OBJECTIVE: To summarize the research progress on the mechanism related to traumatic brain injury (TBI) to promote fracture healing, and to provide theoretical basis for clinical treatment of fracture non-union. METHODS: The research literature on TBI to promote fracture healing at home and abroad was reviewed, the role of TBI in fracture healing was summarized from three aspects of nerves, body fluids, and immunity, to explore new ideas for the treatment of fracture non-union. RESULTS: Numerous studies have shown that fracture healing is faster in patients with fracture combined with TBI than in patients with simple fracture. It is found that the expression of various cytokines and hormones in the body fluids of patients with fracture and TBI is significantly higher than that of patients with simple fracture, and the neurofactors released by the nervous system reaches the fracture site through the damaged blood-brain barrier, and the chemotaxis and aggregation of inflammatory cells and inflammatory factors at the fracture end of patients with combined TBI also differs significantly from those of patients with simple fracture. A complex network of humoral, neural, and immunomodulatory networks together promote regeneration of blood vessels at the fracture site, osteoblasts differentiation, and inhibition of osteoclasts activity. CONCLUSION TBI promotes fracture healing through a complex network of neural, humoral, and immunomodulatory, and can treat fracture non-union by intervening in the perifracture microenvironment.
Humans ; Fracture Healing/physiology* ; Brain Injuries/metabolism* ; Brain Injuries, Traumatic ; Fractures, Bone ; Osteogenesis

BACKGROUND:The remediation and treatment of bone defects present considerable challenges,with a variety of clinical intervention strategies available.One such approach,the Masquelet technique,has demonstrated high rates of success and reliable outcomes and is currently employed in clinical practice.However,the underlying mechanisms of this technique remain incompletely understood,and certain challenges persist in its clinical application,indicating that this technique is not yet fully mature. OBJECTIVE:To compile and categorize the biomaterials currently employed in research aimed at improving the Masquelet technique,in order to provide insights and references for the further development of this technique. METHODS:A literature search of the China National Knowledge Infrastructure and PubMed databases was conducted,spanning publications from January 2013 to November 2022.The search terms used included"Masquelet technique;induced membrane technique;induced membrane;biomaterial;bone defect"in both Chinese and English.A total of 58 articles meeting the inclusion criteria were reviewed. RESULTS AND CONCLUSION:(1)The emergence and continual development of the Masquelet technique provide a therapeutic strategy for treating bone defects.Some researchers are focusing on developing superior spacer materials,autograft substitutes,and membrane materials that mimic the properties of the induced membrane,to simplify the two-stage procedure,shorten treatment duration,and reduce patient distress.(2)Calcium sulfate,silicone,poly(lactic-co-glycolic acid),and polypropylene can replace polymethylmethacrylate bone cement to form induced membranes in animal experiments or clinical applications,each with their advantages.Contrary to expectations,common materials such as titanium and polyvinyl alcohol sponge cannot replace polymethylmethacrylate bone cement.(3)Autograft substitutes are diverse,with allograft bone,β-tricalcium phosphate,absorbable gelatin sponge,α-calcium sulfate hemihydrate,bioactive glass,titanium,and tantalum demonstrating their ability to reduce the quantity of autologous cancellous bone graft required in the second stage of the procedure.Among them,allograft bone,β-tricalcium phosphate,bioactive glass,titanium and tantalum can replace autogenous bone as grafts,and other materials need to be mixed with autogenous bone,in both clinical and fundamental experiments.(4)Biomimetic-induced membranes,human amnion,human decellularized dermis,polytetrafluoroethylene,and even autogenous cortical bone have been shown to possess properties similar to the induced membrane.(5)Most of the application and research of biomaterials in this technology still exist in the stage of basic research and have not been applied in clinical practice or popularized on a large scale,but the above materials can provide more sufficient theoretical basis and new ideas for the exploration of Masquelet technical mechanism,the improvement of surgical methods and clinical application.

Over the years of exploration and development, the surgical techniques and prognosis of liver transplantation in China have been significantly improved, resulting in a notable decrease in the prevalence of postoperative complications. However, ischemic-type biliary lesion remain a non-negligible issue. The Third Affiliated Hospital of Sun Yat-sen University formulated and published the "Expert Consensus on the Diagnosis and Treatment of Ischemic-Type Biliary Lesions after Liver Transplantation in Mainland China" in 2015, which has now been updated into a guideline based on current conditions and literature reports. This guideline elaborates in detail on the definition, incidence, pathogenesis, diagnosis, prevention of high-risk factors, and treatment of ischemic-type biliary lesion, aiming to provide standardized and normative guidance for the diagnosis and treatment of ischemic-type biliary lesion after liver transplantation, thereby reducing the rate of re-transplantation and fatality, and to improve the overall quality of life of liver transplant recipients.

Objective　To explore the molecular epidemiological characteristics of local Mycobacterium tuberculosis in Chongqing, China using genotyping methods and establish a suitable genotyping system tuberculosis genotyping in the region. Methods A total of 268 isolates collected from the sputum of tuberculosis patients at two national drug resistance monitoring sites in Chongqing from 2019 to 2021. The DNA of these isolates was extracted, and genotyping of the isolates was performed using VTNR 24 locus typing method. Epidemiological investigations were conducted on clustered isolates, and the clustering rates of isolates from the two surveillance sites were compared to analyze their transmission differences. Results In the two regions, the Hunter-Gaston discriminatory index (HGI) in Fengjie County ranged from 0 to 0.85, with 10 loci having an HGI above 0.6, 11 loci with an HGI between 0.3 and 0.6, and 3 loci with an HGI below 0.3; the highest resolution site was MIRU31, while the lowest resolution site was MIRU24. The HGI index in Fengdu County ranged from 0 to 0.81, with 12 loci having an HGI above 0.6, 9 loci with an HGI between 0.3 and 0.6, and 3 loci with an HGI below 0.3; the highest resolution site was MIRU26, while the lowest resolution site was MIRU23. In the clustering analysis, among the 140 isolates from Fengdu County, 10 samples clustered into 4 clusters, with the largest cluster consisting of 4 samples, resulting in a clustering rate of 4.1%. Among the 128 isolates in Fengjie County, 10 samples clustered into 5 clusters, with a clustering rate of 4.2%. Conclusion In Fengdu County and Fengjie County of Chongqing, the main population of the disease show independent genotypes, indicating a low recent transmission rate. The incidence of patients is mainly endogenous recurrence, that is, latent infection develops into active tuberculosis. While conducting standardized management of tuberculosis patients, prevention and control agencies should also increase the screening of latent infection at two monitoring points and carry out preventive treatment of latent infection, which is the key to reduce the incidence of tuberculosis in the two places.

Isocitrate dehydrogenase (IDH) is an essential metabolic enzyme in the tricarboxylic acid cycle (TAC). The high mutation frequency of the IDH gene plays a complicated role in gliomas. In addition to affecting gliomas directly, mutations in IDH can also alter their immune microenvironment and can change immune-cell function in direct and indirect ways. IDH mutations mediate immune-cell infiltration and function by modulating immune-checkpoint gene expression and chemokine secretion. In addition, IDH mutation-derived D2-hydroxyglutarate can be absorbed by surrounding immune cells, also affecting their functioning. In this review, we summarize current knowledge about the effects of IDH mutations as well as other gene mutations on the immune microenvironment of gliomas. We also describe recent preclinical and clinical data related to IDH-mutant inhibitors for the treatment of gliomas. Finally, we discuss different types of immunotherapy and the immunotherapeutic potential of IDH mutations in gliomas.
Brain Neoplasms/therapy* ; Glioma/therapy* ; Humans ; Immunotherapy ; Isocitrate Dehydrogenase/genetics* ; Mutation/genetics* ; Tumor Microenvironment

ObjectiveTo investigate the influencing factors for the short-term prognosis of patients with HBV-related acute-on-chronic liver failure (HBV-ACLF). MethodsClinical data were collected from 240 HBV-ACLF patients without liver transplantation who were admitted To The Second Affiliated Hospital of Xi’an Jiaotong University from January 2009 to December 2019, and the patients were divided into groups according to survival on days 28 and 90 after admission (28-day survival group with 164 patients and 28-day death group with 76 patients; 90-day survival group with 140 patients and 90-day death group with 100 patients). The data collected included predisposing factors, liver function parameters, Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, and complications. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The receiver operating characteristic (ROC) curve was plotted to calculate the area under the ROC curve (AUC), and a multivariate logistic regression analysis was used to investigate the risk factors for the short-term prognosis of HBV-ACLF. ResultsThe main predisposing factors of HBV-ACLF included spontaneous activation of HBV (55.6%) and HBV activation caused by the withdrawal of or resistance to nucleoside analogues (25.2%). There were significant differences in age, prothrombin time activity (PTA), neutrophil-lymphocyte ratio (NLR), serum sodium, MELD score, MELD-Na score, and total bilirubin (TBil) at baseline between the 28-day survival group and the 28-day death group (Z=-2.400,-6.015, -5.070, -5.103, -5.044, -7.430, and -6.637, all P＜0.05), and there were also significant differences in age, PTA, NLR, serum sodium, MELD score, MELD-Na, TBil, and cholesterol at baseline between the 90-day survival group and the 90-day death group (Z=-2.205, -7.728, -3.335, -4.015, -6.053, -7.908, -6.655, and -3.607, all P＜0.05). The multivariate logistic regression analysis showed that TBil ＞260.20 mmol/L (odds ratio ［OR］=4.572, 95% confidence interval ［CI］: 1.321-15823, P＜0.05), PTA ＜24.8% (OR=8.934, 95%CI: 3.026-26.374, P＜0.05), NLR＞5.63 (OR=2.632, 95%CI: 1.126-6.152, P＜0.05), serum sodium ＜130.8 mmol/L (OR=27.467, 95%CI: 6.113-123.423, P＜0.05), MELD score ＞17.84 (OR=4.303, 95%CI: 1.048-17.663, P＜0.05), and MELD-Na score ＞25.1 (OR=3.453, 95%CI: 1.614-7.387, P＜0.05) were independent risk factors for 28-day survival; TBil＞260.20 mmol/L (OR=5.148, 95%CI: 1.918-13.822, P＜0.05), PTA ＜25.5% (OR=15.718, 95%CI: 5.161-47.866, P＜0.05), serum sodium ＜135.3 mmol/L (OR=10.080, 95%CI: 3.244-31.323, P＜005), MELD score ＞17.84 (OR=11.157, 95%CI: 2.580-48.254, P＜0.05), MELD-Na score ＞25.1 (OR=4.391, 95%CI: 2057-9.372, P＜0.05) were independent risk factors for 90-day survival. Among the 240 patients, 160 (66.7%) experienced infection within 90 days, among whom 140 had bacterial infection, 12 had viral infection, and 8 had fungal infection. The 160 patients with infection had a significantly higher 90-day mortality rate than the patients without infection (46.3% vs 32.5%, χ2=6.720, P=0.010). Of all 240 patients, 176 had ascites, 44 had pleural effusion, 36 had acute renal injury, 60 had hepatic encephalopathy, and 12 had gastrointestinal bleeding within 28 days, and there were significant differences in the proportion of patients with acute renal injury, grade Ⅲ-Ⅳ hepatic encephalopathy, or gastrointestinal bleeding between the 28-day survival group and the 28-day death group (χ2=64.088，29811，7.797，all P＜0.05). ConclusionTBil, PTA, serum sodium, MELD score, and MELD-Na score at baseline are independent risk factors for the 28- and 90-day prognosis of HBV-ACLF. Liver inflammation and necrosis caused by HBV activation may be the initiating factor for ACLF, and infection, acute renal injury, hepatic encephalopathy, and gastrointestinal bleeding are the main complications affecting the prognosis of patients.

Objective To observe the effect of recombinant human granulocyte/macrophage colonystimulating factor (rhGM-CSF) combined with nano-silver for deep burn degreen Ⅱ. Methods The burn model were done with Wistar rats. They were randomly divided into four groups , group A (n = 30): petrolatum treatment, group B(n = 30): nano-silver treatment, group C(n = 30): rhGM-CSF treatment, and group D(n =30): rhGM-CSF combined with nano-silver treatment. The healing rates of the four groups were observed on postburn day 1, 4, 7, 10, 14, 21. Meanwhile the levels of VEGF and EGF in serums were measured with ELISA. Results All groups started to heal on postburn day 10. Group A had inflammation obviously , and group D moderately. There were significant difference in the healing retes on postburn day 10 , 14, 21 between four groups (P < 0.05). The level of VEGF in group A peaked on postburn day 21 (25.76 ± 1.46)pg/mL, but the levels of VEGF in group B, group C and group D peaked on postburn day 14[(29.73 ± 1.58)pg/mL, (38.91 ± 2.38)pg/mL, (43.54 ± 1.28)pg/mL]. On postburn day 4, 7, 10, 14, 21, there were significant difference(P <0.05). The level of EGF peaked on postburn day 21 in all groups [(0.72 ± 0.14)ng/mL, (0.93 ± 0.13)ng/mL, (1.18 ± 0.16)ng/mL, (1.50 ± 0.15)ng/mL]. There were significant difference on postburn day 7, 10, 14, 21 between four groups (P < 0.05). Conclusions rhGM-CSF combined with nano-silver treatment could promote wound healing, and be better than rhGM-CSF and nano-silver singly.

Objective To observe the effect of recombinant human granulocyte/macrophage colonystimulating factor (rhGM-CSF) combined with nano-silver as a treatment on deep burn degreen Ⅱ about inflammation .Methods The burn model was built with Wistar rats .They were randomly divided into four groups ,petrolatum treatment (group A ,n= 30) ,nano-silver treatment (group B ,n=30) ,rhGM-CSF treatment(group C ,n=30) ,and rhGM-CSF combined with nano-silver treatment(group D ,n=30) . observation the inflammatory reaction ,and culture bacteria on wound of the four groups at 1st ,4th ,7th ,10th ,14th ,21th day after treatment were made .The level of IL-2 and IL-8 were measured in serums with ELISA .Results The inflammatory reaction:group A>group B>group C>group D ;Bacterias were observed in group A ,group B/C and group D at 4th ,10th ,14th day respectively af-ter treatment .The number of bacterial growed in group D was less than in group A ,group B and group C .The numbers of bacterial growed in group B and group C were less than in group A .And after 10 ,14 ,21 days treatment ,there was significantly statistical difference(P<0 .05) .There was difference among groups in the levele of IL-2 and IL-8 ,which were the lowest in group D and the highest in group A .The level of IL-2 has no significantly statistical difference between every groupat 1st day and between B and C group at 4th day(P>0 .05) .After other days treatment ,there was significantly statistical difference(P<0 .05) .There was signifi-cantly statistical difference in every group at each day of the IL-8 levele except A and B group ,B and C group ,C and D group at 1st day (P<0 .05) .Conclusion rhGM-CSF combined with nano-silver treatment could alleviate inflammatory reaction ,and be better than rhGM-CSF or nano-silver alone .

Objective:To investigate the predictive value of serumal retinol-binding protein 4(RBP4) level fro fetal macrosomia of non-diabetic pregnant women .Methods :The serumal levels of RBP4 of 500 non-diabetic pregnant women at 12 week ,20 week and 24 week of pregnancy were measured by immune projection turbidimetric method .Fetal macrosomia was defined as birth weight≥4000 g .The cut-off value ,sensitivity and specificity were calculated with receiver operating characteristic (ROC) curve .Results:Of the 500 non-diabetic pregnant women ,30 cases(6% ) got fetal macrosomia .The ROC curve showed that the predictive cut-off values of RBP4 at 12 week ,20 week and 24 week of pregnancy were 61 .0 mg/L ,50 .5 mg/L and 52 .5 mg/L , respectively ;the predictive sensitivity and specificity at 12 week ,20 week and 24 week of pregnancy were 42 .9% and 94 .5% , 70 .0% and 69 .5% ,76 .9% and 73 .2% ,respectively .The predictive cut-off value of RBP4 no later than 24 week of pregnancy was 51 .5 mg/L ;the predictive sensitivity and specificity were 61 .8% and 69 .5% .There was significant difference(P<0 .05) between the serumal level of RBP4 at 24 week of pregnancy in group fetal macrosomia and that in group nonfetal macrosomia . Conclusions :The predictive sensitivity of RBP4 increases in accordance with the increase of serumal level of RBP 4 .The serumal level of RBP4 of non-diabetic pregnant women at 24 week of pregnancy may have higher sensitivity and specificity in the predic-tion of fetal macrosomia .If the serumal level of RBP4 no later than 24 week of pregnancy is beyond 50 mg/L ,then the risk of fetal macrosomia will be higher .