Widely targeted metabolomic and KEGG analyses of natural deep eutectic solvent-based saponins extraction from Camellia oleifera Abel.: Effects on composition.

Camellia saponins are important by-products of Camellia Oleifer Abel. processing. In this study, an eco-friendly method based on natural deep eutectic solvents (NaDESs, proline and glycerol at a molar ratio of 2:5) was established to extract saponins from C.oleifera cakes. The content of saponin (702.22 ± 1.28 mg/g) obtained using NaDES was higher than those extracted using water or methanol. UPLC-Q-TOF MS analysis of chemical structure showed that the difference in the extraction technique alter individual saponins. A widely targeted metabolomic approach and KEGG metabolic pathway analysis showed that the upregulated metabolites in the NaDES-based extract mainly included flavonoids, alkaloids, and phenolic acids; and they were involved in arginine and proline metabolism, metabolic pathways, phenylpropanoid biosynthesis, biosynthesis of secondary metabolites, and flavonoid biosynthesis. The present study proposes a selective substitute for use in the extraction of camellia saponins with composition analysis.

Mechanism of salt tolerance in the endangered semi-mangrove plant Barringtonia racemosa: anatomical structure and photosynthetic and fluorescence characteristics.

To elucidate the mechanisms governing the salt tolerance of the endangered semi-mangrove plant Barringtonia racemosa, the biomass, photosynthetic and fluorescent characteristics, and anatomical structure of B. racemosa were studied under low, medium and high salt stress. The results showed that the stem dry weight, net photosynthetic rate, intercellular CO2 concentration, Fv/Fm, and ΦPSI of B. racemosa decreased under high salt stress, which led to a significant reduction in total dry weight. Stem dry weight was significantly positively correlated with the thickness of palisade tissue and significantly negatively correlated with the thickness of the epidermis of roots and xylem of stems. Therefore, a stable net photosynthetic rate and intercellular CO2 concentration, an increase in Fv/Fm and ΦPSI, an increase in or stable palisade tissue and spongy mesophyll of leaves and an increase in xylem thickness of the stem and epidermis, outer cortex, and stele diameter of roots could contribute to the salt tolerance of B. racemosa.

Novel CAD gene mutations in a boy with developmental and epileptic encephalopathy 50 with dramatic response to uridine therapy: a case report and a review of the literature.

BACKGROUND: Developmental and epileptic encephalopathy-50 (DEE-50) is a rare clinical condition believed to be caused by a mutation in the CAD gene and is associated with a bleak prognosis. CAD-related diseases have a wide range of clinical manifestations and other symptoms that may be easily overlooked. Like other rare diseases, the clinical manifestations and the treatment of DEE-50 necessitate further investigation. CASE PRESENTATION: A 1-year-old male patient presented with developmental delay, seizures, and anaemia at 3 months of age. He further developed refractory status epilepticus (SE), rapid deterioration of cognitive and motor function, and even became comatose at 5 months of age. Whole-exome sequencing of trios (WES-trios) revealed a compound heterozygous variant in the CAD gene, with one locus inherited from his father (c.1252C>T: p.Q418* nonsense mutation) and one from his mother (c.6628G>A: p.G2210S, missense mutation). This compound heterozygous CAD variant was unreported in the Human Gene Mutation Database. After uridine treatment, his cognitive faculties dramatically improved and he remained seizure-free. Forty two cases with CAD gene mutation reported in the literatures were reviewed. Among them, 90% had onset before 3 years of age, with average of 1.6±1.8 years old. The average age of diagnosis was 7.7 ± 10 years. The mortality rate was approximately 9.5%, with all reported deaths occurring in patients without uridine treatment. The clinical entity could be improved dramatically when the patient treated with uridine. CONCLUSIONS: We present a boy with DEE 50 caused by novel CAD gene mutations and reviewed the clinical features of 42 patients reported previously. DEE 50 has early onset, refractory seizures, even status epilepticus leading to death, with favorable response to treatment with oral uridine. Early uridine treatment is recommended if CAD defect is suspected or genetically diagnosed. This study enhances the knowledge of DEE 50 and expands the spectrum of CAD gene mutations.

The effect of environmental credit rating on audit fees: A quasi-natural experiment from China.

Environmental credit rating (ECR) is a new policy that deeply integrates the construction of ecological civilisation and the social credit system in China; however, there is a paucity of research on the response of external auditors to the ECR. This study takes the environmental credit evaluation policy implementation as a quasi-natural experiment, using China's A-share listed companies in heavily polluting industries from 2008 to 2019 as samples. We construct a heterogeneous timing difference-in-differences model to empirically explore the impact of ECR on audit fees. The results show that the ECR significantly reduces companies' audit fees. Importantly, our analysis suggests that the ECR improves environmental information transparency and enhances sustainable operation ability, thereby reducing audit fees. Further analysis shows that the negative correlation between the ECR and audit fees is more obvious in non-state enterprises, in poor legal environments and low levels of trust. Our study provides scientific evidence for the economic consequences of the environmental credit evaluation policy and enriches the literature on the factors affecting audit fees. It has revelatory significance for China and other developing countries to implement and improve the environmental credit evaluation policies and better guide enterprises to fulfil their environmental responsibilities.

Knockdown of SETD5 inhibited glycolysis and tumor growth in gastric cancer cells by down-regulating Akt signaling pathway.

Gastric cancer (GC) is the 5th most common cancer and the 3rd leading cause of cancer-related death worldwide. It is of great significance to study the underlying molecular mechanism of GC, and targeting glycolysis is a good strategy to treat GC. SET domain containing 5 (SETD5) contains a catalytic methyltransferase SET domain, which is known as a lysine methyltransferase that affects the progression of multiple cancers. However, its possible role in GC was still unclear. Here, we revealed that SETD5 was highly expressed in GC and was associated with a poor prognosis. Further through the in vitro experiments, we revealed that the downregulation of SETD5 inhibited the proliferation and migration of GC cells. Knockdown of SETD5 inhibited glucose consumption and glycolysis. Further studies have shown that SETD5 knockdown restrained the Akt signaling pathway. Therefore, we thought that SETD5 could act as a GC target.

Precarious Employment and Subjective Career Success During the School-to-Work Transition.

Purpose: The transition from school to work is an important stage in the career development of university students, and precarious employment during this period can significantly impact their early career success. In today's unstable employment environment, this study examines how employment instability during the transition from school to work directly and indirectly affects college students' subjective career success. This contributes to a thorough understanding of this transitional period and provides university students with the necessary resources to cope with a smooth transition from school to work. Patients and Methods: We recruited senior students at five universities in Harbin, China, from May to July 2022. After obtaining participants' consent, questionnaires were distributed via social media, resulting in 967 valid questionnaires. Based on this sample, we examined the chain mediating effect of financial stress and occupational self-efficacy in the association between precarious employment and career success and the moderating effect of employability. Results: The study found that precarious employment hurts career success and can also affect career success by increasing financial stress and decreasing occupational self-efficacy among college students. At the same time, financial stress can also decrease students' self-efficacy. Finally, employability can reduce the adverse effects of precarious employment on career success and occupational self-efficacy. Conclusion: The link between employment instability and subjective career success during the transition from school to work has been demonstrated for university students. Employment instability not only increases college students' financial stress but also reduces career self-efficacy, which in turn affects college students' perceptions of early subjective career success. Importantly, employability plays a positive role in the smooth school-to-work transition and subjective career success of university students.

Covalent organic frameworks assisted for food safety analysis.

Food safety incidents threaten human health and life safety. It is an effective method to prevent and control the occurrence of food safety events by enhancing the rapid and sensitive detection of food contaminants. Emerging porous materials provide for the development of efficient and stable detection methods. Covalent organic frameworks (COFs) are favored by researchers for their highly ordered pore structure, large specific surface area, and good structural and functional designability. Especially in the sensing field, COFs play the roles of carriers, conductors, quenchers, and reporters, and have broad application prospects. To better understand COFs-based sensing studies, this review briefly introduces the characteristics and different functional roles of COFs in food safety analysis, focusing on the applications of COFs in the detection of various food contaminants (including foodborne pathogens, mycotoxins, pesticides, antibiotics, heavy metals, and others). Finally, the challenges and opportunities for COFs-based sensing are discussed to facilitate further applications and development of COFs in food safety.

A Comprehensive Review of Health-Benefiting Components in Rapeseed Oil.

Rapeseed oil is the third most consumed culinary oil in the world. It is well-known for its high content of unsaturated fatty acids, especially polyunsaturated fatty acids, which make it of great nutritional value. There is increasing evidence that a diet rich in unsaturated fatty acids offers health benefits. Although the consumption of rapeseed oil cuts across many areas around the world, the nutritional elements of rapeseed oil and the exact efficacy of the nutrients remain unclear. In this review, we systematically summarized the latest studies on functional rapeseed components to ascertain which component of canola oil contributes to its function. Apart from unsaturated fatty acids, there are nine functional components in rapeseed oil that contribute to its anti-microbial, anti-inflammatory, anti-obesity, anti-diabetic, anti-cancer, neuroprotective, and cardioprotective, among others. These nine functional components are vitamin E, flavonoids, squalene, carotenoids, glucoraphanin, indole-3-Carbinol, sterols, phospholipids, and ferulic acid, which themselves or their derivatives have health-benefiting properties. This review sheds light on the health-benefiting effects of rapeseed oil in the hope of further development of functional foods from rapeseed.

Rapid Screening of Phenolic Compounds with Anti-Enteritis Activity from Camellia oleifera Oil Using a Smurf Drosophila Model and Molecular Docking Methods.

Screening and identifying the active compounds in foods are important for the development and utilization of functional foods. In this study, the anti-enteritis activity of ethanol extract from Camellia oleifera oil (PECS) was quickly evaluated using a Smurf Drosophila model and the metabolomics approach, combined with molecular docking techniques, were performed to rapidly screen and identify compounds with potential anti-enteritis activity in PECS. PECS showed good anti-enteritis activity and inhibited the activity of 5-lipoxygenase (LOX), cyclooxygenase 2 (COX-2) and inducible nitric oxide synthase (iNOS). In particular, wighteone and p-octopamine were newly identified in C. oleifera oil and were proven to have good anti-enteritis activity. The inhibitory activity of kaempferitrin (IC50 = 0.365 mmol L-1) was higher than that of wighteone (IC50 = 0.424 mmol L-1) and p-octopamine (IC50 = 0.402 mmol L-1). Of note, the IC50 value of salazosulfapyridine was 0.810 mmol L-1. Inhibition of LOX activity is likely one of the anti-enteritis mechanisms of PECS. These new findings lay the foundation for further investigations into the underlying mechanisms of anti-enteritis activity in C. oleifera oil.

ED50 value of remifentanil in inhibiting coughing during extubation in children with snoring.

Objective: This study aimed to determine the effective dose 50% (ED50) value of remifentanil in inhibiting coughing during extubation in children with snoring. Methods: The subjects were children who scored a grade I in the American Society of Anesthesiology (ASA) metric and who were undergoing tonsillectomy (with or without adenoidectomy) under general anesthesia. Using Dixon's up-and-down sequential method, the initial infusion rate of remifentanil was 0.06 µg/kg/min, and the difference between the infusion rates of the two adjacent groups was 0.01 µg/kg/min. If a child had no cough response during extubation, the infusion rate for the next child was reduced by 0.01 µg/kg/min. If that child had cough response, the infusion rate for the next child was increased by 0.01 µg/kg/min, and the test was terminated when seven pairs of children with positive-negative alternating results were obtained. The ED50 value and its 95% confidence interval (CI) were calculated by probit regression. The times for extubation, awakening, agitation, and respiratory complications after extubation were compared between the two groups. Results: 1) The ED50 value of a continuous infusion of remifentanil required to inhibit the cough response of children during extubation was 0.042 µg/kg/min, and the 95% confidence interval was 0.025-0.062 µg/kg/min. 2) The total dosage and infusion rate of remifentanil in the cough suppression group were higher than those in the cough group (p < 0.05), but the differences in the times for extubating and awakening between the two groups were not statistically significant (p > 0.05). 3) There was no correlation between the infusion rate of remifentanil and the time for extubating and awakening in the cough suppression group; the r values were 0.13 and 0.12, respectively, and p > 0.05. 4) The differences in postoperative respiratory complications between the two groups were not statistically significant (p > 0.05). Conclusion: The ED50 value of a continuous infusion of remifentanil required to inhibit the cough response of children during extubation after tonsillectomy (with or without adenoidectomy) was 0.042 µg/kg/min, and a low-dose infusion of remifentanil does not affect the times for awakening and extubating in children.

Quality improvement of sweet rice wine fermented with Rhizopus delemar on key aroma compounds content, phenolic composition, and antioxidant capacity compared to Rhizopus oryzae.

The pure culture fermentation has led to less flavorful rice wine and relatively lower bioactive substance level compared to traditional mixed culture fermentation; however, a pure strain is easily controlled by industrialized producers. The purpose of the present research was to screen a species of Rhizopus for improving the flavor deficiency and antioxidant function of sweet rice wine. Seven rice wine samples fermented with isolated strains were analyzed for their total phenolics, total flavonoids, peptide and antioxidant activity using spectrophotometry, as well as ethanol, ethyl acetate, ß-phenethyl alcohol, and volatile alcohol contents measured by headspace gas chromatography (HS-GC), the further principal component analysis determined Rhizopus delemar rice wine better on aroma and antioxidant capacity. A comparison of phenolics profile between R. delemar and R. oryzae rice wines was made based on the measurement data of ultrahigh-performance liquid chromatography coupled with Q-exactive orbitrap mass spectrometry (UHPLC-QE-MS) data. Thirty-two phenolics were identified in sweet rice wine. Overall, the results presented in this study showed that a strain of R. delemar is available for the improvement of flavor and antioxidant activity in sweet rice wine, which has the great potential to be applied to industrialized products. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-021-05250-x.

Application of Educational Psychology-Based Dance Therapy in College Students' Life Education.

The purpose is to strengthen the life education of contemporary college students and give better play to the vital role of life education in preventing college students' mental diseases. Specifically, it discusses the role of dance therapy (DT) in College Students' Life Education (CSLE). Firstly, based on educational psychology (EP), this manuscript analyzes the relevant theoretical concepts of EP and life education and discusses the importance of life education to contemporary college students. Secondly, following a Questionnaire Survey (QS) and using deep learning (DL) Convolutional Neural Network (CNN) and Facial Emotion Recognition (FER), this manuscript reviews and examines the CSLE's current situation and the DT effect. Research findings are summarized combined with the QS results and scores of 20 subjects before and after five activities in 3 months. (I) After DT intervention, the positive dimensions of college students' life values have improved, especially self-development and dedication, and their quality of life is refined. Thus, DT group counseling proves the positive role of DT in CSLE. (II) After DT intervention, 96.5% of the members think DT is effective. Therefore, EP-based DT is more effective and scientific in CSLE. The research findings provide a DT-based teaching concept for CSLE, explore the feasibility and effectiveness of life education, and enrich the DT scheme of CSLE. The research provides a practical reference for further applying DT in college students' psychological education.

Case Report: A report on the countermeasures after the rupture of the scalp venous indwelling needle catheter in 12 cases.

As a substitute for a scalp needle, the intravenous indwelling needle is easy to operate and easy to use. it is not only conducive to the rescue of critically ill children, improves nursing efficiency, but also avoids pain caused by repeated venipuncture. However, cases of indwelling needle catheter breaking and remaining in scalp vessels are rarely reported. This study collected 12 cases of scalp vein indwelling needle rupture and retention in scalp vessels in our center from January 2012 to January 2022. It was found that there were 7 males and 5 females, with an average age of 19.17 ± 8.96 months. The average length of the severed end was 15.00 ± 1.54 mm. In 8 cases, the catheter was broken during the haircut, and in 2 cases, the wall structure was damaged and broken after repeated folding of the catheter. In 2 cases, the children did not cooperate during extubation, the head twisted violently and the catheter was broken.5 cases tried to extract it by manipulation and hemostatic forceps, of which 4 cases were successful, and 1 case was successfully removed after the completion of three-dimensional computerized tomography (3D-CT) imaging positioning. The remaining 7 cases were removed by operation, and the success rate of the first operation was 100% in 4 cases who chose 3D-CT. The other 3 cases chose ordinary CT plain scan positioning, the success rate of the first operation was 66.6%, and one child was successfully removed after the second operation after the failure of the operation plus 3D-CT scan positioning. All the children were in stable condition after the operation and were discharged smoothly. When the broken catheter is relatively shallow and the scalp is not completely closed, we could choose the preliminary positioning of B-ultrasound or ordinary CT, and then try to remove it by manual squeezing combined with hemostatic forceps. However B-ultrasound and ordinary CT could not meet the requirements of accurate location, 3D-CT has a very important localization value for surgery, which can improve the success rate and help successfully remove the ruptured catheter.

Characterization of the key aroma compounds of a sweet rice alcoholic beverage fermented with Saccharomycopsis fibuligera.

This study aims to examine the effect of the non-Saccharomyces yeast Saccharomycopsis fibuligera on the sensory quality and flavour characteristics of a sweet rice alcoholic beverage. The strain S. fibuligera was isolated from a traditional Chinese hand-made starter with the purpose to improving sweet rice wine fragrance. Here, sweet rice wines were produced by six combinations of three species of fermentation strains, including S. fibuligera, Rhizopus and Saccharomyces cerevisiae, for evaluation. The study results showed significant diversities within these rice wines based on indicators including the score of quantitative descriptive analysis and volatile variety and content as well as odour activity value (OAV). Quantitative results showed that 43 volatile compounds were identified by headspace-solid phase microextraction with gas chromatography-mass spectrometry among samples. Based on the principal component analysis and OAV calculation, the two samples (S-2 and S-3) fermented with S. fibuligera and Rhizopus possessed high scores and were distinguished from the others, and ethyl butanoate, ethyl hexanoate, ß-phenylethyl alcohol and 1-octen-3-one with high OAVs were responsible for the key aroma of sweet rice wine fermented with S. fibuligera. Co-inoculating S. fibuligera, Rhizopus or/and S. cerevisiae generated more pleasant aroma compounds in a sweet rice alcoholic beverage than when inoculated individually.

Effect of positive end-expiratory pressure ventilation on plasma nitric oxide, endothelin-1 and vascular celladhesion molecule-1 levels in patients undergoing uvulopalatopharyngoplasty.

BACKGROUND: During uvulopalatopharyngoplasty (UPPP), cardiovascular adverse events may occur which can be harmful to patients. OBJECTIVE: To evaluate the effect of the protective ventilation strategy on the function of vascular endothelial cells. METHODS: Forty obstructive apnea syndrome (OSA) patients who underwent uvulopalatopharyngoplasty (UPPP) were enrolled. Patients were randomly divided into the control group (group C, PEEP = 0 cm H2O) and PEEP group (group P, PEEP = 5 cm H2O). Each group (n= 20) received intermittent volume controlled ventilation (VCV) with tidal volume 6 ml/kg of the predicted body weight, I:E 1:2, rate titrated for ETCO2 35-45, FiO2 0.7. Blood from the radial artery was sampled for blood gas analysis at four time points: the fifth minute of inhaling pure oxygen (T0), after tracheal intubation (T1), at the end of the operation (T2), and 20 minutes after extubation (T3). Three ml of arterial blood was retained, preserved at -20∘C after serum isolation, and plasma nitric oxide (NO), endothelin-1 (ET-1) and vascular celladhesion molecule-1 (VCAM-1) levels were determined by enzyme linked immunosorbent assay (ELISA). RESULTS: Compared with group C, plasma ET-1 at T3 decreased in group P, and plasma NO levels at T2 and T3 increased (P< 0.05). Compared with samples collected at T0, plasma VCAM-1 levels at T1, T2 and T3 increased in group C, while plasma VCAM-1 levels at T2 and T3 decreased in group P (P< 0.05). Compared with group C, plasma VCAM-1 levels T2 and T3 decreased in group P (P< 0.05). CONCLUSIONS: Positive end-expiratory pressure (PEEP) ventilation has a protective effect on vascular endothelial cell function in patients during UPPP.

Protective Effect of Tangeretin and 5-Hydroxy-6,7,8,3',4'-Pentamethoxyflavone on Collagen-Induced Arthritis by Inhibiting Autophagy via Activation of the ROS-AKT/mTOR Signaling Pathway.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by long duration and repeated relapse. This study explored the preventive effect of tangeretin (TAN) and 5-hydroxy-6,7,8,3',4'-pentamethoxyflavone (5-HPMF) on RA, and the underlying molecular mechanism based on a rat model stimulated by bovine type II collagen (BIIC). After the intervention of TAN or 5-HPMF (TAN/5-HPMF) for 5 weeks, the RA lesions and autophagy levels of the synovial tissue were significantly reduced, and the ROS content and HO-1 expression level were down-regulated simultaneously. The relative expression levels of p-AKT and p-mTOR were down-regulated after TAN/5-HPMF feeding. Meanwhile, the relative expression level of p62 increased by more than two-fold for TAN/5-HPMF treated rats at 200 mg/kg BW comparing with those in BIIC group. Results of immunofluorescence staining and Western blotting further confirmed that TAN/5-HPMF treatment reduced BIIC-induced conversion from LC3I to LC3II. Observations under transmission electron microscope also demonstrated that the autophagy level was reduced upon TAN/5-HPMF intervention. Collectively, these results revealed that TAN and 5-HPMF prevented the pathological process of BIIC-stimulated arthritis through inhibiting the autophagy of synovial cells, achieved via the ROS-AKT/mTOR signal axis. Thus, our findings confirmed the protective potential of TAN and 5-HPMF for RA disease.

Quantitative Proteomics Analysis by Sequential Window Acquisition of All Theoretical Mass Spectra-Mass Spectrometry Reveals a Cross-Protection Mechanism for Monascus To Tolerate High-Concentration Ammonium Chloride.

To achieve the accumulation of targeted secondary metabolites, microorganisms must adopt various protection mechanisms to avoid or reduce damage to cells caused by abiotic stresses, which formed from the changes of physical and chemical culture conditions. The protection mechanism of Monascus sp. to tolerate high-concentration ammonium chloride was analyzed by sequential window acquisition of all theoretical mass spectra-mass spectrometry proteomics in this work, and the results indicated that abiotic stresses caused by high-concentration ammonium chloride inhibited the synthesis of chitin and glycoprotein, leading to a decrease in cell wall integrity and, thus, affecting cell growth. At the same time, it also inhibited the complex enzyme III and IV activities of the mitochondrial cytochrome respiratory chain, leading to an increase in reactive oxygen species (ROS) levels. With the aim to respond to abiotic stresses, the cross-protection mechanism was implemented in Monascus, including self-protection of the Monascus cell by promoting synthesis of trehalose, a molecular chaperone that facilitates protein folding (such as heat-shock protein) and autophagy-related proteins, through not the enzyme protection system (superoxide dismutase, peroxidase, catalase, NADPH oxidase, and alternative oxidase) but the glutathione/glutaredoxin system, to maintain the intracellular redox state and then eliminate or reduce ROS damage to the cell. At the same time, an alternative respiratory pathway related to NADH dehydrogenase was activated to balance the material and energy metabolism.

Quantitative Proteomics Analysis by Sequential Window Acquisition of All Theoretical Mass Spectra-Mass Spectrometry Reveals Inhibition Mechanism of Pigments and Citrinin Production of Monascus Response to High Ammonium Chloride Concentration.

Various Monascus bioactive metabolites used as food or food additives in Asia for centuries are subjected to constant physical and chemical changes and different Monascus genus. With the aim to identify enzymes that participate in or indirectly regulate the pigments and citrinin biosynthesis pathways of Monascus purpureus cultured under high ammonium chloride, the changes of the proteome profile were examined using sequential window acquisition of all theoretical mass spectra-mass spectrometry-based quantitative proteomics approach in combination with bioinformatics analysis. A total of 292 proteins were confidently detected and quantified in each sample, including 163 that increased and 129 that decreased (t-tests, p ≤ 0.05). Pathway analysis indicated that high ammonium chloride in the present study accelerates the carbon substrate utilization and promotes the activity of key enzymes in glycolysis and ß-oxidation of fatty acid catabolism to generate sufficient acetyl-CoA. However, the synthesis of the monascus pigments and citrinin was not enhanced because of inhibition of the polyketide synthase activity. All results demonstrated that the cause of initiation of pigments and citrinin synthesis is mainly due to the apparent inhibition of acyl and acetyl transfer by some acyltransferase and acetyltransferase, likely malony-CoA:ACP transacylase.

Titanium cable isotonic annular fixation system for the treatment of distal tibiofibular syndesmosis injury.

Distal tibiofibular syndesmosis injury (DTS) occurs frequently with ankle sprains. Current treatments pose several limitations including causing soft tissue irritation, bringing damage to fixation secondary to weight-bearing, and requiring follow-up surgeries. Here, we investigated the clinical effects of a new technique, titanium cable isotonic annular fixation, for the treatment of DTS injury. From January 2015 to June 2017, 36 patients with ankle fractures and DTS injuries had their fractures repaired with the titanium cable isotonic annular fixation system. Recovery was scored by the AOFAS ankle function score system. We also assessed the differences in ankle motion between healthy and operative joints, and recorded the complications. All patients recovered from surgery without any serious complications. We followed all the cases for 18-25 months with an average follow-up of 21.26±3.23 months. 12 months after the operation, X-ray images showed that the titanium cables were fixed in the correct position without any fracture or loosening. Additionally, no degeneration or traumatic arthritis was observed in the ankle joint. There were no incision or bone mineral density changes between the titanium fix and tibiofibular bones. Nearly all patients recovered well except for three who developed inflammation and infection. However, these three patients recovered following 1 week of intravenous antibiotics and local radiofrequency physiotherapy. According to the AOFAS scoring system, all patients achieved satisfactory recovery 12 months post operation. Our titanium cable isotonic annular fixation system has both the advantages of elastic and rigid fixations. It can restore isotonic strength of the distal tibiofibular joint, and its biomechanical performance approaches normal physiological function. After the operation, patients tolerated weight-bearing exercise and recovered joint mobility. Finally, there is no need to remove the distal tibiofibular implant after 12 weeks. Overall, it is a highly effective surgical method to treat DTS injury.