[Assessment of the local blood supply when femoral neck fracture occurs:advances in the anatomy research and its clinical application].

The stability of internal fixation of femoral neck fractures can be obtained through surgical techniques, the configuration of screws and bone grafting, etc. However, the blood supply injury caused by fractures could not be completely reversed by the current medical management. Hence, the comprehensive evaluation of the residual blood supply of the femoral neck, to perioperatively avoid further iatrogenic injury, has become a hotspot. The anatomy of the extraosseous blood supply of the femoral neck has been widely reported, while its clinical application mostly involved the assessment of the medial circumflex femoral artery and retinacular arteries. However, further studies are needed to explore the prognosis of patients with these artery injuries, with different degrees, caused by femoral neck fractures. Direct observations of nutrient foramina in vivo are not possible with current clinical technologies, but it is possible to make reasonable preoperative planning to avoid subsequent femoral head necrosis based on the distribution features of nutrient foramina. The anatomy and clinical application studies of the intraosseous blood supply focused on the junction area of the femoral head and neck to probe the mechanism of femoral head necrosis. Thus, the intraosseous blood supply of other regions in the femoral neck remains to be further investigated. In addition, a blood supply evaluation system based on a three-level structure, extraosseous blood vessels, nutrient foramina, and intraosseous vascular network, could be explored to assist in the treatment of femoral neck fractures.

Reoperation rate and implants' position variation features of displaced femoral neck fractures with sliding compression or length-stable fixation in young and middle-aged population.

INTRODUCTION: Sliding compression fixation and length-stable fixation are two basic internal fixation concepts in the treatment of displaced femoral neck fractures. In this study, we aimed to compare the reoperation rates for different methodologies of internal fixation for femoral neck fractures in young and middle-aged population. MATERIALS AND METHODS: This a retrospective study. A total of 215 patients with displaced femoral neck fractures treated with cannulated screw fixation were enrolled and divided into the sliding compression and length-stable groups according to the fixation pattern. The occurrence of and reason for revision surgery within one year were recorded. Forty-five patients with complete CT data (including CT scanning on the first postoperative day and at the last follow up) were selected from the total sample. A newly established computerized image processing method was used to evaluate variations in the spatial location of screws. RESULTS: The reoperation rate was significantly higher in the length-stable group (23.8%) than in the sliding compression group (7.3%). The rate of revision surgery due to nonunion was also higher in the length-stable group (11.4%) than in the sliding compression group (1.8%). However, no significant difference was observed in terms of joint penetration or soft tissue irritation. The sliding compression group (6.58 ± 3.18 mm) showed higher femoral neck shortening than length-stable group (4.16 ± 3.65 mm). When analyzing the spatial variations, a significantly greater screw withdrawal distance was observed in the sliding compression group than in the length-stable group, but with a smaller rotation angle. CONCLUSION: Length-stable internal fixation of displaced femoral neck fractures may lead to an increased reoperation rate in young and middle-aged population. TRIAL REGISTRATION: Name of the registry: Chinese Clinical Trial Registry. TRIAL REGISTRATION NUMBER: ChiCTR2000032327. Trial registration date: 2020-4-26.

A quantitative study of bone defects in displaced femoral neck fractures based on virtual reduction techniques.

BACKGROUND: Bone defects in femoral neck fractures are strongly associated with the prognosis after internal fixation. However, qualitative analysis of bone defects in femoral neck fractures has already been performed, quantitative studies have not been reported. In this study, we aimed to systematically analyse the morphological characteristics of bone defects in patients with femoral neck fractures using computed tomography (CT) images combined with computer image analysis techniques. METHODS: Four hundred and sixty-nine patients with femoral neck fractures from January 2014 to December 2018 at two grade A tertiary hospitals were included. Models were created in Mimics software based on CT images collected within 1 week after injury and then imported into 3-matic software for virtual reduction. The volume of the bone defect (VBD), maximum defect thickness (MDT), extent of the bone defect region (EBDR) , main defect quadrant (MDQ), collapse type and fracture classification were calculated and recorded. RESULTS: The EBDR, collapse type and MDT all had a significant positive effect on the VBD (P <0.05), with a more significant effect at higher quantiles. Age also had a significant positive effect on the VBD (P < 0.05), but its effect was more pronounced at lower quantiles. Compared to non-subcapital fractures, subcapital fractures had a positive effect on the VBD only at the 50 and 75% quantiles (P < 0.01). The female sex had a significant negative effect on the VBD compared to the male sex (P < 0.05). CONCLUSION: This study established a reliable computer image processing method for quantitative analysis of the VBD in femoral neck fractures and revealed that all patients with femoral neck fractures had bone defects, which can occur at any part of the femoral neck. The EBDR, MDT, collapse type, and patient age and sex were all important risk factors for the extent of the defect and should be taken into account in surgical planning.

Controllable spontaneous resolution in ultrasmall Cu-Ag bimetallic cluster ion pairs from achiral components.

Bimetallic cluster ion pairs containing a quaternary phosphonium and an ultrasmall Cu2Ag3 anionic cluster protected by thiolates: (PPh3R'')[Cu2Ag3(SR')6] (R'SH = cyclohexylthiol (CySH), R'' = Ph, 1; Me, 2; Et, 3; Pr, 4; R'SH = tert-butylthiol (tBuSH) and R'' = Ph, 5) were reported. Without any chiral source, 1 crystallizes as conglomerate crystals with homochiral packings and spontaneous resolution occurs, while four other clusters 2-5 crystallize as racemic crystals with heterochiral packings. These results indicate that racemic and homochiral crystallization in the cluster system could be controlled through fine-tuning internal achiral structural components.

A lithium passivated MoO3 nanobelt decorated polypropylene separator for fast-charging long-life Li-S batteries.

Dissolution of lithium polysulfide (LiPS) into the electrolyte during discharging, causing shuttling of LiPS from the cathode to the lithium (Li) metal, is mainly responsible for the capacity decay and short battery life of lithium-sulfur batteries (LSBs). Herein, we designed a separator comprising polypropylene (PP) coated with MoO3 nanobelts (MNBs), prepared through facile grinding of commercial MoO3 powder. The formation of Li2Sn-MoO3 during discharging inhibited the polysulfide shuttling; during charging, Li passivated LixMoO3 facilitated ionic transfer during the redox reaction by decreasing the charge transfer resistance. This dual-interaction mechanism of LiPS-with both Mo and the formation of LixMoO3-resulted in a substantially high initial discharge capacity at a very high current density of 5C, with 29.4% of the capacity retained after 5000 cycles. The simple fabrication approach and extraordinary cycle life observed when using this MNB-coated separator suggest a scalable solution for future commercialization of LSBs.

Mitigating Metal Dendrite Formation in Lithium-Sulfur Batteries via Morphology-Tunable Graphene Oxide Interfaces.

Despite issues related to dendrite formation, research on Li metal anodes has resurged because of their high energy density. In this study, graphene oxide (GO) layers are decorated onto Li metal anodes through a simple process of drop-casting and spray-coating. The self-assembly of GO is exploited to synthesize coatings having compact, mesoporous, and macroporous morphologies. The abilities of the GO coatings to suppress dendrite formation are compared through Li|Li symmetrical cell charging at a current density of 5 mA cm-2 for 2000 cycles-a particularly abusive test. The macroporous structure possesses the lowest impedance, whereas the compact structure excels in terms of stability. Moreover, GO exhibits a low nucleation overpotential and is transformed into reduced GO with enhanced conductivity during the operation of the cells; both factors synergistically mitigate the issue of dendrite formation. Li-S batteries incorporating the GO-decorated Li anodes exhibit an initial capacity of 850 mA h g-1 and maintain their stability for 800 cycles at a C-rate of 1 C (1675 mA h g-1), suggesting the applicability of GO in future rechargeable batteries.

Modified Separator Performing Dual Physical/Chemical Roles to Inhibit Polysulfide Shuttle Resulting in Ultrastable Li-S Batteries.

In this paper we describe a modified (AEG/CH) coated separator for Li-S batteries in which the shuttling phenomenon of the lithium polysulfides is restrained through two types of interactions: activated expanded graphite (AEG) flakes interacted physically with the lithium polysulfides, while chitosan (CH), used to bind the AEG flakes on the separator, interacted chemically through its abundance of amino and hydroxyl functional groups. Moreover, the AEG flakes facilitated ionic and electronic transfer during the redox reaction. Live H-cell discharging experiments revealed that the modified separator was effective at curbing polysulfide shuttling; moreover, X-ray photoelectron spectroscopy analysis of the cycled separator confirmed the presence of lithium polysulfides in the AEG/CH matrix. Using this dual functional interaction approach, the lifetime of the pure sulfur-based cathode was extended to 3000 cycles at 1C-rate (1C = 1670 mA/g), decreasing the decay rate to 0.021% per cycle, a value that is among the best reported to date. A flexible battery based on this modified separator exhibited stable performance and could turn on multiple light-emitting diodes. Such modified membranes with good mechanical strength, high electronic conductivity, and anti-self-discharging shield appear to be a scalable solution for future high-energy battery systems.

A New Look at Genetic and Environmental Architecture on Lipids Using Non-Normal Structural Equation Modeling in Male Twins: The NHLBI Twin Study.

This study examined genetic and environmental influences on the lipid concentrations of 1028 male twins using the novel univariate non-normal structural equation modeling (nnSEM) ADCE and ACE models. In the best fitting nnSEM ADCE model that was also better than the nnSEM ACE model, additive genetic factors (A) explained 4%, dominant genetic factors (D) explained 17%, and common (C) and unique (E) environmental factors explained 47% and 33% of the total variance of high-density lipoprotein cholesterol (HDL-C). The percentage of variation explained for other lipids was 0% (A), 30% (D), 34% (C) and 37% (E) for low-density lipoprotein cholesterol (LDL-C); 30, 0, 31 and 39% for total cholesterol; and 0, 31, 12 and 57% for triglycerides. It was concluded that additive and dominant genetic factors simultaneously affected HDL-C concentrations but not other lipids. Common and unique environmental factors influenced concentrations of all lipids.

Uric acid correlates to oxidation and inflammation in opposite directions in women.

OBJECTIVE: To evaluate the association of uric acid (UA) levels with a panel of markers of oxidative stress and inflammation. METHODS: Plasma UA levels, along with a panel of oxidative stress and inflammatory markers, were measured in 755 Chinese women. RESULTS: Plasma UA levels were inversely associated with urinary levels of the oxidative stress marker F2-isoprostanes and positively correlated to levels of inflammatory markers, such as C-reactive protein and some proinflammatory cytokines (tumor necrosis factor-α and interleukin-6) in blood as well as prostaglandin E2 metabolites in urine. CONCLUSIONS: Plasma UA levels correlate to oxidation and inflammation biomarkers in opposite directions in women.

Genetic and environmental influences on the prospective correlation between systemic inflammation and coronary heart disease death in male twins.

OBJECTIVE: Because of lack of evidence, we aimed to examine to what degree low-grade systemic inflammation and coronary heart disease (CHD) death shared common genetic and environmental substrates. APPROACH AND RESULTS: From the 41-year prospective National Heart, Lung, and Blood Institute Twin Study, we included 950 middle-aged male twins at baseline (1969-1973). Low-grade systemic inflammation was measured with plasma levels of interleukin-6 (IL-6) and C-reactive protein. Univariate and bivariate structural equation models were used, adjusted for a risk score for CHD death. The score-adjusted heritability was 19% for IL-6, 27% for C-reactive protein, and 22% for CHD death. The positive phenotypic correlation of IL-6 with CHD death (radjusted=0.27; 95% confidence interval [CI], 0.08-0.43) was driven by additive genetic factors (contribution [relative contribution], 0.30 [111%]) but attenuated by unique environment (-0.03 [-11%]). The genetic correlation between IL-6 and CHD death was 0.74 (95% CI, 0.21-1.00), whereas the unique environmental correlation was -0.05 (95% CI, -0.35 to 0.25). The proportion of genetic variance for CHD death shared with that for IL-6 was 74%. The phenotypic correlation of C-reactive protein with CHD death (radjusted=0.10; 95% CI, -0.02 to 0.22) was explained by additive genetic factors (0.20 [149%]) but was attenuated by the unique environment (-0.09 [-49%]). The genetic correlation of C-reactive protein with CHD death was 0.63 (95% CI, -0.07 to 1.00), whereas the unique environmental correlation was -0.07 (95% CI, -0.29 to 0.17). CONCLUSIONS: Low-grade systemic inflammation, measured by IL-6, and long-term CHD death share moderate genetic substrates that augment both traits.

Heritability of usual alcohol intoxication and hangover in male twins: the NAS-NRC Twin Registry.

BACKGROUND: Alcohol consumption is influenced by heritable factors. The genetic influence on usual high-density drinking, including alcohol intoxication and hangover, is unknown. We aim to estimate the heritability of usual high-density drinking. METHODS: A total of 13,511 male twins in this cross-sectional study were included from the National Academy of Sciences-National Research Council (NAS-NRC) Twin Registry. Data on the frequency of alcohol intoxication and alcohol hangover over the past year, that is, usual high-density drinking (phenotypes), were collected through a self-administered questionnaire when twins were middle-aged in 1972. Structural equation modeling was used to estimate the variance components of phenotypes. RESULTS: The mean of the frequency of usual high-density drinking in the entire twin population was 0.16 times per month for intoxication and 0.18 times per month for hangover. The heritability of usual alcohol intoxication was 50.7% (95% confidence interval [CI] 46.2 to 55.0) before and 49.9% (95% CI 45.3 to 54.2) after the body mass index (BMI) adjustment. The heritability of usual hangover was 55.4% (95% CI 51.2 to 58.6) before and 54.8% (95% CI 50.6 to 58.8) after adjustment for BMI. Unshared environmental factors between co-twins explained the remaining variance in alcohol intoxication and in hangover. CONCLUSIONS: Both genetic and unshared environmental factors have important influences on usual alcohol intoxication and hangover. These findings are important in understanding the occurrence of and developing interventions for usual high-density drinking.

Cruciferous vegetable intake is inversely correlated with circulating levels of proinflammatory markers in women.

BACKGROUND: Higher intakes of cruciferous vegetables or their constituents have been shown to lower inflammation in animal studies. However, evidence for this anti-inflammatory effect of cruciferous vegetable consumption in humans is scarce. OBJECTIVE/DESIGN: In this cross-sectional analysis, we evaluated associations of vegetable intake with a panel of inflammatory and oxidative stress markers among 1,005 middle-aged Chinese women. Dietary intake of foods was assessed by a food frequency questionnaire. RESULTS: Multivariable-adjusted circulating concentrations of tumor necrosis factor-α (TNF-α), interlukin-1ß (IL-1ß), and IL-6 were lower among women with higher intakes of cruciferous vegetables. The differences in concentrations of inflammatory biomarkers between extreme quintiles of cruciferous vegetable intake were 12.66% for TNF-α (Ptrend=0.01), 18.18% for IL-1ß (Ptrend=0.02), and 24.68% for IL-6 (Ptrend=0.02). A similar, but less apparent, inverse association was found for intakes of all vegetables combined but not for noncruciferous vegetables. Levels of the urinary oxidative stress markers F2-isoprostanes and their major metabolite, 2,3-dinor-5,6-dihydro-15-F2t-IsoP, were not associated with intakes of cruciferous vegetables or all vegetables combined. CONCLUSIONS: This study suggests that the previously observed health benefits of cruciferous vegetable consumption may be partly associated with the anti-inflammatory effects of these vegetables.

Nonexercise physical activity and inflammatory and oxidative stress markers in women.

BACKGROUND: Leisure time exercise has been linked to lower circulating levels of inflammatory markers. Few studies have examined the association of nonexercise physical activity with markers of inflammation and oxidative stress. METHODS: This cross-sectional analysis included 1005 Chinese women aged 40-70 years. Usual physical activity was assessed through in-person interviews using a validated physical activity questionnaire. Plasma proinflammatory cytokines and urinary F2-isoprostanes were measured. Multivariable linear models were used to evaluate the association of inflammatory and oxidative stress markers with nonexercise physical activity and its major components. RESULTS: Nonexercise physical activity accounted for 93.8% of overall physical activity energy expenditure. Levels of nonexercise physical activity were inversely associated with circulating concentrations of interleukin (IL)-6 (Ptrend=0.004), IL-1ß (Ptrend=0.03) and tumor necrosis factor-alpha (TNF-α) (Ptrend=0.01). Multivariable-adjusted concentrations of these cytokines were 28.2% for IL-6, 22.1% for IL-1ß, and 15.9% for TNF-α lower in the highest quartile of nonexercise physical activity compared with the lowest quartile. Similar inverse associations were found for two major components of nonexercise physical activity, walking and biking for transportation, and household activity. No significant associations were observed between nonexercise physical activity and oxidative stress markers. CONCLUSION: Daily nonexercise physical activity is associated with lower levels of systemic inflammation. This finding may have important public health implications because this type of activity is the main contributor to overall physical activity among middle-aged and elderly women.

Soy food consumption and lung cancer risk: a meta-analysis using a common measure across studies.

A published meta-analysis pooled individual studies by using the study-specific odds ratio (OR) or relative risk (RR) for the highest vs. lowest category of soy or isoflavone intake from each study, but it should be problematic to make comparison between studies/populations for lung cancer risk as the quantiles are so different from different studies/populations. Therefore, we conducted a meta-analysis to explore the association between exposure of estimated daily soy protein intake in grams and lung cancer risk. We extracted ORs or RRs and 95% confidence intervals (CIs), converted them to the estimated ones for daily soy protein intake and pooled them using fixed or random effects models from 11 epidemiologic studies. Overall, the inverse association between daily grams of soy protein intake and risk of lung cancer was borderline statistically significant (OR = 0.98, 95% CI = 0.96 to 1.00); the inverse association was statistically significant in nonsmokers (OR = 0.96; 95% CI = 0.93 to 0.99) and stronger than in smokers (P for difference <0.05). No statistical significance for the associations was observed between genders, the origin of the participants, study design and types of soy intake. This study suggests a borderline reduction in risk of lung cancer with daily soy protein intake in grams, and a significant inverse association in nonsmokers.

Sunlight exposure and breast density: a population-based study.

PURPOSE: This study aims to assess the association of sunlight exposure with breast cancer risk, measured by the breast density assessed from Tabár's mammographic pattern in Chinese women. METHODS: A total of 676 premenopausal women were recruited to participate in this study, in which 650 completed a validated sunlight exposure questionnaire via telephone. The mammograms were classified according to Tabár's classification for parenchyma, and patterns IV & V and I, II & III indicated respectively high and low risk mammographic patterns for breast cancer. The odds ratios (OR) and 95% confidence intervals (CIs) for sun exposure-related variables were estimated using unconditional logistic regression with adjustment for potential confounders. RESULTS: Among 646 participants, women with high breast cancer risk (Tabár's patterns IV &V) had less hours spent in the sun than those with low risk (I, II & III) at any age stage. A higher level of sunlight exposure was associated with a significantly lower risk having high risk Tabár's pattern. Women aged 40 to 44 years who were in the highest tertile of lifetime total hours spent in the sun had a multi-adjusted OR of 0.41 (95% CI, 0.18-0.92; p for trend=0.03) compared with those in the lowest tertile (>2.19 hr/day vs. <1.32 hr/day). For hours spent in the sun across the ages of 6 to 12 years, the comparable OR was 0.37 (95% CI, 0.15-0.91; p for trend=0.03). CONCLUSION: These findings suggest that higher sunlight exposure is related to a lower risk of having high risk breast density pattern in premenopausal women. Our results also suggest the most relevant period of exposure is during earlier life.

The role of vitamin D in blood pressure, endothelial and renal function in postmenopausal women.

BACKGROUND: Vitamin D is a pro-hormone that plays an essential role in the vasculature and in kidney function. AIMS: To review the extra-skeletal effects of vitamin D on blood pressure, endothelial and renal function with emphasis on recent findings in postmenopausal women. METHODS: Included in this review was a PubMed database search for English language articles through March 2013. This review discussed the physiology and definition of vitamin D deficiency, the recent evidence for the role vitamin D in blood pressure, vascular and renal function. RESULTS: Experimental and epidemiological data suggest that vitamin D plays an important role in the vasculature and in kidney function. Low vitamin D concentrations appear to significantly associate with hypertension, endothelial and renal dysfunction. However, the results of clinical trials have generally been mixed. Studies specifically conducted among postmenopausal women are limited and findings are still inconsistent. CONCLUSIONS: Definitive studies are warranted to elucidate the effects of vitamin D supplementation on vascular and renal function and a more detailed work is needed to outline the route, duration and optimal dose of supplementation. It is premature to recommend vitamin D as a therapeutic option in the improvement of vascular and renal function at the current stage.

Worldwide socioeconomic status and stroke mortality: an ecological study.

INTRODUCTION: The effect of socioeconomic status (SES) on stroke mortality at population level has been controversial. This study explores the association of SES in childhood and adulthood with stroke mortality, as well as variations in this association among countries/regions. METHODS: Sex-specific stroke mortality at country level with death registry covering ≥ 70% population was obtained from the World Health Organization. Human Development Index (HDI) developed by the United Nations was chosen as the SES indicator. The associations between the latest available stroke mortality with HDI in 1999 (adulthood SES) and with HDI in 1960 (childhood SES) for the group aged 45-54 years among countries were examined with regression analysis. Age-standardized stroke mortality and HDI during 1974-2001 were used to estimate the association by time point. RESULTS: The population data were available mostly for low-middle to high income countries. HDI in 1960 and 1999 were both inversely associated with stroke mortality in the group aged 45-54 years in 39 countries/regions. HDI in 1960 accounted for 37% of variance of stroke mortality among countries/regions; HDI in 1999 for 35% in men and 53% in women (P < 0.001). There was a quadratic relationship between age-standardized stroke mortality and HDI for the countries from 1974 to 2001: the association was positive when HDI < 0.77 but it became negative when HDI > 0.80. CONCLUSIONS: SES is a strong predictor of stroke mortality at country level. Stroke mortality increased with improvement of SES in less developed countries/region, while it decreased with advancing SES in more developed areas.

Adiposity and fat distribution in relation to inflammation and oxidative stress in a relatively lean population of Chinese women.

OBJECTIVES: This study evaluated associations of various anthropometric measures of adiposity with a panel of inflammatory and oxidative stress markers in a relatively lean population of Chinese women. METHODS: This analysis included 1,005 Chinese women aged 40-70 years. Plasma concentrations of inflammatory and oxidative stress markers were measured. Anthropometric measurements were taken by trained interviewers. RESULTS: Body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) were all positively and linearly associated with the inflammatory markers, CRP, TNF-α, soluble TNF-receptor 1 (sTNF-R1), and IL-6. A significant positive association of these measures of adiposity with the oxidative stress marker F_2-IsoP-M, a metabolite of F_2-IsoPs, but with not F_2-IsoPs was found. Differences in biomarkers between extreme quartiles of anthropometric measurements varied widely, ranging from 9.7% for sTNF-R1 to 162.0% for CRP. For each specific biomarker, various anthropometric measurements exhibited similar ability to explain variations in the biomarker, with the biggest partial r^{2} (11%) observed for CRP. CONCLUSIONS: This study suggests that both general adiposity (measured by BMI) and central adiposity (measured by WC and WHtR) are positively and similarly associated with various markers of inflammation and oxidative stress in relatively lean Chinese women. The metabolite F_2-IsoP-M of F_2-IsoPs may be a better marker of in vivo oxidative stress than its parent compounds.