Objective:To evaluate the efficacy of arthroscopic minimally invasive reduction in the treatment of talus posterior process fractures.Methods:The clinical data were retrospectively studied of the 42 patients with talus posterior process fracture who had been admitted to Department of Orthopedics, The Fourth Hospital of Wuhan from January 2010 to June 2021. There were 25 males and 17 females, aged from 21 to 60 years (average, 40.5 years). They were assigned into 2 groups according to their different treatments. In the arthroscopic group of 15 cases, arthroscopic reduction and internal fixation (ARIF) were conducted via the posteromedial and posterolateral approaches; in the open reduction group of 27 cases, open reduction and internal fixation (ORIF) were conducted via the posteromedial para-Achilles approach. The 2 groups were compared in terms of operation time, blood loss, hospital stay, fracture clinical healing time, postoperative complications, and the American Society for Foot and Ankle Surgery (AOFAS) ankle-hindfoot score at one year postoperation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P> 0.05). The arthroscopic group incurred significantly less blood loss [(32.0±11.5) mL], hospital stay [(5.3±1.8) d], and fracture clinical healing time [(4.6±1.0) months], and a significantly lower incidence of postoperative complications [20.0% (3/15)] than the open reduction group did [(80.0±15.2) mL, (8.4±2.4) d, (6.3±2.2) months, and 29.6% (8/27)], but significantly longer operation time [(74.0±8.9) min] than the open reduction group [(62.9±5.1) min] ( P<0.05). The AOFAS ankle-hindfoot scores at one year postoperation in both groups were higher than those before operation. The AOFAS ankle-hindfoot scores in the arthroscopic group [(83.0±13.0) points] were significantly higher than those in the open reduction group [(72.3±16.0) points] ( P<0.05). Conclusion:ARIF is a preferred minimally invasive treatment for talus posterior process fractures, because it leads to a smaller incision, less blood loss, shorter hospital stay, quicker clinical healing, a lower incidence of postoperative complications, and better functional improvement of the ankle and hindfoot than ORIF.

Objective? To?explore?the?clinical?effect?of?laparoscopic?exploration?in?the?diagnosis?and?treatment?of?abdominal?open?trauma.? Methods? Patients?with?abdominal?open?trauma?admitted?to?the?First?Affiliated?Hospital?of?Dalian?Medical?University?from?August?to?December?in?2018?were?enrolled.?According?to?different?exploration?methods,?11?patients?undergoing?laparoscopic?exploration?were?grouped?into?laparoscopy?group?and?20?patients?undergoing?exploratory?laparotomy?were?grouped?into?laparotomy?group.?The?operation?time,?the?length?of?hospital?stay,?cases?without?abdominal?visceral?injury,?postoperative?exhaustion?time,?cases?with?complications?and?incision?length?were?compared?between?the?two?groups.? Results? All?the?31?patients?were?experienced?with?knife?stab?wound,?with?26?males?and??5?females,?and?the?age?was?(33.39±11.47)?years?old.?Compared?with?the?laparotomy?group,?the?length?of?hospital?stay?was?significantly?shorted?in?the?laparoscopy?group?(days:?6.64±2.94?vs.?11.65±5.62),?the?postoperative?exhaustion?time?was?significantly?decreased?(hours:?40.36±29.04?vs.?75.60±42.84),?the?cases?with?complication?was?significantly?decreased?(case:?1?vs.?9),?the?incision?length?was?significantly?shorted?(cm:?5.50±5.14?vs.?16.95±5.28),??all?of?which?results?had?statistical?significance?(all?P??0.05).?Confirmed?by?surgical?exploration,?5?patients?had?no?abdominal?visceral?injury,?with?3?in?the?laparoscopy?group?and?2?in?the?laparotomy?group,?and?the?result?had?no?significant?difference?between?the?two?groups?(P?>?0.05).? Conclusion? For?patients?with?abdominal?open?trauma,?laparoscopic?exploration?is?helpful?for?diagnosis?as?quickly?as?possible,?with?less?trauma?and?reduction?of?complications?incidence,?and?is?conducive?to?postoperative?rehabilitation.

Objective To evaluate the efficacy of arthroscopic Brostr(o)m technique in the treatment of chronic ankle instability.Methods Seventeen patients with chronic ankle instability were treated at Department of Foot and Ankle Surgery,Wuhan Fourth Hospital from March to December 2016.They were 5 males and 12 females,aged from 18 to 52 years (mean,28 years).The ankle instability confirmed preoperatively involved the left side in 9 cases and the right side in 8 ones.Arthroscopic Brostr(o)m technique was used to repair the anterior talofibular ligament.All the patients were evaluated preoperatively and at the last follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS).The talar tilt angle and anterior translation were also assessed radiographically in pre-and postoperative ankle stress views.Results They obtained a mean follow-up of 12 months (range,from 10 to 18 months).Wound infection occurred in none of the patients;paresthesia appeared in the superficial fibular nerve area in one case which was recovered spontaneously.At the last follow-up,their AOFAS scores were improved from preoperative 47.5 ± 3.4 to 95.7 ± 2.1,VAS pain scores were decreased from preoperative 5.7 ± 1.8 to 1.6 ± 1.4,anterior talar translation was reduced from preoperative 10.12 ± 3.23 mm to 4.02 ± 1.68 mm,and talar tilt angle decreased from 15.20° ± 3.43° to 6.02° ± 2.64°.All the above differences were statistically significant (P ＜ 0.05).Conclusion Arthroscopic Brostr(o)m technique may be considered as a valid option for treatment of chronic ankle instability,because it can well restore the stability of ankle joint and lead to satisfactory short-term results.

Objective To observe the apoptosis of interstitial cells of Cajal in deep muscular layer ( ICC-DMP ) of small intestine in rats with multiple organ dysfunction syndrome ( MODS ) as a result of bacterial peritonitis, and the expression of c-kit ( an ICC phenotype marker ) and Bax/Bcl-2, in order to investigate the mechanism of gastrointestinal motility dysfunction in MODS. Methods According to the random number table, 40 Wistar rats were randomly divided into two groups:control group ( n=20 ) and MODS group ( n=20 ). The MODS model in rats was reproduced by intraperitoneal injection of 8×108 cfu/mL Escherichia coli suspension 1 mL, and the control group was given the same amount of normal saline. After 24 hours, the upper small intestine was harvested for examination. Ultrastructure of ICC-DMP was observed using electron microscope. The network structure of ICC-DMP and the expression of c-kit and Bax/Bcl-2 were observed and determined with immunofluorescence and laser scanning confocal microscope. Results Macroscopic observation revealed that the gastrointestinal motility of rats was normal in the control group. Compared with the control group, gastro intestine was significantly expanded with parulytic ileus in MODS group. It was shown by transmission electron microscopy that intermediate filament structure of ICC-DMP was clear without swelling of mitochondria; chromatin distributed uniformly with small amounts of heterochromatin aggregated in perinuclear. Compared with the control group, intermediate filament structure of ICC-DMP was fuzzy, and mitochondria were swollen obviously in MODS group;chromatin was assembled in nucleus centre. It was shown by laser scanning confocal microscope that the network structure of ICC-DMP was clear, the expression of c-kit and Bcl-2 was strongly and overlapping;the expression of Bax was weak and scatter distributed. Compared with control group, ICC-DMP quantity in MODS group was significantly reduced ( cells/HP: 15.80±2.30 vs. 25.70±3.97, t = 6.819, P = 0.000 ), and ICC network was incomplete. The expression of c-kit and Bcl-2 was significantly decreased as compared with control group [ c-kit ( fluorescence intensity ):129.56±36.90 vs. 307.23±40.07, t=10.314, P=0.000;Bcl-2 ( fluorescence intensity ):103.23±25.19 vs. 378.92±43.79, t=17.259, P=0.000 ], whereas, the expression of Bax was significantly increased ( fluorescence intensity:270.94±36.98 vs. 92.57±20.92, t=-13.277, P=0.000 ). Conclusion The mechanism of gastrointestinal motility dysfunction in MODS maybe closely related to ultrastructural damage of ICC-DMP, changes of c-kit phenotypic and activation of mitochondrial apoptosis pathway.

ObjectiveTo discuss the mechanism of promotion of gastrointestinal motility during multiple organ dysfunction syndrome ( MODS ) by Dachengqi decoction, by examining the expression of Bcl-2, Bax of mitochondrial pathway, and nuclear factor-κB (NF-κB) in smooth muscle of the small intestinal in rats.Methods According to the random number table, 100 healthy adult Wistar rats were divided into three groups: control group with 20 rats, model group with 40 rats, and Dachengqi decoction group with 40 rats. Rat model of MODS was reproduced by bacterial peritonitis induced by an injection of 1 mLEscherichia coli suspension (8×108 cfu/mL) into peritoneal cavity. The rats in control group were given 1 mL normal saline intraperitoneally. The rats in Dachengqi decoction group were given 10 mL/kg Dachengqi decoction by gavage, twice a day, before inoculation of the bacterial suspension. Twenty-four hours after modelling, rats in all groups were sacrificed by cervical vertebra luxation, and the upper small intestine was harvested to detect the protein expressions of Bcl-2, Bax, and NF-κB in smooth muscle tissue using immunohistochemical staining.Results In the control group, a large amount of Bcl-2 protein was expressed and it was distributed uniformly in small intestinal smooth muscle. On the other hand, a small amount of Bax and NF-κB protein was expressed, and they were also distributed uniformly. Compared with the control group, Bcl-2 protein was distributed only sparsely, and it was scattered in intestinal smooth muscle in blocks in the model group. The expression of Bcl-2 protein was obviously down-regulated [integral optical density (A) value: 7 115.3±1 797.2 vs. 22 085.5±4 892.2, P< 0.05], and this phenomenon was more prominent in circular muscle layer. Bax and NF-κB were densely distributed, and their expressions were upgraded obviously [Bax (A value): 33 802.6±5 778.0 vs. 7 984.4±1 804.5, NF-κB (A value): 2 465.9±664.8 vs. 1 572.6±256.0, bothP< 0.05]. This phenomenon was more outstanding in circular muscle layer. Compared with that of the model group, the expression of Bcl-2 protein was stronger obviously in intestinal smooth muscle in Dachengqi decoction group (A value: 12 458.6±2 491.1 vs. 7 115.3±1 797.2,P<0.05). The expressions of Bax and NF-κB were down-regulated obviously [Bax (A value): 12 529.2±2 018.5 vs. 33 802.6±5 778.0, NF-κB (A value): 1 843.1±373.6 vs. 2 465.9±664.8, bothP< 0.05], and the change was more obvious in circular muscle layer.Conclusions Dachengqi decoction may promote recovery of gastrointestinal motility through an increase of Bcl-2 expression in nuclear membrane, thus preventing translocation of Bax to mitochondrion, thereby reduces mitochondrial damage in MODS.