PURPOSE: Hidden blood loss (HBL) during the perioperative period significantly impacts postoperative recovery and complications, yet it is frequently disregarded. This study aimed to investigate the effects of tip-apex distance (TAD) and calcar-referenced tip-apex distance (calTAD) on HBL in the treatment of intertrochanteric fractures utilizing proximal femoral nail antirotation (PFNA). The study also seeks to evaluate the possible decrease in HBL subsequent to PFNA treatment by optimizing nail positioning. METHOD: A historical cohort study was conducted from January 2020 to December 2022. Patients diagnosed with unilateral acute closed femoral intertrochanteric fracture and who underwent PFNA internal fixation surgery met the inclusion criteria, and were grouped according to the value of calTAD and TAD. The participants were divided into low TAD group (TAD<20 mm) and high TAD group (TAD≥20 mm); low calTAD group (calTAD<7.625 mm) and high calTAD group (calTAD≥7.625 mm), respectively. The primary outcome measures were intraoperative blood loss (including HBL, overt blood loss, and total blood loss). Continuous data were analyzed using an independent sample t-test or Mann-Whitney U test, and categorical data were analyzed using the Pearson Chi-square test. Univariate analysis was used to evaluate the association between various indicators and perioperative HBL. A stepwise multiple linear regression analysis model was used to determine the independent factors affecting perioperative HBL. A p value less than 0.05 was considered statistically significant. RESULTS: A total of 131 patients were initially included, of which 80 were assigned to the calTAD group (with 61 in the high calTAD group and 19 in the low calTAD group), and 80 were assigned to the TAD group (with 34 in the high TAD group and 46 in the low TAD group). The average HBL for the low TAD group was 772.85 mL, whereas for the high TAD group it was 919.68 mL (p>0.05). The average HBL for the low calTAD group was 611.42 mL, whereas for the high calTAD group it was 904.97 mL (p<0.05). Subsequent analysis revealed that the patient's height, preoperative hemoglobin levels, changes in hemoglobin and hematocrit levels from pre- to post-surgery, and calTAD are independent risk factors influencing HBL. CONCLUSION In summary, our investigation revealed a significant correlation between the positioning of nails in PFNA and HBL during the perioperative period. By optimizing the placement of the cephalic nail, specifically by ensuring a calTAD of less than 7.625 mm, a significant decrease in HBL can be attained. Additionally, we identified that height, preoperative hemoglobin, differences in preoperative and postoperative hemoglobin and hematocrit, and the positioning of the cephalic nail were independent risk factors for HBL.
Humans ; Retrospective Studies ; Male ; Blood Loss, Surgical/prevention & control* ; Female ; Hip Fractures/surgery* ; Aged ; Fracture Fixation, Intramedullary/methods* ; Bone Nails ; Perioperative Period ; Middle Aged ; Aged, 80 and over

Cholesterol (CH) plays a crucial role in enhancing the membrane stability of drug delivery systems (DDS). However, its association with conditions such as hyperlipidemia often leads to criticism, overshadowing its influence on the biological effects of formulations. In this study, we reevaluated the delivery effect of CH using widely applied lipid microspheres (LM) as a model DDS. We conducted comprehensive investigations into the impact of CH on the distribution, cell uptake, and protein corona (PC) of LM at sites of cardiovascular inflammatory injury. The results demonstrated that moderate CH promoted the accumulation of LM at inflamed cardiac and vascular sites without exacerbating damage while partially mitigating pathological damage. Then, the slow cellular uptake rate observed for CH@LM contributed to a prolonged duration of drug efficacy. Network pharmacology and molecular docking analyses revealed that CH depended on LM and exerted its biological effects by modulating peroxisome proliferator-activated receptor gamma (PPAR-γ) expression in vascular endothelial cells and estrogen receptor alpha (ERα) protein levels in myocardial cells, thereby enhancing LM uptake at cardiovascular inflammation sites. Proteomics analysis unveiled a serum adsorption pattern for CH@LM under inflammatory conditions showing significant adsorption with CH metabolism-related apolipoprotein family members such as apolipoprotein A-V (Apoa5); this may be a major contributing factor to their prolonged circulation in vivo and explains why CH enhances the distribution of LM at cardiovascular inflammatory injury sites. It should be noted that changes in cell types and physiological environments can also influence the biological behavior of formulations. The findings enhance the conceptualization of CH and LM delivery, providing novel strategies for investigating prescription factors' bioactivity.

As a non-invasive biomarker, circulating tumor DNA (ctDNA) can sensitively identify minimal residual disease (MRD), offering a novel approach for prognosis prediction and efficacy evaluation in patients with colorectal cancer liver metastasis (CRLM), thereby aiding in the formulation of personalized treatment strategies. This article summarized the progress in the application of ctDNA detection for MRD in CRLM and provided insights into its future directions.

The tumor microenvironment (TME) is the cellular milieu in which tumor cells thrive, comprising interacting cells and associated factors that form a complex network of interactions, directly or indirectly influencing the initiation, progression, and metastasis of lung cancer. Through TCM pattern identification, it has been observed thatphlegm-pathogen is closely associated with disorder in the inflammatory-metabolic-immune microenvironments of lung cancer. This involves three key pathological mechanisms: "phlegm-stasis complicated by toxin, qi deficiency with exuberant phlegm, and phlegm-pathogen impairing healthy qi". Molecular mechanism studies have revealed that phlegm-resolving agents can extensively modulate multiple targets or pathways, thereby remodeling the inflammatory-metabolic-immune microenvironments of lung cancer. Consequently, a comprehensive therapeutic strategy integrating "resolving phlegm, dispelling stasis, and detoxifying; supplementing qi, warming yang, and resolving phlegm; and reinforcing healthy qi, tonifying the lung, and eliminating phlegm" is essential to reshape the lung cancer TME and enhance antitumor efficacy.

Objective To explore the high-resolution computed tomography(HRCT)imaging findings and prognosis for the welder pneumoconiosis.Methods The HRCT imaging findings and follow-up changes in 11 cases of welder pneumoconiosis diag-nosed by occupational diseases were analyzed retrospectively.Results There were 7 cases(63.7%)showed central lobular nodule shadow,5 cases(45.5%)developed patchy ground glass shadows in the center of the lobule("light ink sign"),5 cases(45.5%)showed branching fine line shadow,2 cases(18.2%)showed interlobular septal thickening,and 3 cases(37.5%)showed better ima-ging performance than before.Conclusion HRCT imaging findings of welder pneumoconiosis mainly include diffuse distribution of nodules in the center of lobules,"light ink sign",and branching fine line shadows in both lungs,with rare hilar and mediastinal lymphadenopathy and calcification.When the image shows nodule shadow or"light ink sign"in the center of the lobule,it is more likely to improve after leaving environment exposure.

We reported a 32 years female patient in whom lung metastasis from breast cancer was presented as solitary pulmonary pure ground-glass opacity (GGO) lesion. The patient received rational preoperative examinations and surgery though the preoperative diagnosis was not accurate. Because of different therapy strategies and purposes, it is crucial to make distinction of atypical metastases from primary cancers. Thus, for patients with a history of malignancy, possible metastasis should be taken into consideration if new GGO was found on the CT. Besides this, the follow-up interval of CT should be shortened appropriately, preoperative examinations and surgical procedures should be made according to the suggestions of multidisciplinary team.

BACKGROUND:Spinal cord injury involves mechanisms such as oxidative stress,inflammation,apoptosis and autophagy.Activation of autophagy can improve neuromotor function after spinal cord injury and play a protective role in the spinal cord. OBJECTIVE:To investigate the effects of Periplaneta americana powder on hindlimb motor function and the autophagy protein Beclin-1 in the injured site of rats after spinal cord hemisection. METHODS:Thirty Sprague-Dawley rats,6-8 weeks of age,were randomly divided into three groups(n=10 per group).In the sham-operated group,the lamina was just opened to exposure the spinal cord followed by suturing.Normal saline group and Periplaneta americana powder group both underwent left hemisection of the spinal cord to prepare animal models of spinal cord hemisection.The normal saline group was continuously gavaged with normal saline for 14 days,and the Periplaneta americana powder group was continuously gavaged with Periplaneta americana powder for 14 days.The Basso Beattie Bresnahan scale score was performed at the 6th hour,1st day,3rd day,7th day and 14th day after operation to observe the hindlimb motor function.After 14 days of administration,the rats were sacrificed and sampled.Immunohistochemistry,western blot and immunofluorescence were used to detect the expression of Beclin-1 in the injured site of the spinal cord after hemisection. RESULTS AND CONCLUSION:After operation,the Basso Beattie Bresnahan scale scores were gradually increased in the normal saline group and Periplaneta americana powder group.Compared with the sham-operated group,the Basso Beattie Bresnahan scale scores were significantly reduced in the normal saline group and Periplaneta americana powder group at the 6th hour,1st day,3rd day,7th day and 14th day after operation(P<0.05).The Basso Beattie Bresnahan scale scores in the Periplaneta americana powder group were significantly higher than those in the normal saline group at the 7th and 14th days after operation(P<0.05).Immunohistochemical staining showed that Beclin-1 was weakly positive in the sham-operated group,mainly expressed in the cytoplasm;in the normal saline group,Beclin-1 was mainly expressed in the cytoplasm and partially expressed in the nuclear membrane;in the Periplaneta americana powder group,Beclin-1 was mainly expressed in the cytoplasm and partially expressed in the nuclear membrane.The proportion of Beclin-1 positive cells was higher in the normal saline and Periplaneta americana powder groups than in the sham-operated group(P<0.05),while the proportion of Beclin-1 positive cells was higher in the Periplaneta americana powder group than in the normal saline group(P<0.05).Western blot assay and immunofluorescence staining showed that the Beclin-1 protein expression was higher in the normal saline and Periplaneta americana powder groups than in the sham-operated group(P<0.05),and moreover,the Beclin-1 protein expression was higher in the Periplaneta americana powder group than in the normal saline group(P<0.05).To conclude,Periplaneta americana powder could improve the hindlimb motor function of rats with spinal cord hemisection injury,and the mechanism may be that polysaccharides in the Periplaneta americana powder increase the expression of Beclin-1.

The sternum is the pivotal component of the thoracic cavity. It is connected with the clavicle and ribs on the upper part and both sides respectively, and plays an important role in protecting the stability of the chest wall. Sternal resection usually results in a large segmental chest wall defect that causes the chest wall to float and requires sternal reconstruction. This paper reports a 62 years male patient with thymic squamous cell carcinoma with sternal metastasis, who underwent thymotomy, sternal tumor resection and autologous lilum graft combined with sternal reconstruction by titanium plate after relevant examination was completed and surgical contraindications were eliminated. The patient was followed up for 6 months, the respiratory and motor functions were normal and the thoracic appearance was good.

Objective To explore the protective effect and possible mechanism of Periplaneta americana powder on rats with spinal cord injury.Methods Forty-eight male SD rats were randomly divided into sham operation,saline,Periplaneta americana powder,and Toll-like receptor 4(TLR4)inhibitor groups.Except for the sham operation group,a rat spinal cord hemi-transection injury model was established in the other three groups.The sham operation group received no treatment after the operation,saline and drug groups were subjected to intragastric administration of equal volumes of normal saline and Periplaneta americana powder(630 mg/kg),respectively,and the TLR4 inhibitor group was administered an intraperitoneal injection of TLR4 inhibitor(3 mg/kg).On days 1,3,7,and 14 after the operation,the motor function of rat hind limbs was evaluated by the Basso,Beattie,and Bresnahan(BBB)score.Histopathological changes of the spinal cord were observed by hematoxylin-eosin staining.Changes in the number of neurons were observed by immunohistochemistry.The levels of inflammatory factors IL-1,IL-6,IL-10,and TNF-α were measured by ELISA,and expression of TLR4,myeloid differentiation factor 88(MyD88),and NF-κB p65 was detected by Western Blot.Results Compared with the sham operation group,the BBB score and number of neurons in the saline group were significantly decreased,while the degree of pathological damage,and IL-1,IL-6,TNF-α,TLR4,MyD88,and NF-κB p65 levels were significantly increased(P＜0.05).Compared with the saline group,periplaneta americana powder and TLR4 inhibitor groups showed an increase in BBB scores and the number of neurons,and decreases in the degree of pathological damage and IL-1,IL-6,TNF-α,TLR4,MyD88,and NF-κB p65 levels(P＜0.05).Compared with the TLR4 inhibitor group,the periplaneta americana powder group had better increases in the BBB score,number of neurons and decreases in the degree of pathological damage and expression of IL-1 and TNF-α.Conclusions Periplaneta americana powder reduces the production of inflammatory factors after spinal cord injury by inhibiting the TLR4/MyD88/NF-κB pathway,protects nerves,and promotes motor recovery.

Objective:To investigate the clinical efficacy of total laparoscopic technique in the treatment of pelvic and acetabular fractures.Methods:A total of 7 patients with pelvic and acetabular fractures admitted to the First Affiliated Hospital of Nanjing Medical University from April 2017 to August 2023 were retrospectively analyzed. There were 5 males and 2 females, aged 43.9±9.9 years (range, 27-56 years). There was 1 pelvic fracture (Tile B3) and 6 acetabular fractures, Letournel typing transverse in 2 cases, double column in 1 case, transverse combined anterior column in 1 case, anterior column in 1 case, and "T" shape in 1 case. The causes of injury included traffic accident in 4 cases, falling from height in 1 case, falling in 1 case, and heavy object injury in 1 case. The operation time, intraoperative blood loss, iatrogenic injuries of blood vessels, nerves, bladder and rectum, and incidence of postoperative complications were recorded. Matta imaging criteria was used to evaluate the quality of fracture reduction, and the hip function was evaluated by modified Merle d'Aubigné-Postel score.Results:All 7 patients were successfully operated and followed up for 12.0 (7.0, 72.0) months (range, 7-77 months). The operation time was 251.1±80.2 min (range, 150.0-370.0 min), and the intraoperative blood loss was 100.0 (50.0, 300.0) ml (range, 50-350 ml). There was no nerve, blood vessel, bladder or rectum injury during operation. Postoperative pelvic X-ray and CT showed no internal fixation into the joint. Anatomic reduction was achieved in 5 cases and satisfactory reduction in 2 cases. One patient with a transverse acetabular fracture had a slight separation and displacement of the posterior column, but the acetabular articular surface was flat as a whole without obvious steps and was not fixed. One patient with pelvic fracture had a comminuted anterior pelvic ring with severe displacement and did not achieve anatomical repositioning intraoperatively, but the anterior pelvic ring was a non-intra-articular fracture, and the fracture ends were immobilized with bilateral plates, and the morphology and stability of the anterior pelvic ring recovered well after the operation. The Merle d'Aubigné - Postel score at the final follow-up was 18.0 (17.0, 18.0) points (range, 17.0-18.0 points), with 4 excellent and 3 good cases. All 7 patients achieved clinical healing with a healing time of 2.5 (2.5, 3.0) months (range, 1.0-3.0 months). No delayed union or nonunion occurred. At the last follow-up, there were no complications such as internal fixation fracture, incision and internal fixation infection, and deep vein thrombosis.Conclusion:Total laparoscopic technique for the treatment of pelvic and acetabular fractures has less intraoperative blood loss, less surgical trauma, and satisfactory clinical efficacy. It can be used as a new choice of minimally invasive treatment of pelvic and acetabular fractures.