Weight change patterns across adulthood are associated with the risk of osteoarthritis: a population-based study.

BACKGROUND: Body weight has been recognized as a driving factor of osteoarthritis. Few studies had investigated the association between weight status across adulthood and risk of osteoarthritis (OA). This study investigates the association of weight change patterns across adulthood (lasting at least 25 years) with the risk of OA from the National Health and Nutrition Examination Survey (NHANES) 2013-2018. METHODS: The study assessed the relationship between weight change across adulthood and OA in 7392 individuals aged > 50 spanning a minimum of 25 years. Multivariate linear regression analyses were utilized to detect the association between weight change patterns and self-reported OA. Restricted cubic splines (RCS) were used to examine the nonlinear relationship between absolute weight change and OA risk. RESULTS: From 10 years ago to survey, the risk of OA was 1.34-fold (95% CI 1.07-1.68) in people changed from obese to non-obese, 1.61-fold (95% CI 1.29-2.00) in people change from non-obese to obese, and 1.82-fold (95% CI 1.49-2.22) in stable obese people compared with people who were at stable normal weight. Similar patterns were also observed at age 25 years to baseline and age 25 years to 10 years before the baseline. The dose-response association of RCS found a U-shaped relationship between absolute weight change and OA risk. CONCLUSIONS: The study suggests that weight patterns across adulthood are associated with the risk of OA. These findings stressed important to maintain a normal weight throughout adulthood, especially to prevent ignored weight gain in early adulthood to reduce OA risk later.

Effect of O-arm on reduction quality and functional recovery of acetabular dome impaction fractures: a retrospective clinical study.

BACKGROUND: Acetabular dome impaction fractures (ADIF) are difficult to reduce and have a high failure rate. Consistency between the acetabulum and the femoral head is usually assessed using intraoperative X-ray fluoroscopy to evaluate the quality of fracture reduction. This study examines the effects of intraoperative mobile 2D/3DX imaging system (O-arm) on the reduction quality and functional recovery of ADIF. METHODS: We retrospectively analysed the data of 48 patients with ADIF treated at Honghui Hospital between October 2018 and October 2021.The patients were divided into the X-ray and O-arm groups. The residual step-off and gap displacements in the acetabular dome region were measured, and fracture reduction quality was evaluated. Hip function was evaluated using the modified Merle d'Aubigné and Postel scoring systems. RESULTS: There were no significant intergroup differences in the preoperative general data (p > 0.05). The mean residual average step displacement in the acetabular dome region was 3.48 ± 2.43 mm and 1.61 ± 1.16 mm (p < 0.05), while the mean gap displacement was 6.72 ± 3.69 mm and 3.83 ± 1.67 mm (p < 0.05) in the X-ray and the O-arm groups, respectively. In the X-ray group, according to the fracture reduction criteria described by Verbeek and Moed et al., one case was excellent, 13 cases were good, 11 cases were poor; 56% were excellent or good. In the O-arm group, seven cases were excellent, 12 cases were good, and four cases were poor; overall in this group, 82.6% were excellent or good (p < 0.05). A total of 46 patients achieved fracture healing at the last follow-up. In the X-ray group, according to the modified Merle d'Aubigné and Postel function score, three cases were excellent,12 cases were good, six cases were middle, three cases were poor; 62.5% were excellent or good, In the O-arm group, 15 cases were excellent, four cases were good, two cases were middle, one case was poor; 86.4% were excellent or good (p < 0.05). CONCLUSIONS: The application of O-arm in ADIF can improve fracture reduction quality and functional recovery.

High sensitivity detection of tumor cells in biological samples using a multivalent aptamer strand displacement strategy.

Monitoring the cell surface-expressed nucleolin facilitates early cancer diagnosis. Herein, we developed a multivalent aptamer displacement strand duplex strategy on cell membranes using a multi-receptor co-recognition design for improving the sensitivity and specificity of cancer cell recognition with an ultra-low background. The AS1411 aptamer labeled with the FAM fluorophore can be quenched using a partial complementary sequence modified with a BHQ1 tag which is partially hybridized with the AS1411 aptamer to create a receptor-activating aptamer. The multi-AS1411 activable probe based on the strand displacement strategy was constructed using multiple copies of the structure-switching AS1411 aptamer (bearing a short poly-A tail) linked together using the poly-T long chain (as a scaffold) which was synthesized by Terminal Deoxynucleotidyl Transferase (TDT)-mediated extension. We demonstrated the promising efficacy and sensitivity of our method in recognizing tumor cells in both cell mixtures and clinical cytology specimens. Due to its simple and fast operation with excellent cell recognition sensitivity and accuracy, it is expected to achieve the detection of low abundance target cells. Our approach will have broad application in clinical rapid detection and personalized medicine.

The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study.

BACKGROUND: It is difficult to judge the stability of lateral compression type-1 (LC-1) pelvic fracture, as it is often based on static images of the pelvis. Compared with the traditional experience strategy, ultrasonography examination may be able to distinguish operative and conservative patients before definitive treatment. However, in previous studies, we have not compared the outcomes between traditional experience strategy (TES group) and combined ultrasonography examination (CUE group). Thus, the aim of the study is comparing the differences between TES and CUE strategy, to identify the value of ultrasonography examination. METHODS: Medical records system for patients with LC-1 pelvic fractures who were treated with TES and CUE strategy were included. Patients' baseline characteristics, treatment strategy, and function were recorded at follow-up. Functional outcomes were evaluated using the Majeed grading system. RESULTS: In total, 77 patients with LC-1 pelvic fractures were included in the study. There were 42 and 35 patients in TES and CUE group, respectively. Compared to TES group (69 %), there were less proportion patients chosen the operative treatment in CUE group (43 %, P = 0.021). The volume of intraoperative blood loss in CUE operative group was more than TES operative group (P = 0.037). There were more patients with complete sacral fracture in CUE operative group than TES operative group (P = 0.002). The Majeed scores in CUE conservative group was higher than TES conservative group (P = 0.008). The overall Majeed scores in CUE group was higher than that in TES group (P = 0.039). CONCLUSIONS: The ultrasonography examination could relatively accurately identify the unstable LC-1 pelvis than the traditional experience strategy, the operative rate could be reduced and the overall function of LC-1 patients could be improved under the ultrasonography examination. LEVEL OF EVIDENCE: Level III.

Yam-Containing Serum Promotes Proliferation and Chondrogenic Differentiation of Rabbit Bone Marrow Mesenchymal Stem Cells and Synthesis of Glycosaminoglycan.

The chondrogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) is affected by a variety of factors, including environmental, physical, and chemical factors and growth factors, and traditional Chinese medicine (TCM) preparations can further influence this process. In this study, the effects of different concentrations of Yam-containing serum of rabbits on BMSC proliferation and chondrogenic differentiation were investigated, as were the underlying molecular mechanisms. The growth and proliferation of BMSCs were significantly enhanced upon treatment with Yam-containing serum. Under both monolayer and micromass culture conditions, Yam-containing serum promoted the differentiation of BMSCs into chondrocytes. Toluidine blue staining results revealed that chondrocyte differentiation in the group treated by Yam-containing serum was significantly more pronounced than in the control group. Glycosaminoglycan levels, as measured by 1,2-dimethylmethylene blue (DMMB) detection, were significantly higher in cells of the Yam-containing group relative to the control group. This is the first study to our knowledge that demonstrates that Yam-containing serum can promote BMSC proliferation and chondrogenic differentiation. This study therefore lays an experimental groundwork for further application of TCM as a means of treating degenerative cartilage diseases and provides an experimental and theoretical basis for the combination of TCM and stem cells for the treatment of such diseases.

Diagnostic value of rapid on-site evaluation during endobronchial ultrasound with a guide sheath for peripheral pulmonary lesions.

OBJECTIVE: To evaluate the applied value of rapid on-site evaluation during endobronchial ultrasound (EBUS) with a guide sheath for peripheral pulmonary lesions (PPLs). METHODS: Consecutive patients who underwent EBUS with a guide sheath for PPLs at our hospital from December 2015 to June 2017 in this retrospective study. The samples obtained from each operation were made rapid on-site evaluation at the same time. The results of rapid on-site evaluation were compared with the pathological diagnosis. RESULTS: A total of 127 PPLs in 124 patients were included in the study. 70 lesions were malignancy in the final pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of rapid on-site evaluation for malignancy during EBUS with a guide sheath for PPLs was 88.6%, 98.2%, 98.4%, 87.5% and 92.9%, respectively. CONCLUSIONS: Rapid on-site evaluation during EBUS with a guide sheath has a high diagnostic value for malignant PPLs.

Therapeutic efficacy of Transpedicular Intracorporeal cement augmentation with short segmental posterior instrumentation in treating osteonecrosis of the vertebral body: a retrospective case series with a minimum 5-year follow-up.

BACKGROUND: Transpedicular intracorporeal cement augmentation (TCA) with short segmental posterior instrumentation (SSPI), which provides an ideal immediate analgesic effect and long-term reconstructive stability, is thought to be a sensible advancement to the operative strategy in treating osteonecrosis of the vertebral body (ONV). However, long-term follow-up studies about the treatment are scarce. METHODS: Forty-six ONV patients (22 males and 24 females, mean age of 62.8 ± 7.11 years) underwent TCA with SSPI were retrospectively analyzed. During follow-up, clinical outcomes, such as the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) score, were evaluated, as well as radiologic outcomes, such as the average vertebral height and kyphotic angle. RESULTS: A total of 36 patients completed a follow-up period of at least 5 years (mean follow-up period of 67 ± 4.2 months). Among them, seven patients experienced complications, i.e., pneumonia (2/36, 5.56%), screw loosening (2/36, 5.56%), moderate hematoma in the subcutaneous tissue (1/36, 2.78%), and cement leakage (2/36, 5.56%). Compared to the preoperative score, the mean VAS score was significantly reduced 6 months postoperatively (P < 0.05), and it concluded being virtually identical to the preoperative score (P > 0.05). The mean ODI score exhibited a comparable trend. Regarding the radiologic evaluation, the mean kyphotic angle and average vertebral body height were significantly corrected postoperatively (both P < 0.05). However, these radiological parameters were maximally ameliorated during the direct postoperative period and slowly deteriorated over time. CONCLUSION: The present study shows that TCA with SSPI may be only mildly effective for symptom relief and correction of kyphotic deformity during a relatively long follow-up, thus we do not recommend it for ONV.

Elevated serum interferon γ-inducible protein-10 in women with polycystic ovary syndrome.

BACKGROUND: Interferon γ-induced protein 10 kDa (IP10/CXCL10) is a chemokine related to endocrine disorders; however, the serum concentrations of IP10 in women with polycystic ovary syndrome (PCOS) have not yet been reported. Therefore, we investigated whether IP10 is increased in PCOS patients and its potential clinical value in PCOS patients. METHODS: For this research, the serum IP10, glucose, insulin, high sensitivity C-reactive protein (hs-CRP), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and total testosterone (TT) concentrations were measured in 60 women with PCOS and healthy controls. RESULTS: The median IP10 concentration was 45.60 pg/mL [interquartile range (IQR):29.75, 79.69], which was significantly higher than that of the body mass index (BMI)-matched controls (median: 36.46 pg/mL; IQR:28.98, 45.80). In the multivariate linear regression analysis, hs-CRP and the homeostasis model assessment of insulin resistance index (HOMA2-IR) were independent predictors of the IP10 values, while FSH was inversely associated with the IP10.No significant association was observed between the IP10 and BMI, glucose, LH and TT. CONCLUSIONS: The serum IP10 concentrations increase in women with PCOS, moreover, IP10 appears to be correlated with the inflammatory and IR statuses of PCOS. IP10 may be a potential biomarker to estimate the disease activity of PCOS.

Utility of Rapid On-Site Evaluation during Bronchoscopy in the Diagnosis of Pulmonary Tuberculosis.

INTRODUCTION: The diagnostic value of rapid on-site evaluation (ROSE) in bronchoscopy for lung tumors has been widely researched. However, the diagnostic efficacy of ROSE for pulmonary tuberculosis (TB) has not been extensively assessed yet. This study aimed to examine the value of ROSE in diagnosing pulmonary TB during bronchoscopy, and the relationship between ROSE cytology patterns and acid-fast bacilli (AFB) smears and mycobacterial cultures. METHODS: A retrospective study was conducted at a single respiratory endoscopy center, including 418 patients under clinical or radiological suspicion of having pulmonary TB who underwent bronchoscopy. In addition to the use of ROSE and definitive cytology, material obtained by aspiration/lavage or brushing was sent for AFB smear and mycobacterial culture. If histopathological examination was required, endobronchial biopsy, transbronchial lung biopsy, and transbronchial needle aspiration were performed at the discretion of the clinician. A composite reference standard (CRS) was used as the diagnostic gold standard for this study. The diagnosis obtained by ROSE was compared with the final diagnosis. RESULTS: Of the 418 patients studied, 282 (67.5%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary TB, in 238 (84.4%); non-TB, in 44 (15.6%). In 238 pulmonary TB patients, ROSE cytology showed granulomas without necrosis were observed in 107 cases, granulomas and necrosis in 51 cases, caseous necrosis only in 25 cases, and nonspecific inflammation in 55 cases. For the diagnosis of TB according to CRS, ROSE showed the sensitivity, specificity, positive predictive value, and negative predictive value were 76.9%, 68.2%, 92.9%, and 35.3%, respectively. The positivity rate for bacterial detection through acid-fast staining and culture during bronchoscopy was 51.7%. The cytological pattern showed a higher detection rate for bacteria in cases of necrosis. DISCUSSION: The application of ROSE during bronchoscopy is a straightforward procedure that delivers an immediate and precise assessment regarding the adequacy of collected samples, enabling a preliminary diagnosis of pulmonary TB. ROSE has exhibited a higher sensitivity in detecting pulmonary TB compared to microbiological examinations. In addition, the cytological presentation of ROSE tends to show a higher positivity rate for microbiological testing in caseous necrosis. Therefore, samples with these characteristics should be prioritized for microbiological examination after on-site evaluation.

Association between composite dietary antioxidant and bone mineral density in children and adolescents aged 8-19 years: findings from NHANES.

Dietary antioxidants may have beneficial effects on bone health, but it remains uncertain in children and adolescents. This study investigates the association of composite dietary antioxidant index (CDAI) with bone mineral density (BMD) in children and adolescents aged 8-19 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2010. The study assessed the relationship between CDAI and BMD in 2994 individuals aged 8-19 years (average age 13.48 ± 3.32 years) from the NHANES 2007-2010. Multivariate linear regression analyses were utilized to detect the association between CDAI and total spine, femur neck, and total femur BMD, adjusting for confounders including age, race/ethnicity, sex, poverty income ratio (PIR), body mass index (BMI), serum phosphorus and calcium. Stratified analyses and interaction tests were performed to examine the stability of the results. The weighted characteristics showed that subjects in the fourth CDAI quartile were more likely to be older, men, and Non-Hispanic White. They have higher values of serum total calcium and phosphorus. After adjusting all confounders, CDAI was positively associated with the total spine (ß = 0.0031 95% CI 0.0021-0.0040), total femur (ß = 0.0039 95% CI 0.0028-0.0049), and femur neck BMD (ß = 0.0031 95% CI 0.0021-0.0040) in children and adolescents. Furthermore, we found no interaction effects between different race/ethnicity, age, and sex groups. Our findings suggest that dietary intake of multiple antioxidants was positively associated with BMD in children and adolescents. These findings provide valuable evidence for improving bone health in the early stages of life. However, more prospective studies are required to validate our findings and their causal relationship.

Molecular epidemiology of carbapenem-resistant Acinetobacter spp. from XiangYa Hospital, in Hunan Province, China.

Carbapenem-resistant Acinetobacter baumannii has been known as an opportunistic pathogen that causes a variety of illness worldwide. In this study, we characterize the molecular epidemiology of 174 non-repetitive clinical isolates of A. baumannii collected from January to June 2009 from Xiangya Hospital, in Hunan Province, China, including an outbreak period of A. baumannii. These 174 isolates harbored A. baumannii intrinsic gene OXA-51. They were resistant to multiple antibiotics with resistance rates as 49.4% to imipenem, 48.3% to meropenem, 46.6% to ampicillin-sulbactam, 6.9% to cefoperazone-sulbactam, and 6.3% to minocycline. 74 out of 174 isolates were identified as carbapenemase-producing strains, among which bla(OXA-23) gene was found in 71 isolates. These 74 carbapenemase expression strains could be divided into four genotypes by enterobacterial repetitive intergenic consensus (ERIC)-PCR, with 19, 17, 33 and 5 clones in each group. We also found four imipenem resistant isolates carrying OXA-23 gene without showing carbapenemase phenotype. Our findings show that the bla(OXA-23) gene is the common carbapenemase gene among carbapenem-resistant Acinetobacter spp. isolates, suggesting that clonal spread of carbapenemase-producing isolates may be one important factor which results in the high carbapenem resistance rate in the local hospital in Hunan Province, China.

Confined Bismuth-Organic Framework Anode for High-Energy Potassium-Ion Batteries.

Metal-organic frameworks (MOFs) with inherent porosity, controllable structures, and designable components are recognized as attractive platforms for designing advanced electrodes of high-performance potassium-ion batteries (PIBs). However, the poor electrical conductivity and low theoretical capacity of many MOFs lead to inferior electrochemical performance. Herein, for the first time, a confined bismuth-organic framework with 3D porous matrix structure (Bi-MOF) as anode for PIBs via a facile wet-chemical approach is reported. Such a porous structure design with double active centers can simultaneously ensure the structure integrity and efficient charge transport to enable high-capacity electrode with super cycling life. As a result, the Bi-MOF for PIBs exhibits high reversible capacity (419 mAh g-1 at 0.1 A g-1 ), outstanding cycling stability (315 mAh g-1 at 0.5 A g-1 after 1200 cycles), and excellent full battery performance (a high energy density of 183 Wh kg-1 is achieved, outperforming all reported metal-based anodes for PIBs). Moreover, the K+ storage mechanisms of the Bi-MOF are further unveiled by in situ Raman, ex situ high-resolution transmission electron microscopy, and ex situ Fourier-transform infrared spectroscopy. This ingenious electrode design may provide further guidance for the application of MOF in energy storage systems.

Comparison of the Effects of Intramedullary Nailing and Plate Fixation on Lower-Extremity Deep Vein Thrombosis after Tibial Fractures.

Lower-extremity deep vein thrombosis (DVT) is prone to occur after internal fixation of tibial fractures. This study analyzed the effect of intramedullary nailing (IMN) and plate fixation (PF) on lower-extremity DVT, providing reliable reference and guidance for future clinical treatment of tibial fractures. Sixty-eight patients with tibial fractures admitted to Honghui Hospital, Xi'an Jiaotong University, between February 2019 and October 2020 were selected as research participants, of which 32 cases treated with open reduction and locking-compression plate fixation were assigned to the FP group and 36 cases treated with closed reduction and interlocking IMN were included in the FN group. The two groups were compared regarding the following items: clinical efficacy, operation, rehabilitation, joint function, pain, inflammatory factors (IFs), incidence of adverse reactions (ARs), blood loss, prognosis, and quality of life (QoL). The related factors affecting the occurrence of DVT were analyzed. The results identified no evident difference in the overall response rate between the two groups (P > 0.05). The FN group showed longer operation time, higher incidence of ARs, and better rehabilitation, while there were lower incision length, VAS score, and IF levels (P < 0.05). The results revealed no significant difference in estnimated blood volume(EBV) and the incidence of DVT between the two groups(P > 0.05); however, the total blood loss (TBL), hidden blood loss (HBL), and blood transfusion rates in FN group were higher while the visible blood loss (VBL) was lower compared to the FP group (P < 0.05). Logistic regression analysis identified that blood transfusion, VBL, HBL, TBL, and treatment methods were independent risk factors affecting the occurrence of lower-extremity DVT (P < 0.05). In addition, the prognostic QoL was better in the FN group (P < 0.05). Therefore, closed reduction and interlocking IMN are more effective than open reduction and locking-compression plate fixation in the treatment of tibial fractures, but patients are more likely to suffer from lower-extremity DVT. In the future, it is necessary to carefully choose the treatment method in the treatment of tibial fracture patients to ensure their rehabilitation.

Clinical Analysis of Single and Double Sacroiliac Screws in the Treatment of Tile C1 Pelvic Fracture.

We investigated the difference between fixation of single and double sacroiliac screws in the treatment of Tile C1 pelvic fractures. The data of 54 patients with Tile C1 pelvic fractures who were admitted to the trauma center of the Red Society Hospital Affiliated to Xi'an Jiaotong University between August 2016 and August 2020 were retrospectively analyzed. All patients with posterior pelvic ring injuries underwent fixation with sacroiliac screws assisted by a percutaneous robotic navigation system. The operative time, amount of intraoperative blood loss, and postoperative follow-up time between the two groups (single sacroiliac and double sacroiliac screw groups) were compared. The Matta and Majeed scores at the last follow-up were compared between the groups to evaluate fracture reduction and functional recovery. Forty-nine patients were followed up for 17.2 (±4.5) months and 16.2 (±3.4) months in the single and double sacroiliac screw groups, respectively. All patients had excellent fracture reduction immediately after surgery, according to the Matta score. All fractures healed without complications. There was no statistically significant difference in preoperative general information, amount intraoperative blood loss, intraoperative anterior ring fixation method, and postoperative follow-up time between the two groups (P > 0.05). The operative time of the single sacroiliac screw group was shorter than that of the double sacroiliac screw group (P < 0.05). At the last follow-up, the Matta score of the double sacroiliac screw group was significantly better than that of the single sacroiliac screw group (P < 0.05), and there was no statistically significant difference in the Majeed functional scores (P > 0.05). For Tile C1 pelvic fractures, double sacroiliac screw fixation of posterior ring injuries can provide a more stable treatment with no statistically significant difference in functional recovery.

The Correlation Between Preoperative Lower Extremity Deep Vein Thrombosis (DVT) and the Time from Injury to Surgery (TFITS).

OBJECTIVE: To investigate the correlation between preoperative DVT and the time from injury to surgery (TFITS), and provide a clinical reference for the prevention of preoperative DVT. PATIENTS AND METHODS: We collected the clinical data of patients with lower extremities fractures between September 1, 2014, and May 31, 2019. Doppler ultrasonography was used to diagnose DVT. Patients were divided into the 0-2d group, 3-4d group, 5-7d group, and >7d group according to TFITS. The correlation between TFITS and preoperative DVT was assessed using logistic regression according to the adjusted model. RESULT: A total of 2831 patients were included in the study. The mean（+/-SD） TFITS was 6.11 ± 3.76 (0 to 21 d). A total of 821 (29.0%) cases had preoperative DVT, with the incidence of DVT being 8.0% in the 0-2d group, 23.8% in the 3-4d group, 32.0% in the 5-7d group, and 36.2% in the >7d group, with statistically significant differences(P＜0.05) among all the groups. The incidence of preoperative DVT increased with prolonged preoperative time. In the fully adjusted model, TFITS was positively correlated with the incidence of preoperative DVT (OR: 1.093; 95% CI: 1.068-1.118; P = 0.000), and the strength of the association increased with increasing time. CONCLUSION: TFITS was an independent risk factor on the incidence of preoperative DVT. After excluding the effect of other factors, each 1d increases in TFITS was correlated with a 9.3% increase in the risk of preoperative DVT. The TFITS should be decreased to reduce the risk of preoperative DVT.

Management of LC Type I (LC-1) Pelvic Injuries with Complete Sacral Fracture: Comparison of Solitary Anterior Fixation with Combined Anterior-Posterior Fixation.

BACKGROUND: Management of LC-1 type pelvic injuries, particularly in patients with complete sacral fracture (LC-1 PICSF, OTA type 61-B2.1), remains controversial. Specific indications for solitary fixation remain unclear, and there is a paucity of outcomes data in comparison to combined fixation. We undertook a retrospective study in patients with LC-1 PICSFs to compare outcomes between solitary anterior fixation and combined anterior-posterior fixation. METHODS: A retrospective cohort study was conducted with enrollment from 2016 to 2018 at a single tertiary-referral center in China. Adults with operatively managed LC-1 PICSFs were enrolled. Patients with sacral displacement < 1 cm as assessed by axial CT received solitary anterior ring fixation (group A); patients with displacement ≥ 1 cm received combined fixation of both the anterior and posterior rings (group B). Reduction was confirmed by manipulation under anesthesia. Patients followed up for at least 24 months postoperatively. Primary outcome was function (Majeed score). Secondary outcomes included intraoperative characteristics, pain (VAS score), quality of fracture reduction (Tornetta and Matta radiographic grading), rate of nonunion, early weight-bearing status, and complication rate. RESULTS: 68 (89%) of 76 enrolled patients completed follow-up. Patients in group A exhibited improved operative times, less time under fluoroscopy, and less blood loss as compared to group B. There were no significant differences between groups A and B regarding quality of fracture reduction, rate of union, functional outcomes, or rate of complications. Notably, group B patients were more likely to achieve full early weight-bearing. CONCLUSION: LC-1 PFCSFs can get benefits from ORIF; the treatment algorithm should be differently made following the degree of the sacral fractures displacement. Less than 1 cm sacral fracture displacement may get good functional outcomes from solitary anterior fixation. However, for the sacral fractures displacement greater or equal to 1 cm, both the anterior and posterior pelvic rings should be surgical stabilization.

[Recombinant human bone morphogenetic protein 2/porous calcium phosphate cement/autologous bone and combination of platelet-rich plasma in repairing of large bone defects in rabbits by Masquelet technique].

Objective: To investigate the optimal mixing ratio of recombinant human bone morphogenetic protein 2 (rhBMP-2) with porous calcium phosphate cement (PCPC) and autologous bone as bone grafting material for the repair of large bone defects using Masquelet technique. The effect of platelet-rich plasma (PRP) on the healing of bone defects was evaluated under the optimal ratio of mixed bone. Methods: Fifty-four New Zealand White rabbits were taken to establish a 2 cm long bone defect model of the ulna and treated using the Masquelet technique. Two parts of the experiment were performed in the second phase of the Masquelet technique. First, 36 modeled experimental animals were randomly divided into 4 groups ( n=9) according to the mass ratio of autologous bone and rhBMP-2/PCPC. Group A: autologous bone (100%); group B: 25% autologous bone+75% rhBMP-2/PCPC; group C: 50% autologous bone+50% rhBMP-2/PCPC; group D: 75% autologous bone+25% rhBMP-2/PCPC. The animals were executed at 4, 8, and 12 weeks postoperatively for general observation, imaging observation, histological observation (HE staining), alkaline phosphatase (ALP) activity assay, and biomechanical assay (three-point bending test) were performed to assess the osteogenic ability and to determine the optimal mixing ratio. Then, 18 modeled experimental animals were randomly divided into 2 groups ( n=9). The control group was implanted with the optimal mixture ratio of autologous bone+rhBMP-2/PCPC, and the experimental group was implanted with the optimal mixture ratio of autologous bone+rhBMP-2/PCPC+autologous PRP. The same method was used to observe the above indexes at 4, 8, and 12 weeks postoperatively. Results: The bone healing process from callus formation to the cortical connection at the defected gap could be observed in each group after operation; new bone formation, bridging with the host bone, and bone remodeling to normal bone density were observed on imaging observation; new woven bone, new capillaries, bone marrow cavity, and other structures were observed on histological observation. The ALP activity of each group gradually increased with time ( P<0.05); the ALP activity of group A was significantly higher than that of the other 3 groups at each time point after operation, and of groups C and D than group B ( P<0.05); there was no significant difference between groups C and D ( P>0.05). Biomechanical assay showed that the maximum load in three-point bending test of each group increased gradually with time ( P<0.05), and the maximum loads of groups A and D were significantly higher than that of groups B and C at each time point after operation ( P<0.05), but there was no significant difference between groups A and D ( P>0.05). According to the above tests, the optimal mixing ratio was 75% autogenous bone+25% rhBMP-2/PCPC. The process of new bone formation in the experimental group and the control group was observed by gross observation, imaging examination, and histological observation, and the ability of bone formation in the experimental group was better than that in the control group. The ALP activity and maximum load increased gradually with time in both groups ( P<0.05); the ALP activity and maximum load in the experimental group were significantly higher than those in the control group at each time point after operation ( P<0.05), and the maximum load in the experimental group was also significantly higher than that in group A at 12 weeks after operation ( P<0.05). Conclusion: In the second phase of Masquelet technique, rhBMP-2/PCPC mixed with autologous bone to fill the bone defect can treat large bone defect of rabbit ulna, and it has the best osteogenic ability when the mixing ratio is 75% autologous bone+25% rhBMP-2/PCPC. The combination of PRP can improve the osteogenic ability of rhBMP-2/PCPC and autologous bone mixture.

Multimodal Neuroelectrophysiological Monitoring Combined with Robot-Assisted Placement of a Transiliac-Transsacral Screw for the Treatment of Transforaminal Sacral Fractures.

Objective: This study aimed to evaluate the safety and efficacy of the fixation of transforaminal sacral fractures using TiRobot-assisted transiliac-transsacral (TITS) screws under multimodal neuroelectrophysiological monitoring (MNM). Methods: From January 2019 to May 2021, 22 patients (17 male and 5 female patients) with transforaminal sacral fractures who were treated with closed reduction and placement of TiRobot-assisted TITS screws under MNM were retrospectively evaluated. The average age of the patients was 43.32 ± 11.40 years (range: 19-63). The patients received MNM, including somatosensory-evoked potentials (SEPs), motor-evoked potentials (MEPs), and electromyographic monitoring (EMG), prior to surgery, during closed reduction and the placement of the guidewire and TITS screw, and at the end of surgery. The operation was adjusted according to the MNM results. Results: Overall, 22 TITS screws were inserted in 22 patients, including 5 TITS screws in the S1 body and 17 TITS screws in the S2 body. The average time needed for screw placement was 27.95 ± 6.84 mins, and the average frequency of X-ray fluoroscopy exposures was 31.00 ± 5.56 for each patient. Anterior ring fixation was performed in 4 patients using an external fixator, in 5 patients using cannulated screws, and in 13 patients using reconstruction plates. The mean follow-up time was 14.46 ± 2.46 months (12-20 months). Tornetta and Matta radiographic outcomes were excellent in 10 patients, good in 9 patients, fair in 2 patients, and poor in 1 patient. The proportion of excellent and good ratings was 86.36%. At the final follow-up, the average Majeed score was 82.18 ± 14.52, with clinical outcomes that were excellent in 9 patients, good in 9 patients, fair in 1 patient, and poor in 3 patients. The proportion of excellent and good ratings was 82.82%. Preoperatively, the amplitude of the SEP on the injured side was lower than that on the contralateral side before reduction in 9 patients (>50%). In this study, no screw was mistakenly inserted into the sacral canal, and no surgical site infection occurred. Conclusion: MNM combined with TiRobot assistance can safely implant TITS screws and can effectively identify the neurological function of patients under anesthesia and reduce iatrogenic nerve injury.

High-Sensitive Detection of Small-Cell Lung Cancer Cells Based on Terminal Deoxynucleotidyl Transferase-Mediated Extension Polymerization Aptamer Probe.

Small-cell lung cancer (SCLC) is characterized by early metastasis and high invasiveness, poor prognosis, and a low five-year survival rate. Therefore, the development of the effective detection of SCLC cells and imaging methods has potential significance for the prognosis and treatment of SCLC. We designed a terminal deoxynucleotidyl transferase (TdT)-mediated extension polymerization aptamer probe (denoted as TEPAP). Aptamer HCC03 was used as an element of recognizing SCLC, and it was extended as a long poly(T) tail at the 3'-hydroxyl terminus by TdT and then hybridized with short poly(A) labeled with 6-carboxyfluorescein (FAM) to construct TEPAP for the high-sensitivity detection of SCLC. The results showed that the probe could specifically recognize NCI-H446 cells. Compared with HCC03 labeled with FAM, TEPAP has demonstrated a higher fluorescence signal in recognizing NCI-H446 cells, and the fluorescence intensity of TEPAP recognizing the target cells was 10 times higher than that of nontarget cells. Flow cytometric analysis showed that the detection limit of this method was as low as 17 NCI-H446 cells in 200 µL of binding buffer. In the application of clinical cytology cell blocks, the sensitivity, specificity, and accuracy of TEPAP were 89.74, 94.44, and 91.23%, respectively. The high sensitivity and specificity of TEPAP in the application of clinical samples show that the proposed probe has great potential in the diagnosis of SCLC.