OBJECTIVE: To evaluate the short-term effectiveness of Ilizarov technique combined with steel needle internal fixation in treating Charcot neuroarthropathy (CN) of the foot and ankle. METHODS: Between June 2020 and December 2023, 12 patients with Eichenholtz stage Ⅲ CN of the foot and ankle were treated with Ilizarov technique and steel needle internal fixation. There were 9 males and 3 females with an average age of 48.6 years (range, 19-66 years). The disease duration ranged from 1 to 16 months (mean, 6.8 months). Ankle joint involvement predominated in 7 cases, while midfoot involvement occurred in 5 cases; 3 cases presented with skin ulceration and soft tissue infection. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 31.2±9.0, 36-Item Short-Form Health Survey (SF-36)-Physical Component Summary (PCS) score was 32.6±6.8, and Mental Component Summary (MCS) score was 47.8±8.4. Postoperative assessments included wound healing, regular X-ray film/CT evaluations of fusion status, and effectiveness via AOFAS and SF-36-PCS, MCS scores. RESULTS: All operations were successfully completed without neurovascular complication. Two patients experienced delayed wound healing requiring intervention, and the others achieved primary healing. All patients were followed up 15-43 months (mean, 23.3 months). Imaging confirmed successful joint fusion within 13-21 weeks (mean, 16.8 weeks). At last follow-up, the AOFAS score was 72.5±6.4, and the SF-36-PCS and MCS scores were 63.2±8.4 and 76.7±5.3, respectively, all of which improved compared to preoperative levels, with significant differences ( P<0.05). CONCLUSION Ilizarov technique combined with steel needle internal fixation effectively restores walking function and achieves satisfactory short-term effectiveness in CN of the foot and ankle.
Humans ; Middle Aged ; Male ; Female ; Adult ; Ilizarov Technique ; Arthropathy, Neurogenic/surgery* ; Aged ; Ankle Joint/surgery* ; Treatment Outcome ; Needles ; Fracture Fixation, Internal/instrumentation* ; Steel ; Young Adult ; Foot Joints/surgery*

The mixed evaluation system uses the network platform as a carrier to construct a dynamic evaluation model that spans time and space between online and offline, between individuals and teams. Mixed evaluation system of physiology was performed for two years, and the process evaluation and the summative evaluation in the mixed evaluation system showed a good correlation, and the students' learning ability and learning effect showed consistency with the evaluation results. Practice has proved that the mixed evaluation system not only optimizes the traditional evaluation system, but also fully expands the five principles of formative evaluation; however, while reflecting the advantages of the network platform, it also exposes the defects of insufficient supervision of the network platform. Thus, we should further improve the mixed evaluation system of physiology.

Objective: To evaluate the effectiveness of the "Internet Plus-based AIDS Comprehensive Prevention Service System" among men who have sex with men in Guangzhou. Methods: Data through case-reporting and follow-up programs on MSM HIV/AIDS in Guangzhou was collected from the China Information System for Disease Control and Prevention, which including those from the referral and follow-up treatment compliance programs in 2008-2014 (pre-treatment) and 2017-2018 (post-treatment). According to the types of care services, three groups were set as: with "Internet Plus" service, with 'HIV counseling/testing service’ or with 'routine medical service’. General Estimating Equation (GEE) was used to analyze the follow up situation of HIV/AIDS cases, annually. Cox proportional hazard regression model was used to analyze the proportions of treatment referral, within the 30 days of diagnosis. Results: Before the implementation of immediate treatment after HIV diagnosis, 90.6% (707/780) of the HIV/AIDS cases received the first follow up program including the CD₄⁺ T cells counts (CD₄) test service within 90 days of diagnosis, in the "Internet Plus-based HIV/AIDS care service" group presented 1.19 times (95%CI: 1.14-1.25) of the routine medical service group. The implementation of immediate treatment after HIV diagnosis, compared with the routine medical service group, the "Internet Plus" service group presented 1.71 times (95%CI: 1.03- 2.83) more treatment referrals within the 30 days of diagnosis, when the first testing CD₄ was ≤200 cells/μl. Compared with the routine medical service group, the HIV counseling and testing service group showed 1.37 times (95%CI: 1.20-1.56) more of the treatment referrals within the 30 days of HIV diagnosis, after the first testing CD₄ counts as >200 cells/μl. Conclusion Standardized care and follow-up service should be promoted as soon as the referral and treatment programs were set after the diagnosis was made, under the "Internet Plus-based AIDS Comprehensive Prevention Service System" for the MSM population, in Guangzhou.

Objective To investigate the correlation between carotid intima-media thickness (CIMT) and left atrial and left ventricular enlargement in patients with acute cerebral infarction. Methods A total of 224 patients with acute cerebral infarction were included. Based on the thickness of CIMT, it was divided into three groups which were normal CIMT group, thickening CIMT group, and carotid plaque (CP) group, with 57, 97, and 70 patients included respectively. Clinical data were collected, and carotid artery color Doppler ultrasound, cardiac color Doppler ultrasound and other examinations were determined to carry out relevant statistical analysis.Results The left anterior-posterior diameter (LAD) , left atrial diameter index (LADI) , left ventricular end-diastolic septal thickness (IVSD) , and left ventricular mass index (LVMI) in the CP group were all higher than those in the normal CIMT group and thickening CIMT group (P < 0.05). The percentage of the left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) took in the thickening CIMT group were both higher than those in the CP group (P < 0.05). Multi-factor logistic regression analysis indicated that there were statistically significant differences in age, homocysteine and left LVMI (P < 0.05). In the Pearson correlation analysis, CIMT and LADI were positively correlated (r= 0.184, P < 0.01) , and there was a positive correlation between CIMT and LVMI (r = 0.236, P < 0.01). Conclusions Left ventricular enlargement is one of the highrisk factors for CIMT abnormalities in patients with acute cerebral infarction. Left atrial and left ventricular enlargement are closely correlated to the severity of CIMT in patients with acute cerebral infarction, indicating that abnormal CIMT in patients with acute cerebral infarction has a certain predictive effect on left atrial and left ventricular enlargement.

To screen the pathogenic mutation location in a genetic family with the neurofibromatosis (NF1) by the next generation sequencing and analyze the clinical phenotype,Illumina Miseq sequencing was applied to capture and analyze the target regions of NF1 family's probands,and furtherly find out the suspicious mutations,as well as to verify the family members by Sanger sequencing.Two rare variants were identified in proband,including the heterozygous missense mutation c.C3649T (p.P1217S) in KIF1B gene and the missense mutation c.T6311C (p.L2104P) on exon 41 of NF1 gene (NM_000267.3).The amino acid at position 2104 was found to be changed from leucine to proline in NF1.The protein prediction SIFT and Polyphen-2 values were 0,0.997,which predicted a conformational change in the encoded protein and eventually affected its function.The mutation c.T6311C in NF1 gene was detected in all patients in this family,which showed genetic co-segregation.The clinical phenotype was neurofibroma in the spinal canal.There were no café au lait spots,iris Lisch nodules,scoliosis,tinnitus,heating loss,or elevated intracranial pressure.The missense mutation c.T6311C (p.L2104P) in NF1 gene might be the genetic cause of this hereditary disease of neurofibromatosis.

Objective To study the effect of enhanced MK gene expression in hepatic carcinoma cells.Methods The recombinant plasmid pIRES2-EGFP-MK was transfected into SMMC 7721 cells.The mRNA and protein expression levels of MK gene in these cells were determined by real-time PCR,Western blotting and flow cytometry.The intracellular DNR accumulation of these cells was measured by flow cytometry.To investigate the effect of MK gene mediated multidrug resistance,MTT assay was employed to determine the cellular sensitivity of different chemotherapeutic drugs in MK-overexpressed SMMC 7721 cells.Results The mRNA and protein expression levels of MK gene significantly increased after the recombinant plasmid pIRES2-EGFP-MK transfected into SMMC 7721 cells,suggesting that the recombinant plasmid pIRES2-EGFP-MK can enhance the transcription of MK effectively.The DNR accumulation of MK transfected cells decreased significantly (4.06 ± 0.88,P ＜ 0.05),and IC50 of MK transfected cells to ADM/5-FU increased significantly (15 ± 3,27 ± 4,P ＜ 0.05).Conclusions After the recombinant plasmid pIRES2-EGFP-MK transfected into hepatic carcinoma cells,expression of midkine increased,enhancing the resistance of hepatic carcinoma cells to chemotherapeutic drugs.

Objective To analyze the clinical value of anterior decompression and fusion with internal fixation and simple decompression in the treatment of cervical vertebral multilevel degeneration.Methods Selected 40 patients with cervical degenerative changes in our hospital from 2012 to 2014,and 20 patients of them underwent anterior decompression and fusion with internal fixation while the other 20 cases took simple decompression.All the patients were well followed up,and the clinical therapeutic effect of the two groups were compared and analyzed.Results After operation,the VAS score and JOA score showed that the scores of the patients underwent anterior decompression and fusion with internal fixation were significandy improved compared with the simple decompression group,and the difference was statistically significant(P ＜ 0.05).Compared with the simple decompression group,the cervical curvature and the curvature of the surgerysection in the anterior decompression and fusion with internal fixation group were significantly improved,especially in the first year after surgery (P ＜ 0.05).The cervical spine joint activity of the two group were improved in the first year after surgery,and the difference was significant (P ＜ 0.05),but there was no significant difference in the degree of cervical joint activity at the last follow-up(P ＞ 0.05).The anterior decompression and fusion with internal fixation is better than simple decompression in the degree of cervical joint activity with statistical significance (P ＜ 0.05).Conclusion The clinical effect of anterior decompression and fusion with internal fixation in treatment of multiple segment degeneration of cervical spine is better than that of simple decompression,it can meet the clinical requirements of biomechanics.

Objective: To investigate the effect of midkine (MK) gene silencing on chemosensitivity of human liver cancer 5-fluorouracil (5-Fu)-resistant cell line Bel/Fu, and to explore its possible mechanism. Methods: The specific sequence targeting MK gene (MK-siRNA) was transfected into Bel/Fu cells, then the expression levels of MK mRNA and protein were detected by real-time fluorescent quantitative PCR and Western blotting, respectively. Bel/Fu cells were transfected with MK-siRNA and treated with 5-Fu, then the proliferation and apoptosis of Bel/Fu cells were detected by MTT and FCM assay, respectively. Furthermore, the expression levels of phosphorylated-phosphoinositide 3-kinase (p-PI3K), phosphorylated-protein kinase B (p-PKB, p-Akt), nuclear factor-kappa B (NF-?B), Bcl-2, survivin and caspase-3 proteins were detected by Western blotting. Results: The expression levels of MK mRNA and protein in Bel/Fu cells transfected with MK-siRNA were significantly down-regulated (both P < 0.05). The half inhibitory concentration (IC50) of 5-Fu in Bel/Fu cells transfected with MK-siRNA was (472± 21) μg/mL, significantly lower than that in untransfected blank control group (2 035 ± 34) μg/mL (P < 0.05). The apoptotic rate of Bel/Fu cells transfected with MK-siRNA was (32.10±3.61)%, significantly higher than that in untransfected blank control group (7.90±0.91)% (P < 0.01). The expression levels of p-PI3K, p-Akt, NF-?B, Bcl-2 and survivin proteins were significantly down-regulated (all P < 0.05), while the expression level of caspase-3 was significantly up-regulated (P < 0.05) in Bel/Fu cells transfected with MK-siRNA. Conclusion: MK gene silencing can enhance the chemosensitivity of hepatocellular cancer Bel/Fu cells to 5-Fu. The mechanism may be involved in activation of PI3K/Akt signal pathway.

Objective To investigate the effects of the popliteofibular ligament (PFL) and/or the popliteus tendon (POP) reconstruction in an external rotation injury model of the knee.Methods Six nonpaired cadaveric knees were tested under the following POP and PFL states:intact,sectioned,and reconstructed using 3 different techniques.Each knee was subjected to 5 N·m external rotation torque at flexion angles of 0°,30°,45°,60°,90°,and 120°.A navigation system was used to measure the motion changes of the tibia with respect to the femur.Results The external rotation increased 2.1°±0.7° (2.0°-2.3°) after sectioning only PFL while flexing the knee from 30° to 120°,and increased 1.3°±1.2° (0.5°-2.0°) after sectioning only POP while flexing the knee from 30° to 120°.There was no significant difference between two groups.There was significant increase in external rotation as 4.1°±1.6° (2.8°-5.0°) after sectioning both POP and PFL.Comparing the POP and POP+PFL reconstruction techniques to the intact state,there were significant differences.The external tibial rotation in POP or POP+PFL reconstruction group was significant different from that in intact or PFL reconstruction group while flexing the knee from 30° to 90°.Conclusion In a LCL-intact PLC injury model,the POP and PFL function as a unit in resisting external rotation.All surgical procedures we described and tested are able to reduce the increased external rotational laxity found in the sectioned state.The PFL reconstruction is able to restore external rotation to near normal.However the techniques involving POP reconstruction over constrained external rotation during laxity testing.

Objective:To assess the efficacy of terbinafine combined with fluconazole in the treatment of recurrent vulvovaginal candidiasis(RVVC).Method:94 patients with recurrent vulvovaginal candidiasis were randomly divided into three groups.30 cases in the terbinafine monotherapy group were treated with an oral 250mg-dose of terbinafine once daily; 31 cases in the fluconazole monotherpy group were treated with an oral 150mg-dose of fluconazole once daily;33 cases in the combined therapy group were given terbinafine and fluconazole together,and the usage and dosage were the same as those of the monotherapy groups.The treatment period of the three groups was 7 days.The efficacy was evaluated in the second week,sixth month and twelfth month after the treatment.Result:In the second week or sixth month or twelfth month after the treatment,the clinical cure rate,clinical effective rate and fungous clearance rate of the combined therapy group were higher than those of the monotherapy groups,which had statistically significant difference.Conclusion:The combined therapy with terbinafine and fluconazole can effectively improve the clinical signs and symptoms of RVVC patients and eliminate candida,which is more effective than the monotherapy with terbinafine or fluconazole.