BACKGROUND:The treatment of infected nonunion is a difficult problem in orthopedic trauma, which needs to completely eliminate foci of osteomyelitis to control infection, repair soft tissue defect and close the wound, repairs bone defects to promote healing and protect limb function as much as possible. Autogenous micromorselized bone can be easily obtained and recombinant human bone morphogenetic protein-2 has variety of sources. Their mixed grafting mode is safe and reliable in repairing of bone defects, which are suitable for repair of infected nonunion. ＜br> OBJECTIVE:To study the operating method and clinical results of repairing infected nonunion using autogenous micromorselized bone grafting mixed with bone morphogenetic protein-2. ＜br> METHODS:Twenty-three cases underwent infected nonunion repair with autogenous micromorselized bone (l ium, long bone metaphyseal cancellous bone) mixed with bone morphogenetic protein-2, including 7 cases of femoral bone defect caused by osteomyelitis after debridement and external fixation and 16 cases of tibial bone infected nonunion. Eleven of 23 cases continued to use the external fixation because of scar contraction or poor conditions of soft tissue, and the other 12 cases switched to use internal fixation. X-tray was taken to evaluate the bone healing at the 1st, 3rd, 6th and 12th months after operation. The function of the affected extremity was assessed by Johner-Wruhs grade. ＜br> RESULTS AND CONCLUSION:Al of the cases were averagely fol owed up for 13.4 months. The bone defects and bone fracture healed in al cases without infection, and the wounds were al sealed. The excellent and good rate according to Johner-Wruhs grade was 95%. These findings indicate that the bone grafting mode of autogenous micromorselized bone mixed with bone morphogenetic protein-2 is characterized as variety of sources, high safety and reliable osteogenic ability in repair of bone defects.

Aim To test the skin healing and repairing efficacy and the mechanism of Hibiscus rosa-sinensis L bud extract by using the animal models. Methods KM mice were randomly divided into three groups:the model group, the positive control group, and the n-bu-tyl alcohol extract ( HrBN) group. Using the boils and carbuncles model, the healing condition of all the animals were observed. KM mice were kept in the SPF condition room and divided into five groups: the model group, the positive control group, and the low, middle, high dose groups. Using the full-thickness loss model, the repairing results of all the mice were ob-served. Through the antimicrobial test, the results of MIC and inhibition zone were obtained. The carbon clearance test was used to collect the blood at the time 5min and 15min, and get the liver and spleen, and the results of K andαwere obtained. Results In vivo ex-periments showed there was significant difference be-tween groups;the HrBN extract had the outstanding ef-ficacy in healing and repairing skin boils and full-thickness loss models. It had higher recovery rate than other ethanol extract, such as ethyl acetate extract and chloroform extract. In vitro experiments showed that the HrBN extract, ethyl acetate extract ( HrBE) ,AB-8 macroporous resin 30% alcohol part and 60% alcohol part had obvious antimicrobial efficacy. The carbon clearance test showed HrBN had a good effect in im-proving immune function, and it can increase the K and α. Conclusion HrBN in animal models exerts good skin healing and repairing efficacy, which might be related to its antibacterial activity and immunologic enhancement function.

Objective To observe the influence of nursing intervention on heart function and emotion in elder patients with chronic heart failure(CHF)based on "Timing It Right".Methods A total of 100 elder patient with CHF in Nanyang City Center Hospital from January 2016 to January 2017 were recruited,and divided into control group and observation group by random number table method,with 50 cases in each group.The control group received routine care and follow-up,while the observation group received routine care and nursing intervention base on "Timing It Right" for 12 weeks.The heart function and emotion were compared between those two group at before and after nursing intervention by LVEF％,NT-proBNP,heart output and Chinese version of Brief Profile of Mood States(BPOMS).Results The patients' heart function and emotion of both groups improved after intervention.After intervention,the LVEF％,NT-proBNP and heart output of the observation group were(59.65±2.29)％,(249.21±58.79)ng/L and(5.72±1.10)L/min,the differences compared with the control group were statistically significant(t=-28.473,8.473,-5.505;P < 0.05).The total score of BPOMS of the control group and the observation group was(25.55±4.41)and(22.62±5.40)respectively(t=2.878,P<0.05).Conclusions Nursing intervention based on "Timing It Right" can improve patient's heart function and emotion in elderly patients with CHF,which has better effect then routine nursing intervention.

Objective:To analyze the value of peritumoral vascular invasion (PVI) on the prognosis of patients with osteosarcoma.Methods:A total of 232 patients with primary osteosarcoma from 2007 to 2016 were retrospectively analyzed, including 142 males and 90 females. The average age was 17.9±8.2 years (range, 3-39 years). There were 22 positive and 210 negative cases of PVI, 94 deaths and 138 survivals. Univariate survival analysis (Log-rank test and univariate Cox regression) was used to evaluate the effects of age, gender, PVI status, tumor location, surgical method, sensitivity to chemotherapy, and chemotherapy regimen on the prognosis of osteosarcoma. The indicators with statistically significant differences were included in the multivariate Cox regression model to finally determine the risk factors affecting the prognosis of osteosarcoma. The relationship between PVI status and 5-year survival and the incidence of recurrence or metastasis was evaluated using the Kaplan-Meier method.Results:All patients were followed up for 7.6±4.5 years (range, 0.1-15 years). The differences in sensitivity to chemotherapy (χ 2=9.52, P=0.002), choice of chemotherapy regimen (χ 2=8.87, P=0.012), choice of surgical modality (χ 2=13.50, P<0.001), tumor metastasis rate (χ 2=8.51, P=0.004) and mortality rate (χ 2=5.39, P= 0.020) of PVI positive group and PVI negative group had statistically significant differences. Univariate survival analysis was performed on 232 patients with osteosarcoma (gender, age, PVI status, site of tumor development, surgical modality, sensitivity to chemotherapy, and chemotherapy regimen). Indicators with statistically significant differences were included in a multifactorial Cox regression model. The results showed PVI positive [5-year survival rate: HR=2.02, 95% CI (1.61, 2.79), P=0.010; 5-year recurrence or metastasis rate: HR=2.25, 95% CI (1.55, 3.14), P<0.001], surgical procedure as amputation [5-year survival rate: HR=1.22, 95% CI (0.94, 1.78), P=0.037; 5-year recurrence or metastasis rate: HR=1.58, 95% CI (1.11, 2.23), P=0.026] and poor sensitivity to chemotherapy [5-year survival rate: HR=2.71, 95% CI (1.84, 3.98), P=0.001; 5-year recurrence or metastasis rate: HR=2.52, 95% CI (1.88, 3.45), P<0.001] was associated with poor prognosis. Kaplan-Meier curve showed that the 5-year survival rate of PVI positive group was 34%, which was lower than 68% of PVI negative group. The 5-year recurrence or metastasis rate was 72% in the PVI negative group, which was significantly higher than 38% in the PVI negative group ( P<0.05). Conclusion:The 5-year survival rate of PVI positive group was lower than that of PVI negative group, and the 5-year recurrence or metastasis rate was higher than that of PVI negative group. The presence of microvascular angiosarcoma plugs infiltrating the peritumoral tissue in surgical specimens of osteosarcoma after neoadjuvant chemotherapy is a useful indicator to assess the prognosis of patients with osteosarcoma.

Objective To explore the imaging features, clinical outcome, and prognosis of indeterminate pulmonary nodules (IPN) in patients with high-grade soft tissue sarcoma. Methods A retrospective study of 82 patients with high-grade soft tissue sarcoma who have IPNs. The clinical characteristics, imaging features of IPN, and survival of patients were analyzed with statistical software. Results The IPN size of 82 patients was 6.453±0.864 mm. IPN diameter, shape, density, and nodule discovery interval may be CT imaging features related to malignancy tendency. Age (HR=1.047, 95%CI: 1.007-1.088) and interval between each nodule discovery (HR=3.194, 95%CI: 1.052-9.694) are independent factors that affect the survival of patients with malignant IPN. Conclusion The imaging features of chest CT may provide important guidance for determining the nature and survival prognosis of benign and malignant nodules.

Objective:To explore the incidence, clinical characteristics, imaging features, clinical outcome and prognosis of indeterminate pulmonary nodules (IPN) in patients with osteosarcoma.Methods:A total of 69 patients of osteosarcoma with IPN in lung treated in the Bone tumor Center of Eastern Theater General Hospital from January 2011 to January 2021 were collected retrospectively, there were 47 males and 22 females, with a median age of 19 years old (range 7-60 years old). The clinical characteristics including disease-free interval, the chemotherapy response, with recurrence/non-pulmonary, IPN presence before / during / after chemotherapy and imaging features of IPN including number of IPN, location of IPN, density of IPN, boundary clarity of IPN and outcome. The patients were divided into the metastasis pulmonary nodules group and the benign nodules group according to the final outcome of IPN. Further, χ 2 test was performed for comparison of the clinical and imaging characteristics between the two groups. The survival of patients was counted and the correlation between single factor and survival was compared by Kaplan-Meier test, and multivariate survival analyses were performed using Cox proportional hazards regression models. Results:Sixty-nine cases occurred IPN in 211 patients with osteosarcoma, with an incidence of 32.7%. Of the 69 patients, 45 patients (65.2%) with IPN were diagnosed as metastases, and 24 patients (34.8%) with IPN were diagnosed as benign nodules. Follow-up length ranged from 1 to 124 months, with the median follow up time 43 months. To the end of follow-up, 41 patients (59.4%) remained alive and 28 patients (40.6%) had died. The median survival time was 41.0 (20.0, 65.0) months and the median survival time after diagnosis of IPN was 25.0 (10.0, 43.0) months. There were significant differences in lung nodule density ( P<0.001), boundary ( P=0.002), history of recurrence/extra-pulmonary metastasis ( P=0.023) and chemotherapeutic effect ( P<0.001) between the metastasis pulmonary nodules group and the benign nodules group. Multivariate survival analysis showed that chemotherapeutic effect was an independent factor affecting the overall survival of patients [ HR=0.048, 95% CI (0.01, 0.26)]. Boundary definition [ HR=0.12, 95% CI (0.02, 0.93)] and chemotherapeutic effect [ HR=0.06, 95% CI (0.01, 0.29)] were independent factors influencing survival after diagnosis of IPN. Conclusion:Osteosarcoma patients with IPN have a poor prognosis. The poor effect of chemotherapy is an independent risk factor for the overall survival time of those patients and the survival time after diagnosis of IPN. The boundary definition of IPN is an independent risk factor for the survival time after diagnosis of IPN.

Hydrogels/therapeutic use* ; Tissue Engineering ; Gelatin ; Intervertebral Disc/surgery* ; Methacrylates ; Tissue Scaffolds