Biomechanical Study of Intramedullary Versus Extramedullary Implants for Four Types of Subtrochanteric Femoral Fracture

ObjectivesTo compare the biomechanical performance of proximal femoral nail anti‐rotation (PFNA), the “upside‐down” less invasive plating system (LISS), and proximal femoral locking plate (PFLP) in fixing different fracture models of subtrochanteric fractures.MethodsThirty composite femurs were divided into three equal groups (PFNA, PFLP, and reverse LISS). The implant‐femur constructs were tested under axial compression load (0–1400 N) from models I to IV, which represented the Seinsheimer type I subtrochanteric fracture, type IIIa subtrochanteric fracture with the posteromedial fragment reduced; type IIIa subtrochanteric fracture with the posteromedial fragment lost; and type IV subtrochanteric fracture, respectively. Axial stiffness was analyzed for each group. Each group was then divided into two subgroups, one of which underwent torsional and axial compression failure testing, while the other subgroup underwent axial compression fatigue testing. The torsional stiffness, failure load, and cycles to failure were analyzed.ResultsPFNA had the highest axial stiffness (F = 761.265, p < 0.0001) and failure load (F = 48.801, p < 0.0001) in model IV. The axial stiffness and failure load of the PFLP were significantly higher than those of the LISS (p < 0.0001, p = 0.001). However, no significant difference in axial stiffness was found between models I to III (model I: F = 2.439, p = 0.106; model II: F = 2.745, p = 0.082; model III: F = 0.852, p = 0.438) or torsional stiffness in model IV (F = 1.784, p = 0.187). In fatigue testing, PFNA did not suffer from construct failure after 90,000 cycles of axial compression. PFLP and LISS were damaged within 14,000 cycles, although LISS withstood more cycles than PFLP (t = 3.328, p = 0.01).ConclusionThe axial stiffness of the three implants was similar in models I to III. The biomechanical properties of PFNA were the best of the three implants in terms of axial stiffness, failure load, and fatigue testing cycles in model IV. The axial stiffness and failure load of the PFLP were better than those of the reverse LISS, but PFLP had fewer cycles in the fatigue tests than the reverse LISS.     

Challenging surgical treatment of giant retroperitoneal liposarcoma: A case report

Liposarcoma is a rare malignant tumor type and surgical resection is the gold standard treatment. The present study reported on the case of a 51-year-old woman who presented with a mass in the left upper abdomen. Computed tomography revealed a 32-cm giant retroperitoneal liposarcoma. Complete tumor resection was performed without the removal of other organs. Postoperative pathological examination indicated retroperitoneal well-differentiated liposarcoma and immunohistochemistry revealed S-100(−), MDM2(+), vimentin(+), CDK4(+), p16(+) and STAT6(+) results. The patient recovered well after the surgery. Complete tumor resection during the first surgery is key to cure liposarcoma. The present case report will be helpful for clinical oncologists to fully understand giant retroperitoneal liposarcoma and treat it accordingly.     

A systematic review of the efficacy of donepezil hydrochloride combined with nimodipine on treating vascular dementia

Background:Vascular dementia (VaD) is a comprehensive syndrome related to the damage of cognitive function and various cerebral vascular illnesses. VaD is also generally recognized as the second most common type of dementia after Alzheimer disease, contributing to 30% of the dementia population in Asia and developing countries. The ability of donepezil hydrochloride and nimodipine had been respectively proven in improving cognitive function in vascular dementia. However, whether the combined application of both drugs contribute to better efficacy remains as a research hotspot. Studies had shown definite satisfactory result with such combination, however evidence-based evaluation of the efficacy is still lacking. Therefore, meta-analysis is employed in this study to evaluate the efficacy and safety of using donepezil hydrochloride combined with nimodipine in treating VaD to provide references for clinical treatments. The efficacy of donepezil hydrochloride combined with nimodipine on treating vascular dementia is systematically reviewed to provide evidence-based references for clinical applications.Methods:Both Chinese and English databases were searched from the start till August, 2020 for any RCT regarding the combined use of the 2 drugs in treating vascular dementia. Two investigators would later evaluate and screened out research and data based on an improved Jaded scale. Software Rev Man 5.3.0 was employed to carry out meta-analysis on clinical effificacy, mini-mental state examination (MMSE) ratings, activity of daily living (ADL) ratings, and clinical dementia scale (CDR) ratings.Results:Donepezil hydrochloride combined with nimodipine had demonstrated satisfactory efficacy on the treatment of vascular dementia. Improvements were namely spotted on MMSE scale, ADL scale, and CDR scale, with the utmost efficacy by 12 weeks after intervention.Conclusions:Donepezil hydrochloride combined with nimodipine had good efficacy in the treatment of patients with vascular dementia, mainly in terms of improving the Simple MMSE scores, the ability to use daily living scale (ADL) scores and the CDR, and the best results were obtained after 12 weeks of intervention. Such conclusion should be cautiously evaluated.     

AQP1、AQP2和AQP3在人膀胱尿路上皮癌组织中的表达及其意义

目的：观察水通道蛋白1（Aquaporin 1,AQP1）、水通道蛋白2（Aquaporin 2,AQP2）、水通道蛋白3（Aquaporin 3,AQP3）在膀胱尿路上皮癌组织及正常膀胱组织中的表达与分布,探讨其意义。方法：取膀胱尿路上皮癌组织25例及正常膀胱组织25例,应用免疫组织化学方法检测AQP1 、AQP2和AQP3在膀胱尿路上皮癌和正常膀胱组织中的表达及分布。结果：AQP1散在表达于正常膀胱组织中微血管和小动脉的内皮细胞的细胞膜及细胞质,在膀胱尿路上皮癌组织中AQP1大量表达于肿瘤的血管内皮细胞的细胞膜及细胞质;膀胱尿路上皮癌中AQP1表达水平较正常膀胱组织明显增高,差异有统计学意义(P<0.05);AQP2主要表达于膀胱尿路上皮癌组织及正常膀胱组织的细胞间质中,两者表达强度基本相同,差异无统计学意义(P＞0.05);AQP3主要表达在膀胱尿路上皮癌组织及正常膀胱组织的黏膜上皮细胞的胞质及胞膜,在癌组织中的表达强度明显增高,差异有统计学意义(P<0.05)。结论：AQP1 、AQP3在膀胱尿路上皮癌组织中表达明显增高。提示AQP1、AQP3可能与膀胱尿路上皮癌的发生和发展密切相关,其机制需要进一步深入研究。     

真皮导管瘤一例

患者男,61岁,因头枕部丘疹3年就诊。患者于3年前无明显诱因下发现枕部丘疹,无自觉症状,后缓慢增大。否认病程中出血、溃疡、脱屑等。体检：一般情况好,各系统检查未见异常。皮肤科检查：枕部见一枚黄豆大小丘疹,直径约9 mm,淡红色,境界清晰,表面光滑,质地坚实（图1A）……     

Differential Associations of Intakes of Whole Grains and Coarse Grains with Risks of Cardiometabolic Factors among Adults in China

There is a lack of studies on the association between whole grain intake and cardiometabolic risk factors in China and the current definition of whole grains is inconsistent. This study defined whole grains in two ways, Western versus traditional, and examined their associations with the risks of major cardiometabolic factors (CMFs) among 4706 Chinese adults aged ≥18 years, who participated in surveys both in 2011 and in 2015. Diet data were collected by consecutive 3 d 24 h recalls, together with household seasoning weighing. Whole grains were defined as grains with a ratio of fiber to carbohydrate of ≥0.1, while coarse grains were defined as grains except for rice and its products, and wheat and its products. Multivariable logistic regressions were modeled to analyze the associations of intakes of whole grains and coarse grains, respectively, with risks of major CMFs including obesity-, blood pressure-, blood glucose- and lipid-related factors, which were defined by International Diabetes Federation and AHA/NHLBI criteria. After adjusting for potential confounders, the odds of elevated LDL-C decreased with the increasing intake levels of whole grains (OR 0.64, 95% CI 0.46–0.88, p-trend < 0.05). Moreover, adults with the whole grain intake of 50.00 to 150.00 g/day had 27% lower odds of overweight and obesity (OR 0.73, 95% CI 0.54–0.99) and 31% lower odds of elevated LDL-C (OR 0.69, 95% CI 0.49–0.96), as compared with non-consumers. In conclusion, given the significant nutrient profiles of whole grains and coarse grains, the adults with higher intakes of whole grains only may have a lower risk of LDL-C and overweight and obesity.     

PRRSV Induces HMGB1 Phosphorylation at Threonine-51 Residue to Enhance Its Secretion

Porcine reproductive and respiratory syndrome virus (PRRSV) induces secretion of high mobility group box 1 (HMGB1) to mediate inflammatory response that is involved in the pulmonary injury of infected pigs. Our previous study indicates that protein kinase C-delta (PKC-delta) is essential for HMGB1 secretion in PRRSV-infected cells. However, the underlying mechanism in HMGB1 secretion induced by PRRSV infection is still unclear. Here, we discovered that the phosphorylation level of HMGB1 in threonine residues increased in PRRSV-infected cells. A site-directed mutagenesis study showed that HMGB1 phosphorylation at threonine-51 was associated with HMGB1 secretion induced by PRRSV infection. Co-immunoprecipitation (co-IP) of HMGB1 failed to precipitate PKC-delta, but interestingly, mass spectrometry analysis of the HMGB1 co-IP product showed that PRRSV infection enhanced HMGB1 binding to ribosomal protein S3 (RPS3), which has various extra-ribosomal functions. The silencing of RPS3 by siRNA blocked HMGB1 secretion induced by PRRSV infection. Moreover, the phosphorylation of HMGB1 at threonine-51 was correlated with the interaction between HMGB1 and RPS3. In vivo, PRRSV infection also increased RPS3 levels and nuclear accumulation in pulmonary alveolar macrophages. These results demonstrate that PRRSV may induce HMGB1 phosphorylation at threonine-51 and increase its interaction with RPS3 to enhance HMGB1 secretion. This finding provides insights into the pathogenesis of PRRSV infection.     

微动刺激幅值对骨组织与钛珠涂层界面的骨生长与微损伤的影响

目的 通过微动力学刺激改善人工关节生物固定界面的性能。 方法 以活性大鼠骨组织与非活性钛珠涂层的结合试样作为研究对象,利用自制的微动力学刺激试验装置,探究不同切向微动幅值的力学刺激对固定界面骨组织生长促进作用及骨组织微损伤的影响,揭示微动刺激下骨组织在钛珠涂层表面的促进生长与微损伤机制。 结果 微动幅为 40 μm 力学刺激组骨组织与钛珠涂层间的界面结合力最大,切向摩擦力-位移曲线由椭圆形转变为直线形,结合界面处于粘着区,不易产生松动,骨组织结构最完整,钛珠涂层表面黏附生长的组织细胞数量最多,分布范围最广。 随着微动幅值的增加,微动刺激对骨生长的促进作用减弱,骨组织与钛珠涂层界面间结合强度逐渐降低,内部空腔区域增多,组织细胞的数量及增殖活性也有不同程度的降低。 结论 不同幅值微动刺激对于组织的生长促进与微损伤同时存在,最优的微动幅值为 40 μm。     

心力衰竭对门静脉频谱形态的影响

目的探讨心力衰竭对门静脉频谱形态的影响,摸索超声检查评价心功能的新途径。方法选取临床Ⅰ～Ⅲ度心力衰竭患者60例,按心衰竭程度分组,每组各20例;健康对照组20例。排除肝脏及门静脉、下腔静脉病变。经右侧肋间及剑突下探查门静脉,在取得门静脉清晰二维切面图像后,记录1～3个呼吸周期中的门静脉频谱,观察频谱形态,记录各组不同门静脉频谱形态的例数,所获资料采用统计软件SPSS11.0处理。结果健康对照组门静脉频谱均表现为单向连续频谱,各心力衰竭组出现不同程度的门静脉收缩末期反向血流,Ⅲ度心力衰竭组门静脉频谱多出现恒定的收缩末期反向血流。结论心力衰竭可导致门静脉频谱形态异常,观察门静脉频谱形态,可作为判断心力衰竭程度的辅助依据。