Objective To explore the peak moment characteristics of lower limb joints,as well as the contribution rate and compensation mechanism of lower limb joints when older adults with a history of falls cross obstacles at different paces.Methods Thirty healthy older adults and 30 eldely fallers were recruited.The Qualisys infrared high-speed motion capture system and the Kistler three-dimensional force platform were used to collect the biomechanical data of the older adults when they crossed an obstacle with a height of 15％of their height at three walking speeds(1.05,1.41,1.74 m/s).The data were then modeled and analyzed using Visual 3D software.Results As walking speed increased,the peak knee extension moment,peak ankle plantar flexion moment,and double peak value of hip flexion moment in healthy group all increased significantly(P＜0.05).Compared with healthy group,the double peak values of hip flexion moment in faller group were significantly smaller than those in healthy group(P＜0.05).During walking at moderate speed,the contribution rate of the left hip joint in faller group was significantly higher than that of healthy group(P=0.025),while the contribution rate of the ankle joint was significantly lower(P=0.044).The margin of stability in the anterior-posterior direction at the moment of ground contact of the stance leg and the stride leg increased with walking speed(P=0.007,P=0.002).Conclusions Compared with healthy older adults,the elderly fallers have lower peak torque,peak ground reaction force,and dynamic stability in the anterior-posterior direction.As the walking speed increases,the mechanical parameters and the margin of stability of older adults increase significantly,and walking stability is improved.Compared with healthy older adults,elderly fallers usually rely more on the contribution of hip joint movements and reduce the involvement of ankle joints.It is recommended to incorporate fast walking exercises into the daily fall prevention exercise program for older adults,with combination of coordinated training of the hip,knee,and ankle joints.

Objective:To evaluate the efficacy of different anti-reflux surgery combined with laparoscopic hiatal hernia repair in the treatment of gastroesophageal reflux disease (GERD) complicated with hiatal hernia.Methods:A retrospective analysis was conducted on 405 patients with GERD and hiatal hernia undergoing laparoscopic hiatal hernia repair combined with different anti-reflux surgery at the First Affiliated Hospital of Zhengzhou University from Jan 2013 to Jun 2019. The patients were divided into four groups based on the anti-reflux surgery: 38 patients underwent Nissen fundoplication (Nissen group), 67 patients underwent Toupet fundoplication (Toupet group), 101 patients underwent Dor fundoplication (Dor group), and 199 patients underwent His angle plasty (His group). The improvement of symptoms, the use of proton pump inhibitor (PPI), surgical outcomes, and postoperative complications were compared among the four groups at 5 years after surgery.Results:Compared with preoperative scores, the scores of acid regurgitation and heartburn in all four groups decreased significantly after surgery (Nissen group: Z=-4.974, -4.905; Toupet group: Z=-9.245, -9.413; Dor group: Z=-8.080, -8.225; His group: Z=-11.705, -11.619, all P<0.05), and there was no significant difference in postoperative symptom scores among the four groups (acid regurgitation: 2.2 vs. 2.0 vs. 1.9 vs. 1.9; heartburn: 2.0 vs. 1.7 vs. 1.7 vs. 1.8, all P>0.05). There was no significant difference in the total effective rate of treatment among the four groups (86.8% vs. 92.5% vs. 87.1% vs. 91.5%, χ2=2.314, P=0.510). Additionally, there was no significant difference in the PPI independence among the four groups (63.2% vs. 61.2% vs. 60.4% vs. 60.3%, χ2=0.120 P=0.989). The incidence of severe dysphagia and abdominal distension was higher in the three fundoplication groups (Nissen, Toupet, and Dor groups) than in the His group (all P<0.05). Conclusions:Laparoscopic hiatal hernia repair combined with different anti-reflux surgery is safe and effective in the long-term treatment of GERD complicated with hiatal hernia. His angle plasty has the advantages of simple surgical operation and low incidence of postoperative dysphagia and abdominal distension, and is a recommended new anti-reflux surgery.

Objective To explore the peak moment characteristics of lower limb joints,as well as the contribution rate and compensation mechanism of lower limb joints when older adults with a history of falls cross obstacles at different paces.Methods Thirty healthy older adults and 30 eldely fallers were recruited.The Qualisys infrared high-speed motion capture system and the Kistler three-dimensional force platform were used to collect the biomechanical data of the older adults when they crossed an obstacle with a height of 15％of their height at three walking speeds(1.05,1.41,1.74 m/s).The data were then modeled and analyzed using Visual 3D software.Results As walking speed increased,the peak knee extension moment,peak ankle plantar flexion moment,and double peak value of hip flexion moment in healthy group all increased significantly(P＜0.05).Compared with healthy group,the double peak values of hip flexion moment in faller group were significantly smaller than those in healthy group(P＜0.05).During walking at moderate speed,the contribution rate of the left hip joint in faller group was significantly higher than that of healthy group(P=0.025),while the contribution rate of the ankle joint was significantly lower(P=0.044).The margin of stability in the anterior-posterior direction at the moment of ground contact of the stance leg and the stride leg increased with walking speed(P=0.007,P=0.002).Conclusions Compared with healthy older adults,the elderly fallers have lower peak torque,peak ground reaction force,and dynamic stability in the anterior-posterior direction.As the walking speed increases,the mechanical parameters and the margin of stability of older adults increase significantly,and walking stability is improved.Compared with healthy older adults,elderly fallers usually rely more on the contribution of hip joint movements and reduce the involvement of ankle joints.It is recommended to incorporate fast walking exercises into the daily fall prevention exercise program for older adults,with combination of coordinated training of the hip,knee,and ankle joints.

Objective:To evaluate the efficacy of different anti-reflux surgery combined with laparoscopic hiatal hernia repair in the treatment of gastroesophageal reflux disease (GERD) complicated with hiatal hernia.Methods:A retrospective analysis was conducted on 405 patients with GERD and hiatal hernia undergoing laparoscopic hiatal hernia repair combined with different anti-reflux surgery at the First Affiliated Hospital of Zhengzhou University from Jan 2013 to Jun 2019. The patients were divided into four groups based on the anti-reflux surgery: 38 patients underwent Nissen fundoplication (Nissen group), 67 patients underwent Toupet fundoplication (Toupet group), 101 patients underwent Dor fundoplication (Dor group), and 199 patients underwent His angle plasty (His group). The improvement of symptoms, the use of proton pump inhibitor (PPI), surgical outcomes, and postoperative complications were compared among the four groups at 5 years after surgery.Results:Compared with preoperative scores, the scores of acid regurgitation and heartburn in all four groups decreased significantly after surgery (Nissen group: Z=-4.974, -4.905; Toupet group: Z=-9.245, -9.413; Dor group: Z=-8.080, -8.225; His group: Z=-11.705, -11.619, all P<0.05), and there was no significant difference in postoperative symptom scores among the four groups (acid regurgitation: 2.2 vs. 2.0 vs. 1.9 vs. 1.9; heartburn: 2.0 vs. 1.7 vs. 1.7 vs. 1.8, all P>0.05). There was no significant difference in the total effective rate of treatment among the four groups (86.8% vs. 92.5% vs. 87.1% vs. 91.5%, χ2=2.314, P=0.510). Additionally, there was no significant difference in the PPI independence among the four groups (63.2% vs. 61.2% vs. 60.4% vs. 60.3%, χ2=0.120 P=0.989). The incidence of severe dysphagia and abdominal distension was higher in the three fundoplication groups (Nissen, Toupet, and Dor groups) than in the His group (all P<0.05). Conclusions:Laparoscopic hiatal hernia repair combined with different anti-reflux surgery is safe and effective in the long-term treatment of GERD complicated with hiatal hernia. His angle plasty has the advantages of simple surgical operation and low incidence of postoperative dysphagia and abdominal distension, and is a recommended new anti-reflux surgery.