Pulmonary inflammation strongly promotes alveolar hypercoagulation and fibrinolytic inhibition. NF‑κB signaling regulates the expression of molecules associated with coagulation and fibrinolytic inhibition in type‑II alveolar epithelial cells (AECII) stimulated by lipopolysaccharide. However, whether TNF‑α‑induced alveolar hypercoagulation and fibrinolysis inhibition is also associated with the NF‑κB pathway remains to be determined. The aim of the present study was to determine whether BAY11‑7082, an inhibitor of the NF‑κB pathway, inhibits the expressions of tissue factor (TF) and plasminogen activator inhibitor‑1 (PAI‑1) in AECⅡ in response to TNF‑α. Rat AECII were treated with BAY11‑7082 for 24 h and stimulated with TNF‑α for 1 h. The expression of TF and PAI‑1 were determined using western blotting and reverse transcription‑quantitative PCR. The concentrations of TF and PAI‑1 in culture supernatant were also measured by ELISA. Moreover, levels of NF‑κB p65 (p65), phosphorylated (p)‑p65 (p‑p65), inhibitor of NF‑κB α (IκBα) and p‑IκBα were also evaluated. Immunofluorescence was used to detect p65 levels in cell nuclei. TNF‑α significantly promoted TF and PAI‑1 expression either at the mRNA or protein level in AECII cells. Concentrations of TF and PAI‑1 in supernatant also significantly increased upon TNF‑α stimulation. Furthermore, TNF‑α upregulated the levels of p‑IκBα, p65, and p‑p65 in the cytoplasm. Immunofluorescence analysis indicated that TNF‑α increased p65 translocation from the cytoplasm to the nucleus. However, AECII pre‑treated with BAY11‑7082 expressed lower levels of TF and PAI‑1 following TNF‑α treatment. Levels of p‑IκBα, p65 and p‑p65 in the cytoplasm also decreased, and translocation of p65 from cytoplasm into the nucleus was inhibited by BAY11‑7082 pretreatment. These findings suggest that BAY11‑7082 improves the hypercoagulation and fibrinolytic inhibition induced by TNF‑α in alveolar epithelial cells via the NF‑κB signaling pathway. BAY11‑7082 might represent a therapeutic option for alveolar hypercoagulation and fibrinolytic inhibition in acute respiratory distress syndrome.

Objective To introduce a new technique using real-size 3D-printed acromioclavicular joint models as preoperative tools for treating acromioclavicular (AC) joint dislocation. Methods Both the injured AC joint and the mirrored normal side AC joint are 3D printed into real-size models. A proper hook plate is selected and pre-bended to fit the normal side AC joint. The bended plate is then used to perform a reduction operation on a real-size injured AC joint model and the result is compared with the mirrored normal AC joint model to see if the reduction is accurate. Results It is easy to select and bend a clavicle hook plate to achieve an accurate reduction with the help of a 3D printing technique. Conclusion With this technique, surgeons can achieve an accurate reduction of the injured AC joint with a clavicle hook plate which might be helpful to reduce the risk of complications. Ziel Einführung einer neuen Technik unter Verwendung von 3D-gedruckten akromioklavierförmigen Gelenkmodellen in realer Größe als präoperative Werkzeuge zur Behandlung akromioklavikulärer (AC) Gelenkverrenkungen. Methoden Sowohl das verletzte AC-Gelenk als auch das gespiegelte normale Seiten-AC-Gelenk werden in 3D-Formate gedruckt. Eine richtige Hakenplatte wird ausgewählt und vorgebogen, um die normale Seitenacac-Verbindung zu passen. Die gebogene Platte wird dann verwendet, um eine Reduktionsoperation auf einem realen verletzten AC-Gelenkmodell durchzuführen und das Ergebnis wird mit dem gespiegelten normalen AC-Gelenkmodell verglichen, um zu sehen, ob die Reduzierung korrekt ist. Ergebnisse Es ist einfach, eine Schlüsselklappenplatte auszuwählen und zu biegen, um eine genaue Reduktion mit Hilfe einer 3D-Drucktechnik zu erreichen. Fazit Mit dieser Technik können Chirurgen eine genaue Reduktion des verletzten AC-Gelenks mit einer Schlüsselbeinhakenplatte erreichen, die hilfreich sein könnte, um das Risiko von Komplikationen zu reduzieren. ^* Xuhua Wu and Gang Wang are co-first author; contributed equally

To explore a new quantitative index to assess the matching performance of anatomical bone plates using digital technology. CT data of normal tibias of 40 adults were collected. Two brands of medial distal tibia plates were digitized. Two trained orthopedists simulated the surgical operation in Rhino 5.1 software by placing the plate curve on the medial distal tibia surface. The volume of the interstice between the plate curve and the bone surface was measured. The inverse value of this average interstice distance was used as the matching performance index (MPI). A wall thickness analysis tool was used to mark various interstice distances with varied colors. The Kangli medial distal tibia plate had a MPI of 0.55 ± 0.08 by operator A and 0.55 ± 0.06 by operator B. The general care medial distal tibia plate had a MPI of 0.32 ± 0.06 by operator A and 0.31 ± 0.05 by operator B. There were significant variations in the MPI between the two types of plates by both operators (p < 0.001). And significant variations were observed in the MPI of general care medial distal tibia plates among various operator groups (p = 0.028). This quantitative index of matching performance is straightforward and intuitive. However, we still need a method to improve the experimental repeatability, especially when it comes to a plate with poor matching performance.

(1) Background: To investigate the clinical effect of the novel patient-specific 3D printing templates based on external fixation for pelvic screw insertion. (2) Methods: We retrospectively studied 8 patients with pelvic fractures who were treated using this novel template from July 2017 to July 2018. During the operation, the screws were inserted with the aid of the template. The operative time per screw, radiation exposure time, and accuracy of the screw insertions as evaluated by post-operative CT scans were analyzed statistically and compared with previous outcomes using the fluoro-navigation technique. (3) Results: In the template group, a total of 9 pubis screws and 6 sacroiliac screws were inserted. The mean surgical time was 11.3 min/screw and the mean X-ray exposure time was 11.8 ± 3.9 s/screw. The mean deviation distance and angle between the actual and planned screw position was 2.6 ± 0.2 mm and 2.0 ± 0.3 degrees, and blood loss during the surgery was 12.2 ml/screw. No superficial and deep infections and no patient sustained recognized neurologic, vascular, or urologic injury occurred in the template group. The surgical time and X-ray exposure time was less than that in the fluoro-navigation group((P < 0.05) (4) Conclusions: The patient-specific template based on external fixation can guide the insertion of the pelvic screw accurately, safely and invasively and significantly reduce operation and radiation exposure time.