OBJECTIVE: To evaluate the effectiveness of early internal fixation combined with free anterolateral thigh perforator flap (ALTPF) transplantation in the treatment of open ankle fracture-dislocation. METHODS: A retrospective analysis was performed on the clinical data of 13 patients with open ankle fracture-dislocation who were admitted and met the inclusion criteria between January 2021 and May 2024. Among them, there were 9 males and 4 females, with the ages ranging from 23 to 61 years (mean, 45.3 years). Fracture types included 5 cases of simple medial or lateral malleolar fracture-dislocation, 7 cases of bimalleolar (medial and lateral) fracture-dislocation, and 1 case of trimalleolar fracture-dislocation. Additionally, 3 cases were complicated with bone defects (1 medial malleolus defect and 2 lateral malleolus defects). All injuries were classified as type ⅢB according to the Gustilo-Anderson classification for open fractures. The size of wound defects ranged from 7 cm×5 cm to 18 cm×12 cm. The time from injury to surgery was 2-20 hours (mean, 4 hours). All patients underwent emergency thorough debridement upon admission. The fracture-dislocation was temporarily stabilized with an external fixator, and the wound was covered with antibiotic-impregnated bone cement sheets or vacuum sealing drainage. Definitive internal fixation of the fracture and free ALTPF transplantation were performed 5-7 days after the initial emergency procedure. Postoperatively, wound healing, flap survival, and fracture union were monitored. At last follow-up, clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. RESULTS: All 13 patients were followed up 6-24 months (mean, 8.2 months). All flaps survived completely, and all fractures achieved union, with an union time of 3-11 months (mean, 5.5 months). One patient developed a superficial infection at the wound margin, which healed after regular dressing changes and drainage. No internal fixation-related complication (e.g., deep infection, implant loosening, or secondary ankle instability) were observed. At last follow-up, the total AOFAS ankle-hindfoot score was 78.6±13.5, with 3 excellent, 7 good, 2 fair, and 1 poor cases, yielding an excellent and good rate of 76.9%. CONCLUSION Early internal fixation combined with ALTPF transplantation for open ankle fracture-dislocation can shorten the treatment course and maximize the recovery of ankle joint function.
Humans ; Fracture Fixation, Internal/methods* ; Male ; Middle Aged ; Female ; Adult ; Retrospective Studies ; Perforator Flap/transplantation* ; Ankle Fractures/surgery* ; Thigh/surgery* ; Fractures, Open/surgery* ; Treatment Outcome ; Young Adult ; Plastic Surgery Procedures/methods* ; Fracture Dislocation/surgery*

Objective To explore the efficacy of bilateral facial muscle training combined with visual electromyography biofeedback on facial nerve function recovery in patients with idiopathic facial nerve palsy. Methods Patients with idiopathic facial nerve palsy admitted to Shanghai Fifth People’s Hospital, Fudan University from July 2022 to July 2024 were selected and randomly divided into a control group and an intervention group. The control group received conventional physical factor therapy, while the intervention group received bilateral facial muscle training combined with visual electromyography biofeedback therapy based on the control group’s regimen. After 20 treatment sessions, the total effective rate, the House-Brackmann (H-B) facial nerve grading system, the Sunnybrook Facial Grading System (SFGS) score, and the average value ratio of maximal amplitudes of bilateral frontalis and zygomaticus muscles were compared between the two groups. Results A total of 90 patients were included, 45 in each group. After 20 treatment sessions, the total effective rate was significantly higher in the intervention group than in the control group (84.4% vs 75.6%, P＝0.003). Compared with the control group, the intervention group demonstrated a significantly lower H-B grade (P＝0.003) and a higher SFGS score (P＝0.001). The average value ratios of maximal amplitudes of the affected versus healthy side frontalis (P＝0.013) and zygomatic (P＝0.022) muscles were higher in the intervention group than in the control group. Conclusions Bilateral facial muscle training combined with visual electromyography biofeedback is an effective approach for treating idiopathic facial nerve palsy, effectively promoting the recovery of facial nerve function, and improving facial symmetry and facial muscle function.

Objective:To analyze the changes and significance in clinical cardiac indicators of early cardiac myocardial dysfunction and cardiac substructure dose during conventional radiotherapy for N 2-N 3 non-small cell lung cancer (NSCLC) with mediastinal lymph node metastases. Methods:The data of 34 NSCLC patients with lymph node metastases in regions 4-8 admitted to the Affiliated Cancer Hospital of Guizhou Medical University from June 2022 to August 2023 were observed and analyzed. All patients were treated with volumetric modulated arc therapy with a prescribed dose of 60-70 Gy. Cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured at 6 time points: within 1 week before radiotherapy ( t0); when the cumulative radiotherapy dose reaches 20 Gy ( t20), 40 Gy ( t40), 60 Gy ( t60) during radiotherapy; within 1 week after radiotherapy ( tp); 1 month after radiotherapy( tp1). Left ventricular global longitudinal strain (LVGLS) and left atrial global longitudinal strain (LAGLS) were assessed at 4 time points: t0, t40, tp and tp1, respectively. The changes in cardiac indicators at different time points during radiotherapy and their correlation with substructure doses were analyzed using analysis of variance, linear regression analysis, and Pearson correlation. Results:The correlation between cardiac substructure dose and mean heart dose (MHD) in the study cohort in the descending order was as follows: left ventricle ( B=0.43, P<0.001), right ventricle ( B=0.37, P=0.002), left atrium ( B=0.16, P<0.001), and right atrium ( B=0.15, P=0.001). There were significant differences in the changes of LVGLS and LAGLS across different time points ( F=3.13, P=0.029; F=17.18, P<0.001). At 1 month after radiation, LAGLS was significantly decreased compared to pre-radiation levels ( P=0.009), whereas no significant difference was observed in LVGLS ( P=1.000). No significant differences were observed in the changes of cTnT and NT-proBNP across different time points (all P>0.05). Significant correlations were identified between cTnT and right ventricle mean dose at t40 ( r=0.38, P=0.025), as well as between NT-proBNP and right atrium mean dose at t60 and tp ( r=0.54, P=0.001; r=0.41, P=0.016). Conclusions:At present, there is no significant difference between the sensitive serum markers of myocardial injury and LVGLS in detecting early myocardial injury. LAGLS may hold substantial clinical value. There is uncertainty about radiation injury and repair of various cardiac substructures.

BACKGROUND:Multiple studies and observations have indicated a close relationship between inflammation,metabolites,and osteoporosis.However,it is still unclear whether there is a genetic causal effect between inflammation-related proteins and osteoporosis and whether metabolites play a mediating role in this process.OBJECTIVE:To investigate the causal relationships between inflammation-related proteins and osteoporosis using Mendelian randomization method as well as the mediating effect of plasma metabolites in this process.METHODS:Summary data from genome-wide association studies(GWAS)were used,with osteoporosis data sourced from the Fengenn database,and GWAS data on inflammation-related proteins and plasma metabolites obtained from published studies.The inverse-variance weighted method was primarily used to assess the exposure-outcome relationships.Bidirectional Mendelian randomization analyses were used to explore the causal relationships between inflammation-related proteins and osteoporosis,and two-step Mendelian randomization was used to discover potential mediating metabolites.Sensitivity analyses were then performed to further validate the robustness of the results.Cochran's Q test was used to assess heterogeneity,and horizontal pleiotropy was evaluated using the MR-Egger intercept and MR-PRESSO methods.RESULTS AND CONCLUSION:The initial bidirectional Mendelian randomization analysis identified five inflammation-related proteins that showed a positive causal relationship with osteoporosis and no reverse causal relationship.Artemin(odds ratio[OR]=0.895,95%confidence interval[CI]:0.819-0.979,P=0.015)was negatively associated with osteoporosis,whereas chemokine(C-X-C Motif)ligand 1(OR=1.100,95%CI:1.002-1.209,P=0.046),chemokine(C-X-C Motif)ligand 11(OR=1.150,95%CI:1.043-1.268,P=0.005),interleukin 17C(OR=1.087,95%CI:1.004-1.176,P=0.040),and tumor necrosis factor-like weak inducer of apoptosis(OR=1.108,95%CI:1.002-1.226,P=0.046)were positively associated with osteoporosis.Sensitivity analyses indicated no heterogeneity or pleiotropy in these causal effects.Subsequently,we conducted a two-step Mendelian randomization to discover potential mediating metabolites.This study showed that 1-palmitoyl-gpc(16:0)increased the negative effect of Artemin on osteoporosis.5α-androstan-3α,17β-diol monosulfate increased the risk of osteoporosis mediated by chemokine(C-X-C Motif)ligand 1 and chemokine(C-X-C Motif)ligand 11.The ratio of α-ketoglutarate to succinate led to an increased risk of osteoporosis mediated by chemokine(C-X-C Motif)ligand 11 and interleukin-17C.Spermidine and the ratio of proline to trans-4-hydroxyproline contributed to an increased risk of osteoporosis mediated by chemokine(C-X-C Motif)ligand 11.12,13-DiHOME contributed to an increased risk of osteoporosis mediated by interleukin-17C.The sulfate level of piperine metabolite C16H19NO3(3)and adenosine 3',5'-cyclic monophosphate contributed to an increased risk of osteoporosis mediated by tumor necrosis factor-like weak inducer of apoptosis.In conclusion,the above data indicate that some inflammation-related proteins can influence the risk of osteoporosis,both positively and negatively,and some of these effects are mediated by plasma metabolites.This provides new insights for future investigations into the occurrence and development mechanisms of osteoporosis.

Objective The biomechanical performance of Ilizarov fixator models with different configurations for humeral shaft defect was compared,so as to provide a biomechanical basis for selecting the appropriate circular external fixation structure for the clinical treatment of humeral shaft defects using Ilizarov technology.Methods Based on CT data of the humerus from a healthy volunteer,the external fixators with three configurations,namely,hybrid frame,semi-ring frame and 90° fan frame were established.The finite element method was used to simulate the displacement and stress distribution under different loading conditions,and the finite element results were validated by biomechanical tests.Results Finite element analysis results:in terms of displacement,under compression,tensile and torque conditions,the displacement of 90° fan model was smaller than that of hybrid and semi-ring models.In terms of stress,the 90° fan model had the smallest displacement under tensile condition.In compression and torque tests,the semi-annular model had the lowest stress.Biomechanical test results:the semi-ring model exhibited the smallest displacement under axial compression,but there was no significant difference between the three models(P＞0.05).Conclusions The semi-ring and 90° fan frames can achieve a similar stability as the traditional hybrid frame through the strategy of'reducing the ring and increasing the stem'.The unilateral structure of the 90° fan frame has the advantages of small size,light weight,and structural stability,as well as a small impact on the shoulder and elbow joints,which makes it more valuable in clinical applications.

Objective To establish an electrical field(EF)stimulation model for Schwann cells(SCs),and to provide a basis for exploring the mechanisms of EF stimulation in promoting proliferation,migration and epithelial-to-mesenchymal transition of SCs.Methods A YC-3 bipolar programmable electrical stimulator and an electrotaxis chamber were used to construct an EF stimulation system to stimulate SCs.In the study,SCs were divided into control group(Ctrl)receiving no EF stimulation and EF group stimulated by continuous constant-voltage EF(100 mV/mm,3 h).The effects of EF stimulation on the proliferation and migration of SCs were analyzed using CCK-8 assay,and wound healing assay+Transwell assay,separately;and its effect on SCs adhesion was observed by analyzing the expressions of E-cadherin and N-cadherin using Western Blot.Results The CCK-8 assay results suggested that the absorbance at 450 nm was significantly higher in EF group than in Ctrl group(P<0.05).The results of wound healing assay+Transwell assay revealed that EF group had higher cell migration efficiency than Ctrl group(P<0.05).Western Blot results showed decreased E-cadherin expression and increased N-cadherin expression in EF group as compared with Ctrl group(P<0.05).Conclusion The improved EF stimulation system for SCs is operable.EF stimulation can promote the proliferation and migration of SCs.The decreased E-cadherin expression and increased N-cadherin expression may be related to the occurrence of epithelial-to-mesenchymal transition in SCs after EF stimulation.

Objective Based on the diffusion tensor imaging(DTI)technique,this study aims to analyze the impact of early acupuncture intervention on the microstructure of brain white matter fibers,explore the brain mechanisms underlying the arousal effect of acupuncture intervention in comatose patients after traumatic cerebral injury,so as to provide a theoretical basis for early awakening promotion.Methods This study enrolled 32 comatose patients with traumatic brain injury admitted to the Department of Acupuncture and Rehabilitation with a disease course ranging from 10 to 30 days.Participants were randomly allocated into a control group(n=16)and an acupuncture group(n=16)using a random number table method.Both groups received conventional awakening-promoting rehabilitation treatment,while the acupuncture group additionally treated with the Xingnao Kaiqiao acupuncture therapy.Before and after the treatment,the Glasgow Coma Scale(GCS)scores and DTI examination were conducted respectively to assess the awakening rate and measure FA values.Explore the correlation between FA values within the acupuncture group and the GCS scores for the regions where inter-group differences occur after treatment.Results After 28 days of treatment in both groups,the awakening rate in the acupuncture group reached 75.00％,significantly higher than that in the control group(43.75％)(P=0.047).After treatment,FA values showed a significant increase compared to baseline levels in both groups(P<0.05).The acupuncture group exhibited a significantly greater increase in FA values in the midbrain,pons,thalamus,posterior limb of the internal capsule,and the splenium of the corpus callosum compared to the control group(P<0.05),while no statistically significant between-group differences were observed in the regions of anterior limb of the internal capsule,genu of the corpus callosum,and the semioval center(P>0.05).Correlation analysis revealed FA values in the midbrain,pons,thalamus,posterior internal capsule,and splenium were significantly positively correlated with GCS scores in the acupuncture group after treatment,particularly in the midbrain(r=0.785)and thalamus(r=0.739).Conclusions Acupuncture combined with conventional awakening therapy can effectively improve the consciousness state of comatose patients with TBI.The midbrain,pons,thalamus,posterior limb of the internal capsule,and splenium of the corpus callosum may be the key regions affected by acupuncture.The underlying mechanism may be related to promoting the repair and remodeling of white matter fibers in these critical areas.

Objective The biomechanical performance of Ilizarov fixator models with different configurations for humeral shaft defect was compared,so as to provide a biomechanical basis for selecting the appropriate circular external fixation structure for the clinical treatment of humeral shaft defects using Ilizarov technology.Methods Based on CT data of the humerus from a healthy volunteer,the external fixators with three configurations,namely,hybrid frame,semi-ring frame and 90° fan frame were established.The finite element method was used to simulate the displacement and stress distribution under different loading conditions,and the finite element results were validated by biomechanical tests.Results Finite element analysis results:in terms of displacement,under compression,tensile and torque conditions,the displacement of 90° fan model was smaller than that of hybrid and semi-ring models.In terms of stress,the 90° fan model had the smallest displacement under tensile condition.In compression and torque tests,the semi-annular model had the lowest stress.Biomechanical test results:the semi-ring model exhibited the smallest displacement under axial compression,but there was no significant difference between the three models(P＞0.05).Conclusions The semi-ring and 90° fan frames can achieve a similar stability as the traditional hybrid frame through the strategy of'reducing the ring and increasing the stem'.The unilateral structure of the 90° fan frame has the advantages of small size,light weight,and structural stability,as well as a small impact on the shoulder and elbow joints,which makes it more valuable in clinical applications.

Objective Based on the diffusion tensor imaging(DTI)technique,this study aims to analyze the impact of early acupuncture intervention on the microstructure of brain white matter fibers,explore the brain mechanisms underlying the arousal effect of acupuncture intervention in comatose patients after traumatic cerebral injury,so as to provide a theoretical basis for early awakening promotion.Methods This study enrolled 32 comatose patients with traumatic brain injury admitted to the Department of Acupuncture and Rehabilitation with a disease course ranging from 10 to 30 days.Participants were randomly allocated into a control group(n=16)and an acupuncture group(n=16)using a random number table method.Both groups received conventional awakening-promoting rehabilitation treatment,while the acupuncture group additionally treated with the Xingnao Kaiqiao acupuncture therapy.Before and after the treatment,the Glasgow Coma Scale(GCS)scores and DTI examination were conducted respectively to assess the awakening rate and measure FA values.Explore the correlation between FA values within the acupuncture group and the GCS scores for the regions where inter-group differences occur after treatment.Results After 28 days of treatment in both groups,the awakening rate in the acupuncture group reached 75.00％,significantly higher than that in the control group(43.75％)(P=0.047).After treatment,FA values showed a significant increase compared to baseline levels in both groups(P<0.05).The acupuncture group exhibited a significantly greater increase in FA values in the midbrain,pons,thalamus,posterior limb of the internal capsule,and the splenium of the corpus callosum compared to the control group(P<0.05),while no statistically significant between-group differences were observed in the regions of anterior limb of the internal capsule,genu of the corpus callosum,and the semioval center(P>0.05).Correlation analysis revealed FA values in the midbrain,pons,thalamus,posterior internal capsule,and splenium were significantly positively correlated with GCS scores in the acupuncture group after treatment,particularly in the midbrain(r=0.785)and thalamus(r=0.739).Conclusions Acupuncture combined with conventional awakening therapy can effectively improve the consciousness state of comatose patients with TBI.The midbrain,pons,thalamus,posterior limb of the internal capsule,and splenium of the corpus callosum may be the key regions affected by acupuncture.The underlying mechanism may be related to promoting the repair and remodeling of white matter fibers in these critical areas.

BACKGROUND:Multiple studies and observations have indicated a close relationship between inflammation,metabolites,and osteoporosis.However,it is still unclear whether there is a genetic causal effect between inflammation-related proteins and osteoporosis and whether metabolites play a mediating role in this process.OBJECTIVE:To investigate the causal relationships between inflammation-related proteins and osteoporosis using Mendelian randomization method as well as the mediating effect of plasma metabolites in this process.METHODS:Summary data from genome-wide association studies(GWAS)were used,with osteoporosis data sourced from the Fengenn database,and GWAS data on inflammation-related proteins and plasma metabolites obtained from published studies.The inverse-variance weighted method was primarily used to assess the exposure-outcome relationships.Bidirectional Mendelian randomization analyses were used to explore the causal relationships between inflammation-related proteins and osteoporosis,and two-step Mendelian randomization was used to discover potential mediating metabolites.Sensitivity analyses were then performed to further validate the robustness of the results.Cochran's Q test was used to assess heterogeneity,and horizontal pleiotropy was evaluated using the MR-Egger intercept and MR-PRESSO methods.RESULTS AND CONCLUSION:The initial bidirectional Mendelian randomization analysis identified five inflammation-related proteins that showed a positive causal relationship with osteoporosis and no reverse causal relationship.Artemin(odds ratio[OR]=0.895,95%confidence interval[CI]:0.819-0.979,P=0.015)was negatively associated with osteoporosis,whereas chemokine(C-X-C Motif)ligand 1(OR=1.100,95%CI:1.002-1.209,P=0.046),chemokine(C-X-C Motif)ligand 11(OR=1.150,95%CI:1.043-1.268,P=0.005),interleukin 17C(OR=1.087,95%CI:1.004-1.176,P=0.040),and tumor necrosis factor-like weak inducer of apoptosis(OR=1.108,95%CI:1.002-1.226,P=0.046)were positively associated with osteoporosis.Sensitivity analyses indicated no heterogeneity or pleiotropy in these causal effects.Subsequently,we conducted a two-step Mendelian randomization to discover potential mediating metabolites.This study showed that 1-palmitoyl-gpc(16:0)increased the negative effect of Artemin on osteoporosis.5α-androstan-3α,17β-diol monosulfate increased the risk of osteoporosis mediated by chemokine(C-X-C Motif)ligand 1 and chemokine(C-X-C Motif)ligand 11.The ratio of α-ketoglutarate to succinate led to an increased risk of osteoporosis mediated by chemokine(C-X-C Motif)ligand 11 and interleukin-17C.Spermidine and the ratio of proline to trans-4-hydroxyproline contributed to an increased risk of osteoporosis mediated by chemokine(C-X-C Motif)ligand 11.12,13-DiHOME contributed to an increased risk of osteoporosis mediated by interleukin-17C.The sulfate level of piperine metabolite C16H19NO3(3)and adenosine 3',5'-cyclic monophosphate contributed to an increased risk of osteoporosis mediated by tumor necrosis factor-like weak inducer of apoptosis.In conclusion,the above data indicate that some inflammation-related proteins can influence the risk of osteoporosis,both positively and negatively,and some of these effects are mediated by plasma metabolites.This provides new insights for future investigations into the occurrence and development mechanisms of osteoporosis.