Treatment of Unstable Distal Clavicle Fractures With Multiple Steinmann Pins-A Modification of Neer's Method: A Series of 56 Consecutive Cases.

OBJECTIVES: To introduce an alternative fixation technique for Neer type II fractures using Steinmann pins (S-pins). DESIGN: Retrospective case series study. SETTING: Operating room followed by clinic in tertiary hospital. PATIENTS/PARTICIPANTS: Between 2001 and 2013, among 66 consecutive patients diagnosed with Neer type II distal clavicle fractures, 11 patients were excluded and 56 clavicles of 55 patients who underwent surgical treatment with multiple transacromial S-pins were selected for analysis. INTERVENTION: Multiple transacromial S-pin (2.0-mm diameter) fixation was performed. Interfragmentary fixation was performed with 2.7-mm screws in case of oblique fractures. MAIN OUTCOME MEASURES: Radiographic results, complications, and clinical outcomes including the Constant-Murley score, the University of California at Los Angeles Shoulder score, and the disabilities of the arm, shoulder, and hand score were evaluated. RESULTS: Radiologic union was achieved in all patients. Coracoclavicular distance was increased by 6.4% compared with that of the uninjured side (P < 0.001). Fourteen patients had lateral migrations of 1 pin (mean migration distance, 11.6 mm). The mean Constant-Murley score was 94.3 (range, 85-100), mean University of California at Los Angeles score was 33.1 (range, 29-35), and mean disabilities of the arm, shoulder, and hand score was 2.7 (range, 0-8.3). The average follow-up period was 30.5 months (range, 24-81 months). CONCLUSIONS: Good functional and radiologic results were achieved by the insertion of multiple transacromial S-pins with interfragmentary screw fixation. With its wide indication and relatively simple procedure, this technique may be a possible surgical option for the treatment of Neer type II distal clavicle fractures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Urinary trypsin inhibitors afford cardioprotective effects through activation of PI3K-Akt and ERK signal transduction and inhibition of p38 MAPK and JNK.

BACKGROUND: We determined the effect of urinary trypsin inhibitors (UTI) in regional myocardial ischemia/reperfusion (I/R) injury and its underlying mechanisms involving the role of prosurvival kinases such as phosphatidylinositol-3-OH kinases (PI3K)-Akt and extracellular signal-regulated kinases (ERK 1/2) and apoptotic kinases such as p38 and JNK. METHODS: The rats were anesthetized and subjected to an I/R insult consisting of 30-min left anterior descending coronary artery (LAD) occlusion followed by reperfusion. Infarct size was measured after 120 min of reperfusion. UTI was given alone or along with wortmannin (inhibitor of PI3K) or PD098059 (inhibitor of ERK1/2) before LAD occlusion. The phosphorylation of Akt, ERK1/2, p38 and JNK was determined by immunoblotting after 5 min of reperfusion. UTI was administered 10 min before LAD occlusion, and wortmannin and PD098059 were administered 20 min before LAD occlusion. RESULTS: UTI significantly reduced the infarct size compared with the control. Wortmannin or PD098059 alone did not affect the infarct size, but they abolished the UTI-induced cardioprotective effect. UTI significantly reduced the phosphorylation of p38 and JNK, while it enhanced that of Akt and ERK1/2. CONCLUSIONS: UTI has a protective effect against regional myocardial I/R injury through activation of survival kinases PI3K-Akt and ERK1/2 and attenuation of p38 and JNK.

Dose-dependent pharmacokinetics of KR-31378, a new neuroprotective agent for ischaemia-reperfusion damage in dogs.

Dose-dependent pharmacokinetic parameters of KR-31378, a new neuroprotective agent for ischaemia-reperfusion damage, were evaluated after intravenous and oral administration of the drug at doses of 5, 10 and 25 mg/kg to male beagle dogs. After intravenous administration, the dose-normalized (based on 5 mg/kg) areas under the plasma concentration-time curve from time zero to time infinity (AUC values, 725, 1450 and 2300 micro g min/ml for 5, 10 and 25 mg/kg, respectively) were significantly different among the three dose ranges studied; the value increased more proportionally as the dose increased. This could be due to slower total body clearance (Cl) with increasing doses (6.90, 3.46 and 2.17 ml/min/kg). The slower Cl value with increasing doses may be due to saturable metabolism of KR-31378 in dogs. After oral administration, the dose-normalized (based on 5 mg/kg) AUC values (833, 1450 and 1920 micro g min/ml) at 5 mg/kg were significantly smaller than those at 10 and 25 mg/kg. Note that the AUC values were comparable (not significantly different) between intravenous and oral administration at all doses studied, indicating that the absorption of KR-31378 from the gastrointestinal tract was essentially complete and the first-pass (gastric, intestinal and/or hepatic first-pass) effects were almost negligible in dogs.