Objective:To evaluate the efficacy of reduction robot system combined with minimally invasive, microenvironmental protection, micro-stress shielding fixator (short for "3M fixator") for Sanders types II and III calcaneal fractures.Methods:A retrospective case series study was conducted to analyze the clinical data of 26 patients (26 feet) with calcaneal fractures admitted to Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to June 2024, including 21 males and 5 females, aged 27-69 years [(46.5±2.5)years]. Among them, 10 patients had fractures in the left foot and 16 in the right. According to the Sanders classification, the fractures were classified as type II in 16 patients and type III in 10. All the patients were treated with the close reduction with reduction robot system combined with 3M fixator in a minimally invasive procedure. The surgical waiting time, operative duration, and fracture healing time were recorded. The length, width and height of the calcaneus, B?hler′s angle and Gissane′s angle were compared before operation and at 1, 3 months after operation. The visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before operation and at 1, 3 months after operation and at the last follow-up were detected. The postoperative complications were recorded.Results:All the patients were followed up for 6-12 months [(9.7±1.1)months]. The surgical waiting time was 1-4 days [(2.0±0.8)days]. The operative duration was 36-66 minutes [(53.2±9.5)minutes]. All the fractures achieved primary union with a healing period of 3-4 months [(3.2±0.4)months]. At 1, 3 months after operation, the length of the calcaneus [(83.3±3.7)mm and (83.6±3.6)mm], width of the calcaneus [(44.3±5.8)mm and (44.3±5.7)mm], height of the calcaneus [(50.1±3.8)mm and (50.3±3.6)mm], B?hler′s angle [(29.8±2.9)° and (29.8±3.0)°], and Gissane angle [(121.1±6.7)° and (123.9±5.9)°] were significantly improved compared with those before operation [(79.3±4.5)mm, (53.6±4.1)mm, (46.2±3.7)mm, (18.9±3.8)°, (109.0±7.5)°, respectively] ( P<0.05), with no significant differences between those indicators at 1, 3 months after operation ( P>0.05). The VAS scores were (3.2±0.6)points, (1.9±0.5)points, and (1.6±0.3)points at 1, 3 months after operation and at the last follow-up, which were lower than (7.1±0.5)points preoperatively and decreased with the prolongation of follow-up time ( P<0.05). The AOFAS scores were (73.5±6.9)points, (90.1±4.3)points, and (92.0±3.6)points, which were higher than (32.0±4.6)points preoperatively and increased with the follow-up time ( P<0.05). One patient had lateral calcaneal pain after operation, and was alleviated after rehabilitation. No complications such as infection or nonunion were found after operation. Conclusion:The reduction robot system combined with 3M fixator for Sanders types II and III calcaneal fractures demonstrates significant clinical advantages, such as reduced surgical waiting time and operative duration, promoted fracture healing, early alleviated pain, enhanced ankle joint functional recovery, and decreased complication occurrence.

Objective:To evaluate the efficacy of reduction robot system combined with minimally invasive, microenvironmental protection, micro-stress shielding fixator (short for "3M fixator") for Sanders types II and III calcaneal fractures.Methods:A retrospective case series study was conducted to analyze the clinical data of 26 patients (26 feet) with calcaneal fractures admitted to Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to June 2024, including 21 males and 5 females, aged 27-69 years [(46.5±2.5)years]. Among them, 10 patients had fractures in the left foot and 16 in the right. According to the Sanders classification, the fractures were classified as type II in 16 patients and type III in 10. All the patients were treated with the close reduction with reduction robot system combined with 3M fixator in a minimally invasive procedure. The surgical waiting time, operative duration, and fracture healing time were recorded. The length, width and height of the calcaneus, B?hler′s angle and Gissane′s angle were compared before operation and at 1, 3 months after operation. The visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score before operation and at 1, 3 months after operation and at the last follow-up were detected. The postoperative complications were recorded.Results:All the patients were followed up for 6-12 months [(9.7±1.1)months]. The surgical waiting time was 1-4 days [(2.0±0.8)days]. The operative duration was 36-66 minutes [(53.2±9.5)minutes]. All the fractures achieved primary union with a healing period of 3-4 months [(3.2±0.4)months]. At 1, 3 months after operation, the length of the calcaneus [(83.3±3.7)mm and (83.6±3.6)mm], width of the calcaneus [(44.3±5.8)mm and (44.3±5.7)mm], height of the calcaneus [(50.1±3.8)mm and (50.3±3.6)mm], B?hler′s angle [(29.8±2.9)° and (29.8±3.0)°], and Gissane angle [(121.1±6.7)° and (123.9±5.9)°] were significantly improved compared with those before operation [(79.3±4.5)mm, (53.6±4.1)mm, (46.2±3.7)mm, (18.9±3.8)°, (109.0±7.5)°, respectively] ( P<0.05), with no significant differences between those indicators at 1, 3 months after operation ( P>0.05). The VAS scores were (3.2±0.6)points, (1.9±0.5)points, and (1.6±0.3)points at 1, 3 months after operation and at the last follow-up, which were lower than (7.1±0.5)points preoperatively and decreased with the prolongation of follow-up time ( P<0.05). The AOFAS scores were (73.5±6.9)points, (90.1±4.3)points, and (92.0±3.6)points, which were higher than (32.0±4.6)points preoperatively and increased with the follow-up time ( P<0.05). One patient had lateral calcaneal pain after operation, and was alleviated after rehabilitation. No complications such as infection or nonunion were found after operation. Conclusion:The reduction robot system combined with 3M fixator for Sanders types II and III calcaneal fractures demonstrates significant clinical advantages, such as reduced surgical waiting time and operative duration, promoted fracture healing, early alleviated pain, enhanced ankle joint functional recovery, and decreased complication occurrence.

Objective:To explore the clinical effectiveness of a self-designed robot reduction system for femoral intertrochanteric fractures.Methods:A retrospective study was conducted to analyze the 57 patients with intertrochanteric fracture who had been treated at Department of Orthopedics, The Fourth Affiliated Central Hospital of Tianjin Medical University from June 2022 to February 2023. The patients were divided into a robot group (using the self-designed robot reduction system to assist intramedullary nailing) and a traction bed group (using a traction bed to assist intramedullary nailing) based on their fracture reduction method. The robot group: 31 patients, 11 males and 20 females, with an age of (78.7±9.3) years; 16 left and 15 right sides; 17 cases of type 31-A1, 12 cases of type 31-A2 and 2 cases of type 31-A3 by the AO/OTA classification. The traction bed group: 26 patients, 12 males and 14 females, with an age of (78.7±7.7) years; 13 left and 13 right sides; 16 cases of type 31-A1, 9 cases of type 31-A2 and 1 cases of type 31-A3 by the AO/OTA classification. The 2 groups were compared in terms of reduction and operation time, intraoperative blood loss, fluoroscopy frequency, reduction quality, and VAS and Harris score at preoperation, 1 week and 6 months postoperation.Results:The 2 groups were comparable due to insignificant differences in their preoperative general data ( P>0.05). The robot group was significantly better than the traction bed group in reduction time [(4.4±2.2) min versus (9.4±3.2) min], operation time [(29.0±13.5) min versus (49.3±13.3) min], intraoperative blood loss [(76.5±30.5) mL versus (115.0±38.4) mL], fluoroscopy frequency [(10.2±2.6) times versus (14.8±3.2) times], and good/excellent rate of reduction [80.6% (25/31) versus 50.0% (13/26)] ( P<0.05). All patients were followed up for (6.8±0.3) months. Respectively, the VAS scores at preoperation and 6 months postoperation was (6.2±1.3) and (2.4±0.8) points for the robot group, and (6.3±1.3) and (2.7±0.8) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the VAS score was (3.3±1.2) points for the robotic group and (4.8±1.5) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.001). Respectively, the Harris scores at preoperation and 6 months postoperation were (35.3±3.0) and (88.7±3.4) points for the robot group, and (35.6±2.9) and (87.2±3.5) points for the traction bed group, showing no statistically significant differences between the 2 groups ( P>0.05). However, the Harris score was (57.3±3.7) points for the robotic group and (46.7±2.8) points for the traction bed group at 1 week postoperation, showing a statistically significant difference between the 2 groups ( P<0.05). The patient satisfaction rates in the robot and traction bed groups were 96.8% (30/31) and 92.3% (24/26), respectively, showing no statistically significant difference ( P>0.05). Conclusion:Our self-designed robot reduction for femoral intertrochanteric fractures can effectively shorten reduction and operation time, reduce bleeding and fluoroscopy frequency, and enhance anatomical reduction.

Objective To investigate the relationship between the vaginal microecology and CC chemokine ligand 28(CCL28)expression levels in the vaginal lavage fluid of patients with persistent high-risk human papillomavirus(HR-HPV)infection.Methods A total of 132 patients with HR-HPV infection at Tangshan Maternal and Child Health Hospital from April 2021 to April 2023 were selected as study subjects.Patients with HR-HPV infection were categorized into the single infection group and the persistent infection group according to the review results.The CCL28 and vaginal microecological indicators of the two groups were compared.Logistic regression was used to analyze the risk factors for persistent HR-HPV infection.The dose-response relationship between CCL28 and persistent HR-HPV infection was analyzed by fitting restricted cubic splines with logistic regression.Spearman and multiple linear regression were used to analyze the relationship between CCL28 and vaginal microecological indicators.Results After the re-examination of patients,there were 84(63.64％)cases of single infection and 48(36.36％)cases of persistent infection.The percentage of colony density grade Ⅰ(54.17％vs 16.67％),colony diversity grade Ⅰ(47.92％),pH＞4.5(47.92％),hydrogen peroxide positivity(54.17％),and vaginal microecological imbalance(66.67％),and the level of CCL28[83.63(77.11,99.62)ng/L]in the persistent infection group were higher than those of the single infection group[16.76％,21.43％,15.48％,30.95％,41.67％,71.11(58.12,82.16)ng/L],and the differences were statistically significant(x2/Z=5.064～20.338,all P＜0.05).Logistic regression analysis showed that colony density grade Ⅰ(OR=3.556,95％CI:1.241～10.194,P=0.018),PH＞4.5(OR=4.366,95％CI:1.164～16.380,P=0.029),and high CCL28 levels(OR=1.048,95％CI:1.018～1.080,P=0.002)were independent risk factors for persistent infection in HR-HPV-infected patients.Logistic regression fitting restricted cubic splines showed a linear relationship between CCL28 and persistent HR-HPV infection(nonlinear test x2=0.61,P=0.437).Spearman correlation analysis results showed that CCL28 was positively correlated with age(r=0.205,P=0.018),colony density(r=0.429,P＜0.001),colony diversity(r=0.389,P＜0.001),pH(r=0.357,P＜0.00l),hydrogen peroxide(r=0.409,P＜0.001),leukocyte esterase(r=0.392,P＜0.00l),and vaginal microecology(r=0.473,P＜0.001).Linear regression analysis showed that colony density(β=12.295,P=0.003)and colony diversity(β=9.196,P=0.032)were independently associated with CCL28.Conclusion Colony density and colony diversity were independently correlated with CCL28.Colony density grade Ⅰ,pH＞4.5,and high CCL28 levels suggest an increased risk of persistent infection in patients with HR-HPV infection.

Silicosis is a leading cause of occupational disease-related morbidity and mortality worldwide, but the molecular basis underlying its development remains unclear. An accumulating body of evidence supports gasdermin D (GSDMD)-mediated pyroptosis as a key component in the development of various pulmonary diseases. However, there is little experimental evidence connecting silicosis and GSDMD-driven pyroptosis. In this work, we investigated the role of GSDMD-mediated pyroptosis in silicosis. Single-cell RNA sequencing of healthy and silicosis human and murine lung tissues indicated that GSDMD-induced pyroptosis in macrophages was relevant to silicosis progression. Through microscopy we then observed morphological alterations of pyroptosis in macrophages treated with silica. Measurement of interleukin-1β release, lactic dehydrogenase activity, and real-time propidium iodide staining further revealed that silica induced pyroptosis of macrophages. Additionally, we verified that both canonical (caspase-1-mediated) and non-canonical (caspase-4/5/11-mediated) signaling pathways mediated silica-induced pyroptosis activation, in vivo and in vitro. Notably, Gsdmd knockout mice exhibited dramatically alleviated silicosis phenotypes, which highlighted the pivotal role of pyroptosis in this disease. Taken together, our results demonstrated that macrophages underwent GSDMD-dependent pyroptosis in silicosis and inhibition of this process could serve as a viable clinical strategy for mitigating silicosis.

Objective:To investigate the efficacy of elastic locking intramedullary nail (ELIN) in the treatment of mid clavicle fractures.Methods:From January 2014 to December 2020, the data of 61 patients with mid-clavicle fracture treated with ELIN were retrospectively analyzed. Among them, 38 patients were from the Fourth Central Hospital Affiliated to Nankai University and 23 were from the Second People's Hospital of Hulunbuir City. There were 36 males and 25 females, aged from 19 to 85 years (average, 54.5 years), 39 cases on the left side and 22 cases on the right side. According to Robinson's classification, there were 20 cases of type 2A2, 29 cases of type 2B1 and 12 cases of type 2B2. There was no nerve or vascular injury before operation. The postoperative evaluation measures included incision length, operation time, blood loss, fracture reduction, fracture healing time, ELIN removal time, shoulder Constant-Murley score, disabilities of the arm, shoulder, and hand (DASH) score, and related complications.Results:All patients were followed up for 13-51 weeks (average, 21.8 weeks). There were 34 cases of closed reduction and 27 cases of mini-open reduction, and the length of incision was 2.04±1.08 cm. The closed reduction operation time was 20.32±7.11 min, and the mini-open reduction operation time was 20.30±5.37 min. The intraoperative blood loss was 6.47±2.31 ml in the closed reduction group and 27.41±11.55 ml in the mini-open reduction group. Compared with the healthy side, the clavicle length of the affected side was shortened by 7.74%±3.51% of pre-operation and 0.71%±1.00% of post-operation, there was statistically significant difference in the length of clavicle shortening of pre- and post-operation ( t=3.84, P<0.001). The fracture healing time was 10.48±2.39 weeks. The removal time of ELIN was 13.39±2.69 weeks. At the last follow-up, the Constant-Murley score of shoulder joint was 98.87±1.74. The average of DASH score was 1.13 (range, 0-10). There were 18 cases of skin irritation after operation, of which 13 cases formed pressure sores at the tail end 3-6 weeks after the operation, and were treated with dressing change and keeping clean; 4 cases of skin irritation at the tail end formed bursitis, which disappeared after removal of the internal fixation. In 1 case, the tip of ELIN penetrated the anterior cortex from the proximal clavicle and stimulated the skin. Radiograms showed continuous callus at 4 weeks after operation, and there was no local tenderness on the physical examination, which reached the clinical healing standard, and the symptoms were relieved after the nail was removed. No serious complications such as neural and vascular injury, nail breaking, delayed healing, infection, numbness or discomfort in the subclavian area occurred in all cases, and all patients were satisfied or basically satisfied with the aesthetic of the skin appearance. Conclusion:Minimally invasive and microstress shielding fixation of mid-clavicle fracture with ELIN have the advantages of simple operation, minimally invasive, beautiful appearance, anti-short-shrinkage and rapid fracture healing etc. It is an effective surgical method for the treatment of mid-clavicle fractures.

Objective To evaluate the efficacy and safety of the gemcitabine(GEM) plus S-1 in unresectable cholangiocarcinoma. Methods Forty-nine unresectable cholangiocarcinoma patients from January 2010 to June 2014 were randomly divided into two groups. The experimental group contained 25 patients treated with gemcitabine and S-1 and the control group contained 24 patients treated with gemcitabine and cisplatin. Results The experimental group′s release rate (RR) and disease control rate (DCR) was 36.0% (9/25) and 76.0% (19/25),the control group′s was 25.0(6/24) and 58.3% (14/25), and there were no statistically significant differences (P=0.403 and 0.187). One-year survival rate for the experimental and the control groups were 40.0% (8/25) and 29.2% (7/24), and there was no statistically significant difference (P=0.426). Median overall survival (OS) in the experimental and control groups was 13.0 and 12.3 months, and there was no statistically significant difference (χ2=0.273, P=0.602). The rate ofⅠ～Ⅱgrade of oral mucositis was more higher than that in the control group [25.0%(6/24) vs. 4.0% (1/25), P=0.036 ]. Conclusions Combination of GEM and S-1 provides a better OS and response rate, and is safer.

Objective To evaluate the efficacy of mesalazine combined with compound glutamine in the treatment of radiation related enteritis. Methods Ninety-four patients were randomly divided into the observation group and the treatment group, with 47 cases in each group. Patients in control group were given compound glutamine orally. On the basis of compound glutamine, patients in the observation group was added mesalazine orally. Before and after treatment, all patients were assessed according to acute radiation injury grading (RTOG), and the quality of life (QOL) scale for cancer patients was used to evaluate the improvement of quality of life. Results The total effective rate of the observation group was 95.7％(45/47) , and that of the control group was 78.7％(37/47).The difference was statistically significant (P<0.05). At the end of radiation therapy, patients in the observation group showed significant superiority in quality of life (P<0.05). Conclusions Mesalazine combined with compound glutamine in the treatment of radiation-associated enteritis has advantages and can improve the quality of life.

Objective: To investigate and analyze the clinical teaching of residents standardized training in Zhejiang University, so as to provide references to improve the quality of residents standardized training. Methods: Questionnaires were designed and electronic surveys via WJX software were conducted among residents from six affiliated hospitals of Zhejiang University School of Medicine on management, clinical teaching and assessment of residents. SPSS 19.0 was used to perform the χ² test of relevant data. Results: A total of 799 residents, including 312 males and 487 females, took part in this survey. In terms of satisfaction degree, trained residents had a relatively high satisfaction degree on training base (73.46%), satisfaction degrees of residents from Grade one, two and three were 69.05%, 74.72% and 79.30%, respectively. Satisfaction degree of residents with different identities to training base was social men (85.71%) > staff working in units (74.08%) > professional postgraduates (56.7%). In terms of teaching, 64.45% residents thought that clinical teachers spent 20% more time on the clinical teaching than on the daily routine work, 39.42% residents thought that clinical teachers spent 30% more and 18.52% residents thought clinical teachers spent 40% more. In addition, 70.47% residents responded that their teachers revised and instructed the medical history writing more than twice a week; 78.84% trained residents admitted that all teachers made full preparations for clinical teaching rounds. Besides, the process evaluation of training base was well implemented. Implementation rate of after-department examination and annual examination were 99.37% and 98.50%, respectively. Conclusion Residents of Zhejiang University have a high satisfaction degree on training management and clinical teaching. Homogenized management of training base should be strengthened, and evaluation and feedback should be stressed.

Dexmedetomidine (DEX ) is an α₂ adrenalin-receptor agonist with potent sedation, analgesia, anti-anxiety and anti-sympathetic effect. Moreover, DEX exert no inhibition of respiratory function with high safety and has considerable clinical application prospect. Children often experience emergency agitation (EA) and other uncomfortable symptom which is associated with special physical and mental state. Thus, an ideal pediatric anesthetic premedication is getting a lot of attention. DEX is superior to other premedication in sedation with high safety. Compared with others, DEX by nasal spray is an ideal drug delivery method to reduce the side effects and facilitate the implementation of the drug. The relevant research progress of the effective dose, efficacy and safety will be reviewed.