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Cancer stem cells (CSCs) are a group of tumor cells with the potential for self-replication, multicellular differentiation, and therapeutic resistance—factors which contribute to tumor recurrence, distant metastasis, and the failure of tumor treatment. Mitochondrial homeostasis plays a key role in stemness maintenance and differentiation regulation of CSCs. Mitophagy or selective autophagy of mitochondria, is an important regulatory mechanism for the maintenance of mitochondrial homeostasis. However, the role of mitophagy in CSCs is controversial. Considering that mitophagy regulates mitochondrial quality control, it was originally thought to positively regulate tumor suppression and maintain intracellular homeostasis. However, in recent years, mitophagy has been reported to be involved in reducing oxidative stress damage of tumor cells and promoting tumor progression. Further research on the mechanism of mitophagy regulation can reveal new therapeutic targets for tumor treatment. In this review, we have focused on the role of mitophagy in stemness maintenance, metabolic transformation, and therapeutic resistance of CSCs.
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Objective To evaluate the clinical effect of mini-plate internal fixation via anterior elbow approach in treating coronoid process fractures.Methods A retrospective case series study was conducted on the clinical data of 43 cases of ulnar coronoid process fractures treated from December 2014 to December 2016.There were 29 males and 14 females,with an average age of 32.4 years (range,24-64 years).Twenty-four cases were injured on the right,and 19 on the left.There were 18 cases of simple coronoid process fractures,23 combined with ipsilateral capitulum radius fractures,and two combined with ipsilateral ulna olecranon fractures.According to the O'Driscoll classification,there were four cases of type Ⅰ,3 type Ⅱa,9 type Ⅱb,17 type Ⅱc,6 type Ⅲa,and 4 type Ⅲb.The elbow flexion and extension range was 40°-90°[(64 ± 18)°],and the rotation range 60°-130°[(83 ± 15)°].All the patients underwent mini-plate internal fixation via anterior elbow approach.The operation time,intraoperative blood loss,wound healing,fracture healing,and postoperative complications were recorded.Function of elbow joint was evaluated by Mayo elbow performance score (MEPS).Results All patients were followed up for 12-24 months (mean,15.7 months).The average operation time was 52 minutes (range,36-86 minutes).The average blood loss was 20 ml (range,10-50 ml).At the last follow-up,all were seen incision healing by first intention and clinical fracture healing.The index finger,and middle finger palmaris numbness occurred in one patient after surgery,and the patient recovered at 2 months of follow up.The elbow flexion and extension range was 86°-145° [(117 ± 114) °],and the rotation range of 114°-155° [(132 ± 17) °],showing significant difference in comparison with the preoperative measure (P ＜ 0.05).According to the MEPS one year after operation,14 cases were evaluated excellent,27 good,and four fair,with an excellent and good rate of 91％.Conclusion The mini-plate internal fixation via the anterior elbow approach is effective in treating ulnar coronoid process fractures,for the operation is simple,allows full exposure,reduction,or reconstruction under direct vision,and effectively restores the function of the elbow joint.
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Objective To investigate application of modified isosceles triangle osteotomy which is designed with the assistance of Picture Archiving and Communication System ( PACS ) in supracondylar surgery for cubitus varus. Methods We reviewed the 31 patients who had been treated for cubitus varus from January 2012 to July 2017. They were 12 males and 19 females, aged from 17 to 24 years ( average, 20. 6 years) . Their elbow varus angles ranged from 14° to 35° (average, 22. 4°) . Preoperatively, the modified isosceles triangle osteotomy was designed using the PACS. The angle of osteotomy = carrying angle of the normal arm + the angle of cubitus varus. The lateral length of the isosceles triangle osteotomy was calculated according to the osteotomy angle. All the cases were fixated with a locking plate. Results The follow-ups lasted from 12 to 40 months ( average, 16 months ) . Bony union was achieved in the osteotomy site by all cases after 7 to 12 weeks ( average, 9 weeks ) . The carrying angles ranged from 8° to 15° ( average, 11°) at final follow-ups. The affected elbow obtained a range of flexion and extension from 126° to 150° ( average, 139°) and a range of rotation from 134° to 160° ( 144°) . According to the Mayo elbow performance score ( MEPS ) one year after operation, 23 cases were rated as excellent, 7 as good and one as fair, yielding an excellent to good rate of 96. 8％. No loss of carrying angle, neural deficit, malunion, delayed union, or myositis ossifi-cans of the elbow was observed during the follow-ups. Conclusion The PACS can be used in preoperative design of the modified isosceles triangle osteotomy for cubitus varus, leading to accuracy in the angle and length of the osteotomy to guarantee fine clinical results.
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Objective To summarize the characteristics of deltoid ligament rupture and explore the feasibility and shortterm clinical outcomes of targeted suture anchor repair technique according to the rupture site.Methods From May 2011 to October 2014,19 cases of complete deltoid ligament rupture (17 males and 2 females) were recruited in this study,with an average age of 34.15± 1.23 years (ranged from 15 to 60 years).According to Lauge-Hansen classification,there were 7 cases of pronation external rotation grade ⅣV injury,including 3 cases of Maisonnuve fracture;1 case of pronation abduction type Ⅲ degree injury,1 case of pronation abduction grade ⅣV injury;and 10 cases of supination external rotation grade ⅣV injury.According to AO / OTA classification,there were 9 cases of 43B type injury and 10 cases of 43C type injury.According to the rupture site of deltoid ligament,the targeted suture anchor repair surgery was operated respectively.Early mobilization with the help of hinged ankle brace was encouraged.The evaluation at last follow-up was based on the American Orthopedic and Ankle Association (AOFAS) criteria of ankle and hindfoot,and the visual analogue scale (VAS) scoring system.Results Nineteen patients were all followed up for 24 to 48 months,with an average of 30.42±5.11 months.Fourteen cases (73.7％,14/19) with talus end avulsion were treated by double suture anchor in the talus,with continuous locking suture of the avulsed end.Four cases (21.1％,4/19) with middle part rupture were treated by double suture anchor in the talus,with the sutures crossing three bone tunnels at the medial malleolus.One case (5.3％,1/19) with medial malleolus end avulsion was treated by single suture anchor at the medial malleolus,with continuous locking suture of the avulsed end.At the last follow-up,the AOFAS score was ranged from 70 points to 96 points,with an average of 90.53 points,and excellent in 16 cases,good in 2 cases,fair in 1 case,excellent and good rate was 94.7％.The VAS score was ranged from 0 to 2 points,with an average of 0.42 point.No wide medical clear space was detected.But traumatic arthritis was happened in 2 patients.Conclusion The targeted suture anchor repair technique according to the rupture site was a save technique in treating deltoid ligament rupture,which is conducive to early postoperative functional exercise,with excellent short-term clinical outcomes and few complications.
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Objective To evaluate the efficacy of anatomical locking titanium plate via the posterior elbow approach in the treatment of comminuted fractures of proximal ulna.Methods From January 2011 to December 2013,22 comminuted fractures of proximal ulna were treated by anatomical locking titanium plate via the posterior elbow approach.They were 14 men and 8 women,from 21 to 57 years of age (average,42.7 years).Nine cases were on the left side and 13 on the right.All were unilateral closed fractures.By the Schatzker classification,12 cases were type Ⅲ A,6 type Ⅲ C and 4 a combination of type Ⅲ A and type Ⅲ C.The Broberg & Morrey criteria were used to evaluate the elbow function one year postoperation.Results The follow-ups for the 22 cases ranged from 12 to 24 months (average,16 months).All the cases obtained clinical healing after 10 to 16 weeks (average,13 weeks).According to the Broberg & Morrey criteria,12 cases were evaluated as excellent,7 as good,and 3 as fair,yielding an excellent to good rate of 86.4％.No such complications as infection or necrosis of soft tissues,elbow stiffness,or obvious pain were observed during the follow-up period.Conclusion It is an effective treatment of comminuted fractures of proximal ulna with anatomical locking titanium plate through the posterior elbow approach.
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Objective To explore the clinical efficacy of PRGD composite nerve conduit in the treatment of human large-diameter,critical peripheral nerve defect in upper extremity.Methods From December,2011 to August,2014,19 patients with large-diameter,critical peripheral nerve defect in upper extremity were treated with PRGD composite nerve conduit.The patients were followeded-up periodically.The sensory and motor function recovery,high frequency ultrasound,and EMG were employed to assess the efficacy.Results The patients were followed up for an average time of 12-32 months(mean 21.75 ± 6.86 months),sensory and motor function recovered excellent in 7 patients,satisfactory in 7 patients,tolerable in 3 patients and no improvement in 2 patients were obtained according to the peripheral nerve function assessment standard built by British medical research council,the rate excellent and satisfactory results was 73.7％.Conclusion It is clinically promising to use PRGD composite nerve conduit to repair large-diameter,critical peripheral nerve defect in upper extremity,thus laying a foundation for its further application in clinical practice.
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BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) can be induced to differentiate into neuron-like cells directional y. Accordingly, BMSCs can be used as seed cells theoretical y in constructing tissue-engineered peripheral nerves. OBJECTIVE:Using combination of two cytokines to induce BMSCs differentiating into neuron-like cells directional y, and further to discusse its application in peripheral nerve injury. METHODS:BMSCs were isolated and purificated from the bone marrow of Wistar rats by using the differential adherence method. Basic fibroblast growth factor and epidermal growth factor were used to induce the BMSCs differentiating into neuron-like cells. The morphological change was observed and the neuronal specific markers were detected by immunohistochemistry technique. The morphological and immunohistological changes were also studied after the induce agent were removed. RESULTS AND CONCLUSION:With presence of morphological and immunohistochemical features of nerve cells induced by neurotrophic factors, BMSCs exhibited two or more processes that were interconnected as a meshwork;cellnucleus and nucleus could be observed with strong light refraction of cytoplasm. After immunohistochemical staining, neuroln specific enolase, neurofilament protein and synaptophysin protein positive cells were detected. A great amount of cells reversed to their original fibroblast-like morphology, and the expression of the three above-mentioned proteins decreased as the induce agent withdrawn. Our study showed that BMSCs can be induced to differentiate into neuron-like cells, but the transdifferentiation is a short-time reversible phenomenon.
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BACKGROUND: Chinese anatomical parameters of antedor atlantoaxial transarticular screw fixation have been rarely reported although the technique is a novel method out of China for patients with C1-C2 instability. OBJECTIVE: To provide Chinese anatomical data for anterior C1-C2 transarticular screw fixation. DESIGN, TIME AND SETTING: A measurement experiment was performed at the Department of Anatomy, Southern Medical University and Department of Orthopedics, Wuhan General Hospital, Guangzhou Command of Chinese PLA between September 2006 and April 2008. MATERIALS: A total of 50 sets of dried Chinese adult human C1 and C2 specimens, without regard to gender and age, but no abnormality and breakage, were measured with an electronic digital caliper (precision 0.01 mm) and a goniometer(precision 0.5°) made in China. METHODS: One proper screw was drilled through the atlantoaxial joint respectively in the direction to middle part of laterosuperior angle in the posterior of C1 lateral mass, and the screw point should not break through the superior facet articularsurface of the C1. In the procedure, the screw drilling point was at the junction of the lateral border of C2 body to 4 mm above the inferior border of C2 anterior arch. border of transverse foramen of C2 body and the median line of C2 body, and the distance between the inserting point and the medial border of transverse foramen of C2 body. RESULTS: The data from all specimens were involved in the result analysis. In the sagittal plane, the minimum lateral angulation of the screw tract was (10.80±2.10)°(left) and (10.76±2.40)°(right) respectively, and the maximum lateral angulation was (25.13±3.12)°(left) and (25.12±2.86)°(right), respectively. In the coronal plane, the minimum posterior angulation was (8.85±2.12)° (left) and (9.28±2.65)° (right) respectively, and the maximum posterior angulation was (26.96±3.09)°(left) and (27.49±2.51)°(right), respectively. The left screw tract length was from (17.48±2.10) mm to (25.41±2.59) ram, and the right was from (17.49±2.23) mm to (25.58±2.42) mm. The left distance between the inserting point and the median line of C2 body was (9.84±0.69) mm, and the right was (9.81±0.66) mm. The left distance between the median line of C2 body and medial border of transverse foramen of C2 body was (14.12±1.28) mm, and the right was (14.60±1.36) mm. The left distance between the inserting point and medial border of transverse foramen of C2 body was (6.28±1.38) mm, and the right was (6.79±1.39) mm. CONCLUSION: It is optimal for the anterior C1-C2 transarticular screw fixation to place the antedor screw with a length of 17 to 25 mm in lateral angulation ranging from 10° to 25° and the posterior angulation ranging from 9° to 27°. During the procedure, the dissecting distance from the middle of C2 body to lateral should not exceed 14 mm.
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[Objective]To explore the techniques and effect of atlantoaxial instability with posterior transarticular screw fixation.[Method]A prospective clinical analysis was performed for the results of the modified posterior C1、2 transarticular screw fixation,in which the middle site of lower margin in the axial inferior articular process was used as the screw entry point in the procedure.Twenty cases of atlantoaxial instability underwent the modified C1、2 stabilization with morselized autograft from September 2001 to September 2006.There were 15 males and 5 females,averaged 32.2 years(range 17 to 49 years).Of them,4 cases suffered from fresh injuries,14 from old trauma,1 from congenital deformity,and 1 from intraspinal tumor.Postoperative indexes including the reduction extent of vertebral body,internal fixation,bone fusion,clinical symptoms and their complication were observed periodically.[Result]Bilateral screw fixation was used alone in 17 cases,with Gallie interspinous wiring for added stability in 3.Anatomical reduction of the atlantoaxial joints was achieved in19 cases,while rotational dislocation was restored to a great extent in 1.Fixation of all the internal devices was very well in the group.All cases were followed up from 16 to 64 months(21 months on average).C1、2 bony fusion was obtained in postoperative 2 to 3 months,clinical symptoms relieved and no complications occurred.[Conclusion]The modified posterior transarticular screw fixation using new screw entry site is recommended as an effective treatment for C1、2 instability due to its simple procedure and satisfying curative effect.
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0.05). Removal of two thirds or the entire horizontal portion of the TFCC caused a statistically significant difference in the percentage of force transmitted through the ulna compared with the intact force data (t=3.4,P
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Objective To investigate complications and mortality of primary reamed intramedullary nailing for femoral shaft fractures in patients a ssociated with thoracic injuries. Methods A retrospective a nalysis of trauma data was performed and the case selection based on the followi ng criteria: (1) patient age of 17-65 years, (2) patients with multiple injury ( ISS≥16) as well as complicated thoracic trauma (AIS≥2), (3) hospitalization stay ≥48 hours, (4)no serious pre-existing medical diseases in history, (5) as sociated femoral shaft fractures treated with reamed intramedullary nailing, ext ernal fixation, plate, cast, traction and unreamed intramedullary nailing. The s elected patients were divided into two groups according to the interval from inj ury to operation, ie, those within 24 hours as Group A and beyond 24 hours as Gr oup B. Results During the study period, 96 patients met the criteria for the investigation. There were 57 patients in the Group A and 39 pa tients in the Group B. In two groups, there was significant difference in incide nce of open femoral shaft fractures (53% in the Group A and 31% in the Group B, ? 2=4.496, P