OBJECTIVE: To explore effectiveness of musculoskeletal ultrasound combined with Wide-Awake technique in extensor indicis proprius tendon (EIP) transfer for repairing extensor pollicis longus tendon (EPL) rupture. METHODS: A clinical data of 20 patients with EPL spontaneous rupture, who were admitted between January 2019 and June 2024 and met the selective criteria, was retrospectively analyzed. During EIP transfer surgery, the musculoskeletal ultrasound-guided incision marking combined with Wide-Awake technique was used in combination group (n=10) and the tourniquet-assisted surgery under brachial plexus block anesthesia in the control group. There was no significant difference in the baseline data between groups (P>0.05), including gender, age, affected side, cause and location of tendon rupture, and time from injury to hospitalization. The accuracy of preoperative musculoskeletal ultrasound in predicting the actual tendon rupture site was evaluated in the combination group. The operation time, intraoperative blood loss, visual analogue scale (VAS) scores during operation and at 6 hours after operation, total incision length, and postoperative complications were recorded. Surgical outcomes were assessed at 12 months after operation using the specific EIP-EPL evaluation method (SEEM), which included measurements of thumb elevation loss, thumb flexion loss, index finger dorsiflexion loss, and total score. RESULTS: In the combination group, the incision position marked by preoperative musculoskeletal ultrasound positioning was consistent with the actual tendon rupture position. Compared with the control group, the operation time and total incision length in the combination group were significantly shorter and the VAS score at 6 hours after operation was significantly higher (P<0.05). There was no significant difference in intraoperative blood loss or intraoperative VAS score between groups (P>0.05). All incisions in both groups healed by first intention. Two patients in the control group developed swelling and blisters in the tourniquet area, which subsided spontaneously without special treatment. All patients were followed up 12-14 months, with an average of 12.5 months. The thumb dorsiflexion function of all patients recovered to varying degrees. At last follow-up, the thumb elevation loss in combination group was significantly lower than that in control group, and the total score was significantly higher (P<0.05); there was no significant difference in thumb flexion loss or index finger dorsiflexion loss between groups (P>0.05). CONCLUSION Musculoskeletal ultrasound can accurately locate the site of tendon rupture, assist the Wide-Awake technique in implementing precise anesthesia, and adjust tendon tension while reducing tissue trauma, with satisfactory effectiveness.
Humans ; Male ; Tendon Injuries/diagnostic imaging* ; Tendon Transfer/methods* ; Female ; Retrospective Studies ; Adult ; Middle Aged ; Ultrasonography/methods* ; Rupture/surgery* ; Treatment Outcome ; Operative Time ; Tendons/surgery* ; Young Adult

OBJECTIVE: To investigate effectiveness of the bridge combined fixation system (BCFS) for Bado typeⅠchronic Monteggia fractures (CMF) in children. METHODS: A clinical data of 8 children with Bado type ⅠCMF, who were treated with the BCFS between November 2023 and February 2025, was retrospectively analyzed. There were 6 boys and 2 girls, with a mean age of 7.0 years (range, 4-12 years). The time from injury to operation ranged from 29 to 370 days (median, 68.5 days). Preoperative elbow range of motion was (111.3±17.9)° in flexion, (13.1±13.9)° in extension, (71.9±14.6)° in pronation, and (75.6±13.5)° in supination. Fracture healing time and postoperative complications were observed, and clinical outcomes were evaluated using the Mayo elbow performance score. RESULTS: All incisions healed by primary intention without infection, non-healing of the incision, or iatrogenic nerve injury. All children were followed up 4-18 months (mean, 10.3 months). At last follow-up, the elbow range of motion significantly improved to (142.5±2.7)° in flexion, (2.5±2.7)° in extension, (87.5±2.7)° in pronation, and (88.8±2.3)° in supination ( P<0.05). According to the postoperative Mayo elbow performance score, all cases were rated as excellent. Radiographic review showed no radial head dislocation, nonunion at the ulnar osteotomy site, or elbow stiffness, and no breakage of the BCFS or screw loosening. The fracture healing time ranged from 3 to 6 months, with a median of 4 months. CONCLUSION The BCFS was confirmed to be effective in the treatment of pediatric Bado type Ⅰ CMF, with good restoration of elbow function and the advantage of avoiding secondary implant removal surgery.
Humans ; Child ; Monteggia's Fracture/surgery* ; Male ; Female ; Child, Preschool ; Range of Motion, Articular ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Elbow Joint/physiopathology* ; Bone Plates ; Treatment Outcome ; Fracture Healing ; Bone Screws ; Elbow Injuries

Atherosclerosis is the most common cause of ischemic stroke. Antiplatelet aggregation is considered as the effective treatment for atherosclerotic ischemic stroke. Ticagrelor is a novel P2Y12 receptor antagonist, which has the advantages as rapid onset, strong effect, no need for liver metabolism activation and reversible platelet inhibition. Studies have confirmed that ticagrelor has a better therapeutic effect on ischemic stroke patients who are resistant to clopidogrel; especially in dual antiplatelet therapy, patients used ticagrelor have lower stroke risk and severe hemorrhage risk does not increase in these patients. This article reviews the recent advances in mechanism of ticagrelor and its application in acute ischemic stroke, with the aim of providing references for clinical application of ticagrelor.

Objective: To explore the association between mediterranean diet (MD) patterns and dental caries among children and adolescents with neurodevelopmental disorders (NDD), so as to provide a basis for developing scientific anti caries strategies related to diet. Methods: From December 2021 to June 2024, a questionnaire survey, a three day 24 hour dietary review survey, oral health examination, physical development measurement and Childhood Autism Rating Scale (CARS) evaluation were conducted involving 147 children and adolescents aged 2-22 years with NDD from nine special education schools and rehabilitation institutions in Tianjin. Group comparisons were carried out using the Mann-Whitney U test, Chi-square test, or Fisher s exact probability method. The correlation between dietary quality and dental caries was analyzed by adopting multiple linear regression analysis and restricted cubic spline. Results: There were 46 children and adolescents (31.3%) in the non dental caries group and 101 children and adolescents (68.7%) in the dental caries group. The number of decayed missing and filled teeth (dmft) was 2.0 (4.0), and the MD score was 4.0 (2.0) points. There were 62 children and adolescents (42.2%) in the low MD scores group and 85 children and adolescents (57.8%) in the high MD scores group. There was no significant difference in MD scores between NDD children in the non dental caries group and those in the dental caries group [nondental caries group:4.0(2.0), dental caries group:4.0(2.0), Z= -0.14, P >0.05]. The MD scores and dmft exhibited increasing and then decreasing trend ( P total =0.02, P non lineary = 0.04 ). Children and adolescents with NDD in the MD high scores group had a lower number of dmft than those in the MD low scores group ( β= -2.00 , 95%CI =-3.39 to -0.62, P <0.05). However, in children and adolescents with NDD and CARS scores ≥30, the above association was insignificant ( β=-0.63, 95%CI=-0.29-0.15, P >0.05). Conclusion Children and adolescents with NDD who have dietary patterns similar to the Mediterranean diet, are found to have fewer dental caries, and this is observed among those with no or mild symptoms of autism spectrum disorder.

Objective: To investigate the incidence trend and epidemic characteristics of notifiable infectious diseases in Nanjing City from 2004 to 2022, so as to provide the basis for improving the prevention, control, and monitoring strategies of infectious diseases. Methods: Data pertaining to notifiable infectious diseases reported in Nanjing City from 2004 to 2022 were retrieved from the Infectious Disease Surveillance System of Chinese Disease Prevention and Control Information System. Infectious diseases were classified by law and transmission routes. Temporal distribution incidence of notifiable infectious diseases were descriptively analyzed. The trends in incidence of notifiable disease were analyzed using annual percent change (APC) and average annual percent change (AAPC). Results: A total of 33 types of notifiable infectious diseases with 505 275 cases were reported in Nanjing City from 2004 to 2022. The average annual reported incidence was 347.45/105, showing a decreasing trend from 2018 to 2022 (APC=-13.499%, P<0.05), and there was no significant trend overall (AAPC=-1.586%, P>0.05). A total of 203 235 cases of 25 types of class A and B notifiable infectious diseases were reported, with an average annual reported incidence of 139.75/100 000, showing an overall decreasing trend (AAPC=-4.954%, P<0.05). Eight types of class C notifiable infectious diseases with 302 042 cases were reported, with an average annual reported incidence of 207.69/100 000. The reported incidence showed an increasing trend from 2004 to 2018 (APC=10.117%, P<0.05), and a decreasing trend from 2018 to 2022 (APC=-27.467%, P<0.05). There was no trend overall (AAPC=-0.360%, P>0.05). The reported incidence of blood-borne and sexually transmitted infectious diseases was the highest in class A and B infectious diseases, with an average annual reported incidence of 69.88/100 000, which was at a high epidemic level throughout the year, except February. The reported incidence of respiratory infectious diseases was 51.30/100 000, with a high reported incidence in April and December. The reported incidence of intestinal infectious diseases was the highest (178.06/100 000) in class C infectious diseases, with a high reported incidence in June and November. Conclusions The reported incidence of notifiable infectious diseases in Nanjing City was generally stable from 2004 to 2022. The peak incidence of respiratory infectious diseases occurred in winter and spring, and that of intestinal infectious diseases was in summer and autumn. It is necessary to strengthen the surveillance and intervention of blood-borne and sexually transmitted infectious diseases, respiratory infectious diseases, and intestinal infectious diseases to reduce the risk of infectious diseases.

OBJECTIVE: To observe the effect of electroacupuncture at "Sishencong" (EX-HN1) and "Fengchi" (GB20) on hippocampal neuronal ferritinophagy mediated by the nuclear receptor coactivator 4 (NCOA4)/ferritin heavy chain 1 (FTH1) signaling pathway in vascular dementia (VD) rats, and to explore the potential mechanisms of electroacupuncture for VD. METHODS: A total of 60 male rats of SPF grade were randomly divided into a blank group (12 rats), a sham surgery group (12 rats) and a modeling group (36 rats). In the modeling group, the modified 4-vessel occlusion method was used to establish the VD model. The 24 successfully modeled rats were randomly divided into a model group and an electroacupuncture group, with 12 rats in each group. In the electroacupuncture group, electroacupuncture was applied at left and right "Sishencong" (EX-HN1), and bilateral "Fengchi" (GB20), with continuous wave, in frequency of 2 Hz and current intensity of 1 mA, 30 min a time, once daily for 21 consecutive days. The learning and memory abilities were assessed using the Morris water maze test before modeling, after modeling and after intervention, as well as the novel object recognition test after intervention. After intervention, the neuronal morphology in the hippocampus was observed by Nissl staining; the iron deposition was observed by Prussian blue staining; the reactive oxygen species (ROS) level was detected by dihydroethidium (DHE) fluorescence staining; the levels of iron, malondialdehyde (MDA) and superoxide dismutase (SOD) in the hippocampal tissue were measured by the colorimetric assay, TBA method, and WST-1 method, respectively; the positive expression of NCOA4, FTH1 and glutathione peroxidase 4 (GPX4) was detected by immunohistochemistry; the protein expression of NCOA4, FTH1, GPX4, and the ratio of microtubule-associated protein 1 light chain 3B (LC3B) Ⅱ/Ⅰ in the hippocampus were detected by Western blot. RESULTS: Compared with the sham surgery group, in the model group, the escape latency was prolonged, and the number of platform crossings reduced (P<0.01), the recognition index (RI) was decreased (P<0.01); the hippocampal neurons displayed a blurred laminar structure, disorganized cellular arrangement, and the number of Nissl bodies was decreased (P<0.01); the percentage of iron deposition area in the hippocampus was increased (P<0.01); in the hippocampus, the levels of ROS, iron, MDA, and the protein expression of NCOA4, as well as the LC3B Ⅱ/Ⅰ ratio were increased (P<0.01), the SOD level, and the protein expression of FTH1 and GPX4 were decreased (P<0.01). Compared with the model group, in the electroacupuncture group, the escape latency was shortened and the number of platform crossings was increased (P<0.01), the RI was increased (P<0.01); the hippocampal neurons exhibited more regular morphology, better-organized cellular structure, and the number of Nissl bodies was increased (P<0.05); the percentage of iron deposition area in the hippocampus reduced (P<0.01); in the hippocampus, the levels of ROS, iron, MDA, and the protein expression of NCOA4, as well as the LC3B Ⅱ/Ⅰ ratio were decreased (P<0.01, P<0.05), the SOD level, and the protein expression of FTH1 and GPX4 were increased (P<0.01). CONCLUSION Electroacupuncture at "Sishencong" (EX-HN1) and "Fengchi" (GB20) can improve learning and memory abilities in VD rats, and its mechanism may be associated with the regulation of the hippocampal NCOA4/FTH1 signaling pathway, inhibition of ferritinophagy, and alleviation of oxidative stress damage.
Animals ; Electroacupuncture ; Dementia, Vascular/genetics* ; Male ; Rats ; Signal Transduction ; Humans ; Memory ; Rats, Sprague-Dawley ; Nuclear Receptor Coactivators/genetics* ; Ferritins/genetics* ; Learning ; Hippocampus/metabolism* ; Acupuncture Points

Objective:To compare the clinical application of the anterolateral thigh perforator flap (ALTPF) and the calf pedicled propeller perforator flap (PPPF) in reconstruction of soft tissue defect of foot and ankle.Methods:A retrospective observational study was conducted. From March 2013 to June 2019, 48 patients with soft tissue defect around ankle and in foot were reconstructed with ALTPF and PPPF in the Department of Orthopaedics, 920th Hospital of the Joint Logistic Support Force, People's Liberation Army of China. According to the types of flap, the patients were divided into 2 groups: ALTPF group (21 patients,13 males and 8 females, aged 16-67 years, mean 38.71 years±15.30 years. Donor sites were all directly sutured.) and PPPF group (27 patients, 12 males and 15 females, aged 12-69 years, mean 35.18 years±13.96 years. Five cases in the donor site required partial skin grafting, and the rest 22 cases were repaired by directly suture.). The wound size of the former was 5 cm×6 cm-15 cm×18 cm, and at 2 cm×3 cm-14 cm×17 cm for the latter. The surgical time and flap size of the 2 groups were recorded during the surgery. The survival and complications of the flap were observed, and the days of hospital stay were recorded after surgery. Follow-ups were conducted by outpatient clinic and via telephone and WeChat interviews. The colour, texture, appearance, donor scar, complications and thinning of the flap were observed during the follow-up. The ankle function was evaluated according to the score of American Orthopaedic Foot and Ankle Society (AOFAS), and the donor scar was evaluated according to the score of Vancouver Scar Scale (VSS). SPSS 22.0 statistical software was used for data analysis, and P<0.05 was considered statistically significant. Results:The surgical time for the ALTPF group was 118-203 (154.71±25.42) min, and that for the PPPF group was 52-92 (72.78±10.04) min. The size of the flap in the ALTPF group was 5 cm×8 cm-8 cm×18 cm (75.00 cm 2±8.69 cm 2), while it was 3 cm×7 cm-7 cm×17 cm (53.56 cm 2±19.49 cm 2) in the PPPF group. In the ALTPF group, 3 flaps had vascular complications within 24 hours after surgery, which survived after exploration and thrombectomy. Partial necrosis occurred in 1 flap. The rest 17 flaps survived uneventfully. In the PPPF group, 2 flaps had partial necrosis due to infection and they healed after dressing changes, 3 flaps had venous occlusion and survived after phlebotomy, partial suture removal and massage. The rest 22 flaps in 2 groups survived uneventfully. The postoperative days of hospital stay for the ALTPF group was 6-14 (8.71±2.03) days, and that was 4-12 (6.03±2.16) days in the PPPF group. Flap thinning was performed on 19 flaps in the ALTPF group and 2 in the PPPF group. Follow-up was performed for 7 to 21 months. All the flaps were good in colour, shape and texture. All donor sites healed well. At the final follow-up, 19 patients achieved ankle function of excellent, 1 of good and 1 of fair in the ALTPF group, and 21 patients achieved ankle function of excellent, 4 of good and 2 of fair in the PPPF group, according to the AOFAS. According to the VSS, scores of donor site scar was rated 4-8 (6.33±1.35) points for the ALTPF group, and 3-10 (5.92±1.80) points for the PPPF group. Statistical analysis showed no significant differences between the 2 groups in terms of early postoperative complications, flap survival rate, ankle function, and VSS scores ( P>0.05). However, there were statistically significant differences between the 2 groups in terms of surgical time, hospital stay, flap size, and the number of flap thinning ( P<0.05). Conclusion:Both ALTPF and PPPF have good clinical effects in reconstruction of soft tissue defect of foot and ankle. For small to medium-sized wounds, PPPF is the preferred choice due to the advantages in surgical time and postoperative hospital stay. For larger wounds, the ALTPF is the first choice with multiple surgery.

Objective:To compare the clinical application of the anterolateral thigh perforator flap (ALTPF) and the calf pedicled propeller perforator flap (PPPF) in reconstruction of soft tissue defect of foot and ankle.Methods:A retrospective observational study was conducted. From March 2013 to June 2019, 48 patients with soft tissue defect around ankle and in foot were reconstructed with ALTPF and PPPF in the Department of Orthopaedics, 920th Hospital of the Joint Logistic Support Force, People's Liberation Army of China. According to the types of flap, the patients were divided into 2 groups: ALTPF group (21 patients,13 males and 8 females, aged 16-67 years, mean 38.71 years±15.30 years. Donor sites were all directly sutured.) and PPPF group (27 patients, 12 males and 15 females, aged 12-69 years, mean 35.18 years±13.96 years. Five cases in the donor site required partial skin grafting, and the rest 22 cases were repaired by directly suture.). The wound size of the former was 5 cm×6 cm-15 cm×18 cm, and at 2 cm×3 cm-14 cm×17 cm for the latter. The surgical time and flap size of the 2 groups were recorded during the surgery. The survival and complications of the flap were observed, and the days of hospital stay were recorded after surgery. Follow-ups were conducted by outpatient clinic and via telephone and WeChat interviews. The colour, texture, appearance, donor scar, complications and thinning of the flap were observed during the follow-up. The ankle function was evaluated according to the score of American Orthopaedic Foot and Ankle Society (AOFAS), and the donor scar was evaluated according to the score of Vancouver Scar Scale (VSS). SPSS 22.0 statistical software was used for data analysis, and P<0.05 was considered statistically significant. Results:The surgical time for the ALTPF group was 118-203 (154.71±25.42) min, and that for the PPPF group was 52-92 (72.78±10.04) min. The size of the flap in the ALTPF group was 5 cm×8 cm-8 cm×18 cm (75.00 cm 2±8.69 cm 2), while it was 3 cm×7 cm-7 cm×17 cm (53.56 cm 2±19.49 cm 2) in the PPPF group. In the ALTPF group, 3 flaps had vascular complications within 24 hours after surgery, which survived after exploration and thrombectomy. Partial necrosis occurred in 1 flap. The rest 17 flaps survived uneventfully. In the PPPF group, 2 flaps had partial necrosis due to infection and they healed after dressing changes, 3 flaps had venous occlusion and survived after phlebotomy, partial suture removal and massage. The rest 22 flaps in 2 groups survived uneventfully. The postoperative days of hospital stay for the ALTPF group was 6-14 (8.71±2.03) days, and that was 4-12 (6.03±2.16) days in the PPPF group. Flap thinning was performed on 19 flaps in the ALTPF group and 2 in the PPPF group. Follow-up was performed for 7 to 21 months. All the flaps were good in colour, shape and texture. All donor sites healed well. At the final follow-up, 19 patients achieved ankle function of excellent, 1 of good and 1 of fair in the ALTPF group, and 21 patients achieved ankle function of excellent, 4 of good and 2 of fair in the PPPF group, according to the AOFAS. According to the VSS, scores of donor site scar was rated 4-8 (6.33±1.35) points for the ALTPF group, and 3-10 (5.92±1.80) points for the PPPF group. Statistical analysis showed no significant differences between the 2 groups in terms of early postoperative complications, flap survival rate, ankle function, and VSS scores ( P>0.05). However, there were statistically significant differences between the 2 groups in terms of surgical time, hospital stay, flap size, and the number of flap thinning ( P<0.05). Conclusion:Both ALTPF and PPPF have good clinical effects in reconstruction of soft tissue defect of foot and ankle. For small to medium-sized wounds, PPPF is the preferred choice due to the advantages in surgical time and postoperative hospital stay. For larger wounds, the ALTPF is the first choice with multiple surgery.

Atherosclerosis is the most common cause of ischemic stroke. Antiplatelet aggregation is considered as the effective treatment for atherosclerotic ischemic stroke. Ticagrelor is a novel P2Y12 receptor antagonist, which has the advantages as rapid onset, strong effect, no need for liver metabolism activation and reversible platelet inhibition. Studies have confirmed that ticagrelor has a better therapeutic effect on ischemic stroke patients who are resistant to clopidogrel; especially in dual antiplatelet therapy, patients used ticagrelor have lower stroke risk and severe hemorrhage risk does not increase in these patients. This article reviews the recent advances in mechanism of ticagrelor and its application in acute ischemic stroke, with the aim of providing references for clinical application of ticagrelor.

Objective To investigate the therapeutic effect and underlying mechanism of Qishishenshu Capsule on renal fibrosis in mice with early diabetic nephropathy(DN).Methods A DN mouse model was established by multiple injections of streptozotocin.The mice were randomly divided into a normal group(NC),model group(DN),and Qishi group(QS)(0.9 g/(kg·d)),with eight mice in each group.Mice were gavaged continuously for 4 weeks,and fasting blood glucose(FBG)was measured weekly.Four weeks later,urinary albumin/creatinine(UACR),serum creatinine,and blood urea nitrogen were measured.Hematoxylin-eosin,periodicacid-Schiff,and Sirius red staining were used to analyze renal pathological changes.Real-time fluorescence quantitative reverse-transcription polymerase chain reaction was used to detect the mRNA levels of fibronectin(FN),collagen type Ⅰ alpha 1(Col1a1),and α-smooth muscle actin(α-SMA).Immunohistochemistry and Western blot were performed to detect FN,collagen type Ⅰ(Collagen Ⅰ),collagen typeⅢ(Collagen Ⅲ),α-SMA,Podocin,Nephrin,and transforming growth factor-β1/SMAD family member2/3(TGF-β1/Smad2/3)pathway-related proteins.Results Compared with mice in the NC group,those in the DN group showed significantly higher levels of FBG and UACR(P＜0.001),and mesangial hyperplasia,basement membrane thickening,and collagen deposition in the renal tissue.The mRNA levels of FN,Col1a1,and α-SMA were increased(P＜0.05).Protein levels of Podocin and Nephrin were decreased(P＜0.05).The levels of FN,Collagen I,Collagen Ⅲ,α-SMA,and TGF-β1/Smad2/3 pathway proteins were increased(P＜0.05).Compared with the DN group,the QS group's level of UACR was decreased(P＜0.05),their renal pathological injury was alleviated,and mRNA levels of FN,Collagen Ⅰ,andα-SMA were attenuated(P＜0.05);whereas their protein levels of Podocin and Nephrin were elevated(P＜0.05).The levels of FN,Collagen Ⅰ,Collagen Ⅲ,α-SMA,and TGF-β1/Smad2/3 pathway proteins were also decreased(P＜0.05).Conclusions Qishishenshu Capsule improved renal fibrosis in DN mice,probably through the inhibition of the TGF-β1/Smad2/3 signaling pathway.