Objective:To compare the clinical and radiological outcomes between the ankle dislocation exposure versus the traditional posterolateral approach exposure in the treatment of complex posterior ankle malunion.Methods:This retrospective study analyzed the 50 patients (50 feet) with posterior ankle malunion who had been treated at Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from May 2015 to June 2023. This cohort included 18 males and 32 females, with an age of (46.2±12.0) years. The duration from injury to surgery averaged 7.0 (4.0, 12.2) months. The patients were divided into 2 groups based on the surgical exposure methods: an ankle dislocation group (22 cases) in which the posterior ankle malunion was exposed by ankle dislocation before reduction and fixation, and a traditional posterolateral approach group (28 cases) in which the posterior ankle malunion was exposed by the traditional posterolateral approach before reduction and fixation. Evaluation indices included operative time, ankle arthritis grading, incidence of complications, as well as pre-operative and last follow-up recordings of distal tibial articular angle and joint step-off, visual analogue scale (VAS) pain score, and ankle-hindfoot score of American Orthopaedic Foot and Ankle society (AOFAS).Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). The average follow-up was (39.4±17.9) months. The operative time in the dislocation group [(95.8±9.9) min] was significantly shorter than that in the posterolateral approach group [(121.9±14.3) min] ( P<0.05). The step-off on the distal tibial articular surface at the last follow-up in the dislocation group [0.3 (0.0, 0.9) mm] was significantly lower than that in the posterolateral approach group [1.0 (0.3, 1.1) mm] ( P<0.05). The grading of ankle arthritis was significantly worse in the posterolateral approach group than that in the dislocation group ( P<0.05). There were no differences in distal tibial articular angle, VAS pain score, AOFAS ankle-hindfoot score, or postoperative complications between the 2 groups at the last follow-up ( P>0.05). Conclusions:Both ankle dislocation exposure and traditional posterolateral approach exposure yield satisfactory clinical and radiological outcomes in patients with complex posterior ankle malunion. However, the ankle dislocation exposure offers a novel method for direct visualization of the malunion on multiple planes, which is more advantageous for restoration of the anatomical consistency of the distal tibial articular surface.

LHFPL5 gene is involved in the electromechanical conduction of cochlear hair cells and plays an important role in maintaining hearing and balance functions.This review aims to investigate the mechanism of LHF-PL5 gene and its related proteins in the pathogenesis of hearing loss.We analyzed the hearing loss caused by LHF-PL5 gene mutation,and discussed the characteristics of hearing loss population.The molecular etiology of deafness caused by LHFPL5 gene was discussed through the conclusion and summary of the study results,which provided a basis for whether LHFPL5 gene screening was necessary for deaf people in China,and provided theoretical guidance for subsequent basic research and clinical diagnosis and treatment.

Objective Excavate the prescriptions containing the drug pair of Aurantii Fructus Immaturus-Magnoliae Officinalis Cortex(AFI-MOC),and statistically analyze the rules of prescription medication,and explore its potential mechanism of action in the treatment of food retention disorder.Methods The prescriptions containing the pair of AFI-MOC in the Great Dictionary of Traditional Chinese Medicine Prescriptions were retrieved and typed into Excel to establish a database.The source,dosage form,frequency of compatibility of traditional Chinese medicine,nature,taste and meridian attribution and indications were analyzed.Using R language(4.3.3)software with OriginPro to analysis co-occurrence frequency,association rule,correlation clustering analysis,and visualization.Then,the network construction,Protein-Protein Interaction Network(PPI)analysis,Gene Ontology(GO)function and Kyoto Encyclopedia of Genes and Genome(KEGG)pathway enrichment analysis of the"AFI-MOC-active ingredient-food retention disorder target"network were performed for the AFI-MOC drug pair and its indications food retention disorder.The binding between the core active ingredients and key target proteins was evaluated by molecular docking.Results A total of 349 prescriptions containing the pair of AFI-MOC were included,involving 267 Chinese herbs.Among them,the high-frequency compatibility drugs included Citri Reticulatae Pericarpium,Glycyrrhizae Radix et Rhizoma,Atractylodis Macrocephalae Rhizoma,Rhei Radix et Rhizoma and Aucklandiae Radix.They are mainly warm in nature,spicy,bitter and sweet in taste,spleen,liver and stomach in meridian.There were 141 kinds of indications,most of which were diseases of the spleen and stomach system such as food retention disorder,dysentery and fullness.Correlation cluster analysis shows that the AFI-MOC drug pair is frequently combined with drugs that have the efficacy of promoting qi circulation,strengthening the spleen,clearing heat,and eliminating dampness.Found through the analysis of network pharmacology AFI-MOC drug pair on the core of the active ingredient of Luteolin,BU3,Naringenin,Honokiol and Nobiletin.Key targets for food retention disorder are BDNF,AKT1,ESR1,TNF and IL-6.Molecular docking results show Luteolin,combined with AKT1 is most closely.Conclusion AFI-MOC drug pair often compatible with Citri Reticulatae Pericarpium,Atractylodis Macrocephalae Rhizoma,Aucklandiae Radix.The advantages of the prescription containing AFI-MOC drug pair is food retention disorder.Its key active components can exert therapeutic effects through multiple targets such as AKT1 and TNF.This study reveals the AFI-MOC drug pair on compatibility laws,preliminary interpretation of the mechanism for the treatment of food retention disorder.It can provide references and a basis for studying the compatibility mechanism of AFI-MOC and guiding rational clinical medication.

LHFPL5 gene is involved in the electromechanical conduction of cochlear hair cells and plays an important role in maintaining hearing and balance functions.This review aims to investigate the mechanism of LHF-PL5 gene and its related proteins in the pathogenesis of hearing loss.We analyzed the hearing loss caused by LHF-PL5 gene mutation,and discussed the characteristics of hearing loss population.The molecular etiology of deafness caused by LHFPL5 gene was discussed through the conclusion and summary of the study results,which provided a basis for whether LHFPL5 gene screening was necessary for deaf people in China,and provided theoretical guidance for subsequent basic research and clinical diagnosis and treatment.

Objective Excavate the prescriptions containing the drug pair of Aurantii Fructus Immaturus-Magnoliae Officinalis Cortex(AFI-MOC),and statistically analyze the rules of prescription medication,and explore its potential mechanism of action in the treatment of food retention disorder.Methods The prescriptions containing the pair of AFI-MOC in the Great Dictionary of Traditional Chinese Medicine Prescriptions were retrieved and typed into Excel to establish a database.The source,dosage form,frequency of compatibility of traditional Chinese medicine,nature,taste and meridian attribution and indications were analyzed.Using R language(4.3.3)software with OriginPro to analysis co-occurrence frequency,association rule,correlation clustering analysis,and visualization.Then,the network construction,Protein-Protein Interaction Network(PPI)analysis,Gene Ontology(GO)function and Kyoto Encyclopedia of Genes and Genome(KEGG)pathway enrichment analysis of the"AFI-MOC-active ingredient-food retention disorder target"network were performed for the AFI-MOC drug pair and its indications food retention disorder.The binding between the core active ingredients and key target proteins was evaluated by molecular docking.Results A total of 349 prescriptions containing the pair of AFI-MOC were included,involving 267 Chinese herbs.Among them,the high-frequency compatibility drugs included Citri Reticulatae Pericarpium,Glycyrrhizae Radix et Rhizoma,Atractylodis Macrocephalae Rhizoma,Rhei Radix et Rhizoma and Aucklandiae Radix.They are mainly warm in nature,spicy,bitter and sweet in taste,spleen,liver and stomach in meridian.There were 141 kinds of indications,most of which were diseases of the spleen and stomach system such as food retention disorder,dysentery and fullness.Correlation cluster analysis shows that the AFI-MOC drug pair is frequently combined with drugs that have the efficacy of promoting qi circulation,strengthening the spleen,clearing heat,and eliminating dampness.Found through the analysis of network pharmacology AFI-MOC drug pair on the core of the active ingredient of Luteolin,BU3,Naringenin,Honokiol and Nobiletin.Key targets for food retention disorder are BDNF,AKT1,ESR1,TNF and IL-6.Molecular docking results show Luteolin,combined with AKT1 is most closely.Conclusion AFI-MOC drug pair often compatible with Citri Reticulatae Pericarpium,Atractylodis Macrocephalae Rhizoma,Aucklandiae Radix.The advantages of the prescription containing AFI-MOC drug pair is food retention disorder.Its key active components can exert therapeutic effects through multiple targets such as AKT1 and TNF.This study reveals the AFI-MOC drug pair on compatibility laws,preliminary interpretation of the mechanism for the treatment of food retention disorder.It can provide references and a basis for studying the compatibility mechanism of AFI-MOC and guiding rational clinical medication.

Objective:To compare the clinical and radiological outcomes between the ankle dislocation exposure versus the traditional posterolateral approach exposure in the treatment of complex posterior ankle malunion.Methods:This retrospective study analyzed the 50 patients (50 feet) with posterior ankle malunion who had been treated at Department of Foot and Ankle Orthopedics, Foshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine from May 2015 to June 2023. This cohort included 18 males and 32 females, with an age of (46.2±12.0) years. The duration from injury to surgery averaged 7.0 (4.0, 12.2) months. The patients were divided into 2 groups based on the surgical exposure methods: an ankle dislocation group (22 cases) in which the posterior ankle malunion was exposed by ankle dislocation before reduction and fixation, and a traditional posterolateral approach group (28 cases) in which the posterior ankle malunion was exposed by the traditional posterolateral approach before reduction and fixation. Evaluation indices included operative time, ankle arthritis grading, incidence of complications, as well as pre-operative and last follow-up recordings of distal tibial articular angle and joint step-off, visual analogue scale (VAS) pain score, and ankle-hindfoot score of American Orthopaedic Foot and Ankle society (AOFAS).Results:There was no significant difference in the baseline data between the 2 groups, indicating comparability ( P>0.05). The average follow-up was (39.4±17.9) months. The operative time in the dislocation group [(95.8±9.9) min] was significantly shorter than that in the posterolateral approach group [(121.9±14.3) min] ( P<0.05). The step-off on the distal tibial articular surface at the last follow-up in the dislocation group [0.3 (0.0, 0.9) mm] was significantly lower than that in the posterolateral approach group [1.0 (0.3, 1.1) mm] ( P<0.05). The grading of ankle arthritis was significantly worse in the posterolateral approach group than that in the dislocation group ( P<0.05). There were no differences in distal tibial articular angle, VAS pain score, AOFAS ankle-hindfoot score, or postoperative complications between the 2 groups at the last follow-up ( P>0.05). Conclusions:Both ankle dislocation exposure and traditional posterolateral approach exposure yield satisfactory clinical and radiological outcomes in patients with complex posterior ankle malunion. However, the ankle dislocation exposure offers a novel method for direct visualization of the malunion on multiple planes, which is more advantageous for restoration of the anatomical consistency of the distal tibial articular surface.

Objective:To analyze the related factors that affect the occurrence of femoral head necrosis in patients with femoral neck fracture after surgery, and to build a nomogram predictive model.Methods:Using a retrospective study method, 180 patients with femoral neck fracture who were admitted to Hainan Provincial Hospital of Traditional Chinese Medicine from June 2019 to October 2021 were selected as the study objects. According to whether the patients had femoral head necrosis, they were divided into the occurrence group (75 cases) and the non occurrence group (105 cases). The receiver operating characteristic (ROC) curve was used to analyze the predictive value; Logistic regression was used to analyze the risk factors of postoperative femoral head necrosis; internal data were used to verify the clinical efficacy of nomogram model.Results:There was no significant difference in age, sex, body mass index and other general data between the two groups ( P>0.05); compared with the non occurrence group, Garden fracture in the occurrence group was mostly classified as type Ⅲ or Ⅳ, and more patients with preoperative traction, fracture displacement and unsatisfactory reduction quality, and the time from trauma to surgery was longer ( P>0.05). The area under curve of the time from trauma to surgery was 0.766 (95% CI 0.697 to 0.826), and the optimal cutoff value was 42 h; Garden fracture classification (type Ⅲ or Ⅳ), preoperative traction (yes), fracture displacement (yes), reduction quality (unsatisfactory) and time from trauma to surgery (>42 h) were the risk factors affecting the postoperative femoral head necrosis in patients with femoral neck fracture ( P<0.05). The risk of femoral head necrosis predicted by nomogram model was 0.802 (95% CI 0.692 to 0.873). The risk threshold of femoral head necrosis predicted by the model was >0.09, and nomogram model provides clinical net income. Conclusions:Garden fracture classification (type Ⅲ or Ⅳ), preoperative traction (yes), fracture displacement (yes), reduction quality (unsatisfactory) and time from trauma to surgery (>42 h) are the risk factors affecting the postoperative femoral head necrosis in patients with femoral neck fracture, and the nomogram model based on variables has a better predictive ability.

Objective The objective of this study was to investigate the effects of propofol on glycolysis of lung cancer,and to further explore its potential mechanism of inhibiting glycolysis in lung cancer through glucose transporter 4(GLUT4).Methods Human lung cancer A549 cells and mouse lung cancer LLC cells were cultured,and the experimental groups were set as the blank control group(Control group)and propofol(10μmol/L)group(Propofol group).The CCK-8 assay was used to detect cell viability;Immunofluorescence(IF)was used to detect the expression of Ki-67 in lung cancer cells and A549 cell xenografts.Extracellular acidi-fication rate(ECAR)and mitochondrial oxygen consumption(OCR)assays were used to detect the cellular metabolic levels;ELISA was used to detect the cell lactate and pyruvate content;Molecular docking experiments were used to detect the binding ability of GLUT4 with propofol using CB-Dock online tool;The glucose uptake kit was used to detect glucose uptake;Western blot was used to detect the expression of GLUT4,HK2,and PFK1 proteins in lung cancer cells.Results The cell viability of A549 cells(0.661±0.052)and LLC cells(0.632±0.033)in the propofol group was significantly inhibited by 10 μmol/L of propofol in lung cancer cells(P＜0.001).Compared with the control group,the average fluorescence intensity of Ki-67 in A549 and LLC positive cells(0.663±0.064 and 0.540±0.070)was significantly suppressed(P＜0.001).The ELISA results showed that compared with the control group,the levels of lactate and pyruvate in the propofol group decreased(P＜0.001),and under the action of propofol,the glucose uptake ability of cells decreased(P＜0.001).Molecular docking experiments using the CB-Dock online tool showed that GLUT4 had the strongest binding force with propofol.The results of Western blot showed a decrease in the expression of GLUT4 and its downstream HK2 and PFK1 pro-teins.After transient transfection and knockdown of GLUT4,cellular lactate(P＜0.001)and pyruvate content(P＜0.01)decreased,glu-cose uptake capacity reduced,and the inhibitory effect of propofol on glycolysis disappeared.In A549 cell xenografts,the weight of xenografts in the propofol group was significantly smaller than that of the model group(P＜0.001).Compared with the model group,the lactate content and pyruvate content decreased in the propofol group(P＜0.001).Conclusion Propofol can inhibit the proliferation of lung cancer cells and the progression of A549 cell xenografts in bearing mice by inhibiting the glycolysis of lung cancer cells,and its mechanism may be related to the targeted effect of GLUT4 on the glycolysis of lung cancer cells.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Objective:To search, review and summarize the best evidence on promoting maturation of autologous arteriovenous fistula (AVF) in patients undergoing maintenance hemodialysis (MHD) .Methods:In accordance with the relevant methods of evidence-based nursing, evidence was retrieved from relevant websites and databases according to the "6S" pyramid model, including clinical decision-making, guidelines, expert consensus, group standards, and systematic reviews. The search time limit was from April 20, 2012 to April 20, 2022. Two investigators assessed the quality of the evidence, and the evidence team extracted and summarized the evidence.Results:A total of 17 articles were included, including 1 clinical decision-making, 6 guidelines, 1 expert consensus, 1 group standard and 8 systematic reviews. Totally 28 best evidences were summarized from 6 aspects: team education, perioperative management, functional exercise, physical therapy, drug application, first puncture timing and scheme.Conclusions:The best evidence provides a reference for medical staff to standardize the management of AVF in MHD patients. It is recommended that medical staff develop individualized plans based on medical conditions, clinical judgment, and patient wishes when applying relevant evidence.