An Alternative Strategy for Treatment of Distal Tibiofibular Syndesmotic Disruption: A Technical Note.

Metal screws are the most widely used in treating syndesmotic injuries; however, failure and the rigidity of the screws can threaten the success of the treatment and increase the cost of care. We performed open reduction and internal fixation of a fibula fracture followed by fixation of the tibiofibular joint with an olive wire and one half of an external fixator. We present a review of 1 patient treated with this material. We believe this method to be a physiologic fixation system with the advantage of being safe, inexpensive, adjustable, and effective; however, further clinical investigation and comparison to other methods is needed in order to better understand it clinical utility.

A 22-year retrospective study: educational update and new referral pattern of age at orchidopexy.

OBJECTIVES: To determine the current age at orchidopexy in China and whether changing targets have altered practice, as research suggesting progressive deterioration in an undescended testis (UDT) has led to the reduction in the target age for orchidopexy to 6-12 months but it is still unknown whether changing targets have altered practice. PATIENTS AND METHODS: The demographics of orchidopexies performed in the Children's Hospital of Chongqing Medical University between 1993 and 2014 were reviewed. A survey of the general publics' awareness of UDT and survey of primary healthcare practitioners' current opinion on age at orchidopexy and referral patterns were performed. RESULTS: In all, 3784 orchidopexies were performed over 22 years. The median age at orchidopexy fell between 1993 and 2014. There was an initial drop in the median age for orchidopexy between 2000 and 2010 (36 months) compared with 1993 and 2000 (48 months) (P < 0.05); however, beyond the corresponding target age (<18 months). The age for orchidopexy between 2010 and 2014 was also beyond the corresponding target age (6-9 months). The survey of the general public showed that 0.98% had knowledge of UDT and none of them knew about the target age for orchidopexy in the survey of 5393 cases. In all, 63.46% of them were told about the UDT by healthcare practitioners at the 1-4 months postnatal baby check. Furthermore, only 2% of the healthcare practitioners knew the recommended age for orchidopexy was 6-9 months and only 14.3% of them would directly make a surgical referral to paediatric surgery specifically at this point. CONCLUSIONS: The recommended orchidopexy age is not being achieved and we recognise the national need to address this. The approach should include the right cognition of cryptorchidism among the general public and earlier primary care referral directly from the routine postnatal baby check to a specialist centre prepared to undertake surgery in this age group.

[Effect of Di-(2-ethylhcxyl) phthalate exposure on blood-testis barrier integrity in rats].

OBJECTIVE: To investigate mechanism of di-(2-ethylhcxyl)phthalate (DEHP) exposure in causing blood-testis barrier (BTB) impairment in rats. METHODS: Two-months-old male SD rats were randomly divided into corn oil control group and DEHP (750 mg/kg) exposure group for daily intragastic treatment for 30 consecutive days. After the treatments the rats were examined for histomorphological changes of the testicle using HE staining and the expressions of the junction proteins N-cadherin ß-catenin, occludin and connexin43 of the BTB using Western blot. In the in vitro study, the vitality and ROS generation level in Sertoli cells exposed to different concentrations of DEHP were examined with MTT and ROS assay kits, respectively, and Nrf2 and p-p38 expressions were detected with Western blot. RESULTS: Compared with the control group, the rats with DEHP exposure showed structural damage of the seminiferous tubule and polarity loss of the spermatids. DEHP exposure caused significantly decreased expressions of occludin and connexin43 but increased expressions of N-cadherin and ß-catenin in the testicle tissues of the rats (P<0.05). The vitality of Sertoli cells was obviously decreased and ROS level increased significantly after exposure of the cells to increasing concentrations of DEHP, which also resulted in significantly up-regulated Nrf2 and p-p38 expressions (P<0.05). CONCLUSIONS: DEHP exposure causes increased oxidative stress in the Sertoli cells of the testis, activates p38 MAPK signaling pathway, and results eventually in impaired spermatogenesis in rats.

Urban fine particulate matter exposure causes male reproductive injury through destroying blood-testis barrier (BTB) integrity.

Blood-testis barrier (BTB) provides a suitable microenvironment for germ cells that is required for spermatogenesis. Exposure to particulate matter (PM) is recognized to occasion male reproductive impairment, but the mechanism of which remains unclear. Male Sprague-Dawley (SD) rats were used to establish animal models with PM2.5 exposure concentration of 0, 10, and 20mg/kg.b.w. once a day for four weeks. Success rate of mating, sperm quality, epididymal morphology, expressions of spermatogenesis markers, superoxide dismutases (SOD) activity and expression in testicular tissues, and expressions of BTB junction proteins were detected. In addition, in vitro experiments were also performed. After PM2.5 treatment, reactive oxygen species (ROS) production and apoptosis of Sertoli cells were analyzed. Our results indicated that after PM2.5 exposure male rats presented inferior uberty and sperm quality, with decreased expressions of spermatogenesis markers, escalated SOD activity and expression levels, and reduced expressions of tight junction, adherens junction, and gap junction proteins in testicular tissues. Meantime, PM2.5-treated Sertoli cells displayed increased SOD production and apoptosis. PM2.5 exposure engenders male reproductive function injury through breaking BTB integrity.