Objective:To investigate the effect of subfibular ossicle excision on the clinical efficacy of Brostr?m procedure for chronic lateral ankle instability (CLAI).Methods:From March 2014 to December 2018, 76 patients were treated by the modified Brostr?m procedure using the suture anchor technique for CLAI at Department of Foot & Ankle Surgery, Wuhan Fourth Hospital. Of them, 33 had subfibular ossicles (SFO group) and 43 did not (NSFO group). In the SFO group, there were 19 males and 14 females, aged (28.4±8.6) years; in the NSFO group, there were 21 males and 22 females, aged (27.8±7.4) years. Subfibular ossicles were excised in the SFO group. The 2 groups were compared in terms of American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and visual analogue scale (VAS) pain scores at preoperation and the final follow-up.Results:The 2 groups were comparable due to insignificant differences between them in their preoperative general data ( P>0.05). All the patients were followed up for 24 to 72 months (average, 28 months). The AOFAS ankle-hindfoot scores improved significantly from 54.5±3.4 to 95.7±2.1 in the SFO group and significantly from 56.2±2.7 to 95.2±2.4 in the NSFO group at the final follow-up; the VAS scores reduced significantly from 5.7±1.8 to 1.6±1.4 in the SFO group and significantly from 5.7±1.6 to 1.7±1.2 in the NSFO group at the final follow-up (all P<0.05). No significant differences were found between the 2 groups in terms of AOFAS or VAS scores at the final follow-up ( P>0.05). Conclusion:Since the modified Brostr?m procedure plus subfibular ossicle excision may result in similar good clinical efficacy as merely the modified Brostr?m procedure may for the CLAI patients without subfibular ossicle, subfibular ossicle excision should be suggested for the CLAI patients with subfibular ossicle.

At present, 2019 novel coronavirus (2019-nCoV) mutations occur frequently, and the current mutation, represented by omicron, has significantly enhanced its transmission and greatly increased the difficulty of prevention and control of Coronavirus Disease 2019 (COVID-19). In order to effectively deal with the epidemic situation of COVID-19, it is urgent to develop accurate, sensitive and field-applicable diversified detection techniques for the mutants. In this review, we introduce the current technical method for 2019-nCoV detection, focus on the application of different method in mutation detection, and analyze their advantages and disadvantages. In addition to the traditional detection techniques such as nucleic acid and immunity, we also discuss the importance of establishing phenotypic correlation detection method such as affinity of 2019-nCoV mutants. It is meaningful for accurately detecting and analyzing the important indexes such as infectivity and pathogenicity of the mutant, as well as for improving the efficiency of epidemic screening and its treatment.

Objective:To investigate the prevalence of deep vein thrombosis (DVT) in patients after selective ankle or mid-hindfoot surgery.Methods:A retrospective analysis was conducted of the 109 patients with ankle or mid-hindfoot disease who had been treated from January 2018 to December 2019 at Department of Orthopaedics, Wuhan Fourth Hospital. They were 65 males and 44 females, aged from 32 to 74 years (average, 49.0 years). Ultrasonography was performed at preoperative 1 day, postoperative 2 and 6 weeks to determine the occurrence, location and clinical symptoms of DVT. The patients were divided into an early DVT group, a late DVT group and a DVT-free group according to the occurrence and onset time of DVT. The 3 groups were compared in terms of gender, age, body mass index and tourniquet duration.Results:The incidence of postoperative lower limb DVT was 22.9% (25/109). All the thromboses were observed beyond the distal plane of the popliteal vein. 72.0% of the DVT patients were clinically asymptomatic. There was no significant difference in gender, age or body mass index between early DVT group ( n=17), late DVT group ( n=8) and DVT-free group ( n=84) ( P>0.05). The incidence was 68.0% (17/25) for early DVT and 32.0% (8/25) for late DVT. The intraoperative tourniquet duration for the early DVT group [(77.7±12.3) min] was significantly longer than that for the late DVT group [(66.8±11.2) min] and for the DVT-free group [(65.9±10.5) min] ( P<0.05). Conclusions:The majority of postoperative DVTs may be clinically asymptomatic in patients after selective ankle or mid-hindfoot surgery. Although DVT tends to occur within postoperative 2 weeks, its risk may continue after 2 weeks. Increased tourniquet duration may be associated with incidence of early DVT.

Objective:To evaluate the clinical application of an individualized 3D printed drill template to create a fibular channel in the anatomical reconstruction of the lateral ankle ligament for chronic lateral ankle instability.Methods:From October 2012 to June 2015, 15 patients with lateral ankle in-stability underwent surgery at Department of Foot and Ankle Surgery, The Fourth Hospital of Wuhan.They were 4 men and 11 women, with a mean age of 26.3 years (range, from 18 to 42 years).For each of them, anatomical reconstruction of the lateral ankle ligament was performed through a fibular channel which was created with the aid of an individualized 3D printed drill template.The American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analogue Scale (VAS) scores were used to assess the patients preoperation and at the last follow-up.Results:The 15 patients obtained a mean follow-up of 15.2 months (range, from 12 to 18 months).Their preoperative AOFAS scores (47.1±3.8) were increased to 88.3±4.7 at the last fol-low-up, and their preoperative VAS scores (5.8±1.8) decreased to 1.55±1.35 at the last follow-up, showing significant differences ( P<0.05).There were 11 excellent and 4 good cases by the AOFAS ankle-hindfoot scale.No significant complications were found. Conclusion:In the anatomical reconstruction of the lateral ankle ligament for chronic lateral ankle instability, an individualized 3D printed drill template can help create a fibular channel which exactly fits each individual, leading to positive therapeutic effects.

Objective:To report our experience in the emergent foot and ankle surgery in the epidemic of COVID-19.Methods:The data of 18 patients with acute foot and ankle injury were reviewed who had been admitted to the Department of Foot and Ankle Surgery, Wuhan Fourth Hospital from 20th January, 2020 to 26th February, 2020. They were 11 men and 7 women, aged from 18 to 70 years (average, 42.5 years). There were 5 cases of acute open injury and 13 ones of acute closed injury. COVID-19 infection was diagnosed or suspected in 5 cases but not in the other 13 cases. Emergency operation was carried out for 2 patients with open injury plus COVID-19 infection and one with complicated pilon fracture plus COVID-19 infection, one of whom received secondary operation. One patient with closed fracture of the left calcaneus plus COVID-19 infection was hospitalized from emergency department for secondary surgery, and another with closed fracture of the right lateral malleolus was referred to the isolation ward after emergency plaster fixation. Of the 10 patients with closed injury but without COVID-19 infection, 3 received conventional secondary surgery after admission and the others conservative treatment at the outpatient department. Recorded were COVID-19 infections in the patients after admission and in the medical staff. The measures taken and experience in control and prevention of COVID-19 infection after outbreak of the epidemic were reviewed.Results:Of the 11 patients who had been hospitalized for foot and ankle injury in emergency, 5 were definitely diagnosed of or suspected of COVID-19 infection and 6 free of COVID-19 infection. During hospitalization, COVID-19 infection was confirmed in the 5 cases and no COVID-19 infection occurred in the other 6 patients. No COVID-19 infection occurred in the medical staff; no cross infection was observed between the patients and the medical staff.Conclusions:Reasonable strategies are advised to balance the foot and ankle surgery and epidemic prevention. A simplified management is not advised for all the cases. The operative procedures in emergent foot and ankle surgery should be optimized in line with the epidemic control and prevention principles to facilitate functional rehabilitation for the patients.

Objective To evaluate the outcomes achieved by using left internal mammary artery(LIMA) to radial artery (RA) total arterial composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease.Methods From January 2009 to September 2015, 39 patients(24 males) with multiple vessel disease underwent MIDCAB with LIMA-RA total arterial composite grafts without cardiopulmonary bypass in our hospital .MIDCAB was performed through a left anterior minithoracotomy .Results All patients successfully underwent MIDCAB with LIMA-RA total arterial composite grafts.No patient required to convert to strenotomy during the surgery.Mean operation time was(176.1 ± 14.1)min.Revascularization was performed for 2 target vessels in 11 cases, 3 target vessels in 25 cases and 4 target vessels in 3 cases.Mean postoperative ventilation time was(21.9 ±27.9) h.Mean ICU time was(2.8 ±2.1) days, and mean postoper-ative inhosptial time was(11.2 ±3.3)days.There was no early death in perioperation.At a follow-up of 6 to 86 months[aver-age(27.5 ±18.0) months], one patient died.The overall survival at 2 years postoperatively was(96.0 ±3.9)%.The paten-cy rate of LIMA was 100%.The overall patency rate of RA grafts at 2 years postoperatively was(91.8 ±4.0)%.Conclusion MIDCAB with LIMA-RA total arterial composite grafts is a safe and effective procedure with favorable early and mid-term out-comes for patients with multiple vessel disease .

Objective To review the literature and synthesize current evidence on the use of kidneys with small renal cancer as donor kidneys.Method To locate eligible studies,four bibliographic databases including PubMed,Embase,Cochrane Library and ClinicalTrials.gov were screened,while key informants were collected and bibliographies of included studies were scrutinised.Two reviewers independently assessed studies for inclusion,extracted data.Data were synthesised as a narrative review.Results 1680 articles were found while eventually 15 studies were selected for this systematic review.All of the 15 included studies were case reports or case series.Totally 96 documented cases of donor kidneys after resection of small renal cancer were transplanted and no definite recurrence happened.Conclusion It is suggested from current limited evidence that cancer recurrence rate of allotransplanting kidney after resection of SRC was relatively low,thus it deserved much more well-designed clinical trials and clinical use.

Objective To summarize the clinical characteristics,diagnosis and treatment of malignant tumor after renal transplantation.Methods The clinical data of 2106 renal transplants in 1945 patients undertaken in our hospital from September 1978 to December 2009 was retrospectively studied.Results Of these 1945 patients, 39 cases were diagnosed as having malignant tumor (incidence: 2.0 ％).The interval between transplantation and clinical diagnosis ranged from 8 to 124 months with a median of 57.0 months.Among the 39 cases of malignancy, there were 22 urinary system carcinomas, 8 digestive system carcinomas,2 lung cancers,2 breast cancers,2 lymphomas,1 dura small cell carcinoma,1 pleura poorly differentiated carcinoma and 1 metastatic carcinoma of liver with unknown primary tumor. Surgery was conducted in 28 patients,of which 16 were survived but the other 12 patients died of metastasis ranged from 3 months to 96 months (median,33 months) after operation.11 cases without operation died within from 3 d to 36 months (median,5 months) after diagnosis.Conclusions The incidence of malignant tumors in renal transplant recipients increased markedly.The most common type of the malignant tumors is urinary system carcinoma.The key measure of success in treating malignancy after renal transplantation is early diagnosis and surgical resection.

Objective To summarize the preliminary experience of early anticoagulant therapy after endovascular stent graft exclusion for Stanford B type aortic dissection.Methods From June 2006 to June 2011,75 patients[ 65 males,10 fe males,mean age (59.1±13.5) years,range 22 -81 years ] under went endovascular stent-graft exclusion for Stafford B type aortic dissection in Shanghai Xinhua Hospital.Computed tomography angiography (CTA) was used to evaluate the lesions of aortic dissection before endovascular stent-graft exchusion.The descending thoracic aortic diameters were 22 mm to 42 mm [ mean (30.3±4.0) mm ].The distance from the breakage of dissection to the left vertebral artery(LSA)was longer than 1.5 mm in 29 cases,and shorter than 1.5cmin 46 cases.During the operation,left subclavian artery revascularization was per formed to patient,whose left vertebral artery was advantage and needs to be fully or partially covered From the second day after operation,asprin was given to patint,whose left subclavian artery was fully or partially coverd by endovascular stent-graft(no endoleak and residual distal tear).Early anticoagulant therapy lasted 3 months.The symptoms or signs about nervous system were observed in the early stage of postoperation,and the CTA was examined at postoperative 3 months.Results The operation succeeded in 75 patients.The diameters of aortic stent were 26mm to 46rmm[ mean(34.3±4.0) mm ].Left subclavian ar tery revascularization was carried out for 2 cases of all patients.The left subclavian artery was fully or partially coverd in 58 patients(fully covered in 19 cases,2/3 covered in 15 cases,1/2 covered in 24 cases),and 56 patints(no endoleak and residualdistal tear) were given anticoagulant therapy to prevent vertebral artery thrombosis.2 patients(2.7％)died in the early stage after operation.1 patient died of renal failure,1 patient died of dissection rupture,The duration of hospitalization was 4 to 19 days [ mean (7.9±3.5)days ].No neurological complications occurred in hospital.The follow-up period was 6 to 66 months.1 patient died during the follow-up,1 patient had recurrence of Stanford A type aortic dissection and was cured by ascending aorta and aortic arch replacement,1 patient had recurrence of Stanford B type aortic dissection and was cured by second endovascular stent-graft exclusion.All patients had no neurological complications,such as cerebral infarction and paraplegia.Concluslon Early anticoagulant therapy could safely and effectively prevent the neurological complications (such as cerebral infarction and paraplegia) related to vertebral artery thrombosis for Stanford B type aortic dissection patients whose left subclavian artery was fully or partially coverd by endovascular stent-graft.

Objective To analyze the epidemiographic features of urological de novo malignant tumor in kidney transplant recipients in the General Hospital of Jinan Military Command.Methods The clinical data of 1945 patients who received kidney transplantation between September 1978 and December 2009 were retrospectively studied.Among 1945 recipients,22 cases were diagnosed as having urological de novo malignant tumors ( incidence:1.13％ ),including renal papillary adencaicinoma (n =1 ),papillary renal cell carcinoma (n =1 ),renal hemangiosarcoma (n =1 ) ; pelvic transitional cell carcinoma (TCC) (n =1 ),pelvic and ureter TCC (n =6),ureter TCC (n =7),pelvic and ureter and urinal bladder TCC (n =1 ),4 cases of bladder malignant tumors (including 3 cases of bladder TCC and 1 case of borderline bladder tumor).Of the 22 cases,17 had a main clinical manifestation of gross hematuria and 2 had microscopic hematuria,and the rest 3 had no obvious symptom.The average age at diagnosis of these 22 cases was 54.3 ± 12.3 years,with a mean time of 53 months after kidney transplantation.Ten cases received immunosuppressive treatment by using cyclosporine A (CsA) + azathioprine (Aza) + prednisone (Pred),while the remaining 12 received CsA + MMF + Pred.Surgical treatment was carried out in all cases:radical nephrectomy was conducted for 3 cases of renal carcinoma; total resection of kidney,ureter and sleeve-shaped resection of bladder in affected side were conducted for the 15 cases of pelvis or ureter carcinoma; for the 4 cases of bladder carcinoma,transurethral resection of bladder tumor was conducted for 3 cases while partial cystectomy was conducted for the other one case.Results During a follow-up period of 2 to 97 months,there were 9 deaths 6 to 97 months after toumorectomy.One died of bone metastasis,one pulmonary metastasis,two brain metastasis,two hepatic metastasis,and three extensive metastatic tumor soon after the diagnosis.Thirteen patients survived through the follow-up,with the longest survival time being 92 months in one patient with urinary bladder tumor.Four patients survived longer than 4 years,and 5 cases longer than 1 year.Conclusion Urological de novo malignant tumor is an important complication after renal transplantation with a main clinical manifestation of painless gross hematuria,and surgical resection is the most important treatment.