The Efficacy of Diabetic Foot Treatment in a "TOSF" Pattern: A Five-Year Retrospective Study.

Aim: To evaluate the advantages and problems in the diagnosis and treatment of diabetic foot (DF) patients by analyzing the results of a 5-year follow-up of the organ system based (TOSF) treatment model. Methods: A retrospective study was conducted in 229 patients with diabetic foot. Chi-square test and rank-sum test were used to analyze the effects of patients' general condition, behavioral and nutritional status, degree of infection (inflammatory markers), comorbidity, diabetic foot grade/classification, and revascularization on readmission rate, amputation rate, all-cause mortality, incidence of other complications, and wound healing time. Logistic regression was used to analyze the risk factors affecting the prognosis of diabetic foot. Kaplan-Meier survival curve was used to analyze the differences in amputation rate and mortality rate at each time point. Results: This study showed that nutritional status, degree of infection, and revascularization influenced readmission rates. General condition, behavior and nutritional status, degree of infection, Wagner grade and revascularization affect the amputation rate. General conditions, behavioral and nutritional status, degree of infection, comorbidities, classification and revascularization affect the mortality of patients. Age and white blood cell(WBC) count affected the incidence of other complications. Influence of infection degree and Wagner grade and revascularization in patients with wound healing time. Revascularization was an independent protective factor for readmission, amputation, and mortality.Elevated serum inflammatory markers are an independent risk factor for amputation. Hypoproteinemia is an independent risk factor for mortality. Conclusion: In the "TOSF" diagnosis and treatment pattern, diabetic foot patients have a good prognosis. Special attention should be paid to the screening and revascularization of lower extremity vascular disease in patients with diabetic foot.

Lactic acid induces lactate transport and glycolysis/OXPHOS interconversion in glioblastoma.

The Warburg effect is a dominant phenotype of most tumor cells. Recent reports have shown that the Warburg effect can be reprogrammed by the tumor microenvironment. Lactic acidosis and glucose deprivation are the common adverse microenvironments in solid tumor. The metabolic reprogramming induced by lactic acid and glucose deprivation remains to be elucidated in glioblastoma. Here, we show that, under glucose deprivation, lactic acid can preserve high ATP levels and resist cell death in U251 cells. At the same time, we find that MCT1 and MCT4 are significantly highly expressed. The metabolic regulation factor HIF-1α decreased and C-MYC increased. Nuclear respiratory factor 1 (NRF1) and oxidative phosphorylation (OXPHOS)-related proteins (NDUFB8, ND1) are all distinctly increased. Therefore, lactic acid can induce lactate transport and convert the dominant Warburg effect to OXPHOS. Through bioinformatics analysis, the high expression of HIF-1α, MCT1 or MCT4 indicate a poor prognosis in glioblastoma. In addition, in glioblastoma tissue, HIF-1α, MCT4 and LDH are highly expressed in the interior region, and their expression is decreased in the lateral region. MCT1 can not be detected in the interior region and is highly expressed in the lateral region. Hence, different regions of glioblastoma have diverse energy metabolic pathways. Glycolysis occurs mainly in the interior region and OXPHOS in the lateral region. In general, lactic acid can induce regional energy metabolic reprogramming and assist tumor cells to adapt and resist adverse microenvironments. This study provides new ideas for furthering understanding of the metabolic features of glioblastoma. It may promote the development of new therapeutic strategies in GBM.

[MRI study on tendon regeneration after anterior cruciate ligament reconstruction with hamstring tendon autografts].

OBJECTIVE: To evaluate the tendon regeneration after anterior cruciate ligament (ACL) reconstruction with semitendinosus tendon and gracilis tendon autografts by MRI. METHODS: Between September 2007 and September 2009, 52 patients undergoing ACL reconstructions with semitendinosus tendon and gracilis tendon autografts were enrolled. There were 29 males and 23 females with an average age of 31.6 years (range, 19-42 years). The left knees were involved in 34 cases and the right knees in 18 cases. The injury was caused by traffic accident in 11 cases, by sports in 38 cases, by heavy pound injury in 2 cases, and by other in 1 case. The time between injury and operation was 6 days to 31 months (median, 11.4 months). Joint pain occurred in 19 cases, joint instability in 28 cases, and joint swelling in 5 cases. The physical examination on admission showed thigh amyotrophy in 7 cases (thigh circumference side-to-side difference > 1 cm) and limitation of joint motion in 2 cases. The results of floating patella test, Lachman test, pivot shift test, and anterior drawer test were positive in 5, 51, 49, and 52 cases, respectively. The range of motion of knee was (127.77 +/- 5.73) degrees, International Knee Documentation Committee (IKDC) score was 49.50 +/- 4.08, and Lysholm score was 52.40 +/- 3.45. Of the patients, 23 were accompanied with medial meniscus tear, 6 with lateral meniscus tear, 2 with plica synovialis, and 1 with loose body. RESULTS: All incisions healed by first intention. All the patients were followed up 12-18 months (mean, 14.9 months). At 12 months postoperatively, the results of Lachman test and pivot shift test were positive in 1 case, respectively; the results of anterior drawer test were negative in 52 cases. The range of motion of knee was (131.91 +/- 1.81)degrees, Lysholm score was 94.98 +/- 2.77, IKDC score was 93.65 +/- 2.42; and there were significant differences when compared with the preoperative ones (P < 0.05). At 12 months postoperatively, at 90 degrees resisted flexion of the knee, a very distinct fibrous band could be identified on the posteromedial aspect of the knee in 39 cases. MRI showed that both semitendinosus tendon and gracilis tendon regeneration in 10 cases, only semitendinosus tendon regeneration in 29 cases, only gracilis tendon regeneration in 2 cases, and no tendon regeneration in 11 cases. The regeneration rate of the semitendinosus tendon was 75.0% (39/52); the regeneration rate of the gracilis tendon was 23.1% (12/52); and the regeneration rate of the semitendinosus tendon and gracilis tendon was 78.8% (41/52). CONCLUSION: MRI results suggest that some of the semitendinosus tendon and gracilis tendon could regenerate after harvested for ACL reconstruction.

[Arthroscopic double-bundle posterior cruciate ligament reconstruction using achilles tendon allograft].

OBJECTIVE: To study the method and clinical results of arthroscopic double-bundle posterior cruciate ligament (PCL) reconstruction using achilles tendon allograft. METHODS: From September 2005 to September 2006, 17 patients with PCL injuries of grade III received arthroscopic double-bundle PCL reconstruction using achilles tendon allograft. There were 12 males and 5 females with an average age of 31.7 years (range, 19-48 years), including 10 cases of left PCL injuries and 7 cases of right PCL injuries. Injury was caused by sports in 6 cases and traffic accident in 11 cases. The average time from injury to surgery was 16 days (range, 7-30 days). The preoperative knee flexion was (121.8 +/- 4.1) degrees. The posterior drawer test was positive and the varus angulation test was negative in all 17 patients. Lysholm score was 50.8 +/- 6.1 and Tegner score was 1.3 +/- 0.7. The side-to-side difference was (10.5 +/- 1.6) mm by KT-1000 arthrometer. RESULTS: The hospitalization were (13.6 +/- 2.4) days. The operation time was (67.8 +/- 9.4) minutes. The time was (5.4 +/- 1.2) days when the body temperature was higher than 37.4 degrees C after operation. All incisions healed by first intention. No complication occurred. All 17 patients were followed up 25 months on average (range, 18-30 months). The knee flexion was (116.9 +/- 3.1) degrees at the final follow-up, showing no significant difference when compared with that of preoperation (P > 0.05). The posterior drawer test and the varus angulation test were negative in all 17 patients. Lysholm score and Tegner score were 91.6 +/- 3.2 and 6.0 +/- 0.7, respectively, and the side-to-side difference was (2.7 +/- 1.7) mm, showing significant differences when compared with those of preoperation (P < 0.05). CONCLUSION: Achilles tendon allograft is fit for PCL reconstruction. Arthroscopic double-bundle posterior cruciate ligament reconstruction using achilles tendon allograft can reconstruct both anterolateral and posteromedial bundles of the PCL. The knee joint function can be restored effectively. The short-term outcome has been proved, but the long-term outcome needs more observations.

[The clinical value of cartilaginous surface and corresponding osseous contour of patellofemoral joint].

OBJECTIVE: to investigate if the cartilaginous surface and corresponding osseous contour of the patellofemoral joint match in the axial plane for providing theoretical basis with evaluating alignment of patellofemoral joint and designing the part of patellofemoral joint in knee prosthesis. METHODS: from January 2009 to March 2010, 9 human cadaver knees were prepared, which chandra of patellofemoral joint didn't degenerate. Each specimen was sectioned in the axial plane at 20° to 30° knee flax. The cross-sections revealed characteristics in the bony anatomy and corresponding articular surface geometry of the patellofemoral joint in the axial plane. Evaluating parameters included osseous patella congruence angle (OPCA), chondral patella congruence angle (CPCA), patella chondral convex point parameter (PCCPP), patella subchondral osseous convex point parameter (PSOCPP), the parameters of the deepest (chondral or osseous) point of the intercondylar sulcus. After that, the osseous and cartilaginous contours and subchondral osseous contours of the patella in the axial plane were analyzed through MRI data of 11 patients who didn't degenerate in patellofemoral joint cartilage. Parameters as same as cadaver knees were compared. RESULTS: data from specimens of OPCA was (-4.5 ± 1.1)°, CPCA was (0.5 ± 0.8)°, PCCPP was 1.13 ± 0.11, PSOCPP was 1.67 ± 0.14, PCDPIS was 1.35 ± 0.28, PODPIS was 1.38 ± 0.33. Date from MRI of OPCA was (-3.8 ± 1.4)°, CPCA was (0.7 ± 1.0)°, PCCPP was 1.05 ± 0.21, PSOCPP was 1.73 ± 0.18, PCDPIS was 1.41 ± 0.21, PODPIS was 1.37 ± 0.27. The patella exhibited significant differences in the bony vs. chondral anatomy (P < 0.05), but the intercondylar sulcus nearly match in the bony vs. chondral anatomy. CONCLUSIONS: the cartilaginous surface and corresponding osseous contour of the patella don't match in the patellofemoral joint axial plane, but that of the trochlea nearly matches. This is very important for accurately evaluating alignment of patellofemoral joint because the normal osseous alignment of patellofemoral joint don't represent the normal alignment and helpful for designing the part of patellofemoral joint in knee prosthesis.

[Treatment of patellar instability of adolescence through arthroscopic reconstruction of medial patellofemoral ligament with trabs of medial soft tissues].

OBJECTIVE: To explore the clinical effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with trabs of medial soft tissues in the treatment of patellar instability of adolescence. METHODS: From January 2005 to December 2006, 23 cases of patellar instability were treated, including 10 males and 13 females with an average age of 16 years old (13 to 20 years old). The locations were left knee in 11 cases, right knee in 12 cases. The disease course was 1-28 weeks (mean 15 weeks). All patients had patellar instability sense and knee arthralgia during strenuous exercise. Preoperative, the International Knee Documentation Committee (IKDC) score and Lysholm score were 48.30 +/- 5.77 and 50.80 +/- 7.61. The congruence angle, lateral patellar angle, and Q angle were (9.00 +/- 2.46), (2.94 +/- 2.55) and (19.10 +/- 4.16) degrees. All of the patients experienced the operation of reconstruction of MPFL with trabs of medial soft tissues (medial patellar retinaculum, joint capsule and vastus medialis oblique muscle fiber) through arthroscope. RESULTS: All the wounds healed by first intention, and no postoperative early complication occurred. All cases were followed up 19 months on average (12 to 24 months). Apprehensive test and patella tilt test were negative. The range of motion returned to normal. There was no recurrence of dislocation after operation. At 12 months after operation, the congruence angle, lateral patellar angle, and Q angle were (-7.03 +/- 0.60), (11.00 +/- 3.47) and (11.30 +/- 1.90) degrees; the IKDC score and Lysholm score were 93.20 +/- 3.51 and 94.10 +/- 4.26. There were statistically significant differences between preoperation and postoperation (P < 0.05). CONCLUSION: Arthroscopic reconstruction of MPFL with trabs of medial soft tissues can improved obviously the affected limb function in treatment of patellar instability of adolescence.

[Treatment of Pes anserinus bursitis with debridement under arthroscopy].

OBJECTIVE: To explore the clinical effectiveness of debridement in treatment of Pes anserinus bursitis under arthroscopy by comparing the curative effect of three therapies: local block therapy, open operation and debridement under arthroscopy. METHODS: From January 2000 to January 2007, 90 cases of unilateral Pes anserinus bursitis were treated with debridement under arthroscopy (group A, n=30), local block therapy (group B, n=30) and open operation (group C, n=30), respectively. The group A included 18 males and 12 females, aged (40.0 +/- 2.5) years old; the locations were left knee in 16 cases and right knee in 14 cases; 10 cases had injury history, 7 cases had tired history and 13 cases had no obvious inducement; the course of disease was (24.0 +/- 3.2) weeks. The group B included 17 males and 13 females, aged (37.0 +/- 2.5) years old; the locations were left knee in 15 cases and right knee in 15 cases; 10 cases had injury history, 8 cases had tired history and 12 cases had no obvious inducement; the course of disease was (26.3 +/- 3.5) weeks. The group C included 16 males and 14 females, aged (39.8 +/- 2.2) years old; the locations were left knee in 18 cases and right knee in 12 cases; 8 cases had injury history, 10 cases had tired history and 12 cases had no obvious inducement; the course of disease was (25.0 +/- 3.9) weeks. There was no statistically significant difference in the general data among three groups (P > 0.05). RESULTS: All patients were followed up 15 months on average (12-24 months). In group C, the inflammatory reaction occurred at wound in 9 cases (30%) at 3-10 days after operation and was cured after symptomatic management; other incision healed by first intention; and showing statistically significant differences when compared with other 2 groups (P < 0.05). In group C, joint swelling occurred at 1 week after operation in 1 case, limitation of joint motion in 2 cases at 10-12 weeks after operation and was recovered after symptomatic management. In group B, 21 cases (70%) had a recurrence at 6-12 months after operation, all patients of other 2 groups had no recurrence; showing statistically significant differences between group B and groups A, C (P < 0.05). At last follow-up, the pain remain rates were 3.3% (group A), 0 (group B) and 33.3% (group C), and the complication incidence rates were 3.3%, 26.7% and 70.0%, respectively; all showing statistically significant differences among three groups (P < 0.05). At last follow-up, there were statistically significant differences in the visual analogue scale (VAS) score, the HSS score, and range of motion (ROM) between preoperation and postoperation in group A (P < 0.05); there was no statistically significant difference in the VAS score, HSS score and ROM between preoperation and postoperation in group B (P > 0.05); the ROM of postoperation in group C was smaller than that of preoperation (P < 0.05). There were statistically significant differences in the VAS score and HSS score between group A and groups B, C (P < 0.05), and in ROM among three groups after operation (P < 0.05). CONCLUSION: The treatment of Pes anserinus bursitis with debridement under arthroscopy has advantages of easy-to-do, less complication, low relapse rate and good functional rehabilitation.