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*

Objective:To investigate the risk factors for dural tears in patients with thoracolumbar burst fracture (TLBF) and their predictive efficacy.Methods:A retrospective cohort study was conducted to analyze the clinical data of 135 TLBF patients admitted to Tianjin Fifth Central Hospital from March 2020 to February 2025, including 83 males and 52 females, aged 16-65 years [41(31, 50)years]. Among them, 31 patients had thoracic fracture and 104 lumbar fracture. The patients were divided into dural tear group ( n=82) and dural intact group ( n=53) based on the presence of dural tear. The following data of the two groups were collected including gender, age, underlying diseases, body mass index (BMI), bone density T-score, cause of injury, AO fracture classification, distribution of injured vertebrae, vertical laminar fracture (VLF) classification, radiological parameters (pedicle spacing, vertebral canal area, sagittal diameter of the vertebral canal, vertebral compression rate), and American Spinal Injury Association (ASIA) impairment scale. Univariate analysis and multivariate Logistic regression analysis were conducted to assess and identify the independent risk factors for dural tears in TLBF patients. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the predictive efficacy of each independent risk factor. Results:Univariate analysis showed statistically significant differences in VLF classification, pedicle spacing, vertebral canal area, sagittal diameter of the vertebral canal, vertebral compression rate, and ASIA impairment scale between the two groups ( P<0.05). Multivariate Logistic regression analysis revealed that VLF classification ( OR=4.16, 95% CI 1.03, 11.46, P<0.05), pedicle spacing ( OR=1.08, 95% CI 0.81, 1.16, P<0.05), and ASIA impairment scale ( OR=3.06, 95% CI 2.00, 8.48, P<0.01) were significantly associated with dural tears in TLBF patients. ROC curve analysis showed that VLF classification (AUC=0.86, 95% CI 0.62, 0.95), pedicle spacing (AUC=0.86, 95% CI 0.77, 1.00), and ASIA impairment scale (AUC=0.76, 95% CI 0.74, 0.97) had relatively high predictive efficacy for dural tear. The combination of VLF classification and pedicle spacing had the highest predictive efficacy (AUC=0.89, 95% CI 0.78, 1.01). Conclusions:VLF classification, pedicle spacing, and ASIA impairment scale are independent risk factors for dural tears in TLBF patients. VLF classification and pedicle spacing have relatively high independent predictive efficacy and their combination can further improve the predictive efficacy.

Ischemic stroke (IS) ranks as a leading cause of death and disability globally. The blood-brain barrier (BBB) poses significant challenges for effective drug delivery to brain tissues. Recent decades have seen the development of targeted nanomedicine and biomimetic technologies, sparking substantial interest in biomimetic drug delivery systems for treating IS. These systems are devised by utilizing or replicating natural cells and their derivatives, offering promising new pathways for detection and transport across the BBB. Their multifunctionality and high biocompatibility make them effective treatment options for IS. In addition, the incorporation of engineering techniques has provided these biomimetic drug delivery systems with active targeting capabilities, enhancing the accumulation of therapeutic agents in ischemic tissues and specific cell types. This improvement boosts drug transport and therapeutic efficacy. However, it is crucial to thoroughly understand the advantages and limitations of various engineering strategies employed in constructing biomimetic delivery systems. Selecting appropriate construction methods based on the characteristics of the disease is vital to achieving optimal treatment outcomes. This review summarizes recent advancements in three types of engineered biomimetic drug delivery systems, developed from natural cells and their derivatives, for treating IS. It also discusses their effectiveness in application and potential challenges in future clinical translation.
Humans ; Drug Delivery Systems/methods* ; Ischemic Stroke/drug therapy* ; Animals ; Blood-Brain Barrier/metabolism* ; Stroke/drug therapy*

Chronic, unresolved inflammation correlates with persistent hepatic injury and fibrosis, ultimately progressing to hepatocellular carcinoma (HCC). Bisdemethoxycurcumin (BDMC) demonstrates therapeutic potential against HCC, yet its mechanism in preventing hepatic "inflammation-carcinoma transformation" remains incompletely understood. In the current research, clinical HCC specimens underwent analysis using hematoxylin-eosin (H&E) staining and immunohistochemistry (IHC) to evaluate the expression of fibrosis markers, M2 macrophage markers, and CXCL12. In vitro, transforming growth factor-β1 (TGF-β1)-induced LX-2 cells and a co-culture system of LX-2, THP-1, and HCC cells were established. Cell functions underwent assessment through 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), flow cytometry, and Transwell assays. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR), Western blotting and immunofluorescence evaluated the differential expression of molecules. The interaction between β-catenin/TCF4 and CXCL12 was examined using co-immunoprecipitation (Co-IP), dual luciferase, and chromatin immunoprecipitation (ChIP) assays. A DEN-induced rat model was developed to investigate BDMC's role in liver fibrosis-associated HCC (LFAHCC) development in vivo. Our results showed that clinical HCC tissues exhibited elevated fibrosis and enriched M2 macrophages. BDMC delayed liver fibrosis progression to HCC in vivo. BDMC inhibited the inflammatory microenvironment induced by activated hepatic stellate cells (HSCs). Furthermore, BDMC suppressed M2 macrophage-induced fibrosis and HCC cell proliferation and metastasis. Mechanistically, BDMC repressed TCF4/β-catenin complex formation, thereby reducing CXCL12 transcription in LX-2 cells. Moreover, CXCL12 overexpression reversed BDMC's inhibitory effect on macrophage M2 polarization and its mediation of fibrosis, as well as HCC proliferation and metastasis. BDMC significantly suppressed LFAHCC development through CXCL12 in rats. In conclusion, BDMC inhibited LFAHCC progression by reducing M2 macrophage polarization through suppressing β-catenin/TCF4-mediated CXCL12 transcription.
Animals ; Liver Neoplasms/etiology* ; Humans ; Carcinoma, Hepatocellular/immunology* ; Liver Cirrhosis/complications* ; Macrophages/drug effects* ; Male ; Rats ; Chemokine CXCL12/genetics* ; Diarylheptanoids/pharmacology* ; Rats, Sprague-Dawley ; beta Catenin/genetics*

ObjectiveTo investigate the clinical features and traditional Chinese medicine （TCM） syndrome distribution of treatment-naïve patients with hepatitis B virus-related primary liver cancer （HBV-PLC）， and to provide a basis for integrated traditional Chinese and Western medicine in the prevention and treatment of HBV-PLC. MethodsA retrospective analysis was performed for the clinical data of 99 treatment-naïve HBV-PLC patients who were admitted to Department of Hepatology and Infectious Diseases in The First Affiliated Hospital of Hunan University of Chinese Medicine from January 2019 to December 2024. According to whether the patient received standardized antiviral therapy （for ≥3 years）， they were divided into antiviral group and non-antiviral group， and according to the status of HBeAg， they were divided into HBeAg-positive group and HBeAg-negative group. Demographic features， laboratory test results， imaging data， and TCM syndrome data were collected， and neutrophil-to-lymphocyte ratio （NLR）， Child-Pugh score， and CNLC stage were calculated. The independent samples t-test was used for comparison of normally distributed continuous data between two groups， and the chi-square test was used for comparison of categorical data between groups. ResultsThe 99 treatment-naïve HBV-PLC patients had a mean age of 57.12±11.60 years， and the patients aged 50 — 75 years accounted for the highest proportion of 72.7%， with a male/female ratio of 5.2∶1. The patients with liver cirrhosis accounted for 81.8%， and 67.7% of the patients did not receive antiviral therapy in the past. The positive rates of HBV DNA， HBeAg， and alpha-fetoprotein were 80.8%， 18.2%， and 69.7%， respectively， and the patients with Child-Pugh class A/B disease accounted for 89.9%. Compared with the non-antiviral group， the antiviral group had a significantly smaller maximum tumor diameter （t=2.310， P=0.024）， a significantly lower HBV DNA positive rate （χ²=14.006， P<0.001）， and a significantly lower number of tumor thrombi （χ²=7.347， P=0.007）. In addition， there were significant differences between the HBeAg-negative group and the HBeAg-positive group in Child-Pugh class （χ²=6.780， P=0.034） and CNLC stage （χ²=8.746， P=0.033）. Among the 99 treatment-naïve HBV-PLC patients， 41.4% had liver depression and spleen deficiency with blood stasis， 22.2% had Qi deficiency and blood stasis syndrome， and 19.2% had damp-heat accumulation with blood stasis. ConclusionTreatment-naïve HBV-PLC patients are mainly middle-aged and elderly male individuals， and most of the patients are comorbid with liver cirrhosis. Standardized antiviral therapy can significantly reduce tumor burden and improve virologic response， with better hepatic compensation in HBeAg-negative patients， and hypoproteinemia is more common in patients with Qi deficiency and blood stasis syndrome.

Objective To investigate the relationship between vertical laminar fracture(VLF)in thoracolumbar burst fractures and both neurological injury and dural tear.Methods A retrospective analysis was conducted on the clinical data and multi spiral computed tomography(MSCT)coronal images of 255 patients of thoracolumbar burst fractures.The patients were divided into three groups based on the presence of VLF[Ⅰ group(complete VLF group),Ⅱ group(partial VLF group),and Ⅲ group(normal lamina group)].Statistical analysis was performed using analysis of variance and Fisher's exact test to compare radiological parameters,inci-dence of dural tear,and neurological injury among the groups.Results The Ⅰ group showed significant differences in spinal canal sagittal diameter,pedicle distance,and spinal canal area compared with the other two groups(P<0.05).However,there was no sig-nificant difference in vertebral body compression rate between the Ⅰ group and the Ⅱ group(P>0.05).The Ⅰ group had the high-est incidence of severe neurological injury[American Spinal Injury Association(ASIA)impairment scale grades A and B]and dural tear(P<0.05).Conclusion The severity of VLF is closely related to dural tear and neurological injury.MSCT coronal images can clearly display the extent of VLF,providing an important basis for clinical evaluation and treatment plan.

Objective:To investigate the clinical efficacy of 3D-printed metal augment or integrated acetabular prostheses for reconstruction of bone defects in hip revision.Methods:A total of 11 patients who underwent total hip revision in Zhengzhou Orthopaedic Hospital from June 2021 to July 2023 were retrospectively analysed. There were 5 males and 6 females, age 64.8±10.7 years (range, 58-75 years), and body mass index 23.3±4.8 kg/m 2 (range, 21-27 kg/m 2). Paprosky classification of acetabular bone defects: 3 cases of type IIA, 4 cases of type IIB, 3 cases of type IIIA, 1 case of type IIIB. Reasons for revision: 8 cases of aseptic loosening, 3 cases after infection exclusion procedure. A 3D-printed metal augment was used in 9 cases (8 cases of aseptic loosening and 1 case of infected exclusion procedure) and a 3D-printed integrated acetabulum was used in 2 cases (infected exclusion procedure). The time from primary total hip arthroplasty to revision was 11.8±5.6 years (range, 5-17 years). Harris hip score and visual analogue scale (VAS) were used to evaluate the improvement of hip function and pain recovery. The leg length discrepancy, vertical height and horizontal position of the hip rotation center were measured on pelvic anteroposterior X-ray films. Results:All patients successfully completed the operation. The operation time was 145.9±35.5 min (range, 110-159 min), and the intraoperative blood loss was 950.5±310.8 ml (range, 680-1,450 ml). The postoperative Harris hip function score was significantly higher than that before operation ( F=554.085, P<0.001). One year after operation, the Harris hip function score was 74.36±5.16, which was higher than that before operation 32.18±4.07, and the difference was statistically significant ( P<0.05). The VAS scores of all patients decreased after operation, and the difference was statistically significant compared with that before operation ( F=177.717, P<0.001). The VAS score at 1 year after operation was 1.27±0.65, which was lower than that before operation 6.18±1.17, and the difference was statistically significant ( P<0.05). The preoperative leg length discrepancy was 1.97±0.71 cm, which was greater than 0.69±0.52 cm at the last follow-up, and the difference was statistically significant ( t=4.824, P<0.001). The vertical height of the hip rotation center was 1.88±0.46 cm on the affected side and 1.67±0.35 cm on the healthy side, showing no significant difference ( t=1.205, P=0.242). The postoperative horizontal position of the hip rotation center was 3.48±0.55 cm on the affected side and 3.54±0.32 cm on the healthy side, and the difference was no statistically significant ( t=-0.313, P=0.758). One case had an intraoperative greater trochanteric fracture that healed 3 months after reduction and internal fixation. All patients were followed up for 21.3±9.5 months (range, 15-31 months). All incisions healed in one stage, and all patients were fully weight-bearing at 3 months after operation. At the last follow-up, there was no case of loosening, dislocation or infection of the prosthesis; 4 cases had mild claudication, 1 case had heterotopic ossification, and the patients had good hip flexion and extension functions, which did not affect daily life without further treatment. Conclusion:The clinical efficacy of 3D-printed metal augment or integrated acetabular prosthesis for reconstruction of acetabular bone defects is satisfactory, which can restore the normal center of rotation of the hip joint and has a low incidence of postoperative complications.

Objective To investigate the effects of in vitro culture with different concentrations of glucose and serum on hypoxia-induced activation and Yes-associated protein(YAP)expression in primary cardiac fibroblasts(CF).Methods Primary CF were isolated from ICR suckling mice with enzyme digestion and then purified using differential adhesion technique.The cells were ran-domly assigned into 6 groups:low glucose high serum group(1.0 g/L glucose+10％serum),high glucose high serum group(4.5 g/L glucose+10％serum),low glucose medium serum group(1.0 g/L glucose+5％serum),high glucose medium serum group(4.5 g/L glucose+5％serum),low glucose serum-free group(1.0 g/L glucose+0％serum)and high glucose serum-free group(4.5 g/L glucose+0％serum).In 24 h after above culture,the cell morphology was observed.Western blotting was used to detect the expression of α-smooth muscle actin(α-SMA),transforming growth factor beta(TGF-β),type Ⅰ collagen(Col Ⅰ).and YAP.Immunofluorescence assay was em-ployed to observe the expression and localization of α-SMA and YAP.EDU staining and cell scratch assay were applied to measure cell proliferation and migration ability,respectively.Results After culture in 1％O2 for 24 h,the cell morphology was gradually altered toward myofibroblasts as the concentration of glucose rose and the serum level fell in the culture medium,especially in the group of high glucose and serum-free.The expression levels of Col Ⅰ,TGF-β,α-SMA and YAP were significantly higher in the high glucose no serum group than in the high glucose high serum group(P＜0.05).The fluorescence intensity of α-SMA was obviously increased in the low glucose no serum group than the low glucose high serum group[(9.23±2.45)％vs(2.40±2.04)％,P＜0.05].Compared to the low-sugar serum-free group,the high glucose serum-free group showed a significant increase in the levels of Col Ⅰ,TGF-β,α-SMA and YAP(P＜0.05).Notably higherα-SMA fluorescence intensity,more YAP nuclear translocation,and enhanced cell migration were observed in the high glucose serum-free group when compared to the high glucose high serum group and the low glucose serum-free group(P＜0.05).Conclusion Under the hypoxic condition of 1％O2,high-glucose serum-free is the most appropriate culture condition to construct an in vitro cell model of hypoxia-induced activation,and the activation of YAP is of most significant im-portance.

Objective:To investigate the clinical efficacy of 3D-printed metal augment or integrated acetabular prostheses for reconstruction of bone defects in hip revision.Methods:A total of 11 patients who underwent total hip revision in Zhengzhou Orthopaedic Hospital from June 2021 to July 2023 were retrospectively analysed. There were 5 males and 6 females, age 64.8±10.7 years (range, 58-75 years), and body mass index 23.3±4.8 kg/m 2 (range, 21-27 kg/m 2). Paprosky classification of acetabular bone defects: 3 cases of type IIA, 4 cases of type IIB, 3 cases of type IIIA, 1 case of type IIIB. Reasons for revision: 8 cases of aseptic loosening, 3 cases after infection exclusion procedure. A 3D-printed metal augment was used in 9 cases (8 cases of aseptic loosening and 1 case of infected exclusion procedure) and a 3D-printed integrated acetabulum was used in 2 cases (infected exclusion procedure). The time from primary total hip arthroplasty to revision was 11.8±5.6 years (range, 5-17 years). Harris hip score and visual analogue scale (VAS) were used to evaluate the improvement of hip function and pain recovery. The leg length discrepancy, vertical height and horizontal position of the hip rotation center were measured on pelvic anteroposterior X-ray films. Results:All patients successfully completed the operation. The operation time was 145.9±35.5 min (range, 110-159 min), and the intraoperative blood loss was 950.5±310.8 ml (range, 680-1,450 ml). The postoperative Harris hip function score was significantly higher than that before operation ( F=554.085, P<0.001). One year after operation, the Harris hip function score was 74.36±5.16, which was higher than that before operation 32.18±4.07, and the difference was statistically significant ( P<0.05). The VAS scores of all patients decreased after operation, and the difference was statistically significant compared with that before operation ( F=177.717, P<0.001). The VAS score at 1 year after operation was 1.27±0.65, which was lower than that before operation 6.18±1.17, and the difference was statistically significant ( P<0.05). The preoperative leg length discrepancy was 1.97±0.71 cm, which was greater than 0.69±0.52 cm at the last follow-up, and the difference was statistically significant ( t=4.824, P<0.001). The vertical height of the hip rotation center was 1.88±0.46 cm on the affected side and 1.67±0.35 cm on the healthy side, showing no significant difference ( t=1.205, P=0.242). The postoperative horizontal position of the hip rotation center was 3.48±0.55 cm on the affected side and 3.54±0.32 cm on the healthy side, and the difference was no statistically significant ( t=-0.313, P=0.758). One case had an intraoperative greater trochanteric fracture that healed 3 months after reduction and internal fixation. All patients were followed up for 21.3±9.5 months (range, 15-31 months). All incisions healed in one stage, and all patients were fully weight-bearing at 3 months after operation. At the last follow-up, there was no case of loosening, dislocation or infection of the prosthesis; 4 cases had mild claudication, 1 case had heterotopic ossification, and the patients had good hip flexion and extension functions, which did not affect daily life without further treatment. Conclusion:The clinical efficacy of 3D-printed metal augment or integrated acetabular prosthesis for reconstruction of acetabular bone defects is satisfactory, which can restore the normal center of rotation of the hip joint and has a low incidence of postoperative complications.

Objective:To compare the efficacy of hip hemiarthroplasty via the fracture line approach versus modified Harding approach in the treatment of unstable intertrochanteric fractures in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 79 elderly patients with unstable intertrochanteric fractures who were admitted to Zhengzhou Orthopaedic Hospital between July 2018 and February 2024, including 17 males and 62 females, aged 80-96 years [(84.0±9.6)years]. According to the AO classification, the fractures were classified as type A2 in 61 patients and type A3 in 18. All the patients underwent hip hemiarthroplasty, 33 of whom were treated via the fracture line approach (fracture line approach group) and 46 via the modified Harding approach (modified Harding approach group). The incision length, operation duration, intraoperative blood loss, blood transfusion volume, and weight-bearing time were documented. At 1 month, 3 months after surgery and at the last follow-up, hip function and pain were assessed using the Harris hip score and visual analogue scale (VAS). Postoperative dislocation rate, fracture nonunion rate, incidence of other complications (vascular injury, neurologic impairment, prosthesis loosening, lower extremity venous thrombosis, and surgical site infection) and 12-month mortality rate were recorded.Results:All the patients were followed up for 12-36 months [(18.0±5.1)months]. The operation duration and intraoperative blood loss were (68.2±8.4)minutes and (286.6±63.7)ml in the fracture line approach group, which were significantly shorter or less than (72.4±6.7)minutes and (321.3±76.2)ml in the modified Harding approach group ( P<0.05). However, there were no statistically significant differences in the incision length, blood transfusion volume or weight-bearing time between the two groups ( P>0.05). Harris hip scores and VAS scores at 1 month, 3 months, and at the last follow-up showed no significant differences between the two groups ( P>0.05). The dislocation rate was 0 in the fracture line approach group, superior to 13% in the modified Harding approach group ( P<0.05). There were no statistically significant differences in the fracture nonunion rate, incidence of other complications, or 12-month mortality rate between the two groups ( P>0.05). Conclusion:Compared with the modified Harding approach, hip hemiarthroplasty via the fracture line approach in the treatment of unstable intertrochanteric fractures in the elderly can shorten the operation time, reduce intraoperative blood loss, and lower the postoperative dislocation rate.