Impact of homocysteine on acute ischemic stroke severity: possible role of aminothiols redox status

BACKGROUND

Acute ischemic stroke (AIS) is one of the most common cerebrovascular diseases which accompanied by a disruption of aminothiols homeostasis. To explore the relationship of aminothiols with neurologic impairment severity, we investigated four aminothiols, homocysteine (Hcy), cysteine (Cys), cysteinylglycine (CG) and glutathione (GSH) in plasma and its influence on ischemic stroke severity in AIS patients.

METHODS

A total of 150 clinical samples from AIS patients were selected for our study. The concentrations of free reduced Hcy (Hcy), own oxidized Hcy (HHcy), free reduced Cys (Cys), own oxidized Cys (cysteine, Cyss), free reduced CG (CG) and free reduced GSH (GSH) were measured by our previously developed hollow fiber centrifugal ultrafiltration (HFCF-UF) method coupled with high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). The concentration ratio of Hcy to HHcy (Hcy/HHcy), Cys to Cyss (Cys/Cyss) were also calculated. The neurologic impairment severity of AIS was evaluated using National Institutes of Health Stroke Scale (NIHSS). The Spearman correlation coefficient and logistic regression analysis was used to estimate and perform the correlation between Hcy, HHcy, Cys, Cyss, CG, GSH, Hcy/HHcy, Cys/Cyss and total Hcy with NIHSS score.

RESULTS

The reduced Hcy and Hcy/HHcy was both negatively correlated with NIHSS score in AIS patients with P = 0.008, r=-0.215 and P = 0.002, r=-0.249, respectively. There was no significant correlation of Cys, CG, GSH, HHcy, Cyss, Cys/Cyss and total Hcy with NIHSS score in AIS patients with P value > 0.05.

CONCLUSIONS

The reduced Hcy and Hcy/HHcy, not total Hcy concentration should be used to evaluate neurologic impairment severity of AIS patient.

Amplitude Analysis of the B^{0}→K^{*0}μ^{+}μ^{-} Decay

An amplitude analysis of the B^{0}→K^{*0}μ^{+}μ^{-} decay is presented using a dataset corresponding to an integrated luminosity of 4.7  fb^{-1} of pp collision data collected with the LHCb experiment. For the first time, the coefficients associated to short-distance physics effects, sensitive to processes beyond the standard model, are extracted directly from the data through a q^{2}-unbinned amplitude analysis, where q^{2} is the μ^{+}μ^{-} invariant mass squared. Long-distance contributions, which originate from nonfactorizable QCD processes, are systematically investigated, and the most accurate assessment to date of their impact on the physical observables is obtained. The pattern of measured corrections to the short-distance couplings is found to be consistent with previous analyses of b- to s-quark transitions, with the largest discrepancy from the standard model predictions found to be at the level of 1.8 standard deviations. The global significance of the observed differences in the decay is 1.4 standard deviations.

Fraction of χ_{c} Decays in Prompt J/ψ Production Measured in pPb Collisions at sqrt[s_{NN}]=8.16 TeV

The fraction of χ_{c1} and χ_{c2} decays in the prompt J/ψ yield, F_{χ_{c}→J/ψ}=σ_{χ_{c}→J/ψ}/σ_{J/ψ}, is measured by the LHCb detector in pPb collisions at sqrt[s_{NN}]=8.16  TeV. The study covers the forward (1.5 Collapse

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Enhanced Production of Λ_{b}^{0} Baryons in High-Multiplicity pp Collisions at sqrt[s]=13 TeV

The production rate of Λ_{b}^{0} baryons relative to B^{0} mesons in pp collisions at a center-of-mass energy sqrt[s]=13  TeV is measured by the LHCb experiment. The ratio of Λ_{b}^{0} to B^{0} production cross sections shows a significant dependence on both the transverse momentum and the measured charged-particle multiplicity. At low multiplicity, the ratio measured at LHCb is consistent with the value measured in e^{+}e^{-} collisions, and increases by a factor of ∼2 with increasing multiplicity. At relatively low transverse momentum, the ratio of Λ_{b}^{0} to B^{0} cross sections is higher than what is measured in e^{+}e^{-} collisions, but converges with the e^{+}e^{-} ratio as the momentum increases. These results imply that the evolution of heavy b quarks into final-state hadrons is influenced by the density of the hadronic environment produced in the collision. Comparisons with several models and implications for the mechanisms enforcing quark confinement are discussed.

[Construction of a diagnostic model for fatty liver using human body composition analysis]

Objective: To construct a diagnostic model for fatty liver using body composition analysis and further evaluate the diagnostic effect of the model on fatty liver. Methods: 726 cases with chronic liver disease who visited Tianjin Second People's Hospital from April 2019 to June 2022 and had body composition analysis tests were retrospectively enrolled and were divided into a fatty liver group (551 cases with fatty liver) and a control group (175 cases without fatty liver) according to the measured values of abdominal ultrasound and controlled attenuation parameter. An independent sample t-test and a non-parametric rank sum test were used for statistical processing. Logistic regression was used to construct a diagnostic model. Hosmer-Lemeshow was used to validate the fit of model. Receiver operating characteristic curve was used to confirm the diagnostic efficiency of the model. In addition, 341 cases of chronic liver disease who visited Tianjin Second People's Hospital were included to further verify the application effect of the model between July 2022 and February 2023. Results: Compared with the control group, the differences in various indicators of body composition analysis in the fatty liver group were statistically significant (P < 0.05). Basal metabolic rate (X1), visceral fat area (X2), and body fat (X3) were eventually included in the diagnostic model for BCA-FL (body composition analysis-fatty liver)= -7.771+0.002X1-0.035X2+0.456X3 with the Hosmer-Lemeshow test (P=0.059). The measured area under the receiver operating characteristic curve, the sensitivity, and the specificity were 0.888, 0.889, and 0.726, respectively, when the diagnostic threshold value was 0.615 with the Youden index and the receiver operating characteristic curve. In the validated model group, the area under the receiver operating characteristic curve, Youden index, sensitivity, and specificity were 0.875, 0.624, 0.799, and 0.825, respectively. Conclusion: The diagnostic model BCA-FL for fatty liver constructed using human body composition analysis has good diagnostic efficacy and is suitable for screening fatty liver in different basic liver disease populations.

[Construction and preliminary validation of a risk prediction model for the recurrence of diabetic foot ulcer in diabetic patients]

Objective: To develop a risk prediction model for the recurrence of diabetic foot ulcer (DFU) in diabetic patients and primarily validate its predictive value. Methods: Meta-analysis combined with retrospective cohort study was conducted. The Chinese and English papers on risk factors related to DFU recurrence publicly published in China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and PubMed, Embase, Cochrane Library, and Web of Science, and the search time was from the establishment date of each database until March 31st, 2022. The papers were screened and evaluated, the data were extracted, a meta-analysis was performed using RevMan 5.4.1 statistical software to screen risk factors for DFU recurrence, and Egger's linear regression was used to assess the publication bias of the study results. Risk factors for DFU recurrence mentioned in ≥3 studies and with statistically significant differences in the meta-analysis were selected as the independent variables to develop a logistic regression model for risk prediction of DFU recurrence. The medical records of 101 patients with DFU who met the inclusion criteria and were admitted to Affiliated Hospital of Guizhou Medical University from January 2019 to June 2022 were collected. There were 69 males and 32 females, aged (63±14) years. The receiver operating characteristic (ROC) curve of the predictive performance of the above constructed predictive model for DFU recurrence was drawn, and the area under the ROC curve, maximum Youden index, and sensitivity and specificity at the point were calculated. Dataset including data of 8 risk factors for DFU recurrence and the DFU recurrence rates of 10 000 cases was simulated using RStudio software and a scatter plot was drawn to determine two probabilities for risk division of DFU recurrence. Using the β coefficients corresponding to 8 DFU recurrence risk factors ×10 and taking the integer as the score of coefficient weight of each risk factor, the total score was obtained by summing up, and the cutoff scores for risk level division were calculated based on the total score × two probabilities for risk division of DFU recurrence. Results: Finally, 20 papers were included, including 3 case-control studies and 17 cohort studies, with a total of 4 238 cases and DFU recurrence rate of 22.7% to 71.2%. Meta-analysis showed that glycosylated hemoglobin >7.5% and with plantar ulcer, diabetic peripheral neuropathy, diabetic peripheral vascular disease, smoking, osteomyelitis, history of amputation/toe amputation, and multidrug-resistant bacterial infection were risk factors for the recurrence of DFU (with odds ratios of 3.27, 3.66, 4.05, 3.94, 1.98, 7.17, 11.96, 3.61, 95% confidence intervals of 2.79-3.84, 2.06-6.50, 2.50-6.58, 2.65-5.84, 1.65-2.38, 2.29-22.47, 4.60-31.14, 3.13-4.17, respectively, P<0.05). There were no statistically significant differences in publication biases of diabetic peripheral neuropathy, diabetic peripheral vascular disease, glycosylated hemoglobin >7.5%, plantar ulcer, smoking, multidrug-resistant bacterial infection, or osteomyelitis (P>0.05), but there was a statistically significant difference in the publication bias of amputation/toe amputation (t=-30.39, P<0.05). The area under the ROC curve of the predictive model was 0.81 (with 95% confidence interval of 0.71-0.91) and the maximum Youden index was 0.59, at which the sensitivity was 72% and the specificity was 86%. Ultimately, 29.0% and 44.8% were identified respectively as the cutoff for dividing the probability of low risk and medium risk, and medium risk and high risk for DFU recurrence, while the corresponding total scores of low, medium, and high risks of DFU recurrence were <37, 37-57, and 58-118, respectively. Conclusions: Eight risk factors for DFU recurrence are screened through meta-analysis and the risk prediction model for DFU recurrence is developed, which has moderate predictive accuracy and can provide guidance for healthcare workers to take interventions for patient with DFU recurrence risk.

[Evaluation of the efficacy and safety of Nocardia rubra cell wall skeleton immunotherapy for cervical high-risk HPV persistent infection]

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ²=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ²=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.

[Perioperative management and operative treatment of malignant tumor of anal canal merging severe abdominal protuberance]

Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.

[Summary of the best evidence on exercise for the prevention and treatment of diabetic foot]

Objective: To summarize the best evidence on exercise for the prevention and treatment of diabetic foot. Methods: A bibliometric approach was used. Systematic searches were carried out to retrieve all the publicly published evidences till July 2022 on exercise for the prevention and treatment of diabetic foot, including guidelines, evidence summary, recommended practices, expert consensus, systematic review, and original research, from foreign language databases including BMJ Best Practice, UpToDate, Joanna Briggs Institute Evidence-Based Practice Database, Cochrane Library, Embase, PubMed, Guideline International Network, National Guideline Clearinghouse, Chinese databases including China National Knowledge Infrastructure, Wanfang Database, VIP Database, China Biology Medicine disc, China Clinical Guidelines Library, and the official websites of relevant academic organizations including National Institute for Health and Care Excellence of the United Kingdom, Registered Nurses' Association of Ontario of Canada, the International Working Group on the Diabetic Foot, International Diabetes Federation, American College of Sports Medicine, American Diabetes Association, and Chinese Diabetes Society. The literature was screened and evaluated for the quality, from which the evidences were extracted and evaluated to summarize the best evidences. Results: Nine guidelines, three expert consensuses, one evidence summary (with two systematic reviews being traced), two systematic reviews, 6 randomized controlled trials were retrieved and included, with good quality of literature. Totally 33 pieces of best evidences on exercise for the prevention and treatment of diabetic foot were summarized from the aspects of appropriate exercise prevention of diabetic foot, exercise therapy of diabetic foot, precautions for exercise, health education, and establishment of a multidisciplinary limb salvage team. Conclusions: Totally 33 pieces of best evidences on exercise for the prevention and treatment of diabetic foot were summarized from 5 aspects, providing decision-making basis for clinical guidance on exercise practice for patients with diabetic foot.

Spine-Related Malpractice Claims in China: A 2-year National Analysis

STUDY DESIGN

Retrospective cross-sectional study.

OBJECTIVE

To investigate the prevalence, characteristics, and risk factors of spine-related malpractice claims in China in a 2-year period.

METHODS

The arbitration files of the Chinese Medical Association (CMA) were reviewed for spine-related malpractice claims. Descriptive statistics and correlation analysis were conducted on claim characteristics, clinical data, plaintiff's main allegations, and arbitration outcomes.

RESULTS

A total of 288 cases of spinal claims filed in the CMA between January 2016 and December 2017 were included. Most claims were found in lumbar degenerative disorders (59.4%), lumbar trauma (13.2%), and cervical degenerative disorders (11.8%). The most common adverse events (AEs) leading to claims were new neurologic deficit (NND) (47.6%), infection (11.5%), and insufficient symptom relief (10.4%). The most common patient allegation was surgical error (66.0%), although the main arbitrated cause of AEs was disease/treatment itself (49.0%), while providers were judged as mainly responsible in only 47.3% cases. In multivariate regression analysis, cervical spine, misdiagnosis/mistreatment, and unpredictable emergency correlated with more severe damage to patients; minimally invasive surgery was predictive of judgment in plaintiff's favor, while claims in the eastern region and unpredictable emergencies were predictive of defendant's favor; only NND was associated with being arbitrated as surgical error in surgical cases where surgeons accepted major liability.

CONCLUSION

The current study provided a descriptive overview and risk factor analysis of spine-related malpractice claims in China. Gaining improved understanding of the facts and causes of malpractice claims may help providers reduce the risk of claims and subsequent litigation.

[Identification of core pathogenic genes and pathways in elderly osteoporosis based on bioinformatics analysis]

Objective: Using bioinformatics methods to analyze the core pathogenic genes and related pathways in elderly osteoporosis. Methods: From November 2020 and August 2021, eight elderly osteoporosis patients who received treatment and five healthy participants who underwent physical examinations in Beijing Jishuitan Hospital were selected as subjects. The expression level of RNA in the peripheral blood of eight elderly osteoporosis patients and five healthy participants was collected for high-throughput transcriptome sequencing and analysis. The gene ontology (GO) analysis Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was performed for the differentially expressed genes (DEGs). The protein-protein interaction (PPI) network was constructed using the STRING website and Cytoscape software, and the most significant modules and hub genes were screened out. Results: Among the eight elderly osteoporosis patients, there were seven females and one male, with an average age of 72.4 years (SD=4.2). Among the five healthy participants, there were four females and one male, with an average age of 68.2 years (SD=5.7). A total of 1 635 DEGs (847 up-regulated and 788 down-regulated) were identified. GO analysis revealed that the molecular functions of DEGs were mainly enriched in structural constituents of the ribosome, protein dimerization activity, and cellular components were mainly enriched in the nucleosome, DNA packaging complex, cytosolic part, protein-DNA complex and the cytosolic ribosome. KEGG pathway analysis showed that DEGs were mainly enriched in systemic lupus erythematosus and ribosome. Gene UBA52, UBB, RPS27A, RPS15, RPS12, RPL13A, RPL23A, RPL10A, RPS25 and RPS6 were selected and seven of them could encode ribosome proteins. Conclusion: The pathogenesis of elderly osteoporosis may be associated with ribosome-related genes and pathways.

[Expression and clinical significance of circRNA cSMARCA5 in patients with acute myocardial infarction]

Objective: To investigate the expression level and clinical significance of cSMARCA5 in the patients with acute myocardial infarction (AMI). Methods: This study was a case-control study. A total of 100 patients with AMI and 100 patients without coronary heart disease who received treatment in the Department of Cardiology, Peking University Third Hospital from September to December 2021 were included in the study according to the principle of 1∶1 frequency matching. The expression levels of cSMARCA5 in the peripheral blood of AMI patients and control groups were measured by real-time quantitative polymerase chain reaction (RT-qPCR). The receiver operating characteristic (ROC) curve was used to calculate the diagnostic ability of cSMARCA5 for AMI. Spearman or Pearson correlation analysis was used to explore the correlation between cSMARCA5 and the degree of myocardial necrosis, coronary lesion severity and GRACE risk stratification score. Bioinformatics analysis was used to predict the possible mechanism of cSMARCA5 in pathological changes of AMI. Results: The age [M (Q₁,Q₃)] of AMI patients and control group was 63.0 (56.0, 71.5) and 63.0 (53.0, 75.5) (P=0.622), and the proportion of males was 75.0% (75 cases) and 46.0% (46 cases) (P<0.001), respectively. The expression level [M (Q₁,Q₃)] of cSMARCA5 was significantly lower in AMI patients compared with the control group [0.37 (0.22, 0.73) vs 1.03(0.71, 1.75), P<0.001]. ROC analysis showed that the area under the curve of cSMARCA5 in diagnosing AMI was 0.83 (95%CI: 0.77-0.89, P<0.001), with a sensitivity of 89.0% and specificity of 67.7%. cSMARCA5 was negatively correlated with creatine kinase isoenzyme MB (r=-0.203, P=0.041), troponin T (r=-0.230, P=0.023) and N-terminal brain natriuretic peptide precursor (r=-0.250, P=0.012), and positively correlated with left ventricular ejection fraction (r=0.201, P=0.042). In addition, the expression level of cSMARCA5 was negatively correlated with SYNTAX score (r=-0.196, P=0.048) and GRACE risk score (r=-0.321, P=0.001). Bioinformatic analysis suggested that cSMARCA5 might be involved in the process of AMI through regulating the gene expression of tumor necrosis factor. Conclusions: The expression of cSMARCA5 is significantly decreased in peripheral blood of AMI patients compared with control group, and its expression level is negatively correlated with the severity of myocardial infarction. cSMARCA5 is expected to be a potential biomarker of AMI.

A more accurate indicator to evaluate oxidative stress in rat plasma with osteoporosis

Background: oxidative stress is linked to various human diseases which developed into the idea of "disrupted redox signaling". Osteoporosis (OP) is a chronic skeletal disorder characterized by low bone mineral density and deterioration of bone microarchitecture among which estrogen deficiency is the main cause. Lack of estrogen leads to the imbalance between oxidation and anti-oxidation in patients, and oxidative stress is an important link in the pathogenesis of OP. The ratio of the reduced to the oxidized thiols can characterize the redox status. However, few methods have been reported for the simultaneous determination of reduced forms and their oxidized forms of thiols in plasma. Methods: we developed a hollow fiber centrifugal ultrafiltration (HFCF-UF) method for sample preparation and validated a high-performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS) method to determine two reduced forms of thiols-homocysteine (Hcy), cysteine (Cys) levels and their respective oxidized compounds, homocystine (HHcy) and cystine (Cyss) in rat plasma simultaneously for the first time. Thirty-six female rats were randomly divided into three groups: normal control (NC), oxidative stress (ovariectomy, OVX) and ovariectomy with hydrogen-rich saline administration (OVX + HRS). Results: the validation parameters for the methodological results were within the acceptance criteria. There were both significant differences of Hcy/HHcy (Hcy reduced/oxidized) and Cys/Cyss (Cys reduced/oxidized) in rat plasma between three groups with both p < 0.05 and meanwhile, the p values of malondialdehyde, superoxide dismutase and glutathione peroxidase were all less than 0.01. The value of both Hcy/HHcy and Cys/Cyss were significantly decreased with the change of Micro-CT scan result of femoral neck in OVX group (both the trabecular thickness and trabecular number significantly decreased with a significant increase of trabecular separation) which demonstrate OP occurs. The change of Hcy/HHcy is more obvious and prominent than Cys/Cyss. Conclusions: the Hcy/HHcy and Cys/Cyss could be suitable biomarkers for oxidative stress and especially Hcy/HHcy is more sensitive. The developed method is simple and accurate. It can be easily applied in clinical research to further evaluate the oxidative stress indicator for disease risk factors.

Guidelines for management of pediatric acute hyperextension spinal cord injury

Pediatric acute hyperextension spinal cord injury (SCI) named as PAHSCI by us, is a special type of thoracolumbar SCI without radiographic abnormality and highly related to back-bend in dance training, which has been increasingly reported. At present, it has become the leading cause of SCI in children, and brings a heavy social and economic burden. Both domestic and foreign academic institutions and dance education organizations lack a correct understanding of PAHSCI and relevant standards, specifications or guidelines. In order to provide standardized guidance, the expert team formulated this guideline based on the principles of science and practicability, starting from the diagnosis, differential diagnosis, etiology, admission evaluation, treatment, complications and prevention. This guideline puts forward 23 recommendations for 14 related issues.

[Analysis of non-bacterial respiratory pathogens in children in Ningbo City from 2019 to 2021]

Objective: To investigate the distribution characteristics of respiratory non-bacterial pathogens in children in Ningbo from 2019 to 2021. Methods: A retrospective analysis was performed on 23 733 children with respiratory tract infection who visited the department of pediatrics of Ningbo Women and Children's Hospital from July 2019 to December 2021. There were 13 509 males (56.92%) and 10 224 females (43.08%), with an age range of 1 day to 18 years old. There were 981 cases in the neonatal group (younger than 1 month old), 5 880 cases in the infant group (1 month to younger than 1 year old), 6 552 cases in the toddler group (1 to younger than 3 years old), 7 638 cases in the preschool group (3 to younger than 7 years old), and 2 682 cases in the school-age group (7 to 18 years old). Thirteen respiratory pathogens were detected by multiple polymerase chain reaction (PCR) based on capillary electrophoresis, and SPSS 23.0 software was used for statistical analysis of the results, the count data were expressed as percentages, and the χ² test was used for comparison between groups. Results: Of the 23 733 specimens, 13 330 were positive for respiratory pathogens, with a total positive rate of 56.17%. The positive rates of human rhinovirus (HRV) 24.05% (5 707/23 733), human respiratory syncytial virus (HRSV) 10.45% (2 480/2 3733) and mycoplasma pneumoniae (Mp) 7.03% (1 668/23 733) were in the first three. The positive rates of pathogens in the male and female children were 57.47% (7 763/13 509) and 54.45% (5 567/10 224), respectively, and the difference was statistically significant (χ²=21.488, P<0.001). The positive rates in the neonatal group, infant group, toddler group, preschool group, and school-age group were 31.80% (312/981), 54.71% (3 217/5 880), 63.23% (4 143/6 552), 59.83% (4 570/7 638), 40.57% (1 088/2 682), respectively, and the difference among the groups was statistically significant (χ²=681.225, P<0.001). The single infection rate was 47.43% (11 256/23 733), the mixed infection rate of two or more pathogens was 8.74% (2 074/23 733), most of which were mixed infections of two pathogens. HRV, HADV, HCOV, Ch disseminated in the whole year. HRSV, HMPV, Boca, HPIV occurred mostly in fall and winter. The positive rates of FluA, FluB, Mp were at a low level after the corona virus disease 2019 (COVID-19) epidemic (2020 and 2021). The positive rates of FluA, H1N1, H3N2, FluB, HADV, Mp in 2020 were significantly lower than in 2019 (P<0.05). The positive rates of HPIV, HRV, HCOV, Ch in 2020 were significantly higher than in 2019 (P<0.05). The positive rates of FluA, H1N1, H3N2, HPIV, HCOV, Mp, Ch in 2021 were significantly lower than in 2020 (P<0.05). The positive rates of Boca, HMPV, HRSV in 2021 were significantly higher than in 2020 (P<0.05). Conclusion: From 2019 to 2021, the main non-bacterial respiratory pathogens of children in Ningbo City were Mp and HRV, and the detection rates of respiratory pathogens varied among different ages, seasons and genders.

[Prognosis and fertility outcomes of patients with borderline ovarian tumors after fertility-sparing surgery]

Objective: To explore the clinical prognosis and fertility outcomes in patients with borderline ovarian tumors (BOT) who underwent fertility-sparing surgery, and evaluate the related risk factors. Methods: The study examined the clinicopathological characteristics of 280 patients diagnosed with BOT from Qilu Hospital of Shandong University between January 2009 and December 2019. According to the surgery plan, the patients were divided into the fertility-sparing group (167 cases) and the radical surgery group (113 cases). The information of the patients' age, preoperative serum CA-125 level, surgery method, pathological type, FIGO stage (2014), tumor location, and whether focal canceration combined were collected. The Kaplan-Meier method was used to compare disease-free survival (DFS) between the fertility-sparing surgery group and the radical surgery group. The univariate and multivariate Cox proportional hazard regression analysis was used to explore high-risk factors associated with DFS. Results: A total of 280 BOT patients were identified in the study, with a median age of 35.0 (26.0, 51.0) years old. The median follow-up time was 55.2 (34.7, 79.3)months. 25 patients (15.0%) developed recurrence in the fertility-sparing surgery group, 11 patients (8.7%) developed recurrence in the radical surgery group. There was no significant difference in 5-year DFS rate between the two groups (84.4% vs 90.1%, P=0.223). Only FIGO stage was found to be related to DFS through the univariable and multivariable Cox proportional hazard regression analysis, and patients with FIGO Ⅱ/Ⅲ had higher risk of recurrence [HR (95%CI) 2.872(1.283-6.431)] (P=0.010); Fertility-sparing surgery does not increase the recurrence risk of BOT patients (P=0.116). Pregnancies were reported in 39 patients (54.2%), among whom 37 patients gave birth successfully, and 2 patients selected to terminate pregnancy. Conclusions: The fertility-sparing surgery does not increase the risk of recurrence in BOT patients, and patients who underwent the fertility-sparing surgery have a favorable outcome. FIGO stage is the independent risk factor of DFS in BOT patients.

Characteristics of Deep Venous Thrombosis in Isolated Lower Extremity Fractures and Unsolved Problems in Guidelines: A Review of Recent Literature

Deep venous thrombosis (DVT) has been characterized by a disorder of venous return caused by abnormal blood clotting in deep veins. It often occurs in the lower limbs and is a common complication in orthopaedics. Therefore, relevant professional organizations domestic and overseas had formulated and constantly updated relevant guidelines to prevent the occurrence of DVT. According to the management strategy of the guidelines, the incidence of DVT can be significantly reduced. However, due to the variety of fractures types, the guidelines cannot expound precautions and characteristics of DVT for all fracture types at present, and there are other related unresolved problems. For example, there is still a lack of consistent optimal strategies for the management of DVT following isolated lower extremity fractures with a higher incidence. The best anticoagulant strategies for patients with upper limb fractures, pediatric fractures, and those combined with other injuries are rarely described in orthopaedic guidelines, but such fractures are common in clinical orthopaedics. The long‐term complications after DVT, such as post‐thrombotic syndrome, are not well‐understood. In the absence of clear guidance, orthopaedic surgeons often resort to empiric anticoagulation or conservative treatment, so the prevention effects of DVT are inconsistent. The purpose of this review is to summarize the characteristics of DVT events after isolated lower extremity fractures and to discuss the unsolved issues in the guidelines by reviewing the previous literature and tracing the history of DVT discovery, to provide more scientific and comprehensive recommendations for the prediction and prevention of DVT.

Characteristics and Treatment Strategy of Isolated Calf Deep Venous Thrombosis after Fractures: A Review of Recent Literature

Isolated calf deep venous thrombosis (ICDVT) includes thrombosis located at the far end of the popliteal vein, such as the anterior tibial vein, posterior tibial vein, fibular vein, and intramuscular vein of the soleus and gastrocnemius. This type of thrombosis has the highest incidence, accounting for approximately half of all deep vein thrombosis (DVT) cases; however, there is no consistent recommendation for ICDVT treatment across countries, and there is also no optimal management strategy. In recent years, increasing evidence has shown that ICDVT can develop into proximal DVT, even causing pulmonary embolism (PE). Therefore, some experts suggest anticoagulant therapy for this type of DVT, while others hold an opposing attitude. Therefore, the treatment strategy for this type of DVT has become a hot and difficult research topic. The purpose of this review is to summarize the characteristics of ICDVT and the effects of different treatment strategies by analyzing recent and important classical works in the literature in an attempt to provide recommendations for the treatment of this most common type of DVT in orthopaedic clinics.

[Advances of minimally invasive glaucoma surgery in the combined treatment of primary angle-closure glaucoma]

Glaucoma is the leading irreversible blinding eye disease worldwide, and China has the largest amount of primary angle-closure glaucoma (PACG). To reduce blindness, the therapeutic evolution can play a role. With the technical development of minimally invasive glaucoma surgery (MIGS), the treatment of angle-closure glaucoma has been in a transformation. This article reviews the literatures related to the advances of MIGS in the combined treatment of PACG. The research findings show that MIGS may become one of the preferred surgical treatments for PACG in the future clinical management of glaucoma.

Propofol ameliorates acute postoperative fatigue and promotes glucagon-regulated hepatic gluconeogenesis by activating CREB/PGC-1α and accelerating fatty acids beta-oxidation

Postoperative fatigue (POF) is the most common and long-lasting complication after surgery, which brings heavy burden to individuals and society. Recently, hastening postoperative recovery receives increasing attention, but unfortunately, the mechanisms underlying POF remain unclear. Propofol is a wildly used general anesthetic in clinic, and inspired by the rapid antidepressant effects induced by ketamine at non-anesthetic dose, the present study was undertaken to investigate the anti-fatigue effects and underlying mechanisms of propofol at a non-anesthetic dose in 70% hepatectomy induced POF model in rats. We first showed here that single administration of propofol at 0.1 mg/kg ameliorated acute POF in hepatectomy induced POF rats. Based on metabonomics analysis, we hypothesized that propofol exerted anti-fatigue activity in POF rats by facilitating free fatty acid (FFA) oxidation and gluconeogenesis. We further confirmed that propofol restored the deficit in FFA oxidation and gluconeogenesis in POF rats, as evidenced by the elevated FFA utilization, acetyl coenzyme A content, pyruvic acid content, phosphoenolpyruvic acid content, hepatic glucose output and glycogen storage. Moreover, propofol stimulated glucagon secretion and up-regulated expression of cAMP-response element binding protein (CREB), phosphorylated CREB, peroxlsome prolifeator-activated receptor-γ coactivator-1α (PGC-1α), phosphoenolpyruvate carboxykinade1 and carnitine palmitoltransferase 1A. In summary, our study suggests for the first time that propofol ameliorates acute POF by promoting glucagon-regulated gluconeogenesis via CREB/PGC-1α signaling and accelerating FFA beta-oxidation.

[Short-term outcome of programmed cell death protein1 (PD-1) antibody combined with total neoadjuvant chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer with high risk factors]

Objective: Total neoadjuvant chemoradiotherapy is one of the standard treatments for locally advanced rectal cancer. This study aims to investigate the safety and feasibility of programmed cell death protein 1 (PD-1) antibody combined with total neoadjuvant chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer with high-risk factors. Methods: A descriptive cohort study was conducted. Clinicopathological data of 24 patients with locally advanced middle-low rectal cancer with high-risk factors receiving PD-1 antibody combined with neoadjuvant chemoradiotherapy in Gastrointestinal Cancer Center, Unit III, Peking University Cancer Hospital between January 2019 and April 2021 were retrospectively analyzed. Inclusion criteria: (1) rectal adenocarcinoma confirmed by pathology; patient age of ≥ 18 years and ≤ 80 years; (2) the distance from low margin of tumor to anal verge ≤ 10 cm under sigmoidoscopy; (3) ECOG performance status score 0-1; (4) clinical stage T3c, T3d, T4a or T4b, or extramural venous invasion (EMVI) (+) or mrN2 (+) or mesorectal fasciae (MRF) (+) based on MRI; (5) no evidence of distant metastases; (6) no prior pelvic radiation therapy, no prior chemotherapy or surgery for rectal cancer; (7) no systemic infection requiring antibiotic treatment and no immune system disease. Exclusion criteria: (1) anticipated unresectable tumor after neoadjuvant treatment; (2) patients with a history of a prior malignancy within the past 5 years, or with a history of any arterial thrombotic event within the past 6 months; (3) patients received other types of antitumor or experimental therapy; (4) women who were pregnant or breast-feeding; (5) patients with any other concurrent medical or psychiatric condition or disease; (6) patients received immunotherapy (PD-1 antibody). The neoadjuvant therapy consisted of three stages: PD-1 antibody (sintilimab 200 mg, IV, Q3W) combined with CapeOx regimen for three cycles; long-course intensity modulated radiation therapy (IMRT) with gross tumor volume (GTV) 50.6 Gy/CTV 41.8 Gy/22f; CapeOx regimen for two cycles after radiotherapy. After oncological evaluation following the end of the third stage of treatment, surgery or watch and wait would be carried out. Surgical safety, histopathological changes and short-term oncological outcome were analyzed. Results: There were 15 males and 9 females with a median age of 65 (47-78) years. Median distance from the lower margin of the tumor to the anal verge was 4 (3-7) cm. The median maximal diameter of the tumor was 5.1 (2.1-7.5) cm. Twenty patients were cT3, 4 were cT4, 8 were cN1, 5 were cN2a, 11 were cN2b. Ten cases were MRF (+) and 10 were EMVI (+). All the patients were mismatch repair proficient (pMMR). During the neoadjuvant treatment period, 6 patients (25.0%) developed grade 1-2 treatment-related adverse events, including 3 immune-related adverse events. As of April 30, 2021, 20 patients (83.3%, 20/24) had received surgical resection, including 19 R0 resections and 16 sphincter-preservation operations. Morbidity of postoperative complication was 25.0% (5/20), including 2 cases of Clavien-Dindo grade II (1 of anastomotic bleeding and 1 of pseudomembranous enteritis), 3 cases of grade I anastomotic stenosis. Pathological complete response (pCR) rate was 30.0% (6/20) and major pathological response rate was 20.0% (4/20). None of Ras/Raf mutants had pCR or cCR (0/5), while 6 of 17 Ras/Raf wild-type patients had pCR and 3 had cCR, which was significantly higher than that of Ras/Raf mutants (P<0.01). Nine of 16 patients with Ras/Raf wild-type and differentiated adenocarcinoma had pCR or cCR. Among other 4 patients without surgery, 3 patients preferred watch and wait strategy because their tumors were assessed as clinical complete response (cCR), while another one patient refused surgery as the tumor remained stable. After a median follow-up of 11 (6-24) months, only 1 patient with signet ring cell carcinoma had recurrence. Conclusions: PD-1 antibody combined with total neoadjuvant chemoradiotherapy in the treatment of locally advanced rectal cancer has quite good safety and histopathological regression results. Combination of histology and genetic testing is helpful to screen potential beneficiaries.

Epidemiological Characteristics of Major Joints Fracture-Dislocations

Objective

To describe the epidemiological features of major joints fracture‐dislocations between 2015 and 2019.

Methods

This retrospective study enrolled patients with majorintra‐articular fracture‐dislocations who were treated in the third hospital of Hebei Medical University from January 2015 to December 2019. A total of 582 patients (389 [66.84%] males and 193 [33.16%] females) were identified. The distribution characteristics of intra‐articular fracture‐dislocations involving shoulder, elbow, wrist, hip, knee, and ankle joints were included. The potential associations between fractures with concomitant dislocations and related factors, such as age, gender and sites were explored.

Results

There were 92 cases (15.81%) of shoulder joints, 67 cases (11.51%) of elbow joints, 45 cases (7.73%) of wrist joints, 181 cases (31.10%) of hip joints, 42 cases (7.22%) of knee joints, and 155 cases (26.63%) of ankle joints. The overall male‐to‐female ratio was 2.02:1.The highest proportion age group of the six types intra‐articular fracture‐dislocations included the ages 25‐34 years. For males, the highest proportion age group was 25‐34 years, for females, it was 45–54 years. For male patients, hip was the most common, accounted for 35.48%, but ankle fracture‐dislocation was the most common for females, accounted for 30.57%. The highest proportion age group of shoulder fracture‐dislocation included the ages 55‐64 years(22.83%), with a male to female ratio of 1.24:1. While the age group with the highest risk of elbow, wrist, hip, knee and ankle fracture‐ dislocation was 25‐34 years (28.36%) with a male to female ratio of 2.19:1, 25‐34 years (31.11%) with a male to female ratio of 8:1, 45‐54 years (27.07%) with a male to female ratio of 3.21:1, 15‐24 years (45.24%) with a male to female ratio of 0.75:1, 25‐44 years (43.87%) with a male to female ratio of 1.63:1, respectively. The most common site of joint fracture‐dislocation in different age groups was corresponding as follows, 0‐14 years(elbow), 15‐24 years(knee), 25‐34 years(hip), 35‐44 years(hip), 45‐54 years(hip), 55‐64 years(ankle), 65‐74 years(shoulder), ≥75 years(shoulder).

Conclusion

Major joints fracture‐dislocations were most common in the hip and the least common in the knee, and there were more men than women. Hip was the most common affected joint in men while ankle in women. Age and sex factors can significantly affect the location of intra articular fracture and dislocation. The current study could aid orthopaedic surgeons in a better understanding of this injury and help to implement targeted preventive measures.

Blood transfusion practices affect CD4+ CD25+ FOXP3+ regulatory T cells/T helper-17 cells and the clinical outcome of geriatric patients with hip fracture

Hip fracture (HF) is common among older individuals and associated with high mortality, poor vitality and functional impairment. HF patients suffer whole body immunological changes and that lead to severe consequences, including immobilization, physical impairment and a high risk of complications. The objective of this study was to decipher the pattern of dynamic immunological changes, especially in two major T cell subsets, CD4⁺ CD25⁺ FOXP3⁺ regulatory T (Treg) cells and T helper-17 (Th17) cells, and their balance, during the hospital stay and to observe whether blood transfusion could influence these cells and clinical patietns' prognosis. In this study, ninety-eight consecutive HF patients were initially enrolled, and finally fifty-one patients qualified for the study, and correlation analysis of their clinical parameters was carried out to predict the meaning of their distribution in clinical practice. Our results showed that the frequency of Tregs gradually decreased, while the frequency of Th17 cells slowly increased in HF patients who received blood transfusion. The Treg frequency was inversely correlated with the level of hemoglobin (Hb), and Th17 cell frequency was positively related to fluctuations in Hb levels in HF patients after trauma. HF patients with a better prognosis and survival time showed decreased a Treg frequency and a decreased Treg/Th17 ratio. Transfusion helped reverse the imbalance in the frequencies of Tregs and Th17 cells and the Treg/Th17 ratio and especially contributed to a better outcome in HF patients with moderate-to-severe anemia. In conclusion, a higher frequency of peripheral blood Tregs and a higher Treg/Th17 ratio may be associated with unfavorable outcomes in HF patients, and blood transfusion may benefit moderate-to-severe HF patients rebalance their immune response.

Design of an electric-driven nonvolatile low-energy-consumption phase change optical switch

Traditional optical switches relying on the weak, volatile thermo-optic or electro-optic effects of Si or SiN waveguides show a high consumption and large footprint. In this paper, we reported an electric-driven phase change optical switch consisting of a Si waveguide, Ge₂Sb₂Te₅(GST) thin film and graphene heater suitable for large-scale integration and high-speed switching. The reversible transition between the amorphous and crystalline states was achieved by applying two different voltage pulses of 1.4 V (SET) and 4 V (RESET). The optical performance of the proposed switch showed a high extinction ration of 44-46 dB in a wide spectral range (1525-1575 nm), an effective index variation of Δn_eff = 0.49 and a mode loss variation of Δα = 15 dBμm^-1at the wavelength of 1550 nm. In thermal simulations, thanks to the ultra-high thermal conductivity of graphene, the proposed switch showed that the consumption for the SET process was only 3.528 pJ with a 1.4 V pulse of 5 ns, while a 4 V pulse of 1.5 ns was needed for RESET process with a consumption of 1.05 nJ. Our work is helpful to analyze the thermal-conduction phase transition process of on-chip phase change optical switches, and the design of the low-energy-consumption switch is conducive to the integrated application of photonic chips.

Titanium Alloy Gamma Nail versus Biodegradable Magnesium Alloy Bionic Gamma Nail for Treating Intertrochanteric Fractures: A Finite Element Analysis

OBJECTIVE

To using finite element analysis to investigate the effects of the traditional titanium alloy Gamma nail and a biodegradable magnesium alloy bionic Gamma nail for treating intertrochanteric fractures.

METHODS

Computed tomography images of an adult male volunteer of appropriate age and in good physical condition were used to establish a three-dimensional model of the proximal femur. Then, a model of a type 31A1 intertrochanteric fracture of the proximal femur was established, and the traditional titanium alloy Gamma nails and biodegradable magnesium alloy bionic Gamma nails were used for fixation, respectively. The von Mises stress, the maximum principal stress, and the minimum principal stress were calculated to evaluate the effect of bone ingrowth on stress distribution of the proximal femur after fixation.

RESULTS

In the intact model, the maximum stress was 5.8 MPa, the minimum stress was -11.7 MPa, and the von Mises stress was 11.4 MPa. The maximum principal stress distribution of the cancellous bone in the intact model appears in a position consistent with the growth direction of the principal and secondary tensile zones. After traditional Gamma nail healing, the maximum stress was 32 MPa, the minimum stress was -23.5 MPa, and the von Mises stress was 31.3 MPa. The stress concentration was quite obvious compared with the intact model. It was assumed that the nail would biodegrade completely within 12 months postoperatively. The maximum stress was 18.7 MPa, the minimum stress was -12.6 MPa, and the von Mises stress was 14.0 MPa. For the minimum principal stress, the region of minimum stress value less than -10 MPa was significantly improved compared with the traditional titanium alloy Gamma nail models. Meanwhile, the stress distribution of the bionic Gamma nail model in the proximal femur was closer to that of the intact bone, which significantly reduced the stress concentration of the implant.

CONCLUSION

The biodegradable magnesium alloy bionic Gamma nail implant can improve the stress distribution of fractured bone close to that of intact bone while reducing the risk of postoperative complications associated with traditional internal fixation techniques, and it has promising clinical value in the future.

Comparison of Clinical and Radiological Outcomes Between Upper Fibular Curvature and Non-Curvature with Medial Knee Osteoarthritis Following Proximal Fibular Osteotomy: A Retrospective Cohort Study with Minimum 2-Year Follow-up

Objective

To evaluate and compare the clinical and radiographic outcomes of proximal fibular osteotomy (PFO) in treating medial knee osteoarthritis (KOA) patients with upper fibular curvature and non‐curvature.

Methods

A retrospective cohort study was performed. From January 2016 to January 2017, a total of 51 patients (nine males and 42 females) at a mean age of 63.7 years (range 48–79 years) with medial KOA who underwent PFO procedure at the Third Hospital of Hebei Medical University were included in the study. The patients were divided into the two groups, namely curvature group (28 patients, six males and 22 females, aged 62.6 ± 7.7 years) and non‐curvature group (23 patients, three males and 20 females, aged 64.5 ± 7.6 years). Perioperative parameters and Kellgren‐Lawrence classification were recorded and analyzed in the two groups, respectively. All patients were followed up at 1, 3, 6, and 12 months at the first year of post‐operation, and then every 6 months from the second year of post‐operation. A telephone survey with standard questionnaire survey, including Visual Analog Scale (VAS) score and Hospital for Special Surgery (HSS) scoring system, was used to evaluate postoperative clinical outcomes. Radiological results were assessed using the femorotibial angle (FTA), hip‐knee‐ankle angle (HKA), and settlement value of medial tibial platform (MTP) in the two groups.

Results

The average follow‐up periods of the curvature group and the non‐curvature group were 34.8 ± 6.1 and 33.9 ± 5.4 months, respectively. There were no significant differences between the two groups of demographic data in terms of number of patients, age, body mass index (BMI), gender, KOA side, and Kellgren‐Lawrence classification (P > 0.05). The VAS scores of the curvature group and non‐curvature group were (3.53 ± 1.62 vs 3.68 ± 1.43 at 1 month, 3.46 ± 0.79 vs 3.57 ± 0.66 at 3 months, and 2.43 ± 0.88 vs 2.83 ± 0.94 at 6 months, both P > 0.05), while significant differences were found from 12 months post‐operation (1.54 ± 0.72 vs 2.03 ± 0.85 at 12 months, and 1.04 ± 0.69 vs 1.74 ± 0.75 at 24 months, both P < 0.05). The HSS scores of the curvature group and non‐curvature group were (79.67 ± 5.14 vs 78.25 ± 6.37 at 1 month, 84.65 ± 3.76 vs 83.18 ± 3.64 at 3 months, and 86.27 ± 3.13 vs 85.49 ± 3.25 at 6 months, both P > 0.05), while significant differences were found from 12 months post‐operation (90.64 ± 4.32 vs 87.71 ± 5.63 at 12 months, and 92.93 ± 2.07 vs 90.06 ± 2.08 at 24 months, both P < 0.05). In addition, the FTA and settlement value of the curvature group were lower than the non‐curvature group (177.18 ± 1.52 vs 178.35 ± 1.86, and 5.29 ± 1.74 vs 6.49 ± 2.09, both P < 0.05) while the HKA were higher than the non‐curvature group (175.32 ± 2.34 vs 173.83 ± 2.64, P < 0.05) at the final follow‐up.

Conclusions

Medial KOA patients with upper fibular curvature is an optimal surgical indication for PFO surgery, with the advantages of pain relief, better functional recovery, and alignment correction.

Atlas of Human Skeleton Hardness Obtained Using the Micro-indentation Technique

Objectives

Measure and systematically evaluate the distribution of microhardness in the human skeleton.

Methods

Three fresh corpses were obtained, aged 62 (male), 45 (female), and 58 years (male). Soft tissues were removed, and all axial and unilateral appendicular bones were freshly harvested. All three skeletons were examined by X‐ray and computed tomography (CT) to exclude skeletal pathology. Only bones from donors with no known skeletal pathology were included in the study. Axial and unilateral appendicular skeleton bones from each of the three donors were obtained, except for ear ossicles, hyoid bone, tailbone, and 14 phalanges of the foot, for which samples were difficult to obtain. Precision bone specimens with a thickness of 3 mm, which were cut with a Buehler IsoMet 11‐1280‐250 low‐speed diamond saw (Buehler, USA), were obtained from all important anatomic sites in a direction perpendicular to the mechanical axis of each bone. Micro‐indentation (the Vickers hardness test) was performed on the surface of each specimen using a microhardness tester with a diamond indenter. Hardness value (HV) was computed for each indentation. Each bone specimen was divided into several regions of interest. Indentations were carefully made and computed. Then we analyzed the data to identify hardness distribution rules at different anatomic sites.

Results

In total, 5360 indentations were made in 1072 regions of interest in each donor. Hardness of the axial and appendicular bones were all inhomogeneous depending on the anatomic sites, but the distribution of microhardness followed certain rules. The mean hardness value ranged from 24.46 HV (HV = hardness value, kgf/mm²) for the sacrum to 53.20 HV for the shaft of the tibia. The diaphysis was harder than the metaphysis, and the proximal and distal epiphysis had lower values (8.85%– 40.39%) than the diaphysis. Among the long bone diaphyses, the tibia cortical bone (51.20 HV) was the hardest, harder than the humerus (47.25 HV), the ulna (43.26 HV), the radius (42.54 HV), and the femur (47.53 HV). However, in some anatomic sites such as the lumbar vertebra (cortical bone 32.86 HV, cancellous bone 31.25 HV), the cortical shells were sometimes not harder than the internal cancellous bones. The lumbar vertebra (32.86 HV) was harder than the cervical vertebra (28.51 HV) and the thoracic vertebra (29.01 HV).

Conclusions

The distribution of microhardness in the human skeleton follows certain rules. These distribution rules could be used to predict the mechanical properties of bone and progress in this field could provide data for the basis of a new three‐dimensional printing technique, which may lead to new perspectives for custom‐made implants.

Associations Between Periosteal Reaction of Proximal Tibial and Medial Compartment Knee Osteoarthritis

Objective

To evaluate and analyze the potential relationship between periosteal reaction and medial compartment knee osteoarthritis (KOA), and to assess the independent risk factors for the development of periosteal reaction associated with medial compartment KOA.

Methods

This is a retrospective comparative study. From January 2019 to December 2019 at the Third Hospital of Hebei Medical University, a total of 363 patients (726 knees) with medial compartment KOA were enrolled in this study according to our inclusion and exclusion criteria, including 91 males and 272 females, with an mean age of 57.9 ± 12.8 years (range, 18–82 years). Among these patients, 206 patients (412 knees) were allocated to the periosteal reaction group (44 males and 162 females) and 157 patients (314 knees) were allocated to the non‐periosteal reaction group (47 males and 110 females). The classification of KOA severity was based on Kellgren and Lawrence (K‐L) grading system. The malalignment of the lower extremities in coronal plane was evaluated as medial proximal tibial angle (MPTA), hip‐knee‐ankle angle (HKA), and lateral distal femoral angle (LDFA). Patients demographics and radiographic parameters were recorded in the two groups. Intra‐observer and inter‐observer reliabilities of all radiological measurements were analyzed by intraclass correlation coefficients (ICCs). Univariate analyses were conducted for comparison of differences with continuous variables between patients with periosteal reaction and without periosteal reaction. Multivariate logistical regression analysis was performed to determine the independent risk factors of radiographic parameters for periosteal reaction.

Results

The overall incidence of periosteal reaction associated with medial compartment KOA was 56.7%. Furthermore, we observed that the incidence of periosteal reaction significantly increased with age and correlated with K‐L grade progression (P < 0.05). There was a statistically significant difference between the two groups. In the multivariate logistical regression analysis, HKA and JLCA were identified as independent risk factors of the development of periosteal reaction in patients with medial compartment KOA (odds ratio [OR], 0.594; 95% confidence interval [CI] 0.544–0.648; P < 0.05; OR, 0.851; 95% confidence interval CI 0.737–0.983; P < 0.05; respectively), with other radiographic parameters including MTPA (OR 0.959; 95% CI 0.511–0.648; P > 0.05), LDFA (OR 0.990; 95% CI 0.899–1.089; P > 0.05), and JSW (OR 1.005; 95% CI 0.865–1.167; P > 0.05).

Conclusions

In this retrospective study, patients with lower HKA and higher JLCA were identified as independent risk factors for the development of periosteal reaction, which occurred most commonly adjacent to the lateral of proximal tibia diaphysis, and thus we concluded that periosteal reaction may be an anatomical adaptation for medial compartment KOA based upon these results.

[The prognostic impact of diabetic mellitus and hyperglycemia during DLBCL treatment on patients with diffuse large B-cell lymphoma]

目的

探讨弥漫大B细胞淋巴瘤（DLBCL）患者的临床特征和预后因素，评估合并糖尿病（DM）及治疗过程中发生血糖升高对DLBCL预后的影响。

方法

回顾性收集2009年1月1日至2019年12月31日天津医科大学肿瘤医院及中山大学肿瘤防治中心收治的481例初诊DLBCL患者的临床资料，重点关注其治疗前及治疗中的血糖水平，采用Cox回归风险模型进行单因素分析评估预后影响因素，采用Kaplan-Meier法绘制生存曲线分析血糖异常对DLBCL患者总生存（OS）、无进展生存（PFS）的影响。

结果

82例（17.0％）患者在诊断DLBCL前患DM，88例（18.3％）患者在DLBCL治疗过程中至少发生一次血糖升高。单因素分析显示，年龄、Ann-Arbor分期、IPI评分、是否合并DM与OS、PFS相关（P值均<0.05）。组间比较显示，合并DM组与治疗过程中血糖升高组的OS和PFS均较无血糖异常组差（OS：P值分别为0.001、0.003，PFS：P值均<0.001），合并DM组与治疗过程中血糖升高组相比OS和PFS的差异均无统计学意义（P值分别为0.557、0.463）。化疗期间血糖控制良好组的OS和PFS优于血糖控制差组（OS：P＝0.037，PFS：P＝0.007）。

结论

合并DM是影响DLBCL患者预后的重要因素，治疗过程中血糖升高与DLBCL患者的不良预后相关。

Age- and Gender-Specific Epidemiologic Characteristics of Major Intra-Articular Fractures: Five-Year Data from a Level 1 Trauma Center

Objective

To investigate the epidemiological characteristics of major intra‐articular fractures.

Methods

This retrospective study enrolled patients with major intra‐articular fractures who were treated in the Third Hospital of Hebei Medical University from January 2015 to December 2019. A total of 11,084 patients (7,338 [66.20%] males and 3,746 [33.80%] females) meeting the inclusion and exclusion criteria were included. The distribution characteristics of intra‐articular fractures involving shoulder, elbow, wrist, hip, knee, ankle, and subtalar joints were identified.The potential associations between fractures and various other factors, such as age, gender, sites, were explored.

Results

There were 74 cases (0.67%) of shoulder fractures, 1,941 cases (17.51%) of elbow fractures, 1,155 cases (10.42%) of wrist fractures, 520 cases (4.69%) of hip fractures, 3,118 cases (28.13%) of knee fractures, 2,156 cases (19.45%) of ankle fractures, and 2,120 cases (19.13%) of subtalar fractures. The overall male‐to‐female ratio was 1.96:1. The highest proportion age group of major intra‐articular fractures included the ages 45–54 years. For males, the highest proportion age group was 45–54 years, for females, it was 55–64 years. The knee joint fracture was the most common type, accounting for 28.13%. For male and female patients, knee fractures accounted for 26.19% and 31.93%, respectively, with a male to female ratio of 1.13:1. The proportion of shoulder fractures was the smallest among this investigation, accounting for 0.67%. For male and female patients, shoulder fractures accounted for 0.44% and 1.12%, respectively, with a male to female ratio of 0.76:1. The age group with the highest proportion of shoulder joint fractures was ≥65 year olds (41.89%), with a male to female ratio of 0.76:1. The age group with the highest risk of elbow, wrist, hip, knee, ankle, and subtalar joint fracture was 5–14 year olds (33.59%) with a male to female ratio of 3.29:1, 5–14 year olds (23.98%) with a male to female ratio of 6.91:1, 45–54 year olds (26.92%) with a male to female ratio of 5.67:1, 45–54 year olds (24.60%) with a male to female ratio of 1.68:1, 25–34 year olds (20.36%) with a male to female ratio of 2.30:1, 45–54 year olds (27.41%) with a male to female ratio of 9.02:1, respectively. The most common site of intra‐articular fractures in different age groups was corresponding as follows: 0–4 year olds (elbow), 5–14 year olds (elbow), 15–24 year olds (ankle), 25–34 year olds (subtalar joint), 35–44 year olds (subtalar joint), 45–54 year olds (knee), 55–64 year olds (knee), 65–74 year olds (knee), and ≥75 year olds (knee).

Conclusion

The current study revealed the age‐ and gender‐specific epidemiological characteristics of major intra‐articular fractures, providing a basis for clinical evaluation and practices.

An Autograft for Anterior Cruciate Ligament Reconstruction Results in Better Biomechanical Performance and Tendon-Bone Incorporation Than Does a Hybrid Graft in a Rat Model

BACKGROUND

The biomechanical and tendon-bone incorporation properties of allograft-augmented hybrid grafts for anterior cruciate ligament (ACL) reconstruction compared with traditional autografts are unknown.

HYPOTHESIS

Using an autograft for ACL reconstruction yields better results on biomechanical testing, radiographic analysis, and histological evaluation versus using a hybrid graft.

STUDY DESIGN

Controlled laboratory study.

METHODS

A total of 66 adult male Sprague Dawley rats underwent unilateral ACL reconstruction with an autograft (AT group; n = 33) or a hybrid graft (HB group; n = 33). The grafts used in both groups were harvested from the peroneus longus tendon and were fixed by suturing to the surrounding periosteum. Samples were harvested for biomechanical testing, micro-computed tomography (CT), and histological evaluation at 4, 8, and 12 weeks postoperatively. Bone tunnels on the femoral and tibial sides were divided into 3 subregions: intra-articular (IA), midtunnel (MT), and extra-articular (EA). A cylinder-like volume of interest in the bone tunnel and a tubular-like volume of interest around the bone tunnel were used to evaluate new bone formation and bone remodeling, respectively, via micro-CT.

RESULTS

In the AT group, there were significantly higher failure loads and stiffness at 8 weeks (failure load: 3.04 ± 0.40 vs 2.09 ± 0.54 N, respectively; P = .006) (stiffness: 3.43 ± 0.56 vs 1.75 ± 0.52 N/mm, respectively; P < .001) and 12 weeks (failure load: 9.10 ± 1.13 vs 7.14 ± 0.94 N, respectively; P = .008) (stiffness: 4.45 ± 0.75 vs 3.36 ± 0.29 N/mm, respectively; P = .008) than in the HB group. With regard to new bone formation in the bone tunnel, in the AT group, the bone volume/total volume (BV/TV) was significantly higher than in the HB group on the tibial side at 8 weeks (IA: 22.21 ± 4.98 vs 5.16 ± 3.98, respectively; P < .001) (EA: 19.66 ± 7.19 vs 10.85 ± 2.16, respectively; P = .030) and 12 weeks (IA: 30.50 ± 5.04 vs 17.11 ± 7.31, respectively; P = .010) (MT: 21.15 ± 2.58 vs 15.55 ± 4.48, respectively; P = .041) (EA: 20.75 ± 3.87 vs 10.64 ± 3.94, respectively; P = .003). With regard to bone remodeling around the tunnel, the BV/TV was also significantly higher on the tibial side at 8 weeks (MT: 33.17 ± 8.05 vs 15.21 ± 7.60, respectively; P = .007) (EA: 25.19 ± 6.38 vs 13.94 ± 7.10, respectively; P = .030) and 12 weeks (IA: 69.46 ± 4.45 vs 47.80 ± 6.16, respectively; P < .001) (MT: 33.15 ± 3.88 vs 13.76 ± 4.07, respectively; P < .001) in the AT group than in the HB group. Sharpey-like fibers had formed at 8 weeks in the AT group. A large number of fibroblasts withdrew at 12 weeks. In the AT group, the width of the interface was significantly narrower at 4 weeks (85.86 ± 17.49 vs 182.97 ± 14.35 μm, respectively; P < .001), 8 weeks (58.86 ± 10.99 vs 90.15 ± 11.53 μm, respectively; P = .002), and 12 weeks (42.70 ± 7.96 vs 67.29 ± 6.55 μm, respectively; P = .001) than in the HB group.

CONCLUSION

Using an autograft for ACL reconstruction may result in improved biomechanical properties and tendon-bone incorporation compared with a hybrid graft.

CLINICAL RELEVANCE

Augmenting small autografts with allograft tissue may result in decreased biomechanical performance and worse tendon-bone incorporation, increasing the risk of graft failure.

Phase stability, brittle-ductile transition, and electronic structures of the TiAl alloying with Fe, Ru, Ge, and Sn: a first-principle investigation

Phase stability, brittle-ductile transition, and electronic structures of M (M = Fe, Ru, Ge, and Sn) and content change of L10-TiAl (γ-TiAl) and B2-TiAl (β-TiAl) have been investigated using first-principle methods. It is found that M metal atoms preferentially occupy the Al (2e) sites in L10-TiAl and B2-TiAl. According to Pugh's ratio and Poisson's ratio, the brittle-ductile transition is predicted for L10-TiAl and B2-TiAl with Fe, Ru, Ge, and Sn. It is found that the brittle-ductile transition from brittle regions to ductile regions with the transition metal elements Fe and Ru in L10-TiAl and B2-TiAl at the low concentration is approximately from 0 to 6.25 at.%. However, the brittle-ductile transition of Ge and Sn at the high concentration approximates from 6.25 to 12.5 at.% in L10-TiAl, comparing with B2-TiAl which approximates from 12.5 to 18.75 at.%. Electronic structure analysis shows that the improvement of brittleness can be attributed to two factors, including different hybridizations of Al-2p (Ti-3d) orbits with Fe-3d (Ge-4p) and Ru-4d (Sn-5p) orbits and different bandwidths of pseudo-gap. Furthermore, the L10-TiAl and B2-TiAl at low concentration of Fe and Ru can increase the value of ELF, where Ge and Sn atoms become bigger at a high concentration in L10-TiAl and B2-TiAl. At last, elastic constant (C_ij), bulk modulus (B), shear modulus (G), and Young's modulus (E) of L10 and B2-TiAl with content change are systematically given.

Triplanar Chevron Osteotomy: A Newly Proposed Method to Treat Hallux Valgus Deformities

Objective

To present a novel method called triplanar chevron osteotomy to treat hallux valgus (HV).

Methods

This is a retrospective study. In this study, the CT data of HV patients with painful callosities were evaluated retrospectively between 1 June 2018 and 1 June 2020. CT data from 49 consecutive patients (59 feet) with HV were evaluated. The average age at the time of surgery was 49.6 years (range, 30–63 years). The apex of the chevron osteotomy procedure was located at the center of the first metatarsal and was defined as the line formed by the central point perpendicular to the fourth metatarsal bone. The cut planes of the plantarward oblique chevron osteotomy (POCO) were defined as follows: chevron osteotomy along with 20° of plantarward obliquity. The triplanar osteotomy incision was made using the POCO method, with the direction inclined by 10° distally. The intermetatarsal angle (IMA), the HV angle (HVA), the projection of the second metatarsal (PSM), the metatarsal protrusion index (MPI), and the metatarsal protrusion distance (MPD) were all calculated before and after the operations. The length of the first metatarsal was measured and calculated with an equation.

Results

The results showed that the HVA was significantly decreased after surgery (32.7° ± 4.6° vs 14.9° ± 2.1°, t = 25.583, P < 0.001) in the triplanar, traditional, and POCO groups. The IMA was also significantly decreased (14.7° ± 2.0°) compared with the results before surgery (8.0° ± 1.1°, t = 22.739, P < 0.001) in these groups. Compared with traditional osteotomy and POCO, there were no differences in correcting deformities on axial planes for the HVA (14.5° ± 1.7° vs 14.9° ± 2.1°, t = 1.835, P = 0.072) and IMA (8.1° ± 1.1° vs 8.0° ± 1.1°, t = −0.97, P = 0.336). There was a statistically significant decrease following surgery in terms of the PSM, MPI, and MPD after triplanar osteotomy. The length of the first metatarsal increased (10.9 ± 1.3 mm), as measured through three‐dimensional images in the triplanar osteotomy group. The length was calculated as follows: H = L2 * Tan θ ≈ L/COS β * Tan θ.

Conclusion

The new triplanar osteotomy technique is safe and effective for treating HV, and in simulation experiments reveals potential benefits of correction and preventing transfer metatarsalgia.

Prophylactic Closed Suction Drainage Is Irrelevant to Accelerated Rehabilitation after Open Reduction and Internal Fixation for Closed Distal Femur Fractures

Objective

To investigate whether closed suction drainage (CSD) is related to accelerated rehabilitation of patients after open reduction and internal fixation (ORIF) for closed distal femur fractures.

Methods

This study was a prospective, randomized controlled clinical trial. Between October 2018 and June 2020, 160 closed distal femur fracture patients who were prepared for ORIF were prospectively randomized into two groups: a CSD group with the mean age of 57.91 ± 14.38 years (32 [40%] men and 48 [60%] women) and a non‐CSD group with the mean age of 59.73 ± 17.55 years (27 [34%] men and 54 [66%] women). Wound visual analogue scale (VAS) pain scores, peri‐wound skin temperature, hematocrit (Hct), hemoglobin (Hb) concentrations, hidden blood loss (HBL), dressing change, period of wound oozing, postoperative blood transfusion, and length of postoperative hospital stay were recorded. Postoperative wound complications, namely wound infections, wound haematoma, wound dehiscence, erythema of wound, and lower limb deep vein thrombosis (DVT) were collected. All the patients were administrated by a single surgical team and followed up for 1 month after the ORIF.

Results

The patients without CSD were identified with lower peri‐wound skin temperature and wound VAS pain scores during the first three postoperative days (36.69 ± 0.33 vs 36.86 ± 0.38 °C, P = 0.002; 1.88 ± 0.82 vs 3.15 ± 1.15, P = 0.000). However, both the peri‐wound skin temperature and wound VAS pain scores did not differ significantly between the two groups on the fifth postoperative day. In addition, patients with CSD had a longer length of postoperative hospitalization time (11.45 ± 5.95 vs 9.78 ± 4.64 days, P = 0.049). There was no statistically significant difference between CSD and non‐CSD groups within 1 month after the ORIF regarding blood loss, period of wound oozing, and postoperative complications, such as incidence of wound infection, haematoma, erythema, dehiscence, and lower limb DVT.

Conclusion

Prophylactic CSD after primary ORIF for closed distal femur fractures not only had no significant advantage to minimize blood loss and wound complications, but increased local inflammation and postoperative hospital stay, and thus we suggest that prophylactic CSD after primary ORIF for closed distal femur fractures is not recommended for optimized clinical pathways and accelerated recovery.

Age-related dynamic deformation of the femoral shaft and associated osteoporotic factors: a retrospective study in Chinese adults

Dynamic skeletal deformation with ageing showed important signs of degenerative and osteoporotic diseases. We found that both femoral bowing and cortical thickness were correlated with ageing in a Chinese population. Further, femoral cortical index, an osteoporotic indicator, was negatively correlated with femoral bowing angle. Hence, more attention should be paid to these femoral morphological changes to avoid fragility fractures and failed internal fixation.

PURPOSE

The purpose of this study was to determine whether morphological parameters of the femoral shaft are in age-related deformation and identify correlations between parameters of femoral cortical thickness and femoral shaft bowing.

METHODS

One hundred twenty patients (mean 50 years, range 18~104 years) who had received standard long-standing anteroposterior and femoral lateral radiographs from October 2016 to October 2019 were included in this retrospective study. The sagittal femoral bowing angle (sFBA), sagittal femoral cortical index (sFCI), coronal femoral bowing angle (cFBA), and coronal femoral cortical index (cFCI) were measured by two orthopaedists separately. All the participants' demographic data, including age, sex, body laterality, height, and weight, were collected. The Student's t test, Mann-Whitney U test, two-way ANOVA, Pearson correlation, and multiple linear regression were used in the statistical analysis.

RESULTS

The mean age of the male and female participants was 46.95 ± 15.25 and 52.22 ± 15.61 years, respectively. Two-way ANOVA revealed that females had a significantly lower sFCI than males at the right side (P < 0.05). There were no significant interactions between sex or body laterality and the sFBA, cFBA, sFCI, and cFCI groups (P > 0.05). Pearson correlation revealed that sFCI was strongly correlated with sFBA (r = - 0.535, P < 0.05) and cFBA (r = - 0.535, P < 0.05). Multiple linear regression analysis demonstrated that both age (β = 0.304 and 0.308 respectively) and sFCI (β = - 0.322 and - 0.414 respectively) were two independent predictors associated with sFBA and cFBA respectively.

CONCLUSIONS

The femoral shaft bowing of the Chinese population was positively correlated with ageing, whereas the sagittal femoral cortical thickness negatively correlated with ageing. A high FBA occurred in femoral shafts with a low sFCI, which revealed that femoral shaft bowing was associated with femoral cortical thickness. During femur-related surgery in older patients, more attention should be paid to these femoral morphological changes.

[Tap-hammer elicited vestibular-evoked myogenic potentials system: its design and preliminary application]

Objective: The aim of this study was to design and perform "Tap-hammer"system that can be used to elicit vestibular evoked myogenic potentials (VEMP) in normal adults and to report the preliminary results of this system. Methods: A triggered Tap-hammer was designed, made and connected with an electric recording system, to form as a system for Tap-VEMP recording. Twenty healthy adult volunteers (7 males and 13 females, aged 20 to 37 years, 40 ears in total) were recruited for air-conducted sound VEMP (ACS-VEMP) and Tap-VEMP examinations. Waveforms and parameters of both VEMPs were recorded and analyzed. SPSS 22.0 software was used for statistical analysis. Results: The response rates of ACS-, Tap-ocular VEMP (oVEMP) and ACS-, Tap-cervical VEMP (cVEMP) were both 100% (40/40). The mean±SD n1 latency, p1 latency, n1-p1 interval, amplitude, and asymmetry ratio (AR%) of Tap-oVEMP were (9.80±2.51)ms, (13.90±3.26)ms, (4.09±1.43)ms, (16.43±9.61)μV, (22.68±17.35)% respectively. The mean±SD p1 latency, n1 latency, p1-n1 interval, amplitude, and asymmetry ratio (AR%) of Tap-cVEMP were (13.26±2.07)ms, (21.84±2.89)ms, (8.58±2.10)ms, (457.65±274.94)μV, (20.42±13.46)% respectively. Both n1 latency and p1 latency of Tap-VEMPs were shorter than those in ACS-VEMPs (P<0.05). No statistical difference could be found between the two stimulation methods in the parameters of n1-p1 interval, amplitude, and asymmetry ratio(P>0.05). Conclusion: The Tap-hammer system can elicit VEMP responses in healthy young people. This system can be used as an alternative stimulation method for bone conduction VEMP.

Volar, Splitting, and Collapsed Type of Die-Punch Fracture Treated by Volar Locking Plate (VLP): A Retrospective Study

OBJECTIVE

To compare the results of different types of die-punch fractures treated by volar locking plate (VLP).

METHODS

Between January 2013 and February 2018, a total of 71 patients with die-punch fracture of distal radius were treated by VLP and their medical records were retrospectively reviewed. Of them, 18 were classified as volar type, 24 as splitting type, and 28 as collapsed type of fracture, based on the preoperative radiographs and CT scans. The minimum follow-up period was 12 months. Radiological parameters, wrist function, range of motion (ROM), and complications were evaluated and compared. Pearson chi-square test was used to assess the difference of gender distribution, injury side, dominance, mechanism, type and classification of fracture, and postoperative complications, when necessary (P < 0.05), followed by pairwise comparisons using partitions of chi-square test. Two-tailed P value <0.05 was considered as statistically significant. For pairwise comparisons, adjustment of statistical level as P < 0.017 (0.05/3) was used. SPSS 21.0 was used to perform all the analyses.

RESULTS

The mean follow-up time was 14.5 months, and at the mean of postoperative 8 weeks all patients obtained bony union, without delayed or non-union. The grip strength was 26.6 ± 7.9 kg for patients in volar fracture group, 27.0 ± 9.4 kg in splitting group, and 26.2 ± 9.4 kg in collapsed group, without significant difference (P = 0.628).The disabilities of the arm, shoulder, and hand (DASH) (9.2 ± 10.0 for volar group, 8.8 ± 7.9 for splitting group, and 10.6 ± 8.7 for collapsed group) or Gartland-Werley score (5.1 ± 2.8 for volar group, 4.8 ± 3.2 for splitting group, and 6.4 ± 2.7 for collapsed group) either did not differ among the three groups (all P > 0.05). There was a poorer ROM in the group of collapsed fractures, but the difference was non-significant for any parameter (P > 0.05). As for radiographic parameters, we did not find any significant difference for volar tilt, radial inclination, radial height, and ulnar variance (all P > 0.05), except for articular step-off (P < 0.001). Pairwise comparisons showed a significantly greater step-off (1.2 mm vs 0.4 mm, 0.5 mm) and higher rate of total complications in group of collapsed fracture (39.3%), compared to either volar (10.5%) or splitting type (12.5%).

CONCLUSIONS

The collapsed type of die-punch fracture posed a greater articular step-off and a higher rate of complications, especially secondary wrist osteoarthritis, which deserved more attention in clinical treatment.

[Circular RNA-UBXN7 promotes proliferation, migration and suppresses apoptosis in hepatocellular cancer]

Objective: To investigate the effect and molecular mechanism of circular RNA-UBXN7 (circ_UBXN7) on the proliferation, migration and apoptosis of hepatocellular carcinoma cells. Methods: Circ_UBXN7 expression in the tissues and cells of hepatocellular cancer was detected by quantitative real-time polymerase chain reaction (qRT-PCR), and the relationship between circ_UBXN7 expression and clinicopathological features, including age, gender, tumor volume, pathological classification, staging, and lymph node metastasis was analyzed. The full-length sequence of circ_UBXN7 with lentivirus carrying lenti circ_UBXN7 and lenti circ_UBXN7 shRNA was constructed to transfect hepatocellular cell lines (HepG2 and Huh-7), respectively. CCK-8 experiments were performed to detect the ability of up- or down-regulation of circ_UBXN7 on the proliferation of HEPG2 and HUH-7 cells. Annexin V / PI experiment was used to detect the changes in apoptosis of HEPG2 and HUH-7 cells after up-regulation or down-regulation of circ_UBXN7 expression. JC-1 assay was used to detect the changes in mitochondrial potential energy of HEPG2 and HUH-7 cells after up-regulation or down-regulation of circ_UBXN7 expression. Transwell was used to detect the migration ability of HEPG2 and HUH-7 cells after up-regulation or down-regulation of circ_UBXN7 expression. Western blotting was used to detect the expressional change of TWIST, E-cadherin, N-cadherin and vimentin. Statistical analysis: The expression levels of circ_UBXN7 and clinicopathological features were measured by chi-square test. Two groups were compared by t-test and three groups and above were compared by single factor analysis of variance. LSD method was used for comparison between groups. Results: The expression of circ_UBXN7 in liver cancer tissues was significantly higher than adjacent tissues, and its expression level was significantly positively correlated with tumor volume, stage, and lymph node metastasis (P < 0.05). Lenti-circ_UBXN7 had up-regulated the expression of circ_UBXN7 in HEPG2 and HUH-7 cells and promoted cell proliferation. Lenti-circ_UBXN7-shRNA had down-regulated the expression of circ_UBXN7 and induced apoptosis. Lenti-circ_UBXN7-shRNA had reduced the mitochondrial membrane potential of cells. Lenti-circ_UBXN7 had promoted cell migration, while lenti-circ_UBXN7-shRNA had inhibited cell migration. Lenti-circ_UBXN7 had induced increased expression of Twist, N-cadherin, and Vimentin proteins, and reduced the expression of E-cadherin protein. Lenti-circ_UBXN7-shRNA had opposite effects on the expression levels of each protein. Starbase V2.0 software showed that miR-203a and circ_UBXN7 had potential binding sites, and miR-203a and circ_UBXN7 expression levels were negatively correlated in HEP ​​G2 and HUH-7 cells. Conclusion: circ_UBXN7 plays an important role in promoting the occurrence and development of liver cancer, and is expected to become a potential target for the treatment of liver cancer.

[Ultrastructural study of ampulla of mouse inner ear]

Objective: To observe the ultrastructure of the ampulla, and analyze its physiological and pathological significance. Methods: In this study, 20 Kunming mice were used, and scanning electron microscopy was used to observe the ultrastructure of the ampulla of inner ear. Results: Otoconia was found among the cilia bundles of different haircell(intercilla otoconia of ampulla). The cupula was attached to the lateral wall of the ampulla, and easily to be separated; after separated, a kind of slender crystal(surface otoconia of ampulla) could be seen between the cupula and lateral wall of the ampulla, both sides of ampullary crest were covered with slender crystals too. On the canal side of the ampulla wall, there was more particulate matter attached to the wall near the bottom of ampullary crest, partially embedded in the wall, and less on the utricle side of the ampulla wall. Conclusions: The observation of the ultrastructure of the ampulla is helpful for better understanding the physiological functions of the semicircular canals and the ampulla, and better understanding the pathogenesis and solution of some vertigo diseases.

Relationships between Morphological Changes of Lower Limbs and Gender During Medial Compartment Knee Osteoarthritis

Objectives

To evaluate the dynamic changes of key morphology indicators of the lower extremities in the coronal plane with progressing medial compartment knee osteoarthritis (KOA) with an emphasis on gender‐dependent regional differences.

Methods

The radiographs of patients with non‐traumatic knee pain and varying degrees of genu varus were reviewed. Radiographs were studied in 1538 lower limbs of 883 consecutive patients who visited our hospital from January to July 2017; all patients had long‐standing anteroposterior image‐splicing radiographs taken of their lower limbs. Morphological indicators of bones and joints that can change the alignment of lower limbs or reflect cartilage wear and soft‐tissue relaxation were selected and measured with the help of picture archiving and communication systems. After comparing the data of different genders, the data of males and females was separated into three age groups, <40 years, 40–60 years, >60 years respectively, and then compared among age groups using the Kruskal‐Wallis and Mann–Whitney U tests. Scatterplots of age and all the measurements were drawn to determine the strength of the relations. The Pearson correlation test was performed to reveal correlations of measurements and age.

Results

Femoral bowing angle (FBA) and joint line convergence angle (JLCA) have obvious differences between different genders (P = 0.001, 0.000, respectively). This suggests that females have greater femoral curvature and joint space angle than males. Significant differences were found in hip‐knee‐ankle angle (HKA), FBA, distal femoral valgus resection angle (DFVRA), medial proximal tibial angle (MPTA), JLCA, and minimum joint space width (min‐JSW) by age groups in females (P = 0.000, 0.000, 0.000, 0.000, 0.003, 0.002, respectively). The difference of mechanical medial distal femoral angle (mMDFA) was significant with P values less than 0.05 deemed significant (P = 0.030). Significant correlations were found between age and all measurements (r = −0.166, 0.253, 0.270, −0.147, 0.089, −0.105, −0.076, respectively, P < 0.01). Whereas, the difference in min‐JSW by age group was the only significant one in males (P = 0.001), and no significant correlation was found between age and measurements (r = −0.107, 0.041, 0.134, −0.067, 0.079, −0.134, −0.098, respectively, P > 0.01).

Conclusions

As KOA progressed, both dynamic deformation of lower extremities and degeneration of articular cartilage could be found in females, while no obvious dynamic deformations were found in males. Dynamic deformation of lower extremities was the important feature and the major causative factor of KOA in females.

[The clinical efficacy of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint]

Objective: To explore the short-term effectiveness of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint. Methods: A retrospective study was performed on 17 patients with anterior cruciate ligament injury combined with varus deformity of knee joint who underwent arthroscopic combined with dual-plane high tibial osteotomy at Department of Bone and Joint, the Affiliated Hospital of Southwest Medical University from January 2017 to June 2018.There were 11 males (11 knees) and 6 females (6 knees), aged 41.3 years (range: 32 to 49 years) .During the surgery, the weight bearing line of lower extremity was set to 62.5% position of the tibial plateau on coronal plane. The tibial slope was adjusted to the normal range on sagittal plane, and anterior cruciate ligament was reconstructed to improve the stability of knee joint.At final follow up, full length weight bearing X ray was used to evaluate the position of weight bearing line, femoral tibial angle and tibial slope pre- and post-operatively.The Lysholm scores, Hospital for Special Surgery score, Tegner knee activity scores and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test, KT-1000 side-to-side difference and pivot-shift test were used to estimate the knee joint stability. Results: The patients were followed up for 1.8 years(range:1.2 to 2.5 years). No complication such as infection, deep vein thrombosis, graft failure, nonunion or delayed union was observed.The weight bearing line was corrected from (28.48±2.24)% preoperatively to (57.43±1.02)% postoperatively (t=46.80, P=0.00) .The femoral tibial angle was improved from (172.31±3.37) ° preoperatively to (178.91±1.34) ° postoperatively(t=10.46, P=0.00). The tibial slope was decreased from (14.29±1.26) ° preoperatively to (9.31±0.79) ° postoperatively (t=24.59, P=0.00) . The KT-1000 side-to-side difference decreased from (7.95±1.19) mm preoperatively to (1.79±0.49)mm postoperatively(t=18.34, P=0.00). At the last follow-up, Lysholm score, Hospital for Special Surgery score, Tegner score, and the IKDC knee evaluation score of patients showed significant improvement from preoperative(P<0.05). Conclusion: Arthroscopic combined with dual-plane high tibial osteotomy can get a good short term efficacy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint which can significantly improve the alignment of lower extremity and knee joint stability.

Hamstring Autograft Versus Hybrid Graft for Anterior Cruciate Ligament Reconstruction: A Systematic Review

BACKGROUND

Hamstring tendon autografts are commonly used for primary anterior cruciate ligament (ACL) reconstruction. Some patients have small hamstring tendons however, which may compromise the clinical outcome of the autograft. To solve this problem, many surgeons use hybrid grafting that involves augmentation of small hamstring autografts with allograft tissue.

PURPOSE/HYPOTHESIS

The purpose was to compare the clinical outcomes between primary ACL reconstructions performed with hamstring autografts and those performed with hybrid grafts in terms of patient-reported evaluation, failure rate, and knee stability. The hypothesis was that primary ACL reconstruction performed with hamstring autograft alone will not differ significantly from that performed with a hybrid graft in terms of patient-reported evaluation, failure rate, or knee stability.

STUDY DESIGN

Systematic review.

METHODS

A systematic review was performed to identify prospective and retrospective comparative studies and cohort studies (evidence levels 1-3) comparing outcomes of primary ACL reconstructions performed with hamstring autografting alone and hybrid grafting. Outcomes included patient-reported evaluation, failure rate, and knee stability.

RESULTS

Ten studies were included: 1 of level 2 and 9 of level 3. Collectively, they included 398 autografts and 341 hybrid grafts. Mean respective follow-up durations ranged from 24.0 to 69.6 months and from 24.0 to 70.8 months. Patient-reported evaluations, including Lysholm, Tegner, and subjective International Knee Documentation Committee scores, were reported in 8 of 10 studies. Failure rates were reported in all 10 studies. Results of knee stability examinations-including KT-1000 arthrometer measurements, the pivot-shift test, Lachman test, and overall International Knee Documentation Committee results-were reported in 4 of 10 studies. In this review, there were no statistically significant differences between autografts and hybrid grafts in terms of patient-reported evaluations, failure rates, or KT-1000 measurements.

CONCLUSION

In this systematic review, there was no significant difference in patient-reported evaluation or failure rate between primary ACL reconstructions performed with autografts alone and those performed with hybrid grafts. Whether there is a substantial difference in knee stability examination results between autografts and hybrid grafts remains unknown, given a relative lack of reports on knee stability.

An Often Easily Missed Injury in the Presence of Orthopaedic Trauma: A Case Series of Derived Injury

Derived disaster is a common concept in emergencies such as earthquakes. With the progress of society, the incidence of fractures caused by high-energy trauma has increased year by year. After the first injury, the possibility of derived injury caused by the original injury also increases rapidly. Orthopaedic surgeons, especially trauma orthopaedic surgeons, lack sufficient understanding and recognition of this kind of injury. The purpose of this article is to present a case series of an often missed injury pattern that is associated with an original injury. The diagnosis of derived injury may go unrecognized in a considerable number of cases and delayed treatment decreases the success rate of soft tissue repairing; therefore, a high index of suspicion and a proper early diagnosis is of paramount importance. We also describe the current surgical management used by the authors, and propose the concept of "derived injury", studying its clinical significance in traumatic orthopaedics.

[Analysis on the consciousness of the cancer early detection and its influencing factors among urban residents in China from 2015 to 2017]

Objective: To understand the consciousness of the cancer early detection among urban residents and identify the influencing factors from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. Self-designed questionnaires were used to collect population, socioeconomic indicators, self-cancer risk assessment, regular participation in physical examination and other information. The multivariate logistic regression model was used to identify the factors of people who had not regularly participated in the regular physical examination in the past five years. Results: The self-assessment results of 32 357 residents showed that there were 27.54% (8 882) of total study population with self-reported cancer risk, 45.48% (14 671) without cancer risk and 26.98% (8 704) with unclear judgement on their own cancer risk. Among population with cancer risk, 79.84% (7 091) considered physical examination accounted. In the past five years, there were 21 105 (65.43%) residents participated in regular physical examination and 11 148 (34.56%) participated in non-scheduled one, respectively. The multivariate logistic regression analysis showed that compared with unmarried and western region residents, divorced, middle and eastern region residents had a stronger consciousness to participate in the regular physical examination (P<0.05). Compare with residents with annual household income less than 20 000 CNY in 2014, cancer risk assessment/screening intervention population, and self-assessment with cancer risk, residents with annual household income between 20 000 CNY and 59 000 CNY in 2014, occupational population, community residents, cancer patients, self-reported cancer-free risk, and self-assessment with unclear judgement of cancer risk were less likely to participate in the regular physical examination (all P values <0.05). Conclusion: From 2015 to 2017, the Chinese urban residents had a acceptable consciousness of the cancer early detection. The marital status, annual household income, population group and self-assessment of cancer risk were related to the consciousness of the cancer early detection of people who had not participated in the regular physical examination in the past five years.