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Objective:To investigate the treatment strategy for pediatric humeral supracondylar fractures with callus formation and displacement neglected for over 1 week.Methods:A retrospective analysis was made of the clinical data of 36 children who had been treated at Department of Pediatric Orthopaedics, Medical Center, The Second Affiliated Hospital, Inner Mongolia Medical University from January 2011 to January 2021 for humeral supracondylar fractures with callus formation and displacement neglected for over 1 week. There were 22 boys and 14 girls, with an age of (6.7±2.7) years (from 2.3 to 12.8 years). All fractures were Gartland type Ⅲ. The patients were divided into 2 groups according to their treatment methods: a closed reduction and percutaneous pinning (CRPP) group of 15 patients subjected to the CRPP treatment only, and a leverage group of 21 patients subjected to CRPP assisted by the "lever technique" with posterior elbow Kirschner wire prying and pulling. The 2 groups were compared in terms of operation time, fluoroscopy frequency, quality of reduction, and recovery time for elbow range of motion; the elbow range of motion, visual analogue scale (VAS), Mayo elbow performance score (MEPS) and complications were assessed at the last follow-up.Results:The 2 groups were comparable because there was no significant difference between them in the general information before operation ( P>0.05). All patients were followed up for (26.2±16.3) months (from 6 to 96 months). All the fractures obtained acceptable reduction and clinical union 4 to 6 weeks after operation. The operation time [(28.2±6.8) min] and fluoroscopy frequency [(27.0±6.0) times] in the leverage group were significantly less than those in the CRPP group [(40.8±10.8) min and (43.3±11.4) times] ( P<0.05). The CRPP group was significantly better than the leverage group in the intraoperative Baumann angle (78.1°±1.6° versus 73.7°±4.1°), lateral capitellohumeral angle (58.3°±2.6° versus 49.6°±5.2°) and horizontal rotation rate (109.5%±3.0% versus 103.2%±4.9%) ( P<0.05). The intraoperative reduction in the CRPP group was significantly closer to the normal mean value than that in the leverage group ( P<0.05). There was no significant difference in the recovery time for elbow range of motion between the CRPP and the leverage groups ( P>0.05). At the last follow-up, the Baumann angle (75.4°±2.8°) and the lateral capitellohumeral angle (53.2°±3.6°) in the leverage group were still significantly better than those in the CRPP group (78.3°±1.5° and 57.5°±2.3°) ( P<0.05). However, there was no significant difference in the elbow range of motion, VAS, MEPS or incidence of complications between the 2 groups ( P>0.05). Conclusion:To treat humeral supracondylar fractures with callus formation and displacement neglected for over 1 week in children, CRPP assisted by the "lever technique" with posterior elbow Kirschner wire prying and pulling is an efficient and accurate method, because it can lead to more satisfactory reduction than CRPP only.
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Objective:To explore the clinical effect of observation and psychological intervention, splint or brace fixation as well as surgical treatment on habitual dislocation of the hip (HDH) and to combine the authors' data with a compilation of the cases from the literature, evaluingating the epidemiological characteristics of HDH and the treatment scheme to maintain the stability of hip joint by systematic literature review in children.Methods:A retrospective analysis of the relevant data of 11 patients (12 hips) with HDH were treated from March 2007 to March 2021, including 2 boys and 9 girls. The age of the first dislocation was 2.25 (1.66, 3.75) years old and 4.33 (3.33, 6.17) years old at the age of diagnosis. At the same time, the relevant literature reports were searched from 1932 to 2022, and 24 HDH patients reports and clinical studies were confirmed to be included in this study according to the inclusion and exclusion criteria. The data of 33 patients (38 hips) with HDH who were obtained in the literature, including 5 boys and 28 girls. The age of the first dislocation was 2.00 (1.50, 2.00) years old and 4.00 (2.55, 5.00) years old at the age of diagnosis. A total of 44 patients (50 hips) with HDH who were analyzed, including gender, age of first dislocation, age of diagnosis, mode of stimulating dislocation, side and direction of dislocation, accompanying symptoms, family history, trauma history and imaging examination. The data of 41 patients with HDH (3 patients were excluded due to lack of treatment description) were treated with observation and psychological intervention in 19 patients, splint or brace fixation in 13 patients, and surgical treatment in 9 patients. The femoral neck-stem angle, acetabular index, central edge angle (CE angle) and Reimers instability index were measured by AutoCAD software, and the hip function was evaluated by Harris standard. Meantime, the disappearance time of dislocation was recorded.Results:The average follow-up time of 44 patients (50 hips) with HDH were 4.05±2.93 years old, and the time of disappearance of dislocation after treatment were 1.28±1.19 years old. Patients were diagnosed as 7 boys and 37 girls, 30 right and 8 left as well as 6 bilateral, the age of the first dislocation was 2.64±1.54 years old and 4.52±2.64 years old at the age of diagnosis. The data of 39 patients took hip flexion, adduction, internal rotation or hip flexion and adduction as the mode of stimulating dislocation. There were 43 patients with posterior dislocation, 41 patients with an audible "click" sound during dislocation, 36 patients with painless dislocation, and 37 patients with "vacuum phenomenon" were captured at the moment of dislocation. All patients with HDH had no specific family history and obvious history of trauma. There was no significant difference in general data between observation and psychological intervention group, splint or brace fixation group as well as surgical treatment group ( P>0.05). Harris standard to evaluate hip function, CE angle and Reimers instability index of the affected side were significantly different from those before and after treatment at the moment of dislocation ( H=127.51, P<0.001; H=55.70, P<0.001; H=54.69, P<0.001). Compared with the immediate disappearance of dislocation in the surgical treatment group, the disappearance time of dislocation in the observation and psychological intervention group and the splint or brace fixation group were significantly longer, and the difference was statistically significant ( H=20.83, P<0.001). Conclusion:Without specific family history and obvious trauma at young girls, painless posterior dislocation of hip with an audible "click" sound and "vacuum phenomenon" at the moment of dislocation are the significant epidemiological characteristics of HDH. Observation and psychological intervention, splint or brace fixation are recommended as the initial treatment scheme. When conservative treatment is ineffective, surgical treatment is needed to stabilize the hip joint quickly.
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Objective:Compared with closed reduction and percutaneous pinning (CRPP) treatment, evaluating the clinical observation of utilizing a transolecranon pin joystick technique combined with CRPP in the teatment of multidirectionally unstable supracondylar humeral fractures in children.Methods:From thirty nine pediatric multidirectionally unstable supracondylar humeral fractures hospitalized between January 2012 and January 2019, twenty seven males (69.23%) and twelve females (30.77%) were included in the study, with a average age of 6.68±2.52 years (range, 2.17-13.75 y), twenty three fractures (65.7%) were treated with CRPP (CRPP group) and the remaining Sixteen fractures (41.03%) were treated utilizing a transolecranon pin joystick technique combined with CRPP (joystick group). Both groups were followed over 16 weeks. The paired sample t test or χ2 test and Fisher's exact test were used to compare the surgical time, times of fluoroscopy, quality of reduction and neurological or vascular complications, Baumann angle, carrying angle, lateralcapitellohumeral angle, postoperative range of motion as well as function-al outcomeduringthe Sixteen weeks and the last follow-up appointment. Results:All caseswere followed up for 1.98±1.43 years, and all fractures achieved clinical healing at 4 to 6 weeks postoperation. The surgical time and times of fluoroscopy were significantly shorter for patients in the joystick group (27.17±9.68 min, 24.25±5.92 times) when compared with CRPP group (48.59±15.75 min, 49.65±23.83 times, P<0.05). All cases showed restoration of the normal lateral capitellohumeral angle. Compared with Baumann angle of normal contralateral upper extremity during the sixteen weeks and the last follow-up appointment, the quality of reduction on the anteroposterior radiographic view was significantly better for patients in the joystick group than that of CRPP group ( P<0.05). The Baumann angle of the affected upper extremity was 77.70°±2.16°, and that of the normal contralateral upper extremity was 73.78°±4.04° in the CRPP group, joystick group was 73.06°±1.81° and 72.81°±3.45°, respectively at the sixteen weeks follow-up. The Baumann angle of the affected upper extremity was 77.13°±2.20°, and that of the normal contralateral upper extremity was 74.17°±4.17° in the CRPP group, joystick group was 72.69°±1.70° and 73.38°±3.48°, respectively at the last follow-up. The range of motion and clinical outcomes based on the criteria of Flynn were similar in both groups ( P<0.05). The elbow joint function of excellent and good rate of the criteria of Flynn was 82.61%, elbow flexion was 134.13°±8.61°, elbow extension was -3.48°±6.47° in the CRPP group, joystick group was 81.25%, 132.19°±9.48° and -3.44°± 4.37°, respectively at the sixteen weeks follow-up. The elbow joint function of excellent and good rate of the criteria of Flynn was 91.30%, elbow flexion was 140.14°±5.76°, elbow extension was -0.65±3.79° in the CRPP group, joystick group was 93.75%, 141.88°±5.12° and -0.31°±3.86°, respectivelyat the last follow-up. No immediate postoperative complications were observed. Conclusion:A transolecranon pin joystick technique combined with CRPP is a safe and effective method, can decrease surgical time and times of fluoroscopy and improve quality of reduction with no increasing risk of complications for closed reduction of multidirectionally unstable supracondylar humeral fractures in children.
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Objective:To test the effectiveness of electrical stimulation of the median nerve (MNES) for relieving post-stroke cognitive impairment (PSCI) and explore the possible mechanism.Methods:Thirty patients with PSCI were randomly divided into a routine treatment group (the control group) and an MNES group, each of 15. Both groups were given routine rehabilitation treatment, including cognitive rehabilitation training, medications and acupuncture. The MNES group additionally received 30 minutes of MNES on their right hands every day, five times a week for six weeks. One electrode was positioned over the median nerve 2cm up from the rasceta of the right wrist. The other was on the muscles of the thenar eminence. Forty seconds of stimulation were applied with intervals of 20 seconds, for 30 min daily. Before and after 3 and 6 weeks of treatment, both groups were evaluated using the mini-mental state examination (MMSE), the Montreal cognitive assessment (MoCA), the modified Barthel index (MBI) and the Fugl-Meyer assessment (FMA). In another 15 patients oxyhemoglobin levels in the brain before and during the MNES were observed using near-infrared spectroscopy.Results:After 3 weeks of treatment, a significant improvement was observed in the average MMSE, FMA and MBI scores of both groups, and the average MoCA score of the observation group. Three weeks later, the average MMSE, FMA, MBI and MoCA scores of both groups had improved significantly compared with before the treatment, with the average MMSE and MoCA improvements in the MNES group significantly greater than the control group′s averages. After 6 weeks of treatment the significant improvements persisted in both groups. Both group′s average FMA scores had also improved significantly, as had the average MBI score of the control group. After 6 weeks of treatment, the observation group′s average time orientation, location orientation, language instant memory, attention, calculation and short-term memory in MMSE had all improved significantly along with visual space capacity, executive capacity, attention, language, orientation and memory in MoCA. The spectroscopic results showed significantly improved oxyhemoglobin concentration in the bilateral frontal lobes after the MNES.Conclusions:Electrical stimulation of the median nerve can help to improve cognition after a stroke. It increases oxyhemoglobin concentration in the bilateral frontal lobes.
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The liver is the metabolic center of mammalian body. Systematic study on liver's proteome expression under different physiological and pathological conditions helps us understand the functional mechanisms of the liver. With the rapid development of liquid chromatography tandem mass spectrometry technique, numerous studies on liver physiology and pathology features produced a large number of proteomics data. In this paper, 834 proteomics experiments of mouse liver were systematically collected and the mouse liver proteome database (Mouse Liver Portal, http://mouseliver.com) was established. The Mouse Liver Portal contains the liver's proteomics data under different physiology and pathology conditions, such as different gender, age, circadian rhythm, cell type and different phase of partial hepatectomy, non-alcoholic fatty liver. This portal provides the changes in proteins' expression in different conditions of the liver, differently expressed proteins and the biological processes which they are involved in, potential signal transduction and regulatory networks. As the most comprehensive mouse liver proteome database, it can provide important resources and clues for liver biology research.
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Animals , Mice , Chromatography, Liquid , Databases, Factual , Liver , Proteome , ProteomicsABSTRACT
BACKGROUND: Steroid-induced avascular necrosis of the femoral head is a worldwide problem, and its pathogenesis still remains unclear. Its pathogenesis is still the focus of research in this field. OBJECTIVE: To discuss the role of autophagy gene Beclin1 in steroid-induced avascular necrosis of the femoral head and the effect of 3-methyladenine on Beclin1. METHODS: Thirty-six 5-month-old Japanese white rabbits (provided by Xi'an Dilepu Biological Resource Development Co., Ltd.) were included and randomly divided into control group (intramuscular injection of normal saline), avascular necrosis of the femoral head group (intramuscular injection of methylprednisolone) and 3-methyladenine group (intramuscular injection of methylprednisolone and 3-methyladenine), with 12 rabbits in each group. The injection was conducted four times, with 1 week in between. The animals from each group were sacrificed at 1, 2, 3 and 4 weeks for sample taken. Vacant bone lacunae were counted under optical microscope. mRNA and protein expression levels of Beclin1 were detected by RT-PCR and western blot assay. RESULTS AND CONCLUSION: (1) Histomorphological observation under optical microscope showed that the rate of vacant lacunae in the avascular necrosis of the femoral head and 3-methyladenine groups was significantly increased (P ＜ 0.05), and was significantly lower in the 3-methyladenine group than that in the avascular necrosis of the femoral head group (P ＜ 0.05). (2) Glucocorticoid could rapidly stimulate the expression of Beclin1 mRNA in the femoral head tissue, and the protein level was significantly increased at the first two weeks, suggesting that autophagy was activated. 3-Methyladenine could inhibit this process. (3) These findings indicate that enhanced autophagy gene Beclin1 expression is important for avascular necrosis of the femoral head. 3-Methyladenine can regulate Beclin1, thereby controlling autophagy, which alleviates the occurrence and development of avascular necrosis of the femoral head.
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BACKGROUND: Autophagy of osteocytes has been found to be implicated in the pathogenesis of steroid-induced necrosis of the femoral head and closely related to apoptosis.OBJECTIVE: To summarize the research progress of autophagy in the pathogenesis of steroid-induced necrosis of the femoral head by studying the interaction between cell autophagy and cell apoptosis as well as osteocytes.METHODS: A computer-based online retrieval of PubMed, Embase and CNKI databases was performed for relevant literatures published from October 1996 to October 2016 with the keywords of steroid, necrosis of the femoral head, cell apoptosis, cell autophagy, osteocyte in Chinese and English, respectively. The articles concerning steroid-induced necrosis of femoral head and cell autophagy were collected, and the redundant and old researches or Meta analysis were removed.RESULTS AND CONCLUSION: Mammalian target of rapamycin, Beclin-1, microtubule-associated protein 1 light chain 3, bone morphogenetic proteins, fork box protein and transcription gene family and transcription factor 4 are closely related to autophagy. The interaction between autophagy and osteocytes is correlated with steroid dose: the autophagy shows protective factor under the low dose corticosteroids; however, with the increase of the dosage, a large number of apoptotic cells, and the phenomenon of bone loss can been observed. Furthermore, the relationship of cell autophagy with apoptosis and bone mass maintenance is still controversial, which needs to be explored in depth via a series of rational experiments.
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It analyzed the definition, mechanism, characteristics of Mirror Visual Feedback and summarized the application of mirror visual feedback in recovering upper limb function after stroke patients at home and abroad, so as to provide evidences for the further research in China.
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BACKGROUND:Cilium is an antenna-like organele that plays a vital role in al organs generation and maintenance.Ciliopathiesrefer tomultisystem diseasescaused bydisordersofthecilia structure and function. OBJECTIVE:To introduce current understanding of the structure and function of the cilium,with afocus on the study progress ofciliopathies. METHODS:PubMed databasewas searched by computerusing the keywords of“primary cilium, motion cilium,ciliopathy”.Totally 371 relevantarticlespublished from 1959 to 2015 were retrieved. After excluding repetitive and irrelevant articles,we enrolled32 English literaturesregardingcilia structure, functionand ciliopathiesin accordance with the inclusion criteria. RESULTS AND CONCLUSION:Ciliopathiesalmostinvolve every system of the human body, such asthe brain, eyes, liver, kidney, bone and reproductive system.Most ciliopathies are related to human developmental or degenerative diseases, which characterized by wide-ranging clinical and genetic heterogeneity,such asprimary ciliary dyskinesia,ploycystic kidney disease, infertility, blindness and tumor. In view ofthemedical importanceof the cilium, scholars have devoted tostudyingthe underlying celular mechanisms.Thesein turnhave revealed thatciliopathiesare not only caused bydefectiveassemblyof the cilium,but also by impaired ciliarysignaling.
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[Objective]To explore the change and its significance of the expression of vascular endothelial growth factor(VEGF) messenger RNA and bone morphogenic protein-2(BMP-2) of the local femoral head in the nontraumatic osteonecrosis of femoral head(NONFH).[Method]Sixteen samples of femoral heads of NONFH were collected as the experimental group and fresh 10 samples of femoral heads of femoral neck fracture as control group,overall examples were collected from total articular replacement arthroplasty.The samples were splitted in coronal plane and get one bone block from necrosis area and another one from healthy area,make them into microtome section after the process of immobility and decalcification.Their pathological change was observed by using optical microscope and electron microscope and detect the expression of BMP-2 and VEGFmRNA in femoral head through making use of immunohistochemistry and in-situ hybridization technique.[Result]The organization structure of experimental group was disorganized,cracked and the bone trabecula was rarefactive and non-intact and there was a great number of empty lacuna in bone trabecula.While there was the reverse situation in the control group.The intensity and area of positive expression of BMP-2 and VEGFmRNA in femoral head of the experimental group were lower than that of control group obviously.The result showed statistical significance(P