Objective: To summarize the related research results of open wedge high tibial osteotomy (OWHTO) complicated with lateral hinge fracture. Methods: To review the relevant literature of OWHTO at home and abroad in recent years and summarize and analyse the clinical experience. Results: The lateral hinge rupture may occur during the OWHTO, which may lead to the loss of correction angle after operation, delayed healing or non-union of osteotomy and so on. The lateral hinge plays an important role in the stability of the osteotomy. During the operation, the "safe zone" internal osteotomy can be used to protect the bone. Once the lateral hinge breaks, the TomoFix plate can be used to obtain the sufficient stability. For patients with lateral hinge rupture, functional exercise and full weight loading time should be guided by hinge breakage classification. Conclusion: The intact lateral hinge is beneficial to the healing and rehabilitation of OWHTO. The lateral hinge should be paid enough attention by clinicians.

With the aging of population, cerebral small vessel disease has attracted more and more attention. A growing body of literature has confirmed that retinal vascular changes can be used as a potential marker for the prediction of cerebral small vessel disease. The retina is recognized as a window into cerebrovascular and systemic vascular conditions. Combining traditional fundus photograph and fundus fluorescein angiography with optical coherence tomography angiography, the retinal vascular system of patients with cerebral small vessel disease can be comprehensively analyzed. This paper summarizes and analyzes the application of retinal angiography technology in different image types of cerebral small vessel disease and makes a review, in order to provide reference for the early diagnosis and prevention of cerebral small vessel disease.

Objective:To explore the clinical mechanism of PD-1 and VEGFR2 inhibitors combined in intervening the progression of colon cancer liver metastasis.Methods:120 patients with colon cancer liver metastasis from Feb. 2021 to Dec. 2022 were selected as research subjects. According to the treatment plan, patients were divided into control group ( n=60) and observation group ( n=60). The control group received PD-1 inhibitor treatment, while the observation group received combination of PD-1 inhibitor and VEGFR2 inhibitor treatment. Tumor vascular density and permeability were evaluated by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). The expression of PD-1 and VEGFR2 proteins were analyzed through protein blot. The levels of serum inflammatory factors IFN - γ, TNF - α, and IL-12 in patients before and after intervention were detected using ELISA. The tumor control effects between the two groups of patients were compared. The average overall survival and average progression free survival between the two groups of patients were compared. Results:Before intervention, there was no statistically significant difference in vascular permeability or density between the observation group and the control group patients; After 6 weeks of intervention, the vascular permeability and density of patients in the observation group decreased compared to the control group. There were no significant changes in vascular permeability or density in the control group before and after intervention. Before intervention, there was no statistically significant difference in the expression of PD-1 or VEGFR2 proteins between the observation group and the control group; P>0.05; After 6 weeks of intervention, the expression of PD-1 and VEGFR2 proteins in both groups of patients decreased compared to that before intervention. The expression of PD-1 and VEGFR2 proteins in the observation group decreased compared to that of the control group (PD-1: 1.04±0.02 vs. 1.30±0.04; VEGFR2: 1.12±0.01 vs. 1.57±0.16) ; P<0.05. Before intervention, there was no statistically significant difference in serum levels of IFN - γ, TNF - α, or IL-12 between the observation group and the control group; After 6 weeks of intervention, the serum levels of IFN - γ, TNF - α, and IL-12 in both groups of patients increased compared to those before intervention. However, the observation group showed a more significant increase in IFN - γ, TNF - α, and IL-12 levels compared to the control group (IFN - γ: 38.44±3.28 pg/mL vs. 27.55±2.63 pg/mL; TNF - α: 44.62±2.15 pg/mL vs. 30.57±2.09 pg/mL) ; IL-12: 33.49±2.51 pg/mL vs. 20.75±1.86 pg/mL; P<0.05). In the control group, there were 8 cases of partial tumor remission, 14 cases of stable tumor phase, and 22 cases of effective tumor control. In the observation group, there were 17 cases of partial tumor remission, 24 cases of stable tumor phase, and 41 cases of effective tumor control. PR, SD, and DCR in the observation group were higher than those in the control group, and the difference was statistically significant ( P<0.05). The average overall survival and mean progression free survival of the observation group were longer than those of the control group. Conclusions:Combined treatment with PD-1 and VEGFR2 inhibitors significantly improves tumor control and survival in patients with colon cancer liver metastases. By reducing tumor vessel density and permeability, enhancing immune responses, and reducing immune evasion of tumor cells, the combined intervention provides a more effective clinical strategy for the treatment of colon cancer liver metastases.

Objective:To investigate the relationship between enlarged perivascular space (EPVS) and retinal vessel abnormalities in transient ischemic attack (TIA) and mild stroke patients.Methods:TIA and mild cerebral infarction (National Institutes of Health Stroke Scale score≤3) patients were enrolled from March to August 2019 in Changzhou Second People′s Hospital. Magnetic resonance imaging and retinal fundus photography were performed in all patients. Retinal arteriovenous diameter was semi-automatically measured, and retinal arteriosclerosis grades, vascular curvature, hemorrhages, microangioma, hard exudation, soft exudation, arteriovenous nicking and venous beads were assessed. Patients were divided into two groups according to the existence of EPVS: EPVS group and non-EPVS group. The baseline data of the two groups were compared and further multivariate Logistic regression was carried out. After normal transformation of the number of EPVS, the correlation between the grades of EPVS and converted EPVS was analyzed. The relationship between the number of converted EPVS and the grades and retinal fundus vascular lesions was further analyzed.Results:A total of 123 patients were included, including 99 patients with cerebral infarction, 24 patients with TIA; 52 patients without EPVS and 71 patients with EPVS. The EPVS group was more than the non-EPVS group in age ((68.61±12.71) years and (63.37±13.53) years, t=-2.198, P=0.030), history of hypertension (52 (73.2%) and 25 (48.1%), χ 2=8.118, P=0.004), hemangioma (17 (23.9%) and 5 (9.6%), χ 2=4.196, P=0.041), arteriovenous nicking (50 (70.4%) and 8 (15.4%), χ 2=36.488, P<0.05) and arteriosclerosis grades (1 (1, 2) and 0 (0, 1), Z=-7.454, P<0.05), and less than the non-EPVS group in central retinal artery equivalent (CRAE; (106.31±15.02) mm and (113.89±11.86) mm, t=3.014, P=0.003) and arteriole-to-venule ratio (AVR; 0.54±0.07 and 0.59±0.05, t=4.553, P<0.05). Multivariate Logistic regression analysis showed arteriosclerosis grades ( OR=7.781, 95 %CI 2.876-21.055, P<0.05) and hypertension ( OR=3.203, 95 %CI 1.049-9.777, P=0.041) were related factors for EPVS. Adjusting for age, sex, hypertension and diabetes, the normally transformed EPVS was found positively correlated with arteriovenous nicking ( B=0.556, 95 %CI 0.203-0.910, P=0.003) and arteriosclerosis grade ( B=0.417, 95 %CI 0.259-0.576, P<0.05), and negatively correlated with AVR ( B=-4.213, 95 %CI-6.712--1.714, P=0.001). The grades of EPVS were positively correlated with arteriosclerosis ( r=0.764, P<0.05), and negatively correlated with CRAE ( r=-0.287, P<0.05) and AVR ( r=-0.422, P<0.05). Conclusions:Hypertension and retinal arteriosclerosis are related factors of EPVS in mild stroke and TIA patients. EPVS is correlated with retinal vessel abnormalities. The more serious of EPVS is, the more serious of retinal arteriosclerosis is, the higher ratio of arteriovenous nicking is, the smaller of CRAE and AVR are.

Objective:To investigate the relationship between renal function and the total cerebral small vessel disease(CSVD)score in elderly patients with a mild stroke.Methods:Patients with a mild stroke(National Institutes of Health Stroke Scale score≤3)and aged 60 years and above hospitalized in our hospital from March to December 2019 were consecutively enrolled.Total CSVD scores were evaluated based on enlarged perivascular spaces, cerebral microbleeds, white matter hyperintensities of presumed vascular origin and lacunes of presumed vascular origin.The estimated glomerular filtration rate(eGFR)was derived by using the formula of chronic kidney disease epidemiology collaboration based on serum creatinine(CKD-EPI Scr). The relationship between eGFR and the total CSVD score was analyzed. Results:Of the 152 patients enrolled, 35, 38, 39, 28 and 12 had total CSVD scores of 0, 1, 2, 3 and 4, respectively.The age of patients increased and eGFR decreased with the increase of total CSVD scores(CSVD from 0 to 4, [(67.43±6.59), (68.42±6.83), (72.18±7.94), (76.46±7.75) vs.(79.92±6.17)years old, F=12.018, P<0.001]; [(92.94±12.45)ml·min -1·1.73m -2, (90.52±8.62)ml·min -1·1.73m -2, (89.45±8.48)ml·min -1·1.73m -2 and(83.90±7.19)ml·min -1·1.73m -2vs.(79.16±7.77)ml·min -1·1.73m -2, F=7.210, P<0.001]. Spearman correlation analysis showed that eGFR was negatively correlated with the total CSVD score( r=-0.399, P<0.001). After adjusting for risk factors including age, gender and hypertension, multivariate ordinary regression analysis showed that decreased eGFR was an independent risk factor for the total CSVD score( OR=0.957, 95% CI: 0.924-0.990, P=0.012). Conclusions:In elderly patients with a mild stroke, eGFR is an independent risk factor for the total CSVD score, which shows an increased burden as eGFR decreases.

Objective:To evaluate the clinical effect of striated free wrist transverse flap pedicled with superficial palmar branch of radial artery carrying sensory nerve in repairing pulp defect of middle-and-distal segments of fingers.Methods:From February 2019 to March 2021, the data of 20 patients with defects of middle-and-distal finger segment were collected. The defects were repaired with striated free wrist transverse flaps pedicled with superficial palmar branch of radial artery. The defects sized were 2.0 cm×1.5 cm-4.0 cm×1.5 cm, and the flaps sized were 2.5 cm×2.0 cm-4.5 cm×2.0 cm. The flap carried metacarpal cutaneous branch of median nerve for the reconstruction of the sensation of finger pulps. The donor sites were directly sutured. After operation, the patients were evaluated according to the shape, sensation and functional recovery of the repaired fingers through outpatient visits and reviews via WeChat.Results:All 20 flaps survived and the wounds healed well. All patients entered regular follow-up for 6-12(average, 8) months. The colour of the flaps was close to the finger skin, without bloating flaps. The flaps were soft in good shapes and function. TPD were 6-11 mm, at 8 mm in average. The scars at the donor sites were hidden and the wrist function was not affected. According to the Trial Evaluation Standard of Upper Limb Function of Hand Surgery Society of Chinese Medical Association, 16 patients were classified as excellent and 4 as good.Conclusion:The striated transverse wrist flap with radial artery palmar superficial branch and sensory nerve offers many advantages, such as a good texture, hidden donor site, convenient flap harvesting, good recovery of sensation, etc. More clinical studies and the promotion of the technique are expected.

Objective To investigate the correlations of postoperative serum levels of soluble CD40 ligand(sCD40L)and CC-chemokine ligand 3(CCL3)with postoperative deep venous throm-bosis(DVT)in patients with multiple rib fractures.Methods A total of 110 patients with multiple rib fractures were selected as the study subjects and divided into non-DVT group(n=79)and DVT group(n=31)based on the occurrence of postoperative DVT.Enzyme-linked immunosorbent assay was used to determine the expression levels of serum sCD40L and CCL3.Pearson correlation analysis was employed to analyze the correlations of serum sCD40L,CCL3 with coagulation function indicators.Logistic regression analysis was conducted to identify the influencing factors of postoperative DVT in pa-tients with multiple rib fractures.Receiver operating characteristic(ROC)curves were plotted to eval-uate the predictive value of serum sCD40L and CCL3 for postoperative DVT.Results The expres-sion levels of serum sCD40L and CCL3 in the DVT group were significantly higher than those in the non-DVT group(P＜0.05).There were statistically significant differences in D-dimer,prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)between the two groups(P＜0.05).In the DVT group,serum levels of sCD40L and CCL3 were positively correlated with D-dimer and FIB,and negatively correlated with PT,TT and APTT(P＜0.05).D-dimer,PT,APTT,FIB,sCD40L and CCL3 were identified as influencing factors for postoperative DVT in patients with multiple rib fractures(P＜0.05).The area under the curve(AUC)of serum sCD40L and CCL3 alone for predicting postoperative DVT in patients with multiple rib fractures was 0.753 and 0.754,respectively,which was significantly smaller than 0.863 of their combined prediction(P＜0.05).Conclusion Postoperative DVT in patients with multiple rib fractures is associated with high levels of serum sCD40L and CCL3,which have certain predictive value for postoperative DVT.

Objective To investigate the correlations of postoperative serum levels of soluble CD40 ligand(sCD40L)and CC-chemokine ligand 3(CCL3)with postoperative deep venous throm-bosis(DVT)in patients with multiple rib fractures.Methods A total of 110 patients with multiple rib fractures were selected as the study subjects and divided into non-DVT group(n=79)and DVT group(n=31)based on the occurrence of postoperative DVT.Enzyme-linked immunosorbent assay was used to determine the expression levels of serum sCD40L and CCL3.Pearson correlation analysis was employed to analyze the correlations of serum sCD40L,CCL3 with coagulation function indicators.Logistic regression analysis was conducted to identify the influencing factors of postoperative DVT in pa-tients with multiple rib fractures.Receiver operating characteristic(ROC)curves were plotted to eval-uate the predictive value of serum sCD40L and CCL3 for postoperative DVT.Results The expres-sion levels of serum sCD40L and CCL3 in the DVT group were significantly higher than those in the non-DVT group(P＜0.05).There were statistically significant differences in D-dimer,prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)between the two groups(P＜0.05).In the DVT group,serum levels of sCD40L and CCL3 were positively correlated with D-dimer and FIB,and negatively correlated with PT,TT and APTT(P＜0.05).D-dimer,PT,APTT,FIB,sCD40L and CCL3 were identified as influencing factors for postoperative DVT in patients with multiple rib fractures(P＜0.05).The area under the curve(AUC)of serum sCD40L and CCL3 alone for predicting postoperative DVT in patients with multiple rib fractures was 0.753 and 0.754,respectively,which was significantly smaller than 0.863 of their combined prediction(P＜0.05).Conclusion Postoperative DVT in patients with multiple rib fractures is associated with high levels of serum sCD40L and CCL3,which have certain predictive value for postoperative DVT.

Objective:To investigate the clinical effects of free superficial circumflex iliac artery (SCIA) superficial branch perforator flap combined with full-thickness skin graft far from the flap donor site in repairing the large wounds in extremities.Methods:The study was a retrospective observational study. From January 2020 to June 2022, 19 patients with large wounds in extremities who met the inclusion criteria were admitted to the First Affiliated Hospital of Bengbu Medical College, including 15 males and 4 females, aged 28-75 years. The debridement, fracture reduction and fixation, tendon, vessel, and nerve repair, and vacuum sealing drainage were performed in the first stage surgery. After debridement in the second stage surgery, the total wound area was 13.0 cm×8.0 cm-34.0 cm×15.0 cm. The tendon and bone exposed wound with area of 9.0 cm×6.0 cm-14.0 cm×7.0 cm was repaired with free SCIA superficial branch perforator flap with area of 10.0 cm×6.5 cm-15.0 cm×8.0 cm. The remaining granulation tissue wound with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm was repaired with full-thickness skin graft far from the flap donor site with area of 5.0 cm×3.5 cm-13.0 cm×8.0 cm. All the wounds in donor site were sutured. The operation time and amount of bleeding of patients during the surgery were recorded, the survival of flap and skin graft were observed after surgery. During follow-up, the flap and skin graft, scar in the donor site and its effect on donor site function were observed. At the last follow-up, the satisfaction of patients with the efficacy was evaluated by the efficacy satisfaction rating score.Results:The operation time of patients was 2.0-3.5 h. The amount of bleeding of patients during the surgery was 100-320 mL. One patient had ecchymosis and venous crisis in the edge of flap on the second day after surgery, and the flap survived after exploration. The flaps of the other patients survived smoothly. The skin grafts of patients all survived smoothly. Two patients had bloated flaps due to obesity in the later stage, and the expected results were achieved after flap thinning surgery 6 months after operation. During the follow-up of 6 to 24 months, the flaps had good elasticity and soft texture, and the skin grafts had no wear or ulceration; linear scars were left in all the donor sites but their functions were not affected. The patients were all satisfied with the efficacy.Conclusions:Free SCIA superficial perforator flap combined with full-thickness skin graft far from the donor site was used to repair the large wounds in extremities, which was safe, reliable, and less traumatic and short in operation time, and resulted in good postoperative appearance and function in the donor sites and recipient sites.

Objective:To explore the clinical effect of a modified surgical procedure for replantation of severed digit-tips in Tamai zones I-II.Methods:From November 2019 to October 2022, the Department of Hand and Foot Microsurgery of the First Affiliated Hospital of Bengbu Medical College employed a modified procedure (to abandon the anatomically labelling of blood vessels and nerves after naked-eye debridement and fracture fixation, then perform the microscopic dissections and anastomoses of blood vessels and nerves, and the anastomosis of dorsal veins though an auxiliary small incision by the lateral nail fold of the severed digit-tip) to replant severed digit-tips in Tamai zones I-II of 26 patients (29 digits). The patients were 20 males (23 digits) and 6 females (6 digits), aged 3-66 years old, with mean age at 28 years old. Nineteen digit-tips were severed in Tamai zone I and 10 in Tamai zone II. The severed digit-tips were 7 of thumbs, 9 of index fingers, 5 of middle fingers, 5 of ring fingers and 3 of little fingers. Causes of injury were 12 of cut, 8 of crush and 6 of avulsion. Postoperative management included infection prevention, antispasmodic for 3 days and keeping in bed for 5 days. The time of surgery was recorded on all patients. Postoperative follow-ups were conducted at outpatient clinics for 6 to 12 months to observe the survival of digit-tips and the appearance, recovery of sensation and motor functions, strength of digits and patient satisfaction.Results:(1)The surgical time was about 1.0 hour for replantation of a severed digit-tip in Tamai zone I, while it took about 1.5 hours for those in Tamai zone II. (2)Survival rate and appearance: all 29 replanted digit-tips survived, except 2 in Tamai zone I which encountered venous occlusion and survived after small incision for bloodletting. Twenty-two digit-tips gained pulp fat pads with full digit pulps. Four avulsed digit-tips had mild atrophy of pulp. The 15 digit-tips severed in Tamai zone I were about 2 mm shorter than the healthy sides, but without deformity. One digit-tip had poor nail appearance due to preoperative fungal infection of nail bed. (3)Sensory recovery: with the British Medical Research Council (BMRC), 23 digit-tips recovered to S 3+, and 2 digit-tips of avulsion and 1 digit-tip of crush recovered to S 3. TPD of the replanted digit-tips were: 4-7 mm in those of cut injury; 6-8 mm in those of crush and 9-11 mm in those of avulsion. (4)Motion and digit strength: results of functional assessment according to the total active mobility standard promoted by China's Society for Surgery of the Hand were: 21 cases of excellent and 5 of good, without pain in digit pulp when pinching and griping. The mobility of the digits with replanted digit-tips of both Tamai zones I and II were close to that of the healthy sides. The motions of the digits with replanted digit-tips in Tamai zone I were close to the healthy sides and the 5 of those in Tamai zone II had 0° in extension and 2°-3° in flexion, due to the severed plane at distal interphalangeal joint. (5)Patient satisfaction: 25 patients were satisfied, however 1 patient was dissatisfied to the poor function of the distal interphalangeal joint due to the severed thumb-tip in Tamai zone II. Conclusion:Modified replantation procedure for severed digit-tip in Tamai zones I-II has significant achievement in cutting down the surgical time through a modified procedure of debridement and fracture fixation (tendon suture) by naked-eyes operation first, followed by dissections and anastomoses of the blood vessels and nerves under the surgical microscope. The auxiliary small incision by the lateral nail fold of digit-tip in Tamai zone I facilitates an exposure of a constant, healthy lateral nail fold vein. It enables the anastomosis with a high-quality vein, hence improves the success rate of replantation. The appearance and function of the replanted digit-tip are found better in the severed digit-tips of cut injury than those with injuries of avulsion and crush.