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 specimen quality of intersphincteric resection with transabdominal transanal mixed approach for rectal cancer in the Chinese Transanal Total Mesorectal Excision Registry Collaborative (CTRC) database.Methods:The retrospective case-control study was conducted. Based on the concept of real-world research, the clinicopathological data of 281 pati-ents with rectal cancer in the CTRC database who underwent intersphincteric resection with trans-abdominal transanal mixed approach in 19 medical centers, including the Beijing Friendship Hospital of Capital Medical University et al, from November 15,2017 to December 31,2023 were collected. There were 196 males and 85 females, aged 61(range, 27-87)years. Observation indicators: (1) preoperative examinations; (2) neoadjuvant therapy; (3) postoperative examinations; (4) analysis of influencing factors for positive circumferential margin in surgical specimen of intersphincteric resec-tion for rectal cancer. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers or percentages. The chi-square test was used for univariate analysis. Logistic regression model was used for multivariate analysis. Results:(1) Preoperative examinations. Of the 281 patients, 234 cases underwent preoperative pelvic magnetic resonance imaging (MRI) examina-tion. There were 2 cases in clinical stage T0, 3 cases in clinical stage T1, 58 cases in clinical stage T2, 137 cases in clinical stage T3, 24 cases in clinical stage T4, 3 cases in clinical stage Tx, 7 cases missing clinical T staging data. There were 87 cases in clinical stage N0, 68 cases in clinical stage N1, 60 cases in clinical stage N2, 9 cases in clinical stage Nx, 10 cases missing clinical N staging data. There were 30 cases with mesorectal fascia invasion, 53 cases with extramural venous invasion. The distance from lower margin of tumor to anal margin was 41.9(range, 1.0-80.0)mm. (2) Neoadjuvant therapy. Of the 281 patients, 125 cases underwent neoadjuvant therapy, including 39 cases receiving chemo-therapy alone, 6 cases receiving short-course simultaneous chemoradiotherapy, 5 cases receiving short-course simultaneous chemoradiotherapy and delayed surgery, 48 cases receiving long-course simultaneous chemoradiotherapy, 2 cases receiving other treatments, and 25 cases missing neoadju-vant therapy data. (3) Postoperative examinations. Of the 281 patients, 249 cases achieved R 0 resection, 9 cases achieved R 1 resection, and there were 23 cases missing surgical margin data. The maximum tumor diameter, the number of lymph nodes harvested and positive rate of vessel carcinoma embolus were 30.0(range, 0.5-200.0)mm, 13(range, 0-70) and 27.55%(73/265) in 281 patients. There were 252 patients with circumferential margin records, showing positive in 15 cases, with a positive rate as 5.95%(15/252). The minimum distance from deep part of tumor to circumferential margin was 7.0(range, 0-150.0)mm in 252 patients. There were 85 cases with distal margin records, showing positive in 1 case, and the distance from lower margin of tumor to distal margin was 10.0(range, 0-202.0)mm. There were 273 patients with specimen integrity records, which showed intact specimen in 208 cases, fair specimen in 58 cases, poor specimen in 4 cases, unevaluated specimen in 3 cases. There were 7 cases with rectal perforation. Of the 281 patients, cases in pathological stage T0, Tis, T1, T2, T3, T4 were 14, 5, 22, 107, 113, 12, respectively, and there were 8 cases missing pathological T staging data. Of the 281 patients, cases in pathological stage N0, N1a, N1b, N1c, N2a, N2b were 176, 27, 27, 11,20, 12, respectively, and there were 8 cases missing pathological N staging data. Of the 281 patients, there were 4 cases with distant metastasis, 262 cases without distant metastasis, 5 cases not evaluated, and 10 cases missing tumor metastasis data. Of the 125 patients undergoing neoadjuvant therapy, there were 85 cases with tumor regression grade records, including 16 cases as grade 1, 27 cases as grade 2, 19 cases as grade 3, 15 cases as grade 4, 8 cases as grade 5. (4) Analysis of influencing factors for positive circumferential margin in surgical specimen of intersphincteric resection for rectal cancer. Results of univariate analysis showed that preoperative T staging on preoperative pelvic MRI, mesorectal fascia invasion, extramural venous invasion, pathological T staging, and pathological N staging were related factors for positive circumferential margin in surgical specimen of intersphincteric resection for rectal cancer ( P<0.05). Conclusions:Intersph-incteric resection with transabdominal transanal mixed approach has good specimen quality and low positive rate of surgical margin. T staging on preoperative pelvic MRI may be related to positive circumferential margin after intersphincteric resection for rectal cancer.

[Abstract] Objective: To construct a circRNA profile of esophageal squamous cell carcinoma (ESCC) and analyze differentially expressed circRNAs. Methods: Samples were taken from 3 patients with esophageal squamous cell carcinoma who were hospitalized in the Department of Thoracic Surgery, Jintan Hospital, Jiangsu University from June 2018 to February 2019. The circRNA expression profile was constructed by high-throughput sequencing technique, and the circRNA differentially expressed in 3 pairs of esophageal squamous cell carcinoma tissues and adjacent tissues was detected. The biological functions and related signal pathways of these circRNA were analyzed by GO and KEGG techniques. Results: By comparing the expression levels of circRNA between esophageal squamous cell carcinoma and adjacent tissues, 905 differentially expressed circRNA were found, of which 404 were up-regulated and 501 were down-regulated. hsa_circ_0004390 was the CIRC RNA with the highest up-regulation factor (FC=7.9712), and novel_circ_0012687 was the one with the highest down-regulation factor. GO and KEGG analysis showed that these circRNA may be involved in biological processes such as cell cycle, cell components and protein binding of cancer cells, and signal pathways such as Hippo and cGMP-PKG. Conclusion: The expression profile analysis of circRNA in esophageal squamous cell carcinoma showed that the significantly differentially expressed circRNA could be used as a potential biomarker of esophageal squamous cell carcinoma.

Currently there is no successful platform technology for the sustained release of protein drugs. It seems inevitable to specifically develop new materials for such purpose, and hence the understanding of protein-material interactions is highly desirable. In this study, we synthesized cholesterol-grafted polyglutamate (PGA--Chol) as a hydrophobically-modified polypeptide, and thoroughly characterized its interaction with a model protein (human serum albumin) in the aqueous solution by using circular dichroism, fluorescence methods, and light scattering. With the protein concentration fixed at 5 μmol/L, adding PGA--Chol polymers into the solution resulted in continuous blue shift of the protein fluorescence (from 339 to 332 nm), until the polymer molar concentration reached the same value as the protein. In contrast, the un-modified polyglutamate polymers apparently neither affected the protein microenvironment nor formed aggregates. Based on the experimental data, we proposed a physical picture for such protein-polymer systems, where the polymer first bind with the protein in a 1:1 molar ratio a fraction of their hydrophobic pendant cholesterol resides along the polymer chain. In this protein/polymer complex, there are excess unbound cholesterol residues. As the polymer concentration increases, the polymers form multi-polymer aggregates around 200 nm in diameter the same hydrophobic cholesterol residues. The protein/polymer complex also participate in the aggregation their excess cholesterol residues, and consequently the proteins are encapsulated into the nanoparticles. The encapsulation was also found to increase the thermal stability of the model protein.

Mycophenolic acid (MPA, ) and its derivatives are first-line immunosuppressants used in organ transplantation and for treating autoimmune diseases. Despite chemical synthetic achievements, the biosynthetic formation of a seven-carbon carboxylic acid pharmacophore side chain of , especially the processes involving the cleavage of the prenyl side chain between DHMP () and DMMPA (), remains unknown. In this work, we identified a membrane-bound prenyltransferase, PgMpaA, that transfers FPP to to yield FDHMP (). Compound undergoes the first cleavage step a new globin-like enzyme PgMpaB to form a cryptic intermediate . Heterologous expression of genes in demonstrates that the second cleavage step (from to ) of is a cluster-independent process . Our results, especially the discovery of the broad tolerance of substrates recognized by PgMpaB, set up a strategy for the formation of "pseudo-isopentenyl" natural products using fungal globin-like enzymes.

Objective To observe the expression of Caspase-12 and GRP78 of endoplasmic reticulum stress (ERS) in cardiac arrest and beating heart mitral valve replacement Methods Thirty patients with rheumatic heart disease mitral stenosis were randomly divided into beating heart group (BH,n=15) and cardiac arrest group(CA, n = 15). Both groups accepted MVR by beating heart surgery and cardiac arrest surgery under cardiopulmonary bypass (CPB) respectively. Right atrial myocardial tissues were collected at prior the start of CPB (T0), after aortic cross-clamping 30 minutes (BH group 30 minutes after CPB, T1) and stitched right atrium (T2) respectively. The method of reverse transcriptase polymerase chain reaction (RT-PCR) was applied to detect the expression level of Caspase-12 and GRP78 in two groups and positive staining of Caspase-12 and GRP78 of myocardial tissue slices in both groups was observed by immunohistochemical method. Results The expression of Caspase-12 in CA group heightened at T1and significantly increased at T2 (P < 0.05) but the expression of Caspase-12 in BH group had increased in T2 only (P < 0.05). Caspase-12 in CA group expressed higher than that in BH group at T1 and T2. The expression of GRP78 had increased at T1 in two groups but it in CA group expressed higher than that inBH group at T2. The number of positive staining of Caspase-12 and GRP78 in CA group was higher than that in BH group at T2. Conclusion MVR of beating heart can reduce the reaction of ERS to enhance the myocardial protection under CPB.

Hepatolenticular degeneration was one of the rare several genetic metabolic diseases in clinic that could be cured by liver transplantation method, developing slowly and being irreversible. Metabolic disorders of copper lead to abnormal copper accumulation in various of tissues and organs. So that, the disease′s clinical manifestations were lacking in specificity and many patients missed the best opportunity of drug treatment. With the maturity of technologies and innovation of theory of liver transplantation, there were more and more methods that will be applied to personalized treatment. In this paper, a review of the research progress in the treatment of hepatolenticular degeneration with liver transplantation was made with reference to the relevant literature at home and abroad.

Objective To study and analyze the efficacy and adverse reactions of beraprost sodium combined with aspirin in the treatment of diabetic foot.Methods 90 cases with diabetic foot were selected and they were randomly divided into the observation group and control group,35 cases in each group.Two groups were both treated with basic treatment.On the basis of the basic treatment,the control group was given aspirin,while the observation group was treated with beraprost sodium combined with aspirin.The clinical efficacy,ulcer healing rate,ankle back index,transcutaneous oxygen pressure,average healing time and the occurrence of adverse reactions were compared between the two groups.Results The clinical effective rate of the observation group was 93.3％ (42/45),which was significantly higher than 84.4％ (38/45) of the control group,the difference between the two groups was statistically significant (x2 =8.030,P ＜ 0.05).The wound healing rate,ankle dorsal index,average healing time,the degree of improvement of transcutaneous and oxygen pressuer of the observation group were (81.4 ± 2.7) ％,(11.2 ± 2.1),(39.1 ± 2.1) d and (26.3 ± 1.8) mmHg,which were significantly better than (69.3 ± 1.9) ％,(8.4 ± 2.9) ％,(52.3 ± 8.2) d and (16.3 ± 2.6)mmHg of the control group.The differences of these indicators between the two groups were statistically significant(t =12.72,7.92,12.06,9.97,P ＜ 0.05).The difference of adverse reactions between the two groups was not statistically significant (P ＞ 0.05).Conclusion Beraprost sodium combined with aspirin has better clinical efficacy in the treatment of diabetic foot.It can improve the patients'ulcer healing rate,the ankle back index,transcutaneous oxygen pressure,shorter the average healing time,and it has few adverse reactions.

Objective The present study aims to determine the correlation between liver function dam-age and hepatitis B virus ( HBV ) reactivation caused by chemotherapy , and the preventive effect of entecavir on HBV reactivation in lung cancer with HBV carriers .Methods A total of 160 lung cancer patients with HBV car-riers in the affiliated tumor hospital of Harbin Medical University from January 2011 to December 2012 was inves-tigated and the clinical data were studied retrospectively .The patients were divided into prophylactic group ( n=80)and control group(n=80).In prophylactic group,0.5 mg of daily oral entecavir was administered before the chemotherapy until 6 months after the completion of chemotherapy .Control group received no entecavir .The inci-dence of HBV reactivation ,functional damage of liver ,toxicities and disruption of chemotherapy were measured . Results The comparison between the control group (25%) and prevent group (5%) showed a statistically signifi-cant difference in the incidence of HBV reactivation (P<0.01).Moreover,HBV-DNA level(HBV-DNA≥104 copies/mL)was risk factors of HBV reactivation (P<0.05).Histology and stage of lung cancer,the chemother-aphy scheme containing platinum , positive HBeAg were not significantly correlated with HBV reactivation ( P>0.05).There were significant differences in grade III and IV hepatic toxicity (P<0.05)between control group (30%)and prevent group(5%),but was not in grade I and II hepatic toxicity (P>0.05).Disruption of chemo-therapy showed significant difference between control group (20%)and prevent group(5%)(P<0.05).The ma-jor grade 1 ~2 toxicities were myelosuppression,nausea,vomiting,skin rash,diarrhoea,neurotoxicity,fatigue, headache,insomnia,etc.All adverse reactions were cured after treatment .Conclusion The prophylactic adminis-tration of oral entecavir could reduce the risk of HBV reactivation in lung cancer with HBV carriers .

Objective To evaluate the effect of finasteride on perioperative bleeding following transurethral plasmakinetic resection of prostate (PKRP).Methods A total of 118 patients with benign prostatic hyperplasia (BPH) undergoing PKRP were randomly divided into three groups:40cases received 5mg of finasteride daily for 7 days before surgery as 1 week group,38 cases received 5mg of finasteride daily for 3 months before surgery as 3 months group,the other 40 cases without taking finasteride before surgery as control group.A comparative study of clinical data was made among the three groups.Results The operation was successfully completed in 118 cases.As compared to control group,intraoperative irrigating fluid volume[(31.5 ± 5.6) L vs.(26.4 ± 6.2) L and (24.3±5.2)L],intraoperative blood loss[(173.5± 16.9) ml vs.(163.5± 15.8) ml and (156.4±16.2) ml],loss of 1 gram prostate tissue for resection[(8.6±4.8)ml/g vs.(7.4±5.4) ml/g and (6.6±5.6) ml/g]and operation time(72.5±16.2) min vs.(58.4±17.8) min and (56.7±16.5) min in 1 week and 3 months groups with taking finasteride were decreased (all P＜0.05).And there were differences in the above indexes (all P＜ 0.05) between 1 week group and 3 months groups.Conclusions The use of finasteride before PKRP is safe and reliable to reduce perioperative bleeding in BPH patients.Moreover,taking 5mg of finasteride for three months is of better effectiveness than taking 5mg of finasteride for 1 week.