Objective:To explore the effect of the defect area and volume of intra-articular impacted fragments (IAIF) on the contact stress of the ankle joint surface.Methods:A 23-year-old male volunteer, 168 cm in height and 60 kg in weight, with no history of trauma or anatomic abnormality of the ankle, was selected. On the basis of a normal ankle finite-element model, IAIF-defect finite-element models were established. The first group consisted of IAIF-defect models with identical area but different volumes: on the distal tibial articular surface the defect area was 4 mm × 5 mm (20 mm 2), and the heights were 2 mm, 3 mm, 4 mm, 5 mm and 6 mm. The second group consisted of IAIF-defect models with identical defect volume but different areas. The defect volume was 90 mm 3, while the defect areas on the distal tibial articular surface were 2 mm×3 mm, 3 mm×3 mm, 3 mm×5 mm, 3 mm×6 mm, and 5 mm×6 mm, with corresponding heights of 15 mm, 10 mm, 6 mm, 5 mm, and 3 mm. Under a 600 N vertical load the contact stress of the ankle joint was calculated, and the finite-element data were recorded and analyzed. Pearson correlation analysis was used to analyze, separately for the two groups, the correlation between IAIF defect and the maximum contact stress (MCS) of the distal tibial articular surface, and simple linear regression analysis was performed to obtain regression equations. Equivalence zero testing was used to verify the correlations and to compare their differences. Results:For IAIF defects with the same area but different volumes, including 4 mm×5 mm×2 mm, 4 mm×5 mm×3 mm, 4 mm×5 mm×4 mm, 4 mm×5 mm×5 mm, and 4 mm× 5 mm×6 mm, the corresponding maximum contact stress (MCS) on the distal tibial joint surface were 3.846 MPa, 3.839 MPa, 3.835 MPa, 3.833 MPa, and 3.831 MPa, respectively, with an average of 3.837 MPa. The mean ±1% range is from 3.799 MPa to 3.875 MPa. The correlation analysis showed that the IAIF defects with the same area but different volumes were negatively correlated with contact stress ( r=-0.956, P=0.011). The linear regression equation was MCS=-0.0002×VI+3.851, where VI denotes IAIF volume. Equivalence zero testing confirmed that all measured values lay within the predefined ±1 % margin, satisfying the equivalence null hypothesis. For IAIF defects of identical volume (90 mm 3) but varying articular surface areas—2 mm×3 mm, 3 mm×3 mm, 3 mm×5 mm, 3 mm×6 mm and 5 mm×6 mm—the corresponding MCS values were 2.147 MPa, 2.812 MPa, 3.622 MPa, 4.476 MPa and 6.186 MPa, respectively (mean 3.849 MPa; equivalence band 3.811-3.887 MPa at ±1% of the mean). Correlation analysis demonstrated a strong positive relationship between identical-volume varying-area IAIF defects and contact stress ( r=0.996, P<0.001). The linear regression equation was MCS=0.168×AI+1.236, where AI denotes IAIF area. Equivalence zero testing indicated that none of the measured values fell within the predefined ±1% margin, failing to satisfy the equivalence null hypothesis. Conclusion:In posterior ankle fractures, the volume change of IAIF defects has no clinical significance in relation to MCS, showing a small negative correlation. However, the area change of IAIF defects is clinically significant in relation to MCS, demonstrating a larger positive correlation.

Traumatic aortic injury (TAI) is an acute, critical, and severe disease, and then combined with multiple organ damage, it is even more dangerous. TAI progresses very rapidly, with a pre-hospital mortality rate of 57%-80%, and even when arriving at the hospital, more than one-third of the patients die within 4 h, and it is the 2nd leading cause of death in individuals aged 4-34 years. In addition, the incidence of TAI combined with injury was 81.4%. Therefore, early diagnosis, expeditious surgery, and timely and effective multidisciplinary cooperation are essential for successful rescue. The authors report 2 patients with acute traumatic aortic dissection combined with multiple organ injuries and treated with emergency endovascular surgery to discuss their clinical characteristics and treatment experience, and to provide experience in the diagnosis and treatment of such patients.
Humans ; Aortic Dissection/surgery* ; Endovascular Procedures ; Multiple Trauma/surgery*

BACKGROUND:The reduction of contact area,edge load,and stress increase of adjacent cartilage caused by knee cartilage defect are considered to easily cause degenerative changes in this tissue,which may develop into knee osteoarthritis.Growth factors are considered to be a treatment method to promote the healing of damaged cartilage and delay the progression of degenerative arthritis.OBJECTIVE:To analyze the hotspots and prospects of growth factor-promoted knee cartilage regeneration research by bibliometric methods.METHODS:The first author retrieved 321 articles related to growth factor-promoted knee cartilage regeneration research from the Web of Science core set database.VOSviewer 1.6.19 software was used to analyze the publication volume,country,institution,keyword,and literature citation status of the articles,and investigate the research hotspots.RESULTS AND CONCLUSION:(1)From 2000 to 2024,the annual number of publications in the field of growth factor-promoted knee cartilage regeneration showed an overall upward trend,with the highest number of publications in 2021.Harvard University in the United States published the most papers.(2)Keyword analysis showed that the frequency of keywords such as growth factor,cartilage,cartilage repair,platelet-rich plasma,and cartilage regeneration was high.In addition,the keyword co-occurrence network diagram showed that growth factor was closely related to keywords such as cartilage repair and cartilage regeneration,indicating that growth factor research plays an important role in the field of cartilage regeneration.(3)The results of literature citation analysis showed that the combination of platelet-rich plasma and muscle-derived stem cells may provide a new and effective treatment strategy for patients with osteoarthritis,which can deepen the understanding of cartilage repair mechanisms by promoting stem cell proliferation and cartilage formation.Fibroblast growth factor 2,fibroblast growth factor 18,and insulin growth factor 1 play a key role in cartilage repair and can promote chondrocyte proliferation and matrix synthesis.In particular,fibroblast growth factor 18 can promote the repair of damaged cartilage,thereby alleviating patients'pain and dysfunction,which deserves further in-depth study in the future.The latest research has developed a new Polyhedrin Delivery System(PODS)that can continuously release growth factors such as bone morphogenetic protein 2 and 7,significantly promoting chondrocyte proliferation and cartilage repair.This system provides a new perspective and potential therapy for the treatment of osteoarthritis.(4)Therefore,bone morphogenetic protein 2,7,insulin growth factor 1,and recombinant human fibroblast growth factor 18 are promising growth factor therapies for promoting cartilage regeneration.In the future,further in-depth research on the mechanism of action of growth factors,optimization of treatment strategies,and strengthening of long-term efficacy and safety evaluation are needed.

Objective:To explore the effect of the defect area and volume of intra-articular impacted fragments (IAIF) on the contact stress of the ankle joint surface.Methods:A 23-year-old male volunteer, 168 cm in height and 60 kg in weight, with no history of trauma or anatomic abnormality of the ankle, was selected. On the basis of a normal ankle finite-element model, IAIF-defect finite-element models were established. The first group consisted of IAIF-defect models with identical area but different volumes: on the distal tibial articular surface the defect area was 4 mm × 5 mm (20 mm 2), and the heights were 2 mm, 3 mm, 4 mm, 5 mm and 6 mm. The second group consisted of IAIF-defect models with identical defect volume but different areas. The defect volume was 90 mm 3, while the defect areas on the distal tibial articular surface were 2 mm×3 mm, 3 mm×3 mm, 3 mm×5 mm, 3 mm×6 mm, and 5 mm×6 mm, with corresponding heights of 15 mm, 10 mm, 6 mm, 5 mm, and 3 mm. Under a 600 N vertical load the contact stress of the ankle joint was calculated, and the finite-element data were recorded and analyzed. Pearson correlation analysis was used to analyze, separately for the two groups, the correlation between IAIF defect and the maximum contact stress (MCS) of the distal tibial articular surface, and simple linear regression analysis was performed to obtain regression equations. Equivalence zero testing was used to verify the correlations and to compare their differences. Results:For IAIF defects with the same area but different volumes, including 4 mm×5 mm×2 mm, 4 mm×5 mm×3 mm, 4 mm×5 mm×4 mm, 4 mm×5 mm×5 mm, and 4 mm× 5 mm×6 mm, the corresponding maximum contact stress (MCS) on the distal tibial joint surface were 3.846 MPa, 3.839 MPa, 3.835 MPa, 3.833 MPa, and 3.831 MPa, respectively, with an average of 3.837 MPa. The mean ±1% range is from 3.799 MPa to 3.875 MPa. The correlation analysis showed that the IAIF defects with the same area but different volumes were negatively correlated with contact stress ( r=-0.956, P=0.011). The linear regression equation was MCS=-0.0002×VI+3.851, where VI denotes IAIF volume. Equivalence zero testing confirmed that all measured values lay within the predefined ±1 % margin, satisfying the equivalence null hypothesis. For IAIF defects of identical volume (90 mm 3) but varying articular surface areas—2 mm×3 mm, 3 mm×3 mm, 3 mm×5 mm, 3 mm×6 mm and 5 mm×6 mm—the corresponding MCS values were 2.147 MPa, 2.812 MPa, 3.622 MPa, 4.476 MPa and 6.186 MPa, respectively (mean 3.849 MPa; equivalence band 3.811-3.887 MPa at ±1% of the mean). Correlation analysis demonstrated a strong positive relationship between identical-volume varying-area IAIF defects and contact stress ( r=0.996, P<0.001). The linear regression equation was MCS=0.168×AI+1.236, where AI denotes IAIF area. Equivalence zero testing indicated that none of the measured values fell within the predefined ±1% margin, failing to satisfy the equivalence null hypothesis. Conclusion:In posterior ankle fractures, the volume change of IAIF defects has no clinical significance in relation to MCS, showing a small negative correlation. However, the area change of IAIF defects is clinically significant in relation to MCS, demonstrating a larger positive correlation.

BACKGROUND:The reduction of contact area,edge load,and stress increase of adjacent cartilage caused by knee cartilage defect are considered to easily cause degenerative changes in this tissue,which may develop into knee osteoarthritis.Growth factors are considered to be a treatment method to promote the healing of damaged cartilage and delay the progression of degenerative arthritis.OBJECTIVE:To analyze the hotspots and prospects of growth factor-promoted knee cartilage regeneration research by bibliometric methods.METHODS:The first author retrieved 321 articles related to growth factor-promoted knee cartilage regeneration research from the Web of Science core set database.VOSviewer 1.6.19 software was used to analyze the publication volume,country,institution,keyword,and literature citation status of the articles,and investigate the research hotspots.RESULTS AND CONCLUSION:(1)From 2000 to 2024,the annual number of publications in the field of growth factor-promoted knee cartilage regeneration showed an overall upward trend,with the highest number of publications in 2021.Harvard University in the United States published the most papers.(2)Keyword analysis showed that the frequency of keywords such as growth factor,cartilage,cartilage repair,platelet-rich plasma,and cartilage regeneration was high.In addition,the keyword co-occurrence network diagram showed that growth factor was closely related to keywords such as cartilage repair and cartilage regeneration,indicating that growth factor research plays an important role in the field of cartilage regeneration.(3)The results of literature citation analysis showed that the combination of platelet-rich plasma and muscle-derived stem cells may provide a new and effective treatment strategy for patients with osteoarthritis,which can deepen the understanding of cartilage repair mechanisms by promoting stem cell proliferation and cartilage formation.Fibroblast growth factor 2,fibroblast growth factor 18,and insulin growth factor 1 play a key role in cartilage repair and can promote chondrocyte proliferation and matrix synthesis.In particular,fibroblast growth factor 18 can promote the repair of damaged cartilage,thereby alleviating patients'pain and dysfunction,which deserves further in-depth study in the future.The latest research has developed a new Polyhedrin Delivery System(PODS)that can continuously release growth factors such as bone morphogenetic protein 2 and 7,significantly promoting chondrocyte proliferation and cartilage repair.This system provides a new perspective and potential therapy for the treatment of osteoarthritis.(4)Therefore,bone morphogenetic protein 2,7,insulin growth factor 1,and recombinant human fibroblast growth factor 18 are promising growth factor therapies for promoting cartilage regeneration.In the future,further in-depth research on the mechanism of action of growth factors,optimization of treatment strategies,and strengthening of long-term efficacy and safety evaluation are needed.

Gallbladder polypoid lesions (GPLs) refer to any elevated lesion of the mucosal surface of the gallbladder wall, and the prevalence is estimated to be between 0.9% and 12.1%. GPLs include benign polyps and malignant polyps. Benign polyps are further classified as non-neoplastic polyps and neoplastic polyps. Cholesterol polyps are the most common benign polyps and adenocarcinoma is the main type of malignant polyp. Hepatitis B virus infection, liver function abnormalities, dyslipidemia, and obesity are the main risk factors for GPLs. Studies of biological mechanisms have focused on malignant gallbladder polyps, the development of which is regulated by hormone levels in vivo, gut microbiota, inflammation, oxidative stress, Salmonella typhimurium, and related molecules. Diagnostic modalities include chemical examination and imaging examination, with imaging examination currently being the mainstay. Treatment of patients with GPLs is based on the presence or absence of symptoms, age, size of the polyps, tendency of the polyp to increase, and risk factors for symptomatic malignancy to determine whether surgery should be performed.

Objective To evaluate the stability,safety and immune enhancement and anti-tumor effects of Wilms'tumor gene 1(WT1)peptide combined with AddaVaxTM emulsion vaccine for acute myeloid leukemia.Methods The stability of WT1 peptide in the adjuvant vaccine was evaluated using MALDI-TOF-MS time-of-flight mass spectrometry.Female C57BL/6 mice were randomly divided into PBS group,WT1 peptide group,and WT1 peptide+AddaVaxTMemulsion adjuvant vaccine group.The immunization was performed at a dose of 50 μg/mouse for antigen and 50 μg/mouse for adjuvant,with intramuscular injection on days 0,14,and 28.HE staining was used to assess the toxicity of intramuscular vaccination on mouse organ tissues.Cytokine levels were detected by ELISA,and the number of IFN-γ-secreting splenocytes was measured by ELISpot.Flow cytometry was employed to detect the maturation of bone marrow-derived dendritic cells(BMDCs)promoted by the vaccine in vitro and the promotion for lymphocyte activation,and H-2Db WT1 tetramer was utilized to detect the proportion of specific CD8+T cells.After establishing a mouse leukemia tumor model using the C1498-mWT1 stable cell line,the anti-tumor effects of the vaccine for prevention and treatment were evaluated.Results The WT1 peptide stably existed in the vaccine without causing significant organ tissue changes in mice after intramuscular injection.Compared to the mice immunized with WT1 aqueous solution,the mice after intramuscular injection of the WT1 peptide emulsion adjuvant vaccine showed stronger immune responses of Th1 cells,including IFN-γ and TNF-α,as well as Th17 cells of IL-17A(P＜0.05),and the mice had not only promoted number of IFN-γ secreting splenocytes(P＜0.01)but also enhanced maturation of BMDCs,as indicated by an increase in the proportions of CD40+/CD11c+and CD86+CD80+/CD11c+ cells(P＜0.05).Additionally,there were increases in both the proportion of CD4+/CD3+T and CD69+/CD8+T cells(P＜0.05)and the proportion of specific CD8+T cells(P＜0.05).In the anti-tumor effect study using the C1498-mWT1 mouse model,the median survival time of the WT1+AddaVaxTM group was extended by 6 d compared to the WT1 aqueous solution group.At day 50,the survival rate of mice in the WT1+AddaVaxTM group was still 28.5％,while all mice in the other groups had died(P＜0.05).Conclusion The vaccine with the WT1 peptide and AddaVaxTM emulsion adjuvant exhibits good immunological and anti-tumor effects.

Objective:To evaluate the efficacy and safety of peroral endoscopic myotomy (POEM) in achalasia of cardia (AC) patients with the long course.Methods:A total of 159 AC patients who received POEM from January 2015 to March 2022 in the First Affiliated Hospital of Soochow University were divided into the long course group (≥10 years) and the non-long course group (<10 years). The baseline information, POEM procedure and postoperative recurrence were compared and the differences between the recurrent patients and non-recurrent patients in the long course group were explored.Results:The age (57.09±14.30 years VS 42.08±15.68 years, t=5.569, P<0.001), the rate of treatment history [28.9% (13/45) VS 9.6% (11/114), χ2=9.319, P=0.020], the proportion of Henderson grade Ⅲ esophagus [17.8% (8/45) VS 6.1% (7/114), χ2=7.020, P=0.030] in the long course group were significantly higher than those in the non-long course group. The recurrence rate in the long course group was significantly higher than that in the non-long course group [33.3% (15/45) VS 14.9% (17/114), χ2=6.811, P=0.009]. In the long course group, the age (62.50 ± 16.94 years VS 53.77 ± 12.95 years, t=-2.121, P=0.040), and the rate of treatment history [53.3% (8/15) VS 16.7% (5/30), χ2=6.544, P=0.016] in the recurrent patients were higher than those in the non-recurrent patients. Conclusion:POEM is safe and effective for long-course AC patients. In patients with the long course, the aged patients with previous treatment are more likely to relapse.

Objective:To compare the short-term efficacy of Billroth Ⅱ+Braun anasto-mosis versus Roux-en-Y anastomosis in totally three-dimensional (3D) laparoscopic distal gastrectomy.Methods:The retrospective cohort study was conducted. The clinicopathological data of 140 patients with gastric cancer who were admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2020 were collected. There were 105 males and 35 females, aged from 23 to 84 years, with a median age of 55 years. Of the 140 patients, 54 patients undergoing totally 3D laparoscopic distal gastrectomy with Billroth Ⅱ+Braun anastomosis were allocated into Billroth Ⅱ+Braun group, and 86 patients undergoing totally 3D laparoscopic distal gastrectomy with Roux-en-Y anastomosis were allocated into Roux-en-Y group, respectively. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect remnant gastritis and its severity, bile reflux, reflux esophagitis in the postoperative 3 months up to April 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was analyzed using the Mann-Whitney U test. Results:(1) Surgical situations: 140 patients underwent totally 3D laparoscopic distal gastrectomy. The operation time, cases with volume of intraoperative blood loss <50 mL, 50 to 200 mL or >200 mL, the number of lymph node dissected were (233±39)minutes,15, 35, 4, 30±13 for the Billroth Ⅱ +Braun group , respectively, versus (240±52)minutes,25, 51, 10, 27±10 for the Roux-en-Y group, showing no significant difference between the two groups ( t=0.856， χ2=0.774， t=1.518， P>0.05). (2) Postoperative situations: cases with drainage tube, time to postoperative first flatus, cases with postoperative grade Ⅱ, Ⅲ, Ⅳ, Ⅴ complications, cases with postoperative complications, cases with postoperative severe complications, duration of postoperative hospital stay, surgery cost and total hospitalization cost of the Billroth Ⅱ+Braun group were 38, (3.5±0.8)days,4, 1, 0, 0, 5, 1, (9.0±5.0)days, (3.8±1.2)×10 4 yuan and (9.7±2.1)×10 4 yuan, respectively. The above indicators of the Roux-en-Y group were 59, (3.7±1.0)days, 9, 1, 0, 1, 11, 2, (9.0±4.0)days, (4.3±1.0)×10 4 yuan and (9.2±2.1)×10 4 yuan, respectively. There was a significant difference in the surgery cost between the two groups ( t=2.453, P<0.05), while there was no significant difference in cases with drainage tube, time to postoperative first flatus, cases with postoperative grade Ⅱ, Ⅲ, Ⅳ, Ⅴ complications, cases with postoperative complications, duration of postoperative hospital stay or total hospitalization cost between the two groups ( χ2=0.049, t=?1.339, Z=0.000, χ2=0.409, t=0.197, 1.383, P>0.05). There was also no significant difference in cases with postoperative severe complications between the two groups ( P>0.05).(3) Follow-up: 134 of 140 patients received the follow-up, including 52 cases in the Billroth Ⅱ+Braun group and 82 cases in the Roux-en-Y group. Results of follow-up within postoperative 3 months showed that the incidence rates of remnant gastritis, bile reflux, reflux esophagitis were 61.5%(32/52), 38.5%(20/52), 26.9%(14/52) for the Billroth Ⅱ+Braun group, respectively, versus 41.5%(34/82), 22.0%(18/82), 12.2%(10/82) for the Roux-en-Y group, showing significant differences between the two groups ( χ2=5.131, 4.270, 4.695, P<0.05). Cases with grade 0,Ⅰ,Ⅱ, Ⅲ, Ⅳ residual food were 42, 3, 5, 2,0 for the Billroth Ⅱ+Braun group, versus 67, 9, 1, 5,0 for the Roux-en-Y group, showing no significant difference between the two groups ( Z=?0.156, P>0.05). Cases with minimal lesion, grade A, grade B gastritis (severity of gastritis) were 6, 5, 3 for the Billroth Ⅱ+Braun group, versus 8, 2, 0 for the Roux-en-Y group, showing no significant difference between the two groups ( Z=?1.468, P>0.05). Conclusions:It is safe and feasible to operate Billroth Ⅱ+Braun or Roux-en-Y anastomosis in totally 3D laparoscopic distal gastrectomy. Billroth Ⅱ+Braun anastomosis can reduce the surgical cost. Roux-en-Y anastomosis has advantages in reducing the incidence of reflux esophagitis, bile reflux and reflux gastritis.

Titanium mesh cage is one of the fusion devices used in anterior cervical corpectomy and fusion (ACCF). It can not only immediately rebuild the stability of cervical spine during the operation, maintain the height and physiological curvature of intervertebral vertebrae, but also avoid the complications of bone donor area caused by autologous bone extraction. Therefore, titanium mesh cage has become the most commonly used internal plant in ACCF. However, there exist many problems in traditional titanium cage, such as stress shielding and titanium cage sinking, which will affect the surgical effect to a certain extent, and even lead to serious postoperative complications requiring revision surgery. At present, a variety of new titanium cages have been invented, which can solve the problems caused by traditional titanium cage to a certain extent. Biomechanical evaluation and its testing methods are an indispensable process for judging whether a new type of spinal fusion cage can be used in clinical practice. This article reviews the biomechanical studies related to cervical spine anatomy, the biomechanical properties of traditional titanium cages and new titanium cages, so as to provide new ideas for the improvement of traditional titanium cages and the development of new titanium cages.