BACKGROUND:The quadriceps strength of patients with osteoporosis and sarcopenia is significantly reduced,which can further reduce the function of the knee joint,affect the function of the lower limbs and even lead to a decrease in whole-body coordination.It is speculated that a reasonable quadriceps training program and personalized guidance are beneficial to the recovery of knee joint function in patients with osteoporosis and sarcopenia.OBJECTIVE:To observe the effect of short-term moderate-intensity resistance rehabilitation training on the mass and function of the quadriceps and knee joint function in patients with osteoporosis and sarcopenia.METHODS:Using the integrated physical examination and rehabilitation model,375 patients with osteoporosis and sarcopenia were screened at the Health Management Center of Shanghai Public Health Clinical Center.They underwent 12 weeks of combined/comprehensive exercise rehabilitation based on resistance exercise,including quadriceps resistance isotonic and isometric contraction training twice a week(3-5 sets each time,10-15 minutes per set)and aerobic exercise/balance exercise two or three times a week(30 minutes each time).Assessments and data collection were performed before rehabilitation training,12 weeks after rehabilitation training,and at follow-up 12 weeks after stopping rehabilitation training,mainly including knee joint range of motion and proprioception,quadriceps muscle strength,and cross-sectional area(magnetic resonance imaging results),pain,knee joint function(Hospital for Special Surgery score)and walking function("up-and-go"time and 6 m pace test results)as well as the patient's psychological status assessment.RESULTS AND CONCLUSION:All 375 patients completed 12 weeks of rehabilitation training and 12 weeks of follow-up without any adverse events.(1)Compared with before training,the patients' gait speed and knee range of motion increased significantly after 12 weeks of rehabilitation training(P＜0.01),the time of"stand-to-walk"decreased(P＜0.01),and the proprioception of the knee joint and the strength of the quadriceps femoris were significantly improved(P＜0.01);and at the follow-up visit 12 weeks after stopping training,the above indicators and functions of the patients were well maintained(P＞0.05).(2)Magnetic resonance imaging results showed that the effective cross-sectional area of the quadriceps femoris did not improve significantly after 12 weeks of rehabilitation training(P＞0.05);but the Hospital for Special Surgery score of knee joint function increased significantly(P＜0.01),and the visual analog pain scale score decreased significantly(P＜0.01),suggesting that this may be related to the improvement of quadriceps femoris quality by resistance rehabilitation training.(3)The results of the Hospital Anxiety and Depression Scale score showed that the anxiety and depression scores of the patients continued to decrease,both at 12 weeks of rehabilitation training and at 12 weeks after stopping training(P＜0.01).It is suggested that resistance rehabilitation training of the quadriceps can help patients with osteoporosis and sarcopenia to restore quadriceps muscle strength,increase range of motion,improve proprioception and joint stability,thereby enhancing knee joint function,reducing pain,improving depression and anxiety,and to a certain extent promoting the coordinated recovery of the musculoskeletal system.

BACKGROUND:The quadriceps strength of patients with osteoporosis and sarcopenia is significantly reduced,which can further reduce the function of the knee joint,affect the function of the lower limbs and even lead to a decrease in whole-body coordination.It is speculated that a reasonable quadriceps training program and personalized guidance are beneficial to the recovery of knee joint function in patients with osteoporosis and sarcopenia.OBJECTIVE:To observe the effect of short-term moderate-intensity resistance rehabilitation training on the mass and function of the quadriceps and knee joint function in patients with osteoporosis and sarcopenia.METHODS:Using the integrated physical examination and rehabilitation model,375 patients with osteoporosis and sarcopenia were screened at the Health Management Center of Shanghai Public Health Clinical Center.They underwent 12 weeks of combined/comprehensive exercise rehabilitation based on resistance exercise,including quadriceps resistance isotonic and isometric contraction training twice a week(3-5 sets each time,10-15 minutes per set)and aerobic exercise/balance exercise two or three times a week(30 minutes each time).Assessments and data collection were performed before rehabilitation training,12 weeks after rehabilitation training,and at follow-up 12 weeks after stopping rehabilitation training,mainly including knee joint range of motion and proprioception,quadriceps muscle strength,and cross-sectional area(magnetic resonance imaging results),pain,knee joint function(Hospital for Special Surgery score)and walking function("up-and-go"time and 6 m pace test results)as well as the patient's psychological status assessment.RESULTS AND CONCLUSION:All 375 patients completed 12 weeks of rehabilitation training and 12 weeks of follow-up without any adverse events.(1)Compared with before training,the patients' gait speed and knee range of motion increased significantly after 12 weeks of rehabilitation training(P＜0.01),the time of"stand-to-walk"decreased(P＜0.01),and the proprioception of the knee joint and the strength of the quadriceps femoris were significantly improved(P＜0.01);and at the follow-up visit 12 weeks after stopping training,the above indicators and functions of the patients were well maintained(P＞0.05).(2)Magnetic resonance imaging results showed that the effective cross-sectional area of the quadriceps femoris did not improve significantly after 12 weeks of rehabilitation training(P＞0.05);but the Hospital for Special Surgery score of knee joint function increased significantly(P＜0.01),and the visual analog pain scale score decreased significantly(P＜0.01),suggesting that this may be related to the improvement of quadriceps femoris quality by resistance rehabilitation training.(3)The results of the Hospital Anxiety and Depression Scale score showed that the anxiety and depression scores of the patients continued to decrease,both at 12 weeks of rehabilitation training and at 12 weeks after stopping training(P＜0.01).It is suggested that resistance rehabilitation training of the quadriceps can help patients with osteoporosis and sarcopenia to restore quadriceps muscle strength,increase range of motion,improve proprioception and joint stability,thereby enhancing knee joint function,reducing pain,improving depression and anxiety,and to a certain extent promoting the coordinated recovery of the musculoskeletal system.

Objective To investigate the status of hearing impaired children's hearing device independence skills,and to explore the ways to improve their self-use of hearing equipment.Methods This study surveyed 64 re-habilitation teachers and 411 parents of children with hearing impairment aged 0-12 years.Through face-to-face or remote telephone interview,3 good habits(A asking parents for advice before removing the HA,B putting the de-vice into a moisture-proof box after removing it,C bringing batteries to school and knowing where are them)and 3 key abilities[D wearing the device independently,E replacing the battery independently,and F independently handle foreign bodies in the ear mold(Fa)and water vapor(Fb)]was investigated.The age when mastering skills or de-veloping habits difference of hearing impaired children in different groups were compared.Results ① The ratio of ability D in the bilateral CI group and the bilateral HA group of preschool children was 30.97％and 18.57％respec-tively.Among elementary school children,85.29％and 90.70％had this ability respectively.② The ratio of ability E in the bilateral CI group,the bilateral HA group and the bimodel group were 11.50％,15.71％and 16.49％,re-spectively.Among elementary school children,64.71％,53.49％and 68.52％had this ability,respectively.③Among preschool children,there was no statistical difference in age when different equipment groups developed the three good habits and acquired ability D and E(P＞0.05).④ Among primary school children,there was a statisti-cal difference in the age when different equipment groups formed habit A(P＜0.05),and the age when double CI group had this ability was slightly earlier than the double HA group.There was no significant difference in other abilities among age groups(P＞0.05).Conclusion The age at which hearing impaired children develop the three good habits precedes the age at which they master the key skills,which accords with the law of skill acquisition and development of ordinary children.Corresponding teaching process should be based on the age and ability of hearing-impaired children without considering the type of equipment.

BACKGROUND:Patients with osteoporotic compression fractures of the lumbar spine have varying degrees of changes in the sagittal parameters of the spine and pelvis,resulting in disequilibrium and rebalancing of the sagittal plane of the whole spine/lumbar spine.If the primary osteoporotic vertebral compression fracture is not treated promptly,it develops into an old osteoporotic vertebral compression fracture with nonunion over time. OBJECTIVE:To observe the effect of percutaneous vertebroplasty in nine patients with old osteoporotic lumbar compression fracture with nonunion. METHODS:A retrospective analysis was conducted on the clinical data of nine elderly patients with old osteoporotic lumbar compression fractures with nonunion treated in the Orthopedics Department of Shanghai Public Health Clinical Center from September 2018 to August 2022.All patients underwent revision treatment with percutaneous vertebroplasty and received regular anti-osteoporosis treatment and rehabilitation training.The lumbar spine X-ray plain film and three-dimensional CT test results were reviewed before discharge and during follow-up to evaluate the diffusion of bone cement.Visual analog scale score,lumbar Oswestry disability index score,and Roussouly classification were recorded before,after surgery and during follow-up. RESULTS AND CONCLUSION:(1)During postoperative follow-up,none of the 9 cases in this group experienced serious surgical complications such as nerve injury,infection,bone cement leakage,pulmonary embolism,and allergic shock,and no adverse reactions related to bone cement occurred.One patient died of respiratory failure due to COVID-19 infection 2 years after operation.(2)The visual analog scale score and Oswestry disability index score of postoperative pain in patients with recurrent vertebral fractures after percutaneous vertebroplasty were significantly lower than those before revision surgery.After the last follow-up percutaneous vertebroplasty revision surgery,the Roussouly classification of patients significantly improved.There was no statistically significant difference between the changes in vertebral body height during the last follow-up measurement and preoperative comparison.(3)These findings indicate that for patients with old osteoporotic lumbar compression fractures with nonunion,moderate injection of bone cement and effective dispersion of bone cement have a significant relieving effect on postoperative pain.Regular anti-osteoporosis and effective postoperative rehabilitation training can help patients improve their postoperative lumbar spine function.

Hypoxia inducible factors(HIFs)are core molecules that enable the body to adapt to hypoxia environments.By sensing changes in intracellular oxygen pressure,HIFs regulate gene expression related to hypoxia adaptation,thereby enhancing the body's hypoxia tolerance at cellular,tissue and organ levels.On the other hand,HIFs promote the generation of red blood cells,angiogenesis,and regulate the body's energy metabolism,thereby improving its hypoxia tolerance.The enhancement of hypoxia tolerance is of great significance for the prevention and treatment of hypoxia-related diseases,upgrading of athletes'performance,enhancement of workers'efficiency at high-altitudes,and the improvement of individu-als'quality of life.This article reviews the relationships between HIFs and hypoxia tolerance as well as related mechanisms in order to provide strategies for enhancing hypoxia tolerance in the body.

Objective To investigate the status of hearing impaired children's hearing device independence skills,and to explore the ways to improve their self-use of hearing equipment.Methods This study surveyed 64 re-habilitation teachers and 411 parents of children with hearing impairment aged 0-12 years.Through face-to-face or remote telephone interview,3 good habits(A asking parents for advice before removing the HA,B putting the de-vice into a moisture-proof box after removing it,C bringing batteries to school and knowing where are them)and 3 key abilities[D wearing the device independently,E replacing the battery independently,and F independently handle foreign bodies in the ear mold(Fa)and water vapor(Fb)]was investigated.The age when mastering skills or de-veloping habits difference of hearing impaired children in different groups were compared.Results ① The ratio of ability D in the bilateral CI group and the bilateral HA group of preschool children was 30.97％and 18.57％respec-tively.Among elementary school children,85.29％and 90.70％had this ability respectively.② The ratio of ability E in the bilateral CI group,the bilateral HA group and the bimodel group were 11.50％,15.71％and 16.49％,re-spectively.Among elementary school children,64.71％,53.49％and 68.52％had this ability,respectively.③Among preschool children,there was no statistical difference in age when different equipment groups developed the three good habits and acquired ability D and E(P＞0.05).④ Among primary school children,there was a statisti-cal difference in the age when different equipment groups formed habit A(P＜0.05),and the age when double CI group had this ability was slightly earlier than the double HA group.There was no significant difference in other abilities among age groups(P＞0.05).Conclusion The age at which hearing impaired children develop the three good habits precedes the age at which they master the key skills,which accords with the law of skill acquisition and development of ordinary children.Corresponding teaching process should be based on the age and ability of hearing-impaired children without considering the type of equipment.

Objective:Investigating the efficacy of unilateral adrenalectomy in treatment for primary pigmented nodular adrenocortical disease (PPNAD).Methods:Clinical data of 26 patients with PPNAD treated in our hospital from January 2013 to June 2023 was retrospectively analyzed.There were 11 males and 15 females, with an average age of (19.4±4.7) years. 25 cases presented with typical Cushing's syndrome, and 16 cases were diagnosed with Carney's syndrome. PRKAR1A gene mutation detected in 8 out of 10 cases. CT showed multiple small nodules on bilateral adrenal glands in 14 cases, unilateral small nodules or mild thickening with normal contralateral glands in 8 cases, and no obvious abnormalities in 4 cases. All patients showed autonomous oversecretion of cortisol by endocrine laboratory tests, with a median 24 h-UFC of 408.35 (334.28, 800.78) μg/24 h and decreased level of adrenocorticotropic hormone. All 26 patients underwent laparoscopic unilateral adrenalectomy, with left side adrenalectomy in 8 cases and right side adrenalectomy in 18 cases.Results:The average surgical duration was (85.2±28.7) minutes, with intraoperative blood loss <50 ml in all cases. The median time to drainage tube removal post-operation was 3 (2, 3) days. One patient developed a postoperative pulmonary infection, and 3 patients required postoperative hormone replacement therapy. The median follow-up duration was 64 (31.5, 103.8) months, and all patients showed alleviation of Cushing syndrome clinical manifestations after operations. 19 patients (73.1%) had their 24 h-UFC levels normalized to a median of 42.0 (22.4, 58.3) μg/24 h within 8.5 (5, 46) days post-surgery. 7 patients (26.9%) did not achieve normal 24 h-UFC levels, yet experienced an average reduction of (73.2±10.4)%. 13 patients (50.0%) did not experience recurrence, with a median follow-up of 51 (7, 89.5) months, including two cases without recurrence at 10 years post-surgery. 13 patients showed recurrent increase in postoperative cortisol levels, with a median of 225.6 (188.9, 397.2) μg/24 h. The median time to increased 24 h-UFC post-surgery was 27 (13.5, 50.5) months, with the longest duration reaching 104 months. Among these, 9 cases exhibited clinical signs and symptoms of recurrence, while 4 cases did not. Of the 13 patients with recurrence, 9 underwent contralateral adrenalectomy or subtotal resection, while 4 were observed with follow-up.Conclusions:Unilateral adrenalectomy could be a surgical treatment option for PPNAD. Despite the recurrence in some patients postoperatively, unilateral adrenalectomy could effectively and rapidly reduce cortisol levels in PPNAD patients and alleviate the clinical manifestations of Cushing syndrome.

Objective:To investigate the feasibility of digital reconstruction technology in virtual planning of the free perforator flap of anterior tibial artery (ATA) for reconstruction of soft tissue defects in foot and ankle.Methods:From May 2018 to April 2023, 10 patients, including 7 males and 3 females, with foot or ankle defects were admitted in the Department of Orthopaedics Surgery, 920th Hospital of Joint Logistics Support Force. There were 5 defects in dorsal foot, 3 in plantar foot and 2 in medial malleolus. The sizes of defects ranged from 3.0 cm×2.5 cm to 5.5 cm×4.0 cm, all with exposed bones or tendons. Preoperative CTA scans from aorta abdominalis to feet were performed, and 3D digital models of bones, arteries and skin were reconstructed with Mimics. The most suitable perforators were selected to design the perforator flaps of ATA with the software, then the digital virtual flaps were superimposed onto the surfaces of donor sites and marked under a translucent image by Sina. During the surgery, flaps were harvested according to preoperative digital designs with the size of 3.5 cm×3.0 cm-6.0 cm×4.0 cm. The perforating branches were dissected along the way, and the origin, diameter, course, location and length of the perforators were recorded. The perforating branches of the flaps were anastomosed to the proximal vessels in the recipient sites, and the flaps were sutured to cover the wound. For the 10 donor sites, skin graft was used in 2 donor sites and direct suture were performed on 8 donor sites. After discharge of the patients, scheduled outpatient or online follow-ups were carried out to assess the progress of fracture healing as well as the appearance, texture and colour of flaps, and the recovery of donor sites. Ankle function was evaluated by Maryland foot scoring system.Results:Three-dimensional digital reconstructions of donor sites were successfully performed on all patients, enabling successful design and harvest of the free perforator flaps of ATA. The flaps were able to be used in complete reconstruction of the respective defects and made the anatomical parameters of perforators of the donor sites closely matching with those of preoperative modeling. Follow-up periods ranged from 6 to 19 months, apart from 1 flap experienced partial necrosis at distal endge, and another flap with partial exfoliation after blistering. The rest of 8 flaps were all survived smoothly, with appropriate thickness, aesthetic appearance, good texture and colour. Sensations in both donor sites and dorsal feet were all normal. Seven patients achieved excellent and 3 were good according to Maryland's ankle-foot function score. The donor sites healed well without scar hyperplasia.Conclusion:Digital reconstruction technology enables an accurate identification of perforators as well as individualised design and harvest procedures for perforator flaps of ATA, thereby it facilitates precise reconstructions of small-to-medium-sized defects in foot or ankle. It is a good method for vascular anatomy and flap harvesting.

Objective:To investigate the feasibility of digital reconstruction technology in virtual planning of the free perforator flap of anterior tibial artery (ATA) for reconstruction of soft tissue defects in foot and ankle.Methods:From May 2018 to April 2023, 10 patients, including 7 males and 3 females, with foot or ankle defects were admitted in the Department of Orthopaedics Surgery, 920th Hospital of Joint Logistics Support Force. There were 5 defects in dorsal foot, 3 in plantar foot and 2 in medial malleolus. The sizes of defects ranged from 3.0 cm×2.5 cm to 5.5 cm×4.0 cm, all with exposed bones or tendons. Preoperative CTA scans from aorta abdominalis to feet were performed, and 3D digital models of bones, arteries and skin were reconstructed with Mimics. The most suitable perforators were selected to design the perforator flaps of ATA with the software, then the digital virtual flaps were superimposed onto the surfaces of donor sites and marked under a translucent image by Sina. During the surgery, flaps were harvested according to preoperative digital designs with the size of 3.5 cm×3.0 cm-6.0 cm×4.0 cm. The perforating branches were dissected along the way, and the origin, diameter, course, location and length of the perforators were recorded. The perforating branches of the flaps were anastomosed to the proximal vessels in the recipient sites, and the flaps were sutured to cover the wound. For the 10 donor sites, skin graft was used in 2 donor sites and direct suture were performed on 8 donor sites. After discharge of the patients, scheduled outpatient or online follow-ups were carried out to assess the progress of fracture healing as well as the appearance, texture and colour of flaps, and the recovery of donor sites. Ankle function was evaluated by Maryland foot scoring system.Results:Three-dimensional digital reconstructions of donor sites were successfully performed on all patients, enabling successful design and harvest of the free perforator flaps of ATA. The flaps were able to be used in complete reconstruction of the respective defects and made the anatomical parameters of perforators of the donor sites closely matching with those of preoperative modeling. Follow-up periods ranged from 6 to 19 months, apart from 1 flap experienced partial necrosis at distal endge, and another flap with partial exfoliation after blistering. The rest of 8 flaps were all survived smoothly, with appropriate thickness, aesthetic appearance, good texture and colour. Sensations in both donor sites and dorsal feet were all normal. Seven patients achieved excellent and 3 were good according to Maryland's ankle-foot function score. The donor sites healed well without scar hyperplasia.Conclusion:Digital reconstruction technology enables an accurate identification of perforators as well as individualised design and harvest procedures for perforator flaps of ATA, thereby it facilitates precise reconstructions of small-to-medium-sized defects in foot or ankle. It is a good method for vascular anatomy and flap harvesting.

Objective To investigate the viral infection subtypes and epidemiological characteristics of upper respiratory tract infection (URTI) in Beijing area in 2020, and to provide references for URTI specific treatment and vaccination. Methods A total of 22 318 patients with URTI in Beijing area from January 2020 to December 2020 were enrolled in the study. Basic demographic information and clinical characteristics of the patients were collected, and their respiratory tract samples were collected. Eight major respiratory viruses (including respiratory syncytial virus, parainfluenza virus, adenovirus, coronavirus, influenza virus, rhinovirus, bocavirus, and metapneumovirus) in the respiratory samples were detected by PCR. The pathogen composition and epidemiological characteristics of URTI were analyzed. Results ① Among the 22 318 cases of URTI, most of them were children under 5 years old and elderly patients over 70 years old, accounting for 25.02% and 19.43%, respectively; ② URTI mainly occurred in spring (35.71%) and winter (37.35%); ③ The total positive rate of respiratory virus was 49.35%, among which 45.42% were infected with single virus, 3.30% were infected with two viruses, and 0.63% were infected with three or more viruses; ④ Respiratory syncytial virus (49.35%) had the highest detection rate, followed by parainfluenza virus (12.98%), rhinovirus (9.48%), influenza virus (8.40%), adenovirus (6.01%), bocavirus (4.43%), coronavirus (3.97%), and metapneumovirus (2.90%); ⑤ The detection rates of respiratory syncytial virus and parainfluenza virus in children aged 0-5 years old and the elderly aged over 71 years old were higher than those in other age groups, while the detection rates of other pathogens of all age groups were similar; ⑥ Among 22,318 URTI patients, 290 cases were complicated with pneumonia, with a complication rate of 1.300%. The complication rate of pneumonia in patients with positive virus pathogens was significantly higher than that in patients with negative virus pathogens (χ²=18.011, P<0.05). The complication rate of pneumonia in patients with mixed infection was significantly higher than that in patients with single virus infection (χ²=884.085, P<0.05). Conclusion Children under 5 years old and the elderly over 70 years old are the high-risk population of URTI, and URTI mainly occurs in spring and winter. Respiratory syncytial virus and parainfluenza virus are the main pathogens leading to URTI, and patients with virus infection and mixed virus infection suffer a higher risk of pneumonia.