Objective:To investigate the efficacy of our self-made distractor in assistance of percutaneous minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Method:A retrospective study was conducted to analyze the clinical data of 51 patients with calcaneal fracture who had been treated from March 2020 to August 2022 at Department of Orthopedic Trauma, Changsha Central Hospital Affiliated to University of South China. There were 42 males and 9 females with an age of (44.6±10.2) years. All the 34 Sanders type Ⅱ fractures and 17 Sanders type Ⅲ fractures were isolated unilateral ones which were treated by percutaneous reduction and fixation with percutaneous screws assissted by our self-made calcaneal distractor. All patients were evaluated both clinically and radiologically. The interval from injury to surgery, surgery duration, hospitalization period, fracture union, complications, reduction of the posterior inferior articular surface, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were recorded. The length, width, height, B?hler angle, and Gissane angle of the calcaneus were measured and compared between pre-surgery and the last follow-up.Results:All patients in this cohort were followed up after uneventfull surgery for 21 (18, 24) months. The interval from injury to surgery was 0 (0, 1) d, the surgery duration 38 (35, 40) min, and the hospitalization period 4 (3, 4) d. All the surgical incisions healed smoothly without any wound-related complications. All fractures got united by the 12-week postoperative assessment with normal alignment of the posterior foot and no varus or valgus. One patient developed symptoms of sural nerve injury after surgery, and one patient experienced a screw rupture after surgery. Evaluation of the posterior subtalar articular surfaces revealed an anatomic reduction rate of 66.7% (34/51), a near-anatomical reduction rate of 33.3% (17/51), and no cases of approximate reduction or failure in articular surface reduction. The last follow-up found no loss of reduction. At the last follow-up, the AOFAS ankle-hindfoot score was 91.3 (87.0, 98.0) points, giving 32 excellent, 17 good, and 2 fair cases, resulting in an excellent and good rate of 96.1%, and the VAS pain score 0 (0, 1) point. At the last follow-up, the width [34.0 (32.6, 34.9) mm], height [49.6 (47.1, 50.4) mm], B?hler angle [35.8 (34.0, 37.8)°], and Gissane angle [129.0 (124.2, 135.6)°] of the calcaneus were all significantly improved compared with the preoperative values [(41.0±2.1) mm, 39.3 (37.9, 40.2) mm, -5.7 (-20.4, 4.6)°, 94.5 (80.4, 104.0)°] ( P < 0.05). There was no statistically significant difference in the length of the calcaneus between pre-surgery and post-surgery ( P > 0.05). Conclusion:In the percutaneous minimally invasive treatment of Sanders Ⅱ and Ⅲ calcaneal fractures, use of our self-made calcaneal distractor has demonstrated favorable clinical outcomes, making the surgery minimally invasive and efficient.

Diabetic ulcers are serious complications of diabetes mellitus and are characterized by delayed healing,susceptibility to infection,and inclination to amputation or sepsis.The mechanism of refractory diabetic ulcers is complex,and changes in microorganisms in the wound and the immune response produced by interactions with different cells participate in the repair of the wound.In recent years,researchers have proposed the concept of the"skin-gut axis"due to the physiological similarities and pathological correlation between the skin and intestinal tract;thus,skin diseases are considered to be closely related to gut flora.Therefore,this article reviews the relationship between intestinal microflo-ra and diabetic ulcers from the perspective of the interaction between skin and intestinal microorganisms.

Objective:To observe the effect of well-designed board sanding training on the upper extremity motor functioning of hemiplegic stroke survivors.Methods:Sixty stroke survivors with hemiplegia were randomly divided into an observation group (30 cases) and a control group (30 cases). All received conventional rehabilitation. The observation group′s training involved intelligent board sanding, while the control group′s training involved traditional sanding.Results:After the treatment, significant improvement was observed in the Fugl-Meyer upper extremity scores, modified Barthel index scores and reported shoulder pain in both groups, with the observation group′s averages significantly better than those of the control group. After the intervention, the average scores of both groups on the modified Ashforth scale had also improved significantly.Conclusions:Supplementing conventional rehabilitation treatment with intelligent board sanding can significantly improve upper extremity motor function and ability in the activities of daily living of stroke survivors with hemiplegia while somewhat relieving shoulder pain. The effect is better than with traditional board sanding.

OBJECTIVE: To analyze the current status of diagnosis and management of acute appendicitis (AA) in China. METHODS: Questionnaire survey was used to retrospectively collect data of hospitalized patients with AA from 43 medical centers nationwide in 2017 (Sort by number of cases provided: Jinling Hospital of Medical School of Nanjing University, The First Affiliated Hospital of Xinjiang Medical University, Lu'an People's Hospital, Tengzhou Central People's Hospital, Dalian Central Hospital, The Affiliated Hospital of Xuzhou Medical University, Dongying People's Hospital, Jinjiang Hospital of Traditional Chinese Medicine, Huangshan Shoukang Hospital, Xuyi People's Hospital, Nanjing Jiangbei People's Hospital, Lanzhou 940th Hospital of PLA, Heze Municipal Hospital, The First College of Clinical Medical Science of China Three Gorges University, Affiliated Jiujiang Hospital of Nanchang University, The Second People's Hospital of Hefei, Affiliated Central Hospital of Shandong Zaozhuang Mining Group, The Third People's Hospital of Kunshan City, Xuzhou First People's Hospital, The 81st Group Army Hospital of PLA, Linyi Central Hospital, The General Hospital of Huainan Eastern Hospital Group, The 908th Hospital of PLA, Liyang People's Hospital, The 901th Hospital of Joint Logistic Support Force, The Third Affiliated Hospital of Chongqing Medical University, The Fourth Hospital of Jilin University, Harbin Acheng District People's Hospital, The First Affiliated Hospital of Zhengzhou University, Nanjing Luhe People's Hospital, Taixing Municipal People's Hospital, Baotou Central Hospital, The Affiliated Hospital of Nantong University, Linyi People's Hospital, The 72st Group Army Hospital of PLA, Zaozhuang Municipal Hospital, People's Hospital of Dayu County, Taixing City Hospital of Traditional Chinese Medicine, Suzhou Municipal Hospital, Beijing Guang'anmen Hospital, Langxi County Hospital of Traditional Chinese Medicine, Nanyang Central Hospital, The Affiliated People's Hospital of Inner Mongolia Medical University).The diagnosis and management of AA were analyzed through unified summary. Different centers collected and summarized their data in 2017 and sent back the questionnaires for summary. RESULTS: A total of 8 766 AA patients were enrolled from 43 medical centers, including 4 711 males (53.7%) with median age of 39 years and 958 (10.9%) patients over 65 years old. Of 8 776 patients, 5 677 cases (64.6%) received one or more imaging examinations, and the other 3 099 (35.4%) did not receive any imaging examination. A total of 1 858 (21.2%) cases received medical treatment, mainly a combination of nitroimidazoles (1 107 cases, 59.8%) doublet regimen, followed by a single-agent regimen of non-nitroimidazoles (451 cases, 24.4%), a nitroimidazole-free doublet regimen (134 cases, 7.2%), a triple regimen of combined nitroimidazoles (116 cases, 6.3%), nitroimidazole alone (39 cases, 2.1%) and nitroimidazole-free triple regimen (3 cases, 0.2%). Of the 6 908 patients (78.8%) who underwent surgery, 4 319 (62.5%) underwent laparoscopic appendectomy and 2589 (37.5%) underwent open surgery. Ratio of laparotomy was higher in those patients under 16 years old (392 cases) or over 65 years old (258 cases) [15.1%(392/2 589) and 10.0%(258/2 589), respectively, compared with 8.5%(367/4 316) and 8.0%(347/4 316) in the same age group for laparoscopic surgery, χ²=91.415, P<0.001; χ²=15.915,P<0.001]. Patients with complicated appendicitis had higher ratio of undergoing open surgery as compared to those undergoing laparoscopic surgery [26.7%(692/2 589) vs. 15.6%(672/4 316), χ²=125.726, P<0.001].The cure rates of laparoscopic and open surgery were 100.0% and 99.8%(2 585/2 589) respectively without significant difference (P=0.206). Postoperative complication rates were 4.5%(121/2 589) and 4.7%(196/4 316) respectively, and the difference was not statistically significant (χ²=0.065, P=0.799). The incidence of surgical site infection was lower (0.6% vs. 1.7%, χ²=17.315, P<0.001), and hospital stay was shorter [6(4-7) days vs. 6(5-8) days, U=4 384 348.0, P<0.001] in the laparoscopic surgery group, while hospitalization cost was higher (median 12 527 yuan vs. 9 342 yuan, U=2 586 809.0, P<0.001). CONCLUSIONS The diagnosis of acute appendicitis is still clinically based, supplemented by imaging examination. Appendectomy is still the most effective treatment at present. Laparoscopic appendectomy has become the main treatment strategy, but anti-infective drugs are also very effective.
Acute Disease ; Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Appendectomy ; Appendicitis ; diagnosis ; therapy ; China ; Female ; Health Care Surveys ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.

BACKGROUND:Due to good function and aesthetic effect, implant dentures become prevalent in osteoporotic patients with missing teeth. However, whether osteoporosis is a contraindication of dentures as wel as effects of osteoporosis on the bone-implant integration have been not ful y understood.
OBJECTIVE:To compare the levels of alkaline phosphatase, bone mineral density and implant stability in patients with osteoporosis and non-osteoporosis, and to explore whether the osteoporotic patients can achieve good prognosis. METHODS:Forty patients undergoing implant dentures in the Department of Prosthodontics, the First Affiliated Hospital of Xinjiang Medical University since February 2015 were enrol ed, and al otted to experimental (osteoporosis) and control (non-osteoporosis) groups (n=20 per group).
RESULTS AND CONCLUSION:The levels of salivary alkaline phosphatase, bone mineral density and initial implant stability in the experiment and control groups both were lower than those before surgery. There were significant
differences in the implant stability quotient at 1 and 3 months and immediately after implantation between groups. These results indicate that osteoporotic patients undergoing implant surgery can achieve a good prognosis that is similar with non-osteoporosis ones.

OBJECTIVETo evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner.

METHODSClinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation.

RESULTSAll the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months.

CONCLUSIONLaparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.

Abdomen ; Aged ; Anal Canal ; Blood Loss, Surgical ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Operative Time ; Perineum ; Postoperative Complications ; Postoperative Period ; Rectal Neoplasms ; surgery ; Rectum ; Retrospective Studies

Objective To establish the high performance liquid chromatography(HPLC) fingerprint of wuzi yanzong pills. Methods HPLC was performed on Agilent Extend C18 column (250 mmí4. 6 mm,5 μm) with a gradient elution system using acetonitrile:methanol (101)-0. 4% phosphoric acid as the mobile phase. The column temperature was set at 30 ℃ and the flow rate was 1. 0 mL·min-1 . The eluate was detected at the wavelength of 254 nm. Chromatographic peaks were identified by LC-MS method. Results Nine common peaks in wuzi yanzong pill samples were identified by comparing their LC-MS data with those of reference compounds and related reference reports. The HPLC fingerprint of wuzi yanzong pills was finally developed based on the analysis of sixteen batches of samples and their similarities were above 0. 93. Conclusion This method has high precision,stability and repeatability. This study could be used for overall quality assessment of wuzi yanzong pills.

Objective To explore the value of helical computed tomography (CT) in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thicked gallbladder cancer (GBC).Methods The CT signs of 18 XGCs and 20 wall-thicked GBCs were retrospectively analyzed.The maximum thickness of gallbladder wall, intramural hypoattenuated nodules, mucosal line of gallbladder inner wall,patterns of enhancement of thickened wall,whether combined with stones,the pericholecystic adjacent liver tissue involvement and biliary tract obstruction were observed.Measurement data were analyzed by independent sample t test and count date were analyzed by Fisher precisely the probability method.Results The mean maximum thickness of the gallbladder wall of XGC and wall-thicked GBC was (22.11±10.19) mm and (20.55±7.94) mm respectively,and there was no statistical significance (t=0.530,P=0.600).Eighteen cases of XGC and five cases of wall- thicked GBC patients were with intramural hypoattenuated nodules (Fisher precisely the probability method,P＜0.01 ),14 cases of XGC and six cases of GBC were with integrated mucosal line (Fisher precisely the probability method,P =0.004 ),three cases of XGC and 12 cases of GBC were with biliary tract obstruction (Fisher precisely the probability method,P=0.009).There was no statistical significance in the CT signs of the range of wall thickness,patterns of enhancement and enhanced degree of thickened wall,adjacent liver tissue involvement, lymphadenopathy, combined with gallbladder or bile duct stone between XGC and wall-thicked GBC patients (Fisher precisely the probability method,all P ＞ 0.05).Conclusions The thickened gallbladder wall with intramural hypoattenuated nodules and integrated gallbladder inner wall mucosal line were characteristic signs for diagnosing XGC.Helical CT scanning can provide evidence for differential diagnosis in XGC and wall- thicked GBC.

Objective To discuss clinic effect of pulmonary artery valvuloplasty for right ventricle outflow tract (RVOT) reconstruction in patients with repaired tetralogy of fallot (TOF). Methods A total of 93 cases TOF were randomly divided into Group A (n = 49) or Group B (n = 44) to perform the procedure with repaired tetralogy of fallot Group A received autogenous pericardium to enlarge RVOT and pulmonary valvuloplasty.Group B received autogenous pericardium to enlarge RVOT by routine therapy. Pulmonary regurgitation index (PRi) and the ratio between pulmonary regurgitant jet width and pulmonary annulus diameter were measured with echoeardiography. Results The mean follow-up was 3. 1 ± 0. 2 years. The PRi and the ratio between pulmonary regurgitant jet width and pulmonary annulus diameter in Group A were-significantly lower than Group B (0. 55 ± 0. 13 vs. 0. 61 ± 0. 10, t = 2. 685, P < 0.01) and ([52.0 ± 10.4] % vs. [57.1 ± 10. 5]% ,t = 2. 349, P < 0.05) . Three-dimensional ultrasound examination showed that 69% (34/69) of pulmonary valves in Group A was developed well. Conclusion Pulmonary valvuloplasty during transannular patch for repaired TOF may prevent fre'e pulmonary regurgitation and can obtain good clinical outcome.