OBJECTIVE: To summarize the methods of ankle hinge position design in the correction of clubfoot deformity by Ilizarov method, and to explore its application value in the prevention of ankle dislocation. METHODS: A retrospective study was conducted including 28 patients with rigid clubfoot deformity (34 feet) who met the selection criteria and admitted between September 2021 and December 2024. There were 19 males and 9 females with an average age of 31.8 years (range, 19-47 years). According to Dimeglio classification, there were 21 feet of degree Ⅲ and 13 feet of degree Ⅳ. The causes were traumatic sequelae in 9 cases, congenital foot deformity in 15 cases, spina bifida sequelae in 1 case, peripheral neuropathy in 1 case, and cerebral palsy sequelae in 2 cases. The malformation lasted from 6 to 46 years, with an average of 29.3 years. All patients were treated with Ilizarov circular external fixator, and the hinge position of ankle joint was planned according to the standard lateral X-ray film of foot and ankle and the principle of Ilizarov limb deformity correction center of rotation angulation (CORA) before operation. The 2008 International Clubfoot Study Group (ICFSG) scoring system was used to evaluate the efficacy. RESULTS: The deformity of rigid clubfoot was completely corrected in all patients, and the patients could walk with plantar weight-bearing, and the ankle weight-bearing walking significantly improved when compared with that before operation. There was no complication such as ankle dislocation, talus impact or extrusion, local skin necrosis, needle tract infection, or numbness of extremities during the correction process. All patients were followed up 5-39 months, with an average of 18.1 months. At last follow-up, according to the ICFSG scoring system, 23 feet were excellent, 10 feet were good, and 1 foot was fair, and the excellent and good rate was 97%. CONCLUSION Designing the position of the ankle hinge according to the principle of CORA can effectively avoid ankle dislocation, talus impingement, tibiotalar joint extrusion, and other ankle adverse events in the process of correcting clubfoot deformity, which has good application value in clinical practice.
Humans ; Male ; Female ; Clubfoot/diagnostic imaging* ; Ilizarov Technique/instrumentation* ; Adult ; Retrospective Studies ; External Fixators ; Ankle Joint/diagnostic imaging* ; Middle Aged ; Joint Dislocations/prevention & control* ; Treatment Outcome ; Young Adult

Objective:To investigate the clinical effectiveness of autologous hamstring tendon reconstruction with preserved synovial sheath combined with remnant suture in the treatment of anterior cruciate ligament (ACL) tears.Methods:A retrospective study was conducted to analyze the clinical data of 38 patients with ACL tear who had been admitted to Department of Sports Medicine, The Fourth Hospital of Wuhan from January 2016 to July 2020. There were 30 males and 8 females, with an age of (25.4±7.2) years. By the typing of MRI Sherman tear locations (MSTL) for anterior cruciate ligament, 7 cases were Type I and 31 cases type II. A total of 18 patients underwent single bundle reconstruction of autologous hamstring tendon combined with remnant suture (group A), and the other 20 patients underwent conventional reconstruction to clean the synovial sheath of ACL (group B). The operation time,Tenger scores, Lysholm scores, International Knee Documentation Committee (IKDC) subjective score and side-to-side differences in relaxation at pre- operation, 1 year and 2 years after operation, as well as ACL healing of the affected knee at 2 years after operation, were observed and compared between the 2 groups. The graft synovial coverage was evaluated by secondary arthroscopy in some cases.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (38.5±8.4) months. No surgical site infection or knee stiffness occurred in the 2 groups after operation, and 2 patients in each group developed intermuscular venous thrombosis at a lower limb. There was no significant difference in operation time between the 2 groups ( P>0.05). There were significant differences in Tenger score [(6.3±1.6) points versus (4.7±1.7) points], Lysholm score [(93.4±4.2) points versus (85.9±4.3) points] and IKDC subjective score [(89.1±2.9) points versus (81.2±2.9) points] between group A and group B at 1 year after operation ( P<0.05), but there was no significant difference in Tenger score, Lysholm score or IKDC subjective score between the 2 groups at 2 years after operation ( P>0.05). There was no significant difference in side-to-side difference in relaxation between the 2 groups at 1 year or 2 years after operation ( P>0.05). MRI evaluation at 2 years after operation showed no recurrent rupture or no sign of impingement between the graft and the intercondylar fossa in either group. Conventional secondary arthroscopy for 2 patients in group A and 3 patients in group B revealed better synovial coverage in group A. Conclusion:In the treatment of ACL tears of MSTL types I and II, compared with conventional reconstruction to clean the synovial sheath of ACL, autologous hamstring tendon reconstruction with preserved synovial sheath combined with remnant suture can lead to better functional recovery at 1 year after operation, though there is no significant difference in function at 2 years after operation.

BackgroundChildhood represents a critical stage for cognitive development. Accurate assessment of children's cognitive abilities and understanding their developmental characteristics are essential for promoting healthy growth. However， traditional cognitive assessment methods typically rely on manual administration， presenting limitations such as low efficiency and insufficient engagement. These methods struggle to meet the assessment needs of children and are difficult to scale up for large-scale applications. ObjectiveTo develop a digital cognitive assessment tool for children， so as to provide a more convenient approach for evaluating children's cognitive functions. MethodsBased on classic psychological paradigms （Stroop Task， N-back， digit span， spatial orientation， and face-name matching）， a digital cognitive assessment tool was developed. This tool includes five tasks including color matching， shape matching， greening the home， great collector， and face-name matching， designed to assess core cognitive functions such as inhibitory control， working memory， short-term memory， spatial orientation， and semantic processing， respectively. From August 2024 to March 2025， a total of 750 students aged 9–12 yeas old from a primary school in Chengdu were enrolled and assessed using the digital cognitive assessment tool. Three months later， 40 children were randomly selected for retesting using both the digital tool and its corresponding standardized psychological paradigms. Pearson correlation analysis was conducted to examine the correlation between the pre-test and retest scores of the digital cognitive assessment tool， as well as the correlation between the digital cognitive task scores and the corresponding psychological paradigm assessment results， in order to evaluate the reliability and validity of the digital cognitive assessment tool. Additionally， differences in scores across the cognitive tasks were compared among children of different age groups and genders. ResultsA total of 699 valid samples were included. The younger age group consisted of children aged 9–10 years old （n=460）， while the older age group comprised those aged 11–12 years old （n=239）. There were 356 boys （50.93%） and 343 girls （49.07%）. In the reliability analysis， the Pearson correlation coefficients between the pre-test and retest scores of each assessment task ranged from 0.732 to 0.970 （P<0.01）， indicating statistically significant results. In the validity analysis， the Pearson correlation coefficients between each task and its corresponding standard cognitive test ranged from 0.679 to 0.988 （P<0.01）. In the color-matching task， both the main effects of age and gender were statistically significant （F=31.071， 21.198， P<0.01）. In the shape-matching task， the main effects of age， gender， and their interaction were all statistically significant （F=20.933， 5.926， 4.318， P<0.05 or 0.01）. In the greening the home task， the main effect of age was significant （F=5.243， P=0.023）. In the great collector task， the main effect of age was significant （F=33.697， P<0.01）. In the face-name matching task， only the main effect of gender was significant （F=27.016， P<0.01）. Further analysis showed that within the female group， older group scored significantly higher than younger group in five tasks（P<0.05 or 0.01）. Within the male group， younger group scored lower than older group in both the color-matching and great collector tasks （P<0.05 or 0.01）. Within the younger group， boys scored significantly higher than girls in color-matching and shape-matching tasks （P<0.01）. In the older group， girls scored significantly higher than boys in face-name matching task （P<0.01）. ConclusionThe digital cognitive assessment tool developed in this study demonstrates good reliability and validity. The development of cognitive functions in children aged 9–12 years old showed significant differences in age and gender， with specific developmental trajectories across different cognitive dimensions. At younger ages， boys outperformed girls in inhibitory control and working memory tasks， though this advantage diminished with age. At older ages， girls exhibited superior performance in semantic processing compared with boys.

Objective To investigate the therapeutic effects of copper-doped barium titanate(BaCuTiO4)piezoelectric materials combined with low-intensity pulsed ultrasound(LIPUS)to activate their piezoelectric-catalytic synergistic effect for treating implant-associated infections.Methods BaCuTiO4 coatings were synthesized on the surface of Ti-6Al-4V substrates using a hydrothermal method,and their surface morphology was characterized by scanning electron microscopy.The piezoelectric characteristics of the coatings were analyzed using a piezoresponse force microscope.An in vitro biofilm model of methicillin-resistant staphylococcus aureus(MRSA)was used,with barium titanate(BaTiO3)coatings serving as the control group.Under LIPUS intervention(1.0 W/cm2,1 MHz,10 min),the bacterial viability was assessed using colony counting to evaluate the antibacterial performance of the BaCuTiO4 coatings.Confocal microscopy was used to observe biofilm viability in different groups,assessing the biofilm removal capability of the coatings.Reactive oxygen species(ROS)generation in each group was detected using Rhodamine b as a probe to evaluate the catalytic efficiency of the coatings in generating ROS.Results Copper doping significantly reduced the piezoelectric coefficient of the coating(from 17.7 pm/V to 7.8 pm/V),bringing its piezoelectric performance closer to the requirements of natural bone tissues.Under LIPUS activation,the BaCuTiO4 coatings increased the generation efficiency of reactive oxygen species by 67.5％and effectively disrupted and removed biofilms formed by MRSA,achieving an antibacterial rate of 90.5％.Conclusions The BaCuTiO4 coatings achieve efficient antibacterial and biofilm-clearing functions through a piezoelectric-catalytic synergistic mechanism.Their piezoelectric properties are well-matched with natural bone tissues,promoting implant osseointegration.

Objective To investigate the therapeutic effects of copper-doped barium titanate(BaCuTiO4)piezoelectric materials combined with low-intensity pulsed ultrasound(LIPUS)to activate their piezoelectric-catalytic synergistic effect for treating implant-associated infections.Methods BaCuTiO4 coatings were synthesized on the surface of Ti-6Al-4V substrates using a hydrothermal method,and their surface morphology was characterized by scanning electron microscopy.The piezoelectric characteristics of the coatings were analyzed using a piezoresponse force microscope.An in vitro biofilm model of methicillin-resistant staphylococcus aureus(MRSA)was used,with barium titanate(BaTiO3)coatings serving as the control group.Under LIPUS intervention(1.0 W/cm2,1 MHz,10 min),the bacterial viability was assessed using colony counting to evaluate the antibacterial performance of the BaCuTiO4 coatings.Confocal microscopy was used to observe biofilm viability in different groups,assessing the biofilm removal capability of the coatings.Reactive oxygen species(ROS)generation in each group was detected using Rhodamine b as a probe to evaluate the catalytic efficiency of the coatings in generating ROS.Results Copper doping significantly reduced the piezoelectric coefficient of the coating(from 17.7 pm/V to 7.8 pm/V),bringing its piezoelectric performance closer to the requirements of natural bone tissues.Under LIPUS activation,the BaCuTiO4 coatings increased the generation efficiency of reactive oxygen species by 67.5％and effectively disrupted and removed biofilms formed by MRSA,achieving an antibacterial rate of 90.5％.Conclusions The BaCuTiO4 coatings achieve efficient antibacterial and biofilm-clearing functions through a piezoelectric-catalytic synergistic mechanism.Their piezoelectric properties are well-matched with natural bone tissues,promoting implant osseointegration.

Objective:To investigate the clinical effectiveness of autologous hamstring tendon reconstruction with preserved synovial sheath combined with remnant suture in the treatment of anterior cruciate ligament (ACL) tears.Methods:A retrospective study was conducted to analyze the clinical data of 38 patients with ACL tear who had been admitted to Department of Sports Medicine, The Fourth Hospital of Wuhan from January 2016 to July 2020. There were 30 males and 8 females, with an age of (25.4±7.2) years. By the typing of MRI Sherman tear locations (MSTL) for anterior cruciate ligament, 7 cases were Type I and 31 cases type II. A total of 18 patients underwent single bundle reconstruction of autologous hamstring tendon combined with remnant suture (group A), and the other 20 patients underwent conventional reconstruction to clean the synovial sheath of ACL (group B). The operation time,Tenger scores, Lysholm scores, International Knee Documentation Committee (IKDC) subjective score and side-to-side differences in relaxation at pre- operation, 1 year and 2 years after operation, as well as ACL healing of the affected knee at 2 years after operation, were observed and compared between the 2 groups. The graft synovial coverage was evaluated by secondary arthroscopy in some cases.Results:There was no significant difference in the preoperative general data between the 2 groups, indicating comparability ( P>0.05). All patients were followed up for (38.5±8.4) months. No surgical site infection or knee stiffness occurred in the 2 groups after operation, and 2 patients in each group developed intermuscular venous thrombosis at a lower limb. There was no significant difference in operation time between the 2 groups ( P>0.05). There were significant differences in Tenger score [(6.3±1.6) points versus (4.7±1.7) points], Lysholm score [(93.4±4.2) points versus (85.9±4.3) points] and IKDC subjective score [(89.1±2.9) points versus (81.2±2.9) points] between group A and group B at 1 year after operation ( P<0.05), but there was no significant difference in Tenger score, Lysholm score or IKDC subjective score between the 2 groups at 2 years after operation ( P>0.05). There was no significant difference in side-to-side difference in relaxation between the 2 groups at 1 year or 2 years after operation ( P>0.05). MRI evaluation at 2 years after operation showed no recurrent rupture or no sign of impingement between the graft and the intercondylar fossa in either group. Conventional secondary arthroscopy for 2 patients in group A and 3 patients in group B revealed better synovial coverage in group A. Conclusion:In the treatment of ACL tears of MSTL types I and II, compared with conventional reconstruction to clean the synovial sheath of ACL, autologous hamstring tendon reconstruction with preserved synovial sheath combined with remnant suture can lead to better functional recovery at 1 year after operation, though there is no significant difference in function at 2 years after operation.

OBJECTIVE: To summarize the research progress on the role of macrophage-mediated osteoimmune in osteonecrosis of the femoral head (ONFH) and its mechanisms. METHODS: Recent studies on the role and mechanism of macrophage-mediated osteoimmune in ONFH at home and abroad were extensively reviewed. The classification and function of macrophages were summarized, the osteoimmune regulation of macrophages on chronic inflammation in ONFH was summarized, and the pathophysiological mechanism of osteonecrosis was expounded from the perspective of osteoimmune, which provided new ideas for the treatment of ONFH. RESULTS: Macrophages are important immune cells involved in inflammatory response, which can differentiate into classically activated type (M1) and alternatively activated type (M2), and play specific functions to participate in and regulate the physiological and pathological processes of the body. Studies have shown that bone immune imbalance mediated by macrophages can cause local chronic inflammation and lead to the occurrence and development of ONFH. Therefore, regulating macrophage polarization is a potential ONFH treatment strategy. In chronic inflammatory microenvironment, inhibiting macrophage polarization to M1 can promote local inflammatory dissipation and effectively delay the progression of ONFH; regulating macrophage polarization to M2 can build a local osteoimmune microenvironment conducive to bone repair, which is helpful to necrotic tissue regeneration and repair to a certain extent. CONCLUSION At present, it has been confirmed that macrophage-mediated chronic inflammatory immune microenvironment is an important mechanism for the occurrence and development of ONFH. It is necessary to study the subtypes of immune cells in ONFH, the interaction between immune cells and macrophages, and the interaction between various immune cells and macrophages, which is beneficial to the development of potential therapeutic methods for ONFH.
Humans ; Femur Head/pathology* ; Osteonecrosis/therapy* ; Macrophages/pathology* ; Inflammation ; Femur Head Necrosis/pathology*

Objective To evaluate the safety and effectiveness of endoscopic mucosal resection with circumferential incision(EMR-CI)and endoscopic submucosal dissection(ESD)for the rectal neuroendocrine neoplasm(RNEN).Methods Databases such as PubMed,the Cochrane Library,Embase,Web of Science,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang Data and Weipu database were searched by computer.The retrieval time limit was Nov.22,2022.The Chinese and English literatures on the efficacy of EMR-CI vs ESD in treatment of RNEN patients were collected.According to inclusion and exclusion criteria,the included literatures were screened,extracted data,and evaluated the methodological quality by Newcastle-Ottawa scale(NOS),Meta-analysis was performed using Rev Man 5.3 software.Results Seven clinical control studies were included,including 199 cases in the EMR-CI group and 443 cases in the ESD group.Results of Meta-analysis of validity outcome indicators,there was no significant difference in histological complete resection rate between the EMR-CI group and the ESD group(O(R) = 0.56,95%CI:0.30～1.02,P = 0.060);The endosopic complete resection rate of EMR-CI was similar to that of ESD with no significant difference(O(R) = 0.33,95%CI:0.09～1.17,P = 0.090);The size of lesions removed by EMR-CI was smaller than that of ESD with significant difference(WMD =-0.86,95%CI:-1.33～-0.40,P = 0.000);The time EMR-CI required to remove the lesion was significantly shorter than that of ESD(WMD =-12.48,95%CI:-16.42～-8.54,P = 0.000).The positive rate of horizontal resection margin of EMR-CI was similar to that of ESD,with no significant difference(O(R) = 1.74,95%CI:0.64～4.75,P = 0.280);The positive rate of vertical resection margin was significantly higher than that of ESD(O(R) = 2.41,95%CI:1.09～5.32,P = 0.030).Due to the low local recurrence rate and distant metastasis rate,Meta-analysis couldn't be compared.Safety outcome index showed that,there were no significant differences in the incidence of total complications,bleeding and perforation among groups.Conclusion In the treatment of RNEN,EMR-CI can achieve the endosopic complete resection,histological complete resection and positive rate of horizontal resection margin similar to ESD without increasing surgical complications and significantly saving surgical time.However,attention should be paid to the differences between EMR-CI and ESD in positive rate of vertical resection margin.

【Objective】 To explore the effects of insulin on the QT interval and induced arrhythmias of cardiomyocytes derived from human induced pluripotent stem cells （hiPSC-CMs）. 【Methods】 Immunofluorescence staining and flow cytometry were used to analyze the purity of hiPSC-CMs. Microelectrode array （MEA） was utilized to detect the electrophysiological changes including heart rate （HR）， field potential duration （FPD， which is similar to QT interval in ECG）， FPDc （FPD corrected by HR）， conduction velocity （CV）， and spike amplitude before and after insulin treatment. The effects of E4031 on QT interval prolongation and induced arrhythmias of hiPSC-CMs were evaluated before and after treatment with insulin. 【Results】 hiPSC-CMs highly expressed myocardial specific marker cTnT. The purity of hiPSC-CMs was 97.1%. After 5-day insulin treatment of hiPSC-CMs， HR increased by （11.9±3.3）%， FPD shortened by （22.7±2.8）%， FPDc shortened by （15.6±1.6）%， and spike amplitude increased by （39.1±7.9）% when compared with untreated group， but CV remained unchanged. 10 nmol/L of E4031 could prolong the FPDc of hiPSC-CMs by （37.8±9.0）%， and 30 nmol/L of E4031 could induce arrhythmias. After insulin treatment， 10 nmol/L of E4031 prolonged the FPDc of hiPSC-CMs by （21.8±3.1）% （compared with the untreated group， insulin decreased FPDc prolongation by E4031， 37.8%±9.0% vs. 21.8%±3.1%， P<0.05）， while 30 nmol/L of E4031 did not induce arrhythmias. 【Conclusion】 Insulin can shorten the QT interval of hiPSC-CMs and significantly reduce the QT interval prolongation and the risk of arrhythmias induced by drugs.

Based on the requirements of military professional education reform and in view of the problems existing in the operation and maintenance of first-aid medical equipment in grass-roots forces. We put forward a construction scheme of online course which named operation and maintenance of first-aid medical equipment in grass-roots forces, and then expound the scheme from teaching content construction and teaching mode construction. The teaching content construction consists of two parts: the management theory of conventional medical equipments and the operation and maintenance teaching of specific first-aid medical equipments. In the construction of teaching mode, we elaborate on the organization forms of teaching, answering questions, training and examination units in detail. The design scheme of the online course is in line with the learning characteristics and meets the demand of learning the knowledge of the operation and maintenance of first-aid medical equipment systematically, so as to improve the post competency of the grass-roots forces.