[Clinical effect of compound internal fixations in treating extreme distal radial fractures]

Objective: To investigate the clinical character and treating strategy of extreme distal radial fractures. Methods: From June 2012 to May 2014, 12 patients who suffered from extreme distal radial fractures were treated in Department of Orthopedics, Tongji Hospital, Tongji University. According to AO/OTA classification, there were 4 cases of type 23B1, 3 cases of 23B2, 3 cases of 23C1 and 2 cases of 23C3.When classified by morphological features, there were 4 of simple styloid process fracture, 3 of simple extreme distal radial fracture without articular surface involved, 3 of styloid process fracture combined with distal radial articular fracture, and 2 of articular surface splintered or collapse fracture. According to the fracture features that radiographic exams showed, different surgical paths and fixation methods were chosen in order to protect soft tissues to the best advantage. To those patients with simple styloid process fracture, screw alone, Kirschner-wire or styloid plate were used for fixation. To the other types of fracture, open reduction and compound internal fixation with low-notch volar plate, dorsal or volar mini-plate, screw or Kirschner-wire was applied to ensure the stability of fixation, and maximally protect soft tissues like tendons, ligaments and neurovascular bundles, counting on the "stuffing-squeezing" effects after reduction or reconstruction of the articular surface. Situation of the wound and soft tissue were mainly checked in the first 2 weeks, and in the 3rd month post-operatively, fracture reduction and internal fixation were evaluated by radiographic methods like X-ray and CT scan. When 12 months post-operatively, not only radiographic follow-up such as fracture reduction, internal fixation and osteoarthritis were taken, but also some other evaluation, such as pain of wrist, rotation range of forearm, grip strength, and function of wrist according to DASH scores. Results: All of the 12 cases were followed up for at least 1 year. The wound healed well in all cases 2 weeks post-operatively, and no soft tissue infections, necrosis or neurovascular complications occurred. All fractures healed and no loss of reduction occurred 3 months post-operatively. Internal fixations were at good condition except in 2 cases, whose Kirschner-wire had been removed 2.5 and 2.8 months after the operation due to loosening and partly backing out on dorsal side. When followed up at 12 months post-operatively, one from these 2 patients suffered from a mild pain of wrist, and grip strength together with the function of the affected wrist dramatic declined when compared to the unaffected side. With the help of radiograph, local collapse on the articular surface was found, which meant to be traumatic arthritis. There were no pain in the rest 11 cases, and flexion-extension range of the wrist, rotation range of forearm and grip strength of the affected side recovered to over 80% of the unaffected side, with a DASH score was from 7 to 15 points(average 11.9 points)below 15 points. Conclusions: Traditional volar plates can not be used for extreme distal radial fractures. It may be an effective way to treat extreme distal radial fractures with compound internal fixation on the basis of morphological feature of fractures and the situation of soft tissue because of vivid of the fixation, reducing damage of soft tissue and early functional training.

Analysis of soft-tissue complications of volar plate fixation for managing distal radius fractures and clinical effect while preserving pronator quadratus

The aim of the study was to analysis soft-tissue complications of volar plate fixation and it's prevention strategies along with exploring clinical effects of preserving pronator quadratus (PQ) muscle. From February 2011 to February 2013, sixty-five patients with distal radius fracture underwent open reduction and internal fixation with the volar locking palmar plates. The group with preserving PQ involved 30 patients and group with PQ repair involved 35 patients. Surgeons must took great care of not -letting drill pierce dorsal cortical bone rapidly and dorsal carpal tangential fluoroscopy was also taken in addition to lateral fluoroscopy to get accurate screw length. Volar plate must be placed not go beyond the watershed region of distal radius. The wrist pain, forearm range of motion, grip strength, wrist functional recovery score, X-ray and CT imaging were followed-up after surgery. Two groups were compared for Clinical efficacy. The minimum follow-up for the whole cohort was one year. The relevant post operative data were collected after 2 weeks, 6 weeks, 3 and 12 month respectively. Fractures healing after postoperative 3 months are significant in X -ray and CT imaging. Fixation position and stability were good, but each group had one case with a screw piercing the dorsal cortical. The -differences between the two groups were significant regarding the wrist pain, forearm range of motion, grip and strength at 2 and 6 weeks after operation, but not significant at 3 and 12 month after operation. The differences between the two groups were also significant regarding wrist functional scores at 6 weeks, but not significant at 3 and 12 month after operation. Drilling the dorsal cortical bone gently and accurate screws length can avoid extensor tendon injury. -Dorsal carpal tangential fluoroscopy is a useful supplement for accurate screws length besides lateral fluoroscopy. Volar plate's position not go beyond the watershed region of distal radius is the key factor in reducing the flexor tendon injury and preservation of the PQ muscle can also prevent the flexor tendon -injury, yield better early wrist function and shorten rehabilitation time.

Lenalidomide treatment and prognostic markers in relapsed or refractory chronic lymphocytic leukemia: data from the prospective, multicenter phase-II CLL-009 trial

Efficacy of lenalidomide was investigated in 103 patients with relapsed/refractory chronic lymphocytic leukemia (CLL) treated on the prospective, multicenter randomized phase-II CLL-009 trial. Interphase cytogenetic and mutational analyses identified TP53 mutations, unmutated IGHV, or del(17p) in 36/96 (37.5%), 68/88 (77.3%) or 22/92 (23.9%) patients. The overall response rate (ORR) was 40.4% (42/104). ORRs were similar irrespective of TP53 mutation (36.1% (13/36) vs 43.3% (26/60) for patients with vs without mutation) or IGHV mutation status (45.0% (9/20) vs 39.1% (27/68)); however, patients with del(17p) had lower ORRs than those without del(17p) (21.7% (5/22) vs 47.1% (33/70); P=0.049). No significant differences in progression-free survival and overall survival (OS) were observed when comparing subgroups defined by the presence or absence of high-risk genetic characteristics. In multivariate analyses, only multiple prior therapies (⩾3 lines) significantly impacted outcomes (median OS: 21.2 months vs not reached; P=0.019). This analysis indicates that lenalidomide is active in patients with relapsed/refractory CLL with unfavorable genetic profiles, including TP53 inactivation or unmutated IGHV. (ClinicalTrials.gov identifier: NCT00963105).

Effect and mechanism analysis of siRNA in inhibiting VEGF and its anti-angiogenesis effects in human osteosarcoma bearing rats

OBJECTIVE

To explore the effect of siRNA in inhibiting vascular endothelial growth factor (VEGF) expression in tumor cells from human osteosarcoma bearing rats and its anti-angiogenesis effect, to further study the reliability, effectiveness and safety of VEGF as a therapeutic target in treating osteosarcoma.

MATERIALS AND METHODS

After treatment, the long diameter and short diameter of tumor lesion were detected by Vernier caliper, and the tumor volume and tumor inhibition rate were calculated. The whole-body fluorescence imaging was used to detect the general morphology and volume change of tumor lesion before and after treatment. The rats were killed after treatment, RT-PCR and Western blot were used to detect VEGF expression. MTT was used to detect the proliferative ability of tumor cells in vitro.

RESULTS

Three chemotherapies could inhibit the growth of tumor lesion, the decrease of tumor volume was significant (p < 0.05), the therapeutic effect in Ad-VEGF-siRNA + neoadjuvant chemotherapy group was better than the other two groups, the differences were statistically significant (p < 0.05). Furthermore, the three chemotherapies could inhibit the invasiveness of tumor cells, which was most significant in Ad-VEGF-siRNA + neoadjuvant chemotherapy group (p < 0.05).

CONCLUSIONS

The growth of tumor tissue in osteosarcoma bearing rats is inhibited in Ad-VEGF-siRNA group, Ad-VEGF-siRNA + neoadjuvant chemotherapy group and Ad-VEGF-siRNA + anti-angiogenesis chemotherapy group. The effect in Ad-VEGF-siRNA + neoadjuvant chemotherapy is more significant than simple biological therapy or Ad-VEGF-siRNA + anti-angiogenesis chemotherapy.

CD4+Foxp3+ regulatory T cell differentiation mediated by endometrial stromal cell-derived TECK promotes the growth and invasion of endometriotic lesions

Endometriosis is associated with an abnormal immune response to endometrial cells, which can facilitate the implantation and proliferation of ectopic endometrial tissue. The proportion of CD4(+)Foxp3(+) regulatory T cells (Tregs) is significantly increased in the peritoneal fluid of women with endometriosis. The thymus-expressed chemokine TECK/CCL25 directly promotes the invasiveness of endometrial stromal cells (ESCs). The aim of this study was to investigate the effects of ESC-derived TECK on the crosstalk between Tregs and ESCs in the progress of endometriosis. We determined that the percentage of Tregs and the concentration of TECK increased in the peritoneal fluid with the progression of endometriosis. The supernatant from co-cultured human ESCs and macrophages not only induced Treg differentiation and increased Treg expression of interleukin-10 (IL-10), transforming growth factor-β (TGF-β) and CD73 by activating the AKT/STAT3 signaling pathway but also repressed Treg apoptosis by downregulating Fas and FasL expression and enhanced the Treg-mediated suppression of CD4(+)CD25(-) T cells. In addition, in vitro and in vivo trials confirmed that these effects could be inhibited by anti-TECK neutralizing Abs. The secretion of IL-10 and TGF-β by Tregs increased MMP2 expression and decreased TIMP1 expression and further stimulated the proliferation and invasion of ESCs and the growth of ectopic lesions. These results indicate that TECK derived from ESCs and macrophages upregulates the number and function of Tregs in the ectopic milieu, which contributes to endometriotic immunotolerance and high levels of ESC proliferation and invasion, thereby facilitating the progression of endometriosis.

Decellularized kidney scaffold-mediated renal regeneration

Renal regeneration approaches offer great potential for the treatment of chronic kidney disease, but their availability remains limited by the clinical challenges they pose. In the present study, we used continuous detergent perfusion to generate decellularized (DC) rat kidney scaffolds. The scaffolds retained intact vascular trees and overall architecture, along with significant concentrations of various cytokines, but lost all cellular components. To evaluate its potential in renal function recovery, DC scaffold tissue was grafted onto partially nephrectomized rat kidneys. An increase of renal size was found, and regenerated renal parenchyma cells were observed in the repair area containing the grafted scaffold. In addition, the number of nestin-positive renal progenitor cells was markedly higher in scaffold-grafted kidneys compared to controls. Moreover, radionuclide scan analysis showed significant recovery of renal functions at 6 weeks post-implantation. Our results provide further evidence to show that DC kidney scaffolds could be used to promote renal recovery in the treatment of chronic kidney disease.

The impact of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) fasting glucose diagnostic criterion on the prevalence and outcomes of gestational diabetes mellitus in Han Chinese women

AIMS

The International Association of Diabetes and Pregnancy Study Groups (IADPSG) proposed that a one-time value of fasting plasma glucose of 5.1 mmol/l or over at any time of the pregnancy is sufficient to diagnose gestational diabetes. We evaluated the repercussions of the application of this threshold in pregnant Han Chinese women.

METHODS

This is a retrospective study of 5360 (72.3% of total) consecutively recruited pregnant Han Chinese women in one centre from 2008 to 2011. These women underwent a two-step gestational diabetes diagnostic protocol according to the previous American Diabetes Association criteria. The IADPSG fasting plasma glucose criterion was used to reclassify these 5360 women. The prevalence, clinical characteristics and obstetric outcomes were compared among the women classified as having gestational diabetes by the previous American Diabetes Association criteria (approximately 90% were treated), those reclassified as having gestational diabetes by the single IADPSG fasting plasma glucose criterion (untreated), but not as having gestational diabetes by the previous American Diabetes Association criteria, and those with normal glucose tolerance.

RESULTS

There were 626 cases of gestational diabetes defined by the previous American Diabetes Association criteria (11.7%) and these cases were associated with increased risks of maternal and neonatal outcomes when compared with the women with normal glucose tolerance. With the IADPSG fasting plasma glucose criterion, another 1314 (24.5%) women were reclassified as having gestational diabetes. Gestational diabetes classified by the IADPSG fasting plasma glucose criterion was associated with gestational hypertension (P = 0.0094) and neonatal admission to nursery (P = 0.035) prior to adjustment for maternal age and BMI, but was no longer a predictor for adverse pregnancy outcomes after adjustment.

CONCLUSION

The simple IADPSG fasting plasma glucose criterion increased the Chinese population with gestational diabetes by 200%. The increased population with gestational diabetes was not significantly associated with excess obstetric and neonatal morbidity.

Incremental cost-effectiveness of improving treatment results among migrant tuberculosis patients in Shanghai

SETTING

Two projects were introduced in October 2007 to improve treatment completion among rural-to-urban migrant tuberculosis (TB) patients in Shanghai. The Communicable Disease Research Consortium (COMDIS) project provided financial incentives to poor patients, whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) project provided incentives to all patients and increased staff time.

OBJECTIVE

To assess the incremental cost-effectiveness of these two projects.

METHODS

Case study. Costs were assessed from a societal perspective. The primary measure of effectiveness was the treatment completion rate. The incremental cost-effectiveness ratio was calculated as the additional cost of the intervention divided by the additional percentage of patients completing treatment compared to controls.

RESULTS

Post intervention, the treatment completion rates in the COMDIS and Global Fund projects were respectively 89% and 88%, 17% and 16% higher than in the control district (76%). For one additional per cent of patients to complete treatment, the additional cost of the COMDIS intervention was US$1891, 91% lower than that of the Global Fund intervention (US$21,904).

CONCLUSION

The intervention that addressed the financial barriers of poor patients was more cost-effective than the comprehensive intervention that provided assistance to both patients and providers. Further study is needed to understand the process of interventions prior to wider scale-up.

First determination of the weak charge of the proton

The Q(weak) experiment has measured the parity-violating asymmetry in ep elastic scattering at Q(2)=0.025(GeV/c)(2), employing 145 μA of 89% longitudinally polarized electrons on a 34.4 cm long liquid hydrogen target at Jefferson Lab. The results of the experiment's commissioning run, constituting approximately 4% of the data collected in the experiment, are reported here. From these initial results, the measured asymmetry is A(ep)=-279±35 (stat) ± 31 (syst) ppb, which is the smallest and most precise asymmetry ever measured in ep scattering. The small Q(2) of this experiment has made possible the first determination of the weak charge of the proton Q(W)(p) by incorporating earlier parity-violating electron scattering (PVES) data at higher Q(2) to constrain hadronic corrections. The value of Q(W)(p) obtained in this way is Q(W)(p)(PVES)=0.064±0.012, which is in good agreement with the standard model prediction of Q(W)(p)(SM)=0.0710±0.0007. When this result is further combined with the Cs atomic parity violation (APV) measurement, significant constraints on the weak charges of the up and down quarks can also be extracted. That PVES+APV analysis reveals the neutron's weak charge to be Q(W)(n)(PVES+APV)=-0.975±0.010.

Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis

Objectives:

To evaluate the efficiency and safety of endovenous laser ablation (EVLA) for primary lower extremity varicosities compared with high ligation and stripping (HLS).

Method:

Prospective non-randomized studies and randomized control trials on comparison of EVLA and HLS in treating varicose vein were included in this study. A meta-analysis on the data of suitable 13 clinical trials was performed using the Mantel–Haenszel method and the risk ratio was calculated. Thirteen studies including a total of 2245 limbs were eligible for inclusion. Among them, 1128 limbs were treated with endovenous laser ablation, whereas 1117 were treated with high ligation and stripping. Primary outcome measures were technical success rates and recurrence rates at different follow-up duration and complication rates.

Results:

No significant difference in initial technical success rates, Procedural failures were more common following EVLA compared with conventional surgery at one- and two-year follow-up. However, the duplex-detected and clinical recurrence rate was similar between conventional surgery and EVLA after one and two years. No statistical significance was found in postoperative phlebitis and bruise in EVLA and HLS (17.9% versus 21.5%). However, fewer complications were observed in EVLA compared with HLS, including bleeding and haematoma (1.28% versus 4.83%), wound infection (0.33% versus 1.91%) and paraesthesia (6.73% versus 11.27%).

Conclusions:

EVLA for varicose veins is safe and effective compared with HLS in a two-year range. More randomized controlled studies follow-up results are needed to clarify longterm recurrence (5 years).

Genetic diversity analysis of an indigenous Chinese buffalo breed and hybrids based on microsatellite data

Chinese native buffaloes have faced the threat of extinction, along with an increase in crossbreeding with domesticated river buffaloes; consequently, conservation of local buffalo genetic resources has become a priority. A Chinese native breed, Jianghan, is often crossed intentionally and unintentionally with imported breeds from India and Pakistan, Murrah, and Nili-Ravi. A total of 128 buffaloes of the breeds Jianghan, Murrah, and Nili-Ravi and their presumed hybrid offspring were genotyped for 10 microsatellite markers. Heterozygosity and Wright's F-statistics were calculated to determine the genetic variation in those populations. The observed average heterozygosities ranged from 0.836 (Murrah) to 0.986 (Jianghan), higher than the expected heterozygosities and all the inbreeding values within the populations were negative. The genetic distances between the presumed hybrid buffaloes and the two imported river type dairy buffalo breeds (Murrah and Nili-Ravi) were lower than with the native Jianghan, indicating strong contributions of the imported breeds to this presumed hybrid buffalo population. This information will be useful for the development of rational breeding for the dairy buffalo industry and for conservation strategies for the Jianghan buffalo.

Simultaneous operation of concomitant diseases in the esophagus and lung

The aim of this study was to retrospectively review our experience of performing simultaneous operations on concomitant diseases in the esophagus and lungs. From January 1998 to July 2009, simultaneous operations were performed on 13 patients with concomitant esophageal and pulmonary diseases, using coordinated surgical approaches. Among the 13 patients, six had primary cancers in the esophagus and lungs, five had primary esophageal cancer accompanied by a benign pulmonary disease, one had benign diseases in both esophagus and lung, and one had primary esophageal cancer with metastasis to the left lower lung. All patients survived the operations. Two major complications occurred postoperatively. One complication was bronchopleural fistula and the other was intrathoracic gastric laceration. Both patients recovered after additional treatments. Simultaneous operation of concomitant diseases in the esophagus and lungs is feasible and safe in selected patients who have received careful preoperative assessment, well-designed surgical approach, and proper perioperative management.

Asymptomatic paraganglioma of the posterior mediastinum misdiagnosed until operation

A 23-year-old female patient was treated for a posterior mediastinal tumor of unknown histology. Her systemic blood pressure increased rapidly to a critical level immediately after starting surgical manipulation of the tumor, which was suggestive of a hyperfunctioning pheochromocytoma. The tumor was removed after controlling the blood pressure and was histologically diagnosed as an extra-adrenal pheochromocytoma. Further postoperative investigations showed the tumor to be a sporadic type through further postoperative investigations and the patient had subsequently an uneventful course.

The prenatal porcine intestine has low transforming growth factor-beta ligand and receptor density and shows reduced trophic response to enteral diets

Transforming growth factor-beta (TGF-β) plays a role in enterocyte proliferation control, cell differentiation, and immune regulation via binding to specific TGF-β receptors (TGF-β R) in the intestinal epithelium. Endogenous TGF-β production is low in the intestine during the perinatal period, but some exogenous TGF-β ligands are supplied by amniotic fluid intake in the fetus and by colostrum ingestion in the neonate. It is not clear, however, whether luminal TGF-β receptors are present and functional at this critical time. We studied intestinal TGF-β receptors by immunohistochemistry during the last 20% of gestation in pigs and in chronically catheterized fetuses following exposure to colostrum, milk, and amniotic fluid (control). In fetal pigs, the TGF-β Rs were predominantly localized to the crypt epithelium, but staining intensity increased markedly just before term and shifted to the villous epithelium in newborn pigs, concurrently with marked increases in villous heights and crypt depths (+100–200%, P < 0.05). In contrast to previous observations in term newborn pigs, fetal pigs did not show any milk-induced change in TGF-β receptor densities or localization, although a moderate increase in villous height was observed, relative to control (+25–50%, P < 0.05). We conclude that intestinal TGF-β receptor density and localization are immature and unresponsive to TGF-β containing milk diets in prenatal pigs. Immaturity of TGF-β-mediated immune regulation may play a role in the increased sensitivity of preterm neonates to diet-induced intestinal inflammatory disorders.