The association between hemoglobin at admission and mortality of older patients with hip fracture: a mean 3-year follow-up cohort study.

BACKGROUND: Hip fracture patients often have a large drop in hemoglobin (Hgb) concentration that is associated with the initial trauma. However, there is no study of a correlation between Hgb concentration at admission and short-term mortality. Thus, we evaluated a possible linear and nonlinear association between Hgb and mortalityfor older patients with hip fracture. METHODS: Consecutive older patients who had hip fractures were screened between January 2015 and September 2019. Demographic and clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify association between Hgb at admission and mortality. All analyses were performed with EmpowerStats and R software. RESULTS: Two thousand five hundred eighty-nine patients were included in the study. There were 849 men and 1740 women. The mean age was 79.6 ± 6.8 years. The mean follow-up was 39.0 months. Nine hundred seven (35.0%) patients died for all-cause reasons. The mean Hgb at admission was 11.07 ± 1.95 g/dL. Linear multivariate Cox regression models showed Hgb at admission was associated with mortality ([Hazard Ratio] HR 0.91, 95% CI 0.87-0.95, P < 0.0001) after adjusting for confounding factors. However, the linear association was unstable, and nonlinearity was found between Hgb at admission and mortality. The Hgb concentration of 9.8 g/dL was an inflection point. A Hgb at admission < 9.8 g/dL was associated with mortality (HR 0.81, 95% CI 0.74-0.89, P < 0.0001), whereas > 9.8 g/dL was not a risk factor for mortality (HR 0.98, 95% CI 0.92-1.04, P = 0.4730). CONCLUSIONS: The Hgb concentration at admission was nonlinearly associated with mortality of older patients with hip fracture, and Hgb at admission < 9.8 g/dL was a risk predictor of 3-year mortality. RESEARCH REGISTRATION: ChiCTR2200057323.

Results of sacrospinous ligament fixation using conventional instruments for symptomatic stage 2 and 3 apical prolapse over 3 years.

OBJECTIVE: To evaluate the long-term efficacy and quality of life concerning sacrospinous ligament fixation (SSLF) using conventional instruments for Chinese women with symptomatic stage 2 and 3 apical prolapse. METHODS: This single-arm prospective cohort study was conducted at our hospital between October 2011 and December 2018. Eligible participants were followed up over 3 years after surgery. The primary surgical outcome was composite surgical failure. Secondary outcomes included rate of satisfaction, quality of life (QoL) scores, and long-term complications. RESULTS: Fifty-nine patients were enrolled (mean age 57.1 years), of whom 55 (93.22%) completed the 3-year follow up. At year 3, the composite failure rate was 21.34% (95% confidence interval [CI] 9.30%-31.79%), and satisfaction rate was 81.40% (95% CI 66.09%-91.08%). Right thigh pain and de novo dyspareunia occurred in 1.8% and 14.6% patients after year 1, respectively, but at year 3 there were no complications. Lower urinary tract symptoms were present in 5.5% of patients. Improvement was found in urinary symptoms and prolapse symptoms, but sexual function showed no significant change. CONCLUSIONS: Compared with results at year 1, complication rates of SSLF decreased at year 3. The composite failure rate was relatively low and satisfaction rate was relatively high at year 3. Prolapse and urinary symptoms improved significantly after surgery.

Changes in Type II NRG-1 Expression during Regeneration Following Autologous Nerve Transplantation in Rats.

AIM: To investigate the changes in type II neuregulin-1 (NRG-1) during the regeneration process following autologous sciatic nerve transplantation in rats. MATERIAL AND METHODS: In total, 40 healthy male Sprague-Dawley (SD) rats of clean grade with body weights between 250 g and 300 g were randomly divided into an experimental and control group, with 20 rats per group. Five time points were set, including the 3 < sup > rd < /sup > , 7 < sup > th < /sup > , 14 < sup > th < /sup > , 21 < sup > st < /sup > and 28 < sup > th < /sup > days after surgery. In the experimental group, reversed autologous transplantation of the sciatic nerve was performed, while in the control group, the sciatic nerve was simply exposed without autologous transplantation. At the different time points, changes in the rat footprints were observed, the sciatic functional index (SFI) was calculated, changes in the regeneration of the myelin sheath at the nerve end after transplantation were observed by transmission electron microscopy, changes in type II NRG-1 protein expression were detected by a western blot analysis, and changes in type II NRG-1 mRNA expression were detected by real-time PCR. RESULTS: The SFI in the experimental group was lower than that in the control group at all time points after surgery, and the SFI in the experimental group gradually increased; these differences were statistically significant (p < 0.05). The expression of type II NRG-1 protein in the experimental group was significantly increased on the 3rd day after nerve transplantation and peaked on the 7 < sup > th < /sup > day, which continued until the 28 < sup > th < /sup > day after surgery, indicating a significant difference from the control group (p < 0.01). NRG-1 mRNA expression was markedly increased on the 7th day after nerve transplantation, further increased, and peaked on the 14 < sup > th < /sup > day (p < 0.01). The area of medullated nerve fibers (?m2) in the experimental group significantly differed from that in the control group on the 7 < sup > th < /sup > , 14 < sup > th < /sup > , 21 < sup > st < /sup > and 28 < sup > th < /sup > days (p < 0.01), and the diameters of the axons in the experimental group notably differed from those in the control group on the 7 < sup > th < /sup > , 14 < sup > th < /sup > and 21 < sup > st < /sup > days (p < 0.01). CONCLUSION: Type II NRG-1 expression peaked between the 3 < sup > rd < /sup > day and 14 < sup > th < /sup > day after autologous nerve transplantation and is likely involved in the regulation of myelin sheath regeneration during this period.

The Postoperative Effects of Patellar Eversion in Total Knee Arthroplasty: An Updated Systematic Review and Meta-Analysis.

Background: During total knee arthroplasty (TKA), surgeons mobilize the patella to facilitate clear visualization of the articular surfaces and allow better prosthesis placement. According to the manipulation, this manipulation can be divided into patellar eversion and noneversion. However, the effect of patellar eversion in TKA is controversial, with substantial variability in clinical practice. This systematic review is aimed at assessing the adverse effects of patellar eversion and patellar noneversion duration in TKA. Methods: This updated systematic literature review identified randomized controlled trials comparing patellar eversion and noneversion durations in TKA. Two investigators independently extracted data and evaluated the quality of the studies. A meta-analysis was performed using RevMan version 5.3. Results: Nine studies with a total of 608 patients (730 knees) were included. Of these, 374 knees were classified in the eversion group and 356 knees in the noneversion group. The quality of the studies was high. The results showed that patellar eversion could increase the postoperative complication rate (relative risk [RR] = 1.67; 95% confidence interval [CI], 1.09-2.54; P = 0.02) and postoperative pain before discharge (mean deviation [MD] = 0.19; 95% CI, 0.04-0.34; P = 0.01), compared to noneversion. Additionally, patellar eversion could prolong the time until the patient is able to raise the leg while straightened (MD = 0.42; 95% CI, 0.24-0.59; P < 0.00001) and increase the length of stay (MD = 0.65; 95% CI, 0.05-1.25; P = 0.03). However, patellar eversion did not influence postoperative pain at 1 year (MD = 0.02; 95% CI, -0.23-0.28; P = 0.85), operative time (MD = -2.66; 95% CI, -8.84-3.52; P = 0.40), recovery of quadriceps force throughout the follow-up period, and Insall-Salvati ratio (MD = -0.04; 95% CI, [-0.11-0.02]; P = 0.23). Conclusions: The patellar eversion could increase the postoperative complication rate and postoperative pain. Current evidence supports the avoidance of patellar eversion in TKA. Further large-sample and long-term trials are required to validate these results.

Vitamin E-Enhanced Liners in Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

OBJECTIVE: Adding vitamin E to highly cross-linked polyethylene liners is frequently performed in clinical practice, aiming at reducing liner wear, increasing liner survival, and delaying revision surgery. This study is aimed at evaluating the revision rate, total femoral head penetration, and postoperative clinical function of highly cross-linked polyethylene liners with and without vitamin E in total hip arthroplasty. METHODS: We conducted a systematic literature search to identify the use of highly cross-linked vitamin E liners compared to other liners in patients who received total hip arthroplasty (THA) before April 2021. The study quality assessment and data collection were conducted by two independent reviewers. Studies were artificially grouped, and vitamin E-enhanced liners (VE-PE) were compared with vitamin E-free liners (non-VE-PE). Analyses were executed using Review Manager version 5.4.1. RESULTS: From the preliminary screening of 568 studies, fourteen studies met the research criteria. Compared to non-VE-PE, using VE-PE reduced the all-cause revision rate (odds ratio = 0.54; 95% confidence interval (CI) 0.40, 0.73; P < 0.0001). The total femoral head penetration of the VE-PE was lower than that of the non-VE-PE (mean difference = -0.10; 95% CI -0.17, -0.03; P = 0.007). However, there was no difference in clinical function, including the Harris Hip Score and EuroQol Five-Dimension Questionnaire scores. CONCLUSION: Compared to the liners without vitamin E, the addition of vitamin E to liners could reduce the all-cause revision rate by approximately 46% in the short-term follow-up. In addition, even though addition of vitamin E could also slow down femoral head penetration, there is no contribution to clinical function.

[Effects of environment and canopy structure on stem sap flow in a Larix principis-rupprechtii plantation.] / çŽ¯å¢ƒå’Œå† å±‚ç»“æž„å¯¹åŽåŒ—è½å¶æ¾æž—æ ‘å¹²æ¶²æµçš„å½±å“.

Accurately quantifying the impacts of environmental factors and canopy structure on stem sap flow is of great significance for deeply understanding water use strategies of trees in changing environment. The stem sap flow of Larix principis-rupprechtii plantation was observed using thermal diffusion probes from June to September of 2019 in the Xiangshuihe small watershed of Liupan Mountains, with the meteorological conditions, root-zone soil water content and canopy structure being simultaneously recorded. We first analyzed the relationships of sap flow rate (Jc) to potential evapotranspiration (PET), relative extract water (REW) and canopy leaf area index (LAI), and then quantified their relative contribution to Jc. The results showed that the response of Jc to PET, LAI, and REW conformed to binomial, linearly increase and saturated exponential function, respectively. The Jc model coupling multiple factors was established as a continuous multiplication of the response functions of Jc to PET, REW and LAI, which had good simulation precision. PET was the main factor leading to the difference of Jc in different weather conditions. The average contribution rate of PET had obvious difference in sunny (with a contribution rate of 40.3%), cloudy (4.3%), and rainy days (-26.3%). PET and LAI were the leading factors affecting the Jc variation among months. The ranges of the contribution rates of PET and LAI were from -23.1% to 16.8% and from -12.3% to 11.0%, respectively. The Jc model coupling the multi-factor effect developed in this study could be used to predict Jc, and quantify the impacts of each leading factor, which had the potential to be an effective tool to analyze the water use of trees in the changing environment.

Ganoderic acid A from Ganoderma lucidum ameliorates lipid metabolism and alters gut microbiota composition in hyperlipidemic mice fed a high-fat diet.

Ganoderic acid A (GA) is one of the most abundant triterpenoids in Ganoderma lucidum, and has been proved to possess a wide range of beneficial health effects. The aim of the current study is to investigate the amelioration effects and mechanism of GA on improving hyperlipidemia in mice fed a high-fat diet (HFD). The results showed that GA intervention significantly inhibited the abnormal growth of body weight and epididymal white adipose tissue (eWAT), prevented the hypertrophy of epididymal adipocytes, and ameliorated the biochemical parameters of serum and liver related to lipid metabolism in HFD-fed mice. Histological analysis also showed that the excessive accumulation of lipid droplets in the liver induced by HFD-feeding was greatly alleviated by GA intervention. In addition, GA intervention also increased the level of short chain fatty acids (SCFAs) in the intestine and promoted the excretion of bile acids (BAs) through feces. High-throughput sequencing of bacterial full-length 16S rDNA revealed that daily supplementation with GA made significant structural changes in the gut microbial population of mice fed with HFD, in particular modulating the relative abundance of some function related microbial phylotypes. The relationships between lipid metabolic parameters and gut microbial phylotypes were also revealed by correlation analysis based on a heatmap and network. The result showed that 46 key gut microbial phylotypes (OTUs) were markedly correlated with at least one lipid metabolic parameter. Moreover, UPLC-QTOF/MS-based liver metabolomics showed that 111 biomarkers (47 up-regulated metabolites and 64 down-regulated metabolites) were significantly changed after high-dose GA intervention (75 mg kg-1 day-1), compared with the HFD-fed hyperlipidemic mice. Metabolic pathway enrichment analysis of the differential hepatic metabolites demonstrated that GA intervention had significant regulatory effects on primary bile acid biosynthesis, fatty acid biosynthesis, amino sugar and nucleotide sugar metabolism, inositol phosphate metabolism, and so on. In addition, GA intervention regulated the mRNA levels of hepatic genes involved in fatty acid metabolism and bile acid homeostasis. These findings present new evidence supporting that GA from G. lucidum has the potential to alleviate lipid metabolic disorders and ameliorate the imbalance of gut microflora in a positive way.

Effects of alendronate for treatment of glucocorticoid-induced osteoporosis: A meta-analysis of randomized controlled trials.

BACKGROUND: Alendronate has been used to prevent or treat glucocorticoid-induced osteoporosis (GIO), data regarding its efficacy are inconsistent. We conducted the current systematic review and meta-analysis to evaluate both efficacy and safety of alendronate in the treatment of GIO. METHODS: PubMed, Embase, the Cochrane Controlled Trials Registry, and the China Academic Journal Network Publishing Databases were searched up through March 1, 2018. Randomized controlled trials (RCTs) involving patients which received alendronate treatment were included. Outcome measures were bone mineral density (BMD) changes, bone fractures, and adverse reactions. Data from the individual studies were pooled using random or fixed effect models based on heterogeneity. Effect size was reported as standardized mean differences (SMD) for continuous outcomes and pooled odds ratios (OR) for dichotomous outcomes, with 95% confidence interval (CI). RESULTS: Overall, 10 studies involving 1002 patients were included in the present investigation. Alendronate treatment significantly increased BMD of the lumbar spine and femoral neck during 6 to 24 months. These beneficial effects were apparent at 12 months after treatment for the lumbar spine but not the femoral neck BMD. Alendronate treatment did not significantly change fracture risk nor induce significant differences in adverse gastrointestinal effects. CONCLUSION: Alendronate significantly increases BMD of the lumbar spine and femoral neck in patients with GIO, but does not appear to reduce the risk of fractures. As relatively insufficient data regarding the GIO fracture incidence has been reported, more RCTs need to be carried out to determine the efficacy of alendronate in the prevention of GIO fracture.

Effects of teriparatide versus alendronate for treatment of postmenopausal osteoporosis: A meta-analysis of randomized controlled trials.

OBJECTIVES: Osteoporosis remains a clinical challenge. Teriparatide is an anabolic drug and alendronate is an antiresorptive agent; both are used in the treatment of osteoporosis. Comprehensive reviews investigating the comparative safety and efficacy of teriparatide versus alendronate are scarce. Therefore, we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the safety and efficacy of teriparatide versus alendronate for the treatment of postmenopausal osteoporosis. METHODS: We conducted a comprehensive literature review of the PubMed, EMBASE, Cochrane Controlled Trials Registry, and the China Academic Journal Network Publishing databases for relevant RCTs of teriparatide versus alendronate in postmenopausal osteoporosis patients. Outcome measures were percentage change in lumbar spine and femoral neck bone mineral density (BMD) and incidence of vertebral and nonvertebral fractures. Effect size was reported as weighted mean differences (WMDs) for continuous outcomes and odds ratios (OR) for dichotomous outcomes, with associated 95% confidence intervals (CIs). RESULTS: Six trials involving 618 patients were included. The meta-analysis demonstrated a significant increase in lumbar spine BMD (WMD: 3.46, 95% CI: 2.15-4.77, P < .00001), but not femoral neck BMD (WMD = 1.50, 95% CI: 0.04-2.95, P = .04), in postmenopausal osteoporosis patients treated with teriparatide compared with alendronate for 6 to 18 months. These beneficial effects were apparent in the lumbar spine at 12 months of treatment (WMD: 4.49, 95% CI: 2.57-6.40, P < .01). Teriparatide was not superior to alendronate in reducing fracture risk (OR: -0.03, 95% CI: -0.12 to 0.07; P = .52). CONCLUSION: Teriparatide may be superior to alendronate for increasing lumbar spine BMD in postmenopausal osteoporosis. The efficacy and safety of long-term teriparatide and alendronate treatment in postmenopausal osteoporosis should be further investigated in clinical trials.

[Anaerobic digestion of lignocellulosic biomass with animal digestion mechanisms].

Lignocellulosic material is the most abundant renewable resource in the earth. Herbivores and wood-eating insects are highly effective in the digestion of plant cellulose, while anaerobic digestion process simulating animal alimentary tract still remains inefficient. The digestion mechanisms of herbivores and wood-eating insects and the development of anaerobic digestion processes of lignocellulose were reviewed for better understanding of animal digestion mechanisms and their application in design and operation of the anaerobic digestion reactor. Highly effective digestion of lignocellulosic materials in animal digestive system results from the synergistic effect of various digestive enzymes and a series of physical and biochemical reactions. Microbial fermentation system is strongly supported by powerful pretreatment, such as rumination of ruminants, cellulase catalysis and alkali treatment in digestive tract of wood-eating insects. Oxygen concentration gradient along the digestive tract may stimulate the hydrolytic activity of some microorganisms. In addition, the excellent arrangement of solid retention time, digesta flow and end product discharge enhance the animal digestion of wood cellulose. Although anaerobic digestion processes inoculated with rumen microorganisms based rumen digestion mechanisms were developed to treat lignocellulose, the fermentation was more greatly limited by the environmental conditions in the anaerobic digestion reactors than that in rumen or hindgut. Therefore, the anaerobic digestion processes simulating animal digestion mechanisms can effectively enhance the degradation of wood cellulose and other organic solid wastes.