Application of one-third tubular steel plates and screws for fixation of medial column in pilon fractures.

Background: The present study sought to explore the efficacy of one-third tubular steel plates and screws for the treatment of medial column of pilon fractures. Methods: The present retrospective study comprised 40 subjects with Rüedi-Allgöwer type III pilon fractures that attended Northern Jiangsu People's Hospital from April 2016 to April 2019. Patients were assigned to 2 groups based on reconstruction and fixation components used on the medial column. The medial column of participants in the control group (n=20) was anchored using screws. The medial column for subjects in the treatment group (n=20) was reconstructed using a one-third tubular steel plate. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at 1, 2, 3, 6, 12 and 24 months after operation, intraoperative blood loss, fracture healing time, preoperative detumescence duration, operation time, postoperative weightbearing duration, and postoperative Burwell-Charnley radiological score of the 2 groups were compared. Results: The findings showed that intraoperative blood loss, preoperative detumescence time, and operation time for the treatment group were not statistically different relative to the control group (P>0.05). The fracture healing time and postoperative weightbearing time in the treatment group were 15.07±0.98 weeks and 6.91±0.61 weeks, respectively, while those in the control group were 15.84±0.59 weeks and 8.60±0.53 weeks, respectively (P<0.05). Patients in the treatment group showed markedly higher AOFAS scores relative to the AOFAS scores of subjects in the control group at month 1, 2, and 3 post-operation (P<0.05). AOFAS scores for the 2 groups were not significantly different at month 6, 12 and 24 post-operation. Subjects in the control group had a significantly lower Burwell-Charnley number radiology score relative to that of subjects in the treatment group (P<0.05). Conclusions: The present findings show that the medial column of subjects with Rüedi-Allgöwer type III pilon fracture can be repaired using a one-third tubular steel plate. Compared with simple screw fixation, the use of a one-third tubular steel plate allows earlier postoperative weightbearing, decreases the rate of postoperative reduction loss, and leads to better clinical effects and prognosis.

The safety and efficiency of fluoroless site-specific transseptal puncture guided by three-dimensional intracardiac echocardiography.

BACKGROUND: Although fluoroless transseptal puncture (TSP) guided by intracardiac echocardiography (ICE) has been used for many years, there are no reports of an accurate site-specific method for TSP in detail, especially about the safety and efficiency of the method. This study aimed to compare the efficacy and safety of TSP guided by three-dimensional ICE using a fluoroless site-specific method with that of the conventional fluoroless method in patients with atrial fibrillation (AF). METHODS: This prospective study included 60 patients with AF scheduled for radiofrequency ablation who were assigned to undergo modified fluoroless site-specific TSP (SS-ICE group, n = 30) or conventional fluoroless TSP (C-ICE group, n = 30). TSP was guided by three-dimensional ICE in both study groups. RESULTS: All fluoroless TSP were performed successfully in both groups. There were no significant differences in patient characteristics, Pre-TSP time (11.3 ± 1.7 min vs. 11.1 ± 1.6 min, P = 0.822) and TSP time (3.4 ± 0.9 min vs. 3.5 ± 1.1 min, P = 0.772) between the SS-ICE group and the C-ICE group. The distance between the actual traversing point and the presetting point in the fossa ovalis was less than 5 mm in 87% of patients (26/30, 3.1 ± 1.2 mm) in the SS-ICE group. There were no TSP-related complications in either group. CONCLUSION: SS-ICE method is a simple, safe, and effective approach for fluoroless site-specific TSP.

Efficacy and safety of baricitinib for active rheumatoid arthritis in patients with an inadequate response to conventional synthetic or biological disease-modifying anti-rheumatic drugs: A meta-analysis of randomized controlled trials.

The purpose of the present meta-analysis was to assess the efficacy and safety of baricitinib for active rheumatoid arthritis (RA) in patients with an inadequate response or intolerance to conventional synthetic or biological disease-modifying anti-rheumatic drugs (DMARDs). A total of 7 randomized controlled trials (RCTs) were included. The primary effective outcome was the RA improvement to reach an American College of Rheumatology 20% (ACR20) response rate. The safety outcomes were composed of clinical laboratory parameters. All patients included received 4 mg baricitinib once daily to treat RA for 12 or 24 weeks. The ACR20 response rate in the baricitinib group was significantly higher compared with that in the control group at 12 weeks [relative risk (RR), 1.77; 95% confidence interval (CI), 1.62-1.94; P<0.00001] and 24 weeks (RR, 1.76; 95% CI, 1.48-2.10; P<0.00001). Similarly, other effective outcome measures also exhibited significant improvements in the baricitinib group compared with those in the placebo group. Regarding the safety outcomes, no significant difference in adverse events (AEs) was identified at 12 weeks (P=0.14), but AEs were significantly higher in the baricitinib group compared with those in the control group at 24 weeks (P=0.03). Most laboratory values were significantly different between the baricitinib and placebo groups; however, the clinical significance of these changes remains to be determined. In summary, the present meta-analysis demonstrated that 4 mg baricitinib once daily was beneficial in patients with active RA with an inadequate response or intolerance to conventional synthetic or biological DMARDs. More high-quality RCTs are required to determine the sustained efficacy and the safety of baricitinib.

Comparison of navigated and conventional high tibial osteotomy for the treatment of osteoarthritic knees with varus deformity: A meta-analysis.

BACKGROUND: High tibial osteotomy (HTO) is a usefully surgical procedure to correct the malalignment and delay the progression of osteoarthritis. It is still controversy whether navigation system can offer more accuracy of targeted alignment and achieve better clinical outcomes than conventional method. The purpose of present meta-analysis was to investigate whether navigation system was superior to conventional method with regard to clinical and radiographic outcomes. METHOD: The included studies compared the clinical and radiographic outcomes between navigated HTO group and conventional group. The clinical assessments were Lysholm Score, AKS Function Score and Arc of motion, and the radiographic outcomes were Mechanical axis (MA), Weight bearing line ratio (WBL), Outliers of alignment and Change in TPS used to evaluate alignment correction. The meta-analysis was performed using Review Manager 5.3 software. Downs and Black and the Newcastle-Ottawa Scale (NOS) were used to evaluate the study quality. RESULT: Sixteen studies were eligible in present meta-analysis, including thirteen studies concerning opening wedge HTO and three studies involving closing wedge HTO. Clinical outcomes were only reported in studies which used opening wedge HTO. No significant differences were observed in all clinical outcomes between navigated and conventional HTO. Regarding radiographic outcomes, no significant difference in WBL ratio was observed between navigated and conventional HTO. Patients undergoing navigated HTO were associated with significantly greater in MA and lower in Outliers of alignment compared with those undergoing conventional HTO. Compared with conventional HTO, increase in TPS was significantly lower in navigated HTO group using opening wedge HTO, but decrease in TPS was significantly greater in navigated HTO group using closing wedge HTO. CONCLUSION: Our meta-analysis demonstrated that navigated HTO offered more accuracy and precision of alignment correction, except WBL ratio. However, better clinical outcomes were not observed in navigation group.

[Classification and treatment of syndesmotic injury].

The distal tibiofibular syndesmosis is a critical structure in maintaining the ankle stability. Syndesmotic injuries are usually associated with ankle fractures and high fibula fractures. Non-isolated and partially isolated syndesmotic injuries are involved in unstable injuries, which need to operative treatment. Partially isolated syndesmotic injuries belong to stable injuries, which should be treated with non-operative management. It is becoming clear that early fixation and stabilization for unstable injuries are probably better than non-treatment or delayed treatment. It still remains without consensus of accurately defining stable from unstable injuries and sufficiently differentiating between acute and chronic injuries. Because of stability, fixation type, and duration, the clinical efficacy is different. Screw fixation is a gold standard treatment of syndesmotic injury. However, it remains controversial that whether removal of the syndesmotic screw is required and effect of the level of syndesmotic screw insertion, limited micro-movement is one of disadvantages of screw fixation. Micro-movement of the distal tibiofibular syndesmosis has been paid more and more attention. Dynamic fixation is a viable alternative to the static fixation device, with lower re-operation rates and less complications, which has obtained a great short-term clinical efficacy. However, further long-term studies should be carried out to confirm this clinical efficacy. Optimized treatment strategies considering stability of syndesmotic injury, duration, and fixation type can help to improve clinical efficacy.

Proliferative Constituents from the Leaves of Micromelum integerrimum.

Two new compounds, 5-O-methyl-4-desmethyl-myricanol (1) and 6-formyl-5-isopropyl-3-hydroxymethyl-7-methyl-1H-indene (2), were isolated from the leaves of Micromelum integerrimum. Their structures were determined by spectroscopic methods. Additionally, compound 1 could stimulate the growth of NIH3T3 cells and promote cell migration. Compound 1 might exert its effects through increasing the protein expression of connective tissue growth factor.