Nomilin targets the Keap1-Nrf2 signalling and ameliorates the development of osteoarthritis.

Osteoarthritis (OA) is a long-term and inflammatory disorder featured by cartilage erosion. Here, we describe nomilin (NOM), a triterpenoid with inflammation modulatory properties in variety of disorders. In this study, we demonstrated the latent mechanism of NOM in alleviating the progress of OA both in vitro and in vivo studies. The results showed that NOM pre-treatment suppressed the IL-1ß-induced over-regulation of pro-inflammation factors, such as NO, IL-6, PGE2 , iNOS, TNF-α and COX-2. Moreover, NOM also down-regulates the degradation of ECM induced by IL-1ß. Mechanistically, the NOM suppressed NF-κB signalling via disassociation of Keap1-Nrf2 in chondrocytes. Furthermore, NOM delays the disease progression in the mouse OA model. To sum up, this research indicated NOM possessed a new potential therapeutic option in osteoarthritis.

A technique combining "U" shape suture and shared tunneling to treat the posterior cruciate ligament rupture and posterior root tears of the medial meniscus.

BACKGROUND: The standard treatment of the posterior cruciate ligament (PCL) rupture accompanied with the posterior root of medial meniscus (PRMM) tears is controversial. Our research describes a minimally invasive technique for the PCL rupture accompanied with the PRMM tears. METHODS: We described a "U" shape suture and shared tunneling technique to treat the PCL rupture accompanied with PRMM tears. Three patients (ages 28, 42, and 59 years old) who underwent this surgery have been followed up for more than 1 year at most. The MRI was done, and the hospital for special surgery (HSS) score was adopted to evaluate the clinical effect. Firstly, we built both femoral and tibial bone tunnels for the PCL reconstruction. Secondly, we used the suture hook to pass the suture line through the PRMM. Thirdly, we passed the prepared tendon through the bone tunnel and fixed the prepared tendon by an endobutton plate and an interference screw (Smith & Nephew) respectively on the side of the femur and tibia. At last, we used an endobutton plate (Smith & Nephew) outside the tibial bone tunnel to fix the PRMM. RESULTS: These three patients did not show any complications. At 1 year after the operation, we found good knee stability, negative posterior drawer test, and normal range of motion compared with the contralateral knee joint. The MRI also showed a good union of the PRMM and PCL. The hospital for special surgery (HSS) score was 90 points. CONCLUSIONS: With an ideal therapeutic effect, this technique is worthy to be promoted for patients with the PCL rupture and PRMM tears.

Salidroside inhibits steroid-induced avascular necrosis of the femoral head via the PI3K/Akt signaling pathway: In vitro and in vivo studies.

Dexamethasone (Dex) and other glucocorticoids are widely used to treat serious infections and immunological diseases, however they may cause steroid­induced avascular necrosis of the femoral head (SANFH). Salidroside (Sal) has demonstrated an anti­apoptotic effect on neurocytes by activating the phosphoinositide 3­kinase (PI3K)/protein kinase B (Akt) signaling pathway. In the present study, primary osteoblasts were used in vitro and in rats in vivo to determine the anti-apoptotic effect of Sal on SANFH. The result of the present study demonstrated that pretreatment with Sal increased the cell survival rate while decreasing the cell apoptosis and lactate dehydrogenase release rate. Additionally, Sal also caused the reduction of TUNEL positive cells in TUNEL staining assay. Sal decreased the expression of cleaved caspase-3, cleaved caspase­9, apoptosis regulator BAX and cytochrome C, while it increased the expression of B cell lymphoma­2 and phosphorylated­Akt in Dex­induced osteoblasts. In vivo Sal protected against SANFH in rats by decreasing the percentage of empty lacunae. The present study demonstrated that Sal alleviated Dex­induced osteoblast apoptosis by activating the PI3K/Akt signaling pathway and downregulating caspase­3 expression in osteoblasts. Sal also protected against SANFH in a rat model of SANFH by decreasing the percentage of empty lacunae. The inhibition of the mitochondrial apoptosis pathway was also involved. Further research is required to determine the full underlying mechanisms by which Sal has an effect.

Calcifying tendinitis of the long head of the biceps brachii and superior labrum: a report of one case and literature review.

Calcifying tendinitis of the shoulder is characterized with the formation of the calcium deposits in tendon, which mostly involves supraspinatus. The formation of the calcium deposits may be related to the excessive mechanical stimulation and non-tenocytes generation from tendon stem cell. The disease is usually associated with pain, especially when activating the shoulder. We describe one case of calcifying tendinitis involving the long head of the biceps brachii and superior labrum. The related literature and researches are also reviewed. After reviewing the past articles, there are no similar cases of calcification involving the long head of the biceps brachii and superior labrum. The diagnosis and treatment scheme may be similar with Calcifying tendinitis of the supraspinatus. The differential diagnosis of calcification involving the long head of the biceps brachii and superior labrum and glenoid cavity fracture is very important. Calcifying tendinitis involving the long head of the biceps brachii and superior labrum is rare and the diagnosis need to rule out fractures. The surgical treatment of arthroscopy is effective and relieves the symptoms quickly, but may not be the first choice.

Intramedullary nailing versus plating for extra-articular distal tibial metaphyseal fracture: a systematic review and meta-analysis.

INTRODUCTION: With development in the techniques of reduction and fixation, there has been a controversy in comparison between intramedullary nailing (IMN) and plating for the treatment of distal tibial metaphyseal fracture (DTF). The study aimed to investigate: (1) which fixation, IMN or plating, was better in the clinical outcomes and in the complications for the treatment of DTF and (2) which modifying variables affected the comparative results between the two modalities. METHODS: PubMed, EMBASE, OVID, Scopus, ISI Web of Science, the Cochrane Library, Google Scholar and specific orthopaedic journals were searched from inception to July 2013, using the search strategy of '('Fracture Fixation, Intramedullary' [MeSH]) AND ('Tibial Fractures' [MeSH]) AND (plate OR plating)'. All prospective and retrospective controlled trials comparing function, pain, bone union and complications between IMN and plating for DTF were identified. Our analysis had no limitation of the language or the publication year. The primary outcome measurements were complication rate, union time, operation time and hospital stays, while the secondary outcome measurements were functional score and pain score. RESULT: Fourteen of 6620 studies with 842 patients were included. IMN was probably preferential to plating for DTF given its higher functional score (p=0.01), lower risk of infection (p=0.02) and comparable pain score (p=0.33), total complication rate (p=0.53) and time to union (p=0.86). However, plating had a lower malunion rate than IMN (p<0.0001). All the results were based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence of moderate quality. CONCLUSIONS: With a satisfying alignment obtained, IMN may be preferential to plating for fixation of DTF with better function and lower risk of infection. However, IMN showed higher malunion rate for fixation of DTF. With the biases in our meta-analysis, it will ultimately require a rigorous and adequately powered randomised controlled trial (RCT) to prove. LEVEL OF EVIDENCE: Level III, therapeutic study (systematic review).