BACKGROUND: Osteonecrosis of the femoral head (ONFH) following internal fixation of femoral neck fractures is difficult to be cured in clinic.OBJECTIVE: To analyze the literatures concerning ONFH in patients with femoral neck fractures treated with screw internal fixation in recent 15 years, and to summarize the research progress in views of epidemiology, etiology, diagnosis,treatment and rehabilitation.METHODS: Databases of CNKI, WanFang, CqVip, PubMed, Medline, Web of Science were searched with the keywords of femoral neck fracture, osteonecrosis of femoral head, osteonecrosis, internal fixation, internal fixation with screw in English and Chinese, respectively. Afterwards, the reviews and case reports were excluded. RESULTS AND CONCLUSION: (1) A total of 54 eligible articles addressing the ONFH following internal fixation for femoral neck fractures were included, and the incidence of ONFH varied from 8.1% to 37.2%, which was found at an average of 17 months after injury. (2) ONFH was found to be related to age, preoperative fracture displacement, preoperative traction,reduction condition, time from injury to operation, elderly patients companied with other diseases, older patients undergoing removal of the screws, closed or open internal fixation, restored time postoperatively, high body mass index, hyperlipidemia, season, and depression. (3) Early prevention and remedial surgery were used to treat ONFH. (4) The patients without weight-bearing activities at 3-6 months postoperatively could be beneficial for functional recovery. (5) These results suggest that choosing appropriate surgical programs and rehabilitation plan can reduce the incidence of ONFH and achieve good treatment outcomes, such as reasonable preoperative planning, standardized operation skills, correct diagnosis and treatment, proper postoperative rehabilitation and good doctor-patient cooperation.

Objective:After general anesthesia and mechanical ventilation for laparoscopic colorectal cancer resection, about 90% of patients would have different degrees of atelectasis. Authors speculated that an open-lung strategy (OLS) comprising moderate positive end-expiratory pressure (PEEP) and intermittent recruitment maneuvers (RM) can reduce atelectrauma and thus reduce the incidence of oxygenation-impairment during low-tidal-volume ventilation for laparoscopic colorectal cancer resection. The purpose of this study was to verify this hypothesis and provide a better intraoperative ventilation scheme for laparoscopic colorectal cancer resection.Methods:This was a prospectively randomized controlled clinical trial which was approved by the Ethics Committee of the Sixth Affiliated Hospital, Sun Yat-sen University (2017ZSLYEC-002), and registered at the ClinicalTrials.gov (NCT03160144). From January to July 2017, patients who underwent laparoscopic colorectal cancer resection, with age > 40 years, estimated pneumoperitoneum time ≥ 1.5 h, pulse oxygen saturation ≥ 92%, and risk grade for postoperative pulmonary complications ≥ 2 were prospectively enrolled. The patients with American Society of Anesthesiologists physical status ≥ IV, body mass index ≥ 30 kg/m 2, pneumonia, acute respiratory failure or sepsis within 1 month, severe chronic obstructive pulmonary disease, pulmonary bullae and progressive neuromuscular diseases, and those participating in other interventional clinical trials were excluded. The enrolled patients were randomly assigned (1:1) to the OLS group (with a PEEP of 6-8 cm H 2O and intermittent RM), and the NOLS group (without using PEEP and RM). Partial pressure of arterial oxygen (PaO 2) /fraction of inspired oxygen (FiO 2) and shunt fraction (Q S/Q T) were calculated via arterial and central venous blood gas analysis performed at 0.5 h (T 1), 1.5 h (T 2) after pneumoperitoneum induction and at 20 min after admission to the recovery room. Driving pressure immediately before pneumoperitoneum induction (T 0) and at T 2 were calculated via monitoring data. The primary outcome was oxygenation-impairment (PaO 2/FiO 2 ≤ 300 mmHg) during mechanical ventilation. Results:In each group, 48 patients under general anesthesia and low-tidal-volume ventilation were included in the final analysis. During ventilation, the oxygenation-impairment occurred in 7 patients (14.6%) of OLS group and in 17 patients (35.4%) of NOLS group, whose difference was statistically significant between two groups (χ 2=5.556, RR=0.31, 95%CI: 0.12 to 0.84, P=0.033). During ventilation, the patients in the OLS group had higher PaO 2/FiO 2 [T 1: (427±103) mmHg vs. (366±109) mmHg, t=-2.826, P=0.006; T 2: (453±103) mmHg vs. (388±122) mmHg, t=-2.739, P=0.007], lower Q S/Q T [ T 1: (9.2±6.5) % vs. (12.6±7.7) %, t=2.322, P=0.022; T 2: (7.0±5.8)% vs.(10.9±9.2)%, t=2.408, P=0.019], and lower driving pressure [T 0: (6±3) cm H 2O vs. (10±2) cm H 2O, t=7.421, P<0.001; T 2: (13±3) cm H 2O vs. (17±4) cm H 2O, t=5.417, P<0.001] than those in the NOLS group, with stratistical differences in all comparisons. In recovery room, though PaO 2/FiO 2 [(70.3±9.4) mmHg vs. (66.8±9.4) mmHg, P=0.082] was still higher and Q S/Q T [(18.6±8.3)% vs. (21.8±8.4)%, P=0.070] was still lower in the OLS group as compared to the NOLS group, the differences were not statistically significant (both P>0.05). Conclusion:The application of such an OLS during low-tidal-volume ventilation can greatly reduce the incidence of oxygenation-impairment in laparoscopic colorectal cancer resection, and such effect may last to the period of emergence from anesthesia.

Objective:After general anesthesia and mechanical ventilation for laparoscopic colorectal cancer resection, about 90% of patients would have different degrees of atelectasis. Authors speculated that an open-lung strategy (OLS) comprising moderate positive end-expiratory pressure (PEEP) and intermittent recruitment maneuvers (RM) can reduce atelectrauma and thus reduce the incidence of oxygenation-impairment during low-tidal-volume ventilation for laparoscopic colorectal cancer resection. The purpose of this study was to verify this hypothesis and provide a better intraoperative ventilation scheme for laparoscopic colorectal cancer resection.Methods:This was a prospectively randomized controlled clinical trial which was approved by the Ethics Committee of the Sixth Affiliated Hospital, Sun Yat-sen University (2017ZSLYEC-002), and registered at the ClinicalTrials.gov (NCT03160144). From January to July 2017, patients who underwent laparoscopic colorectal cancer resection, with age > 40 years, estimated pneumoperitoneum time ≥ 1.5 h, pulse oxygen saturation ≥ 92%, and risk grade for postoperative pulmonary complications ≥ 2 were prospectively enrolled. The patients with American Society of Anesthesiologists physical status ≥ IV, body mass index ≥ 30 kg/m 2, pneumonia, acute respiratory failure or sepsis within 1 month, severe chronic obstructive pulmonary disease, pulmonary bullae and progressive neuromuscular diseases, and those participating in other interventional clinical trials were excluded. The enrolled patients were randomly assigned (1:1) to the OLS group (with a PEEP of 6-8 cm H 2O and intermittent RM), and the NOLS group (without using PEEP and RM). Partial pressure of arterial oxygen (PaO 2) /fraction of inspired oxygen (FiO 2) and shunt fraction (Q S/Q T) were calculated via arterial and central venous blood gas analysis performed at 0.5 h (T 1), 1.5 h (T 2) after pneumoperitoneum induction and at 20 min after admission to the recovery room. Driving pressure immediately before pneumoperitoneum induction (T 0) and at T 2 were calculated via monitoring data. The primary outcome was oxygenation-impairment (PaO 2/FiO 2 ≤ 300 mmHg) during mechanical ventilation. Results:In each group, 48 patients under general anesthesia and low-tidal-volume ventilation were included in the final analysis. During ventilation, the oxygenation-impairment occurred in 7 patients (14.6%) of OLS group and in 17 patients (35.4%) of NOLS group, whose difference was statistically significant between two groups (χ 2=5.556, RR=0.31, 95%CI: 0.12 to 0.84, P=0.033). During ventilation, the patients in the OLS group had higher PaO 2/FiO 2 [T 1: (427±103) mmHg vs. (366±109) mmHg, t=-2.826, P=0.006; T 2: (453±103) mmHg vs. (388±122) mmHg, t=-2.739, P=0.007], lower Q S/Q T [ T 1: (9.2±6.5) % vs. (12.6±7.7) %, t=2.322, P=0.022; T 2: (7.0±5.8)% vs.(10.9±9.2)%, t=2.408, P=0.019], and lower driving pressure [T 0: (6±3) cm H 2O vs. (10±2) cm H 2O, t=7.421, P<0.001; T 2: (13±3) cm H 2O vs. (17±4) cm H 2O, t=5.417, P<0.001] than those in the NOLS group, with stratistical differences in all comparisons. In recovery room, though PaO 2/FiO 2 [(70.3±9.4) mmHg vs. (66.8±9.4) mmHg, P=0.082] was still higher and Q S/Q T [(18.6±8.3)% vs. (21.8±8.4)%, P=0.070] was still lower in the OLS group as compared to the NOLS group, the differences were not statistically significant (both P>0.05). Conclusion:The application of such an OLS during low-tidal-volume ventilation can greatly reduce the incidence of oxygenation-impairment in laparoscopic colorectal cancer resection, and such effect may last to the period of emergence from anesthesia.

Objective To investigate the long and mid-term clinical outcomes of the impacting bone graft and impact factors in treating osteonecrosis of femoral head (ONFH).Methods Impacting bone graft was utilized to treat 54 patients (64 hips)with ONFH.There were 44 cases male and 10 female with an average age of 35.44±8.86 (range,20-55) years.There were 5 hips caused by trauma,23 hips by glucocorticoid administration,28 hips by intake of alcohol,4 hips by alcohol and glucocorticoid induced,and 4 hips by idiopathic factors.There were 14 hips at ARCO (Association Research Circulation Osseous) stage Ⅱ,50 hips at stage Ⅲ and 6 hips at JIC (Japanese Osteonecrosis Investigation Committee) type B,23 hips at type C1,35 hips at C2 type.Harris hip score (HHS) was used to evaluate the clinical effects.Potential factors,including age,etiologies,pain duration,ARCO stage and JIC type,were evaluated to investigate their impacts on clinical outcomes.Surgery failure was defined as diverting to other surgeries,or poor HHS score evaluation (＜70 points).The survival time of femoral head was defined as the interval between time of impacting bone graft and the failure of surgery.Results The mean follow-up duration was 8.61 ± 1.45 (range,5.13-10.84) years.The proportion of patients with excellent or good Harris score was 81.3％ (52/64).The excellent or good rate was 76.0％ (38/50) at 8 years follow-up.Furthermore,the total survival rate of femoral head was 92％ at 8 years follow-up.The number of surgical failure was 10 (12 hips) and the failure rate was 18.8％ (12/64).There were no significant differences in ages,etiologies,pain duration,ARCO stage and JIC type among these patients before surgery (P ＜ 0.05).There were significant differences in the post-operational Harris score and excellent or good rate among the 20-30 years group,31-40 years group and over 40 years group (P ＜ 0.05).No significant difference for both two indexes was observed among different etiologies (P ＞ 0.05).When considering the duration after the initial pain,there were significant differences among 6 months group,7-12 months group and over 12 months group (P ＜0.05).There were significant differences between the Ⅲa stage and Ⅲc stage (P＜ 0.05),and between the C1 type and C2 type (P ＜ 0.05).Multifactor Logistic regression showed that there was closely relationship between the Harris score (excellent or good rate) after surgery and pain duration,ARCO stage,JIC type (P ＜ 0.05).Conclusion Impacting bone graft for ONFH is satisfy in the long and mid-term follow up duration.Impacting bone graft would be more suitable for patients with the collapse less than 2 mm,the lateral wall preservation and interval after the initial pain less than 12 months.

Cathepsin D (CTSD), the major lysosomal aspartic protease that is widely expressed in different tissues, potentially regulates the biological behaviors of various cells. Follicular granulosa cells are responsive to the increase of ovulation number, hence indirectly influencing litter size. However, the mechanism underlying the effect of CTSD on the behaviors of goat granulosa cells has not been fully elucidated. This study used immunohistochemistry to analyze CTSD localization in goat ovarian tissues. Moreover, western blotting was applied to examine the differential expression of CTSD in the ovarian tissues of monotocous and polytocous goats. Subsequently, the effects of CTSD knockdown on cell proliferation, apoptosis, cell cycle, and the expression of candidate genes of the prolific traits, including bone morphogenetic protein receptor IB (