Objective To explore the short-term clinical outcomes of ankle arthrodesis for the treatment of posttraumatic ankle arthritis.Methods Retrospectively study the data of 47 patients with posttraumatic ankle arthritis who were followed up after receiving ankle arthrodesis from January 2008 to May 2012.There were 28 males and 19 females,with an average age of 44 years (range,14-72 years).All of them wereclassified into stage-3 arthritis according to Morrey-Wiedeman,among whom 31 had obvious foot varus deformity or equines deformity,and 16 were almost normal in appearance.The ankle joint function of patients were assessed by Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score,Maryland foot score systems and visual analog scale (VAS) preoperatively and at the last follow-up.Results The patients were followed up from 5 to 52 months (average,25 months).All the ankles got fused at the last follow-up,with one receiving removal of internal fixation and debride because of infection.Forty-three patients were satisfied with or without reservations; the others thought it so.The satisfaction rate was 91.5％(43/47).The Kofoed,AOFAS,Maryland foot scores and VAS were significantly improved from 48.11 ±5.00,53.38±5.52,49.74±5.71,7.89±0.87 to 80.96±6.07,82.21±4.26,88.94±5.14,2.28±1.10 respectively at the last follow-up.The normotopia X-ray of ankle joint showed that there were 22 cases in which the ankle got fused at neutral position,19 cases in which the eversion was less than 5°,3 cases in which the eversion was between 5° to 10°,2 cases in which the varus was less than 5°,and 1 case in which the varus was between 5° to 10°.Lateral X-ray showed that there were 32 cases in which the ankle got fused in dorsiflexion neutral position,12 cases plantar flexion 5°,and 3 cases plantar flexion 5° to 10°.Conclusion Ankle arthrodesis is still the preferable surgical treatnent option in patients with end-stage ankle arthritis,which shows high reliability and effectively in correcting deformity,pain relieving and function improvement.

Objective To investigate the xenotransplantation model of fetal pig skin precursor tissue and its development after transplantaion. Methods Porcine skin precursor tissue was obtained from the embryo of gestation day 56 (E56), and made into microskin or stamp skin graft. The microskin was transplanted to the dorsal wound in BALB/c nude mice, then covered with human corpse skin. The stamp skin graft was imbedded subcutaneously into the back of nude mice, and microskin was injected subcutaneously into the auricles of nude mice. Their growth and development were observed and they were examined by HE staining at 6th and 12th week after transplantation respectively. Two-sample t test was used to analyze the size of newly grown skin tissue. Results Porcine skin precursor tissue graft in three models above survived and continued growth after transplantation, and growth ability of the dorsal wound transplantation model was significantly stronger than that of the auricle model. Epidermis and hypodermis were detected in newly grown skin tissues. Hair follicles, a few of sebaceous glands, but no sweat glands were observed in auricle model, while many sebaceous glands and sweat glands were observed in the dorsal wound model. Conclusion Transplantation of microskin to dorsal wound is the optimal model of investigating the xenotransplantation of fetal pig skin precursor tissue and its development after transplantion.

OBJECTIVE:To investigate the inhibitory effect of siRNA expression vector inhibiting human insulin-like growth factor 2(IGF2)gene on the proliferation of hepatoma cell line Huh-7. METHODS:siRNA expression vector pGL3-hAFP-hTERT-siRNA3(“siRNA3”)which inhibited IGF2 gene by dual promoter regulation of recombinant human alpha-foetoprotein(hAFP)and human telomerase reverse transcriptase(hTERT)was transfected into the Huh-7 cell and normal hepatocyte L-02,and then a nega-tive control group(vector pGL3-hAFP-hTERT)and a blank control group were set up. IGF2 mRNA expression was detected by re-al-time fluorescent quantitative polymerase chain reaction 48 h after transfection into the cells in all groups;the activity of the cells by the microplate reader 0,24,48 and 72 h thereafter;and the cell cycle and apoptosis by the flow cytometer 48 h thereafter,and the changes in the protein levels of IGF2,PCNA,Cyclin E2,Cyclin D2,Cdc2 and Bcl-2 in the cell were detected by Western blot. RESULTS:Compared with the negative control group and blank control group,IGF2 mRNA expression in the Huh-7 cell transfected with siRNA3 was obviously weaker;at 48 and 72 h after transfection,the activity of Huh-7 cell signigicantly reduced, Huh-7 cells at G1 phase obviously increased and those at S phase markedly decreased;the occurrence of early,late and total apopto-sis in Huh-7 cells apparently increased,and the protein expression of IGF2,PCNA,Cyclin E2,Cyclin D2,Cdc2 and Bcl-2 in cells significantly weakened,with statistically significance(P<0.01 or P<0.05). No obvious change in the above-mentioned index-es could be found in L-02 cells transfected with siRNA3 expression vector (P>0.05). CONCLUSIONS:siRNA which inhibited IGF2 gene by dual promoter regulation of recombinant hAFP and hTERT can specially inhibit IGF2 gene expression and the prolifer-ation of Huh-7 cells,which may be involved with down-regulated protein expression of cell proliferation-associated gene PCNA, cell cycle control-associated genes Cyclin E2,Cyclin D2 and Cdc2 and apoptosis regulation-associated gene Bcl-2 as a result of down-regulated IGF2 mRNA expression and protein expres-sion.

Objective To explore the clinical results of total ankle replacements with the Scandinavian Total Ankle Replacement (STAR) prosthesis for end-stage ankle arthritis.Methods Data of 73 cases with end-stage ankle arthritis who received Scandinavian total ankle replacement from January 2005 to May 2013 were retrospectively analyzed.They were 34 males and 39 females,with an average age of 59.6 years old (range,37-76 years old),average body mass index (BMI) of 25.3 kg/m2 (range,21.8-28.0 kg/m2).All patients were classified into stage-3 arthritis according to Morrey-Wiedeman.Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analog scale (VAS) were used to evaluate the function of foot and ankle.Patients with a hindfoot deformity below 10° were compared with those who above 10°;and patients above 55 years old were compared with those who below it.Results 5 replacement failed (2 liner ruptured and received replacement;2 metal components displaced,1 received TTC fusion and the other underwent revision with inferior tibiofibular joint fusion,the last patient suffered from deep infection and received the STAR removal and secondary fusion) in 73,and the rest were followed up for 12 to 110 months (average,55.2 months).59 patients were satisfied with or without reservations.The satisfaction rate was 80.8％ (59/73).The pre-op values of AOFAS,Kofoed,VAS and range of motion (ROM) were 46.6±3.5,43.0±4.7,8.7±0.7,34.4°±7.1° and the post-op values were 86.6±4.3,82.6±4.6,3.0±1.0,45.1°±8.2° respectively,and all were significantly improved compared with before.The AOFAS,AOFAS Function and ROM values of patients below 55 years old were 86.1±3.8,47.0±2.7,45.7°±7.0°,and the same values of patients above 55 were 86.7±4.6,46.8±3.1,44.9°±8.8°.The AOFAS,AOFAS Function and ROM values of patients with above 10° coronal deformity were 86.1±4.7,47.0±2.7,43.0°±7.7°,and the same values of patients below 10° were 86.8±4.2,46.8±3.1,46.1°±8.2°.There was no difference between the groups.Conclusion The STAR is the preferable surgical treatment option in patients with end-stage ankle arthritis,showing high reliability and effectivity in pain relieving and function improvement.

Objective:To evaluate the radiologic and clinical outcomes of supramalleolar dome osteotomy in the treatment of varus-type ankle arthritis.Methods:From June 2018 to December 2019, 13 patients with varus-type ankle arthritis underwent supramalleolar dome osteotomy at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. Of them, 13 (5 males and 8 females) were included in the study. Their average age at surgery was 47.2 years (range, from 16 to 65 years). By the modified Takakura staging for arthritis, 3 cases were stage 2, 4 cases stage 3a and 6 cases stage 3b. Comparisons were made between preoperation and the last follow-up in ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS), foot function index (FFI), visual analogue scale (VAS), Takakura staging, dorsal extension, plantar flexion, range of motion (ROM), tibial anterior surface angle (TAS), tibial lateral surface angle (TLS), and talar tilt (TT).Results:This cohort were followed up for 12 to 29 months (average, 17.2 months). At the last follow-up, AOFAS score (86.5±8.0), FFI (14.5±1.6), VAS score (1.5±1.0), Takakura staging (2.7±1.3), ROM (39.4°±8.0°), TAS (92.4°±6.0°), TT (3.7°±4.4°) were significantly improved than the preoperative values (68.3±14.4, 43.7±3.0, 4.2±1.4, 3.2±0.8, 43.3°±7.6°, 78.2°±8.3° and 7.0°±5.1°), and dorsal extension (10.9°±4.4°) was significantly smaller than the preoperative value (13.6°±5.1°) (all P<0.05). There were no significant differences between preoperation and the last follow-up in plantar flexion (29.7°±4.6° versus 28.5°±5.2°) or TLS (77.8°±4.5° versus 78.1°±5.3°) ( P>0.05). Conclusions:Supramalleolar dome osteotomy has shown promising short-term clinical efficacy in the treatment of varus-type ankle arthritis. It can significantly relieve pain, improve function, substantially correct deformity and retard progression of arthritis, but it may affect dorsal extension.

Objective To establish the background information of physiological parameters for germ?free ( GF ) Taihu piglets. Methods In this study we selected 25 days old GF Taihu piglets and 4 conventional ( CV) littermates, the male and female ratio was 1∶3, to measure the normal clinical values of hematology and serum biochemistry, immunoglobu?lin concentration and main organ coefficients. The analysis of relative growths of main organ weight to body weight was con?ducted in the Taihu GF and CV pigs by allometric scaling model. Results (1) Twelve hematological parameters and 8 blood biochemical parameters in the GF piglets were significantly lower than those in CV pigs (P<0?05). (2) The aver?age body weight, IgM concentration of GF pigs and CV pigs had significant difference ( P <0?05 ) , and no mesenteric lymph nodes were found in the GF pigs. (3) The gut weight had the largest allometric association with body weight in the GF pigs, while spleen weight has the largest allometric association with body weight in the CV pigs. Both the weight of heart and stomach in CV and GF pigs had a negative allometric association with body weight (allometric coefficient b<1), respectively. Conclusions Different microbe control grades affect the body weight, hematology and serum biochemistry, expression of immunoglobulin and development of main organs in laboratory pigs.

Objective To analyze the associations of age and gender with post-operative outcomes after pilon fracture and the effect of interaction between age and gender on the outcomes.Methods A retrospective cohort study was performed of the 101 successive patients with pilon fracture who had been treated by open reduction and internal fixation from March 2009 to November 2013 and completely followed up.The distributions of potential prognostic factors (diabetes,injury mechanism,open fracture,Rüedi-Allg(o)wer classification and AO classification) were analyzed in different age and gender groups.The outcomes were evaluated in terms of reduction quality by the Burwell-Charnley criteria,time for return to work,traumatic osteoarthritis by Kellgren-Lawrence grading scale and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.The odds ratio and regression coefficients were estimated by Logistic regression and linear regression model;P values for interaction between age and gender were estimated by likelihood ratio tests.Results Of all the 101 pilon patients,84 were male and 12 were the aged.The distributions of gender (P =0.028) and mechanism (P =0.032) were significantly different between the aged and the younger patients,showing there were more females in the aged patients and low-energy injury was more likely to cause a pilon fracture in the aged patients.As multivariate analyses suggested,with the above influencing factors controlled,a median follow-up of 41.2 months revealed age was an independent favorable prognostic factor for reduction quality (OR =3.919,P =0.041).The association between gender and time for return to work was significantly different between the aged and the younger patients,as indicated by interaction analyses (P =0.030).Conclusions There may be more females in the aged patients with pilon fracture than in the younger ones.It is likely that the aged patients sustain a pilon fracture because of low-energy injury and achieve a fracture reduction of poorer quality.Although the quality of reduction may be poorer for the aged,there may be no significant difference between the aged and the younger patients in the mid-long-term AOFAS score.It is advisable for surgeons to provide personalized treatment to better help the patients.

Objective:To analyze the relationship between health belief and the stages of parental decision-making on childhood 13-valent pneumococcal conjugate vaccine (PCV13) immunization in China.Methods:Cross-sectional multistage survey sampling method was used to select study subjects. The study subjects were parents who were aged 20-45 years and had one and more children ≤5 years old in three cities in China. A self-administered questionnaire designed based on health belief model was used to collect the information. Multinomial logistic regression analysis was used to assess the relationships between perceived susceptibility, perceived severity of illness, perceived effect of PCV13 and stages of parental decision-making on childhood PCV13 immunization.Results:A total of 1 716 valid questionnaires were returned (89.33%). The average age of the study subjects was (35.33±4.95) years, and 79.60% of them were women. In the study subjects, 48.31% had in action, 21.79% were in contemplation and 29.90% were in pre-contemplation. The multinominal logistic regression analysis indicated that high perceived susceptibility ( OR=0.14, 95% CI:0.09-0.22; OR=0.54, 95% CI:0.39-0.76), high perceived severity of illness ( OR=0.55, 95% CI:0.42-0.73), and high perceived effect of PCV13 ( OR=0.27, 95% CI:0.18-0.40; OR=0.51, 95% CI:0.32-0.81) were significantly lower in those who were in contemplation or pre-compared with those who had in action. For study subjects with low perceived susceptibility, high perceived effect of PCV13 might decrease the probabilities of contemplation ( OR=0.53, 95% CI:0.32-0.87) and pre-contemplation ( OR=0.27, 95% CI:0.18-0.41). For those with high perceived susceptibility, perceived severity of illness might decrease the probability of contemplation ( OR=0.43, 95% CI:0.23-0.82). Conclusions:Childhood PCV13 vaccination willingness and level is low in China. It is important to pay greater attention to the intervention on health belief in child parents, such as perceived effect of PCV13, perceived severity of illness, and perceived susceptibility, in health policy development and health promotion.

Objective: To explore the morphological characteristics and differences of posterior malleolus fracture fragments in ankle fracture combined with posterior malleolus fracture and spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture, and to analyze the relationship between the posterior malleolus fracture fragments and the above two types of fracture injury. Methods: A retrospective analysis was performed. One hundred patients with ankle fracture were admitted to Beijing Jishuitan Hospital from January 2011 to December 2011, including 59 males and 41 females, aged (42.0±14.1) years, with an age range of 17-73 years. Among them, 57 patients who were ankle fracture combined with posterior malleolus fracture were in Group A. Meanwhile, 90 patients with spiral fracture of middle and lower third of tibial were admitted to Beijing Jishuitan Hospital from January 2013 to December 2013, including 42 males and 48 females, aged (45.2±13.0) years, with an age range of 18-77 years. Among them, 35 patients who were spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture were in group B. A total of 92 patients in the two groups were examined by CT before operation. The patient′s fracture classification was determined according to Haraguchi classification. On axial plane, the angle between posterior malleolus fracture line and medial and lateral malleolus axis was defined as Ⅰa in Haraguchi Ⅰ, angles between posterior malleolus fracture line and medial and lateral malleolus axis were defined as Ⅱa and Ⅱb in Haraguchi Ⅱ, and angle Ⅰc and Ⅱc were angles between posterior malleolus fracture line and tibial axis on sagittal CT. Measurement data were expressed as mean±standard deviation (Mean±SD). Mann-whitney and Chi-square test were used to compare the differences of different angles in type I and type Ⅱ, and whether there were statistical differences in different angles between the two groups. Results: In the 92 cases, 75 were type Ⅰ, 12 were type Ⅱ and 5 were type Ⅲ. The angle of Ⅰa was (26.6±5.6)°, the angle of Ⅰc was (15.4±4.1)°, the angle of type Ⅱa was (22.1±3.3)°, and the angle of Ⅱc was (16.4±5.4)°. The difference between Ⅰa and Ⅱa data was statistically significant (P=0.003), but there was no significant difference between Ⅰc and Ⅱc(P=0.667). In group A and group B, the angle of Ⅰa was (26.6±5.9)°and (26.6±5.1)°, the angle of Ⅰc was (15.7±4.2)°and (14.9±3.9)°, the angle of Ⅱa was (22.0±3.0)°and (22.2±4.3)°, the angle of Ⅱb was (45.4±9.0)°and (46.5±10.0)°, the angle of Ⅱc was (17.0±5.4)°and (15.3±6.2)°, respectively. There were no significant differences in the angles of Ⅰa, Ⅰc, Ⅱa, Ⅱb and Ⅱc between the two groups (P values were 0.862, 0.387, 1.000, 0.932 and 0.444, respectively). Conclusion The posterior malleolar fragments is not associated with fracture type of ankle fracture combined with posterior malleolus frature and the spiral fracture of middle and lower third of tibial combined with posterior malleolus fracture.

Objective:To explore the short- and mid-term clinical outcomes of surgical treatment of chronic Lisfranc injuries.Methods:A retrospective analysis was conducted of the clinical and imaging data of the 19 patients with chronic Lisfranc injury who had been treated surgically from April 2013 to September 2020 at Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital. There were 13 males and 6 females, aged from 25 to 58 years (mean, 49 years). The median course of disease before operation was 24 months (from 3 to 312 months). All patients underwent fusion of the 1st, 2nd and 3rd tarsometatarsal joints (TMTJ) plus reduction and fixation or arthroplasty of the 4th and 5th TMTJ by the same surgeon. The clinical outcomes were evaluated by comparison of the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS) and Lublin score between pre-operation and the final follow-up and by Likert satisfaction scale and post-operative complications as well.Results:The 19 patients were followed up for (66.1±23.2) months (from 12 to 104 months). At the final follow-up, the AOFAS midfoot score was 87 (79, 90), the VAS score 1 (0, 2), and the Lublin score 70 (60, 75), all significantly improved compared with their preoperative corresponding values [51 (44, 63), 4 (4, 6) and 50 (40, 55), respectively] ( P<0.05). Sixteen patients were satisfied with their surgery. Fusion was not healed in 3 cases; plate breakage happened in one case but none of the cases had infection or other complications related to the skin or wound. Conclusion:Fusion of the 1st, 2nd and 3rd TMTJ plus reduction and fixation or arthroplasty of the 4th and 5th TMTJ can lead to good short- and mid-term clinical outcomes in the surgical treatment of chronic Lisfranc injuries.