1.Correlation Analysis of Peripheral Blood B Cell Count with Clinical Features and Prognosis in Patients Newly Diagnosed with Diffuse Large B-Cell Lymphoma
Tian LU ; Hao MI ; Dan-Dan ZHAO ; Shui-Ge YANG ; Yun-Wen BU ; Fang ZHANG ; Wen-Ming CHEN ; Dao-Ping SUN
Journal of Experimental Hematology 2024;32(2):458-465
		                        		
		                        			
		                        			Objective:To explore the correlation between peripheral blood B cell count and clinical features and prognosis of patients with newly diagnosed diffuse large B-cell lymphoma(DLBCL).Methods:The relationship of peripheral blood B cell count with clinical features,laboratory indexes and prognosis in 67 patients with newly diagnosed DLBCL was retrospectively analyzed.Results:Patients were divided into low B-cell count group(B cell<0.1 × 109/L,n=34)and high B-cell count group(B cell≥0.1 × 109/L,n=33)according to the median B cell count values.Compared with the high B cell count group,the low B cell count group had a higher proportion of patients with Lugano stage Ⅲ-Ⅳ,elevated LDH,elevated β2-MG and IPI score 3-5 and increased CRP(P=0.033,0.000,0.023,0.001,0.033).The peripheral CD3+and CD4+cell counts of patients in the low B cell count group were significantly lower than those in the high B cell count group(P=0.010,0.017).After initial treatment,overall response rate(ORR)and complete remission(CR)rate in high B cell count group were significantly higher than those in low B cell count group(P=0.032,0.013).The median follow-up time of patients was 23(2-77)months,progression-free survival(PFS)and overall survival(OS)of patients in the high B cell count group were significantly better than those in the low B cell count group(P=0.001,0.002).Univariate analysis showed that pretreatment low B cell count in the peripheral blood was associated with shortened PFS and OS(HR=4.108,P=0.002;HR=8.218,P=0.006).Multivariate analysis showed that low B cell count was an independent prognostic factor for shortened PFS(HR=3.116,P=0.037).Conclusion:Decreased peripheral blood B cell count in newly diagnosed DLBCL patients is associated with high-risk clinical features and may affect the efficacy of immunochemotherapy,which is associated with poor clinical prognosis.
		                        		
		                        		
		                        		
		                        	
2.To compare the efficacy and incidence of severe hematological adverse events of flumatinib and imatinib in patients newly diagnosed with chronic phase chronic myeloid leukemia.
Xiao Shuai ZHANG ; Bing Cheng LIU ; Xin DU ; Yan Li ZHANG ; Na XU ; Xiao Li LIU ; Wei Ming LI ; Hai LIN ; Rong LIANG ; Chun Yan CHEN ; Jian HUANG ; Yun Fan YANG ; Huan Ling ZHU ; Ling PAN ; Xiao Dong WANG ; Gui Hui LI ; Zhuo Gang LIU ; Yan Qing ZHANG ; Zhen Fang LIU ; Jian Da HU ; Chun Shui LIU ; Fei LI ; Wei YANG ; Li MENG ; Yan Qiu HAN ; Li E LIN ; Zhen Yu ZHAO ; Chuan Qing TU ; Cai Feng ZHENG ; Yan Liang BAI ; Ze Ping ZHOU ; Su Ning CHEN ; Hui Ying QIU ; Li Jie YANG ; Xiu Li SUN ; Hui SUN ; Li ZHOU ; Ze Lin LIU ; Dan Yu WANG ; Jian Xin GUO ; Li Ping PANG ; Qing Shu ZENG ; Xiao Hui SUO ; Wei Hua ZHANG ; Yuan Jun ZHENG ; Qian JIANG
Chinese Journal of Hematology 2023;44(9):728-736
		                        		
		                        			
		                        			Objective: To analyze and compare therapy responses, outcomes, and incidence of severe hematologic adverse events of flumatinib and imatinib in patients newly diagnosed with chronic phase chronic myeloid leukemia (CML) . Methods: Data of patients with chronic phase CML diagnosed between January 2006 and November 2022 from 76 centers, aged ≥18 years, and received initial flumatinib or imatinib therapy within 6 months after diagnosis in China were retrospectively interrogated. Propensity score matching (PSM) analysis was performed to reduce the bias of the initial TKI selection, and the therapy responses and outcomes of patients receiving initial flumatinib or imatinib therapy were compared. Results: A total of 4 833 adult patients with CML receiving initial imatinib (n=4 380) or flumatinib (n=453) therapy were included in the study. In the imatinib cohort, the median follow-up time was 54 [interquartile range (IQR), 31-85] months, and the 7-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.2%, 88.4%, 78.3%, and 63.0%, respectively. The 7-year FFS, PFS, and OS rates were 71.8%, 93.0%, and 96.9%, respectively. With the median follow-up of 18 (IQR, 13-25) months in the flumatinib cohort, the 2-year cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) were 95.4%, 86.5%, 58.4%, and 46.6%, respectively. The 2-year FFS, PFS, and OS rates were 80.1%, 95.0%, and 99.5%, respectively. The PSM analysis indicated that patients receiving initial flumatinib therapy had significantly higher cumulative incidences of CCyR, MMR, MR(4), and MR(4.5) and higher probabilities of FFS than those receiving the initial imatinib therapy (all P<0.001), whereas the PFS (P=0.230) and OS (P=0.268) were comparable between the two cohorts. The incidence of severe hematologic adverse events (grade≥Ⅲ) was comparable in the two cohorts. Conclusion: Patients receiving initial flumatinib therapy had higher cumulative incidences of therapy responses and higher probability of FFS than those receiving initial imatinib therapy, whereas the incidence of severe hematologic adverse events was comparable between the two cohorts.
		                        		
		                        		
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Adolescent
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		                        			Imatinib Mesylate/adverse effects*
		                        			;
		                        		
		                        			Incidence
		                        			;
		                        		
		                        			Antineoplastic Agents/adverse effects*
		                        			;
		                        		
		                        			Retrospective Studies
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		                        			Pyrimidines/adverse effects*
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		                        			Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy*
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		                        			Treatment Outcome
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		                        			Benzamides/adverse effects*
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		                        			Leukemia, Myeloid, Chronic-Phase/drug therapy*
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		                        			Aminopyridines/therapeutic use*
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		                        			Protein Kinase Inhibitors/therapeutic use*
		                        			
		                        		
		                        	
3.Surveillance of human soil-transmitted nematodiasis in Jurong City from 2016 to 2020
Qing-hua ZHAO ; Jun CAO ; Shui-ming LI ; Jin-hua HOU ; Dan WU ; Yu-han ZHANG ; Cheng-gong JIANG
Chinese Journal of Schistosomiasis Control 2022;34(1):89-91
		                        		
		                        			
		                        			 Objective To investigate the prevalence of soil-transmitted nematode human infections in Jurong City from 2016 to 2020, so as to provide the scientific evidence for formulating the control strategy. Methods During the period from 2016 to 2020, the permanent residents at ages of over 3 years living in Jurong City were selected as the study subjects. Stool samples were collected for the detection of soil-transmitted nematode eggs using the modified Kato-Katz thick smear method (two detections for one stool sample), and the species of hookworm was identified in stool-positive stool samples using the culture method. The prevalence and intensity of soil-transmitted nematode infections were calculated, and the change of the infection prevalence among years was examined using the Cochran-Armitage test for trend. Results A total of 10 011 people-time populations were detected for soil-transmitted nematode infections in Jurong City from 2016 to 2020, and 56 egg-positives were identified, with mean prevalence of 0.56%. The prevalence of soil-transmitted nematode human infections appeared a tendency towards a decline year by year in Jurong City (χ2trend = 5.15, P < 0.01). The mean prevalence of hookworm, Ascaris lumbricoides and Trichuris trichiura infections was 0.44%, 0.11% and 0.20% in Jurong City from 2016 to 2020, respectively, and individuals with hookworm infections accounted for 78.57% of all cases with soil-transmitted nematode infections. Single parasite (98.21%) and mild infection were pre-dominant in individuals with soil-transmitted nematode infections, and no multiple infections were seen after 2016. Conclusions The prevalence of human soil-transmitted nematodiasis is low in Jurong City. Based on reinforcement of soil-transmitted nematodiasis surveillance, an increase in the health education investment is required to consolidate the control achievements. 
		                        		
		                        		
		                        		
		                        	
4.Cross sectional study of familial hypercholesterolemia in dyslipidemia patients receiving lipid-lowering therapy: DYSIS-China subgroup analysis.
Xiao Na WANG ; Fan WANG ; Ping YE ; Da Yi HU ; Shui Ping ZHAO ; Yong Jun WANG ; Yi Ming MU ; Xiao Wei YAN ; Zhan Quan LI ; Yi Dong WEI
Chinese Journal of Cardiology 2021;49(6):564-571
		                        		
		                        			
		                        			Objectives: To analyze the incidence, blood lipid levels and cardiovascular disease of familial hypercholesterolemia (FH) in dyslipidemia patients receiving lipid-lowing therapy from the DYSIS-China. Methods: Dyslipidemia International Study-China (DYSIS-China) database was re-analyzed according to the criteria of "Chinese guidelines for prevention and treatment of dyslipidemia in adults-2016 version". DYSIS-China database included 25 317 dyslipidemia out-patients who received at least one lipid-lowering drug for at least three months. All the patients were divided into three groups: unlikely HF, possible FH and definite FH according to the Dutch Lipid Clinic Network diagnostic criteria. Age, gender, lipids levels, drug use and complications were compared among the three groups. Factors were compared between Possible FH group and definite FH group in terms of age stratification. Results: A total of 23 973 patients with dyslipidemia were included. The average age was (64.8±9.9) years, 11 757 patients were females (49.0%). The proportion of unlikely FH in the total population was 20 561 (85.7%), possible FH was 3294 (13.7%), and the definite FH was 118(0.5%). Patients in the definite FH group (58.3±8.5 years) was younger than in unlikely HF(65.3±9.8 years) and possible FH(61.8±9.9 years) group. LDL-C ((5.6±1.9) mmol/L) levels were significantly higher in definite FH group than in unlikely HF ((2.5±0.9) mmol/L) and possible FH ((4.3±1.0) mmol/L) group. TC ((7.4±1.8) mmol/L) levels were also significantly higher in definite FH group than in unlikely HF ((4.3±1.0) mmol/L) and possible FH ((6.0±1.0) mmol/L) group. Percent of female sex, sedentary lifestyle and systolic blood pressure value were significantly higher in definite FH group than in other two groups (all P<0.05). Statin use was similar among the 3 groups. Prevalence of ischemic cardiomyopathy (70(59.3%)) was significantly higher in the definite FH group than in unlikely FH group7519 (36.6%) and possible FH group1149 (34.9%). The rate of hypertension (82 (69.5%)) was also significantly higher in the definite FH group than in unlikely FH group (2 063 (62.6%) and in possible FH group (13 928 (67.7%)). The possible FH group had the highest proportion of patients aged 55-64 years (1 146 (34.8%)), and the prevalence of hypertension 358 (76.8%), diabetes 189 (40.6%), ischemic heart disease 186 (39.9%), cerebrovascular disease 149 (32.0%) and heart failure 28 (6.0%) was the highest in patients over 75 years old. The definite FH group had the highest proportion of patients aged 55-64 years (49 (41.52%)), and the prevalence of ischemic heart disease (70 (59.3%)) was the highest in patients aged 45-54 years old group, there was no significant difference in the prevalence of diabetes,hypertension,heart failure,peripheral artery disease and cerebrovascular disease among different age groups. Conclusion: The detection rate of FH in Chinese patients with dyslipidemia is not low, the blood lipid level is poorly controlled, and the risk of cardiovascular disease is high in Chinses FH patients.
		                        		
		                        		
		                        		
		                        			Adult
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		                        			Aged
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		                        			China/epidemiology*
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		                        			Cholesterol, LDL
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		                        			Cross-Sectional Studies
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		                        			Dyslipidemias/epidemiology*
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		                        			Female
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		                        			Humans
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		                        			Hyperlipoproteinemia Type II/epidemiology*
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		                        			Lipids
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		                        			Male
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		                        			Middle Aged
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		                        			Prevalence
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		                        			Risk Factors
		                        			
		                        		
		                        	
5.Microwave-induced Apoptosis and Cytotoxicity of NK Cells through ERK1/2 Signaling.
Li ZHAO ; Jing LI ; Yan Hui HAO ; Ya Bing GAO ; Shui Ming WANG ; Jing ZHANG ; Ji DONG ; Hong Mei ZHOU ; Shu Chen LIU ; Rui Yun PENG
Biomedical and Environmental Sciences 2017;30(5):323-332
OBJECTIVETo investigate microwave-induced morphological and functional injury of natural killer (NK) cells and uncover their mechanisms.
METHODSNK-92 cells were exposed to 10, 30, and 50 mW/cm2 microwaves for 5 min. Ultrastructural changes, cellular apoptosis and cell cycle regulation were detected at 1 h and 24 h after exposure. Cytotoxic activity was assayed at 1 h after exposure, while perforin and NKG2D expression were detected at 1 h, 6 h, and 12 h after exposure. To clarify the mechanisms, phosphorylated ERK (p-ERK) was detected at 1 h after exposure. Moreover, microwave-induced cellular apoptosis and cell cycle regulation were analyzed after blockade of ERK signaling by using U0126.
RESULTSMicrowave-induced morphological and ultrastructural injury, dose-dependent apoptosis (P < 0.001) and cell cycle arrest (P < 0.001) were detected at 1 h after microwave exposure. Moreover, significant apoptosis was still detected at 24 h after 50 mW/cm2 microwave exposure (P < 0.01). In the 30 mW/cm2 microwave exposure model, microwaves impaired the cytotoxic activity of NK-92 cells at 1 h and down regulated perforin protein both at 1 h and 6 h after exposure (P < 0.05). Furthermore, p-ERK was down regulated at 1 h after exposure (P < 0.05), while ERK blockade significantly promoted microwave-induced apoptosis (P < 0.05) and downregulation of perforin (P < 0.01).
CONCLUSIONMicrowave dose-dependently induced morphological and functional injury in NK-92 cells, possibly through ERK-mediated regulation of apoptosis and perforin expression.
Apoptosis ; radiation effects ; Cell Cycle ; radiation effects ; Cell Line ; Dose-Response Relationship, Radiation ; Down-Regulation ; Humans ; Killer Cells, Natural ; radiation effects ; MAP Kinase Signaling System ; Microwaves ; adverse effects ; NK Cell Lectin-Like Receptor Subfamily K ; genetics ; metabolism ; Signal Transduction
6.Influence of tobacco-Chuanminshen violaceum rotation on microbe community in soil.
Dong-Yan ZHANG ; Jian ZHAO ; Shui-Ping YANG ; Jing-Jing MO ; Da-Min HE ; Jun WANG ; Jian-Yu GOU ; Xue ZHANG ; Wei JIANG ; Ming-Xia WEN
China Journal of Chinese Materia Medica 2016;41(24):4556-4563
		                        		
		                        			
		                        			Soil microbes are the important indicator of soil quality. For exploring Chuanminshen violaceum planting to microbial effects in tobacco soil, this paper adopted Illumina MiSeq high-throughput sequencing to research the change of bacteria and fungi at the phylum and genus in the soil. The results showed that the Ch. violaceum planting increased the biodiversity of bacteria and fungi. The influence on fungi was greater than that on bacteria. It greatly increased the sequence of fungi, it obtained 32 978 16S rDNA and 32 229 18S rDNA sequence number. There was no change of the top three phylums in bacteria, but the content changed, Proteobacteria and Acidobacteria reduced by 1.73% and 1.4% respectively, and Actinobacteria increased by 0.65%. The advantage phylum Ascomycete in tobacco reduced by 27.99% to be second advantage phylum after Ch. violaceum planting, and the second advantage phylum Basidiomycete increased by 23.69% to become the first dominant fungi. At the genus, Ch. violaceum planting changed the order of dominant genus and the abundance was also changed. Some changed largely such as uncultured Acidobacteriaceae Subgroup-1, Gemmatimonas, Subgroup-2,uncultured Nitrosomonadaceae for bacteria, norank Sordariales, norank Agaricomycetes, Phialophora for fungi. Especially the rotation increased antagonistic microbes and physiological microbes and decreased pathogenic microbes. So the Ch. violaceum planting can improve the microbe community in tobacco soil.
		                        		
		                        		
		                        		
		                        	
7.Cytisine, a Partial Agonist of α4β2 Nicotinic Acetylcholine Receptors, Reduced Unpredictable Chronic Mild Stress-Induced Depression-Like Behaviors.
Jing HAN ; Dong Sheng WANG ; Shui Bing LIU ; Ming Gao ZHAO
Biomolecules & Therapeutics 2016;24(3):291-297
		                        		
		                        			
		                        			Cytisine (CYT), a partial agonist of α4β2-nicotinic receptors, has been used for antidepressant efficacy in several tests. Nicotinic receptors have been shown to be closely associated with depression. However, little is known about the effects of CYT on the depression. In the present study, a mouse model of depression, the unpredictable chronic mild stress (UCMS), was used to evaluate the activities of CYT. UCMS caused significant depression-like behaviors, as shown by the decrease of total distances in open field test, and the prolonged duration of immobility in tail suspension test and forced swimming test. Treatment with CYT for two weeks notably relieved the depression-like behaviors in the UCMS mice. Next, proteins related to depressive disorder in the brain region of hippocampus and amygdala were analyzed to elucidate the underlying mechanisms of CYT. CYT significantly reversed the decreases of 5-HT1A, BDNF, and mTOR levels in the hippocampus and amygdala. These results imply that CYT may act as a potential anti-depressant in the animals under chronic stress.
		                        		
		                        		
		                        		
		                        			Amygdala
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		                        			Animals
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		                        			Brain
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		                        			Brain-Derived Neurotrophic Factor
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		                        			Depression
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		                        			Depressive Disorder
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		                        			Hindlimb Suspension
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		                        			Hippocampus
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		                        			Mice
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		                        			Physical Exertion
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		                        			Receptors, Nicotinic*
		                        			
		                        		
		                        	
8.Etiology, pathology, management and prognosis of chronic pancreatitis in Chinese population: A retrospective study.
Soriba Naby CAMARA ; Sonam RAMDANY ; Gang ZHAO ; Shan-Miao GOU ; Jiong-Xin XIONG ; Zhi-Yong YANG ; Tao YIN ; Ming YANG ; Oumar Taibata BALDE ; Ahmed Boubacar BARRY ; Seid ADJI ; Xiang LI ; Yan JIN ; He-Shui WU ; Chun-You WANG
Journal of Huazhong University of Science and Technology (Medical Sciences) 2015;35(3):384-389
		                        		
		                        			
		                        			The purpose of this study was to investigate the etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population. The clinical data of 142 patients with chronic pancreatitis were retrospectively studied. All patients were of Chinese nationality and hospitalized from January 2008 to December 2011. Their ages ranged from 14 to 76 years, with a mean of 43 years. Of 142 patients, there were 72 cases of obstructive chronic pancreatitis (50.70%), 19 cases of alcoholic chronic pancreatitis (13.38%), 14 cases of autoimmune pancreatitis (9.86%) and 37 cases of undetermined etiology (26.06%). Pathologically, the average inflammatory mass diameter was 3.8 ± 3.3 cm, biliary obstruction occurred in 36 cases, gall stones in 70 cases, calcification in 88 cases, ductal dilatation in 61 cases, side branch dilatation in 32 cases, ductal irregularity in 10 cases, lymphocytic inflammation in 23 cases, obliterative phlebitis in 14 cases, extra pancreatic lesion in 19 cases and fibrosis in 142 cases. Location of pancreatic lesion in the region of head (n=97), neck (n=16), body (n=12), tail (n=15) and whole pancreas (n=2) influenced the choice of surgical procedures. Ninety-four patients (66.20%) received surgical treatment and 33.80% received other treatments. After operation, 80.85% of 94 patients experienced decreased pain, and 8.51% of 94 showed recovery of endocrine function but with a complication rate of 12.77%. All the operations were performed successfully. According to the pain scale of European Organization for Research and Treatment of Cancer (QLQ-C30) a decrease from 76 ± 22 to 14 ± 18 was observed. Etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population vary from others.
		                        		
		                        		
		                        		
		                        			Adolescent
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		                        			Adult
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		                        			Aged
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		                        			Autoimmune Diseases
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		                        			epidemiology
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		                        			therapy
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		                        			China
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		                        			epidemiology
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		                        			Cholestasis
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		                        			epidemiology
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		                        			therapy
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		                        			Female
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		                        			Humans
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		                        			Male
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		                        			Middle Aged
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		                        			Pancreatitis, Alcoholic
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		                        			epidemiology
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		                        			therapy
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		                        			Pancreatitis, Chronic
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		                        			etiology
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		                        			pathology
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		                        			therapy
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		                        			Prognosis
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		                        			Retrospective Studies
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		                        			Treatment Outcome
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		                        			Young Adult
		                        			
		                        		
		                        	
9.Case-control study on superior labrum from anterior to posterior repair and biceps tenodesis for the treatment of type II SLAP injury.
Chen ZHAO ; Jin-tao HU ; Ming-xiang KONG ; Bin-song QIU ; Hai-feng GU ; Shui-jun ZHANG ; Ji-feng XU ; Bing XIA ; Qing BI
China Journal of Orthopaedics and Traumatology 2015;28(6):531-535
OBJECTIVETo compare clinical outcomes of superior labrum from anterior to posterior (SLAP) repair and biceps tenodesis in treating type I SLAP injury.
METHODSFrom March 2009 to March 2012, 38 patients with type II SLAP injury were treated with SLAP repair and biceps tenodesis, and all patients were unilateral SLAP injury. Sixteen patients treated with biceps tenodesis included 8 males and 7 females with an average age of (49.3±3.7) years old (ranged, 45 to 54); 10 cases were on the left side and 6 cases on the right side; 10 cases were caused by falling down, 2 cases were caused by throwing damage and 4 cases were caused by daily life damage; the time from injury to operation were from 3 to 8 weeks. Twenty-two patients treated with SLAP repair included 14 males and 8 females with an average age of (49.0±2.8) years old (ranged, 44 to 56); 13 cases were on the left side and 9 cases were on the right side; 14 cases were caused by falling down, 5 cases were caused by throwing damage and 3 cases were caused by daily life damage; the time from injury to operation were from 3 to 7 weeks. Preoperative, postoperative at 6 months, 1 year and 2 years' UCLA and SST score were compared between two groups.
RESULTSThere was no significant differences in UCLA and SST score between two groups before operation. At 6 months after operation, UCLA and SST score in biceps tenodesis group was higher than SLAP group, and action,range of anteflexion, strength of anteflexion, degree of satisfaction in biceps tenodesis group was higher than SLAP group. There was no significant meaning in SST and UCLA score between two groups at 1 and 2 years after operation.
CONCLUSIONShort-term efficacy of biceps tenodesis for SLAP injury is better than SLAP repair, but long-term efficacy is fairly.
Aged ; Case-Control Studies ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Shoulder Joint ; injuries ; surgery ; Tendon Injuries ; surgery ; Tenodesis
10.Analysis of the relevant factors for ischemic necrosis of the talus fracture.
China Journal of Orthopaedics and Traumatology 2015;28(4):368-370
OBJECTIVETo explore the relationship of the classification of talus fracture and surgery methods with avascular necrosis.
METHODSFrom March 2009 to November 2013, 78 patients with talus fracture were treated, of them, 43 cases were followed up from 2 to 5 years. There were 27 males and 16 females, aged from 17 to 65 years old with the mean of 38.6 years. Thirty-nine cases had talar neck injury and 4 cases had talar body injury. Different treatments were performed according to different injury conditions. The time from injury to treatment was from 6 to 48 hours. The effect of classification of talus fracture and surgery methods on avascular necrosis was analyzed.
RESULTSIn 43 cases,19 cases occurred avascular necrosis, including talar neck fracture of type I in 2 cases, type II in 5 cases, type III in 5 cases, type IV in 5 cases and talar body fracture in 2 cases (combined with talar neck fracture). And 29 patients were treated with operation, there was no statistically significant differences in avascular necrosis with different operations.
CONCLUSIONCompared with talar body fracture, talar neck fracture is more easily to develop into avascular necrosis. In the 4 types of talar neck fracture, the possibilities of type III and IV were the most ones.
Adolescent ; Adult ; Aged ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; classification ; surgery ; Humans ; Male ; Middle Aged ; Osteonecrosis ; surgery ; Talus ; blood supply ; injuries
            
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