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OBJECTIVE: To explore the causes and management of the complications in diabetic foot treated with tibial transverse transport (TTT). METHODS: Between September 2015 and September 2019, 196 patients with diabetic foot were treated with TTT. There were 109 males and 87 females, with an average age of 67.6 years (range, 45-86 years). According to Wagner’s classification, there were 124 cases of grade 3, 62 cases of grade 4, and 10 cases of grade 5; the course of disease was 1-12 months, with an average of 2.6 months. All patients underwent the minimally invasive tibial osteotomy. The osteotomy site was the middle and lower tibia in 62 cases and the middle and upper tibia in 134 cases. The area of osteotomy was 20 cm(2) in 83 cases and 7.5 cm(2) in 113 cases. The osteotomy block was moved back and forth once in 92 cases and twice in 104 cases. The complications were recorded, including secondary fracture at tibial osteotomy, skin necrosis in osteotomy area, and pin tract infection. RESULTS: Among 196 patients, 41 cases (20.9%) had complications. Nine cases (4.6%) had secondary fracture at tibial osteotomy, among which 6 cases (9.6%) of middle and lower segment osteotomies and 3 cases (2.2%) of middle and upper segment osteotomies. The incidence between the patients with different osteotomy sites was significant (χ(2)=5.354, P=0.021). The area of osteotomy was 20 cm(2) in 5 cases (6.0%) and 7.5 cm(2) in 4 cases (3.5%). There was no significant difference in the incidence between patients with different areas (χ(2)=0.457, P=0.499). Skin necrosis occurred in the osteotomy area in 12 cases (6.1%), all of which were moved back and forth once. There was a significant difference in the incidence between patients who were treated with transport once and twice (P=0.001). There were 18 cases (9.1%) with pin tract infection, including 12 cases (6.1%) with mild infection and 6 cases (3.0%) with severe infection. There was no significant difference in the incidence between the patients with mild and severe infections (P=0.107). CONCLUSION: TTT is an effective method to treat diabetic foot, but there are complications such as secondary fracture at tibial osteotomy, skin necrosis in osteotomy area, and pin tract infection during transport. Preoperative evaluation of indication, standardization of osteotomy mode, size and position of osteotomy block, establishment of individualized removal plan, and strengthening of pin track nursing after operation can effectively reduce complications.

MIR155HG is a long non-coding RNA (lncRNA) that has been shown to be dysregulated in a range of tumor types, but the functions of this lncRNA in melanoma remain to be explored.We explored the functions of lncRNA MIR155HG in melanoma progression.The expression of miR155HG was analyzed in clinical melanoma. Bioinformatics analysis was performed to assess the potential tumor-related functions of miR155HG. The interaction of miR155HG and SP1 and the inhibition of PSIP1 by miR-485-3p were analyzed by ChIP, luciferase reporter experiments, and the biological effects in melanoma were explored by colony formation assays, EdU cell proliferation assays, Transwell analysis, and intracranial melanoma mouse model.Herein, we found that MIR155HG was markedly upregulated in melanoma cell lines and tissues. We further determined that the SP1 transcription factor was responsible for driving MIR155HG upregulation in melanoma. Elevated MIR155HG levels were linked to decreased overall survival (OS) in melanoma patients, and we further determined that MIR155HG expression was an independent predictor of melanoma patient prognosis. When MIR155HG was knocked down in melanoma cells, this impaired their proliferative, migratory, and invasive activity. By using predictive bioinformatics analyses, we identified miR-485-3p as a microRNA (miRNA) capable of binding to both MIR155HG and the 3' UTR of PSIP1.Together, these results suggest that MIR155HG is capable of promoting melanoma cell proliferation via the miR-485-3p/PSIP1 axis. These novel findings provide new insights into the development of melanoma, potentially highlighting future avenues for therapeutic intervention.

Background Familial benign chronic pemphigus, also known as Hailey-Hailey disease (HHD), is a clinically rare bullous Dermatosis. However the mechanism has not been clarified. The study aim to detect novel mutations in exons of ATP2C1 gene in HHD patients; to explore the possible mechnism of HHD pathogenesis by examining the expression profile of hSPCA1, miR-203, p63, Notch1 and HKII proteins in the skin lesions of HHD patients. Methods Genomic DNA was extracted from peripheral blood of HHD patients. All exons of ATP2C1 gene in HHD patients were amplified by PCR and the products were purified and sequenced. All related signaling proteins of interest were stained by using skin lesion tissues from HHD patients and miR-203 levels were also determined. Results One synonymous mutation c.G2598A (in exon 26), one nonsense mutation c.C635A and two missense mutations c.C1286A (p.A429D) and c. A1931G (p. D644G) were identified. The nonsense mutation changed codon UCG to stop codon UAG, causing a premature polypeptide chain of the functional region A. The two missense mutations were located in the region P (phosphorylation region) and the Mn binding site of hSPCA1. The level of hSPCA1 was significantly decreased in HHD patients compared to the normal human controls, accompanied by an increase of miR-203 level and a decrease of p63 and HKII levels. Conclusion In our study, we found four mutations in HHD. Meanwhile we found increase of miR-203 level and a decrease of p63 and HKII levels. In addition, Notch1, which was negatively regulated p63, is downregulated. These factors may be involved in the signaling pathways of HHD pathogenesis. Our data showed that both p63 and miR-203 may have significant regulatory effects on Notch1 in the skin.

To discuss the role of the bone suture anchors for repair of avulsed deep radioulnar ligaments in maintaining the rotatory stability of the distal radioulnar joint.Nine upper limbs specimens were selected from fresh adult cadavers to make wrist joint-bone capsular ligaments complex specimen. All the specimens were tested under conditions of intact (normal group), deep radioulnar ligaments injury (injury group), and deep radioulnar ligaments injury repaired with anchoring (repair group). The internal and external rotation torque values were recorded in 45° wrist extension, neutral position, and 45° wrist flexion by AG-IS series MS biomechanical testing system. The statistic software was used to compare difference in rotation torque between groups.In 45° wrist extension, neutral position, and 45° wrist flexion, the internal rotation torque values in normal group were (0.83±0.33), (0.86±0.34), and (0.36±0.30) N·m respectively; the external rotation torque values were (0.86±0.38), (0.44±0.22), and (0.25±0.21) N·m respectively. The internal rotation torque values in injury group were (0.18±0.17), (0.22±0.17), and (0.16±0.15) N·m respectively; the external rotation torque values were (0.27±0.26), (0.13±0.17), and (0.04±0.04) N·m respectively. The internal rotation torque values in repair group were (0.79±0.34), (0.73±0.33), and (0.41±0.23) N·m respectively; the external rotation torque values were (0.80±0.39), (0.41±0.22), (0.41±0.40) N·m respectively. In 45° wrist extension, neutral position, and 45° wrist flexion, the internal and external rotation torque values in injury group were significantly lower than those in normal group and repair group (The deep radioulnar ligaments are important structure for maintaining rotatory stability of distal radioulnar joint. Bone anchoring of the avulsed deep radioulnar ligaments to the ulna fovea is critically important in reconstructing function anatomy of the distal radioulnar joint.通过生物力学测试探讨骨锚技术修复深层尺桡韧带于尺骨凹对于恢复远侧尺桡关节旋转稳定性的重要性，为选择手术方法提供生物力学理论依据。.取 9 具新鲜成年尸体上肢标本，按照完整标本（正常组）、深层尺桡韧带损伤（损伤组）、螺钉固定并肌腱缝线缝合修复深层尺桡韧带（修复组）顺序制备模型后，采用 AG-IS 系列 MS 型生物力学测试系统，分别于腕关节背伸 45°、中立位及屈曲 45° 进行内、外旋生物力学测试，测量其扭矩。统计分析比较各组内、外旋扭矩差异。.腕关节背伸 45°、中立位及屈曲 45° 时，正常组内旋扭矩分别为（0.83±0.33）、（0.86±0.34）、（0.36±0.30）N·m，外旋扭矩分别为（0.86±0.38）、（0.44±0.22）、（0.25±0.21）N·m；损伤组内旋扭矩分别为（0.18±0.17）、（0.22±0.17）、（0.16±0.15）N·m，外旋扭矩分别为（0.27±0.26）、（0.13±0.17）、（0.04±0.04）N·m；修复组内旋扭矩分别为（0.79±0.34）、（0.73±0.33）、（0.41±0.23）N·m，外旋扭矩分别为（0.80±0.39）、（0.41±0.22）、（0.41±0.40）N·m。腕关节背伸 45°、中立位及屈曲 45° 时，损伤组内、外旋扭矩显著低于正常组和修复组，差异均有统计学意义（深层尺桡韧带是维持远侧尺桡关节旋转稳定性的重要结构，骨锚技术修复深层尺桡韧带于尺骨凹止点，对于恢复远侧尺桡关节旋转稳定性有着重要意义。.

To explore the therapeutic effect of Masquelet technique combined with tissue flap grafting for bone defect and soft tissue defect.Between August 2012 and April 2015, 18 cases of bone defect and soft tissue defect were treated by using Masquelet technique combined with tissue flap grafting. There were 11 males and 7 females, aged from 23 to 59 years (mean, 37.1 years). The time between injury and treatment was 15 days to 39 months (mean, 0.9 months). Defect located at the proximal tibia in 4 cases, at the middle tibia in 8 cases, at the distal tibia in 4 cases, and at the lateral heel in 2 cases. All patients were treated with debridement. After debridement, the bone defect was (5.7±1.8) cm in length, and the soft tissue defect was 5 cm×4 cm to 13 cm×11 cm in size. In one-stage operation, bone defect was repaired with the antibiotic cement and fracture was fixed by temporary external fixation. The surfaces of wound were repaired with tissue flap. After 6 to 8 weeks when wounds healed with no sign of infection, bone grafting from iliac bone and/or fibula was performed in two-stage operation.Eighteen patients followed up 10-38 months (mean, 24.3 months). After one-stage operation, 6 cases had pin track infection, which was cured by strengthened disinfection and oral antibiotics. All the tissue flaps survived. Bone healing was observed on X-ray film at 15-57 weeks (mean, 25.3 weeks) after two-stage operation. The function of the knee and ankle joint recovered well. According to the American Orthopaedic Foot and Ankle Society (AOFAS) score for the ankle joint, the scores of ankle function ranged from 74 to 98, with an average of 89.7; the results were excellent in 7 cases, good in 10 cases, and fair in 1 case.The Masquelet technique combined with tissue flap grafting is an effective method to treat bone defect and soft tissue defect.探讨Masquelet技术联合组织瓣移植修复骨软组织复合缺损的疗效。.2012年8月-2015年4月，采用Masquelet技术联合组织瓣移植修复18例小腿及足骨软组织复合缺损患者。其中男11例，女7例；年龄23～59岁，平均37.1岁。受伤至该次手术时间15 d～39个月，平均0.9个月。缺损部位：胫骨上段4例，胫骨中段8例，胫骨下段4例，足跟外侧2例。扩创后骨缺损长度（5.7±1.8）cm，软组织缺损范围5 cm×4 cm～13 cm×11 cm。入院后均先行清创处理，待创面好转后，一期手术采用抗生素骨水泥填充骨缺损区，并用外固定支架临时固定，组织瓣修复创面；6～8周后待创面完全愈合、无感染迹象后，二期手术取髂骨或（和）腓骨棒植骨修复骨缺损。.18例患者均获随访，随访时间10～38个月，平均24.3个月。一期术后组织瓣均成活；钉道感染6例，经加强消毒护理及口服抗生素后治愈。二期术后植骨均获骨性愈合，愈合时间15～57周，平均25.3周。患者膝、踝关节功能均恢复良好；二期术后6个月按美国矫形足踝协会（AOFAS）踝与后足功能评分评定为74～98分，平均89.7分；其中优7例，良10例，中1例。.采用Masquelet技术联合组织瓣移植治疗骨软组织复合缺损是一种有效的治疗方法。.

Summary Background Cutaneous lichen planus (CLP) is a chronic inflammatory and immune-mediated disease. Wnt5a is one of the most extensively studied Wnt proteins, and has important functions in stimulating inflammation, cell proliferation, cell fate determination and cell differentiation. Wnt5a expression in CLP has not been comprehensively studied to date. Aim To determine the expression and distribution of Wnt5a in CLP. Methods Skin samples were obtained from patients with CLP and healthy controls (HCs). The WNT5A gene was detected by real-time quantitative PCR, and Wnt5a protein by immunohistochemical analysis and western blotting. Results WNT5A mRNA was upregulated in CLP samples compared with the HC skin samples (P

Benign chronic familial pemphigus or Hailey-Hailey disease (HHD, OMIM 169600) is a rare, autosomal dominant blistering skin disorder characterized by suprabasal cell separation (acantholysis) of the epidermis. To date, the proteomic changes in skin lesions from HHD patients has not been reported yet. In this study, a sample of skin lesions from HHD patients was collected for isobaric tags for relative and absolute quantitation to analyze proteome changes compared with unaffected individuals. The 134 differentially expressed proteins were assigned to at least one Gene Ontology term, and 123 annotated proteins with significant matches were assigned to 187 known metabolic or signaling pathways listed in the Kyoto Encyclopedia of Genes and Genomes. Most of the altered proteins in skin lesions of HHD patients were enriched in pathways involved in the PI3K-Akt signaling, focal adhesion, extracellular matrix (ECM)-receptor interaction, and protein digestion and absorption, such as collagen family members, microfibril-associated glycoprotein 4 and plakophilin. The changes of proteins related to cell adhesion, ECM-receptor interaction, and protein folding and glycosylation suggested that strategy targeted to alter cell junction and extracellular microenvironment might provide a potential treatment for HHD.

Alterations in the levels and functions of microRNAs (miRs) have been associated with carcinogenesis. In this study, we investigated the role and underlying mechanism of miR-4262 in the proliferation of human cutaneous malignant melanoma (CMM) cells. The expression levels of miR-4262 were significantly upregulated in cancerous tissues compared with those in matched adjacent normal tissues from 110 CMM patients. miR-4262 was also regulated in five types of CMM cell lines, displaying an opposite expression pattern to that of Kruppel-like 6 (KLF6), a proven tumor suppressor in several cancers other than CMM. KLF6 overexpression sharply reduced A375 cell proliferation, suppressed the activation of epidermal growth factor receptor (EGFR) and increased p21 expression levels, while knockdown of KLF6 by siRNA transfection had an opposite effect. Furthermore, KLF6 was proven to be a direct target gene of miR-4262 by bioinformatic analysis and KLF6‑3'UTR luciferase reporter assay. Finally, our data on miR-4262 mimic and inhibitor transfection indicated that miR-4262 could markedly reduce the expression of KLF6 protein and had a stimulatory effect on A375 cell proliferation. Our findings indicate that KLF6 acts as a tumor suppressor in CMM cells and miR-4262 promotes the proliferation of CMM cells through KLF6-mediated EGFR inactivation and p21 upregulation.

The gene ATP2C1 is identified as the defective gene in Hailey-Hailey disease (HHD). The nonsense and missense are two common types of mutations and have, respectively, been detected in many HHD patients. The aims of our study were to identify the pathogenic ATP2C1 abnormality in Chinese HHD patients, and to compare nonsense and missense mutations in vivo to provide further understanding of the molecular and the physiological basis of HHD. The nucleotide sequencing of the ATP2C1 gene was performed in HHD patients, unaffected family members and 100 unrelated individuals. Meanwhile, we detected and analyzed the clinical manifestations, the expression of ATP2C1 mRNA and hSPCA1 protein in the two types of mutations. Three heterozygous mutations were identified, including a previously reported nonsense mutation (R799X), two novel missense mutations (D644G) and (R417K). The results of comparisons between two types of mutations showed that the common clinical features, the similarly low-level expressions of ATP2C1 mRNA and hSPCA1 protein, but the ATP2C1 mRNA expression of nonsense mutation was lower than missense mutation and even less than half the level of normal people. Our findings expand the known spectrum of ATP2C1 mutations in HHD. We supported the haploinsufficiency theory as prevalent mechanism in both types of mutations, and believed that the differences of ATP2C1 mRNA expressions in peripheral blood may relate with the type of mutation and reflect the state of illness of patients.

To evaluate the long-term effectiveness of lunate excision and vascularized capitate osteotomy transposition for advanced Kienböck's disease.Between June 2004 and January 2008, 16 patients with Kienböck disease in Lichtman stages IIIB-IV were treated with lunate excision and vascularized capitate osteotomy transposition. There were 10 males and 6 females at the age of 27-59 years (mean, 38.8 years). The disease was caused by trauma in 10 cases, and unknown reason in 6 cases. The main clinical symptoms were pain and limited activity of the wrist joint, and the disease duration was 5-32 months (mean, 26.5 months). The carpal height index was 0.88 ± 0.05; the radioscaphoid angle was (63.8 ± 9.1)degrees. The visual analogue scale (VAS) score, range of motion (ROM), grip strength, Evans score, and radiographic changes were used to assess the effectiveness during follow-up.All patients obtained healing of incision by first intention and were followed up 5 years and 4 months to 9 years (mean, 5.8 years). VAS score was 2.0 ± 1.5 at the final follow-up. The ROM of the flexion and extension of the wrist joint at the affected side were significantly less than those at the normal side (P0.05). However, no significant difference was found in the grip strength and Evans score between the affected side and normal side (t = -0.997, P = 0.327; t = -1.852, P = 0.077). Postoperative radiographs showed that the carpal height index was 0.94 ± 0.03, and the radioscaphoid angle was (48.4 ± 4.8) degrees, which were improved significantly when compared with preoperative ones (t = -3.927, P = 0.000; t = 5.987, P = 0.000). Osteophyte at the dorsal side of the radius and scaphoid rotation occurred in 6 cases and 2 cases, respectively.Lunate excision and vascularized capitate osteotomy transposition is a reliable method for advanced Kienböck's disease, with favorable improvement in wrist pain and grip strength for long-term follow-up.

To evaluate the results of open arthrolysis by elevated the lateral and medial collateral ligament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness.From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral ligament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 cases were extremely serious (less than 30 degrees extension-flexion arc) and 18 cases were serious (30-60 degrees extension-flexion arc). The range of motion of the elbow stiffness was (32.5 +/- 28.9) degrees and the Mayo score was 51.9 +/-13.1 before operation. All initial fractures were healed according to clinical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months).Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instability and debilitating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 +/- 14.4 and the range of motion of elbow stiffness was (108.8 +/- 36.0) degrees; showing significant differences when compared with preoperation (P0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrolysis.Open elbow arthrolysis and postoperative rehabilitation for patients with elbow stiffness can improve joint function and ensure the stability of elbows.