Objective:To compare the clinical outcomes between OTA/AO-C open and closed fractures of the distal humerus treated by open reduction and internal fixation.Methods:The clinical data were retrospectively analyzed of the 70 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for OTA/AO-C fractures of the distal humerus from January 2014 to June 2017. Of them, 22 suffered from open fractures (Gustilo types Ⅰ/Ⅱ) and 48 closed fractures. There were 18 males and 4 females with an age of (42.6±13.0) years in the open group and 21 males and 27 females with an age of (42.2±17.1) years in the closed group. Analyzed were interval from injury to surgery, hospitalization time, injury energy and functional outcomes which included range of motion (ROM) in elbow flexion and extension, ROM in elbow rotation, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH), complications and rate of secondary surgery.Results:There was no significant difference between the 2 groups in age, injury energy or interval from injury to surgery ( P>0.05), but there were significantly more males in the open group than in the closed group ( P=0.011). The follow-up time for all the patients averaged 34.0 months (from 25 to 54 months). There were no statistically significant differences between the 2 groups in hospitalization time [9.5(6.0, 13.0) d versus 8.5 (6.0, 11.0) d], ROM in flexion and extension [120.0° (100.0°, 137.8°) versus 128.5° (110.0°, 140.0°)], ROM in rotation [155.0° (151.3°, 155.0°) versus 155.0° (155.0°, 155.0°)], MEPS [95.0 (80.0, 100.0) versus 95.0 (80.0, 100.0)] or DASH [2.6 (0.63, 9.2) versus 1.7 (0.0, 8.5)] ( P>0.05). There were no statistically significant differences between the 2 groups either in rate of secondary surgery [36.4% (8/22) versus 33.3% (16/48)], ulnar nerve symptoms [54.5% (12/22) versus 60.4% (29/48)], local irritability in the region of internal fixation [9.1% (2/22) versus 6.3% (3/48)] or elbow stiffness [13.6% (3/22) versus 10.4% (5/48)] ( P>0.05). Conclusion:Open reduction and internal fixation can lead to similar clinical outcomes in the treatment of both open (Gustilo types Ⅰ/Ⅱ) and closed distal humeral fractures of OTA/AO-C, with no significant differences in postoperative ROM, functional scores or complications.

Objective To understand the supply situation of the UAE’s medicinal market and provide reference for Chinese medicines which are going to import into the UAE. Methods The data related to the existing varieties and dosage forms in the UAE’s medicinal market were collected and analyzed, and compared to the medicines in China. Results To December 31st, 2021, the number of existing pharmaceutical products in the UAE was 5 395 and the number of varieties was 1 637. According to the statistical results of the New Pharmacotherapeutics (18th Edition), the number of pharmaceutical varieties in China was 1 558. The number of overlapping pharmaceutical varieties between the two countries was 604, and the differences mainly focus on medicines of alimentary tract and metabolism, anti-infectives for systemic use, medicines for the nervous system, antiparasitic products, insecticides and repellents. There were 194 pharmaceutical dosage forms in the UAE, with oral administration, injectable administration and dermal administration ranking among the top three. Conclusion There are certain commonalities and also differences in pharmaceutical varieties and dosage forms between China and the UAE, which indicated that our pharmaceutical varieties need to be investigated in detail before importing into the UAE. At the same time, China also could learn from the experience of the UAE and strengthen the research of new medicines and mechanical combinations to further enrich the domestic pharmaceutical market.

Objective: To compare the clinical outcomes between young and elderly patients with humeral intercondylar fracture treated by open reduction and internal fixation (ORIF) with either parallel or orthogonal double-plate. Methods: From January 2013 to December 2017, 54 patients with humeral intercondylar fracture were treated at Department of Orthopedic Trauma, Jishuitan Hospital by ORIF with anatomical locking compression plate (LCP) (either parallel or orthogonal double-plate configuration). According to their age, the patients were divided into a young group (from 18 to 30 years old) of 29 cases with an age of 25.5±3.6 years and an elderly group (≥60 years old) of 25 cases with an age of 67.1±5.8 years. The 2 groups were compared in terms of perioperative data, ranges of motion (flextion, extension and rotation), numeric rating scale for pain (NRS), Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (Quick-DASH) at the last follow-up, complications and secondary surgery. Results: The 2 groups were comparable because there were no significant differences in the preoperative general data except in injury energy, combined injury and gender between them (P>0.05). The young group had significantly more cases of high-energy injury and combined injuries than the elderly group(P<0.05). All patients were followed up for 33.6±15.0 months (from 12 to 63 months). The total blood loss in the elderly group (643.9±298.7 mL) was significantly less than that in the young group (953.9±554.6 mL) (P<0.05). At the last follow-up, there were no significant differences between the 2 groups in ranges of motion, NRS or MEPS (P>0.05), but the elderly group had significantly higher Quick-DASH scores (13.9±14.4 points) than the young group (5.7±8.9 points) (P<0.05). There was no significant difference in postoperative elbow stiffness or postoperative ulnar nerve symptoms betwee the 2 groups (P>0.05), but the rate of secondary surgery in the young group (37.9%, 11/29) was significantly higher than that in the elderly group (4.0%, 1/25) (P<0.05). Conclusions In the treatment of humeral intercondylar fractures, ORIF with LCP (either parallel or orthogonal double-plate configuration) can lead to similarly safe and effective clinical outcomes for both young and elderly patients.

Objective: To explore the risk factors for elbow stiffness after open reduction and internal fixation (ORIF) for intercondylar fractures of the distal humerus. Methods: From January 2013 to May 2017, 159 patients underwent ORIF for intercondylar fractures of the distal humerus with dual plating. They were 83 males and 76 females with a mean age of 42.6 years (from 14 to 79 years). They were divided into 2 groups according to their range of motion at the latest follow-up and the secondary elbow arthrolysis they had undergone or not. The stiffness group had extension-flexion and/or pronation-supination <100° and secondary elbow arthrolysis while the non-stiffness group had extension-flexion and pronation-supination ≥100° and no secondary elbow arthrolysis. Age, gender, fracture side, mechanism of injury, AO fracture classification, open/close fracture, additional fracture, preoperative nerve injury, time from injury to surgery, surgical approach, configuration of plating, medication for anti-heterotopic ossification and implant removal were analyzed as risk factors for elbow stiffness using Logistic regression analysis. Results: The mean follow-up period for this cohort was 32.0 months (from 10 to 63 months). The latest follow-up showed fracture union in all the patients. The stiffness group had 38 patients and the non-stiffness group 121. Multivariate regression analysis showed that high energy trauma (OR=3.141, 95%CI 1.396~7.070, P=0.006) and time from injury to surgery >one week (OR=2.596, 95%CI 1.123~6.000, P=0.026) were independent risk factors for elbow stiffness after ORIF for intercondylar fractures of the distal humerus. Conclusion The patients with high energy trauma and time from injury to surgery >one week should be treated with caution and special care in clinical practice because the 2 factors are closely related to posttraumatic elbow stiffness after ORIF for intercondylar fracture of the distal humerus.

Objective:To investigate the efficacy of TiRobot navigation for hinged external fixation in elbow arthrolysis.Methods:The 11 patients were retrospectively analyzed who had been treated by elbow arthrolysis at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital using TiRobot navigation for hinged external fixation. There were 9 males and 2 females with a mean age of 39.3 years (from 21 to 66 years). Their elbow range of motion (ROM) was compared between preoperation and the final follow-up. Their visual analogue scale (VAS) and Mayo elbow performance score (MEPS) and complications were documented at the final follow-up.Results:The rotation axis of the elbow joint was positioned with the aid of intraoperative robot navigation in 11 patients.The deviation of entry point averaged 0.21 mm (from 0.05 to 0.41 mm) and the deviation of exit point 0.23 mm (from 0.06 to 0.38 mm). The follow-up time for the 11 patients averaged 25.8 months (from 16 to 32 months). Their elbow flexion and extension was 133.0° (134.9°, 138.7°) and rotation 164.6° ±17.5° at the final follow-up, significantly improved compared with their preoperative values [0.8°(0°, 33.7°) and 122.9°±49.0°] ( P<0.05). Their VAS averaged 0.2 (from 0 to 1) and MEPS 96.8 (from 85 to 100) at the final follow-up, giving 9 excellent and 2 good cases. There was no case of radial nerve injury, pin instability, pin breakage, pin infection or peri-pin fracture. Conclusion:When TiRobot navigation is used for hinged external fixation in elbow arthrolysis, the axis of rotation can be accurately located, leading to satisfactory functional outcomes for the patients.

The most common indications for total elbow arthroplasty (TEA) are rheumatoid arthritis, osteoarthritis, and post-traumatic arthritis. However, with the rapid development of the prosthesis and surgical techniques, the indications of TEA have been expanded to post-traumatic instability, failure of internal fixation, and acute comminuted distal humeral fractures in elderly patients. The most common complications of the classic Bryan-Morrey approach are postoperative ulnar nerve symptoms and weakness of the triceps muscle. Although the triceps-sparing approach enters the elbow joint through both sides of the triceps and retains the triceps brachii, it adds the operation difficulty and there still exist problems regarding postoperative ulnar nerve symptoms, extensive subcutaneous dissection, and large amount of drainage. In September 2018, Professor O'Driscoll introduced his modified small tongue-shaped flap approach, named as Diamond-Pop approach, but it has not been reported yet in recent literatures. The authors conducted a retrospective case series study to evaluate the clinical outcomes of 20 patients with elbow trauma or arthritis treated by TEA using this approach in Beijing Jishuitan Hospital from September 2018 to September 2019.

Objective:To study the clinical efficacy of modified open elbow arthrolysis in the treatment of traumatic elbow stiffness.Methods:A retrospective analysis was performed on 120 patients who underwent modified open elbow arthrolysis in Beijing Jishuitan Hospital from January 2018 to December 2020. The age of the included patients was (37.7±12.4) years (ranged 18-64 years), including 54 males and 66 females. The medical records were reviewed, the range of motion (ROM) and functional status of the patients before operation and at the last follow-up were compared including visual analogue scale (VAS), Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) score. Complications and secondary operations were also recorded. Measurement data with normal distribution were presented as mean ± standard deviation( ± s) and comparison between groups was conducted using the t-test; Measurement data of skewed distribution were expressed as M ( Q1, Q3), and Rank-sum test was used for inter-group comparison. Results:The preoperative extension of 120 patients was 43.6° (33.8°, 60.1°), the flexion was 78.7° (59.8°, 98.1°), and the flexion-extension ROM was 25.6° (0.0°, 54.5°); the preoperative pronation was 51.8° (33.0°, 67.0°), the supination was 85.1° (65.7°, 90.0°), and the rotation ROM was 136.9° (99.1°, 157.5°). Postoperative extension was 14.2° (7.0°, 24.8°), flexion was 129.5° (120.0°, 138.1°), flexion-extension ROM was 115.5° (94.4°, 127.3°); postoperative pronation was 65.0° (47.1°, 75.0°), the supination was 88.3° (78.6°, 90.0°), and the rotation ROM was 151.9° (131.7°, 163.4°). Postoperative extension, flexion, flexion-extension ROM, pronation, supination, and rotation ROM were all higher than those before operation, and the differences were statistically significant ( P<0.001). The VAS of 120 patients was 1.0 (0.0, 3.0) scores before operation and 0.0 (0.0, 1.0) scores after operation. The MEPS was 60.0 (50.0, 75.0) scores before operation and 100.0 (85.0, 100.0) scores after operation. The preoperative DASH was 37.5 (20.1, 51.3) scores, and the postoperative DASH was 7.9 (3.3, 13.3) scores. The postoperative VAS, MEPS, and DASH were significantly improved compared with those before operation, and the differences were statistically significant ( P<0.001). Residual ulnar nerve symptoms occurred in 18 cases, recurrence of heterotopic ossification in 42 cases, and hematoma in 3 cases. Conclusions:Modified open elbow arthrolysis is a safe and effective surgical method for the treatment of traumatic elbow stiffness. It can significantly improve the function of the patient, reduce the occurrence of elbow instability, avoid the use of external fixators, and reduce the cost of the patient.

Objective To investigate the mechanism of Bixie Fenqing Pills in improving renal injury caused by hyperuricemia(HUA).Methods The HUA model rats were induced by gavaging with oxonic acid potassium salt,adenine combined with 10％yeast powder feed for 2 weeks.The model was evaluated based on serum uric acid(SUA)level.The successfully modeled rats were ran-domly divided into model group,low-dose Bixie Fenqing Pills group,medium-dose Bixie Fenqing Pills group,high-dose Bixie Fenqing Pills group,and febuxostat group,with 8 rats in each group.The drug administration groups were gavaged with the corresponding drugs,while the control group and the model group were gavaged with an equal volume of 0.5％carboxymethyl cellulose sodium(CMC-Na).After 4 weeks of continuous drug administration,the rats were sacrificed for sampling.Biochemical method was used to detect the serum levels of SUA,adenosine deaminase(ADA),xan-thine oxidase(XOD),blood urea nitrogen(BUN),and serum creatinine(SCr)in the rats in each group;hematoxylin-eosin(HE)staining was used to observe the pathological changes of renal tis-sues;the Western blot was used to detect the expression levels of ATP-binding cassette subfamily G member 2(ABCG2),glucose transporter 9(GLUT9),and multi-drug resistance-associated protein 4(MRP4)in renal tissues;immunohistochemistry was used to detect the protein expression levels of phosphatidylinositol-3-kinase(PI3K),protein kinase B(AKT),and nuclear factor-κB(NF-κB)in renal tissues.Results HE staining showed that the renal unitstructure in the model group was incomplete,with multiple edema in the renal interstitium,a small number of glomeruli showing atro-phy,and incomplete epithelial cells on the glomerular capsule wall;the serum levels of SUA,ADA,XOD,SCr and BUN in the model group were significantly increased(P＜0.01);the expression of GLUT9 protein in renal tissue was upregulated,while the expression levels of ABCG2 and MRP4 proteins were significantly decreased(P＜0.05);immunohistochemical results showed that the ex-pression levels of PI3K,AKT and NF-κB proteins in renal tissues in the model group were increased significantly(P＜0.05).Compared with the model group,Bixie Fenqing Pills could significantly ef-fectively improve renal injuryin HUA rats,reduce serum levels of SUA,ADA,XOD,SCr and BUN,downregulate the expression of GLUT9 protein in renal tissues,and increase the expression levels of ABCG2,MRP4,PI3K,AKT and NF-κB proteins(P＜0.05).Conclusion Bixie Fenqing Pills may affect the production and metabolism of uric acid by regulating the PI3K/AKT/NF-κB pathway and the expression of uric acid transporter proteins,thereby improving renal injury in HUA rats.

Objective To investigate the mechanism of Bixie Fenqing Pills in improving renal injury caused by hyperuricemia(HUA).Methods The HUA model rats were induced by gavaging with oxonic acid potassium salt,adenine combined with 10％yeast powder feed for 2 weeks.The model was evaluated based on serum uric acid(SUA)level.The successfully modeled rats were ran-domly divided into model group,low-dose Bixie Fenqing Pills group,medium-dose Bixie Fenqing Pills group,high-dose Bixie Fenqing Pills group,and febuxostat group,with 8 rats in each group.The drug administration groups were gavaged with the corresponding drugs,while the control group and the model group were gavaged with an equal volume of 0.5％carboxymethyl cellulose sodium(CMC-Na).After 4 weeks of continuous drug administration,the rats were sacrificed for sampling.Biochemical method was used to detect the serum levels of SUA,adenosine deaminase(ADA),xan-thine oxidase(XOD),blood urea nitrogen(BUN),and serum creatinine(SCr)in the rats in each group;hematoxylin-eosin(HE)staining was used to observe the pathological changes of renal tis-sues;the Western blot was used to detect the expression levels of ATP-binding cassette subfamily G member 2(ABCG2),glucose transporter 9(GLUT9),and multi-drug resistance-associated protein 4(MRP4)in renal tissues;immunohistochemistry was used to detect the protein expression levels of phosphatidylinositol-3-kinase(PI3K),protein kinase B(AKT),and nuclear factor-κB(NF-κB)in renal tissues.Results HE staining showed that the renal unitstructure in the model group was incomplete,with multiple edema in the renal interstitium,a small number of glomeruli showing atro-phy,and incomplete epithelial cells on the glomerular capsule wall;the serum levels of SUA,ADA,XOD,SCr and BUN in the model group were significantly increased(P＜0.01);the expression of GLUT9 protein in renal tissue was upregulated,while the expression levels of ABCG2 and MRP4 proteins were significantly decreased(P＜0.05);immunohistochemical results showed that the ex-pression levels of PI3K,AKT and NF-κB proteins in renal tissues in the model group were increased significantly(P＜0.05).Compared with the model group,Bixie Fenqing Pills could significantly ef-fectively improve renal injuryin HUA rats,reduce serum levels of SUA,ADA,XOD,SCr and BUN,downregulate the expression of GLUT9 protein in renal tissues,and increase the expression levels of ABCG2,MRP4,PI3K,AKT and NF-κB proteins(P＜0.05).Conclusion Bixie Fenqing Pills may affect the production and metabolism of uric acid by regulating the PI3K/AKT/NF-κB pathway and the expression of uric acid transporter proteins,thereby improving renal injury in HUA rats.

Objective:To explore the effect of combined administration of intravenous and topical tranexamic acid on perioperative blood loss in elbow arthrolysis.Methods:A retrospective analysis was conducted of 31 patients who had undergone elbow arthrolysis due to elbow stiffness from April 2019 to November 2020 at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital. An observational group of 15 patients were subjected to combined administration of intravenous and topical tranexamic acid while a control group of 16 patients to no administration of tranexamic acid. In the observational group, 15 mg/kg of tranexamic acid was injected intravenously 5 to 10 minutes before surgery and 1.0 g of tranexamic acid was injected locally in the area of anterior and posterior joint capsules after incision was closed while drainage tubes were clamped for 2 hours before release. In the control group, there was no special operative procedure while drainage tubes were also clamped for 2 hours before release. The 2 groups were compared in terms of blood loss on day 1 and day 3 after operation, drainage volume on day 1 after operation, total drainage volume, time for indwelling drainage tube, complications, and Mayo elbow performance score (MEPS) at 3 months after operation.Results:There were no statistically significant difference in preoperative general data between the 2 groups, showing they were comparable ( P>0.05).On day 1 and day 3 after operation, the blood loss was respectively (533.4±318.3) mL and (792.0±375.6) mL in the observational group, and respectively (866.4±480.5) mL and (1,403.0±636.5) mL in the control group, showing significantly differences between the 2 groups ( P<0.05). The drainage volume on day 1 after operation was (151.3±90.1) mL in the observational group and (235.0±126.1) mL in the control group, showing a significant difference between the 2 groups ( P<0.05). There was no statistically significant difference in total drainage volume or time for indwelling drainage tube between the 2 groups ( P>0.05). There were no such complications as thromboembolic events in either group. There was no significant difference in MEPS between the 2 groups at 3 months after operation ( P>0.05). Conclusions:Combined administration of intravenous 15 mg/kg and topical 1.0 g tranexamic acid may reduce blood loss on day 1 and day 3 after operation and drainage volume on day 1 after operation, and may not increase the risk of thromboembolic events, but cannot reduce total drainage volume or time for indwelling drainage tube. Application of tranexamic acid may not affect early elbow joint function after operation.