A novel computed tomography-based three-column MLP classification of intertrochanteric fracture

OBJECTIVES

The aim of the present study was to introduce a novel three-dimensional computed tomography (3DCT)-based three-column classification (named "MLP classification system") of intertrochanteric fractures and evaluate its reproducibility and reliability.

METHODS

From September 2020 to September 2022, a total of 258 consecutive patients (60 male, 198 female;mean age 81.3 years) with intertrochanteric fractures were included in this study. The fracture in each case was assessed using a novel three-dimensional computed tomography-based three-column classification. Two examiners tested the intra and inter-observer reliability of this new classification system using kappa variance.

RESULTS

The intertrochanteric region was divided into the medial column, lateral column, and posterior column. Intertrochanteric fractures were documented as M0/1/2L0/1/2/3P0/1/2/3. All fractures were classifiable into the new classification system. The intra-observer kappa values were 0.91 and 0.89, while the inter-observer kappa value was 0.82, both indicating almost perfect reliability.

CONCLUSION

This novel 3DCT-based MLP classification system for intertrochanteric fractures is comprehensive, and reproducible with good agreement. It is based on proximal femur biomechanic characteristics and traumatic mechanism, contributing to formulating more reasonable treatment protocols involving various late-model internal fixation devices. J. Med. Invest. 70 : 524-529, August, 2023.

[Arthroscopic treatment of tibial avulsion fracture of posterior cruciate ligament with a knot-free anchor and Endobuton titanium plate]

OBJECTIVE

To investigate the clinical effect of arthroscopic fixation of tibial avulsion fracture of posterior cruciate ligament with a knot-free anchor and Endobuton titanium plate.

METHODS

From October 2019 to October 2020, 12 patients with tibial avulsion fracture of posterior cruciate ligament were treated with the arthroscopic knot-free anchor and Endobuton titanium plate, including 9 males and 3 females. The age ranged from 23 to 58 years old. The time from injury to operation ranged from 2 to 9 days. There were 2 cases of Meyers typeⅡand 10 cases of Meyers type Ⅲ. There were 2 cases of meniscus injury and 1 case of partial injury of medial collateral ligament. The fracture healing and knee range of motion were evaluated after operation, and the clinicalefficacy was evaluated by Lysholm function score.

RESULTS

All patients were followed up for 12 months. All patients healed within 6 months, and there were no complications such as incision infection, lower extremity deep venous thrombosis and internal fixation falling off. The knee flexion range of motion recovered from 50°-90° before operation to 115°-130° 6 months after operation, and no patient had straightening disorder. Lysholm functional score recovered from preoperative 29-54 scores to 86-100 scores 12 months after operation.

CONCLUSION

Arthroscopic reduction and fixation of tibial avulsion fracture of posterior cruciate ligament with the knot-free anchor and Endobuton titanium plate has less complications, high fracture healing rate, good extension and flexion angle and early function recovery of knee joint.

A MEMS SOI-based piezoresistive fluid flow sensor

In this paper, a SOI (silicon-on-insulator)-based piezoresistive fluid flow sensor is presented; the presented flow sensor mainly consists of a nylon sensing head, stainless steel cantilever beam, SOI sensor chip, printed circuit board, half-cylinder gasket, and stainless steel shell. The working principle of the sensor and some detailed contrastive analysis about the sensor structure were introduced since the nylon sensing head and stainless steel cantilever beam have distinct influence on the sensor performance; the structure of nylon sensing head and stainless steel cantilever beam is also discussed. The SOI sensor chip was fabricated using micro-electromechanical systems technologies, such as reactive ion etching and low pressure chemical vapor deposition. The designed fluid sensor was packaged and tested; a calibration installation system was purposely designed for the sensor experiment. The testing results indicated that the output voltage of the sensor is proportional to the square of the fluid flow velocity, which is coincident with the theoretical derivation. The tested sensitivity of the sensor is 3.91 × 10^-4 V ms²/kg.

[Clinical experience on the employment of the staged step-up approach in the treatment of local complications secondary to severe acute pancreatitis]

Objective: To explore the experience and prognostic factors associated with the employment of the step-up approach in the treatment of local complications secondary to severe acute pancreatitis (SAP). Methods: The clinical data of 279 patients admitted to the Department of Pancreatic and Biliary Surgery, First Affiliated Hospital of Harbin Medical University from January 2011 to December 2015, whose local complications secondary to SAP were treated in a staged step-up framework, were retrospectively analyzed.For patients with documented or suspected infected pancreatic necrosis or gastrointestinal tract obstruction, some non-surgical interventions were initialed with the aim of postponing the timing of surgery to the forth week from the onset of SAP.The first-step intervention was a percutaneous catheter drainage (PCD) under the guidance of ultrasound. A minimal access retroperitoneal pancreatic necrosectomy, representing the second-step intervention, was conducted when PCD had failed. Finally, an open necrosectomy (the third-step intervention) was immediately resorted to when all of previous minimal invasive interventions had failed.Normally distributed quantitative variables were analyzed by t-test, non-normally distributed quantitative variables were analyzed by Wilcoxon chi-square test and categorical variables were analyzed by χ² test or Fisher's exact test.A multivariable Logistic regression analytic model was established to figure out the prognostic factors that were independently associated with the requirement of debridement in addition to drainage procedure during the staged step-up framework of patients with local complications secondary to SAP. Results: The initial interventions in this series were performed at 12 d (9-22 d) from the on-set of SAP and 104 cases (37.3%) were cured with ultrasound guided PCD alone.There were 152 cases (54.5%) cured by debridement in addition to PCD with the time interval of 30 d (25 to 44 d) since the on-set of the disease.The overall incidence of postoperative complications was 22.6% (63 cases) and in-hospital mortality was 8.2% (23 cases) in the present series.Multiple organ failures(MOF)(P<0.01, OR=3.15), heterogeneous collections (P<0.01, OR=2.40) and tertiary transfer (P=0.03, OR=1.80) were verified as the prognostic factors that were independently associated with the requirement of debridement in addition to PCD during the staged step-up framework of patients with local complications secondary to SAP. Conclusions: The staged step-up framework is a promising innovation that complies well with the era of minimal invasive surgery and is optimally suitable for the surgical interventions against SAP.MOF, heterogeneous collections and tertiary transfer are the prognostic factors that are independently associated with the requirement of debridement in addition to PCD during the staged step-up framework of patients with local complications secondary to SAP.

Town mouse or country mouse: identifying a town dislocation effect in Chinese urbanization

Understanding urbanization and evaluating its impact are vital for formulating global sustainable development. The results obtained from evaluating the impact of urbanization, however, depend on the kind of measurement used. With the goal of increasing our understanding of the impact of urbanization, we developed direct and indirect subjective indicators to measure how people assess their living situation. The survey revealed that the projected endorsements and perceived social ambiance of people toward living in different types of settlements did not improve along with the urbanization level in China. The assessment scores from the city dwellers were not significantly different from those from the country areas and, more surprisingly, both were significantly higher than the assessment scores of the town dwellers, which we had expected to fall between the assessment scores of the country and city dwellers. Instead their scores were the lowest. We dubbed this V-shaped relationship the "town dislocation effect." When searching for a potential explanation for this effect, we found additional town dislocation effects in social support, loss aversion, and receptivity toward genetically modified food. Further analysis showed that only social support mediated the relationship between the three tiers of settlements (cities, country areas, and towns) and the subjective indicator. The projected endorsements yielded significant subjective assessments that could enhance our understanding of Chinese urbanization. Towns posed specific problems that require special attention.

Lycopene protects pancreatic acinar cells against severe acute pancreatitis by abating the oxidative stress through JNK pathway

This study investigated the anti-oxidative and anti-inflammatory effects of lycopene on severe acute pancreatitis (SAP) in both in vivo and in vitro models. Utilizing a rat model, we found that lycopene administration protected against SAP, as indicated by the decreased levels of serum amylase and C-reactive protein. Pathological changes were alleviated by pretreatment with lycopene. The serum levels of tumor necrosis factor-α, interleukin-6, macrophage inflammatory protein-1α, and monocyte chemotactic protein-1 were decreased by lycopene. The decreased reactive oxygen species (ROS) content in the pancreatic tissues of the lycopene-treated group were indirectly evaluated by measuring the levels of myeloperoxidase, lipid peroxidase, and superoxide dismutase. Lycopene protected acinar cells against necrosis and apoptosis by relieving the mitochondrial and endoplasmic stress caused by ROS which was shown in electron microscopy and immunohistochemistry staining of active nuclear factor-κB p65. The protective effect was also observed in a simulated SAP model in a rat acinar cell line. ROS and apoptotic staining were compared between groups. Lycopene exerts protective effects against SAP in rats that may be related to its anti-inflammatory property through inhibiting the expression of damage-associated molecular patterns, and anti-oxidative property which can thus maintain cellular homeostasis and prevent the phosphorylation of JNK pathway.

Effect of the route of foot-and-mouth disease virus infection of piglets on the course of disease

Three different routes of Foot-and-mouth disease virus (FMDV) infection of piglets, namely intranasal (i.n.) through drops, intradermal (i.d.) into the foot, and intramuscular (i.m.) were compared regarding the onset and severity of the disease. The results showed that the i.d. injection of the virus resulted in the fastest onset of the disease. The i.m. injection led to a delayed onset, but the final effect was identical with i.d. injection. Moreover, the i.m. injection was simpler to perform and easier to evaluate. Therefore, the i.m. injection of piglets is recommended as the optimal infection route for evaluation of the FMDV vaccine potency.

Can overconfidence be debiased by low-probability/high-consequence events?

During the first half of 2008, China suffered three natural disasters: a heavy snow storm, an outbreak of hand-foot-mouth disease, and a severe earthquake. The aim of the present study is to explore how low-probability/high-consequence events influence overconfidence. In Study 1, opportunity samples were obtained by recruiting residents in three different types of disaster-hit areas to answer a peer-comparison probability judgment questionnaire about 1 month after the corresponding disaster occurred. The performance of 539 participants in disaster-hit areas was compared with that of 142 residents in a nondisaster area. The findings indicate that residents in disaster-hit areas were less overconfident than those in the nondisaster area on both positive and negative events. In Study 2, we surveyed a total of 336 quake-victims 4 and 11 months after the earthquake to examine whether the impact of disasters on overconfidence would decay with time. The resulting data indicate that the disaster victims became more overconfident as time elapsed. The overall findings suggest that low-probability/high-consequence events could make people less overconfident and more rational and seem to serve as a function of debiasing.

Progression of the "Psychological Typhoon Eye" and variations since the Wenchuan earthquake

BACKGROUND

In 2008 after a massive earthquake jolted Wenchuan, China, we reported an effect that we termed a "Psychological Typhoon Eye": the closer to the center of the devastated area, the lower the level of concern felt by residents about safety and health. We now report on the progression of this effect and the development of new variations after the quake as well as investigating potential explanations.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted two sequential surveys of 5,216 residents in non-devastated and devastated areas in September-October 2008 and April-May 2009. Respondents were asked five questions to assess their concerns about safety and health. A MANCOVA showed a significant inverse effect of residential devastation level on the estimated number of medical and psychological workers needed, the estimated probability of an epidemic outbreak, and the estimated number of self-protective behaviors needed (Ps<0.001), in spite of the passage of one year. The level of post-earthquake concern decreased significantly with an increase in the residential devastation level. Additionally, we observed two variations in the "Psychological Typhoon Eye" effect, in that the respondents' concern decreased with increasing relational distance between a respondent and victims who had suffered either physical or economic damage.

CONCLUSIONS/SIGNIFICANCE

The previously reported effect of a "Psychological Typhoon Eye" remains robust over a 1-year period. We found that the "psychological immunization" theory did not provide a satisfactory explanation for these intriguing results. Our findings may be useful in understanding how people become resilient to threats.

Psychological typhoon eye in the 2008 Wenchuan earthquake

Background

On May 12, 2008, an earthquake measuring 8.0 on the Richter scale jolted Wenchuan, China, leading to 69,227 deaths and 374,643 injured, with 17,923 listed as missing as of Sept. 25, 2008, and shook the whole nation. We assessed the devastating effects on people's post-earthquake concern about safety and health.

Methodology/Principal Findings

From June 4 to July 15, 2008, we surveyed a convenience sample of 2,262 adults on their post-earthquake concern about safety and health. Residents in non-devastated areas (Fujian and Hunan Provinces, and Beijing) and devastated areas (Sichuan and Gansu Provinces) responded to a questionnaire of 5 questions regarding safety measures, epidemic disease, medical workers, psychological workers, and medication. The ANOVAs showed a significant effect of residential devastation level on the estimated number of safety measures needed, the estimated probability of the outbreak of an epidemic, and the estimated number of medical and psychological workers needed (Ps<0.001). The post-earthquake concern decreased significantly as the level of residential devastation increased. Because of the similarity with the meteorological phenomenon of the eye of a typhoon, we dubbed these findings a “Psychological Typhoon Eye”: the closer to the center of the devastated areas, the less the concern about safety and health a resident felt.

Conclusions/Significance

Contrary to common perception and ripple effect that the impact of an unfortunate event decays gradually as ripples spread outward from a center, a “Psychological Typhoon Eye” effect was observed where the post-earthquake concern was at its lowest level in the extremely devastated areas. The resultant findings may have implications for Chinese governmental strategies for putting “psychological comfort” into effect.

[Treatment of refractory acute rejection after renal transplantation with lymphogloline]

156 patients received renal transplantation in the Nanfang Hospital from October 1992 to December 1993. 27 patients developed refractory acute rejection (RAR). Of them, rejection was reversed completely with lymphogloline (ATG) in 22 patients and reversed with OKT3 in 4. One patient died of cerebral hemorrhage after removal of the donor's kidney. The results suggest that ATG is safe, effective, highly specific, sensitive, and of less side-effect. The pathogenesis, diagnosis of RAR and cautions for ATG are discussed.

[Hypertensive chemotherapy of advanced gastric cancer]

Hypertensive chemotherapy of advanced gastric cancer is reported in this paper. The blood pressure of the patient was first elevated by intravenous angiotensin II, then mitomycin C was given for two consecutive days at doses of 20 mg and 10 mg. Out of 20 cases, it was effective in 11 (55%), especially for those with Borrmann III and IV types and poorly differentiated adenocarcinoma which recurred after subtotal gastrectomy. The side effect of this treatment was not marked and the response satisfactory Therefore, it may easily be accepted as the treatment for advanced gastric cancer.