A novel retrograde tibial nail for treatment of distal tibial fracture: preliminary results / 中华创伤骨科杂志

Objective:To investigate the effects of a novel retrograde tibial nail (RTN) in the treatment of distal tibial fractures.Methods:A retrospective study was conducted in the 11 patients with distal tibial fracture who had been admitted to Department of Traumatic Orthopedics, The Second Affiliated Hospital, Hengyang Medical School from July 2020 to July 2021. There were 5 male and 6 females, aged from 18 to 70 years (average 54.7 years). By the AO/OTA classification, there were 7 extra-articular distal fractures (3 cases of type 43-A1, 3 cases of type 43-A2 and one type 43-A3) and 4 intra-articular fractures (2 cases of type 43-C1 and 2 cases of type 43-C2); by the Gustilo classification, there were 7 closed fractures and 4 open fractures (2 cases of type I and 2 cases of type Ⅱ). All fractures were fixated with a novel RTN. Deformities like distal tibial varus and valgus as well as fracture-related complications were observed after operation while the curative effects evaluated by the ankle-hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS).Results:This cohort was followed up for an average of 7.4 months (from 5 to 12 months). All patients obtained clinical union and recovered daily life and work. Radiographic evaluation showed no distal tibial varus or valgus. There were no such complications as postoperative infection, exposure of bone and internal fixation, compartment syndrome, or neurovascular lesion. According to the ankle-hindfoot score of AOFAS, 7 cases were excellent and 4 cases good.Conclusion:This novel retrograde tibial nail may result in good efficacy in the treatment of distal tibial fracture, but its advantages still need further verification.

Effects of calcium sulfate on proliferation of osteoblast-like MG-63 cells and osteoprotegerin/receptor activator of NF-κB ligand/receptor activator of NF-κB system / 中华创伤骨科杂志

Objective:To investigate the effects of calcium sulfate on the proliferation of osteoblast-like MG-63 cells and the osteoprotegerin/receptor activator of NF-κB ligand/receptor activator of NF-κB (OPG/RANKL/RANK) system.Methods:The extract of calcium sulfate was prepared. The osteoblast-like MG-63 cells were cultured for 24 hours in the medium containing calcium sulfate (the calcium sulfate group) and in the normal medium without calcium sulfate (the blank group), respectively. The growth of osteoblast-like MG-63 cells was observed and their proliferation detected by CCK-8. The mRNA and protein expression levels of OPG/RANKL were detected.Results:The growth of osteoblast-like MG-63 cells was fine in both groups. The CCK-8 test showed that the absorbance value at 24 h was 0.997±0.008 for the calcium sulfate group, significantly higher than that for the blank group (0.640±0.003) ( P<0.001). Respectively, the mRNA expression levels of OPG were 2.834±0.176 and 1.005±0.102 and the mRNA expression levels of RANKL 0.355±0.035 and 1.002±0.068 for the calcium sulfate group and the blank control group, showing statistically significant differences ( P<0.001). The results of Western blot showed that compared with the blank control group, the protein expression of OPG in osteoblast-like MG-63 cells was promoted but the protein expression of RANKL inhibited in the calcium sulfate group. Conclusion:Calcium sulfate may have a positive effect on bone formation, because it can promote the proliferation and activity of osteoblast-like MG-63 cells and regulate the OPG/RANKL/RANK system.

Establishment of a trauma center improves therapeutic efficacy for patients with severe multiple injuries / 中华创伤骨科杂志

Objective:To investigate the effects of establishment of a trauma center on the therapeutic efficacy for patients with severe multiple injuries.Methods:A retrospective study was conducted in the patients who had been treated at The Second Affiliated Hospital, University of South China for severe multiple injuries from October 2015 to September 2019. They were assigned into 2 groups. The study group included 102 patients who had been treated after establishment of our trauma center (from October 2017 to September 2019) while the control group 126 patients who had been treated before establishment of our trauma center (from October 2015 to September 2017). The 2 groups were compared in terms of time for emergency treatment (from admission to emergency surgery or ICU), ICU stay, hospital stay, total medical costs and mortality.Results:There was a significant difference between the 2 groups in time for emergency treatment [51 (47, 57) min for the study group versus 97 (87, 107) min for the control group] ( P<0.05). There were no significant differences between the 2 groups in ICU stay [4 (1.8, 9.3) d versus 4 (2.0, 10.0) d], hospital stay [25.5 (15.8, 39.0) d versus 21.5 (12.8, 41.5) d], or total medical costs [￥41,259.0 yuan (￥26,950 yuan, ￥81,599 yuan)] ( P>0.05). There was a significant difference between the 2 groups in mortality [12.7% (13/102) for the study group versus 24.6% (31/126) for the control group] ( P<0.05). Conclusion:Establishment of a trauma center can effectively shorten time for emergency treatment, improve treatment efficacy and reduce mortality for patients with severe multiple injuries.

Development of hedgehog pathway inhibitors by epigenetically targeting GLI through BET bromodomain for the treatment of medulloblastoma

Medulloblastoma (MB) is a common yet highly heterogeneous childhood malignant brain tumor, however, clinically effective molecular targeted therapy is lacking. Modulation of hedgehog (HH) signaling by epigenetically targeting the transcriptional factors GLI through bromodomain-containing protein 4 (BRD4) has recently spurred new interest as potential treatment of HH-driven MB. Through screening of current clinical BRD4 inhibitors for their inhibitory potency against glioma-associated oncogene homolog (GLI) protein, the BRD4 inhibitor

3D printing used to assist treatment of pilon fracture combined with ipsilateral tibial shaft fracture / 中华创伤骨科杂志

Objective To investigate the efficacy of three-dimensional (3D) printing used to assist the treatment of pilon fracture combined with ipsilateral tibial shaft fracture.Methods From May to July 2016,3 patients with pilon fracture combined with ipsilateral tibial shaft fracture were treated at Department of Traumatic Orthopedics,The Second Affiliated Hospital,University of South China.They were all male,aged from 26 to 47 years.They all had preoperative 3D CT scan.Their CT data were imported to Mimics software for 3D reconstruction.After their fracture 3D models were manufactured by 3D printing,precise patient-specific surgical plans were made to guide their actual operations.Postoperatively,Johner-Wruhs scores were used to evaluate the treatment of tibial shaft fracture,Burwell-Charnley scores to evaluate the treatment of pilon fracture and Tornetta scores to evaluate the therapeutic outcomes.Results All the operations were performed according to the patient-specific surgical plans designed preoperatively.All the fractures achieved bony union without any infection,exposure of bone or internal fixation,osteofascial compartment syndrome or neurovascular injury.The outcomes of tibial shaft fracture were excellent by Johner-Wruhs scoring,anatomic reduction was achieved for pilon fractures by Burwell-Charnley scoring and the therapeutic outcomes were excellent by Tornetta scoring.Conclusion In the treatment of pilon fracture combined with ipsilateral tibial shaft fracture,3D printing can help making of precise and patient-specific surgical plans to promote clinical efficacy.