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@#Carboxymethylcysteine (CMC) is a common drug for the clinical treatment of chronic obstructive pulmonary disease, yet its long-term use can cause severe irritation to the gastrointestinal tract.As the substrate of nitric oxide (NO) synthase (NOS), L-arginine can be converted in the body into NO beneficial to the cardiovascular system, the gastrointestinal tract and so on.As a basic amino acid, L-arginine can be salified with some compounds containing acidic groups to improve the water solubility of the parent drug and may enhance the activity and alleviate side effects due to NO release.In this study, we designed and synthesized carboxymethylcysteine L-arginate (CMCA), and tested its physico-chemical properties, and the abilities to scavenge reactive oxygen species (ROS), inhibit apoptosis and release NO in cigarette smoke-induced injury model of human bronchial epithelial cells.The results revealed that CMCA is superior to CMC or L-arginine in that it could capture ROS, release NO and suppress apoptosis, suggesting that CMCA is worthy of further research and development.
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Objective:To explore the effects and molecular mechanisms of ginsenoside Rg1 on the expression of neuronal autophagosome-related proteins in a rat model of Alzheimer's disease(AD).Methods:Six-week-old SD rats were decapitated to prepare hippocampal brain slices.The slices were randomly divided into the blank control group, the model group, the low-concentration, medium-concentration and high-concentration Rg1 groups, with 10 in each group.In the model group, Aβ 1-42(final concentration: 5 μmol/L)was added into an artificial cerebrospinal fluid(CSF)for 2 h treatment.The low-concentration, medium-concentration and high-concentration Rg1 groups were treated with Aβ 1-42(final concentration: 5 μmol/L)for 2 h, and then treated with Rg1(final concentrations: 60 μmol/L, 120 μmol/L, 240 μmol/L, respectively)for 3 h. The blank control group was not given any intervention drugs.At the end of intervention, histological changes of hippocampal brain slices in each group were examined via hematoxylin-eosin(HE)staining.Autophagosomes in hippocampal brain slices of each group were detected using transmission electron microscopy.The expression levels of autophagy-related proteins(P62, LC3-Ⅱ/LC3-Ⅰ), Aβ 1-42and shank protein in hippocampal brain slices of each group were detected with Western blot. Results:The results of HE staining showed that the arrangement of hippocampal neurons were disordered in the model group, with death and depletion of neurons.The arrangement and depletion of hippocampal neurons in each Rg1 group were less severe compared with the model group, with most significant improvement seen in the high-concentration Rg1 group.The results of transmission electron microscopy showed that the number of autophagosomes in brain slices in the model group was significantly higher than that in the blank control group, while each Rg1 group had fewer autophagosomes than the model group.The results of Western blot showed that, compared with the blank control group, levels of Shank1, P62 and LC3-Ⅰ proteins in brain slices were decreased(all P<0.05), while levels of Aβ 1-42and LC3-Ⅱ protein were significantly increased(all P<0.05)in the model group.Compared with the model group, levels of Shank1, P62 and LC3-Ⅰ proteins in brain slices were increased(all P<0.05), while levels of Aβ 1-42and LC3-Ⅱ protein were decreased( P<0.05)in each Rg1 group.These changes were the most significant in the high-concentration Rg1 group. Conclusions:Ginsenoside Rg1 may inhibit autophagy by up-regulating the expression of Shank1, P62 and LC3-Ⅰ proteins in hippocampal brain slices of rats in the AD model, thus playing protective roles in brain neurons.
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Objective:To investigate the clinical outcomes of unstable pelvic fractures in adolescents treated with robot-assisted posterior pelvic channel screw.Methods:From October 2016 to October 2020, 14 adolescent patients with unstable pelvic fractures were retrospectively analyzed. There were 8 males and 6 females, average age of 14.57±1.69 years (range, 12-17 years). Pelvic fracture classification: according to Tile classification, 2 cases of B1, 3 cases of B2, 1 case of B3, 2 cases of C1, 5 cases of C2, 1 case of type C3. According to Torode-Zieg classification, 2 cases of type IIIb, 12 cases of type IV. According to Young-Burgess classification, 1 case of APC II, 1 case of APC III, 2 cases of LC I, 2 cases of LC III, 8 cases of VS type. The diameter of the sacroiliac screw channel, operation time, intraoperative blood loss, fracture reduction quality, pelvic asymmetry, pain visual analogue scale (VAS), Majeed score, screw placement accuracy, postoperative complications were analyzed. The pelvic asymmetry and VAS at presurgery, one week after surgery and the last follow-up were statistically analyzed.Results:There were 8 cases of robot-assisted sacroiliac screw placement and 6 cases of robot-assisted triangular fixation. All patients were followed up for 24.85±10.26 months (range, 12-51 months). The average height of S 1 sacroiliac screw channel was 14.85±3.59 mm (range, 8-22 mm). The average width was 13.78±2.64 mm (range, 9-19 mm). The average height of S 2 sacroiliac screw channel was 14.07±3.08 mm (range, 8-21 mm), and the average width was 12.64±2.84 mm (range, 7-19 mm). The operation time was 63.57±21.61 min (range, 20-120 min), and the intraoperative blood loss was 65.71±41.83 ml (range, 20-200 ml). According to Mears and Velyvis imaging evaluation criteria, 7 cases were anatomically reduced, 6 cases were satisfactory, and 1 case was unsatisfactory, and the satisfactory reduction rate was 93% (13/14). The pelvic asymmetry was 18.14±6.07 mm (range, 9-33 mm) before surgery, while one week after surgery, it was 5.43±2.44 mm (range, 3-13 mm), and it was 4.64±2.27 mm (range, 3-12 mm) in the last follow-up. One week after surgery, the last follow-up, and preoperative pelvic asymmetry was statistically different ( F=50.21, P<0.001); As for VAS for pelvic pain, the score was 6.93±1.21 points (range, 5-9 points) preoperative, 3.93±0.99 points (range, 3-6 points) one week after surgery, and 1.21±0.97 points (range, 0-3 points) at the last follow-up. There was statistical difference between 1 week after operation, the last follow-up and preoperative VAS ( F=100.89, P<0.001). The Majeed score was 86.14±7.35 points (range, 70-95 points), and the excellent and good rate was 93%(13/14). All the robot-assisted screws were located in the bone, the screw placement accuracy was 100%. No postoperative complications such as wound infection occurred, and only 1 patient complained of discomfort because of the nail tail. Conclusion:For unstable pelvic fractures in adolescents, robot-assisted pelvic posterior channel screws shows satisfactory postoperative clinical effects, which is minimally invasive, with fewer postoperative complications.
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Objective:To discuss the clinical value of magnetic resonance neurography (MRN) on diagnosis and treatment of lumbosacral nerve injury associated with sacral fractures and analyze the characters of nerve injury which was caused by sacral fractures.Methods:The clinical data of 40 patients who had lumbosacral nerve injury associated with sacral fractures and accepted treatment in Tianjin hospital from August 2018 to December 2020 were collected based on inclusion and exclusion criteria. Twenty-four patients had unilateral sacral fractures (Tile C1) which included 16 Denis II type fractures and 8 Denis III type fractures. Sixteen patients had bilateral sacral fractures which were all Tile C3, U shaped and Denis II type sacral fractures. All patients had symptoms or signs of lumbosacral nerve injury, and accepted contrast-enhanced three-dimensional magnetic resonance neurography (CE-3D MRN) to diagnose the injury part and severity degree. The L 5-S 4 nerves were separated to three parts based on injured side and intraspinal type (IS), intraforaminal type (IF) and extraforaminal type (EF) location, and were judged the mild, medium or severe degree of nerve injury severity. Overall and pairwise Chi-square test was performed on the number of nerve injuries. Eleven patients accepted the operation of nerve dissection and exploration. The nerve injury part and severity were recorded under direct vision, and were statistically analyzed with CE-3D MRN outcome. Results:The outcome of 239 lumbosacral nerve injuries which had different part and severity were found by MRN, and all combined with sacral fractures of the same side. The nerves which ranked from largest to fewest according to injured numbers were L 5, S 1, S 2, S 3 and S 4. The statistical analysis showed that there were significant differences of injured nerve numbers except between S 1 and S 2, S 3 and S 4, and there were no significant difference of nerve injury part and severity degree between the direct visual judgement intraoperatively and preoperative CE-3D MRN examination. Conclusion:MRN can reveal the part and severity degree of lumbosacral nerve injury associated with sacral fracture clearly and accurately, which has important clinical value and should become the preferred examination of such injuries. The lumbosacral nerve injury has the most frequent features of S 1 and S 2, followed by L 5, and the least in S 3 and S 4.
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Objective:To measure the anatomical parameters of three-dimensional available space of S 1 and S 2 vestibules on Chinese adults by imaging methods, and discuss their clinical values. Methods:Data of 200 cases of pelvic CT with complete posterior ring were collected from January 2015 to January 2021, included 110 males and 90 females. The ages ranged from 21 to 63 years (average, 40.72±10.70 years). Then the parameters of both the left vestibule and the right vestibule of S 1 and S 2 such as vestibular width, vestibular height and vestibular area were measured by the three-dimensional CT reconstructions. Statistical analyses were performed among the groups which were classified according to the gender, side of vestibule to compare the difference of vestibular morphological characteristics among different groups. Results:The average vestibular area of S 1 was 425.71± 45.07 mm 2 (range, 296.3-604.4 mm 2), which was 449.80±28.62 mm 2 (range, 338.3-604.4 mm 2) in males and 388.25±34.01 mm 2 (range, 296.3-498.4 mm 2) in females. The average vestibular width was 28.52±4.34 mm (range, 17.1-36.3 mm), 31.77±2.33 mm (range, 22.46-36.30 mm) in males and 24.55±2.55 mm (range, 17.1-26.1 mm) in females. The mean vestibular height was 21.05±2.29 mm (range, 17.5-32.0 mm), with 21.34±2.37 mm (range, 18.5-32.0 mm) of men and 20.69±1.60 mm (range, 17.5-25.6 mm) of women. The mean S 2 vestibular area was 230.19±35.57 mm 2 (range, 142.5-297.3 mm 2), which was 258.91±28.04 mm 2 (range, 218.3-297.3 mm 2) in males and 205.61±24.12 mm 2 (range, 142.5-258.6 mm 2) in females. The average vestibular width was 15.94±1.72 mm (range, 12.4-20.3 mm), 16.51±1.59 mm (range, 14.4-20.3 mm) in male and 15.25±1.63 mm (range, 12.4-18.1 mm) in female. The mean vestibular height was 14.30±1.20 mm (range, 12.9-17.8 mm), 15.49±1.46 mm (range, 13.6-17.8 mm) in males and 13.73±0.93 mm (range, 12.9-16.1 mm) in females. There were significant differences in vestibular width, height and area between S 1 and S 2 (vestibular width t=3.934, P< 0.001; vestibular height t=3.692, P< 0.001; vestibular area t=4.816, P< 0.001). There were significant differences in S 1 vestibular width, S 1 vestibular height, S 1 and S 2 vestibular area between male groups and female groups (S 1 vestibular width: t=2.969, P=0.003; S 1 vestibular height: t=0.316, P=0.049; S 1 vestibular area: t=1.975, P=0.049; S 2 vestibular area: t=2.023, P=0.044). While there was no significant difference in S 2 vestibular width and height between the two gender groups. There were significant differences in S 1 and S 2 vestibular width, height and area between male and female groups ( P < 0.001). There were no significant difference in parameters between the left and right values of the same vestibular site. Conclusion:The parameters of S 1 sacral vestibule are larger than that of S 2. It implies that S 1 was more feasible to insert iliosacral screws than S 2; lesser diameter iliosacral screws should be selected to insert into S 2. The female S 1 vestibule is smaller than the male, so the iliosacral screws placement has more stringent requirements on the selection of the insertion point and the direction of the screw. And the surgeon can utilize the intact contralateral sacral vestibule as the damaged side to proceed the iliosacral screw inserted simulation.
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Objective:To investigate the clinical efficacy of MIPO combined with non-contact bridging periprosthesis fracture plate (NCB.PP) in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture.Methods:From October 2015 to January 2020, 12 patients with re-fracture around the nail after intramedullary fixation of intertrochanteric fracture were treated in our hospital. There were 7 males and 5 females with an average age of 74.88±12.1 years (range, 65-83 years old); 8 patients on the left side and 4 patients on the right side received short nail of proximal femoral nail (PFN), 6-36 months after operation, they fell down and caused closed fracture around the nail body. According to Vancouver classification system, all the patients were Vancouver type B; preoperative bone mineral density examination showed that 1 case had normal bone mass, 10 cases had osteoporosis, and 1 case had low bone mass. All patients were treated with minimally invasive plate osteosynthesis (MIPO) technique for reduction and fixation, and fixed with proximal femur NCB.PP. The visual analogue scale (VAS) and Harris hip score at 1 day, 3 months and the last follow-up were compared.Results:The average operation time was 68.7±4.33 min (range, 65-75 min); the average intraoperative blood loss was 291.67±114.48 ml (range, 150-400 ml); the average postoperative drainage volume was 79.17±17.17 ml (range, 50-100 ml). After fracture reduction, all patients were able to obtain 2-5 bicortical screws fixation, with an average of 3.25±0.96. Among them, 3 cases were fixed with additional binding straps; 3 cases underwent autologous iliac bone grafting during the operation. All cases were followed up for 9-60 months, with an average of 16 months. At the last follow-up, 10 patients had fracture healing, the healing time was 7.75±2.83 months (range, 4-13 months), and the fracture healing rate was 83.3% (10/12). Among the other two patients, one was an 83 years old patient with severe osteoporosis, who was bedridden after operation and remained unhealed after 12 months of follow-up; a 68 years old patient had bone restoration at the broken end of the fracture 6 months after operation. The second operation was performed. Iliac combined with allogeneic bone graft was taken from the broken end. At the end of 13 months after operation, the fracture was partially healed. The VAS at one week, three months and the last follow-up were 8.00 (8.00, 9.00), 2.50 (2.00, 3.00) and 0.00 (0.00, 0.75), respectively. There were significant differences in VAS scores between 1 week after operation and 3 months after operation, 1 week after operation and the last follow-up, and 3 months after operation and the last follow-up ( Z=-3.129, -3.097, -3.134, all P < 0.05). The Harris scores at 3 months after operation and at the last follow-up were 72.50±2.91 and 86.67±5.30 respectively. After statistical analysis, the difference was statistically significant ( t=8.857, P< 0.001). At the last follow-up, except for 1 case of fracture nonunion and 1 case of reoperation, the Harris score of hip joint of the other 10 patients was excellent in 6 cases and good in 4 cases, and the excellent and good rate was 83.3% (10/12). One case of superficial wound infection was healed by intravenous drip of sensitive antibiotics. One patient had incision fat liquefaction and was given local dressing change to heal the incision. Conclusion:MIPO combined proximal femoral NCB.PP in the treatment of re-fracture around the nail after intramedullary fixation of intertrochanteric fracture has the advantage of less surgical damage, less blood loss, higher healing rate, and it can obtain satisfactory short and medium-term clinical efficacy.
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Objective:To evaluate the clinical outcomes of traumatic spinopelvic dissociation treated with robot-assisted bilateral triangular fixation.Methods:From March 2016 to March 2020, 30 patients with traumatic spinopelvic dissociation were retrospectively analyzed. According to operation and fixation methods, the patients were divided into robot-assisted minimally invasive bilateral triangular fixation group (Robot triangular group) and traditional open reduction lumbopelvic fixation group (Lumbopelvic group). There were 16 patients in the Robot triangular group, 4 males and 12 females, average age 35.7±13.3 years (range, 16-58 years). There were 10 cases of U-shaped, 4 cases of H-shaped, 2 cases of Y-shaped sacral fractures according to shape classification of sacral fractures. According to ROY-Camille classification, there were 4 cases of type I, 9 cases of type II, 3 cases of type III. There were 13 cases with sacral nerve injuries, including 10 cases of Gibbons grade II, 3 cases of grade III. There were 14 patients in the Lumbopelvic group, 4 males and 10 females, average age 37.4±15.1 years (range, 18-66 years), there were 10 cases of U-shaped, 3 cases of H-shaped, 1 case of Y-shaped sacral fractures according to shape classification of sacral fractures. According to ROY-Camille classification, there were 1 case of type I, 10 cases of type II, 3 cases of type III. There were 10 cases with sacral nerve injuries, 7 cases of Gibbons grade II, 3 cases of grade III. The patients' age, operation time, intraoperative blood loss, and Majeed score of the two groups were compared by independent sample t-test; gender, sacral fracture classification, ROY-Camille classification, fracture reduction quality, postoperative wound infection, and sacral nerve recovery were compared by Chi-square test. Results:All patients were followed up for 23.6 months (range, 12-54 months). In the Robot triangular group, the operation time was 95.3±27.5 min (range, 70-180 min), and intraoperative blood loss was 98.7±47.5 ml (range, 50-250 ml). According to Mears and Velyvis imaging evaluation criteria, anatomical reduction was achieved in 6 cases, satisfactory reduction was achieved in 9 cases and unsatisfactory reduction in 1 case. The Majeed score was 85.5±7.7 points. 8 cases of Gibbons grade II sacral nerve injury were recovered to grade I after surgery, 1 case of grade III recovered to grade I, and 1 case recovered to grade II. In the Iliolumbar fixation group, the operation time was 148.6±59.1 min (range, 90-240 min), and intraoperative blood loss was 582.1±244.6 ml (range, 300-1 200 ml). According to Mears and Velyvis imaging evaluation criteria, anatomical reduction was achieved in 7 cases, satisfactory reduction was achieved in 6 case and unsatisfactory in 1 case. The Majeed score was 77.6±7.7 points. 5 of 7 cases of Gibbons grade II sacral nerve injury were recovered to grade I after surgery, and 2 of 3 cases of grade III recovered to grade I. Compared with the Iliolumbar fixation group, the Robot triangular group has shorter operation time ( t=3.23, P<0.05), less bleeding ( t=7.76, P<0.05), and higher postoperative Majeed score ( t=2.83, P<0.05). There are statistical differences in the above indicators significance. Conclusion:For traumatic spinopelvic dissociation, especially fractures involving the lumbosacral junction, those who do not require sacral nerve decompression, Robot-assisted bilateral triangular fixation shows satisfactory clinical outcomes, which is minimally invasive, with fewer postoperative complications.
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Objective:To evaluate the efficacy and safety of perioperative rehabilitation approaches based on the concept of Enhanced Recovery After Surgery (ERAS) for pelvic fractures.Methods:A prospective randomized control trial was conducted to include 114 emergency patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital for surgical treatment of pelvic fractures from June 2019 to December 2020. Of them, 57 were assigned into an intervention group according to a random digits table. They were 42 males and 15 females, aged from 18 to 77 years and subjected to management of pelvic fractures with tentative perioperative ERAS approaches which were adjusted at different stages. The other random 57 patients were assigned into a control group. They were 40 males and 17 females, aged from 17 to 70 years and subjected to management of pelvic fractures with conventional rehabilitation approaches which included postoperative in-hospital consultation and guidance by rehabilitation physicians. The 2 groups were compared in terms of Majeed pelvis scores and Barthel indexes at postoperative 2, 6, 12 and 24 weeks, and visual analogue scale (VAS) pain scores and SF36 scores at postoperative 12 and 24 weeks.Results:A total of 105 patients (55 in the intervention group and 50 in the control group) were completely followed up for 151 to 254 d (mean, 177 d). The 2 groups were comparable due to no significant difference between them in the preoperative general data ( P>0.05). The Majeed scores (44±13, 67±16, 86±14 and 98±7) and Barthel indexes (57±13, 79±16, 95±8 and 100±2) at postoperative 2, 6, 12 and 24 weeks in the intervention group were significantly higher than those in the control group [(35±16, 51±16, 73±14 and 91±12) and (45±19, 67±18, 86±12 and 98±4)] (all P<0.05). At postoperative 12 and 24 weeks, the SF-36 scores (129±15 and 141±6) in the intervention group were significantly higher than those in the control group (114±15 and 131±12) ( P<0.05). There was no significant difference in the pain degree between the 2 groups ( P>0.05). Conclusion:In management of pelvic fractures, compared with conventional perioperative rehabilitation approaches, the perioperative ERAS rehabilitation approaches may improve early functional outcomes and thus help the patients restore their activities of daily living earlier.
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To investigate the effects of ceramide pathway on the inhibition of artesunate (Art) to hepatic fibrosis. LX-2 cells were divided into control group, Art treated group with 350 μmol/L, fumonisin B1 (FB1) treated group with 6 μmol/L, and Co-administration group of artesunate 350 μmol/L and fumonisin B1 6 μmol/L. There were 7 compound holes in each group. After 24 hours of treatment, the cells and supernatant were collected and detected. The expressions of homo sapiens longevity assurance homologue 2 (LASS2), peroxisome proliferators-activated receptors-γ (PPAR-γ) and Caspase-3 were evaluated by Western blot, the content of ceramide was evaluated by HPLC-FLD method, MTT assay was adopted to measure the rate of proliferation of LX-2 cells. The content of hydroxyproline was determined by digestive method. Compared with the control group, the expression of ceramide synthase protein and the ceramide content were increased significantly, the proliferation of LX-2 cells was inhibited significantly, the expressions of PPAR-γ and Caspase-3 protein were up-regulated and the secretion of hydroxyproline was inhibited in Art treated group (P＜0.05). In FB1 treated group, the protein expression of ceramide synthase and the ceramide content were decreased significantly, the proliferation of LX-2 cells was increased significantly, the expressions of PPAR-γ and Caspase-3 protein were down-regulated, and the secretion of hydroxyproline was increased (P＜0.05). Compared with the Art alone group, the combination of the two drugs could significantly reduce the effects of Art on the expression of ceramide synthase protein and the increase of ceramide content, and attenuate the effects of Art on the cell proliferation , PPAR-γ, Caspase-3 protein expression and hydroxyproline level of LX-2 cells (P＜0.05). Artesunate could inhibit hepatic fibrosis by increasing the content of ceramide through the ceramide synthase-ceramide pathway.
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Objective:To explore the efficacy of posterior iliac screw rod for unilateral unstable Denis I and II sacral fractures.Methods:Data of 50 patients with unilateral unstable Denis I, II sacral fractures treated from March 2016 to October 2018 were retrospectively analyzed. According to fixation methods, the patients were divided into posterior iliac screw rod group (Iliac screw rod group) and robot-assisted iliosacral screw group (Iliosacral screw group). There were 20 patients in the Iliac screw rod group, 13 males and 7 females, with an average age of 41.10±14.07 years (range, 22-76 years), and there were 5 cases of Denis type I and 15 cases of type II sacral fractures. All of them had anterior pelvic ring injuries, and according to pelvic Tile classification, there were 2 B1 type, 12 B2 type, 6 C1 type, and 3 cases of Gibbons grade II sacral nerve injuries. There were 30 patients in the Iliosacral screw group, 18 males and 12 females, with an average age of 44.70±13.35 years (range,16-78 years), and there were 6 cases of type I and 24 cases of type II sacral fractures. There were 2 cases of type B1, 20 cases of B2, 8 cases of C1 pelvic fractures, 4 cases combined with sacral nerve injuries including 3 cases of Gibbons grade II and 1 case of grade III. The patients’ age, operation time, amount of bleeding, times of fluoroscopy, postoperative Majeed score were compared by the independent t test. The quality of fracture reduction was compared by Chi-square test, and the postoperative Gibbons grade was compared by the rank sum test.Results:All patients were followed up for 22.8 months (range, 12-40 months). In the Iliac screw rod group, the operation time was 41.40±7.30 min, intraoperative blood loss 105.00±61.94 ml, intraoperative times of fluoroscopy 19.10±7.33, and according to Mears and Velyvis valuation criterion, there were 9 cases of anatomical reduction, 10 cases of satisfactory reduction, and 1 case of unsatisfactory reduction, with the Majeed score of 84.25±8.29. There were 3 cases with Gibbons grade II sacral nerve injury, and 2 of them recovered to grade I. In the Iliosacral screw group, the operation time was 18.27±5.89 min, intraoperative blood loss 33.00±17.54 ml, intraoperative times of fluoroscopy 14.93±4.49, and according to Mears and Velyvis valuation criterion, there were 15 cases of anatomical reduction, 13 cases of satisfactory reduction and 2 cases of unsatisfactory reduction, with the Majeed score of 86.43±7.43. There were 3 cases with Gibbons grade II sacral nerve injury, and 2 of them recovered to grade I, and 1 case with grade III recovered to grade II postoperation. Compared to Iliosacral screw group, the Iliac screw rod group has longer operation time ( t=-12.36, P<0.001), more blood loss ( t=-6.04, P<0.001) and more intraoperative times of fluoroscopy ( t=-2.50, P=0.016). There were no statistical differences for quality of fracture reduction ( χ2=0.23, P=0.89), Majeed score ( t=0.97, P=0.34), and the Gibbons grade ( Z=-0.224, P=0.82) between the two groups. In the Iliac screw rod group, 1 patient had a unilateral superficial wound infection and 1 patient complained of discomfort because of the nail. In the Iliosacral screw group 1 patient had iatrogenic S 1 neurological injury. Conclusion:For the unstable sacral fractures, who are not suitable for iliosacral screw fixation, posterior iliac screw rod fixation is an effective alternative with similar clinical effect as robot assisted iliosacral screw fixation.
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Objective:To compare the clinical outcomes between minimal-invasive triangular fixation with orthopedic robot and traditional open fixation method for unilateral unstable sacral fracture patients.Methods:Data of 24 consecutive patients with unilateral unstable sacral fracture who were treated from August 2014 to February 2018 were retrospectively analyzed. All patients were associated with anterior ring injuries of pelvis and received magnetic resonance of nerve (MRN) preoperatively to exclude the compression of sacral nerve by bone. All patients received surgical treatment of sacral fractures with triangular fixation and the fixation of pelvic anterior ring injuries simultaneously and two groups were divided according to the different surgical methods of sacral fractures. There were 10 males and 2 females with an average age of 36.3±1.2 years in the orthopaedic robot group. According to Dennis classification, there were 4 type I and 8 type II fractures. Two patients were associated with nerve injuries (Gibbons II 1 case, III 1 case). In traditional posterior-midline open fixation group, there were 11 males and 1 female with an average age of 38.2±1.6 years. According to Dennis classification, there were 3 type I and 9 type II fractures. Three patients were associated with nerve injuries (Gibbons II 2 cases, III 1 case). The clinical data of two group patients were collected and compared statistically. T test was used to compare the operation time, intraoperative bleeding, intraoperative fluoroscopy times, Majeed function assessment which was to evaluate the patients' clinical prognosis and healing time of fracture. χ2 test was used to compare the healing rate of fracture, accuracy assessment of fixation insertion, and Mears radiological assessment which was applied to evaluate the reduction quality of fractures. The rank sum test was used to compare Gibbons score which was applied as the index of neurological deficiency recovery. The Fisher exact test was used to compare the infection rate. Results:All patients were followed up continuously for an average time of 21.2±3.2 months. The average operation time of robot group was 100.3±14.5 minutes, meanwhile the open fixation group was 202.0±18.5 min. The average intraoperative bleeding of robot group was 180.0±17.4 ml, meanwhile the open fixation group was 850.0±15.2 ml. The average intraoperative fluoroscopy time of robot group was 23.3±4.5 s, meanwhile the open fixation group was 90.0±7.7 s. All fractures were healed and no loss of reduction or fail of fixation occurred in both groups. The healing time of fracture of robot group was 8.5±1.9 months, meanwhile the open fixation group was 12.8±2.4 months. The satisfaction rates of reduction which was based on Mears-Velyvis radiological criterion of both groups were 91.7%. The accuracy rate of fixation insertion of robot group was 100% meanwhile the open fixation group was 77.78%. Majeed function assessment score of robot group was 86.2±3.4, meanwhile the open fixation group was 84.2±2.7. There was no infection occurred in robot group, meanwhile 3 patients infected in open fixation group. The Gibbons score of one patient changed from II preoperative to I postoperative and one case changed from III preoperative to II postoperative in robot group, meanwhile two patients changed from II preoperative to I postoperative and one case changed from III preoperative to II postoperative in open fixation group. The healing rate of fracture, infection rate, Majeed function assessment, Mears-Velyvis radiological evaluation criterion and Gibbons score of two groups had no significant statistical difference ( P >0.05), meanwhile the operation time ( t=14.99), intraoperative bleeding ( t=100.46), intraoperative fluoroscopy time ( t=32.13), healing time of fracture ( t=4.87) and accuracy rate of fixation insertion ( χ2=9.00) of orthopedic robot group were better than traditional open group and had the significant difference ( P< 0.05). Conclusion:The minimal-invasive triangular fixation with orthopedic robot for unilateral unstable sacral fracture had the advantages of less operation time, less intraoperative bleeding and less times of fluoroscopy, more accurate of fixation insertion and less healing time of sacral fractures compared to traditional open fixation method and should be recommended as an effective and advanced choice.
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Objective@#To explore the treatment outcome of triangular osteosynthesis (TOS) for the treatment of unilateral Isler type II lumbosacral junction injuries (LSJIs).@*Methods@#Data of sixteen patients with unilateral Isler type II LSJIs surgically who were treated in our Hospital from March 2015 to February 2017 were retrospectively analyzed. There were 13 males and 3 females with an average age of 35.5 years (range, 24-61 years). Seven patients were multiple injuries including head, thoracic, musculoskeletal and nerve injuries. According to Isler classification of LSJIs, there were 5 cases of type IIa, 9 of type IIb and 2 of type IIc. All the LSJIs combined with ipsilateral sacral fractures. The sacral fractures were classified by Denis classification with 1 case of zone I, 13 cases of zone II and 2 cases of zone III. According to Tile classification of pelvic fractures, there were 3 cases of type B2, 11 of type C1 and 2 of type C3. There were 3 cases combined with sacral nerve injury among which there were 2 cases of grade II and 1 case of grade III according to Gibbons classification of neurologic deficits. All cases were surgically treated with triangular osteosynthesis. There were 14 cases combined with iliosacral screws fixation in S1 and 2 cases combined with posterior locking plates.@*Results@#All patients were followed up for 20.6 months (range, 16-30 months). CT scan was conducted 12 to 24 months after surgery which showed all the sacral fractures were union, and 2 cases achieved bony fusion in L5S1 facets while the other 14 didn’t. According to Majeed’s pelvic injury evaluation, clinical outcomes were rated with excellent in 12 cases, good in 2 cases, fair in 2 cases. The excellent and good rate was 87.5% (14/16) . According to Mears-Velyvis evaluation criterion, there were 14 cases with anatomical reduction and 2 cases with satisfactory reduction. Among the 3 cases with sacral nerve injury, 2 cases were improved from Gibbons grade II to grade I and the other 1 case was improved from Gibbons grade III to grade II, still feeling numbness on the lateral foot. There were no intraoperative complications in all patients such as neurovascular injuries. No incision infection, fat liquefaction and other incision related complications occurred postoperatively. Irritation and pain in iliac spine about prominent implant occurred in 1 case and lumboscaral stiffness in 1 case, in which the symptom relieved and disappeared after implants removal.@*Conclusion@#Triangular osteosynthesis can provide enough stabilization for Isler type II LSJIs and achieve satisfactory outcomes.
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Objective@#To compare the differentially expressed proteins in mice with kidney-yang deficiency and those with kidney-yin deficiency induced by hydrocortisone, and explore the similar and different material bases of male infertility caused by the two types of kidney deficiency.@*METHODS@#Thirty Kunming mice were equally randomized into a normal control, a kidney-yang deficiency and a kidney-yin deficiency group. The animals of the normal control group were injected intraperitoneally with normal saline at 0.2 ml qd for 7 days, while those of the latter two groups with hydrocortisone at 25 mg/kg/d for 10 days and 50 mg/kg/d for 7 days, respectively, for establishment of kidney-yang deficiency and kidney-yin deficiency models. Then the pathological changes in the testicular tissue of the mice were observed by HE staining and the differentially expressed proteins were compared among different groups using isobaric tags for relative and absolute quantitation (iTRAQ) and the bioinformatics method.@*RESULTS@#Sod1 was found to be a reproduction-related node protein differentially expressed in the testis tissues of the two types of kidney-deficiency mice, more highly expressed in the kidney-yin than in the kidney-yang deficiency group (P < 0.05). Five reproduction-associated node proteins were co-expressed in the testes of the two groups of kidney-deficiency mice, with significantly up-regulated expression of Rps28 and down-regulated expressions of Rpl11, Rplp2, Svs2 and Svs3a (P < 0.01).@*CONCLUSIONS@#Sod1 may be one of the key material bases for the differentiation of male infertility caused by kidney-yang deficiency from that induced by kidney-yin deficiency, while Rps28, Rpl11, Rplp2, Svs2 and Svs3a may be the common material bases of male infertility caused by the two types of kidney deficiency.
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Objective To explore the treatment outcome of triangular osteosynthesis (TOS) for the treatment of unilateral Isler type II lumbosacral junction injuries (LSJIs). Methods Data of sixteen patients with unilateral Isler type II LSJIs surgically who were treated in our Hospital from March 2015 to February 2017 were retrospectively analyzed. There were 13 males and 3 fe?males with an average age of 35.5 years (range, 24-61 years). Seven patients were multiple injuries including head, thoracic, mus?culoskeletal and nerve injuries. According to Isler classification of LSJIs, there were 5 cases of type IIa, 9 of type IIb and 2 of type IIc. All the LSJIs combined with ipsilateral sacral fractures. The sacral fractures were classified by Denis classification with 1 case of zone I, 13 cases of zone II and 2 cases of zone III. According to Tile classification of pelvic fractures, there were 3 cases of type B2, 11 of type C1 and 2 of type C3. There were 3 cases combined with sacral nerve injury among which there were 2 cases of grade II and 1 case of grade III according to Gibbons classification of neurologic deficits. All cases were surgically treated with triangular osteosynthesis. There were 14 cases combined with iliosacral screws fixation in S1 and 2 cases combined with posterior locking plates. Results All patients were followed up for 20.6 months (range, 16-30 months). CT scan was conducted 12 to 24 months af?ter surgery which showed all the sacral fractures were union, and 2 cases achieved bony fusion in L5S1 facets while the other 14 didn’t. According to Majeed’s pelvic injury evaluation, clinical outcomes were rated with excellent in 12 cases, good in 2 cases, fair in 2 cases. The excellent and good rate was 87.5%(14/16). According to Mears?Velyvis evaluation criterion, there were 14 cas?es with anatomical reduction and 2 cases with satisfactory reduction. Among the 3 cases with sacral nerve injury, 2 cases were im?proved from Gibbons grade II to grade I and the other 1 case was improved from Gibbons grade III to grade II, still feeling numb?ness on the lateral foot. There were no intraoperative complications in all patients such as neurovascular injuries. No incision infec?tion, fat liquefaction and other incision related complications occurred postoperatively. Irritation and pain in iliac spine about prominent implant occurred in 1 case and lumboscaral stiffness in 1 case, in which the symptom relieved and disappeared after im? plants removal. Conclusion Triangular osteosynthesis can provide enough stabilization for Isler type II LSJIs and achieve satis?factory outcomes.
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Objective To explore the effect of blended teaching model based on "Rain Class" in general practitioner training.Methods Random sampling method was adopted in which totally 132 general practitioners were divided into two groups,66 in experimental group,66 in the control group.Blended teaching method and traditional teaching method was implemented in the experimental group and the control group,respectively.At the end of the course,unified examination questions were used to evaluate the teaching effect,and questionnaires were used to investigate the students' evaluation of the "rain classroom" teaching method.Results The final exam score of experimental group was significantly higher than that of control group [(82.95 ± 12.86) vs.(60.45 ± 18.91),P=0.000].Further stratification analysis was conducted according to educational background,and the average score of low education group in the observation group was significantly higher than that of high education group [(88.06 ± 9.12) vs.(49.66 ± 13.88),P=0.000].55.3％ of the general practitioners in experimental group were very satisfied with "Rain Class" teaching,34.8％ satisfied,and only 9.9％ of the general practitioners were dissatisfied.Conclusion Blended teaching model could help to promote the exchange and interaction between students and teachers and improve learning efficiency and clinical ability.
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There haven't been an uniform criterion for the treatment of posterolateral tibial plateau fracture till now.For this type of fractures,surgical approaches are divided into two main parts,non-osteotomy approach and osteotomy approach.The non-osteotomy approach includes posterolateral approach,anterolateral approach,lateral approach,posteromedial approach and posterior approach.Each of them includes advantage and disadvantage.Posterolateral approach is the most effective exposure of posterolateral tibial plateau fracture.Satisfactory reduction and buttress fixation could be achieved under direct view.Posterolateral tibial plateau fracture could also be exposed from the gap between fibular head and posterolateral tibial plateau via anterolateral approach,but the raft plate should be placed backwardly to achieve the best fixation result.With a single lateral incision of the tibial plateau,the anterolateral and posterolateral plateau fragments could be fixed simultaneously through the anterolateral and posterolateral interval of the deep tissue.The anatomy of the posteromedial approach is simpler,however,it's difficult to view all the comminuted fragments of the posterolateral tibial plateau.The injury risk of popliteal blood vessels and nerves is relatively high,therefore it's rarely used right now.The osteotomy approach includes fibular head,lateral femoral epicondyle and tibial Gerdy tuberosity osteotomy.The osteotomy approaches of lateral femoral epicondyle and tibial Gerdy tuberosity are usually used in the cases associated with the anterolateral approach of the knee.The best view of the posterolateral tibial plateau could be obtained via the fibular head osteotomy approach.But the extra damage is too severe to recommend routinely.On the other hand,there are several fixation options when posterolateral tibial plateau fractures are treated.The buttress plate was verified to be the best fixation method and the rim plating provided a novel idea for this fracture pattern.The fibular support is a reliable method for posterolateral compression fracture as well.We will summarize the selection of surgical approaches and internal fixation methods to provide a reference for the clinical doctors.
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There haven't been an uniform criterion for the treatment of posterolateral tibial plateau fracture till now.For this type of fractures,surgical approaches are divided into two main parts,non-osteotomy approach and osteotomy approach.The non-osteotomy approach includes posterolateral approach,anterolateral approach,lateral approach,posteromedial approach and posterior approach.Each of them includes advantage and disadvantage.Posterolateral approach is the most effective exposure of posterolateral tibial plateau fracture.Satisfactory reduction and buttress fixation could be achieved under direct view.Posterolateral tibial plateau fracture could also be exposed from the gap between fibular head and posterolateral tibial plateau via anterolateral approach,but the raft plate should be placed backwardly to achieve the best fixation result.With a single lateral incision of the tibial plateau,the anterolateral and posterolateral plateau fragments could be fixed simultaneously through the anterolateral and posterolateral interval of the deep tissue.The anatomy of the posteromedial approach is simpler,however,it's difficult to view all the comminuted fragments of the posterolateral tibial plateau.The injury risk of popliteal blood vessels and nerves is relatively high,therefore it's rarely used right now.The osteotomy approach includes fibular head,lateral femoral epicondyle and tibial Gerdy tuberosity osteotomy.The osteotomy approaches of lateral femoral epicondyle and tibial Gerdy tuberosity are usually used in the cases associated with the anterolateral approach of the knee.The best view of the posterolateral tibial plateau could be obtained via the fibular head osteotomy approach.But the extra damage is too severe to recommend routinely.On the other hand,there are several fixation options when posterolateral tibial plateau fractures are treated.The buttress plate was verified to be the best fixation method and the rim plating provided a novel idea for this fracture pattern.The fibular support is a reliable method for posterolateral compression fracture as well.We will summarize the selection of surgical approaches and internal fixation methods to provide a reference for the clinical doctors.
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OBJECTIVE@#To investigate the protective effect and underlying mechanism(s) of icariin (ICA) in preventing hydrogen peroxide (HO)-induced vascular endothelial cell injury via endoplasmic reticulum stress (ERS).@*METHODS@#To study the effects of ICA on HO-induced damage, we used the cell counting kit-8 assay to detect cell viability and the terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay to determine cell adhesion and apoptosis, respectively. Spectrophotometry and enzyme-linked immunosorbent assay were used to measure the expression levels of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). Subsequently, glucose-regulated protein 78 (GRP78), activating transcription factor-4 (ATF4) and eukaryotic initiation factor-2α (eIF2α) were detected using Western blotting.@*RESULTS@#In human umbilical vein endothelial cells, different concentrations of ICA exhibited multiple effects, including reduced HO damage, improved cell viability and adhesion, reduced cell apoptosis and increased SOD and GSH-Px activity. Among the ICA concentrations used, only the HO + 100 μmol/L ICA group had significant differences compared to the HO group. ERS activators HO and dl-dithiothreitol (DTT) significantly increased GRP78, ATF4 and eIF2α expressions, decreased cell activity and reduced SOD and GSH-Px activity. In contrast, the HO + 100 μmol/L ICA and HO + 100 μmol/L ICA + DTT groups had significant inhibitory effects on the expressions of GRP78, ATF4 and eIF2α proteins, showing enhanced cell viability and SOD and GSH-Px activity.@*CONCLUSION@#The results showed the dose-dependent effects of ICA against HO-induced injury in vascular endothelial cells. The inhibition of GRP78, ATF4 and eIF2α protein expressions in the ERS, and the subsequent alleviation of oxidative stress damage, might be the molecular mechanism.
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Objective To evaluate the association between vitamin D (VD) and vascular endothelial injury in hypertensive patients.Methods Ninety nine patients with hypertension and 126 healthy subjects (control group) from the same community in Nanjing were recruited in the study.The serum levels of fasting blood glucose (GLU),total cholesterol (TC),low-density lipoprotein cholesterol (LDL-C),high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were measured.Serum 25-hydroxy vitamin D (25-OH-D) and nitric oxide (NO) levels were determined by enzyme-linked immunosorbent assay.The level of plasma endothelial microparticles was measured by flow cytometry.The data were statistically analyzed with SPSS version 19.O.Results The serum 25-(OH)-D [(55.22 ± 11.92) nmol/L vs.(64.17 ± 21.52) nmol/L,t =-3.71],vitamin D binding protein (VDBP) [(257.32 ±141.31) ng/mlvs.(314.21±124.13) ng/ml,t=-3.21],NO levels [(39.35±13.33)μmol/L vs.(43.42 ± 11.83) μmol/L,t =-2.42] in hypertension group were significantly lower than those in control group.And the circulating endothelial cell particles (4.95 ± 1.78 vs.2.84 ± 2.07,t =8.05) in hypertension group was significantly higher than that in control group.In hypertensive patients,the circulating endothelial cell particles in VD deficiency group was significantly higher than that in low VD group and normal VD group [(6.42 ± 1.25)％ vs.(4.6 ± 1.68)％,(3.15 ±0.90)％,F =15.08].And the serum NO level in VD deficiency group was significantly lower than that in other two groups [(36.57 ± 10.52) μmol/L vs.(39.77 ± 13.01) μmol/L,(46.26 ± 25.90) mol/L,F =1.20].Multiple linear regression analysis showed that low serum 25 (OH) D(B =-0.189,SE =0.033,β =0.509,t =-5.72) and gender (B =-0.682,SE =0.351,β =-0.182,t =-2.054) were the risk factors of vascular endothelial injury.Conclusion The serum vitamin D levels in hypertensive patients is decreased,and vitamin D deficiency may be a risk factor for endothelial injury in hypertension.
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Objective To investigate the indication of approach,type of fixation and the clinical outcome of minimally invasive internal fixation for treatment of pelvic anterior ring injury.Methods From January 2012 to August 2016,data of 32 patients with 44 pelvic anterior ring injuries who had been treated with minimally invasive internal fixation were retrospectively analyzed.There were 22 males and 10 females with an average age of 38.2 years old (range,20-65 years).14 patients were injured by traffic accident,12 patients by falling and 6 patients by crush injury.There were 4 cases of pubic symphysis diastasis,27 fractures of anterior ring which included 12 billatral fractures and 1 combined vertical displacement of pubic symphysis associated with pubic fracture.According to AO classification,there were 3 cases in A2.3,3 cases in B1.2,4 cases in B2.2,4 cases in B2.3,2cases in C1.1,1 case in C1.2,5 cases in C1.3,4 cases in C2,6 cases in C3.There were 25 patients associated with other injuries,including brain injury in 2,thoracic injury in 17,abdominal injury in 8,urogenital system injury in 5,lumbosacral nerve plexus injury in 4 and the extremity or lumbar fracture in 19.The average period from injury to operation was 9.2 d (range,5-32 d).4 patients who had the pubic symphysis diastasis,3 had pelvic anterior ring fracture medial obturator foramen and 1 combined vertical displacement of pubic symphysis associated with pubic fracture were reduced by modified Pfannenstiel incision and fixed with cannulated screws,while 36 patients with fractures of lateral obturator foramen were reduced by modified Pfannenstiel incision associated with small ilial crest incision and fixed with locking reconstruction plates,and 25 patients received the fixation of pelvic posterior ring injury simultaneously.Results The average time of operation was 44.5 min (range,30-65 min),and the average amount of blood loss intraoperative was 56.2 ml (range,20-150 ml).All patients were followed up successfully,with an average time of 28.2 months (range,16-42 months).All the fractures were healed with an average time of 4.5 months (range,3-9 months).According to Matta standard of reduction assessment,30 fractures' reduction were excellent,12 were good and 2 were fair,which the rate of satisfaction was 95.5％ (42/44).Neither reduction loss or fixation failure nor infection occurred,and the occurrence rate of complication was 9.1％ (4/44),including one patient with fatal liquefaction and was cured 3 weeks after wound dressing,one patient with lateral femoral cutaneous nerve injury who was cured within 3 months by oral drug and 2 patients who complained discomfort of inguinal area because of the fixation prominence and were lessened by physical therapy.Conclusion Minimally invasive internal fixation can be recommended for treatment of pelvic anterior ring injury because of the advantages of less damage,safer manipulation,less complications and good prognosis.