An in-vitro three-dimensional surgical simulation technique to predict tibial tunnel length in transtibial posterior cruciate ligament reconstruction.

BACKGROUND: During the transtibial posterior cruciate ligament (PCL) reconstruction, drilling depth excessively longer than the tibial tunnel length (TTL) is an important reason to cause popliteal neurovascular bundle injury when preparing the tibial tunnel. This study aims to develop an in-vitro three-dimensional surgical simulation technique to determine the TTL in anteromedial (AM) and anterolateral (AL) approaches. METHODS: A total of 63 knees' 3-dimensional (3D) computed tomography models were included in this study. The SuperImage system was used to reconstruct the 3D knee model and locate the tibial PCL site. The established 3D knee model and the coordinates of the tibial PCL site were imported into Rhinoceros 3D modeling software to simulate AM and AL tibial tunnel approaches with different tibial tunnel angles (TTA). The TTL and the tibial tunnel height (TTH) were measured in this study. RESULTS: In AM and AL tibial tunnel approaches, the TTL showed a strong correlation with the TTA (for AM: r = 0.758, p < 0.001; for AL: r = 0.727, p < 0.001). The best fit equation to calculate the TTL based on the TTA was Y = 1.04X + 14.96 for males in AM approach, Y = 0.93X + 17.76 for males in AL approach, Y = 0.92X + 14.4 for females in AM approach, and Y = 0.94X + 10.5 for females in AL approach. CONCLUSION: Marking the TTL on the guide pin or reamer could help to avoid the drill bit over-penetrated into the popliteal space to damage the neurovascular structure.

Multivariate analysis of alveolar bone dehiscence and fenestration in anterior teeth after orthodontic treatment: A retrospective study.

OBJECTIVE: To compare the prevalence of fenestration and dehiscence between pre- and post-orthodontic treatment and to explore the factors related to fenestration and dehiscence in the anterior teeth after treatment. METHODS: This study included 1000 cone-beam computed tomography (CBCT) scans of 500 patients before (T1) and after (T2) orthodontic treatment. These images were imported into Dolphin 11.9 software to detect alveolar fenestration and dehiscence in the anterior teeth area. The chi-square test and Fisher's exact test were performed to compare the prevalence of alveolar bone defects between time points T1 and T2. A total of 499 patients were selected for logistic regression analysis to examine the correlation among age, sex, crowding, sagittal facial type, extraction, miniscrew use and fenestration or dehiscence post-treatment. RESULTS: Except for the maxillary lingual fenestration and labial fenestration of mandibular canines, a significant change in the prevalence of fenestration and dehiscence was noted between time points T1 and T2 (P < .025). Multinomial logistic regression showed that age, miniscrew use and extraction highly influenced the prevalence of anterior lingual dehiscence (P < .05). Dehiscence of the mandibular labial side (skeletal Class III vs. I, OR = 2.368, P = .000) and fenestration of the mandibular lingual side (skeletal Class II vs. I, OR = 2.344, P = .044) were strongly correlated with the sagittal facial type. Dehiscence of the maxillary labial side (moderate vs. mild, OR = 1.468, P = .017) was significantly associated with crowding. CONCLUSIONS: Older age, maxillary moderate crowding, skeletal Class III, extraction and miniscrew potentially significantly affect the prevalence of anterior teeth dehiscence. Adult females, skeletal Class III patients on the mandibular labial side and skeletal Class II patients on the mandibular lingual side should be monitored for anterior teeth fenestration.

Long-term morphometric changes in the anterior alveolar bone in adolescents and adults after space closure: A retrospective study.

OBJECTIVES: To analyse the morphometric changes in the anterior alveolar bone of both the maxilla and mandible after space closure and retention for 18-36 mo in adults and adolescents. MATERIALS AND METHODS: Forty-two subjects with 4 first premolars extracted followed by retracting anterior teeth were included and divided into two age groups: adult group (4 males, 17 females, mean age: 23.67 ± 5.29 y, treatment duration: 27.95 mo, retention duration: 26.96 mo, ANB: 4.8 ± 2.1, U1-L1: 117.2 ± 9.2, U1-PP: 120.2 ± 7.2, L1-MP: 99.2 ± 5.3) and adolescent group (6 males, 15 females, mean age: 11.52 ± 1.21 y, treatment duration: 26.18 mo, retention duration: 25.79 mo, ANB: 5.2 ± 2.1, U1-L1: 116.0 ± 8.6, U1-PP: 119.8 ± 4.9, L1-MP: 99.7 ± 4.9). Alveolar bone height and thickness of anterior teeth in both groups were measured using cone beam computed tomography (CBCT) imaging performed at the pretreatment (T1), posttreatment (T2) and retention phases (T3). One-way repeated-measure ANOVAs were performed to evaluate the alveolar bone changes. Voxel-based superimpositions were performed to measure the amount of tooth movement. RESULTS: After orthodontic treatment, the lingual bone height and thickness of both arches and the labial bone height of the mandible decreased significantly in both age groups (P < .05). Most of the labial bone height and thickness of the maxilla in both groups remained unchanged (P > .05). After retention, the lingual bone height and thickness increased significantly in both age groups (P < .05). The amounts of increased height ranged from 1.08 to 1.64 mm in adults and from 0.78 to 1.21 mm in adolescents, and the amounts of increased thickness ranged from 0.23 mm to 0.62 mm in adults and from 0.16 mm to 0.36 mm in adolescents. Obvious movements of the anterior teeth during retention were not found (P > .05). CONCLUSIONS: Although lingual alveolar bone loss occurred in adolescents and adults during orthodontic treatment, continuous remodelling occurred in the later retention phase, which provides a reference for clinical treatment planning of bimaxillary dentoalveolar protrusion.

Comprehensive positional and morphological assessments of the temporomandibular joint in adolescents with skeletal Class III malocclusion: a retrospective CBCT study.

BACKGROUND: Condyle-fossa relationships in adolescents with skeletal Class III malocclusion remain unclear. Therefore, this study used cone-beam computed tomography (CBCT) to evaluate the position and morphology of the temporomandibular joint (TMJ) in adolescents with skeletal Class III malocclusion. METHODS: In this cross-sectional retrospective study, CBCT images from 90 adolescents with skeletal Class III malocclusion and 30 controls were analysed. Adolescents with skeletal Class III malocclusion were divided into different groups based on (1) sex (male and female), (2) sides (right and left), (3) age (early, middle, and late adolescence), and (4) vertical skeletal patterns (hyperdivergent, normodivergent, and hypodivergent). Morphology of the condyle and fossa as well as condylar position, was compared among groups. Data were collected and submitted for statistical analysis. This study adheres to STROBE guidelines. RESULTS: Regarding the intergroup comparisons, there were significant differences in TMJ position and morphology between the skeletal Class III malocclusion with different vertical skeletal patterns and control groups (P < 0.05). Within groups, condyle-fossa relationships differed significantly according to sex, age, and vertical skeletal patterns (P < 0.05); however, the mean values were not statistically different between left and right sides in adolescents with skeletal Class III malocclusion. CONCLUSIONS: Our findings can be used clinically and radiographically to evaluate the condyle and glenoid fossa features in adolescents with skeletal Class III malocclusion, providing a basis for better TMD diagnosis and orthodontic treatment.

Age-related variations in position and morphology of the temporomandibular joint in individuals with anterior openbite and crossbite: a multi-cross-sectional comparative study.

BACKGROUND: This study aimed to compare the age-related positional and morphological characteristics of the temporomandibular joint (TMJ) between individuals with anterior openbite or crossbite and controls. METHODS: This multi-cross-sectional comparative study analysed cone-beam computed tomography images of 750 participants, equally divided into the openbite, crossbite, and control groups (OBG, CBG, and CG, respectively). Each group was further divided into five subgroups (8-11 years, 12-15 years, 16-19 years, 20-24 years, and 25-30 years). Measurements of the TMJ included the position of the condyles in their respective fossae and morphology of the condyles and fossae. Data were submitted to statistical analysis. The study adhered to the STROBE Statement checklist for reporting of cross-sectional studies. RESULTS: Condyles were positioned more posteriorly with increasing age in all groups, and the condylar position was more posterior in the OBG than in the CBG. The articular eminence inclination increased with age in all the groups. There were significant differences in the articular eminence inclination among the three major groups at the age of > 15 years, and the condylar path was flatter in the CBG than in the OBG. CONCLUSIONS: Age-related morphological and positional characteristics of the TMJ differed considerably among OBG, CBG and CG. Contrary to CBG, OBG was found to have relatively posterior condylar position and steeper condylar path.

Association of the lateral wall integrity with clinical outcomes in older patients with intertrochanteric hip fractures treated with the proximal femoral nail anti-rotation-Asia.

PURPOSE: The purpose of this study is to assess the role of the lateral wall in post-operative clinical outcomes in patients with intertrochanteric fractures treated with the proximal femoral nail anti-rotation-Asia (PFNA-II). METHODS: A cohort of 466 patients (OTA type 31A1 or A2) was divided into two groups: one was intact lateral wall group, and the other was fractured lateral wall group. Radiographic outcomes were measured by using the loss of neck-shaft angle (NSA), femoral neck shortening (FNS), and offset shortening (OS). Functional outcomes were assessed by using the Harris score and SF-36 Physical Component Summary (SF-36 PCS). Post-operative complications were recorded. RESULTS: The fractured lateral wall group had a greater loss of NSA (mean [SD], fractured group (8.7°) [2.7°] vs intact group (4.8°) [2.8°]; mean difference, 3.3° [95% CI 2.9 to 3.8]; P < 0.001) compared with the intact lateral wall group. Similar results were found for FNS and OS. The fractured lateral wall group had a worse Harris scores at the three month follow-up (mean [SD] score, fractured group (66.6) [5.2] points vs intact group (71.3) [5.8] points; mean difference, - 3.3 points [95% CI - 3.9 to - 2.7]; P < 0.001) compared with the intact lateral wall group. Similar results were observed for Harris scores at the three and 12-month follow-ups and SF-36 PCS at the three, six and 12-month follow-ups. The fractured lateral wall group had a higher risk of post-operative complications compared with the intact lateral wall group. CONCLUSION: Among older patients with intertrochanteric fractures, the fractured lateral wall was associated with worse clinical outcomes compared with the intact lateral wall. Clinicians should pay attention to the lateral wall integrity in patients with intertrochanteric fractures treated with the PFNA-II.

Sauchinone attenuates inflammatory responses in dendritic cells via Blimp-1 and ameliorates dextran sulfate sodium (DSS)-induced colitis.

Inflammatory bowel disease (IBD) is a complex inflammatory disorder of the digestive tract with dysregulated innate and adaptive immune responses. Dendritic cells (DC), the most important antigen presenting cells, act as bridges connecting the adaptive and innate immune systems, and play a crucial role in the regulation of local homeostasis in the gut and are also essential mediators in the initiation and development of intestinal inflammation. Our recent study found that sauchinone (SAU) was able to ameliorate experimental colitis in mice by restraining Th17 cell differentiation and their pathogenicity. Here, we found that SAU significantly inhibited LPS-induced DC activation. Moreover, SAU suppressed the ability of LPS-primed DC to induce Th1/Th17 cell differentiation, but SAU-treated DC up-regulated their ability to initiate Foxp3+ Treg cell generation. Of note, we found that genetical ablation of Blimp-1 in DC markedly abrogated the SAU suppression of pro-inflammatory cytokine or promote immunomodulatory molecule production by DC. Blimp-1 deficiency boosted the ability of DC to polarize naïve CD4+ T cells into Th1/Th17 cell lineages. SAU failed to alleviated DSS-induced colitis in mice with Blimp-1-deficient DC. Our results shed new lights on the mechanisms of how SAU regulates DC biology and intestinal inflammation.

miR-340 affects sauchinone inhibition of Th17 cell differentiation and promotes intestinal inflammation in inflammatory bowel disease.

The pathogenesis of inflammation bowel disease (IBD) involves exaggerated effector T cell responses and impaired regulatory T cell functions. We previously found that sauchinone (SAU) ameliorated experimental colitis via facilitating Th17 cell production of IL-10, but how SAU regulated Th17 cell differentiation remains unknown. MicroRNAs (miR) have been recognized as a crucial regulator of T cell biology and play a considerable role in IBD. Here, we demonstrated that SAU significantly suppressed miR-340 expression in Th17 cells, and enforced miR-340 expression abrogated SAU inhibition of Th17 differentiation. miR-340 itself was found to facilitate Th17 differentiation, especially the pathogenic "Th1-like" subset. In human IBD, miR-340 was intimately correlated with the disease severity. SAU markedly decreased miR-340 in the inflamed mucosa tissues from IBD patients. Scaffold/matrix-associated region-binding protein 1 (SMAR1) was identified as a target gene of miR-340. We revealed that blockade of miR-340 significantly reduced mucosal damage and Th17 responses in the lamina propria in a mouse colitis model. Our findings suggest that miR-340 negatively affects SAU inhibition of Th17 differentiation and might play a crucial role in the regulation of pathogenic "Th1-like" Th17 cell generation, which might serve as a novel therapeutic target of IBD.

Sauchinone ameliorates intestinal inflammation and promotes Th17 cell production of IL-10 via Blimp-1.

Inflammatory bowel disease (IBD) is characterized by chronic, unpredictable relapsing and inflammatory disease of the gastrointestinal tract. Daily diet patterns have long been one of the most important hotspots for IBD therapeutic strategies. Sauchinone (SAU), a key bioactive lignin isolated from the roots of the herb Saururus chinensis, has been known to play an anti-inflammatory role in several diseases. However, its effect on IBD has not yet been investigated. In the current study, we established 2,4,6-trinitrobenzene sulfonic acid (TNBS)-induced colitis in mice and treated them with SAU. Flow cytometric analysis was performed to determine the phenotype of T cells in the lamina propria. qRT-PCR and ELISA were performed to measure cytokine transcript and protein levels, respectively. We found that SAU ameliorated TNBS-induced mouse colitis and inflammatory responses in mucosal tissues and peripheral blood CD4+ T cells from IBD patients. SAU significantly suppressed Th17 differentiation but facilitated IL-10 production, and SAU-treated Th17 cells exhibited inhibitory functions in vitro and in vivo. Mechanistically, we demonstrated that SAU induced Blimp-1 expression (encoded by Prdm1) in Th17 cells, and SAU failed to increase IL-10 production in Prdm1-knockout Th17 cells. Our data reveal an uncharacterized mechanism through which SAU regulates intestinal inflammation and Th17 differentiation.

Effects of gE/gI deletions on the miRNA expression of PRV-infected PK-15 cells.

Pseudorabies virus (PRV) belongs to the Alphaherpesvirinae subfamily of Herpesviridae. PRV-induced pseudorabies is a highly contagious disease that has caused huge economic losses to the global swine industry. The PRV gE/gI gene deletion vaccine strain (Fa ΔgE/gI strain) constructed from the PRV Fa wild-type strain was shown to have a protective effect against infection. However, the interaction between PRV gE/gI genes and host miRNA needs further exploration, and little is known about the regulatory mechanisms of non-coding RNAs during PRV infection. miRNAs play a key regulatory role in viral infection and immune responses, so we analyzed the differential expression of miRNAs induced by the PRV Fa ΔgE/gI strain and Fa wild-type strain in the PK15 cell line. High-throughput sequencing reads were aligned to known Sus scrofa pre-miRNAs in the miRBase database. Target genes of differentially expressed miRNAs were predicted using the miRGen 3.0 database, then filtered miRNA target genes were subjected to Gene Ontology (GO) analysis and Search Tool for the Retrieval of Interacting Genes/ Proteins (STRING) analysis. Stem-loop quantitative real-time PCR was performed to confirm the accuracy of high-throughput sequencing data. In total, 387, 472, and 490 annotated and novel mature miRNAs were identified from PRV Fa ΔgE/gI strain-infected, Fa wild-type strain-infected, and non-infected PK-15 cells, respectively. Five PRV-encoded miRNAs were also identified. GO analysis showed that target genes of differentially expressed miRNAs in PRV Fa ΔgE/gI strain-infected and Fa wild-type strain-infected PK-15 cells were mainly involved in biological regulation and metabolic processes. STRING analysis showed that immune-related target genes of differentially expressed miRNAs in the Toll-like receptor signaling pathway, B cell receptor signaling pathway, T cell receptor signaling pathway, nuclear factor-κB signaling pathway, and transforming growth factor-ß signaling pathway were interrelated. This is the first report of the small RNA transcriptome in PRV mutant wild-type strain-infected and Fa ΔgE/gI strain-infected porcine cell lines. Our findings will contribute to the prevention and treatment of PRV mutant strains.

Computer-assisted preoperative planning improves the learning curve of PFNA-II in the treatment of intertrochanteric femoral fractures.

BACKGROUND: Intertrochanteric femoral fractures are prevalent among the elderly, and usually demands surgical treatments. Proximal femoral nail antirotation Asian version (PFNA-II) is widely used for intertrochanteric fracture treatment. The computer-assisted preoperative planning (CAPP) system has the potential to reduce the difficulty of PFNA-II in the treatment of intertrochanteric fractures. The aim of the study was to investigate and compare the learning curves of PFNA-II treatment with CAPP and conventional preoperational planning methods for intertrochanteric femoral fractures. METHODS: A total of 125 patients with intertrochanteric fracture who were treated with PFNA-II between March 2012 and June 2015 were retrospectively analyzed. Patients who underwent surgery with CAPP procedure by a junior surgeon were regarded as group A (n = 53); patients who underwent the conventional surgery by another junior surgeon were regarded as group B (n = 72). Each group was divided into three subgroups (case 1-20, case 21-40, case 41-53 or case 41-72). RESULTS: The average operation time of group A was 45.00(42.00, 50.00) minutes, and in group B was 55.00 (50.00, 60.00) minutes (P < 0.01). Average radiation frequency and blood loss were 13.02 ± 2.32, 160.00 (140.00, 170.00) ml and 20.92 ± 3.27, 250.00 (195.00, 279.50) ml, respectively, with significant differences (P < 0.01). The learning curve of the surgical procedure in group A was steeper than that in group B. There were no significant differences in patient reported outcomes, hospital stay and complication rate between the two groups. Significant differences were observed between group A and B in Harris score at last follow-up in the AO/OTA type 31-A2 intertrochanteric fracture (P < 0.05). CONCLUSION: Compared with conventional preoperative planning methods, CAPP system significantly reduced operation time, radiation frequency and blood loss, thus reshaped the learning curve of PFNA-II treatment with lower learning difficulty. TRIAL REGISTRATION: researchregistry4770. Registered 25 March 2019.

The accuracy of intra-operative fluoroscopy in evaluating the reduction quality of intertrochanteric hip fractures.

PURPOSE: To investigate the capability of intra-operative fluoroscopy to determine the reduction quality of intertrochanteric fractures and to determine which view (anteroposterior [AP] or lateral) can better predict the reduction quality. METHODS: A retrospective analysis of 128 patients with intertrochanteric fractures. Two observers were asked to independently evaluate the quality of reduction (positive or non-positive support) based on intra-operative fluoroscopy (AP and lateral view). Results based on CT scans were considered as the gold standard. Sensitivity, specificity, percentage of correct interpretations, and agreement were calculated. RESULTS: At the first reading, sensitivity, false-negative rate, specificity, false-positive rate, and percentage of correct interpretations were 86.1%, 13.9%, 69.4%, 30.6%, and 79.7% for junior resident and 81.0%, 19.0%, 67.3%, 32.7%, and 75.8% for senior resident (all p > 0.05). It was highly predictive of a reliable cortical support when cortical position in AP view was consistent with that in lateral view (85/85, 100% for junior, and 86/86, 100% for senior). Lateral view was generally predictive of a final cortical support when the position between AP and lateral view was inconsistent (90.7% [39/43] vs 9.3% [4/43] for junior, p < 0.001; 92.9% [39/42] vs 7.1% [3/42] for senior). Comparable results were reported at the second reading. The average inter-observer and intra-observer agreement was 0.670 and 0.654, respectively. CONCLUSIONS: We should ensure the cortical support for both AP and lateral view are positive intra-operatively as far as possible. Even if this is not possible, we need to make sure the lateral position is positive support.

Computer-assisted virtual surgical technology in pre-operative design for the reconstruction of calcaneal fracture malunion.

PURPOSE: No computer-assisted pre-operative design for calcaneal fracture malunions has been presented. The aim of the study is to evaluate the intra-operative realization of computer-assisted pre-operative planning (CAPP) and the clinical outcomes based on computer-assisted virtual surgical technology for calcaneal malunions. METHODS: Between 2010 and 2016, 20 patients with 21 calcaneal fracture malunions were retrospectively reviewed with the average follow-up time of 22.3 months (range, 12 to 43 months), which were operatively treated with the help of CAPP. The CAPP steps included the image segmentation, exostectomy of lateral wall, simulated reconstruction of calcaneal thalamus, morphological evaluation, and the implantation of internal fixation devices. Post-operative outcomes were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, SF-36 physical component summary (PCS), VAS for pain, range of motion of ankle, and the morphological parameters of the calcaneus including the axial length of the calcaneus, the height of the posterior facet, the talocalcaneal angle, Böhler's angle, and Gissane's angle. RESULTS: The mean time required for CAPP was 41.8 minutes. All the surgical processes were carried out according to CAPP. Six patients (6 feet) were treated with the joint-preserving osteotomy. Fourteen patients (15 feet) underwent the subtalar distraction bone block arthrodesis, among which the medial displacement calcaneal osteotomy was additionally performed in six patients (6 feet). At the final follow-up, the average AOFAS, SF-36 PCS, and VAS scores were significantly improved to 77.4, 64.3, and 1.4, respectively (P < 0.001). The postoperative calcaneal morphological parameters and the range of motion of ankle were significantly restored (P < 0.05). CONCLUSION: CAPP can assist surgeons in understanding calcaneal malunions, thereby improving intraoperative correction and reconstruction. The satisfying clinical and radiographic outcomes could be provided after treating calcaneal malunions aided by the computer-assisted virtual surgical technology.

Analysis of the influence of living environment and age on vaginal fungal microbiome in giant pandas (Ailuropoda melanoleuca) by high throughput sequencing.

A recent study has described the normal vaginal bacterial community in giant pandas, but there is a lack of knowledge of the fungal community residing in the vagina of giant pandas. In order to comprehensively understand the vaginal fungal microbial diversity and abundance in giant pandas, high throughput sequencing was used to analyse the ITS1 region, based on thirteen samples taken from the pandas' vaginas, which were grouped by sampling points and age. The results showed that the most abundant phyla were Basidiomycota (73.37%), followed by Ascomycota (20.04%), Zygomycota (5.23%), Glomeromycota (0.014%) and Chytridiomycota (0.006%). At the genus level, Guehomyces (37.92%) was the most abundant, followed by Cladosporium (9.072%), Trichosporon (6.2%) and Mucor (4.97%). Furthermore, Candida only accounted for a low percentage of the vaginal fungal community. With the saturation of rarefaction curves and fungal diversity indices, the samples from Dujiangyan and Chungking Safari Park (DC group) showed a higher fungal species richness and diversity than other living environments. Shannon diversity indices showed significant difference between group WL (Wolong nature reserve) and DC (P < .05). Additionally, a higher diversity was found in ten to fifteen years old (Group 2) than other groups. Group 2 and Group 3 displayed significant differences in the diversities of their vaginal fungal communities (P < .05). These data that has been collected from this research will be helpful for further study to improve the reproductive status of giant pandas.

Frequency of antimicrobial resistance and integron gene cassettes in Escherichia coli isolated from giant pandas (Ailuropoda melanoleuca) in China.

Escherichia coli (E. coli) is considered as a common opportunistic pathogen, which causes seriously intestinal infections to giant pandas (Ailuropoda melanoleuca) and other animals. The aim of this investigation was to characterize the antimicrobial resistance and integron gene cassettes in E. coli isolated from the faeces of giant pandas in China. A total of 89 E. coli were isolated, after diagnosis of isolates and genomes were extracted. All the isolates were screened for the presence of related drug-resistance genes and integron gene cassettes through the Polymerase Chain Reaction (PCR) and sequencing. In addition, antimicrobial resistance testing was performed according to the standard disk diffusion method (CLSI 2013). The results demonstrated that all the isolates were multi-drug resistance (MDR). High resistance proportions of the E. coli isolates were to streptomycin (93%), cefazolin (90%), amikacin (75%), tetracycline (65%), ampicillin (62%), cefotaxime and trimethoprim-sulfamethoxazole (54%, each). With respect to the various resistance genes; blaCTX-M, sul1, ant (3')-Ia, tetA, qnrB, tetE, floR, aac (6')-Ib, sul2, rmtA, cmlA, rmtB and tetC were identified with the respective frequencies of 44%, 45%, 38%, 37%, 35%, 27%, 26%, 20%, 18%, 15%, 10%, 7% and 4%. None of the isolates was positive for qnrA and cfr genes. Moreover, a further investigation of integron revealed that the emergence of class 1 and 2 integrons were in 47% and 8% isolates, respectively. While class 3 integron was not screened. Six types of containing in class 1 integron specific gene cassettes (dfrA12-orfF-aadA2, dfrA17-aadA5, aadA1, aadA5, dfrA1 and dfrA7) were identified. However, only one gene cassette (dfrA1-sat2-aadA1) was detected in class 2 integron. These finding emphasize that a high level of E. coli isolates harbored antibiotics resistance and integron gene cassettes, which may bring so many potential threats to the health of giant pandas.

Assessment of Screw Length of Proximal Humerus Internal Locking System (PHILOS) Plate for Proximal Humeral Fractures Using Three-Dimensional Computed Tomography Scan.

BACKGROUND Screw perforation and varus collapse are common complications of treatment with a PHILOS (proximal humerus internal locking system) plate for proximal humerus fractures, which are associated with improper screw length selection and lack of medial column support. The purposes of this study were: (1) to measure the proper length of periarticular screws of the PHILOS plate in the humeral head, and (2) to determine what factors influence the screw length and implantation of the inferomedial support screw. MATERIAL AND METHODS Computed tomography (CT) images of the normal proximal humerus in 134 cases were retrospectively reviewed. The length of periarticular screws was measured using three-dimensional (3D) techniques. Intraobserver and interobserver reliability of measurement were evaluated using intraclass correlation coefficients (ICCs). Sex and body height influences on screw length and implantation of the inferomedial screw were analyzed. RESULTS All measurements had excellent agreement (ICC>0.75). The screw length and implantation rate of the inferomedial screw were greater in males than in females. Positive correlations were observed between body height and screw length and implantation of the inferomedial screw (all P<0.001). CONCLUSIONS The screws were longer and the implantation rate was higher for inferomedial screws in males than in females, and were positively correlated with body height. Our data can be used as a reference for surgeons to reduce the number of times screws are changed intraoperatively and to reduce operation duration and minimize use of intraoperative fluoroscopy for proximal humerus fractures treated with the PHILOS plate.

Morphometry of the Tibial Plateau at the Surface and Resected Levels.

BACKGROUND: We aim to make an anthropometric analysis of tibial plateau at the surface level and the resected level and analyze the correlation in lengths between 2 levels. We hypothesized that lengths at the surface level were longer than those at the resected level, which brought soft tissue tolerance for tibial component to overhang. METHODS: Anthropometric data were measured using three-dimensional structures reconstructed from tibial plateaus of 100 knees in 100 Chinese subjects (50 men and 50 women). Mediolateral, medial anteroposterior, and lateral anteroposterior lengths at the surface level and the resected level were measured, and the Pearson's correlation coefficients of these data were calculated. RESULTS: Mediolateral and medial anteroposterior lengths at the surface level were longer than those at the resected level by a mean 2.38 ± 1.29 and 1.99 ± 1.76 mm, respectively. Lateral anteroposterior length at the surface level was shorter than that at the resected level by a mean 1.54 ± 2.49 mm. All these differences between 2 levels had no gender difference. CONCLUSION: Our findings suggest that tibial overhang could be better tolerated in the medial compared to the lateral compartment but this hypothesis has to be further investigated in a clinical study.

Post-operative radiological predictors of satisfying outcomes occurring after intra-articular calcaneal fractures: a three dimensional CT quantitative evaluation.

PURPOSE: No functional outcome related to 3-D CT evaluations for calcaneal fractures has been presented. The aims of this study are to analyze the post-operative morphological parameters of calcaneal fractures in 3-D space and to correlate the 3-D morphological parameters with functional outcomes. METHODS: Between 2009 and 2015, 156 patients operatively treated for displaced calcaneal fractures were retrospectively reviewed with an average follow-up time of 32.4 months. Böhler's angle, Gissane's angle, the length of calcaneal axis, the height of posterior facet, the length of posterior facet, and the subtalar joint congruity were evaluated post-operatively in accordance with 3-D CT. Each parameter was quantified, and then its association with the clinical outcomes assessed by the AOFAS score and Short Form-36 questionnaire was evaluated. RESULTS: The restoration of the length of calcaneal axis, the height of posterior facet, and the length of posterior facet had no significant correlation with the clinical outcomes (P > 0.05). The restoration of Böhler's angle and Gissane's angle had significant correlation with the better AOFAS score (P < 0.001), while no correlation was found with the SF-36 physical component summary score (P > 0.05). No significant association emerged between the clinical outcomes and reconstruction of the posterior facet congruity (P > 0.05). CONCLUSION: The predictable functional outcome is related to the reconstruction of post-operative morphological characteristics of the calcaneus as evaluated on 3-D CT, especially the Böhler's angle and Gissane's angle. Despite post-operative step-off of the posterior facet exiting, the clinical outcomes appear to be not related to the posterior facet congruity.

The morphology of medial malleolus and its clinical relevance.

OBJECTIVE: To provide morphological data of medial malleolus to decrease the possibility of posterior tibial tendon injury and inadvertent ankle penetration. METHODS: Computed tomography scans of the ankle in 215 patients were reviewed. Then parameters in the 3-D reconstruction images were measured by three independent, qualified observers on two separate occasions. RESULTS: The average angle between tibia plafond and the articular facet of the medial malleolus was 55.88±4.11°. The distance from the most anterior point of the anterior colliculus to the center of the intercollicular groove was 11.68±1.13 mm. And the average angle between the bimalleolar axis and the articular facet of the medial malleolus was 76.61±2.04°. Significant differences were observed in the distance from the most anterior point of the anterior colliculus to the center of the intercollicular groove between males and females. (P<0.05) All of the parameters exhibited moderate to excellent intra-class correlation coefficient (ICC). CONCLUSIONS: According to this study, the insertion angle is much smaller than previously believed, and adequate space only exists for two 4.0-mm screws in some large cases. The second screw will probably be near the posterior tibial tendon, especially in some small cases.

[Molecular mechanism of residual lumbago and leg pain after transforaminal endoscopic treatment of lumbar disc herniation].

OBJECTIVE: To observe the residual of lumbago and leg pain with contained type （CT） and non-contained type （NCT） lumbar disc herniation （LDH） after transforaminal endoscopic treatment, and to explore the role of hypoxia-inducible factor-1α（HIF-1α） and transient receptor potential vanillate 1（TRPV1） pathway. METHODS: A total of 68 single-segment LDH patients were selected from July 2021 to October 2022, including 44 males and 24 females；aged 26 to 67 years old with an average of（43.63±11.94） years old；course of disease was 4 to 36 （18.91±10.34） months；body mass index was （24.45±4.00） kg·m-2；there were 7 cases of L3,4 segments, 32 cases of L4,5 segments, and 29 cases of L5S1 segments. All of them were performed with percutaneous intervertebral endoscopic extraction of nucleus pulposus and were divided into contained group（CT group） and non-contained group （NCT group） with 34 cases respectively according to the integrity of outer layer of fibrous annulus observed during operation. A total of 17 patients who underwent open surgery for scoliosis or vertebral fracture were selected as control group, including 12 males and 5 females；aged 21 to 65 years old with an average of （39.41±12.80） years old；body mass index was （24.86±4.11） kg·m-2. The relative mRNA expression quantity of HIF-1α, TRPV1 in nucleus pulposus were measured by quantitative real-time PCR. The contents of neurokinin 1 receptor （NK1R）, nerve growth factor （NGF）, vascular endothelial growth factor （VEGF） in nucleus pulposus and the serum substance P （SP） and calcitonin gene-related peptide （CGRP） were detected by enzyme linked immunosorbent assay （ELISA）. The threshold of lumbar tenderness was detected by a pressure pain meter. The degree of lumbago and lumbar function were evaluated by visual analog scale （VAS） and Oswestry disability index （ODI） separately. The residual rate of postoperative lumbago and leg pain was assessed. RESULTS: The mRNA relative expression quantity of HIF-1α and TRPV1, and the contents of NK1R, NGF and VEGF in nucleus pulposus, and the levels of serum SP and CGRP before surgery in the NCT group were higher than those in the CT group（P<0.05）, and those in the CT group were higher than the control group（P<0.05）. At day 7 after surgery, the serum SP and CGRP levels, lumbago and leg pain VAS scores and lumbar ODI index in two LDH groups were lower than before surgery （P<0.05）, and those in the NCT group were higher than the CT group（P<0.05）, and the threshold of lumbar tenderness in the NCT group was lower than the CT group（P<0.05）. The differences of lumbago and leg pain VAS scores, lumbar ODI index and lumbar tenderness threshold between preoperative and postoperative 7 days in the NCT group were lower than those in the CT group（P<0.05）. The residual rate of lumbago and leg pain at 7 days after surgery in the NCT group was higher than that in the CT group（P<0.05）. CONCLUSION: HIF-1α and TRPV1 pathway promoted the excessive production of NGF, VEGF, NK1R in nucleus pulposus and serum neuropeptides SP and CGRP, which may lead to the higher residual rate of lumbago and leg pain with non-contained lumbar disc herniation postoperative.