BACKGROUND:For the treatment of osteochondral lesions of the talus,different treatment methods are adopted according to different types or clinical symptoms,including rehabilitation treatment,surgical treatment and biological agent treatment. Most of the rehabilitation treatment relieved the symptoms and delayed the disease in a short time. In recent years,arthroscopic microfractures,kirschner wire drilling,talus cartilage transplantation,autologous osteochondrocyte transplantation,stem cell transplantation,and biological preparation platelet-rich plasma can achieve good results.OBJECTIVE:To summarize the progress in the treatment of osteochondral lesions of the talus and provide a reference for their clinical treatment. METHODS:Using English search terms "talus,osteochondral lesions of the talus" and Chinese search terms "microfracture,transplantation,platelet-richplasma,stem cell," we searched the PubMed and CNKI databases for related articles published from January 2019 to January 2024. A total of 67 articles were included for comprehensive analysis.RESULTS AND CONCLUSION:(1) There are many ways to treat osteochondral lesions of the talus. Conservative rehabilitation and biological agents can alleviate the condition for Hepple type Ⅰ and Ⅱ lesions. Microfracture or Kirschner wire drilling bone marrow stimulation treatment is used for Hepple type Ⅲ and above and lesion diameter<15 mm,but the long-term efficacy is poor. Replacement and regeneration strategies are used for larger lesions,and transplant failure is the main risk. (2) Biological agent treatment is a new treatment method and is often used in combination therapy. (3) In view of the treatment of osteochondral lesions of the talus,many factors such as the area and location of cartilage injury should be taken into account. The selection of the treatment plan should also take into account the level of medical technology,patient acceptance,economic status and other factor. Personalized combination treatment of various schemes is recommended to achieve good results.

Objective To explore the application effect of isokinetic strength combined with conventional training in the rehabilitation after elbow joint release surgery.Methods A retrospective cohort study was conducted to analyze the clinical data of 82 patients who underwent elective elbow joint release surgery in our hospital from June 2022 to June 2023.They were divided into the control group and the observation group,with 41 cases in each group.Patients in the control group received routine training,while patients in the observation group received isokinetic strength training on the basis of the control group.The elbow joint function,elbow joint range of motion,pain degree,and ability of daily living before and after surgery of patients in the two groups were compared and analyzed.Results Three months after surgery,compared with the control group,the Mayo elbow function score of patients in the observation group were higher(P<0.05),the elbow flexion,extension,forearm supination,and forearm pronation ranges of motion of patients in the observation group were greater(P<0.05),the VAS score of patients in the observation group was lower(P<0.05),the ability of daily living of patients in the observation group was better(P<0.05).Conclusion The application of isokinetic strength combined with conventional training in elbow joint release surgery can promote elbow joint functional recovery,alleviate pain degree,and enhance ability of daily living.

BACKGROUND:For the treatment of osteochondral lesions of the talus,different treatment methods are adopted according to different types or clinical symptoms,including rehabilitation treatment,surgical treatment and biological agent treatment. Most of the rehabilitation treatment relieved the symptoms and delayed the disease in a short time. In recent years,arthroscopic microfractures,kirschner wire drilling,talus cartilage transplantation,autologous osteochondrocyte transplantation,stem cell transplantation,and biological preparation platelet-rich plasma can achieve good results.OBJECTIVE:To summarize the progress in the treatment of osteochondral lesions of the talus and provide a reference for their clinical treatment. METHODS:Using English search terms "talus,osteochondral lesions of the talus" and Chinese search terms "microfracture,transplantation,platelet-richplasma,stem cell," we searched the PubMed and CNKI databases for related articles published from January 2019 to January 2024. A total of 67 articles were included for comprehensive analysis.RESULTS AND CONCLUSION:(1) There are many ways to treat osteochondral lesions of the talus. Conservative rehabilitation and biological agents can alleviate the condition for Hepple type Ⅰ and Ⅱ lesions. Microfracture or Kirschner wire drilling bone marrow stimulation treatment is used for Hepple type Ⅲ and above and lesion diameter<15 mm,but the long-term efficacy is poor. Replacement and regeneration strategies are used for larger lesions,and transplant failure is the main risk. (2) Biological agent treatment is a new treatment method and is often used in combination therapy. (3) In view of the treatment of osteochondral lesions of the talus,many factors such as the area and location of cartilage injury should be taken into account. The selection of the treatment plan should also take into account the level of medical technology,patient acceptance,economic status and other factor. Personalized combination treatment of various schemes is recommended to achieve good results.

Objective To explore the application effect of isokinetic strength combined with conventional training in the rehabilitation after elbow joint release surgery.Methods A retrospective cohort study was conducted to analyze the clinical data of 82 patients who underwent elective elbow joint release surgery in our hospital from June 2022 to June 2023.They were divided into the control group and the observation group,with 41 cases in each group.Patients in the control group received routine training,while patients in the observation group received isokinetic strength training on the basis of the control group.The elbow joint function,elbow joint range of motion,pain degree,and ability of daily living before and after surgery of patients in the two groups were compared and analyzed.Results Three months after surgery,compared with the control group,the Mayo elbow function score of patients in the observation group were higher(P<0.05),the elbow flexion,extension,forearm supination,and forearm pronation ranges of motion of patients in the observation group were greater(P<0.05),the VAS score of patients in the observation group was lower(P<0.05),the ability of daily living of patients in the observation group was better(P<0.05).Conclusion The application of isokinetic strength combined with conventional training in elbow joint release surgery can promote elbow joint functional recovery,alleviate pain degree,and enhance ability of daily living.

Glyceryl phenylbutyrate(GPB)serves as a long-term management medication for Ornithine transcarbamylase deficiency(OTCD),effectively controlling hyperammonemia,but there is a lack of experience in using this medicine in China.This article retrospectively analyzes the case of a child diagnosed with OTCD at Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,including a review of related literature.After diagnosis,the patient was treated with GPB,followed by efficacy follow-up and pharmacological monitoring.The 6-year and 6-month-old male patient exhibited poor speech development,disobedience,temper tantrums,and aggressive behavior.Blood ammonia levels peaked at 327 μmol/L;urine organic acid analysis indicated elevated uracil levels;cranial MRI showed extensive abnormal signals in both cerebral hemispheres.Genetic testing revealed de novo mutation in the OTC gene(c.241T＞C,p.S81P).Blood ammonia levels were approximately 43,80,and 56 μmol/L at 1,2,and 3 months after starting GPB treatment,respectively.During treatment,blood ammonia was well-controlled without drug-related adverse effects.The patient showed improvement in developmental delays,obedience,temperament,and absence of aggressive behavior.

Objective To establish an ideal modeling method for diarrhea predominant irritable bowel syndrome(IBS-D)with anxiely and depression in rats,and to provide a basis for the clinical study of IBS-D.Methods 60 rats were used in this study.(1)At first,20 rats were randomly divided into blank,3%acetic acid enema,4%acetic acid enema,and 5%acetic acid enema groups.After the modeling and observation period,the diarrhea status and the degree of colon injury caused by different modeling concentrations were observed by diarrhea related index and colon histopathology.(2)After the optimal modeling concentration was assessed,40 rats were randomly divided into control(a),acetic acid enema(b),acetic acid+binding(c),and acetic acid+binding+tail clip(d)groups and correspondingly treated for 8 days.After the treatments,the general condition,diarrhea-related index,open field test(OFT)score,and colonic histopathology of rats were evaluated.Results(1)Compared with the blank group,the fecal trait score of 4%acetic acid enema group was increased on days 1 to 3 after intervention(P＜0.001),and gradually decreased on days 4 to 7 after intervention.After 1 week,there was no significant difference between the fecal trait score and that of the blank group(P＞0.05).Body weight was lower(P＜0.01),fecal water content was higher(P＜0.001).Compared with blank group,body weight of the 5%acetic acid enema group was decreased(P＜0.001),the fecal trait score and diarrhea index were increased(P＜0.01).No significant difference was found between 3%acetic acid enema and blank groups.The pathological colon tissue showed that,compared with the blank group,the mucosal structure of the 4%acetic acid enema group was complete with a small amount of inflammatory cell infiltration,and the pathological tissue score showed no significant difference(P＞0.05),whereas the 5%acetic acid enema had a medium to large amount of inflammatory cell infiltration,and the pathological tissue score was increased(P＜0.01).(2)Compared with group a,group b had lower body weight(P＜0.001),and higher fecal trait score,fecal water content and diarrhea index(P＜0.01).Compared with a and b groups,the body weight of c and d groups was lower(P＜0.001),the fecal traits score,fecal water content,and diarrhea index were increased(P＜0.01),and the colon running time was decreased(P＜0.01).Compared with group c,Fecal water content in group D was higher(P＜0.001).In the OFT score,compared with a and b groups,the OFT distance,standing times,and upright times in c and d groups were lower(P＜0.05).Compared with c,the OFT distance,standing times,and upright times in d group were lower(P＜0.05).The pathological tissue of colon showed that the mucosal structure of the four groups was complete,and there were different degrees of inflammatory cell infiltration.The pathological tissue scores of groups c and d were higher than those of groups a and b(P＜0.05).Conclusions The 4%acetic acid concentration is appropriate for IBS-D modeling.After superposition and binding,the IBS-D diarrhea and internal hypersensitivity characteristic state can be better simulated.After superposition of a tail clip,the IBS-D model of liver stagnation and spleen deficiency can be established successfully.

Objective To investigate the effect of a three-tier delirium care management process in patients with acute stroke in neurology intensive care unit(NICU).Methods A total of 50 patients with acute stroke admitted to the NICU of the Fourth Hospital of Changsha from May to September 2021 were assigned to the control group.The patients in the control group received routine NICU nursing care to prevent delirium.Another 50 patients with acute stroke admitted to the NICU from December 2021 to April 2022 were assigned to the trial group.They were managed with the three-tier delirium nursing management process on top of the routine NICU nursing care for the control group.The incidence of ICU delirium(DICU),duration of DICU,length of stay in NICU and the incidence of delirium-related adverse events were compared between the two groups.The degree of delirium and cognitive function before and after the intervention were compared between the two groups as well.Results The trial group had significantly shorter duration of DICU and NICU stay(both P<0.05)and lower incidence rate of delirium-related adverse events(P<0.05)compared to the control group.After the intervention,the trial group showed significantly lower scores on the intensive care delirium screening checklist(ICDSC)and significantly higher scores of cognitive function compared to those of the control group(both P<0.05).Conclusion The three-tier delirium nursing management process can lower the occurrence of delirium in NICU patients with acute stroke,shorten the NICU stay,reduce the safety risk in nursing,and improve the cognitive function.

Objective To develop a Nomogram prediction model for post-stroke delirium (PSD) in patients with acute stroke and to verify the effectiveness of the prediction model. Methods A total of 400 patients with acute stroke,admitted to the Department of Neurology in our hospital between June 2022 and March 2023,were retrospectively included in the study as the training group. Independent risk factors for PSD were identified by Logistic regression analysis. A calibration model was constructed to evaluate the consistency of the model. The area under ROC curve (AUC) was used to evaluate the accuracy of the prediction model. Between April and July 2023,172 patients with acute stroke were selected,as the validation group,for external validation of the model. Results The incidence of PSD was found at 27.50％ in the training group and 26.74％ in the validation group. A Nomogram prediction model was constructed with the five predictors:cerebrovascular interventional surgery,hypersensitive C-reactive protein,smoking,National Institutes of Health Stroke Scale (NIHSS) score and age. The calibration curve was found close to the ideal curve with an AUC at 0.797 for the training group,and the risk prediction corresponding to the maximum Youden index was 0.554 with a predicted threshold of 134.63. The calibration curve of the validation group was also found close to the ideal curve,with an AUC of 0.844. Conclusion The nomogram prediction model for PSD in patients with acute stroke demonstrates a good risk prediction value for risk assessment,which can help medical staff to effectively predict the risk for PSD in patients with acute stroke and to take corresponding measures in prevention of PSD.

Objective To develop a Nomogram prediction model for post-stroke delirium (PSD) in patients with acute stroke and to verify the effectiveness of the prediction model. Methods A total of 400 patients with acute stroke,admitted to the Department of Neurology in our hospital between June 2022 and March 2023,were retrospectively included in the study as the training group. Independent risk factors for PSD were identified by Logistic regression analysis. A calibration model was constructed to evaluate the consistency of the model. The area under ROC curve (AUC) was used to evaluate the accuracy of the prediction model. Between April and July 2023,172 patients with acute stroke were selected,as the validation group,for external validation of the model. Results The incidence of PSD was found at 27.50％ in the training group and 26.74％ in the validation group. A Nomogram prediction model was constructed with the five predictors:cerebrovascular interventional surgery,hypersensitive C-reactive protein,smoking,National Institutes of Health Stroke Scale (NIHSS) score and age. The calibration curve was found close to the ideal curve with an AUC at 0.797 for the training group,and the risk prediction corresponding to the maximum Youden index was 0.554 with a predicted threshold of 134.63. The calibration curve of the validation group was also found close to the ideal curve,with an AUC of 0.844. Conclusion The nomogram prediction model for PSD in patients with acute stroke demonstrates a good risk prediction value for risk assessment,which can help medical staff to effectively predict the risk for PSD in patients with acute stroke and to take corresponding measures in prevention of PSD.

OBJECTIVES: To explore the effect of acupuncture and moxibustion on intestinal flora in the rats with diarrhea-predominant irritable bowel syndrome (IBS-D) based on 16S rDNA technique. METHODS: Ten rats were randomized from 58 SPF-grade male SD rats to be the blank group. The remained 48 rats were prepared to be IBS-D models by the modified method of acetic acid enema combined with binding tail-clip stress. Forty successfully-modeled rats were randomly divided into a model group, an acupuncture group, a moxibustion group and a western medication group, with 10 rats in each one. In the acupuncture group, the needle was inserted at bilateral "Zusanli" (ST 36) and remained for 15 min in each rat. In the moxibustion group, the suspending moxibustion was delivered at bilateral "Zusanli" (ST 36) for 15 min. The rats in the western medication group were given pinaverium bromide suspension (10 mL/kg) by intragastric administration. The above interventions were performed once daily for consecutive 14 days. The body mass and the score of fecal trait were compared before and after modeling, as well as after intervention in each group. Fecal water content, diarrhea index and colon transit time (CTT) were measured after modeling and intervention in the rats of each group separately. After intervention, the colonic morphology of rats in each group was observed, and using 16S rDNA technique, the intestinal flora was detected. RESULTS: After modeling, compared with the blank group, the body mass and CTT were reduced (P<0.01); fecal trait scores, fecal water contents and diarrhea index increased (P<0.01) in the other 4 groups. After intervention, the body mass and CTT of the rats decreased (P<0.01), and fecal trait score, fecal water content and diarrhea index increased (P<0.01) in the model group compared with those in the blank group. In the acupuncture group, the moxibustion group and the western medication group, when compared with the model group, the body mass and CTT were elevated (P<0.01), while fecal trait scores, fecal water contents and diarrhea index declined (P<0.01). Compared with the western medication group, fecal water content decreased in the acupuncture group and the moxibustion group (P<0.05), while CTT increased in the acupuncture group (P<0.01), the body mass increased and fecal trait score was dropped in the moxibustion group (P<0.05). The colonic mucosa structure was clear and complete, and there was no obvious inflammatory cell infiltration in the blank group. The mild interstitial edema of intestinal mucosa was presented with the infiltration of few inflammatory cells in the model group. There was the infiltration of few inflammatory cells in the mucosa of the acupuncture group, the moxibustion group and the western medication group. Compared with the blank group, the indexes of Richness, Chao1, ACE and Shannon decreased in the model group (P<0.05). Indexes of Richness, Chao1 and ACE increased in the acupuncture group and the moxibustion group (P<0.05), and the Richness index in the western medication group increased (P<0.05) when compared with those in the model group. The relative abundance of Bacteroidetes, Proteobacteria and Prevotella increased (P<0.05), and that of Firmicutes and Muribaculaceae decreased (P<0.05) in the model group compared with those in the blank group. When compared with the model group, the relative abundance of Bacteroidetes, Proteobacteria and Prevotella was reduced (P<0.05), while that of Firmicutes and Muribaculaceae increased (P<0.05) in the acupuncture group, the moxibustion group and the western medication group; and that of Actinobacteria and Bifidobacterium increased in the acupuncture group and the moxibustion group (P<0.05). Compared with the blank group, the relative abundance of lipopolysaccharide (LPS) biosynthesis was elevated (P<0.05), and that of folate biosynthesis, lipoic acid metabolism, zeatin biosynthesis, ubiquinone and other terpenoid quinone biosynthesis decreased (P<0.05) in the model group. The relative abundance of LPS biosynthesis was dropped (P<0.05), and that of folate biosynthesis, lipoic acid metabolism, zeatin biosynthesis, ubiquinone and other terpenoid quinone biosynthesis increased (P<0.05) in the acupuncture group, the moxibustion group and the western medication group compared with those of the model group. CONCLUSIONS Either acupuncture or moxibustion can relieve the symptoms of IBS-D and protect intestinal mucosa, which may be associated with regulating the structure of intestinal flora and promoting nutrient metabolism and biosynthesis.
Rats ; Male ; Animals ; Irritable Bowel Syndrome/therapy* ; Moxibustion/methods* ; Rats, Sprague-Dawley ; Gastrointestinal Microbiome ; Lipopolysaccharides ; Thioctic Acid ; Ubiquinone ; Zeatin ; Acupuncture Therapy ; Diarrhea/therapy* ; Terpenes ; Water ; Folic Acid ; Acupuncture Points