Objective:To investigate the clinical efficacy of arthroscopic double-row double-pulley technique in the treatment of Ideberg type IA scapular glenoid fracture.Methods:A retrospective case series study was conducted to analyze the clinical data of 16 patients with Ideberg type IA scapular glenoid fracture admitted to Jiading Branch of Shanghai General Hospital from January 2018 to December 2021, including 10 males and 6 females, aged 25-65 years [(42.9±5.1)years]. The patients were treated with arthroscope-assisted reduction and double-row double-pulley technique. The operation time was recorded. Three-dimensional reconstruction of the shoulder joint with CT was performed to assess fracture displacement and healing. Modified University of California Los Angeles (UCLA) score and Constant-Murley score were used to evaluate shoulder function and Visual Analogue Scale (VAS) score was used to evaluate pain before surgery, at 3, 6, 12 months after surgery and at the last follow-up. The complications were observed.Results:All the patients were followed up for 12-36 months [(20.3±4.4)months]. The operation time was 60-90 minutes [(74.7±8.9)minutes]. Three-dimensional construction of the shoulder joint with CT performed at 3 months after surgery showed that there was no fracture re-displacement and all the patients had bone union. The modified UCLA score, Constant-Murley score and VAS score at 3 months after surgery were (30.4±0.4)points, (84.3±1.4)points and 2.0(1.3, 3.0)points, respectively, which were significantly improved compared with those before surgery [(21.1±0.5)points, (56.4±1.3)points and 5.0(5.0, 6.0)points respectively] ( P<0.05). The modified UCLA score, Constant-Murley score and VAS score at 6 months after surgery were (33.1±0.4)points, (91.0±0.5)points and 1.0(1.0, 2.0)]points respectively, which were significantly improved compared with those at 3 months after surgery ( P<0.05). The modified UCLA score, Constant-Murley score and VAS score at 12 months after surgery were (33.5±0.3)points, (92.6±0.6)points and 1.0(0.3, 1.8)points respectively, showing no significant differences from those at 6 months after surgery ( P>0.05). The modified UCLA score, Constant-Murley score and VAS score at the last follow-up were (33.8±0.8)points, (93.7±1.8)points and 1.0(0.0, 1.0)points respectively, with no significant differences from those at 12 months after surgery ( P>0.05). There were no complications such as wound infection, neurovascular injury or shoulder stiffness after surgery. Conclusion:Arthroscopic double-row double-pulley technique for the treatment of Ideberg type IA scapular glenoid fracture has a short operation time, a high fracture healing rate, good shoulder function recovery, and pain relief, with no common complications.

Objective:To explore the molecular mechanism of circDDX17 regulating the proliferation and apoptosis of non-small cell lung cancer cells by targeting the miR-223-3p/RIP3 molecular axis.Methods:The expression levels of circDDX17, miR-223-3p, and RIP3 in human normal lung epithelial cell lines BEAS-2B and non-small cell lung cancer cells H1299, A549, and H446 were detected by reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). The plasmids of pcDNA, pcDNA-circDDX17, anti-miR-con, anti-miR-223-3p, pcDNA-circDDX17 and miR-con, pcDNA-circDDX17 and miR-223-3p mimics were transfected into H1299 cells. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay was used to detect the cell proliferation. Flow cytometry was used to detect the cell cycle and cell apoptosis. Plate cloning experiment was used to detect cell proliferation ability. The dual luciferase report experiment was applied to verify the targeting relationship between miR-223-3p with circDDX17 and RIP3. Western blot was used to detect the protein expression of cyclinD1, CDK2, cleaved caspase-3 and Bax.Results:The expression levels of circDDX17 and RIP3 mRNA in H1299, A549, and H446 cells were significantly reduced ( P<0.05), the expression level of miR-223-3p mRNA was significantly increased ( P<0.05) compared with BEAS-2B. The cell viability [(69.46±4.68)%], the number of cell clones (83.49±7.86), the proportion of cells in S phase [(22.52±1.41) %], the protein expression levels of cyclinD1 and CDK2 in PCDNa-CircDDX17 group were lower than those in pcDNA group [(97.54±7.72)%, 205.03±13.37, (28.69±1.49)%, respectively, P<0.05], while the percentage of G 0/G 1 phase cells [(64.45±3.56)%], apoptosis rate [(18.36±1.63)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17 group were higher than those of pcDNA group [(51.33±2.76) % and (5.21±0.54) %, respectively, P<0.05]. The viability [(72.64±5.44)%], the number of cell clones (78.16±8.23), the proportion of S-stage cells [(21.34±1.59) %], the protein expression levels of CyclinD1 and CDK2 in anti-miR-223-3p group were lower than those in anti-miR-con group [(103.47±6.25)%, 169.32±14.53, (28.43±1.26)%, respectively, P<0.05]. Percentage of G 0/G 1 phase cells [(62.86±3.28)%], apoptosis rate [(14.64±1.67)%], the protein expression levels of cleaved caspase-3 and Bax in the anti-miR-223-3p group were higher than those of anti-miR-con group [(51.33±2.71)% and (4.83±0.39)%, respectively, P<0.05]. MiR-223-3p has complementary sites with circDDX17 or RIP3. The viability [(135.45±9.28)%], the number of cell clones (174.64±10.68), the proportion of S-phase cells [(26.39±2.25)%], the protein expression levels of cyclinD1 and CDK2 in pcDNA-circDDX17+miR-223-3p group were higher than those in pcDNA-circDDX17+miR-con group [(101.56±6.68)%, 107.65±7.62, (21.64±1.72)%, P<0.05]. Percentage of G 0/G 1 phase cells [(56.64±2.76)%], apoptosis rate [(8.34±0.76)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17+miR-223-3p group were lower than those of pcDNA-circDDX17+miR-con group [(64.03±3.48)% and (15.21±1.18)%, respectively, P<0.05]. Conclusion:circDDX17 could inhibit the proliferation and induce apoptosis of non-small cell lung cancer cells via targeting the miR-223-3p / RIP3 molecular axis.

Objective:To explore the molecular mechanism of circDDX17 regulating the proliferation and apoptosis of non-small cell lung cancer cells by targeting the miR-223-3p/RIP3 molecular axis.Methods:The expression levels of circDDX17, miR-223-3p, and RIP3 in human normal lung epithelial cell lines BEAS-2B and non-small cell lung cancer cells H1299, A549, and H446 were detected by reverse transcription-quantitative real-time polymerase chain reaction (RT-qPCR). The plasmids of pcDNA, pcDNA-circDDX17, anti-miR-con, anti-miR-223-3p, pcDNA-circDDX17 and miR-con, pcDNA-circDDX17 and miR-223-3p mimics were transfected into H1299 cells. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay was used to detect the cell proliferation. Flow cytometry was used to detect the cell cycle and cell apoptosis. Plate cloning experiment was used to detect cell proliferation ability. The dual luciferase report experiment was applied to verify the targeting relationship between miR-223-3p with circDDX17 and RIP3. Western blot was used to detect the protein expression of cyclinD1, CDK2, cleaved caspase-3 and Bax.Results:The expression levels of circDDX17 and RIP3 mRNA in H1299, A549, and H446 cells were significantly reduced ( P<0.05), the expression level of miR-223-3p mRNA was significantly increased ( P<0.05) compared with BEAS-2B. The cell viability [(69.46±4.68)%], the number of cell clones (83.49±7.86), the proportion of cells in S phase [(22.52±1.41) %], the protein expression levels of cyclinD1 and CDK2 in PCDNa-CircDDX17 group were lower than those in pcDNA group [(97.54±7.72)%, 205.03±13.37, (28.69±1.49)%, respectively, P<0.05], while the percentage of G 0/G 1 phase cells [(64.45±3.56)%], apoptosis rate [(18.36±1.63)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17 group were higher than those of pcDNA group [(51.33±2.76) % and (5.21±0.54) %, respectively, P<0.05]. The viability [(72.64±5.44)%], the number of cell clones (78.16±8.23), the proportion of S-stage cells [(21.34±1.59) %], the protein expression levels of CyclinD1 and CDK2 in anti-miR-223-3p group were lower than those in anti-miR-con group [(103.47±6.25)%, 169.32±14.53, (28.43±1.26)%, respectively, P<0.05]. Percentage of G 0/G 1 phase cells [(62.86±3.28)%], apoptosis rate [(14.64±1.67)%], the protein expression levels of cleaved caspase-3 and Bax in the anti-miR-223-3p group were higher than those of anti-miR-con group [(51.33±2.71)% and (4.83±0.39)%, respectively, P<0.05]. MiR-223-3p has complementary sites with circDDX17 or RIP3. The viability [(135.45±9.28)%], the number of cell clones (174.64±10.68), the proportion of S-phase cells [(26.39±2.25)%], the protein expression levels of cyclinD1 and CDK2 in pcDNA-circDDX17+miR-223-3p group were higher than those in pcDNA-circDDX17+miR-con group [(101.56±6.68)%, 107.65±7.62, (21.64±1.72)%, P<0.05]. Percentage of G 0/G 1 phase cells [(56.64±2.76)%], apoptosis rate [(8.34±0.76)%], the protein expression levels of cleaved caspase-3 and Bax in pcDNA-circDDX17+miR-223-3p group were lower than those of pcDNA-circDDX17+miR-con group [(64.03±3.48)% and (15.21±1.18)%, respectively, P<0.05]. Conclusion:circDDX17 could inhibit the proliferation and induce apoptosis of non-small cell lung cancer cells via targeting the miR-223-3p / RIP3 molecular axis.

Objective:To discuss the perioperative management strategy of the HeartCon left ventricular assist device in the treatment of adult patients with end-stage heart failure and evaluate the effectiveness of blood pump.Methods:Ten consecutive patients with end-stage heart failure treated with the LVAD HeartCon at the Department of Cardiovascular Surgery, Jiangsu Province Hospital from July 2021 to July 2023 were enrolled in this study. The clinical data and follow-up results were retrospectively analyzed. Blood pump parameter, cardiac function classification, liver and kidney function, coagulation, myocardial markers, N-terminal pro-B-type natriuretic peptide, von Willebrand factor antigen, echocardiography, cardiothoracic ratio, and 6-minute walking distance test (6MWT) were evaluated before and after implantation of LVAD in 30, 60, 90, 180, 360, 540, and 720 days. EQ-5D-5L questionnaire was used to evaluate the quality of life.Results:There were 9 males and 1 female with a mean age of (53.7±9.7) years. All patients survived. Renal insufficiency occurred in 1 patient and recurrent aseptic granuloma occurred in 1 patient. There were no significant differences in aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), serum creatinine (Scr), blood urea nitrogen (BUN), right ventricular fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) between pre-operation and 30, 60 and 90 days post-operation( P>0.05). The levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), von Willbrand factor (vWF) antigen, left ventricular end-diastolic diameter (LVDd) and cardiothoracic ratio decreased significantly on the 30th, 60th and 90th day after operation ( P<0.05). The left ventricular ejection fraction (LVEF), 6MWT and EQ-5D-5L scores were significantly increased at 30, 60 and 90 days after operation compared with those before operation ( P<0.05). Conclusion:With the left ventricular assist device HeartCon, the cardiac function and quality of life of patients were significantly improved within 3 months after operation, and no serious complications were observed, proving that the device is safe and effective.

Objective:To evaluate the curative effect of arthroscopic long head of biceps tendon (LHBT) transfer to reconstruct shoulder superior capsule for repairing massive rotator cuff tears.Methods:A retrospective case-control study was conducted on clinical data of 64 patients with massive rotator cuff tears admitted to Shanghai Tenth People's Hospital of Tongji University between December 2017 to January 2019. There were 26 males and 38 females, with the age of 50-75 years [(62.5±4.8)years]. All patients were treated by arthroscopic superior capsular reconstruction with LHBT. The shoulder range of motion in flexion, abduction, external rotation, acromiohumeral distance, visual analogue scale (VAS), Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score were evaluated and recorded before operation and at the last follow-up. The MRI was used to evaluate the integrity of the reconstructed structure at the last follow-up and rotator cuff re-tear rate. Postoperative complications were detected.Results:All patients were followed up for 13-25 months [(18.2±4.3)months]. At the last follow-up, the shoulder range of motion was (149.5±7.8)° in flexion, (162.0±6.6)° in abduction, and (60.6±11.8)° in external rotation; the acromiohumeral distance was (7.4±0.6)cm, the VAS was 1.0(0.0, 1.0)points, the Constant-Murley score was (90.5±2.6)points, the ASES was (90.8±4.2)points, which were significantly improved compared with those before operation [flextion: (73.8±5.3)°, abduction: (85.8±5.5)°, external rotation: (34.3±5.8)°, acromiohumeral distance: (5.9±0.8)cm, VAS: 6.5(6.0, 7.0)points, Constant-Murley score: (41.8±5.4)points, ASES: (41.4±6.1)points, respectively]( P<0.01). of all, 56 patients had intact reconstruction structure at the last follow-up, 7 patient with smalll retears in the reconstruction were not revised, and 1 patient underwent revision operation after reconstruction failure. The retear rate after rotator cuff repair was 13% (8/64). There were no obvious surgical complications after operation, with the incision free from infection. Conclusion:Arthroscopic superior capsular reconstruction with LHBT for repairing massive rotator cuff is safe and reliable, which can effectively relieve the pain of shoulder joint, recover the function and improve the joint mobility.

Objective:To analyse clinical outcomes and risk factors of vascular crisis on patients received oral and maxillofacial defect repairations with free tissue flap.Methods:From January, 2013 to July, 2018, 1 049 patients with soft tissue defect of oral and maxillofacial were reconstructed with free tissue flap, in which 64 cases occurred vascular crisis. Among the cases, 28 defect were reconstructed with radial forearm free flap (RFFF), 19 with anterolateral thigh flap (ALTF), and 17 with fibula flap. All patients underwent surgical exploration. The clinical data and surgical outcomes were collected. The univariate analysis and multivariate regression analysis were performed by using SPSS version 22.0 software. The result was supposed to statistically significant when P<0.05. Results:Among 64 patients occurred vascular crisis, 44 flaps were rescued successfully by surgical procedures (68.8%). Univariate analysis revealed that the salvage rate was related to the smoking history, type of tissue flap, time of vascular crisis occurrence, cause of vascular crisis and the time interval between crisis occurrence and surgical exploration ( P<0.05). Multivariate regression analysis revealed that only type of tissue flap, the time of vascular crisis occurrence and the interval time were the independent significant factors for salvage rate ( P<0.05). Conclusion:The salvage rate became higher when the vascular crisis occurred earlier, and the interval time was shorter. The type of tissue flap could affect the outcome of surgical exploration. The success rate decreased with an order of RFFF, ALTF to fibula flaps. The primary principle in the management of vascular crisis was early identification and early surgical exploration.

Objective:To investigate the clinical effect of different surgical methods in the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ).Methods:A total of 20 cases of BRONJ who were treated for surgical treatment from January 2013 to March 2019 were included for the retrospective analysis in this study. There were 14 males and 6 females in this study. The average age of onset was 65.4 years, including 67.4 years for males and 60.7 years for females. There were 9 patients in stage 1, 7 in stage 2, 3 in stage 3, and 1 patient with maxillary lesions in stage 2 and mandibular lesions in stage 3. For patients in stage 1 or stage 2 who had poor systemic conditions and could not tolerate general anesthesia or surgical trauma. Different surgical treatments should be performed according to the results of imaging evaluation. If completely dead bones were formed locally, sequestrectomy under local anesthesia was performed. For patients whose dead bones were not completely separated, partial jaw resection was performed. For stage 3 BRONJ patients with severe symptoms occurring in the mandible, such as the formation of intraoral and external fistulas, pathological fractures, or lesions involving the lower margin of the mandible, segmental osteotomy was usually performed when general conditions were stable.Results:Of the 20 patients, 6 cases (including 1 patient with lesions involving both maxilla and mandible) underwent sequestrectomy, 11 cases partial jaw resection and 4(including 1 patient with lesions involving both maxilla and mandible) mandibular segmental osteotomy. The patients were followed up for 1-67 months (mean 32.8 months). All the patients who underwent mandibular segmental osteotomy were recovered well and discharged. 6 patients were clinically asymptomatic after partial jawbone resection. The symptoms of the rest of the patients were alleviated, showing relieved pain, disappeared dead bone and so on, while the course of disease was significantly slowed down.Conclusions:Sequestrectomy and partial jaw resection can relieve symptoms and improve quality of life of patients, so that some patients can achieve clinical cure. Mandibular segmental osteotomy as a more effective treatment method, can be considered as the preferred treatment for stage 3 patients with lesions in the mandible and with good systemic condition.

Objective:To investigate the effect of mini-retromandibular and transparotid approach in open reduction and internal fixation of middle or low condylar fractures.Methods:A total of 28 condylar fracture cases which were treated with mini-retromandibular approach from January 2016 to January 2019 in Nanjing Stomatological Hospital were included in this study. These cases included 18 males and 10 females with ameanage of 42.5 years. There were 11 cases of left condyle fractures, 13 cases of right condyle fractures and 4 of bilateral condyle fractures. During the operations, incisions of 2-3 cm long were made on the skin and subcutaneous tissue along the posterior margin of the mandible. Then we performed blunt dissections parallel to the facial nerves, directly passing through the parotid gland and masseter muscles, without the facial nerve injuried. After exposing the fracture line, the fracture ends were fixed and restored with two 4-hole titanium miniplates under direct vision.The medical reviews were performed on the third day and 3-6 months after operation by imaging examination and clinical examination. The contents included: postoperative hematoma, postoperative infection, nerve injury, salivary fistula, maximum mouth opening degree, mouth opening type, occlusal relationship, scar condition, etc.Results:All of the 28 patients had good restoration of fracture ends without nerve injury, salivary fistula or other complications. Only one patient suffered with postoperative infection. After 3 months, titanium miniplate was removed by second operation. The mouth opening of patients ranged 1.5-3.8 cm, with an average of 3.1 cm, which was significantly improved compared to the pre-operation (0.5-2.0 cm, average 1.2 cm). One patient’s chin was slightly deviated to the affected side at the time of opening, and the occlusal relationship was recovered well with intermaxillary elastic traction for 3-5 days.The mouth opening type of other patients was nearly normal. Followed up for 6-36 months, all of the patients had no obvious scars after operation.The patients were satisfied with the operation effect. All patients took postoperative CT and 3D reconstruction 3 to 6 months after operation, which showed that the fracture reduction was good.Conclusions:Mini-retromandibular and transparotid approach is effective, simple, efficient and fast in the treatment of condylar middle or low fracture, without facial nerve dissection. It can not only reduce the operation time and the possibility of facial nerve injury, but also make postoperative scar relatively inconspicuous.

Objective:To investigate the clinical effect of different surgical methods in the treatment of bisphosphonate-related osteonecrosis of the jaw (BRONJ).Methods:A total of 20 cases of BRONJ who were treated for surgical treatment from January 2013 to March 2019 were included for the retrospective analysis in this study. There were 14 males and 6 females in this study. The average age of onset was 65.4 years, including 67.4 years for males and 60.7 years for females. There were 9 patients in stage 1, 7 in stage 2, 3 in stage 3, and 1 patient with maxillary lesions in stage 2 and mandibular lesions in stage 3. For patients in stage 1 or stage 2 who had poor systemic conditions and could not tolerate general anesthesia or surgical trauma. Different surgical treatments should be performed according to the results of imaging evaluation. If completely dead bones were formed locally, sequestrectomy under local anesthesia was performed. For patients whose dead bones were not completely separated, partial jaw resection was performed. For stage 3 BRONJ patients with severe symptoms occurring in the mandible, such as the formation of intraoral and external fistulas, pathological fractures, or lesions involving the lower margin of the mandible, segmental osteotomy was usually performed when general conditions were stable.Results:Of the 20 patients, 6 cases (including 1 patient with lesions involving both maxilla and mandible) underwent sequestrectomy, 11 cases partial jaw resection and 4(including 1 patient with lesions involving both maxilla and mandible) mandibular segmental osteotomy. The patients were followed up for 1-67 months (mean 32.8 months). All the patients who underwent mandibular segmental osteotomy were recovered well and discharged. 6 patients were clinically asymptomatic after partial jawbone resection. The symptoms of the rest of the patients were alleviated, showing relieved pain, disappeared dead bone and so on, while the course of disease was significantly slowed down.Conclusions:Sequestrectomy and partial jaw resection can relieve symptoms and improve quality of life of patients, so that some patients can achieve clinical cure. Mandibular segmental osteotomy as a more effective treatment method, can be considered as the preferred treatment for stage 3 patients with lesions in the mandible and with good systemic condition.

Objective:To investigate the effect of mini-retromandibular and transparotid approach in open reduction and internal fixation of middle or low condylar fractures.Methods:A total of 28 condylar fracture cases which were treated with mini-retromandibular approach from January 2016 to January 2019 in Nanjing Stomatological Hospital were included in this study. These cases included 18 males and 10 females with ameanage of 42.5 years. There were 11 cases of left condyle fractures, 13 cases of right condyle fractures and 4 of bilateral condyle fractures. During the operations, incisions of 2-3 cm long were made on the skin and subcutaneous tissue along the posterior margin of the mandible. Then we performed blunt dissections parallel to the facial nerves, directly passing through the parotid gland and masseter muscles, without the facial nerve injuried. After exposing the fracture line, the fracture ends were fixed and restored with two 4-hole titanium miniplates under direct vision.The medical reviews were performed on the third day and 3-6 months after operation by imaging examination and clinical examination. The contents included: postoperative hematoma, postoperative infection, nerve injury, salivary fistula, maximum mouth opening degree, mouth opening type, occlusal relationship, scar condition, etc.Results:All of the 28 patients had good restoration of fracture ends without nerve injury, salivary fistula or other complications. Only one patient suffered with postoperative infection. After 3 months, titanium miniplate was removed by second operation. The mouth opening of patients ranged 1.5-3.8 cm, with an average of 3.1 cm, which was significantly improved compared to the pre-operation (0.5-2.0 cm, average 1.2 cm). One patient’s chin was slightly deviated to the affected side at the time of opening, and the occlusal relationship was recovered well with intermaxillary elastic traction for 3-5 days.The mouth opening type of other patients was nearly normal. Followed up for 6-36 months, all of the patients had no obvious scars after operation.The patients were satisfied with the operation effect. All patients took postoperative CT and 3D reconstruction 3 to 6 months after operation, which showed that the fracture reduction was good.Conclusions:Mini-retromandibular and transparotid approach is effective, simple, efficient and fast in the treatment of condylar middle or low fracture, without facial nerve dissection. It can not only reduce the operation time and the possibility of facial nerve injury, but also make postoperative scar relatively inconspicuous.