Objective:To investigate whether deltoid ligament (DL) injury produces axial-plane rotational instability of the ankle in patients with chronic ankle instability (CAI).Methods:A retrospective study was conducted to analyze the 33 patients with CAI who had been treated at Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University between January 2023 and December 2024. The cohort consisted of 17 males and 16 females with an age of (31.5±9.9) years. The patients were assigned into 2 groups based on the presence of DL injury: a lateral chronic ankle instability (LCAI) group ( n=17) and a rotational ankle instability (RAI) group ( n=16). Barefoot natural walking trials were performed in all patients. Three-dimensional kinematic data were synchronously collected using an optical motion capture system (12 cameras) and force plates. A lower extremity model was constructed to obtain shank axial rotation (internal/external rotation) and rear-foot inversion/eversion angles. Continuous relative phase (CRP) analysis was employed to assess shank-rearfoot movement coupling. The mean absolute relative phase (MARP) and deviation phase (DP) were calculated. Results:There was no statistically significant difference in the clinical baseline data between the 2 groups, indicating comparability ( P>0.05). Throughout the gait cycle, no significant differences were found in shank rotation angles or rear-foot eversion angles between the RAI group and the LCAI group. However, CRP analysis revealed that during the early stance phase (initial contact and loading response), shank-rearfoot coupling was significantly lower in the RAI group than in the LCAI group. In the early stance phase, the CRP values in the RAI group were significantly higher than those in the LCAI group. The CRP curve changes in the RAI group were consistently higher in the standce phase of the entire gait cycle than those in the LCAI group, and the peak value of the CRP curve was larger in the RAI group. Concurrently, the RAI group exhibited significantly higher MARP and DP values than the LCAI group (27.48°±14.54° versus 15.21°±9.56°; 26.02°±11.73° versus 17.83°±9.82°) (both P<0.05). Conclusion:DL injury significantly damages the axial rotational stability of the ankle joint and significantly exacerbates the mechanical instability of the ankle joint in CAI patients.

In the non-acute phase, when the collateral circulation is poorly compensated due to atherosclerotic occlusion of the middle cerebral artery, it can lead to significant neurological dysfunction and a higher recurrence rate of stroke. Traditional treatments primarily involve managing risk factors and administering symptomatic pharmacotherapy, yet the outcomes are often unsatisfactory. In recent years, with the development of endovascular interventional techniques and interventional materials, microsurgical anastomosis, techniques, and the present of distal ischemic modulation, the treatment of symptomatic arteriosclerosis occlusion of the non-acute middle cerebral artery is attracting more and more attention in the field. This article reviews the progress of the treatment of symptomatic arteriosclerosis occlusion of the non-acute middle cerebral artery. For the surgical treatment of symptomatic non-acute middle cerebral artery atherosclerosis occlusion (SNMCAO) in non-acute phase, the superior temporal artery middle cerebral artery (STA-MCA) low flow bypass and intravascular interventional recanalization have their own advantages. For patients with short expected occlusion time, short occlusion segment, straight blood vessels, and good distal vascular bed, they may be more inclined to undergo endovascular recanalization treatment, otherwise they may choose STA-MCA low flow bypass surgery. Regardless of which treatment method is chosen, precise individualized evaluation must be conducted before surgery to select an individualized surgical approach that can maximize the benefits for patients with SNMCAO.

Human papillomavirus (HPV) can cause various tumors such as cervical cancer in women. Further study of HPV infection and its pathogenic mechanism, as well as the development of vaccines and anti-tumor drugs, have been hindered due to the strong host specificity and tissue affinity of HPV, along with the challenges in in vitro culture and the lack of animal infection models. To advance the study of HPV infection and its pathogenic mechanism and to development better prevention and treatment measures, it is important to establish an animal model that closely resembles the infection and pathogenesis pathways in humans. This article reviews previous research on HPV-related animal models using mice, rabbits, macaques, and Drosophila, including infectious models, tumor models, and transgenic models, aiming to provide reference for the selection of appropriate animal models for HPV-related research.

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Objective To investigate the role of matrix GLA protein(MGP)in the pathogenesis of idiopathic calcium oxalate kidney stones(ICOS),and to find potential biomarkers for early diagnosis and disease evaluation.Methods A total of 120 patients admitted to our hospital from September 2021 to September 2023 were prospectively included,of which 60 patients with ICOS were in the calculus group and 60 patients without calculus were in the control group.Serum biochemical indexes and immunohistochemical scores of the two groups were detected,urinary MGP levels were determined by ELISA,and MGP mRNA and protein expression in renal papilla tissues were detected by qPCR and Western blot.The independent risk factors of ICOS were screened by Logistic regression analysis,and the prediction model was drawn by nomogram.Results Compared with control group,urinary MGP content in calculus group was decreased[(1 805.91±244.44)pg/ml vs.(2 014.79±252.14)pg/mnl,P＜0.05).Expression of MGP mRNA and MGP protein in renal papillae decreased(0.89±0.15 vs.1.00±0.00,P=0.001)and decreased(0.87±0.18 vs.1.00±0.00,P＜0.05).MGP immunohistochemical scores of renal tissue were decreased[4(2-6)scores vs.6(4-8)scores,P＜0.001].Multivariate analysis showed that urinary calcium(OR=1.370),urinary MGP(OR=1.127),renal papilla MGP relative expression level(OR=27.532)and renal tissue MGP immunohistochemical score(OR=1.359)were independent risk factors for ICOS.Area under ROC curve of the nomogram prediction model built based on the above factors is 0.839,indicating that the model has good differentiation ability in risk prediction.Conclusion MGP is closely related to the pathogenesis of ICOS.Urinary and renal tissue MGP levels may be potential biomarkers for early diagnosis and disease assessment of ICOS.

Objective To explore and analyze the characteristics and transmission routes of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains in intensive care unit(ICU).Methods From January to October 2023,17 clinical infection isolates(clinical infection group),5 active screening isolates(active screening group),and 7 envi-ronmental isolates(environmental group)of CRKP in the liver surgery ICU of a hospital were selected and analyzed by whole-genome sequencing.The differences in resistance genes,virulence genes,and sequence typing(ST)were compared,and transmission routes were analyzed based on the phylogenetic tree.Results 29 strains of CRKP car-ried 4-18 resistance genes and 52-98 virulence genes,respectively.There were no statistically significant diffe-rences in genotype distribution of resistance genes,the number of virulence genes,and gene types among three groups of CRKP(all P＞0.05).ST showed that 29 CRKP strains mainly consisted of two categories:ST11 and ST15.Based on the phylogenetic tree constructed from the core genome,there were 7 highly homologous groups of CRKP,among which 4 groups had clear epidemiological associations.Conclusion CRKP in ICU carries more re-sistance and virulence genes,and some strains are highly homologous in ST and phylogenetic tree,which may lead to cross transmission.In the future,prevention and control measures should be strengthened to reduce the trans-mission of CRKP.

In the non-acute phase, when the collateral circulation is poorly compensated due to atherosclerotic occlusion of the middle cerebral artery, it can lead to significant neurological dysfunction and a higher recurrence rate of stroke. Traditional treatments primarily involve managing risk factors and administering symptomatic pharmacotherapy, yet the outcomes are often unsatisfactory. In recent years, with the development of endovascular interventional techniques and interventional materials, microsurgical anastomosis, techniques, and the present of distal ischemic modulation, the treatment of symptomatic arteriosclerosis occlusion of the non-acute middle cerebral artery is attracting more and more attention in the field. This article reviews the progress of the treatment of symptomatic arteriosclerosis occlusion of the non-acute middle cerebral artery. For the surgical treatment of symptomatic non-acute middle cerebral artery atherosclerosis occlusion (SNMCAO) in non-acute phase, the superior temporal artery middle cerebral artery (STA-MCA) low flow bypass and intravascular interventional recanalization have their own advantages. For patients with short expected occlusion time, short occlusion segment, straight blood vessels, and good distal vascular bed, they may be more inclined to undergo endovascular recanalization treatment, otherwise they may choose STA-MCA low flow bypass surgery. Regardless of which treatment method is chosen, precise individualized evaluation must be conducted before surgery to select an individualized surgical approach that can maximize the benefits for patients with SNMCAO.

Human papillomavirus (HPV) can cause various tumors such as cervical cancer in women. Further study of HPV infection and its pathogenic mechanism, as well as the development of vaccines and anti-tumor drugs, have been hindered due to the strong host specificity and tissue affinity of HPV, along with the challenges in in vitro culture and the lack of animal infection models. To advance the study of HPV infection and its pathogenic mechanism and to development better prevention and treatment measures, it is important to establish an animal model that closely resembles the infection and pathogenesis pathways in humans. This article reviews previous research on HPV-related animal models using mice, rabbits, macaques, and Drosophila, including infectious models, tumor models, and transgenic models, aiming to provide reference for the selection of appropriate animal models for HPV-related research.

Objective:To investigate whether deltoid ligament (DL) injury produces axial-plane rotational instability of the ankle in patients with chronic ankle instability (CAI).Methods:A retrospective study was conducted to analyze the 33 patients with CAI who had been treated at Department of Orthopaedics, The First Affiliated Hospital of Nanjing Medical University between January 2023 and December 2024. The cohort consisted of 17 males and 16 females with an age of (31.5±9.9) years. The patients were assigned into 2 groups based on the presence of DL injury: a lateral chronic ankle instability (LCAI) group ( n=17) and a rotational ankle instability (RAI) group ( n=16). Barefoot natural walking trials were performed in all patients. Three-dimensional kinematic data were synchronously collected using an optical motion capture system (12 cameras) and force plates. A lower extremity model was constructed to obtain shank axial rotation (internal/external rotation) and rear-foot inversion/eversion angles. Continuous relative phase (CRP) analysis was employed to assess shank-rearfoot movement coupling. The mean absolute relative phase (MARP) and deviation phase (DP) were calculated. Results:There was no statistically significant difference in the clinical baseline data between the 2 groups, indicating comparability ( P>0.05). Throughout the gait cycle, no significant differences were found in shank rotation angles or rear-foot eversion angles between the RAI group and the LCAI group. However, CRP analysis revealed that during the early stance phase (initial contact and loading response), shank-rearfoot coupling was significantly lower in the RAI group than in the LCAI group. In the early stance phase, the CRP values in the RAI group were significantly higher than those in the LCAI group. The CRP curve changes in the RAI group were consistently higher in the standce phase of the entire gait cycle than those in the LCAI group, and the peak value of the CRP curve was larger in the RAI group. Concurrently, the RAI group exhibited significantly higher MARP and DP values than the LCAI group (27.48°±14.54° versus 15.21°±9.56°; 26.02°±11.73° versus 17.83°±9.82°) (both P<0.05). Conclusion:DL injury significantly damages the axial rotational stability of the ankle joint and significantly exacerbates the mechanical instability of the ankle joint in CAI patients.

Objective To explore and analyze the characteristics and transmission routes of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains in intensive care unit(ICU).Methods From January to October 2023,17 clinical infection isolates(clinical infection group),5 active screening isolates(active screening group),and 7 envi-ronmental isolates(environmental group)of CRKP in the liver surgery ICU of a hospital were selected and analyzed by whole-genome sequencing.The differences in resistance genes,virulence genes,and sequence typing(ST)were compared,and transmission routes were analyzed based on the phylogenetic tree.Results 29 strains of CRKP car-ried 4-18 resistance genes and 52-98 virulence genes,respectively.There were no statistically significant diffe-rences in genotype distribution of resistance genes,the number of virulence genes,and gene types among three groups of CRKP(all P＞0.05).ST showed that 29 CRKP strains mainly consisted of two categories:ST11 and ST15.Based on the phylogenetic tree constructed from the core genome,there were 7 highly homologous groups of CRKP,among which 4 groups had clear epidemiological associations.Conclusion CRKP in ICU carries more re-sistance and virulence genes,and some strains are highly homologous in ST and phylogenetic tree,which may lead to cross transmission.In the future,prevention and control measures should be strengthened to reduce the trans-mission of CRKP.