Complication Follow-up With Ultrasonographic Analyses of 91 Cases With Donor Gallbladder Preservation in Living Donor Liver Transplantation of Left Lateral Sectionectomies

BACKGROUND

Preserving the donor's gallbladder during living donor liver transplantation (LDLT) is a better method for liver transplantation surgery, but not enough is known about gallbladder complications after the operation.

METHODS

We retrospectively investigated postsurgical donor gallbladder complications in clinical LDLT with gallbladder preservation. The feasibility of retaining the gallbladder during liver graft procurement is discussed. Ninety-one donors with retained gallbladder after LDLT with the hepatic left lateral sectionectomy (from June 2013 to October 2015) were retrospectively analyzed. Donors were followed for 12.6 to 40.7 months after surgery (median 26.1 months). Sonography was used to evaluate gallbladder characteristics before and after surgery.

RESULTS

Gallbladder function had recovered to almost normal 1 month after transplantation. Four donors (4.40%) experienced gallbladder enlargement that resolved after 3 days. Thickening of the gallbladder wall in 31 donors (34.07%) was restored within 2 to 75 days. Biliary sludge appeared in 9 donors (9.89%); 6 of them recovered within 3 to 34 days. Three (3.30%) and 1 donor (1.10%) suffered gallstone and gallbladder polyps, respectively, which persisted until the last follow-up.

CONCLUSION

The rate of postoperative complications of the gallbladder in donors was relative low. Preserving the gallbladder in liver transplantation donors during liver graft procurement is feasible and safe.

Expert Tibial Nails for Treating Distal Tibial Fractures With Soft Tissue Damage: A Patient Series

Distal tibial fractures with soft tissue damage are relatively difficult to treat. We assessed the outcomes of patients with these fractures treated with the Expert Tibial Nail^® (DePuy Synthes, Raynham, MA) from March 2012 to December 2014. At 6 months postoperatively, the general health quality of patients was assessed using operative time, interval to return to work, American Orthopaedic Foot and Ankle Society ankle scale score, pain measured using a visual analog scale, and short-form health outcomes 36-item survey physical functioning and mental health dimension scores. Of 11 cases, 7 (63.6%) were open fractures (3 [27.3%] Gustilo-Anderson type II, 3 [27.3%] type IIIA, and 1 [9.1%] type IIIB) and 4 (36.4%) were closed fractures with Tscherne-Oestern type II tissue damage. Their mean age was 52.2 (range 28 to 66) years. The mean operative time was 83 (range 65 to 105) minutes. The mean follow-up period was 16.3 (range 14 to 18) months. The median short-form 36-item survey scores were 79.1 (range 68.9 to 89.0) for the physical function dimension and 77.0 (range 64.3 to 90.0) for the mental health dimension. The mean postoperative ankle score was 88.6 (range 84 to 94). The mean pain score was 1.6 (range 0 to 4) mm. The mean interval to return to work was 14 (range 11 to 17) months. No patient showed evidence of neurovascular damage, malunion, nonunion, or shortening of the tibia. Taken together, we have confirmed that Expert Tibial Nails can effectively treat distal tibial fractures with soft tissue damage.

Outcomes of Pediatric Liver Transplantation: Deceased Donor Liver Transplantation vs Living Donor Liver Transplantation

BACKGROUND

The use of pediatric donor liver for pediatric liver transplantation (LT) remains controversial and few studies have focused on pediatric deceased donors. To address this issue, we decided to perform a retrospective research, trying to compare the clinical effects between deceased donor LTs (DDLTs) and living donor LTs (LDLTs).

METHODS

A retrospective review of pediatric LTs using grafts from deceased donors and living donors from June 2013 to August 2016 was performed. The children were divided into a DDLT group and a LDLT group based on their donor styles. The incidence of early vascular complications (VC), biliary complications, and graft and patient survival rates were observed between the 2 groups.

RESULTS

There were 217 cases of pediatric LTs performed in our hospital from June 2013 to August 2016 (83 DDLTs and 134 LDLTs). The 1-year cumulative survival rates of grafts and recipients were 89.16% and 91.57% in DDLTs, and 95.47% and 95.52% in LDLTs, respectively (P > .05). The incidence of early VC was lower in LDLTs than that in DDLTs (3.7% vs 19.3%, P < .001). The incidence of HAT in children aged less than 1 year was significantly higher in the DDLT group (P < .001) and can be up to 31.82%. The incidence of biliary complications was similar in the 2 groups (8.4% vs 13.5%, P = .285).

CONCLUSIONS

Pediatric DDLTs have similar graft and patient survival rates with LDLT. The incidence of early VC was higher in DDLTs, and children aged less than 1 year are at a higher risk of developing HAT.

Anti-TNF-α antibody alleviates insulin resistance in rats with sepsis-induced stress hyperglycemia

PURPOSE

To explore the effects and mechanisms of anti-tumor necrosis factor-α (TNF-α) antibody on insulin resistance (IR) in rats with sepsis-induced stress hyperglycemia.

METHODS

The sepsis-induced stress hyperglycemic rat model was constructed by cecal ligation and puncture combined with the intraperitoneal injection of lipopolysaccharide. The rats were randomly divided into six groups: normal control (NC) group, surgical rats (Cntl) group, high-dose anti-TNF-α antibody therapy (TNF, 6 mg/kg) group, low-dose anti-TNF-α antibody therapy (Tnf, 3 mg/kg) group, insulin therapy (INS) group, and INS + Tnf group. The blood glucose and serum insulin concentrations were detected, followed by analysis of intraperitoneal glucose tolerance test (IPGTT) and hyperinsulinemic-euglycemic clamp. Finally, the expression levels of phospho-Akt (p-Akt), Akt, p-mTOR, mTOR, nuclear factor-κB (NFκB), I kappa beta kinase (IKKβ), and suppressor of cytokine signaling (SOCS-3) were detected by western blotting.

RESULTS

There was no significant difference in blood glucose concentrations among these groups, while the serum insulin concentration in TNF and Tnf groups was lower than that in the Cntl group at postoperative 6 h (P < 0.05). IPGTT analysis revealed that blood glucose level was lower in the TNF group than that in the Cntl group (P < 0.05). The glucose infusion rate in the Cntl group was lower than that in the Tnf and TNF groups (P < 0.05). The p-Akt/Akt, p-mTOR/mTOR ratio, and expression levels of NFκB, IKKβ and SOCS-3 were lower in the drug intervention than that in the Cntl group (P < 0.05).

CONCLUSIONS

Anti-TNF-α antibody could reduce IR by inhibiting AKt/mTOR signaling pathway and the expression levels of NFκB, IKKβ, and SOCS-3 in rats with sepsis-induced stress hyperglycemia.

[Research on the negative immune regulation of NK cells in patients with primary immune thrombocytopenia]

目的

探讨原发免疫性血小板减少症（ITP）患者外周血中NK细胞及其相关细胞因子IFN-γ、IL-10、TGF-β的变化。

方法

以22例初诊ITP患者（初诊组）、20例治疗后完全缓解ITP患者（完全缓解组）为研究对象，以20名健康志愿者为对照组。采用ELISA法检测三组受试者血清IFN-γ及IL-10水平；用流式细胞术检测NK细胞（CD3⁻CD56⁺）及其Bright亚群（CD3⁻CD56^bright CD16⁻）、Dim亚群（CD3⁻CD56^dim CD16⁺）水平；采用免疫磁珠法分离NK细胞，实时荧光定量PCR检测IFN-γ、IL-10、TGF-β基因mRNA的表达，并将以上测得结果做相关性分析。

结果

①初诊组ITP患者血清IFN-γ浓度[（653.0±221.6）ng/L]高于完全缓解组[（484.4±219.5）ng/L]和对照组[（390.9±253.5）ng/L]（P值分别为0.022、0.001），血清IL-10浓度低于对照组[（52.09±26.66）ng/L对（79.44±38.43）ng/L，P=0.007]。②初诊组、完全缓解组患者外周血NK细胞比例[（9.53±3.93）%、（9.03±3.78）%]均低于对照组[（13.72±7.42）%]（P=0.013，P=0.007）；初诊患者外周血Bright亚群占NK细胞的比例高于对照组[（6.85±4.43）%对（4.05±2.81）%，P=0.032]；初诊组外周血Dim亚群占NK细胞的比例低于对照组[（93.14±4.43）%对（95.94±2.81）%，P=0.032]。③初诊组、完全缓解组及对照组NK细胞IFN-γ基因mRNA表达差异无统计学意义（P>0.05），初诊组NK细胞IL-10、TGF-β基因mRNA表达高于对照组（1.82±1.32对1.02±1.03，P=0.023；2.80±2.31对1.46±1.37，P=0.028）。外周血Bright细胞占NK细胞的比例与NK细胞IL-10及TGF-β基因mRNA表达呈正相关（r=0.424，P=0.001；r=0.432，P<0.001）。

结论

NK细胞可能通过加强分泌免疫负调控因子来代偿其数量的不足，在疾病中起保护作用。

Correlation Between Survival Interval and CD4+ T-Cell Intracellular ATP Levels in Liver Transplant Recipients

OBJECTIVE

The objectives of this study were to analyze the potential correlation between post-liver transplantation survival interval and CD4⁺ T-cell intracellular ATP (iATP) levels, and to describe the distribution of CD4⁺ T-cell iATP levels in liver transplant recipients.

METHODS

This was a retrospective analysis of clinical data of 273 patients who underwent liver transplantation from July 2010 to October 2012 in our center and achieved long-term stable survival. CD4⁺ T-cell iATP level was detected using Cylex ImmuKnow assay. Post-liver transplantation survival was analyzed.

RESULTS

CD4⁺ T-cell iATP level significantly differed among patients with different post-liver transplantation survival intervals. The peak CD4⁺ T-cell iATP levels typically occurred within the first 3 postoperative months.

CONCLUSIONS

Post-liver transplantation survival interval is correlated with CD4⁺ T-cell iATP levels.

Reconstruction of the Outflow Tract in Cross-Auxiliary Double-Domino Donor Liver Transplantation

BACKGROUND

Auxiliary liver transplantation is accepted as an effective manner to expand the liver donor pool. A difficult surgical technical challenge of the procedure is hepatic vein reconstruction of the graft.

METHODS

To resolve this problem, complex techniques are used to perform an innovative outflow tract reconstruction in the world's first cross-auxiliary double-domino donor liver transplantation with two whole liver grafts. The inferior vena cava-sparing hepatectomy technique was applied at harvest in the two domino liver donors. For each donor, the three major hepatic veins (right, middle, and left) were joined together to create one single orifice, but there was no sufficient tissue to perform a direct anastomosis.

RESULTS

The hepatic vein was reconstructed with the use of a longitudinally opened iliac vein graft from a cadaveric donor to prolong the outflow tract for the piggyback suturing.

CONCLUSIONS

This new technique might provide an innovative surgical approach for reconstructing the complex outflow tract of domino transplantation.

[Quantities and function of NK cells in patients with immune thrombocytopenia]

Objective: To investigate natural killer (NK) cell quantities and function in patients with immune thrombocytopenia (ITP) . Methods: A total of 66 ITP patients (34 newly diagnosed and 32 in complete remission) were collected from September 2015 to May 2016 in Tianjin Medical University General Hospital, and 30 healthy volunteers were recruited as controls. The percentages of NK cells and their subsets in peripheral blood, the expression of activating receptor (NKp44), inhibitory receptor (NKG2A) and CD16, perforin and granzyme β were detected by flow cytometry. The correlation between the above parameters and patients' immune status and platelet level were evaluated. Results: (1)The percentage of CD3(-)CD56(+) NK cells in newly diagnosed patients (10.99%±4.89%)and patients in complete remission (9.73%±6.75%) were significantly lower than that in healthy controls (14.67%±7.24%)(P=0.023, 0.003). The percentage of NK cells Bright subset was significantly lower in the newly diagnosed patients(0.48%±0.23%)and those in complete remission (0.41%±0.33%) than in healthy controls(0.64%±0.32%)(P=0.037, 0.002); the percentage of Dim subset was also significantly lower in the newly diagnosed (10.16%±5.02%) and patients in complete remission (8.07%±5.74%) than in healthy controls(14.16%±7.19%) (P=0.009, 0.007). (2)The proportion of Bright subset in total NK cells in new diagnosed ITP patients (6.48%±4.33%) was significantly higher than that in healthy controls (4.21%±2.70%)(P=0.020); the proportion of Dim NK cells subset in new diagnosed ITP patients (93.51%±4.33%) was significantly lower than that in healthy controls(95.79%±2.70%) (P=0.020). (3)The expression of activating receptor NKp44 in new diagnosed ITP patients was significantly lower than that in complete remission group and healthy controls[0.28%(0.95%)vs 0.61%(2.05%), 0.92%(0.90%); P=0.047, 0.048]; the expression of inhibitory receptor NKG2A in new diagnosed ITP patients was significantly higher than that in healthy controls(42.34%±23.86% vs 29.25%±12.83%, P=0.009). The proportion of CD16 was significantly lower in the newly diagnosed patients than in healthy controls(93.51%±4.33%95.79%±2.70%, P=0.020). (4)The expression of perforin in the newly diagnosed ITP patients was significantly lower than that in healthy controls [87.52%(25.29%)vs 91.55%(8.29%), P=0.025]; the expression of granzyme β in ITP patients and controls showed no statistically significant difference. (5)The level of NK cells in ITP patients was negatively correlated with CD3(+) CD8(+) T cells (r=-0.387, P=0.012) and CD5(+) CD19(+) B cells in peripheral blood (r=-0.273, P=0.028), positively correlated with the ratio of CD3(+) CD4(+) /CD3(+) CD8(+) (r=0.358, P=0.028) and peripheral platelet count (r=0.314, P=0.011). Conclusion: Deceased quantities and impaired total NK function, insufficient suppression of autoreactive T and B cells might play a role in the pathogenesis of ITP.

Correlation Between Immunosuppressive Therapy and CD4(+) T-Cell Intracellular Adenosine Triphosphate Levels in Liver Transplant Recipients

OBJECTIVE

The aim of this work was to analyze the correlation between immunosuppressive therapy and CD4(+) T-cell intracellular adenosine triphosphate (iATP) levels after liver transplantation and to describe the distribution characteristics of iATP in CD4(+) T cells among liver transplant recipients.

METHODS

We studied 172 patients who were followed regularly after liver transplantation with long-term stable conditions from July 2010 to October 2012. CD4(+) T-cell iATP levels were detected with the use of the Cylex Immuknow Assay method and analyzed retrospectively according to immunosuppressive therapy protocol.

RESULTS

There was a significant difference in CD4(+) T-cell iATP level among the recipients receiving different immunosuppressive therapy protocols after liver transplantation. CD4(+) T-cell iATP level in the FK506 group and FK506 + prednisone (Pred) groups was higher than in the FK506 + mycophenolate mofetil (MMF), FK506 + MMF + Pred, and rapamycin (Rapa) groups. CD4(+) T-cell iATP level in patients receiving an MMF protocol was lower than in the group without MMF.

CONCLUSIONS

There is a relationship between distribution immunosuppressive therapy protocol and CD4(+) T-cell iATP level after liver transplantation. MMF and Rapa lower the CD4(+) T-cell iATP level significantly.

Functional analysis of distraction arthroplasty in the treatment of ankle osteoarthritis

Background

Ankle joint distraction arthroplasty (AJDA) is an alternative surgical procedure for the management of moderate to severe ankle osteoarthritis. However, the benefit of this procedure and failure relative factors are still in debate. The purpose of the current study was to evaluate the functional outcomes of AJDA in treatment of moderate to severe ankle OA and to evaluate the relative factors correlated with treatment failure.

Methods

Forty-six van Dijk stages II and III ankle osteoarthritis patients were included. Fifteen males and 31 females with a mean age of 54.8 (range, 42–71) years were followed with a mean of 42.8 (range, 24–68) months. The Ankle Osteoarthritis Scale (AOS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were used for functional outcome evaluation. The talar tilt (TT) angle and ankle joint space distance (AJSD) were evaluated. The risk ratio (RR) was calculated for each potential failure relative factor.

Results

The AOS and AOFAS scores were significantly improved at the last follow-up time (P < 0.01). The AJSD was improved in 61% of patients and with a significant improvement compared with the preoperative conditions (P < 0.01). The TT angle and range of motion reached no significant difference. The failure rate was 21.7%. Patients with large TT (≥5°) angle (RR = 3.81, 95% CI 1.28–11.33, P = 0.02) and obesity (RR = 3.58, 95% CI 1.30–9.89, P = 0.01) were found to have positive correlation with failure. No correlation was found between failure and gender, or overweight, or side, or age, or type and stage of OA, or pin infection.

Conclusions

The current study confirmed the early functional outcomes of ankle distraction arthroplasty. However, this procedure still has a relatively high failure rate, especially for those obese patients and patients with large TT angles.

Electronic supplementary material

The online version of this article (doi:10.1186/s13018-017-0519-x) contains supplementary material, which is available to authorized users.

Do environmental pollutants increase obesity risk in humans?

OBJECTIVES

Obesity has become a global epidemic and threat to public health. A good understanding of the causes can help attenuate the risk and spread. Environmental pollutants may have contributed to the rising global obesity rates. Some research reported associations between chemical pollutants and obesity, but findings are mixed. This study systematically examined associations between chemical pollutants and obesity in human subjects.

METHODS

Systematic review of relevant studies published between 1 January 1995 and 1 June 2016 by searching PubMed and MEDLINE®.

RESULTS

Thirty-five cross-sectional (n = 17) and cohort studies (n = 18) were identified that reported on associations between pollutants and obesity measures. Of them, 16 studies (45.71%) reported a positive association; none reported a sole inverse association; three (8.57%) reported a null association only; six (17.14%) reported both a positive and null association; seven (20.00%) reported a positive and inverse association; and three studies (8.57%) reported all associations (positive, inverse and null). Most studies examined the association between multiple different pollutants, different levels of concentration and in subsamples, which results in mixed results. Thirty-three studies reported at least one positive association between obesity and chemicals, such as polychlorinated biphenyls, biphenyl A, dichlorodiphenyltrichloroethane, dichlorodiphenyldichloroethylene and more. Certain chemicals, such as biphenyl A, were more likely to have high ORs ranging from 1.0 to 3.0, whereas highly chlorinated polychlorinated biphenyls were more likely to have negative ORs. Effects of chemicals on the endocrine system and obesity might vary by substance, exposure level, measure of adiposity and subject characteristics (e.g. sex and age).

CONCLUSIONS

Accumulated evidences show positive associations between pollutants and obesity in humans. Future large, long-term, follow-up studies are needed to assess impact of chemical pollutants on obesity risk and related mechanisms.

Severe open Lisfranc injuries: one-stage operation through internal fixation associated with vacuum sealing drainage

BACKGROUND

This study aimed to investigate the clinical feasibility of treating severe open Lisfranc injuries by means of one-stage internal fixation with k-wires associated with vacuum sealing drainage (VSD).

METHODS

The clinical outcomes of 20 cases of severe open Lisfranc joint fracture-dislocation treated by using one-stage internal fixation with k-wires associated with VSD, after debridement and suturing during emergency treatment, were reviewed.

RESULTS

At 6 and 12 months after surgery, the American Orthopaedic Foot and Ankle Society midfoot scores were 69.2 and 78.2, the positive rates were 75 and 85 %, and the average visual analogue scale scores were 4.3 and 1.3, respectively. The average time of internal fixation surgery was 47 min (30-70 min). There were three cases of wound-edge necrosis; however, there were no cases of skin necrosis around the incision, or deep infection. The mean time of first hospital stay was 16.1 days (10-23 days).

CONCLUSIONS

Treatment of severe open Lisfranc fracture and dislocation through one-stage internal fixation with k-wires in association with VSD led to fast anatomical reduction, stabilized bony structure, fast soft tissue recovery, and good short-term follow-up results.

Measles Virus Infection in Pediatric Liver Transplantation Recipients

OBJECTIVE

This study was conducted to analyze the clinical characteristics and outcome of measles in pediatric liver transplant recipients.

METHODS

This study includes a retrospective data analysis of five pediatric liver transplant recipients with measles who were treated at the Liver Transplant Section, Beijing Friendship Hospital, China, from March to April 2014.

RESULTS

The clinical manifestations of measles in pediatric liver transplant recipients were serious. There were three cases complicated with pneumonia, and one with laryngitis. Two cases presented with severe measles pneumonia that developed into severe respiratory failure requiring mechanical ventilation. Four patients recovered after treatment and one patient died of respiratory failure.

CONCLUSION

Pediatric liver transplant recipients with measles are at high risk of severe pneumonia. Measles pneumonitis is frequently fatal to immunocompromised pediatric patients. Treatment should be initiated as soon as possible.

Paediatric liver re-transplantation after primary partial liver graft transplantation: a report of four cases

OBJECTIVE

To discuss rules of anatomic shifting of the porta hepatis structures of the original graft and dissection techniques for the portal vein (pull-out technique) in pediatric liver re-transplantation.

METHOD

We summarized four cases of paediatric liver re-transplantation. The main donor type is partial liver graft especially using the left lateral lobe.

RESULT

In paediatric liver re-transplantation, gross morphological changes were observed in the liver, and the spatial position of the porta hepatis structures was shifted clockwise (with the anastomosis of the hepatic vein as the origin). Preoperative three-dimensional imaging showed that segment 3 of the liver graft increased in a compensatory manner. The pull-out technique could expose the surgical field without dissection and separation, and reduce the technical difficulty of identifying and dissociating the anatomical structures.

CONCLUSION

Changes in the spatial location and structure of the liver portal anatomy increase the difficulties and risks of surgery. We can reduce the difficulty of surgical anatomy, and the risk of bleeding and injury and increase the safety of paediatric liver re-transplantation by evaluation and the application of special techniques.

A Two-Stage Protocol With Vacuum Sealing Drainage for the Treatment of Type C Pilon Fractures

Management of type C pilon fractures remains controversial and challenging. The aim of the present study was to provide a 2-stage protocol with vacuum sealing drainage for the treatment of type C pilon fractures. From March 2009 to March 2012, 16 patients (mean age 42.3 years) were admitted to our department with type C pilon fractures and treated with single-stage external fixation and second-stage internal fixation (anteromedial incision) combined with vacuum sealing drainage. The American Orthopaedic Foot and Ankle Society scale score averaged 86.5 for this group of patients. The range of motion was 30° ± 8.9°. An excellent or good American Orthopaedic Foot and Ankle Society scale score was obtained for all patients. None of the 16 patients developed skin necrosis, nonunion, or fixation failure during the follow-up period. Moreover, the visual analog scale pain scores were 0.7 ± 0.8, 0.9 ± 0.7, and 1.4 ± 1.0 during rest, active movement, and weightbearing, respectively. The postoperative radiographs showed excellent treatment effects. A 2-stage protocol, combined with vacuum sealing drainage, for the treatment of type C pilon fractures can eliminate deep infection and complex surgery and is a simple and effective treatment method. In addition, full exposure of the anteromedial incision, the avoidance of the anterior tibial muscle tendon sheath, and the avoidance of soft tissue injuries are generally recommended in this operation.

Electron transfer driven highly valent silver for chronic wound treatment

This paper shows that reducing the dose of silver, additionally conferring electron transfer potential, could simultaneously achieve good biocompatibility and strong bactericidal ability without introducing extra chemical residuals for chronic wound treatment.

Talar neck fractures: anatomic landmarks of suitable position for posterolateral screw insertion

OBJECTIVE

The posterolateral window is a suitable position for screw insertion. The aim of this study was to define this position for posterolateral screw insertion.

METHODS

Fifteen adult cadaver ankles were used in this study. When the ankle was positioned in a neutral position, the posterolateral window was exposed. Height and width of the window were measured. Vertical distance from the center of the window to the lateral malleolus tip (LMT), horizontal distance from the center of the window to the lateral of the Achilles tendon (LAT), and horizontal distance from the lateral of the Achilles tendon to the sural nerve (SN) were measured. Additionally, the anatomical relationships between the center of the window (the screw insertion point) and surrounding tissues were noted.

RESULTS

The results indicated that the posterolateral window was bounded medially by the lateral tubercle of the posterior process of the talus (LTPT), laterally by the posterior border of lateral malleolar (PBLM), superiorly by the trochlear articular surface (TAS), and inferiorly by the posterior calcaneal facet (PCF). The height and width of the posterolateral window were 1.89±0.04 cm and 0.91±0.01 cm, respectively. LMT was 0.40±0.01 cm, LAT was 0.19±0.02 cm, and SN was 0.62±0.04 cm. The present data showed that posterior screw insertion may be a safer screw insertion technique for talar neck fractures. Performing the operation through the posterolateral window had no negative effect on surrounding tissues such as the flexor hallucis longus and posterior talofibular ligament tissues when the ankle joint was positioned in a neutral position. Additionally, the screw head should be countersunk to reduce intraoperative risk.

CONCLUSION

The posterolateral window is a safer point for posterolateral screw insertion for talar neck fractures.

Investigation of several biomarkers associated with diabetic nephropathy

OBJECTIVE

The aim of this study was to facilitate the systematic discovery of diagnostic biomarkers of diabetic nephropathy (DN).

METHODS

3 publicly available independent cohorts were got from Gene Expression Omnibus database. Gene expression array were used to screen for genome-wide relative significance (GWRS) and genome-wide global significance (GWGS). The most significant up- and down-regulated top 100 gene signatures were identified using a fold change based model. Then the protein-protein interaction (PPI) network was constructed, while the hub genes in this PPI network were identified by centrality analysis. Modules detection was performed to explore the functions of the modules. Meanwhile, gene enrichment analysis was performed to illuminate the biological pathways and processes associated with DN.

RESULTS

The most significant up- and down-regulated top 100 gene signatures were identified and a PPI network was established. Several hub genes (VEGFA, IL8, MYC, CD14, ALB) were discovered. Several functional modules were revealed. Biological pathways including cytokine-cytokine receptor interaction and p53 signaling pathway, and processes including inflammatory response, response to wounding and enzyme linked receptor protein signaling pathway were identified.

CONCLUSION

Our study displayed underlying biomarkers including biological pathways and several hub genes of DN.

Danshensu-mediated protective effect against hepatic fibrosis induced by carbon tetrachloride in rats

The culprit of hepatic fibrosis (HF) is linked to suprathreshold deposition of collagen. Thus, collagen reduction by improved metabolism contributes to HF management. In this study, we aimed to investigate the hepatoprotective effects of Danshensu (DSS) against carbon tetrachloride (CCl4)-induced HF rats. The results showed that DSS-administrated rats resulted in decreasing in hepatosomatic indexes, and lowering serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Meanwhile, the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) were increased, while the content of malonaldehyde (MDA) was lessened in liver tissue of DSS administration group. In addition, the pro-fibrotic markers of hydroxyproline (Hyp), type III procollagen (PCIII) and hyaluronic acid (HA) contents were decreased. Histopathological examination confirmed that the hepatotoxicity in CCl4-injured rats was alleviated following the DSS administration. Furthermore, intrahepatic protein expressions of alpha-smooth muscle actin (α-SMA), phosphorylated JAK2 (p-JAK2) and phosphorylated STAT3 (p-STAT3) were effectively down-regulated, respectively. Overall, this work demonstrates that DSS played the protective effect against CCl4-induced cytotoxicity in liver tissue, which the probable mechanism is associated with attenuation of lipid peroxidation, collagen accumulation and enhancement of anti-oxidative defense capability, as well as regulation of intrahepatic JAK/STAT pathway for maintaining collagenic homoeostasis.