A predictive model for identifying secondary underlying diseases of hemophagocytic lymphohistiocytosis.

Background: Secondary hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disease of immune hyperactivation that arises in the context of infectious, inflammatory, or neoplastic triggers. The aim of this study was to establish a predictive model for the timely differential diagnosis of the original disease resulting in HLH by validating clinical and laboratory findings to further improve the efficacy of therapeutics for HLH. Methods: We retrospectively enrolled 175 secondary HLH patients in this study, including 92 patients with hematologic disease and 83 patients with rheumatic disease. The medical records of all identified patients were retrospectively reviewed and used to generate the predictive model. We also developed an early risk score using multivariate analysis weighted points proportional to the ß regression coefficient values and calculated its sensitivity and specificity for the diagnosis of the original disease resulting in HLH. Results: The multivariate logistic analysis revealed that lower levels of hemoglobin and platelets (PLT), lower levels of ferritin, splenomegaly and Epstein-Barr virus (EBV) positivity were associated with hematologic disease, but young age and female sex were associated with rheumatic disease. The risk factors for HLH secondary to rheumatic diseases were female sex [OR 4.434 (95% CI, 1.889-10.407), P =0.001], younger age [OR 6.773 (95% CI, 2.706-16.952), P<0.001], higher PLT level [OR 6.674 (95% CI, 2.838-15.694), P<0.001], higher ferritin level [OR 5.269 (95% CI, 1.995-13.920), P =0.001], and EBV negativity [OR 27.656 (95% CI, 4.499-169.996), P<0.001]. The risk score included assessments of female sex, age, PLT count, ferritin level and EBV negativity, which can be used to predict HLH secondary to rheumatic diseases with an AUC of 0.844 (95% CI, 0.836~0.932). Conclusion: The established predictive model was designed to help clinicians diagnose the original disease resulting in secondary HLH during routine practice, which might be improve prognosis by enabling the timely treatment of the underlying disease.

Respiratory Function Tolerance of Rats with Vaying Degrees of Thoracic Volume Reduction.

OBJECTIVE: To compare the effects of respiratory function on different degrees of reduced thoracic volume and evaluate the tolerance of rats with reduced thoracic volume, and to assess the feasibility of thoracic volume as a measure of the severity of rib fractures. METHODS: A total of 24 10-week-old female Sprague-Dawley (SD) rats were randomly divided into four groups (n = 6 in each group) according to the displacement degree of bilateral rib fractures (2, 4, 6, and 8 mm). The respiratory function of the rats（Tidal volume, Inspiration time, Expiration time, Breath rate, Minute volume, Peak inspiration flow) measured via whole-body barometric plethysmography before and after operation for 14 consecutive days. Respiratory function parameters of each group were analyzed. Chest CT scans were performed before and 14 days after operation, after that we reconstructed three-dimensional of the thoracic and lung and measured their volumes by computer software. We calculated the percentage of thoracic and lung volume reduction after operation. RESULTS: At the 14th day after the operation, the decline of thoracic volume rates of in the 2, 4, 6, and 8 mm groups were 5.20%, 9.01%, 16.67%, and 20.74%, respectively. The 8 mm group showed a significant reduction in lung volume. The postoperative tidal volumes were lower in each of the groups than the baseline values before the operation. The tidal volume of the 2 mm group gradually recovered after the operation and returned to a normal level (1.54 ± 0.07 mL) at 14th day after the operation. The tidal volume of the 4, 6, and 8 mm groups recovered gradually after the operation, but did not return to baseline level at the 14th day. In particular, the tidal volume of the 8 mm group was significantly lower than that of the other groups during the 14 days (1.23 ± 0.12 mL, p < 0.05). There were no significant changes in the inspiratory and expiratory times, peak inspiratory and expiratory flows, respiratory rate, and minute ventilation during the 14 days after the operation in each group. CONCLUSIONS: Displaced rib fractures lead to thoracic collapse and reduced thoracic volume, which can affect tidal volume in rats. The greater the decrease of thoracic volume, the more obvious the decrease of early tidal volume. The thoracic volume can be used as an objective parameter to evaluate the severity of multiple rib fractures. Early operation to restore thoracic volume may improve early respiratory function. Decreased thoracic volume affected respiratory function and can be compensated and recovered in the long term.

A rare complication of pelvic perforation by an excessive medial slide of the helical blade after treatment of an intertrochanteric fracture with proximal femoral nail anti-rotation: A case report and literature review.

Intertrochanteric fractures have become a severe public health problem in elderly patients. Proximal femoral nail anti-rotation (PFNA) is a commonly used intramedullary fixation device for unstable intertrochanteric fractures. Pelvic perforation by cephalic screw is a rare complication. We reported an 84-year-old female who fell at home and sustained an intertrochanteric fracture. The patient underwent surgery with PFNA as the intramedullary fixation device. Routine postoperative examination revealed medial migration of the helical blade that eventually caused pelvic perforation. We performed a cemented total hip arthroplasty as the savage procedure. At the latest follow-up of 12 months after total hip arthroplasty, the patient had no pain or loosening of the prosthesis in the left hip. Pelvic perforation should be considered when choosing PFNA as the intramedullary fixation device, especially in patients with severe osteoporosis wherein the helical blade can be easily inserted during the operation. The lack of devices to avoid oversliding of the helical blade in PFNA is an unreported cause of this complication and should be considered in such cases.

Reversible congestive heart failure associated with hypocalcemia: A case report.

BACKGROUND: Hypoparathyroidism is a rare disease that may occur due to primary or secondary etiologies. The estimated incidence in the United States is 24-37/100000 person-years. Congestive heart failure associated with hypocalcemia due to hypoparathyroidism is an even rarer presentation. CASE SUMMARY: Here, we present a 64-year-old woman with congestive heart failure following hypocalcemia. The patient was transferred to our emergency department with complaints of rapidly progressive dyspnea, shortness of breath and heaviness of the chest for 4 d. She had a history of undergoing thyroidectomy and partial tracheotomy 2 years prior due to a malignant thyroid tumor. Muscle spasms had been present 1 year ago, and cataracts were treated with intraocular lens replacement in both eyes. Most tests were within normal ranges, except serum calcium at 1.33 mmol/L (2.20-2.65 mmol/L), ionized calcium at 0.69 mmol/L (1.15-1.29 mmol/L), and parathyroid hormone at < 1.0 pg/mL (12-88 pg/mL). Echocardiography revealed an ejection fraction of 28.48%. Cardiac function was quickly reversed by restoring the serum calcium concentration. Significant improvements were noted with an ejection fraction of up to 48.50% at follow-up. CONCLUSION: For patients with potential hypocalcemia, monitoring calcium levels and dealing with hypocalcemia in time to avoid serious complications are important.

Assessment of thoracic volume changes after the collapse of lateral rib fractures based on chest computed tomography data: computer simulation and a multiple variable linear regression analysis.

BACKGROUND: Chest blunt trauma (CBT) and the resultant rib fractures often lead to thoracic collapse. The purpose of this study was to explore the effect of displacement of the rib fracture and thoracic collapse on the thoracic volume by using normal chest CT data. METHODS: In this retrospective study, seven consecutive normal participants were selected from our hospital between June and July 2018. Normal thoracic models were reconstructed, followed by simulation of lateral fractures through the 4th to 9th ribs under three collapse modes with 1-5 cm of collapse. The thoracic collapse models (n = 630) were reconstructed using 3Dmax 2014. We calculated the thoracic volume and reduction percentage for each thoracic collapse model. Linear regression-based comparisons of thoracic volume reductions were performed. RESULTS: In all three collapse modes, the degree of the collapse was linearly correlated with the mean thoracic volume reduction. The reduction percentage in the posterior collapse mode was higher than that in the anterior collapse mode (P < 0.001). The largest volume reductions in the anterior, posterior, and simultaneous collapse models were in the 6th rib fracture model (P < 0.001), 8th rib fracture model (P < 0.001), and 7th rib fracture model (P < 0.001), respectively. CONCLUSIONS: The influences of rib fracture displacement and collapse on the thoracic volume in the 6th through 8th ribs are critical in lateral rib fractures. For patients with 6th to 8th rib fractures and posterior rib collapse, surgical intervention to restore thoracic volume may be more essential.

Hydrogen inhibits the osteoclastogenesis of mouse bone marrow mononuclear cells.

Hydrogen (H2) is one of the major biodegradation products of magnesium (Mg) alloys implanted for bony fracture healing and reconstruction; H2 thus plays a significant role in the regulation of local microenvironment and the biology of resident cells. The interactions between the H2 and the local cells are of great interest, and a full understanding of the effect of H2 on bone marrow mononuclear cells (BMMCs) would accelerate the development of effective strategies for successful bony healing. This study investigates how H2, with different concentrations and durations, regulates the osteoclastogenesis of mouse BMMCs. First, using H2 with five concentrations (0%, 2%, 25%, 50% and 75%) and three durations (5, 7 and 10 days), the osteoclastogenesis of mouse BMMCs in these H2 conditions were measured using TRAP staining, F-actin ring formation assay, pit formation assay and RT-qPCR analysis. Based on these findings, the proliferation assay, apoptosis assay, western blot analysis and ELISA assay of BMMCs after osteoclast induction were performed. The findings showed that H2 (especially the 50% and 75% H2) obviously inhibited the osteoclast formation, function and osteoclast-related genes expression of osteoclast-induced BMMCs; additionally, H2 (50%) was found to reduce the proliferation, promote the apoptosis and inhibit the expression of osteoclast-related proteins of BMMCs with the presence of osteoclast-induced medium. Therefore, H2 significantly inhibited the osteoclastogenesis of mouse BMMCs, which may become a new therapeutic agent for anti-bony resorption and open new avenues for the translational research of Mg alloys.

Establishment of trauma treatment teams within a regional severe trauma treatment system in China: study protocol for a national cluster-randomised trial.

INTRODUCTION: The implementation of first aid processes for patients with trauma in China faces significant challenges. These challenges include long response times of prehospital first aid services, lack of information exchange between prehospital first aid services and in-hospital emergency services, lack of a professional rescue team in the majority of hospitals, and lack of standardised training for prehospital and in-hospital emergency personnel. The purpose of the trial is to guide the establishment of an urban trauma treatment system in China, highlight the construction of a trauma treatment system tailored to the Chinese context and improve levels of medical treatment by selecting approximately 100 counties across China as pilots to establish a regional trauma treatment system. METHODS AND ANALYSIS: A cluster-randomised controlled trial will be performed in 98 county-level research institutes. Included research institutes will be randomised into an experimental group and a control group. Patients in both experimental and control groups will receive basic treatments. A trauma treatment team will be established in the experimental group. The primary outcome measure is in-hospital mortality rate of patients. The secondary outcome measures include mortality rate of patients within 30 days after trauma attack and within 30 days after discharge, the time between arrival in the institution and receiving consultation, and the time from admission to the start of surgery. The effects of establishment of trauma treatment teams on the treatment of severe trauma will be evaluated in all counties. ETHICS AND DISSEMINATION: The procedures have been approved by The Medical Ethics Committee of Peking University People's Hospital (No.2017PHB098-01) and conform to the Declaration of Helsinki. Data will be collected and analysed in accordance with participant privacy laws and regulations. Results will be disseminated through policy briefs, workshops, peer-reviewed publications and conferences. TRIAL REGISTRATION NUMBER: NCT03363880; Pre-results.

[Surgical treatment of internal fixation failure after clavicular fracture operation].

OBJECTIVE: To investigate the surgical treatment results of implant failure after clavicular fracture open reduction and internal fixation (ORIF). METHODS: Fifteen cases from Jan. 2005 to Jan. 2013 were treated surgically according to fracture classification, time of implant failure and implant type. The fracture union, shoulder function and pain were evaluated postoperatively. RESULTS: All the patients had full follow-up for 5 to 101 months (mean: 43.8 months). All the fractures were united well. The constant scores to assess the shoulder function were 82 to 100 (mean: 93.3 in the fracture side) and were 85 to 100 (mean: 96.7 in the uninjured side); statistically significant difference of the constant scores between the two sides was found (P=0.02). Eight cases did not have shoulder pain in the fracture side, while the other 7 cases had mild pain, The visual analogue scale (VAS) scores to evaluate shoulder pain were 1 to 3 in the fracture side, which were statistically different from those in the uninjured side (P=0.03). CONCLUSION: Implant instability causes early implant failure after clavicular fracture ORIF and re-fixation with stable implant is effective. Fracture nonunion leads to late implant failure, and bridging fixation using locking plate associated with bony autograft with iliac crest is a successful method to treat atrophy clavicular nonunion. Surgical treatment can bring good results.

[Impact of hip fracture on coagulation function in elderly patients].

OBJECTIVE: To investigate the impact of hip fracture on coagulation function in elderly patients. METHODS: In our study, 127 elderly patients with hip fracture were diagnosed and admitted to Peking University People's Hospital from January 2011 to March 2012. Specimens of their venous blood were obtained before and after the surgery, and measured for fibrinogen (FIB) and D-dimer. Also, we analyzed their age, type of fracture, fracture time, and concomitant diseases. RESULTS: The FIB level of the patients (127 cases) before surgery was (3.91 ± 1.06) g/L, and 42.52% (54/127) patients' FIB was higher than normal. After the surgery, 28 patients underwent FIB test [(4.21 ± 1.24) g/L], which was higher than the FIB value before surgery, but was not statistically significant. Before surgery, 15 patients underwent D-dimer test [(2 059.5 ± 1 948.0) µg/L]. After the surgery, 26 patients underwent D-dimer test [(2 574.9 ± 1 702.4) µg/L].The two values were significantly higher than normal (P<0.05). The elevated value of FIB had no relationship with age, diabetes, cardiovascular or cerebrovascular diseases. Before surgery, 45.83% (22/48) of the intertrochanteric fracture patients had abnormal FIB, and 40.50% (32/79) of the patients with femoral neck fracture had abnormal FIB, but they were not statistically significant. Grouped according to the fracture time, when fracture time was longer than 96 h, the ratio of abnormal FIB was 26.7%, lower than those of other groups, and the difference was statistically significant (P<0.05). CONCLUSION: The hip fracture in elderly patients has a direct impact on coagulation system, and FIB and D-dimer have significantly changed. According to the variation of FIB after fracture,we speculate that fracture surgery after 96 h may affect the coagulation system at the lowest level.

Minimally invasive treatment of the KobyGard system for plantar fasciitis: a retrospective study.

BACKGROUND: Calcodynia is a persistent condition that podiatric surgeons frequently see among their patients, and plantar fasciitis is the main reason for pain. When systematic conservative treatments fail to alleviate these conditions, it requires surgical intervention, mainly plantar fascia release surgery, which used to be an open heel release surgery. This study aimed to investigate whether minimally invasive treatment of the KobyGard system is more safe and effective for plantar fasciitis. METHODS: From May 2009 to May 2012, a total of nine patients, three males and six females with plantar fasciitis, were treated in the Peking University People's Hospital with minimally invasive instruments, the KobyGard system, for the release of plantar fascia. Three patients, experiencing bilateral calcaneodynia, underwent bilateral surgery. One patient had bilateral calcaneodynia with enthesiopathy of Achilles tendon, and underwent Achilles tendon surgery. Preoperative and postoperative Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, Roles and Maudsley scores and SF-36 questionnaires were evaluated. RESULTS: The nine patients were successfully followed up. The average postoperative follow-up time was 13.2 months and it varied from 2.0 months to 21.0 months. Pre- and postoperative average scores of VAS was 9.3 and 1.9 (P < 0.001), respectively. Pre- and postoperative average scores of AOFAS hind foot was 36.0 and 82.0 (P < 0.001), respectively. There was also a statistically significant amelioration in SF-36 scores and the Roles and Maudlesy scores. Eight patients were satisfied with the surgery outcome. CONCLUSION: Minimally invasive surgery treatment of the KobyGard system for plantar fasciitis has the advantages of shorter operation time, ease of operation, and similar satisfaction rates with open surgery, but with smaller surgical incision.

A retrospective study of posterior malleolus fractures.

PURPOSE: In this retrospective study, we evaluated the treatment effect of ankle joint fracture surgery involving the posterior malleolus, and discuss relevant factors influencing the occurrence of traumatic arthritis of the ankle joint. METHODS: A total of 102 cases of ankle joint fractures involving the posterior malleolus in five large-scale skeletal trauma centres in China, from January 2000 to July 2009, were retrospectively analysed in terms of surgical treatment and complete follow-up. Ankle joint mobility, posterior malleolus fragment size, articular surface evenness, Ankle-Hindfoot Scale of the American Orthopedic Foot and Ankle Society (AOFAS) score, and imaging scale score for arthritis were recorded. The degree of fracture pain during rest, active movement, and weight-bearing walking, and satisfaction with treatment were evaluated using a visual analogue scale (VAS). RESULTS: The average AOFAS score was 95.9, excellence rate was 92.2 %, and average VAS scores for degree of fracture pain during rest, active movement, and weight-bearing walking were 0.15, 0.31, and 0.68, respectively. Thirty-six cases showed arthritic manifestations. Ankle joint mobility along all directions on the injured side was lower than that on the unaffected side. There was no obvious difference in treatment effect between the fixed and unfixed posterior malleolus fragment groups for all and for fragment size of < 25 %; between fixing the posterior malleolus fragment from front to back or from back to front; or between elderly patients (≥ 60 years old) and young patients (< 60 years old). There was a distinct difference in the treatment effect between articular surface evenness and unevenness for all and for fragment size of ≥ 25 %. CONCLUSIONS: For all 102 cases of ankle joint fracture involving the posterior malleolus, the treatment effect was satisfactory. Restoration of an even articular surface, especially when fragment size ≥ 25 %, should be attempted during treatment.

[Three kind of scoring system for proximal humeral fractures in patients with postoperative functional review of evaluation: a multicenter study].

OBJECTIVE: To evaluate the ASES, Constant and HSS score systems and their significance on postoperative function of the shoulder. METHODS: Totally 172 cases of proximal humeral fracture of five affiliated hospital from September 2004 to September 2008 were analyzed. All the functional outcome of the involved shoulder were evaluated by ASES, Constant, HSS score and patient self score. The correlations and agreement of three shoulder scales were analyzed with Pearson correlation test and Bland-Altman plot in different age groups and fracture types. RESULTS: (1) The Constant score were lower than other two scores in the same age group and fracture type (F = 13.62 and 4.80, P < 0.05). (2) The correlations between three shoulder scales: ASES and Constant (r = 0.754, P = 0.0003), ASES and HSS (r = 0.755, P = 0.0001), Constant and HSS (r = 0.858, P = 0.0002). The correlations between three shoulder scales and patient self evaluation: ASES (r = 0.602, P = 0.0002), Constant (r = 0.705, P = 0.0001), HSS (r = 0.663, P = 0.0037). The Bland-Altman plot shows three shoulder scales have good agreement. (3)The correlation between Constant score and patient self evaluation decreased in the elder group and severe fracture type. CONCLUSIONS: ASES, Constant, HSS shoulder score systems are all fit to evaluate the functional outcome of the shoulder, they have good correlation and agreement. Constant score in recommended for its high correlation coefficient with patient self evaluation score. However, its age bias must be paid attention in clinical practice. ASES shoulder score can be used in remote follow-up.

Multicenter follow-up study of ankle fracture surgery.

BACKGROUND: Few data on ankle fractures in China from large multicenter epidemiological and clinical studies are available. The aim of this research was to evaluate the epidemiological features and surgical outcomes of ankle fractures by reviewing 235 patients who underwent ankle fracture surgery at five hospitals in China. METHODS: This study included patients who underwent ankle fracture surgery at five Chinese hospitals from January 2000 to July 2009. Age, gender, mechanism of injury, Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture type, fracture pattern, length of hospital stay and treatment outcome were recorded. Statistical analyses were conducted using SPSS software. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, visual analogue scale (VAS), and arthritis scale were used to evaluate outcome. RESULTS: Of 235 patients with ankle fractures, 105 were male with an average age of 37.8 years and 130 were female with an average age of 47.3 years. The average follow-up period was 55.7 months. There were significant differences in the ratios of patients in different age groups between males and females, and in mechanisms of injury among different age groups. There were also significant differences in the length of hospital stay among different fracture types and mechanisms of injury. In healed fractures, the average AOFAS ankle-hindfoot score was 95.5, with an excellence rate of 99.6%, the average VAS score was 0.17, and the average arthritis score was 0.18. Movement of the injured ankle was significantly different to that of the uninjured ankle. There were no significant differences between AO fracture types, fracture patterns or follow-up periods and AOFAS score, but there were some significant differences between these parameters and ankle joint movements, pain VAS score and arthritis score. CONCLUSIONS: Ankle fractures occur most commonly in middle-aged and young males aged 20 - 39 years and in elderly females aged 50 - 69 years. The most common mechanisms of injury are twisting injuries and falls from a standing height or less. The results of surgical treatment are satisfactory.

[Clinical features analysis of femoral neck fractures in 219 patients].

OBJECTIVES: To investigate the clinical features of femoral neck fractures and analyze related causes. METHODS: The clinical data of patients with femoral neck fractures from June 2002 to August 2009 were retrospectively analyzed. The gender, age, fracture side, fracture type, basic social data, activities before injury, injury causes and treatment were analyzed. RESULTS: A total of 219 patients (106 male and 113 female) was analyzed. All patients were divided into children group (age < 16 years), adult group (age ranged from 16 to 60 years) and older group (> 60 years). There were 5 patients (2.3%) in the children group, 81 patients (37.0%) in the adult group and 133 patients (60.7%) in the older group. There were 11 patients (5.0%) with Garden I fractures, 32 patients (14.6%) with Garden II fractures, 90 patients (41.1%) with Garden III fractures and 86 patients (39.3%) with Garden IV fractures. Fall damage and traffic injury were the main injury types. Home and public place were the main injury sites. CONCLUSIONS: The incidence of femoral neck fracture shows the highest in the old persons. The male patients with femoral neck fractures are more than female patients in children and adult group, while the male patients with femoral neck fractures are less than female patients in older group. The dominant fractures type according to Garden classification is Garden III fractures in children and adult groups, but Garden IV fractures in older group. Fall damage and traffic injury are the main injury types. Home and public place are the main injury sites.

[Effect of calcitonin gene-related peptide on RUNX2 expression in primary rat osteoblasts].

OBJECTIVE: To investigate the effects of exogenous calcitonin gene-related peptide (CGRP) on RUNX2 expression in primary cultured rat osteoblasts. METHODS: Primary cultured rat osteoblasts were obtained by collagenase / trypsinenzyme digestion from calvarial bone of neonate rats and were identified by ALP staining; The cells were exposed to gradient concentrations, and the effect of CGRP on the proliferation of osteoblasts was determined by MTT assay. The expressions of RUNX2 were quantified by RT-PCR and Western blotting after 48-hour exposure to different CGRP concentrations. RESULTS: CGRP could promote the proliferation of osteoblasts .When the concentration of CGRP were at 10(-8)-10(-6) mol/L, the proliferation rates of osteoblasts were 71.9%, 142.1%, 321.0%, respectively (P<0.05); when CGRP was at concentrations of 10(-7) and 10(-6) mol /L in osteoblasts for 48 h, the mRNA levels of RUNX2 was significantly increased, which increased (46.2±11.2)% and (58.6±14.0)% respectively (P<0.05); the expression of RUNX2 protein levels was consistent with the change of the mRNA levels. CONCLUSION: CGRP could promote RUNX2 expression in primary cultured rat osteoblasts, which suggests that RUNX2 is involved in the mechanism of osteoblast proliferation induced by CGRP.

[Retrospective study of therapy of periprosthetic femoral supracondylar fractures after total knee arthroplasty with open reduction and less invasive stabilization system (LISS) internal fixation].

OBJECTIVE: To investigate the clinical results of therapy of periprosthetic femoral supracondylar fractures after total knee arthroplasty (TKA) with open reduction and internal fixation (ORIF) using less invasive stabilization system (LISS). METHODS: Eight cases of periprosthetic femoral supracondylar fractures after TKA were treated with ORIF using distal femoral LISS in our department. They had full follow-up for 3 to 39 months. Their knee functions were evaluated through radiological and clinical checkups and functional evaluations by HSS (The Hospital for Special Surgery) scoring system and Lysholm Questionnaire. RESULTS: None of the fractured patients had any infection or internal-fixation failure. The average knee motion range was 0-94°. There was no statistic difference of the femorotibial angle between pre- and postoperation. At the end of the last follow-up, the average HSS score was 79.38 and Lysholm score 80.25. All the average scores were good and excellent. CONCLUSION: ORIF with LISS is a one of the valuable treatments for periprosthetic femoral supracondylar fractures after TKA.

[Neurofilament immune fluorescence staining: a new method for observing the morphology of the motor endplate].

OBJECTIVE: To investigate the effect of neurofilament (NF) immune fluorescence staining on observing morphology of the motor endplate. METHODS: Six SPF rats were used and their bilateral soleus muscles harvested under anesthesia. Then the samples were fixed with polyphosphate formaldehyde, and made frozen sections. Finally the neurofilament immunofluorescence staining was performed. The morphology of the motor endplate was observed under fluorescence microscope and laser scanning confocal fluorescence microscope. RESULTS: The claw-shape motor endplate was seen clearly under the fluorescent microscope and laser scanning confocal fluorescence microscope, and the images observed used to reconstruct the three-dimensional structure of motor endplate. CONCLUSION: Neurofilament immune fluorescence staining is a useful method for the morphology study of the motor endplate.

[The anatomic study of transferring thoracic nerve roots to lumbar nerve root inside the spinal canal of paraplegia].

OBJECTIVE: To study the fundamental anatomy of transferring T(9-12) nerve roots to L(2-4) nerve root for the quadriceps function recovery inside the spinal canal of paraplegia. METHODS: Thoracic and lumbar spinal canal and spinal dura mater of 5 adult cadavers (male 2 and female 3) were opened and explored. Investigated including: the position which T9-L4 nerve root generated from spinal cord; the relation between the position which T9-L4 nerve root generated from spinal cord and T12 vertebrae and L1 vertebrae; The length beginning part of T9-L4 nerve root inside the spinal canal. The diameter of T9-L4 nerve root. The distance between the T9-L4 nerve root separately. The distance between the position which T(9-12) nerve root separately generated from dura mater and the middle of L2 vertebrae. RESULTS: T9 nerve root generated from the middle part of T9 vertebrae; L4 nerve root generates from middle part of L2 vertebrae. The average length of T9-L4 nerve root inside the spinal canal separately was 16.12, 22.97, 30.43, 43.47, 56.02, 70.03, 88.70 and 113.65 mm. The average diameter of T9-L4 nerve root separately was 2.45, 2.04, 1.96, 2.18, 2.32, 2.56, 3.10 and 3.26 mm. The average distance between the beginning part of T9-L4 nerve root separately was 22.87, 25.08, 28.47, 27.38, 29.78, 31.93 and 31.00 mm. The average distance between the position which T(9-12) nerve root separately generated from dura mater and the middle of L2 vertebrae was 118.69, 95.82, 70.74, and 42.27 mm. CONCLUSIONS: T(9-12) nerve root can be used as donor nerve for repair L(2-4) nerve root. The level of L2 vertebrae can be anastomose site of the recipient nerve.

Stereochemistry of an agonist determines coupling preference of beta2-adrenoceptor to different G proteins in cardiomyocytes.

A fundamental question regarding receptor-G protein interaction is whether different agonists can lead a receptor to different intracellular signaling pathways. Our previous studies have demonstrated that although most beta(2)-adrenoceptor agonists activate both G(s) and G(i) proteins, fenoterol, a full agonist of beta(2)-adrenoceptor, selectively activates G(s) protein. Fenoterol contains two chiral centers and may exist as four stereoisomers. We have synthesized a series of stereoisomers of fenoterol and its derivatives and characterized their receptor binding and pharmacological properties. We tested the hypothesis that the stereochemistry of an agonist determines selectivity of receptor coupling to different G protein(s). We found that the R,R isomers of fenoterol and methoxyfenoterol exhibited more potent effects to increase cardiomyocyte contraction than their S,R isomers. It is noteworthy that although (R,R)-fenoterol and (R,R)-methoxyfenoterol preferentially activate G(s) signaling, their S,R isomers were able to activate both G(s) and G(i) proteins as evidenced by the robust pertussis toxin sensitivities of their effects on cardiomyocyte contraction and on phosphorylation of extracellular signal-regulated kinase 1/2. The differential G protein selectivities of the fenoterol stereoisomers were further confirmed by photoaffinity labeling studies on G(s),G(i2), and G(i3) proteins. The inefficient G(i) signaling with the R,R isomers is not caused by the inability of the R,R isomers to trigger the protein kinase A (PKA)-mediated phosphorylation of the beta(2)-adrenoceptor, because the R,R isomers also markedly increased phosphorylation of the receptor at serine 262 by PKA. We conclude that in addition to receptor subtype and phosphorylation status, the stereochemistry of a given agonist plays an important role in determining receptor-G protein selectivity and downstream signaling events.

[Comparative study of distal radial fractures in the elderly treated with locking and non-locking plates].

OBJECTIVE: To evaluate the clinical difference of locking and non-locking plates in the treatment of distal radial fractures in the elderly. METHODS: Forty-nine patients with an average age of 68 years were included. The mean follow-up was 30 months. Five cases were traffic related injury, and others were simple falls. Fractures were classified according to AO classification system: 9 cases of A3, 4 cases of B, 11 cases of C1, 18 cases of C2, 7 cases of C3. Patients were grouped as locking group (29 cases) and non-locking group (20 cases). RESULTS: Significant difference was not found between the two groups in active range of motion, Gartland and Werley score, radiological measurements and score. CONCLUSION: Locking and non-locking plates have the same clinical outcome in the treatment of distal radial fractures in the elderly.