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Non-coding RNAs (ncRNAs), which are thought to regulate articular cartilage through endochondral osteogenesis, consist of mRNA-interfering complementary RNA (miRNA) and long non-coding RNAs (lncRNA). More and more experimental evidence reveals the role of ncRNAs in chondrocyte differentiation and the pathogenesis of several skeletal diseases, including osteoarthritis. In the past few years, increasingly sophisticated DNA sequencing methods and a large number of sepigenetic modifications have greatly contributed to our understanding of the pathophysiological mechanisms of osteoarthritis. Recent studies have revealed that RNA interacts with RNA-binding proteins, regulates gene transcription and protein translation, and is involved in various pathological processes in OA, promising to be a therapeutic target for osteoarthritis.
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Objective:To investigate the basic characteristics and treatment of aseptic nonunion of femoral shaft in Xi'an Red Cross Hospital from 2013 to 2020.Methods:The data were analyzed retrospectively of the patients with aseptic nonunion of femoral shaft who had been treated at Department of Orthopaedics and Trauma, Red Cross Hospital Affiliated to Medical College, Xi'an Jiaotong University from January 2013 to December 2020. The patients' data from 2013 to 2016 were assigned into group A while those from 2017 to 2020 into group B. The data like gender, age and nonunion were statistically analyzed and compared between the 2 groups.Results:A total of 311 patients with aseptic nonunion of femoral shaft were diagnosed and treated during the 8 years, accounting for 54.6% (311/570) of the femur nonunion, 32.8% (311/949) of the lower extremity nonunion, 25.0% (311/1,242) of the extremity nonunion, and 22.7% (311/1,370) of the whole body nonunion. There were 244 males and 67 females; the majority of patients were in the age group of 21 to 50 (67.2%, 209/311). The occupation distribution was the most common in farmers (49.2%, 153/311). Traffic injury was the most common cause for primary fractures (40.8%, 127/311). The most common type of injury was closed injury (89.4%, 278/311); the most common type of nonunion was atrophic nonunion (87.8%, 273/311); intramedullary nailing was the main treatment for primary fractures (54.3%, 169/311); channel osteogenesis was the main treatment for secondary nonunion (62.1%, 193/311); autologous iliac bone grafting was the most common grafting for atrophic nonunion (83.5%, 228/311). Compared with group A, the proportion of aseptic nonunion of femoral shaft in group B increased by 9.2% in the femoral nonunions, by 6.9% in the lower extremity nonunions, and by 6.0% in the extremity nonunions, and by 5.2% in the whole body nonunions, showing statistically significant differences ( P < 0.05). There were significant differences in the types of nonunion, occupational distribution, first-stage fracture treatment, second-stage nonunion treatment, and bone grafting method between the 2 groups ( P < 0.05). Conclusions:The patients with aseptic nonunion of the femoral shaft were more common in young and middle-aged male heavy manual laborers, and the condition was increasing in recent years. The channel osteogenesis technique was still the preferred treatment method in the hospital investigated.
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Objective:To assess the effects of preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage on blood loss in complex tibial plateau fractures (Schatzker types Ⅴ-Ⅵ).Methods:A sequence randomly generated by computer was used to randomize a cohort of 40 patients into 2 groups who were to receive surgery at Department of Orthopaedics and Trauma, Hong Hui Hospital from June 2018 to January 2019 for complex tibial plateau fractures. They were 24 men and 16 women, aged from 35 to 55 years (average, 46.0 years). In group A, intravenous injection of normal saline was conducted 5 to 10 min before surgical incision and no elastic bandage was used after surgery. In group B, a dose of 15 mg/kg tranexamic acid was intravenously given 5 to 10 min before surgical incision and elastic bandage was used to bandage the knee with compression after surgery. The 2 groups were compared in terms of total blood loss, hidden blood loss, transfusion rate, 48-h drainage flow, venous thromboembolism, postoperative wound complications, postoperative visual analogue scale (VAS), and D-dimer value 24 h after surgery.Results:There were no significant differences between the 2 groups in age, gender, body mass index, smoking history, concomitant medical conditions, American Society of Anesthesiologists (ASA) score, preoperative hemoglobin, preoperative hematocrit, preoperative D-dimerization or fibrin degradation products, showing comparability ( P>0.05). In groups A and B, hemoglobin values 24 h after surgery were 104.6 g/L ± 10.4 g/L versus 113.3 g/L ± 11.9 g/L, drainage volumes 48 h after surgery 277.1 mL ± 229.2 mL versus 207.1 mL ± 124.3 mL, hidden blood loss volumes 318.0 mL ± 83.4 mL versus 266.2 mL ± 60.9 mL, total blood loss volumes 792.8 mL ± 202.8 mL versus 692.2 mL ± 124.9 mL, D-dimer values 24 h after surgery 5.1 mg/L ± 1.3 mg/L versus 4.1 mg/L ± 0.7 mg/L, postoperative VAS scores 5.2 ± 0.9 versus 3.9 ± 1.1, lower limb cross-section diameters 24 h after surgery 35.5 cm ± 3.0 cm versus 34.4 cm ± 2.6 cm, lower limb cross-section diameters 72 h after surgery 33.8 cm ± 2.1 cm versus 32.8 cm ± 2.3 cm, postoperative rates of wound ecchymosis hematoma 20.0% (4 cases) versus 0 (0 cases), and hospital stays 6.6 d ± 1.0 d versus 6.2 d ± 1.2 d. There were significant differences between the 2 groups in all the above items ( P<0.05). However, there were no significant differences between the 2 groups in incidence of postoperative DVT, pulmonary embolism or other wound complications ( P>0.05). Conclusions:Preoperative intravenous injection of tranexamic acid and postoperative local use of elastic bandage is reasonable and safe for complex tibial plateau fractures, because it significantly reduces intraoperative blood loss but does not increase the risk of venous thromboembolism, and thus has a positive role in accelerating the recovery of patients.
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Objective:To investigate the effects of surgical revision for humeral shaft nonunion on health-related quality of life.Methods:The data of 62 patients were studied retrospectively who had been hospitalized at Department of Orthopaedics and Traumatology, Hong-Hui Hospital for humeral shaft nonunion from March 2013 to September 2018. They were 43 males and 19 females, aged from 20 to 73 years (average, 42.3 years). Their nonunions belonged to the atrophic type in 19 cases, to the ischemic type in 14 cases and to the hypertrophic type in 29 cases. Their demographic and clinical data, imaging manifestations and treatment methods were recorded and analyzed. The 12-item short form health survey (SF-12) and brief pain inventory (BPI) were used to evaluate their health-related quality of life and the Mayo elbow performance score (MEPS) was used to evaluate their elbow function.Results:Upon admission, their physical component summary (PCS) scored 24.3±5.2, mental component summary (MCS) 26.3±3.8, brief pain inventory- severity (BPI-S) 6.5±1.9, and brief pain inventory-interference (BPI-I) 6.7±2.5. At 1-year follow-up, their PCS averaged 43.6±8.1, MCS 34.7±4.4, BPI-S 4.9±1.2, and BPI-I 4.4±1.4. There were statistically significant differences between preoperation and postoperation in the above 4 groups of indicators ( P<0.05). Their MEPS at the last follow-up revealed a 95.2% rate of excellent elbow function (59/62). By comparison with the literature data, their postoperative PCS scores were not significantly different from those for the patients with Barrentt＇s esophagus, primary hypertension, chronic obstructive pulmonary disease and silicosis ( P>0.05). There was no significant difference either in the postoperative MCS scores between them and stroke patients ( P>0.05). Conclusions:As a destructive chronic disease, humeral shaft nonunion has negative effects on physical and mental health and quality of life of the patients. Although the pain effect on the limb can be alleviated by surgical revision, the entire treatment may cause permanent psychological trauma to the patients.
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Objective To investigate the safety and effect of tranexamic acid combined with drainage tube clamping to reduce perioperative blood loss of Schatzker Ⅴ and Ⅵ tibial plateau fracture.Methods A prospective case-control study was performed on 87 patients with Schatzker Ⅴ and Ⅵ tibial plateau fracture admitted from March 2018 to January 2019 in Honghui Hospital,including 53 males and 34 females,aged 24 to 69 years [(39.05 ± 2.7) years].All patients underwent tibial plateau reduction and internal fixation.According to the random number table method,the patients were divided into intravenous group (27 cases),articular cavity group (30 cases) and control group (30 cases).The intravenous group were given a total of 1 g of tranexamic acid intravenously 5-10 minutes before loosening the tourniquet,the joint cavity group were perfused with 1 g of tranexamic acid before closing the incision,and the control group were given the same amount of normal saline.The drainage tube was temporarily clamped for 4 hours in the three groups.Data were recorded and compared among the groups,including the surgical limb side,tourniquet use time,hemoglobin (Hb),D-dimer level,drainage,total blood loss,number of allogeneic blood transfusions,postoperative complications,and presence or absence of deep vein thrombosis (DVT) of the lower extremities at 72 hours after discharge.Results There was no significant difference in baseline data between the three groups (P ＞ 0.05).There were no significant differences in the extremity side,tourniquet use time,and number of allogeneic blood transfusions among the three groups (P ＞ 0.05).At postoperative 24 hours,the Hb was (112.7 ± 11.8) g/L in the intravenous group,(107.7 ± 16.1) g/L in the articular cavity group,At (100.0 ± 10.4) g/L in the control group.At postoperative 24 hours,the D-dimer vein was (5.5 ± 2.9) mg/L in the intravenous group,(5.9 ± 2.5) mg/L in the joint cavity group,and (7.5 ± 3.6) mg/L in the control group.At postoperative 24 hours,the drainage volume was (62.8 ± 20.5) ml in the intravenous group,(60.2 ± 17.4) ml in the articular cavity group,and (81.2 ± 21.1)ml in the control group.The hidden blood loss was (577.1 ± 212.1)ml in the intravenous group,(634.2 ± 139.8)ml in the articular cavity group,(750.3 ±124.1)ml in the control group.The total blood loss was (950.1 ± 170.5)ml in the intavenous group,(1 005.4 ± 179.8)ml in the articular cavity group,and (1 148.8 ± 129.1)ml in the control group.The incidence of postoperative wound swelling and exudation was 1 case (4％) in the intravenous group,0 cases in the articular cavity group,5 cases (17％) in control group.The above indexes showed significant differences between the three groups (P ＜ 0.05 or 0.01),but there was no significant difference between the intravenous group and the articular cavity group (P ＞ 0.05).The Hb at 72 hours postoperatively,total drainage,number of allogeneic blood transfusions,lower extremity DVT and incidence of skin ecchymosis had no significant difference among the three groups (P ＞ 0.05).No pulmonary embolism occurred after the operation.Conclusions For patients with Schatzker Ⅴ and Ⅵ tibial plateau fracture,tranexamic acid combined with drainage tube clamping is safe and effective when used perioperatively.Either intravenous infusion or local joint cavity injection of tranexamic acid can effectively reduce the drainage volume at 24 hours postoperatively,hidden blood loss and total blood loss without increasing the risk of postoperative DVT.Tranexamic acid can reduce the and exudation after operation.
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Objective@#To investigate the safety and effect of tranexamic acid combined with drainage tube clamping to reduce perioperative blood loss of Schatzker V and VI tibial plateau fracture.@*Methods@#A prospective case-control study was performed on 87 patients with Schatzker V and VI tibial plateau fracture admitted from March 2018 to January 2019 in Honghui Hospital, including 53 males and 34 females, aged 24 to 69 years [(39.05±2.7)years]. All patients underwent tibial plateau reduction and internal fixation. According to the random number table method, the patients were divided into intravenous group (27 cases), articular cavity group (30 cases) and control group (30 cases). The intravenous group were given a total of 1 g of tranexamic acid intravenously 5-10 minutes before loosening the tourniquet, the joint cavity group were perfused with 1 g of tranexamic acid before closing the incision, and the control group were given the same amount of normal saline. The drainage tube was temporarily clamped for 4 hours in the three groups. Data were recorded and compared among the groups, including the surgical limb side, tourniquet use time, hemoglobin (Hb), D-dimer level, drainage, total blood loss, number of allogeneic blood transfusions, postoperative complications, and presence or absence of deep vein thrombosis (DVT) of the lower extremities at 72 hours after discharge.@*Results@#There was no significant difference in baseline data between the three groups (P>0.05). There were no significant differences in the extremity side, tourniquet use time, and number of allogeneic blood transfusions among the three groups (P>0.05). At postoperative 24 hours, the Hb was (112.7±11.8)g/L in the intravenous group, (107.7±16.1) g/L in the articular cavity group, At (100.0±10.4) g/L in the control group. At postoperative 24 hours, the D-dimer vein was (5.5±2.9)mg/L in the intravenous group, (5.9±2.5)mg/L in the joint cavity group, and (7.5±3.6)mg/L in the control group. At postoperative 24 hours, the drainage volume was (62.8±20.5)ml in the intravenous group, (60.2±17.4)ml in the articular cavity group, and (81.2±21.1)ml in the control group. The hidden blood loss was (577.1±212.1)ml in the intravenous group, (634.2±139.8)ml in the articular cavity group, (750.3±124.1)ml in the control group. The total blood loss was (950.1±170.5)ml in the intavenous group, (1 005.4±179.8)ml in the articular cavity group, and (1 148.8±129.1)ml in the control group. The incidence of postoperative wound swelling and exudation was 1 case (4%) in the intravenous group, 0 cases in the articular cavity group, 5 cases (17%) in control group. The above indexes showed significant differences between the three groups (P<0.05 or 0.01), but there was no significant difference between the intravenous group and the articular cavity group (P>0.05). The Hb at 72 hours postoperatively, total drainage, number of allogeneic blood transfusions, lower extremity DVT and incidence of skin ecchymosis had no significant difference among the three groups(P>0.05). No pulmonary embolism occurred after the operation.@*Conclusions@#For patients with Schatzker V and VI tibial plateau fracture, tranexamic acid combined with drainage tube clamping is safe and effective when used perioperatively. Either intravenous infusion or local joint cavity injection of tranexamic acid can effectively reduce the drainage volume at 24 hours postoperatively, hidden blood loss and total blood loss without increasing the risk of postoperative DVT. Tranexamic acid can reduce the and exudation after operation.
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Objective To observe the clinical efficacy of long-snake moxibustion in treating asthma due to deficiency of lung and spleen. Method Seventy patients were randomized into a treatment group and a control group. The treatment group was intervened by using long-snake moxibustion, while the control group was by regular acupuncture treatment. The therapeutic efficacy was evaluated after 1-month treatment. Result In the treatment group, 22 subjects showed marked efficacy, 27 showed effective, 6 failed, and the total effective rate was 89.1%; in the control group, 18 subjects showed marked efficacy, 25 showed effective, 12 failed, and the total effective rate was 78.2%. The therapeutic efficacy of the treatment group was significantly higher than that of the acupuncture group(P＜0.05). Conclusion Long-snake moxibustion can produce a higher therapeutic efficacy than regular acupuncture in treating asthma due to deficiency of lung and spleen.