Objective:To compare the effectiveness of TightRope system and plate-screw internal fixation in the treatment of avulsion fractures of the posterior calcaneal tuberosity of Beavis type Ⅱ.Methods:A retrospective study was conducted to analyze the clinical data of the 42 patients with avulsion fracture of the posterior calcaneal tuberosity of Beavis type Ⅱ who had undergone surgical treatment at Foot-ankle Surgery Center, The Fourth Hospital of Wuhan from January 2019 to January 2024. There were 25 males and 17 females, with an age of (64.4±10.1) years. The left side was affected in 23 cases and the right side in 19 cases. The patients were divided into 2 groups according to their different ways of internal fixation: a TR group of 22 cases subjected to open reduction and internal fixation with TightRope system and a PS group of 20 cases subjected to open reduction and plate-screw internal fixation. The operation time, bone healing time, complications, and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, MOS item short form health survey (SF-36) score and visual analogue scale (VAS) at 12 months after operation were compared between the 2 groups.Results:There were no significant differences in the preoperative clinical baseline data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (19.9±3.1) months. In the TR group, the operation time [(59.3±7.1) min] was significantly shorter than that in the PS Group [(72.1±10.7) min], the incidence of complications [4.5% (1/22)] significantly lower than that in the PS group [35.0% (7/20)], and the AOFAS ankle-hindfoot score [(83.5±8.2) points] and SF-36 scale score [(88.2±5.3) points] were significantly higher than those in the PS Group [(64.4±10.8) points and (78.6±11.2) points] (all P<0.05). There was no significant difference in the bone healing time or VAS pain score at 12 months after operation between the 2 groups ( P<0.05). Conclusions:In the treatment of avulsion fractures of the posterior calcaneal tuberosity of Beavis type Ⅱ, compared with the plate-screw internal fixation, the TightRope system can shorten operation time, improve functional recovery, and reduce complications.

[Purpose]To analyze the diagnostic yield of quantitative fecal immunochemical test(FIT)at different cut-offs in colorectal cancer(CRC)screening.[Methods]The sequential screening method was adapted in Jiashan CRC screening program for local residents aged 40～74 years old,which included a quantitative FIT and high-risk factor questionnaire for primary screening and subsequent colonoscopy for the diagnostic screening.Subjects who participated in quantitative FIT were included in this study between September,2021 and August,2023.The positive predictive values(PPVs)for colorectal neoplasms were calculated at the cut-offs of 100,120,140,160,180 and 200 ng/mL of FIT.The Cochran-Armitage trend test was performed to compare the trend of PPVs at different cut-offs.The effects of different starting age and FIT cut-offs on requirement of colonoscopy and advanced neoplasia detection were assessed.[Results]A total of 58 256 individuals completed the quantitative FIT,and 3 106 had fecal hemoglobin concentrations＞100 ng/mL,among whom 2 186 underwent colonoscopic examination with a compliance rate of 70.38％.The colonoscopy detected 588 cases of non-advanced adenomas and 355 cases of advanced neoplasms(AN),in-cluding 30 cases of CRC and 325 cases of advanced adenomas.Progressively increasing the cut-off showed a decrease in PPVs of non-advanced adenomas and an increase of AN.The ratio of the rate of reduced requirement of colonoscopy to the missed rate of the progressive lesions was the smallest when the screening start age was 45 years old and the positive FIT threshold was set at 100 ng/mL.[Conclusion]There were significant differences in the diagnostic yield at different cut-offs of FIT.Increasing the cut-offs of FIT will elevate PPVs for the advanced neoplasms.

Apolipoprotein B mRNA editing enzyme catalytic polypeptide like 3A(APOBEC3A)mutation is a major driver of cervical cancer.APOBEC3A and human papilloma virus(HPV)is closely related.On the one hand,APOBEC3A can effectively inhibit HPV infection;on the other hand,it can promote the integration of HPV DNA into cervical keratinocytes.This paper reviews the complex interaction between HPV and APOBEC3A,and analyzes the involved viral mechanism and cellular signal pathway.A large number of studies have confirmed that APOBEC3A gene can effectively induce the evolution and development of a variety of malignant tumors,including cervical cancer.However,APOBEC3A protein level is not so high in cancer cells in clinic.This paper also discusses the significance and the potential therapeutic value of APOBEC3A activity in cervical cancer.

[Purpose]To analyze the diagnostic yield of quantitative fecal immunochemical test(FIT)at different cut-offs in colorectal cancer(CRC)screening.[Methods]The sequential screening method was adapted in Jiashan CRC screening program for local residents aged 40～74 years old,which included a quantitative FIT and high-risk factor questionnaire for primary screening and subsequent colonoscopy for the diagnostic screening.Subjects who participated in quantitative FIT were included in this study between September,2021 and August,2023.The positive predictive values(PPVs)for colorectal neoplasms were calculated at the cut-offs of 100,120,140,160,180 and 200 ng/mL of FIT.The Cochran-Armitage trend test was performed to compare the trend of PPVs at different cut-offs.The effects of different starting age and FIT cut-offs on requirement of colonoscopy and advanced neoplasia detection were assessed.[Results]A total of 58 256 individuals completed the quantitative FIT,and 3 106 had fecal hemoglobin concentrations＞100 ng/mL,among whom 2 186 underwent colonoscopic examination with a compliance rate of 70.38％.The colonoscopy detected 588 cases of non-advanced adenomas and 355 cases of advanced neoplasms(AN),in-cluding 30 cases of CRC and 325 cases of advanced adenomas.Progressively increasing the cut-off showed a decrease in PPVs of non-advanced adenomas and an increase of AN.The ratio of the rate of reduced requirement of colonoscopy to the missed rate of the progressive lesions was the smallest when the screening start age was 45 years old and the positive FIT threshold was set at 100 ng/mL.[Conclusion]There were significant differences in the diagnostic yield at different cut-offs of FIT.Increasing the cut-offs of FIT will elevate PPVs for the advanced neoplasms.

Objective:To compare the effectiveness of TightRope system and plate-screw internal fixation in the treatment of avulsion fractures of the posterior calcaneal tuberosity of Beavis type Ⅱ.Methods:A retrospective study was conducted to analyze the clinical data of the 42 patients with avulsion fracture of the posterior calcaneal tuberosity of Beavis type Ⅱ who had undergone surgical treatment at Foot-ankle Surgery Center, The Fourth Hospital of Wuhan from January 2019 to January 2024. There were 25 males and 17 females, with an age of (64.4±10.1) years. The left side was affected in 23 cases and the right side in 19 cases. The patients were divided into 2 groups according to their different ways of internal fixation: a TR group of 22 cases subjected to open reduction and internal fixation with TightRope system and a PS group of 20 cases subjected to open reduction and plate-screw internal fixation. The operation time, bone healing time, complications, and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, MOS item short form health survey (SF-36) score and visual analogue scale (VAS) at 12 months after operation were compared between the 2 groups.Results:There were no significant differences in the preoperative clinical baseline data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (19.9±3.1) months. In the TR group, the operation time [(59.3±7.1) min] was significantly shorter than that in the PS Group [(72.1±10.7) min], the incidence of complications [4.5% (1/22)] significantly lower than that in the PS group [35.0% (7/20)], and the AOFAS ankle-hindfoot score [(83.5±8.2) points] and SF-36 scale score [(88.2±5.3) points] were significantly higher than those in the PS Group [(64.4±10.8) points and (78.6±11.2) points] (all P<0.05). There was no significant difference in the bone healing time or VAS pain score at 12 months after operation between the 2 groups ( P<0.05). Conclusions:In the treatment of avulsion fractures of the posterior calcaneal tuberosity of Beavis type Ⅱ, compared with the plate-screw internal fixation, the TightRope system can shorten operation time, improve functional recovery, and reduce complications.

Objective:To analyze the injury characteristics of peritalar dislocations using ankle models reconstructed with software Mimics.Methods:A retrospective study was conducted to analyze the medical records of 36 patients with peritalar dislocation who had been treated at Department of Orthopaedics, The Fourth Hospital of Wuhan from January 2008 to April 2022. There were 28 males and 8 females with an age of (46.0±14.6) years, and 16 left and 20 right limbs. Their CT data were imported into software Mimics to reconstruct ankle models to observe the fractures of the postero-medial process of the talus, the affiliated injuries to the surrounding bone structures outside the talus, and the complete or incomplete dislocations of the talonavicular articulation.Results:32 patients (88.9%, 32/36) had fracture of the postero-medial process of the talus, and 24 patients (66.7%, 24/36) a total of 33 affiliated injuries to the surrounding bone structures outside the talus, including 12 lateral malleolus ones, 4 medial malleolus ones, 7 scaphoid ones, 6 calcaneus ones, 3 fractures of the cuboid and 1 fracture of the fifth metatarsal. Sixteen patients were complicated with 1 affiliated injury, 7 patients with 2 affiliated injuries, and 1 patient with 3 affiliated injuries. The 8 patients with 2 or more affiliated injuries all had complete dislocation of the talonavicular articulation. Of the 36 patients, 26 had complete dislocation of the talonavicular articulation and 10 incomplete dislocation of the talonavicular articulation. The incidence of affiliated injuries [84.6% (22/26)] in the patients with complete dislocation of the talonavicular articulation was significantly higher than that [20.0% (2/10)] in those with incomplete dislocation of the talonavicular articulation ( P=0.001). Conclusions:Most of the peritalar dislocations are combined with the fracture of the postero-medial process of the talus. The incidence of complete dislocation of the talonavicular articulation is high. Patients with complete dislocation of the talonavicular articulation are more likely to have an affiliated injury, or even more than two injuries.

Objective:To investigate the effects of exenatide on podocyte in diabetic nephropathy mice.Methods:Diabetic nephropathy mice models were induced by using streptozocin-treated C57BL/6J mice on high fat diets, which were randomized by random number table to diabetic nephropathy control group (DN group, n=8) and exenatide treatment diabetic nephropathy group (DN+ Ex group, n=8). The C57BL/6J mice on normal chow diet were used as normal control group (NC group, n=8). After the intervention, blood glucose, renal function, and urine albumin/creatinine ratio were measured. Pathological glomerular changes were observed by pexiodic acid-Schiff stain (PAS) staining. The mRNA expression of profibrotic molecules Collagen Ⅳ, transforming growth factor-β (TGF-β), and Fibronectin in glomerular lysates were measured by realtime quantitative PCR (RT-PCR). Podocyte injury and apoptosis were evaluated by immunofluorescent staining and transmission electron microscopy. The expression of Nephrin, Cleaved caspase-3, protein kinase B (Akt), and phosphorylated Akt (p-Akt) in glomerular lysates were examined by western blotting. Results:Compared with the DN group, urine albumin/creatinine ratio was significantly decreased in the DN+ Ex group ( P<0.01). PAS staining and analysis found that exenatide administration ameliorated mesangial matrix expansion and glomerular hypertrophyin in DN group ( P<0.05). RT-PCR analyses showed that the glomerular expression for Fibronectin, TGF-β, and Collagen Ⅳ were significantly decreased in the DN+ Ex group compared with the DN group ( P<0.01). Immunofluorescent staining and transmission electron microscopy revealed that exenatide treatment improved podocyte injury and apoptosis in DN group. Western blotting analyses showed that exenatide increased the Nephrin expression, decreased the Cleaved caspase-3 expression, increased the p-Akt expression in glomerular lysatesin diabetic nephropathy mice ( P<0.01). Conclusion:Exenatide attenuates podocyte injury and apoptosis and proteinuria, and prevents the progression of diabetic nephropathy mice. Phosphatidylinositol 3-kinase (PI3K)/Akt pathway in glomerular lysates may be related to the protective effects of exenatide.

Objective To explore the safety and effectiveness of enhanced recovery after surgery (ERAS) in the perioperative nursing of cerebral glioma patients. Methods ERAS optimized nursing was developed based on ERAS of other specialties combined with neurosurgical features. A total of 80 cerebral glioma patients recruited in the Department of Neurosurgery of Tang Du Hospital from June 2016 to April 2017 were investigated and divided into the experimental group (40 cases) and control group (40 cases) using the envelope random sampling with the registration number assigned when a patient was admitted to the hospital. Patients in the control group were treated with routine treatment, while patients in the experimental group received the ERAS nursing. The complications, nursing satisfaction rate, the time of taking food, removing urine tube, stopping the infusion and hospital stay were compared between two groups. Results There was no significant difference in the occurrence of complications between two groups (P>0.05). The nursing satisfaction rate was 82.5% in the experimental group and 62.5% in the control group with significant difference between two groups (P<0.05). The rate of removing urine tube within 24 hours after surgery was 85.0% in the experimental group and 25.0% in the control group; the bed activity rates within 3 days after surgery in the experimental and control groups were 95.0% and 30.0% respectively; the differences between two groups were statistically significant (P<0.05). The time of taking food, stopping the infusion and hospital stay in the experimental group were significantly shorter than those of the control group (P<0.05). Conclusions The application of ERAS in the perioperative nursing of cerebral glioma patients is safe and effective, which allows faster rehabilitation, and reduces postoperative hospital stay and hospitalization costs.

OBJECTIVETo judge whether algesia sensitization of some acupoints is existed and whether the acupoint algesia sensitization area is expanded in the patients of intestinal cancer.

METHODSTotally, 30 patients of intestinal cancer and 30 healthy subjects were included. The electronic Von Fray was used to determine the pressure-pain thresholds at 13 acupoints relevant with gastrointestinal disorders and the reference points at the sites 1and 2lateral to those points as well as the sites at the corresponding nerve segments. Compared with the pressure-pain thresholds at the reference points of the different segments, the relative value was calculated. The changes were analyzed in the pressure-pain thresholds at the relevant acupoints on the body surface in the patients of intestinal cancer as compared with the relative pressure-pain thresholds in the healthy volunteers.

RESULTSThe pressure-pain thresholds at Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Quchi (LI 11) and Dachangshu (BL 25) in the patients of intestinal cancer were all significantly reduced as compared with those of the healthy subjects (<0.05,<0.01,<0.001). At the non-acupoint sites 1and 2lateral to those acupoints as well as at the sites of the same segments, the pressure-pain thresholds were reduced significantly as compared with the control group (<0.05,<0.01,<0.001). Particularly, the sensitization zone of Yinlingquan (SP 9) focused on the acupoint, the site 1lateral to it as well as the non-acupoint sites of the same segments (<0.01,<0.001).

CONCLUSIONThe acupoint sensitization is displayed at Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Quchi (LI 11), Dachangshu (BL 25) and Yinlingquan (SP 9) and the sensitization area is expended in the patients of intestinal cancer.

Objective To analyze and investigate dopamine combined with milrinone treatment effect on elderly patients with intractable heart failure and N-terminal B-type natriuretic peptide level and cardiac function.Methods 80 cases of elderly patients with heart failure according to the number table method randomly divided into two groups: control group and experimental group, and control group was given conventional drugs.The patients in experimental group were received dopamine +Milrinone on the basis of control group.Clinical efficacy, N-terminal pro-B-type natriuretic peptide levels ( NT proBNP ) and heart function condition between two groups are compared and analyzed.Results The total effective rate of experimental group (95.00%) was higher than that of control group (70.00%) (P<0.05).NT-proBNP(2013.31 ±295.84)ng/L、LVEDD(61.48 ± 10.11)mm、LVEF(59.69 ±8.44)% in the experimental group was significantly better than the control group(P <0.05).Conclusion Dopamine combined with milrinone in the treatment of elderly patients with intractable heart failure is remarkable, can relieve the level of NT proBNP, and promote the recovery of cardiac function.