Multiplex analysis of serum hormone and cytokine in patients with cervical cOPLL: towards understanding the potential pathogenic mechanisms.

Cervical ossification of the posterior longitudinal ligament (cOPLL) is one of the major causes of myelopathy. However, the mechanism underlying remains elusive. In the present study, using MILLIPLEX magnetic bead panel, we investigated four serum hormones and six serum cytokines in cOPLL patients and healthy subjects. The results showed that tumor necrosis factore-α (TNF-α) were significantly increased, and DDK-1 was significantly decreased in the serum from male and female cOPLL patients compared with those from healthy controls, respectively. Osteopontin (OPN) and fibroblast growth factor-23 (FGF-23) were significantly increased in male cOPLL patients compared with that in healthy male controls. Further analysis showed that FGF-23 and OPN significantly increased, dickkopf-1 (DKK-1) decreased in the extensive cOPLL group. In addition, a significant positive correlation between the OPN and FGF-23 was observed in male cOPLL patients. The results are useful for understanding the mechanism underlying cOPLL.

Effect of inflammatory response on joint function after hip fracture in elderly patients: A clinical study.

BACKGROUND: Excellent hip joint function facilitates limb recovery and improves the quality of survival. This study aimed to investigate the potential risk factors affecting postoperative joint functional activity and outcomes in elderly hip fractures patients and to provide evidence for patient rehabilitation and clinical management. AIM: To explore the relationship between inflammatory factors and hip function and the interaction between inflammation and health after hip fracture in elderly patients. METHODS: The elderly patients who had hip fracture surgery at our hospital between January 1, 2021, and December 31, 2022 were chosen for this retrospective clinical investigation. Patients with excellent and fair postoperative hip function had their clinical information and characteristics gathered and compared. Age, gender, fracture site, surgical technique, laboratory indices, and other variables that could have an impact on postoperative joint function were all included in a univariate study. To further identify independent risk factors affecting postoperative joint function in hip fractures, risk factors that showed statistical significance in the univariate analysis were then included in a multiple logistic regression analysis. In addition to this, we also compared other outcome variables such as visual analogue scale and length of hospital stay between the two groups. RESULTS: A total of 119 elderly patients with hip fractures were included in this study, of whom 37 were male and 82 were female. The results of univariate logistic regression analysis after excluding the interaction of various factors showed that there was a statistically significant difference in interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), and complement C1q (C1q) between the fair and excellent joint function groups (P < 0.05). The results of multiple logistic regression analysis showed that IL-6 > 20 pg/mL [(Odds ratio (OR) 3.070, 95%CI: 1.243-7.579], IL-8 > 21.4 pg/ mL (OR 3.827, 95%CI: 1.498-9.773), CRP > 10 mg/L (OR 2.142, 95%CI: 1.020-4.498) and C1q > 233 mg/L (OR 2.339, 95%CI: 1.094-5.004) were independent risk factors for poor joint function after hip fracture surgery (all P < 0.05). CONCLUSION: After hip fractures in older patients, inflammatory variables are risk factors for fair joint function; therefore, early intervention to address these markers is essential to enhance joint function and avoid consequences.

A sophisticated fracture classification system of the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images.

Objective: Fracture classification evolves dynamically with new and enhanced imaging modalities. This paper aims to introduce a novel hypothesis of a sophisticated fracture classification system for the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images and accommodate the clinical requirement of the worldwide outbreak of geriatric hip fractures with large amounts of surgical operations. Methods: In the current practice of widely preoperative 3D-CT application and cephalomedullary nailing, we attempt to propose a new comprehensive classification system to describe the fracture characteristics in a more detailed and sophisticated architecture, and pay the most important concern to the parameters that contribute to fracture stability reconstruction in osteosynthesis. Results: The new four-by-four comprehensive classification system, followed the structure of the AO/OTA system, incorporates many fracture characteristics as dividing indexes into multiple grade levels, such as fracture line direction, the number of fragments, the lesser trochanter fragment and its distal extension (>2 cm), the posterior coronal fragment and its anterior expansion (to the entry portal of head-neck implant at the lateral cortex), the lateral wall and anterior cortex fracture, and the anteromedial inferior corner comminution. From a panoramic perspective, there are four types and each type has four subtypes. A1 is simple two-part fractures (20%), A2 is characterized by lesser trochanter fragment and posterior coronal fractures (62.5%), A3 is reverse obliquity and transverse fractures with complete lateral wall broken (15.5%), and A4 is medial wall comminution which further lacks anteromedial cortex transmission of compression force (2%). For subtypes, A2.2 is with a banana-like posterior coronal fragment, A2.4 is with distal cortex extension >2 cm of the lesser trochanter and anterior expansion of the posterior coronal fragment(s) to the entry portal of head-neck implants, A3.4 is a primary pantrochanteric fracture, and A4.4 is a concomitant ipsilateral segmental fracture of the neck and trochanter region. Conclusion: Classification represents diversity under consistency. The four-by-four sophisticated classification system delineates fracture characteristics in more detail. It is applicable in the time of rapid outbreak of trochanteric fractures in the older population, the large amounts of surgical operations, and incorporates various rare and/or more complicated subtypes which is unclassifiable before.

Positive or negative anteromedial cortical support of unstable pertrochanteric femoral fractures: A finite element analysis study.

OBJECTIVE: To explore the mechanical stability of unstable pertrochanteric fractures with proximal femoral nail anti-rotation (PFNA-Ⅱ) fixation under different anteromedial cortical support reduction patterns. METHODS: A 65-year-old healthy male volunteer with no history of hip or systemic disease was recruited. High-resolution computed tomography images with a slice thickness of 0.67 mm of his right femur were obtained. These images were used to establish three-dimensional (3D) models. The lesser trochanter and lateral femoral wall were cut off to create an AO Foundation/Orthopaedic Trauma Association type 31-A2 unstable pertrochanteric fracture model. PFNA-Ⅱ was used to simulate fixation. Nine different fracture reduction patterns, which included positive-positive, positive-neutral, positive-negative, neutral-positive, neutral-neutral, neutral-negative, negative-positive, negative-neutral, and negative-negative cortical support reductions, were simulated. A load of 700 N was applied to simulate a 70 kg elderly patient standing on one leg. The models were subjected to finite element analysis. The displacement and von Mises stress distributions were analyzed. RESULTS: The positive-positive cortical support reduction pattern showed minimal stress and the negative-negative reduction pattern showed maximal stress on the intramedullary nail. The stress was mainly concentrated at the junction of the helical blade and the main nail and at the site of the lateral aspect of the insertion point of the nail in the great trochanter. The positive cortical support reduction patterns seemed to have smaller maximum displacements of the entire fragment-implant assembly and relative displacements between the head-neck and shaft fragments. Meanwhile, the negative reduction patterns seemed to have larger displacements. CONCLUSION: The positive-positive support reduction pattern showed better mechanical stability for unstable pertrochanteric fractures. The negative-negative support reduction pattern was prone to fixation failure and should be avoided during an operation.

[Effect of tumor vascular invasion upon cardio-pulmonary exercise functions in patients with lung cancer].

OBJECTIVE: To investigate the correlation between the tumor vascular invasion and the change of cardio-pulmonary exercise function in patients with lung cancer. METHODS: The cardio-pulmonary exercise test was performed in 405 patients with lung cancer (293 with vascular invasion and 112 without). The peak load indices examined included maximal work power (measured value/predicted value, W%), maximal oxygen uptake per weight (VO(2)/kg), anaerobic threshold (AT), maximal oxygen pulse (measured value/predicted value, VO(2)/HR%), maximal minute ventilation (V(E)), maximal breath reserve (BR), maximal breath frequency (BF) and maximal tidal volume during expiration (VTex). RESULTS: (1) W%, VO(2)/kg, AT, VO(2)/HR% of patients with vascular invasion [(73 +/- 18)%, (17 +/- 5) ml * min(-1) * kg(-1), (51 +/- 14)%, (79 +/- 18)% respectively] decreased than those without vascular invasion [(86 +/- 20)%, (19 +/- 5) ml * min(-1) * kg(-1), (55 +/- 14)%, (88 +/- 20)% respectively, all P < 0.01) while BF increased [(32.1 +/- 6.1)/min vs (30.6 +/- 5.1)/min, P < 0.05). (2) The patients were divided according to TNM stage, number, kind of tumor vascular invasion and its relationship with tumor, W%, VO(2)/HR% decreased in the groups of 1-, 2- and >or= 3-vessel invasion versus the control group (P < 0.01), AT decreased in the groups of 1- and >or= 3-vessel invasion versus the control group (P < 0.05, P < 0.01), VO(2)/kg decreased in the groups of 2- and >or= 3-vessel invasion versus the control group (P < 0.05, P < 0.01), VO(2)/kg decreased in the group of >or= 3-vessel invasion versus 1- and 2-vessel invasion (P < 0.05 or P < 0.01), VO(2)/HR% decreased in the group of >or= 3-vessel invasion versus 1-vessel invasion (P < 0.01), VTex decreased in the group of >or= 3-vessel invasion versus the control group and 1-vessel invasion (P < 0.05). There was correlation between VO(2)/HR% and the number of tumor invaded vessels (r = 0.220, P < 0.01). CONCLUSIONS: The amount of oxygen uptake, exercise ability and cardiac function during exercise decrease in patients of lung cancer with tumor vascular invasion. The main reason is the number of the invaded vessels.

Dynamic alterations of the levels of tumor necrosis factor-α, interleukin-6, and interleukin-1ß in rat primary motor cortex during transhemispheric functional reorganization after contralateral seventh cervical spinal nerve root transfer following brachial plexus avulsion injuries.

The transfer of a contralateral healthy seventh cervical spinal nerve root (cC7) to the recipient nerve in the injured side is considered a reliable and effective procedure for restoration of the physiological functions of an injured hand after brachial plexus root avulsion injury (BPAI). Growing evidence shows that the transhemispheric cortical reorganization is induced after cC7 nerve transfer surgery. However, little is known about the underlying molecular mechanism. Proinflammatory cytokines reportedly play an important role in the neural plasticity. We hypothesize that proinflammatory cytokines are involved in the transhemispheric functional reorganization after cC7 transfer. In the present study, we investigated the level of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1ß (IL-1ß) in the rat primary motor cortex after cC7 transfer following BPAI by enzyme-linked immunosorbent assay. The results showed that, in the sham group, no statistical significance was observed between the level of TNF-α, IL-6, and IL-1ß at each time point after the operation compared with that at day 0, respectively. However, in the unrepaired and repaired groups, the level of TNF-α, IL-6, and IL-1ß changed dynamically. The study is the first to provide evidence for the involvement of proinflammatory cytokines in transhemispheric functional reorganization after cC7 transfer following BPAI, which are useful for understanding the underlying mechanism.

Expressions of miR-132, miR-134, and miR-485 in rat primary motor cortex during transhemispheric functional reorganization after contralateral seventh cervical spinal nerve root transfer following brachial plexus avulsion injuries.

The transfer of a contralateral healthy seventh cervical spinal nerve root (cC7) to the recipient nerve in the injured side is considered a promising procedure for restoration of the physiological functions of an injured hand after brachial plexus root avulsion injury (BPAI). Growing evidence shows that transhemispheric cortical reorganization plays an important role in the functional recovery of the injured arm after cC7 nerve transfer surgery. However, the molecular mechanism underlying the transhemispheric cortical reorganization after cC7 transfer remains elusive. In the present study, we investigated the expression of miR-132, miR-134, and miR-485 in the rat primary motor cortex after cC7 transfer following BPAI by quantitative PCR. The results demonstrated the dynamic alteration in the expression of miR-132, miR-134, and miR-485 in the primary motor cortex of rats after cC7 transfer following BPAI. It indicates that microRNAs are involved in the dynamic transhemispheric functional reorganization after cC7 root transfer following BPAI. Together, this study is the first to provide evidence for the involvement of microRNAs during dynamic transhemispheric functional reorganization after cC7 transfer following BPAI. The results are useful for understanding the mechanism underlying transhemispheric functional reorganization after contralateral seventh cervical spinal nerve root transfer following BPAI.

Decreased expression of microRNA-130a correlates with TNF-α in the development of osteoarthritis.

OBJECTIVE: Increased expression of tumor necrosis factor a (TNF-α) has emerged as an important inflammatory factor in osteoarthritis (OA) and other joint diseases. The study was performed to investigate whether the expression of TNF-α in human chondrocytes was regulated by miRNAs. METHODS: MiRNA-130a and TNF-α expression in cartilage specimens was examined in patients with knee osteoarthritis, chondrocytes and osteoarthritis rat model. Chondrocytes were transfected with siRNAs as a gene silencing methods. Expression of genes and proteins were analyzed by real-time PCR and western blotting respectively. RESULTS: Increased TNF-α and decreased miRNA-130a were observed in tissues from osteoarthritis patients. Moreover, we found a highly negitive correlation between miRNA-130a and TNF-α. Next, miRNA-130a loss-of-function increased the expression of TNF-α and promoted inflammation in chondrocytes. It was reasonable that miRNA-130a regulated a distinct underlying molecular and pathogenic mechanism of OA by forming a negative feedback loop with TNF-α. Furthermore, there were the abnormalities of bone metabolism in OA rat, which showed the miRNA-130a and TNF-α dysfunction that was one of important factors for the occurrence and development of OA. CONCLUSIONS: Our results indicated that miR-130a played an important role in regulating the expression of TNF-α in human chondrocytes and identified miR-130a as a novel therapeutic target in OA.

Comparison of proximal femoral nail antirotation blade and reverse less invasive stabilization system-distal femur systems in the treatment of proximal femoral fractures.

OBJECTIVE: To compare the effects of proximal femoral nail antirotation blade (PFNA) and reverse less invasive stabilization system-distal femur (Liss-DF) systems in the treatment of proximal femoral fractures. METHODS: Between June 2007 and October 2009, 41 proximal femoral fractures were treated, 22 with PFNA (group A) and 19 with reverse LISS-DF plates (group B). The time to starting full weight-bearing, fracture healing time, functional recovery (Parker and Palmer mobility score), neck-shaft angle discrepancies with the intact contralateral hip, preoperative American Society of Anesthesiologists (ASA) scores, the operation durations and amount of intraoperative bleeding were recorded and compared. RESULTS: The mean follow-up period was 11.2 months (range, 10-12 months). Compared with Group A, Group B showed a statistically longer mean time to bear full body weight and heal their fractures, but a smaller neck-shaft angle discrepancy (all P < 0.05). The groups were similar in ASA score, operation duration, amount of intraoperative bleeding and Parker and Palmer mobility score. CONCLUSION: Both PFNA and reverse Liss-DF were satisfactory for the treatment of proximal femoral fractures, but had different advantages. PFNA allowed earlier weight-bearing and accelerated fracture healing. Reverse Liss-DF more effectively avoided coxa vara and may be indicated for patients with very severe osteoporosis.