A screw view model of navigation guided minimal invasive percutaneous pelvic screws insertion for lateral compression pelvic ring injuries: A case report.

RATIONALE: The objective of the present study was to evaluate the accuracy, effectiveness, and safety of screw view model of navigation (SVMN) guided minimal invasive percutaneous pelvic screws (PPSs) insertion for lateral compression pelvic ring injuries (PRI). PATIENT CONCERNS: A female patient experienced a high falling injury, and presented with pain, swelling, deformity, and movement limitation of the left hip for 3 hours. DIAGNOSES: She was diagnosed with pelvic fractures, left iliac fracture, left pubic branch fracture, left ischial branch fracture, and lumbar transverse process fracture. INTERVENTIONS: We used a SVMN technique to guide PPSs insertion, including a percutaneous anterior inferior iliac spine screw, a percutaneous iliac screw (PIS), and a percutaneous sacroiliac screw (PSIS). OUTCOMES: In total, 3 PPSs were inserted and all were presented with excellent position postoperatively. The designing time of all screws was 11.7 minutes, the time of all guide needles insertion was 18.1 minutes, the time of all screws insertion was 32.8 minutes, blood loss was 21 mL, and the time of radiation exposure lasted 7.2 minutes. Moreover, surgical complications, including neurovascular compromise, wound infection, fracture nonunion, and screw loosening, were not observed during the 12 months follow up visit. LESSONS: SVMN technique guided PPSs insertion is an effective and safety approach for the treatment of PRI in selected patients. Besides, it is necessary for surgeons to master the rationale of computer navigation, to familiar with the anatomy of pelvis and to select suitable patients.

Calycosin induces apoptosis via p38­MAPK pathway­mediated activation of the mitochondrial apoptotic pathway in human osteosarcoma 143B cells.

Previous studies have demonstrated that calycosin is a natural phytoestrogen with a similar structure to estrogen, which can inhibit cell proliferation and induce apoptosis in a variety of tumors. Calycosin exerts potential pharmacological effects on osteosarcoma cells by inducing apoptosis. The aim of the present study was to elucidate the specific molecular mechanism of calycosin­induced apoptosis in osteosarcoma cells. Cell proliferation was determined by an MTT assay. Annexin V/PI and JC­1 staining were used to detect apoptosis and mitochondrial dysfunction, respectively, by flow cytometry. Western blot analysis was used to detect the expression of caspases or mitochondrial proteins. The results revealed that calycosin reduced the cell viability of human osteosarcoma 143B cells, induced apoptosis and increased the loss of mitochondrial membrane potential (MMP). In addition, calycosin increased the expression of the proapoptotic antiapoptotic proteins cleaved caspase­3, cleaved caspase­9, cleaved poly(ADP­ribose) polymerase and Bcl­2­associated X protein (Bax), and decreased the expression of the antiapoptotic proapoptotic protein B­cell lymphoma­2 (Bcl­2), thus altering the Bax/Bcl­2 ratio. In addition, the expression levels of cytochrome c were markedly decreased in the mitochondria and increased in the cytoplasm following calycosin treatment. Furthermore, calycosin treatment induced p38­mitogen­activated protein kinase (MAPK) phosphorylation, whereas the p38­MAPK inhibitor BIRB 796 markedly reversed cell viability, apoptosis and loss of MMP in 143B cells. These results suggested that calycosin inhibited osteosarcoma 143B cell growth via p38­MAPK regulation of mitochondrial­dependent intrinsic apoptotic pathways.

Calycosin induces apoptosis in osteosarcoma cell line via ERß­mediated PI3K/Akt signaling pathways.

Previous studies have shown that calycosin, a natural phytoestrogen which is structurally similar to estrogen, inhibits proliferation and induces apoptosis in estrogen­dependent cancer types via the estrogen receptor (ER)ß­induced inhibition of PI3K/Akt. Therefore, the aims of the present study were to investigate the effects of calycosin on human osteosarcoma (OS), and to examine the molecular mechanisms associated with ERß. Human OS MG­63 cells were treated with various concentrations of calycosin, and MTT and flow cytometry assays were used to assess the effects of calycosin on cellular proliferation and apoptosis. In addition, protein expression levels of ERß, phosphorylated (p)­PI3K, p­Akt, cleaved poly (ADP­ribose) polymerase 1 (PARP) and cleaved caspase­3 were evaluated by western blot analysis. The present results suggested that calycosin inhibited proliferation and induced apoptosis in MG­63 cells. Furthermore, increased ERß expression was detected in OS MG­63 cells treated with calycosin, and an ERß inhibitor (PHTPP) reversed calycosin­induced cytotoxicity and apoptosis. Moreover, phosphorylation levels of PI3K and Akt were significantly downregulated after calycosin treatment, whereas PHTPP reversed their phosphorylation. ERß­mediated PI3K/Akt downstream signaling pathways were found to influence the activity of poly (ADP­ribose) polymerase 1 and caspase­3. Thus, the present results indicated that calycosin inhibited proliferation and induced apoptosis in OS MG­63 cells, and that these effects were mediated by ERß­dependent inhibition of the PI3K/Akt pathways.

Technology of percutaneous cannulated screw implantation using screw view model of navigation in Garden type I of femoral neck fracture: A case report.

RATIONALE: The aim of the present study was to assess the efficacy and safety of percutaneous cannulated screw (PCS) implantation assisted by screw view model of navigation (SVMN) to treat femoral neck fracture (FNF). PATIENT CONCERNS: A 42-year-old male patient suffered from a high falling injury, causing pain, swelling, deformity, and limited mobility on his right hip. DIAGNOSES: He was diagnosed with Garden type I of FNF. INTERVENTIONS: PCS implantation assisted by SVMN was used to treat fracture of femoral neck in this patient. OUTCOMES: The follow up lasted for 48 months. A total of 3 screws were inserted into femoral neck, all exhibiting excellent position. The mean screw deviation was 0.43° and 5.73° of femoral neck-shaft and anteversion angle, respectively. The guide wire drilling attempt of each screw was one-time. The fluoroscopic time lasted 6.3 minutes, the Harris hip scores improved from 67 to 88, and the blood loss was 35 mL. It took 11.7 minutes for designing the screws, 13.9 minutes for implanting the guide wires, and 37.3 minutes for placing the screws. No clinical complications were found during 48-month follow-up visit, including head penetration, implant failure, fracture nonunion, and femoral head osteonecrosis. LESSONS: The study revealed that SVMN is conducive to the PCS insertion for FNF. Our lesson is that the FNF must be well reduction before SVMN assisted PCS placement.

Combined navigated drilling and arthroscopy facilitate minimally invasive surgical treatment of ulnar-radial joint dislocation caused by epiphyseal premature closure: A case report.

RATIONALE: In this paper, the efficacy and safety of using navigated drilling and arthroscopy (NDA) to assist surgery for ulnar-radial joint dislocation caused by epiphyseal premature closure (EPC) are described. Deformity correction surgery was mentioned in the literature, but there were numerous complications, for example, poor correction, infection, neurovascular injury, osteofascial compartment syndrome, failure of internal fixation, and nonunion after osteotomy. In order to minimize surgical complications, we utilized navigated drilling to finish accuracy bone bridge resection and applied arthroscopy to assess wrist lesions. PATIENT CONCERNS: An 11-year-old male patient showed swelling and pain of the left wrist. DIAGNOSES: The patient was diagnosed with a postoperative of Kirschner wire internal fixation for epiphyseal injury, left lower ulnar-radial joint dislocation, left wrist deformity, and EPC. INTERVENTIONS: A NDA was used to assist the bone bridge resection in this patient. OUTCOMES: Pain was relieved clearly in the patient. Dorsiflexion increased from 60.8° to 85.3°, palmar flexion increased from 45.3° to 65.8°, supination increased from 41.3° to 69.5°, and pronation increased from 31.6° to 62.9°. The preoperative disabilities of the arm, shoulder, and hand (DASH) score was 86.1, which was increased to 16.4 postoperatively. Surgery designing lasted for 2 minutes, bone bridge resection lasted for 56 minutes, and fluoroscopic time was 2.4 minutes. Complications, for example, neurological injury, vascular injury, infection and deformity aggressive, were not found during the 5-month follow up. LESSONS: The outcome of the present study suggests that the NDA maximizes the bone bridge resection accuracy in EPC treatment, which is made efficient by reducing surgical trauma and avoiding neurovascular injury. An experience was gained that in the process of bone bridge removal, the bit of navigated drill should be continuously washed with normal saline to cool down, so as to avoid damage of nerve caused by heat conduction.