内固定与关节置换手术治疗骨质疏松性髋部骨折的临床效果及术后并发症的影响因素分析

目的:分析内固定与关节置换手术治疗骨质疏松性髋部骨折的临床效果及其术后并发症的影响因素。方法:将2017年4月至2018年5月因骨质疏松性髋部骨折于我院进行手术治疗的78例患者作为研究对象,参考患者自身意愿按照采取手术方案的不同将所有患者分为内固定组与关节置换组。内固定组主要采用动力髋螺钉内固定治疗;关节置换组采用全髋关节置换术治疗。对比分析两组治疗后并发症的发生情况及关节功能恢复程度。结果:关节置换组手术治疗后关节功能的恢复情况显著优于内固定组(P0.05),术后并发症发生率低于内固定组(P0.05);患者术后并发症发生的主要影响因素包括:术前存在合并症、手术时机≥2h、采用内固定手术。结论:与内固定术相比,关节置换手术治疗骨质疏松性髋部骨折患者的疗效和安全性均更高,但采用该手术治疗时需注意手术操作的规范性及手术时机。     

Polarization of Myosin II Refines Tissue Material Properties to Buffer Mechanical Stress

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Sensitivity of stress and strain calculations to passive material parameters in cardiac mechanical models using unloaded geometries

Cardiac stress (load) and strain (stretch) are widely studied indicators of cardiac function and outcome, but are difficult or impossible to directly measure in relation to the cardiac microstructure. An alternative approach is to estimate these states using computer methods and image-based measurements, but this still requires knowledge of the tissue material properties and the unloaded state, both of which are difficult to determine. In this work, we tested the sensitivity of these two interdependent unknowns (reference geometry and material parameters) on stress and strain calculations in cardiac tissue. Our study used a finite element model of the human ventricle, with a hyperelastic passive material model, and was driven by a cell model mediated active contraction. We evaluated 21 different published parameter sets for the five parameters of the passive material model, and for each set we optimised the corresponding unloaded geometry and contractility parameter to model a single pressure-volume loop. The resulting mechanics were compared, and calculated systolic stresses were largely insensitive to the chosen parameter set when an unloading algorithm was used. Meanwhile, material strain calculations varied substantially depending on the choice of material parameters. These results indicate that determining the correct material and unloaded configuration may be highly important to understand strain driven processes, but less so for calculating stress estimates.     

Using neutron crystallography to elucidate the basis of selective inhibition of carbonic anhydrase by saccharin and a derivative

Up-regulation of carbonic anhydrase IX (CA IX) expression is an indicator of metastasis and associated with poor cancer patient prognosis. CA IX has emerged as a cancer drug target but development of isoform-specific inhibitors is challenging due to other highly conserved CA isoforms. In this study, a CA IX_mimic construct was used (CA II with seven point mutations introduced, to mimic CA IX active site) while maintaining CA II solubility that make it amenable to crystallography. The structures of CA IX_mimic unbound and in complex with saccharin (SAC) and a saccharin-glucose conjugate (SGC) were determined using joint X-ray and neutron protein crystallography. Previously, SAC and SGC have been shown to display CA isoform inhibitor selectivity in assays and X-ray crystal structures failed to reveal the basis of this selectivity. Joint X-ray and neutron crystallographic studies have shown active site residues, solvent, and H-bonding re-organization upon SAC and SGC binding. These observations highlighted the importance of residues 67 (Asn in CA II, Gln in CA IX) and 130 (Asp in CA II, Arg in CA IX) in selective CA inhibitor targeting.     

Label‐free multi‐parametric imaging of single cells: dual picosecond optoacoustic microscopy

Advances in microscopy with new visualization possibilities often bring dramatic progress to our understanding of the intriguing cellular machinery. Picosecond optoacoustic micro‐spectroscopy is an optical technique based on ultrafast pump‐probe generation and detection of hypersound on time durations of picoseconds and length scales of nanometers. It is experiencing a renaissance as a versatile imaging tool for cell biology research after a plethora of applications in solid‐state physics. In this emerging context, this work reports on a dual‐probe architecture to carry out real‐time parallel detection of the hypersound propagation inside a cell that is cultured on a metallic substrate, and of the hypersound reflection at the metal/cell adhesion interface. Using this optoacoustic modality, several biophysical properties of the cell can be measured in a noncontact and label‐free manner. Its abilities are demonstrated with the multiple imaging of a mitotic macrophage‐like cell in a single run experiment.      

Homology modeling and examination of the effect of the D92E mutation on the H5N1 nonstructural protein NS1 effector domain

Virulent H5N1 strains of influenza virus often harbor a D92E point mutation in the nonstructural protein NS1. This crucial mutation has been correlated with increased virulence and/or cytokine resistance, but the structural implications of such a change are still unclear. Furthermore, NS1 protein could also be a potential target for the development of novel antiviral agents against H5N1 strains. Therefore, a reasonable 3D model of H5N1 NS1 is important for the understanding of the molecular basis of increased virulence and the design of novel antiviral agents. Based on the crystal structure of a non-H5N1 NS1 protein, a model of H5N1 NS1 was developed by homology modeling, molecular mechanics and molecular dynamics simulations. It was found that the D92E mutation could result in weakened interactions of the carboxylate side chain with other phosphorylated residues, thereby activating phosphorylation of NS1. Figure Superposition of snapshots picked from the two molecular dynamic (MD) trajectories: a H5N1 NS1 homology model and b non-H5N1 NS1 crystal structure after 0 (green ribbon), 5 (blue ribbon) and 10 ns (pink ribbon) MD simulation     

Lower-limb muscle function during sidestep cutting

To investigate lower-limb muscle function during sidestep cutting, prior studies have analysed electromyography (EMG) data together with three dimensional motion analysis. Such an approach does not directly quantify the biomechanical role of individual lower-limb muscles during a sidestep cut. This study recorded three dimensional motion analysis, ground reaction force (GRF) and EMG data for eight healthy males executing an unanticipated sidestep cut. Using a musculoskeletal modelling approach, muscle function was determined by computing the muscle contributions to the GRFs and lower-limb joint moments. We found that bodyweight support (vertical GRF) was primarily provided by the vasti, gluteus maximus, soleus and gastrocnemius. These same muscles, along with the hamstrings, were also primarily responsible for modulating braking and propulsion (anteroposterior GRF). The vasti, gluteus maximus and gluteus medius were the key muscles for accelerating the centre-of-mass towards the desired cutting direction by generating a medially-directed GRF. Our findings have implications for designing retraining programs to improve sidestep cutting technique.     

Sensor-to-body calibration procedure for clinical motion analysis of lower limb using magnetic and inertial measurement units

Magnetic and Inertial measurement units (MIMUs) have become exceedingly popular for ambulatory human motion analysis during the past two decades. However, measuring anatomically meaningful segment and joint kinematics requires virtual alignment of the MIMU frame with the anatomical frame of its corresponding segment. Therefore, this paper presents a simple calibration procedure, based on MIMU readouts, to align the inertial frame of the MIMU with the anatomical frames, as recommended by ISB. The proposed calibration includes five seconds of quiet standing in a neutral posture followed by ten consecutive hip flexions/extensions. This procedure will independently calibrate MIMUs attached to the pelvis, thigh, shank, and foot. The accuracy and repeatability of the calibration procedure and the 3D joint angle estimation were validated against the gold standard motion capture system by an experimental study with ten able-bodied participants. The procedure showed high test-retest repeatability in aligning the MIMU frame with its corresponding anatomical frame, i.e., the helical angle between the MIMU and anatomical frames did not significantly differ between the test and retest sessions (except for thigh MIMU). Compared to previously introduced procedures, this procedure attained the highest inter-participant repeatability (inter-participant coefficient of variations of the helical angle: 20.5–42.2%). Further, the proposed calibration would reduce the offset errors of the 3D joint angle estimation (up to 12.8 degrees on average) compared to joint angle estimation without calibration (up to 26.3 degrees on average). The proposed calibration enables MIMU to measure clinically meaningful gait kinematics.     

Development and validation of a kinematically-driven discrete element model of the patellofemoral joint

Quantifying the complex loads at the patellofemoral joint (PFJ) is vital to understanding the development of PFJ pain and osteoarthritis. Discrete element analysis (DEA) is a computationally efficient method to estimate cartilage contact stresses with potential application at the PFJ to better understand PFJ mechanics. The current study validated a DEA modeling framework driven by PFJ kinematics to predict experimentally-measured PFJ contact stress distributions. Two cadaveric knee specimens underwent quadriceps muscle [215 N] and joint compression [350 N] forces at ten discrete knee positions representing PFJ positions during early gait while measured PFJ kinematics were used to drive specimen-specific DEA models. DEA-computed contact stress and area were compared to experimentally-measured data. There was good agreement between computed and measured mean and peak stress across the specimens and positions (r = 0.63–0.85). DEA-computed mean stress was within an average of 12% (range: 1–47%) of the experimentally-measured mean stress while DEA-computed peak stress was within an average of 22% (range: 1–40%). Stress magnitudes were within the ranges measured (0.17–1.26 MPa computationally vs 0.12–1.13 MPa experimentally). DEA-computed areas overestimated measured areas (average error = 60%; range: 4–117%) with magnitudes ranging from 139 to 307 mm² computationally vs 74–194 mm² experimentally. DEA estimates of the ratio of lateral to medial patellofemoral stress distribution predicted the experimental data well (mean error = 15%) with minimal measurement bias. These results indicate that kinematically-driven DEA models can provide good estimates of relative changes in PFJ contact stress.