Lateral retraction could achieve better early postoperative knee function than patellar eversion in total knee arthroplasty: a systematic review and meta-analysis.

OBJECTIVE: Comparisons between patellar eversion (PE) and lateral retraction (LR) in total knee arthroplasty (TKA) are still inconclusive. To determine the most suitable procedure, we aimed to evaluate the safety and efficacy of PE and LR in TKA in this meta-analysis. MATERIALS AND METHODS: This meta-analysis complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Web-based literature databases, including WANFANG, VIP, CNKI, the Cochrane Library, Embase, and PubMed, were utilized to conduct a comprehensive literature search for studies published until June 2022 that compared PE with LR in primary TKA. The quality of the selected randomized controlled trials (RCTs) was evaluated using guidelines of the Cochrane Reviews Handbook 5.0.2. RESULTS: A total of 10 RCTs, including 782 patients and 823 TKAs, were selected in this meta-analysis. Our results showed that using LR improved postoperative knee extensor function and range of motion (ROM). In addition, PE and LR resulted in similar clinical benefits in terms of Knee Society Function score, pain, length of hospital stay, Insall-Salvati ratio, the occurrence of patella baja, and complications related to the operation. CONCLUSIONS: Existing evidence suggested that using LR in TKA improved early postoperative knee function. Similar clinical and radiographic outcomes were obtained 1 year after the procedures were performed. Based on these findings, we recommended the use of LR in TKA. However, studies with large sample sizes are needed to validate these findings.

[A comparative study on the difference of gut microbiota and its biomarkers between patients with pulmonary tuberculosis and healthy controls].

Objective: To analyze the differences in the composition and abundance of gut microbiota between patients with active pulmonary tuberculosis and healthy controls, and to identify the specific bacteria as biomarkers to distinguish between the two groups. Methods: Patients with active pulmonary tuberculosis treated in three municipal designated tuberculosis medical institutions in Sichuan, Jiangsu and Shanghai from September 2017 to September 2019 were selected as the case group (n=88), and the healthy people without a history of tuberculosis from the same regions were recruited as the control group (n=62). The fecal samples of the two groups were detected by 16S rRNA gene sequencing, and the differences of gut microbiota diversity, community composition and relative abundance at phylum and genus level from the two groups were analyzed. The random forest method was used to construct a predictive model to assess whether the specific bacterial flora could be used as biomarkers to distinguish tuberculosis patients from healthy people. Results: The alpha diversity analysis showed that the species richness and evenness of gut microbiota in tuberculosis patients were significantly lower than those in healthy controls (P<0.001). There was a statistically significant difference in the composition of microbiota between the two groups (Bray-Curtis distance, P<0.001). In the gut microbiota of tuberculosis patients, opportunistic pathogens were relatively enriched, while some of the beneficial bacteria that can produce short-chain fatty acids were less abundant. The discrimination accuracy of the random forest model composed of Lachnospira, Lachnospiraceae ND3007 group and Roseburia was 76.67%, with area under the curve (AUC) being 75.29% (95%CI: 0.661-0.845). Conclusion: There were differences in gut microbiota between patients with active pulmonary tuberculosis and healthy people, and specific bacterial flora showed the potential to be used as biomarkers to distinguish between the two groups.

Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical study on anastomotic leakage.

BACKGROUND: Esophagectomy through cervico-thoraco-abdominal approach is a useful surgical technique in treating patients with esophageal cancer. However, the cervical reconstruction is also known to have a high rate of anastomotic leakage, as well as anastomotic stricture, intrathoracic stomach syndrome, reflux esophagitis and other complications, thereby influencing postoperative recovery and quality of life. AIMS: The objective of this study was to investigate whether tubular stomach is superior to whole stomach in reducing anastomotic leakage for esophageal reconstruction through the cervico-thoraco-abdominal (3-field) approach. METHODS: A total of 850 patients undergoing the 3-field esophagectomy were retrospectively included in this study and divided into a tubular stomach reconstruction group (Group A, n=453) and a whole stomach reconstruction group (Group B, n=397). All patients underwent esophagectomy through right thorax, left cervical part, abdominal triple incisions and done in esophageal reconstruction by hand-sewn two-layer anastomosis. RESULTS: Results revealed that in comparison with whole stomach, esophageal reconstruction with tubular stomach had a lower incidence of anastomotic leakage (5.5 vs. 9.3%, P<0.05), less manifestation of intrathoracic syndrome (3.3 vs. 9.8%, P<0.001) and less occurence of reflux esophagitis (5.1 vs. 11.1%, P<0.01). However, for the incidence of anastomotic stricture, there was no significant difference between the two groups (9.3 vs. 9.8%). CONCLUSIONS: This observation study suggests that for esophageal cancer patients undergoing the 3-field esophagectomy tubular stomach is better than whole stomach for esophageal reconstruction as reflected by a reduced postoperative anastomotic leakage, intrathoracic syndrome and reflux esophagitis.

[Detection of HPV DNA and its relationship with peripheral T cell subsets in patients with condyloma acuminata].

OBJECTIVE: To study the relationship between presence of HPV DNA related sequence and cellular-immune responses in patients with condyloma acuminata (CA). METHODS: HPV DNA related sequences in biopsy material of 30 CA patients were determined by using Southern blot hybridization, and typed according to the restricted fragment length polymorphism (RFLP) analysis. At the same time, the T-cell subpopulations in peripheral blood of 30 patient with CA were also measured by using anti-CD3, CD4, CD8 monoclonal antibody labeled SERC direct rosette assay. RESULTS: HPV DNA positive results were revealed in 19 of 30 patients with CA(63.3%). Among them, 3 cases possessed HPV 6 DNA homologous sequence (15.8%), 15 had HPV 11 DNA homologous sequence(78.9%), and only one case had a sequence homologous to HPV 16 DNA(5.2%). The percentages of CD3 and CD4 cells were significantly lower (P< 0.01) in CA patients than those in controls. However the percentage of CD8 cell was strikingly higher (P< 0.001) in CA patients than that in controls. Consequently the CD4/CD8 ratio was noticeably lower (P<0.001) in patients with CA than that in controls. The decrease of CD3 cell and the lowering of C D4/CD8 ratio were closely related to the positivity of HPV DNA homologous sequence (P =0.008 02, P=0.004 17). Conclusion The presence of HPV DNA in the patients with CA results in inhibitory effects on a series of cellular-immune responses, which may play an important role in the pathogenesis of CA.

Protection against mammary tumor growth by vaccination with full-length, modified human ErbB-2 DNA.

ErbB-2 is overexpressed in several human cancers and conveys a transforming activity that is dependent on tyrosine kinase activity. Antibodies and T cells to ErbB-2 have been isolated from cancer patients, indicating ErbB-2 as a potential target of active vaccination. In this study, 3 mutant ErbB-2 DNA constructs encoding full-length, ErbB-2 proteins were tested as tumor vaccines. To eliminate tyrosine kinase activity, the ATP binding lysine residue 753 was substituted with alanine by replacing codon AAA with GCA in mutant ErbB-2A. To direct recombinant ErbB-2 to the cytoplasm where major histocompatibility complex (MHC) I peptide processing takes place, the endoplasmic reticulum (ER) signal sequence was deleted in cyt ErbB-2. The third construct cyt ErbB-2A contained cytoplasmic ErbB-2 with the K to A mutation. Expression of recombinant proteins was measured by flow cytometry in transfected murine mammary tumor cell line D2F2. Transmembrane ErbB-2 and ErbB-2A were readily detected. Cytoplasmic ErbB-2 and ErbB-2A were detected only after the transfected cells were incubated overnight with a proteasome inhibitor, indicating prompt degradation upon synthesis. ErbB-2 autophosphorylation was eliminated by the K to A mutation as demonstrated by Western blot analysis. Growth of ErbB-2-positive tumor in BALB/c mice was inhibited after vaccination with ErbB-2 or ErbB-2A, but not with cyt ErbB-2 or cyt ErbB-2A. ErbB-2A that is free of tyrosine kinase activity is a potential candidate for anticancer vaccination. The 3 mutant constructs should be useful tools to delineate the role of individual immune effector cell in ErbB-2-specific antitumor immunity and to develop strategies for enhancing such immunity.

Neoplastic progression of breast epithelial cells--a molecular analysis.

Molecular changes associated with breast cancer progression were characterized using the MCF-10F cell series. MCF-10F was established from fibrous mastectomy tissue of a patient without detectable cancer. In vitro treatment of MCF-10F cells with benzo(a)pyrene resulted in a transformed subclone MCF-10F-BP1 (BP1). Transfection of clone BP1 with T24-Hras resulted in the tumorigenic line MCF-10F-BP1-Tras (BP1-Tras). Using flow cytometry, the expression of HLA I, ERBB-2 and MUC-1 was found to be comparable in 'normal' MCF-10F, transformed BP1 and tumorigenic BP1-Tras cells. Glycosylated mucin is elevated in BP1 but reduced in BP1-Tras cells. Using mRNA differential display analysis, cDNA profiles of the 'normal', transformed and tumorigenic cell lines were strikingly similar, yet distinct and elevated expression of several common cDNA fragments was detected in BP1 and BP1-Tras when compared with MCF-10F cells. These fragments were cloned and sequenced. The sequences of clones T1-360 and C4-310 are homologous to two reported EST cDNA clones from human fetal tissue and were further characterized. Elevated expression of the genes corresponding to clones T1-360 and C4-310 was verified using Northern blotting. High-level expression of these genes was also detected in the breast cancer cell line MCF-7 that was derived from the pleural effusion of a patient with advanced breast cancer. Therefore, specific molecular changes associated with breast cancer development were identified and may be indicators of neoplastic progression.