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C23H29NO3, orthorhombic, Pbcn (no. 60), a = 18.781(7) Å, b = 15.749(6) Å, c = 14.081(5) Å, V = 4165(3) Å3, Z = 8, Rgt(F) = 0.0614, wRref(F2) = 0.1874, T = 296(2) K. [ABSTRACT FROM AUTHOR]

C23H29NO3, orthorhombic, Pbcn (no. 60), a = 18.781(7) Å, b = 15.749(6) Å, c = 14.081(5) Å, V = 4165(3) Å3, Z = 8, Rgt(F) = 0.0614, wRref(F2) = 0.1874, T = 296(2) K. [ABSTRACT FROM AUTHOR]

Background: Osteosarcoma (OS) patients with metastasis have very dismal prognoses, and lack effective target therapies. Overexpression of cytosolic phospholipase A2 (cPLA 2 ) has been shown to promote progression in several types of cancers, but its functions in OS have not been investigated., Materials and Methods: In our study, the expression of cPLA 2 a was detected with immunohistochemistry in 102 cases of OS. The clinical significance of cPLA 2 a was evaluated by analyzing its correlation with clinicopathological factors. The prognostic significance of cPLA 2 a was estimated by univariate and multivariate analysis. The oncogenic functions of cPLA 2 a on cell proliferation and invasion were investigated by MTT assay and tranwell assay respectively. Western blotting was applied to detect the markers of epithelial-mesenchymal transition (EMT) after silencing cPLA 2 a expression or inhibiting its activity by a specific antagonist., Results: In our study, high expression of cPLA 2 a was significantly associated with metastasis and advanced Enneking stage. High cPLA 2 a expression was significantly associated with poor prognosis and it was an independent prognostic biomarker of OS. By silencing cPLA 2 a or inhibiting its activity by a specific antagonist, we demonstrated that cPLA 2 a promoted cell invasion of OS cells via inducing the EMT process., Conclusions: High cPLA 2 a expression was an independent prognostic biomarker of OS, and cPLA 2 a could promote OS cell invasion via inducing the EMT process, indicating that cPLA 2 a was an independent prognostic biomarker and may be an effective drug target for OS., (Copyright © 2019 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Objective: To evaluate the effectiveness of distal femoral osteotomy aided by three-dimensional (3D) printing cutting block for correction of vaglus knee with osteoarthritis., Methods: Between January 2014 and January 2016, 12 patients (15 knees) with vaglus deformity and lateral osteoarhritis underwent medial closing wedge distal femoral osteotomy. There were 5 males and 7 females, aged 30-60 years (mean, 43.8 years). The mean disease duration was 6.6 years (range, 1-12 years). The unilateral knee was involved in 9 cases and bilateral knees in 3 cases. According to Koshino's staging system, 1 knee was classified as stage I, 9 knees as stage II, and 5 knees as stage III. The X-ray films of bilateral lower extremities showed that the femorotibial angle (FTA) and anatomical lateral distal femoral angle (aLDFA) were (160.40±2.69)° and (64.20±2.11)° respectively. Mimics software was used to design and print the cutting block by 3D printing technique. During operation, the best location of distal femoral osteotomy was determined according to the cutting block. After osteotomy, internal fixation was performed using a steel plate and screws., Results: All incisions healed primarily; no complication of infection or deep vein thrombosis was observed. All patients were followed up 6-18 month (mean, 12.2 months). At 6 months after operation, the hospital for special surgery (HSS) score for knee was significantly improved to 89.07±2.49 when compared with preoperative score (65.27±1.49, t =-28.31, P =0.00); the results were excellent in 10 knees, good in 4 knees, and fair in 1 knee with an excellent and good rate of 93.3%. The bony union time was 2.9-4.8 months (mean, 3.3 months). Bone delayed union occurred in 1 case (1 knee). The postoperative FTA and aLDFA were (174.00±1.41)° and (81.87±1.06)° respectively, showing significant differences when compared with preoperative ones ( t =-18.26， P =0.00; t =-25.19, P =0.00). The percentage of medial tibial plateau in whole tibial plateau was 49.78%±0.59%, showing no significant difference when compared with intraoperative measurement (49.82%±0.77%, t =0.14, P =0.89)., Conclusion: 3D printing cutting block can greatly improve the accuracy of distal femoral osteotomy, and ensure better effectiveness for correction of vaglus knee with osteoarthritis.

Objective: To explore the feasibility and the effectiveness of the accurate placement of lumbar pedicle screws using three-dimensional (3D) printing navigational templates in Quadrant minimally invasive system., Methods: The L 1-5 spines of 12 adult cadavers were scanned using CT. The 3D models of the lumbar spines were established. The screw trajectory was designed to pass through the central axis of the pedicle by using Mimics software. The navigational template was designed and 3D-printed according to the bony surface where the soft tissues could be removed. The placed screws were scanned using CT to create the 3D model again after operation. The 3D models of the designed trajectory and the placed screws were registered to evaluate the placed screws coincidence rate. Between November 2014 and November 2015, 31 patients with lumbar instability accepted surgery assisted with 3D-printing navigation module under Quadrant minimally invasive system. There were 14 males and 17 females, aged from 42 to 60 years, with an average of 45.2 years. The disease duration was 6-13 months (mean, 8.8 months). Single segment was involved in 15 cases, two segments in 13 cases, and three segments in 3 cases. Preoperative visual analogue scale (VAS) was 7.59±1.04; Oswestry disability index (ODI) was 76.21±5.82; and the Japanese Orthopaedic Association (JOA) score was 9.21±1.64., Results: A total of 120 screws were placed in 12 cadavers specimens. The coincidence rate of placed screw was 100%. A total of 162 screws were implanted in 31 patients. The operation time was 65-147 minutes (mean, 102.23 minutes); the intraoperative blood loss was 50-116 mL (mean, 78.20 mL); and the intraoperative radiation exposure time was 8-54 seconds (mean, 42 seconds). At 3-7 days after operation, CT showed that the coincidence rate of the placed screws was 98.15% (159/162). At 4 weeks after operation, VAS, ODI, and JOA score were 2.24±0.80, 29.17±2.50, and 23.43±1.14 respectively, showing significant differences when compared with preoperative ones ( t =14.842, P =0.006; t =36.927, P =0.002; t =-36.031, P =0.001). Thirty-one patients were followed up 8-24 months (mean, 18.7 months). All incision healed by first intention, and no complication occurred. During the follow-up, X-ray film and CT showed that pedicle screw was accurately placed without loosening or breakage, and with good fusion of intervertebral bone graft., Conclusion: 3D-printing navigational templates in Quadrant minimally invasive system can help lumbar surgery gain minimal invasion, less radiation, and accurate placement.

Objective: To evaluate the effectiveness of high tibial osteotomy (HTO) assisted by three-dimensional (3-D) printing technology for correction of varus knee with osteoarthritis., Methods: Between January 2014 and June 2015, 16 patients (20 knees) with varus knee and osteoarthritis underwent HTO assisted by 3-D printing technology; a locking compression plate was used for internal fixation after HTO. There were 6 males and 10 females, aged 30-60 years (mean, 45.5 years). The disease duration was 1-10 years (mean, 6.2 years). The unilateral knee was involved in 12 cases and bilateral knees in 4 cases. According to Koshino's staging system, 3 knees were classified as stage I, 7 knees as stage II, 8 knees as stage III, and 2 knees as stage IV. Preoperative Hospital for Special Surgery (HSS) knee score was 63.8 ± 2.2; the femorotibial angle was (184.8 ± 2.9)°; and Insall-Salvati index was 1.03 ± 0.13., Results: All the wounds healed primarily, and no complication of infection, osteofacial compartment syndrom, or deep vein thrombosis was observed. All patients were followed up 6-18 months (mean, 12.6 months). Personal paralysis was observed in 1 case (1 knee), and was cured after expectant treatment. Bone union time was 2.7-3.4 months (mean, 2.9 months). At 6 months after operation, the femorotibial angle was (173.8 ± 2.0)°, showing significant difference when compared with preoperative one (t = 11.70, P = 0.00); Insall-Salvati index was 1.04 ± 0.12, showing no significant difference when compared with preoperative one (t = -0.20, P = 0.85); and HSS knee score was significantly increased to 88.9 ± 3.1 (t = -25.44, P = 0.00). At last follow-up, the results were excellent in 13 knees, good in 6 knees, fair in 1 knee, and the excellent and good rate was 95%., Conclusion: 3-D printing cutting block can greatly improve the accuracy of HTO, avoid repeated X-ray and multiple osteotomy, shorten the operation time, and ensure better effectiveness for correction of varus knee with osteoarthritis.

Objective: To study the method of internal fixation by the navigation embedded plate from standard parts database for the distal femoral fractures based on digital design by Mimics software with 3D printing technology, and to explore its feasibility and accuracy., Methods: A total of 21 cases with distal femoral fractures admitted into the Department of Orthopedics, Affiliated Hospital of Putian University were included in this study. Dicom format data of lamellar CT scanning was imported into Mimics software for 3D anatomical modeling and virtual fracture reduction. The steel plates was chose from standard parts database for virtual internal fixation, and to design the navigation module with screw. 3D printing skeleton, steel plates, navigation module, internal fixation implants were simulated based on the printed bones model. Locations of steel plates and screws were determined by the navigation module. Then the sticking effects of navigation module, screws position and postoperative appearance were observed. After second CT scan and 3D reconstruction, 3D registration was performed to obtain the data of the three-dimensional coordinate values of screws entrance points and piercing points to analyze the results., Results: A total of 21 plates and 180 screws were placed with the assistance of navigation module. CT scanning and 3D reconstruction was performed in twenty-one cases of postoperative bone model. The position of plates was in high accordance with the digital design by Mimics software. There were no significant differences between spatial location of screw entrance points and piercing points. The real operation was quite consistent with preoperative design. Navigation module and the corresponding distal femur bony structure jointed closely. The sticking effects and stability of navigation module were good, which was able to guide placement of steel plates and screws., Conclusion: These methods can enhance the accuracy of internal fixation of the standard parts database steel plate in distal femur fractures, with the assistance of navigation module.

Objective: To explore the method and feasibility of digital internal fixation for proximal tibia fractures using standard parts database and three-dimensional (3D) printing technology., Methods: Ten adult lower extremity specimens were selected to take continuously thin-layer scanning. After Dicom image was imported into the Mimics software, the model of Schatzker II-VI types proximal tibia fracture was established, 2 cases each type. The virtual internal fixation was performed with plate and screw from standard parts database. The pilot hole of the navigation module design was printed by 3D printing technique. The plate and screw were inserted by the navigation module. X-ray film and CT were taken postoperatively to observe the position. Thirty patients with proximal tibia fracture underwent digital internal fixation using standard parts database and 3D printing technology (study group), and another 30 patients underwent traditional open reduction and internal fixation (control group). There was no significant difference in sex, age, side, causes, fracture classification, associated injury, and course of disease between 2 groups (P > 0.05). The preparative time, incision length, fracture healing time, operation time, and intraoperative blood loss were recorded. Follow up of imaging evaluation, clinical efficacy was evaluated by MacNab criteria., Results: The navigation models were designed to fit the bony structure of proximal tibia and to guide implant insertion. The parameters of orientation, length, diameter, and angle were consistent with the preoperative plan. No statistically significant difference was found in the preparative times of pre-operation between 2 groups (t = 1.393, P = 0.169). The incision length, wound healing time, blood loss, operation time, and the cost of treatment in study group were significantly less than those in control group (P < 0.05). All patients were followed up 12-16 months (mean, 13.5 months). The fracture healing time of study group was significantly shorter than that of control group (t = 4.070, P = 0.000). At 12 months postoperatively, there was no significant difference in the efficacy based on MacNab criteria between 2 groups (U = 377.000, P = 0.238)., Conclusion: Digital internal fixation for proximal tibia fractures using standard parts database and 3D printing technology has the advantages of short process, less blood loss, high safety and rapid fracture healing.