[Correlation between combined deflection angle classification adduction typing and complications after internal fixation of adduction femoral neck fracture]

Objective

To analyze the correlation between postoperative complications and combined deflection angle classification adduction type (CDAC-ADT) of femoral neck fractures after cannulated screw internal fixation.

Methods

The clinical data of 121 patients with CDAC-ADT femoral neck fracture admitted between January 2018 and December 2021 and met the selected criteria were retrospectively analyzed. There were 69 males and 52 females, the age ranged from 19 to 79 years (mean, 48.1 years). The causes of injury included 52 cases of traffic accident, 24 cases of falling from height, and 45 cases of fall. The time from injury to operation ranged from 2 to 12 days, with an average of 6.0 days. Among them, there were 18 cases of CDAC-ADT type Ⅰ, 46 cases of type Ⅱ, and 57 cases of type Ⅲ; 6 cases of Garden type Ⅱ, 103 cases of type Ⅲ, and 12 cases of type Ⅳ; and according to the location of the fracture line, there were 26 cases of subcapitate type, 88 cases of transcervical type, and 7 cases of basal type. All patients were treated with cannulated screw internal fixation. The occurrence of complications (including internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head) was recorded, and the correlation between complications and CDAC-ADT typing, Garden typing, and fracture line location were analyzed.

Results

The patients were followed up 8-44 months, with a mean of 24.9 months. There were 10 cases of internal fixation failure, 7 cases of fracture nonunion, and 30 cases of osteonecrosis of the femoral head after operation. Correlation analysis showed that patients' CDAC-ADT typing was significantly correlated with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency were 0.435, 0.251, 0.254, and 0.241, respectively. Garden typing did not correlate with the overall incidence of complication and the incidence of internal fixation failure and fracture nonunion ( P>0.05), but correlated with the incidence of osteonecrosis of the femoral head ( P<0.05), and the Pearson coefficient of contingency was 0.251. Fracture line position typing had no correlation with the overall incidence of complication and the incidence of internal fixation failure, fracture nonunion, and osteonecrosis of the femoral head ( P>0.05).

Conclusion

CDAC-ADT typing has obvious correlation with postoperative complications of femoral neck fracture and can be used to predict complications of femoral neck fracture.

[Correlation analysis between combined deflection angle and osteonecrosis of femoral head after femoral neck fracture]

Objective

To evaluate the correlation between pelvic incidence (PI) angle, hip deflection angle (HDA), combined deflection angle (CDA) and osteonecrosis of the femoral head (ONFH) after femoral neck fracture, in order to explore early predictive indicators for ONFH occurrence after femoral neck fracture.

Methods

A study was conducted on patients with femoral neck fractures who underwent cannulated screw internal fixation between December 2018 and December 2020. Among them, 208 patients met the selection criteria and were included in the study. According to the occurrence of ONFH, the patients were allocated into ONFH group and non-NOFH group. PI, HDA, and CDA were measured based on the anteroposterior X-ray films of pelvis and axial X-ray films of the affected hip joint before operation, and the differences between the two groups were compared. The receiver operating characteristic curve (ROC) was used to evaluate the value of the above imaging indicators in predicting the occurrence of ONFH.

Results

Among the 208 patients included in the study, 84 patients experienced ONFH during follow-up (ONFH group) and 124 patients did not experience ONFH (non-ONFH group). In the non-ONFH group, there were 59 males and 65 females, the age was 18-86 years (mean, 53.9 years), and the follow-up time was 18-50 months (mean, 33.2 months). In the ONFH group, there were 37 males and 47 females, the age was 18-76 years (mean, 51.6 years), and the follow-up time was 8-45 months (mean, 22.1 months). The PI, HDA, and CDA were significantly larger in the ONFH group than in the non-ONFH group ( P<0.05). ROC curve analysis showed that the critical value of PI was 19.82° (sensitivity of 40.5%, specificity of 86.3%, P<0.05); the critical value of HDA was 20.94° (sensitivity of 77.4%, specificity of 75.8%, P<0.05); and the critical value of CDA was 39.16° (sensitivity of 89.3%, specificity of 83.1%, P<0.05).

Conclusion

There is a correlation between PI, HDA, CDA and the occurrence of ONFH after femoral neck fracture, in which CDA can be used as an important reference indicator. Patients with CDA≥39.16° have a higher risk of ONFH after femoral neck fracture.

[Xinfeng capsule inhibits immune inflammation in osteoarthritis by inhibiting the miR- 23a-3p/PETN/PI3K/AKT/mTOR pathway]

OBJECTIVE

To observe the inhibitory effect of Xinfeng capsule (XFC) on immune inflammatory response in the coculture system of chondrocytes and CD4+ T cells from patients with osteoarthritis (OA).

OBJECTIVE

Thirty OA patients and 30 healthy subjects were examined for the expression of miR-23a-3p/PTEN/PI3K/AKT/mTOR. The changes in the miR-23a-3p/ PTEN/PI3K/AKT/mTOR pathway and the clinical indicators of the OA patients after XFC treatment were observed. OA-CD4+ T cells and OA-Chondrocytes cells were cultured in Transwel chambers, and the expressions of miR-23a-3p, PTEN, PI3K, AKT and mTOR mRNA were detected by RT-PCR; the levels of IL-1β, IL-6, IL-10 and TNF-α were detected by ELISA. The protein expressions of PTEN, PI3K, AKT, p-AKT, mTOR and p-mTOR were detected by Western blotting.

OBJECTIVE

Compared with healthy individuals, OA patients showed significantly increased expressions of miR-23a-3p, PTEN, PI3K, AKT, IL-1β, IL-6 and TNF-α and lowered expressions of PTEN and IL-10 (P < 0.01). Positive correlations were found between miR-23a-3p and IL-6 and between PI3K and IL-10; mTOR was positively correlated with IL-6, IL-10, complement C3 and C4 (P < 0.01 or 0.05). Intervention with XFC obviously down-regulated the expressions of IL-1β, IL-6, and TNF-α and up-regulated the expression of IL-10 (P < 0.01). In the cell co-culture systems, the expressions of miR-23a-3p, PI3K, Akt, mTOR, IL-1β, IL-6 and TNF-α were up-regulated while the expressions of PTEN and IL-10 were down-regulated in the model group (P < 0.01). Overexpression of miR-23a-3p significantly up-regulated the expressions of IL-1β, IL-6, TNF-α, miR-23a-3p, PI3K, AKT and mTOR and lowered the expressions of PTEN and IL-10 (P < 0.01 or 0.05). The expressions of IL-1β, IL-6, TNF-α, miR-23a-3p, PI3K, AKT and mTOR were down-regulated and the expressions of IL-10 and PTEN were up-regulated in XFC-treated cells (P < 0.01 or 0.05).

OBJECTIVE

XFC can reduce the inflammatory response in patients with OA by down-regulating the expression of miR-23a-3p, inhibiting the activation of the PTEN/PI3K/AKT/ mTOR pathway, and regulating the expression of IL-1β, IL-6, IL-10 and TNF-α.

[Effect of ozone oil for prevention and treatment of sorafenib-induced hand-foot skin reactions: a randomized controlled trial]

OBJECTIVE

To compare the effects of medical ozone oil and urea ointment for prevention and treatment of hand-foot skin reaction (HFSR) caused by sorafenib in patients with hepatocellular carcinoma (HCC).

METHODS

A total of 99 patients diagnosed with advanced HCC according to National Comprehensive Cancer Network (NCCN) who were scheduled to receive sorafenib treatment for the first time were enrolled in this study between April, 2018 and January, 2020. The patients were randomized into medical ozone oil group (n=49) and urea ointment group (control group, n=49) for treatment with local application of 1 mL medical ozone oil (experimental group) and 10% urea ointment (2 g) on the palm and plantar skin (including the fingers and joints) for 12 weeks (3 times per day) starting at the beginning of sorafenib treatment, respectively. The patients were observed for occurrence of HFSR every 2 weeks for 14 weeks.

RESULTS

Eight patients were excluded for poor compliance or protocol violations, leaving a total of 91 patients for analysis, including 44 in medical ozone oil group and 47 in urea ointment group. Sixteen (36.4%) of patients in ozone oil group developed HFSR, a rate significantly lower than that in urea ointment group (57.4%; P < 0.05). The incidence of grade 2/3 HFSR was also lower in ozone oil group than in urea ointment group (15.9% [7/44] vs 27.7 [13/47]).

CONCLUSIONS

Medical ozone oil can significantly reduce the incidence and severity of HFSR to improve the quality of life of HCC patients receiving sorafenib treatment.

[Correlations of echocardiographic parameters in Gout patients: a retrospective analysis]

OBJECTIVE

To explore the correlations of echocardiographic parameters in patients with gout.

METHODS

The hospitalization data and medical records of patients with gout between January, 2012 and June, 2019 were retrieved from the database of Anhui Provincial Hospital of Traditional Chinese Medicine, and the echocardiographic parameters and clinical laboratory test results of the inflammatory, immunological and metabolic indicators were analyzed. SPSS 22.0, SPSS Clementine 11.1 Aprior and other statistical software were used to determine the association rules and carry out correlation analysis, heat map analysis and multi-factor logistic regression analysis of the indicators.

RESULTS

Heat map analysis showed that the expressions of EF and SV were the most significant, followed by AODd, LADs, LVDd and FS. Cluster analysis showed that AODd, EF, FS, LADs, LVDd, and SV were all in cluster 1, and IVSTd, LVPWTd, MPAD, Pmax, and RVDd were in cluster 2. Correlation analysis showed that in the 383 patients, EF was negatively correlated with LVDd (P &lt; 0.05) and positively correlated with FS and SV (P &lt; 0.05); AODd was positively correlated with IVSTd, LADs, LVDd, LVPWTd, RVDd, SV, and ESR (P &lt; 0.05); FS was positively correlated with EF and SV (P &lt; 0.05) and negatively correlated with LVDd (P &lt; 0.05);IVSTd was positively correlated with AODd, LADs, LVPWTd, and complement C4 (P &lt; 0.05); LADs were positively correlated with AODd, IVSTd, MPAD, RVDd, and SV (P &lt; 0.05); LVDd was positively correlated with AODd, IVSTd (P &lt; 0.05), and negatively correlated with LVDd and complement C3 (P &lt; 0.05); MPAD and LADs, HDLC and TC were positively correlated (P &lt; 0.05)and negatively correlated with Pmax (P &lt; 0.05); Pmax was positively correlated with LVDd, RVDd and SV (P &lt; 0.05)and negatively correlated with FS and MPAD (P &lt; 0.05); RVDd was positively correlated with AODd, LADs, LVDd, Pmax, SV (P &lt; 0.05); SV was positively correlated with AODd, EF, LADs, LVDd, Pmax, and RVDd (P &lt; 0.05); complement C3 was positively correlated with complement C4 and CRP (P &lt; 0.05), and negatively correlated with LVPWTd (P &lt; 0.05); complement C4 was positively correlated with IVSTd, complement C3, CRP, and ESR (P &lt; 0.05); CRP was positively correlated with complement C3, complement C4, IgA, IgG (P &lt; 0.05), and negatively correlated with TC, HDLC, and TG (P &lt; 0.05); TG was positively correlated with HDLC, IgM, and TC (P &lt; 0.05), and negatively correlated with CRP (P &lt; 0.05); HDLC was positively correlated with MPAD, HDLC and TC (P &lt; 0.05) and negatively correlated with CRP (P &lt; 0.05); IgA was positively correlated with CRP, IgG and IgM (P &lt; 0.05); IgG was positively correlated with CRP, IgA and IgM (P &lt; 0.05); IgM is positively correlated with TG, IgA, IgG, UA (P &lt; 0.05) and negatively correlated with CRP (P &lt; 0.05); UA was positively correlated with IgM (P &lt; 0.05); ESR was positively correlated with AODd and complement C4 (P &lt; 0.05); HCY was negatively correlated with RVDd (P &lt; 0.05); TC was positively correlated with MPAD and TG (P &lt; 0.05), and negatively correlated with CRP (P &lt; 0.05). The increase of Pmax was significantly associated with the increase of LDL-C, UA, complement C4, TG, HCY, HDL-C, IgG, ESR, CRP, and complement C3; the increase of SV was associated with the elevations of UA, LDL-C, complement C4, HDL-C, CRP, IgG, HCY, TC, ESR, TG, and complement C3. Multivariate logistic regression analysis indicated that FS was positively correlated with LDL-C (P &lt; 0.05), Pmax was negatively correlated with IgM (P &lt; 0.05), and SV was negatively correlated with ESR (P &lt; 0.05).

CONCLUSIONS

The changes of echocardiographic parameters in patients with gout are correlated with the increase in inflammation, immunity, and metabolic indexes. Patients with a history of smoking and drinking do not show obvious changes in cardiac function. The changes in metabolic indexes are risk factors for changes in echocardiographic parameters.