Occurrence and distribution of salsolinol-like compound, 1-acetyl-6,7-dihydroxy-1,2,3,4-tetrahydroisoquinoline (ADTIQ) in Parkinsonian brains

Parkinson’s disease (PD) arises from the loss of dopaminergic neurons in the substantia nigra. 1-Methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) is well known to cause Parkinsonism in humans with neurotoxicity specific for dopaminergic neurons. The experience with MPTP supports the hypothesis that endogenous or xenobiotic neurotoxins are involved in the pathogenesis of PD in humans. In our study, 1-acetyl-6, 7-dihydroxy-1, 2, 3, 4-tetrahydro-isoquinoline (ADTIQ), a novel compound, was found in frozen human brain tissues. The formation of ADTIQ was demonstrated using dopamine and methylglyoxal under physiological conditions. Methylglyoxal is a by-product of glycolysis. ADTIQ and its precursors, dopamine and methylglyoxal, were detected in different regions of frozen human brains such as the substantia nigra, caudate nucleus, putamen, frontal cortex, and the cerebellum. A significant difference in ADTIQ levels between control and Parkinson’s patients was found; for instance, the ADTIQ level in putamen of PD patients was 0.76 ± 0.27 nmol/g compared to 0.10 ± 0.01 nmol/g in control. Our results might indicate that ADTIQ is possibly related to Parkinson’s disease.     

体质量指数对全髋关节置换后早期髋关节功能恢复影响的三维步态分析

文题释义：三维步态分析系统：通过对利用摄像机得到的人体运动图像进行图像处理，来进行步态分析的技术及装置。以获取人体在各体态和运动下的生理、病理的力学和数学参数，进行人体各部位和机能检测，所检测的数据经进一步分析计算后可获得人体各部位(特别是关节)的受力状态，以及机械功、代谢能量消耗的情况。 体质量指数：是一个计算值，当需要比较及分析一个人的体质量对于不同高度的人所带来的健康影响时，体质量指数值是一个中立而可靠的指标。 背景：肥胖对全髋关节置换的影响已有学者进行讨论，但目前尚缺乏对不同体质量指数患者使用三维步态分析技术进行随访的研究。 目的：通过三维步态分析系统定量分析体质量指数对全髋关节置换后早期髋关节功能恢复的影响。 方法：选择大连大学附属中山医院关节外科2017年1月至2018年6月收治的全髋关节置换患者60例，根据入院时体质量指数分为超重组(体质量指数≥25 kg/m²)与正常组(体质量指数< 25 kg/m²)，每组30例。所有患者对检测方案均知情同意，且得到医院伦理委员会批准。收集患者的手术部位、年龄、性别、身高、体质量、手术时间等临床基本资料；术后6个月时使用三维步态分析技术采集时间-距离参数(步幅、步频、平均步速)、动力学参数及运动学参数对髋关节功能进行评价。 结果与结论：①2组在手术部位、性别比例及年龄方面差异无显著性意义(P > 0.05)；但超重组手术时间明显长于正常组，差异有显著性意义(P=0.000)；②时间-距离参数方面，2组在步幅、步频及平均步速上差异虽无显著性意义，但超重组步幅(1.08±0.18) m小于正常组(1.35±1.45) m；③运动学参数中，超重组在髋关节各个面的活动范围均小于正常组，差异有显著性意义(P < 0.05)；④动力学参数方面，屈髋力矩峰值超重组小于正常组，差异有显著性意义(P=0.011)；伸髋力矩峰值2组差异无显著性意义(P=1.000)；⑤提示肥胖对全髋关节置换后早期功能恢复存在一定影响。 ORCID: 0000-0003-1824-687X(陈浩鹏) 中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程     

松质骨移植血管束植入治疗四肢骨不愈合的实验和临床研究

研究血管束植入移植松质骨治疗四肢骨不愈合的疗效。人工造成兔桡骨骨缺损后 ,分别用松质骨移植血管束植人及单纯松质骨移植进行修复 ,术后 4、 8、 1 6周进行大体标本。X线、光镜和电镜观察 ,并应用前种方法治疗四肢骨不连患者 1 8例。结果显示血管束植入移植松质骨较单纯血管束植入法和单纯松质骨移植治疗骨缺损效果好 ,应用这种方法治疗的 1 8例骨不连患者均取得了满意的疗效。认为血管束植入移植松质骨是一种治疗四肢骨不愈合的简便、有效的方法     

股骨头缺血性坏死骨瓣移植过程的有限元模拟

基于临床上的一例股骨头三期缺血性坏死患者的单侧CT图像数据，建立了股骨近端的三维有限元模型，包括：正常模型、坏死模型和修复模型。并基于医学OF图像数据，分别对三种有限元模型赋予材料性质。最后应用有限元软件，对股骨头缺血性坏死骨瓣移植手术过程进行了数值模拟。分析结果表明，切除掉坏死区域后，股骨头近端的位移及应力值均增加较大，而采用骨瓣移植手术，可以有效地减少股骨近端的位移及应力值，使其更接近正常状态。说明了该手术方法安全可靠并行之有效。     

Epiphyseal Arterial Network and Inferior Retinacular Artery Seem Critical to Femoral Head Perfusion in Adults With Femoral Neck Fractures

Background

A better understanding of the blood supply of the femoral head is essential to guide therapeutic strategies for patients with femoral neck fractures. However, because of the limitations of conventional techniques, the precise distribution and characteristics of intraosseous arteries of the femoral head are not well displayed.

Questions/purposes

To explore the characteristics and interconnections of the intraosseous vessel system between different areas of the femoral head and the possible blood supply compensatory mechanism after femoral neck fracture.

Methods

The three-dimensional (3-D) structures of the intraosseous blood supply in 30 uninjured normal human femoral heads were reconstructed using angiography methods and microCT scans. The data were imported in the AMIRA^® and MIMICS^® software programs to reconstruct and quantify the extra- and intraosseous arteries (diameter, length). In a separate experiment, we evaluated the residual blood supply of femoral heads in 27 patients with femoral neck fractures before surgery by analyzing digital subtraction angiography data; during the study period, this was performed on all patients in whom hip-preserving surgery was planned, rather than arthroplasty. The number of affected and unaffected subjects included in the three groups (superior, inferior, and anterior retinacular arteries) with different types of fractures (Garden Types I–IV) were recorded and analyzed (Fisher’s exact test) to reflect the affected degrees of these three groups of retinacular arteries in patients after femoral neck fractures.

Results

The main results of our cadaver study were: (1) the main blood supply sources of the femoral head were connected by three main network structures as a whole, and the epiphyseal arterial network is the most widely distributed and the primary network structure in the femoral head; (2) the main stems of the epiphyseal arteries which were located on the periphery of the intraosseous vascular system have fewer anastomoses than the network located in the central region; (3) compared with the round ligament artery and anterior retinacular artery, the inferior retinacular artery has a relatively large caliber. Digital subtraction angiography of the 27 patients with hip fractures indicated that the inferior retinacular arterial system had a high likelihood of being unaffected after femoral neck fracture (100% [14 of 14] in nondisplaced fractures and 60% [six of 10] in Garden Type III fractures).

Conclusions

The epiphyseal arterial network and inferior retinacular arterial system appear to be two important structures for maintaining the femoral head blood supply after femoral neck fracture. Increased efforts to protect these key structures during surgery, such as drilling and placing internal implants closer to the central region of the femoral head, might be helpful to reduce the effect of iatrogenic injury of the intraosseous vascular system.

Clinical Relevance

3-D anatomic evidence of intraosseous arterial distribution of the femoral head and the high frequency with which the inferior retinacular arteries remained patent after femoral neck fracture lead us to consider the necessity of drilling and placing internal implants closer to the central region of the femoral head during surgery. Future controlled studies might evaluate this proposition.

     

Increased ratio of neutrophil elastase to α1‐antitrypsin is closely associated with liver inflammation in patients with nonalcoholic steatohepatitis

An imbalance between neutrophil elastase (NE) and its inhibitor α1‐antitrypsin (A₁AT) is known to contribute to the development of obesity‐related inflammation. This study aimed to investigate the role of the NE‐A₁AT system in the histological progression of non‐alcoholic fatty liver disease (NAFLD), and to evaluate the ability of it to predict nonalcoholic steatohepatitis (NASH). A total of 252 adults (NAFLD group, n = 202; healthy group, n = 50) were recruited. Clinical biochemical characteristics, NE and A₁AT concentrations were measured in all subjects. Among the NAFLD group, 86 patients had previously undergone liver biopsy and information on histological characteristics was consequently available. The area under the receiver operating characteristic curve (AUC) was used to determine the predictive accuracy of the NE‐A₁AT system for NASH. NAFLD patients had an elevated serum NE concentration and a reduced A₁AT level with consequent NE/A₁AT imbalance. NE increased in the early stage of steatosis, preceding the decline in A₁AT, dating from the onset of NASH (NAS 3–4), and subsequently NE/A₁AT increased in the presence of NASH. Nonetheless, this increase began to resolve as the disease state progressed to advanced fibrosis. A₁AT had a sensitivity (SEN) of 83.8% and a specificity (SP) of 83.3% with the optimal cut‐off of ?1459.43, NE/A₁AT had a SEN of 88.8% and a SP of 83.3% with cut‐off of 0.363 to predict NASH. An increased NE: A₁AT ratio is closely associated with liver Inflammation in patients with NASH and could serve as a novel marker to predict NASH in humans.     

难治性胃食管反流病的非药物治疗进展

胃食管反流病(GERD)是一种常见的上消化道疾病。目前质子泵抑制剂(PPI)是治疗该病的首选药物,但约40%GERD患者经规范治疗后疗效不佳,即难治性GERD,且易合并不同程度的精神心理症状,严重降低患者生活质量。因此积极探索一些非药物治疗手段成为近年来rGERD相关研究的热点。本文就生活方式的调整、穴位刺激、膈肌生物反馈、内镜下治疗、外科手术等rGERD非药物治疗方法进展做一综述。     

Retrospective Long-Term Follow-Up Survival Analysis of the Management of Osteonecrosis of the Femoral Head With Pedicled Vascularized Iliac Bone Graft Transfer

BackgroundOsteonecrosis of the femoral head (ONFH) often affects young, active adults and leads to the destruction of the hip joint and disabling arthritis. Several procedures have been developed to prevent conversion to total hip arthroplasty (THA), especially in young patients who have a high rate of hip revision surgery. The aim of this long-term follow-up is to analyze the results of vascularized iliac bone flap transfer for ONFH treatment.MethodsWe retrospectively reviewed 856 patients (1006 hips) who accepted hip-preserving surgery with vascularized iliac bone grafting due to ONFH (Ficat and Arlet stages II-IV) from January 1985 to December 2012 at our hospital. Radiographic assessment was performed with the Ficat and Arlet system, clinical assessment was performed with the Harris Hip Score system, and quality of life was evaluated with the 36-Item Short Form Survey. The hips included 575 stage II hips, 382 stage III hips, and 49 stage IV hips. We defined clinical failure as conversion to THA or any other hip-preserving surgery because of hip symptoms.ResultsA total of 856 patients (1006 hips) were eventually followed up with an average time of 15 years (range 5-25). In total, 75 patients were lost to follow-up, and 105 hips were converted to THA. The average Harris Hip Score was 87.43 ± 6.42 points at the last follow-up, representing a great improvement compared to the 66.42 ± 6.52 points obtained preoperatively. The Kaplan-Meier survival analysis showed no difference in the 15-year survival rate between patients with stages II and III disease (using THA as an end point). However, the survival rate was lower for patients with stage IV disease than that for patients with stages II and III disease. The survival rate for patients in the glucocorticoid group was lower than that for patients in the idiopathic, alcoholic, and trauma groups. The Physical Component Summary scores ranged from 78 ± 10 to 85 ± 14 postoperatively compared to 30 ± 14 to 55 ± 15 preoperatively, and the postoperative Mental Component Summary scores (range from 34 ± 11 to 59 ± 12) were significantly higher than the preoperative scores (range from 72 ± 11 to 90 ± 10), representing great improvement in patient quality of life. Postoperative complications occurred in 86 patients (4.5%) during the follow-up, including 23 patients with deep venous thrombosis, 16 patients with meralgia paresthetica (which resolved), and 47 patients with secondary wound healing.ConclusionThe vascularized iliac bone flap grafting technique yields significant improvement (particularly in the precollapse disease stages in young patients) for restoration of the biomechanical support of the collapsed femoral head and reconstruction of the blood supply to the osteonecrotic area. This procedure allows these patients to avoid or delay the need for THA surgery.     

术前FIB-4评分与肝细胞癌术后患者预后的关系研究

  目的   探讨FIB（Fibrosis）-4评分系统与肝细胞癌（HCC）患者临床病理特征及预后的关系。  方法   收集2009年1月至2012年12月间245例接受根治性肝切除手术的HCC患者的临床及随访资料进行分析,利用Kaplan-Meier进行单因素生存分析,Cox比例风险回归模型进行多因素生存分析。  结果   根据患者术前FIB-4评分,将患者分为FIB-4Ⅰ（≤3.25）和FIB-4Ⅱ（ > 3.25）。FIB-4能够预测肝硬化程度（Ishak分级:1~5级 vs. 6级,r=0.681,P < 0.001）,其主要与患者的肝功能指标如谷草转氨酶（P < 0.001）、胆红素（P=0.009）、白蛋白（P=0.001）及血小板计数（P < 0.001）相关,与其他病理特征无关。单因素及多因素分析均表明FIB-4能够预测HCC患者的预后（总生存时间:P=0.037,0.011;无瘤生存时间:P=0.027,0.043）。  结论  FIB-4有可能作为HCC根治性切除术后的预后参考指标之一。      

股骨转子间截骨联合术式治疗晚期髋关节发育不良

目的探讨股骨转子间截骨联合术式治疗晚期髋关节发育不良的临床效果。方法采用股骨转子间截骨、髋臼成形或加盖及带血管蒂髂骨瓣转移治疗晚期髋关节发育不良31例(42髋)。结果随访1．2～12年,平均4．3年,全部患者术后髋关节疼痛消失或明显减轻,髋关节功能明显改善。结论股骨转子间截骨联合术是一种治疗晚期髋关节发育不良的有效方法,可以避免或延缓全髋关节置换术。