OBJECTIVE: This review summarized the first 10-year progresses and controversies in the concept of anteromedial cortical support reduction, to provide references for further study and clinical applications. METHODS: Relevant domestic and foreign literature on cortical support reduction was extensively reviewed to summarize the definition of positive, neutral, and negative support, anteromedial cortices at the inferior corner, intraoperative technical tips for fracture reduction, radiographic assessment at different periods, comparison between positive versus neutral and medial versus anterior support, and the clinical efficacy of Chang reduction quality criteria (CRQC) and postoperative stability score. RESULTS: Anteromedial cortical support reduction was only focused on the cortex of anteromedial inferior corner, with no concern the status of lateral wall or lesser trochanter. Anteromedial cortex was seldom involved by fracture comminution, it was thicker, denser, and stronger, and was the key for mechanical buttress of the head-neck fragment to share compression load. Positive, neutral, and negative support were also called "extramedullary, anatomic, and intramedullary reduction", respectively. There was hardly seen parallel cortical apposition, but characterized by some kinds of head-neck rotation, for example 10°-15° flexed rotation for positive cortical contact and support. Due to intraoperative compression and postoperative impaction, the status of cortical support may be changed at different time of radiographic examination. The positive medial cortex support was more reliable with less reduction loss than its neutral counterpart, and the anterior cortex contact was more predictive than the medial cortex for final results. As incorporation the bearing of cortex apposition and using a 4-point score, CRQC demonstrated more efficacy and was gradually accepted and applied in the evaluation of trochanteric fracture reduction quality. Postoperative stability score (8 points) provided a assessment tool for early weight-bearing in safety to prevent mechanical failure. CONCLUSION Anteromedial cortical support reduction is a key point for stability reconstruction in the treatment of trochanteric femur fractures. Evidence has definitely shown that non-negative (positive and neutral) is superior to negative (loss of cortical support). There is a tendency that positive cortex support is superior to neutral, but high quality study with large sample size is needed for a clear conclusion.
Humans ; Femur/diagnostic imaging* ; Fracture Fixation, Internal/methods* ; Hip Fractures/diagnostic imaging* ; Treatment Outcome ; Fracture Fixation, Intramedullary/methods*

BACKGROUND/OBJECTIVES: Tibetan tea is a kind of dark tea, due to the inherent complexity of natural products, the chemical composition and beneficial effects of Tibetan tea are not fully understood. The objective of this study was to unravel the composition of Tibetan tea using knowledge-guided multilayer network (KGMN) techniques and explore its potential antioxidant and hypolipidemic mechanisms in mice.MATERIALS/METHODS: The C57BL/6J mice were continuously gavaged with Tibetan tea extract (T group), green tea extract (G group) and ddH 2 O (H group) for 15 days. The activity of total antioxidant capacity (T-AOC) and superoxide dismutase (SOD) in mice was detected.Transcriptome sequencing technology was used to investigate the molecular mechanisms underlying the antioxidant and lipid-lowering effects of Tibetan tea in mice. Furthermore, the expression levels of liver antioxidant and lipid metabolism related genes in various groups were detected by the real-time quantitative polymerase chain reaction (qPCR) method. RESULTS: The results showed that a total of 42 flavonoids are provisionally annotated in Tibetan tea using KGMN strategies. Tibetan tea significantly reduced body weight gain and increased T-AOC and SOD activities in mice compared with the H group. Based on the results of transcriptome and qPCR, it was confirmed that Tibetan tea could play a key role in antioxidant and lipid lowering by regulating oxidative stress and lipid metabolism related pathways such as insulin resistance, P53 signaling pathway, insulin signaling pathway, fatty acid elongation and fatty acid metabolism. CONCLUSIONS This study was the first to use computational tools to deeply explore the composition of Tibetan tea and revealed its potential antioxidant and hypolipidemic mechanisms, and it provides new insights into the composition and bioactivity of Tibetan tea.

ObjectiveTo compare the functional connectivity of brain networks in stroke patients with upper limb motor dysfunction during unilateral or bilateral upper limb movement using functional near-infrared spectroscopy (fNIRS). MethodsFrom April to June, 2021, 40 stroke patients with upper limb motor dysfunction in Department of Rehabilitation Medicine, Huashan Hospital, finished unilateral (affected) and bilateral upper limb movement. Eight-minute fNIRS data were collected before and after movement, and the functional activities and connectivity of prefrontal cortex (PFC), upper limb and hand functional area (H), primary sensory cortex (S1) were analyzed based on oxygenated hemoglobin. ResultsFunctional activities increased in affected H after unilateral task (t = -3.135, P < 0.05), while the functional connectivity increased between affected H and affected S1, affected H and unaffected S1, and affected S1 and unaffected S1 (|t| > 3.218, P < 0.05). There was no significant difference in the functional activities and connectivity of all the areas after bilateral upper limb task (|t| < 2.385, P > 0.05). The improvement of affected H was more after unilateral task than after bilateral upper limb task (t = 2.026, P < 0.05). ConclusionUnilateral affected upper limb training is more effective on functional activities and connectivity for corresponding brain regions than bilateral task.

Objective:To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot with the help of the three dimensional computerized tomography angiography(3D-CTA).Methods:From November 2013 to February 2018, 19 patients with anterior foot defects were treated in the Yidu Central Hospital of Weifang. There were 12 males and 7 females. The patients ranged from 16 to 45 years old, with an average age of 29.6 years. Preoperative 3D-CTA examination of the ipsilateral foot was performed to find out the blood vessels in the donor site, to determine the location, course, length of the superficial branch of the medial plantar toe artery and its relationship with the surrounding tissues, and to design the medial saphenous nerve nutrient vessel skin flap for retrograde repair of the skin and soft tissue defect at the front of the foot. Sensitive recovery were evaluated according to Swanson evaluation of clinical effect of peripheral nervous impairment.Results:Preoperative three-dimensional CT angiography showed that the superficial branches of the medial plantar toe artery were detected, and the perforating vessels during the operation were basically consistent according to the result of the examination. The 19 cases of forefeet skin detects were successfully reconstructed with the reverse saphenous nerve neurocutaneous flaps. All patients were followed up with the mean of 8 months. All flaps survived totally without diabrosis and swelling. The walking and weight-bearing were normal and the blood supply of foot were good. The functional recovery of foot and ankle was excellent in 8 cases, good in 10 cases and middle in 1 case. The sensory recovery of the forefoot: S4 5 feet, S3 10 feet, S2 4 feet; R4 3 feet, R3 9 feet, R2 7 feet.Conclusions:Preoperative 3D-CTA examination can confirm the anatomy of the superficial branch of the medial toe base artery in the donor site and guide the design of the medial saphenous nerve nutrient vessel flap for retrograde repair of skin and soft tissue defects of the distal foot. The blood supply is reliable, the wound is small and the effect is satisfactory.

Objective:To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot with the help of the three dimensional computerized tomography angiography(3D-CTA).Methods:From November 2013 to February 2018, 19 patients with anterior foot defects were treated in the Yidu Central Hospital of Weifang. There were 12 males and 7 females. The patients ranged from 16 to 45 years old, with an average age of 29.6 years. Preoperative 3D-CTA examination of the ipsilateral foot was performed to find out the blood vessels in the donor site, to determine the location, course, length of the superficial branch of the medial plantar toe artery and its relationship with the surrounding tissues, and to design the medial saphenous nerve nutrient vessel skin flap for retrograde repair of the skin and soft tissue defect at the front of the foot. Sensitive recovery were evaluated according to Swanson evaluation of clinical effect of peripheral nervous impairment.Results:Preoperative three-dimensional CT angiography showed that the superficial branches of the medial plantar toe artery were detected, and the perforating vessels during the operation were basically consistent according to the result of the examination. The 19 cases of forefeet skin detects were successfully reconstructed with the reverse saphenous nerve neurocutaneous flaps. All patients were followed up with the mean of 8 months. All flaps survived totally without diabrosis and swelling. The walking and weight-bearing were normal and the blood supply of foot were good. The functional recovery of foot and ankle was excellent in 8 cases, good in 10 cases and middle in 1 case. The sensory recovery of the forefoot: S4 5 feet, S3 10 feet, S2 4 feet; R4 3 feet, R3 9 feet, R2 7 feet.Conclusions:Preoperative 3D-CTA examination can confirm the anatomy of the superficial branch of the medial toe base artery in the donor site and guide the design of the medial saphenous nerve nutrient vessel flap for retrograde repair of skin and soft tissue defects of the distal foot. The blood supply is reliable, the wound is small and the effect is satisfactory.

Objective: To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Methods: Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation (PFNA) were randomly divided into trial group (intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group (conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded; the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex (positive, neutral, and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed; Harris score was used to evaluate the recovery of hip function at 12 months after operation. Results: In the trial group, 6 cases (30%) had 2 Kirschner wires implanted less than 4 times, 7 cases (35%) had 5-8 times, and 7 cases (35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group ( P<0.05). Both groups were followed up 13-21 months, with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group ( Z=-2.794, P=0.024). The Harris score of the trial group was significantly better than that of the control group at 12 months after operation ( t=2.98, P=0.01). Conclusion: The use of Kirschner wire-fixation-cortical bone technique during intertrochanteric fracture closed reduction and PFNA internal fixation surgery can effectively maintain the reduction effect, reduce the number of fluoroscopy, improve the reduction quality, reduce allogeneic blood input, obtain better hip function, and do not increase the operation time and intraoperative blood loss.

Objective To study safety and efficacy of transurethral Thulium laser resection of high-risk stage bladder tumor in anticoagulant state.Methods A total of 26 non-muscle invasive bladder cancer patients receiving long-term anticoagulant therapy,including 16 cases with cerebral infarction,7 cases with coronary heart disease,3 patients with coronary stenting,were retrospectively analyzed in our hospital from July 2012 to July 2014.In condition not stopping anticoagulants,Thulium laser transurethral resection of bladder tumor was performed,and hemoglobin,thrombin time,the operative time,intraoperative blood loss,postoperative bladder irrigation duration,postoperative hospital stay,bladder tumor recurrence within two years,the postoperative complications were recorded before and after surgery.Results All patients were successfully treated.The operative time was(29.1 ± 12.8) min,int raoperative blood loss was (29.4 ± 16.9) ml portions,postoperative bladder irrigation time was (1.25 ± 0.55) d,postoperative hospital stay was(5.51 ± 1.06) d.Hemoglobin before and after operation were (131.35 ± 6.57) g/L and (129.75 ± 11.05) g/L respectively,there was no statistically significant differences (t =1.014,P ＞ 0.05) between them.Prothrombin time before and after operation were (12.50 ± 0.25) s and(12.44 ± 0.27) s,with no statistically significant difference (t =0.908,P＞0.05)between them.During the followed-up of 48 months,tumor recurred at heterotopia in 2 patients.Conclusions Thulium laser transurethral resection of bladder tumor is safe and effective for patients undergoing long-term oral anticoagulation drugs,without a needto stop taking anticoagulant drugs.

Cell Differentiation ; Cell Line, Tumor ; Cell Proliferation ; Humans ; Interferon-alpha ; Leukemia, Promyelocytic, Acute ; Tretinoin

Objective: To assess the impact of viable myocardium in left ventricular aneurysm (LVA) and ventricular arrhythmia on prognosis of LVA patients.
Methods: A total of one hundred and sixty LVA patients who received99Tcm-MIBI SPECT and18F-FDG PET were enrolled, including 139 male and 21 female with the mean age of (58 ± 10) years.There were 42 (26.3%) patients combining ventricular arrhythmia. LVEDV, LVESV and LVEF were detected. Semi-quantitative analysis of myocardium perfusion imaging was conducted, viable myocardium in aneurysm was deifned as the perfusion-metabolism mismatch score (MMS) ≥ 2.0. According to myocardium viability, the patients were divided into 2 groups: No viability group,n=97 and With viability group,n=63;based on ventricular arrhythmia, the patients were divided into another 4 groups: Group①, viability-, ventricular arrhythmia-, n=68, Group②, viability-, ventricular arrhythmias+,n=29, Group③, viability+, ventricular arrhythmias-,n=50 and Group④, viability+,ventricular arrhythmias+,n=13. The average follow-up time was (50 ± 7) months, the end point was cardiac death. The survival curve was obtained by Kaplan-Meier method and survival rates were compared by Log-rank analysis.
Results: The mean LVEF in 160 patients was (34 ± 11) %, cardiac death occurred in 19 (11.9%) patients. Long-term survival rates in Groups①,② and③ were 94.1%, 89.7% and 86.0%, respectively,P>0.05; while in Group④, the survival rate was 61.5%, which was lower than the other 3 groups,P=0.004. Multivariate Cox regression analysis showed that female (HR=5.101, 95% CI 1.853-14.044, P=0.002), GPET-ESV (HR=1.009, 95% CI 1.002-1.015,P=0.013), interaction between MMS and ventricular arrhythmia (HR=1.368, 95%CI 1.113-1.681,P=0.003) were independent risk factors for cardiac death;while surgical treatment (HR=0.199, 95% CI 0.054-0.742,P=0.016) could decrease the risk of cardiac death.
Conclusion: Patients with viable aneurysm and ventricular arrhythmia had poor long-term prognosis; while early and active treatment is needed for them (surgery with anti-arrhythmic therapy).