Evaluation of brain iron deposition in different cerebral arteries of acute ischaemic stroke patients using quantitative susceptibility mapping.

AIM: To investigate differences in iron deposition between infarct and normal cerebral arterial regions in acute ischaemic stroke (AIS) patients using quantitative susceptibility mapping (QSM). MATERIALS AND METHODS: Forty healthy controls and 40 AIS patients were recruited, and their QSM images were obtained. There were seven regions of interest (ROIs) in AIS patients, including the infarct regions of responsible arteries (R1), the non-infarct regions of responsible arteries (R2), the contralateral symmetrical sites of lesions (R3), and the non-responsible cerebral arterial regions (R4, R5, R6, R7). For the healthy controls, the cerebral arterial regions corresponding to the AIS patient group were selected as ROIs. The differences in corresponding ROI susceptibilities between AIS patients and healthy controls and the differences in susceptibilities between infarcted and non-infarct regions in AIS patients were compared. RESULTS: The susceptibilities of infarct regions in AIS patients were significantly higher than those in healthy controls (p<0.0001). There was no significant difference in non-infarct regions between the two groups (p>0.05). The susceptibility of the infarct regions in AIS patients was significantly higher than those of the non-infarct region of responsible artery and non-responsible cerebral arterial regions (p<0.01). CONCLUSIONS: Abnormal iron deposition detected by QSM in the infarct regions of AIS patients may not affect iron levels in the non-infarct regions of responsible arteries and normal cerebral arteries, which may open the door for potential new diagnostic and treatment strategies.

[Trend analysis of influenza vaccination among hospitalized elderly people in Beijing, 2013-2019].

OBJECTIVE: To analyze the influenza vaccination trend of hospitalized elderly people (≥ 60 years old) in Beijing from 2013 to 2019. METHODS: The influenza vaccination status and hospitalization information of elderly people were extracted from the Beijing Elderly Influenza Vaccination database (2013-2019) and the Beijing Urban Employee Basic Medical Insurance database (2013-2019), se-parately. The influenza vaccine coverage rates and annual percentage change were calculated to compare the vaccination trends of elderly people hospitalized due to different diseases. The subjects in 2018-2019 influenza season were divided into different groups according to demographic status, health conditions and hospitalization outcomes to describe and compare the distribution of influenza vaccination rates. RESULTS: The influenza vaccine coverage rates among the elderly people hospitalized due to cardiovascular diseases, cerebrovascular diseases, respiratory diseases or diabetes mellitus were 14.6%, 13.4%, 13.4% and 11.8%, respectively. The influenza vaccination rate among those hospitalized for cardiovascular diseases remained the highest across six influenza seasons and those hospitalized for diabetes mellitus remained the lowest. The largest annual decline of influenza vaccine coverage rate was observed among the hospitalized elderly due to diabetes mellitus (-7.85%). The distribution of vaccinated population was significantly associated with age, gender, hospitalization outcome and comorbidities among the hospitalized elderly people with specific diseases in 2018-2019. Among the elderly people hospitalized due to four different diseases, the vaccination rate of the patients aged 70-79 years was higher than that of the other age groups and that of the patients aged 60-69 years was the lowest. Among the elderly people hospitalized due to respiratory diseases, the vaccination rate of men was higher than that of women, while the situation reversed among the elderly people hospitalized due to cardiovascular diseases and diabetes mellitus. Vaccination rates decreased among the older adults with poor hospitalization outcomes. Among the elderly people hospitalized due to diabetes mellitus, those with 0 comorbidity had the lowest vaccination rate (7.9%). CONCLUSION: The trend of influenza vaccine coverage rates among the elderly people in Beijing from 2013 to 2019 was downward. We should pay more attention to influenza vaccination in elderly people with diabetes mellitus and aged 60-69 years, and carry out more research on the protective effects of influenza vaccine to promote influenza vaccine coverage among people with chronic diseases.

[Relationship between treatment and prognosis in patients with late-onset severe pneumonia after allogeneic hematopoietic stem cell transplantation].

OBJECTIVE: To explore the relationship between drug treatment and outcomes in patients with late-onset severe pneumonia (LOSP) after allogeneic stem cell transplantation (allo-SCT). METHODS: We retrospectively analyzed the effects of the initiation time of treatment drugs, especially antiviral drugs and glucocorticoids on the clinical outcomes in 82 patients between January 2016 and August 2021 who developed LOSP after allo-SCT in Peking University People's Hospital. Univariate analysis was performed by Mann-Whitney U test and χ2 test, and multivariate analysis was performed by Logistic regression. When multiple groups (n>2) were involved in the χ2 test, Bonferroni correction was used for the level of significance test. RESULTS: Of all 82 patients in this study, the median onset time of LOSP was 220 d (93-813 d) after transplantation, and the 60-day survival rate was 58.5% (48/82). The median improvement time of the survival patients was 18 d (7-44 d), while the median death time of the died patients was 22 d (2-53 d). Multivariate analysis showed that the initiation time of antiviral drugs from the onset of LOSP (< 10 d vs. ≥10 d, P=0.012), and the initiation time of glucocorticoids from antiviral drugs (< 10 d vs. ≥10 d, P=0.027) were the factors affecting the final outcome of the patients with LOSP at the end of 60 d. According to the above results, LOSP patients were divided into four subgroups: group A (antiviral drugs < 10 d, glucocorticoids ≥10 d), group B (antiviral drugs < 10 d, glucocorticoids < 10 d), group C (antiviral drugs ≥10 d, glucocorticoids ≥10 d) and group D (antiviral drugs ≥10 d, glucocorticoids < 10 d), the 60-day survival rates were 91.7%, 56.8%, 50.0% and 21.4%, respectively. CONCLUSION: Our study demonstrated that in patients who developed LOSP after allo-SCT, the initiation time of antiviral drugs and glucocorticoids were associated with the prognosis of LOSP, and the survival rate was highest in patients who received antiviral drugs early and glucocorticoids later. It suggested that for patients with LOSP of unknown etiology should be highly suspicious of the possibility of a secondary hyperimmune response to viral infection.

Conventional transarterial chemoembolization combined with systemic therapy versus systemic therapy alone as second-line treatment for unresectable colorectal liver metastases: randomized clinical trial.

BACKGROUND: The combination of conventional transarterial chemoembolization (cTACE) and systemic therapy has the potential to treat chemotherapy-refractory unresectable colorectal liver metastases (CRLMs). This study aimed to compare survival after this combined treatment versus systemic chemotherapy alone. METHODS: This single-centre RCT included patients with unresectable CRLMs that progressed after first-line treatment. Patients were randomized on a 1 : 1 basis to either systemic chemotherapy with or without cTACE, without further stratification. The primary outcome was progression-free survival (PFS). Secondary outcomes were overall response rate, disease control rate, conversion rate to liver resection, overall survival, and adverse events. RESULTS: Of 180 patients recruited, 168 were randomized. Eighty-five patients in arm A received systemic chemotherapy plus cTACE and 83 in arm B received systemic chemotherapy alone. Median PFS was longer in arm A than B (6.7 versus 3.8 months; hazard ratio (HR) 0.67, 95 per cent c.i. 0.49 to 0.91; P = 0.009), but did not translate into prolonged median overall survival (18.4 versus 14.8 months; HR = 0.92, 0.62 to 1.36; P = 0.669). Overall response rates (20 versus 22 per cent; P = 0.788) and conversion rate to liver resection (18 versus 16 per cent; P = 0.730) were no different between arms A and B. The disease control rate was higher in arm A than arm B (67 versus 51 per cent; P = 0.030). No adverse event higher than grade 3 according to the Common Terminology Criteria for Adverse Events was observed during treatment. CONCLUSION: Systemic chemotherapy plus cTACE is a safe option as second-line treatment for unresectable colorectal liver metastases, with a modest effect on PFS. Registration number: NCT03783559 (http://www.clinicaltrials.gov).

Bone marrow mesenchymal stem cell-derived exosomal MiR-338-3p represses progression of hepatocellular carcinoma by targeting ETS1.

The present study aims to explore the function of human bone marrow mesenchymal stem cell (BMSC)-derived exosomal micro ribonucleic acid (miR)-338-3p in hepatocellular carcinoma (HCC) and further investigate its effect on HCC cell functions. Firstly, BMSCs were co-cultured with HCC cells, and BMSC-derived exosomes were identified. Next, Transwell assay and methyl thiazolyl tetrazolium (MTT) experiments were carried out to detect the effects of miR-338-3p and E26 transformation specific-1 (ETS1) on the viability, invasion, migration, and apoptosis of HCC cells through the exosomes derived from BMSCs. Furthermore, the targeting relationship between miR-338-3p and EST1 was verified via bioinformatics study and dual-luciferase reporter gene analysis. Additionally, Western blotting (WB) was carried out to measure the expression levels of EST1 and other proteins in HCC cells. It was found that BMSCs inhibited HCC cell proliferation, invasion and migration, and induced cell apoptosis, while the inhibitors of exosomes played the opposite roles. In addition, the up-regulation of exosomal miR-338-3p or the silencing of EST1 restrained HCC cell proliferation, invasion and migration, and induced cell apoptosis. In conclusion, BMSC-derived exosomal miR-338-3p delays the development of HCC by down-regulating EST1, providing a new promising treatment target for HCC.

Phonotactic steering and representation of directional information in the ascending auditory pathway of a cricket.

Directional hearing is crucial for animals depending on acoustic signals to locate a mate. We focused on crickets to explore the reliability of directional information forwarded to the brain by the ascending auditory interneuron AN1, which is crucial for phonotactic behavior. We presented calling song from -45° to +45° in steps of 3° and compared the phonotactic steering of females walking on a trackball with the directional responses of AN1. Forty percent of females showed good steering behavior and changed their walking direction when the speaker passed the body's longitudinal axis. The bilateral latency difference between right and left AN1 responses was small and may not be reliable for auditory steering. In respect to spike count, all AN1 recordings presented significant bilateral differences for angles larger than ±18°, yet 35% showed a mean significant difference of 1-3 action potentials per chirp when the frontal stimulus deviated by 3° from their length axis. For small angles, some females had a very similar AN1 activity forwarded to the brain, but the accuracy of their steering behavior was substantially different. Our results indicate a correlation between directional steering and the response strength of AN1, especially for large angles. The reliable steering of animals at small angles would have to be based on small bilateral differences of AN1 activity, if AN1 is the only source providing directional information. We discuss whether such bilateral response difference at small angles can provide a reliable measure to generate auditory steering commands descending from the brain, as pattern recognition is intensity independent.NEW & NOTEWORTHY The ascending auditory interneuron AN1 has been implicated in cricket auditory steering, but at small acoustic stimulation angles, it does not provide reliable directional information. We conclude that either the small bilateral auditory activity differences of the AN1 neurons are enhanced to generate reliable descending steering commands or, more likely, directional auditory steering is mediated via a thoracic pathway, as indicated by the reactive steering hypothesis.

Prevalence and cardiovascular risk factors of asymptomatic intracranial arterial stenosis: the Kongcun Town Study in Shandong, China.

BACKGROUND AND PURPOSE: This study was to investigate the prevalence and cardiovascular risk factors (CRFs) of asymptomatic intracranial atherosclerotic stenosis (aICAS) amongst middle-aged and older adults living in rural communities in China. METHODS: This population-based study included 2019 subjects (aged ≥40 years, 52.3% women) who were free of stroke and living in rural communities in China. From October 2017 to May 2018, data on demographics, CRFs and health conditions were collected through face-to-face interviews, physical examination and laboratory tests. Asymptomatic ICAS was detected through a two-phase procedure: a screening phase with transcranial Doppler ultrasound, followed by a diagnostic phase with magnetic resonance angiography examination. Multivariable logistic regression models were used to analyse CRFs associated with aICAS. RESULTS: Of the 2019 participants, aICAS was detected in 153 persons. The overall prevalence of aICAS was 7.6%, and the prevalence of moderate-to-severe aICAS was 5.0%. The multi-adjusted odds ratio (95% confidence interval) of aICAS associated with CRFs was 2.40 (1.56-3.69) for hypertension, 1.91 (1.32-2.76) for high hypersensitive C-reactive protein, 1.68 (1.14-2.49) for diabetes and 1.61 (1.08-2.41) for overweight or obesity. When these four CRFs were aggregated, compared with participants without any of these factors, the multi-adjusted odds ratios (95% confidence interval) of aICAS for persons concurrently having one, two and three or more of these factors were 1.14 (0.52-2.48), 2.91 (1.42-5.99) and 5.51 (2.64-11.50), respectively (P for linear trend <0.001). CONCLUSIONS: Asymptomatic ICAS is common amongst rural-dwelling middle-aged and older Chinese people. Hypertension, diabetes, overweight or obesity and high hypersensitive C-reactive protein, especially when coexisting, are strongly associated with aICAS.

Primary tumour location is an important prognostic factor in colorectal cancer liver metastases following radiofrequency ablation.

AIM: To examine the outcomes and different prognoses for colorectal cancer patients with liver metastases (CRCLM) treated with radiofrequency ablation (RFA) based on the origin of the primary tumour (rectum versus colon). MATERIALS AND METHODS: Patients diagnosed with CRCLM from July 2011 to June 2018 were assessed in the study. The study included 114 patients with 176 lesions. All of the patients underwent RFA of their CRCLM. The overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier survival function estimate curves and Cox regression analysis between the group of patients with rectal cancer liver metastases (RCLM) and colon cancer liver metastases (CCLM). RESULTS: Patients with RCLM exhibited worse OS and PFS than those with CCLM. The 1-, 2-, and 3-year OS rates were 87.5%, 75%, and 54.2% in the RCLM group and 93.9%, 87.8%, and 81.8% in the CCLM group (p=0.001), respectively. The 1-, 2-, and 3-year PFS rates were 43.7%, 22.9%, and 20.8% in the RCLM group and 57.6%, 45.4%, and 36.5% in the CCLM group (p=0.001), respectively. Multivariate analysis showed that primary tumour location, carcinoembryonic antigen (CEA), and response to pre-ablation chemotherapy were independent variables for OS and PFS. The N state of the primary tumour also had a significant impact on OS. CONCLUSION: This study showed that patients with CCLM had better prognoses than those with RCLM following RFA treatment. If patients intend to undergo RFA for CRCLM, the location of the primary tumour should be considered in the assessment of long-term therapeutic effects.

[Effects of occupational nickel exposure on glycemic parameters in workers].

Objective: To explore the effect of occupational nickel exposure on blood glucose related indicators of workers. Methods: In March 2019, five electroplating enterprises and one plastic hardware enterprise were selected by cluster sampling method. 159 nickel plating workers were selected as the contact group, and 66 administrative personnel of the same enterprise were selected as the control group. The serum nickel concentration, fasting blood glucose (FPG) , fasting insulin (FIns) and glycosylated hemoglobin (HbA1c) were measured in the contact group and the control group. The differences of blood glucose related indexes between the two groups were compared, and the risk factors of abnormal blood glucose indexes were analyzed. Results: Compared with the control group, the blood nickel concentration and detection rate of nickel in the contact group were higher, the levels of FIns were lower, and the proportion of HbA1c was higher in the contact group (P<0.05) . Stratified analysis showed that compared with the control group, the blood glucose index of men in the contact group changed significantly (P<0.05) ; logistic regression analysis showed that male was an independent influencing factor for decreased FIns (OR=8.264, P<0.05) . Conclusion: Long term exposure to nickel can affect the blood glucose related indexes such as fins and HbA1c.

Optimized mid-long term management of ketogenic diet in children with refractory epilepsy.

This study aims to explore the mid-long term management of ketogenic diet (KD) for the treatment of refractory epilepsy in children, and carry out an efficacy assessment. The data of epileptic children who received KD in our hospital from January 2011 to August 2012 (basic management plan group, n=57) were retrospectively analyzed. On this basis, epileptic children who received KD from September 2012 to April 2014 (optimized management plan group, n=52) were managed according to the mid-long term management plan. The effective rate of KD at the first, third, sixth and ninth month was 90.4%, 73.1%, 65.4% and 38.5%, respectively, in the optimized management plan group, and 63.2%, 45.6%, 38.6% and 21.1%, respectively, in the basic management plan group, and the differences were statistically significant. The compliance rate of KD at the third, sixth and ninth month was 94.2%, 78.8% and 63.5%, respectively, in the optimized management plan group, and 82.5%, 47.4% and 28.1%, respectively, in the basic management plan group, and the differences were statistically significant. Optimized mid-long term management of KD in children can improve the control rate of epileptic seizures, and the compliance of patients.

Microglia M1/M2 polarization contributes to electromagnetic pulse-induced brain injury.

The development of electronic technology has attracted attention on the biological effects of electromagnetic fields (EMFs) and electromagnetic pulse (EMP). It remains controversial whether EMP irradiation is neurotoxic or beneficial for recovery from injuryies such as cerebral ischemia. Microglia is innate immune cells in the brain, exhibiting either neurotoxicity or neuroprotection effect during various central nervous system diseases, depending on their activation into a classical (M1) or alternative (M2) phenotype, respectively. The Toll-like receptor-4 (TLR4), myeloid differentiation factor 88 (MyD88) and nuclear factor kappa B (NFκB) pathway is important for microglia activation. In this study, we investigated the effect of EMP on neuronal apoptosis and microglia polarization in vivo and in vitro, using an EMP of 400 kV/m and 1 hertz for 200 pulses. Short EMP irradiation (≤24 h) resulted in microglial conversion from the resting to the M1-type state, activation of the TLR4/MyD88/NFκB pathway, higher levels of inflammatory cytokines including interleukin (IL)-6, IL-1ß and tumor necrosis factor-α, as well as neuronal apoptosis induction. In contrast, long EMP irradiation (3 days) resulted in microglial activation into the M2-type, decreased apoptosis and inflammatory mediator production, and increased levels of the neuroprotective effectors IL-10, transforming growth factor beta, and brain-derived neurotrophic factor. EMP induces both neuronal damage and neuronal recovery by influencing the switch of M1/M2 polarization and the TLR4/MyD88/NFκB pathway.

[The Rice OsDUF810 Family: OsDUF810.7 May be Involved in the Tolerance to Salt and Drought].

With the advance of sequencing technology, the number of sequenced plant genomes has been rapidly increasing. However, understanding of the gene function in these sequenced genomes lags far behind; as a result, many coding plant sequences in public databases are annotated as proteins with domains of unknown function (DUF). Function of a protein family DUF810 in rice is not known. In this study, we analysed seven members of OsDU810 (OsDUF810.1-OsDUF810.7) family with three distinct motifs in rice Nipponbare. By phylogenetic analysis, OsDUF810 proteins fall into three major groups (I, II, III). Expression patterns of the seven corresponding OsDUF810 protein-encoding genes in 15 different rice tissues vary. Under drought, salt, cold and heat stress conditions and ABA treatment, the expression of OsDUF810.7 significantly increases. Overexpression of this protein in E. coli lead to a significant enhancement of catalase (CAT) and peroxidase (POD) activities, and improved bacterial resistance to salt and drought.

Detection of IL-1ß, IL-6 and TNF-α in Sprague-Dawely rats' atrophic thymus induced by lipopolysaccharide.

OBJECTIVE: This study aimed to investigate developmental changes of the thymus and intra- thymic IL-1ß, IL-6 and TNF-α expression in weaned Sprague-Dawley rats induced by lipopolysac- charide. METHODS: Forty healthy weaned rats aged 26 days and weighing 83±4 g were randomly and equally divided into two groups. The lipopolysaccharide group was treated daily with a single injection of lipopolysaccharide for 10 consecutive days, and the saline group was treated with an equal volume of sterilized saline. On the 1st, 4th, 7th and 10th day, histological changes and distribu- tion of IL-1ß-, IL-6- and TNF-α-positive cells were detected in the thymus by hematoxylin-eosin and immunohistochemistry staining, respectively. Subsequently, the expression levels of IL-1ß, IL-6 and TNF-α were evaluated in the thymus by the ELISA method. RESULTS: Thymus weight and index were significantly smaller in lipopolysaccharide-treated rats than in saline-treated rats (p⟨0.05), but no substantial changes were found in the thymus microstructure after lipopolysaccharide induction. Moreover, a large number of IL-1ß-, IL-6- and TNF-α-positive cells were observed with brownish-yellow color and mainly distributed in the thy- mus parenchyma, both integrated optical density and average optical density increased signifi- cantly in lipopolysaccharide-treated rats than those in saline-treated rats. Compared with the saline group, most of the thymic homogenates had higher levels of IL-1ß, IL-6 and TNF-α in the lipopolysaccharide group on different days. CONCLUSION: These findings indicate that the thymus atrophied after lipopolysaccharide induction in weaned Sprague-Dawley rats, and excessive production of intrathymic IL-1ß, IL-6 and TNF-α was probably involved in the atrophic process.

Genomic and phylogenetic evidence that Maize rough dwarf and Rice black-streaked dwarf fijiviruses should be classified as different geographic strains of a single species.

Maize rough dwarf disease (MRDD) has long been known as one of the most devastating viral diseases of maize worldwide and is caused by single or complex infection by four fijiviruses: Maize rough dwarf virus (MRDV) in Europe and the Middle East, Mal de Rio Cuarto virus (MRCV) in South America, rice black-streaked dwarf virus (RBSDV), and Southern rice black-streaked dwarf virus (SRBSDV or Rice black-streaked dwarf virus 2, RBSDV-2) in East Asia. These are currently classified as four distinct species in the genus Fijivirus, family Reoviridae, but their taxonomic status has been questioned. To help resolve this, the nucleotide sequences of the ten genomic segments of an Italian isolate of MRDV have been determined, providing the first complete genomic sequence of this virus. Its genome has 29144 nucleotides and is similar in organization to those of RBSDV, SRBSDV, and MRCV. The 13 ORFs always share highest identities (81.3-97.2%) with the corresponding ORFs of RBSDV and phylogenetic analyses of the different genome segments and ORFs all confirm that MRDV clusters most closely with RBSDV and that MRCV and SRBSDV are slightly more distantly related. The results suggest that MRDV and RBSDV should be classified as different geographic strains of the same virus species and we suggest the name cereal black-streaked dwarf fijivirus (CBSDV) for consideration.

[Application of bilateral direct anterior approach total hip arthroplasty: a report of 22 cases].

OBJECTIVE: To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA). METHODS: We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital. A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study. There were 17 males and 5 females, and the median age was 48 years (range: 34-67 years). All the surgery was done by DAA method by two senior surgeons. The clinic characters, early surgery treatment results and complications were analyzed. RESULTS: We used the cementless stems in all the cases. The average operating time was (167±23) min; the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL; the wound drainage in average was (111±73) mL. Most of the patients could move out of the bed by themselves on the first day after operation, 5 patients could walk without crutches on the first operating day, and 13 patients could squat on the third days after operation. The patients were discharged averagely 4 days after operation. We followed up all the patients for averagely 16 months (range: 8-24 months). There was no loosening or failure case in the latest follow up. In the study, 2 patients had great trochanter fracture, 2 patients had thigh pain, 4 patients had lateral femoral cutaneous nerve palsy, and 3 patients had muscle damage. The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01). CONCLUSION: The DAA THA can achieve faster recovery and flexible hip joint after operation. However it is a kind of surgery with high technique demanding. Carefully selected patients, and skilled technique, can help the surgeon avoid the early complications. It is associated with high complication rate in the learning curve for bilateral DAA THA.

[Surgical technique and early clinical outcomes of direct anterior approach to total hip arthroplasty].

OBJECTIVE: To describe the surgical technique of direct anterior approach to total hip arthroplasty and to report the early clinical outcomes. METHODS: A series of 100 consecutive, unselected patients who had 116 primary total hip arthroplasty surgeries (16 bilateral) done through direct anterior approach from March 11 2015 to June 21 2016 was reviewed. There were 50 male patients and 50 female patients. The average patient age was 51 years, and the average body mass index was 24.69 kg/m2. The preoperative diagnosis included avascular necrosis of femoral head, hip osteoarthritis, osteoarthritis secondary to acetabular dysplasia, sequelae of hip old infection, ankylosing spondylitis, rheumatoid arthritis and avascular necrosis of femoral head after cannulated screws fixation of femoral neck fracture. There were 7 hips which had surgical history prior to the index hip arthroplasty, including 3 cases with bone graft treatment for avascular necrosis of femoral head through Smith-Peterson approach, 2 cases with acetabular shelf procedures for acetabular dysplasia through Smith-Peterson approach, and 2 cases with cannulated screws fixation for femoral neck fracture (internal fixation residual). All were uncemented hips. The stems used in this study included 67 Triloc stems (DePuy company, USA), 45 Corail stems (DePuy company, USA), 2 Accolade stems (Stryker company, USA), 1 Synergy stem (Smith-Nephew company, USA) and 1 Polarstem (Smith-Nephew company, USA). RESULTS: The average follow up period was 8.5 months, the average incision scar length was 10 cm, and the average postoperative Harris score was 93.62. There was 95% postoperative leg length discrepancy within 3 mm. The average cup inclination angle was 38.7° with 94.8% in the range of 30° to 50°. The average cup anteversion angle was 14.3° with 94.2% within the target range of 5° to 25°.The were 15 (12.9%) operative complications, including two femoral perforations (changing stem from Triloc to Corail), three calcar fractures (treated with cerclage wires), four greater trochanter fractures (2 were treated wire tension band, and 2 nondisplaced fractures untreated), one deep infection (debridement and retaining of the prothesis), one superficial infection (debridement), one hematoma and three wound healing complications (debridement). All the complications were successfully treated without any sequelae at the end of the latest follow-up. There was no postoperative dislocation. There was no major nerve and vascular injuries. There were 35 cases (30.2%) reporting symptoms of lateral femoral cutaneous nerve palsy. CONCLUSION: Direct anterior approach to total hip arthroplasty allows accurate and reproducible cup orientation positioning and leg length restoration and decreases the risk of postoperative dislocation, which is helpful for early rapid postoperative recovery.

[Imaging diagnostic methods for identification of sentinel lymph nodes in patients with early squamous cell carcinoma of the oral cavity mucosa: a literature review]. / Luchevye metody diagnostiki v obnaruzhenii storozhevykh limfaticheskikh uzlov u patsientov s rannim ploskokletochnym rakom slizistoi obolochki polosti rta: obzor literatury.

The paper describes properties of clinical visualization approaches which are applied for detection of sentinel lymph nodes in patients suffering from oral cavity squamous cell cancer. Diagnostic efficiency results and technological features of different imaging techniques are discussed.

Matrix metalloproteinase 12 is an indicator of intervertebral disc degeneration co-expressed with fibrotic markers.

OBJECTIVE: Recent evidence suggests a role of fibrogenesis in intervertebral disc (IVD) degeneration. We aim to explore if fibrotic genes may serve as IVD degeneration indicators, and if their expression is associated with myofibroblast activity. DESIGN: Transcriptional expression of fibrosis markers (COL1A1, COL3A1, FN1, HSP47, MMP12, RASAL1) were analyzed in degenerated (D) and non-degenerated (ND) human nucleus pulposus (NP) and annulus fibrosus (AF) cells, along with traditional (SOX9, ACAN) and newly established degeneration markers (CDH2, KRT19, KRT18, FBLN1, MGP, and COMP). Protein expression was investigated by immunohistochemistry in human IVDs, and in rodent IVDs undergoing natural ageing or puncture-induced degeneration. Co-expression with myofibroblast markers was examined by double staining on human and rat specimens. Disc degeneration severity and extent of fibrosis were determined by histological scoring and picrosirius red staining respectively. RESULTS: Human D-NP showed more intensive staining for picrosirius red than ND-NP. Among the genes examined, D-NP showed significantly higher MMP12 expression along with lower KRT19 expression. Protein expression analysis revealed increased MMP12(+) cells in human D-IVD. Histological scoring indicated mild degeneration in the punctured rat discs and discs of ageing mouse. Higher MMP12 positivity was found in peripheral NP and AF of the degenerative rat discs and in NP of the aged mice. In addition, human D-NP and D-AF showed increased α-SMA(+) cells, indicating enhanced myofibroblast activity. MMP12 was found co-expressed with α-SMA, FSP1 and FAP-α in human and rat degenerative IVDs. CONCLUSIONS: Our study suggests that in addition to a reduced KRT19 expression, an increased expression of MMP12, a profibrotic mediator, is characteristic of disc degenerative changes. Co-expression study indicates an association of the increased MMP12 positivity with myofibroblast activity in degenerated IVDs. Overall, our findings implicate an impact of MMP12 in disc cell homeostasis. The precise role of MMP12 in IVD degeneration warrants further investigation.

Effects of epidural block combined with general anesthesia on antitumor characteristics of T helper cells in hepatocellular carcinoma patients.

This study discusses the changes of T helper cells (Th cells) of patients who received different anesthesia methods in liver cancer resection. We selected 122 patients who were diagnosed with hepatocellular carcinoma and underwent liver cancer resection and divided them into a general anesthesia combined with epidural anesthesia group (group A) and general anesthesia group (group B). Peripheral blood was collected to detect Th cells on the day of surgery, and on the second and seventh days after surgery. Th1 and Th2 cell frequency and mRNA expression of interferon-γ (IFN-γ) of all patients significantly rose on the second day but recovered to the previous level on the seventh day. Th1/Th2 increased remarkably on the seventh day compared to the second day. Compared to the day of surgery, Th17, regulatory T (Treg)cells as well as mRNA expression of interleukin-17 (IL-17) and FoxP3 had no obvious changes on the second day, but dramatically declined on the seventh day. Compared to group B, Th1 cell frequency and Th1/Th2 in group A had a slight increase on the second day, and a remarkable increase on the seventh day; but Th2, Th17 and Treg cell frequency in group A slightly decreased on the second day and remarkably decreased on the seventh day. mRNA of IFN-γ, cytokine levels and IFN-γ/IL-4 of group A were all higher than group B on the seventh day, while mRNA of IL-17, concentration of IL-17 as well as concentration of transforming growth factor-ß1 (TGF-ß1) in group A were much lower than group B. These findings suggest that improving antitumor activity of Th cells can benefit patients who receive liver cancer resection.

[Estimation of femoral version based on broach geometry after femoral-neck osteotomy].

OBJECTIVE: To find out whether it is accurate to estimate femoral version based on femoral broach after femoral neck osteotomy using computed tomography scans. METHODS: In 32 total hip arthroplasty (THA), we performed CT scans before and after operation. Four possible levels (lesser trochanter, 5 mm above, 10 mm above and 15 mm above the lesser trochanter) of broach version were calculated based on the preoperative CT scan. Stem versions were measured on the postoperative CT scan. We determined the difference between the preoperative broach version and the postoperative stem version using the Student's t test for paired samples assuming equal variance. RESULTS: For the operated hips, preoperative hip version differed according to the level of measurement. Our findings showed that the average femoral version was 37.0°±11.0° at the level of the lesser trochanter (section 1), 34.3°±10.6° at 5 mm above the lesser trochanter (section 2), 28.1°±10.9° at 10 mm above the lesser trochanter (section 3), and 22.4°± 13.7° at 15 mm above the lesser trochanter (section 4), and that the average version for the femoral neck (FNV) was 12.9°±13.8°. The postoperative hip version was the stem version (FSV), which we found to be an average of 26.1°±11.0°. The mean femoral version for section 1 and 2 was larger than the mean postoperative stem version (P<0.01); the mean version for sections 3 and 4 did not differ from the mean postoperative stem version (P>0.05). The mean femoral neck version was less than the mean postoperative stem version (P<0.01); the difference was 13.2°±11.1° of the increased anteversion on average for the FSV compared with FNV. CONCLUSION: The accuracy of estimated femoral version after arthroplasty depends on broach level. When it is 10 mm above the lesser trochanter, stem version estimation is accurate, but below that level, there is a tendency to overestimate.