[Observation of curative effect in treatment of distal tibial fractures with minimall invasive percutaneous technique].

OBJECTIVE: To explore the application of minimally invasive percutaneous plate osteosynthesis (MIPPO) the clinical curative effect of treatment of fractures of the distal tibia. METHODS: From 2010 June to 2014 June, the application of MIPPO technology combined with LCP (low bend medial distal tibial plates) for treatment of 67 cases of distal tibial fracture patients, to evaluate the healing of fracture, function etc. RESULTS: 67 patients with effective follow-up, time was 6-20 months, mean 15 months. The incision healed in one stage, 3 weeks. The effect of 12-16 weeks to fracture healing standard weight, nomalunion and nonunion cases, no fracture, bone plate and screw loosening, exit and other phenomena. The postoperative function was evaluated according to Johner-Wruch criteria, excellent in 45 cases, good in 16 cases, 6 cases, poor in 0 cases. CONCLUSION: MIPPO technique combined with LCP (low bend medial distal tibial plates) in treatment of distal tibial fractures in accord with biological osteosynthesis requirements, is a recommendable method to treat fracture extension.

[Risk factors for mortality in nonagenarians with femoral neck fractures undergoing joint replacement].

OBJECTIVE: To explore the risk factors for mortality in nonagenarians with femoral neck fractures and clarity the relationships between risk factors and postoperative mortality. METHODS: For this retrospective study, a total of 197 patients with consecutive isolated nonpathologic hip fractures undergoing hemiarthroplasty were recruited. There were 64 males and 133 females with an age range of 70 years or above. They were divided into three age groups: A, 70-79 years; B, 80-89 years; and C, ≥ 90 years. A retrospective chart review was conducted to compare these groups in terms of age, gender, nutritional status, blood albumin, total lymphocyte count, hemoglobin levels at admission, comorbidities, American Society of Anesthesiologists (ASA) rating of operative risk and time period between injury and surgery. RESULTS: Among them, 14 patients died within 1 year. There was one in-hospital death and 13 patients died during follow-ups. The mortality rates of groups A, B and C were (n = 3, 3.9%), (n = 5, 7.2%) and (n = 6, 24.0%). The ASA scores were III (n = 9) and IV (n = 4). And 13 patients had a preoperative blood albumin level < 35 g/L while 11 patients showed a preoperative lymphocyte count level < 1 500 cells/ml. The mortality rates were similar in groups A and B but were significantly lower than that of group C. CONCLUSION: The nonagenarians have a significantly higher mortality. And lower lymphocyte count, nonagenarian, > 2 comorbidities, high ASA score, low blood albumin level and low hemoglobin levels at admission are significant factors for assessing 1-year mortality in elders with femoral neck fractures.

Relationship between post-SARS osteonecrosis and PAI-1 4G/5G gene polymorphisms.

OBJECTIVE: To explore the correlation between post-severe acute respiratory symptom (SARS) patients with osteonecrosis, investigate the etiology of post-SARS osteonecrosis and select the sensitive molecular symbols for early diagnosis and distinguish the high-risk population. METHODS: The studied subjects were divided into two groups. Sixty-two post-SARS patients with osteonecrosis were one group, and 52 age- and sex-matched healthy people were as normal controlled group. Empty stomach blood samples from cubital veins were collected from both groups. Plasminogen activator inhibitor (PAI) by means of enzyme-linked immunosorbent assay and PAI-1 4G/5G polymorphism was detected by polymerase chain reaction and solid phase oligonucleotide assay. RESULTS: The blood agents of post-SARS patients changed obviously with 15.64 ± 13.85 U/ml while the control group 7.96 ± 4.27 U/ml; 4G/4G genotype for the PAI-1 polymorphism detected in post-SARS group was more than that of the control group, but had no statistical significance. The plasma PAI activity was related to homozygote 4G/4G genotype. This reveals that homozygote 4G/4G genotype may be a susceptible gene mark to Chinese osteonecrosis patients. CONCLUSION: Plasminogen activator inhibitor-1 is sensitive blood symbol for screening high-risk susceptible population; 4G/4G PAI-1 genotype may be an etiological factor in osteonecrosis.

Frequency and Risk Factors of Deep Venous Thrombosis in Aged Patients with Intertrochanteric Fracture on Admission.

OBJECTIVE: To investigate the frequency of deep vein thrombosis (DVT) in patients aged over 80 years on admission after intertrochanteric femur fracture and to explore the risk factors of DVT. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China, from 1st January 2019 to 31st December 2022. METHODOLOGY: A group of patients aged over 80 years with intertrochanteric fracture were included according to the presence or absence of DVT confirmed by ultrasonography on admission. The patients were divided into the non-DVT and DVT groups. Clinical data were retrospectively compared between the two groups and analysed by multivariate logistic regression to screen risk factors of DVT. RESULTS: A total of 130 patients meeting the inclusion criteria were enrolled, and 37 of them had DVT on admission, with a prevalence of 28.5%, including 25 (67.6%) distal peripheral DVT, 11 (29.7%) proximal central DVT, and 1 (2.7%) mixed DVT. The American Society of Anaesthesiologists (ASA) classification, Charlson comorbidity index, the serum levels of D-dimer, fibrinogen degradation products, albumin, potassium, inorganic phosphorus, and calcium showed significant differences between the two groups (p <0.1). Multivariate analysis identified increased D-dimer (>6.005 mg/L), decreased albumin (<36.45 g/L), and reduced potassium (<3.650 mmol/L) as independent factors for DVT in aged intertrochanteric fracture patients (AIFPs). CONCLUSION: A high incidence of DVT was revealed in AIFPs, and elevated D-dimer levels, reduced albumin levels, and reduced potassium concentrations were shown to be correlated to DVT. KEY WORDS: Intertrochanteric fracture, Deep vein thrombosis, Aged patients, Risk factor, Multivariate logistic regression.

ChartGPT: Leveraging LLMs to Generate Charts from Abstract Natural Language.

The use of natural language interfaces (NLIs) to create charts is becoming increasingly popular due to the intuitiveness of natural language interactions. One key challenge in this approach is to accurately capture user intents and transform them to proper chart specifications. This obstructs the wide use of NLI in chart generation, as users' natural language inputs are generally abstract (i.e., ambiguous or under-specified), without a clear specification of visual encodings. Recently, pre-trained large language models (LLMs) have exhibited superior performance in understanding and generating natural language, demonstrating great potential for downstream tasks. Inspired by this major trend, we propose ChartGPT, generating charts from abstract natural language inputs. However, LLMs are struggling to address complex logic problems. To enable the model to accurately specify the complex parameters and perform operations in chart generation, we decompose the generation process into a step-by-step reasoning pipeline, so that the model only needs to reason a single and specific sub-task during each run. Moreover, LLMs are pre-trained on general datasets, which might be biased for the task of chart generation. To provide adequate visualization knowledge, we create a dataset consisting of abstract utterances and charts and improve model performance through fine-tuning. We further design an interactive interface for ChartGPT that allows users to check and modify the intermediate outputs of each step. The effectiveness of the proposed system is evaluated through quantitative evaluations and a user study.

Infection-responsive long-term antibacterial bone plates for open fracture therapy.

The infections in open fracture induce high morbidity worldwide. Thus, developing efficient anti-infective orthopedic devices is of great significance. In this work, we designed a kind of infection-responsive long-term antibacterial bone plates. Through a facile and flexible volatilization method, a multi-aldehyde polysaccharide derivative, oxidized sodium alginate, was crosslinked with multi-amino compounds, gentamycin and gelatin, to fabricate a uniform coating on Ti bone plates via Schiff base reaction, which was followed by a secondary crosslinking process by glutaraldehyde. The double-crosslinked coating was stable under normal condition, and could responsively release gentamycin by the triggering of the acidic microenvironment caused by bacterial metabolism, owning to the pH-responsiveness of imine structure. The thickness of the coating was ranging from 22.0 µm to 63.6 µm. The coated bone plates (Ti-GOGs) showed infection-triggered antibacterial properties (>99%) and high biocompatibility. After being soaked for five months, it still possessed efficient antibacterial ability, showing its sustainable antibacterial performance. The in vivo anti-infection ability was demonstrated by an animal model of infection after fracture fixation (IAFF). At the early stage of IAFF, Ti-GOGs could inhibit the bacterial infection (>99%). Subsequently, Ti-GOGs could promote recovery of fracture of IAFF. This work provides a convenient and universal strategy for fabrication of various antibacterial orthopedic devices, which is promising to prevent and treat IAFF.

Investigation of perioperative blood loss of femoral shaft fractures treated with intramedullary nail or locking compression plate.

INTRODUCTION: Femoral shaft fractures (FSFs) are associated with significant blood loss, resulting in anemia and hemorrhagic shock. However, there has been limited data for the blood loss of FSFs during the whole perioperative period. Our primary aim is to quantify the blood loss associated with FSFs treated with intramedullary nail or locking compression plate fixation, as well as to identify the relative affecting factors for perioperative hidden blood loss (HBL). PATIENTS AND METHODS: 131 consecutive patients with FSFs were enrolled in the retrospective study between January 2009 and January 2020, including 90 cases for intramedullary nail (Nail group) and 41 cases for locking compression plate fixation (Plate group). Demographics and perioperative data were collected and analyzed. Total blood loss (TBL), visible blood loss (VBL), HBL, and percentage of HBL (PHBL) were calculated based on hematocrit (Hct) changes. RESULTS: There was a large drop of hemoglobin (Hb) during the perioperative time. Of all 131 patients, the average HBL was 1445.5 ± 443.2 mL, accounting for 78.7% of TBL (1815.1 ± 446.3 mL). TBL and HBL in Nail group were 1886.1 ± 438.6 mL and 1546.0 ± 424.7 mL; while TBL and HBL in Plate group were 1659.5 ± 427.9 mL and 1225.1 ± 405.7 mL. The differences between the two groups were statistically significant (p = 0.007, p < 0.001, respectively). Besides, statistical significance (p< 0.05, p< 0.05, respectively) was also reported in HBL between Type-A and Type-C, and between Type-B and Type-C (1395.8 ± 444.8 mL vs. 1651.6 ± 495.7 mL; and 1411.2 ± 383.4 mL vs. 1651.6 ± 495.7 mL, respectively). CONCLUSIONS: Patients of FSFs had significant TBL and HBL, the amount of which was much larger than that observed intra-operatively. Moreover, two readily available preoperative factors for nail fixation and Type-C were associated with a higher likelihood of more HBL. Therefore, it was argued that regular perioperative monitoring and timely blood transfusion were crucially important for patients to avoid possible risks of anemia and facilitate recovery.

miR-206 inhibits osteogenic differentiation of bone marrow mesenchymal stem cells by targetting glutaminase.

Osteoblast-mediated bone formation is a complex process involving various pathways and regulatory factors, including cytokines, growth factors, and hormones. Investigating the regulatory mechanisms behind osteoblast differentiation is important for bone regeneration therapy. miRNAs are known as important regulators, not only in a variety of cellular processes, but also in the pathogenesis of bone diseases. In the present study, we investigated the potential roles of miR-206 during osteoblast differentiation. We report that miR-206 expression was significantly down-regulated in human bone marrow mesenchymal stem cells (BMSCs) at days 7 and 14 during osteogenic induction. Furthermore, miR-206 overexpressing BMSCs showed attenuated alkaline phosphatase (ALP) activity, Alizarin Red staining, and osteocalcin secretion. The mRNA levels of osteogenic markers, Runx2 and Osteopontin (OPN), were significantly down-regulated in miR-206 overexpressing BMSCs. We observed that significantly increased glutamine uptake at days 7 and 14 during the osteogenic induction and inhibition of glutamine metabolism by knocking down glutaminase (GLS)-suppressed osteogenic differentiation of BMSCs. Here, we discover that miR-206 could directly bind to the 3'-UTR region of GLS mRNA, resulting in suppressed GLS expression and glutamine metabolism. Finally, restoration of GLS in miR-206 overexpressing BMSCs led to recovery of glutamine metabolism and osteogenic differentiation. In summary, these results reveal a new insight into the mechanisms of the miR-206-mediated osteogenesis through regulating glutamine metabolism. Our study may contribute to the development of therapeutic agents against bone diseases.

[Repair of articular cartilage defects by autologous adipose derived mesenchymal stem cell: experiment with rabbits].

OBJECTIVE: To evaluate the effectiveness of autologous adipose derived mesenchymal stem cells (ADSCs) transduced by adenovirus-mediated human transforming growth factor 2 (Ad-hTGF-beta2) gene in the repair of articular cartilage defects. METHODS: Rabbit ADSCs were obtained, cultured, and transfected with Ad-hTGF-beta2 containing human transforming growth factor (hTGF)-beta2. Three days later RT-PCR was used to detect the mRNA expression of hTGF-beta2 in the ADSCs, and ELISA was used to detect the protein expression of hTGF-beta2 in the supernatant. phosphorylation of Smad was examined by Western blotting. Articular cartilage defects at the femoral trochlea were made on 20 rabbits (40 sides) so as to establish animal models. The culture-expanded rabbit ADSCs transfected with Ad-hTGF-2 were seeded on poly (L-lactic-co-glycolic acid) (PLGA) scaffolds. The cell-adhered PLGA scaffolds were implanted into the articular cartilage defects. Plain PLGA was implanted into the left-side defects of 10 rabbits as control group and the defects of 10 sides remained untreated as blank control group. The rabbits were sacrificed 4, 12, and 24 weeks after the operation respectively. The specimens of defects were examined histologically and stained immunohistochemically for type II collagen. RESULTS: After transfection the ADSCs expressed mRNA and protein expression of hTGF-beta2 and Western blotting showed bands of phosphorylated Smad. The cartilage specimens harvested from the experimental group rabbits demonstrated hyaline cartilage formation mingled closely with the nearby tissues and expression of type II collagen. However, only fibroblasts, not cartilage-like cells, were seen in the control groups that lacked the expression of type II collagen too. CONCLUSION: Culture-expanded autologous ADSCs adhered with PLGA composites facilitate the formation of hyaline-cartilage.

[Minimally invasive percutaneous plate osteosynthesis versus open reduction and internal fixation for distal tibial fractures in adults: a meta-analysis].

OBJECTIVE: To perform a meta-analysis on clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults. METHODS: Pubmed database (from 1968 to March 2014), Cochrane library and CNKI database (from 1998 to March 2014) were searched. Case-control study on minimally invasive percutaneous plate osteosynthesis (MIPPO) or open reduction and internal fixation (ORIF) for distal tibial fractures in adults were chosen,and postoperative infection, operative time, blood loss, fracture nonunion rate, delayed union,fracture malunion rate were seen as evaluation index for meta analysis. The system review was performed using the method recommended by the Cochrane Collaboration. RESULTS: Totally 5 studies (366 patients) were enrolled. Meta-analysis showed that there were significant meaning in postoperative infection between MIPPO and ORIF [OR = 0.23,95% CI (0.06,0.92), P = 0.04]; fracture nonunion rate in MIPPO was lower than in ORIF group [OR = 0.16, 95% CI (0.03,0.76), P = 0.02]; operative time in MIPPO was shorter than in ORIF group, and had significant difference [MD = -14.42, 95% CI (-27.79, -1.05), P < 0.05]; blood loss in MIPPO was less than in ORIF group [MD= -87.17,95%CI (-99.20, -75.15), P < 0.05]; there was no obviously meaning in delayed union between two groups. CONCLUSION: For distal tibial fractures in adults, MIPPO has, advantages of short operative time, less blood loss, lower incidence of infection and fracture non-uniom, but with high fracture malunion rate. MIPPO for distal tibial fractures in adults is better than ORIF, and the best treatment should choose according to patient's condition.

Rotational acetabular osteotomy through an Ollier lateral U approach for early-stage osteoarthritis secondary to acetabular dysplasia.

OBJECTIVE: To explore the surgical technique and mid-term results of rotational acetabular osteotomy for early -stage osteoarthritis secondary to acetabular dysplasia. METHODS: Rotational acetabular osteotomies were performed on 14 hips of 12 patients from May 2000 to May 2006 and the patients followed up. All patients were female and their average age was 28.9 years (range, 13-46 years) at the time of surgery. The mean duration of clinical and roentgenographic follow-up was 6.0 years (range, 3.1-9.1 years). The lateral center-edge (CE) angle, acetabular roof angle and head lateralization index were measured on radiographs taken preoperatively, postoperatively and at the time of final follow-up. Clinical follow-up included use of the Harris hip score. The acetabular osteotomies were performed through an Ollier lateral U transtrochanteric approach and postoperative traction and cast immobilization were not used. RESULTS: All patients had satisfactory pain relief. The mean preoperative Harris score was 72 points; this had improved to a mean of 91 points at the time of last follow-up (P < 0.05). The mean CE angle improved from 0.9° preoperatively to 27° postoperatively (P < 0.05), the mean acetabular roof angle from 29° to 5° (P < 0.05) and the mean head lateralization index from 0.68 to 0.65. Solid bone-to-bone healing of the osteotomy sites and great trochanters occurred in all patients. CONCLUSIONS: Rotational acetabular osteotomy through an Ollier lateral U approach, which provides wide exposure and technical ease, for early-stage osteoarthritis secondary to acetabular dysplasia can relieve pain and delay the appearance or reduce the severity of osteoarthritis. Satisfactory mid-term results can be obtained.

[Effect of glucocorticoid on production of reactive oxygen species in bone microvascular endothelial cells].

OBJECTIVE: Glucocorticoid is the main cause of non-traumatic avascular necrosis of femoral head. To explore the changes of reactive oxygen species (ROS) in the bone microvascular endothelial cells treated with glucocorticoid so as to investigate the pathogenesis of steroid-induced avascular necrosis of femoral head. METHODS: The cancellous bone of femoral head was harvested from voluntary donators undergoing total hip arthroplasty, and then the bone microvascular endothelial cells were isolated by enzyme digestion. The cells at passage 3 were cocultured with different concentrations of hydrocortisone (0, 0.03, 0.10, 0.30, and 1.00 mg/mL) for 24 hours. MTT assay was used for the inhibitory rate of cell proliferation, flow cytometry for apoptosis rate, and fluorescence probe for the production of ROS and xanthine oxidase (XOD). RESULTS: At 2-3 days primary culture, the cells were spindle and arranged like cobbles and they reached confluence after 1 week. The inhibitory rates of cell proliferation in 0.03, 0.10, 0.30, and 1.00 mg/mL groups were 20.22% +/- 2.97%, 22.94% +/- 4.52%, 43.98% +/- 3.35%, and 78.29% +/- 3.85%, respectively; and 2 high-concentration groups (0.30 and 1.00 mg/mL groups) were significantly higher (P < 0.05) than 2 low-concentration groups (0.03 and 0.10 mg/mL groups). The apoptosis rates in 0, 0.03, 0.10, 0.30, and 1.00 mg/mL groups were 0.10% +/- 0.01%, 0.23% +/- 0.02%, 1.83% +/- 0.04%, 6.34% +/- 0.11%, and 15.33% +/- 0.53%, respectively; 2 high-concentration groups (0.30 and 1.00 mg/mL groups) were significantly higher (P < 0.05) than 0 mg/mL group. In 0, 0.30, and 1.00 mg/mL groups, the ROS levels were 57.35 +/- 7.11, 120.47 +/- 15.68, and 166.15 +/- 11.57, respectively, and the XOD levels were 0.017 9 +/- 0.000 9, 0.028 3 +/- 0.0017, and 0.067 7 +/- 0.0041, respectively; there were significant differences in the levels of ROS and XOD among 3 groups (P < 0.05). CONCLUSION: Increasing of ROS production in bone microvascular endothelial cells can be induced by high concentration glucocorticoid, and it can result in cell injury.

Early and middle term results after surgical treatment for slipped capital femoral epiphysis.

OBJECTIVE: To evaluate the early and middle-term results of in situ single screw fixation and subtrochanteric osteotomy of the femur with external fixator for slipped capital femoral epiphysis (SCFE). METHODS: From June 1998 to July 2008, 11 patients (seven male [eight hips] and four female [four hips]) of average age 14.3 years (range, 9-18 years) were treated in our hospital. According to the Southwick measurement, seven hips were mildly affected (<30°), two moderately (30-50°), and three severely (>50°). The average body mass index (BMI) was 31.1 g/m(2) (range, 27-35 g/m(2) ). All the mild and moderate cases underwent in situ single screw fixation, and the three severe cases subtrochanteric osteotomy of femur with external fixator. All cases were evaluated both clinically and radiographically at 3 months, 6 months and every year postoperatively. RESULTS: All cases were followed up for 2-12 years (average 5.6 years). The Harris hip score increased from a mean of 74.8 (70 ∼ 85) points preoperatively to 90.6 (70 ∼ 100) points postoperatively. X-ray films showed epiphyseal closure in the in situ single screw fixation cases, and no further increase in epiphyseal-shaft angle. Partial reduction of slipped epiphysis with normal joint spaces was observed after subtrochanteric osteotomy of the femur in the external fixator cases. CONCLUSION: In situ single screw fixation for treating mild and moderate SCFE has a satisfactory clinical outcome, and the advantage of prevention of further slippage. Subtrochanteric osteotomy of the femur with external fixator is suitable for severe SCFE with late deformity; the realignment procedure can correct deformity and postpone or prevent subsequent osteoarthritis.

Experimental study on phase-contrast imaging with synchrotron hard X-ray for repairing osteonecrosis of the femoral head.

Synchrotron radiation light is 1 of 4 artificial light sources, the others being electric light, X-ray, and laser. Phase-contrast imaging with hard X-ray has achieved wide application in many scientific fields, such as biomedicine and material science. This article compares the effectiveness of nanohydroxyapatite/collagen (nHAC) and autologous mesenchymal stem cell for the repair of defects in a rabbit model with osteonecrosis of the femoral head under the monitoring of phase-contrast imaging with synchrotron hard X-ray. We established models of bilateral osteonecrosis of the femoral head defect using New Zealand rabbits and divided them into 3 groups. Imaging techniques such as phase-contrast imaging and diffraction enhanced imaging with synchrotron hard X-ray were applied to assess the degradation and repair process of nHAC and mesenchymal stem cell at 4, 8, and 12 weeks postoperatively. We found phase-contrast imaging with synchrotron hard X-ray displayed the reparative process of the bone defect, degradation of nHAC, and osteocyte substitution. There were significant differences in the repair of the bone defect and osteogenesis in groups B and C compared with group A (control). Osteogenesis was more significant in group C. We provided experimental data for the development and application of synchrotron hard X-ray imaging techniques and concluded that phase-contrast microimaging with synchrotron hard X-ray displays the reparative process of bone tissue at a micro-level and plays an important role in the development of tissue engineering.