Mortality and Related Risk Factors of Fragile Hip Fracture.

OBJECTIVE: To explore the mortality of patients with fragile hip fractures and assess the death-associated risk factors. METHODS: A total of 690 patients with osteoporotic hip fractures (age, 50-103 years) that were treated from January 2010 to December 2015 were enrolled and followed-up in this study and the clinical data were retrospectively collected. Three months, 1 year, and the total mortality were measured. Mortality-related risk factors were assessed including age, gender, surgery, the duration from injury to operation, pulmonary infection, and the number and type of complications. The mortality of each group was compared by chi-square test or corrected chi-square test for univariate analysis, and the factors with statistically significant mortality difference confirmed by univariate analysis were analyzed by binary logistic multivariate analysis. RESULTS: The 3-month mortality was 7.69%, the 1-year mortality was 15.60%, and the total mortality of the follow-up time was 24.06%. The 1-year and total mortality during the follow-up of the patients were higher in the >75-year-old group than those in the ≤75-year-old group (p = 0.000, respectively); were higher in the male patients than that in the female patients (p = 0.042; p = 0.017, respectively); were significantly lower in the operation group than that in the non-operation group (p = 0.000, respectively); were significantly lower in the patients that underwent the operation in ≤5 days than the patients that underwent the operation within >5 days (p = 0.008; p = 0.000, respectively); were significantly lower in patients with >2 kinds of combined medical diseases than those with ≥2 kinds of chronic diseases (p = 0.000, respectively); were significantly lower in patients receiving anti-osteoporosis treatment than in patients not receiving anti-osteoporosis treatment (p = 0.000, p = 0.002, respectively). Binary logistic regression analysis showed that the independent risk factors affecting mortality included advanced age >75-years-old (OR = 5.653, p = 0.000), male (OR = 1.998, p = 0.001), non-surgical treatment (OR = 9.909, p = 0.000), the number of combined medical diseases ≥2 (OR = 1.522, p = 0.042), and non-anti-osteoporosis treatment (OR = 1.796, p = 0.002). CONCLUSION: Age, whether or not surgical treatment was performed, the number of medical diseases, and whether or not anti-osteoporosis treatment was performed were independent risk factors for 3-month and 1-year mortality in patients with fragile hip fractures.

Analysis of Related Factors of Brittle Hip Fracture in Postmenopausal Women with Osteoporosis.

OBJECTIVE: To investigate the effects of age, body mass index (BMI), bone mineral density (BMD), and levels of serum 25-hydroxyvitamin D (25OHD) on hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. METHODS: A total of 252 postmenopausal women patients, whose bone density had reached the threshold of osteoporosis and age ≥50 years (50-98 years), collected from the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018, were performed by retrospective analysis. According to whether or not they had a hip fracture, including femoral neck fracture or intertrochanteric fracture, the patients were divided into two groups, including 117 cases (50-84 years old) in the non-hip fracture group and 135 cases (57-98 years old) in the hip fracture group. BMD was measured by Hologic Discovery A DXA bone mineral densitometer. Levels of serum 25OHD were detected by ROCHE detection instrument. Comparisons of age, BMI, bone density of femoral neck, and levels of serum 25OHD between the two groups were performed by using the Student's t-test. Furthermore, the statistically significant factors were analyzed by multiple regression analysis to investigate the independent risk factors of hip fracture. RESULTS: The group without hip fracture: 117 cases; average age: 67.4 ± 8.5 years; BMI: 22.3 ± 3.2 kg/m2 ; bone density of femoral neck: (0.504 ± 0.067) g/cm2 ; T-value of femoral neck: -3.1 ± 0.6; levels of serum 25OHD: (24.9 ± 8.5) ng/mL. The group with brittle hip fracture: 135 cases; average age: 80.7 ± 7.6 years; BMI: 20.3 ± 3.5 kg/m2 ; bone density of femoral neck: (0.426 ± 0.077) g/cm2 ; T-value of femoral neck: -3.8 ± 0.7; levels of serum 25OHD: (15.9 ± 8.9) ng/mL. Age, BMI, bone density of femoral neck, and 25OHD level of the group without hip fracture were markedly lower than hip fracture group (P < 0.05). The results of logistic regression analysis suggested that age, bone density of femoral neck, and levels of serum 25OHD were independent risk factors for fragile hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. CONCLUSION: Higher age, lower levels of bone density and 25OHD are the main risk factors of hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.

Anti-Osteoporosis Medications Associated with Decreased Mortality after Hip Fracture.

OBJECTIVE: To study the effect of anti-osteoporosis therapies on mortality after hip fracture. METHODS: This retrospective study was carried out in the Second Affiliated Hospital of Fujian Medical University and enrolled 690 patients 50 years of age and older who were admitted with hip fractures between 2010 and 2015. The patients were followed in 2017: 690 patients aged was from 50 to 103 years. There were 456 women and 234 men. There were 335 patients with fractures of the femoral neck and 355 patients with intertrochanteric fractures of the femur. There were 444 (64.35%) patients who also had internal diseases. The Charlson comorbidity index was 0-6. The anti-osteoporosis medications were classified into no anti-osteoporosis medication, calcium + vitamin D supplementations, non-bisphosphonate medication, and bisphosphonate medication. The physicians followed the patients or family members by personal visit and telephone. Multivariable Cox regression analyses were done with known risk factors for mortality of hip fracture, such as gender, age, number of combined internal diseases, fracture type, place of residence, and Charlson comorbidity index, to show which anti-osteoporosis medications had significant effects on mortality after adjustment for these variables. RESULTS: Out of 690 patients with hip fractures, 149 patients received no anti-osteoporosis medication, 63 patients received calcium +vitamin D supplementations, 398 patients received non-bisphosphonate medication, and 80 patients received bisphosphonate medication. The patients were followed between 7 months and 52 months, with the average of 28.53 ± 9.75 months. A total of 166 patients died during the follow-up period. Of 166 deaths, 43 occurred within 3 months, 65 within 6 months, and 99 within 1 year after the hip fracture. In this study, fracture type, place of residence, and Charlson comorbidity index were not associated with the mortality, and the male gender, age > 75 years, and ≥ 2 combined internal diseases were the independent factors for deaths post-hip fracture. The cumulative mortality was 36.24% in the patients receiving no anti-osteoporosis medication. The hazard ratio for mortality after hip fracture with bisphosphonate medication, non-bisphosphonate medication, and calcium/vitamin D supplementation was 0.355 (95% CI, 0.194-0.648), 0.492 (95% CI, 0.347-0.699) and 0.616 (95% CI, 0.341-1.114), respectively, as compared with no anti-osteoporosis group. Bisphosphonate and non-bisphosphonate medications for osteoporosis were significantly associated with the reduction of cumulative mortality post-hip fracture (P < 0.01). CONCLUSIONS: Bisphosphonate and non-bisphosphonate medications for osteoporosis were significantly associated with decreased mortality after fragility hip fracture.

Repression of let-7b-5p prevents the development of multifidus muscle dysfunction by promoting vitamin D accumulation via upregulation of electron transfer flavoprotein alpha subunit in a rat model of multifidus muscle injury.

Multifidus muscle dysfunction is associated with the multifidus muscle injury (MMI), which ultimately result in the low-back pain. Increasing evidence shows that microRNAs (miRs) may be involved in multifidus muscle dysfunction. In this study, we tested the hypothesis that downregulation of let-7b-5p may inhibit the multifidus muscle dysfunction development and progression. The target prediction program and luciferase activity determination confirmed electron transfer flavoprotein alpha subunit (ETFA) as a direct target gene of let-7b-5p. To study the mechanisms and functions of let-7b-5p in relation to ETFA in MMI progression, we prepared rats with experimental MMI, and a lentivirus-based packaging system was designed to upregulate expressions of let-7b-5p, and downregulate the expression of ETFA. ETFA was identified as a target gene of let-7b-5p. Older age, a longer duration of pain, and higher visual analog scale and Oswestry disability index scores for the patients with chronic low-back pain were linked to a more severe degree of degenerative muscle atrophy and fatty infiltration. Increased expression of let-7b-5p and decreased expression of ETFA and vitamin D receptor (VDR) were positively correlated with multifidus muscle dysfunction. Downregulated let-7b-5p could inhibit infiltration of collagen fibers, reverse the ultrastructural changes of multifidus muscle, and induce the VDR expression, thereby repair the MMI. The results provided a potential basis for let-7b-5p that could support targeted intervention in multifidus muscle dysfunction. Collectively, this study confirmed that downregulation of let-7b-5p has a potential inhibitory effect on the development of the function of the musculus myocytes by upregulating ETFA.

Effect of osteoprotegerin gene polymorphisms on the risk of cervical spondylotic myelopathy in a Chinese population.

OBJECTIVE: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Our study aims to explore the correlation of osteoprotegerin (OPG) gene polymorphisms and the risk factors and severity of CSM. PATIENTS AND METHODS: The peripheral blood samples from 494 CSM patients and 515 healthy individuals were collected for detecting the 950T/C, 1181G/C and 163A/G genotypes and genetic equilibrium of OPG in the CSM and control groups and analyzing the genotype distribution and allele frequency. The severity of CSM and the impaired segments were evaluated by the Japanese Orthopedic Association (JOA) scoring combined with cervical magnetic resonance imaging (MRI), in order to investigate the relations between the three genotypes of OPG promoter gene loci (950T/C, 163A/G and 1181G/C) and occurrence as well as severity of CSM. RESULTS: The risk rate of TC genotype carrier suffered from CSM was 0.46, of TT genotype carrier was 0.27. The risk rate of T allele carrier suffered from CSM was 0.37. In 950T/C single nucleotide polymorphism (SNP), patients with TC, TT and T genotypes had lower risk to suffer from CSM. CONCLUSION: Taken together, OPG 950T/C SNP protects against CSM, and it is correlated with the severity of CSM, providing a new idea for the prevention and treatment of CSM.

LncRNA DLX6-AS1/miR-129-5p/DLK1 axis aggravates stemness of osteosarcoma through Wnt signaling.

Osteosarcoma is the most common primary bone tumor and occurs most frequently in adolescents. Cancer stem cells (CSCs) are resistant to chemotherapy and radiotherapy, and can drive cancer recurrence. In this study, we aimed to investigate the effect of Long noncoding RNAs (lncRNAs) DLX6-AS1 on osteosarcoma stemness and the underlying mechanism involved. DLX6-AS1 enhanced osteosarcoma stemness in vitro and in vivo. Moreover, DLX6-AS1 competitively interacted with miR-129-5p to DLK1, resulting in activation of Wnt signaling and promotion of stemness in osteosarcoma. DLX6-AS1 functionally interplayed with miR-129-5p to form a reciprocal feedback loop to activate Wnt signaling. High DLX6-AS1 expression was observed in osteosarcoma tissues, and predicted a poor prognosis for osteosarcoma patients. Our study suggests that DLX6-AS1, combined with miR-129-5p and DLK1, can be utilized as factors for the clinical diagnosis and prognosis of osteosarcoma, and may be potential targets for the treatment of osteosarcoma.

Hyperspectral Imaging Detection of Total Viable Count from Vacuum Packing Cooling Mutton Based on GA and CARS Algorithms.

In the process of spectral modeling, spectral extraction of characteristic bands with different variable screening algorithms is an important step for improving the model effects. Total viable count of cooling mutton under vacuum packing condition was chosen as the research index in this paper, while the influence of 2 variable screening algorithms on its hyperspectral PLS model effects was compared. Mutton muscle spectra of Regions of interest (ROIs) were extracted and preprocessed. Subsequently, Genetic Algorithm (GA) and Competitive Adaptive Reweighted Sampling (CARS) were applied to extract characteristic bands from preprocessed spectra at full band range of 473～1 000 nm. Model effects of GA-PLS, CARS-PLS and W-PLS with corresponding bands selection were contrasted and analyzed. The results indicated that both model effects of GA-PLS, CARS-PLS were better than that of W-PLS, and CARS-PLS model effect was optimal. As for the CARS-PLS model, the determination coefficient (R2c) and root mean square error (RMSEC) of calibration set was 0.96 and 0.29, and the determination coefficient (R2cv) and root mean square error (RMSECV) of leave-one-out cross validation was 0.92 and 0.46, respectively. Meanwhile, the determination coefficient (R2p), root mean square error of prediction (RMSEP) and the ratio of standard deviation to standard error of prediction (RPD) of prediction set was 0.92 and 0.47 and 3.58, respectively. Therefore, hyperspectral imaging (HSI) technology combined with CARS-PLS can achieve quick, non-destructive and accurate detection of mutton total viable count.

[Study on the Rapid Evaluation of Total Volatile Basic Nitrogen (TVB-N) of Mutton by Hyperspectral Imaging Technique].

Total Volatile Basic Nitrogen (TVB-N) was usually taken as the physicochemical reference value to evaluate the mutton freshness. In order to explore the feasibility of hyperspectral (HSI) imaging technique to detect mutton freshness, 71 representative mutton samples were collected and scanned using a diffuse reflectance hyperspectral imaging (HSI) system in the Visible-Near infrared (NIR) spectral region (400-1 000 nm), and the chemical values of TVB-N content were determined using the semimicro Kjeldahl method according to the modified Chinese national standard. The representative spectra of mutton samples were extracted and obtained after selection of the region of interests (ROIs). The samples of calibration set and prediction set were divided at the ratio of 3 : 1 according to the content gradient method. Optimum HSI calibration models of the mutton (TVB-N) were established and evaluated by comparing different spectral preprocessing methods and modeling methods, which included Stepwise Multiple Linear Regression (SMLR), Partial Least Squares Regression (PLSR) and Principal Component Regression (PCR) methods. The results are that through the utilization of Multiplicative Scatter Correction (MSC), first derivative, Savitzky-Golay (S-G) smoothing and mean-centering together, both PLSR and PCR were able to achieve quantitative detection of mutton TVB-N. As for the PLSR model of mutton TVB-N established, the spectral pretreatment methods chosen included MSC, first derivative, S-G (15,2) smoothing and mean-centering, and the latent variables (LVs) number used was 11. As for the calibration set of PLSR model of mutton TVB-N, the correlation coefficient (r) and root mean square error of calibration (RMSEC) were 0.92 and 3.00 mg x (100 g)(-1), respectively. As for the prediction set of PLSR model of mutton TVB-N, the correlation coefficient (r), Root Mean Square Error of Prediction (RMSEP), and ratio of standard deviation to standard error of prediction (RPD) were 0.92, 3.46 mg x (100 g)(-1) and 2.35, respectively. The study demonstrated that the rapid and accurate analysis of TVB-N, the key freshness attribute, could be implemented by using the hyperspectral imaging (HSI) technique. The study provides the basis for further rapid and non-destructive detection of other mutton freshness attributes by using the hyperspectral imaging (HSI) technique, the improvement of current modeling effect of TVB-N content and the application involved of the technique in the practical production.

[Study on Characteristic Bands Selection of Lamb pH Value Based on Hyperspectral Imaging and Partial Least Squares(PLS)].

Characteristic bands method selection and subsequent spectral extraction has a great influence on the hyperspectral model performance. For rapid and accurate detection of mutton pH value, the effects of 2 band-selection methods on PLS models of mutton pH based on HSI technique were carried out and discussed. Initially, the preprocessing method of second derivative (2D), multiplicative scatter correction (MSC) and mean-centering together was implemented on the representative spectra of mutton muscle portion. Then, 2 methods of synergy interval partial least square (siPLS) and the combination of synergy interval partial least squares with genetic algorithm (siPLS-GA) were used to extract the characteristic bands in the spectral range of 473～1 000 nm. Finally, 2 PLS models of lamb pH value were established with the corresponding characteristic bands, and were also compared with the effect of full-band PLS model. The results indicated that the effect of siPLS-GA-PLS model was the best. As for the siPLS-GA-PLS model, 56 characteristic wavelength points were chosen, the correlation coefficient(Rcal) and root mean square error(RMSEC) of calibration set was 0.96 and 0.043 respectively, and the correlation coefficient(Rp) and root mean square error(RMSEP) of prediction set was 0.96 and 0.048 respectively. Spectral variables were reduced and model accuracy was improved. It can be concluded that characteristic bands selection and rapid and accurate detection of lamb pH can be achieved using hyperspectral imaging technique combined with siPLS-GA method.

[Surgical options for delayed osteoporotic vertebral collapse].

OBJECTIVE: To investigate the surgical options and clinical effects of delayed osteoporotic vertebral collapse. METHODS: From May 2010 to October 2014, 19 patients (20 vertebrae) with delayed osteoporotic vertebral collapse(Kümmell's disease) were enrolled in this study. There were 7 males and 12 females, aged from 65 to 87 years old with a mean of (73.5±5.62) years. According to Li staging system of Kümmell's disease, 3 cases were stage II, 13 cases (14 vertebrae) were stage III without spinal cord injury, 3 cases were stage III with spinal cord injury. Patients were respectively treated with percutaneous vertebroplasty(PVP) or percutaneous kyphoplasty(PKP) on the basis of the degree of postural reduction during operation. Injected cement volume, cement leakage, vertebral height restoration and local kyphotic reduction were observed. Visual analogue scale (VAS) and Oswestry Disability Index(ODI) were respectively used to assess the pain and function before and after operation. Frankel grade were used to evaluate neurological status. RESULTS: Seven vertebrae with satisfactory postural reduction were treated with PVP, 13 vertebrae with unsatisfactory postural reduction were treated with PKP, 3 patients with spinal cord injury were treated with decompression and posterior short segment fixation at the same time. All patients were followed up from 10 to 48 months with an average of 21.2 months. Cement leakage occurred in 4 cases with no symptom, 1 cases in PVP group and 3 cases in PKP group, there was no significant difference between two groups(P=0.561). The priming volume of cement was (6.40±0.94) ml in PVP group and (5.46±1.09) ml in PKP group (P>0.05). Three days after operation vs preoperation, the vertebral height restoration and kyphotic improvement was(31.71±11.35)%, (9.79±4.64)° in PVP group and (24.77±8.51)%, (8.15±2.97)° in PKP. There was no significant difference between two groups(P>0.05). Three days after operation, VAS of low back pain and ODI in all patients were improved than preoperative data(P<0.05), but there was no significant difference between two groups or between postoperative at 3 d and final follow up(P>0.05). Nerve function of 3 patients underwent decompression and fixation from Frankel D to E. CONCLUSIONS: According to Li staging system and the degree of introperative postural reduction, individualized surgical treatment for Kümmell's disease can obtain good clinical results. Bad postural reduction during operation maybe a risk factor of cement leakage.

[Case-control study on suture-assisted locking plate for the treatment of proximal humeral fractures in elderly].

OBJECTIVE: To explore clinical effects of suturing-assisted locking plate in treating elderly proximal humeral fractures. METHODS: From January 2005 to January 2013, 55 elderly patients with three- and four-part fractures of proximal humeral fractures were divided into treatment group and control group. In treatment group, there were 31 patients including 12 males, and 19 females aged from 65 to 85 with an average of (74.00±5.42) years old, and treated with suturing-assisted locking plates; 19 patients were Neer 3-part fractures, and 12 patients were Neer 4-part fractures of proximal humerus; 23 patients were suffered from low-energy injuries and 8 patients were caused by high-energy injuries. In control group, there were 24 patients including 7 males, and 17 females aged from 65 to 85 with an average of (72.79±5.34) years old, and treated with locking plates; 16 patients were Neer 3-part fractures, and 8 patients were Neer 4-part fractures of proximal humerus; 17 patients were suffered from low-energy injuries and 7 patients were caused by high-energy injuries. Operative time, blood loss during operation, and bone healing time between two groups were observed and compared. Postoperative Neer scoring were used to evaluate recovery of shoulder joint function. RESULTS: All patients were followed up from 6 to 24 months with an average of 16.1 months. In treatment group, blood loss was (495.806±143.150) ml, function of Neer scoring was 22.645±2.443, range of action was 18.194±2.613, anatomy was 7.935±1.504 and total score of Neer scoring was 77.161±8.335; while in control group, blood loss was (641.667±169.851) ml, function of Neer scoring was 13.958±1.989, range of action was 13.083±2.165, anatomy was 5.500±1.978 and total score of Neer scoring was 58.792±7.313. There were sigificant difference between two groups in these indexes. CONCLUSION: Suturing-assisted locking plate for the treatment of proximal humerus fractures in elderly, has advantages of less blood loss, simple fracture reduction and rapid recovery of shoulder joint, and is a effective method.