Femoral neck system versus dynamic hip screw for fixation of femoral neck fracture in the adult: a meta-analysis.

Objective: To determine the efficacy of femoral neck system compared to dynamic hip screws in treating femoral neck fractures. METHODS: The systematic review was conducted from January to March 2023, and comprised literature search on PubMed, Embase, Scopus, Ovid, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure and Wanfang databases for relevant studies published up to March 1, 2023. Study data as well as demographic and outcome parameters related to the patients were extracted, and the methodological index for non-randomised studies was used to assess the risk of bias. Review Manager software was used to conduct metaanalysis. RESULTS: Of the 567 studies initially found, 6(1%) were included, with the publication date ranging from August 2021 to February 2023. There were 5(83.3%) studies published in English and 1(16.7%) in Chinese. Of the 577 patients with femoral neck fractures, 287(49.7%) were treated with femoral neck system and 290(50.3%) with dynamic hip screws. Significant differences were shown between the two groups regarding operation duration, blood loss, internal fixation failure rate and Harris hip score (p=<0.05). There was no significant differences between the groups regarding time from injury to surgery, hospitalisation, complication rate and femoral neck shortening rate (p>0.05). Conclusion: The novel femoral neck system could optimise surgical procedures, with shorter operation times and lesser blood loss. The femoral neck system and dynamic hip screws were comparable in terms of complication rates and postoperative hip function.

A novel computed tomography-based three-column MLP classification of intertrochanteric fracture.

OBJECTIVES: The aim of the present study was to introduce a novel three-dimensional computed tomography (3DCT)-based three-column classification (named "MLP classification system") of intertrochanteric fractures and evaluate its reproducibility and reliability. METHODS: From September 2020 to September 2022, a total of 258 consecutive patients (60 male, 198 female;mean age 81.3 years) with intertrochanteric fractures were included in this study. The fracture in each case was assessed using a novel three-dimensional computed tomography-based three-column classification. Two examiners tested the intra and inter-observer reliability of this new classification system using kappa variance. RESULTS: The intertrochanteric region was divided into the medial column, lateral column, and posterior column. Intertrochanteric fractures were documented as M0/1/2L0/1/2/3P0/1/2/3. All fractures were classifiable into the new classification system. The intra-observer kappa values were 0.91 and 0.89, while the inter-observer kappa value was 0.82, both indicating almost perfect reliability. CONCLUSION: This novel 3DCT-based MLP classification system for intertrochanteric fractures is comprehensive, and reproducible with good agreement. It is based on proximal femur biomechanic characteristics and traumatic mechanism, contributing to formulating more reasonable treatment protocols involving various late-model internal fixation devices. J. Med. Invest. 70 : 524-529, August, 2023.

Therapeutic effect of psoralen on muscle atrophy induced by tumor necrosis factor-α.

OBJECTIVES: To observe and determine the effect and mechanism of psoralen on tumor necrosis factor-α (TNF-α)-induced muscle atrophy. MATERIALS AND METHODS: Three sets of C2C12 cells, including blank control, TNF-α (10 or 20 ng/ml) treatment and a TNF-α (10 or 20 ng/ml) plus psoralen (80 µM) administration were investigated. Cell viability was assessed using Cell Counting Kit-8 (CCK-8) assay. Western blot analysis was used to detect protein expression of atrophic markers. Flowcytometry was used to observe the effect of psoralen on apoptosis. A quantitative real-time PCR (qRT-PCR) assay was performed to detect the mRNA level of miR-675-5P. RESULTS: TNF-α (1, 10, 20 and 100 ng/ml) treatment inhibited C2C12 myoblast viability (P<0.001), while 24 hr of psoralen administration increased the viability, and lowered TNF-α cytotoxicity (P<0.001). MURF1, MAFbx, TRIM62 and GDF15 expressions were significantly increased in TNF-α (10 ng/ml or 20 ng/ml)-treated group (P<0.001), and psoralen could significantly decrease the expression of these proteins (P<0.001). Apoptotic rate of C2C12 myoblasts was increased after TNF-α (10 ng/ml and 20 ng/ml) treatment, and was significantly decreased after psoralen treatment (P<0.001). miR-675-5P was increased in TNF-α-treated C2C12 myoblasts compared to control group, and it was significantly decreased after psoralen treatment. CONCLUSION: Psoralen could reduce TNF-α-induced cytotoxicity, atrophy and apoptosis in C2C12 myoblasts. The therapeutic effect of psoralen may be achieved by down-regulating miR-675-5P.

Modified Sijunzi decoction in the treatment of ulcerative colitis in the remission phase: study protocol for a series of N-of-1 double-blind, randomised controlled trials.

BACKGROUND: Modified Sijunzi decoction (SJZD) has been used to treat ulcerative colitis (UC) in remission. However, more rigorous clinical trials are necessary to evaluate its effectiveness. Therefore, a series of single-case randomised controlled trials (N-of-1 trials) is proposed to compare the efficacy of modified SJZD with mesalazine for treating UC in remission. METHODS: This is a single-site, hospital-based, double-blind N-of-1 trial for 10 single subjects. Three cycles of N-of-1 trials are planned. There are two treatment periods in each cycle. Modified SJZD combined with mesalazine placebo or mesalazine combined with modified SJZD placebo will be randomised during each 8-week treatment period. There is no washout period in the study. Subjects will be selected by the researcher strictly in accordance with the inclusion and exclusion criteria. DISCUSSION: Paired t tests and mixed-effect models will be used to analyse the visual analogue scale (VAS) for clinical symptoms and the quality of life questionnaire responses. The findings will be interpreted with caution. We anticipate that the results will show that modified SJZD is effective for patients with UC in remission. TRIAL REGISTRATION: Chinese Clinical Trial Register, ID: ChiCTR1900024086. Registered on 24 June 2019.

Efficacy and safety of tacrolimus in Osserman grade III and Osserman grade IV Myasthenia Gravis.

OBJECTIVE: A retrospective observational cohort study was conducted to evaluate the efficacy and safety of tacrolimus in Osserman grade III and Osserman grade IV myasthenia gravis (MG) patients. PATIENTS AND METHODS: MG patients admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine between June 2011 and January 2017 with grade III and grade IV according to the modified Osserman scale were recruited and received a telephone follow-up in September 2017. Patients treated with tacrolimus plus prednisone were compared with those treated without tacrolimus. The efficacy of tacrolimus was assessed using MG-activities of daily living (MG-ADL) score, Osserman classification, Myasthenia Gravis Foundation of America (MGFA) post intervention status (PIS), the number of hospitalizations, the number of myasthenic crises and deaths. The adverse drug effects of tacrolimus were monitored. RESULTS: A total of 124 patients were included. The tacrolimus group had a significantly lower MG-ADL score than the control group at follow-up (1.90 ± 2.27vs 2.97 ± 2.78, p = 0.029). The difference of MG-ADL score between baseline and after follow-up was significantly greater in the tacrolimus group than the control group (-7.20 ± 2.95 vs -5.52 ± 2.91, p = 0.003). Fewer patients were hospitalized in the tacrolimus group (p = 0.011). The Osserman classification, MGFA PIS, the number of myasthenic crises and deaths did not differ significantly between the two groups. Nineteen patients in the tacrolimus group had adverse drug reactions, but no severe adverse effects appeared. CONCLUSION: Our study suggested that tacrolimus could be an effective and safe treatment for Osserman grade III and Osserman grade IV MG patients.