CEP120-mediated KIAA0753 recruitment onto centrioles is required for timely neuronal differentiation and germinal zone exit in the developing cerebellum.

Joubert syndrome (JS) is a recessive ciliopathy in which all affected individuals have congenital cerebellar vermis hypoplasia. Here, we report that CEP120, a JS-associated protein involved in centriole biogenesis and cilia assembly, regulates timely neuronal differentiation and the departure of granule neuron progenitors (GNPs) from their germinal zone during cerebellar development. Our results show that depletion of Cep120 perturbs GNP cell cycle progression, resulting in a delay of cell cycle exit in vivo. To dissect the potential mechanism, we investigated the association between CEP120 interactome and the JS database and identified KIAA0753 (a JS-associated protein) as a CEP120-interacting protein. Surprisingly, we found that CEP120 recruits KIAA0753 to centrioles, and that loss of this interaction induces accumulation of GNPs in the germinal zone and impairs neuronal differentiation. Importantly, the replenishment of wild-type CEP120 rescues the above defects, whereas expression of JS-associated CEP120 mutants, which hinder KIAA0753 recruitment, does not. Together, our data reveal a close interplay between CEP120 and KIAA0753 for the germinal zone exit and timely neuronal differentiation of GNPs during cerebellar development, and mutations in CEP120 and KIAA0753 may participate in the heterotopia and cerebellar hypoplasia observed in JS patients.

Prediction of hospital mortality among critically ill patients in a single centre in Asia: comparison of artificial neural networks and logistic regression-based model.

INTRODUCTION: This study compared the performance of the artificial neural network (ANN) model with the Acute Physiologic and Chronic Health Evaluation (APACHE) II and IV models for predicting hospital mortality among critically ill patients in Hong Kong. METHODS: This retrospective analysis included all patients admitted to the intensive care unit of Pamela Youde Nethersole Eastern Hospital from January 2010 to December 2019. The ANN model was constructed using parameters identical to the APACHE IV model. Discrimination performance was assessed using area under the receiver operating characteristic curve (AUROC); calibration performance was evaluated using the Brier score and Hosmer-Lemeshow statistic. RESULTS: In total, 14 503 patients were included, with 10% in the validation set and 90% in the ANN model development set. The ANN model (AUROC=0.88, 95% confidence interval [CI]=0.86-0.90, Brier score=0.10; P in Hosmer-Lemeshow test=0.37) outperformed the APACHE II model (AUROC=0.85, 95% CI=0.80-0.85, Brier score=0.14; P<0.001 for both comparisons of AUROCs and Brier scores) but showed performance similar to the APACHE IV model (AUROC=0.87, 95% CI=0.85-0.89, Brier score=0.11; P=0.34 for comparison of AUROCs, and P=0.05 for comparison of Brier scores). The ANN model demonstrated better calibration than the APACHE II and APACHE IV models. CONCLUSION: Our ANN model outperformed the APACHE II model but was similar to the APACHE IV model in terms of predicting hospital mortality in Hong Kong. Artificial neural networks are valuable tools that can enhance real-time prognostic prediction.

Public awareness of preventive measures against COVID-19: an infodemiology study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has led to an increase in global awareness of relevant public health preventive measures. This awareness can be explored using online search trends from major search engines, such as Google Trends. We investigated the relationship between public awareness of preventative measures and progression of the COVID-19 pandemic. METHODS: Search data for five queries ('mask', 'hand washing', 'social distancing', 'hand sanitizer', and 'disinfectant') were extracted from Google Trends in the form of relative search volume (RSV). Global incidence data for COVID-19 were obtained from 1 January to 30 June 2020. These data were analysed and illustrated using a global temporal RSV trend diagram, a geographical RSV distribution chart, scatter plots comparing geographical RSV with average number of daily cases, and heat maps comparing temporal trends of RSV with average number of daily cases. RESULTS: Global temporal trends revealed multiple increases in RSV, associated with specific COVID-19-related news events. The geographical distribution showed top regions of interest for various preventive measures. For the queries 'mask', 'hand washing', 'hand sanitizer', and 'disinfectant', heat maps demonstrated patterns of early RSV peaks in regions with lower average number of daily cases, when the temporal element was incorporated into the analysis. CONCLUSION: Early public awareness of multiple preventive measures was observed in regions with lower average number of daily cases. Our findings indicate optimal public health communication regarding masks, hand washing, hand sanitiser, and disinfectant in the general population during early stages of the COVID-19 pandemic. Early public awareness may facilitate future disease control efforts by public health authorities.

[Clinical outcomes of endovascular therapy in acute stroke patients with anterior circulation tandem occlusions due to atherosclerosis and dissection].

Objective: To compare the clinical outcomes of endovascular therapy in acute stroke patients with anterior circulation tandem occlusions caused by atherosclerosis or dissection. Methods: A retrospective cohort study. A total of 98 patients with anterior circulation tandem lesions undergoing endovascular therapy in the Wuhan NO.1 Hospital (March 2016 to March 2022) were analyzed. Median age was 64(55,71) years old, and 82.7% (81/98 cases) were males. According to the lesion etiology, the patients were divided into atherosclerosis and dissection groups. The differences in clinical outcomes between the two groups were investigated, including favorable 90-day functional outcome (modified Rankin Scale score of 0-2), successful reperfusion (modified Thrombolysis in Cerebrovascular Infarction score of 2b-3), symptomatic intracranial hemorrhage, stroke-associated pneumonia, 90-day all-cause mortality, and average hospitalization days. Logistic regression analysis was used to adjust for potential confounders affecting functional outcomes in both groups, and to determine odds ratios and 95% confidence intervals. Results: Seventy-one patients were grouped into the atherosclerotic cause and 27 into the dissection cause cohorts. The rate of favorable 90-day functional outcome was 43.7% (31/71 cases) in the atherosclerosis group versus 55.6% (15/27 cases) in the dissection group (adjusted odds ratio=1.339; 95% confidence interval, 0.374-4.798; P=0.654). No significant differences were found in other clinical outcomes between the two groups (all P>0.05). Conclusion: The clinical prognosis of patients with tandem lesions caused by atherosclerotic stenosis or artery dissection was similar after endovascular therapy. Future studies are still needed to verify our results.

[Efficacy of Hintermann calcaneal lengthening osteotomy for flexible flatfoot].

Objective: To investigate the clinical efficacy of Hintermann osteotomy (H-LCL) for flexible flatfoot. Methods: A follow-up study. Clinical data of 30 patients with flexible flatfoot treated with H-LCL operation from January 2020 to December 2021 in Sports Medical Center of the First Affiliated Hospital of Army Medical University were retrospectively analyzed. There were 8 males and 22 females, with a mean age of (39.0±15.2) years. The mean time from symptom onset to the diagnosisï¼»M（Q1，Q3）］was 24.0 (5.5, 102.0) months. The functional and imaging scores of the patients before and after the last follow-up were compared to evaluate the clinical efficacy of the operation. The functional scores included American Orthopedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) of pain, pain interference (PI) and physical function (PF) index in Patient-Reported Outcomes Measurement Information System (PROMIS). And the imaging scores included Meary's angle, calcaneal pitch angle, calcaneal valgus angle and talonavicular coverage angle. Results: The mean operation time was (82.3±24.4) min, and the follow-up periods was (17.9±6.9) months. At the last follow-up, VAS of pain [M(Q1, Q3)] decreased from 5 (4, 6) to 2 (1, 2); PI decreased from 59.8±5.0 to 44.6±5.7; AOFAS increased from 65.2±10.0 to 85.8±3.3; PF increased from 50 (48.5,51.0) to 58.5 (54.0, 66.0); Meary's angle (antero-posterior image) decreased from 15.7° (10.1°, 29.2°) to 3.9° (2.6°, 5.3°); Meary's angle (lateral image) decreased from 13.5°±6.8° to 4.4°±2.6°; calcaneal pitch angle increased from 14.0°±3.3° to 18.6°±4.2°; calcaneal valgus angle decreased from 12.6°±7.3° to 4.3°±2.5°; and talonavicular coverage angle decreased from 20.9°±10.7° to 7.7°±5.2°. The up-mentioned parameters were all improved statistically significant at the last follow-up when compared with those before the operation (all P<0.05). Conclusion: H-LCL brings a significant improvement of clinical outcome scores and good radiological correction of flatfoot deformities in correcting flexible flatfoot, it conforms to the anatomical characteristics of the subtalar joint.

[The progress of clinical research and treatment of monocular elevation deficiency].

Monocular elevation deficiency (MED) is a functional defect in upward eye movement caused by paralysis, restriction, or a combination of factors. The affected eye experiences limited movement in the upward, nasal, and temporal directions, often accompanied by downward deviation and ptosis. Previously known as double elevator palsy (DEP), MED can result from muscle paralysis responsible for upward movement, restriction of the inferior rectus muscle, or lesions in the supranuclear pathway. The Knapp procedure was once the most commonly used surgical approach for MED. However, in cases involving restriction of the inferior rectus muscle, a staged approach combining inferior rectus muscle weakening and subsequent Knapp procedure is necessary to avoid anterior segment ischemia. This has led to the development of alternative surgical techniques, such as single-rectus muscle transposition, partial tendon transposition, and muscle belly transposition. Differentiating MED subtypes based on the underlying paralysis or restriction etiology is crucial for determining the appropriate surgical plan. This review article summarizes the clinical features, classification, and available surgical options for MED, aiming to provide valuable insights for clinical research and treatment.

Loss of CPAP in developing mouse brain and its functional implication for human primary microcephaly.

Primary microcephaly (MCPH) is a neurodevelopmental disorder characterized by small brain size with mental retardation. CPAP (also known as CENPJ), a known microcephaly-associated gene, plays a key role in centriole biogenesis. Here, we generated a previously unreported conditional knockout allele in the mouse Cpap gene. Our results showed that conditional Cpap deletion in the central nervous system preferentially induces formation of monopolar spindles in radial glia progenitors (RGPs) at around embryonic day 14.5 and causes robust apoptosis that severely disrupts embryonic brains. Interestingly, microcephalic brains with reduced apoptosis are detected in conditional Cpap gene-deleted mice that lose only one allele of p53 (also known as Trp53), while simultaneous removal of p53 and Cpap rescues RGP death. Furthermore, Cpap deletion leads to cilia loss, RGP mislocalization, junctional integrity disruption, massive heterotopia and severe cerebellar hypoplasia. Together, these findings indicate that complete CPAP loss leads to severe and complex phenotypes in developing mouse brain, and provide new insights into the causes of MCPH.

A novel HIF1α-STIL-FOXM1 axis regulates tumor metastasis.

BACKGROUND: Metastasis is the major cause of morbidity and mortality in cancer that involves in multiple steps including epithelial-mesenchymal transition (EMT) process. Centrosome is an organelle that functions as the major microtubule organizing center (MTOC), and centrosome abnormalities are commonly correlated with tumor aggressiveness. However, the conclusive mechanisms indicating specific centrosomal proteins participated in tumor progression and metastasis remain largely unknown. METHODS: The expression levels of centriolar/centrosomal genes in various types of cancers were first examined by in silico analysis of the data derived from The Cancer Genome Atlas (TCGA), Gene Expression Omnibus (GEO), and European Bioinformatics Institute (EBI) datasets. The expression of STIL (SCL/TAL1-interrupting locus) protein in clinical specimens was further assessed by Immunohistochemistry (IHC) analysis and the oncogenic roles of STIL in tumorigenesis were analyzed using in vitro and in vivo assays, including cell migration, invasion, xenograft tumor formation, and metastasis assays. The transcriptome differences between low- and high-STIL expression cells were analyzed by RNA-seq to uncover candidate genes involved in oncogenic pathways. The quantitative polymerase chain reaction (qPCR) and reporter assays were performed to confirm the results. The chromatin immunoprecipitation (ChIP)-qPCR assay was applied to demonstrate the binding of transcriptional factors to the promoter. RESULTS: The expression of STIL shows the most significant increase in lung and various other types of cancers, and is highly associated with patients' survival rate. Depletion of STIL inhibits tumor growth and metastasis. Interestingly, excess STIL activates the EMT pathway, and subsequently enhances cancer cell migration and invasion. Importantly, we reveal an unexpected role of STIL in tumor metastasis. A subset of STIL translocate into nucleus and associate with FOXM1 (Forkhead box protein M1) to promote tumor metastasis and stemness via FOXM1-mediated downstream target genes. Furthermore, we demonstrate that hypoxia-inducible factor 1α (HIF1α) directly binds to the STIL promoter and upregulates STIL expression under hypoxic condition. CONCLUSIONS: Our findings indicate that STIL promotes tumor metastasis through the HIF1α-STIL-FOXM1 axis, and highlight the importance of STIL as a promising therapeutic target for lung cancer treatment.

An accurate potential model for the a3Σu+ state of the lithium dimer.

An accurate Tang-Toennies (TT) model potential is introduced to describe the interatomic potential of the lithium dimer in the a3Σu+ state. With only one well-known parameter, the ionization energy, the new model potential compares favorably with the experimentally fitted Morse/Long-range (MLR) potential of Dattani and Le Roy [J. Mol. Spectrosc., 2011, 268, 199] and is in excellent agreement with the state-of-the-art ab initio potential of Lesiuk et al. [Phys. Rev. A, 2020, 102, 062806]. With the known dispersion coefficients and the ionization energy, the new potential requires only two experimental parameters, namely the depth of the potential well De and its location Re. The new potential can be extended to the region of zero separation by the united atom limit.

Association between low skeletal muscle mass and subclinical coronary atherosclerosis in asymptomatic individuals evaluated by CT.

AIM: To investigate the associations of skeletal muscle area and density with coronary atherosclerotic plaques and significant stenosis in asymptomatic adults. MATERIALS AND METHODS: A total of 243 consecutive subjects who had voluntarily undergone abdominal unenhanced computed tomography (CT) and coronary CT angiography (CCTA) as part of a general health examination were investigated retrospectively. Skeletal muscle area index (SMI) and skeletal muscle density (SMD) was assessed using CT. Coronary atherosclerotic plaques and stenosis on CCTA were evaluated. The associations of low SMI and low SMD with coronary atherosclerotic plaques and significant stenosis were determined by logistic regression analysis. RESULTS: After adjustment for cardiovascular risk factors, there were significant associations of low SMI or low SMD with atherosclerotic plaque, total significant stenosis, and significant stenosis caused by calcified or mixed plaques (for all p<0.05). In addition, multivariate regression analysis also showed that low SMI was independently associated with calcified plaque (p=0.038) and non-calcified plaque (p=0.006), and individuals with low SMD were more likely to have mixed plaque (p=0.001). CONCLUSION: Assessment of the skeletal muscle on CT help to identify asymptomatic adults at risk for coronary atherosclerosis.

Association of multimorbidity of non-communicable diseases with mortality: a 10-year prospective study of 0.5 million Chinese adults.

OBJECTIVES: Non-communicable diseases (NCDs) account for seven out of 10 deaths worldwide, whereas the pattern of multimorbidity of NCDs and its long-term impact on all-cause mortality remains largely unknown, especially among the Chinese population. This study aimed to investigate the associations between the number and patterns of multimorbidity with long-term risks of mortality and to estimate the influence of age on the relationship between multimorbidity and mortality. STUDY DESIGN: This was a prospective population-based cohort study. METHODS: Data were obtained from the China Kadoorie Biobank study, which enrolled adults aged 30-79 years from 10 regions of China. The outcome was all-cause mortality, which was measured at a 10-year follow-up (9.93 ± 1.82 years). A principal component analysis (PCA) was used to identify patterns of individuals with multimorbidity based on 16 self-reported or baseline-detected chronic conditions. Cox proportional hazards models were used to examine the associations of both the number and patterns of multimorbidity of NCDs with all-cause mortality. Stratified analyses were carried out to explore whether the associations of multimorbidity with all-cause mortality were modified by age, number, and the patterns of multimorbidity. RESULTS: We included 512,712 individuals in our analysis, of which 176,619 (34.5%) had only one long-term condition (LTC), and 81,360 (15.9%) had multimorbidity. The crude mortality rate was highest in those aged between 70 and 79 years who also had ≥4 LTCs (44.38 per 1000 person-years). In participants with at least four LTCs at baseline, fully adjusted HRs were 4.58 (95% CI 2.65-7.93) for people belongs to 1960s-1970s, compared to 2.73 (95% CI 2.50-2.97) for 1920s-1930s. Six multimorbidity patterns were identified, including cardiometabolic syndrome, respiratory diseases, digestive/renal/urologic diseases, articular/rheumatic diseases, and neuropsychiatric diseases. For the multimorbidity patterns of cardiometabolic syndrome, fully adjusted HRs for all-cause mortality were 1.60 (95% CI 1.55-1.65) in participants with one LTC and 8.19 (95% CI 6.45-10.40) in those with four LTCs compared with the reference group (no LTCs). CONCLUSIONS: The observed higher risk of mortality in younger people with multimorbidity, as middle aged (30-49 years), calls for advocating primary prevention in the younger population and secondary prevention for the elderly to strengthen early detection and timely treatment. Health systems need to shift from single-disease models to more effective multimorbidity management.

[Analysis of the effectiveness of coracoid osteotomy and concentric coaxial reconstruction of the glenoid cavity in the treatment of recurrent anterior dislocation of the shoulder joint].

Objective: To investigate the clinical efficacy of the modified Latarjet procedure in the treatment of recurrent anterior subluxation of the shoulder by "coaxial co-arc" reconstruction of the glenoid cavity. Methods: The clinical data of 103 cases (106 shoulders) of recurrent anterior dislocation of the shoulder admitted to the First Affiliated Hospital of the Army Military Medical University from January 2005 to December 2020 were retrospectively studied. Out of these cases, 84 were males and 19 were females; 31 with left-sided injuries while 75 with right-sided injuries, with a mean age of (29.4±11.5) years (16-61 years). The preoperative anterior fear test was positive, and a modified Latarjet procedure was used to reconstruct the shoulder glenoid defect through a "coaxial co-arc". The Rowe score, simple shoulder test (SST) score, and Visual analogue scale (VAS) score of pain were used to assess the shoulder's function. Parameters such as the postoperative shoulder recurrent dislocation rate, shoulder body external rotation angle, and subscapularis muscle strength changes were recorded postoperatively. Moreover, radiographs and CT scans were used to check for the incidence of osteoarthritis (Samson-Prieto score). Results: After a mean follow-up of 9.0 years (1 to 16 years), bony healing occurred 3 to 6 months postoperatively. The Rowe score improved from 40.4±6.5 preoperatively to 93.2±2.5 (P<0.001), the SST score improved from 5.2±1.3 preoperatively to 10.1±1.5 (P<0.001), and the VAS pain score decreased from 3.5±1.9 preoperatively to 1.1±1.2 (P<0.001) at the final follow-up. The angle of lateral external rotation of the shoulder joint was 58.8°±15.6° preoperatively and 57.6°±14.5° postoperatively with no statistically significant difference (P>0.05). There was no statistically significant difference in the measurement of subscapularis muscle strength between the healthy side and the affected side (P>0.05). In 89.6% of patients after surgery, coaxial co-arc reconstruction of the shoulder glenoid was obtained, and the shoulder glenoid defect and postoperative inclusion angle were significantly improved compared with those before surgery (P<0.001). Postoperatively, new-onset osteoarthritis developed in 7 cases (7/98), arthritis progressed in 2 cases (2/8), incisional healing was poor in 2 cases (2/98), and revision surgery was performed in 2 cases (2/98) due to bone mass detachment. Conclusion: Coracoid osteotomy and concentric coaxial reconstruction of the glenoid cavity elicits adequate good clinical efficacy for cases of recurrent anterior shoulder dislocation, with low recurrence rates, low revision rates and low incidence of osteoarthritis.

Topical preparations for the treatment of mild-to-moderate acne vulgaris: systematic review and network meta-analysis.

BACKGROUND: Acne is very common and can have a substantial impact on wellbeing. Guidelines suggest first-line management with topical treatments, but there is little evidence regarding which treatments are most effective. OBJECTIVES: To identify the most effective and best tolerated topical treatments for acne using network meta-analysis. METHODS: CENTRAL, MEDLINE, Embase and World Health Organization Trials Registry were searched from inception to June 2020 for randomized trials that included participants with mild/moderate acne. Primary outcomes were self-reported improvement in acne, and trial withdrawal. Secondary outcomes included change in lesion counts, Investigator's Global Assessment, change in quality of life and total number of adverse events. Network meta-analysis was undertaken using a frequentist approach. Risk of bias was assessed using the Cochrane Risk of Bias Tool and confidence in evidence was assessed using CINeMA. RESULTS: A total of 81 papers were included, reporting 40 trials with a total of 18 089 participants. Patient Global Assessment of Improvement was reported in 11 trials. Based on the pooled network estimates, compared with vehicle, benzoyl peroxide (BPO) was effective (35% vs. 26%) for improving self-reported acne. The combinations of BPO with adapalene (54% vs. 35%) or with clindamycin (49% vs. 35%) were ranked more effective than BPO alone. The withdrawal of participants from the trial was reported in 35 trials. The number of patients withdrawing owing to adverse events was low for all treatments. Rates of withdrawal were slightly higher for BPO with adapalene (2·5%) or clindamycin (2·7%) than BPO (1·6%) or adapalene alone (1·0%). Overall confidence in the evidence was low. CONCLUSIONS: Adapalene in combination with BPO may be the most effective treatment for acne but with a slightly higher incidence of withdrawal than monotherapy. Inconsistent reporting of trial results precluded firmer conclusions.

Correction: The development of a full range analytical interatomic potential.

Correction for 'The development of a full range analytical interatomic potential' by X. W. Sheng et al., Phys. Chem. Chem. Phys., 2021, DOI: 10.1039/d0cp04083e.

The development of a full range analytical interatomic potential.

A chronological account is given to the development of a full range interatomic potential. Starting with a simple phenomenological model, the terms in the model are gradually modified, so that they can carry some definite physical meaning. To gain insight, a systematic, order by order interaction potential theory is developed. Conversely, this theory suggests the functional form for the potential model. At present, we have a simple interaction model that is capable of describing the van der Waals potentials of many systems from R = 0 to R→∞.

Correlations between control of COVID-19 transmission and influenza occurrences in Malaysia.

OBJECTIVES: The transmission of COVID-19 has sent Malaysia into cycles of tightening and relaxation of movement control, which are still continuing currently in line with local fluctuations of new COVID-19 cases. During movement control, measures comprising physical distancing, hand cleaning or sanitizing, and sanitization of premises are consistently implemented while self-isolation and travel restrictions are adaptively enforced. This study aims to examine if the control of COVID-19 transmission has an effect on the national influenza occurrences as some measures for COVID-19 control are similar to those for influenza. STUDY DESIGN: For this study, data of weekly new cases of influenza and COVID-19 were obtained from official platforms for non-parametric statistical analysis. METHODS: This study compared the influenza occurrences before and after the onset of COVID-19 using the Mann-Whitney U-test and explored Spearman's correlations between COVID-19 and influenza incidences after the onset of COVID-19. RESULTS: It shows that influenza incidences before and after the onset of COVID-19 were significantly different and that influenza cases have significantly reduced after the onset of COVID-19. The weekly cases of influenza and COVID-19 were significantly and negatively correlated. CONCLUSIONS: This study underscores the co-benefits of COVID-19 control measures and alleviates the concern for the risk of COVID-19 and influenza co-infection.

[Recognition of ankle sprain: not only lateral collateral ligament injury].

Ankle sprains are a common cause of morbidity in the general and athletic population. The majority of sprains involve the lateral aspect of the ankle, affecting the anterior talofibular ligament. However, the extent and categories of injury will depend upon the mechanism of injury. The ankle injury caused by ankle sprain is not only the injury of lateral collateral ligaments, but also chondral or osteochondral lesions of the talus, anterior ankle impingement, posterior ankle impingement and so on. In addition to the involvement of ankle joint, ankle sprain often leads to the injury of subtalar joint and transverse tarsal joint, even stress fracture, special part fracture or tendon soft tissue injury; multiple injuries often coexist. In clinical work, we should pay more attention to it.

[Arthroscopic treatment through Tang's approach in the treatment of posterior talus impingement syndrome].

Objective: To analyze the efficacy of arthroscopic posterior ankle debridement through Tang's approach for the treatment of impingement of posterior tubercle of the talus. Methods: A retrospective analysis was performed on 64 patients (35 males and 29 females) with posterior tubercle impingement of the talus who underwent surgical treatment from September 2011 to May 2019 in First Affiliated Hospital of Military Medical University of the Army. The disease occurred in left foot in 31 cases and in right foot in 33 cases, with an age ranged from 15 to 65 years ((36±7) years). All patients underwent arthroscopic debridement of the posterior tubercle of the talus through Tang's approach, in which the patients were placed in the lateral decubitus position, and the arthroscopic access was constructed via the lateral malleolus apex approach and the posterolateral Achilles tendon approach. All patients were assessed preoperatively and postoperatively with the American Association of Ankle Surgeries (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) for pain, as well as imaging, and the data were compared before and after the operation. Results: All patients were followed-up effectively for (15.6±4.2) months. The preoperative AOFAS ankle-hind foot function score was (84±11) points, and it was (92±9) points at the last follow-up (P<0.05); the VAS score for preoperative pain was (4.5±3.0) points and it was (1.0±0.3) points at the last follow-up (P<0.05). The distance from the preoperative posterior tubercle of the talus to the perpendicular to the tangent line in the imaging evaluation was (4.0±2.0) mm, the vertical distance between the posterior edge of calcaneal joint surface and tangent line was (-8.4±4.2) mm, and the average vertical distance between posterior tubercle of talus and tangent line was (-7.9±4.6) mm after operation, the exposed distance from the lower joint was (-2.1±3.0) mm after operation. Conclusions: Arthroscopic debridement of the posterior tubercle of talus through Tang's approach can effectively alleviate the symptoms caused by the posterior tubercle of talus. Tang's approach has the advantages of avoiding repeated position change and disinfection, and reducing the possibility of infection.

[Mid-and-long term follow-up of autogenous tibial periosteum-bone complex transplantation for treatment of cystic osteochondral lesion of talus].

Objective: To further clarify the mid-and-long term follow-up results of self-designed tibial periosteum-bone complex transplantation in the treatment of Hepple V osteochondral lesion of the talus(OLTs). Methods: The clinical data of 30 patients with Hepple V OLTs who received treatment in the Sports Medicine Center of the First Affiliated Hospital of Army Military Medical University from October 2011 to January 2019 were analyzed. There were 19 males and 11 females with a mean age of (40±11) years. Patients were treated with autogenous tibial periosteum-bone complex transplantation and were followed up for at least 2 years. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale score (VAS) of pain, the simplified symptomatology evaluation (SSE) and imaging results before the operation and at the follow-up were recorded and compared. Results: The cohort were followed-up for a mean of 63.9 months (range 24-110 months). Twenty-nine (96.7%) patients were satisfied with the curative effect. The FAOS score was improved from 53.5±6.2 preoperatively to 88.4±6.6 at the final follow-up (P<0.001). The AOFAS ankle-hindfoot scale improved from 61.6±8.2 preoperatively to 90.8±6.8 at the last follow-up (P<0.001). The VAS score decreased from 4.3±0.2 preoperative to 0.7±0.7 at the last follow-up (P<0.001). The SSE score was poor in 14 cases (46.7%), average in 16 cases (53.3%) before the operation; and it was excellent in 23 cases (76.7%), good in 6 cases (20%), average in 1 case (3.3%) at the last follow-up. Imaging examination showed cystic change cure rate was 83.3%, cartilage defects were completely infilled with repair tissue, which didn't show any signs of degeneration. However, repair tissue showed varying degrees of heterogeneous signal compared to the normal articular cartilage. Conclusion: The autograft of tibial periosteum-bone complex transplantation is a safe and feasible method for the treatment of osteochondral lesion of the talus in Hepple V type, with good mid-and-long term clinical effect.

[Early clinical efficacy analysis of personalized three-dimensional printing talus prosthesis in the treatment of collapse talus necrosis].

Object To examine the preliminary clinical efficacy of custom-made three-dimensional(3D) printed talus prosthesis in the treatment of collapse talus necrosis. Methods: The clinical data of 8 patients who received 3D printed custom-made talus prostheses replacement for severe collapsed necrosis of the talus at the Orthopaedic Sports Medical Center, the First Affiliated Hospital to Army Medical University were analyzed retrospectively.All patients were male,with an average age of 38.0 years (range:22 to 65 years).There were 5 cases of left talus collapse and 3 cases of right talus collapse,with the course of disease of 29.7 weeks (range:6 to 96 weeks).The CT data of contralateral healthy talus were used for mirror image design references for the prosthesis,and the electron-beam 3D printing technology was used to prepare the prosthesis.Titanium alloy (Ti6Al4V) was taken as the material for the preparation of the talus body prosthesis,and Co-Cr-Mo material was used as the material for the preparation of the tibialis talus lateral joint surface prosthesis,and the subtalar joint surface of the prosthesis was made from a microporous casting technique.The prosthesis was analyzed preoperatively by digital three-dimensional finite element analysis and solid comparison techniques to measure anatomic match of the prosthesis.A longitudinal incision on medial ankle was made.The necrotic talus was completely removed and the prosthesis was then implanted.The patient was reexamined in the outpatient department 3, 6, and 12 months after surgery.Primary outcome measures were the American Orthopaedic Foot and Ankle Society(AOFAS) ankle-hind foot score,visual analogue scale(VAS) and ankle range of motion.Changes in imaging data and plantar pressure were also assessed.Repeated measures analysis of variance and paired-t test were used to compare the data. Results: The talus prosthesis measure preoperatively was completely consistent with that contralateral healthy talus and there was no operation-related complication. All the wounds healed primarily. The patients were followed up effectively for 23.17 months (range:12 to 48 months).The preoperative dorsiflexion of patients was (7.6±5.7)°,it increased to(14.2±6.6)° at 12 month after surgery (t=-2.67,P=0.03).The plantar flexion increased from (22.0±9.9)°preoperatively to (29.2±8.7)° at 12 month after surgery (t=-8.95,P<0.01).Preoperative AOFAS ankle-hind foot score was 26.3±6.6,and it increased to 70.1±2.2,76.0±3.4 and 79.3±4.2 at 3 month,6 month and 12 month after surgery(F=56.81,P<0.01);Pre-operative VAS was[M(QR)]3.0(0.8),and it increased to 2.5(1.0),1.5(1.0),1.0(1.0)at 3 month,6 month and 12 month after surgery(F=20.00,P<0.01).At the last follow-up,imaging reexamination showed that the prosthesis of all patients were in stable position with no sign of subsidence.No secondary ankle fusion or revision was required.The talus height increased from (27.6±6.0)mm preoperatively to (34.6±3.5)mm (t=-2.94,P<0.01).The plantar pressure showed that the maximum pressure on the healthy ankle was(629.9±26.1)N,and that on the affected side was(521.4±14.4)N.The pressure on the healthy ankle was(350.6±29.6)N,and that on the necrotic side was (212.3±9.7)N.The load on the contralateral forefoot was(38.1±2.8)% and that on the necrotic side was(11.5±2.0)%.The load on the contralateral hindfoot was (24.6±2.5)% and that on the necrotic side was (21.1±1.8)%. Conclusions: The custom-made 3D printed talus prosthesis could restore the talus anatomy,recover the ankle joint function,relieve the pain of patients and improve the life quality of patients.The effect on plantar pressure is mainly achieved by adjusting the center of gravity of plantar pressure backwards and the increase of weight bearing of the healthy foot.