Establishment of a reference interval for total carbon dioxide using indirect methods in Chinese populations living in high-altitude areas: A retrospective real-world analysis.

BACKGROUND: Hypoxia leads to different concentrations of the bicarbonate buffer system in Tibetan people. Indirect methods were used to establish the reference interval (RI) for total carbon dioxide (tCO2) based on big data from the adult population of Tibet, a high-altitude area in Western China. METHODS: Anonymous tCO2 test data (n = 442,714) were collected from the People's Hospital of the Tibet Autonomous Region from January 2018, to December 2021. Multiple linear regression and variance component analyses were performed to assess the effects of sex, age, and race on tCO2 levels. Indirect methods, including Hoffmann, Bhattacharya, expectation maximization (EM), kosmic and refineR, were used to calculate the total RI and ethnicity-partitioned RI. RESULTS: A total of 230,821 real-world tCO2 test results were eligible. Sex, age, and race were significantly associated with the tCO2 levels. The total and ethnically-partitioned RIs estimated using the five indirect methods were comparable. The total RI of tCO2 was 14-24 mmol/L (calculated using Hoffmann and refineR) and 15-24 mmol/L (Bhattacharya, EM and kosmic). For Han nationality, the RIs were 14-25 mmol/L (calculated using Hoffmann and Bhattacharya), 16-23 mmol/L (EM), 15-24 mmol/L (kosmic), and 14.2-24.5 mmol/L (refineR). For the Tibetan population, the RIs were 14-24 mmol/L (calculated using Hoffmann and refineR), 15-24 mmol/L (Bhattacharya and kosmic), and 15-23 mmol/L (EM). The established RIs were significantly lower than those living at lower altitudes area (22-29 mmol/L) that was provided by the manufacturer. CONCLUSION: The tCO2 RI of the populations living on the Tibetan Plateau was significantly lower than those at the lower altitudes. The RIs established using indirect methods are suitable for clinical applications in Tibet.

Clinical efficacy of arthroscopy combined with irrigation and drainage in the treatment of brucellosis of the hip.

PURPOSE: To evaluate the short-term clinical efficacy of hip arthroscopy combined with catheter irrigation and drainage in the treatment of brucellosis of the hip. METHODS: From 2015 to 2020, 11 patients with a diagnosis of brucellosis-induced unilateral hip joint arthritis were treated with arthroscopic debridement and lesion synovectomy. Catheterization was performed during the operation, and normal saline lavage was continued after the operation. A regimen of doxycycline plus rifampicin, plus a third-generation cephalosporin in cases of refractory infections, were used for three months. RESULTS: The rate of positive synovial bacterial culture during the operation was 91% (10/11). Postoperative pathological examination of 11 patients showed purulent arthritis; this result combined with the disease history led to the diagnosis of all patients with brucellosis of the hip. All patients were followed up for more than 24 months. From three months after surgery to the last follow-up, both ESR and CPR were within the normal range, but the VAS score decreased significantly (P < 0.05), and the mHHS and HOS-ADL scores increased significantly (P < 0.01). Compared with that on preoperative imaging, the measurement of the hip joint space on imaging at the last follow-up showed no significant change (P > 0.01). CONCLUSION: Arthroscopic treatment of brucellosis in the hip joint not only preserves the joint fluid and lesion tissue for a clear diagnosis but also allows thorough removal of the infected and injured tissue during surgery. Hip arthroscopy combined with postoperative tube irrigation and drainage is an effective method for the diagnosis and treatment of brucellosis in the hip joint.

Modified posterior fibular groove deepening procedure with repair of the superior peroneal retinaculum for peroneal tendon subluxation.

PURPOSE: To evaluate the clinical results of modified peroneal sulcus deepening combined with superior peroneal retinaculum repair in peroneal tendon subluxation treatment. METHODS: From 2016 to 2020, 18 patients with peroneal tendon subluxation were diagnosed and treated; all patients underwent modified peroneal sulcus deepening combined with superior peroneal retinaculum repair. The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS-AH) score, and subjective patient satisfaction were evaluated before surgery and during follow-up. RESULTS: The operative time was 66.44 ± 5.22 min. All patients' surgical incisions showed grade A healing, and there were no complications. All patients were followed up for 24-48 months; no patients were lost to follow-up. At the last follow-up, the VAS and AOFAS-AH scores were significantly improved compared with those pre-operatively (P < 0.05). There was no significant difference in the activity of the 18 patients between pre- and post-operatively, and all patients recovered their normal gait before injury. CONCLUSION: Modified fibular groove deepening combined with superior peroneal retinaculum repair for treating peroneal tendon subluxation may be a simple operation with minimal trauma, rapid recovery, and good clinical efficacy.

Suspension fixation of iliac bone grafts under arthroscopy is an effective method for the treatment of unstable bony Bankart disease of the shoulder joint in patients with joint relaxation.

PURPOSE: To evaluate the results of arthroscopic autologous iliac bone graft suspension fixation combined with the Remplissage procedure in the treatment of recurrent shoulder dislocation with bony Bankart lesions and joint hyperlaxity. METHODS: From 2018 to 2020, 22 patients with joint laxity underwent arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure due to recurrent shoulder dislocation. Clinical assessment included range of motion (forward flexion, abduction, 90° external rotation, conventional external rotation, adduction, and internal rotation), visual analog scale (VAS) score, Rowe score, University of California Los Angeles (UCLA) score, and Western Ontario Shoulder Instability Index (WOSI) score. Post-operatively, the healing of the bone graft was evaluated with computed tomography (CT) scanning. RESULTS: All 22 patients were followed up for a mean of 19.3 ± 4.1 months. CT imaging showed that the healing time of the bone graft was 6-8 weeks. The patient satisfaction rate was 100%, there were no cases of redislocation, all patients returned to their preinjury training state, and the fear test was negative. At the final follow-up, the UCLA, VAS, Rowe, and WOSI scores were 29.8 ± 2.1, 2.2 ± 0.8, 89.4 ± 4.2, and 482.3 ± 46.2, respectively (p < 0.001). CONCLUSION: Arthroscopic autologous iliac bone graft suspension fixation and Bankart repair combined with the Remplissage procedure are effective in preventing recurrent instability with joint hyperlaxity. Furthermore, no patient had redislocation. LEVEL OF EVIDENCE: IV.

The safety and effectiveness comparison of Delta Medical's PEEK interface screw and Endobutton and that of Smith & Nephew's in arthroscopic anterior cruciate ligament reconstruction: A multicenter prospective double-blind randomized controlled clinical trial.

Background: To reduce the costs and financial burden in the ACLR treatment, we compare the early clinical outcomes and Magnetic Resonance Imaging (MRI) results of Delta Medical's PEEK (polyether ether ketone) interference screw and EndoButton with those of Smith & Nephew's PEEK interference screw and EndoButton in patients with arthroscopic anterior cruciate ligament reconstruction. Methods: A total of 104 patients in five different medical centers were randomly allocated into two groups: 1: Delta Medical's PEEK interference screw and EndoButton (53 patients); 2: Smith & Nephew's PEEK interference screw and EndoButton (51 patients). The modified Lysholm knee score, the laxity examination, and clinical and functional range of motion were evaluated at 3 and 6 months postoperatively. The clinical effective rate was calculated and classified as excellent and good at 6 months postoperatively. MRI examinations were performed at 3 and 6 months postoperatively to determine the healing process. Computerized tomography (CT) was performed at 2 weeks and 3 months postoperatively to evaluate the complications. Results: Significant improvements in knee function and functional scores were observed in both groups after surgery regardless of the fixation materials applied (P < 0.05). No differences were observed in the functional scores and range of motion. The assessments of Lysholm knee scores at 3 and 6 months produced no statistical differences (both P > 0.05). The clinical effective rate revealed no difference between the groups at 6 months postoperatively (non-inferiority analysis P = 0.0220). The differences of laxity examination between the groups were not statistically significant (Fisher's test, P = 0.6139, 0.2004, respectively). No significant differences in the functional range of motion were found at each follow-up time-point (P > 0.05). No major intra- or postoperative complications, such as infection, and vessel or nerve injury were observed. Conclusions: Knee function and functional scores were improved after ACLR in both groups, regardless of the PEEK interference screw and EndoButton applied. The difference in functional scores and range of motion were not significant in groups 1 and 2. Delta Medical's PEEK interference screw and EndoButton had a non-inferiority effect compared to Smith & Nephew's PEEK interference screw and EndoButton. Delta Medical's PEEK interference screw and EndoButton were suitable for arthroscopic ACLR.

High-Energy Transsyndesmotic Ankle Fracture Dislocation: A Case Report and Systematic Literature Review.

High-energy trauma can cause transsyndesmotic ankle fracture dislocation. These fractures are quite rare. Here we present a clinical case of a male patient with this type of injury. A systematic review of PubMed, Ovid MEDLINE, and Embase electronic databases revealed only two prior publications on a similar topic. We discuss the typical clinical features of these injuries, the treatment of high-energy trauma which can cause transsyndesmotic ankle fracture dislocation, and its prognosis.

[Study on therapeutic effects of arthroscopic repair on medial patellar retinaculum acute injury].

OBJECTIVE: To accurately define the injury position of medial patellar retinaculum with acute injury under the guiding of high frequency ultrasonography, and to study therapeutic effects of suture operation on medial patellar retinaculum in the injuried position. METHODS: From June 2009 to March 2014, there were 17 patients with acute patellar dislocation, 6 males and 11 females with average age of (16.2±6.2) years old. The duration time of patellar dislocation was 2 weeks. Before operation, the medial patellar retinaculum of all patients were examined with the high frequency ultrasonography, and the skin with the non-continuous fiber was iudicated as the surface mark under the high frequency ultrasonography. The injury position of medial retinaculum was in the middle of 5 patients who were treated with suture operation of arthroscopic medial retinaculum. The injury position was in the patellar edge in 12 patients who were treated with fixing bone anchor on patella and arthroscopic suture operation of medial retinaculum. The CT examination and Kujala scores, patellar tilt angle on CT film, measured maximal angles of passive or active knee flexion and apprehension test were observed before treatment and postoperative 18 months. RESULTS: Eighteen months after treatment, Kujala scores were 92.2±11.1 and patellar tilt angle were(11.5±4.2) °, and there was no statistical difference between post-operation and pre-operation. The difference between maximal angles of passive knee flexion(133.5±4.2) ° and normal had no statistically significance. Maximal angles of active knee flexion were(153.5±4.6) °. Ultrasonography showed the continuous fiber of medial retinaculum. A patient showed positive apprehension test and no patient had the recurrence patella instability after operation. CONCLUSIONS: The injury position of medial patellar retinaculum was accurately shown by high frequency ultrasonography and treated with arthroscopic suture operation. Knee immobilization time after operation was shorten. Eighteen months after operation, knee joint function was good, and no patient had the recurrence patella instability.

[JAK2/STAT3 signal pathway mediating curcumin in cartilage cell metabolism of osteoarthritis].

OBJECTIVE: To observe influence of JAK2/STAT3 signal pathway mediating curcumin in cartilage cell metabolism of osteoarthritis and mitochondria oxidative stress resistance;also explore the role of JAK2/STAT3 signal pathway and effect of curcumin in this process. METHODS: Fifteen male SPF C57BL/6 rats rweighted from 10.05 to 15.00 g with an average of 12.80 g were collected and randomly divided into control group, OA group(modeled as OA by Glasson SS), curcumin with OA group (100 mg/kg curcumin were performed intraperitoneal injection every day based on OA group), 5 rats in each group. Rats were taken off the neck after 4 weeks, morphologic change were observed, specimens changes were observed by histochemical methods;p-JAK2, p-STAT3 and Bax protein expression were detected by Western blot;At the same time, the changes of mitochondria oxidative stress index such as succinate dehydrogenase(SDH) and cytochrome C oxydase(COX) in each group were detected. RESULTS: After 4 weeks, cartilage tissue showed translucent shape, no swelling and congestion, the number of cartilage cell increased, nuclei liked oval, chromatin arranged uniform in control group;in curcumin with OA group, joint showed slightly swelling without congestion, the formation of cartilage cell was regular, and number of cell decreased;while in OA group, the surface of joint was roughness with mild damage, cell arrangement was a bit disorder, nuclear was disappeared under vision and dyeing was uneven. Compared with control group, p-JAK2, p-STAT3 protein expression was decreased in OA and curcumin with OA group(P<0.05), Bax protein expression was increased (P<0.05), SDA and COX protein expression were reduced (P<0.05). Compared with OA group, p-JAK2, p-STAT3 protein expression was increased in curcumin with OA, Bax protein expression was decreased (P<0.05), SDA and COX protein expression were increased (P<0.05), and had statistical differences among three groups. CONCLUSIONS: JAK2/STAT3 signal pathway is closely associated with pathology course of osteoarthritis, curcumin could stimulate JAK2/STAT3 signal pathway and promote mitochondria oxidative stress. It could obviously relieve degeneration of articular cartilage and slow lower progress of OA.

[Case-control study on therapeutic effects between arthroscopic medial retinaculum plication and plaster external fixation for the treatment of acute patella dislocation].

OBJECTIVE: To compare therapeutic effects between arthroscopic medial retinaculum plication and plaster external fixation for the treatment of acute patellar dislocation. METHODS: From February 2006 to October 2012,29 patients with acute patellar dislocation were divided into two groups: operation group and non-operation group. The patellar dislocation duration was 2 weeks. In operation group, there were 7 males and 10 females, with an average age of (16.2 ± 6.2) years old, and the patients were treated with arthroscopic medial retinaculum plication. In non-operation group, there were 5 males and 7 females,with an average age of (16.3 ± 5.0) years old,and the patients were treated with plaster external fixation. The Kujala scores, patellar tilt angle measured on CT film, apprehension test and recurrence rate of patellar instability were observed before and 1 year after treatment. RESULTS: In operation group, the pre-treatment and post-treatment patellar tilt angles had no statistical difference, but the post-treatment Kujala score was lower than that of pre-treatment; while in non-operation group, the post-treatment patellar tilt angle was larger than that of pre-treatment, and the post-treatment Kujala score was lower than that of pre-treatment. At 1 year after treatment, the patellar tilt angle (21.2 ± 5.3) of patients in non-operation group was larger than (13.5 ± 3.5) of operation group, and the Kujala score 73.3 ± 10.5 of patient in non-operation group was lower than 84.1 ± 5.6 of operation group. CONCLUSION: During 1 year after operation, arthroscopic medical retinaculum plication is a more effective treatment for acute patellar dislocation compared with plaster external fixation.

[Posterior capsule releasing in total knee arthroplasty for patients with rheumatoid arthritis with stiff knees in flexion].

OBJECTIVE: To investigate the correct method of bone resection and posterior capsular soft tissue releasing in total knee arthroplasty (TKA) for the patients with rheumatoid arthritis with stiff knee in flexion. METHODS: From November 2009 to January 2012,15 patients with rheumatoid arthritis with stiff knee in flexion underwent primary TKA and releasing of the posterior soft tissues. There were 7 males and 8 females,aged 22 to 75 years old (58.7 years old on average). The preoperative range of movement(ROM) was (3.2 ± 1.7)°. According to Knee Society score (KSS) criterion, the preoperative clinical score was 23.3 ± 12.5 and functional score was 35.2 ± 9.8. Based on the correct osteotomy, effective releasing of posterior structures was used for different degrees of flexion contracture during the TKA procedure. RESULTS: All the patients were followed up, and the average duration was 2.3 years (1.6 to 3 years). At the latest follow-up,the KSS clinical score was 81.7 ± 6.5 and functional score was 82.8 ± 9.3. The flexion and extension ROM of the knee joint was (103.5 ± 13.1). Three knees remained 50 flexion contracture deformity, but the function of the affect knees was good. CONCLUSION: The effective releasing of the soft tissue of posterior capsule is a major management for correction of the flexion contracture in TKA. The correct releasing of posterior structure can not only achieve fundamental gap of TKA but also effectively avoid bone over-resection.

Allograft pretreatment for the repair of sciatic nerve defects: green tea polyphenols versus radiation.

Pretreatment of nerve allografts by exposure to irradiation or green tea polyphenols can eliminate neuroimmunogenicity, inhibit early immunological rejection, encourage nerve regeneration and functional recovery, improve tissue preservation, and minimize postoperative infection. In the present study, we investigate which intervention achieves better results. We produced a 1.0 cm sciatic nerve defect in rats, and divided the rats into four treatment groups: autograft, fresh nerve allograft, green tea polyphenol-pretreated (1 mg/mL, 4°C) nerve allograft, and irradiation-pretreated nerve allograft (26.39 Gy/min for 12 hours; total 19 kGy). The animals were observed, and sciatic nerve electrophysiology, histology, and transmission electron microscopy were carried out at 6 and 12 weeks after grafting. The circumference and structure of the transplanted nerve in rats that received autografts or green tea polyphenol-pretreated nerve allografts were similar to those of the host sciatic nerve. Compared with the groups that received fresh or irradiation-pretreated nerve allografts, motor nerve conduction velocity in the autograft and fresh nerve allograft groups was greater, more neurites grew into the allografts, Schwann cell proliferation was evident, and a large number of new blood vessels was observed; in addition, massive myelinated nerve fibers formed, and abundant microfilaments and microtubules were present in the axoplasm. Our findings indicate that nerve allografts pretreated by green tea polyphenols are equivalent to transplanting autologous nerves in the repair of sciatic nerve defects, and promote nerve regeneration. Pretreatment using green tea polyphenols is better than pretreatment with irradiation.

[Case-control study on therapeutic effects of Chinese herb of promoting blood circulation to dissipate blood stasis in the treatment of mudslide injuries].

OBJECTIVE: To observe the effects of Chinese herb of promoting blood circulation to dissipate blood stasis on the levels of tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6) in serum of patients with mudslide injuries, and investigate the mechanisms of Chinese herb of promoting blood circulation to dissipate blood stasis in the treatment of mudslide injuries. METHODS: Patients with mudslide injuries who were translated from Zhouqu and Chengxian to Lanzhou from 12th August 2010 were divided into two groups (group A and group B). Twenty-five patients in group A, containing 15 males and 10 females, with an average age of (39.0 +/- 3.9) years. According to AIS scoring system, 1 point in 2 cases, 2 points in 3, 3 points in 17 and 4 points in 3. No patients got 5 points. Based on ISS rating system, 16 cases got 16 points or less, 7 cases rated between 16 and 25, only 2 cases were equal to 25 points or more. Another 25 patients were in group B, including 11 males and 14 females, with a mean age of (40.1 +/- 3.6) years; AIS score showed 3 cases got 1 point, 4 got 2 points, 16 got 3 and 2 got 4 points, no patients got 5 points. Patients in group B were divided into three parts by ISS score:15 cases (16 points or less); 9 cases (range 16 to 25 points) and 1 case (25 points or more). All the patients accepted general physical checkup. Eight patients were treated by surgical treatment in group A (3 patients were treated with open reduction plate fixation, 4 patients were treated with debridement BHID, and 1 patient underwent foreign body removal) and 6 cases in group B (1 patient was treated with craniocerebral surgery,2 patients were treated with chest surgery, and 3 patients were treated with soft tissue debridement). All the patients of two groups were treated by support treatment, detumescence treatment and preventing infection, complications. A seven days course of treatment with detumescence analgesic mixture 50 ml p.o. bid, traumatologic cleansing liquid 20 ml ad us, ext 20 to 30 min qid to group A,continuous treatment of two courses. Using immunometric assay to determine serum levels of inflammatory cytokine TNF-alpha, IL-6 at the 2nd, 7th, 14th days after admission. Analysis of data were done with the help of SPSS 16.0 statistic software. RESULTS: There were no statistical differences of TNF-alpha, IL-6 between two groups at the second day after admission, and there were statistical differences at the 7th and 14th days between two groups. There were significant differences of TNF-alpha and IL-6 levels between the 7th day and the 2nd day, the 14th day and 2nd day after admission. CONCLUSION: The Chinese herb of promoting blood circulation to dissipate blood stasis can inhibit the release of inflammatory factor after traumatism.