Objective To evaluate the clinical effects of the treatment of recurrent anterior dislocation of shoulder in soldiers with bipolar lesions by arthroscopic Bankart repair and Remplissage surgery.Methods From February 2019 to March 2022,15 patients with recurrent anterior dislocation of shoulder in our hospital were selected,all of whom were male;The age ranged from 18～33(23.07±4.39)years,Beighton score was(4.40±1.89).4 cases of left shoulder and 11 cases of right shoulder.Preoperative CT evaluation of Hill-Sachs injury was(16.93±2.17)%.The range of motion was recorded,and the function and stability of the shoulder was evaluated by the American Shoulder and Elbow Surgeons(ASES)score and Constant-Murley score.Results All patients were followed up for 10～28(18.47±6.46)months.No patient had clinical complications such as infections,neurovascular injuries and redislocation.Shoulder flexion and lifting increased from(152.41±14.28)° pre-operatively to(167.48±10.23)° at the latest follow-up,and internal rotation,preoperative spinous process levels were T5 1 cases,T6 2 cases,T7 6 cases,T8 3 cases,T9 2 cases,T10 1 cases,postoperative spinous process levels were T5 1 cases,T6 1 cases,T7 3 cases,T8 6 cases,T9 4 cases,the average lateral external rotation and abduction 90° external rotation decreased from(60.31±13.43)°and(97.41±13.17)° pre-operatively to(51.23±14.27)° and(89.47±14.15)° at the latest follow-up,respectively.The ASES score and Constant-Murley score were significantly improved.Conclusion The clinical effect of rehabilitation of Bankart repair combined with Remplissage under arthroscopy in the treatment of recurrent dislocation of shoulder in soldiers with Bipolar lesions is satisfactory.Although the external rotation angle of shoulder is slightly decreased after operation,it can significantly reduce the recurrence rate of shoulder dislocations and return to the training.

Promoting wound healing is a common clinical challenge faced by surgeons, with a variety of repair method and materials currently available for clinical use. In recent years, with the continuous development of disciplines such as tissue engineering, regenerative medicine, and materials science, research on wound repair materials has progressed rapidly. This article will organize the classification, advantages and disadvantages, and the latest advancements in the preparation processes of wound repair materials. It will also discuss the current challenges faced by wound repair materials and future research directions, with the aim of providing a reference for related studies in wound repair.

Promoting wound healing is a common clinical challenge faced by surgeons, with a variety of repair method and materials currently available for clinical use. In recent years, with the continuous development of disciplines such as tissue engineering, regenerative medicine, and materials science, research on wound repair materials has progressed rapidly. This article will organize the classification, advantages and disadvantages, and the latest advancements in the preparation processes of wound repair materials. It will also discuss the current challenges faced by wound repair materials and future research directions, with the aim of providing a reference for related studies in wound repair.

Objective To investigate vascular remodeling and low-density lipoprotein(LDL)deposition,the growth and development trends of lateral branch plaques in bifurcated vessels,and the potential locations of subsequent plaque growth due to the presence of plaques.Methods An idealized model of bifurcated vessels was established and the distribution of wall shear stress before and after the growth of edge-branch plaques was obtained using computational fluid dynamics.Seven sections were intercepted in the areas of low shear stress:planes 1-3 were the low shear stress areas on the lateral branch before plaque formation,planes 4-5 were the proximal and distal edges of the plaque,and planes 6-7 were the lower shear stress areas of the plaque.Vascular remodeling and LDL deposition in the cross section were simulated.The growth and development trends of plaques are also discussed.Results Among planes 1-3,plane 2 produced obvious negative remodeling and the highest concentration of LDL deposition(102.266 mmol/L),thereby indicating that this was the initial location of the atherosclerotic plaque.Compared to plane 4,plane 5 produced more pronounced vascular remodeling,lumen narrowing,and the highest deposition concentration(110.17 mmol/L)after plaque formation,which indicated that the patch had a tendency for eccentric growth downstream.Compared to plane 6,plane 7(blood flow separation reattachment site)produced more negative remodeling and the highest deposition concentration(93.851 mmol/L),thereby indicating the possibility of new plaque formation near the reattachment point of blood flow separation.Conclusions Obvious vascular remodeling at low shear stress in the lateral branches leads to lumen stenosis and high LDL deposition,thus,forming atherosclerotic plaques.The lateral wall of the bifurcated blood vessels is the initial location of atherosclerotic plaque growth.After growth,the plaque tends to develop downstream,and subsequent plaques may form at the flow separation and reattachment points.

Objective:To investigate the clinical efficacy of arthroscopic modified anatomic glenoid reconstruction with Enden-Hybinette procedure combined with loop plate fixation in the treatment of recurrent anterior dislocation of shoulder combined with severe glenoid bone loss.Methods:A retrospective case series study was conducted to analyze 36 patients with recurrent anterior dislocation of the shoulder combined with severe glenoid bone loss who were admitted to 901st Hospital of the Joint Logistics Support Force of PLA from January 2019 to January 2021, including 28 males and 8 females, aged 18-33 years [(29.5±3.0)years]. All the patients had injury history. The dislocation frequency range was 2-40 times [(20.5±6.5)times]. Beighton scale scores were 3-9 points [(4.0±0.8)points]. All the patients underwent anatomic reconstruction of the glenoid bone with arthroscopic modified Enden-Hybinette procedure using iliac autograft and loop plate elastic fixation. Posterior glenoid version angle, the breadth of the glenoid cavity and the A-P glenoid cavity depth were measured and osseous anatomy of the reconstructed glenoid bone was evaluated. Union of the Iliac bone block and glenoid bone loss was observed and the absorption rate of the bone block was evaluated at 6 months after surgery. The shoulder stability score, functional activity score, joint range of motion score and total Rowe score of shoulder function were used to evaluate the shoulder stability, functional activity and movement before surgery, at 3, 6 months after surgery and at the last follow-up. The incidence of complications was observed.Results:All the patients were followed up for 12-24 months [(18.8±3.5)months]. At 1, 3, 6 months after surgery and at the last follow-up, posterior glenoid version angle was (11.3±1.7)°, (10.6±1.2)°, (9.1±2.0)° and (9.2±1.9)° respectively; the breadth of the glenoid cavity was (34.2±1.3)mm, (33.2±1.0)mm, (32.2±1.0)mm and (31.3±1.1)mm respectively; the A-P glenoid cavity depth was (2.6±0.1)mm, (2.4±0.1)mm, (2.3±0.2)mm and (2.2±0.2)mm respectively, which were all significantly improved compared with those before surgery [(-5.9±1.0)°, (24.3±1.2)mm and (0.6±0.1)mm respectively] ( P<0.01), with no significant differences among those at different postoperative time points ( P>0.05). Bony union was observed in the iliac bone block and glenoid bone loss after bone grafting in all the patients at 6 months after surgery and the iliac bone block resorption rate was (20.5±4.1)%. At 3, 6 months after surgery and at the last follow-up, the shoulder stability score was (41.5±6.1)points, (43.9±6.3)points and (44.7±5.0)points respectively; the functional activity score was (26.9±2.5)points, (27.1±2.5)points and (28.6±2.3)points respectively; the joint range of motion score was (13.9±1.0)points, (14.9±1.2)points and (15.8±1.5)points respectively; the total Rowe score of shoulder function was (81.4±11.5)points, (85.8±12.3)points and (86.4±9.8)points respectively, which were significantly improved compared with those before surgery [(6.1±1.5)points, (11.9±1.5)points, (8.5±1.4)points and (27.4±7.5)points respectively] ( P<0.01), with no significant differences among those at different postoperative time points ( P>0.05). At the follow-up, no complications such as incision infection, neurological injuries, implant failure of displacement, recurrent re-dislocation of the shoulder or osteoarthritis were observed. Conclusion:Arthroscopic modified anatomic glenoid reconstruction with Enden-Hybinette procedure combined with loop plate fixation in the treatment of recurrent anterior dislocation of shoulder combined with severe glenoid bone loss has the advantages of better osseous anatomy of the reconstructed glenoid bone, better bony union, satisfactory shoulder stability, functional restoration, etc.

Humans ; Aminoquinolines/therapeutic use* ; Carcinoma, Non-Small-Cell Lung/genetics* ; Lung Neoplasms/genetics* ; Mutation/genetics* ; Standard of Care

Objective:To evaluate the application of metagenomic next-generation sequencing (mNGS) in the diagnosis of osteoarticular infection.Methods:The clinical data of 37 inpatients aged 32-90 year with osteoarticular infection admitted in the Department of Spine Surgery of Qingdao Chest Hospital from January to December 2019 were retrospectively analyzed. There were 31 cases of spine infection and 6 cases of other joint infection. The tissue samples were obtained from the infected sites through puncture or surgical approach in all patients. The tissue samples were subjected to routine culture of mycobacteria, aerobic bacteria and anaerobic bacteria, respectively. The gene amplification and mNGS were performed for detection of mycobacterium tuberculosis DNA (MTB-DNA). The chi-square test or Fisher’s exact test were used to compare the detection rates of pathogen and simple bacterial infection between mNGS and conventional culture. The conventional culture, mNGS and MTB-DNA amplification detection were performed for all samples; with clinical diagnosis as the gold standard, the diagnostic values of 3 methods were evaluated with receiver operating characteristic curve (ROC). Paired sample t test was used to compare white blood cell(WBC) count, erythrocyte sedimentation rate, C-reactive protein of patients before and after treatment. P<0.05 was considered statistically significant. Results:The pathogens were detected by mNGS for 42 times: bacteria for 39 times (92.8%), fungi for twice (4.8%) and Kirks body for once (2.4%). Among 37 patients there were 29 cases of pure bacterial infection (78.4%), 2 cases of pure fungi infection (5.4%), 1 case of pure Kirks body infection (2.7%), and 5 cases of mixed infection of two or more pathogens (13.5%). The detection rates of mNGS and conventional culture were 100.0% (37/37) and 67.6% (25/37), respectively ( χ2=13.987, P<0.05). The detection rates of mNGS and conventional culture in 29 patients with pure bacterial infection were 100.0% (29/29) and 69.0% (20/29), respectively ( χ2=16.913, P<0.05). The area under the ROC curve (AUC) of conventional culture, mNGS, and MTB-DNA in the diagnosis of osteoarticular tuberculosis infection was 0.958 (95% CI: 0.866-1.000, P<0.05), 1.000 (95% CI: 1.000-1.000, P<0.05) and 0.958 (95% CI: 0.866-1.000, P<0.05). All the 37 patients were treated with anti-infective drugs according to the results of mNGS and conventional culture. Among them, 28 patients received surgical intervention. The patients were followed up until April 30, 2020, 1 patient died. After 3 months of follow-up, the WBC count, erythrocyte sedimentation rate and C-reactive protein were (5.5±1.5)×10 9/L, (41±38)mm/h and (5.0±4.6) mg/L, respectively, which were lower than those before anti-infection treatment [(8.0±2.9)×10 9/L, (79±42)mm/h and(63±52)mg/L] ( t=6.536, 8.302 and 6.373, all P<0.05). Conclusion:The metagenomic next-generation sequencing may have important clinical value in the differential diagnosis of osteoarticular infection.

Genomic instability remains an enabling feature of cancer and promotes malignant transformation. Alterations of DNA damage response (DDR) pathways allow genomic instability, generate neoantigens, upregulate the expression of programmed death ligand 1 (PD-L1) and interact with signaling such as cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) signaling. Here, we review the basic knowledge of DDR pathways, mechanisms of genomic instability induced by DDR alterations, impacts of DDR alterations on immune system, and the potential applications of DDR alterations as biomarkers and therapeutic targets in cancer immunotherapy.

Objective To summarize the practice experience of establishing a stable abdominal heart transplantation model combined with tail vein injection in mice. Methods In the preliminary experiment, 50 pairs of donor and recipient Kunming mice received isotransplantation, 40 pairs of donor and recipient C57BL/6J mice underwent isotransplantation. In the formal experiment, 10 pairs of donor and recipient C57BL/6J mice received isotransplantation, 30 pairs of Balb/c mice as the donor and C57BL/6J mice as the recipient received allotransplantation. The time of each step of the heart transplantation (including harvesting and dressing of the donor heart, vascular anastomosis of the recipient, etc.) was recorded. The duration of transplanted heart beat and the survival time of the recipient was observed daily after operation. The time required for tail vein injection in the transplanted mice was recorded. Pathological examination of the transplanted heart was performed at 30 d after isotransplantation (n=5) and 7 d after allotransplantation (n=5). Results In the formal experiment, the success rate of heart transplantation was 90%. The harvesting and dressing time of donor heart was (13.9±0.6) min. The cold ischemia time of the recipient was (14.2±1.2) min. The vascular anastomosis time was (34.2±3.1) min. The total operation time was (86.6±5.4) min. Postoperatively, the transplanted heart of the mice undergoing isotransplantation survived longer than 100 d. Pathological examination at postoperative 30 d demonstrated only a slight amount of inflammatory cell infiltration. The survival time of the mice receiving allotransplantation was (7.2±0.5) d due to rejection reaction. At postoperative 7 d, pathological examination showed a large quantity of inflammatory cells infiltrating into the myocardium, manifested with acute cellular rejection. The success rate reached 90% after over 200 times of tail vein injection. Conclusions In this study, a stable mouse abdominal heart transplantation model is successfully established. The mouse models in the preliminary experiment can be utilized for tail vein injection.

Objective To explore the feasibility and safety of visualization puncture combined with flexible ureteroscopy in the treatment of lower calyx stones.Method Visualization puncture combined with flexible ureteroscopy to treat the lower calyx stones was done in our center from January to August 2016 in our hospital.32 cases of patients were enrolled to have a retrospective analysis.There were 18 males and 14 females,aged from 25 to 65 years,with an average age of 43 years.The diameter of stone was 1.0-2.0 cm,with an average of (1.4 ± 0.6) cm.We used general anesthesia and then adjusted the surgery bed to operation side lateral elevation was 30 °-35.Flexible ureteroscopy with 200μm holmium laser was used firstly to break calculi as much as possible.Ultrasound-guided F4.8 visualization puncture system was used to establish F4.8 channel.The power option was 2001μm hohnium laser to crush calculus of the renal calculi to treat the calculus of the distal end of soft lens which still can not be touched by ureteroscopy.Routine nephrostomy tube was not placed.The soft ureter sheath F5 double-J tube,and indwelling balloon catheter were routinely placed.We removed the catheter after 1-2 days and the double J tube after 4 to 6 weeks.Results The flexible ureteroscopy lithotripsy operation time was 8-25 mins in all of the 32 patients.Visualization puncture channels were successfully established in 3-7 mins,and the visualized puncture stone search rate of 100％ (32/32).The success rate of first stage lithotripsy was 93.8％ (30/32).Two cases of lower calyx stones diverticulum diverted to PNCL due to poor visibility by bleeding.The operation time was 30-60 mins and the average of 45 mins.KUB review at day one after the surgery showed that there were residual stones in 5 cases.The stone free rate at one month after the surgery is 100.0％.The average postoperative hospital stay was (2.0 ± 1.5) days.There were uo bleeding,ureteral avulsion and perforation,septic shock,pleural effusion and intestinal injury and other serious complications.Conclusions Navigation ultrasound-guided visualization puncture combined with flexible ureteroscopy is safe and effective to treat lower calyx stones.