BACKGROUND:Recently, periprosthetic femoral fractures have been a common complication after total hip replacement. Vancouver type B1 periprosthetic femoral fractures commonly received internal fixation due to stable femoral prosthesis and less bone defects.
OBJECTIVE:To evaluate the effect of the application of Synthes cable system in the treatment of Vancouver type B1 periprosthetic femoral fractures after total hip replacement.
METHODS:From May 2009 to October 2012, 18 patients with Vancouver type B1 periprosthetic femoral fractures were treated with Synthes cable system in the Department of Orthopedics, Nantong First People’s Hospital. There were 8 males and 10 females with an average age of (62.67±8.67) years ranging 45 to 80 years. They received a further consultation at 1, 3 and 6 months after treatment. The function of hip joint was evaluated by Harrris evaluation standard:ful marks, 100 points, ≥ 90 points, excellent;80-89 points, better;70-79 points, good;<70 points, poor.
RESULTS AND CONCLUSION:Al 18 patients were fol owed up for 6 to 43 months. Mean healing period was (19.06±4.04) weeks. Harris score was (22.3±3.6) points before treatment in 18 cases. Harris score was higher significantly at 1, 3 and 6 months after treatment compared with that before treatment (P<0.01), and the recovery of hip function was good. Results indicated that Synthes cable system could help to restore the normal anatomic structure of femur in the greatest extent, showing simple operation, little injury, high stability and high safety. It is an ideal method for treating Vancouver type B1 periprosthetic femoral fractures.

BACKGROUND:Serious patel ar comminuted fractures can be treated by a number of methods such as cerclage with tension band steel wire or steel wire, or fixation with the nickel titanium patel a concentrator and absorption lines, or cerclage with 10# double-loop wire plus fixation with split-type patel a claws or with the memory al oy patel a concentrator. But it is difficult to achieve strongly fixed effect on patel a fractures by these methods.
OBJECTIVE:To investigate the clinical effects of suture with polyester braided wire and cerclage with belt lock cable on serious comminuted patel ar fractures.
METHODS:A retrospective analysis was performed on the clinical data of 57 patients with serious comminuted patel ar fractures who received suture with polyester braided wire and cerclage with belt lock cable from January 2007 to October 2012. According to AO classification of fractures, there were nine cases of type B3, 22 cases of type C2 and 26 cases of type C3. After satisfactory reduction of comminuted patel ar fractures during the operation, firstly we sewed up both sides of the expansion region of quadriceps muscle and stitched on periosteum and prepatel ar tissue with thick polyester braided wire fol owed by patel ar cerclage with belt lock cable. According to the stability of fracture blocks, tension band fixation with polyester braided wire was partial y added. After the operation, the clinical effects were assessed based on the Bostman score system.
RESULTS AND CONCLUSION:Total y 46 out of 57 cases were fol owed up with an average of 8 months (4-18 months). Al patients obtained bone union within 3-5 months. Wounds healed in the first stage without any infections, and fractures in al patients healed without complications such as implant loosening and skin irritation. According to the Bostman score system, 33 cases were scored excellent, 10 good and three fair. The excellent and good rate was 93.5%. It suggests that treatment of serious patel ar comminuted fracture by the combination of polyester braided wire and belt lock cable leads to closely contact fracture sites and reliably fix bone fragments. It can facilitate early postoperative range of motion exercises.

Objective To analyze whether β1,4-galactosyltransferase-Ⅰ(β1,4-GaiT-Ⅰ)expression correlates with the expression of tumor necrosis factor(TNF)-α in osteoarthritis(OA).Methods Synovial tissue samples from eight OA patients and eight healthy people were obtained as the experimental group and controls respectively.The mRNA levels of β1,4-GalT-Ⅰ and TNF-α were measured by reverse transcriptionpolymerase chain reaction(RT-PCR)and real-time PCR.Enzyme linked immunosorbent assay(ELISA)was used to test the expression of TNF-α in the protein level.Cellular colocalization of β1,4-GalT-Ⅰ and TNF-α was analyzed by double immunofluorescence.ANOVA and t-test was used for statistical analysis.Results ①Compared with the control group[β1,4-GalT-Ⅰ(0.48±0.09),TNF-α(0.46±0.07)],the expression of β1,4-GalT-Ⅰ(0.94±0.16)and TNF-α(1.19±0.19)were significantly increased in OA synovial tissue(t=3.47,t=4.06,P＜0.01)and there was colocalization between β1,4-GalT-Ⅰ and TNF-α;② Lipopolysaccharide (LPS)could induce fibroblast-like synoviocytes(FLSs)β1,4-GalT-Ⅰ[11.2±0.9 vs 2.9±0.5(dose effect),22.3±2.3 vs 4.4±0.9(time effect),F=83.03,F=157.58,P＜0.05]overexpression;③ LPS could induce FLSs TNF-α[(1256±96)vs(101±7)pg/ml,F=431.96,P＜0.01]overexpression;④ Not only endogenous TNF-α,but exogenous TNF-α could induce FLSs β1,4-GalT-Ⅰ[23.2±1.9 vs 8.4±1.3(dose effect),23.9±1.8 vs 11.5±1.3(time effect),F=124,F=93.6,P＜0.05]overexpression.Conclusion It is possible that FLSs mayuse TNF-αto control β1,4-GalT-Ⅰ functions during inflammation in OA.

Objective To investigate the expressions of spleen tyrosine kinase (Syk), c-Jun amino terminal kinase (JNK) and nucleotide binding oligomerization domain-like receptor protein 3 (NLRP3) inflammasome in the heart tissue in SD rat model of diabetic cardiomyopathy, and to explore the relationship between Syk, JNK and NLRP3. Methods Clean male SD rats were randomly divided into the control (Ctrl) group and diabetic cardiomyopathy model (DCM) group. Rats of DCM group were treated with a single intraperitoneal injection of streptozotocin (STZ), while rats of Ctrl group were injected with the same dose of citrate buffer. The random blood glucose level and body weight were monitored every week until 20 weeks after STZ or citrate buffer injection, then all the rats were killed and their hearts were obtained. Rat H 9c2 cardiomyocytes were randomly divided into normal glucose treatment (NG) group, high glucose treatment (HG) group, Syk inhibitor control (BAY) group and Syk inhibitor high glucose (HG+BAY) group. The Syk and JNK phosphorylations and NLRP3 protein expression were detected by Western blot assay in the heart tissue of SD rats and H9c2 cardiomyocytes. The NLRP3, cysteine-containing aspartate specific protease 1(caspase-1) and interleukin (IL)-1β expressions at mRNA level were detected by reverse transcription-polymerase chain reaction (RT-PCR). Results The random blood glucose level was significantly increased (P<0.05) and the body weight was significantly decreased (P<0.05) in DCM group compared with those of Ctrl group. The expressions of cardiac p-Syk, p-JNK and NLRP3 at protein level were significantly increased in DCM group compared with those of Ctrl group (P<0.05). Furthermore, the mRNA levels of NLRP3, caspase-1 and IL-1β were significantly up-regulated (P < 0.05). BAY treatment significantly inhibited the high glucose-induced NLRP3, caspase-1 and IL-1β mRNA expressions and p-JNK, NLRP3 protein expressions in H9c2 cardiomyocytes (P < 0.05). Conclusion JNK phosphorylation and NLRP3 inflammasome activation induced by Syk play an important role in the pathogenesis of diabetic cardiomyopathy.

Background::Sepsis is a systemic inflammatory syndrome induced by several infectious agents. Multiple organs are affected by sepsis, including the liver, which plays an important role in metabolism and immune homeostasis. Fibroblast growth factors (FGFs) participate in several biological processes, although the role of FGF5 in sepsis is unclear. Methods::In this study, lipopolysaccharide (LPS) was administrated to mice to establish a sepsis-induced liver injury. A similar in vitro study was conducted using L-02 hepatocytes. Western blot and immunohistochemistry staining were performed to evaluate the FGF5 expression level in liver tissues and cells. Inflammatory cell infiltrations, cleaved-caspase-3 expressions, reactive oxygen species and levels of inflammatory cytokines were detected by immunofluorescence, dihydroethidium staining, and reverse transcription quantitative polymerase chain reaction analysis, respectively. Flow cytometry was used to detect the apoptosis level of cells. In addition, ribonucleic acid (RNA)-sequencing was applied to explore the possible mechanism by which FGF5 exerted effects. Results::LPS administration caused FGF5 down-regulation in the mouse liver as well as in L-02 hepatocytes. Additionally, with FGF5 overexpression, liver injury and the level of hepatocyte apoptosis were ameliorated. Further, RNA sequencing performed in hepatocytes revealed the phosphoinositide-3-kinase/protein kinase B (PI3K/AKT) pathway as a possible pathway regulated by FGF5. This was supported using an inhibitor of the PI3K/AKT pathway, which abrogated the protective effect of FGF5 in LPS-induced hepatocyte injury. Conclusion::The anti-apoptotic effect of FGF5 on hepatocytes suffering from LPS has been demonstrated and was dependent on the activation of the PI3K/AKT signaling pathway.

Objective:To explore the application effect of the teaching method combining process-oriented-guided inquiry learning (POGIL) theory and micro-class in orthopedic clinical internship.Methods:The 118 interns who completed internship from January 2022 to December 2022 were randomly divided into a control group (58) and an experimental group (60). The control group received traditional teaching, while the experimental group received a teaching method combining POGIL theory and micro-class. After the internship, the two groups were compared for assessment scores (basic theoretical knowledge and professional theoretical knowledge), learning status (classroom performance and self-learning ability), clinical practice ability (Leicester Assessment Scale), and teaching satisfaction. The t-test and chi-square test were performed using SPSS 21.0. Results:After the internship, the assessment scores, classroom performance, self-directed learning ability scores, clinical skills, case writing scores, and teaching satisfaction of the experimental group were all higher than those of the control group ( t/ χ2=5.01, 3.72, 2.20, 6.57, 3.56, 4.52, P<0.05). Conclusions:The teaching method combining POGIL theory and micro-class can enhance the master of theoretical knowledge by orthopedic interns, optimize classroom performance, cultivate self-learning ability, and improve clinical practice ability and teaching satisfaction.

BACKGROUND: Syringomyelia is a progressive chronic disease that leads to nerve pain, sensory dissociation, and dyskinesia. Symptoms often do not improve after surgery. Stem cells have been widely explored for the treatment of nervous system diseases due to their immunoregulatory and neural replacement abilities. METHODS: In this study, we used a rat model of syringomyelia characterized by focal dilatation of the central canal to explore an effective transplantation scheme and evaluate the effect of mesenchymal stem cells and induced neural stem cells for the treatment of syringomyelia. RESULTS: The results showed that cell transplantation could not only promote syrinx shrinkage but also stimulate the proliferation of ependymal cells, and the effect of this result was related to the transplantation location. These reactions appeared only when the cells were transplanted into the cavity. Additionally, we discovered that cell transplantation transformed activated microglia into the M2 phenotype. IGF1-expressing M2 microglia may play a significant role in the repair of nerve pain. CONCLUSION Cell transplantation can promote cavity shrinkage and regulate the local inflammatory environment.Moreover, the proliferation of ependymal cells may indicate the activation of endogenous stem cells, which is important for the regeneration and repair of spinal cord injury.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.