Hydrogen sulfide and nitric oxide regulate the adaptation to iron deficiency through affecting Fe homeostasis and thiol redox modification in Glycine max seedlings.

Iron (Fe) is a vital microelement required for the growth and development of plants. Hydrogen sulfide (H2S) and nitric oxide (NO), as messenger molecules, participated in the regulation of plant physiological processes. Here, we studied the interaction effects of H2S and NO on the adaptation to Fe deficiency in Glycine max L. Physiological, biochemical and molecular approaches were conducted to analyze the role of H2S and NO in regulating the adaptation to Fe deficiency in soybean. We found that H2S and NO had obvious rescuing function on the Fe deficiency-induced the plant growth inhibition, which was significantly correlated with the increase in Fe content in the leaves, stems, and roots of soybean. Meanwhile, H+-flux, ferric chelate reductase (FCR) activity, and root apoplast Fe content were significantly affected by H2S and NO. Under Fe deficiency conditions NO and H2S regulated the expression of genes related to Fe homeostasis. Moreover, photosynthesis (Pn) and photosystem II (PSII) efficiency were enhanced by H2S and NO, and thiol redox modification was important for regulating the adaptation of Fe deficiency. The aforementioned affirmative influences caused by H2S and NO were also totally reversed by cPTIO (a NO scavenger). Our results suggested that H2S might act upstream of NO in response to Fe deficiency by affecting the Fe homeostasis enzyme activities and gene expression, and by promoting Fe accumulation in plant tissues as well as by enhancing thiol redox modification and photosynthesis in soybean plants.

[Short-term effectiveness of TiRobot combined with O-arm navigation system in minimally invasive treatment of hindfoot fracture].

Objective: To investigate the short-term effectiveness of TiRobot combined with O-arm navigation system in the minimally invasive treatment of hindfoot fracture. Methods: Between March 2019 and March 2021, 25 patients with hindfoot fractures were admitted. There were 14 males and 11 females, with an average age of 51.7 years (range, 19-76 years). The causes of injuries included falling from height in 17 cases and traffic accident in 8 cases. The interval between injury and operation was 1-3 days (mean, 2.1 days). There were 16 cases of calcaneus fracture, 7 cases of talus fracture, and 2 cases of calcaneus and talus fractures. According to Sanders classification criteria, the calcaneus fractures were classified as type Ⅱ in 10 cases and type Ⅲ in 8 cases; according to the Hawkins classification criteria, the talus fractures were classified as type Ⅱ in 4 cases and type Ⅲ in 5 cases. Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 48.1±9.1. During operation, the fractures were fixed with the percutaneous cannulated screws with the assistance of the TiRobot combined with the O-arm navigation system. The operation time, hospital stay, and the occurrence of related complications were recorded. X-ray films were reviewed to evaluate the fracture healing and the occurrence of talus osteonecrosis, and the width, length, height, Böhler's angle, and Gissane's angle of the calcaneus were measured; AOFAS ankle-hindfoot score was used to evaluated the foot function. Results: The operation time ranged from 47 to 71 minutes (mean, 60.5 minutes). The length of hospital stay ranged from 2 to 5 days (mean, 3.4 days). All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17.3 months). One patient demonstrated hypoesthesia on the lateral side of foot after operation and recovered after symptomatic treatment. All fractures healed confirmed by X-ray films and the healing time ranged from 10 to 16 weeks (mean, 11.8 weeks). No talus osteonecrosis occurred during follow-up. There were significant differences in the width, length, height, Böhler's angle, and Gissane's angle of the calcaneus between pre-operation and at last follow -up ( P<0.05). At last follow-up, AOFAS ankle-hindfoot score was 91.2±5.0, the difference was significant when compared with preoperative score ( t=22.169, P<0.001). The results were excellent in 16 cases and good in 9 cases, with an excellent and good rate of 100%. Conclusion: TiRobot combined with O-arm navigation system for minimally invasive treatment of hindfoot fractures can obtain the satisfactory short-term effectiveness, with the advantages of less surgical trauma, precise fixation, and fewer complications.

The Efficacy of Teriparatide in Improving Fracture Healing in Hip Fractures: A Systematic Review and Meta-Analysis.

BACKGROUND: This systematic review and meta-analysis assessed the role of teriparatide in improving hip fracture healing and function to provide a clinical guide. METHODS: The systematic literature review identified randomized controlled trials (RCTs) and controlled studies evaluating teriparatide for elderly hip fractures. A meta-analysis was performed using RevMan version 5.3. RESULTS: This study included two RCTs and four retrospective studies comprising 607 patients, with 269 and 338 patients in the teriparatide and control groups, respectively. The quality of these six studies was moderate. Compared to the control group, teriparatide reduced the time to union (weighted mean difference (WMD) = -1.95; 95% confidence interval (CI): -3.23--0.68; P = 0.003) but did not improve the rate of fracture union at 3 months (odds ratio (OR) = 1.46; 95% CI: 0.50-4.24; P = 0.49) or 6 months (OR = 0.89; 95% CI: 0.44-1.81; P = 0.75). In addition, teriparatide did not decrease the complications, need for reoperation, mortality, rate of deformity after fracture healing, and subsequent fracture or improve hip function. CONCLUSIONS: The current limited evidence did not support that teriparatide improves fracture healing in hip fractures, due to study heterogeneity and various sources of biases. Further high-quality, large-sample trials are needed. This trial is registered with PROSPERO with registration number CRD42020152205.

Treatment outcomes after reduction of the target volume of intensity-modulated radiotherapy following induction chemotherapy in patients with locoregionally advanced nasopharyngeal carcinoma: A prospective, multi-center, randomized clinical trial.

PURPOSE: To investigate whether reducing the target volume of intensity-modulated radiotherapy (IMRT) after induction chemotherapy (IC) improves the quality of life (QOL) in locoregionally advanced nasopharyngeal carcinoma (NPC) without decreasing the local control and survival rate. PATIENTS AND METHODS: A total number of 212 NPC patients staged as III-IVb were randomly assigned to group A (n=97) or group B (n=115) in this prospective clinical trial. All patients received IC followed by cisplatin concurrent with IMRT. IMRT was planned using the images of pre-IC in group A and post-IC in group B. RESULTS: The dose received by normal tissues in group B was lower than that of group A (P<0.05). The recovery of the dry mouth symptoms in group B was significantly improved than group B. The quality of life (QOL) scores in group B were higher than group A. With a median follow-up of 35months, the 1-year estimated overall survival (OS), progression-free survival (PFS), locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS) in group A versus group B were 97.9% vs 97.3%, 90.7% vs 92,2%, 99.0% vs 98.2%, 91.8% vs 94.8%. The 2-year OS, PFS, LRFFS, DMFS in group A versus group B were 93.7% vs 92.9%, 83.4% vs 84.3%, 96.8% vs 95.5%, 86.5% vs 89.5%. The 3-year OS, PFS, LRFFS, DMFS in group A versus group B were 82.3% vs 87%, 74.7% vs 83.4%, 91.8 vs 93.9%, 81.3% vs 88.6%, respectively. CONCLUSION: Reducing the IMRT target volume after IC did not reduce the local control and survival rate in locoregionally advanced NPC but the doses received by normal tissues were decreased, and the QOL scores were improved.

Tranexamic acid reduces hidden blood loss in the treatment of intertrochanteric fractures with PFNA: a single-center randomized controlled trial.

BACKGROUND: Hidden blood loss is a major concern for patients undergoing hip surgery for intertrochanteric fracture. The objective of this study was to investigate whether tranexamic acid (TXA) could reduce postoperative hidden blood loss in patients undergoing hip surgery for intertrochanteric fracture. METHODS: A total of 77 patients with intertrochanteric fracture were enrolled in this randomized controlled study. Patients received either 200 mL (1 g) of TXA (n = 37) or normal-saline (NS) (n = 40) i.v. before hip surgery using proximal femoral nail anti-rotation (PFNA). Hemoglobin and hematocrit levels were measured preoperatively and postoperatively at day 1 and 3. Visible and hidden blood loss volumes were calculated at postoperative day 3. RESULTS: On postoperative day 3, the transfusion rate was significantly lower in the TXA group compared to the NS group, although mean hemoglobin and hematocrit levels were not significantly different between the two groups. However, the estimated hidden blood loss volume (210.09 ± 202.14 mL vs. 359.35 ± 290.12 mL; P < 0.05) and total blood loss volume (279.35 ± 209.11 mL vs. 417.89 ± 289.56 mL; P < 0.05) were significantly less in the TXA group compared to the NS group, respectively. CONCLUSION: TXA significantly reduced postoperative hidden blood loss in patients with intertrochanteric fracture who underwent PFNA. (Registration number: ChiCTR-INR-16008134).

Comparison of clinical outcomes between two methods of posterior lumbar interbody fusion in adult spondylolisthesis.

OBJECTIVE: To compare the clinical outcomes of posterior lumbar interbody fusion (PLIF) using simple cage alone fusion with pedicle screw fixation and autogenous bone grafting and cage fusion with pedicle screw fixation in adult spondylolisthesis. METHODS: From March 2003 to March 2004, twenty-seven patients with lumbar spondylolisthesis were divided in two groups. In group A, 15 patients were treated by PLIF using simple cage alone fusion with pedicle screw fixation, including 4 males and 11 females, aging 53-68 years. Isthmic defects were located at L4 in 9 cases, at L5 in 6 cases. Four patients were smokers. The preoperative mean disc space height was 5.4 +/- 2.3 mm, the mean percentage of slip was 36.8% +/- 7.2%. In group B, 12 patients were treated by PLIF using autogenous bone grafting and cage fusion with pedicle screw fixation, including 3 males and 9 females, aging 56 years. Isthmic defects were located at L4 in 8 cases, at L5 in 4 cases. Five patients were smokers. The preoperative mean disc space height was 5.7 +/- 2.5 mm, the mean percentage of slip was 37.8% +/- 6.2%. Two groups were compared in the amount of blood loss, duration of hospitalization, back pain, radiating pain, fusion rate, the intervertebral disc space height, the postoperative degree of slip and the fusion rate. RESULTS: All patients were followed up for 24-38 months. The mean follow-up was 29 (24-36) months in group A and 26 (24-38) months in group B. There were no statistically significant differences in follow-up period, age, sex, the location of isthmic defects, smoking, the preoperative disc space height and the percentage of slip between two groups (P > 0.05). There were no statistically significant differences in the amount of blood loss, the duration of hospitalization, the fusion time between two groups (P > 0.05). But there were statistically significant differences in the back pain score, the radiating pain score and the fusion rate between two groups (P < 0.05). The postoperative disc space height and the degree of slip of the last follow-up were 5.8 +/- 2.2 mm and 25.6% +/- 7.2% in group A, 6.2 +/- 2.5 mm and 24.1% +/- 7.4 % in group B, showing statistically significant difference (P < 0.05). CONCLUSION: The PLIF using autogenous bone grafting and cage fusion with pedicle screw fixations is more beneficial to improving the fusion rate and preventing longterm instabilities than simple cage alone fusion with pedicle screw fixation in adult spondylolisthesis.