BACKGROUND:Ankle fracture complicated with deltoid ligament injury is clinically common,and one stage repair of deltoid ligament with internal fracture fixation has gradually become a main therapeutic method,which can significantly reduce the long-term complications of ankle joint.In recent years,new progress has been made in anatomical structure characteristics and dynamic biomechanical research of deltoid ligament,thus greatly improving repairing techniques for injury in the deep layer of deltoid ligament,but there are still some controversies.OBJECTIVE:To explore the clinical efficacy of suture anchor and medial malleolus repair in the treatment of ankle joint fractures with the deep layer of deltoid ligament.METHODS:A total of 56 patients with ankle joint fractures and complete fracture of the deep and superficial layer of deltoid ligament treated in Affiliated Haikou Hospital,Xiangya School of Medicine,Central South University from January 2017 to January 2022 were selected,and they were divided into two groups according to different treatment methods in repairing the deep layer of deltoid ligament with suture anchor:suture anchor repair group(n=32)and medial malleolus repair group(n=24).The medial clear space of ankle joint and American Orthopedic Foot and Ankle Society Score of patients in the two groups were evaluated before and after operative treatment.RESULTS AND CONCLUSION:(1)All the 56 patients finished the surgery smoothly and were followed up for more than 12 months after operation.Their ankle fracture healed,and the time for fracture healing was 8-12 weeks,with a mean of 10.5 weeks.(2)The medial clear space of ankle joint in the two groups 12 months after operation was remarkably narrower than that before operation,and the difference was statistically significant(P＜0.001).The medial clear space of ankle joint in the two groups maintained a normal range 12 months after operation,and there was no statistically significant difference between the two groups(P＞0.05).(3)The AOFAS scale of patients in the two groups 6 and 12 months after operation was obviously bigger than that before operation(P＜0.001),but there was no statistically significant difference in the American Orthopedic Foot and Ankle Society Score of patients between the two groups at corresponding time points(P＞0.05).(4)It is concluded that both suture anchor and medial malleolus repair in the treatment of injury in the deep layer of deltoid ligament can recover the medial clear space of ankle joint,effectively keep the stability of ankle,and thus achieve good clinical efficacy.

Objective:To analyze the clinical characteristics of inconsistent symptoms and signs of dry eye in patients with Sj?gren syndrome (SS).Methods:A case-control study was performed.Thirty-eight patients (38 eyes) who visited the dry-eye outpatient department at Peking University People's Hospital were enrolled from January to October 2021.The patients were divided into a non-SS (NSS) group (25 cases, 25 eyes) and a SS group (13 cases, 13 eyes) according to without or with SS.The data of right eyes were analyzed.The patients' subjective symptoms were scored and their objective clinical parameters were evaluated.Evaluation of subjective symptoms included Ocular Surface Disease Index (OSDI), Standard Patient Evaluation of eye dryness (SPEED) Questionnaire and Dry Eye Questionnaire-5 (DEQ-5).Objective clinical parameters included Schirmer Ⅰ test (SⅠt), tear film breakup time (TBUT), SICCA ocular staining score (OSS), National Eye Institute (NEI) score, Marx line score, non-invasive tear film breakup time (NIBUT), non-invasive tear meniscus height (NITMH), meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells.Differences in subjective symptoms and clinical parameters were compared between the two groups, and correlation analysis between ocular symptom scores and objective clinical parameters was performed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.RDY2020-03).Written informed consent was obtained from each subject.Results:The OSDI, SPEED and DEQ-5 scores of SS group were 10.9(2.1, 23.1), 4.0(2.0, 7.0) and 7.0(3.5, 9.5), respectively, which were significantly lower than 37.5(26.0, 64.9), 10.5(7.0, 13.0) and 13.0(6.8, 14.3) of NSS group ( Z=-2.70, -3.01, -2.14; all P<0.05).TBUT was longer in the SS group than in the NSS group, and the difference was statistically significant ( Z=-2.10, P=0.038).No significant difference was found in SⅠt, OSS, Marx line score, NIBUT, NITMH, meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells (all P>0.05).The OSS of nasal conjunctiva was significantly higher in the SS group than in the NSS group ( Z=-2.32, P=0.023).There were no correlations between the subjective symptoms and objective clinical parameters in NSS group (all P>0.05).The SPEED score was positively correlated with the Marx line score of upper eye lid ( rs=0.573, P=0.041) and the OSDI score was negatively correlated with the minimum nerve length ( rs=-0.606, P=0.037) in SS group. Conclusions:Patients with SS dry eye have more nasal conjunctival staining and fewer subjective symptoms than NSS dry eye patients with the same signs, which manifests as a separation of symptoms and signs.

Objective:To analyze the clinical characteristics of inconsistent symptoms and signs of dry eye in patients with Sj?gren syndrome (SS).Methods:A case-control study was performed.Thirty-eight patients (38 eyes) who visited the dry-eye outpatient department at Peking University People's Hospital were enrolled from January to October 2021.The patients were divided into a non-SS (NSS) group (25 cases, 25 eyes) and a SS group (13 cases, 13 eyes) according to without or with SS.The data of right eyes were analyzed.The patients' subjective symptoms were scored and their objective clinical parameters were evaluated.Evaluation of subjective symptoms included Ocular Surface Disease Index (OSDI), Standard Patient Evaluation of eye dryness (SPEED) Questionnaire and Dry Eye Questionnaire-5 (DEQ-5).Objective clinical parameters included Schirmer Ⅰ test (SⅠt), tear film breakup time (TBUT), SICCA ocular staining score (OSS), National Eye Institute (NEI) score, Marx line score, non-invasive tear film breakup time (NIBUT), non-invasive tear meniscus height (NITMH), meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells.Differences in subjective symptoms and clinical parameters were compared between the two groups, and correlation analysis between ocular symptom scores and objective clinical parameters was performed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Peking University People's Hospital (No.RDY2020-03).Written informed consent was obtained from each subject.Results:The OSDI, SPEED and DEQ-5 scores of SS group were 10.9(2.1, 23.1), 4.0(2.0, 7.0) and 7.0(3.5, 9.5), respectively, which were significantly lower than 37.5(26.0, 64.9), 10.5(7.0, 13.0) and 13.0(6.8, 14.3) of NSS group ( Z=-2.70, -3.01, -2.14; all P<0.05).TBUT was longer in the SS group than in the NSS group, and the difference was statistically significant ( Z=-2.10, P=0.038).No significant difference was found in SⅠt, OSS, Marx line score, NIBUT, NITMH, meibomian gland loss area ratio, the number of corneal subepithelial nerves, total nerve length, mean nerve length, maximum nerve length, minimum nerve length, nerve curvature, and number of dendritic cells (all P>0.05).The OSS of nasal conjunctiva was significantly higher in the SS group than in the NSS group ( Z=-2.32, P=0.023).There were no correlations between the subjective symptoms and objective clinical parameters in NSS group (all P>0.05).The SPEED score was positively correlated with the Marx line score of upper eye lid ( rs=0.573, P=0.041) and the OSDI score was negatively correlated with the minimum nerve length ( rs=-0.606, P=0.037) in SS group. Conclusions:Patients with SS dry eye have more nasal conjunctival staining and fewer subjective symptoms than NSS dry eye patients with the same signs, which manifests as a separation of symptoms and signs.

BACKGROUND:Ankle fracture complicated with deltoid ligament injury is clinically common,and one stage repair of deltoid ligament with internal fracture fixation has gradually become a main therapeutic method,which can significantly reduce the long-term complications of ankle joint.In recent years,new progress has been made in anatomical structure characteristics and dynamic biomechanical research of deltoid ligament,thus greatly improving repairing techniques for injury in the deep layer of deltoid ligament,but there are still some controversies.OBJECTIVE:To explore the clinical efficacy of suture anchor and medial malleolus repair in the treatment of ankle joint fractures with the deep layer of deltoid ligament.METHODS:A total of 56 patients with ankle joint fractures and complete fracture of the deep and superficial layer of deltoid ligament treated in Affiliated Haikou Hospital,Xiangya School of Medicine,Central South University from January 2017 to January 2022 were selected,and they were divided into two groups according to different treatment methods in repairing the deep layer of deltoid ligament with suture anchor:suture anchor repair group(n=32)and medial malleolus repair group(n=24).The medial clear space of ankle joint and American Orthopedic Foot and Ankle Society Score of patients in the two groups were evaluated before and after operative treatment.RESULTS AND CONCLUSION:(1)All the 56 patients finished the surgery smoothly and were followed up for more than 12 months after operation.Their ankle fracture healed,and the time for fracture healing was 8-12 weeks,with a mean of 10.5 weeks.(2)The medial clear space of ankle joint in the two groups 12 months after operation was remarkably narrower than that before operation,and the difference was statistically significant(P＜0.001).The medial clear space of ankle joint in the two groups maintained a normal range 12 months after operation,and there was no statistically significant difference between the two groups(P＞0.05).(3)The AOFAS scale of patients in the two groups 6 and 12 months after operation was obviously bigger than that before operation(P＜0.001),but there was no statistically significant difference in the American Orthopedic Foot and Ankle Society Score of patients between the two groups at corresponding time points(P＞0.05).(4)It is concluded that both suture anchor and medial malleolus repair in the treatment of injury in the deep layer of deltoid ligament can recover the medial clear space of ankle joint,effectively keep the stability of ankle,and thus achieve good clinical efficacy.

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts′ expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig′s angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

Objective: To detect the expression of B cell transposition gene 3(BTG3) in pancreatic ductal adenocarcinoma(PDAC), and explore its relationship with postoperative recurrence and metastasis of tumor. Methods: Six self-paired frozen PDAC specimens and 3 normal pancreatic tissues from the Second Hospital of Jiaxing Affiliated to Jiaxing University were collected and the expression of BTG3 was detected by qPCR. Ten normal pancreatic tissues and 52 cases of PDAC tumor and paracarcinomatous tissues from the Second Hospital of Jiaxing Affiliated to Jiaxing University were collected from June 2009 to December 2016. The expression of BTG3 and relationship among BTG3 and clinicopathological characteristics of PDAC and patients′ prognosis were detected and analyzed using immunohistochemistry.χ² test, Kaplan-Meier method and Cox regression model were used to analyzed the data. Results: The results of qPCR showed that expression level of BTG3 in PDAC (0.63±0.17) was lower significantly than that in paracarcinomatous (0.96±0.04) and normal tissues (1.00)(t=4.673, 5.502; both P<0.05). Immunohistochemistrv showed that BTG3 mainly expressed in the cytoplasm.The high expression rate of BTG3 in PDAC tumor tissues was 25.0%(13/52), which was remarkably lower than that in paracarcinomatous tissues(65.4%) and normal liver tissues(7/10)(χ²=17.120 and 5.849, both P<0.05). The low expression of BTG3 in PDAC was correlated with primary tumor, and TNM stage(χ²=7.704, P=0.006; U=154.000, P=0.018, respectively). Survival analysis showed that disease free survival rate of patients with low expression of BTG3 was significantly less than that with high expression(χ²=192.493, P<0.01). The Cox multivariate analysis demonstrated that low expression of BTG3 was independent risk factors for disease free survival in patients with PDAC after a curative resection(RR=3.366, 95%CI: 1.040-10.889, P=0.043). Conclusion BTG3 may be involved in the occurence and development of tumor, and its low expression may be associated with poor prognosis in patients with PDAC.