Risk Factors for Femoral Cortical Button Malposition in Posterior Cruciate Ligament Reconstruction.

Background: Femoral cortical button suspension fixation is a popular and reliable technique for posterior cruciate ligament reconstruction (PCLR). Button malposition during graft fixation can lead to postoperative graft loosening. Purpose: To determine the risk factors of femoral cortical button malposition in PCLR when neither direct visualization nor intraoperative fluoroscopy is used. Study Design: Case-control study; Level of evidence, 3. Methods: Of the 206 consecutive patients who underwent PCLR without direct visualization or intraoperative radiographs in 2019 at a single institution, 182 met the selection criteria and were included in the study. The distance from the suspension button to the femoral cortex was measured on postoperative computed tomography scans. The button was considered malpositioned if its distance to the femoral cortex was ≥2 mm. We evaluated patient-related and surgery-related variables, including age, sex, concomitant ligament reconstruction, button type, and surgeon experience. Multivariate logistic regression was conducted to evaluate the risk factors for button malposition. Results: The overall prevalence of button malposition was approximately 17.0% (31/182), and the mean distance from the button to the femoral cortex was 6.11 ± 5.82 mm in the malposition group. Male sex was the most significant risk factor for button malposition (odds ratio [OR], 13.86; 95% confidence interval [CI], 1.73-111.17; P = .013). Other independent risk factors were low surgical volume (completing ≤3 procedures; OR, 6.41; 95% CI, 1.89-21.72; P = .003), concomitant ligament reconstruction (OR, 5.56; 95% CI, 2.12-14.58; P < .001), and fixed-loop button (OR, 3.96; 95% CI, 1.11-14.18; P = .034). Conclusion: Male sex, low surgical volume, concomitant ligament reconstruction, and fixed-loop button were independent risk factors for femoral cortical button malposition during PCLR.

Influence of Sargassum pallidum and the synergistic interaction mechanism of 6-gingerol and poricoic acid A on inhibiting ovalbumin glycation.

This study aimed to investigate the antiglycation capacity of Sargassum pallidum extract on ovalbumin (OVA) glycation, and the interaction mechanism of its active compounds, including 6-gingerol (6G) and poricoic acid A (PA). The results showed that Sargassum pallidum extract, PA and 6G had excellent suppression on the formation of fructosamine, 5-hydroxymethylfurfural (5-HMF), acrylamide and advanced glycation end products (AGEs), which was higher than aminoguanidine (AG). The combination of PA and 6G showed good synergistic effect on inhibiting the formation of AGEs. PA exhibited the strongest inhibition activity for protein glycation products, and the content of 5-HMF and acrylamide decreased from 277.44 and 10.60 µg mL-1 to 208.37 and 5.46 µg mL-1, respectively, at 30.08 × 10-5 M compared with the control group. 6G and PA quenched the fluorescence of OVA with a static mechanism, and enhanced the hydrophilic microenvironment of the tyrosine (Tyr) and tryptophan (Trp) residues. The binding of 6G and PA with OVA was spontaneous and driven by hydrogen bonds and van der Waals interactions. Molecular docking indicated that 6G and PA entered the hydrophobic cavity of OVA, and formed hydrogen bonds with Ser103, Leu101 and Thr 91. These findings suggested that Sargassum pallidum extract, PA and 6G have great potential as antiglycation inhibitors to treat diabetes complications in healthy food.

Investigation into the mechanisms of quercetin-3-O-glucuronide inhibiting α-glucosidase activity and non-enzymatic glycation by spectroscopy and molecular docking.

The inhibition of α-glucosidase and glycation is closely related to the treatment of type 2 diabetes mellitus (DM) and its complications. In this study, quercetin-3-O-glucuronide (Q3GA) showed reversible and mixed-mode inhibition of α-glucosidase activity, with an IC50 value of 108.11 ± 4.61 µM. This was mainly due to the spontaneous formation of Q3GA-α-glucosidase driven by hydrogen bonding and van der Waals forces, which could change the microenvironments and conformation of α-glucosidase. In addition, Q3GA showed strong suppression of the formation of glycation products, including fructosamine, advanced glycation end products (AGEs), and 5-hydroxymethylfurfural (5-HMF). Molecular docking analysis demonstrated that Q3GA entered the hydrophobic pocket of ovalbumin to form six hydrogen bonds with amino acid residues, which affected the glycation process. These findings indicate that Q3GA is an excellent inhibitor of α-glucosidase and glycation, and promote its development as a drug or dietary supplement for DM.

Human papillomavirus 16E6/E7 activates autophagy via Atg9B and LAMP1 in cervical cancer cells.

BACKGROUNDS: Although the role of high-risk human papillomavirus (HPV) E6 and E7 in cellular malignant transformation has been elucidated， the function of both genes in cellular homeostasis is still unknown. Autophagy functions in maintenance of cellular homeostasis play a key role in the initiation and development of cancer and infectious disease. METHODS: Cervical cancer cell lines SiHa and CaSki were utilized in this study. RESULTS: We found that HPV 16E6/E7 (16E6/E7) downregulation inhibited autophagy, and consequently suppressed cell proliferation and promoted early apoptosis. Transcriptome sequencing demonstrated that Atg9B and LAMP1 were downregulated in 16E6/E7 knockdown cells. Gene function experiments revealed that 16E6/E7 downregulation depressed Atg9B and LAMP1, and Atg9B and LAMP1 overexpression compensated, at least partially, autophagy blockage induced by 16E6/E7 knockdown. Immunoprecipitation assay showed that 16E7 interacted with Atg9B and dual-luciferase reporter system revealed that 16E6 most likely regulated -1750 to -2000 nt in Atg9B and -1800 to -2000 nt in LAMP1 promoter region. CONCLUSIONS: Our findings verified that 16E6/E7 activated autophagy via accelerating autophagosome formation and degradation, and Atg9B and LAMP1 were involved in the process of 16E6/E7 modulating autophagy, suggesting that targeting autophagy may be a potential approach in cervical cancer therapeutics.

Directional multistage intraoperative microvascular Doppler in the hemilaminectomy surgical obliteration of spinal dural arteriovenous fistular.

OBJECTIVES: To present our experience with the use of microvascular Doppler measurement procedure in spinal dural arteriovenous fistula (sDAVF) surgery. PATIENTS AND METHODS: All patients with sDAVF from March 2008 to March 2017 who consecutively underwent hemilaminectomy surgical obliteration with the assistance of microvascular Doppler were included. We reviewed patient records, radiological images, operative notes, microvascular Doppler files, as well as intraoperative videos RESULTS: During the study period, 7 patients with sDAVF underwent surgical treatment facilitated by microvascular Doppler. Microvascular Doppler measurement was performed in all enrolled patients. Doppler measurement was reliable to define direction and the value of the flow of sDAVF vessels in all cases, thereby determining the location of fistula and confirming its obliteration. During temporary clip occlusion, Doppler identified successful disconnection in all cases by detecting a disappearance of arterial spectrum flow as well as a significant flow drop in venous drainages between before and after clip. At the final stage of obliteration, disappearance of the arterial spectrum and a significant flow drop in venous drainages was detected in all cases. No microflow probe-induced sDAVF vessel injury was detected. Complete obliteration of sDAVF was achieved in all cases. No recurrence was recorded during follow-up. CONCLUSION: Multistage intraoperative microvascular Doppler measurement proved to be a feasible, safe, repeatable, and reliable methodology to assist surgery in different phases of sDAVF obliteration. Further studies are needed to assess the impact of this approach on sDAVF patient outcomes.

Effect of gradient decompression on the occurrence of intraoperative hypotension and prognosis in traumatic brain injury.

AIM: To investigate the effect of gradient decompression on the occurrence of intraoperative hypotension and prognosis in traumatic brain injury. MATERIAL AND METHODS: A retrospective analysis was performed in 186 hospitalized patients from January, 2008 to January, 2012 in the Affiliated Hospital of Jiangsu University. Demographic data, the abnormality of pupils, and Glasgow Coma Scale (GCS) before operation, and gradient decompression measures, and intraoperative hypotension during operation, and mortality after operation were recorded. Gradient decompression measures were mannitol, hyperventilation, graded craniotomy, and Chi-square test was conducted to evaluate the association of gradient decompression with intraoperative hypotension and prognosis. RESULTS: All the gradient decompression measures were shown non-significantly associated with the occurrence of intraoperative hypotension and prognosis, including mannitol (p=0.852, p=0.328), hyperventilation (p=0.484, p=0.619) and graded craniotomy (p=0.326, p=0.605). Mannitol with hyperventilation (p=0.733, p=0.758), mannitol with graded craniotomy (p=0.319, p=1.000), hyperventilation with graded craniotomy (p=0.269, p=0.685) and all the three measures (p=0.135, p=0.589) were also non-significantly associated with the occurrence of intraoperative hypotension and prognosis. The abnormality of pupils (p=0.006), GCS (p<0.001) and hypotension (p=0.006) were closely associated with the prognosis. CONCLUSION: Gradient decompression is not effective in avoiding the occurrence of intraoperative hypotension and improving the prognosis. It provides a new insight into clinical measures for curing patients with severe traumatic brain injury (sTBI).

Combined application of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging in early diagnosis of vulnerable carotid atherosclerotic plaques.

OBJECTIVE: To assess the correlations between atherosclerotic plaque characteristics and inflammatory activity by combined use of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI). METHODS: Patients underwent (18)F-FDG PET/CT and MRI. Target/background ratios (TBR) of axial sections were determined from mean standard uptake values (SUV). Correlations between TBR and mean vessel wall thickness, total vessel area, lumen area, vessel wall area and normalized wall index were calculated. Plaque types were defined as calcified, collagen, lipid or haemorrhage. Plaques were also classified as thick, thin, or ruptured fibrous cap. RESULTS: The study included 31 patients (1178 plaque slices). There was a significant decrease in TBR values across the fibrous cap groups, such that ruptured > thin > thick. Lipid and haemorrhage plaques had significantly higher TBR than calcification and collagen plaques. There were weak positive correlations between TBR and mean vessel wall thickness, vessel wall area and normalized wall index. CONCLUSIONS: Thin or ruptured plaques, lipid-rich plaques and haemorrhagic plaques possess high inflammatory activity. The combination of (18)F-FDG PET/CT and MRI could be useful for qualitative and quantitative diagnosis of carotid atherosclerotic plaques.

Comparative study on early period of recovery between minimally invasive surgery total knee arthroplasty and minimally invasive surgery-quadriceps sparing total knee arthroplasty in Chinese patients.

BACKGROUND: Different kinds of minimally invasive surgery (MIS) procedures have now been used in total knee arthroplasty (TKA). Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing (QS) procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients' vastus medialis and if the QS procedure had some advantages in patients' early recovery. METHODS: Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees (15 men and 91 women, with a mean age of 65.1+/-7.4 years); osteoarthritis in 97 patients (91.5%) and rheumatoid arthritis in 9 patients (8.5%). MIS TKA was performed in 49 cases (MIS TKA group), while MIS-QS TKA in 57 cases (MIS-QS TKA group). During the operation, the type I, II and III insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery (HSS) scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded. RESULTS: There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 (0.9%) case with a type I insertion of the vastus medialis, 4 (3.8%) cases with type II insertions, 101 (95.3%) cases with type III insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was (53.3+/-12.4) minutes in the MIS TKA group and (64.1+/-15.1) minutes in the MIS-QS TKA group (P<0.001). In the MIS-QS TKA group, 1 patient had delayed healing of the partial skin incision (1.8%). No other complications were found in either group. CONCLUSIONS: Although most of the Chinese patients had type III insertions of the vastus medialis, the MIS-QS TKA procedure showed less injury to the quadriceps than the standard MIS TKA and this could contribute to the earlier recovery of the patients. But a shorter skin incision and more tension on the skin may also lead to more skin complications.