BACKGROUND: Mechanisms related to bone fracture and nonunion have been clarified, but the healing time and treatment strategy of delayed union remain controversial. OBJECTIVE: To establish a reliable model of femoral delayed union using external fixation in the New Zealand white rabbit. METHODS: Seventy-two New Zealand white rabbits were randomized to three groups. After removal of 10-mm femoral middle bone cortex with internal and external periosteum and bone marrow, a uniplanar external fixator was used. There was a 1 mm gap between broken ends (group A), and the broken ends were sealed by bone wax (group B). For controls, only bone cortex was cut and then fixed to contact the broken ends. The gross, radiological and histological observations were performed to observe the bone healing at 4, 8 and 12 weeks after modeling. RESULTS AND CONCLUSION: The control group achieved bone healing at the 4th week, which was considered as the normal time of bone healing. The groups A and B achieved healing at the 12th week, which was remarkably longer than that in the control group. The rabbit femoral delayed union model showed the typical X-ray imaging and pathological features of delayed union. Our results suggest that the model is reasonable and reliable, which can provide reference for clinical research.

BACKGROUND: Many methods have been developed to establish a rabbit VX2 tumor model, but the reliability of each method has not been explored. In order to develop a reliable method, we made some improvements based on the existing methods. OBJECTIVE: To investigate the reliability of rabbit VX2 tumor tissue block implantation and cell suspension via modified and traditional implantation to make the rabbit tibia VX2 tumor model. METHODS: Forty healthy adult New Zealand white rabbits were randomly divided into two groups. Group A was treated with tissue block implantation for tibia VX2 tumor modeling, and group B was treated with cell suspension for tibia VX2 tumor modeling. Modified and traditional implantation was performed on the left and right tibia of the experimental animals, respectively. One hour after successful modeling, ultrasound examination of the puncture site was performed to determine whether there is hematoma. All experimental animals were sacrificed at 3 weeks. X-ray examination of the bilateral tibia was performed to confirm the tumor growth range. Tumor tissue and soft tissue around the puncture site were taken for general and pathological observation to compare the size of the tumor and identify whether there is tumor cell metastasis. RESULTS AND CONCLUSION: One rabbit died in the tissue block group, and all the experimental animals in the cell suspension group survived. X-ray examination indicated the tumors in the tissue block group invaded the cortex, but the tumors in the cell suspension group did not invade the cortex. Gross observation revealed that the tumor volume of the tissue block group was greater than that of the cell suspension group. In the tissue block group, there were one and seven cases of hematoma around the puncture site at 1 hour after modified and traditional implantation, respectively. In the cell suspension group, there were two and nine cases of hematoma around the puncture site at 1 hour after modified and traditional implantation, respectively. Pathological examination showed that local tumor invasion was found in 1 and 8 cases in the tissue block group as well as in 2 and 11 cases in the cell suspension group at 3 months after modified and traditional implantation, respectively. Our findings indicate that the tissue block implantation method is easier and more convenient than the cell suspension method for making rabbit VX2 bone tumors, and the tumor invasion rate of the tissue block implantation method is lower than that of the cell suspension method. Improved tissue block implantation can effectively reduce the tumor invasion rate during modeling.

Objective To study the expression of interleukin-1β (IL-1β) in synovia and synovium of rats after high intensity exercise.Methods 24 healthy male Sprague-Dawley rats were randomly divided into control group and high intensity group, and the latter were forced to run 60 min at the speed of 28 m/min for 6 weeks. The histological changes of cartilage from the lesion areas of medial femoral condyle and synovium of knee joint were examined with HE stain and the expression of IL-1β in synovium with immunohistochemistry, in synovial fluid with the enzyme-linked immunosorbent assay (ELISA). Results The articular cartilage of knee were injured and synovitis were found in high intensity group. The expression of IL-1β both in synovial fluid and in synovium of the knee were more in high intensity group than in control group (P<0.05). Conclusion High intensity exercise could cause aticular cartilage injury, synovitis and over expression of IL-1β in synovia and synovium, which may associated with post-traumatic osteoarthritis.

Objective:To establish a reliable approach for measuring proximal femoral 3 dimensional anatomy, and to compare post-operative differences of proximal femoralanatomy in the inter-trochanter fractures with two kinds of antegrade nailings.Methods: Some computer assisted design ( CAD ) soft-wares, e.g.Mimics, were used to establish a reliable approach for measuring proximal femoral 3 dimen-sional (3D) anatomy.Intra-class correlation coefficient ( ICC) was used to test the reliability of intra-and inter-observers.The post-operative pelvic CT data of 19 cases of inter-trochanter fracture patients treated with InterTAN nailing and 21 cases of inter-trochanter fracture patients treated with proximal femo-ral nail anti-rotation ( PFNA) were retrospectively analysed and used to measure bilateral proximal femo-ral anatomical parameters, including 2D and 3D femoral neck-shaft ( NS) angle and femoral neck ante-version (NA) angle, and 2D and 3D anteversion angles of the intramedullary (IM) nailings.ICC was used to test the consistency of the NA angles in the different groups, and the paired student T-test was used to test the differences of the paired quantitative data.Results:The established measurement method hasdexcellent consistency within the intra-and inter-observers, with all the ICCs higher than 0.9.The paired student T-test showed no significant difference between the post-operative bilateral 2D or 3D NA angles.The ICCs results showed that there were no consistency between the post-operative bilateral 2D or 3D NA angles (P values were 0.099 and 0.055, respectively), but the excellent consistency between the 2D injured side NA angle and 2D IM nailing’ s NA angle, or between the 3D injured side NA angle and 3D IM nailing’s NA angle (the ICCs were 0.81 and 0.8, respectively, P values <0.001).In PF-NA group, 57%of the differences between the 2D post-operative injured side’s and intact side’s NA an-gles were higher than 15°, which was more than 15.78%in InterTAN group.The paired student T-test showed no significant difference between the post-operative injured side’ s 2D or 3D NS angles and the in-tact side’s respective 2D or 3D angles in PFNA group (P values were 0.925 and 0.367, respectively), but in InterTAN group, the post-operative injured side’s 2D or 3D NS angles were significantly smaller than the intact side’s respective angles (P values were 0.033 and 0.009, respectively).Conclusion:By analyzing and comparing bilateral proximal femoral anatomical parameters after two kinds of IM nailings procedures, the differences between the bilateral post-operative NA angles in PFNA group were significantly larger than those in InterTAN group.There was significant correlation between the NA angles of the injured sides and NA angles of IM nailings in both the groups.

Objective To investigate the dynamic expression of the drug resistance protein P-glycoprotein (P-gp) within 72 hours in the pentylenetetrazol (PTZ)-induced status epilepticus (SE) model, and to identify the optimal detection time to inhibit P-gp. Methods mRNA and protein expressions of P-gp in rats hippocampal tissue were detected by using immunohistochemistry , RT-qPCR and Western blot at different time points after modeling (0, 3, 6, 12, 24, 48, 72 h). Results The mean density of P-gp protein in the hippocampus of status epilepticus model was 0.325 1 ± 0.008 2 at 24 h, and was 0.396 3 ± 0.016 8 at 48 h, which were consistently higher than those of the control group (P < 0.05, P < 0.01, respectively). Results of qRT-PCR showed that MDR1a expression was significantly upregulated at 24 h and at 48 h (P < 0.05, P < 0.01, respectively). Western blot assay revealed that P-gp protein was also significantly increased at 48 h after seizures (P < 0.05). Conclusions The upregulation of P-gp after SE peaked at 48 h, which maybe the optimal detection time to detect drug resistant after SE.

Objective:To investigate the guiding significance of monitoring of immune factors and T lymphocyte subsets in immunomodulatory treatment of sepsis.Methods:Eighty patients with sepsis admitted to Nangyang First People's Hospital from June 2022 to December 2023 were selected as sepsis group,and 80 healthy volunteers who underwent physical examination during the same period were selected as health group.Detection of immune factors[complement C3,IgA,IgG,IgM,IFN-γ,programmed cell death receptor-1(PD-1)]and T lymphocyte subsets(CD4+,CD8+,CD4+/CD8+)on the day of physical examination in healthy group,the day after sepsis group was enrolled,before treatment,and on day 1,3,and 7 after treatment,expressions of immune factors and T lymphocyte subsets were compared between the two groups.All 80 patients with sepsis received comprehensive treatment,during which thymosine-α1 was added for immunoconditioning treatment.Patients were divided into groups according to the improvement of their condition after immunoconditioning treatment[low-risk group(n=31),medium-risk group(n=34),high-risk group(n=15)]and disease outcome[survival group(n=55)and death group(n=25)].To analyze the efficacy of immune factors and T lymphocyte subsets in predicting the condition improvement and disease outcome of patients with sepsis after immune conditioning treatment.Results:Compared with healthy group,expression levels of immune factor complements C3,IgA,IgG,IgM and IFN-γ in sepsis group were decreased,relative expression level of PD-1 mRNA was increased,the values of CD4+T and CD4+T/CD8+T of T lymphocyte subsets were decreased,while CD8+T was increased(P<0.05).Compared with before treatment and 1 day after treatment,expression levels of complements C3,IgA,IgG,IgM,IFN-γ,CD4+T and CD4+T/CD8+T of T lymphocyte subsets were significantly increased in patients with sepsis after treatment on 3 and 7 days,while the relative expression level of PD-1 mRNA and CD8+T were significantly decreased(P<0.05).Condition of sepsis patients improved significantly after immune conditioning treatment,that is,proportion of low-risk patients increased,and proportion of medium-risk patients and high-risk patients decreased(Z=6.954,P<0.05).Levels of C3,IgA,IgG,IgM,IFN-γ,CD4+T and CD4+T/CD8+T in high-risk groups were significantly decreased,while PD-1 and CD8+T were significantly increased in low-risk and medium-risk groups(P<0.05).Levels of C3,IgA,IgG,IgM,IFN-γ,CD4+T and CD4+T/CD8+T in death group were significantly lower than those in survival group,while PD-1 and CD8+were significantly increased(P<0.05).ROC curve analysis showed that AUC of the combination of immune factors and T lymphocyte subsets to predict the improve-ment of the condition of sepsis patients after immune conditioning treatment was 0.923,the sensitivity was 89.90%,and the specificity was 82.31%.The efficacy of predicting the disease outcome of sepsis patients after immune conditioning treatment showed that the pre-dicted AUC was 0.965.The sensitivity was 95.60%and the specificity was 86.57%,which were obviously better than the single item.Conclusion:Sepsis patients have immune dysfunction related to immune factors and abnormal T lymphocyte subsets,immunomodu-latory therapy can help improve immune dysfunction,monitor immune factors upon admission,and levels of T lymphocyte subsets are helpful for early prediction of disease progression and prognosis in sepsis patients after immunomodulatory therapy.

Sepsis can cause life-threatening organ dysfunction and is one of the leading causes of death in critically ill patients. Early diagnosis and correct treatment of sepsis are the key to reducing the fatality, however, there is no golden standard for diagnosis at present. The ideal sepsis biomarker can be used for early diagnosis and predicting poor prognosis with good sensitivity and specificity. There are many candidate biomarkers for sepsis. This article reviews the latest developments on acute phase proteins, soluble receptors, non-coding RNAs and other candidate biomarkers of sepsis that attracted more recent attention.

Objective To investigate the levels of serum interferon-γ(IFN-γ),CD47 and lym-phocyte subsets in patients with sepsis and their relationships with prognosis.Methods A total of 180 patients with sepsis who were treated in our hospital were selected as observation group,and 180 healthy volunteers in the same period as control group.Based on the survival status of patients within 28 days of hospitalization,the patients were divided into survival group of 120 cases and death group of 60 cases.The levels of serum IFN-γ and CD47 in patients with sepsis were detected by enzyme-linked immunosorbent assay(ELISA);the level of serum lymphocyte subsets was detected by flow cytometry.Logistic regression analysis was performed on the factors affecting the prognosis of patients with sepsis;the clinical value of the levels of serum IFN-γ,CD47 and lymphocyte subsets in predic-ting the prognosis of patients with sepsis was analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the control group,the levels of serum IFN-γ,T lymphocytes,B lym-phocytes,and natural killer cells in the observation group were decreased,while the level of CD47 was increased(P＜0.05).In the death group,the levels of serum IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells were also decreased,while the acute physiology and chronic health evaluation-Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,C-reactive protein,procalcitonin,endotoxin,and CD47 levels were increased compared with the death group(P＜0.05).The SOFA score was negatively correlated with the levels of serum IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells(r=-0.469,-0.572,-0.521,-0.505,P＜0.05),but positively correlated with the serum CD47 level(r=0.539,P＜0.05).Elevated levels of APACHE Ⅱ score,SOFA score,C-reactive protein,procalcitonin,endotoxin,and CD47 were risk factors for the prognosis of patients with sepsis,while increased levels of IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells were protective factors for the prognosis(P＜0.05).The areas under the curve(AUC)for predicting the prognosis of sepsis patients using IFN-γ,CD47,T lym-phocytes,B lymphocytes,and natural killer cells alone and their combination were 0.805,0.808,0.888,0.846,0.854,and 0.984,respectively,and the AUC of the combined detection was supe-rior to that of the individual detection(P＜0.001).Conclusion The levels of serum IFN-γ,T lymphocytes,B lymphocytes and natural killer cells in patients with sepsis are decreased,and the level of CD47 is increased,which is related to the prognosis of patients with sepsis and has certain predictive value for the prognosis of patients with sepsis.

Objective To discuss the application effect of clinical nursing pathway of Traditional Chinese Medicine ( TCM) in facial paralysis patients. Methods A total of 80 cases of facial paralysis patients from February 2012 to August 2014 were randomly divided into the observation group ( n=40 ) and the control group (n=40) according to random number table method. The control group was adopted routine treatment and nursing care, while the observation group was given clinical nursing pathway of TCM treatment and nursing care. The average length of hospital stay, hospital expenses, nursing compliance and satisfaction were compared. Results The hospitalization time and cost of the observation group were (13 ± 2. 3) days and (7 382. 0 ± 123. 1) yuan, which were significantly better than those of the control group (t=10. 70, 39. 55, respectively;P<0. 05). In the observation group, 36 patients were totally complied, three patients were partially complied, and one patient was not complied, which were significantly better than those of the control group (Z=4. 96,P<0. 05). In the observation group, 37 patients were totally satisfied, three patients were basically satisfied, and no patient was not satisfied, which were significantly better than those of the control group (Z =4. 97,P <0. 05). Conclusions The application of TCM clinical nursing pathway in facial paralysis patients can reduce the length of hospital stay and hospital costs, and improve patients′care compliance and satisfaction.

Objective To investigate the levels of serum interferon-γ(IFN-γ),CD47 and lym-phocyte subsets in patients with sepsis and their relationships with prognosis.Methods A total of 180 patients with sepsis who were treated in our hospital were selected as observation group,and 180 healthy volunteers in the same period as control group.Based on the survival status of patients within 28 days of hospitalization,the patients were divided into survival group of 120 cases and death group of 60 cases.The levels of serum IFN-γ and CD47 in patients with sepsis were detected by enzyme-linked immunosorbent assay(ELISA);the level of serum lymphocyte subsets was detected by flow cytometry.Logistic regression analysis was performed on the factors affecting the prognosis of patients with sepsis;the clinical value of the levels of serum IFN-γ,CD47 and lymphocyte subsets in predic-ting the prognosis of patients with sepsis was analyzed by the receiver operating characteristic(ROC)curve.Results Compared with the control group,the levels of serum IFN-γ,T lymphocytes,B lym-phocytes,and natural killer cells in the observation group were decreased,while the level of CD47 was increased(P＜0.05).In the death group,the levels of serum IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells were also decreased,while the acute physiology and chronic health evaluation-Ⅱ(APACHE Ⅱ)score,Sequential Organ Failure Assessment(SOFA)score,C-reactive protein,procalcitonin,endotoxin,and CD47 levels were increased compared with the death group(P＜0.05).The SOFA score was negatively correlated with the levels of serum IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells(r=-0.469,-0.572,-0.521,-0.505,P＜0.05),but positively correlated with the serum CD47 level(r=0.539,P＜0.05).Elevated levels of APACHE Ⅱ score,SOFA score,C-reactive protein,procalcitonin,endotoxin,and CD47 were risk factors for the prognosis of patients with sepsis,while increased levels of IFN-γ,T lymphocytes,B lymphocytes,and natural killer cells were protective factors for the prognosis(P＜0.05).The areas under the curve(AUC)for predicting the prognosis of sepsis patients using IFN-γ,CD47,T lym-phocytes,B lymphocytes,and natural killer cells alone and their combination were 0.805,0.808,0.888,0.846,0.854,and 0.984,respectively,and the AUC of the combined detection was supe-rior to that of the individual detection(P＜0.001).Conclusion The levels of serum IFN-γ,T lymphocytes,B lymphocytes and natural killer cells in patients with sepsis are decreased,and the level of CD47 is increased,which is related to the prognosis of patients with sepsis and has certain predictive value for the prognosis of patients with sepsis.