BACKGROUND:Bone cement containing antibiotics for repair of bone defects can achieve sustained release of a higher concentration of sensitive drugs, which wil help kil bacteria and provide the necessary bone grafting bed and space to reduce massive bleeding due to removal of the granulation at bone defects during the second phase. OBJECTIVE:To analyze the clinical efficacy of antibiotic bone cement combined with autologous bone transplantation and Ilizarov external fixator on tibial bone defects after traumatic osteomyelitis. METHODS:A total of 31 patients with tibial bone defects after chronic osteomyelitis, including 19 males and 12 females, aged 17-40 years old. After positive debridement of necrotic tissues at bone stump, Ilizarov external fixator was used for fracture fixation, and autogenous iliac bone grafting combined with bone cement containing antibiotics was performed to repair bone defects. Fracture healing time, knee and ankle scoring were fol owed up. RESULTS AND CONCLUSION:The 31 patients were fol owed up for 6 months to 3.5 years. Tibial fractures were healed without infection recurrence in al patients. The bony union time was 3-6 months, the fixation time was 3-6 months, and the limb extended length was (7.50±1.01) cm. No adverse reactions related to bone cement and bone graft occurred. At 3 months after bone grafting, the scores on the knee and ankle joints were improve significantly. These findings indicate that the antibiotic bone cement combined with autologous bone transplantation and Ilizarov external fixator for repair of post-osteomyelitis posterior tibial bone defects can control infection, promote fracture healing, and restore joint functions.

Objective: To explore the compliance of functional exercise and related factors in patients with Parkinson's disease（PD）. Methods: A total of 108 PD patients were selected from Department of Neurology of General Hospital of Panzhihua Iron and Steel Group. An anonymous survey was conducted with general questionnaire,Mini-Mental State Examination,Hamilton Depression Rating Scale,Hamilton Anxiety Rating Scale and functional exercise compliance questionnaire. Multivariate linear regression model was used to analyze the influencing factors for the scores of functional exercise compliance in PD patients. Results: The total score of functional exercise compliance of 108 PD patients was 36.88±4.62. The scores of compliance of physical exercise,exercise monitoring,seeking advice and tips for attention were 15.65±1.92,9.61±1.48,5.67±1.08 and 5.95±1.18,respectively. The results of multivariate linear regression analysis showed that educational background（β'=0.748）,duration of illness（β'=-0.252）,Hoehn-Yahr stage（β'=-0.677）,rehabilitation guidance（β'=0.293）,self-care ability（β'=0.313）,primary caregiver（β'=0.182）,cognitive dysfunction（β'=0.745）,depression（β'=0.588）and anxiety（β'=0.520）could affect the compliance of functional exercise among PD patients（all P<0.05）. Conclusion The compliance of functional exercise among PD patients was at low level,with educational background,duration of illness,Hoehn-Yahr stage,rehabilitation guidance,self-care ability,primary caregiver,cognitive dysfunction,depression and anxiety as the influencing factors.

OBJECTIVE: To search for ideal bone graft substitute. METHODS: The beta TCP/rhBMP-2 composite was constructed by combining beta-Tricalcium phosphat (beta-TCP) that was prepared by the authors with recombinant human morphogenetic protein-2 (rhBMP-2) and was implanted into the muscle pouches in the thigh of mice. beta-TCP alone was implanted on the opposite side as controls. At intervals of 1,3,7,14 and 28 days after the implantation, the specimens were obtained, and histologic study and alkaline phosphatase assay (7,14,28 days) were performed. RESULTS: There was a large amount of cartilage and bone formation within the composite, increasing with time; whereas there was no new bone formation where beta-TCP alone was implanted. Besides, the levels of alkaline phosphatase in the beta-TCP/rhBMP-2 implants also were increasing with time and were higher than those in controls. CONCLUSIONS: The results indicate that beta-TCP/rhBMP-2 composite possesses heterotopic osteoinductive potential.

ObjectiveTo investigate whether Xiayuxue decoction exerts an anti-liver fibrosis effect by inhibiting glial cell line-derived neurotrophic factor (GDNF). MethodsA total of 24 C57BL/6 mice were randomly divided into control group, model group, and Xiayuxue decoction group. The mice in the model group and the Xiayuxue decoction group were given intraperitoneal injection of 10% CCl4, and those in the Xiayuxue decoction group were given 0.4678 g/kg Xiayuxue decoction by gavage since week 4. The liver function parameters alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured, and liver histopathology was observed. Immunohistochemistry was used to measure the protein expression of alpha-smooth muscle actin (α-SMA) and GDNF. GFP-Col-HSC and human primary hepatic stellate cells (HSCs) were treated with GDNF (10 ng/ml), and HSC activation was measured. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the control group, the model group had significant increases in the levels of ALT and AST, and compared with the model group, the Xiayuxue decoction group had significant reductions in the levels of ALT and AST (all P＜0.01). Liver histopathology showed that the model group had marked inflammatory cell infiltration and formation of fibrous septa by proliferated collagen fibers, and the Xiayuxue decoction group had loose fibrous septa and alleviated inflammatory cell infiltration. Immunohistochemistry showed that compared with the control group, the model group had significant increases in the expression of α-SMA and GDNF (both P＜0.01), which were observed in fibrous septa, and compared with the model group, the Xiayuxue decoction group had significant reductions in the expression of α-SMA and GDNF (both P＜0.05). Western blotting showed that the control group had relatively low expression of GDNF in liver tissue, the formation of liver fibrosis at week 6 of CCl4 modeling, and an around 10-fold increase in the expression of GDNF, and the Xiayuxue decoction group had significantly inhibited protein expression of GDNF (P＜0.01); there were significant increases in the expression of α-SMA and collagen type I α1 (Col1) in mice with liver fibrosis, with significant reductions in α-SMA and Col1 after treatment with Xiayuxue decoction (all P＜0.01). The in vitro experiment showed that GDNF induced the significant increases in the protein expression of α-SMA and Col1 in HSCs, which was significantly inhibited by Xiayuxue decoction (all P＜0.01). ConclusionThe expression of GDNF is significantly upregulated in the formation of liver fibrosis. GDNF can induce HSC activation, and Xiayuxue decoction can exert an anti-liver fibrosis effect by inhibiting GDNF.

Objective:To analyze the therapeutic effect of medial gastrocnemius muscle flap transfer combined with induced membrane technique in repairing anterior medial Gustilo-Anderson type ⅢB injury of the middle and upper tibia accompanied by bone defect.Methods:A retrospective case series study was conducted to analyze 21 patients with anterior medial Gustilo-Anderson type ⅢB injury of middle and upper tibia accompanied by bone defectanterior medial tibial fractures admitted to Xijing Hospital，Air Force Military Medical University from April 2017 to January 2019. There were 15 males and 6 females，with the age of （38.6 ± 7.6）years （range，18-66 years）. After admission，all patients had bone defect repair and fixation and soft tissue defect repair using membrane induction technique in the first stage. The area of soft tissue defect ranged from 8.0 cm × 6.0 cm to 16.0 cm × 12.0 cm. The length of tibial defect was （5.5 ± 1.8） cm （ranged，3.5-11.0 cm）. The size of metastasis of medial gastrocnemius flap ranged from 12.0 cm × 8.0 cm to 22.0 cm × 13.0 cm. The survival rate of muscle flap was observed. One week after the wound was stabilized，skin grafting on the surface of muscle flap was performed at second stage. The graft survival was observed. The induced membrane technique was used to reconstruct bone defects at third stage. The infection index，lower extremity functional scale （LEFS） and Mazur ankle function score were compared before and at the last follow-up. The fracture healing and related complications were observed，and the lower limb function was evaluated by Johner-Wruhs scoring system at the last follow-up.Results:All patients were followed up for 11-26 months ［（18.4 ± 5.1） months］. The muscle flap transferred survived in all patients at first stage. The skin graft survived at second stage，and the wound healing time was 1-4 weeks ［（3.1 ± 0.5）weeks］. After the surgery at third stage，the healing time of bone fracture was （8.2 ± 0.7）months （range，6-10 months）. A significantly lowered level of infection was observed at the last follow-up compared to that before operation （ P < 0.01）. The LEFS and Mazur ankle function scores of the affected limb were （52.2 ±8.9）points and （75.2 ± 13.1）points at the last follow-up，significantly higher than those before operation ［（36.0 ± 5.6）points，（53.7 ± 14.6）points］ （ P < 0.01）. The soft tissue defect was repaired satisfactorily，and the broken ends of bone defects were healed at the last follow-up. Delayed bone union occurred in 3 patients，but no infection，osteomyelitis，foot drop or other complications occurred. According to Johner- Wruhs score，18 patients were rated as excellent，2 patients as good，1 patient as fair and 0 patient as poor，with the excellent and good rate of 95%. Conclusion:For patients with anterior medial Gustilo-Anderson type ⅢB injury of the middle and upper tibia accompanied by bone defect，transfer of medial gastrocnemius head muscle flap combined with induced membrane technique can effectively repair the injured limb，reduce infection and restore partial function of the lower limb，indicating that the procedure is an effective treatment strategy with satisfactory clinical results.

Objective: To explore the therapeutic feasibility of uterus transplantation for uterine infertility. Methods: Retrospective analysis was performed for the diagnosis, treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed. The recipient was a 22-year-old woman with a congenital absence of uterus and vagina. Previously she underwent vaginal reconstruction and the donor was her mother. The specific procedures included donor/recipient screening, ethical argumentation, assisted reproductive technology of obtaining frozen embryos, Vinci robot-assisted uterine procurement, orthotopic replacement & fixation of retrieved uterus, revascularization; immunoregulation & monitoring of transplanted uterine recipient, assisted reproductive technology after transplantation and gestational management. Results: The durations of donor and recipient surgeries were 360 and 530 min respectively. No complications of recipient or donor occurred during the perioperative period. First menstruation occurred at 40 days post-transplantation and regularly thereafter. Pregnancy occurred after embryo transfer at 31 months post-transplantation. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred near gestational week 34. The boy weighed 2000 grams at birth and the mother remained well. Conclusions In conjunctions with literature review, uterine infertility may be treated by modified uterus transplantation. And a new path is paved for healthy pregnancy of women with uterine infertility.

ObjectiveTo investigate the role and mechanism of podoplanin （PDPN） in hepatic stellate cell （HSC） activation and liver fibrosis. MethodsLiver biopsy samples were collected from 75 patients with chronic hepatitis B who attended Department of Infectious Diseases， Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine， for the first time from September 2019 to June 2022， and RT-PCR and immunohistochemistry were used to measure the expression of PDPN in liver tissue of patients in different stages of liver fibrosis. A total of 12 male C57/BL6 mice were randomly divided into control group and model group. The mice in the model group were given intraperitoneal injection of 10% CCl₄， and those in the control group were injected with an equal volume of olive oil， for 6 weeks. HE staining and Sirius Red staining were used to observe liver histopathological changes； primary mouse liver cells were separated to measure the mRNA expression of PDPN in various types of cells； primary mouse HSCs were treated with PDPN protein， followed by treatment with the NF-‍κB inhibitor BAY11-708， to measure the expression of inflammatory factors in HSCs induced by PDPN. The independent-samples t test was used for comparison of normally distributed continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for further comparison between two groups. The Spearman correlation analysis was used to investigate data correlation. ResultsAs for the liver biopsy samples， there was a relatively low mRNA expression level of PDPN in normal liver， and there was a significant increase in the mRNA expression level of PDPN in liver tissue of stage S3 or S4 fibrosis （all P<0.001）. Immunohistochemical staining showed that PDPN was mainly expressed in the fibrous septum and the hepatic sinusoid， and the PDPN-positive area in S4 liver tissue was significantly higher than that in S0 liver tissue （t=8.892， P=0.001）. In normal mice， PDPN was mainly expressed in the hepatic sinusoid， and there was a significant increase in the expression of PDPN in CCl₄ model mice （t=0.95， P<0.001）， mainly in the fibrous septum. RT-PCR showed a significant increase in the mRNA expression of PDPN in the CCl₄ model mice （t=11.25， P=0.002）. Compared with hepatocytes， HSCs， Kupffer cells， and bile duct endothelial cells， hepatic sinusoidal endothelial cells showed a significantly high expression level of PDPN （F=20.56， P<0.001）. Compared with the control group， the primary mouse HSCs treated by PDPN protein for 15 minutes showed significant increases in the mRNA expression levels of the inflammation-related factors TNFα， CCL3， CXCL1， and CXCR1 （all P<0.05）， and there were significant reductions in the levels of these indicators after treatment with BAY11-7082 （all P<0.05）. ConclusionThere is an increase in the expression of PDPN mainly in hepatic sinusoidal endothelial cells during liver fibrosis， and PDPN regulates HSC activation and promotes the progression of liver fibrosis via the NF-κB signaling pathway.

Objective To investigate the therapeutic effect of Taohong Siwu decoction on a mouse model of carbon tetrachloride (CCl 4 )-induced liver fibrosis and its mechanism of action. Methods A total of 24 male C57BL/6 mice were randomly divided into normal group, model group, and Taohong Siwu decoction group, with 8 mice in each group. The mice in the model group and the Taohong Siwu decoction group were given intraperitoneal injection of 10% CCl 4 , and Taohong Siwu decoction was given by gavage since week 3 for 4 consecutive weeks. Liver function [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] was measured, and liver pathomorphology was observed. Real-time PCR was used to measure the mRNA expression of α-smooth muscle actin (α-SMA), hyaluronic acid synthase-2 (HAS-2), and collagen type Ⅰ(Col1), and Western blotting was used to measure the protein expression of α-SMA, Col1, and HAS-2. Primary hepatic stellate cells (HSCs) were isolated, and HAS-2 was silenced by siRNA to observe its influence on HSC activation. The t -test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK or least significant difference t -test was used for further comparison between two groups. Results Compared with the normal group, the model group had significant increases in serum liver function parameters (ALT, AST) and the Taohong Siwu decoction group had significant reductions in the serum levels of ALT and AST (all P < 0.01). Pathological staining showed that the model group had marked inflammatory cell infiltration and formation of fibrous septa by proliferated collagen fibers, and the Taohong Siwu decoction group had loose fibrous septa and alleviated inflammatory cell infiltration. Compared with the model group, the Taohong Siwu decoction group had significant reductions in the mRNA and protein expression of α-SMA and Col1(all P < 0.001). Compared with the normal group, the model group had a significant increase in the mRNA expression level of HAS-2 in liver tissue ( t =6.14, P < 0.05), and compared with the model group, the Taohong Siwu decoction group had a significant reduction in the protein expression level of HAS-2 (0.29±0.10 vs 1.00±0.12, t =70.73, P < 0.001). After HAS-2 was silenced by siRNA, the Si HAS-2+transforming growth factor β (TGFβ) group (treated with TGFβ) had significant reductions in the mRNA expression levels of α-SMA and Col-Ⅰ compared with the NC+TGFβ group ( P < 0.01). Conclusion Taohong Siwu decoction exerts a marked therapeutic effect on CCl 4 -induced liver fibrosis in mice by inhibiting HAS-2.