[Early effectiveness of local injection of multimodal drug cocktail during anterior cruciate ligament reconstruction and its influence on cartilage].

Objective: To explore the early effectiveness and influence on cartilage of local injection of multimodal drug cocktail (MDC) during anterior cruciate ligament reconstruction (ACLR). Methods: Between February 2022 and August 2023, patients undergone arthroscopic ACLR using autologous hamstring tendons were selected as the study subjects. Among them, 90 patients met the selection criteria and were randomly divided into 3 groups ( n=30) according to the different injection drugs after ligament reconstruction. There was no significant difference in baseline data such as gender, age, body mass index, surgical side, disease duration, preoperative thigh circumference, and preoperative levels of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), IL-1, matrix metalloproteinase 3 (MMP-3), MMP-13, and aggrecan (ACAN) in synovial fluid between groups ( P>0.05). After the ligament reconstruction during operation, corresponding MDC (consisting of ropivacaine, tranexamic acid, and betamethasone in group A, and ropivacaine, betamethasone, and saline in group B) or saline (group C) were injected into the joint and tendon site, respectively. The length of hospital stay, postoperative tramadol injection volume, incidence of complications, degree of knee joint swelling and range of motion, visual analogue scale (VAS) score, International Knee Documentation Committee (IKDC) score, Lyshlom score, and Hospital for Special Surgery (HSS) score were recorded and compared between groups. The T2 * values in different cartilage regions were detected by MRI examination and the levels of TNF-α, IL-6, IL-1, MMP-3, MMP-13, and ACAN in synovial fluid were detected by ELISA method. Results: The patients in group A, B, and C were followed up (12.53±3.24), (13.14±2.87), and (12.82±3.32) months, respectively. All incisions healed by first intention. Compared with group C, group A and group B had shorter length of hospital stay, less tramadol injection volume, and lower incidence of complications, showing significant differences ( P<0.05); there was no significant difference between group A and group B ( P>0.05). The degree of knee swelling in group A was significantly less than that in group B and group C ( P<0.05), but there was no significant difference between group B and group C ( P>0.05). At 3, 6, 12, 24, and 48 hours after operation, VAS scores of group A and group B were significantly lower than those of group C ( P<0.05); at 72 hours after operation, there was no significant difference among the three groups ( P>0.05). At 3 days, 14 days, and 1 month after operation, the range of motion of knee joint in group A were significantly better than those in group C ( P<0.05), and there was no significant difference between the other groups ( P>0.05). At 1 month after operation, the IKDC score of group A and group B was significantly higher than that of group C ( P<0.05); there was no significant difference among the three groups at other time points ( P>0.05). There was no significant difference in Lyshlom score and HSS score among the three groups at each time point ( P>0.05). At 14 days after operation, the levels of IL-1 and IL-6 in the synovial fluid in groups A and B were significantly lower than those in group C ( P<0.05). There was no significant difference in the levels of TNF-α, MMP-3, MMP-13, and ACAN between groups A and B ( P>0.05). At 1 month after operation, there was no significant difference in the above indicators among the three groups ( P>0.05). At 3, 6, and 12 months after operation, there was no significant difference in the T2 * values of different cartilage regions among the three groups ( P>0.05). Conclusion: Injecting MDC (ropivacaine, tranexamic acid, betamethasone) into the joint and tendon site during ACLR can achieve good early effectiveness without significant impact on cartilage.

[Research progress on early postoperative pain management strategies after arthroscopic anterior cruciate ligament reconstruction].

Objective: To summarize the early postoperative pain management strategies for anterior cruciate ligament reconstruction (ACLR), and to select a reasonable and effective pain management plan to promote functional rehabilitation after ACLR. Methods: The literature about the early postoperative pain management strategies of ACLR both domestically and internationally in recent years was extensiverly reviewed, and the effects of improving postoperative pain were reviewed. Results: Currently, physical therapy and oral medication have advantages such as economy and simplicity, but the effect of improving postoperative pain is not satisfactory, often requires a combination of intravenous injection or intravenous pump, which is also a common way to relieve pain. However, in order to meet the analgesic needs of patients, the amount of analgesic drugs used is often large, which increases the incidence of various adverse reactions. Local infiltration analgesia (LIA), including periarticular or intra-articular injection of drugs, can significantly improve the early postoperative pain of ACLR, and achieve similar postoperative effectiveness as nerve block. LIA can be used as an analgesic technique instead of nerve block, and avoid the corresponding weakness of innervated muscles caused by nerve block, which increases the risk of postoperative falls. Many studies have confirmed that LIA can alleviate postoperative early pain in ACLR, especially the analgesic effects of periarticular injection are more satisfactory. It can also avoid the risk of cartilage damage caused by intra-articular injection. However, the postoperative analgesic effect and timeliness still need to be improved. It is possible to consider combining multimodal mixed drug LIA (combined with intra-articular and periarticular) with other pain intervention methods to exert a synergistic effect, in order to avoid the side effects and risks brought by single drugs or single administration route. LIA is expected to become one of the most common methods for relieving postoperative early pain in ACLR. Conclusion: Early pain after arthroscopic ACLR still affects the further functional activities of patients, and all kinds of analgesic methods can achieve certain effectiveness, but there is no unified standard at present, and the advantages and disadvantages of various analgesic methods need further research.

[Effectiveness analysis of arthroscopic single/double-row suture techniques in repairing of moderate rotator cuff tears].

Objective: To compare the early effectiveness of arthroscopic repair of moderate rotator cuff tears with single-row modified Mason-Allen technique and double-row suture bridge technique. Methods: The clinical data of 40 patients with moderate rotator cuff tears who met the selection criteria between January 2021 and May 2022 were retrospectively analyzed. Among them, 20 cases were repaired with single-row modified Mason-Allen suture technique (single-row group) and 20 cases with double-row suture bridge technique (double-row group). There was no significant difference in gender, age, disease duration, rotator cuff tear size, and preoperative visual analogue scale (VAS) score, Constant-Murley score, and T2* value between the two groups ( P>0.05). The VAS score, Constant-Murley score (including subjective influence, pain, flexion, internal rotation, external rotation, abduction, and muscle strength score) were compared between the two groups before operation and at 6 weeks, 3, 6, and 12 months after operation. Functional MRI and ultrashort-echo-time (UTE)-T2* technique were performed to calculate T2* value and quantitatively evaluate the healing of rotator cuff tissue; and the healing of rotator cuff was evaluated by Sugaya classification at 12 months after operation. Results: Patients in both groups were followed up 1 year. There was no complication such as muscle atrophy, joint stiffness, or postoperative rotator cuff tear. The intra-group comparison showed that the scores of pain, subjective influence, flexion, abduction, and muscle strength in Constant-Murley scores at each time point after operation in the two groups were significantly higher than those before operation, while VAS scores were significantly lower than those before operation ( P<0.05). Internal rotation, external rotation, and total score of Constant-Murley score in the two groups were lower at 6 weeks due to abduction immobilization within 6 weeks after operation, and gradually increased at 6 months after operation, with significant differences at 3, 6, and 12 months after operation when compared with those before operation and at 6 weeks after operation ( P<0.05). The T2* values of the two groups showed a downward trend over time, and there were significant differences between the two groups at other time points ( P<0.05), except that there was no significant difference between at 6 and 12 months after operation in the single-row group and between at 3, 6, and 12 months after operation in the double-row group ( P>0.05). The comparison between groups showed that the VAS score and T2* values of the double-row group were significantly lower than those of the single-row group at 6 weeks, 3 months, 6 months, and 12 months after operation ( P<0.05). The scores of subjective influence, flexion, abduction, and internal rotation in the double-row group were significantly better than those in the single-row group at 6 weeks and 3 months after operation ( P<0.05), and the external rotation score and total score in the double-row group were significantly better than those in the single-row group at 3 months after operation ( P<0.05), but there was no significant difference at 6 and 12 months after operation ( P>0.05). There was no significant difference in muscle strength and pain scores between the two groups at 6 weeks, 3 months, 6 months, and 12 months after operation ( P>0.05). There was no significant difference in the results of Sugaya classification between the two groups at 12 months after operation ( Z=1.060, P=0.289). Conclusion: The effectiveness of arthroscopic repair of moderate rotator cuff tears with modified Mason-Allen technique and double-row suture bridge technique is satisfactory, but suture bridge technique is helpful to the early rehabilitation training of shoulder joint and the recovery of motor function of patients.

Comparison of adiposity indices in relation to prehypertension by age and gender: A community-based survey in Henan, China.

BACKGROUND: To compare the efficiency of bioelectrical indices (visceral fat index [VFI], percentage body fat [PBF]) and anthropometric indices (body mass index, waist circumference, waist-to-height ratio, a body shape index ) in the relation to prehypertension (120-139/80-89 mm Hg) among the Chinese population. METHODS: Using stratified multistage random sampling method, a general population-based sample of 11 175 adults in Henan province were selected from 2013 to 2015. The individuals were divided into three categories by blood pressure levels: normotension (<120 and 80 mm Hg), stage 1 prehypertension (120-129/80-84 mm Hg) and stage 2 prehypertension (130-139/85-89 mm Hg). RESULTS: VFI and PBF tended to increase with age in men and women. However, for each age-specific group, men tended to have higher VFI than women (all P < 0.01) and women tended to have greater PBF (all P < 0.0001). The odds ratios (OR) and area under the receiver operating characteristic curves for prehypertension associated with adiposity indices declined with age. VFI and PBF showed higher standardized adjusted ORs for prehypertension in young (~40 years) men (VFI: 2.02-3.05; PBF: 1.82-2.80) and young women (VFI: 1.90-2.58; PBF:1.70-2.29). Moreover, based on Youden's index, VFI and PBF exhibited the superiority for identifying prehypertension in men (0.20-0.32) and women (0.31-0.39), respectively. CONCLUSION: In summary, there was stronger association of VFI and PBF with prehypertension in men than in women, respectively, especially for young adults.

Association between resting heart rate and hypertension in Chinese with different waist-to-height ratio: a population-based cross-sectional study.

Elevated resting heart rate (RHR) and obesity are important risk factors for hypertension. However, studies are rare on the combined impact of RHR and obesity on prehypertension and hypertension. This study aimed to investigate the association between RHR and hypertension with different waist-to-height ratio (WHtR) in Chinese. The population-based cross-sectional study was conducted during 2013-2015 in Henan province, China, and 15,536 participants aged ≥15 years were included. RHR was classified according to sex-specific quartiles. The cutoff value of WHtR was 0.5 in both sexes. Multilinear and multilogistic regression models were used to evaluate the association of RHR and WHtR with prehypertension and hypertension. In both sexes, higher RHR was associated with higher blood pressure and lower pulse pressure. Compared with the lowest RHR quartile, participants in the highest RHR quartile had an increased risk of prehypertension (odds ratio [OR]: 1.40, 95% confidence interval [CI]: 1.18-1.65; OR: 1.27, 95% CI: 1.09-1.48) and hypertension (OR: 1.75, 95% CI: 1.43-2.15; OR: 1.36, 95% CI: 1.13-1.63) for male and female, respectively, after fully adjusting the data. In addition, adjusted ORs for prehypertension and hypertension of participants with high WHtR and high RHR were 2.91 (95% CI: 2.38-3.55) and 6.28 (4.96-7.97) for male and 2.45 (2.05-2.93) and 4.63 (3.66-5.85) for female, respectively, compared with the normal WHtR and normal RHR. In conclusion, elevated RHR was significantly associated with the risk of prehypertension and hypertension in Chinese and WHtR as a measure of abdominal obesity further increased this association.

Stroke and (or) myocardial infarction attributable to modifiable risk factors in Henan, China.

Estimating population attributable risks of potential modifiable risk factors for stroke and (or) myocardial infarction may be useful for planning cardiovascular disease (CVD) preventive strategies. A population of 17,292 adults aged 18 years and older from a cross-sectional survey was included in the study. The binary logistic regression was used to evaluate the association between risk factors with disease events, then population attributable fraction according to prevalence and odds ratios were calculated to identify and compare the effects at different subpopulations. We found that the main risk factor for CVD events was hypertension with about 50% of population attributable fraction; prehypertension (22.24%) only acts at rural older females; the efficiency of low- and moderate-level physical activities were higher in males (over 20%) than females (under 20%); ever smoked contributed to CVDs in rural older populations (males, 19.25%; females, 5.57%) and urban younger males (54.52%); while as for high body mass index, overweight (12.59%) only made contribution to rural males over 60 years. In conclusion, hypertension control in the whole population, physical activity increasing in males and older females, smoking prevention in rural elders and urban younger males, and slimming in rural elder males might be effective to reduce the burden of CVDs in Henan.

Association of reproductive history with hypertension and prehypertension in Chinese postmenopausal women: a population-based cross-sectional study.

Hypertension and prehypertension may have important roles in the etiology of cardiovascular disease. However, the risk factors of hypertension and prehypertension have not been thoroughly elucidated to date. This study intended to explore the relative effects between reproductive history and the prevalence of hypertension and prehypertension. A population-based cross-sectional survey of postmenopausal women (n=6252), aged 41-93 years, was conducted from August 2013 to August 2015. All subjects, selected by the multistage random sampling method in Henan province, were categorized as normotension, prehypertension and hypertension according to blood pressure (BP) levels. Ordinal logistic regression models were used to estimate the risks of prehypertension and hypertension with three categories of BP as dependent variables. Hypertension was associated with a positive history of induced abortion (adjusted odds ratio (OR)=1.190, 95% confidence interval (CI): 1.020, 1.388), but there was no association between hypertension and a positive history of spontaneous abortion (adjusted OR=1.126, 95% CI: 0.973, 1.303) after adjusting for age, alcohol consumption, education status, smoking, body mass index, physical activity and occupation. Compared with women with one or no children, those with two or three children were at a lower risk of hypertension (adjusted OR=0.605, 95% CI: 0.434, 0.845). In addition, individuals with an age of menopause between 46 and 51 years may have a decreased risk of both prehypertension and hypertension, especially in terms of systolic BP. In conclusion, a positive history of induced abortion may be a predictive risk factor for hypertension and prehypertension. However, a menopausal age of 46-51 years or having two children may be protective factors against hypertension and prehypertension.

Association analyses of genetic variants in long non-coding RNA MALAT1 with breast cancer susceptibility and mRNA expression of MALAT1 in Chinese Han population.

The long non-coding RNA (lncRNA) Metastasis-associated lung adenocarcinoma transcript 1(MALAT1) has been implicated in breast cancer (BC). Polymorphisms in MALAT1 may play a vital role in the progress of breast cancer by its regulation function. However, potential genetic variants in MALAT1 affecting the development of BC is rarely explored. In our current molecular epidemiology study, all three tagging SNPs (rs3200401, rs619586 and rs7927113) in lncRNA MALAT1 were selected for genotyping in 487BCE patients and 489 cancer-free controls in Chinese Han population, and futher experiment of quantitative real-time (qRT) PCR was conducted to examine the relative expression of MALAT1. The results showed that individuals with genotype AG of rs619586 has a decreased risk of BC in codominant model (OR: 0.684, 95%CI: 0.478-0.979), dominant mode (OR: 0.675, 95%CI: 0.479-0.951) and over-dominant model (OR: 0.692, 95%CI: 0484-0.989). Also, qRT-PCR results revealed that the expression for MALAT1 with AG (0.827±0.490), GG (0.511±0.149) and AG+GG genotypes (0.743±0.447) of rs619586 was significantly lower than that with genotype AA (1.511±0.737). In addition, females with genotype CT of rs3200401 had a lower risk of BC in the codominant model (OR: 0.75, 95%CI: 0.559-1.007) and over-dominant model (OR: 0.741, 95%CI: 0.552-0.993). In summary, our results implied that the genetic variants of lncRNA MALAT1 were associated with the susceptibility of BC, and meaningful genetic alteration might affect the corresponding mRNA expression of lncRNA MALAT1.

Associations of Functional MicroRNA Binding Site Polymorphisms in IL23/Th17 Inflammatory Pathway Genes with Gastric Cancer Risk.

IL23/Th17 axis acts as an inflammatory pathway in gastric carcinogenesis. MicroRNA- (miRNA-) binding site single-nucleotide polymorphisms (SNPs) of inflammatory genes may alter gastric cancer (GC) susceptibility. In this study, four miRNA binding site SNPs (rs3748067 of IL17A, rs887796, rs1468488 of IL17RA, and rs10889677 of IL23R) were genotyped from 500 patients and 500 controls. Unconditional logistic regression analyses and multifactor dimensionality reduction software were used to evaluate the relationships of SNPs with GC and gene-environment interactions, respectively. Quantitative real-time PCR, Western blot analysis, and luciferase report gene assay were applied for function verification. We found that CT (ORadj = 0.59; 95% CI: 0.44-0.79), CT + TT (ORadj = 0.58; 95% CI: 0.43-0.77) genotypes, and T allele (ORadj = 0.77; 95% CI: 0.47-0.80) of rs3748067 reduced GC risk; the rs10889677 CC genotype (ORadj = 2.22; 95% CI: 1.27-3.87) and C allele (ORadj = 1.24; 95% CI: 1.02-1.52) increased GC risk. A meaningful interaction among ever smoked, family history of GC, and rs3748068 could intensify GC risk by 2.25-fold. Functional tests demonstrated the inhibitory effect of miR-10a-3p on IL17A expression in SGC-7901 cells. These results suggested that miRNA binding site SNPs within IL23/Th17 inflammatory pathway genes and their interactions with environmental factors could be associated with GC risk.