OBJECTIVE: To compare the impact of different peroneus longus tendon (PLT) stump management techniques on ankle function following arthroscopic anterior cruciate ligament (ACL) reconstruction with autologous PLT grafts. METHODS: A retrospective analysis was conducted on 60 patients with ACL rupture who met the inclusion criteria between August 2020 and July 2024. All patients underwent arthroscopic ACL reconstruction using the autologous PLT grafts. Patients were assigned to group A [PLT stump sutured to peroneus brevis tendon (PBT), n=30] or group B (no stump intervention, n=30). The two groups showed no significant difference ( P>0.05) in baseline data, including gender, age, body mass index, injury mechanism, affected side, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle muscle strength, ankle range of motion, and arch-related angles. Postoperative outcomes were assessed using the AOFAS score, ankle muscle strength (eversion and first-ray plantar flexion), arch-related angles (medial/lateral longitudinal and anterior/posterior arch), ankle range of motion (eversion, inversion, dorsiflexion, plantarflexion), and limb symmetry index (LSI). Change values in muscle strength, arch-related angles, and range of motion from preoperative to 12 months postoperatively were calculated for intergroup comparison. RESULTS: Groups A and B had comparable PLT graft lengths and diameters ( P>0.05). All patients were followed up 13-16 months (mean, 14.5 months). Postoperative complications included 1 case of incision infection, 1 case of deep vein thrombosis, and 1 case of knee stiffness in group A, 1 case of knee stiffness in group B. There was no significant difference in the overall complication incidences between groups ( P>0.05). No significant difference was found in the AOFAS scores between different time points and between groups ( P>0.05). At 12 months after operation, neither group showed significant changes from preoperative baseline in ankle strength, range of motion, or arch-related angles, and there was no significant difference in these change values between groups ( P>0.05). There was no significant difference in LSI between the two groups at 6 or 12 months postoperatively ( P>0.05). CONCLUSION Both suturing and leaving the PLT stump untreated during arthroscopic ACL reconstruction provided comparable ankle outcomes and well-preserved foot and ankle function.
Humans ; Anterior Cruciate Ligament Reconstruction/methods* ; Male ; Retrospective Studies ; Female ; Adult ; Anterior Cruciate Ligament Injuries/surgery* ; Tendons/transplantation* ; Range of Motion, Articular ; Arthroscopy/methods* ; Young Adult ; Treatment Outcome ; Muscle Strength ; Transplantation, Autologous ; Ankle Joint/surgery* ; Middle Aged ; Adolescent

This report presents a case of esophageal fistula with recurrent cervical abscess as the initial symptom. The patient underwent anterior cervical fracture reduction and internal fixation in 2021 due to trauma. In 2023, the patient received radiofrequency ablation for bilateral thyroid lobe lesions, after which recurrent cervical abscesses occurred over an 8-month period. Fiberoptic laryngoscopy with the biopsy channel insufflation method revealed a large esophageal fistula at the esophageal inlet. After removing the internal fixation plate, the patient received daily wound care, and serial fiberoptic laryngoscopy revealed spontaneous healing of the esophageal fistula. During the 1-year follow-up, no recurrence of cervical abscess was observed, and the esophageal fistula healed well.
Humans ; Abscess ; Recurrence ; Neck ; Female ; Adult ; Fracture Fixation, Internal

Objective:To study the outcomes of the modified Devine + Shiraki surgical approach in the treatment of severe concealed penis.Methods:A retrospective analysis was conducted on the clinical data of initially treated patients with severe concealed penis admitted to the Department of Urology, Henan Provincial People’s Hospital from March 2020 to September 2022. The therapeutic effects of three surgical approaches (Devine, Shiraki, and modified Devine + Shiraki) were analyzed and compared. The Devine approach mainly focuses on eliminating the pathological morphology of the concealed penis, thoroughly releasing the penile shaft, and correcting the concealed state; the Shiraki approach emphasizes the rational distribution of skin flaps; the key of the modified Devine + Shiraki approach lies in combining the advantages of the two approaches, achieving both complete correction of the concealed state and rational distribution of skin flaps. Improvements were made to the conventional surgical sequence: skin flap distribution was pre-designed before correcting the concealed penis to avoid difficulties in skin flap arrangement caused by degloving, thereby preventing postoperative complications such as stricture rings, lymphedema, or erectile pain. Three months after the operation, follow-up was performed to assess incision healing, presence of lymphedema or stricture rings, satisfaction with penile exposure, recurrence of the concealed state, urination patency, presence of urethral injury, and normal erectile function. A patient satisfaction survey was conducted 6 months after the operation. Measurement data with normal distribution were expressed as Mean± SD, and one-way analysis of variance was used for comparison among the three groups; categorical variables were expressed as case numbers and percentages, and chi-square test was used for comparison among the three groups. Results:Eighty, fifty, and forty-five male children were enrolled in the Devine + Shiraki group, Devine group, and Shiraki group, respectively. There were no statistically significant differences in age and body mass index (BMI) among the three groups [age: (7.6±4.5) years vs. (7.2±4.4) years vs. (6.7±4.2) years, F=0.61, P=0.546; BMI: (17.4±3.1) kg/m 2 vs. (17.7±3.2) kg/m 2 vs. (18.0±3.3) kg/m 2,F=0.57, P=0.565]. During surgery, all concealed penile shafts were completely released, and the penile skin was rationally distributed. The postoperative follow-up period ranged from 3 months to 18 months, with an average follow-up time of 13.6 months. At the 3-month postoperative follow-up, all three groups showed satisfactory wound healing with no signs of infection or skin flap necrosis; penile skin coverage was adequate, and all children demonstrated unobstructed urination without evidence of urethral injury; normal erectile function was preserved in all cases, with no reports of erectile dysfunction or pain. The recurrence rate of the concealed penis in the Devine + Shiraki group was significantly lower than that in the Devine group and Shiraki group, with a statistically significant difference [0 (0/80) vs. 6.0% (3/50) vs. 31.1% (14/45), χ2=32.88, P<0.001]; the proportion of patients without postoperative lymphedema and stricture rings in the Devine + Shiraki group was higher than that in the Devine group and Shiraki group, with a statistically significant difference [97.5% (78/80) vs. 70.0% (35/50) vs. 86.7% (39/45), χ2=20.39, P<0.001]. The Devine+ Shiraki, Devine, and Shiraki groups reported postoperative satisfaction in 76 (95.0%), 35 (70.0%), and 31 (68.9%) cases, respectively. Conclusion:The modified Devine + Shiraki surgical approach has definite efficacy, good safety, and a low incidence of complications, and can be used as an option for the treatment of severe concealed penis.

Objective To explore the causal relationship between gut microbiota and colorectal cancer,and to investigate whether metabolites have a mediating effect through Mendelian randomization(MR)analysis.Methods Genome-wide association studies data of 473 gut microbiota,233 metabolites,and colorectal cancer were obtained from public databases.Bidirectional MR analyses were performed between gut microbiota,metabolites,and colorectal cancer,respectively.Subsequently,a two-step MR was used to explore whether specific gut microbiota affect the occurrence and development of colorectal cancer through metabolites.Results The study found that the abundances of 7 gut microbiota were positively correlated with the risk of colorectal cancer:Alloprevotella,Atopobiaceae,Clostridium S felsineum,Hungatella,Microvirga,Peptococcia and Ruminococcus A;The abundances of 4 gut microbiota were negatively correlated with the risk of colorectal cancer:Paenibacillales,Prevotella buccae,Psychroserpens and Succinivibrionaceae.Through the two-step mediation analysis,it was confirmed that the ratio of Triglycerides to total lipids ratio in medium very low-density lipoprotein could reduce the impact of Clostridium S felsineum as a risk factor for the occurrence of colorectal cancer.Conclusion The results of this study confirm the causal relationship between some gut microbiota,metabolites,and colorectal cancer,and discover potential interaction chains,providing ideas for the pathogenesis and prevention of colorectal cancer.

Objective:To investigate the differences in prosthesis implantation accuracy, biomechanical indicators, and 2-year postoperative clinical outcomes between robotic-assisted traditional posterior approach (RA-PLA) and robotic-assisted direct anterior approach (RA-DAA) in total hip arthroplasty (THA).Methods:This study is a prospective randomized controlled trial. Patients with unilateral femoral head ischemic necrosis or primary hip osteoarthritis who meet the inclusion and exclusion criteria and were admitted to the Department of Orthopedics,Xinqiao Hospital, Army Medical University from May to September 2022. Divided into RA-PLA group and RA-DAA group through central randomization. Use cumulative and fitting methods to analyze the learning curve of robotic surgery and eliminate cases before the inflection point of the learning curve. Compare the abduction angle and anteversion angle of acetabular cup implantation between two groups of patients, as well as the rate of falling into the safe zone, the difference in length between the two lower limbs, hip joint eccentricity, rotation center height, the complete accuracy of prosthesis planning (the number of cases in which acetabular cup prosthesis, femoral stem prosthesis specifications, and neck shaft angle were completely consistent with surgical planning during surgery/total cases×100%), patient reported outcome indicators (including Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC), and 12 item Short Form Health Survey (SF-12) score) and clinical outcomes. Data comparison was conducted using independent sample t-test, Wilcoxon rank sum test, chi square test, Fisher′s exact probability method, or repeated measures analysis of variance. Results:A total of 98 patients were included in this study, with 48 in the RA-PLA group and 50 in the RA-DAA group. After excluding cases before the inflection point of the learning curve, 30 patients were included in each group. There was no statistically significant difference in baseline data between the two groups before surgery (all P>0.05). There was no significant difference in the values of the anterior tilt angle and abduction angle between the two groups of acetabular cups compared to preoperative planning (all P>0.05). The proportion of patients who fell into the Lewinnek and Callanan safe zones was 90.0% (27/30) and 96.7% (29/30), respectively ( χ2=0.268, P=0.605). There was no significant difference in postoperative lower limb length, hip joint eccentricity, and rotation center height deviation and grading between the two groups (all P>0.05). The complete accuracy of prosthesis planning in the RA-DAA group was higher than that in the RA-PLA group (86.7% (26/30) compared to 63.3% (19/30), χ2=4.356, P=0.037).All patients were followed up for more than 2 years. In terms of postoperative HHS, WOMAC, and SF-12 score, there was no statistically significant difference in the inter group effect comparison (all P>0.05), but there was a significant statistical significance in the time effect (all P<0.05). There was no significant difference in the incidence of perioperative complications and adverse events between the RA-DAA group and the RA-PLA group (20.0% (6/30) vs. 13.3% (4/30), χ2=0.480, P=0.488). Conclusions:RA-DAA and RA-PLA techniques can achieve similar clinical efficacy after two years of surgery, and both can achieve similar reconstruction accuracy in terms of acetabular cup implantation angle, lower limb length, hip joint eccentricity, and rotation center height. The accuracy of prosthesis planning in RA-DAA is higher.

OBJECTIVE: To investigate the current status of long-term quality of life in patients with severe acute pancreatitis (SAP) who have been cured and discharged, and to analyze the influencing factors affecting long-term quality of life in SAP cured patients after discharge. METHODS: A retrospective collection was conducted. Patients who were received standardized treatment before being cured and discharged from the hospital admitted to the first department of critical care medcine of the Second Affiliated Hospital of Anhui Medical University from January 2017 to December 2023 were enrolled. According to the 36-item short form health survey scale (SF-36) score, patients were divided into high score group (high quality of life, the top 50% of patients with total SF-36 score) and low score group (low quality of life, the bottom 50% of patients with total SF-36 score). The gender, age, history of hypertension and diabetes, etiology of pancreatitis, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), CT severity index (CTSI), laboratory indicators such as C-reactive protein (CRP), procalcitonin (PCT), blood glucose, and triglycerides upon admission, use of vasoactive drugs, non-invasive/high-flow ventilation, invasive ventilation, retroperitoneal puncture and drainage, open pancreatic surgery treatment and secondary infection during hospitalization were collected, as well as the retention of abdominal drainage tubes at discharge from hospital. Distribute follow-up questionnaires or telephone follow-up surveys through WeChat and Question Star programs to investigate the pancreatic secretion function, chronic abdominal pain, and recurrence of pancreatitis of patients after discharge. Multivariable Logistic regression was used to analyze the relevant factors affecting the long-term quality of life of cured patients with SAP. RESULTS: A total of 86 patients were ultimately enrolled. There were 43 patients in both the high and low score groups. Among 86 patients, 20 experienced acute pancreatitis recurrence, with a recurrence rate of 23.26%. Twenty-two (25.58%) experienced chronic abdominal pain after discharge, and 5 patients (5.81%) needed medication to relieve pain. Thirty-three patients (38.37%) had pancreatic exocrine dysfunction after discharge, characterized by abdominal distension, constipation or diarrhea. Twenty-two patients (25.58%) suffered from pancreatic endocrine dysfunction, and were diagnosed with diabetes. Univariate analysis showed that compared with the high score group, the low score group had more patients with hypertension, initial renal dysfunction, initial severe metabolic acidosis, initial serum calcium < 2.0 mmol/L, blood glucose > 11.1 mmol/L and cultured Gram positive bacteria (from blood/body fluid/pancreatic necrotic tissue) during treatment (48.84% vs. 16.28%, 60.47% vs. 32.56%, 18.60% vs. 4.65%, 88.37% vs. 62.79%, 55.81% vs. 30.23%, 34.88% vs. 13.95%), had higher CTSI score (6.60±1.61 vs. 5.77±1.32), lower hemoglobin level at discharge (g/L: 102.30±18.78 vs. 110.72±16.68), and a lower proportion of etiological interventions after discharge (34.88% vs. 67.44%), the differences were statistically significant (all P < 0.05). Multivariate Logistic regression analysis showed that hypertension [odds ratio (OR) = 4.814, 95% confidence interval (95%CI) was 1.196-19.378], initial serum calcium < 2.0 mmol/L (OR = 6.688, 95%CI was 1.321-33.873) and initial blood glucose > 11.1 mmol/L (OR = 6.473, 95%CI was 1.399-29.950) were risk factors for long-term quality of life in cured SAP patients (all P < 0.05), while post discharge prophylactic intervention was a protective factor for long-term quality of life (OR = 0.092, 95%CI was 0.020-0.425, P < 0.01). CONCLUSIONS Cured SAP patients have varying degrees of impaired secretion function and the possibility of recurrence of acute pancreatitis. Hypertension, initial serum calcium < 2.0 mmol/L and blood glucose > 11.1 mmol/L are independent influencing factors for low long-term quality of life in cured SAP patients. Prevention and intervention targeting the etiology of pancreatitis after discharge can improve the long-term quality of life of cured SAP patients.
Humans ; Quality of Life ; Retrospective Studies ; Pancreatitis/therapy* ; Patient Discharge ; Male ; Female ; Middle Aged ; APACHE ; Adult ; Acute Disease ; Aged

[Purpose]To analyze the results of upper gastrointestinal cancer screening in rural areas of Lhasa from 2015 to 2019.[Methods]Upper gastrointestinal cancer screening program was conducted among residents aged 40～69 years old from 3 rural project sites in Lhasa selected by cluster sampling method from 2015 to 2019.The detected malignant tumors and precancerous le-sions were treated and confirmed by pathological examination.The detection rate of esophagus and stomach cancer were calculated by region,sex and age and compared by x2 test.[Results]A total of 1 399 people underwent gastroscopy,among whom 1 288 completed pathological biopsy(92.07％).Three cases of esophageal cancer were detected with a detection rate of 0.21％(3/1 399),all of which were advanced squamous cell carcinoma.Eight cases of gastric cancer were detected with a detection rate of 0.57％(8/1 399),and 2 cases were early gastric cancer.The detection rate of low-grade and high-grade epithelial neoplasia of gastric mucosa was 0.64％(9/1 399)and 0.21％(3/1 399),respectively.There was no significant difference in the detection rate among different regions,sexes and age groups(all P＞0.05).[Conclusion]The detection rate of upper gastrointesti-nal cancer in screening population in Lhasa is lower than the national average level.Men and the elderly are important target populations for upper gastrointestinal cancer screening,and increasing participation rates is necessary for more effective screening outcomes.

Aim To investigate whether adipose differentiation-related proteins promote macrophage lipid accu-mulation by upregulating acyl-CoA synthetase long-chain family member 3(ACSL3)expression through PI3K/Akt.Methods The experiments were divided into 24 h group,different PLIN2 expression groups,HA-PLIN2+SC97 group and HA-PLIN2+LY294002 group.Western blot was used to detect the protein expression of PLIN2,Akt,p-Akt and ACSL3 in cells,RT-qPCR was used to detect the mRNA level of PLIN2 in cells,and oil red O was used to observe the degree of lipid accumulation in cells.Results The protein expression levels of Akt,p-Akt and ACSL3 in macrophages overex-pressing PLIN2 were significantly increased(P＜0.05),and p-Akt nuclear translocation was increased,with fluorescence labeling of PLIN2 and Akt overlapping.After adding the PI3K/Akt agonist SC97 to macrophages overexpressing PLIN2,the expression level of ACSL3 significantly increased(P＜0.05),and the degree of intracellular lipid accumulation in-creased;After adding the PI3K/Akt inhibitor LY294002 to macrophages overexpressing PLIN2,the expression level of AC-SL3 significantly decreased(P＜0.05),and the degree of intracellular lipid accumulation decreased.Conclusion PLIN2 upregulates ACSL3 expression through PI3K/Akt,thereby promoting macrophage lipid accumulation.

BACKGROUND:Intertrochanteric femoral fractures are the main type of fragility fracture in the elderly,and proximal femoral nail antirotation is the preferred surgical option,but the factors associated with postoperative internal fixation failure are controversial.OBJECTIVE:A new"three-column"classification of intertrochanteric femoral fractures was proposed by evaluating patients'imaging data preoperatively and analyzing its interaction with postoperative internal fixation failure.A risk prediction model was developed and validated by using numerical algorithms,which facilitates clinicians to identify and intervene in high-risk patients preoperatively.METHODS:Patients with intertrochanteric femur fractures in Sanshui Branch of Foshan Hospital of Traditional Chinese Medicine between June 2012 and June 2022 were selected.The patients were divided into the internal fixation failure group and the internal fixation maintenance group according to whether they had internal fixation failure after surgery.According to the preoperative radiographs,the proximal femur was divided into three columns:the medial column,the lateral column,and the middle column.Each column had different subgroups.The relationship between the morphological characteristics of the"three columns"and the failure of proximal femoral nail antirotation internal fixation was analyzed,and the independent risk factors for internal fixation failure were screened out by single and then multifactorial logistic regression analyses.A risk prediction model was constructed according to the independent risk factors using R language software.The Bootstrap method was used to resample 1 000 times.The area under the curve,calibration curve,and clinical decision curve were used to evaluate the differentiation,calibration ability,and clinical application value of the model.The Youden index was used to determine the optimal risk cut-off value of the prediction model,according to which the patients were divided into high and low risk groups.The stability and extensibility of the model were evaluated according to the accuracy of its risk prediction ability.RESULTS AND CONCLUSION:(1)The four independent risk factors for postoperative internal fixation failure after surgery were predicted using the"three-column"typing system:medial column(comminuted fracture of the lesser trochanter and femoral talar)[odds ratio=5.385,95％CI(1.961,14.782),P=0.001],medial column(chimney type)[odds ratio=2.893,95％CI(1.167,7.173),P=0.022],lateral column(lateral wall thickness＜20.5 mm)[odds ratio=2.804,95％CI(1.078,7.297),P=0.035]and lateral column(lateral wall fracture)[odds ratio=4.278,95％CI(1.670,10.959),P=0.012].(2)The constructed risk prediction model showed good discrimination and accuracy[area under the receiver operating characteristic curve=0.852,95％CI(0.837,0.922)].The calibration curve showed good agreement between the model-predicted risk and the actual risk of occurrence.(3)The clinical decision curve suggested that the model had good clinical applicability when the risk threshold probability was in the range of 0.2-0.82.The risk probability of 28％was the optimal threshold for risk stratification of the model,and the predictive performance of the model was better in patients with different risk groups.(4)The"three-column"typing system constructs a predictive model to calculate the risk probability of postoperative internal fixation failure in patients with intertrochanteric femoral fractures.This method is accurate,simple,and easy to apply clinically,and can be used as a digital tool to guide personalized clinical treatment.

Objective:To investigate impacts of paeoniflorin on inflammation and nuclear transcription factor-κB(NF-κB)/nucleotide-binding oligomeric domain-like receptor protein 3(NLRP3)signal pathway in knee osteoarthritis(KOA)model rats.Meth-ods:SD rats were randomly grouped into model group,glucosamine group,paeoniflorin low-dose group,paeoniflorin high-dose group,paeoniflorin high-dose+phorbol ester(PMA)(NF-κB activator)group,with 10 rats in each group,another 10 rats were regarded as control group,and only knee joint capsule was cut,after treatment with glucosamine,paeoniflorin and PMA,joint pain symptoms of rats were detected by mechanical stimulation method and thermal radiation method;knee joint width,joint swelling and synovial thick-ness were measured;HE staining was applied to detect joint tissue structure and morphology of rats in each group;levels of inflamma-tory factors IL-1β,monocyte chemoattractant protein 1(MCP-1)and IL-9 in joint fluid and serum of rats were detected by ELISA;and Western blot was applied to detect expressions of NF-κB/NLRP3 signal pathway related proteins in rat joint tissue.Results:Com-pared with control group,joint tissue structure of model group was significantly damaged,mechanical pain threshold and thermal sen-sitivity pain threshold were significantly lower(P<0.05),knee joint width,joint swelling and synovial thickness,levels of IL-1β,MCP-1 and IL-9 in joint fluid and serum,and expression of p-NF-κB p65/NF-κB p65 and NLRP3 proteins in joint tissue were higher(P<0.05).Compared with model group,joint tissue damage of rats in glucosamine group,paeoniflorin low-dose group and paeoniflorin high-dose group was reduced,mechanical pain threshold and thermal sensitivity pain threshold were higher(P<0.05),knee joint width,joint swelling and synovial thickness,levels of IL-1β,MCP-1 and IL-9 in joint fluid and serum,and expressions of p-NF-κB p65/NF-κB p65 and NLRP3 proteins in joint tissue were lower(P<0.05);joint tissue injury of rats in paeoniflorin high-dose group was further reduced compared with paeoniflorin low-dose group,mechanical pain threshold and thermal sensitivity pain threshold were further higher(P<0.05),knee joint width,joint swelling and synovial thickness,levels of IL-1β,MCP-1 and IL-9 in joint fluid and serum,and expression of p-NF-κB p65/NF-κB p65 and NLRP3 proteins in joint tissue were further lower(P<0.05).Compared with paeoniflorin high-dose group,joint tissue damage of rats in paeoniflorin high-dose+PMA group was increased,mechanical pain threshold and thermal sensitivity pain threshold were lower(P<0.05),knee joint width,joint swelling and synovial thickness,levels of IL-1β,MCP-1 and IL-9 in joint fluid and serum,and expression of p-NF-κB p65/NF-κB p65 and NLRP3 proteins in joint tissue were higher(P<0.05);there was no significant change in all indexes of rats in glucosamine group(P>0.05).Conclusion:Paeoniflorin can play an anti-inflammatory role by down-regulating the NF-κB/NLRP3 signal pathway,thus alleviating joint injury and joint pain symptoms of KOA rats.