Analysis of the Ability of a Distal Tibial Anatomical Locking Plate to Capture the Distal Tibial Fragments in Patients with Pilon Fractures.

OBJECTIVE: Although pilon fractures are rare in clinical practice, they are difficult to treat because of their complexity. Effective fixation of the fracture fragment is the key to the treatment of pilon fractures. Plate osteosynthesis is common clinically, but there are many types of plates and the evaluation of the effect of fixation plates is not comprehensive. This study attempted to compare the capture effect of different fixation plates on the fracture fragments based on 3D modeling and fine distinctions of fracture fragments. METHODS: The computed tomography (CT) images before treatment of 127 patients with pilon fractures from January 2019 to December 2021 were retrospectively collected. The fracture lines were mapped and digitally displayed as 3D images using MIMICS 21 software. APLUS distal tibia anatomical locking plate (Plate A) and ZIMMER distal tibia anatomical plate (Plate B) were placed on a pseudo-bone model and CT scans were used to determine the number of screws in the major and minor fragments of pilon fractures. The frequency of the two plates capturing the fracture fragments was recorded. RESULTS: Under Assumption 1 or 2, Plate A performed significantly better than Plate B in capturing the major, Chaput, Volkmann, medial malleolus, and die-punch fracture fragments. Plate A captured markedly more minor fragments than Plate B under Assumption 2 but was not significantly different from Plate B under Assumption 1. Plate A or Plate B showed no obvious difference between major and minor capture rates under the same assumption, and A1 or B1 showed a markedly higher capture rate compared with A2 or B2. In addition, there was a significant positive correlation between the major capture rate and the major fragments in B1, and a significant negative correlation between the minor capture rate and the minor fragments in Plates A and B. However, there was no correlation between the major capture rate of Plate A and the major fragments. CONCLUSION: The APLUS distal tibial anatomical locking plate is superior to the ZIMMER distal tibia anatomical plate in the ability to capture distal tibial fragments in pilon fracture cases.

A retrospective comparison of double-hooked locking plates versus non-locking plates in minimally invasive percutaneous plate osteosynthesis for the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures.

BACKGROUND: Surgical approach and fixation material are crucial in the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures. This study compared the efficacy of double-hooked locking plates and anatomic plates in minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures. METHODS: Clinical data were collected from 96 patients diagnosed with comminuted distal fibular fractures accompanied by tibial Pilon fractures who had undergone MIPPO. Patients in the study group (n = 48) received double-hooked locking plate fixations and the control group (n = 48) received anatomical plate fixations. The operating time, intraoperative bleeding, length of hospital stays, full weight-bearing time, fracture healing time and complication rates in the two groups were compared. The quality of fracture reduction was evaluated using the Burwell-Chamley imaging scoring system; the ankle function was assessed based on the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score. RESULTS: Patients in the study group had shorter operating time, less bleeding, significantly shorter hospital stays, and shorter time to full weight-bearing as well as fracture healing compared to the control group (P < 0.05). Additionally, the post-operative complication rates were significantly lower in the study group (6.16% vs. 22.92%) (P < 0.05), but there was no significant difference in the fracture reduction rate between the two groups (P > 0.05). Patients in the study group experienced better ankle recovery than those in the control group (93.75% vs. 75.00%) (P < 0.05). CONCLUSION: Double-hooked locking plates have advantages in the treatment of comminuted distal fibular fractures accompanied by tibial Pilon fractures during MIPPO due to their shorter operating time and less intraoperative bleeding, as well as shorter hospital stays, full weight-bearing time and fracture healing time, fewer complications and better ankle recovery. Therefore, double-hooked locking plates are worthy of clinical application.

[Intradermal needling combined with heat-sensitive moxibustion for moderate to severe cancer pain].

OBJECTIVE: To observe the effect of intradermal needling combined with heat-sensitive moxibustion for moderate to severe cancer pain. METHODS: A total of 60 patients with moderate to severe cancer pain were randomly divided into an observation group and a control group，30 cases in each one. In the control group，opioids were taken to relief pain according to the three-step analgesic method of World Health Organization. On the base of the treatment as the control group, intradermal needling combined with heat-sensitive moxibustion were applied at Neiguan (PC 6), Hegu (LI 4), Zusanli (ST 36), Taichong (LR 3), etc. in the observation group, 14 days of treatment were required. The equivalent morphine consumption at the first day and whole course, the scores of cancer quality of life questionnaire-C30 (QLQ-C30) and Hamilton anxiety scale before and after treatment, and the adverse reaction rate were compared in the two groups. The total analgesic effective rate was evaluated. RESULTS: The total analgesic effective rate was 93.3% (28/30) in the observation group, higher than 73.3% (22/30) in the control group (P<0.05). The total equivalent morphine consumption in the observation group was less than the control group (P<0.05). After treatment, the QLQ-C30 scores were increased (P<0.001) and the HAMA scores were decreased (P<0.001) in the both groups, and those in the observation group were superior to the control group (P<0.001). The adverse reaction rates of fatigue, dizziness, nausea and vomiting, constipation in the observation group were lower than the control group (P<0.05). CONCLUSION: Intradermal needling combined with heat-sensitive moxibustion can reduce the dose of opioids, improve the quality of life, relief the anxiety in patients with moderate to severe cancer pain, and reduce the incidence of common adverse reaction of opioids.

Protein disulfide isomerase inhibits endoplasmic reticulum stress response and apoptosis via its oxidoreductase activity in colorectal cancer.

Protein disulfide isomerase (PDI), a principal endoplasmic reticulum resident oxidoreductase chaperone, is known to play a role in malignancies. This study aims to explore the molecular mechanism by which PDI regulates endoplasmic reticulum stress and the apoptosis signaling pathway in colorectal cancer (CRC). We determined the expression of PDI in CRC tissues and adjacent normal tissues. Gain- and loss- of function assays were conducted to evaluate the effects of PDI on oxidative stress, endoplasmic reticulum stress, and apoptosis in CRC cells, as reflected by hydrogen peroxide (H2O2) level and the expression of related proteins. PDI protein expression was upregulated in CRC tissues. Small molecule inhibitor of PDI or PDI knockdown reduced CRC cell viability and induced apoptosis. Overexpression of wild-type PDI augmented the viability of CRC cells and inhibited endoplasmic reticulum stress response and apoptosis. Small molecule inhibitor of PDI or PDI knockdown increased intracellular H2O2 level and activated apoptosis signaling pathway, which could be reversed by wild-type PDI restoration. Moreover, the catalytic active site of C-terminal of PDI was found to be indispensable for the regulatory effects of PDI on H2O2 levels, apoptosis and cell viability in CRC cells. Collectively, PDI inhibits endoplasmic reticulum stress and apoptosis of CRC cells through its oxidoreductase activity, thereby promoting the malignancy of CRC.

Syntheses, structures and luminescent properties of zinc(II) and cadmium(II) coordination complexes based on new bis(imidazolyl)ether and different carboxylate ligands.

A series of mixed-ligand coordination complexes, namely [Zn(CA)(2)(BIE)] (1), [Zn(OX)(BIE)].H(2)O (2), [Zn(2)(m-BDC)(2)(BIE)(2)] (3), [Cd(m-BDC)(BIE)] (4), [Cd(5-OH-m-BDC)(BIE)] (5), [Zn(5-OH-m-BDC)(BIE)] (6), [Zn(2)(p-BDC)(2)(BIE)(2)].2.5H(2)O (7), [Cd(3)(p-BDC)(3)(BIE)] (8), [Cd(3)(BTC)(2)(BIE)(2)].0.5H(2)O (9) and [Zn(BTCA)(0.5)(BIE)] (10), where CA = cinnamate anion, OX = oxalate anion, m-BDC = 1,3-benzenedicarboxylate anion, 5-OH-m-BDC = 5-OH-1,3-benzenedicarboxylate anion, p-BDC = 1,4-benzenedicarboxylate anion, BTC = 1,3,5-benzenetricarboxylate anion, BTCA = 1,2,3,4-butanetetracarboxylate anion, and BIE = 2,2'-bis(1H-imidazolyl)ether, were synthesized under hydrothermal conditions. In 1, a pair of BIE ligands bridge adjacent Zn(II) atoms to give a centrosymmetric dimer. In 2 and 3, BIE ligands connect Zn(II)-carboxylate chains to form hexagonal honeycomb 6(3)-hcb and square 4(4)-sql layers, respectively. In 4 and 5, m-BDC and 5-OH-m-BDC bridge Cd(II) atoms to give dimeric units, respectively, which are further linked by BIE ligands to form sql nets. In 6, the BIE ligands extend the Zn(II)-carboxylate chains into 2D sinusoidal-like sql nets. The undulated sql nets polycatenate each other in the parallel manner with DOC (degree of catenation) = 2, yielding a rare 2D --> 3D parallel polycatenation net. In 7, the BIE and p-BDC ligands link the Zn(ii) atoms to give a rare 3-fold interpenetrated 3-connected 10(3)-ths net. 8 contains unusual edge-sharing polyhedral rods formed by [Cd(3)(CO(2))(6)] clusters. Each rod is connected by the benzene rings of p-BDC in four directions into a simple alpha-Po topology. In 9, two kinds of different 2D Cd-BTC layers are alternately linked to each other by sharing Cd(ii) centers to form a 3D framework, which is further linked by two kinds of BIE ligand to produce a complicated 3D polymeric structure. 10 possesses a unique (3,4)-connected 3D framework with (8(3))(2)(8(5).10) topology. The structural differences described indicate the importance of carboxylate ligands and metals in the framework formation of coordination complexes. The infrared spectra, thermogravimetric and luminescent properties were also investigated in detail for the compounds.