OBJECTIVE: To investigate the effectiveness of Holosight robotic navigation-assisted percutaneous cannulated screw fixation for femoral neck fractures. METHODS: A retrospective analysis was conducted on 65 patients with femoral neck fractures treated with cannulated screw fixation between January 2022 and February 2024. Among them, 31 patients underwent robotic navigation-assisted screw placement (navigation group), while 34 underwent conventional freehand percutaneous screw fixation (freehand group). Baseline characteristics, including age, gender, fracture side, injury mechanism, Garden classification, Pauwels classification, and time from injury to operation, showed no significant differences between the two groups ( P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency, fracture healing time, and complications were recorded and compared, and hip function was evaluated by Harris score at last follow-up. Postoperative anteroposterior and lateral hip X-ray films were taken to assess screw distribution accuracy, including deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex. RESULTS: No significant difference was observed in operation time between the two groups ( P>0.05). However, the navigation group demonstrated superior outcomes in intraoperative blood loss, fluoroscopy frequency, deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex ( P<0.05). No incision infections or deep vein thrombosis occurred. All patients were followed up 12-18 months (mean, 16 months). In the freehand group, 1 case suffered from cannulated screw dislodgement and nonunion secondary to osteonecrosis of femoral head at 1 year after operation, 1 case suffered from screw penetration secondary to osteonecrosis of femoral head at 5 months after operation; and 1 case suffered from nonunion secondary to osteonecrosis of femoral head at 6 months after operation in the navigation group. All the 3 patients underwent internal fixators removal and total hip arthroplasty. There was no significant difference in the incidence of complications between the two groups ( P>0.05). The fracture healing time and hip Harris score at last follow-up in the navigation group were significantly better than those in the freehand group ( P<0.05). CONCLUSION Compared to freehand percutaneous screw fixation, Holosight robotic navigation-assisted cannulated screw fixation for femoral neck fractures achieves higher precision, reduced intraoperative radiation exposure, smaller incisions, and superior postoperative hip function recovery.
Humans ; Femoral Neck Fractures/diagnostic imaging* ; Bone Screws ; Fracture Fixation, Internal/instrumentation* ; Male ; Female ; Retrospective Studies ; Robotic Surgical Procedures/methods* ; Middle Aged ; Aged ; Adult ; Treatment Outcome ; Operative Time ; Fracture Healing ; Surgery, Computer-Assisted/methods* ; Fluoroscopy

Asthma is a chronic inflammatory disease of the airway involving various cellular players. Among the different phenotypes of asthma, neutrophilic asthma is often associated with severe airway inflammation and a notable resistance to corticosteroid treatment. Macrophages, as innate immune cells, play a crucial role in the pathogenesis of neutrophilic asthma. They regulate neutrophil recruitment and activation to promote the progression of airway inflammation. During this process, macrophages also undergo changes in aspects such as efferocytosis. We reviewed the recent research progresses regarding the role of macrophages in the pathogenesis of neutrophilic asthma, aiming to provide valuable insights for future studies in this area.
Humans ; Asthma/pathology* ; Neutrophils/pathology* ; Macrophages/immunology* ; Animals ; Phagocytosis

Objective:To explore the clinical efficacy of retrograde tibial intramedullary nail (RTN) combined with less invasive stabilization system (LISS) in the treatment of distal femoral fractures.Methods:A retrospective analysis was conducted on the data of 11 patients with distal femoral fractures who underwent RTN combined with LISS locking plate treatment at the 909th Hospital from June 2021 to December 2022. There were 5 males and 6 females, with an average age of 56.5±17.5 years. The fracture types were AO/OTA 33A2 in 2 cases, A3 in 2 cases, C1 in 2 cases, and C2 in 2 cases. There were 3 cases of periprosthetic femoral fractures after total knee arthroplasty (TKA), all classified as Rorabeck type Ⅱ. They were treated with retrograde intramedullary nailing of the tibia combined with a minimally invasive lateral internal fixation system. The operation time, intraoperative blood loss, fracture healing time, full weight-bearing time, femorotibial angle, range of motion (ROM) of the knee joint, Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) for pain, and complications were recorded.Results:The operation was successfully completed in all 11 cases. The operation time was 98.3±9.0 min (range 83-115 min), and the intraoperative blood loss was 167.8±24.3 ml (range 120-210 ml). All 11 cases were followed up for 11.0±1.9 months (range 9-15 months). The healing time of 11 cases was 5.3±0.8 months (range 4-6 months) after operation. The time of complete weight-bearing activity after operation was 55.7±6.5 d (range 46-67 d). At the last follow-up, the femoral-tibial angle of 11 cases was 171.2°±1.8° (range 169°-174°), the ROM of knee joint was 129.5°±4.7° (range 120°-135°), and the HSS score was 86.8±6.9 points (range 69-95 points). There were no major complications except for one case of superficial infection of surgical incision after operation.Conclusion:RTN combined with lateral LISS locking plate showed good clinical effect with the advantages of less trauma, reliable fixation, rapid recovery, less postoperative complications.

BACKGROUND:The age distribution of patients with distal femur fracture is bimodal,being more common in young adults with high-energy injuries and older individuals with low-energy injuries.In cases of complex distal femoral fractures,a single less invasive stabilization system or retrograde femoral nail is insufficient to provide a stable environment for fracture healing and combined fixation is often necessary.OBJECTIVE:A novel combined fixation method(less invasive stabilization system combined with retrograde tibial nail)was developed for the treatment of type A3 distal femur fractures.Using finite element analysis,the bio-mechanical properties of this method were compared with two common combined fixation methods—dual plate(less invasive stabilization system combined with locking compression plate)and nail plate combination(less invasive stabilization system combined with retrograde femoral nail).This study aims to provide a theoretical basis for the selection of clinical internal fixation methods for distal femur fracture.METHODS:CT images of a 23-year-old healthy male volunteer were utilized to reconstruct the femur three-dimensional model using Mimics and Geomagic Studio software.This model was then compared with in vitro finite element analysis data from existing literature to validate the accuracy of the femoral three-dimensional model.The three-dimensional model of type A3 distal femur fractures and internal fixation were then created using Creo 5.0 software.Three kinds of different combined fixation methods(less invasive stabilization system+retrograde tibial nail,less invasive stabilization system+locking compression plate,less invasive stabilization system+retrograde femoral nail)were assembled and subjected to Boolean operation to establish three sets of finite element models.These models were then imported into Abaqus finite element analysis software to assign material properties,apply consistent boundary conditions,and submit calculations under three loads(normal standing,slow walking,and descending stairs).The resulting stress distribution within the internal fixation as well as overall and local deformation of the femur was analyzed.Furthermore,the failure risk and anti-deformation ability of the new combined fixation method(less invasive stabilization system combined with retrograde tibial nail)were evaluated.RESULTS AND CONCLUSION:(1)Although the anti-deformation ability of the less invasive stabilization system combined with retrograde tibial nail was approximately 10％lower than that of the less invasive stabilization system combined with locking compression plate,it was comparable to that of less invasive stabilization system combined with retrograde femoral nail and demonstrated good anti-deformation ability.(2)The stiffness of the femur with all three combined fixation methods remained consistent during gait,while femur displacement increased linearly with load,indicating high stability.(3)The failure risk associated with less invasive stabilization system combined with retrograde tibial nail was lower than that of the other two methods,with a 2.94％reduction in failure risk compared to less invasive stabilization system combined with locking compression plate.(4)This new combined fixation method offers distinct advantages in terms of anti-deformation ability,safety,and effectiveness,laying a theoretical foundation for further clinical application.

The Synopsis of Golden Chamber(Jinui Yaolue)first identified consumption as the primary pathogenesis of male infertility.The core mechanism underlying infertility owing to consumption lies in the deficiency of bodily fluids(Jin and Ye)and blood,referred to as fluid-blood deficiency.This condition links the overall vitality of the body's righteous qi with fertility,permeating the entire disease course and serving as the central focus for treatment with classical formulas(Jingfang).Although the causes of consumptive disease differ between ancient and modern times—ranging from physical labor and famine in historical contexts to mental stress,disordered dietary and sleep patterns,and delayed marriage or childbearing in contemporary society,the pathogenesis consistently converges on fluid-blood deficiency.Modern patients often present with mild symptoms owing to improved living conditions,which can obscure the underlying consumptive disease.Therefore,accurate diagnosis requires meticulous attention to subtle clinical signs,including specific symptoms,pulse manifestations,and complexion changes.Clinical differentiation of the two stages of fluid-blood deficiency is essential.The first stage,characterized as an early-stage fluid-blood deficiency,presents with middle energizer weakness,impaired pivot function,and upper heat-lower cold patterns.Treatment at this stage emphasizes fortifying the middle energizer(Jianzhong),harmonizing yin-yang,and restoring fluid-blood production,as demonstrated by the use of formulas like Guizhi Decoction and its variants.The second stage is advanced fluid-blood deficiency,marked by triple energizer qi collapse and phlegm-blood stasis obstruction.In accordance with the principle from Jingui Yaolue of"gentle tonification while resolving stagnation"(Huan Zhong Bu Xu),treatment focuses on warming the lower energizer,consolidating fluids-blood,dissolving stasis,and relieving abdominal fullness in the middle energizer.For this stage,Tianxiong Powder is recommended in cases dominated by cold,Dahuang Zhechong Pill in cases dominated by phlegm-stasis,and Shenqi Pill in cases involving dual yin-yang deficiency.

Objective:To explore the clinical efficacy of retrograde tibial intramedullary nail (RTN) combined with less invasive stabilization system (LISS) in the treatment of distal femoral fractures.Methods:A retrospective analysis was conducted on the data of 11 patients with distal femoral fractures who underwent RTN combined with LISS locking plate treatment at the 909th Hospital from June 2021 to December 2022. There were 5 males and 6 females, with an average age of 56.5±17.5 years. The fracture types were AO/OTA 33A2 in 2 cases, A3 in 2 cases, C1 in 2 cases, and C2 in 2 cases. There were 3 cases of periprosthetic femoral fractures after total knee arthroplasty (TKA), all classified as Rorabeck type Ⅱ. They were treated with retrograde intramedullary nailing of the tibia combined with a minimally invasive lateral internal fixation system. The operation time, intraoperative blood loss, fracture healing time, full weight-bearing time, femorotibial angle, range of motion (ROM) of the knee joint, Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) for pain, and complications were recorded.Results:The operation was successfully completed in all 11 cases. The operation time was 98.3±9.0 min (range 83-115 min), and the intraoperative blood loss was 167.8±24.3 ml (range 120-210 ml). All 11 cases were followed up for 11.0±1.9 months (range 9-15 months). The healing time of 11 cases was 5.3±0.8 months (range 4-6 months) after operation. The time of complete weight-bearing activity after operation was 55.7±6.5 d (range 46-67 d). At the last follow-up, the femoral-tibial angle of 11 cases was 171.2°±1.8° (range 169°-174°), the ROM of knee joint was 129.5°±4.7° (range 120°-135°), and the HSS score was 86.8±6.9 points (range 69-95 points). There were no major complications except for one case of superficial infection of surgical incision after operation.Conclusion:RTN combined with lateral LISS locking plate showed good clinical effect with the advantages of less trauma, reliable fixation, rapid recovery, less postoperative complications.

BACKGROUND:The age distribution of patients with distal femur fracture is bimodal,being more common in young adults with high-energy injuries and older individuals with low-energy injuries.In cases of complex distal femoral fractures,a single less invasive stabilization system or retrograde femoral nail is insufficient to provide a stable environment for fracture healing and combined fixation is often necessary.OBJECTIVE:A novel combined fixation method(less invasive stabilization system combined with retrograde tibial nail)was developed for the treatment of type A3 distal femur fractures.Using finite element analysis,the bio-mechanical properties of this method were compared with two common combined fixation methods—dual plate(less invasive stabilization system combined with locking compression plate)and nail plate combination(less invasive stabilization system combined with retrograde femoral nail).This study aims to provide a theoretical basis for the selection of clinical internal fixation methods for distal femur fracture.METHODS:CT images of a 23-year-old healthy male volunteer were utilized to reconstruct the femur three-dimensional model using Mimics and Geomagic Studio software.This model was then compared with in vitro finite element analysis data from existing literature to validate the accuracy of the femoral three-dimensional model.The three-dimensional model of type A3 distal femur fractures and internal fixation were then created using Creo 5.0 software.Three kinds of different combined fixation methods(less invasive stabilization system+retrograde tibial nail,less invasive stabilization system+locking compression plate,less invasive stabilization system+retrograde femoral nail)were assembled and subjected to Boolean operation to establish three sets of finite element models.These models were then imported into Abaqus finite element analysis software to assign material properties,apply consistent boundary conditions,and submit calculations under three loads(normal standing,slow walking,and descending stairs).The resulting stress distribution within the internal fixation as well as overall and local deformation of the femur was analyzed.Furthermore,the failure risk and anti-deformation ability of the new combined fixation method(less invasive stabilization system combined with retrograde tibial nail)were evaluated.RESULTS AND CONCLUSION:(1)Although the anti-deformation ability of the less invasive stabilization system combined with retrograde tibial nail was approximately 10％lower than that of the less invasive stabilization system combined with locking compression plate,it was comparable to that of less invasive stabilization system combined with retrograde femoral nail and demonstrated good anti-deformation ability.(2)The stiffness of the femur with all three combined fixation methods remained consistent during gait,while femur displacement increased linearly with load,indicating high stability.(3)The failure risk associated with less invasive stabilization system combined with retrograde tibial nail was lower than that of the other two methods,with a 2.94％reduction in failure risk compared to less invasive stabilization system combined with locking compression plate.(4)This new combined fixation method offers distinct advantages in terms of anti-deformation ability,safety,and effectiveness,laying a theoretical foundation for further clinical application.

The Synopsis of Golden Chamber(Jinui Yaolue)first identified consumption as the primary pathogenesis of male infertility.The core mechanism underlying infertility owing to consumption lies in the deficiency of bodily fluids(Jin and Ye)and blood,referred to as fluid-blood deficiency.This condition links the overall vitality of the body's righteous qi with fertility,permeating the entire disease course and serving as the central focus for treatment with classical formulas(Jingfang).Although the causes of consumptive disease differ between ancient and modern times—ranging from physical labor and famine in historical contexts to mental stress,disordered dietary and sleep patterns,and delayed marriage or childbearing in contemporary society,the pathogenesis consistently converges on fluid-blood deficiency.Modern patients often present with mild symptoms owing to improved living conditions,which can obscure the underlying consumptive disease.Therefore,accurate diagnosis requires meticulous attention to subtle clinical signs,including specific symptoms,pulse manifestations,and complexion changes.Clinical differentiation of the two stages of fluid-blood deficiency is essential.The first stage,characterized as an early-stage fluid-blood deficiency,presents with middle energizer weakness,impaired pivot function,and upper heat-lower cold patterns.Treatment at this stage emphasizes fortifying the middle energizer(Jianzhong),harmonizing yin-yang,and restoring fluid-blood production,as demonstrated by the use of formulas like Guizhi Decoction and its variants.The second stage is advanced fluid-blood deficiency,marked by triple energizer qi collapse and phlegm-blood stasis obstruction.In accordance with the principle from Jingui Yaolue of"gentle tonification while resolving stagnation"(Huan Zhong Bu Xu),treatment focuses on warming the lower energizer,consolidating fluids-blood,dissolving stasis,and relieving abdominal fullness in the middle energizer.For this stage,Tianxiong Powder is recommended in cases dominated by cold,Dahuang Zhechong Pill in cases dominated by phlegm-stasis,and Shenqi Pill in cases involving dual yin-yang deficiency.

Objective:To evaluate the fixation with a locking fibular intramedullary nail for treatment of extra-articular distal tibial fracture complicated with fibular fracture (AO/OTA 43A).Methods:A retrospective study was conducted to analyze the data of 31 patients who had been treated by fixation with a locking fibular intramedullary nail for extra-articular distal tibial fracture complicated with fibular fracture at Department of Orthopaedics, The 909th Hospital of Joint Logistics Support Force between January 2018 and December 2021. There were 20 males and 11 females; (41.5±15.7) years in age; AO classification of the distal tibial fractures: 10 cases of type 43A1, 10 cases of type 43A2, and 11 cases of type 43A3; 11 open fractures and 20 closed fractures. Fracture healing, fibular alignment, tibiotalar angle, and incidence of complications were regularly followed up and recorded after surgery. At the last follow-up, the ankle joint function was assessed using the Olerud Molander ankle score (OMAS) and the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS).Results:All the 31 patients were followed up for (17.5±3.3) months after surgery. All of them achieved fine fracture union. The union time was (3.9±0.8) months for tibial fractures, and (3.6±0.9) months for fibular fractures. No internal fixation failure was observed. The last follow-up revealed the following: the fibular alignment was 1.8°±1.3° and the ankle tibiotalar angle 9.1°±2.3°; no fibular rotation, shortening, or separation displacement happened; the OMAS score was (88.3±6.2) points, and the AOFAS ankle-hindfoot score (87.4±6.0) points. Two patients required removal of the distal locking screw of the fibular intramedullary nail due to soreness around the lateral malleolus caused by screw loosening. There were no other related complications.Conclusion:Fixation with a locking fibular intramedullary nail is an effective treatment for extra-articular distal tibial fracture complicated with fibular fracture, demonstrating advantages of firm fixation, limited complications, minimal trauma and soft tissue irritation, and good clinical efficacy.

Objective To deeply analyze the problems of public hospitals in medical service satisfaction,construct a more applicable and explanatory service satisfaction evaluation model,and provide reference for the improvement path of patients'medical service satisfaction.Methods Based on the ESCI model,this paper puts forward a research hypothesis,compiles the"Medical Service Satisfaction Evaluation Scale of Public Hospitals in S City",selects S public hospitals as the research object,and evaluates medical service satisfaction from the perspective of patients.Results At present,the main problems affecting the improvement of patients'satisfaction with medical service management in public hospitals in S city are as follows:it is urgent to improve the diagnosis and treatment technology in terms of hardware quality and optimize the environmental hygiene of public hos-pitals,and it is an urgent task to shorten the waiting time for medical treatment in software quality.The score of medical service satisfaction evaluation of S public hospitals was 3.76,and the satisfaction of patients in S public hospitals with their medical serv-ices was at a moderately low level.Conclusion In view of the above problems,it is recommended to strengthen the construction of key specialties,strengthen the construction of talent team,optimize the medical process,open digital linkage services,and strengthen service management,so as to promote the improvement of patients'satisfaction with medical services.