Thoracoscopic mitral valve replacement is a common minimally invasive cardiac surgery procedure. However, small annulus, severe calcification of the annulus, and severe thickening of the posterior valve leaflet or sub valvular structure are the difficulties of thoracoscopic mitral valve replacement. Improper treatment can easily lead to left ventricular rupture or prosthesis-patient mismatch. This paper reports a thoracoscopic mitral bioprosthesis replacement case using the chimney technique in Guangdong Provincial People's Hospital and summarizes its operating key points. The patient was a 68-year-old female, weighing 36 kg. The preoperative diagnosis was rheumatic mitral stenosis and atrial fibrillation, the preoperative transthoracic echocardiogram showed the left ventricular end-diastolic diameter was 39 mm. The surgical effect was satisfactory. The patient was in good condition at the follow-up 2 months after the operation.

OBJECTIVE: To compare the effectiveness of clavicular hook plate fixation in the treatment of acromioclavicular joint dislocation and distal clavicle fractures. METHODS: A clinical data of 90 patients, who underwent clavicular hook plate fixation between January 2014 and June 2023, was retrospectively analyzed. There were 40 patients with distal clavicle fractures (fracture group) and 50 with acromioclavicular joint dislocations (dislocation group). There was no significant difference in the baseline data of gender, age, cause of injury, side of injury, time from injury to operation, and constituent ratio of osteoporosis patients between the two groups ( P>0.05). The time to remove the internal fixators and the occurrence of complications were recorded. Before removing the internal fixator and at 3 months after removing, the visual analogue scale (VAS) score was used to evaluate the degree of pain, and the mobility of the shoulder joint in forward flexion, elevation, and abduction was measured. Before removing the internal fixators, the Constant-Murley score and the University of California, Los Angeles (UCLA) score were used to evaluate the function of the shoulder joint. X-ray films of the shoulder joint were taken during follow-up to observe the occurrence of subacromial osteolysis, acromioclavicular joint osteoarthritis, and distal clavicle bone atrophy. Subgroup comparison was conducted between patients with and without subacromial osteolysis in the two groups. RESULTS: All incisions healed by first intention in both groups. All patients were followed up 1-9 years, with a median of 5 years; the difference in follow-up time between the two groups was not significant ( P>0.05). During follow-up, subacromial osteolysis occurred in 74 cases, including 41 cases of typeⅠand 33 cases of type Ⅱ, distal clavicle bone atrophy in 15 cases, and acromioclavicular joint osteoarthritis in 8 cases. There were significant differences in the removal time of internal fixators, the incidence of bone atrophy, and the incidence of osteoarthritis between the two groups ( P<0.05). There was no significant difference in the incidence of subacromial osteolysis ( P>0.05). Before removing the internal fixators, there was no significant difference in VAS score, UCLA score, and Constant-Murley score between the two groups ( P>0.05), while there were significant differences in shoulder joint range of motion in all directions ( P<0.05). After removing the internal fixators, only the difference in elevation was significant ( P<0.05). Within the group comparison, the VAS score and mobility of shoulder joint in abduction and elevation after removing the internal fixators were significantly superior to those before removing ( P<0.05). In the fracture and dislocation groups, there was only a significant difference in plate length between the subgroup with and without subacromial osteolysis ( P<0.05), while there was no significant difference in the above other indicators ( P>0.05). CONCLUSION Clavicular hook plate is a good choice for treating acromioclavicular dislocation or distal clavicle fractures, but the incidence of subacromial osteolysis is higher, and the degree of bone resorption is more severe in fracture patients. After removal of the internal fixator, the shoulder functions significantly improve. It is recommended to remove the internal fixator as soon as possible within the allowable range of the condition.
Humans ; Clavicle/surgery* ; Acromioclavicular Joint/surgery* ; Bone Plates ; Fracture Fixation, Internal/instrumentation* ; Fractures, Bone/surgery* ; Male ; Retrospective Studies ; Female ; Adult ; Middle Aged ; Treatment Outcome ; Joint Dislocations/surgery* ; Aged ; Range of Motion, Articular ; Young Adult ; Postoperative Complications

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective To discuss the regulatory mechanism of nucleotide-binding oligomerzation domain 2(NOD2)/receptor interacting protein 2(RIP2)signaling pathway on inflammatory activation of macrophages in intestinal mucosa and provide experimental evidence for intestinal mucosal inflammation caused by bacterial products.Methods Using the THP-1 monocyte cell line,macrophages were stimulated with muramyl dipeptide(MDP)at varying concentrations and durations.mRNA and protein expression levels of NOD2 and RIP2 were detected.The secretion levels of tumor necrosis factor(TNF)-α and interleukin(IL)-1β in the cell culture supernatant were measured.The most effective siRNA targeting RIP2 and optimal transfection concentration were screened,and the impact of RIP2 gene silencing on MDP-induced inflammatory activation of macrophages was observed.Results After silencing the RIP2 gene,MDP induced a significant decrease in TNF-α and IL-1βsecretion in macrophages,but the changes in cell phenotype were not significantly affected.Conclusion This study revealed the important role of NOD2/RIP2 signaling pathway in inflammatory activation of macrophages,and it is possible to effectively inhibit inflammatory activation of macrophages by interfering with this signaling pathway.

Objective·To preliminarily investigate the regulatory effect and underlying mechanism of fibroblast growth factor 2(FGF2)on R-spondin 1(Rspo1)expression in CD34+CD81+stromal cells from the mouse colon.Methods·Colonic CD45-CD326-CD31-GP38+CD81+Rspo1-tdTomato+stromal cells were sorted from Rspo1-tdTomato reporter mice by flow cytometry and subsequently cultured in vitro.The expression of surface protein markers was evaluated by flow cytometry after 14 d of culture.qPCR was employed to quantify Rspo1 expression in response to stimulation with FGF2,FGF9,epidermal growth factor(EGF),platelet-derived growth factor-bb(PDGF-bb),insulin-like growth factor 1(IGF1),or hepatocyte growth factor(HGF).RNA sequencing and bioinformatic analyses were used to identify the signaling pathways underlying FGF2-mediated regulation of Rspo1,followed by preliminary validation with pathway-specific inhibitors and qPCR.Results·After 14 d of culture,the sorted colonic stromal cells retained expression of CD34,CD81,and glycoprotein GP38,while remaining negative for other lineages markers CD45,CD326,and CD31.qPCR revealed that 20 ng/mL FGF2 significantly suppressed Rspo1 expression,whereas the other tested growth factors exerted no notable effect.RNA sequencing and bioinformatic analysis indicated that mitogen-activated protein kinase(MAPK)signaling pathway played a key role in the regulatory effect of FGF2 on Rspo1.qPCR further demonstrated that pretreatment with U0126,an inhibitor of mitogen extracellular kinase 1/2(MEK1/2),reversed FGF2-mediated suppression of Rspo1 expression.Conclusion·FGF2 may inhibit Rspo1 expression in mouse colonic CD34+CD81+stromal cells via the MEK1/2-extracellular regulated protein kinase 1/2(ERK1/2)signaling pathway.

Objective To discuss the regulatory mechanism of nucleotide-binding oligomerzation domain 2(NOD2)/receptor interacting protein 2(RIP2)signaling pathway on inflammatory activation of macrophages in intestinal mucosa and provide experimental evidence for intestinal mucosal inflammation caused by bacterial products.Methods Using the THP-1 monocyte cell line,macrophages were stimulated with muramyl dipeptide(MDP)at varying concentrations and durations.mRNA and protein expression levels of NOD2 and RIP2 were detected.The secretion levels of tumor necrosis factor(TNF)-α and interleukin(IL)-1β in the cell culture supernatant were measured.The most effective siRNA targeting RIP2 and optimal transfection concentration were screened,and the impact of RIP2 gene silencing on MDP-induced inflammatory activation of macrophages was observed.Results After silencing the RIP2 gene,MDP induced a significant decrease in TNF-α and IL-1βsecretion in macrophages,but the changes in cell phenotype were not significantly affected.Conclusion This study revealed the important role of NOD2/RIP2 signaling pathway in inflammatory activation of macrophages,and it is possible to effectively inhibit inflammatory activation of macrophages by interfering with this signaling pathway.

Objective·To preliminarily investigate the regulatory effect and underlying mechanism of fibroblast growth factor 2(FGF2)on R-spondin 1(Rspo1)expression in CD34+CD81+stromal cells from the mouse colon.Methods·Colonic CD45-CD326-CD31-GP38+CD81+Rspo1-tdTomato+stromal cells were sorted from Rspo1-tdTomato reporter mice by flow cytometry and subsequently cultured in vitro.The expression of surface protein markers was evaluated by flow cytometry after 14 d of culture.qPCR was employed to quantify Rspo1 expression in response to stimulation with FGF2,FGF9,epidermal growth factor(EGF),platelet-derived growth factor-bb(PDGF-bb),insulin-like growth factor 1(IGF1),or hepatocyte growth factor(HGF).RNA sequencing and bioinformatic analyses were used to identify the signaling pathways underlying FGF2-mediated regulation of Rspo1,followed by preliminary validation with pathway-specific inhibitors and qPCR.Results·After 14 d of culture,the sorted colonic stromal cells retained expression of CD34,CD81,and glycoprotein GP38,while remaining negative for other lineages markers CD45,CD326,and CD31.qPCR revealed that 20 ng/mL FGF2 significantly suppressed Rspo1 expression,whereas the other tested growth factors exerted no notable effect.RNA sequencing and bioinformatic analysis indicated that mitogen-activated protein kinase(MAPK)signaling pathway played a key role in the regulatory effect of FGF2 on Rspo1.qPCR further demonstrated that pretreatment with U0126,an inhibitor of mitogen extracellular kinase 1/2(MEK1/2),reversed FGF2-mediated suppression of Rspo1 expression.Conclusion·FGF2 may inhibit Rspo1 expression in mouse colonic CD34+CD81+stromal cells via the MEK1/2-extracellular regulated protein kinase 1/2(ERK1/2)signaling pathway.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Bone formation and deposition are initiated by sensory nerve infiltration in adaptive bone remodeling. Here, we focused on the role of Semaphorin 3A (Sema3A), expressed by sensory nerves, in mechanical loads-induced bone formation and nerve withdrawal using orthodontic tooth movement (OTM) model. Firstly, bone formation was activated after the 3rd day of OTM, coinciding with a decrease in sensory nerves and an increase in pain threshold. Sema3A, rather than nerve growth factor (NGF), highly expressed in both trigeminal ganglion and the axons of periodontal ligament following the 3rd day of OTM. Moreover, in vitro mechanical loads upregulated Sema3A in neurons instead of in human periodontal ligament cells (hPDLCs) within 24 hours. Furthermore, exogenous Sema3A restored the suppressed alveolar bone formation and the osteogenic differentiation of hPDLCs induced by mechanical overload. Mechanistically, Sema3A prevented overstretching of F-actin induced by mechanical overload through ROCK2 pathway, maintaining mitochondrial dynamics as mitochondrial fusion. Therefore, Sema3A exhibits dual therapeutic effects in mechanical loads-induced bone formation, both as a pain-sensitive analgesic and a positive regulator for bone formation.
Humans ; Bone Remodeling ; Cell Differentiation ; Osteogenesis ; Semaphorin-3A/pharmacology* ; Trigeminal Ganglion/metabolism*

Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.