Stilbenes from the leaves of Cajanus cajan and their in vitro anti-inflammatory activities.

Eighteen stilbenes (1-18), including six previously undescribed ones (1-6), with diverse modification patterns were isolated from the leaves of edible and medicinal plant Cajanus cajan. Among the new isolates, compounds 1-3 were initially obtained as three racemic mixtures, which were further resolved into three pairs of optically pure enantiomers, respectively, by chiral HPLC. Besides, compounds 8, 10, 11, and 18 were obtained from C. cajan for the first time. The chemical structures and absolute configurations of the new stilbenes were elucidated unambiguously on the basis of extensive spectroscopic analyses, single crystal X-ray crystallographic study, and quantum chemical electronic circular dichroism (ECD) calculations. In addition, the in vitro anti-inflammatory activities of all isolated stilbenes were evaluated. Compounds 2, 9, 10, 11, and 14 exerted moderate suppression of nitric oxide (NO) secretion in lipopolysaccharide (LPS)-induced RAW264.7 cells without exhibiting substantial cytotoxicity.

Bone marrow mesenchymal stem cells attenuate LPS-induced acute lung injury in mice by promoting RvE1/ProD1 and modulating Treg/Th17 balance.

Acute lung injury (ALI) and its severe form acute respiratory distress syndrome (ARDS) are respiratory failures caused by excessive alveolar inflammation with high mortality. In this study, we investigated the effects of bone marrow mesenchymal stem cells (BMSCs) on lung injury of lipopolysaccharide (LPS)-induced ALI and explored the associated mechanisms. BMSCs were isolated, cultured, identified by staining with CD34 and CD44 surface markers. LPS-induced ALI mouse model was generated by injecting with LPS and divided into ALI group and ALI+BMSCs group. Mice treated without any reagents were assigned as Control, mice transplanted with BMSCs were assigned as BMSCs group. Regulatory T (Treg) and Th17 percentages were evaluated using flow cytometry. Proresolving mediators (resolvin E1 (RvE1), protectin D1 (ProD1)) in lung tissue and cytokines (interleukin-6 (IL-6) and IL-17) in serum were analyzed by ELISA. Myeloperoxidase (MPO) activity was determined. Cultured cells demonstrated typical characteristics of BMSCs. BMSCs transplantation (ALI+BMSCs) obviously alleviated LPS-induced ALI in mice. BMSCs transplantation significantly decreased MPO activity in LPS-induced ALI in mice compared to the Control group (p < 0.05). BMSCs transplantation markedly increased Treg percentages and decreased dendritic cells (DCs) and Th17 cells percentages compared to those of the Control group (p < 0.05). BMSCs transplantation remarkably enhanced RvE1 and ProD1 levels in LPS-induced ALI (ALI+BMSCs) compared to the ALI group (p < 0.05). BMSCs transplantation significantly attenuated IL-6 and IL-17 levels in serum of mice treated with LPS (ALI+BMSCs) compared to those of the ALI group (p < 0.05). In conclusion, BMSCs transplantation effectively attenuated LPS-induced pathological injury of ALI in mice, at least partly through promoting proresolving mediators RvE1 and ProD1 and modulating the balance of Treg/Th17.

Discovery of Neuritogenic Securinega Alkaloids from Flueggea suffruticosa by a Building Blocks-Based Molecular Network Strategy.

A combined strategy of building blocks recognition and molecular network construction, termed the building blocks-based molecular network (BBMN), was first presented to facilitate the efficient discovery of novel natural products. By mapping the BBMN of the total alkaloid fraction of Flueggea suffruticosa, three Securinega alkaloids (SEAs) with unusual chemical architectures, suffranidines A-C (1-3), were discovered and isolated. Compound 1 characterizes an unprecedented 8/5/6/5/6/6/6/6-fused octacyclic scaffold with a unique cage-shaped 3-azatricyclo[6.4.0.03,11 ]dodecane core. Compounds 2 and 3 are highly modified SEA dimers that incorporate additional C6 motifs. A hypothetical biosynthetic pathway for 1-3 was proposed. In addition, 1 significantly induced neuronal differentiation and neurite extension by upregulating eukaryotic elongation factor 2 (eEF2)-mediated protein synthesis.

A case report of multi-ligaments injury of the ACL-MCL-PT combined with an occult fracture of the posterolateral tibial plateau.

The anterior cruciate ligament and medial collateral ligament are important static stabilizers of the knee. The patellar tendon is part of the knee extensor mechanism. The injury simultaneously involving these three structures is very rare. This paper reports a case with simultaneous ipsilateral rupture of the anterior cruciate ligament, medial collateral ligament, patellar tendon, and an occult compression fracture of the posterolateral tibial plateau. This injury pattern has not been reported in literature yet. The injury mechanism was hypothesized as a sudden anterior translation and valgus of the proximal tibia when the knee was in high flexion, followed by an eccentric quadriceps' contracture. In the followed management, ruptured medial collateral ligament and patellar tendon were sutured with augment, while the torn anterior cruciate ligament and fracture were treated conservatively. The outcome of the treatment was satisfactory, and no complication was observed. To this combined injury, a comprehensive consideration, including physical examination, multiple imaging examinations, and analysis of injury mechanism, is essential for a full diagnosis and treatment decision. Especially, computed tomography may help to identify an occult or non-displaced fracture, which would be easily misdiagnosed when nothing unusual was found in routine X-rays. In the treatment, it is suggested to perform a selective or step-by-step repair to the damaged structures, rather than an immediate total repair after injury.

Cajanusoids A-D, Unusual Atropisomeric Stilbene Dimers with PTP1B Inhibitory Activities from the Leaves of Cajanus cajan.

Four novel stilbene dimers (1-4), together with their biosynthetically related stilbene monomers (5 and 6), were isolated from the leaves of Cajanus cajan. Their structures with absolute configurations were determined by comprehensive analysis of spectroscopic data and electronic circular dichroism calculations. Compounds 1 and 2 are two novel dimeric stilbenes with an unusual coupling pattern that resulted in a rare configurationally stable Csp2-Csp3 chiral axis with both point and axial chirality in their molecules. Due to their unique inherent structural features, both of them naturally occur as equilibrating mixtures of unequally populated atropo-diastereomers and their respective enantiomers. Compounds 3 and 4 are two pairs of novel dimeric stilbene atropisomers featuring a rotationally hindered central biaryl axis. Notably, 3 contains a rare arylbenzoquinone core and 4 is a symmetric dimer with a C2 symmetry axis. The hypothetical biosynthetic pathway of 1-4 was also proposed herein. All the new compounds exhibited significant protein tyrosine phosphatase-1B (PTP1B) inhibition effects. In addition, the preliminary mode of action for the most potent compound 3 was investigated by molecular docking and binding free energy calculation.

Novel Rim Plating Technique for Treatment of the Inferior Pole Fracture of the Patella.

To aim of the present paper was to introduce a novel fixation technique for the treatment of inferior pole fracture of the patella. We performed a prospective observational study of consecutive cases of inferior pole fracture of the patella that were treated at our institution between January 2018 and June 2019. The patients include three men and one woman, with an average age of 47 years (range: 42-59 years). All patients were treated with the novel rim plating fixation technique for preserving the inferior pole of the patella. During the surgery, a 2.4 mm straight locking compression plate was contoured to adapt to the arc of the lower half of the patella as the rim plate. After reduction of the fracture, the rim plate was fixed to the proximal fragment of the patella through multiple locking screws, against the continuous pull of the patellar tendon. The rim plate encircles and constricts the inferior pole fragments, functioning as a compression and blocking construct. If necessary, an additional anterior tension band or mini locking plate can be used to further prevent anterior displacement of the inferior pole fragments. Under this rigid fixation, motion of the knee and full weight-bearing were encouraged postoperatively. The patients were followed up monthly until 12 months after surgery. The time to achieve 90°pain-free, full range of motion of the knee, and fracture healing, were recorded. Related complications were monitored, including infection, loss of reduction, fixation failure, anterior knee pain, and soft-tissue irritation. The modified Cincinnati knee rating system was used for knee function assessment. The average operative time was 58.8 min (range: 52-63 min). The average blood loss was 59.8 mL (range: 45-71 mL). For all patients, pain-free 90° range of motion was restored in 2-4 weeks, and the full range of motion was restored in 8-11 weeks. All patients achieved bone union in 6-9 weeks with no displacement of the fragments or breakage of the implant. No patient complained of anterior knee pain or soft-tissue irritation. The modified Cincinnati score at 12-month follow up demonstrated excellent outcomes in all four patients. The rim plating technique may be a feasible option for the treatment of the inferior pole fracture of the patella.

Loss of Reduction after Cephalomedullary Nail Fixation of Intertrochanteric Femoral Fracture: A Brief Report.

OBJECTIVE: At present, cephalomedullary nail is the most frequently used implant in the management of intertrochanteric fractures around the world. The implant design and fixation techniques of the cephalomedullary nail have been continuously improved to ensure uncomplicated bone union during the past decade. However, a degree of reduction loss during bone healing is still not rare in clinical work. Many attributed this complication to misoperation during the surgery and hold that a series of techniques and tips could help to avoid the loss of reduction. However, until now there has been no research to explore whether the reduction loss after the operation can be fully prevented in the best cases. The purposes of the study are as follows: (i) to evaluate the efficiency of the current established CMN techniques; (ii) to quantify the loss of reduction under an appropriately implanted CMN to anatomically realigned intertrochanteric fractures; and (iii) to explore the possible underlying causes for the inevitable loss of reduction. METHODS: In the retrospective study, 163 consecutive cases with the intertrochanteric fractures fixed with standard cephalomedullary nail technique were reviewed. The anatomical reduction and optimal positioning of the nail were confirmed by postoperative imaging. The fracture types ranged from 31-A1.1-2.3 according to the OTA/AO fracture classification. One hundred and fifteen cases with stable fracture types (31A1.1-2.1) were allocated to Group A, and 48 cases with unstable 31A2.2-2.3 fracture types were allocated to Group B. The radiological measurements included femoral neck shortening, loss of the neck-shaft angle, cutout, and cut-through of the blade. The outcomes between postoperative and 1 year after the operation were evaluated and compared. RESULTS: The patients consisted of 66 males and 97 females with an average age of 69.4 (range: 46-78, SD: 14.6) years. At the 1-year follow-up, no fixation failure or nonunion was observed in each group. The mean femoral neck shortening and loss of the neck-shaft angle were 4.47 mm (range: 0.43-17.68, SD: 3.71) and 5.4° (range: 0.51-19.10, SD: 3.58) separately. The mean cutout and cut-through were 1.84 mm (range: 0.24-11.30, SD: 2.33) and 1.25 mm (range: 0.51-10.29, SD: 1.74). The average femoral neck shortening and loss of the neck-shaft angle were higher in Group B than Group A. Among the 23 cases with the femoral neck shortening more than 10 mm, 19 cases (16.5%) were from Group A and four cases (8.3%) were from Group B. There were nine (7.8%) cases with the loss of the neck-shaft angle more than 10° in Group A and six (12.5%) cases in Group B. CONCLUSIONS: Current established CMN techniques are efficient in treating intertrochanteric femoral fracture. However, even with currently consensual techniques of cephalomedullary nail, the process of fracture healing still risks the loss of reduction, although the migration of the blade could be minimized. This situation may associate with the intrinsic design of the CMN and further improvement is still needed.

Giant Cell Tumor of Tendon Sheath with Tarsal Bones and Intertarsal Joint Invasion: A Case Report.

The giant cell tumor of tendon sheath (GCTTS) is a benign lesion most commonly attached to the tendons and bones of the fingers, hands, and wrists. The involvement of GCTTS to the foot is uncommon. The GCTTS invading tarsal bones and intertarsal joints is not described yet, and the appropriate diagnosis and treatment remain unclear. We report a case of GCTTS with the involvement of tarsal bones and intertarsal joint. Computed tomography scan and magnetic resonance imaging were used to further diagnose and evaluate the quality and range of tumor. The patient was treated with surgical excision of the tumor without application of bone graft. After adequate clearance of the tumor, the patient returned to an asymptomatic walk in 3 months. No malfunction, fracture, or tumor recurrence was found in 2-years follow-up. This report includes clinical, radiologic, histologic diagnostic, and surgical challenges in an unexpected lesion and a review of the literature.

Alkaloid constituents from the fruits of Flueggea virosa.

Three new indole alkaloids, flueindolines A-C (1-3), along with nine known alkaloids (4-12), were isolated from the fruits of Flueggea virosa (Roxb. ex Willd.) Voigt. Compounds 1 and 2 are two new fused tricyclic indole alkaloids possessing an unusual pyrido[1, 2-a]indole framework, and 3 presents a rare spiro (pyrrolizidinyl-oxindole) backbone. Their structures with absolute configurations were elucidated by means of comprehensive spectroscopic analysis, chemical calculation, as well as X-ray crystallography. Chiral resolution and absolute configuration determination of the known compounds 4, 10, and 11 were reported for the first time. The hypothetical biogenetical pathways of 1-3 were herein also proposed.

Medial Open-wedge Osteotomy with Double-plate Fixation for Varus Malunion of the Distal Femur.

OBJECTIVE: To present our clinical experience of treating varus malunion of the distal femur through a medial open-wedge osteotomy with double-plate fixation. METHODS: A prospective cohort study was performed. From January 2005 to February 2015, 15 consecutive patients with varus malunion following distal femur fractures were surgically treated at a single level I trauma center. The coronal and sagittal deformity were corrected by a medial open-wedge osteotomy of the distal femur. A medial buttress plate was used to maintain the realignment. A lateral locking plate was additionally used as a protection plate. The mean age of patients at the time of the surgery was 35.5 years (range, 22-58 years). The radiographical evaluation included the mechanical femorotibial angle, the mechanical lateral distal femoral angle, the anatomic posterior distal femoral angle, and the leg length discrepancy. Clinical outcome evaluation consisted of the range of motion (ROM) and Hospital for Special Surgery (HSS) score. RESULTS: Mean follow-up was 7.4 years (range, 4-11.5 years). Varus and flexion malalignment and limb discrepancy were adequately corrected in all patients. The mechanical femorotibial angle, the mechanical lateral distal femoral angle, and the anatomic posterior distal femoral angle were restored from 17.5° (range, 13°-25°) to 2.3° (range, - 2°-7°), 102.3° (range, 95°-112°) to 85.2° (range, 81°-92°), and 77.1° (range, 65°-87°) to 82.7° (range, 76°-88°), respectively. The leg length discrepancy was diminished from 3.4 cm (range, 2.4-4.5 cm) to 0.8 cm (range, 0-1.7 cm). The average bone healing time was 4.1 months (range, 2.5-6 months). The average ROM of the affected knees at 24-month follow-up was 3.4°-112.55°. The score of HSS at 4-years follow-up was 76.1 (range, 64-88). No internal fixation failure or secondary operation was noted until the last follow-up. CONCLUSION: Medial open-wedge osteotomy can adequately correct the posttraumatic varus malunion of the distal femur. With fixation of the double plate, non-displaced bone healing and good functional outcome are expected.

Tibial plateau fractures in elderly people: an institutional retrospective study.

BACKGROUND: Tibial plateau fractures are the most common intra-articular fractures, which require careful evaluation and preoperative planning. The treatment of tibial plateau fractures in elderly patients is challenging, and the comprehension of epidemiology and morphology can be helpful. This study described the characteristics of geriatric tibial plateau fractures. METHODS: A total of 327 (23.24%) patients aged ≥60 years were reviewed in our level one trauma center over a 4-year period (from January 2013 to November 2016). The following parameters were collected and evaluated: (1) demographic data, (2) injury mechanisms and (3) fracture classifications. RESULTS: Females accounted for 60.86% in all included elderly patients. Electric-bike accidents were the cause of 32.42% of all these injuries, and 39.62% of these led to high-energy injuries. The most common type of fracture was Schatzker II (54.74%). According to the three-column classification, single lateral column fracture (28.75%) and four-quadrant fracture (involving lateral, medial, posterolateral and posteromedial fractures) (23.24%) were the two most frequent patterns. In all cases, 67.58% involved the posterior column, and the prevalence of posterolateral and posteromedial fractures were 62.69% and 37.92% respectively. Isolated posterior column fractures accounted for 12.54% of patients in total, which mostly consisted of posterolateral fracture in older females (85.37%). CONCLUSIONS: The majority of elderly patients with tibial plateau fractures are females, and Electric-bike accidents are an important cause of injury. Geriatric tibial plateau fractures have unique distribution in classification.

A biomechanical evaluation of different fixation strategies for posterolateral fragments in tibial plateau fractures and introduction of the 'magic screw'.

BACKGROUND: Posterior plate fixation is biomechanically the strongest fixation method for posterolateral column fracture (PLCF) of the tibial plateau; however, there are inherent deficiencies and risks of a posterior approach. Thus, the 'magic screw' was proposed to enhance fixation stability of the lateral rafting plate used for PLCF. The purpose of this study was to re-examine and compare the stability of different fixation methods for PLCF. METHODS: Synthetic tibiae models were used to simulate posterolateral split fractures. The fracture models were randomly assigned into three groups: Group A, fixed with posterolateral buttress plates; Group B, with lateral locking compression plates (LCP); and Group C fixed with lateral LCPs and one 'magic screw'. Gradually increased axial compressive loads were applied to each specimen. RESULTS: There was a mean subsidence hierarchy of the posterolateral fragment at different load levels: Group A had the least subsidence, followed by Group C, and Group B had the most. There were no significant differences in the mean loads at different displacements between Group A and Group C. Group A had the highest axial stiffness. Additionally, there was a significant difference in axial stiffness between Group B and Group C. CONCLUSION: Biomechanical stability of the combined fixation of the posteriorly positioned lateral rafting plate with the 'magic screw' was much closer to that of posterior plate fixation for split-type PLCF. The necessity of posterior fixation through a posterior approach may be reduced for selected patients.

Cajanusflavanols A-C, Three Pairs of Flavonostilbene Enantiomers from Cajanus cajan.

Three pairs of new flavonostilbene enantiomers, cajanusflavanols A-C (1-3), along with their putative biogenetic precursors 4-6, were isolated from Cajanus cajan. Compound 1 possesses an unprecedented carbon skeleton featuring a unique highly functionalized cyclopenta[1,2,3-de]isobenzopyran-1-one tricyclic core. Compounds 2 and 3 are the first examples of methylene-unit-linked flavonostilbenes. Their structures with absolute configurations were elucidated by spectroscopic analyses, X-ray diffraction, and computational calculations. Compounds 1 and 2 exhibited significant in vitro anti-inflammatory activities.

Reinforcement strategy for lateral rafting plate fixation in posterolateral column fractures of the tibial plateau: The magic screw technique.

BACKGROUND: A posterolateral column fracture of the tibial plateau (PLCF) is not uncommon, especially lateral and bicondylar tibial plateau fractures. Currently, there is no consensus on the methods of surgical treatment for PLCF, including the surgical approach or the fixation strategy. Though various posterior approaches have been explored and can allow posterior buttress plate fixation, the necessity of a posterior approach with fixation for PLCFs is increasingly questioned. Meanwhile, there is no literature to analyse the morphological features of PLCFs. None of the available surgical techniques can solve all of the problems of PLCFs. METHODS: From February 2016 to June 2016, an inconsecutive series of 16 patients who suffered Schatzker type II tibial plateau fractures involving the posterolateral column were selected based on an analysis of the morphological characteristics of PLCFs. The patients were all treated by lateral rafting plate fixation with magic screw implantation through the extended lateral approach. RESULTS: According to PLCF morphology, 4 patients had mild slope-type depression fractures (MSDF) of the articular surface, and the other 12 patients had block-type splitting fractures (BSF). After a 12-month follow-up period, there were no complications related to the fixation technique and no significant changes in limb alignment. At the final follow-up, the average range of motion (ROM) of the affected knees was 2.3°-125°, and the average HSS score was 94.2. CONCLUSIONS: The selected patients who suffered Schatzker type II fractures involving the posterolateral column could be successfully treated via lateral rafting plate fixation with the magic screw technique. For PLCF treatment, magic screw fixation is a valuable technique that may reduce the utilization of posterior approaches and posterior fixations.

Plate fixation for Letenneur type I Hoffa fracture: a biomechanical study.

BACKGROUND: A coronal fracture of the posterior femoral condyle, also known as a Hoffa fracture, is an unusual injury, and there are only a handful of case reports or series exploring it. The optimal fixation method of these intraarticular fractures remains controversial; improper or unstable fixation usually lead to an unsatisfactory prognosis. The use of posterior-anterior or reversed lag screw fixation is still a popular method. Additional buttress plating is also recommended for fixation of these difficult fractures. The purpose of this study was to compare the mechanical strength of four different fixation patterns for this uncommon fracture. MATERIAL AND METHODS: Sixteen sawbone simulated models of Letenneur type I Hoffa fractures were created with one of four fixation patterns: two screws implanted in the anterior-posterior (AP) direction or posterior-anterior (PA) direction; one screw in the PA direction with a plate implanted in the posterior position of the distal femoral condyle or with a plate in the lateral position. Biomechanical testing was performed to determine the post-fixation axial stiffness, the maximum load to failure and the fragment vertical displacement for each of the four constructs. RESULTS: The plate fixation patterns whether implanted in the posterior or lateral position were shown to provide higher overall axial stiffness and load to failure, and less vertical displacement than the other two patterns of pure screw fixation. Among these constructs, the lateral plate fixation was found to provide the highest stiffness and load to failure and the least displacement for the posterior condylar fragments, followed by the posterior plate fixation. The lowest overall stiffness and load to failure and the largest vertical displacement were found in the construct with the AP direction placed screws. CONCLUSION: It was concluded that the lateral position implanted plate is biomechanically the strongest fixation method for Letenneur type I Hoffa fractures. However, this plate fixation is not recommended for all cases. The choice of internal fixation pattern depends on the surgeons.

[Application of enriched bone marrow compound with fibrin glue in repairing old radial bone defect in rabbits].

OBJECTIVE: To explore the feasibility of using enriched bone marrow (BM) compound with fibrin glue (FG) in repairing old radial bone defect. METHODS: Totally 36 New Zealand rabbits were equally randomized into three groups: simple FG group, BM+FG group, and enriched BM+FG group. A 1.5-cm segmental bone defect was made at the left radial in each animal. After one month, the defect was implanted with the engineered bone. Before implantation, a compound of enriched BM with FG underwent electron microscopy, long-term culture, and bacteriological culture. Four, 8, and 12 weeks after operations, the osteogenetic effect was evaluated using X-ray observation, HE staining, or Van Gieson staining, and a semi-quantitative analysis was performed. RESULTS: Electron microscopy showed enriched BM were compatible well with FG. No bacterial contamination or oncogenicity was observed after long-term culture. X-ray showed the repair effectiveness was significantly higher in BM+FG group and enriched BM+FG group than in simple FG group. Eight and 12 weeks after surgery, the Yang scores were significantly higher in enriched BM+FG group than in BM+FG group [(9.348±0.364évs.(7.984±0.229éìF=40.167ìP=0.001; (12.664±0.388)vs. (10.584±0.836é, F=20.3647ìP=0.004]. In addition, the Yang's scores at bone defects in BM+FG group and enriched BM+FG group were higher at the 12(th) week than in the 8(th) week. (F=36.004ìP=0.001; F=155.141ìP=0.000; respectively)The bone defects were repaired at varied degrees were histologically observed in BM+FG group and enriched BM+FG group during the observations. CONCLUSION: Implantation of BM+FG or enriched BM+FG are effective in repairing old radial bone defects, while simple FG shows not such effect.