Antegrade intramedullary fixation for adolescent fifth metacarpal neck fracture and its impact on epiphyseal growth.

BACKGROUND: Antegrade intramedullary nailing (AIMN) with Kirschner wire (K-wire) is a minimally invasive osteosynthesis technique. This procedure has been widely performed to treat the fifth metacarpal neck fracture (FMNF) in adults. This study was performed to determine whether using AIMN with a single K-wire to treat FMNF in adolescents would have good clinical and radiographic outcomes. METHODS: In this retrospective study, 21 children (aged 11-16 years) with FMNF were treated using AIMN with a single K-wire from May 2017 to January 2020 in our hospital. Indications for intervention were severe displacement with malrotation deformity, apex dorsal angulation of greater than 40°, or both. Collected data included apex dorsal angulation, range of motion (ROM) in the fifth metacarpophalangeal (MCP) joint, Visual Analog Scale (VAS) for pain, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS: All patients were followed up for 12-24 months (average, 16.57 months), and all patients obtained anatomical reduction postoperatively. The healing time was 2.69 ± 0.83 months (range, 2-4 months). Average apex dorsal angulation was reduced significantly from 44.49°±2.64° to 15.74°±2.47° (P < 0.001). The average ROM in the MCP joint and apex dorsal angulation of the injured side were not significantly different from those of the uninjured side. The average DASH score was 1.76 ± 1.48 (range, 0-4), the mean VAS was 0.19 ± 0.60 (range, 0-2), and the mean grip strength was 91.55 %±4.52 % (range, 85-101 %). No secondary displacement, dysfunction, nonunion, infection, or osteonecrosis was observed during the follow-up. Although premature epiphyseal closure was found in one patient, no long-term clinical finding of angulation or shortening was identified. CONCLUSIONS: Antegrade intramedullary fixation with single K-wire was an effective and reliable technique that successfully resulted in good functional and cosmetic outcomes for treating adolescents with FMNF. The impact on the growth plate was low in this population given that most patients were at or approaching skeletal maturity. LEVEL OF EVIDENCE: Level IV.

Synthesis and biological evaluation of novel dihydro-aryl/alkylsulfanyl-cyclohexylmethyl-oxopyrimidines (S-DACOs) as high active anti-HIV agents.

A novel dihydro-aryl/alkylsulfanyl-cyclohexylmethyl-oxopyrimidines (S-DACOs) combinatory library was synthesized and evaluated with C8166 cells infected by the HIV-1(IIIB) in vitro, using Nevirapine (NVP) and Zidovudine (AZT) as positive control. The anti-HIV screening results revealed that C-6-cyclohexylmethyl substituted pyrimidinones possessed higher selective index than its 6-arylmethyl counterparts. Compounds 1g, 1c, 1e and 1b showed potent anti-HIV activities with EC(50) values of 0.012, 0.025, 0.088 and 0.162nM, respectively.

A formal [3 + 3] cycloaddition of allenyl imide and activated ketones for the synthesis of tetrasubstituted 2-pyrones.

CsOH·H2O-catalyzed formal [3 + 3] cycloadditions of allenyl imide with ß-ketoesters, 1,3-diketones or ß-ketonitriles for the synthesis of tetrasubstituted 2-pyrone derivatives have been demonstrated. The allenyl imide was utilized as a C3-synthon, and a ketenyl intermediate was proposed via the process of 1,4-addition of carbon anion to allene followed by elimination of the 2-oxazolidinyl group.

The anti-HIV activity of three 2-alkylsulfanyl-6-benzyl-3, 4-dihydropyrimidin-4 (3H)-one derivatives acting as non-nucleoside reverse transcriptase inhibitor in vitro.

It was recently shown that several new synthetic 2-alkylsulfanyl-6-benzyl-3, 4-dihydropyrimidin-4(3H)-one (S-DABO) derivatives demonstrated anti-HIV-1 activity. Three of the derivatives namely RZK-4, RZK-5 and RZK-6 were used in this study to explore their inhibitory effects on a variety of HIV strains. These compounds at a concentration of 200 microg mL(-1) almost completely inhibited the activity of recombinant HIV-1 reverse transcriptase. All of the three compounds reduced replication of HIV-1 laboratory-derived strains, low-passage clinical isolated strain, and the drug resistant strain. In particular RZK-6 showed potent activity against the HIV-1 drug resistant strain. In general, the antiviral activities are similar in magnitude to nevirapine (NVP), which is a non-nucleoside reverse transcriptase inhibitor approved by FDA. The therapeutic indexes of these compounds were remarkable, ranging from 3704 to 38462 indicating extremely low cytotoxicity. These results suggest that the three S-DABO derivatives in this study have good potential for further development in anti-HIV-1 therapy. It may be particularly useful to target at the non-nucleoside reverse transcriptase inhibitors resistant HIV-1 strain.

External electric field reduces the explosive sensitivity: a theoretical investigation into the hydrogen transference kinetics of the NH2NO2∙∙∙H2O complex.

Controlling the selectivity of detonation initiation reaction to reduce the explosive sensitivity has been a Holy Grail in the field of energetic materials. The effects of the external electric fields on the homolysis of the N-NO2 bond and initiation reaction dynamics of NH2NO2∙∙∙H2O (i.e., intermolecular and 1,3-intramolecular hydrogen transfers) were investigated at the MP2/6-311++G(2d,p) and CCSD/6-311++G(2d,p)//MP2/6-311++G(2d,p) levels. The results show that the N-NO2 bond is not the "trigger linkage." The notable transiliences of the activation energy of the intermolecular hydrogen transfer are found with the field strength of - 0.012 a.u. along the -x-direction, leading to the conversion of the main reaction between the intermolecular and 1,3-intramolecular hydrogen transference. The activation energies of two kinds of the hydrogen transferences are increased under the external electric fields along the -y-direction. In particular, due to the conversion of the main reaction, the activation energies of the overall reaction are increased significantly along the -x-direction, leading to the significant reduced explosive sensitivities. Therefore, by controlling the field strengths and orientations between the "reaction axis" and external electric field along the y- and x-directions, the selectivity of the initiation reaction could be controlled and the explosive sensitivity could be reduced. Employing AIM (atoms in molecules) and surface electrostatic potentials, the origin of the control of reaction selectivity and the reduction of sensitivity is revealed. This work is of great significance to the improvement of the technology that the external electric fields are added safely into the energetic material system to enhance the explosive performance. Graphical abstract.

6-Cyclo-hexyl-methyl-2-cyclo-hexyl-sul-fanyl-5-isopropyl-pyrimidin-4(3H)-one.

The title compound, C(20)H(32)N(2)OS, was obtained during the course of our investigation on 2-alkylsulfanyl-6-benzyl-3,4-dihydropyrimidin-4(3H)-ones (S-DABOs) showing favourable anti-HIV-1 activity. Both cyclo-hexane rings adopt chair conformations. The angle at the methyl-ene C atom linking the pyrimidine and cyclo-hexane ring is 113.7 (3)°, which is in the range considered optimal for maximum activity of non-nucleoside reverse transcriptase inhibitors. Inter-molecular N-H⋯O hydrogen bonds link the mol-ecules into dimers and stabilize the crystal structure of the compound. In addition, an intra-molecular C-H⋯O hydrogen bond is observed.

Case report: dermatomyositis associated with lung cancer with heterogeneous morphology.

Dermatomyositis (DM) complicated with non-small cell lung cancer (NSCLC) is not rare, and could rapidly develop into severe lung cancer [performance-status score (PS) between 2 and 4]. Moreover, tumor has remarkable heterogeneity, and it is not possible to properly target treatments in cases of relapse without knowing pathological diagnosis. We retrospectively analyzed the diagnosis and treatment of a patient with DM complicated with NSCLC, which developed into severe lung cancer with heterogeneity of the tumor during chemotherapy. In this report, we addressed that in patients with severe lung cancer, both the cancer and factors associated with exacerbation should be simultaneously managed to reduce the PS score and avoid unnecessary delay. A second biopsy is important for proper management of the tumor with heterogeneity.

Comparison of Surgical versus Non-Surgical Treatment of Displaced 3- and 4-Part Fractures of the Proximal Humerus: A Meta-Analysis.

PURPOSE/AIM: This meta-analysis compares the clinical outcomes of surgical versus conservative treatment of displaced, 3- or 4-part, proximal humeral fractures. MATERIALS AND METHODS:  Medline, Cochrane, EMBASE, and Google Scholar were searched for studies published until October 2013, reporting functional outcomes of 3- or 4-part fractures of the proximal humerus in skeletally mature patients. Only randomized controlled trials were included. The treatments that were evaluated included non-surgical, open surgery, intramedullary pin, locking plate, arthroplasty, and minimally invasive surgical treatments. A meta-analysis was performed on the difference in functional outcomes and quality of life (QoL) between participants undergoing surgical versus non-surgical treatment. RESULTS: Out of 254 participants in the studies who were analyzed, 127 were treated surgically. The difference in mean values of functional score showed similar results between surgical and non-surgical treatments (difference in mean values = 0.015, 95% CI = -0.232 to 0.261, p = .908).The difference in mean values of QoL showed that surgical treatment provided better post-operative QoL than non-surgical treatment (difference in mean values = 0.146, 95% CI = 0.052 to 0.240, p = .002). CONCLUSIONS: Surgical treatment of displaced, multi-fragment fractures of the proximal humerus did not improve shoulder functional outcome, based on the Constant-Murley Score, when compared with conservative and non-surgical treatments. However, health-related QoL was significantly improved with surgical treatment compared with conservative treatment.