[Treatment of lateral ankle joint ligament sprain by shaking and poking manipulation based on finite element method].

OBJECTIVE: To conduct a preliminary study on joint injuries of anterior and calcaneal fibular ligaments of the lateral ankle joint, and to analyze mechanism of action of shaking and poking in treating ankle joint and biomechanical properties of ankle during the recovery of joint injuries. METHODS: CT scan was performed on a male volunteer with right ankle sprain. Mimics 10.0, Solidworks 2016, Hypermesh 12.0 and Abaqus 6.13 software were used to establish 3D nonlinear finite element analysis model of foot and ankle, and the validity of model was verified. Combined with clinical study, the finite element simulation analysis was carried out on the toe flexion, dorsiflexion, varus and valgus of ankle joint under different treatment periods by adjusting elastic modulus of ligament to simulate ligament injury. RESULTS: With the treatment of shake and prick and recovery of ligament injury, the maximum stress and area with large stress on tibial pitch and fibular joint surface gradually increased under the four working conditions, and the stress value of the maximum stress ligament gradually increased, and the stress of the anterior and calcaneal fibular ligament dispersed and transferred, and the axial force gradually decreased. CONCLUSION: The finite element method was used to simulate the mechanical condition of the shaking and stamping technique, and the changes of the forces of the ligament and articular surface before and after treatment of anterior and calcaneal ligament combined injury of ankle talus were intuitively observed. The treatment effect was quantified, and could provid objective and scientific basis for clinical promotion and application of this technique.

Evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fracture.

BACKGROUND: Elderly patients tend to have poor self-efficacy and poor confidence in postoperative rehabilitation for hip fractures, and are prone to negative emotions, which affect treatment compliance. AIM: To evaluate the effects of evidence-based intervention on postoperative fear, compliance, and self-efficacy in elderly patients with hip fractures. METHODS: A total of 120 patients with hip fracture surgically treated from June 2018 to June 2020 at the orthopedic department of our hospital were selected and divided into intervention and routine groups (n = 60 each) according to different nursing methods. The basic rehabilitation methods of the two groups were consistent, but patients in the intervention group received evidence-based nursing interventions at the same time. Differences between groups in the scores of motion phobia, pain fear, rehabilitation training compliance, self-efficacy, nursing satisfaction, and hip joint function were compared before and after the intervention. RESULTS: Before the intervention, there were no statistically significant differences in motion phobia and pain fear scores between the groups (all P > 0.05). However, motion phobia scores at 1 wk after intervention initiation (P < 0.05), and pain fear scores at 1 wk and 2 wk after intervention initiation (all P < 0.05), were significantly lower in the intervention group than in the routine group. On the first day of intervention, there was no significant difference in rehabilitation treatment compliance between the groups (P > 0.05); however, at 2 wk after intervention initiation, rehabilitation compliance was significantly better in the intervention group than in the routine group (P < 0.05). Before the intervention, there were no statistically significant differences in the scores for the two self-efficacy dimensions (overcoming difficulties and rehabilitation exercise self-efficacy) and the total self-efficacy score between the groups (all P > 0.05). After 2 wk of intervention, the scores for these two dimensions of self-efficacy and the total self-efficacy score were significantly higher in the intervention group than in the routine group (all P < 0.05). At 3 and 6 mo after surgery, hip function as evaluated by the Harris hip score, was significantly better in the intervention group than in the routine group (P < 0.05). Additionally, overall nursing satisfaction was significantly higher in the intervention group than in the routine group (P < 0.05). CONCLUSION: Evidence-based nursing intervention can alleviate fear of postoperative rehabilitation in elderly patients who underwent hip fracture surgery, and improve rehabilitation treatment compliance and patient self-efficacy, which promote hip function recovery.

Biomechanical Rationale for the Development of Atlantoaxial Instability and Basilar Invagination in Patients with Occipitalization of the Atlas: A Finite Element Analysis.

OBJECTIVE: Occipitalization of the atlas (OA) often is associated with atlantoaxial dislocation and basilar invagination. The purpose of this study is to determine the biomechanical difference between normal and OA conditions in the craniovertebral junction and to further explore the rationale for development of atlantoaxial dislocation and basilar invagination using the finite element model (FEM). METHODS: A ligamentous, nonlinear, sliding-contact, 3-dimensional FEM of the occipitoatlantoaxial complex was generated. Validation of the model was accomplished by comparing kinematic predictions with experimental data. We defined the atlantooccipital joint as a tie contact to simulate the OA deformity. The range of motion and the value of the maximum Von Mises stress were compared between the intact and OA models. RESULTS: We found all of the predicted data in the intact FEM fell within 1 standard deviation of the cadaver data for all 6 loadings. The OA simulation significantly reduced the overall range of motion of the occipitoatlantoaxial complex at all loadings. The maximum Von Mises stress was predicted to increase at the transverse ligament and the superior articular facet of the axis for all the flexion, extension, lateral bending, and axial rotation loadings. CONCLUSIONS: The OA could result in hypermobility of the atlantoaxial segment and cause overstress in the transverse ligament and the lateral atlantoaxial joints. These changes explain the pathogenesis of atlantoaxial dislocation and basilar invagination associated with OA. Follow-up should be scheduled regularly due to the nature of the dynamic development of atlantoaxial dislocation and basilar invagination.

Cerebral Functional Reorganization in Ischemic Stroke after Repetitive Transcranial Magnetic Stimulation: An fMRI Study.

AIMS: Our study aimed to figure out brain functional reorganization evidence after repetitive transcranial magnetic stimulation (rTMS) using the resting-state functional magnetic resonance imaging (rsfMRI). METHODS: Twelve patients with unilateral subcortex lesion in the middle cerebral artery territory were recruited. Seven of them received a 10-day rTMS treatment beginning at about 5 days after stroke onset. The remaining five received sham treatment. RsfMRI and motor functional scores were obtained before and after rTMS or sham rTMS. RESULTS: The rTMS group showed motor recovery according to the behavioral testing scores, while there was no significant difference of motor functional scores in the sham group before and after the sham rTMS. It proved that rTMS facilitates motor recovery of early ischemic stroke patients. Compared with the sham, the rTMS treatment group achieved increased functional connectivity (FC) between ipsilesional M1 and contralesional M1, supplementary motor area, bilateral thalamus, and contralesional postcentral gyrus. And decreased FC was found between ipsilesional M1 and ipsilesional M1, postcentral gyrus and inferior and middle frontal gyrus. CONCLUSION: Increased or decreased FC detected by rsfMRI is an important finding to understand the mechanism of brain functional reorganization. The rTMS treatment is a promising therapeutic approach to facilitate motor rehabilitation for early stroke patients.

Comparative proteomic analysis of mesenchymal stem cells derived from human bone marrow, umbilical cord and placenta: implication in the migration.

Umbilical cord (UC) and placenta (P) have been suggested as alternatives to bone marrow (BM) as sources of mesenchymal stem cells (MSC) for cell therapy, with both UC- and P-MSC possess immunophenotypic and functional characteristics similar to BM-MSC. However, under defined conditions, the migration capacity of BM- and P-MSC was found to be 5.9- and 3.2-folds higher than that of UC-MSC, respectively. By the use of 2-DE and combined MS and MS/MS analysis, six differentially expressed proteins were identified among these MSC samples, with five of them known to be involved in cell migration as migration enhancing or inhibiting proteins. Interestingly, the expression levels of those proteins reflect perfectly the migration capacity of corresponding MSC, which is also proved by in vitro overexpression and silencing techniques. Our study indicates that a bunch of migration-related proteins are pivotal in governing the migration capacity of MSC.

Altered regional homogeneity in motor cortices in patients with multiple system atrophy.

Typical histopathological findings of multiple system atrophy (MSA) have been observed in motor related cortices, in addition to the common areas of the striatum, substantia nigra, olivopontocerebellar pathways, the intermediolateral cell columns of the spinal cord, and the cerebellum. The purpose of this study is to test the hypothesis that functional impairment associated with the histopathological findings exists in the motor cortex of MSA patients using resting-state fMRI. Twenty clinically probable MSA patients (9 with MSA-P and 11 with MSA-C subtype) and 11 healthy controls (HCs) were studied. The regional homogeneity (ReHo) approach was used to analyze low frequency spontaneous fluctuation of blood oxygen level dependent signal. Compared with the HCs, the MSA patients showed significantly decreased ReHo in the left primary sensorimotor cortex, posterior cingulate cortex, left lateral prefrontal cortex (PFC) and right inferior parietal lobule (IPL), together with increased ReHo in the right primary sensorimotor cortex, bilateral premotor cortices, bilateral supplementary motor areas, medial PFC and left IPL. The results support the hypothesis that motor cortex areas can be functionally involved and likely play a role in motor circuit dysfunction in MSA patients.

Flavonoids of Herba Epimedii regulate osteogenesis of human mesenchymal stem cells through BMP and Wnt/beta-catenin signaling pathway.

Herba Epimedii is one of the most commonly used Chinese herbs for treating osteoporosis. In the present study, the flavonoids of Herba Epimedii (HEF) have shown to promote the osteogenic differentiation of human bone marrow-derived mesenchymal stem cells. They were noted to enhance the mRNA expression of BMP-2, BMP-4, Runx2, beta-catenin and cyclinD1, all of which are BMP or Wnt-signaling pathway related regulators. The osteogenic effect was inhibited by the introduction of noggin and DKK-1, which is classical inhibitor of BMP and Wnt/beta-catenin signaling, respectively. These results suggest that HEF exerts promoting effect on osteogenic differentiation, which plausibly functions via the BMP and Wnt/beta-catenin signaling pathways. Considering the therapeutic efficiency and economical issues, HEF may be a potential candidate for promoting bone regeneration. On the other hand, osteogenic differentiation of MSCs may also be a promising and attractive tool to apply in bone repair.

[Diffusion weighted imaging combined with magnetic resonance conventional sequences for the diagnosis of rectal cancer].

OBJECTIVE: To evaluate the clinical value of diffusion weighted imaging (DWI) combined with conventional sequences of magnetic resonance imaging (T1 and T2-weighted imaging) for the diagnosis of rectal cancer. METHODS: DWI and conventional sequences were performed in 29 patients with endoscopically diagnosed rectal cancer and 15 patients without rectal cancer. Two doctors who were blind to the history of the patients interpreted the imaging findings. The sensitivity and specificity of conventional sequences with and without DWI were analyzed using receiver operating characteristic curve (ROC). RESULTS: The areas under ROC were 0.915 and 0.930 for conventional sequences alone, and 0.990 and 0.994 for conventional sequences with DWI, respectively, indicating that although both of them were optimal methods for the diagnosis of rectal cancer, the accuracy of conventional sequences with DWI was significantly superior to that of conventional sequence alone (P < 0.05). The Kappa value was 0.850 for conventional sequences alone and 0.858 for DWI with conventional sequences. CONCLUSION: DWI was necessary for the diagnosis of rectal cancer when performing conventional sequences.

Total flavonoids of Herba Epimedii improves osteogenesis and inhibits osteoclastogenesis of human mesenchymal stem cells.

INTRODUCTION: In China Herba Epimedii is one of the most common herbs that could be prescribed for treating osteoporosis. It is known to increase the overall mineral content, therefore, to promote bone formation and to increase lumbar bone mineral density (BMD). The present study was aimed at investigating the effect of flavonoids of Herba Epimedii (HEF) on osteogenesis in human MSCs. METHODS: The human bone marrow-derived MSCs (BM-MSCs) were isolated and their osteogenic differentiation was evaluated by their alkaline phosphatase (ALP) activities and level of mineralization. After treating with total flavonoids during osteogenic differentiation process, differential mRNA expression was examined by RT-PCR. RESULTS: The total time needed for osteogenic differentiation of BM-MSCs was significantly shortened by adding HEF. Up-regulation of mRNA expression by HEF was observed for several marker genes and osteogenic regulators. HEF was also found to inhibit osteoclastogenesis of MSCs by enhancing the ratio OPG/RANKL. CONCLUSIONS: Our study demonstrated that the HEF could improve osteogenic differentiation and inhibit the osteoclast differentiation of BM-MSCs concurrently.

Comparative proteomic analysis of mesenchymal stem cells derived from human bone marrow, umbilical cord, and placenta: implication in the migration.

Umbilical cord (UC) and placenta (P) have been suggested as alternatives to bone marrow (BM) as sources of mesenchymal stem cells (MSC) for cell therapy, with both UC- and P-MSC possess immunophenotypic and functional characteristics similar to BM-MSC. However, their migration capacity, which is indispensable during tissue regeneration process, is unclear. Under defined conditions, the migration capacity of BM- and P-MSC was found 5.9- and 3.2-folds higher than that of UC-MSC, respectively. By the use of 2-DE and combined MS and MS/MS analysis, six differentially expressed proteins were identified among these MSC samples, with five of them known to be involved in cell migration as migration enhancing or inhibiting proteins. Consistent with their migration capacity, the levels of migration enhancing proteins including cathepsin B, cathepsin D and prohibitin,were significantly lower in UC-MSC when compared with those in BM- and P-MSC. For the migration inhibiting proteins such as plasminogen activator inhibitor-1 (PAI-1) and manganese superoxide dismutase, higher expression was found in the UC-MSC. We also showed that the overexpression of the PAI-1 impaired the migration capacity of BM- and P-MSC while silencing of PAI-1 enhanced the migration capacity of UC-MSC. Our study indicates that PAI-1 and other migration-related proteins are pivotal in governing the migration capacity of MSC.

Differences in interictal perfusion patterns between refractory and non-refractory temporal lobe epilepsies evaluated with fair at 3. 0T.

OBJECTIVE: To investigate the difference in interictal perfusion patterns between refractory and non-refractory temporal lobe epilepsies evaluated with flow-sensitive alternating inversion recovery (FAIR) magnetic resonance (MR) sequence. METHODS: Nine patients with refractory temporal lobe epilepsy, 21 patients with non-refractory temporal lobe epilepsy, and 13 normal volunteers underwent FAIR MR scanning. The relative cerebral blood flow (rCBF) in bilateral hemispheres and mesial temporal lobes were measured. And we also calculated the asymmetry index (AI) values. RESULTS: The AI values of bilateral hemispheres in refractory and non-refractory epilepsy patients were both significantly different from those of volunteers (P = 0.012 and 0.029, respectively). There was significant difference in AI values of bilateral mesial temporal lobes between non-refractory epilepsy patients and volunteers (P = 0.049), while no significant difference between refractory epilepsy patients and volunteers. CONCLUSIONS: The hypoperfusion pattern of interictal refractory temporal lobe epilepsy patients is different from that of non-refractory patients. Although the hypoperfusion tends to extend out of temporal lobes in all patients, the refractory epilepsy patients have a preference of bilateral mesial temporal hypoperfusion, which may be valuable for evaluating prognosis.

Evaluation of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes with magnetic resonance imaging and proton magnetic resonance spectroscopy.

OBJECTIVE: To study the characteristics of spectra on proton magnetic resonance spectroscopy (1H-MRS) and its value in patients with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). METHODS: Seven clinically diagnosed patients with MELAS underwent magnetic resonance imaging (MRI) and 1H-MRS examinations. The 1H-MRS techniques, characteristics of the spectra, and its correlation with the laboratory tests were analyzed. RESULTS: Cerebral abnormalities were revealed in all 7 patients on conventional MR images, and most abnormal signals were observed in bilateral occipital, parietal, and temporal lobes. We found 4 cases with basal ganglia involvement, 2 cases with mild frontal lobe lesions, and 1 case with involvement of lateral cerebral peduncles and thalami. Additionally, 1 patient was involved with left insular lobe. Spectra from prominent lesions in brain parenchyma showed lactate doublet peak in 6 patients, 3 of whom were also noted lactate peak in ventricular cerebrospinal fluid (CSF). CONCLUSION: 1H-MRS may provide more direct information about the metabolism changes, which aids to affirm the diagnosis, and may replace the conventional invasive method of quantifying lactate in CSF.

[Comparison of radiographs and magnetic resonance imaging in the detection of carpal lesions in patients with rheumatoid arthritis].

OBJECTIVE: To compare MR imaging with radiographs in detection of the erosions of the wrists in patients with rheumatoid arthritis (RA). METHODS: In 50 wrists of 25 patients with RA, radiographs of AP projection and MR imaging examination were performed within 1 week. The MRI sequences were SE T1-weighted image, FSE T2-weighted image, and GE T2* weighted image in coronal plane. Gd-DTPA enhanced SE T1-weighted image with same parameters of pre-contrast administration SE T1WI was performed in 25 wrists, which showed prominent lesions in each 25 patients. RESULTS: In 50 wrists of 25 patients with RA, bone erosions were found by MR images compared to radiographs in 46 versus 14 wrists, respectively. There were 170 sites of carpal erosions found by MR images, while radiographs found only 23 sites of carpal erosions. Among them triquetrum and lunate were the most frequently involved sites. Significant difference (P < 0.001) was statistically found between conventional radiography and MR imaging in detection of erosions of the wrists of RA. MR imaging also permitted demonstrating synovitis and joint effusion in the wrists. Gd-DTPA-enhanced images allowed distinguishing pannus changes from joint effusion. CONCLUSION: MRI is superior to conventional radiography with respect to detection of bone erosion in wrists. For those whose conventional radiographs show suspected RA, MRI examination should be advised for the early diagnosis.

[Fat at sacroiliac joints: MR imaging findings (comparison and analysis of 18 volunteers and 52 patients with ankylosing spondylitis)].

OBJECTIVE: In aid of MR imaging diagnosis of ankylosing spondylitis (AS), MRI findings of sacroiliac (SI) joints in volunteers were compared with those in patients with AS, with special reference to the fat findings. METHODS: 18 normal volunteers and 52 AS patients underwent the MRI examinations with the same protocols, i.e., SE T1WI, FSE T2WI, GE T2*WI sequences were taken using a 0.3T imager. All the images were observed and analyzed by two radiologists. RESULTS: Symmetric or patchy distribution fat component either in sacrum and/or ilium was detected in 52.8% of SI joints of volunteers. Thin zone distribution of fat was seen in 35.6% of SI joints of AS patients, which was adjacent to the erosion and sclerosis. In another 25.0% of SI joints of AS patients, the distribution of fat component was found similar to that of the normal volunteers. Cartilage changes were detected in 85.6% of the SI joints of AS patients. In addition, bone erosion, sclerosis and subchondral bone marrow edema were also detected. CONCLUSION: Subchondral fat infiltration associated with erosion and sclerosis should be considered as sacroiliitis. The knowledge of the characteristics of fat component could be helpful for evaluating sacroiliac joints.