Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures.

The objective of this study was to compare the clinical results and complications of proximal femoral nail antirotation (PFNA) on treatment of intertrochanteric fractures in 120 elderly Chinese patients using Randomized Controlled Trials (RCTs). Totaly 120 cases enrolled were randomly assigned to a lateral decubitus position group and supine position group. The hospital stay, operating time, intraoperative blood loss, length of incision, X-ray fluoroscopy time, and out-of-bed activity time in the lateral decubitus position group were significantly lower than those in the supine position group. There was not statistical significance on union time and Harris values in the two position groups. Moreover, only complications of superficial wound infection were observed in the lateral decubitus position group, but two complications of deep venous thrombosis and wound deep infection were found in the supine position group. The present findings suggested that PFNA applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the treatment of intertrochanteric fractures using lateral decubitus position showed a satisfactory clinical outcome and a lower radiological complication rate.

Anesthetic Management of Patients After Scoliosis Surgery: A Single-Center Retrospective Study.

PURPOSE: To evaluate the effect of anesthetic management on scoliosis surgery and review the incidence rate of perioperative adverse events. METHODS: This was a retrospective study and approved by the ethics committee. Patients who underwent scoliosis surgery from April 2011 to March 2018 in the Third Hospital of ChengDu were enrolled in this study. Characteristics of patients were obtained from the hospital's electronic records. The following information on patients was collected: preoperative assessment details, premedication, type of anesthesia and operation, the main postoperative outcome, and complications. Data were presented as the mean ± standard deviations (SD) for normally distributed continuous variables and numbers for categorical variables. Statistical analyses were performed using SPSS version 22.0. RESULTS: In total, 513 patients were enrolled in the present study. The main preoperative complication was cardiopulmonary dysfunction (386 cases, 75.24%). Anesthesia induction was performed with conscious tracheal intubation after oral surface anesthesia. In total, the common postoperative complications involved anesthesia (24 cases, 4.68%), surgery (23 cases, 4.48%), the respiratory system (138 cases, 26.90%), and the gastrointestinal tract (nine cases, 1.75%). The majority of postoperative complications were postoperative hypoxemia and hypercapnia, caused by poor cardiopulmonary function. Rare and serious complications still occurred. Three patients died in hospital. CONCLUSION: Our study demonstrated a high incidence of complications in scoliosis surgery, especially postoperative complications. Extreme postoperative vigilance is required and high-level monitoring of conditions is highly recommended.

EMT-related gene expression is positively correlated with immunity and may be derived from stromal cells in osteosarcoma.

BACKGROUND: Osteosarcoma is the most common type of bone cancer in children and young adults. Recent studies have shown a correlation between epithelial-mesenchymal transition (EMT)-related gene expression and immunity in human cancers. Here, we investigated the relationship among EMT, immune activity, stromal activity and tumor purity in osteosarcoma. METHODS: We defined EMT gene signatures and evaluated immune activity and stromal activity based on the gene expression and clinical data from three independent microarray datasets. These factors were evaluated by single sample Gene Set Enrichment Analyses and the ESTIMATE tool. Finally, we analyzed the key source of EMT gene expression in osteosarcoma using microarray datasets from the Gene Expression Omnibus and human samples that we collected. RESULTS: EMT-related gene expression was positively correlated with immune and stromal activity in osteosarcoma. Tumor purity was negatively correlated with EMT, immune activity and stromal cells. We further demonstrated that high EMT gene expression could significantly predict poor overall survival (OS) and recurrence-free survival (RFS) in osteosarcoma patients, while high immune activity cannot. However, combining these factors could have further prognostic value for osteosarcoma patients in terms of OS and RFS. Finally, we found that stromal cells may serve as a key source of EMT gene expression in osteosarcoma. CONCLUSION: The results of this study reveal that the expression of EMT genes and immunity are positively correlated, but these signatures convey disparate prognostic information. Furthermore, the results indicate that EMT-related gene expression may be derived from stromal rather than epithelial cancer cells.

[Apoptosis and caspase-12 expression in progressive compressive spinal cord injury: experiment with rats].

OBJECTIVE: To investigate the apoptosis and caspase-12 expression in progressive compression of spinal cord (PCSC). METHODS: 120 adult Wistar rats were randomly divided into 2 equal groups, experimental group, undergoing operation so as to establish PCSC models, and control group, undergoing sham operation. 1, 3, 7, 14, 21, and 28 days after the operation, 5 rats from each group were anesthetized with their spinal cords taken out. TUNNEL method was used to observe the apoptosis of the neurons in the compressed segments. Another 5 rats from each group at different time points were anesthetized with their spinal cords as well. Immunohistochemistry was used to detect the mRNA expression of caspase-12 in the compressed segments. Western blotting was used to detect the protein expression of caspase-12. RESULTS: The apoptotic rates of neurons and gliocytes 1, 3, 7, 14, 21, and 28 days after were 12.5% +/- 2.3%, 13.0% +/- 3.6%, 17.2% +/- 4.3%, 29.4% +/- 4.4%, 36.1% +/- 6.5%, and 2.3% +/- 7.9% respectively, with significant differences among the values 14, 21, and 28 days and those at other time points after the operation (all P < 0.05). Immunohistochemistry showed that the number of caspase-12 positive neurons increased since 1 day after, and became remarkably high 14, 21, and 28 days after with significant differences among different time points (all P < 0.05). Western blotting showed that the protein expression of caspase-12 was low 1, 3, and 7 days after, and peaked 14 days after, and then gradually decreased, however, the expression levels 21 and 28 days after were still significantly higher then those 1, 3, and 7 days after (all P < 0.05). CONCLUSION: Caspase-12 is involved in the apoptosis of neurons in PCSC.

Control of pore size and permeability of a glucose-responsive gating membrane for insulin delivery.

The pore size and permeability control of a glucose-responsive gating membrane with plasma-grafted poly(acrylic acid) (PAAC) gates and covalently bound glucose oxidase (GOD) enzymes were investigated systematically. The PAAC-grafted porous polyvinylidene fluoride (PVDF) membranes with a wide range of grafting yields were prepared using a plasma-graft pore-filling polymerization method, and the immobilization of GOD was carried out by a carbodiimide method. The linear grafted PAAC chains in the membrane pores acted as the pH-responsive gates or actuators. The immobilized GOD acted as the glucose sensor and catalyzer; it was sensitive to glucose and catalyzed the glucose conversion to gluconic acid. The experimental results showed that the glucose responsivity of the solute diffusional permeability through the proposed membranes was heavily dependent on the PAAC grafting yield, because the pH-responsive change of pore size governed the glucose-responsive diffusional permeability. It is very important to design a proper grafting yield for obtaining an ideal gating response. For the proposed gating membrane with a PAAC grafting yield of 1.55%, the insulin permeation coefficient after the glucose addition (0.2 mol/l) was about 9.37 times that in the absence of glucose, presenting an exciting result on glucose-sensitive self-regulated insulin permeation.

Preparation of glucose-sensitive microcapsules with a porous membrane and functional gates.

A glucose-sensitive microcapsule with a porous membrane and with linear-grafted polyacrylic acid (PAAC) chains and covalently bound glucose oxidase (GOD) enzymes in the membrane pores acting as functional gates was successfully prepared. Polyamide microcapsules with a porous membrane were prepared by interfacial polymerization, PAAC chains were grafted into the pores of the microcapsule membrane by plasma-graft pore-filling polymerization, and GOD enzymes were immobilized onto the PAAC-grafted microcapsules by a carbodiimide method. The release rates of model drug solutes from the fabricated microcapsules were significantly sensitive to the existence of glucose in the environmental solution. In solution, the release rate of either sodium chloride or VB(12) molecules from the microcapsules was low but increased dramatically in the presence of 0.2mol/L glucose. The prepared PAAC-grafted and GOD-immobilized microcapsules showed a reversible glucose-sensitive release characteristic. The proposed microcapsules provide a new mode for injection-type self-regulated drug delivery systems having the capability of adapting the release rate of drugs such as insulin in response to changes in glucose concentration, which is highly attractive for diabetes therapy.