Predictive value of bone mineral density for postoperative efficacy and factors influencing treatment outcomes in patients undergoing total hip arthroplasty: a retrospective study.

OBJECTIVE: To investigate the value of bone mineral density (BMD) in predicting postoperative efficacy in patients undergoing total hip arthroplasty (THA), and to analyze the influencing factors of short-term outcomes. PATIENTS AND METHODS: Clinical data, including general data, perioperative indicators, and postoperative follow-up information, were collected from patients undergoing THA from July 2018 to June 2020 at Jiangsu Taizhou People's Hospital for retrospective analysis. Using the Harris Hip Score (HHS) at 12 months after THA as the therapeutic effect evaluation index, the BMD levels of patients with different therapeutic effects were compared, and the correlation of BMD with therapeutic efficacy was analyzed. Furthermore, the influencing factors of postoperative efficacy were discussed by using a logistic regression model. RESULTS: The HHS scores of 194 patients undergoing THA improved markedly at postoperative month 12 compared with the preoperative values (p<0.05), with a treatment excellent and good rate of 79.90% (155/194). The BMD level varied greatly among patients with different curative effects (p<0.05). Pearson correlation analysis identified a significant positive correlation between BMD values and HHS scores in patients undergoing THA. THA patients with different body mass index (BMI), surgical approach, occult blood loss, postoperative complications, length change of the affected limb, postoperative exercise time, and BMD had statistically significant differences in the excellent and good rate of clinical efficacy (p<0.05). According to the multivariate Logistic regression analysis, BMI, surgical approach, length change of the affected limb, and BMD were independent factors influencing the postoperative excellent and good rate of efficacy in THA patients (p<0.05). CONCLUSIONS: Preoperative BMD levels are strongly correlated with postoperative efficacy improvement in patients undergoing THA. BMD is an independent influencing factor of excellent and good postoperative efficacy in patients undergoing THA, and increasing the BMD is conducive to improving outcomes in such patients.

[Ultrasound biomicroscopic differences between fellow eyes of acute angle-closure glaucoma and chronic angle-closure glaucoma].

Objective: To compare the structural differences of the anterior segment between fellow eyes of acute angle-closure glaucoma (AACG) and the eyes of chronic angle-closure glaucoma (CACG) with milder glaucomatous damage. Methods: In this case-control study, patients with AACG (41 eyes) and CACG (46 eyes) without prior treatment in the glaucoma clinic of Peking University People's Hospital from September 2016 to October 2018 were enrolled. Ultrasound biomicroscopy was performed under dark condition. Parameters were measured on images including lens vault (LV), anterior chamber depth (ACD), iris thickness (IT750 and IT2000), angle-opening distance (AOD500 and AOD750), and trabecular iris angle (TIA500 and TIA750). The independent t-test was used to compare the continuous variables of the fellow eyes of AACG patients and the eyes of CACG patients with milder glaucomatous damage. After adjusting for age and gender, univariate and multivariate logistic regression analyses were performed to explore the most important parameters that may distinguish AACG from CACG. Results: The mean age of AACG patients was (65±10) years old and the age of CACG patients was (67±12) years old (P>0.05). The ACD [(1.79±0.25) mm vs. (1.99±0.34) mm], IT750 [(0.39±0.07) mm vs. (0.43±0.05) mm], AOD500 [(0.12±0.06) mm vs. (0.15±0.07) mm], TIA500 (10.91°±5.23° vs. 13.93°±6.33°), and TIA750 (9.33°±5.02° vs. 13.93°±6.82°) were less and the LV [(0.99±0.44) mm vs. (0.72±0.30) mm] was greater in the fellow eyes of AACG as compared to the eyes of CACG with milder glaucomatous damage (all P<0.05). In the forward multivariate logistic regression analysis, every 1-degree decrease in TIA750 (odds ratio=0.872, 95%CI: 0.794 to 0.958, P<0.01) and every 1-mm increase in LV (odds ratio=14.138, 95%CI: 2.348 to 85.130, P<0.01) were significantly associated with AACG. Conclusions: Compared with the eyes of CACG with milder glaucomatous damage, fellow eyes of AACG have thinner peripheral iris thickness, narrower angle width, shallower ACD, and greater LV. LV and TIA750 may play important roles in distinguishing eyes predisposed to AACG or CACG. (Chin J Ophthalmol, 2021, 57: 672-678).

Overall adjustment acupuncture for postmenopausal osteoporosis (PMOP): a study protocol for a randomized sham-controlled trial.

BACKGROUND: Osteoporosis is becoming more prevalent in aging societies worldwide, and the economic burden attributable to osteoporotic fractures is substantial. The medications presently available to treat osteoporosis have side effects. Acupuncture is widely used for treating osteoporotic postmenopausal women because it is non-invasive and has fewer side effects, but the powerful clinical evidence for its efficacy remains insufficient. Our study intends to explore the effect of overall adjustment acupuncture (OA) in the treatment of postmenopausal osteoporosis (PMOP). METHODS/DESIGN: This study is a randomized, sham-controlled, patient- and assessor-blinded trial and aims to evaluate the effect of OA in women with PMOP. We will recruit 104 women aged 45-70 years with a diagnosis of PMOP. Participants will be randomly allocated in a 1:1 ratio to the OA group and the sham acupuncture (SA) group. Both groups will receive real herbal medicine treatment as a basic treatment twice a day for 3 months, the OA group receives real acupuncture treatment and the SA group receives placebo acupuncture treatment (non-penetrating, sham skin-needle therapy, sham cupping). All patients will receive acupuncture treatment twice per week for 3 months. The primary outcome is bone mineral density (BMD) and the secondary outcomes include estradiol (E2), follicle-stimulating hormone (FSH), bone gla protein (BGP), bone alkaline phosphatase (BALP), total antioxidant capacity (TAC), advanced oxidation protein products (AOPP), PPARγ, ß-catenin, FoxO3a levels, visual analog pain scale score (VAS), Traditional Chinese medicine (TCM) syndrome scores and quality of daily life score (QOL). Outcome measures will be collected at baseline, middle of the treatment (1.5 months), the end of treatment (3 months). The present protocol followed the SPIRIT guidelines and fulfills the SPIRIT Checklist. CONCLUSION: This study will be conducted to compare the efficacy of OA versus SA. This trial should help to evaluate whether OA can effectively prevent and treat PMOP by improving the estrogen levels of postmenopausal women. The mechanism is to improve the imbalance of osteogenic differentiation and lipogenesis of bone-marrow cells under oxidative stress. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ID: ChiCTR1800017581. Registered on 5 August 2018. URL: http://www.chictr.org.cn.

[Relationship between visual field index and visual field morphological stages of glaucoma and their diagnostic value].

Objective: To investigate the rationality of visual field morphological stages of glaucoma, its relationship with visual field index and their diagnostic value. Methods: Retrospective series case study. Two hundred and seventy-four glaucoma patients and 100 normal control received visual field examination by Humphrey perimeter using standard automatic perimetry (SAP) program from March 2014 to September 2014. Glaucoma patients were graded into four stages according to characteristic morphological damage of visual field, distribution of mean defect (MD) and visual field index (VFI) of each stage were plotted and receiver operation characteristic curve (ROC) was used to explore its correlation with MD and VFI. The diagnostic value of MD and VFI was also compared. For the comparison of general data of subjects, categorical variables were compared using χ(2) test, numerical variables were compared using F test. MD and VFI were compared using ANOVA among stages according to visual field, followed by multiple comparisons using LSD method. The correlation between MD and VFI and different stages according to visual field defined their diagnostic value, and compared using area under the curve (AUC) of ROC. Results: No characteristic visual field damage was found in normal control group, and MD and VFI was (-0.06±1.24) dB and (99.15±0.76)%, respectively. Glaucomatous visual field damage was graded into early, medium, late and end stage according to morphological characteristic. MD for each stage were (-2.83±2.00) dB, (-9.70±3.68) dB, (-18.46±2.90) dB, and (-27.96±2.76) dB, respectively. VFI for each stage were (93.84±3.61)%, (75.16±10.85)%, (49.36±11.26)% and (17.65±10.59)%, respectively. MD and VFI of each stage of glaucomatous group and normal control group were all significantly different (F=1 165.53 and P<0.01 for MD; F=1 028.04 and P<0.01 for VFI). AUC of ROC was A(MD)=0.91 and Se(MD)=0.01 (95% confident interval was 0.89-0.94) for MD, and A(VFI)=0.97, Se(VFI)=0.01 (95% confident interval was 0.94-0.10) for VFI. So, AUC(VFI)>AUC(MD) (P<0.05). Conclusions: It is feasible and rational of glaucomatous visual field damage to be graded into early, medium, late and end stage using Humphrey perimeter. Distribution of MD and VFI for each stage was relatively concentrative. Both MD and VFI were useful for grading glaucomatous visual field damage with preference for VFI. (Chin J Ophthalmol, 2017, 53: 92-97).

Differential expression and effect of the porcine ANGPTL4 gene on intramuscular fat.

In a previous study, we investigated differences in gene expression in backfat between Meishan and Large White pigs and their F1 hybrids, Large White x Meishan, and Meishan x Large White pigs. One potential differentially expressed sequence tag from the mRNA differential display was a homolog of the human angiopoietin-like 4 (ANGPTL4) gene, which encodes a protein that is secreted by both liver and white adipose tissues and can inhibit lipoprotein lipase activity and stimulate white adipose tissue lipolysis. Here, ANGPTL4 mRNA was found to be upregulated in the backfat of Large White compared with that in the Meishan pigs and the F1 hybrids, Meishan x Large White and Large White x Meishan, whereas expression was lowest both in the longissimus dorsi and the heart, as shown by the tissue distribution profile. Only one mutation, a G/A transition located in the third intron, was found. The ANGPTL4 G/A polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) showed a significant effect on intramuscular fat (IMF), water moisture of the longissimus dorsi, meat marbling of the longissimus dorsi, and pH of the longissimus dorsi (P < 0.05). This site seemed to be significantly (P < 0.05) additive in its actions on IMF, water moisture, and pH, whereas it showed significant dominance in its action on meat marbling (P < 0.05). This locus can be potentially considered as a marker for IMF improvement.

Superior laryngeal nerve loop: patterns and surgical implications.

This study clarifies the patterns of the superior laryngeal nerve loop (SLN loop), connecting the cervical sympathetic chain (CSC) and the SLN and its branches, so as to provide an anatomic basis for decreasing the risk of injury to the external laryngeal nerve (ELN) during neck surgery. Fifty Chinese adult human cadavers fixed with 4 % formalin were dissected, and their SLN loop patterns were analyzed and summarized. In 98 of 100 sides the CSC anastomosed with the SLN and its branches, forming a looped nerve structure which we called the SLN loop. The SLN loops could be divided into five types: e ( n ), t ( n ), i ( n ), t ( n ) e ( n ), and i ( n ) e ( n ) based on morphological variations. The results demonstrated that e ( n ) was most frequently found in the samples (82/100) followed by t ( n ) (9/100), i ( n ) (3/100), t ( n ) e ( n ) (2/100), and i ( n ) e ( n ) (2/100). Comparing with the previous work, we identified additional 18 subtypes of the SLN loop. The relations of the SLN loop to the surrounding structures were complicated, which brought more challenges to thyroidectomy. Thus, we do not advocate routine identification of ELN/ELN loop during the process of thyroidectomy, especially systematic identification of ELN during operation. However, this study introduces the possibility that nerve injury can be avoided by exposure of the nerve via careful dissection in the region of the superior pole of the thyroid gland to the extent that we can initiate individual ligation of the superior polar vessels, along with the help of neuromonitors, video monitors, and magnifying loupes.

Differential proteome analysis of porcine skeletal muscles between Meishan and Large White.

Western and indigenous Chinese pig breeds show obvious differences in muscle growth and meat quality; however, the underlying molecular mechanism remains unclear. In this study, proteome analysis of LM between purebred Meishan and Large White pigs was performed by 2-dimensional gel electrophoresis and mass spectrometry. A total of 25 protein spots were differentially expressed in the 2 breeds. The 14 identified proteins could be divided into 4 groups: energy metabolism, defense and stress, myofibrillar filaments, and other unclassified proteins. Quantitative real-time PCR was used to analyze the partly differentially expressed proteins in mRNA level, which revealed a positive correlation between the content of the proteins and their mRNA levels. We also analyzed the mRNA levels of myosin heavy chain isoforms using quantitative real-time PCR. The results indicated that IIa and IIx fibers were elevated in Meishan pigs, whereas the IIb fiber was more highly expressed in Large White pigs. To the best of our knowledge, this was the first proteomics-based investigation of total skeletal muscle protein in different pig breeds, and these results may provide valuable information for understanding the molecular mechanism responsible for breed-specific differences in growth performance and meat quality.

Molecular characterization and SNPs analysis of the porcine Deleted in AZoospermia Like (pDAZL) gene.

The Deleted in AZoospermia Like (DAZL) gene is expressed in prenatal and postnatal germ cells. In this study, we cloned and characterized the porcine Deleted in AZoospermia Like (pDAZL) gene. We found the full-length coding sequence of the pDAZL encoded a protein of 295 amino acids with a RNA recognition motif (amino acids 41-111) and a DAZ repeat (amino acids 167-120). The deduced protein sequence of pDAZL is 92.5% and 91.5% similar to those of human and bovine, respectively. PCR-MspI-RFLP and PCR-TaqI-RFLP were established to detect an A/G mutation in intron 7 and a C/A mutation in intron 9, respectively. Associations of two SNPs with litter size traits were assessed in Large White (n=275) and DIV (n=128) pig populations, and the statistical analysis demonstrated that CC produced 0.716 more (P<0.05) piglets born alive than CD genotypes in Large White pigs at TaqI locus (C/A mutation in intron 9), and the dominance effect was 0.304 pig per litter (P<0.05). This result suggests that the pDAZL gene might be a good candidate gene of litter size trait and provides some marker information for marker-assisted selection (MAS).