Admission Inflammation Markers Influence Long-term Mortality in Elderly Patients Undergoing Hip Fracture Surgery: A Retrospective Cohort Study.

OBJECTIVES: Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that some inflammation biomarkers may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission inflammation biomarkers in elderly patients with hip fracture. METHODS: We reports on a retrospective study of elderly hip fracture patients admitted to a hospital in China between January 2015 and December 2019. A total of 1085 patients were included in the study, and their demographic and pre-operative characteristics were analyzed. The inflammation biomarkers included monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), and C-reactive protein (CRP) to albumin ratio (CAR). The predictive performance of NLR, MLR and CAR was assessed by receiver operating characteristics (ROC) curve analysis and the association between admission inflammation markers and mortality was evaluated by Cox proportional regression. RESULTS: The 30-day, 1-year, 2-year, and 4-year mortality were 1.6%, 11.5%, 21.4% and 48.9%, respectively. The optimal cut-off values of admission NLR, MLR and CAR for 1-year mortality were 7.28, 0.76, and 1.36. After adjusting the covariates, preoperative NLR ≥ 7.28 (HR = 1.419, 95% CI: 1.080-1.864, p = 0.012) were found to be only independent risk factors with 4-year all-cause mortality, the preoperative CAR ≥ 1.36 was independently associated with 1-year (HR = 1.700, 95% CI: 1.173-2.465, p = 0.005), 2 year (HR = 1.464, 95% CI: 1.107-1.936, p = 0.008), and 4-year (HR = 1.341, 95% CI: 1.057-1.700, p = 0.016) all-cause mortality, While age, CCI score, and low hemoglobin at admission were also risk factors for postoperative all-cause mortality. CONCLUSION: Admission CAR and NLR may be useful indicators for predicting the long-term mortality of elderly patients undergoing hip fracture surgery, and that more research is needed to validate these findings.

Improved Calculation Method of TAD for Intertrochanteric Fractures.

Purpose: To investigate the relative position of femur fixed screws using intramedullary systems for intertrochanteric fractures and to improve the accurate measurement method of the tip-to-apex distance (TAD) while providing a theoretical basis for the clinical treatment of such fractures. Methods: In the anteroposterior (AP) radiographs of the hip joint, the femoral neck axis through the femoral head geometry point was designated as the X-axis, while the line perpendicular to the X-axis passing through the femoral head geometry point was designated as the Y-axis. In the lateral radiographs of the hip joint, the line perpendicular to the X-axis passing through the femoral head geometry point was identified as the Z-axis. The head of the nail tip's location projected on the three axes was described as A AP, B in the AP radiographs; and A LAT, C in the lateral radiograph. The TAD was described as X AP and X LAT. The radius of the femoral head was D. All distance units were expressed in mm. Results: When the lateral projection angle was standardized, the A AP was equal to the A LAT, while the X AP 2=B 2+(D - A AP)2 and X LAT 2=C 2+(D - A LAT)2. When the lateral projection angle was not standardized, the value of C had no significant change; however, the (D - A LAT) value changed. Conclusions: The measurement value did not match the actual values of TAD when the lateral projection angle was not standardized, possibly leading to a misinterpretation during clinical work. The X LAT should be amended using the formula X LAT 2=C 2+(D - A AP)2.

Finite element analysis of new headless compression supporting screw for the treatment of unstable femoral neck fracture.

BACKGROUND: Femoral neck fracture is an unsolved challenge in orthopedics. The complication rate in particular is high. There remains a lack of consensus on the optimal choice of internal fixation for unstable femoral neck fracture. OBJECTIVE: The study aimed to develop a new headless compression supporting screw (HCSS) for the treatment of unstable foemoral neck fracture. METHODS: We designed a new HCSS and used a femoral neck fracture (Pauwels III fracture) model (left, fourth-generation composite, Sawbones) and three-dimensional finite element analysis to compare the biomechanical performance of HCSSs with that of cannulated compression screws (CCSs) for treatment of unstable femoral neck fracture. RESULTS: Maximum displacement, peak von Mises stress, peak strain, and rotation for the HCSS were smaller than those for the CCS. The stress was more widely distributed for the HCSS, whereas the stress was concentrated for the CCS. CONCLUSIONS: The HCSS resulted in better biomechanical stability than that from the CCS. For Pauwels III fractures the HCSS exhibits better resistance to shear forces and better support, providing a new clinical treatment.

The impact of perioperative glucose variability on outcomes after hip fracture.

ABSTRACT: Diabetes is considered an independent risk factor for hip fracture. In the present study, we evaluated whether perioperative glucose variability (GV) was a significant predictor of the outcomes of patients with diabetes after hip fracture.We analyzed the characteristics and outcomes of all patients with hip fractures admitted to our hospital between September 2008 and December 2012. Patients with diabetes were grouped into tertiles for GV, and multivariate survival analysis included age, sex, fracture type, mean fasting plasma glucose, and GV.Among the 1099 patients included in this study, 239 (21.7%) had diabetes. Patients with diabetes were more likely to develop infectious complications (5.4% vs 2.8%, P = .045), and experience mortality postoperatively (1 month: 5.5% vs 2.7%, P = .052; 12 months: 15.1% vs 8.7%, P = .006). The postoperative mortality rate was increased across the GV tertiles, and GV was an independent predictor of 1- and 12-month mortality after surgery.Patients with diabetes had poor prognoses after hip fracture. Perioperative GV is an independent predictor of mortality in patients with diabetes. Therefore, GV might be considered a valid additional parameter to consider in the management of these patients.

Analysis on risk factors for neck shortening after internal fixation for Pauwels II femoral neck fracture in young patients.

BACKGROUND: Femoral neck shortening can occur in young patients receiving internal fixation for Pauwels type II femoral neck fracture. The risk factors for neck shortening, which can affect hip function, are not clear. This study aimed to retrospectively identify risk factors for neck shortening after internal fixation with parallel partially threaded cannulated cancellous screws (FPTCS) for Pauwels type II femoral neck fracture in relatively young patients. METHODS: Clinical data from 122 cases with Pauwels type II femoral neck fracture from February 2014 to February 2019 were reviewed and analyzed, and causes of neck shortening were statistically analyzed. And the Chi-squared test or Fisher's exact test was used to compare indicators. Multivariate analysis was conducted with non-conditional logistic regression analysis. RESULTS: Statistically significant differences were found in age, sex, BMD, BMI, fracture type, posterior medial cortex comminution, and reduction quality between patients with femoral neck shortening and those without femoral neck shortening. Logistic regression analysis showed that fracture type, posterior medial cortex comminution, and reduction quality were the main risk factors for neck shortening. CONCLUSION: Fracture type, posterior medial cortex comminution, and reduction quality can be used as important reference indexes to predict the possibility of neck shortening after internal fixation with FPTCS for Pauwels type II femoral neck fracture in young patients. BMD and BMI may be also risk factors.

Benefit of lag screw placement by a single- or two-screw nailing system in elderly patients with AO/OTA 31-A2 trochanteric fractures.

OBJECTIVE: To retrospectively analyze the clinical outcomes of two intramedullary fixation devices, the INTERTAN nail and Gamma3 nail, for treatment of AO/OTA 31-A2 trochanteric fractures in elderly patients. METHODS: In total, 165 elderly patients underwent treatment for AO/OTA 31-A2 trochanteric fractures in our hospital from June 2017 to June 2018 (INTERTAN group, n = 79; Gamma3 group, n = 86). All patients underwent radiological and clinical investigations and were followed up for an average of 12 months. Age, sex, fracture type, surgical time, intraoperative blood loss, fracture healing time, and complications were compared between the two groups. RESULTS: The surgical time was significantly shorter and the intraoperative blood loss volume was significantly lower in the Gamma3 than INTERTAN group (58.2 ± 2.5 vs. 81.7 ± 14.2 minutes and 170 ± 29 vs. 220 ± 16 mL, respectively). However, there were no significant differences in the reduction quality, hospital stay, fracture healing time, Harris hip score, postoperative complications, or 1-year postoperative mortality. CONCLUSION: Both INTERTAN and Gamma3 nails may be effective for surgical treatment of AO/OTA 31-A2 trochanteric fractures in elderly patients. However, the Gamma3 nail was superior to the INTERTAN nail in terms of surgical time and intraoperative blood loss.

Correlation of oxidative stress-related biomarkers with postmenopausal osteoporosis: a systematic review and meta-analysis.

Oxidative stress (OS) is implicated in postmenopausal osteoporosis (PO). Results show an imbalance between antioxidative and oxidative markers in PO. Thus, monitoring of OS-related biomarkers and keeping balance between reactive oxygen species and antioxidant system are beneficial to the diagnosis and prognosis of PO. PURPOSE: Oxidative stress (OS) has been implicated in postmenopausal osteoporosis (PO). However, the relations between OS-related markers and PO are controversial. This study aimed to quantitatively and comprehensively assess the roles of OS-related biomarkers in PO. METHODS: Relevant articles were retrieved from electronic databases. All OS-associated biomarkers with at least 2 independent study outcomes were meta-analyzed. The pooled standardized mean differences (SMD) with its 95% confidence intervals (CI) were presented. RESULTS: A total of 36 studies involving 16 OS-related biomarkers were investigated. The overall results showed that total oxidant status (TOS), superoxide dismutase (SOD), hydroperoxides (HY), paraoxonase (PON1), nitric oxide (NO), and homocysteine (Hcy) were not statistically different between the PO and control groups, whereas significantly increased levels of oxidative stress index (OSI), malondialdehyde (MDA), advanced oxidation protein products (AOPP), and vitamin B12, along with decreased total antioxidant status (TAS), total antioxidant power (TAP), catalase (CAT), glutathione peroxidase (GPx), uric acid (UA), and folate, were detected in the PO group. Subgroup analysis based on biological samples displayed significantly elevated NO in erythrocyte and Hcy in serum, along with decreased SOD in serum. CONCLUSION: Monitoring of certain OS-related biomarkers might be beneficial to the diagnosis and prognosis of PO.

Humeral Head Replacement in the Treatment of Comminuted Proximal Humeral Fracture.

OBJECTIVE: To investigate the outcomes of humeral head replacement in the treatment of patients with comminuted proximal humeral fracture. METHODS: Between February 2013 and September 2016, 56 patients underwent humeral head replacement in our hospital. Of them, 18 cases were diagnosed as comminuted proximal humeral fracture before the operation. The mean age of the patients was 69.5 years old (ranging from 61 to 79 years old). Of them, there were six males and 12 females. All the patients in this group had fresh fractures. They were all treated by artificial humeral head replacements. After the prosthesis was fixed by bone cement reliably, the greater or lesser trochanter and prosthesis handle were sutured and fixed firmly. The interval time from injury to operation ranged from 1 to 5 days. The Constant Functional Score, operation time, blood loss, nerve injury, joint dislocation rate, and infection rate were recorded at the final follow-up. The clinical data of these patients were retrospectively studied. All of the data were recorded in average form. RESULTS: In this study, the mean duration of follow-up was 4 years, ranging from 3 to 6 years. The operation time ranged from 75 to 120 min, with the average of 82 min. The blood loss ranged from 100 to 400 mL, with the average of 210 mL. The mean score of Constant Functional Score was 83.5 ± 3.1. Of them, 14 cases achieved excellent and good (scores of more than 80), and four cases achieved moderate and poor (scores of less than 80). No patient suffered from joint dislocation, unstable joint, or infection after the operation. There were two patients with axillary nerve injury before the operation. However, the function could be recovered within 3-6 weeks after the surgery. CONCLUSION: The artificial humeral head replacement could be applied for the treatment of patients with comminuted proximal humeral fracture. During the surgery process, the stable structure of shoulder joint could be completely restructured, and the rehabilitation plan should be adjusted reasonably and timely after the operation.

Effect of Capsular Closure on Outcomes of Hip Arthroscopy for Femoracetabular Impingement: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the effect of hip arthroscopy with or without capsular closure in femoracetabular impingement (FAI) by meta-analysis. METHODS: Pertinent studies were identified by searching Pubmed, EMBASE databases with the last search update on 16 February 2020. Studies that reported hip arthroscopy for FAI were collected. Meta-analysis was performed by the use of Review Manager 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables. Additionally, the I2 was used to assess heterogeneity among studies, and the fixed-effects model or the random-effects model was selected for the quantitative analysis. Outcomes were evaluated by forest plots. For statistical analysis, P < 0.05 was considered significant. RESULTS: There was no significant difference among the preoperative mHHS (MD = -2.66，95% CI [-7.25, 1.92], I2 = 80%, P = 0.25), preoperative (MD = -4.94, 95% CI [-11.56, 1.67], I2 = 50%, P = 0.14) and postoperative HOS-SSS (MD = -1.00, 95% CI [-6.98, 4.98], I2 = 66%, P = 0.74), patient satisfaction (MD = 0.03, 95% CI [-0.25, 0.31], I2 = 19%, P = 0.84; OR = 0.94, 95% CI [0.59, 1.50], I2 = 0%, P = 0.78), complications (OR = 1.23, 95%CI [0.56, 2.67], I2 = 0%, P = 0.61), revisions (OR = 1.77, 95% CI [0.87, 3.60], I2 = 36%, P = 0.11), and surgery time (SMD = -0.38, 95% CI [-1.16, 0.40], I2 = 92%, P = 0.34) between the capsule closure group and the non-closure group. For the comparison of postoperative mHHS (MD = -2.66, 95% CI [-7.25, 1.92], I2 = 80%, P = 0.25) and HOS-ADL (MD = -4.20, 95% CI [-5.75, -2.65], I2 = 24%, P < 0.00001), the score of the non-closure group was significantly better than that of the closure group. CONCLUSIONS: Remain capsule unclosed after hip arthroscopy for FAI may, to some extent, has a better postoperative functional score than the non-closure treatment.

Effect of cervus and cucumis polypeptide combined with zoledronic acid on bone metabolic biochemical markers in glucocorticoids - Induced osteoporosis patients.

OBJECTIVE: To investigate the effect of cervus and cucumis polypeptide combined with zoledronic acid on bone metabolic biochemical markers in glucocorticoids - induced osteoporosis patients. METHODS: A total of 100 patients with glucocorticoids - induced osteoporosis admitted to our hospital from January 2015 to June 2017 were enrolled in this study. Patients were divided into observation group and control group by random number table method, 50 cases in each group. Patients in the observation group were treated with deer melon polypeptide in combination with zoledronic acid, and patients in the control group were treated with zoledronic acid alone. The patients in both groups were treated for 2 months. The changes of bone mineral density (BMD) and biochemical markers of bone metabolism in lumbar vertebrae L1-4, left femoral neck and large trochanter were analyzed before and after treatment. RESULTS: The pre- BMD at lumbar spine L1-4, left femoral neck and great trochanter had no statistic difference (P > 0.05), the BMD at each sites improved after treatment, and the difference were statistical before and after treatment (P < 0.05). BMD at above sites of two groups after treatment had statistical difference (P < 0.05), and the BMD at lumbar spine L1-4, left femoral neck and great trochanter in the observation group was higher than that of the control group. There were no significant differences in PTH, 25-(OH)D3, TRACP, ß-CTX and BGP levels between the two groups before treatment (P > 0.05). The levels of 25-(OH)D3, TRACP, ß-CTX and BGP in the two groups were significantly improved after treatment (P < 0.05), and the levels of PTH, TRACP and ß-CTX in the observation group were significantly lower than those in the control group. The levels of 25-(OH) D3 and BGP were significantly higher than those of the control group (P < 0.05). CONCLUSION: The cervus and cucumis polypeptide combined with zoledronic acid can improve the BMD at lumbar spine L1-4, left femoral neck and great trochanter, and ameliorate the bone metabolic biochemical markers for patients with glucocorticoids - induced osteoporosis.

Cost-utility analysis of total knee arthroplasty for osteoarthritis in a regional medical center in China.

BACKGROUND: To analyze the cost-effective ratio of total knee arthroplasty (TKA) in the osteoarthritis (OA) treatment of at a regional medical center in China. METHODS: One hundred thirty-nine patients with osteoarthritis who underwent TKA at the Department of Osteoarthritis in Luhe hospital (Tongzhou, Beijing) from January 2011 to January 2012 were followed up. Their health-related quality of life (HRQoL) was evaluated using Short-Form Health Survey (SF) -36 Chinese version, and compared with those of the normal population to assess quality-adjusted life years (QALYs) gained after surgery for its effectiveness of the treatment. The total expense was the cost of patient hospitalization. The cost per QALY was calculated. The cost-benefit ratio (CBR) was expressed as a ratio of each QALY's expenditure to per capita gross domestic product (GDP). Factors affecting the cost, including age, gender, length of stay, and ICU experience, were also considered. RESULTS: The total hospitalization fee was Ò°8,053,736.68, Ò°57,940.55 in average, of which, 81.59% constituted out-of-pocket expenses. The SF-36 scores were as follows: Physical Function: 25.14, Role Physical: 7.12, Bodily Pain: 9.60, Role emotional: 5.58, Vitality: 19.9, Mental Health: 25.84, Social Function: 9.86 and General Health: 21.15. Compared with normal people of the same age and sex, a total of Ò°2487.74 QALYs and Ò°3237.37/QALY were gained, 10% less than the regional GDP per capita. The cost-effective ratio of TKA for osteoarthritis in China was 1: 10.78. The main cost of the patient was the cost of prosthesis (61.78%). The average cost afforded by patients' themselves was Ò°47,242.64 after the deduction of government subsidies. There were Ò°31,306.64 difference compared with the annual average income of the local people. The cost might be affected by length of stay and ICU experience. Longer stay caused more cost of treatment. Patients who remained in ICU after surgery had higher overall costs and blood transfusion costs. CONCLUSION: The factors that affect TKA cost are hospital and postsurgical ICU stay. It is cost-effective for regional medical care center to treat osteoarthritis using TKA economically. However, considering the average income of patients in the area, it is necessary to reduce the cost of the treatment.

Analysis of risk factors for perioperative mortality in elderly patients with intertrochanteric fracture.

OBJECTIVE: To investigate risk factors for perioperative death in elderly patients with intertrochanteric fracture. METHODS: Clinical data from 1051 cases with intertrochanteric fracture from March 2005 to March 2015 were reviewed and analyzed, and causes of death during the perioperative period were statistically analyzed. Various indicators were compared by t test and χ2 test. Multivariate analysis was performed using non-conditional logistic regression analysis. RESULTS: Chronic diseases of major organs (heart, brain, and lung), postoperative complications, and various indicators within 24 h after admission (albumin, hemoglobin, brain natriuretic peptide [BNP], glucose, creatinine, arterial blood pH, PaO2, and APACHE II) were statistically significantly different between patients who survived and those who died. Logistic regression analysis indicated that postoperative complications, APACHE II score, BNP, and chronic diseases of major organs were the risk factors for perioperative mortality in elderly patients with intertrochanteric fracture. CONCLUSION: BNP and APACHE II score could be used as important reference indexes for predicting possible perioperative mortality in elderly patients with intertrochanteric fracture and chronic diseases of major organs. Complications after fracture may be also risk factors.

The lncRNA PCAT1 is correlated with poor prognosis and promotes cell proliferation, invasion, migration and EMT in osteosarcoma.

INTRODUCTION: Osteosarcoma is a malignant primary bone cancer and is lethal to children and adolescents. Recently, the dysregulation of long noncoding RNAs (lncRNAs) has been shown in various types of cancers. AIM: The present study aimed to examine the role of the lncRNA prostate cancer-associated transcript 1 (PCAT1) in osteosarcoma progression. MATERIALS AND METHODS: The expression levels of relevant genes in clinical samples and cell lines were determined by quantitative real-time polymerase chain reaction. Cell proliferation, invasion and migration were examined by CCK-8 assay, transwell invasion and migration assay, respectively. Cell apoptosis and cell cycle were detected by flow cytometry. Protein levels were detected by Western blot. RESULTS: Our results showed that PCAT1 was upregulated in osteosarcoma tissues when compared to normal bone tissues. PCAT1 was also upregulated in osteosarcoma cell lines when compared to normal bone cell line. The upregulation of PCAT1 was significantly associated with advanced clinical stage, tumor metastasis and shorter overall survival in patients with osteosarcoma. In vitro studies showed that overexpression of PCAT1 in MG-63 cells enhanced cell proliferation, cell invasion and migration and epithelial-to-mesenchymal transition (EMT); decreased cell apoptotic rate; and also caused an increase in cell population at S phase with a decrease in cell population at G0/G1 phase. Knockdown of PCAT1 in U2OS cells suppressed cell proliferation, cell invasion and migration, and EMT; increased cell apoptotic rate; and caused an increase in the cell population at G0/G1 phase with a decrease in cell population at S phase. CONCLUSION: Taken together, our results suggest the oncogenic role of PCAT1 in osteosarcoma progression.

(5R)-5-hydroxytriptolide (LLDT-8) prevents collagen-induced arthritis through OPG/RANK/RANKL signaling in a rat model of rheumatoid arthritis.

(5R)-5-hydroxytriptolide (LLDT-8) extracts from Tripterygium have anti-inflammatory, antineoplastic and immunity adjustment functions. The present study used a collagen-induced arthritis (CIA) model to evaluate whether LLDT-8 prevents collagen-induced arthritis, and investigated the signaling underlying this. Male Sprague-Dawley rats were induced to generate CIA, mimicking rheumatoid arthritis (RA). The presence of arthritis was determined using RA progression scores. The inflammatory cytokines interleukin (IL)-1ß, IL-6 and nuclear factor-κB were detected using enzyme-linked immunosorbent assay kits. Induced nitric oxide synthase (iNOS) and matrix metalloprotease (MMP)-13 protein expression were measured using western blot analysis. Lastly, reverse transcription-quantitative polymerase chain reaction was used to evaluate osteoprotegerin (OPG) and receptor activator of nuclear factor κB (RANK) gene expression. LLDT-8 improved RA progression scores and reduced the incidence and severity of CIA. Furthermore, LLDT-8 administration inhibited collagen-induced inflammation and iNOS protein expression in arthritic rats. The current data indicated that MMP-13 production was suppressed and OPG/RANKL expression was increased by LLDT-8 treatment in the arthritic rat. The present results suggest that LLDT-8 attenuates CIA through OPG/RANK/RANK ligand signaling in a rat model of RA.

Increased receptor activator of nuclear factor κß ligand/osteoprotegerin ratio exacerbates cartilage destruction in osteoarthritis in vitro.

Osteoarthritis (OA) is a degenerative joint disease characterized by progressive cartilage destruction, matrix degradation and bony changes. Subchondral bone alterations in osteoarthritis are associated with cartilage destruction. It has previously been demonstrated that osteoprotegerin (OPG) and receptor activator of nuclear factor κß ligand (RANKL) mediate this process. The RANKL/OPG ratio is altered in OA chondrocytes compared with normal chondrocytes. In the pathogenesis of OA, abnormal expression levels of matrix metalloproteinase-13 (MMP-13) are secreted by chondrocytes has a vital role in the progression of cartilage erosion. In the present study, the effect of various RANKL/OPG ratios on MMP-13 expression levels was investigated in interleukin-1ß-stimulated SW1353 human chondrosarcoma cells. Cell viability was assessed by MTT assay and MMP-13 mRNA and protein expression levels were analyzed by quantitative reverse-transcription-quantitative polymerase chain reaction, ELISA and western blot analyses, respectively. The results demonstrated that an increase in MMP-13 mRNA and protein expression levels was observed with increasing RANKL/OPG ratio. These findings suggest that this mechanism may be used as a novel therapeutic strategy against OA.

Biomechanical effect of the configuration of screw hole style on locking plate fixation in proximal humerus fracture with a simulated gap: A finite element analysis.

BACKGROUND: Locking plate fixation for proximal humeral fractures is a commonly used device. Recently, plate breakages were continuously reported that the implants all have a mixture of holes allowing placement of both locking and non-locking screws (so-called combi plates). In commercialized proximal humeral plates, there still are two screw hole styles included "locking and dynamic holes separated" and "locking hole only" configurations. It is important to understand the biomechanical effect of different screw hole style on the stress distribution in bone plate. METHODS: Finite element method was employed to conduct a computational investigation. Three proximal humeral plate models with different screw hole configurations were reconstructed depended upon an identical commercialized implant. A three-dimensional model of a humerus was created using process of thresholding based on the grayscale values of the CT scanning of an intact humerus. A "virtual" subcapital osteotomy was performed. Simulations were performed under an increasing axial load. The von Mises stresses around the screw holes of the plate shaft, the construct stiffness and the directional displacement within the fracture gap were calculated for comparison. RESULTS: The mean value of the peak von Mises stresses around the screw holes in the plate shaft was the highest for combi hole design while it was smallest for the locking and dynamic holes separated design. The stiffness of the plate-bone construct was 15% higher in the locking screw only design (132.6N/mm) compared with the combi design (115.0N/mm), and it was 4% higher than the combi design for the locking and dynamic holes separated design (119.5N/mm). The displacement within the fracture gap was greatest in the combi hole design, whereas it was smallest for the locking hole only design. CONCLUSIONS: The computed results provide a possible explanation for the breakages of combi plates revealed in clinical reports. The locking and dynamic holes separated design may be a better configuration to reduce the risk of plate fracture.

Serum microRNA-195 is down-regulated in breast cancer: a potential marker for the diagnosis of breast cancer.

MicroRNA-195 (miR-195) is a tumor suppressor that plays an important role in tumorigenesis. There are few studies on miR-195 expression in breast cancer patients and the results have been inconsistent; therefore, this study examined miR-195 expression in the serum of BC patients. Samples from 102 normal subjects and 210 subjects with BC who had detailed clinical follow-up information available were selected. An internal reference (miR-16) and serum miR-195 were amplified and quantitatively detected by SYBR green-based real-time RT-PCR. We analyzed the differences in miR-195 levels between BC and healthy cases and the relationships between the miR-195 level and TNM stage and other clinicopathological parameters. In addition, changes in miR-195 levels were examined for 21 BC cases using paired samples before and after neoadjuvant chemotherapy. miR-195 was downregulated in BC compared with control samples (P = 0.000, Mann-Whitney U test). The sensitivity and specificity of miR-195 in the diagnosis of BC were 69.0 and 89.2 %, respectively; whereas, the sensitivities of carcinoembryonic antigen (CEA) and carbohydrate antigen 153 (CA153) were only 15.08 and 21.1 %, respectively. Remarkably, serum miR-195 had higher sensitivity, 73.97 % (108/146), as a tumor marker in the diagnosis of early stage BC [ductal carcinoma in situ, tumor-node-metastasis (TNM) I, II] compared with the conventional tumor markers CA153 and CEA (12.41 and 7.59 %). Moreover, compared with CEA and CA153, miR-195 had a higher sensitivity for detecting the response to neoadjuvant chemotherapy and significantly increased, more than twofold, after neoadjuvant chemotherapy (P = 0.025, paired t test) in 52.381 % (11/21) of BC cases. However, there were no significant relationships between miR-195 expression and other clinicopathological parameters (TNM stage/pathotype/ER/PR/lymph node status). Our data indicate serum miR-195 is a promising tumor marker for BC diagnosis and general screening, especially for early stage BC. The high sensitivity of miR-195 to neoadjuvant chemotherapy may lay the foundation for future studies on the use of miRNA-based methods for monitoring BC treatment and therapy.

Superparamagnetic polymer emulsion particles from a soap-free seeded emulsion polymerization and their application for lipase immobilization.

Using emulsion copolymer of styrene (St), glycidyl methacrylate (GMA) and 2-hydroxyethyl methacrylate (HEMA) as seed latexes, the superparamagnetic polymer emulsion particles were prepared by seeded emulsion copolymerization of butyl methacrylate (BMA), vinyl acetate (VAc) and ethylene glycol dimethacrylate in the presence of the seed latexes and superparamagnetic Fe3O4/SiOx nanoparticles (or Fe3O4-APTS nanoparticles) through a two-step process, without addition of any emulsifier. The magnetic emulsion particles named P(St-GMA-HEMA)/P(BMA-VAc) were characterized by transmission electron microscope and vibrating sample magnetometry. The results showed that the magnetic emulsion particles held a structure with a thinner shell (around 100 nm) and a bigger cavity (around 200 nm), and possessed a certain level of magnetic response. The resulting magnetic emulsion particles were employed in the immobilization of lipase by two strategies to immobilized lipase onto the resulting magnetic composites directly (S-1) or using glutaraldehyde as a coupling agent (S-2), thus, experimental data showed that the thermal stability and reusability of immobilized lipase based on S-2 were higher than that of S-1.

The role of the serum RANKL/OPG ratio in the healing of intertrochanteric fractures in elderly patients.

Intertrochanteric fractures occur most commonly in elderly patients. Osteoblasts and osteoclasts have been reported to be regulated by the receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG), during bone modeling and remodeling, respectively. Based on these observations, we hypothesized that the serum levels of RANKL, OPG and the RANKL/OPG ratio are important in the healing of intertrochanteric fractures in elderly patients. Enzyme-linked immunosorbent assays were used to measure the serum concentrations of RANKL and OPG in 36 elderly patients with intertrochanteric fractures and 30 age-matched healthy control subjects, at baseline and 4, 8 and 12 weeks following injury. The RANKL/OPG ratio in the two groups was also evaluated. Similar trends in RANKL and OPG levels were detected during the fracture healing process. The serum levels of RANKL and OPG were higher in the fracture group than in the controls, and were significantly higher at baseline and 4 weeks following injury (P<0.05). Notably, although the RANKL/OPG ratio gradually increased during healing, it was lower in the fracture group than in the control group. The RANKL/OPG ratio was significantly lower immediately after and 4 weeks after injury in the fracture group (P<0.05). Our data suggest a close correlation between higher serum levels of RANKL and OPG and the fracture healing process, indicating that RANKL and OPG are involved in fracture healing. The serum RANKL/OPG ratio also appears to be significant in the healing of intertrochanteric fractures in elderly patients.

Mitochondrial protection and anti-aging activity of Astragalus polysaccharides and their potential mechanism.

The current study was performed to investigate mitochondrial protection and anti-aging activity of Astragalus polysaccharides (APS) and the potential underlying mechanism. Lipid peroxidation of liver and brain mitochondria was induced by Fe(2+)-Vit C in vitro. Thiobarbituric acid (TBA) colorimetry was used to measure the content of thiobarbituric acid reactive substances (TBARS). Mouse liver mitochondrial permeability transition (PT) was induced by calcium overload in vitro and spectrophotometry was used to measure it. The scavenging activities of APS on superoxide anion (O(2) (•-)) and hydroxyl radical (•OH), which were produced by reduced nicotinamide adenine dinucleotide (NADH)-N-Methylphenazonium methyl sulfate (PMS) and hydrogen peroxide (H(2)O(2))-Fe(2+) system respectively, were measured by 4-nitrobluetetrazolium chloride (NBT) reduction and Fenton reaction colorimetry respectively. The Na(2)S(2)O(3) titration method was used to measure the scavenging activities of APS on H(2)O(2). APS could inhibit TBARS production, protect mitochondria from PT, and scavenge O(2) (•-), •OH and H(2)O(2) significantly in a concentration-dependent manner respectively. The back of the neck of mice was injected subcutaneously with D-galactose to induce aging at a dose of 100 mg/kg/d for seven weeks. Moreover, the activities of catalase (CAT), surperoxide dismutase (SOD) and glutathione peroxidase (GPx) and anti-hydroxyl radical which were assayed by using commercial monitoring kits were increased significantly in vivo by APS. According to this research, APS protects mitochondria by scavenging reactive oxygen species (ROS), inhibiting mitochondrial PT and increasing the activities of antioxidases. Therefore, APS has the effect of promoting health.