Objective:To analyze the risk factors for the lateral condyle fracture of the humerus concomitant with fractures of ulna olecranon and coronoid (triple fracture) in children.Methods:A retrospective study was conducted to analyze the data of 584 children who had been hospitalized for lateral condyle fracture of the humerus from January 2012 to December 2022 at Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University. There were 392 males and 192 females with an age of 60.5 (43.0, 86.0) months, and 327 left and 257 right sides affected. There were 546 cases of simple lateral condyle fracture of the humerus (simple group) and 38 cases of triple lateral condyle fracture of the humerus (triple group). The treatment methods for the triple group were recorded, and the elbow function of the children in the triple group was assessed using the Mayo Elbow Performance Score (MEPS) at the last follow-up. First, a univariate analysis was conducted of the gender, side profile, surgical age, height, weight, and distribution of the Jacob and Milch types of the lateral condyle of the humerus in the 2 groups. Next, the P<0.1 factors screened were further analyzed by the multivariate logistic regression to determine the final variables. Results:All the fractures of the lateral condyle of the humerus were treated by internal fixation with Kirschner wires after closed or open reduction. The 38 patients in the triple group were followed up for 15.0 (13.0, 21.3) months after surgery. There were no such serious complications as bone nonunion, malunion, ischemic necrosis, cubitus valgus, or delayed ulnar nerve paralysis. At the last follow-up, the MEPS score was 97.5 (95.0, 100.0) points. The univariate analysis showed that surgical age ( P=0.087), Jacob type ( P=0.044) and Milch type ( P<0.001) were the risk factors for a triple fracture. The multivariate logistic regression analysis showed that Milch type Ⅰ was an independent risk factor for a triple fracture ( OR=25.764, 95% CI: 11.645 to 57.001, P<0.001). Conclusion:Milch type Ⅰ is an independent risk factor for a triple fracture of lateral condyle fracture of the humerus in children.

Objective:To study the application of scenario simulation teaching combined with modular training in nursing education of medical rescue in manned space flight.Methods:Twenty nurses from the medical rescue team of Strategic Support Force Characteristic Medical Center were selected as the research objects. The research objects were randomly divided into the scenario simulation combined with practical training group (practical training group, n=10) and traditional teaching group (control group, n=10). Scenario simulation teaching combined with modular training and traditional teaching were used to carry out nursing training. After the training, theoretical assessment, operation assessment and satisfaction survey were organized. Results:The scenario simulation teaching combined with modular training group was significantly better than the traditional training group in theory assessment, operation assessment and satisfaction survey of nursing staff (all P<0.05). Conclusions:Scenario simulation teaching combined with modular training has obvious teaching effect, which can improve the ability and quality of nursing staff, and help to complete the manned space medical rescue mission efficiently.

Objective:To compare the efficacy between metallic screw fixation and absorbable screw fixation after open reduction in the treatment of adolescent distal tibial epiphyseal fractures.Methods:A retrospective study was conducted to analyze the data of 82 patients with closed distal tibial epiphyseal fracture who had been admitted to Department of Pediatric Orthopedics, Shengjing Hospital Affiliated to China Medical University from January 2013 to December 2020. There were 61 males and 21 females (aged from 8 to 15 years), and 39 left sides and 43 right sides. The Salter-Harris classification: type Ⅱ in 25 cases, type Ⅲ in 8 cases, and type Ⅳ in 49 cases. They were divided into 2 groups according to different internal fixation methods. Group A (42 cases) was subjected to open reduction and metallic screw fixation and group B (40 cases) to open reduction and absorbable screw fixation. Preoperative data, operation time, total treatment cost and complications during follow-up were recorded and compared between the 2 groups. In both groups at the last follow-up, anteroposterior and lateral ankle radiographs were taken for radiographic evaluation of the injury to the distal tibial epiphysis and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was used to assess the ankle function.Results:The 2 groups were comparable because there were no significant differences in all their preoperative demographic data ( P>0.05). Group A was followed up for 18.0(16.0, 21.3) months while group B for 16.0(13.0, 20.0) months. The treatment cost for group A [27, 000 (25, 000, 33, 000) Yuan] was significantly higher than that for group B [23, 000 (19, 000, 27, 000) Yuan] ( P<0.05). The operation time was (112.4±34.3) min for group A and (101.0±41.1) min for group B, showing no significant difference ( P>0.05). The lateral distal tibial angle was 89.5 (88.0, 91.0)° on the affected side and 89.7°±1.8° on the unaffected sides in group A; it was 90.0 (88.3, 90.8)° on the affected side and 89.5°±1.8° on the unaffected side in group B. The anterior distal tibial angle was 81.9°±1.8° on the affected side and 81.8°±1.5° on the unaffected side in group A; it was 82.0 (81.0, 83.0)° on the affected side and 82.1°±2.2° on the unaffected side in group B. There was no significant difference in the above comparisons at the last follow-up in radiographic evaluation of the distal ankle joint between the affected and the unaffected sides in either group or between groups( P>0.05). There was a significant difference between the 2 groups in the rate of superficial skin infection [11.9% (5/42) versus 0% (0/40)] ( P<0.05), but there was no significant difference in the incidence of premature physeal closure between the 2 groups [11.9% (5/42) versus 5.0% (2/40)] ( P>0.05). The last follow-up revealed no significant difference in the AOFAS ankle-hindfoot score between group A [(90.6±4.9) points] and group B [(92.1±4.6) points] ( P>0.05). Conclusions:In the treatment of adolescent distal tibial epiphyseal fractures, compared with metallic screw fixation, absorbable screw fixation may lead to comparable efficacy in fixation, functional recovery and imaging evaluation, but no increased risk of premature physeal closure. Moreover, it spares the need for secondary surgical removal, and reduces operation time and treatment cost.

Objective:To review and summarize the main problems that have occurred in the history of manned spaceflight worldwide and the experience of the medical rescue support for astronauts at the main landing site since the first manned spaceflight mission of the Shenzhou-5 in China in 2003, focus on the technical status and return characteristics during the construction of the space station since the Shenzhou-12, and formulate a targeted injury treatment plan to ensure the safety of astronauts.Methods:This article summarized the lessons of accidental injuries of astronauts in foreign aerospace history, especially in the space station stage, combined with the experience of medical support of astronauts in manned spaceflight in China, and put forward a series of organizations, plans and treatments according to the mission characteristics of long-term orbits and adjustments of the main landing sites of space station mission spacecraft.Results:On the basis of the original pre-cabin emergency and helicopter ICU comprehensive rescue platform, the emergency procedures were further optimized, and the treatment plans under different complex terrains and the principles of rapid treatment and evacuation of astronauts were formulated.Conclusions:The effective treatment of astronauts returning from the space station in various situations could be ensured by the comprehensive rescue plan for the medical rescue of the space station mission and the construction and organization of the helicopter rescue platform.

Objective:This study aims to analyze the characteristics and basic principles of emergency surgery risks and anesthesia care of medical support at the landing site for China’s taikonauts of the Shenzhou-12, and to summarize China’s experience in medical support at the landing site for manned spaceflight, and ensure supports in special environments such as an emergency return of manned spaceflight.Methods:This study was carried out through literature research on relevant reports on the emergency surgery risks and aids of domestic and foreign astronauts at the landing sites, and summaries of the experience in medical support for taikonauts of spacecrafts from Shenzhou-5 to Shenzhou-11 at the landing sites. At the same time, according to the characteristics of Shenzhou-12 such as the long on-orbit time, the adjustment in the landing area, the optimization of the mission mode, and new search and rescue power, a series of organization, pre-arranged planning, equipment allocation, and effective anesthesia treatment plan were proposed and inspected in practice.Results:Based on the original anesthesia care plan of medical support, the first-aid carrier was adjusted and modified, the first-aid procedure was optimized, a new generation of supraglottic airway opening tool, video laryngoscope, portable ultrasound, and other devices were added, and the anesthesia care plan at the landing site for manned spaceflight was formulated to provide strong support for the medical care of taikonauts that had stayed in the outer space for a long time.Conclusions:Upon the targeted improvement and process optimization, the anesthesia care plan of medical support for taikonauts of Shenzhen-12 in the landing area fully meets the anesthesia requirement of medical support in special environments such as the emergency return of the taikonauts that have stayed in the outer space for a long time under the new orbital altitude.

Objective:To investigate the disease incidence of medical rescue teammates during medical security missions in the dry and hot areas of the Gobi Desert, and to explore its related influencing factors and solutions, so as to provide references for the establishment of a health maintenance system for medical rescue teammates in the Gobi Desert in summer.Methods:Fourteen medical rescue teammates during the medical support mission of the Shenzhou-12 spacecraft from May 2021 to June 2021 were selected as the research objects. A questionnaire survey was conducted and the data were analyzed.Results:During the mission, each teammate had suffered one or more kinds of diseases, mainly manifested in upper respiratory tract infection, dermatosis, systemic muscle soreness, diseases of ophthalmology and otorhinolaryngology, digestive system diseases and sleep disorders, with incidences of 20.3%, 20.3%, 18.5%, 18.5%, 12.9%, and 9.2%, respectively. Training or accidental injuries were mainly manifested as hand trauma, foot friction blisters, recurrence of joint synovitis, joint soft tissue injury, and accidental head injury, with incidences of 31.2%, 25%, 75%, 18.7%, and 6.2%, respectively. The recurrence rate was high in patients who previously suffered synovitis. There was a high possibility of secondary injury in patients who were suffered joint soft tissue trauma before.Conclusions:The incidence of certain diseases is high during the medical rescue support mission in the Gobi Desert. During the mission, the teammates should pay good attention to self-protection at all times, carry out targeted prevention and scientific training, and avoid non-combat attrition.

To analyze how the handover were effected by the conditions of manned spaceflight medical support mission through the practice of medical equipment and drugs in Shenzhou-12 and Shenzhou-13 manned spaceflight medical rescue support missions, this article discussed the preparation, organization and implementation in the handover of medical equipment and drugs in the changing of medical rescue teams, summarized the notices in the work of handover, and provided experience for the smooth handover of different manned spaceflight medical rescue teams in the future.

Objective:To summarize the nursing experience of medical rescue mission of Chinese manned spaceflight and space station astronauts returning to Dongfeng landing site, to analyze the characteristics of different mission stages of Shenzhou-12 manned spacecraft and Dongfeng landing site, and to take steps to implement effective medical rescue support of the space station missions.Methods:The relevant literature and reports at home and abroad were consulted, the nursing experience of previous medical rescue support tasks was summarized, and the corresponding clinical measures were put forward according to the orbit time of Shenzhou-12 and the complex terrain and climate of the main landing site.Results:Based on the existing experience, the rescue process had been further detailed, the emergency plan had been formulated, the clinical process in each plan had been refined, the clinical process in front of the cabin, in the carrier and in the evacuation process of nurses under different injury conditions had been formulated and improved, and the special training of nurses' own quality and nursing skills was carried out to improve the overall quality and combat ability of the nursing echelon.Conclusions:The improvement and refinement of clinical process in the medical rescue support task of the main landing site of Shenzhou-12 has provided a solid assurance for the successful completion of manned aerospace medical rescue support task.

Objective:To study the environmental characteristics of launch section during the space medical rescue mission of Shenzhou-13 spacecraft, evaluate the influence of special environment on peripheral veins, and investigate the coping strategies.Methods:Combined with the practice of launch section during space medical rescue mission of Shenzhou-13 spacecraft, the main factors of aerospace special environment, cold and faint light, were selected and the related literature was reviewed to explore the feasibility, advantages and disadvantages of peripheral venipuncture, central venous catheter and bone marrow puncture. The experience of the space medical rescue mission was summarized and the coping strategies were provided for follow-up task training.Results:The environmental characteristics of launch section during the space medical rescue mission of Shenzhou-13 spacecraft included cold, faint light, sand-wind and complex terrain. The vascular filling, vascular elasticity and visibility of peripheral vein decreased in different degrees under special environmental, the vascular visibility was most affected. The literature analysis showed that bone marrow puncture was a suitable method to establish infusion access in cold and faint light environment.Conclusions:The special environment of space launch mission has greater impact on peripheral veins. In order to assurance the successful implementation of manned space project, the training of basic operational skills should be consolidated, the training of ability in special environment should be enhanced and the advanced clinical auxiliary equipment should be equipped in follow-up space medical mission training.

Pancreatoduodenectomy (PD) is a very challenging operation in pancreatic surgery. Robotic surgery system has obvious advantages in precise operation. In specific patients, minimally invasive (laparoscopic and robotic surgery system) PD is less invasive than conventional open PD, showing good safety and feasibility. There are some differences between robotic surgery system and laparoscopic system in surgical field of vision, surgical operation and anastomosis mode. The authors review the relevant studies and conduct a Meta-analysis to evaluate the perioperative efficacy of robotic versus open approach for PD.