Development and validation of a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle / 中华显微外科杂志

Objective:To develop a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle, and to verify its effectiveness and repeatability.Methods:A retrospective observational study was conducted. A total of 40 necroses of foot and ankle pedicled flaps were selected by 2 senior surgeons based on the flap surgery performed by the same surgical group in Department of Orthopaedic Surgery, the 920 Hospital of Joint Logistic Support Force of PLA from January 2010 to January 2022. A grading system for pedicled flap necrosis was proposed by a working group and the 40 necrotic flaps were graded. The coincidence rate was calculated to evaluate the effectiveness of the grading system through correlation studies between grading and clinical treatment. One photo of a typical postoperative necrotic flap was collected from each of the 40 flaps. Then 5 extramural surgeons were asked to grade the necroses shown on the photos according to the proposed grading system. Moreover, weighted Kappa analysis was performed on the results of proposed grading system and also on the standard grading currently in use, to evaluate the repeatability of the proposed grading system. Evaluated data were expressed by Mean±SD, and the coincidence rate was expressed by percentage. The reproducibility was studied by weighted Kappa analysis.Results:Of the 40 necrotic flaps, 7 flaps were classified in Grade I, 16 in Grade Ⅱ, 12 in Grade Ⅲ and 5 in Grade IV. In comparison with the actual treatment methods, the overall coincidence rate of the grading system was 92.5%. It indicated that the proposed grading system could effectively guide the selection of a treatment procedure. The average weighted Kappa coefficient of surgeons was at 0.628 with a 95% confidence interval (95%CI) between 0.460-0.796, which was strongly consistent with the standard of the grading system currently in use.Conclusion:The grading system for necrosis of pedicled flap in reconstruction of foot and ankle proposed in this study is simple and clear. It is able to effectively guide the treatment of flap necrosis. The preliminary validation shows that the classification system has good repeatability.

Robotics in orthopedic surgery / 中华创伤骨科杂志

Surgical robots, as a new means for surgeons, have been gradually applied in orthopedics. Initially, the development of orthopedic robots was stagnant for a long time because of limited techniques available, clumsy equipment, high costs, and low market demands. The recent decade has witnessed rapid growth of artificial intelligence in all walks of life, increasing investment in research and development, reducing manufacture costs and expanding demands for precise and individualized medical treatment so that a wide variety of novel and ingenious robotic systems have been proposed, prototyped, and commercialized in most of the major procedures in orthopedic surgery, including knee and hip replacements, cruciate ligaments surgery, spine surgery, corrective osteotomy, bone tumor surgery, and trauma surgery. This review depicts the history of development and future prospects in application of surgical robots in the field of orthopedics.

Screening of the protein interacting with inhibitor of differentiation 1′ using yeast two hybrid method / 第三军医大学学报

Objective To obtain the protein interacting with inhibitor of differentiation1′(Id1′). Methods The recombinant bait plasmid pHybLex/Zeo Id1′ was constructed and transformed into yeast strain EGY48/ pSH18 34 to test pHybLex/Zeo Id1′ for non specific activation. Adult human lung cDNA libraries were screened to obtain true positive library plasmid. The true positive library clone was obtained by sequencing and basic local alignment sequence tool (BLAST). Results The recombinant bait vector, named as pHybLex/Zeo Id1′, was confirmed by sequencing. pHybLex/Zeo Id1′ was transformed into yeast strain EGY48/pSH18 34 and the transformants had no autonomously activated reporter genes. One true positive clone, obtained by screening of the adult human lung cDNA libraries, was confirmed to be Fyn by sequencing and BLAST. Conclusion Id1′ can interact with Fyn.

The significance of the expression of endothelial ICAM-1 induced by LPS / 中华烧伤杂志

<p><b>OBJECTIVE</b>To investigate the significance of the expression pattern and its signal modulating mechanism of endothelial ICAM-1 induced by LPS.</p><p><b>METHODS</b>(1) The expression pattern of the ICAM-1 was observed at mRNA level in cultured human umbilical vascular endothelial cells (HUVECs) strain ECV-304 after being stimulated by different LPS concentrations at different time points. (2) The modulating effects of different signal pathways on the ICAM-1 expression of the HUVECs were observed at mRNA and protein levels under the stimulation of LPS after the cells were primed by signal pathway blocking agents for 30 mins.</p><p><b>RESULTS</b>(1) The ICAM-1 mRNA expression could be induced by LPS (100 pg/ml) for 6 hours, and the expression was enhanced along with the increase of LPS concentration. The expression peaked when LPS was at concentrations of 100 approximately 1 000 ng/ml. Temporally, the mRNA expression reached the top level at 6 approximately 8 hours and remained high 12 hours after the stimulation. (2) The expressions of ICAM-1 mRNA and protein could be significantly inhibited by PSI, the NF-kappaB inhibitor. Moreover, the expression of ICAM-1 could all be partially inhibited at mRNA and protein levels by PD98059, the ERK1/2MAPK inhibitor, as well as SB203580, the p38MAPK inhibitor.</p><p><b>CONCLUSION</b>The ICAM-1 mRNA expression of HUVECs could be induced by LPS in both dose and time dependent manner. NF-kappaB might be the major signal pathway of modulating ICAM-1 expression, and p38 and ERK1/2 could possibly be signal pathways of minor importance.</p>

The Effects of hTERT Transfection on the Collagen Expression of Human Embryonic Fibroblasts / 中国医师杂志

Objective The recombinant fluorescent eukaryotic expressing vector containing hTERT cDNA was transfected into human embryonic fibroblasts (hEFs) to explore the effects of exogenous hTERT on the type I and III collagens expression in hEFs. Methods p IRES2-EGFP-hTERT plasmid and pIRES2-EGFP plasmids were transfected into primary hEFs respectively by Lipofectin reagent. Expression of type I and III collagen was determined by Western blotting and the content of type I and III collagens in the cellular medium at 3 days after transfection were examined by radio-immunoassay. Results The expression levels of type I and III collagens in hTERT gene transfected hEFs(hEF-hTERT) were obviously higher than those in untransfected hEFs and vacant vector transfected hEFs(hEF-EGFP). The content of type I and III collagens in the cellular medium in hEF-hTERT cells at 3 days after transfection was also higher than that in untransfected hEFs and hEF-EGFP cells. Conclusions The synthesis ability of type I and III collagens in hEFs could be promoted by exogenous hTERT gene transfection.