The diagnostic value of CT-guided puncture biopsy combined with serum gamma-glutamyltransferase and abnormal prothrombin in serum alpha-fetoprotein negative primary liver cancer / 中国医师进修杂志

Objective:To investigate the diagnostic value of CT-guided puncture biopsy combined with serum gamma-glutamyltransferase (GGT) and abnormal prothrombin (PIVKA-Ⅱ) in serum alpha-fetoprotein(AFP) negative primary liver cancer (PHC).Methods:Eighty patients with AFP negative PHC treatment in Fuyang Women and Children′s Hospital from January 2018 to March 2021 were selected as AFP negative PHC group, and another 85 patients diagnosed with benign liver tumor during the same period were selected as the control group retrospectively. The patients of the two groups underwent CT-guided biopsy and the levels of GGT and PIVKA-Ⅱ were detected. The single diagnostic value and combined diagnostic value of AFP negative PHC were analyzed by receiver operating characteristic (ROC) curve.Results:Seventy-five of the 80 patients in the AFP negative PHC group were confirmed as liver malignant lesions by biopsy, with a coincidence of 93.75%, and 84 of the 85 patients in the control group were confirmed as liver benign lesions by biopsy, with a coincidence of 98.82%. The levels of AFP, GGT and PIVKA-Ⅱ in AFP negative PHC group were significantly higher than those in the control group: (175.67 ± 39.58) μg/L vs. (18.74 ± 7.42) μg/L, (1 245.37 ± 255.41) U/L vs. (486.63 ± 89.05) U/L, (385.49 ± 30.27) AU/L vs. (25.84 ± 7.66) AU/L, there were statistical differences ( P<0.05). Spearman correlation analysis showed that serum AFP was positively correlated with GGT and PIVKA-Ⅱ ( r = 0.858 and 0.429, P<0.05). The results of ROC curve showed that the area under curve of CT-guided biopsy combined with GGT and PIVKA-Ⅱ in the diagnosis of AFP negative PHC was 0.877, the sensitivity was 91.19%, the specificity was 87.34%. Conclusions:CT-guided biopsy combined with GGT and PIVKA-Ⅱ detection of AFP negative PHC can effectively improve the diagnostic value.

Use of recombinant microRNAs as antimetabolites to inhibit human non-small cell lung cancer

During the development of therapeutic microRNAs (miRNAs or miRs), it is essential to define their pharmacological actions. Rather, miRNA research and therapy mainly use miRNA mimics synthesized in vitro. After experimental screening of unique recombinant miRNAs produced in vivo, three lead antiproliferative miRNAs against human NSCLC cells, miR-22-3p, miR-9-5p, and miR-218-5p, were revealed to target folate metabolism by bioinformatic analyses. Recombinant miR-22-3p, miR-9-5p, and miR-218-5p were shown to regulate key folate metabolic enzymes to inhibit folate metabolism and subsequently alter amino acid metabolome in NSCLC A549 and H1975 cells. Isotope tracing studies further confirmed the disruption of one-carbon transfer from serine to folate metabolites by all three miRNAs, inhibition of glucose uptake by miR-22-3p, and reduction of serine biosynthesis from glucose by miR-9-5p and -218-5p in NSCLC cells. With greater activities to interrupt NSCLC cell respiration, glycolysis, and colony formation than miR-9-5p and -218-5p, recombinant miR-22-3p was effective to reduce tumor growth in two NSCLC patient-derived xenograft mouse models without causing any toxicity. These results establish a common antifolate mechanism and differential actions on glucose uptake and metabolism for three lead anticancer miRNAs as well as antitumor efficacy for miR-22-3p nanomedicine, which shall provide insight into developing antimetabolite RNA therapies.

SBC (Sanhuang Xiexin Tang combined with Baihu Tang plus Cangzhu) alleviates NAFLD by enhancing mitochondrial biogenesis and ameliorating inflammation in obese patients and mice / 中国天然药物

In the context of non-alcoholic fatty liver disease (NAFLD), characterized by dysregulated lipid metabolism in hepatocytes, the quest for safe and effective therapeutics targeting lipid metabolism has gained paramount importance. Sanhuang Xiexin Tang (SXT) and Baihu Tang (BHT) have emerged as prominent candidates for treating metabolic disorders. SXT combined with BHT plus Cangzhu (SBC) has been used clinically for Weihuochisheng obese patients. This retrospective analysis focused on assessing the anti-obesity effects of SBC in Weihuochisheng obese patients. We observed significant reductions in body weight and hepatic lipid content among obese patients following SBC treatment. To gain further insights, we investigated the effects and underlying mechanisms of SBC in HFD-fed mice. The results demonstrated that SBC treatment mitigated body weight gain and hepatic lipid accumulation in HFD-fed mice. Pharmacological network analysis suggested that SBC may affect lipid metabolism, mitochondria, inflammation, and apoptosis-a hypothesis supported by the hepatic transcriptomic analysis in HFD-fed mice treated with SBC. Notably, SBC treatment was associated with enhanced hepatic mitochondrial biogenesis and the inhibition of the c-Jun N-terminal kinase (JNK)/nuclear factor-kappa B (NF-κB) and extracellular signal-regulated kinase (ERK)/NF-κB pathways. In conclusion, SBC treatment alleviates NAFLD in both obese patients and mouse models by improving lipid metabolism, potentially through enhancing mitochondrial biogenesis. These effects, in turn, ameliorate inflammation in hepatocytes.

Intranasal delivery of NS1-deleted influenza virus vectored COVID-19 vaccine restrains the SARS-CoV-2 inflammatory response

The emergence of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) variants and "anatomical escape" characteristics threaten the effectiveness of current coronavirus disease (COVID-19) vaccines. There is an urgent need to understand the immunological mechanism of broad-spectrum respiratory tract protection to guide broader vaccines development. In this study, we investigated immune responses induced by an NS1-deleted influenza virus vectored intranasal COVID-19 vaccine (dNS1-RBD) which provides broad-spectrum protection against SARS-CoV-2 variants. Intranasal delivery of dNS1-RBD induced innate immunity, trained immunity and tissue-resident memory T cells covering the upper and lower respiratory tract. It restrained the inflammatory response by suppressing early phase viral load post SARS-CoV-2 challenge and attenuating pro-inflammatory cytokine (IL-6, IL-1B, and IFN-{gamma}) levels, thereby reducing excess immune-induced tissue injury compared with the control group. By inducing local cellular immunity and trained immunity, intranasal delivery of NS1-deleted influenza virus vectored vaccine represents a broad-spectrum COVID-19 vaccine strategy to reduce disease burden.

Lineage-mosaic and mutation-patched spike proteins for broad-spectrum COVID-19 vaccine

The widespread SARS-CoV-2 in humans results in the continuous emergence of new variants. Recently emerged Omicron variant with multiple spike mutations sharply increases the risk of breakthrough infection or reinfection, highlighting the urgent need for new vaccines with broad-spectrum antigenic coverage. Using inter-lineage chimera and mutation patch strategies, we engineered a recombinant monomeric spike variant (STFK1628x), which showed high immunogenicity and mutually complementary antigenicity to its prototypic form (STFK). In hamsters, a bivalent vaccine comprised of STFK and STFK1628x elicited high titers of broad-spectrum antibodies to neutralize all 14 circulating SARS-CoV-2 variants, including Omicron; and fully protected vaccinees from intranasal SARS-CoV-2 challenges of either the ancestral strain or immune-evasive Beta variant. Strikingly, the vaccination of hamsters with the bivalent vaccine completely blocked the within-cage virus transmission to unvaccinated sentinels, for either the ancestral SARS-CoV-2 or Beta variant. Thus, our study provides new insights and antigen candidates for developing next-generation COVID-19 vaccines.

Propensity matching study of mitral valve management strategy during coronary artery bypass grafting in patients with moderate ischemic mitral insufficiency / 中华胸心血管外科杂志

Objective:To explore the surgical strategy of coronary artery bypass grafting(CABG) for moderate ischemic mitral regurgitation(IMR), and to clarify the impact of mitral valve surgical intervention(MVS) on the long-term prognosis of such patients.Methods:The clinical data of 234 consecutive patients with moderate IMR who received CABG from January 2013 to December 2018 were retrospectively included, with 184 males and 50 females. The age ranged from 29 to 78 years, with a mean of(61.5 ± 8.7) years old. According to whether MVS was performed at the same time, they were divided into CABG group(108 cases, CABG alone) and CABG+ MVS group(126 cases, CABG+ MVS at the same time). The long-term cardiac events, all-cause deaths, major cardiovascular and cerebrovascular adverse events(MACCE) and other end events were followed up. A matching queue was established by propensity matching score for statistical analysis.Results:After propensity matching score, a matching queue was established, including 78 pairs of patients. Survival analysis showed that the incidence of long-term cardiac events and postoperative new onset atrial fibrillation in CABG+ MVS group was significantly higher( P<0.05). However, there was no significant difference between the two groups in all-cause mortality, cardiogenic mortality, and the incidence of MACCE events( P>0.05). Cox regression analysis showed that simultaneous CABG+ MVS was a risk factor for long-term cardiac events and new postoperative atrial fibrillation. The results of subgroup studies showed that for patients without tricuspid regurgitation before operation, left ventricular end diastolic diameter>55 mm, and left ventricular ejection fraction(LVEF) ≤0.55, the probability of cardiac events after MVS at the same time of CABG was higher( P<0.05). However, patients with no tricuspid regurgitation before operation, left ventricular end diastolic diameter>55 mm, LVEF≤0.55, and left atrial diameter≥40 mm had a higher probability of atrial fibrillation after MVS at the same time of CABG( P<0.05). Conclusion:CABG can improve left ventricular remodeling in patients with moderate IMR, whether MVS intervention is performed at the same time or not, and the long-term survival rate of both is similar. CABG+ MVS in the same period can maintain a low residual reflux, but the incidence of long-term cardiac events and arrhythmias is high. The longer-term prognosis needs to be further studied. The surgical strategy of such patients should be selected individually according to the specific situation and the surgical quality in medical centers.

A live attenuated influenza virus-vectored intranasal COVID-19 vaccine provides rapid, prolonged, and broad protection against SARS-CoV-2 infection

Remarkable progress has been made in developing intramuscular vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, they are limited with respect to eliciting local immunity in the respiratory tract, which is the primary infection site for SARS-CoV-2. To overcome the limitations of intramuscular vaccines, we constructed a nasal vaccine candidate based on an influenza vector by inserting a gene encoding the receptor-binding domain (RBD) of the spike protein of SARS-CoV-2, named CA4-dNS1-nCoV-RBD (dNS1-RBD). A preclinical study showed that in hamsters challenged 1 day and 7 days after single-dose vaccination or 6 months after booster vaccination, dNS1-RBD largely mitigated lung pathology, with no loss of body weight, caused by either the prototype-like strain or beta variant of SARS-CoV-2. Lasted data showed that the animals could be well protected against beta variant challenge 9 months after vaccination. Notably, the weight loss and lung pathological changes of hamsters could still be significantly reduced when the hamster was vaccinated 24 h after challenge. Moreover, such cellular immunity is relatively unimpaired for the most concerning SARS-CoV-2 variants. The protective immune mechanism of dNS1-RBD could be attributed to the innate immune response in the nasal epithelium, local RBD-specific T cell response in the lung, and RBD-specific IgA and IgG response. Thus, this study demonstrates that the intranasally delivered dNS1-RBD vaccine candidate may offer an important addition to fight against the ongoing COVID-19 pandemic, compensating limitations of current intramuscular vaccines, particularly at the start of an outbreak.

Effect evaluation of standardized first aid simulation training / 中华医学教育探索杂志

Objective:To provide standardized and normalized first aid simulation training for trainees, and to enhance the level of first aid knowledge and operational capacity.Methods:Based on the first aid training course of American Heart Association, we set up the faculty of first aid simulation training teachers in the hospital. In accordance with the established teaching contents, procedures and forms, the instructor conducted standardized first aid simulation training for residents in the skill center of the hospital by using unified training and video materials. Before and after the training, students' theoretical and operational skills were assessed, and questionnaires were conducted among them after the training. SPSS 19.0 was used for data analysis, and paired data bilateral t test was used for statistical analysis. Results:No matter the theory test or the skill test, the results after the training were obviously better than those before the training, with statistical differences ( P < 0.05). The post-training survey showed that 100 percent of the participants believed that professional knowledge has been strengthened and first-aid skills have been improved through the training. Conclusion:Standardized first aid simulation training based on the American Heart Association helps to improve the comprehensive first aid ability of trainees.

Construction of hollow polydopamine nanoparticle based drug sustainable release system and its application in bone regeneration / 国际口腔科学杂志·英文版

Nanomaterial-based drug sustainable release systems have been tentatively applied to bone regeneration. They, however, still face disadvantages of high toxicity, low biocompatibility, and low drug-load capacity. In view of the low toxicity and high biocompatibility of polymer nanomaterials and the excellent load capacity of hollow nanomaterials with high specific surface area, we evaluated the hollow polydopamine nanoparticles (HPDA NPs), in order to find an optimal system to effectively deliver the osteogenic drugs to improve treatment of bone defect. Data demonstrated that the HPDA NPs synthesized herein could efficiently load four types of osteogenic drugs and the drugs can effectively release from the HPDA NPs for a relatively longer time in vitro and in vivo with low toxicity and high biocompatibility. Results of qRT-PCR, ALP, and alizarin red S staining showed that drugs released from the HPDA NPs could promote osteogenic differentiation and proliferation of rat bone marrow mesenchymal stem cells (rBMSCs) in vitro. Image data from micro-CT and H&E staining showed that all four osteogenic drugs released from the HPDA NPs effectively promoted bone regeneration in the defect of tooth extraction fossa in vivo, especially tacrolimus. These results suggest that the HPDA NPs, the biodegradable hollow polymer nanoparticles with high drug load rate and sustainable release ability, have good prospect to treat the bone defect in future clinical practice.

SIRT6 as a key event linking P53 and NRF2 counteracts APAP-induced hepatotoxicity through inhibiting oxidative stress and promoting hepatocyte proliferation

Acetaminophen (APAP) overdose is the leading cause of drug-induced liver injury, and its prognosis depends on the balance between hepatocyte death and regeneration. Sirtuin 6 (SIRT6) has been reported to protect against oxidative stress-associated DNA damage. But whether SIRT6 regulates APAP-induced hepatotoxicity remains unclear. In this study, the protein expression of nuclear and total SIRT6 was up-regulated in mice liver at 6 and 48 h following APAP treatment, respectively.

Risk factors for calcaneal fracture combined with vertebral fracture / 中华创伤骨科杂志

Objective:To analysis the risk factors for calcaneal fracture combined with vertebral fracture.Methods:A retrospective study was performed of the 745 calcaneal fractures which had been surgically treated from May, 2005 to September, 2020 in Nanjing Drum Tower Hospital Affiliated to Medical School, Nanjing University. There were 651 males and 94 females, aged from 11 to 89 years (mean, 43.8 years). The incidence of calcaneal fracture combined with vertebral fracture was recorded. The risk factors were screened out by univariate analysis from gender, age, body mass index, unilateral or bilateral calcaneal fractures, injury severity score (ISS), cause of injury, fall height, classifications of calcaneal and number of vertebral fracture; binary logistic regression analysis was used to determine independent risk factors from the rtsk factors with P<0.05. Results:Vertebral fracture occurred in 70 of the 745 patients with calcaneal fracture (9.40%). Univariate analysis showed significant differences in gender, body mass index, unilateral or bilateral calcaneal fractures, ISS and fall height between patients with simple calcaneal fracture and patients with calcaneal fracture combined with vertebral fracture ( P<0.05); Binary logistic regression analysis showed that gender ( OR=0.225, 95% CI:0.095~0.532, P=0.001), unilateral or bilateral calcaneal fractures ( OR=3.582, 95% CI:1.705~7.526, P=0.001), ISS ( OR=5.229, 95% CI:1.605~17.035, P=0.006), and fall height ( OR=49.820, 95% CI:23.068~107.597, P<0.001) were the independent risk factors for calcaneal fracture combined with vertebral fracture. Conclusion:A more likely combined vertebral fracture should be taken into consideration in male patient with bilateral calcaneal fractures, a falling height > 3 m, or a high ISS.

Sterilizing immunity against SARS-CoV-2 in hamsters conferred by a novel recombinant subunit vaccine

A safe and effective SARS-CoV-2 vaccine is essential to avert the on-going COVID-19 pandemic. Here, we developed a subunit vaccine, which is comprised of CHO-expressed spike ectodomain protein (StriFK) and nitrogen bisphosphonates-modified zinc-aluminum hybrid adjuvant (FH002C). This vaccine candidate rapidly elicited the robust humoral response, Th1/Th2 balanced helper CD4 T cell and CD8 T cell immune response in animal models. In mice, hamsters, and non-human primates, 2-shot and 3-shot immunization of StriFK-FH002C generated 28- to 38-fold and 47- to 269-fold higher neutralizing antibody titers than the human COVID-19 convalescent plasmas, respectively. More importantly, the StriFK-FH002C immunization conferred sterilizing immunity to prevent SARS-CoV-2 infection and transmission, which also protected animals from virus-induced weight loss, COVID-19-like symptoms, and pneumonia in hamsters. Vaccine-induced neutralizing and cell-based receptor-blocking antibody titers correlated well with protective efficacy in hamsters, suggesting vaccine-elicited protection is immune-associated. The StriFK-FH002C provided a promising SARS-CoV-2 vaccine candidate for further clinical evaluation.

Virus-free and live-cell visualizing SARS-CoV-2 cell entry for studies of neutralizing antibodies and compound inhibitors

The ongoing COVID-19 pandemic, caused by SARS-CoV-2 infection, has resulted in hundreds of thousands of deaths. Cellular entry of SARS-CoV-2, which is mediated by the viral spike protein and host ACE2 receptor, is an essential target for the development of vaccines, therapeutic antibodies, and drugs. Using a mammalian cell expression system, we generated a recombinant fluorescent protein (Gamillus)-fused SARS-CoV-2 spike trimer (STG) to probe the viral entry process. In ACE2-expressing cells, we found that the STG probe has excellent performance in the live-cell visualization of receptor binding, cellular uptake, and intracellular trafficking of SARS-CoV-2 under virus-free conditions. The new system allows quantitative analyses of the inhibition potentials and detailed influence of COVID-19-convalescent human plasmas, neutralizing antibodies and compounds, providing a versatile tool for high-throughput screening and phenotypic characterization of SARS-CoV-2 entry inhibitors. This approach may also be adapted to develop a viral entry visualization system for other viruses.

Characterization of the SARS-CoV-2 Spike in an Early Prefusion Conformation

Pandemic coronavirus disease 2019 (COVID-19) is caused by the emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for which there are no efficacious vaccines or therapeutics that are urgently needed. We expressed three versions of spike (S) proteins--receptor binding domain (RBD), S1 subunit and S ectodomain--in insect cells. RBD appears monomer in solutions, whereas S1 and S associate into homotrimer with substantial glycosylation. The three proteins confer excellent antigenicity with six convalescent COVID-19 patient sera. Cryo-electron microscopy (cryo-EM) analyses indicate that the SARS-CoV-2 S trimer dominate in a unique conformation distinguished from the classic prefusion conformation of coronaviruses by the upper S1 region at lower position ~15 [A] proximal to viral membrane. Such conformation is proposed as an early prefusion state for the SARS-CoV-2 spike that may broaden the knowledge of coronavirus and facilitate vaccine development.

Adjustment of automated peritoneal dialysis prescription based on volume management / 中华全科医师杂志

Volume management is recognized as an important determinant of dialysis adequacy. The optimal ultrafiltration and sodium removal will improve the volume management and reduce the cardiovascular mortality. Automated peritoneal dialysis (APD), as one of renal replacement therapies, has become a choice for more and more patients with end-stage renal disease. APD allows an individualized dialysis prescription by providing more dialysis doses and more exchange times to improve ultrafiltration and sodium removal, achieving or even exceeding the efficacy of continuous ambulatory peritoneal dialysis. New strategies for volume control have emerged, including adapted APD, using icodextrin and low-sodium dialysate, to provide new ideas for APD prescription adjustment.

Effect of auditory integration training on core symptoms in children with autism spectrum disorders whose auditory conduction dysfunction repaired / 中华行为医学与脑科学杂志

Objective:To explore the improvement of core symptoms in children with autism whose auditory pathway dysfunction were repaired after accepting auditory integration training(AIT).Methods:The ASD children with abnormal auditory evoked potentials were divided into AIT group (the ones whose BAEP return to normal after AIT training into test group), control group A (blank control group) and control group B (ABA training group). The ASD children were assessed by Portage Development Checklist, Child Autism Rating Scale (CARS) and Autism Therapy Assessment Scale (ATEC) at the time of admission, one month after admission, three months after admission.The curative effect with the change value of each factor fraction was evaluated.Results:At the time of enrollment, there were no significant differences among the scores of CARS((36.31±4.08), (36.33±3.76), (36.33±5.14)) as well as ATEC language ((19.08±6.43), (16.40±6.42), (18.48±5.96)), social ((15.63±7.13), (16.05±7.57), (16.19±7.19)), and perception ((16.78±5.39) (16.92±6.75), (17.12±6.73)) and self-care ((15.98±8.71), (17.93±8.22), (17.26±8.93), respectively)) in the AIT group, control group B and control group A. After one month and three months from enrollment, the scores of CARS were ((33.96±3.79), (35.09±4.38) and (34.30±3.98), respectively after one month; (32.95±3.15), (36.86±3.86) and (33.95±3.90), respectively) after three months in the AIT group, control group B and control group A. The repeated measurement analysis of variance showed that the main effect of time was significant ( F=22.308, P<0.01), the main effect of group was not significant ( F=2.647, P>0.05), and there was interaction between time and group ( F= 8.626, P<0.01). For the scores of ATEC language (one month: (16.18±7.10), (18.62±6.63), (13.40±5.44); three months: (14.13±6.13), (18.40±6.35), (10.75±5.17)), social(one month: (12.31±6.68), (17.76±6.82), (15.08±6.75); three months: (10.71±5.42), (16.31±6.30), (12.15±7.30)), perception (one month: (14.37±5.86), (17.43±7.22), (18.58±6.92); three months: (10.35±5.43), (16.44±7.05), (16.68±7.37)) in AIT group, control group B and control group A. The main effect of time was significant ( F=35.534, 40.729, 40.401, all P<0.01), the main effect of group was also significant ( F=7.600, 6.193, 7.675, all P<0.01), and there was interaction between time and group ( F=7.602, 3.355, 7.649, all P<0.05). Multiple comparisons showed that there were statistically significant differences between the AIT group and the control group B, the control group A and the control group B in the scores of ATEC language scale after intervention (I1-J1=-1.69, P1<0.05; I2-J2=-4.98, P2<0.01) between the AIT group and the control group A in the scores of ATEC social scale after intervention (I-J=-4.54, P<0.01) .There were significant differences between the AIT group and the control group A, the AIT group and the control group B in the scores of ATEC perception scale after intervention (I1-J1=-3.16, P1<0.05; I2-J2=-4.89, P2<0.01); for the scores of ATEC self-care ability subscale the main effect of time was significant ( F=22.876, P<0.01), the main effect of group was also significant ( F=3.427, P<0.05), and time and group had no interaction ( F=1.885, P>0.05). Multiple comparisons showed that the scores of ATEC self-care ability scale between the AIT group and the control group A were statistically significant (I-J=-4.46, P<0.05). Conclusion:The results of this study show that AIT training can improve the core symptoms of the ASD children whose BAEP returns to normal.

Adjustment of automated peritoneal dialysis prescription based on volume management / 中华全科医师杂志

Volume management is recognized as an important determinant of dialysis adequacy. The optimal ultrafiltration and sodium removal will improve the volume management and reduce the cardiovascular mortality. Automated peritoneal dialysis (APD), as one of renal replacement therapies, has become a choice for more and more patients with end-stage renal disease. APD allows an individualized dialysis prescription by providing more dialysis doses and more exchange times to improve ultrafiltration and sodium removal, achieving or even exceeding the efficacy of continuous ambulatory peritoneal dialysis. New strategies for volume control have emerged, including adapted APD, using icodextrin and low-sodium dialysate, to provide new ideas for APD prescription adjustment.

Progress in genetic research on cognitive function of attention deficit hyperactivity disorder / 中华医学遗传学杂志

Attention deficit hyperactivity disorder (ADHD) is a form of neuronal dysplasia featuring high hereditary (up to 76%). This paper reviews recent progress made in genetic research on the cognitive function in ADHD. Two aspects of cognitive function were explored from the perspective of genetics, including intelligence and executive function.

Clinical outcomes of induced membrane technique in treatment of traumatic segmental bone defects / 中华创伤骨科杂志

Objective To evaluate the clinical outcomes of induced membrane technique in the treatment of traumatic segmental bone defects.Methods From May 2011 to January 2016,we treated 10 patients with traumatic segmental bone defect of the lower limb.They were 7 men and 3 women,with an average age of 41.6 years (from 18 to 61 years.The bone defects involved 8 tibias and 2 femurs;the mean length of the bone defects was 5.1 cm (from 2 to 15 cm).All the segmental bone defects were teated by induced membrane technique.At the first stage,the bone defects were filled with antibiotic-impregnated cement spacer after thorough debridement,the limb was fixated with external fixtor,and soft tissue repair was performed in 5 patients.On average all the patients received emergency treatment at the first stage 8.1 hours (from 4 to 13 hours) after trauma.At the second stage,after the cement was removed,the bone defects were filled with cancellous autografts.An allograft was used when the autograft was not adequate enough.The external fixtor was exchanged by internal fixation in one patient according to his soft tissue condition and will;the exteranl fixation was retained in the other 9 patients.Results The average follow-up was 2.8 years (from 1.0 to 5.5 years).Bone healing was achieved in 9 patients after an average of 7.1 months (from 5 to 9 months),and nonunion happened in one patient whose bone graft had been not sufficient enough.Stress fracture occurred in one patient 7 months after bone healing,but it responded to conservative management.One patient reported numbness on the anterolateral thigh of the donor site.Pin tract infection occurred in 3 patients.Follow-ups revealed no limb length discrepancy or deep infection.Conclusion Induced membrane technique is a simple and reliable technique for the treatment of traumatic segmental bone defects.

Factors influencing articular function after surgery for ankle fractures / 中华创伤骨科杂志

Objective To analyze the factors that influence the articular function after open reduction and internal fixation for ankle fractures.Methods From July 2014 to January 2016,111 ankle fractures received surgery in our hospital.There were 54 males and 57 fenales,with a mean age of 43.5 years (frown 18 to 75 years).By the Broos & Bisschop classification,there were 43 unimalleolar,38 bimalleolar and 30 trimalleolar fractures.The postoperative articular function was evaluated according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scoring at the final follow-up.Comparisons were made between the patients with excellent functional scores and those with lower than excellent functional scores.The potential influencing factors were analyzed,including age,gender,body mass index,smoking history,primary hypertension history,diabetes history,injured side,fracture cause,Broos & Bisschop classification,combined presence of obvious inferior tibiofibular separation,combined presence of ankle dislocation,combined presence of other injury,time from injury to surgery,physical status classification by the American Society of Anesthesiologists system,operation time,early functional exercise,removal of internal fixation and postoperative complications.The influencing factors were identified using univariate analysis and logistic regression analysis.Results The average follow-up period was 15.5 months (from 8 to 25 months).The clinical union time of the fractures averaged 3.2 months (from 3 to 5 months).The ankle function at the final follow-up was excellent in 58 cases,good in 48,fair in 5 and poor in 0,with an excellent and good rate of 95.5％.Removal of internal fixation (P =0.001),early functional exercise (P =0.002),and postoperative complications (P =0.049) were identified as the independent risk factors influencing the articular function after surgery for ankle fractures.Conclusion For patients with ankle fracture,enhancing intraoperative procedures,reducing postoperative complications,encouraging the patients to do early functional exercise,and removing internal fixation after firacture union can effectively improve their ankle function.