OBJECTIVE: To evaluate the functional and aesthetic evaluation of external fixator lengthening through plantar approach for fourth brachymetatarsia. METHODS: A retrospective analysis was conducted on 20 patients (23 feet) with fourth brachymetatarsia who met the selection criteria between January 2016 and January 2024, including 3 males and 17 females, with 8 left, 9 right, and 3 bilateral cases. The mean age was 24.7 years (range, 14-51 years). The preoperative metatarsal shortening length was (13.8±3.2) mm. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was 79.5±3.9, the visual analogue scale (VAS) score of appearance satisfaction was 1.7±0.8, and the appearance index (AI) score was 13.6±0.9. All patients underwent external fixator lengthening through plantar approach. The lengthening length of metatarsal bone, lengthening ratio, healing time, and healing index were recorded. Functional outcomes were assessed using the AOFAS forefoot score, VAS score of appearance satisfaction, and quality-of-life impact with AI questionnaire. RESULTS: All 20 patients were followed up 14-55 months with an average of 36.3 months. During the follow-up, complications occurred in 4 cases (17.4%), including 2 cases of metatarsophalangeal joint stiffness, which had no significant effect on the function and appearance. Delayed union of osteotomy occurred in 1 case (healed at 12 weeks after operation). Pin loosening occurred in 1 case and recovered after outpatient reinforcement. No complications related to plantar scar occurred. At last follow-up, the lengthening length of metatarsal bone was (13.9±3.1) mm, and the lengthening ratio was 25.8%±5.6%. All cases achieved bony union, with a mean healing time of (64.3±12.5) days and a healing index of (46.9±4.8) d/cm. At last follow-up, AOFAS score was 98.9±2.1, the VAS score of appearance satisfaction was 9.3±0.7, and the AI score was 0.6±0.8, which significantly improved when compared with those before operation ( t=27.398, P<0.001; t=32.994, P<0.001; t=56.135, P<0.001). CONCLUSION External fixator lengthening through plantar approach is a safe and effective technique for fourth brachymetatarsia, achieving satisfactory functional and aesthetic outcomes.
Humans ; Male ; Female ; Adult ; External Fixators ; Retrospective Studies ; Bone Lengthening/instrumentation* ; Middle Aged ; Metatarsal Bones/abnormalities* ; Adolescent ; Young Adult ; Treatment Outcome ; Patient Satisfaction ; Esthetics ; Osteotomy/methods* ; Foot Deformities, Congenital/surgery*

OBJECTIVE: To review the nomenclature, functional unit construction, technical essentials, and prevention and treatment of complications of functional perforator flaps, so as to provide references for the structural and functional reconstruction of composite tissue defects. METHODS: By retrieving and analyzing domestic and foreign literature on anatomical research, technical innovation and clinical application of functional design and application of perforator flaps, combined with the clinical practice of our team, the methods for harvesting and integrating functional units of perforator flaps were summarized. RESULTS: Functional perforator flap refers to a perforator flap that, on the basis of perforator blood supply, carries one or more tissue functional units (such as muscles, nerves, lymphatic vessels, lymph nodes, bones, mucous membranes, joints or articular cartilages, etc.) with sufficient blood supply located in the supra-fascia and/or sub-fascia, and is used to reconstruct one or more functions of the recipient site. The design and transfer of functional perforator flaps should not only meet the needs of precise coverage of the wound, but also reconstruct the functions of the recipient site such as muscle contraction, flap sensation, lymphatic drainage, blood flow bridging, bone growth, glandular secretion or joint movement, while avoiding iatrogenic dysfunction in the donor site. CONCLUSION Functional perforator flaps have broken through the limitation of "wound coverage" and realize the integrated reconstruction of "structure-function-aesthetics".
Humans ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Soft Tissue Injuries/surgery* ; Tissue and Organ Harvesting/methods* ; Skin Transplantation/methods*

OBJECTIVE: To review the clinical applications of functional perforator flaps in restoring human body functions. METHODS: An extensive literature review was conducted on both domestic and international publications to summarize the clinical use of functional perforator flaps for functional restoration. RESULTS: Perforator flaps are among the most commonly used flaps in reconstructive surgery. Beyond providing soft tissue repair, they are increasingly employed to reconstruct diverse bodily functions, leading us to propose the concept of the "functional perforator flap". Although various forms of functional perforator flaps are currently utilized, reports are predominantly scattered case studies, lacking systematic organization. Commonly used functional perforator flaps can be categorized into five types: chimeric perforator flaps, perforator flaps for nerve function restoration, perforator flaps for lymphatic drainage enhancement, flow-through perforator flaps, and perforator flaps for restoring bone and joint motion. These flaps significantly broaden the application scope of perforator flaps, elevating the goal of reconstruction from mere wound repair to achieving repair concurrent with functional reconstruction. CONCLUSION The application of various functional perforator flap designs significantly improves wound reconstruction outcomes and represents an effective approach for managing complex defects. Future developments will undoubtedly see more forms of functional perforator flaps reported to meet increasingly sophisticated reconstructive demands.
Humans ; Perforator Flap/blood supply* ; Plastic Surgery Procedures/methods* ; Soft Tissue Injuries/surgery* ; Skin Transplantation/methods* ; Wound Healing

OBJECTIVE: To explore the application value of infrared thermography in the design and harvesting of ultrathin anterolateral thigh perforator flaps. METHODS: Between June 2024 and December 2024, 9 cases of ultrathin anterolateral thigh perforator flaps were designed and harvested with the assistance of infrared thermography. There were 7 males and 2 females, aged 21-61 years (mean, 39.8 years). The body mass index ranged from 19.49 to 26.45 kg/m² (mean, 23.85 kg/m²). Causes of injury included 5 cases of traffic accident injuries and 4 cases of machine crush injuries. There were 3 cases of leg wounds, 2 cases of foot wounds, and 4 cases of hand wounds. After debridement, the size of wound ranged from 7 cm×4 cm to 13 cm×11 cm. The time from admission to flap repair surgery was 5-12 days (mean, 7 days). Preoperatively, perforator localization was performed using a traditional Doppler flow detector and infrared thermography, respectively. The results were compared with the actual intraoperative locations; a discrepancy ≤10 mm was considered as consistent localization (positive), and the positive predictive value was calculated. All 9 cases were repaired with ultrathin anterolateral thigh perforator flaps designed and harvested based on thermographic images. The size of flap ranged from 8 cm×5 cm to 14 cm×8 cm, with a thickness of 3-6 mm (mean, 5.2 mm). One donor site was repaired with a full-thickness skin graft, and the others were sutured directly. Postoperatively, anti-inflammatory, anticoagulant, and anti-vascular spasm treatments were administered, and follow-up was conducted. RESULTS: The Doppler flow detector identified 22 perforating vessels within the set range, among which 16 were confirmed as superficial fascia layer perforators intraoperatively, with a positive predictive value of 72.7%. The infrared thermograph detected 23 superficial fascia layer perforating vessels, and 21 were verified intraoperatively, with a positive predictive value of 91.3%. There was no significant difference between the two methods [OR (95%CI)=3.93 (0.70, 22.15), P=0.100]. The perforator localization time of the infrared thermograph was (5.1±1.3) minutes, which was significantly shorter than that of the Doppler flow detector [(10.1±2.6) minutes; MD (95%CI)=-5.00 (-7.08, -2.91), P<0.001]. Postoperatively, 1 case of distal flap necrosis healed after dressing change; all other flaps survived successfully. The skin grafts at donor site survived, and all incisions healed by first intention. All patients were followed up 3-6 months (mean, 4.7 months). No pain or other discomfort occurred at the donor or recipient sites. All patients with foot wounds could walk with shoes, and no secondary flap revision was required. Flaps in 3 hand wound cases, 2 foot wound cases, and 3 leg wound cases recovered light touch and pressure sensation, but not pain or temperature sensation; the remaining 2 cases had no sensory recovery. CONCLUSION Preoperative localization using infrared thermography for repairing ultrathin anterolateral thigh perforator flaps can help evaluate the blood supply status of perforators, reduce complications, and improve surgical safety and flap survival rate.
Humans ; Perforator Flap/blood supply* ; Adult ; Male ; Thermography/methods* ; Female ; Thigh/blood supply* ; Middle Aged ; Plastic Surgery Procedures/methods* ; Tissue and Organ Harvesting/methods* ; Infrared Rays ; Skin Transplantation/methods* ; Soft Tissue Injuries/surgery* ; Young Adult

Traditional development of small protein scaffolds has relied on display technologies and mutation-based engineering, which limit sequence and functional diversity, thereby constraining their therapeutic and application potential. Protein design tools have significantly advanced the creation of novel protein sequences, structures, and functions. However, further improvements in design strategies are still needed to more efficiently optimize the functional performance of protein-based drugs and enhance their druggability. Here, we extended an evolution-based design protocol to create a novel minibinder, BindHer, against the human epidermal growth factor receptor 2 (HER2). It not only exhibits super stability and binding selectivity but also demonstrates remarkable properties in tissue specificity. Radiolabeling experiments with ^99mTc, ⁶⁸Ga, and ¹⁸F revealed that BindHer efficiently targets tumors in HER2-positive breast cancer mouse models, with minimal nonspecific liver absorption, outperforming scaffolds designed through traditional engineering. These findings highlight a new rational approach to automated protein design, offering significant potential for large-scale applications in therapeutic mini-protein development.

Objective: To develop a facial image generation method based on a facial color-preserving generative adversarial network (FCP-GAN) that effectively decouples identity features from diagnostic facial complexion characteristics in traditional Chinese medicine (TCM) inspection, thereby addressing the critical challenge of privacy preservation in medical image analysis. Methods: A facial image dataset was constructed from participants at Nanjing University of Chinese Medicine between April 23 and June 10, 2023, using a TCM full-body inspection data acquisition equipment under controlled illumination. The proposed FCP-GAN model was designed to achieve the dual objectives of removing identity features and preserving colors through three key components: (i) a multi-space combination module that comprehensively extracts color attributes from red, green, blue (RGB), hue, saturation, value (HSV), and Lab spaces; (ii) a generator incorporating efficient channel attention (ECA) mechanism to enhance the representation of diagnostically critical color channels; and (iii) a dual-loss function that combines adversarial loss for de-identification with a dedicated color preservation loss. The model was trained and evaluated using a stratified 5-fold cross-validation strategy and evaluated against four baseline generative models: conditional GAN (CGAN), deep convolutional GAN (DCGAN), dual discriminator CGAN (DDCGAN), and medical GAN (MedGAN). Performance was assessed in terms of image quality [peak signal-to-noise ratio (PSNR) and structural similarity (SSIM)], distribution similarity [Fréchet inception distance (FID)], privacy protection (face recognition accuracy), and diagnostic consistency [mean squared error (MSE) and Pearson correlation coefficient (PCC)]. Results: The final analysis included facial images from 216 participants. Compared with baseline models, FCP-GAN achieved superior performance, with PSNR = 31.02 dB and SSIM = 0.908, representing an improvement of 1.21 dB and 0.034 in SSIM over the strongest baseline (MedGAN). The FID value (23.45) was also the lowest among all models, indicating superior distributional similarity to real images. The multi-space feature fusion and the ECA mechanism contributed significantly to these performance gains, as evidenced by ablation studies. The stratified 5-fold cross-validation confirmed the model’s robustness, with results reported as mean ± standard deviation (SD) across all folds. The model effectively protected privacy by reducing face recognition accuracy from 95.2% (original images) to 60.1% (generated images). Critically, it maintained high diagnostic fidelity, as evidenced by a low MSE (< 0.051) and a high PCC (> 0.98) for key TCM facial features between original and generated images. Conclusion The FCP-GAN model provides an effective technical solution for ensuring privacy in TCM diagnostic imaging, successfully having removed identity features while preserving clinically vital facial color features. This study offers significant value for developing intelligent and secure TCM telemedicine systems.

Objective To explore the role of protective function of Sestrin2(Sesn2)to mitochondria in alleviating cognitive dysfunction in mice with sepsis-associated encephalopathy(SAE).Methods 6-week-old male C57BL/6J mice were randomly divided into three groups:sham group,CLP group and CLP plus eupatilin group,40 mice in each group.A sepsis model was induced by cecal ligation and perforation(CLP).The CLP plus eupatilin group was treated with eupatilin.Neurobehavioral test and Morris water maze(MWM)were used to deter-mine neurobehavior and spatial learning and memory function in mice.The number of neurons in hippocampal CA1 area was counted by Nissl staining.HT22 cells were randomly divided into a control group(Con),lipopolysaccha-ride group(LPS),LPS plus eupatilin treatment group(LPS plus eupatilin)and LPS plus eupatilin and Nrf2 siRNA treatment group(LPS plus eupatilin and si-Nrf2).Apoptosis was analyzed by terminal deoxynucleotidyl transferase-mediated nick end labeling(TUNEL)staining,Mitochondrial membrane potential(MMP)was used to analyze mitochondrial damage.Results Seven days after CLP,as compared with sham mice,Sesn2 in hippocampus and cortex decreased significantly in CLP mice(P<0.01).As compared with CLP group,the survival rate in CLP plus eupatilin group increased significantly(P<0.05).As compared with sham group,the mice in CLP group showed a relatively high nerve injury score(P<0.05),and had fewer platform crossings and shorter target stay time,while the mice in CLP plus eupatilin group exhibited a lower injury score(P<0.05),and stayed in the target area for a longer time(P<0.05).As compared with sham group,the co-localization rate of neurons,Sesn2 and Nrf2 in CLP group decreased significantly(P<0.05),and the number of CD68/Iba-1 positive microglia increased significantly(P<0.05),while CLP plus eupatilin group reversed these changes.As compared with Con group,apoptosis and MMP level in LPS group increased significantly(P<0.01),while apoptosis and MMP level in LPS plus eupatilin group were lower than those in LPS group(P<0.05).However,Nrf2 knockdown(LPS plus eupatilin and si-Nrf2 group)reversed the anti-apoptosis and mitochondrial protection of eupatilin.Conclusions Eupatilin can alleviate cognitive dysfunction and neurological deficit in SAE mice by activating Sesn2-Nrf2 pathway,and improve inflammatory microenvironment by alleviating mitochondrial dysfunction.

Objective To compare the clinical application value of medical glue and a new-type medical anchor positioning needle in thoracoscopic resection of pulmonary nodules.Methods A total of 182 patients with pulmonary nodules,who received video-assisted thoracic surgery(VATS)at the Department of Thoracic Surgery of Affiliated Hospital of Shaoxing University of China between January 2020 and December 2022,were enrolled in this study.Preoperative CT-guided localization of the pulmonary nodule was performed in all patients,including medical glue positioning in 89 patients(medical glue group)and anchor needle positioning in 93 patients(anchor needle group).The incidences of pneumothorax and bleeding,the time spent for positioning,the interval between localization and operation,the time spent for operation,and the radiation dose during localization process were recorded and the data were statistically analyzed.Results The success rate of positioning was 100％(93/93)in the anchor needle group and 96.7％(86/89)in the medical glue group.There was no statistically significant difference between the two groups(P>0.05).The incidence of bleeding was 31.2％(29/93)in the anchor needle group and 15.7％(14/89)in the medical glue group,and the difference between the two groups was statistically significant(P<0.05).The incidence of pneumothorax was 30.1％(28/93)in the anchor needle group and 20.2％(18/89)in the medical glue group,and there was no significant difference between the two groups(P>0.05).No statistically significant difference in the time spent for operation existed between the two groups(P>0.05).The time spent for positioning and the interval between localization and operation in the medical glue group were longer than those in the anchor needle group,and the radiation dose in the medical glue group was higher than that in the anchor needle group,and the differences between the two groups were statistically significant(P<0.05).Conclusion For the preoperative localization of ground glass opacity(GGO)or solitary pulmonary nodule(SPN),both medical glue positioning method and anchor needle positioning method have high clinical application value.The clinical and interventional physicians should adopt appropriate positioning method according to the patient's condition.

Objective:To analyze the association between visceral fat area (VFA) and fatty liver based on quantitative CT (QCT) in people receiving health examination with normal body mass index (BMI).Methods:A cross-sectional study. A total of 1 305 physical examiners who underwent chest CT and QCT examination in the Department of Health Management of Henan Provincial People′s Hospital from January to December 2021 were retrospectively selected as subjects. The physical components at the central level of the lumbar two cone were measured with QCT, including subcutaneous fat area (SFA), VFA and liver fat content (LFC). And the metabolic indexes, such as blood lipids and blood glucose, were collected. The t-test and χ2 test were used to analyze the correlation between the detection rate of fatty live and LFCr and age and gender. According to level of VFA (<100 cm 2, 100-150 cm 2 and≥150 cm 2), the subjects were divided into three groups, and one-way ANOVA and χ2 test were used in comparison between groups. Multiple linear regression was used to analyze the correlation between VFA and metabolic indexes and LFC. Results:Of the 1 305 subjects, there were 634 males and 671 females. The detection rate of fatty liver in normal BMI population was 65.67%, and it was 72.71% and 59.02% respectively in men and women ( χ2=27.12, P<0.001), and the detection rate of fatty liver and LFC increased with age (both P<0.05). With the increase of VFA, the age, BMI, SFA, LFC, total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBG), alanine aminotransferase (ALT), blood uric acid and prevalence of fatty liver increased (all P<0.05), and the low-density lipoprotein cholesterol (HDL-C) decreased ( P<0.001). Multiple linear regression analysis showed that after adjustment for age factors, regardless of male or female, LFC was independently positively related with VFA, BMI, and ALT (male β=0.206, 0.145, 0.174, female β=0.194, 0.150, 0.184; all P<0.05). FBG was positively correlated with male independently ( β=0.134; P<0.001). The indicators related to female independently were TC, TG, and blood uric acid ( β=-0.121, 0.145, 0.141, all P<0.05) Conclusion:In the population receiving health examination with normal BMI, the VFA measured by QCT technique is closely related to fatty liver.

Objective:To investigate the role of TcpC, a virulence factor of uropathogenic Escherichia coli (UPEC), in immune evasion, and analyze its related pathogenic mechanism. Methods:C57BL/6 mice were injected with 10 9 colony-forming unit of wild-type (CFT073 wt) or tcpc gene-knockout (CFT073 Δ tcpc) UPEC CFT073 strains from urethra into bladder to construct a mouse model of pyelonephritis. These mice were sacrificed 5 d after infection and their kidneys were taken to observe the gross pathological changes. Hematoxylin-eosin staining was used to observe histopathological changes in kidney tissues and immunohistochemistry was performed to locate TcpC in kidney tissues. The bacterial loads in urine samples of UPEC infected-mice were counted by ten-fold dilution method, and the presence of tcpc gene in the genomic DNA of bacteria from CFT073-infected mouse kidney or urine samples was measured by PCR. The expression of TcpC at mRNA level was detected by qRT-PCR after infecting dendritic cells with CFT073 wt strains. The influences of UPEC infection on the activation of NF-κB signaling pathway and the secretion of proinflammatory factors by dendritic cells were analyzed by Western blot and ELISA, respectively. The viability of UPEC strains in dendritic cells were observed by laser confocal microscope. Results:Compared with the CFT073 Δ tcpc group, the mice in the CFT073 wt group had obvious abscess in the kidneys as well as massive neutrophil infiltration and abundant TcpC in kidney tissues. The bacterial loads in the urine of CFT073 wt-infected mice were significantly higher than those in the urine of CFT073 Δ tcpc mice. PCR results showed that tcpc gene was successfully amplified from mouse kidney and urine samples. Increased expression of TcpC at both mRNA and protein levels was detected in CFT073 wt-infected dendritic cells. CFT073 wt infection inhibited the phosphorylation of NF-κB p50 and the production of proinflammatory factors in dendritic cells. TcpC promoted the survival of CFT073 wt in dendritic cells. Conclusions:TcpC expression increases significantly during CFT073 wt infection or in mice with CFT073 wt-induced pyelonephritis. It promotes the survival of CFT073 wt in dendritic cells by inhibiting the activation of NF-κB signaling pathway and reducing the secretion of pro-inflammatory cytokines. TcpC is involved in the pathogenesis of UPEC and immune evasion.