A Randomized Comparison Between Anterior Talofibular Ligament Repair Using Broström Operation with and without an Internal Brace.

The aim of the study was to compare the intermediate-term (>24 months) clinical outcomes between anterior talofibular ligament repair using Broström operation with and without an internal brace. Nineteen patients underwent surgery using an arthroscopic traditional Broström repair with an internal brace technique (IB) and Eighteen patients underwent surgery using an arthroscopic traditional Broström repair without an internal brace technique (TB) . All patients were evaluated clinically using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). According to FAAM, sports activity scores of TB and IB groups were 83.33 ± 5.66 and 90.63 ± 6.21 at the final follow-up (p = .02). There were no significant differences in preoperative and postoperative stress radiographs between the two groups. Total medical expense was more in the IB group (p < .001). It also has a significant superiority in the terms of FAAM scores at sports activity. However, there was no difference during daily life.

Procyanidin B2 regulates the Sirt1/Nrf2 signaling pathway to improve random-pattern skin flap survival.

Random-pattern skin flaps have been widely used in the reconstruction of damaged tissues. Ischemia-reperfusion injury occurring in the distal regions of the flap is a common issue, which often leads to flap necrosis and restricts its clinical applications. Procyanidin B2 (PB2), a naturally occurring flavonoid in large quantities in various fruits, has been demonstrated to exhibit several significant pharmacological properties. However, the effect of PB2 on flap viability is not clearly known. Here, using Western blot analysis, immunohistochemistry, and immunofluorescence staining, we observed that PB2 significantly reduced oxidative stress and inflammation and enhanced angiogenesis. Mechanically, we provided evidence for the first time that the beneficial effects of PB2 occur through the activation of the Sirt1/Nrf2 signaling pathway. Moreover, co-administration of PB2 and EX527, a selective inhibitor of Sirt1, resulted in down-regulation of the expression of Sirt1, Nrf2, and downstream antioxidants. In summary, our study showed that PB2 might be a novel therapeutic strategy for improving the survival of random-pattern skin flaps.

[Experimental study on improving stability of anchor by adding anchor].

OBJECTIVE: To explore whether anchor placement could improve holding force of anchors under the condition of osteoporosis, in order to solve the problem of clinical treatment for rotator cuff injury associated with osteoporosis. METHODS: Twenty one bone modules, which included 13 males and 8 females aged from 60 to 95 years old with an average of (77.6±10.3) years old, and were divided into three experimental groups named as group A, B and C, and 7 in each group. A single anchor was inserted in group A, two parallel anchors were screwed in group B, and a single anchor was screwed in group C, then after the anchor was pulled out, anchor was screwed back and another anchor was screwed in close to the anchor. X-ray examination was performed in all three groups to observe situation of anchor in osteoporosis module; the maximum axial pull-out force (Fmax) of the three groups was measured. RESULTS: Fmax of group A, B and C was (170.35±31.21) N, (314.47±23.47) N, and(292.74±25.36) N, respectively. Compared with group A, there were statistical difference of Fmax in group B and C(P<0.05), while no difference of Fmax between group B and C(P>0.05). CONCLUSION: In the case of loose anchors in the osteoporosis module, holding force of anchors could be improved by adding anchor, which provide a remedy for single anchor failure in clinical operation.

Anatomical Study on the Reconstruction of the Anterior Talofibular Ligament.

The purpose of this study aimed to (1) identify the relationship between the fibula and the talus of the anterior talofibular ligament (ATFL); (2) collect detailed anatomical data and provide anatomical basis for ATFL anatomical reconstruction. We selected 27 ankle specimens of adult cadavers (9 left feet and 18 right feet in 11 males and 16 females; mean age 41.6 years) with the exception of ankle deformities, fractures, underdevelopment and degenerative diseases. In these 27 specimens,15 cases of ATFL were divided into two bundles and 12 cases of ATFL were single bundles. The average ATFL length was 20.31 ± 3.12mm. The center of the ATFL in 11 specimens was located in the calcaneofibular ligament (CFL) foot print area. The long axis of the fibula side stop point was 8.83±1.82 mm, and the short axis was 3.12±0.49 mm. The distance from the center of the ATFL fibula attachment area to the tip of the fibula was 14.22±2.87 mm, and the distance from the center of the CFL is 5.57±1.80mm. The distance from the center of the ATFL talar attachment area to the tibiotalar articular surface was (9.74±2.12) mm, and the distance from the anterior external cartilage surface of the talus was (4.87±1.82) mm. The angle between ATFL and the long axis of the fibula is 78°±12°. Our results suggest that in ATFL reconstruction, the anatomical attachment points around the ATFL or the angle between ATFL and the long axis of the fibula both can be used for bone canal positioning.

Knockdown of microRNA-203 reduces cisplatin chemo-sensitivity to osteosarcoma cell lines MG63 and U2OS in vitro by targeting RUNX2.

Clinical studies have reported that miRNAs abnormal expression are associated with the generation of cisplatin-resistant to osteosarcoma. Our previous research found that miR-203 is downregulated in osteosarcoma cells and overexpressed miR-203 exerts antitumor properties on osteosarcoma cells. However, the role and mechanism of miR-203 in regulating the sensitivity of cisplatin in osteosarcoma cells remains unclear. This study aimed to investigate the effects of miR-203 in cisplatin therapy for osteosarcoma cells in vitro and determined the underlying mechanism. In this study, we found that miR-203 was significantly upregulated in osteosarcoma cells after exposure to cisplatin. miR-203 knockdown reduced the sensitivity of osteosarcoma cells to cisplatin by suppressing cell apoptosis, cell cycle arrest, and inducing invasion. Meanwhile, we found that miR-203 knockdown reduces the therapeutic sensitivity of osteosarcoma cells by upregulating RUNX2. Moreover, we found that RUNX2 silencing sensitizes osteosarcoma cells to chemotherapy treatment of cisplatin. In summary, our findings demonstrated that miR-203 knockdown reduces cisplatin chemo-sensitivity to osteosarcoma cells in vitro by targeting RUNX2, and speculated that miR-203 may be a target for drug resistance of osteosarcoma to cisplatin.

Liposomal Bupivacaine Single-Injection Compared With Continuous Local Anesthetic Nerve Blocks for Painful Surgeries: A Meta-Analysis of Randomized Controlled Trials and Trial Sequential Analysis.

OBJECTIVE: This meta-analysis aimed to determine whether liposomal bupivacaine (LB) single-injection could achieve an analgesic effect similar to that of continuous local anesthetic nerve blocks (CNBs) after painful surgeries. METHODS: Embase, PubMed, and the Cochrane Library databases were comprehensively searched. Randomized controlled trials (RCTs) with a modified Jadad score ≥ 4 compared LB single-injection with CNBs in patients after painful surgeries were included. The primary outcomes were VAS pain score and opioid consumption. The secondary outcomes were complications and length of hospital stay. Review Manager 5.3 and trial sequential analysis (TSA) 0.9.5.10 were used to analyze the extracted data. RESULTS: Six RCTs of 625 patients were included for meta-analysis. Both groups in 5 RCTs described standard concomitant treatment with multimodal analgesia. There were no significant differences in mean VAS scores for postoperative day 0 (P = 0.12), day 1 (P = 0.18), and day 2 (P = 0.41); highest VAS scores for day 0 (P = 0.18), day 1 (P = 0.46), and day 2 (P = 0.18); total opioid consumption for day 0 (P = 0.05), day 1 (P = 0.28), and day 2 (P = 0.57); complications (P = 0.30); and length of hospital stay (P = 0.64) between the 2 groups. TSA of primary outcomes showed that all cumulative Z curves failed to cross the TSA boundary and did not reach the required information size. CONCLUSIONS: This meta-analysis showed that LB single-injection and CNBs have similar efficacy of pain relief and safety in patients after painful surgeries when concomitant with multimodal analgesia. However, the results of TSA indicate that further trials are still needed to confirm these findings.

Spatiotemporal scale and integrative methods matter for quantifying the driving forces of land cover change.

Land cover change (LCC) is a major part of environmental change. Exploring the spatiotemporal differences in LCC and the driving factors is the basis for comprehensive research on landscape planning, and it is of great significance for future effective and sustainable landscape management. In this respect, cross-scale research with integrated methods is worthy of more attention, although some studies have discussed the driving forces of LCCs at either regional or local scale. We combined a structural equation model and a mixed-effects model for quantifying the driving forces of LCCs across different scales in the Loess Plateau (China), which is a typical region that has experienced significant LCCs over recent decades. The impacts of biophysical and socioeconomic factors on different change trajectories (agricultural intensification, urbanization and ecological restoration) were found to be inconsistent at different temporal and spatial scales. We found that topography had a negative effect on agricultural intensification during 1990-2010 and on urbanization during 1990-2000, but it had a positive effect on ecological restoration during 2000-2015 at the regional scale. Moreover, although there was no significant impact from economic development on any type of LCCs at the regional scale, its important influence could be seen in some of the township categories. Therefore, the path and scale dependence of driving forces is an important consideration in landscape planning and management to accommodate local conditions and fine-tuned analysis as decision-making supports.

Freestanding Triboelectric Nanogenerator Enables Noncontact Motion-Tracking and Positioning.

Recent development of interactive motion-tracking and positioning technologies is attracting increasing interests in many areas, such as wearable electronics, intelligent electronics, and the internet of things. For example, the so-called somatosensory technology can afford users strong empathy of immersion and realism due to their consistent interaction with the game. Here, we report a noncontact self-powered positioning and motion-tracking system based on a freestanding triboelectric nanogenerator (TENG). The TENG was fabricated by a nanoengineered surface in the contact-separation mode with the use of a free moving human body (hands or feet) as the trigger. The poly(tetrafluoroethylene) (PTFE) arrays based interactive interface can give an output of 222 V from casual human motions. Different from previous works, this device also responses to a small action at certain heights of 0.01-0.11 m from the device with a sensitivity of about 315 V·m-1, so that the mechanical sensing is possible. Such a distinctive noncontact sensing feature promotes a wide range of potential applications in smart interaction systems.