Pan-cancer and single-cell analysis reveal the prognostic value and immune response of NQO1.

Background: Overexpression of the NAD(P)H: Quinone Oxidoreductase 1 (NQOI) gene has been linked with tumor progression, aggressiveness, drug resistance, and poor patient prognosis. Most research has described the biological function of the NQO1 in certain types and limited samples, but a comprehensive understanding of the NQO1's function and clinical importance at the pan-cancer level is scarce. More research is needed to understand the role of NQO1 in tumor infiltration, and immune checkpoint inhibitors in various cancers are needed. Methods: The NQO1 expression data for 33 types of pan-cancer and their association with the prognosis, pathologic stage, gender, immune cell infiltration, the tumor mutation burden, microsatellite instability, immune checkpoints, enrichment pathways, and the half-maximal inhibitory concentration (IC50) were downloaded from public databases. Results: Our findings indicate that the NQO1 gene was significantly upregulated in most cancer types. The Cox regression analysis showed that overexpression of the NQO1 gene was related to poor OS in Glioma, uveal melanoma, head and neck squamous cell carcinoma, kidney renal papillary cell carcinoma, and adrenocortical carcinoma. NQO1 mRNA expression positively correlated with infiltrating immune cells and checkpoint molecule levels. The single-cell analysis revealed a potential relationship between the NQO1 mRNA expression levels and the infiltration of immune cells and stromal cells in bladder urothelial carcinoma, invasive breast carcinoma, and colorectal cancer. Conversely, a negative association was noted between various drugs (17-AAG, Lapatinib, Trametinib, PD-0325901) and the NQO1 mRNA expression levels. Conclusion: NQO1 expression was significantly associated with prognosis, immune infiltrates, and drug resistance in multiple cancer types. The inhibition of the NQO1-dependent signaling pathways may provide a promising strategy for developing new cancer-targeted therapies.

Impact of intra-articular injection with tranexamic acid on total blood loss and postoperative pain after arthroscopic rotator cuff repair surgery.

Objectives: To evaluate the impact of intra-articular injection with tranexamic acid (TXA) on total blood loss (TBL) and postoperative pain after arthroscopic rotator cuff repair (ARCR). Methods: This study retrospectively included patients with full-thickness rotator cuff tears who underwent shoulder ARCR surgery in Taizhou hospital, China, between January 2018 and December 2020. Patients received 10 ml (100 mg/ml) of intra-articular TXA injection (TXA group) or 10 ml of normal saline (non-TXA group) after the incision was sutured. The primary variable was the type of drug injected into the shoulder joint at the end of the operation. The primary outcome were perioperative TBL and postoperative pain [measured by visual analog scale (VAS)]. The secondary outcomes were differences in red blood cell count, hemoglobin count, hematocrit, platelet count. Results: A total of 162 patients were included, 83 patients in TXA group and 79 patients in non-TXA group. Notably, patients in TXA group were more likely to have lower TBL volume [261.21 (175.13-506.67) ml vs. 382.41 (236.11-593.31), P = 0.025], and postoperative VAS score ≤ 2 within 24 h (P = 0.031) compared with those in non-TXA group. In addition, the median hemoglobin count difference was significantly lower in TXA group than that of in non-TXA group (P = 0.045), while, the differences in median counts of red blood cell, hematocrit, and platelet between the two groups were comparable (all P > 0.05). Conclusion: Intra-articular injection of TXA might reduce the TBL and degree of postoperative pain within 24 h after shoulder arthroscopy.

Hemorrhagic shock due to ruptured lower limb vascular malformation in a neurofibromatosis type 1 patient: A case report.

BACKGROUND: Neurofibromatosis type 1 (NF-1) is a common autosomal dominant genetic disorder. It is characterized by café-au-lait spots and cutaneous neurofibromas. Although NF-1 typically involves the skin, nerves, bones, and eyes, vascular manifestation in the form of devastating hemorrhage can occur rarely. CASE SUMMARY: We present the case of a 47-year-old female with NF-1 who had a ruptured right lower limb arterial malformation. She presented with sudden right lower limb swelling for two hours and symptoms of hemorrhagic shock on admission. The physical examination revealed a right lower limb presenting as elephantiasis and visible dark-brown pigmentation over a large area. Computed tomography angiography showed right lower limb arteriovenous malformation. Therefore, the patient underwent emergency right lower limb digital subtraction angiography (DSA) and vascular embolization after blood transfusions. However, after DSA, vascular embolization, and repeated blood transfusions, the anemia and right lower limb swelling and tenderness did not improve. As a result, the patient underwent right lower extremity above-knee amputation. After amputation, the patient's hemoglobin level improved significantly without blood transfusion, and she was discharged from the hospital after the incision healed. Postoperative pathological examination suggested neurogenic tumors. No other complications had occurred 1-year follow-up. CONCLUSION: Vascular malformation and rupture are fatal complications of NF-1. Embolization may not provide complete relief, the patient might need to undergo neurofibroma resection or amputation.

Clinical Outcomes of Arthroscopy-Assisted Modified Triple Endobutton Plate Fixation in Rockwood Type III Acute Acromioclavicular Joint Dislocation: A Retrospective Study.

OBJECTIVE: The common triple Endobutton plate (CTEP) fixation is a lengthy procedure that is associated with high failure rates. Therefore, we used arthroscopy to improve the Endobutton fixation method by shortening the duration of surgery and reducing operative complications. This study explored the safety and effectiveness of arthroscopy-assisted modified triple Endobutton plate (MTEP) fixation in Rockwood type III managing acute acromioclavicular joint (ACJ) dislocation. METHODS: This was a retrospective single-center study involving 73 patients with Rockwood type III acute ACJ dislocation treated between January 2016 and January 2021. The 73 patients were classified into three groups, the acromioclavicular hook plate (ACHP) group (22 cases), CTEP group (24 cases) and MTEP group (27 cases), based on the type of surgical treatment they received. Clinical outcome data from the patient records, including the Constant-Murley score (CMS), American Shoulder and Elbow Surgeons score (ASES) and University of California at Los Angeles shoulder rating scale score (UCLA), were retrospectively reviewed. The scores were assessed before surgery and at the third and twelfth month after surgery. The clavicle-coracoid (CC) distance on the affected side was estimated from imaging scans taken before surgery, on the second day after surgery, and within the third and twelfth month after surgery. The student's t-test was used to compare normally distributed data for independent samples, while homogeneity of variance test was used to compare normally distributed data among multiple groups. Non-normally distributed data were compared using Mann-Whitney rank-sum tests. RESULTS: There were no differences in age, gender, body mass index (BMI), dislocated side, trauma etiology, and duration of follow-up among the three groups. There was also no significant difference in the duration of surgery between the ACHP and MTEP groups, although the duration in the two groups was shorter than in the CTEP group (P < 0.05). The duration of hospitalization for the MTEP group was significantly shorter than for the CTEP group which was in turn shorter than for the ACHP group (both P < 0.05). There was no significant difference in postoperative CMS, ASES, and UCLA scores between the CTEP and MTEP groups but the score for the two groups differed significantly from those of the ACHP group (all Ps < 0.05). In addition, there was no significant difference in CC distance among the three groups after surgery (P > 0.05). CONCLUSION: Arthroscopic reconstruction of the coracoclavicular ligament using MTEP fixation to manage acute Rockwood type III ACJ dislocation is minimally invasive, and is associated with rapid functional recovery, few complications and satisfactory early clinical results.

Maffucci syndrome complicated by giant chondrosarcoma in the left ankle with an IDH1 R132C mutation: a case report.

BACKGROUND: Maffucci syndrome (MS) is a rare, nonhereditary congenital mesodermal dysplasia characterized by multiple enchondromas and hemangiomas, associated with an increased risk of developing malignant tumors. Given their rarity, the pathogenesis of these tumors has not been clarified, and there is no standard treatment. CASE PRESENTATION: We present a case of a 45-year-old man with MS to supplement the clinical manifestations and explore the molecular mechanism of MS. The patient underwent amputation surgery to inhibit tumor development and was diagnosed with MS with 1-2 grade giant chondrosarcoma in the left ankle. In addition, the whole exon analysis results revealed isocitrate dehydrogenase 1 (IDH1) R132C mutation in chondrosarcoma lesions but not in blood DNA. CONCLUSIONS: This case report showed MS complicated by giant chondrosarcoma in the left ankle with an IDH1 R132C mutation, which is appropriate to monitor the development of MS pathology and other concomitant lesions.

One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip: A case report.

BACKGROUND: A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip (DDH) and a drainage sinus is a rare condition. There are no previous reports of this condition, and it is a complex challenge for surgeons to develop a treatment scheme. CASE SUMMARY: We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month. Approximately 40 years ago, a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy. After the sinus healed, gradual pain occurred in the left hip for 40 years. Approximately one month prior, hip pain was sharply aggravated, and a drainage sinus reoccurred in the left hip. The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur, as well as an acetabular deformity. The results of Mycobacterium tuberculosis antibody and Xpert were positive. Therefore, the patient was diagnosed with advanced TH combined with Crowe type IV DDH. After 22 d of treatment with anti-tuberculosis chemotherapy, the sinus healed, and the patient underwent one-stage total hip arthroplasty (THA) surgery consisting of debridement, osteotomy, and joint replacement. After surgery, the patient received anti-tuberculosis chemotherapy drugs for nine months, with no recurrent infection. After one year of follow-up, the Harris score of the patient increased from 21 pre-THA to 86. CONCLUSION: Although drainage sinuses are a contraindication to one-stage THA, one-stage THA is still an effective and safe surgical method after the sinus heals.

Arthroscopy-Assisted Treatment of Wear Debris Pseudotumor After Total Knee Arthroplasty: A Case Report.

BACKGROUND: Wear debris pseudotumors are a rare complication after total knee arthroplasty (TKA) and have seldom been reported in the recent literature. There is no consensus on the best therapeutic method, but the high quality curative treatment, safe, low invasive treatments are required for the patients. CASE PRESENTATION: In this paper, we present the case of a 74-year-old man with a wear debris pseudotumor after TKA with symptoms of severe pain and functional disability of his right knee. X-ray examination showed that the medial compartment of the right knee was narrowing. Magnetic resonance imaging (MRI) and Doppler ultrasound both revealed a polycystic mass at the posteromedial side of the patient's right knee. Considering the bad health condition and the minimally invasive surgery requirement of this senior patient, arthroscopic knee debridement and percutaneous cystic mass suction were carried out simultaneously. Video arthroscopy of the right knee showed visible inflammatory soft tissue, obvious polyethylene fragments, wear of the polyethylene prothesis, and a broken polyethylene insert. The intraarticular polyethylene wear debris was removed as much as possible, and inflammatory soft tissue was debrided and sent for pathology. Postoperative pathology showed polyethylene debris in the soft tissue with an apparent multinucleated giant cell response, which was consistent with foreign body granuloma. All clinical manifestation was improved and Lysholm scores were significantly better at one year with this treatment, increasing from 32 points to 71 points. CONCLUSION: After two years of follow-up, the patient's knee joint was significantly relieved from soreness and pain, and walking was not significantly restricted. Our treatment could not address the root cause of the wear debris pseudotumor, which was due to prosthesis failure, but sometimes, such an approach is the safest, most economical, and most effective choice for patients who are intolerant to reoperation.

[Clinical study on the treatment of acromioclavicular joint dislocation of tossy grade III with double endobutton].

OBJECTIVE: To investigate the clinical effects of internal fixation with double endobutton for the treatment of acromioclavicular joint dislocation of Tossy Grade III. METHODS: From 2007.7 to 2008.12, 27 patients with acromioclavicular joint dislocation of Tossy Grade III were fixed with double endobutton. Among the patients, 17 patients were male and 10 patients were female, with an average age of (35.0 +/- 1.3) years (ranged from 23 to 60 years). Fourteen patients were injured by traffic accident, 6 patients were work-related injuries, 4 patients were sports injuries, and 3 patients were injured by falling down. Sixteen patients had injuries in the left, and 11 patients in the right. All the patients were Tossy III type dislocation without clavicle fracture. The therapeutic effects were evaluated by Karlsson criteria based on range of motion of acromioclavicular joint, pain, muscle force and postreduction X-ray. RESULTS: All the patients were followed up for 6 to 14 months, mean 10.2 months. According to the Karlsson score criteria, 24 patients obtained an excellent result, 2 fair and 1 poor. CONCLUSION: Fixation with double endobutton is to be a new method for the treatment of acromioclavicular joint dislocation, which has the advantages of minimal trauma, reliable fixation, early functional rehabilitation and so on.

[Controlled clinical trials on the Pizhen and massage for the treatment of thoracic lateral cutaneous nerve entrapment syndrome].

OBJECTIVE: To investigate the clinical effects of Pizhen for the treatment of thoracic lateral cutaneous nerve entrapment syndrome. METHODS: From March 2004 to April 2008, among the 320 patients with thoracic lateral cutaneous nerve entrapment syndrome, 160 patients (105 patients were male and 55 patients were female, ranging in age from 26 to 66 years, with an average of 46.00 +/- 0.79 years) were treated with Pizhen for 3 to 7 days, and 160 patients (98 patients were male and 62 patients were female, ranging in age from 19 to 64 years,with an average of 47.00 +/- 0.35 years) were treated with massage for 1 to 2 months. The therapeutic effects of the two groups were compared based on changes of tension test of local soft tissues, local pain and tenderness. RESULTS: All the patients were followed up and the duration ranged from 7 to 12 months, averaged in 10.3 months. Among the patients in Pizhen group, 119 patients got an excellent result, 27 good, 12 fair, and 2 poor, and the tension test of local soft tissues decreased from preoperative (3.68 +/- 0.28) to postoperative (2.13 +/- 0.35). In the control group, 73 patients got an excellent result, 38 good, 40 fair, and 9 poor, the tension test of local soft tissues decreased from preoperative (3.59 +/- 0.22) to postoperative (3.17 +/- 0.19). The therapeutic effects and tension test of local soft tissue in the two groups had statistical differences (P < 0.01). The therapeutic effects of Pizhen group was better than that of the control group, and the postoperative tension test of local soft tissues of patients in Pizhen group was lower than that of the control group. CONCLUSION: The clinical effect of Pizhen is better than the massage for the treatment of thoracic lateral cutaneous nerve entrapment syndrome. The Pizhen is effective to decrease the pressure around nerve, relax the adhesion, so as to eliminate the stimulation and compression of sensory nerve endings to relieve the pain quickly. But massage need longer course of treatment. So Pizhen therapy is safe, good and easily to practice, which is better than massage therapy.

[Comparative study on the Pizhen and acupuncture for the treatment of supraclavicular nerve-entrapment syndrome].

OBJECTIVE: To investigate the clinical effects of Pizhen for the treatment of supraclavicular nerve-entrapment syndrome. METHODS: From March 2004 to April 2006, among the 200 patients of supraclavicular nerve-entrapment syndrome, 100 patients (75 patients were male and 25 patients were female, ranging in age from 25 to 65 years, with an average of 45 years)were treated with Pizhen, 100 patients (60 patients were male and 40 patients were female, ranging in age from 16 to 63 years, with an average of 35 years) were treated with Acupuncture. The therapeutic effects of the two groups were compared. RESULTS: All the patients were followed up and the duration ranged from 6 to 12 months, 9.6 months in average. Among the patients in Pizhen group, 79 patients got an excellent result, 12 good, 8 fair, and 1 poor, and the tension exponent of soft tissues decreased from preoperative 3.56 +/- 0.35 to postoperative 2.11 +/- 0.41. In the control group, 43 patients got an excellent result, 21 good, 17 fair, and 19 poor, the tension exponent of soft tissues decreased from preoperative 3.61 +/- 0.21 to postoperative 3.13 +/- 0.56. The therapeutic effects and tension exponent of soft tissue in the two groups had statistical differences (P < 0.05 and P < 0.01). CONCLUSION: The clinical effect of Pizhen is better than the the acupuncture for the treatment of supraclavicular nerve-entrapment syndrome. The therapy of Pizhen is safe, good and easily to practice.