OBJECTIVE: To evaluate the effectiveness of tibial nerve transection with epineurial suture and division of the common plantar digital nerve branches in the treatment of congenital macrodactyly in children. METHODS: A retrospective analysis was conducted on clinical data from 9 children with congenital macrodactyly who met the selection criteria and were admitted between January 2018 and December 2024. The cohort included 4 boys and 5 girls, aged 1-6 years (median, 3 years). Syndactyly of the second and third toes was present in 2 patients. Hypertrophy distribution was as follows: 1 case of single-ray involvement, 4 of double-ray, 1 of triple-ray, 1 of quadruple-ray, and 2 of quintuple-ray. Preoperatively, 7 cases exhibited limitations in both active and passive flexion and extension of the affected toes; in 2 cases, active movement was restricted while passive motion remained intact. All 9 children were unable to wear standard-sized footwear for the unaffected foot. Six presented with a limp, and 3 had difficulty walking. All 9 cases were moderate to severe progressive macrodactyly, and the growth rate of the affected foot was significantly faster than that of the healthy side. Six cases had undergone prior surgical interventions at other institutions, but disease progression continued postoperatively. All 9 patients underwent tibial nerve transection with epineurial suture and selective division of the common plantar digital nerve branches. At last follow-up, the foot growth rate was calculated (compared with that immediately after operation), and the changes of plantar pain sensation in the affected foot were detected before operation, immediately after operation, and at last follow-up, and the surgical efficacy was evaluated based on improvements in shoe fit and gait function. RESULTS: All 9 children were followed up 6-36 months, with an average of 18 months. All the incisions healed by first intention, and no infection or plantar ulceration occurred. At last follow-up, the growth rate of the affected foot was 0.10 (0.04, 0.14) cm/month, which was significantly slower than that of the healthy foot [0.14 (0.08, 0.18) cm/month] ( Z=3.951, P<0.001). Preoperatively, plantar pain sensation was absent in all cases; it was restored immediately after operation. At last follow-up, 6 patients had absent pain sensation, 2 had partial preservation (involving certain toes and central plantar regions), and 1 patient (with 3-year follow-up) exhibited regained sensation in multiple plantar areas. Gait improved in most cases, in which 8 children achieved normal ambulation, while 1 continued to limp due to leg-length discrepancy. Surgical efficacy were rated as excellent in 1 case, good in 7, and fair in 1. CONCLUSION Tibial nerve transection with epineurial suture combined with selective division of the common plantar digital nerve branches effectively reduces the growth rate of congenital macrodactyly in children, has minimal impact on plantar sensory function, and does not result in plantar ulcers or impaired ambulation.
Humans ; Male ; Female ; Child, Preschool ; Child ; Retrospective Studies ; Infant ; Tibial Nerve/surgery* ; Toes/surgery* ; Treatment Outcome ; Suture Techniques ; Fingers/surgery* ; Foot/innervation* ; Limb Deformities, Congenital

In the pathogenesis of many neurological diseases such as epilepsy,immune responses and neuroinflammation play a key role and provide new directions for treatment.In the era of personalized medicine,with the reduction of anti-epileptic treatment resources,there is an increasing focus on the application of neuroimmunomodulators or anti-inflammatory treatments in epilepsy patients.Therefore,this article reviews the latest progress in the epileptogenic mechanisms related to immune activation or neuroin-flammation,with particular attention to current and potential new treatments for epilepsy in the future.Neuroinflammation can lead to various types of epilepsy,including structural,infectious,post-traumatic,autoimmune and hereditary epilepsy.In recent years,some emerging studies have identified multiple major molecular pathways in the neuroinflammatory process,which may become future thera-peutic targets for epilepsy.A variety of drugs that are currently known or under development have been proven to have the ability to inhibit or regulate immune or neuroinflammatory molecules in epilepsy,and some of these drugs are expected to become new options for antiepileptic treatment.

Objective:To quantify and compare electromyographic(EMG)amplitude changes in the activation of the tibia-lis anterior muscle by 12 commonly used training methods in clinical rehabilitation training,and to identify the optimal activation method of the tibialis anterior muscle.Method:Sixteen healthy college students were participated in the study.Surface electromyography(sEMG)was used to quantify the activity level of the tibialis anterior muscle during 12 tests.Univariate variance was used to analyze the integrated electromyography(iEMG)and root mean square(RMS).Result:Among the 12 training methods targeting the activation of the tibialis anterior muscle,the maximum activation mode is T2"double feet standing(foam pad)ankle joint from zero to the maximum angle",fol-lowed by T1"double feet standing(floor),ankle joint from zero to the maximum angle"and T5"double feet standing(foam pad)ankle joint from zero to the maximum angle"foot dorsiflexion and invertion to the maxi-mum angle;The minimum activation was T12"the subject walked on the ground with a natural step",fol-lowed by T6"the subject jumped from a 30cm high step to the floor"and T7"the subject jumped from a 30cm high step to a foam pad".In RMS comparison,there was a statistical difference between the activation of T12,T6,T7,and T2(P＜0.05),and between the activation of T12,T6,and T1(P＜0.05).In iEMG com-parison,there were statistical differences(P＜0.05)between the activation of T12,T6,T7 and T2,T1,and T5(P＜0.05),and between the activation of T12,T6,and T3,with no significant statistical difference noted other comparisons.When comparing activation between male and female participants across the 12 tests,males generally had higher activation in the anterior tibial muscle than that in female,but no significant statistical difference was found.Conclusion:Increasing weight bearing,reducing support surface stability,increasing initial muscle initial length,and selecting difficulty training methods matching patient abilities can enhance the activation of anteri-or tibial muscle,while functional activities and balance strategies are not as effective in healthy population as other targeted tests.The training method for activating the tibialis anterior muscle is to stand on both feet(foam pad)with ankle dorsiflexion from a neutral position to maximum angle.The results of this study pro-vide information on the relative activation of the tibialis anterior muscle during specific movements,which can serve as evidence for prescribing exercise in clinical rehabilitation treatment and injury prevention.

Objective:To explore the effect of the defect area and volume of intra-articular impacted fragments (IAIF) on the contact stress of the ankle joint surface.Methods:A 23-year-old male volunteer, 168 cm in height and 60 kg in weight, with no history of trauma or anatomic abnormality of the ankle, was selected. On the basis of a normal ankle finite-element model, IAIF-defect finite-element models were established. The first group consisted of IAIF-defect models with identical area but different volumes: on the distal tibial articular surface the defect area was 4 mm × 5 mm (20 mm 2), and the heights were 2 mm, 3 mm, 4 mm, 5 mm and 6 mm. The second group consisted of IAIF-defect models with identical defect volume but different areas. The defect volume was 90 mm 3, while the defect areas on the distal tibial articular surface were 2 mm×3 mm, 3 mm×3 mm, 3 mm×5 mm, 3 mm×6 mm, and 5 mm×6 mm, with corresponding heights of 15 mm, 10 mm, 6 mm, 5 mm, and 3 mm. Under a 600 N vertical load the contact stress of the ankle joint was calculated, and the finite-element data were recorded and analyzed. Pearson correlation analysis was used to analyze, separately for the two groups, the correlation between IAIF defect and the maximum contact stress (MCS) of the distal tibial articular surface, and simple linear regression analysis was performed to obtain regression equations. Equivalence zero testing was used to verify the correlations and to compare their differences. Results:For IAIF defects with the same area but different volumes, including 4 mm×5 mm×2 mm, 4 mm×5 mm×3 mm, 4 mm×5 mm×4 mm, 4 mm×5 mm×5 mm, and 4 mm× 5 mm×6 mm, the corresponding maximum contact stress (MCS) on the distal tibial joint surface were 3.846 MPa, 3.839 MPa, 3.835 MPa, 3.833 MPa, and 3.831 MPa, respectively, with an average of 3.837 MPa. The mean ±1% range is from 3.799 MPa to 3.875 MPa. The correlation analysis showed that the IAIF defects with the same area but different volumes were negatively correlated with contact stress ( r=-0.956, P=0.011). The linear regression equation was MCS=-0.0002×VI+3.851, where VI denotes IAIF volume. Equivalence zero testing confirmed that all measured values lay within the predefined ±1 % margin, satisfying the equivalence null hypothesis. For IAIF defects of identical volume (90 mm 3) but varying articular surface areas—2 mm×3 mm, 3 mm×3 mm, 3 mm×5 mm, 3 mm×6 mm and 5 mm×6 mm—the corresponding MCS values were 2.147 MPa, 2.812 MPa, 3.622 MPa, 4.476 MPa and 6.186 MPa, respectively (mean 3.849 MPa; equivalence band 3.811-3.887 MPa at ±1% of the mean). Correlation analysis demonstrated a strong positive relationship between identical-volume varying-area IAIF defects and contact stress ( r=0.996, P<0.001). The linear regression equation was MCS=0.168×AI+1.236, where AI denotes IAIF area. Equivalence zero testing indicated that none of the measured values fell within the predefined ±1% margin, failing to satisfy the equivalence null hypothesis. Conclusion:In posterior ankle fractures, the volume change of IAIF defects has no clinical significance in relation to MCS, showing a small negative correlation. However, the area change of IAIF defects is clinically significant in relation to MCS, demonstrating a larger positive correlation.

Objective:To evaluate the effect of remimazolam tosilate on postoperative delirium (POD) in elderly patients undergoing urological surgery.Methods:In this randomized controlled trial, 220 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ elderly patients of either sex, aged≥65 yr, with body mass index of 18-28 kg/m 2, scheduled for elective urological surgery under general anesthesia, were divided into 2 groups ( n=110 each) using a random number table method: propofol group (group P) and remimazolam tosilate group (group R). Group P received propofol 1.0-1.5 mg/kg for induction and propofol 2-6 mg·kg -1·h -1 for maintenance, while group R received remimazolam tosilate 0.2-0.3 mg/kg for induction and remimazolam tosilate 0.5-1.2 mg·kg -1·h -1 for maintenance. The other drugs for induction and maintenance were the same in the two groups. POD was assessed using the Chinese version of the 3-minute diagnostic interview for Confusion Assessment Method within 3 days after surgery in the two groups. The intraoperative consumption of remifentanil and usage of vasoactive drugs, extubation time, 15-item Quality-of-Recovery scale scores at 24 h after operation, requirement for rescue analgesia within 24 h after operation, and postoperative adverse effects were recorded. Results:There were no significant differences in the incidence of POD within 3 days after operation, 15-item Quality-of-Recovery scale scores at 24 h after operation, or rate of rescue analgesia within 24 h after operation between two groups ( P>0.05). Compared with group P, the requirement for intraoperative vasoactive drugs was significantly reduced, the extubation time was shortened, and the incidence of hypoxemia was decreased within 24 h after operation in group R ( P<0.05 or 0.001). Conclusions:Remimazolam tosilate has no marked effect on the occurrence of POD in elderly patients undergoing urological surgery.

BACKGROUND:The reduction of contact area,edge load,and stress increase of adjacent cartilage caused by knee cartilage defect are considered to easily cause degenerative changes in this tissue,which may develop into knee osteoarthritis.Growth factors are considered to be a treatment method to promote the healing of damaged cartilage and delay the progression of degenerative arthritis.OBJECTIVE:To analyze the hotspots and prospects of growth factor-promoted knee cartilage regeneration research by bibliometric methods.METHODS:The first author retrieved 321 articles related to growth factor-promoted knee cartilage regeneration research from the Web of Science core set database.VOSviewer 1.6.19 software was used to analyze the publication volume,country,institution,keyword,and literature citation status of the articles,and investigate the research hotspots.RESULTS AND CONCLUSION:(1)From 2000 to 2024,the annual number of publications in the field of growth factor-promoted knee cartilage regeneration showed an overall upward trend,with the highest number of publications in 2021.Harvard University in the United States published the most papers.(2)Keyword analysis showed that the frequency of keywords such as growth factor,cartilage,cartilage repair,platelet-rich plasma,and cartilage regeneration was high.In addition,the keyword co-occurrence network diagram showed that growth factor was closely related to keywords such as cartilage repair and cartilage regeneration,indicating that growth factor research plays an important role in the field of cartilage regeneration.(3)The results of literature citation analysis showed that the combination of platelet-rich plasma and muscle-derived stem cells may provide a new and effective treatment strategy for patients with osteoarthritis,which can deepen the understanding of cartilage repair mechanisms by promoting stem cell proliferation and cartilage formation.Fibroblast growth factor 2,fibroblast growth factor 18,and insulin growth factor 1 play a key role in cartilage repair and can promote chondrocyte proliferation and matrix synthesis.In particular,fibroblast growth factor 18 can promote the repair of damaged cartilage,thereby alleviating patients'pain and dysfunction,which deserves further in-depth study in the future.The latest research has developed a new Polyhedrin Delivery System(PODS)that can continuously release growth factors such as bone morphogenetic protein 2 and 7,significantly promoting chondrocyte proliferation and cartilage repair.This system provides a new perspective and potential therapy for the treatment of osteoarthritis.(4)Therefore,bone morphogenetic protein 2,7,insulin growth factor 1,and recombinant human fibroblast growth factor 18 are promising growth factor therapies for promoting cartilage regeneration.In the future,further in-depth research on the mechanism of action of growth factors,optimization of treatment strategies,and strengthening of long-term efficacy and safety evaluation are needed.

Objective:To explore the effect of task oriented 3D upper limb robot training on upper limb function in pa-tients with subacute stroke.Method:Forty-five stroke patients from the occupational therapy department of Kunming Changhe Tiancheng Rehabilitation Hospital from January to December 2023 were selected and randomly divided into an experimen-tal group(n=23)and a control group(n=22).The control group received occupational therapy for 60 min per session;the experimental group received routine occupational therapy combined with robot-assisted EMU adju-vant therapy for 60 min(40min+20min)per session.Both groups were intervened for a total of 4 weeks,5 times per week.Before and after treatment,the Fugl-Meyer upper limb assessment scale(FMA-UE),modi-fied Barthel index(MBI),and surface electromyography(sEMG)were used to evaluate upper limb motor function,daily living activity,muscle activation and synergy(biceps and triceps).Result:Before treatment,there was no significant difference in FMA-UE,MBI,muscle activation,and syner-gy between the two groups(P>0.05).After treatment,both groups showed improvements in FMA-UE,MBI,muscle activation,and synergistic evaluation.The experimental group demonstrated significantly greater improve-ments in FMA-UE scores and muscle synergistic evaluation than the control group(P<0.05).There was no sig-nificant difference in MBI and muscle activation assessment between the two groups(P>0.05).Conclusion:Task-oriented 3D robot-assisted training may have more advantages in improving post-stroke pa-tient's upper limb function and muscle synergy compared to conventional occupational therapy alone.Further studies are warranted to determine optimal training parameters and long-term effects.

Objective:To explore the effect of the defect area and volume of intra-articular impacted fragments (IAIF) on the contact stress of the ankle joint surface.Methods:A 23-year-old male volunteer, 168 cm in height and 60 kg in weight, with no history of trauma or anatomic abnormality of the ankle, was selected. On the basis of a normal ankle finite-element model, IAIF-defect finite-element models were established. The first group consisted of IAIF-defect models with identical area but different volumes: on the distal tibial articular surface the defect area was 4 mm × 5 mm (20 mm 2), and the heights were 2 mm, 3 mm, 4 mm, 5 mm and 6 mm. The second group consisted of IAIF-defect models with identical defect volume but different areas. The defect volume was 90 mm 3, while the defect areas on the distal tibial articular surface were 2 mm×3 mm, 3 mm×3 mm, 3 mm×5 mm, 3 mm×6 mm, and 5 mm×6 mm, with corresponding heights of 15 mm, 10 mm, 6 mm, 5 mm, and 3 mm. Under a 600 N vertical load the contact stress of the ankle joint was calculated, and the finite-element data were recorded and analyzed. Pearson correlation analysis was used to analyze, separately for the two groups, the correlation between IAIF defect and the maximum contact stress (MCS) of the distal tibial articular surface, and simple linear regression analysis was performed to obtain regression equations. Equivalence zero testing was used to verify the correlations and to compare their differences. Results:For IAIF defects with the same area but different volumes, including 4 mm×5 mm×2 mm, 4 mm×5 mm×3 mm, 4 mm×5 mm×4 mm, 4 mm×5 mm×5 mm, and 4 mm× 5 mm×6 mm, the corresponding maximum contact stress (MCS) on the distal tibial joint surface were 3.846 MPa, 3.839 MPa, 3.835 MPa, 3.833 MPa, and 3.831 MPa, respectively, with an average of 3.837 MPa. The mean ±1% range is from 3.799 MPa to 3.875 MPa. The correlation analysis showed that the IAIF defects with the same area but different volumes were negatively correlated with contact stress ( r=-0.956, P=0.011). The linear regression equation was MCS=-0.0002×VI+3.851, where VI denotes IAIF volume. Equivalence zero testing confirmed that all measured values lay within the predefined ±1 % margin, satisfying the equivalence null hypothesis. For IAIF defects of identical volume (90 mm 3) but varying articular surface areas—2 mm×3 mm, 3 mm×3 mm, 3 mm×5 mm, 3 mm×6 mm and 5 mm×6 mm—the corresponding MCS values were 2.147 MPa, 2.812 MPa, 3.622 MPa, 4.476 MPa and 6.186 MPa, respectively (mean 3.849 MPa; equivalence band 3.811-3.887 MPa at ±1% of the mean). Correlation analysis demonstrated a strong positive relationship between identical-volume varying-area IAIF defects and contact stress ( r=0.996, P<0.001). The linear regression equation was MCS=0.168×AI+1.236, where AI denotes IAIF area. Equivalence zero testing indicated that none of the measured values fell within the predefined ±1% margin, failing to satisfy the equivalence null hypothesis. Conclusion:In posterior ankle fractures, the volume change of IAIF defects has no clinical significance in relation to MCS, showing a small negative correlation. However, the area change of IAIF defects is clinically significant in relation to MCS, demonstrating a larger positive correlation.

Objective:To evaluate the effect of remimazolam tosilate on postoperative delirium (POD) in elderly patients undergoing urological surgery.Methods:In this randomized controlled trial, 220 American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ elderly patients of either sex, aged≥65 yr, with body mass index of 18-28 kg/m 2, scheduled for elective urological surgery under general anesthesia, were divided into 2 groups ( n=110 each) using a random number table method: propofol group (group P) and remimazolam tosilate group (group R). Group P received propofol 1.0-1.5 mg/kg for induction and propofol 2-6 mg·kg -1·h -1 for maintenance, while group R received remimazolam tosilate 0.2-0.3 mg/kg for induction and remimazolam tosilate 0.5-1.2 mg·kg -1·h -1 for maintenance. The other drugs for induction and maintenance were the same in the two groups. POD was assessed using the Chinese version of the 3-minute diagnostic interview for Confusion Assessment Method within 3 days after surgery in the two groups. The intraoperative consumption of remifentanil and usage of vasoactive drugs, extubation time, 15-item Quality-of-Recovery scale scores at 24 h after operation, requirement for rescue analgesia within 24 h after operation, and postoperative adverse effects were recorded. Results:There were no significant differences in the incidence of POD within 3 days after operation, 15-item Quality-of-Recovery scale scores at 24 h after operation, or rate of rescue analgesia within 24 h after operation between two groups ( P>0.05). Compared with group P, the requirement for intraoperative vasoactive drugs was significantly reduced, the extubation time was shortened, and the incidence of hypoxemia was decreased within 24 h after operation in group R ( P<0.05 or 0.001). Conclusions:Remimazolam tosilate has no marked effect on the occurrence of POD in elderly patients undergoing urological surgery.

Objective:To quantify and compare electromyographic(EMG)amplitude changes in the activation of the tibia-lis anterior muscle by 12 commonly used training methods in clinical rehabilitation training,and to identify the optimal activation method of the tibialis anterior muscle.Method:Sixteen healthy college students were participated in the study.Surface electromyography(sEMG)was used to quantify the activity level of the tibialis anterior muscle during 12 tests.Univariate variance was used to analyze the integrated electromyography(iEMG)and root mean square(RMS).Result:Among the 12 training methods targeting the activation of the tibialis anterior muscle,the maximum activation mode is T2"double feet standing(foam pad)ankle joint from zero to the maximum angle",fol-lowed by T1"double feet standing(floor),ankle joint from zero to the maximum angle"and T5"double feet standing(foam pad)ankle joint from zero to the maximum angle"foot dorsiflexion and invertion to the maxi-mum angle;The minimum activation was T12"the subject walked on the ground with a natural step",fol-lowed by T6"the subject jumped from a 30cm high step to the floor"and T7"the subject jumped from a 30cm high step to a foam pad".In RMS comparison,there was a statistical difference between the activation of T12,T6,T7,and T2(P＜0.05),and between the activation of T12,T6,and T1(P＜0.05).In iEMG com-parison,there were statistical differences(P＜0.05)between the activation of T12,T6,T7 and T2,T1,and T5(P＜0.05),and between the activation of T12,T6,and T3,with no significant statistical difference noted other comparisons.When comparing activation between male and female participants across the 12 tests,males generally had higher activation in the anterior tibial muscle than that in female,but no significant statistical difference was found.Conclusion:Increasing weight bearing,reducing support surface stability,increasing initial muscle initial length,and selecting difficulty training methods matching patient abilities can enhance the activation of anteri-or tibial muscle,while functional activities and balance strategies are not as effective in healthy population as other targeted tests.The training method for activating the tibialis anterior muscle is to stand on both feet(foam pad)with ankle dorsiflexion from a neutral position to maximum angle.The results of this study pro-vide information on the relative activation of the tibialis anterior muscle during specific movements,which can serve as evidence for prescribing exercise in clinical rehabilitation treatment and injury prevention.