Objective To study the incidence and prognosis of avascular necrosis after talus fracture. Methods A retrospective survey was performed in 12 patients ( 13 feet) with talus fractures admitted into hospital from July 2004 to November 2009 to analyze necrosis rate, ankle function recovery and disability rate. According to Hawkin' s classification system, there were two patients with type Ⅰ feet, four with type Ⅱ feet, five with type Ⅲ feet and two with type Ⅳ feet. Results All patients were followed up for average period of 19.6 months (range 11-52 months). Avascular necrosis was detected in eight feet, of which one foot was treated with ankle fusion, one with subtalar arthrodesis and one with bone implantation. The other five feet had good ankle and subtalar function, with no collapse or osteoarthritis. According to Maryland foot score, the result was excellent in eight patients, good in two, fair in one and failure in two, with excellence rate of 77%. Conclusion The incidence of avascular necrosis after talus fracture is related to the location and energy of trauma. However, the function prognosis of the talus shows no correlation with necrosis.

Objective To investigate the clinical characteristics,treatment methods,and clinical outcomes of open injury of foot and ankle in children.Methods From February 2004 to June 2010,35 children with open injury of foot and ankle were treated,including 22 males and 13 females,aged from 3 years to 14 years (average,8.4 years).Twenty-eight cases resulted from traffic accidents; 7 cases occurred from sharp instruments and machine-related crush injuries.Thirty cases were associated with bone fractures,and according to the Gustilo classification of open fractures,five cases were Type Ⅰ injuries,eight cases were Type Ⅱ injuries and 22 cases were Type Ⅲ.Twenty three cases (type Ⅰ,type Ⅱ and type Ⅲ) underwent surgical debridement and/or internal fixation with skin flap grafting.Twelve type Ⅲ cases underwent debridement,temporary Kirschner wire or plaster fixation and VSD in the first stage of treatment.In the second stage of treatment,fracture reduction and internal fixation (with or without bone graft) + skin flap grafting was performed in all 12 cases.Results Thirty patients (85.7％) were followed-up for an average of 38.7months (range,6-89 months).Skin grafting was performed in two Type Ⅱ cases that developed necrosis in parts of the wound.Wound healing time was an average of 8.3 weeks (range,3-15 weeks).One Type Ⅲ case suffered chronic osteomyelitis with the formation of a sinus tract.Two cases suffered from club foot ab normalities 3 years postoperatively.All three patients above mentioned healed after treatment.In 12 type Ⅲpatients with staged treatment,the flap survived,and its color and elasticity were good.Healing time ranged from 3 to 8 weeks (average,6.8 weeks).According to the Maryland standard,17 cases were excellent,9good,3 fair,and 1 bad; the excellent and good rate was 86.7％.Conclusion Traffic accidents are the major causes of open foot and ankle trauma in children.A good surgical outcome can be achieved when patients receive staged treatment that is appropriate to injury severity.

Objective To investigate the correlations of serum eukaryotic translation promoter 2α(eIF2α)and activated transcription factor 4(ATF4)levels with the degree of renal tissue injury and renal function in patients with diabetic nephropathy(DN).Methods A total of 102 patients with DN(DN group)and 102 patients with simple diabetes(control group)were selected.According to the severe degree of renal tissue damage,the patients with DN were divided into microalbuminuria group(MG group,35 cases)and dominant albuminuria group(PG group,41 cases)and renal dysfunction group(RIG group,26 cases).Serum levels of eIF2α,ATF4,urea nitrogen(BUN),creatinine(Scr),cystatin C(CysC)and estimated glomerular filtration rate(eGFR)were measured.Pearson correlation analysis was used to explore the correlations of eIF2α and ATF4 with BUN,Scr,CysC and eGFR;multivariate Logistic regression analysis was used to explore the risk factors of DN;receiver op-erating characteristic(ROC)curve was used to analyze the value of eIF2α and ATF4 in diagnostic of DN.Results Serum levels of eIF2α,ATF4,BUN,Scr and CysC in the DN group were higher than those in control group,eGFR was lower than that in control group(P＜0.05).Serum eIF2α and ATF4levels in the RIG group were higher than those in PG and MG groups(P＜0.05).Serum eIF2α and ATF4 levels in DN patients were positively correlated with BUN,Scr and CysC,and neg-atively correlated with eGFR(P＜0.05).Long duration of diabetes,higher body mass index,high level of eIF2α and high level of ATF4 were risk factors for DN(P＜0.05).The area under the curve of eIF2α and ATF4 in diagnosis DN was 0.770 and 0.799,respectively,and the area under the curve of their combined diagnosis was 0.879,which was higher than that of single diagnosis(P＜0.05).Conclusion Serum levels of eIF2α and ATF4 are increased in patients with DN,which is related to the severity of renal injury and renal dysfunction in DN.The combination of eIF2α and ATF4 is of high value in the diagnosis of DN.

Objective To investigate the correlations of serum eukaryotic translation promoter 2α(eIF2α)and activated transcription factor 4(ATF4)levels with the degree of renal tissue injury and renal function in patients with diabetic nephropathy(DN).Methods A total of 102 patients with DN(DN group)and 102 patients with simple diabetes(control group)were selected.According to the severe degree of renal tissue damage,the patients with DN were divided into microalbuminuria group(MG group,35 cases)and dominant albuminuria group(PG group,41 cases)and renal dysfunction group(RIG group,26 cases).Serum levels of eIF2α,ATF4,urea nitrogen(BUN),creatinine(Scr),cystatin C(CysC)and estimated glomerular filtration rate(eGFR)were measured.Pearson correlation analysis was used to explore the correlations of eIF2α and ATF4 with BUN,Scr,CysC and eGFR;multivariate Logistic regression analysis was used to explore the risk factors of DN;receiver op-erating characteristic(ROC)curve was used to analyze the value of eIF2α and ATF4 in diagnostic of DN.Results Serum levels of eIF2α,ATF4,BUN,Scr and CysC in the DN group were higher than those in control group,eGFR was lower than that in control group(P＜0.05).Serum eIF2α and ATF4levels in the RIG group were higher than those in PG and MG groups(P＜0.05).Serum eIF2α and ATF4 levels in DN patients were positively correlated with BUN,Scr and CysC,and neg-atively correlated with eGFR(P＜0.05).Long duration of diabetes,higher body mass index,high level of eIF2α and high level of ATF4 were risk factors for DN(P＜0.05).The area under the curve of eIF2α and ATF4 in diagnosis DN was 0.770 and 0.799,respectively,and the area under the curve of their combined diagnosis was 0.879,which was higher than that of single diagnosis(P＜0.05).Conclusion Serum levels of eIF2α and ATF4 are increased in patients with DN,which is related to the severity of renal injury and renal dysfunction in DN.The combination of eIF2α and ATF4 is of high value in the diagnosis of DN.