Biomechanical Research of Three Parallel Cannulated Compression Screws in Oblique Triangle Configuration for Fixation of Femoral Neck Unstable Fractures.

OBJECTIVE: Surgical treatment with internal fixation, specifically percutaneous fixation with three cannulated compression screws (CCSs), is the preferred choice for young and middle-aged patients. The mechanical advantage of the optimal spatial configuration with three screws provides maximum dispersion and cortical support. We suspect that the spatial proportion of the oblique triangle configuration (OTC) in the cross-section of the femoral neck isthmus (FNI) may significantly improve shear and fatigue resistance of the fixed structure, thereby stabilizing the internal fixation system in femoral neck fracture (FNF). This study aims to explore the mechanical features of OTC and provide a mechanical basis for its clinical application. METHODS: Twenty Sawbone femurs were prepared as Pauwels type III FNF models and divided equally into two fixation groups: OTC and inverted equilateral triangle configuration (IETC). Three 7.3 mm diameter cannulated compression screws (CCSs) were used for fixation. The specimens of FNF after screw internal fixation were subjected to static loading and cyclic loading tests, respectively, with five specimens for each test. Axial stiffness, 5 mm failure load, ultimate load, shear displacement, and frontal rotational angle of two fragments were evaluated. In the cyclic loading test, the load sizes were 700 N, 1400 N, and 2100 N, respectively, and the fracture end displacement was recorded. Results were presented as means ± SD. Data with normal distributions were compared by the Student's t test. RESULTS: In the static loading test, the axial stiffness, ultimate load, shear displacement, and frontal rotational angle of two fragments were (738.64 vs. 620.74) N/mm, (2957.61 vs. 2643.06) N, (4.67 vs. 5.39) mm, and (4.01 vs. 5.52)° (p < 0.05), respectively. Comparison between the femoral head displacement after 10,000 cycles of 700N cyclic loading and total displacement after 20,000 cycles of 700-1400N cyclic loading showed the OTC group was less than the IETC group (p < 0.05). A comparison of femoral head displacement after 10,000 cycles of 1400N and 2100N cycles and total displacement after 30,000 cycles of 700-2100N cycles showed the OTC group was less than another group, but the difference was not significant (p > 0.05). CONCLUSION: When three CCSs are inserted in parallel to fix FNF, the OTC of three screws has obvious biomechanical advantages, especially in shear resistance and early postoperative weight-bearing, which provides a mechanical basis for clinical selection of ideal spatial configuration for unstable FNF.

Early administration of dobutamine in the treatment of septic shock patients with tumor-a retrospective comparative cohort study.

Background: Studies have found that dobutamine may be beneficial to protect organs function in patients with septic shock, but there is still a lack of relevant research in septic shock patients with tumor. The study sought to explore the role of the early administration of dobutamine in the treatment of septic shock patients with tumors. Methods: We retrospectively collected the data of tumor patients who developed septic shock at Sun Yat-sen University Cancer Center between June 2008 and November 2021. All the patients were divided into the following 3 groups: (I) the early administration group (<3 days, n=15); (II) the late administration group (≥3 days, n=22); and (III) the non-administration group (n=85). The primary observation indicator was 28-day mortality, and the secondary observation indicators included the shock reversal rate, the length of stay in the intensive care unit (ICU) and the duration of mechanical ventilation. There was no statistical difference in the basic data of the three groups. Results: The early administration group had a significant decrease in 28-day mortality compared to the late and non-administration groups (log-rank P=0.018). The comparison between the groups showed that the 28-day mortality of the early administration group was significantly lower than that of the non-administration group [20.0% vs. 58.8%, P=0.013, hazard ratios (HRs) =0.248, 95% confidence intervals (CIs): 0.077-0.796]. There was no statistically significant difference in 28-day mortality between the late administration group and the non-administration group (63.6% vs. 58.8%, P=0.682, HR =0.983, 95% CI: 0.543-1.778). Additionally, the early administration group had a significantly increased shock reversal rate (P=0.014), shortened length of stay in the ICU (P<0.001), and reduced duration of mechanical ventilation (P=0.049). Conclusions: Early use of dobutamine may be beneficial to reduce the in-hospital mortality of septic shock patients with tumor, but the sample size of this study was small, which still needs to be confirmed by a multi-center randomized controlled clinical study.

Initial procalcitonin level predicts infection and its outcome in patients with non-Hodgkin lymphoma with febrile neutropenia.

We explored whether initially determined procalcitonin (PCT) levels could facilitate assessment of the risks of infection and death due to treatment failure in patients with non-Hodgkin lymphoma (NHL) with newly developed febrile neutropenia (FN). In the 212 examined episodes, the initial PCT value was markedly higher in patients with microbiologically documented infection (MDI) or clinically documented infection compared with patients with fevers of unknown origin (p < 0.001 for both). Patients with initial PCT values ≥ 0.50 ng/mL were at high risk of MDI (sensitivity 83.5%, specificity 77.2%). A significantly elevated PCT level was closely correlated with patient mortality (area under the curve [AUC] 0.864, 95% confidence interval [CI] 0.811-0.907, p < 0.001) and patients' admission to the intensive care unit (AUC 0.926, 95% CI 0.882-0.957, p < 0.001). In conclusion, the initially determined PCT value was a useful marker for identifying infection and predicting outcome in patients with NHL with FN.

Effects of CXCR4 gene silencing by lentivirus shRNA on proliferation of the EC9706 human esophageal carcinoma cell line.

CXCL12/CXCR4 has been studied as an important biomarker for many human malignancies, but studies are limited for esophageal squamous cell carcinoma (ESCC). In this study, an effective RNAi sequence targeting the CXCR4 gene was selected, a lentiviral shRNA vector was constructed to specifically silence CXCR4 expression in the EC9706 ESCC cell line, and the effects of CXCR4 silencing on cell growth in vitro and tumour growth in nude mice were then evaluated. The expression of CXCR4 in EC9706 was significantly downregulated after transfection with a lentiviral shRNA vector. The expression of the apoptosis-related gene Bcl-2 was decreased. In addition, after CXCR4 inhibition, cell growth was considerably inhibited, increased apoptosis in the EC9706 cells was found, the G0/G1 percentage was significantly increased, and the number of cells in S phase was reduced. Moreover, tumour growth in nude mice was inhibited. In conclusion, the downregulation of CXCR4 expression by transfection with a lentiviral shRNA vector in ESCC cells could inhibit tumour proliferation. Our data may provide an avenue for finding new ESCC treatments.

Effect of coriolus versicolor polysaccharide-B on the biological characteristics of human esophageal carcinoma cell line eca109.

OBJECTIVE: To investigate the effect of Coriolus versicolor polysaccharide-B (CVPs-B) on the biological characteristics of human esophageal carcinoma cell line Eca109 in vitro. METHODS: The cells of experimental group (EG) were cultured in DMEM with 10% FCS and 150µg/mL CVPs-B, the cells of control group (CG) were cultured in DMEM with 10% FCS without CVPs-B. MTT reduction assay was performed to detect the effect of CVPs-B on the proliferation of Eca109 cells after the compound was administrated in varying concentrations. The living conditions of the Eca109 cells were determined using trypan blue exclusion. Then, cell growth curves were drawn. Flow cytometry was performed to detect the effect of CVPs-B on the apoptosis and cell cycle of Eca109. RESULTS: In comparison with the CG, a marked decrease in the proliferation of Eca09 cells was observed in the EG, after incubation with CVPs-B. The survival rate of Eca09 cells decreased as the time of CVPs-B incubation prolonged. Comparing the cell cycles and apoptotic rates between the two groups, the proportions of cells in the G0/G1, S, and G2/M phases in the EG were found to be (68.4±3.7)%, (13.9±2.1)%, and (17.7±1.4)%, respectively, after 24 h incubation with CVPs-B. The cells had an apoptotic rate of (9.7±0.7)%. On the other hand, the proportions of the G0/G1, S, and G2/M cells of the CG were found to be (53.9±3.6)%, (26.6±2.8)%, and (19.5±2.3)%, respectively, with an apoptotic rate of (5.7±1.4)%. In comparison with the CG cells, significant cell growth in the G0/G1 phase was observed in the EG (P<0.05). Furthermore, a significant decrease in the number of cells in the S phase was observed (P<0.05) in the EG. CONCLUSIONS: CVPs-B can inhibit proliferation and enhance apoptosis of Eca109 cells and may be useful in the treatment of esophageal carcinoma.

[Efficacy of sublingual nifedipine and intravenous urapidil for treatment of acute postoperative hypertension].

OBJECTIVE: To compare the clinical efficacy and safety of sublingual nifedipine and intravenous urapidil in the treatment of acute postoperative hypertension. METHODS: The clinical data of 215 patients with APH after tumorectomy were retrospectively analyzed, among whom 165 were treated with sublingual nifedipine and 50 with intravenously urapidil. RESULTS: Treatment with sublingual nifedipine caused a reduction of the systolic blood pressure by 5.9% and diastolic blood pressure by 5.2%. Urapidil treatment resulted in significantly greater reductions in the systolic and diastolic blood pressures (by 12.1% and 8.6%, respectively) (P(s)<0.001, P(d)=0.019). Urapidil treatment was associated with a significantly higher rate of adequate antihypertensive effect than nifedipine treatment (68% vs 35.8%, P<0.001). CONCLUSION: Although both urapidil and nifedipine are associated with minimal adverse effects, intravenous urapidil shows better therapeutic effect than sublingual nifedipine and is more suitable for the treatment of APH.

Expression profiles of early esophageal squamous cell carcinoma by cDNA microarray.

An effective way to decrease the mortality rate in esophageal cancer (EC) is to provide diagnosis and treatment for early EC patients. Identification of molecular markers would be helpful for early diagnosis. In this study, we obtained the gene expression profile of early esophageal squamous cell carcinoma (ESCC) and further screened molecular markers that might be useful in early diagnosis and treatment. RNA extracted from EC cancer tissues and matched normal esophageal epithelium of four EC patients were analyzed using whole-genome microarrays. Welch's t-test was applied to normalized data to identify genes expressed differently between cancer and normal tissues. Significantly differentially expressed genes were classified according to gene ontology. Gene mapping software was used to identify pathways involving the genes that were significantly changed. Among the 54,613 gene transcripts and variants analyzed, 367 were differentially expressed between early ESCC and normal esophageal epithelium (Welch's t-test, P<0.01). Specifically, 104 genes were significantly upregulated and 263 were downregulated in early ESCC, compared with normal esophageal epithelium. Functional gene sets expressed differentially between ESCC cancer and normal tissues included those involved in gene transcription, cell proliferation, motility, apoptosis, and metabolism (specifically, pathways of cell apoptosis, the cell cycle, G protein, and TGF-beta signal transduction). We conclude that a large number of genes are involved in the occurrence and development of early ESCC and take part in various cell processes and pathways. The present findings contribute theoretical information for further screening of genes related to early ESCC.

Expression of CXCL12/CXCR4 and its correlation to prognosis in esophageal squamous cell carcinoma.

BACKGROUND AND OBJECTIVE: CXCL12/CXCR4 is expressed in many kinds of tumors, which is associated with tumor proliferation and invasion. This study was to investigate the expression of CXCL12/CXCR4, and explore its correlation to prognosis and clinicopathologic factors of esophageal squamous cell carcinoma (ESCC). METHODS: The expression of CXCL12/CXCR4 protein in 186 specimens of ESCC was assessed by immunohistochemistry. RESULTS: The positive rates of CXCL4 and CXCR12 protein in ESCC tissues were 67.2% and 63.4%, respectively. CXCL4 and CXCR12 were not expressed in 20 specimens of normal esophageal epithelium. PTNM stage and positive expression of CXCR4 were independent prognostic factors of ESCC (p < 0.05). The five-year survival rates of CXCL12-positive and CXCL12-negative groups were not significantly different (21.0% vs. 18.8%, p > 0.05), while the five-year survival rate was significantly higher in CXCR4-negative group than in CXCR4-positive group (28.5% vs. 2.2%, p < 0.05). The expression of CXCR4 was higher in the group with lymph node metastasis and pathological T3 stage than in the group without lymph node metastasis and with pathological T1-T2 stages (p < 0.05). The expression of CXCR4 was not correlated with the expression of CXCL12 in ESCC. CONCLUSIONS: CXCL12/CXCR4 is intensively expressed in esophageal squamous cell carcinoma. The level of CXCR4 is positively correlated to progression and prognosis of ESCC.

[Effect of Coriolus versicolor polysaccharide B on membrane glycosaminoglycans and cellular glutathione changes in RAW264.7 macrophages exposed to angiotensin II].

OBJECTIVE: To investigate the effect of Coriolus versicolor polysaccharide B (CVP-B) on increased membrane glycosaminoglycans (GAG) expression and intracellular glutathione (GSH) of RAW264.7 macrophages exposed to angiotensin II (Ang II). METHODS: The plasma membrane of RAW264.7 macrophages exposed to Ang II treatment was isolated by ultracentrifugation, and the membrane GAG expression was analyzed using 1, 9-dimethylmethylene blue (DMMB) spectrophotometric assay for sulfated GAG. The intracellular reduced GSH was determined using fluorophotometry. RESULTS: The GAG content in the macrophage membranes increased by up to 54% following cell exposure to 1.0 micromol/L Ang II, whereas in presence of 1.0 micromol;/L Ang II, CVP-B at 1, 10, and 50 microg/ml decreased the GAG content by 13%, 43% (P<0.01), and 52% (P<0.01), respectively. The macrophage GSH activity decreased by 69% following incubation with 1.0 micromol;/L Ang II for 24 h, and CVP-B treatment at 1, 10, and 50 microg/ml in presence of 1.0 micromol;/L Ang II resulted in significant increment of GSH activity by 31%(P<0.05), 104% (P<0.01), and 168% (P<0.01), respectively. CONCLUSION: These data provide the first evidence that CVP-B inhibits elevated GAG expression in RAW264.7 macrophage membrane induced by Ang II.

[Expression and prognostic value of survivin protein in early-stage non-small cell lung cancer].

BACKGROUND & OBJECTIVE: As a member of the inhibitor of apoptosis (IAP) family, Survivin is highly expressed in various cancers, and is considered as an indicator of poor prognosis. This study was to investigate the expression and prognostic value of Survivin in early-stage non-small cell lung cancer (NSCLC). METHODS: The expression of Survivin in 213 specimens of NSCLC was detected by immunohistochemistry. Patients' survival was analyzed by Kaplan-Meier method. The prognosis was analyzed by Cox multivariate model. RESULTS: Survivin was expressed in both nuclei and cytoplasm. Of the 213 patients, 170 (79.8%) had low expression of Survivin (positive rate of < or =75%), 43 (20.8%) had high expression of Survivin (positive rate of >75%). Cox analysis showed that the expression of survivin was an independent predictor of overall survival (P>0.05). Among the 39 patients with small lung adenocarcinoma (tumor diameter of <3 cm), the difference in survival between Survivin-positive and Survivin-negative groups was not significant (P>0.05). CONCLUSION: The prognostic value of Survivin in early-stage NSCLC is unclear.

[Differential diagnosis and treatment of esophageal stromal tumors and smooth muscle tumors].

BACKGROUND & OBJECTIVE: Esophageal stromal tumors and smooth muscle tumors are not easy to be distinguished in clinic though they have different pathologic features. This study was to compare the clinicopathologic features of esophageal stromal tumors and smooth muscle tumors, and discuss their treatments. METHODS: The expression of CD117 and CD34 in 16 specimens of primarily diagnosed esophageal leiomyoma, 4 specimens of esophageal leiomyosarcoma, and 1 specimen of stromal tumor was detected by immunohistochemistry. The clinicopathologic features of the patients were analyzed, and the treatment principles and curative efficacies were summarized. RESULTS: Of the 16 cases of primarily diagnosed esophageal leiomyoma, 5 were CD117(+) and finally diagnosed as non-high aggressive fatal stromal tumor according to the assessment criteria of stromal tumors; 11 were CD117(-). The stromal tumor was CD117(+) and CD34(+), and diagnosed as high aggressive fatal stromal tumor. The 4 cases of primarily diagnosed esophageal leiomyosarcoma were CD117(-) and CD34(-). There was no obvious difference in clinicopathologic manifestations, treatment and prognosis between esophageal non-high aggressive fatal stromal tumor and leiomyoma, and between esophageal high aggressive fatal stromal tumor and leiomyosarcoma. CONCLUSIONS: Esophageal stromal tumors and smooth muscle tumors can not be distinguished with clinicopathologic exhibitions. The immunohistochemical examination of antibody CD117 is necessary for identifying them. Lumpectomy or esophageal partial resection is enough for esophageal non-high aggressive fatal stromal tumor and leiomyoma. Esophageal partial resection is necessary for esophageal high aggressive fatal stromal tumor and leiomyosarcoma.

[Expression and clinical significance of apoptosis-related oncogenes in stage I-II non-small cell lung cancer].

BACKGROUND & OBJECTIVE: The prognosis of stage I-II non-small cell lung cancer (NSCLC) after operation is related to many factors. Apoptosis-related oncogenes play an important role in occurrence and development of tumors. This study was to investigate the expression and prognostic significance of representative apoptosis-related oncogenes (Survivin, Bcl-2, Bax, and Fas) in stage I-II NSCLC. METHODS: The expression of Survivin, Bcl-2, Bax, and Fas in 115 specimens of stage I-II NSCLC and 20 specimens of non-tumor lung tissue were detected by SP immunohistochemistry. RESULTS: The positive rates of Survivin and Bcl-2 were significantly higher in NSCLC than in non-tumor lung tissues (62.61% vs. 10.00%, P<0.001; 49.57% vs. 15.00%, P<0.05); the positive rates of Bax and Fas were significantly lower in NSCLC than in non-tumor lung tissues (31.30% vs. 65.00%, P<0.05; 46.96% vs. 80.00%, P<0.05). TNM stage and positive expression of Survivin were independent prognostic factors of stage I-II NSCLC (P<0.01). The survival time of patients was significantly shorter in Survivin-positive group than in Survivin-negative group [(33+/-7) months vs. (52+/-9) months, P<0.05]. CONCLUSIONS: Apoptosis-related oncogenes may have some impacts on the occurrence and development of stage I-II NSCLC. TNM stage and positive expression of Survivin are independent prognostic factors.