BACKGROUND:This study provided insight into the molecular mechanisms by which exogenous basic fibroblast growth factor(bFGF)promotes wound healing. OBJECTIVE:To investigate the effect of exogenous bFGF on macrophage phenotype transition and granulation regeneration during wound repair in rats. METHODS:(1)In vitro experiment:Cells were divided into normal control group,low-dose bFGF group,high-dose bFGF group,and bFGF+valproic acid group.100 and 200 μg/L bFGF was added into the cell culture medium of low-dose bFGF group and high-dose bFGF group,respectively,while 200 μg/L bFGF and 20 mmol/L valproic acid were added into the cell culture medium of valproic acid group.EdU test,scratch test and tubule formation test were used to detect the effects of bFGF on proliferation,migration and angiogenesis of human umbilical vein endothelial cells.(2)In vivo experiment:Sprague-Dawley rats were randomly divided into model group,low-dose bFGF group,high-dose bFGF group and bFGF+valproic acid group.The open wound model of full-thickness skin defect was established in low-dose bFGF group,high-dose bFGF group and bFGF+valproic acid group.Rats in the low-and high-dose bFGF groups were given 100 and 200 μg/L bFGF through subcutaneous injection,while those in the bFGF+valproic acid group received subcutaneous injection of 200 μg/L bFGF and intraperitoneal injection of 10 mg/kg valproic acid.The wound healing rate of rats was detected at 7 and 14 days of administration.TUNEL was used to detect the apoptosis of cells in wound tissue.Enzyme linked immunosorbent assay was used to detect the serum levels of malondialdehyde,superoxide dismutase,tumor necrosis factor-α and interleukin-10.Immunofluorescence detection was conducted to detect the phenotypic transformation of macrophages in wound tissue.Immunohistochemistry was used to detect the expression of proliferating cell nuclear antigen,platelet endothelial cell adhesion molecule-1(CD31)and vascular endothelial growth factor in wound tissue.Western blot was used to detect the expression of Notch1 and Jagged1 in wound tissue. RESULTS AND CONCLUSION:(1)Compared with the normal control group,bFGF could significantly promote the proliferation,migration and angiogenesis of human umbilical vein endothelial cells in a dose-dependent manner.(2)Compared with the model group,bFGF could significantly promote wound healing,downregulate the rate of apoptosis in wound tissue,decrease the levels of malondialdehyde and tumor necrosis factor-α in serum,increase the levels of superoxide dismutase and interleukin-10,promote the conversion of macrophages to type M2 in wound tissue,upregulate the expression of proliferating cell nuclear antigen,CD31 and vascular endothelial growth factor in wound tissue,and inhibit the expression of Notch1 and Jagged1 in a dose-dependent manner.Valproic acid could partially reverse the promoting effect of bFGF on wound healing.To conclude,bFGF can significantly promote wound healing and granulation regeneration and induce the conversion of macrophages to M2,which may be related to the regulation of Notch1/Jagged1 signaling pathway.

Objective:To investigate the effect of thrombocytopenia and coagulation dysfunction on bleeding complications in patients undergoing percutaneous liver biopsy.Methods:The clinical, laboratory, and demographic data of patients undergoing percutaneous liver biopsy at the First Affiliated Hospital of Air Force Medical University from January 2005 to January 2024 were retrospectively analyzed. The incidence of bleeding was recorded. Univariate and multivariate logistic regression analyses were used to assess the effects of thrombocytopenia and coagulation dysfunction on the risk of postoperative bleeding. Furthermore, we assessed the bleeding risk in patients with autoimmune hepatitis.Results:A total of 2 885 liver perforations were performed in 2 364 patients, 98.4% of whom had an autoimmune liver disease. There were 27 cases of postoperative bleeding (0.9%). The univariate logistic regression analysis showed that platelet count (PLT)( P<0.05, OR=0.975), coagulation dysfunction (international normalized ratio; INR)( P<0.05, OR=6.954), and cirrhosis ( P<0.05, OR=3.857) were associated with bleeding. The multivariate logistic regression analysis showed that PLT was an independent risk factor for bleeding ( P<0.05, OR=0.975). PLT scores of 40×10 9/L and 65×10 9/L can classify the bleeding risk of patients with thrombocytopenia into high, medium, and low risk. There was no difference in the risk of bleeding between the 40×10 9/L0.05, χ2=0.10). The risk of bleeding in the 31×10 9/L≤PLT≤40×10 9/L group was higher than that in the 40×10 9/L0.05, χ2=0.10). Furthermore, the bleeding cases were considered mild as the bleeding stopped after pressure hemostasis. Conclusions:PLT is an independent risk factor for bleeding after hepatocentesis. When the PLT is >40×10 9/L, hepatocentesis can still be performed safely with appropriate management measures.

Objective:To dynamically assess liver fibrosis using magnetic resonance elastography (MRE) and explore factors associated with fibrosis reversal in patients with metabolic dysfunction-associated steatohepatitis (MASH).Methods:This study included data from patients diagnosed with MASH by liver biopsy who underwent at least two MRE examinations. Patients were divided into a fibrosis reversal group and a non-reversal group according to whether MRE values decreased by 20% during follow-up. Differences in clinical data between the groups were compared using analysis of variance, the Kruskal-Wallis test, and the chi-square test. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for fibrosis reversal in MASH.Results:A total of 46 cases were included in this study (mean age 50.1±12.3 years, BMI 26.1±3.1 kg/m2). Among them, the reversal group accounted for 26.1%. The rate of decrease in MRI proton density fat fraction (PDFF) was significantly higher in the reversal group (-50.0% vs. -8.1%, P=0.001) than in the non-reversal group between the two MRE examinations. The reversal group showed a more significant change rate of decreases in fasting insulin (-37.3% vs. -3.6%, P=0.011), insulin resistance index (-38.6% vs. -6.5%, P=0.044), and ALP (-24.9% vs. 0, P=0.004). Multivariate logistic regression analysis indicated that the rate of change in MRI PDFF was an independent predictor of fibrosis reversal ( OR=0.96, 95% CI: 0.92-1.00, P=0.046). Conclusion:A decrease in MRI proton density fat fraction levels is independently associated with liver fibrosis reversal in MASH, suggesting that intervention targeting liver fat content may be an effective treatment strategy.

Objective:To investigate the effect of thrombocytopenia and coagulation dysfunction on bleeding complications in patients undergoing percutaneous liver biopsy.Methods:The clinical, laboratory, and demographic data of patients undergoing percutaneous liver biopsy at the First Affiliated Hospital of Air Force Medical University from January 2005 to January 2024 were retrospectively analyzed. The incidence of bleeding was recorded. Univariate and multivariate logistic regression analyses were used to assess the effects of thrombocytopenia and coagulation dysfunction on the risk of postoperative bleeding. Furthermore, we assessed the bleeding risk in patients with autoimmune hepatitis.Results:A total of 2 885 liver perforations were performed in 2 364 patients, 98.4% of whom had an autoimmune liver disease. There were 27 cases of postoperative bleeding (0.9%). The univariate logistic regression analysis showed that platelet count (PLT)( P<0.05, OR=0.975), coagulation dysfunction (international normalized ratio; INR)( P<0.05, OR=6.954), and cirrhosis ( P<0.05, OR=3.857) were associated with bleeding. The multivariate logistic regression analysis showed that PLT was an independent risk factor for bleeding ( P<0.05, OR=0.975). PLT scores of 40×10 9/L and 65×10 9/L can classify the bleeding risk of patients with thrombocytopenia into high, medium, and low risk. There was no difference in the risk of bleeding between the 40×10 9/L0.05, χ2=0.10). The risk of bleeding in the 31×10 9/L≤PLT≤40×10 9/L group was higher than that in the 40×10 9/L0.05, χ2=0.10). Furthermore, the bleeding cases were considered mild as the bleeding stopped after pressure hemostasis. Conclusions:PLT is an independent risk factor for bleeding after hepatocentesis. When the PLT is >40×10 9/L, hepatocentesis can still be performed safely with appropriate management measures.

Objective:To dynamically assess liver fibrosis using magnetic resonance elastography (MRE) and explore factors associated with fibrosis reversal in patients with metabolic dysfunction-associated steatohepatitis (MASH).Methods:This study included data from patients diagnosed with MASH by liver biopsy who underwent at least two MRE examinations. Patients were divided into a fibrosis reversal group and a non-reversal group according to whether MRE values decreased by 20% during follow-up. Differences in clinical data between the groups were compared using analysis of variance, the Kruskal-Wallis test, and the chi-square test. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for fibrosis reversal in MASH.Results:A total of 46 cases were included in this study (mean age 50.1±12.3 years, BMI 26.1±3.1 kg/m2). Among them, the reversal group accounted for 26.1%. The rate of decrease in MRI proton density fat fraction (PDFF) was significantly higher in the reversal group (-50.0% vs. -8.1%, P=0.001) than in the non-reversal group between the two MRE examinations. The reversal group showed a more significant change rate of decreases in fasting insulin (-37.3% vs. -3.6%, P=0.011), insulin resistance index (-38.6% vs. -6.5%, P=0.044), and ALP (-24.9% vs. 0, P=0.004). Multivariate logistic regression analysis indicated that the rate of change in MRI PDFF was an independent predictor of fibrosis reversal ( OR=0.96, 95% CI: 0.92-1.00, P=0.046). Conclusion:A decrease in MRI proton density fat fraction levels is independently associated with liver fibrosis reversal in MASH, suggesting that intervention targeting liver fat content may be an effective treatment strategy.

Objective:To compare the clinical outcomes of arthroscopic external tension band fixation versus open reduction and internal fixation in the treatment of greater tubercle fracture of the humerus.Methods:A retrospective cohort study was conducted on 55 patients with greater tubercle fracture of the humerus admitted to Taizhou Hospital of Zhejiang Province from September 2019 to June 2022, including 24 males and 31 females, aged 26-80 years [(61.7±10.5)years]. Out of them, 35 patients treated with open reduction and internal fixation (open reduction group), and 20 patients were treated with external anchor tension band under arthroscopy (arthroscopy group). The operation time, and the Visual Analogue Scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score and shoulder active range of motion (anterior flexion, abduction and posterior extension) before operation, at 1 month after operation and at the last follow-up were compared between the two groups. Bone healing was observed in both groups at the last follow-up. Postoperative complications were compared between the two groups.Results:All the patients were followed up for 12-29 months [(16.9±4.0)months]. There was no significant difference in operation time between the two groups ( P>0.05). There were no significant differences in the VAS score, ASES score, Constant-Murley score and shoulder active range of motion between the two groups before operation ( P>0.05). The VAS score of the arthroscopy group was 3(2, 3)points at 1 month after operation, which was significantly lower than that of the open reduction group [4(3, 4) points] ( P<0.01). No significant difference was found in the VAS score at the last follow-up between the two groups ( P>0.05).The ASES scores of the arthroscopy group were (70.6±4.2)points and (90.2±3.7)points at 1 month after operation and at the last follow-up respectively, which were significantly higher than those of the open reduction group [(64.7±6.4)points and (87.5±4.9)points respectively] ( P<0.05 or 0.01). There was no significant difference in the Constant-Murley score between the arthroscopy group [(71.8±4.3)points] and the open reduction group [(70.9±5.3)points] at 1 month after operation ( P>0.05), while the Constant-Murley score of the arthroscopy group was (94.1±3.1)points at the last follow-up, which was significantly higher than that of the open reduction group [(89.2±4.7)points] ( P<0.01). At 1 month after operation and at the last follow-up, ranges of motion of the anterior flexion, abduction and posterior extension were (52.7±12.3)° and (140.0±16.9)°, (57.4±8.6)° and (125.0±14.3)°, and 16(15, 19)° and 25(20, 30)° in the arthroscopy group respectively, which were significantly higher than those in the open reduction group [(42.2±5.2)° and (110.9±14.0)°, (52.8±6.0)° and (103.7±11.7)°, and 10(10, 20)° and 16(15, 25)° respectively] ( P<0.05 or 0.01). At the last follow-up, it was found that bony union was achieved in both groups. There were no obvious complications such as incision infection or joint stiffnessin both groups. In the open reduction group, 2 patients had internal fixation failure within 1-3 months after operation but was treated with revision operation; 6 patients developed shoulder stiffness at 3-6 months after operation but had outpatient rehabilitation. The incidence rate of postoperative complications in the arthroscopy group [0%(0/20)] was significantly lower than that in the open reduction group [23%(8/35)] ( P<0.05). Conclusion:Compared with open reduction and internal fixation with plates and screws, arthroscopic external anchor tension band fixation in the treatment of greater tuberosity fracture of the humerus has the advantages of earlier pain relief, better shoulder functional improvement, better recovery of shoulder mobility, and fewer complications.

Objective:To assess the efficacy of modified arthroscopic lower trapezius transfer with autologous hamstring tendon bridging for irreparable massive posterosuperior rotator cuff tears.Methods:A retrospective analysis was conducted on 59 patients (11 males and 48 females; mean age 66.70±6.10 years, range 55-79 years) treated between June 2019 and November 2022 for posterior superior irreparable massive rotator cuff tears. The treatment involved total arthroscopic oblique muscle transposition combined with partial rotator cuff repair. Shoulder mobility was measured in active supination, forward flexion, posterior external rotation, and abduction external rotation before surgery and at the final follow-up. The Constant-Murley shoulder function score, visual analogue scale (VAS) for pain, and American Shoulder and Elbow Surgeons (ASES) scores were assessed preoperatively, at 3 months, 6 months postoperatively, and at the final follow-up. MR examinations were conducted preoperatively and at 3, 6, and 12 months postoperatively to evaluate rotator cuff healing and retear rates.Results:All surgeries were successfully completed using an average of 3.2±0.5 anchor nails (range 3-5) per case. The mean follow-up period was 15.9±5.7 months (range 12-37 months). Significant improvements in shoulder mobility were observed postoperatively compared to preoperative measurements. The mean body external rotation angle increased from 12.0°±19.4° preoperatively to 35.3°±19.6° at the final follow-up ( P<0.05), and the mean abduction external rotation angle increased from 33.4°±22.4° to 43.4°±23.1° ( P<0.05). The mean preoperative abduction angle improved from 121.7°±47.9° to 136.4°±40.6° ( P<0.05), and the mean forward flexion supination angle improved from 117.6°±45.8° to 139.5°±33.7° ( P<0.05). Postoperative VAS scores significantly improved from 4.8±1.8 preoperatively to 0.3±0.8 at the final follow-up ( F=104.868, P<0.001). The ASES scores improved from 42.0±14.9 preoperatively to 71.7±14.6 at the final follow-up ( F=47.287, P<0.001). The Constant-Murley scores increased from 54.3±17.1 preoperatively to 76.4±13.0 at the final follow-up ( F=44.082, P<0.001). Postoperative complications included 2 complete tears and 7 partial tears (re-tear rate 15.3%). No serious complications such as shoulder joint infection, joint stiffness, or vascular nerve injury were observed. One patient developed a localized subcutaneous hematoma at the tendon extraction site, and another developed deep vein thrombosis of the lower extremity, which improved with symptomatic anticoagulation. Conclusion:Modified arthroscopic lower trapezius transfer with autologous hamstring tendon bridging effectively reduces shoulder pain, improves shoulder joint activity and function scores, and is associated with a low rate of surgical complications for patients with irreparable massive posterosuperior rotator cuff tears.

Objective:To analyse the clinical efficacy of arthroscopic double-bundle Endobutton fixation of the thin bone channel in the treatment of Rockwood type III-V acromioclavicular joint dislocation.Methods:A total of 34 patients with acromioclavicular joint dislocation, 24 males and 10 females, aged 50.9±11.0 years (range, 21-74 years), who underwent arthroscopic double-bundle Endobutton fixation of the thin bone channel at Zhejiang Province Taizhou Hospital, Wenzhou Medical University, from February 2015 to February 2022 were retrospectively analyzed. There were 24 cases on the left side and 10 cases on the right side. Causes of injury: 23 cases of car accident, 7 cases of fall, 4 cases of falling from height. Rockwood classification: Type III 17 cases, type IV 9 cases, type V 8 cases. The visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and joint range of motion were used to evaluate shoulder pain and functional improvement.Results:All patients successfully completed the operation and were followed up for an average of 16.6±2.8 months (range, 12-24 months). Postoperative VAS scores were significantly lower compared to preoperative scores ( F=199.408, P<0.001), with the final follow-up VAS score being 1.32±0.47, significantly lower than the preoperative score of 4.71±1.19 ( P<0.001). Postoperative ASES scores were significantly higher compared to preoperative scores ( F=335.838, P<0.001), with the final follow-up ASES score being 88.85±6.41, significantly higher than the preoperative score of 34.76±5.79 ( P<0.001). The Constant-Murley scores of 3 months, 6 months after operation and the last follow-up were 77.79±5.34, 87.40±5.19 and 88.17±4.40, respectively, which were higher than that before operation 37.41±6.52, and the difference was statistically significant ( P<0.05). At the final follow-up, shoulder flexion, adduction, and abduction were 172.9°±6.4°, 59.2°±6.2°, and 59.3°±5.9°, respectively. The coracoclavicular distance was 1.76±0.42 mm, 0.84±0.19 mm, and 0.87±0.18 mm before operation, 3 months after operation, and at the last follow-up, respectively, and the difference was statistically significant ( F=101.160, P<0.001). Whereas, 3 months postoperative and the final follow-up were smaller than the preoperative ones, and the difference was statistically significant ( P<0.05). All incisions healed in one stage, and there was no vascular or nerve injury, internal fixation infection, coracoid process or clavicle bone tunnel fracture, or internal fixation loosening or breakage. Conclusion:Arthroscopic double-bundle Endobutton fixation with thin bone channel for the treatment of Rockwood type III-V acromioclavicular joint dislocation can improve shoulder function and reduce pain, with high surgical safety.