Objective:To investigate the pathogenesis and clinical efficacy of arthroscopic treatment for hallux ganglion cyst deriving from ankle joint.Methods:The clinical data of 21 patients with ankle arthroscopic in the Department of Hand and Foot Surgery,Affiliated Hospital of Jining Medical College from January 2019 to March 2021 were analyzed retrospectively.There were 15 male cases and 6 female cases,aged (52.6±8.2) years (range:42 to 70 years).There were 9 cases of primary operation and 12 cases of recurrence after operation in other hospital.All the patients were examined by ankle arthrography and MRI before operation.The synovial membrane of the ankle was debrided and the tendon sheath of flexor longus was removed at the ankle canal.One year after operation,MRI was performed,and the American Orthopedic Foot and Ankle Society(AOFAS) score of forefoot function and visual analogue scale (VAS) before and after operation were compared by the paired t test or Mann-Whitney U test.The postoperative complications and recurrence were recorded. Results:All patients were operated successfully.The joint capsule at the back of the ankle joint of the patients were ruptured and communicated with the tendon sheath of the flexor longus tendon at the ankle canal.No wound infection,vascular and nerve injury occurred.The follow-up period was (15.0±2.2) months (range:12 to 18 months).During the follow-up period,there was no recurrence of toe appearance and MRI.At the last follow-up,the AOFAS score (90.8±4.3) was significantly higher than that before operation (72.8±6.3) ( t=-10.810, P<0.01),and the VAS score( M(IQR)) was significantly lower than that before operation,the difference was significant (1.0(1.0) vs. 3.0(0.5), Z=-4.081, P<0.01). Conclusions:The possible mechanism of hallux ganglion cyst deriving from ankle joint is that the joint capsule at the back of the ankle joint ruptures and communicates with the tendon sheath of the flexor longus tendon at the ankle canal,and the intra-articular synovial fluid through the cylinder effect generated by sliding with the flexor tendon of the flexor longus tendon in the tendon sheath sac leads to the heel valange cyst.Ankle-synovial cleansing of the ankle joint under ankle arthroscopy and resection of the flexor tendon sheath of the flexor longus tendon at the ankle canal are effective and less invasive.

Objective:To investigate the pathogenesis and clinical efficacy of arthroscopic treatment for hallux ganglion cyst deriving from ankle joint.Methods:The clinical data of 21 patients with ankle arthroscopic in the Department of Hand and Foot Surgery,Affiliated Hospital of Jining Medical College from January 2019 to March 2021 were analyzed retrospectively.There were 15 male cases and 6 female cases,aged (52.6±8.2) years (range:42 to 70 years).There were 9 cases of primary operation and 12 cases of recurrence after operation in other hospital.All the patients were examined by ankle arthrography and MRI before operation.The synovial membrane of the ankle was debrided and the tendon sheath of flexor longus was removed at the ankle canal.One year after operation,MRI was performed,and the American Orthopedic Foot and Ankle Society(AOFAS) score of forefoot function and visual analogue scale (VAS) before and after operation were compared by the paired t test or Mann-Whitney U test.The postoperative complications and recurrence were recorded. Results:All patients were operated successfully.The joint capsule at the back of the ankle joint of the patients were ruptured and communicated with the tendon sheath of the flexor longus tendon at the ankle canal.No wound infection,vascular and nerve injury occurred.The follow-up period was (15.0±2.2) months (range:12 to 18 months).During the follow-up period,there was no recurrence of toe appearance and MRI.At the last follow-up,the AOFAS score (90.8±4.3) was significantly higher than that before operation (72.8±6.3) ( t=-10.810, P<0.01),and the VAS score( M(IQR)) was significantly lower than that before operation,the difference was significant (1.0(1.0) vs. 3.0(0.5), Z=-4.081, P<0.01). Conclusions:The possible mechanism of hallux ganglion cyst deriving from ankle joint is that the joint capsule at the back of the ankle joint ruptures and communicates with the tendon sheath of the flexor longus tendon at the ankle canal,and the intra-articular synovial fluid through the cylinder effect generated by sliding with the flexor tendon of the flexor longus tendon in the tendon sheath sac leads to the heel valange cyst.Ankle-synovial cleansing of the ankle joint under ankle arthroscopy and resection of the flexor tendon sheath of the flexor longus tendon at the ankle canal are effective and less invasive.

Primary hypomagnesemia with secondary hypocalcemia(HSH) is a rare cause of hypoparathyroidism. This article presents a case of a 26-year-old male with recurrent generalized weakness and tetany, and a literature review of diagnosis and treatment of primary HSH. The biochemical tests revealed the patient had severe hypomagnesemia, mild hypocalcemia, hypokalemia, and hypoparathyroidism. Transient receptor potential melastatin-6(TRPM6) gene mutation were detected by gene test, which confirmed the diagnosis of primary HSH. The patient had been treated with long term oral magnesium supplementation, who remained asymptomatic during the follow-up. Primary HSH is a rare autosomal-recessive disorder caused by mutations in the TRPM6 gene which encoding a magnesium permeable channel expressed in the intestine and the kidney. The primary defect is impaired intestinal absorption of magnesium with secondary renal excretion, leading to a series of clinical symptoms. The treatment is mainly through lifelong magnesium supplementation.

Syndrome of resistance to thyroid hormone(RTH)is a rare hereditary thyroid disease with various clinical manifestations and laboratory findings. RTH could be misdiagnosed and mistreated, resulting in aggravation of the disease. We reviewed the medical records of a patient with RTH over the past six years. In addition, we provided a summary of latest progress for RTH to help the clinicians to improve the understanding of the disease.

Aldosterone-producing adrenocortical carcinoma (ACC) is a rare endocrine malignancy. Only a few cases are reported in China. This systematic review investigated the diagnosis and treatment strategy of aldosterone-producing ACC through a recent case of the disease. A case of a 49-year-old female who diagnosed with aldosterone-producing ACC by hormonal assays, medical imaging and pathology. Her condition has been alleviated after surgery. Aldosterone-producing ACC is a rare malignancy with limited treatment options and surgery is the primary treatment strategy.

Objective To investigate the features of lipid ratios in patients with newly diagnosed T2DM, and the effects of intensive insulin treatment on them. Methods 90 patients with newly diagnosed T2DM and 58 matched people with normal glucose were enrolled to assess height,weight,waist circumference,blood glucose and lipid profiles. BMI,TC/HDL-C,TG/HDL-C,log(TG/HDL-C),LDL-C/HDL-C,HOMA-B and HOMA-IR were calculated respectively. All the patients received the continuous subcutaneous insulin infusion with insulin pump. The treatment continued for more 10~14 days after blood glucose reached the standard. All the above indi-cators were reexamined after treatment. Results Dyslipidemia in patients with newly diagnosed T2DM mainly showed as hypertriglyceridemia and decreased HDL-C compared to the control group(P<0.05). TC/HDL-C,TG/HDL-C,log(TG/HDL-C)and LDL-C/HDL-C significantly increased in these patients(P<0.01). After short-term intensive insulin therapy,all lipid ratios were significantly decreased and the changes of lipid ratios were positively correlated with the change of HOMA-IR(P<0.05). Conclusion Short-term intensive insulin therapy for patients with newly diagnosed type 2 diabetes can significantly lower the lipid ratios related to HDL-C. The effects may be closely related to improvement of insulin resistance.

Objective To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM).Methods This was a 26-week,randomized,open-label,parallel-group,treat-to-target trial in 560 Chinese subjects with T2DM (men/women:274/263,mean age 56 years,mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs).Subjects were randomized 2:1 to once-daily IDeg (373 subjects) or IGlar(187 subjects),both in combination with metformin.The primary endpoint was changes from baseline in glycosylated hemoglobin(HbA1c) after 26 weeks.Results Mean HbA1c decreased from 8.2％ in both groups to 6.9％ in IDeg and 7.0％ in IGlar,respectively.Estimated treatment difference (ETD) of IDegIGlar in change from baseline was-0.10％ points (95％ CI-0.25-0.05).The proportion of subjects achieving HbA1c ＜ 7.0％ was 56.3％ and 49.7％ with IDeg and IGlar,respectively [estimated odds ratio of IDeg/IGlar:1.26 (95 ％ CI 0.88-1.82)].Numerically lower rateof overall confirmed hypoglycaemia and statistically significantly lower nocturnal confirmed hypoglycemia were associated with IDeg compared with IGlar,respectively [estimated rateratio of IDeg/IGlar 0.69 (95％ CI 0.46-1.03),and 0.43 (95％ CI 0.19-0.97)].No differences in other safety parameters were found between the two groups.Conclusions IDeg was non-inferior to IGlar in terms of glycaemic control,and was associated with a statistically significantly lower rate of nocturnal confirmed hypoglycaemia.IDeg is considered to be suitable for initiating insulin therapy in Chinese T2DM patients on OADs requiring intensified treatment.Clinical trail registration Clinicaltrials.gov,NCT01849289.

[Summary] The aim of the study was to explore the effect and its clinical relevance of short -term intensive insulin treatment on plasma concentrations of lipoprotein-associated phospholipase A 2 ( Lp-PLA2 ) and secretory phospholipase A2(sPLA2) in newly diagnosed type 2 diabetes mellitus (T2DM).Ninety newly diagnosed T2DM patients were recruited and received continuous subcutaneous insulin infusion (CSII) for about 2 weeks.After CSII, sPLA2 levels [173.78 (80.95, 278.09) μg/L] were significantly decreased compared with the levels before [219.33 (130.03, 337.30) μg/L], P <0.01, while no statistic significant changes could be viewed in Lp-PLA2 levels.Correlation analysis showed that the changes of Lp-PLA2 and sPLA2 were both positively correlated with the changes of homeostasis model assessment of insulin resistance(HOMA-IR)after CSII (r=0.537,0.493 respectively, all P<0.05).The Lp-PLA2 and sPLA2 level reduction after CSII might help to protect the patients from diabetic macroangiopathy . Trial registration Chinese Clinical Trial Registry , ChiCTR-TRC-10001618.

_ Objective_ To evaluate plasma concentrations of lipoprotein-associated phospholipase A2 (LP-PLA2)andsecretoryphospholipaseA2(sPLA2)inpatientswithnewlydiagnosedtype2diabetes,andtoexplore their clinical significance. Methods Oral glucose tolerance test ( OGTT) was carried out in our hospital to all the subjects without history of diabetes. According to the results of OGTT, they were divided into two groups:patients with newly diagnosed type 2 diabetes and subjects with normal fasting glucose and normal glucose tolerance. Anthropometric data such as height, weight, waist circumference, and blood pressure were measured and concentrations of blood glucose, insulin, lipid profile ( including total cholesterol, triglycerides, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol), LP-PLA2, and sPLA2 were determined in both groups. Results Ninety patients with newly diagnosed type 2 diabetes and fifty-eight subjects with normal glucose tolerance were enrolled in our study. As to gender, age, body mass index, blood pressure, and lipid profile, there were no statistically differences between these two groups (P>0. 05). Plasma levels of LP-PLA2 and sPLA2 in diabetic patients were significantly higher than normoglycemic participants [102. 98(76. 34,134. 31) vs 50. 89(23. 71,90. 40) ng/ml, 219. 33 (130. 03,337. 330) vs 78. 55 (75. 15,87. 02) ng/ml, both P<0. 01]. Plasma concentrations of LP-PLA2 and sPLA2 in diabetic patients with atherosclerosis were significantly higher than those without [ 133. 43 ( 111. 54, 145. 17 ) vs 99. 11 ( 63. 02, 130. 85) ng/ml,235. 73 (180. 48, 416. 46) vs 182. 97 (9. 08, 280. 79) ng/ml, both P<0. 05]. LP-PLA2 and sPLA2 were both positively correlated with homeostasis model assessment for insulin resistance (HOMA-IR), while negatively correlated with insulin function index. In a multiple linear regression analysis, LP-PLA2 and sPLA2 were independent correlative factors of HOMA-IR(both P<0. 05). Conclusions Plasma levels of LP-PLA2 and sPLA2 were significantly higher in patients with newly diagnosed type 2 diabetes than in individuals with normal glucose tolerance, even more significant in diabetic patients with atherosclerosis. And their concentrations were both closely related to insulin resistance.

To discuss the relationship between dietary glycemic load (GL) and blood glucose and lipid,201 patients with newly-diagnosed type 2 diabetes and 126 subjects with normal glucose tolerance were enrolled,who were all above 40 years old and permanently lived in communities of Guangzhou.GL,blood glucose and lipid were assessed based on 3-d dietary records.The results showed that the level of dietary glycemic load in diabetic patients was significantly higher than control group (169.61 ± 44.83 vs 157.50 ± 38.47,P＜0.05).Correlation analysis showed that dietary GL was positively correlated with body mass index and HbA1C,and negatively correlated with HDL-C in diabetic patients (all P＜0.05).Adjusted for age and sex by multiple regression,the result was the same.Therefore,dietary with high level of GL may be associated with the occurrence of type 2 diabetes,and is closely related to glucose control and blood lipid metabolism suggesting the necessity to control the level of dietary GL in the nutritional therapy for diabetic patients.