Objective To study the effect of application of vascular endoth el ial growth factor (VEGF) and anti-VEGF on the expression of fracture healing rel ated factors and observe the pathological changes at fractured site. Methods Fra cture models were established in 105 rabbits. All rabbits were randomly assigned into controlled group, VEGF treated group and anti-VEGF treated group. The fact ors related to fracture healing were detected, and pathological changes were obs erved at 8, 24, 72 h and 1, 3, 5, 8 weeks after fracture. Results After the appl ication of VGEF, BMP was expressed earlier and the express period was prolonged . On the contrary, anti-VEGF completely inhibited the expression of BMP in the f ractured ends. The fractured sites were filled with fibrous callus, cartilage ca llus and bony callus at the 3rd week and they were converted into woven bone at the 5th week. The fracture reached to normal healing at the 8th week in the VEGF treated group. Cellular necrosis increased in the earlier period in the VEGF po lyclonal antibody treated group, continuous focal necrosis was seen in the fract ured sites between 1st week to 5th week, vascularization reduced obviously at th e 3rd week. Conclusion Fracture healing is the result of mutual modulation and c oordination among many factors. VEGF may be an important factor which plays impo rtant role in the course of fracture healing.

In order to explore the effect of anti vegf on fracture healing process,rabbits with left radius fracture were used as an animal model and divided randomly into control and experiment groups.VEGF polyclonal antibody was given to the animals of the experiment group films were thken at the fracture sites after 1,3,5 and 8 weeks of the fracture.the results showed that the cellular necrosis increased in the experiment group shortly after the fracture.Although there was fibroblast proliferation at 72 hours after the fracture,continuous focal necrosis was seen from 1 to 5 weeks in the fracture sites,and the vascularization reduced obviously 3 weeks after the injury.The organelle degeneration was observed in the fibroblasts and osteoblasts under microscope.The fracture sites were filled with fibrous tissue at the 8 th week and nonunion was ween in the fracture sites on X ray films.These results suggest that the lack of VEGF in the fracture sites might be one of the important reasons of fracture healing.

Objective To investigate the efficiency of radiofrequency ablation (RFA) and microwave ablation (MWA) in treating uterine leiomyoma.Methods The clinical data of thermal ablation with RFA and MWA were retrospectively analyzed in 42 patients.All patients were followed up at least 12 months to observe the therapeutic effects after the treatment.The changes of vital signs and the size of uterine leiomyoma,the score of uterine leiomyoma symptom and quality of Iife(UFS-QOL) were compared after RFA or MWA,the two thermal ablations techniques of clinic efficiency and influence on complications were analyzed.Results 23 patients received treatment of RFA and 19 patients received MWA,the visual analogue scale(VAS)during operation and postoperation were statistically significant differences between the two groups(P ＜0.05).The sizes of uterine leiomyoma were significantly reduced after the thermal ablation,the differences of volume within two groups in different time were statistics significance(P ＜0.05),but there were no statistics significance differences between two groups (P ＞0.05).The symptoms in two groups were improved significantly after treatment and the scores of UFS-QOL were no statistics significance differences between two groups (P ＞0.05).Conclusions Both of RFA and MWA have significant clinic efficiency in treating uterine leiomyoma.Compared with MWA,RFA with lower adverse reactions during operation and postoperation.

Objective:To explore the teaching effect of 3D simulated wound model combined with problem -based learning (PBL) teaching in the standardized residency training of plastic surgery department. Methods:Totally 90 residents trained in the plastic surgery department of Changhai Hospital of Naval Medical University from June 2016 to September 2019 as the research objects were divided into control group and experimental group in average. The control group received traditional teaching and the experimental group accepted the 3D simulated wound model combined with PBL teaching. Then the out -department examination results and questionnaires evaluation were compared between the two groups. SPSS 19.0 was used to conduct t test on the experimental data. Results:The theoretical and practical scores of residents in the experimental group [(49.23±7.25) points and (36.38±5.29)] points were significantly better than those in the control group [(44.43±5.57) points and (28.94±6.97)] points ( P<0.05). In the questionnaire, the scores of active learning initiative, practical operation ability and clinical strain capacity of residents in the experimental group were all higher than those in the control group ( P<0.05), and there was no statistically significant difference in teamwork ability between the two groups ( P>0.05). Conclusion:The 3D simulated wound model combined with PBL teaching can be used in the teaching of standardized residency training of plastic surgery. Compared with traditional teaching, this teaching method has significant advantages and is worthy of promotion.

According to the pathological characteristics of symptomatic chronic thoracic and lumbar osteoporotic vertebral fracture (SCOVF), the different clinical treatment methods are selected, including vertebral augmentation, anterior-posterior fixation and fusion, posterior decompression fixation and fusion, and posterior correction osteotomy. However, there is still a lack of a unified understanding on how to choose appropriate treatment method for SCOVF. In order to reflect the new treatment concept and the evidence-based medicine progress of SCOVF in a timely manner and standardize its treatment, the clinical guideline for surgical treatment of SCOVF is formulated in compliance with the principle of scientificity, practicability and advancement and based on the level of evidence-based medicine.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.

The acute combination fractures of the atlas and axis in adults have a higher rate of neurological injury and early death compared with atlas or axial fractures alone. Currently, the diagnosis and treatment choices of acute combination fractures of the atlas and axis in adults are controversial because of the lack of standards for implementation. Non-operative treatments have a high incidence of bone nonunion and complications, while surgeries may easily lead to the injury of the vertebral artery, spinal cord and nerve root. At present, there are no evidence-based Chinese guidelines for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults. To provide orthopedic surgeons with the most up-to-date and effective information in treating acute combination fractures of the atlas and axis in adults, the Spinal Trauma Group of Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field of spinal trauma to develop the Evidence-based guideline for clinical diagnosis and treatment of acute combination fractures of the atlas and axis in adults ( version 2023) by referring to the "Management of acute combination fractures of the atlas and axis in adults" published by American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) in 2013 and the relevant Chinese and English literatures. Ten recommendations were made concerning the radiological diagnosis, stability judgment, treatment rules, treatment options and complications based on medical evidence, aiming to provide a reference for the diagnosis and treatment of acute combination fractures of the atlas and axis in adults.

Ankylosing spondylitis (AS) combined with lower cervical fracture is often categorized into unstable fracture, with a high incidence of neurological injury and a high rate of disability and morbidity. As factors such as shoulder occlusion may affect the accuracy of X-ray imaging diagnosis, it is often easily misdiagnosed at the primary diagnosis. Non-operative treatment has complications such as bone nonunion and the possibility of secondary neurological damage, while the timing, access and choice of surgical treatment are still controversial. Currently, there are no clinical practice guidelines for the treatment of AS combined with lower cervical fracture with or without dislocation. To this end, the Spinal Trauma Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate Clinical guidelines for the treatment of ankylosing spondylitis combined with lower cervical fracture in adults ( version 2024) in accordance with the principles of evidence-based medicine, scientificity and practicality, in which 11 recommendations were put forward in terms of the diagnosis, imaging evaluation, typing and treatment, etc, to provide guidance for the diagnosis and treatment of AS combined with lower cervical fracture.