Evaluation of brain iron deposition in different cerebral arteries of acute ischaemic stroke patients using quantitative susceptibility mapping

AIM

To investigate differences in iron deposition between infarct and normal cerebral arterial regions in acute ischaemic stroke (AIS) patients using quantitative susceptibility mapping (QSM).

MATERIALS AND METHODS

Forty healthy controls and 40 AIS patients were recruited, and their QSM images were obtained. There were seven regions of interest (ROIs) in AIS patients, including the infarct regions of responsible arteries (R1), the non-infarct regions of responsible arteries (R2), the contralateral symmetrical sites of lesions (R3), and the non-responsible cerebral arterial regions (R4, R5, R6, R7). For the healthy controls, the cerebral arterial regions corresponding to the AIS patient group were selected as ROIs. The differences in corresponding ROI susceptibilities between AIS patients and healthy controls and the differences in susceptibilities between infarcted and non-infarct regions in AIS patients were compared.

RESULTS

The susceptibilities of infarct regions in AIS patients were significantly higher than those in healthy controls (p<0.0001). There was no significant difference in non-infarct regions between the two groups (p>0.05). The susceptibility of the infarct regions in AIS patients was significantly higher than those of the non-infarct region of responsible artery and non-responsible cerebral arterial regions (p<0.01).

CONCLUSIONS

Abnormal iron deposition detected by QSM in the infarct regions of AIS patients may not affect iron levels in the non-infarct regions of responsible arteries and normal cerebral arteries, which may open the door for potential new diagnostic and treatment strategies.

Improving Blood Pressure Control and Pregnancy Outcomes: The Impact of Evidence-Based Care and Aerobic Exercise in Patients with Hypertensive Disorders During Pregnancy

Objective

To explore the effect of evidence-based care plus aerobic exercise on blood pressure control and pregnancy outcome in patients with hypertensive disorders during pregnancy.

Methods

A total of 100 patients diagnosed with hypertensive disorder in pregnancy treated in our hospital between February 2020 and November 2021 were recruited, analyzed and assigned at a ratio of 1:1 to receive routine nursing (control group) or evidence-based care plus aerobic exercise (experimental group) via random number table method. Outcome measures included blood pressure, negative emotions, sleep duration, and pregnancy outcome.

Results

The blood pressure of both groups decreased after nursing, and the diastolic and systolic blood pressure of patients in the experimental group (79.84±5.18 mmHg, 111.62±7.96 mmHg) were lower than those in the control group (88.65±5.69 mmHg, 132.15±8.14 mmHg) (P < .05). After the completion of the nursing period, assessments using the Self-Rating Anxiety Scale and Hamilton Depression Scale were conducted. The results revealed significantly lower scores in the experimental group, which received evidence-based care along with aerobic exercise, compared to the control patients who received routine care. The sleep duration was prolonged in both groups after nursing, and patients in the experimental group got longer sleep duration than those in the control group (P < .05). The experimental group showed a significantly lower incidence of adverse pregnancy outcomes than the control group (P < .05).

Limitations

While our study demonstrates the positive impact of evidence-based care combined with moderate aerobic exercise on patients with hypertensive disorders during pregnancy, it is essential to acknowledge some notable limitations. First, the sample size was relatively small, which may limit the generalizability of our findings to a larger population. Furthermore, our study primarily focused on short-term outcomes, and future research could explore the sustained benefits of this approach. Finally, individual variations in exercise tolerance and compliance may also affect the effectiveness of the intervention. Despite these limitations, our findings hold promise and provide a foundation for further research in this area.

Conclusion

Evidence-based care combined with moderate aerobic exercise has proven to be an effective approach in enhancing the overall management of patients with hypertensive disorders during pregnancy. This combined intervention not only effectively regulates blood pressure levels but also mitigates adverse emotional states, enhances sleep quality, and ultimately leads to improved pregnancy outcomes. These findings hold significant promise for clinical application. Healthcare providers may consider implementing this approach to improve the well-being of pregnant individuals with hypertensive disorders, potentially reducing the risk of complications and enhancing the overall quality of care. Pregnant individuals, on the other hand, can benefit from a more comprehensive and holistic approach to their care, which may result in better health and pregnancy outcomes. Future research in this area could explore the long-term sustainability and cost-effectiveness of this intervention, as well as its potential applicability to diverse patient populations and healthcare settings.

Efficacy of Quality Care on Maternal and Infant Outcomes in Patients with Hypertensive Disorders Complicating Pregnancy Complicated with Cerebral Hemorrhage

Objective

This study aimed to evaluate the impact of quality care on maternal and infant outcomes in patients with hypertensive disorders complicating pregnancy (HDCP) complicated by cerebral hemorrhage.

Methods

From February 2020 to September 2021, 68 women with HDCP complicated by cerebral hemorrhage hospitalized at our hospital were included and divided into a routine group (standard care) and a quality group (quality care). Outcome measures included National Institutes of Health Stroke Scale (NIHSS) scores, blood pressure, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, and maternal and infant outcomes.

Results

Patients in the quality group (3.22±1.89) had significantly lower NIHSS scores aftercare than those in the routine group (6.15±3.24) (P < .05). Quality care resulted in lower diastolic blood pressure (Quality group:81.23±6.15; Routine: 90.58±7.98), systolic blood pressure (Quality group:125.49±13.37; Routine: 139.74±16.67), SAS scores (Quality group: 48.42±2.65; Routine: 58.15±2.43), and SDS scores versus routine care (Quality group:48.42±2.65; Routine: 58.15±2.43)(P < .05). The quality group showed a lower incidence of adverse maternal and infant pregnancy outcomes than the routine group (P < .05).

Conclusion

The findings underscore the positive impact of quality care in reducing adverse maternal and newborn pregnancy outcomes. This reduction is particularly significant for clinical practice, as it is achieved through the amelioration of various factors, such as neurological impairments, blood pressure regulation, and the alleviation of negative emotions, including anxiety and depression, in patients with HDCP complicated by cerebral hemorrhage. The practical implications of these findings for healthcare providers and patients are substantial. They highlight the potential to improve patient outcomes, enhance the overall quality of care, and reduce the burden on healthcare systems. By addressing these factors, healthcare providers can enhance the well-being of both mothers and newborns, leading to improved clinical outcomes and increased patient satisfaction.

ABHD2 deficiency aggravates ovalbumin-induced airway remodeling through the PI3K/Akt pathway in an animal model of chronic asthma

Airway remodeling is a major pathological characteristic of chronic obstructive pulmonary disease (COPD). This study aimed to investigate the effect of Abhd2 deficiency on ovalbumin (OVA)-induced airway remodeling and inflammation in vivo. Abhd2-deficient mice were used to establish an OVA-induced asthma model. Lung tissues were analyzed using hematoxylin and eosin (HE) staining, Masson staining, immunohistochemistry, quantitative reverse transcription- polymerase chain reaction (qRT-PCR), and western blotting were used to determine the role of Abhd2 in the regulation of OVA-induced airway remodeling and inflammation. Our findings revealed that the RNA expression of inflammatory factors, including IL-1β, IL-6, IL-4, and IL-13, was significantly increased in OVA-induced Abhd2 Gt/Gt asthmatic mice. The expression of IFN-γ was decreased significantly in OVA-induced Abhd2 Gt/Gt asthmatic mice. The protein expression of airway remodeling factors, including α-SMA, type I collagen, and Ki67, was also increased in OVA-induced Abhd2 Gt/Gt asthmatic mice compared to that in OVA-induced wild-type (WT) mice. Additionally, Abhd2 deficiency promoted the expression of p-Akt in tissues of the asthma model. These results suggest that Abhd2 deficiency exacerbates airway remodeling and inflammation through the PI3K/Akt pathway in chronic asthma.

Conventional transarterial chemoembolization combined with systemic therapy versus systemic therapy alone as second-line treatment for unresectable colorectal liver metastases: randomized clinical trial

BACKGROUND

The combination of conventional transarterial chemoembolization (cTACE) and systemic therapy has the potential to treat chemotherapy-refractory unresectable colorectal liver metastases (CRLMs). This study aimed to compare survival after this combined treatment versus systemic chemotherapy alone.

METHODS

This single-centre RCT included patients with unresectable CRLMs that progressed after first-line treatment. Patients were randomized on a 1 : 1 basis to either systemic chemotherapy with or without cTACE, without further stratification. The primary outcome was progression-free survival (PFS). Secondary outcomes were overall response rate, disease control rate, conversion rate to liver resection, overall survival, and adverse events.

RESULTS

Of 180 patients recruited, 168 were randomized. Eighty-five patients in arm A received systemic chemotherapy plus cTACE and 83 in arm B received systemic chemotherapy alone. Median PFS was longer in arm A than B (6.7 versus 3.8 months; hazard ratio (HR) 0.67, 95 per cent c.i. 0.49 to 0.91; P = 0.009), but did not translate into prolonged median overall survival (18.4 versus 14.8 months; HR = 0.92, 0.62 to 1.36; P = 0.669). Overall response rates (20 versus 22 per cent; P = 0.788) and conversion rate to liver resection (18 versus 16 per cent; P = 0.730) were no different between arms A and B. The disease control rate was higher in arm A than arm B (67 versus 51 per cent; P = 0.030). No adverse event higher than grade 3 according to the Common Terminology Criteria for Adverse Events was observed during treatment.

CONCLUSION

Systemic chemotherapy plus cTACE is a safe option as second-line treatment for unresectable colorectal liver metastases, with a modest effect on PFS. Registration number: NCT03783559 (http://www.clinicaltrials.gov).

MiR-200b-5p inhibits proliferation of ovarian cancer cells by targeting ATAD2 and regulating PI3K/AKT signaling pathway

OBJECTIVE

The purpose of this study was to investigate the influences of micro ribonucleic acid (miR)-200b-5p on proliferation and apoptosis of ovarian cancer (OC) cells, and to explore its correlations with the target gene ATPase family, AAA domain containing 2 (ATAD2), and the phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway.

MATERIALS AND METHODS

Human ovarian fibroblasts (HOFs) or human OC cell lines (A2780) were cultured in vitro, and then, A2780 cells were separately transfected with miR-200b mimics or miR-NC or cultured with ATAD2-specific inhibitor BAY-850. Thereafter, the expression levels of miR-200b and ATAD2 messenger RNA (mRNA) were measured via qRT-PCR, and the proliferative capacity of cells was detected by CCK-8 assay. Next, the cell apoptosis was determined by means of flow cytometry and one-step TUNEL assay. Finally, the targeted regulatory relationship between miR-200b and ATAD2 was examined using a Luciferase reporter assay system, and the protein expressions were detected through Western blot (WB) assay.

RESULTS

It was found that the expression level of miR-200b was remarkably lower (p<0.05), while the mRNA expression level of ATAD2 was notably higher (p<0.05) in A2780 cells than those in HOFs. The transfection with miR-200b mimics markedly reduced the mRNA expression level of ATAD2 (p<0.05) and the proliferative capacity (p<0.05) and increased the apoptosis rate (p<0.05) of A2780 cells. Besides, it was detected via the Luciferase reporter assay system that miR-200b inhibited ATAD2. BAY-850 significantly decreased the expression level of ATAD2 protein (p<0.05) and the proliferative capacity (p<0.05) but improved the apoptosis rate (p<0.05) of cells. Moreover, both miR-200b mimics and BAY-850 could distinctly repress the protein expression levels of PI3K and p-Akt of the PI3K/Akt signaling pathway (p<0.05) and enhance the expression of suppressor gene p53 (p<0.05).

CONCLUSIONS

MiR-200b-5p can inhibit the proliferation and promote the apoptosis of OC cells through targeted inhibition of ATAD2 expression and regulation of the PI3K/Akt signaling pathway.

Effect of UV-B radiation on growth, flavonoid and podophyllotoxin accumulation, and related gene expression in Sinopodophyllum hexandrum

Sinopodophyllum hexandrum is an alpine medicinal plant that produces the anticancer compound podophyllotoxin (PPT). Although a positive relationship between PPT content and altitude has been proved and low temperature enhances plant growth and PPT accumulation has also been revealed, the role of UV radiation in regulating growth and PPT accumulation is still unclear In this study, morphophysiological traits, metabolites content and related genes expression were investigated by exposing S. hexandrum seedlings to treatment with UV-B radiation. The results showed that the contents of soluble sugars and flavonoids, and the expression levels of genes involved in glycometabolism (XET and β-1,3-glucanase) and flavonoid biosynthesis (PAL,C4H,4CL,CHS1 and DTX41) were enhanced in response to UV-B compared to CK. Moreover, genes involved in stress tolerance (MYB, WRKY,APX3 and EX2) were also upregulated in response to UV-B radiation. Although the whole plant biomass exhibited slightly increased values that depended largely on root development, the contents of chlorophyll and PPT and the expression levels of genes involved in photosynthesis (matK, ndhF,rbcL and ycf5) and PPT biosynthesis (C3H,CCoAMT,CCR,CAD, DPO, PLR,SDH, CPY719A23,OMT3,CYP71CU1,OMT1and 2-ODD) were significantly decreased in response to UV-B compared to CK. It can be concluded that UV-B radiation promotes soluble sugars and flavonoids accumulation, but inhibits PPT biosynthesis in S. hexandrum.

Cardiac Remodeling During Pregnancy With Metabolic Syndrome: Prologue of Pathological Remodeling

BACKGROUND

The heart undergoes physiological hypertrophy during pregnancy in healthy individuals. Metabolic syndrome (MetS) is now prevalent in women of child-bearing age and might add risks of adverse cardiovascular events during pregnancy. The present study asks if cardiac remodeling during pregnancy in obese individuals with MetS is abnormal and whether this predisposes them to a higher risk for cardiovascular disorders.

METHODS

The idea that MetS induces pathological cardiac remodeling during pregnancy was studied in a long-term (15 weeks) Western diet-feeding animal model that recapitulated features of human MetS. Pregnant female mice with Western diet (45% kcal fat)-induced MetS were compared with pregnant and nonpregnant females fed a control diet (10% kcal fat).

RESULTS

Pregnant mice fed a Western diet had increased heart mass and exhibited key features of pathological hypertrophy, including fibrosis and upregulation of fetal genes associated with pathological hypertrophy. Hearts from pregnant animals with WD-induced MetS had a distinct gene expression profile that could underlie their pathological remodeling. Concurrently, pregnant female mice with MetS showed more severe cardiac hypertrophy and exacerbated cardiac dysfunction when challenged with angiotensin II/phenylephrine infusion after delivery.

CONCLUSIONS

These results suggest that preexisting MetS could disrupt physiological hypertrophy during pregnancy to produce pathological cardiac remodeling that could predispose the heart to chronic disorders.

[Effects of occupational nickel exposure on glycemic parameters in workers]

Objective: To explore the effect of occupational nickel exposure on blood glucose related indicators of workers. Methods: In March 2019, five electroplating enterprises and one plastic hardware enterprise were selected by cluster sampling method. 159 nickel plating workers were selected as the contact group, and 66 administrative personnel of the same enterprise were selected as the control group. The serum nickel concentration, fasting blood glucose (FPG) , fasting insulin (FIns) and glycosylated hemoglobin (HbA1c) were measured in the contact group and the control group. The differences of blood glucose related indexes between the two groups were compared, and the risk factors of abnormal blood glucose indexes were analyzed. Results: Compared with the control group, the blood nickel concentration and detection rate of nickel in the contact group were higher, the levels of FIns were lower, and the proportion of HbA1c was higher in the contact group (P<0.05) . Stratified analysis showed that compared with the control group, the blood glucose index of men in the contact group changed significantly (P<0.05) ; logistic regression analysis showed that male was an independent influencing factor for decreased FIns (OR=8.264, P<0.05) . Conclusion: Long term exposure to nickel can affect the blood glucose related indexes such as fins and HbA1c.

Primary tumour location is an important prognostic factor in colorectal cancer liver metastases following radiofrequency ablation

AIM

To examine the outcomes and different prognoses for colorectal cancer patients with liver metastases (CRCLM) treated with radiofrequency ablation (RFA) based on the origin of the primary tumour (rectum versus colon).

MATERIALS AND METHODS

Patients diagnosed with CRCLM from July 2011 to June 2018 were assessed in the study. The study included 114 patients with 176 lesions. All of the patients underwent RFA of their CRCLM. The overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier survival function estimate curves and Cox regression analysis between the group of patients with rectal cancer liver metastases (RCLM) and colon cancer liver metastases (CCLM).

RESULTS

Patients with RCLM exhibited worse OS and PFS than those with CCLM. The 1-, 2-, and 3-year OS rates were 87.5%, 75%, and 54.2% in the RCLM group and 93.9%, 87.8%, and 81.8% in the CCLM group (p=0.001), respectively. The 1-, 2-, and 3-year PFS rates were 43.7%, 22.9%, and 20.8% in the RCLM group and 57.6%, 45.4%, and 36.5% in the CCLM group (p=0.001), respectively. Multivariate analysis showed that primary tumour location, carcinoembryonic antigen (CEA), and response to pre-ablation chemotherapy were independent variables for OS and PFS. The N state of the primary tumour also had a significant impact on OS.

CONCLUSION

This study showed that patients with CCLM had better prognoses than those with RCLM following RFA treatment. If patients intend to undergo RFA for CRCLM, the location of the primary tumour should be considered in the assessment of long-term therapeutic effects.

Optimization of an improved aqueous method for the production of high quality white sesame oil and de-oiled meal

Research into the production of white sesame oil by aqueous extraction has been promoted because of concerns about the environment, health, and cost. The advanced aqueous method using a 1.95:10 liquid-to-raw material ratio, which was finally developed in this study, recovered 96.06% white sesame oil and produced de-oiled meal with high quality (3.98% residual oil content). The acid value and peroxide value of the oil produced were quite low at 0.19 mg KOH/kg and < 3.25 mmol/kg, respectively, which were better than the values required by the Chinese national standard for first class edible sesame oils and oils produced by hexane extraction. No wastewater was discharged during the extraction of white sesame oils by an aqueous salt solution. The protein rich de-oiled meal may be a good material for making protein isolate with high purity (e.g. > 90%). It can also be a nutritious ingredient or raw material for producing many food products.

Prevalence and cardiovascular risk factors of asymptomatic intracranial arterial stenosis: the Kongcun Town Study in Shandong, China

BACKGROUND AND PURPOSE

This study was to investigate the prevalence and cardiovascular risk factors (CRFs) of asymptomatic intracranial atherosclerotic stenosis (aICAS) amongst middle-aged and older adults living in rural communities in China.

METHODS

This population-based study included 2019 subjects (aged ≥40 years, 52.3% women) who were free of stroke and living in rural communities in China. From October 2017 to May 2018, data on demographics, CRFs and health conditions were collected through face-to-face interviews, physical examination and laboratory tests. Asymptomatic ICAS was detected through a two-phase procedure: a screening phase with transcranial Doppler ultrasound, followed by a diagnostic phase with magnetic resonance angiography examination. Multivariable logistic regression models were used to analyse CRFs associated with aICAS.

RESULTS

Of the 2019 participants, aICAS was detected in 153 persons. The overall prevalence of aICAS was 7.6%, and the prevalence of moderate-to-severe aICAS was 5.0%. The multi-adjusted odds ratio (95% confidence interval) of aICAS associated with CRFs was 2.40 (1.56-3.69) for hypertension, 1.91 (1.32-2.76) for high hypersensitive C-reactive protein, 1.68 (1.14-2.49) for diabetes and 1.61 (1.08-2.41) for overweight or obesity. When these four CRFs were aggregated, compared with participants without any of these factors, the multi-adjusted odds ratios (95% confidence interval) of aICAS for persons concurrently having one, two and three or more of these factors were 1.14 (0.52-2.48), 2.91 (1.42-5.99) and 5.51 (2.64-11.50), respectively (P for linear trend <0.001).

CONCLUSIONS

Asymptomatic ICAS is common amongst rural-dwelling middle-aged and older Chinese people. Hypertension, diabetes, overweight or obesity and high hypersensitive C-reactive protein, especially when coexisting, are strongly associated with aICAS.

Phonotactic steering and representation of directional information in the ascending auditory pathway of a cricket

Directional hearing is crucial for animals depending on acoustic signals to locate a mate. We focused on crickets to explore the reliability of directional information forwarded to the brain by the ascending auditory interneuron AN1, which is crucial for phonotactic behavior. We presented calling song from -45° to +45° in steps of 3° and compared the phonotactic steering of females walking on a trackball with the directional responses of AN1. Forty percent of females showed good steering behavior and changed their walking direction when the speaker passed the body's longitudinal axis. The bilateral latency difference between right and left AN1 responses was small and may not be reliable for auditory steering. In respect to spike count, all AN1 recordings presented significant bilateral differences for angles larger than ±18°, yet 35% showed a mean significant difference of 1-3 action potentials per chirp when the frontal stimulus deviated by 3° from their length axis. For small angles, some females had a very similar AN1 activity forwarded to the brain, but the accuracy of their steering behavior was substantially different. Our results indicate a correlation between directional steering and the response strength of AN1, especially for large angles. The reliable steering of animals at small angles would have to be based on small bilateral differences of AN1 activity, if AN1 is the only source providing directional information. We discuss whether such bilateral response difference at small angles can provide a reliable measure to generate auditory steering commands descending from the brain, as pattern recognition is intensity independent.NEW & NOTEWORTHY The ascending auditory interneuron AN1 has been implicated in cricket auditory steering, but at small acoustic stimulation angles, it does not provide reliable directional information. We conclude that either the small bilateral auditory activity differences of the AN1 neurons are enhanced to generate reliable descending steering commands or, more likely, directional auditory steering is mediated via a thoracic pathway, as indicated by the reactive steering hypothesis.

Optimized mid-long term management of ketogenic diet in children with refractory epilepsy

This study aims to explore the mid-long term management of ketogenic diet (KD) for the treatment of refractory epilepsy in children, and carry out an efficacy assessment. The data of epileptic children who received KD in our hospital from January 2011 to August 2012 (basic management plan group, n=57) were retrospectively analyzed. On this basis, epileptic children who received KD from September 2012 to April 2014 (optimized management plan group, n=52) were managed according to the mid-long term management plan. The effective rate of KD at the first, third, sixth and ninth month was 90.4%, 73.1%, 65.4% and 38.5%, respectively, in the optimized management plan group, and 63.2%, 45.6%, 38.6% and 21.1%, respectively, in the basic management plan group, and the differences were statistically significant. The compliance rate of KD at the third, sixth and ninth month was 94.2%, 78.8% and 63.5%, respectively, in the optimized management plan group, and 82.5%, 47.4% and 28.1%, respectively, in the basic management plan group, and the differences were statistically significant. Optimized mid-long term management of KD in children can improve the control rate of epileptic seizures, and the compliance of patients.

ED50 of intrathecal ropivacaine for cesarean delivery with and without epidural volume extension with normal saline: a randomized controlled study

Background

It was reported that epidural volume extension could decrease the ED₅₀ of intrathecal plain bupivacaine. In this study, we investigated the ED₅₀ of intrathecal hyperbaric ropivacaine followed by epidural normal saline bolus for cesarean section.

Methods

Sixty parturients were allocated into two groups in this prospective study. About 10 mL of epidural normal saline was given after the intrathecal dose of hyperbaric ropivacaine in the Group S (normal saline group), and no epidural injection of normal saline was given after the intrathecal ropivacainve injection in the Group C (control group). The dose of intrathecal ropivacaine for each parturient was decided by up-down allocation method. The initial dose was set as 10 mg. Effective anesthesia was defined as the level of T6 or above achieved within 10 minutes after intrathecal injection and no additional epidural drug to complete operation. The Massey formula was applied to calculate the ED₅₀ of intrathecal ropivacaine.

Results

The ED₅₀ of intrathecal ropivacaine for cesarean section determined by up-and-down method was 7.51 mg (95% CI, 7.09–7.93 mg) in the Group S and 8.29 mg (95% CI, 7.73–8.85 mg) in the Group C, and there was a significant difference in ED₅₀ of ropivacaine between the two groups (P<0.05). Compared with the Group C, the ED₅₀ of intrathecal ropivacaine decreased when followed by epidural normal saline bolus.

Conclusion

The ED₅₀ of intrathecal hyperbaric ropivacaine for cesarean section is 8.29 mg, and it is reduced when followed by epidural normal saline bolus (www.chictr.org.cn, registration number: ChiCTR-ROC-17013382).

[Imaging diagnostic methods for identification of sentinel lymph nodes in patients with early squamous cell carcinoma of the oral cavity mucosa: a literature review]

The paper describes properties of clinical visualization approaches which are applied for detection of sentinel lymph nodes in patients suffering from oral cavity squamous cell cancer. Diagnostic efficiency results and technological features of different imaging techniques are discussed.

[Surgical technique and early clinical outcomes of direct anterior approach to total hip arthroplasty]

OBJECTIVE

To describe the surgical technique of direct anterior approach to total hip arthroplasty and to report the early clinical outcomes.

METHODS

A series of 100 consecutive, unselected patients who had 116 primary total hip arthroplasty surgeries (16 bilateral) done through direct anterior approach from March 11 2015 to June 21 2016 was reviewed. There were 50 male patients and 50 female patients. The average patient age was 51 years, and the average body mass index was 24.69 kg/m². The preoperative diagnosis included avascular necrosis of femoral head, hip osteoarthritis, osteoarthritis secondary to acetabular dysplasia, sequelae of hip old infection, ankylosing spondylitis, rheumatoid arthritis and avascular necrosis of femoral head after cannulated screws fixation of femoral neck fracture. There were 7 hips which had surgical history prior to the index hip arthroplasty, including 3 cases with bone graft treatment for avascular necrosis of femoral head through Smith-Peterson approach, 2 cases with acetabular shelf procedures for acetabular dysplasia through Smith-Peterson approach, and 2 cases with cannulated screws fixation for femoral neck fracture (internal fixation residual). All were uncemented hips. The stems used in this study included 67 Triloc stems (DePuy company, USA), 45 Corail stems (DePuy company, USA), 2 Accolade stems (Stryker company, USA), 1 Synergy stem (Smith-Nephew company, USA) and 1 Polarstem (Smith-Nephew company, USA).

RESULTS

The average follow up period was 8.5 months, the average incision scar length was 10 cm, and the average postoperative Harris score was 93.62. There was 95% postoperative leg length discrepancy within 3 mm. The average cup inclination angle was 38.7° with 94.8% in the range of 30° to 50°. The average cup anteversion angle was 14.3° with 94.2% within the target range of 5° to 25°.The were 15 (12.9%) operative complications, including two femoral perforations (changing stem from Triloc to Corail), three calcar fractures (treated with cerclage wires), four greater trochanter fractures (2 were treated wire tension band, and 2 nondisplaced fractures untreated), one deep infection (debridement and retaining of the prothesis), one superficial infection (debridement), one hematoma and three wound healing complications (debridement). All the complications were successfully treated without any sequelae at the end of the latest follow-up. There was no postoperative dislocation. There was no major nerve and vascular injuries. There were 35 cases (30.2%) reporting symptoms of lateral femoral cutaneous nerve palsy.

CONCLUSION

Direct anterior approach to total hip arthroplasty allows accurate and reproducible cup orientation positioning and leg length restoration and decreases the risk of postoperative dislocation, which is helpful for early rapid postoperative recovery.

[Application of bilateral direct anterior approach total hip arthroplasty: a report of 22 cases]

OBJECTIVE

To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA).

METHODS

We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital. A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study. There were 17 males and 5 females, and the median age was 48 years (range: 34-67 years). All the surgery was done by DAA method by two senior surgeons. The clinic characters, early surgery treatment results and complications were analyzed.

RESULTS

We used the cementless stems in all the cases. The average operating time was (167±23) min; the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL; the wound drainage in average was (111±73) mL. Most of the patients could move out of the bed by themselves on the first day after operation, 5 patients could walk without crutches on the first operating day, and 13 patients could squat on the third days after operation. The patients were discharged averagely 4 days after operation. We followed up all the patients for averagely 16 months (range: 8-24 months). There was no loosening or failure case in the latest follow up. In the study, 2 patients had great trochanter fracture, 2 patients had thigh pain, 4 patients had lateral femoral cutaneous nerve palsy, and 3 patients had muscle damage. The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01).

CONCLUSION

The DAA THA can achieve faster recovery and flexible hip joint after operation. However it is a kind of surgery with high technique demanding. Carefully selected patients, and skilled technique, can help the surgeon avoid the early complications. It is associated with high complication rate in the learning curve for bilateral DAA THA.

Matrix metalloproteinase 12 is an indicator of intervertebral disc degeneration co-expressed with fibrotic markers

OBJECTIVE

Recent evidence suggests a role of fibrogenesis in intervertebral disc (IVD) degeneration. We aim to explore if fibrotic genes may serve as IVD degeneration indicators, and if their expression is associated with myofibroblast activity.

DESIGN

Transcriptional expression of fibrosis markers (COL1A1, COL3A1, FN1, HSP47, MMP12, RASAL1) were analyzed in degenerated (D) and non-degenerated (ND) human nucleus pulposus (NP) and annulus fibrosus (AF) cells, along with traditional (SOX9, ACAN) and newly established degeneration markers (CDH2, KRT19, KRT18, FBLN1, MGP, and COMP). Protein expression was investigated by immunohistochemistry in human IVDs, and in rodent IVDs undergoing natural ageing or puncture-induced degeneration. Co-expression with myofibroblast markers was examined by double staining on human and rat specimens. Disc degeneration severity and extent of fibrosis were determined by histological scoring and picrosirius red staining respectively.

RESULTS

Human D-NP showed more intensive staining for picrosirius red than ND-NP. Among the genes examined, D-NP showed significantly higher MMP12 expression along with lower KRT19 expression. Protein expression analysis revealed increased MMP12(+) cells in human D-IVD. Histological scoring indicated mild degeneration in the punctured rat discs and discs of ageing mouse. Higher MMP12 positivity was found in peripheral NP and AF of the degenerative rat discs and in NP of the aged mice. In addition, human D-NP and D-AF showed increased α-SMA(+) cells, indicating enhanced myofibroblast activity. MMP12 was found co-expressed with α-SMA, FSP1 and FAP-α in human and rat degenerative IVDs.

CONCLUSIONS

Our study suggests that in addition to a reduced KRT19 expression, an increased expression of MMP12, a profibrotic mediator, is characteristic of disc degenerative changes. Co-expression study indicates an association of the increased MMP12 positivity with myofibroblast activity in degenerated IVDs. Overall, our findings implicate an impact of MMP12 in disc cell homeostasis. The precise role of MMP12 in IVD degeneration warrants further investigation.

Tumorigenic potential is restored during differentiation in fusion-reprogrammed cancer cells

Detailed understanding of the mechanistic steps underlying tumor initiation and malignant progression is critical for insights of potentially novel therapeutic modalities. Cellular reprogramming is an approach of particular interest because it can provide a means to reset the differentiation state of the cancer cells and to revert these cells to a state of non-malignancy. Here, we investigated the relationship between cellular differentiation and malignant progression by the fusion of four independent mouse cancer cell lines from different tissues, each with differing developmental potentials, to pluripotent mouse embryonic stem (ES) cells. Fusion was accompanied by loss of differentiated properties of the four parental cancer cell lines and concomitant emergence of pluripotency, demonstrating the feasibility to reprogram the malignant and differentiative properties of cancer cells. However, the original malignant and differentiative phenotypes re-emerge upon withdrawal of the fused cells from the embryonic environment in which they were maintained. cDNA array analysis of the malignant hepatoma progression implicated a role for Foxa1, and silencing Foxa1 prevented the re-emergence of malignant and differentiation-associated gene expression. Our findings support the hypothesis that tumor progression results from deregulation of stem cells, and our approach provides a strategy to analyze possible mechanisms in the cancer initiation.