Double plating for the treatment of distal tibia and fibula fractures: case series of twenty five patients

BACKGROUND

The treatment of fractures of the distal third of the tibia and fibula usually involves two incisions, thus raising the risk of wound dehiscence, wound necrosis, infection, and the delayed union or non-union of distal tibial fractures. To decrease and prevent aforementioned serious complications, one-incision double-plating technique was advocated here.

AIM

The aim of this work was to evaluate the results and effects of the one-incision, double-plating technique in the fractures of distal third of the tibia-fibula and fibula.

PATIENTS AND METHODS

Twenty-five patients with fractures of the distal third of the tibia-fibula, were treated with one incision, double plating between June 2007 and January 2009. The reduction and fixation of the tibia and fibula were conducted in all patients using one incision. The type of fractures based on AO classification were A1 (n = 6), A2 (n = 4), B1 (n = 12) and C1 (n = 3). All patients were followed-up at least until the patient was fully weight-bearing and the soft tissues had healed (median, 15 months; range, 12-24).

RESULTS

Postoperative follow-up showed that 24 fractures healed within the range of the normal healing time. Only one patient with delayed union healed without surgical intervention by 7 months postoperatively. There were no cases of malunion or non-union. Importantly, at their last follow-up visit, the fracture was in excellent position and healed radiographically, and the patient could walk without pain and support.

CONCLUSIONS

One-incision double-plating is a safe and effective alternative for treatment of distal tibia and fibula fractures.

Growth factor receptor-bound protein 10-mediated negative regulation of the insulin-like growth factor-1 receptor-activated signalling pathway results in cognitive disorder in diabetic rats

Growth factor receptor-bound protein 10 (Grb10) is a Src homology 2 domain-containing protein and one of the binding partners for several transmembrane tyrosine kinase receptors, including insulin receptor (IR) and insulin-like growth factor-1 receptor (IGF1-R). The hippocampus, which is critical for cognitive functions, is one of the main distribution areas of Grb10 in the central nervous system. In recent years, diabetic encephalopathy has been defined as a third type of diabetes and the IGF1-IR pathway was shown to be critical for the neuropathogenic process of cognitive disorder in diabetes. However, the role of endogenous Grb10 in regulating the IGF1-IR pathway and neurobehavioural changes is not explicit. The present study aimed to determine the in vivo function of endogenous Grb10 in diabetic encephalopathy and the underlying mechanisms. Using stereotaxic surgical techniques and lentiviral vectors expressing specific short hairpin RNA, we could steadily knockdown Grb10 expression in the hippocampus. More importantly, we demonstrated that hippocampus-specific modulation of Grb10 protein levels led to a prominent remission of cognitive disorder, including improvements in both ultrastructural pathology and abnormal neurobehavioural changes. Our findings indicate that endogenous overexpression of Grb10 functions as a suppressor of the IGF1-IR pathway, which may represent an important mechanism for regulating cognitive disorder in diabetes.

[Influence of decomposition of Cladophora sp. on phosphorus concentrations and forms in the overlying water]

Sediments were sampled in the dominated zone of Cladophora sp. in Rongcheng Swan Lake, and cultivated with algae in the laboratory to reveal the influence of Cladophora decomposition on concentrations and forms of phosphorus in the overlying water. Concentrations of total phosphorus (TP), dissolved total phosphorus (DTP), soluble reactive phosphorus (SRP), particulate phosphorus (PP) and dissolved organic phosphorus (DOP) in overlying water were investigated, and some physicochemical parameters, such as dissolved oxygen (DO), pH and conductivity were monitored during the experiment. In addition, the influence of algae decomposition on P release from sediments was analyzed. Due to the decomposition of Cladophora, DO concentration in the overlying water declined remarkably and reached the anoxic condition (0-0.17 mg x L(-1)). The pH value of different treatments also decreased, and treatments with algae reduced by about 1 unit. Concentrations of TP and different P forms all increased obviously, and the increasing extent was larger with the adding algae amount. TP concentrations of different treatments varied from 0.04 mg x L(-1) to 1.34 mg x L(-1). DOP and PP were the main P forms in the overlying water in algae without sediments treatments, but SRP concentrations became much higher in algae with sediments treatments. The result showed that P forms released from decomposing Cladophora were mainly DOP and PP, and the Cladophora decomposition could also promote the sediments to release P into the overlying water.

Differences in imaging characteristics of HPV-positive and HPV-Negative oropharyngeal cancers: a blinded matched-pair analysis

BACKGROUND AND PURPOSE

Human papillomavirus-positive oropharyngeal cancers typically have younger age of onset, limited tobacco exposure, and more favorable prognosis than HPV-negative oropharyngeal cancers. We assessed whether HPV-positive and HPV-negative oropharyngeal cancers have consistent differences in pretreatment imaging characteristics.

MATERIALS AND METHODS

A retrospective review of 136 pretreatment CT examinations of paired HPV-positive and HPV-negative oropharyngeal cancers matched for T stage, tumor subsite, and smoking status was performed with the reviewing radiologist blinded to HPV status and clinical stage. Demographic/clinical characteristics and imaging characteristics of primary lesions and metastatic nodal disease were compared by use of Fisher exact testing. The McNemar χ(2) test was used for the matched-pair analysis.

RESULTS

By imaging, HPV-negative tumors were more likely to demonstrate invasion of adjacent muscle (26% versus 6%, P = .013). HPV-positive primary tumors were more likely to be enhancing and exophytic with well-defined borders, whereas HPV-negative primary tumors were more likely to be isoattenuated and demonstrate ill-defined borders, though these results were not statistically significant. HPV-positive tumors were more likely to demonstrate cystic nodal metastases than HPV-negative tumors (36% versus 9%, P = .002).

CONCLUSIONS

In this matched and blinded analysis of the imaging differences between HPV-positive and HPV-negative oropharyngeal cancers, HPV-positive carcinomas often had primary lesions with well-defined borders and cystic nodal metastases, whereas HPV-negative primaries more often had poorly defined borders and invasion of adjacent muscle.

Tendencies for higher co-expression of EGFR and HER2 and downregulation of HER3 in prostate cancer lymph node metastases compared with corresponding primary tumors

The epidermal growth factor receptor (EGFR) family members are potential targets for therapy using extra-cellular domain receptor binding agents, such as the antibodies trastuzumab and cetuximab, or antibodies labeled with therapeutically useful radionuclides or toxins. This is especially the case when the tumor cells are resistant to chemotherapy and tyrosine kinase inhibitors. Studies concerning the expression of these receptors in prostate cancer vary in the literature, possibly due to differences in patient inclusion, sample preparations and scoring criteria. In our study, EGFR, HER2 and HER3 expression was analyzed in prostate cancer samples from primary tumors and corresponding lymph node metastases from 12 patients. The expression of HER2 and EGFR was scored from immunohistochemical preparations and the HercepTest criteria (0, 1+, 2+ or 3+), while HER3 expression was scored as no, weak or strong staining. There were 5 EGFR-positive (2+ or 3+) primary tumors and 6 EGFR-positive lymph node metastases, and there was EGFR upregulation in one metastasis. Only 4 of the 12 patients had marked HER2 expression (2+ or 3+) in their primary tumors and there was one downregulation and 5 cases of upregulation in the metastases. Thus, a total of 8 out of 12 analyzed metastases were HER2-positive. Of the 12 primary tumors, 9 expressed HER3 while only 2 of the lymph node metastases expressed recognizable HER3 staining, so 7 metastases appeared to have downregulated HER3 expression. In one of the primary tumors there was positive co-expression of EGFR and HER2, while this co-expression was observed in 4 of the metastases. Thus, there were tendencies for upregulation of HER2, increased co-expression of EGFR and HER2 and downregulation of HER3 in the prostate cancer lymph node metastases in comparison to the primary tumors. The results are encouraging for studies involving more patients. Possible strategies for EGFR- and HER2-targeted therapy are briefly discussed in the present study, especially with regard to the expression and co-expression of EGFR and HER2 in metastases.

Korean red ginseng: a new approach for the treatment of graft-versus-host disease after liver transplantation

BACKGROUND

Graft-versus-host disease (GVHD) is a rare complication after liver transplantation with an extremely poor prognosis; its occurrence offers great challenges.

METHODS

We have reported herein one case of acute GVHD after liver transplantation who was treated with a traditional Chinese medicine named Korean Red Ginseng (KRG).

RESULTS

The acute GVHD was successfully cured by KRG.

CONCLUSIONS

The successful salvage of acute GVHD after liver transplantation by KRG may provide a new viable therapeutic option.

Clinical features of axial undifferentiated spondyloarthritis (USpA) in China: HLA-B27 is more useful for classification than MRI of the sacroiliac joint

OBJECTIVES

To analyse the clinical features of Chinese undifferentiated spondyloarthritis (USpA) patients with predominantly axial involvement, and in particular the influence of human leucocyte antigen (HLA)-B27 and magnetic resonance imaging (MRI) of the sacroiliac joint (SIJ) on the classification of axial USpA.

METHODS

Patients with low back pain for ≥ 3 months and no definite radiographic sacroiliitis were enrolled in this study. They were diagnosed as USpA based on rheumatologists' findings. Correlations between clinical features and HLA-B27 status or MRI manifestations were analysed.

RESULTS

A total of 197 USpA patients were recruited, of whom 135 (70.3%) were positive for HLA-B27. Acute inflammation, structural damage lesions, and normal findings on SIJ MRI were recorded in 64.5, 13.2 and 22.3% of patients, respectively. Classification criteria for axial SpA according to the European Spondylarthropathy Study Group (ESSG), Amor, and the Assessment of SpondyloArthritis International Society (ASAS) were fulfilled by 63.5, 64.5 and 83.2% patients, respectively. Cross-validation showed significant correlation among these three criteria. Patients positive for HLA-B27 included more males, with earlier onset age, better response to non-steroidal anti-inflammatory drugs (NSAIDs), and higher erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) levels. In addition, more HLA-B27-positive than HLA-B27-negative patients fulfilled the ESSG, Amor, and ASAS criteria. Patients with acute inflammation on SIJ MRI had a higher level of ESR/CRP, and a greater proportion of them fulfilled the Amor and ASAS criteria. However, the proportion of those fulfilling the ESSG criteria did not differ with different MRI manifestations.

CONCLUSION

Both HLA-B27 status and SIJ MRI findings influence the classification of Chinese axial USpA patients, but HLA-B27 seems of more value.

Solution-Based Synthesis of Magnesium Oxide Nanorods

A solution-based synthesis route was developed to produce large quantities of MgO nanorods. Hydrated basic magnesium chloride, which has needle-like crystal structure, was used as a precursor. A subsequent two-step transformation process with magnesium hydroxide as an intermediate product was used to preserve the morphology of the precursor to yield magnesium oxide nanorods. Scanning electron microscopy, powder X-ray diffraction and energy dispersive X-ray spectroscopy show that the products are very pure (>95%) crystalline MgO nanorods with diameters from 40 nm to 200 nm and lengths 10 microns or longer. High-resolution transmission electron microscopy and electron diffraction further reveal that these MgO nanorods are single crystals and that the rod axis is along the <110> crystal direction. A model for the structural transformation from hydrated basic magnesium chloride to magnesium oxide has been developed and compared to our experimental results. This solution-based process can be easily scaled-up, and is a low-cost source of pure magnesium oxide nanorods needed in many industrial applications, for example, as reinforcing agents in matrix composites and as flux-pinning centers in high-TC superconductors.

Synthesis of Single Crystal Bismuth-Telluride and Lead-Telluride Nanowires for New Thermoelectric Materials

Dimensionality can play an important role in determining the properties of materials. In the case of thermoelectric materials, it has been proposed that one-dimensional quantum wires, or nanowires, and two-dimensional superlattices could exhibit substantially higher efficiencies compared to the corresponding bulk, three-dimensional solids. To explore such predictions we have initiated a program directed towards the controlled growth of nanowires, and herein, we report the synthesis of single crystal Bi2Te3 and PbTe nanowires by a pulsed laser ablation method. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) show that Bi2Te3 wires 80 nm to 200 nm in diameter and lengths exceeding 10 microns, and PbTe wires 25 nm to 60 nm in diameter and lengths to 2 microns can be readily produced by the laser ablation method. High-resolution TEM and electron diffraction show that Bi2Te3 nanowires are single crystals with wire axes along the <110> crystal direction. TEM and electron diffraction measurements also show that the PbTe nanowires are single crystals with a <100> growth axis. The transport properties of these new nanowire materials will be discussed.

Adeno-associated viral vector mediated and cardiac-specific delivery of CD151 gene in ischemic rat hearts

Our previous studies demonstrated that CD151 gene promoted neovascularization in ischemic heart model. To improve the delivery efficacy and target specificity of CD151 gene to ischemic heart, we generated an adeno-associated virus (AAV) vector in which CD151 expression was controlled by the myosin light chain (MLC-2v) promoter to achieve the cardiac-specific expression of CD151 gene in ischemic myocardium and to limit unwanted CD151 expression in extracardiac organs. The function of this vector was examined in rat ischemic myocardium model. The protein expression of CD151 in the ischemic myocardium areas, liver and kidney was confirmed by using Western blot, while the microvessels within ischemic myocardium areas were detected by using immunohistochemistry. The results showed that MLC-2v significantly enhanced the expression of CD151 in ischemic myocardium, but attenuated its expression in other organs. The forced CD151 expression could increase the number of microvessels in the ischemic myocardium. This study demonstrates the AAV-mediated and MLC-2v regulated CD151 gene is highly expressed in the ischemic myocardium and cardiac-specific delivery that is more efficiently targets CD151 to the ischemia myocardium after myocardial infarction.

Doping Induced Internal Stress Reduction in Diamondlike Carbon Films Deposited by Pulsed Laser Ablation

We have investigated the effect of dopants on the reduction of internal compressive stress in diamond-like carbon (DLC) films prepared by pulsed laser deposition on Si(100) substrates. A novel target configuration was used to incorporate dopants into DLC films by sequential pulsed laser ablation of two targets. These dopants include copper, titanium and silicon. The thickness of the DLC films deposited was measured in the range 400nm - 600nm using a profilometer. Raman spectroscopy was employed to analyze the chemistry of the films. The shifts of the G-peak position in the Raman spectrum, due to different concentrations of dopant, were used to estimate the internal stress changes. All of the films showed a Raman spectrum typical of DLC films containing a high fraction of sp3 species, with the G-peak centered at around 1510–1560cm−1. The shift of the G-peak due to the presence of dopants was observed for all the DLC films as compared to the undoped one. It was found that Ti has the strongest tendency to reduce the compressive stress of DLC films. This effect increases with increasing concentration of dopants. Silicon was also observed to have this effect, but the G-peak position did not appear to shift with different Si concentrations. Buckling occurred in the as-deposited, undoped DLC film because of the relief of the large compressive stress accumulated in the film, while all the doped DLC films showed good adhesion to the substrate. The results are discussed combining the atomic structure of DLC and the structure and properties of the dopants.

Construction of a genetic linkage map for silver carp (Hypophthalmichthys molitrix)

For silver carp (Hypophthalmichthys molitrix), a combined microsatellite (or simple sequence repeat) and amplified fragment length polymorphism (AFLP) sex average linkage map was constructed. A total of 483 markers (245 microsatellites and 238 AFLPs) were assigned to 33 linkage groups. The map spanned 1352.2 cM, covering 86.4% of the estimated genome size of silver carp. The maximum and average spaces between 420 loci were 21.5 cM and 3.2 cM, respectively. The length of linkage groups ranged from 3.6 cM to 98.5 cM with an average of 41.0 cM. The number of markers per group varied from 2 to 44 with an average of 14.6. The AFLP markers significantly improved the integrity of microsatellite-based linkage groups and increased the genome coverage and marker evenness. A genome-wide recombination suppression was observed in male. In an extreme case, six microsatellites co-segregated in male, but spanned a 45.1 cM region in female.

EGFR, HER2 and HER3 expression in primary colorectal carcinomas and corresponding metastases: Implications for targeted radionuclide therapy

Members of the epidermal growth factor receptor, EGFR, family are interesting as targets for radionuclide therapy using targeting agents labeled with α- or β-emitting radionuclides, especially when EGFR-positive colorectal carcinomas, CRC, are resistant to EGFR inhibiting agents like cetuximab and various tyrosine kinase inhibitors. The expression of EGFR, HER2 and HER3 was therefore analyzed in CRC samples from primary tumors, corresponding lymph node metastases and, in a few cases, liver metastases. The expression of HER2 and EGFR was scored from immunohistochemical preparations using the HercepTest criteria 0, 1+, 2+ or 3+ for cellular membrane staining while HER3 expression was scored as no, weak or strong cytoplasm staining. Material from 60 patients was analyzed. The number of EGFR 2+ or 3+ positive primary tumors was 16 out of 56 (29%) and for lymph node metastases 8 out of 56 (14%) whereas only one out of nine (11%) liver metastases were positive. Thus, there was lower EGFR positivity in the metastases. Only one among 53 patients was strongly HER2 positive and this in both the primary tumor and the metastasis. Eight out of 49 primary tumors (16%) were strongly HER3 positive and the corresponding numbers for lymph node metastases were 9 out of 49 (18%) and for liver metastases 2 out of 9 (22%). The observed number of strongly EGFR positive cases was somewhat low but EGFR might be, for the cases with high EGFR expression in metastases, a target for radionuclide therapy. HER2 seems not to be of such interest due to rare expression, neither HER3 due to mainly expression in the cytoplasm. The requirements for successful EGFR targeted radionuclide therapy are discussed, as well as patient inclusion criteria related to radionuclide therapy.

Identification of lobar fissures in pathological lungs

Identification of lobar fissures in human lungs is a non-trivial task due to their variable shape and appearance, along with the low contrast and high noise in computed tomographic (CT) images. Pathologies in the lungs can further complicate this identification by deforming and/or disrupting the lobar fissures. Current algorithms rely on the general anatomy of the lungs to find fissures affected by pathologies. This can be unreliable as deformations and/or disruptions of these fissures will alter the general lung anatomy. To overcome this, we developed an algorithm with the following novelties: (1) a new application of neural network based texture analysis to generalize fissure regions; and (2) a new method of fissure surface identification. We tested our algorithm on CT image stacks from 8 anonymous patients with pathological lungs. Compared to manually segmented fissures, our algorithm produced an average mean difference of 0.71 mm and 0.68 mm for identifying the left and right oblique fissures, respectively. Using a 3-mm percentile measure, the algorithm yielded an average accuracy of 86.8% for the left oblique fissure with a mean worst-case error of 3.18 mm. For the right oblique fissure, the algorithm produced an accuracy of 88.8% with a mean worst-case error of 3.13 mm. The above results show feasibility of using our algorithm for identifying fissures in pathological lungs.

Lift-off PMN-PT Thick Film for High Frequency Ultrasonic Biomicroscopy

Piezoelectric 0.65Pb(Mg(1/3)Nb(2/3))O(3)-0.35PbTiO(3) (PMN-35PT) thick film with a thickness of approximately 12 µm has been deposited on the platinum buffered Si substrate via a sol-gel composite method. The separation of the film from the substrate was achieved using a wet chemical method. The lifted-off PMN-35PT thick film exhibited good dielectric and ferroelectric properties. At 1 kHz, the dielectric constant and the dielectric loss were 3,326 and 0.037, respectively, while the remnant polarization was 30.0 µC/cm(2). A high frequency single element acoustic transducer fabricated with this film showed a bandwidth at -6 dB of 63.6% at 110 MHz.

Increased sensitivity of Aspergillus flavus and Aspergillus parasiticus aflatoxin biosynthesis polyketide synthase mutants to UVB light

One strategy to reduce aflatoxin contamination of maize and cottonseed is to introduce spores of non-aflatoxigenic strains as competitors. Using isogenic mutants we show that, upon 5 or 20 min exposure to 302 nm (UVB) light, the viability of conidia of Aspergillus flavus and Aspergillus parasiticus mutants lacking the ability to accumulate any aflatoxin precursor metabolite is reduced five-fold compared to that of aflatoxin-producing strains or pigmented mutants that accumulate aflatoxin precursors. This result suggests that the long-term viability of introduced non-aflatoxigenic competitor strains may be lower than that of natural aflatoxin-producing isolates when exposed to sunlight.

A study on using texture analysis methods for identifying lobar fissure regions in isotropic CT images

The major hurdle for segmenting lung lobes in computed tomographic (CT) images is to identify fissure regions, which encase lobar fissures. Accurate identification of these regions is difficult due to the variable shape and appearance of the fissures, along with the low contrast and high noise associated with CT images. This paper studies the effectiveness of two texture analysis methods - the gray level co-occurrence matrix (GLCM) and the gray level run length matrix (GLRLM) - in identifying fissure regions from isotropic CT image stacks. To classify GLCM and GLRLM texture features, we applied a feed-forward back-propagation neural network and achieved the best classification accuracy utilizing 16 quantized levels for computing the GLCM and GLRLM texture features and 64 neurons in the input/hidden layers of the neural network. Tested on isotropic CT image stacks of 24 patients with the pathologic lungs, we obtained accuracies of 86% and 87% for identifying fissure regions using the GLCM and GLRLM methods, respectively. These accuracies compare favorably with surgeons/radiologists' accuracy of 80% for identifying fissure regions in clinical settings. This shows promising potential for segmenting lung lobes using the GLCM and GLRLM methods.

Strong strain hardening in nanocrystalline nickel

Low strain hardening has hitherto been considered an intrinsic behavior for most nanocrystalline (NC) metals, due to their perceived inability to accumulate dislocations. In this Letter, we show strong strain hardening in NC nickel with a grain size of approximately 20 nm under large plastic strains. Contrary to common belief, we have observed significant dislocation accumulation in the grain interior. This is enabled primarily by Lomer-Cottrell locks, which pin the lock-forming dislocations and obstruct dislocation motion. These observations may help with developing strong and ductile NC metals and alloys.