Human Umbilical Cord Mesenchymal Stem Cell-Derived Extracellular Vesicles Carrying MicroRNA-181c-5p Promote BMP2-Induced Repair of Cartilage Injury through Inhibition of SMAD7 Expression.

The therapy role of mesenchymal stem cell- (MSC-) derived extracellular vesicles (EVs) in cartilage regeneration has been well studied. Herein, we tried to analyze the role of human umbilical cord MSC- (hUCMSC-) EVs carrying microRNA- (miR-) 181c-5p in repair of cartilage injury. After successful isolation of hUCMSCs, the multidirectional differentiation abilities were analyzed. Then, the EVs were isolated and identified. After coculture of PKH26-labled EVs with bone marrow MSCs (BMSCs), the biological behaviors of which were detected. The relationship between the predicted early posttraumatic osteoarthritis-associated miRNA, miR-181c-5p, and SMAD7 was verified. Gain- and loss-of functions were performed for investing the role of miR-181c-5p and SMAD7 in BMP-induced chondrogenesis in vitro and in vivo. hUCMSC-EVs could be internalized by BMSCs and promote the proliferative, migratory, and chondrogenic differentiation potentials of BMSCs. Additionally, miR-181c-5p could target and inhibit SMAD7 expression to promote the bone morphogenic protein 2- (BMP2-) induced proliferative, migratory, and chondrogenic differentiation potentials of BMSCs. Also, overexpression of SMAD7 inhibited the repairing effect of BMP2, and overexpression of BMP2 and miR-181c-5p further promoted the repair of cartilage injury in vivo. Our present study highlighted the repairing effect of hUCMSC-EVs carrying miR-181c-5p on cartilage injury.

Lisfranc injuries with dislocation the first tarsometatarsal joint: primary arthrodesis or internal fixation (a randomized controlled trial).

BACKGROUND: Open reduction and internal fixation (ORIF) is a popular method for treatment of displaced Lisfranc injuries. However, even with anatomic reduction and solid internal fixation, treatment does not provide good outcomes in certain severe dislocations. The purpose of this study was to compare ORIF and primary arthrodesis (PA) of the first tarsometatarsal (TMT) joint for Lisfranc injuries with the first TMT joint dislocation. METHODS: Seventy-eight Lisfranc injuries with first TMT joint dislocation were finally enrolled and analyzed in a prospective, randomized trial comparing ORIF and PA. They were 50 males and females with a mean age of 40.7 years and randomized to ORIF group and PA group. Outcome measures included radiographs, American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale, Foot and Ankle Ability Measure (FAAM) Sports subscale, visual analog scale (VAS), and the 36-Item Short Form Health Survey (SF-36). Complications and revision rate were also analyzed. RESULTS: Forty patients were treated by ORIF, while PA group includes 38 cases. Patients were followed up for 37.8(range, 24-48) months. At final follow-up, the mean AOFAS midfoot score (P < 0.01), the FAAM Sports subscale (P < 0.01), the physical function score (P < 0.05), and the Bodily Pain score of SF-36 (P < 0.05) after ORIF treatment were significantly lower than PA group. The mean VAS score in ORIF group was higher (P < 0.01). In ORIF group, redislocation of the first TMT joint was observed in ten cases, and thirteen patients had pain in midfoot. No redislocation and no hardware failure were identified in PA group. CONCLUSION: PA of the first TMT joint provided a better medium-term outcome than ORIF for Lisfranc injuries with the first TMT dislocation. Possible complications and revision could be avoided by PA for dislocated first ray injuries.

Microwave biochars produced with activated carbon catalyst: Characterization and sorption of volatile organic compounds (VOCs).

A series of microwave biochars derived from wheat straw in the presence of a granulated activated carbon (GAC) catalyst, using a range of microwave conditions, were produced, characterized and tested as sorbents of three benzene series volatile organic compounds (VOCs). The microwave biochar with the greatest specific surface area (SSA), total pore volume (TPV), and micropore volume (312.62 m2 g-1, 0.2218 cm3 g-1, and 0.1380 cm3 g-1, respectively), were produced with 1:3 biomass:GAC catalyst mass ratio, 10 min microwave irradiation time, and at 500 W power level (WB500). Maximum adsorption capacities of WB500 to benzene, toluene and o-xylene were 53.9 mg g-1, 75.8 mg g-1 and 63.0 mg g-1, respectively, and were directly correlated to microwave biochar properties such as SSA, TPV or micropore volume, but were also influenced by VOC properties such as molecular polarity and boiling point. Kinetic modeling suggested that adsorption was governed by both physical partitioning and chemisorption mechanisms. In addition, microwave biochars maintained 79% to 92% of their initial adsorption capacity after ten adsorption/desorption cycles. These results suggest that microwave biochars produced with an GAC catalyst have excellent potential for efficient use in the removal of VOCs from waste gas.

Effect of Amniotic Membrane/Collagen-Based Scaffolds on the Chondrogenic Differentiation of Adipose-Derived Stem Cells and Cartilage Repair.

Objectives: Repairing articular cartilage damage is challenging. Clinically, tissue engineering technology is used to induce stem cell differentiation and proliferation on biological scaffolds to repair defective joints. However, no ideal biological scaffolds have been identified. This study investigated the effects of amniotic membrane/collagen scaffolds on the differentiation of adipose-derived stem cells (ADSCs) and articular cartilage repair. Methods: Adipose tissue of New Zealand rabbits was excised, and ADSCs were isolated and induced for differentiation. An articular cartilage defect model was constructed to identify the effect of amniotic membrane/collagen scaffolds on cartilage repair. Cartilage formation was analyzed by imaging and toluene blue staining. Knee joint recovery in rabbits was examined using hematoxylin and eosin, toluidine, safranine, and immunohistochemistry at 12 weeks post-operation. Gene expression was examined using ELISA, RT-PCR, Western blotting, and immunofluorescence. Results: The adipose tissue was effectively differentiated into ADSCs, which further differentiated into chondrogenic, osteogenic, and lipogenic lineages after 3 weeks' culture in vitro. Compared with platelet-rich plasmon (PRP) scaffolds, the amniotic membrane scaffolds better promoted the growth and differentiation of ADSCs. Additionally, scaffolds containing the PRP and amniotic membrane efficiently enhanced the osteogenic differentiation of ADSCs. The levels of COL1A1, COL2A1, COL10A1, SOX9, and ACAN in ADSCs + amniotic membrane + PRP group were significantly higher than the other groups both in vitro and in vivo. The Wakitani scores of the ADSC + amniotic membrane + PRP group were lower than that in ADSC + PRP (4.4 ± 0.44**), ADSC + amniotic membrane (2.63 ± 0.38**), and control groups (6.733 ± 0.21) at week 12 post-operation. Osteogenesis in rabbits of the ADSC + amniotic membrane + PRP group was significantly upregulated when compared with other groups. Amniotic membranes significantly promoted the expression of cartilage regeneration-related factors (SOX6, SOX9, RUNX2, NKX3-2, MEF2C, and GATA4). The ADSC + PRP + amniotic membrane group exhibited the highest levels of TGF-ß, PDGF, and FGF while exhibiting the lowest level of IL-1ß, IL6, and TNF-α in articular cavity. Conclusion: Amniotic membrane/collagen combination-based scaffolds promoted the proliferation and cartilage differentiation of ADSCs, and may provide a new treatment paradigm for patients with cartilage injury.

Vorinostat ameliorates IL-1α-induced reduction of type II collagen by inhibiting the expression of ELF3 in chondrocytes.

Osteoarthritis (OA) is a common joint disease that ultimately causes physical disability and imposes an economic burden on society. Cartilage destruction plays a key role in the development of OA. Vorinostat is an oral histone deacetylase (HDAC) inhibitor and has been used for the treatment of T-cell lymphoma. Previous studies have reported the anti-inflammatory effect of HDAC inhibitors in both in vivo and in vitro models. However, it is unknown whether vorinostat exerts a protective effect in OA. In this study, our results demonstrate that treatment with vorinostat prevents interleukin 1α (IL-1α)-induced reduction of type II collagen at both gene and protein levels. Treatment with vorinostat reduced the IL-1α-induced production of mitochondrial reactive oxygen species (ROS) in T/C-28a2 cells. Additionally, vorinostat rescued the IL-1α-induced decrease in the expression of the collagen type II a1 (Col2a1) gene and the expression of Sry-related HMG box 9 (SOX-9). Importantly, we found that vorinostat inhibited the expression of matrix metalloproteinase-13 (MMP-13), which is responsible for the degradation of type II collagen. Furthermore, vorinostat suppressed the expression of E74-like factor 3 (ELF3), which is a key transcription factor that plays a pivotal role in the IL-1α-induced reduction of type II collagen. Also, the overexpression of ELF3 abolished the protective effects of vorinostat against IL-1α-induced loss of type 2 collagen by inhibiting the expression of SOX-9 whilst increasing the expression of MMP-13. In conclusion, our findings suggest that vorinostat might prevent cartilage destruction by rescuing the reduction of type II collagen, mediated by the suppression of ELF3.

Lateral Fracture-Dislocation of the Calcaneus: Case Reports and a Systematic Review.

OBJECTIVE: To report a case series of calcaneal fracture-dislocations, which have not been described previously in China, and to provide a systematic review to explore the clinic manifestations, methods for diagnoses, and treatments. METHODS: Between January 2018 and December 2019, 4 patients (4 men; average age, 33.0 ± 16.67 years; range, 15-50 years) were diagnosed with fracture-dislocation of the calcaneus and treated by surgery. We also reviewed published cases and studies of calcaneal fracture-dislocations through the databases of PubMed and Web of Science between January 1977 and December 2019. RESULTS: Between January 2018 and December 2019, 4 cases were identified as calcaneal fracture-dislocations in our hospital. The main clinical manifestations include hindfoot pain, swelling, and deformity. The diagnoses were confirmed via radiographic examination. Two patients underwent open reduction and internal fixation (ORIF) and two were treated with a minimally invasive approach. Diagnosis had been missed in one patient and, consequently, presented with early signs of post-traumatic arthritis, which may require extra subtalar arthrodesis in the future. Two patients were diagnosed inaccurately but achieved satisfactory outcomes through open reduction and internal fixation. The average follow-up period was 9.75 ± 5.19 months. Except for the 1 misdiagnosed patient, the other 3 patients showed functional improvement. Only 23 fracture-dislocations of calcaneus cases were reported in the literature between January 1977 and December 2019. There were 15 Sanders type II fractures (65.22%) and 7 (30.43%) Sanders type III fractures, and there was 1 grade II open calcaneal fracture. Among them, 1 was a medial dislocation and 2 were "joint-elevation" dislocations; the rest of them (20/23, 86.96%) were lateral dislocations. A total of 11 patients (47.83%) exhibited the double-density sign, and varus tilt of the talus was revealed on plain radiographs for 9 patients (39.13%). Increased Bohler's angle was evident in lateral X-ray films for 2 patients (2/23, 8.70%). A total of 21 cases (86.96%) were treated with surgical intervention and achieved satisfactory outcomes. Only 1 patient was treated with external fixation. Another 2 patients were treated conservatively and had poor clinic outcomes. CONCLUSION: Calcaneal fracture-dislocation is a rare injury that is challenging to treat. Clinical manifestations such as fibular tendon dislocation, the double-density sign on profile radiography, and abnormal talar tilt in the distal talofibular joint are important signs that may indicate this rare injury pattern. Timely surgical intervention is essential for satisfactory clinic outcomes. Orthopaedic surgeons should be aware of this uncommon injury to avoid misdiagnosis or inappropriate treatment.

Transcription factor ELK1 accelerates aerobic glycolysis to enhance osteosarcoma chemoresistance through miR-134/PTBP1 signaling cascade.

Osteosarcoma is a malignancy that primarily affects children and young adults. The poor survival is largely attributed to acquisition of chemoresistance. Thus, the current study aimed to elucidate the role of ELK1/miR-134/PTBP1 signaling cascade in osteosarcoma chemoresistance. Doxorubicin (DXR)-resistant human osteosarcoma cells were initially self-established by continuous exposure of MG-63, U2OS and HOS cells to increasing DXR doses. Osteosarcoma chemoresistance in vitro was evaluated using CCK-8 assays and EdU staining. Aerobic glycolysis was evaluated by lactic acid production, glucose consumption, ATP levels, and Western blot analysis of GLUT3, HK2 and PDK1 proteins. The nude mice were injected with 5.0 mg/kg DXR following the subcutaneous transplantation of osteosarcomas. PTBP1 was upregulated in tumor tissues derived from non-responders to DXR treatment and correlated with patient poor survival. PTBP1 enhanced chemoresistance in cultured osteosarcoma cells in vitro and in vivo by increasing aerobic glycolysis. Additionally, miR-134 inhibited translation of PTBP1. ELK1 bound to miR-134 promoter and inhibited its expression. Overexpressed ELK1 enhanced chemoresistance and increased aerobic glycolysis by downregulating miR-134 and upregulating PTBP1 in DXR-resistant cells. Altogether, the key findings of the present study highlight ELK1/miR-134/PTBP1 signaling cascade as a novel molecular mechanism underlying the acquisition of osteosarcoma chemoresistance.

Ball milling biochar with ammonia hydroxide or hydrogen peroxide enhances its adsorption of phenyl volatile organic compounds (VOCs).

Pristine biochar (CN600), ball-milled biochar (CN600-BM), H2O2 modified BM-biochar (CN600-O), and NH4OH modified BM-biochar (CN600-N) derived from corn stalk were applied to adsorb phenyl volatile organic compounds (VOCs). H2O2 and NH4OH modification of BM-biochar significantly improved its physicochemical characteristics and adsorption abilities. The specific surface area of CN600-O increased 2.05 and 1.23 times compared to CN600 and CN600-BM, respectively; while CN600-N increased 2.41 and 1.45 times, respectively. In addition, the ball milled biochars, especially CN600-O, showed higher acidity and polarity than CN600. The VOC adsorption amount onto biochars was 10.96-130.21 mg/g. CN600-O and CN600-N had high uptake of the VOCs and reached 100.07-111.79 mg/g and 110.49-130.21 mg/g, respectively. CN600-N showed the best performance with P-xylene adsorption up to 130.21 mg/g. VOC adsorption onto the CN600-O and CN600-N were mainly governed by surface adsorption and associated with morphology characteristics of the biochars as well as VOC properties such as boiling point and molecular size. Five cycles of adsorption-desorption experiments showed that CN600-O and CN600-N had good reusability with the reuse efficiencies of 88.01 %-92.21 % and 92.19 %-95.39 %, respectively. The results indicate that O- and N-doped ball-milled biochars are promising in adsorption for effective and sustainable VOC removal.

Chinese Consensus on Insertional Achilles Tendinopathy.

BACKGROUND: Insertional Achilles tendinopathy (IAT) is a common finding in the clinic. However, consensus on its mechanism, pathological process, diagnosis, treatment, and rehabilitation is lacking. Thus, the Chinese Society of Sports Medicine organized and invited experts representing the fields of ankle disease and tendinopathy to jointly develop an expert consensus on IAT. STUDY DESIGN: A consensus statement of the Chinese Society of Sports Medicine. METHODS: A total of 34 experts in the field of sports medicine and orthopaedics were invited to participate in the compilation of a consensus statement regarding IAT. Consensus was achieved according to the Delphi method. First, 10 working groups composed of 34 experts were established to compile draft statements about clinical problems related to IAT by reviewing and analyzing the available literature. An expert consensus meeting to discuss drafts was then arranged. Each statement was individually presented and discussed, followed by a secret vote. Consensus was reached when more than 50% of the experts voted in its favor. The strength of the proposed recommendation was classified based on the proportion of favorable votes: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimity, 100%. RESULTS: Of the 10 expert consensus statements on the clinical diagnosis and treatment of IAT, there was strong consensus for 8 statements and unanimity for 2 statements. CONCLUSION: This expert consensus focused on the concepts, causes, pathological process, clinical diagnosis, and treatment of IAT. Accepted recommendations in these areas which will assist clinicians in carrying out standardized management of related diseases.

Ginsenoside Rg3 Prolongs Survival of the Orthotopic Hepatocellular Carcinoma Model by Inducing Apoptosis and Inhibiting Angiogenesis.

AIM: Microvessel density is a marker of tumor angiogenesis activity for development and metastasis. Our preliminary study showed that ginsenoside Rg3 (Rg3) induces apoptosis in hepatocellular carcinoma (HCC) in vitro. The aim of this study was to investigate the cross-link for apoptosis induction and antiangiogenesis effect of Rg3 on orthotopic HCC in vivo. METHODS: The murine HCC cells Hep1-6 were implanted in the liver of mouse. With oral feeding of Rg3 (10 mg/kg once a day for 30 days), the quantitative analysis of apoptosis was performed by using pathology and a transmission electron microscope and microvessel density was quantitatively measured by immunohistochemical staining of the CD105 antibody. The mice treated with Rg3 (n = 10) were compared with the control (n = 10) using Kaplan-Meier analysis. Animal weight and tumor weight were measured to determine the toxicity of Rg3 and antitumor effect on an orthotopic HCC tumor model. RESULTS: With oral feeding of Rg3 daily in the first 30 days on tumor implantation, Rg3 significantly decreased the orthotopic tumor growth and increased the survival of animals (P < 0.05). Rg3-treated mice showed a longer survival than the control (P < 0.05). Rg3 treatment induced apoptosis and inhibited angiogenesis. They contributed to the tumor shrinkage. Rg3 initialized the tumor apoptotic progress, which then weakened the tumor volume and its capability to produce the vascularized network for further growth of the tumor and remote metastasis. CONCLUSION: Rg3 inhibited the activation of microtumor vessel formation in vivo besides its apoptosis induction. Rg3 may be used as an adjuvant agent in the clinical HCC treatment regimen.

Ochronotic arthritis and ochronotic Achilles tendon rupture in alkaptonuria: A 6 years follow-up case report in China.

INTRODUCTION: Alkaptonuria (AKU) is a rare disease caused by deficiency of homogentisate 1,2-dioxygenase which results in deposition of homogentisic acid (HGA). Ochronotic arthritis, the deposition of excess oxidized HGA in the connective tissues, causes pigmentation and degeneration of the joint tissues ultimately resulting in chronic inflammation and osteoarthritis. The ochronotic arthritis has similar clinical features with osteoarthritis. There is currently no specific treatment for AKU and management is usually symptomatic. In severe cases, total joint arthroplasty is the major treatment approaches. It is rarely reported in China. PATIENT CONCERNS: Here we reported a case of a patient with bilateral knee pain for more than 1 year. He complained of a 20-year history of chronic, nonspecific low back pain and stiffness. His urine was black since he was a child. Six years after the knee surgery, his Achilles tendon ruptured. DIAGNOSIS: Specific radiographic and magnetic resonance imaging manifestations were observed. Darkly pigmented full-thickness cartilage and subchondral bone were found during the operation. Histological investigation also manifested dark stains in meniscus and synovial tissues. Black-denatured tendon tissue was also found during the operation. The patient was diagnosed as AKU. INTERVENTIONS: Total knee arthroplasty and Achilles tendon repair were operated separately after the disease was diagnosed. OUTCOMES: The patient recovered very well after the second surgery. He returned to full activities, described no knee pain, and presented to the clinic walking without any aid. Physical examination revealed 0 to 20 of plantar flexion and 0 to 15 of dorsiflexion of the ankle. CONCLUSIONS: Ochronosis is a very rare disease in Asia. This paper supplies new information for study of this disease. The mechanism is still unknown right now. Further studies will be necessary.

Activation of Anti-tumor Immune Response by Ablation of HCC with Nanosecond Pulsed Electric Field.

Locoregional therapy is playing an increasingly important role in the non-surgical management of hepatocellular carcinoma (HCC). The novel technique of non-thermal electric ablation by nanosecond pulsed electric field has been recognized as a potential locoregional methodology for indicated HCC. This manuscript explores the most recent studies to indicate its unique anti-tumor immune response. The possible immune mechanism, termed as nano-pulse stimulation, was also analyzed.

Environmental temperature affects physiology and survival of nanosecond pulsed electric field-treated cells.

Nanosecond pulsed electric field (nsPEF) is a novel non-thermal tumor ablation technique. However, how nsPEF affect cell physiology at different environmental temperature is still kept unknown. But this issue is of critical clinical practice relevance. This work aim to investigate how nsPEF treated cancer cells react to different environmental temperatures (0, 4, 25, and 37°C). Their cell viability, apoptosis, mitochondrial membrane potential, and reactive oxygen species (ROS) were examined. Lower temperature resulted in higher apoptosis rate, decreased mitochondria membrane potential, and increased ROS levels. Sucrose and N-acetylcysteine (NAC) pre-incubation inhibit ROS generation and increase cell survival, protecting nsPEF-treated cells from low temperature-caused cell death. This work provides an experimental basis for hypothermia and fluid transfusion during nsPEF ablation with anesthesia.

The reliability and validity of a new professionalism assessment scale for young health care workers.

With the development of medical technique, many medical challenges have been solved. This cross-sectional study was aimed to assess the reliability and validity of a new developed scale for assessing the professionalism of young health care workers.This cross-sectional population-based study was conducted based on cluster sampling method in 2015. The participants were from 2 medical centers of Nantong city of Jiangsu province in China. The internal consistency reliability was assessed using Cronbach's alpha and split-half reliability coefficients. Construct validity was analyzed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Content, convergent, and discriminant validities were also assessed in this study.Total 749 individuals aged 29.09 ±â€Š3.91 years old participated in this investigation. There were 745 valid questionnaires and 730 were complete. Cronbach's alpha value (0.944) and the split-half reliability coefficient (0.873) reflected satisfactory internal consistency reliability of this new professionalism assessment scale. EFA extracted a 7-factor model. About 63.4% of the total variance was explained by these factors. However, CFA showed a good model fit after excluding the items with factor loading lower than 0.5. Good discriminant validity of this new developed professionalism assessment scale was also shown (P < .05). However, the evidences for content and convergent validity were not enough in this study.The results showed the satisfactory reliability of this new developed professionalism assessment scale. However, this scale should be modified to improve the validity in further studies.

Nano-pulse stimulation (NPS) ablate tumors and inhibit lung metastasis on both canine spontaneous osteosarcoma and murine transplanted hepatocellular carcinoma with high metastatic potential.

BACKGROUND: Nanosecond pulsed electric field (nsPEF), which is also termed as nano-pulse stimulation (NPS), has the potential of stimulating immune responses toward cancer cells. The current study investigates its local and systemic antitumor efficacy in vivo in late stage tumors with lung metastasis. METHOD: The 12 canines with spontaneous osteosarcomas and 12 nude mice transplanted with human hepatocellular carcinoma were divided randomly and were given NPS treatment, surgery or no treatment control. Nanosecond pulsed electric field was delivered with puncture electrodes at 40 kV/cm with 500 pulses at 1 Hz. The survival time, tumor volume, serum alkaline phosphatase (ALP), joint capsule damage and lung metastasis were followed up. The efficacy was compared with control. RESULTS: Nanosecond pulsed electric field reduced primary tumor volume and extended the survival significantly compared to the control group (P<0.05). Inhibition of serum alkaline phosphatase and lung metastasis without joint deformity or thermal damage were also observed. CONCLUSION: Locally applied nanosecond pulsed electric field is a novel non-thermal ablation method. It can ablate the primary tumor and decrease lung metastasis as a palliative therapy for late stage tumor.

Therapeutic Outcomes of Kalix II in Treating Juvenile Flexible Flatfoot.

OBJECTIVES: To evaluate the therapeutic outcomes with Kalix II subtalar arthroereisis in sinus tarsi for juvenile flexible flatfoot. METHODS: A retrospective analysis of the data of 20 juveniles with symptomatic flexible flatfoot (27 feet) who underwent the Kalix II implant procedure from January 2008 to September 2012 was performed. The pain during daily activities was assessed and followed up by use of a standard 10-point visual analog scale (VAS), and function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, and anteroposterior talar-first metatarsal angle, lateral talar-first metatarsal angle, calcaneal pitch angle, and talar declination angle at X-ray film were measured to assess the therapeutic outcomes. Patients were asked to grade the result of the procedure as excellent, good, fair, or poor at latest follow-up. The data was expressed as mean ± standard deviation (SD). A paired Student's t -test was used for comparisons of the preoperative and postoperative angular measurements for each foot, VAS scores, and AOFAS scores. In all tests, P < 0.05 was considered statistically significant. RESULTS: The mean age of the patients was 12.1 years (range, 7-16 years), and 16 left feet and 11 right feet were involved. All patients finished the follow-up with a mean period of 28.1 months (range, 23-60 months). Eleven feet were treated with subtalar arthroereisis combined with reconstruction of the end point of the posterior tibialis tendon after dissection of the accessory scaphoid. The subtalar arthroereisis device displaced in 1 foot due to a fall from the inversion position 3 months after surgery, and was replaced by a new device after the failure of conservative treatment. The mean VAS score decreased from 5.6 ± 0.5 preoperatively to 1.2 ± 0.2 (P < 0.001), and the mean AOFAS hindfoot and ankle score improved from 71.1 ± 6.1 preoperatively to 88.1 ± 6.3 (P < 0.001). Differences between preoperative and postoperative measurements for each radiographic variable were statistically significant (P < 0.001). Comparison of radiographic measurements showed that the anteroposterior talar-first metatarsal (Meary) angle decreased by a mean of 12.8° ± 1.5°, the lateral talar-first metatarsal (Meary) angle decreased by a mean of 15.4° ± 1.3°, the calcaneal pitch angle increased by a mean of -2.1° ± 0.7°, and the talar declination angle decreased by a mean of 17.9° ± 2.8°. Overall, 12 patients rated the result as excellent, 6 as good, and 2 as fair. CONCLUSION: The application of Kalix II in subtalar arthroereisis combined with dissection of accessory scaphoid and reconstruction of posterior tibialis tendon is an effective therapy for flexible juvenile flatfoot.

Reconstruction of Kuwada grade IV chronic achilles tendon rupture by minimally invasive technique.

BACKGROUND: Transfer of a flexor hallucis longus (FHL) tendon can not only reconstruct the Achilles tendon but also provide ischemic tendinous tissues with a rich blood supply to enhance wound healing. This retrospective study aims to investigate clinical outcomes in patients who underwent repair of Kuwada grade IV chronic Achilles tendon rupture with long hallucis longus tendons harvested using a minimally invasive technique. MATERIALS AND METHODS: 35 patients who were treated for Kuwada grade IV Achilles tendon injuries from July 2006 to June 2011 were included in this retrospective study. The age ranged between 23 and 71 years. The duration from primary injury to surgery ranged from 29 days to 34 months (mean value, 137.6 days). All 35 patients had difficulties in lifting their calves. Thirty two were followed up for a mean 32.2 months (range 18-72 months), whereas three were lost to followup. Magnetic resonance imaging (MRI) showed that the tendon rupture gap ranged from 6.0 to 9.2 cm. During surgery, a 2.0 cm minor incision was made vertically in the medial plantar side of the midfoot, and a 1.5 cm minor transverse incision was made in the plantar side of the interphalangeal articulation of the great toe to harvest the FHL tendon, and the tendon was fixed to the calcaneus with suture anchors. Postoperative appearance and function were evaluated by physiotherapists based American Orthopedic Foot and Ankle Society-ankle and hindfoot score (AOFAS-AH), and Leppilahti Achilles tendon ratings. RESULTS: Results were assessed in 32 patients. Except for one patient who suffered complications because of wound disruption 10 days after the operation, all other patients had primary wound healing, with 28 of 32 able to go up on their toes at last followup. The AOFAS-AH score was increased from preoperative (51.92 ± 7.08) points to (92.56 ± 6.71) points; Leppilahti Achilles tendon score was increased from preoperative (72.56 ± 7.43) to (92.58 ± 5.1). There were statistically significant differences. The result of the total excellent and good rate was 93.8% (30/32). MRI of Achilles tendon showed even signal without evidence of tear or cystic degeneration. CONCLUSION: Reconstruction of a chronic Achilles tendon rupture with an FHL tendon harvested using a minimally invasive technique showed good outcomes.

Treatment of Calcified Insertional Achilles Tendinopathy by the Posterior Midline Approach.

The present study investigated the clinical outcomes of the posterior midline approach in the treatment of 34 patients with significantly calcified insertional Achilles tendinopathy. The posterior midline approach was applied for the surgical treatment of 34 patients with chronic significantly calcified insertional Achilles tendinopathy after failed conservative treatment. Gastrocnemius recession was performed simultaneously for patients with gastrocnemius contracture. The Fowler-Philip angle and parallel pitch lines were measured before surgery, and the visual analog scale, Tegner score, and Victorian Institute of Sport tendon study group score were recorded before and after surgery. The mean follow-up period was 45.2 ± 17.7 (range 24 to 84) months. After surgery, the visual analog scale score had decreased notably, and the Tegner score and Victorian Institute of Sport tendon study group score had increased significantly. The posterior midline approach can achieve satisfactory outcomes in the treatment of significantly calcified insertional Achilles tendinopathy, and gastrocnemius recession (Strayer procedure) should be performed for patients with gastrocnemius contracture to improve the surgical outcome.

Effect of PI3K-mediated autophagy in human osteosarcoma MG63 cells on sensitivity to chemotherapy with cisplatin.

OBJECTIVE: To investigate the influence of autophagy on sensitivity to the chemotherapy drug cisplatin (DDP) and the role of PI3K in autophagy. METHODS: MTT methods and flow cytometer, with rapamycin up-regulating the autophagy and 3-MA down-regulating the autophagy, were employed to measure the proliferation inhibition rate on DDP-treated osteosarcoma cells and the change in cell cycle. The expression of intracellular protein was detected by Western blot. The autophagy of MG63 cell was observed using fluorescence microscope and transmission electron microscope. RESULTS: Western blot showed that basic autophagy level of MG63 cell was significantly lower than that of hFOB cell. MTT test revealed that the cell proliferation inhibition rate in the group treated with rapamycin and DDP, group treated with 3-MA and DDP, and group only treated with DDP was significantly different. It was demonstrated by the flow cytometry that in group treated with DDP, inhibition on autophagy can increase the cell numbers in G1 phase and reduce the cell numbers in S phase of cell cycle. Increase of autophagosome in MG63 cytoplasm was observed under fluorescence microscope. CONCLUSIONS: Up-regulating the autophagy significantly reduced the sensitivity of MG63 cell to chemotherapy with DDP. DDP induced autophagy of MG63 cell and blocked the cell cycle at G1 phase.