Specifying the Starting Point for S1 Iliosacral Screw Placement in the Dysmorphic Sacrum.

BACKGROUND: Sacral dysmorphism is not uncommon and complicates S1 iliosacral screw placement partially because of the difficulty of determining the starting point accurately on the sacral lateral view. We propose a method of specifying the starting point. METHODS: The starting point for the S1 iliosacral screw into the dysmorphic sacrum was specifically set at a point where the ossification of the S1/S2 intervertebral disc (OSID) intersected the posterior vertebral cortical line (PVCL) on the sacral lateral view, followed by guidewire manipulation and screw placement on the pelvic outlet and inlet views. Computer-simulated virtual surgical procedures based on pelvic computed tomography (CT) data on 95 dysmorphic sacra were performed to determine whether the starting point was below the iliac cortical density (ICD) and in the S1 oblique osseous corridor and to evaluate the accuracy of screw placement (with 1 screw being used, in the left hemipelvis). Surgical procedures on 17 patients were performed to verify the visibility of the OSID and PVCL, to check the location of the starting point relative to the ICD, and to validate the screw placement safety as demonstrated with postoperative CT scans. RESULTS: In the virtual surgical procedures, the starting point was consistently below the ICD and in the oblique osseous corridor in all patients and all screws were Grade 1. In the clinical surgical procedures, the OSID and PVCL were consistently visible and the starting point was always below the ICD in all patients; overall, 21 S1 iliosacral screws were placed in these 17 patients without malpositioning or iatrogenic injury. CONCLUSIONS: On the lateral view of the dysmorphic sacrum, the OSID and PVCL are visible and intersect at a point that is consistently below the ICD and in the oblique osseous corridor, and thus they can be used to identify the starting point. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Chronic intermittent hypobaric hypoxia ameliorates osteoporosis after spinal cord injury through balancing osteoblast and osteoclast activities in rats.

Introduction: As a common complication of spinal cord injury (SCI), most SCI patients suffer from osteoporosis. In our previous study, chronic intermittent hypobaric hypoxia (CIHH) could promote bone fracture healing. We speculated that it may act a role in the progression of osteoporosis. The current study purposed to explore the role of CIHH in the osteoporosis triggered by SCI in rats. Methods: A SCI-induced SCI model was established by completed transection at T9-T10 spinal cord of Wistar rats. One week after SCI, the rats were conducted to CIHH treatment (PB = 404 mmHg, Po2 = 84 mmHg) 6 hours a day for continuously 7 weeks. Results: The results of X-radiography and Micro-CT assessment demonstrated that compared with sham rats, the areal bone mineral density (BMD), bone volume to tissue volume, volumetric BMD, trabecular thickness, trabecular number, and trabecular connectivity were decreased. Trabecular bone pattern factor, trabecular separation, as well as structure model index were increased at the distal femur and proximal tibia of SCI rats, which were effectively reversed by CIHH treatment. Histomorphometry showed that CIHH treatment increased bone formation of SCI rats, as evidenced by the increased osteoid formation, the decreased number and surface of TRAP-positive osteoclasts. Furthermore, ELISA and real time PCR results showed that the osteoblastogenesis-related biomarkers, such as procollagen type 1 N-terminal propeptide, osteocalcin in serum, as well as ALP and OPG mRNAs in bone tissue were decreased, while the osteoclastogenesis-related biomarkers, including scleorostin in serum and RANKL and TRAP mRNAs in bone tissue were increased in SCI rats. Importantly, the deviations of aforementioned biomarkers were improved by CIHH treatment. Mechanically, the protective effects of CIHH might be at least partly mediated by hypoxia-inducible factor-1 alpha (HIF-1α) signaling pathway. Conclusion: The present study testified that CIHH treatment ameliorates osteoporosis after SCI by balancing osteoblast and osteoclast activities in rats.

Comparison of surgical efficacy of locking plates and interlocking intramedullary nails in the treatment of proximal humerus fractures.

BACKGROUND: The objective of this study was to evaluate the efficacy of locking plates versus interlocking intramedullary nails in the treatment of proximal humerus fractures to provide clinical data support and theoretical guidance. METHODS: Patients with proximal humerus fracture from the Third hospital of Shijiazhuang city and Third hospital of Hebei medical university and from January 2017 to June 2019 were selected, included and divided into the locking plate group and the interlocking intramedullary nail group according to the intervention received. Information pertaining to the perioperative period (operation time, hospital stay, blood loss, etc.) of patients in both groups was collected. VAS pain scores, shoulder activity Constant-Murley scores and postoperative complications were documented. The perioperative data of the two groups were compared, and P < 0.05 was considered statistically significant. RESULTS: A total of 64 patients were enrolled, including 36 patients in the locking plate group, with a mean age of 61.3 ± 13.9 years, while the mean age of the interlocking intramedullary nail group was 65.6 ± 11.2 years. There was no statistical difference in gender, affected side, injury mechanism and Neer classification between the two groups (P > 0.05). However, the average operation time of the locking plate group was shorter than that of the interlocking nail group (84.9 ± 11.7 vs. 102.6 ± 22.1 min, P = 0.00), and the intraoperative blood loss of the locking plate group (137.4 ± 16.8 ml) was higher than that of the interlocking nail group (72.5 ± 10.5 ml, P = 0.00). There was no significant difference in the VAS score and Constant-Murley score between these two groups at the final follow-up. CONCLUSION: Interlocking intramedullary nails are more minimally invasive than locking plates, but fracture reduction and fixation take longer. There was no significant difference in pain and shoulder function scores between the two internal fixation strategies for the treatment of proximal humerus fracture.

Three-dimensional mapping study of pure transverse acetabular fractures.

BACKGROUND: To describe and analyze the morphological characteristics, location and frequency of pure transverse acetabular fracture lines through fracture mapping and quantitative measurements. METHODS: Transverse fractures were retrospectively reviewed and analyzed. All computed tomography (CT) data were used for reconstruction and manual reduction. The reductive fracture fragments were graphically overlaid onto a three-dimensional (3D) right hemipelvis template. Then, the fracture lines were accurately depicted onto the surface of the 3D template. The fracture lines were overlapped onto the model to create the 3D fracture map and heatmap. All cases were subdivided into infratectal (62-B1.1), juxtatectal (62-B1.2), and transtectal (62-B1.3) types based on the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification. Some anatomic parameters of the transverse fractures were also analyzed in these 3 groups. RESULTS: Our study included forty-nine transverse fractures from 32 male and 17 female patients (mean age, 42 years; range 21-74 years) and included 19 type 62-B1.1, 17 type 62-B1.2, and 13 type 62-B1.3 fractures. The average anterior rim fracture angle was 70.0° (± 11.6°), and the posterior rim fracture angle was 92.4° (± 28.5°). The anterior rim fracture angles in 40 cases (40/49, 81.6%) fell within a wide range between 63° and 80°. On the heatmap, the hot zones were located on the highest position of the cotyloid fossa and the narrowed region, and the cold zone was on the inferior third of the articular surface. For type 62-B1.3 fractures, the hot zone was located on the posterior of the acetabular dome. There were no significant differences in anterior rim fracture angle and anterior height among the three patterns (P = 0.071, P = 0.072). Post hoc tests of the posterior rim fracture angle and the posterior height revealed significant differences among fracture subtypes (P < 0.01). The posterior intra-articular fracture line was significantly longer than the anterior intra-articular fracture line in type 62-B1.1 and type 62-B1.2 fractures (P < 0.01). CONCLUSION: The fracture lines of transverse fractures through the anterior rim were concentrated on the narrowed zone, and the posterior fracture lines were diffusely distributed. The intra-articular fracture line distribution was focused on the superior and middle thirds of the joint surface. The recurrent fracture lines involving the weight-bearing dome mainly converged on the posterior region of the roof.

Risk factors for preoperative deep venous thrombosis in hip fracture patients: a meta-analysis.

STUDY DESIGN: A meta-analysis. BACKGROUND: Hip fracture (HF), as common geriatric fracture, is related to increased disability and mortality. Preoperative deep vein thrombosis (DVT) is one of the most common complications in patients with hip fractures, affecting 8-34.9% of hip fracture patients. The study aimed to assess the risk factors of preoperative DVT after hip fractures by meta-analysis. METHODS: An extensive search of the literature was performed in the English databases of PubMed, Embase, and the Cochrane Library; and the Chinese databases of CNKI and WAN FANG. We collected possible predictors of preoperative DVT from included studies, and data analysis was conducted with RevMan 5.3 and STATA 12.0. RESULTS: A total of 26 English articles were included, and the rate of DVT was 16.6% (1627 of 9823 patients) in our study. Our findings showed that advanced age [p = 0.0003, OR = 0.13 95% CI (0.06, 0.21)], female patients [p = 0.0009, OR = 0.82 95% CI (0.72, 0.92)], high-energy injury [p = 0.009, OR = 0.58 95% CI (0.38, 0.87)], prolonged time from injury to admission [p < 0.00001, OR = 0.54 95% CI (0.44, 0.65)], prolonged time from injury to surgery [p < 0.00001, OR = 2.06, 95% CI (1.40, 2.72)], hemoglobin [p < 0.00001, OR = - 0.32 95% CI (- 0.43, - 0.21)], coronary heart disease [p = 0.006, OR = 1.25 95% CI (1.07, 1.47)], dementia [p = 0.02, OR = 1.72 95% CI (1.1, 2.67)], liver and kidney diseases [p = 0.02, OR = 1.91 95% CI (1.12, 3.25)], pulmonary disease [p = 0.02, OR = 1.55 95% CI (1.07, 2.23)], smoking [p = 0.007, OR = 1.45 95% CI (1.11, 1.89)], fibrinogen [p = 0.0005, OR = 0.20 95% CI (0.09, 0.32)], anti-platelet drug [p = 0.01, OR = 0.51 95% CI (0.30, 0.85)], C-reactive protein [p = 0.02, OR = 5.95 95% CI (1.04, 10.85)], < 35 g/l albumin [p = 0.006, OR = 1.42 95% CI (1.1, 1.82)], and thrombosis history [p < 0.00001, OR = 5.28 95% CI (2.85, 9.78)] were risk factors for preoperative DVT. CONCLUSIONS: Many factors, including advanced age, female patients, high-energy injury, prolonged time from injury to admission, prolonged time from injury to surgery, patients with a history of coronary heart disease, dementia, liver and kidney diseases, pulmonary disease, smoking, and thrombosis, fibrinogen, C-reactive protein, and < 35 g/l albumin, were found to be associated with preoperative DVT. Our findings suggested that the patient with above characteristics might have preoperative DVT. LEVEL OF EVIDENCE: Level III.

Is Plating Fixation Through the Kocher-Langenbeck Approach for Associated Posterior Wall Fragment Indispensable in Both-Column Acetabular Fractures?

OBJECTIVE: The treatment methods for posterior wall (PW) in both-column acetabular fractures are controversial. The purpose of this study was to compare reduction quality, clinical outcomes, and complications of nonfixation for posterior wall fragment and plating via the Kocher-Langenbeck (KL) approach after anterior surgical procedures in both-column acetabular fractures. METHODS: Forty-nine patients with both-column acetabular fractures associated with PW fixed via iliac fossa and Stoppa approaches from October 2012 to October 2017 were recruited into this study and were divided into two groups: Nonfix group (nonfixation for PW) and KL group (PW plating through the KL approach). Operation duration, intraoperative blood loss, reduction quality, fracture healing, and relevant complications of patients were reviewed. Merle d'Aubigné scores were used for assessing functional outcome. RESULTS: The mean blood loss and operation durations were lower in Nonfix group than in KL group (both p < 0.05). The mean hospital stay durations were (18.54 ± 6.42) days and (21.17 ± 7.32) days in groups Nonfix and KL, respectively (p = 0.186). All fractures healed well with no significant difference in union time between the two groups (p = 0.210). The rates of satisfactory reduction were 84.62% (22/26) in Nonfix group and 86.96% (20/23) in KL group (p = 1.000). The mean Merle d'Aubigné scores were 15.62 ± 2.28 in Nonfix group and 16.17 ± 2.19 in KL group (p = 0.388). The complication rates were 7.69% (2/26) in Nonfix group and 34.78% (8/23) in KL group (p = 0.046). CONCLUSIONS: For both-column acetabular fractures associated with PW fragment, although fixation of PW was not performed after anterior surgical procedures, satisfactory outcomes could also be obtained. However, nonfixation was a less invasive choice with a lower complication rate.

Association between sleep duration and quality with rapid kidney function decline and development of chronic kidney diseases in adults with normal kidney function: The China health and retirement longitudinal study.

Research have shown that sleep is associated with renal function. However, the potential effects of sleep duration or quality on kidney function in middle-aged and older Chinese adults with normal kidney function has rarely been studied. Our study aimed to investigate the association of sleep and kidney function in middle-aged and older Chinese adults. Four thousand and eighty six participants with an eGFR ≥60 ml/min/1.73 m2 at baseline were enrolled between 2011 and 2015 from the China Health and Retirement Longitudinal Study. Survey questionnaire data were collected from conducted interviews in the 2011. The eGFR was estimated from serum creatinine and/or cystatin C using the Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI). The primary outcome was defined as rapid kidney function decline. Secondary outcome was defined as rapid kidney function decline with clinical eGFR of <60 ml/min/1.73 m2 at the exit visit. The associations between sleep duration, sleep quality and renal function decline or chronic kidney disease (CKD) were assessed based with logistic regression model. Our results showed that 244 (6.0%) participants developed rapid decline in kidney function, while 102 (2.5%) developed CKD. In addition, participants who had 3-7 days of poor sleep quality per week had higher risks of CKD development (OR 1.86, 95% CI 1.24-2.80). However, compared with those who had 6-8 h of night-time sleep, no significantly higher risks of rapid decline in kidney function was found among those who had <6 h or >8 h of night time sleep after adjustments for demographic, clinical, or psychosocial covariates. Furthermore, daytime nap did not present significant risk in both rapid eGFR decline or CKD development. In conclusion, sleep quality was significantly associated with the development of CKD in middle-aged and older Chinese adults with normal kidney function.

Role of the Lumbosacral Transition Vertebra and Vertebral Lamina in the Pathogenesis of Lumbar Disc Herniation.

OBJECTIVE: To investigate the prevalence of lumbosacral transition vertebrae (LSTVs) in both the normal population and the lumbar disc herniation (LDH) population and to determine the risk factors for LDH. METHODS: Between January 2019 and September 2020, all patients aged 18-39 years and underwent an anteroposterior (AP) X-ray of the lumbar vertebrae were retrospective reviewed in our institution. Those patients who were diagnosed with LDH were eligible for inclusion in the LDH group. During the same period, those patients admitted to our hospital who underwent an anteroposterior X-ray of the lumbar spine and had not been diagnosed with LDH were included in the control group. Those patients with disease that might affect the lumbar anatomy were excluded from both groups. The type of LSTV was classified according to the Castellvi classification. The height of the lumbar vertebral lamina was evaluated through the h/H index. The inter- and intra-observer reliability was evaluated by one senior radiologist and one senior orthopedist using intraclass correlation coefficient (ICC). The association between the LSTV and the herniation level was also investigated. Binary logistic regression was used to explore the association of different factors between the LDH group and the control group. RESULTS: Two hundred LDH patients (115 male and 85 female) and 200 individuals (108 male and 92 female) were investigated retrospectively. The prevalence of LSTVs was 71.5% (n = 143) in the LDH group and 34.0% (n = 68) in the control group. The most frequent LSTV types were type Ib and type IIa. The inter- and intra-observer ICCs of the measurement of "h/H" index and the classification of LSTV were all "excellent" (ICC > 0.90). The median h/H index in the control group was significantly higher than that in the LDH group (0.28 (0.26, 0.31) vs 0.34 (0.31, 0.37), P = 0.000). The distribution of the Castellvi classification in the L4/5 and L5/S1 herniation patients was significantly different (P = 0.048). LSTVs, BMI and the h/H index were closely associated with LDH, with odds ratios of 3.06 (95% CI: 2.12-4.43), 1.23 (95% CI: 1.13-1.33) and 0.09 (95% CI: 0.05-0.15), respectively. The incidence of L4/5 disc herniation in patients with an LSTV was significantly more common than that in patients with L5/S1 disc herniation (P = 0.048). CONCLUSION: The prevalence of LSTVs was 34.0% in the control group and 71.5% in the LDH group; LSTVs and BMI were positively correlated with LDH, and h/H was negatively correlated with LDH.

Open-Wedge HTO with Absorbable ß-TCP/PLGA Spacer Implantation and Proximal Fibular Osteotomy for Medial Compartmental Knee Osteoarthritis: New Technique Presentation.

PURPOSE: The purpose of this study was to present a new absorbable spacer for medial compartmental knee osteoarthritis (OA). The functional and radiographic results of patients treated with the novel surgical technique were also evaluated to investigate its clinical feasibility. METHODS: Patients with medial compartmental knee OA who underwent open-wedge high tibial osteotomy (HTO) with absorbable ß-TCP/PLGA [30% beta-tricalcium phosphate and 70% poly (lactic-co-glycolic acid)] spacer implantation and proximal fibular osteotomy from January 2016 to February 2017 were retrospectively analyzed. The operation time, blood loss, and relevant complications were reviewed. The femorotibial angle (FTA), varus angle (VA), joint line convergence angle (JLCA), American Knee Society Score (KSS), and visual analog scale (VAS) score were recorded preoperatively and at the final follow-up, respectively. RESULTS: At the final follow-up, the mean FTA and JLCA were 179.85° ± 4.34° and 2.44° ± 1.26°, respectively, which were smaller than the preoperative values (182.94° ± 3.86° and 4.12° ± 1.65°, respectively; both p < 0.001). The final VA and VAS score were lower than those measured preoperatively (both p < 0.001). The clinical and functional KSSs at the final follow-up were higher than the preoperative scores (p < 0.001). CONCLUSIONS: This novel absorbable spacer could provide adequate stability for the tibial osteotomy gap, at a lower cost than a traditional plate. With the use of this spacer as an osteoinductive and biodegradable device, secondary surgery for fixation removal could be avoided. The novel surgical technique could improve both the radiographic appearance and the function of the knee in patients with knee OA.

Treatment of Unstable Intertrochanteric Fractures with Proximal Femoral Nailing Antirotation: Traction Table or Double Reverse Traction Repositor.

ObjectiveThe objective of this retrospective study was to compare the efficacy of the double reverse traction repositor (DRTR) and traction table with proximal femoral nailing antirotation (PFNA) in the treatment of unstable intertrochanteric fractures. Patients and Methods: Data from 66 patients (36 patients treated with the traction table and 30 patients treated with DRTR) with unstable intertrochanteric fractures were reviewed from January 2017 to June 2017. The demographics, fracture characteristics, surgical data, and prognostic parameters were collected to compare the differences between the two groups. Results: The collodiaphyseal angle (CDA) was significantly lower in the DRTR group than in the traction table group (129.37° ± 7.47 and 135.67° ± 6.95, respectively, p < 0.001). The open reduction rate was significantly lower in the DRTR group than in the traction table group (3.3% and 13.9%, respectively, p < 0.001). No significant differences were found in the demographics, fracture characteristics, other surgical data, or prognostic parameters between the two groups. Conclusions: DRTR can facilitate safe, effective, and minimally invasive treatment of unstable intertrochanteric fractures with PFNA.

Intramedullary nailing versus a locking compression plate for humeral shaft fracture (AO/OTA 12-A and B): A retrospective study.

INTRODUCTION: There has been great progress in surgical techniques for treating humeral shaft fractures over the past few decades. The purpose of this study was to compare the therapeutic effects of intramedullary nailing (IMN) and locking compression plate (LCP) for humeral shaft fractures (AO/OTA 12-A and B). HYPOTHESIS: Compared with LCP, better therapeutic effects could be obtained with less invasive IMN. MATERIALS AND METHODS: Patients with a humeral shaft fracture who received anterograde IMN or LCP fixation in our institution from December 2011 to June 2016 were reviewed in this study. They were divided into two groups according to the different fixation methods: Group A (IMN) and Group B (LCP). The surgical time, intraoperative blood loss, and complications of the patients were reviewed. Fracture healing was evaluated by radiographs performed at each follow-up. The functional outcome was assessed by the DASH (Disabilities of the Arm, Shoulder and Hand) scoring system at the final follow-up. RESULTS: Thirty-four patients in Group A and forty-six patients in Group B were included in this study. Mean incision length and blood loss in Group B were greater than those in Group A (p<0.001). The average surgical times were 118.53minutes in Group A and 128.91minutes in Group B (p=0.114). The mean DASH scores were 23.76±16.78 in Group A and 22.37±15.18 in Group B (p=0.609). The complication rates were 8/34 in Group A and 7/46 in Group B, respectively (p=0.887). DISCUSSION: The study hypothesis was partially confirmed. Although IMN was a less invasive technique, similar therapeutic results were obtained for humeral shaft fractures (AO/OTA 12-A and B) fixed with two surgical methods. LEVELS OF EVIDENCE: III, retrospective comparative study.

Lumbopelvic Fixation Versus Novel Adjustable Plate for Sacral Fractures: A Retrospective Comparative Study.

Purpose: The purpose of this study is to compare the therapeutic effects of the lumbopelvic technique and a novel adjustable plate for sacral fractures. Materials and Methods: Patients with unilateral sacral fractures fixed via the lumbopelvic technique or using a novel adjustable plate from June 2011 to June 2017 were recruited into this study and were divided into two groups: group A (lumbopelvic fixation) and group B (novel adjustable plate). Surgical time, intraoperative blood loss, frequency of intraoperative fluoroscopy, reduction quality, and related complications were reviewed. Fracture healing was assessed by the radiographs conducted at follow-up. Functional outcome was evaluated according to the Majeed score at the final follow-up. Results: The mean blood loss and frequency of intraoperative fluoroscopy in group B were reduced compared with group A (both P < 0.001). The mean surgical time was 122.22 ± 13.09 minutes in group A and 103.96 ± 24.80 minutes in group B (P = 0.007). All patients healed well in this study, and no difference in the fracture healing time was noted between the two groups (P = 0.685). Satisfactory rates of reduction quality and functional outcome did not differ (both P > 0.05) in this study. The complication rate was 22.22% (4/18) in group A and 4.16% (1/24) in group B (P = 0.191). Conclusion: For patients with unilateral sacral fractures, satisfactory radiographic appearance and functional outcome could be obtained by both the lumbopelvic technique and a novel adjustable plate. However, the novel adjustable plate represents a less invasive technique with lower radiograph exposure.

The Effect of Configuration of Rhombic Cannulated Screws on Internal Fixation of Femoral Neck Fractures.

Femoral neck fractures are commonly encountered clinical problems, especially in patients with osteoporosis, and have high morbidity and mortality. Internal fixation of femoral neck fractures using 3 cannulated screws placed in an inverse triangle configuration is commonly performed. Recently, the use of 4 cannulated screws in a rhombic configuration has been proposed. The aim of this study was to investigate the outcomes of femoral neck fractures treated using either an inverse triangle or rhombic configuration to determine which had a better clinical prognosis. A total of 138 consecutive patients without any previous hip surgery who had femoral neck fractures treated with cannulated compression screws in either an inverse triangle or rhombic configuration were reviewed. Patients' demographic and radiological data were collected from the authors' institutional database. The authors found that the rhombic configuration did not have a better result in decreasing complications, such as femoral neck shortening or screw exit, or in Harris Hip Scores and other clinical prognoses compared with the inverse triangle configuration. In addition, the technique used for applying 4 screws (especially the posterior ones) needs to be improved, so until then, using 3 screws in an inverse triangle configuration remains the gold standard for the treatment of femoral neck fractures. [Orthopedics. 2020; 43(2):e72-e78.].

Gold Nanorod Array-Bridged Internal-Standard SERS Tags: From Ultrasensitivity to Multifunctionality.

Bimetallic gold core-silver shell (Au@Ag) surface-enhanced Raman scattering (SERS) tags draw broad interest in the fields of biological and environmental analysis. In reported tags, silver coating tended to smooth the surface and merge the original hotspot of Au cores, which was disadvantageous to signal enhancement from the aspect of surface topography. Herein, we developed gold nanorod (AuNR)-bridged Au@Ag SERS tags with uniform three-dimensional (3D) topography for the first time. This unique structure was achieved by selecting waxberry-like Au nanoparticles (NPs) as cores, which were capped by vertically oriented AuNR arrays. Upon selective surface blocking with thiol-ligands, Ag NPs were controlled to anisotropically grow on the tips of the AuNRs, producing high-density homo- (Ag-Ag) and hetero- (Au-Ag) hotspots in a single NP. The 3D hotspots rendered this NP extraordinary SERS enhancement ability (an analytical enhancement factor of 3.4 × 106) 30 times higher than the counterpart with a smooth surface, realizing signal detection from a single NP. More importantly, multiplexing signals ("blank" or multiplex "internal standard") can be achieved by simply changing thiol-ligands, as exemplified in the synthesis of NPs with 8 signatures. Furthermore, the multifunctionality has been demonstrated in living cell/in vivo imaging, photothermal therapy, and SERS substrates for ratiometric quantitative analysis, relying on the inherent internal standard signal. The prepared Au@Ag NPs have great potential as standard tools in many SERS-related fields.

Three-Column Classification for Acetabular Fractures: Introduction and Reproducibility Assessment.

BACKGROUND: The Judet-Letournel classification has been widely used to diagnose acetabular fractures since it was proposed. However, there has been growing evidence of incompleteness and comprehension difficulty in this classification, which may adversely affect its clinical use. The purposes of this study were to introduce a novel 3-column classification system for acetabular fractures and to evaluate its reliability and reproducibility. METHODS: A total of 1,028 patients with acetabular fractures, who had undergone surgical treatment from June 2011 to January 2017 in 7 level-I trauma centers, were recruited into this study. Preoperative radiographs and computed tomographic (CT) scans were conducted for each patient. To evaluate the reproducibility of the 3-column classification system for acetabular fractures, the interobserver and intraobserver reliability (kappa coefficient, κ) of this classification system compared with those of the Judet-Letournel classification system was investigated by 4 observers. RESULTS: A total of 209 patients (20.33%) could not be classified by the Judet-Letournel classification, and 3 cases (0.29%) could not be classified by the novel 3-column classification. The mean κ value of the interobserver reliability for the Judet-Letournel classification was 0.591 (range, 0.508 to 0.681), indicating moderate agreement, whereas the mean κ value was 0.735 (range, 0.594 to 0.930), indicating substantial agreement, when using the 3-column classification. The mean κ value for the intraobserver reliability was 0.751 (range, 0.708 to 0.793) for the Judet-Letournel classification and 0.909 (range, 0.792 to 0.957) for the 3-column classification. CONCLUSIONS: The 3-column classification, based on the anatomic character of the acetabulum, showed higher interobserver and intraobserver reliability than the Judet-Letournel classification. Additionally, certain fracture patterns in the 3-column classification scheme generally correlated with surgical approaches. This novel classification system may be used as a supplement to the traditional Judet-Letournel classification system. CLINICAL RELEVANCE: The 3-column concept of the acetabulum proposed in this study is helpful to master acetabular fractures for less experienced surgeons. The novel classification system could assist with acetabular fracture diagnosis and the choice of surgical approaches.

MiR-200-3p Is Potentially Involved in Cell Cycle Arrest by Regulating Cyclin A during Aestivation in Apostichopus japonicus.

The sea cucumber (Apostichopus japonicus) has become a good model organism for studying environmentally induced aestivation in marine invertebrates. We hypothesized that mechanisms that arrest energy-expensive cell cycle activity would contribute significantly to establishing the hypometabolic state during aestivation. Cyclin A is a core and particularly interesting cell cycle regulator that functions in both the S phase and in mitosis. In the present study, negative relationships between miR-200-3p and AjCA expressions were detected at both the transcriptional and the translational levels during aestivation in A. japonicus. Dual-luciferase reporter assays confirmed the targeted location of the miR-200-3p binding site within the AjCA gene transcript. Furthermore, gain- and loss-of-function experiments were conducted in vivo with sea cucumbers to verify the interaction between miR-200-3p and AjCA in intestine tissue by qRT-PCR and Western blotting. The results show that the overexpression of miR-200-3p mimics suppressed AjCA transcript levels and translated protein production, whereas transfection with a miR-200-3p inhibitor enhanced both AjCA mRNA and AjCA protein in A. japonicus intestine. Our findings suggested a potential mechanism that reversibly arrests cell cycle progression during aestivation, which may center on miR-200-3p inhibitory control over the translation of cyclin A mRNA transcripts.

Polystyrene Encapsulated SERS Tags as Promising Standard Tools: Simple and Universal in Synthesis; Highly Sensitive and Ultrastable for Bioimaging.

Surface coating determined the sensitivity and stability of surface-enhanced Raman scattering (SERS) tags in bioanalysis. The reported various coatings suffered from the drawbacks of a lack of rigidity, stability, or synthesis versatility. Herein, we demonstrated robust polystyrene (PS) coated SERS tags that could be prepared by an easy and universal approach. Taking advantages of biocompatible, transparent, compact properties of PS shell, the coated tags showed satisfactory sensitivity, biocompatibility, and superior structural stability in cell and in vivo imaging applications. More importantly, the PS coating strategy allowed for the encapsulation of SERS tags encoded with not only thiolated but also nonthiolated Raman reporters without loss of sensitivity, as exemplified in the synthesis of 9 different resonant dye-encoded tags. Moreover, the coating of SERS tags with various kinds of substrates was achieved via the same standard protocol. Comparing with widespread silica coated tags, the PS coated ones were more stable in harsh conditions and had an easily expanded ultrasensitive (resonant) tags library with much lower cost (no need of expensive sulfhydryl/isothiocyano reporters with limited types), illustrating great promise as standard analytical tools of commercialized value for bioanalysis, medical diagnostics, and environmental science studies.

Sacroiliac screw versus a minimally invasive adjustable plate for Zone II sacral fractures: a retrospective study.

OBJECTIVE: Fracture line of the sacrum always involves the Zone II region because sacral foramina are anatomically and physiologically weak regions of the sacrum. The purpose of this study is to compare the therapeutic effects of a sacroiliac screw and a minimally invasive adjustable plate (MIAP) for Zone II sacral fractures. METHODS: Patients with unilateral Zone II sacral fractures fixed with a unilateral sacroiliac screw or MIAP from August 2009 to January 2016 were recruited into this study and were divided into two groups: group A (sacroiliac screw) and group B (MIAP). Surgical time, blood loss, frequency of intraoperative fluoroscopy, and relative complications were reviewed. Radiographs and CT scans were routinely acquired to evaluate the fracture displacement and reduction quality. Fracture healing was evaluated in the radiographs at each follow-up. Functional outcome was assessed based upon the Majeed scoring system at the final follow-up. RESULTS: Thirty-one patients in group A and thirty-nine patients in group B were included in this study. No significant differences in average surgical time (P = 0.221) or blood loss (P = 0.234) were noted between group A and group B. The mean frequency of intraoperative fluoroscopy was 15.74±2.98 in group A and 6.08±1.94 in group B (P = 0.000). All fractures healed well within four months in all patients, and the healing time exhibited no significant difference between the two groups (P = 0.579). Satisfactory rates of reduction quality and functional outcome were not statistically different between the two groups (P > 0.05). The complication rate was 16.13% (5/31) in group A and 5.13% (2/39) in group B (P = 0.222). CONCLUSION: MIAP has a fixation effect and exhibits reduction potential for Zone II sacral fractures. Favourable radiographic and functional results could be obtained through the MIAP technique, which is easy to conduct without pre-contouring. Compared with the unilateral S1 sacroiliac screw technique, repeated projections and iatrogenic sacral injury can be avoided.

Anterior subcutaneous internal fixator (INFIX) versus plate fixation for pelvic anterior ring fracture.

The aim of this study was to compare the clinical outcomes in patients with unstable anterior pelvic ring fractures after treatment with anterior subcutaneous internal fixator (INFIX) or plate fixation. We performed a retrospective study from August 2015 to October 2017. A consecutive series of 74 patients who underwent surgical treatment of their anterior pelvic ring (35 treated with INFIX and 39 treated with plates) were studied. Data collected included patients' demographic data, injury severity score (ISS), AO/OTA classification, injury mechanism, time to surgery, procedure time, and blood loss. The quality of postoperative reduction were assessed by postoperative radiographs using the Tornetta and Matta method. Functional outcome was evaluated using Majeed scoring system. In the INFIX group, ten patients developed LFCN paralysis, one patient suffered from superficial infection. Three screw loosening cases and two wound infection cases occurred in the plate group. INFIX is relatively minimally invasive and time-saving than the reconstruction plate in the treatment of anterior pelvic ring fracture. However, plate fixation increases the rate of anatomic reduction of the pelvic anterior ring fracture. Plates also provide a higher functional outcome compared with INFIX. INFIX is especially suitable in patients with urological injury, which can also decrease the wound infection rate.

Fixation of Displaced Acetabular Fractures With an Anatomic Quadrilateral Surface Plate Through the Stoppa Approach.

Satisfactory fixation for displaced acetabular fractures involving the quadrilateral surface remains difficult to obtain with conventional reconstruction plates. To achieve minimally invasive management of fractures of the quadrilateral surface, the authors designed a type of anatomic quadrilateral surface plate (AQSP). A retrospective study to assess the therapeutic results of the AQSP was performed at their institution. A total of 26 patients with quadrilateral surface fractures fixed with an AQSP through the Stoppa approach from February 2014 to February 2015 were included in this study. There were 16 men and 10 women with a mean age of 37.5 years. The patients were followed for a mean of 28.81 months (range, 24-36 months). The mean operative time was 98.85±16.08 minutes, and the mean intraoperative blood loss was 353.85±124.84 mL. Postoperative radiographs and computed tomography scans showed that anatomic and good reductions were obtained in 88.46% (23 patients) and 11.54% (3 patients) of the patients, respectively. Screw loosening was not observed. All of the fractures healed well at a mean of 3.54 months. Two cases of obturator nerve injury and 1 case of corona mortis rupture were observed. However, permanent complications were not observed. The mean Merle d'Aubigné score at final follow-up was 16.38±1.33 points. The authors conclude that satisfactory fixation with the AQSP system can be achieved through the Stoppa approach. [Orthopedics. 2019; 42(2):e180-e186.].