OBJECTIVE: To explore the safety and effectiveness of the "talus home technique (THT) " in the surgery of pronation open ankle fractures (POAF). METHODS: A retrospective analysis was conducted on 14 patients with POAF admitted between January 2023 and December 2023 who met the selection criteria. There were 7 males and 7 females; age ranged from 26 to 58 years, with a median age of 53 years. Injury causes included 9 cases of traffic accident injury, 3 cases of fall from hight injury, and 2 cases of crush injury. There were 5 cases of type Ⅱ, 6 cases of type ⅢA, and 3 cases of type ⅢB according to Gustilo classification; and 6 cases of pronation-abduction grade Ⅲ and 8 cases of pronation-external rotation grade Ⅳ according to Lauge-Hansen classification. Emergency first-stage debridement of the ankle joint was performed, followed by second-stage open reduction and internal fixation surgery. The THT was used through a limited incision on the lateral malleolus to restore the height of the lateral malleolus, rotational alignment, and anatomical relationship of the distal tibiofibular syndesmosis (DTFS). Wound healing was observed postoperatively. At 4 months postoperatively, weight-bearing anteroposterior, lateral, and mortise view X-ray films and CT scans of both ankles were reviewed to measure the medial clear space (MCS), tibiofibular clear space (TFCS), distal fibular tip to lateral process of talus (DFTL), and anterior/posterior syndesmosis distances of DTFS, and the quality of reduction of ankle fractures was evaluated. Ankle joint function was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and active dorsiflexion/plantar flexion range of motion were recorded at last follow-up. RESULTS: After second-stage internal fixation, 8 patients achieved wound healing by first intention, 1 case had skin edge necrosis, 2 cases had local skin necrosis, 1 case had extensive medial soft tissue defect, and 2 cases developed medial wound infection with sinus formation. All 14 patients were followed up 13-24 months (mean, 16.8 months). Postoperative X-ray films showed 1 case of delayed union of the lateral malleolus, which healed after bone grafting at 12 months; the remaining 13 cases achieved clinical union at 12-32 weeks (mean, 21.5 weeks). At 4 months postoperatively, X-ray films and CT examination showed no significant differences in MCS, TFCS, DFTL, and anterior/posterior syndesmosis distances of DTFS between the healthy and affected sides ( P>0.05), with no poor DTFS reduction. AOFAS ankle-hindfoot score ranged from 80 to 95, with an average of 87.7; ankle range of motion ranged from 10° to 25° (mean, 19.6°) in dorsiflexion and from 32° to 50° (mean, 41.2°) in plantar flexion. CONCLUSION THT is safe and effective in POAF surgery. It can restore lateral malleolar height and rotational alignment, enhance DTFS reduction quality, and obtain satisfactory short-term functional recovery of the ankle.
Humans ; Male ; Female ; Middle Aged ; Ankle Fractures/surgery* ; Adult ; Retrospective Studies ; Fracture Fixation, Internal/methods* ; Pronation ; Fractures, Open/surgery* ; Talus/surgery* ; Treatment Outcome ; Debridement/methods* ; Ankle Joint/surgery* ; Open Fracture Reduction/methods*

OBJECTIVE: To evaluate the safety and effectiveness of reducing posterior malleolar fractures via the modified Rammelt transfibular approach. METHODS: A retrospective analysis was conducted on 26 patients with ankle fractures who met the selection criteria and were admitted between September 2023 and May 2024. There were 13 males and 13 females, aged from 14 to 59 years (median, 43.5 years). Causes of injury included traffic accident (1 case), falls (7 cases), and sprains (18 cases). Time from injury to operation ranged from 1 to 13 days (mean, 3.9 days). According to the Lauge-Hansen classification, there were 5 supination-external rotation type Ⅲ fractures and 21 supination-external rotation type Ⅳ fractures. According to the Bartoníček classification for posterior malleolar fractures, there were 12 type Ⅱ fractures, 10 type Ⅲ fractures, and 4 type Ⅳ fractures. During operation, the fracture was exposed via the modified Rammelt transfibular approach; then, the fracture reduction was achieved under direct vision using techniques such as towel clip traction, posterolateral compression, and lifting with a posterior transverse periosteal elevator; finally, the fracture was fixed using anteroposterior cannulated screws or Kirschner wires. The incision healing was observed after operation. At 4 months after operation, X-ray film and CT were reviewed to evaluate the quality of fracture reduction. The medial clear space, tibiofibular clear space, and the anterior/posterior tibiofibular syndesmotic distances were measured. At last follow-up, the ankle function was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the range of motion. RESULTS: The marginal necrosis occurred in 2 lateral malleolar incisions, and superficial infection occurred in 1 lateral malleolar incision; the remaining incisions healed by first intention. All 26 patients were followed up 13-21 months (mean, 15.6 months). X-ray films showed that fractures in 25 patients achieved clinical union within 3-8 months (mean, 5.4 months); 1 case had delayed union of the lateral malleolus. At 4 months after operation, no significant difference was found between the injured and healthy sides in the medial clear space, tibiofibular clear space, or the anterior/posterior tibiofibular syndesmotic distances ( P>0.05). No malreduction of the posterior malleolus or the tibiofibular syndesmosis occurred. At last follow-up, the AOFAS score ranged from 80 to 100 (mean, 91.9). The range of motion ranged from 17° to 22° (mean, 21.0°) in active ankle dorsiflexion and from 40° to 49° (mean, 44.6°) in plantar flexion. Internal fixator was removed in 12 patients at 1 year after operation, with no ankle instability occurring. Ankle joint degeneration was observed in 1 patient at last follow-up. CONCLUSION The modified Rammelt transfibular approach is a safe and reliable technique. It enables precise reduction under direct vision, improves the quality of reduction for the distal tibial articular surface and the tibiofibular syndesmosis, and provides satisfactory ankle functional recovery in short-term follow-up.
Humans ; Male ; Female ; Adult ; Ankle Fractures/diagnostic imaging* ; Middle Aged ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Adolescent ; Treatment Outcome ; Young Adult ; Bone Screws ; Ankle Joint/surgery* ; Fibula/surgery* ; Range of Motion, Articular

Objective To explore the medication law of Professor Zhao Jinxi in the treatment of diabetic kidney disease(DKD).Methods The outpatient prescriptions of Professor Zhao Jinxi from Dongzhimen Hospital of Beijing University of Chinese Medicine in the treatment of DKD were collected from Jan 2021 to May 2024.The Ancient and Modern Medical Case Cloud Platform 2.3.9,Origin 2024,R 4.4.2,SPSS Modeler 18.0,SPSS Statistics 26.0 and Cytoscape 3.10.2 were used to count the frequency,property and taste,meridian tropism,efficacy and dosage of drugs.Association rules,complex networks and clustering analysis were carried out.Results Totally 1 168 prescriptions were included,involving 237 kinds of Chinese materia medica.The high-frequency drugs were Astragali Radix,Salviea Miltiorrhizae Radix et Rhizoma,Dioscoreae Spongiosae Rhizoma,Smilacis Glabrae Rhizoma,etc.The medicinal properties were mostly warm,neutral and cold.The medicinal tastes were mainly bitter,sweet and pungent.They mainly belonged to the liver meridian,spleen meridian and lung meridian.The efficacy was mainly heat-clearing drugs,tonic drugs,and water-clearing and dampness-percolating drugs.18 and 12 drug combinations were obtained by association rules and cluster analysis,respectively.Conclusion Professor Zhao Jinxi's treatment of DKD pays attention to the formation of pathogenesis of"micro abdominal mass",emphasizes"treatment from wind",commonly uses"five methods of kidney treatment"such as tonifying qi,activating blood circulation,dispelling wind,promoting qi and detoxification,and attaches importance to the treatment idea of"three-dimension maintenance kidney",which can provide references for clinical treatment of DKD.

Objective:To evaluate the sample preparation proficiency and storage proficiency of 11 clinical biobanks in Beijing through simulated experiments, and to establish an assessment method for the quality comparability of biological samples.Methods:An exploratory research design was adopted. In November 2023, artificial composite serum quality control materials containing six recombinant human protein markers—recombinant human alanine aminotransferase (rhALT), recombinant human aspartate aminotransferase (rhAST), recombinant human creatine kinase (rhCK), recombinant human creatine kinase-MB (rhCK-MB), recombinant human B-type natriuretic peptide (rhBNP), and recombinant human troponin I (rhTNI)—were distributed to 11 clinical biobanks in Beijing City. Sample preparation and storage followed the standardized operating procedures. Proficiency differences were assessed through statistical analysis.Results:Three-way repeated measures ANOVA revealed all six protein markers showed a declining trend over storage time in ultra-low-temperature environments ( F values 11.68-4 179.66, all P<0.01). However, neither long-term/temporary refrigerator types ( F values 0.01-1.23, all P>0.05)nor placement locations within refrigerators significantly affected the stability of these six proteins ( F valus 0.03-1.47, all P>0.05). The biases in detection results for rhALT, rhAST, rhTNI, and rhBNP at different storage time points were within the allowable bias limits for each item, supporting their use as markers for protein stability in biobank samples. All 11 institutions passed the storage proficiency assessment. In the preparation proficiency assessment, deviations were observed in post-preparation sample results, with a notably high out-of-control rate for rhCK (36.36%). Conclusion:Sample preparation proficiency can serve as a quality control metric for clinical biobanks. Future external quality assessment systems for biobanks should focus on sample preparation rather than storage processes.

Objective:To evaluate the sample preparation proficiency and storage proficiency of 11 clinical biobanks in Beijing through simulated experiments, and to establish an assessment method for the quality comparability of biological samples.Methods:An exploratory research design was adopted. In November 2023, artificial composite serum quality control materials containing six recombinant human protein markers—recombinant human alanine aminotransferase (rhALT), recombinant human aspartate aminotransferase (rhAST), recombinant human creatine kinase (rhCK), recombinant human creatine kinase-MB (rhCK-MB), recombinant human B-type natriuretic peptide (rhBNP), and recombinant human troponin I (rhTNI)—were distributed to 11 clinical biobanks in Beijing City. Sample preparation and storage followed the standardized operating procedures. Proficiency differences were assessed through statistical analysis.Results:Three-way repeated measures ANOVA revealed all six protein markers showed a declining trend over storage time in ultra-low-temperature environments ( F values 11.68-4 179.66, all P<0.01). However, neither long-term/temporary refrigerator types ( F values 0.01-1.23, all P>0.05)nor placement locations within refrigerators significantly affected the stability of these six proteins ( F valus 0.03-1.47, all P>0.05). The biases in detection results for rhALT, rhAST, rhTNI, and rhBNP at different storage time points were within the allowable bias limits for each item, supporting their use as markers for protein stability in biobank samples. All 11 institutions passed the storage proficiency assessment. In the preparation proficiency assessment, deviations were observed in post-preparation sample results, with a notably high out-of-control rate for rhCK (36.36%). Conclusion:Sample preparation proficiency can serve as a quality control metric for clinical biobanks. Future external quality assessment systems for biobanks should focus on sample preparation rather than storage processes.

Objective To explore the medication law of Professor Zhao Jinxi in the treatment of diabetic kidney disease(DKD).Methods The outpatient prescriptions of Professor Zhao Jinxi from Dongzhimen Hospital of Beijing University of Chinese Medicine in the treatment of DKD were collected from Jan 2021 to May 2024.The Ancient and Modern Medical Case Cloud Platform 2.3.9,Origin 2024,R 4.4.2,SPSS Modeler 18.0,SPSS Statistics 26.0 and Cytoscape 3.10.2 were used to count the frequency,property and taste,meridian tropism,efficacy and dosage of drugs.Association rules,complex networks and clustering analysis were carried out.Results Totally 1 168 prescriptions were included,involving 237 kinds of Chinese materia medica.The high-frequency drugs were Astragali Radix,Salviea Miltiorrhizae Radix et Rhizoma,Dioscoreae Spongiosae Rhizoma,Smilacis Glabrae Rhizoma,etc.The medicinal properties were mostly warm,neutral and cold.The medicinal tastes were mainly bitter,sweet and pungent.They mainly belonged to the liver meridian,spleen meridian and lung meridian.The efficacy was mainly heat-clearing drugs,tonic drugs,and water-clearing and dampness-percolating drugs.18 and 12 drug combinations were obtained by association rules and cluster analysis,respectively.Conclusion Professor Zhao Jinxi's treatment of DKD pays attention to the formation of pathogenesis of"micro abdominal mass",emphasizes"treatment from wind",commonly uses"five methods of kidney treatment"such as tonifying qi,activating blood circulation,dispelling wind,promoting qi and detoxification,and attaches importance to the treatment idea of"three-dimension maintenance kidney",which can provide references for clinical treatment of DKD.

Objective To observe the value of ultrasonic biomicroscopy(UBM)imaging for diagnosing chestnut thorn foreign bodies in anterior segment.Methods A total of 70 patients who underwent UBM examination due to chestnut thorn injury or residue of chestnut thorn after removal and then operation were retrospectively enrolled.The distance of chestnut thorn foreign bodies from corneal limbus,and the subconjunctival depth and length of them were measured based on UBM imaging.The efficacy of UBM for diagnosing chestnut thorn foreign bodies in anterior segment was evaluated according to surgical findings,and the correlation of quantitative parameters of foreign bodies were analyzed.Results Among 70 cases of chestnut thorn foreign bodies in anterior segment,single ocular tissue(5/70,7.14％)involvement was detected in 5 cases,while multiple ocular tissues involvement(65/70,92.86％)were noticed in 65 cases according to UBM.Totally 109 foreign bodies were detected by UBM,among which 98 were consistent with surgical findings,with the diagnostic accuracy of 89.91％(98/109),while 11 foreign bodies were not found during operation,with the false positive rate of 10.09％(11/109).Meanwhile,4 foreign bodies found and removed with operation were not displayed with UBM,and the false negative rate of UBM was 3.92％(4/102).Among 98 chestnut thorn foreign bodies correctly diagnosed with UBM,10 located in stromal layer of cornea(10/98,10.20％)and 88 located in ocular wall(88/98,89.80％),including 43 subconjunctival(43/88,48.86％)and 45 sclerotic(45/88,51.14％)foreign bodies,with the median length of 0.200 mm.The distance of 88 foreign bodies in ocular wall from corneal limbus was(2.963±1.504)mm,and the subconjunctival depth was(0.785±0.388)mm.The distance of foreign bodies from corneal limbus were positively correlated with their subconjunctival depth(r,=0.361,P＜0.010),while their lengths were not correlated with their distance from corneal limbus and subconjunctival depth(both P＞0.05).Conclusion UBM imaging was valuable for clinical diagnosis and localization of chestnut thorn foreign bodies in anterior segment.

AIM:To explore the possible mechanism of Yiqi-Huoxue formula(YQHXF)in treating cerebral ischemia-reperfusion injury.METHODS:Male SD rats were randomly divided into six groups,namely,the sham,mod-el,nimodipine,and low-,middle-and high-dose YQHXF groups.The middle cerebral artery occlusion/reperfusion(MCAO/R)model was established in all groups except the sham group.After successful modeling,the YQHXF low-,me-dium-,and high-dose groups were given 3.8,7.5,and 15 g?kg-1?d-1 of YQHXF,respectively,by gavage,while the ni-modipine group was given 12 mg?kg-1?d-1 of nimodipine tablets by gavage.The sham and model groups were given 10 mL?kg-1?d-1 of distilled water by gavage.After 14 days of drug intervention,the rats were euthanized and the neurological func-tion was evaluated.The infarct volume was assessed using 2,3,5-triphenyltetrazolium chloride(TTC)staining and brain histopathological changes were determined by hematoxylin-eosin(HE)staining.Transmission electron microscopy was used to investigate changes in autophagosomes,with immunofluorescence used to assess expression of microtubule-associ-ated protein 1 light chain 3(LC3)protein in the cerebral cortex,Western blot was used to measure protein levels of p-PI3K,PI3K,p-Akt,Akt,p-mTOR,mTOR,LC3B,p62,beclin-1,and Atg5,and RT-qPCR was used to determined LC3 and P62 mRNA expression.RESULTS:Compared with the sham group,the neural function scores of rats in the model group rats were significantly increased,and TTC staining revealed large areas of white cerebral infarction.There was severe pathological damage to the cerebral tissue in the ischemic cortical area,and large numbers of autophagosomes were seen inside the cells.Immunofluorescence staining showed significant numbers of LC3B-positive cells(P<0.01).Protein expression of beclin-1,Atg5,and LC3-Ⅱ/LC3-Ⅰ was significantly upregulated(P<0.01),while that of p62 was markedly downregulated(P<0.01).The expression of p-PI3K/PI3K,p-Akt/Akt,and p-mTOR/mTOR proteins was also significantly reduced(P<0.01).In addition,the mRNA expression of LC3 was significantly upregulated(P<0.01),with downregulation of P62 mRNA levels(P<0.01).Compared with the model group,both the YQHXF medium-and high-dose groups showed upregulated LC3-Ⅱ/LC3-Ⅰ values after 12 h of reperfusion(P<0.01),followed by downregulation of the ratios(P<0.05)after 3,7,and 14 days of reperfusion.Furthermore,after 14 days of reperfusion,compared with the model group,the middle-and high-dose YQHXF groups and the nimodipine group showed reduced neurological function scores(P<0.01),reduced cerebral infarction volumes(P<0.01),improvements in the pathological damage to cortical tis-sue,and reduced autophagosome formation to varying degrees.At the same time,the number of LC3B-positive cells was reduced(P<0.01).Protein expression of beclin-1,Atg5,and LC3-Ⅱ/LC3-Ⅰ was significantly downregulated,while that of p62 was upregulated(P<0.01).The mRNA expression of LC3 and p62 was consistent with the protein levels(P<0.01).In addition,the expression of p-PI3K/PI3K,p-Akt/Akt,and p-mTOR/mTOR proteins was upregulated(P<0.01).CONCLUSION:YQHXF can dynamically regulate autophagy in ischemic brain tissue,with inhibition of excess autophagy by activation of the PI3K/Akt/mTOR signaling pathway,thus reducing the infarct volume,alleviating brain dam-age,and promoting the recovery of neurological function.

Objective Th is aim of this review was to clarify the role of neutrophils in diabetes by summarizing the characterization studies,potential trends,and research hotspots relating to neutrophils in the diabetes research field.Methods 2998 relevant studies on neutrophils in the diabetes research field indexed in Web of Science from 2010 to 2023 were retrieved,and a visual analysis of the relevant literature was conducted using CiteSpace 6.1.R6.Results Since 2012,the number of publications on this topic has grown rapidly.Bayat Mohammad,Liu Tong,Amini Abdollah,and Zhang Rui are high-yield authors,with seven related articles published.China and Shanghai Jiao Tong University are the country and institution with the most published papers.The most influential journal in this field is"Nature Medicine".Literature co-citation analysis of topics related to diabetes showed that the greatest focus is currently on"extracellular trap"and"COVID-19 patient".Co-occurrence analysis,clustering analysis,and keyword burst analysis indicated that"lymphocyte ratio"(13.08)and"neutrophil extracellular trap"(7.2)are the most researched topics in the field of neutrophils and diabetes.Literature in this field mainly focuses on"myocardial infarction","endothelial","oxidative stress",and"apoptosis".Conclusions This article highlights the evolving trends in research into neutrophils in the diabetes field using CiteSpace,providing new insights for researchers aiming to conduct research in this area.

Objective To observe the value of ultrasonic biomicroscopy(UBM)imaging for diagnosing chestnut thorn foreign bodies in anterior segment.Methods A total of 70 patients who underwent UBM examination due to chestnut thorn injury or residue of chestnut thorn after removal and then operation were retrospectively enrolled.The distance of chestnut thorn foreign bodies from corneal limbus,and the subconjunctival depth and length of them were measured based on UBM imaging.The efficacy of UBM for diagnosing chestnut thorn foreign bodies in anterior segment was evaluated according to surgical findings,and the correlation of quantitative parameters of foreign bodies were analyzed.Results Among 70 cases of chestnut thorn foreign bodies in anterior segment,single ocular tissue(5/70,7.14％)involvement was detected in 5 cases,while multiple ocular tissues involvement(65/70,92.86％)were noticed in 65 cases according to UBM.Totally 109 foreign bodies were detected by UBM,among which 98 were consistent with surgical findings,with the diagnostic accuracy of 89.91％(98/109),while 11 foreign bodies were not found during operation,with the false positive rate of 10.09％(11/109).Meanwhile,4 foreign bodies found and removed with operation were not displayed with UBM,and the false negative rate of UBM was 3.92％(4/102).Among 98 chestnut thorn foreign bodies correctly diagnosed with UBM,10 located in stromal layer of cornea(10/98,10.20％)and 88 located in ocular wall(88/98,89.80％),including 43 subconjunctival(43/88,48.86％)and 45 sclerotic(45/88,51.14％)foreign bodies,with the median length of 0.200 mm.The distance of 88 foreign bodies in ocular wall from corneal limbus was(2.963±1.504)mm,and the subconjunctival depth was(0.785±0.388)mm.The distance of foreign bodies from corneal limbus were positively correlated with their subconjunctival depth(r,=0.361,P＜0.010),while their lengths were not correlated with their distance from corneal limbus and subconjunctival depth(both P＞0.05).Conclusion UBM imaging was valuable for clinical diagnosis and localization of chestnut thorn foreign bodies in anterior segment.