The application of B1 inhomogeneity-corrected variable flip angle T1 mapping for assessing liver fibrosis.

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of the B1 inhomogeneity-corrected variable flip angle (VFA) method using native T1 values in the staging of liver fibrosis. METHODS: Eighty-three patients who presented for liver biopsy due to varying degrees of liver damage, underwent MR examinations and had T1-mapping images of the liver acquired using the B1 inhomogeneity-corrected VFA VIBE method. Among them, 65 patients underwent Fibroscan, and their results were used to evaluate the elasticity of liver tissue. Additionally, T1-mapping images were collected from 19 normal control patients. Independent sample t-tests were used to analyze the correlation between T1 mapping and Fibroscan. The diagnostic efficacy of T1 mapping in patients with different stages of liver fibrosis was evaluated using receiver operating characteristic (ROC) curves. RESULTS: The consistency between different observer groups was intraclass correlation coefficient (ICC) =0.802. T1 mapping demonstrated significant differences between mid-stage liver fibrosis (S = 2) and late-stage liver fibrosis (S = 3), as well as moderate inflammation (G = 2) and severe inflammation (G = 3), P < 0.05. The Area Under Curve(AUC) values of T1 mapping for early liver fibrosis (S ≥ 1), significant liver fibrosis (S ≥ 2), advanced liver fibrosis (S ≥ 3), and end-stage liver fibrosis (S = 4) were 0.760, 0.709, 0.790, and 0.768, respectively. T1 mapping combined with Fibroscan had an AUC value of 0.860. CONCLUSIONS: The B1 inhomogeneity-corrected VFA T1 mapping may be useful for the staging of liver fibrosis. It has a superior diagnostic efficiency for diagnosing advanced fibrosis (≥S3), while native T1 values combined with Fibroscan have potential value for the staging of liver fibrosis.

Staging liver fibrosis with various diffusion-weighted magnetic resonance imaging models.

BACKGROUND: Diffusion-weighted imaging (DWI) has been developed to stage liver fibrosis. However, its diagnostic performance is inconsistent among studies. Therefore, it is worth studying the diagnostic value of various diffusion models for liver fibrosis in one cohort. AIM: To evaluate the clinical potential of six diffusion-weighted models in liver fibrosis staging and compare their diagnostic performances. METHODS: This prospective study enrolled 59 patients suspected of liver disease and scheduled for liver biopsy and 17 healthy participants. All participants underwent multi-b value DWI. The main DWI-derived parameters included Mono-apparent diffusion coefficient (ADC) from mono-exponential DWI, intravoxel incoherent motion model-derived true diffusion coefficient (IVIM-D), diffusion kurtosis imaging-derived apparent diffusivity (DKI-MD), stretched exponential model-derived distributed diffusion coefficient (SEM-DDC), fractional order calculus (FROC) model-derived diffusion coefficient (FROC-D) and FROC model-derived microstructural quantity (FROC-µ), and continuous-time random-walk (CTRW) model-derived anomalous diffusion coefficient (CTRW-D) and CTRW model-derived temporal diffusion heterogeneity index (CTRW-α). The correlations between DWI-derived parameters and fibrosis stages and the parameters' diagnostic efficacy in detecting significant fibrosis (SF) were assessed and compared. RESULTS: CTRW-D (r = -0.356), CTRW-α (r = -0.297), DKI-MD (r = -0.297), FROC-D (r = -0.350), FROC-µ (r = -0.321), IVIM-D (r = -0.251), Mono-ADC (r = -0.362), and SEM-DDC (r = -0.263) were significantly correlated with fibrosis stages. The areas under the ROC curves (AUCs) of the combined index of the six models for distinguishing SF (0.697-0.747) were higher than each of the parameters alone (0.524-0.719). The DWI models' ability to detect SF was similar. The combined index of CTRW model parameters had the highest AUC (0.747). CONCLUSION: The DWI models were similarly valuable in distinguishing SF in patients with liver disease. The combined index of CTRW parameters had the highest AUC.

Application of multi-echo Dixon and MRS in quantifying hepatic fat content and staging liver fibrosis.

This study associated the liver proton density fat fraction (PDFF), measured by multi-echo Dixon (ME-Dixon) and breath-hold single-voxel high-speed T2-corrected multi-echo 1H magnetic resonance spectroscopy (HISTO) at 1.5 T, with serum biomarkers and liver fibrosis stages. This prospective study enrolled 75 patients suspected of liver fibrosis and scheduled for liver biopsy and 23 healthy participants with normal liver function. The participant underwent ME-Dixon and HISTO scanning. The agreement of PDFF measured by ME-Dixon (PDFF-D) and HISTO (PDFF-H) were compared. Correlations between PDFF and serum fat biomarkers (total cholesterol, triglyceride, and high- and low-density lipoproteins) and the liver fibrosis stages were assessed. PDFF were compared among the liver fibrosis stages (F0-F4) based on clinical liver biopsies. The Bland-Altman plot showed agreement between PDFF-D and PDFF-H(LoA, - 4.44 to 6.75), which have high consistency (ICC 0.752, P < 0.001). The correlations with the blood serum markers were mild to moderate (PDFF-H: r = 0.261-0.410, P < 0.01; PDFF-D: r = 0.265-0.367, P < 0.01). PDFF-D, PDFF-H, and steatosis were distributed similarly among the liver fibrosis stages. PDFF-H showed a slight negative correlation with the liver fibrosis stages (r = - 0.220, P = 0.04). Both ME-Dixon and HISTO sequences measured liver fat content noninvasively. Liver fat content was not directly associated with liver fibrosis stages.

A guidebook of spatial transcriptomic technologies, data resources and analysis approaches.

Advances in transcriptomic technologies have deepened our understanding of the cellular gene expression programs of multicellular organisms and provided a theoretical basis for disease diagnosis and therapy. However, both bulk and single-cell RNA sequencing approaches lose the spatial context of cells within the tissue microenvironment, and the development of spatial transcriptomics has made overall bias-free access to both transcriptional information and spatial information possible. Here, we elaborate development of spatial transcriptomic technologies to help researchers select the best-suited technology for their goals and integrate the vast amounts of data to facilitate data accessibility and availability. Then, we marshal various computational approaches to analyze spatial transcriptomic data for various purposes and describe the spatial multimodal omics and its potential for application in tumor tissue. Finally, we provide a detailed discussion and outlook of the spatial transcriptomic technologies, data resources and analysis approaches to guide current and future research on spatial transcriptomics.

SRC3 acetylates calmodulin in the mouse brain to regulate synaptic plasticity and fear learning.

Protein acetylation is a reversible posttranslational modification, which is regulated by lysine acetyltransferase (KAT) and lysine deacetyltransferase (KDAC). Although protein acetylation has been shown to regulate synaptic plasticity, this was mainly for histone protein acetylation. The function and regulation of nonhistone protein acetylation in synaptic plasticity and learning remain largely unknown. Calmodulin (CaM), a ubiquitous Ca2+ sensor, plays critical roles in synaptic plasticity such as long-term potentiation (LTP). During LTP induction, activation of NMDA receptor triggers Ca2+ influx, and the Ca2+ binds with CaM and activates calcium/calmodulin-dependent protein kinase IIα (CaMKIIα). In our previous study, we demonstrated that acetylation of CaM was important for synaptic plasticity and fear learning in mice. However, the KAT responsible for CaM acetylation is currently unknown. Here, following an HEK293 cell-based screen of candidate KATs, steroid receptor coactivator 3 (SRC3) is identified as the most active KAT for CaM. We further demonstrate that SRC3 interacts with and acetylates CaM in a Ca2+ and NMDA receptor-dependent manner. We also show that pharmacological inhibition or genetic downregulation of SRC3 impairs CaM acetylation, synaptic plasticity, and contextual fear learning in mice. Moreover, the effects of SRC3 inhibition on synaptic plasticity and fear learning could be rescued by 3KQ-CaM, a mutant form of CaM, which mimics acetylation. Together, these observations demonstrate that SRC3 acetylates CaM and regulates synaptic plasticity and learning in mice.

Steroid Receptor Coactivator 3 Regulates Synaptic Plasticity and Hippocampus-dependent Memory.

Steroid hormones play important roles in brain development and function. The signaling of steroid hormones depends on the interaction between steroid receptors and their coactivators. Although the function of steroid receptor coactivators has been extensively studied in other tissues, their functions in the central nervous system are less well investigated. In this study, we addressed the function of steroid receptor coactivator 3 (SRC3) - a member of the p160 SRC protein family that is expressed predominantly in the hippocampus. While hippocampal development was not altered in Src3+/- mice, hippocampus-dependent functions such as short-term memory and spatial memory were impaired. We further demonstrated that the deficient learning and memory in Src3+/- mice was strongly associated with the impairment of long-term potentiation (LTP) at Schaffer Collateral-CA1 synapses. Mechanistic studies indicated that Src3+/- mutation altered the composition of N-methyl-D-aspartate receptor subunits in the postsynaptic densities of hippocampal neurons. Finally, we showed that SRC3 regulated synaptic plasticity and learning mainly dependent on its lysine acetyltransferase activity. Taken together, these results reveal previously unknown functions of SRC3 in the hippocampus and thus may provide insight into how steroid hormones regulate brain function.

LncRNA NEAT1 promotes cell proliferation, migration, and invasion via the miR-186-5p/PTP4A1 axis in cholangiocarcinoma.

Cholangiocarcinoma (CCA) is a highly aggressive and malignant tumor. In this study, the effect and molecular mechanism of nuclear enriched abundant transcript 1 (NEAT1) in CCA were elucidated. The expressions of NEAT1, microRNA-186-5p (miR-186-5p), and PTP4A1 were measured by quantitative real-time PCR. The protein levels were measured by Western blotting. Kaplan-Meier analysis was performed to create survival curves. The interactions between NEAT1, miR-186-5p, and PTP4A1 were assessed through the dual luciferase reporter assay. Additionally, the cell proliferation, apoptosis, migration, and invasion were measured by colony formation, flow cytometry, the Transwell assay, and the wound healing assay, respectively. NEAT1 and PTP4A1 were significantly upregulated in CCA tissues and cells, but miR-186-5p was downregulated. NEAT1 expression was negatively correlated with the survival of CCA patients and has remarkable correlation with serum CA199 levels and lymph node metastasis. Besides, NEAT1 could act as a molecular sponge for miR-186-5p to upregulate PTP4A1 expression. More importantly, the knockdown of NEAT1 or overexpression of miR-186-5p inhibited the proliferation, migration and invasion of CCA cells, and the inhibition of miR-186-5p reversed the effects of the knockdown of NEAT1. In addition, NEAT1 could also activate the PI3K/AKT signaling pathway and regulate the epithelial-mesenchymal transition (EMT) through the miR-186-5p/PTP4A1 axis. In conclusion, NEAT1 was involved in cell proliferation, migration and invasion in CCA, and the NEAT1/miR-186-5p/PTP4A1/PI3K/AKT axis indicated novel regulatory mechanisms and therapeutics for the treatment of CCA.

The Application of Iodine Quantitative Information Obtained by Dual-Source Dual-Energy Computed Tomography on Chemoradiotherapy Effect Monitoring for Cervical Cancer: A Preliminary Study.

OBJECTIVE: The aim of the study is to investigate the potential contribution of the iodine quantitative parameters of dual-phase dual-energy computed tomography (DECT) scanning for chemoradiotherapy (CRT) response monitoring for cervical cancer. METHODS: Patients who were pathologically certified having cervical cancer and intended for concurrent radiotherapy and chemotherapy were prospectively included in our study. Contrast-enhanced DECT scanning was performed before CRT, which was repeated after 1 month of therapy, using a dual-source CT scanner onset. Changes in tumor size were assessed according to RECIST 1.0. Quantification of volume-normalized iodine uptake (mg/mL) was measured in dual phases and was standardized using the iodine uptake in the iliac artery. The decreased ratio of the standard iodine uptake was calculated and compared with the tumor size for the evaluation of the CRT effect. Data were analyzed using the statistics software SPSS version 19.0. Twenty women who performed normal pelvic contrast-enhanced CT scanning were randomly chosen as the control group for the radiation dose comparison with the dual-energy group. RESULTS: A total of 21 patients who completed therapeutic courses and performed the contrast-enhanced CT scanning were subsequently evaluated. According to RECIST 1.0, 15 cases were classified into the regression (R, including 5 completed regression cases and 10 partial regression cases) group. The remaining 6 cases were classified into the nonregression (NR, including 6 stable disease cases) group. The iodine value decreased ratio in the arterial phase (standardized iodine in arterial phase [SAI]) of the partial regression group was significantly higher than that of the stable disease group (P < 0.01), and there was no significant difference in the venous phase (P > 0.05). In a general quantitative comparison between the R group and the NR group before CRT, we controlled for the maximum diameter, age, iodine uptake in the arterial phase before CRT (pre-SAI), iodine uptake in the venous phase before CRT, and cell differentiated level, and we ultimately found no significant statistical differences except for the pre-SAI. In other words, the iodine value in the arterial phase of the R group before CRT was significantly higher than that of the NR group (P < 0.01). When the pre-SAI was 0.345, the area under the curve was 0.875 for therapeutic effect prediction. The mean effective dose was 5.63 ± 1.68 mSv for the DECT group and 5.37 ± 1.82 mSv for the control group (t = -1.137, P = 0.262), which showed no statistical difference in the radiation dose between the 2 scanning methods. CONCLUSIONS: The iodine mapping can be used to help evaluate the radiochemotherapy response effectively on the basis of tumor size change and can also be helpful in predicting the radiochemotherapy outcome for cervical cancer. The dual-phase DECT scanning did not increase the radiation dose and provided more valuable information, and thus, it was suitable for promotion in clinical application.

Case-control study of diarrheal disease etiology in individuals over 5 years in southwest China.

BACKGROUND: Acute diarrhea is one of the major public health problems worldwide. Most of studies on acute diarrhea have been made on infants aged below 5 years and few efforts have been made to identify the etiological agents of acute diarrhea in people over five, especially in China. METHODS: 271 diarrhea cases and 149 healthy controls over 5 years were recruited from four participating hospitals between June 2014 and July 2015. Each stool specimen was collected to detect a series of enteric pathogens, involving five viruses (Rotavirus group A, RVA; Norovirus, NoV; Sapovirus, SaV; Astrovirus, As; and Adenovirus, Ad), seven bacteria (diarrheagenic Escherichia coli, DEC; non-typhoidal Salmonella, NTS; Shigella spp.; Vibrio cholera; Vibrio parahaemolyticus; Aeromonas spp.; and Plesiomonas spp.) and three protozoa (Cryptosporidium spp., Giardia lamblia, G. lamblia, and Blastocystis hominis, B. hominis). Standard microbiological and molecular methods were applied to detect these pathogens. Data was analyzed using Chi square, Fisher-exact tests and logistic regressions. RESULTS: The prevalence of at least one enteric pathogen was detected in 29.2% (79/271) acute diarrhea cases and in 12.1% (18/149) in healthy controls (p < 0.0001). Enteric viral infections (14.4%) were the most common in patients suffering from acute diarrhea, followed by bacteria (13.7%) and intestinal protozoa (4.8%). DEC (12.5%) was the most common causative agent in diarrhea cases, followed by NoV GII (10.0%), RVA (7.4%) and B. hominis (4.8%). The prevalence of co-infection was statistically higher (p = 0.0059) in the case group (7.7%) than in the healthy control (1.3%). RVA-NoV GII (3.0%) was the most common co-infection in symptomatic cases. CONCLUSIONS: DEC was the most predominant pathogen in diarrhea cases, but it was largely overlooked because the lack of laboratory capacities. Because of the high prevalence of co-infections, it is recommended the urgent development of alternative laboratory methods to assess polymicrobial infections. Such methodological improvements will result in a better prevention and treatment strategies to control diarrhea illness in China.

In vivo enhancement of anticancer therapy using bare or chemotherapeutic drug-bearing nanodiamond particles.

BACKGROUND: This study investigated the use of nanodiamond particles (NDs) as a promising material for drug delivery in vivo and in vitro. METHODS: HepG2 cells (a human hepatic carcinoma cell line) were used to determine the characteristics of a nanodiamond-doxorubicin complex (ND-DOX) when taken up by cells in vitro using laser scanning confocal microscopy and dialysis experiments. We also compared the survival rate and histopathology of tumor-bearing mice after treatment with NDs or ND-DOX in vivo. RESULTS: In vitro investigation showed that ND-DOX has slow and sustained drug release characteristics compared with free doxorubicin. In vivo, the survival rate of tumor-bearing mice treated with ND-DOX was four times greater than that of mice treated with free doxorubicin. Interestingly, the survival rate in mice treated with NDs alone was close to that of mice treated with free doxorubicin. This indicates that treatment with ND-DOX can prolong the lifespan of tumor-bearing mice significantly compared with conventional doxorubicin and that NDs can have this effect as well. Histopathological analysis showed that neither the NDs nor ND-DOX were toxic to the kidney, liver, or spleen in contrast with the well-known toxic effects of free doxorubicin on the kidney and liver. Further, both the bare NDs and ND-DOX could suppress tumor growth effectively. CONCLUSION: NDs can potentially prolong survival, and ND-DOX may act as a nanodrug with promising chemotherapeutic efficacy and safety.

Diagnostic accuracy of digital breast tomosynthesis versus digital mammography for benign and malignant lesions in breasts: a meta-analysis.

OBJECTIVE: To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) and digital mammography (DM) for benign and malignant lesions in breasts. METHODS: Document retrieval was conducted on PubMed, EMBASE, the Cochrane Library, Web of Science and Chinese Biomedical Literature Database, etc., from 1950 to June 2013. Metadisc1.4 software was used to analyse the pooled sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio. The heterogeneity was assessed using forest plots and the inconsistency index (I(2)). Before statistical comparison, the area under (AUC) the summary receiver-operating characteristic curve (SROC) of two different diagnostic methods was calculated respectively. RESULTS: A total of seven studies involving 2,014 patients and 2,666 breast lesions were included. Compared with the gold standard (histological results), the pooled sensitivity and specificity of DBT were 90.0% and 79.0%, and for DM they were 89.0% and 72.0%, respectively. The pooled positive likelihood ratio of DBT and DM was 3.50 and 2.83; the pooled negative likelihood ratio of DBT and DM was 15% and 18%; the pooled DOR for DBT and DM was 26.04 and 16.24, respectively. CONCLUSIONS: Digital breast tomosynthesis has a higher sensitivity and specificity in breast diagnosis than digital mammography. KEY POINTS: • Digital breast tomosynthesis has high sensitivity and specificity in breast diagnosis.• DBT appears to have superior diagnostic accuracy relative to digital mammography. • DBT images were captured at a lower dose than 2D images. • DBT displays abnormal features of lesions more clearly than DM. • Digital breast tomosynthesis could become the first choice for assessing breast lesions.

Quality of life of methylphenidate treatment-responsive adolescents with attention-deficit/hyperactivity disorder.

Quality of life (QOL) in methylphenidate treatment-responsive adolescents with attention deficit/hyperactivity disorder (ADHD) was assessed. Patients were 12- to 18-year-old adolescents with ADHD (total n = 45) who had been on methylphenidate treatment for at least 3 months and were clinically judged to be improved. The self-completed Taiwanese Quality of Life Questionnaire for Adolescents (TQOLQA) was used, and the resulting measures were compared between adolescents with ADHD and: (1) community adolescents (n = 2316); (2) treatment-responsive adolescents with a chronic medical condition (i.e., adolescents with leukemia in its first and complete continuous remission for at least 3 years after chemotherapy) (n = 39). Patients' cognitive profile and their daily executive functioning were also obtained for analysis. The QOL of the treated adolescents with ADHD was reported to be worse than that of both the community healthy adolescents and the adolescent leukemia survivors in the self-reported TQOLQA domain of "psychological well-being". Treated adolescents with ADHD still had impaired executive skills in natural, everyday environments, and the scores for daily executive abilities could predict the QOL measures. Factors besides pharmacotherapy should be explored to further improve the QOL of medication-treated adolescents with ADHD.

Simultaneous arthroscopic reconstruction of the anterior and posterior cruciate ligament using hamstring and quadriceps tendon autografts.

BACKGROUND: Most dislocated knees involved tears in the two cruciate ligaments were often accompanied by other collateral ligament complexes. Surgical repair or reconstruction seems to achieve results superior to conservative treatment. Various methods of reconstructing anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) after knee dislocation have been described, but few reports discuss simultaneous ACL and PCL reconstructions in a single operation. METHODS: Eleven consecutive patients (6 males and 5 females) with both ACL and PCL disruptions were enrolled in the prospective study and treated with arthroscopic combined reconstruction of ACL and PCL using hamstring and quadriceps tendon autografts in a single operation. The average period from injury to operation was 76 days (range, 30-150 days), and the mean age was 33 years (range, 19-48 years) for those who underwent the operation. Mean follow-up time was 55 months (range, 36-78 months). Follow-up examinations included Lysholm knee score, Tegner activity score, International Knee Documentation Committee (IKDC) score, thigh muscle assessment, and radiographic evaluation. RESULTS: Ten of 11 (91%) patients showed good or excellent results. Statistically significant improvements were observed in Lysholm score (p = 0.008), Tegner score (p = 0.038), postoperative KT-1000 scores (p = 0.001), final IKDC rating (p = 0.032), and thigh atrophy and muscle strength (p < 0.05). Regarding IKDC final rating, 82% (9 of 11) of the patients were assessed as normal or nearly normal (grade A or B). CONCLUSIONS: Simultaneous arthroscopically assisted reconstruction of both ACL and PCL using hamstring and quadriceps autografts can effectively and safely restore knee stability.

Improved divergence angles with femoral interference screw placement through the tibial tunnel as measured by multiplanar reconstruction computed tomography.

PURPOSE: A modified technique for anterior cruciate ligament (ACL) reconstruction without graft injury by femoral interference screw insertion directly through the tibial tunnel is reported. This study evaluated femur bioabsorbable interference screw divergence and obliquity of the graft and tunnel positions as measured by multiplanar reconstruction computed tomography (MPR-CT) after endoscopic ACL reconstruction. METHODS: Twenty-five patients who underwent single-incision arthroscopically assisted ACL reconstruction using hamstring tendon autografts were enrolled in this prospective study. All procedures were performed using the same technique: femoral bioabsorbable interference screw insertion directly through the tibial tunnel. Divergence angles of oblique sagittal and oblique axial views of the graft and tunnel positions using MPR-CT evaluation were obtained. CT images were evaluated in a blinded manner by 3 experienced radiologists. RESULTS: The average divergence angles in oblique sagittal and oblique axial views were 0.88 +/- 1.06 and 1.44 +/- 1.17, respectively. Sagittal, axial, and coronal obliquity of the graft in reconstructed patients averaged 64 degrees (range, 46 degrees to 69 degrees ), 19 degrees (range, 17 degrees to 22.5 degrees ), and 73.6 degrees (range, 70 degrees to 77.6 degrees ), respectively. Radiologic analysis of the femoral insertion according to the quadrant technique showed that the femoral center of the anteromedial (grafted) bundle was 18.6% and 23.6% of the depth of Blumensaat's line and the height of the femoral condyle. At the tibia, the tibial ACL attachment at the center of the anteromedial bundle was at 41.1% of the maximal tibial diameter. CONCLUSIONS: Our study showed that MPR-CT is a useful diagnostic tool for evaluation of the femoral interference screw divergence, obliquity of the graft, and the exact femoral and tibial insertion site of the graft. The screw will have little or no divergence using this novel technique as measured by the very accurate MPR-CT. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

New vertebral fracture after vertebroplasty.

BACKGROUND: Because the complications of vertebroplasty are serious and can include new fracture, we retrospectively evaluated potential risk factors for new fracture after vertebroplasty. Our hypothesis is that thoracolumbar vertebrae adjacent to a vertebroplasty site have a higher incidence of new compression fracture than do other vertebrae. METHODS: Between March 2001 and December 2002, a total of 271 patients underwent vertebroplasty and a retrospective review of charts was performed. Patients reached 24 months of follow-up were included for analyses. Age, gender, bone mineral density, the numbers of prior vertebroplasty procedures, cement volume, postoperative kyphotic angle, the vertebral level, and kyphotic changes were assessed in relation to surgical outcome. RESULTS: The 220 patients had a mean age of 72.7 years (range, 53-97 years) and a mean follow-up interval of 25.6 months (range, 24-36 months). A total of 15 patients had 18 new fractures, and 11 new fractures were at the thoracolumbar junction (T12-L1) (p = 0.61). New fractures were in vertebrae adjacent to a treated vertebra in 55.6% (10 of 18 cases) of cases. Analysis of potential predictors for new vertebral fracture failed to identify statistically significant risk factors, despite a large sample size. CONCLUSIONS: Overall, 6.16% (18 of 292) of all treated vertebra developed associated new vertebral fractures. Cranial vertebrae were most likely to fracture at the adjacent level, whereas thoracic vertebrae were least likely to fracture at the adjacent level. Additional risk factors for new vertebral fracture are poorly understood.

Arthroscopy-assisted surgery for tibial plateau fractures: 2- to 10-year follow-up results.

PURPOSE: This study evaluated the outcome of arthroscopy-assisted reduction with internal fixation for treating tibial plateau fractures at 2- to 10-year follow-up. METHODS: Fifty-four patients with tibial plateau fractures treated by arthroscopy-assisted reduction with internal fixation were enrolled in this prospective study. According to the Schatzker classification, the fractures types were as follows: type I, 1 (2%); type II, 21 (39%); type III, 4 (7%); type IV, 10 (19%); type V, 8 (15%); and type VI, 10 (19%). The mean age at operation was 48 years (range, 22 to 68 years). The mean follow-up period was 87 months (range, 28 to 128 months). Clinical and radiologic outcomes were scored by the Rasmussen system. RESULTS: The mean postoperative Rasmussen clinical score was 28.4 (range, 19 to 30), and the mean radiologic score was 16.1 (range, 12 to 18). Good or excellent clinical and radiologic results were achieved in 96% of patients. The 6 fracture types did not significantly differ with regard to Rasmussen score or rate of satisfactory results (P > .05). Secondary osteoarthritis was noted in 10 injured knees (19%). All 54 fractures were successfully united. The mean preoperative fracture depression was 13.7 mm (range, 6 to 25 mm). Fracture depression at the final follow-up averaged 0.3 mm (range, 0 to 4 mm). No complications directly associated with arthroscopy were noted in any of the 54 patients. CONCLUSIONS: Arthroscopic surgery for tibial plateau fractures with associated soft-tissue injuries is a safe, reproducible, and effective procedure that provides precise diagnosis and effective treatment in a 1-stage procedure. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases.

PURPOSE: This investigation arthroscopically assesses the frequency of soft tissue injury in tibial plateau fracture according to the severity of fracture patterns. We hypothesized that use of arthroscopy to evaluate soft tissue injury in tibial plateau fractures would reveal a greater number of associated injuries than have previously been reported. METHODS: From March 1996 to December 2003, 98 patients with closed tibial plateau fractures were treated with arthroscopically assisted reduction and osteosynthesis, with precise diagnosis and management of associated soft tissue injuries. Arthroscopic findings for associated soft tissue injuries were recorded, and the relationship between fracture type and soft tissue injury was then analyzed. RESULTS: The frequency of associated soft tissue injury in this series was 71% (70 of 98). The menisci were injured in 57% of subjects (56 in 98), the anterior cruciate ligament (ACL) in 25% (24 of 98), the posterior cruciate ligament (PCL) in 5% (5 of 98), the lateral collateral ligament (LCL) in 3% (3 of 98), the medial collateral ligament (MCL) in 3% (3 of 98), and the peroneal nerve in 1% (1 of 98); none of the 98 patients exhibited injury to the arteries. No significant association was noted between fracture type and incidence of meniscus, PCL, LCL, MCL, artery, and nerve injury. However, significantly higher injury rates for the ACL were observed in type IV and VI fractures. CONCLUSIONS: Soft tissue injury was associated with all types of tibial plateau fracture. Menisci (peripheral tear) and ACL (bony avulsion) were the most commonly injured sites. A variety of soft tissue injuries are common with tibial plateau fracture; these can be diagnosed with the use of an arthroscope. LEVEL OF EVIDENCE: Level III, diagnostic study.

Complications of hip arthroscopy: analysis of seventy three cases.

BACKGROUND: Hip arthroscopy is recognized as a highly effective means of treating joint disorders. Complications in hip arthroscopy, including neurovascular traction injury, compression injury to the perineum and scope trauma, have been reported. We report our experience with 73 hip arthroscopy procedures and complications at Chang Gung Memorial Hospital. METHODS: Seventy-two patients with 73 hips with severe hip pain were enrolled in this prospective study. The average age of the patients was 42 years (range, 22-61 years). The average follow-up period was 16 months (range, 12-36 months). Surgical indications for hip arthroscopy were labral tears (54 cases, 73.9%); painful dysplastic hips (7 cases, 9.5%); osteoarthritis (5 cases, 6.8%); synovitis (3 cases, 4.1%); ligament teres tears (2 cases, 2.8%); chondromatosis (1 case, 1.4%); and avascular necrosis of the femoral head (1 case, 1.4%). With the patient in the supine position with the involved leg in traction, 2 or 3 portals (anterior, anterolateral or posterolateral) were made. Intraoperative and postoperative arthroscopic complications were recorded and prospectively analyzed. RESULTS: The average operative time was 67 minutes (range, 30-190 minutes) and the average traction time was 58 minutes (range, 30-150 minutes). During surgery, 12 of 73 (16.4%) patients had mild scope trauma to the femoral head, which did not affect their excellent outcomes. Five (7%) patients had transient sciatic nerve neuropraxia and achieved complete recovery within 2 weeks after surgery. CONCLUSION: No major complications of hip arthroscopy were noted in this series. The most frequent complication was mild scope trauma to the femoral head. With experience in the technique and good hip arthroscopic instrumentation, hip arthroscopy complications can be minimized. We suggest that hip arthroscopy is a safe technique, providing an additional valuable tool for hip surgery.

[Effect of yizhi jiannao granule on the behavior and neuron apoptosis in SAMP/8 mice].

OBJECTIVE: To investigate the effect of yizhi jiannao granule concentration fluid (YCF) on the behavior, the apoptosis rate of hippocampus neuron and the expression of apoptosis gene Bcl-2, Bax in senescence accelerated mice Senile-Prone/8 (SAMP/8), and to discuss some mechanism of traditional chinese medicine YCF in improving the capability of learning and memory. METHODS: Forty 6-month old SAMP/8 mice were randomly divided into the old group, huperzine A (Hup-A) group and YCF group. Ten 4-month old SAMP/8 mice were served as a young control group. Four groups were given different drugs for 8 weeks, their behavior changes were observed, and the hippocampus were taken out to examine the apotosis rate by flow cytomeutry (FCM) and the expression of Bcl-2, Bax mRNA by RT-PCR. RESULTS: In the YCF group, the escape latency was significantly shortened, the time of swim in the platform quadrant significantly increased, the apoptosis rate of hippocampus neural decreased; the level of Bcl-2 mRNA and the rate of Bcl-2/Bax increased, and the level of Bax mRNA decreased. CONCLUSION: Yizhi jiannao granule can decrease the neuron apoptosis rate and the Bax level, increase the Bcl-2 level, and modulate the rate of Bcl-2/Bax in SAMP/8 brain, which is probably part of the mechanisms of inhibiting the apoptosis and improving learning and memory.