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Understanding the function and regulatory mechanism of miR-140-3p on the osteogenic differentiation of bone mesenchymal stem cells (BMSCs). Alizarin Red staining, Alkaline phosphatase (ALP) staining, and ALP activity were used to detect the ability osteogenic differentiation. miR-140-3p or Spred2 overexpression into BMSCs using lentiviral vectors and the result were analyzed by Reverse transcription quantitative polymerase chain reaction (RT-qPCR). The relation between miR-140-3p and Spred2 was examined by luciferase reporter assay. CCK8 assay was used to detect the proliferation of BMSCs. RT-qPCR and Western blot analysis were both used to detect altered gene and protein in osteogenic differentiation of BMSCs, respectively. The BMSCs which were induced for 21 days were analyzed by Alizarin Red staining, (ALP) staining and ALP activity. RT-qPCR analysis showed that overexpressed miR-140-3p promotes osteogenic differentiation. Western blots results indicated that the overexpression of Spred2 suppressed miR-140-3p. Luciferase reporter assay indicated that Spred2 can integrate with miR-140-3p directly. Meanwhile, the protein level of ALP, OCN, and Runx2, the markers of chondrogenesis, was increased when miR-140-3p increased or Spred2 overexpressed in the osteoinductive medium applied to the BMSCs. Our study demonstrated the association between miR-140-3p and Spred2 in osteogenic differentiation of BMSCs for the first time. Furthermore, our detections also revealed that Spred2-induced autophagic signaling accelerates the progress of osteogenic differentiation ability of BMSCs.

BACKGROUND: This study aimed to investigate the incidences of pre- and post-operative lower extremity deep venous thrombosis (DVT) in hospitalized patients with intertrochanteric fractures and to analyze the relevant risk factors. METHODS: A retrospective study was conducted between July 2014 and October 2016 in 218 intertrochanteric fracture patients who presented at Xi’an Honghui Hospital and underwent Doppler ultrasonography for DVT diagnosis. We divided DVT into distal, proximal, and mixed thrombosis. Patients were divided into either the thrombosis or no thrombosis group according to preoperative and postoperative ultrasonography results. All patients were evaluated for the risk factors associated with thrombosis. RESULTS: A total of 37.61% of preoperative patients had DVT, and the postoperative incidence increased to 58.72%. The days between fracture and hospitalization and the days between fracture and surgery were independent risk factors for preoperative DVT. The days between fracture and hospitalization and d-dimer levels at postoperative 1 day were independent risk factors of postoperative DVT. In total 23.4% of the patients progressed from having no thrombosis preoperatively to having distal, proximal, or mixed DVT postoperatively (22.02%, 0.46%, and 0.92%, respectively). Distal DVT constituted 86.59% and 90.63% of all preoperative and postoperative DVTs, respectively. CONCLUSION: Intertrochanteric fracture is a common type of hip fracture in the elderly, and the incidence of DVT after intertrochanteric fracture may be underestimated. Early intervention (early admission and early surgery) might reduce the incidence of DVT.

The purpose of this study was to identify patients at higher risk of deep venous thrombosis (DVT) in the uninjured lower extremity both preoperatively and postoperatively in patients with lower extremity fractures. We collected the clinical data of patients with lower extremities fractures who presented at Xi’an Honghui Hospital between 1 July, 2015 and 31 October, 2017. Doppler ultrasonography was used to diagnose the DVT. Patients were examined pre- and postoperatively. The patients were divided into thrombosis group and no thrombosis group according to the preoperative and postoperative ultrasonography results. The thrombosis group was defined as patients with DVT in the uninjured lower extremity and the no thrombosis group was defined as patients without DVT in the uninjured lower extremity. This study enrolled 1454 patients who met the inclusion criteria. The incidence of preoperative DVT in the uninjured lower extremity was 9.63% whereas the postoperative incidence was 20.29%. Age (OR = 0.965, 95 CI%: 0.954-0.977; P ≤ 0.001) and female (OR = 0.667, 95% CI: 0.451-0.986, P = 0.042) were independent risk factors for preoperative DVT in the uninjured lower extremity. Blood loss (OR = 0.997, 95 CI%: 0.995-1.000; P = 0.020), D-dimer level at admission (OR = 0.941, 95 CI%: 0.887-0.999; P = 0.045), and postoperative day 5 D-dimer level (OR = 0.889, 95 CI%: 0.819-0.965; P = 0.005), were independent risk factors for postoperative DVT in the uninjured lower extremity. For the patients with lower extremity fractures, age and female were associated with the preoperative DVT in the uninjured lower extremity. Blood loss, D-dimer at admission and postoperative day 5 D-dimer were associated with the postoperative DVT in the uninjured lower extremity.

Objective: The purpose of this study was to investigate the incidence of deep venous thrombosis (DVT) in the uninjured limb, before and after operation, in patients with lower extremity fractures.Methods: We collected the clinical data of patients with lower extremities fractures who presented at Xi’an Honghui Hospital between 1 July, 2015 and 31 October, 2017. Doppler ultrasonography was used to diagnose the DVT. Patients were examined pre- and postoperatively. The patients were then divided into a thrombosis group and a no thrombosis group according to the preoperative and postoperative ultrasonography results. The thrombosis group was defined as patients admitted to our hospital with DVT in the uninjured limb and the no thrombosis group was defined as patients without DVT in the uninjured limb. Results: This study enrolled 1454 patients who met the inclusion criteria. The incidence of preoperative DVT in the uninjured limb was 9.63% whereas the postoperative incidence was 20.29%. Age (OR=0.965, 95 CI%: 0.954 - 0.977; P≤0.001) and gender (OR=0.667, 95% CI: 0.451-0.986, P=0.042) were independent risk factors for preoperative DVT in the uninjured limb. Blood loss (OR=0.997, 95 CI%: 0.995-1.000; P=0.020), D-dimer levels at admission (OR=0.941, 95 CI%: 0.887-0.999; P=0.045), and postoperative day 5 D-dimer levels (OR=0.889, 95 CI%: 0.819-0.965; P=0.005), were independent risk factors for postoperative DVT in the uninjured limb.Conclusion: In conclusion, the actual incidence of DVT in the uninjured lower extremity after fracture may currently be underestimated and should be pay more attention.

Objective: The purpose of this study was to investigate the incidence of and independent risk factors for deep venous thrombosis (DVT) in the uninjured limb, before and after operation, in patients with lower extremity fractures.Methods: We collected the clinical data of patients with lower extremities fractures who presented at Xi’an Honghui Hospital between 1 July, 2015 and 31 October, 2017. Doppler ultrasonography was used to diagnose the DVT. Patients were examined pre- and postoperatively. The patients were then divided into a thrombosis group and a no thrombosis group according to the preoperative and postoperative ultrasonography results. The thrombosis group was defined as patients admitted to our hospital with DVT in the uninjured limb and the no thrombosis group was defined as patients without DVT in the uninjured limb.Results: This study enrolled 1454 patients who met the inclusion criteria. The incidence of preoperative DVT in the uninjured limb was 9.63% whereas the postoperative incidence was 20.29%. Age (OR=0.965, 95 CI%: 0.954 - 0.977; P=0.000) and gender (OR=0.667, 95% CI: 0.451-0.986, P=0.042) were independent risk factors for preoperative DVT in the uninjured limb. Blood loss (OR=0.997, 95 CI%: 0.995-1.000; P=0.020), D-dimer levels at admission (OR=0.941, 95 CI%: 0.887-0.999; P=0.045), and postoperative day 5 D-dimer levels (OR=0.889, 95 CI%: 0.819-0.965; P=0.005), were independent risk factors for postoperative DVT in the uninjured limb.Conclusion: In conclusion, the actual incidence of DVT in the uninjured lower extremity after fracture may currently be underestimated and should be pay more attention.

Bin-Fei Zhang,* Xing Wei,* Hai Huang, Peng-Fei Wang, Ping Liu, Shuang-Wei Qu, Jia-Hao Li, Hu Wang, Yu-Xuan Cong, Yan Zhuang, Kun Zhang Department of Orthopedic Trauma, Hong-Hui Hospital, Xi’an Jiaotong University College of Medicine, Beilin District, Xi’an, Shaanxi, China *These authors contributed equally to this work Objective: To investigate the incidences of deep vein thrombosis (DVT) before and after operation in inpatients with hip fractures in both lower extremities.Patients and methods: We collected the clinical data of 463 patients with lower extremities fractures who presented at Xi’an Honghui Hospital between July 1, 2014, and October 31, 2016 and met all the inclusion criteria. Doppler ultrasonography was used to diagnose DVT. The patients were examined preoperatively and postoperatively and divided into the thrombosis and non-thrombosis group according to the ultrasonographic findings. We divided the DVT cases into central, peripheral, and mixed thromboses.Results: The incidence of preoperative DVT was 34.98%, and the prevalence of DVT on the uninjured side was 13.60%. This composition ratio increased to 57.23% postoperatively, and the prevalence of DVT on the uninjured side was 25.05%. Age (odds ratio [OR], 1.03; 95% CI: 1.01–1.04; P=0.002), venous thrombosis at admission (OR, 4.05; 95% CI, 2.30–7.13; P=0.000), and the days between the fracture and the operation (OR, 1.10; 95% CI, 1.02–1.20; P=0.020) were the independent risk factors of preoperative DVT. Coronary heart disease (OR, 1.85; 95% CI: 1.18–2.89; P=0.007), venous thrombosis at admission (OR, 22.35; 95% CI: 6.78–73.60; P=0.000), days between fracture and operation (OR, 1.06; 95% CI: 1.01–1.11; P=0.021), and blood loss (OR, 1.002; 95% CI: 1.000–1.003; P=0.014) were independent risk factors of postoperative DVT.Conclusion: The actual incidence of DVT after hip fracture may be underestimated. The incidences of preoperative and postoperative DVTs and the incidence of DVT on the uninjured limb were high. Keywords: deep vein thrombosis, ultrasonography, hip fracture, anticoagulation, low-molecular-weight heparin

Objective The relationship between the use of screws and acetabular cup stability in total hip arthroplasty (THA) remains controversial. We evaluated cup stability in THA with and without the use of screws. Methods We performed a systematic literature search to identify studies on cup stability relative to the use of screws in patients undergoing THA before October 2018. Methodological quality assessment and data collection were performed by two individual reviewers. Meta-analysis was performed using Review Manager version 5.3.5. Results We included seven trials involving 1402 patients (1469 THAs): 767 patients (809 THAs) with screws and 635 patients (660 THAs) without screws. The findings of meta-analysis indicated that uncemented acetabular component fixation with the use of additional screws was not correlated with migration of the cup, migration on roentgen stereophotogrammetry, or reoperation after THA. Moreover, operation time was not significantly different according to whether screws were used. There was no relationship between use of additional screws and osteoporosis or Harris Hip Score; however, THA with or without the use of screws might be related to bone sclerosis in the C1 region. Conclusion Currently, limited evidence shows that the use of screws during THA may not improve cup stability.

Objective. This study is aimed at investigating the incidence of deep vein thrombosis (DVT) in the uninjured limb during hospitalization and 1 month after surgery in patients with lower extremity fractures. Methods. We collected the clinical data of patients with lower extremity fractures in Xi’an Honghui Hospital. Doppler ultrasonography was used to diagnose DVT. According to the results of ultrasonography, the patients were divided into two groups: uninjured limb with DVT group and uninjured limb without DVT group. Results. A total of 494 patients who met all inclusion criteria were included in this study. The incidence rate of DVT in the uninjured limb was 19.84% and 18.83% during hospitalization and 1 month after surgery, respectively. Age (OR=1.035, 95% CI: 1.013–1.059; P=0.002) and D-dimer level 1 day after surgery (OR=1.065, 95% CI: 1.030–1.102; P<0.001) were independent risk factors for DVT during hospitalization. Similarly, age (OR=1.045, 95% CI: 1.021–1.070; P<0.001) and D-dimer level 1 day after surgery (OR=1.048, 95% CI: 1.014–1.083; P=0.006) were independent risk factors for DVT 1 month after surgery. During hospitalization and 1 month after surgery, 15.79% and 12.35% of patients had double lower limb thrombosis and 4.04% and 6.48% of patients had DVT in the uninjured limb only, respectively. Conclusion. The actual incidence of DVT in the uninjured limb in patients with lower extremity fractures cannot be ignored despite the use of anticoagulants for prevention or treatment during hospitalization. We should also be aware of DVT in the uninjured limb while focusing on DVT in the injured limb.