Diagnosis and treatment of posterior shoulder dislocation combined with reverse Hill-Sachs lesion / 中华创伤骨科杂志

Objective:To explore the diagnosis and treatment of posterior shoulder dislocation combined with reverse Hill-Sachs lesion.Methods:Two male patients were treated at Department of Joint Surgery, Affiliated Hospital of Qingdao University for posterior shoulder dislocation combined with reverse Hill-Sachs lesion from August to November 2022. Case 1 was a 46-year-old man, admitted 1 day after right should injury, and case 2 a 57-year-old man, admitted 2 days after right should injury. The injury was caused by electric shock in both, and their fractures were fresh with an injury area>50%. After anatomical reduction of the collapsed humeral head via the pectoralis major deltoid approach, an artificial bone was implanted and fixated with countersunk screws in both cases to reduce the shoulder joint. The Constant-Murley scale and visual analogue scale (VAS) were used to evaluate the functional recovery of the shoulder and pain after treatment.Results:No such perioperative complications as incision infection, brachial plexus injury or vascular injury was observed in either of the 2 patients. Reexamination 3 months after surgery showed in case 1: 110° of shoulder anterior flexion, 90° of shoulder abduction, 30° of external rotation (neutral position), 70° of internal rotation (neutral position), 70 points of Constant-Murley shoulder score, and 3 points of VAS pain score; in case 2: 130° of shoulder anterior flexion, 120° of shoulder abduction, 50° of external rotation (neutral position), 80° of internal rotation (neutral position), 70 points of Constant-Murley shoulder score, and 2 points of VAS pain score.Conclusion:For patients with posterior shoulder dislocation complicated with reverse Hill-Sachs lesion and humeral head collapse greater than 50%, open reduction and screw internal fixation combined with artificial bone grafting can achieve good short-term curative efficacy.

Recent advances in understanding the role of immune related factors in osteoarthritis / 中华骨科杂志

Osteoarthritis (OA), a chronic joint degenerative disease, is the significant cause of the loss of joint function in middle-aged and older people. Bone destruction, synovial hyperplasia, osteophyte formation, and subchondral bone sclerosis are the main features of osteoarthritis, and the typical symptom is severe joint pain. Consequent to unprecedented global population aging, osteoarthritis remains a leading cause of disability, and the treatment often comes at a high cost. With an in-depth understanding of related research, osteoarthritis is proven to be a multifactorial disease whose onset is not simply a cartilage lesion, and the immune plays an essential role in the development of the disease. Some studies proposed that chondrocytes are capable of altering gene expression and mediating osteoarthritis progression by regulating immune responses. Previous studies showed that the extent of immune dysregulation significantly correlates with the severity of osteoarthritis, revealing an association between immunity response and clinical manifestations. The study of immune infiltration, genetic alterations, and pathogenesis of osteoarthritis may provide new perspectives and methods for the treatment of osteoarthritis in the future. Therefore, this review, combined with the recent decade of literature, provides an overview of the research progress of the main immune cells and related cytokines in OA, which may provide a new direction of thinking for diagnosing and preventing this disease.

Identification of key pathways and genes involved in microglia inflammation by bioinformatics analysis of transcriptome sequencing / 中华骨科杂志

Objective:To explore the key pathways and genes involved in microglia inflammation through transcriptome sequencing and bioinformatics analysis.Methods:BV2 cells were stimulated by lipopolysaccharide to establish microglia inflammation model. The levels of IL-6 and TNF-α were detected by ELISA and RT-qPCR. The established microglia inflammation model was sequenced by transcriptome sequencing, and the differentially expressed genes were screened by bioinformatics method. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis of differentially expressed genes were performed. The protein-protein interaction network of differentially expressed genes was constructed by using string database, and the protein-protein interaction network was visualized by using Cytoscape software. The protein interaction network module was extracted by using MCODE app. The hub gene was extracted by using cytohubba app and was verified through RT-qPCR. We conducted enrichment analysis of hub genes, predicted their targeted miRNAs and interacting drugs.Results:The microglia inflammation model was successfully established and verified by ELISA and RT-qPCR. We screened 434 differentially expressed genes by bioinformatics analysis of transcriptome sequencing results. GO analysis showed that these differentially expressed genes were mainly concentrated in cellular response to cytokine stimulus, inflammatory response, regulation of response to external stimulation. KEGG analysis showed that these differentially expressed genes were mainly concentrated in Chemokine signaling pathway, TNF signaling pathway, IL-17 signaling pathway. We constructed the protein interaction network of these differentially expressed genes, and carried out module analysis and extraction of hub genes. Most of hub genes are located in module 1, and the seed gene of module 1 is S1pr1. Hub genes include S1pr1, Cxcr4, Cx3cl1, Cx3cr1, Cxcl10, Cxcl2, Ccl4, Ccl5, Ccl9, Fpr1. RT-qPCR results showed that compared with the culture medium group, the mRNA expressions of S1pr1, Cxcr4, Cx3cl1 and Cx3cr1 were down-regulated, and the mRNA expressions of Cxcl10, Cxcl2, Ccl4, Ccl5, Ccl9 and Fpr1 were up-regulated in the LPS group. The enrichment analysis of hub genes mainly focused on chemokine-mediated signaling pathway, Class A/1 (Rhodopsin-like receptors), cell chemotaxis and so on. Drugs and miRNAs that may interact with hub genes were predicted. Conclusion:Through transcriptome sequencing and bioinformatics analysis of microglia inflammation model, differentially expressed genes were screened, hub genes and seed genes were extracted, which will help us further understand the molecular mechanism of microglia inflammation and provide potential targets for the treatment of related diseases.

Depletion of microglia combined with transplantation of bone marrow mesenchymal stem cells for repairing spinal cord injury / 中华骨科杂志

Objective:To study the effect of microglia depletion combined with bone marrow mesenchymal stem cells (BMSC) transplantation for spinal cord injury (SCI) repair.Methods:GFP-BMSCs were cultured, identified and detected for expression levels of growth factors. The effects of BMSCs ondorsal root ganglion (DRG) axon outgrowth were observed by the co-culture of BMSCs with DRGs. Mice were depleted of microglia by administrating the colony stimulating factor 1 receptor (CSF1R) inhibitor PLX3397. The spinal cords of these microglia-depleted mice were subjected to crush injury. BMSCs were transplanted into SCI area after microglia depletion. Mice were randomly divided into control group (SCI+BMSCs) and experimental group (PLX3397+SCI+BMSCs). Mice were sacrificed at corresponding time points after transplantation for observing the survival of transplanted BMSCs and the repair of spinal cord. BMS score was used for evaluation of motor function recovery.Results:BMSCs secreted a large number of neurotrophic factors and promoted the growth of DRG axons when co-cultured with DRGs. Depletion of microglia significantly improved the survival of transplanted BMSCs. Compared with BMSCs transplantation alone, the combined treatments slightly but non-significantly reduced the area of the lesion ( t=2.141, P=0.065). Immunofluorescence staining showed that both BMSC transplantation alone and the combined treatments did not cause the corticospinalaxons across the lesion and into distal spinal cord. BMS scores were (1.20±0.45), (3.20±0.45), (3.80±0.45), (4.20±0.45), and (4.60±0.55) points in control group at 1, 7, 14, 21 and 28 d after injury. The experimental groups were(0.60±0.55), (3.00±0.71), (3.80±0.84), (4.20±0.84), and (4.40±0.89) points, respectively. Conclusion:Depletion of microglia improves the survival of transplanted cells, depletion of microglia combined with BMSC transplantation did not result in a significant reduction in lesion area. At the same time, the damaged CST axons were notregenerated. Thus, combining cell transplantation with axon-promoting strategy may be necessary for SCI repair.

Relationship between fibular head height and varus knee osteoarthritis occurrence and severity / 中华骨科杂志

Objective:To explore the correlation between fibular head height and varus knee osteoarthritis occurrence and severity.Methods:A retrospective analysis was performed on 618 participants (618 knees, 184 males and 434 females, mean age 61.12±10.98 years) who underwent standard weight-bearing full-leg radiographs and were diagnosed as non-knee osteoarthritis or varus knee osteoarthritis from January 2019 to June 2019. Knee osteoarthritis was diagnosed according to Kellgren-Lawrence grading: 0-I grades were diagnosed as non-osteoarthritis, II-IV grades were diagnosed as osteoarthritis. Joint line convergence angle (JLCA), medial proximal tibial angle (MPTA) and hip-knee-ankle angle were measured on X-rays to reflect varus deformity. The fibular head height was defined as the vertical distance from upper edge of fibular head to lateral tibial plateau. Patients were divided into 5 groups according to Kellgren-Lawrence grading. Differences of age, gender, height, weight, body mass index, varus deformity (JLCA, MPTA and hip-knee-ankle angle) between Kellgren-Lawrence 0-IV grades were compared. Ordinal logistic regression was performed to analyze the correlation between fibular head height and Kellgren-Lawrence grades. Pearson's correlation analysis was used for the correlation among fibular head height, JLCA, MPTA and hip-knee-ankle angle, and the main factor of JLCA, MPTA and hip-knee-ankle angle was extracted by factor analysis. Multiple linear regressions were used to analyze the correlation between fibular head height and varus deformity score.Results:There were 68, 66, 97, 98, 289 participants in Kellgren-Lawrence grades 0-IV respectively that was 134 participants were diagnosed as non-osteoarthritis and 484 participants were diagnosed as osteoarthritis. Fibular head height and MPTA showed a decreasing trend ( F=129.076, 24.875; P<0.001) while JLCA and hip-knee-ankle angle showed an increasing trend ( F=414.346, 105.996; P<0.001) with the increase in Kellgren-Lawrence grading. Age, body mass index and fibular head height are influencing factors of Kellgren-Lawrence grading with OR(95%CI) were 1.116(1.093, 1.141), 1.363(1.060, 1.754), 0.617(0.575, 0.662) . Fibular head height was negatively correlated with JLCA and hip-knee-ankle angle ( r=-0.641, -0.478; P<0.001) , respectively, and positively correlated with MPTA ( r=0.320, P<0.001). There were significant correlations between age, fibular head height and the varus deformity score ( β=0.274, -0.457; P<0.001). Conclusion:Fibular head height of patients with varus knee osteoarthritis is lower than that of non-osteoarthritis. In addition to age and body mass index, fibular head height is a risk factor for varus knee osteoarthritis occurrence. The smaller the fibular head height is, the more serious the osteoarthritis severity and varus deformity are.

Comparison of pressing tendon suture with a lateral anchor and knotted suture in treatment of severe rotator cuff tear under shoulder arthroscopy / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between the pressing tendon suture with a lateral anchor and the knotted suture with a lateral anchor in the treatment of severe rotator cuff tear under shoulder arthroscopy.Methods:A retrospective study was conducted of the 42 patients who had been treated at Department of Orthopedic Sports Medicine, Affiliated Hospital to Qingdao University from December 2018 to December 2019 for severe rotator cuff tear. They were 13 males and 29 females, with an age of (58.3±10.1) years (from 32 to 74 years). The injury was on the right side in 26 cases and on the left side in 16 cases. Of them, 22 received pressing tendon suture with a lateral anchor under shoulder arthroscopy and 20 knotted suture with a lateral anchor under shoulder arthroscopy. The flexion, abduction and external rotation of the shoulder, Visual Analog Scale (VAS) pain score, University of California-Los Angeles (UCLA) score, Constant-Murley shoulder score, American Shoulder and Elbow Surgeons (ASES) score and imaging MRI Sugaya grading were compared between the 2 groups 12 months after operation.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability between them ( P>0.05). At 12 months after operation, the pressing tendon suture group had better abduction and flexion of the shoulder, a lower VAS pain score and a higher ASES score than the knotted suture group, but the differences were insignificant ( P>0.05). At 12 months after operation, the pressing tendon suture group achieved significantly better external rotation (39.2°±11.7°) and significantly higher UCLA score (28.1±4.7) and Constant-Murley shoulder score (77.0±9.3) than the knotted suture group (29.8°±14.6°, 22.1±5.7 and 66.4±11.0) ( P<0.05). At 12 months after operation, the imaging MRI Sugaya grading was significantly lower for the pressing tendon suture group than that for the knotted suture group ( P<0.05). Conclusion:In the treatment of patients with severe rotator cuff tear under shoulder arthroscopy, the pressing tendon suture with a lateral anchor may lead to better clinical prognosis than the knotted suture with a lateral anchor.

Arthroscopic treatment of tibial eminence avulsion fracture by four-point fixation with suture anchors / 中华创伤骨科杂志

Objective:To explore the clinical effectiveness of arthroscopic treatment of tibial eminence avulsion fracture by four-point fixation with suture anchors.Methods:A retrospective analysis was performed of the 58 patients with tibial eminence avulsion fracture who had been treated by the same group of surgeons using four-point fixation technique with suture anchors under arthroscopy at Department of Sports Medicine, The Affiliated Hospital to Qingdao University from January 2015 to December 2018. They were 33 males and 25 females, with an average age of 18.4 years (from 14 to 32 years). By the modified Meyers-McKeever classification, 15 fractures were type Ⅱ, 19 type Ⅲ and 24 type Ⅳ. Recorded and compared were knee Lysholm scores, International Knee Documentation Committee (IKDC) scores and tibial eminence height between preoperation and one year postoperation; recorded at the last follow-up were range of knee motion and results of Lachman and pivot-shift tests.Results:The 58 patients were followed up for a mean of 20.7 months (from 12 to 33 months). Bony union was achieved in all patients within 12 weeks after operation. In this cohort, the Lysholm score (85.2±4.9) and IKDC score (86.2±4.3) at one year postoperation were significantly higher than the preoperative values (43.2±5.2 and 51.2±4.9), and the post-operative tibial eminence height [(9.1±1.2) mm] was significantly lower than the preoperative value [(12.6±1.2) mm] (all P<0.05). The correlation coefficients between the tibial eminence height and the Lysholm & IKDC scores at one year postoperation were -0.16 and -0.17, respectively. The last follow-up showed a 132°±5° range of knee motion for all patients, a positive result of pivot-shift test (grade Ⅱ) for 3 and a positive result of Lachman test (grade Ⅰ) for 2. Conclusion:Arthroscopic treatment of tibial eminence avulsion fracture by four-point fixation with suture anchors can lead to satisfactory effectiveness, showing advantages of minimal invasion, anatomic reduction, reliable fixation, and little impact on the epiphysis plate.

Direct sampling introduction and atomic fluorescence spectrometry for determination of selenium content in mice liver and urine / 中华地方病学杂志

Objective Through determination of selenium content in liver and urine of selenium-induced mice, direct sampling atomic fluorescence spectrometry was established to provide a more accurate and convenient determination method for detection of selenium-related biological samples. Methods Selenium in the sample was released by the electrically heated quartz tube,the selenium in the atomic state was captured by the quartz tube,and the selenium released by the heating quartz tube was carried by the argon-hydrogen mixed gas into the argon-argon flame atomic fluorescence detector for determination; standard curve was established based on selenium content and fluorescence area, and then the content of selenium in the sample was calculated. Results The detection limit of selenium in samples by direct sampling atomic fluorescence spectrometry was 0.28 μg/kg, the correlation coefficient of standard curve was 0.999 3, and the relative standard deviation range was 1.82% - 4.19%. The adding standard recovery of the liver in mice was 87.30%- 100.20%; meanwhile the adding standard recovery of the urine in mice was 93.10% - 96.60%. Conclusions Direct sampling atomic fluorescence method is simple and easy to operate, accuracy and precision are better, the linear range is wide. The samples need not be processed by complex pretreatment,such as acid,etc.,elements loss is avoided and efficiency of detection is improved.The method can be used in a variety of samples for rapid detection of trace selenium.

Similarity Investigation on Dissolution Curves of Metronidazole Tablets from Different Manufacturers / 医药导报

Objective To compare the dissolution curves of metronidazole tablets from 38 national manufactures and original drugs of Britain in four dissolution mediums,and provide the reference for the quality and clinical effect consistency evaluation of metronidazole tablets.Methods Paddle method was adopted at 50 r · min-1 in four dissolution mediums with the volume of 900 mL.The dissolution profiles were determined by ultraviolet spectrophotometry.The cumulative dissolution percentages were calculated and the dissolution curves were drawn.Similarity factor (f2)was used for comparing of the differences between dissolution curves.Results The dissolution profiles of 4 manufactures in pH 1.2 and 9 manufactures in pH 4.5 were similar (f2 ≥ 50)to that of original drugs,only 1 and 3 were similar to original drugs in water and pH 6.8,respectively.There are no companies whose dissolution curve were similar to that of original drugs in 4 dissolution mediums.Conclusion Great difference exists between domestic manufactures and pharmaceutical enterprises of origin in dissolution behaviors of metronidazole tablets.In order to ensure the consistency between the metronidazole tablets generics and original drugs of Britain in quality and clinical effect.It is advisable for the relevant companies to improve their product quality by improving the formulation and preparation.

The transformation of primary myelofibrosis into acute myeloid leukemia: a case report and review of literatures / 白血病·淋巴瘤

Objective To improve the recognition of diagnosis, treatment and leukemia transformation of primary myelofibrosis (PMF). Methods One case with PMF which transformed into acute myeloid leukemia (AML) was reported and the literatures on this topic were reviewed. Results The patient was diagnosed according to the 2008 version of the WHO classification of PMF leukemia transformation was diagnosed after 2.5 years. The JAK2 V617F gene mutation was detectable both before and after leukemia transformation. The outcome of low dose chemotherapy could keep a short time. Conclusion JAK2 V617F gene could remain detectable after leukemia transformation in PMF patients. It is difficult to control the disease progress by low dose chemotherapy.

Effect of Aerobic Exercise and Dietary Fat on the Formation of Atherosclerotic Plaque in ApoE-Deficient Mice / 中国运动医学杂志

To approach the effects of aerobic exercise anddietary fat on the formation of atherosclerotic plaque, we have adopted the ApoE-gene knockout mice as the model to study the effects on an animal treadmill. The results show that the plaque area at the aortic sinuses of the exercised and low fat diet fed mice group were significantly reduced as comparing with the control group respectively. Mice of aerobic exercise and low fat diet combined treated group have the least lesion area of plaque as compared with the other groups. These results have indicated that either aerobic exercise or low fat diet is beneficial and effective to alleviate the formation of atherosclerotic lesions. However, aerobic combined with exercise can provide the greatest benefit in the alleviation of the formation of atherosclerotic plaque as compared with the single factor of either exercise or low fat diet.