Objective To evaluate the surgical technique and clinical significance of the therapy for ankle soft tissue defect with 2 different flee perforator flaps.Methods Twenty-five cases of ankle soft tissue defect with exposed bone of the ankle were involved in this study from August 2006 to April 2012.and the wound sizes varied from 4.0 cm × 5.5 cm to 11.0 cm × 23.0 cm.Twenty cases with acrotarsium soft tissue defect were repaired by free anterolateral thigh perforator flap,five cases with pelma soft tissue defect were repaired by free saphenous artery perforator flap.Results All Twenty-five flaps survived.At 3 to 50 months follow-up [on an average of (18.0 ± 0.8) months] postoperatively,appearance of the flaps was satisfactory,with 10 to 22 mm in 2-PD,and the sensation percentage beyond S2+ was 13/20 cases and 5/5 cases at 3 months follow-up,respectively.Conclusion The optimal therapy for the acrotarsium soft tissue defect is the free perforator anterolateral thigh flap,and free saphenous artery perforator flap should be used for pelma soft tissue defect.Avoid secondary orthopaedic surgery,pay more attention to the donor site of the flap.VSD can significantly promoting the survival rates of the free perforator flaps if the soft defects are caused by open injury.

Objective To explore the clinical effects of variable angle locking plate ( VLP ) in the treatment of pediatric subtrochanteric femoral fractures. Methods Between January 2012 and November 2014, 9 pre-school children were treated at our department for subtrochanteric femoral fractures. They were 6 boys and 3 girls, with an average age of 4. 8 years ( from 4 to 6 years ) . By the Seinsheimer classification, 5 cases were of typeⅡB and 2 of typeⅡC and 2 of typeⅢA. The intervals between injury and surgery averaged 3 days ( from 2 to 5 days ) . All of them were treated with open reduction and VLP internal fixation. Results All the wounds healed well without any infection. All the stitches were removed within 12 days. They were followed up for 8 to 26 months ( average, 16 months ) . All the fractures united within 3 months after operation. Follow-ups revealed no plate or screw loosening, or refracture at the same site. According to the Beaty imaging criteria, the early outcomes were all satisfactory. At the final follow-ups, all the children gained normal gait after full-weight rehabilitation. The affected and normal hips are nearly identical in range of motion and muscle strength. All the children recovered their pre-injury status. By the Sanders scoring for function of the affected hip, 7 cases were rated as excellent and 2 as good. Conclusion VLP can be an effective option for treatment of subtrochanteric femoral fractures in preschool children patients.

With deepening understanding of surgical treatment of calcaneal fractures,clinical applications of external fixators have drawn more attention.At present,however,there has been no systematic review of such applications for intra-articular calcaneal fracture.This review collected all the recent reports available on such applications to analyze the use and clinical indications of different external fixators.Moreover,on the basis of our own clinical experience,we further proposed a novel treatment protocol for intraarticular calcaneal fractures which integrates internal and external fixation and minimally invasive techniques.

Objective To clarify the function of LIM and SH3 domain protein-1 (LASP1) and ferritin in rhBMP2-induced osteogenic differentiation of beagle bone marrow mesenchymal stem cells (BMSCs).Methods After BMSCs from 3-18-month-old C57BL/6J mice were cultured adherently for 24 hours,they were subjected to osteogenic differentiation for 7,14 and 21 days in 3 groups.BMP2 (100 μg/L) and osteogenic differentiation medium was added in the experimental group,only osteogenic differentiation medium was added in the control group,and nothing was added in the blank group.Osteoblast differentiation was determined by examining marker genes (Runx2,OSX,OCN and OPN) using qRT-PCR.The protein expression of both LASP1 and ferritin was investigated using western blotting.After LASP1 and ferritin were silenced in the cells in the experimental group after transfection of shRNA to target LASP1(m),rhBMP2-induced osteogenesis was repeated to verify the roles of LASP1 and ferritin in osteoblast differentiation.Results The qRT-PCR showed successful osteoblast differentiation in the experimental group.Western blotting verified significant down-regulation of LASP1 and up-regulation of ferritin in the experimental group.After the LASP1 gene was silenced,the expression levels of osteoblast differentiation marker genes in the experimental group were higher than those in the control group.Conclusions rhBMP2 can induce mouse BMSCs to differentiate into osteoblasts in a significant manner.Combined with our preliminary research,the present study may confirm that LASP1 and ferritin,which play an important role in regulating cytoskeleton activity and iron metabolism,are critical in the osteogenic differentiation of mouse BMSCs induced by rhBMP2.

Objective To explore the clinical technical points of the treatment of soft tissue defect of the foot and ankle with the supercharged peroneal artery perforator propeller flap,and to provide theoretical support by anatomical observation.Methods From January,2010 to February,2018,a total of 10 patients with soft tissue defect of foot and ankle were treated with supercharged peroneal artery perforator propeller flap.Cause of injury:trauma in 7 cases,wound ulcer in 1 case,and poor healing of the calcaneus incision in 2 cases.Defect site:5 cases of heel,2 cases of medial and lateral malleolus,and 3 cases of dorsum and sole.The size of flap ranged from 6.0 cm×3.0 cm to 16.0 cm×5.0 cm.All patients were followed-up at 1,3,6 months after operation,and the function recovery was judged by AOFAS Ankle Hindfood Scale at 3 months post-opertively.From November,2016 to May,2017,the anatomical basis and operative points of the supercharged peroneal artery perforator flap were summarized.Results All the 10 cases of supercharged peroneal artery perforator propeller flap survived.Two of them had local epidermal necrosis at the proximal end of the flap.After 1 to 2 weeks of dressing,they finally healed.The other 8 cases healed well.Anatomical studies showed that different planes of the supercharged peroneal artery perforator propeller flap can only reduce the compression of the double pedicles and reduce the distal necrosis rate of the flap by rotating in different rotation directions.Conclusion The supercharged peroneal artery perforator propeller flap can enhance the blood supply and venous return in the "big paddle" artery of the flap,preventing distal necrosis.

The transition metal cobalt, an essential cofactor for many enzymes in prokaryotes, is taken up by several specific transport systems. The CbiMNQO protein complex belongs to type-1 energy-coupling factor (ECF) transporters and is a widespread group of microbial cobalt transporters. CbiO is the ATPase subunit (A-component) of the cobalt transporting system in the gram-negative thermophilic bacterium Thermoanaerobacter tengcongensis. Here we report the crystal structure of a nucleotide-free CbiO at a resolution of 2.3 Å. CbiO contains an N-terminal canonical nucleotide-binding domain (NBD) and C-terminal helical domain. Structural and biochemical data show that CbiO forms a homodimer mediated by the NBD and the C-terminal domain. Interactions mainly via conserved hydrophobic amino acids between the two C-terminal domains result in formation of a four-helix bundle. Structural comparison with other ECF transporters suggests that non-conserved residues outside the T-component binding groove in the A component likely act as a specificity determinant for T components. Together, our data provide information on understanding of the structural organization and interaction of the CbiMNQO system.
Adenosine Triphosphatases ; chemistry ; Amino Acids ; chemistry ; Biological Transport ; Catalytic Domain ; Cobalt ; chemistry ; Crystallography, X-Ray ; Protein Binding ; Protein Conformation ; Protein Structure, Secondary ; Structure-Activity Relationship ; Thermoanaerobacter ; enzymology

[Objective]To study the mechanism of Luhong Formula in relieving myocardial fibrosis after myocardial infarction.[Methods]The myocardial fibrosis model after myocardial infarction was prepared by coronary artery ligation.Sixty SD rats were randomly assigned to sham operation group,model group,Luhong Formula group and Perindopril group.Each group completed the corresponding intervention for 4 weeks.Heart structure and left ventricular ejection fraction were measured by ultrasonic cardiogram.The pathological changes of cardiac fibrosis were observed by hematoxylin-eosin(HE)staining,Masson and Sirius red staining.The secretion of cardiac signal transduction and activator of transcription 3(STAT3)was analyzed by Western blot.Enzyme-linked immunosorbent assay(ELISA)was used to detect the serum levels of pro-fibrotic factor including connective tissue growth factor(CTGF),platelet reactive protein-1(TSP-1)and matrix metalloproteinase inhibitor-1(TIMP-1).[Results]Compared with model group,the intervention of Luhong Formula and Perindopril could inhibit the increase of left ventricular enddiastolic volume and left ventricular enddiastolic diameter,while the value of left ventricular ejection fraction was significantly increased(P<0.05).The effect of Luhong Formula group on improving ventricular dysdilation and increasing left ventricular ejection fraction was similar to that of Perindopril group.HE staining results showed that compared with model group,the number of abnormal cardiomyocytes in Luhong Formula group and Perindopril group was significantly reduced,the interstitial swelling was reduced,and the inflammatory cell infiltration was reduced.Masson and Sirius red staining showed that compared with model group,both Luhong Formula group and Perindopril group could reduce the degree of myocardial fibrosis after intervention.The effect of Luhong Formula group on improving the myocardial pathological changes and alleviating myocardial fibrosis was similar to that of Perindopril group.Western blot results showed that compared with model group,intervention in both Luhong Formula group and Perindopril group could significantly increase the myocardial STAT3 secretion(P<0.05),and the effect of Luhong Formula group on promoting myocardial STAT3 secretion was similar to that of Perindopril group(P>0.05).ELISA results showed that the levels of CTGF,TSP-1 and TIMP-1 in Luhong Formula group and Perindopril group were significantly lower than those in model group(P<0.05),and the inhibitory effects of CTGF,TSP-1 and TIMP-1 in Luhong Formula group were similar to those in Perindopril group(P>0.05).[Conclusion]Luhong Formula can significantly inhibit myocardial fibrosis after myocardial infarction,and its mechanism is related to up-regulating STAT3 level and inhibiting the secretion of pro-fibrotic factors CTGF,TSP-1 and TIMP-1.

According to the requirement of the national assessment for achieving the infection control criteria, 42 villages (among them,25 villages belonged to the first stratum, and 17 villages belonged to the second stratum) in 14 counties from 5 provinces, including Hunnan, Hubei, Jiangxi, Anhui and Yunnan, were selected as sampling villages for the assessment.The results from the field assessment showed that 154 out of 9 067 people were found infected with Sckistosoma japonicum, with an average infection rate of 1.7% ranged from 0.31 % to 4.10% , and only Yongping Village from Weishan County and Tenglong Village from Eryuan County were not found any case. A total of 46 out of 3 323 head of cattle were infected with S. japonicum, with an average infection rate of 1.38% ranged from 0.26% to 3.79% , and no any infected individual detected in Nanling County. No outbreak occurred in those sampling villages. Therefore, it is indicated that the five sampling provinces have reached the national criteria on infection control of schistosomiasis.

Objective To explore the effectiveness of a PBL-CBL teaching model oriented towards competency evaluation after the introduction of standardized patients in orthopedic clinical internship teaching.Methods Eighty-nine medical students undergoing orthopedic internships at our hospital from 2022 to 2023 were divided into an S-PC teaching group and a PC teaching group.Based on Milestones 2.0,a competency evaluation model for orthopedic interns was established,including six primary in-dicators:patient care,clinical knowledge and skills,interpersonal communication,and more.After the course,students were as-sessed according to the established model.Results The S-PC group showed statistically significant differences in scores for pa-tient care,clinical knowledge and skills,interpersonal communication,system-based practice,and practice-based learning com-pared to the PC group(P＜0.05),with all scores in the S-PC group being higher than those in the PC group.Conclusion In-troducing standardized patients into the PBL-CBL teaching model in clinical education significantly enhances the competency of orthopedic interns.