Objective To retrospectively analyze management of chronic lateral ankle instability and evaluate its clinical results. Methods There were 74 patients including 43 males and 31 females at age range of 15-63 years (mean 39 years). All patients had at least half year of disease history, more than twice repeated strains and over six weeks of conservative management. Of all, 41 patients were trea-ted with surgical operations including modified Brostrom in 12 patients, Myerson in eight and Chrisman-Snook in 21. The aasoeiated pathological problems should be treated at the same time, ie, tenedesis for the peroneal tendon subluxations in six patients, Achilles tendon lengthening in nine, lateral shift of cal-caneal osteotomies in eight and clearance and holes-making for the osteochondral lesions in 13. Results Of all, functional instability was alleviated in 21 patients through conservative treatment before surgery. Of 53 patients with either functional or mechanical instability, 10 patients showed symptomatic relief, two refused surgical operation and the remained 41 patients were treated surgically. Thirty-nine patients trea-ted surgically and 28 treated conservatively were followed up for 6-91 months. The Roos Functional Out-come Score was used for validating the results. The average value of the ankle functional outcome was 86.24 and 97.34 respectively following operation and conservative management. Conclusions The full examination is needed to remove any possible pathological factors for the patients with chronic lateral ankle instability. The surgical operation can obtain satisfactory functional recovery of the ankle if the conserva-tive management is failed.

Objective To study if β-elemene can increase radiation-induced deoxyribonucleic acid (DNA) damage and decrease the damage repair.Methods Exponentially growing human lung adenocarcinoma cells (A549) were exposed to 10 or 20 μg/ml β-elemene for 24 h before irradiation.The effect of β-elemene on the in vitro radiosensitivity of A549 cells was evaluated using clonogenic assay.DNA damage and repair were evaluated using comet assay.Results Exposure to β-elemene before irradiation increased the radiosensitivity of A549 cells.The SERD0 for 10 μg/ml and 20 μg/ml β-elemene was 1.55 and 1.64, respectively.The SERDq for 10 μg/ml and 20 μg/ml β-elemene was 1.43 and 1.75, respectively.Combined treatment, comparing to irradiation or β-elemene treatment alone, induced higher levels of DNA damage and slower rate of damage repair.A549 cells exposed to 20 μg/ml β-elemene followed by irradiation showed a higher levels of tail moment (TM) than those exposed to irradiation or β-elemene alone at 0 h,2 h,6 h and 24 h after irradiation.The TM of the three groups at 0 h,2 h,6 h and 24 h after irradiation was 7.16±2.61,0.95±0.65 and 1.81±1.23(F=231.24,P<0.01), 3.65±2.06,0.11±0.07 and 1.58±1.40(F=90.22,P<0.01), 2.09±0.83,0.1±0.05 and 0.45±0.25(F=238.44,P<0.01), 1.45±1.37,0.11±0.08 and 0.60±0.40(F=38.94,P<0.01), respectively. Conclusions β-elemene can enhance the radiosensitivity of A549 cells through the enhancement of DNA damage and the inhibition of DNA damage repair.

Objective To evaluate the efficacy of arthroscopic debridement combined with microfracture on management of chronic enthesiopathy of Achilles tendon.Methods Fifteen cases of chronic enthesiopathy of Achilles tendon were enrolled in this study from January 2013 to January 2016.There were 11 males and 4 females,with an average age of 55.5±8.9 years.Five were in left side,and 10 in right side.All the patients failed to recover after conservative treatments for 18 months to 10 years.Pathological tissue was eliminated by blade.Then microfracture was made.Arthroscopic awls (1.5 or 2 mm in diameter) were used for making multiple holes at the footprint of achilles tendon.These holes were made far enough (3-4 mm) apart so they do not break into each other.Fat droplets and bleeding from the marrow cavity were seen when the appropriate depth (approximately 5 to 10 mm) has been reached.The patients were evaluated preoperatively and postoperatively using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores and visual analogue scale (VAS) scores.Results Average operation time and length of stay were 30.6± 15.4 min and 6.2±2.8 d,respectively.Postoperative incisions were Ⅰ stage healing for all patients.There were no perioperative and postoperative complications related to the procedure,such as rupture of achilles tendon,blood vessel and nerve injury.No infection and recurrence was found in all cases.All patients were followed up for an average time of 13.5 months.No rupture of achilles tendon or relapsing symptom was found.Average VAS scores before surgery,6 month after surgery and at the lattest follow-up were 7.3± 1.6,2.4± 1.3,and 2.3± 1.3,respectively.Average AOFAS Ankle-Hindfoot scores were 38.5± 7.8,92.9±6.9,and 91.6±7.1,respectively.Average postoperative VAS scores and AOFAS Ankle-Hindfoot scores were significantly improved compared with those before surgery.There was no statistically significant difference among all check point after operation in VAS scores and AOFAS Ankle-Hindfoot scores.At the latest follow-up,all patients were satisfied with the degree of painful relief.According to AOFAS Ankle-Hindfoot scores,overall excellent and good rate was 93.3％ (excellent in 10 cases,good in 4 cases,and fair in 1 case).Conclusion Clinical results of arthroscopic debridement combined with microfracture for treatment of chronic enthesiopathy of Achilles tendon are good.This technique is easy and safe to perform.

ObjectiveTo investigate the relationship of lymphotoxin β receptor (LTβR) and classical nuclear factor-κB (NF-κB) activation pathway in the pathogenesis and progress of cystitis and bladder cancer.MethodsThe LTβR and P65 mRNA expression were detected by Real-time quantitative PCR in 108 cases of fresh bladder tissue specimens (75 cases of bladder cancer,10 cases of inflammation and 23 normal bladder mucosa cases grouped by the tissue classification ),and protein expression were analyzed by immunohistochemistry assay in 118 cases of paraffin-embedded biopsy specimens (73 cases of bladder cancer,30 cases of cysitis and 15 normal bladder mucosa cases).The correlation analysis between the expressions of LTβR and P65 with clinical pathological data was then performed.Differences between LTβR and P65 mRNA and protein expression level were compared in different groups of bladder tissues using Kruskal-Wallis H test and the Chi-square test.Results( 1 )The mRNA expressions of LTβR and NF-κB/P65were higher in bladder cancer than those in normal group ( LTβR:29.4 ( 14.2 - 46.7 ) × 10 - 3/1.2 ( 0.3 -7.0) ×10-3,Z=-5.508; P65:9.7 (2.7 -21.1) ×10-3/1.0(0.8 ～1.8) ×10-3,Z=-5.030,P＜0.05 ).There were significantly differences between bladder cancer with different histological grades ( LTβR:18.2(2.1-31.3) × 10-3/ 28.4(16.6-36.2) × 10-3/47.9(34.3 -70.5) ×10-3,x2K-W=20.378;P65:4.9(1.3 - 12.0) × 10-3/7.4(3.0-21.9) × 10-3/17.0(10.0 ～28.3)× 10-3 ,x2K-W2 =15.219,P all ＜0.05) and lymph node metastasis (LTβR:27.2(9.7-40.1) ×10-3/39.4(26.7 -52.6) ×10-3,Z=-2.552; P65:7.4(2.3-15.6) ×10-3/13.4(6.7-23.3) ×10-3,Z=-2.026,P＜0.05).(2)The positive rates of LTβR and phosphorylated P65 ( p-P65 ) protein in cancer were higber than those of normal group (LTβR:69.8％/13.3％,x2 =16.600 ; p-P65:56.2％/6.7％,x2 =12.220,P ＜ 0.05 ).Upregulation of LTβR and p-P65 were associated with the histological grade (LTβR:56.3％/70.0％/90.4％,x2 =7.055; p-P65:40.6％ /60.0％/76.2％,x2 =6.679,P ＜0.05) and with lymph node metastasis (LTβR:58.3％/92.0％,x2 =8.849; p-P65:52.1％/64.0％,x2 =5.088,P ＜0.05).(3)There was a positive correlation between LTβR and P65 expression ( mRNA:r =0.654,P ＜ 0.05,protein:r =0.399,P ＜ 0.05 )in the bladder cancer and cystitis (r =0.521,P＜0.05).ConclusionsThe activation of LTβR and P65 was associated with progression and metastasis of bladder cancer.The activation of classical NF-κB pathway by LTβR may be achieved by P65.

Objective:To explore the predictive value of vertebral trabecular and endplate HU values on cage subsidence after posterior lumbar interbody fusion (PLIF), hope to provide reference for surgical planning.Methods:All of 72 patients with lumbar disc herniation that underwent PLIF were retrospectively reviewed, who were divided into two groups according to the occurrence of cage subsidence at one-year follow up. Cage subsidence was defined as more than 4 mm subsidence into the vertebrae valuated by CT at one-year follow up. There were 18 patients enrolled into Subsidence group and 54 patients enrolled into N-Subsidence group. The lumbar lordosis, segmental lordosis, intervertebral height, off-bed time, hospital stay, complications, the trabecular and endplate HU values of upper instrumented vertebrae (UIV) and lower instrumented vertebrae (LIV) were compared between the two groups. ROC was used to explore the thresholds of HU values.Results:There were 14 patients presented cage subsidence into the L4, 4 patients presented cage subsidence into the L5. There was no significant difference in lumbar lordosis, segmental lordosis, intervertebral height, off-bed time, hospital stay, or complications between the two groups. Both UIV and LIV trabecular and endplate showed a lower HU value in Subsidence group than those in N-Subsidence group. The most appropriate thresholds of HU value were 146, 172, 307, 254 for trabecular of UIV, trabecular of LIV, lower endplate of UIV, and upper endplate of LIV, respectively.Conclusion:Vertebral trabecular and endplate HU values could effectively predict the cage subsidence after PLIF, patients should be completely informed the risk of cage subsidence and larger cage should be recommended if they presented HU values under the certain threshold.

Objective:To compare the difference between the operation of ureteral calculi patients with COVID-19 infection during COVID-19 infection and after recovery to find out the best timing for surgery.Methods:The clinical data of 327 ureteral calculi patients with COVID-19 infection were retrospectively analyzed, including 141 cases who underwent ureteroscopic surgery. According to the time of ureteroscopic surgery, the patients were divided into two groups: operation before recovery of COVID-19 infection group ( n=81) and operation after recovery of COVID-19 infection group ( n=60). The success rate of primary surgery, stone removal incidence, complication inciednce, mortality, operation time, postoperative hemoglobin decline, hospital stay, and total hospitalization cost and other indicators of the two groups were compared between the two groups. Measurement data were expressed as mean±standard deviation ( ± s), independent t-test was used for inter-group comparison. Chi-test or continuous correction Chi-test was used for inter-group comparison for count data. Results:The success rate of primary surgery (38.3%, 31/81), stone removal rate (86.4%, 70/81) in the operation before recovery of COVID-19 infection group were significantly lower than those in the operation after recovery of COVID-19 infection group [80.0% (48/60), 98.3% (59/60)], and the differences were statistically significant ( P< 0.05). The incidence of complication, postoperative hemoglobin decline [(2.1±0.6) g/L vs (0.6±0.3) g/L], hospital stay [(14.7±3.6) d vs (4.1±1.1) d], total hospitalization cost [(34 733.3±4 412.4) yuan vs (21 919.7±3 251.3) yuan] of the operation before recovery of COVID-19 infection group were significantly higher than those in the operation after recovery of COVID-19 infection group, and the differences were statistically significant ( P< 0.001). The operation time of the operation before recovery of COVID-19 infection group was shorter [(16.9±5.4) min vs (37.7±8.9) min], and the difference was statistically significant ( P< 0.001). There was no significant difference in mortality between the two groups (3.7% vs 0, P> 0.05). Conclusion:The risk of surgical treatment for ureteral calculi patients with COVID-19 infection is high, The treatment of them should mainly be conservative treatment, and operation should be performed after COVID-19 infection is cured.

Objective:To evaluate the clinical outcomes of arthroscopic debridement combined with in situ ulnar nerve release in patients with osteoarthritic elbow stiffness complicated by tardy ulnar neuritis.Methods:A retrospective chart review was conducted on 36 patients with osteoarthritic elbow stiffness and tardy ulnar neuritis who underwent arthroscopic debridement and in situ ulnar nerve release between January 2018 and October 2022. The mean patient age was 51.3±6.5 years (range: 40-62 years), with 29 males and 7 females. The procedure was performed on 28 right and 8 left elbows, all on the dominant side. Radiographic classification of elbow osteoarthritis (OA) revealed 16 cases of Kellgren-Lawrence grade II, 15 cases of grade III, and 5 cases of grade IV. The duration of OA was 4.2±1.8 years (range: 2-8 years), and the duration of ulnar nerve compression symptoms was 4.6±3.2 months (range: 2 months-1 year). Elbow function and pain were assessed preoperatively and 12 months postoperatively using flexion-extension range of motion, the Mayo Elbow Performance Index (MEPI), and the Visual Analogue Scale (VAS) for pain. Ulnar nerve function was evaluated through grip strength, pinch strength, two-point discrimination of the little finger, and motor and sensory nerve conduction velocities (MNCV and SNCV).Results:The mean operation time was 151.4±16.2 minutes (range: 125-180 minutes), with an average hospital stay of 6.5±1.0 days (range: 5-8 days). One patient (2.8%) experienced skin necrosis at the ulnar nerve release incision, while all other incisions healed at the first stage. At the 12-month follow-up, significant improvements were observed in elbow extension [26.00° (20.00°, 30.00°) vs. 6.00° (5.00°, 10.00°), Z=-5.235, P<0.001], flexion range of motion [98.00° (88.25°, 100.00°) vs. 120.50° (109.00°, 128.00°), Z=-5.234, P<0.001], VAS pain scores (7.5±0.9 vs. 1.8±0.8, t=32.788, P<0.001), and MEPI [32.50 (26.25, 43.75) vs. 85.00 (80.00, 85.00), Z=-5.269, P<0.001]. Improvements in grip strength (24.1±2.4 N vs. 35.0±2.7 N, t=30.745, P<0.001), pinch strength (16.2±1.3 N vs. 23.8±1.7 N, t=40.239, P<0.001), two-point discrimination [16.00 (14.00, 18.00) mm vs. 5.00 (3.00, 7.00) mm, Z=-5.270, P<0.001], and MNCV (27.5±3.0 m/s vs. 41.6±3.0 m/s, t=53.673, P<0.001) / SNCV (25.1±2.7 m/s vs. 35.0±2.9 m/s, t=47.538, P<0.001) were also noted. At the 12-month follow-up, 5 patients (13.9%) had an elbow extension lag greater than 15° (range: 18°-20°), though elbow flexion recovered to at least 100°, sufficient for daily activities. One patient (2.8%) had incomplete relief of ulnar nerve symptoms postoperatively, but was generally satisfied with the outcome. Three patients (8.3%) experienced temporary worsening of ulnar nerve symptoms during rehabilitation, which improved with adjusted exercise routines, and the symptoms resolved by the 1-year follow-up. Conclusion:Arthroscopic debridement combined with in situ ulnar nerve release is a safe and effective treatment for osteoarthritic elbow stiffness complicated by tardy ulnar neuritis. This minimally invasive procedure is associated with a low complication rate and yields significant functional improvements.

Objective:To investigate the clinical efficacy of unicompartmental knee arthroplasty (UKA) in the treatment of medial compartment knee osteoarthritis (OA) with concomitant lateral discoid meniscus.Methods:A retrospective analysis was conducted on 13 patients (16 knees) who underwent UKA for medial compartment OA of the knee associated with lateral discoid meniscus at Central Hospital of Cangzhou between January 2016 and July 2021. The mean age of the patients was 59.1±7.7 years (range, 49-74 years), with a mean body mass index (BMI) of 28.9±1.7 kg/m 2 (range, 25.2-31.3 kg/m 2). Of the 13 patients, 7 were male (9 knees) and 6 were female (7 knees). The procedure was performed on 10 knees of the left leg and 6 knees of the right leg. Preoperative radiographic assessment showed that all patients had Kellgren-Lawrence grade 3-4 knee OA (9 knees with grade 3, 7 knees with grade 4). The average duration of knee pain was 6.0±1.5 years (range, 3-8 years). No surgical intervention was performed on the lateral discoid meniscus during the UKA procedure. The alignment of the lower limbs was assessed by measuring the hip-knee-ankle (HKA) angle using full-length weight-bearing X-rays. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) score, Oxford knee score (OKS), and American Knee Society (AKS) knee and function scores. The presence of lateral knee pain or tenderness along the lateral joint line was used to assess symptoms related to lateral meniscus injury. Results:The average surgical time for the 16 knees was 55.9±4.5 min (range, 48-62 min), and the mean length of hospital stay was 10.2±3.2 days (range, 7-15 days). The mean follow-up duration was 53.2±11.1 months (range, 36-68 months). At 6 months, 1 year, and the final follow-up, significant improvements were observed in HSS scores [57.00(54.25, 58.00) vs. 91.00 (89.25, 92.00) vs. 95.50(92.00, 97.00) vs. 96.50 (95.00, 97.75)], OKS [37.00(36.00, 39.00) vs. 15.00(15.00, 16.00) vs. 14.00(13.00, 14.00) vs. 13.00(12.25, 13.00)], AKS knee scores [52.00(50.00, 53.75) vs. 91.50(91.00, 92.00) vs. 95.00(95.00, 97.00) vs. 96.50 (95.00, 97.00)], and AKS function scores [53.00(45.00, 55.00) vs. 90.00(90.00, 90.00) vs. 95.00(92.00, 99.25) vs. 95.00(95.00, 100.00)] compared to preoperative values ( P<0.001). Statistically significant differences were found between the 6-month follow-up and the 1-year or final follow-up ( P<0.05), but no significant differences were observed between the 1-year and final follow-up ( P>0.05). Preoperative HKA angle was 8.00°(6.25°, 9.75°) of varus, whereas the postoperative HKA angle was 3.00° (3.00°, 3.75°) of varus. The postoperative alignment showed a significant reduction in varus deformity, with a statistically significant difference compared to preoperative values ( Z=-3.419, P=0.001). One knee developed symptomatic intra-articular loose body at 5 years postoperatively, which was successfully treated with arthroscopic removal. At the final follow-up, all prostheses were well-positioned, with no signs of loosening, subsidence, periprosthetic infection, or the need for revision surgery. No symptoms were indicative of lateral discoid meniscus injury were observed. Conclusion:UKA for the treatment of medial compartment knee OA in patients with lateral discoid meniscus yields favorable clinical outcomes, with significant improvements in knee function and pain relief, as well as stable midterm prosthesis performance.

Alkaline phosphatase(ALP)is widely expressed in human tissues.ALP plays an important role in the dephosphorylation of proteins and nucleic acids.Therefore,quantitative analysis of ALP plays a vital role in disease diagnosis and the development of biological detection methods.Terminal deoxynucleotidyl transferase(TdT)catalyzes continuous polymerization of deoxynucleotide triphosphates at the 3'-OH end of single-stranded DNA in the absence of a template.In this study,we developed a highly sensitive and selective method based on TdT and endonuclease Ⅳ(Endo Ⅳ)to quantify ALP activity.After ALP hydrolyzes the 3'-PO4 end of the substrate and generates 3'-OH,TdT can effectively elongate the 3'-OH end with deoxynucleotide adenine triphosphate(dATP)and produce a poly A tail,which can be detected by the poly T probes.Endo Ⅳ digests the AP site in poly T probes to generate a fluorescent signal and a new 3'-OH end,leading to the generation of exponential fluorescence signal amplification.The substrate for TdT elongation was optimized,and a limit of detection of 4.3×10-3 U/L was achieved for ALP by the optimized substrate structure.This method can also detect ALP in the cell lysate of a single cell.This work has potential applications in disease diagnosis and biomedical detection.