Research progress on the mechanism of ferroptosis on osteosarcoma / 中国医师杂志

Osteosarcoma is the most common malignant bone tumor disease in young children and young people. It usually has strong invasiveness, and conventional treatment cannot achieve the expected results. Therefore, studying the mechanism of tumor cell death and exploring more effective treatment methods is of great significance. As a new form of cell death, ferroptosis has been found to have three main regulatory pathways closely related to tumor cell molecular mechanisms, genes, etc. This provides a theoretical basis for the application of ferroptosis in the treatment of osteosarcoma. This article reviews recent research on the interaction between ferroptosis and osteosarcoma in regulating molecules, genes, and other factors, as well as the application of ferroptosis in the treatment of osteosarcoma.

Association of frailty and serum C-terminal agrin fragment with the prognosis in elderly patients with acute coronary syndrome / 中华老年医学杂志

Objective:To explore the association of frailty and serum C-terminal agrin fragment(CAF)with the prognosis of elderly patients with acute coronary syndrome(ACS).Methods:In this prospective cohort study, clinical data of 207 older patients with ACS between January 2020 and May 2022 were collected.Serum samples were obtained within 24 hours after enrollment to detect CAF levels.Meanwhile, the thrombolysis in myocardial infarction(TIMI)and frailty screening questionnaire(FSQ)scores were assessed on admission.Patients were followed up for major adverse cardiovascular and cerebrovascular events(MACCE)for 90 days.Multivariate logistic regression was used to analyze the influencing factors of MACCE.The receiver operating characteristic(ROC)curve was performed to evaluate the predictive ability of the FSQ score, serum CAF and their combination for MACCE.According to 90-day mortality, patients were divided into a survival group(n=176)and a death group(n=31). The Cox proportional hazards regression model was used for survival analysis.Results:The FSQ score( Z=4.412, P<0.001)and serum CAF( Z=6.702, P<0.001)in the MACCE group were higher than those in the non-MACCE group.Logistic regression analysis showed that after adjusting for age, sex, TIMI score and complete revascularization, frailty defined by FSQ( OR=1.714; 95% CI: 1.059-2.775; P=0.028)and high serum CAF( OR=1.230; 95% CI: 1.122-1.350; P<0.05)were independent risk factors for MACCE.The area under the ROC curve(AUC)of the FSQ score for predicting MACCE was 0.797(95% CI: 0.735-0.850; P<0.001), the predictive cut-off point was an FSQ score >2, and the Youden index(YI)was 0.419, yielding a sensitivity of 0.708 and a specificity of 0.711.In addition, the AUC of serum CAF for predicting MACCE was 0.766(95% CI: 0.701-0.822; P<0.001), the predictive cut-off point was >6.01 μg/L, and YI was 0.460, yielding a sensitivity of 0.750 and a specificity of 0.710.The predictive ability of FSQ combined with CAF for MACCE was higher than FSQ( Z=2.294, P=0.022)or CAF( Z=2.545, P=0.011)alone.Cox regression analysis showed that frailty defined by FSQ( HR=3.487; 95% CI: 1.329-9.153; P=0.011)was independently associated with all-cause mortality within 90 days after ACS. Conclusions:Frailty assessment and serum CAF detection can improve the risk stratification of elderly patients with ACS.

Erector Spinae Atrophy Correlates with Global Sagittal Imbalance and Postoperative Proximal Junctional Kyphosis Incidence in Lumbar Degenerative Kyphosis

Methods@#This study enrolled 51 patients with LDK out of 382 patients with adult degenerative spinal deformity. Baseline information was reviewed including demographic data and complications. Sagittal spinopelvic alignments and global imbalance parameters were assessed on full-length X-ray images of the spine. Muscularity and the fatty infiltration area of the ES and multifidus (MF) were measured at the L4/5 level on preoperative magnetic resonance image to evaluate the lumbar erector muscle atrophy. Stratification by sagittal vertical axis (SVA) was performed: group 1 with SVA 100 mm, and these groups were compared. Spearman correlation and multivariable logistic regression analyses were performed to analyze and define risk factors of postoperative proximal junctional kyphosis (PJK). @*Results@#Group 2 had lower ES and MF muscularity than group 1. ES muscularity correlated with SVA (r=−0.510, p<0.003), lumbar lordosis (r=−0.415, p<0.018), and postoperative PJK (r=−0.508, p<0.022). MF muscularity did not correlate with the above parameters. Multivariable logistic regression analysis verified ES muscularity (odds ratio [OR], 0.001; p<0.039) and SVA (OR, 1.034; p<0.048) as the risk factors for postoperative PJK. @*Conclusions@#ES atrophy, besides the MF, is an important predictor in distinguishing decompensated LDK from well-compensated ones. It plays an important role in compensatory mechanism, not only correlates with global sagittal imbalance but also ties to PJK after deformity corrective surgery.

Clinical and radiological outcomes of selective fusion for rotatory olisthesis in degenerative lumbar scoliosis: a retrospective cohort study

Methods@#A cohort of 54 consecutive patients with DLS and RO was included in the study. All the included patients underwent selective RO fusion and at least 2 years of follow-up. They were divided into two groups: group 1 with a curve 30° because of a higher complication rate and a worse clinical outcome at the final follow-up.

O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.

Association of serum 25 hydroxy-vitamin D with short-term prognosis in elderly patients in emergency care settings / 中华急诊医学杂志

Objective:To explore the association of Vitamin D (Vit D) nutritional status and prognosis in elderly patients in emergency care settings.Methods:The clinical data of 317 elderly patients admitted in the Emergency Care Unit and Emergency Observation Ward of Beijing Bo'Ai hospital from January 2021 to September 2021 were collected continuously. Blood routine, biochemical indicators, serum interleukin-6 (IL-6), thyroid-stimulating hornone (TSH), cortisol (COR) and 25-hydroxyvitamin D [25(OH)D] levels were detected within 24 hours after enrollment. Patients were divided into severe vitamin D deficiency group and non-severe vitamin D deficiency group according to the level of serum 25(OH)D. Patients were followed up for the treatment with machinery ventilation during hospitalization and 28-day all-cause mortality. Multivariable logistic regression model was used to analyze the association between the Vit D nutritional status and machinery ventilation. In order to evaluate the predictive ability of serum 25(OH)D for the requirement of machinery ventilation, the receiver operating characteristic (ROC) curve was applied and the area under the ROC curve (95% confidence interval) [AUC (95% CI)] was calculated. Cox proportional hazards regression model was used to analyze the association between Vit D nutritional status and 28-day all-cause mortality. Results:Serum 25(OH) level in the machinery ventilation group was significantly lower than that in the non-mechanical ventilation group ( Z = 5.150, P < 0.001). Multivariable logistic regression analysis showed that severe Vit D deficiency ( OR = 7.223, 95% CI: 1.546-33.742, P = 0.012) was independently associated with machinery ventilation. The AUC (95% CI) of serum 25(OH)D for predicting machinery ventilation was 0.825 (0.770-0.871) ( P < 0.001), the predictive cut-off point was 11.0 μg/L, and the Youden index was 0.580, yielding a sensitivity of 0.903 and a specificity of 0.677. Cox regression analysis showed that severe Vit D deficiency ( HR = 2.403, 95% CI: 1.133-5.096, P = 0.022) was an independent predictor of 28-day all-cause mortality in elderly emergency patients. Conclusions:Serum 25(OH)D can be used as an independent predictor of short-term prognosis in elderly emergency patients.

Clinical efficacy of small incision conjoint fascial sheath suspension in treatment of severe congenital blepharoptosis / 中华医学美学美容杂志

Objective:To analyze the clinical effect of small incision approach conjoint fascial sheath (CFS) suspension in the treatment of congenital severe blepharoptosis, and to discuss its advantages and disadvantages compared with conventional CSF suspension.Methods:From February 2020 to August 2022, 42 cases of severe blepharoptosis in the Department of Burn, Plastic and Cosmetic Surgery, Shaanxi Provincial People's Hospital were divided into the observation group (23 cases, 39 eyes) and the control group (19 cases, 37 eyes). The observation group was treated with small incision CFS suspension surgery, while the control group was treated with conventional CFS suspension surgery. The correction effect, complications, recovery time and other conditions between the two groups at different times after surgery were compared.Results:During postoperative follow-up at 1 week, 1 month, 3 months, and 6 months, there was no significant difference in the corrective effect between the two surgical methods at each time point (all P>0.05). The incidence of complications in the observation group at each time point that was 26.3%, 15.7%, 10.5%, and 5.2%, respectively, while the incidence of complications in the control group was 60.0%, 20.0%, 14.2%, and 8.6%, with statistical differences in the first week after surgery (χ 2=8.74, P=0.011). The average postoperative swelling time in the observation group was 4.2 days, which was less than 5.8 days in the control group. During a 6-month follow-up, it was found that there was a decrease in scar hyperplasia in the observation group of 9.1% (2/22) compared to the control group of 16.7% (3/18) (χ 2=0.023, P=0.878). The difference was of no statistical significance. Conclusions:CFS suspension with small incision in the treatment of moderate and severe blepharoptosis has the advantages of ideal correction effect, small damage range, and few postoperative complications, but the operation area is small, the operation is difficult, and the surgeon has higher requirements.

Construction and efficacy evaluation of a scoring system for predicting major adverse cardiovascular and cerebrovascular events within 1 year in elderly patients with acute coronary syndrome / 中华急诊医学杂志

Objective:To establish a prediction model for major adverse cardiovascular and cerebrovascular events (MACCE) in elderly patients with emergency acute coronary syndrome (ACS) within 1 year, and to evaluate its prediction efficiency.Methods:This was a prospective cohort study. Elderly ACS patients who were admitted to the Cardiovascular Care Unit (CCU) or the Emergency Intensive Care Unit (EICU) in Beijing Bo'Ai Hospital through emergency department from January 2019 to December 2021 were successively enrolled. General data of the patients were collected within 24 h after admission, the incidence of malignant arrhythmia, complete revascularization and acute kidney injury (AKI) during hospitalization were recorded. Within 24 h, laboratory indexes such as serum creatinine (Scr), albumin (Alb), hypersensitive C-reactive protein (hs-CRP), creatine kinase isoenzyme MB (CK-MB), D-dimer, cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were measured. In addition, transthoracic echocardiography and the Frailty Screening Questionnaire (FSQ) were performed. Patients were followed up for the occurrence of MACCE within 1 year. The influencing factors of MACCE were screened by univariable and multivariable logistic regression analysis. The cut-off values of continuous variables were determined by receiver operating characteristic (ROC) curve and discretization was carried out with reference to clinical practice. Corresponding scores were set up according to the β regression coefficient of each variable to establish a clinical prediction score scale of MACCE. Finally, ROC curve was used to evaluate its prediction efficiency.Results:The study enrolled 322 elderly ACS patients, and the incidence of MACCE within 1 year was 24.5%. After preliminary screening of independent variables by univariable logistic regression analysis, the influencing factors of MACCE ( P<0.2) were as follows: ① Continuous indicators: age, body mass index (BMI), Alb, hs-CRP, D-dimer, NT-pro-BNP, ejection fraction (EF), Killip grade and FSQ score; ② Discrete indicators: ≥3 comorbidities, incomplete revascularization, and AKI. Multivariable logistic regression analysis after discretization of continuous indicators showed that age ≥84 years old [odds ratio ( OR)=4.351, 95% confidence interval (95% CI): 1.635-11.576, P=0.003], incomplete revascularization ( OR=6.580, 95% CI: 2.397-18.060, P < 0.001), combined with AKI ( OR=2.647, 95% CI: 1.085-6.457, P=0.032), EF ≤50% ( OR=2.742, 95% CI: 1.062-7.084, P=0.037), and FSQ≥3 points ( OR=9.345, 95% CI: 3.156-27.671, P < 0.001) were independent risk factors for MACCE. The total score of the clinical prediction system for MACCE was 8 points, including age ≥84 years old (2 points), incomplete revascularization (2 points), FSQ ≥3 points (2 points), EF ≤50% (1 point), and combined with AKI (1 point). The area under ROC curve (AUC) of the scoring system for predicting MACCE was 0.891, (95% CI: 0.844-0.938, P < 0.001). The optimal cut-off value was >3 points, and the sensitivity and specificity were 0.825 and 0.792, respectively. Conclusions:The prediction score scale of MACCE has a good diagnostic efficacy and has certain guiding value for clinicians to judge the prognosis of elderly ACS patients.

Ideal cardiovascular health and mortality: pooled results of three prospective cohorts in Chinese adults / 中华医学杂志(英文版)

BACKGROUND@#Evidence on the relations of the American Heart Association's ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps.@*METHODS@#A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis.@*RESULTS@#During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed.@*CONCLUSIONS@#ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.

Osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in treatment of tibial plateau fractures involving posterolateral column collapse / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation in the treatment of tibial plateau fractures involving posterolateral column collapse.@*METHODS@#A clinical data of 23 patients with tibial plateau fractures involving posterolateral column collapse, who had undergone osteotomy of non-core weight-bearing area of the lateral tibial plateau, reduction, and internal fixation between January 2015 and June 2021, was retrospectively analyzed. There were 14 males and 9 females with an average age of 42.6 years ranging from 26 to 62 years. The causes of injury included traffic accident in 16 cases, falling from height in 5 cases, and other injuries in 2 cases. According to Schatzker classification, there were 15 cases of type Ⅴ and 8 cases of type Ⅵ. The time from injury to operation was 4-8 days with an average of 5.9 days. The operation time, intraoperative blood loss, fracture healing time, and complications were recorded. The depth of articular surface collapse of posterolateral column and posterior inclination angle (PSA) of the tibial plateau were compared before operation and at 2 days and 6 months after operation; fracture reduction of tibial plateau fracture was evaluated by Rasmussen anatomic score. The recovery of knee function was evaluated by Hospital for Special Surgery (HSS) score at 2 days and 6 months after operation.@*RESULTS@#All 23 patients were completed the operation successfully. The operation time was 120-195 minutes, with an average of 152.8 minutes; the intraoperative blood loss was 50-175 mL, with an average of 109.5 mL. All patients were followed up 12-24 months, with an average of 16.7 months. One patient had superficial wound infection after operation, and the incision healed after dressing change; primary healing of incision of other patients was obtained. The fracture healing time was 12-18 weeks, with an average of 13.7 weeks. No failure of internal fixation, varus and valgus deformity of the knee joint, and instability of the knee joint was found at last follow-up. One patient developed joint stiffness and the range of motion of the knee joint was 10°-100°; the range of motion of the knee joint of other patients was 0°-125°. At 2 days and 6 months after operation, the depth of articular surface collapse of posterolateral column, PSA, and Rasmussen anatomic scores significantly improved when compared with those before operation ( P<0.05). There was no significant difference between the two postoperative time points ( P>0.05). The HSS score at 6 months after operation was significantly higher than that at 2 days after operation ( P<0.05).@*CONCLUSION@#For tibial plateau fractures involving posterolateral column collapse, reduction and internal fixation through osteotomy of non-core weight-bearing area of the lateral tibial plateau has the advantages of fully expose the posterolateral column fragment, good articular surface reduction, sufficient bone grafting, and fewer postoperative complications. It is beneficial to restore knee joint function and can be widely used in clinic.

Relationship between Fusion Mass Shift and Postoperative Distal Adding-on in Lenke 1 Adolescent Idiopathic Scoliosis after Selective Thoracic Fusion

Methods@#This study included 60 patients with Lenke 1 AIS who underwent selective thoracic fusion surgery. Coronal spinal alignment parameters were analyzed preoperatively, postoperatively, and at the final follow-up. The postoperative FMS was divided into two groups: the balanced group (FMS ≤20 mm) and the unbalanced group (FMS >20 mm). An independent t-test was used to compare quantitative data between groups, and a chi-square test was used for qualitative data. Furthermore, binary logistic regression and receiver operating characteristics curve analyses were used to identify the risk factors for postoperative distal adding-on in AIS. @*Results@#At 2-year follow-up, the unbalanced group was more likely to have adding-on (17 of 24 patients) than the balanced group (six of 36 patients; p<0.001). Twenty-three patients with distal adding-on had significantly greater preoperative and postoperative lower instrumented vertebrae (LIV) rotation, FMS, and FMS angle (FMSA) than those without postoperative distal adding-on. Binary logistic regression analysis selected three independent risk factors for adding-on incidence after surgery: FMS (odds ratio [OR], 1.115; 95% confidence interval [CI], 1.049–1.185; p<0.001), FMSA (OR, 1.590; 95% CI, 1.225–2.064; p<0.001), and postoperative LIV rotation (OR, 6.581; 95% CI, 2.280–19.000; p<0.001). @*Conclusions@#Achieving a balanced fusion mass intraoperatively is important to avoid postoperative distal adding-on, with FMS of <20 mm and FMS angle of <4.5°. Furthermore, correcting LIV rotation helps to decrease the incidence of postoperative distal addingon.

Research progress in the mechanism and treatment of osteosarcoma / 中华医学杂志(英文版)

Osteosarcoma (OS) is the most common primary malignant bone tumor that more commonly occurs in children and adolescents. The most commonly used treatment for OS is surgery combined with chemotherapy, but the treatment outcomes are typically unsatisfactory. High rates of metastasis and post-treatment recurrence rates are major challenges in the treatment of OS. This underlines the need for studying the in-depth characterization of the pathogenetic mechanisms of OS and development of more effective therapeutic modalities. Previous studies have demonstrated the important role of the bone microenvironment and the regulation of signaling pathways in the occurrence and development of OS. In this review, we discussed the available evidence pertaining to the mechanisms of OS development and identified therapeutic targets for OS. We also summarized the available treatment modalities for OS and identified future priorities for therapeutics research.

Finite element analysis of five internal fixation modes in treatment of Day type Ⅱcrescent fracture dislocation of pelvis / 中国修复重建外科杂志

OBJECTIVE@#To compare the biomechanical differences among the five internal fixation modes in treatment of Day type Ⅱ crescent fracture dislocation of pelvis (CFDP), and find an internal fixation mode which was the most consistent with mechanical principles.@*METHODS@#Based on the pelvic CT data of a healthy adult male volunteer, a Day type Ⅱ CFDP finite element model was established by using Mimics 17.0, ANSYS 12.0-ICEM, Abaqus 2020, and SolidWorks 2012 softwares. After verifying the validity of the finite element model by comparing the anatomical parameters with the three-dimensional reconstruction model and the mechanical validity verification, the fracture and dislocated joint of models were fixed with S 1 sacroiliac screw combined with 1 LC-Ⅱ screw (S 1+LC-Ⅱ group), S 1 sacroiliac screw combined with 2 LC-Ⅱ screws (S 1+2LC-Ⅱ group), S 1 sacroiliac screw combined with 2 posterior iliac screws (S 1+2PIS group), S 1 and S 2 sacroiliac screws combined with 1 LC-Ⅱ screw (S 1+S 2+LC-Ⅱ group), S 2-alar-iliac (S 2AI) screw combined with 1 LC-Ⅱ screw (S 2AI+LC-Ⅱ group), respectively. After each internal fixation model was loaded with a force of 600 N in the standing position, the maximum displacement of the crescent fracture fragments, the maximum stress of the internal fixation (the maximum stress of the screw at the ilium fracture and the maximum stress of the screw at the sacroiliac joint), sacroiliac joint displacement, and bone stress distribution around internal fixation were observed in 5 groups.@*RESULTS@#The finite element model in this study has been verified to be effective. After loading 600 N stress, there was a certain displacement of the crescent fracture of pelvis in each internal fixation model, among which the S 1+LC-Ⅱ group was the largest, the S 1+2LC-Ⅱ group and the S 1+2PIS group were the smallest. The maximum stress of the internal fixation mainly concentrated at the sacroiliac joint and the fracture line of crescent fracture. The maximum stress of the screw at the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 2AI+LC-Ⅱ group. The maximum stress of the screw at the ilium fracture was the largest in the S 1+2PIS group and the smallest in the S 1+2LC-Ⅱ group. The displacement of the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 1+S 2+LC-Ⅱ group. In each internal fixation model, the maximum stress around the sacroiliac screws concentrated on the contact surface between the screw and the cortical bone, the maximum stress around the screws at the iliac bone concentrated on the cancellous bone of the fracture line, and the maximum stress around the S 2AI screw concentrated on the cancellous bone on the iliac side. The maximum bone stress around the screws at the sacroiliac joint was the largest in the S 1+LC-Ⅱ group and the smallest in the S 2AI+LC-Ⅱ group. The maximum bone stress around the screws at the ilium was the largest in the S 1+2PIS group and the smallest in the S 1+LC-Ⅱ group.@*CONCLUSION@#For the treatment of Day type Ⅱ CFDP, it is recommended to choose S 1 sacroiliac screw combined with 1 LC-Ⅱ screw for internal fixation, which can achieve a firm fixation effect without increasing the number of screws.

Research progress in the regulation of exosomes on cell Ferroptosis / 中国医师杂志

Ferroptosis is an iron-dependent, apoptotic cell death caused by massive lipid peroxidation-mediated cell membrane damage. Recent evidence suggests that exosomes, as a 30-100 nm diameter follicular body, contain a variety of active ingredients such as proteins, various RNAs and lipids that can have a great impact on the diagnosis and treatment of related diseases by regulating cellular iron death. To this end, this paper elaborates the research significance of exosomes in the regulation of cell ferroptosis, analyzes their role in disease treatment, and reviews the relevant reports and studies on exosomes regulating cell ferroptosis in recent years.

The role and treatment progress of ferroptosis in osteoarthritis / 中国医师杂志

Osteoarthritis is a chronic inflammatory disease characterized by non inflammatory degeneration of articular cartilage and the formation of osteophytes at the edge of the joint, caused by complex causes. Its pathology is complex, and its pathogenesis is not yet clear, ultimately leading to joint stiffness and functional activity disorders. At present, the treatment for osteoarthritis is limited to alleviating symptoms and improving function, with varying degrees of side effects. Ferroptosis is a new type of programmed cell death discovered in recent years, which is related to the pathological and physiological processes of osteoarthritis and plays an important regulatory role in the occurrence and development of osteoarthritis. Its main characteristics include iron metabolism imbalance and accumulation of reactive oxygen species. Therefore, ferroptosis inhibitors targeting ferroptosis have shown great application prospects in the treatment of osteoarthritis. In this review, the author summarizes the relevant mechanisms of ferroptosis in the occurrence and development of osteoarthritis, outlines a large number of specific therapeutic drugs and their corresponding targets, with the aim of delaying and reversing the progression of osteoarthritis by regulating chondrocyte ferroptosis, which has certain clinical guiding significance.

Research progress on the relationship between steroid-induced avascular necrosis of the femoral head and microRNA / 中国医师杂志

Steroid-induced avascular necrosis of the femoral head (SANFH) is the death of the femoral head caused by long-term use of glucocorticoid (GC). Its pathological manifestations are mainly trabecular bone collapse and increased empty bone lacunas, osteocyte apoptosis rate and autophagy rate. Its pathogenesis is complicated, and the exact pathogenesis is still unclear. MicroRNAs (miRNAs) are a group of endogenous, non-coding small RNAs with an average length of 23 nucleotides. They are responsible for negatively regulating gene expression after transcription by inhibiting target messenger RNAs (mRNAs). MiRNAs play an important role in physiological processes, including cell development, proliferation, differentiation, metabolism, migration and apoptosis. According to bioinformatics analysis, MiRNAs play an important role in regulating gene expression, and it is estimated that more than one-third of human genes are regulated by them. In the past few years, more and more miRNAs have been found to be related to osteonecrosis, such as regulating the proliferation and differentiation of mesenchymal stem cells and osteoblasts. This article aims to review the relationship between steroid-induced femoral head necrosis and miRNAs.

Research progress of lncRNA regulating miRNA in osteoarthritis / 中国综合临床

Non-coding RNAs (ncRNAs), which are thought to regulate articular cartilage through endochondral osteogenesis, consist of mRNA-interfering complementary RNA (miRNA) and long non-coding RNAs (lncRNA). More and more experimental evidence reveals the role of ncRNAs in chondrocyte differentiation and the pathogenesis of several skeletal diseases, including osteoarthritis. In the past few years, increasingly sophisticated DNA sequencing methods and a large number of sepigenetic modifications have greatly contributed to our understanding of the pathophysiological mechanisms of osteoarthritis. Recent studies have revealed that RNA interacts with RNA-binding proteins, regulates gene transcription and protein translation, and is involved in various pathological processes in OA, promising to be a therapeutic target for osteoarthritis.

Effect of hollow lag screw combined with calcaneal locking plate in the treatment of Letenneur type III Hoffa fracture / 中华创伤杂志

Objective:To compare the clinical effect of cannulated lag screw combined with calcaneal locking plate versus cannulated lag screw in the treatment of Letenneur type III Hoffa fracture.Methods:A retrospective cohort study was performed on clinical data of 41 patients with Letenneur type III Hoffa fracture admitted to General Hospital of Central Theater Command of PLA from January 2010 to June 2020. There were 22 males and 19 females, aged 28-78 years［(51.9±1.9)years］. A total of 18 patients were treated with cannulated lag screw combined with calcaneal locking plate (plate-screw group) and 23 patients were treated with cannulated lag screw (screw group). The bed rest time, hospital time and bone healing time were compared between the two groups. Range of motion (ROM) of the knee at 3 and 6 months postoperatively, knee society score (KSS) at 3 and 6 months postoperatively and incidence of long-term complications were compared between the two groups.Results:All patients were followed up for 10-24 months［(14.5±2.1)months］. The bed rest time was (37.6±2.4)days in plate-screw group, lower than (45.2±1.6)days in screw group ( P<0.05). The hospital time was (16.7±3.7)days in plate-screw group, and (15.8±3.7)days in screw group ( P>0.05). The bone healing time was (12.2±0.9)weeks in plate-screw group and (12.7±0.7) weeks in screw group ( P>0.05). ROM of the knee at 3 and 6 months after operation was (119.9±2.9)° and (125.4±4.5)° in plate-screw group, greater than (116.6±4.5)°and (122.1±3.9)° in screw group (both P<0.05). KSS at 3 and 6 months after operation was (83.4±3.1)points and (86.2±2.5)points in plate-screw group, greater than (79.5±2.1)points and (82.2±2.2)points in screw group (both P<0.05). ROM of the knee and KSS in two groups increased significantly over time (both P<0.01). The long-term complications in plate-screw group included delayed fracture healing in 1 patient, traumatic arthritis in 1 and stiff joint in 1, showing the complication rate of 17% (3/18). The long-terem complications in screw group included internal fixation failure in 1 patient, delayed fracture healing in 2, nonunion in 1, traumatic arthritis in 2 and stiff joint in 2, showing the complication rate of 35% (8/23). The two groups had no significant difference in the complication rate ( P>0.05) .Conclusion:For Letenneur type III Hoffa fracture, cannulated lag screw fixation combined with calcaneal locking plate is superior to seperate cannulated lag screw fixation in aspects of short bed-term bed rest, early functional exercise, improved ROM and good function recovery.

Efficacy comparison of navigation-assisted percutaneous cannulated screw fixation and posterior percutaneous plate fixation for the treatment of Day type II crescent fracture dislocation of pelvis / 中华创伤杂志

Objective:To compare the clinical outcome of navigation-assisted percutaneous cannulated screw fixation and posterior percutaneous plate fixation for Day type II crescent fracture dislocation of pelvis (CFDP).Methods:A retrospective cohort analysis was performed on clinical data of 40 patients with Day type II CFDP treated in General Hospital of Central Theater Command of PLA from January 2012 to June 2021. There were 23 males and 17 females, with age range of 42-73 years [(54.2±7.8)years]. A total of 19 patients were treated with navigation-assisted percutaneous cannulated screw fixation (navigation group) and 21 with posterior percutaneous plate fixation (plate group). The incision length, operation time, intraoperative blood loss and in-hospital time were compared between the two groups. The reduction quality was evaluated by Matta radiographic standard at day 2 after surgery. The functional recovery was assessed by Majeed functional score at 3 and 6 months after surgery. The postoperative complications were observed.Results:All patients were followed up for 10-24 months [(13.6±2.9)months]. The incision length, operation time, intraoperative blood loss and in-hospital time was (2.4±0.3)cm, (43.1±5.2)minutes, (48.4±18.4)ml and (14.4±1.9)days in navigation group, showing significant difference compared with plate group [(8.8±0.4)cm, (132.2±19.4)minutes, (302.9±57.5)ml, (18.9±3.7)days] (all P<0.01). According to Matta radiographic standard at day 2 after surgery, the excellent and good rate was 89% in navigation group (excellent in 13 patients, satisfactory in 4 and poor in 2) and 95% in plate group (excellent in 15 patients, satisfactory in 5 and poor in 1) ( P>0.05). According to Majeed criteria at 3 months after surgery, the excellent and good rate was 89% in navigation group (excellent in 12 patients, good in 5 and poor in 2) and 95% in plate group (excellent in 15 patients, good in 5 and poor in 1) ( P>0.05). According to Majeed criteria at 6 months after surgery, the excellent and good rate was 95% in navigation group (excellent in 14 patients, good in 4 and poor in 1) and 95% in plate group (excellent in 17 patients, good in 3 and poor in 1) ( P>0.05). There was no iatrogenic neurovascular injury. The incidence of complications was 11% (2/19) in navigation group, including one patients with sacroiliac screw loosening and one with posterior iliac screw penetrating the medial cortex of the bone, while that was 29% (6/21) in plate group, including two patients with skin tenderness, two with deep vein thrombosis in the lower extremity and two with incision infection ( P<0.05). Conclusions:For Day type II CFDP, both navigation-assisted percutaneous cannulated screw fixation and posterior percutaneous plate fixation can attain satisfactory efficacy, but the former has advantages of shorter operation time, less surgical trauma, less bleeding, shorter in-hospital time and lower incidence of complications.

Efficacy of miniplates plus reconstruction plate fixation assisted by preoperative digital design in the treatment of comminuted posterior acetabular wall fracture / 中华创伤杂志

Objective:To compare the clinical effect of miniplates plus reconstruction plate fixation assisted by preoperative digital design and conventional miniplates plus reconstruction plate fixation in the treatment of comminuted posterior acetabular wall fracture.Methods:A retrospective cohort study was used to analyze the clinical data of 35 patients with comminuted posterior acetabular wall fracture admitted to General Hospital of Central Theater Command of PLA from January 2012 to June 2019, including 26 males and 9 females, aged 25-63 years [(45.5±9.8)years]. A total of 16 patients received miniplates plus reconstruction plate fixation assisted by preoperative digital design (digital design group) and 19 patients received conventional miniplates plus reconstruction plate fixation (conventional group). The operation time, intraoperative blood loss, hospitalization time and fracture healing time were compared in the two groups. Matta radiological standard score was performed to assess the quality of fracture reduction at postoperative 2 days. Modified Merle d′Aubign-Postel score was used to evaluate hip function at postoperative 3 months, 6 months and final follow-up. Postoperative complications were observed.Results:All patients were followed up for 12-48 months [(30.1±8.9)months]. The operation time and intraoperative blood loss were (114.7±16.1)minutes and (323.4±26.1)ml in digital design group, significantly less than (179.8±67.3)minutes and (392.6±87.8)ml in conventional group (all P<0.01). There were no significant differences in hospitalization time, fracture healing time, excellent and good rate of quality of fracture reduction between the two groups (all P>0.05). The modified Merle d′Aubign-Postel score was higher in digital design group [(14.1±2.3)points, (15.4±2.3)points and (17.1±1.8)points] than those in conventional group [(13.7±2.2)points, (15.0±2.5)points and (16.8±2.1)points] at 3 months, 6 months and last follow-up, but there were no significant differences (all P>0.05). The modified Merle d′Aubign-Postel score showed significant differences within each group at each time point (all P<0.01). In digital design group, one patient was found with heterotopic ossification and one with traumatic arthritis. In conventional group, two patients were found with heterotopic ossification, one with traumatic arthritis and one with avascular necrosis of the femoral head. The rate of postoperative complications was 12.5% (2/16) in digital design group and was 21.1% (4/19) in conventional group ( P>0.05). Neither of the two groups had complications such as penetration of screws into the articular cavity, failure of internal fixation or iatrogenic sciatic nerve injury. Conclusion:Both miniplates plus reconstruction plate fixation assisted by preoperative digital design and conventional miniplates plus reconstruction plate fixation can achieve satisfactory clinical efficacy in the treatment of comminuted posterior acetabular wall fracture, but the former can significantly reduce operation time and intraoperative blood loss.