Objective:To compare the clinical and radiological outcomes between the ankle dislocation exposure versus the traditional posterolateral approach exposure in the treatment of complex posterior ankle malunion.Methods:This retrospective study analyzed the 50 patients (50 feet) with posterior ankle malunion who had been treated at Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from May 2015 to June 2023. This cohort included 18 males and 32 females, with an age of (46.2±12.0) years. The duration from injury to surgery averaged 7.0 (4.0, 12.2) months. The patients were divided into 2 groups based on the surgical exposure methods: an ankle dislocation group (22 cases) in which the posterior ankle malunion was exposed by ankle dislocation before reduction and fixation, and a traditional posterolateral approach group (28 cases) in which the posterior ankle malunion was exposed by the traditional posterolateral approach before reduction and fixation. Evaluation indices included operative time, ankle arthritis grading, incidence of complications, as well as pre-operative and last follow-up recordings of distal tibial articular angle and joint step-off, visual analogue scale (VAS) pain score, and ankle-hindfoot score of American Orthopaedic Foot and Ankle society (AOFAS).Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). The average follow-up was (39.4±17.9) months. The operative time in the dislocation group [(95.8±9.9) min] was significantly shorter than that in the posterolateral approach group [(121.9±14.3) min] ( P<0.05). The step-off on the distal tibial articular surface at the last follow-up in the dislocation group [0.3 (0.0, 0.9) mm] was significantly lower than that in the posterolateral approach group [1.0 (0.3, 1.1) mm] ( P<0.05). The grading of ankle arthritis was significantly worse in the posterolateral approach group than that in the dislocation group ( P<0.05). There were no differences in distal tibial articular angle, VAS pain score, AOFAS ankle-hindfoot score, or postoperative complications between the 2 groups at the last follow-up ( P>0.05). Conclusions:Both ankle dislocation exposure and traditional posterolateral approach exposure yield satisfactory clinical and radiological outcomes in patients with complex posterior ankle malunion. However, the ankle dislocation exposure offers a novel method for direct visualization of the malunion on multiple planes, which is more advantageous for restoration of the anatomical consistency of the distal tibial articular surface.

Objective:To compare the clinical and radiological outcomes between the ankle dislocation exposure versus the traditional posterolateral approach exposure in the treatment of complex posterior ankle malunion.Methods:This retrospective study analyzed the 50 patients (50 feet) with posterior ankle malunion who had been treated at Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from May 2015 to June 2023. This cohort included 18 males and 32 females, with an age of (46.2±12.0) years. The duration from injury to surgery averaged 7.0 (4.0, 12.2) months. The patients were divided into 2 groups based on the surgical exposure methods: an ankle dislocation group (22 cases) in which the posterior ankle malunion was exposed by ankle dislocation before reduction and fixation, and a traditional posterolateral approach group (28 cases) in which the posterior ankle malunion was exposed by the traditional posterolateral approach before reduction and fixation. Evaluation indices included operative time, ankle arthritis grading, incidence of complications, as well as pre-operative and last follow-up recordings of distal tibial articular angle and joint step-off, visual analogue scale (VAS) pain score, and ankle-hindfoot score of American Orthopaedic Foot and Ankle society (AOFAS).Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). The average follow-up was (39.4±17.9) months. The operative time in the dislocation group [(95.8±9.9) min] was significantly shorter than that in the posterolateral approach group [(121.9±14.3) min] ( P<0.05). The step-off on the distal tibial articular surface at the last follow-up in the dislocation group [0.3 (0.0, 0.9) mm] was significantly lower than that in the posterolateral approach group [1.0 (0.3, 1.1) mm] ( P<0.05). The grading of ankle arthritis was significantly worse in the posterolateral approach group than that in the dislocation group ( P<0.05). There were no differences in distal tibial articular angle, VAS pain score, AOFAS ankle-hindfoot score, or postoperative complications between the 2 groups at the last follow-up ( P>0.05). Conclusions:Both ankle dislocation exposure and traditional posterolateral approach exposure yield satisfactory clinical and radiological outcomes in patients with complex posterior ankle malunion. However, the ankle dislocation exposure offers a novel method for direct visualization of the malunion on multiple planes, which is more advantageous for restoration of the anatomical consistency of the distal tibial articular surface.

Objective To analyze the hepatitis B virus infection with extreme reduction of cholinesterase(CHE)not caused by liver synthesis dysfunction,and to explore its clinical significance.Methods The clinical data of 2 rare cases hospitalized in the 3rd people's hospital of Kunming in July 2021 and February 2022,including liver function,coagulation function,hepatitis B markers,hepatitis B virus volume,and whole exon sequencing,were collected and analyzed,and literature was reviewed.Results CHE was extremely reduced in 2 patients with HBV infection,liver synthesis function was good,and whole exon sequencing showed the presence of butyrylcholinesterase(BCHE)gene mutation.Conclusion The extremely low CHE in this case is not due to liver function disorder.Exon sequencing detected mutations in the BCHE gene in two patients.Screening for BCHE mutations may be necessary in patients with extremely low cholinesterase levels not due to liver dysfunction.

Objective:To evaluate the clinical effects of anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy in the treatment of chronic ankle instability after trauma.Methods:A retrospective study was conducted to analyze of the clinical data of 16 patients with chronic post-traumatic instability of the medial malleolus who had been treated at The Eighth Department of Orthopedics, Foshan Hospital of Traditional Chinese Medicine from December 2015 to February 2017. There were 14 males and 2 females with an age of (28.1±4.2) years. Seven left sides and 9 right sides were affected; the time from injury to operation was (8.9±2.4) months. Before operation, X-rays (anteroposterior, lateral and Saltzman views) and MRI of weight-bearing ankle were taken. All patients were treated by anatomical reconstruction of the deltoid ligament using the autologous semitendinosus and medial migration osteotomy of the calcaneus. The time for injury healing and occurrence of complications were recorded. The talus tilt angle, Meary angle, hindfoot valgus angle, visual analogue scale (VAS), and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot function score were compared between the preoperation and the last follow-up. The Sefton evaluation for efficacy in ankle ligament reconstruction was used to assess stability of the ankle joint.Results:Of this cohort, 14 patients were followed up for (16.4±4.9) months after operation and 2 patients lost to follow-up. The 14 patients all returned to normal physical activities 3 months after operation. All incisions healed at the first stage with no infection. One patient experienced pain at the site for harvest of the semitendinosus but the symptoms were relieved after rehabilitation treatment like massage and physical therapy. At the last follow-up, the talus tilt angle [1.0 (0.0, 2.0)°], Meary angle (1.4°±4.2°), hindfoot valgus angle (3.2°±2.4°), VAS score [0.5 (0.0, 1.0) points], and AOFAS ankle-hindfoot score [(89.2±6.1) points] were all significantly improved compared with the preoperative values [8.3°±1.8°, 0.8°±3.8°, 9.9°±3.4°, (5.7±2.5) points, and (49.6±9.8) points] (all P<0.05). According to the Sefton evaluation, the stability of the ankle joint was excellent in 9 cases, good in 4 cases, and fair in 1 case. Conclusion:In the treatment of chronic ankle instability after trauma, anatomical reconstruction of the deltoid ligament and medial migration calcaneal osteotomy is safe and effective, resulting in limited complications.

Objective:To illustrate a relatively complete knowledge system (e.g., research outputs, current hotspots, and future trends) in the sepsis field and to help scholars grasp the scientific research direction or clinical focus of treatment.Methods:The relevant literatures of sepsis during the time from 1985 to 2019 in Web of Science database were collected. Sepsis-related research contents were generated using softwares (CiteSpace 5.6.R2 and VOSviewer 1.6.13), which using data mining, information processing and knowledge map methods, to analyze the historical evolution and predict the development trend.Results:A total of 8 189 papers on sepsis were published. The volume of publications were increasing yearly from 1985 to 2019, and reached the top list of 1 276 in 2019. For research contents of sepsis, it has formed the basic characteristics of sepsis which focusing on epidemiological studies and animal experiments. Through cluster analysis, the researches mainly focused on six aspects: septic rat, necrotizingenterocolitis, sepsis-associated encephalopathy, acute kidney injury (AKI), gut-derived sepsis, and inflammatory mediator. And it presented the literature characteristics that related to the injury or dysfunction of intestines, brain, liver, kidney or other organs, but the heart and lung researches were more marginal. Additionally, based on the top key words with the strongest citation bursts, it reflected that the development trend of the continuous attention hotspots with "endotoxin" or "endotoxin shock", the significant attention hotspots with "inflammation", "immunity" and "multiple organ dysfunction syndrome" (MODS), and the novel burst attention hotspots with sepsis management including "diagnosis" and "chemotherapy".Conclusions:Through the hotspots and trends visualization of sepsis, the current researches are prefer to animal experiments, epidemiology, or other basic scientific aspects. Meanwhile, the researches are mostly focusing on inflammatory reaction, immune function or organ dysfunctions. Integrating the knowledge maps of hotspots and trends, based on researches of epidemiology, diagnosis, risk factors, pathogenesis, or treatment, we predict that the future scientific topics will concentrating on childhood sepsis, organ injury mechanism or intervention relating to MODS, and integrated management of sepsis by combining traditional Chinese medicine and Western medicine.

Objective:To screen and identify plasma differentially expressed genes and related signal pathway by human gene expression profile array and fluorescent quantitative PCR.Methods:From September 2018 to October 2019, 291 workers from a Mercury-in-glass thermometer factory in Jiangsu Province were selected for an occupational health examination, a total of 60 persons were divided into two groups: high and low mercury exposure groups (30 persons in each group) . Plasma total RNA samples from the high exposure group and the low exposure group (10 cases each) were detected by gene expression microarray, and differentially expressed genes (DEGs) with fold change >2 were selected. DEGs were submitted to David and Metascape for gene function clustering, pathway and protein interaction network analysis. Finally, fluorescence quantitative PCR was performed to verify the changes in the expression levels of key DEGs in the high exposure group and the low exposure group (another 20 cases in each group) .Results:A total of 269 DEGs, of which 203 up regulated and 66 down regulated were identified in the differential expression analysis of gene expression microarray. Bioinformatics analysis suggested that, DEGs were involved in forebrain development, glial cell fate determinants of GO biological process and PID NF-KB, PTEN signal pathway. NFE2L1, SOX8, SOX6 and RNF2 ( P<0.05) were confirmed down regulated in high level group by fluorescent quantitative PCR compared with the low level group (fold changes were 2.10, 11.52, 2.19, and 4.38 respectively) . Conclusion:The plasma NFE2L1, SOX8, SOX6 and RNF2 gene expressions are significantly altered in occupa tional high mercury exposure population. PTEN signaling pathway and fate of glia cells determines the biological process may be closely related to the body injury caused by mercury exposure.

Objective:To screen and identify plasma differentially expressed genes and related signal pathway by human gene expression profile array and fluorescent quantitative PCR.Methods:From September 2018 to October 2019, 291 workers from a Mercury-in-glass thermometer factory in Jiangsu Province were selected for an occupational health examination, a total of 60 persons were divided into two groups: high and low mercury exposure groups (30 persons in each group) . Plasma total RNA samples from the high exposure group and the low exposure group (10 cases each) were detected by gene expression microarray, and differentially expressed genes (DEGs) with fold change >2 were selected. DEGs were submitted to David and Metascape for gene function clustering, pathway and protein interaction network analysis. Finally, fluorescence quantitative PCR was performed to verify the changes in the expression levels of key DEGs in the high exposure group and the low exposure group (another 20 cases in each group) .Results:A total of 269 DEGs, of which 203 up regulated and 66 down regulated were identified in the differential expression analysis of gene expression microarray. Bioinformatics analysis suggested that, DEGs were involved in forebrain development, glial cell fate determinants of GO biological process and PID NF-KB, PTEN signal pathway. NFE2L1, SOX8, SOX6 and RNF2 ( P<0.05) were confirmed down regulated in high level group by fluorescent quantitative PCR compared with the low level group (fold changes were 2.10, 11.52, 2.19, and 4.38 respectively) . Conclusion:The plasma NFE2L1, SOX8, SOX6 and RNF2 gene expressions are significantly altered in occupa tional high mercury exposure population. PTEN signaling pathway and fate of glia cells determines the biological process may be closely related to the body injury caused by mercury exposure.

Objective: To investigate whether plasma microRNAs has-let-7d and has-let-7e can be used as potential molecular markers for workers with occupational exposure to mercury. Methods: October 2013, the workers with occupational exposure to mercury who worked in a mercury thermometer factory and participated in occupational health examination were selected as subjects, and biological samples and basic data were collected. The subjects were divided into chronic mercury poisoning group,mercury absorption group,and control group,with 30 individuals in each group. AmicroRNA microarray combined with RT-qPCR was used to measure the expression of has-let-7d and has-let-7e in the three groups, the receiver operating characteristic(ROC)curve was used to analyze the values of has-let-7d and has-let-7e in the diagnosis of occupational chronic mercury poisoning,a software platform was used to predict target genes. Gene ontology enrichment analysis and KEGG pathway analysis were also performed. Results: Compared with the control group, the chronic mercury poisoning group and the mercury absorption group had significant increases in the expression of has-let-7d and has-let-7e(P<0.05). The areas under the ROC curve for microRNAs has-let-7d and has-let-7e in the diagnosis of occupational chronic mercury poisoning were 0.912(95% confidence interval[CI]0.843-0.981)and 0.908(95%CI0.837-0.979),respectively,and there was a significant difference between them(P<0.001). Conclusion Plasma microRNAs has-let-7d and has-let-7e can be used as potential molecular markers for workers with occupational exposure to mercury.

Objective: To investigate the incidence of occupational diseases in a province of China during the period of "Twelfth Five-Year Plan" , and to analyze the features of disease spectrum, the characteristics of regional and industrial distribution, and incidence trend. Methods: Data (2011-2015) were collected from the Information System of Occupational Diseases and Occupational Health to analyze the reported cases of occupational diseases during the period of "Twelfth Five-Year Plan". A statistical analysis was performed to identify the characteristics of the disease distribution in terms of sex, age, working years, enterprise type, enterprise scale, and region, as well as the incidence trend. Results: The overall incidence of occupational diseases in this province fluctuated and decreased gradually. There were a total of 5036 new cases of occupational diseases during the period of "Twelfth Five-Year Plan" ; 89.45% of them were male, and 69.78% of them were aged 40-69 years; the most frequently seen occupational diseases were pneumoconiosis (72.48%) and ear, nose, throat, and oral diseases (7.23%). Most cases of pneumoconiosis occurred after 5-10 years of exposure, and other occupational diseases usually developed within 10 years of exposure. New cases of occupational diseases were often seen in small and micro enterprises, as well as Wuxi, Suzhou, and Yancheng. Conclusion During the period of "Twelfth Five-Year Plan" , the incidence of occupational diseases in this province decreased gradually, indicating improved control of occupational diseases, but we still need to pay attention to the high-risk population (male, aged over 40 years) , as well as the prevention of occupational noise-induced hearing loss, and to strengthen the supervision of small and micro enterprises.

OBJECTIVETo investigate atmospheric mercury concentration in the workplace and urinary mercury concentration in workers exposed to mercury in a thermometer factory, and to determine the levels and influencing factors of urinary Β₂-microglobulin (Β₂-MG) and retinol-binding protein (RBP) in these workers.

METHODSAn occupational health survey of the workplace was completed according to relevant national occupational health standards. Questionnaire survey and occupational health examination were conducted in 178 workers exposed to mercury in the factory. Statistical analysis was accomplished using SPSS 19.0.

RESULTSIn the workplace, atmospheric mercury concentration was out of limits at seven of eight detection points expressed by short-term exposure limit; it was out of limits at all the eight detection points shown by time-weighted average. Statistically significant difference in atmospheric mercury concentration was found among different detection points (F = 138.714, P < 0.001). The geometric mean of urinary mercury concentration measured in 154 workers was 171.607 µg/g. There were 127 workers with urinary mercury concentration exceeding the standard (82.5% over-standard rate). Significant difference in urinary mercury concentration was shown in the workers among different positions (χ² = 44.531, P < 0.01). Urinary mercury concentration was positively correlated with atmospheric mercury concentration (r = 0.624, P < 0.01). The mean urinary Β₂-MG level measured in 148 workers was 0.142 mg/L, and seven workers had urinary Β₂-MG levels greater than 0.3 mg/L (4.7% abnormal rate). The mean urinary RBP level measured in 153 workers was 0.485 mg/L, and 19 workers had urinary RBP levels greater than 0.7 mg/L (12.4% abnormal rate). Ordinal logistic regression showed that age >34 years (OR = 4.88, 95%CI: 2.24∼10.62) and length of service >15 years (OR = 2.50, 95%CI: 1.06-5.92) were risk factors for increased urinary Β₂-MG level. Age >45 years (OR = 7.52, 95%CI: 2.50∼22.65) was a risk factor for increased urinary RBP level.

CONCLUSIONIn the thermometer factory under study, atmospheric and urinary mercury concentrations both seriously exceeded the standards, which were harmful to the health of workers. High atmospheric mercury concentration, old age, and long length of service were risk factors for increased urinary Β₂-MG and RBP levels in workers exposed to mercury.

Adult ; Environmental Exposure ; Humans ; Kidney ; drug effects ; Kidney Diseases ; chemically induced ; Mercury ; analysis ; toxicity ; Occupational Exposure ; Risk Factors ; Threshold Limit Values ; Time Factors ; Workplace