Objective:To explore the clinical efficacy of Masquelet technique combined with tissue flap transfer in the treatment of infectious composite bone and soft tissue defects in the early and middle stages after internal fixation for tibial fractures.Methods:From October 2017 to November 2020, 12 patients (13 tibial fractures) with infectious bone and soft tissue defects in the early and middle stages after internal fixation were treated in the Department of Orthopaedics, 988th Hospital of the Joint Logistics Support Force of CPLA by two-phased surgery with retaining internal fixation. Phase I procedures were thoroughly removal of the infected lesions and failed screws, preserving internal implants as many as possible, implantation of absorbable calcium sulphate and an antibiotics blended string of beads into the distal and proximal medullary cavity of the fractured bones, filling the bone defect and wrapping the internal implants with antibiotics loaded bone cement. The size of defects was 3.5 cm × 5.0 cm-7.5 cm × 14.5 cm, and the flaps for wound coverage sized 4.0 cm × 5.5 cm-8.0 cm × 15.0 cm. As for the repair of donor site, 8 limbs were sutured directly, 5 limbs could not be closed completely, and the remaining wounds were covered by skin grafting after suture. Based on well control of infection and stable clinical signs, fillings of bone cement were then removed in Phase II surgery, or 6-9 weeks after primary surgery. Autologous cancellous bone pieces or composite allogeneic bone were fully implanted around the induction membrane formed by Masquelet technique, and auxiliary steel plates were implanted for internal fixation of unstable fractures. After discharge, the patients visited the outpatient clinic regularly, and combined with Wechat follow-up. The texture, colour and bone healing were observed. At the last follow-up, the function of the affected limbs were assessed according to Johner-Wruhs evaluation standard.Results:After Phase I surgery, 13 flaps survived smoothly without vascular compromise. The wounds healed in Phase I. Two patients (2 sides) had recurrent infections. Re-debridement was performed and external fixation was applied after removal of internal fixation. After Phase II surgery, all patients were included in 12-26 months of follow-up, with an average of 18 months. Thirteen lower leg fractures healed well, and the time of bone healing was 16-25 (average 19.5) weeks. The Johner Wruhs criteria was used in evaluation of the function of affected limbs, and it was found that 6 patients were in excellent, 5 in good and 2 in fair.Conclusion:It is feasible while preserving the internal implants, to use membrane induction technique (Masquelet technique) combined with flap transfer, together with the absorbable calcium sulphate antibiotic sustained-release beads as a carrier in the phased treatment of infectious bone defects and bone exposure in the early and middle stages after the surgery of tibial internal fixation. It also gives a higher rate of excellence in surgical outcome. This study explores a treatment procedure for traumatic bone infection combined with composite soft tissue defects.

Objective To investigate the changes of chromosome aberration and micronucleus frequencies in the peripheral blood of patients with cancer before and after treatment, and to provide a basis for clinical prevention and treatment. Methods We collected the physical examination data of 102 patients with cancer before and after treatment from 2016 to 2021 to analyze the changes of chromosome aberration and micronucleus frequencies in peripheral blood. Results Before and after treatment, there were significant differences in chromosome aberration frequency and micronucleus frequency in peripheral blood lymphocytes in patients having radiotherapy or chemoradiotherapy (all P < 0.05), but no significant difference was observed in either index for patients having chemotherapy (both P > 0.05). Before and after radiotherapy, there were significant differences in the numbers of patients with abnormal chromosome aberration frequency and those with abnormal micronucleus frequency in lymphocytes (both P < 0.001). Before and after chemotherapy, there was no significant difference in the number of patients with abnormal chromosome aberration frequency (P = 0.100) or those with abnormal micronucleus frequency (P = 0.110). Conclusion Radiotherapy can cause abnormalities in chromosome aberration and micronucleus frequencies in peripheral blood lymphocytes, which can be useful for monitoring radiotherapy injury to formulate effective emergency plans and evaluate radiation dose in each course of treatment.

Objective:To investigate the surgical method and clinical value of free medial sural artery perforator (MSAP) flap for repairing the wound of toe.Methods:The patients with isolated toe skin defects admitted to the Department of Trauma Microsurgery of No.988 Hospital of Joint Logistics Support Force were treated with MSAP flap for wound repair from June 2014 to December 2018. All the donor site were closed primarily. After the operation, the appearance, texture, hair growth and functional recovery of donor and recipient sites were observed through regular follow-up in outpatient or WeChat.Results:A total of 11 cases were enrolled, including 7 males and 4 females, aged from 19 to 44 years, with an average of 31.3 years. The wound sites were located at the first toe in 8 cases, the second toe in 2 cases, and the fourth toe in 1 case. The size of the skin defects was from 2.2 cm×1.8 cm to 5.7 cm×3.8 cm, the primary repair was performed in 4 cases and secondary repair in 7 cases, and the flaps ranged from 2.6 cm×2.1 cm-6.1 cm×4.2 cm. Ten cases survived successfully, and the wounds healed primarily. One case had local necrosis at the distal end of the flap, the wound healed after secondary repair surgery. All patients were followed-up from 6 to 18 months. The appearance of flaps was good in 9 cases and slightly swollen in 2 cases. All flaps had good texture, no discomfort of wearing shoes, no obvious influence on walking, and linear scar remained in the donor area. Three cases were treated with laser hair removal because of the flap hair growth.Conclusions:The method of using a free MSAP flap to repair the small toe wound can restore its appearance to satisfaction and achieve a good aesthetic repair effect.

Objective:To investigate the surgical method and clinical value of free medial sural artery perforator (MSAP) flap for repairing the wound of toe.Methods:The patients with isolated toe skin defects admitted to the Department of Trauma Microsurgery of No.988 Hospital of Joint Logistics Support Force were treated with MSAP flap for wound repair from June 2014 to December 2018. All the donor site were closed primarily. After the operation, the appearance, texture, hair growth and functional recovery of donor and recipient sites were observed through regular follow-up in outpatient or WeChat.Results:A total of 11 cases were enrolled, including 7 males and 4 females, aged from 19 to 44 years, with an average of 31.3 years. The wound sites were located at the first toe in 8 cases, the second toe in 2 cases, and the fourth toe in 1 case. The size of the skin defects was from 2.2 cm×1.8 cm to 5.7 cm×3.8 cm, the primary repair was performed in 4 cases and secondary repair in 7 cases, and the flaps ranged from 2.6 cm×2.1 cm-6.1 cm×4.2 cm. Ten cases survived successfully, and the wounds healed primarily. One case had local necrosis at the distal end of the flap, the wound healed after secondary repair surgery. All patients were followed-up from 6 to 18 months. The appearance of flaps was good in 9 cases and slightly swollen in 2 cases. All flaps had good texture, no discomfort of wearing shoes, no obvious influence on walking, and linear scar remained in the donor area. Three cases were treated with laser hair removal because of the flap hair growth.Conclusions:The method of using a free MSAP flap to repair the small toe wound can restore its appearance to satisfaction and achieve a good aesthetic repair effect.

Objective:To provide useful information for in-depth understanding of the epidemic and molecular evolution of Coxsackievirus A4 (CV-A4), the genetic characteristics of the complete genome and recombination events in some genome regions of CV-A4 strain isolated from a patient with severe hand, foot and mouth disease (HFMD) in Yunnan province were analyzed.Methods:The CV-A4 strain was isolated from feces using RD, KMB17 and A549 cells respectively, and the viral RNA was extracted from the supernatant with CPE. The whole VP1 and complete genome sequences of the virus were amplified by RT-PCR and sequenced through Sanger’s sequencing. Complete genome sequence and genome regions of the isolated virus were analyzed through MEGA7.0 and SimPlot 3.5.1 software.Results:The virus isolated from RD cells belonged to CV-A4 and was designated as R11-20/YN/CHN/2011 strain. This CV-A4 strain was C2 sub-genotype through phylogenetic analysis based on the VP1 sequence. CV-A4 R11-20/YN/CHN/2011 has the highest nucleotide sequence identity with 09214/SD/CHN/2009 in VP1 and CVA4/SZ/CHN/09 in the complete genome. Recombination occurred between CV-A4 R11-20/YN/CHN/2011 and EV-A71 in 3D region.Conclusions:The CV-A4 R11-20/YN/CHN/2011 strain belongs to C2 sub-genotype and recombines with EV-A71 in 3D region.

After the New Coronary Pneumonia pandemic, people^'s social behavior has changed, and the current health management and development approaches should also change accordingly. This article analyzes the changes of social behavior during different anti-epidemic periods, demonstrates the necessity and possibility to change the current health management formats and development paths, and proposes a new concept of family-centered health management. The main target of the current urgent need for family health management is to expand the household entry units, build learning and sports units, etc. This article provides ideas for health management in the post-pandemic era.

OBJECTIVE: To analyze the association of integrinα5 (ITGA5) with grading of liver cancer and the overall patient survival and investigate the effects of integrin α5 (ITGA5) silencing on the proliferation, invasion and migration abilities of human liver cancer Bel-7404 cells. METHODS: UALCAN was used to analyze the expression of ITGA5 in liver cancer tissues and normal tissues, and expression in different grades of liver cancer tissues. GEPIA was used to analyze the relationship between ITGA5 expression and the survival of liver cancer patients through.The ITGA5 shRNA lentiviral vector was used to infect Bel-7404 cells to establish a cell line with stable ITGA5 silencing verified by Western blotting. Plate clone formation assay and Transwell assay were used to detect the proliferation, invasion and migration of Bel-7404 cells. The correlation between ITGA5 and PI3K in liver cancer tissues and control tissues was analyzed using Oncomine cancer specimen database. RESULTS: The expression of ITGA5 was significantly higher in liver cancer than in normal tissues ( < 0.05). The expression of ITGA5 was significantly lower in grade 1 than in grade 2 liver cancer, and also lower in grade 2 than in grade 3 liver cancer ( < 0.05). The patients with high ITGA5 expression had a significantly lower overall survival rate than those with low ITGA5 expression ( < 0.05). Plate clone formation assay showed that the clone formation rate was significantly lowered in Bel-7404 cells with ITGA5 silencing compared with the blank and negative control cells ( < 0.05). ITGA5 silencing significantly attenuated the migration of Bel-7404 cells as shown by Transwell assay ( < 0.05). ITGA5 and PI3K were both highly expressed and showed a positive correlation in liver cancer tissues ( < 0.05). CONCLUSIONS ITGA5 is closely related to the progression of liver cancer and the patients' prognosis. ITGA5 silencing inhibits the proliferation, invasion and migration of liver cancer cells. ITGA5 promotes the liver cancer growth and metastasis possibly by regulating the PI3K signaling pathway.
Cell Line, Tumor ; Cell Movement ; Cell Proliferation ; Gene Expression Regulation, Neoplastic ; Humans ; Integrin alpha5 ; Liver Neoplasms ; Neoplasm Invasiveness ; Phosphatidylinositol 3-Kinases

To study the methods and principles for simultaneous treatment in the children with pectus excavatum (PE) combined with congenital cardiothoracic diseases.
 Methods: The medical records of all children, who underwent simultaneous repair of PE combined with congenital cardiothoracic diseases, were retrospectively reviewed in Hunan Children's Hospital from January 2007 to September 2018. The patients were divided into a PE combined with congenital heart disease (CHD) group (n=17) and a PE combined with thoracic disease group (n=10). The repair with a custom-made sternal lifting device, a Nuss repair, were performed in the treatment of PE, and the correction of the CHD was performed by heart open surgery using cardiopulmonary bypass (through sternotomy or right infra-axillary thoracotomy) or by transcatheter closure under echocardiography or X-ray-guided percutaneous intervention in the PE combined with CHD group. The children in the PE combined with thoracic disease group underwent thoracic surgery plus Nuss procedure concurrently.
 Results: All 27 pediatric patients underwent simultaneous repair of the PE combined with congenital cardiothoracic diseases. In the PE combined with CHD group, the duration of hospital stay ranged from 8.0 to 25.0 (13.2±4.8) days. Two patients had delayed healing of the surgical wound and 1 patient developed a small left pleural effusion postoperatively. In the PE combined with thoracic disease group, the duration of hospital stay ranged from 10.0 to 34.0 (19.9±7.5) days. One patient was complicated with chylothorax and 2 patients were complicated with pleural effusionin. The treatment for the patients in the 2 groups was satisfactory. No severe complications like surgical death, severe bleeding, chest organ injuries, and implant rejections were observed.
 Conclusion: According to the characteristics of patients, individualized programs should be selected in order to correct children's PE combined with congenital cardiothoracic diseases in the same period, which are safe, effective and can avoid the risk of multiple operations and anesthesia, and can reduce the financial burden of family.
Cardiac Surgical Procedures ; Child ; Funnel Chest ; surgery ; Heart Defects, Congenital ; Humans ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Sternotomy ; Treatment Outcome

BACKGROUND:Tissue-engineered biomaterials have the similar structure and function with autologous tissues. OBJECTIVE:To explore the osteoinduction of the bone biomaterial composited with rat bone marrow mesenchymal stem cel s in the treatment of large costal defects. METHODS:Forty Wistar rats were enrol ed used for the preparation of right large costal defect models, and then randomized into two groups, fol owed by the implantation of calcium chloride-sodium alginate gel (control group) or chloride-sodium alginate-bone marrow mesenchymal stem cel s (experimental group). At 2, 4 and 8 weeks after implantation, chest X-ray radiograph and histological examination of the defect region were conducted. RESULTS AND CONCLUSION:X-ray showed that in the experimental group, the defect area had no significant changes at the 2nd week after implantation until the formation of few bones at the 4th week;and at the 8th week, both ends of the defect region gradual y connected, and newly formed bones were ful of the defect. In contrast, the defect region in the control group showed no obvious bone healing, and both ends of the defect closed and osteosclerosis occurred. In the experimental group, there were a smal amount of fibrous tissues and numerous inflammatory cel s infiltratied in the material compartment, and no connection occured between the material and broken ends;there were numerous inflammatory cel s but no bone tissues in the control group at the 2nd week. At the 4th week, the scaffold degraded gradual y and abundant bone tissues were seen in the experimental group;the scaffold degraded little, and bone tissues aggregatied at the both defect ends in the control group. Up to the 8th week, the two kinds of scaffolds degraded mostly. A large number of bone tissues and trabeculae formed and the both defect ends were connected with the newly formed bones in the experimental groups, while in the control group, osteosclerosis appeared at both ends of the defect. To conclude, the bone biomaterial composited with rat bone marrow mesenchymal stem cel s promotes the repair of large costal defects.

Objective To evaluate the miRNA change between hypothermia circulatory arrest at different temperature and its impact on intestinal protection.Methods Sixteen piglets were randomly(n =4) divided into four groups:deep hypothermia circulatory arrest (DHCA,18℃) group,moderate hypothermia circulatory arrest(MHCA,24℃) group,cardiopulmonary bypass(CPB) group and sham operation(SO) group.They were subjected to 80 min hypothermia circulatory arrest,305 min CPB or thoracotomy,respectively.Pick-and-mix custom miRNA real-time PCR panels were utilized to detect intestinal samples.miRNA expression between DHCA and MHCA were compared directly(DHCA vs.MHCA) and indirectly(DHCA/SO vs.MHCA/SO,DHCA/CPB vs.MHCA/CPB).Results Exposure to DHCA caused less intestinal miRNA dysregulation than MHCA.Besides,seven miRNAs(miR-122,miR-145-5p,miR-421-5p,miR-99a,miR-365-5p,miR-31 and miR-192)were differentially expressed between the two hypothermia circulatory arrest groups.Conclusion Better intestinal miRNA protection was provided by DHCA than MHCA.Intestinal miRNA were differentially expressed between hypothermia circulatory arrest at different temperature.