Objective:To compare the clinical outcomes between percutaneous Kirschner wire leverage plus plaster fixation and elastic intramedullary nailing in the treatment of radial neck fractures in children.Methods:A retrospective study was conducted to analyze the 60 children with radial neck fracture who had been treated by percutaneous Kirschner wire leverage plus plaster fixation at Department of Pediatric Orthopedics, Children's Hospital of Soochow University from January 2016 to July 2023 (set as an internal fixation-free group). They were 30 males and 30 females (34 left and 26 right sides) with an age of (7.7±3.0) years. At the same time, another cohort of 60 patients were chosen as an intramedullary nailing group who had been treated by percutaneous Kirschner wire leverage plus elastic intramedullary nailing and matched in age and gender with those in the internal fixation-free group. The preoperative fracture angulation, operative time, hospitalization time, fracture angulation on the first postoperative day, fracture angulation at 1 month postoperatively, rate of angulation loss after reduction, Mayo elbow performance score (MEPS) at the last follow-up and complications were compared between the 2 groups.Results:There was no significant difference between the 2 groups in their preoperative general data, showing comparability ( P<0.05). The 120 pediatric patients were followed up for (7.5±3.2) months. The operative time [(27.4±15.0) min] and hospitalization time [(3.4±1.9) d] in the internal fixation-free group were significantly shorter than those in the intramedullary nailing group [(45.4±13.5) min and (4.4±1.3) d] ( P<0.05). The preoperative fracture angulation (50.8°±1.9°), fracture angulation on the first postoperative day (11.3°±1.2°), fracture angulation at 1 month postoperatively (12.1°±1.3°), rate of angulation loss after reduction (2.9%±0.5%), and MEPS at the last follow-up [(90.4±2.0) points] in the internal fixation-free group showed no significant differences from those in the intramedullary nailing group [49.5°±1.7°, 11.1°±1.2°, 13.3°±1.5°, 3.9%±1.4%, and (90.2±2.3) points] ( P>0.05). None of the patients in the internal fixation-free group developed pin-tail irritation sign or premature epiphyseal closure after surgery, whereas 3 patients in the intramedullary nailing group developed pin-tail irritation sign and 2 ones premature epiphyseal closure after surgery, showing a significant difference in the complication rate between the 2 groups [0 (0/60) versus 8.3% (5/60)] ( P<0.05). Conclusions:Percutaneous Kirschner wire leverage plus plaster fixation and close elastic intramedullary nailing can both achieve satisfactory outcomes in the treatment of radial neck fractures in children. However, percutaneous Kirschner wire leverage plus plaster fixation needs shorter operative time and hospitalization time, leads to fewer complications, and requires no reoperation to remove internal fixation.

Objective:To review the risk factors for early and medium-term complications of fenestration-branch endovascular thoracic aortic repair (F/B-TEVAR) in patients with complex aortic arch disease.Methods:The clinical and follow-up data of 202 patients undergoing F/B-TEVAR treatment from Feb 2019 to Sep 2023 in these centers were retrospectively analyzed .Results:There were 46 cases suffering from postoperative complications (22.8%). The risk factors with statistical significance included aortic atherosclerotic plaque [ OR=2.843; 95% CI (1.4-5.6); P<0.01], aortic intramural thrombosis [ OR=2.358; 95% CI (1.2-4.6), P=0.011], the aortic dilatation [ OR=4.219; 95% CI (1.6-11.3), P<0.01], the history of stroke [ OR=2.088; 95% CI (1.1-4.1), P=0.032], smoking history [ OR=2.680; 95% CI: (1.3-5.5); P<0.01], duration of surgery [ OR=1.9; 95% CI: (1.2-2.9); P=0.042].While the application of 3D printing assistive technology [ OR=0.392; 95% CI: (0.2-0.9); P=0.048] was in a negative correlation with postoperative complication. Conclusions:The independent risk factors for complications after F/B-TVAR included aortic atherosclerotic plaque, aortic intramural thrombosis, the aortic dilatation, the history of stroke, smoking history,duration of surgery.The application of 3D printing technology can effectively reduce the complication rate.

Objective To investigate the predictive value of CALLY index for ischemic post-stroke depression(PSD).Methods The clinical data of 179 patients with ischemic stroke were included,and the demographic information,medical history,stroke severity and laboratory indicators at admission were collected.After 6 months of follow-up,all patients were assessed for depressive symptoms using the 17-item Hamilton Depression Scale(HAMD-17).Patients were divided into the PSD group(48 cases)and the non-PSD group(131 cases).Differences in clinical characteristics were compared between the PSD group and the non-PSD group.CALLY index was calculated from C-reactive protein(CRP),albumin(ALB)and lymphocyte counts.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of CALLY index to PSD.Spearman correlation analysis was used for the correlation between CALLY index and neurological and cognitive function in PSD patients.K-M curve and Cox regression were used for analyzing the influence of CALLY index on PSD.Results The CALLY index of 179 patients ranged from 0.54 to 1.79,with a median of 1.08.ROC curve analysis showed that the optimal critical value of CALLY index to predict PSD was 1.09,and the area under ROC curve was 0.757(95%CI:0.687-0.818).Compared with the non-PSD group,the proportion of females was higher in the PSD group,and the proportion of patients with hyperlipidemia was increased with shorter years of education.The serum C-reactive protein(CRP)was higher,and albumin(ALB)and CALLY index were lower(P＜0.05).The K-M curve showed that the incidence of PSD was significantly higher in the low CALLY index group(CALLY≤1.08)than that in the higher CALLY index group(CALLY＞1.08,33.0%vs.20.5%,Log rank χ2=8.553,P=0.004).Cox regression analysis showed that after adjusting for other covariates,the decreased CALLY index was an independent risk factor for PSD(HR=2.651,95%CI:1.269-5.540,P＜0.05).Conclusion CALLY index has a certain predictive value for PSD in acute ischemic stroke patients,which is helpful for early identification and timely intervention to improve the prognosis of patients.

Objective:To evaluate the impact of bladder volume on dosimetric parameters of clinical target volume (CTV) and organs at risk (OAR) of intensity modulated proton therapy (IMPT) for localized prostate cancer during the treatment planning and daily treatment.Methods:Clinical data of 25 patients with localized prostate cancer admitted to Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from November 2021 to June 2022 and enrolled in the "Proton Therapy System" (SAPT-PS-01) registered clinical trial were retrospectively analyzed. All patients were male and the median age was 72 years old. A total of 30 sets of IMPT plans were obtained. Based on the planning CT (30 sets) and weekly verification CT during treatment (172 sets), bladder volume, CTV and OAR dose parameters were collected. Spearman correlation analysis was used to evaluate the correlation between bladder volume in CT and the dosimetric parameters of CTV and OAR during IMPT plans, and Wilcoxon-Mann-Whitney test was adopted to compare the dosimetric parameters of CTV and OAR among different bladder volume change groups.Results:The V 95% of CTV1 and CTV2 were both 100.0%±0.0% in IMPT plans. Bladder volume was significantly negatively correlated with D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder ( P<0.001, 0.003, <0.001, <0.001,<0.001), and D mean, V 50 Gy(RBE) of the small intestine (both P<0.001). During treatment, bladder D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE)( P<0.001, 0.001, <0.001, <0.001, <0.001), rectal D mean, V 50 Gy(RBE), V 40 Gy(RBE) (all P<0.001), small intestine D mean, V 50 Gy (RBE) (both P<0.001) of patients with bladder volume increase >20% compared to baseline were significantly decreased compared to those in IMPT plans. But CTV1 V 100%, and CTV2 V 95% were significantly decreased too( P=0.029, 0.020). In the bladder volume decreased>20% patients, the D mean, V 70 Gy(RBE), V 60 Gy(RBE), V 50 Gy(RBE), V 40 Gy(RBE) of the bladder were significantly increased compared to those in IMPT plans (all P<0.001). However, a bladder volume reduction of ≤20% and increase of ≤20% from baseline had no significant impact on CTV and OAR dosimetric parameters during treatment. Conclusions:For patients with localized prostate cancer undergoing proton therapy, a certain bladder volume should be ensured during planning CT scans. During the daily treatment, the bladder volume should be maintained between 80%-120% of the baseline level to ensure CTV coverage and good dose sparing to OAR.

Spinal microglia and astrocytes are both involved in neuropathic and inflammatory pain, which may display sexual dimorphism. Here, we demonstrate that the sustained activation of spinal astrocytes and astrocyte-derived interleukin (IL)-17A promotes the progression of mouse bone cancer pain without sex differences. Chemogenetic or pharmacological inhibition of spinal astrocytes effectively ameliorates bone cancer-induced pain-like behaviors. In contrast, chemogenetic or optogenetic activation of spinal astrocytes triggers pain hypersensitivity, implying that bone cancer-induced astrocytic activation is involved in the development of bone cancer pain. IL-17A expression predominantly in spinal astrocytes, whereas its receptor IL-17 receptor A (IL-17RA) was mainly detected in neurons expressing VGLUT2 and PAX2, and a few in astrocytes expressing GFAP. Specific knockdown of IL-17A in spinal astrocytes blocked and delayed the development of bone cancer pain. IL-17A overexpression in spinal astrocytes directly induced thermal hyperalgesia and mechanical allodynia, which could be rescued by CaMKIIα inhibitor. Moreover, selective knockdown IL-17RA in spinal Vglut2 ⁺ or Vgat ⁺neurons, but not in astrocytes, significantly blocked the bone cancer-induced hyperalgesia. Together, our findings provide evidence for the crucial role of sex-independent astrocytic signaling in bone cancer pain. Targeting spinal astrocytes and IL-17A/IL-17RA-CaMKIIα signaling may offer new gender-inclusive therapeutic strategies for managing bone cancer pain.

Objective To investigate the effect of salidroside on intestinal mucosal immune status in rats under compound stress of hypoxia and training (HTCS) and the mechanism. Methods SD rats were randomly divided into HTCS model group (model), placebo group (placebo) and salidroside group (salidro). Model group received no intervention, and placebo and salidro group received intraperitoneal injection of normal saline and salidroside, respectively. Then, ileum tissue of rats were collected and the intestinal damage was assayed by HE staining and Chiu scores. Intestinal permeability indices, including serum D-diamine oxidase (DAO), D-lactic acid (DLA) and endotoxin (END) and secretory immunoglobulin A (sIgA) of intestinal tissue were detected by ELISA. T lymphocyte subsets of intestinal tissue were detected by flow cytometry. Expression of tight junction molecules, including ZO-1, Claudin-3, occluding, were detected by PCR and western blot. Activation of TLR4/NF-κB signaling pathway was detected by Western blot analysis. Results Compared with model group and placebo group, salidro group had the decreased intestinal mucosal injury and low Chiu score, and the level of intestinal permeability indices including serum DAO, DLA and END fell off. CD4⁺ T cell percentage, CD4⁺/CD8⁺ ratio and sIgA level were went up, while CD8⁺ T cell percentage was went down. mRNA and the level of protein expressions of ZO-1, claudin-3 and occludin increased, while activation of TLR4/NF-κB signaling pathway was inhibited. Conclusion Salidroside can alleviate the intestinal barrier injury and improve intestinal mucosal immune status of rats under compound stress of hypoxia and training via inhibiting TLR4/NF-κB signalling pathway.
Animals ; Rats ; Rats, Sprague-Dawley ; NF-kappa B ; Toll-Like Receptor 4/genetics* ; Claudin-3 ; Hypoxia ; Immunoglobulin A, Secretory ; Signal Transduction

Objective:To evaluate the mid-term results of fenestrated/branched endovascular aortic repair (f/b EVAR) for the treatment of thoracoabdominal aortic aneurysms. M ethods The clinical data of 105 thoracoabdominal aortic aneurysm patients treated with f/b EVAR at the Department of Vascular Surgery of Nanjing Drum Tower Hospital from 2018 to 2019 were retrospectively analyzed. Results:There were 43 cases of thoracoabdominal aortic aneurysm and 62 cases of thoracoabdominal aortic aissection.A total of 336 branch arteries were reconstructed,and technical success rate was 94.3%. 100 cases (95.2%) were followed-up, 6 cases (5.7%) received reoperation interventions, and 11 cases (10.5%) died. During the follow-up period, 69 cases had complete imaging data. Based on the recent CT date of the thoracoabdominal aorta, 58 patients hael positive aortic remodeling and 11 patients hael negative and indeterminate remodeling; there were 31 cases (29.5%) of endoleaks, including 7 cases (6.7%) of type Ⅰb endoleaks, 8 cases (7.6%) of type Ⅱ, 1 case (0.95%) of type Ⅲa, 13 cases (12.4%) of type Ⅲc endoleaks and 2 cases (1.9%) of type Ⅳ. Conclusions:The mid-term follow-up results were satisfactory for TAAA treated with f/b EVAR. Internal leakage remains key point for f/b EVAR.

Objective:To investigate the clinical effect of composite transplantation of artificial dermis and autologous razor-thin graft combined with vacuum sealing drainage in the repair of joint scar after burn.Methods:The clinical data of patients with scar contracture deformity or scar ulcer after extensive burn admitted to the Department of Burns and Plastic Surgery of No. 926 Hospital of the Joint Logistics Force of PLA from January 2019 to December 2020 were retrospectively analyzed. Patients received one-stage contracture scar excision and release or scar ulcer debridement, Lando ?artificial dermis transplantation combined with vacuum sealing drainage, removal of the silicone membrane after complete vascularization of the wound, and secondary transplantation of autologous razor-thin graft. The survival and long-term appearance of skin graft, formation of scar and function recovery of joint were observed. Results:A total of 32 patients were included, including 24 males and 8 females, aged from 18 to 45 years, with an average age of 33 years. Scars were found in 4 cases of the metacarpophalangeal joint, 4 cases of the wrist joint, 10 cases of the elbow joint, and 14 cases of the knee joint and popliteal fossa. One patient underwent surgery to repair bilateral knee joint scar ulcers simultaneously, resulting in a total of 33 surgical sites. Among them, there were 23 sites of scar contracture deformities, 5 sites of scar ulcers, and 5 sites of scar contracture deformities with scar ulcers. After 2 weeks of artificial dermis coverage, the negative pressure device was removed, and the artificial dermis stent vascularization was good in 32 patients (33 surgical sites). After autologous skin graft transplantation, the survival rate was 100% (33/33). Postoperative follow-up for 3 to 12 months showed that there was no ulceration in the skin graft area, the skin color was close to normal, and there were no obvious scar contractures or hyperplasia. The joint function was satisfactory.Conclusion:The composite transplantation of artificial dermis and autologous razor-thin graft combined with vacuum sealing drainage is good to repair scar contracture or scar ulcer of joint after burn, the skin color and texture after operation, and the recovery of joint function is satisfactory.

Objective:To investigate the clinical effect of composite transplantation of artificial dermis and autologous razor-thin graft combined with vacuum sealing drainage in the repair of joint scar after burn.Methods:The clinical data of patients with scar contracture deformity or scar ulcer after extensive burn admitted to the Department of Burns and Plastic Surgery of No. 926 Hospital of the Joint Logistics Force of PLA from January 2019 to December 2020 were retrospectively analyzed. Patients received one-stage contracture scar excision and release or scar ulcer debridement, Lando ?artificial dermis transplantation combined with vacuum sealing drainage, removal of the silicone membrane after complete vascularization of the wound, and secondary transplantation of autologous razor-thin graft. The survival and long-term appearance of skin graft, formation of scar and function recovery of joint were observed. Results:A total of 32 patients were included, including 24 males and 8 females, aged from 18 to 45 years, with an average age of 33 years. Scars were found in 4 cases of the metacarpophalangeal joint, 4 cases of the wrist joint, 10 cases of the elbow joint, and 14 cases of the knee joint and popliteal fossa. One patient underwent surgery to repair bilateral knee joint scar ulcers simultaneously, resulting in a total of 33 surgical sites. Among them, there were 23 sites of scar contracture deformities, 5 sites of scar ulcers, and 5 sites of scar contracture deformities with scar ulcers. After 2 weeks of artificial dermis coverage, the negative pressure device was removed, and the artificial dermis stent vascularization was good in 32 patients (33 surgical sites). After autologous skin graft transplantation, the survival rate was 100% (33/33). Postoperative follow-up for 3 to 12 months showed that there was no ulceration in the skin graft area, the skin color was close to normal, and there were no obvious scar contractures or hyperplasia. The joint function was satisfactory.Conclusion:The composite transplantation of artificial dermis and autologous razor-thin graft combined with vacuum sealing drainage is good to repair scar contracture or scar ulcer of joint after burn, the skin color and texture after operation, and the recovery of joint function is satisfactory.