Surgical treatment for both-column acetabular fractures using pre-operative virtual simulation and three-dimensional printing techniques.

BACKGROUND: Surgical treatment of both-column acetabular fractures is challenging because of the complex acetabular fracture patterns and the curved surface of the acetabulum. Seldom study has compared the application of three-dimensional (3D) printing technology and traditional methods of contouring plates intra-operatively for the surgical treatment of both-column acetabular fractures. We presented the use of both 3D printing technology and a virtual simulation in pre-operative planning for both-column acetabular fractures. We hypothesized that 3D printing technology will assist orthopedic surgeons in shortening the surgical time and improving the clinical outcomes. METHODS: Forty patients with both-column acetabular fractures were recruited in the randomized prospective case-control study from September 2013 to September 2017 for this prospective study (No. ChiCTR1900028230). We allocated the patients to two groups using block randomization (3D printing group, n = 20; conventional method group, n = 20). For the 3D printing group, 1:1 scaled pelvic models were created using 3D printing, and the plates were pre-contoured according to the pelvic models. The plates for the conventional method group were contoured during the operation without 3D printed pelvic models. The operation time, instrumentation time, time of intra-operative fluoroscopy, blood loss, number of times the approach was performed, blood transfusion, post-operative fracture reduction quality, hip joint function, and complications were recorded and compared between the two groups. RESULTS: The operation and instrumentation times in the 3D printing group were significantly shorter (130.8 ±â€Š29.2 min, t = -7.5, P < 0.001 and 32.1 ±â€Š9.5 min, t = -6.5, P < 0.001, respectively) than those in the conventional method group. The amount of blood loss and blood transfusion in the 3D printing group were significantly lower (500 [400, 800] mL, Mann-Whitney U = 74.5, P < 0.001 and 0 [0,400] mL, Mann-Whitney U = 59.5, P < 0.001, respectively) than those in the conventional method group. The number of the approach performed in the 3D printing group was significantly smaller than that in the conventional method group (pararectus + Kocher-Langenbeck [K-L] approach rate: 35% vs. 85%; χ = 10.4, P < 0.05). The time of intra-operative fluoroscopy in the 3D printing group was significantly shorter than that in the conventional method group (4.2 ±â€Š1.8 vs. 7.7 ±â€Š2.6 s; t = -5.0, P < 0.001). The post-operative fracture reduction quality in the 3D printing group was significantly better than that in the conventional method group (good reduction rate: 80% vs. 30%; χ = 10.1, P < 0.05). The hip joint function (based on the Harris score 1 year after the operation) in the 3D printing group was significantly better than that in the conventional method group (excellent/good rate: 75% vs. 30%; χ = 8.1, P < 0.05). The complication was similar in both groups (5.0% vs. 25%; χ = 3.1, P = 0.182). CONCLUSIONS: The use of a pre-operative virtual simulation and 3D printing technology is a more effective method for treating both-column acetabular fractures. This method can shorten the operation and instrumentation times, reduce blood loss, blood transfusion and the time of intra-operative fluoroscopy, and improve the post-operative fracture reduction quality. CLINICAL TRAIL REGISTRATION: No.ChiCTR1900028230; http://www.chictr.org.cn.

[Application of 3D printing and computer-assisted surgical simulation in preoperative planning for acetabular fracture].

OBJECTIVE: To evaluate the feasibility and effectiveness of using 3D printing and computer-assisted surgical simulation in preoperative planning for acetabular fractures. METHODS: A retrospective analysis was performed in 53 patients with pelvic fracture, who underwent surgical treatment between September, 2013 and December, 2015 with complete follow-up data. Among them, 19 patients were treated with CT three-dimensional reconstruction, computer-assisted virtual reset internal fixation, 3D model printing, and personalized surgery simulation before surgery (3D group), and 34 patients underwent routine preoperative examination (conventional group). The intraoperative blood loss, transfusion volume, times of intraoperative X-ray, operation time, Matta score and Merle D' Aubigne & Postel score were recorded in the 2 groups. Preoperative planning and postoperative outcomes in the two groups were compared. RESULTS: All the operations were completed successfully. In 3D group, significantly less intraoperative blood loss, transfusion volume, fewer times of X-ray, and shortened operation time were recorded compared with those in the conventional group (P<0.05). According to the Matta scores, excellent or good fracture reduction was achieved in 94.7% (18/19) of the patients in 3D group and in 82.4% (28/34) of the patients in conventional group; the rates of excellent and good hip function at the final follow-up were 89.5% (17/19) in the 3D group and 85.3% (29/34) in the conventional group (P>0.05). In the 3D group, the actual internal fixation well matched the preoperative design. CONCLUSIONS: 3D printing and computer-assisted surgical simulation for preoperative planning is feasible and accurate for management of acetabular fracture and can effectively improve the operation efficiency.

[Clincial effect of 3D printing-assisted minimal invasive surgery through a small incision lateral to the rectus abdominis for pelvic fracture].

OBJECTIVE: To evaluate the clinical effect of 3D printing-assisted minimal invasive surgery on pelvic fracture by plate internal fixation through a small incision lateral to the rectus abdominis. METHODS: This retrospective study was conducted among 50 patients with pelvic fracture undergoing anteromedial plate internal fixation between September, 2013 and June, 2015. Thin-layer computed tomography scan data of the patients were input into Mimics software in DICOM format for 3D editing and virtual surgery before the operation. The pelvic model was created by 3D printing. Simulated operation was performed to design the optimum location of the plate screw, prelflex of the plate, screw length measurement and screwing approach. Diaplasis and internal fixation were performed through the extraperitoneal space with a small incision lateral to the rectus abdominis. Matta standard was employed for diaplasis evaluation, and Majeed assessment was used for function evaluation 6 months after the operation. RESULTS: According to Matta standard, excellent and good diaplases were achieved in 96% of the cases, as compared with 94% according to Majeed assessment. Radiographic examination showed a good consistency between the internal fixation and simulated operation. No screw entry into the hip joint cavity occurred in these cases. The mean operation time was 127 min in these cases with a mean intraoperative blood loss of 728 mL and a mean incision length of 8.4 cm. Based on the postoperative VAS score, 12 patients reported severe pain, 28 reported moderate pain and 10 reported mild pain. All the patients were advised for early functional exercise after the operation and clinical healing was achieved in a mean of 8 weeks. CONCLUSIONS: 3D printing with simulated operation can improve the accuracy and safety of the operation. Preoperative simulation of plate preflex and screw length measurement can shorten the operation time. A small incision lateral to the rectus abdominis allows minimally invasive operation for pelvic fractures.

Silencing of CXCR4 inhibits tumor cell proliferation and neural invasion in human hilar cholangiocarcinoma.

BACKGROUND/AIMS: To evaluate the expression of CXC motif chemokine receptor 4 (CXCR4) in the tissues of patients with hilar cholangiocarcinoma (hilar-CCA) and to investigate the cell proliferation and frequency of neural invasion (NI) influenced by RNAi-mediated CXCR4 silencing. METHODS: An immunohistochemical technique was used to detect the expression of CXCR4 in 41 clinical tissues, including hilar-CCA, cholangitis, and normal bile duct tissues. The effects of small interference RNA (siRNA)-mediated CXCR4 silencing were detected in the hilar-CCA cell line QBC939. Cell proliferation was determined by MTT. Expression of CXCR4 was monitored by quantitative real time polymerase chain reaction and Western blot analysis. The NI ability of hilar-CCA cells was evaluated using a perineural cell and hilar-CCA cell coculture migration assay. RESULTS: The expression of CXCR4 was significantly induced in clinical hilar-CCA tissue. There was a positive correlation between the expression of CXCR4 and lymph node metastasis/NI in hilar-CCA patients (p<0.05). Silencing of CXCR4 in tumor cell lines by siRNA led to significantly decreased NI (p<0.05) and slightly decreased cell proliferation. CONCLUSIONS: CXCR4 is likely correlated with clinical recurrence of hilar-CCA. CXCR4 is involved in the invasion and proliferation of human hilar-CCA cell line QBC939, indicating that CXCR4 could be a promising therapeutic target for hilar-CCA.

In vitro neuraotropic growth of cholangiocarcinoma: an experimental study.

OBJECTIVE: Perineural invasion of cholangiocarcinoma happens in the early stage of the disease but is often not recognized until its later stages. Research about the behaviour and mechanism of perineural invasion by cholangiocarcinoma is urgently needed for a useful new model. The aim of this work is to establish a novel model to address the problem. DESIGN: Neural cells and cholangiocarcinoma cells were co-cultured to mimic the neurotropic invasion of cholangiocarcinoma. SETTING: Human embryonic stem cells were induced to form neural cells by glial cell-derived neurotropic factor and retinoic acid; neural cells and cholangiocarcinoma cells were co-cultured in Transwell chamber. PARTICIPANTS: Human embryonic stem cells and cholangiocarcinoma cells were applied. MAIN OUTCOME MEASURES: Paired t-test was used to compare the counts of penetrating cholangiocarcinoma cells in co-culture and control group. RESULTS: Formation of neurospheres and neural-like cells were observed following induction at 24 and 48 h, respectively; synapses were viewed to protrude from neural-like cell bodies after incubation for 96 h. Forty-eight hours after incubation, immunocytochemical staining of the cells showed that synaptophysin and glial fibrillary acidic protein were expressed in the neuron-like cells and gliocytes-like cells, respectively. The cholangiocarcinoma cells that had penetrated through the Matrigel/polyethylene terephthalate membrane from the upper chamber to the lower chamber of the Transwell in the co-culture group were significantly more numerous than those in the control group (68 ± 8.3/field versus 46 ± 5.7/field, P < 0.05). CONCLUSION: The novel model is a valuable tool to study the perineural invasion of cholangiocarcinoma.

Follicle-stimulating hormone regulation of microRNA expression on progesterone production in cultured rat granulosa cells.

MicroRNAs (miRNAs) regulate gene expression post-transcriptionally by interacting with the 3' untranslated regions of their target mRNAs. Previously, miRNAs have been shown to regulate genes involved in cell growth, apoptosis, and differentiation, but their role in ovarian granulosa cell follicle-stimulating hormone (FSH)-stimulated steroidogenesis is unclear. Here we show that expression of 31 miRNAs is altered during FSH-mediated progesterone secretion of cultured granulosa cells. Specifically, 12 h after FSH treatment, miRNAs mir-29a and mir-30d were significantly down-regulated. However, their expression increased after 48 h. Bioinformatic analysis used to predict potential targets of mir-29a and mir-30d revealed a wide array of potential mRNA target genes, including those encoding genes involved in multiple signaling pathways. Taken together, our results pointed to a novel mechanism for the pleiotropic effects of FSH.

Dinuclear copper(II) complexes of macrocyclic polyamines: synthesis, characterization, and DNA cleavage.

Two macrocyclic polyamine ligands and their dinuclear copper(II) (CuII) complexes were synthesized and characterized. In the complexes, two 1,4,7,10-tetraazacyclododecane (cyclen) moieties were bridged by a dipeptide spacer, and CuII as metal ion was coordinated to the ligands to form the novel complexes. These complexes were characterized by UV/VIS, IR, EPR, and ESI-MS analyses. The catalyzed DNA cleavage and DNA binding properties of these complexes were studied under physiological conditions. The effects of complex concentrations, cleavage time, and temperature on the DNA cleavage reactions were systematically investigated. The results strongly suggested that the plasmid DNA (pUC 19) can be cleaved by the dinuclear CuII complexes. At pH 7.0 and 37 degrees, incubating DNA with the complexes for 24 h, all Form I was selectively converted into Form II. At 55 degrees, pH 7.0, the time was shortened to less than 30 min. According to the mechanism experiment, these complexes cleave plasmid pUC19 DNA by oxidative mechanism. The synergistic effect of the CuII ions is important to improve the DNA cleavage.

DNA cleavage by novel copper (II) complex and the role of beta-cyclodextrin in promoting cleavage.

A new cyclen derivative N-1-naphthyl-[4-amino-5-oxo-5-(1,4,7,10-tetraazacyclododecan-1-yl)]valeramide and the copper (II) complex were synthesized and characterized. The copper (II) complex showed DNA cleavage ability without the existence of other additives. The pUC19 plasmid DNA was cleaved to linear form by 0.71 microM of complex under physiological conditions. beta-Cyclodextrin was used to investigate the relationship of nuclease activity and DNA binding ability. The addition of beta-cyclodextrin exhibited an unexpected ability to promote the cleavage of DNA. The role of the beta-cyclodextrin in DNA cleavage process was studied by (1)H NMR and fluorescence spectrum. According to the data of viscosity measurement, it was confirmed that the binding of complex with DNA should be a groove binding model. All the results suggested that the increasing of the DNA cleavage ability was attributed to the interaction between beta-cyclodextrin and the naphthyl moieties. beta-Cyclodextrin could include the naphthyl moieties and keep it from the minor/major groove of DNA and decreased the DNA binding ability, therefore, the copper (II) center was activated to generate more reactive oxygen species, which was responsible for DNA cleavage.

Synthesis and DNA-cleavage properties of metal complexes of 1,4,7,10-tetraazacyclododecane (cyclen) functionalized with a pendant benzocrown ether.

The synthesis and DNA-cleavage properties of a series of novel mononuclear Zn(II), Cu(II), and Co(II) complexes 2 of a crown-ether-functionalized cyclen ligand is described. The Cu complex 2b displayed the highest catalytic activity towards pUC 19 DNA. The effects of reaction time, complex concentration, and pH were investigated, showing that 2b readily and efficiently converts supercoiled (type I ) plasmid DNA to nicked (type II) DNA under physiological conditions (37 degrees, pH 7.4).

The conjugates of uracil-cyclen Zn(II) complexes: synthesis, characterization, and their interaction with plasmid DNA.

As an important nucleobase in RNA, uracil was introduced into the side chain of cyclen (1,4,7,10-tetraazacyclododecane) by using phenylene dimethylene group as bridge. The target compounds 5 were obtained in high yields. Subsequent experiments demonstrated that the uracil-cyclen conjugates can bind Zn(2+) cation rapidly in water, and the catalytic activities of their Zn(II) complexes 6 in DNA cleavage were also studied. The results showed that Zn(II) complexes can catalyze the cleavage of supercoiled DNA (pUC 19 plasmid DNA) (Form I) to produce nicked DNA (Form II and Form III) with high selectivity. In water solution, complex 6b may form a unique and stable supramolecular structure, which benefits the DNA cleavage process.

[cDNAs cloning of SARS-CoV PUMC2 viral genome].

OBJECTIVE: To get the cDNA clones which cover the whole genome of SARS-CoV PUMC2 strain. METHODS: Using the SARS-CoV PUMC2 strain genomic RNA as the template, the cDNA fragments were amplified by RT-PCR, the PCR products were further purified and ligated into the pGEM-T vector, and all the clones obtained were sequenced. RESULTS: The cDNA clones which cover the whole genome of SARS-CoV PUMC2 strain were obtained. CONCLUSIONS: These cDNAs can be provided for the function study of SARS-CoV proteins and the construction of full-length infectious cDNA clone of SARS-CoV.

[Cloning, expression and purification of SARS coronavirus PUMC2 strain nucleocapsid protein].

OBJECTIVE: To clone, express and purify nucleocapsid protein from SARS coronavirus PUMC2 strain. METHODS: According to the published SARS coronavirus genome sequences, the full length cDNA of N protein from SARS coronavirus PUMC2 strain was cloned by RT-PCR and the cDNA was cloned into the pET32a expression vector. The recombinant N protein was expressed in E. coli BL21 (DE3), and purified by Ni(2+)-NTA. RESULTS: Prokaryoticly expressed and purified N protein of SARS coronavirus PUMC2 strain was obtained. CONCLUSIONS: The SARS coronavirus recombinant N protein obtained by genetic engineering methods can be used for further functional study of SARS coronavirus N protein.