Intracranial mesenchymal tumor with multiple extracranial metastases: A case report and literature review.

This study presents a rare case of an older woman with an intracranial mesenchymal tumor in the right frontal and parietal lobes. Despite prompt surgical intervention, her condition rapidly deteriorated because of tumor dissemination, leading to her demise. We highlight the tumor's marked invasiveness and heterogeneity, coupled with a propensity for distant systemic metastasis, which negatively impacted the patient's prognosis. This particular clinical behavior had not been previously reported, making this a novel observation. Thus, through a comprehensive review of relevant literature, we aim to provide valuable insights for further understanding, diagnosing, and treating such tumors.

High anteromedial insertion reduced anteroposterior and rotational knee laxity on mid-term follow-up after anatomic anterior cruciate ligament reconstruction.

Background: The position of the femoral insertion has a great influence on the laxity of the knee joint after ACLR, especially for rotational laxity. Purpose: To compare the effects of different femoral tunnel positions on knee stability after arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods: The clinical outcomes of 165 patients after autograft ACLR were analyzed retrospectively. The patients were separated into three groups according to the position of the femoral tunnel, as follows: low center (LC) group, 53 patients; high center (HC) group, 45 patients; and high anteromedial (HAM) group, 67 patients. The side-to-side differences (SSDs) in anteroposterior knee laxity measured using a KT-2000 arthrometer and the pivot shift test (PST) pre- and postoperatively were compared among the three groups and analyzed. Results: After 5 years postoperatively, the SSD in the anteroposterior knee laxity in the three groups was significantly decreased postoperatively compared with preoperatively in knees; meanwhile, the negative PST rate was significantly increased in the three groups. The postoperative SSD in anteroposterior knee laxity was significantly increased in the HC group compared with the LC and HAM groups (1.5 ± 1.3 VS 1.0 ± 1.1 VS 1.0 ± 1.0, P<0.05). The negative postoperative PST rate was higher in both the LC and HAM groups than in the HC group (84.9% VS 91.0% VS 71.1%, P<0.05), and there was no significant difference in the negative PST rate between the LC and HAM groups (84.9% VS 91.0%, P>0.05). The negative postoperative PST rate was significantly higher in the HAM group than in the LC and HC groups for patients with a high degree of laxity preoperatively (31.3% VS 3.3% VS 14.4%, P>0.05). Conclusion: Patients in HAM group showed better control over anteroposterior laxity, rotational laxity, and subjective knee function compared to other groups post operation. Therefore, the HAM point is the closest to the I.D.E.A.L point concept, and is recommended as the preferred location for the femoral tunnel in ACLR.

[Retracted] Inhibition of δ­opioid receptors induces brain glioma cell apoptosis through the mitochondrial and protein kinase C pathways.

[This retracts the article DOI: 10.3892/ol.2013.1546.].

Effects of Platelet-Rich Plasma on Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

BACKGROUND: Many studies have documented the use of platelet-rich plasma (PRP) alongside anterior cruciate ligament (ACL) reconstruction (ACLR) in the management of ACL injury, but evidence on the benefits of PRP in improving the clinical outcomes of ACLR is inconsistent. PURPOSE: To help in our understanding, we undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the effects of PRP on patient-reported functional scores, the clinical assessments of knee function and structure, and complications. STUDY DESIGN: Systematic review; Level of evidence, 1. METHODS: We searched 9 online databases for RCTs published in English or Chinese that examined the effects of PRP on ACLR. The primary outcome measures were visual analog scale (VAS) for pain and International Knee Documentation Committee (IKDC) scores. The secondary outcomes included KT-1000 arthrometer, pivot-shift test, Lysholm and Tegner scores, tunnel widening, graft characterization, and complications. Subgroup analyses were performed according to time of assessments. Fixed- and random-effects models were selected for data analysis. RESULTS: A total of 14 studies were included. When PRP was injected to graft tunnels, the pooled VAS scores of the 2 groups were similar (P = .31), and the subgroup analysis found that VAS and IKDC only improved at 3 months postoperatively (P = .0003 and P < .00001, respectively). When PRP was used at the bone-patellar tendon-bone harvest sites, VAS was decreased in the first 6 months postoperatively (P < .00001), whereas IKDC score was not remarkably different (P = .07). After PRP injection, Lysholm scores at 3 months postoperatively was different between the 2 groups (P < .00001), but the Tegner scores (P = .86), KT-1000 measurements (P = .12), the positive rate of pivot-shift test (P = .64), the enlargement of tunnels (femoral, P = .91; tibial, P = .80), and the characterization of grafts (P = .05) were not different. No difference in complications was found in either group. CONCLUSION: PRP applied alongside ACLR could reduce postoperative pain and improve knee function in the short and medium terms but is ineffective in the long term. PRP does not improve knee stability and the enlargement of tunnels and does not accelerate the healing of grafts. Further studies would be required.

COVID-19 countermeasures of Chinese national athletes: Prevention, treatment, and return to play.

Under the condition of normalized epidemic, how athletes train and compete well has been in the spotlight. This article reported the symptom, hospitalization and training situation of seven confirmed cases of coronavirus-disease-2019 (COVID-19) among Chinese national teams. Moreover, the paper summarized the experience of Chinese national teams in terms of epidemic prevention and control, treatment of infection, and safe return to play. Through a scientific combination of medication and non-medical treatment, seven athletes were all discharged from the hospital. These discharged athletes underwent strict isolation and scientific training before returning to sports teams. Before returning to play, continuous monitoring of physical and mental condition was required. All seven athletes returned to play safely and performed excellently. As for hosting large-scale sporting events, the entire enclosed-loop management from immigration to competition was proposed in this paper. This study could serve as a standard of epidemic prevention and control, treatment for infection and safe return to play during competition and training around the world.

Single-Cell Transcriptome Analysis Profile of Meniscal Tissue Macrophages in Human Osteoarthritis.

Osteoarthritis (OA) has long been considered as a degenerative disease, but growing evidence suggests that inflammation plays a vital role in its pathogenesis. Unlike rheumatoid arthritis and other autoimmune diseases, inflammation in OA is chronic and, in relatively low grade, mainly mediated by the innate immune system, especially macrophages. However, due to its low abundance, there is a lack of systematic studies on macrophages in the OA condition. Here, we have used single-cell RNA sequencing analysis to gain insight into the heterogeneity and functional specialization of human knee macrophages. We also compared the gene expression profiles of macrophages in healthy people and OA patients and found the characteristic changes of special macrophages in the OA knee. We believe that this in-depth understanding of the basis of OA inflammation will bring hope for the development of new therapies.

Outcomes of Hip Arthroscopy for Femoroacetabular Impingement in Chinese Patients Aged 50 Years or Older.

OBJECTIVE: To investigate the outcomes of hip arthroscopy for femoroacetabular impingement (FAI) in patients over the age of 50 years. METHOD: This is a therapeutic case series study. A total of 27 FAI patients over the age of 50 years who met inclusion and exclusion criteria and were being followed up for at least 2 years in the orthopaedics department at our hospital between January 2015 and October 2017 were recruited for a prospective analysis on the outcomes of hip arthroscopy. All patients underwent unilateral surgery. Of the patients included, there were 15 men and 12 women, who were aged 50-74 years old (57 ± 6.4 years). The outcomes were assessed using the visual analog scale (VAS), the modified Harris hip score (mHHS), and the International Hip Outcome Tool (iHOT-12). RESULTS: A total of 27 patients were followed up for at least 2 years. The postoperative center-edge angle, the alpha angle, and the offset decreased significantly compared with preoperative measurements (P < 0.01). The mHHS before surgery and at 1 year and 2 years after surgery was 62.19 ± 7.47, 86.70 ± 5.80, and 87.89 ± 5.08, respectively; iHOT-12 scores were 30.44 ± 4.22, 73.56 ± 3.89, and 73.77 ± 3.72, respectively; VAS scores were 6.07 ± 0.78, 1.93 ± 0.73, and 1.59 ± 0.64, respectively. As compared with the condition before surgery, there was a significant improvement in the mHHS, iHOT-12, and VAS scores at 1 year and 2 years after surgery (P < 0.01). The mHHS score at 2-year follow up after surgery was higher than that at 1 year after surgery, and the difference observed was statistically significant (P = 0.04). One patient with severe acetabular and femoral cartilage damage underwent total hip replacement 11 months after surgery. CONCLUSION: Hip arthroscopy considerably improved hip symptoms and function in Chinese FAI patients aged 50 years or older who did not have severe radiographic osteoarthritis. The conversion to THA and complications were low. Strict surgical indications and appropriate surgical strategies lay the foundation for satisfactory postoperative results in elderly patients with FAI.

KLF2 protects BV2 microglial cells against oxygen and glucose deprivation injury by modulating BDNF/TrkB pathway.

Cerebral ischemia injury is common in cerebral ischemic disease, and treatment options remain limited. Krueppel-like factor 2 (KLF2) is reported to negatively regulate inflammation in several ischemic diseases. Our study aimed to investigate the effects and underlying mechanism of KLF2 in BV2 microglial cells exposed to oxygen and glucose deprivation (OGD). We first found decreased KLF2 and toll-like receptor 2 (TLR2)/TLR4 in these cells. OGD also led to decrease in cell viability and increase in LDH release, apoptosis, the Bax/Bcl-2 ratio, and caspase3/9 expression, as well as production of inflammatory cytokines (e.g., TNFα, IL-1ß and IL-6), reactive oxygen species (ROS), and TLR2/TLR4. To examine KLF2's effects on these OGD effects, we infected BV2 microglial cells with an ad-KLF2 or negative control vector, and we found that KLF2 reversed all of the effects of OGD exposure. Furthermore, KLF2 significantly increased levels of BDNF and TrkB in these cells, but these effects were blocked by K252a, a BDNF/TrkB inhibitor. K252a also decreased cell viability and increased apoptosis, inflammatory factors, ROS production, and TLR2/TLR4 expression in OGD-exposed BV2 cells that were treated with KLF2, were implying that K252a could reverse the effects of KLF2 on these cells. Taken together, our study results indicate that KLF2 may protect BV2 microglial cells against OGD injury by activating the BDNF/TrkB pathway.

Static Low-Angle Squatting Reduces the Intra-Articular Inflammatory Cytokines and Improves the Performance of Patients with Knee Osteoarthritis.

Osteoarthritis (OA) is one of the major diseases leading to disability, and inflammation plays an important role in the pathogenesis of OA. However, inflammation of OA is multifactorial, chronic, and in low intensity, which makes drug-based immunotherapy difficult. Here, we have designed a novel method of exercise-static low angle squat (SLAS), which reduces the intra-articular inflammation of OA knee as well as strengthens the vastus medialis of quadriceps. A two-year follow-up trial of current exercise methods demonstrated long-term, significant improvement in pain relief, range of motion, muscle strength, and knee stability.

[Progress on relationship between transforming growth factor-beta1 and tendinopathy].

As a common soft tissue disease, the mechanism of tendinopathy has not been clarified and is lack of effective treatment method. Change of tissue fibrosis is the one of the main pathological features. Transforming growth factor beta 1 (TGF-ß1), which is one of the important factor, participated in fibrosis. Inconsonant expressions of TGF-ß1 could be found in tendinopathy. The studies are still controversial, but the vast majority of studies had showed that TGF-ß1 was abnormal, and it is given priority to increase, which means that TGF-ß1 plays an important role in the process of tendinopathy. In the process of tendon injuries and repairs, the time of TGF-ß1 increasing is inconsistent. The time for TGF-ß1 plays a significant role has not been determined. TGF-ß1 has abnormal expressions in both tendinopathy and tendon repairs, which are two opposite processes. Thus, it may not be a one-way adjustment factor, but has a pleiotropic. Recent studies showed that TGF-ß1 was considered as binding to receptor and transferring signal into the cell. Now there are three different receptors are found. The classical pathway of TGF-ß1 in intracellular signal transduction is mainly through activation of Smad pathway. In the same time, there are also some non-classical pathways. TGF-ß1 could break balance of extracellular matrix, which may be a reason to cause tendinopathy. But the regulations of TGF-ß1 on the extracellular matrix are complex and diverse, further studies are required. Existing researches showed that the performance of treatments on tendinopathy is unsatisfied by blocking TGF-ß1 downstream pathway. Therefore, it is a good way to study the upstream mechanism of produce TGF-ß1. It may be an effective method to find new targets to inhibit the development of tendinopathy better by finding the original source of TGF-ß1.

c-Fos/microRNA-18a feedback loop modulates the tumor growth via HMBOX1 in human gliomas.

Glioma is one of the most aggressive and lethal human cancers in central nervous system (CNS). Recent studies have identified many dysregulated microRNAs (miRNA, miR) in human glioma, which are a class of small non-coding RNA molecules. Increasing data have shown that miR-18a plays significant roles in several tumors. However, its effects on glioma are unclear. In this study, we found the elevated expression of c-Fos and miR-18a in tissues of human glioma patients and glioma cells. Then the miR-18a inhibitor or c-Fos siRNA were transfected into glioma cells line H4 to determine their effects on H4 cells. MTT assay showed that both miR-18a inhibitor and si-c-Fos suppressed the H4 cell proliferation. Transwell assay showed the reduced cell migration by miR-18a inhibitor and si-c-Fos in H4 cells. The increased level of H4 cells apoptosis by miR-18a inhibitor and si-c-Fos was also determined. Moreover, knockout of c-Fos decreased the miR-18a level, while miR-18a inhibitor reduced the c-Fos level in H4 cells. Added with the results of ChIP assay, this report showed a positive feedback between c-Fos and miR-18a. Finally, luciferase assay showed that HMBOX1 was directly targeted by miR-18a in H4 cells, and the HMBOX1 siRNA reversed the effects of miR-18a inhibitor on cell proliferation, migration and apoptosis of H4 cells. In conclusion, our study determine that c-Fos/miR-18a feedback loop promotes the tumor growth of gliomas by HMBOX1, providing important clues for understanding the key roles of transcription factor mediated mRNA-miRNA functional network in the regulation of gliomas.

A Morphologic and Quantitative Study of Mechanoreceptors in the Remnant Stump of the Human Anterior Cruciate Ligament.

PURPOSE: To investigate the morphology and quantity of mechanoreceptors in the remnant stumps of injured anterior cruciate ligaments (ACLs) and the association of the number of mechanoreceptors with the time from injury to surgery. METHODS: Complete ACL stump specimens were collected from 40 volunteer patients who underwent arthroscopic ACL reconstruction surgery. Serial sections, 20 µm in thickness, were prepared from each specimen. After H&E staining and immunohistochemical labeling, the morphology, type, size, and quantity of the mechanoreceptors were observed under an optical microscope. RESULTS: A total of 176 Ruffini corpuscles, 61 pacinian corpuscles, 15 Golgi-like tendon organs, and 66 atypical mechanoreceptors were observed. Free nerve endings were commonly present in the specimens. The time from injury to surgery (log10 days) was negatively correlated with the number of total mechanoreceptors (r = -0.43, P < .006), Ruffini corpuscles (r = -0.45, P < .003), and the volume of the ACL stump (r = -0.52, P < .01), and these correlations were independent of age, gender, injury side, and career. CONCLUSIONS: The number of mechanoreceptors in an ACL stump and the volume of the stump decreased with the time from injury to surgery. CLINICAL RELEVANCE: This study provides a further theoretical basis for ACL reconstruction with remnant preservation.

The effect of medial meniscal horn injury on knee stability.

PURPOSE: This study investigated the effect of damage of the posterior and anterior horns of the medial meniscus on knee stability. METHODS: Twenty fresh-frozen porcine knees were divided into two groups (anterior horn and posterior horn injury). Each group was tested in three states: intact medial meniscus, posterior or anterior horn of medial meniscus resection and total medial meniscectomy. A robotic testing system was used to test anterior tibial translation (ATT) at 30° (full extension), 60° and 90° of knee flexion with an external anterior tibial load of 89 N, internal rotation (IR) and external rotation (ER) at 30° and 60° of knee flexion under a 4 N m tibial rotation torque. RESULTS: In response to an IR torque, there was a significant difference between the state of intact medial meniscus and anterior and posterior horn damage, except for anterior horn resection at 60° of knee flexion. In response to an ER torque, there were no significant differences between the state of intact meniscus and horn damage except for anterior horn resection at 30° of knee flexion. Meniscal damage had no significant effect on ATT. CONCLUSION: The results indicated that the posterior horn was more important in controlling the IR stability than the anterior horn with knee flexion, and the anterior horn was more important in controlling the ER stability than the posterior horn at full knee extension in the anterior cruciate ligament-intact knee. These findings further the understanding of the mechanisms, the prevention of injuries and rehabilitation of meniscal horn injury in clinical practice.

Effect of graft fixation sequence on knee joint biomechanics in double-bundle anterior cruciate ligament reconstruction.

PURPOSE: To investigate the effect of graft fixation sequence in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics. METHODS: Twelve mature porcine knees underwent double-bundle ACL reconstruction with a randomized fixation order of the two graft bundles. The knees were subjected to external loadings of (1) an 89 N anterior tibial load at 30°, 60° and 90° of knee flexion and (2) 4 N-m internal and external tibial torques at 30° and 60° of knee flexion for ACL intact, deficient and reconstructed states. Knee kinematics and in situ graft forces were measured under the applied loads. RESULTS: The anterior tibial translation of the two reconstructions was not different from each other but was significantly different from the intact ACL. There was no difference in internal and external rotations between the intact knees and the reconstructions. At lower flexion angles, the graft that was fixed last (whether anteromedial or posterolateral) tended to carry significantly higher in situ load under anterior tibial loading and tibial torques. CONCLUSION: While a difference in knee kinematics may not be observable with different graft fixation sequences, fixation sequence can alter the in situ forces that the grafts bear under knee loading.

Anterior cruciate ligament: an anatomical exploration in humans and in a selection of animal species.

PURPOSE: Many anatomical anterior cruciate ligament (ACL) studies have indicated that the human ACL is composed of two functional bundles: the antero-medial (AM) and postero-lateral (PL). The purpose of this study is to compare the ACL anatomy among human and assorted animal species. METHODS: Twenty fresh-frozen knees specimen were used: five humans, ten porcine, one goat, one Kodiak bear, one African lion, one Diana monkey and one Gazelle antelope. All the specimens were dissected to expose the ACL and to visualize the number of bundles and attachment patterns on the tibia and femur. Following the fibre orientation of the individual bundles, a wire loop was used to bluntly separate the bundles starting from the tibial insertion site to the femoral insertion site. In the human and porcine ACL, each bundle was separated into approximately 2 mm diameter segments and then tracked in order to establish the individual bundle's specific pattern of insertion on the femur and tibia. RESULTS: It appeared that all human and animal knee specimens had three bundles that made up their ACL. In addition, it was noted that among the various specimens species, all viewed with an anterior view, and at 90° knee flexion, the ACL bony insertion sites had similar attachment patterns. CONCLUSION: In all the specimens, including human, the ACL had three distinct bundles: AM, intermediate (IM) and PL. The bundles were composed of multiple fascicles arranged in a definite order and similar among the different species.

Inhibition of δ-opioid receptors induces brain glioma cell apoptosis through the mitochondrial and protein kinase C pathways.

Brain glioma is a malignant tumor with a high incidence rate and poor prognosis that has become a focus of studies of central nervous system diseases. Previous studies have suggested that δ-opioid receptors may affect the proliferation and apoptosis of numerous types of tumor cells. However, to date, their precise mechanism(s) of action have not been elucidated. The present study aimed to investigate the effects of inhibiting δ-opioid receptors in brain glioma cell proliferation and apoptosis and their relevant molecular mechanisms. Various doses of naltrindole were supplied to treat brain glioma cells using the MTT method to assess the proliferation index. Flow cytometry was used to investigate the changes in cell apoptosis and mitochondrial membrane potential. The expression levels of Bax, Bcl-2, Bcl-xL, cytochrome c, caspase-9, caspase-3 and protein kinase C (PKC) were measured using western blotting. Naltrindole was observed to inhibit brain glioma cell proliferation and promote apoptosis in a dose- and time-dependent manner. Furthermore, the addition of naltrindole lead to changes in the brain glioma cell membrane potential and regulated Bax translocation to the mitochondrial membrane, consequently promoting the release of cytochrome c into the cytoplasm, followed by the activation of caspase-9 and -3, which caused cell apoptosis. In addition, naltrindole was able to regulate the expression levels of the cellular internal phosphorylated PKC proteins, which are closely associated with the inhibition of cell proliferation. In conclusion, the inhibition of δ-opioid receptors may inhibit brain glioma cell proliferation and lead to apoptosis, which is closely associated with the mitochondrial and PKC pathways.

[Research advances in anterior cruciate ligament reconstructions with remnant preservation].

More ACL tissue were preserved in ACL reconstruction with remnant-preserving than in classic ACL reconstruction. Some studies showed the results in promoting biological healing after undergoing these two procedures, while other studies did not find the clear advantages in clinical outcomes comparing with the classical ACL reconstruction. There were still some controversies in clinical significances for these complicated ACL reconstructions with remnant-preserving. The article summarized recent original studies about ACL reconstruction with remnant-preserving, as well as reviewed the biological characteristics, classification, procedure and clinical outcomes for these two techniques.