Lever sign test for anterior cruciate ligament injuries: a diagnostic meta-analysis.

BACKGROUND: Sports-related ACL (anterior cruciate ligament) injuries are frequent. Successful management requires early diagnosis and treatment. One of the clinical tests used to identify ACL damage is the lever sign test. This meta-analysis aimed to assess the lever sign test's diagnostic efficacy for ACL injuries. METHODS: An extensive investigation of the Cochrane Library, Embase, and PubMed databases was conducted until April 2023. Studies assessing the lever sign test's diagnostic efficacy for ACL injuries were also included. A bivariate random-effects model was employed to acquire the pooled estimates of diagnostic odds ratios, specificity, positive and negative likelihood ratios, sensitivity, and curves of the summary receiver operating characteristic (SROC). RESULTS: The meta-analysis comprised twelve investigations with a total of 1365 individuals. The lever sign test's combined sensitivity and specificity for the purpose of diagnosing injuries to the ACL were 0.810 (95% confidence interval [CI] 0.686-0.893) and 0.784 (95% CI 0.583-0.904), respectively. The positive and negative likelihood ratios were 3.148 (95% CI 1.784-5.553) and 0.210 (95% CI 0.084-0.528), respectively. The study revealed a diagnostic odds ratio of 17.656, with a 95% CI ranging from 4.800 to 64.951. The SROC curve's area was determined to be 0.912 (95% CI 0.857-0.967). CONCLUSION: With high specificity and sensitivity, the lever sign test is a reliable diagnostic modality for ACL injuries. However, the test should be used in combination with other diagnostic tests to increase the accuracy of the diagnosis. Further investigations are warranted to assess the clinical practicability of the lever sign test in various populations and settings.

Biomechanical Stability of Femoral Neck System for Pauwels Type III Femoral Neck Fractures Based on Different Reduction Quality.

To further investigate the biomechanics of a femoral neck system (FNS) for Pauwels type III femoral fractures based on three different reductions.We constructed three different reduction (anatomical reduction, negative buttress reduction, and positive buttress reduction) models of Pauwels type III femoral neck fractures. Then, three cannulated screws (3CS), dynamic hip screws (DHS), dynamic hip screws combined with an anti-rotation screw (DHS + ARS), one-hole femoral neck system (1HFNS), and two-hole femoral neck system (2HFNS) were assembled with the reduction models, respectively, to simulate the internal fixation surgical procedure. All models had a load of 2100 N in line with the femoral mechanical axis applied. The implant stress, the head and implant displacements, and the rotational angles of all models were recorded and analyzed.Compared to 3CS and 2HFNS, 1HFNS had higher implant stress (higher than 92.5 MPa and 46.3 MPa, respectively) and displacement (higher than 0.9 mm and 0.8 mm, respectively) in the anatomical reduction. 2HFNS exhibited the highest stress values (225.5 MPa) in the anatomical reduction but the lowest values (159.8 MPa) in the positive buttress reduction when compared to the other implants. 2HFNS showed the best rotational stability in the negative and positive buttress reduction (rotational angels of 0.8° and 0.6°, respectively).Based on the outcome of this computational study, it might be concluded that 2HFNS was an alternative fixation for the treatment of Pauwels type III femoral neck fracture, especially when anatomical reduction cannot be perfectly attained. More relevant clinical and biomechanical studies are needed in the future.

Sisal-Fiber-Reinforced Polypropylene Flame-Retardant Composites: Preparation and Properties.

Natural-fiber-reinforced polypropylene (PP) composites with a series of advantages including light weight, chemical durability, renewable resources, low in cost, etc., are being widely used in many fields such as the automotive industry, packaging, and construction. However, the flammability of plant fiber and the PP matrix restricts the application range, security, and use of these composites. Therefore, it is of great significance to study the flame retardants of such composites. In this paper, sisal-fiber-reinforced polypropylene (PP/SF) flame-retardant composites were prepared using the two-step melt blending method. The flame retardant used was an intumescent flame retardant (IFR) composed of silane-coated ammonium polyphosphate (Si-APP) and pentaerythritol (PER). The influence of different blending processes on the flammability and mechanical properties of the composites was analyzed. The findings suggested that PP/SF flame-retardant composites prepared via different blending processes showed different flame-retardant properties. The (PP/SF)/IFR composite prepared by PP/SF secondary blending with IFR showed excellent flame-retardant performance, with a limited oxygen index of about 28.3% and passing the UL-94 V-0 rating (3.2 mm) in the vertical combustion test. Compared with the (PP/IFR) /SF composite prepared by a matrix primarily blended with IFR and then secondly blended with SF, the peak heat release rate (pk HRR) and total heat release (THR) of the (PP/SF)/IFR composite decreased by 11.3% and 13.7%, respectively. In contrast, the tensile strength of the (PP/SF)/IFR system was 5.3% lower than that of the (PP/IFR)/SF system; however, the overall mechanical (tensile, flexural, and notched impact) properties of the composites prepared using three different mixing processes were similar.

Dual plate has better biomechanical stability than hook plate or superior single plate for the fixation of unstable distal clavicle fractures: a finite element analysis.

INTRODUCTION: A variety of surgical techniques have been addressed for distal clavicle fractures, while none of these is considered to be gold standard fixation. Currently, dual plate fixation has been proposed and achieved satisfying clinical results. However, the biomechanical study about dual plate technique in treating unstable distal clavicle fractures is limited. Thus, the purpose of this study was to investigate the biomechanical properties of this technique by finite element analysis. MATERIALS AND METHODS: A geometry model of distal clavicle fractures was combined with hook plate, superior single plate and dual plate, respectively, to simulate the implant fixation process. Two loading conditions and two boundary conditions were applied in the finite element models following a mesh convergence test. The stress distribution was observed, and peak von Mises stress and maximum displacement were used as indexes for analysis. RESULTS: The dual plate model showed the highest clavicle stress (13.1 MPa), but lowest fixation stress (18.9 MPa) compared to the hook plate and superior single model. In regarded to stability, dual plate model exhibited a minimum displacement with only 0.099 mm. CONCLUSIONS: Dual plate fixation has better biomechanical stability with lower risk of implant failure. Thus, dual plate fixation is an alternative technique for unstable distal clavicle fracture. The complication of peri-implant fracture of dual plate technique should also be cautious in clinical practice, and more clinical evidence is needed.

Role of diet in osteoporosis incidence: Umbrella review of meta-analyses of prospective observational studies.

An umbrella review and meta-analysis were conducted to summarize evidence for the association between dietary factors and the incidence of osteoporosis in adults. Only systematic reviews or meta-analyses were eligible for this study. Two researchers independently performed reading, data extraction, and quality evaluation of the included literature. The outcomes included in this study were all associated with osteoporosis, including osteoporotic fractures and low bone density. A total of 54 studies were included in this study, with 83 adjusted hazard ratios on diet, dairy group (n = 13), alcohol (n = 2), tea (n = 6), coffee (n = 3), micronutrient (n = 31), dietary pattern (n = 21), and foods (n = 7) regarding the incidence of osteoporosis. Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) quality assessment method was used in this study. The high, medium, low and very low quality studies accounted for 27.7, 41, 21.7 and 9.6% of this study, respectively. Based on the included literature studies in this umbrella review, it was found that dietary factors have a relevant impact on the incidences of human osteoporosis, appropriate consumption of dairy products, vegetables, fruits, and micronutrients, as well as reduced intake of alcohol and coffee, can reduce the risk of osteoporosis.

Repair of Bilateral Quadriceps Tendon Rupture Using a Modified Knotless Suture Anchor and Internal Brace Technique: Surgical Technique and Case Report.

BACKGROUND: Quadriceps tendon rupture (QTR) is a rare clinical condition often caused by indirect injury in healthy people. In addition, spontaneous and bilateral ruptures can occur in patients with predisposing factors, such as endocrine or rheumatic disease. Currently, several QTR repair techniques have been proposed; however, no consensus exists about the best repair technique. CASE PRESENTATIONS: A 55-year-old man with renal failure secondary to glomerulonephritis suffered from spontaneous bilateral quadriceps tendon ruptures. Based on a knotless suture anchor and internal brace, a novel double-row suture-bridge configuration surgical approach was used to treat the patient. At 11-month follow-up, the patient maintained excellent function, with a Lysholm score of 91 for both knees. CONCLUSIONS: This technique may be an effective method for repairing ruptured quadriceps tendons.

Ranking the efficacy of anticoagulants for the prevention of venous thromboembolism after total hip or knee arthroplasty: A systematic review and a network meta-analysis.

BACKGROUND: Anticoagulants are essential in the prevention of venous thromboembolism. However, the effectiveness and safety of different anticoagulants have always been controversial. Therefore, we aimed to expand the sample of anticoagulant results and rank the efficacy and safety of 19 anticoagulants in the prevention of venous thromboembolism when total knee or total hip arthroplasty procedure is performed. METHODS: A systematic review and network meta-analysis of randomized trials of adult patients undergoing total hip or knee arthroplasty were conducted. The trials were identified from PubMed, Web of Science, Cochrane Library, and Embase databases, in which anticoagulants were used as interventions randomized controlled trial. The incidence of venous embolism and bleeding are the key outcomes of assessing the efficacy of intervention drugs. We used the Physical Therapy Evidence Database (PEDro) to assess risk bias and used pairwise comparison and network meta-analysis with random effects to estimate the summary relative risk. The study has been registered with PROSPERO, number CRD42020200747. RESULTS: From the 4083 identified manuscripts, 45,067 participants from 53 randomized trials were included in the analysis and randomly assigned to 19 anticoagulants. With Enoxaparin as a control, Rivaroxaban (risk difference 0.07, 95 % credible interval 0.06 to 0.08), Edoxaban (RD 0.09, 95 % CrI 0.08 to 0.11), and Apixaban (RD 0.05, 95 % CrI 0.04 to 0.06) had the best effect in preventing VTE. However, in terms of comprehensive bleeding rate, Apixaban, Edoxaban, and Darexaban were the most effective and stable. Although effective in preventing VTE, bleeding remains relatively high in Rivaroxaban. Enoxaparin is low-molecular-weight heparin that is widely used in clinics, and although its overall efficacy is not the best, its efficacy and safety are very stable. CONCLUSION: According to the available data, Apixaban, Edoxaban, and Darexaban are better than any anticoagulants in the prevention of VTE and bleeding during total knee or total hip arthroplasty. In our study, Fondaparinux, Eribaxaban, Dalteparin, Betrixaban, Bemiparin, Reviparin, Acenocoumarol, and Tinzaparin were scarce in the included studies, therefore, more evidence is needed to prove their efficacy and safety.

The effectiveness of lateral ankle ligament reconstruction when treating chronic ankle instability: A systematic review and meta-analysis.

Chronic ankle instability predominantly occurs due to multiple exercise-related diseases. Conservative treatment methods regarding this condition have not effectively improved in recent years, which is why more focus has been put on exploring different novel reconstruction procedures of the lateral ankle ligament for the treatment of chronic ankle instability. OBJECTIVES: This study aims to obtain the overall effectiveness of various lateral ankle ligament reconstruction methods for chronic ankle ligament instability. METHODS: We gathered data from PubMed and EMBASE databases using the keywords: ankle, malleolar, and reconstruction. Newcastle - Ottawa quality assessment was carried out for the obtained studies; effect volume combination and image drawing were performed by Stata14, and Excel was used for data statistics. RESULTS: A total of 12 articles were included in the quantitative analysis by performing full-text reading and data inclusion. Among them, 476 patients (485 ankle joints) were treated. The results showed that the overall valid efficiency of "excellent" was 59% and "good" lateral ligament reconstruction was 26%, I2=87.3%, P = 0.000; the subgroup analysis anatomic reconstruction group I2=0.0%, P = 0.993; the autograft group I2=0.0%, P = 1.000; allograft group I2=0.0%, P = 0.993. CONCLUSION: Reconstruction of the lateral ankle ligament is a relatively stable treatment for chronic ankle instability.

Surgical hand rubbing versus surgical hand scrubbing: Systematic review and meta-analysis of efficacy.

BACKGROUND: Surgical hand rubbing (SHR) and surgical hand scrubbing (SHS) are two common methods used by surgeons to reduce surgical site infections. To date, the optimal method that can effectively reduce these infections remains unknown. In this study, we performed a comprehensive statistical analysis to compare the efficacy of these two methods in effectively controlling surgical site infections. METHODS: A systemic review and meta-analysis was performed by mining literature from major databases, including Pubmed, Embase, Cochrane library, Ovid and Google Scholar, and recruiting studies published between 1980 and 1st April 2019. Analysis was performed using Revman, version 5.3, software, and focused on primary outcomes that included colony-forming unit (CFU) counts and logarithmic reduction of CFU after hand antisepsis and after surgery. RESULTS: Seven clinical trials met our inclusion criteria, with a total of 764 healthcare workers analyzed. We found no statistically significant differences between the two methods with regards to CFU counts and logarithmic reduction of CFU after hand antisepsis and surgery, as well as antisepsis and surgery times. CONCLUSION: From the literature, it was evident that SHR had similar efficacy to SHS, without necessarily increasing costs. Owing to advantages such as ease of application, exposure to less dermal irritation, and less time consumption, SHR is recommended as a cost-effective alternative for management of surgical site infections.

O-arm navigation versus C-arm guidance for pedicle screw placement in spine surgery: a systematic review and meta-analysis.

BACKGROUND: O-arm and C-arm are commonly used in spine surgery to guide pedicle screw placement. However, concerning the accuracy and efficiency of them, no systematical review and meta-analyses are available to help surgeons make comparisons. PURPOSES: This study aims to investigate the accuracy and efficiency of O-arm-navigated versus C-arm-guided pedicle screw placement in thoracic and lumbar spine surgery. It would help surgeons choose the optimal technique for pedicle screw placement. PATIENTS AND METHODS: A systematic review and meta-analyses were performed after searching the PubMed, Embase, and Cochrane databases to identify all studies that assessed the accuracy and efficiency of navigation coupled with O-arm and conventional C-arm fluoroscopy. RESULTS: Eight studies were finally recruited in this systematic review, all of which reported pedicle screw placement outcomes related to accuracy or efficiency in both C-arm and O-arm groups. Five studies showed higher screw insertion accuracy in the O-arm group, while one study showed no significant difference. And the pooled results also indicated that the incidence of screw misplacement in the C-arm groups is higher. Moreover, the pooled results from five studies indicated no significant difference in insertion time between C-arm and O-arm. CONCLUSIONS: Navigation coupled with O-arm imaging displayed a lower efficiency outcome in pedicle screw placement compared to conventional C-arm fluoroscopy. However, in terms of accuracy, O-arm navigation had significant advantages in accuracy over conventional C-arm fluoroscopy.

Correction: Se2Mo10V3, a heteropoly compound containing selenium, inhibits tumor growth.

[This corrects the article DOI: 10.18632/oncotarget.18909.].

Se2Mo10V3, a heteropoly compound containing selenium, inhibits tumor growth.

Selenium compounds have strong anti-tumor effects and are well-tolerated. We examined the anti-tumor effects of (NH4)2H15Se2VIMo10V3O52·2H2O (Se2Mo10V3), a heteropoly compound containing selenium. Se2Mo10V3 inhibited proliferation in K562 cells with a half-maximal inhibitory concentration of 78.72±2.82 mg/L after 48 h and 24.94±0.88 mg/L after 72 h. Typical apoptotic morphologies were also observed in K562 cells treated with Se2Mo10V3, as were increased intracellular levels of Ca2+, Mg2+, H+, and reactive oxygen species, and decreased mitochondrial membrane potential. In addition, Se2Mo10V3 treatment triggered cytochrome C release and inhibited IκBα degradation and NF-κB translocation. In vivo experiments revealed that 5 or 10 mg/kg Se2Mo10V3 inhibited the growth of sarcoma 180 and hepatoma 22 xenograft tumors. These results indicate that Se2Mo10V3 inhibits tumor growth both in vitro and in vivo and induces apoptosis in K562 cells, possibly by inhibiting the NF-κB/IκBα pathway.

iTRAQ-based differential proteomic analysis in Mongolian gerbil brains chronically infected with Toxoplasma gondii.

The aim of our study was to detect differentially regulated proteins and specific signaling pathways in Mongolian gerbil brains during chronic Toxoplasma gondii (T.gondii) PRU strain infection. We use a iTRAQ-based strategy to detecte 4935 proteins, out of which 110 proteins were differentially expressed (>/=2.0-fold, p value <0.05) when the brain of gerbils infected with T.gondii was compared to control brain tissues. We confirmed the authenticity and the accuracy of iTRAQ results through quantitative real-time PCR and western blot (WB), which was consistent with mass spectrometry analysis. Pathway analysis and GO (Gene Ontology) annotations indicated the deregulation of several pathways related to immune response, metabolism and neurological processes, like neuronal growth and neurotransmitter transport. Through the iTRAQ-based strategy, we obtained a comparative proteome profile of brain tissues from Mongolian gerbils with chronic infection of T.gondii. Several differentially expressed proteins involved in neurological pathways, like Parvalbumin, Drebrin or Synaptotagmin, can be further investigated to enhance our understanding of central nervous system (CNS) injury caused by T.gondii. BIOLOGICAL SIGNIFICANCE: T.gondii can infect almost all nucleated cells with a preference for the CNS, which can induce Toxoplasma encephalitis (TE). However, the pathogenesis and mechanisms between the parasite and host associated with TE are largely unexplored. Around 30% of the world population is considered to have latent infection with T.gondii and >90% patients died of TE, while the proportion of secondary paralysis is also high. Patients of TE may have highly varied neurological symptoms with both focal and diffuse neurological lesions, while mental symptoms and behavior disorders are frequently accompanied, like the Alzheimer's disease (AD). We present a comparative proteomics analysis to explore the differences of protein expression caused by chronic T.gondii infection. The results of this analysis can be helpful for identifying key proteins involved in the pathogenesis of TE. In addition, the study can contribute to a better understanding of molecular mechanisms underlying the host-parasite relationship in chronic infection of T.gondii and facilitate further development of new therapies for TE.

Recombinant canine adenovirus type-2 expressing TgROP16 provides partial protection against acute Toxoplasma gondii infection in mice.

We previously demonstrated that the survival time of BALB/c mice challenged with Toxoplasma gondii RH strain was prolonged by immunising the mice with a eukaryotic vector expressing the protein ROP16 of T. gondii. Building upon previous findings, we are exploring improved vaccination strategies to enhance protection. In this work, a novel recombinant canine adenovirus type 2 expressing ROP16 (CAV-2-ROP16) of T. gondii was constructed and identified to express ROP16 in Madin-Darby canine kidney cells (MDCK) cells by western blot (WB) and indirect immunofluorescence (IFA) assays. Intramuscular immunisation of BALB/c mice with CAV-2-ROP16 was performed to evaluate the humoral and cellular immune responses. This vaccination triggered significant humoral and cellular responses, including ROP16-stimulated lymphoproliferation (P<0.05). Compared to control groups, the CAV-2-ROP16 immunised mice had high production of IFN-γ, IL-2 and IL-12 (P<0.05), with a predominance of IgG2a production, but not IL-10 (P>0.05), revealing that a predominant Th1-type response had developed. The cell-mediated cytotoxic activity with high levels of IFN-γ and TNF-α was significantly increased in both CD4+ and CD8+ T-cell compartments in the mice immunised with CAV-2-ROP16 (P<0.05), compared to three control groups. In addition, when immunised mice were challenged with the RH strain of T. gondii, they showed a significantly increased survival rate (25%) 80days post infection compared with control mice that all died within seven days (P<0.05). The 25% protection rate elicited by the recombinant virus CAV-2-ROP16 has not been achieved in the field of anti-T. gondii vaccination until now. Our work presents the successful use of recombinant virus CAV-2-ROP16 in vaccination protocols to protect against intraperitoneal challenge with the virulent RH strain of T. gondii. This system was shown to be extremely efficient in eliciting humoral and cellular immune responses that led to a significant improvement in survival time in mice.