Objective:To evaluate the safety and efficacy of digital technology-assisted debridement and bone and soft tissue reconstruction in the treatment of chronic osteomyelitis of the tibia.Methods:This retrospective study analyzed clinical data from 38 patients (26 males, 12 females; mean age 45.61±18.36 years, range 16-83 years) with chronic post-traumatic osteomyelitis complicated by soft tissue defects in the tibia, treated at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital between June 2021 and June 2023. There were 18 cases of traffic accidents, 6 cases of high-altitude falls, 6 cases of heavy objects and 6 cases of low-energy falls. Lesion sites: 12 cases in the upper segment of the tibia, 12 cases in the middle segment, and 14 cases in the lower segment. According to the Cierny-Mader classification, there were 24 cases of type III and 14 cases of type IV. Before the operation, the "3D point cloud technology" was used to plan the debridement range of bone and soft tissue. During the operation, the optical navigation system was used to monitor the debridement range in real time. The flap was designed by combining "Reading Tablet Treasure" with CT angiography, and the amount of bone graft was predicted by AI algorithm. The surgical method adopted is the Masquelet technique, namely thorough debridement, bone cement occupation and soft tissue repair in the first stage, and bone reconstruction in the second stage. Comparing the calculated bone defect amount and soft tissue defect area before the operation with the actual measured values after debridement. The cure rate of infection was evaluated by using the McKee bone infection treatment criteria after the operation. The visual analogue scale (VAS) for pain, lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) were used to evaluate the improvement of the quality of life of postoperative patients.Results:38 patients were followed up with a mean follow-up of 13.53±2.37 months. 37 patients' infections were effectively controlled, and 1 patient had a recurrence of infection, with an effectiveness rate of 97% for the treatment of McKee's infections. The preoperative calculated bone defect amount and soft tissue defect area were 51.05±26.31 cm 3 and 68.42±43.45 cm 2 respectively, and the actual measured values after debridement during the operation were 51.66±26.35 cm 3 and 68.82±43.76 cm 2 respectively. There was no statistically significant difference before and after the operation ( P>0.05). The interval between the first and second stage surgeries was 10.36±1.61 weeks, and all flaps survived after the first stage surgery. Two months after the operation, one case had recurrent osteomyelitis. After palliative treatment, sinus tracts were formed at the infection site. At the 12-month regular dressing change follow-up, there were still purulent secretions in the sinus tracts. There was no recurrence of infection after primary debridement in 37 cases, and the bone grafts healed. The bone healing time was 3.58±0.97 months. The postoperative VAS, LEFS, and SAS scores were 1.00±0.91, 66.68±7.91, and 34.30±4.29, respectively, which were significantly improved compared with the preoperative scores of 7.54±1.52, 21.22±4.29, and 52.70±6.74, respectively, and the difference was statistically significant ( P<0.05). Conclusions:The application of digital technology to precisely design the debridement range of bone and soft tissue, and the real-time holographic visualization monitoring of the debridement range during the operation can achieve precise debridement of bone and soft tissue and personalized and precise repair of soft tissue defects. It is a safe and effective technique for the treatment of chronic osteomyelitis of the tibia.

Objective:To investigate the efficacy of the supercharged gracilis myocutaneous flap in reconstruction of the surgical defects following resection of soft tissue sarcoma (STS) in extremities.Methods:A retrospective analysis was conducted on 6 patients who received surgery to remove STS in extremities followed by reconstructive surgery with a supercharged gracilis myocutaneous flap to reconstruct the surgical defect (16.0 cm×4.8 cm-25.0 cm×8.0 cm), at the Department of Microsurgery, the 4th Medical Centre, Chinese PLA General Hospital between January 2023 and January 2024. The locations of sarcoma were: 3 in left forearm, 2 in right calf and 1 in left calf. The pathological types of the sarcoma were: 1 of myxoid liposarcoma, 1 of dedifferentiated liposarcoma, 1 of alveolar rhabdomyosarcoma, 1 of low-grade myxofibrosarcoma and 2 of fibrosarcoma. According to the Enneking classification, 2 sarcomas were in stage I and 4 in stage Ⅱa. All patients underwent expanded resection of the sarcoma and followed by reconstruction of the surgical defect with supercharged gracilis myocutaneous flap. The flap size ranged from 18.0 cm×5.2 cm to 27.7 cm×10.2 cm, with the length of the muscle flap at 25.92 cm±5.57 cm and 17.0 cm×2.8 cm×2.7 cm-32.0 cm×6.0 cm×3.5 cm in volume. The surgical defects were filled with muscle flaps, while the wounds were covered by cutaneous flaps. The perforating branches of the deep femoral artery carried by proximal vascular pedicle of the myocutaneous flap were anastomosed end-to-end with the prominent vessels of the recipient site. Where, the perforators of the distal femoral artery of the myocutaneous flap were anastomosed end-to-end with the recipient vessels for external blood perfusion, and the great saphenous vein of the flap was anastomosed end-to-end with the superficial veins of the recipient site. All donor sites were directly sutured. Scheduled postoperative follow-ups at outpatient clinic were conducted to assess the viability of the transferred myocutaneous flap. Limb function was evaluated using the Musculoskeletal Tumour Society-93 (MSTS-93) and the Toronto Extremity Salvage Score (TESS).Results:The postoperative follow-up lasted for 12 to 20 months. All 6 myocutaneous flaps survived without distal necrosis. All patients regained daily activities and functioned well. The MSTS-93 scores achieved 24 to 30 (27.0 ± 2.4) points; while the recovery rate of limb function were 85% to 100% (90.00% ± 7.89%) and the TESS were 85% to 100% (93.65% ± 5.47%). No patients exhibited tumour recurrence over the period of follow-up.Conclusion:The supercharged gracilis myocutaneous flap is a safe and effective myocutaneous flap. It serves as an effective method for soft tissue reconstruction after surgical resection of STS in extremities.

Objective:To evaluate the safety and efficacy of digital technology-assisted debridement and bone and soft tissue reconstruction in the treatment of chronic osteomyelitis of the tibia.Methods:This retrospective study analyzed clinical data from 38 patients (26 males, 12 females; mean age 45.61±18.36 years, range 16-83 years) with chronic post-traumatic osteomyelitis complicated by soft tissue defects in the tibia, treated at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital between June 2021 and June 2023. There were 18 cases of traffic accidents, 6 cases of high-altitude falls, 6 cases of heavy objects and 6 cases of low-energy falls. Lesion sites: 12 cases in the upper segment of the tibia, 12 cases in the middle segment, and 14 cases in the lower segment. According to the Cierny-Mader classification, there were 24 cases of type III and 14 cases of type IV. Before the operation, the "3D point cloud technology" was used to plan the debridement range of bone and soft tissue. During the operation, the optical navigation system was used to monitor the debridement range in real time. The flap was designed by combining "Reading Tablet Treasure" with CT angiography, and the amount of bone graft was predicted by AI algorithm. The surgical method adopted is the Masquelet technique, namely thorough debridement, bone cement occupation and soft tissue repair in the first stage, and bone reconstruction in the second stage. Comparing the calculated bone defect amount and soft tissue defect area before the operation with the actual measured values after debridement. The cure rate of infection was evaluated by using the McKee bone infection treatment criteria after the operation. The visual analogue scale (VAS) for pain, lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) were used to evaluate the improvement of the quality of life of postoperative patients.Results:38 patients were followed up with a mean follow-up of 13.53±2.37 months. 37 patients' infections were effectively controlled, and 1 patient had a recurrence of infection, with an effectiveness rate of 97% for the treatment of McKee's infections. The preoperative calculated bone defect amount and soft tissue defect area were 51.05±26.31 cm 3 and 68.42±43.45 cm 2 respectively, and the actual measured values after debridement during the operation were 51.66±26.35 cm 3 and 68.82±43.76 cm 2 respectively. There was no statistically significant difference before and after the operation ( P>0.05). The interval between the first and second stage surgeries was 10.36±1.61 weeks, and all flaps survived after the first stage surgery. Two months after the operation, one case had recurrent osteomyelitis. After palliative treatment, sinus tracts were formed at the infection site. At the 12-month regular dressing change follow-up, there were still purulent secretions in the sinus tracts. There was no recurrence of infection after primary debridement in 37 cases, and the bone grafts healed. The bone healing time was 3.58±0.97 months. The postoperative VAS, LEFS, and SAS scores were 1.00±0.91, 66.68±7.91, and 34.30±4.29, respectively, which were significantly improved compared with the preoperative scores of 7.54±1.52, 21.22±4.29, and 52.70±6.74, respectively, and the difference was statistically significant ( P<0.05). Conclusions:The application of digital technology to precisely design the debridement range of bone and soft tissue, and the real-time holographic visualization monitoring of the debridement range during the operation can achieve precise debridement of bone and soft tissue and personalized and precise repair of soft tissue defects. It is a safe and effective technique for the treatment of chronic osteomyelitis of the tibia.

Objective:To investigate the efficacy of the supercharged gracilis myocutaneous flap in reconstruction of the surgical defects following resection of soft tissue sarcoma (STS) in extremities.Methods:A retrospective analysis was conducted on 6 patients who received surgery to remove STS in extremities followed by reconstructive surgery with a supercharged gracilis myocutaneous flap to reconstruct the surgical defect (16.0 cm×4.8 cm-25.0 cm×8.0 cm), at the Department of Microsurgery, the 4th Medical Centre, Chinese PLA General Hospital between January 2023 and January 2024. The locations of sarcoma were: 3 in left forearm, 2 in right calf and 1 in left calf. The pathological types of the sarcoma were: 1 of myxoid liposarcoma, 1 of dedifferentiated liposarcoma, 1 of alveolar rhabdomyosarcoma, 1 of low-grade myxofibrosarcoma and 2 of fibrosarcoma. According to the Enneking classification, 2 sarcomas were in stage I and 4 in stage Ⅱa. All patients underwent expanded resection of the sarcoma and followed by reconstruction of the surgical defect with supercharged gracilis myocutaneous flap. The flap size ranged from 18.0 cm×5.2 cm to 27.7 cm×10.2 cm, with the length of the muscle flap at 25.92 cm±5.57 cm and 17.0 cm×2.8 cm×2.7 cm-32.0 cm×6.0 cm×3.5 cm in volume. The surgical defects were filled with muscle flaps, while the wounds were covered by cutaneous flaps. The perforating branches of the deep femoral artery carried by proximal vascular pedicle of the myocutaneous flap were anastomosed end-to-end with the prominent vessels of the recipient site. Where, the perforators of the distal femoral artery of the myocutaneous flap were anastomosed end-to-end with the recipient vessels for external blood perfusion, and the great saphenous vein of the flap was anastomosed end-to-end with the superficial veins of the recipient site. All donor sites were directly sutured. Scheduled postoperative follow-ups at outpatient clinic were conducted to assess the viability of the transferred myocutaneous flap. Limb function was evaluated using the Musculoskeletal Tumour Society-93 (MSTS-93) and the Toronto Extremity Salvage Score (TESS).Results:The postoperative follow-up lasted for 12 to 20 months. All 6 myocutaneous flaps survived without distal necrosis. All patients regained daily activities and functioned well. The MSTS-93 scores achieved 24 to 30 (27.0 ± 2.4) points; while the recovery rate of limb function were 85% to 100% (90.00% ± 7.89%) and the TESS were 85% to 100% (93.65% ± 5.47%). No patients exhibited tumour recurrence over the period of follow-up.Conclusion:The supercharged gracilis myocutaneous flap is a safe and effective myocutaneous flap. It serves as an effective method for soft tissue reconstruction after surgical resection of STS in extremities.

Objective : To investigate the mechanism of miRNAs in glycyrrhizic acid treatment of alcohol⁃induced liver injury in rats . Methods : 45 male SD rats were randomly divided into glycyrrhizin group , model group and control group . The rats in glycyrrhizin group were given 56% liquor and glycyrrhizin , the rats in model group were given 56% liquor , and the rats in control group were given distilled water for 8 weeks . The blood was collected and the serum was separated by centrifugation to detect the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) . RNA were extracted from liver tissues , miRNAs were detected by rat miRNA microarray , and their expression levels were analyzed . The miRNA target genes of differential miRNA were predicted . Gene Ontology (GO) and KEGG Pathway enrichment analysis were used to understand the function of differential miRNA , and the differential miRNA⁃mRNA⁃Pathway regulatory network was constructed using Cytoscape to further screen the regulatory key miRNA and key pathways . qRT⁃PCR was used to verify the expression of selected miRNA . Results : Compared with the model group , the glycyrrhizin group could significantly improve the liver tissue lesions , and reduce the liver serum AST and ALT levels (P < 0. 05) . Compared the microarray data of glycyrrhizin group and model group , a total of 13 differentially expressed miRNA were screened ( P < 0. 05 , fold change ≥ 1 . 5) , of which 10 were up⁃regulated and 3 were down⁃regulated . The GO classification annotation of differential miRNA target genes showed that differential miRNA were related to cell adhesion , antioxidant activity , metabolic process , biological process regulation , cell killing , immune system and other functions . The KEGG Pathway analyling pathway , Hippo signaling pathway , PI3K⁃Akt signaling pathway , wnt signaling pathway , apoptosis and other signaling pathways might play an important regulatory role in the improvement of alcoholic liver injury by glycyrrhic acid . Conclusion This study established the miRNA expression profile of glycyrrhizin in the treatment of alcoholic liver injury in rats , suggested that miR⁃615 , miR⁃107 ⁃3p and miR⁃292⁃5p might play an important role in the treatment of alcoholic liver injury by glycyrrhizin .

Objective:To explore the surgical method and clinical effect of correcting lateral type alar retraction with intercartilaginous graft and lateral crural strut graft.Methods:A retrospective study was performed on the data of patients with moderate to severe lateral alar retraction treated in Shenzhen Mylike Medical Plastic Aesthetic Hospital from October 2018 to June 2020. During the operation, lower lateral cartilages was totally dissected and strengthened by lateral crural strut graft while scroll area was released and lengthened with intercartilaginous graft to correct lateral type alar retraction. The preoperative and postoperative distance from the nostril’s long axis to the alar rim was measured from the side view, the nasal measurements were expressed as Mean±SD, and paired t-test was used for statistical analysis. Results:A total of 32 patients were enrolled, including 5 males and 27 females, with an average age of 31 years (18-47 years). Twenty-three cases underwent primary rhinoplasty and 9 cases underwent second rhinoplasty. The preoperative data of distance from the nostril’s long axis to the alar rim was (4.1±0.5) mm (3.2-5.0 mm). The postoperative effect of nasal alar retraction defomity correction was obvious. After a follow-up period of 20 cases from 6 to 18 months, the distance from the nostril’s long axis to the alar rim was 1.5-2.8 mm [(2.1±0.3) mm on average]. Comparison of preoperative and postoperative measured values showed statistically significant difference ( P<0.01). There was 1 patient emerged complication alar flaring, and no contracture and deformation of the nasal rim occurred. All of patients were satisfied. Conclusions:The intercartilaginous graft combined with lateral crural strut graft is an effective new method for correction of lateral type alar retraction. It has stable clinical effect and high satisfaction.

Objective:To explore the surgical method and clinical effect of correcting lateral type alar retraction with intercartilaginous graft and lateral crural strut graft.Methods:A retrospective study was performed on the data of patients with moderate to severe lateral alar retraction treated in Shenzhen Mylike Medical Plastic Aesthetic Hospital from October 2018 to June 2020. During the operation, lower lateral cartilages was totally dissected and strengthened by lateral crural strut graft while scroll area was released and lengthened with intercartilaginous graft to correct lateral type alar retraction. The preoperative and postoperative distance from the nostril’s long axis to the alar rim was measured from the side view, the nasal measurements were expressed as Mean±SD, and paired t-test was used for statistical analysis. Results:A total of 32 patients were enrolled, including 5 males and 27 females, with an average age of 31 years (18-47 years). Twenty-three cases underwent primary rhinoplasty and 9 cases underwent second rhinoplasty. The preoperative data of distance from the nostril’s long axis to the alar rim was (4.1±0.5) mm (3.2-5.0 mm). The postoperative effect of nasal alar retraction defomity correction was obvious. After a follow-up period of 20 cases from 6 to 18 months, the distance from the nostril’s long axis to the alar rim was 1.5-2.8 mm [(2.1±0.3) mm on average]. Comparison of preoperative and postoperative measured values showed statistically significant difference ( P<0.01). There was 1 patient emerged complication alar flaring, and no contracture and deformation of the nasal rim occurred. All of patients were satisfied. Conclusions:The intercartilaginous graft combined with lateral crural strut graft is an effective new method for correction of lateral type alar retraction. It has stable clinical effect and high satisfaction.

Pentostatin is a nucleoside antibiotics with a strong inhibitory effect on adenosine deaminase, and is widely used in the clinical treatment of malignant tumors. However, the high cost hampers its application. In the past 10 years, the biosynthesis of pentostatin were focused on strain breeding, optimization of medium composition and fermentation process. To date, there are no reviews summarizing the elucidated biosynthetic mechanism of pentostatin. This review starts by introducing the various chemical route for production of pentostatin, followed by summarizing the mechanisms of pentostatin biosynthesis in different microorganisms. Finally, challenges for biosynthesis of pentostatin were discussed, and strategies for regulating and improving the microbial synthesis of pentostatin were proposed.
Anti-Bacterial Agents ; Pentostatin

Objective:To investigate the clinical characteristics and risk factors for patients with chronic periprosthetic joint infection (PJI) combined with sinus tract.Methods:The patients with PJI following hip and knee arthroplasty from July 2014 to January 2020 in our institution were retrospectively reviewed. There were 96 males and 101 females, aged from 26 to 86 years with mean age of 62.02±13.54 years. There were 95 hip PJI patients (48.2%, 95/197), 102 knee PJI patients (51.8%, 102/197), 68 patients (34.5%, 68/197) with sinus tract, 129 patients (65.5%, 129/197) without sinus tract, 162 patients (82.2%, 162/197) with positive culture results and 35 patients (17.8%, 35/197) with negative culture results. The patients were divided into two groups according to the sinus tract formation. The diagnosis of PJI was based on the 2011 Musculoskeletal Infection Society (MSIS) criteria. All of the included patients underwent serological laboratory tests (white blood cell count, neutrophil percentage, lymphocyte percentage, hemoglobin, platelet count, mean platelet volume, urea, creatinine, albumin, erythrocyte sedimentation rate, C-reactive protein) and pathogen isolation. The influence of sinus tract on the above test and the effects of complications on sinus tract formation were analyzed. We further investigated the relationship between sinus tract formation and the features of pathogen. In addition, the risk factors for sinus tract formation were analyzed.Results:The mean values of all serological tests were without statistical difference between the groups with and without sinus tract ( P>0.05). The presence of complications had no effect on the occurrence of sinus tract ( P>0.05). The incidence of sinus tract with highly virulent pathogen infection group (52.1%, 25/48) was significantly higher than that in low virulence pathogen group (27.5%, 19/69), in culture negative patients (40.0%, 14/35) and in other cases (22.2%, 10/45; χ 2=11.519, P=0.009). There was no statistical difference between groups based on the Gram staining, antibiotic resistance and polymicrobial infection. Multivariate logistic regression analysis revealed positive associations of extra joint infections ( OR=4.426, 95% CI: 1.095, 17.884) and high virulent pathogen infections ( OR=2.633, 95% CI: 1.171, 5.918) and negative association of age ≥70 ( OR=0.436, 95% CI: 0.205, 0.927) with the risk of sinus tract formation. Conclusion:The presence of sinus tract has no effect on the routine serum tests in patients with chronic PJI. There is only virulence factor which might affect sinus tract formation. For patients with the extra joint infections and high virulence pathogen infections, the formation of sinus tract should be vigilant during treatment.

The article reviewed the research progress of ligustilide in recent years and elaborated its pharmacological functions and mechanisms in detail,especially in ischemic brain injury.Its mechanism includes reducing cerebral infarct volumes and improving neurobehavioral deficits,anti-oxidant and anti-apoptosis,antithrombotic activity,calcium channel blockers function,and effect on erythropoietin.Other pharmacological effects of ligustilide including inhibiting vascular smooth muscle cell proliferation,anti-inflammatory and analgesic effects,effects on LPS-induced endotoxic shock,inhibiting constriction effect,suppression of the central nervous system,and ameliorating the memory impairment induced by scopolamine and so on,are also introduced.Ligustilide has potential pharmacological value,which provides a reference for its further research and development.