Changes and Clinical Value of Serum miR-24 and miR-223 Levels in Patients with Severe Pneumonia.

Introduction: Severe pneumonia progresses rapidly, so early assessment of the severity and prognosis is crucial for reducing mortality rates. Objective: We explore the role of serum microRNA-24 (miR-24) and microRNA-223 (miR-223) in the prognosis of severe pneumonia. Methods: There were a total of 96 patients with general pneumonia, 94 patients with severe pneumonia, and 93 healthy people, who were enrolled in this study. The levels of serum miR-24 and miR-223 were detected by real-time fluorescent quantitative PCR in all groups. Results: The serum miR-223 level in the severe group was higher than that in the common group and the control group, and the miR-24 level was lower than that in the common group and the control group (P<0.05). The serum miR-223 levels and APACHEII scores in the death group were higher than those in the survival group on the first, third, and seventh day after admission, while the miR-24 levels were lower than those in the survival group (P<0.05). The proportion of patients with mechanical ventilation in the death group was higher than that in the survival group (P<0.05). The level of serum miR-24 was negatively correlated with APACHEII score and mechanical ventilation in patients who died of severe pneumonia (P<0.05), and miR-223 was positively correlated with APACHEII score and mechanical ventilation (P<0.05). The AUC predicted by serum miR-24, miR-223, and APACHEII scores alone and jointly were 0.867, 0.839, 0.791, and 0.952, respectively. MiR-24 and miR-223 are protective and independent risk factors for mortality in severe pneumonia patients, respectively (P<0.05). MiR-24 was a protective factor affecting the death of patients with severe pneumonia, and miR-223 was an independent risk factor affecting the death of patients with severe pneumonia (P<0.05). Conclusion: The combination of serum miR-24 and miR-223 levels on the first day after admission and APACHEII score can effectively predict prognosis.

Iguratimod promotes functional recovery after SCI by repairing endothelial cell tight junctions.

Destruction of the blood-spinal cord barrier (BSCB) after spinal cord injury (SCI) is an important factor promoting the progression of the injury. This study addressed how to repair the BSCB in order to promote the repair of injured spinal cords. Iguratimod (IGU), an anti-rheumatic drug, has been approved for clinical use. A spinal cord injury mouse model and TNF-α-stimulated bEnd.3 cells were used to investigate the effect and mechanism of IGU on injured BSCB. An intracerebroventricular osmotic pump was used to administer drugs to the SCI mouse model. The results showed that the SCI mice in the treatment group had better recovery of neurological function than the control group. Examination of the tissue revealed better repair of the BSCB in injured spinal cords after medication. According to the results from the cell model, IGU promoted the expression of tight junction proteins and reduced cell permeability. Further research found that IGU repaired the barrier function by regulating glycolysis levels in the injured endothelial cells. In studying the mechanism, IGU was found to regulate HIF-1α expression through the NF-κB pathway, thereby regulating the expression of the glycolytic enzymes related to endothelial injury. In summary, IGU promoted functional recovery in vivo by repairing the BSCB. In vitro, IGU regulated the level of glycolysis in the damaged endothelium through the NF-κB pathway, thereby repairing the tight junctions between the endothelium. Therefore, IGU may become a potential drug for treating spinal cord injury.

Coal-Rock Dynamic Disaster Prevention Mechanism Based on the Dual Loads of Dynamic Barrier and Static Pressure Relief by Hydraulic Slotting.

According to the characteristics of coal-rock dynamic disasters and hydraulic slotting, the mechanism of dynamic load barrier and static load pressure relief in hydraulic slotting is proposed. The stress distribution in a coal mining face and the slotted area of a section coal pillar is analyzed by numerical simulation. The results show that the slot formed by hydraulic slotting can effectively alleviate the stress concentration and transfer the high-stress area to a deeper coal seam. When slotting and blocking the dynamic load propagation path in a coal seam, the wave intensity of the stress wave transmitted into the slot is greatly reduced, so the risk of a coal-rock dynamic disaster is reduced. A field application of hydraulic slotting prevention technology was carried out in the Hujiahe coal mine. An investigation of microseismic events and an evaluation of the rock noise system show that the average event energy within 100 m mining mileage decreased by 18%, the microseismic energy per unit footage decreased by 37%, the times of strong mine pressure behavior evaluated in the working face decreased by 17%, and the number of risks decreased by 89%. In conclusion, hydraulic slotting technology can effectively reduce the risk of coal-rock dynamic disasters in mining faces and provides a more effective technical means for coal-rock dynamic disaster prevention.

A prospective marker for the prediction of postoperative deep venous thrombosis: Neutrophil extracellular traps.

Deep venous thrombosis (DVT) is a common medical complication in patients with lumbar fractures. The current study aimed to investigate the predictive value of neutrophil extracellular traps (NETs) in postoperative DVT formation in patients with lumbar fractures and to develop a nomogram relating clinical admission information for prediction. Patients who underwent open reduction and pedicle screw internal fixation in the treatment of single-segment lumbar fracture in the Department of Spine Surgery, the First Affiliated Hospital of Nanjing Medical University, from December 2020 to June 2022 were enrolled in this study. Baseline data and laboratory results were collected from enrollees, and the primary study endpoint event was the occurrence of DVT in patients after surgery. Multivariable logistic regression analysis was used to identify risk factors associated with higher odds of DVT after surgery. A nomogram was constructed using the results of the multivariable model. The calibration plot and receiver operating characteristics (ROC) curve were used to show the satisfactory predictive capacity of the model. Of these 393 patients who did not have DVT preoperatively, 79 patients developed it postoperatively, and 314 did not, respectively. Multivariate analysis showed that higher body mass index (BMI) (BMI between 24 and 28: RR = 1.661, 95% CI = 0.891-3.094; BMI ≤28: RR = 5.625, 95% CI = 2.590-12.217; reference: BMI <24), neutrophils (RR = 1.157, 95% CI 1.042-1.285), D-dimer (RR = 1.098, 95% CI 1.000-1.206), and citrullinated histone H3 (CitH3) (RR = 1.043, 95% CI 1.026-1.060) were independent risk factors for postoperative DVT. Using the multivariable analysis, we then constructed a nomogram to predict DVT, which was found to have an area under the curve of 0.757 (95% CI = 0.693-0.820). Calibration plots also showed the satisfied discrimination and calibration of the nomogram. In conclusion, patients with lumbar fractures with postoperative DVT had higher levels of NETs in the circulation preoperatively compared to those without postoperative DVT. Furthermore, based on BMI, D-dimer, neutrophils, and CitH3, we developed a predictive model to predict postoperative DVT incidence in these patients.

Development and Clinical Trial of a New Orthopedic Surgical Robot for Positioning and Navigation.

Robot-assisted orthopedic surgery has great application prospects, and the accuracy of the robot is the key to its overall performance. The aim of this study was to develop a new orthopedic surgical robot to assist in spinal surgeries and to compare its feasibility and accuracy with the existing orthopedic robot. A new type of high-precision orthopedic surgical robot (Tuoshou) was developed. A multicenter, randomized controlled trial was carried out to compare the Tuoshou with the TiRobot (TINAVI Medical Technologies Co., Ltd., Beijing) to evaluate the accuracy and safety of their navigation and positioning. A total of 112 patients were randomized, and 108 patients completed the study. The position deviation of the Kirschner wire placement in the Tuoshou group was smaller than that in the TiRobot group (p = 0.014). The Tuoshou group was better than the TiRobot group in terms of the pedicle screw insertion accuracy (p = 0.016) and entry point deviation (p < 0.001). No differences were observed in endpoint deviation (p = 0.170), axial deviation (p = 0.170), sagittal deviation (p = 0.324), and spatial deviation (p = 0.299). There was no difference in security indicators. The new orthopedic surgical robot was highly accurate and optimized for clinical practice, making it suitable for clinical application.

A comparison of robot-assisted and fluoroscopy-assisted kyphoplasty in the treatment of multi-segmental osteoporotic vertebral compression fractures.

Osteoporotic vertebral compression fracture (OVCF) has become a major public health issue that becomes more pressing with increasing global aging. Percutaneous kyphoplasty (PKP) is an effective treatment for OVCF. Robot-assisted PKP has been utilized in recent years to improve accuracy and reduce complications. However, the effectiveness of robot-assisted PKP in the treatment of multi-segmental OVCF has yet to be proved. This study was designed to compare the efficacy of robot-assisted and conventional fluoroscopy-assisted multi-segmental PKP. A total of 30 cases with multi-segmental OVCF between April 2019 and April 2021 were included in this study. Fifteen cases were assigned to the robot-assisted PKP group (robot group) and 15 cases to the conventional fluoroscopy-assisted PKP group (conventional fluoroscopy group). The number of fluoroscopic exposures, fluoroscopic dose, operation time, cement leakage rate, visual analog scale (VAS) score, vertebral kyphosis angle (VKA), and height of fractured vertebral body (HFV) were compared between the 2 groups. The number of fluoroscopic exposures, fluoroscopic doses, and cement leakage rates in the robot group were lower than in the conventional fluoroscopy group ( P<0.05) while the operative time in the robot group was longer than in the conventional fluoroscopy group ( P<0.05). VAS score and VKA were decreased and HFV was increased after surgery in both groups ( P<0.05). Therefore, robot-assisted PKP for the treatment of multi-segmental OVCF can reduce the number of fluoroscopic exposures, fluoroscopic doses, and cement leakage compared to conventional treatment. As such, robot-assisted PKP has good application prospects and is potentially more effective in the treatment of multi-segmental OVCF.

Fatty acids derived from apoptotic chondrocytes fuel macrophages FAO through MSR1 for facilitating BMSCs osteogenic differentiation.

The nonunion following a fracture is associated with severe patient morbidity and economic consequences. Currently, accumulating studies are focusing on the importance of macrophages during fracture repair. However, details regarding the process by which macrophages facilitate endochondral ossification (EO) are largely unknown. In this study, we present evidence that apoptotic chondrocytes (ACs) are not inert corpses awaiting removal, but positively modulate the osteoinductive ability of macrophages. In vivo experiments revealed that fatty acid (FA) metabolic processes up-regulated following EO. In vitro studies further uncovered that FAs derived from ACs are taken up by macrophages mainly through macrophage scavenger receptor 1 (MSR1). Then, our functional experiments confirmed that these exogenous FAs subsequently activate peroxisome proliferator-activated receptor α (PPARα), which further facilitates lipid droplets generation and fatty acid oxidation (FAO). Mechanistically, elevated FAO is involved in up-regulating the osteoinductive effect by generating BMP7 and NAD+/SIRT1/EZH2 axis epigenetically controls BMP7 expression in macrophages cultured with ACs culture medium. Our findings advanced the concept that ACs could promote bone regeneration by regulating metabolic and function reprogram in macrophages and identified macrophage MSR1 represents a valuable target for fracture treatments.

MicroRNA-155-5p modulates the progression of acute respiratory distress syndrome by targeting interleukin receptors.

Acute respiratory distress syndrome (ARDS) is a multifactorial inflammatory lung failure with a high incidence and a high cost burden. However, the underlying pathogenesis of ARDS is still unclear. Recently, microRNA has been shown to have critical function in regulating the pathogenesis of ARDS development and inflammation. To identify the important microRNA in the serum from patients with ARDS that may be potential biomarkers for the disease and explore the underlying disease mechanism. We found significant upregulation of miR-155-5p expression in serum samples from patients with ARDS compared with the control group (p < 0.01). The levels of interleukin receptors and inflammatory cytokines were significantly increased in blood samples from patients with ARDS (p < 0.05). In the cell model, miR-155-5p had a binding site in the 3'-UTR of the three interleukin receptors. In LPS-simulated BEAS-2B cells, transfection of miR-155-5p mimic inhibited the expression levels of these interleukin receptors, and was found to directly target the inflammatory response of leukocyte nodulin receptor through NF-kB signaling. In conclusion, miR-155-5p can alleviate LPS-simulated injury that induces the expression of IL17RB, IL18R1, and IL22RA2 by affecting the NF-kB pathway; however, it cannot change the occurrence of inflammatory storms. Collectively, this suggests that the progression of ARDS is the result of effects of the multiple regulatory pathways, providing novel evidence for the therapy of ARDS.

A novel device for treatment of osteonecrosis of femoral head: Feasibility and preliminary efficacy of animal study.

BACKGROUND: Interruption of blood supply will lead to necrosis of body tissues, such as osteonecrosis of femoral head (ONFH). Vascularization has always been regarded as one of the biggest challenges in tissue engineering. In the current study, a novel device was proposed to reconstruct blood supply of necrotic femoral head. METHODS: Cryo-insult with liquid nitrogen method was adopted to establish the ONFH model. In experimental group, a novel scaffold carrying vascular bundle was implanted into the necrotic femoral head after decompression and the transplanted vascular bundles were anastomosed with the existing blood vessels around the hip. In control group, a traditional porous scaffold was inserted alone without vessels. Feasibility of this strategy was verified by animal experiments. Micro-CT analysis and histological evaluation were performed to investigate its preliminary efficacy. RESULTS: Feasibility of this innovative treatment strategy had been successfully verified in animal experiments. In the area of necrosis repair, more bone tissue grew into the scaffold in experimental group than the control group evaluated by Micro-CT (three months: 29.66% VS 20.35%, P＜0.05; six months: 30.47% VS 25.10%, P＜0.05) and histological analysis (24.71% VS 16.45%, P＜0.05 â€‹at three months; 31.01% VS 20.60%, P＜0.05 â€‹at six months). Implanted vascular bundles had the potential to branch out many branches in the osteonecrosis repair area to facilitate blood supply reconstruction and bone repair. CONCLUSIONS: This study proposed a novel device with clinical application prospects in the treatment of ONFH. It has the potential to provide new possibilities for rebuilding the blood supply of femoral head and repairing osteonecrosis. TRANSLATIONAL POTENTIAL STATEMENT: The novel device proposed in this study has the potential to be applied to the treatment of early femoral head necrosis.

Effectiveness of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture.

BACKGROUND: Percutaneous kyphoplasty is the main method in the treatment of thoracolumbar osteoporotic compression fractures. However, much radiation exposure during the operation harms the health of surgeons and patients. In addition, the accuracy of this surgery still needs to be improved. This study aimed to assess the radiation exposure and clinical efficacy of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture. METHODS: Included in this retrospective cohort study were 60 patients (60-90 years) who had undergone unilateral vertebroplasty for thoracolumbar osteoporotic compression fracture at our hospital between June 2019 and June 2020. All showed no systemic diseases and were assigned to Tirobot group (treated with Tirobot-assisted approach) and control group (treated with traditional approach). Fluoroscopic frequency, operative duration, length of stay (LOS), post-operative complications (cement leakage, infection, and thrombosis), and pre-operative and pre-discharge indexes (VAS score, JOA score, and Cobb's angle) were compared. RESULTS: The fluoroscopic frequency (P < 0.001) and post-operative complications (P = 0.035) in Tirobot group were significantly lower than those in control group. The operative duration and LOS in the Tirobot group were shorter than those in the control group, but the differences were not statistically significant (P = 0.183). Pre-discharge VAS score and Cobb's angle decreased, and JOA increased after surgeries in both groups. These three indexes showed a significant difference after surgery in each group (P < 0.001), but not between groups (PVAS = 0.175, PCobb's = 0.585, PJOA = 0.448). CONCLUSION: The Tirobot-assisted vertebroplasty can reduce surgery-related trauma, post-operative complications, and patients' and operators' exposure to radiation. As a safe and effective strategy, this surgery can realize the quick recovery from thoracolumbar osteoporotic compression fracture.

The risk factors for acute respiratory distress syndrome in patients with severe acute pancreatitis: A retrospective analysis.

ABSTRACT: Acute respiratory distress syndrome (ARDS) is very common in patients with severe acute pancreatitis (SAP), the early interventions are essential to the prognosis of SAP patients. We aimed to evaluate the risk factors for ARDS in SAP patients, to provide insights into the management of SAP.SAP patients treated in our hospital from June 1, 2018 to May 31, 2020 were included. The characteristics and lab test results were collected and compared, and we conducted the logistic regression analyses were conducted to identify the potential risk factors for ARDS in patients with SAP.A total of 281 SAP patients were included finally, the incidence of ARDS in patients with SAP was 30.60%. There were significant differences on the respiratory rate, heart rate, APACHE II and Ranson score between 2 groups (all P < .05). And there were significant differences on the polymorphonuclear, procalcitonin, C-reactive protein, serum creatinine, albumin and PO2/FiO2 between 2 groups (all P < .05), and no significant differences on the K+, Na+, Ca+, white blood cell, neutrophils, urine and blood amylase, trypsin, lipase, alanine aminotransferase, aspartate aminotransferase, total bilirubin, triglyceride, total cholesterol, total bilirubin, fasting blood glucose, and pH were found (all P > .05). Respiratory rate >30/min (odds ratio [OR]: 2.405, 95% confidence interval[CI]: 1.163-4.642), APACHE II score >11 (OR: 1.639, 95% CI: 1.078-2.454), Ranson score >5 (OR: 1.473, 95% CI: 1.145-2.359), polymorphonuclear >14 × 109/L (OR: 1.316, 95% CI: 1.073-2.328), C-reactive protein >150 mg/L (OR: 1.127, 95% CI: 1.002-1.534), albumin ≤30 g/L (OR: 1.113, 95% CI: 1.005-1.489) were the independent risk factors for ARDS in patients with SAP (all P < .05).The incidence of ARDS in SAP patients is relatively high, and it is necessary to carry out targeted early prevention and treatment for the above risk factors.

A Magnetic Iron Oxide/Polydopamine Coating Can Improve Osteogenesis of 3D-Printed Porous Titanium Scaffolds with a Static Magnetic Field by Upregulating the TGFß-Smads Pathway.

3D-printed porous titanium-aluminum-vanadium (Ti6Al4V, pTi) scaffolds offer surgeons a good option for the reconstruction of large bone defects, especially at the load-bearing sites. However, poor osteogenesis limits its application in clinic. In this study, a new magnetic coating is successfully fabricated by codepositing of Fe3 O4 nanoparticles and polydopamine (PDA) on the surface of 3D-printed pTi scaffolds, which enhances cell attachment, proliferation, and osteogenic differentiation of hBMSCs in vitro and new bone formation of rabbit femoral bone defects in vivo with/without a static magnetic field (SMF). Furthermore, through proteomic analysis, the enhanced osteogenic effect of the magnetic Fe3 O4 /PDA coating with the SMF is found to be related to upregulate the TGFß-Smads signaling pathway. Therefore, this work provides a simple protocol to improve the osteogenesis of 3D-printed porous pTi scaffolds, which will help their application in clinic.

SAR study of celastrol analogs targeting Nur77-mediated inflammatory pathway.

Nur77, an orphan member of the nuclear receptor superfamily, plays an important role in the regulation of inflammatory processes. Our previous work found that celastrol, a pentacyclic triterpene, bound to Nur77 to inhibit inflammation in a Nur77-dependent manner. Celastrol binding to Nur77 promotes Nur77 translocation from nucleus to cytoplasm, resulting in clearance of inflamed mitochondria and then alleviation of inflammation. Here, we report the design, synthesis, SAR study and biological evaluation of a series of celastrol analogs. A total of 24 celastrol derivatives were made. Compound 3a with a Kd of 0.87 µM was found to be less toxic than celastrol and could be a hit molecule for further optimization.

Enhanced osteogenic differentiation of human bone-derived mesenchymal stem cells in 3-dimensional printed porous titanium scaffolds by static magnetic field through up-regulating Smad4.

The reconstruction of large bone defects remains a significant challenge for orthopedists. Three-dimensional-printed (3DP) scaffold is considered a promising repair material. Static magnetic field (SMF) treatment is an effective and noninvasive therapeutic method to improve bone regeneration. However, the osteogenic effect of SMF on human bone-derived mesenchymal stem cells (hBMSCs) in 3DP scaffolds, as well as its potential mechanism, are unclear. In this study, the osteogenic effect of SMF on hBMSCs in a 3DP scaffold was investigated in vitro and in vivo. In addition, the potential mechanism for promoting osteogenesis was investigated by proteomic analysis. The results showed that SMF promoted osteogenic differentiation of hBMSCs in vitro. A total of 185 differential proteins were identified under SMF conditions by proteomic analysis. The osteogenic effect might be associated with bone morphogenetic protein-Smad1/5/8-signaling pathway and increased transport of phosphorylated Smad1/5/8 and phosphorylated Smad2/3 to the nucleus by up-regulating Smad4 under SMF conditions. The in vivo experiment showed that bone regeneration and osseointegration was enhanced by SMF in the rat model of bone defect. In conclusion, moderate SMF was a safe and effective method for enhancing osteogenesis in 3DP scaffolds in vitro and in vivo.-He, Y., Yu, L., Liu, J., Li, Y., Wu, Y., Huang, Z., Wu, D., Wang, H., Wu, Z., Qiu, G. Enhanced osteogenic differentiation of human bone-derived mesenchymal stem cells in 3-dimensional printed porous titanium scaffolds by static magnetic field through up-regulating Smad4.

3D Culture of Bone Marrow-Derived Mesenchymal Stem Cells (BMSCs) Could Improve Bone Regeneration in 3D-Printed Porous Ti6Al4V Scaffolds.

Mandibular bone defect reconstruction is an urgent challenge due to the requirements for daily eating and facial aesthetics. Three-dimensional- (3D-) printed titanium (Ti) scaffolds could provide patient-specific implants for bone defects. Appropriate load-bearing properties are also required during bone reconstruction, which makes them potential candidates for mandibular bone defect reconstruction implants. However, in clinical practice, the insufficient osteogenesis of the scaffolds needs to be further improved. In this study, we first encapsulated bone marrow-derived mesenchymal stem cells (BMSCs) into Matrigel. Subsequently, the BMSC-containing Matrigels were infiltrated into porous Ti6Al4V scaffolds. The Matrigels in the scaffolds provided a 3D culture environment for the BMSCs, which was important for osteoblast differentiation and new bone formation. Our results showed that rats with a full thickness of critical mandibular defects treated with Matrigel-infiltrated Ti6Al4V scaffolds exhibited better new bone formation than rats with local BMSC injection or Matrigel-treated defects. Our data suggest that Matrigel is able to create a more favorable 3D microenvironment for BMSCs, and Matrigel containing infiltrated BMSCs may be a promising method for enhancing the bone formation properties of 3D-printed Ti6Al4V scaffolds. We suggest that this approach provides an opportunity to further improve the efficiency of stem cell therapy for the treatment of mandibular bone defects.

Enhanced in vitro biocompatibility and osteogenesis of titanium substrates immobilized with dopamine-assisted superparamagnetic Fe3O4 nanoparticles for hBMSCs.

Titanium (Ti) is an ideal bone substitute due to its superior bio-compatibility and remarkable corrosion resistance. However, in order to improve the osteoconduction and osteoinduction capacities in clinical applications, different kinds of surface modifications are typically applied to Ti alloys. In this study, we fabricated a tightly attached polydopamine-assisted Fe3O4 nanoparticle coating on Ti with magnetic properties, aiming to improve the osteogenesis of the Ti substrates. The PDA-assisted Fe3O4 nanoparticle coatings were characterized by scanning electron microscopy, energy dispersive spectroscopy, atomic force microscopy and water contact angle measurements. The cell attachment and proliferation rate of the human bone mesenchymal stem cells (hBMSCs) on the Ti surface significantly improved with the Fe3O4/PDA coating when compared with the pure Ti without a coating. Furthermore, the results of in vitro alkaline phosphatase (ALP) activity at 7 and 14 days and alizarin red S staining at 14 days showed that the Fe3O4/PDA coating on Ti promoted the osteogenic differentiation of hBMSCs. Moreover, hBMSCs co-cultured with the Fe3O4/PDA-coated Ti for approximately 14 days also exhibited a significantly higher mRNA expression level of ALP, osteocalcin and runt-related transcription factor-2 (RUNX2). Our in vitro results revealed that the present PDA-assisted Fe3O4 nanoparticle surface coating is an innovative method for Ti surface modification and shows great potential for clinical applications.

Single Modified Ilioinguinal Approach for the Treatment of Acetabular Fractures Involving Both Columns.

OBJECTIVES: To report the technical aspects, radiographic results, and complications of a modified ilioinguinal approach for the treatment of bicolumnar acetabular fractures, especially involving the quadrilateral plate. DESIGN: Retrospective review. SETTING: Level I Trauma Center, Wuhan Union Hospital, China. PATIENTS/PARTICIPANTS: Data from all acetabular fractures (n = 96) treated surgically were collected between January 2012 and June 2015. According to the exclusion criteria, 22 patients who had undergone a single supra-ilioinguinal approach with a minimum of 1-year follow-up were included in the study. INTERVENTION: The supra-ilioinguinal approach was used to treat bicolumnar acetabular fractures by modifying the ilioinguinal approach, using the navel, anterior superior iliac spine, and the symphysis pubis as landmarks. MAIN OUTCOME MEASUREMENTS: The surgical exposure and reduction of fractures is expected to become more direct and convenient, with shorter surgical time, less blood loss, and fewer complications. RESULTS: Of the 22 consecutive patients, 5 were anterior column with posterior hemi-transverse, 11 were associated both column, 3 were transverse and 3 were T-type patterns. Average length of incision, operative time, and intraoperative blood loss were 10.7 ± 1.1 cm, 182 ± 40 minutes, and 793 ± 228 mL, respectively. Seventeen cases of the reductions were graded excellent; 4, good; and 1, poor. In the last follow-up, the Merle d 'Aubigné scores showed that 14 cases were excellent; 6, good; and 2, poor. Postoperative deep vein thrombosis occurred in 1 patient and lateral femoral cutaneous nerve injury in 3 patients. CONCLUSIONS: For the treatment of bicolumnar acetabular fractures, the supra-ilioinguinal approach provides direct visualization and convenient access to the quadrilateral plate, and allows for appropriate reduction and fixation with few complications. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Curative efficacy and safety of traditional Chinese medicine xuebijing injections combined with ulinastatin for treating sepsis in the Chinese population: A meta-analysis.

BACKGROUND: Sepsis is a clinically critical disease. However, it is still controversial whether the combined use of traditional Chinese medicine Xuebijing injections (XBJI) and western medicine can enhance curative efficacy and ensure safety compared with western medicine alone. Thus, this research consisted of a systematic review of the curative efficacy and safety of traditional Chinese medicine XBJI combined with ulinastatin for treating sepsis in the Chinese population. METHODS: A total of 8 databases were retrieved: 4 foreign databases, namely, PubMed, The Cochrane Library, Embase, and Web of Science; and 4 Chinese databases, namely, Sino Med, China National Knowledge Infrastructure (CNKI), VIP, and Wangfang Data. The time span of retrieval began from the establishment of each database and ended on August 1, 2017. Published randomized controlled trials about the combined use of traditional Chinese medicine XBJI and western medicine were included, regardless of language. Stata12.0 software was used for statistical analysis. RESULTS: Finally, 16 papers involving 1335 cases were included. The result of meta-analysis showed that compared with the single use of ulinastatin, traditional Chinese medicine XBJI combined with ulinastatin could reduce the time of mechanical ventilation, shorten the length of intensive care unit (ICU) stay, improve the 28-day survival rate, and decrease the occurrence rate of multiple organ dysfunction syndrome, case fatality rate, procalcitonin (PCT) content, APACKEII score, tumor necrosis factor (TNF)-α level, and interleukin (IL)-6 level. CONCLUSION: On the basis of the common basic therapeutic regimen, the combined use of traditional Chinese medicine XBJI and ulinastatin was compared with the use of ulinastatin alone for treating sepsis in the Chinese population. It was found that the number of adverse events of combination therapy is not significantly increased, and its clinical safety is well within the permitted range. However, considering the limitations of this conclusion due to the low-quality articles included in the present research, it is necessary to conduct high-quality randomized controlled trials.

Fabrication of Vascularized Bone Flaps with Sustained Release of Recombinant Human Bone Morphogenetic Protein-2 and Arteriovenous Bundle.

It is a common treatment strategy in the clinic to transplant a vascularized bone flap for a large bone defect. But it is difficult for peripheral blood vessels to grow into the central region of a large bone construct. In this study, we fabricated a vascularized bone flap from a three-dimensional (3D)-printed biodegradable poly(lactide-co-glycolide) (PLGA)/ß-tri-calcium phosphate (ß-TCP) scaffold using the combination of an arteriovenous (AV) bundle and recombinant human bone morphogenetic protein-2 (rhBMP-2). A degradable porous PLGA/ß-TCP scaffold was prepared by adopting 3D plotting and a low-temperature deposition technique. rhBMP-2 chitosan microspheres (CMs) were fabricated and loaded into the scaffolds to induce ectopic bone formation. In Group SBV (scaffold+rhBMP-2+vessel), a femoral AV bundle was implanted into the central tunnel of the composite before embedding into intramuscular pockets. In Group SB (scaffold+rhBMP-2), the composite was directly implanted into intramuscular pockets. Bone formation was evaluated by imaging analysis (X-rays and microcomputed tomography) and histological analysis (Hematoxylin and Eosin staining and Masson staining) after 4 and 12 weeks, respectively. Vascularization was also assessed by imaging analysis (Microfil angiography) and histological analysis (CD31 immunohistochemical staining). The 3D-printed PLGA/ß-TCP scaffold had good cytocompatibility. Ectopic bone formation in the scaffold could be successfully induced by the controlled release of rhBMP-2 through CMs. Comparing groups SBV and SB, vascularization of the composite was significantly enhanced by AV bundle implantation at 4 and 12 weeks. Moreover, rhBMP-2-induced bone formation was also significantly improved by the AV bundle at 4 and 12 weeks. The AV bundle not only improved vascularization and bone formation of the construct, but also provided a defined vascular axis to connect with the vascular system of the bone defect by microsurgical techniques. It provided a new potential treatment strategy to repair large bone defects, especially for those with low vascular supply.

Three-dimensional printing model improves morphological understanding in acetabular fracture learning: A multicenter, randomized, controlled study.

Conventional education results in unsatisfactory morphological understanding of acetabular fractures due to lack of three-dimensional (3D) details and tactile feedback of real fractures. Virtual reality (VR) and 3D printing (3DP) techniques are widely applied in teaching. The purpose of this study was to identify the effect of physical model (PM), VR and 3DP models in education of morphological understanding of acetabular fractures. 141 students were invited to participate in this study. Participants were equally and randomly assigned to the PM, VR and 3DP learning groups. Three-level objective tests were conducted to evaluate learning, including identifying anatomical landmarks, describing fracture lines, identifying classification, and inferring fracture mechanism. Four subjective questions were asked to evaluate the usability and value of instructional materials. Generally, the 3DP group showed a clear advantage over the PM and VR groups in objective tests, while there was no significant difference between the PM and VR groups. 3DP was considered to be the most valuable learning tool for understanding acetabular fractures. The findings demonstrate that 3DP modelling of real fractures is an effective learning instrument that can be used to understand the morphology of acetabular fractures and promote subjective interest.