RIPK3 modulates sarcoma through immune checkpoint HAVCR2.

Sarcomas is a complex group of malignant diseasse with undetermined molecular mechanisms. Receptor interacting serine/threonine kinase 3 (RIPK3) is a necroptosis- and apoptosis-related marker that has been implicated in several immune-associated diseases and aggressive malignant tumours. In the present study, publicly available transcriptome sequencing data were collected from The Cancer Genome Atlas (TCGA) and Therapeutically Applicable Research To Generate Effective Treatments (TARGET) databases and extensive data mining was performed, focusing on RIPK3 and its potential function in the modulation of gene expression and signaling pathways, immune checkpoints and cell infiltration. Analysis of TCGA and TARGET data revealed 603 up- and 260 downregulated genes in the higher RIPK3 expression group compared with the lower RIPK3 expression groups, with transmembrane channel like 8 and transmembrane protein 97 as the top up- and downregulated genes, respectively. Further pathway analysis revealed that the overexpressed genes were enriched in 'cytokine-cytokine receptor interaction'. Higher RIPK3 was found to be associated with improved survival, the immune checkpoint gene hepatitis A virus cellular receptor 2 (HAVCR2) and an improved response to immune blockade therapy. The potential modulation of HAVCR2 expression by RIPK3 was confirmed by reverse transcription-quantiative PCR in KHOS and 143B human osteosarcoma cell lines. Immune cell infiltration analysis revealed that RIPK3 was positively associated with macrophage and monocyte infiltration, suggesting that RIPK3 executes its function through these immune cells. These findings led to the hypothesis that increased RIPK3 expression may result in improved survival, possibly by regulating the immune checkpoint HAVCR2. In conclusion, the present study comprehensively elucidated the RIPK3 profile with regard to sarcoma survival, transcriptome expression, immune checkpoint therapy and immune cell infiltration. These findings suggest that RIPK3 is potentially a therapeutic target for sarcoma.

Incidence, characteristics, and treatments of traumatic open fractures in children and adolescents: A retrospective observational study.

We aimed to investigate the incidence, characteristics, and treatments of open fractures in children and adolescents (≤18 years old). We retrospectively reviewed the records of 2418 children and adolescents who presented with traumatic fractures and were admitted to our university-affiliated hospitals, among which 206 patients (8.5%) presented with open fractures. The patients' clinical and radiographic records were reviewed, and the age, gender, cause of injury, injury season, injury week, associated injuries and complications were collected. This study enrolled 1789 males (74.0%) and 629 females (26.0%) with an average age of 11.2 ± 5.0 years. The patients were divided into an open fracture group (OF group, n = 206) and a group with no open fracture (No-OF group, n = 2212). There were 206 patients (8.5%) who presented with open fractures and the most common fracture sites were the tibia (31.1%, 64/206) and fibula (20.9%, 43/206). The patients in the OF group presented with higher frequency of emergency admission (P < 0.001), self-supporting medical insurance (P < 0.001), MVCs (P < 0.001), wounded by machine (P < 0.001), struck by object (P < 0.001), hurt/cut by others (P < 0.001), lower limb fractures (P < 0.001), multiple fractures (P = 0.010), associated injuries (P < 0.001) and wound infection (P = 0.003) then the patients in the No-OF group. The most common complication were wound infection (5.8%) and pneumonia (1.0%) in the OF group, wound infection (2.1%) and pressure sores (2.0%) in the No- OF group. Multivariate logistic regression analysis indicated that mechanical trauma (OR = 64.229, P < 0.001), being hurt/cut by others (OR = 26.757, P < 0.001), and being struck by an object (OR = 15.345, P < 0.001) were stronger risk factors for open fracture than were low falls; additionally, lower limb fractures (OR = 5.970, P < 0.001), upper limb fractures (OR = 5.865, P < 0.001) and multiple fractures (OR = 5.414, P < 0.001) were stronger risk factors than craniofacial fractures for open fractures. The frequency of surgical treatment for the patients with traumatic open fractures (87.9%, 181/206) was significantly higher than those without open fractures (72.2%, 1596/2212) (P < 0.001). The hospital stays and fees for surgical treatment for the patients with traumatic open fractures were significantly higher than those without open fractures (P < 0.001). Etiology (especially being injured by a machine or being hurt/cut by others) and the fracture site (including lower limb fractures and upper limb fractures) were independent risk factors for open fractures. Traumatic open fractures presented with higher surgical treatment rate, hospital stays and fees.

Extremity fractures in patients presenting with traumatic spinal fractures and spinal cord injury.

Clinical features of extremity fractures (EFs) in patients presenting with traumatic spinal fractures (TSFs) and spinal cord injury (SCI) have not been investigated. To investigate the clinical features and risk factors for EFs in patients presenting with TSFs and SCI.Data from 1392 patients presenting with TSFs and SCI in our hospitals between 2001 and 2010 were retrospectively reviewed, among which 165 patients (129 males and 36 females, 37.5 ±â€Š10.6 years old) presented with EFs. The clinical features of EFs have been investigated.The frequencies of upper limb fractures were significantly higher in the motor vehicle collisions (MVCs) group than in the high-fall group (P = .012) and the struck-by-object group (P = .002). The frequencies of lower limb fractures were significantly higher in the struck-by-object group (P = .019) and the high-fall group (P = .011) than the MVCs group. Univariate logistic regression analysis show that being in the 19 to 39 age group (P = .001), having a lumbar spinal fracture (P < .001) and experiencing a high fall (P < .001) were risk factors for EFs. Multivariate logistic regression analysis showed that we should focus on the factors that having a lumbar spinal fracture and experiencing a high fall.High fall and MVCs were the most common aetiologies for EFs. Having a lumbar spinal fracture and experiencing a high fall were significant risk factors for EFs. We should make early diagnoses and initiate timely treatment according to different patterns of extremity fractures in patients with TSFs and SCI.

The Postoperative Prognosis of Thoracic Ossification of the Ligamentum Flavum can be Described by a Novel Method: The Thoracic Ossification of the Ligamentum Flavum Score.

OBJECTIVE: To create an available thoracic ossification of the ligamentum flavum (TOLF) score as a rudimentary predictor for the postoperative prognosis of TOLF. METHODS: A retrospective review was conducted for all patients with TOLF who received surgical decompression from April 2012 to February 2019. The TOLF score consists of 5 components, namely, the age at surgery (1-3 points), diabetes mellitus (1 point), preoperative duration of symptoms (1-2 points), spinal canal axial remnant area ratio (0-2 points), and intramedullary signal change on magnetic resonance imaging (1 point). The scores of all patients were calculated and analyzed for their correlation with the postoperative recovery ratio. In addition, intraoperative blood loss, urinary catheter indwelling time, cerebrospinal fluid leakage, and postoperative neurologic deterioration were also measured. RESULTS: A total of 64 patients were included. The mean TOLF score at the final follow-up was 4.6 points in the excellent group (20 patients), 5.0 points in the good group (29 patients), and 7.3 points in the poor group (15 patients). A higher TOLF score predicts lower postoperative recovery ratio (P = 0.000), longer urinary catheter indwelling time (P = 0.023), and higher incidence of postoperative neurologic deterioration (P = 0.000). However, no correlation was identified between the TOLF score and intraoperative blood loss (P = 0.755) or cerebrospinal fluid leakage (P = 0.911). CONCLUSIONS: The TOLF score is a novel and rudimentary scoring system that describes the predictive factors that indicate the postoperative prognosis of TOLF.

Age, Gender, Level and Side Differences in the Anatomical Distinctions of Unilateral Percutaneous Kyphoplasty through the Transverse Process-Pedicle Approach.

BACKGROUND: Unilateral and bilateral percutaneous kyphoplasty (PKP) have been widely adopted to treat osteoporotic vertebral compression fractures (OVCFs). Unilateral PKP has a shorter operation time and less radiation exposure time compared with bilateral PKP, but the anatomical distinctions of unilateral PKP are not identical in all cases. OBJECTIVE: The aim of this study was to examine the significance of age, gender, level, and side in relation to the anatomical distinctions of unilateral PKP for lumbar OVCFs through the transverse process-pedicle approach (TPPA). STUDY DESIGN: This was a retrospective study of 200 patients. SETTING: The research took place at General Hospital of Shenyang Military Area Command of Chinese PLA. METHODS: Researchers examined 1000 lumbar spines (L1-L5) of 200 patients and simulated PKP on the 3D-CT scans through unilateral TPPA. The distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), the safe range of the inner inclination angles (SRA), and the success rate (SR) of puncture were measured and compared. RESULTS: There were significant differences (P < 0.05) in the mean DEM between men and women, and between the left and right sides. The DEM was significantly larger in men than women and in right than left. The DEM from L1 to L5 was significantly increased (P < 0.05), from 22.4 ± 2.0 mm to 34.1 ± 4.3 mm. The right maximum PIA was significantly larger than the left. The maximum puncture angle and SRA in men was larger than that in women except for L5. The SRA from L1 to L5 was significantly increased (P < 0.05), from 20.1 ± 6.0 mm to 44.2 ± 8.8 mm. The SR from L1 to L5 was significantly increased (P < 0.05), from 88.3% to 100%. The SR in men was significantly higher than that in women for L1 and L2. LIMITATIONS: Sample size was relatively small. CONCLUSIONS: The DEM was 22.4 mm to 34.1 mm according to different levels. There were significant gender, side, and age differences in the DEM and PIA. The values of DEM, PIA, SRA and SR were significantly increased from L1 to L5. KEY WORDS: Lumbar, osteoporotic vertebral compression fracture, unilateral, percutaneous kyphoplasty, transverse process.

Anatomical feasibility study of unilateral percutaneous kyphoplasty for lumbar through the conventional transpedicular approach: An observational study using 3D CT analysis.

The aim of the study was to discuss the significance of sex, level, age, and side in relation to the anatomical distinctions of unilateral percutaneous kyphoplasty (PKP) for lumbar osteoporotic vertebral compression fractures (OVCFs) through the conventional transpedicle approach (CTPA).We have retrospectively collected lumbar spines (L1-L5) of 200 patients and simulated PKP on the 3D CT scans through unilateral CTPA. We have measured the distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), safe range of the inner inclination angles (SRA), and the success rate (SR) of puncture.Significant differences (P < .05) between the male and female for L1 to L5, left and right side for L1 to L3 in the mean DEM were shown. The DEM from L1 to L5 was significantly increased (P < .05) from (20.6 ±â€Š2.0) mm to (29.8 ±â€Š2.9) mm. For L1 to L5, the right maximum PIA was significantly larger than the left. The maximum PIA and SRA in the male was significantly larger than that in the female. The SRA from L1 to L5 was significantly increased (P < .05) from (19.5 ±â€Š5.9)° to (48.9 ±â€Š8.1)°. The SR in male was significantly higher than that in female for L1 to L4. There were no significant differences in the SR between different age groups except for L4. The SR from L1 to L5 was significantly increased (P < .05) from 26.3% to 99.0%.DEM was 20.6 to 29.8 mm according to different levels. The value of DEM, PIA, SRA, and SR was significantly increased from L1 to L5. No significant differences in the SR between right and left for L1 to L5, different age groups except for L4 were observed.

[An anatomical study of lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation].

Objective: To measure the anatomical parameters related to lumbar unilateral transverse process-pedicle percutaneous vertebral augmentation, and to assess the feasibility and safety of the approach. Methods: A total of 300 lumbar vertebral bodies of 60 patients were randomly selected, and vertebral augmentation were simulated 600 times on X-ray and CT image with unilateral conventional transpedicle approach (control group) and unilateral transverse process-pedicle approach (experimental group). The distance between the entry point and the midline of the vertebral body, the puncture inner inclination angle, the safe range of the puncture inner inclination angle, and the puncture success rate were measured and compared between the left and right with the same approach, and between the two approaches. Results: The distance between the entry point and the midline gradually increased from L 1 to L 5 on both sides in the 2 groups. In the control group, the right sides distance of L 1 and L 2 was much longer than the left sides, and the right sides distance of L 1, L 2, and L 5 was much longer than the left sides in the experimental group ( P<0.05); the distance of the experimental group between the entry point and the midline was much longer than the control group regardless of the sides from L 1 to L 5 ( P<0.05). In the experimental group, the right maximum inner inclination angle from L 1 to L 5, the right middle inner inclination angle from L 1 to L 5, and the right minimum inner inclination angle from L 1, L 2, L 4, L 5 were significantly larger than the left side ( P<0.05). The maximum inner inclination angle and the middle inner inclination angle presented increased tendency, the tendency of minimum inner inclination angle was ambiguous, however, the all inner inclination angles were much larger than those in control group among the different lumbar levels( P<0.05). There was no significant difference of the safe range of the puncture inner inclination angle between 2 sides in 2 groups at L 1 to L 5 ( P<0.05); the safe range angle in experimental group at L 5 was significantly smaller than that in control group ( P<0.05). The difference in total puncture success rate of all lumbar levels was significant between the experimental group and the control group ( χ2=172.252, P=0.000); the puncture success rates of the experimental group were higher than those in the control group form L 1 to L 4 ( P<0.05), but no significant difference was found in the puncture success rate between 2 groups at L 5 ( P>0.05). Conclusion: Compared with the unilateral conventional transpedicle approach, the entry point of the unilateral transverse process-pedicle approach is localized outside, the puncture inclination angle is wider, and the puncture success rate is higher. It shows that the unilateral transverse process-pedicle approach is safer and more reliable than the unilateral conventional transpedicle approach.