The professional care by multi-disciplinary team and priority of prevention should be carried out in the treatment of diabetic foot disease to reduce diabetic amputation.This article describes the professional experience in the treatment of four complicated cases with diabetic foot disease and emphasizes the importance of the co-operation among different specialists,including diabetologists and wound,vascular,orthopedic surgeons,etc.as well as of varied therapies applied in staged management of the diabetic foot care,by treating these patients with diabetic foot disease as early as possible.

Objective To investigate the clinical value of serum ferritin (SF) combined with 4 tumor mark-ers in the early diagnosis of lung cancer in elderly patients .Methods 185 cases of elderly patients with early-stage lung cancer as lung cancer group ,60 cases of elderly patients with benign lung disease as benign lung disease group ,50 healthy people were enrolled as healthy control group ,compared three groups of subjects of serum SF ,carbohydrate antigen 125 (CA125 ) ,carcinoembryonic antigen (CEA ) ,neuron-specific enolase (NSE) ,cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) expression and sensitivity ,specificity ,ROC curve analysis of the diagnostic index value .Results CA125 ,SF ,CEA ,NSE and CYFRA21-1 in lung cancer group , were higher than those of benign lung disease group and healthy control group ,the difference was statistically significant (P＜0 .05) ;SF ,CA125 ,CEA ,NSE and CYFRA21-1 of the benign lung disease group and healthy control group ,which showed no difference (P＞0 .05) .SF and NSE were the highest in patients with small cell lung cancer ,the difference was statistically significant (P＜0 .05) ,CA125 and CEA were the highest in adeno-carcinoma patients ,the difference was statistically significant (P＜0 .05) ,and CYFRA21-1 was the highest in squamous cell carcinoma patients ,the difference was statistically significant (P＜0 .05) .Compared with the single diagnosis of each index ,the sensitivity of combined detection of the five indicators increased ,the differ-ence was statistically significant (P＜0 .05) ,while the specificity did not change ,the difference was not statis-tically significant(P＞0 .05) .The area under the ROC curve of SF ,CA125 ,CEA ,NSE and CYFRA21-1 was 0 .808 ,0 .762 ,0 .761 ,0 .712 and 0 .781 ,respectively .The area under the ROC curve of the 5 indexes was 0 .915 . Conclusion Serum ferritin combined with 4 tumor markers can improve the diagnostic sensitivity of early eld-erly patients with lung cancer ,and effectively improve the diagnostic value of patients ,thereby contributing to the improvement of the clinical prognosis of patients .

Objective: The purpose of this study was to determine the relationship between TCM pattern and Hp infection and apoptosis of stomach mucosa in chronic gastritis, to discover the substance of TCM Pattern of chronic gasuitis on genetic molecular level and to establish syndrome differentiation system of chronic superficial gastritis on molecular level Methods: Get gastric mucosa tissue by electronic gastroscope. Hp infection, expression of Fas and bel-2 of 41 cases of incoordination between the liver and stomach group (IBLS group) and 50 cases of Dampness-beat in spleen and stomach(DHSS group) of chronic superficial gastritis were investigated by immunohistocbemistry examination, with 10 healthy persons as control group. Muti-factor non-condition logistic regression analysis was adopted to analyze the data. Results: The positive rate of HP was of 22%, 52% and 10% respectively in the IBLS group, the DHSS group and the control group. The positive rate of HP in the DHSS group was significant higher than in the IBLS and control group, showing there is a significant correlation between DHSS patern and HP infection. The expression rate of bcl-2 antigen was 24.2%, 76.0% and 30.0% respectively in the IBLS, DHSS and control group. The expression rate of bcl-2 antigen in the DHSS group was significant higher than in and the IBLS and control group(P＜0.01), showing there was significant correlation between DHSS pattern and expression rate of bcl-2 antigen(P＜0.01). The expression rate of Fas antigen was 70.7% and 46% respectively in the IBLS and DHSS group, the expression rate of Fas antigen in the IBLS group was significant higher than in DHSS group(P＜0.01), showing there was a significant correlation between IBLS pattern and expression rate of Fas antigen(P＜0.01).Conclusion: The result suggested that there was a certain relationship between HP infection and TCM pattern, the positive rates of HP was higher in DHSS pattern compared with the IBLS group. There was a certain relationship between the expression of bcl-2 and Fas in DHSS pattern, IBLS pattern may probably promoted apoptosis in gastritis, whereas HP infection performed as a main role in apoptosis in DHSS pattern. Bcl-2, liP and Fas might contribute to syndrome differentiation of chronic gastritis.

In conventional ear implantation surgery, clinical physicians usually make a surgery planning based on their observation on series of 2D X-ray images or CT images. Such a planning method requires the physicians to have a high level of clinical experience. Besides, the whole operation is unintuitive, and might have certain risk. Considering these facts, we have developed a computer-aided system for the surgery planning of the implantation of artificial ear based on CT imaging and 3D reconstruction techniques. The system effectively overcomes the main drawbacks in conventional surgery planning techniques, and it makes the surgery planning procedure more precise, safe, and intuitive.
Artificial Organs ; Ear ; abnormalities ; Humans ; Imaging, Three-Dimensional ; Prosthesis Implantation ; methods ; Surgery, Computer-Assisted ; methods ; Tomography, X-Ray Computed

Objective:To discuss the surgical strategies for anteromedial tibial plateau compression fracture complicated with posterolateral corner injury.Methods:From 2015 January to 2020 July, 18 patients with anteromedial tibial plateau compression fracture complicated with posterolateral corner injury were admitted to Department Ⅲ of Orthopaedics, Zhongshan Hospital of Traditional Chinese Medicine. They were 11 males and 7 females, aged from 28 to 57 years (average, 38.6 years). By the CT three-column theory, all their fractures were medial column ones; by the Fanelli classification, there were 5 cases of type B and 13 cases of type C. Seventeen patients with fresh fracture were treated with arthroscopic ligament reconstruction and meniscus repair followed by primary reduction and fixation of tibial plateau fracture. The one patient with obsolete injury was treated with high tibial osteotomy around the knee joint and reconstruction of the anterior cruciate ligament. Recorded were the patients' fracture healing time, knee Lysholm score, joint range of motion and complications.Results:The 17 patients with fresh injuries were followed up for 12 to 24 months (average, 18.4 months). Their fracture healing time ranged from 12 to 24 weeks (average, 17.7 weeks). By one year after surgery, their knee extension reached 0° and their knee flexion from 120° to 135° (average, 131.9°); their knee Lysholm scores ranged from 88 to 95 points (average, 91.2 points). The one patient with old injuries was followed up for 18 months, with fracture healing time of 18 weeks, knee range of motion from 0° to 120° and knee Lysholm score of 86 points by one year after operation. None of the patients reported such complications as neurovascular injury, wound infection, internal fixation failure or nonunion.Conclusion:For anteromedial tibial plateau compression fracture complicated with posterolateral corner injury, primary repair and reconstruction can restore knee joint stability, leading to fine therapeutic outcomes.

Objective:To evaluate the effect of preoperative mild cognitive impairment (MCI) on the potency of sevoflurane in inhibiting body movement responses during skin incision in aged female patients.Methods:This was a prospective study. Female American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 60-75 yr, with body mass index of 18.5-23.9 kg/m 2, scheduled to undergo radical mastectomy between January 2022 and March 2023 in our hospital, were selected. The patient′s cognitive function was assessed using Mini-Mental State Examination and Montreal Cognitive Assessment. The patients were divided into 2 groups based on whether they had MCI or not before operation: normal group (group N) and MCI group (group M). General anesthesia was induced by inhaling 8% sevoflurane, and the laryngeal mask airway was inserted after they lost consciousness and their jaws relaxed. According to the Dixon′s up-and-down method, the end-tidal concentration of sevoflurane in the first patient was set at 2%. If the body movement response occurred, the concentration was increased by 2% in the next patient, otherwise the concentration was decreased by 2% in the next patient. The MAC and 95% confidence interval ( CI) of sevoflurane were calculated using the probability regression method. Results:The minimum alveolar concentration of sevoflurane was 1.60% (95% CI 1.48% -1.70%) in group N and 1.38% (95% CI 1.25%-1.49%) in group M, and there was statistically significant difference ( P<0.05). Conclusions:Preoperative MCI can increase the potency of sevoflurane in inhibiting body movement responses during skin incision in aged female patients.

Objective:To study the expression level of peripheral blood microRNA(miRNA)-21 and miRNA-192 in patients with papillary thyroid carcinoma (PTC) and their relationship with pathological features and prognosis.Methods:A total 107 PTC patients admitted to Huaian Cancer Hospital in Jiangsu Province from June 2018 to June 2021 were selected as the PTC group, another 76 healthy individuals who underwent physical examination during the same period were selected as the control group. Real-time fluorescence quantitative PCR (qRT-PCR) was used to measure the expression levels of miRNA-21 and miRNA-192 in the peripheral blood of two populations, and the expression of miRNA-21 and miRNA-192 in the peripheral blood of the two populations and patients with different characteristics was compared and analyzed. Kaplan-Meier (K-M) method was used to analyze the relationship between the expression levels of miRNA-21, miRNA-192 in peripheral blood of PTC patients and prognosis.Results:The expression level of miRNA-21 in the peripheral blood of patients in the PTC group (2.21 ± 0.64) was higher than that in the control group (1.01 ± 0.02), while miRNA-192 (0.42 ± 0.14) was lower than that in the control group (0.99 ± 0.03, t = 16.33, 34.90, P < 0.001). In different clinical stages, the expression level of miRNA-21 in peripheral blood of patients in stages Ⅲ - Ⅳ was higher than that in stages Ⅰ - Ⅱ, and the level of miRNA-192 was lower than that in stages Ⅰ - Ⅱ ( t = 9.98, 11.75, P < 0.001). In the case of lymph node metastasis, the expression level of miRNA-21 in peripheral blood of patients with lymph node metastasis was higher than that of the group without lymph node metastasis, and the level of miRNA-192 was lower than that of the group without lymph node metastasis ( t = 12.81, 18.75, P < 0.001). There was no statistically significant difference in the expression levels of miRNA-21 and miRNA-192 in peripheral blood of patients with different genders, ages, body mass index, and tumor sizes ( t = 0.57, 0.42, 0.54, 0.62, 1.15, 1.47, 0.74, 1.13, P > 0.05). The K-M survival curve results showed that the progression free survival time (39.02 months) with high miRNA-21 expression was lower than that with low miRNA-21 expression (55.97 months, P = 0.026); the progression free survival time (34.97 months) with low miRNA-192 expression was lower than that with high miRNA-192 expression (57.04 months, P = 0.008). Conclusion:The high expression of miRNA-21 and low expression of miRNA-192 in peripheral blood of PTC patients, and they are closely related to the clinical stage, lymph node metastasis, and prognosis of patients.

Objective:To This study was to investigate the expression and possible clinical significance of microRNA-146b (miR-146b) and signal transducer and transcriptional activator 1 and 3 (STAT1/3) in peripheral blood mononuclear cells (PBMCs) of patients with primary gouty arthritis (GA).Methods:The peripheral blood samples, clinical data and laboratory indexes of 120 male cases of GA [including 57 cases of acute (AG group) and 63 cases of intermittent (IG group)]and 66 healthy subjects (HC group) were collected. The expression levels of miR-146b and STAT1/3 in PBMCs were detected by real-time fluorescence quantitative PCR (RT-qPCR). The differences among the three groups were compared and the correlation between them and clinical indexes was analyzed. The receiver operating characteristic curve (ROC) was constructed to evaluate its diagnostic value in GA. After the PBMCs of 18 healthy subjects were stimulated by 100 μg/ml MSU for 3 hours to simulate acute gout inflammatory environment, the transcriptional changes of IL-1β, miR-146b and STAT1/3 were detected by RT-qPCR, and the expressions of IL-1β, STAT1/3 protein and phosphorylated protein were detected by Western blotting. T test or one-way ANOVA and LSD- t test were used in accordance with the normal measurement data, Kruskal-Wallis H and Mann-Whitney U test were used in the non-normal data, Spearman correlation analysis was used in the correlation between variables, and the diagnostic value was evaluated by the receiver working characteristic curve ROC. Results:①There were statistical differences in the expression of miR-146b, STAT1 and STAT3 among the three groups ( F=7.02、19.52、17.07, all P<0.001). The expression of miR-146b in gout group [(0.32±0.28)] was significantly higher than that in HC group (0.19±0.18)( t=2.96, P=0.003), while STAT1(0.019±0.012) and STAT3(0.014±0.010) were significantly lower than those in HC group (0.038±0.029),(0.025±0.016)( t=6.26, 5.56, both P<0.001). Further subgroup analysis showed that the expression of miR-146b in AG and IG groups was higher than that in HC group[(0.27±0.17), (0.38±0.35), (0.19±0.18), t=2.09, 3.30, both P<0.05], but that in AG group was lower than that in IG group ( t=2.02, P<0.05). The expression of STAT1 mRNA in AG and IG groups was lower than that in HC group [(0.020±0.012), (0.019±0.012), (0.038±0.029), t=4.89, 4.56, both P<0.001], but there was no statistical significance between AG and IG groups ( t=0.24, P>0.05). The expression of STAT3 mRNA in AG and IG groups was lower than that in HC group [(0.016±0.012), (0.012±0.008), (0.025±0.016), t=5.64, 3.33, both P<0.01], and the expression of STAT3 mRNA in AG group was higher than that in IG group ( t=2.12, P<0.05). ② Spearman correlation analysis showed that the expression of miR-146b in GA was negatively correlated with HCY ( r=-0.37, P=0.014), STAT1 was negatively correlated with Crea ( r=-0.29, P=0.019), positively correlated with eGFR ( r=0.25, P=0.047), and STAT3 was negatively correlated with HDL-C ( r=-0.27, P=0.033). ③ROC curve showed that the AUC (95% CI) of miR-146b, STAT1 and STAT3 were 0.679(0.582, 0.776), 0.710(0.629, 0.791) and 0.705(0.626, 0.783), and the combined AUC(95% CI) of the three was 0.836 (0.765, 0.907). ④Compared with blank control group and negative control group, the expression of miR-146b in PBMCs of 18 cases of HC was significantly decreased ( H=14.44, P=0.003), while the expression of IL-1β, STAT1 and STAT3 mRNA was significantly increased after 3 h of MSU stimulation ( H=26.44、27.26、15.90, all P<0.001). The expression of IL-1β, STAT1 and STAT3 protein and phosphorylated protein in the model group were significantly higher than those in the blank control group, and the differences were statistically significant ( t=9.97、6.63、7.48、11.25、6.28, all P<0.01). Conclusion:The abnormal expression of miR-146b and STAT1/3 in GA is related to some clinical indicators, suggesting that it may be involved in the regulation of gout immune inflammatory response and metabolism, and the specific mechanism is worth further study.