Objective To explore the effects of small incision in situ release on surgical indications,nerve conduction velocity and upper limb function in patients with carpal tunnel syndrome(CTS).Methods A total of 100 CTS patients admitted to our hospital from January 2018 to January 2022 were selected,they were randomly divided into the control group(50 cases,treated with traditional carpal tunnel release)and the observation group(50 cases,treated with small incision in situ release),the clinical data of CTS patients were collected and surgical indications,nerve conduction velocity,upper limb function and the incidence of complications were compared between the two groups.Results The total effective rate was 98.00％in the observation group and 84.00％in the control group(P＜0.05).In the observation group,the length of incision was(1.65±0.29)cm,the time of opening and closing incision was(4.85±1.02)min,the hospitalization time was(3.24±0.62)d,the intraoperative blood loss was(17.88±3.53)mL,and the VAS score was(3.03±0.56)points one day after operation.The control group were(4.02±0.81)cm,(10.06±2.28)min,(7.11±1.34)d,(24.37±5.27)ml,(4.04± 0.89)points,the differences were statistically significant(P＜0.05).After treatment,The thumle-wrist sensory conduction velocity of CTS patients in the study group was(46.05±8.39)m/s,the middle finger-wrist sensory conduction velocity was(45.05±8.95)m/s,the thenar muscles-wrist motor conduction velocity was(53.94±11.47)m/s,the FIM ADL score was(34.38±7.22)points,and FMA The upper limb score was(34.23±7.25)points,and the control group was(41.86±8.22)m/s,(40.88±8.28)m/s,(49.05±10.01)m/s,(27.81±6.01)points,(41.05±9.19)points.The difference between the two groups was statistically significant(P＜0.05).The total incidence of complications was 4.00％in the observation group and 20.00％in the control group(P＜0.05).Conclusion Small incision in situ release is effective in the treatment of CTS patients,which can improve the surgical indications and nerve conduction velocity,help patients recover upper limb function,and reduce the incidence of postoperative complications.

Objective Comparison of therapeutic effects between retrograde island flap of the intrinsic artery and dorsal perforator island flap for repairing skin defects at the distal phalanx of the finger.Methods A total of 128 patients with skin defects at the distal phalanx of the finger were enrolled from August 2020 to September 2022 at Huai'an Second People's Hospital.These patients had 128 affected fingers.Using a random number table,they were divided into two groups:collateral group(64 case)and dorsal branch group(64 case).The collateral group underwent retrograde island flap surgery using the intrinsic artery,while the dorsal branch group underwent repair surgery using the dorsal perforator island flap of the intrinsic artery.Surgical time and intraoperative blood loss were recorded.Follow-up was conducted for 12 months postoperatively,evaluating graft survival rate,finger joint function,sensory function of the transplanted flap at the distal phalanx,degree of wound scar,and postoperative complications.Results The surgical time for the collateral branch group and the dorsalis branch group was(50.03±12.41)minutes and(54.78±15.65)minutes,respectively.The intraoperative blood loss was(22.65±10.03)ml in the collateral branch group and(26.52±12.61)ml in the dorsalis branch group.There was no statistically significant difference in surgical time or intraoperative blood loss between the two groups(P＞0.05).At the 12-month follow-up,all patients in both groups had normal healing of the distal defect,and the success rate of flap transplantation was 100.00％in both groups.There was no statistically significant difference between the groups in terms of flap transplantation success rate(P＞0.05).At the 12-month postoperative period,the Vancouver Scar Scale(VSS)score was(3.15±0.69)in the collateral branch group and(3.17±0.62)in the dorsalis branch group,with no statistically significant difference between the two groups(P＞0.05).The Tangibility,Appearance,and Mobility(TAM)score was(9.71±0.65)in the collateral branch group and(10.93±0.71)in the dorsalis branch group.The TAM score was significantly lower in the collateral branch group compared to the dorsalis branch group(P＜0.05).The two-point discrimination of the flaps was(8.93±2.05)mm in the collateral branch group and(7.51±1.64)mm in the dorsalis branch group.The two-point discrimination was significantly higher in the collateral branch group compared to the dorsalis branch group(P＜0.05).There were 2 cases of venous reflux disorder and 1 case of cold intolerance in the collateral branch group,while no complications occurred in the dorsalis branch group.There was no statistically significant difference in complications between the two groups(P＞0.05).Conclusion Compared to the reverse island flap repair using the intrinsic arterial system,the dorsal island flap repair using the intrinsic arterial system for treating distal skin defects of the finger provides better postoperative functional recovery of the finger and relatively lower risk of venous congestion.

Recently, the situation of the preventing and controlling of the novel coronavirus infection has changed. After patients with mental disorders are infected with the new coronavirus (hereinafter referred to as the new coronavirus), they will face the following problems: whether the drugs related to the new coronavirus infection can be used at the same time as the psychiatric drugs, and whether there will be pharmacokinetic or pharmacodynamic interactions between the medicines How to avoid the safety risks brought by drug interactions? Focusing on the above issues, this article puts forward some suggestions based on the summary of existing evidence, hoping to help front-line doctors.

Recently, the situation of the preventing and controlling of the novel coronavirus infection has changed. After patients with mental disorders are infected with the new coronavirus (hereinafter referred to as the new coronavirus), they will face the following problems: whether the drugs related to the new coronavirus infection can be used at the same time as the psychiatric drugs, and whether there will be pharmacokinetic or pharmacodynamic interactions between the medicines How to avoid the safety risks brought by drug interactions? Focusing on the above issues, this article puts forward some suggestions based on the summary of existing evidence, hoping to help front-line doctors.

We constructed different N-terminal truncated variants based on Bacillus acidopullulyticus pullulanase 3D structure (PDB code 2WAN), and studied the effects of truncated mutation on soluble expression, enzymatic properties, and application in saccharification. Upon expression, the variants of X45 domain deletion existed as inclusion bodies, whereas deletion of CBM41 domain had an effective effect on soluble expression level. The variants that lack of CBM41 (M1), lack of X25 (M3), and lack both of CBM41 and X25 (M5) had the same optimal pH (5.0) and optimal temperature (60 degrees C) with the wild-type pullulanase (WT). The K(m) of M1 and M5 were 1.42 mg/mL and 1.85 mg/mL, respectively, 2.4- and 3.1-fold higher than that of the WT. k(cat)/K(m) value of M5 was 40% lower than that of the WT. Substrate specificity results show that the enzymes exhibited greater activity with the low-molecular-weight dextrin than with high-molecular-weight soluble starch. When pullulanases were added to the saccharification reaction system, the dextrose equivalent of the WT, M1, M3, and M5 were 93.6%, 94.7%, 94.5%, and93.1%, respectively. These results indicate that the deletion of CBM41 domain and/or X25 domain did not affect the practical application in starch saccharification process. Furthermore, low-molecular-weight variants facilitate the heterologous expression. Truncated variants may be more suitable for industrial production than the WT.
Bacillus ; enzymology ; Glycoside Hydrolases ; metabolism ; Molecular Weight ; Protein Conformation ; Sequence Deletion ; Substrate Specificity ; Temperature

Objective To explore the effects of VEGF/bFGF sustained release microspheres combined with hyperbaric oxygen therapy on survival rates of uhralong random pattern flaps in rats.Methods Modified McFarlane flap rat models were randomly divided into 4 groups,VEGF/bFGF microspheres + hyperbaric oxygen group,VEGF/bFGF microspheres group,hyperbaric oxygen group and control group.At the end of 7 days,survival rates of flaps were calculated (Survival rate =Survival area/total area × 100％).The tissue samples were taken from middle portion of flaps to detect the neovascularization.Immunohistochemistry was used to detect the differential expression of VEGF.Results Seven days after the random pattern flap operation in rats,the survival rates of VEGF/bFGF microspheres combined with hyperbaric oxygen therapy experimental group,VEGF/bFGF microspheres experimental group,hyperbaric oxygen therapy experimental group,and control group were (89.54 ± 3.23) ％,(73.54 ± 4.57) ％,(71.89 ± 2.26) ％,(50.36 ± 2.37) ％ respectively.The neovascularization counts of each group in part Ⅱ were (35.14 ± 4.21)/mm2,(23.34 ± 2.53)/mm2,(25.22 ±2.73)/mm2 and (17.37 ± 5.73)/mm2 respectively.VEGF cumulative absorbance in VEGF/bFGF microspheres + hyperbaric oxygen group,VEGF/bFGF microspheres group,hyperbaric oxygen group and control group were 78.39 ± 9.12,52.42 ± 13.59,49.84 ± 12.93,29.24 ± 10.35 respectively.In each experimental result group,there were significant difference between the combination group and the other groups (F =189.956,P ＜ 0.05),but there was no significant difference between VEGF/bFGF microspheres experimental group and hyperbaric oxygen therapy experimental group.Conclusion VEGF/bFGF sustained release microspheres combined with hyperbaric oxygen therapy can promote flap neovascularization,increase the flap blood supply and then improve the survival of random pattern skin flaps.

Objective To explore the histological changes of the wrist interosseous ligaments after radiofrequency electrothermal shrinkage. Methods Six frozen fresh male adult cadaver wrist ligaments were exploited for the research. The ligaments of the right wrists were treated with radiofrequency electrothermal shrinkage with Arthrocare system, while the ligaments of the left wrists were kept as the normal control. The bone-ligament-hone samples of all the scapholunate (SL) and lunotriquetral (LT) ligaments were prepared, sectioned and then stained with the regular HE staining, toluidine blue staining, Sirius-red staining and immunohistochemistry staining of collagen Ⅲ. The image analysis software was used to compare the staining results. Results The histological structures of SL dorsal ligaments (SL-d) and LT volar ligaments (LT-v) were very similar, and the structures of SL volar ligaments (SL-v) and LT dorsal ligaments (LT-d) were also very similar. The membrane parts of both SL and LT ligaments showed the fibrous cartilage structure. The histological structures of SL-d and LT-v were much less destroyed by the radiofrequency than those of SL-v and LT-d. After radiofrequency electrothermal shrinkage, only the distribution areas of collagen Ⅰ and collagen Ⅲ were significantly changed in the membrane parts of SL and LT ligaments. Conclusion Radiofrequency electrothermal shrinkage treatment can cause minor structural damage to the collagen-dominant ligaments such as SL-d and LT-v, while it can lead to quite severe structural damage to the ligaments containing collagen and lots of loose connective tissue, such as SL-v and LT-d.

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.
Adolescent ; Adult ; Follow-Up Studies ; Fractures, Bone ; classification ; surgery ; therapy ; Hamate Bone ; injuries ; surgery ; Humans ; Male ; Retrospective Studies ; Young Adult