ObjectiveTo investigate the effects of Simiaowan on intestinal barrier function and adenosine triphosphate （ATP） binding cassette transporter G2 （ABCG2） expression in hyperuricemic （HUA） rats， and elucidate its therapeutic mechanisms. MethodsForty male Sprague Dawley （SD） rats were randomized into a normal group， a model group， low-dose （282.6 mg·kg^-1） and high-dose （565.2 mg·kg^-1） Simiaowan groups， and a Benzbromarone （4.7 mg·kg^-1） group. The HUA model was established via intraperitoneal injection of potassium oxonate （ip） combined with oral gavage of hypoxanthine （ig） for 14 days. Following modeling， treatments were administered for 14 days. Samples were collected and weighed 4 h after final dosing. Blood uric acid and hepatic function were analyzed. Histopathological changes were evaluated by hematoxylin-eosin （HE） staining， and Chiu's scoring was conducted. Enzyme-linked immunosorbent assay （ELISA） quantified tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， interleukin-1β （IL-1β）， lipopolysaccharide （LPS）， diamine oxidase （DAO）， and D-lactic acid （D-LA） levels. Real-time polymerase chain reaction （Real-time PCR）， Western blot， and immunohistochemistry assessed the expression of Claudin-1， Occludin， occludens-1 （ZO-1）， and ABCG2 mRNAs and proteins. 16S rDNA amplicon sequencing characterized ileal microbiota. ResultsCompared with the normal group， the model group exhibited epithelial shedding in the ileal villus， structural disruption， infiltration of extensive inflammatory cells， and significantly elevated Chiu's scores （P<0.01）. The DAO， TNF-α， IL-6， IL-1β， LPS， and D-LA levels in the ileum were markedly increased （P<0.01）， while mRNA and protein expressions of Claudin 1， Occludin， ZO-1， and ABCG2， as well as positive staining area and proportion， were significantly reduced （P<0.01）. Compared with the model group， the Simiaowan groups at all doses showed improved epithelial damage in the ileal villus， significantly lowered Chiu's scores （P<0.01）， significantly reduced DAO， TNF-α， IL-6， IL-1β， LPS， and D-LA levels in the ileum （P<0.01）， and upregulated mRNA and protein expressions of Claudin 1， Occludin， ZO-1， and ABCG2， as well as positive staining area and proportion （P<0.01）. The 16S rDNA results showed that in the model group， the α-diversity index of the ileal microbiota was increased， and species diversity and richness were enhanced， with microbiota dysfunction observed. The community structure of the gut microbiota was significantly different from that of the normal microbiota. The abundance of probiotics was decreased， and the abundance of pathogenic bacteria was increased， with butyrate-producing bacteria showing a low abundance. In contrast， Simiaowan at all doses reduced species diversity and richness， regulated microbiota dysfunction， and promoted the shift of the structure of the gut microbiota community towards a normal one. This increased the abundance of beneficial bacteria， decreased the abundance of harmful bacteria， and restored the abundance of butyrate-producing bacteria. ConclusionSimiaowan enhances ileal uric acid excretion and further alleviates HUA by modulating the gut microbiota composition to improve the intestinal barrier and upregulate the expression of the urate transporter ABCG2 in HUA rats.

OBJECTIVE: To explore the effectiveness of mini external fixators combined with bone cement spacers in the treatment of gouty hallux rigidus with bone defects. METHODS: A retrospective analysis was conducted on the clinical data of 21 male patients diagnosed with gouty hallux rigidus and bone defects, treated with mini external fixators combined with bone cement spacers between January 2017 and December 2024. The age ranged from 35 to 72 years, with an average age of 61.1 years. The disease duration was 12-35 years, with an average of 18.2 years. The American College of Rheumatology (ACR) gout score ranged from 16 to 23, with an average of 18.6. All 21 cases of hallux rigidus were classified as grade 3 according to the Coughlin classification. Clinical efficacy was evaluated preoperatively and at 6 months postoperatively using the visual analogue scale (VAS) score for pain, the dorsiflexion angle of first metatarsophalangeal joint in a weight-bearing state, and the American Orthopaedic Foot & Ankle Society (AOFAS) score. Radiological evaluation was performed by measuring the hallux valgus angle (HVA) using weight-bearing X-ray films and the tophi volume using dual-energy CT. RESULTS: The operation time ranged from 30 to 56 minutes, with an average of 42.05 minutes. The intraoperative blood loss varied between 10 and 30 mL, averaging 20 mL. All 21 patients were followed up 6-15 months, averaging 9.3 months. One patient experienced delayed wound healing due to the liquefaction of residual tophus; no other patients exhibited complications such as wound or pin tract infections, skin necrosis, fractures, or metastatic metatarsalgia. Six patients experienced acute gout attacks 4-7 days postoperatively, which were effectively alleviated through symptomatic treatment. At 6 months after operation, patients showed significant improvements in HVA, tophus volume, VAS scores, AOFAS scores, and the dorsiflexion angle of first metatarsophalangeal joint compared to preoperative values, with significant differences ( P<0.05). CONCLUSION Mini external fixator combined with a cement spacer is an effective treatment for gouty hallux rigidus with bone defects.
Humans ; Male ; Middle Aged ; External Fixators ; Adult ; Retrospective Studies ; Hallux Rigidus/diagnostic imaging* ; Bone Cements/therapeutic use* ; Aged ; Treatment Outcome ; Metatarsophalangeal Joint/surgery*

Objective To evaluate the analgesic effects of ultrasound-guided hip capsule block and fascia iliaca block in elderly patients undergoing hip replacement surgery and their impacts on postoperative rehabilitation.Methods A total of 44 patients who underwent total hip replacement in the Second Affiliated Hospital of Wenzhou Medical University from May to December in 2023 were selected and divided into fascia iliaca block group(group F)and hip capsule block group(group H)according to the random number table,with 22 cases in each group.All patients were anesthetized by lumbar anesthesia combined with nerve block.The primary indicators included the recovery of lower limb muscle strength at 8h,24h,48h after operation and the rest and movement visual analogue scale(VAS)scores at each observation point.The secondary indicators were sufentanil consumption of analgesic pump,the number of compressions,the use rates of additional parecoxib sodium in ward,the length of hospital stay and the occurrence of adverse reactions.Results The recovery of lower limb muscle strength in group H was better than that in group F at 8h and 24h after operation,and the difference was statistically significant(P<0.05).The rest and movement VAS scores at 30min after block and 4h after operation in group H were significantly lower than those in group F(P<0.05),while there were no significant differences in the rest and movement VAS scores between two groups at other time points(P>0.05).The rest and movement VAS scores at each time point after blockade were lower than those before blockade in two groups(P<0.05).The sufentanil consumption in analgesic pump and the number of compressions in group H was lower than that in group F at 4h after operation(P<0.05),and there were no significant differences in analgesic pump data and the use rates of parecoxib sodium between two groups at subsequent time points(P>0.05).There were no statistically significant difference in the incidence of nausea within 48h after operation and hospital stay between two groups(P>0.05).Conclusion Both fascia iliaca block and hip capsule block can be safely and effectively used in elderly patients with hip replacement,but the analgesic effect of hip capsule block is faster,the early postoperative analgesic effect is better,and the impact on lower limb movement is less.

Objective To evaluate the analgesic effects of ultrasound-guided hip capsule block and fascia iliaca block in elderly patients undergoing hip replacement surgery and their impacts on postoperative rehabilitation.Methods A total of 44 patients who underwent total hip replacement in the Second Affiliated Hospital of Wenzhou Medical University from May to December in 2023 were selected and divided into fascia iliaca block group(group F)and hip capsule block group(group H)according to the random number table,with 22 cases in each group.All patients were anesthetized by lumbar anesthesia combined with nerve block.The primary indicators included the recovery of lower limb muscle strength at 8h,24h,48h after operation and the rest and movement visual analogue scale(VAS)scores at each observation point.The secondary indicators were sufentanil consumption of analgesic pump,the number of compressions,the use rates of additional parecoxib sodium in ward,the length of hospital stay and the occurrence of adverse reactions.Results The recovery of lower limb muscle strength in group H was better than that in group F at 8h and 24h after operation,and the difference was statistically significant(P<0.05).The rest and movement VAS scores at 30min after block and 4h after operation in group H were significantly lower than those in group F(P<0.05),while there were no significant differences in the rest and movement VAS scores between two groups at other time points(P>0.05).The rest and movement VAS scores at each time point after blockade were lower than those before blockade in two groups(P<0.05).The sufentanil consumption in analgesic pump and the number of compressions in group H was lower than that in group F at 4h after operation(P<0.05),and there were no significant differences in analgesic pump data and the use rates of parecoxib sodium between two groups at subsequent time points(P>0.05).There were no statistically significant difference in the incidence of nausea within 48h after operation and hospital stay between two groups(P>0.05).Conclusion Both fascia iliaca block and hip capsule block can be safely and effectively used in elderly patients with hip replacement,but the analgesic effect of hip capsule block is faster,the early postoperative analgesic effect is better,and the impact on lower limb movement is less.

Objective: To compare the diagnostic consistency and efficacy of arthroscopy and MRI on the severity of acute lateral ligament complex (LLC) injury, and to find an effective method to diagnose acute LLC injury accurately in early stage. Methods: Data of 37 patients (27 males, 10 females), with acute lateral ligament complex injury who were treated from February 2015 to December 2016 were retrospectively analyzed. The average age was 28.6±6.2 years (range, 18-42 years) and duration from injury to operation was 4.6±3.3 days (range, 0.3-8 days). The results of MRI and ankle arthroscopy for detecting LLC injury were compared, and the consistency between the two examination results was analyzed. Results: Different consistencies were found between the two examination methods according to different parts of LCC injuries. The consistency of injuries (partial tear,complete tear) at the starting point of anterior talofibular ligament and complete tear at the starting point of calcaneofibularliga-ment was ordinary (kappa=0.641, 0.624, 0.680), while the consistency of damage in other parts of LLC was poor (kappa< 0.4). Compared with arthroscopy, MRI has a diagnostic accuracy of 62% (23/37) for partial tear of anterior talofibular ligament, and 62% (23/37) for complete tear. And that of the calcaneofibularligament complete tear was 78% (29/37). Conclusion MRI had low capability in detecting the severity of acute LLC injury accurately and the diagnosing efficacy was insufficient, while ar-throscopic exploration had a high diagnostic value for acute ankle joint injuries.

Objective To study the short-term and medium-term effects of mini- strip anchor and capsulotomy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis (RA). Methods From January 2015 to December 2016,fifty-eight RA patients with first metacarpophalangeal joint dislocation were randomly divided into study group (20 cases),joint replacement group (19 cases) and non-operation group (19 cases). Postoperative evaluation indexes: the wound healing was observed in accordance with ＂trial standard of functional evaluation of upper limbs of Chinese Medical Association Hand Surgery Society＂. The surgical outcomes of the three groups were compared. The hand function and quality of life were assessed by Michiga Hand Outcomes Questionnaire ( MHQ ) and arthritis impact measurement scale 2 (AIMS2) before treatment, 6 months after treatment and 12 months after treatment. Results All the patients in the study group and the joint replacement group healed by first intention without any early complications. According to the criteria of upper extremity functional evaluation of Chinese Medical Association,the curative effect of the operation was evaluated. In the study group,15 cases were excellent,3 cases were good,2 cases were poor,the excellent and good rate was 90. 0%. In the joint replacement group, 15 cases were excellent,3 cases were good,1 case was poor,and the excellent and good rate was 94. 7%. After treatment for 6months, the MHQ scores were improved significantly in the three groups (( 48. 36 ±8. 24) vs. (73. 06±10. 55); (47. 56±7. 75) vs. (81. 42±8. 54); (48. 75±8. 85) vs. (65. 91±8. 26)) (F＝33. 19,35. 12,28. 42, P＜0. 05). The MHQ scores of study group ( (73. 06±10. 55)points) and joint replacement group ( ( 81. 42 ± 8. 54) points) were significantly higher than those of non-operation group ((65. 91± 8. 26) points) ( P＜0. 05), and the MHQ scores of joint replacement group were significantly higher than those of study group (P＜0. 05). At 12 months after treatment,there was no significant difference in MHQ score between the study group ((82. 45±7. 18)points) and the arthroplasty group ((84. 36±6. 33) points) (P＞0. 05) . At 6 and 12 months after treatment, AIMS2 scores of each group were significantly improved,but AIMS2 scores of study group (( 216. 51 ± 35. 28) points, ( 230. 28 ± 23. 51) points) and arthroplasty group ((221. 45±31. 63) points,(234. 15±21. 42) points) were significantly higher than those of non-operation group ((192.69±41.31) points,(200.43 ±28.42) points) (P＜0.05).At 6 and 12 months after treatment,there was no significant difference in AIMS2 scores between the study group and the arthroplasty group ( P ＞ 0. 05 ) . Conclusion Micro-strip line anchors combined with posterior capsulorrhaphy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis can achieve good stability of articular reduction,significantly improve the joint function and quality of life and have ideal short-term and mid-term effect.

Objective To evaluate the diagnostic effect of galactomannan (GM) on bronchial alveolar lavage in patients with non-granulocyte deficiency.Methods 64 patients with suspected invasive pulmonary aspergill were enrolled in our hospital from May 2016 to May 2017.According to the relevant diagnostic criteria,they were divided into the diagnosis group (n =3),the clinical diagnosis group (n =20),the proposed group (n =14) and non-fungal infection group (n =27).All subjects underwent bronchial alveolar lavage and GM testing.Results When the GM value of bronchoalveolar lavage fluid and serum GM value increased from 0.5 to 1,the sensitivity decreased,while the specificity and positive predictive value increased.The sensitivity,positive predictive value and negative predictive value of GM detection method for bronchial alveolar lavage fluid were significantly higher than that of serum GM (P ＜ 0.05) at the same GM boundary value,and the specificity was significantly lower than that of serum GM (P ＜ 0.05).When the GM boundary value of bronchial alveolar lavage fluid was ≥ 0.86,the diagnostic efficiency of invasive pulmonary aspergillosis was the highest,the sensitivity and specificity reached 80.26％,75.15％,and the area under the curve was 0.945 (95％ CI:0.782-0.986).Conclusions GM detection of bronchial alveolar lavage fluid is more helpful for the diagnosis of invasive pulmonary aspergillosis in patients with non-granulocyte deficiency than serum GM.The optimal threshold is 0.86.

Objective To study the relationship between the rheumatoid arthritis (RA) flatfoot and flexor pollicis longus tendon (FHL) lesion.Methods A total of 120 rheumatoid arthritis flatfoot patients (120 feet) was admitted to our hospital,and were examined by uhrasonography.Foot flexor hallucis longus tendon lesions were analyzed.Theses patients were divided into intact tendon group (group A) with 48 cases,tendon inflammation group (group B) with 45 cases,and tendon rupture group (C group) with 27 cases according to the ultrasound flexor hallucis longus tendon lesions degree.Foot bearing radiographs of all patients were measured,and hallux valgus angle between the first and second metatarsal bones were measured,and the relationship between the flexor pollicis longus tendon lesion degree and hallux valgus angle were analyzed.Results There were 48 cases (40％)with normal FHL,45 cases(37.5％)with FHlL inflammation,and 21 cases(22.5％) with FHL fractures.It revealed that HVA was positively correlated with IMA in group A and B (P ＜ 0.05).But there was no correlation between HVA and IMA in group C (P ＞ 0.05).Conclusion FHL is a common RA flatfoot disease,but FHL is not the initial cause of RA hallux valgus,but is positively correlated with the degree of hallux valgus.

Objective To study the relationship between the rheumatoid arthritis (RA) flatfoot and flexor pollicis longus tendon (FHL) lesion.Methods A total of 120 rheumatoid arthritis flatfoot patients (120 feet) was admitted to our hospital,and were examined by uhrasonography.Foot flexor hallucis longus tendon lesions were analyzed.Theses patients were divided into intact tendon group (group A) with 48 cases,tendon inflammation group (group B) with 45 cases,and tendon rupture group (C group) with 27 cases according to the ultrasound flexor hallucis longus tendon lesions degree.Foot bearing radiographs of all patients were measured,and hallux valgus angle between the first and second metatarsal bones were measured,and the relationship between the flexor pollicis longus tendon lesion degree and hallux valgus angle were analyzed.Results There were 48 cases (40％)with normal FHL,45 cases(37.5％)with FHlL inflammation,and 21 cases(22.5％) with FHL fractures.It revealed that HVA was positively correlated with IMA in group A and B (P ＜ 0.05).But there was no correlation between HVA and IMA in group C (P ＞ 0.05).Conclusion FHL is a common RA flatfoot disease,but FHL is not the initial cause of RA hallux valgus,but is positively correlated with the degree of hallux valgus.

Objective To assess the correlation between tenosynovitis or rupture of the flexor hallucis longus (FHL) and pes planus in patients with rheumatoid arthritis (RA).Methods The data of 47 RA patients (97 feet) with painful feet was retrospectively analyzed which was collected From February 2008 to June 2011.In accordance with the results of the FHL changes got by ultrasonography,the patients were divided into 3 groups.Group A consisted of those with normal FHL (27 feet).Group B consisted of those with FHL tenosynovitis (40 feet),and Group C eonsisted of those with FHL rupture (27 feet).Load bearing lateral radiographs were taken for all the patients.The correlation study was carried out based on the pes planus-related parameters,such as the measurement of heel pitch angle (HPA) and tarsal and 1st metatarsal angle (TM1).Factors like patients' age and course of disease were also taken into the consideration during the study.Results The mean age of those in group A was 49.9±9.2 years vs.56.2±9.2 years in group B and 54.7±8.0 years in group C.The mean duration was 4.7±2.6 years in Group A vs.16.2±7.4 years in Group B 5°±3.6° in Group C.The mean TM1 was 2.5°±2.2° in Group A vs.6.5°±3.2° in Group B and 11.2°±4.9° in Group C.Significant statistics difference were found among the three groups in these parameters.HPA＜ 20° was found among 6/27 feet in group A,31/40 in group B and 27/27 in group C.TM1 ＞4° was found among 5/27 feet in group A,30/40 in group B and 27/27 in group C.Conclusion FHL changes were common in RA patients and its severitv had positive correlation to pes planus.These changes were affected by age and duration,and could be evaluated effectively by ultrasound.