Incidence, clinical features, and risk factors for acute pancreatitis following posterior instrumented fusion surgery for lumbar degenerative disease: a single-center, retrospective analysis of 20,929 patients

PURPOSE

The aim of this study is to identify the incidence, clinical features, and risk factors for postoperative acute pancreatitis (PAP) after lumbar surgery.

METHODS

We retrospectively analyzed patients who developed PAP after posterior lumbar fusion surgery. For each PAP patient, data were collected for four controls who underwent procedures in the same period and did not develop PAP. Statistical methods included univariate and multivariate analyses.

RESULTS

Totally, 21 out of 20,929 patients were diagnosed with PAP (0.10%) after posterior lumbar fusion surgery. Patients with degenerative lumbar scoliosis were at higher risk of developing PAP (P < 0.05). With atypical clinical features, PAP occurred within 3 days (0-5) after surgery. PAP patients had significantly higher incidence of osteoporosis (47.6 vs. 22.6%, P = 0.030) and fusion of L1/2(42.9 vs. 4.3%, P = 0.010), lower albumin (42.2 ± 4.1 vs. 44.3 ± 3.2 g/L, P = 0.010), more fusion segments (median 4 vs. 3, P = 0.022), larger surgical invasiveness index (median 9 vs. 8, P = 0.007), longer operation duration (232 ± 109 vs. 185 ± 90 min, P = 0.041), greater estimated blood loss (median 600 vs. 400 mL, P = 0.025), lower intraoperative mean arterial pressure (87.2 ± 9.9 vs. 92.1 ± 8.8 mmHg, P = 0.024). Multivariate logistic regression analysis found three independent risk factors: fusion of L1/2, surgical invasiveness index > 8, and intraoperative mean arterial pressure < 90 mmHg. All patients were treated with conservative therapy and fully recovered after 8.1 (4-22) days.

CONCLUSION

The incidence of PAP following posterior surgery for degenerative lumbar disease was 0.10%, and its clinical features were not typical. The fusion of L1/2, high surgical invasiveness index, and low intraoperative mean arterial pressure were independent risk factors for PAP after surgery for lumbar degenerative disease.

[A case report of death from toxic encephalopathy caused by emamectin·chlorfenapyr]

Emamectin·chlorfenapyr is insecticide compounded by emamectin benzoate and chlorfenapyr. There is no special antidote after poisoning, and the mortality rate of patients is very high. We admitted a case of toxic encephalopathy caused by oral administration of emamectin·chlorfenapyr. The clinical manifestations of patient were gastrointestinal symptoms, profuse sweating, high fever, changes in consciousness. After admitted to the hospital, despite active comprehensive treatment, the patient died of ineffective rescue eventually.

Trochanteric and subtrochanteric fractures irreducible by closed reduction: a retrospective study

AIM

To explore the preoperative radiographic features and reduction methods of irreducible trochanteric and subtrochanteric fractures of the femur and to compare the perioperative characteristics and prognoses of irreducible and reducible fractures.

METHODS

The data of 1235 patients with femoral trochanteric fractures surgically treated in our hospital between January 2010 and January 2021 were retrospectively analyzed. According to the inclusion criteria and exclusion criteria, 1163 cases of femoral trochanteric and subtrochanteric fractures were included in this study. Fractures in which good or acceptable reduction could not be reached by closed manipulation were defined as irreducible fractures. The preoperative radiographic features, fracture displacement patterns after closed manipulation and intraoperative reduction methods used to treat irreducible fractures were analyzed, and the perioperative characteristics and prognoses of irreducible fractures and reducible fractures were compared.

RESULTS

There were 224 patients in the irreducible group and 939 patients in the reducible group. According to the radiographic features of fractures, irreducible fractures could be divided into four types: those with interlocking of the fracture, sagging of the femoral shaft, splitting of the lateral wall or medial wall, and comminution of the subtrochanteric area. Various kinds of reduction techniques were needed for different types.

CONCLUSIONS

The incidence of irreducible trochanteric fractures was 15.4%, while the incidence of irreducible subtrochanteric fractures was 84.6%. According to the radiographic features of fractures, they can be divided into four types. It is important to identify irreducible fractures preoperatively and make comprehensive plans to the greatest extent possible to shorten the operation time, reduce intraoperative blood loss, and reduce the incidence of complications.

NFATC1 and NFATC2 expression patterns in human osteochondromas

Background

Our previous study in genetic mouse models found that NFATc1 and NFATc2 suppress osteochondroma formation from entheseal progenitors. However, it remains unclear whether NFAT signaling is also involved in human osteochondromagenesis. As the first step in addressing this question, the current study aimed to determine the expression patterns of NFATC1 and NFATC2 in human osteochondroma samples.

Methods

Immunohistochemistry (IHC) was used to examine and analyze NFATC1 and NFATC2 expression in human osteochondroma samples. The human periosteum was used to map the expression of NFATC1 under physiological conditions by IHC. Furthermore, human periosteal progenitors were isolated and identified from the periosteal tissues of bone fracture healing patients. The expression of NFATC1 in human periosteal progenitors was characterized by Western blotting compared to human bone marrow stromal cells (BMSC).

Results

The IHC results showed that the expression of NFATC1 was undetectable in most human osteochondromas cells, and only a small proportion of osteochondroma cells, especially clonally grown chondrocytes, showed positive staining of NFATC1. NFATC2 expression was also undetectable in most chondrocytes in human osteochondromas. The mouse and human periosteum showed a comparable ratio of NFATC1 positive cells (9.56 ± 0.80% vs 11.04 ± 2.05%, P = 0.3101). Furthermore, Western blotting analysis revealed that NFATC1 expression was highly enriched in human periosteal progenitors compared to BMSC.

Conclusions

NFATC1 and NFATC2 are undetectable in most human osteochondroma chondrocytes. The expression pattern of NFATC1 in human osteochondromas and the normal periosteum suggests that NFAT signaling could be suppressed during human osteochondromagenesis.

[Application of transbronchial cryobiopsy in the diagnosis of postoperative complications after lung transplantation: a report of 6 cases]

Objective: To investigate the efficacy and safety of transbronchial cryobiopsy (TBCB) after lung transplantation. Methods: The clinical characteristics, TBCB procedure, diagnosis and treatment, and outcomes of lung transplant recipients of 6 patients (all male, aged 33-67 years) with TBCB in China-Japan Friendship Hospital from May to November 2021 were retrospectively analyzed. Results: Among the 6 patients diagnosed by TBCB, there were 2 cases of organizing pneumonia, 1 acute cellular rejection, 1 antibody-mediated rejection, and 1 bronchiolitis obliterans, and 1 diffuse alveolar damage. After the clinical diagnosis was confirmed, the condition improved after adjustment of the treatments followed. There were no serious complications related to the TBCB procedure. Conclusion: TBCB is valuable and relatively safe in the diagnosis of complications after lung transplantation, but the indications need to be strictly controlled.

Evaluation of femoral head bone quality by Hounsfield units: A predictor of implant failure for intertrochanteric fractures after intramedullary nail fixation

Purpose

The aim of present study is to evaluate the femoral head bone quality by Hounsfield units and its relationship to the occurrence of implant failure for intertrochanteric fractures after intramedullary nail fixation.

Methods

This retrospective study assessed 160 intertrochanteric fractures treated with intramedullary fixation. Patients with and without implant failure were divided into failure and control groups, respectively. The demographic information, femoral head Hounsfield unit (HU) value, the reduction quality, status of posteromedial support and position of the screw/blade were collected and compared. The logistic regression analyses were performed to evaluate risk factors of implant failure in intertrochanteric fractures after intramedullary nail fixation.

Results

Of the patients, 15 (9.38%) suffered from implant failure after intramedullary fixation. The mean HU value of femoral head was much lower in the failure group than the control group (133.25 ± 34.10 vs. 166.12 ± 42.68, p = 0.004). And the univariate analyses showed that A3 fracture and poor reduction quality were associated with implant failure (p < 0.05). After adjustment for confounding variables, the multivariable logistic regression analyzes showed that femoral head HU value (odds ratio [OR], 0.972; 95% CI, 0.952-0.993; p = 0.008) and poor reduction quality (OR, 7.614; 95% CI, 1.390-41.717; p = 0.019) were independent influencing factors for implant failure.

Conclusion

The femoral head HU value was significantly correlated with the incidence of implant failure and can be used as an independent factor to predict implant failure for intertrochanteric fractures after intramedullary fixation.

Cervical Spine Fracture Prediction by Simple Plain X-Ray in Ankylosing Spondylitis Patients after Low-Energy Trauma

Objective

Timely diagnosis is essential in the management of cervical spine fracture (CSF) in ankylosing spondylitis (AS) patients. However, the value of simple plain X‐ray in the early management of ASCSF has not been well‐studied. This study aimed to explore the prediction ability of simple plain X‐ray for CSF in AS patients who suffer from low‐energy trauma (LET).

Methods

From January 2010 to December 2020, AS patients who experienced LET were retrospectively reviewed. Clinical data including gender, age, body mass index, time interval between AS diagnosis and trauma, smoking or not, and a presence of continuous bony bridge between anterior margin of C1 and C2 body or not were collected. Morphological features including atlanto‐occipital gap, Pavlov ratio of C2–7, Angle A–D, Borden's index, and Harrison's value were measured by the lateral cervical X‐ray. All data was compared between patients who had CSF and those who did not. Binary logistic regression analysis and receiver operator characteristic (ROC) curves were applied to discriminate and assess the predictive parameters.

Results

A total of 129 AS patients were divided into Fracture group (41 cases) and Non‐fracture group (88 cases) based on whether CSF existed. Twelve parameters showed significant differences between two groups (p < 0.05). According to the binary logistic regression model, four of the 12 parameters showed a further correlation with the occurrence of CSF, namely, mean Pavlov ratio (p < 0.001, OR = 0.067, 95% CI: 0.023 to 0.194), Angle D (p = 0.031, OR = 1.057, 95% CI: 1.005 to 1.112), Borden's index (p = 0.042, OR = 1.131, 95% CI: 0.994 to 1.287), the time interval between the AS diagnosis and the trauma (p < 0.020, OR = 0.935, 95% CI: 0.883 to 0.990). The ROC curve further revealed the mean Pavlov ratio had the largest AUC (0.793) with the cut‐off of 0.72. While the optimal cut‐off value was 45.65° for Angle D (sensitivity = 61.0%, specificity = 78.4%), 9.79 for Borden's index (sensitivity = 87.8%, specificity = 37.5%), 15.50 years for the time interval between AS diagnosis and trauma (sensitivity = 70.7%, specificity = 56.8%).

Conclusions

The time interval between the AS diagnosis and the trauma, mean Pavlov ratio, Angle D, and Borden's index showed predictive ability for the occurrence of CSF in AS patients who encounter LET. Surgeons should consider measuring these parameters in the management of AS patient.

Repair of critical diaphyseal defects of lower limbs by 3D printed porous Ti6Al4V scaffolds without additional bone grafting: a prospective clinical study

The repair of critical diaphyseal defects of lower weight-bearing limbs is an intractable problem in clinical practice. From December 2017, we prospectively applied 3D printed porous Ti6Al4V scaffolds to reconstruct this kind of bone defect. All patients experienced a two-stage surgical process, including thorough debridement and scaffold implantation. With an average follow-up of 23.0 months, ten patients with 11 parts of bone defects were enrolled in this study. The case series included three females and seven males, their defect reasons included seven parts of osteomyelitis and four parts of aseptic nonunion. The bone defects located at femur (five parts) and tibia (six parts), with an average defect distance of 12.2 cm. Serial postoperative radiologic follow-ups displayed a continuous process of new bone growing and remodeling around the scaffold. One patient suffered tibial varus deformity, and he underwent a revision surgery. The other nine patients achieved scaffold stability. No scaffold breakage occurred. In conclusion, the implantation of 3D printed Ti6Al4V scaffold was feasible and effective to reconstruct critical bone defects of lower limbs without additional bone grafting. Graphical abstract.

Is It Necessary to Remove the Implants After Fixation of Thoracolumbar and Lumbar Burst Fractures Without Fusion? A Retrospective Cohort Study of Elderly Patients

Objective

Fractures of the thoracolumbar spine are the most common fractures of the spinal column. This retrospective cohort study aimed to determine whether it is necessary to remove implants of patients aged over 65 years after the fixation of thoracolumbar and lumbar burst fractures without fusion.

Methods

This retrospective cohort study included 107 consecutive patients aged ≥65 years without neurological deficits, who underwent non-fusion short posterior segmental fixation for thoracolumbar or lumbar burst fractures. Outcome measures included the visual analog score (VAS), Oswestry Disability Index (ODI), residual symptoms, complications, and imaging parameters. Patients were divided into groups A (underwent implant removal) and B (implant retention) and were examined clinically at 1, 3, 6, and 12 months postoperatively and annually thereafter, with a final follow-up at 48.5 months.

Results

Overall, 96 patients with a mean age of 69.4 (range, 65–77) years were analyzed. At the latest follow-up, no significant differences were observed in functional outcomes and radiological parameters between both groups, except in the local motion range (LMR) (P = 0.006). Similarly, between preimplant removal and the latest follow-up in group A, significant differences were found only in LMR (P < 0.001). Two patients experienced screw breakage without clinical symptoms. Significant differences were only found in operation time, blood loss, ODI, and fracture type between minimally invasive group and open group.

Conclusions

Similar radiological and functional outcomes were observed in elderly patients, regardless of implant removal. Implant removal may not be necessary after weighing the risks and benefits for elderly patients. Patients should be informed about the possibility of implant breakage and accelerating degeneration of adjacent segments in advance.

Comparison of femoral neck system to multiple cancellous screws and dynamic hip screws in the treatment of femoral neck fractures

OBJECTIVE

To compare the short-term outcomes of the femoral neck system (FNS) with multiple cancellous screws (MCS) and dynamic hip screws (DHS) in the treatment of femoral neck fractures.

METHODS

A retrospective analysis was performed on 157 patients with fresh femoral neck fractures treated with FNS (from September 2019 to October 2020), MCS, and DHS (from January 2018 to October 2020). According to internal fixation methods, all patients were divided into the FNS group (54 cases), MCS group (51 cases), and DHS group (52 cases). Demographic data were also collected, recorded, and compared, including the follow-up time, days of hospitalization, operation time, blood loss, intraoperative fluoroscopy times (IFT), weight-bearing time (WBT), length of femoral neck shortening (LFNS), Harris hip score, and complications (such as internal fixation failure, bone nonunion, and avascular necrosis of the femoral head) between the three groups.

RESULTS

Overall, 157 patients with a mean age of 61.8 (range, 18-89) years were analyzed. In the FNS group, IFT (median 10.5) was significantly lower than that in the MCS group (median 21) and DHS group (median 20.5) (P<0.05), and WBT was significantly earlier than that of the MCS group (P<0.05). In the FNS group, the median hospitalization time, operation time, and blood loss were 2 (2, 4) days, 45 (40-59) min, and 30 (20, 50) ml, respectively. They were all significantly less than 3.5 (3, 6) days, 72 (55-88.75) min, and 50 (30, 50) ml in the DHS group, respectively (P < 0.05). There was no statistical difference in LFNS, quality of reduction, internal fixation failure rate, and Harris hip score at the latest follow-up (P>0.05). No surgical complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in any of the three groups.

CONCLUSION

FNS, MCS, and DHS are all effective for femoral neck fractures. However, a lower IFT of FNS shortens the operation time. Compared to MCS, FNS has the advantages of being a simple operation, with early WBT; compared to DHS, a minimally invasive operation is the main advantage of FNS.

Non-sliding Fixation Shows Improved Clinical Outcomes for Displaced Femoral Neck Fractures as Compared to Sliding Fixation

Objective

To compare the clinical outcomes between use of sliding fixation (three cannulated screws, TCS) and non-sliding fixation (four cannulated screws, FCS) in the treatment of femoral neck fractures.

Methods

We retrospectively analyzed 102 patients with fresh femoral neck fractures treated with TCS (60 cases) and FCS (42 cases) between January, 2018 and December, 2019. The demographic data, follow-up time, hospitalization time, operation time, blood loss, length of femoral neck shortening (LFNS), soft tissue irritation of the thigh (STIT), Harris hip score, and complications (such as internal fixation failure, non-union, and avascular necrosis of the femoral head) were also collected, recorded, and compared between the two groups.

Results

A total of 102 patients with an average age of 60.9 (range, 18–86) years were analyzed. The median follow-up time was 25 (22 to 32) months. The LFNS in the FCS group (median 1.2 mm) was significantly lower than that in the TCS group (median 2.8 mm) (P < 0.05). In the Garden classification, the number of displaced fractures in the TCS group was significantly lower than that in the FCS group (P < 0.05). The median hospitalization time, operation time, blood loss, reduction quality, internal fixation failure rate (IFFR), STIT, and Harris hip score were not statistically different between the two groups (P > 0.05). However, in the subgroup analysis of displaced fractures, the LFNS (median 1.2 mm), STIT (2/22, 13.6%), and Harris hip score (median 91.5) of the FCS group at the last follow-up were significantly better than the LFNS (median 5.7 mm), STIT (7/16, 43.8%), and Harris hip score (median 89) of the TCS group (P < 0.05). No complications such as incision infection, deep infection, pulmonary embolism, or femoral head necrosis were found in either group.

Conclusion

TCS and FCS are effective for treating femoral neck fractures. For non-displaced fractures, there was no significant difference in the clinical outcomes between the two groups. However, for displaced fractures, the LFNS of the FCS is significantly lower than that of the TCS, which may reduce the occurrence of STIT and improve the Harris hip score.

Percutaneous CT-Guided Microwave Ablation Combined with Vertebral Augmentation for Treatment of Painful Spinal Metastases

BACKGROUND AND PURPOSE

Percutaneous thermal ablation followed by vertebral augmentation is an emerging minimally invasive therapeutic alternative for the management of spinal metastases. This study aimed to retrospectively evaluate the effectiveness and safety of microwave ablation combined with vertebral augmentation for the treatment of painful vertebral metastases.

MATERIALS AND METHODS

Overall, 91 patients with 140 metastatic vertebrae who experienced refractory moderate-to-severe pain were treated with CT-guided microwave ablation and vertebral augmentation. Procedural effectiveness was determined using the visual analog scale, daily morphine consumption, and the Oswestry Disability Index preprocedurally and during follow-up. Local tumor control was assessed at follow-up imaging.

RESULTS

The procedure was technically successful in all patients. The median visual analog scale score and mean morphine dose were 6 (range, 4-10) and 77.8 (SD, 31.5) mg (range, 15-143 mg), preprocedurally; 5 (range 3-8) and 34.5 (SD, 23.8) mg (range, 0-88 mg) at 3 days; 4 (range, 2-7) and 28.7 (SD, 16.4) mg (range, 0-73 mg) at 1 week; 3 (range, 1-6) and 24.6 (SD, 13.2) mg (range, 0-70 mg) at 1 month; 3 (range, 1-6) and 21.70 (SD, 10.0) mg (range, 0-42 mg) at 3 months; and 3 (range, 1-8) and 21.0 (SD, 9.9) mg (range, 0-46 mg) at 6 months postprocedurally (all P < .05). A decrease in the Oswestry Disability Index score was also observed (P < .01). Local control was achieved in 94.8% of the treated metastatic vertebrae during the 6-month follow-up period. Asymptomatic cement leakage occurred in 42 (30%) treated vertebrae. A grade 3 neural injury was observed in 1 patient (1.1%). The patient's neurologic function returned to normal following treatment with mannitol, glucocorticoids, and radiation therapy.

CONCLUSIONS

This study demonstrates that percutaneous CT-guided microwave ablation combined with vertebral augmentation is a safe and effective minimally invasive intervention for the treatment of painful spinal metastases.

The Efficacy of Multidisciplinary Team Co-Management Program for Elderly Patients With Intertrochanteric Fractures: A Retrospective Study

Background

Intertrochanteric fractures increased quickly in past decades owing to the increasing number of aging population. Recently, geriatric co-management was rapidly emerging as a favored clinical care model for older patients with hip fractures. The purpose of this study was to assess the efficacy of a multidisciplinary team (MDT) co-management program in elderly patients with intertrochanteric fractures.

Methods

In this retrospective study, patients were divided into MDT group and traditional orthopedic care (TOC) group according to the healthcare model applied. 249 patients were included in the TOC group from January 2014 to December 2016 and 241 patients were included in the MDT group from January 2017 to December 2019. Baseline data, peri-operative data, and postoperative complications were collected and analyzed using SPSS 21.0.

Results

No significant differences were observed between the two groups in terms of patient baseline characteristics. Patients in the MDT group had significantly lower time from admission to surgery and length-of-stay (LOS) compared with those in the TOC group. Furthermore, the proportion of patients receiving surgery within 24 h (61.4 vs. 34.9%, p &lt; 0.001) and 48 h (80.9 vs. 63.5%, p &lt; 0.001) after admission to the ward was significantly higher in the MDT group compared with those in the TOC group. In addition, patients in the MDT group had significantly lower proportion of postoperative complications (25.3 vs. 44.2%, p &lt; 0.001), deep vein thrombosis (7.9 vs. 12.9%, p = 0.049), pneumonia (3.8 vs. 8.0%, p = 0.045) and delirium (4.1 vs. 9.2%, p = 0.025) compared with those in the TOC group. However, no significant changes were found for in-hospital and 30-day mortality.

Conclusion

The MDT co-management could significantly shorten the time from admission to surgery, LOS, and reduce the postoperative complications for elderly patients with intertrochanteric fractures. Further research was needed to evaluate the impact of this model on patient health outcomes.

Transcriptome and metabolome analyses of the immune response to light stress in the hybrid grouper (Epinephelus lanceolatus ♂ × Epinephelus fuscoguttatus ♀)

Light intensity is an important environmental factor that affects fish growth and health through multiple physiological activities and metabolism and eventually impacts aquaculture harvest. There is a need to evaluate the fish stress response to light intensities, which will benefit aquaculture. Here, hybrid grouper (Epinephelus lanceolatus ♂ × Epinephelus fuscoguttatus ♀) was treated with three light intensities for evaluation of the light stress response, including high light intensity (1 250 lx), low light intensity (10 lx) and moderate light intensity (250 lx). Transcriptome analysis showed that a total of 71 318 unigene sequences were obtained with an N50 of 2 589 bp. Compared to the control group (250 lx), 1 697 differentially expressed genes (DEGs), a considerable quantity, were detected in the 1 250 lx group. Among those genes, 548 were upregulated, and the remaining 149 genes showed decreased expression. Comparatively small numbers of DEGs were detected in the 10 lx group; 54 out of 103 genes exhibited upregulated expression, and 49 genes showed downregulation. For further KEGG analysis, 82 DEGs were enriched in nine common signalling pathways in immunity, of which 73 DEGs were significantly inhibited in the 1 250 lx group. In contrast, only 11 DEGs were enriched in three immunity pathways, with nine DEGs showing a significant increase in the 10 lx group. The metabolome analysis revealed 59 and 44 differential metabolites (DMs) from the 1 250 lx and 10 lx groups, respectively. Of note, those DMs from the 1 250 lx-treated group were tendentiously involved in amino acid metabolism and lipid metabolism pathways, while the purine metabolism, amino acid metabolism and lipid metabolism pathways were mostly found in the 10 lx treatment group. In summary, our data indicated that high light intensity significantly inhibited the immune response in hybrid grouper, while low light intensity presented low stimulation of immune activity. In addition, both high and low light intensity could inhibit protein synthesis and amino acid metabolism. Taken together, hybrid grouper exhibited a much milder stress response to low light intensity than to high light intensity.

Reconstruction of Ipsilateral Femoral and Tibial Bone Defect by 3D Printed Porous Scaffold Without Bone Graft: A Case Report

CASE

This study reported the case of a 42-year-old woman with traumatic ipsilateral critical bone defect of right femur and tibia after a motor accident. Three-dimensional (3D) printed porous titanium scaffolds were innovatively used to reconstruct this challenging situation. The initial stability was safe enough for early exercise and partial weight bearing. The 26-month follow-up showed osseous integration of the prosthesis-bone interface with short-term satisfactory clinical result.

CONCLUSION

The custom-designed 3D-printed porous scaffold has the potential to become an effective option for reconstructing the segmental irregular-shaped bone defect.

Risk factors for implant failure of intertrochanteric fractures with lateral femoral wall fracture after intramedullary nail fixation

INTRODUCTION

Few studies have specifically evaluated the comminution extent of lateral femoral wall (LFW) fracture and risk factors of implant failure in intertrochanteric fractures with LFW fracture. The aim of present study was to evaluate the influence of comminution extent of LFW fracture on implant failure and identify risk factors of implant failure in cases with LFW fracture after intramedullary fixation.

METHODS

This retrospective study included 130 intertrochanteric fracture with LFW fracture treated with intramedullary fixation at a teaching hospital over a 13-year period from January 2006 to December 2018. Demographic information, cortical thickness index, the reduction quality, status of medial support, position of the screw/blade and status of lateral femoral wall were collected and compared. The logistic regression analyzes was performed to evaluate risk factors of implant failure in intertrochanteric fractures with LFW fracture after intramedullary nail fixation.

RESULTS

10 patients (7.69%) suffered from mechanical failure after intramedullary fixation. Univariate analyzes showed that comminuted LFW fracture (OR, 7.625; 95%CI, 1.437~40.446; p = 0.017), poor reduction quality (OR, 49.375; 95%CI, 7.217~337.804; p < 0.001) and loss of medial support (OR, 17.818; 95%CI, 3.537~89.768; p < 0.001) were associated with implant failure. After adjustment for confounding variables, the multivariable logistic regression analyzes showed that poor reduction quality (OR, 11.318; 95%CI, 1.126~113.755; p = 0.039) and loss of medial support (OR, 7.734; 95%CI, 1.062~56.327; p = 0.043) were independent risk factors for implant failure. Whereas, comminuted LFW fracture was not associated with implant failure (p = 0.429).

CONCLUSIONS

The comminution extent of the LFW fracture might influence the stability of intertrochanteric fractures; and intramedullary fixation might be an effective treatment method. Furthermore, poor reduction quality and loss of medial support could increaze the risk of implant failure in intertrochanteric fractures with LFW fractures after intramedullary fixation. Therefore, we should pay great emphasis on fracture reduction quality in future.

Surgical Treatment for Cervical Spine Fracture in Patients With Ankylosing Spondylitis: Single Posterior Approach or Combined Anterior-posterior Approach?

STUDY DESIGN

A retrospective single-center study.

OBJECTIVE

We aimed to compare the clinical outcomes of cervical spine fracture accompanied with ankylosing spondylitis (ASCSF) treated by single posterior approach (PA) and combined anterior-posterior approach (CA) for patients who were followed up for >1 year.

SUMMARY OF BACKGROUND DATA

For ASCSF patients, surgical treatment has been widely accepted as a recommendable therapeutic option. But the optimal surgical approach is still under controversy, and few studies have focused on the comparison between PA and CA.

MATERIALS AND METHODS

From February 2007 to March 2019, 53 patients were enrolled and divided into the PA group (34 cases) and CA group (19 cases). Their general characteristics and clinical materials were recorded. From the aspects of reduction distance, bone fusion, neurological functional restoration, and postoperative complications, patients' surgical outcomes were evaluated qualitatively and quantitatively.

RESULTS

The reduction degree of dislocation (mean PA=2.05 mm, mean CA=2.36 mm, P=0.94) was close between the 2 groups. Besides, with a similar follow-up period (P=0.10), the rate of bone fusion (both 100%) and neurological functional restoration (PA=31.03%, CA=35.29%, P=0.77) were also without significant difference. The occurrence rate of postoperative complications tended to be higher in the CA group (31.58% vs. 23.53%) but with no significant difference (P=0.52). Nevertheless, the surgical duration time (mean=209.15 min) and blood loss (average=388.91 mL) of PA group were significantly less than CA group (mean duration time=285.34 min, mean blood loss=579.27 mL) (P<0.01).

CONCLUSIONS

Compared with to the CA approach and with the equally significant outcome, surgery by single PA was feasible and should be positively recommended for ASCSF patients, especially for those accompanying with a severe chin-on-chest deformity or poor physical conditions which restrain patients from tolerating a long surgery or major surgical trauma.

Clinical predictors for deep vein thrombosis on admission in patients with intertrochanteric fractures: a retrospective study

Background

Limited studies were available to investigate the prevalence of deep vein thrombosis (DVT) on admission in elderly patients with intertrochanteric fractures. The aim of present study was to evaluate risk factors and the prevalence of pre-admission DVT in elderly patients with intertrochanteric fractures.

Methods

This retrospective study included 788 elderly patients with intertrochanteric fracture who were eligible for this study from January 1, 2010, to December 31, 2019. Color doppler ultrasonography was performed for DVT detection at admission. All patients’ clinical data were collected. Univariate analysis and stepwise backward multivariate logistic regression were used to identify the risk factors contributing to the occurrence of DVT.

Results

The overall prevalence of pre-admission DVT in patients with intertrochanteric fractures was 20.81% (164 of 788 patients). The mean time from injury to admission was 2.1 days in the total population, 2.96 and 1.87 days in patients with and without DVT. Univariate analysis showed that significantly elevated risk of DVT were found in patients with longer time from injury to admission, high energy injury, lower Hb value, higher BMI, diabetes, chronic obstructive pulmonary disease (COPD), atrial fibrillation, dementia, varicose veins, higher age-adjusted CCI, higher ASA class and A3 type intertrochanteric fractures (P < 0.05). The adjusted multivariate logistic regression analysis demonstrated that longer time from injury to admission, high energy trauma, COPD, lower Hb, diabetes and A3 type intertrochanteric fractures were independent risk factors of pre-admission DVT.

Conclusions

A high prevalence of pre-admission DVT was found in elderly Chinese patients with intertrochanteric fractures. Therefore, surgeons should be aware of the high prevalence of DVT for elderly patients with intertrochanteric fractures in order to prevent intraoperative and postoperative PE and other lethal complications.

Bidirectional Causal Associations Between Inflammatory Bowel Disease and Ankylosing Spondylitis: A Two-Sample Mendelian Randomization Analysis

Background

Associations between inflammatory bowel disease (IBD) [including ulcerative colitis (UC) and Crohn’s disease (CD)] and ankylosing spondylitis (AS) were discovered in observational studies, but no evidence supported the causal relationship between the two diseases.

Methods

We employed two-sample Mendelian randomization (MR) to estimate the unconfounded bidirectional causal associations between IBD (including UC and CD) and AS. We selected single-nucleotide polymorphisms (SNPs) from genome-wide association studies (GWAS) after strictly assessing the quality of the studies in the IEU GWAS database. Sensitivity analyses were also conducted to verify whether heterogeneity and pleiotropy can bias the MR results.

Results

We found positive causal effects of genetically increased UC, CD, and IBD risk on AS (e.g., UC and AS, IVW OR: 1.0256, 95% CI: 1.0130∼1.0385, p = 6.43E-05). However, we did not find significant causal associations of AS with UC, CD, or IBD (e.g., AS and UC, IVW OR: 1.1858, 95% CI: 0.8639∼1.6278, p = 0.2916). The sensitivity analysis also confirmed that horizontal pleiotropy was unlikely to bias the causality (e.g., UC and AS, MR-Egger: intercept p = 0.1326). The leave-one-out analysis also demonstrated that the observed links were not driven by SNP. No evidence of heterogeneity was found between the genetic variants (e.g., UC and AS, MR-Egger: Q statistic = 43.1297, I²<0.0001, p = 0.7434).

Conclusion

Our results provide new evidence indicating there are positive causal effects of IBD on AS in the European population. We suggest that the features of inflammatory bowel disease in particular should be assessed in the diagnosis of ankylosing spondylitis. We also provide some advice for preventing and treating the two diseases.

Analysis of risk factors for revision in distal femoral fractures treated with lateral locking plate: a retrospective study in Chinese patients

BACKGROUND

To analyze the risk factors of revision operation after the treatment of distal femoral fracture with lateral locking plate (LLP).

METHODS

Retrospective analysis of the clinical data of 152 cases with distal femoral fracture treated in our hospital from March 2005 to March 2019. The SPSS 26.0 software (univariate analysis and logistic regression analysis) was used to analyze the general condition, fracture-related factors, operation-related factors, and construct characteristics of internal fixation.

RESULTS

Sixteen of 152 patients who were included in the study underwent revision surgery, with a revision rate 10.5%. Univariate analysis showed that there were significant differences in age, body mass index (BMI), fracture type, supracondylar involved or not, type of incision, quality of reduction, ratio of length of plate/fracture area (R1), the ratio of the length of the plate/fracture area above the condylar (R2), ratio of distance between proximal part of fracture and screw/working length of proximal plate (R3) between the two groups (P < 0.05). Logistic regression analysis showed that age [OR for age > 61.5 group is 4.900 (1.071-22.414)], fracture type [OR for A3 fracture is 8.572 (1.606-45.750), the OR for periprosthetic fracture after TKA is 9.073 (1.220-67.506)], poor reduction quality [OR is 7.663 (1.821-32.253)], and the ratio of the length of the plate/fracture area above the condylar were the possible risk factors (P < 0.05).

CONCLUSION

Age, fracture type (A3 and periprosthetic fracture after TKA), poor reduction quality, and the ratio of the length of the plate/fracture area above the condylar were the possible risk factors of the revision in distal femoral fractures treated with lateral locking plate. The appropriate application of the locking plate and operation strategy are the key to reduce the revision rate in distal femoral fractures.

An innovative strategy to treat large metaphyseal segmental femoral bone defect using customized design and 3D printed micro-porous prosthesis: a prospective clinical study

Five patients with segmental irregular-shaped bone defect of the femur were recruited in this study from 2017.12 to 2018.11. All patients were treated by customized design and 3D printed micro-porous prosthesis. And the procedure was divided into stages: radical debridement and temporary fixation (the first stage); the membrane formation and virtual surgery (intervening period for 6-8 weeks); definite reconstruction the defects (the second stage). Routine clinical follow-up and radiographic evaluation were done to assess bone incorporation and complications of internal fixation. The weight-bearing time and the joint function of the patients were recorded. The patients were followed up for an average of 16.4 months. The average length of bone defect and the distal residual bone was 12 cm and 6.5 cm. The average time of partial weight-bearing and full weight-bearing was 12.7 days and 2.6 months. X-ray demonstrated good osseous integration of the implant/bone interface. No complications occurred such as implant loosening, subsidence, loss of correction and infection. At the last follow-up, Harris score of hip joint was excellent in 2 cases, good in 2 cases, fair in 1 case; HSS score of knee joint was good in 4 cases, middle in 1 case. From our study, we concluded that meticulous customized design 3D printed micro-porous prosthesis combined with intramedullary nail may be a promising and an alternative strategy to treat metaphyseal segmental irregular-shaped femoral bone defect, especially for cases with massive juxta-articular bone loss.

Medial wall fragment involving large posterior cortex in pertrochanteric femur fractures: a notable preoperative risk factor for implant failure

INTRODUCTION

To introduce a classification for medial wall fragments in pertrochanteric femur fractures and investigate potential preoperative predictors of implant failure following fixation.

MATERIAL AND METHODS

Medical records of 324 adult patients receiving routine operative treatment using intramedullary devices for pertrochanteric femur fractures with medial wall fragments between August 2008 and May 2018 were retrospectively analyzed. Potential predictors including age, gender, body mass index, comorbidities, AO/OTA classification of fractures were noted. The medial wall fractures were categorized into three types: 1) Type I: avulsion of the lesser trochanter; fracture line does not exceed the base of the lesser trochanter; 2) Type II: fragment involving the posterior cortex near the base of the lesser trochanter; fracture line does not reach the midline of the posterior wall; 3) Type III: fragment involving the large posterior cortex; fracture line reaches or exceeds the midline of the posterior wall.

RESULTS

The 8 (2.5%) implant failures comprised 1 in 186 Type I fractures, 1 in 76 Type II fractures and 6 in 62 Type III fractures. The failure rates of each fracture type were 0.5% in Type I, 1.3% in Type II and significantly increased to 9.7% in Type III (odds ratio [OR], 19.821; 95% confidence interval [CI], 2.337-168.135; p=0.001).

CONCLUSIONS

Type III fractures had a significantly increased failure rate. It is important for orthopedists to identify Type III fractures presurgically, reduction of the medial wall fragment and fixation should be considered during surgery using intramedullary nails.

Persistent oppression and simple decompression both exacerbate spinal cord ascorbate levels

Background: Surgical decompression after acute spinal cord injury has become the consensus of orthopaedic surgeons. However, the choice of surgical decompression time window after acute spinal cord injury has been one of the most controversial topics in orthopaedics. Objective: We apply an online electrochemical system (OECS) for continuously monitoring the ascorbate of the rats' spinal cord to determine the extent to which ascorbate levels were influenced by contusion or sustained compression. Methods: Adult Sprague-Dawley rats (n=10) were instrumented for ascorbate concentration recording and received T11 drop spinal cord injury (SCI). The Group A (n=5) were treated with immediately decompression after SCI. The Group B (n=5) were contused and oppressed until 1 h after the injury to decompress. Results: The ascorbate level of spinal cord increased immediately by contusion injury and reached to 1.62 μmol/L ± 0.61 μmol/L (217.30% ± 95.09% of the basal level) at the time point of 60 min after the injury. Compared with the Group A, the ascorbate level in Group B increased more significantly at 1 h after the injury, reaching to 3.76 μmol/L ± 1.75 μmol/L (430.25% ± 101.30% of the basal level). Meanwhile, we also found that the decompression after 1 hour of continuous compression will cause delayed peaks of ascorbate reaching to 5.71 μmol/L ± 2.69 μmol/L (627.73% ± 188.11% of the basal level). Conclusion: Our study provides first-hand direct experimental evidence indicating ascorbate is directly involved in secondary spinal cord injury and exhibits the dynamic time course of microenvironment changes after continuous compression injury of the spinal cord.

Association between Skeletal Muscle Strength and Dysphagia among Chinese Community-Dwelling Elderly Adults

OBJECTIVES

Swallowing disorder is a health burden for the elderly in China. This study aimed to investigate the prevalence of dysphagia and to test the association between skeletal muscle strength and swallowing problems among community-dwelling older adults.

DESIGN

A cross-sectional study.

SETTING

Community-dwelling Chinese elderly in China.

PARTICIPANTS

3361 adults aged 65 years or above were involved, among which 1740 (51.8%) were female, with average age of 72.64 (Standard deviation, SD=6.10) years old.

MEASUREMENTS

Handgrip strength (HGS) was used to evaluate skeletal muscle strength. Dysphagia assessment was performed using the Eating Assessment Tool-10 (EAT-10) and the 30mL water swallow test (WST). Binary logistic regression was used to evaluate the relationship between skeletal muscle strength and dysphagia, and covariates as age, gender, material status, etc. were adjusted.

RESULTS

The prevalence of dysphagia were 5.5% and 12.9%, screened by EAT-10 and 30mL WST respectively. Participants with dysphagia showed lower HGS (21.73 ± 9.20 vs. 25.66 ± 11.32, p<0.001, by EAT-10; 20.26 ± 9.88 vs. 26.22 ± 11.28, p<0.001, by WST). The adjusted model suggested that muscle strength is a protective factor for swallowing disorders (adjusted OR=0.974, 95%CI: 0.950-0.999, by EAT-10; adjusted OR=0.952, 95%CI: 0.933-0.972, by WST). Subgroup analyses of WST found the effects were significant among participants aged in 70-74 years group and ≥75 years group, rather than those aged under 70.

CONCLUSION

Dysphagia was significantly associated with skeletal muscle strength among the community-dwelling elderly population. Effective interventions should be taken to manage the decline of muscle strength for the older adults, especially early prevention before 70 years old.

Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)

BACKGROUND

The incidence of intertrochanteric hip fracture is expected to increase as the global population ages. It is one of the most important causes of mortality and morbidities in the geriatric population. The incidence of reverse oblique and transverse intertrochanteric (AO/OTA 31-A3) fractures is relatively low; however, the incidence of implant failure in AO/OTA 31-A3 fractures is relatively high compared with that in AO/OTA 31-A1 and A2 fractures. To date, the risk factors for implant failure in AO/OTA 31-A3 fractures treated with proximal femoral nail antirotation (PFNA) have remained ambiguous. The purpose of this study was to identify the predictive factors of implant failure in AO/OTA 31-A3 fractures treated with PFNA.

METHODS

The data of all patients who underwent surgery for trochanteric fractures at our institution between January 2006 and February 2018 were retrospectively reviewed. All AO/OTA 31-A3 fractures treated with PFNA were included. Logistic regression analysis of potential predictors of implant failure was performed. Potential predictors included age, sex, body mass index, fracture type, reduction method, status of posteromedial support and lateral femoral wall, reduction quality, tip-apex distance and position of the helical blade in the femoral head.

RESULTS

One hundred four (9.3%) patients with AO/OTA 31-A3 fractures were identified. Forty-five patients with AO/OTA 31-A3 fractures treated with PFNA were suitable for our study. Overall, implant failure occurred in six (13.3%) of forty-five patients. Multivariate analysis identified poor reduction quality (OR, 28.70; 95% CI, 1.91-431.88; p = 0.015) and loss of posteromedial support (OR, 18.98; 95% CI, 1.40-257.08; p = 0.027) as factors associated with implant failure.

CONCLUSIONS

Poor reduction quality and loss of posteromedial support are predictors of implant failure in reverse oblique and transverse intertrochanteric fractures treated with PFNA.

Citrobacter rodentium Induces Tissue-Resident Memory CD4+ T Cells

Tissue-resident memory T cells (TRM cells) are a novel population of tissue-restricted antigen-specific T cells. TRM cells are induced by pathogens and promote host defense against secondary infections. Although TRM cells cannot be detected in circulation, they are the major memory CD4+ and CD8+ T-cell population in tissues in mice and humans. Murine models of CD8+ TRM cells have shown that CD8+ TRM cells maintain tissue residency via CD69 and though tumor growth factor β-dependent induction of CD103. In contrast to CD8+ TRM cells, there are few models of CD4+ TRM cells. Thus, much less is known about the factors regulating the induction, maintenance, and host defense functions of CD4+ TRM cells. Citrobacter rodentium is known to induce IL-17+ and IL-22+ CD4+ T cells (Th17 and Th22 cells, respectively). Moreover, data from IL-22 reporter mice show that most IL-22+ cells in the colon 3 months after C. rodentium infection are CD4+ T cells. This collectively suggests that C. rodentium may induce CD4+ TRM cells. Here, we demonstrate that C. rodentium induces a population of IL-17A+ CD4+ T cells that are tissue restricted and antigen specific, thus meeting the criteria of CD4+ TRM cells. These cells expand and are a major source of IL-22 during secondary C. rodentium infection, even before the T-cell phase of the host response in primary infection. Finally, using FTY 720, which depletes circulating naive and effector T cells but not tissue-restricted T cells, we show that these CD4+ TRM cells can promote host defense.

Intervertebral Bridging Ossification After Percutaneous Kyphoplasty in Osteoporotic Vertebral Compression Fractures

BACKGROUND

Percutaneous kyphoplasty (PKP) is effective in treating osteoporotic vertebral compression fractures (OVCFs). Intervertebral bridging ossification can sometimes be detected after surgery, but studies related to its formation mechanism and its influence on outcome are few.

CASE DESCRIPTION

We reviewed patients' radiologic images and found 7 patients in whom intervertebral bridging ossification developed after PKP. Their personal and clinical information was recorded. The 7 patients had an average age of 63.43 ± 4.79 years. Injured levels included L1 (1 patients) and L2 (1 patient). GeneX and PMMA cement were respectively applied. Both the Cobb angle and the VAS scores were significantly improved after surgery, but all surgical vertebrae showed recollapse combined with larger Cobb angle at the last follow-up visits. In 1 patient the new-onset T11 fracture developed 29 months after surgery.

CONCLUSIONS

We deemed that spinal degeneration, mechanical instability, bone cement, and fracture pattern are all potential promoting factors for intervertebral bridging ossification. Solid bridging ossification may increase local spinal stability, but it also increases the risk of adjacent vertebral fractures.

In vivo study of a bioactive nanoparticle-gelatin composite scaffold for bone defect repair in rabbits

The purpose is to study the in vivo bioactivity of this scaffold and verify its ability to simulate the characteristics of cancellous bone. Twenty-four adult New Zealand white rabbits were divided into three groups. Bone defects above the femoral condylar of both sides were created. A newly designed bioactive nanoparticle-gelatin composite scaffold was implanted to the experimental side, while the control side was left without implantation. The repair of bone defect was monitored by X-ray examination, gross observation, Micro-CT examination and histological observation of the area of bone defect 4, 8 and 12 weeks after surgery. There was void of new bone tissue in medullary cavity in the bone defect area of the control side. In the experimental side, the composite scaffold displayed excellent biodegradability, bioactivity and cyto-compatibility. With the time laps, new bone tissue grew from the edge to center as revealed by both Micro-CT image and staining biopsy, which complies with the "creeping substitution" process. The mechanical properties of the newly designed bioactive nanoparticle-gelatin composite scaffold and the 3-D structure of new bone tissue are comparable to the surrounding cancellous bones. This newly developed bioactive nanoparticle-gelatin composite scaffold possesses good biocompatibility and in vivo osteogenic capability for bone defect repair. It may be a promising artificial bone grafts.

Wild-type phosphatase and tensin homolog deleted on chromosome 10 improved the sensitivity of cells to rapamycin through regulating phosphorylation of Akt in esophageal squamous cell carcinoma

Esophageal squamous cell carcinoma (ESCC) is one of the most frequently diagnosed cancers in China, but the etiology and mode of carcinogenesis of this disease remain poorly understood. Phosphatase and tensin homolog deleted on chromosome 10 (PTEN), as a negative regulator of Akt/mTOR pathway, frequently mutates or is inactive in many cancers. Although mTOR has been thought a promising cancer therapeutic target, the sensitivity of tumor cells to rapamycin was still to be revaluated. In this study, we measured the effects of rapamycin on cell proliferation and phosphorylation of Akt in ESCC cells with varying degrees of differentiation. And then, the relationship between PTEN status and the sensitivity of cells to rapamycin was investigated in EC9706 cells with or without wild-type PTEN in vitro and in vivo. The results demonstrated ESCC cells with poor differentiation were insensitive to rapamycin of high concentration and rapamycin obviously promoted the phosphorylation of Akt in these cells, but it had no obvious effects on p-Akt in cells with well differentiation. Also, we showed that wild-type PTEN improved the sensitivity of poor differentiation cells to rapamycin through inhibiting phosphorylation of Akt in vitro and in vivo. This study explored the possible molecular mechanism of some ESCC cells insensitive to rapamycin and provided a measure for treating ESCC patients with PTEN inactivation using mTOR inhibitors.

In vivo Toll-like receptor 5 (TLR5) imaging with radiolabeled anti-TLR5 monoclonal antibody in rapamycin-treated mouse allogeneic skin transplantation model

BACKGROUND

In organ transplantation, increasing evidence, both in experimental and human studies, indicates that Toll-like receptor (TLR) activation is involved in the innate immune recognition of allograft. TLR5, the only protein recognition receptor of TLRs, is indicated potentially to be the immune regulation target. This study was designed to determine whether TLR5 could be a biomarker for in vivo allograft visualization, after immunosuppressant rapamycin treatment, using radiolabeled sodium iodide ((131) I)-anti-TLR5 monoclonal antibody (mAb).

METHODS

BALB/c mice were transplanted with C57BL/6 skin, with/without rapamycin treatment (the rapamycin-treated group and the phosphate buffered saline [PBS]-rejection group, respectively). In vivo dynamic whole-body phosphor-autoradiography and ex vivo biodistribution studies were conducted after (131) I-anti-TLR5 mAb injection.

RESULTS

Dynamic phosphor-autoradiography imaging showed clear graft localization from 12 h onward. At 72 h after injection, graft uptake quantified from images was higher for the rapamycin-treated group (26,448 ± 904 digital light units [DLU]/mm(2) ), compared with the PBS-treated allo-rejection group (9176 ± 576 DLU/mm(2) ). Treatment with anti-TLR5 mAb inhibited graft uptake. Organ biodistribution study reflected the same tendency, and (131) I-anti-TLR5 mAb uptake reached a maximum of 12.05 ± 1.86 %ID/g (percent injected dose per gram) at 1 h, and graft-to-native skin ratio reached 8.10 ± 0.10 %ID/g at 72 h after injection in rapamycin-treated grafts.

CONCLUSION

Radiolabeled anti-TLR5 mAb showed higher uptake in allo-treated grafts compared with allo-rejection grafts, which was proved by non-invasive dynamic phosphor-autoradiography imaging, and invasive ex vivo biodistribution. Radiolabeled anti-TLR5 mAb is a new tracer for non-invasive in vivo imaging of TLR5 in rapamycin-treated allograft.

Abstract P3-02-04: QM-FISH analysis of the genes involved in the G1/S checkpoint signaling pathway in triple-negative breast cancer

OBJECTIVES: To analyze copy number alterations(CNAs) of the genes involved in the G1/S checkpoint signaling pathway of triple-negative breast cancer (TNBC) and non- triple-negative breast cancer(non-TNBC) and in order to find specific CNAs associated with overall survive for TNBC.In all,to provide an effective target for future treatment.

METHODS: We selected the samples randomly form Tianjin Cancer Hospital between August, 2006 and August, 2007,which contained one hundred TNBC cases and one hundred non-TNBC cases. Quantitative mμlti-gene fluorescence in situ hybridization (QM-FISH) was used to study CNAs of the genes involved in the G1/S checkpoint signaling pathway, including CCND1,c-Myc,p21, CHEK2, p16, Rb1, Mdm2and p53.

RESULTS: The amplification rates of c-Myc and the deletion rates of p53 in TNBC tended to be higher than those in non-TNBC, whereas the amplification rates of CCND1 and Mdm2 in non-TNBC tended to be higher than those in TNBC. In Kaplan-Meier analysis, the amplification of CCND1 (P = 0.02) and c-Myc (P = 0.02) as well as the deletion of p53 (P = 0.01) predicted worse survival in the TNBC group. While in the non-TNBC group, the amplification of CCND1 (P = 0.01) and Mdm2 (P = 0.04) as well as the deletion of p53 (P = 0.049) were associated with worse survival. The amplification of c-Myc and the deletion of p53 in TNBC were associated with higher mortality risk (HR,2.87;95%CI,1.14-7.21[P = 0.03]; HR, 3.34;95%CI, 1.22-9.09 [P = 0.02]), whereas the mortality risk tended to be higher in the patients with amplification of CCND1 (HR, 4.35;95%CI,1.23-15.39 [P = 0.02])in non-TNBC.

CONCLUSIONS: The amplification rates of c-Myc and deletion rates of p53 in TNBC tended to be higher than those in non-TNBC, whereas the amplification rate of CCND1 and Mdm2 tended to be higher in non-TNBC. c-Myc and p53 were independent prognostic factors for TNBC, while CCND1 was the independent prognostic factors for non-TNBC.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-02-04.

Abstract P1-08-05: The prognostic significance of Ki-67 expression before and after neoadjuvant anthracycline-taxane-based chemotherapy in different biological breast cancer phenotypes

Purpose

This study was conducted to analyze the Ki-67 expression before and after neoadjuvant chemotherapy and clinical pathology characteristics of different biological breast cancer phenotypes at our center. A correlation study was performed between Ki-67 index change and the prognosis of different biological breast cancer phenotypes and prognosis in Northern China.

Methods

A regression analysis was performed on 213 patients with invasive breast carcinoma accepted NAC admitted to Tianjin Medical University Cancer Institute and Hospital of Breast Surgery from January 2007 to April 2008. These patients were subtyped by hormone receptor status and HER2 status.The Ki67 index (percentage of Ki67-positive cancer nuclei) were determined immunohistochemically. The prognostic value of the Ki-67 index for different biological breast cancer phenotypes disease-free survival (DFS) and overall survival (OS) was investigated by use of Kaplan–Meier curves and multivariable Cox regression.

Results

The overall pathologic CR (pCR) rate, defined as no invasive residuals in breast and axilla, was 17.8%. The highest pCR rate of 32.1% was observed in patients with HR-/HER2+ tumors, which is 11.4%, 20.0% and 26.2% in HR+/HER2- HR+/HER2-,HR+/HER2+and HR-/HER2- tumor respectively(P = 0.024).The Ki-67 expression of pre-NAC and post-NAC have prognostic significance in HER2- breast cancer, which have not significance different in HER2+ breast cancer:The best Ki-67 idex cut point of pre-NAC and post-NAC to predict long-term survival was respectively 20% and 10% in HR+/HER2- breast cancer. Moreover, patients with a higher Ki-67 index (&gt; cut-off point) showed significantly lower 5year-DFS/OS rates compared with those whose Ki-67 index were below cut-off point. In addition, Ki-67 index of post-NAC were independent prognostic factors for 5 year disease-free survival of patients with HR+/HER2- breast cancer. Ki-67 change between pre- and post-NAC as an independent prognostic factor independently predict prognosis in the patients who have not achieved pCR, while the best cut-off point was 18%.

Conclusion

The Ki-67 index of pre- and post-NAC could predict the prognosis in the patients with HER2- breast cancer. Moreover, the Ki-67 change between pre- and post-NAC was an independent prognostic factor in the patients who have not achieved pCR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-05.

DISTINCT ROLES FOR DISCOIDIN DOMAIN RECEPTOR 1 (DDR1) EXPRESSED ON BONE MARROW DERIVED CELLS AND VESSEL WALL CELLS DURINGATHEROGENESIS

We have recently described a critical role for the discoidin domain receptor 1 (DDR1) collagen receptor tyrosine kinase in the regulation of fibrosis and inflammation during atherosclerotic plaque development. DDR1 isexpressed on both SMCs and macrophages; however the role of DDR1 expressed in these distinct cells during atherogenesis remains unresolved. In the current study, female Ldlr^-/- mice that were either Ddr1^+/+ or Ddr1^-/-were lethally irradiated and reconstituted with bone marrow from male Ddr1^+/+ or Ddr1^-/- donors yielding three groups of chimeric mice: Ddr1^+/+^?^+/+ (control); Ddr1^+/+^?^-/-^ (vessel wall deletion); and Ddr1^-/-^?^+/+ (bone marrow deletion). Chimeric mice were placed on an atherogenic diet for 12 weeks and hadsimilar body weights, total leukocyte counts, levels of Sry chimerism, and fasting plasma triglycerides at sacrifice, although total cholesterol was increased by 42% in Ddr1^+/+^?^-/- mice. Deletion of DDR1 inbone marrow derived cells (Ddr1^-/-^?^+/+) resulted in a 66% reduction in atherosclerotic lesion area in thedescending aorta compared to Ddr1^+/+^?^+/+ mice. Aortic sinus plaquesfrom Ddr1^-/-^?^+/+ mice were 36% smaller than Ddr1^+/+^?^+/+ plaques but the proportion of plaque area occupied by cells and matrix was similar between groups. By contrast, deletion of DDR1 in vessel wall cells (Ddr1^+/+^?^-/-) resulted in a 57% increase in atherosclerosis in the descending aorta. Furthermore, aortic sinus plaques from Ddr1^+/+ ^?^-/- mice had markedly increased fibrillar collagen and elastin accumulation compared to Ddr1^+/+^?^+/+ plaques resulting in a 156% increase in lesion area and reduced SMC and macrophage content. In conclusion, while DDR1 on bone marrow derived cells is required for plaque development, DDR1 expressed on vessel wall cells negatively regulates plaque matrix accumulation and results in the formation of larger lesions with altered cellular composition. Our data suggest a dual role for DDR1 in the regulationof atherogenesis and plaque matrix content.

Synthesis and thrombolytic activity of new thienopyrimidinone derivatives

It has been observed that ticlopidine and clopidogrel show, apart from their delayed antiplatelet properties, an immediate and transient thrombolytic action related to the ability of these thienopyridines to stimulate the secretory function of vascular endothelium. With the objective to construct new molecules with identical thrombolytic potency but at a higher level, we carried out different structural modifications in the thienopyridine chemical molecule to conclude that the presence of a second N atom in the pyridine cycle (yielding pyrimidine moiety) and the presence of an additional cycle fused to the thienyl ring would lead to enhanced thrombolytic effects. Here we report the six-step synthesis of a series of new benzothienopyrimidinone derivatives characterized by this searched for potent thrombolytic activity. The pharmacological assay used anaesthetised Wistar rats with extracorporal circulation in which arterial blood superfused thrombi adhering to a strip of collagen. Weight of thrombi was continuously monitored. Six compounds of the series were much more potent thrombolytic agents than their thienopyridine references: the effective thrombolytic dose that produced 30% of maximum thrombolysis (ED30) was at a range of 8 to 170 microg kg(-1) as compared with ED30 values of 16000 to 20000 microg kg(-1) for clopidogrel and ticlopidine respectively. Especially with the most active compound, this difference in the threshold thrombolytic dose, giving an intensity of action higher by three orders of magnitude, was accompanied by a lengthening of the response. Apart from that these compounds have shown to be synthetic thrombolytics, they certainly deserve further studying.

In vivo blockade of macrophage migration inhibitory factor prevents skin graft destruction after indirect allorecognition

BACKGROUND

The effector mechanisms that ultimately destroy transplanted tissues are poorly understood. In particular, it is not clear how CD4+ T cells primed to donor-derived determinants expressed on recipient MHC molecules (the indirect pathway) can mediate graft destruction in the absence of cognate recognition of peptide: MHC on the graft cells themselves. Macrophage migration inhibitory factor (MIF) inhibits macrophage movement and is a proinflammatory and regulatory cytokine known to be essential for development of delayed-type hypersensitivity reactions.

METHODS

To test whether MIF participates in graft destruction following indirect recognition, we studied rejection of MHC-II-deficient skin grafts placed on allogeneic SCID recipients adoptively transferred with naïve CD4+ T cells, and the recipients were treated with neutralizing anti-MIF monoclonal antibody or isotype control IgG. In this model graft rejection can only occur indirectly as the graft cells lack MHC II for recognition by the recipient CD4+ T cells.

RESULTS

We found that in vivo blockade of MIF inhibited indirect CD4+ cell-mediated skin graft destruction, and markedly reduced detectable macrophages within the grafts. The neutralizing anti-MIF antibody significantly inhibited alloreactive DTH but did not prevent T cell priming or interferon-gamma release by primed T cells.

CONCLUSIONS

The results strongly implicate MIF as an active participant in skin graft destruction after indirect recognition and suggest that this effect is mediated through an inhibition of macrophage migration and/or function.

[Influence of HLA class I molecules expression on tumor cell resistance to NK lysis and the IFN-gamma regulatory effect]

OBJECTIVE

To investigate the relation between the NK lysis and HLA molecules expressed on the target cells as well as the regulatory effect of IFN-gamma.

METHODS

The level of HLA-ABC molecules on seven human tumor cell lines were detected through the indirect immune fluorescence stain. NK lysis changes were observed after the blocking of HLA molecules on the target cells with the anti-HLA monoclonal antibodies or treating target cells with IFN-gamma.

RESULTS

1. Most of the tumor cell lines showed a complete or partial loss of HLA-ABC molecules, 2. After the HLA molecules had been marked on the target cells with the anti-HLA-ABC antibodies, the tumor cell susceptibility to the lysis of NK cells attack increased significantly and 3. After having being treated with IFN-gamma 500 U/ml for more than 48 hours, the HLA-ABC molecule levels on K562, M21 and PG cells went up. At the same time, their susceptibility to NK lysis was reduced. However, the resistance to Karpas, HL60 and HT29 NK lysis demonstrated a noticeable increase. The IFN-gamma promoted the apoptosis of HL60 and HT29 cells.

CONCLUSION

The NK cells are capable of recognizing the HLA molecules on the target cells and show no lysis in providing a negative signal with the KIRs, an effect which the anti-HLA monoclonal antibodies are able to eliminate. IFN-gamma can be applied to make up for the loss of HLA molecules on some of the tumor cells, it can also facilitate some of the tumor cells' apoptosis.

Oriental noodles

Oriental noodles have been consumed for thousands of years and remain an important part in the diet of many Asians. There is a wide variety of noodles in Asia with many local variations as result of differences in culture, climate, region and a host of other factors. In this article noodle classification, formulation, processing and evaluation are reviewed, with emphasis on eight major types. Wheat quality requirements, basic flour specifications, ingredient functions, and production variables are identified for different noodles. In the evaluation of flour for noodle making, three key quality attributes are considered: processability, noodle color and texture. Noodle process behavior is particularly important in the modern industrial production. Each noodle type has its own unique color and texture characteristics. Flour color, protein content, ash content, yellow pigment and polyphenol oxidase activity are important factors responsible for noodle color. Starch characteristics, protein content and quality play major roles in governing the texture of cooked noodles. However, the relative importance of starch and proteins varies considerably with noodle type. Starch pasting quality is the primary trait determining the eating quality of Japanese and Korean noodles that are characterized by soft and elastic texture, while protein quantity and strength are very important to Chinese-type noodles that require firm bite and chewy texture. Other factors such as ingredients added in the noodle formula and processing variables used during noodle preparation also affect the cooked noodle texture as well.

[A study of Wilson's disease gene encoded products and gene mutations]

OBJECTIVE

To investigate the pathogenesis of Wilson's disease(WD).

METHODS

Hepatocytes were isolated from WD patients' bioptic hepatic samples and cultured in vitro; WD proteins, the gene putative encoded products, were detected by SDS-PAGE in conjunction with Western blotting in liver samples of three patients and two controls. Their genomic DNAs were analyzed by means of direct DNA sequencing of WD gene (ATP7B) on exon 8.

RESULTS

The WD proteins lanes from two WD patients were found to be much weaker than that from the control, from which one WD patient was proven as heterozygote of 778 position CGG-->CTG(Arg778Leu) and 770 position CTC-->CTG change of ATP7B.

CONCLUSION

WD is highly heterogeneous in clinical manifestations and inheritance pattern. Abnormally expressed putative WD proteins in WD patients might be the results of ATP7B mutations, and the study of ATP7B products would help to probe into the pathogenesis of WD.

[A study of gene products encoded by Wilson disease gene]

OBJECTIVE

To investigate the pathogenesis of Wilson disease (WD) by detecting its gene products encoded by WD gene (ATP7B).

METHODS

Patients diagnosed as WD were analyzed by SDS-PAGE in conjunction with Western blot. Two antibodies were used, which are specially against the sixth copper binding domain (Anti-CuBD) and ATP binding domain (Anti-ABD) of WD protein.

RESULTS

The WD proteins were not expressed in two patients when using anti-CuBD, and poorly expressed when using anti-ABD.

CONCLUSIONS

WD is highly heterogeneous in clinical manifestations and inheritance pattern. Two WD patients might simultaneously have exon 5 mutations and exon 8 mutations. The study of WD gene products would probe into the pathogenesis of WD.

The discoidin domain receptor tyrosine kinase DDR1 in arterial wound repair

Collagens act as important signaling molecules regulating vascular smooth muscle cell responses during arterial wound repair. Discoidin domain receptors (DDRs) are a novel class of receptor tyrosine kinases that bind to several collagens and stimulate matrix metalloproteinase (MMP) production, but little is known about their expression and function in the vasculature. We posited a critical role for the DDRs controlling smooth muscle cell migration and proliferation and thus repair following arterial injury. Smooth muscle cells were isolated from the aortas of mice with a targeted deletion of the DDR1 gene (DDR1-null) and studied in culture using models that mimic critical steps in neointimal thickening. Our studies suggest that DDR1 plays an important role in regulating attachment to collagen, chemotaxis, proliferation, and MMP production in smooth muscle cells. Following mechanical injury to the carotid arteries, cross-sectional area of the neointima was significantly lower in DDR1-null mice than in wild-type mice. There was also a significant decrease in collagen deposition in the injured arteries of the DDR1-null mice. Our results support the hypothesis that DDR1 plays an important role as a collagen receptor, mediating intimal thickening after vascular injury.

[Using fluorescence PCR analysis for early diagnosis and carriers detection of Chinese Wilson's disease]

OBJECTIVE

To diagnose the pre-symptomatic cases of Chinese Wilson's disease(WD) and detect the potential carriers by using fluorescence PCR technique.

METHODS

Screening the high frequency spot Arg778Leu of WD gene mutation in 66 Chinese WD patients, 55 healthy family members and 30 controls, and selecting 3 random samples (2 from WD patients, 1 from controls) for DNA sequencing to testify the accuracy of fluorescence PCR.

RESULTS

Among 66 Chinese WD cases, 5 were found homozygous for mutation of Arg778Leu and 21 were compound heterozygous; the gene mutation rate was totally 39.4%. Out of 55 healthy family members, 12 were found heterozygous, and it was confirmed that 11 of these 12 individuals were WD gene carriers but not pre-symptomatic patients. The results of direct DNA sequencing consisted with those results detected by fluorescence PCR.

CONCLUSION

The Arg778Leu mutation in exon 8 is the high frequency spot of Chinese Wilson's disease gene. Fluorescence PCR analysis is a rapid, accurate gene diagnostic method and demonstrates a high detecting rate.

[ABO genotyping by PCR-direct sequencing method]

OBJECTIVE

To analyze the sequence difference between human A, B, and O alleles and establish the method of ABO genotyping by PCR direct sequencing.

METHODS

PCR-direct sequencing technique was used to analyze two regions of cDNA from A transferase gene, 233-433 and 660-788.

RESULTS

Two nucleotide substitutions at 258th and 297th were found in 233-433 region, and a nucleotide substitution at 700th was found in 660-788 region. At 258th, the nucleotide was guanine in A and B alleles, and adenine in O allele. At 297th, the nucleotide was adenine in A allele, and guanine in B allele. As this position, O allele was subdivided into two types, O(A) and O(G). At 700th, the nucleotide was guanine in A and O alleles, and adenine in B allele. Therefore, 8 genotypes, AA, AO(A), AB, BB, BO(G), O(A) O(A), O(G) O(G) and O(A) O(G), could be clearly determined by only analyzing the 233-433 region. The other two genotypes, AO(G) and BO(A), could be further distinguished by analyzing the 660-788 region.

CONCLUSION

The technique of PCR-direct sequencing provides an effective and new method for ABO genotyping further.

Thrombolysis by thienopyridines and their congeners

We propose that anti-platelet thienopyridines, such as ticlopidine or clopidogrel, are thrombolytic owing to endothelial release of prostacyclin (PGI2) and tissue plasminogen activator (t-PA). In this study we used anaesthetised Wistar rats with extracorporal circulation in which arterial blood superfused thrombi which adhered to a strip of collagen. Weight of thrombi was continuously monitored. When administered intravenously, clopidogrel or its R enantiomer deprived of anti-platelet action, both at doses of 3 mg x kg(-1), produced lost in weight of thrombi by 14.1 +/- 1.3% or 16.0 +/- 1.4% (n = 9), and at doses 10 mg x kg(-1) by 28.3 +/- 2.3% or 30.4 +/- 1.9% (n = 8), respectively. Maximum of thrombolysis occurred 30-45 min following the drug administration. Ticlopidine at a dose of 30 mg x kg(-1) reduced weight of thrombi by 33.7 +/- 1.7% (n = 32). Thrombolytic action of ticlopidine was accompanied by a rise in 6!keto-PGF1alpha blood levels from 0.42 +/- 0.10 to 1.58 +/- 0.29 ng x ml(-1) and t-PA antigen plasma levels from 4.70 +/- 1.00 to 12.90 +/- 1.15 ng x ml(-1) (n = 7). Five out of eleven tested thienopyridine congeners with pyrimidine or pyrimidinone instead of pyridine rings had thrombolytic potencies similar to that of clopidogrel (ED30s at a range of 6.2-11.4 mg x kg(-1)). A substantial increase in thrombolytic potency (ED30s at a range of 0.3-2.1 mg x kg(-1)) was observed for congeners in which thienyl ring was condensed with an additional cyclopentyl, cyclohexyl or cycloheptyl structures or in which thienopyridine complex was replaced for a pyridopyrimidine one. We claim that thienopyridines, independently of their delayed anti-platelet action, do produce immediate thrombolysis in vivo. This new activity emulates capacity of their native, non-metabolised molecules to release prostacyclin and tissue plasminogen activator. We have also shown that structural changes in molecules of thienopyridines may intensify their thrombolytic potency.