Comparison of surgical efficacy of locking plates and interlocking intramedullary nails in the treatment of proximal humerus fractures.

BACKGROUND: The objective of this study was to evaluate the efficacy of locking plates versus interlocking intramedullary nails in the treatment of proximal humerus fractures to provide clinical data support and theoretical guidance. METHODS: Patients with proximal humerus fracture from the Third hospital of Shijiazhuang city and Third hospital of Hebei medical university and from January 2017 to June 2019 were selected, included and divided into the locking plate group and the interlocking intramedullary nail group according to the intervention received. Information pertaining to the perioperative period (operation time, hospital stay, blood loss, etc.) of patients in both groups was collected. VAS pain scores, shoulder activity Constant-Murley scores and postoperative complications were documented. The perioperative data of the two groups were compared, and P < 0.05 was considered statistically significant. RESULTS: A total of 64 patients were enrolled, including 36 patients in the locking plate group, with a mean age of 61.3 ± 13.9 years, while the mean age of the interlocking intramedullary nail group was 65.6 ± 11.2 years. There was no statistical difference in gender, affected side, injury mechanism and Neer classification between the two groups (P > 0.05). However, the average operation time of the locking plate group was shorter than that of the interlocking nail group (84.9 ± 11.7 vs. 102.6 ± 22.1 min, P = 0.00), and the intraoperative blood loss of the locking plate group (137.4 ± 16.8 ml) was higher than that of the interlocking nail group (72.5 ± 10.5 ml, P = 0.00). There was no significant difference in the VAS score and Constant-Murley score between these two groups at the final follow-up. CONCLUSION: Interlocking intramedullary nails are more minimally invasive than locking plates, but fracture reduction and fixation take longer. There was no significant difference in pain and shoulder function scores between the two internal fixation strategies for the treatment of proximal humerus fracture.

Aggregation performance and adhesion behavior of microbes in response to feast/famine condition: Rapid granulation of aerobic granular sludge.

Periodic starvation was a common strategy for the rapid start-up of aerobic granular sludge (AGS), and investigating the behavior of microbes that originated from inner or outer layer in response to feast/famine condition could provide more details for the development or stability of AGS. In this work, the microbes of the AGS were isolated by layers, the aggregation of microbes, the adhesion behavior of microbes, and viscoelasticity of the layer formed by microbes, at feast/famine conditions, were investigated for the in-depth understanding of the start-up and stability of AGS. The famine condition reduced the negative charge and deprotonated carboxyl groups of the surface thereby boosting the aggregation and adhesion of microbes. The feast condition was more beneficial for the stability of the layer as it caused a denser layer of microbes. The inner core microbes (IC) presented a higher aggregation rate than the outer layer microbes (OL) at feast/famine conditions. Also, the IC presented the highest aggregation rate, adhesion rate, and adhesion mass at famine conditions, which was most in favor of the start-up stage of the aerobic granulation. Since the denser layer was formed by IC, IC had better advantages over OL at the famine stage in the formation of a more stable layer. This study affirmed the role of microbes in the inner layer of the granule during the start-up phase and provided a theoretical basis for understanding the significance of the famine period for rapid granulation.

Enhanced biogas production in anaerobic digestion of sludge medicated by biochar prepared from excess sludge: Role of persistent free radicals and electron mediators.

The addition of biochars to promote the efficiency of anaerobic digestion (AD) has widely received concerns. However, the role of persistent free radicals (PFRs) and the electron transfer ability of biochar in AD has not yet been noticed. In this study, biochars were prepared from excess sludge under 400 °C (B400) or 600 °C (B600) and different ratios of sludge to biochar (5:1, 10:1, 20:1) were applied in the AD of sludge. The results verified that PFRs in biochar participated in the sterilization of microorganisms in sludge, resulting in the release of organic matters. Similar to electron mediators, biochars possessed electron exchangeability and the addition of biochars boosted the biogas production by maximum of 54.5%. The enhancing effect of B400 surpassed that of B600 as high temperature destroyed functional groups and reduced the defect degree of biochar. This study achieved in-situ resource utilization and provided references for the improvement of anaerobic digestion.

Protective effect of 4-Methoxy benzyl alcohol on the neurovascular unit after cerebral ischemia reperfusion injury.

OBJECTIVE: Cerebral ischemia reperfusion injury (CIRI) is a major cause of ischemic stroke (IS) deterioration. Considering the intricate mechanism of the pathological process of CIRI, most drugs only work on one target. The neurovascular unit (NVU) puts forward the concept of neuroprotection from nerve protection to global stabilization. The NVU plays an important role in maintaining the brain microenvironment. This would promote neuronal survival and overall neurological recovery, which would likely lead to the reduction of mortality rate. Previous studies have shown that 4-methoxy benzyl alcohol (4-MA) ameliorated neurological score and cerebral infarct volume and reduced the concentration of Evans blue (EB) in brain tissue. In this research, we investigated the effects of 4-MA on NVU microenvironment improvement in rats impaired by middle cerebral artery occlusion/reperfusion (MCAO/R). METHODS: First, we established a rat model of middle cerebral artery occlusion (MCAO) so as to use Western blot analysis, immunofluorescence and transmission electron microscopy (TEM) evaluating the NVU's protection of 4-MA. Then we established a primary cortical neuron model of oxygen glucose deprivation and re-oxygenation (OGD/R) with the objective of identifying whether 4-MA exhibited anti-oxidant and anti-apoptotic effects on neurons. RESULTS: NVU ultra structural changes were improved by 4-MA. Immunofluorescence and western blot showed that 4-MA protected NVUs through enhancement of the expression of the symbolic neuronal proteins Microtubule Associated Protein-2(MAP-2), and attenuation of protein expression of Asy symbolic protein Glial Fibrillary Acidic Protein(GFAP). Furthermore, in the OGD/R model of I/R injury in vitro, 4-MA significantly increased Superoxide dismutase(SOD), Nitric Oxide(NO), B-cell lymphoma-2(Bcl-2), decreased Bcl-2-Associated X(Bax) and increased Bcl-2/Bax. CONCLUSION: 4-MA can play the role of anti-ischemic stroke drug by ameliorating the microenvironment of NVUs while its neuroprotective effects will contribute towards the inhibition of the antioxidant and anti-apoptotic activities.

Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fracture.

To observe the clinical outcome of the sinus tarsi approach in the operative treatment of intra-articular calcaneal fractures.Forty-nine intra-articular calcaneal fractures in 45 patients were managed surgically with sinus tarsi approach. The anatomical plate and compression bolts were applied in 14 feet. The anatomical plate and screws were applied in 35 feet. Maryland foot score system was used to evaluate the function of the hindfoot at the followup.The reduction of the posterior facet was graded as nearly anatomical (less than 2 mm articular displacement) in 46 feet (93.9%). The width, height, and Böhler angle were significantly improved in all patients (P < .01). After a mean follow-up period of 18.7 months (14.5-29 months), the Maryland foot scores were: 34 feet scored 90-100 points (excellent), 6 feet scored 80-90 points (good), 6 feet scored 70-80 points (fair), and 3 feet scored 60-70 points (poor). Incision-edge necrosis occurred in 2 cases. One case suffered from incomplete medial plantar nerve injury. One case suffered from heel pad branch of the tibial nerve injury. Six cases suffered from sural nerve injury, and 4 cases sustained a lateral wound dehiscence due to a hematoma. No case suffered from lateral impingement syndrome. Up to now, no patient had to accept subtalar arthrodesis.Sinus tarsi approach provides good exposure to the subtalar joint. Open reduction and internal fixation of calcaneus fractures through a sinus tarsi approach allows adequate reduction with low risk of wound-healing complications.