BACKGROUND:Although traditional screw fixation has been successful in treating ankle fractures,rigid fixation solutions tend to restrict ankle movement and delay fracture healing,whereas elastic fixation is more compatible with human mechanics and has unique advantages in patients with ankle fractures. OBJECTIVE:To compare the clinical effectiveness of elastic fixation and absolute fixation in repairing ankle fractures in the elderly with lower tibiofibular instability. METHODS:The clinical data of 108 elderly ankle fractures with lower tibiofibular instability in Hengshui People's Hospital from August 2019 to August 2021 were retrospectively collected.They were divided into screw group and elastic fixation group(n=54 per group)according to the surgical protocol,and traditional screw internal fixation and elastic internal fixation were performed respectively.The perioperative indicators,surgical results,economic benefits,and American orthopedic foot and ankle society scores were collected and compared between the two groups.Serum tumor necrosis factor-α,interleukin-8 levels,ankle cavity width,depth,and lower tibiofibular space were compared before and after surgery. RESULTS AND CONCLUSION:(1)The full weight-bearing time was shorter in the elastic fixation group than that in the screw group;the operating angle was greater in the elastic fixation group than that in the screw group,and the complication rate was lower in the elastic fixation group than that in the screw group(P<0.05).(2)Serum tumor necrosis factor-α and interleukin-8 levels in the elastic fixation group were lower than those in the screw group 3 days after surgery(P<0.05).(3)American orthopedic foot and ankle society scores in the two groups were higher than those before surgery at 6 and 12 months after surgery,and the depth and width of the inferior tibiofibular space and ankle cavity were lower than those before surgery(P<0.05);but no significant difference was detected between the two groups(P>0.05).(4)There was no significant difference in the excellent and good rate between the two groups at 12 months after surgery(P>0.05).(5)There was no significant difference in the comparison of direct non-medical costs,direct medical costs,and total costs between the two groups(P>0.05).(6)It is indicated that elastic fixation for the repair of ankle fractures with lower tibiofibular instability in the elderly can obtain effective outcomes,which can shorten the time of complete weight-bearing,diminish complications,and alleviate inflammatory stress.

Laboratory testing is a vital chain in the prevention and control of genital chlamydia trachomatis infection. The prevalence of genital chlamydia trachomatis infection is high, but the detection rate of the infection is low in men who have sex with men (MSM) in China. Self-sampling for genital chlamydia trachomatis detection by MSM is a new option to address this problem, which would play a significant role in expanding genital chlamydia trachomatis infection screening in this population. This paper summarizes the progress in research of self-sampling for the detection of genital chlamydia trachomatis and the related factors in MSM both at home and abroad to provide reference for the promotion of self-sampling for the detection of genital chlamydia trachomatis in this population.

Objective:To investigate frequency and function of peripheral CD4+CD28-T cells in immune thrombocytopenia(ITP)patients,to deeply understand pathogenesis of ITP.Methods:A total of 30 ITP patients treated in The Second Affiliated Hospi-tal of Dalian Medical University from January 2021 to June 2022 were recruited,and 30 gender/age-matched healthy volunteers were served as control group.Peripheral anticoagulation was collected and mononuclear cells(PBMC)were extracted,frequencies and func-tions of CD4+CD28-T cells in PBMC was analyzed by flow cytometry,plasma levels of IL-18 and IL-18BP in ITP patients were detected by ELISA,and frequencies of CD4+CD28-T cells before and after treated with IL-18 were determined by flow cytometry.Results:Frequencies of CD4+CD28-T cells in peripheral blood of ITP patients were significantly higher than that of healthy control group,and CD4+CD28-T cells had a stronger ability to secrete IFN-γ and TNF-α;level of IL-18 was higher in plasma from ITP patients;IL-18 could increase frequency of CD4+CD28-T cells in PBMC of ITP patients.Conclusion:Frequency of CD4+CD28-T cells in peripheral blood of ITP patients is significantly increased,and has stronger ability to secrete inflammatory factors.

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Background::Ubiquitination plays an essential role in many biological processes, including viral infection, and can be reversed by deubiquitinating enzymes (DUBs). Although some studies discovered that DUBs inhibit or enhance viral infection by various mechanisms, there is lack of information on the role of DUBs in virus regulation, which needs to be further investigated.Methods::Immunoblotting, real-time polymerase chain reaction, in vivo/ in vitro deubiquitination, protein immunoprecipitation, immunofluorescence, and co-localization biological techniques were employed to examine the effect of ubiquitin-specific protease 3 (USP3) on APOBEC3G (A3G) stability and human immunodeficiency virus (HIV) replication. To analyse the relationship between USP3 and HIV disease progression, we recruited 20 HIV-infected patients to detect the levels of USP3 and A3G in peripheral blood and analysed their correlation with CD4 + T-cell counts. Correlation was estimated by Pearson correlation coefficients (for parametric data). Results::The results demonstrated that USP3 specifically inhibits HIV-1 replication in an A3G-dependent manner. Further investigation found that USP3 stabilized 90% to 95% of A3G expression by deubiquitinating Vif-mediated polyubiquitination and blocking its degradation in an enzyme-dependent manner. It also enhances the A3G messenger RNA (mRNA) level by binding to A3G mRNA and stabilizing it in an enzyme-independent manner. Moreover, USP3 expression was positively correlated with A3G expression ( r= 0.5110) and CD4 + T-cell counts ( r= 0.5083) in HIV-1-infected patients. Conclusions::USP3 restricts HIV-1 viral infections by increasing the expression of the antiviral factor A3G. Therefore, USP3 may be an important target for drug development and serve as a novel therapeutic strategy against viral infections.

Objective To evaluate the effect of melatonin pretreament on cell apoptosis and autophagy during lung ischemia-reperfusion (I/R) in rats.Methods Thirty-six adult male Sprague-Dawley rats,weighing 230-280 g,were divided into 3 groups (n=12 each) using a random number table method:sham operation group (group Sham),pulmonary I/R group (LIR group) and melatonin pretreatment group (MLT group).Lung I/R injury model was established by clamping the left hilum of lung for 60 min followed by 2 h reperfusion in LIR and MLT groups.Melatonin 1 mg/100 g was intraperitoneally injected at 15 min before clamping the left hilum of lung in group MLT.The rats were sacrificed at the end of reperfusion,the left lung was lavaged and the broncho-alveolar lavage fluid (BALF) was colleted for determination of protein concentrations.Lungs were removed for microscopic examination of the pathological changes (with a light microscope) which were scored and for determination of wet to dry weight ratio (W/D ratio),cell apoptosis (by TUNEL) and expression of Bcl-2,Bax,microtubule-related protein 1 light chain 3B Ⅰ (LC3B Ⅰ),LC3B Ⅱ,Beclin-1 and phosphorylated mammal rapamycin target protein receptor (p-mTOR) (using Western blot).The apoptosis index,Bcl-2/Bax ratio and LC3B Ⅱ/LC3B Ⅰ ratio were calculated.Results Compared with Sham group,the protein concentration in BALF,W/D ratio of lung tissues,apoptosis index,LC3B Ⅱ/LC3B Ⅰ ratio and Beclin-1 expression were significantly increased,and Bcl-2/Bax ratio and p-mTOR expression were decreased in LIR and MLT groups (P＜0.05).Compared with LIR group,the protein concentration in BALF,W/D ratio of lung tissues,apoptosis index,LC3B Ⅱ/LC3B Ⅰ ratio and Beclin-1 expression were significantly decreased,and Bcl-2/Bax ratio and p-mTOR expression were increased in MLT group (P＜0.05).Conclusion The mechanism by which melatonin pretreatment mitigates lung I/R injury may be related to inhibiting cell apoptosis and autophagy in rats.

The aim of the work is to improve the synthetic process of dexrabeprazole sodium,enhance quality and yield of the product,simplify synthetic steps,and offer a stable and feasible process. Starting from 2-[[[4-(3-methoxypropoxy)-3-methylpyridine-2-yl]methyl]thio]-1 H-benzimidazole,dexrabeprazole was produced by asym-metric oxidation reaction with oxidant cumene hydroperoxide in the presence of chiral catalyst tetraisopropyl titan-ate and L-(+)-tartaric acid diethyl ester. Dexrabeprazole sodium was obtained by the reaction of purified dexrabeprazole with sodium hydroxide in a total yield of 79%with an HPLC purity of ＞99. 5%. The structure of dexrabeprazole sodium was confirmed by NMR,IR,elemental analysis and LC-MS. The improved process of dexrabeprazole sodium possesses simple operations,good yield and high purity,which is feasible for industrializa-tion.

Objective To explore the types of variations in the origin of left gastric artery (LGA) using MSCT angiography.Methods The abdominal MSCT angiography data of 1 500 patients were respectively reviewed,in thoses the abdominal aorta,celiac trunk,LGA,common hepatic artery (CHA),splenic artery (SA) and superior mesenteric artery (SMA)were shown clearly.The origins of the LGA and related artries were focused.A new typing method (types Ⅰ-Ⅹ) was established.And the incidence of various types was calculated.Results The normal anatomical origin (type Ⅰ) of LGAwas noted in 1 342 cases (1 342/1 500,89.47％).Eight types of LGA variant origin were identified in 70 cases (70/1 500,4.67％).LGA variant origin combined with celiomesenteric trunk (CMT) were observed in 47 cases (47/1 500,3.13％).The most common type of LGA origin variation was LGA originated from the abdominal aorta combined with CMT (type Ⅴ) which was found in 24 cases (24/1 500,1.60％).And the least common type was the namely LGA,SA,CHA and SMA arose independently from abdominal aorta (type Ⅵ) which was found in 3 cases (3/1 500,0.20 ％).LGA originated from SMA (type Ⅷ) was not found in all 1 500 cases.Conclusion There are many kinds of variations in the origin of LGA.The new typing method can contribute the comprehensive and intensive data for understanding the anatomical and radiographic features.

Objective To investigate the improving effects of Shenshao decoction on myocardial structure and function in diabetic cardiomyopathy,and its effect on expression of TLR4/MyD88-dependent pathway signal in diabetic cardiomyopathy.Methods Diabetes mellitus was induced in 8-week-old male Wistar rats by a single intraperitoneal injection of streptozotocin.The changes of plasma myocardial enzyme (CK, LDH) and high sensitive C reactive protein (hsCRP) were measured.Cardiac function was measured by left ventricular intubation.Hematoxylin and eosin staining and electron microscopy were used to observe the changes of myocardial morphology and ultrastructure in rats.Expression of Toll-like receptor 4(TLR4), myeloid differentiation protein 88(MyD88), and nuclear factor-κB P65(NF-κB P65) were tested by immunohistochemistry.Results After 6 weeks of treatment, the left ventricular diastolic and systolic functions were obviously improved;the degrees of myocardial fibers and mitochondrial damage were obviously relieved;the content of CK, LDH and hsCRP decreased (P< 0.05), and hsCPR was positively correlated with CK and LDH (r=0.823,r=0.819,P < 0.05).The expressions of TLR4, MyD88, NF-κB P65 were significantly decreased (P< 0.05).There was no significant difference in the above mentioned indicators between the control group and control+Shenshao decoction group (P> 0.05).Conclusions Shenshao decoction can reduce the myocardial injury in diabetic cardiomyopathy and improve cardiac diastolic and systolic functions.The mechanism may be related to attenuated inflammation by TLR4/MyD88 dependent signaling pathway.

Objective To explore the correlation of epicardial adipose tissue (EAT) volume with atrial fibrillation (AF) and its recurrence after radiofrequency ablation (RA).Methods Eighty-five AF patients (AF group) and 90 non-AF patients (control group) were chosen between January 2014 and May 2016.Their EAT volumes were measured by CT scanning.Patients in AF group after RA were followed up 6-18 months,and the recurrence of AF was recorded.The recurrence of AF within 3 months of RA was defined as blanking recurrence group (n =27) and non-blanking recurrence group (n =58),and that after 3 months of RA was defined as the 1 ong-term recurrence.Results The total EAT volume and left atrial EAT volume were significantly larger in blanking recurrence group than in non-blanking recurrence group [(118.71 ±28.94) cn3 vs (97.73 ±24.86)cm3,(29.98 ±8.09)cm3 vs (23.11 ±8.30)cm3,t =6.219,4.451,P ＜ 0.01].Multivariate logistic resgression analysis showed that total EAT volume and left atrial EAT volume were the independent risk factors for AF.All showed that total EAT volume and left atrial EAT volume were the independent risk factors for blanking recurrence.The incidence of long-term recurrence was significantly higher in blanking recurrence group [40.7％ (11/27)] than in non-blanking recurrence group [15.5 ％ (9/58)] (x2 =7.142,P ＜ 0.05).Conclusions The incidence of AF is higher in patients with a Iarger total EAT volume and a larger left atrial EAT volume and AF is easier to recur even though after RA.