Alpha-Mangostin Ameliorates Bleomycin-Induced Pulmonary Fibrosis in Mice Partly Through Activating Adenosine 5'-Monophosphate-Activated Protein Kinase.

Background: Pulmonary fibrosis (PF) is a devastating interstitial lung disease and characterized by an abnormal accumulation of extracellular matrix (ECM). Nintedanib (NDN) and pirfenidone are two approved therapies for PF, but their potential side-effects have been reported. Recently, the use of natural supplements for PF is attracting attention. Alpha-mangostin (α-MG) is an active xanthone-type compound isolated from the nutritious fruit mangosteen. Purpose: In the present study, the potential effect and underlying mechanism of α-MG were evaluated in bleomycin (BLM)-induced PF and activated primary lung fibroblasts (PLFs). Methods: Histopathological changes and collagen deposition were analyzed via hematoxylin-eosin staining and Masson staining, the expression of nicotinamide adenine dinucleotide phosphate oxidase-4 (NOX4) involved in oxidative stress in lung tissues was analyzed by immunochemistry staining. The expressions of α-smooth muscle actin (α-SMA), collagen I (Col I), p-adenosine 5'-monophosphate-activated protein kinase (AMPK)/AMPK, and NOX4 were detected by Western blot, immunofluorescence or RT-PCR, and effects of α-MG on cell viability were detected using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide. Results: In vivo results demonstrated that α-MG treatment (10 mg/kg/day) significantly ameliorated BLM-induced deposition of ECM in lung tissues. Moreover, α-MG could inhibit protein expressions of α-SMA and Col I as well as its mRNA levels. In addition, α-MG also significantly inhibited transforming growth factor-ß1/Smad2/3 pathway and regulated the protein expression of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in lung tissues. In vitro results demonstrated that α-MG significantly increased p-AMPK/AMPK but reduced the protein expression level of α-SMA and Col I as well as NOX4 in activated PLFs. Further study demonstrated that these improvement effects were significantly blocked by compound C. Conclusion: α-MG treatment significantly decreased oxidative stress in lungs partly by activating AMPK mediated signaling pathway in BLM-induced PF and activated PLFs and decreased the deposition of ECM. The present study provides pharmacological evidence to support therapeutic application of α-MG in the treatment of PF.

Comparison of 3 Treatment Methods for Distal Tibial Fractures: A Network Meta-Analysis.

BACKGROUND The choice of optimal internal fixation device for distal tibial fractures remains controversial. The purpose of our study was to evaluate the effectiveness and safety of open reduction and internal fixation, minimally invasive percutaneous osteosynthesis, and intramedullary nailing of distal tibial fractures in adults using network meta-analysis of data from clinical trials. MATERIAL AND METHODS The studies were abstracted from MEDLINE, EMBASE, CNKI, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials meeting inclusion and exclusion criteria were selected. Statistical analyses were conducted using Stata software, version 13.0 (Stata Corporation, College Station, Texas, USA). RESULTS Eleven randomized controlled trials were included. The total number of participants was 710 and the studies were published between 2005 and 2017. There were no significant differences in rates of delayed union, nonunion, or malunion among the various treatments (all p>0.05). The intramedullary nailing group had a lower incidence of wound complications than did the open reduction and internal fixation group and minimally invasive percutaneous osteosynthesis technique group. The SUCRA probabilities were 28.6% for ORIF, 98.4% for IMN, and 22.9% for MIPPO. CONCLUSIONS Given the superior results for intramedullary nailing in terms of wound complications, we recommend this procedure for treatment of distal tibial fractures. More RCTs focused on distal tibial fractures are needed to support the current evidence.

Wedelolactone Attenuates Pulmonary Fibrosis Partly Through Activating AMPK and Regulating Raf-MAPKs Signaling Pathway.

Pulmonary fibrosis is common in a variety of inflammatory lung diseases, there is currently no effective clinical drug treatment. It has been reported that the ethanol extract of Eclipta prostrata L. can improve the lung collagen deposition and fibrosis pathology induced by bleomycin (BLM) in mice. In the present study, we studied whether wedelolactone (WEL), a major coumarin ingredient of E. prostrata, provided protection against BLM-induced pulmonary fibrosis. ICR or C57/BL6 strain mice were treated with BLM to establish lung fibrosis model. WEL (2 or 10 mg/kg) was given daily via intragastric administration for 2 weeks starting at 7-day after intratracheal instillation. WEL at 10 mg/kg significantly reduced BLM-induced inflammatory cells infiltration, pro-inflammatory factors expression, and collagen deposition in lung tissues. Additionally, treatment with WEL also impaired BLM-induced increases in fibrotic marker expression (collagen I and α-SMA) and decrease in an anti-fibrotic marker (E-cadherin). Treatment with WEL significantly prevented BLM-induced increase in TGF-ß1 and Smad2/3 phosphorylation in the lungs. WEL administration (10 mg/kg) also significantly promoted AMPK activation compared to model group in BLM-treated mice. Further investigation indicated that activation of AMPK by WEL can suppressed the transdifferentiation of primary lung fibroblasts and the epithelial mesenchymal transition (EMT) of alveolar epithelial cells, the inhibitive effects of WEL was significantly blocked by an AMPK inhibitor (compound C) in vitro. Together, these results suggest that activation of AMPK by WEL followed by reduction in TGFß1/Raf-MAPK signaling pathways may have a therapeutic potential in pulmonary fibrosis.

[Preliminary analysis of the effect of different administration routes of tranexamic acid on blood loss after total hip arthroplasty for female femur neck fractures].

OBJECTIVE: To study curative effect of different administration routes of tranexamic acid (TXA) on blood loss of elderly female patients with femoral neck fracture in total hip arthroplasty. METHODS: From December 2015 to January 2018, 77 elderly women with femoral neck fractures undergoing total hip replacement were divided into four groups: group A, group B, group C, and group D. The group A (intravenous medication group) included 21 patients with an average age of (77.10±7.02) years old. The patients in group A received 15 mg/kg TXA intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The group B(local medication group) included 18 cases, with an average age of (73.83±6.56) years old. The patients in group B received saline intravenously 5 minutes before skin incision and intraoperative infusion of 3 g TXA into the joint cavity. The group C (combined medication group) included 19 cases, with an average age of (74.26±6.04) year old. The patients in group C received 15 mg/kg TXA intravenously before operation and intraoperative infusion of 1.5 g TXA into the joint cavity. The group D (control group) included 19 cases, with an average age of (76.69±9.27) years old. The patients in group D received saline intravenously 5 minutes before skin incision and intraoperative infusion of saline into the joint cavity. The postoperative wound drainage volume, hemoglobin value, and the total blood loss calculated according to the height and weight and the hematocrit (HCT) before and after operation were observed and compared. RESULTS: In group A, the postoperative drainage was(111.91±35.02)ml; the change of hemoglobin was(26.86±12.99) g/L; and total blood loss was(628.60±306.78) ml. In group B, postoperative drainage was(108.89±36.61) ml; change of hemoglobin was(26.28±8.59) g/L; and the total blood loss was (584.41±250.86) ml. In group C, postoperative drainage was(102.63±47.36) ml; change of hemoglobin was (26.89±12.47) g/L; and total blood loss was(634.78±384.89) ml. In group D, postoperative drainage was(107.37±40.53) ml; change of hemoglobin was(40.95±12.48) g/L; and total blood loss was(1 005.24±483.37) ml. There were no significant differences among 4 groups in postoperative drainage volume (P>0.05). The hemoglobin and total blood loss in group A, B, and C were less than those in the group D(P<0.05), however, there were no significant differences among three groups(P>0.05). CONCLUSIONS: Application of TXA can effectively reduce blood loss during perioperative period of total hip arthroplasty for elderly women with femoral neck fracture. The best administration route and dosage should be further studied.

[Effects of nano-zirconium hydroxide coating on resin bonding of 10-methacryloxy decyldihydrogen phosphate-conditioned zirconia].

OBJECTIVE: This study evaluated the influence of alkaline coating of nano-zirconium hydroxide on resin bonding of 10-methacryloxy decyldihydrogen phosphate (MDP)-conditioned zirconia. METHODS: A total of 140 yttria-stabilized tetragonal zirconia polycrystals (Y-TZP) plates were prepared and sandblasted with alumina particles, and then subjected to different surface treatment. Resin bonding specimens were prepared with a MDP-free resin cement and tested for shear bond strength (SBS). X-ray photoelectron spectroscopy (XPS) was used to investigate the formation of chemical bond on the surface of Y-TZP treated successively with nano-zirconium hydroxide coating and MDP containing primer. RESULTS: The two alkaline coatings increased the 24 h SBS compared to control groups, and groups using nano-zirconium hydroxide coating yielded higher SBS. After thermocycling, no statistical difference was observed between groups, but SBS decreased significantly compared to the 24 h SBS (P<0.05). XPS analysis detected -OH bond on the surface of Y-TZP treated with nano-zirconium hydroxide coating, and -P-O-Zr bond was detected on the surface of Y-TZP treated with nano-zirconium hydroxide coating and MDP-containing primer. CONCLUSIONS: Alkaline coatings improved the bonding of resin to zirconia conditioned with MDP-containing primers.

[The effect of glass fiber volume content on the flexural property of fiber-reinforced composite].

PURPOSE: To investigate the effect of glass fiber volume content on the flexural property of fiber-reinforced composite． METHODS： The specimens of composite were fabricated with 4 different glass fiber volume contents by changing roving winded number of strands dipped in resin matrix, and the mechanical properties were tested by 3-point flexural test in order to determine the optimal fiber volume content. The data was analyzed statistically with SPSS20.0 software package. RESULTS: Self-made fiber-reinforced composites with the glass fiber volume content percentage of 60.4% achieved the maximal flexural strength and the maximal elastic modulus. CONCLUSIONS: As the glass fiber content in matrix of composite material is increased in certain range, the flexural strength and the elastic modulus can be improved，then reaches the peak. However, the flexural property decreases rather than rises when the fiber content is more than 60.4%.

[Case-control study on effects of vacuum drainage on perioperative blood loss after total hip arthroplasty for the treatment of femoral neck fractures].

OBJECTIVE: To compare postoperative blood loss under different negative pressures of drainage after total hip arthroplasty for the treatment of femoral neck fractures. METHODS: From January 1st to December 30th 2013, 74 patients with femoral neck fractures treated with total hip arthroplasty were randomly divided into two groups: high negative pressure drainage group and low negative pressure drainage group. In high negative pressure drainage group, there were 34 cases including 10 males and 24 females, with a mean age of (75.94 ± 9.02) years old, and the patients were treated with 60 kPa negative pressure of drainage. In the low negative pressure drainage group, there were 40 cases including 13 males and 27 females, with an average age of (74.93 ± 8.90) years old, and the patients were treated with 30 kPa negative pressure of drainage. The amount of total drainage, total blood loss, and hemoglobin change were compared between these two groups. RESULTS: All the patients got primary healing without infections. In high negative pressure drainage group,the change of hemoglobin was (41.74 ± 15.69) g/L, total blood loss was (1,217.73 ± 459.50) ml and the drainage volume was (312.94 ± 103.44) ml; while in low negative pressure drainage group,the results were (34.90 ± 12.90) g/L, (904.01 ± 381.58) ml and (129.25 ± 44.25) ml separately. All the results in high negative pressure drainage group were higher than those in the other group. Three days after operation, the change of hemoglobin was (46.00 ± 13.29) g/L and total blood loss was (1,304.72 ± 421.75) ml; while in low negative pressure drainage group, the changes of hemoglobin was (43.87 ± 11.39) g/L and total blood loss was (1,196.78 ± 344.20) ml; there were no statistically significant differences between two groups. CONCLUSION: When placing drainage devices after total hip arthroplasty for the treatment of femoral neck fractures, the level of negative pressure should be chosen according to preoperative level of hemoglobin and HCT in patients. For old patients with femoral neck fracture, low negative pressure is more suitable.

[Improving bonding of zirconia through deposition of silica layer via collosol-gelatin process, the roles of NaHCO3].

OBJECTIVE: To evaluate the effects of NaHCO3 on gelation of silica sols and shear bond strength of silica coated zirconia via collosol-gelatin (Sol-Gel) process. METHODS: The gelation time of silica sols after being mixed with 1%, 3%, 5%, 7%, 10% concentrations of NaHCO3 was recorded. The one got the shortest gelation time was used for the following tests. Zirconia blocks were prepared and divided into five experimental groups according to surface conditioning methods: group A, alumina sandblasting; group B, sandblasting + tribochemical silica coating + silane; group C, sandblasting + silica coating via Sol-Gel process + silane; group D, sandblasting + silica coating via Sol-Gel process (NaHCO3 was used) + silane; group E, sandblasting + zirconia primer. A composite resin column was bonded on the treated zirconia surface with Bis-GMA based composite resin cement. All specimens were subjected to shear bond strength (SBS) tests. RESULTS: The shortest gelation time of silica sols were found when silica sols was mixed with 10% NaHCO3. Group A showed the lowest SBS values of (4.12 ± 0.52) MPa, which was significant different from SBS of group B [(10.24 ± 2.78) MPa], C [(7.36 ± 1.59) MPa], D [(9.79 ± 2.07) MPa], D [(8.39 ± 0.49) MPa], and no statistical difference was found between group C and D. CONCLUSIONS: The silica coating via Sol-Gel process can significantly improve the bond strength of zirconia, and NaHCO3 would not exert influences to bonding.

[Analysis of concurrent intravertebral vacuum sign in thoracolumbar fractures after posterior internal fixation].

OBJECTIVE: To investigate the importance of TLICS classification to surgical options of thoracolumbar fractures by analyzing the cause of intravertebral vacuum sign, vertebral collapse and vertebral pseudarthrosis. METHODS: From January 2006 to December 2010, the clinical data about 15 patients with postoperative complications by thoracolumbar fracture after posterior internal fixation were retrospectively analyzed. There were 9 males and 6 females, ranging in age from 18 to 75 years, with an average of 54.6 years. Of them, fracture site in T12 was 7 cases, L1 was 5 cases, L2 was 3 cases; compression fractures was in 12 cases and burst fracture was in 3 cases; according to classification of TLICS, 12 cases were of type I ,3 cases of type III. And the causes of complications after posterior fixation were analyzed according clinical manifestation and imaging finding combined with review literatures. RESULTS: After 10 to 20 months following-up (with average of 15 months), loss of vertebral height found in 9 cases (4 cases existed vertebral collapse, as well as 3 cases occurred screw loosening) and Intravertebral Vacuum Sign appeared in 6 cases. CONCLUSION: In order to avoid the vertebral vacuum and fixation failure, the clinical data of patients should be roundly and carefully evaluated, surgical indications should be strictly controlled and the surgical approach should be selected according to correct classification. Particularly, the reconstruction of the stability of former spinal column shoud be paid more attention.

[Evaluating on recognition impairment after traumatic brain injury with WCST].

OBJECTIVE: To explore the value of Wisconsin Card Sorting Test (WCST) in evaluating the recognition impairment after traumatic brain injury (TB1). METHODS: WCST and Wechsler Adult Intelligence Scale Revised in China (WAIS-RC) were adopted to assess the cognitive function in 186 patients with brain injury (experimental group) and 180 healthy volunteers (control group), respectively. The cognition between the experimental group and the control group was compared. The correlation between WCST and IQ was analyzed. The correlation between age, education level, the severity of TBI and the executive function were also analyzed. RESULTS: (1) The performances of WAIS-RC and WCST in the experimental group were significantly worse than that of the control group. (2) There were significantly negative correlation between the performance of total errors, percentage of preservative errors, percentage of random errors, response number on first category and IQ (P < 0.05). While there were significantly positive correlation between the categories completed, percentage of conceptual level and IQ (P < 0.05). (3) There was significantly negative correlation between percentage of conceptual level and the severity of TBI. While there were significantly positive correlation between percentage of preservative errors, percentage of random errors, response number on first category and the severity of TBI. CONCLUSION: WCST could be an important method in evaluating cognition of patients with brain injury.

Effect of cilostazol on cerebral arteries in secondary prevention of ischemic stroke.

OBJECTIVE: To compare the effects of cilostazol on cerebral arteries and cerebrovascular blood flow in secondary prevention of ischemic stroke, with those of aspirin. METHODS: Sixty-eight patients who had ischemic stroke during the recent 1-6 months were recruited and randomized into cilostazol or aspirin group. Cerebrovascular condition was assessed by magnetic resonance angiography (MRA) and transcranial doppler ultrasonography (TCD) at the beginning of the study and after 12-month medication. RESULTS: During the clinical follow-up, ischemic stroke recurred in 2 patients in cilostazol group, while in aspirin group, one case of ischemic stroke recurrence and one case of acute myocardial infarction were found. MRA revealed that in aspirin group, the percentages of patients experiencing aggravation and attenuation of cerebrovascular condition were 3.3% and 6.7%, respectively, while in aspirin group, they were 3.3% and 10%, respectively. Moreover, TCD revealed that 26.9% of the patients in aspirin group and 14.3% of the patients in cilostazol group experienced aggravation of cerebrovascular condition. However, the systolic peak flow velocity of the previously abnormal arteries increased by 42.9% after 12-month medication of cilostazol, which was significantly higher than that after aspirin medication (27.5%) (P = 0.04). Furthermore, as a major side effect of antiplatelet therapy, the frequency of bleeding was much less in cilostazol group (0 case in cilostazol group vs 5 in aspirin, P< 0.05). CONCLUSION: Cilostazol is as effective as aspirin in preventing the aggravation of cerebral arteries in secondary prevention of ischemic stroke. Besides, it is more safe. Cilostazol can increase the systolic peak flow velocity of cerebral arteries, which may improve the blood supply of focal ischemia.

[Color property evaluation of 7 kinds of resin-based composite products].

OBJECTIVE: To investigate the color stability and opacity of seven resin-based composite products after ultraviolet irradiation. METHODS: Seven kinds of light-cured resin-based composite products (Aelite Flo, Filtek Z350 Flowable, Clearfil AP-X, Dyract AP, Z100, Durafill VS, Filtek Z350 Universal) were tested in the study (five for each group). Changes in color and opacity of test samples were determined before and after 8, 16 and 24 h ultraviolet irradiation using the CIE 1976 L*a*b* system and CIE 1931 XYZ system by a colorimeter. RESULTS: The color of resin disks suffering ultraviolet irradiation was different in different irradiating time. Color difference values ranged from 1.85-3.21 for 8 h ultraviolet irradiation to 2.88-4.55 for 24 h ultraviolet irradiation. Opacity values ranged from 0.75-0.82 before ultraviolet irradiation to 0.80-0.98 after 24 h ultraviolet irradiation. Among all the groups, Z100 and Filtek Z350 Flowable showed the biggest color change, while Filtek Z350 Universal showed the highest opacity. CONCLUSION: It can be concluded that for some products, ultraviolet irradiation leads to color instability and opacity variation.

[Effects of ultraviolet aging on color and translucency of composite resin cements].

OBJECTIVE: To investigate the color stability and translucency of four composite resin cements after ultraviolet (UV) aging. METHODS: 20 composite resin cement disks for four groups (Group A, dual cured, Biscem; Group B, light cured, Choice; Group C, self cured, PermaCem; Group D, self cured, RelyX Aplicap) were prepared according to their manufacture recommendation. Changes in color and translucency of test samples were determined before and after UV aging for 8, 16 and 24 hour using the CIE L* a* b* system by a colorimeter. The results were analyzed by LSD multi-compare tests. RESULTS: The color changes of composite resin cement disks suffering UV aging were significantly different when irradiated different time. For the same irradiated time, Group C had the highest delta E, and Group B and D had the smaller ones. Translucency was found no difference among different irradiated time for group A, B and D. Translucency of group C decreased after UV aging. CONCLUSION: Translucency of composite resin cement kept stable after UV aging, and color coordinate changed after UV aging.

[Effect of nano-silica coating prepared by different concentration silica sol on shear bond strength of alumina ceramic].

OBJECTIVE: To evaluate the effect of nano-silica coating prepared by different concentration silica sol on shear bond strength between alumina ceramic and resin cement. METHODS: Silica coating was prepared with colloidal silica sol on alumina ceramic surface that was treated with air particle abrasion. Infrared spectrum (IR), scanning electron microscopy (SEM) and energy dispersive spectrometer (EDS) were used to analyze the silica coating. A total of 32 alumina ceramic discs were randomly divided into 4 groups with 8 discs per group, which received different surface treatments as silane couple agent (control group), 20% silica sol + silane (group A), 30% silica sol + silane (group B), 40% silica sol + silane (group C). Each ceramic disc was bonded to composite with resin cement, and then shear bond strength of these samples was tested. RESULTS: It was observed from the IR pictures that symmetrically flexible vibration absorption kurtosis, anti-symmetrically flexible vibration absorption kurtosis, and bending vibration absorption kurtosis of Si-O-Si enhanced after heat treatment. SEM pictures showed that nanoparticles in coating gel were well distributed and some of them conglomerated after heat treatment. There was a little conglomeration in 20% coating, more in 30%, and the most in 40%. Contents of surface silicon increased after modification with silica coating prepared by sol-gel method. Bond strength of three groups with silica coating was significantly higher than that of the group with only silane couple agent [(1.881 +/- 0.156) MPa] (P < 0.05). Group B gained the highest strength [(4.852 +/- 0.178) MPa] compared with group A [(3.196 +/- 0.171) MPa] and group C [(3.576 +/- 0.671) MPa] (P < 0.05). CONCLUSIONS: Surface silicon contents all increased after surface modification with different concentration silica sol. Silica coating followed with silane couple agent could significantly enforce bond strength of alumina ceramic, with 30% silica sol group gaining the highest bond strength.

[Surface modification of dental alumina ceramic with silica coating].

OBJECTIVE: To make silica coating through sol-gel process, and to evaluate the wettability of dental alumina ceramic with or without coating. METHODS: Silica coating was prepared with colloidal silica sol on In-Ceram alumina ceramic surface which had been treated with air particle abrasion. Coating gel after heat treatment was observed with atomic force microscope (AFM), and was analyzed by infrared spectrum (IR) with gel without sintered as control. Contact angles of oleic acid to be finished, sandblasted and coated ceramic surface of were measured. RESULTS: AFM pictures showed that some parts of nano-particles in coating gel conglomerated after heat treatment. It can be seen from the IR picture that bending vibration absorption kurtosis of Si-OH also vanished after heat treatment. Among contact angles of three treated surface, the ones on polished surface were the biggest (P = 0.000, P = 0.000), and sandblasting+silica coating surface the smallest (P = 0.000, P = 0.003). CONCLUSION: Silica coating can be made with sol-gel process successfully. Heat treatment may reinforce Si-O-Si net structure of coating gel. Wettability of dental alumina ceramic with silica coating is higher than with sandblasting and polishing.