Isolated Partial Anomalous Pulmonary Veins: A 10-Year Experience at a Single Center.

INTRODUCTION: Isolated partial anomalous pulmonary venous connection (PAPVC) is difficult to diagnose, and surgical indications remain controversial. We reviewed 10 y of isolated PAPVC cases. METHODS: The data of patients with isolated PAPVC admitted to the Anzhen Congenital Heart Disease Department from 2010 to 2019 were reviewed retrospectively. RESULTS: Thirty patients, aged between 4 mo and 32 y, were included in this study. Significant correlations were found between the right ventricle (RV), end-diastolic dimension Z-score (RVED-z) and age (r = 0.398, P = 0.03), and between estimated pulmonary pressure and age (r = 0.423, P = 0.02). However, no significant correlations were found between the RVED-z and the number of anomalous pulmonary veins (r = 0.347, P = 0.061), between estimated pulmonary pressure and the RVED-z (r = 0.218, P = 0.248), and between estimated pulmonary pressure and the number of anomalous veins (r = 0.225, P = 0.232). Transthoracic echocardiography (TTE) confirmed 90% of isolated PAPVC cases. Surgical repair was performed in 29 patients with RV enlargement, persistent low weight, pulmonary hypertension, or respiratory symptoms. Among the surgical patients, nine had elevated pulmonary pressure before surgery, which decreased postoperatively; no mortality or reintervention was observed. The mean duration of echocardiographic follow-up was 1.9 y. CONCLUSIONS: TTE is recommended for routine assessments, and further clarification can be obtained with computed tomography when TTE proves inconclusive for diagnosis. Transesophageal echocardiography and computed tomography are further recommended for adult patients if TTE fails to provide clear results. PAPVC should be considered as an underlying cause when unexplained RV enlargement is observed. Surgery is recommended for patients with RV enlargement, pulmonary hypertension, or respiratory symptoms.

The development of Tibetan children's racial bias in empathy: The mediating role of ethnic identity and wrongfulness of ethnic intergroup bias.

OBJECTIVES: Individuals often automatically have more empathy for same-race members. However, there are no studies on racial bias in empathy (RBE) among Tibetan school-aged children. The present study aimed to examine the development of RBEs, including racial bias in cognitive empathy, affective empathy, and behavioral empathy, in Tibetan school-aged children. METHOD: In Experiment 1 (N = 108, aged 7-12), ethnic identity was primed using Tibetan and Han names. Then negative and neutral events were applied to measure the RBEs of Tibetan children. In Experiment 2 (N = 148, aged 7-12), negative events were replaced by pain events. In Experiment 3 (N = 60, aged 7-12), Tibetan children's ethnic identity and the awareness of the wrongfulness of ethnic intergroup bias were added to examine the underlying mechanism. RESULT: Results found that RBEs increased among Tibetan children aged 7-10 and decreased among those aged 11-12, Moreover, we analyzed age as a continuous variable and found that 10 years old was the inflection point in the development of RBEs in Tibetan children. Importantly, children aged 11-12 years old realized more wrongfulness of ethnic intergroup bias than children aged 7-10. The ethnic identity of Tibetan children aged 7-10 mediated the relation between age group and RBEs. And the wrongfulness of ethnic intergroup bias mediated the link between age group and RBEs in Tibetan children aged 9-12. CONCLUSION: Our study sheds light on the development of RBEs in Tibetan school-aged children and highlights the importance of identifying the appropriate timing for intervening in prejudice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Serum complement C1q level is associated with left ventricular hypertrophy induced by coarctation of the aorta: A retrospective observational study.

BACKGROUND: The complement system plays an important role in the development of left ventricular hypertrophy. Complement C1q is an initial component of the classical complement pathway and is related to many inflammatory diseases. We aimed to determine whether there was an association between serum complement C1q and left ventricular hypertrophy induced by coarctation of the aorta (CoA). METHODS: Based on whether CoA was combined with a large ventricular septal defect (VSD) or patent ductus arteriosus (PDA), the patients were divided into a simple CoA group (n = 15) and a complex CoA group (n = 13). Meanwhile, we selected simple large VSD (n = 14) patients and normal children (n = 28) as the control group. The serum complement C1q level was compared using immunity transmission turbidity among different groups. RESULTS: The preoperative content of C1q in the simple CoA group was significantly lower than that in the complex CoA group and normal group (96.97 ± 20.66 vs. 130.73 ± 35.78, 96.97 ± 20.66 vs. 156.21 ± 29.14, P < 0.05). There was no significant difference in the preoperative content of C1q between the complex CoA group and the large VSD group (P > 0.05). There was a negative correlation between the preoperative complement C1q content and the interventricular septal thickness and left ventricular posterior wall thickness (r = - 0.035, r = - 0.288, P < 0.05). The percentage of postoperative decrease in C1q in children with simple CoA or complex CoA was positively correlated with the time of cardiopulmonary bypass and aortic cross clamp, respectively (r = 0.797, r = 0.622, r = 0.898, r = 0.920, P < 0.05). There was no significant difference in the content of preoperative triglycerides (TG), total cholesterol (TCHO), high-density lipoprotein cholesterol (HDL-C) or low-density lipoprotein cholesterol (LDL-C) among the different groups (P > 0.05). In the simple CoA group and complex CoA group, the preoperative complement C1q, TG, TCHO, HDL-C and LDL-C levels were significantly higher than those after the operation (P < 0.05). There was no significant correlation between preoperative complement C1q and TG, TCHO, HDL-C or LDL-C (P > 0.05). CONCLUSIONS: Complement C1q has an inhibitory effect on the formation of left ventricular hypertrophy, which may not be mediated by regulating lipid metabolism. During cardiac surgery, complement C1q may have a protective effect against myocardial injury.

Emergency surgical treatment of total anomalous pulmonary venous connection.

BACKGROUND: This study explored the strategy and effect of emergency surgical treatment for total anomalous pulmonary venous connection (TAPVC). METHODS: From March 2009 to February 2020, 78 patients with TAPVC underwent emergency surgical correction. There were 51 males and 27 females. The median age was 39.5 days, and the median weight was 4.0 kg. Preoperative percutaneous oxygen saturation was 80.8% ± 4.5%. RESULTS: Of the cases investigated, seven died during the perioperative period; 16 had a delayed chest closure; 19 had early pulmonary vein obstruction; two had secondary tracheal intubation; one had a brain complication; and one had a third-degree atrioventricular block. Low weight, younger age, cardiopulmonary bypass time, and aortic cross-clamp time were identified as risk factors for early mortality. During the follow-up from 4 to 137 months, 12 cases did not respond to follow-up requests. Ten patients died within 1-6 months after discharge. One patient underwent reoperation due to pulmonary vein obstruction. The longer hospital stay after the operation and intensive care unit time were identified as risk factors for late mortality. CONCLUSIONS: Emergency surgery for severe TAPVC patients after admission achieved good short-term results. Prenatal diagnosis should be strengthened to save more patients. The higher late mortality rate of such patients indicates that post-discharge management should be strengthened to reduce the occurrence of post-discharge deaths.

High-sensitivity chemiluminescent immunoassay investigation and application for the detection of T-2 toxin and major metabolite HT-2 toxin.

BACKGROUND: T-2 toxin is a widely distributed mycotoxin in cereals. HT-2 toxin is the major metabolite, which is also a contaminant in cereals. T-2 toxin and HT-2 toxin have been identified as having carcinogenic, hepatotoxic, teratogenic and immunotoxic properties. To reduce the risk of contamination, a rapid, highly sensitive and inexpensive assay for the detection is required. RESULTS: In this study a high-sensitivity chemiluminescent enzyme-linked immunoassay (CL-ELISA) of T-2 toxin and HT-2 toxin was developed. With the help of the chemiluminescent substrate, this protocol showed a highly sensitive character with an IC50 as low as 33.28 ng mL-1 and 27.27 ng mL-1 for T-2 and HT-2, respectively. In addition, this method had no cross-reaction with other structurally related mycotoxins. CONCLUSION: These results indicated that the developed CL-ELISA could be applied for the detection of T-2 toxin and HT-2 toxin in actual samples without complicated steps. © 2016 Society of Chemical Industry.

Motor recovery at 6 months after admission is related to structural and functional reorganization of the spine and brain in patients with spinal cord injury.

This study aimed to explore structural and functional reorganization of the brain in the early stages of spinal cord injury (SCI) and identify brain areas that contribute to motor recovery. We studied 25 patients with SCI, including 10 with good motor recovery and 15 with poor motor recovery, along with 25 matched healthy controls. The mean period post-SCI was 9.2 ± 3.5 weeks in good recoverers and 8.8 ± 2.6 weeks in poor recoverers. All participants underwent structural and functional MRI on a 3-T magnetic resonance system. We evaluated differences in cross-sectional spinal cord area at the C2/C3 level, brain cortical thickness, white matter microstructure, and functional connectivity during the resting state among the three groups. We also evaluated associations between structural and functional reorganization and the rate of motor recovery. After SCI, compared with good recoverers, poor recoverers had a significantly decreased cross-sectional spinal cord area, cortical thickness in the right supplementary motor area and premotor cortex, and fractional anisotropy (FA) in the right primary motor cortex and posterior limb of the internal capsule. Meanwhile, poor recoverers showed decreased functional connectivity between the primary motor cortex and higher order motor areas (supplementary motor area and premotor cortex), while good recoverers showed increased functional connectivity among these regions. The structural and functional reorganization of the spine and brain was associated with motor recovery rate in all SCI patients. In conclusion, structural and functional reorganization of the spine and brain directly affected the motor recovery of SCI. Less structural atrophy and enhanced functional connectivity are associated with good motor recovery in patients with SCI. Multimodal imaging has the potential to predict motor recovery in the early stage of SCI. Hum Brain Mapp 37:2195-2209, 2016. © 2016 Wiley Periodicals, Inc.

Fracture of the Lateral Process of the Talus in Children: A Kind of Ankle Injury With Frequently Missed Diagnosis.

OBJECTIVE: To analyze the clinical characteristics, the treatment, and the outcome of lateral process fracture of the talus in children. METHODS: From March 2011 to October 2013, 12 children with lateral process fracture of the talus were treated in our hospital. The study contained 3 female and 9 male patients, including 8 patients affected on the left side and 4 on the right side. The age at the time of injury ranged from 8 to 13 years. Concomitant injuries included undisplaced calcaneus fractures in 1 case and distal fibula epiphysis injury in 1 case. The patients presented to our hospital from 2 hours to 2 months after injury. All cases were classified by the Hawkins fracture system. Treatment included immobilization and not bearing weight for 4 weeks for nondisplaced fractures or open reduction and fixation for significantly displaced fractures. Therapeutic effects were evaluated on the basis of the AOFAS (The American Orthopaedic Foot and Ankle Society) Ankle Hindfoot Scale. RESULTS: Seven of the cases were initially diagnosed in our department, and the diagnosis was missed in 5 cases. The missed diagnosis rate was 42%. All patients were followed up for 18 months on an average. Follow-up radiographs did not show avascular necrosis of the talus, nonunion, and malunion in any patient. The mean AOFAS hindfoot score was 96 points. The clinical result was found to be excellent in 10 patients, good in 1 patient, and fair in 1 patient (the success rate was 92%). CONCLUSIONS: The lateral process of talus fracture is a frequently missed injury. The diagnosis must rely on thorough check-ups combined with standard radiographs and computed tomographic scan. Depending on the type and the displacement of the fracture, proper treatment options could be implemented for desirable clinical effects.

Baicalein protect pancreatic injury in rats with severe acute pancreatitis by inhibiting pro-inflammatory cytokines expression.

BACKGROUND/AIM: Inflammatory cytokines is a key point in the development of pathogenesis of SAP. Inflammatory mediators TNF-α and IL-6 are up-regulated in serum of patients with SAP and become good discriminators of SAP severity. MATERIALS AND METHODS: In this study, we investigated the treatment effectiveness of Baicalein on SAP rat model. Baicalein was intravenously injected immediately after SAP induction in rats. The mortality, histopathology score, ascites fluid volume, and pro-inflammatory cytokine production were evaluated at 12 h after SAP induction. RESULTS: Baicalein decreased the pancreatic histopathology score, reduced ascites fluid production, protected against pancreatic injury, and improved survival in rats with SAP. The serum IL-6 and TNF-α concentrations were also down-regulated by Baicalein. CONCLUSION: Baicalein demonstrated a well curative capability on rats with SAP. The mechanism may be alleviateing pancreatic injury and inhibiting pro-inflammatory cytokines expression.

Ulnar Rotation Osteotomy for Congenital Radial Head Dislocation.

PURPOSE: To evaluate an ulnar rotation osteotomy for congenital anterior dislocation of the radial head. METHODS: Nine patients (5 boys and 4 girls aged 6 to 13 years) with congenital anterior dislocation of the radial head were treated with ulnar rotation osteotomy. Magnetic resonance imaging of the elbow showed the proximal radioulnar joint on the anterior-lateral side of the ulna rather than on the lateral side in patients with congenital anterior dislocation of the radial head. On the basis of this finding, we performed an osteotomy on the ulna and laterally rotated the proximal radioulnar joint achieving radial head reduction and restoring the anatomical relationship between the radial head and the capitellum. Clinical and radiographical evaluation of the elbow was performed before surgery and at postoperative follow-up. RESULTS: All patients were followed for 13 to 45 months after surgery. Elbow radiography showed that the radiocapitellar joint was reduced in all patients at the last follow-up visit and that the carrying angle was decreased relative to that in the preoperative condition. Elbow stability and the range of elbow flexion motion were improved at the last follow-up. We did not observe ulnar osteotomy site nonunion or elbow osteoarthritis in these patients. Furthermore, radial head dislocation did not recur. CONCLUSIONS: At early follow-up, ulnar rotation osteotomy was a safe and effective method for the treatment of congenital anterior dislocation of the radial head. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Valgus Osteotomy of the Proximal Humerus to Treat Humerus Varus in Children.

PURPOSE: Humerus varus is a rare disease in children that can cause limited active abduction and forward flexion of the shoulder as well as upper limb length discrepancies. Valgus osteotomy of the proximal humerus is an effective method to treat this disease, although internal fixation with a plate and screws is rarely reported. The purpose of this article is to investigate the clinical outcome and radiographic changes of valgus osteotomy of the proximal humerus through internal fixation with a plate and screws. METHODS: From April 2005 to August 2011, our group treated 5 patients including 1 girl and 4 boys. The left side was the affected side in all cases. The mean operation age was 13 years. We performed valgus osteotomy of the proximal humerus with internal fixation provided by a plate and screws to treat these patients. Follow-ups were performed with an average of 35.6 months (range, 24 to 74 mo). The changes in postoperative shoulder function and radiographic images were analyzed. RESULTS: The actual cause of the humerus varus was not clear. Abduction and forward flexion of the shoulder were significantly increased in all patients. However, there was no obvious improvement in upper limb length. The postoperative humeral neck-shaft angle improved notably as well. We used a paired t test for statistical treatment. The P value was 0.001. No bony nonunion or delayed union was observed. The time required for union was 3 to 6 months. No obvious complications occurred. CONCLUSIONS: Valgus osteotomy of the proximal humerus using a plate-screw fixation method can correct the deformity and provide strong fixation in children. The postoperative improvement of shoulder motion and radiologic changes were satisfactory. However, we need to do second operation to remove the plate. Meanwhile, the patients would require a second operation to elongate the affected limb.

The effect of different preventive strategies during total joint arthroplasty on periprosthetic joint infection: a network meta-analysis.

BACKGROUND: Periprosthetic joint infection after total joint arthroplasty has a large incidence, and it may often require two or more stages of revision, placing an additional burden on clinicians and patients. The purpose of this network meta-analysis is to evaluate the effect of four different preventive strategies during total joint arthroplasty on the prevention of periprosthetic joint infection. METHODS: The study protocol was registered at PROSPERO (CRD: 42,023,448,868), and the literature search databases included Web of Science, PubMed, OVID Cochrane Central Register of Controlled Trials, OVID EMBASE, and OVID MEDLINE (R) ALL that met the requirements. The network meta-analysis included randomized controlled trials, retrospective cohort studies and prospective cohort studies with the outcome of periprosthetic joint infection. The gemtc R package was applied to perform the network meta-analysis to evaluate the relative results of different preventive strategies. RESULTS: This network meta-analysis study included a total of 38 articles with 4 preventive strategies and negative controls. No improvement was observed in antibiotic-loaded bone cement compared with negative controls. Chlorhexidine showed the highest probability of delivering the best preventive effect, and povidone iodine had the second highest probability. Although vancomycin ranked after chlorhexidine and povidone iodine, it still showed a significant difference compared with negative controls. In addition, the incidence after applying chlorhexidine was significantly lower than that after applying negative controls and vancomycin. In the heterogeneity test between direct and indirect evidence, there was no apparent heterogeneity between them. CONCLUSION: The study indicated that chlorhexidine, povidone iodine and vancomycin showed significant efficacy in preventing periprosthetic joint infection after total joint arthroplasty, while antibiotic-loaded bone cement did not. Therefore, more high-quality randomized controlled trials are needed to verify the results above.

The performance of partially substituted composite ester materials with weathered red-bed soil in ecological restoration.

Ester materials have become a significant topic in ecological restoration because of their degradability and lack of pollution. However, these artificial materials have issues such as high resource consumption and high cost. Therefore, finding a scientific substitute for ester materials is crucial to reduce costs. This study proposes the use of weathered red-bed soil to partially replace ester materials. Orthogonal coupled compounding and ecological effect tests were performed to analyze the soil improvement mechanism based on the mineral composition, soil structure, and electrical conductivity properties of the weathered red-bed soil. The experimental findings indicated that the soil modified using ester materials exhibited improved strength, water retention, and aeration owing to changes in the soil structure. Plant germination and height increased by 55% and 37 mm, respectively, when using a ratio of 15 g/m2 absorbent ester material, 2.5 g/m2 adhesive ester material, and 5% weathered red-bed soil. Through this approach, the amount of ester material to be used could be further reduced by 75%. The weathered red-bed soil offers improved ecological effects by altering the physical, mechanical, and hydraulic properties of the soil structure. This study presents a theoretical foundation for ecological conservation using weathered red-bed soil as a substitute for certain ester materials.

Exploring Causal Relationships between Leukocyte Telomere Length, Sex Hormone-Binding Globulin Levels, and Osteoporosis Using Univariable and Multivariable Mendelian Randomization.

OBJECTIVE: Recent evidence supports that leukocyte telomere length (LTL) may be positively associated with healthy living and inversely correlated with the risk of age-related diseases, including osteoporosis. Furthermore, it is important to note that sex hormone-binding globulin (SHBG) levels play a crucial role in the regulation of osteoporosis by influencing the availability of sex hormones. Hence, this study holds significant importance as it aims to unravel the roles of LTL and SHBG levels and determine which one acts as a predominant intermediary factor in influencing osteoporosis. Using Mendelian randomization (MR), we can gain valuable insights into the intricate relationships between aging, sex hormones, and bone health. METHODS: Univariable and multivariable and MR analyses were employed in this study. First, we used genetic variants associated with both LTL, as determined from a study involving 472,174 European participants by Codd et al., and SHBG levels, as identified in a study conducted by Ruth et al. with 370,125 participants, as instrumental variables (IVs). Then we aimed to establish a causal relationship between LTL and SHBG levels and their potential impact on osteoporosis using univariable MR. Finally, we conducted multivariable MR to provide insights into the independent and combined effects of LTL, SHBG levels on osteoporosis risk. We used various MR methods, with the primary analysis employing the inverse-variance weighted (IVW) model. RESULTS: Univariable MR analysis reveals a potential causal effect of longer LTL on reduced risk of osteoporosis [odds ratio (OR): 0.85; 95% confidence interval (CI): 0.73-0.99; p = 0.03]. Conversely, higher genetically determined SHBG levels affect the risk of osteoporosis positively. (OR: 1.38; 95% CI: 1.09-1.75; p < 0.01). We observed a negative causal effect for LTL on the occurrence of SHBG (OR: 0.96; 95% CI 0.94-0.98, p < 0.01). After adjustment of using multivariable MR, the causal effect of LTL on osteoporosis (OR: 0.92; 95% CI: 0.84-1.03; p = 0.14), and the effect of SHBG on osteoporosis (OR: 1.43; 95% CI: 1.16-1.75; p < 0.01) were observed. CONCLUSION: Longer LTL may confer a protective effect against osteoporosis. Additionally, the levels of SHBG appear to play a crucial role in mediating the relationship between LTL and osteoporosis. By understanding the interplay between these factors, we can gain valuable insights into the mechanisms underlying bone health and aging and potentially identify new avenues for prevention and intervention strategies.

Effect analysis of different methods on radial neck fracture in children.

To analyze the curative effect of varying treatment types in 75 pediatric cases of radial neck fracture and explore the prognosis-related factors. Clinical data of 75 children with radial neck fractures treated in our hospital from January 2015 to December 2016 were retrospectively collected. The relationship between age, fracture type, treatment method, X-ray examination after reduction, and prognosis was analyzed. Age was related to prognosis. The excellent and good rate of treatment was 89.25% for children with age ≤ 10 and 57.89% for children over 10 years old. The type of fracture was closely related to the curative effect, 95.0% of O'Brien type I fractures had good curative effects, and the excellent and good rates of O'Brien II type and III type fractures were 87.0 and 66.7%, respectively. According to the type of fracture, the excellent and good rate of patients treated with plaster fixation was the highest (96.42%), but the excellent and good rate was 72.3% in the patients who needed to be reduced by Kirschner wire or elastic intramedullary nail. Although open reduction is superior to closed reduction in imaging evaluation, the excellent and good rate is only 50%.The prognosis of children with radial neck fracture is related to age, type of fracture, and treatment method. In pediatric patients less than 10 years with light, shifted fractures, the excellent and good prognosis rate is higher with less operative intervention. We recommend treating patients with closed reduction and elastic nail fixation according to different fracture types.

Application of computer simulation in the treatment of traumatic cubitus varus deformity in children.

Cubitus varus deformity is common in children. The purpose of this study was to assess the usefulness of computer simulation based on three-dimensional computed tomography (3D-CT) reconstruction with regard to preoperative planning and surgical treatment in children with traumatic cubitus varus deformity.The study included 13 patients with traumatic cubitus varus deformity between January 2012 and January 2015. The original 3D-CT data were transferred to Mimics 10.01 software. Special tools were used for simulation of supracondylar lateral wedge osteotomy of the humerus. Intraoperative elbow arthrography was used to identify the articular surface of the elbow joint for assisting the judgment of the osteotomy site. Kirschner wires were used to determine the osteotomy plane and angle. The osteotomy site was fixed by crossing Kirschner wires and steel wire tension band.Of the 13 patients, 11 were male and 2 were female. The left side was affected in 8 patients, and the right side was affected in 5 patients. The patient age ranged from 2 years to 14 years (mean age, 6 years and 7 months). The varus angle ranged from 12° to 35° (mean angle, 20°). The carrying angle on the contralateral side ranged from 5° to 18° (mean angle, 10°). The varus deformities showed good correction. The 13 patients were followed up for 24 to 60 months (mean follow-up, 38 months). According to the Flynn score of elbow joint function after surgery: 10 patients had excellent function, 2 had good function, and 1 had fair function. The excellent rate was 92.3%. At the final follow-up, the ipsilateral carrying angle ranged from 4° to 15° (mean angle, 11°).Computer simulation based on 3D-CT reconstruction can provide good information on the right humeral osteotomy position and osteotomy angle. It can guide the actual operation and provide better results after surgery. Intraoperative elbow arthrography is useful to determine the level of elbow joint osteotomy, and it can assist in the operation.Level of evidence: Level IV-retrospective case, treatment study.

Double ulnar osteomy for the treatment of congenital radial head dislocation.

OBJECTIVE: The aim of this study was to retrospectively evaluate the effects of our double osteotomy technique in the treatment of congenital radial head dislocation (CRHD). METHODS: A total 14 children (14 elbows; 71.42% male; mean age: 9.31 ± 3.06 years) with CRHD who underwent double osteotomy of the proximal ulna between April 2010 and June 2015 were included in the study. The patients with CRHD were identified according to medical history, plain radiographs or magnetic resonance imagings. The outcomes were evaluated through comparison of the preoperative and postoperative motion range of elbow and Mayo Elbow Performance Score (MEPS). RESULTS: After a follow-up of 13-35 months (22.29 ± 5.80), compared with pre-operation, the flexion (132.14 ± 3.23° vs 123.21 ± 7.75°, P = 0.003), extension (8.21 ± 4.21° vs 1.07 ± 3.50°, P = 0.003), and pronation of elbow (83.21 ± 4.21° vs 80.36 ± 4.14°, P = 0.011) improved significantly in all patients. Furthermore, the carrying angle was recovered to the normal level (5-15°) in all of these patients (18.57 ± 5.69° vs 8.21 ± 2.49°, P = 0.001). MEPS score was significantly increased postoperatively (96.79 ± 2.49 vs. 90.71 ± 1.82, P = 0.000), with the good outcome in CRHD patients. CONCLUSION: The results of our study suggested that this double osteotomy on the proximal ulna might be an effective method for the treatment of CRHD. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.

Closed reduction using the percutaneous leverage technique and internal fixation with K-wires to treat angulated radial neck fractures in children-case report.

Pediatric radial neck fractures are uncommon. Severely displaced and angulated fractures usually require treatment. Our goals for treatment are to avoid incision, reduce the fracture adequately with no reduction loss, and achieve good postoperative function. We aimed to observe the clinical outcomes of closed reduction with the percutaneous leverage technique and internal fixation with Kirschner-wires (K-wires) to treat angulated radial neck fractures in children.From January 2011 to April 2013, we treated 16 cases of angulated radial neck fracture in 12 boys and 4 girls. Five fractures were type II and 11 fractures were type III using the O'Brien classification. One K-wire was percutaneously introduced into the fracture site using the leverage technique to attain good reduction. Two K-wires were introduced from the proximal to the distal areas of the fracture site. The elbow was immobilized by cast in 90° of flexion and the forearm in supination for 3 to 4 weeks. The K-wires were removed at 3 to 4 weeks postoperatively. All cases were followed up for a mean duration of 3 years 6 months.According to the Metaizeau reduction classification, 12 cases were excellent, and 4 cases were good. According to the Metaizeau clinical classification, 14 cases were excellent, and 2 cases were good. There was no necrosis of the radial head. There was no infection, radioulnar synostosis, and damage of the radial nerve deep branch. There was no limitation in the pronation and supination functions of the forearm.Closed reduction using the percutaneous leverage technique and internal fixation using K-wires is easy to perform. It is encouraged to use this approach as the clinical outcome is good. LEVEL OF EVIDENCE: level IV-retrospective case, treatment study.

Identification of key genes associated with Schmid-type metaphyseal chondrodysplasia based on microarray data.

This study aimed to gain a better understanding of the molecular circuitry of Schmid-type metaphyseal chondrodysplasia (SMCD), and to identify more potential genes associated with the pathogenesis of SMCD. Microarray data from GSE72261 were downloaded from the NCBI GEO database, including collagen X p.Asn617Lys knock-in mutation (ColXN617K), ablated XBP1 activity (Xbp1CartΔEx2), compound mutant (C/X), and wild-type (WT) specimens. Differentially expressed genes (DEGs) were screened in Xbp1 vs. WT, Col vs. WT and CX vs. WT, respectively. Pathway enrichment analysis of these DEGs was performed. Transcription factors (TFs) of the overlapping DEGs were identified. Weighted correlation network analysis (WGCNA) was performed to find modules of DEGs with high correlations, followed by gene function analysis and a protein-protein interaction network construction. In total, 481, 1,530 and 1,214 DEGs were identified in Xbp1 vs. WT, Col vs. WT and CX vs. WT, respectively. These DEGs were enriched in different pathways, such as extracellular matrix (ECM)-receptor interaction and metabolism-related pathways. A total of 7 TFs were found to regulate 19 common upregulated genes, and 4 TFs were identified to regulate 21 common downregulated genes. Two significant gene co-expression modules were enriched and DEGs in the 2 modules were mainly enriched in different biological processes, such as ribosome biogenesis. Moreover, Kras (downregulated), Col5a1 (upregulated) and Furin (upregulated) were both identified in the regulatory networks and protein-protein interaction (PPI) network. On the whole, our findings indicate that the Kras, Col5a1 and Furin genes may play essential roles in the molecular mechanisms of SMCD, which warrants further investigation.

A case report of children's divergent dislocation of the elbow and review of literature.

BACKGROUND: The divergent dislocation of the elbow is not common in children, and the imaging is difficult and challenging. This often leads to misdiagnosis or inappropriate treatment. The literature has reported a total of 19 cases currently. METHODS: A 10-year-old girl with divergent dislocation of the elbow was admitted in our department in November 2013. When playing basketball, her right elbow was injured on the concrete floor. After injury, her right elbow joint became severely swollen, with obvious deformity. The anteroposterior X-ray of elbow showed right olecranon and coronoid fractures, the proximal radioulnar separation, and displacement; the lateral X-ray showed the posterior dislocation of right elbow. RESULTS: Under local anesthesia, right elbow manual reduction was performed, and after reduction, 3-dimensional computed tomography reconstruction displayed good reduction of the elbow dislocation. The fracture of coronoid displaced minimally, but the olecranon fracture showed great displacement which underwent the open reduction and internal fixation. Postoperatively, a plaster splint was applied for protection, with regular outpatient follow-ups. At the end of the normal follow-up, the active ROM of the right elbow joint was 5° to 130° and with normal rotation. CONCLUSION: Therefore, through the treatment of this case and the literature review, we believe that for children, most divergent dislocations of the elbow may achieve a better clinical result with closed reduction, and we also believe that after surgery or closed reduction, in the follow-up, proper function exercise is an important condition for the rehabilitation of children. For such patients, correct diagnosis and timely treatment can help to avoid joint dysfunction of elbow.