ABSTRACT
Objective To evaluate surgical treatment of chronic tibial osteomyelitis of Cierny-Mader type Ⅳ with Ilizarov technique and lesion osteotomy. Methods From January 2010 to May 2016, 39 patients with chronic tibial osteomyelitis of Cierny-Mader type Ⅳ were treated at our center. They were 33 males and 6 females, 8 to 54 years of age (average, 33.8 years). After debridement and lesion osteotomy, the tibia was fixated with Ilizarov external fixator. Bone was transported to the bone defect after corticotomy was performed on the proximal and/or distal tibial metaphyses simultaneously. Bifocal corticotomy was per-formed in 11 cases, proximal corticotomy in 21 cases, and distal corticotomy in 7 cases. The transport began 3 to 5 days after operation at a speed of 0.5 to 1.0 mm/d initially. The speed was lowered according to the bone healing and pain. Radiographic examination was done every 2 weeks to observe transporting deviation and osteogenesis in the transporting area. The transporting was adjusted whenever any abnormality was observed. The bone transporting lasted for 50 to 130 days (average, 62.4 days). Results The patients were fol-lowed up for 11 to 49 months (average, 21 months). All the soft tissue wounds healed uneventfully and there was no relapse of osteomyelitis. The bone defects in the 32 cases were reconstructed primarily. Nonunion of fracture ends happened in 5 cases and nonunion of the bone lengthening zone in 2 cases. The 7 cases of nonunion were healed after secondary bone grafting. Malalignment happened in 5 cases, 4 of which responded to timely adjustment of the external fixation and one of which had to receive secondary bone grafting after failure in adjustment of the external fixation. Ankle joint dysfunction occurred in 7 cases, 5 of which re-sponded to functional exercise and 2 of which accepted joint dysfunction because they refused surgery after unsatisfactory functional exercise. Pin tract infection of different severities occurred in 9 cases, one of which was treated by replacement of the K-wires under local anesthesia and the other 8 of which responded to rein-forced dressing change. Conclusions Chronic tibial osteomyelitis of Cierny-Mader typeⅣcan be treated by Ilizarov technique and lesion osteotomy. However, the Ilizarov technique should be improved because of the risks of multiple complications which can be reduced significantly by strengthening postoperative instruction, nursing, and regular follow-up.
ABSTRACT
Objective To explore the influence of cyasterone on the osteoclast and osteoblast differentiation and then to investigate its effect on the bone quality in the osteoporosis mice. Methods CCK8 assay was firstly used to detect the toxic effect of cyasterone on the mouse bone marrow derived mononuclear macrophages (BMMs) and anterior osteoblast lines MC3T3E1. Cell apoptosis was measured by flow cytometry. Then TRAP staining and ALP staining were employed to detect osteoclast differentiation and osteoblast differentiation, respectively. Realtime PCR was carried out to test the expression of osteoclast special gene TRAP and osteogenesis crucial gene ALP. In vivo, 15 mice were divided into three groups: sham-operated group, OVX group and OVX+cyasterone treatment group. In treatment group, cyasterone was used as 5mg/kg every day. Sham-operated group and OVX group were treat with saline solution. After 4 weeks, the tibia was collected for Micro-CT detection to observe the bone quality and microstructure changes. Results Cyasterone with the concentration of less than 10 mg/L had no significant cytotoxicity nor influence on the apoptosis (P＞0.05) . Cyasterone could significantly inhibit the osteoclast differentiation of BMMs (P＜0.05), simultaneously, it also had the effect to promote the osteoblast differetiation of MC3T3E1. Real-time PCR indicated that cyasterone could block the expression of TRAP and increase the expression of ALP (P＜0.05) . In vivo, cyasterone was able to obviously improve the osteoporosis status caused by estrogen deficiency without general toxicity. Conclusion cyasterone could provide a good treatment for osteoporosis through the bidirectional effect of inhibiting osteoclast differetiation and promoting osteoblast differentiation.
ABSTRACT
Objective:To investigate the effects of shikonin on osteoclastogenesis in vitro and amelioration of bone loss in ovariectomized-induced osteoporosis in mouse model.Methods:The optimal concentration of shikonin treating were evaluated in vitro depending on its effect on the viability of C57BL/6J mouse bone-marrow-derived macrophages by CCK-8 method.To establish the osteoclastogenesis cell model,macrophages were cultured with RANKL and M-CSF treatment,and TRAP staining was used to observe the generation of osteoclasts after treating with different concentration of shikonin solution.Expressions of osteoclast marker genes,including TRAP,c-Fos and NFATclwere detected with real-time PCR.Fifthteen mice were randomly allocated into sham operation group,ovariectomized model group and shikonin treatment group.After the modeling,mice in treatment group were received the intraperitoneal injection of shikonin,while the other two groups treated with normal saline.After thirty days treatments,all animals' tibias were dissected for micro-CT analysis.Results:①The macrophages viability was significantly inhibited when the concentration of shikonin was higher than 250 nmol/(P＜0.01).②The osteoclastogenesis was significantly suppressed by differemt dose of shikonin(P＜0.01).③ The expression of the osteoclastic marker genes (TRAP,c-Fos and NFATc 1) were suppressed by addition of shikonin comparing to control group (P＜0.01).④ Shikonin effectively prevented ovariectomy-induced bone loss (P＜0.05).Conclusion:Shikonin suppresses osteoclastogenesis in vitro and ameliorates ovariectomized-induced osteoporosis in mouse model.
ABSTRACT
Objective To evaluate the clinical outcome of reconstruction of the superior peroneal retinaculum (SPR) by using a portion of Achilles’s tendon and suture anchors in the treatment of chronic peroneal tendon dislocation .Methods Seven patients in our hospital from January 2010 to January 2015 who underwent surgical reconstruction of SPR by using a portion of Achilles ’ s tendon and suture anchors were evaluated .The ankle ’ s range of motion ( ROM) and The American Orthopaedic Foot and Ankle Society ( AOFAS) ankle-hindfoot score were used to evaluate the clinical outcome .Results All 7 cases were followed up for 6 to 24 months,the average time was 14 months,with-out recurrence.The ankle’s ROM improved from (23.6 ±1.9) °preoperative to (30.0 ±1.5) °at the final follow-up,and the AOFAS An-kle Hindfoot Scale improved from (60.6 ±3.6) point preoperative to (93.6 ±3.9) point at the final follow-up.Conclusion Surgical re-construction of SPR by using a portion of Achilles ’ s tendon and suture anchors may be an effective alternative surgical method for chronic peroneal tendon dislocation .
ABSTRACT
Objective To investigate the clinical features and characteristics of coronary artery lesion between Hui and Han nationality young pa?tient with acute myocardial infarction(AMI)who were referred to the affiliated hospital of Ningxia Medical University. Methods A total of 189 con?secutive AMI young patients(age≤44 years)who underwent coronary angiography were retrospectively retrieved from the database.Those patients with AMI were divided into Hui group(46 cases)and Han group(143 cases). The clinical features and results of coronary angiogram were com?pared between the two group. Results Compared with Han group,Hui group are more younger than Han group,high prevalence rate of diabetes, lower smoking history and lower drinking history(P<0.05). Coronary angiography showed the incidence of three?vessel lesions was significant low?er in Han group than in Hui group(P<0.05). Both group showed single vessel was the most common lesion. Conclusion Hui nationality patients with acute myocardial infraction are more younger and are are more prone to suffering from diabetes history、lower smoking history and lower drinking history than Han nationality patients. The coronary artery lesions of Hui nationality patients with acute acute myocardial infraction are more three?branch lesions than Han nationality patients.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the clinical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral ligament (MPFL) for the treatment of patellar dislocations.</p><p><b>METHODS</b>From September 2008 to June 2013, 16 patients with patellar dislocation underwent MPFL reconstructions. There were 2 males and 14 females, aged 11 to 27 years old (16 years old on average). Patellar dislocations occurred in 11 left and 5 right knees. The disease course ranged from 3 to 10 years. The frequency of dislocation ranged from 9 to 33 times (19 times on average). Affected knee joints showed patellar instability; the range of action for patella obviously increased. The X-ray films showed patellar dislocation. The preoperative Q angle was (36 ± 9)°, and the congruence angle was (63 ± 18)°. Reconstruction was performed via allograft tendon. Allograft tendon was fixed through the superomedial pole of the patella, and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel. All the patients were evaluated postoperatively; Kujala patellofemoral scores, objective knee function, complications, and reoperations were assessed.</p><p><b>RESULTS</b>Primary healing was achieved in all cases. No infection or necrosis and absorption of grafts was observed. All the patients were followed up for an average of 16.4 months (ranged, 10 to 24 months) postoperatively. At the latest follow-up, all the patients had no pain, swelling and patellar instability; neither patella redislocation nor fracture occurred. The X-ray films showed good position of tunnel 6 months after operation, and the congruence angle was (5 ± 9)°, showing statistically significant difference when compared with preoperation (P < 0.05). The postoperative Q angle was (17 ± 8)°, the Kujala knee function score improved significantly from 45.20 ± 9.20 to 89.30 ± 6.40 at the latest follow-up, showing statistically significant difference (P < 0.05).</p><p><b>CONCLUSION</b>MPFL reconstruction improves clinical symptoms. Anatomical MPFL reconstruction is effective for patellar dislocation, and it offers good recovery of the premorbid patella mechanics. The interference screw provides firm fixation. Allograft can avoid the graft harvest site morbidity, but it increases the cost of the surgery.</p>
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Allografts , Ligaments, Articular , General Surgery , Patellar Dislocation , General Surgery , Patellofemoral Joint , General Surgery , Plastic Surgery Procedures , Methods , Tendons , TransplantationABSTRACT
BACKGROUND:There is little evidence on the use of al ogeneic tendon graft in the reconstruction of ankle joint. OBJECTIVE:To explore the clinical outcome of anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft in patients with chronic ankle instability. METHODS:Twenty-six patients with chronic lateral instability underwent anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon. There were 18 cases of simultaneous injury or chalasia in calcaneofibular ligament and anterior talofibular ligament, and 8 cases of anterior talofibular ligament injury or chalasia. The ankle joint function was evaluated according to AOFAS scale and Good classification. The affect ankle and healthy ankle were compared in the extension, plantar flexion activity, and metaleg activity. RESULTS AND CONCLUSION:Al the 26 patients were fol owed up for 9-24 months with a mean of 15 months. No cases appeared recurrent ankle lateral instability. The mean AOFAS score in the group of calcaneofibular ligament and anterior talofibular ligament was improved from (48.4±3.7) points preoperatively to (88.2±3.8) postoperatively, while that in the group of anterior talofibular ligament was improved from (50.0±6.4) points preoperatively to (89.5±3.4) points postoperatively. According to Good score, there were excellent in 19 feet, good in 6 feet, fair in 1 foot, with an excellent and good rate up to 96%. No serious complication was occurred in this group. Anatomical reconstruction of the lateral ligaments with cryopreserved al ogeneic tendon graft can increase the tendon-bone contact area, improve the rate of tendon healing, and enhance the stability of ankle joint in patients with chronic ankle instability. Further studies are needed to verify its long-term efficacy.
ABSTRACT
<p><b>OBJECTIVE</b>Obesity is becoming a worldwide health problem. The genome wide association (GWA) study particularly for body mass index (BMI) has not been successfully conducted in the Chinese. In order to identify novel genes for BMI variation in the Chinese, an initial GWA study and a follow up replication study were performed.</p><p><b>METHODS</b>Affymetrix 500K SNPs were genotyped for initial GWA of 597 Northern Chinese. After quality control, 281,533 SNPs were included in the association analysis. Three SNPs were genotyped in a Southern Chinese replication sample containing 2 955 Chinese Han subjects. Association analyses were performed by Plink software.</p><p><b>RESULTS</b>Eight SNPs were significantly associated with BMI variation after false discovery rate (FDR) correction (P=5.45×10⁻⁷-7.26×10⁻⁶, FDR q=0.033-0.048). Two adjacent SNPs (rs4432245 & rs711906) in the eukaryotic translation initiation factor 2 alpha kinase 4 (EIF2AK4) gene were significantly associated with BMI (P=6.38×10⁻⁶ & 4.39×10⁻⁶, FDR q=0.048). In the follow-up replication study, we confirmed the associations between BMI and rs4432245, rs711906 in the EIF2AKE gene (P=0.03 & 0.01, respectively).</p><p><b>CONCLUSION</b>Our study suggests novel mechanisms for BMI, where EIF2AK4 has exerted a profound effect on the synthesis and storage of triglycerides and may impact on overall energy homeostasis associated with obesity. The minor allele frequencies for the two SNPs in the EIF2AK4 gene have marked ethnic differences between Caucasians and the Chinese. The association of the EIF2AK4 gene with BMI is suggested to be 'ethnic specific' in the Chinese.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Asian People , Genetics , Body Mass Index , China , Epidemiology , Genetic Predisposition to Disease , Genome-Wide Association Study , Obesity , Ethnology , Genetics , Polymorphism, Single Nucleotide , Protein Serine-Threonine Kinases , GeneticsABSTRACT
<p><b>OBJECTIVE</b>To investigate the characteristics for activated coagulation factor VII(F VIIa) and the R353Q, -323 0/10 bp, HVR4 polymorphisms in the gene in patients with coronary heart disease (CHD) and myocardial infarction from Ningxia Hui and Han populations.</p><p><b>METHODS</b>Four hundred and twenty angiographically proven CHD patients in the Hui population, and 508 healthy blood donors were tested for their plasma levels of coagulation factor VII using recombinant tissue factor method. The coagulation factor VII gene R353Q, -323 0/10 bp and HVR4 genotypes were identified by polymerase chain reaction. In addition, 600 Han patients with CHD and 604 healthy Han control subjects were also investigated.</p><p><b>RESULTS</b>(1) The plasma F VIIa levels was significantly higher in patients with CHD and myocardial infarction than that in healthy control subjects and angor pectoris (P<0.01) in both Hui and Han populations. (2) There were significant differences in the distribution of genotypes and allelic frequencies of the R353Q between myocardial infarction and angor pectoris disease in the Hui population (P<0.05). So was the -323 0/10 bp locus in both the Hui and Han population. (3) The F VIIa level was significantly higher in individuals with RR genotype than those of Q allele carriers in the Hui population.</p><p><b>CONCLUSION</b>There are polymorphisms of the F VII gene R353Q, -323 0/10 bp and HVR4 in the Hui and Han populations. The Q allele might be a protective factor against myocardial infarction in the Hui, and the plasma F VIIa level may be influenced by the R353Q polymorphism of the F VII gene. The 10 allele may be a protective factor against myocardial infarction in both the Hui and Han populations.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Asian People , Ethnology , Genetics , Case-Control Studies , Factor VII , Genetics , Metabolism , Myocardial Infarction , Ethnology , Genetics , Metabolism , Polymorphism, GeneticABSTRACT
Objective This retrospective study is designed to analyze the cardiovascular events of CTO to provide new information on secondary prevention of CHD in patients after hospital discharge. Methods 272 patients with definite diagnosis of CTO were enrolled in this study. Patients were divided into two groups according to whether suffering from cardiovascular events, with 167 patients in group A who had not suffered from the cardiovascular events and 105 patients in group B who had suffered from the cardiovascular events. We com-pared the clinical data, severity of coronary artery lesion, treatment in two groups. Results Between two groups, there was statistic signifi-cance in LDL -C, EF, Gensini scots, the number of coronary artery lesion, the number of chronic total coronary occlusion and PCI success. Logistic regression analysis revealed that Gensini scots was the independent factors for prognosis of CTO. Conclusion Gensini scors was the independent factor for prognosis of CTO.
ABSTRACT
Objective To evaluate the role of different imaging examinations in diagnosis and minimally invasive surgery of intercondylar eminence fracture of the tibia. Methods Different imaging examinations and minimally invasive surgery were done on 43 patients with intercondylar eminence frac-ture of the tibia admitted from July 2004 to December 2007. Preoperative and postoperative imaging data were collected for comparative analysis of functional score. Results Fracture detection rate of X-ray was 95%, that of CT three-dimensional reconstruction 100% and that of MRI 90%. All fractures were healed at one stage, with sound knee function. Conclusions The traditional X-ray examination is the first choice for diagnosis of the intercondylar eminence fracture of the tibia. In the meantime, three-di-mensional reconstruction of CT can help enhance accuracy of diagnosis and MRI can help diagnose cruci-ate ligament injury. Arthroscopic and minimally invasive surgery is rather complex but good to recovery of knee joint function. Compared with other methods, tension band is simple but reliable, for it can avoid breakage of the fractured bone and is suitable for all types of fractures.