Risk factors for patellar clunk syndrome after total knee arthroplasty without patellar surface replacement / 中华创伤骨科杂志

Objective:To analyze the risk factors for patellar clunk syndrome after total knee arthroplasty (TKA) without patellar surface replacement.Methods:Retrospectively analyzed were a total of 222 patients who had undergone TKA without patellar surface replacement at Department of Joint Surgery, The Second Hospital of Shanxi Medical University from June 2020 to June 2021. There were 43 males and 179 females, and 38 cases of rheumatoid arthritis and 184 cases of arthritis. They were divided into a patellar clunk syndrome group ( n = 56) and a non-patellar clunk syndrome group ( n = 166) according to the occurrence of patellar clunk after TKA. The incidence of early patellar clunk syndrome after TKA was 25.2% (56/222). The patient gender, arthritis type, prosthesis type, postoperative range of knee motion, postoperative patellar thickness, Insall-Salvati index, postoperative joint line height, lower extremity muscle strength, and the distance from the tibial plateau to the patellar tendon were recorded. The risk factors for patellar clunk syndrome were determined by univariate analysis and logistic analysis. Results:The univariate analysis showed significant differences between the 2 groups in prosthesis type, postoperative joint line height, postoperative lower extremity muscle strength, and the distance from the tibial plateau to the patellar tendon ( P < 0.05). The logistic analysis showed that the posterior cruciate substituting (PS) prosthesis was an independent risk factor compared with the cruciate-retaining (CR) prosthesis ( OR = 2.791, 95% CI: 1.411 to 5.521, P = 0.003), and the increased lower extremity muscle strength was an independent protective factor ( OR = 0.295, 95% CI: 0.148 to 0.587, P = 0.001). Conclusions:The incidence of patellar clunk syndrome is relatively high. The PS prosthesis may be an independent risk factor relative to the CR prosthesis. As the increased lower extremity muscle strength may be an independent protective factor, the recovery and strengthening of the muscle strength after TKA require more attention.

The Effect of Materials and Porosity on Bone Formation of Degradable Scaffolds / 医用生物力学

Objective To study the effect of different materials and porosities on bone formation in the scaffold after implantation of the degradable bone scaffold into human body. Methods According to natural reaction mechanism of fracture healing, the finite element method was used, combined with geometry of the scaffold, to establish a computationally coupled model based on material degradation curve and bone reconstruction control equation. Through this platform, representative volume elements of the scaffold with five kinds of materials and four types of porosities were selected for calculation and analysis, and dynamic process was reflected by bone mineral density (BMD) and maximum stress of the scaffold. Results The elastic modulus of the materials had a greater influence on growth of bone tissues in the scaffold. The smaller elastic modulus of the materials would lead to the greater amount of bone formation, but it would also have a greater impact on mechanical properties of the scaffold. The scaffold with higher porosity had lower rigidity, which could better promote formation of bone tissues, meanwhile it would also destroy mechanical stability of the scaffold. Conclusions According to performance requirements for different age, gender and location of bone tissues, personalized reference and calculation basis for selection of materials and porosity, structural design and clinical application of degradable porous bone scaffolds can be provided.

CXCL9 mRNA expression in ovarian tumor tissue and its relations with prognosis and characteristics of immune microenvironment / 上海交通大学学报（医学版）

Objective : To investigate the effects of CXCL9 (C-X-C motif chemokine ligand 9) mRNA expression on the overall survival of ovarian cancer patients, and to explore its relations with immune-related pathways and gene expression in tumor microenvironment, so as to re-veal the significance of CXCL9 in the prognosis of ovarian cancer. Methods ¡¤ Kaplan-Meier method was used to analyze the relationship be-tween CXCL9 mRNA expression and the survival of ovarian cancer patients in The Cancer Genome Atlas (TCGA) database. Gene Set Enrich-ment Analysis (GSEA) was used to assess the biological function of CXCL9 mRNA in ovarian cancer. The correlation of CXCL9 mRNA with cluster of differentiation 8A (CD8A) and immune checkpoint mRNA expression was analyzed. Results ¡¤ The high expression of CXCL9 mRNA was significantly associated with better prognosis in patients with ovarian cancer. GSEA showed that CXCL9 mRNA was enriched in the immune response-related pathway. In addition, Pearson correlation analysis showed that CXCL9 mRNA expression was positively correlated with the mRNA expression of CD8A and immune checkpoint. Conclusion ¡¤ The high expression of CXCL9 mRNA in ovarian tumor tissue is a good predictor of prognosis, and the mRNA expression of CXCL9 may be closely related to the recruitment of lymphocytes from tumor margin to the tumor microenvironment to exert the function of anti-tumor immune response.

Myofascial self-release law / 中华创伤杂志

Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons.Clinicians attach great importance to OFCS because of its severe clinical consequences,and decompression of fascial compartment is often performed in emergency treatment.This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome,especially the inconsistent pressure thresholds as the indication for emergency decompression surgery.By observing calf fractures patients with tension blister,we found that the pressure of fascia decreased sharply upon the appearance of blisters.Meanwhile,the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia.In view of the uncertainty of various thresholds of fascial decompression and self-decompression,the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed.The author believes that when intracompartmental pressure rises to a point,some unknown mechanisms of fascia can achieve self-decompression.Therefore,no compartment syndrome will take place.We also emphasize that the ' muscle-swelling syndrome'should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury,so as to provide more precise treatment.We believe that without external restrictions such as casts,splints and compression bandages,the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters,and there is no need for fasciotomy.

Molecular classification of endometrial cancer and its association with PD-1/PD-L1 blockade / 中国免疫学杂志

Endometrial cancer is one of the three common cancer of the female genital tract. According to the molecular char-acteristics of endometrial cancer.The cancer genome atlas proposed four molecular subtypes:POLE (DNA polymerase ε,POLE) mutant;microsatellite instability hypermutation;low copy number and high copy number/serous. Numerous preclinical and clinical researches indicated that PD-1/PD-L1 blockade therapy is a promising method for immunotherapy of endometrial cancer. The subtypes of POLE mutant and MSI hypermutation in endometrial cancers are characterized by high tumor mutation burden which may benefit from the treatment of PD-1/PD-L1 blockade. This molecular classification of endometrial cancer provides a new clinical treatment strategy for individualized immunotherapy.

Antioxidant effects of the Uygur herb, Foeniculum Vulgare Mill, in a rat model of hepatic fibrosis / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To evaluate therapeutic and antioxidant effects of Uygur Herb Foeniculum Vulgare Mill (FVM) in hepatic fibrosis rats.</p><p><b>METHOD</b>Hepatic fibrosis model was built in rats by subcutaneous injection with 40% CCl4 olive oil mixture. At the same time the rats were given high lipoid-low protein animal feeds for 5 weeks. 94 male SD rats were randomly divided into six groups :blank control group (A-group), 8 rats were feed in normal; prevention model control group (B-group), 10 rats were given saline solution by intragastric administration during make of hepatic fibrosis model; FVM prevention group (C-group), 10 rats were given FVM by intragastric administration during make of hepatic fibrosis model; model control group (D-group), FVM treatment group (E-group); Fuzhenghuayu treatment group (F-group). 22 rats in each D, E, F-group were respectively given saline solution, FVM and Fuzhenghuayu by intragastric administration after hepatic fibrosis model were built. At the 5-th weekend, A, B, C- group rats were sacrificed. At the 6-th, 7-th, 8-th, 9-th weekend, 4-6 rats in D, E, F-group were sacrificed. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), hyaluronic acid (HA), laminin (LN) and 8 - hydroxy-2-deoxyguanosine (8-OHdG) were detected, liver tissue homogenate superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), malondialdehyde (MDA) were detected. Histopathologic changes were observed after H.E and Masson staining. The expression of alpha-smooth muscle actin(a-SMA) were detected by immunohistochemical staining. The data were analyzed by SPSS17.0 software.</p><p><b>RESULTS</b>The serum levels of ALT, AST, HA, and LN in the FVM prevention group were significantly reduced compared to the prevention model control group.(P less than 0.05). Rats in FVM treatment group appeared a marked lower serum levels of ALT, AST, HA compared to the model control group (P less than 0.05), and a distinguished lower Inflammation grade and fibrosis stage (P less than 0.05) when the liver section were assayed as well; Rats in FVM treatment group and FVM prevention group had a conspicuous lower content of MDA, 8-OHdG, fibre and a-SMA expression (P less than 0.05), a significantly higher level of SOD, GSH-Px compared to those of in the model control groups.</p><p><b>CONCLUSIONS</b>Foeniculum Vulgare Mill declines liver inflammation response ,and prevent the hepatic fibrosis progression,, this may be due to its effects of antioxidative results.</p>