Enabled homolog shown to be a potential biomarker and prognostic indicator for breast cancer by bioinformatics analysis.

BACKGROUND: Human enabled homolog (ENAH; also known as human ortholog of mammalian enabled, hMENA) is a member of the enabled/vasodilator-stimulated phosphor protein family that regulates fibroblast movement and nervous system development. The ENAH over-expression promotes breast cancer (BC) cell invasion and metastasis. METHODS: We studied ENAH mRNA expression in various tumors and normal tissues using the ONCOMINE database, and in an array of cancer cell lines using Cancer Cell Line Encyclopedia data. We also investigated the prognostic value of ENAH expression in patients with BC using Kaplan-Meier plots. RESULTS: Compared with normal tissues, ENAH expression levels were markedly elevated in BC. We identified a correlation between low ENAH and superior relapse-free survival (RFS) of patients with BC; specifically, those with ER(-), HER-2(+), Grade 3 and wild-type TP53 subtypes. Additionally, a correlation was detected between low ENAH and prolonged overall survival of patients with luminal B disease. CONCLUSION: ENAH is a potential biomarker and important prognostic factor in BC.

Arthroscopic single-bundle ACL reconstruction with modified double-layer bone-patellar tendon-bone allograft.

PURPOSE: The objective of present study was to introduce a modified double-layer bone-patellar tendon-bone (BPTB) allograft for arthroscopic single-bundle ACL reconstruction and investigate the clinical outcomes. METHODS: From 2007 to 2009, a total of 136 patients underwent arthroscopic single-bundle ACL reconstructions with BPTB allograft. Of which, 66 patients were with double-layer BPTB allograft (Group 1), and 70 patients were with conventional BPTB allograft (Group 2). Clinical outcomes including Lachman and pivot-shift tests, KT-1000 arthrometer measurements, and Lysholm and Tegner activity scores were compared between the two groups at a 2-year minimum follow-up. RESULTS: Forty-six patients in each group were at a two-year minimum follow-up. The mean side-to-side difference on the KT-1000 arthrometer was 1.2 ± 1.2 mm for group 1 and 2.1 ± 1.9 mm for group 2, with significant difference between the two groups (p = 0.017). The knee function was significantly better for group 1 than for group 2, because the mean Lysholm score was 94.2 ± 4.8 points versus 86.6 ± 7.1 points (p = 0.000), and the median Tegner score was 8 (range 5-10) points versus 6 (range 4-10) points (p = 0.001). CONCLUSIONS: On the basis of the KT-1000 arthrometer evaluation and clinical measures, single-bundle ACL reconstruction with double-layer BPTB allograft achieves significantly lesser anterior laxity and better knee function than a single-layer allograft reconstruction. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative study, Level III.

Selection of operative approaches for multilevel cervical spondylotic myelopathy by imageological score.

STUDY DESIGN: A retrospective study of the operative approaches for multilevel cervical spondylotic myelopathy (MCSM) patients to establish an imageology scoring system and a prospective study to explore the clinical significance of the scoring system. OBJECTIVE: To develop and establish an imageology scoring system and explore its clinical significance for selecting the best surgical approach to treat MCSM. SUMMARY OF BACKGROUND DATA: MCSM often requires surgical intervention. A number of surgical methods are available, including anterior, posterior, and posterior-anterior united approaches. The key issue is to select an appropriate surgical approach that optimizes clinical outcomes. However, the selection of a surgical approach for MCSM is still controversial. As there is a lack of high-quality quantitative data and a uniform standard for selecting the best surgical approach, the choice is usually based on surgeon experience in practice. METHODS: A total of 226 MCSM patients who underwent different surgical approaches with satisfactory clinical results (>60% recovery rates) from January 1998 to June 2004 were retrospectively analyzed. The patients were divided into 3 groups according to the surgical approach they underwent: anterior, posterior, or posterior-anterior united approach. Six imageological indices closely related to MCSM were collected for each patient. The indices included the following: the stability of the cervical vertebra, the degree of spinal stenosis, the degree of spinal cord compression, hypertrophy of ligamentum flava, and the local (≤2 levels) or continuous (>2 levels) ossification of the posterior longitudinal ligament. The maximum likelihood method for discriminatory analysis was adopted to analyze the imageology indices, thus the imageology scores were obtained and the imageology scoring system was established. During the second stage of the study, 165 MCSM patients were prospectively analyzed between June 2005 and September 2008. The surgical approach with the maximum total score according to the imageology scoring system was regarded as the recommended surgical approach, but the actual surgical approach was determined by the surgeon's clinical experience. The patients were divided into 3 groups according to the actual surgical approach. Patients underwent either an anterior approach, posterior-anterior united approach, or posterior approach in groups A, B, and C, respectively. The following criteria were evaluated: perioperative and postoperative complications, Japanese Orthopedic Association (JOA) scores, and recovery rates. The correlation between the actual surgical approach and the recommended surgical approach by the imageology scoring system was analyzed. RESULTS: The postoperative JOA score improved significantly in all the 3 groups. There were no significant differences in JOA scores (group A: 13.10±1.47, group B: 12.89±1.26, group C: 12.98±1.69) or recovery rates (group A: 61.71%±11.41%, group B: 60.21%±9.35%, group C: 60.93%±15.20%) at a 1-year follow-up in all the 3 groups. The correlation between the actual surgical approach and the recommended surgical approach was 87.27%, 90.16%, and 82.05% in groups A, B, and C, respectively. CONCLUSIONS: The imageological scoring system proved to be effective for selecting a surgical approach for MCSM, which can make surgical techniques more quantified and standardized.

[Epidemiological survey on pre-hypertension and hypertension prevalence among adolescents aged 11 to 17 years in Shanghai].

OBJECTIVE: To assess the prevalence of pre-hypertension and hypertension as well as the association with overweight/obesity in Shanghai adolescents. METHODS: School children aged 11 - 17 years in four schools in Shanghai were included in this survey. All students were visited in May 2010 at school by trained nurses or physicians who administered a questionnaire and carried out anthropometric measurements. Anthropometric measurements included height, weight, heart rate and blood pressure. Repeat measurements were performed in school children with elevated blood pressure within one month. The pre-hypertension and hypertension was defined on the basis of the 2004 National High Blood Pressure Education Program Working Group definitions. The overweight and obesity was defined using cutoff points recommended by Working Group of Obesity, China (WGOC). RESULTS: There were 4175 school children aged 11 - 17 years [mean (15.0 ± 1.9) years, 52.3% (n = 2183) girls and 47.7% (n = 1992) boys]. There were 72.5% (n = 3025) participants with normal blood pressure [ girls (n = 1666) 76.3% and boys (n = 1361) 68.3%], 18.0% (n = 750)participants with pre-hypertension [14.2% (n = 310) for girls and 22.1% (n = 440) for boys], 8.3% (n = 346) participants with stage 1 hypertension [8.2% (n = 179) for girls and 8.3% (n = 165) for boys] and 1.3% (n = 54) participants with stage 2 hypertension [1.3% (n = 28) for girls and 1.3% (n = 26) for boys]. The prevalence of overweight and obesity was 6.7% (n = 147) and 3.0% (n = 66) for girls and 13.7% (n = 273) and 6.3% (n = 125) for boys. After adjusting for gender, age, parental history of hypertension and physical activities, multivariable logistic regression analysis showed that the overweight [adjusted odds ratio and 95% confidence interval: 1.42 (1.16 - 1.75)] and obesity [adjusted odds ratio and 95% confidence interval: 2.35 (1.78 - 3.11)] were independent predictors of elevated blood pressure in this cohort. CONCLUSIONS: The prevalence of elevated blood pressure is common in adolescents in Shanghai. Overweight and obesity are closely associated with the elevated blood pressure in this cohort.

Phlorizin alleviates cholinergic memory impairment and regulates gut microbiota in d-galactose induced mice.

We explored the effect of phlorizin against cholinergic memory impairment and dysbacteriosis in D-galactose induced ICR mice. The control (CON) group, D-galactose model (DGM) group, and three groups (DG-PL, DG-PM, DG-PH) treated with phlorizin at 0.01%, 0.02%, and 0.04% (w/w) in diets were raised for 12 weeks. Supplementing with phlorizin reversed the loss of organ coefficient and body weight caused by D-galactose. The functional abilities of phlorizin on hippocampal-dependent spatial learning and memory, anti-oxidation, anti-inflammation were also observed. Meanwhile, phlorizin intervention upregulated the gene expression of Nrf2, GSH-PX, SOD1, decreased the gene expression of NF-κB, TLR-4, TNF-α, and IL-1ß in the hippocampus, while enhanced the gene expression of JAM-A, Mucin2, Occludin in the caecum. Furthermore, a neurotransmitter of acetylcholine (ACh) was enhanced, while acetylcholinesterase (AChE) activity was inhibited by phlorizin administration. Moreover, phlorizin administration increased short-chain fatty acids (SCFAs) content, and reduced lipopolysaccharides (LPS) levels, which may relate to the rebuilding of gut microbiota homeostasis. Treatment with phlorizin may be an effective intervention for alleviating cognitive decline and gut microbiota dysbiosis.

Functional bundles of the medial patellofemoral ligament.

The purpose of this study was to explore the anatomy and evaluate the function of the medial patellofemoral ligament (MPFL). Anatomical dissection was performed on 12 fresh-frozen knee specimens. The MPFL is a condensation of capsular fibers, which originates at the medial femoral condyle. It runs transversely and inserts to the medial edge of the patella. With the landmark of the medial femur epicondyle (MFE), the femoral origination was located: just 8.90 ± 3.27 mm proximally and 13.47 ± 3.68 mm posteriorly to the MFE. The most interesting finding in present study was functional bundles of its patellar insertion. Approximately from the femoral origination point, fibers of the MPFL form two relatively concentrated fiber bundles: the inferior-straight bundle and the superior-oblique bundle. The whole length of each was 71.78 ± 5.51 and 73.67 ± 5.40 mm, respectively. The included angle between bundles was 15.1° ± 2.1°. Although the superior-oblique bundle and the inferior-straight bundle run on the patellar MPFL inferiorly and superiorly, respectively, as their name indicates, the two bundles are not entirely separated, which make MPFL one intact structure. The inferior-straight bundle is the main static soft tissue restraints where the superior-oblique bundle associated with vastus medialis obliquus (VMO) is to serve as the main dynamic soft tissue restraints. So this finding may provide the theoretical foundation for the anatomical reconstruction of the MPFL and shed lights on the future researchers.

A novel prognostic signature of seven genes for the prediction in patients with thymoma.

PURPOSE: A thymoma is a tumor arising from the epithelium of the thymus, mostly occurring in the anterior mediastinum. The incidence of this disease is low and research progress in this field is slow. Consequently, there is an urgent need to investigate the correlation between molecular regulation and the prediction of survival and prognosis in patients with thymoma. METHODS: We collected thymoma datasets from The Cancer Genome Atlas (TCGA). Differentially expressed genes (DEGs) of TCGA datasets were then determined using R software. A gene signature was obtained by screening prognostic DEGs from the TCGA datasets using univariate and multivariate Cox survival analysis. The summation of the weighted expression levels was calculated as a risk score, which could then be used to predict the survival rate and prognosis of patients with thymoma. The validity of this model was verified by the analysis of receiver operating characteristic (ROC) curves and area under the curve (AUC). RESULTS: In total, 297 DEGs were identified from the integrated results of TCGA datasets. A seven-gene signature, along with a regression model of prognostic risk, was obtained by Cox survival analysis. The expression levels of the seven genes were then weighted and summed to calculate the risk score for each sample. Patients were effectively divided into high- and low-risk groups using the median risk score (P < 0.05). ROC analysis showed that this Cox regression model was effective in predicting the prognosis of patients with thymus tumors (AUC = 0.983, P < 0.05). CONCLUSION: For the first time, we identified an effective seven-gene signature in patients with thymic tumors. In the future, the risk and prognosis of patients can be preliminarily assessed using this model, although further testing is required to improve rigor.

Alendronate retards the progression of lumbar intervertebral disc degeneration in ovariectomized rats.

OBJECTIVE: Increasing evidence has revealed a positive correlation between postmenopausal osteoporosis and intervertebral disc degeneration, the underlying mechanism of which might be associated with changes in the vertebral bone and endplate. Alendronate (ALN) can increase bone mass and improve the microstructure of osteoporotic vertebrae, which might be helpful in preserving disc morphology and mechanical properties. This study aims to investigate the effects of ALN on lumbar intervertebral disc degeneration related to osteoporosis using an ovariectomized (OVX) rat model. METHODS: Thirty female Sprague-Dawley rats aged 3 months were randomly divided into three groups (with 10 rats each) as follows: the Sham group underwent sham surgery; the OVX + ALN group had twice-a-week subcutaneous injections of ALN (15 µg/kg) for 6 months. The OVX + V group received an equivalent volume of saline solution as placebo post-OVX. After animals were sacrificed at 6 months post-OVX, the L3-6 spinal segments were harvested. Bone mineral density (BMD), micro-CT analysis and biomechanical testing were performed to evaluate the bone quality and microstructural changes in the lumbar vertebral bodies. Histological analysis with van Gieson stain and the histological score were used to identify the characteristics of the degenerative discs. The disc height and the thickness of the cartilage endplate were measured and compared. Immunohistochemistry and real-time PCR measurements for aggrecan, type I collagen, type II collagen, and matrix metalloprotease (MMP)-1, MMP-3 and MMP-13 expressions on the disc were performed to assess the underlying molecular signaling changes in matrix metabolism during intervertebral disc degeneration. RESULTS: The OVX + ALN group significantly maintained vertebrae BMD, percent bone volume and biomechanical strength, when compared with the OVX + V group. Histological evaluation suggests that there was no significant difference in disc height between the OVX + ALN and Sham groups, and ALN significantly prevented cartilage endplate thickening and the development of abnormal bony tissues within the cartilage endplate. The histological score in the OVX + ALN group was significantly lower than the OVX + V group, suggesting that ALN treatment was effective in delaying the process of the disc degeneration. The results of molecular analysis revealed a significant increase in aggrecan and type II collagen expressions, but marked reductions in MMP-1, MMP-3 and MMP-13 expressions at both the protein and mRNA levels in the OVX + ALN group. CONCLUSIONS: ALN can retard the progression of lumbar intervertebral disc degeneration in OVX rats. The underlying mechanisms might be related to preservation of the structural integrity and function of the adjacent structures, including the vertebrae and endplates, which further links with modulations in extracellular matrix metabolism to protect the disc from degeneration. These results suggest that ALN might be a promising drug agent for preventing lumbar intervertebral disc degeneration related to osteoporosis.

Axial and tangential views of the acromioclavicular joint: the introduction of new projections.

BACKGROUND: Routine anteroposterior radiographs of the acromioclavicular (AC) joint with or without weight bearing have limitations in demonstrating the AC joint. Transarticular fixation with Kirschner wire is a treatment choice for AC dislocations. However, percutaneous fixation of the AC joint is technically demanding. The C-arm fluoroscopy can be used as routine intraoperative guidance to facilitate this procedure. The current study aims to introduce new projections, the axial and tangential views of AC joint, to help evaluate the severity of the injury and facilitate the percutaneous procedure. METHODS: Three shoulder specimens were used to find the projection directions of the axial and tangential views of the AC joint by using the digital radiography (DR) unit. The axial and tangential views were taken of 20 adult volunteers by referencing the projection directions determined in the shoulder specimens. The angles showed on the DR system and the angles between the coronal plane of the body and the vertical plane of the flat panel detector (FPD) during taking these radiographs were recorded. The C-arm fluoroscopy unit was used to take the axial and tangential views referencing the angles measured on the DR system. Routine anteroposterior radiographs of the AC joint were taken on the volunteers. The minimal distances from the distal clavicle to the acromion were measured on both tangential and anteroposterior radiographs. The data was statistically analyzed. RESULTS: The clear axial and tangential radiographs of AC joints of the volunteers were obtained using both DR and C-arm fluoroscopy units. The angles demonstrated on the DR window are (20.8 ± 2.4)° for male and (18.3 ± 2.3)° for female. During taking the axial views, the angles between the coronal plane of the body and vertical plane of FPD are (23.3 ± 3.2)° for male and (20.1 ± 2.4)° for female. During taking tangential views, the corresponding angles are (117.5 ± 3.7)° for male and (113.1 ± 3.3)° for female. On the tangential radiographs, the minimal distance from the distal clavicle to the acromion is (6.1 ± 1.2) mm, wider than the same measurement on the anteroposterior radiographs (P < 0.05). Statistical analyses showed no significant differences in the above-mentioned angles and the minimal distances between the left and right AC joints (P > 0.05). There were no significant differences in the above-mentioned angles between DR and C-arm fluoroscopy units (P > 0.05). CONCLUSIONS: The axial and tangential radiographs of the AC joint can demonstrate the joint clearly and they can be easily obtained with both DR system and C-arm fluoroscopy unit in similar projection directions.

Comparison of two kinds of intramedullary nails in the treatment of femoral shaft fractures in adults.

BACKGROUND: Intramedullary nails have been widely used in treating femoral shaft fractures. However, end caps falling into soft tissue intraoperatively may cause trouble to surgeons, prolong operative time and increase radiation exposure. Additionally, difficulties may be encountered when removing nails because of callus formation over the nail tip. We performed a prospective study to compare two types of nails in managing femoral shaft fractures. METHODS: Group I consisted of seventy-four patients with unilateral femoral shaft fractures treated with cannulated interlocking anatomical femoral intramedullary nails. Group II consisted of seventy-eight patients treated with cannulated interlocking anatomical femoral intramedullary nails with tail wires. The patients' ages, fracture severity, duration of operation, fluoroscopy time, blood loss and falls of end caps into soft tissue were recorded. Nails were removed after fracture healing. The duration of operation and blood loss during nail removal were recorded. RESULTS: There were no significant differences between groups with respect to age and fracture severity (P > 0.05). End caps fell into soft tissue 17 times in 15 cases in group I and 21 times in 16 cases in group II. An average of seven minutes was spent recovering a lost cap in group I. In group II, all lost caps were recovered immediately. The duration of operation and fluoroscopy time in group II was significantly less than in group I (P < 0.05). Asymptomatic palpable nodules were detected in 4 cases in group II. Nail removals were performed on 58 patients in group I and 69 patients in group II. The duration of operation, blood loss and complications in group II were less than in group I (P < 0.05). CONCLUSION: Intramedullary nails with tail wires facilitate both fracture fixation and nail removal, which can be used to treat femoral shaft fractures with less radiation exposure, shorter surgical time and fewer complications.

Using the T2-weighted magnetic resonance imaging signal intensity ratio and clinical manifestations to assess the prognosis of patients with cervical ossification of the posterior longitudinal ligament.

OBJECT: The aim of this study was to investigate the clinical significance of both the signal intensity ratio obtained from MR imaging and clinical manifestations on the prognosis of patients with cervical ossification of the posterior longitudinal ligament. METHODS: The authors retrospectively reviewed the records of 58 patients with cervical ossification of the posterior longitudinal ligament who underwent cervical laminoplasty from February 1999 to July 2007. Magnetic resonance imaging (1.5-T) was performed in all patients before surgery. Sagittal T2-weighted images of the cervical spinal cord compressed by the ossified posterior longitudinal ligament showed increased intramedullary signal intensity, whereas the sagittal images obtained at the C7-T1 disc levels were of normal intensity. The signal intensity ratio between regions of intramedullary increased signal intensity and the normal C7-T1 disc level was calculated based on the signal intensity values generated from the MR imaging workstation. Patients were divided into 3 groups according to their signal intensity ratio (high, intermediate, and low signal intensity groups). RESULTS: There were significant differences between the 3 groups regarding recovery rate (p < 0.001), age (p = 0.022), duration of disease (p = 0.001), Babinski sign (p < 0.001), ankle clonus (p < 0.001), and both pre- and postoperative Japanese Orthopaedic Association score (p < 0.001). There was no significant difference in sex among the 3 groups (p = 0.391). CONCLUSIONS: Patients with low signal intensity ratios that changed on T2-weighted imaging experienced a good surgical outcome. Low increased signal intensity might reflect mild neuropathological alteration in the spinal cord and greater recuperative potential. An increased signal intensity ratio with positive pyramidal signs indicates less recuperative potential of the spinal cord and a poor surgical outcome.

Combination of medial patellofemoral ligament reconstruction with vastus medialis advancement for chronic patellar dislocation.

BACKGROUND: The medial patellofemoral ligament (MPFL) reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement. METHODS: We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008: twenty eight cases with isolated MPFL reconstruction (group I), forty one cases with the combination of MPFL reconstruction with vastus medialis advancement (group C). All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires. RESULTS: Patients were followed up for a mean of 42 months (12 - 65 months) without a recurrent dislocation reported. Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group I and three in group C had patellar lateral shift exceeding 1.5 cm with a hard end point (P < 0.05). The Kujala score improved significantly from 51.3 ± 4.5 to 79.9 ± 6.2 in group I and from 53.7 ± 5.2 to 83.9 ± 6.5 in group C (P > 0.05). However, the subjective questionnaire revealed a significant difference (P < 0.05), including 12 excellent, seven good and nine fair in group I and 30 excellent, six good and five fair in group C. CONCLUSION: The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.

Caracterísicas cronobiológicas de um grupo de alunos universitários de enfermagem / Chronobiological characteristics of a group of nursing school undergraduade students

Objetivo: Desenvolveu-se estudo sobre as características cronobiológicas individuais em alunos universitários (n=107) para classificá-los segundo tipos, ou cronótipos. Métodos: Os dados foram coletados em sala de aula, utilizando-se o questionário de Horne e Ostberg. Pediu-se aos sujeitos que respondessem o questionário e o devolvessem imediatamente ao terminar. Além disso, investigaram-se os dados de identificação dos sujeitos, antes de classificá-los segundo os cronótipos: matutino (dividido em tipos extremo e moderado), vespertino (dividido em tipos extremo e moderado) e indiferente. Resultados: Os resultados mostraram a classificação de 58 porcento do tipo "Indiferente", 21 porcento para "Moderadamente Matutino"; 18 porcento para "Moderadamente Vespertino", 2 porcento para "Definitivamente Matutino" e 1 porcento para "Definitivamente Vespertino". Conclusão: Concluiu-se que a maior porcentagem coube ao cronótipo "Indiferente", que é considerado padrão na maioria da população; mas não houve correlações estatísticas significativas entre os cronótipos e as características individuais em estudo.