Operative treatments compared with nonoperative treatment of displaced midshaft clavicular fractures

BackgroundFew reports on external fixation to treat displaced midshaft clavicular fractures exist. We sought to compare the clinical effects of external fixation, plate fixation, and nonoperative treatment for treating displaced midshaft clavicular fractures in adults.Material and methodsEighty-nine patients with a displaced midshaft fracture of the clavicle were selected (according to inclusion criteria) for a retrospective analysis and assigned to either operative treatment with external fixation (29 patients), plate fixation (30 patients) or nonoperative treatment with a sling (30 patients). The average follow-up period is 32 months. Outcome analysis included: Constant shoulder score (CSS); disabilities of the arm, shoulder and hand score (DASH); nonunion rate; satisfaction of shoulder appearance.ResultsEighty-five cases were successfully followed up. No significant difference was observed between external fixation and plate fixation (p > 0.05 and p = 0.132, respectively). The operative groups achieved better effects (p < 0.001) compared to the nonoperative treatment. The healing time of the three groups were: 10.4 ± 2.3 weeks for external fixation; 12.1 ± 2.5 weeks for plate fixation; and 15.7 ± 2.2 weeks for nonoperative treatment. In the follow-up, patients in the external fixation group (96%) and plate fixation group (93%) were more likely to be satisfied with the appearance of the shoulder than were those in the nonoperative group (77%).ConclusionThe external fixation and plate fixation are overall better than the nonoperative treatment. As to choose between the two, it depends on the local soft tissue condition, surgeon's techniques, communication between doctor and patients and so on.     

中国中老年人抑郁症状与其吸烟行为关系的队列研究

目的 探索中老年人抑郁症状与吸烟行为的关联，以及社会人口学特征对这种关联的影响。方法 本研究使用CHARLS2011年与2015年的调查数据，选取基线不吸烟的7 722例中老年人作为研究对象。采用10项流调中心抑郁量表（CES - D10）评估抑郁症状，运用logistic 回归模型分析抑郁症状对吸烟行为的影响。结果 随访4年后，有7.17%（554例）的中老年人出现吸烟行为。logistic回归分析显示，有抑郁症状的中老年人出现吸烟行为的风险是无抑郁症状者的1.35倍（OR = 1.35，95%CI:1.09～1.68）。分层分析发现，与无抑郁症状者相比，有抑郁症状的女性（OR = 1.67，95%CI:1.11～2.52）、45～59岁（OR = 1.52，95%CI:1.11～2.09）、居住地在农村者（OR = 1.55, 95%CI:1.17～2.06）吸烟行为风险更高，差异具有统计学意义 (P＜0.05)。结论 中国中老年人的抑郁症状与吸烟行为显著相关，且在女性、45～59岁和居住在农村的人中更为显著。建议未来的研究进一步探索中老年人临床抑郁与吸烟行为的关系研究。     

Reliability of the Brownish-flanked Bush Warbler’s soft song in male-male conflict

Background: Soft song is a low-amplitude song produced by many birds. Recent studies have confirmed that soft song is an aggressive signal. For example, the Brownish-flanked Bush Warblers Cettia fortipes use soft song in male-male conflicts, particularly prior to attacks. Although stable signaling systems require that signals be honest on average,models predict that cheating is an acceptable strategy for some individuals or in some contexts.Methods: This study aimed to test the reliability of soft song as an aggressive signal in the brownish-flanked bush warbler. We used mounted specimens accompanied by broadcast songs or soft songs to simulate a male attempting to invade an existing territory.Results: We found the mounted specimen that coupled playback of soft songs suffered more and quicker attacks from the territory owner and that the relationship between soft song and subsequent attack in the territory owner was far from perfect. We observed territory owners that both over-signaled(i.e., produced soft song but did not attack) and under-signaled(i.e., attacked without producing soft song). Under-signaling territory owners were relatively more commonly than were over-signaling territory owners, particularly in simulated intrusion that coupled playback of soft song with a mount specimen.Conclusions: We discuss the cost of producing soft song and the potential benefit of the unreliable use of soft song and propose a new hypothesis for under-signaling with soft song; i.e., under-signaling territory owners might benefit from taking the initiative in fights.     

Pulsed electromagnetic fields stimulate osteogenic differentiation and maturation of osteoblasts by upregulating the expression of BMPRII localized at the base of primary cilium

Pulsed electromagnetic fields (PEMFs) have been considered as a potential candidate for the prevention and treatment of osteoporosis, however, the mechanism of its action is still elusive. We have previously reported that 50 Hz 0.6 mT PEMFs stimulate osteoblastic differentiation and mineralization in a primary cilium- dependent manner, but did not know the reason. In the current study, we found that the PEMFs promoted osteogenic differentiation and maturation of rat calvarial osteoblasts (ROBs) by activating bone morphogenetic protein BMP-Smad1/5/8 signaling on the condition that primary cilia were normal. Further studies revealed that BMPRII, the primary binding receptor of BMP ligand, was readily and strongly upregulated by PEMF treatment and localized at the bases of primary cilia. Abrogation of primary cilia with small interfering RNA sequence targeting IFT88 abolished the PEMF-induced upregulation of BMPRII and its ciliary localization. Knockdown of BMPRII expression level with RNA interference had no effects on primary cilia but significantly decreased the promoting effect of PEMFs on osteoblastic differentiation and maturation. These results indicated that PEMFs stimulate osteogenic differentiation and maturation of osteoblast by primary cilium-mediated upregulation of BMPRII expression and subsequently activation of BMP-Smad1/5/8 signaling, and that BMPRII is the key component linking primary cilium and BMP-Smad1/5/8 pathway. This study has thus revealed the molecular mechanism for the osteogenic effect of PEMFs.     

Bilateral Transcranial Direct Current Stimulation Over Dorsolateral Prefrontal Cortex Changes the Drug-cued Reactivity in the Anterior Cingulate Cortex of Crack-cocaine Addicts

BackgroundPatients addicted to crack-cocaine routinely have difficulty sustaining treatment, which could be related to dysfunctional cerebral activity that occurs in addiction.ObjectiveTo investigate the indirect electrophysiological effects of single transcranial direct current stimulation (tDCS) on cocaine-addicted brains.MethodsThe patients received either left cathodal/right anodal or sham stimulation over the DLPFC. The region of interest was the anterior cingulate cortex (ACC) during the N2 time window (200–350 ms). Event-related potentials in the ACC were measured during visual presentation of crack-related cues or neutral cues.ResultsLow-resolution brain electromagnetic tomography (LORETA) indicated that exposure to crack-related images led to increased activity in the ACC in the sham group, while the tDCS group showed decreased ACC activity after visualization of drug cues.ConclusionPrefrontal tDCS specifically modulated the ACC response during exposure to visual drug cues in crack-cocaine users.     

DW14006 as a direct AMPKα1 activator improves pathology of AD model mice by regulating microglial phagocytosis and neuroinflammation

Alzheimer’s disease (AD) is a progressively neurodegenerative disease with typical hallmarks of amyloid β (Aβ) plaque accumulation, neurofibrillary tangle (NFT) formation and neuronal death extension. In AD brain, activated microglia phagocytose Aβ and neuronal debris, but also aggravate inflammation stress by releasing inflammatory factors and cytotoxins. Improving microglia on Aβ catabolism and neuroinflammatory intervention is thus believed to be a promising therapeutic strategy for AD. AMP-activated protein kinase (AMPK) is highly expressed in microglia with AMPKα1 being tightly implicated in neuroinflammatory events. Since indirect AMPKα1 activators may cause side effects with undesired intracellular AMP/ATP ratio, we focused on direct AMPKα1 activator study by exploring its potential function in ameliorating AD-like pathology of AD model mice. Here, we reported that direct AMPKα1 activator DW14006 (2-(3-(7-chloro-6-(2′-hydroxy-[1,1′-biphenyl]-4-yl)-2-oxo-1,2-dihydroquinolin-3-yl)phenyl)acetic acid) effectively improved learning and memory impairments of APP/PS1 mice, and the underlying mechanisms have been intensively investigated. DW14006 reduced amyloid plaque deposition by promoting microglial o-Aβ₄₂ phagocytosis and ameliorated innate immune response by polarizing microglia to an anti-inflammatory phenotype. It selectively enhanced microglial phagocytosis of o-Aβ₄₂ by upgrading scavenger receptor CD36 through AMPKα1/PPARγ/CD36 signaling and suppressed inflammation by AMPKα1/IκB/NFκB signaling. Together, our work has detailed the crosstalk between AMPKα1 and microglia in AD model mice, and highlighted the potential of DW14006 in the treatment of AD.     

Parent-adolescent relationship quality as a predictor of leaving home

IntroductionLeaving home is a significant life transition that effects both emerging adults and their families. The age of leaving home has been increasing across industrialized societies, and children remain dependent on their parents for a longer time. The present study investigated the association between parent-adolescent relationships and timing of leaving home over a timespan of six years: From middle adolescence to emerging adulthood.MethodsData came from three cohorts of two longitudinal studies in the Netherlands (N = 1100). At the start of the study, participants had a mean age of 16.41 (SD=.71), and approximately half of them (n = 547) were male. Adolescents completed questionnaires on parent-adolescent relationship quality. The impact of positive and negative relationship characteristics on timing of leaving home were examined separately for mothers and fathers.ResultsSurvival analysis results showed that higher levels of mother's and father's warmth, and higher levels of power attributed to father, but not mother, predicted later timing of leaving home. Higher levels of parental autonomy support predicted earlier timing of leaving home. Conflict with parents was not associated with timing of leaving home, except in the father-daughter relationship. Only, the effect of parental warmth on timing of leaving home remained robust when controlling for age, gender, education level, and SES.ConclusionsOur findings indicate that certain parent-adolescent relationship characteristics contribute to the increase in age of leaving home. Parents may be able to prepare their children for a self-sufficient living by balancing warmth and autonomy support they provide during adolescence.     

Sinecatechins Ointment 15% for the Treatment of External Genital Warts

The human papillomavirus (HPV) is one of the most common viral sexually transmitted infections (STIs) in the United States. External genital warts (EGWs) are a commonly seen clinical manifestation of infection with certain strains of the HPV virus, particularly HPV types 6 and 11. Current treatments for the destruction and elimination of EGWs include in -office, provider -delivered therapy and patient -applied medications. Sinecatechins ointment 15% is the newest FDA -approved patient -applied treatment for EGWs. This article reviews the transmission and clinical presentation of EGWs, describes the use of sinecatechins ointment 15% as one patient -applied treatment option and discusses implications for nurses.