Summary Background The avian influenza A H7N9 virus has caused infections in human beings in China since 2013. A large epidemic in 2016–17 prompted concerns that the epidemiology of the virus might ...have changed, increasing the threat of a pandemic. We aimed to describe the epidemiological characteristics, clinical severity, and time-to-event distributions of patients infected with A H7N9 in the 2016–17 epidemic compared with previous epidemics. Methods In this epidemiological study, we obtained information about all laboratory-confirmed human cases of A H7N9 virus infection reported in mainland China as of Feb 23, 2017, from an integrated electronic database managed by the China Center for Disease Control and Prevention (CDC) and provincial CDCs. Every identified human case of A H7N9 virus infection was required to be reported to China CDC within 24 h via a national surveillance system for notifiable infectious diseases. We described the epidemiological characteristics across epidemics, and estimated the risk of death, mechanical ventilation, and admission to the intensive care unit for patients admitted to hospital for routine clinical practice rather than for isolation purpose. We estimated the incubation periods, and time delays from illness onset to hospital admission, illness onset to initiation of antiviral treatment, and hospital admission to death or discharge using survival analysis techniques. Findings Between Feb 19, 2013, and Feb 23, 2017, 1220 laboratory-confirmed human infections with A H7N9 virus were reported in mainland China, with 134 cases reported in the spring of 2013, 306 in 2013–14, 219 in 2014–15, 114 in 2015–16, and 447 in 2016–17. The 2016–17 A H7N9 epidemic began earlier, spread to more districts and counties in affected provinces, and had more confirmed cases than previous epidemics. The proportion of cases in middle-aged adults increased steadily from 41% (55 of 134) to 57% (254 of 447) from the first epidemic to the 2016–17 epidemic. Proportions of cases in semi-urban and rural residents in the 2015–16 and 2016–17 epidemics (63% 72 of 114 and 61% 274 of 447, respectively) were higher than those in the first three epidemics (39% 52 of 134, 55% 169 of 306, and 56% 122 of 219, respectively). The clinical severity of individuals admitted to hospital in the 2016–17 epidemic was similar to that in the previous epidemics. Interpretation Age distribution and case sources have changed gradually across epidemics since 2013, while clinical severity has not changed substantially. Continued vigilance and sustained intensive control efforts are needed to minimise the risk of human infection with A H7N9 virus. Funding The National Science Fund for Distinguished Young Scholars.
Background Ischemia stroke is a destructive cerebrovascular disease and a major cause of death and lifelong neurological disability. N-Acetyl-l-aspartyl-l-glutamate (NAAG) is a neurotransmitter in ...the mammalian brain and involves a variety of physiological and pathological functions including ischemia brain injury. Full understanding of the functions of NAAG peptidase (GCPII) in the pathogenesis of ischemia brain injury is extremely valuable for effective therapies to ischemia stroke. Methods The expressions of GCPII and NAAG agonist metabotropic glutamate receptor (mGluR3) and TGFb1 were examined by real-time polymerase chain reaction and western blot. Moreover, GCPII knockdown cells were constructed using lentivirus-mediated transfection. Function and molecular mechanisms of GCPII knockdown on apoptosis induced from hypoxic–ischemic-induced injury in neuronal cells were analyzed. Results In this study, we found that the expressions of GCPII and mGluR3 were upregulated in CoCl2 -induced hypoxia environment in neuronal cells. Moreover, knockdown of GCPII in neuronal cells ameliorated apoptosis from hypoxic–ischemic-induced injury through suppressing expressions of caspase 3 and caspase 9. Conclusions Our results highlighted the roles of GCPII in the ischemia brain injury, and might provide an important target in therapeutic implications.
Purpose To investigate the results of resurfacing completely degloved digits using a parallelogram free flap from the medial arm in a spiral fashion. Methods We reviewed the reconstruction of 26 ...digits in 21 patients with a parallelogram free flap from the medial arm in a spiral fashion following a non-replantable degloving injury. Results The sizable perforator was observed consistently in the medial arm with 13 of 21 (62%) originating from the superior ulnar collateral artery, 6 of 21 (29%) directly from the brachial artery, and 2 of 21 (9%) from the superficial brachial artery. All the flaps but one, which sustained partial flap loss, survived uneventfully. Total active motion ranged from 93° to 145° and 112° to 154° in the cases with and without metacarpophalangeal joint involvement, respectively. The static 2-point discrimination test varied from 6 to 13 mm. No scar contracture was recorded in these patients. All the patients were satisfied with the overall results. Conclusions Resurfacing the defect in a spiral fashion is a valuable and reliable technique for the reconstruction of complete finger degloving injuries. The medial arm flap is a good candidate for this procedure, with satisfactory functional recovery and good aesthetic restoration. Type of study/level of evidence Therapeutic IV.
Boutonniere deformity associated with a dorsal avulsion fracture of the central slip overlying the proximal interphalangeal joint results in loss of extension of the joint and hyperextension of the ...distal interphalangeal joint. This article reports a surgical technique for treatment of the injury in 21 digits, which involves application of loop stainless steel wire. We also present the long-term results using the technique on the digits. Loop wire fixation is a successful surgical technique for the treatment of displaced central slip avulsion fracture.
Background Patellofemoral pain is a common orthopedic condition in the athletic population. Previous investigators focused on exploring the etiology and investigating the effectiveness of different ...treatment approaches for patellofemoral pain. However, the severity of symptoms and its corresponding impact on quality of life (QOL) in athletes at different skill levels have not been explored. Such information may help in formulating rehabilitation strategies targeting different levels of athletes. Objective To compare the perception of patellofemoral symptoms and its impact on QOL between professional and amateur athletes with patellofemoral pain. Design Cross-sectional study. Participants Thirty-eight athletes with patellofemoral pain: 19 professional athletes from the Chinese national track and field team and 19 matched amateur participants recruited from a local track and field club. Main Outcome Measures All participants completed the Chinese version of Kujala scale and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), which we used to quantify the severity of patellofemoral symptoms and QOL, respectively. Results Professional athletes demonstrated a significantly higher level of patellofemoral symptoms ( P < .001) and lower physical functioning subscore of SF-36 ( P < .014) than did the amateur athletes. We also found a trend of a lower mental health subscore of SF-36 in professional athletes than in the amateurs ( P = .07). The Kujala scale score was positively correlated with the subscore of “physical functioning” in both professional athletes (rs = 0.688, P = .001) and amateurs (rs = 0.751, P < .001). We also observed a trend of correlation between the subscore in the mental health domain and the severity of patellofemoral symptoms in professional athletes. Conclusions Athletes at different elite levels might have varied perceptions of patellofemoral pain and the corresponding impact on physical aspects of quality of life. The results of this study may highlight the necessity of addressing psychosocial factors when formulating rehabilitation strategies in the athletic population with patellofemoral pain.
Purpose An extensive traumatic defect at the level of the proximal phalanx of the thumb presents difficulty in replantation. We report bilobed second dorsal metacarpal artery–based island flap ...harvested from both the index and middle fingers for reconstruction of the defect and preservation of the normal thumb length. Methods From March 2004 to October 2008, 15 patients (11 men and 4 women; mean age, 35 y; range, 18 to 55 y) with completely or incompletely amputated thumbs associated with extensive defects in the proximal phalanx had replantation and reconstruction. In all cases, a bilobed second dorsal metacarpal artery–based island flap was used due to the large size of the defect. After flap transfer, anastomoses between the veins of the distal part of the thumb and the flap were performed. At the final follow-up, we assessed the mean active range of motion of the metacarpophalangeal and interphalangeal joints of the thumb and the span of the first web in the thumbs that survived. Active motion of the donor fingers was also assessed. Results In this series, 13 thumbs survived and 2 failed. All flaps survived completely. At the mean follow-up of 27 months (range, 24 to 29 mo), the mean active motion arcs of metacarpophalangeal and interphalangeal joints were 32° (range, 15° to 45°) and 31° (range, 0° to 47°), respectively. Full active range of motion was observed in all patients in both the metacarpophalangeal and the proximal interphalangeal joints of the donor index and middle fingers. Conclusions Bilobed second dorsal metacarpal artery–based island flap transfer is a useful and reliable technique for thumb replantation when there is an extensive defect in the proximal phalanx and when a single-digit dorsal metacarpal artery island flap is too small. Type of study/level of evidence Therapeutic IV.
Background Degloving injuries of the foot with involvement of the heel and sole occur relatively rarely but pose an extreme challenge to the reconstructive surgeon due to the unique anatomy of the ...foot. Very limited studies are available regarding the outcomes of reattachment of the degloved skin as a full-thickness graft. Methods Twenty-one patients, including eight children and thirteen adults, were treated for a degloving injury of the foot with an immediate defatted full-thickness skin graft from September 2002 to January 2010. After reattachment to its original anatomical site, the graft was further secured with multiple sutures and was fenestrated to improve skin graft incorporation. Traditional dressings were applied. At the time of follow-up, the clinical outcome was graded with use of the Maryland Foot Score. Results Complete incorporation of the graft occurred in ten of the thirteen adults and seven of the eight children (p > 0.05). Follow-up at an average of 32.8 months (range, twenty-four to sixty months) revealed stable wounds in 81% (seventeen) of the twenty-one patients. All stated that they were satisfied with the cosmetic appearance of the affected foot. At the time of the last follow-up, seventeen of the twenty-one patients had a good to excellent score according to the Maryland Foot Score. Sensation restoration in the pediatric group started earlier and progressed faster than that in the adult group, but all patients obtained at least protective sensation eventually and none complained of cold intolerance in the foot. Conclusions Degloving injuries can be treated successfully with a defatted full-thickness skin graft followed by conventional dressings in both children and adults. This procedure is relatively simple, without the demands of microsurgical techniques, and can provide good functional and cosmetic results. Levels of Evidence Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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