BACKGROUND:Chronic ankle instability can cause traumatic joint disease and secondary adhesive capsulitis, and even result in permanent dysfunction.
OBJECTIVE: To explicit the forming reason of chronic ankle instability and to investigate the diagnosis and treatment methods of chronic ankle instability based on the biomechanical analysis of the ankle joint.
METHODS: PubMed and Wanfang databases were retrieved for review and basic research papers about the anatomy, biomechanics, diagnosis and treatment of chronic ankle instability published from January 1990 to December 2014. The keywords were “chronic ankle instability, anatomy of ankle joint, biomechanics, therapy, research” in English and Chinese, respectively. After screening, 40 papers were included to summarize the anatomical structure of the ankle joint, mechanism and classification, diagnostic methods, and treatment methods of chronic lateral ankle instability.
RESULTS AND CONCLUSION:Diagnostic methods of chronic ankle instability include ankle varus stress test, ankle anterior drawer test, ultrasonic test, modern imaging detection; and therapeutic methods for chronic ankle instability can be divided into conservative treatment and surgical treatment, and the surgical treatment can be subdivided into non-anatomic reconstruction and anatomical repair of the damaged ligament. Early diagnosis and effective treatment are recommended for patients with chronic ankle instability, and the treatment programs should be determined based on comprehensive analysis of ankle anatomical structure, biomechanical characteristics, pathogenesis, and diagnostic results.

Objective To compare the mRNA expressions of interleukin (IL)-17 and IL-23 in peripheral blood of patients with psoriasis vulgaris versus healthy individuals,assess the relationship of these parameters with psoriasis area and severity index (PASI) score,and to investigate the therapeutic mechanisms of total glucosides of peony (TGP) for psoriasis vulgaris.Methods Fifty patients with psoriasis vulgaris and 40 healthy individuals were enrolled in this study.Of these patients,42 were treated with TGP of 600-900 mg twice a day for 8 weeks.Blood samples were obtained from all the healthy individuals,50 patients before treatment,42 patients after 4-week treatment,and 23 patients after 8-week treatment.Real-time fluorescence-based quantitative reverse transcription PCR (RT-PCR) was used to determine the mRNA expression levels of IL-17 and IL-23 in the blood samples.The severity of psoriasis was evaluated using PASI score before and after the treatment.Statistical analysis was done by t test,rank sum test,and Pearson correlation analysis using the SPSS16.0 software.Results The IL-17 and IL-23 mRNA expression levels (given in △Ct value) in the patients before treatment were significantly higher than those in the healthy controls (IL-17,-5.32 ± 0.80 vs.2.79 ± 0.76,t =47.71,P ＜ 0.05; IL-23,-5.43 ± 0.68 vs.-3.77 ± 0.86,t =10.38,P ＜ 0.05),and positively correlated with the PASI score (r =0.61,0.52 respectively,both P ＜ 0.05).A significant decrease was observed in the mRNA expression levels of IL-17 and IL-23 as well as PASI score in the 42 patients after 4-week treatment with TGP compared with those before treatment(IL-17,-2.24 ± 0.61 vs.-5.30 ± 0.78,t =20.40,P ＜ 0.05; IL-23,-1.97 ± 0.74 vs.-5.44 ± 0.68,t =21.69,P ＜ 0.05; PASI,5.8 ± 2.7 vs.9.4 ± 4.2,t =4.68,P ＜ 0.05),and in the 23 patients after 8-week treatment compared with those after 4-wek treatment(IL-17,-1.51 ± 0.78 vs.-2.21 ± 0.59,t =3.50,P ＜ 0.05; IL-23,-1.27 ± 0.81 vs.-1.89 ± 0.72,t =2.70,P＜ 0.05; PASI,3.8 ± 1.8 vs.7.3 ± 2.5,t =5.47,P＜ 0.05).Conclusions It seems that both IL-17 and IL-23 are involved in the pathogenesis of psoriasis vulgaris,and TGP treatment can reduce the mRNA expression levels of IL-17 and IL-23 as well as PASI score in patients with psoriasis vulgaris.

A 53-year-old man presented with prunosus nodules and plaques on the trunk and extremities for half a month and with periorbital swelling for 4 days.Hematological examination in a local hospital showed thrombocytopenia,and pulsed corticosteroid therapy did not work.On physical examination,there were splenomegaly and multiple enlarged superficial lymphnodes.Serum calcium and 1-lactate dehydrogenase (LDH)were increased to 3.12 mmol/L and 853 U/L,respectively.Serum immunofixation electrophoresis evidenced the presence of a monoclonal immunoglobulin IgM (κ chain).Positron emission tomography (PET-CT) showed abnormal uptake in multiple lymph nodes,back wall of the pharynx,and spleen.The biopsy of a nodule in the neck revealed a diffuse infiltration of numerous atypical lymphoid cells in the subcutaneous fat tissue,which were medium-sized with round nuclei,obvious nucleoli and karyokinesis, Immunophenotyping of the abnormal lymphocytes indicated positive reactions for L26,CD79a,Bcl-2,cyclin D1,multiple myeloma oncogene 1 (partly),Ki-67 (＞80％),but negative for CD5,CD21,CD23,CD38,CD3,CD10,Bcl-6,CD45RO,terminal deoxynucleotidyl transferase (TdT),myeloperoxidase (MPO),CD30,anaplastic lymphoma kinase (ALK),CD117,or CD34.Fluorescence in situ hybridization (FISH) revealed the presence of a fusion gene (t(11:14) CCND1/IGH) in the abnormal lymphocytes.Based on the above findings,the diagnosis was made as blastoid mantle cell lymphoma with skin and periorbital involvement complicated by hypercalcemia.After treatment with rituximab injection,cyclophosphamide,vincristine,doxorubicin,dexamethasone,and intermittent treatment with intravenous high dose of methotrexate and cytarabine (R-Hyper-CVAD),serum calcium returned to a normal level three days later,and the patient made a quick and excellent recovery on the 6th day,with the regression of skin lesions and poriorbital swelling.Unfortunately,the patient eventually died of severe pulmonary infection one month later.

Objective To study the correlation between MMP-9 rs3918242 C ＞ T polymorphism and cancer risk.Methods PubMed database was utilized to search the relative artiles concerning association between MMP-9 rs3918242 C ＞T polymorphism and cancer risk (last search updated on April 2011).All the statistical analysis was performed by STATA software.Results 4,124 cancer patients and 4,728 control subjects were included in this meta-analysis.No association was observed in the overall analysis (allelic contrast P=0.378,OR =0.94,95％ CI:0.83-1.07).However,in the stratified analysis by cancer type,MMP-9-1562 T allele was found to decrease the lung cancer(P =0.026,OR =0.70,95％ CI:0.5 1-0.96) and colorectal cancer(P=0.016,OR =0.80,95％ CI:0.66-0.96).Conclusion MMP-9 rs3918242 C/T polymorphism is correlated with colorectal cancer and lung cancer.

Objective To use a simple bedside technique to verify the pathophysiological mechanism of pulmonary hypertension (PH) in different races. Method The Valsalva maneuver (VM) was performed in patients referred to a specialty PH clinic. The blood pressure response of patients to VM was in different fashions. The blood pressure (BP) was measured by using cuff and stethoscope. When the cuff was inflated to 15 mmHg above the systolic pressure, sound could be heard by auscultation during VM and when the cuff was deflated the sound disappeared over 3 heart beats which was considered as abnormal BP response, and less than 3 heart beats defined as normal BP response. The right heart catheterization in patients with PH as a part of the standard evaluation. Results This study included 84 patients with a mean age of (63 ± 16) years. Those with abnormal BP response to VM had higher pulmonary artery wedge pressure (PAWP) [(22.5±6.6) vs. (11.9±4.3) mmHg, P ＜0.0001] and lower pulmonary vascular resistance [(5.8 ± 4.0) vs. (8.1 ± 4.6 ) WU, P = 0.01]. Blood pressure response to VM did not correlate with mean pulmonary artery (PA) pressure [(46.2 ± 9.9) vs. (43.4 ±10.4) mmHg, P =0.20] or cardiac index (both 2.4 ± 0.6 L/min/m2). The abnormal BP response to VM had high sensitivity (89.4%), specificity (86.1%) and accuracy (86.9%) for determining PAWP＞ 15 mmHg.Conclusions BP response to Valsalva maneuver provides important information about left heart filling pressures in patients with PH.

Objective To analyze the risk factors of emergence agitation (EA)in the adult patients during the recovery peri-od after general anesthesia in postanesthesia care unit(PACU).Methods 2 056 adult patients undergoing elective surgery under general anesthesia in PACU were selected,aged more than 18 years old,sex unlimited The following factors of age,gender,body mass,ASA grade,preoperative combined disease,education level,premedicatiou,general anesthesia mode,midazolam use for induc-tion,anesthesia time,operation site,operation mode,operation time,intraoperative blood loss,intraoperative fluid replacement,re-covery time in PACU,body temperature,urinary catheter,urine volume,etc.were recorded.According to whether EA occurring during recovery from general anesthesia,the patients were divided into the quiet group and the EA group.The multivariate Logistic regression was performed to analyze and screen the risk factors for the occurrence of EA.Results 127 cases developed EA during recovery from anesthesia.The occurrence rate of EA was 6.18%.The Logistic regression analysis indicated that high grade ASA, large quantity of intraoperative fluid replacement,placing urinary catheter and postoperative pain were the risk factors for EA(P <0.05).Conclusion Highgrade ASA,large quantity of intraoperative fluid replacement,placing urinary catheter and postoperative pain are the risk factors for EA during the recovery period after general anesthesia in PACU.

Objective To investigate the cytotoxicity of γδ T cells to HIV-1 latency cells in patients with early HIV-1 infection.Methods Sixteen early HIV-1-infected patients were enrolled in this study.Peripheral blood mononuclear cells (PBMCs) of patients were isolated and γδ T cells were expanded using zoledronate (5 μmol/L) and interleukin (IL)-2 (1 000 IU/mL) ex vivo.Lactic dehydrogenase (LDH) was used to detect the cytotoxic role of γδ T cells to HIV-1 latency cells(J-Lat Full Length Clonel0.6).The phenotype of γδ T cells before and after expansion and the intensity of GFP in HIV-1 latency cells were detected by flow cytometry.Results Zoledronate plus IL-2 stimulated rapid and large γδ T cells proliferation ex vivo (P＜0.001).γδ T cells showed high cytotoxici ty to latency cells,and the intensity of GFP in latency cells was decreased significantly (P＜0.05).Moreover,expanded γδ T cells displayed cytotoxic NK-like phenotype,the frequency of CD56+ Vδ2 T cells in patients with early HIV-1 infection was significantly higher than that of healthy controls.Conclusions γδ T cell has an ability to eradicate HIV-1 latency,and γδ T cell-based autologous or xenogenous adoptive immunotherapy will have promise prospects to cure HIV-1 infection.

Objective To study the change of the contractile response of human umbilical artery smooth muscle cells (HUASMCs) during the heat stress, and explore the effect of the antioxidant on the changes. Methods HUASMCs were randomly divided into control group, heat stress group, antioxidant preprocessing group. Cells were stimulated by norepinephrine (NE) at a low concentration (0.05mg/L) and at a normal concentration (1.0mg/L) and cultured in the thermostatic water bath (41℃) for 0.5, 1, 1.5 or 2h, respectively. After stimulated by NE, proportion of the cell surface area contraction was measured to reflect the contractile response of each group. Results Compared with control group, regardless of the NE concentration: in heat stress group, contractile response at 1h increased significantly (P<0.05), while at 2h, it was reduced significantly (P<0.05 or 0.01). In the antioxidant preprocessing group, the contractile response was reduced significantly from heat stress to 2h after heat stress (P<0.05 or 0.01). There was no statistically significant difference in contractile response between different NE concentrations in the control group and heat stress group (P>0.05), but in the antioxidant preprocessing group, the contractile response was more significant to the normal NE concentration than to the low NE concentration (P<0.05 or 0.01). Regardless of the NE concentration, the contractile response was lower in the antioxidant preprocessing group than in the heat stress group. Conclusions In the course of heat stress, the contractile response of HUASMCs presents as time-related change. The usage of antioxidant may correct the over-response of HUASMCs to NE in the early heat stress stage, but cannot correct the reduction of the contractile response in the middle and advanced stage.

Aim To construct 3 D structure model of cardiac Cav1.2 channel and check its accuracy and re-liability.Methods Homology model of Cav1.2 chan-nel α1 subunit was constructed using SWISS-MODEL server.The model was submitted to an online testing server built by University of California and scored by it.The binding of Cav1.2 channel with blocker or drug was simulated by MOE software molecular docking pro-gram to check the model′s accuracy and reliability.Re-sults Both the target sequence Cav1.2 α1 C and the template sequence Cav1.1 α1 S searched by SWISS-MODEL server belonged to L-type Ca2+channel.Since the homology was 7 1.5% revealed by sequence align-ment,homology modeling was performed using automa-ted mode.L-type Ca2+ channel blockers Verapamil, Nifedipine and Diltiazem could bind to the 3 D structure model of Cav1.2 channel,while sodium channel bloc-ker TTX could not.Furthermore,active ingredient of traditional Chinese drug Praeruptorin A and Berberine could also bind to the 3D structure model of Cav1.2 channel.Conclusion The 3 D structure model of Cav1.2 channel was constructed successfully,which provides reliable materials for further studies and estab-lishes the foundation for the application of homology modeling in the study of 3 D structure prediction of ion channels.

Objective To investigate the possibility that procalcitonin (PCT) can predict the outcome of ventilator weaning in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods The AECOPD patients caused by bacteria who received mechanical ventilation in intensive care unit (ICU)of the General Hospital of China National Petroleum Corporation in Jilin from January 2010 to March 2014 were retrospectively selected,and their venous blood PCT levels were monitored daily. When they had passed the spontaneous breathing trial(SBT),their breathing machine and trachea cannula were removed. Afterwards they were closely observed for 48 hours and divided into two groups:success and failure groups according to the outcome of the first weaning,and then the analysis of the PCT difference between the two groups was made. Results In the 52 patients enrolled,there were 38 patients in the success group and 14 patients in the failure group. The baseline information as age,sex,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score between the two groups showed no significant difference(all P>0.05). There was no statistical significant difference in PCT level(μg/L) between success and failure groups when they were admitted(5.33±1.35 and 5.37±1.34,respectively). When they were weaning,the PCT levels of both groups had reduced to some extent(1.37±0.39 and 1.74±0.42,respectively), and the success group was lower than that in the failure group(t=2.971,P=0.005). Conclusion PCT level can be used as a predictive index to guide the time for ventilator weaning in patients with AECOPD.