Comparison of Conservative Treatment and Surgery Treatment for Acute Scaphoid Fracture: A Meta-Analysis of Randomized Controlled Trials.

PURPOSE: This meta-analysis aimed to investigate the effectiveness of conservative and surgical treatments of scaphoid fracture. METHODS: The literature databases of Pubmed, Cochrane library, and Embase were searched in March 2022. This work extracted the data based on healing time, grip strength, range of wrist motion, nonunion, time before returning to work, and complications (including persistent pain, malunion of the fracture, wound infection, scar sensitivity, hypertrophic scar, and implant-related complications). Stata 14.0 software was used for statistical analysis. RESULTS: Twelve RCTs studies met our inclusion criteria. The surgical group had a shorter healing-time and time before returning to work than the conservative group. In addition, the surgical group had significantly better grip strength and range of wrist motion than the conservative group (P < 0.01). However, there was no significant difference between nonunion (P = 0.538) and complications (P = 0.661) between the two groups. CONCLUSION: This meta-analysis showed that surgical treatment of scaphoid fracture achieved better grip strength and range of wrist motion, and had a lower healing time and time before returning to work than the conservative treatment. The two treatments had similar results in nonunion and complications. Further RCTs were required for the research.

Arthrokatadysis from post-injection gluteal muscular fibrosis case report.

BACKGROUND: Gluteal muscle contracture (GMC) is a clinical syndrome characterized by the contracture of gluteal muscles, iliotibial band (ITB), and related fascia. GMC is much more prevalent in China, which has been proven to be associated with repeated intramuscular injections into the buttocks and the subsequent fibrosis and contracture.Generally, GMC is manifested mild. Here, we reported a severe case with arthrokatadysis. CASE PRESENTATIONS: A 25-year old man received multiple intramuscular injections of penicillin in the buttock when he was diagnosed with acute tonsillitis at 6 years old. Since then, he was injected penicillin regularly in local hospital because of the repeated acute tonsillitis until he was in high school. When the patient was found by the physical education teacher to be running in a state of external rotation of both feet, he was suggested to go to the hospital for treatment and was initially diagnosed to have GMC. He complained of occasional pain and limited range of motion in the hip joints. X-ray showed a typical arthrokatadysis. After arthroscopic release of GMC, the patient recovered well. CONCLUSIONS: This is possibly the first reported case of arthrokatadysis that was caused by GMC after repeated intramuscular injections into the buttocks. Although the patient recovered well by arthroscopic surgical release of bilateral gluteus maximus contractures, GMC should be paid more attention and treated as early as possible.

Magnetic resonance imaging based coracoid process morphology and its associations with isolated subscapularis tendon tears in Chinese patients.

OBJECTIVES: This study aims to assess the association between isolated subscapularis tears and coracoid morphology using magnetic resonance imaging (MRI) and to calculate the optimal cut-off values of the significant predictor to predict subscapularis tears. PATIENTS AND METHODS: Between January 2018 and December 2022, a total of 60 patients (29 males, 31 females; mean age: 58.4±8.4 years; range, 18 to 80 years) diagnosed with subscapularis tendon tears who were treated as Group A and 60 patients (29 males, 31 females; mean age: 46.8±11.5 years; range, 18 to 80 years) without subscapularis tendon tears who were treated as Group B were included. Axial coracoid-humeral distance (aCHD), sagittal coracoid-humeral distance (sCHD), coracoid overlap (CO) and coracoid angle (CA) of all patients were measured. Logistic regression was used to investigate the association between subscapularis tears as variables including aCHD, sCHD, CO and CA. Receiver operating characteristic curve analysis was used to determine the diagnostic values of coracoid morphology for subscapularis tears. RESULTS: The mean values of CO, aCHD and sCHD in Group A were 22.16 mm, 5.13 mm, and 5.56 mm, respectively. The mean values in Group B were 16.99 mm, 7.18 mm, and 7.29 mm, respectively. The degree of CA in Group A was 95.81 and 111.69 in Group B. The differences in the above measurement values were significant between two Groups. The CO was found to be associated with higher odds of subscapularis tears. The optimal cut-off value of CO was 19.79 mm. CONCLUSION: Based on our study results, CO is positively associated with isolated subscapularis tears. In addition, coracoid bursa effusion, cysts in the lesser tuberosity or a tear and malposition of long head of the biceps tendon on MRI may predict the presence of a clinically significant subscapularis tear.

A novel circular RNA circRBMS3 regulates proliferation and metastasis of osteosarcoma by targeting miR-424-eIF4B/YRDC axis.

Circular RNAs (circRNAs) have been demonstrated to have critical regulatory roles in tumorigenesis. However, the contribution of circRNAs to OS (osteosarcoma) remains largely unknown. circRNA deep sequencing was performed to the expression of circRNAs between OS and chondroma tissues. The regulatory and functional role of circRBMS3 (a circRNA derived from exons 7 to 10 of the RBMS3 gene, hsa_circ_0064644) upregulation was examined in OS and was validated in vitro and in vivo, upstream regulator and downstream target of circRBMS3 were both explored. RNA pull down, a luciferase reporter assay, biotin-coupled microRNA capture and fluorescence in situ hybridization were used to evaluate the interaction between circRBMS3 and micro (mi)-R-424-5p. For in vivo tumorigenesis experiments, Subcutaneous and Orthotopic xenograft OS mouse models were built. Expression of circRBMS3 was higher in OS tissues due to the regulation of adenosine deaminase 1-acting on RNA (ADAR1), an abundant RNA editing enzyme. Our in vitro data indicated that ShcircRBMS3 inhibits the proliferation and migration of osteosarcoma cells. Mechanistically, we showed that circRBMS3 could regulate eIF4B and YRDC, through 'sponging' miR-424-5p. Furthermore, knockdown of circRBMS3 inhibited malignant phenotypes and bone destruction of OS in vivo. Our results reveal an important role for a novel circRBMS3 in the growth and metastasis of malignant tumor cells and offer a fresh perspective on circRNAs in OS progression.

Clinical efficacy of arthroscopic treatment in ischial tuberosity cyst: A retrospective comparison study.

ABSTRACT: Ischial tuberosity cyst is a common disease, and the conventional incision procedure is associated with several disadvantages, leading to unsatisfactory therapeutic outcomes. The aim of the study was to evaluate the clinical outcomes of arthroscopic treatment for ischial tuberosity cyst and compared it with conventional incision surgery.The clinical data of 57 patients with ischial tuberosity cyst from May 2016 to September 2018 were retrospectively analyzed. According to the inclusion and exclusion criteria, a total of 49 patients were included. Of these patients, 24 patients received arthroscopic procedure (N = 24) and 25 patients received conventional incision procedure (N = 25). The operation time, intraoperative blood loss, postoperative drainage, postoperative hospital stay, and postoperative complications were compared between the 2 groups. Visual analogue scale scores was used to evaluate pain at 1 day, 1 week, and 1 month after the surgery.All 49 patients were followed up for (11.3 ±â€Š3.3) months. All patients in the arthroscopy group achieved phase I healing while 3 patients in conventional incision group developed complications. The operation time, intraoperative blood loss, postoperative drainage, and hospital stay in the arthroscopy group were (54.7 ±â€Š7.7) minutes, (20.8 ±â€Š3.5) mL, (20.3 ±â€Š5.6) mL, and (2.8 ±â€Š0.6) days, and were significantly better than those of (71.8 ±â€Š8.8) minutes, (67.3 ±â€Š12.0) mL, (103.6 ±â€Š20.3) mL, and (7.8 ±â€Š2.9) days in the conventional incision group, respectively. In the arthroscopy group, the visual analogue scale scores at 1 day, 1 week, and 1 month after the surgery [(2.6 ±â€Š0.7), (0.5 ±â€Š0.6), (0.3 ±â€Š0.5) points] were significantly lower than those in the conventional incision group [(6.0 ±â€Š0.7), (3.0 ±â€Š1.0), and (1.1 ±â€Š1.0) points], and the differences were statistically significant (P < .05). Finally, no significant difference was observed in the incidence of postoperative complications between the 2 groups (P > .05).In the treatment of ischial tuberosity cysts, arthroscopy has advantages of minimal invasion, less blood loss during perioperative period, milder postoperative pain, and rapid recovery when compared with conventional incision surgery.

Intelligent triggering of nanomicelles based on a ROS-activated anticancer prodrug and photodynamic therapy (PDT)-synergistic therapy for lung cancers.

The intelligent triggering of drug release at targeted sites is essential for the safety and efficacy of cancer therapies. This study aimed to design and synthesize a novel prodrug (DHA-S-CA) using a reactive oxygen species (ROS)-responsive moiety, thioacetal, to bridge cinnamaldehyde (CA) and dihydroartemisinin (DHA). As ROS are highly expressed in tumor tissues, the design uses the ROS-responsive moiety as an effective target for the nanodrug delivery system. Furthermore, the near-infrared dye IR808 and the prodrug were adopted to prepare co-loaded Soluplus®/TPGS nanomicelles (IR808/DHA-S-CA NMs). The photosensitized agent IR808 exhibited both tumor accumulation and cancer imaging properties while generating ROS during laser irradiation. Intracellular ROS detection indicated that the prodrug DHA-S-CA could degrade via the high concentration of ROS in cancer cells induced by laser irradiation, and the released CA stimulated mitochondria to regenerate additional ROS to further improve the antitumor effect of DHA. Combined with photodynamic therapy (PDT), IR808/DHA-S-CA (+) NMs outperformed free DHA, DHA NMs, and IR808/DHA-S-CA (-) in a comparison of their pharmacokinetic profiles because it had a longer circulation time and a greater area under the curve (AUC). Compared with other DHA groups, the ROS-responsive IR808/DHA-S-CA (+) micelles had comparable cytotoxic activity. Furthermore, the ROS-responsive IR808/DHA-S-CA (+) micelles exhibited markedly higher anticancer efficiency on lung cancer cells than the other DHA groups. Overall, these results indicated that the therapeutic strategy of our novel small-molecule prodrug combined with PDT has great potential for the treatment of tumors.

[Clinical application of acromion radiological classification in diagnosis and treatment of rotator cuff injury].

OBJECTIVE: To develop a new classification of acromion based on the subacromial impingement theory and the Rockwood tilt view. And explore the application value of the new classification in the diagnosis and treatment of rotator cuff tear. METHODS: The clinical data of 101 patients underwent shoulder arthroscopic surgery for impingement syndrome or rotator cuff tear from January to December 2017 were retrospectively analyzed. There were 34 males and 67 females, aged from 34 to 76 years with an average of (56.31±9.63) years old, course of disease from 2 to 12 months with average of 6 months. Preoperative radiographs of the routine anteroposterior view, Rockwood tilt view and the supraspinatus outlet view were obtained. Based on the subacromial impingement theory and Rockwood radiographs, the morphology of the acromion can be divided into three types:typeⅠ(flat type), typeⅡ(bump type), and type Ⅲ (impingement type). Two observers classified 101 shoulder Rockwood radiographs according to the new classification method and the supraspinatus Outlet radiographs according to the traditional acromial morphological classification method. Supraspinatus tendon injuries were classified into no tear, partial-thickness tear, and full-thickness tear according to the arthroscopic findings. Concordance test (Kappa value) between the inter-observer and intra-observer was carried out for the new classification method and the traditional classification method respectively. The rank sum test was used to compare the mean acromiohumeral distance(AHD) of the three acromion forms in the new acromion classification method. Spearman rank correlation test and Gamma method were used to analyze the correlation between the new acromion classification method and the degree of supraspinatus tendon tear. RESULTS: The inter-observer consistency analysis of the new classification system was significantly better than that of the traditional classification (0.827 vs 0.278), the intra-observer consistency analysis of the new classification system were also significantly better than that of the traditional classification (0.921 vs 0.448, 0.890 vs 0.539). There was no statistical significance in the AHD among three types of the new classification(H=2.186, P>0.05). In all 101 patients, the highest proportion of impingement type acromion was 45.5% (46 cases), followed by bump type acromion was 36.6% (37 cases), and flat type acromion was 17.8% (18 cases). The incidence of supraspinatus tendon tear in the patients with impingement type acromion was significantly higher than that of the other two types of acromion, there was a spearman rank correlation between the new acromion type and the degree of the supraspinatus tendon tear(rs=0.719, P<0.001). CONCLUSION: Rockwood radiographs of the shoulder can well display the anterolateral osteophytes of the acromion. The new acromion classification method based on Rockwood radiographs has high reliability and good reproducibility, in which impingement type of acromion is closely related to supraspinatus tendon tear. Compared with the traditional classification and AHD, the new classification method has more diagnostic value than for rotator cuff injury.

[Re discussion on arthroscopic repair of rotator cuff tear in aged patients].

OBJECTIVE: To investigate the method and clinical effects of modified anchor insertion with single-row suture arthroscopic rotator cuff repair for aged patients with rotator cuff tear. METHODS: From March 2016 to February 2020, 96 aged patients with rotator cuff tears were retrospectively analyzed, including 29 males and 67 females, aged from 65 to 85 years, with a mean of (68.8±3.9) years. Patients were treated with modified anchor insertion with single-row suture arthroscopic rotator cuff repair technique. Before and after operation, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder joint function, visual analogue scale (VAS)was used to evaluate patients' pain. Among them, 32 patients underwent magnetic resonance examination one year postoperatively. RESULTS: All operations were completed and the patients were followed up from 11 to 42 months, with a mean of (21.4±7.5) months. The UCLA score increased from preoperative 12.22±3.30 to final follow-up 31.30±2.49 (t=45.21, P<0.01);ASES score increased from preoperative 8.60±1.88 to final follow-up 12.60±0.84 (t=19.05, P<0.01);and the VAS decreased from preoperative 5.00 (2.00 to 8.00)scores to final follow-up 1.00 (0.00 to 3.00)scores (Z=-12.22, P<0.05). One year after operation, one of the 32 patients who underwent MRI showed that the repaired rotator cuff was torn again, but it did not affect the normal life and did not operate again. During the final follow-up, no anchor extraction was found in all 96 aged patients. CONCLUSION: Modified anchor insertion with single-row suture arthroscopic rotator cuff repair technique for rotator cuff tear in aged patients could achieve satisfactory results and effectively reduce the anchor extraction rate.

[Arthroscopic treatment for the calcific tendinitis at soft tissues around hip].

OBJECTIVE: To explore the feasibility and clinical effects of arthroscopic treatment for the calcific tendinitis at soft tissues around hip. METHODS: A total of 16 patients diagnosed as the calcific tendinitis at soft tissues around hip from May 2013 to July 2018 were retrospectively analyzed. All the 16 patients received arthroscopic procedures. There were 10 males and 6 females with an average age of 35 to 63 (44.50±6.67) years old and 9 left hips, 6 right hips were involved. The course of disease were 1 to 8(3.18±1.97) days. Clinical effects were evaluated with visual analogue scale(VAS), modified Harris hip scores (HHS), nonarthritic hip score (NAHS) and imaging examinations before operation, 1 day after operation and the final follow-up. RESULTS: All 16 patients successfully finished the arthroscopic procedures in 0.5 to 1.2 (0.75±0.21) hours. Primary healing of incision were obtained without any complications of infection, wound hematocele and neurovascular injury. All 16 patients received an average postoperative follow-up of 6 to 12 (9.6±2.3) months. Before operation, the VAS were 7.88±0.72, modified HHS were 29.25±3.23, NAHS were 27.42±3.08. The 1st day postoperative VAS were 2.19±0.66, modified HHS were 82.56± 5.64, NAHS were 82.11±2.94, all the difference were statistically significant between before and 1 day after operation (P< 0.05). At the final follow-up, the VAS were 0.38±0.50, modified HHS were 94.31±2.82, NAHS were 94.84±2.85, all the scores were improved significantly compared to that before operation (P<0.05). At final follow-up, there was no recurrence and the calcification disappeared in all patients, there was one patient feel sourness around the hip. CONCLUSION: Arthroscopic treatment for the calcific tendinitis at soft tissues around hip is effective.It has advantages of minimal invasive, rapid pain relief, rapid hip joint function recovery and definite clinical effects.

Norcantharidin inhibits viability and induces cell cycle arrest and apoptosis in osteosarcoma.

Osteosarcoma is the most frequent malignant bone tumor in children and adolescents. Norcantharidin (NCTD) is a purified component from blister beetles and has been identified to exert antitumor effects in a variety of cancer types. However, the antitumor effect of NCTD in osteosarcoma remains to be elucidated. In the current study, it was first demonstrated that NCTD inhibited proliferation and induced G2/M-phase arrest and cell apoptosis in human osteosarcoma cells. Furthermore, NCTD significantly decreased the phosphorylation of Akt and the mammalian target of rapamycin in human osteosarcoma cells. These results suggest that NCTD is a promising candidate for the treatment of osteosarcoma patients in the future.