Objective:To investigate the clinical effect of the first dorsal metatarsal-dorsal phalangeal artery flap in repairing large area of soft tissue defect on the palmar side of finger.Methods:From February, 2016 to June, 2018, 11 fingers of 11 patients (7 males and 4 females, aged 19-46 years old with an average of 32.5 years old) with large area of soft tissue defect on the palmar side of the finger were repaired with the first dorsal metatarsal-dorsal phalangeal artery flap. These included 3 with the first dorsal metatarsal-first dorsal phalangeal artery blood supply, and 8 with the first dorsal metatarsal-second dorsal phalangeal artery blood supply. In which 3 with retained finger pulp was for repairing the defects and bridging arteries, including 1 flexor tendon defect repaired by the extensor digitorum brevis tendon of the second toe with the flap. The type of blood vessel was Gilbert I detected by CDU before surgery. The area of the flaps was from 1.5 cm×5.0 cm to 3.0 cm×8.0 cm. The donor area of the flaps was compressed with full thickness skin grafts of the shank. The follow-up data was collected by outpatient clinic visits and telephone interviews.Results:All the 11 flaps survived and were followed-up for an average of 14 months, ranged from 6 months to 24 months. The colour and texture of the flaps were good. Sensing of temperature, pain and touch restored, without swelling. Function of the fingers was well restored. The range of motion of distal and proximal interphalangeal joints was closed to normal. The TPD of the flaps was 5-11 mm, with an average of 8 mm. Ten had primary wound healing in the donor sites of foot. One case had necrosis of the proximal toe of the skin graft and healed after dressing change. Long-term follow-up of the skin grafting area was wear-resistant, and does not hinder walking without rupture.Conclusion:Application of the first dorsal metatarsal-dorsal toe artery flap to repair large area of soft tissue defect on the palmar side of finger has number of advantages such as it, covers the wound and carry the tendons, bridges the arteries at the same time, plus delivers satisfactory outcome.

Objective: To explore the application and effect of using the lateral second toe flap transfer for reconstruction of great toe defect. Methods: The flap on tibial of second toe was designed according to the size of defect. The pedicle of the flap is the tibial proper plantar digital artery of the toe, and the rotation point is located between the toe web.13 cases of the great toe′s defects were repaired by this method, with the donor sites covered by full thickness skin from the leg. Results: 13 flaps survived postoperatively. All cases were subject to postoperative follow-up, follow-up time was 6-48 months, an average of 18 months. Skin color and texture was close to that of the surrounding tissues, appearance is not bloated. Conclusions The second toe lateral skin flap is easy to operate, is flexible for rotating. As local material, it is an ideal skin flap to repair the great toe defect.

Objective To investigate the relationship between serum high mobility group protein B1(HMGB1),C1q/TNF-associated protein 3(CTRP3)and pain degree and lumbar function.Methods A total of 145 patients with lumbar spinal stenosis treated in the hospital from September 2021 to August 2023 were retrospectively selected as the study objects,and were divided into single-segment group(89 cases)and multi-segment group(56 cases)according to the number of lumbar spinal stenosis segments.Serum levels of HMGB1 and CTRP3 were detected by enzyme-linked immunosorbent assay.The clinicopathological features such as pain degree,lumbar function and serum levels of HMGB1 and CTRP3 were compared between the two groups.The correlation of serum HMGB1 and CTRP3 levels with pain degree and lumbar function were ana-lyzed,and the factors influencing the number of segments of lumbar stenosis were analyzed by multivariate Logistic regression.The diagnostic value of serum HMGB1 and CTRP3 levels on lumbar function of patients was analyzed by receiver operating characteristic(ROC)curve.Results Visual analogue scale(VAS)score and serum HMGB1 level in multi-segment group were higher than those in single-segment group(P＜0.05),Japanese Orthopaedic Association(JOA)score and serum CTRP3 level were lower than those in single-seg-ment group(P＜0.05).Serum HMGB1 level was negatively correlated with CTRP3 and JOA score in pa-tients with lumbar spinal stenosis(r=-0.544,-0.616,P＜0.001),and positively correlated with VAS score(r=0.453,P＜0.001).The serum CTRP3 level was negatively correlated with VAS score(r=-0.550,P＜0.001),and positively correlated with JOA score(r=0.619,P＜0.001).JOA score was nega-tively correlated with VAS score(r=-0.485,P＜0.001).Multivariate Logistic regression analysis showed that JOA score and serum CTRP3 level were protective factors for multi-segmental stenosis(P＜0.05),VAS score and serum HMGB1 level were risk factors for multi-segmental stenosis(P＜0.05).The analysis of ROC curve showed that serum HMGB1 and CTRP3 levels could be used as diagnostic indexes of lumbar spinal function in patients with lumbar spinal stenosis,and the combined diagnosis effect was better(P＜0.05).Conclusion Serum levels of HMGB1 and CTRP3 are closely related to pain degree and lumbar function in pa-tients with lumbar spinal stenosis.The combination of the two indexes can be used for the clinical diagnosis of lumbar function in patients with lumbar spinal stenosis.

Objective:To observe the clinical efficacy of percutaneous minimally invasive bridging combined internal fixation system (BCFS) in the treatment of clavicle fractures through a prospective study.Methods:One hundred and sixty-four patients with clavicle fractures admitted to Fengfeng General Hospital of North China Medical Group from June 2019 to June 2022 were included as the study subjects. They were randomly divided into study group and control group with 82 cases each using random number table method. The control group was treated with reconstruction steel plate internal fixation surgery, while the study group was treated with percutaneous minimally invasive BCFS surgery. Compare surgical related indicators, degree of pain, shoulder joint function, complications and treatment outcomes.Results:The intraoperative blood loss in the study group was less than that in the control group: (43.81 ± 5.29) ml vs. (58.79 ± 6.85) ml, and the surgical time and fracture healing time were shorter than those in the control group: (52.06 ± 7.74) min vs. (67.24 ± 8.28) min, (12.42 ± 2.36) weeks vs. (14.50 ± 3.08) weeks, with statistically significant differences ( P<0.05). There was no statistical difference in the hospital stay between two groups ( P>0.05). The visual analog scale (VAS) scores of both groups at 12 and 24 h after surgery were lower than before surgery. The VAS scores at 12 and 24 h after surgery in study group were lower than those in control group: (4.15 ± 0.69) points vs. (5.68 ± 0.82) points and (2.95 ± 0.62) points vs. (3.46 ± 0.73) points, with statistical significances ( P<0.05). After 6 months of surgery, the shoulder joint function indexes were higher than before surgery, pain degree: (10.87 ± 3.25) points vs. (4.15 ± 1.08) points, (10.52 ± 3.19) points vs. (4.09 ± 1.12) points, and the shoulder joint range of motion: (31.24 ± 5.13) points vs. (16.83 ± 3.39) points, (30.52 ± 4.85) points vs. (17.21 ± 3.47) points, daily life: (16.06 ± 3.12) points vs. (7.86 ± 1.15) points, (15.73 ± 3.58) points vs. (6.94 ± 1.17) points, muscle strength: (20.67 ± 2.62) points to (8.78 ± 2.34) points, (21.06 ± 3.48) points to (9.04 ± 3.07) points, and total scores: (78.84 ± 7.16) points vs. (37.62 ± 5.09) points, (77.83 ± 6.04) points vs. (37.28 ± 6.11) points, the differences were statistically significant ( P<0.05), while there were no statistically significant differences in pain level, shoulder joint range of motion, daily life, muscle strength and total score at 6 months after surgery between the two groups ( P>0.05). After 6 months of surgery, the incidence of complications in the study group was lower than that in the control group: 4.88% (4/82) vs. 14.64% (12/82), and the difference was statistically significant ( P<0.05). After 6 months of surgery, the overall excellent and good rate in the observation group was better than that in the control group: 98.78% (81/82) vs. 89.02% (73/82), with a statistically significant difference ( P<0.05). Conclusions:The percutaneous minimally invasive BCFS surgery has a significant therapeutic effect on clavicle fractures, which is beneficial for reducing intraoperative bleeding, shortening surgical time, promoting fracture healing, reducing postoperative pain, improving shoulder joint function, and reducing the incidence of complications. It has more advantages in the treatment of clavicle fractures.

Objective: To report the operation methods and clinical effects of repairing finger tip defect with the free tibial dorsal nerve flap of the second toe. Methods: 13 patients with finger tip defects were repaired by the tibial dorsal nerve flap of the second toe. The area of finger tip defect was 2.5 cm×1.5 cm-1.3 cm×1.0 cm, and the area of cutting flap was 2.7 cm×1.7 cm-1.5 cm×1.1 cm. All donor site defects on the second toe were covered with full-thickness skin graft. Results: There were 13 cases in this group, and all the flaps and skin grafts were survived. Postoperative follow-up ranged from 6 to 18 months, with an average of 13 months. The appearance of the fingers was satisfied and the sensory recovery was good. Two-point discrimination of the flaps returned to 7-13 mm, with an average of 9 mm. According to the total active move(TAM)scale, results were excellent in 11 fingers, good in 1 finger, and fair in 1 finger. The donor site skin graft was well healed, the second toe pulp was full, and the two-point discrimination of the toe pulps were 6-10 mm, with an average of 8 mm. Conclusions Compared to the traditional method of repairing finger tip defect with the tibial inherent nerve flap of the second toe, our new method can reduce the damage to the donor site, and we can repair finger tip defect as well as the traditional one at the same time. So it was a better operative method to repair finger tip defect with the tibial dorsal nerve flap of the second toe.

Objective:To analyze the dynamic changes of T lymphocytes in patients with COVID-19.Methods:Blood samples were collected from 40 COVID-19 cases and 40 healthy controls in Beihai People′s Hospital from January to February, 2020. The counts of CD4 + T and CD8 + T lymphocytes were detected by flow cytometry. Moreover, the T lymphocyte counts in 24 convalescent patients with two consecutive negative nucleic acid test results were also detected. Results:The leukocytes and lymphocytes in the patients with acute COVID-19 were significantly lower than those in the healthy controls [(4.71±1.54)×10 9 cell/L vs (6.26±1.44)×10 9 cell/L, (1.13±0.41)×10 9 cell/L vs (1.51±0.39)×10 9 cell/L; both P<0.05]. The counts of CD4 + T and CD8 + T lymphocytes in the patients with acute COVID-19 were significantly lower than those in the healthy controls [(447.15±144.42) cell/μl vs (592.83±146.76) cell/μl, (309.35±173.05) cell/μl vs (397.20±136.94) cell/μl; both P<0.05], while no significant difference was observed in the CD4 + /CD8 + T cell ratio ( P>0.05). In the 24 convalescent COVID-19 patients, the counts of CD4 + T and CD8 + T lymphocytes were higher during convalescence than in the acute phase [(598.08±138.71) cell/μl vs (420.67±147.38) cell/μl, (439.08±166.94) cell/μl vs (296.67±151.06) cell/μl; both P<0.05], but there was no significant difference in the T lymphocyte counts between the convalescent patients and the healthy controls ( P>0.05). Conclusions:A transient immune deficiency occurred in patients with acute COVID-19, but the impaired immune function could restore to normal level during recovery.

Objective:To establish a new molecular typing method for Treponema pallidum (TP) based on TP0136 protein sequence heterogeneity. Methods:The amino acid sequences of TP0136 open reading frame (ORF) of 9 strains of Treponema pallidum ssp. Pallidum (TPA) , 3 strains of Treponema pallidum ssp. Pertenue (TPE) , 1 unclassified simian strain of Treponema Fribourg-Blanc (FB) and 1 strain of Treponema pallidum ssp. Endemicum (TEN) were searched from Genbank, and multiple sequence comparisons were performed to obtain the molecular typing results of TP0136 protein. The TP0136 protein-based molecular typing method was used to classify 23 TPA clinical isolates, which were collected from Dermatology Hospital of Southern Medical University from January 2015 to December 2018, and the typing results were compared with those by the traditional typing method based on the tp0548/Arp/Tpr genes. Results:TP0136 protein was highly heterogeneous in different TP strains. According to the amino acid sequence of TP0136, TPE, FB and TEN strains were divided into 4 subtypes of Ⅰ- Ⅳ, TPA strains were divided into 6 subtypes of Ⅴ-Ⅹ, and TPA clinical strains were classified into 4 subtypes of Ⅶ, Ⅸ, Ⅹ, Ⅺ. Through the traditional typing method described above, 23 TPA clinical strains could be divided into 5 types (13D/d, 14D/f, 14D/g, 15D/f, 16A/e) . By using the TP0136 protein-based typing method combined with traditional typing method, the above clinical strains could be further subdivided into 10 types, and the 14D/f type could be further divided into 3 subtypes by using the TP0136 protein-based typing method.Conclusion:The TP0136 protein-based molecular typing method can be used to distinguish TP species, which is helpful for further improvement of traditional TPA molecular typing.

BACKGROUND:Nano-zirconium dioxide has good application potential in the field of bone tissue repair.Studying the effect of nano-zirconium dioxide on osteogenic differentiation will help to promote the clinical application of nano-zirconium dioxide in the treatment of bone defects. OBJECTIVE:To explore the effect of nano-zirconium dioxide on the osteogenic differentiation of ectomesenchymal stem cells in the nasal mucosa. METHODS:Ectomesenchymal stem cells derived from rat nasal mucosa were isolated and cultured,and the biotoxicity of nano-zirconium dioxide to the cells was detected by CCK-8 assay.The biosafety concentration was selected according to the cytotoxicity,and the cells were randomly divided into a control group,a nano-zirconium dioxide group,and a nano-hydroxyapatite group.Osteogenic differentiation of cells was directionally induced in each group.On day 7 of induced differentiation,alkaline phosphatase staining was performed.qRT-PCR and western blot assay were used to detect the expression of early osteogenic markers(Runx2 and Osx).On day 21 of induced differentiation,alizarin red staining was conducted.qRT-PCR and western blot assay were utilized to determine the expression levels of late osteogenic markers(OPN and OCN). RESULTS AND CONCLUSION:(1)The median lethal concentration of nano-zirconium dioxide on ectomesenchymal stem cells in nasal mucosa was 0.6 mg/mL.In the experiment,the mass concentration of 200 μg/mL was selected for intervention.Zirconium dioxide had no significant effect on the proliferation of the cells.(2)Compared with the control group,the alkaline phosphatase staining of the cells in the nano-zirconium dioxide group was more obvious and the level of cell mineralization was higher,but there was no significant difference compared with the nano-hydroxyapatite.(3)Compared with the control group,the expression of bone-related genes and proteins increased significantly,but there was no significant difference compared with nano-hydroxyapatite.(4)The results show that nano-zirconium dioxide has good biological safety and can promote the osteogenic differentiation of ectomesenchymal stem cells in the nasal mucosa.This promoting effect is equivalent to that of nano-hydroxyapatite.

Objective:To explore the pathogenesis of glossopharyngeal neuralgia (GPN) in central nervous system from perspective of brain morphology.Methods:A prospective study was performed. Twenty-seven patients with right primary GPN admitted to Department of Neurosurgery, People's Hospital of Peking University from April 2019 to June 2023 and 27 healthy subjects (controls) matched with age, gender, dominant hand, and education level during the same period were recruited. These patients were divided into GPN with neurovascular compression group ( n=18) and GPN without neurovascular compression ( n=9) based on intraoperative presence of neurovascular compression. SPM8 software based on Matlab R2017b programming platform and VBM8 toolbox were used to process the whole-brain high-resolution 3D-T1 brain structural image data of the participants and analyze the differences in the gray matter volume of each brain region between the 2 groups. Pearson correlation was applied to analyze the correlations of gray matter volumes in brain regions enjoying significant difference with baseline data and pain characteristics of these GPN patients. Results:Compared with controls, patients with GPN had significantly reduced gray matter volumes in the left anterior cingulate gyrus, middle temporal gyrus, transverse temporal gyrus, precentral gyrus, postcentral gyrus, right insula, thalamus, inferior parietal lobule, precentral gyrus, middle temporal gyrus, and inferior temporal gyrus ( P<0.05, FDR corrected). Compared with GPN patients with neurovascular compression, GPN patients without neurovascular compression had significantly reduced gray matter volume in the bilateral anterior cingulate gyrus ( P<0.05, FDR corrected). Changes of gray matter volume in the right insula were negatively correlated with disease duration of GPN patients ( r=-0.521, P=0.005). Conclusion:GPN patients have extensive gray matter atrophy in the brain, which may play an essential role in GPN development and maintenance.