Objective:To investigate the long-term outcomes of using 3D-printed preformed titanium meshes in repair and reconstruction of orbital region.Methods:A retrospective analysis was conducted on patients with tumors invading the naso-orbito-maxillary region who underwent surgical resection and repair/reconstruction with 3D-printed preformed titanium meshes. The patients were collected at three medical centers (the Third Affiliated Hospital of Sun Yat-sen University, Xijing Hospital of Air Force Military Medical University, and Shenzhen Longgang District Ear, Nose and Throat Hospital) from 2016 to 2023. Tumor extent was evaluated radiologically, and the surgical approaches, reconstruction outcomes, surgical complications, and long-term follow-up results were analyzed.Results:A total of 46 patients from the three centers were included in this study, comprising 27 males and 19 females, with an average age of 51 years (range: from 13 to 86 years). Among them, 4 patients had benign tumors, while the remaining 42 had malignant tumors. The median follow-up duration was 60.7 months (range: from 19.0 to 75.0 months). Postoperatively, symmetrical globe position was achieved in 38 cases without significant diplopia; 4 cases exhibited enophthalmos without diplopia, and 4 cases had enophthalmos with diplopia. Twelve patients received preoperative radiotherapy, and 30 patients received postoperative radiotherapy. Six patients developed enophthalmos, and 6 experienced titanium mesh exposure after radiotherapy. Following treatment completion, 3 patients underwent repair using frontal flaps, 1 using a superficial temporal artery island flap, and 2 using free flaps. All remaining patients showed no postoperative infections, and their wounds healed normally.Conclusion:The application of 3D-printed preformed titanium mesh enables precise repair of postoperative defects in patients with naso-orbital tumors, facilitating reliable reconstruction of the orbital and facial contours with straightforward operation and dependable outcomes.

Objective:To investigate the long-term outcomes of using 3D-printed preformed titanium meshes in repair and reconstruction of orbital region.Methods:A retrospective analysis was conducted on patients with tumors invading the naso-orbito-maxillary region who underwent surgical resection and repair/reconstruction with 3D-printed preformed titanium meshes. The patients were collected at three medical centers (the Third Affiliated Hospital of Sun Yat-sen University, Xijing Hospital of Air Force Military Medical University, and Shenzhen Longgang District Ear, Nose and Throat Hospital) from 2016 to 2023. Tumor extent was evaluated radiologically, and the surgical approaches, reconstruction outcomes, surgical complications, and long-term follow-up results were analyzed.Results:A total of 46 patients from the three centers were included in this study, comprising 27 males and 19 females, with an average age of 51 years (range: from 13 to 86 years). Among them, 4 patients had benign tumors, while the remaining 42 had malignant tumors. The median follow-up duration was 60.7 months (range: from 19.0 to 75.0 months). Postoperatively, symmetrical globe position was achieved in 38 cases without significant diplopia; 4 cases exhibited enophthalmos without diplopia, and 4 cases had enophthalmos with diplopia. Twelve patients received preoperative radiotherapy, and 30 patients received postoperative radiotherapy. Six patients developed enophthalmos, and 6 experienced titanium mesh exposure after radiotherapy. Following treatment completion, 3 patients underwent repair using frontal flaps, 1 using a superficial temporal artery island flap, and 2 using free flaps. All remaining patients showed no postoperative infections, and their wounds healed normally.Conclusion:The application of 3D-printed preformed titanium mesh enables precise repair of postoperative defects in patients with naso-orbital tumors, facilitating reliable reconstruction of the orbital and facial contours with straightforward operation and dependable outcomes.

Objective:To investigate the influence of muscle energy technology (MET) combined with Maitland joint mobilization surgery on the elbow joint flexion function in patients with deep burn of elbow joint.Methods:A retrospective controlled clinical trial was conducted. From January 2020 to January 2022, 53 patients with elbow joint flexion dysfunction after deep burns who met the inclusion criteria were treated in Tongren Hospital of Wuhan University & Wuhan Third Hospital, including 32 males and 21 females, aged (37±12) years. According to the treatment method used, the patients were divided into conventional treatment alone group (15 cases), conventional treatment+joint mobilization surgery group (18 cases), and conventional treatment+joint mobilization surgery+MET group (20 cases). Before treatment and 2 months after treatment, the patient's elbow joint range of motion was measured using a protractor, the Mayo elbow joint function score was used to evaluate elbow joint function, a portable muscle strength tester was used to measure elbow extensor muscle strength, and visual analogue scale was used to evaluate pain degree. Data were statistically analyzed with one-way analysis of variance, least significant difference test, paired sample t test, Kruskal-Wallis H test, Wilcoxon signed rank-sum test, chi-square test, Fisher's exact probability test, and Bonferroni correction. Results:After two months of treatment, the elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery group and conventional treatment+joint mobilization surgery+MET group ((103±12)° and 60 (50, 66), (131±14)° and 73 (65, 80)) were significantly larger and higher than those in conventional treatment alone group ((77±15)° and 45 (35, 50), P values all <0.05), respectively. The elbow joint range of motion and elbow joint function scores of patients in conventional treatment+joint mobilization surgery+MET group were significantly larger and higher than those in conventional treatment+joint mobilization surgery group ( P values all <0.05), respectively. After two months of treatment, the elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery+MET group were respectively significantly larger and lower than those in conventional treatment alone group and conventional treatment+joint mobilization surgery group ( P values all <0.05). The elbow extensor muscle strength and pain score of patients in conventional treatment+joint mobilization surgery group were similar to those in conventional treatment alone group ( P>0.05). The elbow joint range of motion and elbow extensor muscle strength (with t values of 9.37, 25.54, 28.71, 6.70, 7.20, and 7.01, respectively, P<0.05), elbow joint function scores and pain scores (with Z values of 3.15, 3.63, 3.93, 3.30, 3.52, and 3.84, respectively, P<0.05) of patients in conventional treatment alone group, conventional treatment+joint mobilization surgery group, and conventional treatment+joint mobilization surgery+MET group after two months of treatment were significantly improved compared with those before treatment. Conclusions:The combination of MET and Maitland joint mobilization surgery can effectively improve elbow joint range of motion, elbow joint function, elbow extensor muscle strength, and pain of patients with deep elbow joint burns, therefore it is worthy of promotion.

Objective:To observe the effects of balance training combined with routine training on patients with lower limb motor and balance dysfunctions after severe burns.Methods:A prospective randomized controlled study was conducted. From January 2016 to January 2020, sixty-four patients with lower limb motor and balance dysfunction after severe burns who met the inclusion criteria were admitted to Tongren Hospital of Wuhan University&Wuhan Third Hospital. According to the random number table, the patients were divided into routine training (RT) group and combined training (CT) group. There were 32 cases in each group, 22 males and 10 females in RT group, aged 40.5 (35.5, 52.8) years, and 24 males and 8 females in CT group, aged 37.0 (30.0, 44.0) years. Patients in RT group performed conventional treatment including knee joint stretch, continuous passive motion, lower limb muscle strength training, and pressure therapy etc., while patients in CT group received balance training in addition to RT treatment including sitting balance, center of gravity transfer, pelvic stability, standing alternately on one leg, and standing on balance pad. Patients in both groups were treated for 4 months. Before treatment and after 4 months of treatment, the Berg Balance Scale, Lower Extremity Function Scale, and Activities-specific Balance Confidence Scale were used to evaluate the balance function, lower limb function, and balance activity self-confidence of patients respectively. Data were statistically analyzed with independent sample t test, paired sample t test, Mann-Whitney U test, Wilcoxon signed rank test or chi-square test. Results:Before treatment, the Berg balance score of patients in RT group was (25±9) points, which was similar to (25±7) points in CT group ( t=-0.154, P>0.05). After 4 months of treatment, the Berg balance score of patients in CT group was (43±6) points, which was significantly higher than (40±6) points in RT group ( t=2.028, P<0.05). The Berg balance scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment ( t=-15.189, -26.200, P<0.01). Before treatment, the lower limb function score of patients in RT group was 25.0 (16.5, 30.0) points, which was similar to 23.0 (10.3, 28.8) points in CT group ( Z=-1.575, P>0.05). After 4 months of treatment, the lower limb function score of patients in CT group was 55.0 (35.0, 60.0) points, which was significantly higher than 43.0 (36.0, 53.0) points in RT group ( Z=-2.744, P<0.01). The lower limb function scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment ( Z=-4.943, -4.955, P<0.01). Before treatment, the balance activity self-confidence scores of patients in the two groups were similar ( t=-0.966, P>0.05). After 4 months of treatment, the balance activity self-confidence scores of patients in CT group was significantly higher than that in RT group ( t=3.343, P<0.01). The balance activity self-confidence scores of patients in RT and CT groups after 4 months of treatment were obviously higher than those before treatment ( t=-19.611, -34.300, P<0.01). Conclusions:Conventional treatment combined with balance training for patients with lower limb motor and balance dysfunctions after severe burns can effectively promote the recovery of their lower limb motor and balance function.

Objective: To observe the therapeutic effects of Archimedes sling system in the rehabilitation of knee joint flexion dysfunction of patients after deep burns. Methods: Thirty-seven patients with knee joint flexion dysfunction after deep burn, conforming to the study criteria and hospitalized in Burn Rehabilitation Center of Tongren Hospital of Wuhan University & Wuhan Third Hospital from March 2015 to December 2017, were recruited in this prospective controlled study. According to the order of admission, 18 odd-numbered patients and 19 even-numbered patients were enrolled in conventional treatment (CT) group [13 males and 5 females, aged (42±10) years] and sling treatment (ST) group [13 males and 6 females, aged (37±10) years] respectively. Patients in group CT were conventionally conducted with knee joint mobilization treatment, continuous passive motion treatment, and pressure therapy, while patients in group ST were conducted with supine knee joint flexion and extension training and micro-squat short arc resistance training with Archimedes sling system besides CT. Patients in the 2 groups were treated for 6 months, and 1 course of treatment was 1 month. Before treatment and after 6 months of treatment, the knee joint active motion range was measured and the difference value was calculated, the American Hospital for Special Surgery (HSS) knee joint score was used to assess the functional disorder of patients, and the self-function satisfaction of patients were evaluated with modified Likert Scale. Data were processed with independent sample t test, paired sample t test, and chi-square test. Results: (1) Before treatment, the difference value of knee joint active motion range of patients in group CT was (45±11)°, which was similar to (44±12)° in group ST (t=-0.206, P>0.05). After 6 months of treatment, the difference value of knee joint active motion range of patients in group ST was (89±14)°, which was obviously higher than (75±12)° in group CT (t=0.897, P<0.01). The difference values of knee joint active motion range of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-13.394, -29.459, P<0.01). (2) Before treatment, the HSS knee joint score of patients in group CT was (40±10) points, which was similar to (36±11) points in group ST (t=0.816, P>0.05). After 6 months of treatment, the HSS knee joint score of patients in group ST was (68±13) points, which was obviously higher than (57±10) points in group CT (t=0.162, P<0.01). The HSS knee joint score of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-12.410, -30.559, P<0.01). (3) Before treatment, the self-function satisfaction scores of patients in the two groups were similar (t=0.140, P>0.05). After 6 months of treatment, the self-function satisfaction score of patients in group ST was obviously higher than that in group CT (t=3.103, P<0.01). The self-function satisfaction scores of patients in groups CT and ST after 6 months of treatment were obviously higher than those before treatment (t=-11.697, -29.029, P<0.01). Conclusions The Archimedes sling system can effectively increase the difference value of knee joint active motion range, alleviate the degree of knee joint dysfunction, and enhance the self-function satisfaction of patients on the basis of conventional rehabilitation treatment for patients with knee joint flexion dysfunction after deep burns.

Objective: To observe the clinical effects of the Joint Active System on the treatment of joint dysfunction after deep burn. Methods: Twenty-two patients with joint dysfunction after deep burn were hospitalized in Institute of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital from January 2015 to October 2016, involving 18 elbow joints with flexion disorder, 10 wrist joints with dorsal extension disorder, and 12 ankle joints with dorsal extension disorder. They were treated with the elbow joint activity training device, the wrist joint activity training device, and the ankle joint activity training device of the Joint Active System, respectively. The treatment was carried out 3 times each day with interval of 6 h, 30 minutes each time, and it lasted for four to seven months, with one month as a course of treatment. Before treatment and 1, 2, 3, 4 month (s) after, active motion range of each joint was measured by joint goniometer. Function improvement of each joint was evaluated, and the total effective ratio was calculated 4 months after treatment. Satisfaction degree of patients was assessed by the modified Likert Scale 1, 2, 3, 4 month (s) after treatment. Data were processed with one-way analysis of variance for repeated measurement and LSD test. Results: Before treatment and 1, 2, 3, 4 month (s) after, flexion active motion range of elbow joints were (61±23), (78±22), (89±20), (96±20), and (103±19)°; dorsal extension active motion range of wrist joints were (23±7), (31±6), (38±9), (44±5), and (49±8)°; dorsal extension active motion range of ankle joints were (-31±12), (-23±10), (-16±7), (-12±6), and (-8±4)°, respectively. The active motion range of each joint was obviously higher 1, 2, 3, 4 month (s) after treatment than the previous time point of the same joint (with P values below 0.01). Four months after treatment, the total effective ratios of function improvement of elbow joints, wrist joints, and ankle joints were 5/6, 9/10, and 2/3, respectively. Scores of satisfaction degree of the patients 1, 2, 3, 4 month (s) after treatment were (1.3±0.7), (2.2±1.0), (2.8±0.8), and (3.3±0.6) points, respectively. Scores of satisfaction degree of the patients were obviously higher 2, 3, 4 months after treatment than the previous time point (with P values below 0.05). Conclusions Joint Active System can improve the active range of motion of each joint obviously in treating joint dysfunction after deep burn, with total effective ratio of function improvement of each joint surpassing 0.66, and the majority of patients are quite satisfied with the curative effects.

Objective To investigate the relationship between thyroid function indexes and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) among patients who had high risks for cardiovascular diseases without thyroid diseases and heart failure.Methods Totally 166 elderly type 2 diabetic patients aged 80 years and over with normal range of thyroid stimulating hormone (TSH) were divided into group of euthyroid sick syndrome (ESS,n=62) and group of normal thyroid hormones (NESS,n=104).The patients in normal thyroid hormones group were divided into three subgroups according to the levels of total triiodothyronine (TT3),(low-level group,n=26; middle-level group,n=50; high-level group,n=28).Levels of thyroid hormones,NT-proBNP,cholesterol,low-density lipoprotein cholesterol,fibrinogen,HbA1C,glomerular filtration rate (eGRF),left ventricular ejection fraction (LVEF) and the incidences of concomitant diseases were measured and detected.lgNT-proBNP was used to calculated after NT-proBNP was changed by Log transformation.Results Compared with NESS group,ESS group showed that age was increased,systolic pressure and LVEF were decreased [(86.3 ± 5.8) years vs.(85.6 ± 5.2) years,(126.6±15.5) mmHg vs.(135.6±17.8) mmHg,(63.9±7.6)％ vs.(67.4±7.5)％,all P＜0.01].Compared with NESS group,ESS group showed that the levels of serum total T3 and free T3 were decreased [(0.89±0.17) nmol/L vs.(1.45±0.31) nmol/L,(3.31±0.55) pmol/L vs.(3.96± 0.59) pmol/L,both P＜0.01].The lgNT-proBNP level was higher and serum total thyroxine (TT4) level was lower in ESS group than in NESS group [(2.40±0.40) ng/L vs.(2.26±0.44) ng/L,(101.80±36.11) nmol/L vs.(111.07±23.29) nmol/L,both P＜0.05].Pearson analysis revealed that serum levels of TT3,TT4 and FT3 were negatively correlated with lgNT-proBNP (r=-0.217,-0.180,-0.174,respectively,all P＜0.05) after adjustment for age,systolic pressure and LVEF.Stepwise regressive analysis showed TT3 was the risk factors for lgNT-proBNP (β=-0.267,P＜ 0.01).Compared with the low-level group,the lgNT-proBNP were significantly reduced in the middle-,and high-level groups [(2.19±0.42) ng/L,(2.19±0.46) ng/L vs.(2.44±0.39) ng/L,both P＜0.05].Conclusions TT3 has a close correlation with NT-proBNP in elderly type 2 diabetic patients with normal TSH.It has a significant meaning to test TT3 level for monitoring heart function in clinical medicine.

Objective To evaluate the predictive value of fracture risk assessment tool (FRAX) for determining fracture probabilities in middle-aged and elderly patients with type 2 diabetes.Methods Retrospective analysis was carried out on 153 type 2 diabetic patients aged over 50 years undergoing dual energy X-ray absorptiometry measurements.Fracture risk factors including age,gender,height,weight,body mass index,history of previous fragility fractures,parental history of hip fracture,history of smoking,excessive drinking,long-term use of steroid hormone,history of rheumatoid arthritis,the history of secondary osteoporosis diseases,and femoral neck T-score of bone mineral density (BMD) were recorded.FRAX scores with BMD (FRAX/BMD) and without BMD (FRAX/-) were calculated.Therapeutic interventions were recommended if the 10-year risk of fractures was more than 3％ for hip osteoporotic fractures and more than 20％ for other major fractures.Subjects were separated into the identical treatment recommendation group and the different treatment recommendation.Fracture risk factors were compared between groups.Results 133 (6.9 ％) patients had identical fracture risk predictions in the FRAX calculation,regardless of whether BMD join in or not.Age,gender and femoral neck T scores had significant differences between the two groups (all P＜0.001),while other risk factors had no statistical differences between the two groups (all P＞0.05).Conclusions In most middle-aged and elderly patients with type 2 diabetes,the FRAX/-provides the same prediction as FRAX/BMD value for predicting fracture risk,which shows that fracture risks can be predicted without bone density examination.The FRAX/-has higher predictive values on fracture for people who are younger,male,and has higher BMD.

Objective To evaluate plasma natriuretic peptide brain (BNP) levels in elderly male patients with type 2 diabetes and primary osteoporosis.Methods A total of 122 elderly male patients with type 2 diabetes were divided into 3 groups according to bone mineral density(BMD):normal group (41 cases),osteopenia group (40 cases) and osteoporosis group (41 cases),and another 33 age matched healthy subjects as control group.Plasma BNP levels were determined by ELISA.Results Plasma BNP levels in osteoporosis group [(1.95 ± 0.49) pmol/L] and osteopenia group [(1.64±0.48) pmol/L] were significantly elevated compared with that in normal group [(1.32±0.38) pmol/L] and control group [(1.26±0.39) pmol/L] (all P＜0.01).There was a statistical difference between osteoporosis group and osteopenia group (t=3.539,P＜0.05),and also between normal group and control group (t=2.726,P＜0.05).Plasma BNP levels had negative correlation with BMD of 2na-4th lumbar vertebra (r=-0.366) and femoral neck (r=-0.375),body mass index (r=-0.288) and estrodiol (E2) (r=-0.352) (all P＜0.05); while had a positive correlation with parathyroid hormone (PTH) (r=0.353,P＜0.05).Conclusions With BMD declining,plasma BNP levels are elevated in elderly male type 2 diabetes,which may be related to the compensatory increase in PTH and the decrease in estradiol.

Objective To investigate the relationship of plasma fibrinogen (FIB) and non-highdensity lipoprotein cholesterol (non-HDL-C) with diabetic nephropathy in the elderly with type 2 diabetes. Methods Totally 152 patients (aged 60 years and over) with type 2 diabetics were divided into normal albuminuria (UAER＜30 mg/24 h,n=89) and abnormal albuminuria (UAER≥ 30 mg/24 h,n=63) groups,with high FIB (＞4.00 g/L,n=88) and normal FTB (2.00-4.00 g/L,n=64)sub-groups.The body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),fasting plasma glucose (FPG),postprandial blood glucose (2 hPG),glycated hemoglobin (HbAlc),serum triglyceride (TG),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),low-density lipoprotein cholesterol (LDL-C),FIB and 24-hour urinary albumin excretion rate (UAER) were measured.The non-HDL-C and estimated glomerular filtration rate (eGFR) were calculated. Results Compared with normal albuminuria group,the values of age,hypertension rate,SBP,Scr and FIB in abnormal albuminuria group were increased [(74.6 ± 7.3) years,57 cases (90.5％),(146.8±23.2)mm Hg,(1.010.7)μmol/L,(4.8±1.5)g/Lvs.(71.6±7.2)years,59 cases (66.3％),(137.7±19.2) mm Hg,(0.8±0.3)μmol/L,(4.2±1.3)g/L,t=-2.536,-2.656,- 2.474,-2.857,x2 =11.936,all P＜0.05] while eGFR was significantly decreased [(68.5±31.2)ml · min-1 · 1.73 m-2 vs.(81.4±25.9)ml · min-1 · 1.73m-2,t=2.791,P＜0.05].The number of patients with high FIB was enhanced in abnormal albuminuria group than normal albuminuria group[45 cases (71.4％) vs. 18 cases (28.6％),x2 =8.085,P=0.004]. The proportion of abnormal albuminuria in high FIB group was lower than that in normal FIB group [(62.6±30.5) ml· min-1 · 1.73 m-2 vs.(83.2±28.7) ml· min-1 · 1.73 m 2,t=2.459,P=0.017].The Pearson analysis revealed that UAER was positively correlated with FIB,TG,TC and non-HDL-C (r=0.276,0.268,0.243,0.176,all P＜0.05).Stepwise regressive analysis showed that FIB was an independent risk factors of urinary albumin in the elderly with type 2 diabetes.Conclusions Higher levels of FIB and non-HDL-C are well correlated with diabetic nephropathy in the elderly with type 2 diabetes.