Effect analysis of trajectory screw technique in fragility fracture of pelvic ring / 中国骨伤

OBJECTIVE@#To assess the clinical efficacy of minimally invasive technology with trajectory screw fixation for fragility fractures of pelvic(FFP).@*METHODS@#A retrospective case control study was performed to analyze the clinical data of 35 patients with FFP who were treated and followed up between January 2016 and December 2019. There were 12 males and 23 females, aged from 65 to 99 years with an average of(75.4±7.8) years old. There were 13 cases of type Ⅱb, 7 cases of type Ⅱc, 8 cases of type Ⅲa, 2 cases of type Ⅲb, 2 cases of type Ⅲc, 1 case of type Ⅳb, and 2 cases of type Ⅳc according to Rommens FFP comprehensive classification. All patients received the treatment of minimally invasive technology with trajectory screws fixation. According to the different methods of anterior pelvic ring fixation, FFP patients were divided into two groups:12 cases were fixed with the pedicle screw rod system in the anterior pelvic subcutaneous internal fixator (INFIX) group;23 cases were fixed with hollow screws of the pubic symphysis, superior ramus of pubis or acetabular anterior column in the screw group. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, length of hospital stay, cost of internal fixation, pre- and post-operative visual analogue scale(VAS) were compared between the two groups. The fracture reduction quality was evaluated according to the Matta criteria, and the clinical function was evaluated by the Majeed functional scoring system respectively.@*RESULTS@#All patients were followed up for 12 to 39(16.5±5.4) months after surgery. There was no statistically significant difference in the operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of hospital stay between the two groups(P>0.05). As for the cost of internal fixation, the cost of internal fixation in the screw group [2 914 (2 914, 4 371) yuan] was significantly lower than that of the INFIX group [6 205 (6 205, 6 205) yuan] (P<0.05). No significant difference was observed in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in VAS assessment at admission, 1 week, and 3 months after surgery between the two groups(P>0.05). However, the VAS assessment at 1 week and 3 months after surgery of the two groups were significantly better than those at admission(P<0.05). There was no significant difference in the quality of fracture reduction after the operation and the efficacy evaluation at the last follow-up between the two groups(P>0.05).@*CONCLUSION@#For the treatment of fragility fractures, minimally invasive technology with trajectory screw fixation can achieve good clinical efficacy. It has the advantages of being relatively minimally invasive, less bleeding, relieving the pain. It deserves clinical application.

Exploration on Effect of Yinhuotang on Depression-like Behavior in Mice with Bilateral Ovariectomy Induced by Chronic Stress Based on E2/ERβ Signaling Pathway / 中国实验方剂学杂志

Objective:To observe the effect of Yinhuotang （YHT） on the depression-like behavior of mice with bilateral ovariectomy （OVX） induced by chronic stress and explore its action mechanism based on estradiol （E₂）-estrogen receptor <italic>β </italic>（ER<italic>β</italic>） pathway. Method:The experiment was divided into two parts. In the first part， mice were randomly divided into the sham operation （Sham） group， model （OVX） group， positive drug （E₂， 0.13 mg·kg^-1） group， and YHT （23.4 g·kg^-1） group. The OVX model was reproduced by OVX combined with chronic unpredictable mild stress （CUMS）. On the 8th day after OVX， the mice in each group were exposed to CUMS and treated with drugs. The changes in immobility time， horizontal movement score， and vertical movement score of mice in each group were observed in forced swimming test （FST）， tail suspension test （TST） and open-field test （OFT）， respectively. Serum and brain E₂ levels were detected by enzyme-linked immunosorbent assay （ELISA）， the aromatizing enzyme （Cyp19） mRNA expression by real-time fluorescence polymerase chain reaction （Real-time PCR）， the expression of ER<italic>α</italic> and ER<italic>β</italic> in dentate gyrus of hippocampus by immunohistochemistry （IHC）， and the total ER<italic>α</italic> and ER<italic>β</italic> levels in the brain by Western blotting. In the second part， the mice were divided into the Sham group， OVX group， YHT group， and blocker （Y+B， 23.4 g·kg^-1+100 μg·kg^-1） group. Mice in the Y+B group were first treated with intragastric administration of YHT and then with intraperitoneal injection of ER<italic>β</italic> blocker （PHTPP） on the next day. The changes in immobility time， horizontal motor score， and vertical motor score were observed in the three behavioral tests. Result:Compared with the Sham group， the OVX group displayed significantly increased immobility time， decreased horizontal and vertical movement scores （<italic>P</italic><0.01）， down-regulated serum and brain E₂levels （<italic>P</italic><0.01） and Cyp19 mRNA expression in the brain （<italic>P</italic><0.01）， and up-regulated total ER<italic>β</italic> in dentate gyrus and brain （<italic>P</italic><0.01）. However， there was no significant change in total ER<italic>α</italic> expression in the dentate gyrus or brain. As revealed by comparison with the OVX group， the immobility time of the E₂ group was decreased significantly， while the horizontal and vertical movement scores were increased significantly （<italic>P</italic><0.01）. The E₂ levels in the serum was significantly elevated （<italic>P</italic><0.01）. The Cyp19 mRNA expression in the brain and the total ER<italic>α</italic> expression in the dentate gyrus and brain were not significantly changed， while the expression levels of total ER<italic>β</italic> in dentate gyrus and brain were significantly increased （<italic>P</italic><0.01）. In the YHT group， the immobility time declined significantly， and the horizontal and vertical movement scores rose significantly （<italic>P</italic><0.01）. The serum E₂ did not increase， whereas the brain E₂ increased significantly （<italic>P</italic><0.01）. The expression of Cyp19 gene in the brain was significantly increased （<italic>P</italic><0.05，<italic>P</italic><0.01）. There was no significant change in the total ER<italic>α</italic> of dentate gyrus and brain， but the expression levels of total ER<italic>β</italic> in dentate gyrus and brain were significantly increased （<italic>P</italic><0.05，<italic>P</italic><0.01）. PHTPP reversed the effects of YHT on OVX mice in FST， TST and OFT. Conclusion:YHT promotes the synthesis and release of endogenous estrogen in brain and improves the depression-like behavior of OVX mice induced by chronic stress， which is possibly related to the activation of E₂/ER<italic>β</italic> pathway.

Analysis of clinical effects of iliolumbar fixation in treating U-shaped sacral fractures / 中国骨伤

OBJECTIVE@#To evaluate the efficacy of iliolumbar fixation in the treatment of U-shaped sacral fractures.@*METHODS@#A retrospective study was conducted on the 14 complex U-shaped sacral fractures which had been treated from January 2014 to December 2019, involved 10 males and 4 females, aged 24 to 48 (35.4±6.5) years. Fracture healing time, nerve function, clinical function and complications were observed in the patients.@*RESULTS@#All patients were followed up for 9 to 16(26.0±5.9) months. The complete weight-bearing time for bone healing was(12.4±2.0) weeks. One case of surgical incision infection occurred after operation, and one case of sacrum nailspenetrated to the outer plate of sacrum. No complications such as pressure ulcers, loosening or rupture of internal fixation occurred. According to Gibbons scoring, the neurological function recovered from preoperative 2.9±0.9 to postoperative 2.1±1.1, there were statistically significant differences between preoperative and postoperative (@*CONCLUSION@#Sacral lumbar fixation is an effective method for the treatment of U-shaped sacrum fractures. It has the advantages of strong internal fixation and satisfactory functional recovery.

Comparison of different minimally invasive internal fixation in the treatment of pelvic anterior ring fracture / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy of three minimally invasive methods of anterior column screw, plate and screw rod system in the treatment of anterior pelvic ring fracture.@*METHODS@#From December 2015 to September 2018, 77 patients with pelvic anterior ring fracture were treated and followed up, including 45 males and 32 females, aged 19 to 73 years. According to AO / OTA classification, there were 26 cases of type B1, 20 cases of type B2, 17 cases of type B3 and 14 cases of type C. According to the different internal fixation methods, they were divided into three groups:anterior column screw group(35 cases), plate group(20 cases), and screw rod system group(22 cases). The operation time, intraoperative fluoroscopy times, blood loss, fracture reduction quality, complications and curative effect of the three groups were compared.@*RESULTS@#All 77 patients were followed up for 12 to 33 (16.5±5.7) months. The operation time, intraoperative blood loss and incision length of anterior column screw group were significantly shorter than those of plate group and screw rod system group, and intraoperative fluoroscopy times of plate group were significantly less than those of anterior column screw group and screw rod system group (@*CONCLUSION@#Minimally invasive internal fixation with anterior column screw, plate and screw rod system can obtain good clinical effect, but anterior column screw fixation has less trauma and lower incidence of surgicalcomplications.

Diagnostic Value of Nanomagicbeabs Sorting-time Resolved Fluoroimmuno Assay for Serum Calgizzar in Pancreatic Carcinoma / 现代检验医学杂志

Objective To detect the serum levels of calpainin (S100A11) using nanomagicbeabs sorting-time resolved fluoroimmuno assay (NMBS-TRFIA) and evaluate its diagnostic value in pancreatic carcinoma.Methods 88 patients with pancreatic carcinoma,50 patients with acute pancreatitis,10 patients with pancreatic cyst and 20 healthy controls were selected as the study subjects.The human peripheral serum blood was sorted with S100A11 antibody coupled nanomagicbeabs,and the concentration of S100A11 was detected by TRFIA method.The area under the receiver operating characteristic (ROC) curve (AUC) was used to determine the cut-off level for diagnosis of pancreatic carcinoma,in order to evaluate the sensitivity and specificity for diagnosis of pancreatic carcinoma.Results S100A11 showed a linear relationship within the range of 6.08～ 500 ng/ml using NMBS-TRFIA method,intraassay CV≤6.35％,inter-assay CV≤7.12％,and the average recovery rate was 104.7％.The serum levels of S100A11 in patients with pancreatic carcinoma,patients with acute pancreatitis and patients with pancreatic cyst were 185.53 ± 161.19,106.06±113.83 and 68.99± 47.83 ng/ml respectively.Compared with the normal control group (37.98±25.14 ng/ml),the differences were statistically significant (t=-8.065,-3.375,-2.266,all P ＜0.01).The serum levels of S100A11 in patients with pancreatic carcinoma was significantly higher than those in patients with acute pancreatitis and patients with pancreatic cyst (all P＜0.05).According to the ROC curve,ROCAUC=0.985 (95％ CI:0.972 ～ 0.997),the best cut-off level for the diagnosis of pancreatic carcinoma was 89.5 ng/ml (sensitivity 81.8 ％,specificity 67.5 ％).Conclusion NMBS-TRFIA can enrich S100A11 in serum and improve the detection sensitivity of serum S100A11,and the method is simple and easy to be popularized.Serum S100A11 has a high sensitivity and specificity in the diagnosis of pancreatic carcinoma,and is a new serum marker for the diagnosis of early pancreatic carcinoma.

Identification of polygala oligosaccharide esters and their metabolites in rat plasma after oral administration of ethanol extract of Kai Xin San by UHPLC-MS / 药学学报

Using a UHPLC-TOF/MS method combined with software of Masslynx V4.1 and database in the literatures, a total of 20 polygala oligosaccharide esters (POEs) were identified in 60% ethanol extract of Kai Xin San (KXS-60%E). Furthermore, 14 POEs as well as 4 POE-metabolites were identified in rat plasma. The results revealed that POEs and POE-metabolites which were identified in rat plasma, were key components in KXS-60%E and the potential bioactive compounds for KXS action in the treatment of AD.

Management of displaced radial neck fractures in children: elastic stable intramedullary nailing vs K-wire fixation / 中国骨伤

<p><b>OBJECTIVE</b>To compare the complications and clinical outcome of titanium elastic nail(TEN) versus K-wire fixation(KW) for the treatment of displaced radial neck fractures in children.</p><p><b>METHODS</b>From January 2009 to December 2014, 56 children with displaced radial neck fractures were studied retrospectively according to the inclusion criteria. Based on the different methods of internal fixation, patients were divided into two groups: titanium elastic nail (TEN group) and K-wire fixation (KW group). Among 25 patients(15 males and 11 females, aged from 3 to 12 years old with an average of 8.6±2.1) treated with TEN, 16 patients had type III fractures, 19 patients had type IV fractures according to Metaizeau-Judet modified classification; 20 patients were treated with closed reduction and 5 patients were treated with open reduction; the time from injury to treatment ranged from 1 to 8 days with an average of (3.6±1.7) days. Among 31 patients (20 males and 11 females, aged from 3 to 11 years old with an average of 9.1±1.9 years old) treated with KW, 19 patients had type III fractures, 12 patients had type IV fractures; 22 patients were treated with closed reduction, and 9 patients were treated with open reduction; the time from injury to treatment ranged from 2 to 7 days with an average of (3.7±1.5) days. No significant differences between two groups were found in general data. Operative time, hospitalization time, healing time of fracture, internal fixation time, postoperative complications and function recovery of the two groups were compared and evaluated.</p><p><b>RESULTS</b>The average follow-up period of the patients was 22.1 months in TEN group(ranged, 16 to 48 months), and 21.9 months in KW group(ranged, 13 to 48 months). There were no significant differences between these 2 groups in follow-up duration, average hospitalization time and fracture healing time. The operation time, hospital costs and internal fixation time in TEN group were (56.6±11.8) min, (18 000±3 000) Yuan(RMB), (9.1±2.5) weeks respectively; and in KW group were(45.5±10.3) min, (8 000±1 000) Yuan(RMB), (4.8±1.6) weeks respectively, there were significant differences between two groups(<0.05). Outcome scores according to Metaizeau and Tibone-Stoltz had no significant differences between two groups(>0.05).</p><p><b>CONCLUSIONS</b>There is no significant difference of therapeutic effects between TEN and KW for children with displaced radial neck fractures. Because the removal of TEN fixation requires the secondary anesthesia, and the TEN costs significantly more than KW, TEN still can't replace the traditional KW for the treatment of radial neck fracture in children.</p>

Titanium elastic nail versus plate-screw fixation for the treatment of upper segment fractures of femoral shaft in children / 中国骨伤

<p><b>UNLABELLED</b>ABSTRA CT OBJECTIVE To compare the complications and clinical outcome of titanium elastic nail (TEN) versus plate-screw fixation (PF) for the treatment of upper segment fractures of femoral shaft in children.</p><p><b>METHODS</b>From May 2006 and August 2012,32 consecutive children with upper segment fractures of femoral shaft were studied prospectively. They were randomly divided into TEN group and PF group. Ninteen patients were treated with titanic elastic nail (TEN) fixation including 11 males and 8 females with an average age of (6.9?2.2) years old ranging from 3 to 11,11 cases of them were type A, 6 cases were type B,2 cases were type C according to AO classification. The other 13 patients were treated with plate-screw fixation (PF) including 9 males and 4 females with an average age of (7.5±2.1) years old ranging from 5 to 12 years, and 3 cases of them were type A,6 cases were type B,2 cases were type C. Operative time, blood loss,incision length,the time of hospitalization,fracture healing time, postoperative complications and function recovery between two groups were compared and evaluated.</p><p><b>RESULTS</b>The average follow-up period of the patients was 25.3 months (ranging from 15 to 48 months) in TEN group, and 36.2 months (ranging from 13 to 36 months) in the PF group. The operation time, time of hospitalization, the time of implants removed after the initial surgery, fracture healing time in TEN group were respectively (56.7±11.2) min, (6.6±3.9) d, (8.1±2.3) months, (12.6+3.8) weeks; and in PF group were respectively (51.5±8.3) min, (7.8±4.8) d, (7.8±1.6) months, (11.8±2.8) weeks, there was no significant difference between two groups (P>0.05). However, the length of incisions was (4.3±1.7) cm and the intraoperative blood loss was (12.7+3.2) ml in TEN group,which were significantly less than that in PF group respectively (89.2±21.1) ml and (11.6?2.3) cm (P<0.05). There was no statistically difference in postoperative in complication between two groups, but the patients in TEN group had a higher incidence of soft tissue irritation and misalignment. Outcome scores according to Sanders had no significant difference between two groups (P>0.05). In TEN group,the result was excellent in 13 cases, good in 3,fair in 2, and poor in 1, while in PF group excellent in 10, good in 2, fair in 1.</p><p><b>CONCLUSION</b>There is no significant difference in therapeutic effects between TEN and PF for children with upper segment fractures of femoral shaft. The internal fixation should be selected according to the associated fracture type, weight, the expected value of the parents, scars, and so on.</p>

Surgical treatment of acetabular type C1 acetabular fracture by posteroproximal-posteroanterior sequential reduction and internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the operative reduction techniques and clinical results of surgical treatment of type C1 (AO/ASIF) acetabular fracture by posteroproximal-posteroanterior sequential reduction and internal fixation.</p><p><b>METHODS</b>From August 2004 to January 2012, 13 patients with type C1 (AO/ASIF) acetabular fracture were treated by posteroproximal-posteroanterior sequential reduction and internal fixation. Of them, 8 cases were male and 5 cases were female with an average age of 42 years years old (ranged, 18 to 64). Pelvis 3-dimentional CT reconstruction were used to confirmed the classification of fracture, and the operation were performed during from 5 to 20 days with an average of 9.5 days. Operation time, blood loss, complications and reduction were recorded and evaluated. The function of hip joint were accessed at the final follow-up.</p><p><b>RESULTS</b>The operation time ranged from 190 to 290 min with an average of 240 min. The mean blood loss was 1 800 ml (ranged, 1 300 to 3 000 ml). One case had superficial infection and healed after 3 weeks. According to Matta reduction criteria, 8 cases obtained anatomical reduction, 4 cases got satisfied results and 1 cases got unsatisfied results. Eleven cases were followed up with an average of (24.0 +/- 8.0) months, and 2 cases were lost to follow-up. According to revised Mede d'Aubingne and Postel evaluation system, 7 cases got excellent results, 2 good, 1 moderate and 1 poor.</p><p><b>CONCLUSION</b>Posteroproximal-posteroanterior sequential reduction and internal fixation for the treatment of type C1 (AO/ASIF) acetabular fracture can achieve satisfied surgical proces and operation quality.</p>

Study on preparation process and analytical methods of ESAC from Ganoderma lucidum / 中国中药杂志

<p><b>OBJECTIVE</b>To develop the procedure for separating the ethanol-soluble and acidic components (ESAC) from Ganoderma lucidum, and to establish a method for quantifying ESAC in G. lucidum.</p><p><b>METHOD</b>The ethanol extract of G. lucidum was extracted with a saturated NaHCO3 solution, acidified and re-extracted by chloroform to obtain ESAC. The quantitative analysis of ESAC was based on the characteristic color reaction between ESAC and H2SO4.</p><p><b>RESULT</b>The optimal conditions for separating ESAC on a 10 g scale are as follows: ratio of material and ethanol (mL), 1:15; immersing time, 24 h; volume of saturated NaHCO3 and chloroform, 1300 mL; extract 3 times. The condition for measuring ESAC is as follows: sample weight, 1 g; solution volume, 1.5 mL; immuersing time, 0.5 h; detecting reagent, 50% H2SO4 in ethanol; heating time in 100 degrees C water bathe, 3 min; measuring wavelength, 490 nm.</p><p><b>CONCLUSION</b>The procedure for ESAC preparation is simple and well-designed, and the established method for ESAC can be used for the qualitative analysis of the G. lucidum related products.</p>