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Abstract Background Traumatic tibial defect complicated with soft tissue defect is a difficult problem in clinic. Vascularized iliac crest bone flap (VIBF) and Ilizarov bone transport are effective methods to treat tibial defects with limited defect length, which most need to be explored accordingly. Methods In this study, a total of 68 patients with traumatic tibial defect (ranging from 4 to 10 cm) and large soft tissue defect were collected retrospectively. The soft tissue defects were repaired by latissimus dorsal musculocutaneous flap (LD), anterolateral thigh flap (ALTF) or both. Thirty-three cases were treated with vascularized iliac crest bone flap transplantation and 35 cases were treated with Ilizarov bone transport. Intraoperative and postoperative follow-up data (including operation time, blood loss, bone union time, external fixation time, external fixation index, complication rate, reoperation rate, and functional evaluation) were recorded, and comparative analysis was performed. Results The median follow-up time was 32 months. Compared with Ilizarov group, the VIBF group exhibited statistically faster bone union time (6.3 ± 1.0 vs. 18.2 ± 3.0 months). Moreover, the VIBF group showed shorter EFT (7.3 ± 1.0 vs. 19.2 ± 3.0 months) and a better EFI (34.8 ± 9.2 vs. 84.2 ± 23.7 days/cm). The excellent and good rate of lower limb appearance evaluation in VIBP group was significantly better than that in Ilizarov group. The complication rate and reoperation rate were significantly higher in Ilizarov group. Conclusion In summary, compared with Ilizarov bone transport, VIBP has the advantages of faster healing, shorter external fixation time, lower complication and reoperation rate, and better appearance within the limited defect length. Ilizarov bone transport is still preferred when the defect length exceeds the maximum repair length of the iliac flap. The daily handling required by bone transport process is painful. Level of evidence III, Case–control study.

BackgroundLegg–Calvé–Perthes disease (LCPD) is a juvenile form of ischemic femoral head osteonecrosis affecting children. The lack of effective and timely treatment results in severe sequelae in children (especially older ones). Although LCPD has been widely studied, little is known about its etiology. As a result, its clinical management is still challenging. This study will investigate the clinical and radiological results of patients older than 6 years and treated with pedicled iliac bone flap grafting for LCPD.Materials and methodsA total of 13 patients (13 hips) with late presentation of LCPD were treated with pedicled iliac bone flap grafting. Of the 13 patients, 11 were male and 2 were female. The average age of the patients was 8.4 years (range 6–13). Preoperational radiographs and pain scores were analyzed for lateral pillar classification and the Oucher scale. The final follow-up radiograph was classified using a modified Stulberg classification. Limping, extremity length inequality, and range of motion were clinically assessed.ResultsThe average follow-up of the patients was 70 months (range 46–120). During the surgery, seven hips were found to be lateral pillar grade B, two were grade B/C, and four were grade C. In the final examination, 12 hips were evaluated as good (Stulberg class I or II) and one as medium (Stulberg class III). There was limb shortening in one patient who was Stulberg class III. There was a significant difference between the preoperational and postoperational radiographic values and the Ocher scale, regardless of the surgical staging (P

Background: Uterine endometrial cancer (UEC) is a common gynecological estrogen‐dependent carcinoma, usually accompanied by intermenstrual bleeding. Active heme metabolism frequently plays an increasingly important role in many diseases, especially in cancers. Tumor‐associated macrophages (TAMs) are the major population in the immune microenvironment of UEC. However, the roles of heme metabolisms in the crosstalk between UEC cells (UECCs) and macrophages are unclear. Materials and Methods: In our study, by using TCGA database analysis, integration analysis of the protein–protein interaction (PPI) network and sample RNA transcriptome sequencing were done. The expression level of both heme‐associated molecules and iron metabolism‐related molecules were measured by quantitative real‐time polymerase chain reaction. Heme level detection was done through dehydrohorseradish peroxidase assay. In addition to immunohistochemistry, phagocytosis assay of macrophages, immunofluorescence staining, intracellular ferrous iron staining, as well as enzyme‐linked immune sorbent assay were performed. Results: In the study, we verified that heme accumulation in UECCs is apparently higher than in endometrial epithelium cells. Low expression of succinate dehydrogenase B under the regulation of estrogen contributes to over‐production of succinate and heme accumulation in UECC. More importantly, excessive heme in UECCs impaired macrophage phagocytosis by regulation of CD36. Mechanistically, this process is dependent on toll‐like receptor (TLR4)/type I interferons alpha (IFN Iα) regulatory axis in macrophage. Conclusion: Collectively, these findings elucidate that active heme metabolism of UECCs directly decreases phagocytosis by controlling the secretion of TLR4‐mediated IFN Iα and the expression of CD36, and further contributing to the immune escape of UEC. [ABSTRACT FROM AUTHOR]

In this paper, a three-dimensional numerical simulation model is established based on smooth particle hydrodynamics (SPH) method. In this model, the dynamic behavior of debris flow is described by using the Bingham fluid model, and the bridge pier is regarded as the terrain condition. The repulsive force at the boundary is introduced to improve the boundary condition. Based on flume experiments, the accumulation processes of debris flow impacting the bridge pier with various viscosities and characteristics of the impact force-time curves are analyzed. The physical models are established, and the simulation of three-dimensional dynamic evolution processes of debris flow impacting the bridge pier with various rheological parameters and weights are realized. Moreover, the simulation results of the accumulation processes of debris flow with various rheological parameters and the impact force-time curves are analyzed. It is found that there are differences between the simulation results and the experimental results of the dynamic evolution processes of low-viscous debris flow impacting the bridge pier. From the view of fluid mechanics, the primary reason lies in the ignorance of the energy dissipation owing to lack of a description of Reynolds stresses caused by turbulence. Besides, the bridge pier safeguard procedures under the impact of debris flow with various viscosities are discussed. This work provides a theoretical support for further optimization of the three-dimensional numerical calculation model of debris flow impacting the bridge pier.