OBJECTIVE: To compare effectiveness of multiple metatarsal osteotomy versus first metatarsophalangeal arthrodesis in treating severe metatarsal adductus hallux valgus deformity. METHODS: A retrospective analysis was conducted on the clinical data of 25 patients with severe metatarsal adductus hallux valgus deformity admitted between June 2010 and May 2014 who met the selective criteria. Among them, 15 patients underwent multiple metatarsal osteotomy (osteotomy group), while 10 patients underwent first metatarsophalangeal arthrodesis (fusion group). There was no significant difference between groups ( P>0.05) in gender, age, disease duration, affected side, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score for pain, intermetatarsal angle (IMA), hallux valgus angle (HVA), or metatarsal adduction angle (MAA). The osteotomy group underwent fixation with screws and/or staples fixation, while the fusion group utilized anatomic fusion plates and trans-articular compression screws. The study compared the following outcome indicators between groups: operation time, pre- and post-operative differences (change values) in AOFAS scores, VAS scores, and radiographic parameters (HVA, MAA), osteotomy healing outcomes, and recurrence of hallux valgus deformity. RESULTS: Both surgical procedures were completed successfully. The operation time was significantly shorter in the fusion group than in the osteotomy group ( P<0.05). All patients were followed up 96-144 months (mean, 116 months). The follow-up time was (129.1±7.2) months in the osteotomy group and (104.4±8.0) months in the fusion group, with no significant difference between groups ( P>0.05). X-ray films revealed the radiographic union in two groups, and the fusion time was significantly shorter in the fusion group than in the osteotomy group ( P<0.05). At last follow-up, both groups demonstrated significant improvements in AOFAS and VAS scores compared to preoperative levels ( P<0.05). However, the differences in the change values of AOFAS and VAS scores between groups were not significant ( P>0.05). During follow-up, 3 cases (20%) of deformity recurrence occurred in the osteotomy group, while no recurrence was observed in the fusion group. There was no significant difference in the incidences of deformity recurrence between groups ( P>0.05). CONCLUSION For severe metatarsus adductus hallux valgus deformities, both multiple metatarsal osteotomy and first metatarsophalangeal arthrodesis can correct the deformity. The former preserves metatarsophalangeal joint mobility but demands high technical proficiency from the surgeon, involves relatively longer operation times, extended bone healing periods, and higher complication incidences. The latter procedure is relatively simpler, facilitates faster postoperative recovery, allows early weight-bearing, and yields more reliable outcomes, though it sacrifices first metatarsophalangeal joint mobility.
Humans ; Osteotomy/methods* ; Hallux Valgus/diagnostic imaging* ; Retrospective Studies ; Arthrodesis/instrumentation* ; Treatment Outcome ; Metatarsal Bones/diagnostic imaging* ; Metatarsophalangeal Joint/diagnostic imaging* ; Male ; Female ; Bone Screws ; Adult ; Middle Aged ; Bone Plates ; Pain Measurement

To observe the feasibility and safety of general anesthesia without muscle relaxant tracheal intubation combined with right stellate ganglion block (SGB) on patients undergoing oropharyngeal surgery.60 patients undergoing selective oropharyngeal surgery were randomly and equally divided into 2 groups:named in non muscle relaxation group and combination group.MAP,HR,SpO2 and PETCO2 were recorded before administration (T0),immediately before tracheal intubation(T1),and immediately after tracheal intubation(T2),and immediately after skin incision (T3).The VAS score at 4,8,12,24 h after surgery were also recorded.The difference of the satisfactory intubation conditions was not statistically significant.MAP and HR were increased at T2 and T3 as compared with non muscle relaxation group.Compared with combination group,HR increased at T2 and T3 in group A.The VAS of patients in combination group was lower than non muscle relaxation group (P ＜ 0.05).Stellate ganglion block on patients undergoing oropharyngeal surgery in general anesthesia without muscle relaxant might provide not only satisfactory intubation conditions but also provoke earlier recovery and improve the quality of postoperartive analgesia.

Objective To explore the association between PI3K polymorphisms in insulin signal transduction pathway and Alzheimer's disease (AD)risk.Methods There were three groups,including 112 cases for AD +T2D group,231 cases for only AD group,and 231 cases for healthy controls group.The polymorphisms in PI3K gene was sequenced by PCR and the concentration of PI3K in serum was tested by enzyme -linked immunosorbent assay (ELISA).Results Overall,there was significantly statistical difference in PI3K rs3730087 polymorphism among three groups (χ2 =20.99,P =0.000 3).The CC frequency of PI3K rs3730087 polymorphism in AD with T2D group and AD control group was significantly higher than that in the healthy control group.The PI3K protein level of differ-ent genotype was statistically significant (F =27.450,P <0.000 1).As for CC genotypes of PI3K rs3730087 poly-morphism,the PI3K protein level was statistically different among these three groups (F =8.096,P =0.000 6).Moreover,the PI3K protein level of the three groups was different (F =9.034,P =0.000 1),which in both AD group was lower as compared with healthy control group.Conclusion The study suggested that CC genotype of PI3K rs3730087 polymorphism in insulin signaling transduction pathway might be a risk factor for AD with T2D and it also affects the expression level of PI3K protein.However,the polymorphism is not shown to be exclusive in AD patients with T2D.

Objective To investigate the effect of isoflurane pretreatment on hypoxia/reoxygenation (H/R)-induced syndecan-1 shedding from human umbilical vein endothelial cells (HUVECs) . Methods HUVECs were cultured in EMB-2 medium and randomly divided into 3 groups ( n = 32 each) : control group (group C), H/R group and isoflurane pretreatment group (group I). H/R was produced by 4 h exposure of HUVECs to hypoxia followed by 2 h reoxygenation in H/R and I groups. HUVECs were exposed to the mixture of 5% CO2 and 95% O2 for 30 min and then cultured in normal culture atmosphere (21% O2) in group C. In group I, HUVECs were expased to 1.73% isoflurane and incubated for 30 min before H/R. The syndecan-1 expression, concentrations of shed syndecan-1 in the medium, and cell permeability and viability were measured at the end of reoxygenation. Results Compared with group C, the shed syndecan-1 concentration in the medium and cell permeability were significantly increased, while the syndecan-1 expression and cell viability decreased in H/R and Ⅰ groups ( P ＜ 0.01) . Compared with group H/R, the shed syndecan-1 concentration in the medium and cell permeability were significantly decreased, while the syndecan-1 expression and cell viability increased in group Ⅰ (P ＜ 0.01) . Conclusion Isoflurane pretreatment can protect HUVECs against H/R injury through inhibiting the syndecan-1 shedding.