Chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PH) are both chronic progressive respiratory diseases that cannot be completely cured. COPD is characterized by irreversible airflow limitation, chronic airway inflammation, and gradual decline in lung function, whereas PH is characterized by pulmonary vasoconstriction, remodeling, and infiltration of inflammatory cells. These diseases have similar pathological features, such as vascular hyperplasia, arteriolar contraction, and inflammatory infiltration. Despite these well-documented observations, the exact mechanisms underlying the occurrence and development of COPD and PH remain unclear. Evidence that mitochondrial dynamics imbalance is one major factor in the development of COPD and PH. Mitochondrial dynamics is precisely regulated by mitochondrial fusion proteins and fission proteins. When mitochondrial dynamics equilibrium is disrupted, it causes mitochondrial and even cell morphological dysfunction. Mitochondrial dynamics participates in various pathological processes for heart and lung disease. Mitochondrial dynamics may be different in the early and late stages of COPD and PH. In the early stages of the disease, mitochondrial fusion increases, inhibiting fission, and thereby compensatorily increasing adenosine triphosphate (ATP) production. With the development of the disease, mitochondria decompensation causes excessive fission. Mitochondrial dynamics is involved in the development of COPD and PH in a spatiotemporal manner. Based on this understanding, treatment strategies for mitochondrial dynamics abnormalities may be different at different stages of COPD and PH disease. This article will provide new ideas for the potential treatment of related diseases.
Humans ; Mitochondrial Dynamics/physiology* ; Pulmonary Disease, Chronic Obstructive/metabolism* ; Hypertension, Pulmonary/metabolism* ; Mitochondria/metabolism* ; Animals

Objective To assess the clinical and safety outcomes of endovascular therapy(EVT)administered beyond 24 h after the onset of symptoms in patients with acute ischemic stroke(AIS)resulting from middle cerebral artery atherosclerotic occlusion.Methods We enrolled consecutive AIS patients with middle cerebral artery atherosclerotic occlusion who received EVT in our hospital between January 2020 and June 2023 and divided them into two groups based on the time from AIS onset to EVT:EVT≤24 h group and EVT＞24 h group.The National Institutes of Health Stroke Scale(NIHSS)scores after surgery,90-day functional independence(defined as mRS 0-2),symptomatic ICH(sICH),postoperative acute thrombosis,as well as mortality,were analyzed in the two groups of patients.Results A total of 161 patients were recruited,with 106 cases in the EVT≤24 h group and 55 cases in the EVT＞24 h group.The NIHSS scores declined after EVT in both groups(P＜0.01).The NIHSS scores after surgery were lower in the EVT≤24 h group(median:4.5 vs.7.0,P＜0.05).90-day functional independence(45.3％vs.30.9％,95％CI:0.93-3.68),sICH(5.7％vs.9.1％,95％CI:0.18-2.06),postoperative acute thrombosis(6.6％vs.3.6％,95％CI:0.37-9.34),and mortality(3.8％vs.1.8％,95％CI:0.23-19.42)did not differ significantly between the groups(P＞0.05).Conclusion Our findings support EVT feasibility in selected patients with middle cerebral artery atherosclerotic occlusion beyond 24 h.Prospective studies are warranted for confirmation.

Objective To assess the clinical and safety outcomes of endovascular therapy(EVT)administered beyond 24 h after the onset of symptoms in patients with acute ischemic stroke(AIS)resulting from middle cerebral artery atherosclerotic occlusion.Methods We enrolled consecutive AIS patients with middle cerebral artery atherosclerotic occlusion who received EVT in our hospital between January 2020 and June 2023 and divided them into two groups based on the time from AIS onset to EVT:EVT≤24 h group and EVT＞24 h group.The National Institutes of Health Stroke Scale(NIHSS)scores after surgery,90-day functional independence(defined as mRS 0-2),symptomatic ICH(sICH),postoperative acute thrombosis,as well as mortality,were analyzed in the two groups of patients.Results A total of 161 patients were recruited,with 106 cases in the EVT≤24 h group and 55 cases in the EVT＞24 h group.The NIHSS scores declined after EVT in both groups(P＜0.01).The NIHSS scores after surgery were lower in the EVT≤24 h group(median:4.5 vs.7.0,P＜0.05).90-day functional independence(45.3％vs.30.9％,95％CI:0.93-3.68),sICH(5.7％vs.9.1％,95％CI:0.18-2.06),postoperative acute thrombosis(6.6％vs.3.6％,95％CI:0.37-9.34),and mortality(3.8％vs.1.8％,95％CI:0.23-19.42)did not differ significantly between the groups(P＞0.05).Conclusion Our findings support EVT feasibility in selected patients with middle cerebral artery atherosclerotic occlusion beyond 24 h.Prospective studies are warranted for confirmation.

Bone Transplantation/adverse effects* ; Transplantation, Autologous/adverse effects*

Objective:To compare the therapeutic effects of intramedullary nail fixation, simple tibial plate fixation, and tibial plate + posterior-to-anterior screw fixation in the surgical treatment of lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture.Methods:A retrospective study was conducted to analyze the clinical data of 78 patients with lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture who had been treated at Department of Orthopedics, The Hospital Affiliated to Qingdao University from June 2015 to June 2022. There were 46 males and 32 females with an age of (48.9±14.6) years. The patients were divided into 3 groups according to their fixation methods. Group A (18 patients) underwent simple intramedullary nail fixation, group B (40 patients) simple tibial plate fixation, and group C (20 patients) tibial plate fixation for tibial fractures and posterior-to-anterior screw fixation for posterior malleolar fractures. The operation time, intraoperative blood loss, fracture union time, postoperative complications, as well as ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society (AOFAS) and Baird-Jackson scores at pre- and post-operation were compared among the 3 groups.Results:The differences in the preoperative baseline data were not statistically significant among the 3 groups, indicating comparability ( P>0.05). All patients were followed up for (24.9±10.1) months. The fracture union time in Group A was 14.0(13.0, 14.0) weeks, significantly longer than that in groups B and C [13 (13, 14) weeks] ( P<0.05). The AOFAS ankle-hindfoot score and Baird-Jackson score at the last postoperative follow-up in all patients were better than those before surgery ( P<0.05). The AOFAS ankle-hindfoot scores at the last follow-up in groups B and C [95.5 (86.0, 96.0) points and 96.0 (89.5, 98.5) points] were significantly higher than that in group A [86.5 (78.0, 93.0) points] ( P<0.05), and the Baird-Jackson scores at the last follow-up in groups B and C [93.0 (88.8, 95.0) points and 95.0 (91.0, 98.0) points] were also significantly higher than that in group A [86.0 (78.0, 89.5) points] ( P<0.05). All the 7 cases of complications (3 ones of poor fracture union and 4 ones of anterior knee pain) were observed in group A. Conclusion:In the surgical treatment of lower 1/3 spiral fracture of the tibia combined with posterior malleolar fracture, tibial plate fixation and tibial plate + posterior-to-anterior screw fixation can achieved better therapeutic effects than intramedullary nail fixation.

Objective:To compare the efficacy of double reverse traction reduction combined with minimally invasive percutaneous plate osteosynthesis (MIPO) and traditional reduction combined with MIPO in treating distal femoral fractures in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 78 elderly patients with distal femoral fractures admitted to Third Hospital of Hebei Medical University from January 2021 to June 2023, including 16 males and 62 females, aged 60-85 years [(74.5±7.1)years]. The bone mineral density T-score was (-2.1±0.9)SD. According to the Orthopedic Trauma Association (OTA) classification, the fractures were classified as type 33-A1 in 27 patients, type 33-A2 in 36, and type 33-A3 in 15. Forty-three patients underwent traditional reduction combined with MIPO (traditional reduction group), while 35 patients received double reverse traction reduction combined with MIPO (double reverse traction group). The two groups were compared in terms of operation time, intraoperative blood loss, number of intraoperative fluoroscopies, time to initial callus formation, radiographic healing time, range of motion of knee flexion and extension and Knee Society score (KSS) at 1 and 3 months postoperatively and at the last follow-up, and the incidence of postoperative complications.Results:All the patients were followed up for 6-18 months [(14.4±2.6)months]. The operation time, intraoperative blood loss and number of intraoperative fluoroscopies were (73.7±7.6)minutes, (112.4±32.3)ml, and (9.8±4.5)times in the double reverse traction group, which were significantly reduced compared with those in the traditional reduction group [(95.2±10.0)minutes, (139.7±49.5)ml, (15.2±3.9)times] in the traditional reduction group ( P<0.01). There was no significant difference in the time to initial callus formation between the two groups ( P>0.05). The radiographic healing time in the double reverse traction group was (25.9±5.1)weeks, shorter than (29.6±8.2)weeks in the traditional reduction group ( P<0.05). At 1 month postoperatively, range of motion of knee flexion and extension in the double reverse traction group was (96.4±5.0)°, greater than (93.9±3.7)° in the traditional reduction group ( P<0.05), and there was no significant difference between the two groups at 3 months postoperatively or at the last follow-up ( P>0.05). KSS scores at 1 and 3 months postoperatively and at the last follow-up showed no significant difference between the two groups ( P>0.05). No malunions occurred in the double reverse traction group, while 9.3% (4/43) in the traditional reduction group had malunion ( P>0.05). No nonunion or infection was observed in either group. Conclusion:Compared with traditional reduction combined with MIPO, double reverse traction reduction combined with MIPO for elderly distal femoral fractures can shorten operation time, reduce intraoperative blood loss and the number of fluoroscopies, promote fracture healing, and facilitate early recovery of knee joint function.

Objective:To compare the efficacy of double reverse traction reduction combined with minimally invasive percutaneous plate osteosynthesis (MIPO) and traditional reduction combined with MIPO in treating distal femoral fractures in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 78 elderly patients with distal femoral fractures admitted to Third Hospital of Hebei Medical University from January 2021 to June 2023, including 16 males and 62 females, aged 60-85 years [(74.5±7.1)years]. The bone mineral density T-score was (-2.1±0.9)SD. According to the Orthopedic Trauma Association (OTA) classification, the fractures were classified as type 33-A1 in 27 patients, type 33-A2 in 36, and type 33-A3 in 15. Forty-three patients underwent traditional reduction combined with MIPO (traditional reduction group), while 35 patients received double reverse traction reduction combined with MIPO (double reverse traction group). The two groups were compared in terms of operation time, intraoperative blood loss, number of intraoperative fluoroscopies, time to initial callus formation, radiographic healing time, range of motion of knee flexion and extension and Knee Society score (KSS) at 1 and 3 months postoperatively and at the last follow-up, and the incidence of postoperative complications.Results:All the patients were followed up for 6-18 months [(14.4±2.6)months]. The operation time, intraoperative blood loss and number of intraoperative fluoroscopies were (73.7±7.6)minutes, (112.4±32.3)ml, and (9.8±4.5)times in the double reverse traction group, which were significantly reduced compared with those in the traditional reduction group [(95.2±10.0)minutes, (139.7±49.5)ml, (15.2±3.9)times] in the traditional reduction group ( P<0.01). There was no significant difference in the time to initial callus formation between the two groups ( P>0.05). The radiographic healing time in the double reverse traction group was (25.9±5.1)weeks, shorter than (29.6±8.2)weeks in the traditional reduction group ( P<0.05). At 1 month postoperatively, range of motion of knee flexion and extension in the double reverse traction group was (96.4±5.0)°, greater than (93.9±3.7)° in the traditional reduction group ( P<0.05), and there was no significant difference between the two groups at 3 months postoperatively or at the last follow-up ( P>0.05). KSS scores at 1 and 3 months postoperatively and at the last follow-up showed no significant difference between the two groups ( P>0.05). No malunions occurred in the double reverse traction group, while 9.3% (4/43) in the traditional reduction group had malunion ( P>0.05). No nonunion or infection was observed in either group. Conclusion:Compared with traditional reduction combined with MIPO, double reverse traction reduction combined with MIPO for elderly distal femoral fractures can shorten operation time, reduce intraoperative blood loss and the number of fluoroscopies, promote fracture healing, and facilitate early recovery of knee joint function.

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.

Infectious bone defect is bone defect with infection or as a result of treatment of bone infection. It requires surgical intervention, and the treatment processes are complex and long, which include bone infection control,bone defect repair and even complex soft tissue reconstructions in some cases. Failure to achieve the goals in any step may lead to the failure of the overall treatment. Therefore, infectious bone defect has been a worldwide challenge in the field of orthopedics. Conventionally, sequestrectomy, bone grafting, bone transport, and systemic/local antibiotic treatment are standard therapies. Radical debridement remains one of the cornerstones for the management of bone infection. However, the scale of debridement and the timing and method of bone defect reconstruction remain controversial. With the clinical application of induced membrane technique, effective infection control and rapid bone reconstruction have been achieved in the management of infectious bone defect. The induced membrane technique has attracted more interests and attention, but the lack of understanding the basic principles of infection control and technical details may hamper the clinical outcomes of induced membrane technique and complications can possibly occur. Therefore, the Chinese Orthopedic Association organized domestic orthopedic experts to formulate An evidence-based clinical guideline for the treatment of infectious bone defect with induced membrane technique ( version 2023) according to the evidence-based method and put forward recommendations on infectious bone defect from the aspects of precise diagnosis, preoperative evaluation, operation procedure, postoperative management and rehabilitation, so as to provide useful references for the treatment of infectious bone defect with induced membrane technique.

Ankylosing spondylitis (AS) combined with spinal fractures with thoracic and lumbar fracture as the most common type shows characteristics of unstable fracture, high incidence of nerve injury, high mortality and high disability rate. The diagnosis may be missed because it is mostly caused by low-energy injury, when spinal rigidity and osteoporosis have a great impact on the accuracy of imaging examination. At the same time, the treatment choices are controversial, with no relevant specifications. Non-operative treatments can easily lead to bone nonunion, pseudoarthrosis and delayed nerve injury, while surgeries may be failed due to internal fixation failure. At present, there are no evidence-based guidelines for the diagnosis and treatment of AS combined with thoracic and lumbar fracture. In this context, the Spinal Trauma Academic Group of Orthopedics Branch of Chinese Medical Doctor Association organized experts to formulate the Clinical guideline for the diagnosis and treatment of adult ankylosing spondylitis combined with thoracolumbar fracture ( version 2023) by following the principles of evidence-based medicine and systematically review related literatures. Ten recommendations on the diagnosis, imaging evaluation, classification and treatment of AS combined with thoracic and lumbar fracture were put forward, aiming to standardize the clinical diagnosis and treatment of such disorder.