Objective To evaluate the clinical results of operative treatments for the complex posterior tibial plateau fractures via posterior approach. Methods Eleven cases with complex posterior tibial plateau fracture from June 2008 through June 2010 were reviewed retrospectively. There were 7 males and 4females, with age from 33 years to 60 years (average, 47.8 years). According to AO classification, there were 41-B2.2.4 type in 2 cases, 41-B3.1.2 type in 3, 41-B3.3.2 type in 3, 41-B3.1.2 type combined 41-B3.3.2 type in 2, 41-C3.3 type in 1. Carlson posterior lateral approach were used in 5 cases, posterior medial approach were used in 3 cases, and posterior medial and/or lateral approach combined with anterior approach were used in 3 cases. All fractures were fixed with plates. Autogenous ilium grafts were used if necessary.Results All cases were followed up. The average follow-up time was 1.6 years (range, 3-24 months). At the final follow-up visit, bone union was obtained in all cases. The mean Rasmussen score was 16.7 (range, 15-18), and the mean HSS was 86.2 (range, 75-96). The postoperative knee range of motion were 0°-135°, 0°-130° and -10°-125° in 5 cases with posterior lateral plateau fractures, 3 cases with posterior medial plateau fractures and 3 cases with anterior and posterior plateau and intercondylar fractures respectively. There was no vascular and nerve injuries. Loosing or breaking of hardware's was not found. Conclusion The Carlson posterior lateral and/or medial approach is preferred for the complex posterior plateau fractures, with the advantages of direct reduction and stabilization.
Key words:
Tibial fractures; Fracture fixation, internal; Treatment outcome
Objective To explore the classification and surgical treatment of scapular neck frac-tures. Methods A retrospective analysis was done based on the clinical data of 18 patients (including 12 males and 6 females) who accepted operation in Tianjin Hospital from January 2000 to December 2007. The average age of the patients was 41 years (17-62 years). All patients accepted CT examina-tion. According to Hardegger classification, there were 10 patients with anatomical neck fractures and eight with surgical neck fractures. According to Miller system, there were five patients with type II A fractures, six with type II B fractures, six with type II C fractures and one with type II B + IIC fracture. Of all, 15 patients had associated injury. The operative approach included posterolateral approach in nine patients, modified Judet approach in six and anteroposterior conjoint approach in three. Reconstruction plates and lag screws were applied to fix the fractures. Results All patients were followed up consecu-tively with an average period of 25. 5 months (6-70 months). The mean Constant-Murley score was 73 points (35-95 points, meadian 75.5 points) after treatment. There were two patients with malreduction,one with shoulder instability and three with traumatic arthritis postoperatively. Conclusions The indi-cations for early operation include: (1) angular deformity in horizontal or coronal planes of fractures, ie,glenopolar angle (GPA) <20°(2) fracture displacement =10 mm;(3) associated with floating shoul-der injury or superior suspensory shoulder complex injury. The major factors influencing prognosis are as-sociated injuries, quality of fractures reduction, fixation stability, injury of rotator cuff and postoperative rehabilitation.
Key words:
Scapula; Fractures; Fracture fixation; internal
The aim of this meta-analysis of randomized controlled trials (RCT) and retrospective cohort studies (CS) regarding the use of volar locking plate (VLP) and external fixation (EF) in distal radius fractures was to determine whether there was any evidence that one treatment was superior to the other.The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Electrical databases (PubMed, EMBASE and the Cochrane library) were retrieved to find RCTs and CSs met the eligibility criteria. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis with RevMan 5.1. The publication bias was test by Stata 14.0. The Begg's and Egger's test were performed by Stata 14.0. The quality of evidence was graded according to the criteria of GRADE. We ultimately included ten RCTs and eleven CSs.A total of 1590 subjects were reported. Publication bias was detected by funnel plot in RCTs. VLP could provide better results such as DASH scores (RCT: MD = -6.12, 95%CI = -12.07-0.17; CS: MD = -6.43, 95%CI = -12.53-0.3), ulnar variance (RCT: MD = -0.81, 95%CI = -1.25-0.37) and infection rate (RCT: RR = 0.25, 95%CI = 0.10-0.65; CS: RR = 0.15, 95%CI = 0.06-0.40). There were no significant differences for G-W scores, VAS and grip strength between the VLP group and EF group. There was significantly greater loss of volar tilt (P = 0.01) and radial inclination (P = 0.02) in patients receiving EF, basing on the CSs.VLP could provide better results, such as DASH scores, ulnar variance, volar tilt, radial inclination and infection rate. The use of VLP appear to be associated with better results of ROM (flexion, pronation, supination and radial deviation), radiographic parameters (volar tilt and radial inclination) and lower total complication rate and CRPS rate in CSs.Level 1, Therapeutic study.
Recent studies revealed that endoplasmic reticulum (ER) stress played an emerging role of in valve calcification. Tanshinone IIA (TanIIA) has been a research hotspot in cardiovascular diseases. Previously we found that sodium TanIIA dampened the pathological phenotype transition of valvular interstitial cells (VICs) by affecting ER stress published in Chinese Journal. Here, we test the hypothesis that TanIIA attenuates the pro-osteogenic effects of oxidized low-density lipoprotein (oxLDL) in VICs by reducing induction of ER stress. Patients' aortic valve (AV) was collected, and porcine VICs were cultured for in vitro model. ER stress markers were tested in human leaflets by immunostaining. Immunoblotting were used to test the osteoblastic factors such as Runx2, osteocalcin, and ER stress markers GRP78, CHOP, XBP1, etc. Alkakine phosphate (ALP) activity assay were used to test the activity of ALP kinase. Pro-inflammatory gene expression was detected by polymerase chain reaction. As a result, ER stress markers were elevated in patients' calcified AVs. OxLDL induced osteogenesis and inflammation via promoting ER stress. TanIIA attenuated oxLDL induced ER stress. TanIIA also inhibited theosteoblastic factors and inflammatory cytokine expressions in VICs. In conclusion, our data provide evidence that TanIIA exerts anti-inflammation and anti-osteogenic effects in VICs by attenuating ER stress, and ER stress acts as an important regulator in oxLDL induced VICs' phenotype transition.
Objective
To assess the clinical value of cross raft screws technique in preventing postoperative collapse of tibial plateau fracture.
Methods
From September 2014 to November 2017, data of 14 patients with tibial plateau fracture who were treated by cross raft screws technique were retrospectively analyzed. There were 9 males and 5 females aged from 30-65 years old (average, 44.4±1.7 years). There were 8 patients that the thickness of subchondral cancellous bone measured preoperatively by CT data was less than 4 mm, and 6 patients that the thickness of subchondral cancellous bone measured intraoperatively was less than 4 mm. 1/4 tubular plate was placed along the anterior rim of lateral tibial plateau, and the 3.5 mm cortical bone screws were fixed as bamboo raft from anterior to posterior through the plate. The collapse of tibial plateau after surgery were measured by CT scan after union of the fracture. The function of knee was evaluated by Rasmussen Anatomical and Functional Grading.
Results
The time of tubular plate procedure was 18 to 35 min (average, 24.1±5.4 min). All 14 patients were successfully followed-up for 13.8±5.1 months. The height of collapse preoperatively by CT scan was 5-21 mm (average, 8.00±1.40 mm). 3 days after the operation, the height between articular line and lateral articular surface was 0-2 mm (average, 0.80±0.06 mm). Compared with CT data preoperatively, the collapse was corrected postoperatively that was proved by CT scan (P< 0.05). After the fracture was healed, according to CT data, the height between articular line and lateral articular surface was 0-2 mm (average, 0.70±0.08 mm). Compared with CT data postoperatively, there was no postoperative collapse happened (P=0.466). The position and length of nails were placed appropriately. The average healing time of fracture was 3.6 months. There were no infection, nonunion and pain of tendon happened. The plate could be touched subcutaneously in 2 patients, who had no discomfort feelings. The patient's postoperative Rasmussen Anatomical Grading were 13-18 (average, 16.7), including 8 cases excellent and 6 cases good. The postoperative Rasmussen Functional Grading was 18-28 (average, 25.7), including 11 cases excellent and 3 cases good.
Conclusion
The cross raft screws technique is a good way to prevent the postoperative collapse of the lateral articular surface of tibial plateau.
Key words:
Tibial fractures; Fracture fixation, internal; Treatment outcome
Objective: Psoriasis is associated with a high prevalence of metabolic syndrome (MS), and patients with concomitant psoriasis and MS are more severely affected and less responsive to treatment. However, the molecular mechanisms behind these effects are unknown. Recent studies have shown that leptin may serve as a molecular link between psoriasis and MS, suggesting that high leptin concentrations may exacerbate psoriasis. However, the molecular mechanism of this effect is still unclear. We aimed to investigate the effect of leptin on autophagy in patients with psoriasis. Methods: From January 2021 to June 2022 in PLA General Hospital, we enrolled 51 patients with psoriasis, including 21 patients with MS and 30 without MS, and 30 healthy controls who had undergone nevus surgery. We measured the epidermal leptin, P62, and LC3B concentratins of patients by immunohistochemistry, and measured the serum leptin concentration by enzyme-linked immunosorbent assay. We then performed correlation analyses to compare these proteins’ concentrations between patients with concomitant psoriasis and MS, patients with psoriasis alone, and healthy control groups. Additionally, we performed western blotting after in vitro culture of HaCaT cells with different concentrations of leptin and measured the expression levels of the autophagy markers Beclin1, LC3B, and P62; the differentiation markers K10, K16, and K17; and PI3K/AKT/mTOR signaling pathway-related proteins of HaCat cells. Next, we transfected ATG5 into HaCaT cells to revert autophagy and used the specific PI3K inhibitor LY294002 to block PI3K/AKT/mTOR signaling. The expression levels of K10, K16, and K17 of HaCat cells were again measured. One-way analysis of variance was used for the comparison of means of multiple samples, and LSD- t post hoc test was used for comparison between the 2 groups. The counting data were analyzed by the chi-square test. Correlations were evaluated by Pearson correlation analysis. Results: The serum leptin concentration was significantly higher in patients with concomitant psoriasis and MS than in patients with psoriasis alone, and healthy controls (1,330.0 ± 244.2 pg/mL, 1,041.0 ± 282.7 pg/mL, and 760.4 ± 361.1 pg/mL, P < 0.001). Optical density of epidermal leptin concentration was significantly higher in patients with psoriasis and MS than in patients with psoriasis alone and healthy controls (0.59 ± 0.15, 0.39 ± 0.12, and 0.27 ± 0.19, P < 0.001). The level of the autophagy marker LC3B was strongly reduced and that of P62 was strongly increased in the epidermis of patients with concomitant psoriasis and MS compared with patients with psoriasis alone and healthy controls (optical density value: LC3B: 0.27 ± 0.11, 0.29 ± 0.13, and 0.46 ± 0.17, P < 0.001; P62: 0.18 ± 0.08, 0.13 ± 0.03, and 0.10 ± 0.03, P < 0.001). We also observed a positive correlation between leptin and P62 concentrations in the blood ( r = 0.40, P < 0.001) and epidermis ( r = 0.27, P = 0.017), and a negative correlation between serum leptin concentrations and epidermal LC3B concentrations ( r = −0.39, P < 0.001). In vitro , leptin significantly decreased Beclin1 and LC3B and increased P62. Western blotting showed that leptin treatment resulted in decreased expression of K10, and increased expressions of K16 and K17; when the decrease in autophagy was restored by ATG5, this phenomenon was reversed. In addition, leptin treatment significantly upregulated the expressions of phosphorylated PI3K, AKT, and mTOR in HaCaT cells compared with the control treatment; when the expression of phosphorylated PI3K was significantly inhibited by LY294002, leptin did not reverse the decreased expression of these proteins. Conclusion: Leptin is negatively associated with autophagy in psoriasis, and leptin markedly decreased autophagy and affected keratinocyte differentiation by downregulating autophagy via the PI3K/AKT/mTOR pathway. Our study enhances the understanding of leptin as the link between MS and psoriasis and provides potential therapeutic targets for patients with concomitant psoriasis and MS.
Parkinson's disease (PD) is a neurodegenerative disorder associated with α-synuclein aggregation and dopaminergic neuron loss in the midbrain. There is evidence that psychological stress promotes PD progression by enhancing glucocorticoids-related oxidative damage, however, the mechanisms involved are unknown. The present study demonstrated that plasma membrane phospholipid peroxides, as determined by phospholipidomics, triggered ferroptosis in dopaminergic neurons, which in turn contributed to stress exacerbated PD-like motor disorder in mice overexpressing mutant human α-synuclein. Using hormonomics, we identified that stress stimulated corticosteroid release and promoted 15-lipoxygenase-1 (ALOX15)-mediated phospholipid peroxidation. ALOX15 was upregulated by α-synuclein overexpression and acted as a fundamental risk factor in the development of chronic stress-induced parkinsonism and neurodegeneration. Further, we demonstrated the mechanism by which corticosteroids activated the PKC pathway and induced phosphatidylethanolamine-binding protein-1 (PEBP1) to form a complex with ALOX15, thereby facilitating ALOX15 to locate on the plasma membrane phospholipids. A natural product isolated from herbs, leonurine, was screened with activities of inhibiting the ALOX15/PEBP1 interaction and thereby attenuating membrane phospholipid peroxidation. Collectively, our findings demonstrate that stress increases the susceptibility of PD by driving membrane lipid peroxidation of dopaminergic neurons and suggest the ALOX15/PEBP1 complex as a potential intervention target.
Abstract Chimeric antigen receptor (CAR) T cells have been successfully used in adoptive cell therapy for malignancies. However, some obstacles, including side effects such as graft‐versus‐host disease and cytokine release syndrome, therapy resistance, limited sources, as well as high cost, limited the application of CAR T cells. Recently, CAR natural killer (NK) cells have been pursued as the effector cells for adoptive immunotherapy for their attractive merits of strong intrinsic antitumor activity and relatively mild side effects. Additionally, CAR NK cells can be available from various sources and do not require strict human leukocyte antigen matching, which suggests them as promising “off‐the‐shelf” products for clinical application. Although the use of CAR NK cells is restrained by the limited proliferation and impaired efficiency within the immunosuppressive tumor microenvironment, further investigation in optimizing CAR structure and combination therapies will overcome these challenges. This review will summarize the advancement of CAR NK cells, CAR NK cell manufacture, the clinical outcomes of CAR NK therapy, the challenges in the field, and prospective solutions. Besides, we will discuss the emerging application of other immune cells for CAR engineering. Collectively, this comprehensive review will provide a valuable and informative summary of current progress and evaluate challenges and future opportunities of CAR NK cells in tumor treatment.
To investigate the correlation between computed tomography (CT) values and bone mineral density (BMD) in elderly Chinese patients with proximal humeral fractures.This was a single-center retrospective study involving 166 elderly patients with proximal humeral fractures between January and June 2015 in our hospital. Following the inclusion and exclusion criteria, 89 patients were finally enrolled in this study. The spiral CT scanning was performed on these patients, and the CT images were obtained by using MIMICS software. The CT values in axial, coronal, and sagittal images of healthy proximal humeri were measured using a circular region of interest (ROI) by Image J. The bone mineral density (BMD) of the lumbar spine and femoral neck was measured using dual-energy X-ray absorptiometry (DXA). Spearman rank correlation methods were used for analysis of the association between the proximal humerus average CT value (CTMean ) and the lumbar spine as well as femoral neck BMD in patients with proximal humeral fractures, or osteoporotic patients.Among the included 89 patients, there were 26 males and 63 females, 69% and 84% of whom were diagnosed with osteoporosis, respectively. The lumbar spine and femoral neck BMD and the CTMean of the proximal humerus were higher in males than females with proximal humeral fractures (P < 0.05). This gender difference was also found in the osteoporotic patient population (P < 0.05). The Spearman rank correlation method showed that the lumbar spine and femoral neck BMD was closely related to the proximal humeral CTMean in males (r = 0.877, P = 0.000; r = 0.832, P = 0.000; respectively) and females (r = 0.806, P = 0.000; r = 0.616, P = 0.000; respectively) with proximal humeral fractures, as well as osteoporotic male (r = 0.745, P = 0.000; r = 0.575, P = 0.000; respectively) and female (r = 0.613, P = 0.000; r = 0.629, P = 0.000; respectively) patients.The CT value of the proximal humerus is a rapid and accurate method by which bone quality can be assessed in elderly patients with proximal humeral fractures. Moreover, the CT value of the proximal humerus is an alternative measurement of BMD that can guide surgeons in selecting the appropriate internal fixation material.
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