Is fixation of both clavicle and scapula better than clavicle alone in surgical treatment of floating shoulder injury? A retrospective study.

BACKGROUND & OBJECTIVE: Little research was available to explore which surgical fixation was better between fixation of both clavicle and scapula and clavicle alone in management of floating shoulder injury. METHODS: Total 69 patients with floating shoulder injury receiving surgery from February 2005 to July 2020 participated in the study. 49 patients underwent fixation of the clavicle alone (Group C) while 20 patients underwent fixation of both clavicle and scapula (Group C + S). They were further divided into subgroups according to age: Group C1, Group C + S1 (age ≤ 55 years old) and Group C2, Group C + S2 (age>55 years old). The radiological parameter (glenopolar angle (GPA)) and clinical outcomes (Herscovici score, Constant-Murley shoulder outcome score (CSS score), and Visual Analogue Scale score (VAS score)) were collected and compared between these groups. The correlation between age and radiological parameter and clinical outcomes was calculated by the Spearman correlation analysis. RESULTS: All people were followed up for at least 1 year. The degree of change in GPA before and after surgery in Group C + S is significantly better than that in Group C. The Herscovici and CSS score in Group C + S2 were significantly higher than those in Group C2 at 1 month, 3 months and 1 year after surgery. However, no significant difference in Herscovici and CSS score was found at final follow-up (1 year after surgery) between Group C + S1 and Group C1. The VAS score in Group C + S2 at final follow-up was significantly lower than that in Group C2. No significant difference in VAS score at final follow-up was found between Group C + S1 and Group C1. In addition, the VAS score was negatively correlated with Herscovici and CSS score. No correlation was found between VAS score and GPA. CONCLUSIONS: Both types of surgical fixation are effective in management of floating shoulder injury. For young people with floating shoulder injury, both types of surgical fixation are equally effective. However, for older people with floating shoulder injury, fixation of both clavicle and scapula is better in prognosis than fixation of clavicle alone.

Pathological Networks Involving Dysmorphic Neurons in Type II Focal Cortical Dysplasia.

Focal cortical dysplasia (FCD) is one of the most common causes of drug-resistant epilepsy. Dysmorphic neurons are the major histopathological feature of type II FCD, but their role in seizure genesis in FCD is unclear. Here we performed whole-cell patch-clamp recording and morphological reconstruction of cortical principal neurons in postsurgical brain tissue from drug-resistant epilepsy patients. Quantitative analyses revealed distinct morphological and electrophysiological characteristics of the upper layer dysmorphic neurons in type II FCD, including an enlarged soma, aberrant dendritic arbors, increased current injection for rheobase action potential firing, and reduced action potential firing frequency. Intriguingly, the upper layer dysmorphic neurons received decreased glutamatergic and increased GABAergic synaptic inputs that were coupled with upregulation of the Na+-K+-Cl- cotransporter. In addition, we found a depolarizing shift of the GABA reversal potential in the CamKII-cre::PTENflox/flox mouse model of drug-resistant epilepsy, suggesting that enhanced GABAergic inputs might depolarize dysmorphic neurons. Thus, imbalance of synaptic excitation and inhibition of dysmorphic neurons may contribute to seizure genesis in type II FCD.

Comparison of pedicle screw fixation by four different posterior approaches for the treatment of type A thoracolumbar fractures without neurologic injury.

Purpose: This study was designed to compare the pedicle screw fixation by four different posterior approaches for the treatment of type A thoracolumbar fractures without neurologic injury. Methods: A total of 165 patients with type A thoracolumbar fractures without neurologic injury who received pedicle screw fixation by posterior approaches from February 2017 to August 2018 were enrolled in this study. They were further divided into the following four groups according to different posterior approaches: Open-C group (conventional open approach), Open-W group (Wiltse approach), MIS-F group (percutaneous approach with fluoroscopy guidance), and MIS-O group (percutaneous approach with O-arm navigation). The demographic data, clinical outcomes, and radiologic parameters were evaluated and compared among the four groups. Results: There were no significant differences in age, gender, fracture segment, and follow-up time. The incision length, blood loss, hospital stay time, and VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) scores at the early stage of post-operation were the worst in the Open-C group. The MIS-O group showed significantly higher accuracy rate of pedicle position than other groups. The preoperative and postoperative AVH (anterior vertebral height) and VWA (vertebral wedge angle) obtain obvious correction in all patients immediately after and 1 year post-operation. No difference was found among the four groups at the final radiographic follow-up. Conclusions: The four different posterior approaches are effective in treating type A thoracolumbar fractures in our study. Each approach has its own individual strengths and weaknesses and therefore requires comprehensive consideration prior to use. Proper approaches selection is critical to patients.

A Unique Type of Highly-Activated Microglia Evoking Brain Inflammation via Mif/Cd74 Signaling Axis in Aged Mice.

Senescence-associated alterations of microglia have only recently been appreciated in the aged brain. Although our previous study has reported chronic inflammation in aged microglia, the mechanism remains poorly understood. Here, we performed morphological detection and transcriptomic analysis of aged microglia at the single cell level. Aged mice showed a large quantity and a large body volume of microglia in the brain. Six subgroups of microglia with unique function were identified by single cell RNA sequencing. Three out of six subgroups showed dramatic variations in microglia between aged and young mice. A unique type of highly-activated microglia (HAM) was observed in aged mice only, with specific expression of several markers, including Lpl, Lgals3, Cst7, and Cd74. Gene clusters with functional implications in cell survival, energy metabolism, and immuno-inflammatory responses were markedly activated in HAM. Mechanistically, neuron-released Mif, acting through Cd74 receptor in HAM, promoted the immunochemotactic activity of microglia, which then triggered immuno-inflammatory responses in aged brains. These findings may reveal new targets for reducing age-related brain inflammation to maintain brain health.

Differential Diagnosis Strategy between Lower Extremity Arterial Occlusive Disease and Lumbar Disc Herniation.

Considering the increasingly incidence rate of lower extremity arterial occlusive disease and difficult to distinguish from lumbar disc herniation, it is very necessary to exclude lower extremity arterial occlusive disease resulting in lower limb symptoms from lumbar disc herniation. More importantly, who have a higher risk of combining with lower extremity arterial occlusive disease and misdiagnosed as lumbar disc herniation? Why those patients are easy to be misdiagnosed as lumbar disc herniation? It is worth analyzing and discussing. The risk factors including age, gender, the medical history of high blood pressure, diabetes, smoking and coronary, pulse pressure, lumbar disc herniation segment and type, ankle-brachial index, and straight leg raising test were observed. The Oswestry disability index and the Japanese Orthopedic Association score were collected preoperative, six months after posterior lumbar interbody fusion and six months after vascular interventional treatment to evaluate the symptoms relief and surgical efficacy. There was a statistically significant difference (P < 0.01) in pulse pressure, ankle-brachial index, central disc herniation, and straight leg raising test between two groups. There was a high risk to missed diagnosis of lower extremity arterial occlusive disease and misdiagnosed as lumbar disc herniation when patients are with a mild central lumbar disc herniation, higher pulse pressure, lower ankle-brachial index, and straight leg raising test negative. Therefore, sufficient history-taking and cautious physical examinations contributed to find risk factors and attach importance to such patients and, further, to exclude lower extremity arterial occlusive disease from lumbar disc herniation using lower extremity vascular ultrasound examination.

LINC00466 Impacts Cell Proliferation, Metastasis and Sensitivity to Temozolomide of Glioma by Sponging miR-137 to Regulate PPP1R14B Expression.

PURPOSE: LINC00466 is a newfound long non-coding RNA (lncRNA) that has been rarely explored in cancers. However, the specific role and molecular mechanism of LINC00466 in glioma remain to be further elucidated. METHODS: Bioinformatic analysis was used to screen differentially expressed genes. Quantitative real-time PCR (qRT-PCR) was used to determine the expression of LINC00466, microRNA-137 (miR-137) and protein phosphatase 1 regulatory subunit 14B (PPP1R14B). Dual-luciferase reporter gene assay and RNA binding protein Immunoprecipitation (RIP) assays were employed to verify the binding relationship among LINC00466, miR-137 and PPP1R14B. The sensitivity of glioma cells to temozolomide (TMZ) was measured by cell counting kit-8 (CCK8) assay. The xenograft nude models were used to test the effects of LINC00466 on glioma tumor growth in vivo. RESULTS: Highly expressed LINC00466 and PPP1R14B and lowly expressed miR-137 were eventually revealed in glioma tissues. Overexpression of LINC00466 could promote proliferation, metastasis and drug sensitivity to TMZ of glioma cells. LINC00466 could bind to miR-137, and up-regulation of miR-137 could attenuate the enhancing effects caused by LINC00466 overexpression. We took a further step and found that miR-137 could bind to PPP1R14B. Besides, LINC00466 could function as a sponge to miR-137 to regulate PPP1R14B. In addition, overexpression of LINC00466 could promote tumor growth in vivo. CONCLUSION: These findings validate LINC00466 could restrain the miR-137 expression to up-regulate PPP1R14B and therefore promote proliferation, metastasis and resistance to TMZ of glioma.

The Changes of Leukocytes in Brain and Blood After Intracerebral Hemorrhage.

Preclinical and clinical research has demonstrated that inflammation is a critical factor regulating intracerebral hemorrhage (ICH)-induced brain injury. Growing evidence suggests that myeloid cells and lymphocytes have an effect on the pathophysiological processes associated with ICH, such as inflammation, immune responses, perihematomal edema formation, blood-brain barrier (BBB) integrity, and cell death. However, the underlying mechanisms remain largely unknown. We aimed to explore the role immune cells played at different stages of the ICH. To achieve this, novel bioinformatics algorithms were employed to analyze the gene expression profiles and three different analytical tools were utilized to predict the abundances of cell types. In this study, we found that natural killer (NK) cells infiltrated into the brain parenchyma after ICH. Infiltrating NK cells may mediate brain injury through degranulation and recruitment of other cells. Besides, in the acute phase of ICH, monocytes in peripheral blood carried out phagocytosis and secretion of cytokines. On the other hand, in the subacute stage, non-classical monocytes were activated and showed a stronger ability to carry out heme metabolism, wound healing, and antigen processing and presentation. In conclusion, our findings emphasize the significance of intracerebral infiltrating immunocytes in ICH and demonstrate that ICH is a systemic disease affected by peripheral blood. The hub genes identified might be promising therapeutic targets. We also provide a reference on how to use bioinformatics approaches to explore non-neoplastic immune-related diseases.

Influence of Chronic Kidney Disease on Patients Undergoing Elective Hip and Knee Orthopedic Surgery: A Systematic Review and Meta-Analysis.

Background: The increasing prevalence of chronic kidney disease (CKD) in recent years and its impact on renal dysfunction on orthopedic surgery continues to draw more attention to orthopedic surgeons. The purpose of this study is to investigate the influence of CKD on comorbidities and complications in patients who underwent elective low limbs surgery. Material and Methods: Until August 2018, Pubmed, Embase, Cochrane library, and Web of science were used to search relevant literature. After reviewing the article title, the abstract, and the full text, a total of 11 articles were identified in the qualitative synthesis. Demographic data, comorbidities, and complications were assessed between CKD and non-CKD patients. Review Manager 5.3 was used for the statistical analysis, and forest plots were constructed for each variable. Results: A total of 137,436 patients (10,732 patients with CKD and 126,704 patients without CKD) from 11 studies were enrolled in this meta-analysis. CKD patients showed worse health conditions in comparison to non-CKD patients. The incidence of several preoperative comorbidities (hypertension, diabetes, and cardiac-cerebral disease) and postoperative complications (infection, transfusion, deep vein thrombosis, and early mortality) were higher in CKD patients. Conclusions: In elective hip and knee surgery, compared with non-CKD patients, CKD patients showed worse health conditions. Due to a higher rate of comorbidities and complications in CKD patients, they should be treated carefully during perioperative periods.

Bone Mineral Density and Related Scores in Parkinson's Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Parkinson's disease (PD) is the second most common degenerative neurologic disorder in older adults, and increasing attention has been paid to bone health in PD. Although several studies have shown that patients with PD have a lower bone mineral density (BMD) than do non-PD controls, there have been no systematic reviews in recent years. METHODS: PubMed, Medline, and Web of Science were used to search relevant studies up to May 2020. BMD, BMD T score, and BMD Z score of patients with and without PD were statistically analyzed. Meta-analysis was conducted using Review Manager version 5.3. RESULTS: This meta-analysis included 17 studies comprising 10,289 individuals. In the meta-analysis, adults with PD had lower total body, total hip, total radius, lumbar spine, total femur, femur neck, right-hand, and left-hand BMD than did non-PD controls. The T score of total body BMD, total hip BMD, total radius BMD, lumbar spine BMD, L1-L4 spine BMD, total femur BMD, and femur neck BMD in adults with PD were lower than those in non-PD controls. Futhermore, the Z score of total body BMD, total hip BMD, total radius BMD, lumbar spine BMD, L1-L4 spine BMD, and femur neck BMD was lower in adults with PD than in non-PD controls. CONCLUSIONS: Patients with PD had a lower BMD, BMD T score, and BMD Z score compared with non-PD controls. Therefore, clinicians should routinely monitor BMD of patients with PD to prevent falling and fragility fractures in older adults and optimize BMD before surgical treatment of severe spinal deformity caused by PD.

Microstructure and mechanical properties of subchondral bone are negatively regulated by tramadol in osteoarthritis in mice.

OBJECTIVES: In the treatment of osteoarthritis (OA), tramadol, a common weak opioid, has become popular due to its effectiveness in inhibition of pain. In the present study, we aimed to explore the effect of tramadol on subchondral bone, especially changes in the microstructure and mechanical properties. METHODS: A mouse model of OA was established in the present study by destabilization of the medial meniscus (DMM). A vehicle or drug was administered for 4 weeks. Specimens were harvested and analyzed radiologically and histologically using micro-computed tomography (micro-CT), scanning electron microscopy (SEM), atomic force microscopy (AFM) and histological staining to evaluate the knee joints of mice undergoing different forms of intervention. RESULTS: In the early stages of OA induced by DMM, the subchondral bone volume fraction in the OA group was significantly higher than in the sham+vehicle (sham+veh) group, while the volume in the treatment groups was lower than in the DMM+vehicle (DMM+veh) and sham+veh groups. In addition, the elastic moduli in the treatment groups clearly decreased compared with the DMM+veh and sham+veh groups. Observations of the subchondral bone surface by SEM indicated serious destruction, principally manifesting as a decrease in lacunae and more numerous and scattered cracks. Histological staining demonstrated that there was no difference in the degeneration of either the articular cartilage or synovial cells whether tramadol was used or not. CONCLUSION: Although tramadol is effective in inhibiting pain in early OA, it negatively regulates the microstructure and mechanical properties of subchondral bone in joints.

Intracranial Rosai-Dorfman disease mimicking melanoma: a case report and review of the literature.

Intracranial Rosai-Dorfman disease is quite rare. Here, we report a 67-year-old man with a 90 day history of pain and numbness in his right limbs. The patient was suspected of suffering from melanoma. Then he received craniotomy and was finally diagnosed with intracranial Rosai-Dorfman disease. MEDLINE was used to search the related literature; and the diagnosis, mechanism, treatment and prognosis of this rare tumor are discussed.

Etoricoxib decreases subchondral bone mass and attenuates biomechanical properties at the early stage of osteoarthritis in a mouse model.

Etoricoxib, a selective Cyclooxygenase-2 (COX-2) inhibitor, is commonly used in osteoarthritis (OA) for pain relief, however, little is known about the effects on subchondral bone. In the current study, OA was induced via destabilization of the medial meniscus (DMM) in C57BL/6 mice. Two days after surgery, mice were treated with different concentrations of Etoricoxib. Four weeks after treatment, micro computed tomography (Micro-CT) analysis, histological analysis, atomic force microscopy (AFM) analysis, and scanning electron microscopy (SEM) were performed to evaluate OA progression. We demonstrated that Etoricoxib inhibited osteophyte formation in the subchondral bone. However, it also reduced the bone volume fraction (BV/TV), lowered trabecular thickness (Tb.Th), and more microfractures and pores were observed in the subchondral bone. Moreover, Etoricoxib reduced the elastic modulus of subchondral bone. Exposure to Etoricoxib further increased the empty/total osteocyte ratio of the subchondral bone. Etoricoxib did not show significant improvement in articular cartilage destruction and synovial inflammation in early OA. Together, our observations suggested that although Etoricoxib can relieve OA-induced pain and inhibit osteophyte formation in the subchondral bone, it can also change the microstructures and biomechanical properties of subchondral bone, promote subchondral bone loss, and reduce subchondral bone quality in early OA mice.

The effectiveness of lumbar cerebrospinal fluid drainage in aneurysmal subarachnoid hemorrhage with different bleeding amounts.

Continuous lumbar drainage (LD) of cerebrospinal fluid can reduce the risk of aneurysmal subarachnoid hemorrhage (aSAH)-related complications. We evaluated the effectiveness of LD in aSAH patients with aneurysmal clipping and the relative benefits of different bleeding amounts. We retrospectively reviewed all consecutive aSAH patients who underwent aneurysm clipping in our hospital between January 1, 2014 and December 31, 2014. Outcomes and incidence of post-operative complications were compared between the LD group and the non-LD group in all patients and further analyzed in patients with the low modified Fisher Scale (mFS) (0-2) and high mFS (3-4). In 193 aSAH patients who underwent clipping, LD reduced the risk of hydrocephalus and improved the Glasgow Outcome Scale (GOS) score at discharge and at 3 months of follow-up. In the higher mFS group, patients who received LD had significantly lower risk of cerebral vasospasm, delayed cerebral infarction, and hydrocephalus; the GOS score was significantly higher in the LD group at discharge and at 3 months of follow-up. However, LD showed no benefits in terms of post-operative complications and outcome in patients with low mFS. LD for aneurysm clipping surgery after aSAH can reduce the risk of post-operative complications and improve the clinical outcome in patients with mFS grades 3 and 4. It should be considered as an adjunctive but dispensable treatment for aneurysm clipping in aSAH patient with low mFS.

Sensory nerves protect from the progression of early stage osteoarthritis in mice.

PURPOSE: Osteoarthritis (OA) is a chronic degenerative joint disease. Sensory nerves play an important role in bone metabolism and in the progression of inflammation. This study explored the effects of sensory nerve on OA progression at early stage in mice. MATERIALS AND METHODS: OA was induced via destabilization of the medial meniscus (DMM) in C57BL/6 mice. Sensory denervation was induced by subcutaneous injection of capsaicin (90 mg/kg) one week prior to DMM. One week after capsaicin injection, sensory denervation in the tibia was confirmed by immunofluorescent staining. Four weeks after DMM, micro-CT scans, histological analysis, and RT-PCR tests were performed to evaluate OA progression. RESULTS: Subcutaneous injection of capsaicin successfully induced sensory denervation in tibia. The Osteoarthritis Research Society International (OARSI) score and synovitis score of the capsaicin+DMM group were significantly higher than the score of the vehicle+DMM group. The BV/TV of the tibial subchondral bone in the capsaicin+DMM group was significantly lower than in the vehicle+DMM group. In addition, the level of expression of inflammatory factors in the capsaicin+DMM group was significantly higher than in the vehicle+DMM group. CONCLUSIONS: Capsaicin-induced sensory denervation accelerated OA progression at early stage in mice. To put it another way, sensory nerve protects from OA progression at early stage in mice.

Impact of obesity on restoration of sagittal balance and clinical efficacy after posterior lumbar interbody fusion.

To investigate the impact of obesity on the restoration of sagittal balance after posterior lumbar interbody fusion (PLIF). To examine the correlation between obesity and sagittal balance and their influence on clinical efficacy. A total of 183 patients who underwent PLIF for degenerative lumbar diseases between Jan 2015 and Dec 2015 were enrolled in this study. Based on their BMI, patients were divided into three groups: normal weight group (Group A), overweight group (Group B), and obesity group (Group C). Demographic data, intraoperative data, sagittal balance parameters, and clinical function scores were compared between each group. Correlation analysis was conducted between the BMI scores and each sagittal balance parameter. Multiple linear regression was used to assess the impact of each variable on clinical outcomes. All patients finished an average of 22.3 months follow-up. Group C had significantly higher blood loss and longer operations than Group A. SL and PT improved significantly in Group A while did not change in Group C. Compared with Group C, Group postoperative pelvic tilt (PT) was better restored in Group A. BMI was significantly correlated with change of lumbar lordosis (LL) and PT. Multiple linear regression analysis indicated that BMI and change of PT had a great influence on ODI improvement. Obesity may hinder the correction of sagittal balance and improvement of clinical efficacy in patients who undergo PLIF. Restoration of PT should be paid more attention to during surgery, as it may be associated with satisfactory clinical outcomes especially for obesity.

Association between sagittal balance and adjacent segment degeneration in anterior cervical surgery: a systematic review and meta-analysis.

BACKGROUND: ASD is a relatively common degenerative alteration after cervical surgery which occurs above or below the fused segment. In addition, some patients may need reoperation to treat severe ASD after the primary surgery. It was considered that sagittal balance is correlated with postoperative clinical outcomes; however, few studies have reported the influence of sagittal balance on ASD. The present study is designed to investigate whether sagittal balance impacts the pathology of adjacent segment disease (ASD) in patients who undergo anterior cervical surgery for degenerative cervical disease. METHODS: Databases including Pubmed, Embase, Cochrane library, and Web of Science were used to search for literature published before June 2018. Review Manager 5.3 was used to perform the statistical analysis. Sagittal balance parameters before and after surgery were compared between patients with and without ASD. Weighted mean difference (WMD) was summarized for continuous data and P < 0.05 was set for the level of significance. RESULTS: A total of 221 patients with ASD and 680 patients without ASD from seven articles were studied in this meta-analysis. There were no significant differences in most sagittal balance parameters between the two groups, except for postoperative cervical lordosis (CL) (WMD -3.30, CI -5.91, - 0.69, P = 0.01). CONCLUSIONS: Some sagittal balance parameters may be associated with the development of ASD after anterior cervical surgery. Sufficient restoration of CL may decrease the incidence of ASD. The results in present study needed to be expanded carefully and further high-quality studies are warranted to investigate the impact of sagittal balance on ASD.

Brain metastasis from early stage endometrial carcinoma 13 years after primary treatment: a case report and review of the literature.

Brain metastases from endometrial adenocarcinoma are quite rare. Here, we report a case of a 64-year-old woman who presented with a history of left limb weakness of 45 days' duration. Her medical history was significant for the endometrial carcinoma diagnosed 13 years earlier, for which she had undergone a total hysterectomy. The patient received a craniotomy and was finally diagnosed with brain metastasis from endometrial adenocarcinoma. We performed a MEDLINE search of the pertinent literature, searching for information focusing on the diagnosis, mechanism, treatment, and prognosis of this rare tumor type.