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Background: Due to the special anatomy of the lower leg, tibial diaphyseal fracture causes increased intracompartmental pressure (ICP). Not only is this increased ICP the manifestation of skeletal muscle injury, but it induces further deterioration of the injury. The aim of this study was to assess the association between short-term ICP elevation and long-term skeletal muscle recovery after severe limb trauma.Methods: In this single-center ambispective cohort study, we retrospectively screened and recruited a cohort of tibial diaphyseal fracture patients with integrated ICP data during the early post-traumatic period, and performed a prospective observational study to evaluate their skeletal muscle recovery through long-term follow-up and MR imaging after the removal of the implants. We analyzed the association between ICP elevation and skeletal muscle recovery using statistical methods.Results: A total of 46 patients with healed fractures underwent intramedullary nail removal and MR imaging. The absolute values of the Pearson product-moment correlation coefficients between various ICP parameters and the cross-sectional area ratio (CSAR) ranged from 0.588 to 0.793, and the correlation coefficients between the ICP parameters and the average T2-weighted signal intensity ratio (T2SIR) varied from 0.566 to 0.775. Statistically significant associations were observed between the ICP parameters and the MR imaging parameters when simple linear regression analysis was performed. Among the ICP parameters, the accumulated ΔP (ΔP = diastolic blood pressure minus ICP) had the highest determination coefficient and explained 62.1% and 59.1% of the variance in CSAR and T2SIR, respectively.Conclusions: Short-term ICP elevation was associated with long-term skeletal muscle recovery following tibial diaphyseal fracture, especially for ICP data that integrated time factors.Level Of Evidence: Level 3. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the protective effect of inorganic nitrate against systemic damage in a mouse model of total body gamma irradiation (TBI).Methods and Materials: C57BL/6 mice in the irradiation (IR) + NaNO3 group were pretreated with 2 mmol/L NaNO3 in their drinking water for 1 week before receiving 5 Gy irradiation. Animals that received only 5 Gy irradiation were designated as the IR group. Survival and body weight were monitored. The peripheral blood lymphocytes, heart, liver, lung, and submandibular gland were harvested and assessed. Reactive oxygen species (ROS) were measured in the lung and submandibular gland. We examined phosphorylated histone H2AX (p-H2AX) and p53-binding protein 1 (53BP1) as markers of early-stage DNA damage and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and Bax/caspase 3 mRNA expression as markers of apoptosis.Results: No improvement of survival was observed in the IR + NaNO3 group after TBI, but body weight loss after 5 Gy TBI was significantly attenuated in the IR + NaNO3 group. The levels of peripheral blood erythrocytes, leukocytes, and platelets at 7 days postirradiation recovered with nitrate treatment; moreover, the p-H2AX level in the peripheral blood lymphocytes was much lower in the IR + NaNO3 group at 2 and 4 hours post irradiation. In the lung and submandibular gland, the levels of p-H2AX, 53BP1 and ROS as well as TUNEL staining were significantly decreased in the IR + NaNO3 group compared with those in the IR group. Gene expression of Bax and caspase 3 was decreased in both the lung and submandibular gland with nitrate treatment, indicating attenuation of apoptosis.Conclusion: Inorganic nitrate delivery could effectively prevent TBI-induced systemic damage. Nitrate-mediated decreases in ROS levels may contribute to this systemic protective effect. [ABSTRACT FROM AUTHOR]

Background: Management of posterolateral tibial plateau quadrant fractures can be challenging, and two posterior approaches were frequently used for exposure, reduction, and fixation: posterolateral approach and posteromedial approach. The purpose of this study was to compare their deep anatomical structure and analyze their limits and the risk of injury to important structures during surgical dissection of two approaches. Method: Five lower limb specimens were used in this study. After dissection of the skin and superficial fascia of each specimen, deep structures were dissected via posteromedial and posterolateral approach, and several parameters including perpendicular distance from the anterior tibial artery coursing through the interosseous membrane fissure to the lateral joint line and apex of fibular head and so on were measured and analyzed. Result: The perpendicular distance from the ATA coursing through the interosseous membrane fissure to the lateral joint line was 49.3 ± 5.6 mm (range 41.3–56.7 mm), while the distance to the apex of fibular head was 37.7 ± 7.2 mm (range 29.0–48.0 mm). The transverse distance of the anterior tibial vascular bundle is around 10 mm. The perpendicular distance from the top accompanying vein of the ATA bundle to lateral joint line and apex of fibular head was 44.1 ± 6.3 mm and 32.5 ± 7.6 mm, respectively. The maximum proportion of posterolateral tibial plateau shielded by the fibular head from the posterior view was 61.7 ± 4.9% (range 55.6–64.1%). The average length of popliteus muscle outside the joint was 83.1 ± 6.0 mm (range 76.5–92.2 mm), and the width in the middle was 28.1 ± 4.3 mm (range 26.6–29.1 mm). Conclusion: Although posterolateral approach seems more direct for exposure of posterolateral quadrant tibial plateau fracture, it has three major disadvantages in deep dissection. Posteromedial approach through the medial board of medial head of gastrocnemius–soleus may be safer, but it was hard for direct visualization of articular surface which limits it usage for only a few cases. [ABSTRACT FROM AUTHOR]

The posterolateral tibial plateau fracture was not easy to be exposed and fixed with usual techniques. The aim of this study was to investigate the biomechanical stability and clinical outcome of the isolated posterolateral tibial plateau fracture fixed with a single horizontal belt plate through the anterolateral supra-fibular-head approach. Fracture models were created by 18 synthetic tibias and fixed with three different fixation modes. Each group was fixed and tested on the loading machine, and final vertical displacement of the fragment was detected and calculated. Clinically, a retrospective analysis of 12 cases of posterolateral tibial plateau fracture from January 2013 to December 2017 was performed. There were 8 males and 4 females, aged 33-72 years, with an average age of 49.6 years. Isolated posterolateral tibial plateau fractures were identified according to preoperative X-ray and computed tomography scan. Through the modified anterolateral supra-fibular-head approach, the fracture was reduced and fixed by a prebending T-shaped distal radius plate and rafting screws, with bone substitute grafting or autogenous iliac bone implantation. Patients were followed up to a minimum one year of time period, and the outcome was evaluated clinically and radiologically. The biomechanical study shows that horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability, allowing early knee functional exercise and partial weight bearing. For clinical case series, the average operation time in this group was 73.3 ± 10.2 mins (range: 55-90), and the average duration of hospitalization was 9.1 ± 3.3 days (range: 5-16). Patients were followed up for 12-24 months with an average of 16.5 months, and all patients achieved radiological fracture union after an average of 13.7 weeks. At one year after operation, the average knee score of the Hospital for Special Surgery (HSS) scale was 93.2 ± 4.2 points(range: 90-98), the average score of SMFA was 21.1 ± 5.6 points (range: 14-31), and the average knee range of motion (ROM) was 121.48 ° ± 8.88 ° (range: 105°-135°). There were 8 cases that were very satisfied and 3 cases that were satisfied with the operation. For an isolated posterolateral tibial plateau fracture, the supra-fibular-head approach can fully expose the fracture site; the horizontal belt plate fixation of the fracture is stable and reliable to allow for early-stage knee rehabilitation, and the outcome of medium-term clinical follow-up was satisfactory. [ABSTRACT FROM AUTHOR]

Inorganic dietary nitrate plays vital roles in biological functions via the exogenous NO3-/NO2-/NO pathway under hypoxia and ischemia. We previously verified the antioxidative effects of inorganic nitrate in a mouse model of total body irradiation (TBI). Accordingly, in this study, we evaluated the effects of inorganic nitrate on prevention of TBI-induced colon injury and dysbiosis of the gut microbiome. Nitrate significantly rescued the abnormal biological indexes (body weight, white blood cell, red blood cell, platelet, hemoglobin level and intestinal canal lengths) induced by TBI. Then, we detected oxidative stress and DNA damage indexes (phospho-histone H2AX and p53 binding protein 1), which were both increased by irradiation (IR) and alleviated by nitrate. IR-induced apoptosis and senescence were ameliorated by inorganic nitrate. The distribution of the gut microbiome differed for mice with TBI and those receiving inorganic nitrate. The average abundance of Lactobacillus significantly increased, and that of Bacteroidales decreased at the genus level in the nitrate group compared with that in the IR alone group. At 30 days after TBI, the abundances of Bacteroides and Faecalibaculum decreased, whereas that of Lactobacillus increased in the IR + nitrate group compared with that in the IR alone group. Inorganic nitrate efficiently prevents TBI-induced colon epithelium injury and maintains the homeostasis of the gut microbiome. Thus, our results showed that inorganic nitrate might be a promising treatment for TBI induced colon injury. Image 1 • We evaluated the effects of inorganic nitrate on TBI-induced colon injury prevention. • Nitrate significantly rescued the abnormal biological indexes induced by TBI. • Oxidative stress and DNA damage were increased by IR and reduced by nitrate. • The gut microbiome differed for mice with TBI and those receiving inorganic nitrate. • Inorganic nitrate prevented TBI-induced colon epithelium injury. [ABSTRACT FROM AUTHOR]

In this study, soybean protein isolate (SPI) and cellulose nanofibers (CNF) were used to prepare an oil-in-water emulsion. The effect of the sequence of adding SPI and CNF on the properties of the emulsion was examined by analyzing the emulsion index, microstructure, droplet size, zeta potential, rheological behavior, and in vitro gastrointestinal digestion characteristics of the emulsion. By using both SPI and CNF as emulsifiers, a better emulsification effect was obtained than using SPI or CNF alone. The particle size of the emulsion with SPI added first and CNF added later was smaller than that of the emulsion with CNF added first and SPI added later. And the emulsions with SPI added first had more cellulose nanofibers in the aqueous phase system. The emulsion with CNF added first and SPI added later was more likely to form a three-dimensional network structure; thus, it is more conducive to reducing the release of free fatty acids. When 50 mmol/L NaCl was added to the emulsion, the emulsion droplets gathered, and the viscosity increased, which was conducive to the formation of three-dimensional network gel structure of emulsion, but at the same time, the ability to release free fatty acids was improved. [Display omitted] • The addition sequence of SPI and CNF will affect the properties of emulsions. • It is easier to form small particle size emulsions by adding SPI first. • It is easier to form a three-dimensional network structure by adding CNF first. • Adding CNF first is more conducive to reducing the release of free fatty acids. • The addition of a small amount of NaCl promotes the formation of the gel network structure. [ABSTRACT FROM AUTHOR]

Background: We aimed to explore the predictive value of retinol binding protein (RBP) for outcomes of hip fractures. Methods: Patients with hip fractures who underwent hip surgeries between December 2017 and February 2021 and met the inclusion criteria were analyzed. Propensity score matching was used to reduce the bias of co-factors and ROC curves based on matched populations were created to determine the optimal cutoff point of RBP. The outcomes between patients with low levels of RBP and high levels of RBP were compared. Results: Four hundred eighty patients were enrolled in this study and 69 patients died within one year. After a 1:1 PSM, patients with more than 1-year survival had significantly higher RBP (p = 0.013) than those who died within one year, as well as patients divided by 6-months survival (p = 0.012). Logistics analysis showed that low RBP may be an independent risk factor for 3-month survival, 6-month survival, 1-year survival, and 3-month free walking ability. Conclusion: RBP may be associated with the survival and 3-month walking abilities of patients with hip fractures. [ABSTRACT FROM AUTHOR]

Objective: Scaphoid fracture was the most common carpal fracture and the most challenging. The purpose of this study was to investigate and compare the clinical effects of closed reduction and percutaneous cannulated screw internal fixation under fluoroscopy and arthroscopy‐assisted percutaneous cannulated screw internal fixation in the treatment of Herbert B2‐type of acute scaphoid fractures. Methods: A retrospective controlled study was conducted on 29 patients with Herbert B2‐type acute scaphoid fracture with a displacement of >1 mm admitted to our hospital from January 2017 to June 2021. Patients were divided into two groups, 11 patients were treated with closed reduction percutaneous cannulated screw internal fixation under fluoroscopy and 18 patients were treated with percutaneous cannulated screw internal fixation assisted by arthroscopy. The operative time, intraoperative fluoroscopy times, fracture healing time, complications, and postoperative wrist function score of the two groups were compared. Results: All patients were followed up for 6–18 months (mean follow‐up duration: 10.38 ± 2.69 months). The respective operation times in the arthroscopy group and fluoroscopy group was 51.50 ± 6.69 min and 56.73 ± 11.48 min, respectively (p > 0.05). The number of fluoroscopies performed in the arthroscopy group was (6.83 ± 1.30), which was less than that in the fluoroscopy group (10.91 ± 2.62) (p < 0.05). All fractures in the arthroscopy group healed after the operation, and the fracture healing time was 11.44 ± 1.25W. Ten patients in the fluoroscopy group healed. The fracture healing time was 13.60 ± 2.32 W. The fracture healing time in arthroscopy group was less than that in the fluoroscopy group (p < 0.05). One patient in the fluoroscopy group had nonunion and healed after bone grafting and internal fixation. At the postoperative 6‐month follow‐up, the modified Mayo wrist function score was used to evaluate the clinical results. The wrist function score of patients in the arthroscopy group was 90 (85, 95), which was >80 (80, 90) in the fluoroscopy group (z = 2.74, p < 0.05). Conclusion: For Herbert B2‐type acute scaphoid fracture with fracture displacement > 1 mm, the arthroscopy‐assisted percutaneous cannulated screw internal fixation has less fluoroscopy times, short fracture healing time, and good recovery effect of wrist function compared to the fluoroscopy. [ABSTRACT FROM AUTHOR]

Objective. To investigate if 3D printed guides and preoperative planning can accurately control femoral stem anteversion. Methods. A prospective comparative study was carried out from 2018 to 2020, including 53 patients who underwent hip arthroplasty for femoral neck fracture. The target rotation center of the femoral head is determined by three-dimensional planning. In group A, planning was made by 2D templates. In group B, preoperative 3D planning and 3D printed osteotomy/positioning guides were performed. After the operation, 3D model registration was performed to calculate the accuracy of anteversion restoration. Results. We screened 60 patients and randomized a total of 53 to 2 parallel study arms: 30 patients to the group A (traditional operation) and 23 patients to the group B (3D preoperative planning and 3D printed guide). There were no significant differences in demographic or perioperative data between study groups. The restoration accuracy of group A was 5.42 ° ± 3.65 ° and of group B was 2.32 ° ± 1.89 ° . The number and rate of abnormal cases was 15 (50%) and 2 (8.7%), respectively. Significant statistical differences were found in angle change, restoration accuracy, and number of abnormal cases. Conclusion. Three-dimensional preoperative planning and 3D printed guides can improve the accuracy of the restoration of femoral anteversion during hip arthroplasty. [ABSTRACT FROM AUTHOR]

Objective. Unstable pertrochanteric fractures are usually treated with internal fixation, and the integrity of the anteromedial cortex is an important factor for stability and healing. In this study, we described and analyzed the three-dimensional mapping technology and morphological characteristics of pertrochanteric fractures. Methods. Fifty-nine pertrochanteric fractures (OTA/AO 2007 types 31A2) were retrospectively reviewed. Computed tomographic (CT) images for all fractures were superimposed on a standard template. Medial wall integrity was analyzed, and three-dimensional fracture maps were created. Results. Pertrochanteric fractures always have a posterior defect in the medial cortex. The mean width of the defect, in our study, was 21.5 mm (SD: 6.1 mm, range: 10–40 mm), 56.3% (SD: 13.7%, range: 27.5-100%). Bone segments that contact by the anteromedial cortex were 16.5 mm (SD: 5.3 mm, range: 0-29 mm). Conclusion. The integrity of the anteromedial cortex should be considered during internal fixation of femoral trochanteric fractures. These morphological characteristics could be used to form postoperative cortical contact and improve stability of the fixation. Three-dimensional mapping technology can help establish a typical fracture model, thereby improving doctors' understanding of fracture characteristics. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) involves chronic inflammation, loss of epithelial integrity, and gastrointestinal microbiota dysbiosis. Effective therapies for IBD have not been established. Accordingly, in this study, we evaluated the effects of inorganic nitrate, a potent nitric oxide (NO) donor and microbiota regulator, in a mouse model of dextran sodium sulfate (DSS)-induced colitis. Mice were pretreated with NaNO 3 (2 mM) in their drinking water for 5 days, and NaCl was used as a control. Feces were collected for microbiota analyses. The results showed that oral administration of dietary nitrate could maintained colon consistency, improved colon length, maintained body weight, decreased apoptosis in colon epithelial cells, and ameliorated inflammatory cell infiltration in both the colon and peripheral blood. Microbiota profiling revealed that nitrate regulated dysbiosis. Analysis of the top bacteria at the genus level showed that Bacteroidales_S24-7_group_unidentified , Lactobacillus , Bacteroides , and Prevotellaceae_UCG-001 decreased in the DSS group compared with that in the normal group, whereas Lactobacillus , Ruminococcaceae_UCG-014 , and Prevotellaceae_UCG-001 were increased in the DSS + NaNO 3 group compared with that in the DSS group. The enriched bacteria in the nitrate group included Gordonibacter , Ureaplasama , and Lachnospiraceae_UCG-006. Moreover, microbiota analysis revealed that nitrate could partially decrease the enriched metabolic pathways (p53 signaling pathway and colorectal cancer pathway) compared with that in the DSS and DSS + NaCl groups. Overall, these findings indicated that nitrate could ameliorate DSS-induced colitis by decreasing inflammation, reducing apoptosis, and regulating the microbiota by activation of the NO 3 −/NO 2 −/NO pathway. Nitrate might be a potential treatment for colitis patients in the future clinical application. Inflammatory bowel disease (IBD) which was characterized by impaired colon epithelium and dysbiosis of gut microbiome, has emerged as a public health challenge worldwide. Inorganic nitrate efficiently alleviated the symptoms of experimental mouse DSS induced colitis via activating the NO 3 −/NO 2 −/NO pathway. The potentially mechanism were via ameliorating inflammatory cell infiltration, regulating microbiota dysbiosis and restoring beneficial bacteria. Image 1 • We evaluated the effect of nitrate on DSS-induced colitis in mice. • Dietary nitrate ameliorated inflammatory cell infiltration in the colon and PB. • Nitrate regulated microbiota dysbiosis and restored beneficial bacteria in the gut. • Nitrate ameliorated DSS-induced colitis by activation of the NO 3 −/NO 2 −/NO pathway. [ABSTRACT FROM AUTHOR]

Background: Although the cannulated screw and cable (CSC) tension band technique is an effective method for fixation of transverse patellar fractures, it has shortcomings, such as extensive soft tissue damage, osseous substance damage, and complex manipulation. We conducted a retrospective comparison of the adjustable patella grapple (APG) technique and the CSC tension band technique. Patients and methods: We retrospectively reviewed 78 patients with transverse patellar fractures (45 in the APG group and 33 in the CSC group). Follow-up was 18 months. Comparison criteria were operation time, fracture reduction, fracture healing time, the knee injury and osteoarthritis outcome score for knee function, and complications. Results: The APG group showed shorter operation time and equal fracture reduction, fracture healing time, and knee function compared with the CSC group. Eleven patients in the APG group experienced skin irritation generated by implants. There was no complication in the CSC group. Conclusions: The APG technique should be considered as an alternative method for treatment of transverse patellar fractures. [ABSTRACT FROM AUTHOR]