Objective:To investigate the predictive value of serum Tartrate-resistant acid phosphatase 5b (TRACP-5b), bone morphogenetic protein 2 (BMP-2), and serum C-terminal telopeptide of type I collagen (Crosslaps) for delayed healing of elderly patients after osteoporotic intertrochanteric fractures (OIF) surgery.Methods:82 elderly patients with OIF who received proximal femoral nail anti-rotation (PFNA) treatment for delayed healing in Linyi Central Hospital Trauma Center from Jan. 2022 to Jan. 2024 were selected as the delayed group. Another 38 elderly OIF patients treated with PFNA for normal healing were selected as the control group. The general data, serum TRACP-5b, BMP-2 and Crosslaps levels were compared, and the influencing factors and the predictive value of each index level were analyzed and screened.Results:The III~V types of Evans-Jensen classification in delayed group were significantly higher than those in the control group ( t = 4.29, P < 0.05) ; Before operation, there were no statistically significant differences in serum TRACP-5b and Crosslaps levels between the two groups ( t = 0.86, 1.10, P > 0.05), but the serum BMP-2 level in the delayed group was significantly lower than that in the control group ( t = 3.75, P < 0.05). Six months after surgery, serum TRACP-5b and Crosslaps levels in delayed group were significantly higher than the other group, and serum BMP-2 levels were significantly lower ( t = 3.88, 5.39, 5.59, P < 0.05) ; The results of multiple linear regression model indicated that the level of TRACP-5b 6 months after surgery, BMP-2 before and 6 months after surgery, and Crosslaps 6 months after surgery were all influential factors for delayed healing after OIF ( t = 4.34, -1.60, 5.03, P < 0.05) ; ROC curve analysis showed that serum TRACP-5b 6 months after surgery, BMP-2 before and 6 months after surgery, Crosslaps6 months after surgery, and the area AUC under the combined prediction curve were significantly different ( Z=3.334, 4.274, 5.321, 2.975, P=0.001, 0.000, 0.000, 0.000) . Conclusion:Serum TRACP-5b, BMP-2 and Crosslaps can predict delayed healing of elderly OIF after PFNA treatment.

Objective:To investigate the predictive value of serum Tartrate-resistant acid phosphatase 5b (TRACP-5b), bone morphogenetic protein 2 (BMP-2), and serum C-terminal telopeptide of type I collagen (Crosslaps) for delayed healing of elderly patients after osteoporotic intertrochanteric fractures (OIF) surgery.Methods:82 elderly patients with OIF who received proximal femoral nail anti-rotation (PFNA) treatment for delayed healing in Linyi Central Hospital Trauma Center from Jan. 2022 to Jan. 2024 were selected as the delayed group. Another 38 elderly OIF patients treated with PFNA for normal healing were selected as the control group. The general data, serum TRACP-5b, BMP-2 and Crosslaps levels were compared, and the influencing factors and the predictive value of each index level were analyzed and screened.Results:The III~V types of Evans-Jensen classification in delayed group were significantly higher than those in the control group ( t = 4.29, P < 0.05) ; Before operation, there were no statistically significant differences in serum TRACP-5b and Crosslaps levels between the two groups ( t = 0.86, 1.10, P > 0.05), but the serum BMP-2 level in the delayed group was significantly lower than that in the control group ( t = 3.75, P < 0.05). Six months after surgery, serum TRACP-5b and Crosslaps levels in delayed group were significantly higher than the other group, and serum BMP-2 levels were significantly lower ( t = 3.88, 5.39, 5.59, P < 0.05) ; The results of multiple linear regression model indicated that the level of TRACP-5b 6 months after surgery, BMP-2 before and 6 months after surgery, and Crosslaps 6 months after surgery were all influential factors for delayed healing after OIF ( t = 4.34, -1.60, 5.03, P < 0.05) ; ROC curve analysis showed that serum TRACP-5b 6 months after surgery, BMP-2 before and 6 months after surgery, Crosslaps6 months after surgery, and the area AUC under the combined prediction curve were significantly different ( Z=3.334, 4.274, 5.321, 2.975, P=0.001, 0.000, 0.000, 0.000) . Conclusion:Serum TRACP-5b, BMP-2 and Crosslaps can predict delayed healing of elderly OIF after PFNA treatment.

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 evaluate the diagnosis of renal function impairment as the serum creatinine (Scr) level raised in pilots by determining the glomerular filtration rate (GFR) ( 99mTc-GFR) through diethylene triamine pentaacetic acid (DTPA) renal dynamic imaging standard method and to compare the accuracy of determining simply elevated Scr between the diagnosing of cystatin C (Cys C) and GFR evaluation for flying personnel. Methods:In this study, pilots and pilot cadets whose Scr level was diagnosed raised twice in the physical examinations at Civil Aviation Medical Center of Civil Aviation Administration of China during 2018-2019 were selected as subjects. The GFR was calculated by the evaluation equations of Cockcroft-Gault creatinine clearance (CG-CCr) and the modification of diet in renal disease (MDRD-GFR) upon the averaged Scr level. Blood Cys C and 99mTc-GFR were examined. According to the examination results, they were divided into 99mTc-GFR normal group ( 99mTc-GFR≥90 ml/min) and 99mTc-GFR reduced group ( 99mTc-GFR<90 ml/min). Results:A total of 95 cases were enrolled, all male with an average age of (35.27±10.32) years. There were 59 cases with renal function impairment, accounting for 62.1%. The correlation coefficients r of Scr, MDRD-GFR, Cys C, CG-CCr and total kidney 99mTc-GFR were 0.218, 0.535, 0.808, 0.857, respectively. There were statistically significant differences in MDRD-GFR, CG-CCr and Cys C between normal and reduced 99mTc-GFR groups ( P<0.01). Conclusion:The percentage of renal impairment in simple Scr raised pilots is 62.1%. Besides 99mTc-GFR, Cys C and CG-CCr have good diagnostic accuracy and can be used as a supplementary examination item for the patients with elevated Scr.

Objective:To evaluate the diagnosis of renal function impairment as the serum creatinine (Scr) level raised in pilots by determining the glomerular filtration rate (GFR) ( 99mTc-GFR) through diethylene triamine pentaacetic acid (DTPA) renal dynamic imaging standard method and to compare the accuracy of determining simply elevated Scr between the diagnosing of cystatin C (Cys C) and GFR evaluation for flying personnel. Methods:In this study, pilots and pilot cadets whose Scr level was diagnosed raised twice in the physical examinations at Civil Aviation Medical Center of Civil Aviation Administration of China during 2018-2019 were selected as subjects. The GFR was calculated by the evaluation equations of Cockcroft-Gault creatinine clearance (CG-CCr) and the modification of diet in renal disease (MDRD-GFR) upon the averaged Scr level. Blood Cys C and 99mTc-GFR were examined. According to the examination results, they were divided into 99mTc-GFR normal group ( 99mTc-GFR≥90 ml/min) and 99mTc-GFR reduced group ( 99mTc-GFR<90 ml/min). Results:A total of 95 cases were enrolled, all male with an average age of (35.27±10.32) years. There were 59 cases with renal function impairment, accounting for 62.1%. The correlation coefficients r of Scr, MDRD-GFR, Cys C, CG-CCr and total kidney 99mTc-GFR were 0.218, 0.535, 0.808, 0.857, respectively. There were statistically significant differences in MDRD-GFR, CG-CCr and Cys C between normal and reduced 99mTc-GFR groups ( P<0.01). Conclusion:The percentage of renal impairment in simple Scr raised pilots is 62.1%. Besides 99mTc-GFR, Cys C and CG-CCr have good diagnostic accuracy and can be used as a supplementary examination item for the patients with elevated Scr.

OBJECTIVE: To investigate the incidence and influencing factors of hypertension among civil aviation pilots. METHODS: A total of 1 169 civil aviation pilots in Northern China were selected into the study by the method of convenient sampling. Physical examination, laboratory test and questionnaire survey were conducted. RESULTS: The prevalence of hypertension in Northern China was 4.7%(55/1 169). Multivariate regression analysis showed that the relative risk factors ranking from high to low were, age over 30 years [odds ratio(OR)=6.81, 95% confidence interval(95%CI) 3.57-12.98)], total flight hours over 1 000 hours(OR=4.24, 95%CI 2.14-8.41), flight hours over 500 hours in the past year(OR=2.91, 95%CI 1.57-5.40), obesity(OR=2.50, 95%CI 1.08-5.81), fasting blood glucose(OR=2.24, 95%CI 1.21-4.13), and frequent long-distance flight(OR=2.38, 95%CI 1.24-4.58). These factors were the risk factors of hypertension in civil aviation pilots(P<0.05). CONCLUSION: Age, total flight hours, flight hours in the past year, obesity, fasting blood glucose, frequent long-distance flight are related to the prevalence of hypertension in civil aviation pilots.

Objective To investigate the manifestations of esophageal motility disorders and evaluate the association between them and dysphagia, laboratory tests and other accessory examinations in patients with Sj(o)gren's syndrome (SS). Methods Esophageal manometry was performed in 31 patients with SS and 18 healthy volunteers by the step pull-through method. Results Decreased upper esophageal sphincter pressure was detected in 19 of the 31 patients (61%) with SS, while 4 of 18 (22%) in controls. The frequency was significantly higher in patients than in healthy controls (P=0.008). Fifteen of 31 patients (48%) showed various patterns of esophageal dysfunction including ineffective esophageal motility in 6 patients, nutcracker esophagus in 3 patients and nonspecific dysmotility in 6 patients. No major differences were found in esophageal parameters (peak amplitude, wave duration and velocity) when comparing primary SS with secondary SS. These esophageal abnormalities were not correlated with clinical manifestations, laboratory examinations and other auxiliary examinations. Conclusion Patients with SS may have esophageal motility disorders, which can presents with different patterns.