ABSTRACT
Objective To evaluate the clinical efficacy of percutaneous piercing cortical bone at fracture ends and local injection of autologous concentrated bone marrow aspirate (cBMA) and platelet rich plasma (PRP) in the treatment of delayed fracture union.Methods A retrospective study was performed on the clinical data of 34 patients with delayed fracture union who had been treated at Department of Orthopaedics,Luoyang Zhenggu Hospital of Henan Province from April 2014 to February 2017.They were 26 males 8 females,aged from 18 to 63 years (average,36.7 years).There were 15 femoral,11 tibial,5 humerus and 3 ulnar fractures.According to the Weber-Crech classification,14 cases belonged to the type of rich blood supply-active end hypertrophy and 20 to the type of poor blood supply and malnutrition.There were 28 closed and 6 open fractures.Of this cohort,21 cases had their primary fixation,7 had revision once,4 had revision twice,and 2 had revision more than thrice;19 cases had intramedullary fixation,12 had plate fixation and 3 had external fixation.Autologous iliac bone grafting was performed previously in 19 cases.Kirschner wire was used under fluoroscopy to pierce percutaneously the cortical bone at fracture ends;bone marrow blood and peripheral venous blood were collected to prepare autologous cBMA and PRP which were to be injected locally at the fracture ends after mixture.At the last follow-up,the patients were evaluated by visual analogue scale (VAS),SF-36 health survey summary scores and modified Radiographic Union Score for Tibia (RUST).Results The patients were followed up for 12 to 42 months (average,21.5 months).Thirty-one patients healed after surgery,yielding a healing rate of 91.2％.The healing time averaged 5.3 months (from 4 to 10 months).No patient reported such complications as infection or neurovascular injury.At the last follow-up,the VAS scores of the 34 patients were 1.3 ± 0.6 points,significantly lower than the preoperative 5.4 ± 3.6 points (P ＜ 0.05);the postoperative SF-36 scores 74.8 ± 16.5 points,significantly increased than the preoperative 44.8 ± 15.6 scores (P ＜ 0.05);the RUST scores 3.3 ± 0.4 points,significantly higher than the preoperative 1.6 ± 0.8 points (P ＜ 0.05).Conclusions Minimally invasive percutaneous piercing of K-wire on the cortical bone at the fracture ends may result in fluid leakage and restart bone healing process.At the same time,local injection of autologous cBMA and PRP may increase the number and concentration of local bone marrow mesenchymal stem cells and growth factors,promoting fracture healing.
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Objective To explore the feasibility and efficiency of metacognitive training (MCT) in inpatients with schizophrenia,as well as the short-term effects of metacognitive training on symptoms,cognitive function,and insight.Methods Sixty inpatients that met the DSM-Ⅳ criteria for schizophrenia were randomly assigned to either MCT (research group,n =30) or an active controlled intervention (control group,n =30).Positive and Negative Syndrome Scale (PANSS),Schizophrenia Cognition Rating Scale (SCoRS),Insight and Treatment Attitude Questionnaire(ITAQ) and beads task are assessed at baseline and after completion of the training.Results After treatment,the scores of the two groups in PANSS,SCoRS,ITAQ and the bead task were significantly improved(P＜0.05).The improvement of positive symptoms,cognitive function and insight in research group (12.8 ± 4.2,31.7 ± 13.9,9.2 ± 6.1 respectively) was significantly better than that in control group (15.6±5.9,38.1± 18.1,5.5±5.8 respectively),and the difference was statistically significant (P＜ 0.05).Conclusion Metacognitive training can effectively improve the clinical symptoms,cognitive function and insight for inpatients with schizophrenia.
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Objective To explore the peripheral blood circulating microRNA expression profile of ischemic and hemorrhagic stroke patients by using microRNA array. Methods The whole blood of 3 patients with acute ischemic stroke, 3 patients with cerebral hemorrhage and 3 healthy volunteers were collected for whole blood RNA through Norgen exosome isolation kit, and then underwent quality and density measurement through PCR. The miRNAs expression profile was studied through μParaflorTM microRNA. All the data were analyzed by associated software and statistics methods. Results 8 miRNAs associated with cerebral stroke in ischemia stroke patients and cerebral hemorrhage patients were discovered, and showed significant difference (P 0.05). Conclusions Different expression profiles of miRNA between ischemic stroke patients and hemorrhagic stroke patients may provide insights into their roles in the pathogenesis and progression of stroke. The study of miRNA can contributes to elucidate the epigenetics molecular mechanism of acute stroke.