Objective:o evaluate the clinical efficacy of the induced membrane technique combined with an antibiotic-impregnated bone cement-coated plate fixation in the treatment of chronic osteomyelitis of the distal femur.Methods:A retrospective study was performed on patients diagnosed with chronic osteomyelitis of the distal femur, who received the induced membrane technique combined with an antibiotic-impregnated bone cement-coated plate fixation at Southwest Hospital from November 2016 to December 2022. All patients underwent a two-stage surgical protocol. Stage I involved thorough debridement, placement of antibiotic-impregnated bone cement spacers, and internal fixation with antibiotic-impregnated bone cement-coated plates. Stage II comprised internal fixation for the repair and reconstruction of bone defects. Intraoperatively, microbial culture, antibiotic susceptibility testing, and pathological examination were conducted on bone tissue lesion samples to guide targeted anti-infective therapy. Postoperatively, laboratory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), along with clinical manifestations (e.g., incision drainage, redness, fever, and pain), were monitored to exclude infection recurrence. Infection control was ultimately confirmed by intraoperative frozen section analysis during the second stage. Additionally, bone healing was evaluated via X-ray of the affected limb every month after the second-stage surgery, and lower limb function was assessed using the final knee range of motion (ROM) and the lower extremity function scale (LEFS).Results:A total of 104 patients met the inclusion criteria, including 70 males and 34 females, with a mean age of 35.2±12.13 years. Thirty-seven patients were diagnosed with chronic hematogenous osteomyelitis (CHO) and 67 with post-traumatic osteomyelitis (PTOM). The mean follow-up was 25.48±6.61 months (range, 12-38 months). After the first-stage surgery, infection recurred in 6 CHO and 15 PTOM patients, requiring repeated debridement. Two CHO patients experienced infection recurrence after second-stage reconstruction, which was successfully controlled with further staged treatment. Five PTOM patients developed nonunion after second-stage bone grafting but ultimately achieved bone union after revision surgery. At final follow-up, CRP levels were 4.45±4.23 mg/L (CHO) and 5.16±4.26 mg/L (PTOM), and ESR levels were 5.47±7.42 mm/h (CHO) and 8.51±8.72 mm/h (PTOM), all significantly lower than preoperative values (CRP: CHO 68.31±65.61, PTOM 42.71±80.46; ESR: CHO 52.18±34.29, PTOM 45.87±39.13; all P<0.05). All patients ultimately achieved bone union. One PTOM patient with a preoperative rupture of the knee extensor mechanism had limited improvement in ROM (15° preoperatively vs. 12° at 4-year follow-up). In the remaining patients, knee ROM at final follow-up was significantly improved (CHO: 101.38°±43.73°, PTOM: 94.28°±43.94°) compared with preoperative values (CHO: 57.17°± 4.53°, PTOM: 39.61°±52.61°; all P<0.05). The final LEFS scores were 72.18±9.51 (CHO) and 71.66±10.25 (PTOM). Conclusion:The findings of this study demonstrate that the combination of the "Chongqing Technique" and the "Membrane-Induced Technique" is effective in eradicating chronic osteomyelitis of the distal femur, promoting bone healing, and restoring satisfactory knee joint function.

Objective:o evaluate the clinical efficacy of the induced membrane technique combined with an antibiotic-impregnated bone cement-coated plate fixation in the treatment of chronic osteomyelitis of the distal femur.Methods:A retrospective study was performed on patients diagnosed with chronic osteomyelitis of the distal femur, who received the induced membrane technique combined with an antibiotic-impregnated bone cement-coated plate fixation at Southwest Hospital from November 2016 to December 2022. All patients underwent a two-stage surgical protocol. Stage I involved thorough debridement, placement of antibiotic-impregnated bone cement spacers, and internal fixation with antibiotic-impregnated bone cement-coated plates. Stage II comprised internal fixation for the repair and reconstruction of bone defects. Intraoperatively, microbial culture, antibiotic susceptibility testing, and pathological examination were conducted on bone tissue lesion samples to guide targeted anti-infective therapy. Postoperatively, laboratory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), along with clinical manifestations (e.g., incision drainage, redness, fever, and pain), were monitored to exclude infection recurrence. Infection control was ultimately confirmed by intraoperative frozen section analysis during the second stage. Additionally, bone healing was evaluated via X-ray of the affected limb every month after the second-stage surgery, and lower limb function was assessed using the final knee range of motion (ROM) and the lower extremity function scale (LEFS).Results:A total of 104 patients met the inclusion criteria, including 70 males and 34 females, with a mean age of 35.2±12.13 years. Thirty-seven patients were diagnosed with chronic hematogenous osteomyelitis (CHO) and 67 with post-traumatic osteomyelitis (PTOM). The mean follow-up was 25.48±6.61 months (range, 12-38 months). After the first-stage surgery, infection recurred in 6 CHO and 15 PTOM patients, requiring repeated debridement. Two CHO patients experienced infection recurrence after second-stage reconstruction, which was successfully controlled with further staged treatment. Five PTOM patients developed nonunion after second-stage bone grafting but ultimately achieved bone union after revision surgery. At final follow-up, CRP levels were 4.45±4.23 mg/L (CHO) and 5.16±4.26 mg/L (PTOM), and ESR levels were 5.47±7.42 mm/h (CHO) and 8.51±8.72 mm/h (PTOM), all significantly lower than preoperative values (CRP: CHO 68.31±65.61, PTOM 42.71±80.46; ESR: CHO 52.18±34.29, PTOM 45.87±39.13; all P<0.05). All patients ultimately achieved bone union. One PTOM patient with a preoperative rupture of the knee extensor mechanism had limited improvement in ROM (15° preoperatively vs. 12° at 4-year follow-up). In the remaining patients, knee ROM at final follow-up was significantly improved (CHO: 101.38°±43.73°, PTOM: 94.28°±43.94°) compared with preoperative values (CHO: 57.17°± 4.53°, PTOM: 39.61°±52.61°; all P<0.05). The final LEFS scores were 72.18±9.51 (CHO) and 71.66±10.25 (PTOM). Conclusion:The findings of this study demonstrate that the combination of the "Chongqing Technique" and the "Membrane-Induced Technique" is effective in eradicating chronic osteomyelitis of the distal femur, promoting bone healing, and restoring satisfactory knee joint function.

Objective:To evaluate and compare the early and long-term outcomes of rheumatic patients who underwent left-side heart valve replacement with concomitant tricuspid valve replacement, and analyze the difference of early mortality and long-term survival rate between mild pulmonary artery systolic pressure (PASP) and moderate to severe PASP patients.Methods:From January 2009 to December 2018, 79 cases of patients were reviewed and summarized. The mean age before operation was (45.7±7.8) years old. These patients were divided into mild PASP group(<50 mmHg, 38 cases) (1 mmHg=0.133 kPa) and moderate-severe PASP group (>50 mmHg, 41 cases) . Kaplan- Meier method was used to estimate the overall long-term survival rate and the incidence of complications, and to compare the long-term survival rate of patients with mild and moderate -severe PASP elevation. Results:The mortality rate of early postoperative patients was 8.9% (7/79). The causes of death included: low cardiac output syndrome in 3 cases, multiple organ failure caused by pulmonary infection in 2 cases, acute renal insufficiency in 1 case, sudden cardiac arrest in 1 case. Although the mortality rate of early moderate-severe PASP group (12.2% vs. 5.3%) was higher than that of mild PASP group, there was no significant difference ( P>0.05). The mean follow-up time was (51.8±31.7) months (3-115 months). Kaplan- Meier method was used to estimate the 10-year survival rate, the rate of avoiding thrombosis, the rate of avoiding serious bleeding event and the rate of avoiding reoperation, which were (67.2±10.6)%, (85.7±6.2)%, (83.4± 6.9)% and (93.7 ± 3.7)%, respectively. Although the long-term survival rate of mild PASP (78.0±10.6) % was higher than that of moderate-severe PASP (62.8 ± 13.4) %, there was no significant difference ( P>0.05). Conclusion:The early mortality rate of rheumatic patients who underwent left-side heart valve replacement with concomitant tricuspid valve replacement is still relatively high. The recurrent heart failure is the major causes of long-term death.

Objective: The incidence of complications after skin soft tissue expansion is relatively high. Occurrence of infection often means the expander has to be taken out ahead of schedule. In this retrospective study, we wanted to identify independent risk factors of infection after skin soft tissue expansion, which could be helpful to guide clinical work. Methods: Demographic information of patients who underwent the skin soft tissue expansion at the department of plastic surgery of Xijing Hospital from January 2003 to December 2012 was collected. Univariate associations with infection were measured by logistic regression and represented as odds ratios. The p-value less than 0.1 was identified the potential risk factor. Multivariate logistic regression was used to calculate odds ratios for risk factors of infection. Independent risk factors were identified if the p-value was less than 0.05. Results: A total of 3382 implants were included in the study. The overall infection rate of tissue expansion was 5.2% in 177 implants. The result of multivariate logistic regression showed that preoperative white blood cell count, age, numbers of expander implanted and volume of expander were independent risk factors of infection. Conclusions Independent risk factors of infection were preoperative white blood cell count, age, numbers of expander implanted and volume of expander. The lower preoperative white blood cell count, age more than 18 years old, more numbers of expander implanted and the bigger volume of the expander, the higher possibility of complications occurred. The result was helpful to guide clinical work and reduce the incidence of infection.

Objective To investigate the effect of laparoscopic Roux-en-Y gastric bypass(LYGB) on body fat distribution,and relationship between the changes of body fat distribution and improvement of insulin resistance.Methods A total of 65 patients with type 2 diabetes who underwent LYGB were selected for a retrospective analysis.Metabolic parameters,anthropometric measurements,body composition and fat distribution measured by dual-energy X-ray absorptiometry (DEXA) were collected separately before and 6 months post LYGB.All data of pre-and postoperation were compared with pair t test,Pearson correlation analysis was used to evaluate correlation of two variables.Results Weight,body mass index,waist circumference,waist-to-hip ratio,triglyceride,fasting plasma glucose,fasting insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were significantly decreased in 6 months after surgery (P ＜ 0.05).Total fat mass,body fat mass of trunk,upper and lower limbs decreased significantly (P ＜0.05).Percent fat mass at the whole body,Android region,upper and lower limbs decreased significantly (P ＜0.05).After 6 months postoperatively,abdominal obesity indices waist circumfernce decreased from (98.10±13.03) cm to (91.60±7.68) cm (P＜0.01) and percent fat mass at the Android region decreased from (35.71 ±10.24)％ to (29.44 ± 12.11) ％ (P＜0.05),HOMA-IR decreased from 3.62 ± 5.18 to 1.79 ± 1.52 (P ＜ 0.05).The improvement of postoperative insulin resistance is positively correlated with the changes in waist circumference (P ＜0.01) and percent fat mass of Android region (P ＜0.05).Conclusions The body fat distribution changes after LYGB,change of abdominal fat distribution is positively correlated to the improvement of insulin resistance.

Objective To evaluate the effect of robot-assisted gait training on the walking ability of hemiplegic patients.Methods Sixty hemiplegic patients were randomly divided into a control group and a treatment group,each of 30.Both groups were given traditional rehabilitation and drug therapy.The control group was additionally provided with the traditional gait training,while the treatment group additionally received robot-assisted gait training.The gait training lasted 30 minutes a day,5 days per week.Before and after 8 weeks of training,the time parameters,phase parameters,the joint angles of the lower limbs,and the peak ground reaction forces of both groups were evaluated using a three-dimensional gait analysis system.Results After the intervention,the walking velocity,stride frequency and stride length had increased in the treatment group,while stride width had decreased.Significant improvement was observed in the treatment group in terms of the percentage of swing phase on the paretic side,the percentage of stance phase on the paretic side,the single support time ratio,the percentage of double support phase,the range of motion of the hip and knee joints,and the peak vertical and forward ground reaction force as a percentage of body weight.The improvements were significantly greater than those observed in the control group.Conclusions Compared with traditional walking training,robot-assisted gait training can be more effective in improving the walking ability of hemiplegic patients.

Objective To investigate the relationship between the neuroprotective effect of epigallocatechin gallate ( EGCG ) for PC12 cells induced by 1-methyl-4-phenyl-pyridinium ( MPP+ ) and activating nuclear factor-related factor 2 ( NRF2 ).Methods Well differentiated PC12 cells treated with MPP+ were used as the in vitro cell models,and PC12 cells were pretreated with different concentrations of EGCG.MTT assay was used to investigate the cell viability.Western blot was used to observe the expression of NRF2 in cells and distribution in the nucleus and the cytoplasm.Real-time PCR was used to observe the antioxidant enzymes,HO-1 and NQO1 mRNA expression.Results Pretreatment of PC12 cells with different concentrations of EG CG for an hour could restore cell viability.Western blot showed that expression of NRF2 in cells treated with MPP+ for 24 hours was increased 148％ +5％ compared with the control group (t =6.102,P ＜0.01 ).The level of NRF2 in EGCG pretreated group was 188％ + 6％ compared with the control group(t =11.172,P ＜0.01 ).Moreover the NRF2 protein level in the nuclear was also increased.Western blot showed that the NRF2 protein level in the nuclear was 258％ +2％ compared with the control group (t =21.995,P ＜ 0.01 ).Further research found U 120,an inhibitor of ERK,could inhibit the effect of EGCG.The levels of NRF2 in both samples were 148％ ± 15％ and 158％ ± 1％ compared with their respective control groups(t =6.118,8.058,both P ＜0.01 ).In accordance with the NRF2 data,real-time PCR indicated that the levels of HO-1 and NQO1 mRNA expression increased obviously in the group pretreated with EGCG.Likewise,U120 could also inhibit HO-1 and NQO1 mRNA expression induced by EGCG.Conclusions EGCG can repair oxidative damage to PC12 cells induced by MPP+.The protective effect may be related through the ways to activate ERK-NRF2 and induce downstream of antioxidant enzyme expression,such as HO-1 and NQO1.

Objective To obtain sufficient recombinant multiepitope peptide of ESAT-6.Methods DNA encoding ESAT-6 peptide was amplified by PCR using a pair of primers which were designed in accordance with the reported ESAT-6 gene sequence.The ESAT-6P gene was inserted into the prokaryotic expression vector pET-30a with the N-terminal 6His-tag.The recombinant peptide vector pET30a-ESAT-6P was transformed into E.coli BL21(DE3) via chemical transformation.The positive clone was screened by means of PCR.The target peptide was expressed in E.coli after induction with IPTG and analyzed by SDS-PAGE.The immunogenicity of the peptide was evaluated by dot immunobinding assay.Results The target peptide was successfully expressed and purified.The solubility analysis showed that the recombinant peptide existed as inclusion body in the E.coli.DIBA indicated that the ESAT-6P was specifically reactive to sera from TB patients.Conclusions The recombinant multiepitope peptide of ESAT-6 engineering bacteria has been obtained,which will be quite helpful to develop novel specific diagnostic reagents and effective vaccine.