Femoral head necrosis rate and risk factors after internal fixation of femoral neck fracture:a Meta-analysis / 中国骨伤

OBJECTIVE@#To study the incidence and risk factors of osteonecrosis of the femoral head (ONFH) after internal fixation in adult patients with femoral neck fracture (FNF) after 2000, and identify high-risk population of ONFH.@*METHODS@#PubMed, Medline, The Cochrane Library, CNKI, Wanfang and VIP Database were searched to collect all the literatures on ONFH and related risk factors after internal fixation of FNF from January 1th 2000 to July 1th 2020. Study extraction was performed according to inclusion and exclusion criteria. Endnote X9 and Excel 2019 were used for literatures extraction, management and data entry, and R Studio 3.6.5 software was used for Meta-analysis. Subgroup analysis, sensitivity analysis and publication bias detection were used to explore the sources of heterogeneity and the reliability of the evaluation results.@*RESULTS@#A total of 16 studies with 5521 patients were included. Meta-analysis showed that the incidence of ONFH after internal fixation for adult FNF was 14.5% [95% CI(0.126-0.165)]. Fracture displacement[OR=0.27, 95%CI(0.21-0.35)] and reduction quality [OR=0.15, 95%CI(0.09-0.27)] were related risk factors for ONFH. The results of subgroup rate analysis showed that the non-displaced fracture necrosis rate was 6.2%[95%CI(0.051-0.077)] and the displaced fracture necrosis rate was 20.4% [95%CI(0.166-0.249)];the good reduction fracture necrosis rate was 8.3%[95%CI(0.072-0.095)] and the poor reduction fracture necrosis rate was 35.5%[95%CI(0.233-0.500)]. The included literatures have good consistency and no publication bias.@*CONCLUSION@#After 2000, the total incidence of ONFH after internal fixation of adult FNF has decreased, while the necrosis rates of patients with displaced fracture and poor reduction are still at a high level. The interval between injury and surgery was not analyzed in this study because of the inconstant division in the original literature.

Blood loss closely correlates with body mass index in total hip arthroplasty performed through direct lateral approach

To investigate total blood loss [TBL], intraoperative blood loss [IBL], post-operative drainage [POD], and other related variables in total hip arthroplasty [THA] performed through direct lateral approach. This study was completed in Shanghai Sixth People's Hospital, Shanghai, China, between January and December 2010. We analyzed 113 patients treated by THA through direct lateral approach. Recordable blood loss [RBL] was measured and TBL was calculated according to the Gross formula. Ordinal logistic regression analysis was used for TBL, IBL, and POD, with gender, age, body mass index [BMI], disease duration, and operative time as independent variables. The average operative time was 51.5 +/- 10.4 [range: 35-70] minutes, with an average RBL of 454 +/- 144 [range: 150-180] ml. Average TBL was significantly higher [975 +/- 355, range: 430-2020 ml; p<0.001]. In the analysis of variables, BMI closely correlated with TBL, IBL, and POD, with odds ratios of 4.80 [95% CI: 2.63-8.78 [TBL]], 5.39 [95% CI: 2.84-10.25 [IBL]], and 4.37 [95% CI: 2.43-7.89 [POD]]. Moreover, TBL [54.172], IBL [55.198], and POD [39.139] correlated with trend test BMI. The TBL, IBL, and POD closely correlate with BMI in patients undergoing THA through direct lateral approach

Reference value of brachial-ankle pulse wave velocity for the eastern Chinese population and potential influencing factors

The present study was conducted to obtain reference values for brachial-ankle pulse wave velocity (baPWV) and to evaluate influencing factors of baPWV according to gender. Using automatic devices, baPWV was measured simultaneously in 2095 subjects. A total of 647 healthy subjects, none of whom presented atherosclerotic risk factors, were analyzed in the present study. Two different statistical methods were used to obtain reference values for baPWV according to subject gender and age. The association between baPWV value and gender, as well as other features, were analyzed. For male subjects, multiple stepwise analysis showed that age, systolic blood pressure (SBP), heart rate (HR), and plasma levels of triglycerides (TG) were independent predictors of baPWV. For female subjects, age, SBP, HR, and plasma levels of uric acid (UA) were independent predictors of baPWV. In male subjects, the upper limits of baPWV values were 1497.43/1425.00, 1518.67/1513.25, 1715.97/1726.50, 1925.20/1971.90, and 2310.18/2115.00 cm/s, obtained using two different statistical methods for the age ranges of 30-39, 40-49, 50-59, 60-69, and 70 and older, respectively. For females, the upper limits of baPWV values were 1426.70/1411.13, 1559.15/1498.95, 1733.50/1739.00, 1958.63/1973.78, and 2720.80/2577.00 cm/s for the age ranges of 30-39, 40-49, 50-59, 60-69, and 70 and older, respectively. Aging is the most important influencing factor for baPWV value and its effect is more prominent in females. The reference values of baPWV according to age and gender may be useful for the clinical diagnosis and preventive therapy of cardiovascular diseases.

Factors affecting avascular necrosis of femoral head after internal fixation with cannulated screws in femoral neck fractures / 第二军医大学学报

Objective: To investigate the factors influencing the avascular necrosis of femoral head after internal fixation of femoral neck fracture. Methods: A total of 99 patients with femoral neck fracture, who were treated with internal fixation between May 1999 and April 2004, were followed up in outpatient Department and by telephone. The data was set up and analyzed by SPSS 14.0 software. Results: Until January 2006, avascular necrosis of the femoral head was found in 15 cases (15.2%). Age X internal fixation,gender X the time of reduction were found interactive in two factors interactive analysis. Age, the displacement of fractures,the quality of reduction,and internal fixation were found to be significant factors in single factor logistic regression analysis. Age, age X internal fixation, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine analysis of interactive after multivariate logistic regression analysis,the removal of internal fixation was the most important risk factor for femoral head necrosis in 56-85yrs group, with the risk ratio being 26.00(95% CI = 3.076-219.747). Conclusion: Elder patients have less chance for avascular necrosis of femoral head. The extraction of cannulated screws might lead to more avascular necrosis of femoral head and collapse in old patients. Dissection reduction can help to reduce avascular necrosis.

Effect of anterior cruciate ligament reconstruction on biomechanical features of knee in level walking: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The anterior cruciate ligament (ACL) is one of the most commonly injured knee ligaments. Even following ACL reconstruction, significant articular cartilage degeneration can be observed and most patients suffer from premature osteoarthritis. Articular cartilage degeneration and osteoarthritis development after ACL injury are regarded as progressive process that are affected by cyclic loading during frequently performed low-intensity daily activities. The purpose of this study was to perform a meta analysis on studies assessing the effects of ACL reconstruction on kinematics, kinetics and proprioception of knee during level walking.</p><p><b>METHODS</b>This meta analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration. An electronic search of the literature was performed and all trials published between January 1966 and July 2010 comparing gait and proprioception of a reconstructed-ACL group with an intact-ACL group were pooled for this review. Thirteen studies were included in the final meta analysis.</p><p><b>RESULTS</b>There was no significant difference in step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion between the reconstructed-ACL group and the intact-ACL group (P > 0.05). However, there was a significant difference in peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle between the reconstructed-ACL group and the intact-ACL group (P < 0.05).</p><p><b>CONCLUSIONS</b>Step length, walking speed, maximum knee flexion angle during loading response, joint position sense and threshold to detect passive motion usually observed with ACL deficiency were restored after the ACL reconstruction and rehabilitation, but no significant improvements were observed for peak knee flexion angle, maximum angular knee flexion excursion during stance, peak knee flexion moment during walking and maximum external tibial rotation angle throughout the gait cycle.</p>

Catalytic metalloporphyrin protects against MPTP-induced Parkinson's disease in mice / 第二军医大学学报

Objective: To observe the effects of manganese( Ⅲ ) meso-tetrakis (N, N'-diethylimidazolium-2-yl) porphyrin (MnTDM) in treatment of early Parkinson's disease(PD) mouse model induced by subcutaneous injection of 1-methyl-4-phenyl1, 2, 3, 6-tetrahydropyridine(MPTP) and to discuss its possible mechanism. Methods:Forty male C57BL/6 mice were evenly randomized into 4 groups: MPTP model group(subcutaneous injection of 25 mg/kg MPTP for 3 days), MnTDM+ MPTP group (15 mg/kg MnTDM was subcutaneously injected 1 h before MPTP injection), MnTDM control group, and normal saline group. Performance of animals in the pole and swimming test was observed 3 days after the last injection. Levels of dopamine (DA) and its metabolites(3,4-dihydroxyphenylacetic acid [DOPAC] and homovanillic acid [HVA]) in the striatum of animals were measured by high-performance liquid chromatography with an electrochemical detector(HPLC-ECD). Thiobarbituric acid (TBA) method was used to examine the levels of malondialdehyde(MDA). Results: Acute injection of MPTP could be used for establishment of PD model. The striatal levels of DA, DOPAC and HVA in MPTP group were significantly lower(P＜0.01)and the striatal level of MDA was significantly higher(P＜0.05) than those of the control group. MPTP had no obvious effect on the behavioral performance of the animals in a short term. MnTDM could partly inhibit the above effects of MPTP. Compared with MPTP group, MnTDM+ MPTP group had significantly higher DA, DOPAC, and HVA levels and significantly lower MDA level(all P＜0.05). There was no significant difference in the behavioral indices of animals between the 4 groups. Conclusion:MnTDM can inhibit lipid peroxidation and promote DA production; it has preventive and therapeutic effects on MPTP induced PD.

Catalytic metalloporphyrin protects against MPTP-induced Parkinson's disease in mice / 第二军医大学学报

Objective: To observe the effects of manganese( Ⅲ ) meso-tetrakis (N, N'-diethylimidazolium-2-yl) porphyrin (MnTDM) in treatment of early Parkinson's disease(PD) mouse model induced by subcutaneous injection of 1-methyl-4-phenyl1, 2, 3, 6-tetrahydropyridine(MPTP) and to discuss its possible mechanism. Methods:Forty male C57BL/6 mice were evenly randomized into 4 groups: MPTP model group(subcutaneous injection of 25 mg/kg MPTP for 3 days), MnTDM+ MPTP group (15 mg/kg MnTDM was subcutaneously injected 1 h before MPTP injection), MnTDM control group, and normal saline group. Performance of animals in the pole and swimming test was observed 3 days after the last injection. Levels of dopamine (DA) and its metabolites(3,4-dihydroxyphenylacetic acid [DOPAC] and homovanillic acid [HVA]) in the striatum of animals were measured by high-performance liquid chromatography with an electrochemical detector(HPLC-ECD). Thiobarbituric acid (TBA) method was used to examine the levels of malondialdehyde(MDA). Results: Acute injection of MPTP could be used for establishment of PD model. The striatal levels of DA, DOPAC and HVA in MPTP group were significantly lower(P＜0.01)and the striatal level of MDA was significantly higher(P＜0.05) than those of the control group. MPTP had no obvious effect on the behavioral performance of the animals in a short term. MnTDM could partly inhibit the above effects of MPTP. Compared with MPTP group, MnTDM+ MPTP group had significantly higher DA, DOPAC, and HVA levels and significantly lower MDA level(all P＜0.05). There was no significant difference in the behavioral indices of animals between the 4 groups. Conclusion:MnTDM can inhibit lipid peroxidation and promote DA production; it has preventive and therapeutic effects on MPTP induced PD.

Expression of vascular endothelial growth factors (VEGF)-A, -C and -D and their prognostic significance and relationship with angio- and lymphangiogenesis in gastric cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the expressions of vascular endothelial growth factors (VEGF)-A, -C and -D and their prognostic significance and relation to angio- and lymphangiogenesis in gastric cancer.</p><p><b>METHODS</b>The expression of VEGF-A, -C and -D in 123 primary gastric cancers was detected by immunohistochemical staining. The lymphatic vessel density (LVD) and microvessel density (MVD) were assessed after immunohistochemical double-staining with D2-40 and CD34, respectively. The correlation between the expression of those VEGF factors and clinicopathological parameters were analyzed by univariate method. The overall survival was evaluated by Kaplan-Meier method and log-rank test. Multivariate analysis was carried out using Cox proportion hazard model.</p><p><b>RESULTS</b>The positive expression rate of VEGF-A, -C and -D in primary gastric cancer samples were 64.2%, 65.9% and 41.5%, respectively. High expression of VEGF-A, or -C or -D, or any two of them was correlated with high LVD (P < 0.05). High expression of both VEGF-A and -C was associated with high MVD, lymph node metastasis, LVI and MVI (P < 0.05). Both VEGF-C and -D high expression was correlated with LVI and lymph node metastasis (P < 0.05). The patients with high expression of these factors had a statistically shorter overall survival (P < 0.05). The patients with both VEGF-A and -C expression had the shortest survival (56 months). Multivariate analysis showed that VEGF-A high expression, MVD, lymph node metastasis and depth of tumor invasion were independent survival predictors (P = 0.033, 0.002, 0.019 and P < 0.001, respectively).</p><p><b>CONCLUSION</b>High expression of both VEGF-A and -C imply high potential of lymphangiogenesis, metastasis and poorer survival in gastric cancer patients. High expression of VEGF-C and -D may induce lymphangiogenesis and promote lymph node metastasis, but only VEGF-A is an independent predictor of survival.</p>