Abstract Purpose Negative buttress reduction should be avoided in the treatment of femoral neck fractures (FNFs) using conventional fixation. As the femoral neck system (FNS) has been recently developed and utilized widely to treat FNFs, the association of reduction quality with postoperative complications and clinical function has not been clarified. The purpose of this study was to evaluate the clinical effect of nonanatomical reduction in young patients with FNFs treated with FNS. Methods This multicenter, retrospective cohort study included 58 patients with FNFs treated with FNS between September 2019 and December 2021. According to the reduction quality immediately following surgery, patients were classified into positive, anatomical, and negative buttress reduction groups. Postoperative complications were assessed with 12 months of follow-up. The logistic regression model was used to identify risk factors for postoperative complications. The postoperative hip function was assessed using the Harris hip scores (HHS) system. Results At a follow-up of 12 months, a total of eight patients (8/58, 13.8%) had postoperative complications in three groups. Compared with the anatomical reduction group, negative buttress reduction was significantly associated with a higher complication rate (OR = 2.99, 95%CI 1.10–8.10, P = 0.03). No significant associations were found between positive buttress reduction and the incidence of postoperative complications (OR = 1.21, 95%CI 0.35–4.14, P = 0.76). The difference was not statistically significant in Harris hip scores. Conclusion Negative buttress reduction should be avoided in young patients with FNFs treated with FNS.
Myasthenia gravis (MG) is an antibody-mediated autoimmune disease and its pathogenesis is closely related to CD4 + T cells. In recent years, gut microbiota is considered to play an important role in the pathogenesis of MG. Astragaloside IV (AS-IV) is one of the main active components extracted from Astragalus membranaceus and has immunomodulatory effects. To study the immunomodulatory effect of AS-IV and the changes of gut microbiota on experimental autoimmune myasthenia gravis (EAMG) mice, we explore the possible mechanism of AS-IV in improving MG.In this study, network pharmacology was utilized to screen the crucial targets of AS-IV in the treatment of MG. Subsequently, a Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was performed to identify potential pathways through which AS-IV acts against MG. Furthermore, experimental investigations were conducted to validate the underlying mechanism of AS-IV in MG treatment. Before modeling, 5 mice were randomly selected as the control group (CFA group), and the other 10 were induced to EAMG model. These mice were randomly divided into EAMG group and EAMG + AS-IV group, n = 5/group. In EAMG + AS-IV group, AS-IV was administered by gavage. CFA and EAMG groups were given the same volume of PBS. Body weight, grip strength and clinical symptoms were assessed and recorded weekly. At the last administration, the feces were collected for 16S RNA microbiota analysis. The levels of Treg, Th1 and Th17 cells in spleen and Th1 and Th17 cells in thymus were detected by flow cytometry. The levels of IFN-γ, IL-17 and TGF-β in serum were measured by ELISA. Furthermore, fecal microbial transplantation (FMT) experiments were performed for exploring the influence of changed intestinal flora on EAMG. After EAMG model was induced, the mice were treated with antibiotics daily for 4 weeks to germ-free. Then germ-free EAMG mice were randomly divided into two groups: FMT EAMG group, FMT AS-IV group, n = 3/group. Fecal extractions from EAMG and EAMG + AS-IV groups as gathered above were used to administered daily to the respective groups for 4 weeks. Body weight, grip strength and clinical symptoms were assessed and recorded weekly. The levels of Treg, Th1 and Th17 cells in spleen and Th1 and Th17 cells in thymus were detected at the last administration. The levels of IFN-γ, IL-17 and TGF-β in serum were measured by ELISA.The network pharmacology and KEGG pathway analysis revealed that AS-IV regulates T cell pathways, including T cell receptor signaling pathway and Th17 cell differentiation, suggesting its potential in improving MG. Further experimental verification demonstrated that AS-IV administration improved muscle strength and body weight, reduced the level of Th1 and Th17 cells, enhanced the level of Treg cells, and resulted in alterations of the gut microbiota, including changes in beta diversity, the Firmicutes/Bacteroidetes (F/B) ratio, and the abundance of Clostridia in EAMG mice. We further conducted FMT tests and demonstrated that the EAMG Abx-treated mice which were transplanted the feces of mice treated with AS-IV significantly alleviated myasthenia symptoms, reduced Th1 and Th17 cells levels, and increased Treg cell levels.This study speculated that AS-IV ameliorates EAMG by regulating CD4 + T cells and altering the structure and species of gut microbiota of EAMG.
Objective: To determine the efficacy of femoral neck system compared to dynamic hip screws in treating femoral neck fractures. Method: The systematic review was conducted from January to March 2023, and comprised literature search on PubMed, Embase, Scopus, Ovid, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure and Wanfang databases for relevant studies published up to March 1, 2023. Study data as well as demographic and outcome parameters related to the patients were extracted, and the methodological index for non-randomised studies was used to assess the risk of bias. Review Manager software was used to conduct meta-analysis. Results: Of the 567 studies initially found, 6(1%) were included, with the publication date ranging from August 2021 to February 2023. There were 5(83.3%) studies published in English and 1(16.7%) in Chinese. Of the 577 patients with femoral neck fractures, 287(49.7%) were treated with femoral neck system and 290(50.3%) with dynamic hip screws. Significant differences were shown between the two groups regarding operation duration, blood loss, internal fixation failure rate and Harris hip score (p=<0.05). There was no significant differences between the groups regarding time from injury to surgery, hospitalisation, complication rate and femoral neck shortening rate (p>0.05). Conclusion: The novel femoral neck system could optimise surgical procedures, with shorter operation times and lesser blood loss. The femoral neck system and dynamic hip screws were comparable in terms of complication rates and postoperative hip function. Key Words: Femoral neck fractures, Internal fixators, Meta-analysis.
Introduction: The pathophysiology of myasthenia gravis (MG), an autoimmune disease affecting the neuro-muscular junction, is closely related to thymic disorders (thymic hyperplasia, thymic involution, thymic neoplasms). Myasthenia gravis often causes or exacerbates thymus disease, which often occurs together with myasthenia gravis. Further studies are needed to determine the relationship between thymus properties and quantitative myasthenia gravis (QMG), swallowing, and respiratory function in patients with myasthenia gravis. Methods: From 2021 to 2022, 93 MG patients with definite thymic disease were found by thymic CT or histopathological biopsy in the Myasthenia Gravis Treatment Center of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine. The Quantitative Myasthenia Gravis (QMG) score was used by physicians at the deputy high level and above to measure patients' swallowing and respiratory function. The purpose of this study was to observe the relationship between myasthenia gravis thymic disease and QMG score, swallowing function score, and respiratory function score. Results：The poor swallowing function score (3 points) accounted for 58.9%, 4.8%, and 13.6% in the thymoma group, thymic hyperplasia group, and thymus without abnormality group, respectively, and the difference between the groups was statistically significant (P<0.05). The respiratory function score was poor (3 points), and the thymus group accounted for 58.7%, which was significantly higher than the thymic hyperplasia group and the thymus without abnormality group. There was significant difference between groups (P<0.05). Myasthenia gravis quantitative score (QMG)>20 points (severe), the thymoma group accounted for 77%, which was significantly larger than the thymic hyperplasia group, and the thymus group had no abnormality, and the difference between the groups was significant (P<0.05). After multiple comparison test results, it was found that the QMG score of the thymoma group was 1.07298 higher than that of the normal thymus, and the difference was significant. The swallowing score of the thymoma group was 1.461 higher than that of the normal thymus group, and the difference was significant. The respiratory function score of the thymoma group was 0.832 higher than that of the normal thymus group, and the difference was significant. The lung function score of the thymoma group was significantly higher than that of the thymic hyperplasia group by 1.509.
Paclitaxel (PTX) is a first-line drug for ovarian cancer (OC) treatment. However, the regulatory mechanism of STUB1 on ferroptosis and PTX resistance in OC remains unclear. Genes and proteins levels were evaluated by RT-qPCR, western blot and IHC. Cell viability and proliferation were measured by CCK-8 and clone formation. The changes of mitochondrial morphology were observed under a transmission electron microscope (TEM). Reactive oxygen species (ROS), iron, malondialdehyde (MDA) and glutathione (GSH) were measured using suitable kits. The interactions among STUB1, HOXB3 and PARK7 were validated using Co-IP, and dual luciferase reporter assay. Our study found that STUB1 was decreased and PARK7 was increased in tumor tissue, especially from chemotherapy resistant ovarian cancer tissue and resistant OC cells. STUB1 overexpression or PARK7 silencing suppressed cell growth and promoted ferroptosis in PTX-resistant OC cells, which was reversed by HOXB3 overexpression. Mechanistically, STUB1 mediated ubiquitination of HOXB3 to inhibit HOXB3 expression, and HOXB3 promoted the transcription of PARK7 by binding to the promoter region of PARK7. Furthermore, STUB1 overexpression or PARK7 silencing suppressed tumor formation in nude mice. In short, STUB1 promoted ferroptosis through regulating HOXB3/PARK7 axis, thereby suppressing chemotherapy resistance in OC. STUB1 mediates the degradation of HOXB3 through ubiquitin, and the decrease of HOXB3 inhibits the level of PARK7, thereby promoting ferroptosis in drug-resistant ovarian cancer cells.
Introduction: While thymectomy is a recommended therapy for patients with Myasthenia Gravis (MG), there is insufficient evidence of its benefits over other therapies in patients in China, specifically, or of the most optimal timing for the procedure. Thus, there remains a clinical need for the investigation of these questions. Therefore, it is important to compare the clinical efficacy of thymectomy plus oral prednisone, an immunosuppressant protocol with prednisone, or immunosuppressants alone. Conclusion: We propose here to prospectively assess 822 cases of MG and 1886 medical records from individuals hospitalized at the First Affiliated Hospital of Guangzhou University of Chinese Medicine and follow them for 3 years. Inclusion criteria will include the following: a Myasthenia Gravis Foundation of America (MGFA) clinical classification between I and IV while on optimal anticholinesterase therapy with or without oral prednisone or immunosuppressive therapy, an MG history of longer than 3 years, being 18 to 60 years of age, and positive testing for serum acetylcholine receptor antibodies (AchR-Ab). Both thymomatous-naïve and non-naïve participants will be included. The primary outcomes will be: mortality, frequency of myasthenic crises, MGFA classification, and changes to the required dose of prednisone and immunosuppressants. Based on these outcomes, we will evaluate the efficacy of thymectomy as well as oral drugs in managing patients with nonthymomatous MG. As of September 2017, this study has been approved by the ethics committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine and the Registration number is ChiCTR1800017564(Version1.0, September 8,2017).
[Introduction] Early gastric cancer with current Helicobacter pylori infection (HpC-EGC) is common but still unclear whether H. pylori eradication therapy (Hp-ET) or endoscopic submucosal dissection (ESD) should be performed first. We evaluated Hp-ET’s short-term effects on horizontal boundary delineations of HpC-EGC in ESD. [Methods] Prospectively enrolled HpC-EGC patients were randomly assigned to eradication or control groups. Operation scopes of HpC-EGC lesion were delineated with marking dots at 5 mm out of the endoscopic demarcation line by an independent endoscopist, unaware of eradication status, before formal circumferential incision. As representatives, precise delineation rate, the shortest distance of all marking dots to the pathological demarcation line in all slices of one intact resected specimen (Dmin), and negative marking dot specimen rate were examined. [Results] 23 HpC-EGC patients (25 lesions) were allocated to eradication group and 26 patients (27 lesions) were allocated to control group with similar eradication success rates and all were differentiated type. With improving background mucosa inflammation after Hp-ET and similar gastritis-like epithelium rates, 10 lesions (40.0%) in eradication group were of precise delineation compared to control group with 2 lesions (7.4%) (RR = 5.40, 95% CI 1.31-22.28). Dmin of eradication and control groups were 4.17 ± 2.52 mm and 2.67 ± 2.30 mm (p = 0.029), accompanied by 4 (14.8%) and none (0.0%) specimens that exhibited positive marking dots (p = 0.11), respectively. [Conclusion] For HpC-EGC patients, administrating eradication medication before ESD is beneficial for the precise delineation of lesions and reducing the risk of positive horizontal resection margins.
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