OBJECTIVE: To evaluate the effectiveness of free medial femoral condyle (MFC) functional chimeric perforator flap (FCPF) transplantation in reconstructing joint function by repairing concomitant osteochondral defects and soft tissue defect in hand and foot joints. METHODS: A retrospective analysis was performed on 6 patients (5 males, 1 female; mean age of 33.4 years, range 21-56 years) with traumatic osteochondral joint defects and associated tendon, nerve, and soft tissue defects treated between January 2019 and November 2024. Defect locations included metacarpal heads (n=2), metacarpophalangeal joint (n=1), first metatarsal head (n=1), base of first proximal phalanx (n=1), and talar head (n=1), with soft tissue defects in all cases. Osteochondral defect sizes ranged from 1.5 cm×1.2 cm×0.7 cm to 4.0 cm×0.6 cm×0.6 cm, and skin defects ranged from 4 cm×3 cm to 13 cm×4 cm. The stage Ⅰ treatment included debridement, antibiotic-loaded bone cement filling of bone-cartilage defects, fracture internal fixation, and coverage with vacuum sealing drainage. Stage Ⅱ involved harvesting a free MFC- FCPF included an osteochondral flap (range of 1.5 cm×1.2 cm×0.7 cm to 4.0 cm×0.6 cm×0.6 cm), gracilis and/or semitendinosus tendon grafts (length of 4-13 cm), saphenous nerve graft (length of 3.5-4.0 cm), and a perforator skin flap (range of 6 cm×4 cm to 14 cm×6 cm), each with independent vascular supply. The flap was transplanted to reconstruct joint function. Donor sites were closed primarily or with skin grafting. Flap survival was monitored postoperatively. Radiographic assessment was used to evaluate bone/joint healing. At last follow-up, the joint function recovery was assessed. RESULTS: All 6 MFC-FCPF survived completely, with primary healing of wounds and donor sites. All patients were followed up 6-44 months (mean, 23.5 months). The flaps at metacarpophalangeal joint in 1 case and at ankle joint in 1 case were treated with degreasing repair because of their bulky appearance, while the other flaps had good appearance and texture. At 3 months after operation, the visual analogue scale (VAS) score for pain during joint movement of recipient site was 0-2, with an average of 0.7; at last follow-up, the VAS score of the donor site was 0-1, with an average of 0.3. According to the Paley fracture healing scoring system, the osteochondral healing of all the 6 patients was excellent. The range of motion of the metacarpophalangeal joint in 3 cases was 75%, 90%, and 100% of contralateral side respectively, the range of motion of the metatarsophalangeal joint in 2 cases was 65% and 95% of contralateral side respectively, and the range of motion of the ankle joint in 1 case was 90% of contralateral side. The hand function was evaluated as excellent in 2 cases and good in 1 case according to the upper limb function evaluation standard of the Chinese Medical Association Hand Surgery Society, and the foot function was evaluated as excellent in 2 cases and fair in 1 case according to the Maryland foot function score of 93, 91, and 69, respectively. The International Knee Documentation Committee (IKDC) score of 6 knees was 91-99, with an average of 95.2. CONCLUSION The free MFC-FCPF enables precise anatomical joint reconstruction with three-dimensional restoration of tendon, nerve, capsule, and soft tissue defects, effectively restoring joint function and improving quality of life.
Humans ; Male ; Adult ; Female ; Middle Aged ; Retrospective Studies ; Plastic Surgery Procedures/methods* ; Soft Tissue Injuries/surgery* ; Perforator Flap/blood supply* ; Femur/surgery* ; Young Adult ; Foot Joints/injuries* ; Treatment Outcome

Objective To evaluate the safety and effectiveness of excessive dynamic airway collapse(EDAC)treated by laser.Methods 13 patients with EDAC confirmed by bronchoscopy from January 2018 to August 2022 were selected and divided into a simple EDAC group(6 cases)and an EDAC combined with tracheobronchomalacia(TBM)group(7 cases)based on whether they were combined with TBM.All patients underwent laser tracheobronchoplasty under bronchoscope.Symptoms,airway collapse,oxygenation index,modified version of British Medical Research Council dyspnoea scale(mMRC)and 6 min walking test before and after treatment were compared to evaluate the therapeutic effect.Results 13 patients underwent 17 times of laser tracheobronchoplasty with laser power of 8～15 W,and 4 patients underwent 2 times of laser tracheobronchoplasty.After treatment,the clinical symptoms of cough,sputum,shortness of breath and dyspnea were improved in all patients.1 week post-treatment,the EDAC group showed a significant improvement in airway lumen stenosis,with a significant statistical difference(P<0.05),1 month post-treatment,enhancements were observed in airway stenosis,oxygenation index,FEV1%,6-minute walk test,and mMRC,which remained stable over a 6 month follow-up.In the EDAC + TBM group,significant enhancements in airway stenosis,oxygenation index,and mMRC were noted 1 week post-treatment,with statistical significance(P<0.05).Between 8 d～6 months post-treatment,some patients exhibited a recurrence of airway stenosis,necessitating comprehensive interventions like balloon dilation,cryotherapy,and stent insertion.Local necrosis and granuloma occurred in some patients after laser therapy,and no serious complications associated with laser intervention were found in all patients.Conclusion Laser tracheobronchoplasty is a safe and effective technique for the treatment of EDAC.For patients with EDAC alone,the therapeutic effect is good,but for patients with EDAC combined with TBM,the long-term effect is not good.

Background/Aims: Despite the high efficacy of direct-acting antivirals (DAAs), approximately 1–3% of hepatitis C virus (HCV) patients fail to achieve a sustained virological response. We conducted a nationwide study to investigate risk factors associated with DAA treatment failure. Machine-learning algorithms have been applied to discriminate subjects who may fail to respond to DAA therapy. Methods: We analyzed the Taiwan HCV Registry Program database to explore predictors of DAA failure in HCV patients. Fifty-five host and virological features were assessed using multivariate logistic regression, decision tree, random forest, eXtreme Gradient Boosting (XGBoost), and artificial neural network. The primary outcome was undetectable HCV RNA at 12 weeks after the end of treatment. Results: The training (n=23,955) and validation (n=10,346) datasets had similar baseline demographics, with an overall DAA failure rate of 1.6% (n=538). Multivariate logistic regression analysis revealed that liver cirrhosis, hepatocellular carcinoma, poor DAA adherence, and higher hemoglobin A1c were significantly associated with virological failure. XGBoost outperformed the other algorithms and logistic regression models, with an area under the receiver operating characteristic curve of 1.000 in the training dataset and 0.803 in the validation dataset. The top five predictors of treatment failure were HCV RNA, body mass index, α-fetoprotein, platelets, and FIB-4 index. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model (cutoff value=0.5) were 99.5%, 69.7%, 99.9%, 97.4%, and 99.5%, respectively, for the entire dataset. Conclusions Machine learning algorithms effectively provide risk stratification for DAA failure and additional information on the factors associated with DAA failure.

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Objective:To investigate Mycoplasma pneumoniae pneumonia (MPP) infected by Mycoplasma pneumoniae (MP) in children of different age and gender admitted to the Pediatric and Respiratory Departments of 31 public hospitals in different regions of Shandong province in autumn and winter, and to further analyze the epidemiological characteristics of MPP in children.Methods:A cross-sectional study was conducted to collect and summarize basic information, epidemiological characteristics of children with MPP, laboratory and etiological test results of hospitalized from 31 public hospitals in Shandong Province from September 1, 2021 to December 15, 2021 through questionnaire issuance.The differences between groups were compared by the χ2 test. Results:Among 39 970 children hospitalized in 31 hospitals from September 1, 2021 to December 15, 2021, 17 613 were diagnosed with MPP, with a prevalence rate of 44.07%.There were more children diagnosed with MPP in Eastern Shandong than those in other regions.Serological tests were the main method of confirming the disease (16 730 cases, 76.06%). The combined infections in MPP patients were primarily caused by the influenza B virus and Streptococcus pneumoniae.A total of 33.03% (5 817/17 613 cases)of children with MPP underwent bronchoscopy.The main indication was atelectasis, and mucosal erosion/ulcers were found in most of the children.The main complication of MPP was pleural atelectasis (23.47%, 4 133/17 613 cases). Severe intrapulmonary and extrapulmonary complications also occurred in some patients, including necrotizing pneumonia (0.53%, 94/17 613 cases), pulmonary embolism (0.16%, 29/17 613 cases) etc. Conclusions:The prevalence of MPP in children in Shandong province is high in autumn and winter.It is necessary to pay attention to the clinical examination indicators of hospitalized children with MPP, actively give treatment to children with MPP, prevent the occurrence of complications, and promote the physical recovery of children.

OBJECTIVE: To obtain eripheral blood mesenchymal stem cells (PBMSCs) from sheep and rabbits by continuous mobilization of granulocyte colony-stimulating factor (G-CSF), and by comparing the success rates, cell yields and biological characteristics of the two sources of PBMSCs, and to provide the experimental basis for the preclinical study of PBMSCs transplantation to repair articular cartilage injury and cartilage tissue engineering. METHODS: Through morphological characteristics, flow cytometry analysis of its surface markers, and induction of trilineage differentiation of the two cells in vitro (ie: adipogenic differentiation, osteogenic differentiation, chondrogenic differentiation), the obtained cells were finally confirmed to be PBMSCs. The colony-forming units (CFUs) and the acquisition success rates of the two PBMSCs were counted and compared, and the production of the second generation of the two PBMSCs was counted and compared by hemocytometer, and the cell counting kit-8 was used to detect the doubling time of the two PBMSCs, and the results of trilineage differentiation were quantitatively analyzed by image processing. RESULTS: Microscopically, the PBMSCs of fusiform sheep and rabbits were arranged in fish group, and the second generation of sheep and rabbit PBMSCs expressed CD44 and CD90, but not CD34 and CD45. The induction of trilineage differentiation of the two cells in vitro were successful. The CFUs of primary sheep and rabbits PBMSCs were: 7.27±1.56, 5.73±1.62, and the success rate of acquisition of sheep and rabbits PBMSCs were 78.57% and 36.67%. The number of the second-generation sheep and rabbits PBMSCs that obtained per milliliter of peripheral blood were: 29 582±2 138, 26 732±2 286, and the cell doubling times (h) of the third-generation sheep and rabbits PBMSCs were: 22.32±0.28, 33.21±0.64, the cell doubling time (h) of the fourth generation sheep and rabbits PBMSCs were: 23.62±0.56, 35.30±0.38, and the quantitative lipid ratio of sheep and rabbit PBMSCs were: 7.77%±3.81%, 17.05%±1.52%, sheep and rabbit PBMSCs chondroglobus acid mucopolysaccharide positive ratios were: 11.67%±0.53%, 8.14%±0.57%. There were statistical differences among the above groups (P < 0.05). CONCLUSION The continuous mobilization of G-CSF to obtain sheep PBMSCs is more efficient. Sheep PBMSCs have more abundant yield and stronger proliferation ability.Sheep PBMSCs can produce more acidic mucopolysaccharides and have lower adipogenic abi-lity under appropriate conditions. Sheep PBMSCs have good research prospects in repair of articular cartilage injury with autologous stem cell transplantation and preclinical animal in vivo experiment of cartilage tissue engineering.This experiment provides further experimental basis for this kind of research.
Sheep ; Rabbits ; Animals ; Osteogenesis ; Hematopoietic Stem Cell Transplantation ; Cells, Cultured ; Transplantation, Autologous ; Mesenchymal Stem Cells ; Cell Differentiation ; Cartilage, Articular/injuries* ; Granulocyte Colony-Stimulating Factor

Objective To investigate the pollution levels of six indicator polychlorinated biphenyls (PCBs) in animal-derived foods in Hebei Province. Methods A total of 96 food samples (including beltfish, snakehead, egg, pork liver, pork and beef meat) were collected from Hebei Province in 2019. The contents of six indicator PCBs (PCB 28, PCB 52, PCB 101, PCB 138, PCB 153 and PCB180) in different food samples were determined using isotope dilution-high resolution gas chromatography-high resolution mass spectrometry (HRGC-HRMS). Results The contents of indicative PCBs in fish samples ranged from 0.12 to 0.32 ngg-1 fresh weight, while the content of PCBs in other samples ranged from 0.11 to 1.10 ng g-1 fat. PCB 138 and PCB 153 were the main compounds detected in fish samples, while PCB 28 and PCB 52 were the main compounds detected in other samples. The average estimated daily dietary intake of PCBs for residents in Hebei Province was 0.14 ng kg^-1·bw^-1·d^-1, and the highest contribution rate was beltfish (61.52%). Conclusion The pollution levels of indicator PCBs in animal-derived foods in Hebei Province are relatively low, and the residents has lower health risks through dietary intake of indicator PCBs.

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.

The function of drugs is based on the interaction between drug molecules and their targets.Qualitative analysis and quantitative detection of drug-target interactions run through the whole process from drug discovery to clinical practice.After decades of development, the study methods on the interaction between drug molecules and target proteins have been transformed from traditional biochemical experiments to a diversity of efficient and accurate technology systems supported by advanced molecular biology and biophysics theory.In this review, representative methods and techniques were introduced from aspects of target discovery and validation, affinity determination, interaction sites and structural analysis, which might provide some references for drug discovery and mechanism exploration.