miR-146a-5p Alleviates Radiation-Induced Liver Fibrosis by Regulating PTPRA-SRC Signaling in Mice.

Patients with hepatobiliary tumors who accept radiotherapy are at risk for radiation-induced liver fibrosis. MicroRNAs (miRNAs) have been implicated in the pathogenesis of radiation-induced liver damage and possess potential as novel biomarkers and therapeutic targets. However, the role of miR-146a-5p in radiation-induced liver fibrosis is less well understood. The current study was designed to evaluate the role of miR-146a-5p in radiation-induced liver fibrosis in mice and to investigate the possible mechanisms involved in miR-146a-5p-mediated effects. The experiments were performed on Institute of Cancer Research (ICR) mice which received fractionated radiation (30 Gy in 5 fractions) to the liver. The results show radiation could induce histopathological changes, liver dysfunction and fibrosis accompanied with decreased miR-146a-5p expression. miR-146a-5p agomir treatment resulted in recovery of liver function and reduced the amount of alpha-smooth muscle actin (α-SMA), collagen 1, protein tyrosine phosphatase receptor type A (PTPRA) and phosphorylated SRC in the livers of irradiated mice. Therefore, our study reveals that miR-146a-5p inhibits the progression of hepatic fibrosis after radiation treatment. And the beneficial role of miR-146a-5p may be relevant to PTPRA-SRC signaling pathway.

Wearable Capacitive Tactile Sensor Based on Porous Dielectric Composite of Polyurethane and Silver Nanowire.

In recent years, the implementation of wearable and biocompatible tactile sensing elements with sufficient response into healthcare, medical detection, and electronic skin/amputee prosthetics has been an intriguing but challenging quest. Here, we propose a flexible all-polyurethane capacitive tactile sensor that utilizes a salt crystal-templated porous elastomeric framework filling with silver nanowire as the composite dielectric material, sandwiched by a set of polyurethane films covering silver nanowire networks as electrodes. With the aids of these cubic air pores and conducting nanowires, the fabricated capacitive tactile sensor provides pronounced enhancement of both sensor compressibility and effective relative dielectric permittivity across a broad pressure regime (from a few Pa to tens of thousands of Pa). The fabricated silver nanowire-porous polyurethane sensor presents a sensitivity improvement of up to 4-60 times as compared to a flat polyurethane device. An ultrasmall external stimulus as light as 3 mg, equivalent to an applied pressure of ∼0.3 Pa, can also be clearly recognized. Our all-polyurethane capacitive tactile sensor based on a porous dielectric framework hybrid with conducting nanowire reveals versatile potential applications in physiological activity detection, arterial pulse monitoring, and spatial pressure distribution, paving the way for wearable electronics and artificial skin.

Recent advances of acellular cartilage matrix in cartilage regeneration / 中华骨科杂志

Osteoarthritis is a common degenerative joint disease, and cartilage damage is often considered an early factor in irreversible joint degeneration. Repairing damaged cartilage remains a medical challenge due to its limited ability to self-repair and regenerate. In recent years, the application of tissue engineering strategies to treat cartilage defects has been recognized as an emerging therapeutic avenue. Acellular cartilage matrix (ACM) is an ideal material for cartilage repair and regeneration as it retains the extracellular matrix structure and bioactive components of natural cartilage, mimicking the extracellular environment of natural cartilage to the greatest extent. Type II collagen is the main type of hyaline cartilage and plays an important role in regulating the mechanical properties of cartilage tissue. It has been shown that type II collagen, growth factors and the hypoxic microenvironment play important roles in promoting cartilage regeneration. Type II collagen induces cell aggregation and chondrogenic differentiation in a specific way; Various growth factors contained in the ACM induce Sox9 expression and promote chondrogenic differentiation of stem cells; The hypoxic microenvironment upregulates the expression of type II collagen (COL2A1), Sox9 and maintains chondrocyte phenotype. In addition, ACM has been widely used in cartilage regeneration studies, either as a decellularized scaffold, hydrogel or 3D bioprinting technique for the repair of defective cartilage. Although the ACM-derived biomaterials discussed in this paper have many advantages, there are still some difficulties in their practical applications, such as loss of ACM components and reduced scaffold performance, which are still worth exploring in depth.

Repair of extremity soft tissue defects using anterolateral femoral flaps with versus without anastomosis of anterolateral femoral cutaneous nerve / 中华创伤骨科杂志

Objective:To analyze the necessity of anastomosis of the cutaneous nerve by comparing anterolateral femoral flaps with versus without anastomosis of the anterolateral femoral cutaneous nerve in the repair of extremity soft tissue defects.Methods:A retrospective analysis was made of the clinical data of 30 patients with extremity soft tissue defects who had been admitted to Department of Orthopedics, The Sixth People＇s Hospital affiliated to Shanghai Jiaotong University School of Medicine from September 2019 to March 2022. The patients were assigned into 2 groups according to whether the anterolateral femoral cutaneous nerve was anastomosed or not in the repair of extremity soft tissue defects using anterolateral femoral flaps. In the anastomosis groups of 14 cases, there were 7 males and 7 females, with an age of (46.4±15.2) years and a flap size of (22.4±7.3) cm×(8.5±1.3) cm. In the non-anastomosis group of 16 cases, there were 11 males and 5 females, with an age of (39.9±15.8) years and a flap size of (23.0±6.4) cm×(9.0±2.1) cm. The 2 groups were compared in terms of flap survival, Semmes-Weinstein recovery degree and area of monofilament tactile sensation, and time periods for temperature sensation and two-point discrimination.Results:There was no statistically significant difference between the 2 groups in the preoperative general data, showing they were comparable ( P>0.05). All the flaps survived completely without vascular crisis. In the anastomosis group, the time periods required for Semmes-Weinstein recovery of monofilament tactile sensation to the areas of 20.0%, 50.0%, and 80.0% [(2.5±0.7) months, (6.7±1.1) months, and (11.0±1.2) months] were significantly shorter than those in the non-anastomosis group [(3.6±1.3) months, (8.6±1.4) months, and (15.0±2.2) months], the recovery area at the last follow-up [100.0% (100.0%, 100.0%)] was significantly larger than that in the non-anastomosis group [84.6% (81.7%, 89.9%)], and the time period for recovery of temperature sensation [(3.9±0.7) months] significantly shorter than that in the non-anastomosis group [(6.1±1.1) months] (all P<0.05). The time for recovery of two-point discrimination in the 14 patients in the anastomosis group was (10.4±1.7) months while only 7 of the 16 patients in the non-anastomosis group recovered two-point discrimination after (14.7±1.4) months, showing a significant difference between the 2 groups ( P<0.05). Conclusion:In the repair of extremity soft tissue defects using anterolateral femoral flaps, compared with no anastomosis of the cutaneous nerve, anastomosis of the anterolateral femoral cutaneous nerve may ensure more or less the sensory recovery of the flaps.

Porous Polydimethylsiloxane Elastomer Hybrid with Zinc Oxide Nanowire for Wearable, Wide-Range, and Low Detection Limit Capacitive Pressure Sensor.

We propose a flexible capacitive pressure sensor that utilizes porous polydimethylsiloxane elastomer with zinc oxide nanowire as nanocomposite dielectric layer via a simple porogen-assisted process. With the incorporation of nanowires into the porous elastomer, our capacitive pressure sensor is not only highly responsive to subtle stimuli but vigorously so to gentle touch and verbal stimulation from 0 to 50 kPa. The fabricated zinc oxide nanowire-porous polydimethylsiloxane sensor exhibits superior sensitivity of 0.717 kPa-1, 0.360 kPa-1, and 0.200 kPa-1 at the pressure regimes of 0-50 Pa, 50-1000 Pa, and 1000-3000 Pa, respectively, presenting an approximate enhancement by 21-100 times when compared to that of a flat polydimethylsiloxane device. The nanocomposite dielectric layer also reveals an ultralow detection limit of 1.0 Pa, good stability, and durability after 4000 loading-unloading cycles, making it capable of perception of various human motions, such as finger bending, calligraphy writing, throat vibration, and airflow blowing. A proof-of-concept trial in hydrostatic water pressure sensing has been demonstrated with the proposed sensors, which can detect tiny changes in water pressure and may be helpful for underwater sensing research. This work brings out the efficacy of constructing wearable capacitive pressure sensors based on a porous dielectric hybrid with stress-sensitive nanostructures, providing wide prospective applications in wearable electronics, health monitoring, and smart artificial robotics/prosthetics.

Radiation Therapy Promotes Hepatocellular Carcinoma Immune Cloaking via PD-L1 Upregulation Induced by cGAS-STING Activation.

PURPOSE: Radiation therapy (RT) is one of the main treatments for patients with unresectable hepatocellular carcinoma (HCC). Emerging evidence indicates that the cyclic guanosine monophosphate-adenosine monophosphate synthase (cGAS) stimulator of interferon gene (STING) pathway is crucial in RT-induced antitumor immune responses. Here, we discovered that activation of the cancer cell-intrinsic cGAS-STING pathway mediated immune cloaking after RT-induced DNA damage. METHODS AND MATERIALS: Key regulatory proteins in the cGAS-STING signaling pathway in human and murine HCC cell lines were knocked out or down using CRISPR and CRISPR-associated protein 9 or small interfering RNA. The underlying mechanism of immune cloaking and clinical significance of cGAS-STING-induced programmed cell death ligand 1 (PD-L1) expression were studied with both ex vivo analyses and in vitro experiments. RESULTS: RT upregulated PD-L1 in patients with HCC, which correlated with poor survival. RT activated cGAS-STING, increasing immune-checkpoint PD-L1 expression in human and mouse liver cancer cells. Ionizing radiation activated the STING-TANK-binding kinase 1 (TBK1)-interferon regulatory factor 3 (IRF3) innate immune pathway, leading to PD-L1 upregulation in HCC cells and inhibiting cytotoxic T-lymphocyte activity and protecting tumor cells from immune-mediated eradication. Knockdown of cGAS, STING, TBK1, and IRF3 reversed the antitumor effect of cytotoxic T-lymphocyte-mediated cytotoxicity after ionizing radiation in vitro or in vivo. RT potentiated the antitumor effect of programmed cell death protein 1 and PD-L1 axis blockade and augmented cytotoxic T-cell (CTL) infiltration in HCC tumors in immunocompetent mice. CD8 depletion compromised the synergetic antitumor effect of combined RT and anti-PD-L1 blockade, demonstrating that CD8+ CTLs are required for antitumor immunity induced by combination therapy. CONCLUSIONS: Our results identified an immune-cloaking mechanism for RT-activated, innate immune cGAS-STING and suggested that RT enhances HCC immunotherapy.

Research progress of inflammatory cytokines in rheumatoid arthritis / 中国药理学通报

Rheumatoid arthritis (RA) is the most common eause of autoimmune arthritis in the world.In RA patients serum or plasma cytokine levels may indicate the severity of the disease.Cytokine gene polymorphism can be used as a marker of RA susceptibility and severity.Rheumatoid arthritis is a systemic connective tissue disease.Not only joints, but other organs (lungs.lymph nodes, spleen, skin, heart or eyes) may also he involved.'Hie main goal of treatment for rheumatoid arthritis is to avoid joint destruction through early and aggressive anti-inflammatory treatment.In the past few decades, various therapies were used for patients when methotrexate was ineffective or intolerant to alter the joint and systemic prognosis and the patients' disability.Among them, cytokine targeted therapy have long been identified to be the most promising therapy.This article re- views the effector functions of different inflammatory factors and their role in the RA pathogenesis and the targeted inhibitors targeting inflammatory factors that can currently be used for the treatment of RA.

Usefulness of diffusion derived vessel density computed from a simplified IVIM imaging protocol: An experimental study with rat biliary duct blockage induced liver fibrosis.

OBJECTIVES: Liver vessel density can be evaluated by DDVD (diffusion derived vessel density): DDVD(b0b1) = Sb0/ROIarea0 - Sb1/ROIarea1, where Sb0 and Sb1 refer to the liver signal when b is 0 or 1 s/mm2. Sb1 and ROIarea1 may be replaced by other b-values. With a rat biliary duct ligation (BDL) model, this study assesses the usefulness of liver DDVD computed from a simplified IVIM imaging protocol using b = 25 and b = 50 to replace b = 1 s/mm2, alone and in combination with other IVIM parameters. METHODS: Male Sprague-Dawley rats were used. The rat number was 5, 5, 5, and 3 respectively, for the timepoints of 7, 14, 21, 28 days post-BDL surgery. 12 rats had partial biliary duct recanalization performed after the rats had BDL for 7 days and then again followed-up for a mean of 14 days. Liver diffusion MRIs were acquired at 3.0 T with a b-value distribution of 0, 25, 50, 75, 100, 150, 300, 700, 1000 s/mm2. DDVDmean (control rats n = 6) was the mean of DDVD(b0b25) and DDVD(b0b50). IVIM fitting started from b = 0 s/mm2 with segmented fitting and a threshold b of 50 s/mm2 (n = 5 for control rats). Three 3-D spaces were constructed using a combination of the four diffusion parameters. RESULTS: The control rats and BDL rats (n = 18) had a liver DDVDmean of 84.0 ± 26.2 and 44.7 ± 14.4 au/pixel (p < 0.001). All 3-D spaces totally separated healthy livers and all fibrotic livers (n = 30, BDL rats and recanalization rats). The mean relative distance between healthy liver cluster and fibrotic liver cluster was 0.331 for PF, Dslow, and Dfast; 0.381 for PF, Dfast, and DDVDmean; and 0.384 for PF, Dslow, and DDVDmean. CONCLUSION: A combination of PF, Dslow, and Dfast allows total separation of healthy livers and fibrotic livers and the integration of DDVD improved the separation.

Enhanced piezocapacitive response in zinc oxide tetrapod-poly(dimethylsiloxane) composite dielectric layer for flexible and ultrasensitive pressure sensor.

We demonstrate polymeric piezocapacitive pressure sensors based on a novel composite dielectric film of poly(dimethylsiloxane) elastomeric silicone and zinc oxide tetrapod. With an appropriate loading of zinc oxide tetrapods, composite piezocapacitive pressure sensors show a 75-fold enhancement of pressure sensitivity over pristine devices, achieving a marked value as high as 2.55 kPa-1. The limit of detection was estimated to be about 10 mg, corresponding to a subtle stimulus of only 1.0 Pa. Besides, versatile functionalities such as detection of finger bending/straightening, calligraphy writing, and air flow blowing have been investigated. It is expected that the proposed piezocapacitive pressure sensors incorporating stress-sensitive additives of zinc oxide nanostructures may provide a promising means for potential applications in ultrasensitive wearable, healthcare systems and human-machine interfaces.

A retrospective evaluation of reliability and reproducibility of Arbeitsgemeinschaftfür Osteosynthesefragen classification and Fernandez classification for distal radius fracture.

This is a retrospective evaluated. The objective of this study was to test the interobserver reliability and intraobserver reproducibility of fracture classification with Arbeitsgemeinschaftfür Osteosynthesefragen (AO) system and Fernandez system used by 5 senior orthopedic surgeons.Anteroposterior and lateral radiographs of 160 patients hospitalized for displaced distal radius fracture were examined. Independently, 5 orthopedic surgeons evaluated the radiographs according to 2 different distal radius classification systems (3 types of results). Three statistical tools were used to measure interobserver reliability and intraobserver reproducibility. The intraclass correlation coefficient and kappa coefficient (k) were used to assess both interobserver and intraobserver agreement of AO and Fernandez. Kappa value indicated poor agreement (<0), slight (0-0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), and perfect (0.81-1.00).The intraobserver reproducibility of AO system (9 types) and Fernandez system were moderate with a value of 0.577 and 0.438. The intraobserver reproducibility of AO system (27 subtypes) was 0.286. The interobserver reliability of AO system (9 types) was moderate with a value of 0.469 and that of Fernandez was moderate with a value of 0.435. The interobserver reliability of AO system (27 subtypes) was 0.299.Neither of the 2 systems can give us a satisfactory agreement between interobserver reliability and intraobserver reproducibility. In AO system, the interobserver reliability and intraobserver reproducibility of the 9 types decreased with the increase of subgroups.

Association Between Circulating Lymphocyte Populations and Outcome After Stereotactic Body Radiation Therapy in Patients With Hepatocellular Carcinoma.

Background and Objective: Radiation-induced lymphopenia has a tangible impact on overall survival (OS) in multiple solid tumors. We investigated the association between circulating lymphocyte populations (CLPs) before and after stereotactic body radiation therapy (SBRT) and OS in patients with hepatocellular carcinoma (HCC). Materials and Methods: Seventy-eight HCC patients treated with SBRT between January 2013 and June 2017 were retrospectively analyzed. Baseline and post-treatment total peripheral lymphocyte counts (TPLCs) and values of different CLPs were obtained and analyzed for clinical outcomes. Univariate and multivariate Cox regression analyses were used to explore the independent prognostic factors for patient survival. Results: The one-, two- and three-year OS rates were 94.8, 75.9, and 63.3%, respectively. The mean TPLCs before and 10 days after SBRT were 1.4 × 109/L and 0.7 × 109/L, respectively. The TPLC recovered to its baseline value 1 year after SBRT. Multivariate analysis results revealed that variables, including tumor necrosis factor-alpha (TNF-α) level <5.5 ng/mL and post-treatment TPLC <0.45 × 109/L were independent factors for inferior OS. Further analysis showed that the values of CLPs, including CD3+, CD4+, CD8+, CD19+, and CD16+56+ cells dropped profoundly 10 days after SBRT, among which CD19+ B cell count was mostly depleted and gradually recovered after 2 months. Univariate analysis showed that both baseline and post-treatment TPLC and CLP (except post-treatment B cell) counts were significantly associated with patient OS (p < 0.05 for each). Further stratified analysis performed according to OS at 2 years demonstrated that the CD16+CD56+ NK cell counts remained significantly elevated in patients with better survival (OS > 2 years) compared to those in short-term survivors at 10 days, 1 month, and 2 months after SBRT (p < 0.05 for each). In addition, there were significant differences in TPLC and CD8+ T cell counts in patients with long-term and short-term OS at 2 months after SBRT (p < 0.05). Conclusions: Peripheral lymphopenia after SBRT might be an independent prognostic factor for poorer outcome in HCC patients. Post-treatment lymphocyte subsets, including CD8+ T cell and NK cell counts were also associated with 2-year OS rates.

MicroRNA-146a-5p Attenuates Fibrosis-related Molecules in Irradiated and TGF-beta1-Treated Human Hepatic Stellate Cells by Regulating PTPRA-SRC Signaling.

MicroRNAs (miRNAs) have been shown to play a pivotal role in the pathogenesis and maintenance of liver fibrosis by altering expression of their downstream target genes. However, their role in radiation-induced liver fibrosis has not been assessed in detail. Here, we investigated the role of miR-146a-5p and the target gene in regulation of fibrosis-related markers in the human hepatic stellate cell line LX2. LX2 cells were stimulated with 8 Gy of X rays and various concentrations of TGF-ß1 (0-5 ng/ml). Expression of α-SMA, collagen 1 and miR-146a-5p was evaluated. The MiR-146a-5p target gene predictions were performed using bioinformatics analysis and confirmed by dual-luciferase reporter experiment. The effect of miR-146a-5p and the involved target gene on the expression of these fibrogenic molecules was also assessed. Expression of α-SMA and collagen 1 were upregulated in response to radiation and/or TGF-ß1 treatment and miR-146a-5p levels were altered in LX2 cells. Restoration of miR-146a-5p expression suppressed expression of α-SMA and collagen 1 in irradiated and TGF-ß1-treated LX2 cells. Subsequent mechanism experiments revealed that miR-146a-5p overexpression inhibited PTPRA expression by binding to its 3'-untrans-lated region and reduced SRC activation. In addition, enhancement of PTPRA partially reversed the suppressive effect of miR-146a-5p on α-SMA and collagen 1 expression in LX2 cells. In conclusion, miR-146a-5p may negatively regulate the PTPRA-SRC signaling to inhibit expression of fibrosis-related markers in irradiated and TGF-ß1-stimulated LX2 cells.

The molecular mechanism of LncRNA34a-mediated regulation of bone metastasis in hepatocellular carcinoma.

BACKGROUND: Bone metastasis (BM) has long been recognized as a major threat to the quality of life of hepatocellular cancer (HCC) patients. While LncRNA34a (Lnc34a) has been shown to regulate colon cancer stem cell asymmetric division, its effect on HCC BM remains unknown. METHODS: In situ hybridization and quantitative real-time polymerase chain reaction (qRT-PCR) were used to detect the expression of Lnc34a in HCC tissues and cell lines. Ventricle injection model was constructed to explore the effect of Lnc34a on BM in vivo. The methylation of miR-34a promoter and histones deacetylation were examined by using bisulfate-sequencing PCR and chromatin immunoprecipitation assays. RNA pull down and RNA immunoprecipitation were performed to investigated the interaction between Lnc34a and epigenetic regulators. Dual-luciferase reporter assay was conducted to find miR-34a target. The involvement of TGF-ß pathway in the BM from HCC was determined by qRT-PCR, western, and elisa assays. RESULTS: We found that Lnc34a was significantly overexpressed in HCC tissues and associated with BM. Both in vitro and in vivo experiments indicate that the restoration or knockdown of Lnc34a expression in HCC cells had a marked effect on cellular migration, invasion, and metastasis. Mechanistic analyses suggested that Lnc34a epigenetically suppresses miR-34a expression through recruiting DNMT3a via PHB2 to methylate miR-34a promoter and HDAC1 to promote histones deacetylation. On the other hand, miR-34a targets Smad4 via the TGF-ß pathway, followed by altering the transcription of the downstream genes (i.e., CTGF and IL-11) that are associated with BM. CONCLUSIONS: Our study is the first to document the pro-bone metastatic role of Lnc34a in BM of HCC and reveal a novel mechanism for the activation of the TGF-ß signaling pathway in HCC BM, providing evidence of a potential therapeutic strategy in HCC BM.

Pre/Post-Treatment Dynamic of Inflammatory Markers Has Prognostic Value in Patients with Small Hepatocellular Carcinoma Managed by Stereotactic Body Radiation Therapy.

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are inflammatory indexes that may reflect immune response to tumors and prognosis. We investigated the prognostic values of pre-treatment and post-treatment NLR and PLR and changes in those ratios in patients with small hepatocellular carcinoma (sHCC) treated with stereotactic body radiation therapy (SBRT). PATIENTS AND METHODS: Sixty patients who received SBRT were retrospectively reviewed. NLR and PLR were calculated by division of neutrophil and platelet counts, respectively, by lymphocyte counts. Independent factors for progression-free survival (PFS) and overall survival (OS) were determined by the Kaplan-Meier method, log-rank test, and Cox multivariate regression. Hazard ratios (HRs) and 95% confidence intervals (CIs) were also calculated. RESULTS: The median follow-up was 36.9 (range: 4.1-73.5) months. Median PFS was 21.4 (range: 1.8-66.9) months. The 1-year and 2-year PFS rates were 76.7% and 55.0%, respectively. The 1-year and 2-year OS rates were 95.0% and 78.3%, respectively. In multivariate analysis, post-treatment PLR ≥263.0 indicated both poor PFS (HR: 3.70; 95% CI: 1.07-12.76, p=0.038) and OS (HR: 3.23; 95% CI: 1.01-9.11, p=0.043) for sHCC patients treated with SBRT. In addition, the presence of hepatitis infection and a low level of red blood cell count were also proved to be significantly associated with patients' poor prognosis (p<0.05 for each). Post-treatment increase in NLR ≥2.7-fold was shown to be a negative independent predictor of inferior OS (HR: 3.43; 95% CI: 1.14-10.38, p=0.029). CONCLUSION: High post-treatment PLR and change in NLR ≥2.7-fold were associated with poor prognosis in patients treated with SBRT and might be considered as reliable and independent prognostic biomarkers for patients with sHCC.

Osteotomy, bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture / 中华创伤骨科杂志

Objective To evaluate osteotomy,bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture.Methods From April 2014 to April 2019,11 consecutive patients with a large bone defect following open femoral fracture were treated at Department of Orthopaedics,The Sixth People's Hospital of Shanghai.They were 9 males and 2 females,with an average age of 40.5 years (from 18 to 70 years).The left side was involved in 6 cases and the right side in 5.All their primary open fractures had deteriorated into osteomyelitis and bone defects after treatment.Their bone defects averaged 60.5 mm after thorough debridement.Postoperative X-ray examinations were taken regularly.Bony union time and index,time till removal of external fixator,external fixation index,flap survival,soft tissue healing,visual analogue scale (VAS),Association for Studying and Application of Methods of Ilizarov (ASAMI) scores for bone healing and lower limb function were recorded.Results All the patients were followed up for 9 to 30 months (mean,21.9 months).The bony union time averaged 10.5 months (from 5.2 to 22.3 months).The bony union indexes averaged 52.9 d/cm (from 33.4 to 73.3 d/cm).The time till removal of external fixator averaged 15.5 months (from 9.8 to 27.5 months).The external fixation indexes averaged 86.0 d/cm (from 60 to 113 d/cm).All the bone nonunions healed with no recurrence of osteomyelitis.Complications like union failure,refracture at ends of bone lengthening or fracture,or leg length discrepancy ＞ 2.5 cm,happened in none.The VAS scores ranged from 0 to 3 points.By ASAMI evaluation,the bony union was excellent in 10 cases and good in one case,and the lower limb function was excellent in 3 cases,good in 7 cases and fair in one.Conclusion Osteotomy,bone shortening and lengthening by one stage with external fixation is a reliable treatment for large femoral bone defects because this strategy can remove the lesions and restore the femoral length at the same time.

Free fibular composite tissue flap with peroneus longus and brevis for complicated extremity trauma / 中华创伤骨科杂志

Objective To report our clinical application of free fibular composite tissue flap with peroneus longus and brevis in the treatment of complicated extremity trauma.Methods From August 2014 to September 2017,5 patients with complicated extremity trauma were treated using a free fibular composite tissue flap with peroneus longus and brevis at Department of Orthopaedics,The Sixth People's Hospital of Shanghai.They were 4 men and one woman,aged from 23 to 52 years (average,35.1 years).All of them had tendon defects;one had a radius defect,one an ulnar defect and three a tibial defect.The length of bone defects ranged from 8 cm to 18 cm;the size of soft tissue defects ranged from 10 cm × 5 cm to 18 cm × 8 cm.A fibular composite tissue flap was designed according to the soft tissue condition and defect area to repair and fixate the bone defect after thorough debridement and cover the wound before functional reconstruction.Postoperatively,survival of the flap and functional recovery of the corresponding tendon at the recipient site,healing time of the tibia,and wound healing,ankle motion and complications at the donor site were all observed.Results The 5 patients were followed up for 18 to 38 months (average,25.2 months).All flaps survived without any vascular crisis or infection.The union time for the fibular graft ranged from 4 to 16 months (average,8.4 months).In the 3 patients with a tibial defect,the maximum angle of dorsal extension ranged from 0° to 10° and no foot drop was observed.Thumb and digital flexion was reconstructed in the patients with a forearm bone defect only to achieve opposition of index finger and thumb but we failed to make them have a fist.At the 5 flap donor sites,the wound was sutured by the second stage after vacuum suction and healed well;obvious scar formed in one of them.No obvious foot varus was observed at the donor site.The patients were satisfactory with their ankle joint motion.No refracture of the fibular graft occurred during follow-up.Conclusion A free fibular composite tissue flap with peroneus longus and brevis is a good choice for complicated extremity trauma.

Clinical application of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction / 中华显微外科杂志

Objective To explore the operative technique and clinical results of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction.Methods From January,2016 to June,2018,9 patients suffered from soft tissue defect were treated by the posterior tibial artery perforator flap containing saphenous nerve branch.Seven patients were males and 2 were females,with age ranged from 31 to 62 years.Soft tissue defects located in hands in 5 patients,plantar in 2 patients,ankle in 1 patient and dorsal foot in 1 patient.The size of soft tissue defects ranged from 8.0 cm×2.5 cm to 21.0 cm×4.0 cm.The regular post-operative followed-up was performed.Results All flaps survived without complications.The size of flap ranged from 10.0 cm×3.5 cm-23.0 cm×5.0 cm.Donor sites were primarily closed in 5 patients and secondary closed in 4 patients.Followed-up ranged from 6 to 15 months with 10 months in average.The contour of flaps were satisfied and the sensory function of the donor sites were normal.At 6 months followed-up,SW test reached 5.07 in all flaps,and 2PD ranged from 14 to 35 mm.Conclusion The novel sensory flap can provide satisfied sensory outcome without sacrificing main artery and saphenous nerve,and is a good candidate for sensory reconstruction of soft tissue defects.

Clinical effect analysis of palmar venous anastomosis in fingertip replantation / 中华显微外科杂志

Objective To investigate the feasibility and clinical effect of palmar venous anastomosis in fingertip replantation.Methods From October,2008 to May,2017,the clinical data of 15 patients with 24 finger replantation were retrospectively analyzed by outpatient,telephone and WeChat followed-up.One artery was anastomosed for revascularization with or without nerve repair,and 1 palmar venous anastomosis was performed to reestablish the outflow system.The finger nerve was sutured randomly according to the injury.Results The patients were followed-up for 18-65 (mean,39.9) months.Except for 1 replantation finger with rotation avulsed injury failed,the remaining 14 cases with 23 fingers survived completely.Excellent restoration of finger motion was observed during the follow-up.The mean regained static 2-point discrimination sensation was 3.6 (2.8-4.0) mm.All patients were satisfied with the treatment effect.Conclusion Successful palmar venous anastomosis can improve the survival rate of replanted fingertips,simplify postoperative care,reduce postoperative complications,and improve the treatment effect.

Osteotomy, bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture / 中华创伤骨科杂志

Objective@#To evaluate osteotomy, bone shortening and lengthening by one stage with external fixation for a large bone defect following open femoral fracture.@*Methods@#From April 2014 to April 2019, 11 consecutive patients with a large bone defect following open femoral fracture were treated at Department of Orthopaedics, The Sixth People’s Hospital of Shanghai. They were 9 males and 2 females, with an average age of 40.5 years (from 18 to 70 years). The left side was involved in 6 cases and the right side in 5. All their primary open fractures had deteriorated into osteomyelitis and bone defects after treatment. Their bone defects averaged 60.5 mm after thorough debridement. Postoperative X-ray examinations were taken regularly. Bony union time and index, time till removal of external fixator, external fixation index, flap survival, soft tissue healing, visual analogue scale (VAS), Association for Studying and Application of Methods of Ilizarov (ASAMI) scores for bone healing and lower limb function were recorded.@*Results@#All the patients were followed up for 9 to 30 months (mean, 21.9 months). The bony union time averaged 10.5 months (from 5.2 to 22.3 months). The bony union indexes averaged 52.9 d/cm (from 33.4 to 73.3 d/cm). The time till removal of external fixator averaged 15.5 months (from 9.8 to 27.5 months). The external fixation indexes averaged 86.0 d/cm (from 60 to 113 d/cm). All the bone nonunions healed with no recurrence of osteomyelitis. Complications like union failure, refracture at ends of bone lengthening or fracture, or leg length discrepancy>2.5 cm, happened in none. The VAS scores ranged from 0 to 3 points. By ASAMI evaluation, the bony union was excellent in 10 cases and good in one case, and the lower limb function was excellent in 3 cases, good in 7 cases and fair in one.@*Conclusion@#Osteotomy, bone shortening and lengthening by one stage with external fixation is a reliable treatment for large femoral bone defects because this strategy can remove the lesions and restore the femoral length at the same time.