Segmental femoral fracture malunion: evidence and prognostic analysis of medical intervention in the third century BC.

We examined the remains of an individual who was unearthed from the Tuchengzi site and was believed to be from the Warring States period in China. The remains exhibited segmental femoral fracture. We aimed to deduce the cause of fracture, medical interventions, healing process, and motion behavior after fracture healing using several techniques, including macroscopic observation, computed tomography (CT), and finite element analysis. Based on the morphology of the long bones, it appeared that the individual was male. The fractures resulted in an adduction angle of 5.47° and an anterior flexion angle of 21.34° in the proximal femur, while the femoral neck anteversion angle had been replaced by a retroversion angle of 10.74°. Additionally, the distal femur formed an abnormal anterior convex angle of 144.60°. CT revealed mature callus formation and visible trabecular bundles. The finite element analysis indicated that the maximum von Mises stress in the femur was 17.44 MPa during standing and 96.46 MPa during walking. We suggest that medical practitioners in the Warring States period possessed a good knowledge of thigh anatomy, enabling them to perform fracture reduction and fixation. Reasonable medical intervention facilitated fracture healing and load recovery. Satisfactory fracture healing ensured that the individual could engage in normal standing and walking activities after rehabilitation.

The role of oxygen vacancies in the performance of LiMn2O4 spinel cathodes for lithium-ion batteries.

Oxygen vacancies, known to have unavoidable existence in a spinel LiMn2O4 material, play an essential role in its physicochemical and electrochemical properties. However, the function mechanism of oxygen vacancies and its influence on electrochemical properties have been poorly understood so far. Hence, we investigate the role of oxygen vacancies in the spinel LiMn2O4 material by controlling the annealing atmosphere. The relative amount of oxygen deficiency in the samples prepared under oxygen and air atmospheres is 0.098 and 0.112, respectively. Impressively, the relative oxygen deficiency of the sample increased from 0.112 to 0.196 after re-annealing with nitrogen. However, the conductivity of the material changes from 2.39 to 10.3 mS m-1, but the ion diffusion coefficient is significantly reduced from ∼10-12 to ∼10-13 cm2 s-1, resulting in a decrease in the initial discharge capacity from 136.8 to 85.2 mA h g-1. In addition, we attempted to use the nitrogen-sample annealing again under oxygen, which can significantly reduce the conductivity (from 10.3 to 6.89 mS m-1), and the discharge capacity also increased by 40% of the original. Therefore, the effect of the mechanism of the interaction of the oxygen vacancies on the material electronic conductivity, lithium-ion diffusion coefficient and electrochemical properties provides a basis for the objective treatment of oxygen vacancies in spinel structured materials.

Embedding cobalt (II, III) oxide nanoparticles into nitrogen-doped carbon nanotubes-grafted hollow polyhedrons as sulfur hosts for ultralong-life lithium-sulfur batteries.

The sluggish reaction kinetics and unfavorable shuttling effect are regarded as obstacles to the practical application of lithium-sulfur (Li-S) batteries. To resolve these inherent drawbacks, we synthesized novel multifunctional Co3O4@NHCP/CNT as the cathode materials consisting of carbon nanotubes (CNTs)-grafted N-doped hollow carbon polyhedrons (NHCP) embedded with cobalt (II, III) oxide (Co3O4) nanoparticles. The results indicate that the NHCP and interconnected CNTs could provide favorable channels for electron/ion transport and physically restrict the diffusion of lithium polysulfides (LiPSs). Furthermore, N doping and in-situ Co3O4 embedding could endow the carbon matrix with strong chemisorption and effective electrocatalytic activity toward LiPSs, thus prominently promoting the sulfur redox reaction. Benefiting from these synergistic effects, the Co3O4@NHCP/CNT electrode exhibits a high initial capacity of 1322.1 mAh/g at 0.1 C, and a capacity retention of 710.4 mAh/g after 500 cycles at 1 C. Impressively, even at a relatively high current density of 4 C, the Co3O4@NHCP/CNT electrode achieves a high capacity of 653.4 mAh/g and outstanding long-term cycle stability for 1000 cycles with a low decay rate of 0.035% per cycle. Hence, the design of N-doped CNTs-grafted hollow carbon polyhedrons coupled with transition metal oxides would provide effective promising perspective for developing high-performance Li-S batteries.

Three-dimensional printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager: A case report.

RATIONALE: Because of the complicated anatomy and considerable change in size and morphology with age in teenagers, the appropriate internal fixator of coronal shear fracture of distal humerus is difficult to choose, and therefore, the fixation of this kind of fracture is difficult and controversial. Furthermore, distal humeral fractures in teenagers often involve the epiphysis, the rigid fixation of fracture and the simultaneous minimally invasive and protection of the epiphysis are contradictory. Coronal shear fractures of the distal humerus in teenagers are great challenge for orthopedic surgeons. Three-dimensional (3D) printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager is a potential satisfactory choice in the treatment of the complex fractures. PATIENT CONCERNS: A teenager suffered from an elbow joint injury due to a fall while running, resulting in pain, swelling and limited movement of the elbow joint. The epiphyseal has not closed in this patient, conventional surgical procedures have great traumatic and invasive, and to some extent affect bone growth in children. DIAGNOSES: Coronal shear fracture of right distal humerus according to computed tomography scan. INTERVENTIONS: We used 3D printing technology to design an internal fixation device for this patient, which was to treat the distal humeral coronal shear fracture in a teenager via an anterior approach to the elbow joint, and finally the child was instructed to perform immediate postoperative functional exercises and rehabilitation. OUTCOMES: Radiographic reexamination performed 1 day and 2 month after the operation showed that the internal fixation was in good position, no fracture displacement. the patient was instructed to perform active flexion and extension internal and external rotation of the right elbow 6 weeks postoperatively. The Mayo elbow function score was excellent 5 months postoperatively. The range of motion of the elbow was (15°-130°). LESSONS: The treatment of coronal shear fractures of the distal humerus in teenager is controversial at present. This report 3D printing technology designed customized plate in treatment of such fractures showed satisfactory results, which provides a feasible method for the treatment of fractures without suitable internal fixation devices in the future.

Common sports injuries and prevention in table tennis players / Lesões esportivas comuns e prevenção em praticantes de tênis de mesa / Lesiones deportivas comunes y prevención en practicantes de tenis de mesa

ABSTRACT Introduction: Table tennis requires rapid mobility and a complex set of movement structures, often resulting in sports injuries in its players during training. These unforeseen events can negatively affect sports instruction and training. Objective: Analyze the common sports injuries of Chinese male table tennis players and present corresponding preventive measures. Methods: 50 Chinese male table tennis players had their injury causes explored. The causes of these injuries and prevention methods were investigated using up-to-date scientific literature, questionnaires, interviews, and statistics. Results: The main regions were the shoulder joint, wrist joint, knee joint, ankle joint, and wrist joint. Exercise fatigue and lack of muscle strength are important factors leading to injuries in table tennis. Conclusion: Table tennis players should properly organize body movements to improve preparation and finishing work before training. The coach should formulate different physical training plans according to the different technical playing styles of the athletes involved. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

RESUMO Introdução: O tênis de mesa exige rápida mobilidade, e um conjunto complexo de estruturas de movimento resultando frequentemente em lesões esportivas nos seus jogadores durante o treinamento. Esses imprevistos podem afetar negativamente o ensino e o treinamento esportivo. Objetivo: Analisar as lesões esportivas comuns aos jogadores de tênis de mesa chineses do sexo masculino e apresentar as medidas preventivas correspondentes. Métodos: 50 jogadores de tênis de mesa chineses do sexo masculino tiveram suas causas lesionais exploradas. As causas dessas lesões e métodos de prevenção foram investigados utilizando a literatura científica atualizada, questionários, entrevistas e estatísticas. Resultados: As principais regiões foram a articulação do ombro, articulação do pulso, articulação do joelho, articulação do tornozelo e articulação do pulso. A fadiga no exercício e a falta de força muscular são fatores importantes que levam a lesões no tênis de mesa. Conclusão: Os jogadores de tênis de mesa devem organizar adequadamente o movimento corporal para melhorar o trabalho de preparação e finalização antes do treinamento. O treinador deve formular diferentes planos de treinamento físico de acordo com os diferentes estilos técnicos de jogo dos atletas envolvidos. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El tenis de mesa requiere una rápida movilidad, y un complejo conjunto de estructuras de movimiento que a menudo dan lugar a lesiones deportivas en sus jugadores durante el entrenamiento. Estos imprevistos pueden afectar negativamente a la enseñanza y al entrenamiento deportivo. Objetivo: Analizar las lesiones deportivas comunes de los jugadores de tenis de mesa chinos y presentar las medidas preventivas correspondientes. Métodos: Se estudiaron las causas de las lesiones de 50 jugadores de tenis de mesa chinos. Las causas de estas lesiones y los métodos de prevención se investigaron utilizando literatura científica actualizada, cuestionarios, entrevistas y estadísticas. Resultados: Las principales regiones fueron la articulación del hombro, la articulación de la muñeca, la articulación de la rodilla, la articulación del tobillo y la articulación de la muñeca. La fatiga del ejercicio y la falta de fuerza muscular son factores importantes que conducen a las lesiones en el tenis de mesa. Conclusión: Los jugadores de tenis de mesa deben organizar adecuadamente el movimiento del cuerpo para mejorar la preparación y el trabajo de acabado antes del entrenamiento. El entrenador debe formular diferentes planes de entrenamiento físico en función de los diferentes estilos técnicos de juego de los deportistas implicados. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Financial toxicity and psychological distress in adults with cancer: A treatment-based analysis.

Objective: To evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress. Methods: This was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress. Results: Significant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P â€‹= â€‹0.032) and psychological distress (P â€‹< â€‹0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50-59 years (P â€‹= â€‹0.035), 60-69 years (P â€‹= â€‹0.007), and 70 years or older (P â€‹= â€‹0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P â€‹< â€‹0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P â€‹= â€‹0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P â€‹= â€‹0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P â€‹= â€‹0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P â€‹= â€‹0.009), the surgery group (P â€‹< â€‹0.001) and adjuvant therapy group (P â€‹< â€‹0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups. Conclusions: The research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.

The Prevalence, Progress and Risk Factor Control of Chronic Kidney Disease in Chinese Adults With Type 2 Diabetes Mellitus in Primary Care.

Objective: This study aimed to evaluate the prevalence of chronic kidney disease (CKD) in Chinese adults with T2DM in primary care, and the association of HbA1c, blood pressure (BP) and triglycerides (TG), i.e. ABC control at follow up (FU) with the progress and regression of CKD. Methods: A total of 5123 patients with ≥3 measurements of estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), HbA1c, BP, LDL-C and TG, and FU ≥ 12 months were included into final analysis. The presence of CKD was defined as the presence of albuminuria (UACR ≥ 30 mg/g), impaired eGFR (eGFR < 60 ml/min/1.73 m2) or both, and was categorised as low, moderate and high/very high risk. The change of CKD risk for outcome was categorised as stable (no change), progress (risk increase) and regress (risk decrease) from baseline to the last visits (LV). Results: The prevalence of CKD, impaired eGFR and albuminuria was 29.6%, 5.8% and 27.1% at baseline, with 70.4%, 20.3%, 7.0% and 2.3% of patients distributed in low, moderate, high and very high risk group. There were 3457 (67.5%), 1120 (21.8%) and 546 (10.7%) patients had CKD outcome risk stable, progressed and regressed respectively. The proportion of patients reaching targets of BP ≤ 130/80 mmHg, HbA1c<7.5%, LDL-C<2.60 mmol/L increased from baseline to FU and LV, together with increased usage of insulin, RAS inhibitors and lipid lowering medications. After multivariable adjustment, the HbA1c<7.5% (OR: 0.66, 95%CI 0.56-0.78), TG< 1.7 mmol/L (OR: 0.81, 95%CI 0.68-0.96) at FU and BP ≤ 130/80 mmHg at LV (OR: 0.82, 95%CI 0.70-0.95) was negatively associated with CKD outcome risk progress. Conclusion: The prevalence of CKD was high with 21.8% of patients progressing to higher CKD outcome risk at FU, attention should be paid on long term and better ABC control.

Bipolar clavicle fractures treatment using medial and lateral double plates: A case report.

RATIONALE: Clavicle fractures are common, accounting for 2.6 to 4% of all fractures, which typically result from direct injuries, including direct force on the shoulder after falling. However, bipolar clavicle fractures are rare, accounting for only 2.8% of all clavicle fractures, and their injury mechanism is speculated to evolve from two independent and continuous forces affecting the clavicle. Due to its low incidence, there is great controversy regarding the treatment of this fracture, as there is no relevant treatment standard or guideline to date. PATIENT CONCERNS: In this case report, we describe a rare case of bipolar clavicle fracture in a 76-year-old man with multiple systemic fracture complications due to a traffic injury. He presented with limited shoulder function and movement upon arrival in the emergency room. DIAGNOSIS: Bipolar clavicle fracture in the right shoulder (Robinson type 1B2, Robinson type 3B2). INTERVENTIONS: We performed trans-sternoclavicular locking plate and lateral clavicular hook plate treatments and instructed patients to perform reasonable postoperative functional exercises. OUTCOMES: Three months postoperatively, the pain was almost completely relieved with a DASH score of 40.0. Furthermore, radiographic examination of the clavicle showed satisfactory fracture healing. The patient had no further demands for shoulder function and no irritative symptoms of internal fixation and refused to undergo a second operation. The patient had a satisfactory prognosis after the treatment. LESSONS: The treatment of bipolar clavicle fractures remains controversial. This study provides evidence of a feasible method to treat bipolar clavicle fractures: trans-sternoclavicular locking plate and lateral clavicular hook plate treatment.

A ZnO@CuO core-shell heterojunction photoanode modified with ZnFe-LDH for efficient and stable photoelectrochemical performance.

In this study, we have designed and synthesized a novel ZnO@CuO core-shell heterojunction photoanode modified with cocatalyst ZnFe-layered double hydroxides (ZnFe-LDH). As expected, the deposition of CuO enhances light harvesting and shortens the diffusion distance for charge transfer. The ZnO@CuO heterojunction also enhances charge separation and suppresses recombination. Furthermore, modification with cocatalyst ZnFe-LDH facilitates photogenerated hole transport and accelerates the surface oxidation reaction kinetics. On account of the synergistic effect of the core-shell heterojunction in ZnO@CuO with cocatalyst ZnFe-LDH, this photoanode exhibits an optimal photocurrent density of 2.08 mA cm-2 at 1.23 V vs. RHE, which is about 5.3 times that of the pristine ZnO photoanode. Therefore, the construction of ZnO@CuO core-shell nanorod arrays coupled with cocatalyst ZnFe-LDH provides an effective and novel route for designing low-cost and high-efficiency photoelectrodes.

A high-efficiency and stable cupric oxide photocathode coupled with Al surface plasmon resonance and Al2O3 self-passivation.

The key to achieving high performance in photoelectrochemical (PEC) water splitting is the design of efficient and stable photoelectrode structures. Herein, we firstly synthesized a novel and high-photoactivity CuO/Al photocathode and then the Al2O3 passivation layer was further introduced through a spontaneous oxidation process in air to protect the photocathode against photocorrosion. On account of the localized surface plasmon resonance (LSPR) of Al nanoparticles (NPs) in conjunction with surface passivation of the Al2O3 layer, the obtained CuO/Al/Al2O3 photocathode exhibits a high photocurrent density of -0.95 mA cm-2 at -0.55 V vs. Ag/AgCl and photocorrosion stability of 89.5% after 1 h.

ANGPTL2 deletion inhibits osteoclast generation by modulating NF-κB/MAPKs/Cyclin pathways.

Osteoclasts are multinucleated cells essential for bone-resorption. Successful repair of bone defciencies still remains a great challenge worldwide. The signaling factor angiopoietin-like protein 2 (ANGPTL2), one of eight ANGPTL proteins, functions in maintenance of tissue homeostasis partly through regulating inflammation. In the study, ANGPTL2 expression was promoted during osteoclast development and that suppressing ANGPTL2 alleviated osteoclast production regulated by macrophage colony-stimulating factor (M-CSF) and receptor activator of NF-κB ligand (RANKL). The results suggested that ANGPTL2 knockdown inhibited M-CSF-caused proliferation of osteoclast precursor cells. Further, ANGPTL2 silence reduced nuclear factor of activated T cell c 1 (NFATC1) and NFATC4 expressions in M-CSF-treated cells, along with decreased Runx2, OPN and Colla1. Moreover, silencing ANGPTL2 down-regulated M-CSF-promoted expressions of pro-inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6, and chemoattractant protein-1 (CCL-2). Consistently, ANGPTL2 knockdown reduced M-CSF-enhanced activation of IKKα, IκBα and nuclear factor κB (NF-κB) and mitogen-activated protein kinases (MAPKs) (p38 MAPK, ERK1/2 MAPK and JNK MAPK). Additionally, knockdown of ANGPTL2 inhibited the induction of Cyclin D1, Cyclin D2 and Cyclin E1 due to M-CSF exposure. In vivo, we confirmed that ANGPTL2 knockout (KO) mice were protected against osteoporosis induced by ovariectomy (OVX), as proved by the improved bone loss and bone mineral density (BMD). Decreased expression of NFATCs was also observed in OVX-induced mice in the absence of ANGPTL2. Elevated release of pro-inflammatory cytokines was abrogated by ANGPTL2 knockout in femoral heads of mice with OVX operation, accompanied with a significant reduction of phosphorylated NF-κB and MAPKs signaling pathways. And down-regulated expression of Cyclin D1, Cyclin D2 and Cyclin E1 was observed in OVX-operated mice with ANGPTL2 knockout. Therefore, our study indicated that ANGPTL2 played an essential role in osteoclast generation through regulating the proliferation and inflammation of osteoclast lineage cells, providing new insights into the therapeutic strategy to alleviate bone loss.

Metformin versus metformin plus rosiglitazone in women with polycystic ovary syndrome.

BACKGROUND: Hyperinsulinemia and insulin resistance are present in the majority of women with polycystic ovary syndrome (PCOS). Both metformin and rosiglitazone can improve the ovulation and endocrine disorders of the patients. How about the combination of the two? It is rarely reported. This study aimed to compare the therapeutic efficacy of metformin versus metformin plus rosiglitazone in patients with PCOS. METHODS: Fifty-eight women with PCOS were randomly assigned to two groups. Metformin group (29) was treated with metformin mono-therapy and metformin plus rosiglitazone group (29) was treated with metformin plus rosiglitazone for 6 months. Treatment was discontinued once pregnancy was diagnosed. RESULTS: Fasting insulin, postprandial insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), luteinizing hormone (LH), triglyceride, lower density cholesterol and testosterone level decreased significantly in both groups (P < 0.05). Metformin plus rosiglitazone had a better effect than metformin mono-therapy. Body mass index decreased by 7.8% in metformin group while no significant change in metformin plus rosiglitazone group. There were eight pregnancies, six in metformin plus rosiglitazone group (one abortion) and two in metformin group. There was no congenital anomaly at birth and seven infants developed well at one year's follow-up. CONCLUSIONS: Metformin can improve insulin resistance and imbalance of endocrine hormones. Metformin plus rosiglitazone has a more pronounced therapeutic effect and achieved more pregnancies than mono-therapy with metformin. The use of metformin and rosiglitazone before pregnancy has no obvious side effect on the development of the infants. Our study might suggest that metformin is the better choice in PCOS patients with serious obese and rosiglitazone plus metformin would be more effective in patients with severe insulin resistance or those do not respond to metformin.