Bone defects caused by different causes such as trauma, severe bone infection and other factors are common in clinic and difficult to treat. Usually, bone substitutes are required for repair. Current bone grafting materials used clinically include autologous bones, allogeneic bones, xenografts, and synthetic materials, etc. Other than autologous bones, the major hurdles of rest bone grafts have various degrees of poor biological activity and lack of active ingredients to provide osteogenic impetus. Bone marrow contains various components such as stem cells and bioactive factors, which are contributive to osteogenesis. In response, the technique of bone marrow enrichment, based on the efficient utilization of components within bone marrow, has been risen, aiming to extract osteogenic cells and factors from bone marrow of patients and incorporate them into 3D scaffolds for fabricating bone grafts with high osteoinductivity. However, the scientific guidance and application specification are lacked with regard to the clinical scope, approach, safety and effectiveness. In this context, under the organization of Chinese Orthopedic Association, the Expert consensus for the clinical application of autologous bone marrow enrichment technique for bone repair ( version 2023) is formulated based on the evidence-based medicine. The consensus covers the topics of the characteristics, range of application, safety and application notes of the technique of autologous bone marrow enrichment and proposes corresponding recommendations, hoping to provide better guidance for clinical practice of the technique.

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.

Chronic refractory wound (CRW) is one of the most challengeable issues in clinic due to complex pathogenesis, long course of disease and poor prognosis. Experts need to conduct systematic summary for the diagnosis and treatment of CRW due to complex pathogenesis and poor prognosis, and standard guidelines for the diagnosis and treatment of CRW should be created. The Guideline forthe diagnosis and treatment of chronic refractory wounds in orthopedic trauma patients ( version 2023) was created by the expert group organized by the Chinese Association of Orthopedic Surgeons, Chinese Orthopedic Association, Chinese Society of Traumatology, and Trauma Orthopedics and Multiple Traumatology Group of Emergency Resuscitation Committee of Chinese Medical Doctor Association after the clinical problems were chosen based on demand-driven principles and principles of evidence-based medicine. The guideline systematically elaborated CRW from aspects of the epidemiology, diagnosis, treatment, postoperative management, complication prevention and comorbidity management, and rehabilitation and health education, and 9 recommendations were finally proposed to provide a reliable clinical reference for the diagnosis and treatment of CRW.

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Objective To investigate the correlations among OCT4, Notch1 and DLL4 and their association with the clinicopathological features of patients with epithelial ovarian cancer (EOC). Methods A total of 207 specimens of EOC and 65 specimens of benign ovarian epithelial tumor tissues were examined for expressions of OCT4, Notch1 and DLL4 proteins using immunohistochemistry. Results The positivity rates of OCT4, Notch1 and DLL4 in EOC tissues were 60.0%, 61.8%and 60.9%, respectively, significantly higher than the rates in benign epithelial tumor tissues (9.2%, 6.2%, and 0, respectively; P<0.05). The expressions of OCT4, Notch1 and DLL4 in EOC were significantly correlated with tumor differentiation, FIGO stage, and lymph node metastasis (P<0.05). DLL4 was positively correlated with OCT4 and Notch1 expressions (r=0.758 and 0.704, respectively, P<0.001), and the latter two were also positively correlated (r=0.645, P<0.001). Overexpressions of OCT4, Notch1 and DLL4 were associated with a poor prognosis, and the survival rate was significantly lower in patients positive for OCT4, Notch1, and DLL4 than in the negative patients (P<0.05). FIGO stage and expressions of OCT4 and DLL4 were independent prognostic factors of EOC (P<0.05). Conclusion The expressions of OCT4, Notch1 and DLL4 are correlated with the differentiation, lymph node metastasis, clinical stage and prognosis of EOC. Combined detection of the 3 proteins has an important value in predicting the progression and prognosis of EOC.

Objective To investigate the correlations among OCT4, Notch1 and DLL4 and their association with the clinicopathological features of patients with epithelial ovarian cancer (EOC). Methods A total of 207 specimens of EOC and 65 specimens of benign ovarian epithelial tumor tissues were examined for expressions of OCT4, Notch1 and DLL4 proteins using immunohistochemistry. Results The positivity rates of OCT4, Notch1 and DLL4 in EOC tissues were 60.0%, 61.8%and 60.9%, respectively, significantly higher than the rates in benign epithelial tumor tissues (9.2%, 6.2%, and 0, respectively; P<0.05). The expressions of OCT4, Notch1 and DLL4 in EOC were significantly correlated with tumor differentiation, FIGO stage, and lymph node metastasis (P<0.05). DLL4 was positively correlated with OCT4 and Notch1 expressions (r=0.758 and 0.704, respectively, P<0.001), and the latter two were also positively correlated (r=0.645, P<0.001). Overexpressions of OCT4, Notch1 and DLL4 were associated with a poor prognosis, and the survival rate was significantly lower in patients positive for OCT4, Notch1, and DLL4 than in the negative patients (P<0.05). FIGO stage and expressions of OCT4 and DLL4 were independent prognostic factors of EOC (P<0.05). Conclusion The expressions of OCT4, Notch1 and DLL4 are correlated with the differentiation, lymph node metastasis, clinical stage and prognosis of EOC. Combined detection of the 3 proteins has an important value in predicting the progression and prognosis of EOC.

AIM:To elucidate the correlation between the expression of aldehyde dehydrogenase 1 (ALDH1)/ATP-binding cassette subfaminly G member 2 ( ABCG2 ) and microvessel density ( MVD ) in epithelial ovarian cancer ( EOC) .METHODS:In 198 specimens of EOC and 60 specimens of ovarian benign epithelial tumor tissues , the protein expression of ALDH1/ABCG2 and CD105 ( microvessel marker ) was detected by immunohistochemical staining .RE-SULTS:The positive rates of ALDH1 and ABCG2 in the EOC were 64.1%and 61.6%, respectively , while the positive rates in benign epithelial tumor tissues were 8.3%and 6.7%, respectively , and there were significant differences between them (P<0.05).In EOC and benign epithelial tumor tissues , the MVD were 22.6 ±9.7 and 5.03 ±3.35, respectively, and the difference was also significant (P<0.05).The expression of ALDH1 and ABCG2 in EOC was significantly related to differentiation, FIGO stage,and abdominal organ and lymph node metastasis (P<0.05).MVD had correlation with dif-ferentiation, FIGO stage, ascite, and abdominal organ and lymph node metastasis (P<0.05).MVD had positive correla-tion with the expression of ALDH1 and ABCG2 (P<0.01).There was also a positive correlation between the expression of ALDH1 and ABCG2 ( P<0.01) .Over-expression of ALDH1/ABCG2 and MVD≥23 were related to the poor prognosis . The survival rates in ALDH1/ABCG2 positive and MVD≥23 groups were significantly lower than those in ALDH 1/ABCG2 negative and MVD<23 groups (P<0.05).The FIGO stage, the expression of ALDH1/ABCG2 and MVD were indepen-dent prognosis factors of EOC ( P<0.05 ) .CONCLUSION: The results suggest that the expression of ALDH 1/ABCG2 and MVD in EOC are related to differentiation , lymph node metastasis , clinical stage and prognosis .Combined detection of these indexes may play an important role in predicting the progression and prognosis of EOC .

Objective To study and summary the treatment of talus fracture. Methods Fifteen patients with talus fracture were treated by limited cut off reduction by leverage and hollow lag screw under C arm X-Ray machine January 2008 to November 2014, of whom there were 11 males and 4 females, aged 15-61 years old. Seven patients sufferred from talus fracture because of traffic accidents, 4 patients because of falls, 2 patients because of crush injury, and 2 patients because of sprains. Hawkins typing:Ⅰtype in 1 patient, Ⅱ type in 6 patients, Ⅲ type in 6 patients of Ⅲ type, and Ⅳ type in 2 patients. Results Followed up for 6 months to 4 years (mean 1.5 years), fracture healed better. Hawkins grading standard:9 patients showed excellent (1 patient ofⅠtype, 5 patients ofⅡtype, 3 patients ofⅢtype), and two patients showed good (Ⅲtype). The excellent and good rate was 11/15. Necrosis of talus occurred in one patient, and degenerative joint disease occured in one patient. Conclusions Minimally invasive internal fixation with hollow lag screw under C arm X-Ray machine in the treatment of talus fracture has a small injury to the periosteum and the blood supply of small soft tissue. It can fix reliably and can pressurize the fracture fragments, and is conducive to fracture healing.

OBJECTIVETo investigate the presence of cancer stem cells (CSCs) exist in non-small cell lung cancer (NSCLC) and explore the relationship among the expressions of CD133, Notch1, and vascular endothelial growth factor (VEGF) and their relations with the clinicopathological parameters of the patients.

METHODSA total of 305 specimens of NSCLC and 80 normal lung tissue specimens were analyzed for CD133, Notch1, and VEGF protein expressions by immunohistochemical staining.

RESULTSIn NSCLC specimens, the positivity rates of CD133, Notch1, and VEGF were 48.9%, 43.9%, and 45.6%, respectively, significantly higher than those in normal lung tissues (10.0%, 15.0%, and 0%, respectively, P<0.01). The expression levels of CD133, Notch1, and VEGF proteins were significantly correlated with the tumor grades, lymph node metastasis, TNM stages, and postoperative survival time of the patients (P<0.01). A positive correlation was found among the expression levels of CD133, Notch1, and VEGF proteins. Kaplan-Meier survival analysis showed a significantly lower overall mean survival time of the patients positive for CD133, Notch1, and VEGF than that of the negative patients (P<0.001). Cox regression analysis suggested that positive expressions of CD133 and Notch1 were independent prognostic factors of NSCLC (P<0.05).

CONCLUSIONSCD133, Notch1, and VEGF may play important roles in the occurrence, progression, invasion, and metastasis of NSCLC. CD133 and Notch1 have important values for predicting the prognosis and evaluating disease progression of the patients.

AC133 Antigen ; Antigens, CD ; metabolism ; Carcinoma, Non-Small-Cell Lung ; metabolism ; Glycoproteins ; metabolism ; Humans ; Kaplan-Meier Estimate ; Lung ; metabolism ; Lung Neoplasms ; metabolism ; Lymphatic Metastasis ; Neoplastic Stem Cells ; metabolism ; Peptides ; metabolism ; Prognosis ; Receptor, Notch1 ; metabolism ; Regression Analysis ; Survival Rate ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo explore the expression of Snail and Slug in primary cervical squamous cell carcinoma (CSCC) and their relationship with KAI1 expression.

METHODSThe expressions of Snail, Slug, and KAI1 proteins were examined by immunohistochemistry in 154 specimens of CSCC tissues, 50 specimens of cervical intraepithelial neoplasm (CIN), and 40 specimens of normal cervical tissues.

RESULTSThe positivity rates of Snail, Slug, and KAI1 expression were 0%, 2.5%, and 95.0% in normal cervical tissues, 32.0%, 34.0% and 64.0% in CIN tissues, and 66.2%, 66.9%, and 43.5% in CSCC tissues, respectively, showing significant differences in the rates among the 3 groups (P<0.05). The expressions of Snail, Slug, and KAI1 were significantly correlated with the histological grades of the tumor, depth of invasion, lymph node metastasis, International Federation of Gynecology and Obstetrics (FIGO) stages, and postoperative survival time (P<0.05). The expressions of Snail and Slug were positively correlated (r=0.752, P<0.001), and both of them were negatively correlated with the expression of KAI1 (P<0.001). Kaplan-Meier analysis showed that patients positive for Snail and Slug had significantly lower survival rates than the negative patients (P<0.001), while a positive expression of KAI1 was associated with a higher survival rate of the patients. Cox regression analysis identified Snail, KAI1, and FIGO stage as independent factors that affected the outcomes of CSCC (P<0.05).

CONCLUSIONThe expressions of Snail, Slug, and KAI1 are related to the tumor grade, FIGO stage, invasive depth, lymph node metastasis, and prognosis of CSCC, and their combined detection can help estimate the outcomes of the patients.

Carcinoma, Squamous Cell ; metabolism ; pathology ; Cervical Intraepithelial Neoplasia ; metabolism ; pathology ; Female ; Humans ; Immunohistochemistry ; Kangai-1 Protein ; metabolism ; Kaplan-Meier Estimate ; Lymphatic Metastasis ; Neoplasm Staging ; Prognosis ; Snail Family Transcription Factors ; Survival Rate ; Transcription Factors ; metabolism ; Uterine Cervical Neoplasms ; metabolism ; pathology