm. The Harris score was 41.49 +/- 10.13 before the operation. In all procedures, the soft tissue was released entirely and the acetabular component was placed in the true acetabulum, but femoral osteotomy was not performed. RESULTS: The average operation time of unilateral THA was 50 minutes. All patients were given transfusion from 2 U to 4U. All incisions healed at the first stage. After the operation, the leg was lengthened 2-6 cm, and the two legs were equally long. The follow-up lasted for 12 to 60 months. The Harris score was 84.71 +/- 9.34 after the operation, showing statistically significant difference (P < 0.05). According to clinical outcomes and X-ray films, no dislocation, femoral fracture, femoral or sciatic nerve palsy was detected. CONCLUSION: It is effective to use THA procedures for osteoarthritis secondary to acetabular dysplasia. If the soft tissue is released entirely, the leg will be lengthened 4-6 cm without nerve palsy.

[Effect of blocking screws on breakage of interlocking intramedullary nails].

OBJECTIVE: To explore the effect of blocking screws on the breakage of interlocking intramedullary nails. METHODS: From January 2003 to August 2005, 56 patients with fresh and close fracture of long shafts were treated by interlocking intramedullary nails. Among them, there were 32 males and 24 females, including 26 femoral fracture and 30 tibial fracture. Fracture of femoral and tibial shaft was fixed with interlocking intramedullary nails normally in group I (n=32). And long oblique, spiral, proximal or distal fracture of bone shaft was fixed with interlocking intramedullary nails and blocking screws in group II (n=24). RESULTS: All cases were followed up 12 to 21 months (16 months on average). In group I, fracture healing failed and the intramedullary nails broke in 3 cases, breakage site was the middle femoral fracture area in 1 case and the first distal interlocking nail hole in 2 cases of distal 1/3 tibial fracture. Fractures healed 6 to 12 months after operations in the other cases, but more bony callus occurred in fracture area. In group II, fractures healing and good alignment were achieved, and no breakage was found in all 24 cases. CONCLUSION: The use of blocking screws added to interlocking intramedullary nails could improve the stability of fracture areas distinctively, and hence reduce the breakage of intramedullary nails.