Trifocal versus Pentafocal bone transport in segmental tibial defects: a matched comparative analysis for posttraumatic osteomyelitis treatment

PURPOSE

The objective of this study was to evaluate and compare the effectiveness and clinical results of trifocal bone transport (TBT) and pentafocal bone transport (PBT) in treating distal tibial defects > 6 cm resulting from posttraumatic osteomyelitis, highlighting the potential advantages and challenges of each method.

METHODS

A retrospective assessment was conducted on an overall population of 46 eligible patients with distal tibial defects > 6 cm who received treatment between January 2015 and January 2019. Propensity score analysis was used to pair 10 patients who received TBT with 10 patients who received PBT. The outcomes assessed included demographic information, external fixation time (EFT), external fixation index (EFI), bone and functional outcomes assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system, and postoperative complications evaluated using the Paley classification.

RESULTS

The demographic and baseline data of the two groups were comparable. Following radical debridement, the average tibial defect was 7.02 ± 0.68 cm. The mean EFT was significantly shorter in the PBT group (130.9 ± 16.0 days) compared to the TBT group (297.3 ± 14.3 days). Similarly, the EFI was lower in the PBT group (20.67 ± 2.75 days/cm) than in the TBT group (35.86 ± 3.69 days/cm). Both groups exhibited satisfactory postoperative bone and functional results. Pin site infection was the most common complication and the rates were significantly different between the groups, with the PBT group demonstrating a higher incidence.

CONCLUSION

Both TBT and PBT effectively treat posttraumatic tibial defects greater than 6 cm, with PBT offering more efficient bone regeneration. However, PBT is associated with a higher rate of pin site infections, highlighting the importance of careful management in these complex procedures and emphasizing the need for expert surgical execution and tailored treatment approaches in orthopedic reconstructive surgery.

Characterization of the H2/NOx reaction process over the La0.9Ce0.1Co0.9Pd0.1O3-BaO/Al2O3 catalyst

An excellent textual properties and performance La0.9Ce0.1Co0.9Pd0.1O3-BaO/Al2O3 catalyst was synthesized. The reaction mechanism of H2/NOx over the La0.9Ce0.1Co0.9Pd0.1O3-BaO/Al2O3 catalyst was investigated by temperature programmed reduction/ desorption/ surface reaction (TPR/D/SR) technologies and in-situ diffuse reflectance Fourier transform (DRIFT) technology. The results show that cerium or palladium species are inserted into the cells of LaCoO3, as well as they synergetic promote the redox properties of the La0.9Ce0.1Co0.9Pd0.1O3-BaO/Al2O3 catalyst. Surface activated nitrates exist over the La0.9Ce0.1Co0.9Pd0.1O3-BaO/Al2O3 catalyst, with thermal stable increasing in the order: absorbed N2O4 < monodentate nitrates < chelating bidentate nitrates < nitrates unidentate < free ionic nitrates < bulk free ionic nitrates. H2 preferentially reacted with absorbed N2O4 and monodentate nitrates at low temperatures, due to their high activity. The concentration of generated NH3 from the redox reaction of H2/NOx achieves the maximum value between 350 and 450 °C over the La0.9Ce0.1Co0.9Pd0.1O3-BaO/Al2O3 catalyst. Compared with the NOx adsorption process at 50 °C, monodentate nitrates and absorbed N2O4 disappeared due to their low thermal stability, chelating bidentate nitrates become stronger, as well as free ionic nitrates converted to bulk free ionic nitrates with higher thermal stability at 350 °C. When H2 is exposed to NOx species adsorbed on La0.9Ce0.1Co0.9Pd0.1O3-BaO/Al2O3, chelating bidentate nitrates and bulk free ionic nitrates are consumed gradually, indicating that although the bulk free ionic nitrates own high stability, it also could be consumed by involving in the H2/NOx reaction at 350 °C. The quantitative H2/NO reaction experiments confirmed the results of H2-TPSR and NSR. It is beneficial to the formation of NH3 when the H2/NO ratio is more than 2.5. Comparing traditional Pt-BaO/Al2O3 catalyst, the La0.9Ce0.1Co0.9Pd0.1O3-BaO/Al2O3 catalyst exhibit an excellent performance, including considerable NH3 production property, lower N2O selectivity, and the precious metal saving.

A predictive scoring model to select suitable patients for surgery on primary tumor in metastatic esophageal cancer

BACKGROUND

Surgery on primary tumor (SPT) has been a common treatment strategy for many types of cancer.

AIMS

This study aimed to investigate whether SPT could be considered a treatment option for metastatic esophageal cancer and to identify the patient population that would benefit the most from SPT.

METHODS

Data from 18 registration sites in the Surveillance, Epidemiology, and End Results Program database (SEER database) were analyzed to select patients with metastatic esophageal cancer. Multivariate Cox regression analysis was used to identify potential risk factors for pre-treatment survival. Variables with a p-value of less than 0.05 were used to construct a pre-treatment nomogram. A pre-surgery predictive model was then developed using the pre-surgery factors to score patients, called the "pre-surgery score". The optimal cut-off value for the "pre-surgery score" was determined using X-tile analysis, and patients were divided into high-risk and low-risk subsets. It was hypothesized that patients with a low "pre-surgery score" risk would benefit the most from SPT.

RESULTS

A total of 3793 patients were included in the analysis. SPT was found to be an independent risk factor for the survival of metastatic esophageal cancer patients. Subgroup analyses showed that patients with liver or lung metastases derived more benefit from SPT compared to those with bone or brain metastases. A pre-treatment predictive model was constructed to estimate the survival rates at one, two, and three years, which showed good accuracy (C-index: 0.705 for the training set and 0.701 for the validation set). Patients with a "pre-surgery score" below 4.9 were considered to have a low mortality risk and benefitted from SPT (SPT vs. non-surgery: median overall survival (OS): 24 months vs. 4 months, HR = 0.386, 95% CI: 0.303-0.491, p < 0.001).

CONCLUSION

This study demonstrated that SPT could improve the OS of patients with metastatic esophageal cancer. The pre-treatment scoring model developed in this study might be useful in identifying suitable candidates for SPT. The strengths of this study include the large patient sample size and rigorous statistical analyses. However, limitations should be noted due to the retrospective study design, and prospective studies are needed to validate the findings in the future.

Development of a risk model based on immune genes in patients with colon adenocarcinoma

BACKGROUND

The rapidly increasing morbidity and the poor prognosis making the colon adenocarcinoma not only common but also highly malignant. On the other hand, immunotherapy emerges as a therapeutic modality of colon cancer recently. In this study, we developed a prognostic risk model that is based on immune genes, which could predict the overall survival (OS) of patients with colon adenocarcinoma.

METHODS

The Cancer Genome Atlas (TCGA) database was used to download both transcriptomic and clinical data, and the ImmPort database was used to obtain immune genes. The least absolute shrinkage and selection operator (LASSO)-Cox regression was adopted to further select the key genes with prognostic value. Then the key genes were inputted into stepwise regression to calculated each patient's immune-related risk score (immune score). Survival, survminer packages and bilateral tests in R language were adopted to determine the optimal cut-off value (cut-off value) for the risk score. This threshold divides patients into immune-score high-risk and low-risk groups. The differences in the levels of infiltrating immune cells and stromal cells in the high and low immune risk groups were then calculated and compared by the CIBERSORT algorithm.

RESULTS

According to our results, a prognostic risk model was constructed based upon 26 immune-related genes. High immune score was shown to be a poor prognostic factor for colon adenocarcinoma patients, such as overall survival, progress free survival for different therapies, and tumor stages. High immune score was also associated with the abundance of CD4+ T cells and CD8+ T cells. In addition, the high immune score group, the expression levels of LMTK3, LAG3 and PD-L1 were higher than those in the low score group.

CONCLUSION

We developed a 26-immune gene model of colon adenocarcinoma to predict patient's survival. This model might be used in clinical practice as a prognostic instrument for patients diagnosed with colon adenocarcinoma.

Understanding the reaction kinetics of diesel exhaust soot during oxidation process

The purpose of the present study is to better understand the reaction kinetics of diesel exhaust soot during oxidation process. A thermogravimetric analyzer was used to oxidize real diesel exhaust soot generated from a Euro VI diesel engine under non-isothermal conditions. The Friedman-Reich-Levi method and the Sestak-Berggren model were used to determine the oxidation kinetics. Raman spectroscopy and high-resolution transmission electron microscopy were employed to follow the changes of the soot structure during oxidation. The activation energy gradually increased with increasing conversion level during soot oxidation. The oxidation process of diesel exhaust soot could be described as three-step kinetics, and the calculated conversions fitted the experimental results very well. The kinetic predictions of diesel soot oxidation that were obtained using the proposed kinetic models were more accurate and precise than those with the common first-order model. The structural order increased as oxidation progressed, which was responsible for the increased activation energy. The structural ordering was principally caused by the preferential oxidation of the disordered fraction in the diesel soot, especially for the amorphous carbon, which was oxidized in the initial stage of the oxidation reaction.

Effects of substituting iron for aluminum on the low-temperature catalytic activity and sulfur resistance of hydrotalcite-derived LNT catalysts

The storage and reduction of NOx on a series of Fe-modified hydrotalcite-based lean NOx trap catalysts were assessed, together with the product selectivity. The crystal structures and micromorphologies of these materials were characterized using X-ray diffraction and scanning electron microscopy, while in situ diffuse reflectance Fourier transform infrared spectroscopy was used to evaluate the evolution of transition state species. The introduction of Fe was found to improve the synergistic interaction between the Mg and Fe in the hydrotalcite structure, allowing these catalysts to work efficiently at low temperatures. In addition, both Pt/BaO/MgAlO and Pt/BaO/MgFeO catalysts exhibited better NOx adsorption and reduction performance compared with Pt/BaO/Al₂O₃. The superior performance of the former two materials was attributed to the enhanced adsorption of NOx in the form of nitrates and nitrites by Fe and Mg and to the ready decomposition of these nitrates at low temperatures. A Pt/BaO/MgFeO catalyst showed excellent low temperature activity and high selectivity for N₂ together with superior sulfur resistance compared with Pt/BaO/Al₂O₃.

Chinese Medicine Syndrome Differentiation for Early Breast Cancer: A Multicenter Prospective Clinical Study

Background

Chinese medicine (CM) syndrome differentiation is one of the fundamental principles that guide the practice of Chinese herbal medicine (CHM). CHM has been widely used among breast cancer patients. Contemporary literature varies in syndrome diagnosis, and there is a need to standardize syndrome differentiation according to the different stages of breast cancer treatment. This multicenter clinical study aims to identify the CM syndromes and the clinical signs and symptoms in women with early breast cancer.

Methods

Participants who met the inclusion and exclusion criteria were interviewed during the five treatment stages: preoperative, postoperative, chemotherapy, radiation therapy, and endocrine therapy. Patient demographic data and CM syndrome (as recorded by the treating CM clinicians in medical records) were gathered. Signs and symptoms were analyzed using descriptive statistics to derive the standardized CM syndromes using hierarchical cluster analysis.

Results

The analysis included 964 interviews with 620 participants enrolled between April 29, 2020 and May 30, 2021 from eight participating hospitals in China. The two most frequent syndromes recorded in medical records were dual deficiency of qi and blood, and dual deficiency of qi and yin during all but the preoperative stage. The symptoms of lassitude, lack of strength, and insomnia were common in all but the preoperative stage. Cluster analysis identified two clusters in the preoperative stage that most closely resembled the syndrome diagnoses of liver stagnation with congealing phlegm, and dual deficiency of the liver and kidney. Two clusters—dual deficiency of qi and blood, and dual deficiency of qi and yin—were common to multiple treatment stages. The syndrome cluster of spleen and stomach disharmony existed in both the postoperative and chemotherapy stages. Cluster analysis of the radiation therapy stage identified the unique syndrome of yin deficiency with fire toxin, while the endocrine therapy included the syndromes of liver depression and kidney deficiency.

Conclusions

This multicenter clinical study showed consistency between results from cluster analysis and the most common syndromes recorded in the medical records. Findings from this clinical study will be further validated in a Delphi study to standardize CM syndromes for various stages of breast cancer treatment.

Clinical Trial Registration

www.chictr.org.cn/index.aspx, identifier ChiCTR2000032497.

[The Autism Spectrum Disorder Cohort-the sub-cohort of China National Birth Cohort]

Autism spectrum disorder (ASD), a representative disease of children's neurodevelopmental disorders, brings huge pressure and financial burden to families and society. It is of great significance to explore its etiology and pathogenesis. Therefore, we established an ASD Cohort based on the existing China National Birth Cohort (CNBC), which applied parallel design to recruit and follow up families who achieved pregnancy after receiving assisted reproductive technologies (ART) and families with spontaneous conception. The main aims of this study are to compare the incidence of ASD among children born after ART with those born under spontaneous pregnancy, and to evaluate the impact of ART on the neurobehavioral development of offspring. Additionally, with a variety of clinical and behavioral related information collected during pregnancy and at early life of offspring, we are able to investigate the risk factors associated with ASD comprehensively. This article briefly introduces the objectives, contents, preliminary progress, strength and limitations, as well as further prospects of the ASD cohort study, mainly focusing on the overall design and current progress.

[Application of cloud-based information platform in China National Birth Cohort]

Birth cohort is an important observational study which can continuously and dynamically collect the exposure changes and health outcomes from gametophyte development to adolescence and even old age. However, because of its complex design and difficult implementation, how to construct birth cohort with high quality and high efficiency is the main difficulty faced by epidemiologists at home and abroad. In 2016, China National Birth Cohort was officially launched. The network and information technology were used to explore, and a set of "cloud-based information platform" was established to support this queue construction, containing 16 units in China. After four years of development, the platform has formed a complete set of programs about the construction of cohort information platform, which including recruitment and follow-up management of participants, real-time data interaction, queue quality control, multi-level authority management and function division. The relevant design framework and functional elements provide the references to the future information construction of large-scale birth cohort and even population-based research in China.

miR-518a-3p Suppresses Triple-Negative Breast Cancer Invasion and Migration Through Regulation of TMEM2

MicroRNAs (miRNAs) are emerging as critical mediators in tumors, including triple-negative breast cancer (TNBC). The role of miR-518a-3p in TNBC was investigated to identify potential therapeutic target. Data from KM Plotter database (www.kmplot.com) showed that high miR-518a-3p expression was significantly associated with overall survival of patients with TNBC (p = 0.04). The expression of miR-518a-3p was dysregulated in TNBC cells. Functional assays revealed that over-expression of miR-518a-3p inhibited cell invasion and migration of TNBC. Additionally, miR-518a-3p could target TMEM2 (transmembrane protein 2), and decreased protein and mRNA expression of TMEM2 in TNBC cells. Knockdown of TMEM2 suppressed cell invasion and migration through inhibiting phospho (p)-JAK1 (Janus kinase 1) and p-STAT (signal transducer and activator of transcription protein) 1/2. Moreover, over-expression of TMEM2 counteracted the suppressive effect of miR-518a-3p on TNBC invasion and migration through promoting the levels of p-JAK1 and p-STAT1/2. In conclusion, miR-518a-3p negatively regulates the JAK/STAT pathway via targeting TMEM2 and suppresses invasion and migration in TNBC, suggesting that miR-518a-3p may be a potential therapeutic target in TNBC.

Clinical significance of epithelial-mesenchymal transition typing of circulating tumour cells in colorectal cancer

AIM

The aim was to determine the diagnostic value of epithelial-mesenchymal transition typing of circulating tumour cells (CTCs) in colorectal cancer (CRC).

METHOD

Peripheral blood samples were collected from 51 CRC patients before anti-tumour treatment from April 2016 to June 2018 at the Peking University Shenzhen Hospital. The blood samples were analysed using the CanPatrol CTC typing technique (SurExam, Guangzhou, China), which combines nanomembrane enrichment with mRNA in situ hybridization. Based on the marker expression, the CTCs were classified into epithelial, epithelial mesenchymal and mesenchymal (M-CTC) types. The correlation between the CTC counts and clinicopathological characteristics such as gender, age, TNM stage, lymph node metastasis and distant metastasis were analysed by univariate and multivariate Cox regression models. The overall survival and progression-free survival (PFS) of patients demarcated by CTC typing were analysed using the Kaplan-Meier method and log-rank tests.

RESULT

M-CTCs were detected more frequently in patients with lymph node metastasis (N2 81.8%; N1 72.7%; N0 38.9%) as well as distant metastasis (M0 50%; M1a 81.25%; M1b 85.7%) compared to those without metastasis. In addition, the presence of M-CTCs was significantly correlated with distant metastasis (P < 0.01). Univariate analysis showed that lymph node metastasis (P = 0.035), distant metastasis (P < 0.001) and total CTC count ≥ 4 (P = 0.007) and M-CTC count ≥ 1 (P < 0.001) were significantly associated with unfavourable PFS, and lymph node metastasis (P = 0.04), distant metastasis (P = 0.01) and M-CTC count ≥ 1 (P < 0.001) were significantly associated with unfavourable overall survival. Multivariate analysis showed that the presence of M-CTCs was the only independent prognostic factor for poor PFS, and patients with M-CTCs had significantly shorter PFS than those without (P = 0.011).

CONCLUSION

M-CTCs are significantly associated with CRC severity and metastasis, and M-CTC count is an independent predictor of prognosis.

[The 477th case: muscular spasms, alopecia, diarrhea]

Diarrhea is a common digestive symptom. Here, we reported a case of young patient admitted with diarrhea caused by lead poisoning and cytomegalovirus infection. Through informative medical history and multi-disciplinary team discussion, Satoyoshi syndrome was finally diagnosed.

Three-Column Classification for Acetabular Fractures: Introduction and Reproducibility Assessment

BACKGROUND

The Judet-Letournel classification has been widely used to diagnose acetabular fractures since it was proposed. However, there has been growing evidence of incompleteness and comprehension difficulty in this classification, which may adversely affect its clinical use. The purposes of this study were to introduce a novel 3-column classification system for acetabular fractures and to evaluate its reliability and reproducibility.

METHODS

A total of 1,028 patients with acetabular fractures, who had undergone surgical treatment from June 2011 to January 2017 in 7 level-I trauma centers, were recruited into this study. Preoperative radiographs and computed tomographic (CT) scans were conducted for each patient. To evaluate the reproducibility of the 3-column classification system for acetabular fractures, the interobserver and intraobserver reliability (kappa coefficient, κ) of this classification system compared with those of the Judet-Letournel classification system was investigated by 4 observers.

RESULTS

A total of 209 patients (20.33%) could not be classified by the Judet-Letournel classification, and 3 cases (0.29%) could not be classified by the novel 3-column classification. The mean κ value of the interobserver reliability for the Judet-Letournel classification was 0.591 (range, 0.508 to 0.681), indicating moderate agreement, whereas the mean κ value was 0.735 (range, 0.594 to 0.930), indicating substantial agreement, when using the 3-column classification. The mean κ value for the intraobserver reliability was 0.751 (range, 0.708 to 0.793) for the Judet-Letournel classification and 0.909 (range, 0.792 to 0.957) for the 3-column classification.

CONCLUSIONS

The 3-column classification, based on the anatomic character of the acetabulum, showed higher interobserver and intraobserver reliability than the Judet-Letournel classification. Additionally, certain fracture patterns in the 3-column classification scheme generally correlated with surgical approaches. This novel classification system may be used as a supplement to the traditional Judet-Letournel classification system.

CLINICAL RELEVANCE

The 3-column concept of the acetabulum proposed in this study is helpful to master acetabular fractures for less experienced surgeons. The novel classification system could assist with acetabular fracture diagnosis and the choice of surgical approaches.

[The efficacy of cyclosporine A as salvage therapy for severe active ulcerative colitis refractory to glucocorticoid]

Objective: To clarify the efficacy and safety of cyclosporine A (CsA) as salvage therapy in patients with severe active ulcerative colitis (UC) and refractory to steroids. Methods: A total of 24 severe active UC patients refractory to steroids and hospitalized from 2006 to 2012, were retrospectively enrolled.Data including demographic features, clinical manifestations, laboratory tests and medications were collected. Results: CsA was effective in 15(62.5%) patients, who did not receive colectomy during 12-week administration. This regimen was tolerable in most patients.Twelve (50.0%) patients reported 16 adverse events, but only one patient withdrew CsA due to intolerance.The rates of adverse events in initial intravenous CsA including 4 mg·kg(-1)·d(-1,) 3 mg·kg(-1)·d(-1) and 2 mg·kg(-1)·d(-1) were 2/2, 9/17 and 1/5 respectively.Responders had higher white blood cell count compared with non-responders (P= 0.045). Conclusions: CsA could be an effective alternative regimen to colectomy in severe active UC patients who are refractory to steroids.

[A comparison of clinical characteristics in elderly patients with ulcerative colitis and ischemic colitis]

OBJECTIVE

To analyze the discrepancy and similarities of clinical characteristics in elderly patients with ulcerative colitis (UC) and ischemic colitis (IC).

METHODS

A total of 43 elderly patients (age≥60 yrs) with UC and 36 elderly patients with IC were enrolled from 2004 to 2015 at Peking Union Medical College Hospital. The clinical characteristics were retrospectively analyzed and compared between the two groups.

RESULTS

Compared with IC group, the disease course was longer with lower incidence of cardiovascular comorbidities in UC patients (P<0.05). In UC group, more patients presented with diarrhea, mucopurulent bloody stool [39(90.7%) vs 16(44.4%) and 34(79.1%) vs 2(5.6%) respectively, both P<0.01]. Yet bloody stool as the only symptom was seen in more IC patients than UC patients [61.1%(22/36) vs 7.0%(3/43), P<0.01]. The ratio of extra-intestinal manifestations was higher [18.6%(8/43) vs 0(0/36)] in UC patients, while complications were lower [11.6%(5/43) vs 30.6%(11/36), P<0.05]. As to the laboratory parameters, median platelet count [(294.38±104.83)×10(9)/L vs (235.47±94.82)×10(9)/L, P<0.05] was higher in UC group. In addition, more patients with UC had positive perinuclear antineutrophil cytoplasmic antibody (p-ANCA) [50.0%(15/30) vs 10.0%(2/20), P<0.05]. The most commonly involved regions of IC were descending colon and sigmoid colon, in which the lesions were clearly demarcated with the normal mucosa. Lesions in patients with UC mainly originated from rectum and might spread to the whole colon. Vascular occlusion and micro thrombosis were characteristic pathological findings of IC. The crypt abscesses were frequently seen in the UC group.

CONCLUSION

Even though UC and IC have some similar manifestations in the elderly patients, clinical and pathological discrepancy is still helpful to differentiate each other.