Fracture-related infection: A consensus on definition from an international expert group

Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition.The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI.Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria.In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future.     

Tetrahydrocurcumin induces G2/M cell cycle arrest and apoptosis involving p38 MAPK activation in human breast cancer cells

Curcumin (CUR) is a major naturally-occurring polyphenol of Curcuma species, which is commonly used as a yellow coloring and flavoring agent in foods. In recent years, it has been reported that CUR exhibits significant anti-tumor activity in vivo. However, the pharmacokinetic features of CUR have indicated poor oral bioavailability, which may be related to its extensive metabolism. The CUR metabolites might be responsible for the antitumor pharmacological effects in vivo. Tetrahydrocurcumin (THC) is one of the major metabolites of CUR. In the present study, we examined the efficacy and associated mechanism of action of THC in human breast cancer MCF-7 cells for the first time. Here, THC exhibited significant cell growth inhibition by inducing MCF-7 cells to undergo mitochondrial apoptosis and G2/M arrest. Moreover, co-treatment of MCF-7 cells with THC and p38 MAPK inhibitor, SB203580, effectively reversed the dissipation in mitochondrial membrane potential (Δψm), and blocked THC-mediated Bax up-regulation, Bcl-2 down-regulation, caspase-3 activation as well as p21 up-regulation, suggesting p38 MAPK might mediate THC-induced apoptosis and G2/M arrest. Taken together, these results indicate THC might be an active antitumor form of CUR in vivo, and it might be selected as a potentially effective agent for treatment of human breast cancer.     

Integration of genomic information in the clinical management of HCC

Molecular profiling of hepatocellular carcinoma (HCC) is enabling the advancement of novel approaches to disease diagnosis and management. Accurate prognosis prediction in HCC is specially critical. Clinical staging systems for HCC support clinical decision-making (e.g., BCLC algorithm) might be complemented by molecular-based information in the near future. Molecular signatures derived from tumour and non-tumour samples are associated with patient recurrence an outcome. Single nucleotide polymorphisms have been linked with HCC development. Next generation sequencing studies have brought to light the genomic diversity of this disease. Gens recurrently altered in HCC and susceptible to be targeted belong to signalling pathways including telomere maintenance, cell cycle, chromatin remodelling, Wnt/beta-catenin, RAS/RAF/MAPK and PI3K/AKT/mTOR pathways. Oncogenic loops are unknown but might include some of the already discovered aberrations. Despite the intratumoral heterogeneity observed in HCC tumours, studies including large number of samples can identify key genetic drivers and contribute to the development of novel treatments and a personalized medicine.     

破裂大脑中动脉动脉瘤的显微手术治疗

目的探讨破裂大脑中动脉动脉瘤的诊断、显微手术治疗及其疗效。方法回顾性分析显微手术治疗的70例破裂大脑中动脉动脉瘤患者的临床资料。64例患者术前进行了头颅3D-CTA或/和DSA检查,6例仅行头颅CT检查。结果 70例患者中,67例行动脉瘤夹闭术,3例行动脉瘤包裹术。术后随访3月～2年,按GOS评分,5分57例,4分5例,3分5例,2分1例,1分2例;60例患者行3D-CTA或/和DSA复查,未见动脉瘤复发,其中1例行包裹术的患者动脉瘤无明显增大。结论破裂大脑中动脉动脉瘤应尽早采取显微手术治疗,以有效改善预后;术中多普勒超声的使用能为手术提供帮助。     

重组人生长激素在成人生长激素缺乏症的应用

近20年来,重组生长激素已可以无限量的制备。近年来的研究已阐明成人生长激素缺乏的影响及生长激素替代治疗的益处。成人生长激素缺乏症对人影响最大的是生活质量、骨骼健康及包括血清脂质谱、身体构成变化的心血管危险因子的改变,而这也正是生长激素替代治疗获益最显著之处。大量的证据显示了重组人生长激素治疗的疗效,尤其在改善骨代谢和改善心血管危险因素等多方面发挥作用,并且是安全的。     

D_1类多巴胺受体对肾上腺素α受体介导的促动脉平滑肌细胞增殖作用的影响

目的观察D1类多巴胺受体对肾上腺素α受体介导的血管平滑肌(VSM)细胞增殖的影响。方法以去甲肾上腺素(NE)10-6~10-9mol/L刺激Sprague-Dawley(SD)大鼠主动脉分离的VSM细胞,观察在D1类多巴胺受体激动剂(Fenoldopam)10-5~10-8mol/L存在的情况下,NE促细胞增殖作用的变化,细胞增殖用3H-TdR掺入量表示。结果NE呈浓度依赖性的促进SD大鼠VSM细胞的增殖,该作用由肾上腺素α受体介导,酚妥拉明存在的情况下可消除NE的促增殖作用。Fenoldopam本身对VSM细胞增殖无影响,但Fenoldopam可通过D1类多巴胺受体减弱NE(10-6mol/L)介导的VSM细胞增殖;该实验结果得到了人VSM细胞实验结果的印证。结论D1类多巴胺受体对NE介导的促VSM细胞增殖具有抑制作用,该作用可能在高血压的发生、发展中发挥一定的作用。     

乙型肝炎病毒多聚酶末端蛋白重链可变区抗体体外抑制病毒的复制

目的用蛋白片段互补法(PCA)选择HBV多聚酶末端蛋白(TP)重链可变区(VH)抗体,研究特异性VH抗体体外抑制HBV的复制与分泌。方法以HBV多聚酶TP区为抗原,用PCA法进行特异性VH抗体筛选。特异性VH抗体基因定向亚克隆人真核表达载体pZeoSV2( ),构建pZeoSV2( )-VH重组质粒,用脂质体介导的转染技术,将其导入HepG 2.2.15细胞,观察特异性抗体的生物学活性。结果用PCA法从抗体库中选择出3个特异性抗体:VH1、VH2和VH3,其中与抗原亲和力最高的是VH1。转染pZeoSV2( )-VH1的HepG 2.2.15细胞比未转染pZeoSV2 ( )-VH1或只转染空载体pZeoSV2( )的HepG 2.2.15细胞病毒颗粒分泌明显减少,上清液内为2.978 7±0.276 1比5.150 4±0.276 1和5.295 1±0.241 0(P<0.05);细胞内为5.283 9±0.162 9比8.300 4±0.323 2和8.532 1±0.138 3(P<0.05)。结论用PCA法可从抗体库中选择出HBV多聚酶TP区特异性VH抗体,该抗体在体外可抑制HBV的复制与分泌。