Objective:To investigate the effect of oleanolic acid(OA)on inflammatory injury of pancreatic acinar cells in-duced by lipopolysaccharide(LPS)by regulating stromal cell-derived factor-1(SDF-1)/CXC chemokine receptor 4(CXCR4)signal axis.Methods:Rat pancreatic acinar cells AR42J were treated with 5,10,20 and 40 μmol/L OA,and the cell viability was detected using CCK-8 method to determine the optimal dosage for subsequent experimental OA treatment;AR42J cells were randomly divided into control group(NC),LPS group(10 mg/L LPS),OA low-dose group(OA-L group,10 mg/L LPS+5 μmol/L OA),OA medium dose group(OA-M group,10 mg/L LPS+10 μmol/L OA),OA high-dose group(OA-H group,10 mg/L LPS+20 μmol/L OA),Rr-SDF-1 activator(SDF-1)group(10 mg/L LPS+20 ng/ml Rr-SDF-1)and OA-H+Rr-SDF-1 group(10 mg/L LPS+20 μmol/L OA+20 ng/ml Rr-SDF-1).CCK-8 method and EdU staining were applied to detect proliferation of AR42J cells;flow cytometry was applied to detect apoptosis of AR42J cells;activity of superoxide dismutase(SOD)and content of malondialdehyde(MDA)in cell supernatant were detected by spectrophotometry;ELISA was applied to detect levels of IL-6 and TNF-α in cell supernatant;Western blot was applied to detect expressions of CyclinD1,Bcl-2 associated X protein(Bax),SDF-1 and CXCR4 proteins in cells.Results:5,10 and 20 μmol/L OA were selected as the low,medium and high doses for subsequent treatment of AR42J cells;compared with NC group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in LPS group decreased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions increased(P<0.05);compared with LPS group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in OA-L group,OA-M group and OA-H group increased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions reduced,the change trends of corre-sponding indicators in Rr-SDF-1 group was opposite to the above(P<0.05);compared with OA-H group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in OA-H+Rr-SDF-1 group decreased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions increased(P<0.05).Conclusion:OA may alleviate LPS induced inflam-matory damage to pancreatic acinar cells in rats by inhibiting the SDF-1/CXCR4 pathway.

Objective:To determine the actual metastasis rate of paracolic lymph nodes (PCN) more than 10 cm proximal to rectal tumors and explore the significance of PCN dissection in the prognosis of patients with rectal cancer. ?Methods:This was a prospective observational cohort study. The clinical data of 457 consecutive patients with rectal cancer who underwent radical surgery at the Colorectal Tumor Center of West China Hospital, Sichuan University from January 2015 to May 2022 were included. Inclusion criteria: (1) Pathologically confirmed rectal adenocarcinoma (anal margin ≤ 12 cm); (2) R0 resection was performed with a proximal margin ≥ 10 cm (measured on the in vivo specimen during surgery after intestinal mobilization); (3) For stage IV patients, only those with resectable metastatic lesions by R0 were included; (4) Patients who completed the full course of neoadjuvant therapy (TNT) must meet the surgical window of 8-12 weeks after radiotherapy. Exclusion criteria: tumors located more than 15 cm from the anal margin, synchronous multiple primary colorectal cancers, positive tumor margins, preoperative imaging suggesting lateral lymph node metastasis (LLNM), presence of Lynch syndrome or familial adenomatous polyposis, emergency surgery, recurrence after rectal cancer surgery, T4b tumors requiring combined organ resection, previous radiotherapy and chemotherapy for non-rectal cancer, and those with cardiac, pulmonary, renal and other organ dysfunction that could not tolerate surgery. After standard total mesorectal excision (TME), the proximal intestinal tube was transected at a level more than 10 cm above the lesion, and then intestinal anastomosis or enterostomy was completed. The distance from the tumor edge was marked and measured in vivo during the operation, and lymph nodes were harvested from the fresh specimen. Patients with PCN metastasis beyond 10 cm proximal to the tumor were classified into the positive lymph node group (pPCN group), while those without PCN metastasis beyond 10 cm proximal to the tumor were classified into the negative lymph node group (nPCN group). The differences in clinicopathological characteristics, overall survival (OS) and disease-free survival (DFS) between the two groups were compared, and risk factor analysis and survival analysis of pPCN were performed.Results:There were 16 cases (3.5%) in the pPCN group, 15 cases (3.3%) had central lymph node metastasis; the nPCN group included 441 cases. When comparing the baseline characteristics between the pPCN group and the nPCN group, there was no statistically significant difference in other aspects except that the cN stage was more advanced in the pPCN group ( P=0.006) (all P>0.05). The number of positive mesenteric lymph nodes in the pPCN group was higher than that in the nPCN group ( P<0.001), and the proportion of patients with a total number of harvested lymph nodes ≥12 and the number of lymph nodes with a short diameter >5 mm were both higher (all P<0.05). The proportion of patients with positive lymph nodes within 10 cm and the number of positive lymph nodes within 10 cm were also higher in the pPCN group (both P<0.001). Similar to the clinical TNM staging, the proportions of patients with pT3 and N2 stages, as well as the incidence of poorly differentiated tumors (G3, G4) were higher in the pPCN group ( P<0.001). The results of multivariate analysis showed that among the preoperative pathological characteristic variables, the presence of positive lymph nodes within 10 cm (OR=14.869, 95%CI: 2.993-73.858, P=0.001) and low tumor differentiation grade (OR=7.189, 95%CI: 2.091- 24.714, P=0.002) were independent risk factors for pPCN. The median follow-up time of the patients in this group was 63 (0-63) months. No local recurrence occurred in the pPCN group, and the 5-year OS was 50.0%, which was significantly lower than 78.0% in the nPCN group (HR=2.496, 95%CI: 1.263-4.930, P=0.008). The 3-year DFS was 43.8%, also significantly lower than 77.7% in the nPCN group (HR=2.950, 95%CI:1.488-5.846, P=0.002). Multivariate Cox prognostic analysis suggested that age ≥65 years (HR=2.041, 95%CI: 1.375-3.031, P<0.001), female (HR=1.838, 95%CI: 1.171-2.884, P=0.008), tumor length ≥3 cm (HR=1.747, 95%CI: 1.076-2.834, P=0.024), more advanced cT stage (HR=2.865, 95%CI: 1.234-6.653, P=0.014), and cM1 (HR=4.368, 95%CI: 2.480-7.694, P<0.001) were independent risk factors affecting OS. No neoadjuvant therapy (HR=0.636, 95%CI: 0.413-0.980, P=0.040) and cM1 (HR=5.556, 95%CI: 3.335-9.256, P<0.001) were independent risk factors affecting DFS. pPCN showed a tendency to be an independent risk factor for DFS (HR=1.942, 95%CI: 0.966-3.906, P=0.063). Conclusion:The incidence of pPCN is higher than expected, and the prognosis of patients is poor. Patients with high-risk factors may benefit from extended proximal intestinal resection (>10 cm) to avoid residual positive PCN, thereby reducing local recurrence.

Objective:To determine the actual metastasis rate of paracolic lymph nodes (PCN) more than 10 cm proximal to rectal tumors and explore the significance of PCN dissection in the prognosis of patients with rectal cancer. ?Methods:This was a prospective observational cohort study. The clinical data of 457 consecutive patients with rectal cancer who underwent radical surgery at the Colorectal Tumor Center of West China Hospital, Sichuan University from January 2015 to May 2022 were included. Inclusion criteria: (1) Pathologically confirmed rectal adenocarcinoma (anal margin ≤ 12 cm); (2) R0 resection was performed with a proximal margin ≥ 10 cm (measured on the in vivo specimen during surgery after intestinal mobilization); (3) For stage IV patients, only those with resectable metastatic lesions by R0 were included; (4) Patients who completed the full course of neoadjuvant therapy (TNT) must meet the surgical window of 8-12 weeks after radiotherapy. Exclusion criteria: tumors located more than 15 cm from the anal margin, synchronous multiple primary colorectal cancers, positive tumor margins, preoperative imaging suggesting lateral lymph node metastasis (LLNM), presence of Lynch syndrome or familial adenomatous polyposis, emergency surgery, recurrence after rectal cancer surgery, T4b tumors requiring combined organ resection, previous radiotherapy and chemotherapy for non-rectal cancer, and those with cardiac, pulmonary, renal and other organ dysfunction that could not tolerate surgery. After standard total mesorectal excision (TME), the proximal intestinal tube was transected at a level more than 10 cm above the lesion, and then intestinal anastomosis or enterostomy was completed. The distance from the tumor edge was marked and measured in vivo during the operation, and lymph nodes were harvested from the fresh specimen. Patients with PCN metastasis beyond 10 cm proximal to the tumor were classified into the positive lymph node group (pPCN group), while those without PCN metastasis beyond 10 cm proximal to the tumor were classified into the negative lymph node group (nPCN group). The differences in clinicopathological characteristics, overall survival (OS) and disease-free survival (DFS) between the two groups were compared, and risk factor analysis and survival analysis of pPCN were performed.Results:There were 16 cases (3.5%) in the pPCN group, 15 cases (3.3%) had central lymph node metastasis; the nPCN group included 441 cases. When comparing the baseline characteristics between the pPCN group and the nPCN group, there was no statistically significant difference in other aspects except that the cN stage was more advanced in the pPCN group ( P=0.006) (all P>0.05). The number of positive mesenteric lymph nodes in the pPCN group was higher than that in the nPCN group ( P<0.001), and the proportion of patients with a total number of harvested lymph nodes ≥12 and the number of lymph nodes with a short diameter >5 mm were both higher (all P<0.05). The proportion of patients with positive lymph nodes within 10 cm and the number of positive lymph nodes within 10 cm were also higher in the pPCN group (both P<0.001). Similar to the clinical TNM staging, the proportions of patients with pT3 and N2 stages, as well as the incidence of poorly differentiated tumors (G3, G4) were higher in the pPCN group ( P<0.001). The results of multivariate analysis showed that among the preoperative pathological characteristic variables, the presence of positive lymph nodes within 10 cm (OR=14.869, 95%CI: 2.993-73.858, P=0.001) and low tumor differentiation grade (OR=7.189, 95%CI: 2.091- 24.714, P=0.002) were independent risk factors for pPCN. The median follow-up time of the patients in this group was 63 (0-63) months. No local recurrence occurred in the pPCN group, and the 5-year OS was 50.0%, which was significantly lower than 78.0% in the nPCN group (HR=2.496, 95%CI: 1.263-4.930, P=0.008). The 3-year DFS was 43.8%, also significantly lower than 77.7% in the nPCN group (HR=2.950, 95%CI:1.488-5.846, P=0.002). Multivariate Cox prognostic analysis suggested that age ≥65 years (HR=2.041, 95%CI: 1.375-3.031, P<0.001), female (HR=1.838, 95%CI: 1.171-2.884, P=0.008), tumor length ≥3 cm (HR=1.747, 95%CI: 1.076-2.834, P=0.024), more advanced cT stage (HR=2.865, 95%CI: 1.234-6.653, P=0.014), and cM1 (HR=4.368, 95%CI: 2.480-7.694, P<0.001) were independent risk factors affecting OS. No neoadjuvant therapy (HR=0.636, 95%CI: 0.413-0.980, P=0.040) and cM1 (HR=5.556, 95%CI: 3.335-9.256, P<0.001) were independent risk factors affecting DFS. pPCN showed a tendency to be an independent risk factor for DFS (HR=1.942, 95%CI: 0.966-3.906, P=0.063). Conclusion:The incidence of pPCN is higher than expected, and the prognosis of patients is poor. Patients with high-risk factors may benefit from extended proximal intestinal resection (>10 cm) to avoid residual positive PCN, thereby reducing local recurrence.

Objective:To investigate the effect of oleanolic acid(OA)on inflammatory injury of pancreatic acinar cells in-duced by lipopolysaccharide(LPS)by regulating stromal cell-derived factor-1(SDF-1)/CXC chemokine receptor 4(CXCR4)signal axis.Methods:Rat pancreatic acinar cells AR42J were treated with 5,10,20 and 40 μmol/L OA,and the cell viability was detected using CCK-8 method to determine the optimal dosage for subsequent experimental OA treatment;AR42J cells were randomly divided into control group(NC),LPS group(10 mg/L LPS),OA low-dose group(OA-L group,10 mg/L LPS+5 μmol/L OA),OA medium dose group(OA-M group,10 mg/L LPS+10 μmol/L OA),OA high-dose group(OA-H group,10 mg/L LPS+20 μmol/L OA),Rr-SDF-1 activator(SDF-1)group(10 mg/L LPS+20 ng/ml Rr-SDF-1)and OA-H+Rr-SDF-1 group(10 mg/L LPS+20 μmol/L OA+20 ng/ml Rr-SDF-1).CCK-8 method and EdU staining were applied to detect proliferation of AR42J cells;flow cytometry was applied to detect apoptosis of AR42J cells;activity of superoxide dismutase(SOD)and content of malondialdehyde(MDA)in cell supernatant were detected by spectrophotometry;ELISA was applied to detect levels of IL-6 and TNF-α in cell supernatant;Western blot was applied to detect expressions of CyclinD1,Bcl-2 associated X protein(Bax),SDF-1 and CXCR4 proteins in cells.Results:5,10 and 20 μmol/L OA were selected as the low,medium and high doses for subsequent treatment of AR42J cells;compared with NC group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in LPS group decreased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions increased(P<0.05);compared with LPS group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in OA-L group,OA-M group and OA-H group increased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions reduced,the change trends of corre-sponding indicators in Rr-SDF-1 group was opposite to the above(P<0.05);compared with OA-H group,A450 value,EdU positive cell rate,SOD activity,and CyclinD1 protein expression in OA-H+Rr-SDF-1 group decreased,while apoptosis rate,MDA content,IL-6,TNF-α levels,Bax,SDF-1 and CXCR4 protein expressions increased(P<0.05).Conclusion:OA may alleviate LPS induced inflam-matory damage to pancreatic acinar cells in rats by inhibiting the SDF-1/CXCR4 pathway.

Objective:To investigate therapeutic effect of reinfusion of tumor-infiltrating lymphocyte(TIL)with clustered regularly interspaced short palindromic repeats/CRISPR-associated 9(CRISPR/CAS9)knockout programmed death-1(PD-1)on colon cancer in mice.Methods:Subcutaneous injection of CT26 was used to establish mouse colon cancer model.TIL was extracted from tumor tissue of three model mice,and peripheral blood lymphocytes were extracted.PD-1 gene was knocked out of TIL.Reinfusion experiments were divided into control group(Control),lymphocyte group(Lym),tumor-bearing mouse TIL group(TIL),lentivirus empty empty group(pVSV-G-PX458-NC)and PX458-PD-1-sgRNA1 group(PD-1-sgRNA1),with 10 mice in each group.Tumor tissue quality and tumor inhibition rate were detected in each group.TUNEL was used to detect cell apoptosis in tumor tissues of mice.ELISA was used to detect contents of TNF-α and IFN-γ in tumor tissues of mice.Immunohistochemistry was used to detect expressions of CD4+T and CD8+T cells in tumor tissue.Immunofluorescence was used to detect expressions of proliferating cell nuclear antigen-67(Ki-67)and vascular endothelial growth factor(VEGF).Western blot was used to detect expressions of PD-1 and its ligand PD-L1 in tumor tissues.Results:PD-1-sgRNA1 could significantly inhibit growth of mouse tumor cells in vivo,inhibit expressions of Ki-67 and VEGF in tumor tissues,as well as expressions of PD-1 and PD-L1,elevate apoptosis rate,contents of TNF-α and IFN-γ in tumor tissues,and expressions of CD4+T and CD8+T cells(all P<0.05).Conclusion:Reinfusion of TIL with CRISPR/CAS9 knockout PD-1 can significantly inhibit expressions of Ki-67 and VEGF in colon cancer mice,enhance infiltration of CD4+T and CD8+T cells,induce tumor cell apoptosis and inhibit tumor growth.

Objective:To investigate impacts of usnic acid(UA)on malignant behavior of gastric cancer cells by regulating the chemokine(C-C motif)ligand 2(CCL2)-CCL2 receptor(CCR2)signal axis.Methods:SGC-7901 cells,a well growing human gastric cancer cell line,were treated with different concentrations of UA,which were grouped into low concentration(UA-L)group(62.5 μmol/L UA),medium concentration(UA-M)group(125 μmol/L UA)and high concentration(UA-H)group(250 μmol/L UA);meantime,the cells were transfected with CCL2 overexpression vector(pc DNA3.1 CCL2),empty vector(pc DNA3.1),silenced CCL2(si CCL2)and negative control(si control),and SGC-7901 cells were treated with 250 μmol/L UA,labeled as UA-H+pc DNA3.1 CCL2 group,UA-H+pc DNA3.1 group,UA-H+si control group and UA-H+si CCL2 group,another untreated SGC-7901 cells were taken as the control group.Flow cytometry,MTT and qRT-PCR were applied to detect cell apoptosis,proliferation,and expres-sion levels of CCL2 and CCR2 mRNA;Western blot was applied to detect expression levels of PD-L1,apoptotic protein(Bax),proli-ferative protein(CyclinD1,CCL2,CCR2)and immune escape related protein(B7H1);after co-culturing with CD8+T cells isolated and cultured in vitro,ELISA was applied to detect levels of IL-4,IFN-γ and IL-10 in the supernatant.Gastric cancer cells in each group were co-cultured with activated peripheral blood mononuclear cell(PBMC)1∶1 for 72 hours,and the sensitivity of gastric can-cer cells in each group to T-cell-mediated killing was compared.Results:Compared with control group,cell proliferation rate,IL-10 level,CyclinD1,PD-L1,CCL2,CCR2 and B7H1 protein and mRNA expressions,cell counts after co-culturing with activated PBMC 1∶1 for 72 hours in UA-L group,UA-M group and UA-H group were obviously reduced,while apoptosis rate,IL-4 and IFN-γ levels,Bax protein expression were obviously increased(P<0.05);compared with UA-H+pc DNA3.1 group,cell proliferation rate,IL-10 level,CyclinD1,PD-L1,CCL2,CCR2 protein and mRNA expressions,cell counts after co-culturing with activated PBMC 1∶1 for 72 hours in UA-H+pc DNA3.1 CCL2 group were obviously increased,while apoptosis rate,IL-4 and IFN-γ levels,and Bax protein ex-pression were obviously reduced(P<0.05);compared with UA-H+si control group,cell proliferation rate,IL-10 level,CyclinD1,PD-L1,CCL2,CCR2 and B7H1 protein and mRNA expressions,cell counts after co-culturing with activated PBMC 1∶1 for 72 hours in UA-H+si CCL2 group were obviously reduced,while apoptosis rate,IL-4 and IFN-γ levels and Bax protein expression were obviously increased(P<0.05).Conclusion:UA can inhibit gastric cancer cells proliferation,immune escape,and induce apoptosis,which may be related to the inhibition of the CCL2-CCR2 signaling axis.

Lipid nanoparticles(LNPs),composed of ionizable lipids,are currently the most promis-ing non-viral nucleic acid drug delivery vectors in clinical practice,and have great potential in gene ther-apy drug delivery and vaccine delivery.Ionizable lipids,the main components of LNPs,play a decisive role in the endosome escape rate,transfection efficiency,organ targeting and safety of LNPs.Among them,the hydrophilic head group of ionizable lipids contains tertiary amine groups,which can improve the buffering capacity of LNPs and thus change the pKa value,and imidazole can enhance the stability and transfection activity of mRNA-LNP.The ligand contains ester groups,which can induce gene silencing efficiently and improve the degradation rate and safety.When the number of hydrophobic tails is 3-4,with 1-2 unsaturation and 8-18 carbon chain length,LNPs can effectively induce gene silencing.Meanwhile,the presence of branching or asymmetric hydrophobic tails can improve the transfection efficiency of LNPs.Based on the chemical structure of ionizable lipids,this review summarizes the influ-ence of the structure of ionizable lipids on the transfection efficiency and safety of nucleic acid carrying drugs LNPs,and the structure-activity relationship of ionizable lipids so as to provide reference for studies on novel ionizable lipids.

Diabetes mellitus with ketoacidosis and combined with coma are acute critical complications, which can be complicated with acute abdomen, such as acute pancreatitis, mesenteric thrombosis, small intestine necrosis, etc. There is no report of massive intestine necrosis in the previous literature. We present an overview and aim to improve the diagnosis of acute complications in diabetes mellitus combined with acute abdomen.

This study aimed to evaluate the efficacy of Chinese herbal medicine (CHM) in patients with severe/critical coronavirus disease 2019 (COVID-19). In this retrospective study, data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20, 2020. All patients were divided into an exposed group (CHM users) and a control group (non-users). After propensity score matching in a 1:1 ratio, 156 CHM users were matched by propensity score to 156 non-users. No significant differences in seven baseline clinical variables were found between the two groups of patients. All-cause mortality was reported in 13 CHM users who died and 36 non-users who died. After multivariate adjustment, the mortality risk of CHM users was reduced by 82.2% (odds ratio 0.178, 95% CI 0.076-0.418; P < 0.001) compared with the non-users. Secondly, age (odds ratio 1.053, 95% CI 1.023-1.084; P < 0.001) and the proportion of severe/critical patients (odds ratio 0.063, 95% CI 0.028-0.143; P < 0.001) were the risk factors of mortality. These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.
Age Factors ; Aged ; COVID-19/therapy* ; China ; Drugs, Chinese Herbal/therapeutic use* ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Odds Ratio ; Propensity Score ; Retrospective Studies ; Survival Rate

Objective To investigate the clinical efficacy of bone grafts containing bone morphogenetic protein 2 (Bone Conduction) treating of nonunion of femoral fracture after intramedullary nailing.Methods The clinical data of 49 patients with nonunion of femoral fracture after intramedullary nailing from August 2008 to August 2016 were analyzed retrospectively.They were divided into experimental group and control group according to different bone grafting methods.The experimental group (n =23) was treated with Bone Conduction combined with allograft bone grafting.The control group (n =26) was treated with autogenous bone grafting.The autogenous bone was taken from the ipsilateral ilium.The two groups were compared operative time,intraoperative blood loss,postoperative wound complications,hospitalization time,postoperative visual analog scale,mean image healing time and the score for distal femoral fractures after the operation.All patients were followed up for 12 to 24 months.Follow-up methods were divided into telephone follow-up and outpatient follow-up.The patients were followed up for outpatients before fracture healing.The patients were followed up by telephone after fracture healing.The healing time of fracture,the flexion and extension activities of the knee joint at 9 months after operation were recorded.SPSS19.0 statistical software was used to analyze the data.Measurement data were expressed as ((x) ±s).The independent sample t test was adopted in measurement data and the counting data was tested by Chi-squared test.Result In the experimental group,operative time was (138.7 ± 34.6) minutes,intraoperative blood loss was (315.4 ± 52.8) ml,postoperative wound complications was 0 case,hospitalization time was (8 ± 3) days,postoperative visual analog scale was 5 scores,but in the control group,operative time was (170.5 ± 32.5) minutes,intraoperative blood loss was (367.2 ± 56.4) ml,postoperative wound complications was 3 cases,hospitalization time was (13 ± 2) days,postoperative visual analog scale was 8 scores.There were significant differences between the two groups,P ＜0.05.All patients who followed up for 12-24 months were recovered,with an average follow-up of 15 months.Mean image healing time in the experimental group and control group was separately(4.9± 2.5) months,(5.2 ± 2.8) months.The excellent and good rates ofthe score for distal femoral fractures 9 months after the operation was separately 95.7％,96.2％,there was no significant difference between the two groups,P ＞ 0.05.Conclusions Bone graft material containing bone morphogenetic protein 2 (Bone Conduction) has the advantages of simple operation,less trauma,less complications,high osteogenic activity and good bone graft effect are equalled with iliac bone graft,the bone graft material containing bone morphogene protein is an effective method to treat nonunion of femoral fracture after intramedullary nail.