The relationship of MITF gene expression and promoter methylation with plumage colour in quail

1. This study focused on the relationship between MITF mRNA expression and plumage colour in quail and the effect of promoter methylation on the expression of MITF mRNA.2. The CDS region of MITF mRNA was cloned by RT-PCR, followed by DNA sequencing. The RT-qPCR method was used to analyse the expression levels of MITF mRNA in dorsal skin tissue in Korean quail and Beijing white quail. The promoter region of the MITF gene was cloned, and the CpG island was predicted by the CpGplot program. The methylation levels of the CpG island were analysed using BS-PCR technology.3. Quail MITF mRNA contains a 1,476 bp complete ORF, which encodes a 492 amino acid residue protein. The MITF protein has no signal peptide or transmembrane region. The expression of MITF mRNA in dorsal tissue of Korean quail was significantly higher than that in Beijing white quail (p < 0.01). Abundant cis-elements and a 346 bp CpG island were found in the promoter region of the MITF gene. The average methylation level of the CpG island was 22 (22%) in Korean quail, and 46 (30%) in Beijing white quail (p < 0.05).4. The hypermethylation of the MITF gene promoter region in Beijing white quail resulted in a decrease in expression level, which was related to white feather colour.

[Medicinal Characteristics of Shao Jiu in Compendium of Materia Medica]

Modern Bai Jiu(liquor) was called Shao Jiu in ancient times.By consulting ancient books, it was found that there was a distillation and preparation process of Shao Jiu before the Ming Dynasty, but due to its high toxicity, the scope of application was limited, and there were few records of its medicinal use.However many records of its medicinal use was found in the Compendium of Materia Medica(«»).By comparing the medical books that recorded Shao Jiu in previous dynasties, it is found that the Compendium of Materia Medica comprehensively records the relevant cognition and application of the medicinal use of Shao Jiu for the first time. The book lists in detail the causes of the toxicity of Shao Jiu and the methods to avoid it, comprehensively expounds its characteristics, efficacy and indications, lists a variety of ways to use it, skillfully uses Shao Jiu to treat syphilis sores, and proposes that high-concentration Shao Jiu can be used as a solvent for medical liquor.The record of Shao Jiu in the Compendium of Materia Medica had a profound impact on the medical liquor of later generations.The use of Shao Jiu in the Qing Dynasty continued to expand, and the types of medicinal liquor were also constantly enriched. The record of Shao Jiu in the Compendium of Materia Medica can also provide a reference for the medicinal use of modern liquor.

Development of an Efficient and Seamless Genetic Manipulation Method for Xenorhabdus and Its Application for Enhancing the Production of Fabclavines

Xenorhabdus can produce numerous natural products, but their development has been hampered by the lack of a seamless genetic manipulation method. In this study, we compared several lethal genes and determined the sacB gene as the most effective counter-selection marker and then established a dual selection/counter-selection system by integrating neo and sacB genes into one cassette. This provides an efficient and seamless genetic manipulation method for Xenorhabdus. Using this method, DNA fragments ranging from 205 to 47,788 bp in length were seamlessly knocked out or replaced with impressively high positive rates of 80 to 100% in Xenorhabdus budapestensis XBD8. In addition, the method was successfully applied with good efficiency (45-100%) in Xenorhabdus nematophila CB6. To further validate the method, different constitutive promoters were used to replace the native fclC promoter in a batch experiment. The positivity rate remained consistently high, at 46.3%. In comparison to WT XBD8, the recombinant strain MX14 demonstrated a significant increase in the production of fabclavine 7 and fabclavine 8 by 4.97-fold and 3.22-fold, respectively, while the overall production of fabclavines was enhanced by 3.52-fold.

A Novel Navigation Device for Precise Percutaneous Placement of the Guidewire in Femoral Neck Fracture Cannulated Screw Fixation Surgery

The accuracy of screw placement is a key factor for the stability of the cannulated screws used in the fixation of femoral neck fractures. In this study we designed a navigation device for ensuring the screw reaches the ideal position for optimal fixation. From March 2019 to September 2020, 66 patients with femoral neck fracture were enrolled and divided into 2 groups, one group was treated using the traditional free-hand cannulated screw fixation and the other using the new navigation device with assisted fixation. The effectiveness of the 2 methods was compared based on surgery duration, intraoperative bleeding, number of fluoroscopic examination and guidewire insertion attempts, screw parallelism, and effective fixation area. Fracture healing, complications and hip joint function were assessed after operation. The new navigation device reduced the duration of surgery without causing additional intraoperative bleeding, and significantly reduced number of fluoroscopy examination and guidewire insertion attempts (4.00±1.58 vs. 6.09±1.94 with traditional surgery). The accuracy of screw implantation was improved, as demonstrated by increased screw parallelism (0.71±0.57° vs. 1.66 ±1.01° with traditional surgery) and higher effective fixed area (64.88±10.52 vs. 58.61±9.19 mm2 with traditional surgery). In the postoperative follow-up, except for one case of femoral head necrosis and one case of bone nonunion in the traditional surgical group, the other patients showed fracture healing. There was no significant difference in hip joint function between the 2 groups. The new navigation device enables rapid and accurate guidewire positioning for cannulated screw fixation through simple operation procedures, resulting in good prospect for clinical transformation.

The application of policy composite indicators to predicting the health risk and recovery: a global comparative investigation

OBJECTIVES

There emerges increasing doubt regarding whether the policy composite indicators are applicable to the COVID-19 pandemic. A few early studies demonstrate that the association between some composite indicators of policy preparedness and the risk of COVID-19 is statistically insignificant, and the relation between any composite indicators and recovery process (e.g., vaccination coverage) remains unexplored. To examine the relation between composite indicators and pandemic risk (as well as the vaccination coverage) with robustness, this study applies different policy preparedness indicators by using data from multi-sources.

STUDY DESIGN

A cross-sectional analysis was performed.

METHOD

Regression analysis is adopted to examine the relation between four policy preparedness indicators (i.e., [1] International Health Regulations core capacity index, [2] Global Health Security Index, [3] epidemic preparedness index, and [4] World Governance Index) and COVID-19-confirmed cases/death/vaccination coverage at different time points. The linear regression is performed, and the spatial distribution of indicators are illustrated.

RESULTS

Countries with higher ranking in policy preparedness indexes can experience less severity of pandemic risk (e.g., confirmed cases and mortality) and faster recovery process (e.g., higher vaccination coverage). However, slight disparity in effectiveness exists across different indicators.

CONCLUSION

Results show that the policy preparedness indicators have predictive value of the confirmed cases, mortality, and vaccination coverage of COVID-19 pandemic, given sufficiently long-time span is observed.

Identification of fabclavine derivatives, Fcl-7 and Fcl-8, from Xenorhabdus budapestensis as major antifungal natural products against Rhizoctonia solani

AIMS

Black scurf disease, caused by Rhizoctonia solani, is a severe soil-borne and tuber-borne disease, which occurs and spreads in potato growing areas worldwide and poses a serious threat to potato production. New biofungicide is highly desirable for addressing the issue, and natural products (NPs) from Xenorhabdus spp. provide prolific resources for biofungicide development. In this study, we aim to identify antifungal NPs from Xenorhabdus spp. for the management of this disease.

METHODS AND RESULTS

Out of the 22 Xenorhabdus strains investigated, Xenorhabdus budapestensis 8 (XBD8) was determined to be the most promising candidate with the measured IC50 value of its cell-free supernatant against R. solani as low as 0.19 ml l-1. The major antifungal compound in XBD8 started to be synthesized in the middle logarithmic phase and reached a stable level at stationary phase. Core gene deletion coupled with high-resolution mass spectrometry analysis determined the major antifungal NPs as fabclavine derivatives, Fcl-7 and 8, which showed broad-spectrum bioactivity against important pathogenic fungi. Impressively, the identified fabclavine derivatives effectively controlled black scurf disease in both greenhouse and field experiments, significantly improving tuber quality and increasing with marketable tuber yield from 29 300 to 35 494 kg ha-1, comparable with chemical fungicide fludioxonil.

CONCLUSIONS

The fabclavine derivatives Fcl-7 and 8 were determined as the major antifungal NPs in XBD8, which demonstrated a bright prospect for the management of black scurf disease.

Global biomarkers of oxidative stress and fractures: a matched case-control study

Background

Evidence for a relationship between oxidative stress and osteoporotic fractures in humans is limited. Fluorescent oxidation products (FlOPs, excitation/emission wavelengths 320/420nm denoted FlOP_320; 360/420nm [FlOP_360]; and 400/475nm [FlOP_400]) are global biomarkers of oxidative stress, and reflect oxidative damage to proteins, phospholipids, and nucleic acids. We investigated the association between FlOPs and a recent osteoporotic fracture.

Methods

We conducted a case-control study in a Chinese population aged 50 years or older. A recent osteoporotic fracture in the cases was confirmed by x-ray. Cases were matched with community-based non-fracture controls (1:2 ratio) for age (± 4 years) and sex. In addition, we conducted a sensitivity unmatched case-control study which included all fracture cases and all eligible non-fracture controls prior to matching. Plasma FlOPs were measured with a fluorescent microplate reader. We used unconditional logistic regression to analyze the association between FlOPs (per 1-SD increase in logarithmic scale) and fracture; odds ratios (OR) and 95% confidence intervals (95% CI) were reported.

Results

Forty-four cases and 88 matched controls (mean age: 68.2 years) were included. After covariate adjustment (i.e., body mass index, physical activity, and smoking), higher FlOP_360 (OR = 1.85; 95% CI = 1.03 - 3.34) and FlOP_400 (OR = 13.29; 95% CI = 3.48 - 50.69) levels, but not FlOP_320 (OR = 0.56; 95% CI = 0.27 - 1.15), were associated with increased fracture risk. Subgroup analyses by fracture site and unmatched case-control study found comparable associations of FlOP_360 and FlOP_400 with hip and non-hip fractures.

Conclusions

Higher FlOP_360 and FlOP_400 levels were associated with increased risk of fracture, and this association was comparable for hip and non-hip fractures. Prospective studies are warranted to confirm this finding.

Identification of Fcl-29 as an Effective Antifungal Natural Product against Fusarium graminearum and Combinatorial Engineering Strategy for Improving Its Yield

Fusarium head blight (FHB), caused by Fusarium graminearum, whose occurrence and prevalence causes 10-70% wheat production loss, is one of the most destructive diseases influencing the production of wheat globally. To identify the potential natural products (NPs) against F. graminearum, we screened 59 Xenorhabdus strains and discovered that the cell-free supernatant (CFS) of X. budapestensis 14 (XBD14) displays the highest bioactivity. Multiple genetic methods coupled with HRMS/MS analysis determined the major antifungal NP to be Fcl-29, a fabclavine derivative. Fcl-29 was found to effectively control FHB of wheat in the field test and demonstrated broad-spectrum antifungal activity against important pathogenic fungi. The production of Fcl-29 was dramatically improved by 33.82-fold with the combinatorial strategy of genetic engineering (1.66-fold) and fermentation engineering (20.39-fold). The exploration of a new biofungicide in global plant protection is now possible.

Contrast-enhanced magnetic resonance angiography in the identification of prostatic arterial anatomy in patients with benign prostatic hyperplasia: prospective comparison with digital subtraction angiography

AIM

To evaluate the utility of contrast-enhanced magnetic resonance angiography (CE-MRA) for identifying prostatic artery (PA) anatomy in patients with benign prostatic hyperplasia (BPH) before PA embolisation (PAE), using digital subtraction angiography (DSA) as the reference standard.

MATERIALS AND METHODS

A total of 176 patients underwent pelvic CE-MRA at 3 T. DSA was performed within the following 7 days. Two interventional radiologists compared the CE-MRA findings with DSA findings to assess the anatomy of the PAs. The rates of correct identification of the origins and collaterals of the PAs by CE-MRA were calculated. The utility for predicting the optimal X-ray tube angle obliquity for visualising the origins of the PAs by CE-MRA was evaluated. An exact McNemar's test was used to compare the detection rates of the PAs and the collaterals with DSA versus CE-MRA. A two-sided p-value of <0.05 was considered statistically significant.

RESULTS

Of the 376 PAs identified by DSA, CE-MRA correctly identified the origins of 369 vessels (98.1%), with a 1.9% false-negative rate and no false-positive results. Of the 57 total collaterals identified by DSA, CE-MRA identified 50 vessels correctly (87.7%), with a 12.3% false-negative rate and no false-positive results. No significant differences were observed between CE-MRA and DSA in the identification of the PA origins (p=0.824) and the collaterals (p=0.327). The optimal degree for an oblique projection to visualise the origins of the PAs could be predicted accurately (100%) by pre-procedural CE-MRA.

CONCLUSION

CE-MRA before PAE can reliably predict the PA anatomy and facilitate procedural planning.

Investigation of the relationships among respiratory syncytial virus infection, T cell immune response and intestinal flora

The aim of this work was to evaluate the relationships among respiratory syncytial virus infection, T cell immune response and intestinal flora. Peer-reviewed papers published in English were collected through extensive searches performed in PubMed, Web of Science, Google Scholar, and China National Knowledge Infrastructure databases. The articles were reviewed to extract relevant information on the immune responses of Th1/Th2 and Treg/Th17 to respiratory syncytial virus infection in the body. RSV (Respiratory syncytial virus, RSV) infection leads to imbalance between Th1/Th2 and Treg/Th17 immune cells, resulting in Th2 or Th17 dominant immune responses, which can generate immune disorder and aggravate clinical symptoms. Intestinal micro-organisms play very important roles in maintaining stable immune environment, stimulating immune system maturation and balancing Th1/Th2 and Treg/Th17 immune systems in children. In our review of various papers from around the world, we speculated that the steady state of intestinal bacteria was disturbed after children got infected with RSV, resulting in intestinal flora disorder. Then, the imbalance between Th1/Th2 and Treg/Th17 immune cells was increased. Both intestinal flora disorder and RSV infection could cause cellular immunity imbalance of Th1/Th2 or Treg/Th17, eventually leading to disease deterioration and even a vicious cycle. Normal intestinal flora can maintain immune system stability, regulate the dynamic balance of Th1/Th2 and Treg/Th17 and prevent or mitigate adverse consequences of RSV infection. Because probiotics can improve intestinal barrier function and regulate immune response, they can effectively be used to treat children with recurrent respiratory tract infections. Using conventional antiviral therapy strategy supplemented with probiotics in the treatment of clinical RSV infection may be better for the body.

Drug delivery systems based on polyethylene glycol hydrogels for enhanced bone regeneration

Drug delivery systems composed of osteogenic substances and biological materials are of great significance in enhancing bone regeneration, and appropriate biological carriers are the cornerstone for their construction. Polyethylene glycol (PEG) is favored in bone tissue engineering due to its good biocompatibility and hydrophilicity. When combined with other substances, the physicochemical properties of PEG-based hydrogels fully meet the requirements of drug delivery carriers. Therefore, this paper reviews the application of PEG-based hydrogels in the treatment of bone defects. The advantages and disadvantages of PEG as a carrier are analyzed, and various modification methods of PEG hydrogels are summarized. On this basis, the application of PEG-based hydrogel drug delivery systems in promoting bone regeneration in recent years is summarized. Finally, the shortcomings and future developments of PEG-based hydrogel drug delivery systems are discussed. This review provides a theoretical basis and fabrication strategy for the application of PEG-based composite drug delivery systems in local bone defects.

Novel Covert-Inferior Pelvic Approach with a Subpubic Plate for Anterior Pelvic Ring Fractures: Preliminary Results

BACKGROUND

Anterior pelvic ring injuries can be treated via Pfannenstiel, modified Stoppa, or ilioinguinal approaches, but these require exposing the abdominal soft tissues and may damage pelvic organs. The scar on the abdominal wall is also unacceptable for some patients. The minimally invasive anterior pelvic ring internal fixator (INFIX) is not ideal for thin patients with easily irritated skin, and it is associated with complications such as femoral nerve palsy, vascular occlusion, and lateral femoral cutaneous nerve injury. In this study, we designed a new external pelvic approach for the treatment of an anterior pelvic ring fracture.

METHODS

We retrospectively reviewed 28 patients with 36 pubic ramus fractures that had been treated via the covert-inferior pelvic approach. All patients underwent a surgical procedure between August 2019 and January 2021. According to the Nakatani classification, there were 6 cases of type-I fracture, 25 cases of type-II fracture, and 5 cases of type-III fracture. Operative time, blood loss, and postoperative radiographic and computed tomographic (CT) findings were recorded. Patients were followed for fracture healing time, functional status, esthetic satisfaction, and complications.

RESULTS

A total of 27 patients had follow-up for at least 12 months (range, 12 to 29 months). Postoperative radiographs and CT scans showed well-positioned plates and screws. The mean preoperative time was 9.4 ± 3.8 days, the mean operative time was 61.3 ± 22.67 minutes, the mean intraoperative blood loss was 63.6 ± 42.62 mL, the mean fracture healing time was 4.1 ± 1.6 months, and the mean Majeed score was 89.74 ± 8.07. There were no complications of nonunion, internal fixation failure, vascular injury, nerve palsy, or hernia. All of the patients were esthetically satisfied with the scar.

CONCLUSIONS

The covert-inferior pelvic approach combined with a subpubic plate effectively fixed Nakatani type-I, II, and III fractures. The advantages of this method include rapid recovery after the surgical procedure, safety, simplicity, a short learning curve, no damage to abdominal soft tissue, no effect on pubic symphysis micromotion, and esthetic benefits. It may be another option for anterior pelvic ring fractures and can supplement other approaches.

LEVEL OF EVIDENCE

Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

[The textbooks in the North China Medical College]

The North China Medical College typically represented medical colleges for traditional Chinese medicine in the 1930s when many of them were set up. It was based on the principles of centring on traditional Chinese medicine, following western medicine and integrated medicine in teaching. This led to the emergence of a great number of people with a high level of traditional Chinese medicine and strong belief in it. In terms of the textbooks and handouts for western medicine, compared to similar textbooks in other medical colleges, such as the Medical College of Xie He, at that time, the textbooks in the North China Medical College covered a variety of perspectives and categories. It was found that 20 textbooks for western medicine in the North China Medical College were designed reasonably in content and were simple and applicable in teaching. More importantly, it contained some traditional Chinese medicine in different degrees, with its typical characteristics. The course design and textbook compilation provided references for the teaching in contemporary medical universities.

Thermosensitive vancomycin@PLGA-PEG-PLGA/HA hydrogel as an all-in-one treatment for osteomyelitis

Osteomyelitis is a difficult-to-treat infectious disease. Treatment, which includes controlling the infection and removing necrotic tissues, is challenging. Considering the side effects and drug resistance of systemic antibiotics, local drug delivery systems are being explored. Antibiotic-loaded bone cement is the main treatment strategy; however, it has several disadvantages. Thus, based on its thermosensitive gelation properties, poly(D, L-lactide-co-glycolide)-poly(ethylene glycol)-poly(D, L-lactide-co-glycolide) (PLGA-PEG-PLGA) copolymer was used as a sustained-release drug carrier by calibrating its synthesis parameters. We prepared and characterized vancomycin@PLGA-PEG-PLGA/hydroxyapatite (HA) thermosensitive hydrogel with an LA/GA ratio of 15:1. The rheological characteristics, sol-gel phase-transition properties, and critical micelle concentration value of the PLGA-PEG-PLGA/HA complex confirmed that it undergoes a temperature-sensitive sol-gel phase transition. Furthermore, the HA in the composite increased the storage modulus of the system. FT-IR, XRD, and TEM findings showed that HA could be dispersed uniformly in the PLGA-PEG-PLGA polymer. Moreover, HA neutralized acidity during polymer degradation, improving in vitro cytocompatibility. In vitro and in vivo antibacterial experiments showed that the composite sustained-release system exhibited good bone repair characteristics owing to its efficacy in infection treatment. Therefore, vancomycin@PLGA-PEG-PLGA/HA allows sustained release of antibiotics and promotes bone tissue repair, showing potential for wide clinical applicability.

Minimally invasive plate osteosynthesis for complex comminuted bone fractures in the Fraser's type II floating knee: a case report

Objective

Floating knee type IIC, according to Fraser’s classification, is an uncommon severe injury that typically occurs in polytrauma. In such cases, intra-articular fracture and the high degree of comminution and deformity of the mid-distal femur make fixation challenging. The purpose of this study was to demonstrate that minimally invasive plate osteosynthesis (MIPO) technology can simplify these complex problems and improve patient prognosis.

Case presentation

A 38-year-old man injured his left leg in a car accident, causing pain, swelling, deformity, and limited mobility on his left knee and thigh, and two small open wounds were noted mainly of the anterior aspect of the mid-distal thigh. Physical examination and computed tomography angiography of the lower limb confirmed that there was no damage to the neurovascular system. The clinical diagnosis was closed intra-articular fracture of the proximal tibia, open intra-articular fracture of the distal femur with extension to the diaphysis, and a patellar fracture on the ipsilateral knee. The treatment strategy involved a locking plate system applying MIPO technology. Postoperative evaluation of the patient was satisfactory, with immediate functional exercise, full weight-bearing after three months, and return to daily activity without pain. Final follow-up taken 3 years after surgery showed good lower limb alignment and complete plasticity of the bone structure, by which time the patient showed good limb function.

Conclusions

Minimally invasive techniques can provide a simple and effective treatment for some complex fractures.

Dietary carotenoid intake and osteoporosis: the National Health and Nutrition Examination Survey, 2005-2018

Higher intake of β-carotene and β-cryptoxanthin were associated with lower risk of osteoporosis. A very high intake of lutein + zeaxanthin was also associated with lower risk of osteoporosis. These results support the beneficial role of carotenoids on bone health.

PURPOSE

To examine the associations of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein + zeaxanthin intake with the risk of osteoporosis based on the cross-sectional data from the National Health and Nutrition Examination Survey (NHANES), 2005-2018.

METHODS

This study identified individuals ≥ 50 years old with valid and complete data on carotenoid intake and bone mineral density (BMD). Intake of α-carotene, β-carotene, β-cryptoxanthin, lycopene, and lutein + zeaxanthin was averaged from two 24-h recall interviews. BMD was measured by dual-energy X-ray absorptiometry (DXA) and converted to T-scores; osteoporosis was defined as a T-score ≤  - 2.5. We used logistic regression models to test the associations between carotenoids and osteoporosis, adjusting for factors such as age, sex, race, and education.

RESULTS

Participants were on average 61.9 years of age, with 57.5% identifying as females. Higher quintiles of β-carotene (odds ratio [OR] for quintile 5 vs. 1:0.33; 95% CI: 0.19-0.59; P for trend = 0.010) and β-cryptoxanthin intake (OR for quintile 5 vs. 1:0.61; 95% CI: 0.39-0.97; P for trend = 0.037) were associated with reduced risk of osteoporosis. Similar and marginally significant results for lutein + zeaxanthin intake was found (OR for quintile 5 vs. 1:0.53; 95% CI: 0.30-0.94; P for trend = 0.076). There was no association of α-carotene and lycopene intake with osteoporosis. These associations did not differ by sex (all P_interaction > 0.05).

CONCLUSIONS

Higher β-carotene and β-cryptoxanthin intake was associated with decreased osteoporosis risk. A very high intake of lutein + zeaxanthin was also associated with lower risk of osteoporosis.

The safety and efficacy of transarterial chemoembolisation with bleomycin for hepatocellular carcinoma unresponsive to doxorubicin: a prospective single-centre study

AIM

To investigate the safety and efficacy of transarterial chemoembolisation (TACE) with bleomycin for hepatocellular carcinoma (HCC) unresponsive to doxorubicin.

MATERIALS AND METHODS

A randomised controlled trial was undertaken of HCC patients resistant to TACE with doxorubicin to assess the survival benefits of the experimental group (TACE with bleomycin) compared with the control group (TACE with doxorubicin). One hundred and seventy patients were allocated randomly between December 2015 and December 2017, and 80 patients of each group were analysed. The modified response evaluation criteria in solid tumours (mRECIST) was used to evaluated the tumour response every 4-6 weeks. The primary endpoint was median progression-free survival (mPFS) and median overall survival (mOS). Safety was assessed by post-procedure complications.

RESULTS

The study was completed in October 2018. Objective response rate (ORR) of the experimental group was 27.5% (22/80), mPFS and mOS was 5.8 and 8.1 months. ORR of the control group was 7.5% (6/80), mPFS and mOS was 2.9 and 4 months. The ORR were significantly different between two groups (χ² = 0.348, p<0.05). The differences of mPFS and mOS between the two groups were statistically significant (χ² = 2.865, p<0.05 and χ² = 0.926, p<0.05, respectively). There were no significant difference in post-procedure complications (p>0.05) and no major complications occurred.

CONCLUSION

It is suggested that TACE with bleomycin is a safe and effective method for HCC and bleomycin can be a second-line chemotherapeutic agent for the HCC patients unresponsive to TACE with doxorubicin.

Extensile lateral versus sinus tarsi approach for calcaneal fractures: A meta-analysis

BACKGROUND

Calcaneal fractures are the most common tarsal bone fracture, and are often accompanied by heel pain, local swelling, tenderness, and inability to walk or stand. Surgical intervention results in better reconstruction of the calcaneal anatomy and reduces future complications; however, the optimal incision approach is still controversial. The incision is exposed better with extensile lateral approach (ELA), while the sinus tarsi approach (STA) causes fewer complications. The purpose of this meta-analysis is to compare the outcomes of STA and ELA.

MATERIALS AND METHODS

Published trials comparing ELA and STA in calcaneal fractures were included in our analysis. The quality of each study was assessed using the revised Jadad scale and the Newcastle-Ottawa scale. Two researchers (CP and BY) independently extracted data from all selected studies. Fixed- or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine the heterogeneity of the included studies.

RESULTS

Calcaneal height and calcaneal width had high heterogeneity. Results showed that the incidence of incision complications in STA was lower than that in ELA (P < .001). There was high heterogeneity in operative time (I2 = 97%), length of hospital stay (I2 = 98%), Böhler angle (I2 = 80%), Gissane angle (I2 = 98%), and American Orthopaedic Foot & Ankle Society scores (I2 = 73%). No source of heterogeneity was found by sensitivity analysis, subgroup analysis, or regression analysis, and the random-effects model was used. STA operative time was significantly shorter than ELA (P < .001). Length of hospital stay after STA was significantly shorter than after ELA (P = .002). There was no statistical difference in the Böhler and Gissane angles between STA and ELA. Postoperative American Orthopaedic Foot & Ankle Society scores after STA were higher than after ELA (P = .01).

CONCLUSIONS

Results show that, compared with ELA, STA is superior for treating calcaneal fractures due to anatomical reduction of the calcaneus, reduction of incision complications incidence, and shortened operative time and postoperative stay.

Treating sacroiliac joint dislocation through percutaneous sacroiliac screw fixation with the aid of 2 fluoroscopes: a novel technique

Background

Percutaneous sacroiliac screw fixation is the standard treatment for sacroiliac joint (SIJ) dislocation. In most hospitals, the procedure is guided by a C-arm X-ray fluoroscopy system, which must be repeatedly repositioned during surgery. In this study, we investigated the feasibility of using 2 fluoroscopes simultaneously.

Methods

A total of 28 consecutive patients with SIJ dislocation were included in this study. The patients were randomly allocated to groups and underwent percutaneous sacroiliac screw fixation using either 1 or 2 fluoroscopes. Total radiation exposure frequency, radiation dose, and operation time were recorded and compared. Dislocation reduction quality was assessed using the Tornetta and Matta standard, and the Majeed functional score was used to evaluate clinical, imaging, and social function following pelvic injury. Complications were also recorded.

Results

The results showed that the radiation exposure frequency was significantly less with 2 fluoroscopes than with a single fluoroscope (21.5±8.6 and 42.6±18.3 times, respectively; P<0.001). However, the radiation dose (156.3±67.2 mGy for 1 fluoroscope and 157.8±38.2 mGy for 2 fluoroscopes; P>0.05) between the 2 groups was not significantly different. The total operation time was also significantly shorter with 2 fluoroscopic devices than with a single device (35.8±12.9 and 65.5±19.7 minutes, respectively; P<0.001). The dislocation reduction quality and Majeed functional score (92.3% and 86.7% for 1 fluoroscope, 93.3% and 84.6% for 2 fluoroscopes, respectively; P>0.05) did not differ significantly between the 2 groups at the final follow-up. Complications, such as pain, superficial infection, restricted squatting, limp, and screw failure, were rarely recorded in either group.

Conclusions

The simultaneous application of 2 fluoroscopes is highly appropriate during percutaneous sacroiliac screw fixation to treat SIJ dislocation, and can significantly reduce radiation exposure frequency and operation time.

[Application effect of sustainable skin-stretching device in scalp and soft tissue defect]

Objective: To explore the application effect of sustainable skin-stretching device in scalp and soft tissue defect. Methods: From June 2017 to January 2020, 5 patients (3 males and 2 females, aged 31-57 (38.0±2.1) years) with large area of scalp and soft tissue defect and skull exposure were admitted to Department of Reparative and Reconstructive Surgery of the Second Hospital of Dalian Medical University. The wound area ranged from 16.0 cm×8.0 cm to 18.0 cm×12.0 cm. The sustainable skin-stretching device was installed after debridement operation for scalp wound. The wound was stretched from the 3rd day after installation of the device, at a basic speed of 1 mm/d and finished for 3 times on average. During stretching, close attention was paid to the changes in blood flow of the wound margin and the subjective feeling of the patients. When the result was negative in the squeezing and pinching test for wound margin after stretching, the further stretching was stopped, the final stretching state was maintained for 3 days, and the wounds were sutured directly. The wound healing during stretching of sustainable skin-stretching device and the occurrence of complications were observed. The rest wound areas after stretching for 5, 10, 15, and 20 days were measured. The wound healing and hair growth were observed during follow-up. Results: All the wounds of 5 patients was sutured directly after stretching for 19-23 d. There was no tension blister on the margin of wounds during stretching, and the margin of wounds healed well after being sutured without skin necrosis. After stretching treatment for 5-20 d, the wound areas were gradually decreased. During follow-up of 2-11 (4.5±1.5) months, the elasticity, color, feeling, and regenerated hair growth of the stretched scalp tissue were close to those of the surrounding normal skin tissue. The linear scar formed on the margin of wounds, but no scar formed on the wounds. Conclusions: The application of sustainable skin-stretching device can reduce the difficulty in repairing scalp and soft tissue defect, with the regenerated hair growing well after treatment, which is worthy of clinical promotion.

[Feasibility study of contrast injection scheme based on body mass and iodine flow rate in coronary computed tomography angiography with wide detector CT]

Objective: To investigate the feasibility of coronary computed tomography angiography (CCTA) with the individualized contrast medium injection scheme based on body mass and iodine flow rate by using wide detector CT at 100 kV. Methods: From May 2018 to July 2018,270 patients with clinically suspected coronary artery disease underwent CCTA in TEDA International Cardiovascular Hospital. They were randomly divided into three groups, 90 cases in each group: group A was 0.5 ml/kg, group B was 0.6 ml/kg, the flow rate of contrast medium injection in group A and group B was (body mass×25 mg)/the concentration of contrast medium,group C was 0.8 ml/kg and the flow rate of contrast medium was 5 ml/s. Iohexol (iodine concentration 350 mgI/ml) was used in all three groups. The CT values of the aorta root in the three groups, the CT value of the middle segment of LAD and RCA, SNR、CNR、SD of the aortic root, subjective score of coronary artery and effective dose (ED) were compared. Results: There was no significant difference in CT value of aortic root, CT value of middle LAD and RCA, SNR、CNR、SD of the aortic root, subjective score of coronary artery among group A, group B and group C (all P>0.05). The flow rates of the three groups of contrast agents were statistically different (4.5±0.5 vs 4.5±0.5 vs 5, P=0.015), and there was no statistical difference between group A and group B (P>0.05) but lower than group C (P=0.015); the amount of contrast agent in the three groups was statistically different (32±3 vs 38±4 vs 53±7, P<0.001), group A<B Group<C group; there was no significant difference in ED between the three groups (1.5±0.5 vs 1.5±0.6 vs 1.3±0.6, P=0.613). Conclusions: CCTA imaging with a wide body detector based on a 0.5 ml/kg contrast agent dosage and a flow rate of ((body mass × 25)/350) ml/s individualized injection scheme can ensure the image quality while reducing the total amount of contrast agent and realizing individualized iodine flow rate.

Emerging role of AMPA receptor subunit GluA1 in synaptic plasticity: Implications for Alzheimer's disease

It is well established that GluA1 mediated synaptic plasticity plays a central role in the early development of AD. The complex cellular and molecular mechanisms that enable GluA1‐related synaptic regulation remain to fully understood. Particularly, understanding the mechanisms that disrupt GluA1 related synaptic plasticity is central to the development of disease‐modifying therapies which are sorely needed as the incidence of AD rises. We surmise that the published evidence establishes deficits in synaptic plasticity as a central factor of AD aetiology. We additionally highlight potential therapeutic strategies for the treatment of AD, and we delve into the roles of GluA1 in learning and memory. Particularly, we review the current understanding of the molecular interactions that confer the actions of this ubiquitous excitatory receptor subunit including post‐translational modification and accessory protein recruitment of the GluA1 subunit. These are proposed to regulate receptor trafficking, recycling, channel conductance and synaptic transmission and plasticity.

Rheological behavior of molecular vs network chalcogenide supercooled liquids

The viscoelastic behavior of supercooled glass-forming liquids along the binary join As₄S₃-GeS₂ with As₄S₃ contents varying from 81.25 to 9 mol. % and correspondingly with structures varying from predominantly molecular to a three-dimensional tetrahedral network is studied by small-amplitude oscillatory shear parallel plate rheometry. The storage shear modulus G' shows a scaling behavior of G'(ω) ∼ ωⁿ in the terminal (low-frequency) regime, where n varies between 1 and 2 and shows an increasingly anomalous departure from the expected value of 2 (Maxwell scaling) with increasing molecule content. A concomitant departure from the Maxwell scaling is also observed for the loss modulus G″ at frequencies above the G'-G″ crossover. On the other hand, the variation in the phase angle δ with the complex modulus indicates that the molecular liquid does not display a purely viscous response even at the lowest frequencies. These results, combined with an analysis of the relaxation spectra of these liquids, suggest that the anomalous behavior of molecular liquids may be linked to their rather broad relaxation spectrum and the presence of slow relaxation processes associated with molecular clusters. Additionally, these liquids are also characterized by a wide high-frequency plateau in the relaxation spectral density that can be linked to the rotational dynamics of the constituent molecules. Such fundamental differences between the rheological behavior of molecular and network liquids may explain the significantly higher fragility of the former.

Doppler coherence imaging of scrape-off-layer impurity flows in the HL-2A tokamak

A new Doppler coherence imaging spectroscopy interferometer has been developed on the HL-2A tokamak for the scrape-off-layer impurity flow measurement. Its spatial resolution is estimated to be up to ∼0.8 mm in the horizontal direction and ∼9 mm in the vertical direction, with a field of view of ∼34°. Its typical temporal resolution is about 1 ms. This salient feature allows for time-resolved 2D measurements in short-time phenomena on HL-2A, such as edge localized modes. Group delay and interference fringe pattern were calibrated with a dedicated calibration system. The robustness of group delay calibration and the feasibility of the extrapolation model for fringe pattern calibration are demonstrated. In this paper, we report the details of the optical instruments, calibration, and the initial experimental results of this Doppler coherence imaging spectroscopy interferometer.

microRNA-144-3p suppresses human neuroblastoma cell proliferation by targeting HOXA7

OBJECTIVE

Dysregulation of microRNAs (miRNAs) expression often resulted in abnormal cell behaviors. It has been demonstrated that miRs may serve as oncogenic or tumor suppressive functions in tumor. We investigated whether or not miR-144-3p has a role in the progression of human neuroblastoma (NB).

PATIENTS AND METHODS

46 NB patients were enrolled in this study. miR-144-3p expression in NB tissues and cell lines was detected by reverse transcription-quantitative polymerase chain reaction. The biological functions of miR-144-3p in NB were detected by cell counting kit-8 assay, flow cytometry assay, and wound-healing assay. Luciferase activity assay and Western blot assay were performed to validate the direct targets of miR-144-3p.

RESULTS

We found miR-144-3p expression was reduced in NB tissues and cell lines and resulted in the stimulation of cell proliferation, cell cycle progression, and cell migration in vitro. Furthermore, we validated homeobox protein A7 (HOXA7) as a direct target of miR-144-3p.

CONCLUSIONS

Taken together, these results demonstrated the tumor suppressive role of miR-144-3p in NB and may advance the understanding of the underlying mechanisms of miR-144-3p and HOXA7 in NB.

The role of macrophages during breast cancer development and response to chemotherapy

Macrophages play an important role in the immune system as a key host defense against pathogens. Non-polarized macrophages can differentiate into pro-inflammatory classical pathway-activated macrophages or anti-inflammatory alternative pathway-activated macrophages, both of which play central roles in breast cancer growth and progression in a process called polarization of macrophages. Classical pathway-activated and alternative pathway-activated macrophages can transform into each other and their transformational properties and orientation are determined by cytokines in the tumor microenvironment. Tumor-associated macrophages display many functions, such as tissue reforming, participating in inflammation and tumor growth in breast cancer progression. Some cytokines, such as interleukins and transcriptional activators, reside in the tumor microenvironment and influence tumor-associated macrophages. Chemotherapy is a common treatment for breast cancer and macrophages play an important role in mammary tumor cell migration, cancer invasion, and angiogenesis. This review summarizes the activities of tumor-associated macrophages in the mammary tumor, chemotherapeutic processes and some potential strategies for breast cancer therapy.

The efficacy of dexamethasone on pain management for knee arthroscopy: A meta-analysis of randomized controlled trials

INTRODUCTION

The impact of dexamethasone on pain management for knee arthroscopy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexamethasone for knee arthroscopy.

METHODS

We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through October 2018 for randomized controlled trials (RCTs) assessing the effect of dexamethasone on pain intensity for patients with dental implant. This meta-analysis is performed using the random-effect model.

RESULTS

Four RCTs involving 228 patients are included in the meta-analysis. Overall, compared with control group for knee arthroscopy, dexamethasone supplementation has no notable effect on pain scores at 4 to 6 hours (Std. MD = 0.99; 95% CI = -2.97 to 4.95; P = .62), but exerts significantly favorable promotion to pain scores at 12 hours (Std. MD = -1.06; 95% CI = -1.43 to -0.69; P < .00001), duration of block (Std. MD = 1.87; 95% CI = 0.65 to 3.10; P = .003), time to first analgesic requirement (Std. MD = 0.90; 95% CI = 0.51 to 1.29; P < .00001), analgesic consumption (Std. MD = -1.62; 95% CI = -2.31 to -0.93; P < .00001), and patient satisfaction (Std. MD = 1.15; 95% CI = 0.73 to 1.58; P < .00001).

CONCLUSIONS

Dexamethasone supplementation has importantly positive influence on pain control for knee arthroscopy.

Single-center experience in the treatment of extremely medial clavicle fractures with vertical fixation of double-plate: A retrospective study

Patients suffering from extremely medial clavicle fractures combined with distinct displacement generally need surgical intervention. Double-plate fixation is a widely applied technique in the treatment of distal radius fracture, which has been reported to fix lateral clavicle fracture as well. This study reveals the effect of double-plate fixation as an innovative procedure in the treatment of extremely medial clavicle fractures for the first time.Nine patients complaint of extremely medial clavicle fracture were enrolled in this research from May 2017 to March 2019. Patients were operated with an open reduction and internal fixation using the double-plate technique. Postoperative x-ray was taken regularly to observe the fracture healing at each visit, and the related complications were also recorded. The rating score systems of Constant Murley score of treated shoulder and contralateral shoulder, ROWE score as well as American Shoulder and Elbow Surgeons (ASES) were evaluated to comment on the postoperative shoulder joint function.All patients achieved postoperative fracture healing with no complications. Only 1 patient complained of slight restriction, 2 patients complained of pain during overhead work, and another patient was found with plate breakage. Meanwhile, the Constant Murley scores of treated and contralateral shoulder were 94.1 and 98.5 points, respectively, indicating the similar shoulder function. Furthermore, the ROWE and ASES scores of the involved shoulder were 96.7 and 96.3 points at average, respectively.It is the first time to introduce the surgical technique of vertical double-plate fixation implied in stable fixation of extremely medial clavicle fractures, which could provide the surgeons with an alternative method for this type of fracture.

[Value of lenvatinib for the treatment of advanced hepatocellular carcinoma]

Objective: To observe the safety and efficacy of lenvatinib for the treatment of medium-advanced hepatocellular carcinoma. Methods: A total of 36 patients with medium-advanced hepatocellular carcinoma from the First Medical Center of the Chinese PLA General Hospital were retrospectively analyzed from January 2018 to May 2019. All patients had shown tumor progression after at least 2 sessions of TACE. The patients were consisted of 30 males and 6 females with age range of 35 to 76 (54±10) years. Patients received orally administered lenvatinib at a dose of 12 mg once daily for patients ≥ 60 kg and 8 mg once daily for patients<60 kg. According to modified RECIST criteria the tumor response, disease control rate, overall survival and progression free survival were evaluated once every 6-8 weeks. The adverse events were recorded. Results: No patient was in complete response, 2 cases (5.7%) in partial response, and 5 cases (14.3%) in stable disease, respectively. Disease control rate was 20.0% (7/35), the overall survival was 11.5 months, and the progression free survival was 5.3 months. The overall incidence of adverse events was 66.7% (24/36). The most frequent adverse events were hypertension, proteinuria, hand-foot skin reaction and abdominal distension. Conclusion: Lenvatinib can extend the overall survival in a percentage of medium-advanced hepatocellular carcinoma patients who were unresectable and refractory to TACE. Although the incidence of adverse events is high, most of them are mild and reversible.

Novel anterior curved incision combined with MIPO for Pilon fracture treatment

Backgrounds

Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues.

Methods

Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient’s ankle pain, and related complications were also recorded.

Results

The mean time for fracture healing was 3.6 months (range: 3–6 months). According to Mazur’s criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up.

Conclusions

This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.

Transarterial embolisation with bleomycin and N-butyl-2-cyanoacrylate -Lipiodol mixture for symptomatic polycystic liver disease: preliminary experience

AIMS

To evaluate the therapeutic effect and safety of transarterial embolisation using a bleomycin-Lipiodol mixture and N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture (BNL) for the treatment of polycystic liver disease (PLD).

MATERIALS AND METHODS

From June 2012 to July 2018, a total of consecutive 14 symptomatic patients (13 women and 1 man; mean age, 49.3±9.9 years) with PLD were referred and underwent transcatheter arterial embolisation (TAE) with BNL.

RESULTS

Technical success was achieved in all cases. PLD-related severe symptoms were improved remarkably in 13 of the treated patients. The mean maximum abdominal circumference decreased significantly from 100.6±9.4 to 94.9±9.1 cm (p<0.01). The total liver volume decreased significantly compared with pre-TAE in 13 patients at 6-12 months after TAE. It decreased from 9,776±2,219 to 8,303±2,009 cm³ (p<0.01). There were no major complications associated with the procedure.

CONCLUSION

TAE with the bleomycin-Lipiodol mixture and NBCA-Lipiodol mixture may be an effective method for treating symptomatic PLD patients, with improvement of symptoms and shrinkage of cyst volume.

[A comparative study of prostatic artery embolization in the treatment of benign prostatic hyperplasia with different prostatic volume]

Objective: To compare the efficacy of prostatic artery embolization (PAE) in the treatment of patients with benign prostatic hyperplasia (BPH) with different prostatic volume (PV). Methods: In this single-center, retrospective study, 137 patients, mean age (70±11) years, range 50-89 years, undergoing PAE for BPH between January 2015 and May 2017 in Chinese PLA General Hospital were involved and divided into three groups according to the PV (group A, >80 ml; group B, 40-80 ml; group C, <40 ml). The changes of international prostate symptoms (IPSS) score, quality of life (QoL) score, and maximum urinary flow rate (Q(max)) were compared among the three groups at 1, 6, and 12 months post-PAE. Correlation between the proportion of prostate ischemia at 1 month post-PAE and the proportion of PV reduction at 12 month post-PAE were analyzed, also the correlation between both of them with IPSS and QoL score were analyzed, respectively. Results: Mean baseline prostate volumes were 110 ml in group A (n=62), 67 ml in group B (n=47) and 33 ml in group C (n=28). At 12 months post-PAE, the outcomes of IPSS score and Q(max) in group A were better than those in group B and C (all P<0.05).The proportion of prostate ischemia at 1 month post-PAE and proportion of PV reduction at 12 month post-PAE in group A, B, and C were 61.4%, 49.3%, 38.0%, and 47.3%, 29.3%, 24.6%, respectively. The proportion of prostate ischemia in group A was larger than that in group B and C (P=0.049, 0.004), also the proportion of PV reduction in group A was greater than that in group B and C (P<0.01). The proportion of prostate ischemia at 1 month post-PAE in all three groups were positively correlated with the proportion of PV reduction at 12 month post-PAE (r=0.699, P=0.024; r=0.719, P=0.019; r=0.821, P=0.004), and there were positive correlations between both of them and the improvement of IPSS score at 12 month post-PAE (0.5<r<1.0, all P<0.05), while no correlation with the improvement of QoL score. Conclusions: Patients with BPH with PV larger than 80 ml are more suitable for PAE. The proportion of prostate ischemia and prostate volume reduction after PAE can predict the efficacy of PAE.

Effects of gangliosides on expressions of caspase-3 and NGF in rats with acute spinal cord injury

OBJECTIVE

To investigate the effects of ganglioside [monostalotetra-hexosylganglioside (GM1)] on the expressions of caspase-3 and nerve growth factor (NGF) in rats with acute spinal cord injury (SCI).

MATERIALS AND METHODS

Male Sprague- Dawley (SD) rats were selected and randomly divided into Sham group, SCI group and GM1 administration group. The rats in Sham group, SCI group and GM1 group were subjected to behavioral examinations of Basso Beattie Bresnahan (BBB) and oblique-plate test at 1, 7 and 14 d after operation. The content of methylene dioxyamphetamine (MDA) and the activity of superoxide dismutase (SOD) of every rat in each group were measured by enzyme-linked immunosorbent assay (ELISA). Immunofluorescence staining assay was used to detect the expression levels of caspase-3 and NGF of rats in each group. The messenger ribonucleic acid (mRNA) and protein expressions of caspase-3 and NGF of rats in Sham group, SCI group and GM1 group were detected using reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blotting assay.

RESULTS

The BBB scores and the results of oblique-plate test in Sham group, SCI group and GM1 group at 1, 7 and 14 d showed that the BBB scores and the results of oblique-plate test of rats in each group were significantly decreased at 1 d after SCI, and had different degrees of recovery at 7 and 14 d after injury. The results of ELISA detection revealed that SCI group had increased content of MDA and clearly decreased activity of SOD in comparison with Sham group; at the same time, MDA content in GM1 group was overtly lower than that in SCI group, while SOD activity was enhanced evidently in GM1 group compared with that in SCI group. According to immunofluorescence assay, significantly increased expression of caspase-3 and distinctly decreased expression of NGF were found in SCI group. However, this phenomenon was significantly reversed by GM1. RT-PCR and Western blotting assay severally proved that the mRNA and protein expressions of caspase-3 were raised in SCI group and decreased clearly after the administration of GM1; while the mRNA and protein expressions of NGF was significantly reduced in SCI group and overtly elevated after the administration of GM1. ANOVA showed that there were statistically significant differences in expressions of caspase-3 and NGF among Sham group, SCI group and GM1 group (p<0.05).

CONCLUSIONS

GM1 has an evident effect on the expressions of caspase-3 and NGF in rats with acute SCI, and is able to down-regulate the expression of caspase-3 and up-regulate the expression of NGF, so as to achieve its therapeutic effect on SCI.

Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) Combined with Onionskin-Like Autologous Bone Grafting: A New Technique for Treatment of Tibial Nonunion

BACKGROUND Established tibial nonunions rarely heal without secondary intervention; revision surgery is the most common intervention. Herein, we evaluated the clinical outcomes of patients with tibial nonunion treated with a new technique - minimally invasive percutaneous plate osteosynthesis (MIPPO) - combined with a new onionskin-like autologous bone grafting method. MATERIAL AND METHODS From 2010 to 2013, 18 patients with tibial nonunions (average bone defect: 9.5 mm) were treated with MIPPO technology combined with onionskin-like autologous bone grafting. Indices for clinical evaluation included operative time, fluoroscopy time, blood loss, hospital stay, healing time, postoperative complaints, radiographic performances, the Short Musculoskeletal Function Assessment (SMFA) questionnaire, and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. RESULTS The average operation and fluoroscopy times for tibial nonunion were 65 min and 15.5 s, respectively, with a total blood loss of 107.7 mL. The mean duration of hospital stay was 12.8 days. The mean follow-up time was 11.9 months, and all patients achieved radiologically confirmed bony healing in an average time of 13.1 weeks. No lower-leg deformity, fixation failure, infection, and vascular, or nerve injuries were recorded in any patient, and only 4 patients complained of slight limb pain upon total weight-bearing at the end of follow-up. The SMFA and AOFAS ankle-hindfoot scores of patients were graded excellent in 14 (77.8%) and good in 4 (22.2%), indicating high functional recovery. CONCLUSIONS MIPPO technology combined with onionskin bone grafting is an efficient method to treat patients with tibial nonunion, especially for patients with poor soft tissue condition.

Injectable Cholesterol-Enhanced Stereocomplex Polylactide Thermogel Loading Chondrocytes for Optimized Cartilage Regeneration

Ideal cartilage tissue engineering requires scaffolds featuring good biocompatibility, large pore structure, high mechanical strength, as well as minimal invasion procedure. Although significant progress has been made in the development of polymer scaffolds, the construction of smart systems with all the desired properties is still emerging as a challenge. The thermogels of stereocomplex 4-arm poly(ethylene glycol)-polylactide (PEG-PLA) (scPLA_gel ) and stereocomplex cholesterol-modified 4-arm PEG-PLA (scPLA-Chol_gel ) from the equimolar enantiomeric 4-arm PEG-PLA and 4-arm PEG-PLA-Chol, respectively, are fabricated as scaffolds for cartilage tissue engineering. scPLA-Chol_gel shows lower critical gelation temperature, higher mechanical strength, larger pore size, better chondrocyte adhesion, and slower degradation compared to scPLA_gel as the benefit of cholesterol modification, which is more appropriate for cartilage regeneration. Moreover, the preservation of morphology, biomechanical property, cartilaginous specific matrix, as well as cartilaginous gene expressions of engineered cartilage mediated by scPLA-Chol_gel are proven superior to those by scPLA_gel . scPLA-Chol_gel serves as a promising chondrocyte carrier for cartilage tissue engineering and gives an alternative solution to clinical cartilage repair.

Surgical versus nonsurgical treatment of primary acute patellar dislocation: A systematic review and meta-analysis

BACKGROUND

To systematically review the efficacy of surgical versus nonsurgical treatment for acute patellar dislocation.

MATERIALS AND METHODS

PubMed, Cochrane, and Embase were searched up to February 12, 2019. After removing duplicates, preliminary screening, and reading the full texts, we finally selected 16 articles, including 11 randomized controlled trials and 5 cohort studies. The quality of the enrolled studies was evaluated by Jadad score or Newcastle-Ottawa scale. Meta-analyses were performed using odds ratio (OR) and standardized mean difference (SMD) as effect variables. The clinical parameters assessed included mean Kujala score, rate of redislocation, incidence of patellar subluxation, patient satisfaction, and visual analog scale (VAS) for pain. Evidence levels were determined using GRADE profile.

RESULTS

The 16 included studies involved 918 cases, 418 in the surgical group and 500 in the nonsurgical group. The results of the meta-analysis showed higher mean Kujala score (SMD = 0.79, 95% confidence interval [CI] [0.3, 1.28], P = .002) and lower rate of redislocation (OR = 0.44, 95% CI [0.3, 0.63], P < .00001) in the surgical group than the nonsurgical group, but showed insignificant differences in the incidence of patellar subluxation (OR = 0.61, 95% CI [0.36, 1.03], P = .06), satisfaction of patients (OR = 1.44, 95% CI [0.64, 3.25], P = .38), and VAS (SMD = 0.84, 95% CI [-0.36, 9.03], P = .84).

CONCLUSION

For patients with primary acute patellar dislocation, surgical treatment produces a higher mean Kujala score and a lower rate of redislocation than nonsurgical treatment.

Abstract P4-06-30: Adipose PD-L1 modulates checkpoint blockade immunotherapy efficacy in breast cancer

Programmed death-ligand 1 (PD-L1) and its receptor programmed cell death protein 1 (PD-1) play important roles in modulating antitumor immune response and are targeted by checkpoint blockade immunotherapy. While PD-L1 expression in both tumor and host cells is associated with antitumor therapeutic efficacy, the exact contribution of PD-L1 in various tissue and cell compartments to antitumor immune response remains to be elucidated. Here we show that PD-L1 expression is markedly elevated in human and mouse mature adipocytes compared to their preadipocyte counterparts. When co-cultured with mouse splenocytes in vitro, adipocytes prevent anti-PD-L1 antibody from activating CD8+T cells. Genetic ablation of adipose PD-L1 obliterates the inhibitory effect of adipocytes on anti-PD-L1 antibody. Conversely, enforced PD-L1 expression in preadipocytes confers the antibody-inhibitory activity. GW9662, a pharmacologic inhibitor of peroxisome proliferator-activated receptor γ (PPARγ) in adipogenesis, selectively reduces PD-L1 expression in mouse adipose tissue. The same PPARγ antagonist also enhances the antitumor efficacy of checkpoint blockade antibodies for treating multiple mammary tumors. Our findings provide a previously unappreciated approach to bolster anticancer immunotherapy efficacy and suggest a mechanism for the role of adipose tissue in breast cancer progression.

Citation Format: Wu B, Sun X, Gupta HB, Yuan B, Ge F, Li J, Hu Y, Curiel TJ, Li R. Adipose PD-L1 modulates checkpoint blockade immunotherapy efficacy in breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-06-30.

Non-dislocation lunate fracture combined with distal radius fracture: A case report

RATIONALE

Lunate fractures are very rare, accounting for only 0.5% to 6.5% of all carpal fractures. They are mostly caused by high-energy trauma and commonly occur with fractures and dislocations of other carpal bones. It is rarely combined with Colles' fracture and the underlying pathogenesis and prognostic significance still remain controversial.

PATIENT CONCERNS

Here we report a case of a fresh lunate fracture combined with Colles' fracture, without dislocations of other carpal bones caused by a low-energy fall injury.

DIAGNOSES

Lunate fracture, Colles' fracture.

INTERVENTIONS

This patient received closed reduction and internal fixation (CRIF) with K-wire.

OUTCOMES

The patient took follow up 1 year and the patient showed good function of the wrist joint LESSONS:: Lunate fractures have no high misdiagnosis rate. Patients suffering persistent wrist swelling after a trauma should be carefully examined and followed up to prevent severe secondary diseases and wrist joint dysfunction.

[Transarterial chemoembolization with bleomycin treatment for moderate-advenced hepatocellular carcinoma]

Objective: To investigate the safety and efficacy of transarterial chemoembolization (TACE) using bleomycin for the treatment of medium-advanced hepatocellular carcinoma (HCC). Methods: Between December 2015 and December 2017, a total of 160 patients from the Chinese PLA General Hospital with moderate-advanced HCC whose diagnoses were confirmed by pathology or clinical imaging and were in accord with the Barcelona Clinic Liver Cancer (BCLC) staging criteria were prospectively analyzed.All patients had shown persistent viable tumor or tumor progression after at least 2 sessions of TACE.All patients included 135 males and 25 females , age 35-74 (57±8)years, were randomly divided into two groups, the treatment group: TACE procedures consisted of bleomycin+ pirarubicin+ oxaliplatin+ fluorouracil, the control group: pirarubicin+ oxaliplatin+ fluorouracil, and according to modified RECIST criteria the tumor response was evaluated once every 4-6 weeks, survival analysis was performed, overall survival and progression free survival were evaluated.the adverse events were recorded. Results: Response rate of the treatment group was 27.5%(22/80), the median progression free survival(mPFS)was 5.8 months, and the median overall survival (mOS) was 8.1 months.Response rate of the control group was 7.5%(6/80), mPFS of 2.9 months, and mOS of 4 months.The differences in mPFS and in mOS between the two groups were statistically significant (P=0.009, 0.002 respectively), and no serious adverse occurred. Conclusion: It is suggested that transarterial chemoembolization with bleomycin is safe and effective for medium-advenced HCC.

Partner-facilitating transmembrane penetration of nanoparticles: a biological test in silico

Transmembrane penetration of nanoparticles (NPs) promises an effective pathway for cargo delivery into cells, and offers the possibility of organelle-specific targeting for biomedical applications. However, a full understanding of the underlying NP-membrane interaction mechanism is still lacking. In this work, the membrane penetration behavior of NPs is statistically analyzed based on the simulations of over 2.2 ms, which are performed with dissipative particle dynamics (DPD). Influences from multiple factors including the NP concentration, shape and surface chemistry are taken into account. It is interesting to find that, the introduction of a partner NP would greatly facilitate the transmembrane penetration of a host spherical NP. This is probably due to the membrane-mediated cooperation between the NPs. Moreover, the proper selection of a partner NP with specific surface chemistry is of great significance. For example, the best partner for a hydrophilic NP to achieve transmembrane penetration is a Janus-like one, in comparison with the hydrophilic, hydrophobic or randomly surface-decorated NPs. Furthermore, such a partner-facilitating effect in NP translocation also works for a shaped NP although less pronounced. Our results are helpful for a better understanding of the complicated nano-bio interactions, and offer a practical guide to the NP-based drug delivery strategy with high efficiency.

Development of a New Inflow Valve for a 20cc Semisoft Ventricle: Preliminary Results

We remodeled and tested our semisoft 20cc ventricle and made a new bileaflet flap inflow valve. Housings, bases, outflow valve, and a newly designed diaphragm were all made by vacuum forming and put together by radiofrequency welding or glue. In vitro, the ventricle produced a cardiac output of 2.5 to 3.0 L/min and showed reliable durability results. Hematological testing showed no important thrombogenecity of the new valve. Cardiac output was higher than expected for the volume of the ventricle, perhaps because of stretching or flow through. Animal experiments with the left ventricular assist device (LVAD) version was done at Ohio State University. Earlier in Utah, we did 20 cc total artificial heart (TAH) implantations and LVAD experiments in lambs and recently in calves with the 60cc TAH version. A soft ventricle is easy to implant and low in production costs.

[Effects of denatured collagen type Ⅰ on differentiation of human fibroblasts into myofibroblasts]

Objective: To investigate the effects of denatured collagen type Ⅰ on differentiation of human fibroblasts into myofibroblasts. Methods: A small amount of normal skin donated by burn patients undergoing scar surgery was collected. Human fibroblasts were obtained by method of explant culture and then sub-cultured. The fourth passage of cells were used in the following experiments. (1) Fibroblasts were divided into normal collagen group and denatured collagen group according to the random number table, with 10 wells in each group. Fibroblasts in normal collagen group were cultured on normal collagen type Ⅰ coated coverslips. Fibroblasts in denatured collagen group were cultured on denatured type Ⅰ collagen coated coverslips. Expression of proliferating cell nuclear antigen (PCNA) was detected by immunohistochemical method, and the percentage of PCNA positive cells was calculated. (2) Another batch of fibroblasts were grouped and treated as in (1), with 12 wells in each group. Proliferation activity of cells was determined with methyl-thiazolyl-tetrazolium colorimetry method. (3) Another batch of fibroblasts were grouped and treated as in (1), and the microfilament morphology of cells was observed by rhodamine-phalloidin staining. (4) Another batch of fibroblasts were grouped and treated as in (1). Expression of α smooth muscle actin (α-SMA) of cells was detected by immunohistochemical method, and expression of OB-cadherin of cells was detected by immunofluorescence method. (5) Another batch of fibroblasts were divided into normal collagen, denatured collagen, and common coverslips groups according to the random number table, with 6 wells in each group. Fibroblasts in normal collagen and denatured collagen groups were treated as in (1), while fibroblasts in common coverslips group were cultured on coverslips without collagen coating. Expressions of α-SMA and OB-cadherin of cells were determined with Western blotting. (6) Another batch of fibroblasts were grouped and treated as in (5), and then the mRNA expressions of collagen type Ⅰ, collagen type Ⅲ, and α-SMA of cells were determined with real-time fluorescent quantitative reverse transcription polymerase chain reaction. Data were processed with t test, one way analysis of variance, and least-significant difference test. Results: (1) The percentage of PCNA positive cells in denatured collagen group was (83±9)%, significantly higher than (29±9)% in normal collagen group (t=13.53, P<0.01). (2) The proliferation activity of fibroblasts in denatured collagen group was 0.32±0.06, significantly higher than 0.25±0.05 in normal collagen group (t=3.06, P<0.01). (3) The microfilament of fibroblasts in normal collagen group was arranged vertically and in parallel way, paralleling the long axis of cells. The microfilament of fibroblasts in denatured collagen group was denser and thicker. (4) Most fibroblasts in normal collagen group showed long shuttle-like shape typically. Morphology of fibroblasts in denatured collagen group changed, and cells were obviously spreading. Expressions of α-SMA and OB-cadherin of fibroblasts in denatured collagen group were stronger than those in normal collagen group. (5) Expressions of α-SMA of fibroblasts in denatured collagen, normal collagen, and common coverslips groups were respectively 1.69±0.41, 0.89±0.27, and 1.46±0.42. Expression of α-SMA of fibroblasts in denatured collagen group was significantly higher than that in normal collagen group (P<0.01). Expressions of OB-cadherin of fibroblasts in denatured collagen, normal collagen, and common coverslips groups were respectively 5.17±0.28, 2.21±0.10, and 4.01±0.56. Expression of OB-cadherin of fibroblasts in denatured group was significantly higher than that in normal collagen group (P<0.01). (6) There was no significant difference in mRNA expression of collagen type Ⅰ of fibroblasts in denatured collagen, normal collagen, and common coverslips groups (F=2.71, P>0.05). The mRNA expressions of collagen type Ⅲ and α-SMA of fibroblasts in normal collagen group were significantly lower than those in denatured collagen group (P<0.01). Conclusions: Denatured collagen type Ⅰ may influence the activity of fibroblasts, thus inducing fibroblasts differentiating into myofibroblasts.