Objective:To investigate the predictive value of a nomogram based on multimodal CT parameters for the outcome of endovascular therapy (EVT) in patients with acute vertebrobasilar artery occlusion (AVBAO).Methods:Patients with AVBAO underwent EVT at Xuzhou Central Hospital from January 2021 to March 2024 were included retrospectively. At 90 days after EVT, the modified Rankin Scale was used to evaluate clinical outcome. 0-3 points were defined as good outcome and 4-6 points were defined as poor outcome. Multivariate stepwise logistic regression model was used to screen for predictive variables. Then a nomogram was drawn and the prediction model was evaluated. Results:A total of 91 patients with AVBAO were included. There were 60 males (65.9%), aged 69.09±10.57 years. Thirty-eight patients (41.8%) had good outcome, 53 (58.2%) had poor outcome, and 35 (38.5%) died. Univariate analysis showed that there were significant differences in white blood cell count, neutrophil count, National Institutes of Health Stroke Scale (NIHSS) score, Glasgow Coma Scale (GCS) score, posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS), Basilar Artery on Computed Tomography Angiography (BATMAN) score, core infarct volume, mismatched volume ratio, onset to door time between the poor outcome group and the good outcome group (all P<0.05). The above indicators were included in a binary multivariate stepwise logistic regression model. The results showed that higher NIHSS scores (odds ratio [ OR] 1.154, 95% confidence interval [ CI] 1.070-1.244; P<0.001), lower BATMAN scores ( OR 0.626, 95% CI 0.416-0.943; P=0.025), and larger core infarct volumes ( OR 1.147, 95% CI 1.046-1.258; P=0.004) on admission were the independent risk factors for poor outcome. A nomogram was plotted using the above three independent risk factors as predictor variables. Its area under the receiver operating characteristic curve for predicting poor outcome was 0.942 (95% CI 0.894-0.990). The sensitivity and specificity were 81.1% and 97.4%, respectively. The calibration curve fluctuates within a small range around the ideal curve. A mean absolute error was 0.027 and a mean square error was 0.001. The clinical decision curve suggested that the model had good clinical applicability. The dynamic nomogram is shown in: https://yuepeng.shinyapps.io/VBAO_model/. Conclusion:The nomogram prediction model based on multimodal CT parameters has good predictive performance for poor outcome in patients with AVBAO after EVT.

Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Objective:To investigate the treatment effect of marrow mesenchymal stem cells (MSC)/endothelial progenitor cells (EPC) extracellular matrix-based tissue engineering bone (ECM-TEB) in repair of femoral defects in rats.Methods:Bone marrow-derived MSC and EPC were isolated and cultured for functional identification, and planted on the nanocrystalline collagen-based artificial bone particles. After culturing for 14 days, the cells were lyophilized to obtain MSC/EPC ECM-TEB and MSC ECM-TEB. A scanning electron microscope was used to observe the morphology of MSC and EPC on the surface of the scaffold. The protein extracts of MSC ECM-TEBs (control group) and the protein extracts of MSC/EPC ECM-TEBs (experimental group) were added to the EPC culture system for migration test, scratch repair assay, and tube formation detection; and to the MSC culture system for alizarin red staining and alkaline phosphatase? (ALP) staining detection. The cell recruitment, angiogenesis and osteogenic differentiation were observed. A total of 12 SD rats were selected to establish a femoral defect model. According to the random number table, the rats were divided into: (1) sham group: debridement treatment was performed only at the defect; (2) MSC ECM -TEB group: MSC ECM-TEB was implanted at the defect; (3) MSC/EPC ECM-TEB group: MSC/EPC ECM-TEB was implanted at the defect, with 4 rats per group. Two months later, micro-computed tomography (Micro-CT) and Masson's tricolor staining were performed to observe the treatment effect of the bone defect. When the cells were stored at low temperature for three months after lyophilization, the different protein profile between MSC ECM-TEB and MSC/EPC ECM-TEB in vascularization was detected by isotope relative labeling and absolute quantification technology (iTRAQ). The gene ontology/Kyoto Encyclopedia of Gene and Genome Technology (GO/ KEGG) function enrichment was used to analyze the key differences.Results:MSC and EPC grew well and formed a smooth cell layered structure on the surface of the scaffold. The number of cell migration, ratio of scratch repair, and length of the tube in experimental group were respective 121.6±8.3, (61.5±5.9)%, (11.3±0.6)mm, significantly increased compared with control group [85.0±6.7, (39.3±3.6)%, (5.9±0.4)mm] (all P<0.01). Alizarin red staining and ALP staining results showed that the proportion of calcium nodule mineralized area in experimental group increased significantly compared with control group [(38.8±3.3)%∶(49.9±3.0)%, (38.8±2.4)%∶(45.3±3.3)%] (all P<0.05). Base on the Micro-CT and Masson staining, bone defect healing was good in MSC/EPC ECM-TEB group, only a small amount of new bone was formed in MSC ECM-TEB group, and there was almost no new bone regenerated in sham group. Significant differences were found in bone volume/total volume, trabecular number and trabecular thickness among groups (all P<0.05), which were in line with Micro-CT and Masson staining results. The protein profile analysis showed that 83 angiogenesis-related factors in MSC/EPC ECM-TEB group were significantly up-regulated compared with MSC ECM-TEB group (fold change>2, P<0.05). GO/KEGG function enrichment analysis showed that MSC/EPC ECM-TEB group had projecting ascendancy in "vascular development" and in "vascular smooth muscle contraction pathway" compared with MSC ECM-TEB group (both P<0.01). Conclusion:MSC/EPC ECM-TEB has advantages in cell recruitment, angiogenesis, and new bone formation compared with MSC ECM-TEB, and is a better construction strategy for repair of traumatic bone defect.

Objective To investigate the effects of heparanase and E-cadherin on the invasion and metastasis of gastric cancer. Methods Fifty specimens of gastric cancer which had been resected at Cancer Hospital of Liaoning Province from February 2005 to May 2007 were collected. The expression of heparanase mRNA and E-cadherin mRNA in these gastric cancer specimens was detected by RT-PCR, and the expression of E-cadherin in these gastric cancer specimens was detected by immunohistochemistry. Data were analyzed by t-test and variance analysis, and the enumeration data analyzed by chi-square test. Results There were significant differences in the expression of heparanase and E-cadherin between gastric cancer cells with high and low differentiation, presence and absence of metastasis, and TNM stages Ⅰ and Ⅱ versus Ⅲ and Ⅳ (t = 1.999, 4.258, 1.735 ; 1.286, 6.794, 3.091; χ~2 =6.273, 9.397, 5.640, P <0.05). The co-expression of heparanase (+) and E-cadherin (-) was correlated with tumor undifferentiation, lymph node metastasis and advanced TNM staging (χ~2 =11.306, 10.208, 8.420, P <0.05). Conclusions Heparanasc shows high expression while E-cadherin shows low expression in gastric cancer tissue. There is a synergistic effect between the abnormal expression of heparanase and E-cadherin, and the gastric cancer cells with coexpression of heparanase and E-cadherin have more malignant potential.

Objective To detect whether mice bone marrow mesenchymal stem cells(BMSCs)can contribute to the regeneration of hepatocytes in bone marrow chimeric mice.Methods Female recipient mice(C57BL/6J)underwent whole body gamma-ray irradiation with a dose of 10 Gy to ablate their bone marrow,followed by immediate tail vein injection of BMSCs isolated from male GFP transgenic mice.Animals were killed at different phase points:1 week,1 month,and 3 months.Using fluorescence microscope we directly observed GFP-positive cells in the liver frozen sections,and we also prepared the parafilm sections to detect the GFP-positive cells and the coexpression of GFP and Alb,CK18 by immunohistochemistry and immunofluorescence respectively.Results We found numerous GFP-positive cells in recipient mice liver at 1 week after BMSCs transplantation,some at 1 month and seldom at 3 months.There were some cells coexpressing GFP and Alb,CK18 at all the phase points.Conclusion Allotype BMSCs can differentiate into Alb and CK18 positive hepatocytes in bone marrow chimeric mice,which will become an ideal cell resource for liver tissue project.

Objective To explore the feasibility of mobilization circulating MSCs by G-CSF and observe the repairing effect of G-CSF mobilization in severe mouse traumatic brain injury(TBI) model.Methods MSCs-derived bone marrow and peripheral blood(PB) were cultured and its CFU-F were counted after mobilization by G-CSF.At 2,24,48,96,120,144,192,264,336 h after severe TBI in mice was establish,the neurobehavior of mice was measured by neurological examination and motor functional test,and mortality rate and pathologic changes were analyzed.Results MSCs-derived PB were successfully cultured.The CFU-F of mobilization group increased significantly than that of control group(P

Objective To explore the diagnosis and treatment of primary small bowel tumors. Methods The clinical data of 58 cases of primary small bowel tumors were retrospectively analyzed. Results Fifty-eight cases of primary small intestinal tumors were comfirmed by operation and/or pathology .Of them,19 suffered from benign tumors and 39 from malignant tumors.The main clinical manifestations of small bowel tumors were abdominal pain, abdominal mass, ileu and upper gastrointestinal hemorrhage.Twenty cases were diagnosed before the operation,and the misdiagnosis rate was 65.5%.All the 19 benign small intestinal tumors underwent local intestinal resection.In 39 malignant cases,18 underwent radical excision of the tumors, 6 received palliative excision and 5 underwent intestinal bypass operation. One patient died after the operation.The 1,3,5 -year survival rate of malignant tumors was 57.1%,28.6%and 9.5% respectively. Conclusions Primary small bowel tumor is uncommon and easy to be misdiagnosed.So attention must be paid to this disease.Endoscopy, X-ray ,BUS, CT and capsule endoscopy are the ideal diagnostic methods for small intestinal tumors .