Therapeutic Effectiveness of Leukocyte- and Platelet-rich Fibrin for Diabetic Foot Ulcers: A Retrospective Study.

OBJECTIVE: Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes. Leukocyte- and platelet-rich fibrin (L-PRF) is a second-generation autologous platelet-rich plasma. This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice. METHODS: Patients with DFU who received L-PRF treatment and standard of care (SOC) from 2018 to 2019 in Tongji Hospital were enrolled. The clinical information including patient characteristics, wound evaluation (area, severity, infection, blood supply), SOC of DFU, and images of ulcers was retrospectively extracted and analyzed. L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction (PVR) greater than 80%. Therapeutic effectiveness, including overall PVR and the overall and weekly healing rates, was evaluated. RESULTS: Totally, 26 patients with DFU were enrolled, and they had an ulcer duration of 47.0 (35.0, 72.3) days. The severity and infection of ulcers varied, as indicated by the Site, Ischemia, Neuropathy, Bacterial Infection, and Depth (SINBAD) scores of 2-6, Wagner grades of 1-4, and the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) scores of 2-4. The initial ulcer volume before L-PRF treatment was 4.94 (1.50, 13.83) cm3, and the final ulcer volume was 0.35 (0.03, 1.76) cm3. The median number of L-PRF doses was 3 (2, 5). A total of 11 patients achieved complete epithelialization after the fifth week of treatment, and 19 patients achieved at least an 80% volume reduction after the seventh week. The overall wound-healing rate was 1.47 (0.63, 3.29) cm3/week, and the healing rate was faster in the first 2 weeks than in the remaining weeks. Concurrent treatment did not change the percentage of complete epithelialization or healing rate. CONCLUSION: Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index, SINBAD score, or Wagner grade, indicating that this method is appropriate for DFU treatment under different clinical conditions.

Recent advances in the adjunctive management of diabetic foot ulcer: Focus on noninvasive technologies.

Diabetic foot ulcer (DFU) is one of the most costly and serious complications of diabetes. Treatment of DFU is usually challenging and new approaches are required to improve the therapeutic efficiencies. This review aims to update new and upcoming adjunctive therapies with noninvasive characterization for DFU, focusing on bioactive dressings, bioengineered tissues, mesenchymal stem cell (MSC) based therapy, platelet and cytokine-based therapy, topical oxygen therapy, and some repurposed drugs such as hypoglycemic agents, blood pressure medications, phenytoin, vitamins, and magnesium. Although the mentioned therapies may contribute to the improvement of DFU to a certain extent, most of the evidence come from clinical trials with small sample size and inconsistent selections of DFU patients. Further studies with high design quality and adequate sample sizes are necessitated. In addition, no single approach would completely correct the complex pathogenesis of DFU. Reasonable selection and combination of these techniques should be considered.

A New Technology Using Mixed Reality Surgical Navigation with the Unlocking Closed Reduction Technique Frame to Assist Pelvic Fracture Reduction and Fixation: Technical Note.

BACKGROUND: Pelvic ring disruption (PRD) is a serious trauma associated with high mortality and disability rates. Poor reduction can lead to complications such as pelvic deformity and delayed fracture healing. Here, we introduce a new technology using mixed reality surgical navigation (MRSN) with an unlocking closed reduction technique (UCRT) frame to assist pelvic fracture reduction and fixation. METHODS: Thirty patients with PRD were enrolled in this study. All of the patients underwent preoperative CT scans, with the pelvis and tracker segmented into three-dimensional models. Under MRSN guidance, auxiliary reduction screws were inserted to grasp the pelvic bone. An ideal trajectory for closed reduction was planned, and suitable CS screws were used for stable fixation after good reduction. Operation time, fluoroscopy frequency, and both Matta and Majeed scores were analyzed. RESULTS: The mean follow-up period was 10.8 months (7.5, 12.25 months) (range 6-24 months). The average duration of operation was 212.5 min (187.5, 272.8 min) (range 133-562 min), and the average reduction time was 23.0 min (15.0, 42.5 min) (range 10-70). The average fluoroscopy frequency was 34.0 times (31.5, 52.5 times) (range 23-68 times). One hundred and fifty screws were successfully inserted on the first attempt. All the fractures healed well with no complications. Excellent reduction quality (Matta score ≤4 mm) was achieved in 29/30 cases, and good reduction quality (Matta score between 4 and 10 mm) was achieved in 1/30 cases. All patients achieved bone healing after an average of 4.0 months (3.5, 5.9 months) (range 3-6), as well as good function recovery with an average Majeed score of 91.0 (87.8, 95.0) (range 71-100). CONCLUSION: The MRSN technique described improved reduction accuracy and radiation exposure without considerable extension of operation time.

A new classification for quadrilateral plate fracture of acetabulum.

BACKGROUND: Recently, quadrilateral plate (QLP) fractures of acetabulum have attracted increasing attention. However, evidence for the appropriate classification of QLP fractures is still lacking, making it difficult to understand and manage these fractures. This study aimed to introduce a new classification for QLP fractures and evaluate its reproducibility. METHODS: A series of 1101 consecutive patients with acetabular fractures from 8 level-I trauma centers were enrolled in this study. All patients underwent preoperative radiograph and computed tomography imaging. QLP fractures were identified and classified using the new and Judet-Letournel classification system. The inter- and intra-observer reliabilities (kappa coefficients, κ) of these two systems were investigated by 4 observers. Furthermore, surgical approaches and fixation methods for each fracture type are described. RESULTS: In total, 243 (243/1101, 22%) patients with QLP fractures were identified and included in this analysis. The mean κ value of the intra-observer reliability was 0.84 (range, 0.763-0.919) for the new classification, indicating excellent agreement, and the inter-observer reliability was 0.762 (range, 0.625-0.876), indicating substantial agreement. The values were 0.649 (range, 0.523-0.708) and 0.584 (0.497-0.646), respectively, according to the Judet-Letournel classification. Six cases (6/243, 2.5%) could not be classified using the Judet-Letournel classification. The selection of surgical approaches and fixation methods depends on the fracture type; however, an anterior intra-pelvic approach and buttressing fixation using the plate or screw are preferred for QLP fractures. CONCLUSION: This study presents a new classification for QLP fractures, showing higher intra- and inter-observer reliabilities than those obtained using the Judet-Letournel classification. This allowed us to obtain an in-depth and comprehensive understanding of QLP fractures. Additionally, the new classification might guide further studies on surgical strategies for QLP fractures. LEVEL OF EVIDENCE: Level II.

Neuroglobin Facilitates Neuronal Oxygenation through Tropic Migration under Hypoxia or Anemia in Rat: How Does the Brain Breathe?

The discovery of neuroglobin (Ngb), a brain- or neuron-specific member of the hemoglobin family, has revolutionized our understanding of brain oxygen metabolism. Currently, how Ngb plays such a role remains far from clear. Here, we report a novel mechanism by which Ngb might facilitate neuronal oxygenation upon hypoxia or anemia. We found that Ngb was present in, co-localized to, and co-migrated with mitochondria in the cell body and neurites of neurons. Hypoxia induced a sudden and prominent migration of Ngb towards the cytoplasmic membrane (CM) or cell surface in living neurons, and this was accompanied by the mitochondria. In vivo, hypotonic and anemic hypoxia induced a reversible Ngb migration toward the CM in cerebral cortical neurons in rat brains but did not alter the expression level of Ngb or its cytoplasm/mitochondria ratio. Knock-down of Ngb by RNA interference significantly diminished respiratory succinate dehydrogenase (SDH) and ATPase activity in neuronal N2a cells. Over-expression of Ngb enhanced SDH activity in N2a cells upon hypoxia. Mutation of Ngb at its oxygen-binding site (His64) significantly increased SDH activity and reduced ATPase activity in N2a cells. Taken together, Ngb was physically and functionally linked to mitochondria. In response to an insufficient oxygen supply, Ngb migrated towards the source of oxygen to facilitate neuronal oxygenation. This novel mechanism of neuronal respiration provides new insights into the understanding and treatment of neurological diseases such as stroke and Alzheimer's disease and diseases that cause hypoxia in the brain such as anemia.

Lumbopelvic fixation with S2 alar-iliac screws for U-shaped sacral fractures.

OBJECTIVE: To investigate the surgical methods and clinical effects of lumbopelvic fixation (LPF) with S2 alar-iliac (S2AI) screws for U-shaped sacral fractures. METHODS: From December 2019 to August 2020, 14 patients with U-shaped sacral fractures were treated with LPF using S2AI screws. Demographics, fracture classification, mechanism of injury, surgical treatment, complications and clinical results were assessed. All patients had a LPF with or without nerve decompression. The reduction quality was evaluated according to the Matta criteria. Neurological function was evaluated according to the Gibbons grading. The activities of daily life were evaluated according to the Majeed scoring system at the last follow-up. RESULTS: Among 14 consecutive patients with U-shaped sacral fractures, the age at injury ranged from 13 to 72 years (average 30.3 ± 17.5 years). There were 4 males and 10 females. All patients were followed up for 6-15 months (average 7.8 ± 2.7 months). Thirteen patients were fixed with bilateral S2AI screws, and one patient was fixed only unilaterally due to unilateral spinopelvic dissociation. The excellent and good rate of postoperative pelvic reduction quality was 92% (excellent 10, good 3, fair 1). At the latest follow-up, the excellent and good rate of pelvic function was 100% (excellent 9, good 5) and all patients achieved different extents of neurological recovery. One patient had a postoperative superficial surgical site infection, which healed after debridement. Radiological examination at 3-6 months after operation showed that all fractures had healed. No complications were found in any patients during follow-up, such as implant fracture, loss of reduction, deep wound infection, wound dehiscence and screw protrusion discomfort. CONCLUSION: LPF with S2AI screws for the treatment of U-shaped sacral fractures has exhibited distinct advantages, including firm fixation, a low rate of surgical site complications and satisfactory clinical efficacy. This approach provides sufficient stability to accelerate the commencement of postoperative rehabilitation.

Displaced posterior pelvic ring fractures treated with an unlocking closed reduction technique: Prognostic factors associated with closed reduction failure, reduction quality, and fixation failure.

PURPOSES: This study aimed to evaluate the clinical effect of the unlocking closed reduction technique (UCRT) for the displaced posterior pelvic ring fractures and to analyze the factors associated with failure of closed reduction and fixation. PATIENTS AND METHODS: Data from patients admitted with displaced posterior pelvic ring fractures initially treated with the URCT from July 2017 to January 2020 were extracted. Clinical and radiological factors including fracture classification, interval days from injury to surgery, number of screws, and type of fixation for the posterior pelvic ring were analyzed to evaluate their correlation with closed reduction failure, reduction quality, and fixation failure. Then a logistic regression model was used for statistical analysis to eliminate confusion factors. RESULTS: Ninety-seven patients with displaced posterior pelvic ring fractures were followed for a mean of 1.7 years after surgery. Successful closed reduction and percutaneous fixation were achieved for 89 patients (91.8%), of which 82 patients (92.1%) achieved an excellent or good reduction. Closed reduction failure which converted to open reduction was recorded for eight patients (8.2%). AO/OTA type C3 fracture (p = 0.036) and osteoporosis (p = 0.012) were significant factors for closed reduction failure. Excellent was recorded for 76 patients (78.4%) and acute (1-21 days) interval days from injury to surgery was an associated factor for reduction quality. For AO/OTA type C1 fractures, no more than two short screws (unilateral iliosacral screws) or a single long screw (transiliac-transsacral screws) were independent prognostic factors of fixation failure (p = 0.026). CONCLUSIONS: Displaced posterior pelvic ring fractures treated with the UCRT are associated with excellent/ good radiological results. However, in patients with AO/OTA type C3 pelvic fracture and osteoporosis, the backup plan of open reduction should be routinely prepared. The patient should be brought to the operating room within three weeks to get a good reduction result. Two long screws or one long screw combined with two short screws are required to create a strong construct for AO/OTA type C1 pelvic fractures.

[A multicenter retrospective study assessing pelvic unlocking closed reduction device for reducing unstable pelvic posterior ring disruption].

Objective: To explore the application value and effectiveness of pelvic unlocking closed reduction device for the treatment of unstable pelvic posterior ring disruption. Methods: A retrospective analysis of clinical data of 243 cases of unstable pelvic posterior ring disruption treated with pelvic unlocking closed reduction device in 13 orthopaedic trauma centers across the country between December 2018 and June 2020 was performed. There were 139 males and 104 females; the age ranged from 18 to 92 years, with an average age of 48.5 years. The cause of injury included 132 cases of traffic accident injuries, 102 cases of falling from height, and 9 cases of crushing injuries. According to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 5 cases of type 61-B1, 13 cases of type 61-B2, 32 cases of type 61-C1.1, 47 cases of type 61-C1.2, 89 cases of type 61-C1.3, 35 cases of type 61-C2, and 22 cases of type 61-C3. The time from injury to operation was 2-121 days, with a median of 10 days. Preoperative preparation time, installation time of unlocking closed reduction device, fracture reduction time, intraoperative fluoroscopy times, intraoperative blood loss, and surgical complications were recorded, and Matta scoring standard was used to evaluate the quality of fracture reduction. According to Matta evaluation results, the patients were divided into two subgroups: excellent-good group and fair-poor group. The differences in gender, age, time from injury to operation, AO/OTA classification, and perioperative clinical indicators were compared between the two groups, and the effects of baseline data and perioperative indicators on the quality of fracture reduction were studied. Results: Pelvic unlocking closed reduction device did not interfere with the display of the pelvic structure and fracture displacement direction during the intraoperative fluoroscopy, effectively correcting the displacement of the pelvic ring. The preoperative preparation time was 17-60 minutes, with an average of 30 minutes; installation time of unlocking closed reduction device was 10-32 minutes, with an average of 21 minutes; intraoperative fracture reduction time was 15-205 minutes, with an average of 49.2 minutes; intraoperative fluoroscopy times were 41-420 times, with an average of 132 times; intraoperative blood loss was 40-1 500 mL, with an average of 71.5 mL. The reduction quality of pelvic fracture was evaluated according to Matta score immediately after operation. The results were excellent in 153 cases, good in 61 cases, fair in 24 cases, and poor in 5 cases. The excellent and good rate was 88.1%. Further subgroup analysis showed that there was no significant difference in other indexes ( P>0.05) between the excellent-good group and the fair-poor group except for the time from injury to operation and AO/OTA classification ( P<0.05). Among them, the excellent-good reduction rate was 92.2% (119/129) in patients with injury-to-operation time less than 10 days, and the fair-poor reduction rate was 25.7% (9/35) and 40.9% (9/22) in patients with AO/OTA 61-C2 and 61-C3 types, respectively. There was no surgery-related complication due to the application of the pelvic unlocked reduction device, no secondary iliac fractures, vascular, or nerve injuries, and postoperative CT showed that all channel screws were located in the osseous channel. Conclusion: The pelvic unlocking reduction device can effectively help to reduce the unstable pelvic posterior ring and maintain reduction, meet the needs of different projection angles of pelvic fracture with intraoperative C-arm fluoroscopy. The system facilitate the operation of pelvic reduction and precise fixation.

Pelvic incidence-guided reduction in transverse parts of U-shaped sacral fractures: Technical recommendations.

OBJECTIVE: The purpose of this study is to present a surgical technique that simultaneously reduces and fixates the transverse parts of U-shaped sacral fractures. METHODS: The sacral fracture was exposed through a posterior median approach. In a flexion injury, the rotation of the lower sacral segment is reduced by distraction along a pre-curved rod. Then, lordotic restoration is performed with a Weber clamp placed at the lower sacral segment through dragging. In an extension injury, longitudinal distraction is performed along the spinopelvic rod to reduce the vertical displacement. Next, the transverse displacement is reduced by a dissector placed between the upper and lower sacral segments through levering. The sagittal reduction on the lateral pelvic view was judged by PI. A regression analysis of Oswestry disability index (ODI) with Z-scores of PI, lumbar lordosis (LL), sacral slope (SS), and pelvic tilt (PT) was performed. RESULTS: At the 1-year follow-up, the average PI, LL, SS, and PT values were 51.6 (range: 43.1-76.0), 44.8 (34.6 - 60.1), 35.4 (18.1 - 48.0), and 16.7 (2.2-35.4) degrees, respectively. All patients were able to maintain an upright stance. The average ODI was 27.6% (2-72%). Surprisingly, the regression analysis demonstrated a significant linear relationship between ODI and LL (R2 = 0.367, p = .048) but not between ODI and PI (R2 = 0.227, p = .138). CONCLUSIONS: Using PI as guidance, the surgical procedures were helpful to reduce the PI of transverse sacral fractures into the normal range. However, the relationship between PI and the prognosis remains to be evaluated by future researches.

Sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures.

BACKGROUND: Malunion and nonunion of vertically displaced pelvic fractures result in lower limb length discrepancies, claudication, and pain. There have been few previous reports of this type of corrective surgery for these old pelvic fractures. We present a surgical technique of sacral osteotomy combined with triangular osteosynthesis in the treatment of malunion and nonunion of vertically displaced pelvic fractures and report on its short-term clinical results. METHODS: We retrospectively reviewed nine patients (five males and four females) with malunion or nonunion of vertically displaced pelvic fractures treated with sacral osteotomy and triangular osteosynthesis from April 2015 to January 2020. The age ranged from 14 to 45 years (average, 30.7 years). The time from injury to deformity correction surgery ranged from 3 months to 5 years (average, 12.8 months). The vertical displacement of a unilateral hemipelvis was 3.0-4.5 cm (average, 3.80 cm). According to AO/OTA classification at the initial fracture, there are eight cases in type C1.3 and one case in type C3.3. Sacral osteotomy and triangular osteosynthesis were used in all nine patients. The degree of unilateral hemipelvic reduction was assessed postoperatively based on measurements from the anteroposterior (AP) X-ray. Majeed score and pain visual analog scale (VAS) were used to assess the therapeutic effect of the patients during follow-up. RESULTS: In all nine patients, postoperative AP X-ray showed correction displacement of 1.7-3.9 cm (average, 3.20 cm). All the patients were followed up for 6-36 months (average, 12.7 months). At the last follow-up, the Majeed score of pelvic fracture increased from an average of 53.9 points (30-84 points) preoperatively to 87.0 points (72-94 points), and the VAS score for pain decreased from an average of 6.0 points (4-8 points) preoperatively to 1.2 points (0-3 points). None had complications like infection, implant broken, screw loosening, iatrogenic nerve, and blood vessel injury. CONCLUSION: Sacral osteotomy combined with triangular osteosynthesis for the treatment of pelvic malunion and nonunion caused by sacral fractures can correct significantly vertical displacement of a unilateral pelvis, prolong limb length, and reconstruct the stability of a pelvic ring, achieving good clinical results.

Circular RNA MELK Promotes Chondrocyte Apoptosis and Inhibits Autophagy in Osteoarthritis by Regulating MYD88/NF-κB Signaling Axis through MicroRNA-497-5p.

Osteoarthritis (OA) is a rheumatic disease and its pathogenesis involves the dysregulation of noncoding RNAs. Therefore, the regulatory mechanism of circular RNA MELK (circMELK) was specified in this work. OA human cartilage tissue was collected, and circMELK, miR-497-5p, and myeloid differentiation factor 88 (MYD88) expression were examined. Human chondrocytes were stimulated with interleukin- (IL-) 1ß and interfered with vectors altering circMELK, miR-497-5p, and MyD88 expression to observe their effects on cell viability, cell cycle and apoptosis, autophagy, and inflammation. The binding relationship between RNAs was verified. The data presented that OA cartilage tissues presented raised circMELK and MYD88 and inhibited miR-497-5p expression. IL-1ß suppressed cell viability, prevented cell cycle, and induced apoptosis, autophagy, and inflammation of chondrocytes. Functionally, IL-1ß-induced changes of chondrocytes could be attenuated by suppressing circMELK or overexpressing miR-497-5p. circMELK acted as a sponge of miR-497-5p while miR-497-5p was a regulator of MYD88. MYD88 restricted the effect of overexpressing miR-497-5p on IL-1ß-stimulated chondrocytes. MYD88 triggered nuclear factor-kappaB (NF-κB) pathway activation. Shortly, CircMELK promotes chondrocyte apoptosis and inhibits autophagy in OA by regulating MYD88/NF-κB signaling axis through miR-497-5p. Our study proposes a new molecular mechanism for the development of OA.

Assessment of serum interleukin-28 as a biomarker to predict mortality in traumatic patients with sepsis.

BACKGROUND: Serious trauma due to various factors is a major global public issue, and sepsis is a major cause of trauma-associated mortality. Timely diagnosis and suitable treatment of post-traumatic sepsis are crucial to improve the hospital outcome of traumatic patients. IL-28 is a newly discovered member of IFN-λ family with multiple functions in inflammatory response. To date, its role in the pathogenic mechanisms of post-traumatic sepsis still remains unknown. METHODS: In total, 20 healthy controls, 55 traumatic patients without sepsis and 54 traumatic patients with sepsis were enrolled in this study. Serum IL-28A/B levels were investigated by ELISA. RESULTS: IL-28A/B levels were significantly increased in traumatic patients compared to healthy volunteers. Moreover, septic trauma patients displayed a significant increase in IL-28A/B levels compared with non-septic patients. In septic patients, IL-28A/B were negatively correlated with IFN-γ, IL-5, IL-13 and IL-17, and positively associated with IL-10. Moreover, IL-28A (AUC: 0.821, 95 %CI: 0.693-0.949) and IL-28B (AUC: 0.811, 95 %CI: 0.691-0.931) were both beneficial to predict increased mortality risk in septic trauma patients, though there was no statistical difference in the predictive value between them. CONCLUSIONS: Early serum levels of IL-28A/B were associated with the development of post-trauma sepsis and could be applied to assess the outcome of traumatic patients with sepsis. Thus, IL-28 may be a potential indicator for post-traumatic sepsis.

S2-Alar-Iliac Screw Fixation versus Iliac Screw Fixation in the Treatment of Sacral Fractures.

PURPOSE: To compare the short-term therapeutic effects of S2-alar-iliac (S2AI) screw fixation and iliac screw fixation techniques in managing sacral fractures. METHODS: From September 2015 to May 2020, 42 patients with sacral fractures who underwent lumbopelvic fixation by a single surgeon were analyzed. The patients were divided into the S2AI screw group (19 patients) and the iliac screw group (23 patients). Operative data, reduction quality, postoperative complications, and functional outcomes were evaluated. RESULTS: The incidence of unplanned reoperation was significantly different between patients treated with S2AI screws than in those treated with iliac screws (0 versus 6, p = 0.02). The mean intraoperative estimated blood loss was 405.26 ± 229.67 mL in the S2AI screw group and 539.13 ± 246.32 mL in the iliac screw group (P = 0.08). No significant difference was observed in either group regarding the quality of reduction, functional outcome, or low back pain. The reduction quality based on the Matta criteria and excellent/good outcomes were 21/2 in the iliac screw group and 17/2 in the S2AI screw group. The functional outcomes based on the Majeed score and excellent/good/fair outcomes were 17/3/3 in the iliac screw group and 17/1/1 in the S2AI screw group. No complications, including implant breakage, loosening of the implant, or loss of reduction were found in either group during follow-up. CONCLUSION: Both S2AI screws and iliac screws were effective in the treatment of sacral fractures. The use of S2AI screws, however, was independently associated with fewer unplanned reoperations for surgical site infection, wound dehiscence, and symptoms of screw protrusion than the use of iliac screws.

Fracture Mapping of Both-Column Acetabular Fractures.

OBJECTIVES: To characterize the location and frequency of the fracture lines and comminution zones of both-column fractures using fracture mapping. METHODS: Both-column fractures were retrospectively reviewed in 4 Level 1 trauma centers. Mimics software was used to reconstruct the both-column fractures and simulate the fracture reduction. Then, the fracture lines and the intra-articular and extra-articular comminution zones were drawn on a 3-dimensional innominate bone template. The distribution of fracture lines and fracture fragments were also mapped on the two-dimensional template of the acetabulum. All the included patients were divided into low-variety group and high-variety group according to the anterior column fracture line above or below the anterior superior spine. The anatomical characteristics of the posterior wall fragment were also analyzed in these 2 groups. RESULTS: Seventy-eight patients with both-column fracture were included. The T type or inverted Y type main fracture lines divided the innominate bone into low-variety (n = 11) and high-variety (n = 67) both-column fractures. The extra-articular comminution zones are usually distributed between the posterior iliac fragment and anterior column fragment. High-variety type both-column fractures are usually combined with high and sharp posterior wall fragments, whereas low-variety type both-column fractures are usually accompanied by low and flat posterior wall fragments. The comminution zones in the acetabulum are mostly concentrated in the anterior and inferior parts of the acetabulum. CONCLUSIONS: The innominate bone is divided into 3 major parts in the both-column fracture, and the fracture center is located at the proximal of the acetabular dome. The both-column fractures are divided into low-variety and high-variety patterns. The location of the anterior column fracture determined the characteristics of the posterior wall fragment.

Circular RNA circZNF652 is overexpressed in osteoarthritis and positively regulates LPS-induced apoptosis of chondrocytes by upregulating PTEN.

Circular RNA circZNF652 promotes LPS-induced inflammation, contributing to the development of osteoarthritis (OA), indicating the potential involvement of circZNF652 in OA. This study was carried to explore the involvement of circZNF652 in OA. RT-qPCR was performed to analyse the expression of circZNF652 and PTEN mRNA in synovial fluid samples from 60 OA patients and 60 healthy controls. Correlations between circZNF652 and PTEN mRNA were analysed by Pearson's correlation coefficient. Overexpression and siRNA silencing of circZNF652 were achieved in chondrocytes, followed by performing RT-qPCR and Western blot to analyse the expression of PTEN. The role of circZNF652 and PTEN in regulating the apoptosis of chondrocytes induced by LPS was analysed by cell apoptosis assay. We found that circZNF652 was overexpressed in OA and positively correlated with PTEN, MMP13, and NF-KB mRNA. In chondrocytes, circZNF652 overexpression increased the expression of PTEN, MMP13, and NF-KB; circZNF652 siRNA silencing decreased the expression of PTEN, MMP13, and NF-KB. Moreover, circZNF652 and PTEN positively regulated the apoptosis of chondrocytes induced by LPS. PTEN overexpression reversed the inhibitory effects of circZNF652 siRNA silencing on cell apoptosis. Therefore, circZNF652 is overexpressed in OA and positively regulates LPS-induced apoptosis of chondrocytes by upregulating PTEN.

Predictive value of soluble fibrinogen-like protein 2 for survival in traumatic patients with sepsis.

BACKGROUND: Despite significant advances in the diagnosis and management of sepsis and trauma over the past few decades, severe infection and injury continue to represent major public health challenges. Fibrinogen-like protein 2 (FGL2), a member of the fibrinogen family, can be expressed as a membrane-associated protein with coagulation activity or in a secreted form possessing unique immune suppressive functions. In this study, we evaluated whether soluble fibrinogen-like protein 2 (sFGL2) can serve as a biomarker to predict the development of sepsis in trauma patients. METHODS: sFGL2 concentrations were determined by ELISA assays in sera of 75 trauma patients clinically classified into non-sepsis group and sepsis group. For comparison, 15 age- and sex-matched healthy individuals were included. RESULTS: sFGL2 concentrations were dramatically elevated in trauma patients compared to healthy controls. In the patient group, the patients with sepsis showed a significant increase in sFGL2 concentrations compared with non-septic patients. Moreover, non-survivors of septic patients displayed higher sFGL2 concentrations compared with survivors. In addition, sFGL2 concentrations were positively correlated with Sequential Organ Failure Assessment (SOFA) scores, serum IL-8 and IL-10 concentrations, but reversely correlated with Glasgow coma scale (GCS) scores, platelet and lymphocyte counts. Furthermore, sFGL2 was found to be an independent predictor of 28-day mortality in traumatic patients with sepsis by logistic regression analysis. CONCLUSION: sFGL2 concentrations were significantly correlated with the development and mortality of sepsis in traumatic patients. Thus, sFGL2 may serve as a potential indicator for traumatic patients with sepsis.

Effects of Mitofusin2 on astrocytes proliferation in vitro induced by scratch injury.

Reactive astrogliosis, a common phenomenon after central nervous system (CNS) injury, exerts negative effects on neuronal repair and recovery by forming a glial scar. Mitofusin2 (Mfn2), a hyperplasia suppression gene, is a potential target of therapeutics to better control astrogliosis. To simulate traumatic injury of the CNS in vivo, an in vitro scratch injury model was established to investigate the role of Mfn2 in the proliferation of astrocytes in this study. We demonstrated that scratch-injury stimulation upregulated the expression of the markers cyclin D1, PCNA and GFAP and turned quiescent astrocytes into mitotic cells, which may have been via activation of Ras-Raf1-ERK1/2 and PI3K-Akt signaling. Meanwhile, both the gene and protein of Mfn2 were markedly inhibited. Furthermore, overexpression of Mfn2 effectively attenuated astrocyte proliferation and halted the cell cycle, concomitant with marker downregulation and wound healing suppression. Our results demonstrate that overexpression of Mfn2 inhibits the reactive astrogliosis process by blocking the Raf1-ERK1/2 and PI3K-Akt signal pathways. Therapeutic approaches that target Mfn2 may have protective effects against reactive gliosis and glia formation.

Interferon Regulatory Factor-2 Binding Protein 2 Ameliorates Sepsis-Induced Cardiomyopathy via AMPK-Mediated Anti-Inflammation and Anti-Apoptosis.

Cardiomyopathy commonly occurs after sepsis and is closely associated with high mortality in clinic. Interferon regulatory factor-2 binding protein 2 (IRF2BP2) has been identified as a negative regulator of inflammation, but its role in septic cardiomyopathy is unknown. The current study aims to illuminate the regulatory function of IRF2BP2 on sepsis-induced cardiomyopathy and to explore the underlying mechanisms. Protein expression of IRF2BP2 in response to sepsis-induced cardiomyopathy was examined in the heart of mice challenged by LPS intraperitoneal injection. AAV9-delivered IRF2BP2 overexpression in the heart was applied to evaluate the regulatory role of IRF2BP2 in sepsis-induced myocardial depression, inflammatory response, and cell death. The molecular mechanisms underlying IRF2BP2-regulated cardiomyopathy were explored using western blot screening assay. Primary cardiomyocytes have been isolated to further confirm the role and mechanism of IRF2BP2 during septic cardiomyopathy. IRF2BP2 expression was dramatically increased in the heart of mice after LPS administration. AAV9-mediated IRF2BP2 overexpression significantly improved sepsis-induced cardiac dysfunction, inhibited inflammatory cell infiltration and cytokine production, and blocked cell death after LPS treatment. Mechanistically, IRF2BP2 activated AMPK signaling in cardiomyocytes, while inhibiting AMPK activation largely reversed IRF2BP2-benefited inflammatory suppression and cell survival. These findings clearly demonstrated that IRF2BP2 is a potent suppressor of sepsis-induced myocardial depression and related heart impairment. Targeting IRF2BP2 represents a promising therapeutic strategy for septic cardiomyopathy.

MicroRNA-486-5p Promotes Acute Lung Injury via Inducing Inflammation and Apoptosis by Targeting OTUD7B.

The aim of this article is to study the effect of miR-486-5p in acute lung injury (ALI). MiR-486-5p expression in peripheral blood was determined in ALI patients and healthy volunteers by qRT-PCR. ALI mouse model were reproduced by LPS treatment, and miR-486-5p NC and miRNA-486 inhibitors were injected through trachea. ALI patients' peripheral blood and LPS-induced acute lung injury in mice had significantly higher miR-486-5p levels than control subjects. Inhibition of miR-486-5p by injection with antagomiR-486-5p markedly reduced LPS-induced lung inflammation. Moreover, knockdown of miR-486-5p can reduce protects A549 cell against LPS-induced injury and its corresponding inflammatory response. In addition, Mechanistic analysis indicated that miR-486-5p on the occurrence of ALI is related to the inhibition of OTUD7B activity, which induces the downregulation of inflammatory in ALI. Our results identified miR-486-5p independently associated with ALI. miR-486-5p can mediate the formation of ALI by promoting inflammation.

Three-Column Classification for Acetabular Fractures: Introduction and Reproducibility Assessment.

BACKGROUND: The Judet-Letournel classification has been widely used to diagnose acetabular fractures since it was proposed. However, there has been growing evidence of incompleteness and comprehension difficulty in this classification, which may adversely affect its clinical use. The purposes of this study were to introduce a novel 3-column classification system for acetabular fractures and to evaluate its reliability and reproducibility. METHODS: A total of 1,028 patients with acetabular fractures, who had undergone surgical treatment from June 2011 to January 2017 in 7 level-I trauma centers, were recruited into this study. Preoperative radiographs and computed tomographic (CT) scans were conducted for each patient. To evaluate the reproducibility of the 3-column classification system for acetabular fractures, the interobserver and intraobserver reliability (kappa coefficient, κ) of this classification system compared with those of the Judet-Letournel classification system was investigated by 4 observers. RESULTS: A total of 209 patients (20.33%) could not be classified by the Judet-Letournel classification, and 3 cases (0.29%) could not be classified by the novel 3-column classification. The mean κ value of the interobserver reliability for the Judet-Letournel classification was 0.591 (range, 0.508 to 0.681), indicating moderate agreement, whereas the mean κ value was 0.735 (range, 0.594 to 0.930), indicating substantial agreement, when using the 3-column classification. The mean κ value for the intraobserver reliability was 0.751 (range, 0.708 to 0.793) for the Judet-Letournel classification and 0.909 (range, 0.792 to 0.957) for the 3-column classification. CONCLUSIONS: The 3-column classification, based on the anatomic character of the acetabulum, showed higher interobserver and intraobserver reliability than the Judet-Letournel classification. Additionally, certain fracture patterns in the 3-column classification scheme generally correlated with surgical approaches. This novel classification system may be used as a supplement to the traditional Judet-Letournel classification system. CLINICAL RELEVANCE: The 3-column concept of the acetabulum proposed in this study is helpful to master acetabular fractures for less experienced surgeons. The novel classification system could assist with acetabular fracture diagnosis and the choice of surgical approaches.