Objective:To compare the efficacy of Ilizarov ring external fixation and unilateral rail external fixation in the treatment of infected bone defects following surgery for tibial fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 50 patients with infected bone defects after surgery for tibial fractures, who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from August 2019 to November 2021, including 37 males and 13 females, aged 19-59 years [(42.2±8.8)years]. After debridement and osteotomy, 28 patients were treated with Ilizarov ring external fixation (Ilizarov group) and 22 with unilateral rail external fixation (unilateral fixation group). All the patients in the two groups had previously undergone internal fixation with plates or Kirschner wires for tibial fracture before bone transport. Bone transport started at one week for three stages after successful infection control and osteotomy and was conducted. The following parameters were compared between the two groups: frame-wearing time and healing index after bone transport, self-rating anxiety scale (SAS) grade at 6 months after bone transport, Paley score and Association for the Study and Application of the Method of Ilizarov (ASAMI) score at the last follow-up, Hospital for Special Surgery (HSS) knee score and Baird-Jackson ankle score on admission, after external fixator removal and at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 28-36 months [(32.5±1.6)months]. There were no significant differences in frame-wearing time or healing index between the two groups after bone transport ( P>0.05). At 6 months after bone transport, the SAS grade in the unilateral fixation group (13 patients with mild anxiety, 8 with moderate anxiety, and 1 with severe anxiety) was better than that in the Ilizarov group (6 patients with mild anxiety, 19 with moderate anxiety, 3 with severe anxiety) ( P<0.01). No significant differences were found in the Paley score or ASAMI score between the two groups at the last follow-up ( P>0.05). There were no significant differences in HSS knee score or Baird-Jackson ankle score between the two groups on admission, after external fixator removal or at the last follow-up ( P>0.05). No significant differences were observed in the incidence of pin tract infection, poor healing, infection in the bone elongation area, or re-fracture between the two groups ( P>0.05). The incidence of postoperative axial deviation was 0 in the Ilizarov group, lower than 18% in the unilateral fixation group (4/22) ( P<0.05). Conclusion:Although Ilizarov ring external fixation and unilateral rail external fixation demonstrate comparable efficacy in the treatment of infected bone defects after surgery for tibial fractures, the former provides superior mechanical stability and postoperative axial deviation correction, while the latter offers advantages in reducing psychological burden and enhancing treatment tolerance.

Objective To investigate the correlation between serum levels of phosphoglycerate mutase family member 5(PGAM5)and YT521-B homology N6-methyladenosine RNA binding protein 2(YTHDF2)with ventricular remodeling and prognosis in patients with heart failure with preserved e-jection fraction(HFpEF).Methods A total of 175 HFpEF patients(HFpEF group)were selected as subjects,and 90 healthy volunteers undergoing physical examinations were chosen as the control group.The HFpEF patients were divided into adverse prognosis group(n=61)and favorable progno-sis group(n=114)based on their prognosis status.Serum PGAM5 and YTHDF2 levels were meas-ured using enzyme-linked immunosorbent assay.Ventricular remodeling indicators[left ventricular posterior wall thickness(LVPWT),left ventricular end-diastolic diameter(LVEDD),interventricular septal thickness at end-diastole(IVST)and left ventricular mass index(LVMI)]were assessed by transthoracic echocardiography.Pearson correlationanalysis was used to analyze the relationship be-tween serum PGAM5 and YTHDF2 levels and ventricular remodeling indicators.The relationships of serum PGAM5 and YTHDF2 levels with the prognosis of HFpEF patients,as well as predictive effi-cacy,were evaluated using multivariate unconditional logistic regression analysis and receiver oper-ating characteristic curve analysis,respectively.Results Levels of LVPWT,LVEDD,IVST,LVMI and YTHDF2 in the HFpEF group were significantly higher than those in the control group,while PGAM5 levels were significantly lower(P＜0.05).Serum PGAM5 levels in HFpEF patients showed negative correlations with LVPWT,LVEDD,IVST and LVMI,whereas YTHDF2 levels showed positive correlation(P＜0.05).The incidence of adverse prognosis among 175 HFpEF pa-tients was 34.86％(61/175).Significant differences were observed in age,New York Heart Asso-ciation(NYHA)heart function classification,N-terminal pro-B-type natriuretic peptide(NT-proBNP),LVPWT,LVEDD,IVST,LVMI,PGAM5 and YTHDF2 between the adverse prognosis group and favorable prognosis group.High levels of PGAM5 and YTHDF2 were independent protective and risk factors for adverse prognosis in HFpEF patients(P＜0.05).The area under the curve for predic-ting adverse prognosis in HFpEF patients using combined serum PGAM5 and YTHDF2 levels was 0.884,which was greater than the values obtained from individual predictions of 0.790 and 0.791(Z=3.722,3.373;P＜0.001).Conclusion Decreased serum PGAM5 levels and increased YTHDF2 levels are associated with worsening ventricular remodeling and poor prognosis in HFpEF patients.Combined measurement of serum PGAM5 and YTHDF2 levels shows high predictive effica-cy for the prognosis of HFpEF patients.

Objective·To investigate the immunotherapeutic effects of exosomes derived from leukemia cells with high expression of B7 molecules(co-stimulatory molecules CD80 and CD86)in tumor-bearing mice.Methods·L1210 leukemia cells were transfected with lentiviral vectors containing the CD80 and CD86 genes,and thereby the leukemia cells with high expression of CD80 and CD86 molecules were obtained.Exosomes LEX-8086 with high expression of CD80 and CD86 molecules were then isolated from the culture supernatant.The biological characteristics of LEX-8086 were analyzed by using transmission electron microscopy(TEM)and Western blotting.A DBA/2-leukemia tumor-bearing mouse model was established.The tumor-bearing mice were divided into LEX-8086 group and PBS group.The LEX-8086 group received intravenous injections of 500 μL LEX-8086(150 μg/mL)via the tail vein 7 d and 12 d after tumor cell inoculation,while the PBS group received injections of equal volumes of PBS at the same time points.Differences in body weight,tumor volume,tumor mass,and survival of the mice between the two groups were observed.Flow cytometry was used to analyze the changes in the immune cells in spleens and lymph nodes of the mice in both groups.Western blotting and real-time fluorescent quantitative PCR(qPCR)were used to detect the expression of markers for M1 and M2 macrophages in the spleens of the mice in both groups.Results·The exosomes LEX-8086 were isolated from the supernatant of L1210 cells overexpressing CD80 and CD86 molecules.TEM revealed that LEX-8086 exhibited a disc-shaped vesicular structure with a diameter of approximately 100 nm.Western blotting demonstrated the expression of exosome-specific markers.In the animal experiments,compared with the PBS group,the body weight of the LEX-8086 group showed no significant change,while both the tumor volume and the relative tumor mass ratio decreased significantly,and the survival was significantly prolonged(all P<0.05).Flow cytometry results indicated that the proportions of natural killer(NK)cells and CD4+T cells in the lymph nodes and spleens of the LEX-8086 group significantly increased(all P<0.05);as for CD8+T cells,they only increased in the lymph modes(P=0.012).Moreover,flow cytometry results showed that the proportion of M1 macrophages in the spleens of mice in the LEX-8086 group was significantly elevated(P=0.003),while the proportion of M2 macrophages remained unchanged.Western blotting and qPCR also revealed that the mRNA and protein expression levels of M1 macrophage markers interleukin-6 and tumor necrosis factor-α in the spleens of mice in the LEX-8086 group increased significantly(all P<0.05).Conclusion·Exosomes derived from leukemia cells with high expression of co-stimulatory molecules CD80 and CD86 can induce a therapeutic anti-leukemic effect,which may be achieved by increasing the proportions of NK cells,M1 macrophages,CD4+T cells,and CD8+T cells.

Objective·To investigate the immunotherapeutic effects of exosomes derived from leukemia cells with high expression of B7 molecules(co-stimulatory molecules CD80 and CD86)in tumor-bearing mice.Methods·L1210 leukemia cells were transfected with lentiviral vectors containing the CD80 and CD86 genes,and thereby the leukemia cells with high expression of CD80 and CD86 molecules were obtained.Exosomes LEX-8086 with high expression of CD80 and CD86 molecules were then isolated from the culture supernatant.The biological characteristics of LEX-8086 were analyzed by using transmission electron microscopy(TEM)and Western blotting.A DBA/2-leukemia tumor-bearing mouse model was established.The tumor-bearing mice were divided into LEX-8086 group and PBS group.The LEX-8086 group received intravenous injections of 500 μL LEX-8086(150 μg/mL)via the tail vein 7 d and 12 d after tumor cell inoculation,while the PBS group received injections of equal volumes of PBS at the same time points.Differences in body weight,tumor volume,tumor mass,and survival of the mice between the two groups were observed.Flow cytometry was used to analyze the changes in the immune cells in spleens and lymph nodes of the mice in both groups.Western blotting and real-time fluorescent quantitative PCR(qPCR)were used to detect the expression of markers for M1 and M2 macrophages in the spleens of the mice in both groups.Results·The exosomes LEX-8086 were isolated from the supernatant of L1210 cells overexpressing CD80 and CD86 molecules.TEM revealed that LEX-8086 exhibited a disc-shaped vesicular structure with a diameter of approximately 100 nm.Western blotting demonstrated the expression of exosome-specific markers.In the animal experiments,compared with the PBS group,the body weight of the LEX-8086 group showed no significant change,while both the tumor volume and the relative tumor mass ratio decreased significantly,and the survival was significantly prolonged(all P<0.05).Flow cytometry results indicated that the proportions of natural killer(NK)cells and CD4+T cells in the lymph nodes and spleens of the LEX-8086 group significantly increased(all P<0.05);as for CD8+T cells,they only increased in the lymph modes(P=0.012).Moreover,flow cytometry results showed that the proportion of M1 macrophages in the spleens of mice in the LEX-8086 group was significantly elevated(P=0.003),while the proportion of M2 macrophages remained unchanged.Western blotting and qPCR also revealed that the mRNA and protein expression levels of M1 macrophage markers interleukin-6 and tumor necrosis factor-α in the spleens of mice in the LEX-8086 group increased significantly(all P<0.05).Conclusion·Exosomes derived from leukemia cells with high expression of co-stimulatory molecules CD80 and CD86 can induce a therapeutic anti-leukemic effect,which may be achieved by increasing the proportions of NK cells,M1 macrophages,CD4+T cells,and CD8+T cells.

Objective:To compare the efficacy of Ilizarov ring external fixation and unilateral rail external fixation in the treatment of infected bone defects following surgery for tibial fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 50 patients with infected bone defects after surgery for tibial fractures, who were admitted to the 940th Hospital of the Joint Logistics Support Force of the PLA from August 2019 to November 2021, including 37 males and 13 females, aged 19-59 years [(42.2±8.8)years]. After debridement and osteotomy, 28 patients were treated with Ilizarov ring external fixation (Ilizarov group) and 22 with unilateral rail external fixation (unilateral fixation group). All the patients in the two groups had previously undergone internal fixation with plates or Kirschner wires for tibial fracture before bone transport. Bone transport started at one week for three stages after successful infection control and osteotomy and was conducted. The following parameters were compared between the two groups: frame-wearing time and healing index after bone transport, self-rating anxiety scale (SAS) grade at 6 months after bone transport, Paley score and Association for the Study and Application of the Method of Ilizarov (ASAMI) score at the last follow-up, Hospital for Special Surgery (HSS) knee score and Baird-Jackson ankle score on admission, after external fixator removal and at the last follow-up, and incidence of postoperative complications.Results:All the patients were followed up for 28-36 months [(32.5±1.6)months]. There were no significant differences in frame-wearing time or healing index between the two groups after bone transport ( P>0.05). At 6 months after bone transport, the SAS grade in the unilateral fixation group (13 patients with mild anxiety, 8 with moderate anxiety, and 1 with severe anxiety) was better than that in the Ilizarov group (6 patients with mild anxiety, 19 with moderate anxiety, 3 with severe anxiety) ( P<0.01). No significant differences were found in the Paley score or ASAMI score between the two groups at the last follow-up ( P>0.05). There were no significant differences in HSS knee score or Baird-Jackson ankle score between the two groups on admission, after external fixator removal or at the last follow-up ( P>0.05). No significant differences were observed in the incidence of pin tract infection, poor healing, infection in the bone elongation area, or re-fracture between the two groups ( P>0.05). The incidence of postoperative axial deviation was 0 in the Ilizarov group, lower than 18% in the unilateral fixation group (4/22) ( P<0.05). Conclusion:Although Ilizarov ring external fixation and unilateral rail external fixation demonstrate comparable efficacy in the treatment of infected bone defects after surgery for tibial fractures, the former provides superior mechanical stability and postoperative axial deviation correction, while the latter offers advantages in reducing psychological burden and enhancing treatment tolerance.

Objective To investigate the prognostic value of serum adenosine deaminase(ADA)and plas-minogen activator inhibitor 1(SERPINE1)levels in patients with type 2 diabetes mellitus(T2DM)complicat-ed with acute cerebral infarction(ACI).Methods A total of 195 patients with T2DM combined with ACI(ACI group)and 174 patients with T2DM alone(control group)admitted to Xi'an Labor Union Hospital from March 2019 to March 2023 were selected.The levels of serum ADA and SERPINE1 were compared be-tween ACI group and control group,and patients with different degrees of neurological defect and prognosis.The influencing factors of poor prognosis in T2DM patients with ACI were analyzed,and the value of each in-dex in predicting poor prognosis was evaluated.Results The levels of ADA and SERPINE1 in ACI group were significantly higher than those in control group(P＜0.05).With the aggravation of neurological deficit in T2DM patients with ACI,serum ADA and SERPINE1 levels increased(P＜0.05).The levels of serum ADA and SERPINE1 in the poor prognosis group were higher than those in the good prognosis group(P＜0.05).Severe neurological deficit and high levels of ADA,SERPINE1 and HbA1c were risk factors for poor prognosis in T2DM patients with ACI(P＜0.05).The area under the curve(AUC)of ADA combined with SERPINE1 for predicting the prognosis of T2DM patients with ACI was 0.896,which was higher than that of Ada and SERPINE1 alone(P＜0.05).Conclusion Elevated serum ADA and SERPINE1 levels are associated with severe neurological deficits and poor prognosis in T2DM patients with ACI.Combined detection of ADA and SERPINE1 can predict poor prognosis in T2DM patients with ACI.

Objective:To investigate the association of exposure to PM 2.5 and its constituents during pregnancy and fetal growth and to further identify critical windows of exposure for fetal growth. Methods:We included 4 089 mother-child pairs from the Jiangsu Birth Cohort Study between January 2016 and October 2019. Data of general characteristics, clinical information, daily average PM 2.5 exposure, and its constituents during pregnancy were collected. Fetal growth parameters, including head circumference (HC), abdominal circumference (AC), and femur length (FL), were measured by ultrasound after 20 weeks of gestation, and then estimated fetal weight (EFW) was calculated. Generalized linear mixed models were adopted to examine the associations of prenatal exposure to PM 2.5 and its constituents with fetal growth. Distributed lag nonlinear models were used to identify critical exposure windows for each outcome. Results:A 10 μg/m 3 increase in PM 2.5 exposure during pregnancy was associated with a decrease of 0.025 ( β=-0.025, 95% CI: -0.048- -0.001) in HC Z-score, 0.026 ( β=-0.026, 95% CI: -0.049- -0.003) in AC Z-score, and 0.028 ( β=-0.028, 95% CI:-0.052--0.004) in EFW Z-score, along with an increased risk of 8.5% ( RR=1.085, 95% CI: 1.010-1.165) and 13.5% ( RR=1.135, 95% CI: 1.016-1.268) for undergrowth of HC and EFW, respectively. Regarding PM 2.5 constituents, prenatal exposure to black carbon, organic matter, nitrate, sulfate (SO 42-) and ammonium consistently correlated with decreased HC Z-score. SO 42- exposure was also associated with decreased FL Z-scores. In addition, we found that gestational weeks 2-5 were critical windows for HC, weeks 4-13 and 19-40 for AC, weeks 4-13 and 23-37 for FL, and weeks 4-12 and 20-40 for EFW. Conclusions:Our findings demonstrated that exposure to PM 2.5 and its constituents during pregnancy could adversely affect fetal growth and the critical windows for different fetal growth parameters are not completely consistent.

Humans ; Adult ; Invasive Pulmonary Aspergillosis ; Pneumonia, Viral/complications* ; Risk Factors ; Pulmonary Aspergillosis/complications*

Objective:To construct a recombinant herpes simplex virus 2 (HSV-2) expressing enhanced green fluorescent protein (EGFP) using clustered, regularly interspaced, short palindromic repeat/CRISPR-associated nuclease 9 (CRISPR/Cas9) technology.Methods:Four strategies for inserting exogenous EGFP gene into HSV-2 genome using CRISPR/Cas9 technology were designed: (1) conventional homology-directed repair: circular two homology arm donor-mediated gene knock-in; (2) linearized single homology arm donor-mediated gene knock-in; (3) homology-independent targeted integration; (4) conventional homology-directed repair-mediated by cell lines stably expressing Cas9 and sgRNA.Results:The recombinant virus HSV-2-EGFP was successfully constructed based on the second, the third and the fourth strategies. The second strategy was the most efficient, followed by the third and the fourth strategies. The purified recombinant virus could stably express green fluorescent protein in seven passages and shared similar growth characteristics in Vero cells to the parental virus.Conclusions:Linearized single homology arm donor could increase the efficiency of gene knock-in, and cell lines stably expressing Cas9 and sgRNA could increase the efficiency of gene knock-in mediated by homology-directed repair.

Objective:To investigate the effects of genomic location of a foreign gene in Shanghai-191 strain measles virus (MV) vector on gene expression and virus replication.Methods:The nucleotide sequence encoding S1 protein of SARS-CoV-2 was inserted at different positions in MV antigenome (the upstream of the N gene, between P and M genes, between H and L genes), and co-transfected into 293T cells with helper plasmids coding T7 RNA polymerase and N, P, and L proteins, respectively. The transfected cells were lysed and the supernatants were used to infected Vero cells to harvest recombinant viruses. S1 proteins expressed by the recombinant viruses were identified by RT-PCR, indirect immunofluorescence assay, Western blot and ELISA. Growth kinetics of the recombinant viruses were analyzed.Results:Recombinant viruses were failed to be rescued when the S1 protein-coding sequence was cloned into the upstream of N gene. Two recombinant viruses, MV-M-S1 and MV-L-S1, were successfully rescued when cloning the S1 protein-coding sequence into the intergenic region between P and M genes, or H and L genes, and could express S1 protein. MV-M-S1 expressed more S1 protein than MV-L-S1, but the titer of MV-M-S1 was lower.Conclusions:Inserting a foreign gene at different positions in the MV genome might have different effects on gene expression and virus replication. This study provided reference for the subsequent construction of MV vector.