Serum Irisin is Associated with Bone Mineral Density in Postmenopausal T2dm Patients Complicated with Osteoporosis and in Mice with Diabetic Osteoporosis.

BACKGROUND: Osteoporosis is a systemic bone disease with low bone mass, destruction of bone microstructure, and increased bone fragility. Gender and metabolic status are well-known risk factors for osteoporosis. Irisin is a newly discovered myokine that is secreted by skeletal muscle and adipose tissue. Serum Irisin was reported to be decreased in type 2 diabetes mellitus (T2DM) and/or osteoporosis patients, and it is correlated with bone mineral density (BMD) of neck bone, but its role in postmenopausal T2DM with osteoporosis remains largely unknown. METHODS: Postmenopausal T2DM patients with or without osteoporosis were recruited, and 50 agematched healthy postmenopausal women were employed as healthy control. C57BL/6J mice were intraperitoneally injected with 65 mg/kg Streptozotocin (STZ) daily for consecutive 5 days to induce diabetes, and 1 mg/kg recombinant Irisin protein was injected into diabetic mice through the tail vein once a week for 4 months. RESULTS: Compared to that of healthy control, serum Irisin levels and BMD in L1-L4 lumbar spine, femoral neck, total hip, and Wards were decreased in postmenopausal T2DM patients and further decreased in T2DM patients with osteoporosis. Moreover, serum Irisin levels were also correlated with BMD in the above body parts in T2DM patients. Furthermore, recombinant Irisin protein improved diabetic osteoporosis and inflammation in STZ-induced diabetic mice with osteoporosis. CONCLUSION: Serum Irisin levels in postmenopausal T2DM patients with osteoporosis were significantly decreased, which may be related to the decreased BMD and the occurrence of osteoporosis in postmenopausal T2DM patients. The combined measurement of serum Irisin levels and BMD in patients with T2DM in the early stage has a certain effect on the diagnosis and treatment of osteoporosis.

Pinocembrin relieves hip fracture-induced pain by repressing spinal substance P signaling in aged rats.

Whether pinocembrin (PCN) could be used to alleviate hip fracture-induced pain is investigated in this research. Aged rats with hip fractures were treated with vehicle or 80 mg/kg/day PCN from week 3 to week 4. Then, hind paw mechanical allodynia, unweighting, warmth, and thickness were measured. The microglia and astrocytes activation and proliferation markers in the spinal dorsal horn were detected with real-time PCR and immunofluorescence staining. The relative expression of substance P and its receptor, tachykinin receptor 1 (Tacr1), was detected with enzyme-linked immunosorbent assay (ELISA) and Western blots. The antinociceptive effect of Tacr1 inhibitor LY303870 was also testified. PCN alleviated hip fracture-induced hind paw nociceptive (allodynia and unweighting) and vascular changes (warmth and thickness) in aged rats with diminished microglia and astrocytes activation and proliferation in the spinal dorsal horn. Upregulated substance P and Tacr1 were induced after hip fracture, which could be reversed by PCN treatment. Furthermore, LY303870 treatment partially reversed both spinal nociceptive sensitization and vascular changes after hip fracture. Substance P signaling contributes to the nociceptive and vascular changes observed in the hip fracture, which could be alleviated by PCN.NEW & NOTEWORTHY Substance P signaling contributes to the nociceptive and vascular changes observed in hip fracture, which could be alleviated by PCN.

Digital analysis of external fixation area of proximal humerus fractures in elderly patients.

INTRODUCTION: The purpose is based on anatomical basis, combined with three-dimensional measurement, to guide the clinical repositioning of proximal humeral fractures, select the appropriate pin entry point and angle, and simulate surgery. METHODS: 11 fresh cadaveric specimens were collected, the distance of the marked points around the shoulder joint was measured anatomically, and the vertical distance between the inferior border of the acromion and the superior border of the axillary nerve, the vertical distance between the apex of the humeral head and the superior border of the axillary nerve, the vertical distance between the inferior border of the acromion and the superior border of the anterior rotator humeral artery, and the vertical distance between the apex of the humeral head and the superior border of the anterior rotator humeral artery were marked on the 3D model based on the anatomical data to find the relative safety zone for pin placement. RESULTS: Contralateral data can be used to guide the repositioning and fixation of that side of the proximal humerus fracture, and uniform data cannot be used between male and female patients. For lateral pining, the distance of the inferior border of the acromion from the axillary nerve (5.90 ± 0.43) cm, range (5.3-6.9) cm, was selected for pining along the medial axis of the humeral head, close to the medial cervical cortex, and the pining angle was measured in the coronal plane (42.84 ± 2.45)°, range (37.02° ~ 46.31°), and in the sagittal plane (28.24 ± 2.25)°, range (19.22° ~ 28.51°). The pin was advanced laterally in front of the same level of the lateral approach point to form a cross-fixed support with the lateral pin, and the pin angle was measured in the coronal plane (36.14 ± 1.75)°, range (30.32° ~ 39.61°), and in the sagittal plane (28.64 ± 1.37)°, range (22.82° ~ 32.11°). Two pins were taken at the greater humeral tuberosity for fixation, with the proximal pin at an angle (159.26 ± 1.98) to the coronal surface of the humeral stem, range (155.79° ~ 165.08°), and the sagittal angle (161.76 ± 2.15)°, with the pin end between the superior surface of the humeral talus and the inferior surface of the humeral talus. The distal needle of the greater humeral tuberosity was parallel to the proximal approach trajectory, and the needle end was on the inferior surface of the humeral talus. CONCLUSION: Based on the anatomical data, we can accurately identify the corresponding bony structures of the proximal humerus and mark the location of the pin on the 3D model for pin placement, which is simple and practical to meet the relevant individual parameters.

Comparison of three methods of Müller type C2 and C3 distal femoral fracture repair.

BACKGROUND: We compared the outcomes of three fixation techniques for Müller type C2 and C3 distal femoral fractures. METHODS: We retrospectively analyzed patients undergoing internal fixation for Müller type C2 and C3 distal femoral fractures via locking plate (Group A), lateral locking condylar plate and medial contoured reconstruction plate (Group B), and lateral locking condylar plate and anterior reconstruction plate (Group C). Knee joint functional recovery and functional outcomes were evaluated 12 months postoperatively. RESULTS: Patients included 34 men and 24 women aged 25 to 74 years (mean, 50.3 ± 10.73 years). Operating times were longest in Group B and similar in Groups A and C. Bleeding volume in Group A was smaller than in Group B and similar to that of Group C. Functional outcomes were excellent in 18 (31%) fractures, good in 24 (41%), moderate in 11 (19%), and poor in 5 (9%). Good-to-excellent results were achieved in 56%, 82%, and 83% of patients (Groups A, B, and C, respectively). Groups B and C's outcomes were superior to Group A's outcomes. No significant difference in postoperative complications between the groups existed. CONCLUSION: Lateral locking condylar and anterior reconstruction plating was useful for complex type C distal femoral fractures.

[Application of self-made fine-tuning device in distal locking process of femoral interlocking intramedullary nail].

OBJECTIVE: To evaluate the curative efficacy of self-made fine-tuning setting in the process of femoral distal implantation of intramedullary nail. METHODS: From October 2015 to October 2017, 66 cases of femoral shaft fracture were treated with anterograde interlocking intramedullary nail including 45 males and 21 females with a mean age of(37.21±11.18) years old. Among them, 36 cases were treated with the manufacture's aiming device and self-made fine-tuning setting (research group), other 30 cases were treated with the manufacture's aiming device(control group). The mean operation time, the times of C-arm scan in surgery, the post-operation complications and the fracture union were observed and compared in two groups. RESULTS: Sixty-two cases acquired 8 to 15 months with a mean time of 12.4 months follow-up visit. The post-operation complications and the fracture union between the two groups had no significant difference(P>0.05), the mean operation time and the times of C-arm scan in surgery had statistically significant difference(P<0.05). CONCLUSIONS: Self-made fine-tuning setting in the process of femoral interblocking intramedullary nail could shorten operation time and reduce the the times of C-arm scan.

Role of total hip replacement arthroplasty between transplantation and acute kidney injury.

Osteonecrosis of the femoral head is a severely disabling complication of steroid immunosuppression in renal transplant patients. The increased number of patients undergoing transplantation has increased the number of transplant recipients undergoing total hip replacement arthroplasty (THRA). In this study, we retrospectively assessed patients who underwent THRA from May 2004 to February 2014, and evaluated their demographic and clinical characteristics, the results of peri-operative laboratory tests, the amounts of fluids transfused during surgery, and anesthesia time. Our results found that post-operative acute kidney injury (AKI) was significantly associated with transplantation, and transplantation was an independent factor predictive of post-operative AKI, so transplant recipients are at risk for AKI following THRA. Total hip replacement is a safe and effective treatment for transplant recipients and, in view of their limited life expectancy, should be considered at an early stage in their treatment.

[Application of tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty].

OBJECTIVE: To explore the application value of self-made tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty (TKA) for improving the lower extremity force line. METHODS: Between January and August 2012, 13 cases (21 knees) of osteoarthritis with tibial extra-articular deformity were treated, including 5 males (8 knees) and 8 females (13 knees) with an average age of 66.5 years (range, 58-78 years). The disease duration was 2-5 years (mean, 3.5 years). The knee society score (KSS) was 45.5 +/- 15.5. Extra-articular deformities included 1 case of knee valgus (2 knees) and 12 cases of knee varus (19 knees). Preoperative full-length X-ray films of lower extremities showed 10-21 degrees valgus or varus deformity of tibial extra joint. Self-made tibial mechanical axis locator was used to determine and mark coronal tibial mechanical axis under X-ray before TKA, and then osteotomy was performed with extramedullary positioning device according to the mechanical axis marker.' RESULTS: All incisions healed by first intention, without related complications of infection and joint instability. All patients were followed up 5-12 months (mean, 8.3 months). The X-ray examination showed < 2 degrees knee deviation angle in the others except 1 case of 2.9 degrees knee deviation angle at 3 days after operation, and the accurate rate was 95.2%. No loosening or instability of prosthesis occurred during follow-up. KSS score was 85.5 +/- 15.0 at last follow-up, showing significant difference when compared with preoperative score (t=12.82, P=0.00). CONCLUSION: The seft-made tibial mechanical axis locator can improve the accurate rate of the lower extremity force line in TKA for tibia extra-articular deformity.