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Abstract This study aims to evaluate the biomechanical performance of the Gamma 3 nail with an anti-rotation screw (GNS) and compare it to two established gold-standard methods for treating unstable femoral neck fractures (UFNFs). Synthetic bone models were prepared with Pauwels’ type III osteotomy and an additional posterior wedge. Three different implant configurations were tested: three cannulated crews (3CS) in an inverted triangle configuration, a dynamic hip screw with an anti-rotation screw (DHSS), and GNS. Non-destructive cyclic axial loading was applied at 7° adduction, with 1000 cycles ranging from 100 to 1000 N. Subsequently, a construct failure test was conducted using progressive axial compression, and fracture reduction loss was recorded. The average axial stiffness was 321 ± 52 N/mm for 3CS, 430 ± 71 N/mm for DHSS, and 519 ± 104 N/mm for GNS. The average ultimate failure loads were 2699.3 N for 3CS, 3427.1 N for DHSS, and 3758.9 N for GNS. GNS demonstrated significantly greater axial stiffness compared to the other two groups (P

Irritable bowel syndrome (IBS) is a very common gastrointestinal disease that, although not as aggressive as tumors, affects patients’ quality of life in different ways. The cause of IBS is still unclear, but more and more studies have shown that the characteristics of the gut microbiota, such as diversity, abundance, and composition, are altered in patients with IBS, compared to the healthy population, which confirms that the gut microbiota plays a crucial role in the development of IBS. This paper aims to identify the commonalities by reviewing a large body of literature. Changes in the characteristics of gut microbiota in patients with different types of IBS are discussed, relevant mechanisms are described, and the treatment modalities of gut microbiota in IBS are summarized. Although there are more clinical trials that have made good progress, more standardized, more generalized, larger-scale, multi-omics clinical studies are what is missing. Overall, gut microbiota plays a crucial role in the development of IBS, and there is even more potential for treating IBS by modulating gut microbiota.

Pseudoaneurysm of the internal iliac artery is a very rare complication of intertrochanteric fracture. Here, the case of an 88-year-old female patient, who presented with intense pain following surgery for intertrochanteric fracture of the femur, is reported. Radiography revealed intertrochanteric fracture of the left femur fixed by proximal femoral nail antirotation (PFNA). The PFNA was found to have disassembled, and the screw had penetrated through the acetabulum. As computed tomography (CT) revealed a haematoma behind the acetabulum, CT angiography was immediately performed. A pseudoaneurysm of the internal iliac artery caused by PFNA was revealed. Percutaneous endovascular treatment of the pseudoaneurysm was undertaken on an urgent basis. Three days later, the PFNA was removed, and the fracture was reduced and fixed with locking proximal femoral plate. The patient’s pain was significantly reduced following this corrective surgery. This case illustrates that substandard PFNA surgery for intertrochanteric fracture may result in pseudoaneurysm of the internal iliac artery.

Urban rivers play a crucial role in human environments and urban development. The use of drone remote sensing for fine-scale water quality inversion is vital for water environment monitoring and protection. However, given the complex and variable nature of water quality environments, the accuracy of most current water quality inversion studies is limited by the constraints of single machine learning models. To address this issue, we have constructed three stacked ensemble models. Among them, the most effective model is Stacked-RF(ST-RF). It uses Random Forest (RF) as the meta-model and combines linear regression models (including Least Absolute Shrinkage and Selection Operator (LASSO) and Multiple Linear Regression (MLR)) and the ensemble of three advanced machine learning techniques (Gradient Boosting, CatBoost, and Adaboost) as base models. By adopting the optimal weight scheme, individual base learners are combined, avoiding the prediction bias of individual base learners caused by differences in specifications and prediction accuracy. The performance of the ensemble model and five basic machine learning methods were evaluated. A new water body index is also proposed for water quality inversion. The results show that the ST-RF model with Random Forest as the meta-learner reached determination coefficients ( $R^{2}$ ) of 0.823, 0.691, and 0.647 for chlorophyll-a (Chl-a), total nitrogen (TN), and total phosphorus (TP), respectively. Compared with the commonly used single machine learning models, the method proposed in this paper has better performance. This research has important practical significance for urban water resource management and ecological environment protection.

Objective Hip fractures are the most common fractures among older adults, with most patients undergoing surgery. The debate regarding the type of anesthetic technique for hip fracture surgery is still ongoing. This meta‐analysis aimed to compare the intraoperative and postoperative outcomes of spinal and general anesthesia in older patients undergoing hip fracture surgery. Methods Eligible studies that compared the effects of spinal and general anesthesia were systematically searched from PubMed, Embase, and the Cochrane Library until May 27, 2022. The intraoperative and postoperative outcomes of the two anesthesia techniques were compared. Quality assessment, heterogeneity analysis, and publication bias of the studies were also assessed. Results Nine articles of methodological quality were included in the meta‐analysis. The pooled results revealed that there were significant differences in hypotension (risk ratio [RR] (95% confidence interval [CI]) = 0.81 (0.68, 0.97), p = 0.02) and ephedrine dose (weighted mean difference [WMD] [95%CI] = −20.94 [−37.50, −4.37] mg, p = 0.01) between the spinal and general anesthesia groups. However, no significant differences were observed in the use of ephedrine (RR [95% CI] = 0.77 [0.19, 3.05]), blood loss (WMD [95%CI] = −34.38 [−89.56, 20.80) mL], myocardial infarction (RR [95% CI] = 0.78 [0.31, 1.94] mL), heart failure (RR [95% CI] = 0.87 [0.17, 4.36] mL), stroke (RR [95%CI) = 0.65 [0.22, 1.95] mL), postoperative nausea and vomiting (RR [95% CI] = 0.88 [0.17, 4.35] mL), delirium (RR [95% CI] = 1.08 [0.89, 1.31] mL), and mortality (RR [95% CI] = 1.10 [0.72, 1.68] mL) (all p

Abstract Background Diabetic cardiomyopathy, a distinctive complication of diabetes mellitus, has been correlated with the presence of intracellular lipid deposits. However, the intricate molecular mechanisms governing the aberrant accumulation of lipid droplets within cardiomyocytes remain to be comprehensively elucidated. Methods Both obese diabetic (db/db) mice and HL‐1 cells treated with 200 μmol/L palmitate and 200 μmol/L oleate were used to simulate type 2 diabetes conditions. Transmission electron microscopy is employed to assess the size and quantity of lipid droplets in the mouse hearts. Transcriptomics analysis was utilized to interrogate mRNA levels. Lipidomics and ubiquitinomics were employed to explore the lipid composition alterations and proteins participating in ubiquitin‐mediated degradation in mice. Clinical data were collected from patients with diabetes‐associated cardiomyopathy and healthy controls. Western blot analysis was conducted to assess the levels of proteins linked to lipid metabolism, and the biotin‐switch assay was employed to quantify protein cysteine S‐sulfhydration levels. Results The administration of H2S donor, NaHS, effectively restored hydrogen sulfide levels in both the cardiac tissue and plasma of db/db mice (+7%, P

Abstract Posterolateral (PL)-depression fractures of the tibial plateau are difficult to manage. The aim of this study was: (1) to present our experience with a novel technique of robot-assisted percutaneous reduction and fixation and (2) to compare it with the traditional percutaneous screw osteosynthesis (PSO) technique for the treatment of PL-depression tibial plateau fractures. The clinical data of patients with PL-depression tibial plateau fractures treated by robot-assisted percutaneous reduction and fixation technique and traditional PSO technique from January 2017 to January 2021 were retrospectively analyzed. Among them, there were 18 cases in the robot-assisted group (RA group) and 23 cases in the PSO group. All fractures were unilateral, closed and fresh PL-depression fractures of the tibial plateau. Patients in the RA group were treated by robot assisted reduction and minimally invasive absorbable screw fixation. The PSO group was treated by closed reduction and percutaneous absorbable screw osteosynthesis. The incision length, operation time, intraoperative blood loss, fluoroscopic times, inpatient time, weight training time and postoperative complications of the two groups were statistically analyzed. The Rasmussen radiological score was used to assess the reduction quality after operation while the Rasmussen functional score was used to evaluate knee joint functions at one year postoperatively. All patients were followed for at least one year. There was no significant difference in demographic information between the two groups (p > 0.05). Compared with the PSO group, the RA group showed less fluoroscopic times and better Rasmussen radiological and functional scores (p 0.05). The novel robot-assisted percutaneous reduction and fixation technique had the characteristics of less radiation, accurate reduction and fixation. It could accelerate the rehabilitation of patients with PL-depression fractures of the tibial plateau and enable patients to obtain good joint functions.

The use of digital image correlation for modal analysis is becoming an appealing option thanks to its non-contact and full-field measurement process. However, frequency response function (FRF) estimation can be challenging due to the limited number of time domain data and heavy measurement noise. Thereby, the present work aims to propose a method which improves the estimation accuracy of point-wise FRFs. Firstly, a Gaussian-process-based spatial-frequency model is proposed, which makes use of the intrinsic properties of the FRF and the local spatial information of field measurements. Then, a Bayesian solution is developed, which is enforced by a stable and efficient numerical procedure. Finally, the effectiveness of the proposed method is verified by making a comparison with the spectral estimator through the use of simulated data, and it is further validated based on an experimental application.

We propose a single-pixel non-imaging target recognition scheme which that exploits the singular values of target objects. By choosing the first few singular values and the corresponding unitary matrices in the singular value decomposition of all the targets, we form the measurement matrices to be projected onto the target in a single-pixel non-imaging scheme. One can quickly and accurately recognize the target images after directly recording the single-pixel signals. From the simulation and experimental results, we found that the accuracy of target recognition was high when the first three singular values were used. The efficiency of target recognition was improved by randomly rearranging the orders of the row vectors in the measurement matrix. Therefore, our research results offer a novel perspective for recognizing non-imaging targets.

ObjectiveWe aimed to evaluate the efficacy of antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation in the treatment of limb-localized osteomyelitis (Cierny–Mader type III) and analyze the causes and risk factors associated with infection recurrence.MethodsClinical data of 163 patients with localized osteomyelitis of the extremities treated with antibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation in Xi’an Honghui Hospital from January 2017 to December 2022 were retrospectively analyzed. All patients were diagnosed with localized osteomyelitis through clinical examination and treated with antibiotic-loaded calcium sulfate combined with autologous iliac bone. Based on the infection recurrence status, the patients were divided into the recurrence group and the non-recurrence group. The clinical data of the two groups were compared using univariate analysis. Subsequently, the distinct datasets were included in the binary logistic regression analysis to determine the risk and protective factors.ResultsThis study included 163 eligible patients, with an average age of 51.0 years (standard deviation: 14.9). After 12 months of follow-up, 25 patients (15.3%) experienced infection recurrence and were included in the recurrence group; the remaining 138 patients were included in the non-recurrence group. Among the 25 patients with recurrent infection, 20 required reoperation, four received antibiotic treatment alone, and one refused further treatment. Univariate analysis showed that education level, smoking, hypoproteinemia, open injury-related infection, and combined flap surgery were associated with infection recurrence (p < 0.05). Logistic regression analysis showed that open injury-related infection (odds ratio [OR] = 35.698; 95% confidence interval [CI]: 5.997–212.495; p < 0.001) and combined flap surgery (OR = 41.408; 95% CI: 5.806–295.343; p < 0.001) were independent risk factors for infection recurrence. Meanwhile, high education level (OR = 0.009; 95% CI: 0.001–0.061; p < 0.001) was a protective factor for infection recurrence.ConclusionAntibiotic-loaded calcium sulfate combined with autologous iliac bone transplantation is an effective method for treating limb-localized osteomyelitis. Patients without previous combined flap surgery and non-open injury-related infections have a relatively low probability of recurrence of infection after treatment with this surgical method. Additionally, patients with a history of smoking and hypoproteinemia should pay attention to preventing the recurrence of infection after operation. Providing additional guidance and support, particularly in patients with lower education levels and compliance, could contribute to the reduction of infection recurrence.

ObjectiveTo compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation.MethodsFrom January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi ‘an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6 months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups.ResultsAll 43 patients were followed up for an average of 9.7 (9–12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3 days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant (p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group.ConclusionThe clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility.

Abstract For Schatzker type II split-depressed tibial plateau fractures involving the fractures of anterolateral and posterolateral columns (APC), the optimal fixation scheme is controversial. The objectives of this study were: (1) to introduce a newly designed plate for treating APC fractures via biomechanical tests and finite element analysis (FEA), and (2) to compare it with two conventional fixation methods. APC fracture models were created and randomly assigned to three groups (Groups A-C). Group A was fixed with a 3.5-mm lateral locking plate, Group B was fixed with a 3.5-mm lateral locking plate and two 3.5-mm cannulated screws (hybrid fixation). Group C was fixed with the newly designed plate. It is an arched locking plate for fixing the lateral tibial plateau via the anterolateral supra-fibular-head approach. Each fracture model experienced a gradually increasing axial compressive load ranging from 250 to 750 N using a customized indenter. Biomechanical analysis demonstrated that the newly designed plate showed the minimum displacement among the three methods, followed by the hybrid fixation method. Conversely, the 3.5-mm lateral locking plate displayed the maximum displacement in APC fractures (p

Background: Osteoporosis (OP) is a chronic bone metabolic disease and a serious global public health problem. Several studies have shown that mitophagy plays an important role in bone metabolism disorders; however, its role in osteoporosis remains unclear.Methods: The Gene Expression Omnibus (GEO) database was used to download GSE56815, a dataset containing low and high BMD, and differentially expressed genes (DEGs) were analyzed. Mitochondrial autophagy-related genes (MRG) were downloaded from the existing literature, and highly correlated MRG were screened by bioinformatics methods. The results from both were taken as differentially expressed (DE)-MRG, and Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed. Protein-protein interaction network (PPI) analysis, support vector machine recursive feature elimination (SVM-RFE), and Boruta method were used to identify DE-MRG. A receiver operating characteristic curve (ROC) was drawn, a nomogram model was constructed to determine its diagnostic value, and a variety of bioinformatics methods were used to verify the relationship between these related genes and OP, including GO and KEGG analysis, IP pathway analysis, and single-sample Gene Set Enrichment Analysis (ssGSEA). In addition, a hub gene-related network was constructed and potential drugs for the treatment of OP were predicted. Finally, the specific genes were verified by real-time quantitative polymerase chain reaction (RT-qPCR).Results: In total, 548 DEGs were identified in the GSE56815 dataset. The weighted gene co-expression network analysis(WGCNA) identified 2291 key module genes, and 91 DE-MRG were obtained by combining the two. The PPI network revealed that the target gene for AKT1 interacted with most proteins. Three MRG (NELFB, SFSWAP, and MAP3K3) were identified as hub genes, with areas under the curve (AUC) 0.75, 0.71, and 0.70, respectively. The nomogram model has high diagnostic value. GO and KEGG analysis showed that ribosome pathway and cellular ribosome pathway may be the pathways regulating the progression of OP. IPA showed that MAP3K3 was associated with six pathways, including GNRH Signaling. The ssGSEA indicated that NELFB was highly correlated with iDCs (cor = −0.390, p < 0.001). The regulatory network showed a complex relationship between miRNA, transcription factor(TF) and hub genes. In addition, 4 drugs such as vinclozolin were predicted to be potential therapeutic drugs for OP. In RT-qPCR verification, the hub gene NELFB was consistent with the results of bioinformatics analysis.Conclusion: Mitophagy plays an important role in the development of osteoporosis. The identification of three mitophagy-related genes may contribute to the early diagnosis, mechanism research and treatment of OP.

Abstract Objective Spiral fracture of tibia combined with posterior malleolar fracture (PMF) is a special and regular injury. There is no uniform fixation method for PMF in this kind of injury. Intramedullary nail is the first choice for the treatment of tibial spiral fracture. We proposed a minimally invasive percutaneous screw combined with intramedullary nail technology to fix the PMF in the tibial spiral fracture. This study aims to explore the effectiveness and advantages of this technology. Materials and methods From January 2017 to February 2020, 116 cases of spiral fracture of tibia combined with PMF who were operated in our hospital were divided into Fixation Group (FG) and No Fixation Group (NG) according to whether PMF was fixed. After minimally invasive percutaneous screw fixation of ankle fracture in FG patients, the tibial intramedullary nail was inserted to fix the fracture. Collected the operation and postoperative recovery of the two groups of patients, including the operation time, intraoperative blood loss, AOFAS score, VAS score and dorsiflexion restriction of ankle joint at the last follow-up, and compared whether there is any difference between the two groups of patients. Results The fracture of both groups healed.2 patients in NG had secondary displacement of PMF during operation, and the fracture finally healed after fixation. There were statistical differences between the two groups in terms of operation time, AOFAS score and weight bearing time. The operation time of FG was 67.9±11.2 min, and that of NG was 60.8±9.4 min; The weight bearing time of FG was 57.35±34.72 days, and that of NG was 69.17±21.43 days; The AOFAS score of FG was 92.50±3.46, and that of NG was 91.00±4.16. There were no significant difference in blood loss, VAS and dorsiflexion restriction of ankle joint between the two groups. The blood loss of FG was 66.8±12.3 ml, the blood loss of NG was 65.6±11.7 ml, the VAS score of FG was 1.37±0.47, the VAS score of NG was 1.43±0.51, the dorsiflexion restriction of FG was 5.8±4.1; the NG was 6.1±5.7. Conclusion For the injury of tibial spiral fracture combined with PMF, our fixation technology can achieve minimally invasive fixation of PMF with percutaneous screws on the basis of intramedullary nail fixation of tibial fracture, promoting early functional exercise of ankle joint and early weight bearing of patients. This fixation technology is also characterized by simple and fast operation.

Abstract This retrospective study compared proximal bone transport and distal bone transport in a series of cases diagnosed with large segmental tibial defects. Patients with a tibial segmental defect (> 5 cm) were eligible for inclusion. Twenty-nine patients were treated using proximal bone transport technique (PBT group) and 21 cases were managed by distal bone transport technique (DBT group). We recorded the demographic information, operation indexes, external fixation index (EFI), visual analog score (VAS), limb function scores, and complications. Patients were followed for 24–52 months. There was no significant difference in operation time, blood loss, time in frame, EFI and HSS score between the two groups (p > 0.05). However, the PBT group displayed better clinical effects than the DBT group, including higher AOFAS scores, lower VAS, and complication incidence (p

Objective This study aimed to compare the clinical effects of using pedicled double‐barrel fibular transplantation (PDBFT) and bone transport (BT) for the treatment of upper tibial osteomyelitis with bone defects. Methods A total of 83 patients with upper tibial osteomyelitis and bone defects were selected and retrospectively studied in Xi'an Hong Hui Hospital from January 2009 to January 2019. There were 52 males and 31 females, aged 19–72 years. The tibial defect range was 5–12 cm. Patients were divided into two groups, including the PDBFT (40 cases) and the BT group (43 cases). All patients were classified according to Cierny–Mader classification, including 48 cases of type III and 35 cases of type IV. Operation time, blood loss and cure time were compared. Ennecking score was used to evaluate limb functions, including pain, activity function, self‐perception, brace use, walking ability, and gait change, while self‐rating anxiety scale (SAS) was used for postoperative mental and psychological status. In addition, complications were recorded. All patients were followed for at least 2 years. SPSS 23.0 software was used to process data. Results There was no significant difference in demographic data between the two groups (p > 0.05). Operation time was 182.5 ± 22.7 min in PDBFT group vs, 124.2 ± 15.6 min in BT group, respectively (p

Abstract In the present study, we presented our experience with a new modified technique of shortening and re-lengthening using a monolateral external frame combined with a calcaneal intramedullary nail and compared it with the bone transport technique for the treatment of distal tibial periarticular post-traumatic defects. Forty-one patients were retrospectively analyzed. Among them 19 were treated using our modified shortening and re-lengthening technique (MSR group) and 22 by bone transport (BT group). The difference in external fixation time (EFT), external fixation index (EFI), self-rating anxiety scale (SAS), and complications were compared between the two groups. The mean EFT was 3.4 ± 0.6 months in the MSR group and 7.5 ± 1.4 months in the BT group; the EFI was 0.57 ± 0.06 month/cm and 1.32 ± 0.23 month/cm, respectively. The EFT, EFI, and SAS scores were significantly lower in the MSR group than in the BT Group (p

BackgroundContraceptive choice is central to reproductive autonomy. The internet, including social networking sites like Reddit, is an important resource for people seeking contraceptive information and support. A subreddit dedicated to contraception, r/birthcontrol, provides a platform for people to post about contraception. ObjectiveThis study explored the use of r/birthcontrol, from the inception of the subreddit through the end of 2020. We describe the web-based community, identify distinctive interests and themes based upon the textual content of posts, and explore the content of posts with the most user engagement (ie, “popular” posts). MethodsData were obtained from the PushShift Reddit application programming interface from the establishment of r/birthcontrol to the start date of analysis (July 21, 2011, to December 31, 2020). User interactions within the subreddit were analyzed to describe community use over time, specifically the commonality of use based on the volume of posts, the length of posts (character count), and the proportion of posts with any and each flair applied. “Popular” posts on r/birthcontrol were determined based on the number of comments and “scores,” or upvotes minus downvotes; popular posts had 9 comments and a score of ≥3. Term Frequency-Inverse Document Frequency (TF-IDF) analyses were run on all posts with flairs applied, posts within each flair group, and popular posts within each flair group to characterize and compare the distinctive language used in each group. ResultsThere were 105,485 posts to r/birthcontrol during the study period, with the volume of posts increasing over time. Within the time frame for which flairs were available on r/birthcontrol (after February 4, 2016), users applied flairs to 78% (n=73,426) of posts. Most posts contained exclusively textual content (n=66,071, 96%), had comments (n=59,189, 86%), and had a score (n=66,071, 96%). Posts averaged 731 characters in length (median 555). “SideEffects!?” was the most frequently used flair overall (n=27,530, 40%), while “Experience” (n=719, 31%) and “SideEffects!?” (n=672, 29%) were most common among popular posts. TF-IDF analyses of all posts showed interest in contraceptive methods, menstrual experiences, timing, feelings, and unprotected sex. While TF-IDF results for posts with each flair varied, the contraceptive pill, menstrual experiences, and timing were discussed across flair groups. Among popular posts, intrauterine devices and contraceptive use experiences were often discussed. ConclusionsPeople commonly wrote about contraceptive side effects and experiences using methods, highlighting the value of r/birthcontrol as a space to post about aspects of contraceptive use that are not well addressed by clinical contraceptive counseling. The value of real-time, open-access data on contraceptive users’ interests is especially high given the shifting landscape of and increasing constraints on reproductive health care in the United States.

A better understanding of the factors that reduce bundle-sheath cell leakage to CO2 (Փ), enhance 13C carbon isotope discrimination, and enhance the photosynthetic capacity of barley leaves will be useful to develop a nutrient- and water-saving strategy for dry-land farming systems. Therefore, barley plants were exposed to a novel nitrification inhibitor (NI) (3,4-dimethyl-1H-pyrazol-1-yl succinic acid) (DMPSA) and a urease inhibitor (UI) (N-butyl thiophosphorictriamide (NBPT)) with mulched drip fertigation treatments, which included HF (high-drip fertigation (370 mm) under a ridge furrow system), MF (75% of HF, moderate-drip fertigation under a ridge furrow system), LF (50% of HF, low-drip fertigation under a ridge furrow system), and TP (traditional planting with no inhibitors or drip fertigation strategies). The results indicated that the nitrification inhibitor combined with mulched drip fertigation significantly reduced bundle-sheath cell leakage to CO2 (Փ) as a result of increased soil water content; this was demonstrated by the light and CO2 response curves of the photosynthesis capacity (An), the apparent quantum efficiency (α), and the 13C-photosynthate distribution. In the inhibitor-based strategy, the use of the urease and nitrification inhibitors reduced Փ by 35% and 39% compared with TP. In the NI-HF strategy, it was found that barley could retain the maximum photosynthesis capacity by increasing the leaf area index (LAI), An, rubisco content, soluble protein, dry matter per plant, and productivity. The CO2 and light response curves were considerably improved in the NI-HF and NI-MF treatments due to a higher 13C carbon isotope (Δ‰), respiration rate (Rd), and Ci/Ca, therefore obtaining the minimum Փ value. With both inhibitors, there was a significant difference between HF and LF drip fertigation. The NI-MF treatment significantly increased the grain yield, total chlorophyll content, WUE, and NUE by 52%, 47%, 57%, and 45%, respectively. Collectively, the results suggest that the new nitrification inhibitor (DMPSA) with HF or MF mulched drip fertigation could be promoted in semi-arid regions in order to mitigate bundle-sheath cell leakage to CO2 (Փ), without negatively affecting barley production and leading to the nutrient and water use efficiency of barley.

Abstract As a widespread direct effect of global warming, drought is currently wreaking havoc on terrestrial ecosystems' structure and function, however, the synthesized analysis is lacked to explore the general rules between drought changes and main functional factors of grassland ecosystems. In this work, meta‐analysis was used to examine the impacts of drought on grassland ecosystems in recent decades. According to the results, drought greatly reduced aboveground biomass (AGB), aboveground net primary production (ANPP), height, belowground biomass (BGB), belowground net primary production (BNPP), microbial biomass nitrogen (MBN), microbial biomass carbon (MBC) and soil respiration (SR), and increased dissolved organic carbon (DOC), total nitrogen (TN), total phosphorus (TP), nitrate nitrogen (NO3−‐N), and the ratio of microbial biomass carbon and nitrogen (MBC/MBN). The drought‐related environmental factor mean annual temperature (MAT) was negatively correlated with AGB, height, ANPP, BNPP, MBC, and MBN, however, mean annual precipitation (MAP) had positive effect on these variables. These findings indicate that drought is threatening the biotic environment of grassland ecosystem, and the positive steps should be taken to address the negative effects of drought on grassland ecosystems due to climate change.

We reported 2 cases of patellar tendon rupture at the lower pole of the patella. For patellar tendon rupture, simple suture fixation has been proved to be inadequate in strength. Our center uses custom-made anchor-like plate and suture to treat proximal patellar fracture. The fixation strength is reliable, no additional bone tunnel is required, and the fixation of the lower patellar fracture can be achieved at the same time. After the operation, the patient starts functional exercise of the knee joint at an early stage, The function of the knee joint of the patient recovered well after 1 year, without other complications.

BackgroundThe imbalance of gut microbiota (GM) is associated with a higher risk of thrombosis in patients with atrial fibrillation (AF). Oral anticoagulants (OACs) have been found to significantly reduce the risk of thromboembolism and increase the risk of bleeding. However, the OAC-induced alterations in gut microbiota in patients with AF remain elusive.MethodsIn this study, the microbial composition in 42 AF patients who received long-term OAC treatment (AF-OAC group), 47 AF patients who did not (AF group), and 40 volunteers with the risk of AF (control group) were analyzed by 16S rRNA gene sequencing of fecal bacterial DNA. The metagenomic functional prediction of major bacterial taxa was performed using the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) software package.ResultsThe gut microbiota differed between the AF-OAC and AF groups. The abundance of Bifidobacterium and Lactobacillus decreased in the two disease groups at the genus level, but OACs treatment mitigated the decreasing tendency and increased beneficial bacterial genera, such as Megamonas. In addition, OACs reduced the abundance of pro-inflammatory taxa on the genus Ruminococcus but increased certain potential pathogenic taxa, such as genera Streptococcus, Escherichia-Shigella, and Klebsiella. The Subgroup Linear discriminant analysis effect size (LEfSe) analyses revealed that Bacteroidetes, Brucella, and Ochrobactrum were more abundant in the anticoagulated bleeding AF patients, Akkermansia and Faecalibacterium were more abundant in the non-anticoagulated-bleeding-AF patients. The neutrophil-to-lymphocyte ratio (NLR) was lower in the AF-OAC group compared with the AF group (P < 0.05). Ruminococcus was positively correlated with the NLR and negatively correlated with the CHA2DS2-VASc score (P < 0.05), and the OACs-enriched species (Megamonas and Actinobacteria) was positively correlated with the prothrombin time (PT) (P < 0.05). Ruminococcus and Roseburia were negatively associated with bleeding events (P < 0.05).ConclusionsOur study suggested that OACs might benefit AF patients by reducing the inflammatory response and modulating the composition and abundance of gut microbiota. In particular, OACs increased the abundance of some gut microbiota involved in bleeding and gastrointestinal dysfunction indicating that the exogenous supplementation with Faecalibacterium and Akkermansia might be a prophylactic strategy for AF-OAC patients to lower the risk of bleeding after anticoagulation.

Abstract Background The reduction in irreducible extracapsular hip fractures has always been controversial. Here, we present a new minimally invasive reduction technique and compare it with limited open reduction (LOR) to treat irreducible extracapsular hip fractures. Methods From January 2016 to January 2018, our institution treated 653 patients with extracapsular hip fractures by intramedullary fixation. Among them, 525 cases got a successful closed reduction. The other 128 were irreducible and reduced by percutaneous reduction with double screwdrivers (PRDS) or LOR. There were 66 cases in the PRDS group while 62 in the LOR group. All fractures were classified using the Evans-Jensen classification. In addition, the differences in incision length, blood loss, fluoroscopic number, operation time, inpatient time, weight training time, Harris score, and complications were analyzed. Results The incision length was 8.4 ± 1.4 cm in the PRDS group and 15.3 ± 3.0 cm in the LOR group, respectively (p 0.05). There was no significant difference in complication incidence between the two groups (p > 0.05). Conclusions The PRDS group presented better clinical effects for managing irreducible extracapsular hip fractures than the LOR. Therefore, the PRDS technique could be the first reduction choice for patients with irreducible fractures.

Abstract Objective An inferior pole fracture of the patella requires surgical treatment to restore the knee extension mechanism of the knee joint. Different from other types of patellar fractures, inferior pole fractures are usually comminuted, and other traditional fixation methods, such as tension band wiring, may not meet the fixation needs. We propose fixing inferior pole fractures of the patella with a custom-made anchor-like plate combined with cerclage and report the surgical outcomes. Material and methods This is a retrospective clinical study. From June 2018 to August 2020, 21 patients with inferior patella fracture treated at Hong Hui Hospital Affiliated to Xi’an Jiaotong University received a custom-made anchor-like plate combined with cerclage. Complications of the surgical fixation methods and final knee function were used as the main outcome measures. Results All fractures achieved good union, and the union time ranged from 8 to 12 weeks. No patients had serious complications, such as internal fixation failure or infection. The average duration of surgery of patients was 75.05 7.26 min, and the intraoperative blood loss was 60.099.49 ml. At the last follow-up, the range of motion of the knee was 120°-140°, with an average of 131.436.92°, the Bostman score was 27–30, and the Lysholm score ranged from 82 to 95. All patients showed good knee function one year after the operation. Conclusion We used a modified T-shaped plate combined with cerclage technology to fix inferior fractures pole of the patella, providing reliable fixation, allowing early functional exercise of the knee joint, and providing patients with good knee joint function after surgery.

Abstract Introduction Intertrochanteric fractures are associated with high mortality rates; however, long-term data on survival and predictors remain scarce. Therefore, this study investigated risk factors associated with 3-year mortality in elderly patients with intertrochanteric fractures. Methods In a retrospective study, 156 elderly patients with intertrochanteric fractures who underwent surgery between January 2017 to January 2018 at our center were included. Association-affecting variables, such as gender, age, time from injury to surgery, hemoglobin (Hb), total lymphocyte count (TLC), albumin, malnutrition, and co-morbidities, were recorded and analyzed. Afterward, logistic regression was used to analyze the significant variables and find independent predictors for 3-year mortality. Results A total of 156 patients were followed up for 3 years. The 1-year, 2-year, and 3-year postoperative cumulative mortality rates were 9.6% (15/156), 16.7% (26/156), and 24.4% (38/156), respectively. Simple analyses found that age, Hb, albumin, and malnutrition were associated with 3-year mortality (p

Abstract Background The purpose of this paper was to compare the clinical effects of acute shortening and re-lengthening (ASR) technique with antibiotic calcium sulfate-loaded bone transport (ACSBT) technique for the management of large segmental tibial defects after trauma. Methods In this retrospective study, 68 patients with large segmental tibial defects were included and completely followed. The bone loss was 3–10 cm. ASR group included 32 patients, while ACSBT group contained 36. There was no significant difference in demographic information between the two groups. The external fixation time (EFT) and external fixation index (EFI) were compared. Bone defect healing and limb functions were evaluated according to the Association for the Study and Application of the Method of Ilizarov (ASAMI) criteria. Complications were compared by Paley classification. Results The mean EFT was 9.2 ± 1.8 months in ASR group and 10.1 ± 2.0 months in ACSBT group, respectively. The mean EFI was 1.5 ± 0.2 month/cm and 1.4 ± 0.3 month/cm. According to the ASAMI criteria, in ASR group bone defect healing was excellent in 22 cases, good in 7 cases and fair in 3 cases. In ACSBT group, it was excellent in 23 cases, good in 11 cases and fair in 2 cases. In ASR group, the limb function was excellent in 15 cases, good in 7 cases and fair in 10 cases, while it was excellent in 14 cases, good in 9 cases and fair in 13 cases with ACSBT group. There was no significant difference in EFI, bone defect healing and limb functions between the two groups (p > 0.05). The mean number of complications per patient in ACSBT group was significantly lower than that in ASR group (p

This paper proposes a hybrid propulsion-based small underwater robot for robust trajectory tracking control in a harsh and complex underwater environment. The robot is equipped with a Coanda-effect jet thruster and a pair of propeller-based reconfigurable magnetic-coupling thrusters, allowing it to traverse safely in confined or cluttered spaces as well as cruise efficiently in the open water. To investigate the robot dynamic modeling, we first formulated its simplified mathematical model and estimated the hydrodynamic coefficients by performing the planar motion mechanism using CFD (computational fluid dynamics) simulation. Then, a double-loop trajectory tracking control architecture was designed considering the model uncertainties and environmental disturbances. Based on Lyapunov theory, the outer-loop kinematic control produces the virtual velocity command, while the inner-loop dynamic control adopts the full-state feedback L1-adaptive control to match the command. The asymptotic convergence of the tracking errors and the stability of the whole closed-loop system are guaranteed. Finally, comparative simulations in the presence of unknown disturbances and the variation of model parameters were carried out to verify the robustness of our proposed trajectory tracking control, which is also suitable for the separated son robots.

Abstract Objective To compare the clinical results of homemade hook plates and hollow lag screws combined with spacers in the treatment of posterior cruciate tibial ligament avulsion fractures. Materials and methods This was a retrospective clinical cohort study that included 64 patients with PCL tibial avulsion fractures. Thirty-two of them were fixed with a homemade hook plate (hook plate group), and 32 were fixed with a hollow lag screen combined with a gasket (hollow lag screen group). By reviewing the medical record data and follow-up results, the operation time, postoperative drainage, fracture healing time, surgical complications, knee mobility, recovery of joint function, and whether postoperative gastrocnemius muscle strength changed in the two groups were compared. Results All patients had successful wound and fracture healing. No adverse events, such as bone nonunion, infection, wound haematoma, or joint stiffness, occurred in either group. There were no patients with decreased gastrocnemius muscle strength in either group. Internal fixation failure occurred in 2 cases in the hollow lag screen group but not in the hook plate group. There were no significant differences between the two groups in terms of operative time, postoperative drainage, fracture healing time, knee mobility at the last follow-up, or Lysholm score. Conclusion It is safe and effective to use a homemade hook plate to fix PCL tibial avulsion fractures through an inverted L-shaped posterior medial approach. A homemade hook plate may have potential advantages over a hollow lag screen combined with gasket fixation.

Abstract Background Bone transport has been successfully applied for the management of large segmental bone defects. However, its main shortcoming is the long-lasting consolidation period, which may cause lots of related complications. To overcome this shortcoming, we developed bone transport combined with bone graft and internal fixation technique. The purpose of this study was to compare the clinical effects of this modified technique with simple bone transport in the treatment of large segmental bone defects of lower limbs after trauma. Methods Eighty-four patients with large segmental bone defects treated in our institution from January 2014 to January 2017 were selected for retrospective study. A total of 77 cases were completely followed. Among them, 35 patients were treated by bone transport combined with bone graft and internal fixation technique (Group A), and 42 by simple bone transport technique (Group B). Patients with open injuries were classified according to Gustilo-Anderson (GA) classification. The general data of Group A and B were compared. The time in external fixator, total cure time and operation times of two groups were recorded. Ennecking score was used to evaluate the recovery of limb functions while self-rating anxiety scale (SAS) for the postoperative anxiety evaluation. In addition, the total complication incidence was compared between Group A and B. Results There was no significant difference in demographic data between Group A and B (p > 0.05). The time in external fixator of Group A and B was (4.8 ± 1.6) and (18.2 ± 3.9) months, respectively (p 0.05). Ennecking score of Group A and B was 84.7 and 75.7% (p

Objective To develop a new approach to intraoperatively identify the presence of coronal plane deformities (both valgus and varus) when treating tibial fractures with closed reduction and intramedullary nail fixation. Methods A retrospective analysis was conducted by enrolling 33 consecutive patients with tibial fractures who received closed reduction and intramedullary nail fixation from January 2018 to January 2019 at our trauma center. Out of the 33 patients, 23 were males and 10 were females and the average age was 41 years (ranging 22 to 69 years of age). Standard anteroposterior and lateral preoperative radiographs were routinely performed. After intraoperatively inserting the tibial intramedullary nail through the standard entry point, the parallel relationship between the distal horizontal interlocking screw and the tibiotalar joint surface on the anteroposterior fluoroscopy was used to determine the occurrence of valgus or varus deformities of the distal tibial fragment. Radiographic and clinical outcomes were analyzed using the average interval from injury to surgery, the lateral distal tibial angle (LDTA) of the unaffected and affected sides, complications and the Olerud–Molander ankle score. Results All 33 patients were postoperatively followed for 13 to 25 months (mean 18.7 months). The fractures achieved bone union at an average of 4.3 months (ranging from 3 to 6 months). The total complication rate was 60.6% (20 cases), including four cases that showed deep vein thrombosis, one case showing an infection and delayed union and 15 cases showing slight to moderate anterior knee pain. The postoperative LDTA of the unaffected side measured 87.3° to 89.6 ° (average 88.7° ± 0.8°), and the LDTA of the affected side was 87.5° to 90.4° (average 88.9° ± 1.1°). There was no significant difference between the unaffected and affected sides (t = −1.865, P = 0.068). The intraoperative measurement indicated six cases of valgus angulation and three cases of varus angulation deformities, and all deformities were corrected during surgery. According to the Olerud–Molander ankle score, clinical outcomes demonstrated 22 excellent cases, eight good cases, two fair cases, and one poor case 12 months after surgery. Conclusion The parallel relationship between the distal horizontal interlocking screw and tibiotalar joint surface on intraoperative anteroposterior films were able to determine the onset of valgus or varus angulations of the distal tibial fragment in the fracture zone after the tibial intramedullary nail was inserted through the standard entry point.

ObjectiveTension band wiring and proximal ulnar plate fixation are commonly used fixation methods for olecranon fractures. However, they may not be suitable for repairing proximal olecranon avulsion fractures. In this study, we present a novel fixation technique for the treatment of proximal avulsion fractures, which is a T-shaped plate combined with a wire.Materials and methodsBetween March 2016 and May 2020, surgery was performed on 16 patients with proximal olecranon avulsion fractures by using a T-shaped plate combined with a wire fixation at our hospital. The parameters followed were fracture healing time, elbow range of motion (ROM), related functional scores (the Mayo score and the DASH score), and complications related to internal fixation.ResultsThe average follow-up period was 17 (14–21) months and fractures had healed in all patients included in the study, with an average fracture union of 9.25 (8–12) weeks. No patient reported fixation failure, serious infection, or revision surgery. The average ROM of the elbow joint was 123° (120–135°). The Mayo score was excellent in 11 patients and good in 5. The average DASH score was 17.75 (12–24).ConclusionOlecranon avulsion fractures were fixed with a T-shaped steel plate combined with a steel wire, which can be used for early functional exercise and for achieving good final functional results. This method can provide stable fixation, especially in elderly patients with osteoporosis.

Abstract Background To compare the clinical efficacy of a femoral neck system (FNS) and cannulated screws (CS) in the treatment of femoral neck fracture in young adults. Methods Data from 69 young adults, who were admitted for femoral neck fracture between March 2018 and June 2020, were retrospectively analyzed. Patients were divided into two groups according to surgical method: FNS and CS. The number of intraoperative fluoroscopies, operative duration, length of hospital stay, fracture healing time, Harris score of hip function, excellent and good rate of hip function, and postoperative complications (infection, cut out the internal fixation, nail withdrawal, and femoral neck shortening) were compared between the two groups. Hip joint function was evaluated using the Harris Hip Scoring system. Results All 69 patients had satisfactory reduction and were followed up for 12–24 months, with a mean follow-up of 16.91 ± 3.01 months. Mean time to fracture healing was13.82 ± 1.59 and 14.03 ± 1.78 weeks in the FNS and CS groups, respectively. There was a statistical difference in the number of intraoperative fluoroscopies between the 2 groups (P = 0.000). There were no significant differences, in operation duration, hospital length of stay, fracture healing time, complications, Harris Hip Score for hip function and excellent and good rate between the two groups (P > 0.05). The incidence of complications was 6.1%(2/33) in the FNS group lower than 25%(9/36) in the CS group, a difference that was statistically significant (P = 0.032). At the last follow-up, the Harris Hip Score of the hip joint in the FNS group was 90.42 ± 4.82and 88.44 ± 5.91 in the CS group. Conclusions Both treatment methods resulted in higher rates of fracture healing and excellent hip function. Compared with CS, the FNS reduced the number of intraoperative fluoroscopies, radiation exposure to medical staff and patients, and short-term complications including femoral neck shortening and bone nonunion.

Abstract Background The purpose of this study was to compare the clinical effects of antibiotic calcium sulfate-loaded hybrid transport (ACSLHT) and traditional Ilizarov bone transport (TIBT) in the treatment of large tibial defects after trauma. Methods Eighty-five patients with large tibial defects after trauma were selected for retrospective study. The range of tibial defects was 6–22 cm. After thorough debridement and infection controlled, bone transport technique was used to reconstruct tibial defects. Forty-four patients were treated with ACSLHT technique (the ACSLHT group), while the other 41 were treated with TIBT technique (the TIBT group). Time in external fixator was evaluated by EFI score. Enneking score was used to evaluate limb functions. SAS score was used to evaluate postoperative anxiety status. In addition, complication incidence was compared, including axis deviation, docking site nonunion, infection recurrence and so on. Results There was no significant difference in preoperative general data between ACSLHT and TIBT group. EFI score in ACSLHT and TIBT group was 0.6 ± 0.1 cm/month and 1.7 ± 0.3 cm/month, respectively (P

Objective Femoral shaft nonunion after intramedullary nailing fixation remains a challenge for orthopedic surgeons. This study evaluated osteoperiosteal decortication and iliac bone grafting combined with wave plating as a treatment for aseptic atrophic nonunion of the femoral shaft after intramedullary nailing. Methods The study included 22 patients (two female, 20 male; mean age 40.8 years [range, 19–61]) with aseptic atrophic nonunion of the femoral shaft who underwent osteoperiosteal decortication and iliac bone grafting combined with wave plating between January 2016 and January 2020. Cases with infected nonunion, hypertrophic nonunion, and nonunion after plate osteosynthesis were excluded. Clinical outcomes were assessed retrospectively using the Samantha X-ray and Paley scale scores. Results The mean follow-up period was 18.8 months (range, 12–35). Bone union was achieved in all patients. The average clinical healing time was 5.7 months (range, 3–14). The mean Samantha X-ray score was 5.7 ± 0.45 and the Paley scores indicated excellent or good clinical results in all cases. One patient developed sterile wound leakage that resolved after a dressing change. Conclusions Osteoperiosteal decortication and bone grafting combined with wave plating is an excellent treatment for aseptic atrophic nonunion of the femoral shaft after intramedullary nailing.

Abstract Background Knowledge about the 1-year outcome of COVID-19 is limited. The aim of this study was to follow-up and evaluate lung abnormalities on serial computed tomography (CT) scans in patients with COVID-19 after hospital discharge. Methods A prospective cohort study of patients with COVID-19 from the First Affiliated Hospital, Zhejiang University School of Medicine was conducted, with assessments of chest CT during hospitalization and at 2 weeks, 1 month, 3 months, 6 months, and 1 year after hospital discharge. Risk factors of residual CT opacities and the influence of residual CT abnormalities on pulmonary functions at 1 year were also evaluated. Results A total of 41 patients were followed in this study. Gradual recovery after hospital discharge was confirmed by the serial CT scores. Around 47% of the patients showed residual aberration on pulmonary CT with a median CT score of 0 (interquartile range (IQR) of 0–2) at 1 year after discharge, with ground-glass opacity (GGO) with reticular pattern as the major radiologic pattern. Patients with residual radiological abnormalities were older (p = 0.01), with higher rate in current smokers (p = 0.04), higher rate in hypertensives (p = 0.05), lower SaO2 (p = 0.004), and higher prevalence of secondary bacterial infections during acute phase (p = 0.02). Multiple logistic regression analyses indicated that age was a risk factor associated with residual radiological abnormalities (OR 1.08, 95% CI 1.01–1.15, p = 0.02). Pulmonary functions of total lung capacity (p = 0.008) and residual volume (p < 0.001) were reduced in patients with residual CT abnormalities and were negatively correlated with CT scores. Conclusion During 1-year follow-up after discharge, COVID-19 survivors showed continuous improvement on chest CT. However, residual lesions could still be observed and correlated with lung volume parameters. The risk of developing residual CT opacities increases with age.

Background: Although open reduction internal fixation (ORIF) with periarticular locking plates, retrograde intramedullary nail (IMN) fixation, and distal femoral replacement (DFR) have been widely used for the treatment of periprosthetic distal femur fractures (PPDFF), it remains unclear which one may be an optimal surgical strategy.Objective: This network meta-analysis aimed to determine the optimal surgical strategy for PPDFF from ORIF, IMN, and DFR by evaluating major complication rates and revision rates.Patients and Methods: We identified eligible studies by performing an updated literature search in PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) and checking published meta-analyses. The methodological index for non-randomized studies (MINORS) was used to assess the methodological quality of eligible studies. Major complications and revision rates were defined as outcomes of interest. All statistical analyses were performed by ADDIS 1.4 software.Results: We included 17 eligible studies in the final analysis. Statistical analyses did not reveal significant differences when ORIF was compared with IMN and ORIF compared with DFR, and IMN compared with DFR in terms of two clinical outcomes. However, DFR achieved a beneficial trend in major complications [odds ratio (OR) = 1.34; 95% CrI = 0.48–3.80] and revision (OR = 1.64; 95% CrI = 0.68–4.38) rates compared with IMN. Ranking probabilities indicate that DFR has the highest probability of being the optimal option, followed by ORIF and IMN.Conclusion: There was no difference in major complications or reoperations between the three treatments. However, ORIF with periarticular locking plates may be a preferred alternative option because DFR is limited by the high cost. Moreover, our study highlights the need for future prospective trials evaluating the outcomes of these three surgical strategies.

Purpose: The extra-articular proximal tibial fractures continue to have high malunion rates despite development in intramedullary nailing (IMN) technology. Combined plate and IMN fixation can increase mechanical stability. The purpose of this study was to investigate combined plate and IMN for the treatment of extra-articular proximal tibial fracture using a biomechanical model.Methods: A 10-mm defective osteotomy was created in the fourth-generation composite tibia to simulate extra-articular proximal tibial fractures (AO/OTA 41A2). The fractures were stabilized with IMN alone (IMN group), IMN with supplementary medial plate (M-IMN group), and IMN with supplementary lateral plate (L-IMN group). The biomechanical properties of each specimen were tested under axial compression loading, bending stress, and cyclic loading. The maximum displacement of the fragments and implant-bone construct failure was recorded.Results: The maximum displacement of the M-IMN group was significantly less than either the L-IMN or IMN group in both axial compression loading and bending stress (p < 0.05 for both comparisons). All specimens in the three groups survived in 10,000 cyclic loading without hardware deformation. The maximum stiffness of failure was similar between the M-IMN and L-IMN groups, but the IMN group was statistically lower than either the L-IMN or the IMN group (p < 0.05).Conclusion: The results indicated that combined medial plate and IMN fixation could effectively increase the mechanical stability of proximal tibial fractures.

Purpose: To compare the clinical outcomes of the Masquelet technique and Ilizarov bone transport method for the treatment of patients with infected bone defects in the lower extremities. Methods: Eligible studies were searched from six databases until 12 April 2021. Data extraction was independently conducted by two investigators, which was followed by a quality assessment. Weighted mean difference (WMD) and 95% confidence interval (CI) were used to analyze continuous variables, while odds ratio (OR) and 95% CI were used to analyze categorical variables. All statistical analyses were conducted using RevMan 5.3 and Stata 12.0. Results: Thirteen articles were included in this meta-analysis. There was a significant difference observed in hospitalization costs (WMD [95% CI] = −1.75 [−2.50, −0.99] thousand US dollar, p < 0.00,001), final union time (WMD [95% CI] = −4.54 [−6.91, −2.17] months, p = 0.0002), time to full weight bearing (WMD [95% CI] = −1.73 [−3.36, −0.10] months, p = 0.04), quality of life (WMD [95% CI] = 7.70 [4.74, 10.67], p < 0.00,001), and the risk of complications (OR [95%CI] = 0.39 [0.19, 0.79], p = 0.009) between the Masquelet and Ilizarov groups. No significant differences in other outcomes were observed between the two groups. Conclusion: Masquelet technique exhibited the advantages in the lower hospitalization cost, shorter final union time, shorter time to full weight bearing, lower rate of complications, and better post-operative quality of life, compared with Ilizarov bone transport method. However, this finding should be confirmed in large-scale clinical samples.

Abstract Background To investigate the clinical efficacy of locking compression plate fixation for the treatment of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity. Methods A retrospective analysis was conducted on 37 patients with femoral intertrochanteric fractures combined with preexisting proximal femoral deformity between January 2013 and July 2019. The patients included 24 males and 13 females aged from 23 to 69 years old, with an average age of 47.5 years. The preexisting proximal femoral deformities resulted from poliomyelitis sequela, proximal femoral fibrous dysplasia, malunion and implant failure combined with coxa vara after intramedullary nailing fixation. There were 6 cases of 31-A2.1, 6 cases of 31-A2.2, 20 cases of 31-A3.1, and 5 cases of 31-A3.2, determined based on the AO classification of intertrochanteric fractures. All fractures were managed through open reduction and locking plate fixation. The hip disability and osteoarthritis outcome score (HOOS) was used to assess hip function before injury and at the last postoperative follow-up. The short form 36 (SF-36) Health Survey Questionnaire was used to assess quality of life. Results Thirty-seven patients were followed up for 12 to 27 months (average, 20.7 months). All patients achieved bone healing within 5.1 months on average (range, 3 to 6 months). Postoperative complications included deep vein thrombosis in three patients, bedsores in one and delayed union in one patient. No other complications, such as surgical site infection, fat embolism, nonunion and re-fracture, were presented. There was no significant difference in the HOOS scores and the SF-36 Health Questionnaire outcomes at pre-injury and at the last postoperative follow-up (p > 0.05). Conclusions It is difficult to perform intramedullary fixation of femoral intertrochanteric fractures in patients with preexisting proximal femoral deformity, while locking compression plate fixation is a simple and effective method of treatment.

Objective To screen serum microRNAs (miRNAs) which could discriminate fracture status in postmenopausal women with or without diabetes. Methods The miRNA expression profile dataset GSE70318 was downloaded from Gene Expression Omnibus (GEO) database. This dataset composed of 74 samples, among these, 55 postmenopausal women was selected for bioinformatics analysis, including 19 osteoporotic fracture patients with type‐2 diabetes, 19 osteoporotic fracture patients without type‐2 diabetes, and 17 healthy control subjects. These samples were divided into two groups: fracture patients with diabetes vs healthy subjects (FH group) and fracture patients without diabetes vs healthy subjects (DFH group). Then, the differentially expressed miRNA (DEMs) in FH group and DFH group were respectively identified. The target genes of DEMs were predicted, followed by functional enrichment analysis. Furthermore, DEMs related to long non‐coding RNAs (lncRNAs) were screened, and DEMs‐lncRNA‐target genes network was constructed. Subsequently, principal component analysis (PCA) of DEMs was performed to further explore the expression characteristics of the selected miRNAs in different types of fracture samples. Finally, the expression level of significant DEMs was calculated by quantitative real‐time polymerase chain reaction (qPCR) to verify the accuracy of the results of bioinformatics analysis. Results A total of 18 and 23 DEMs were identified in FH and DFH groups, respectively. Gene ontology (GO) analysis showed that genes in FH group were significantly enriched in regulation of transcription (GO: 0045449) and genes in DFH group were mainly enriched in cellular response to hormone stimulus (GO: 0032870). Meanwhile, pathway analysis indicated that genes in FH group were primarily enriched in T cell receptor signaling pathway (hsa04660) and genes in DFH group were mainly implicated in neurotrophin‐signaling pathway (hsa04722). Moreover, the miRNA‐lncRNA analysis revealed that miR‐155‐5p regulated by lncRNA MIR155HG was up‐regulated in FH group; in addition, the miR‐181c was significantly up‐regulated and miR‐375 was observably down‐regulated in DFH group. Furthermore, PCA analysis suggested that the screened miRNAs were able to differentiate these two types of fractures in postmenopausal women. The miR‐181c and miR‐375 might be regarded as potential predictors for fracture, while miR‐155‐5p might be a candidate diagnostic biomarker for diabetic fracture. Finally, the results of qPCR were consistent with that of microarray data. Conclusions Overall, these three miRNAs might be regarded as potential diagnostic biomarkers to discriminate fracture status in postmenopausal women with and or without diabetes, and they served a putative role in the pathogenesis of these two diseases. However, these findings were only observed in serum samples and further clinical trials are urgently demanded to validate our results.

Objective To evaluate the clinical efficacy of micro‐locking plate through vertical or parallel technique for treatment of Dubberley B‐type capitellar fractures. Methods A retrospective analysis was performed in 24 patients (17 males and seven females, with an average age of 44.9 years, range from 19 to 75 years) with capitellar fractures that were treated with micro‐locking plate using vertical or parallel technique between January 2016 to January 2019. The inclusion criteria include closed capitellar fracture, normal anterior elbow joint movement before injury, and recent capitellar fracture with injury within past 3 weeks. Fractures classified according to Dubberley included four cases of type IB, eight cases of type IIB, and 12 cases of type IIIB. Radiographic evaluation was performed. Surgery time, blood loss, range of motion of the elbow, forearm rotation, and complications were recorded. Elbow joint function was evaluated by Mayo Elbow Performance Score (MEPS). Results The mean follow‐up period was 19.6 months (range, 12–36 months). The average clinical healing time for fractures was 11.2 ± 3.2 weeks (range, 8–20 weeks). Fracture united in all patients. Two patients showed slight delayed union, but union was achieved eventually. The mean time from injury to surgery was 6.3 ± 3.1 days (range, 2–15 days). The average surgical time was 68.1 ± 11.5 min (range, 50–90 min), and the mean blood loss was 75.2 ± 26.5 mL (range, 40–120 mL). The mean range of flexion was 122.5° ± 10.5°(range, 95°–140°). The mean range of extension was 8.5° ± 5.8°(range, 0°–20°). The mean range of pronation was 79.7° ± 8.0°(range, 65°–90°). The mean range of supination was 80.5° ± 7.1°(range, 60°–90°). The mean MEPS at final follow‐up was 89.8 ± 9.0 (range, 60–100). Based on the MEPS, 18 (75%) patients had excellent, five (20.8%) patients had good, and one (4.2%) patient had fair. None of the 24 patients suffered vascular or nerve injury. One patient showed superficial infection, which was treated with surgical dressing. Conclusions The vertical or parallel technique of the micro‐locking plate is an excellent method for treating Dubberley B‐type capitellar fractures.

Abstract Background There are disputes about which reduction technique should be adopted in treatment of distal radius-ulna fractures in older children who failed to achieve manual reduction. This study compared clinical effects between prying reduction with mosquito forceps (PRMF) and limited open reduction (LOR) of treating irreducible distal radius-ulna fractures in older children. Methods One hundred ten children with irreducible distal radius-ulna fractures were selected from January 2015 to December 2017 in Xi’an Hong Hui hospital. Retrospective analysis was performed. According to different reduction techniques, these children were divided into PRMF group (59 cases) and LOR group (51 cases). All children were treated with percutaneous Kirschner wire fixation and external fixation with plaster. Operation indexes, complications and wrist joint functions were compared between the two groups. Results Operation time of PRMF group was shorter than that of LOR group (P

ObjectiveThis study aimed to evaluate the short-term effects of partial fibular head osteotomy for treating posterolateral tibial plateau fractures.MethodsA retrospective analysis was performed on 25 patients with posterolateral tibial plateau fractures who were treated using a partial fibular head osteotomy approach. Computed tomography was performed for fracture typing and evaluation. The mode of injury, time from injury to surgery, time for fracture union, range of motion of the knee, and complications were recorded. Knee joint function was evaluated using the Hospital for Special Surgery Mayo Score (HSS).ResultsThe mean follow-up period was 21.5 (range, 12–36) months. Fracture united in all patients and the average clinical healing time for fractures was 11.2 ± 1.9 (range, 8–16) weeks. The mean time from injury to surgery was 3.1 ± 1.8 (range, 1–10) days. The mean range of flexion was 131.6° ± 12.5° (range, 110°–145°). The mean range of extension was 1.4°–4.2° (range, −5°–10°). The mean HSS at the final follow-up was 93.5 ± 5.4 (range, 79–100). None of the patients exhibited symptoms of common peroneal nerve injury, knee instability, or upper tibiofibular joint injury. One patient had a superficial infection and was treated with surgical dressing.ConclusionThe partial fibular head osteotomy approach is a feasible alternative for treating posterolateral tibial plateau fractures.

Abstract Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems. Results Baseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values

Abstract Background This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches. Methods A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements. Results A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05). Conclusions In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

Abstract Background This study aimed to screen osteosarcoma (OS) prognosis relevant genes for methylation dysregulation, and the functional mechanisms of FES overexpression in OS cells were investigated. Methods The OS prognosis relevant genes with differentially methylated positions (DMPs) identified from the GSE36001 and GSE36002 datasets, and the UCSC database, were used as a training set to construct a risk model, while the GSE21257 dataset was used as validation set. The expression levels of several key genes in OS cells after 5-Aza-2′-deoxycytidine treatment were detected by qPCR. The effects of FES overexpression on cell proliferation, cell cycle, migration, and invasion of MNNG/HOS were analyzed by CCK8, flow cytometry, and Transwell assays. Results A total of 31 candidate genes, corresponding to 36 DMPs, were identified as OS prognosis relevant genes; from these, the top 10 genes were used to construct a risk model. Following validation of the risk model, FES, LYL1, MAP4K1, RIPK3, SLC15A3, and STAT3 showed expression changes between the OS and control samples. qPCR results showed that the expression of FES was significantly downregulated in three OS cell lines and increased after 5-Aza-DC treatment. The proliferation, cell cycle progression, migration, and invasion of MNNG/HOS cells were significantly inhibited after transfection with FES overexpression plasmid, and the protein expression of FYN and β catenin were decreased in MNNG/HOS cells by FES overexpression. Conclusions The decrease in FES by hypermethylation was associated with OS prognosis, and might contribute to the proliferation, migration, and invasion of OS cells. FES, and its upstream FYN and β catenin, might coordinately exert a tumor suppressor effect in OS cells.

Multi-resource allocation is ubiquitous in datacenters. Usually, the datacenter scheduler associates each user with a utility function and then allocates multiple resources so as to maximize the social welfare, which is the sum of the utilities of the users. We refer to this problem as the Social Welfare Maximization (SWM) problem. Meanwhile, given the dynamic nature of datacenters, the scheduler is supposed to support non-preemptive scheduling, where jobs of users that are being processed would not be interrupted by the reconfiguration of resources. Non-preemptive solutions to SWM incorporating pricing considerations include dynamic pricing and bidding/auctions. However, both strategies are quite complex. Meanwhile, traditional Lagrange solutions to SWM does not support non-preemptive job scheduling. In this paper, we propose Adaptive Dominant Resource Fairness (ADRF), that provides near-optimal social welfare where each user is assigned an α-fair utility function and when 1

To empower advanced traffic engineering (TE) mechanism, while considering the infeasibility of one-step migration to software-defined networking (SDN), SDN nodes are incrementally deployed into legacy network, which gives rise to hybrid SDN. In hybrid SDN, redirecting flow of every source-destination pair through at least one SDN node, can enhance TE performance and obtain flow manageability, while on the other hand leading to increasing demands of TCAM resources in SDN nodes. In this paper, we make minimization of maximum link utilization as the TE objective, and comply with SDN waypoint enforcement and TCAM resource limitation. We first formulate the TE problem as an integer linear programming (ILP) model and solve it in a centralized manner, where SDN waypoint selection and splitting fractions for each flow are jointly determined. Then, based on a fact that the logically centralized control plane in hybrid SDN is composed of multiple physically decentralized controllers, each of which manages part of SDN nodes, as well as considering a real situation that a centralized solution is infeasible or too fragile for large-scale network, we develop a distributed algorithm deriving from Lagrangian decomposition theory to effectively solve the TE problem. The simulation results indicate that, when 30% of the SDN nodes are deployed, the proposed traffic engineering-aware distributed routing (TEDR) algorithm obtains maximum link utilization comparable to that of full SDN, and has a limited influence on the routing efficiency.

In the clinical vascular interventional surgery, experienced surgeons usually rely on visual feedback to reason tool-tissue interaction, because haptic forces are easily contaminated by frictions between the catheter and the introducer sheath, which brings difficulty in collision force perceptions. Thus, cognitive skills are highly demanded for novice surgeons to thoroughly interpret the relative positions between tool and tissue in images and make appropriate decisions about further catheter motions in case of collisions. In this paper, an operator's cognitive skills training system has been introduced, which exploits the tactile sensation to reinforce the visualized spatial positions between catheter tip and vascular wall in the VR simulator. In cooperation with the collision alert module (CAM) in the VR simulator, the newly developed catheter manipulator can provide tactile sensations for novices when catheter tip is threaded beyond safety boundary, so that the VR exhibited tool-tissue interaction can be deliberately intensified. For demonstrating such tactile sensations adequate to strengthen visions, the system model has been established to facilitate the analysis in the perspective of operator's kinesthetic perception. A series of experiments have been conducted at last and the results reveal that the catheter manipulator can not only realize the accurate catheter motions but also provide the enough tactile sensations for novices. Moreover, statistical data prove that subjects under cognitive trainings have developed the ability to interpret the relative spatial positions between catheter tip and vascular wall. Such findings support that the operator's cognitive skills can be enhanced by the tactile reinforcement of VR visualized tool-tissue interaction.