OBJECTIVE: To summarize the clinical characteristics of foot and ankle deformities combined with knee and lower limb deformities and evaluate the advantages, clinical outcomes, and considerations of QIN Sihe's surgical strategy for treating such complex deformities. METHODS: Between January 2022 and December 2024, 32 patients with foot and ankle deformities combined with knee and lower limb deformities were enrolled. The cohort included 23 males and 9 females, aged 10-67 years (mean, 41.1 years). The main etiologies included post-polio sequelae (20 cases) and congenital limb deformities (3 cases). Deformities were categorized as follows: equinovarus foot (12 cases), equinus foot (2 cases), equinovalgus foot (3 cases), equinus foot with swan-neck deformity (2 cases), calcaneus foot (5 cases), foot valgus (2 cases), knee flexion deformity (14 cases), genu recurvatum (4 cases), genu varum (3 cases), genu valgum (3 cases), lower limb shortening (3 cases), and lower limb external rotation (6 cases). QIN Sihe's surgical strategies included osteotomies, tendon releases, and tendon transfers for deformity correction, followed by external fixation for residual deformity adjustment and stabilization. Outcomes were assessed using QIN Sihe's Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction. RESULTS: All patients were followed up 8-32 months (mean, 16.5 months). Complications included pin tract infection (1 case, 1 site), ankle pain (2 cases), delayed healing at the proximal tibial osteotomy site (1 case), and anterior talar dislocation (1 case). At last follow-up, insufficient correction of foot deformity was observed in 1 case; both knee and lower limb deformities were corrected, with only mild recurrence of knee flexion deformity in 1 case. The foot/ankle and knee joint function improved. Based on QIN Sihe's Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction, outcomes were rated as excellent in 30 cases and good in 2 cases, with an excellent-good rate of 100%. CONCLUSION Foot and ankle deformities combined with knee and lower limb deformities are complex, QIN Sihe's surgical strategy can achieve satisfactory clinical outcomes for simultaneous correction.
Humans ; Male ; Female ; Adult ; Middle Aged ; Child ; Adolescent ; Aged ; Treatment Outcome ; Young Adult ; Plastic Surgery Procedures/methods* ; Lower Extremity Deformities, Congenital/surgery* ; Osteotomy/methods* ; Foot Deformities, Congenital/surgery* ; Ankle Joint/surgery* ; Knee Joint/surgery* ; Foot Deformities/surgery*

Objective Gallstone disease(GSD)is one of the common digestive tract diseases with a high worldwide prevalence.The effects of GSD on patients include but are not limited to the symptoms of nausea,vomiting,and biliary colic directly caused by GSD.In addition,there is mounting evidence from cohort studies connecting GSD to other conditions,such as cardiovascular diseases,biliary tract cancer,and colorectal cancer.Early identification of patients at a high risk of GSD may help improve the prevention and control of the disease.A series of studies have attempted to establish prediction models for GSD,but these models could not be fully applied in the general population due to incomplete prediction factors,small sample sizes,and limitations in external validation.It is crucial to design a universally applicable GSD risk prediction model for the general population and to take individualized intervention measures to prevent the occurrence of GSD.This study aims to conduct a multicenter investigation involving more than 90 000 people to construct and validate a complete and simplified GSD risk prediction model.Methods A total of 123 634 participants were included in the study between January 2015 and December 2020,of whom 43 929 were from the First Affiliated Hospital of Chongqing Medical University(Chongqing,China),11 907 were from the First People's Hospital of Jining City(Shandong,China),1 538 were from the Tianjin Medical University Cancer Institute and Hospital(Tianjin,China),and 66 260 were from the People's Hospital of Kaizhou District(Chongqing,China).After excluding patients with incomplete clinical medical data,35 976 patients from the First Affiliated Hospital of Chongqing Medical University were divided into a training data set(n=28 781,80% )and a validation data set(n=7 195,20% ).Logistic regression analyses were performed to investigate the relevant risk factors of GSD,and a complete risk prediction model was constructed.Factors with high scores,mainly according to the nomograms of the complete model,were retained to simplify the model.In the validation data set,the diagnostic accuracy and clinical performance of these models were validated using the calibration curve,area under the curve(AUC)of the receiver operating characteristic curve,and decision curve analysis(DCA).Moreover,the diagnostic accuracy of these two models was validated in three other hospitals.Finally,we established an online website for using the prediction model(The complete model is accessible at https://wenqianyu.shinyapps.io/Completemodel/,while the simplified model is accessible at https://wenqianyu.shinyapps.io/Simplified/).Results After excluding patients with incomplete clinical medical data,a total of 96 426 participants were finally included in this study(35 876 from the First Affiliated Hospital of the Chongqing Medical University,9 289 from the First People's Hospital of Jining City,1 522 from the Tianjin Medical University Cancer Institute,and 49 639 from the People's Hospital of Kaizhou District).Female sex,advanced age,higher body mass index,fasting plasma glucose,uric acid,total bilirubin,gamma-glutamyl transpeptidase,and fatty liver disease were positively associated with risks for GSD.Furthermore,gallbladder polyps,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and aspartate aminotransferase were negatively correlated to risks for GSD.According to the nomograms of the complete model,a simplified model including sex,age,body mass index,gallbladder polyps,and fatty liver disease was constructed.All the calibration curves exhibited good consistency between the predicted and observed probabilities.In addition,DCA indicated that both the complete model and the simplified model showed better net benefits than treat-all and treat-none.Based on the calibration plots,DCA,and AUCs of the complete model(AUC in the internal validation data set=74.1%[95% CI:72.9%-75.3%],AUC in Shandong=71.7%[95% CI:70.6%-72.8%],AUC in Tianjin=75.3%[95% CI:72.7%-77.9%],and AUC in Kaizhou=72.9%[95% CI:72.5%-73.3%])and the simplified model(AUC in the internal validation data set=73.7%[95% CI:72.5%-75.0%],AUC in Shandong=71.5%[95% CI:70.4%-72.5%],AUC in Tianjin=75.4%[95% CI:72.9%-78.0%],and AUC in Kaizhou=72.4%[95% CI:72.0%-72.8%]),we concluded that the complete and simplified risk prediction models for GSD exhibited excellent performance.Moreover,we detected no significant differences between the performance of the two models(P>0.05).We also established two online websites based on the results of this study for GSD risk prediction.Conclusions This study innovatively used the data from 96 426 patients from four hospitals to establish a GSD risk prediction model and to perform risk prediction analyses of internal and external validation data sets in four cohorts.A simplified model of GSD risk prediction,which included the variables of sex,age,body mass index,gallbladder polyps,and fatty liver disease,also exhibited good discrimination and clinical performance.Nonetheless,further studies are needed to explore the role of low-density lipoprotein cholesterol and aspartate aminotransferase in gallstone formation.Although the validation results of the complete model were better than those of the simplified model to a certain extent,the difference was not significant even in large samples.Compared with the complete model,the simplified model uses fewer variables and yields similar prediction and clinical impact.Hence,we recommend the application of the simplified model to improve the efficiency of screening high-risk groups in practice.The use of the simplified model is conducive to enhancing the self-awareness of prevention and control in the general population and early intervention for GSD.

Objective:To understand the genome analysis and molecular typing of foodborne Yersinia enterocolitica ( Y.e) strains in Liaocheng City of Shandong Province from 2020 to 2021. Methods:The Y.e strains were isolated from raw meat and meat products. Then we made the strain identification, drug sensitivity test, virulence gene test, pulsed-field gel electrophoresis (PFGE), and whole genome sequencing (WGS). The genome sequencing data were assembled with the microbial genome annotation package. We performed the multilocus sequence typing (MLST) and core genome multilocus sequence typing (cgMLST) and used WGS-based single nucleotide polymorphism typing (wg-SNPs) method to carry out genetic evolution analysis with 14 domestic and Y.e genomes obtained from the NCBI. Results:A total of 21 strains of Y.e were detected from 165 samples, with a detection rate of 12.73%. The 20 strains of Y.e were sequenced successfully. The 20 strains of Y.e carries a variety of drug resistance genes and virulence genes, showing multiple drug resistance. The virulence gene PCR test showed that 21 strains of Y.e having two virulence genes. Cluster analysis of PFGE, MLST, and cgMLST showed that the genomics of 21 strains was highly diverse. The genetic evolution analysis of wg-SNPs showed that 20 Y.e strains could be divided into two main evolutionary branches. Conclusions:Y.e strains isolated from raw meat in Liaocheng City carry a variety of drug resistance genes and virulence genes, and the molecular typing is highly diverse, which may cause infection risk. The molecular biological monitoring of Y.e in raw meat should be strengthened, and genome sequencing and molecular typing detection be carried out to provide the theoretical basis for foodborne illness caused by Y.e.

Objective:To investigate the clinical security and feasibility of neoadjuvant chemotherapy with imatinib following lap-aroscopy-guided intersphincteric resection for patients with gastrointestinal stromal tumor of the low rectum (GSTLR). Methods:Clini-cal data of nine patients with GSTLR who were admitted to the Shengjing Hospital between January 2007 and January 2011 were re-viewed. These patients were treated with neoadjuvant imatinib chemotherapy after laparoscopic intersphincteric resection. Results:Pri-or to neoadjuvant chemotherapy, the tumor diameter ranged between from 5 cm to 9 cm (median=7.0 cm). After imatinib chemothera-py, the tumor diameter decreased to 2-4.5 cm (median=3.5 cm, P<0.001). Laparoscopic surgery through intersphincteric resection was performed after imatinib treatment for 3-24 months (median=7 months). All patients received a protective stoma, which was closed 3 months after the surgery. The Wexner scale scores ranged from 1 and 4 (median=2) prior to neoadjuvant imatinib chemotherapy and changed to 1-5 (median=2) after the chemotherapy (P=0.397). After stomal closure operation, the scores significantly increased to 4-9 (median=7, P<0.001) but were not statistically significantly different from those before the therapy. One year after laparoscopic surgery, the Wexner scale scores ranged from 1 to 5 (median=2, P=0.842). Six patients were treated with imatinib for 24 and 30 months after lap-aroscopic surgery. Recurrence in pelvis occurred in only one patient, who ceased imatinib administration at the 30th month after the sur-gery. Conclusions: Laparoscopic surgery through intersphincteric resection was secure and feasible and thus could be used for treat-ment of GSTLR.

Objective:To investigate the effect of PTS on the related pathophysiological changes and serum IL-6 level at different time points after the middle cerebral artery occlusion (MCAO) in rat’s brain.Methods:The model of focal cerebral ischemia of rat was established by the suture-occluded method.The effect of PTS on the behavioral disturbance,the pathological change of ischemia tissue and the level of serum IL-6 at different time points(3d,7d,28d) after MCAO and cerebral ischemia in rats were studied.ResultsAfter MCAO,different degrees of motion disturbances were observed in all rats.The infarct spot can be observed in all groups except the normal.The nerve cell necrosis can be found in all rats after 24 hour of MCAO.The result showed that PTS could improve the degree of motion disturbance,reduce the infarct spot obviously;after MCAO,the serum IL-6 were increased obviously but could be reduced by PTS.Conclusion:PTS can protect the neurons,reduce and eliminate the infiammatory reaction of cerebral ischemia cascade reaction effectively,which may relate to its inhibiting effect on cell factors such as IL-6 production after cerebral ischemia.