Objective To evaluate the clinical outcomes of treating Freiberg's disease with dorsal wedge osteotomy and Charlotte breakage screw fixation.Methods From June 2010 to June 2014,11 patients with Freiberg's disease were treated at our department.They were 5 males and 6 females at an average age of 32 years(range,from 15 to 52 years).X-ray revealed osteosclerosis and collapse of the metatarsal head.According to Smillie classification system,there were 5 cases of stage Ⅱ and 6 ones of stage Ⅲ.The duration of symptoms was from 7 to 48 months (average,23 months).The metatarsal heads were rotated to reconstruct the joint surface.After dorsal closed V-shaped osteotomy,Charlotte breakage screws were implanted.Results All wounds healed with no complications in the early postoperative period.The 11 patients were followed up for 14 to 48 months (average,19 months),showing obvious pain relief.X-ray showed that the osteotomy sites got solid union in all patients at an average time of 10 weeks (range,from 8 to 13 weeks) after operation.Average shortening of the metatarsal was 1.5 mm (range,from 1.1 to 1.8 mm).The American Orthopaedic Foot and Ankle Society(AOFAS) score,Lesser Metatarsophalangeal-Interphalangeal Scale(LMIS) score,and range of motion at one day,one month and one year after operation were significantly improved compared with the preoperative ones (P ＜ 0.05).Significant differences were also observed between all postoperative time points (P ＜ 0.05).No such complications happened as referred pain from the adjacent metatarsophalangeal joint,displacement,nonunion,necrosis or infection.All patients returned to sports and recreational activities at 6 months after operation,except one case of stage Ⅲ who had constant swelling in the metatarsophalangeal joint but eventually recovered at 10 months after operation.According to patients' satisfaction at the last follow-ups,including 7 cases were excellent,3 good and one poor.Conclusion Dorsal closed V-shaped osteotomy with Charlotte breakage screw fixation is an effective procedure for Freiberg' s disease of stages Ⅱ and Ⅲ,because it leads to effective reconstruction of the metatarsophalangeal joint,allows early joint motion and avoids a second operation.

Although DNA vaccination is now a promising strategy against hepatitis B virus (HBV) infection, this approach has relatively modest antiviral effect, indicating that immunosuppressive mechanisms may occur in the long-term established infection. In this study, we studied the immunogenicity and anti-HBV efficiency of a combination of HBV surface (HBsAg) and core (HBcAg) DNA vaccine, enhanced by heat shock protein (HSP) gp96 or HSP70 and mediated by in vivo electroporation. Immunization with gp96 adjuvanted HBsAg/HBcAg DNA formulation induced potent T cell and antibody immunity against HBsAg and HBcAg. Notably, treatment with gp96 or HSP70 as adjuvant resulted in reduction of Treg populations by around 20%. Moreover, compared with nonimmunized control mice, immunization with gp96 or HSP70 adjuvanted DNA vaccine dramatically decreased serum HBsAg and viral DNA levels, and HBcAg expression in liver. These results may therefore provide an effective strategy for designing gp96-based DNA vaccine for immunotherapy of chronic HBV infection.
Adjuvants, Immunologic ; Animals ; Electroporation ; HSP70 Heat-Shock Proteins ; immunology ; Hepatitis B Core Antigens ; immunology ; Hepatitis B Surface Antigens ; immunology ; Hepatitis B Vaccines ; immunology ; Hepatitis B, Chronic ; prevention & control ; Immunization ; Membrane Glycoproteins ; immunology ; Mice ; Mice, Transgenic ; Vaccines, DNA ; immunology

Objective To explore the weight for the training target of Applied nursing undergraduate. And find the degree of importance for the indexes of the target , thus highlighting theApplied training objective characteristics. Methods Developed by Bloom's teaching objectives classification theory and educational objectives theory to refined indexes, using Delphi method to establish the Applied nursing undergraduate training objectives. By the importance assignment from experts on each index, using analytic hierarchy process (AHP) method to construct the judgment matrix. Then calculate the weight of each index weight, and test its logical consistency. Results The weight of theattitudes and valueswas 0.56, andknowledgeandabilitywere 0.22. For the secondary indicators, in the values dimension,professional attitudeandideological qualityhad relatively high weight.Under the knowledge dimension, the professional knowledge had the highest weight; and for the ability dimension,communication skillsandapplicationswere heavily maximum. All the random consistency rates (CR) for the indexes were less than 0.10, so there was no logical confusion. ConclusionsAppliednursing undergraduate talents need to combine theory and practice quickly into clinical work. By weight setting, this study provides basis to further quantify and highlight the Applied nursing undergraduate training features, and provides the basis for the application-oriented undergraduate nursing personnel reforms.

Objective To develop the Applied nursing undergraduate students training framework objective, clear the entry of applied training target for undergraduate nursing students. Methods Through literature review and panel discussions, Delphi expert consultation questionnaires were preliminary designed. 23 experts were issued via email and paper questionnaires, conducted two expert advice and analysis. Results A total of 20 valid questionnaires were recovered after two consultation. The expert advice of good scientific reliability:experts had positive reply, and the authority level was 0.857, Kendall were 0.130-0.293, it showed a good level of coordination (P < 0.05). By two rounds of expert advice, three capacity index target level for Applied nursing undergraduate students training were gotten: attitudes, values and basic literacy; knowledge of the target; the ability. The secondary capacity index for target had 15 items, and the third capacity index had 63 items. Conclusions TheAppliednursing undergraduate students training objectives and targets were refined through Delphi which provide the basis for the Applied nursing undergraduate training model and curriculum reform.

Secretory anti-gp96 scFv fragment was expressed in Pichia pastoris to obtain a small molecule antibody that specifically recognizes heat shock protein gp96. The gp96-scFv fragment gene was synthesized and cloned to Pichia pastoris expression plasmid pPICZa-A. Pichia pastoris X33 was electroporated with the linearized recombinant expression vector, and expression of gp96-scFv fragment was induced by methanol. The His-tagged recombinant protein was then purified by affinity chromatography and analyzed with SDS-PAGE and Western blotting assays. The biological activities of recombinant gp96-scFv fragment were determined by Western blotting, Immunofluorescence, ELISA and FACS assays. The gp96-scFv fragment was expressed successfully in Pichia pastoris. About 50 mg of recombinant protein could be purified from 1 liter of the Pichia pastoris culture supernatant. Its molecular weight was about 15 kDa. The gp96-scFv fragment could specifically bind to gp96 protein by Western blotting, immunofluorescence, ELISA and FACS analyses. Pichia pastoris-expressed gp96-scFv fragment specifically recognizes gp96 protein, which could be used for Western blotting, Immunofluorescence, ELISA and FACS analyses.
Blotting, Western ; Chromatography, Affinity ; Electrophoresis, Polyacrylamide Gel ; Enzyme-Linked Immunosorbent Assay ; Membrane Glycoproteins ; immunology ; Pichia ; metabolism ; Plasmids ; Recombinant Proteins ; biosynthesis ; Single-Chain Antibodies ; biosynthesis

Objective To evaluate open reduction and internal fixation (ORIF) combined with Ilizarov joint distraction in the treatment of comminuted talar body fractures.Methods Between July 2010 and May 2016,16 patients with comminuted talar body fracture underwent ORIF followed by ankle joint distraction by Ilizarov external fixator at our department.They were 9 males and 7 females,aged from 17 to 56 years (average,35.6 years).Radiological assessments were conducted by plain radiographs and computed tomography (CT) scans pre-and post-operatively.Clinical outcomes were evaluated according to visual analogue scale (VAS),American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score,the short form (SF)-36 health survey scores and patients' satisfaction.Results Two patients were lost to follow-up.The remaining 14 patients were followed up for an average duration of 33.3 months (from 13 to 52 months).All the fractures united.Superficial wound infection occurred in one case.Eight patients developed post-traumatic osteoarthris;4 patients presented with avascular necrosis.At final follow-ups,the AOFAS scores ranged from 30 to 97 points (mean,69.8 points),the VAS scores from 0 to 6 points (mean,2.5 points),the physical component summary in SF-36 from 18.0 to 55 points (mean,41.7 points),and the mental component summary from 40 to 70 points (mean,54.1 points).Two patients reported strong satisfaction,5 satisfaction,4 moderate satisfaction,and 3 dissatisfaction.Conclusion For comminuted talar body fractures,ORIF combined with Ilizarov joint distraction is a new and effective treatment which can not only provide adequate fixation strength but also reduce the incidence of post-traumatic osteoarthris or avascular necrosis.

Objective To investigate the influence of moderate to severe leukoaraiosis (LA) in prognoses of acute ischemic stroke patients after endovascular treatment.Methods From January 2017 to December 2018, 60 patients with acute ischemic stroke due to anterior circulation large vessel occlusion underwent endovascular treatment and obtained complete vessel recanalization in our hospital were evaluated for degrees of LA severity according to head CT scan and van Swieten scale (2-4 scores were defined as moderate-severe LA). According to modified Rankin scale (mRS) scores 90 d after treatment, the patients were divided into poor prognosis group and good prognosis group. Univariate analysis was used to compare the differences of influencing factors of the two groups. Multivariate Logistic regression analysis was further used to explore the influence of moderate to moderate-severe LA in poor prognosis of patients after endovascular treatment.Results Of the 60 patients, 18 did not have LA, 19 had mild LA, and 23 had moderate-severe LA; 32 had poor prognosis and 28 had good prognosis. Univariate analysis showed that the patients from the poor prognosis group had significantly higher proportion of moderate-severe LA (59. 4％ [19/32]vs. 14.3％ [4/28]), significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores ([23.4±10.1]vs. [14.7±7.0]), significantly higher baseline diastolic blood pressure ([87.5±18.9] mmHgvs. [78.3±15.1] mmHg), significantly higherproportion of patients with hypertension history (68.8％ [22/32]vs. 42.9％ [12/28]), and statistically older age ([70.6±9.4] yearsvs. [61.3±12.5] years) than the patients from the good prognosis group (P<0.05). On multivariable Logistic regression analysis, the presence of moderate-severe LA (OR=5.032, 95％CI: 1.026-24.679,P=0.046) and baseline NIHSS scores were independent risk factors for poor prognosis of patients after endovascular treatment.Conclusion Patients with acute ischemic stroke accompanied with moderate-severe LA are more likely to have poor prognosis after endovascular treatment.

OBJECTIVETo explore the safety and feasibility of cervical triangulating stapled anastomosis(TSA) for esophagogastric anastomosis(EGA) after minimally invasive esophagectomy (MIE).

METHODSClinical data of 137 patients undergoing MIE for esophageal cancer(EC) in our department from January 2013 to March 2014 using end to side circular stapled anastomosis (CSA, 60 cases) or end-to-end triangulating stapled anastomosis (TSA, 77 cases) in the neck were retrospectively analyzed. The short-term outcomes between the two groups were evaluated and compared.

RESULTSCervical anastomotic leakage occurred in 3 patients(3.9%) of TSA group, but in six(10.0%) of CSA group (P=0.152). The incidence of anastomotic stenosis was 1.3%(1/77) and 15.0%(9/60) in TSA and CSA group respectively(P=0.002). The median hospital stay and perioperative mortality were not significantly different between the two groups as well as postoperative respiratory and cardiovascular complications.

CONCLUSIONSTSA is a safely and effectively alternative method for EGA with lower incidence of postoperative gastrointestinal complications, especially in anastomotic stricture.

Anastomosis, Surgical ; methods ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Neck ; surgery ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

Objective Childhood asthma is closely related to MP infection.This study was to investigate the distribution of ORMDL3 and HLA-DQ gene SNP in children with MP-associated asthma and gene-gene interactions.Methods One hundred and ninety-four patients with MP infection were enrolled.Extraction of whole blood genomic DNA was carried out.The genotype was collected by Flnidigm Juno 96.96 Genotyping integrated fluid pathway system.The patients were divided into MP-asthma group and MP-non-asthma group.Gene-gene interaction was analyzed by generalized multifactor dimensionality reduction.Results MP-asthma group included 63 cases (32.5％),MP-non asthma group included 131 cases (67.5％).ORMDL3 gene rs4794820 had three genotypes of AG,GG,AA.,MP-asthma group GG genotype and G allele frequency was higher than that in MP-non-asthma group.The frequency of AA genotype was the lowest among the two groups,but in the MP-non-asthma group were higher than that in the MP-asthma group.The rs7216389 had three genotypes of TT、TC、CC,the frequency of TT genotype and T allele in MP-asthma group was significantly higher than that in MP-non-asthma group.The frequency of CC genotype was the lowest among the two groups,but CC genotype in MP-non-asthma group was significantly higher than that in MP-asthma group.The rs794820 GG genotype and rs7216389 TT genotype were found to be risk factors.ORMDL3、HLA-DQA1 and HLA-DQA2 have gene-gene interaction.Conclusion MP infection is an important external cause of asthma in children.The genotype of rs7794820 GG genotype and rs7216389 TT genotype are an important internal cause of asthma after childhood MP infection.ORMDL3 rs4794820,rs7216389 and HLA-DQA1 rs9272346,HLADQA2 rs7773955 have gene-gene interaction,synergistically enhance the risk of asthma associated with asthma in children with MP.

Objective To analyze the clinical outcomes of a standard protocol of open reduction and internal fixation using a variable angle foot plate for a consecutive series of patients with acute Lisfranc joint injury.Methods This study retrospectively evaluated the clinical outcomes of 11 Chinese patients(13 feet) with acute Lisfranc joint injury who had been treated by open reduction and internal fixation with a variable angle foot plate from December 2016 to June 2017 at Department of Orthopaedics,West China Hospital.They were 8 men(10 feet) and 3 women(3 feet),aged from 19 to 57 years(average,36.4 years).Of them,10 were complicated with fracture of metatarsus,6 with cuneiform fracture and/or dislocation,4 with cuboid fracture,and one with cuboid fracture.According to the Myerson classification for Lisfranc fracture-dislocations,one case(one foot) belonged to type A,2(2 feet) to type Bl,5(6 feet) to type B2,2(3 feet) to type Cl and one(one foot) to type C2.The outcomes were evaluated using the visual analogue scale(VAS) and the midfoot scores of American Orthopedic Foot and Ankle Society(AOFAS).Results This cohort was followed up for 18 to 24 months(average,22 months).Their VAS scores were decreased significantly from preoperative 7.3±1.2(from 6 to 9) to postoperative 1.2±0.2(from 0 to 2)(P<0.05);their AOFAS midfoot scores were increased significantly from preoperative 0 to postoperative 84.6±4.6(P<0.05) Anatomic reduction was obtained in all the patients and all the fractures united successfully without any delayed union or nonunion.Superficial necrosis of the wound edge occurred in 2 cases without deep infection;skin anesthesia occurred in 2 and skin hypesthesia in 4,indicating a lesion of the superficial peroneal nerve.Conclusion Fixation of acute Lisfranc joint injury with a variable angle foot plate can lead to rigid stability,precise reduction and satisfactory short-term clinical outcomes.