OBJECTIVE: To evaluate the mid-term efficacy of talonavicular joint fusion alone combined with navicular stress adjustment in Müller-Weiss disease with significant paradoxical flatfoot deformity. METHODS: Between January 2016 and March 2021, a total of 13 patients diagnosed with Müller-Weiss disease underwent simple talonavicular joint fusion combined with navicular stress adjustmentadjustment.Among them, 5 patients were male and 8 patients were female;age ranged from 42 to 67 years old. The duration of the disease ranged from 8 to 20 years. According to Maceira staging system, 5 patients were in stage III and 8 patients were in stage IV. The American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score, visual analogue scale (VAS), and foot length were evaluated preoperatively and 10 months postoperatively. Additionally, the talonavicular coverage angle, the talus-first metatarsal angle, and the calcaneal inclination angle were assessed preoperatively and 6 months postoperatively. RESULTS: All 13 patients were followed up a period ranging from 24 to 40 months. All patients achieved clinical healing within a period of 3 to 6 months. However, one patient experienced a screw fracture. The VAS decreased from a range of 3 to 7 points preoperatively to a range of 0 to 2 points at the 10 months postoperative. The AOFAS midfoot score improved from a preoperative range of 12 to 66 points to a range of 72 to 100 points at the 10 months postoperative. Based on the AOFAS midfoot score evaluated at 10 months postoperatively, the outcomes were rated as excellent in 3 feet, good in 6 feet, and fair in 4 feet. The talo-navicular coverage angle, the preoperative talus-first metatarsal angle, calcaneal inclination angle were 14.3° to 33.4°, -4.6° to -19.6°, and 3.0°to 16.4° respectively. Six months postoperatively, these angles improved to 2.7°to 9.6°, -8.4°to 1.1°, and 18.8°to 24.9°respectively. Additionally, the foot length increased by 0 to 6 mm at 10 months post-surgery. CONCLUSION Simple talonavicular arthrodesis combined with scaphoid stress adjustment has satisfactory clinical efficacy in Müller-Weiss disease in terms of deformity, foot length, foot function and pain.
Humans ; Male ; Female ; Adult ; Middle Aged ; Arthrodesis/methods* ; Aged ; Flatfoot/physiopathology* ; Tarsal Bones/physiopathology* ; Tarsal Joints/surgery* ; Treatment Outcome

Receptor-interacting protein kinase 1 (RIPK1) plays an essential role in regulating the necroptosis and apoptosis in cerebral ischemia-reperfusion (I/R) injury. However, the regulation of RIPK1 kinase activity after cerebral I/R injury remains largely unknown. In this study, we found the downregulation of protein arginine methyltransferase 1 (PRMT1) was induced by cerebral I/R injury, which negatively correlated with the activation of RIPK1. Mechanistically, we proved that PRMT1 directly interacted with RIPK1 and catalyzed its asymmetric dimethylarginine, which then blocked RIPK1 homodimerization and suppressed its kinase activity. Moreover, pharmacological inhibition or genetic ablation of PRMT1 aggravated I/R injury by promoting RIPK1-mediated necroptosis and apoptosis, while PRMT1 overexpression protected against I/R injury by suppressing RIPK1 activation. Our findings revealed the molecular regulation of RIPK1 activation and demonstrated PRMT1 would be a potential therapeutic target for the treatment of ischemic stroke.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective To investigate the association between the immune microenvironment and gene expression in endometrial cancer(EC)and discuss its predictive value for prognosis,and to identify critical immune-related genes through bioinformatics analysis and machine learning techniques and construct a prognostic model for providing new directions for personalized treatment of EC.Methods Based on data from the Cancer Genome Atlas(TCGA)program,tools such as DESeq2,edgeR,and limma were utilized to screen for differentially expressed genes.Immune-related genes were selected by integrating data from the Immunology Database and Analysis Portal(ImmPort).Machine learning algorithms including Lasso regression,univariate feature selection,Boruta and random forest were employed to refine the selection of feature genes.Univariate and multivariate Cox regression analyses were conducted to assess the prognostic value of the genes,followed by construction of a risk score model.Additionally,tumor immune infiltration was analyzed using CIBERSORT algorithm,and key gene expressions were validated through immunohistochemistry.Results The intersection of 3 difference analysis results and immune-related genes identified 62 differentially expressed immune genes,and 25 potential biomarkers which were selected by a variety of machine learning models were considered as prognosis related genes.Univariate and multivariate Cox regression analyses confirmed that INHBE,SLURP1 and TNFSF11 genes were significantly associated with survival in EC patients.The constructed risk score model effectively distinguished the survival rate of different prognostic groups,and was related to the degree of immune cell infiltration.Immunohistochemical analysis further verified the differences in the expression of these genes between tumor and normal tissues.Conclusion INHBE,SLURP1 and TNFSF11 are key prognostic biomarkers in EC immune microenvironment,and their expression levels are closely associated with immune cell infiltration and patient survival rate,providing theoretical basis for EC precision medicine.

Objective To investigate the association between the immune microenvironment and gene expression in endometrial cancer(EC)and discuss its predictive value for prognosis,and to identify critical immune-related genes through bioinformatics analysis and machine learning techniques and construct a prognostic model for providing new directions for personalized treatment of EC.Methods Based on data from the Cancer Genome Atlas(TCGA)program,tools such as DESeq2,edgeR,and limma were utilized to screen for differentially expressed genes.Immune-related genes were selected by integrating data from the Immunology Database and Analysis Portal(ImmPort).Machine learning algorithms including Lasso regression,univariate feature selection,Boruta and random forest were employed to refine the selection of feature genes.Univariate and multivariate Cox regression analyses were conducted to assess the prognostic value of the genes,followed by construction of a risk score model.Additionally,tumor immune infiltration was analyzed using CIBERSORT algorithm,and key gene expressions were validated through immunohistochemistry.Results The intersection of 3 difference analysis results and immune-related genes identified 62 differentially expressed immune genes,and 25 potential biomarkers which were selected by a variety of machine learning models were considered as prognosis related genes.Univariate and multivariate Cox regression analyses confirmed that INHBE,SLURP1 and TNFSF11 genes were significantly associated with survival in EC patients.The constructed risk score model effectively distinguished the survival rate of different prognostic groups,and was related to the degree of immune cell infiltration.Immunohistochemical analysis further verified the differences in the expression of these genes between tumor and normal tissues.Conclusion INHBE,SLURP1 and TNFSF11 are key prognostic biomarkers in EC immune microenvironment,and their expression levels are closely associated with immune cell infiltration and patient survival rate,providing theoretical basis for EC precision medicine.

Objective: To understand the current status of diagnosis and treatment of chronic lymphocytic leukemia (CLL) /small lymphocytic lymphoma (SLL) among hematologists, oncologists, and lymphoma physicians from hospitals of different levels in China. Methods: This multicenter questionnaire survey was conducted from March 2021 to July 2021 and included 1,000 eligible physicians. A combination of face-to-face interviews and online questionnaire surveys was used. A standardized questionnaire regarding the composition of patients treated for CLL/SLL, disease diagnosis and prognosis evaluation, concomitant diseases, organ function evaluation, treatment selection, and Bruton tyrosine kinase (BTK) inhibitor was used. Results: ①The interviewed physicians stated that the proportion of male patients treated for CLL/SLL is higher than that of females, and the age is mainly concentrated in 61-70 years old. ②Most of the interviewed physicians conducted tests, such as bone marrow biopsies and immunohistochemistry, for patient diagnosis, in addition to the blood test. ③Only 13.7% of the interviewed physicians fully grasped the initial treatment indications recommended by the existing guidelines. ④In terms of cognition of high-risk prognostic factors, physicians' knowledge of unmutated immunoglobulin heavy-chain variable and 11q- is far inferior to that of TP53 mutation and complex karyotype, which are two high-risk prognostic factors, and only 17.1% of the interviewed physicians fully mastered CLL International Prognostic Index scoring system. ⑤Among the first-line treatment strategy, BTK inhibitors are used for different types of patients, and physicians have formed a certain understanding that BTK inhibitors should be preferentially used in patients with high-risk factors and elderly patients, but the actual use of BTK inhibitors in different types of patients is not high (31.6%-46.0%). ⑥BTK inhibitors at a reduced dose in actual clinical treatment were used by 69.0% of the physicians, and 66.8% of the physicians had interrupted the BTK inhibitor for >12 days in actual clinical treatment. The use of BTK inhibitors is reduced or interrupted mainly because of adverse reactions, such as atrial fibrillation, severe bone marrow suppression, hemorrhage, and pulmonary infection, as well as patients' payment capacity and effective disease progression control. ⑦Some differences were found in the perceptions and behaviors of hematologists and oncologists regarding the prognostic assessment of CLL/SLL, the choice of treatment options, the clinical use of BTK inhibitors, etc. Conclusion: At present, a gap remains between the diagnosis and treatment of CLL/SLL among Chinese physicians compared with the recommendations in the guidelines regarding the diagnostic criteria, treatment indications, prognosis assessment, accompanying disease assessment, treatment strategy selection, and rational BTK inhibitor use, especially the proportion of dose reduction or BTK inhibitor discontinuation due to high adverse events.
Female ; Humans ; Male ; Aged ; Middle Aged ; Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy* ; Prognosis ; Lymphoma, B-Cell ; Immunohistochemistry ; Immunoglobulin Heavy Chains/therapeutic use*

In the guidance of
Acupuncture ; Acupuncture Points ; Acupuncture Therapy ; Humans ; Meridians ; Moxibustion ; Spasm

ObjectiveThe present study was conducted to investigate the protective effect on cardiac function and potential mechanism of Compound Danshen Dripping Pills （CDDPs） on myocardial ischemia reperfusion in rats. MethodsThirty two male SD rats were underwent cardiac reperfusion following 45 minutes of left anterior descending coronary artery ligation， and randomly divided into 4 groups （n= 8 ）， rats in each group were given different doses of CDDPs （40，80，120 mg·kg^-1·d^-1 ）， or normal saline （control group） by gavage. Another 8 rats underwent similar procedure but without LAD ligation were set as sham group （were also given same volume of normal saline by gavage）. The treatment lasted for 4 weeks. Then echocardiography was conducted to evaluate the end-point cardiac function. HE and Masson’s trichrome staining were performed to observe the change of histomorphology and fibrosis. CD31/α-SMA immunofluorescence was implemented to investigate the endothelial to mesenchymal transition in cardiac microvessels. Western Blot was used to analyze the expression of α-SMA and CD31 in ventricular tissue of infarcted border zone. Data were analyzed by one-way ANOVA or Kruskal-Wallis H non-parametric test. ResultsCompared with normal saline group， treatment with different doses of CDDP could increase ejection fraction and fractional shortening significantly （P＜0.05 at least）， decrease left ventricular end-diastolic volume and the E/A ratio significantly （P＜0.05 at least）， reduce the cardiac collagen volume fraction （both P<0.05）， and suppress the expression of mesenchymal marker α-SMA in cardiac microvessels detected by immunofluorescent staining（P＜0.05 at least）， and decrease the expression of α-SMA and increase the expression of CD31 in ventricular tissue of infarcted border zone detected by Western blot. ConclusionTreatment with 40/80/120 mg·kg^-1·d^-1 doses of CDDPs for 4 weeks could improve cardiac function in rats underwent ischemia-reperfusion， this might be through reducing the occurrence of endothelial to mesenchymal transition in microvessels within heart tissue， and subsequently decreasing the cardiac fibrosis.

Objective To explore the method of distinguishing the degree of hypoxic-ischemic brain damage ( HIBD) in living mice in early stage, so as to lay a foundation for the follow-up study of the molecular mechanism of different degrees of HIBD. Methods The modified Rice-Vannucci method was used to duplicate the HIBD model of C57BL/6 J mice. On the 1 day and 3 days after the model, the scalp of mice were cut and the brain tissue were observed to distinguish between mild and severe lesions in living mice, and then 2,3, 5-triphenyltetrazolium chloride (TTC) staining, laser speckle cerebral blood flow imaging, HE staining, Fluoro-Jade B ( FJB ) staining and body weight difference before and after operation were used to verify the reliability of observation in living mice. Results Through the gross observation of brain tissue in living mice, HIBD could be divided into mild injury (HI-M) group and severe injury (HI-S) group. On day 1 and day 3 after HIBD, a significant decrease in cerebral blood flow, obvious gray infarction and a large number of necrotic neurons were observed in the HI-S group, and the body weight was significantly lower than that before operation. In the HI-M group, the cerebral blood flow of the injured side decreased only on the 3rd day after HIBD, and the loose arrangement of neurons in the cortex and hippocampus of the injured side was observed morphologically. The body weight was lower than that before operation. Conclusion Gross observation of brain tissue by cutting the scalp is a reliable method to distinguish mild and severe brain injury in the early stage of HIBD in living mice.

Objective:To study the clinical medication regulation for the prevention and treatment of new coronavirus pneumonia with traditional Chinese medicine（TCM），especially prescriptions，on the basis of "treatment in accordance with seasonal conditions". Method:The guidelines and suggestions on novel coronavirus pneumonia formulated and published by national，provincial and municipal governments and experts before February 17，2020, were retrieved and summarized. Data was recorded in stages according to "prevention period，clinical observation period，pre-clinical period，middle clinical period，late clinical period and recovery period". The frequency analysis of TCM and its efficacy，prescription and proprietary Chinese medicine was carried out，and then the factor analysis and cluster analysis of TCM were carried out to obtain rational drug combinations. Result:Totally 172 suggestions on combined structure of drugs，50 suggestions on prescriptions and 31 suggestions on proprietary Chinese medicine were involved in the study，and provided by 24 official agencies and 24 medical experts， 147 kinds of herbs，44 prescriptions and 16 proprietary Chinese medicines were collected. No matter for the drug category or for the specific drug selection，the law of drug use in different stages was not the same. Huoxiang Zhengqi capsule，Shufeng Jiedu capsule，Lianhua Qingwen capsule and Jinhua Qinggan capsule can be used in the observation period. Xuanbai Chengqitang can be used in the middle of the disease. Angong Niuhuangwan，Suhexiangwan or Zixuedan, and Angong Niuhuangwan can be selected in the middle of the disease. And Qingfei Paidu decoction can be used in all stages of the disease. Conclusion:Doctors need to adjust their prescriptions along with the progress of the disease，because the law of medication in each stage of the new coronavirus pneumonia is different.