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

Objective    To summarize the experience of robot-assisted lung basal segmentectomy, and analyze the clinical application value of intersegmental tunneling and pulmonary ligament approach for S9 and/or S10 segmentectomy. Methods    The clinical data of 78 patients who underwent robotic lung basal segmentectomy in our hospital between January 2020 to May 2022 were retrospectively reviewed. There were 32 males and 46 females with a median age of 50 (33-72) years. The patients who underwent S9 and/or S10 segmentectomy were divided into a single-direction group (pulmonary ligament approach, n=19) and a bi-direction group (intersegmental tunneling, n=19) according to different approaches, and the perioperative outcomes between the two groups were compared. Results    All patients successfully completed the operation, without conversion to thoracotomy and lobectomy, serious complications, or perioperative death. The median operation time was 100 (40-185) min, the blood loss was 50 (10-210) mL, and the median number of dissected lymph nodes was 3 (1-14). There were 4 (5.1%) patients with postoperative air leakage, and 4 (5.1%) patients with hydropneumothorax. No patient showed localized atelectasis or lung congestion at 6 months after the operation. Further analysis showed that there was no significant difference in the operation time, blood loss, thoracic drainage time, complications or postoperative hospital stay between the single-direction and bi-direction groups (P>0.05). However, the number of dissected lymph nodes of the bi-direction group was more than that of the single-direction group [6 (1-13) vs. 5 (1-9), P=0.040]. Conclusion    The robotic lung basal segmentectomy for pulmonary nodules is safe and effective. The  perioperative results of robotic S9 and/or S10 complex segmentectomy using intersegmental tunneling and pulmonary ligament approach are similar.

Advances in surgical techniques and internal fixation materials have been continuously improving treatment of intertrochanteric fractures, but postoperative failure of internal fixation is inevitable and its causes are still controversial. An advanced age, female and severe osteoporosis are believed to lead to an unstable fracture and a fall more likely, increasing the risk for failure of internal fixation. Unstable intertrochanteric fractures such as comminuted fracture of medial femur, basicervical fracture, reverse intertrochanteric fracture and lateral wall fracture are more likely to lead to internal fixation failure. Non-anatomical reduction, improper insertion point and poor position of a lag screw are also prone to internal fixation failure. Extramedullary fixation for unstable fractures may increase the risk of failure. Long waiting time for surgery, late weight-bearing and infection may also increase the risk of failure. Therefore, it is still crucial for a successful treatment to clarify the specific risk factors for internal fixation failure and make corresponding countermeasures to enhance the success rate of a primary operation. This paper summarizes the risk factors for postoperative failure of internal fixation for intertrochanteric fracture so as to provide guidance for clinical treatment.

Objective: To observe the effect of applying electro-acupuncture to the governor vessel on the expression of proteins in the MAPK/ERK1/2 signaling pathway. Methods: Sixty-four female C57BL/6 mice were randomly divided into a sham group, a spinal cord injured (SCI) group, an acupuncture (AP) group and an electro-acupuncture (EA) group. An SCI model was induced in all of the rats except those in the sham group. The sham and SCI groups were not given any special treatment, while the AP and EA groups were treated with conventional or electro-acupuncture applied to the Dazhui (DU14) and Mingmen (DU4) acupoints in the governor vessel beginning on the day following the operation. The electrical stimulation was in dense-disperse waves at 2/100Hz frequency and 0.2mA intensity, lasted for 15 minutes daily, 5 days a week for 4 weeks . The expression of myelin basic protein (MBP), the phosphorylation of extracellular signal-regulated kinase (ERK)1/2 and the phosphorylation of protein kinase B (Akt) in the injured volume were determined using immunofluorescence and western blotting on the 3rd, 7th, 14th and 28th days after the modeling. Results: Compared with the SCI group, p-ERK1/2 expression was greatly enhanced in the EA group on the 3rd, 14th and 28th days. It was also significantly enhanced in the AP group by the 28th day. Compared with the AP group, the average p-ERK1/2 expression in the EA group was significantly enhanced on the 3rd and 14th days. Compared with the SCI group, the average p-Akt of the EA group was significantly enhanced on the 14th and 28th days. The average p-Akt of the AP group had decreased significantly on the 3rd day. Compared with the SCI group, the average expression of MBP in the EA group was enhanced significantly on the 3rd, 7th and 14th days and the AP group′s average was significantly greater on the 3rd and 7th days. Conclusion Electro-acupuncture can promote the expression of MBP, the phosphorylation of ERK1/2 and the phosphorylation of Akt after spinal cord injury.

Objective:To establish a hypergravity loading model with a high-acceleration centrifugal loading device and to investigate the effects of different hypergravity loading and icariin on osteoblast adhesion and cytoskeleton.Methods:MC3T3-E1 cells were seeded in the dishes of cell culture at a density of 2×10 5/cm 2. And the experiment was divided into 6 groups: control group (without icariin and loading); simple administration group (only icariin); 10 G loading group (only loading); 10 G administration group (with icariin and loading); 40 G loading group (only loading); 40 G administration group (with icariin and loading). The experimental loading group was loaded with MC3T3-E1 cells using a high-acceleration centrifugal loader. And continuous loading for 3 d, 30 min per d. The control group and the simple administration group were exposed to normal gravity, and the remaining conditions were not different from the experimental group. Icariin was used at a concentration of 10 -7 mol/L in all administration groups, and the experiments were carried out according to the method of preventive administration. At the same time, the related molecular biological techniques such as alizarin red staining, alkaline phosphatase (ALP) activity measurement, CCK-8 cell proliferation experiment, cytoskeleton phalloidin staining, qPCR and Western Blot were used to detect the effects of icariin on osteoblasts adhesion protein integrin α5 and integrin β1 and cytoskeleton protein F-actin under hypergravity extreme mechanical environment. Results:All models were successfully prepared. The alizarin red staining: The icariin could significantly promote the formation of osteoblastic calcified nodules. And the 10 G loading could also promote the mineralization of osteoblasts and increase the number of mineralized nodules, while the mineralization and the number of mineralized nodules of osteoblasts are significantly reduced in 40 G loading. ALP activity test: The OD values of simple administration group, 10 G loading group and 40 G loading group were 0.246, 0.331 and 0.163, respectively. Compared with 0.207 in the control group, the differences were statistically significant ( P<0.05). The 10 G administration group and the 40 G administration group were 0.373 and 0.180, and the differences were statistically significant ( P<0.05). The results of CCK-8 proliferation experiments: The OD value of simple administration group were 0.650, which was statistically significant compared with 0.551 of control group ( P=0.031). The 10 G loading group and 40 G loading group were 1.193 and 0.245, and their differences with the control group were both statistically significant ( P<0.05). The OD value of 10G administration group and the 40 G administration group were 1.300 and 0.310, which were significantly different from the respective loading groups ( P<0.05). Phalloidin staining: 10 G loading significantly increased the number of cells, but the changes in cells morphology and skeleton were not obvious. 40 G loading significantly inhibited the increase of the number of cells, meanwhile, made the pseudopods of cells more shorter and even disappeared. 40 G loading made the seriously damage of the cytoskeleton and even cause the cells to death. Icariin had no effect on the cells morphology, but it did has a certain repair effect after the cells loading. The results of qPCR and Western Blot experiments all confirmed that the expressions of integrin α5, integrin β1 and F-actin were up-regulated after icariin treatment. 10 G loading could promote the expression of integrin α5, integrin β1 and F-actin, and 40 G loading significantly inhibited the expression of the mRNA and proteins. Conclusion:Both 10 G condition and icariin can promote the development, cell adhesion and the cytoskeleton's stability of osteoblasts, while 40 G has a significant inhibitory effect.

Objective To evaluate the relationship between the change rate of regional cerebral ox-ygen saturation ( rSO2 ) and early postoperative cognitive function during laparoscopic surgery in elderly pa-tients. Methods Fifty American Society of Anesthesiologists physical status Ⅰ-Ⅱ patients, aged 65-80 yr, scheduled for elective laparoscopic radical resection for colorectal cancer under general anesthesia, were enrolled in this study. rSO2 was recorded at 5 min before anesthesia induction ( T0 ) , 5 min after tra-cheal intubation ( T1 ) , 5 min after changing position ( T2 ) , 1 h after changing position ( T3 ) , 5 min after stopping pneumoperitoneum ( T4 ) , and 5 min after changing to supine position at the end of pneumoperito-neum ( T5 ) . The change rate of rSO2 was calculated at T3 . Mini-Mental State Examination scores were per-formed at 1 day before surgery and 3 days after surgery. The patients were divided into cognitive disorder group and non-cognitive disorder group. Results Compared with non-cognitive disorder group, rSO2 was significantly increased at T2-5 , and the change rate of rSO2 was enlarged in cognitive disorder group ( P<0. 05) . The change rate of intraoperative rSO2 was negatively correlated with Mini-Mental State Examination scores at 3 days after surgery (r=-0. 516, P<0. 01). Conclusion The increased change rate of rSO2 during laparoscopic surgery may be related to the development of early postoperative cognitive dysfunction in elderly patients.

Objective To investigate the feasibility and clinical effect of percutaneous pedicle screw fixation in the treatment of ankylosing spondylitis (AS) with thoracolumbar fractures.Methods A retrospective case-series study was performed on 12 AS patients with thoracolumbar fractures admitted from January 2013 to January 2016.There were 9 males and 3 females,aged (42.7 ± 13.0) years (range,24-63 years).All patients received percutaneous minimally invasive pedicle screw fixation.The operation duration,intraoperative blood loss,length of incision,ambulation time,and time to basic life were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated before and after operation.Postoperative complications and bone fracture union were observed during the followup period.Results All patients were followed up for average 22 months (range,14-36 months).All patients underwent successful surgery,with operation duration and intraoperative blood loss of (178.0 ± 60.2) min and (116.7 ± 44.2) ml respectively.No serious complications such as blood vessel or nerve injury occurred during the operation.The incision length was 1.2-1.5 cm.All the patients were able to do exercise with the help of brace 2-3 days after the operation and returned to basic life after (23.4 ± 7.3)days postoperatively.At 1,3,6 and 12 months after operation,VAS and ODI differed significantly from the preoperative detections (P ＜ 0.05).During the follow-up,bone fracture union was observed in all patients,with no nail breakage or nail loosening occurred after operation.Conclusion For AS combined with thoracolumbar fractures,minimally invasive fixation can attain satisfactory curative effect,with advantages of minor lesion,little bleeding,fast recovery and sound bone union.

Background and objective Epidermal growth factor receptor (EGFR) and KRAS gene are important driver genes of non-small cell lung cancer (NSCLC).The studies are mainly focused on detection ofEGFR gene for advanced NSCLC,and the mutation feature of EGFR and KRAS gene in early NSCLC tissue is unknown.This study aims to investigate the mutations of EGFR and KRAS gene in NSCLC,and the relationship between the genotype and clinicopathologic features.Methods The hotspot mutations in EGFR and KRAS gene in 754 tissue samples of stage Ⅰ-Ⅲa NSCLC from Department of Pathology,Peking Union Medical College Hospital were detected by modified amplification refractory mutation system (ARMS) real-time PCR kit,and analyzed their correlation with clinical variables.Results The hotspot mutation rates in EGFR and KRAS were 34.5％ and 13.1％ respectively,and there were EGFR-KRAS double mutations in 3 samples.The mutation rate of EGFR was higher in females than that in males (39.5％ vs 29.4％,P=0.076),significantly increased in adenocarcinomas (38.7％) compared to that in the other forms of NSCLC (P＜0.01),but still lower than that reported in some Asian studies of advanced adenocarcinoma (-50％).Meanwhile,the mutation rate of KRAS was remarkably higher in males than that in females (16.6％ vs 9％,P=0.048),increased in adenocarcinomas compared to that in the other forms of NSCLC,but the difference was not significant (P=0.268).Samples harbored EGFR mutation were younger than those harbored KRAS mutation (P=0.031,5),and had significant difference in gender between the two groups (P＜0.01).Conclusion The mutation rate of EGFR in stag Ⅰ-Ⅲa NSCLC patients was lower than that in advanced NSCLC patients.And the percentage of the NSCLC patients with EGFRKRAS double mutations is 0.9％.

Objective To evaluate the effect of 6% hydroxyethyl starch 130∕0. 4 on acute kidney injury in elderly patients in a prospective, multicenter, randomized, double?blind, controlled clinical tri?al. Methods A total of 120 patients of both sexes, aged 65-82 yr, weighing 56-83 kg, of American So?ciety of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective orthopaedics and hernia surgery, were divided into either hydroxyethyl starch group ( group HES) or lactated Ringer′s solution group ( group LR) , with 60 patients in each group. Hydroxyethyl starch and lactated Ringer′s solution were infused intra?venously at a rate of 7. 5 ml∕kg during 1st hour of surgery in HES and LR groups, respectively. Lactated Ringer′s solution was then infused at a rate of 5 ml∕kg starting from 2nd hour of surgery until the end of sur?gery in both groups. Before surgery, at the end of surgery and at 1, 3 and 5 days after surgery, blood sam?ples and urine specimens were collected for determination of the concentrations of neutrophil gelatinase?asso?ciated lipocalin, interleukin?18 (IL?18), plasma creatinine, urine β2 microglobulin and urine albumin.
The estimated glomerular filtration rate was calculated. Results The level of urine IL?18 was significantly higher at each time point after surgery than before surgery and immediately after the end of surgery ( P<0.05) . There were no significant differences between the two groups in the levels of urine IL?18, plasma creatinine, plasma and urine neutrophil gelatinase?associated lipocalin, plasma IL?18, urineβ2 microglob?ulin and urine albumin and estimated glomerular filtration rate at each time point ( P>0.05) . Conclusion Compared with lactated Ringer′s solution, 6% hydroxyethyl starch 130∕0.4 does not aggravate acute kidney injury in elderly patients.

Objective To evaluate the curative effects of percutaneous osteoperiosteal decortication combined with distraction osteogenesis for treatment of nonunion of lower-extremity bones.Methods A retrospective analysis was performed of the 32 patients who had been treated using osteoperiosteal decortication combined with distraction osteogenesis from September 2011 to December 2014 for nonunion of lower-extremity fractures.They were 23 males and 9 females,with a mean age of 33.4 years (range,from 15 to 62 years).After their former internal or external fixators were removed,the 2 fracture ends were fixated by a retractile mono-lateral or circular external fixator.Under radiographic monitoring,a percutaneous incision was made with a 5 mm sharp chisel,down to the bone.Scar and ossified tissue between the fracture ends were debrided and cut along the fracture line.Mter the marrow cavity was reamed,a new irregular wound was created at sclerotic fracture ends.Scale-shaped chips (1 mm thin and 5 mm in diameter) were elevated using a chisel on surface of the cortical bone within 2 cm from the fracture ends.The external fixators were adjusted to compress the fracture sites.On the 8th day after operation,the eternal fixators were applied to distract and compress at nonunion sites to stimulate the osteogenesis.Results All the patients were followed up for an average of 12.5 months (range,from 8 to 42 months).Primary union was successfully achieved in 28 patients while delayed union occurred in 3 patients who finally achieved union after adjuvant therapies like shock wave and or local injection of bone marrow blood.The average time for union was 4.6 months(range,from 4 to 7 months).The mean time for external fixation was 6.2 months (range,from 5 to 8 months).One patient encountered nonunion of lateral tibial cortical bone 6 months after surgery but eventually achieved union by autologous ilium grafting.Joint functions in all postoperative patients were similar to those before operation.Conclusion Percutaneous osteoperiosteal decortication combined with distraction osteogenesis is a simple,minimally invasive and effective treatment for nonunion of lower-extremity bones,avoiding disadvantages brought by traditional surgery,like massive trauma and excessive bleeding.