Treatment of acetabular fracture involving anterior and posterior columns using a single pararectus approach: surgical experience and preliminary results.

PURPOSE: This study aims to evaluate the efficacy of single pararectus approach in patients confirmed with acetabular fracture involving anterior and posterior columns. METHODS: A total of 58 patients confirmed with acetabular fracture involving anterior and posterior columns and treated at our hospital between January 2015 and January 2020 were retrospectively analyzed. A single pararectus approach was applied for all patients. Routine X-rays were performed at follow-up of one, three, six, 12, and 18 months, and three-dimensional CT scans were added at six and 18 months. Fracture reduction quality was assessed using the Matta score system, and functional assessment used the Modified Merle D'Aubigné and Postel score system. Post-operative complications, including fat liquefaction and deep vein thrombosis, were recorded and analyzed. RESULTS: The median operation time was 186 min while the intra-operative blood loss was 421 mL. The rate of good-to-excellent reduction was 94.8%, and the rate of good-to-excellent hip function score reached 93.1%. Seven patients presented with post-operative complications, including three intra-operative small vascular injuries, two peritoneal small perforations, one fat liquefaction, and one deep vein thrombosis. CONCLUSION: Using a single pararectus approach is convenient and effective for treating acetabular fracture involving anterior and posterior columns, especially those involving the quadrilateral area. TRIAL REGISTRATION: ChiCTR, ChiCTR2100054604. Registered 21 December 2022. Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=144783 .

[TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury].

Objective: To evaluate the effectiveness of TiRobot-assisted surgery by O-arm navigation system for percutaneous minimally invasive treatment of posterior pelvic ring injury. Methods: The clinical data of 76 patients with posterior pelvic ring injury between January 2016 and June 2021 were retrospectively analyzed. Among them, 45 cases were treated with minimally invasive percutaneous sacroiliac screw fixation assisted by TiRobot and O-arm navigation system (study group), 31 cases were treated with minimally invasive percutaneous sacroiliac screw fixation under the guidance of C-arm X-ray machine (control group). There was no significant difference in gender, age, cause of injury, Tile classification, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, the times of nail track adjustment, and intraoperative fluoroscopy times were recorded. The quality of fracture reduction was evaluated by Matta score. At last follow-up, Majeed score was used to evaluate the recovery of pelvic function. Results: A total of 72 screws were implanted in the study group, with a median of 1 (1, 2) screws per patient. In the control group, 47 screws were implanted, with a median of 1 (1, 2) screws per patient. There was no significant difference in the number of screws between the two groups ( Z=-0.392, P=0.695). The operation time, intraoperative blood loss, times of nail track adjustment, and intraoperative fluoroscopy times in the study group were significantly less than those in the control group ( P<0.05). All patients were followed up 6-24 months (mean, 14 months). No serious complications was found after operation and during follow-up. Matta score was used to evaluate the quality of fracture reduction at 1 week after operation, and there was no significant difference between the two groups ( Z=-1.135, P=0.256). At last follow-up, there was no significant difference of Majeed score between the two groups ( Z=-1.279, P=0.201). Conclusion: TiRobot-assisted surgery by O-arm navigation system is a reliable surgical method for the treatment of posterior pelvic ring injury, which can reduce the operation time and fluoroscopy times when compared with the traditional operation under the guidance of C-arm X-ray machine. The safety, accuracy, and efficiency of the operation were improved.

O-Arm-Navigated, Robot-Assisted Versus Conventional CT Guided Radiofrequency Ablation in Treatment of Osteoid Osteoma: A Retrospective Cohort Study.

Background: Osteoid osteoma is a common benign bone tumor, and clinically there is severe local pain that typically worsens at night. The conventional CT-guided radiofrequency ablation (RFA) was widely used in the treatment of osteoid osteoma (OO), which could result in some radiation-related and imprecise complications due to the overdose of radiation exposure. This study aimed to compare the surgical effect of robot-assisted RFA with O-arm navigation and conventional CT-guided RFA in the treatment of OO. Methods: Sixty-two patients who underwent robot-assisted RFA with O-arm navigation (Robot-RFA, n = 24) or CT-guided RFA (CT-RFA, n = 38) were included in this retrospective cohort study. The mean follow-up time was 23.3 months. The intra-operative data, primary technical success rate, visual analog scale (VAS), and post-operative complications were analyzed. Results: Primary technical success was obtained in 23 patients who had robot-assisted RFA, and 35 patients who had conventional CT-guided RFA. One patient in Robot-RFA group and three patients in CT-RFA group with pain recurrence received repeat-RFA and had a secondary success. Mean operation time and dose of radiation exposure were lower in Robot-RFA group than that in CT-RFA group. The Robot-RFA group took fewer K-wire adjustment times for each patient than the CT-RFA group. There was a statistically significant difference in the mean operation time, dose of radiation exposure, and K-wire adjustment times between the groups (p < 0.05). No complications associated with the procedure were reported in the two groups during the follow-up period. Conclusion: Robot-assisted RFA with O-arm navigation is a safer and more precise strategy in the treatment of osteoid osteoma with less operation time and radiation exposure compared with the conventional CT-guided radiofrequency ablation.

KLF4, negatively regulated by miR-7, suppresses osteoarthritis development via activating TGF-ß1 signaling.

Osteoarthritis (OA) is a chronic degenerative disease which seriously affects the patients' daily activities and quality of life. In our previous findings, we demonstrated that overexpression of miR-7 was found in OA and promoted OA development. Its exact mechanism remains unclear. Herein, we confirmed that KLF4 was the target gene of miR-7 and KLF4 was down-regulated in human OA tissues and OA chondrocyte. KLF4 was negatively modulated by miR-7 via dual luciferase reporter assay. Cartilage-specific genes (SOX9, COL2A1, RUNX2, MMP13) are crucial regulators in cartilage degeneration. Through qRT-PCR and western blot, we observed that KLF4 overexpression could increase the expression of SOX9 and COL2A1, decrease RUNX2 and MMP13. In the meanwhile, miR-7 was proven to regulate the expression of the above cartilage-specific genes by targeting KLF4, which demonstrated KLF4 could prevent OA development. Subsequently, KLF4 also activated TGF-ß1 signaling pathway, thereby affecting OA progression. Excessive KLF4 could up-regulate TGF-ß1 and p-Smad2/3 level, and Smad4 level was prevented in OA chondrocytes, while adding TGF-ß1 inhibitor SB525334 could rescue this impact, along with reduced TGF-ß1 and p-Smad2/3 level, enriched Smad4 level. KLF4 could also reverse the effect of miR-7 on TGF-ß1 signaling. Besides, it was confirmed that KLF4 could improve OA in rat OA models by HE and Safranin O-Fast green staining, and immunohistochemistry. Collectively, our findings will give more detailed evidence about miR-7 and KLF4 in OA diagnosis and treatment.

A Fault Diagnosis Method of Modular Analog Circuit Based on SVDD and D-S Evidence Theory.

In the actual fault diagnosis process of an analog circuit, there is often a problem due to the lack of fault samples, leading to the low-accuracy of diagnostic models. Therefore, using positive samples that are easy to obtain to establish diagnostic models became a research hotspot in the field of analog circuit fault diagnosis. This paper proposes a method based on Support Vector Data Description (SVDD) and Dempster-Shafer evidence theory (D-S evidence theory) for fault diagnosis of modular analog circuit. Firstly, the principle of circuit module partition is proposed to divide the analog circuit under test, and the output port of each module is selected as test point. Secondly, the paper extracts the feature of the time-domain and frequency-domain output signals of the circuit module through Principal Component Analysis (PCA). Thirdly, four state detection models based on SVDD are established to judge the working state of each circuit module, including TSG, TSP, FSG, and FSP state detection model. Finally, the D-S theory is introduced to integrate the test results of each model for locating fault circuit module. To verify the effectiveness of the proposed method, the dual bandpass filter circuit is selected for simulation and hardware experiment. The results show that the proposed method can locate the analog fault effectively and has a higher diagnosis accuracy.

Oxocrebanine: A Novel Dual Topoisomerase inhibitor, Suppressed the Proliferation of Breast Cancer Cells MCF-7 by Inducing DNA Damage and Mitotic Arrest.

BACKGROUND: DNA topoisomerase (Topo) inhibition plays key role in breast cancer treatment. Stephania hainanensis H. S. Lo et Y. Tsoong (S. hainanensis), a Li nationality plant that has abundant aporphine alkaloids, can inhibit Topo. PURPOSE: To identify a dual Topo inhibitor, a deep and systematic study of active aporphine alkaloids in S. hainanensis and their mechanisms of inhibiting breast cancer proliferation and Topo activity are essential. STUDY DESIGN: This study aimed to assess the anti-breast cancer and Topo inhibitory activities of oxocrebanine and explore the underlying mechanisms. METHODS: The growth inhibitory activities of 12 compounds in S. hainanensis were screened by MTT assay in MCF-7, SGC-7901, HepG-2 cells, and compared with the effects on human normal mammary epithelial MCF-10A cells as non cancer control cells. The Topo inhibitory activity was assessed by DNA relaxation and unwinding assays, kDNA decatenation assay and western blot. Cell cycle and autophagy analyses were carried out with flow cytometry and staining. Acridine orange staining and α-tubulin morphology were observed by fluorescence microscopy. Western blot was used to examine microtubule assembly dynamics and the expression levels of key proteins associated with DNA damage, autophagy and mitotic arrest. RESULTS: Oxocrebanine was the anti-breast cancer active alkaloid in S. hainanensis. It exhibited the best inhibitory effect on MCF-7 cells with an IC50 of 16.66 µmol/l, and had only weak effect on the proliferation of MCF-10A cells. Oxocrebanine inhibited Topo I and II α in a cell-free system and in MCF-7 cells. The DNA unwinding assay suggested that oxocrebanine intercalated with DNA as a catalytic inhibitor. Oxocrebanine regulated the levels of Topo I and IIα and DNA damage-related proteins. Oxocrebanine led to the mitotic arrest, and these effects occurred through both p53-dependent and p53-independent pathways. Oxocrebanine induced autophagy, abnormal α-tubulin morphology and stimulated enhanced microtubule dynamics. CONCLUSION: Oxocrebanine was the anti-breast cancer active aporphine alkaloid in S. hainanensis. Oxocrebanine was a Topo I/IIα dual inhibitor, catalytic inhibitor and DNA intercalator. Oxocrebanine caused DNA damage, autophagy, and mitotic arrest in MCF-7 cells. Oxocrebanine also disrupted tubulin polymerization. Accordingly, oxocrebanine held a great potential for development as a novel dual Topo inhibitor for effective breast cancer treatment.

Configuration of short- and long-threaded cannulated screws in proximal femoral plating decreases varus collapse of femoral neck fractures: A retrospective cohort study.

OBJECTIVES: Proximal femoral plating serves as a good alternative for the fixation of femoral neck fractures, but fixation loss still occurs. This study aimed to evaluate the effect of a hybrid configuration of short- and long-threaded cannulated screws in proximal femoral plating in terms of decreasing varus collapse of femoral neck fractures. MATERIALS AND METHODS: We retrospectively analyzed 86 patients with femoral neck fractures who were fixed by proximal femoral plating from January 2015 to June 2019. These patients were divided into two groups according to screw configuration: short- and long-threaded cannulated screws (SLTS, n = 38) and short-threaded cannulated screws (STS, n = 48). Radiological and clinical outcomes including screw withdraw, nonunion, avascular necrosis, caput-collum-diaphysis (CCD) angle, amount of femoral neck shortening (FNS), and Harris Hip Score (HHS) were compared between the groups. RESULTS: Preoperative characteristics including age, gender, Garden type, duration of surgery, and reduction quality were not significantly different between the two groups (p > 0.05). Less decreased CCD angle was observed in the SLTS group (-0.4° (-1.4 - 1.8)) compared with that in the STS group (7.9° (6.3 - 11.0)) (p < 0.001). The SLTS group also presented with fewer amount of FNS (3.2 (2.7 - 3.8) mm vs. 5.1 (4.2 - 5.9) mm, p < 0.001). Bone union was achieved in all patients and no avascular necrosis was observed during the follow-up. The HHS was higher in the SLTS group (86.4 ± 5.1) than that in the STS group (81.5 ± 4.5) (p < 0.001). CONCLUSION: The hybrid configuration of short- and long-threaded screws in proximal femoral plating offers better resistance against varus collapse and yields better functional outcomes in femoral neck fractures.

TMF, a natural dihydroflavonoid isolated from Scutellaria javanica Jungh, stimulates anticancer activity of s180 cancer-bearing mice, induces apoptosis, inhibits invasion and migration on HepG-2 cells.

ETHNOPHARMACOLOGICAL RELEVANCE: 5-hydroxy-7,8,2',6'-tetramethoxy flavanone (TMF) is a dihydroflavonoid extracted from Scutellaria javanica Jungh. It is a species of genus Scutellaria, and a representative southern herb and Li nationality medicine. The plant has been used as an ethnic medicine in treating cancer and the main components are dihydroflavonoids. However, the underlying mechanisms are yet to be elucidated. AIM OF THE STUDY: The present study aimed at investigating the efficacy of TMF in cancer and the underlying mechanisms. MATERIALS AND METHODS: The s180 cancer-bearing mice experiment in vivo was designed to study the tumor growth inhibition of TMF. Also, we investigated the latent mechanism of TMF induced apoptosis and the inhibitory action of TMF on the metastasis and proliferation in HepG-2 cells. The in vitro experimental groups were treated with TMF or hydroxycamptothecine (HCPT) for 24 h. Apoptosis was detected by flow cytometry. Caspase-3 activity was detected by ELISA. The expressions of PCNA, Bcl-2, Bax, p53, E-Cadherin, MMP-9, MMP-2, STAT3, p-STAT3, JAK2, p-JAK2, AKT, p-AKT, ERK1/2 and p-ERK1/2 were examined by Western blot. RESULTS: After oral administration of TMF in s180 cancer-bearing mice, tumor growth in vivo was suppressed significantly. The MTT assay result and the reduction of PCAN proved that TMF could inhibit HepG-2 cells proliferation. TMF also caused dose-dependent apoptosis on HepG-2 cells. The experimental results showed that the expression of Bcl-2 was reduced, and the expressions of caspase-3, Bax and p53 were increased. Therefore, we speculated that TMF-induced apoptosis might be achieved by regulating the p53-Bcl-2/Bax-caspase-3 pathways. Transwell cell migration and invasion assay showed that treatment with TMF inhibited the invasion and migration in HepG-2 cells. The expressions of MMP-9 and MMP-2 were decreased while that of E-cadherin was enhanced significantly by TMF. Additionally, the expressions of p-JAK2, p-STAT3, p-AKT and p-ERK1/2 were decreased, but those of JAK2, STAT3, AKT and ERK1/2 remained unchanged. Thus, it is indicated that TMF induced apoptosis and inhibited proliferation and metastasis on HepG-2 cells via JAK2/STAT3, MAPK/ERK and PI3K/AKT pathways. CONCLUSION: The present results demonstrated that TMF could stimulate anticancer activity of s180 cancer-bearing mice, induce apoptosis, and inhibit invasion and migration on HepG-2 cells. Our findings displayed a systematic insight into the mechanisms underlying anticancer action of TMF, and provided a better understanding of its use for cancer.

Magnolol induces human Ewing sarcoma SK-ES-1 cell apoptosis via the mitochondrial and death receptor pathways.

New treatments for Ewing's sarcoma (ES) are urgently needed. Magnolol, an active ingredient in Magnolia officinalis, shows anti-oxidative, anti-microbial, and anti-tumor effects, but its effect on ES is unknown. We examined the effect of magnolol on ES cell proliferation and apoptosis in vitro as well as the mechanism of its anticancer effect. The results demonstrated that magnolol inhibited the proliferation of ES and induced ES cell apoptosis through the mitochondrial and death receptor pathways. Magnolol reduced MEK1/2, ERK1/2, and STAT3 phosphorylation in ES cells, suggesting that the MAPK/ERK and JAK/STAT3 signal transduction pathways are involved in the inhibition of ES cell growth by magnolol. In short, magnolol is a potential anti-ES drug.

Dynamic limited axial compression yields favorable functional outcomes in the fixation of Pauwels type-3 femoral neck fractures: A retrospective cohort study.

PURPOSE: Pauwels type-3 femoral neck fractures are challenging injuries to manage with high rates of complications after internal fixation and no consensus has been reached regarding the optimal fixation construct. The current study aims to evaluate the effect of dynamic limited axial compression in parallel screws combined with medial buttress plate (SMBP) or lateral compression plate (LCP) fixation of Pauwels type-3 femoral neck fractures. METHODS: We performed a retrospective analysis of 51 cases of Pauwels type-3 femoral neck fractures who were fixed by SMBP or LCP. Specifically, the screw fixing the femoral head in the buttress plate was omitted. Postoperative complications and functional outcomes were mainly studied. RESULTS: With a mean follow-up of 19.9 months, the rate of neck shortening was higher in the LCP group than that in SMBP group (32.1% vs. 8.7%, p = 0.04). Neither nonunion nor avascular necrosis was observed in both groups. Good-to-excellent Harris hip score accounts for 95.2% in SMBP group and 89.3% in LCP group (p = 0.40). Moreover, older age, fracture comminution and compression plate fixation predispose to neck shortening. CONCLUSION: Dynamic limited axial compression by SMBP or LCP fixation was effective to improve the functional outcome of patients with Pauwels type-3 femoral neck fractures.

Good outcomes at mid-term following the reconstruction of chronic Achilles tendon rupture with semitendinosus allograft.

PURPOSE: Chronic Achilles tendon rupture is commonly treated surgically, yet there are limited available data on tendon allografts for Achilles tendon reconstruction. The purpose of this study was to evaluate the patient-reported outcomes of chronic Achilles tendon rupture reconstructed with semitendinosus allograft. METHODS: A total of 34 patients (30 males and 4 females, average age 36.1 ± 6.8 years ranging from 25 to 50 years) who underwent Achilles tendon reconstruction with semitendinosus allograft from 2011 to 2015 were identified for this retrospective study. The American Orthopedic Foot and Ankle Society (AOFAS) score, Victorian Institute of Sports Assessment-Achilles (VISA-A) score, Achilles tendon total rupture score (ATRS), and Tegner score were evaluated preoperatively and at final follow-up. RESULTS: A total of 33 patients (97.1%) were followed up for a median time of 53 (range 24-80) months. The median AOFAS score increased from 50 (5-75) to 100 (86-100), the median VISA-A score increased from 23 (5-59) to 94 (52-100), the median ATRS score increased from 22.5 (6-67) to 99 (84-100), and the median Tegner score increased from 1 (0-3) to 4 (3-9). CONCLUSIONS: Reconstruction of chronic-ruptured Achilles tendon with semitendinosus allograft offers satisfactory patient-reported results with low risk of re-rupture and complications. This technique could be considered an effective alternative for chronic ruptures of the Achilles tendon. LEVEL OF EVIDENCE: Case series, Level IV.

Six new C-21 steroidal glycosides from Dregea sinensis Hemsl.

Six new C-21 steroidal glycosides (1-6) were separated from the root of Dregea sinensis Hemsl. and their structures were elucidated using extensive nuclear magnetic resonance, mass spectrometry, and infrared spectral analyses. Isolated compounds were evaluated for antitumor activity, which showed that compound 3 had moderate activity in Jurkat cells (IC50 19.54 ± 0.91 µM), and compounds 1-4 had significant effects against IL-2R and TNFR2 (IC50 1.518 ± 0.06 µM to 5.9 ± 0.07 µM).

[Surgical treatment for posterior Pilon fracture through posterolateral approach].

OBJECTIVE: To explore clinical results of open reduction and internal fixation (ORIF) for posterior Pilon fracture through posterolateral approach. METHODS: Seventeen patients with posterior Pilon fracture were treated through posterolateral approach from February 2010 to April 2013. Among them,including 11 males and 6 females aged from 29 to 59 with an average of 43.4 years old. All fractures were associated with more than 20% of articular surface of distal tibial. The causes of injury included falling down (11 cases), traffic accident (4 cases) and sports injury(6 cases). Fracture classification was based on posterior pilon fracture by YU Guang-rong, including type I (6 cases), type II (2 cases) and type III (6 cases). Fracture healing time, fracture reduction and postoperative complications were observed, AOFAS score were applied to evaluate clinical efficacy. RESULTS: All patients were followed up from 13 to 24 months with an average of 20.5 months. All incisions were healed at stage I, and fractures obtained healing,the time of fracture healing ranged from 12 to 21 weeks with an average of 15.2 weeks. No incision infection, neurovascular injury, bone ununion and fracture deformity were found after operation. Postoperative AOFAS score was 92.0 ± 10.2, and 14 cases got excellent results, 2 good and 1 moderate. CONCLUSION: Posterior pilon fracture through posterolateral approach could obtain effective reduction, stable fixation. It is a safe, simple and effective operation for treating posterior Pilon fracture, and it is worth popularizing.

[AO elastic intramedullary nailing for the treatment of clavicle fractures].

OBJECTIVE: To evaluate the outcome of Titanium elastic intramedullary nailing (TEN) for the treatment of displaced midclavicular fractures. METHODS: Between February 2010 and February 2013, 62 patients with displaced midclavicular fractures were treated by TEN, including 27 males and 35 females with an average age of 37.6 years old ranging from 15 to 67 years. The course of disease was from 1 to 9 days (means 2.7 days). Thirty-nine cases were treated by closed reduction and 23 cases by assistant small incision. Based on OTA (the Orthopaedic Trauma Association classification) classification, 31 cases of simple fractures involved 5 cases of 06-A1,15 cases of 06-A2,11 cases of 06-A3; 31 cases of wedge fractures involved 4 cases of 06-B1,12 cases of 06-B2,15 cases of 06-B3. Postoperative pain relief were evaluated by VAS score,and operation time,fracture healing time were recorded. After 6 weeks and after removing internal fixation shoulder joint function was evaluated by Constant score, and shoulder joint function were assessed by Herscovici score after 6 weeks. RESULTS: Except 2 cases were lost to follow-up, 2 cases did not remove internal fixation, 3 cases' fractures were nonunion, the remaining 55 patients received follow-up for an average time of 11.4 months. The average preoperative VAS score was 5.20±0.71, and it turned to be 1.550.59 at 3 days after operation. The average operative duration was 40 min (15 to 65 min). The average bone healing time was (2.71±0.54) months (2 to 5 months). No difference about bone healing time was found between simple fractures and wedge fractures,and between the patients treated by closed reduction and assistant small incision. According to Herscovici standard, the shoulder function was excellent in 49 cases, good in 4, fair in 1, and poor in 1. Simple fractures achieved better Constant score than wedge fractures at 6 weeks postoperatively, whereas no difference was found at 4 weeks after fixation removal. CONCLUSION: Titanium elastic nails (TEN) for treatment of displaced midclavicular fractures has advantages of good clinical effect,rapid pain relief,fast recovery of shoulder joint function. For OTA classification type B patients with comminuted fracture can replace steel to achieve very good effect, but to grasp the appropriate.

C-21 steroidal glycosides from Dregea sinensis.

Two new C-21 steroidal glycosides, dregeosides D (1) and E (2), were isolated from the roots of Dregea sinensis. The structures of the isolated compounds were elucidated on the basis of 1D and 2D NMR spectra and HR-ESI-MS analysis. Finally, the inhibited effects of the isolated compounds on interleukin 2 receptor were evaluated by enzyme-linked immunosorbent assay.