1.Platelet Metabolomics Analysis in Rats of Coronary Heart Disease with Blood Stasis Syndrome by Overexpression of Fibrinogen
Manli ZHOU ; Jiale ZHU ; Liping WANG ; Weixiong JIAN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(6):230-237
ObjectiveTo analyze the metabolomic characteristics of platelets in fibrinogen(FIB) overexpression rats of coronary heart disease with blood stasis syndrome(CHD-BSS), explore potential biomarkers, and investigate the mechanism of FIB overexpression on CHD-BSS. MethodsSD rats were randomly divided into BSS group and BSS+FIB overexpression group(BSS+FIB group), with 10 rats in each group. Both the BSS+FIB group and the BSS group were fed a high-fat diet combined with oral administration of vitamin D3 and subcutaneous injection of isoproterenol, but rats in the BSS+FIB group were overexpressed with FIB during the initial modeling stage by transfection with adeno-associated virus(AAV). The overexpression level of FIB in rat liver and plasma samples was detected by enzyme-linked immunosorbent assay(ELISA) and real-time fluorescence quantitative polymerase chain reaction(Real time PCR), as well as the expression level of liver FIB A(FGA) mRNA. The characteristics of metabolites in rat platelet samples were analyzed by ultra-high performance liquid chromatography-quadrupole-electrostatic field orbital trap high-resolution mass spectrometry(UPLC-Q-Exactive Orbitrap-MS), and the differential metabolites between groups were screened by principal component analysis(PCA) and orthogonal partial least squares-discriminant analysis(OPLS-DA), and the enriched pathways were analyzed. The accuracy of potential biomarkers in the diagnosis of CHD-BSS was evaluated by receiver operating characteristic(ROC) curve. The expression of autophagy related proteins phosphorylated adenosine monophosphate(AMP) activated protein kinase(p-AMPK)/AMPK, phosphorylated mammalian target of rapamycin(p-mTOR)/mTOR, microtubule-associated protein 1 light chain 3(LC3) Ⅱ/Ⅰ and p62 in platelets were detected by Western blot. ResultsCompared with the BSS group, the expression levels of FIB in liver and plasma samples of the BSS+FIB group were significantly increased(P<0.05, P<0.01), and the expression level of FIB mRNA in the liver was remarkably increased(P<0.01), indicating successful overexpression of FIB. Platelet metabolomics results showed significant differences in metabolic profiles between the BSS+FIB group and the BSS group, and a total of 25 significantly enriched metabolic pathways and 8 metabolites involved in these metabolic pathways, among which uric acid, guanosine and ribose 1-phosphate levels were up-regulated, while adenosine diphosphate(ADP), AMP, guanosine diphosphate(GDP), adenylosuccinate and norepinephrine levels were down-regulated. The diagnostic ability analysis of differential metabolites showed that all 8 differential metabolites had good diagnostic ability, with an area under the curve(AUC)>0.85. Western blot results showed that compared with the BSS group, the expression levels of p-mTOR/mTOR and p62 proteins in platelets of the BSS+FIB group was significantly reduced(P<0.01), while the expression levels of p-AMPK/AMPK and LC3Ⅱ/Ⅰ proteins were increased, but the difference was not statistically significant. ConclusionOverexpression of FIB can change the metabolic characteristics of CHD-BSS rat model, involving multiple aspects such as vascular endothelial injury, platelet activation and myocardial function damage. Among them, overexpression of FIB may enhance the occurrence of platelet autophagy, thereby inducing platelet activation and promoting thrombus formation.
2.Establishment of a method for detecting the potency of recombinant human coagulation factor Ⅶa for injection
Rong WU ; Liping WANG ; Jinye LANG ; Yue ZHU ; Jing ZHOU ; Xun LIU ; Jing NI ; Shunbo ZHOU ; Yaling DING
Chinese Journal of Blood Transfusion 2025;38(3):415-420
[Objective] To establish a method for detecting the potency of recombinant human coagulation factor Ⅶa for injection. [Methods] By adding the sample and factor Ⅶ deficient plasma to the sample cup and activating the reaction with prothrombin time assay reagent (PT reagent), the coagulation time of the sample was determined by the change in magnetic bead swing amplitude in the sample cup. The logarithm of coagulation time was inversely proportional to the logarithm of human factor Ⅶa potency. [Results] Under the experimental conditions, the specificity of the methodology was evaluated through spiked recovery, and the recovery rates ranged from 90.0% to 110.0%. Within the range from 0.125 to 1.000 IU/mL, there was a good linear response between the potency and coagulation time of the standard and sample, with correlation coefficients r>0.99. As for the accuracy and repeatability, the recovery rates of various concentrations detected in the stock solution were 101.0%, 100.0% and 112.0%, respectively, with RSD values of 2.6%, 4.0% and 0.0%, respectively. The recovery rates of various concentrations in finished product testing were 104.0%, 94.7% and 112.0%, respectively, with RSD values of 1.9%, 2.4% and 0.0%, respectively. As for the intermediate precision, the RSD were 4.5% and 3.7%, respectively. After treated with sample diluent, the sample was tested at room temperature for 6 hours and still exhibited relatively stable biological activity. [Conclusion] This detection method is accurate, stable, easy to operate and highly automated, and is suitable for detecting the potency of recombinant human coagulation factor Ⅶa for Injection.
3.Mechanism of Fibrinogen Overexpression in Influencing Coronary Heart Disease with Syndrome of Blood Stasis in Rats Based on Mitochondrial Quality Control System
Manli ZHOU ; Liping WANG ; Weixiong JIAN
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(10):149-158
ObjectiveTo study the effect and mechanism of fibrinogen (Fib) overexpression on mitochondrial quality control system in the rat model of coronary heart disease with the syndrome of blood stasis. MethodsForty male SD rats were randomly assigned into normal, model, Fib, and empty vector (AAV) groups, with 10 rats in each group. The model, Fib, and AAV groups were fed with a high-fat diet adaptively and administrated with 3×106 U·kg-1 vitamin D3 powder by gavage after 7 days and 2×106 U·kg-1 vitamin D3 solution after 14 days. After being fed with a high-fat diet for 7 weeks, rats in each group received subcutaneous injection of isoproterenol (5 mg·kg-1) for 3 days. During the modeling period, rats in the normal group were fed with ordinary feed without any special treatment. The changes in blood lipid and hemorheological indexes of rats in each group were measured. The aorta tissue was stained with hematoxylin-eosin (HE), and the standard lead Ⅱ electrocardiograms (ECGs) of rats in each group were recorded. Enzyme-linked immunosorbent assay (ELISA) and real-time PCR were employed to verify the overexpression levels of Fib in the liver and plasma. Western blotting was employed to determine the protein levels of mitofusin 2 (Mfn2), optic atrophy protein 1 (OPA1), dynamin-related protein 1 (Drp1), phosphorylated adenosine monophosphate-activated protein kinase (p-AMPK)/adenosine monophosphate-activated protein kinase (AMPK), peroxisome proliferator-activated receptor γ-coactivator-1α (PGC-1α), PTEN-induced putative kinase 1, and Parkin. Real-time PCR was employed to determine the mRNA levels of AMPK and PGC-1α in the myocardial tissue. The changes in levels of adenosine triphosphate (ATP) and adenosine monophosphate (AMP) in the myocardial tissue were determined by ELISA. ResultsCompared with the normal group, the other three groups showed elevated levels of total cholesterol and low-density lipoprotein cholesterol (P<0.01) and no significant changes in levels of triglyceride and high-density lipoprotein cholesterol. Compared with the model group, the Fib and AAV groups showed risen levels of total cholesterol (P<0.05, P<0.01). Compared with the normal group, the model and Fib groups presented increases in low shear viscosity and middle shear viscosity (P<0.05, P<0.01), and the Fib group showcased an increase in high shear viscosity (P<0.01). Compared with the model group, the Fib group showed increases in low shear viscosity, middle shear viscosity, and high shear viscosity (P<0.05, P<0.01). Compared with the Fib group, the AAV group demonstrated decreases in low shear viscosity, middle shear viscosity, and high shear viscosity (P<0.05, P<0.01). The normal group had an complete aortic structure with well arrangement of elastic fibers. In the model group, the vascular wall became thickened and the intima was rough with inflammatory infiltration. In the Fib group, the intima calcification formed a cavity structure and the intima was abnormally proliferated, while in the AAV group, the intima smooth muscle was slightly proliferated with local calcification. The ECG of the normal group indicated sinus rhythm, and that of the model group presented ST segment oblique elevation (>0.1 mV). The ECG of the Fib group presented characteristic ST segment arch back elevation with T-wave towering, and that of the AAV group presented ST segment oblique elevation. Compared with the normal group, the model and Fib groups showed elevations in levels of liver Fib, plasma Fib, and liver Fibα mRNA (P<0.01), and the AAV group had risen levels of Fib and Fibα mRNA (P<0.01). Compared with the model group, the Fib group presented risen levels of liver Fib and Fibα mRNA (P<0.01). Compared with the Fib group, the AAV group presented decreases in levels of liver Fib, plasma Fib, and liver Fibα mRNA (P<0.01). Compared with the normal group, the other three groups had down-regulated protein and mRNA levels of Mfn2, OPA1, PINK1, Parkin, p-AMPK/AMPK, and PGC-1α (P<0.05, P<0.01) and up-regulated protein levels of Drp1 (P<0.01). Compared with those in the model group, the mRNA and protein levels of Mfn2, OPA1, PINK1, Parkin, p-AMPK/AMPK, and PGC-1α were all down-regulated (P<0.05, P<0.01) and the protein level of Drp1 was up-regulated (P<0.01) in the Fib group. Compared with the Fib group, the AAV group showed differences in protein levels of OPA1, PGC-1α, Parkin, and Drp1 (P<0.05, P<0.01) and an increasing trend in the mRNA levels of AMPK and PGC-1α with no significant difference. Compared with the normal group, the other three groups had elevated levels of ATP in the myocardial tissue (P<0.01). Compared with the model group, the Fib group showed elevated levels of ATP and AMP (P<0.01). Compared with the Fib group, the AAV group exhibited lowered levels of ATP and AMP (P<0.01). ConclusionFib can achieve the overexpression effect in the rat model of coronary heart disease with the syndrome of blood stasis. At the same time, the overexpression of Fib can induce the damage of the mitochondrial quality control system in the myocardial tissue, inhibit mitochondrial dynamics and mitochondrial biosynthesis, and down-regulate mitochondrial autophagy, thereby aggravating myocardial injury in the rat model.
4.Analysis of risk factors for post-prematurity respiratory disease in very preterm infants
You YOU ; Jingwen LYU ; Lin ZHOU ; Liping WANG ; Jufeng ZHANG ; Li WANG ; Yongjun ZHANG ; Hongping XIA
Chinese Journal of Pediatrics 2025;63(1):50-54
Objective:To investigate the risk factors associated with post-prematurity respiratory disease (PPRD) in very preterm infants.Methods:A prospective cohort study was conducted, enrolling 369 very preterm infants who were admitted to the neonatal intensive care unit of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, within one week of birth from January 2019 to June 2023. Data on maternal and infant clinical characteristics, neonatal morbidities, and treatments during hospitalization were collected. The very preterm infants were divided into 2 groups based on whether they developed PPRD. Continuous variables were compared using Mann-Whitney U test, while categorical variables were compared using χ2 tests or continuity correction χ2 test. Multivariate Logistic regression analysis was used to identify the independent risk factors for PPRD in very preterm infants. Results:Among the 369 very preterm infants, 217 cases(58.8%) were male, with a gestational age of 30 (28, 31) weeks at birth and a birth weight of 1 320 (1 085, 1 590) g. Of these, 116 cases (31.4%) developed PPRD, while 253 cases (68.6%) did not. The very preterm infants in the PPRD group had a lower gestational age and lower birth weight (both, P<0.001). The PPRD group also had a higher proportion of males, lower Apgar scores at the 1 th minute after birth and the 5 th minutes after birth, a higher rate of born via cesarean delivery, and a higher incidence of bronchopulmonary dysplasia, more pulmonary surfactant treatment, longer durations of mechanical ventilation, longer total oxygen therapy, and lower Z-score for weight at discharge (all P<0.05). Multivariate Logistic regression analysis showed that gestational age ( OR=0.85, 95% CI 0.73-0.99, P=0.037), born via cesarean delivery ( OR=2.23, 95% CI 1.21-4.10, P=0.010), a duration of mechanical ventilation ≥7 days ( OR=2.51, 95% CI 1.43-4.39, P=0.001), and a Z-score for weight at discharge ( OR=0.82, 95% CI 0.67-0.99, P=0.040) were all independent risk factors for PPRD in very preterm infants. Conclusion:Very preterm infants with a small gestational age, born via cesarean section, mechanical ventilation ≥7 days, and a low Z-score for weight at discharge should be closely monitored for PPRD, and provided with standardized respiratory management after discharge.
5.Effects of di(2-ethylhexyl) phthalate on glucose homeostasis in rats due to impaired autophagy flux of islet β cells mediated by oxidative stress
Hongyang ZHOU ; Yuting HU ; Xue CHEN ; Yunqiang ZHOU ; Liping LI ; Ling LI ; Herong LIU
Journal of Environmental and Occupational Medicine 2025;42(6):674-683
Background Di(2-ethylhexyl) phthalate (DEHP) is the most prevalent environmental endocrine disruptor among phthalate acid esters (PAEs) worldwide. Previous studies have indicated that exposure to DEHP may disrupt glucose metabolism. Objective To investigate the impact of DEHP on glucose homeostasis in rats, focusing on oxidative stress-induced impairment of autophagy in islet β cells. Methods Forty male SD rats were randomly assigned to four groups, receiving DEHP doses of 0, 187, 375, and 750 mg·kg−1 for 12 weeks. Oral glucose tolerance (OGTT) and insulin tolerance tests (ITT) were conducted 24 h after the final exposure. Pancreatic microstructural alterations were assessed using hematoxylin and eosin (HE) staining and transmission electron microscopy (TEM). Commercial ELISA kits were employed to quantify the levels of insulin, adenosine triphosphate (ATP), and adenosine monophosphate (AMP) in rat serum, as well as the protein expression level of activated caspase-3 in pancreatic tissue. Additionally, commercial microplate kits were utilized to measure the concentration of reduced glutathione (GSH) in serum, the activity of superoxide dismutase (SOD) using water-soluble tetrazolium salt-1, the content of malondialdehyde (MDA) by thiobarbituric acid method, and the level of reactive oxygen species (ROS) in pancreatic tissue by chemical fluorescence method. Reverse transcription polymerase chain reaction (RT-PCR) was used to measure sequestosome1 (SQSTM1/p62), Beclin1, microtubule-associated protein 1 light chain 3 (LC3), and cysteinyl aspartate specific proteinase-8 (Caspase-8) mRNA levels. Western blot analysis was applied to detect the protein relative expression levels of p62, Beclin-1, LC3-I, LC3 II, AMPK, p-AMPK, mTOR, p-mTOR, ULK1, and Caspase-8. Results Compared to the 0 mg·kg−1 DEHP group, the 750 mg·kg−1 DEHP group exhibited a significant increase in fasting blood glucose levels at 2, 4, 6, and 12 weeks (P<0.05). The OGTT showed that, following high-glucose gavage, the 187 mg·kg−1 DEHP group had elevated blood glucose at 30 min (P<0.05), the 375 mg·kg−1 DEHP group showed increased glucose levels at 15, 30, and 180 min (P<0.05), and the 750 mg·kg−1 DEHP group exhibited elevated levels at 15, 30, 60, and 180 min (P<0.05). The 375 and 750 mg·kg−1 DEHP groups demonstrated significantly increased OGTT area under the curve (AUC) values (P<0.05). In contrast, ITT results indicated no significant differences in blood glucose levels or AUC among the DEHP exposure groups at all time points (P>0.05). Compared to the 0 mg·kg−1 DEHP group, the 750 mg·kg−1 DEHP group exhibited significantly higher HOMA-IR levels and markedly lower HOMA-ISI values (P<0.05). HE and TEM showed that in each DEHP exposure group, the number of islet cells decreased, the islet area reduced, and chromatin condensation occurred. The endocrine granules in the cytoplasm of islet β cells decreased, and there were varying degrees of widening of the nuclear membrane gap, flattening and expansion of the Golgi complex, and expansion of the endoplasmic reticulum. Ribosome separation was observed, and autophagosomes were visible. In the 375 and 750 mg·kg−1 DEHP groups, the mitochondria were deformed to varying degrees, and some cristae structures disappeared, presenting vacuolization. Moreover, the chromatin condensation in the nuclei was more severe in the 750 mg·kg−1 DEHP group. The serum SOD activity was significantly elevated in the 750 mg·kg−1 DEHP group (P<0.05). Both the 375 mg·kg−1 and 750 mg·kg−1 DEHP groups exhibited a significant increase in the relative ROS content in pancreatic tissue (P<0.05). In DEHP-treated groups, the MDA content increased (P<0.05), while the GSH content decreased (P<0.05). Additionally, in the 750 mg·kg−1 DEHP group, the AMP/ATP ratio in serum was significantly raised (P<0.05), and the expression of cleaved Caspase-3 protein in pancreatic tissue was also significantly increased (P<0.05). The relative mRNA levels of p62, Beclin-1, LC3, and Caspase-8 in the pancreatic tissue of rats exposed to DEHP were significantly elevated (P<0.05). The relative expression levels of p-AMPK/AMPK, p-ULK1/ULK1, and Beclin-1 proteins in the DEHP-treated groups were significantly increased (P<0.05). In the 375 mg·kg−1 and 750 mg·kg−1 DEHP treatment groups, the relative expression levels of p62, LC3 II/LC1, and Caspase-8 proteins were significantly increased (P<0.05), while the relative expression level of p-mTOR/mTOR was significantly decreased (P<0.05). Conclusion DEHP can disrupt glucose homeostasis by inducing oxidative stress, which subsequently activates autophagy via the ROS/AMPK/ULK1 pathway, impairing autophagic flux and promoting apoptosis of islet β cells, ultimately decreasing their function and number.
6.Incidence of pulmonary tuberculosis and its influencing factors in Hubei Province based on the geographically weighted regression model
Xingxing LU ; Xun LIU ; Fan WANG ; Jianjun YE ; Yu ZHANG ; Chengfeng YANG ; Liping ZHOU ; Hongxing WANG ; Wenqian ZHOU
Journal of Public Health and Preventive Medicine 2025;36(5):28-31
Objective To study the spatial distribution of the incidence of pulmonary tuberculosis in Hubei Province and its influencing factors, so as to improve the theoretical basis for scientific development of tuberculosis prevention and control measures in the future. Methods The data of reported incidence of tuberculosis and related influencing factors in various counties and districts of Hubei Province in 2020 were collected. Global Moran's I index, hotspot analysis and geographically weighted regression (GWR) model analysis were used to calculate the spatial autocorrelation of the incidence of tuberculosis, and to analyze the influencing factors affecting the incidence rate of tuberculosis. Results There were obvious regional differences in the space distribution of the incidence rate of tuberculosis. Hot spot analysis showed positive spatial correlation and obvious clustering. The GWR model (AICc=784.251) in this study had higher AICc value compared to the ordinary least squares regression (OLS) model (AICc=804.2585). The GWR model showed that the increase in the proportion of the population aged 65 and above and the proportion of the ethnic minority population had a significant promoting effect on the increase of the incidence rate of tuberculosis, and there was significant spatial heterogeneity. The effect of PM2.5 concentration on the incidence rate of pulmonary tuberculosis varied in different regions, and the degree of effect was also different. Conclusion The proportion of people aged 65 and above and the proportion of ethnic minorities may significantly influence the incidence of pulmonary tuberculosis. The effect of PM2.5 concentration varies in different regions, so targeted measures should be formulated according to the situation in different regions.
7.Influencing factors for sarcopenia among elderly male patients with type 2 diabetes mellitus
LI Meilin ; ZHOU Mengjiao ; WU Jiayun ; YU Zhe ; KONG Liping
Journal of Preventive Medicine 2025;37(6):588-592
Objective:
To explore the influencing factors for sarcopenia among elderly male patients with type 2 diabetes (T2DM), so as to provide the basis for the early prevention and treatment of sarcopenia.
Methods:
Male T2DM patients aged 60 and above admitted to Hangzhou First People's Hospital from January to December 2024 were selected as the study subjects. Demographic data, T2DM complications, and blood biochemical parameters were collected. Physical activity levels were assessed using the Chinese version of the International Physical Activity Questionnaire. The diagnosis of sarcopenia was made according to the diagnostic procedures and criteria established by the Asian Working Group for Sarcopenia in 2019. Factors affecting sarcopenia among elderly male patients with T2DM were analyzed using multivariable logistic regression model.
Results:
A total of 455 elderly male patients with T2DM were surveyed, with a mean age of (71.80±9.55) years. The predominant physical activity level was moderate with 226 cases accounting for 49.67%. The disease course of T2DM was mainly from 10-<20 years, with 229 cases accounting for 50.33%. There were 140 cases of T2DM complications, accounting for 30.77%. A total of 138 cases of sarcopenia were detected, with a prevalence of 30.33%. Multivariable logistic regression analysis showed that age (OR=1.077, 95%CI: 1.003~1.156), body mass index (<18.5kg/m2, OR=11.056, 95%CI: 3.343~36.547; 18.5~<25.0 kg/m2, OR=2.633, 95%CI: 1.420~4.881), physical activity level (low, OR=2.469, 95%CI: 1.421~4.292), chronic obstructive pulmonary disease (yes, OR=1.871, 95%CI: 1.091~3.206), T2DM complications (yes, OR=3.015, 95%CI: 1.516~6.001), glycated hemoglobin (≥7%, OR=2.822, 95%CI: 1.423~5.590) and albumin (OR=0.810, 95%CI: 0.662~0.991) were factors affecting sarcopenia among elderly male patients with T2DM (P<0.05).
Conclusion
Advanced age, body mass index <25.0 kg/m2, low physical activity level, chronic obstructive pulmonary disease, T2DM complications, high glycated hemoglobin and low albumin are associated with a higher risk of sarcopenia in elderly male patients with T2DM.
8.Hub biomarkers and their clinical relevance in glycometabolic disorders: A comprehensive bioinformatics and machine learning approach.
Liping XIANG ; Bing ZHOU ; Yunchen LUO ; Hanqi BI ; Yan LU ; Jian ZHOU
Chinese Medical Journal 2025;138(16):2016-2027
BACKGROUND:
Gluconeogenesis is a critical metabolic pathway for maintaining glucose homeostasis, and its dysregulation can lead to glycometabolic disorders. This study aimed to identify hub biomarkers of these disorders to provide a theoretical foundation for enhancing diagnosis and treatment.
METHODS:
Gene expression profiles from liver tissues of three well-characterized gluconeogenesis mouse models were analyzed to identify commonly differentially expressed genes (DEGs). Weighted gene co-expression network analysis (WGCNA), machine learning techniques, and diagnostic tests on transcriptome data from publicly available datasets of type 2 diabetes mellitus (T2DM) patients were employed to assess the clinical relevance of these DEGs. Subsequently, we identified hub biomarkers associated with gluconeogenesis-related glycometabolic disorders, investigated potential correlations with immune cell types, and validated expression using quantitative polymerase chain reaction in the mouse models.
RESULTS:
Only a few common DEGs were observed in gluconeogenesis-related glycometabolic disorders across different contributing factors. However, these DEGs were consistently associated with cytokine regulation and oxidative stress (OS). Enrichment analysis highlighted significant alterations in terms related to cytokines and OS. Importantly, osteomodulin ( OMD ), apolipoprotein A4 ( APOA4 ), and insulin like growth factor binding protein 6 ( IGFBP6 ) were identified with potential clinical significance in T2DM patients. These genes demonstrated robust diagnostic performance in T2DM cohorts and were positively correlated with resting dendritic cells.
CONCLUSIONS
Gluconeogenesis-related glycometabolic disorders exhibit considerable heterogeneity, yet changes in cytokine regulation and OS are universally present. OMD , APOA4 , and IGFBP6 may serve as hub biomarkers for gluconeogenesis-related glycometabolic disorders.
Machine Learning
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Humans
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Computational Biology/methods*
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Biomarkers/metabolism*
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Diabetes Mellitus, Type 2/genetics*
;
Animals
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Mice
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Gluconeogenesis/physiology*
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Gene Expression Profiling
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Transcriptome/genetics*
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Gene Regulatory Networks/genetics*
;
Clinical Relevance
9.Associations between statins and all-cause mortality and cardiovascular events among peritoneal dialysis patients: A multi-center large-scale cohort study.
Shuang GAO ; Lei NAN ; Xinqiu LI ; Shaomei LI ; Huaying PEI ; Jinghong ZHAO ; Ying ZHANG ; Zibo XIONG ; Yumei LIAO ; Ying LI ; Qiongzhen LIN ; Wenbo HU ; Yulin LI ; Liping DUAN ; Zhaoxia ZHENG ; Gang FU ; Shanshan GUO ; Beiru ZHANG ; Rui YU ; Fuyun SUN ; Xiaoying MA ; Li HAO ; Guiling LIU ; Zhanzheng ZHAO ; Jing XIAO ; Yulan SHEN ; Yong ZHANG ; Xuanyi DU ; Tianrong JI ; Yingli YUE ; Shanshan CHEN ; Zhigang MA ; Yingping LI ; Li ZUO ; Huiping ZHAO ; Xianchao ZHANG ; Xuejian WANG ; Yirong LIU ; Xinying GAO ; Xiaoli CHEN ; Hongyi LI ; Shutong DU ; Cui ZHAO ; Zhonggao XU ; Li ZHANG ; Hongyu CHEN ; Li LI ; Lihua WANG ; Yan YAN ; Yingchun MA ; Yuanyuan WEI ; Jingwei ZHOU ; Yan LI ; Caili WANG ; Jie DONG
Chinese Medical Journal 2025;138(21):2856-2858
10.Effectiveness of free fascia lata flap assisted by indocyanine green angiography in treatment of Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures.
Liping GUO ; Rong ZHOU ; Jihui JU ; Guangzhe JIN ; Liang YANG ; Chao GENG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(5):620-627
OBJECTIVE:
To investigate of effectiveness of free fascia lata flap assisted by indocyanine green angiography (ICGA) in treatment of Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures.
METHODS:
A clinical data of 14 patients with Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures between March 2020 and June 2024 was retrospectively analyzed. All Achilles tendon defects were repaired with the free fascia lata assisted by ICGA during operation. There were 12 males and 2 females with an average age of 45.4 years (range, 26-71 years). The causes of Achilles tendon rupture included sports injury in 10 cases, Achilles tendon-related tendinopathy in 3 cases, and glass laceration injury in 1 case. The time from Achilles tendon rupture to operation was 4-40 weeks (median, 4.5 weeks). Preoperative MRI examination showed that the defect length of the Achilles tendon was 2-5 cm (mean, 3.2 cm). The operation time and intraoperative blood loss were recorded. The color Doppler ultrasound (CDU) and MRI were taken to observe the foot blood vessels and the tendon healing. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Achilles Tendon rupture score (ATRS), and range of motion of the ankle joint were used to estimate the pain and function of ankle joint.
RESULTS:
All operations of the 14 patients were successfully completed. The operation time ranged from 3.00 to 4.50 hours (mean, 3.60 hours). The intraoperative blood loss ranged from 10 to 50 mL (mean, 36.4 mL). After operation, 1 patient had exudation at the recipient site, which healed after dressing change; the other incisions healed by first intention. All incisions at the donor sites healed by first intention. All patients were followed up 6-36 months (mean, 11.4 months). The CDU of the foot at 1 month after operation showed that the blood flow signal of the perforating vessels of the fascia lata flap was clear. The ankle MRI at 2 months after operation showed the good continuity of the Achilles tendon. No complication such as the Achilles tendon re-rupture, ankle stiffness, or scar contracture occurred during follow-up. Compared with preoperative score, the AOFAS score, ATRS score, and plantar flexion range of motion significantly increased at 1, 3, and 6 months after operation ( P<0.05), while the VAS score and dorsiflexion range of motion significantly decreased ( P<0.05). The AOFAS score, ATRS score, and VAS score at 3 and 6 months further improved when compared with those at 1 month ( P<0.05); however, there was no significant difference in the range of motion of the ankle joint ( P>0.05). There was no significant difference in above indicators between 3 and 6 months after operation ( P>0.05).
CONCLUSION
The treatment of Myerson type Ⅱ and Ⅲ chronic Achilles tendon ruptures with free fascia lata flaps under the guidance of ICGA has the advantages of precise design, fast healing, and a wide range of adaptability.
Humans
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Achilles Tendon/diagnostic imaging*
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Male
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Female
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Adult
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Middle Aged
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Retrospective Studies
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Indocyanine Green
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Rupture/surgery*
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Aged
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Fascia Lata/transplantation*
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Angiography/methods*
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Free Tissue Flaps/blood supply*
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Plastic Surgery Procedures/methods*
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Tendon Injuries/diagnostic imaging*
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Treatment Outcome
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Chronic Disease


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