Objective:To investigate the association between plaque vulnerability characteristics and infarction sub-types in patients with acute unilateral anterior circulation cerebral infarction due to intracranial atherosclerotic disease.Methods:A total of 58 eligible patients who underwent intracranial high-resolution magnetic resonance imaging (HRMRI) were finally enrolled in the retrospective study from December 2018 to December 2020. In the current study, all patients were classified into the group with artery-to-artery (A-to-A) embolic infarction ( n=32) and the group without ( n=26), according to infarction sub-types on diffusion-weighted imaging. Baseline information, the presence/absence of hyperintense plaque, irregular plaque surface, remodeling pattern and quadrant distribution by HRMRI were collected and evaluated. Multivariate Logistic regression analysis was performed to determine the relationship between plaque vulnerability and infarction sub-types. Furthermore, the analysis of interaction between hyperintense plaque and positive remodeling in response to A-to-A embolism was visualized by Sankey diagram. Results:The presence of hyperintense plaque ( OR=3.90, 95% CI 1.21-12.59, P=0.023) and arterial remodeling patterns (positive remodeling vs intermediate state, OR=4.32, 95% CI 0.86-21.49, P for trend=0.027) were the strong independent predictors for A-to-A embolism. Importantly, a significantly positive synergy between the remodeling pattern and hyperintense plaque in response to infarction sub-types was found by Sankey diagram ( Wald=10.044, P for interaction=0.007). Similarly, in receiver operating characteristic curve analysis, the discrimination of hyperintense plaque combined with positive remodeling for A-to-A embolism was significantly superior to that of either biomarker alone (area under the curve=0.710, 95% CI 0.576-0.845, P=0.006). Conclusion:A synergistic effect between positive remodeling and hyperintense plaque can promote plaque vulnerability, suggesting a potential target sub-population may benefit from stroke prevention with intensive antithrombotic therapy, although this must be confirmed in future.

Treatment of adult femoral neck fracture is still a great challenge faced by trauma orthopedists. As treatment effects can be infleunced by multiple factors, like age, gender and preoperative physical condition, they may vary with different treatment schemes. Classification of femoral neck fractures plays an important guiding role in choosing a proper treatment scheme and judging the prognosis. The current classic clinical classification systems for femoral neck fractures include Garden, AO/OTA and Pauwels classifications. Since the recent progress in science and technology has put more advanced technologies into clinic application, such as CT, MRI and Digital Subtraction Angiography (DSA), new ways of classification have appeared. However, each classification has its own shortcomings which need to be improved. This paper reviews the research progress in classification of adult femoral neck fractures and their treatment principles.

Objective:To evaluate internal fixation via only the modified Stoppa approach in the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall.Methods:A retrospective study was conducted in the 13 patients with central hip dislocation and fracture of the posterior acetabular wall who had been treated at Department of Orthopedic Trauma, Nanfang Hospital between February 2015 and February 2018. They were 10 men and 3 women, aged from 31 to 65 years (average, 46.7 years). All patients were treated with internal fixation via only the modified Stoppa approach. The reduction of double-column and posterior wall fractures was evaluated according to the X-ray Matta scoring system, as well as to the Wiberg central-edge (CE) angles between the vertical line of the center point of the femoral head and the lateral edge of the acetabulum and acetabular tolerance on the normal and affected sides immediately after operation; the hip function was evaluated by the modified Merle d'Aubigne and Postel scoring system at 12 months after operation.Results:All patients were followed up for 16 to 52 months (average, 25.6 months). In all of them, reduction and fixation of central hip dislocation and acetabular fracture was completed successfully, and indirect reduction of posterior wall fracture and acetabular tolerance were satisfactory. Operation time ranged from 130 to 270 min, averaging 155.5 min; intraoperative blood loss from 600 to 5,600 mL, averaging 1,150.5 mL; intraoperative infusion of concentrated red blood cells from 2 to 12 U, averaging 6 U. By the X-ray Matta scoring system immediately after operation, anatomical reduction was achieved in 4 posterior wall fractures and satisfactory reduction in 9 ones. There was no significant difference between the normal and affected sides in the CE angle (43.53°±3.46° for the affected side versus 43.19°±3.28° for the normal side) or in the acetabular tolerance (76.56%±15.50% for the affected side versus 75.32%±16.24% for the normal side) ( P>0.05). The modified Merle d'Aubigne and Postel scores at 12 months after operation ranged from 12 to 18 points, averaging 16.5 points; the hip function was assessed as excellent in 9 cases, as good in 3 and as fair in one. By the last follow-up, none of the 13 patients lost fracture reduction, and their internal fixation was firm with no loosening or breakage. Conclusion:In the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall, internal fixation via only the modified Stoppa approach can lead to satisfactory fracture reduction, firm fixation, good hip joint tolerance, and fine clinical efficacy.

Femoral neck fracture in children is usually caused by high-energy trauma. This relatively rare injury characterized by skeletal immaturity is different from that in adult patients in proximal femoral anatomy and blood supply. Currently, a variety of fixation methods have been used for paediatric femoral neck fractures but their overall goal is anatomical reduction and stable fixation. Femoral neck fractures in children are usually associated with a high incidence of complications (e.g. femoral head necrosis, premature epiphyseal closure, coxa vara and nonunion) even after appropriate treatment. This review addresses the anatomic characteristics, treatment strategies and complications in the treatment of paediatric femoral neck fractures.

Objective To study the newborn screening program,morbidity,laboratory findings,gene mutations,treatment and follow-up of neonatal propionic academia (PA) in Xuzhou City.Method From September 2015 to September 2018,the blood sample of neonates from newborn screening program in Xuzhou were measured using liquid chromatography tandem mass spectrometry (LC-MS/MS) method to examine the blood acylcarnitine level.The diagnosis was confirmed by urine gas chromatography mass spectrometry (GC-MS) and gene analysis.The clinical manifestation,laboratory findings,gene analysis,treatment and prognosis were retrospectively analyzed.Result A total of 297 610 live birth infants blood samples were screened using MS/MS,and 8 cases were diagnosed with PA,with a prevalence of 1∶37 201.Among the 8 patients,7 had no clinical symptoms before the diagnosis and one already had symptoms including recurrent vomiting,drowsiness,tachypnea and hypotonia.Gene analysis revealed that 6 cases carried propionyl-CoA carboxylase α (PCCA) gene mutations and 2 cases carried propionyl-CoA carboxylase β (PCCB) gene mutations.A total of 10 types of PCCA gene mutations were detected,including 5 missense mutations,4 splicing mutations and 1 synonymous mutation,among which 7 were de-novo mutations.A total of 4 types of PCCB gene mutations were detected,including 2 missense mutations,1 frameshift duplication and 1 splicing mutation,among which 3 were de-novo mutations.1 patient died after refusing treatments.The other 7 cases showed significant decline of the blood propionyl-carnitine level,the ratio of propionyl-carnitine to acetylcarnitine,3-OH-propionate and methylcitrate level in urine after treatment.4 cases had normal growth and development,and 3 cases showed various psychomotor retardation on follow-up.Conclusion Newborn screening using LC-MS/MS method is important for early diagnosis of PA.The incidence of PA is relatively high in Xuzhou City.The major clinical manifestations of PA were neurological symptoms.The main cause is PCCA gene defects and missense mutation is most common.

Objective To explore the clinical effect of endoscope assisted suction-cutter removal of apocrine sweat glands in treatment of osmidrosis.Methods This study generalized and analyzed the curative effects of 30 patients with axillary osmidrosis,treated with endoscopy assisted suction-cutter removal of apocrine sweat glands.The efficacy was evaluated according to the postoperative results and complications.Results In all the 30 patients,wound healed 7 to 10 days after operation,and they resumed almost normal life after treatment.From May 2015 to April 2017,the follow-up visits showed that none of them had relapse,infection or skin necrosis.Surgical scar was slight,and in all the patients,symptoms disappeared.Conclusions The operation of endoscopy assisted suction-cutter removal of apocrine sweat glands is a minimally invasive surgery.The advantages include direct vision,radical operation,well preserved dermal vascular network and lower risk of complications.

Novel biologics that redirect cytotoxic T lymphocytes (CTLs) to kill tumor cells bearing a tumor associated antigen hold great promise in the clinic. However, the ability to safely and potently target CD3 on CTL toward tumor associated antigens (TAA) expressed on tumor cells remains a challenge of both technology and biology. Herein we describe the use of a Half DVD-Ig format that can redirect CTL to kill tumor cells. Notably, Half DVD-Ig molecules that are monovalent for each specificity demonstrated reduced non-specific CTL activation and conditional CTL activation upon binding to TAA compared to intact tetravalent DVD-Ig molecules that are bivalent for each specificity, while maintaining good drug like properties and appropriate PK properties.
Animals ; Antibodies, Bispecific ; immunology ; Antibodies, Monoclonal ; immunology ; pharmacokinetics ; CD3 Complex ; metabolism ; Cell Line, Tumor ; Cytotoxicity, Immunologic ; ErbB Receptors ; metabolism ; Female ; Humans ; Lymphocyte Activation ; immunology ; Mice, SCID ; Neoplasms ; immunology ; pathology ; Rats, Sprague-Dawley ; T-Lymphocytes, Cytotoxic ; immunology

Objective To explore the clinical effects of variable angle locking plate ( VLP ) in the treatment of pediatric subtrochanteric femoral fractures. Methods Between January 2012 and November 2014, 9 pre-school children were treated at our department for subtrochanteric femoral fractures. They were 6 boys and 3 girls, with an average age of 4. 8 years ( from 4 to 6 years ) . By the Seinsheimer classification, 5 cases were of typeⅡB and 2 of typeⅡC and 2 of typeⅢA. The intervals between injury and surgery averaged 3 days ( from 2 to 5 days ) . All of them were treated with open reduction and VLP internal fixation. Results All the wounds healed well without any infection. All the stitches were removed within 12 days. They were followed up for 8 to 26 months ( average, 16 months ) . All the fractures united within 3 months after operation. Follow-ups revealed no plate or screw loosening, or refracture at the same site. According to the Beaty imaging criteria, the early outcomes were all satisfactory. At the final follow-ups, all the children gained normal gait after full-weight rehabilitation. The affected and normal hips are nearly identical in range of motion and muscle strength. All the children recovered their pre-injury status. By the Sanders scoring for function of the affected hip, 7 cases were rated as excellent and 2 as good. Conclusion VLP can be an effective option for treatment of subtrochanteric femoral fractures in preschool children patients.

Objective To explore the clinical efficacy of medial iliosciatic plating via the Stoppa approach for complex acetabular fractures involving the posterior column.Methods Between February 2015 and February 2016,a total of 16 complex acetabular facture cases treated by the medial iliosciatic plate via the Stoppa approach were retrospectively analyzed in this study.This approach provided good exposure to a large region of the pelvis and acetabulum including pubis symphysis,pubic ramus,anterior and inner wall of acetabulum,quadrilateral surface,inner surface of posterior column,true pelvic margin,greater sciatic notch and sacroiliac articulation.The anterior and column was reduced and fixed by the anterior column plate and the medial ilioseiatie plate.The screw direction and angle were adjusted according to the intraoperative X-ray.Surgical time,amount of bleeding,and relevant complications were recorded.The reduction of the posterior column fracture was evaluated by Matta scoring system on the plain X-ray of the pelvic post-surgery,and functional outcomes of the hip joint affected were evaluated one year post-surgery by the Merle d'Aubigne-Postel scoring system.All the cases were followed for at least 12 months.Results The reduction and fixation of the posterior column was accomplished in all the 1 6 patients.The average surgical time was 165.5 min (range,130-270 min).The average blood loss was 1 245.6 ml (range,600-5 600 ml).Thc intraoperative infusionof concentrated red blood cells averaged 6 units.According to the Matta scoring system,anatomical reduction was achieved in 12 cases,satisfactory reduction in 3,and poor reduction in one.The patients were followed from 12 to 22 months.According to the Merle d'Aubigne-Postel scoring system,there were 11 cases of excellent and 3 cases of good,yielding a good or excellent rate of 87.5％.The average Merle d'Aubigne-Postel score was 15.8 (range,8-18).There were 1 case of external iiiac vein rupture and 1 case of bladder rupture.Both were repaired during surgery.Superior gluteal artery rupture was found in 1 case and surgical ligation of the artery was performed during surgery.Conclusion In the treatment of complicated acetabular fractures involving the posterior column,the medial iliosciatic plating via the Stoppa approach is safe and effective,because it can provide a safe and sufficient operative field for surgeons to reduce and fix the posterior column fractures,and it leads to satisfactory recovery of the patients with limited complications.

Arabidopsis ; chemistry ; genetics ; metabolism ; Arabidopsis Proteins ; chemistry ; genetics ; metabolism ; Crystallography, X-Ray ; Intercellular Signaling Peptides and Proteins ; chemistry ; genetics ; metabolism ; Protein Conformation ; Protein-Serine-Threonine Kinases ; chemistry ; genetics ; metabolism