Objectives:Coronary slow flow(CSF)has long been regarded as a marker of coronary microvascular dysfunction(CMD).This study aims to evaluate the diagnostic value of CSF for CMD in patients with angina and nonobstructive coronary arteries(ANOCA).Methods:The study data were derived from the ANOCA-CMD prospective cohort study.All enrolled patients underwent coronary angiography and concurrent coronary physiological assessments in the left anterior descending artery using pressure-wire and thermodilution techniques to obtain coronary flow reserve(CFR)and the index of microcirculatory resistance(IMR).Based on the results,CMD was classified into four subtypes:CMD with elevated IMR(IMR≥25),CMD with reduced CFR(CFR<2.5),CMD with either reduced CFR or elevated IMR(CFR<2.5 or IMR≥25),and CMD with both reduced CFR and elevated IMR(CFR<2.5 and IMR≥25).The corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)in the left anterior descending artery was calculated from coronary angiography images,with CSF defined as CTFC>27.This study evaluated the correlation between CTFC,CFR,and IMR,and investigated the diagnostic value of CSF for CMD in ANOCA patients.Results:A total of 103 ANOCA patients were enrolled in this study,with a mean age of(64.2±10.6)years,and 53.4％were female.Among them,57 patients(55.3％)were diagnosed with coronary slow flow.Patients with slow flow had higher IMR(P<0.001)and CFR(P=0.041).Similarly,the proportion of CMD with elevated IMR was higher in the slow flow group(P<0.001),while the proportion of CMD with reduced CFR was lower(P=0.044).There was no significant difference between the groups in the proportions of CMD with either reduced CFR or elevated IMR or CMD with both reduced CFR and elevated IMR(all P>0.05).CTFC was positively correlated with hyperemic mean transit time(r=0.424,P<0.001),IMR(r=0.430,P<0.001),and CFR(r=0.211,P=0.032).The area under the curve(AUC)of CTFC for diagnosing CMD with elevated IMR was 0.721(95％CI:0.623-0.819)with an accuracy of 67％(57％,76％),for diagnosing CMD with reduced CFR was 0.610(95％CI:0.499-0.720)with an accuracy of 60％(50％,70％),for diagnosing CMD with either reduced CFR or elevated IMR was 0.549(95％CI:0.425-0.673)with an accuracy of 47％(37％,57％),and for diagnosing CMD with both reduced CFR and elevated IMR was 0.582(95％CI:0.471-0.693)with an accuracy of 47％(37％,57％).Thus,CSF demonstrated limited diagnostic values across all subtypes of CMD.Conclusions:In ANOCA patients,CSF cannot serve as an effective diagnostic marker for CMD.Therefore,in clinical practice,the slow flow phenomenon should not be directly equated with the presence of coronary microvascular dysfunction in ANOCA patients.

Objectives:Coronary slow flow(CSF)has long been regarded as a marker of coronary microvascular dysfunction(CMD).This study aims to evaluate the diagnostic value of CSF for CMD in patients with angina and nonobstructive coronary arteries(ANOCA).Methods:The study data were derived from the ANOCA-CMD prospective cohort study.All enrolled patients underwent coronary angiography and concurrent coronary physiological assessments in the left anterior descending artery using pressure-wire and thermodilution techniques to obtain coronary flow reserve(CFR)and the index of microcirculatory resistance(IMR).Based on the results,CMD was classified into four subtypes:CMD with elevated IMR(IMR≥25),CMD with reduced CFR(CFR<2.5),CMD with either reduced CFR or elevated IMR(CFR<2.5 or IMR≥25),and CMD with both reduced CFR and elevated IMR(CFR<2.5 and IMR≥25).The corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)in the left anterior descending artery was calculated from coronary angiography images,with CSF defined as CTFC>27.This study evaluated the correlation between CTFC,CFR,and IMR,and investigated the diagnostic value of CSF for CMD in ANOCA patients.Results:A total of 103 ANOCA patients were enrolled in this study,with a mean age of(64.2±10.6)years,and 53.4％were female.Among them,57 patients(55.3％)were diagnosed with coronary slow flow.Patients with slow flow had higher IMR(P<0.001)and CFR(P=0.041).Similarly,the proportion of CMD with elevated IMR was higher in the slow flow group(P<0.001),while the proportion of CMD with reduced CFR was lower(P=0.044).There was no significant difference between the groups in the proportions of CMD with either reduced CFR or elevated IMR or CMD with both reduced CFR and elevated IMR(all P>0.05).CTFC was positively correlated with hyperemic mean transit time(r=0.424,P<0.001),IMR(r=0.430,P<0.001),and CFR(r=0.211,P=0.032).The area under the curve(AUC)of CTFC for diagnosing CMD with elevated IMR was 0.721(95％CI:0.623-0.819)with an accuracy of 67％(57％,76％),for diagnosing CMD with reduced CFR was 0.610(95％CI:0.499-0.720)with an accuracy of 60％(50％,70％),for diagnosing CMD with either reduced CFR or elevated IMR was 0.549(95％CI:0.425-0.673)with an accuracy of 47％(37％,57％),and for diagnosing CMD with both reduced CFR and elevated IMR was 0.582(95％CI:0.471-0.693)with an accuracy of 47％(37％,57％).Thus,CSF demonstrated limited diagnostic values across all subtypes of CMD.Conclusions:In ANOCA patients,CSF cannot serve as an effective diagnostic marker for CMD.Therefore,in clinical practice,the slow flow phenomenon should not be directly equated with the presence of coronary microvascular dysfunction in ANOCA patients.

Objective:To investigate the efficacy of staged treatment of infectious femoral defects of Cierny-Mader type Ⅳ using bone transport combined with locking plating after En-Bloc resection debridement.Methods:A retrospective analysis was conducted of the 10 patients with distal femoral traumatic bone infection who had been treated at Department of Orthopedics, The People's Hospital of Weifang from January 2020 to January 2023. There were 8 males and 2 females with an age of (48.5±11.4) years. All cases were classified as Cierny-Mader type Ⅳ. At the first stage, En-Bloc resection debridement was performed in all cases to remove previous internal fixation devices and fill the defects with antibiotic bone cement. After infection control, the second stage involved removal of bone cement, re-fixation with internal devices, and external fixation support for bone transport. After the bone segments met, freshening of the bone ends, minor bone grafting, and screw locking of the transported bone segments were performed. Outcomes observed included bone defect length, frame carrying time and index, bone healing time, limb function, and complications.Results:After the first stage of debridement, a bone defect of (9.1±2.1) cm was created in 10 patients. All patients were followed up for (19.8±6.6) months. The duration for carrying external fixation frame was (107.2±25.1) days, and the frame index (11.8±0.5) d/cm. No recurrence was observed postoperatively. Bone union was achieved in 9 patients within 8 months, but in 1 patient only after secondary bone grafting due to poor healing at the meeting ends. All patients returned to their previous life or physical labor with no complications like pain or re-fracture. Three patients experienced varying degrees of knee joint stiffness, but were able to meet needs of daily life; one requested joint release surgery which resulted in satisfactory therapeutic efficacy.Conclusion:Staged treatment of infectious femoral defects of Cierny-Mader type Ⅳ using bone transport combined with locking plating after En-Bloc resection debridement is simple and effective.

A total of 44 patients with diabetic foot ulcers were treated in the Traumatic Orthopedics Department of Weifang People′s Hospital from January 2019 to December 2022. After debridement of foot ulcers the wounds were soaked in alkaline water of pH 7.5-8.0 (study group, n=22) or covered with vaseline gauze following iodophor disinfection (control group, n=22). The therapeutic effects of the two methods were compared. Four weeks after debridement, the wound area of study group was smaller than that of control group (3.15 (0, 7.60) vs. 6.75 (3.50, 9.32)cm 2, P<0.05), and the proportion of positive wound bacterial culture was lower than that of control group (40.9% (9/22) vs. 72.7% (16/22), P<0.05). At 12 weeks after surgery, there was no statistically significant difference in the wound healing rate between the two groups (72.7% (16/22) vs. 63.6% (14/22)), but the healing time of the study group was significantly shorter than that of the control group ((6.56±2.68) vs. (9.50±3.87) weeks, P<0.05). It is suggested that immersion of weak alkaline solution is helpful to promote wound healing for patients with diabetic foot ulcers after debridement surgery.

Objective:To explore the clinical effect on reconstruction of the soft tissue defects after resection of mucous cysts of distal interphalangeal joint (DIP) with transfer of the flap of dorsal branch of proper palmar digital artery.Methods:From September 2021 to September 2023, 8 patients (8 digits) with mucous cysts on DIP were treated in the Department of Hand and Microsurgery, the Affiliated Hospital of Binzhou Medical University. All 8 cases were females, aged 55-65 years old, with an average age of 60 years old. The cyst was located in the thumb in 1 case, in the index finger in 3 cases, in the middle finger in 3 cases, and in the ring finger in 1 case. After extensive resection of the mucous cysts, the size of soft tissue defects was at 0.8 cm×0.6 cm-1.7 cm×0.9 cm. Pedicled with the dorsal branch of proper palmar digital artery, the flaps adjacent to the defects were designed to cover the wounds. The size of the flaps was 1.2 cm×1.0 cm-2.0 cm×1.2 cm. Donor sites of the flap were covered by the full thickness skin grafts of medial upper arm. The postoperative follow-up was conducted by the combination of outpatient revisits and telephone reviews to observe the survival of the flap, and the functional recovery was evaluated according to the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Results:All flaps survived well after surgery. Postoperative follow-up ranged from 4 to 12 months, with a mean of 10 months. At the final follow-up, there was no recurrence of mucous cyst and all symptoms disappeared. All flaps healed well, with good appearance, soft texture and without obvious difference in colour from the surrounding skin. All skin grafts healed in one stage. The range of motion of the affected DIP was 0°-70°, and the TPD was at 7-8 mm, both caused no impact on daily life. The outcomes were excellent according to the evaluation criteria set by the Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association.Conclusion:The flap pedicled with dorsal branch of proper palmar digital artery has obvious advantages with less damage and simple operation in the treatment of a mucous cyst of DIP. It is an ideal surgical procedure.

Objective:To explore the clinical benefits of digital simulation surgery in the limited open reduction and intramedullary nail fixation for treatment of proximal humeral fractures.Methods:A retrospective study was conducted to analyze the clinical data of 40 patients who had been treated by limited open reduction and intramedullary nail fixation at Department of Trauma and Orthopedics, The People's Hospital of Weifang from June 2020 to September 2022 for 3-part proximal humeral fractures by Neer classification. The patients were assigned into 2 groups according to different preoperative strategies. In the observation group of 17 patients [4 males and 13 females with an age of (66.9±8.6) years], the angle of intramedullary nail placement into the humeral head and the sequence of reduction and fixation were simulated in the preoperative digital simulation surgery. In the control group of 23 patients [7 males and 16 females with an age of (63.0±8.6) years], routine reduction and fixation were performed based on the preoperative shoulder joint CT images and intraoperative fluoroscopy without preoperative digital simulation surgery. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, incidence of postoperative complications, fracture healing time, active range of motion of the shoulder joint at the last follow-up, as well as the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, and visual analogue scale (VAS) pain scores at 3 days, 12 weeks, and 24 weeks postoperatively.Results:The 2 groups were comparable because there were no statistically significant differences in the preoperative general data between them ( P>0.05). The operation time in the observation group [(57.5±6.2) min] was significantly shorter than that in the control group [(71.3±10.2) min], and the intraoperative fluoroscopy frequency in the former [(28.5±4.4) times] significantly lower than that in the latter [(45.4±2.6) times] ( P<0.05).The 2 groups were followed up for (15.0±1.6) months. For the observation and the control groups, respectively, the fracture healing time was (10.5±2.4) weeks and (10.0±2.0) weeks, showing no statistically significant differences between groups ( P>0.05). There were no statistically significant differences between the 2 groups in the intraoperative blood loss, or in the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, or VAS pain scores at 3 days, 12 weeks, or 24 weeks postoperatively, or in the active range of motion of the shoulder joint at the last follow-up ( P>0.05). Complications such as infection, humeral head necrosis, and screw removal occurred in none of the patients. Conclusion:In the treatment of proximal humeral fractures, before the routine limited open reduction and intramedullary nail fixation, digital simulation surgery can be performed to reduce the operation time and fluoroscopy frequency without sacrifice of the therapeutic efficacy.

Objective:To explore the clinical benefits of digital simulation surgery in the limited open reduction and intramedullary nail fixation for treatment of proximal humeral fractures.Methods:A retrospective study was conducted to analyze the clinical data of 40 patients who had been treated by limited open reduction and intramedullary nail fixation at Department of Trauma and Orthopedics, The People's Hospital of Weifang from June 2020 to September 2022 for 3-part proximal humeral fractures by Neer classification. The patients were assigned into 2 groups according to different preoperative strategies. In the observation group of 17 patients [4 males and 13 females with an age of (66.9±8.6) years], the angle of intramedullary nail placement into the humeral head and the sequence of reduction and fixation were simulated in the preoperative digital simulation surgery. In the control group of 23 patients [7 males and 16 females with an age of (63.0±8.6) years], routine reduction and fixation were performed based on the preoperative shoulder joint CT images and intraoperative fluoroscopy without preoperative digital simulation surgery. The 2 groups were compared in terms of operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, incidence of postoperative complications, fracture healing time, active range of motion of the shoulder joint at the last follow-up, as well as the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, and visual analogue scale (VAS) pain scores at 3 days, 12 weeks, and 24 weeks postoperatively.Results:The 2 groups were comparable because there were no statistically significant differences in the preoperative general data between them ( P>0.05). The operation time in the observation group [(57.5±6.2) min] was significantly shorter than that in the control group [(71.3±10.2) min], and the intraoperative fluoroscopy frequency in the former [(28.5±4.4) times] significantly lower than that in the latter [(45.4±2.6) times] ( P<0.05).The 2 groups were followed up for (15.0±1.6) months. For the observation and the control groups, respectively, the fracture healing time was (10.5±2.4) weeks and (10.0±2.0) weeks, showing no statistically significant differences between groups ( P>0.05). There were no statistically significant differences between the 2 groups in the intraoperative blood loss, or in the intramedullary nail heights, humeral neck-shaft angles, Constant shoulder function scores, or VAS pain scores at 3 days, 12 weeks, or 24 weeks postoperatively, or in the active range of motion of the shoulder joint at the last follow-up ( P>0.05). Complications such as infection, humeral head necrosis, and screw removal occurred in none of the patients. Conclusion:In the treatment of proximal humeral fractures, before the routine limited open reduction and intramedullary nail fixation, digital simulation surgery can be performed to reduce the operation time and fluoroscopy frequency without sacrifice of the therapeutic efficacy.

Background::Sirtuin-3 (Sirt3) has been documented to protect against mitochondrial dysfunction and apoptosis. Honokiol (HKL) is a Sirt3 pharmacological activator with reported neuroprotective effects in multiple neurological disorders. The present study aimed to explore the neuroprotective effects of HKL and the role of Sirt3 following intracerebral hemorrhage (ICH).Methods::An in vivo ICH model in rats was established by injecting autologous blood into the right basal ganglia. PC12 cells were stimulated with hemin. For the in vivo investigation, the modified Neurological Severity Scores and the Morris water maze test were performed to assess neurological deficits. Hematoxylin-Eosin and Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling staining were employed to evaluate the histopathology and apoptosis. Immunohistochemical staining was used to investigate the expression of Sirt3. Adenosine triphosphate (ATP) levels were quantified to assess mitochondrial dysfunction. Cell counting kit-8, lactate dehydrogenase assay, and flow cytometry were used to analyze cell vitality and apoptosis in vitro. Immunofluorescence staining was performed to observe mitochondrial morphology and dynamin-related protein 1 (Drp1) localization to mitochondria. Western blot was applied to quantify the expression of Sirt3, Bax, Bcl-2, cleaved-caspase-3, Drp1, phosphorylation of Drp1 at serine-616, and phosphorylation of Drp1 at serine-637 in vivo and in vitro.Results::HKL treatment alleviated neurological deficits, attenuated the histopathological damage and cell apoptosis, and restored the decreased ATP levels in ICH rats. HKL improved cell survival rate, reduced cell apoptosis, and inhibited mitochondrial fission in PC12 cells. Moreover, both in vivo and in vitro models showed increased phosphorylation of Drp1 at Ser616, and reduced phosphorylation of Drp1 at Ser637. Meanwhile, immunofluorescence co-localization analysis revealed that hemin increased the overlap of Drp1 and mitochondria in PC12 cells. The phosphorylation and mitochondrial translocation of Drp1 were effectively reversed by HKL treatment. Importantly, the selective Sirt3 inhibitor 3-(1H-1,2,3-triazol-4-yl) pyridine suppressed these effects. Conclusion::Our findings demonstrated that HKL ameliorated ICH-induced apoptosis and mitochondrial fission by Sirt3, suggesting that HKL has immense prospects for the treatment of ICH.

Objective:To investigate the effect of vector sum concept in fine-tuning posterior column screw channel via ilioinguinal approach for the treatment of bi-column acetabular fracture.Methods:A retrospective cohort study was conducted to analyze the clinical data of 42 patients with acetabular double column fracture admitted to Weifang People′s Hospital from July 2015 to May 2021, including 22 males and 20 females, aged 23-77 years [(49.3±16.3)years]. The ilioinguinal approach was used in all patients with the anterior column fixed with a plate and posterior column fixed with a lag screw. The vector sum concept was used intraoperatively to fine-tune the posterior column screw channel in 19 patients (channel fine-tuning group): namely, a 2.5 mm Kirschner wire was inserted into the bony channel of the posterior column screw under fluoroscopy of iliac oblique and obturator oblique positions; when the Kirschner wire was not located in the middle of the ischial ramus under single fluoroscopy, the vector only needed to be adjusted in one direction, with zero in the other direction; when the Kirschner wire was not located in the middle of the ischial ramus under fluoroscopy of both the iliac oblique and obturator obturator oblique positions, the sum of the deviation vectors in the two directions was calculated before fine-tuning. The vector sum concept was not used to fine-tune the posterior column channel screw in 23 patients (channel non-fine-tuning group). The time of posterior column screw placement, intraoperative blood loss, frequency of guide wire adjustment and fracture healing time were recorded and compared between the two groups. At 6 months after operation, the quality of fracture reduction and hip function were assessed by Matta score and Merle D′Aubigne-Postel score, respectively. The complications were observed.Results:All patients were followed up for 7-71 months [(35.7±8.5)months]. In channel fine-tuning group, the time of posterior column screw placement was (5.1±1.5)minutes, with intraoperative blood loss of (798.8±83.9)ml, frequency of guide wire adjustment of (1.8±0.5)times and fracture healing time of (12.4±3.2)weeks; while these parameters [(39.8±12.0)minutes, (1 119.3±172.0)ml, (5.6±1.6)times and (15.6±4.2)weeks] were significantly shorter or less in channel non-fine-tuning group ( P<0.05 or 0.01). There were no significant difference in the quality of fracture reduction and hip function between the two groups at 6 months postoperatively (all P>0.05). After operation, symptoms of lateral femoral cutaneous nerve was found in seven patients, superficial incision infection in two who was healed after debridement and dressing change, deep venous thrombosis of lower limbs in three. There was no significant difference in the incidence of postoperative complications between the two groups [channel fine-tuning group: 26%(5/19), channel non-fine-tuning group: 30%(7/23)] ( P>0.05). Conclusion:For bi-column acetabular fractures via ilioinguinal approach, application of vector and concept to fine-tune the posterior column screw channel is beneficial for rapid screw placement into the osseous channel, significant reduction of intraoperative blood loss and early fracture healing.

Objective:To compare the early and late predictive value of several critical illness scores (CISs) and biomarkers in patients with bloodstream infection (BSI)-associated pneumonia, and to identify the value of procalcitonin (PCT) in etiological diagnosis.Methods:Patients with at least one positive blood culture within 24 hours admission to department of emergency of China-Japan Friendship Hospital from January 2014 to December 2018 and with final diagnosis of pneumonia were enrolled. Sequential organ failure assessment (SOFA), mortality in emergency department sepsis (MEDS), Logistic organ dysfunction system (LODS), and acute physiology and chronic health evaluationⅡ (APACHEⅡ) scores were calculated based on the first parameters on the day of admission. Differences of various indicators among different Gram-stained bacterial infections and among patients with different prognosis at 28-day or 60-day were compared. Receiver operating characteristic (ROC) curve was used to analyze the value of biomarkers in differential diagnosis of pneumonia caused by single bacterial infection, and the predictive value of several CISs and biomarkers on 28-day and 60-day death of patients with pneumonia.Results:Among 540 patients with pneumonia caused by single bacterial infection, 256 (47.4%) patients with Gram-positive bacteria (GPB) infection and 284 (52.6%) with Gram-negative bacteria (GNB) infection. The 28-day mortality was 29.4% (159/540) and the 60-day mortality was 36.3% (196/540). PCT level was significantly higher in patients with GNB infection than that in GPB infected patients [μg/L: 1.99 (0.32, 13.19) vs. 0.45 (0.13, 3.53), P < 0.01]. There were significant differences of CISs and biomarkers between death group and survival group in predicting 28-day and 60-day mortality in BSI-associated pneumonia. ROC curve analysis showed that: ① the optimal cut-off value of PCT in the diagnosis of single bacterial infection was 0.48 μg/L, with the area under ROC curve (AUC) was 0.739 [95% confidence interval (95% CI) was 0.686-0.793]. When PCT value was greater than 4.49 μg/L, the specificity of diagnostic of GNB infection could reach 81.8%, and the positive predictive value (PPV) was 75.0%. When PCT value was greater than 10.16 μg/L, the diagnostic specificity could reach 91.2%. ② In the prediction of 28-day and 60-day mortality, the SOFA score showed highest AUC [28-day: 0.818 (95% CI was 0.768-0.867), 60-day: 0.800 (95% CI was 0.751-0.849)]. SOFA score greater than 8.5 points could help to predict 28-day and 60-day mortality for pneumonia patients with specificity of 90.5% and 91.6%, respectively. AUC of PCT for predicting 28-day and 60-day mortality in patients with BSI associated with pneumonia was 0.637 (95% CI was 0.575-0.700) and 0.628 (95% CI was 0.569-0.688), respectively. When PCT value was greater than 8.15 μg/L, the specificity and negative predictive value (NPV) were 80.2% and 75.1% respectively, and they could reach 80.2% and 68.7% when PCT value was greater than 7.46 μg/L. Conclusion:PCT is more reliable in the identification of pathogen type in BSI-associated pneumonia, while CISs may be more advantageous in the assessment of early and late prognosis.