OBJECTIVE: To explore the mechanism of antibiotic delivery system targeting bacterial biofilm with linezolid (LZD) based on ε-poly- L-lysine (ε-PLL) and cyclodextrin (CD) (ε-PLL-CD-LZD), aiming to enhance antibiotic bioavailability, effectively penetrate and disrupt biofilm structures, and thereby improve the treatment of bone and joint infections. METHODS: ε-PLL-CD-LZD was synthesized via chemical methods. The grafting rate of CD was characterized using nuclear magnetic resonance. In vitro biocompatibility was evaluated through live/dead cell staining after co-culturing with mouse embryonic osteoblast precursor cells (MC3T3-E1), human umbilical vein endothelial cells, and mouse embryonic fibroblast cells (3T3-L1). The biofilm-enrichment capacity of ε-PLL-CD-LZD was assessed using Staphylococcus aureus biofilms through enrichment studies. Its biofilm eradication efficacy was investigated via minimum inhibitory concentration (MIC) determination, scanning electron microscopy, and live/dead bacterial staining. A bone and joint infection model in male Sprague-Dawley rats was established to validate the antibacterial effects of ε-PLL-CD-LZD. RESULTS: In ε-PLL-CD-LZD, the average grafting rate of CD reached 9.88%. The cell viability exceeded 90% after co-culturing with three types cells. The strong biofilm enrichment capability was observed with a MIC of 2 mg/L. Scanning electron microscopy observations revealed the effective disruption of biofilm structure, indicating potent biofilm eradication capacity. In vivo rat experiments demonstrated that ε-PLL-CD-LZD significantly reduced bacterial load and infection positivity rate at the lesion site ( P<0.05). CONCLUSION The ε-PLL-CD antibiotic delivery system provides a treatment strategy for bone and joint infections with high clinical translational significance. By effectively enhancing antibiotic bioavailability, penetrating, and disrupting biofilms, it demonstrated significant anti-infection effects in animal models.
Biofilms/drug effects* ; Animals ; Anti-Bacterial Agents/pharmacology* ; Polylysine/chemistry* ; Cyclodextrins/administration & dosage* ; Humans ; Linezolid/pharmacology* ; Staphylococcus aureus/physiology* ; Rats, Sprague-Dawley ; Mice ; Rats ; Male ; Drug Delivery Systems ; Staphylococcal Infections/drug therapy* ; Microbial Sensitivity Tests ; Human Umbilical Vein Endothelial Cells ; Osteoblasts/cytology*

Replantation of traumatic amputation in children has its own characteristics. This consensus primarily focuses on the issues related to the treatment of traumatically amputated limb injuries in children. Organised along a timeline, the consensus summarises domestic and international clinical experiences in emergency care and injury assessment of traumatic limb amputation limbs, indications and contraindications for replantation surgery, principles and procedures of replantation surgery, postoperative medication and management, as well as rehabilitation in children. The aim of this consensus is to propose standardise the treatment protocols for limb replantation for children therefore to serve as a reference for clinical practitioners in medical practices, and further improve the treatment and care for the traumatic limb amputations in children.

Objective To evaluate the effect of red-blue light photon assisted therapy on wound healing after flap reconstruction of limb traumatic defects.Methods A total of 146 patients who were admitted to the Ward of Microsurgery of ⅢA hospital of Shanghai from January 2020 to December 2021 and received flap reconstruction surgery for soft tissue defects of limbs were included in this prospective observational study.According to the order of admission,patients were divided into a control group(n=70)and an trial group(n=76).In the control group,a 60W thermal lamp was offered to the patients for locally heating the flaps,with continuous irradiation for 24 hours with a maintaining power of 1-2W,at an approximately 30-45 cm in distance from the flap.In the trial group,based on the thermal irradiation applied to the control group,a combined red and blue light photon irradiation therapy was offered as an additional measure,by twice a day at 20 minutes per session of blue-red light photon irradiation,at 8-12cm in distance from the flap.The two groups were compared in terms of tension of tissues around flap,incidence of infection within 7 days after surgery and the survival of flap within 2 weeks after surgery.Results The two groups showed no significant difference in terms of tissue tension between the 1st and 3rd day after surgery(P<0.05),but with significant differences on the 5th and 7th day after surgery(P>0.05).The trial group exhibited significantly lower incidence of infection within 7 days after surgery compared to that of the control group(P<0.05),and with a significantly higher flap survival rate at 2 weeks after surgery(P<0.05).Conclusion After the flap reconstruction of soft tissue defects of limbs,a red-blue light assisted photon irradiation therapy can effectively improve postoperative tissue tension around a flap,reduce infection rate and improve the survival rate of a flap.It provides an effective and safe interventional measures for postoperative care of the transferred flap.

OBJECTIVE: To investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. METHODS: The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. RESULTS: Univariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups ( P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT ( P<0.05). CONCLUSION Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
Humans ; Femoral Neck Fractures/complications* ; Female ; Male ; Aged ; Venous Thrombosis/epidemiology* ; Risk Factors ; Aged, 80 and over ; Retrospective Studies ; Lower Extremity/blood supply* ; Arthroplasty, Replacement, Hip/adverse effects* ; Incidence ; Fracture Fixation, Internal/methods* ; Postoperative Complications/etiology* ; Perioperative Period ; Logistic Models ; Hemiarthroplasty/adverse effects*

Objective:To investigate the understanding of microsurgery education for clinical medical students, and the education methods for microsurgery courses in 8 schools.Methods:The questionnaire was designed around four aspects: the learning status of Chinese medical students in microsurgery learning, the impact of microsurgery learning on future career choices, the current situation of opening microsurgery courses in 8 medical schools, and the opinions and suggestions on improving microsurgery learning in China. Electronic and paper questionnaires were combined to evaluate the condition of understanding microsurgery among 1 000 medical students from Peking University Health Science Center and other 7 schools. Then, the validity of the collected questionnaires was reviewed. SPSS 19.0 were applied for data analysis.Results:A total of 808 valid questionnaires were collected (recovery rate=80.8%). Respondents' understanding of microsurgery remained at the level of "just heard" (2.18±2.83), and 98.41% (795/808) of the students believed that microsurgery related disciplines would bring certain help to their future careers. Male students more recognized the impact of microsurgery learning on future career than female students [(6.19±2.36) vs. (5.76±2.09), P< 0.05)]. In these 8 investigated universities, only Shanghai Jiao Tong University School of Medicine and Zhongshan School of Medicine of Sun Yat-sen University conducted a microsurgery course, while 80.01% (531/663) of the students in the other 6 universities wanted to set microsurgery courses. Microsurgery operation observation (86.82%, 701/808), animal models for microsurgery practical training (82.95%, 670/808), and online theory courses (43.18%, 349/808) were able to increase the interest in microsurgery learning for students. Conclusion:Microsurgery course can bring many benefits to medical students, and it is urgent for domestic medical colleges to carry out microsurgery related courses.

Objective:To evaluate the clinical efficacy of staged surgery in treatment of calf Gustilo-Anderson type IIIC fracture.Methods:A retrospective case series was conducted to analyze clinical data of 16 patients with calf Gustilo-Anderson type IIIC fracture admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital from January 2017 to December 2019. There were 12 males and 4 females, with the age of (38.6±8.2)years (range, 18-53 years). All patients had limb salvage treatment at one stage in the emergency department. The survival of the limb and the occurrence of vascular crisis were examined within one week after limb salvage. The second stage involved the repair of skin and soft tissue defects with the defect area from 12.0 cm×5.0 cm to 20.0 cm×8.0 cm using free flaps. The survival of the flap, vascular crisis, and donor site healing within two weeks after the flap procedure. The third stage used bone graft revision and bone lengthening technology to repair bone tissue. The lower extremity functional scale (LEFS) and Mazur ankle joint function score were used to evaluate the function of the affected limb before bone repair and at the last follow-up. The fracture healing and related complications were observed at the last follow-up.Results:All patients were followed up for (14.2±4.6)months (range, 8-20 months). At one stage, the limb-saving surgery was successful in all patients, among which one had vascular crisis. At second stage, free flaps survived in all patients, among which two had vascular crisis. All donor areas were healed by first intention. At third stage, the LEFS of the affected limb was increased from (32.0±7.4)points before bone repair to (48.0±10.2)points at the last follow-up ( P<0.01) and the Mazur score was increased from (50.9±15.3)points before bone repair to (73.8±11.9)points at the last follow-up ( P<0.01). All bone defects were repaired and healed without complications such as infection or osteomyelitis at the last follow-up. Conclusion:For calf Gustilo-Anderson type IIIC fracture, the staged strategy can effectively save limbs and restore limb function.

Objective:To explore the reliability of preoperative diagnosis of low-grade infectious nonunion using haematological testing and radioisotope scanning (bone 3-phase image).Methods:A retrospective study was conducted of the 265 patients with bone nonunion who had been treated at Department of Orthopaedics, The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University and at Department of Orthopaedics, The Eighth People’s Hospital Affiliated to Shanghai Jiaotong University from June 2010 to June 2018.They were 151 males and 114 females, aged from 19 to 64 years (average, 39.7 years).The nonunions occurred mainly at the tibia (113 cases) and the femur (72 cases).The preoperative results of their white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and radioisotope scanning were recorded.Taking the intraoperative pathological observations as the gold standards, the sensitivity, specificity, area under curve (AUC) of receiver operator characteristic (ROC) and Youden index were statistically analyzed respectively for every preoperative haematological tests and radioisotope scanning as well as for different combinations of the radioisotope scanning and one or more haematological tests.Results:Compared with the pathological observations, the radioisotope scanning showed a sensitivity of 80.7%, a specificity of 73.3%, an AUC of 0.770 and a Youden index of 0.540.In the combinations of radioisotope scanning and one haematological test, that of radioisotope scanning and CRP produced the largest AUC of 0.683, a sensitivity of 98.0%, a specificity of 70.3%, and a Youden index of 0.848.In the combinations of radioisotope scanning and 2 haematological tests, that of radioisotope scanning and WBC and ESR produced the largest AUC of 0.895, a sensitivity of 94.3%, a specificity of 67.3%, and a Youden index of 0.616 and all the 3 ones yielded an AUC of more than 0.880.The combination of radioisotope scanning and all the 3 haematological tests produced a sensitivity of 96.5%, a specificity of 79.7%, an AUC of 0.925 and a Youden index of 0.762.Conclusion:Combination of haematological testing and radioisotope scanning can be a reliable preoperative diagnosis of low-grade infection nonunion.

A reversed-phase HPLC method for simultaneous determination of gatrorrhizine, columbamine, epiberberine, coptisine, palmatine and berberine in Coptis chinensis was developed. Analysis was carried out on an Xtimate C18 column (4.6 mm x 250 mm, 5 microm) eluted with acetonitrile-30 mmol x L(-1) ammonium bicarbonate solution (including 0.7% ammonia and 0.1% triethylamine) by gradient elution. The detective wavelength was 270 nm, the column temperature was 30 degrees C, and the flow rate was 1.0 mL x min(-1). By the above method, the linear ranges of gatrorrhizine, columbamine, epiberberine, coptisine, palmatine and berberine were 0.85-16.96 (r = 0.9997), 1.25-24.96 (r = 0.999 5), 2.05-40.96 (r = 0.999 9), 3.65-72.96 (r = 0.999 9), 2.88-57.60 (r = 0. 999 8),13.25-264.96 mg x L(-1) (r = 0.999 6), respectively. The average recoveries (n = 6) of the six alkaloids were 101.6% (RSD 1.3%),102.5% (RSD 1.5%), 100.8% (RSD 1.9%),102. 6% (RSD 1.2%), 97.80% (RSD 1.3%), 99.01% (RSD 1.5%), respectively. The determined results demonstrate that there is a significant difference in the contents of six alkaloids and total alkaloids among the tested samples. The method is accurate, reliable and repeatable for simultaneous determination of gatrorrhizine, columbamine, epiberberine, coptisine, palmatine and berberine in C. chinensis.
Alkaloids ; isolation & purification ; Berberine ; analogs & derivatives ; isolation & purification ; pharmacology ; therapeutic use ; Berberine Alkaloids ; isolation & purification ; Chromatography, High Pressure Liquid ; methods ; Coptis ; chemistry ; Drugs, Chinese Herbal

Objective To discuss the diagnosis and management of metastatic adrenal carcinoma. Methods Forty-seven cases with metastatic tumor in the adrenal glands were analyzed retrospectively from December 1996 to April 2010. Lung was the most common primary tumor site (51.1 %, 24 cases), followed by the renal cell carcinoma (12.8%, 6 cases), liver cancer (10.6%,5 cases), breast cancer (8.5%, 4 cases), melanoma (4.2%, 2 cases), and other carcinoma (12.8%,6 cases). Most patients with metastatic adrenal carcinoma had no special clinic manifestation. Lesions of 36 cases were surgically removed and 11 cases gave up operation. Results The mean survival time were 33.8±4.5 months for 31 cases underwent adrenalectomy and 6.3±2.7 months for 6 cases without operation. Patients with surgically removed adrenal metastases had better survival than those without surgical resection. Conclusions Adrenal gland is a common site of metastatic carcinoma.Ultrasonographic and CT scans are important diagnosis methods for metastatic adrenal carcinoma. Operation is still effective and long-term survival may be achieved for those well selected patients, but surgical indication must be strictly monitored.

[Objective]To evaluate the therapeutic effects of minimally invasive replacement in complicated femoral intertrochanteric fractures.[Method]A retrospective analysis was done for 49 patients with femoral intertrochanteric fractures in the author's department from March 2005 to August 2008.According to different ways of replacement,the patients were divided into Group A(n=21),open repositioning and Group B(n=28),minimally invasive replacement respectively.And PFN or Gamma nail was fixed after that.Operation time,bleeding volume,length of stay,time of weight loading and average time of fracture union,incidence rate of complications and hip function were recorded.[Result]There great significant differences in operation time,bleeding volume and average time of fracture union between Group B and Group A respectively(P0.05).Hip score(Harris) in Group B was significantly higher than that in group A(P