Objective To evaluate primary open reduction and wire-pin fixation for total dislocation of talus.Methods A retrospective study was conducted of the 12 patients who had been admitted into our hospital from October 2009 to December 2013 for total talar dislocation without fracture of the talar neck or body and had been available for complete follow-up.They were 10 males and 2 females.Their range of age was from 17 to 56 years (average,34.2 years).The total dislocation was open in 4 cases and close in 8.All of them underwent primary open reduction and wire-pin fixation.The functions of ankle joint and hindfoot were evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale.Results The follow-up time ranged from 22 to 72 months (average,35.6 months).Postoperatively,one case suffered skin necrosis and another superficial infection,both of whom responded to skin flap transferring after debridement.Traumatic arthritis of the talotibial or subtalar joint was found more or less in 7 cases,one of whom complained of severe pain but refused the subtalar arthrodesis advised.Their AOFAS scores at the final follow-up ranged from 42 to 96 points (average,72.2 points).Five cases developed avascular necrosis of the talus,but no talar collapse happened.Conclusions Primary open reduction and wire-pin fixation is effective for treatment of close total talar dislocation and open total dislocation of Gustilo type Ⅲ A or below.Although avascular necrosis and traumatic arthritis are common postoperative complications,satisfactory functions can be achieved if there is no collapse,severe pain or infection.

Objective:To examine the effect of anemia on the prognosis of elderly patients with acute coronary syndrome.Methods:We searched PubMed, Scopus, OVID, the Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure, China Biology Medicine Disc, the WanFang and Weipu databases for studies on the association between anemia and the prognosis of acute coronary syndrome in elderly patients.The date range included the period from the establishment of the database to December 10, 2022.Two reviewers independently completed the literature screening and data extraction according to the inclusion and exclusion criteria for the literature.Stata 16.0 software was used to analyze the data.Results:Of 1 399 references retrieved from the initial search, 13 met the inclusion criteria, including a total of 9540 patients with a mean age of 70.3 years.2872 of these patients had concurrent anemia and 6 668 patients had no anemia.In elderly patients with acute coronary syndrome, those with anemia showed significantly increased risk of death, compared with those with no anemia( RR=2.28, 95% CI: 1.74-3.00). Anemia also increased the incidence of ischemia( RR=1.36, 95% CI: 1.13-1.64)and bleeding events( RR=2.18, 95% CI: 1.59-3.01)( P<0.05 for all). Conclusions:Anemia significantly increases the risk of death and is associated with poor prognosis in elderly patients with acute coronary syndrome.

Objective:To evaluate the effectiveness of perioperative fasting abbreviation in traumatic patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery.Methods:The patients were selected for this prospective nonrandomized controlled study who had undergone selective surgery from June 2019 to June 2021 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. They were divided into an intervention group and a control group according to the wards where they stayed. The intervention group was fasted for solids from 0 o'clock on the surgery day and received oral solution with 6.25% maltodextrin which had been prepared by the nutritional department 3 hours prior to surgery. The control group was fasted for either liquids or solids from the midnight before surgery. All patients were evaluated according to the wake-up score and defensive reflex score after surgery. Once they were awakened, they were allowed slag-free drinks. Normal food was allowed if there was no discomfort after 2 hours. The 2 groups were compared in terms of basic information, actual preoperative fasting time, total amount of preoperative drinking, and postoperative time for initial drinking and eating. The perioperative subjective feelings (anxiety, thirst, hunger, nausea, fatigue, dizziness, sweating, stomach discomfort, etc.), grip strength and blood glucose were observed and compared between the 2 groups. Adverse reactions in the 2 groups were also observed.Results:A total of 135 patients were included, including 52 in the intervention group and 83 in the control group. The intervention group consisted of 22 males and 30 females aged from 30 to 84 years; the control group consisted of 39 males and 44 females aged from 29 to 81 years. There was no significant difference in the basic information between the 2 groups, showing comparability ( P>0.05). The intervention group had significantly shorter preoperative fasting time [3.5 (2.5, 6.3) h versus 12.0 (9.0, 16.0) h], significantly higher water intake before surgery [300 (200, 300) mL versus 100 (100, 200) mL], significantly shorter postoperative fasting time [0.08 (0, 1.25) h versus 2.00(0, 6.00) h], and significantly reduced time to return to normal diet [2.0 (2.0, 2.3) h versus 3.0(2.0, 6.0) h] than the control group (all P<0.05). The symptoms of anxiety, fatigue, sweating, and stomach discomfort in the intervention group were significantly fewer than those in the control group throughout the evaluation period. The thirst in the intervention group was significantly alleviated than that in the control group immediately after returning to the ward after surgery, and the dizziness and hunger were significantly alleviated than those in the control group when the patients left the ward to the operation room before surgery and immediately after returning to the ward. The symptom of nausea after returning to normal diet in the intervention group was significantly relieved compared with the control group. All the comparisons above showed statistically significant differences ( P<0.05). The blood glucose in the intervention group 2 hours after taking slag-free drinks was significantly higher than that in the control group ( Z=-2.108, P=0.035). There was no significant difference in the blood glucose between the 2 groups during other measurement periods ( P>0.05). There were no serious adverse reactions in either of the 2 groups. Conclusion:The protocol of perioperative fasting abbreviation may be safe and feasible for the patients with orthopaedic trauma and diabetes mellitus undergoing selective surgery, because it shows benefits of improving the patients' subjective feelings and stabilizing the blood glucose perioperatively.

In recent years, the incidence of hepatocellular carcinoma (HCC) has risen year by year, leading to a high mortality rate. At present, surgical treatment is the major cure for HCC, and in general, HCC is diagnosed at late stages. Due to the heterogeneity of HCC and different sensitivities to drugs, the treatment efficacy of advanced HCC is poor. In this paper, we retrospectively analyzed the prog-ress of HCC treatments and reviewed important progression, which provides new view for the clinical improvement of the total surviv-al of patients with HCC.