Objective:To observe the clinical efficacy of the modified crowbar-assisted minimally invasive Chevron osteotomy for the treatment of hallux valgus.Methods:A total of 42 patients with hallux valgus who underwent modified crowbar-assisted minimally invasive Chevron osteotomy at Huashan Hospital of Fudan University for hallux valgus from January 2019 to July 2022 were retrospectively analyzed. There were 3 males and 39 females, aged 42.3±8.7 years (range, 26-60 years); 18 left-sided and 24 right-sided, with body mass index 22.9±2.3 kg/m 2. According to the size of the hallux valgus angle (HVA), 26 patients were divided into the mild group (15°≤HVA<20°) and 16 patients were divided into moderate group (20°≤HVA≤40°). All patients were treated with modified crowbar-assisted Chevron osteotomy. The preoperative and postoperative HVA, intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) were compared. Results:All patients successfully completed the operation and were followed up for an average of 22.3±6.5 months (range, 18-30 months). The HVA, IMA, and DMAA in the mild group at the last follow-up were 6.6°±1.8°, 8.1°±1.8°, and 4.3°±1.1°, respectively, which were significantly lower than those before operation 17.8°±1.4°, 12.5°±1.5°, and 7.6°±2.4° ( P<0.05). The HVA, IMA, and DMAA in the moderate group at the last follow-up were 7.6°±2.1°, 8.8°±1.6°, and 4.8°±2.9°, respectively, which were significantly lower than those before operation 32.3°±3.5°, 14.8°±3.5°, and 12.7°±5.4° ( P<0.05). At the last follow-up, there was no significant difference in HVA, IMA, or DMAA between the two groups ( P>0.05). The differences of HVA, IMA, and DMAA before and after operation in the moderate group were 24.7°±2.6°, 6.0°±2.3°, and 7.9°±3.8°, respectively, which were greater than those in the mild group 11.2°±1.7°, 4.4°±1.6°, and 3.3°±1.6°, and the differences were statistically significant ( P<0.05). At the last follow-up, the VAS score of the mild group decreased from 2.6±2.0 before surgery to 0.4±0.2, and the difference was statistically significant ( t=6.014, P<0.001). The VAS score of the moderate group decreased from 3.2±2.2 before surgery to 0.4±0.3, the difference was statistically significant ( t=8.777, P<0.001). The preoperative AOFAS Hallux MTP-IP scale of the toe metatarsal joint in the mild group and the moderate group were 71.6±5.9 and 64.3±7.8, respectively, which increased to 93.3±6.0 and 92.3±6.0 at the last follow-up, and the difference was statistically significant ( P<0.05). At the last follow-up, there was no significant difference in AOFAS Hallux MTP-IP scale between the two groups ( P>0.05). Twenty-two of the 26 patients in the mild group were satisfied, and 14 of the 16 patients in the moderate group were satisfied, and the difference in satisfaction between the two groups was not statistically significant ( P>0.05). Conclusion:The clinical efficacy of the modified crowbar-assisted minimally invasive Chevron osteotomy in the treatment of hallux valgus is satisfactory, and it can effectively correct the hallux valgus deformity and improve the function of the metatarsophalangeal joint.

Objective:To observe the clinical efficacy of the modified crowbar-assisted minimally invasive Chevron osteotomy for the treatment of hallux valgus.Methods:A total of 42 patients with hallux valgus who underwent modified crowbar-assisted minimally invasive Chevron osteotomy at Huashan Hospital of Fudan University for hallux valgus from January 2019 to July 2022 were retrospectively analyzed. There were 3 males and 39 females, aged 42.3±8.7 years (range, 26-60 years); 18 left-sided and 24 right-sided, with body mass index 22.9±2.3 kg/m 2. According to the size of the hallux valgus angle (HVA), 26 patients were divided into the mild group (15°≤HVA<20°) and 16 patients were divided into moderate group (20°≤HVA≤40°). All patients were treated with modified crowbar-assisted Chevron osteotomy. The preoperative and postoperative HVA, intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) were compared. Results:All patients successfully completed the operation and were followed up for an average of 22.3±6.5 months (range, 18-30 months). The HVA, IMA, and DMAA in the mild group at the last follow-up were 6.6°±1.8°, 8.1°±1.8°, and 4.3°±1.1°, respectively, which were significantly lower than those before operation 17.8°±1.4°, 12.5°±1.5°, and 7.6°±2.4° ( P<0.05). The HVA, IMA, and DMAA in the moderate group at the last follow-up were 7.6°±2.1°, 8.8°±1.6°, and 4.8°±2.9°, respectively, which were significantly lower than those before operation 32.3°±3.5°, 14.8°±3.5°, and 12.7°±5.4° ( P<0.05). At the last follow-up, there was no significant difference in HVA, IMA, or DMAA between the two groups ( P>0.05). The differences of HVA, IMA, and DMAA before and after operation in the moderate group were 24.7°±2.6°, 6.0°±2.3°, and 7.9°±3.8°, respectively, which were greater than those in the mild group 11.2°±1.7°, 4.4°±1.6°, and 3.3°±1.6°, and the differences were statistically significant ( P<0.05). At the last follow-up, the VAS score of the mild group decreased from 2.6±2.0 before surgery to 0.4±0.2, and the difference was statistically significant ( t=6.014, P<0.001). The VAS score of the moderate group decreased from 3.2±2.2 before surgery to 0.4±0.3, the difference was statistically significant ( t=8.777, P<0.001). The preoperative AOFAS Hallux MTP-IP scale of the toe metatarsal joint in the mild group and the moderate group were 71.6±5.9 and 64.3±7.8, respectively, which increased to 93.3±6.0 and 92.3±6.0 at the last follow-up, and the difference was statistically significant ( P<0.05). At the last follow-up, there was no significant difference in AOFAS Hallux MTP-IP scale between the two groups ( P>0.05). Twenty-two of the 26 patients in the mild group were satisfied, and 14 of the 16 patients in the moderate group were satisfied, and the difference in satisfaction between the two groups was not statistically significant ( P>0.05). Conclusion:The clinical efficacy of the modified crowbar-assisted minimally invasive Chevron osteotomy in the treatment of hallux valgus is satisfactory, and it can effectively correct the hallux valgus deformity and improve the function of the metatarsophalangeal joint.

Objective To observe the effects of different frequencies of electroacupuncture on the degree of atrophy of quadriceps femoris in rabbits with anterior cruciate ligament(ACL)injury model;To explore the possible mechanisms of electroacupuncture in treating ACL injury.Methods Totally 24 New Zealand rabbits were randomly divided into blank group,model group,low-frequency electroacupuncture group and high-frequency electroacupuncture group,with 6 rabbits in each group.Except for the blank group,ACL injury models were established in the other groups.On the 7th day after modeling,the low-frequency electroacupuncture group and the high-frequency electroacupuncture group performed electroacupuncture treatment(continuous wave,frequency of 2 Hz and 100 Hz respectively,and left the needle in place for 20 min)at"Xuehai"and"Liangqiu"of the operation side,and the remaining groups were only grasped and immobilized,for 21 days.The mass ratio of the quadriceps femoris was calculated,the histopathological morphology of the quadriceps femoris tissue of the rabbits in each group was observed by HE staining,the expressions of NO,iNOS in quadriceps femoris tissue were detected by ELISA,the content of ROS in quadriceps femoris tissue was detected by fluorescent probe,the protein expressions of PERK,ATF6,IRE1,MuRF1,MAFbx in quadriceps femoris tissue were detected by Western blot.Results Compared with the blank group,the quadriceps femoris muscle mass ratio of the model group rabbits was significantly reduced(P<0.01),with irregular arrangement of muscle cells,accompanied by swelling and atrophy,significant interstitial edema,and extensive inflammatory infiltration,the contents of NO,iNOS and ROS in quadriceps femoris tissue significantly increased(P<0.01),while the expressions of PERK,ATF6,IRE1,MuRF1 and MAFbx proteins significantly increased(P<0.01).Compared with the model group,the quadriceps femoris muscle mass ratio in the low-frequency and high-frequency electroacupuncture groups significantly increased(P<0.01),with regular arrangement of muscle cells,improved swelling and atrophy of cells,and reduced interstitial edema and inflammation,the contents of NO,iNOS and ROS in quadriceps femoris tissue were significantly reduced(P<0.01),and the expressions of PERK,ATF6,IRE1,MuRF1 and MAFbx proteins significantly decreased(P<0.01).Moreover,the low-frequency electroacupuncture group had better effects than the high-frequency electroacupuncture group(P<0.05).Conclusion Different frequencies of electroacupuncture intervention in ACL injury rabbits can better delay the degree of quadriceps femoris atrophy,and its mechanism may be related to reducing the expressions of oxidative metabolites NO,iNOS,ROS,and reducing the expressions of endoplasmic reticulum stress-related proteins PERK,ATF6,IRE1 in quadriceps fermoris,which in turn inhibit the expressions of quadriceps atrophy factors MuRF1,MAFbx,and delaying the degradation of quadriceps muscle proteins.The effect of low-frequency electroacupuncture is superior to the high-frequency electroacupuncture.

Objective:To compare the operative treatment and non-operative treatment of the re-ruptured Achilles tendon with rupture end distance within 1 cm.Methods:We retrospectively analyzed 14 cases with Achilles tendon postoperative re-rupture in our hospital from May 2012 to March 2019. All 14 cases showed distance of rupture end less than 1cm during imaging in a passive plantarflexion position. Among the 14 cases with re-rupture, 8 were in the operative treatment group (7 males and 1 female, mean age 36.3±6.4 years, duration from initial rupture to re-rupture 3 to 213 weeks, height 174.9±8.7 cm, weight 75.5±13.9 kg, body mass index 24.5±2.7 kg/m 2, distance of re-ruptured ends 4.9±2.5 mm) and 6 were in the non-operative treatment group (5 males and 1 female, mean age 40.0±9.0 years, duration from initial rupture to re-rupture 4 to 60 weeks, height 173.8±3.5 cm, weight 77.5±7.4 kg, body mass index 25.7±2.5 kg/m 2, distance of re-ruptured ends 5.7±2.1 mm). The Achilles tendon rupture score (ATRS), visual analogue scale (VAS), and foot and ankle ability measure (FAAM) were used to evaluate the result at the patients' last follow-up. Results:All the 14 cases were followed for 8.7 to 92.2 months, with mean follow-up of 39.6 months. Ultrasound or MRI was performed at 6 months postoperatively or at last follow-up to ensure the Achilles tendons' healing. The average ATRS score, VAS score, FAAM-ADL score, and FAAM-Sports score of the operative treatment group were 85.4±13.5, 0 (0, 1.0) , 86.9±8.3, and 76.3±15.4, respectively. While those of the non-operative treatment group were 82.8±5.7, 0.5 (0, 1.3) , 88.1±8.3, and 77.2±15.0, respectively. The average VAS score, FAAM-ADL score, and FAAM-Sports score of the operative treatment group and those of the non-operative treatment group was not significantly different. The ATRS scores of 7 patients of the operative treatment group were between 81 and 96. The satisfaction rate of operative treatment group was 87.5% (7/8). The ATRS scores of 5 patients of the non-operative treatment group were between 81 and 91. The satisfactory rate of non-operative treatment group was 83.3% (5/6). All Achilles tendon re-rupture cases had no complications such as a third time Achilles tendon rupture or wound infection after treatment.Conclusion:For the re-ruptured Achilles tendon with rupture end distance within 1 cm, non-operative treatment achieved similar curative effect compared to operative treatment through extended duration of immobilization and non-weightbearing.

Objective To analyze the effect of extralateral approach interbody fusion in the treatment of degenerative lumbar diseases. Methods A total of 50 patients with lumbar degenerative diseases admitted to our hospital were selected, and were treated with extralateral approach interbody fusion, and the therapeutic effect was observed and analyzed. Results All patients successfully completed the operation. The average amount of bleeding during operation was (145. 5 ± 4. 7) m L, the average operation time was (56. 3 ± 2. 2) min, and the average hospitalization time was (7. 2 ± 1. 5) days. Four patients suffered from hip flexion weakness after operation, and the symptoms recovered completely after two months. Six patients suffered from sensory numbness in front of thighs after operation, and the symptoms disappeared or relieved after 6 to 8 weeks. No complications such as abdominal organs and blood vessels injury, cerebrospinal fluid leakage, mislocation of intervertebral space, paralytic intestinal obstruction and permanent injury of genitofemoral nerve occurred. All patients were followed up for 24 months. The results showed that at the last follow-up, the Visual Analogue Scale (VAS) scores of low back pain and lower limb pain were significantly lower, and the lumbar spine scores of Japanese Orthopaedic Association (JOA) were significantly higher than before operation (P ＜ 0. 05). Conclusion Extralateral approach interbody fusion can achieve satisfactory results in the treatment of lumbar degenerative diseases, with fewer complications and higher fusion rate.

Objective To analyze the effect of extralateral approach interbody fusion in the treatment of degenerative lumbar diseases. Methods A total of 50 patients with lumbar degenerative diseases admitted to our hospital were selected, and were treated with extralateral approach interbody fusion, and the therapeutic effect was observed and analyzed. Results All patients successfully completed the operation. The average amount of bleeding during operation was (145. 5 ± 4. 7) m L, the average operation time was (56. 3 ± 2. 2) min, and the average hospitalization time was (7. 2 ± 1. 5) days. Four patients suffered from hip flexion weakness after operation, and the symptoms recovered completely after two months. Six patients suffered from sensory numbness in front of thighs after operation, and the symptoms disappeared or relieved after 6 to 8 weeks. No complications such as abdominal organs and blood vessels injury, cerebrospinal fluid leakage, mislocation of intervertebral space, paralytic intestinal obstruction and permanent injury of genitofemoral nerve occurred. All patients were followed up for 24 months. The results showed that at the last follow-up, the Visual Analogue Scale (VAS) scores of low back pain and lower limb pain were significantly lower, and the lumbar spine scores of Japanese Orthopaedic Association (JOA) were significantly higher than before operation (P ＜ 0. 05). Conclusion Extralateral approach interbody fusion can achieve satisfactory results in the treatment of lumbar degenerative diseases, with fewer complications and higher fusion rate.

[Objective] To investigate the characteristics of PD-1/PD-L1 expressed on T cell and bladder cancer cell and clinical significance.[Methods] 64 patients with primary bladder cancer were into experiment group and 10 normal people were into control group.Peripheral bloods were used to test the PD-1 expressed on CD8+ T lymphocytes by flow cytometry.Immunohistochemistry staining was used to detect the PD-L1 expression in tumor and normal specimen.[Results] PD-1 expressed on CD8+T lymphocytes was (2.25 ± 0.60)％ in experiment group and (0.68 ± 0.17)％ in control group,respectively (P ＜ 0.001).And the PD-1 expression on T cell in invasive bladder cancer patient was significant higher than superficial bladder cancer patients [(3.04 ± 0.46)％ vs (0.68± 0.17)％,P ＜ 0.001].The expression of PD-L1 in experiment group was higher than control group,(26/64 vs 0/15,P ＜ 0.001).But there was no different between invasive and superficial bladder cancer patients,(41.3％ vs 38.8％,P ＞ 0.01).[Conclusions] Expression of negative stimulatory molecule PD-1 in CD8+T lymphocytes of peripheral blood is significantly correlated with bladder cancer advanced.Bladder cancer cell was strongly expressed PD-L1,and this expression is not related to cancer advanced.

OBJECTIVE: To analyze chromosome damage and its possible influencing factors in patients with occupational chronic benzene poisoning. METHODS: Fifty patients with occupational chronic benzene poisoning were selected as chronic benzene poisoning group,and 53 workers without occupational exposure to benzene and other toxic substances were chosen as control group by using convenience sampling method. Questionnaire and routine blood test were conducted on all study subjects. Micronucleus rate test was performed by micronucleus blocking cytokinesis assay. RESULTS: Peripheral blood tests of chronic benzene poisoning group showed significantly reduced hemoglobin level,counts of red blood cells,white blood cells,platelets,lymphocytes and neutrophils( P < 0. 01),and higher lymphocyte micronucleus rates compared to control group( !: 6. 26‰ vs 3. 91‰,P < 0. 01). The proportion of increased lymphocyte micronucleus rate in chromic benzene poisoning group was also higher than that in control group( 46. 0% vs 5. 7%,P < 0. 01). The multivariate Poisson analysis results indicated that the time after disengagement from benzene exposure was the influencing factor of micronucleus rate in chronic benzene poisoning group( P < 0. 05),after adjusting the confounding factors of gender,age,smoking status,alcohol drinking status and working age of benzene exposure. CONCLUSION: Occupational chronic benzene poisoning leads to increase of chromosome damage in lymphocytes of patients. The time after disengagement from benzene exposure was positively correlated with chromosome damage.

Aim To study the mechanism of 8-isopro-pylaminomethyl hesperitin ( IPHP ) intestinal absorp-tion using Caco-2 cell lines. Methods Using Caco-2 cell lines as an intestinal epithelial cell model, the effects of drug concentration, temperature, pH, P-gly-coprotein ( P-gp) inhibitor verapamil and multidrug re-sistance protein 2 ( MRP2 ) inhibitors MK-571 or pro-benecid on IPHP transport across Caco-2 cell lines were all investigated. Results The transportation of IPHP was related to drug concentration. The Papp ( AP-BL) ( × 10 -5) was (2. 21 ± 0. 200) cm·s-1,(3. 56 ± 0. 306) cm·s-1,(3. 81 ± 0. 179) cm·s-1,(4. 23 ± 0. 229 ) cm · s-1 , ( 4. 17 ± 0. 262 ) cm · s-1 , re-spectively, and Papp(BL-AP) ( × 10 -5) was (3. 57 ±0. 209) cm·s-1,(4. 51 ± 0. 113) cm·s-1,(4. 97 ± 0. 229) cm·s-1,(5. 24 ± 0. 550) cm·s-1,(5. 07 ± 0. 557) cm·s-1,respectively. Efflux rate was 1. 61, 1. 26,1. 3,1. 23,1. 21,respectively. Temperature and pH both influenced the transport, While the P-gp in-hibitor verapamil had no effect on the transport of IPHP. MRP2 inhibitors MK-571 or probenecid led to an apparent decrease in the efflux of IPHP. Conclu-sion The results suggest that the transport of IPHP is mainly passive diffusion, and MRP2 but not P-gp may be involved in the transport of IPHP.

Aim To observe the effect of melittin on human hepatocelluar carcinoma HepG2 cell prolifera-tion in vitro and its further mechanisms.Methods The capacity of cellular proliferation and apoptosis was measured with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay,Hoechst 33258 assay and Annexin V-FITC /PI assay.The mR-NA expression of Shh, PTCH1, SMO, GLi1 and HDAC2 was performed by qRT-PCR.And the protein expression of Shh,PTCH1,SMO,GLi1 and HDAC2 was assessed by western blotting.Results Our study found that melittin effectively inhibited cell prolifera-tion and promoted cell apoptosis in vitro using MTT method and Flow cytometry.The mRNA and protein expression of Shh,PTCH1,SMO,GLi1 and HDAC2 were obviously decreased after treated with various con-centrations of melittin for 48h in HepG2 cells.Conclu-sions Taken together,our data suggest that melittin could inhibit cell proliferation and promote cell apopto-sis,reduce the level of HDAC2 and down-regulate the Hedgehog signaling pathway in this process simultane-ously.