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Objective:To construct a column-line diagram diagnostic model based on serum and joint fluid inflammatory markers for the diagnosis of periprosthetic joint infections (PJI) after joint arthroplasty and to validate its predictive ability.Methods:The clinical data of 181 patients diagnosed with PJI or aseptic loosening in the Department of Orthopedics of the First Affiliated Hospital of Chongqing Medical University from January 2015 to June 2020 were retrospectively collected as a modeling group. The best indicators for diagnosing PJI were screened by lasso regression, single-factor and multifactor analysis. By comprehensively considering the weights and intrinsic connections of the indicators, a column-line diagram diagnostic model was constructed and used to develop a clinical decision support system (CDSS). Prospectively, the clinical data of patients diagnosed with PJI or aseptic loosening in the Department of Orthopedics of the First Hospital of Chongqing Medical University from July 2020 to December 2022 were collected as a validation group, and the diagnostic performance of the column-line diagram model was externally validated by methods such as receiver operating characteristic curve (ROC).Results:There were 85 cases of PJI in the 181 cases modeling group and 23 cases of PJI in the 49 cases validation group. Among the 27 potential factors analyzed by lasso regression analysis, body mass index (BMI), blood tests including platelet (PLT), absolute lymphocyte value, interferon γ (IFN-γ), ESR, IL-6, C-reactive protein, D-dimer, and joint fluid tests including C-reactive protein, IL-1, IL-4, IL-6, percentage of multinucleated neutrophils (PMN%), and CD64 may be potential indicators for the diagnosis of PJI. Univariate found significant differences between hematologic tests including sedimentation, C-reactive protein, IL-6, D-dimer and joint fluid tests including C-reactive protein, joint fluid CD64 index, C-reactive protein, IL-1, IL-4, IL-6, PMN%( P<0.05). Further multifactorial regression analysis screened serum IL-6, D-dimer, joint fluid CD64 index, C-reactive protein, IL-1, IL-4, IL-6, and percentage of multinucleated neutrophils, and based on that, the column-line graph model and CDSS system were constructed. The area under the ROC in the validation group was 0.978, and the AUC in the internal validation was 0.995; the C-index of the calibration curve was 99.50%, and the C-index of the internal validation was 99.53%, suggesting that the column-line diagram model has a good predictive ability. Conclusions:The column-line diagram for diagnosing PJI based on multiple diagnostic indicators showed good diagnostic performance. The CDSS system constructed by column-line diagrams could assist clinicians in diagnosing PJI and making reasonable strategies in time.
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Objective:To evaluate the accuracy of the domestic "Skywalker" surgical robot in implementing personalized lower limb alignment reconstruction scheme in total knee arthroplasty (TKA) and the short-term clinical outcome of robotic assisted TKA.Methods:From September 2020 to January 2021, the data of patients who received surgical robot assisted TKA in 5 clinical centers in China (Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Southwest Hospital affiliated to Third Military Medical University, The Affiliated Hospital of Qingdao University, The First Affiliated Hospital of Chongqing Medical University and Yantai Yuhuangding Hospital, and Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine was the group leader) were prospectively collected and retrospectively analyzed. There were 24 males and 82 females with an average age of 67.6±7.3 years, (range 45-80 years); Average body mass index 26.42±4.31 kg/m 2, all the operation were performed by "Skywalker" surgical robot system according to preoperative design based on CT. The operation time, intraoperative blood loss, hospitalization days and postoperative complications were recorded, and the imaging indexes including hip-knee-ankle (HKA), lateral distal angle of femur (LDFA) and medial proximal angle of tibia (MPTA) measured before and after the operation, implant model indexes (preoperative planning implant model and postoperative implant model) and short-term clinical efficacy indexes [Western Ontario and McMaster Universities (WOMAC) osteoarthritis index] pain score, stiffness score, joint function score, total score and SF-12 score before and 3 months after the operation) were compared. Results:The average follow-up period was 109.60±9.80 d, (range 95-143 d). The average operation time of 106 patients was 105.30±23.22 min; The average intraoperative blood loss was 141.70±58.33 ml; The average length of hospitalization was 5.82±2.80 d. One patient had ischemic stroke after operation, and one patient had abnormal liver function after operation. According to the judgment of the investigator, all of them were not related to the operation. The actual angle error is the difference between the preoperative planning angle and the postoperative measurement angle. The absolute error of 99.1% (105/106) of the HKA angle was within 3°, 90.8% (69/76) of LDFA, 98.7% (75/76) of the MPTA. In 45 patients in one center where data were available, the actual implant models used in all patients were consistent with the preoperative planning size, and there were only differences in version selection such as Asian condyle. WOMAC pain score, joint function score, total score was improved from 7.34±2.85, 25.10±9.85, 34.75±13.02 to 3.34±2.66, 14.68±9.64, 18.66±13.49 before and after operation, respectively, which were statistically significant ( P<0.001) and SF-12 physiological score and psychological score were improved form 27.24±6.42, 30.68±8.26 to 38.83±5.74, 39.36±7.85 before and after operation, respectively, which were statistically significant ( t=7.33, P<0.001; t=4.53, P=0.043). Conclusion:Domestic surgical robot system "Skywalker" can assist the surgeon to achieve accurate and personalized reconstruction of lower limb alignment and achieve satisfactory short-term clinical outcomes. The long-term clinical outcomes of personalized reconstruction and survival rate of implant still need to be further studied.
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Femoral neck fracture (FNF) in the elderly patients is currently a major health challenge worldwide, with excessive consumption of medical resources, high incidence of complications as well as suboptimal outcome and prognosis. Hip joint arthroplasty (HJA) has been the mainstream treatment for FNF in the elderly, but the conventional surgical approaches and techniques are still confronted with a series of bottlenecks such as dislocation, limp and limb length discrepancy. In recent years, direct anterior approach (DAA) for HJA (DAA-HJA) has been a major new choice in the field of joint replacement, which achieves improved clinical effectiveness of HJA in the treatment of elderly FNF, due to the fact that DAA approach involves the neuromuscular interface and accords with the idea of soft tissue retention and enhanced recovery after surgery. However, there is still a lack of unified understanding of standard technique and procedure of DAA-HJA in the treatment of elderly FNF. Therefore, relevant experts from the Hip Joint Group of Chinese Orthopedics Association of Chinese Medical Association, Youth Arthrology Group of Orthopedic Committee of PLA, Orthopedic Committee of Chongqing Medical Association, Branch of Orthopedic Surgeons of Chongqing Medical Doctor Association and Sport Medicine Committee of Chongqing Medical Association were organized to formulate the " Chinese expert consensus on the technical standard of direct anterior hip arthroplasty for elderly femoral neck fracture ( version 2023)" based on evidence-based medicine. This consensus mainly proposed 13 recommendations covering indications, surgical plans, prosthesis selections, surgical techniques and processes, and postoperative management of DAA-HJA in elderly patients with FNF, aiming to promote standardized, systematic and patient-specific diagnosis and treatment to improve the functional prognosis of the patients.
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Objective: To study the effects of dihydromyricetin (DMY) on the proliferation, apoptosis and epithelial mesenchymal transition (EMT) of esophageal squamous cell carcinoma (ESCC) cell KYSE150 and KYSE410. Methods: KYSE150 and KYSE410 cells were treated with different concentrations of DMY (0, 25, 50, 100, 150, 200 μmol/L) for 24 hours. The median inhibition concentration (IC50) values of KYSE150 and KYSE410 were detected by cell counting kit-8 (CCK-8) method. Then 0.5‰ dimethyl sulfoxide (DMSO) was used as control group, dihydromyricetin (DMY), dihydromyricetin and transforming growth factor-β1 (DMY+ TGF-β1), transforming growth factor-β1 (TGF-β1) were used as experimental group. Cell proliferation and apoptosis rates were measured by clonal formation and flow cytometry. Transwell invasion and wound healing assay were used to detect cell invasion and migration. The protein expression levels of Caspase-3, Caspase-9, Bcl-2, Bax, Smad2/3, phosphorylation-Smad2/3 (p-Smad2/3) and Vimentin were detected by western blot. Results: The IC50 values of DMY on KYSE410 and KYSE150 cells were 100.51 and 101.27 μmol/L. The clone formation numbers of KYSE150 and KYSE410 in DMY group [(0.53±0.03) and (0.31±0.03)] were lower than those in DMSO group [(1.00±0.10) and (1.00±0.05), P<0.05]. The apoptosis rates of KYSE150 and KYSE410 cells in DMY group [(1.84±0.22)% and (2.80±0.07)%] were higher than those in DMSO group [(1.00±0.18)% and (1.00±0.07)%, P<0.05]. The invasion numbers of KYSE150 and KYSE410 cells in DMY group [(0.42±0.03) and (0.29±0.05)] were lower than those in DMSO group [(1.00±0.08) and (1.00±0.05), P<0.05]. The migration rates of KYSE150 and KYSE410 cells in DMY group [(0.65±0.14)% and (0.40±0.17)%] were lower than those in DMSO group [(1.00±0.10)% and (1.00±0.08)%, P<0.05]. The clone formation numbers of KYSE150 and KYSE410 in TGF-β1 group [(1.01±0.08) and (0.99±0.25)] were higher than those in DMY+ TGF-β1 group [(0.73±0.10) and (0.58±0.05), P<0.05]. The apoptosis rates of KYSE150 and KYSE410 cells in TGF-β1 group [(0.81±0.14)% and (1.18±0.10)%] were lower than those in DMY+ TGF-β1 group [(1.38±0.22)% and (1.85±0.04)%, P<0.05]. The invasion numbers of KYSE150 and KYSE410 cells in TGF-β1 group [(1.19±0.11) and (1.39±0.11)] were higher than those in DMY+ TGF-β1 group [(0.93±0.09) and (0.93±0.05), P<0.05]. The migration rates of KYSE150 and KYSE410 cells in TGF-β1 group [(1.87±0.19)% and (1.32±0.04)%] were higher than those in DMY+ TGF-β1 group [(0.86±0.16)% and (0.77±0.12)%, P<0.05]. The protein expression levels of Bax, Caspase-3 and Caspase-9 in KYSE150 and KYSE410 cells in DMY group were higher than those in DMSO group, while the protein expression level of Bcl-2 was lower than that in DMSO group (P<0.05). The protein expression levels of p-Smad2/3, Smad2/3 and Vimentin in KYSE150 and KYSE410 cells in DMY group were lower than those in DMSO group (P<0.05). The protein expression levels of Bax, Caspase-3 and Caspase-9 in KYSE150 and KYSE410 cells in TGF-β1 group were lower than those in DMY+ TGF-β1 group, and the protein expression level of Bcl-2 was higher than that in DMY+ TGF-β1 group (P<0.05). The protein expression levels of Bax, Caspase-3 and Caspase-9 in KYSE150 and KYSE410 cells in DMY+ TGF-β1 group were lower than those in DMY group, and the protein expression level of Bcl-2 was higher than that in DMY group (P<0.05). The protein expression levels of p-Smad2/3, Smad2/3 and Vimentin in KYSE150 and KYSE410 cells in TGF-β1 group were higher than those in DMY+ TGF-β1 group (P<0.05). Conclusion: DMY can inhibit the proliferation and EMT of ESCC mediated by TGF-β1 and promote cell apoptosis.
Subject(s)
Humans , Apoptosis , Caspase 3/metabolism , Caspase 9/metabolism , Cell Line, Tumor , Cell Movement , Cell Proliferation , Dimethyl Sulfoxide/pharmacology , Epithelial-Mesenchymal Transition , Esophageal Neoplasms/metabolism , Esophageal Squamous Cell Carcinoma , Flavonols , Signal Transduction , Transforming Growth Factor beta1/pharmacology , Vimentin/metabolism , bcl-2-Associated X Protein/pharmacologyABSTRACT
Liposomes with precisely controlled composition are usually used as membrane model systems to investigate the fundamental interactions of membrane components under well-defined conditions. Hydration method is the most common method for liposome formation which is found to be influenced by composition of the medium. In this paper, the effects of small alcohol (ethanol) on the hydration of lipid molecules and the formation of liposomes were investigated, as well as its coexistence with sodium chloride. It was found that ethanol showed the opposite effect to that of sodium chloride on the hydration of lipid molecules and the formation of liposomes. The presence of ethanol promoted the formation of liposomes within a certain range of ethanol content, but that of sodium chloride suppressed the liposome formation. By investigating the fluorescence intensity and continuity of the swelled membranes as a function of contents of ethanol and sodium chloride, it was found that sodium chloride and ethanol showed the additive effect on the hydration of lipid molecules when they coexisted in the medium. The results may provide some reference for the efficient preparation of liposomes.
Subject(s)
Ethanol/pharmacology , Lipids , LiposomesABSTRACT
We explored the pharmacodynamic material basis and network regulatory mechanism of Fufang Yuxingcao Mixture (FYM) for the treatment of fever and inflammation. Targets of the 25 compounds in FYM were predicted according to the reverse pharmacophore method and TCMSP, UniProt database. Gene ontology (GO) function enrichment and pathway analysis of the targets was analyzed by Omicsbean software and the Kyoto Gene and Genome Encyclopedia (KEGG) database. A "compound-target-pathway-pharmacological action-effect" network was established with Cytoscape 3.6.1 software. The lipopolysaccharide (LPS)-induced RAW264.7 cell inflammation model was used to verify the anti-inflammatory effects of FYM and its 10 important components. The network pharmacology experiment showed that 25 compounds affected 97 pathways through 211 targets, of which 15 key targets [including RAC-alpha serine/threonine-protein kinase (AKT1), insulin (INS), vascular endothelial growth factor A (VEGFA), interleukin-6 (IL-6), cellular tumor antigen p53 (TP53), tumor necrosis factor (TNF), transcription factor AP-1 (JUN), caspase-3 (CASP3), matrix metalloproteinase-9 (MMP9), interleukin-8 (IL-8), prostaglandin G/H synthase 2 (PTGS2), proto-oncogene c-Fos (FOS), tyrosine-protein kinase SRC (SRC), c-Jun N-terminal kinase 1 (MAPK8), estrogen receptor 1 (ESR1)] and 46 pathways (including NF-kappa B signaling pathway, Toll-like receptor signaling pathway, MAPK signaling pathway, IL-17 signaling pathway, arachidonic acid metabolism, cAMP signaling pathway, T cell receptor signaling pathway, calcium signaling pathway, inflammatory mediator regulation of TRP channels, chemokine signaling pathway, Th1 and Th2 cell differentiation, natural killer cell mediated cytotoxicity, etc.) were related to anti-inflammatory, antipyretic, immune regulation, and analgesia. In vitro cell experiments showed that FYM and the 10 components (including isoquercitrin, luteoloside, baicalein, wogonin, wogonoside, phillyrin, forsythoside A, chlorogenic acid, isochlorogenic acid A, and sweroside) could significantly reduce the expression of nitric oxide (NO), TNF-α and IL-6 in cell supernatants, indicating that the above 10 components may be the key pharmacodynamic material basis of FYM.
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Management of bone defects caused by fractures，bone tumors or infections is clinically difficult as well as a hot topic in current studies. With further researches over bone defects，the construction of tissue-engineered bone has played a great role in the treatment of bone defects. Blood vessels not only provide the necessary nutritional mineral salts，growth factors，hormones for bone formation，also are able to mediate the interaction among osteoblasts and osteoclasts，osteocytes，bone autonomic nerve and endothelial cells，since bone formation exist spatially and temporally connection with angiogenesis. Therefore，the authors make a systematic literature review on the research progress of the coupling mechanism of angiogenesis and osteogenic differentiation，blood vessels and related signal pathways on osteogenic differentiation and angiogenesis-related molecules in osteogenic differentiation during the process of traumatic bone defects，so as to provide new ideas for the treatment of bone defects.
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Objective:To evaluate and analyze the clinical value of Gd-EOB-DTPA magnetic resonance imaging in the differential diagnosis of cirrhotic nodules and small hepatocellular carcinoma.Methods:A total of 40 patients with cirrhosis admitted to Yuyao People's Hospital from January 2017 to June 2018 were enrolled in this study.MRI scan, Gd-EOB-DTPA dynamic enhanced scan and hepatobiliary specific scan were performed in these patients, and their magnetic resonance images were analyzed.All patients underwent magnetic resonance examination and were given surgery or needle biopsy to detect their pathological results.According to the signal intensity of hepatobiliary specific lesions, the patients were divided into three groups: low signal, mixed signal and other signals, and the results were compared with pathological grades of postoperative specimens.Results:After 40 patients with cirrhosis received MRI and dynamic contrast-enhanced scans, 136 nodules were diagnosed as cirrhotic regenerative nodules or hyperplastic nodules.Thirty-four patients were diagnosed with small hepatocellular carcinoma, and 42 small liver cancers were found after combined with Gb-EOB-DTPA hepatobiliary specific scan, the difference was statistically significant (χ 2=8.962, P<0.05). There was statistically significant difference between the signal intensity and pathological grade of 42 cases with hepatocellular carcinoma.There were no statistically significant differences in tumor size and pathological grade. Conclusion:For patients with clinically suspected hepatocellular carcinoma, Gd-EOB-DTPA magnetic resonance imaging is helpful to early detection of cirrhotic nodules and small liver cancer with malignant tendency, and can improve the accuracy of clinical diagnosis of diseases.
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Objective:To compare the clinical value of magnetic resonance imaging (MRI) and enhanced CT in the diagnosis of liver cancer.Methods:From January 2017 to December 2017, 72 patients with liver neoplasms who received treatment in Yuyao People's Hospital were selected as the subjects of this study.Enhanced CT scan and liver MRI scan were used in all patients respectively to compare the examination conditions of the two scanning methods for the lesions, the positive rate and accuracy of the detection, as well as the sensitivity and specificity of the two methods.Results:There was no statistically significant difference in the detection of extrahepatic lesions between the two methods(41.67% vs.36.11%, P>0.05). The detective rate of intrahepatic lesions of MRI (94.44%) was higher than that of enhanced CT(77.78%), the difference was statistically significant(χ 2=8.361, P<0.05). The missed diagnosis rate[5.56%(4/72)], misdiagnosis rate[1.39%(1/72)] of MRI were lower than those of enhanced CT[22.22%(16/72), 11.11%( 8/72)], and the accuracy of MRI[93.06%(67/72)] was higher than that of enhanced CT[66.67%(48/72)], the differences were statistically significant(χ 2=8.361, 4.354, 15.587, all P<0.05). The sensitivity[92.86%(52/56)], specificity[93.75%(15/16)] of MRI were higher than those of enhanced CT[71.43%(40/56), 50.00%(8/16)](χ 2=8.675, 7.575, all P<0.05). Conclusion:In the clinical diagnosis of liver cancer, the diagnostic accuracy of liver MRI is relatively high, which is conducive to the establishment and implementation of patients' treatment plan, and is conducive to clinical application and promotion.
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Objective:To compare the clinical outcomes of percutaneous screw fixation at the key points using a self-made calcaneal distraction device with traditional open reduction plate internal fixation for the treatment of patients with displaced intra-articular calcaneal fractures (DIACFs).Methods:A retrospective case-control study was made on clinical data of 60 patients (69 feet) with DIACFs admitted to First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2019. There were 51 males and 9 females, with an average age of 47.2 years [(47.2±8.7)years]. According to the Sanders classification, there were 42 feet of type II, 15 feet of type III and 12 feet of type IV. According to the Essex-Lopresti classification, there were 43 feet of tongue type fractures and 23 feet of joint depression fractures. Another 3 feet were not applicable to this classification system. In Group A, 30 patients (35 feet) were treated by percutaneous reduction or reduction using tarsal sinus approach with the self-made calcaneal distraction device followed by percutaneous screw fixation. In Group B, 30 patients (34 feet) were treated by open reduction and internal fixation with plates using the traditional extended lateral approach. Waiting time for surgery, operation time, length of hospital stay, efficacy of reduction and fracture healing, American Orthopedic Foot and Ankle Society (AOFAS) score, Maryland score, visual analog scale (VAS), and incidence of surgical site related complications were compared between groups. The efficacy of reduction was evaluated by measuring the height, length and width as well as the B?hler angle of the calcaneus.Results:All patients were followed up for an average of 28.2 months [(28.2±11.3)months]. The waiting time for surgery in Group A was (3.4±1.3)days, significantly shorter than that in Group B [(6.9±1.9)days] ( P<0.05). The operation time was (91.7±10.3)minutes in Group A and (92.8±11.5)minutes in Group B ( P>0.05). The length of hospital stay in Group A was (7.0±1.4)days, significantly shorter than that in Group B [(12.7±1.7)days] ( P<0.05). At the final follow-up, all fractures were healed, with no reduction loss of fixation observed. The height of the calcaneus was (48.9±2.0)mm in Group A and (49.3±2.6)mm in Group B ( P>0.05). The length of the calcaneus was (83.2±2.9)mm in Group A and (83.5±2.7)mm in Group B ( P>0.05). The width of the calcaneus was (35.8±2.3)mm in Group A and (35.1±1.3)mm in Group B ( P>0.05). The B?hler angle of the calcaneus was (24.7±6.4)° in Group A and (25.9±5.8)° in Group B ( P>0.05). At the final follow-up, the AOFAS score was (87.1±8.5)points in Group A and (86.7±7.8)points in Group B, with the good and excellent rate of 89% (31/35) and 88% (30/34) respectively ( P>0.05). The Maryland score was (85.3±9.5)points in Group A and (84.9±9.5)points in Group B, with the good and excellent rate of 86% (30/35) and 85% (29/34), respectively ( P>0.05). The VAS was (2.3±1.5)points in Group A and (2.5±1.5)points in Group B ( P>0.05). No surgical site related complication was observed in Group A. While in Group B, there was one foot of superficial incision infection, three necrosis of the skin at the edge of the incision, and one deep infection ( P<0.05). Conclusions:For the treatment of DIACFs, percutaneous screw fixation at the key point using the self-made calcaneal distraction device can achieve the same clinical outcome as traditional open reduction plate internal fixation, but it has advantages like significant shorter waiting time for surgery, less invasiveness, faster recovery and lower incidence of incision-related complications. This method is especially suitable for patients with contraindications of open reduction and internal fixation.