OBJECTIVE: To investigate the effectiveness of the suture anchor technique without knots for reconstruction of the anterior talofibular ligament (ATFL) combined with the reinforcement of the inferior extensor retinaculum in treating chronic lateral ankle instability (CLAI). METHODS: The clinical data of 31 patients with CLAI who were admitted between August 2017 and December 2023 and met the selection criteria were retrospectively analyzed. There were 18 males and 13 females, with an age range from 20 to 48 years (mean, 34.6 years). All patients had a history of repeated ankle sprain, with a disease duration of 6-18 months (mean, 9.65 months). The anterior drawer test and inversion stress test were positive, and tenderness was present in the ligament area. Stress X-ray films of the ankle joint showed a talar tilt angle of (10.00±2.78)° and an anterior talar displacement of (9.48±1.96) mm on the affected side. MRI revealed discontinuity, tortuosity, or disappearance of the ATFL structure. Preoperatively, the visual analogue scale (VAS) score was 5.2±2.1, and the American Orthopaedic Foot and Ankle Society (AOFAS) score was 62.9±7.1. All patients underwent arthroscopic debridement of the ankle joint followed by reconstruction of the ATFL using the suture anchor technique without knots combined with reinforcement of the inferior extensor retinaculum. Postoperatively, pain and function were assessed using the VAS and AOFAS scores. Stress X-ray films were taken to measure the talar tilt angle and anterior talar displacement to evaluate changes in ankle joint stability. Patient satisfaction was assessed according to the Insall criteria. RESULTS: All 31 surgeries were successfully completed. One case had wound exudation, while the remaining surgical incisions healed by first intention. Two cases experienced numbness on the lateral aspect of the foot, which disappeared within 1 month after operation. All patients were followed up 15-84 months (mean, 47.2 months). No complication such as anchor loosening, recurrent lateral ankle instability, superficial peroneal nerve injury, rejection reaction, or wound infection occurred postoperatively. The anterior drawer test and inversion stress test were negative at 3 months after operation. Stress X-ray films taken at 3 months after operation showed the talar tilt angle of (2.86±1.72)° and the anterior talar displacement of (2.97±1.32) mm, both of which were significantly different from the preoperative values ( t=12.218, P<0.001; t=15.367, P<0.001). At last follow-up, 2 patients had ankle swelling after exercise, which resolved spontaneously with rest; all 31 patients returned to their pre-injury level of sports or had no significant discomfort in daily activities. At last follow-up, 25 patients were pain-free, 4 had mild pain after exercise, and 2 had mild pain after walking more than 2 000 meters. The VAS score was 0.8±0.9 and the AOFAS score was 91.6±4.1, both of which were significantly different from the preoperative scores ( t=10.851, P<0.001; t=-19.514, P<0.001). According to the Insall criteria, 24 patients were rated as excellent, 4 as good, and 3 as fair, with a satisfaction rate of 90.3%. CONCLUSION The suture anchor technique without knots for reconstruction of the ATFL combined with reinforcement of the inferior extensor retinaculum provides satisfactory short- and mid-term effectiveness in treating CLAI.
Humans ; Male ; Adult ; Female ; Joint Instability/surgery* ; Lateral Ligament, Ankle/surgery* ; Retrospective Studies ; Middle Aged ; Ankle Joint/diagnostic imaging* ; Young Adult ; Suture Anchors ; Treatment Outcome ; Suture Techniques ; Plastic Surgery Procedures/methods* ; Chronic Disease ; Ankle Injuries/surgery*

OBJECTIVE:With the popularity of simulated barefoot running,minimalist shoes have become a new way of foot exercise.As an important muscle group of the foot,the maintenance of foot muscle morphology is important for the execution of foot functions.In this paper,by combing the literature about the effect of minimalist shoes on foot muscle morphology in recent years,we systematically evaluate the effect of minimalist shoes on foot muscle morphology compared with traditional running shoes. METHODS:The relevant articles published from 2012 to 2022 were searched in Chinese and English databases(PubMed,Web of Science,ProQuest,CNKI and WanFang databases)with"minimal shoes,minimal footwear,minimalist shoes,minimalist footwear,foot muscle,feet muscle"as Chinese and English keywords,respectively.Meta-analysis,sensitivity tests were performed on the included literature using Review Manager 5.4.1 and Stata 14 software,the Egger method was used to test for publication bias in the literature,and Meta-regression was used to identify the subgroups with heterogeneity. RESULTS:Compared with traditional running shoes,minimalist shoes increased muscle circumference of the abductor hallucis[standardized mean difference=2.034,95%confidence interval(1.192,2.877),Z=4.73,P＜0.001].And the results were not reversed after clipping and patching,with a more robust combined effect size(P＜0.05).For the toe short flexors,the total combined effect size did not show a difference between traditional running shoes and minimalist shoes[standardized mean difference=0.470,95%confidence interval(-0.45,1.39),Z=1.00,P=0.318]. CONCLUSION:Compared with traditional running shoes,minimalist shoes intervention can effectively improve muscle circumference of the abductor hallucis,but the promoting effect on the flexor digitorum brevis muscle is not obvious.Running in minimalist shoes has positive implications for the maintenance of the medial longitudinal arch,but it is necessary to enrich the research content of minimalist shoes on different foot muscles and different populations in order to further explore the mechanisms by which minimalist shoe interventions promote foot function.

The Ehlers-Danlos syndrome(EDS)is a rare inherent connective tissue disorder.The prev-alence of EDS in the population is estimated at one out of ten thousand to one out of a hundred thousand.The vascular EDS(vEDS)are rare among the subtypes but are the worst in prognosis.The article reports a case of vEDS admitted to the hospital.The patient was a young man complaining of a sudden onset of aphasia in right hemiparalysis and severe left abdominal pain for unknown reasons.The diagnosis was made after the genetic testing.The patient suffered from vEDS.Then,the multi-disciplinary team(MDT)made a treatment plan tailored to this young patient.The complexity in classification and delusive presentations of the EDS make the correct diagnosis very challenging.This article hopes to report this case and to share the experiences to the bet-ter understanding of this disease.

Objective To evaluate the effect of medial meniscal posterior root tear(MMPRT)on tibi-al external rotation through the dial test and assess the effect of pull-out repair for MMPRT on patho-logical tibial rotation.Methods Totally 40 patients undergoing MMPRT repair using pull-out way be-tween January 2022 and January 2023 were studied retrospectively.The dial test at 30°/90° knee flex-ion was performed on the affected and healthy sides of the patients before and after surgery to assess the tibial external rotation.Results The mean age of the 40 patients was 56.4±7.5 years,with a mean body mass index(BMI)of 24.1±3.0.Among them,6 were male(34%)and 34 were female(85%).The median time from injury to surgery was 3.8±2.9 months.The preoperative tibial external rotation angles measured by the dial test at 30°and 90°knee flexion were 31.34±5.38°and 36.75°±6.62°respectively.Postoperatively,these angles decreased significantly to 24.24°±5.88°and 24.76°±5.47°,respectively(P=0.00).Moreover,significant differences were observed in the changes in tibial external rotation angles of the affected knee before and after surgery,7.10°(95%CI[6.01°,8.19°])at 30°flexion and 11.99°(95%CI[10.68°,13.29°])at 90°flexion.The gap in the tibial external rotation angle between the affected and unaffected sides were significant before surgery at 30°(8.33°,95%CI[7.32°,9.33°])and 90°(13.03°,95%CI[11.82°,14.23°])flexion but not after surgery at 30°(0.48°,95%CI[-0.25°,0.98°])and 90°(0.34°,95%CI[-0.02°,0.70°])flexion.Conclusion The dial test finds increased tibial external rotation in patients with MMPRT,and pull-out repair can correct this pathological tibial external rotation.Moreover,an increased tibial external rotation angle measured by the dial test at 30°and 90°can indicate MMPRT.Therefore,special attention should be given to inter-preting the results of the dial test in cases of MMPRT.

Objective To express recombinant Burkholderia pseudomallei(B.pseudomallei)type Ⅲ secretion system BipD protein,prepare its polyclonal antibodies and verify their immunological traits.Methods The recombinant pET-28a-BipD plasmid was generated,and the pET-28a-BipD-carried E.coli BL21(DE3)bacteria were induced with isopropyl-β-d-thiogalactoside(IPTG)to express recombinant BipD(rBipD)protein.The rBipD was obtained by affinity chromatography using His Trap column,then mixed with Fredrick's adjuvant to immunize BALB/c mice by intraperitoneal injection in order to obtain anti-rBipD polyclonal antibodies.The immunoreactivity of rBipD was detected by Western blot assay using rabbit anti-melioidosis serum and the serum from melioidosis patients.The immunogenicity of rBipD was evaluated using Western blotting and immunofluorescence staining.Finally,rBipD was used to establish an indirect ELISA to detect serum antibodies of clinical melioidosis patients.Results The recombinant plasmid pET-28a-BipD was successfully constructed and transformed into E.coli BL21(DE3)to induce rBipD expression with IPTG treatment.The obtained rBipD had a relative molecular weight of 36×103 and a purity of 95.4％,and had good immunogenicity and immunoreactivity.It could induce the production of specific antibodies after immunizing mice,and mouse polyclonal antibodies against rBipD were prepared with the titer of 1∶512 000.rBipD of 5.0 μg/mL produced specific immune response with the serum of melioidosis patients,but had no specific reaction with the serum of tuberculosis patients,with statistical difference(P＜0.01).Conclusion rBipD with immunological activity is successfully prepared and purified,and its polyclonal antibodies are also developed,which provide a good tool for clinical immunological diagnosis and study of immune mechanism of B.pseudomallei infection.

Objective To analyze the mechanism that Hcp1 protein in type Ⅵ secretion system of Burkholderia pseudomallei(B.pseudomallei)mediates the formation of multinucleated giant cells(MNGCs)when host cells are infected by the bacterium.Methods The mutant strain(BPC006 Δhcp1)and complementation strain(BPC006 Δhcp1::hcp1)were constructed by homologous recombination and plasmid complement technology,respectively.After RAW264.7 cells were infected with B.pseudomallei,the localization of Hcp1 in host cells was analyzed by immunofluorescence staining.The localization was further verified by cytoplasmic-membrane isolation in 293T cells after transfecting pCDNA4.1-Hcp1.The biological significance and effect of Hcp1 were explored by the anti-Hcp1 polyclonal antibody blocking and the formation of MNGC was detected by Giemsa staining.Results Western blotting showed that BPC006 Δhcp1 could not express Hcp1,while BPC006 Δhcp1::hcp1 restored Hcp1 expression.The above results proved that the mutant and complement strains were successfully constructed.Both cellular immunofluorescence co-localization and cytoplasmic-membrane isolation experiments showed that Hcp1 localized to host cell membranes.Last but not least,compared with the control group,anti-Hcp1 polyclonal antibodies inhibited the formation of MNGC(P＜0.01).Conclusion Hcp1 protein in type Ⅵ secretion system of B.pseudomallei is able to translocate to the RAW264.7 cell membranes and plays an important role in the formation of MNGCs.

Maintaining the homeostasis of gut microbes is essential for the maintenance of human health.The evolution of the human gut microbiota is involved in many physiological functions.Besides，changes in gut flora can be traced back to early life.The prevalence of malnutrition in infants and young children is persistently high，especially in low-and middle-income countries.More and more researches have confirmed that the immature development of intestinal microbiota and abnormal metabolites are related to malnutrition.Due to nutritional diet is the most important factor affecting the microbiota，studies have begun to assess the therapeutic potential of microbiota oriented food interventions in improving infant and young child malnutrition.Therefore，this review summarizes the latest advances in the field and recommend further progress towards finding new treatments for the malnutrition of infant and young child.

Objective:To investigate the effectiveness and feasibility of whole exome sequencing (WES), as a molecular diagnosis technique, for adult patients with genetic diseases.Methods:The present retrospective analysis included 445 adult patients (ages 18-80 years) with suspected genetic diseases who underwent whole exome sequencing (WES) from August 2021 to December 2022. The pathogenicity classification of each variant was assessed in accordance with the recommendations developed by the American Society of Medical Genetics and Genomics.Results:The overall positive rate of WES among adult patients with suspected genetic diseases was 28.08% (125/445). The highest positive rate was observed in the age group of 41-50 years (34.33%, 23/67). Among the diagnosed genetic diseases, those affecting the cardiovascular system (63.16%, 84/133), nervous system (18.05%, 24/133), and endocrine system (13.53%, 18/133) ranked as the top three. The most common genetic diseases identified through WES in adult patients were hypertrophic cardiomyopathy (18.80%, 25/133), dilated cardiomyopathy (16.54%, 22/133), Marfan syndrome (15.04%, 20/133), epilepsy (9.02%, 12/133), and familial hypercholesterolemia (4.51%, 6/133). The main causative genes identified included FBN1 (14.29%, 19/133), MYBPC3 (9.02%, 12/133), MYH7 (9.02%, 12/133), LDLR (3.76%, 5/133), TTN (3.76%, 5/133), and TNNI3 (3.01%, 4/133).Conclusion:Applying the WES technique in clinical practice can improve the diagnostic rate of adult genetic diseases, especially in adult patients with suspected genetic conditions involving the cardiovascular system, nervous system, and endocrine system.

Clinical research coordinator (CRC) can improve the efficiency of clinical research, ensure the accuracy and reliability of the research process, as well as the standardized implementation of research projects and the safety of subjects. However, the CRCs dispatched by the site management organization have problems such as high liquidity, uneven quality, low work initiative, and high management costs. Since 2004, a research hospital in South China had started to employ CRCs by itself, exploring and forming three self-employed CRC management modes: hospital employ-hospital manage, researcher employ hospital manage, and researcher employ-third-party labor dispatch agency manage. The CRCs under hospital employ-hospital manage mode were recruited and selected by the hospital. The hospital established a labor relationship with CRC, and the hospital′s personnel department was responsible for salary distribution and promotion management of professional titles/positions. The relevant labor costs were borne by the hospital′s funds, and the salary standards were also formulated by the hospital. This type of CRC could participate in the promotion of health technology series titles. The CRCs under researcher employ-hospital manage mode were recruited and selected by the researcher. The hospital established a labor relationship with them. The relevant labor costs were borne by the research funding, and the researchers determined the specific salary standards for CRCs based on the salary guidance plan formulated by the hospital. These kind of CRCs could not be promoted to professional titles in hospitals. The CRCs under researcher employ-third-party labor dispatch agency manage mode were recruited and selected by researchers. The third-party labor dispatch agency established an employment relationship with them and provided personnel services. The relevant labor costs were borne by the research funding, and the researchers formulated their own salary standards. Such CRCs could not be promoted to professional titles in hospitals. As of July 2023, the number of self-employed CRCs in the hospital had reached 185, with 75.8% having a bachelor′s degree or above and an average work experience of 4.58 years. Among them, there were 26 people in the hospital hiring-hospital management mode, 45 people in the researcher hiring-hospital management mode, and 114 people in the researcher hiring-third-party labor dispatch agency management mode. These measures had fully released management efficiency, effectively met manpower needs, promoted rapid growth in the number of clinical research projects, and reduced management costs through third-party labor dispatch mode, which could provide references for CRC management in clinical trial institutions of China.

OBJECTIVES: This study investigated the seasonal impact of diurnal temperature range (DTR) on hospitalization rates for intracerebral hemorrhage (ICH) in middle-aged and elderly adults. METHODS: We collected data on the DTR and hospitalization records of ≥45-year-old patients with ICH in 2019 in Hunan Province, central China. Time-series analyses were performed using a distributed lag non-linear model. RESULTS: Overall, 54,690 hospitalizations for ICH were recorded. DTR showed a non-linear relationship with ICH hospitalization in both middle-aged and elderly populations (45-59 and ≥60 years, respectively). During spring, a low DTR coupled with persistently low temperatures increased ICH risk in both age groups, while a high DTR was associated with an increased risk in the middle-aged group only (relative risk [RR], 1.24; 95% confidence interval [CI], 1.21 to 1.27). In the summer, a low DTR combined with persistently high temperatures was linked to a higher risk exclusively in the middle-aged group. A high DTR in the autumn was correlated with increased risk in both age groups. In winter, either a low DTR with a continuously low temperature or a high DTR elevated the risk solely in the elderly population (RR, 1.37; 95% CI, 1.00 to 1.69). In the elderly group, the impact of DTR on hospitalization risk manifested within a 5-day period. CONCLUSIONS The impact of DTR on ICH hospitalization risk differed significantly across seasons and between age groups. Elderly individuals demonstrated greater sensitivity to the impact of DTR. Weather forecasting services should emphasize DTR values, and interventions targeting sensitive populations are needed.