Anterolateral thigh free-flap reconstruction remains an important limb-salvage option for patients with diabetic foot ulcers,particularly when complex soft-tissue defects,infection,or exposed deep structures preclude ...Anterolateral thigh free-flap reconstruction remains an important limb-salvage option for patients with diabetic foot ulcers,particularly when complex soft-tissue defects,infection,or exposed deep structures preclude simpler reconstructive approaches.However,intraoperative perfusion insufficiency continues to limit flap reliability and may compromise wound healing,flap survival,and long-term limb salvage.In this setting,flap perfusion should not be regarded as a purely technical consequence of microsurgical anastomosis but rather as the product of a systemic-regional-microcirculatory continuum shaped by distal vascular capacity,diabetes-related microvascular dysfunction,and modifiable host factors.This review summarizes current advances in intraoperative perfusion assessment for anterolateral thigh flap reconstruction in diabetic foot ulcer,with particular emphasis on indocyanine green fluorescence angiography(ICG-FA).We highlight the limitations of relying on static fluorescence intensity alone and argue that quantitative fluorescence-time curve metrics,including wash-in slope,time to maximum intensity,and area under the curve,may provide more robust and reproducible information for intraoperative decision-making.Because diabetes-associated medial arterial calcification and microvascular impairment can confound perfusion interpretation,ICG-FA should be integrated with complementary measures such as toe pressureoe-brachial index,skin perfusion pressure,and transcutaneous oxygen tension rather than used as a stand-alone tool.We further discuss the importance of preoperative and perioperative optimization of modifiable systemic factors,including glycemic control,anemia,oxygenation and ventilation,and nutritional reserve,all of which influence tissue oxygen delivery and flap viability.Finally,we propose a quantitative,multimodal clinical framework that links preoperative vascular assessment,standardized intraoperative perfusion imaging,and structured postoperative monitoring to clinically meaningful outcomes.Future priorities include harmonization of ICG-FA acquisition and reporting protocols,prospective multicenter validation,and development of registry-based prediction models to improve reproducibility,risk stratification,and implementation of evidence-based limb-salvage strategies in diabetic foot reconstruction.展开更多
Because of the continuous improvement of the quality of life,the population of gout patients is also increasing,which seriously affects the quality of life of patients.Traditional Chinese medicine compound has a long ...Because of the continuous improvement of the quality of life,the population of gout patients is also increasing,which seriously affects the quality of life of patients.Traditional Chinese medicine compound has a long history and remarkable clinical effect in treating gout patients,and has been widely used.Intestinal flora and its metabolites are the focus of current research,which can promote intestinal mucosal barrier,improve immunity and improve metabolism.The regulation of intestinal flora can reduce serum uric acid and inhibit inflammation to fight gouty arthritis.Moreover,the mechanism of intestinal flora is related to the spleen in Chinese medicine theory.Therefore,this study discusses the research mechanism and clinical application of traditional Chinese medicine compound in treating gout by regulating intestinal flora,and provides theoretical basis for the clinical application of traditional Chinese medicine and the expansion of new dosage forms.展开更多
Research on treating knee osteoarthritis(KOA)is becoming more challenging due to a growing number of younger patients being affected.The pathogenesis of KOA is complex for being a multifactorial disease affecting the ...Research on treating knee osteoarthritis(KOA)is becoming more challenging due to a growing number of younger patients being affected.The pathogenesis of KOA is complex for being a multifactorial disease affecting the entire joint,with remodeling of subchondral bone playing a key role in the degeneration of the overlying cartilage.Therefore,this study constructed a bipedal postmenopausal KOA mouse model to better understand how the interplay between subchondral bone remodeling and cartilage degeneration contributes to KOA development.A single-cell atlas of the osteochondral composite tissue was established.Furthermore,three novel subtypes of chondrocytes,including Smoc2+angiogenic chondrocytes,Angptl7+angiogenic chondrocytes,and Col1a1+osteogenic chondrocytes,were identified in femoral condyles of KOA mice.In addition,the Angptl7+chondrocytes promoted angiogenesis in the subchondral bone of KOA mice by interacting with endothelial cells via the FGF2-FGFR2 signaling pathway.The number of H-type vessels was increased in the subchondral bone,recruiting osteoprogenitor cells and facilitating osteogenesis in KOA mice.Sparc+osteoblasts have negatively regulated bone mineralization and osteoblastic differentiation,aggravated the pathological remodeling of subchondral bone,and promoted the progression of KOA.The above findings have offered new targets and opened up an avenue for the therapeutic intervention of KOA.展开更多
基金Supported by the 2023 Henan Provincial Medical Science and Technology Research Program(Joint Co-Construction Project),No.LHGJ20230409.
摘要Anterolateral thigh free-flap reconstruction remains an important limb-salvage option for patients with diabetic foot ulcers,particularly when complex soft-tissue defects,infection,or exposed deep structures preclude simpler reconstructive approaches.However,intraoperative perfusion insufficiency continues to limit flap reliability and may compromise wound healing,flap survival,and long-term limb salvage.In this setting,flap perfusion should not be regarded as a purely technical consequence of microsurgical anastomosis but rather as the product of a systemic-regional-microcirculatory continuum shaped by distal vascular capacity,diabetes-related microvascular dysfunction,and modifiable host factors.This review summarizes current advances in intraoperative perfusion assessment for anterolateral thigh flap reconstruction in diabetic foot ulcer,with particular emphasis on indocyanine green fluorescence angiography(ICG-FA).We highlight the limitations of relying on static fluorescence intensity alone and argue that quantitative fluorescence-time curve metrics,including wash-in slope,time to maximum intensity,and area under the curve,may provide more robust and reproducible information for intraoperative decision-making.Because diabetes-associated medial arterial calcification and microvascular impairment can confound perfusion interpretation,ICG-FA should be integrated with complementary measures such as toe pressureoe-brachial index,skin perfusion pressure,and transcutaneous oxygen tension rather than used as a stand-alone tool.We further discuss the importance of preoperative and perioperative optimization of modifiable systemic factors,including glycemic control,anemia,oxygenation and ventilation,and nutritional reserve,all of which influence tissue oxygen delivery and flap viability.Finally,we propose a quantitative,multimodal clinical framework that links preoperative vascular assessment,standardized intraoperative perfusion imaging,and structured postoperative monitoring to clinically meaningful outcomes.Future priorities include harmonization of ICG-FA acquisition and reporting protocols,prospective multicenter validation,and development of registry-based prediction models to improve reproducibility,risk stratification,and implementation of evidence-based limb-salvage strategies in diabetic foot reconstruction.
摘要Because of the continuous improvement of the quality of life,the population of gout patients is also increasing,which seriously affects the quality of life of patients.Traditional Chinese medicine compound has a long history and remarkable clinical effect in treating gout patients,and has been widely used.Intestinal flora and its metabolites are the focus of current research,which can promote intestinal mucosal barrier,improve immunity and improve metabolism.The regulation of intestinal flora can reduce serum uric acid and inhibit inflammation to fight gouty arthritis.Moreover,the mechanism of intestinal flora is related to the spleen in Chinese medicine theory.Therefore,this study discusses the research mechanism and clinical application of traditional Chinese medicine compound in treating gout by regulating intestinal flora,and provides theoretical basis for the clinical application of traditional Chinese medicine and the expansion of new dosage forms.
基金jointly supported by the National Key Research and Development Program of China(2023YFB4606700)National Natural Science Foundation of China(82272561,82402869)+1 种基金the Sichuan Science and Technology Program(23ZDYF2641,2024NSFSC0002)the“1.3.5”Project for Disciplines of Excellence,West China Hospital,Sichuan University(ZYGD23037).
摘要Research on treating knee osteoarthritis(KOA)is becoming more challenging due to a growing number of younger patients being affected.The pathogenesis of KOA is complex for being a multifactorial disease affecting the entire joint,with remodeling of subchondral bone playing a key role in the degeneration of the overlying cartilage.Therefore,this study constructed a bipedal postmenopausal KOA mouse model to better understand how the interplay between subchondral bone remodeling and cartilage degeneration contributes to KOA development.A single-cell atlas of the osteochondral composite tissue was established.Furthermore,three novel subtypes of chondrocytes,including Smoc2+angiogenic chondrocytes,Angptl7+angiogenic chondrocytes,and Col1a1+osteogenic chondrocytes,were identified in femoral condyles of KOA mice.In addition,the Angptl7+chondrocytes promoted angiogenesis in the subchondral bone of KOA mice by interacting with endothelial cells via the FGF2-FGFR2 signaling pathway.The number of H-type vessels was increased in the subchondral bone,recruiting osteoprogenitor cells and facilitating osteogenesis in KOA mice.Sparc+osteoblasts have negatively regulated bone mineralization and osteoblastic differentiation,aggravated the pathological remodeling of subchondral bone,and promoted the progression of KOA.The above findings have offered new targets and opened up an avenue for the therapeutic intervention of KOA.