[Objective]To explore the results of the treatment of the ischemic necrosis of femoral head using titanium alloy cage in animal models.[Method]The ischemic necrosis of femur head was made with the liquid nitrogen in 15 hybrid adult dogs.The titanium alloy cage of threaded central empty cylinder with multi-hole periphery was driven into the full depth of the center decompression canal to the subchondral bone.The dogs were divided into 3 groups,5 dogs in each groups were sacrificed respectively at 3,6,12 weeks after operation.Radiograph and histologic examination were used to evaluate the results.[Result]No collapse of femoral head was observed postoperation.The position of the cages was located wall in X-ray films.Under microscope,the cancellous bone of necrotic femoral head rebuilted up gradually.The cancellous bone grew into cage.After 12-week creeping substitution,the cancellous bone filled up the hollow and the peripheral holes of the cages.[Conclusion]The titanium alloy cage can provide structural support to the subchondral bone and prevent collapse.The cancellous bone grows into the cages through the peripheral holes.The necrotic femoral heads are restoration.The titanium alloy cage could be recommended for the treatment of the ischemic necrosis of femoral head.

Abstract: Objective Based on the results of previous studies that diabetic foot is the most common type of chronic wound in Hainan, the study aims to clarify the severity of diabetic foot residents and the risk factors of diabetic foot gangrene in Hainan Island, and to provide a scientific basis for reducing the incidence of amputation in diabetic foot patients. Methods A total of 457 diabetic foot patients from 19 hospitals in 11 cities and counties in Hainan Province were investigated from July 2022 to June 2023 using a survey design. The data collected included demographic characteristics, diabetes, and diabetic foot information. Counting data were described by frequency and percentage, and chi-square test was used for the comparison of differences between groups. A binary Logistic regression multi-factor analysis was used, and an incremental model was set up in the regression to test the impact of potential confounding factors on the results. Results The incidence of gangrene in diabetic foot patients in Hainan is 56.01% (95%CI: 51.21%-61.49%), which is higher than that in other areas. Univariate analysis showed that age, lifestyle habits, medication, comorbidities, family history, and wound infection are associated with the risk of diabetic foot gangrene. Multivariate logistic regression analysis further confirmed that the independent risk factors for diabetic foot gangrene are not receiving diabetes medication, having complications/complications of diabetes, and not checking both feet daily. No significant interaction between gender and the above factors was found in the subgroup analysis. Conclusions The incidence of gangrene in diabetic foot patients in Hainan is higher than that in other areas, and the risk factors are related to the lack of standardized, timely treatment, and patients' lack of knowledge about diabetes and diabetic foot. It is suggested to speed up the construction of wound treatment centers in primary hospitals, improve the treatment level of diabetic foot, pay attention to the education of diabetes and diabetic foot, and improve patients' compliance with treatment, so as to achieve early detection, timely diagnosis and treatment, and reduce the severity of diabetic foot and the risk of gangrene.

Objective To investigate the effect of sufentanil postconditioning on myocardial ischemiareperfusion (I/R) injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods Sixty ASA Ⅱ or Ⅲ patients ( NYHA Ⅱ or Ⅲ ) of both sexes,aged 19-64 yr,scheduled for cardiac valve rreplacement under CPB,were randomly divided into 4 groups ( n =15 each):control group ( group C),sufentanil 0.5 μg/kg group (group S1 ),sufentanil 1.0 μg/kg group (group S2 ) and sufentanil 2.0 μg/kg group ( group S3 ).In groups S1,S2 and S3,sufentanil 0.5,1.0 and 2.0 μg/kg were infused over 2 min via aortic root 5 min before aortic unclamping respectively.In group C,the equal volume of normal saline (2 ml/kg) was infused instead of sufentanil.Blood samples were taken from the radial artery immediately before induction of anesthesia ( T2 ) and at 2,4,8,24 and 48 h after aortic unclamping ( T1-5 ) for determination of plasma concentrations of cardiac troponin-I (cTnI) and malondialdehyde (MDA) and activities of creatine kinase isoenzyme-MB (CK-MB) and superoxide dismutase (SOD).The duration of CPB,time of aortic clamping,extubation time,duration of stay in ICU,and myocardial contractility score and volume of drainage at 24 h after the operation were recorded.The restoration of spontaneous heart beat and adverse cardiovascular events were observed.Results The plasma cTnI,and MDA concentrations and CK-MB activity were significantly lower,while the SOD activity was significantly higher at T1-3 in group S1 than in group C ( P ＜ 0.05).The plasma cTnl concentration and CK-MB activity were significantly lower at T1-5,the plasma MDA concentration was significantly lower at T1-4,and SOD activity was significantly higher at T1-4,the extubation time and duration of stay in ICU were significantly shorter,and the myocardial contractility score at 24 h after the operation and incidence of adverse cardiovascular events were significantly lower in groups S2,3 than in group C ( P ＜ 0.05),The plasma cTnl concentration and CK-MB activity were significantly lower at T4,5,The plasma MDA concentration was significantly lower at T4,the SOD activity was significantly higher at T3,4,and the myocardial contractility score at 24 h after the operation was significantly lower in groups S2,3 than in group S1 ( P ＜ 0.05).Conclusion Sufentanil postconditioning can relieve myocardial I/R injury in patients undergoing cardiac valve replacement under CPB,and the mechanism is related to inhibition of lipid peroxidation.

ObjectiveTo explore the correlation between phosphatase of regenerating liver-3 (PRL-3) and portal vein tumor thrombus in hepatocellular carcinoma (HCC).MethodsClinical data of 248 patients with HCC undergoing hepatectomy in the First People's Hospital of Foshan between December 2003 and December 2008 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval had been received. Among the 248 patients, 193 were males and 55 were females with the age ranging from 18 to 75 years old and the median of 48 years old. Forty-ifve cases were complicated with portal vein tumor thrombus. The expression of PRL-3 in HCC and portal vein tumor thrombus were observed by immunohistochemistry. The correlation between the expression of PRL-3 and the clinicopathological parameters of HCC patients and its signiifcance in portal vein tumor thrombus formation were analyzed. The analysis on the correlation between the expression of PRL-3 and the clinicopathological parameters of HCC was conducted usingχ2 test and the analysis on the risk factors associated with portal vein tumor thrombus formation was conducted using Logistic regression analysis.ResultsThe positive expression rate of PRL-3 in HCC and portal vein tumor thrombus was 70% (174/249) and 98% (44/45) respectively, and the positive expression rate in portal vein tumor thrombus was signiifcantly higher than that in HCC (χ2=15.253,P<0.05). The positive expression of PRL-3 was associated with the serum AFP, tumor diameter, histological differentiation of tumor, portal vein tumor thrombus formation, tumor TNM staging and early recurrence (χ2=4.836, 7.186, 4.226, 5.357, 13.862, 10.824;P<0.05). The positive expression of PRL-3 was the risk factor for portal vein tumor thrombus formation (OR=2.674,P<0.05).ConclusionsPRL-3 expression increases in HCC portal vein tumor thrombus and positive expression of PRL-3 may be closely associated with the invasion and metastasis of HCC.

Objective:To evaluate the role of O-sialoglycoprotein endopeptidase (OSGEP) in hepatic ischemia-reperfusion injury (HIRI) and the relationship with oxidative stress in mice.Methods:Experiment Ⅰ Twenty-four SPF healthy male C57BL/6 mice, 12 wild-type and 12 OSGEP knockdown, aged 6-8 weeks, weighing 18-22 g, were divided into 4 groups ( n=6 each) by the random number table method: wild-type shamoperation group (Sham group), wild-type HIRI group (HIRI group), OSGEP knockdown+ sham operation group (Sham+ KD group) and OSGEP knockdown+ HIRI group (HIRI+ KD group). Ischemia-reperfusion model was prepared by blocking the hepatic artery and portal vein for 60 min followed by reperfusion in anesthetized animals, the blood vessels were only exposed without occlusion in Sham group and Sham+ KD group, and the blood vessels were clamped for 60 min followed by reperfusion in HIRI group and HIRI+ KD group. The mice were sacrificed after 6-h reperfusion to extract liver tissue samples for microscopic examination of histopathological changes (with an optical microscope after HE staining) which were evaluated using Suzuki score and for determination of the serum concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), level of reactive oxygen species (ROS) (using the DCFH-DA fluorescent probe method), contents of malondialdehyde (MDA) and glutathione(GSH) in liver tissues (using a colorimetric method) and expression of OSGEP (using Western blot). Experiment Ⅱ The well-growing AML12 cells were divided into 4 groups ( n=30 each) using a random number table method: control group (C group), oxygen-glucose deprivation/restoration (OGD/R) group, OGD/R+ OSGEP knockdown group (OGD/R+ KD group), and OGD/R+ OSGEP knockdown negative control group (OGD/R+ NC group). Group C was cultured under normal conditions. Group OGD/R was subjected to O 2-glucose deprivation for 6 h followed by restoration of O 2-glucose supply for 24 h in OGD/R group. In OGD/R+ KD group, stable transfection of AML12 cells with OSGEP knockdown was performed prior to the experiment, and the other procedures were the same as those previously described. The cell survival rate was measured by the CCK-8 assay, the release of lactate dehydrogenase (LDH) was measured, the DCFH-DA method was used to detect the levels of ROS, and the contents of MDA and GSH were determined using a colorimetric method. Results:Experiment Ⅰ Compared with Sham group, the expression of OSGEP was significantly down-regulated, the serum concentrations of AST and ALT, Suzuki score, levels of ROS and content of MDA were increased, and the GSH content was decreased in HIRI group ( P<0.05), and no significant change was found in each parameter in Sham+ KD group ( P>0.05). Compared with HIRI group, the serum concentrations of AST and ALT, Suzuki score, levels of ROS and content of MDA were significantly increased, and the GSH content was decreased in HIRI+ KD group ( P<0.05). Experiment Ⅱ Compared with group C, the expression of OSGEP was significantly down-regulated, the cell survival rate and GSH content were decreased, and the release of LDH, levels of ROS and content of MDA were increased in group OGD/R ( P<0.05). Compared with OGD/R group, the cell survival rate and GSH content were significantly decreased, and the release of LDH, levels of ROS and content of MDA were increased in OGD/R+ KD group ( P<0.05), and no significant change was found in each parameter in OGD/R+ NC group ( P>0.05). Conclusions:OSGEP plays an endogenous protective role in HIRI by inhibiting oxidative stress in mice.

Gastric cancer (GC) is known as a top malignant type of tumors worldwide. Despite the recent decrease in mortality rates, the prognosis remains poor. Therefore, it is necessary to find novel biomarkers with early diagnostic value for GC. In this study, we present a large-scale proteomic analysis of 30 GC tissues and 30 matched healthy tissues using label-free global proteome profiling. Our results identified 537 differentially expressed proteins, including 280 upregulated and 257 downregulated pro-teins. The ingenuity pathway analysis (IPA) results indicated that the sirtuin signaling pathway was the most activated pathway in GC tissues whereas oxidative phosphorylation was the most inhibited. More-over, the most activated molecular function was cellular movement, including tissue invasion by tumor cell lines. Based on IPA results, 15 hub proteins were screened. Using the receiver operating character-istic curve, most of hub proteins showed a high diagnostic power in distinguishing between tumors and healthy controls. A four-protein (ATP5B-ATP5O-NDUFB4-NDUFB8) diagnostic signature was built using a random forest model. The area under the curve (AUC) values of this model were 0.996 and 0.886 for the training and testing sets, respectively, suggesting that the four-protein signature has a high diag-nostic power. This signature was further tested with independent datasets using plasma enzyme-linked immune sorbent assays, resulting in an AUC value of 0.778 for distinguishing GC tissues from healthy controls, and using immunohistochemical tissue microarray analysis, resulting in an AUC value of 0.805. In conclusion, this study identifies potential biomarkers and improves our understanding of the pathogenesis, providing novel therapeutic targets for GC.

Lower extremity deep vein thrombosis (DVT) is one of the main complications in patients with traumatic fractures, and for severe patients, the DVT can even affect arterial blood supply, resulting in insufficient limb blood supply. If the thrombus breaks off, pulmonary embolism may occur, with a high mortality. The treatment and rehabilitation strategies of thrombosis in patients with lower extremity fractures have its particularity. DVT in traumatic fractures patients has attracted extensive attention and been largely studied, and the measures for prevention and treatment of DVT are constantly developing. In recent years, a series of thrombosis prevention and treatment guidelines have been updated at home and abroad, but there are still many doubts about the prevention and treatment of DVT in patients with different traumatic fractures. Accordingly, on the basis of summarizing the latest evidence-based medical evidence at home and abroad and the clinical experience of the majority of experts, the authors summarize the clinical treatment and prevention protocols for DVT in patients with traumatic fractures, and make this consensus on the examination and assessment, treatment, prevention and preventive measures for DVT in patients with different fractures so as to provide a practicable approach suitable for China ′s national conditions and improve the prognosis and the life quality of patients.

Delayed diabetic wound healing has placed an enormous burden on society. The key factors limiting wound healing include unresolved inflammation and impaired angiogenesis. Platelet-rich plasma (PRP) gel, a popular biomaterial in the field of regeneration, has limited applications due to its non-injectable properties and rapid release and degradation of growth factors. Here, we prepared an injectable hydrogel (DPLG) based on PRP and laponite by a simple one-step mixing method. Taking advantages of the non-covalent interactions, DPLG could overcome the limitations of PRP gels, which is injectable to fill irregular injures and could serve as a local drug reservoir to achieve the sustained release of growth factors in PRP and deferoxamine (an angiogenesis promoter). DPLG has an excellent ability in accelerating wound healing by promoting macrophage polarization and angiogenesis in a full-thickness skin defect model in type I diabetic rats and normal rats. Taken together, this study may provide the ingenious and simple bioactive wound dressing with a superior ability to promote wound healing.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.