Management of a rare giant cell tumor of the distal fibula: A case report.

BACKGROUND: Aggressive giant cell tumor of the distal fibula is so rare that no consensus on a surgical strategy has been reached. Thus, an appropriate treatment strategy is still important to discuss. CASE SUMMARY: A 61-year-old man who had been experiencing progressive swelling of the left lateral malleolus accompanied by pain for half a year was presented at our hospital. He had never been treated prior to coming to our hospital. Preoperative imaging revealed a 10 cm × 6 cm mass located in the body of the distal fibula. Pathological biopsies confirmed it was a giant cell tumor. Preoperative examination revealed he had dilated cardiomyopathy with class 3 cardiac function. The cardiologist and anesthesiologist determined that he could tolerate the operation, but the operation should be as short and minimally invasive as possible. With the patient's consent, we performed a tibiotalar fusion and followed up with him for 2 years, finding no recurrence and a satisfactory recovery. CONCLUSION: Tibial talus fusion is an effective method for the treatment of distal fibula tumors.

The need for nutritional assessment and interventions based on the prognostic nutritional index for patients with femoral fractures: a retrospective study.

BACKGROUND: The incidence of adverse perioperative outcomes in surgery for femoral fractures is high and associated with malnutrition. Here, we identified independent factors and assessed the predictive value of the prognostic nutritional index (PNI) for perioperative adverse outcomes in patients with femoral fractures. METHODS: This retrospective study included 343 patients who underwent surgery for a single femur fracture. Demographic characteristics, surgery and anaesthesia records and blood test results at admission, 1 day postoperatively and before discharge were evaluated using logistic regression analysis. The discriminatory ability of the independent factors was assessed using the receiver operating characteristic curve analysis, and DeLong's test was used to compare the area under the curve (AUC). RESULTS: Overall, 159 patients (46.4%) experienced adverse perioperative outcomes. Amongst these, 123 (35.9%) had lower limb vein thrombus, 68 (19.8%) had hospital-acquired pneumonia, 6 (1.7%) were transferred to the postoperative intensive care unit, 4 (1.2%) had pulmonary embolism, 3 (0.9%) died during hospitalisation and 9 (2.6%) had other adverse outcomes, including incision disunion, renal and liver function impairment, acute heart failure, acute cerebral infarction and stress gastroenteritis. The PNI at admission, age, postoperative hospital stay, time to admission, hypertension, combined injures and surgery type were independent factors for adverse perioperative outcomes. Based on the AUC (PNI at admission: 0.772 [0.723-0.821], P < 0.001; age: 0.678 [0.622-0.734], P < 0.001; postoperative hospital stay: 0.608 [0.548-0.668], P = 0.001; time to admission: 0.585 [0.525-0.646], P = 0.006), the PNI at admission had optimal discrimination ability, indicating its superiority over other independent factors (age vs. PNI at admission, P = 0.002; postoperative hospital stay vs. PNI at admission, P < 0.001; time to admission vs. PNI at admission, P < 0.001). CONCLUSIONS: Patients with femoral fractures require a nutritional assessment and appropriate nutritional intervention at admission, and that the PNI value at admission may be a good nutritional assessment indicator.

Prognostic roles of KL-6 in disease severity and lung injury in COVID-19 patients: A longitudinal retrospective analysis.

To investigate the dynamic changes of Krebs von den Lungen-6 (KL-6) among patients with coronavirus disease 2019 (COVID-19) and the role of KL-6 as a noninvasive biomarker for predicting long-term lung injury, the clinical information and laboratory tests of 166 COVID-19 patients were collected, and a correlation analysis between KL-6 and other parameters was conducted. There were 17 (10.2%, 17/166) severe/critical and 149 (89.8%, 149/166) mild COVID-19 patients in our cohort. Serum KL-6 was significantly higher in severe/critical COVID-19 patients than in mild patients (median 898.0 vs. 451.2 U/ml, p < .001). KL-6 was next confirmed to be a sensitive and specific biomarker for distinguishing mild and severe/critical patients and correlate to computed tomography lung lesions areas. Serum KL-6 concentration during the follow-up period (>100 days postonset) was well correlated to those concentrations within 10 days postonset (Pearson r = .867, p < .001), indicating the prognostic value of KL-6 levels in predicting lung injury after discharge. Finally, elevated KL-6 was found to be significantly correlated to coagulation disorders, and T cells subsets dysfunctions. In summary, serum KL-6 is a biomarker for assessing COVID-19 severity and predicting the prognosis of lung injury of discharged patients.

Three-dimensional silk fibroin scaffolds enhance the bone formation and angiogenic differentiation of human amniotic mesenchymal stem cells: a biocompatibility analysis.

Silk fibroin (SF) is a fibrous protein with unique mechanical properties, adjustable biodegradation, and the potential to drive differentiation of mesenchymal stem cells (MSCs) along the osteogenic lineage, making SF a promising scaffold material for bone tissue engineering. In this study, hAMSCs were isolated by enzyme digestion and identified by multiple-lineage differentiation. SF scaffold was fabricated by freeze-drying, and the adhesion and proliferation abilities of hAMSCs on scaffolds were determined. Osteoblast differentiation and angiogenesis of hAMSCs on scaffolds were further evaluated, and histological staining of calvarial defects was performed to examine the cocultured scaffolds. We found that hAMSCs expressed the basic surface markers of MSCs. Collagen type I (COL-I) expression was observed on scaffolds cocultured with hAMSCs. The scaffolds potentiated the proliferation of hAMSCs and increased the expression of COL-I in hAMSCs. The scaffolds also enhanced the alkaline phosphatase activity and bone mineralization, and upregulated the expressions of osteogenic-related factors in vitro. The scaffolds also enhanced the angiogenic differentiation of hAMSCs. The cocultured scaffolds increased bone formation in treating critical calvarial defects in mice. This study first demonstrated that the application of 3D SF scaffolds co-cultured with hAMSCs greatly enhanced osteogenic differentiation and angiogenesis of hAMSCs in vitro and in vivo. Thus, 3D SF scaffolds cocultured with hAMSCs may be a better alternative for bone tissue engineering.

Morphological measurements and classification of the spinoglenoid notch: A three-dimensional reconstruction of computed tomography in the Chinese population.

BACKGROUND: The spinoglenoid notch (SGN) is the second most common location for suprascapular nerve (SN) entrapment; however, there are few relative morphological reports on this condition. Hence, the present morphological study mainly explored the anatomical structure and classification of the SGN and the relationship with entrapment of SN. MATERIALS AND METHODS: Four hundred seventy-eight scapulae were analysed thoroughly and systematically in this study. Anatomical structure and classification of the SGN were observed and measured by a three-dimensional (3D) reconstruction of computed tomography (CT). The measurement results were then analysed and recorded. RESULTS: Chinese scapulae were classified into three types at the SGN, and it was found that left scapulae had deeper SGN than right ones. Then, significant differences were also noted between sexes. Men had thicker, wider and deeper SGN than women. Type II (small U, 46.04%) was the most common. Type I (large U) was the widest (15.67±1.43mm) and deepest (13.71±2.39mm) compared with other types. Lastly, no significant differences in the above criteria were found in other measurements. CONCLUSIONS: These morphological measurements of the SGN may help to improve the diagnosis and successful treatment rate of the surgery for the SN entrapment, but the relative clinical trial is necessary to support it.

Pharmacokinetic behaviors of ligustrazine after single- and multiple-dose intravenous Shenxiong glucose injection in rats by high-performance liquid chromatography.

Shenxiong glucose injection (SXG) is a traditional Chinese medicine that is used for cardio-cerebral vascular diseases on the national essential drug list of China. To date, a comprehensive knowledge concerning the pharmacokinetic profile of SXG-related components, especially following multiple dosing, is still lacking. This study was designed to investigate the pharmacokinetics and tissue distribution of ligustrazine after single- and multiple-dose intravenous administration of SXG in rats. A simple HPLC method was developed for the determination of ligustrazine in biological samples. The pharmacokinetic profiles of ligustrazine in rats were linear after both single- and multiple-dose intravenous administration of SXG, with a half-life of approximately 35 min. Ligustrazine was readily distributed in highly perfused organs and almost eliminated from organs after 90 min of SXG injection. The AUC0-t and C0 of ligustrazine after SXG injection (18 ml/kg, equal to 9.0 mg/kg ligustrazine) were increased significantly compared to those of single ligustrazine administration (9.0 mg/kg), indicating that the pharmacokinetics of ligustrazine in the SXG were affected by other ingredients. This study provided first evidence for the pharmacokinetic characteristics of ligustrazine after both single and multiple-dose SXG in rats, which would be helpful for its clinical application.

Eukaryotic translation initiation factor 3H suppression inhibits osteocarcinoma cell growth and tumorigenesis.

Eukaryotic translation initiation factor 3H subunit (EIF3H) is a member of the EIF3 family and exhibits a central role in translation initiation in higher eukaryotes. Although EIF3H expression is upregulated in numerous tumour types, its potential role in human osteosarcoma (OS) has not yet been investigated. In the present study, it was demonstrated that EIF3H mRNA expression was upregulated in the human OS cell lines Saos-2 and U2OS. A recombinant lentivirus harbouring short hairpin RNA targeting EIF3H was constructed and successfully infected human OS Saos-2 and U2OS cells, resulting in 95% downregulated EIF3H expression compared with the respective control groups. Knockdown of EIF3H significantly inhibited the proliferation and colony formation of OS cells in vitro, and tumour growth in nude mice in vivo. Flow cytometry analysis revealed cell cycle arrest and promotion of apoptosis in OS cells with EIF3H knocked down. In conclusion, the results strongly suggested that EIF3H is a critical factor mediating the growth of OS cells and may represent a novel therapeutic target.

[Differentiation of directly co-cultured bone marrow mesenchymal stem cells and ligament fibroblasts into ligament cells after induced by transforming growth factor ß1 and basic fibroblast growth factor].

OBJECTIVE: To investigate the effect of transforming growth factor ß1 (TGF-ß1) and basic fibroblast growth factor 1 (bFGF-1) on the cellular activities, proliferation, and expressions of ligament-specific mRNA and proteins in bone marrow mesenchymal stem cells (BMSCs) and ligament fibroblasts (LFs) after directly co-cultured. METHODS: BMSCs from 3-month-old Sprague Dawley rats were isolated and cultured using intensity gradient centrifugation. LFs were isolated using collagenase. The cells at passage 3 were divided into 6 groups: non-induced BMSCs group (group A), non-induced LFs group (group B), non-induced co-cultured BMSCs and LFs group (group C), induced BMSCs group (group D), induced LFs group (group E), and induced co-cultured BMSCs and LFs group (group F). The cellular activities and proliferation were examined by inverted contrast microscope and MTT; the concentrations of collagen type I and type III were determined by ELISA; and mRNA expressions of collagen types I and III, fibronectin, tenascin C, and matrix metalloproteinase 2 (MMP-2) were measured by real-time fluorescent quantitative PCR. RESULTS: A single cell layer formed in the co-cultured cells under inverted contrast microscope. Group F had fastest cell fusion (> 90%). The MTT result indicated that group F showed the highest absorbance (A) value, followed by group D, and group B showed the lowest A value at 9 days after culture, showing significant difference (P < 0.05). Moreover, the result of ELISA showed that group F had the highest concentration of collagen type I and type III (P < 0.05); the concentration of collagen type III in group E was significantly higher than that in group D (P < 0.05), but no significant difference was found in the concentration of collagen type I between 2 groups (P > 0.05). The ratios of collagen type I to type III were 1.17, 1.19, 1.10, 1.25, 1.17, and 1.18 in groups A-F; group D was higher than the other groups. The real-time fluorescent quantitative PCR results revealed that the mRNA expressions of collagen type I and type III and fibronectin were highest in group F; the expression of tenascin C was highest in group D; the expression of MMP-2 was highest in group E; and all differencs were significant (P < 0.05). CONCLUSION: Directly co-cultured BMSCs and LFs induced by TGF-ß1 and bFGF-1 have higher cellular activities, proliferation, and expressions of ligament-specific mRNA and protein, which can be used as a potential source for ligament tissue engineering.