OBJECTIVE: To compare the difference in forefoot width between minimally invasive extra-articular osteotomy via small incision and traditional Chevron osteotomy in the treatment of hallux valgus. METHODS: A retrospective analysis was conducted on the clinical data of 45 patients with hallux valgus between April 2019 and July 2022. Among them, 22 cases underwent minimally invasive extra-articular osteotomy via small incision (minimally invasive group), and 23 cases underwent traditional Chevron osteotomy (traditional group). There was no significant difference in the baseline data between the two groups ( P>0.05), including gender, age, affected side, Mann classification of hallux valgus, disease duration, and preoperative intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), bony forefoot width, soft tissue forefoot width, osteophyte width, and American Orthopaedic Foot and Ankle Society (AOFAS) score. The osteotomy healing time and the occurrence of complications in the two groups were recorded. The differences between pre- and post-operation (changes) in various imaging indicators and AOFAS scores in the two groups were calculated. And the bony forefoot width and soft tissue forefoot width at 1, 6, and 12 months after operation were also recorded and compared between the two groups. RESULTS: One case of skin injury occurred during operation in the minimally invasive group, while 3 cases of poor wound healing occurred after operation in the traditional group. None of the patients experienced infections, nerve injuries, or other complications. All patients were followed up 12-31 months (mean, 22.5 months). The osteotomy healed in the two groups and no significant difference in healing time between the two groups was found ( P>0.05). The IMA, HVA, DMAA, osteophyte width, and AOFAS score at 12 months after operation significantly improved compared to those before operation ( P<0.05). There was no significant difference between the two groups in the changes of IMA, HVA, and osteophyte width ( P>0.05). However, the differences in the changes of AOFAS score and DMAA were significant ( P<0.05). There was no significant difference between the two groups in bony and soft tissue forefoot widths at different time points after operation ( P>0.05). However, there were significant differences in the two groups between the pre- and post-operation ( P<0.05). CONCLUSION The minimally invasive extra-articular osteotomy via small incision for hallux valgus, despite not removing the medial osteophyte of the first metatarsal, can still effectively improve the forefoot width and osteophyte width. While correcting the IMA and HVA, it can more effectively restore the DMAA, resulting in better AOFAS scores.
Humans ; Hallux Valgus/surgery* ; Osteotomy/methods* ; Male ; Female ; Minimally Invasive Surgical Procedures/methods* ; Retrospective Studies ; Middle Aged ; Forefoot, Human/pathology* ; Adult ; Treatment Outcome ; Aged

Objective To investigate the current status of occupational protection behaviors of nurses in pharmacy intravenous drug admixture service (hereinafter referred to as "PIVAS") and its association with occupational exposure to hazardous drugs. Methods A total of 312 PIVAS nurses from 10 tertiary-A hospitals in Xi'an City were selected as the research subjects using the convenience sampling method. Their occupational exposure to hazardous drugs was investigated, and their occupational protection behaviors were assessed using the "Nurse Occupational Protection Behavior Questionnaire". Results The rate of occupational exposure to hazardous drugs of PIVAS nurses was 40.1% (125/312), and their score for occupational protection behaviors was (77.7±9.3) points. The results of binary logistic regression analysis showed that educational level, length of service, workload, dispensing environment, drug packaging, and occupational protection behaviors were influencing factors for the occupational exposure in PIVAS nurses (all P<0.05). Conclusion The incidence of occupational exposure to hazardous drugs among PIVAS nurses in Xi'an City is relatively high. It is necessary to strengthen training on knowledge of occupational protection behavior to reduce occupational exposure.

Objective To observe the correlations of chest CT quantitative parameters in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with blood eosinophil(EOS)level.Methods Chest CT data of 162 AECOPD patients with elevated eosinophils were retrospectively analyzed.The patients were divided into low EOS group(n=105)and high EOS group(n=57)according to the absolute counting of blood EOS.The quantitative CT parameters,including the number of whole lung bronchi and the volume of blood vessels,low-attenuation area percentage(LAA％)of whole lung,of left/right lung and each lobe of lung,as well as the luminal diameter(LD),wall thickness(WT),wall area(WA)and WA percentage of total bronchial cross-section(WA％)of grade 3 to 8 bronchi were compared between groups.Spearman correlations were performed to analyze the correlations of quantitative CT parameters with blood EOS level.Results LAA％of the whole lung,of the left/right lung and each lobe of lung,as well as of the upper lobe of right lung LDgrade4,middle lobe of right lung WTgrade5,upper lobe of right lung WAgrade4,middle lobe of right lung WAgrade5 and lower lobe of left lung WAgrade3 in low EOS group were all higher than those in high EOS group(all P＜0.05).Except for the upper lobe of right lung LDgrade4,the above quantitative CT indexes being significant different between groups were all weakly and negatively correlated with blood EOS level(r=-0.335 to-0.164,all P＜0.05).Conclusion Chest CT quantitative parameters of AECOPD patients were correlated with blood EOS level,among which LAA％,a part of WT and WA were all weakly negatively correlated with blood EOS level.

Esketamine,which was recently intro-duced in China,is a type of intravenous general an-esthetic that is widely used in clinical practice for general anesthesia and anti-depression therapy.Studies have found that esketamine can be safely used to intrathecally produce analgesic,sedative,and anti-depressive effects at subanesthetic doses.This review summarizes the mechanism of action,safety,adverse reactions,and various clinical appli-cations of esketamine intrathecally,so as to pro-vide relevant references for further research.

With rapid development of information technology,blended teaching model has gradually become mainstream teaching model in most colleges and universities.How to evaluate students'learning effect and analyze factors that affect students'per-formance is a key research direction of this teaching model.Taking blended teaching of Medical Immunology course in Xinxiang Medical University as an example,this paper introduces implementation process and evaluation system of blended teaching,analyzes main factors affecting students'performance and learning effect,and focuses on discussing influence of formative evaluation and"flipped classroom"on students'academic performance.

Both cholinergic dysfunction and protein citrullination are the hallmarks of rheumatoid arthritis (RA), but the relationship between the two phenomena remains unclear. We explored whether and how cholinergic dysfunction accelerates protein citrullination and consequently drives the development of RA. Cholinergic function and protein citrullination levels in patients with RA and collagen-induced arthritis (CIA) mice were collected. In both neuron-macrophage coculture system and CIA mice, the effect of cholinergic dysfunction on protein citrullination and expression of peptidylarginine deiminases (PADs) was assessed by immunofluorescence. The key transcription factors for PAD4 expression were predicted and validated. Cholinergic dysfunction in the patients with RA and CIA mice negatively correlated with the degree of protein citrullination in synovial tissues. The cholinergic or alpha7 nicotinic acetylcholine receptor (α7nAChR) deactivation and activation resulted in the promotion and reduction of protein citrullination in vitro and in vivo, respectively. Especially, the activation deficiency of α7nAChR induced the earlier onset and aggravation of CIA. Furthermore, deactivation of α7nAChR increased the expression of PAD4 and specificity protein-3 (SP3) in vitro and in vivo. Our results suggest that cholinergic dysfunction-induced deficient α7nAChR activation, which induces the expression of SP3 and its downstream molecule PAD4, accelerating protein citrullination and the development of RA.

ObjectiveAn analytical method was developed for the qualitative screening of 52 illegally adulterated weight-losing compounds in foods by ultra high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry. MethodsThe samples were extracted by methanol. Waters CORTECS T3 column （100 mm×2.1 mm， 2.7 μm） was used with acetonitrile -0.1% formic acid aqueous solution as mobile phases by gradient elution. The compounds were detected by electrospray ionization mass spectrometry and Q-TOF-MS detector in positive and negative ion mode. A standard spectrum library was established by reference standards， and the qualitative analysis was finished by the comparison of the retention time， parent ion and fragment ion accurate molecular mass of each compound in the sample and the library. ResultsThe method was specific without interference of blank matrix， and repeatable in sextuplicate. The detection limits of 52 compounds in 5 matrix were 1‒100 mg‧kg^-1. The method was successfully applied to the analysis of actual samples，and 16 compounds were checked out in 246 samples. ConclusionThe method is accurate， specific and sensitive， which can be used to combat the illegal adulteration behavior effectively.

Objective:To explore the different values of minimal residual disease (MRD) detection by multiparameter flow cytometry (MFC) and real-time quantitative polymerase chain reaction (RQ-PCR) before hematopoietic stem cell transplantation (HSCT) for predicting relapse, leukemia-free survival (LFS) , and overall survival (OS) in Philadelphia chromosome-positive ALL (Ph + ALL) . Methods:A retrospective study ( n=280) was performed. MRD was determined using multiparameter flow cytometry and RQ-PCR. Results:MRD analysis with MFC and RQ-PCR of the BCR-ABL fusion transcript showed a strong correlation before transplantation. The positive rates of MRD detected by MFC and RQ-PCR before transplantation were 25.7% (72/280) and 60.7% (170/280) , respectively. MFC MRD-positive (MRDpos) Ph + ALL patients had a higher 3 year cumulative incidences of relapse (CIR) than did MFC MRD-negative (MRDneg) Ph + ALL patients (23.6% vs 8.6%; P<0.001) . However, the RQ-PCR MRDpos group had similar rates of 3 year OS, LFS, and NRM compared with those in the RQ-PCR MRDneg group. Moreover, patients with RQ-PCR MRD ≥1% experienced higher 3 year CIR (23.1% vs 11.4%; P=0.032) , lower LFS (53.8% vs 74.4%; P=0.015) , and OS (57.7% vs 79.1%; P=0.009) compared with the RQ-PCR MRD<1% group. Multivariate analyses confirmed the association of MFC MRD status and RQ-PCR MRD ≥1% with outcomes ( P<0.05) . The sensitivity, specificity, positive predictive value (PPV) , and negative predictive value (NPV) of MFC detection MRD to predict recurrence were 48.50%, 77.56%, 23.62%, and 87.16%, respectively. Moreover, the sensitivity, specificity, PPV, and NPV were 23.00%, 88.59%, 17.15%, and 91.84%, respectively, when RQ-PCR MRD ≥1% was used to predict recurrence. Additionally, the sensitivity, specificity, PPV, and NPV were 54.29%, 73.88%, 45.7% and 91.87%, respectively, when MRD-positive status before transplantation (MFC MRDpos or RQ-PCR MRD ≥1%) was used to predict recurrence after transplantation. Conclusions:Both MFC and RQ-PCR detection of pretransplant MRD levels can predict the prognosis of Ph + B-ALL patients receiving allogeneic HSCT. MFC MRD-positive status before transplantation is the risk factor of leukemia recurrence after transplantation. The combined use of the two methods (MFC MRDpos or RQ-PCR MRD ≥1%) can improve the sensitivity, PPV, and NPV of predicting recurrence and help to better screen high-risk patients for intervention, thereby improving clinical efficacy.

Objective:To investigate the value of minimal residual disease (MRD) in prediction of prognosis in acute lymphoblastic leukemia (ALL) patients with or above complete remission 2 (CR2) underwent.Methods:A retrospective analysis was performed on 201 ALL patients who received allogeneic stem cell transplantation (allo-SCT) and pretransplant disease status ≥CR2 in Peking University People′s Hospital from January 2009 to December 2018. MRD was measured by multi-parameter flow cytometry at 1 month before transplantation and 1 month, 2 months, 3 months, 4 months, 6 months, 9 months or 12 months after transplantation. To investigate the influence of dynamic changes of MRD before and after transplantation on prognosis.Results:201 ALL patients, including 126 males and 75 females, with a median age of 18 years. The 3-year cumulative incidence of relapse (CIR), non-relapse mortality (NRM), leukemia-free survival (LFS) and overall survival (OS) of all cases were 34%, 16%, 50%, and 56%, respectively. Positive pre-SCT MRD patients with higher 3-year CIR (47% vs 26%, P=0.003), lower 3-year LFS (40% vs 55%, P=0.047) and OS (42% vs 60%, P=0.065) than those with negative one. Subjects with positive post-MRD had higher 3-year CIR (73% vs 22%, P<0.001) and lower 3-year LFS (28% vs 56%, P=0.005) and OS (32% vs 60%, P=0.040) compared with those with negative one. Multivariate analysis showed that both pre-MRD and post-MRD were associated with higher CIR ( HR=1.823, P=0.018; HR=3.474, P<0.001), lower LFS ( HR=1.779, P=0.007; HR=2.185, P=0.001) and OS ( HR=1.609, P=0.034; HR=1.970, P=0.001). Negative pre-and post-SCT MRD group had lower 3-year CIR (17%, 42%, 82%; P<0.001) and higher 3-year LFS (61%, 44%, 18%; P<0.001) and OS (63%, 47%, 27%; P<0.001) compared with those unrisen post-SCT MRD group, and increased post-SCT MRD group. Multivariate analysis showed that pre-and post-SCT MRD dynamics were associated with CIR, LFS and OS ( P<0.01 for all) independently. The pre-and post-SCT MRD dynamics could better distinguish CIR (C=0.669) from that of pre-SCT MRD (C=0.587) and post-SCT MRD (C=0.629). Conclusion:Our data suggest that pre-SCT MRD, post-SCT MRD and the dynamic peri-SCT MRD could be used to predict transplant outcome of ALLpatients with or above CR2 who underwent allo-SCT.

Objective:To investigate the characteristics of posttraumatic stress disorder (PTSD) symptom and posttraumatic growth (PTG) in the patients with burns during rehabilitation, and the relationships among PTSD symptom, PTG, neuroticism and resilience.Methods:A cross-sectional study was carried out among 110 patients with burns during rehabilitation.The PTSD Check-list-Civilian Version (PCL-C), Posttraumatic Growth Inventory (PTGI), Five Factors Inventory-Neuroticism Subscale (FFI-N) and the 10-item Connor-Davidson Resilience Scale (CD-RISC) were used.Result:A significant effect of different groups of marital status (F=5.66, P=0.019), annual household income (F=7.97, P=0.006), and neuroticism (F=34.24, P＜0.001, Partial η2=0.259) on PCL-C scores.A significant effect of different groups of gender (F=6.44, P=0.013) and resilience (F=14.87, P＜0.001, Partial η2=0.132) were significant for PTG scores.There existed a significant interaction between neuroticism and resilience on PTG (F=4.47, P=0.037, Partial η2=0.044).Conclusion:Being married, low annual household income, and high levels of neuroticism were associated with high PTSD symptom levels.Being female and high levels of resilience were associated with high PTG levels.Resilience moderated the effect of neuroticism on PTSD symptoms.