Development and validation of self-screening tool for nutrition risk in patients with gastric cancer after gastrectomy: A study protocol.

AIM: This study aims to develop and validate a clinical nutrition risk screening tool to predict nutrition risk in home for the patients with gastric cancer after surgery at home so that high-risk patients can be targeted for preventive nutrition care. DESIGN: The development of self-screening tool for nutrition risk in patients with gastric cancer after gastrectomy (SNRSGC) through literature review, expert panel ratings and cognitive interview; the validation of SNRSGC is evaluated through prospective research on participants. METHODS: This research is divided into four parts: Step 1, Identification of a potential referred nutritional risk screening; Step 2, Item generation and scoring are selected through literature review methods to screen sensitive indicators which can reflect the nutritional characteristics of patients after gastric cancer surgery, establish the frame and update according to the latest guidelines; Step 3, Item reduction is determined by the rating of SNRSGC items by an expert panel and cognitive interview; Step 4, During the validation stage, we conducted research design based on the Consensus-based Standards for the selection of health Measurement Instruments checklist to evaluate the validity, reliability, interpretability and acceptability of SNRSGC. RESULTS: SNRSGC is the first screening tool specifically to predict nutrition risk for stay-at-home postoperative patients with gastric cancer, which can help patients at home detect nutritional risks at home in time and guide patients to seek medical treatment as soon as possible to improve their nutritional status.

Development of nomogram and discussion of radiotherapy effect for osteosarcoma survival.

This study aimed to develop a predictive system for prognostic evaluation of osteosarcoma patients. We obtained osteosarcoma sample data from 1998 to 2016 using SEER*Stat software version 8.3.8, and established a multivariable Cox regression model using R-4.0.3 software. Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The diagnosis of the model was completed through influential cases, proportionality, and multicollinearity. The predictive ability of the model was tested using area under the curve (AUC), calibration curves, and Brier scores. Finally, the bootstrap method was used to internally verify the model. In total, data from 3566 patients with osteosarcoma were included in this study. The multivariate Cox regression model was used to determine the independent prognostic variables. A nomogram and Kaplan-Meier survival curve were established. The AUC and Brier scores indicated that the model had a good predictive calibration. In addition, we found that the radiotherapy appears to be a risk factor of patients with osteosarcoma and made a discussion. We developed a prognostic evaluation system for patients with osteosarcoma for 1-, 3-, and 5-year overall survival with good predictive ability using sample data extracted from the SEER database. This has important clinical significance for the early identification and treatment of high-risk groups of osteosarcoma patients.

microRNA-136-5p from bone marrow mesenchymal stem cell-derived exosomes facilitates fracture healing by targeting LRP4 to activate the Wnt/ß-catenin pathway.

AIMS: Exosomes derived from bone marrow mesenchymal stem cells (BMSCs) have been reported to be a promising cellular therapeutic approach for various human diseases. The current study aimed to investigate the mechanism of BMSC-derived exosomes carrying microRNA (miR)-136-5p in fracture healing. METHODS: A mouse fracture model was initially established by surgical means. Exosomes were isolated from BMSCs from mice. The endocytosis of the mouse osteoblast MC3T3-E1 cell line was analyzed. CCK-8 and disodium phenyl phosphate microplate methods were employed to detect cell proliferation and alkaline phosphatase (ALP) activity, respectively. The binding of miR-136-5p to low-density lipoprotein receptor related protein 4 (LRP4) was analyzed by dual luciferase reporter gene assay. HE staining, tartrate-resistant acid phosphatase (TRAP) staining, and immunohistochemistry were performed to evaluate the healing of the bone tissue ends, the positive number of osteoclasts, and the positive expression of ß-catenin protein, respectively. RESULTS: miR-136-5p promoted fracture healing and osteoblast proliferation and differentiation. BMSC-derived exosomes exhibited an enriched miR-136-5p level, and were internalized by MC3T3-E1 cells. LRP4 was identified as a downstream target gene of miR-136-5p. Moreover, miR-136-5p or exosomes isolated from BMSCs (BMSC-Exos) containing miR-136-5p activated the Wnt/ß-catenin pathway through the inhibition of LRP4 expression. Furthermore, BMSC-derived exosomes carrying miR-136-5p promoted osteoblast proliferation and differentiation, thereby promoting fracture healing. CONCLUSION: BMSC-derived exosomes carrying miR-136-5p inhibited LRP4 and activated the Wnt/ß-catenin pathway, thus facilitating fracture healing. Cite this article: Bone Joint Res 2021;10(12):744-758.

Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion under intraoperative neuromonitoring: A case report.

INTRODUCTION: Traditional open discectomy and intervertebral fusion surgery is the common strategy for lumbar disc herniation (LDH). However, it has the disadvantages of long recovery time and severe paravertebral soft tissue injury. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF), as a novel minimally invasive surgical technique for LDH, has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH. PATIENT CONCERNS: A 51-year-old male presented to our hospital with left lower extremity pain and numbness for 1 year. DIAGNOSIS: Lumbar disc herniation (LDH). INTERVENTIONS: This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin's triangle. Each step of the operation was performed under INM. OUTCOMES: The follow-up period lasted 12 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 min. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, non-union, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively. CONCLUSION: ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar's exiting nerve root directly with minimal invasion in selected patients.

Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7 mm endoscope and a 6.9 mm endoscope for cervical disc herniation: a retrospective comparative cohort study.

BACKGROUND: Posterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope. METHODS: From January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up. RESULTS: Tthere was a significant difference in regard to the average identification time of the "V" point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05). CONCLUSION: The application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of "V" point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.

[Application of percutaneous pie-crusting deep medial collateral ligament release for posterior horn surgery of medial meniscus].

OBJECTIVE: To explore clinical and radiographic effects of percutaneous pie-crusting deep medial collateral ligament release in patients with posterior horn tear of medial meniscus combined with tight medial compartment. METHODS: From January 2012 to December 2016, 35 patients with medial meniscus posterior horn injury were treated with percutaneous pie crusting deep medial collateral ligament release technique, including 21 males and 14 females, aged from 21 to 55 years old with an average of (39.1±6.5) years old. Degree of meniscus extrusion were recorded before and 24 months after operation. The knee valgus stress test was performed to evaluate stability of medial collateral ligament, and compared difference between healthy and affected side. Lysholm and IKDC functional scores were compared before and 24 months after operation. RESULTS: All patients were followed up from 27 to 60 months with an average of (36.7±6.8) months. All patients were underwent operation, the wound healed well without complications. Operative time ranged from 0.5 to 1.2 h with an average of (0.8±0.4) h. Nineteen patients were performed partial meniscectomy, 16 patients were performed repair suture. Convex of meniscus before operation was (1.5±0.7) mm, and (1.7±0.4) mm after operation;had no statistical difference(P>0.05). Lysholm score was improved from 53.4±8.8 before operation to 91.5±4.6 at 24 months after operation;IKDC score was increased from 50.7±9.2 before operation to 90.6±3.9 at 24 months after operation;there was statistically significant (P<0.05). Valgus stress test was performed on 0 ° and 30 ° position of knee flexion in affected side and compared with ipsilateral side, all patients showed negative. CONCLUSION: For patients with medial meniscus tear of posterior horn combined with tight medial compartment, percutaneous pie-crusting deep medial collateralligament release could improve medial compartment space, and Knee valgus instability and meniscus extrusion are not affected.

Selective nerve root block combined with posterior percutaneous cervical endoscopic discectomy for cervical spondylotic radiculopathy with double nerve root variation: A case report.

RATIONALE: The aim of this report is to present the technique of selective nerve root blockage combined with posterior percutaneous cervical endoscopic discectomy (PPECD) for cervical spondylotic radiculopathy (CSR). PATIENT CONCERNS: A 49-year-old female has pain in the skin area of the left scapular, pain in left elbow and limitation of left upper limb movement for 1.5 years. DIAGNOSIS: She was diagnosed with CSR and C6-7 double nerve root variation. INTERVENTIONS: We used selective nerve root block to determine the lesion segment and applied PPECD to relieve pressure on the patient's nerve roots. OUTCOMES: The pain symptoms disappeared after the patient was treated with C6-7 nerve root block. Endoscopic displayed C6-7 double nerve root variation on the left side of the spinal cord intraoperative. The neurological function was intact postoperatively and no recurrence of cervical disc herniation during the 5 months' follow-up period. The hospitalization time was 5 days, the operation time was 68.2 minutes and the bleeding volume was 52.6 ml. There was no change in cervical curvature and cervical disc height postoperatively. Japanese Orthopaedic Association score, SF-36 score and Visual Analogue Scale score improved significantly postoperatively. LESSONS: The application of selective nerve root blockage combined with PPECD for CSR could achieve satisfactory effect of position and decompression of the injured nerve root. Besides, we recommend that surgery be performed under general anesthesia to minimize patients' emotional stress and discomfort.

Avulsion of the femoral attachment of the medial collateral ligament in the setting of knee multiligament injury: A case report.

RATIONALE: Medial collateral ligament (MCL) injury is a common sports injury. The damage mainly occurs in ligament fibers, but MCL avulsion fracture is extremely rare and only a few reports have been published. PATIENT CONCERNS: Herein, we present a healthy 21-year-old man with an avulsion fracture of the MCL of the right knee sustained during snowboarding. DIAGNOSIS: Clinical and radiographic findings confirmed the presence of an avulsion fracture at the proximal attachment of the MCL, combined with complete anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) rupture. INTERVENTIONS: The patient underwent single-stage ACL, PCL reconstruction, and MCL repair. OUTCOMES: Two weeks after the surgery, the patient developed heterotopic ossification (HO) at the medial side of the knee, HO tended to be stable and mature at the 3-month follow-up examination. One year after the operation, the patient's knee was fully functional, stable, and pain free. LESSONS: Femoral attachment avulsion fracture of the MCL is in contrast to common isolated MCL injuries. Early surgical repair is advocated for the greatest benefit. Orthopedic surgeons should keep the potential complication HO in mind and develop rational strategies for HO prevention and treatment.

[Arthroscopic pullout suture repair of posterior root tear of the medial meniscus via the double tibial tunnels].

OBJECTIVE: To evaluate the surgical technique and clinical effect of arthroscopic pullout suture repair of posterior root tear of the medial meniscus via the double tibial tunnels. METHODS: From May 2014 to May 2017, 22 patients with posterior root tear of medial meniscus were treated by pullout suture repair via the double tibial tunnels, including 8 males and 14 females, aged 34 to 53 years old, with a mean of averaged(45.7±4.7) years old. The patients were followed up for 12 to 24 months, with a mean of (16.4±5.2) months. RESULTS: The Lysholm score of knee joint before operation was 61.8±4.3, IKDC score before operation was 59.9±2.9, Lysholm score at the latest follow-up was 89.1±3.0, and IKDC score was 89.0±2.5. The difference was statistically significant. CONCLUSIONS: Arthroscopic pullout suture repair via the double tibial tunnelsis an effective treatment for symptomatic posterior root tear of medial meniscus, and it can significantly improve the knee functional outcome.

[Ultrasound-guided suprascapular nerve block combined with acupuncture for the treatment of calcified tendinitis of rotator cuff].

OBJECTIVE: To explore the method and effect of ultrasound-guided suprascapular nerve block combined with acupuncture in the treatment of calcified tendinitis of rotator cuff. METHODS: From January 2015 to December 2017, total 30 patients with calcified tendinitis, including 23 cases of supraspinatus tendon, 5 cases of infraspinatus tendon and 2 cases of subscapular tendon, were treated with ultrasound-guided suprascapular nerve block combined with acupuncture. There were 7 males and 23 females, ranging in age from 36 to 71 years old, with an average of 51.6 years old. There were 17 cases on the right and 13 cases on the left. VAS pain score, Constant-murley score, UCLA score and X-ray examination were used to evaluate the clinical results before and after surgery. RESULTS: The mean follow-up was 14.3 months (6 to 30 months). The preoperative VAS score was 3.82±1.13, Constant-Murley score was 36.91±7.95 and UCLA score was 11.35±2.17. The final follow-up scores were 1.32±1.06, 90.61±2.89 and 33.22±1.51, respectively. The final follow-up scores were improved significantly(P<0.05). CONCLUSIONS: Conservative treatment of calcified rotator cuff tendinitis is ineffective. Suprascapular nerve block guided by ultrasound combined with acupuncture has a good therapeutic effect. It is a minimally invasive, economic, safe and effective method, which is worth promoting.

Upregulation of long noncoding TNFSF10 contributes to osteoarthritis progression through the miR-376-3p/FGFR1 axis.

Osteoarthritis (OA) is a common joint disease with high morbidity, but there is still no definitive treatment for it. Long noncoding RNAs (lncRNAs) have been confirmed to play key roles in OA progression. This work was done to investigate the roles and action mechanism of lncRNA TNFSF10 in OA. The messenger RNA levels of TNFSF10 in articular cartilage samples from patients or chondrocytes were detected by Quantitative real-time PCR assay (qRT-PCR). The effects of TNFSF10 on chondrocytes were evaluated on the basis of cell growth, apoptosis, and inflammation. Then, the interaction between TNFSF10 and miR-376-3p was explored by dual-luciferase reporter test, RNA-binding protein immunoprecipitation, and RNA pull-down assay. Finally, various cell experiments, Western blot analysis, and qRT-PCR were performed to study the interaction among TNFSF10, miR-376-3p, and fibroblast growth factor receptor 1 (FGFR1). It was found that TNFSF10 was upregulated in OA cartilages and stimulated cell proliferation, antiapoptosis, and inflammation for chondrocytes. In addition, TNFSF10 acted as a competing endogenous RNA to downregulate miR-376-3p, and the influence of TNFSF10 on chondrocytes was partly reversed by miR-376-3p. Moreover, FGFR1, as a target of miR-376-3p, had reversal functions on the outcomes mediated by miR-376-3p. The further analysis displayed that there was a negative relationship between TNFSF10 and miR-376-3p as well as miR-376-3p and FGFR1, while FGFR1 was positively related with TNFSF10. Altogether, TNFSF10 overexpression probably stimulated proliferation and inflammation, and inhibited apoptosis by regulating the miR-376-3p/FGFR1 axis, implying that its increase contributed to OA progression. Our study provided a new potential biomarker or therapeutic target-TNFSF10, which was helpful to develop an efficient approach to cure OA.

Upper pole sleeve fracture of the patella secondary to patellar dislocation: A case report.

RATIONALE: Upper pole sleeve fractures of the patella are rare in adolescents; however, they are serious injuries that require early diagnosis and treatment. PATIENT CONCERNS: We present a rare case of a 15-year-old girl who suffered a sleeve fracture at the superior pole of the right patella. The patient had a history of dislocation of the patella 2 weeks ago. Physical examination showed tenderness on palpation over the upper pole of the patella and absence of active movement of the knee accompanied by swelling and joint effusion. A plain radiograph showed an avulsed fragment of the superior pole of the patella. DIAGNOSES: Magnetic resonance imaging showed a superior pole patellar avulsion fracture and dysfunction of the knee extensor mechanism. INTERVENTIONS: Under general anesthesia, the patient underwent open surgery for reduction of the patellar fracture and reconstruction of the knee extension apparatus through an anterior approach. OUTCOMES: Six months after the operation, the knee function was fully restored, there was absence of pain and swelling, and the patient was able to return to sports. LESSONS: Upper pole sleeve fracture of the patella is usually serious and it needs to be diagnosed and treated as soon as possible, the sports medicine practitioner must be aware of this type of injury.

Clinical effect of intravenous infusion of zoledronic acid combined with oral medication of cinobufagin in the treatment of metastatic bone tumors.

Aim of the study was to observe and analyze the clinical effect of intravenous infusion of zoledronic acid combined with oral medication of cinobufagin in treating metastatic bone tumors. The 120 patients who have been treated in the hospital for metastatic bone tumor from June 2014 to June 2017 were selected as research objects. They were randomly divided into research group and control group, each containing 60. The research group was treated with intravenous infusion of zoledronic acid combined with oral medication of cinobufagin. In the control group, only zoledronic acid intravenous infusion was administered. The overall treatment effect of the two groups was observed. The pain of two groups was evaluated using numerical rating scale (NRS). The results showed that compared with the control group, the research group achieved better clinical effect and had a higher quality of life, and the intergroup difference was of statistical significance, P<0.05. There was no difference in rate of adverse reactions between the two groups, P>0.05, without statistical significance. The combined therapy of intravenous infusion of zoledronic acid and oral medication of cinobufagin can obtain better therapeutic effect in treating metastatic bone tumors.

Sirt1/Nrf2 signalling pathway prevents cognitive impairment in diabetic rats through anti­oxidative stress induced by miRNA­23b­3p expression.

In the present study the exact roles and mechanisms underlying the effect of miRNA­23b­3p on the cognitive impairment of diabetic rats were investigated. The in vivo model of diabetes was established in Wistar rats via a single injection of streptozotocin (STZ). Cognitive function was evaluated using a Morris water maze test. Oxidative stress was measured using ELISA kits, and the protein expression levels of B­cell lymphoma 2­associated X protein, silent information regulator 1 (SIRT1), nuclear factor erythroid 2­related factor 2 (Nrf2) and GAPDH were measured by western blot analysis. Micro (mi)RNA­23b­3p mimics were employed to increase miRNA­23b­3p expression in the in vitro model. Overexpression of miRNA­23b­3p increased oxidative stress (as indicated by the levels of glutathione peroxidase, glutathione, superoxide dismutase and malondialdehyde) and apoptosis in neurocytes following high­glucose treatment. The overexpression of miRNA­23b­3p also suppressed SIRT1 and Nrf2 expression in neurocytes following high­glucose treatment; it also promoted the SIRT1­induced inhibition of apoptosis and oxidative stress. The promotion of SIRT1 also decreased the effect of miRNA­23b­3p on cognitive impairment in diabetic rats. In conclusion, miRNA­23b­3p prevents the cognitive impairment of diabetic rats via anti­oxidative stress effects and the Sirt1/Nrf2 signaling pathway.

MEF2D overexpression contributes to the progression of osteosarcoma.

The underlying molecular pathogenesis of osteosarcoma remains poorly understood. The transcription factor MEF2D promotes the survival of various types of cells and functions as an oncogene in liver cancer. However, its potential contribution to osteosarcoma has not been explored. In this study, we investigated MEF2D expression and function in osteosarcoma, finding that MEF2D elevation in osteosarcoma clinical specimens was associated with patients' poor prognosis. MEF2D suppression was shown to decrease the proliferation of osteosarcoma cells, while forced expression of MEF2D was able to promote the proliferation of normal bone fibroblast. Notably, MEF2D silencing abolished osteosarcoma tumorigenicity in an animal model. Mechanistic investigations revealed that MEF2D silencing triggered G2-M arrest in osteosarcoma cells by suppressing RPRM and CDKN1A. miR-144 was found to suppress the expression of MEF2D in osteosarcoma cells. Collectively, our results demonstrated that MEF2D is a candidate oncogene for osteosarcoma and a potential molecular target for cancer therapy.