BACKGROUND:Lisfranc ligament is an important structure to maintain the transverse and longitudinal arch of the foot.This injury is a serious middle-foot injury.Lisfranc ligamentous injuries are complex,and their treatment,along with the preferred method of fixation,is controversial. OBJECTIVE:To compare the short-term efficacy of plate combined with Suture tape versus plate combined with headless compression screw in the treatment of Lisfranc injury with comminuted fractures of the 1st and 2nd proximal metatarsal bones. METHODS:A retrospective analysis was performed on 48 patients with Lisfranc injury due to comminuted fractures of the 1st and 2nd proximal metatarsal bones in Seventh Department of Orthopedics,Dongguan Hospital of Traditional Chinese Medicine from January 2019 to June 2022.Among them,25 were fixed with plate combined with Suture tape(observation group)and 23 were fixed with plate combined with headless compression screw(control group).Preoperative classification was performed according to Myerson classification system based on preoperative imaging data.Postoperative follow-up was performed according to fracture healing time,visual analog scale,and American Orthopaedic Foot and Ankle Society(AOFAS)criteria to assess the recovery of foot functions.Postoperative complications were compared and analyzed between the two groups. RESULTS AND CONCLUSION:(1)All cases completed the operation successfully and obtained follow-up in the two groups.The postoperative follow-up time of the two groups was 12-36 months,with a mean of(18.0±5.42)months.(2)There were no significant differences in operation time and intraoperative blood loss between the two groups(P>0.05).(3)The fracture healing time of observation group was slightly longer than that of control group(P<0.05).(4)After 3,6,and 12 months of follow-up,the visual analog scale score of the observation group was significantly lower than that of the control group(P<0.05).(5)At 6 and 12 months after operation,AOFAS score of foot function in the observation group was significantly improved compared with the screw group at various time points after operation(P<0.05),and was significantly higher than that before operation(P<0.05).(6)The postoperative complications were 1 case of traumatic arthritis in the observation group and 1 case of incision infection,1 case of screw fracture,and 2 cases of traumatic arthritis in the control group.There was no significant difference between the two groups(P>0.05),considering the correlation with a small sample size.(7)It is indicated that as for the surgical method of Lisfranc injury with comminuted fractures of the 1st and 2nd proximal metatarsal bones,the application of plate combined with Suture tape internal fixation has a reliable effect in the treatment of Lisfranc joint injury,which can improve the function of the foot joint of patients,and has the advantages of less surgical trauma,fewer postoperative complications,and lower risk of long-term iatrogenic traumatic arthritis.Compared with headless compression screw,it is more beneficial to the recovery of foot function.

Objective To observe the expression of GLIS3 in triple negative breast cancer(TNBC)and analyze its relationship with the prognosis of TNBC patients.Methods Bioinformatic analysis was applied to analyze the expression level of GLIS3 in Gene Expression Omnibus(GEO).Kaplan-Meier survival curve was plotted to evaluate the impact of GLIS3 expression on the survival rate of patients based on DNA chip data.A total of 125 patients pathologically diagnosed as TNBC in the Fourth Hospital of Hebei Medical University from January to December 2014 were enrolled by cluster random sampling.Among them,53 patients had complete tissue specimens,medical records and follow-up data.Immunohistochemical assay was used to detect the expression of GLIS3 in TNBC and adjacent tissues to tumors,while the relationships between GLIS3 protein expression in breast cancer tissues and clinicopathological parameters such as age,menstrual status,tumor size,clinical stage,histological grade,pathological type,axillary lymph node metastasis,vascular tumor thrombus,and expression of TP53 and Ki-67 were analyzed.Kaplan-Meier survival curve was plotted to analyze the effect of GLIS3 on the overall and disease-free survival of TNBC patients.Cox regression model was established to identify the risk factors impacting the prognosis of the patients.Results Analysis of GEO data showed that the expression of GLIS3 in TNBC was significantly higher than that in paracancer tissues(P＜0.05).The expression of GLIS3 was notably higher in the TNBC tissue than the adjacent tissue to tumor(P＜0.05).A marked augmentation of GLIS3 expression was observed in both the advanced and larger-sized tumors(P＜0.05).Univariate analysis of Cox regression model revealed that lymph node metastasis,TNM stage and GLIS3 expression were all related to disease-free survival of TNBC patients(P＜0.05).Univariate and multivariate analyses displayed that TNM stage was related to the overall survival of TNBC patients(P＜0.05).The patients with high expression of GLIS3 had significant shorter disease-free survival time than those with low expression(P＜0.05),but had no statistical difference in overall survival(P＞0.05).Conclusion GLIS3 protein is highly expressed in TNBC tissues,and tumor size and TNM stage are correlated with its high expression.The high expression of GLIS3 suggests that the patients have poor prognosis and low disease-free survival rate.

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the efficacy of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects who were previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extended or switched TMF treatment for 48 weeks. Efficacy was evaluated based on virological, serological, biological parameters, and fibrosis staging. Statistical analysis was performed using the McNemar test, t-test, or Log-Rank test according to the data. Results:593 subjects from the initial TMF group and 287 subjects from the TDF group were included at week 144, with the proportions of HBV DNA<20 IU/ml at week 144 being 86.2% and 83.3%, respectively, and 78.1% and 73.8% in patients with baseline HBV DNA levels ≥8 log10 IU/ml. Resistance to tenofovir was not detected in both groups. For HBeAg loss and seroconversion rates, both groups showed a further increase from week 96 to 144 and the 3-year cumulative rates of HBeAg loss were about 35% in each group. However, HBsAg levels were less affected during 96 to 144 weeks. For patients switched from TDF to TMF, a substantial further increase in the alanine aminotransferase (ALT) normalization rate was observed (11.4%), along with improved FIB-4 scores.Conclusion:After 144 weeks of TMF treatment, CHB patients achieved high rates of virological, serological, and biochemical responses, as well as improved liver fibrosis outcomes. Also, switching to TMF resulted in significant benefits in ALT normalization rates (NCT03903796).

Objective:In chronic hepatitis B (CHB) patients with previous 96-week treatment with tenofovir amibufenamide (TMF) or tenofovir disoproxil fumarate (TDF), we investigated the safety profile of sequential TMF treatment from 96 to 144 weeks.Methods:Enrolled subjects that previously assigned (2:1) to receive either 25 mg TMF or 300 mg TDF with matching placebo for 96 weeks received extending or switching TMF treatment for 48 weeks. Safety profiles of kidney, bone, metabolism, body weight, and others were evaluated.Results:666 subjects from the initial TMF group and 336 subjects from TDF group with at least one dose of assigned treatment were included at week 144. The overall safety profile was favorable in each group and generally similar between extended or switched TMF treatments from week 96 to 144. In subjects switching from TDF to TMF, the non-indexed estimated glomerular filtration rate (by non-indexed CKD-EPI formula) and creatinine clearance (by Cockcroft-Gault formula) were both increased, which were (2.31±8.33) ml/min and (4.24±13.94) ml/min, respectively. These changes were also higher than those in subjects with extending TMF treatment [(0.91±8.06) ml/min and (1.30±13.94) ml/min]. Meanwhile, switching to TMF also led to an increase of the bone mineral density (BMD) by 0.75% in hip and 1.41% in spine. On the other side, a slight change in TC/HDL ratio by 0.16 (IQR: 0.00, 0.43) and an increase in body mass index (BMI) by (0.54±0.98) kg/m 2 were oberved with patients switched to TMF, which were significantly higher than that in TMF group. Conclusion:CHB patients receiving 144 weeks of TMF treatment showed favorable safety profile. After switching to TMF, the bone and renal safety was significantly improved in TDF group, though experienceing change in metabolic parameters and weight gain (NCT03903796).

Objective:To investigate the clinical effect of turbocharged large free anterolateral thigh flaps (ALTF) by anastomosis with a superior perforator of the flap in reconstruction of large soft tissue defects of limbs.Methods:From June 2017 to June 2021, 6 patients with large soft tissue defects of limbs with exposed joints and tendons were treated in the Department of Hand and Foot Surgery of the Affiliated Hospital of Qingdao University with turbocharged large free ALTFs. The pressurised blood supply of ALTF was achieved by anastomosing a superior perforating branch carried in the flap. Such large and turbocharged ALTFs were used to repair large soft tissue defects with exposed joints and tendons in limbs. Of the 6 patients, there were 4 males and 2 females, and aged 32-60(46.0±8.1) years old. Cause of injury: 5 by traffic accident and 1 by machine crush. Four patients had soft tissue defects in lower limbs: 2 with open tibia and fibula fractures, 1 had patellar defect and fibula fracture, and 1 associated with fibula fracture. The other 2 patients had soft tissue defect in upper limbs with bone and tendon exposed but without fracture. The sizes of wound were 25.0 cm×12.0 cm-35.0 cm×19.0 cm. In the primary surgery, Vacuum sealing drainage (VSD) was applied. In the second stage, free ALTFs were used to cover the wound. The area of flap incision was increased by anastomosing the superior perforators and as the consequence, the size of flaps was achieved to 26.0 cm×13.0 cm-36.0 cm×15.0 cm. Donor site of 6 cases were reduced by direct suture, and the remaining wound was covered by free skin graft. Postoperative follow-ups were conducted at outpatient clinic reviews at 1, 2, 3 and 6 months after surgery, and followed by telephone or WeChat interviews. The results of the operation were evaluated according to the appearance, texture and sensory recovery of the flap.Results:All 6 flaps survived and the patients completed the postoperative follow-up that lasted for 6-24 (16.7±5.0) months. No necrosis of flap occurred after surgery. The appearance and texture of the flaps were satisfactory without wear and tear. Sensation recover was evaluated by the standered of British Medical Research Council (BMRC), 4 patients recovered to S 3 and 2 patients to S 2. The Mayo score of the elbow joint was good in 2 patient with upper extremity injuries. Of the other 4 patients with lower limb injuries, the knee function evalued by Hospital for Special Surgery(HSS) score were excellent in 3 patients and good in 1 patient, and the American Orthopedic Foot and Ankle Societ(AOFAS) ankle-hind foot function score was excellent in 2 patients and good in 2 patients. There was no infection or function loss at all donor sites. Conclusion:The perforator of an ALTF is relatively constant, and the flap can partially restore sensation. The superior perforator is reliable and the incision area of the flap can be enlarged by anastomosing the superior perforator vessels. It is a better way to reconstruct a large soft tissue defects in limbs.

Objective:To investigate the clinical effect of free posterior tibial artery perforator flap in repair of forefoot soft tissue defect.Methods:From January 2017 to January 2021, a retrospective study was conducted on 13 patients with forefoot soft tissue defect, metatarsal head exposed, and forefoot transverse arch integrity, including 9 males and 4 females. The age was (40.0±13.0) years old. Cause of injury: 8 cases of traffic accident injury, 5 cases of heavy object smashing injury. Seven cases had forefoot skin defect and toe damage, and 6 cases had forefoot skin avulsion injury, open toe fracture with tendon, blood vessel and nerve injury. The wound area was 4.5 cm×3.0 cm-8.0 cm×6.0 cm. VSD treatment was performed in the first stage, and free posterior tibial artery perforator flap was used for the second stage. The flap area was 5.5 cm×4.0 cm-9.0 cm×7.0 cm. Outpatient reviews scheduled at 1, 2, 3, and 6 months after surgery, through outpatient clinic, telephone or WeChat. The flaps were evaluated according to appearance, texture, sensory recovery, and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot function scoring system.Results:All 13 flaps survived. The follow-up lasted for 6 to 24 months. The feet were in good shape, walking with weight beries, and the flaps had satisfactory appearance without wear and tear. Five cases were S 3, 6 were S 2, and 2 were S 1. According to AOFAS ankle-hindfoot function score, 4 had excellent scores, 7 were in good, and 2 in fair. Conclusion:The free posterior tibial artery perforator flap has relatively constant perforators, and the pedicle of the middle and upper perforators is longer, and the flap can build part of the sensation. Posterior artery perforator flap is a good flat for repairing the soft tissue defects of the metatarsal head of the forefoot.

Objective:To investigate the effects of supplemental parenteral nutrition on postoperative nutritional status, immune function and inflammatory response in patients with esophageal cancer after operation.Methods:A prospective study was performed on 72 patients with esophageal cancer who visited the Department of Thoracic and Cardiovascular Surgery of the Affiliated Hospital of Putian University from June 2018 to June 2020. According to the random table of new drug data statistics and processing software, they were randomly divided into experimental group (supplementary parenteral nutrition group) and the control group (complete enteral nutrition group), with 36 cases in each group. The experimental group was given enteral nutrition (EN) from the first day after operation, and EN and parenteral nutrition (PN) was given on the 4th to 8th day after operation. In the control group, EN was started on the first day after operation. The changes of nutritional status, immune function and inflammatory indexes in the perioperative period were compared between the two groups. Mann-Whitney U test was used for measurement data that did not meet the normality standard, and t test was used to compare measurement data that met the normality standard between groups. Nutrition indicators, inflammatory indicators and immune indicators used repeated measures analysis of variance. For enumeration data, Mann-Whitney U test was used for hierarchical classification data, and χ 2 test was used for unordered multi-classification data. Results:On the 1st day after operation, the prealbumin concentration ((95.34±37.93) mg/L and (81.60±37.68) mg/L) in the experimental group and the control group was significantly higher than that before the operation ((144.86±46.79) mg/L and (130.39±50.91) mg/L), and the differences were statistically significant (all P<0.001), and there was no significant difference between the two groups (all P>0.05). Immunoglobulin (Ig) A ((0.48±0.39) g/L and (0.41±0.30) g/L), IgG ((4.21±3.44) g/L and (4.08±2.98) g/L), IgM( (0.32±0.26) g/L and (0.30±0.27) g/L) in the experimental group and the control group were compared with preoperative ((0.55±0.45) g/L and (0.47±0.39) g/L, (5.16±3.36) g/L and (5.48±3.30) g/L, (0.38±0.32) g/L and (0.35±0.30) g/L), and the difference was not statistically significant (all P>0.05), and there was no significant difference between the two groups (all P>0.05). In the experimental group and the control group, CD3 ((31.75±11.81) % and (28.03±9.30)%) were lower than those before operation ((40.86±12.50)% and (42.31±8.09)%), CD4 ((14.19±5.39)% and (16.06±9.08)%) were lower than those before operation ((21.69±8.54)% and (24.11±12.09)%), CD4/CD8 ((0.24±0.09) and (0.29±0.18)) were lower than those before operation ((0.42±0.16) and (0.50±0.28)), and CD8 ((59.03±8.14)% and (56.39±7.42)%) were lower than those before operation ((51.25±6.64)% and (49.14±6.53)%), the differences were statistically significant (all P<0.05). There was no significant difference in C3, C4 and C reactive protein (CRP) compared with preoperatively (all P>0.05), and there was no significant difference between the two groups (all P>0.05). On the 7th day after operation, the prealbumin concentration ((186.70±40.88) mg/L) in the experimental group was higher than that before operation and on the 1st day after operation, and the difference was statistically significant (all P<0.05), which was higher than that in the control group ((131.62±53.37) mg/L), the difference was statistically significant (all P<0.05); the prealbumin concentration in the control group ((131.62±53.37) mg/L) was higher than that on the 1st day after operation, and the difference was statistically significant (all P<0.05). IgA ((0.88±0.42) g/L), IgG ((10.70±4.39) g/L) in the experimental group was higher than that before operation, and the difference was statistically significant (all P<0.05), and it was higher than that on the 1st day after operation, and the difference was statistically significant (all P<0.05), lower than those in the control group ((0.59±0.44) g/L and (4.08±2.98) g/L), the difference was statistically significant (all P<0.05). In the test group, CD3 ((45.92±14.31)%), CD4 ((27.06±10.53)%), CD4/CD8 (0.66±0.33) increased and and CD8 (43.64±11.34%) decreased compared with the first day after operation, with statistically significant differences (all P<0.05). The elevated levels of CD4 and CD4/CD8 were statistically significant compared with the control group (all P<0.05). The CRP ((8.90±7.56) mg/L) in the experimental group on the 7th postoperative day was lower than that before operation and on the 1st postoperative day, and the difference was statistically significant (all P<0.05), which was lower than the control group ((16.24±13.53) mg/L), the difference was statistically significant (all P<0.05). The incidence of postoperative pulmonary infection (22.22% (8/36)), the incidence of anastomotic leakage (5.56% (2/36)), and the postoperative hospital stay ((14.17±4.79) d) in the experimental group were lower than those in the control group (44.44% (16/36), 25.00% (9/36), (18.47±6.34) d), the total hospitalization expenses in the experimental group ((71 261.94±11 503.50) yuan) were higher than those in the control group ((65 226.81±10 106.43) yuan), the difference was statistically significant (the statistical values were χ 2=4.00, χ 2=5.26, t=3.74, t=2.37; P values were 0.046, 0.022, <0.001 and 0.021, respectively). Conclusion:Supplemental parenteral nutrition for perioperative esophageal cancer patients can effectively maintain nutritional status, improve immune function, and reduce the inflammatory stress response.

Objective:To explore the clinicopathological features, immunophenotype and molecular genetic characteristics of malignant solitary fibrous tumor (MSFT).Methods:Seven cases of MSFT were collected from the First Affiliated Hospital of Zhengzhou University from July 2018 to December 2020. Immunohistochemistry, RNA-based NGS and DNA-based NGS were performed. Results Among the 7 patients, there were 5 males and 2 females with a median age of 53 years (37-69 years). Two tumors located at skull base, and one in the tentorium of cerebellum, parietal occipital region, occipital area, chest and buttock respectively. The maximum diameter of the tumor was 2.5-20.0 cm. Microscopically, typical hemangiopericomatoid structures were noted; the tumor was cellular, fusiform or oval, very pleomorphic, with necrosis and high mitotic figures (>4/10 HPF). In some cases, classical solitary fibrous tumor morphology and dedifferentiated region were observed. Immunohistochemically, the tumor was positive for CD34 (6/7), STAT6 (7/7), bcl-2 (7/7), but negative for S-100 (7/7); CKpan or EMA was positive to varying degrees; mutated p53 was noted (3/7); Ki-67 positive index was more than 10%. NAB2-STAT6 gene fusion was typically detected in all the 7 cases. In 4 cases, ZNF415-FGFR1, COPG1-MET, IPO11-LRRC70_ncRNA-PLAG1 and Clorf198-CD274 (PD-L1) gene fusions were also detected. NOTCH1 mutation was found in 7 cases and TP53 mutation in 4 cases. TERT promoter mutations were not detected in all the cases. Conclusions:MSFT is rare and needs to be differentiated from many other spindle cell tumors. Especially when tumors express epithelial markers, they are easily misdiagnosed as sarcomatoid carcinoma and synovial sarcoma, etc. Immunohistochemistry and molecular detection of NAB2-STAT6 gene fusion have important diagnostic values. NOTCH1 and TP53 mutations may be associated with the progression of MSFT. Some patients have FGFR1 gene fusion and MET gene fusion, which may be potential therapeutic targets.

Objective:To explore the clinical effects of fractional carbon dioxide laser combined with autologous fat injection in the treatment of hypertrophic scar after burn.Methods:From April 2018 to April 2019, 12 patients with hypertrophic scar after burn who met the inclusion criteria were admitted to the Department of Plastic Surgery and Burns of Xuzhou Renci Hospital, and were included in this prospective randomized controlled clinical study. There were 7 males and 5 females with age of (32±11) years and scar area of (612±195) cm 2. One scar was selected from each patient and divided into two equal area scars, and they were divided into combined treatment group and laser alone group with 12 scars in each group according to the random number table. The scar in laser alone group was only treated with fractional carbon dioxide laser, while the scar in combined treatment group was injected with autologous granular fat and then treated with fractional carbon dioxide laser. Scars in the two groups were treated once every 2 months, totally 3 times. Before the first treatment and 6 months after the last treatment, the scars in the two groups were evaluated by modified Vancouver Scar Scale (mVSS), hematoxylin-eosin staining and color Doppler ultrasound. Six months after the last treatment, the curative effect of scars in the two groups was evaluated, and the effective number of scar treatment was calculated. The adverse reactions during the whole treatment were recorded. Data were statistically analyzed with independent sample t test, paired sample t test, and McNemar exact probability method test. Results:Six months after the last treatment, the mVSS score of scars in combined treatment group was (4.5±0.4) points, which was significantly lower than (7.8±0.6) points in laser alone group ( t=10.000, P<0.01). Six months after the last treatment, the mVSS scores of scars in combined treatment group and laser alone group were significantly lower than those before the first treatment ((13.5±0.7) and (13.8±0.6) points, t=8.805, 9.010, P<0.01). The effective number of scar treatment in combined treatment group was significantly more than that in laser alone group ( P<0.05). There was no scar aggravation, infection, or other adverse reactions during the treatment of scars in both groups. Before the first treatment, the scars in both groups had large collagen, disordered arrangement, proliferation of capillaries, infiltration of some inflammatory cells, and disappearance of skin appendages. Six months after the last treatment, the scar collagen in both groups was sparse and orderly arranged, and the vascular density was reduced. The improvement of scars in combined treatment group was more obvious than that of laser alone group. Six months after the last treatment, the scar thickness in combined treatment group was significantly smaller than that in laser alone group ( t=2.657, P<0.05). Before the first treatment, the blood flow of scars in both groups was abundant; 6 months after the last treatment, the blood flow of scars in combined treatment group was significantly less than that in laser alone group. Conclusions:Fractional carbon dioxide laser combined with autologous fat injection in the treatment of hypertrophic scar after burn can significantly reduce the pain and itching symptoms of scar, and improve the thickness, texture, and congestion of scar. The combined treatment has synergistic effect and less adverse reactions, providing a more effective treatment for patients with hypertrophic scar.

Objective:To explore the effects of fractional carbon dioxide laser combined with autologous fat injection in the treatment of hypertrophic scar after burn.Methods:From April 2018 to April 2019, 12 patients with hypertrophic scar after burn who met the inclusion criteria were admitted to the Department of Plastic Surgery and Burns of Xuzhou Renci Hospital, and were included in this prospective parallel controlled clinical study. There were 7 males and 5 females with an age of (32±11) years old and scar area of (412±295) cm 2. One scar was selected from each patient and divided into two equal area scars, and they were divided into combined treatment group and laser alone group with 12 scars in each group according to the ramdom number table.The scar in laser alone group was only treated with fractiona carbon dioxide laser, while the scar in combined treatment group was injected with autologous granular fat and then treated with fractional carbon dioxide laser. Scars in the two groups were treated once every 2 months, a total of 3 times. Before the first treatment and 6 months after the last treatment, the scars in the two groups were evaluated by modified Vancouver Scar Assessment Scale (mVSS), hematoxylin-eosin staining and color Doppler ultrasound. Six months after the last treatment, the curative effect of scars in the two groups was evaluated. The adverse reactions during the whole treatment were recorded. Data were statistically analyzed with independent sample t test, paired sample t test, and McNemar exact probability method test. Results:Six months after the last treatment, the mVSS score of scars in combined treatment group was (4.5±0.4) points, which was significantly lower than (7.8 ±0.6) points in laser alone group ( t=10.000, P<0.01). Six months after the last treatment, the mVSS scores of scars in combined treatment group and laser alone group were significantly lower than those before the first treatment [(13.5±0.7) and (13.8±0.6) points, t=8.805, 9.010, P<0.01]. The effective number of scar treatment in combined treatment group was significantly more than that in laser alone group ( P<0.05). There was no scar aggravation, infection, or other adverse reactions during the treatment of scars in both groups. Before the first treatment, the scars in both groups had large collagen, disordered arrangement, proliferation of capillaries, infiltration of some inflammatory cells, and disappearance of skin appendages. Six months after the last treatment, the scar collagen in both groups was sparse and orderly arranged, and the vascular density was reduced. The improvement of scars in combined treatment group was more obvious than that of laser alone group. Six months after the last treatment, the scar thickness in combined treatment group was significantly smaller than that in laser alone group ( t=2.657, P<0.05). Before the first treatment, the blood flow of scars in both groups was abundant; 6 months of the last treatment, the blood flow of scars in combined treatment group was significantly less than that in laser alone group. Conclusions:Fractional carbon dioxide laser combined with autologous fat injection in the treatment of hypertrophic scar after burn can significantly reduce the pain and itching symptoms of scar, and improve the thickness, texture, and congestion of scar. The combined treatment has synergistic effect and less adverse reactions, which provides a more effective treatment for patients with hypertrophic scar.