Objective:This study aims to explore clinical subtypes of Garden typeⅠfemoral neck fractures and develop corresponding reduction strategies based on the characteristics of the fractures.Methods:A retrospective analysis was conducted on the data of 256 patients with Garden type I femoral neck fractures admitted to Tianjin Hospital from January 2015 to January 2018. There were 89 males and 167 females included, with a mean age of 56.5±12.8 years (range, 17-86 years), and with 159 on the left side and 97 on the right side. According to the anteroposterior and lateral X-ray images, the fractures were further classified into two subtypes: 111 cases of Garden type I a (simple abduction without hypsokinesis of the femoral head), characterized by abduction and impaction of the femoral head on anteroposterior images, and no obvious hypsokinesis of the femoral head or only central impaction of the femoral head on lateral images; 145 cases of Garden I b type (femoral head abduction with hypsokinesis), characterized by abduction and impaction of the femoral head on anteroposterior images, and remarkable hypsokinesis on lateral images. The injury mechanism of type I a involved abduction and impaction caused by the violent extension, abduction, and external rotation of the hip joint. Mild flexion and adduction of the hip joint can be used to reduce the abduction and impaction. The injury mechanism of type I b is similar to type Ia in the first stage, but the violence continues to increase and leading to significant hypsokinesis of the femoral head. Reduction was achieved by excessive flexion, adduction, and mild internal rotation, tilting the femoral head backward to facilitate reduction. The surgical strategy were close reduction and cannulated screw fixation (three cannulated screws in an "inverted triangle" arrangement). Postoperatively, anteroposterior and lateral X-rays were taken immediately to assess the quality of reduction, including the Garden index, Lowell "S" curve, and screw placement. During follow-up, fracture healing and complications were recorded, and Harris score was used to evaluate hip joint function at the final follow-up.Results:All patients successfully received operative therapy and were followed up with a mean of 7.1±1.9 years (range, 5-10 years). Garden index showed 91.4%(234/256) achieved anatomical reduction, with an excellent reduction rate of 97.3%(249/256). The excellent rate of the Lowell "S" curve was 97.7%(250/256), and the excellent and good rate for screw insertion was 98.8%(253/256). All patients achieved primary fracture healing without infection, nonunion of fractures, failure of internal fixation, or other complications. Two patitents with Garden I b fractures (0.8%) developed femoral head necrosis due to premature weight-bearing at 9 and 12 months postoperatively, respectively, after fracture healing. However, with strict hip preservation treatment, their symptoms resolved without further progression of necrosis or need for reoperation. At the final follow-up, the mean Harris score was 93.9±4.5 points (range, 81-100 points), with an excellent and good rate of 98.8%(253/256).Conclusions:Garden I femoral neck fractures can be categorized into two subtypes based on their characteristics and injury mechanisms. Adopting corresponding reduction methods according to subtypes can achieve anatomical reduction and favorable early to mid-stage therapeutic outcomes (primary fracture healing and low incidence of femoral head necrosis).

Objective:This study aims to explore clinical subtypes of Garden typeⅠfemoral neck fractures and develop corresponding reduction strategies based on the characteristics of the fractures.Methods:A retrospective analysis was conducted on the data of 256 patients with Garden type I femoral neck fractures admitted to Tianjin Hospital from January 2015 to January 2018. There were 89 males and 167 females included, with a mean age of 56.5±12.8 years (range, 17-86 years), and with 159 on the left side and 97 on the right side. According to the anteroposterior and lateral X-ray images, the fractures were further classified into two subtypes: 111 cases of Garden type I a (simple abduction without hypsokinesis of the femoral head), characterized by abduction and impaction of the femoral head on anteroposterior images, and no obvious hypsokinesis of the femoral head or only central impaction of the femoral head on lateral images; 145 cases of Garden I b type (femoral head abduction with hypsokinesis), characterized by abduction and impaction of the femoral head on anteroposterior images, and remarkable hypsokinesis on lateral images. The injury mechanism of type I a involved abduction and impaction caused by the violent extension, abduction, and external rotation of the hip joint. Mild flexion and adduction of the hip joint can be used to reduce the abduction and impaction. The injury mechanism of type I b is similar to type Ia in the first stage, but the violence continues to increase and leading to significant hypsokinesis of the femoral head. Reduction was achieved by excessive flexion, adduction, and mild internal rotation, tilting the femoral head backward to facilitate reduction. The surgical strategy were close reduction and cannulated screw fixation (three cannulated screws in an "inverted triangle" arrangement). Postoperatively, anteroposterior and lateral X-rays were taken immediately to assess the quality of reduction, including the Garden index, Lowell "S" curve, and screw placement. During follow-up, fracture healing and complications were recorded, and Harris score was used to evaluate hip joint function at the final follow-up.Results:All patients successfully received operative therapy and were followed up with a mean of 7.1±1.9 years (range, 5-10 years). Garden index showed 91.4%(234/256) achieved anatomical reduction, with an excellent reduction rate of 97.3%(249/256). The excellent rate of the Lowell "S" curve was 97.7%(250/256), and the excellent and good rate for screw insertion was 98.8%(253/256). All patients achieved primary fracture healing without infection, nonunion of fractures, failure of internal fixation, or other complications. Two patitents with Garden I b fractures (0.8%) developed femoral head necrosis due to premature weight-bearing at 9 and 12 months postoperatively, respectively, after fracture healing. However, with strict hip preservation treatment, their symptoms resolved without further progression of necrosis or need for reoperation. At the final follow-up, the mean Harris score was 93.9±4.5 points (range, 81-100 points), with an excellent and good rate of 98.8%(253/256).Conclusions:Garden I femoral neck fractures can be categorized into two subtypes based on their characteristics and injury mechanisms. Adopting corresponding reduction methods according to subtypes can achieve anatomical reduction and favorable early to mid-stage therapeutic outcomes (primary fracture healing and low incidence of femoral head necrosis).

Objective:To compare the efficacy of closed reduction and internal fixation combined with percutaneous kyphoplasty (PKP) and non-operative treatment for intertrochanteric fracture combined with osteoporotic vertebral compression fracture (OVCF) in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 59 patients with intertrochanteric fracture combined with OVCF admitted to Tianjin Hospital from June 2020 to June 2023, including 16 males and 43 females, aged 66-91 years [(80.2±6.8)years]. The injured vertebral segments included T 10 in 3 patients, T 11 in 9, T 12 in 18, L 1 in 17, L 2 in 8, and L 3 in 4. According to the Genant semi-quantitative classification of vertebral fracture, 42 patients were scaled into grade 1 and 17 into grade 2. Based on the AO classification of intertrochanteric fracture, 33 patients were classified as type A1, 21 type A2, and 5 type A3. All the patients underwent closed reduction and internal fixation for intertrochanteric fractures, among whom 26 patients received PKP after the internal fixation of OVCF (PKP group) and 33 patients received non-surgical treatment after the internal fixation of OVCF (non-surgical group). The healing of the hip incision at 2 weeks after internal fixation and the healing of intertrochanteric fractures at 6 months after surgery were observed in both groups. The visual analogue scale (VAS) for low back pain was compared between the two groups before PKP, immediately after PKP, at 3 months after PKP, and at the last follow-up. The Oswestry disability index (ODI), anterior vertebral height ratio, and Cobb angle of the injured vertebrae were compared between the two groups before PKP, at 3 months after PKP, and at the last follow-up. The Harris hip function score was compared between the two groups at 3 months after internal fixation and at the last follow-up. Cement leakage was observed. The incidence of deep vein thrombosis (DVT) in the lower extremities after internal fixation were compared between the two groups. Results:All the patients were followed up for 10-46 months [(25.5±9.9)months]. The hip incisions of both groups all healed by first intention at 2 weeks after internal fixation, and the intertrochanteric fracture in both groups had bony union at 6 months after surgery. There were no significant differences between the two groups in VAS or ODI before PKP ( P>0.05). Immediately after PKP, at 3 months after PKP, and at the last follow-up, the VAS scores for low back pain were (2.6±0.6)points, (2.4±0.9)points, and (1.5±0.5)points in the PKP group, which were lower than those in the non-surgical group [(8.2±0.8)points, (3.7±1.2)points, and (3.3±0.6)points] ( P<0.01). At 3 months after PKP and at the last follow-up, the ODI values were (21.4±6.9)% and (16.2±6.3)% in the PKP group, which were lower than (38.6±11.6)% and (32.7±12.0)% in the non-surgical group ( P<0.01). The VAS for low back pain and ODI in both groups were gradually improved at each time point after PKP compared with those before PKP ( P<0.05 or 0.01). There were no significant differences in the anterior vertebral height ratio or Cobb angle of the injured vertebrae in the two groups before PKP ( P>0.05). At 3 months after PKP and at the last follow-up, the anterior vertebral height ratio was (79.8±9.6)% and (79.3±9.4)% in the PKP group, which were higher than (73.4±9.3)% and (62.0±10.4)% in the non-surgical group ( P<0.05 or 0.01); the values of the Cobb angle of the injured vertebrae were (12.6±3.6)° and (12.0±3.3)°in the PKP group, which were lower than (15.5±2.6)° and (20.4±4.9)° in the non-surgical group ( P<0.01). There were no significant differences in the anterior vertebral height ratio and Cobb angle of the injured vertebrae in the PKP group before PKP and at each time point after PKP ( P>0.05) while in the non-surgical group, the anterior vertebral height ratio at each time point after PKP was lower than that before PKP and the Cobb angle of the injured vertebrae was increased compared with that before PKP ( P<0.01). At 3 months after internal fixation and at the last follow-up, the Harris hip function scores in the PKP group were (76.4±3.4)points and (87.7±4.5)points, which were higher than (57.0±6.8)points and (76.3±8.9)points in the non-surgical group ( P<0.01). The Harris hip function scores in both groups were improved at the last follow-up, compared with those at 3 months after internal fixation. Five patients had cement leakage in the PKP group, all of which were lateral leakage.There was no occurrence of radiating pain in the lower extremities. The incidence of DVT at 1 month after internal fixation was 19.2% (5/26) in the PKP group, which was lower than 57.6% (19/33) in the non-surgical group ( P<0.01). Conclusion:Compared with non-operative treatment after the closed reduction and internal fixation, PKP after internal fixation can significantly relieve low back pain in the early stage, improve the functional restoration of the vertebral column, maintain vertebral height, prevent kyphosis, promote the recovery of the hip joint function, and reduce the occurrence of DVT in the lower extremities in the treatment of intertrochanteric fracture combined with OVCF.

Objective:To compare the efficacy of closed reduction and internal fixation combined with percutaneous kyphoplasty (PKP) and non-operative treatment for intertrochanteric fracture combined with osteoporotic vertebral compression fracture (OVCF) in the elderly.Methods:A retrospective cohort study was conducted to analyze the clinical data of 59 patients with intertrochanteric fracture combined with OVCF admitted to Tianjin Hospital from June 2020 to June 2023, including 16 males and 43 females, aged 66-91 years [(80.2±6.8)years]. The injured vertebral segments included T 10 in 3 patients, T 11 in 9, T 12 in 18, L 1 in 17, L 2 in 8, and L 3 in 4. According to the Genant semi-quantitative classification of vertebral fracture, 42 patients were scaled into grade 1 and 17 into grade 2. Based on the AO classification of intertrochanteric fracture, 33 patients were classified as type A1, 21 type A2, and 5 type A3. All the patients underwent closed reduction and internal fixation for intertrochanteric fractures, among whom 26 patients received PKP after the internal fixation of OVCF (PKP group) and 33 patients received non-surgical treatment after the internal fixation of OVCF (non-surgical group). The healing of the hip incision at 2 weeks after internal fixation and the healing of intertrochanteric fractures at 6 months after surgery were observed in both groups. The visual analogue scale (VAS) for low back pain was compared between the two groups before PKP, immediately after PKP, at 3 months after PKP, and at the last follow-up. The Oswestry disability index (ODI), anterior vertebral height ratio, and Cobb angle of the injured vertebrae were compared between the two groups before PKP, at 3 months after PKP, and at the last follow-up. The Harris hip function score was compared between the two groups at 3 months after internal fixation and at the last follow-up. Cement leakage was observed. The incidence of deep vein thrombosis (DVT) in the lower extremities after internal fixation were compared between the two groups. Results:All the patients were followed up for 10-46 months [(25.5±9.9)months]. The hip incisions of both groups all healed by first intention at 2 weeks after internal fixation, and the intertrochanteric fracture in both groups had bony union at 6 months after surgery. There were no significant differences between the two groups in VAS or ODI before PKP ( P>0.05). Immediately after PKP, at 3 months after PKP, and at the last follow-up, the VAS scores for low back pain were (2.6±0.6)points, (2.4±0.9)points, and (1.5±0.5)points in the PKP group, which were lower than those in the non-surgical group [(8.2±0.8)points, (3.7±1.2)points, and (3.3±0.6)points] ( P<0.01). At 3 months after PKP and at the last follow-up, the ODI values were (21.4±6.9)% and (16.2±6.3)% in the PKP group, which were lower than (38.6±11.6)% and (32.7±12.0)% in the non-surgical group ( P<0.01). The VAS for low back pain and ODI in both groups were gradually improved at each time point after PKP compared with those before PKP ( P<0.05 or 0.01). There were no significant differences in the anterior vertebral height ratio or Cobb angle of the injured vertebrae in the two groups before PKP ( P>0.05). At 3 months after PKP and at the last follow-up, the anterior vertebral height ratio was (79.8±9.6)% and (79.3±9.4)% in the PKP group, which were higher than (73.4±9.3)% and (62.0±10.4)% in the non-surgical group ( P<0.05 or 0.01); the values of the Cobb angle of the injured vertebrae were (12.6±3.6)° and (12.0±3.3)°in the PKP group, which were lower than (15.5±2.6)° and (20.4±4.9)° in the non-surgical group ( P<0.01). There were no significant differences in the anterior vertebral height ratio and Cobb angle of the injured vertebrae in the PKP group before PKP and at each time point after PKP ( P>0.05) while in the non-surgical group, the anterior vertebral height ratio at each time point after PKP was lower than that before PKP and the Cobb angle of the injured vertebrae was increased compared with that before PKP ( P<0.01). At 3 months after internal fixation and at the last follow-up, the Harris hip function scores in the PKP group were (76.4±3.4)points and (87.7±4.5)points, which were higher than (57.0±6.8)points and (76.3±8.9)points in the non-surgical group ( P<0.01). The Harris hip function scores in both groups were improved at the last follow-up, compared with those at 3 months after internal fixation. Five patients had cement leakage in the PKP group, all of which were lateral leakage.There was no occurrence of radiating pain in the lower extremities. The incidence of DVT at 1 month after internal fixation was 19.2% (5/26) in the PKP group, which was lower than 57.6% (19/33) in the non-surgical group ( P<0.01). Conclusion:Compared with non-operative treatment after the closed reduction and internal fixation, PKP after internal fixation can significantly relieve low back pain in the early stage, improve the functional restoration of the vertebral column, maintain vertebral height, prevent kyphosis, promote the recovery of the hip joint function, and reduce the occurrence of DVT in the lower extremities in the treatment of intertrochanteric fracture combined with OVCF.

Objective:To explore the relationships among the activity level of coagulation factor XII (FXII), coagulation function indexes, polymorphisms of F12 gene loci rs17876030 and rs1801020, as well as their correlations with deep venous thrombosis (DVT) in fracture patients. Methods:A case-cohort control study was conducted. 200 fracture patients diagnosed and treated in the Department of Traumatic Orthopedics of Tianjin Hospital from September 2015 to September 2023 were included. They received routine anticoagulant prophylaxis for DVT treatment but still developed DVT during hospitalization (thrombus group). 100 fracture patients hospitalized during the same period without DVT under the same anticoagulant strategy were matched (non-thrombus group). 100 healthy people who underwent physical examinations in the outpatient department of Tianjin Hospital during the same period were also matched (normal group). Plasma samples of all subjects were collected. Laboratory tests were performed to measure activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (Fg), D-Dimer. The activity level of FXII was detected by the one-stage fixation method, the antigen of FXII was detected by enzyme-linked immunosorbent assay, and the polymorphisms of F12 gene loci rs17876030 and rs1801020 were detected by direct sequencing method. The relationships among various detection indexes and their correlations with DVT were analyzed. Results:There were no statistically significant differences in APTT, PT, and TT among the thrombus group, non-thrombus group, and normal group ( F=0.748, P=0.483; F=0.092, P=0.840; F=0.031, P=0.660). The Fg in the thrombus group was 4.5±2.4 g/L and D-Dimer was 786.2±234.9 mg/L, which were statistically different from 2.9±1.8 g/L and 261.3±165.5 mg/L in the non-thrombus group and 2.2±1.1 g/L and 198.1±96.4 mg/L in the normal group respectively ( F=3.473, P=0.046; F=34.960, P<0.001; P<0.05). The activity of FⅫ in the thrombus group was 78.3%±21.9%, which was statistically different from 97.8%±31.4% in the non-thrombus group and 94.5%±35.7% in the normal group ( F=3.581, P=0.032; P<0.05). The activity of FXII was negatively correlated with APTT ( r=-0.149, P=0.035). In the thrombus group, there were 122 cases (61.0%) with the TT genotype of rs17876030, which was statistically different from 34 cases (34.0%) in the non-thrombus group and 30 cases (30.0%) in the normal group (χ 2=12.630, P=0.002). In the thrombus group, there were 115 cases (57.5%) with the CC genotype of rs1801020, which was statistically different from 25 cases (25.0%) in the non-thrombus group and 16 cases (16.0%) in the normal group (χ 2=26.820, P<0.001). The activity levels of FXII of the TT genotype of rs17876030 in the thrombus group, non-thrombus group, and normal group were lower than those of the CC and CT genotypes, and the differences were statistically significant ( F=27.130, P<0.001; F=18.384, P<0.001; F=12.830, P=0.001; P<0.05). The activity levels of FXII of the CC genotype of rs1801020 in the three groups were lower than those of the TT and CT genotypes, and the differences were statistically significant ( F=38.631, P<0.001; F=23.562, P<0.001; F=25.829, P<0.001; P<0.05). The proportion of the TT genotype of rs17876030 was the highest in the thrombus group, and the activity level of FⅫ in patients with this genotype was lower. The TT genotype of rs17876030 was related to DVT ( r=-0.831, P=0.043). The proportion of the CC genotype of rs1801020 was the highest in the thrombus group, and the activity level of FⅫ in patients with this genotype was lower. The CC genotype of rs1801020 was related to DVT ( r=-0.784, P=0.040). Conclusion:Fg and D-Dimer are related to DVT. The activity level of FXII is negatively correlated with APTT. Prolonged APTT suggests the possibility of FⅫ deficiency, and the decreased activity level of FXII may be related to DVT.

Objective:To explore the relationships among the activity level of coagulation factor XII (FXII), coagulation function indexes, polymorphisms of F12 gene loci rs17876030 and rs1801020, as well as their correlations with deep venous thrombosis (DVT) in fracture patients. Methods:A case-cohort control study was conducted. 200 fracture patients diagnosed and treated in the Department of Traumatic Orthopedics of Tianjin Hospital from September 2015 to September 2023 were included. They received routine anticoagulant prophylaxis for DVT treatment but still developed DVT during hospitalization (thrombus group). 100 fracture patients hospitalized during the same period without DVT under the same anticoagulant strategy were matched (non-thrombus group). 100 healthy people who underwent physical examinations in the outpatient department of Tianjin Hospital during the same period were also matched (normal group). Plasma samples of all subjects were collected. Laboratory tests were performed to measure activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (Fg), D-Dimer. The activity level of FXII was detected by the one-stage fixation method, the antigen of FXII was detected by enzyme-linked immunosorbent assay, and the polymorphisms of F12 gene loci rs17876030 and rs1801020 were detected by direct sequencing method. The relationships among various detection indexes and their correlations with DVT were analyzed. Results:There were no statistically significant differences in APTT, PT, and TT among the thrombus group, non-thrombus group, and normal group ( F=0.748, P=0.483; F=0.092, P=0.840; F=0.031, P=0.660). The Fg in the thrombus group was 4.5±2.4 g/L and D-Dimer was 786.2±234.9 mg/L, which were statistically different from 2.9±1.8 g/L and 261.3±165.5 mg/L in the non-thrombus group and 2.2±1.1 g/L and 198.1±96.4 mg/L in the normal group respectively ( F=3.473, P=0.046; F=34.960, P<0.001; P<0.05). The activity of FⅫ in the thrombus group was 78.3%±21.9%, which was statistically different from 97.8%±31.4% in the non-thrombus group and 94.5%±35.7% in the normal group ( F=3.581, P=0.032; P<0.05). The activity of FXII was negatively correlated with APTT ( r=-0.149, P=0.035). In the thrombus group, there were 122 cases (61.0%) with the TT genotype of rs17876030, which was statistically different from 34 cases (34.0%) in the non-thrombus group and 30 cases (30.0%) in the normal group (χ 2=12.630, P=0.002). In the thrombus group, there were 115 cases (57.5%) with the CC genotype of rs1801020, which was statistically different from 25 cases (25.0%) in the non-thrombus group and 16 cases (16.0%) in the normal group (χ 2=26.820, P<0.001). The activity levels of FXII of the TT genotype of rs17876030 in the thrombus group, non-thrombus group, and normal group were lower than those of the CC and CT genotypes, and the differences were statistically significant ( F=27.130, P<0.001; F=18.384, P<0.001; F=12.830, P=0.001; P<0.05). The activity levels of FXII of the CC genotype of rs1801020 in the three groups were lower than those of the TT and CT genotypes, and the differences were statistically significant ( F=38.631, P<0.001; F=23.562, P<0.001; F=25.829, P<0.001; P<0.05). The proportion of the TT genotype of rs17876030 was the highest in the thrombus group, and the activity level of FⅫ in patients with this genotype was lower. The TT genotype of rs17876030 was related to DVT ( r=-0.831, P=0.043). The proportion of the CC genotype of rs1801020 was the highest in the thrombus group, and the activity level of FⅫ in patients with this genotype was lower. The CC genotype of rs1801020 was related to DVT ( r=-0.784, P=0.040). Conclusion:Fg and D-Dimer are related to DVT. The activity level of FXII is negatively correlated with APTT. Prolonged APTT suggests the possibility of FⅫ deficiency, and the decreased activity level of FXII may be related to DVT.

Objective:To investigate the relationship between the expression level of thymocyte selection-associated high mobility group box protein ( TOX) gene and the radiosensitivity of lower-grade glioma (LGG) patients. Methods:Using bioinformatics research methods, 474 LGG patients from The Cancer Genome Atlas (TCGA) database were selected as the test set (TCGA-474 set), and two different genetic data sets ( n=412 and n=171) from the Chinese Glioma Genome Atlas (CGGA) database were selected as the validation set (CGGA-412 set and CGGA-171 set). Patients were stratified based on whether received radiotherapy, and divided into the high and low TOX expression group according to the expression level of TOX gene in LGG. Survival curves of all patients were plotted. The overall survival (OS) and progression-free survival (PFS) of patients in the high and low TOX expression groups were compared and analyzed using log-rank test. Results:Multivariate analysis of OS in the TCGA-474 set showed that high expression of TOX was a protective factor for OS ( HR=0.061, 95% CI: 0.005-0.791, P=0.044). After stratification analysis based on radiotherapy and adjustment for confounding factors, the HR (95% CI) of patients with high TOX expression in the TCGA-474, CGGA-412, and CGGA-171 sets were 0.405 (0.261-0.629), 0.581 (0.418-0.806), and 0.464 (0.269-0.800), respectively, with P values of <0.001, 0.001, and 0.008, respectively. Among patients receiving radiotherapy in the TCGA-474 set, the OS and PFS of patients with high TOX expression were significantly longer than those in the low TOX expression group, and the differences were statistically significant (both P<0.001). The OS benefit of patients with high expression of TOX was significantly prolonged in both the CGGA-412 and CGGA-171 sets compared to those with low TOX expression, and the differences were statistically significant (both P<0.001). Conclusion:The high expression of TOX may be related to the radiosensitivity of LGG, which may be a gene marker of the radiosensitivity of LGG.

Objective:To investigate the early effects of cup in cup technique in reconstructing paprosky III acetabular bone defect in revision hip arthroplasty.Methods:From January 2017 to December 2019, a total of 20 cases (20 hips) with paprosky III acetabular bone defect were reconstructed by Cup-in-Cup technique, including 9 males and 11 females. The age ranged from 45 to 76 years, with an average of 64.6 years. The causes of revision were aseptic loosening of prosthesis in 17 cases and loosening of prosthesis caused by periprosthetic infection in 3 cases. There were 13 hips with acetabular bone defect of paprosky IIIA and 7 hips with paprosky IIIB. The acetabular side was repaired in 13 cases, and the acetabulum and femoral side were repaired in 7 cases at the same time. Harris hip score was used to evaluate hip function during postoperative follow-up. The occurrence of serious complications such as intraoperative vascular and nerve injury, postoperative prosthesis dislocation, periprosthetic infection and fracture were counted. The height and horizontal position of hip rotation center were measured by X-ray film.Results:The operation duration was 110±25 min (range 80-180 min) and intraoperative bleeding was 700±180 ml. All cases were followed up for 12-36 months, with an average of 18 months. At the last follow-up, the Harris hip score of 16 cases was more than 80, with excellen in 2 cases, good in 14 cases and fair in 4 cases. The Harris score was 84.3±7.5, which was significantly higher than that before operation 40.1±16.6 ( t=15.34, P<0.001). The height of hip joint rotation center on the affected side decreased from 34.2± 3.3 mm before operation to 18.6±2.8 mm after operation with significant difference ( t=15.11, P<0.001). The horizontal distance increased from 18.1±5.5 mm before operation to 26.2±7.3 mm after operation with significant difference ( t=-5.95, P<0.001). After operation, the height of hip joint rotation center on the affected side was slightly higher than that on the opposite side, with a significant difference between the affected side 18.6±2.8 mm and the opposite side 12.2±3.3 mm ( t=6.73, P=0.018). The horizontal position was 26.2±7.3 mm, which had no significant difference compared with the contralateral 30.1±5.5 mm ( t=-3.29, P=0.381). There was no vascular and nerve injury, periprosthetic infection or incision related complications. During the following-up, the prosthesis was in satisfied position without prosthesis or screw loosening and fracture. Conclusion:The reconstruction of paprosky III acetabular bone defect with Cup-in-Cup technique in revision hip arthroplasty can obtain satisfied early effects, with achieving relatively normal hip rotation center and initial stability.

BACKGROUNDBreast cancer is one of the most common malignant female diseases worldwide. It is a significant threat to every woman's health. Vascular endothelial growth inhibitor (VEGI) is known to be abundant in endothelial cells. According to previous literature, overexpression of VEGI has been shown to inhibit tumor neovascularisation and progression in cellular and animal models, but there has been limited research on the significance of VEGI in the breast cancer.

METHODSIn our study, cell lines MDA-MB-231 were first constructed in which VEGI mediated by lentivirus over-expressed. The effects of VEGI over-expression on MDA-MB-231 cells were investigated both in vitro and in vivo. The expression of VEGI in the MDA-MB-231 cells after infection of lentivirus was analyzed using real-time PCR and Western blotting. The effect of the biological characteristics of MDA-MB-231 cells was assessed by growth, invasion, adhesion, and migration assay with subcutaneous tumor-bearing nude mice models. Then the growth curves of the subcutaneous tumors were studied. Expressions of VEGI, CD31 and CD34 in the tumors were analyzed by immunohistochemistry and apoptosis was detected by flow cytometry and immunohistochemistry.

RESULTSInfection of MDA-MB-231 cells within the lentivirus resulted in approximately a 1 000-fold increase in the expression of VEGI. As can be seen in the invasion, adhesion and migration assay, the over-expression of VEGI can inhibit the ability of MDA-MB-231 cells during migration, adhesion and invasion. The volume of the subcutaneous tumor in the over-expression group was distinctly and significantly less than that of the control groups. Immunohistochemistry analysis of the tumor biopsies clearly showed the expression of VEGI in the over-expression group increased while CD31 and CD34 decreased significantly. In vitro and in vivo, the early apoptosis rate and the apoptosis index were increased within the VEGI over-expression group as compared with the control group.

CONCLUSIONSTaken together, recombinant lentivirus that were successfully constructed, demonstrated up-regulated VEGI gene expression in breast cancer cells. Lentivirus-mediated over-expression of VEGI weakened the ability of the breast cancer cell migration, adhesion and invasion. Over-expression of VEGI diminished the tumorigenic capacity of breast cancer cells in vivo. Up-regulation of VEGI gene expression however inhibited breast cancer MDA-MB-231 cell in the early apoptosis.

Apoptosis ; genetics ; physiology ; Breast Neoplasms ; genetics ; metabolism ; pathology ; Cell Line, Tumor ; Cell Proliferation ; genetics ; physiology ; Female ; Gene Expression Regulation, Neoplastic ; genetics ; physiology ; Genetic Vectors ; genetics ; Humans ; Lentivirus ; genetics ; Vascular Endothelial Growth Factors ; genetics ; metabolism

Objective To investigate the influence of anti-angiogenesis therapy on proliferation and apoptosis of fibroblasts derived from keloids. Methods Thirty pieces of keloids from a patient were implanted into subcutaneous tissue of the nude mice, 24 pieces of which survived were divided into three groups which were treated with perilesional injection of vascular endothelial growth factor( VEGF) (0.4 mg/0.2 mL) , Endostar(0.125 g/0.2 mL) and physiological saline (0.2 mL)on the 21 d, 23 d, 25 d, 27 d after implantation. Sample were collected on the 10th day after perilesional injection, the proliferating fibroblasts in keloid tissue were immunohistochemically detected by proliferating cell nuclear antigen (PCNA) expression. The apoptotic cell was detected by terminal deoxynucleotidyl transferase dUTP-nick end labeling (TUNEL) staining. Results IHC staining indicated that PCNA expression of fibroblasts was significantly increased in keloid tissue after VEGF injection, PCNA expression of fibroblasts was significantly reduced in keloid tissue after Endostar injection,TUNEL assay revealed lower apoptotic cells expression in the keloid tissue after VEGF injection and higher in the Endostar group than control group. The rate of proliferative index (PI) , apoptotic index(AI) and AI/PI of fibroblasts in keloid after VEGF (PI:41.13 ±2.29,AI:5.75 ±1.28,AI/PI: 0.14 ± 0.04)or Endostar injection (PI:27.25 ±2.61,AI:11.00±1.31,AI/PI:0.41 ±0.09)and control group (PI: 34.75 ±3.62,AI:7. 88 ± 1.64,AI/PI:0. 23 ±0.07) showed statistical differences. Conclusion Anti-angiogenesis therapy is shown to induce keloid regression through suppression of keloid fibroblast proliferation,induction of apoptosis, which may be a new approach for the treatment of keloids.