Objective:To explore the clinical efficacy of reconstructing the calcaneocuboid and calcaneonavicular ligaments with the autologous semitendinosus for chronic bifurcate ligament injury.Methods:A retrospective study was conducted to analyze the clinical data of 12 patients with chronic bifurcate ligament injury who had been treated by anatomical reconstruction with the autologous semitendinosus from March 2018 to January 2021 at Department of Foot and Ankle Surgery, The Fourth Hospital of Wuhan. There were 4 males and 8 females with an age of (41.4±9.6) years. Seven left and 5 right feet were affected; the time from injury to surgery was (9.3±4.3) months. The surgical efficacy was evaluated based on anteroposterior and lateral imaging assessments of foot weight-bearing at 6 months postoperation, comparison of the visual analogue scale (VAS) pain scores for foot weight-bearing walking and the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scores between preoperation and the last follow-up, stress test for stability of the transverse tarsal joint, recovery of movement, and occurrence of complications.Results:All patients were followed up for (18.4±4.0) months. Their sports activities were completely resumed after postoperative (6.8±3.9) months. Primary wound healing was achieved in all patients. One patient suffered from cutaneous nerve lesion and skin numbness, the symptoms of which disappeared after conservative treatment. Double harmonic curves were observed on the anteroposterior and lateral imaging films of foot weight-bearing in all patients. The spaces in the calcaneocuboid and the calcaneonavicular joints were normal, the articular positions were matched, and the calcaneocuboid joint was stable without recurrence or worsening of displacement. The VAS decreased significantly from preoperative 6.5 (5.6, 7.0) to 0.0 (0.0, 1.0) at the last follow-up, and the AOFAS mid-foot score increased significantly from preoperative (55.6±8.8) points to (92.3±2.6) points at the last follow-up ( P<0.05). The stress test for the stability of the transverse tarsal joint showed joint stability. Conclusion:Reconstruction of the calcaneocuboid and calcaneonavicular ligaments using the autologous semitendinosus is an alternative treatment for patients with chronic bifurcate ligament injury, because it can restore the stability of the bifurcate ligament and obviously improve the foot and ankle functions with limited postoperative complications.

Objective:To investigate the role of cholinergic anti-inflammatory pathway in the regulation of peptide transporter 1 (PepT1) expression in small intestinal epithelium of septic rats by Ghrelin.Methods:One hundred adult male Sprague-Dawley (SD) rats were randomly divided into sham operation group, sepsis group, sepsis+vagotomy group, sepsis+Ghrelin group, and sepsis+vagotomy+Ghrelin group, with 20 rats in each group. In the sham operation group, the cecum was separated after laparotomy, without ligation and perforation. In the sepsis group, the rats received cecal ligation puncture (CLP). In the sepsis+vagotomy group, the rats received CLP and vagotomy after laparotomy. In the sepsis+Ghrelin group, 100 μmol/L Ghrelin was intravenously injected after CLP immediately. The rats in the sepsis+vagotomy+Ghrelin group received CLP and vagotomy at the same time, then the Ghrelin was intravenously injected immediately with the same dose as the sepsis+Ghrelin group. Ten rats in each group were taken to observe their survival within 7 days. The remaining 10 rats were sacrificed 20 hours after the operation to obtain venous blood and small intestinal tissue. The condition of the abdominal intestine was observed. The injury of intestinal epithelial cells was observed with transmission electron microscopy. The contents of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in serum and small intestinal tissue were detected by enzyme-linked immunosorbent assay (ELISA). The brush border membrane vesicle (BBMV) was prepared, the levels of mRNA and protein expression of PepT1 in the small intestinal epithelium were detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and Western blotting.Results:All rats in the sham operation group survived at 7 days after operation. The 7-day cumulative survival rate of rats in the sepsis group was significantly lower than that in the sham operation group (20% vs. 100%, P < 0.05). The cumulative survival rate of rats after Ghrelin intervention was improved (compared with sepsis group: 40% vs. 20%, P < 0.05), but the protective effect of Ghrelin was weakened after vagotomy (compared with sepsis+Ghrelin group: 10% vs. 40%, P < 0.05). Compared with the sham operation group, in the sepsis group, the small intestine and cecum were dull red, the intestinal tubules were swollen and filled with gas, the intestinal epithelial cells were seriously injured under transmission electron microscopy, the levels of TNF-α and IL-1β in serum and small intestinal were significantly increased, and the expression levels of PepT1 mRNA and protein in the small intestinal epithelium were significantly decreased. It indicated that the sepsis rat model was successfully prepared. After vagotomy, the intestinal swelling and gas accumulation became worse in septic rats, leading to the death of all rats. Compared with the sepsis group, the abdominal situation in the sepsis+Ghrelin group was improved, the injury of intestinal epithelial cells was alleviated, the serum and small intestinal TNF-α and IL-1β were significantly decreased [serum TNF-α (ng/L): 253.27±23.32 vs. 287.90±19.48, small intestinal TNF-α (ng/L): 95.27±11.47 vs. 153.89±18.15, serum IL-1β (ng/L): 39.16±4.47 vs. 54.26±7.27, small intestinal IL-1β (ng/L): 28.47±4.13 vs. 42.26±2.59, all P < 0.05], and the expressions of PepT1 mRNA and protein in the small intestinal epithelium were significantly increased [PepT1 mRNA (2 -ΔΔCt): 0.66±0.05 vs. 0.53±0.06, PepT1 protein (PepT1/GAPDH): 0.80±0.04 vs. 0.60±0.05, both P < 0.05]. Compared with the sepsis+Ghrelin group, after vagotomy in the sepsis+vagotomy+Ghrelin group, the effect of Ghrelin on reducing the release of inflammatory factors in sepsis rats was significantly reduced [serum TNF-α (ng/L): 276.58±19.88 vs. 253.27±23.32, small intestinal TNF-α (ng/L): 144.28±12.99 vs. 95.27±11.47, serum IL-1β (ng/L): 48.15±3.21 vs. 39.16±4.47, small intestinal IL-1β (ng/L): 38.75±4.49 vs. 28.47±4.13, all P < 0.05], the up-regulated effect on the expression of PepT1 in small intestinal epithelium was lost [PepT1 mRNA (2 -ΔΔCt): 0.58±0.03 vs. 0.66±0.05, PepT1 protein (PepT1/GAPDH): 0.70±0.02 vs. 0.80±0.04, both P < 0.05], and the injury of small intestinal epithelial cells was worse. Conclusion:Ghrelin plays a protective role in sepsis by promoting cholinergic neurons to inhibit the release of inflammatory factors, thereby promoting the transcription and translation of PepT1.

Objective:To investigate the role of LncRNA-TUG1 in the injury of intestinal epithelial cells induced by lipopolysaccharide (LPS).Methods:LPS was used to treat HIEC-6 human intestinal epithelial cells for 24 h to construct a sepsis injury model. Whole transcriptome RNA sequencing was used to analyze the expression changes of mRNA, microRNA and lncRNA in HIEC-6 cells after LPS treatment. Real-time fluorescence quantitative (qRT-PCR) and Western blot was performed to detect the expression changes of lncRNA-TUG1, microRNA-132-3p (miR-132-3p), SIRT1 mRNA and SIRT1 protein in HIEC-6 cells after LPS treatment. The expression levels of LncRNA-TUG1, miR-132-3p and SIRT1 were artificially changed by in vitro transfection. qRT-PCR and Western blot were used to confirm the regulatory effect of lncRNA-TUG1 on microRNA-132-3p and SIRT1. CCK-8 and flow cytometry were used to analyze the effects of LncRNA-TUG1, miR-132-3p and SIRT1 on the proliferation and apoptosis of HIEC-6 cells. The dual luciferase report analysis was used to verify the targeting relationship between LncRNA-TUG1, miR-132-3p and SIRT1. Statistical analysis was performed using SPSS 17.0, and differences between the two groups were compared using independent sample t test. Results:RNA sequencing results showed that the expressions of lncRNA-TUG1 and SIRT1 were decreased in HIEC-6 cells after LPS treatment ( t=3.26, P<0.05 and t=2.55, P<0.05), but the expression of miR-132-3p was increased ( t=4.12, P<0.05). In vitro cell experiments, the expression of lncRNA-TUG1 and SIRT1 were decreased in HIEC-6 cells treated with LPS ( t=5.69, P<0.05 and t=5.712, P<0.05), while the expression of miR-132-3p was increased ( t=3.88, P<0.05). Overexpression of lncRNA-TUG1 increased the proliferation rate ( t=6.55, P<0.05) and decreased the apoptosis rate ( t=3.94, P<0.05) of LPS-treated cells. Upregulation of lncRNA-TUG1 decreased the expression of miR-132-3p ( t=4.66, P<0.05), and increased the mRNA and protein levels of SIRT1 ( t=3.91, P<0.05). Transfection of miR-132-3P mimic could inhibit the mRNA ( t=4.08, P<0.05) and protein levels of SIRT1. In LPS-treated cells, the cells co-transfected with miR-132-3pmimic and siRNA-SIRT1 had a lower proliferation rate ( t=4.55, P<0.05 and t=5.67, P<0.05) and a higher apoptosis rate ( t=3.90, P<0.05 and t=4.22, P<0.05) than those transfected with only pcDNA3.1-lncRNA-TUG. Conclusions:lncRNA-TUG1 may act as a ceRNA to regulate miR-132-3p/SIRT1, therefore alleviating HIEC-6 cell injury caused by LPS. Intervention of lncRNA-TUG1/miR-132-3p/SIRT1 regulatory pathway may become a potential strategy to prevent sepsis-induced intestinal mucosal damage.

Objective To evaluate the supercutaneous fixation with locking plate for treatment of open metacarpal fractures.Methods From March 2015 to November 2016,16 open metacarpal fractures were treated with supercutaneous locking plate after emergency debridement at Department of Hand Surgery,The Second Affiliated Hospital to Wenzhou Medical University.They were 11 men and 5 women,from 20 to 67 years of age (average,37.5 years).There were 2 cases of the 1st metacarpal fracture,6 ones of the 2ed metacarpal fracture,one of the 3rd metacarpal fracture,2 ones of the 4th metacarpal fracture and 5 ones of the 5th metacarpal fracture.All fractures were open injury.By the Gustilo-Anderson classification,there were 9 cases of type Ⅱ and 7 ones of type Ⅲ A.Functional rehabilitation was encouraged immediately after operation.The outcomes were evaluated at the 4th and 24th weeks postoperatively according to the Total Angle of Motion (TAM) for digital joints recommended by the Hand Surgery Society,Chinese Medical Association.Results The mean operation time was 46.8 minutes (from 35 to 108 minutes).All cases were followed up for an average of 9.8 months (from 7 to 25 months).All fractures healed without breakage or loosening of the supercutaneous locking plate after an average of 6.2 weeks(from 4.3 to 7.8 weeks).Nail tract infection occurred in 3 cases.According to the TAM at the 4th week postoperatively,5 cases were rated as excellent,8 as good,2 as fair and one as poor;according to the TAM at the 24th week postoperatively,11 cases were rated as excellent,4 as good and one as fair.Conclusion For open metacarpal fractures with severe contamination or soft tissue injury,supercutaneous locking plate fixation can achieve fine clinical outcomes.

Objective To explore the TCM pathogenesis regularity of nonalcoholic fatty liver disease (NAFLD);To provide basis for clinical syndrome differentiation and treatment. Methods A cross-sectional study was used. The clinical observation form of NAFLD was used to collect the patient data. Factor analysis and singular value decomposition methods were used to study the internal factors of the four diagnostic characteristics. The differences between the various analytical methods were compared. Results Factor analysis used the α factor analysis method, the principal component method, and the image factor method. The results of α-factor analysis were the best. The first three factors had the highest explanatory rates of data, namely spleen-dampness factor, kidney deficiency factor and qi deficiency factor, which constituted the basic pathogenesis factor of NAFLD. The singular value decomposition method obtained 3 singular values, namely spleen and kidney qi deficiency, liver and kidney yin deficiency, and qi and yin deficiency, also highlighted the spleen and kidney deficiency in the pathogenesis of NAFLD. Conclusion Spleen-kidney deficiency plays an important role in the pathogenesis of NAFLD. Treatment based on deficiency for nonalcoholic fatty liver disease has great clinical significance.

Objective To investigate the prevalence of feeding intolerance (FI),and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients.Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014,and all clinical,laboratory,and survival data were prospectively collected.The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms,feeding details and organ dysfunction within the first week of ICU stay.The intra-abdominal pressures (IAP) was measured using AbViser device.Results Of 550 patients enrolled,418 were assessed in GI symptoms and feeding details within 7 days of ICU stay.The mean age and SOFA score were (65.1 ± 18.3) years and (8.96 ±4.10),respectively.Of them,355 patients (84.9％) were under mechanical ventilation support,and 37 (8.85％) received renal replacement therapy.The mean length of time for enteral feeding was (30.8 ±26.2) h,and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2％ and 25.4％,respectively.Compared to those with FI within 7 days of ICU stay,the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3％ vs.5.7％,P =0.003) and higher rate of withdrawal of vasoactive medication (45.5％ vs.20.0％,P =0.037),as well as lower mortality rate of 28-day (24.4％ vs.38.7％,P =0.004) and 60-day (29.6％ vs.44.3％,P =0.005).In multivariate Cox regression model with adjustment for age,sex,participant center,serum creatinine and lactate,AGI grade on the first day of ICU stay,and comorbidities,the FI within 7 days of ICU stay (x2 ≥ 7.24,P ＜ 0.01) remained to be independent predictors for 60-day mortality.After further adjusted for SOFA score,the FI within 7 days of ICU stay (HR =1.71,95％ CI:1.18-2.49;P =0.006) and AGI grade on the first day of ICU stay (HR =1.33,95 ％ CI:1.07-1.65;P =0.009) could provide independent prognostic values of 60-day mortality.Conclusions There is high rate of FI occurred within 7 days of ICU stay,and is significantly associated with worse outcome.In addition,this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality.

Inflammation response is the most crucial link in the pathogeneses of spinal cord injury (SCI),and is the basis of secondary damage. NF-κB Signalling pathway is activated excessively after SCI,so that numerous NF-κB possessing biological activities is quickly translocated into the nuclear and regulates the target genes,resulting in heightened inflammation and further tissue damage. Suppressing NF-κB signalling pathway and controlling inflammation response effectively are effective approaches to promoting SCI repair. It is found that curcumin has multiple target molecules to suppress NF-κB signalling pathway,block the excessive activation of NF-κB and reduce the expression of proinflammation cytokines,which plays an important role in SCI repair. This article discusses NF-κB signalling pathway,the contribution of NF-κB signalling pathway to SCI and the role of curcumins inhibition of NF-κB signalling pathway in SCI.

Objective To discuss the classification and treatment of the degloving hand.Methods All 68 degloving hand treated between January, 2005 and December, 2014 in our department were reviewed.The cases were divided into three types according to the extent of the injury.Type Ⅰ the degloving tissue had enough blood supply which was debrided and stitched.Type Ⅱ the degloving tissue had less or no blood supply which was revascularized with replantation or vein anastomosis, some degloving palm or dorsum resurfaced the wound by the degloving skin graft.Type Ⅲ the degloving tissue had no blood supply or severely damaged,the tissue defect should be resurfaced with other tissue reconstruction.Type Ⅱ and Ⅲ were further divided into subtype A, B and C depending on the degloving scope and location, each subtype has its own surgical procedure.Results The total survival rate was 83.8％.The survival rate decreased with the increasing extent of the injury and the increasing degloving scope.Conclusion Classification of the hand degloving injuries depending on the extent of the injury, the degloving scope and location is useful for the assessment of injury and the selection of proper operation procedures.

ObjectiveTo investigate the relationship between syndrome differentiation types and the objective indexes of fatty liver.MethodsA cross-sectional study was adopted. Clinical observation table of fatty liver for TCM diagnostic performance was used to collect the data of patients and cluster analysis was adopted for syndrome differentiation. The difference of the objective indexes among different syndromes was studied.ResultsFatty liver showed more severity in spleen Qi deficiency and dampness group compared with heart and liver yin deficiency group(χ2=8.218,P=0.041). Patients in the spleen and stomach Qi deficiency group had less smoking history(χ2=8.416,P=0.038). Patients in the spleen Qi deficiency and dampness group had higher AST, TP, ALP and WHR indexes and lower Alb.ConclusionsDifferences of objective indexes in different fatty liver syndromes can be used for enriching syndrome differentiation contents, and provide the basis for microcosmic syndrome differentiation of fatty liver.

Bronchopulmonary Sequestration ; diagnosis ; Coronary Vessels ; pathology ; Humans ; Male ; Middle Aged