Early posterior column internal fixation: A staged treatment of type C3 tibial pilon fracture.

Pilon fractures represent a challenging subset of tibial fractures. The management of AO/OTA Type C3 fractures remains complex due to associated complications and lack of clear guidelines for surgical timing and methods. A prospective cohort study was conducted to evaluate two staged treatment strategies for AO/OTA Type C3 tibial pilon fractures. The study focused on assessing surgical difficulty, complications, and patient prognosis. One group of patients received early internal fixation of the fibula and tibial posterior column combined with external fixation, while the other group received external fixation alone in the first stage. Patients who received early internal fixation of the fibula and tibial posterior column combined with external fixation had better outcomes, including lower rate of allogeneic bone grafting (67.74 % versus 94.64 %), reduced incidence of wound delay and skin necrosis (3.23 % versus 21.43 %), shorter surgical time (133.06 ± 23.99 min versus 163.04 ± 26.83 min), shorter hospital stay (13.77 ± 2.53 days versus 18.25 ± 3.67 days), and higher AOFAS (83.05 ± 8.68 versus 79.36 ± 8.92). Additionally, avoiding fibular shortening was shown to be crucial in preventing prolonged surgery and improving patient function. The study demonstrated that the staged treatment approach with early internal fixation led to shorter operative times, improved ankle function, and reduced complications, including a lower risk of infection. The findings support the use of this treatment to optimize outcomes in AO/OTA Type C3 pilon fractures.

Early Reduction of the Posterior Column: A Surgical Technique in AO/OTA C3 Tibial Pilon Fractures.

Staged treatment for pilon fractures is widely accepted. It remains to be discussed how to reduce and fix posterior column fractures while avoiding clinical complications. We provided a staged treatment protocol with detailed surgical techniques for closed AO Foundation/Orthopaedic Trauma Association (AO/OTA) C3 tibial pilon fractures with fibular fractures. In the first stage, the internal fixation of the fibula and distal tibial posterior column is accompanied by an external fixator. After swelling, the medial and anterior columns were fixed via the posteromedial approach in the second stage. We advocate early reduction and fixation of the posterior column and lateral column. The right timing of surgery can ensure well-reduced articular surface and alignment while minimizing soft tissue complications.

A double-suture cerclage reduction technique with Nice knots for comminuted patella fractures (AO/OTA 34-C3).

BACKGROUND: Comminuted patella fractures place high demands on surgeons' surgical skills. We used a double-suture cerclage reduction with Nice knots as an intra-operative reduction technique to displaced comminuted patella fractures. METHODS: Patients were divided into two groups by whether or not an intra-operative suture cerclage reduction technique was used. Fragments count, surgical time, quality of the reduction, and fracture healing time were recorded. The postoperative function was assessed by Böstman score and range of motion. RESULTS: With the inclusion and exclusion criteria, 48 patients we included in the cohort between Sept. 2016 and Oct. 2021. The double-suture cerclage reduction technique with a Nice knot achieved a satisfactory reduction. When the number of fragments was over 5, this technique showed significant advantages in saving surgery time. CONCLUSIONS: In this study, the double-suture cerclage reduction technique combined with the Nice knot shows significant advantages for displaced highly comminuted patella fractures. This technique simplifies the operation and saves surgical time, which is helpful for clinical practice.

Characterisation and preliminary functional analysis of N-acetyltransferase 13 from Schistosoma japonicum.

BACKGROUND: N-acetyltransferase 13 (NAT13) is a probable catalytic component of the ARD1A-NARG1 complex possessing alpha (N-terminal) acetyltransferase activity. RESULTS: In this study, a full-length complementary DNA (cDNA) encoding Schistosoma japonicum NAT13 (SjNAT13) was isolated from schistosome cDNAs. The 621 bp open reading frame of SjNAT13 encodes a polypeptide of 206 amino acids. Real-time PCR analysis revealed SjNAT13 expression in all tested developmental stages. Transcript levels were highest in cercariae and 21-day-old worms, and higher in male adult worms than female adult worms. The rSjNAT13 protein induced high levels of anti-rSjNAT13 IgG antibodies. In two independent immunoprotection trials, rSjNAT13 induced 24.23% and 24.47% reductions in the numbers of eggs in liver. RNA interference (RNAi) results showed that small interfering RNA (siRNA) Sj-514 significantly reduced SjNAT13 transcript levels in worms and decreased egg production in vitro. CONCLUSIONS: Thus, rSjNAT13 might play an important role in the development and reproduction of schistosomes.

A novel cerclage wiring technique in intertrochanteric femoral fractures treated by intramedullary nails in young adults.

BACKGROUND: Intertrochanteric femoral fractures (IFFs) in young adults, generally due to severe trauma, are increasingly presented. Different from IFFs in the geriatric population, these fractures in young adults are always comminuted and substantially displaced. Natural traction induced by musculature following IFFs determines closed reduction on a fracture table is extremely difficult. METHODS: To achieve anatomical reduction before intramedullary nail (IMN) fixation, we made an extended or a mini petrotrochantetic incision to facilitate temporary reduction using a pointed clamp. Subsequently, a curved and cannulated wire-passer was employed to pass through a multistrand cable to surround displaced fragments and strengthen intertrochanteric fixation. Afterward, a standard procedure was conducted to nail the fracture. RESULTS: We used the surgical technique in 9 young patients with an age range of 28~ 48 years old. The fractures were categorized as AO/OTA 31-A2.2 (3 cases) and 31-A2.3 (6 cases). The injury-to-surgery interval was 2.5 days on average. Mean operation time was 55 min. All fractures achieved anatomical reduction and healed within 14 weeks postoperatively without cable breakage, implant irritation or deep infection. CONCLUSIONS: In conclusion, the surrounding technique with cerclage wire in IFFs in young adults is an effective surgical technique with easily achieved anatomical reduction to facilitate operative maneuvers and fracture healing.

Downregulation of SOX3 leads to the inhibition of the proliferation, migration and invasion of osteosarcoma cells.

Sex determining region Y-box protein 3 (SOX3) is involved in embryonic development and tumorigenesis. However, the expression and precise role of SOX3 in osteosarcoma remain unclear. In this study, we reported that SOX3 expression was upregulated in osteosarcoma tissues compared with non-cancerous bone cyst tissues. To elucidate the cellular and molecular function of SOX3, we examined the consequences of SOX3 knockdown in osteosarcoma cells. We found that the downregulation of SOX3 inhibited the proliferation, migration and invasion of osteosarcoma cells. SOX3 downregulation also increased the cell population in the G1 phase and induced cell apoptosis. SOX3 knockdown-mediated cell cycle arrest and cell apoptosis were associated with decreased levels of Cdc25A, cyclin D1, proliferating cell nuclear antigen (PCNA) and Bcl-2, as well as an increased Bax expression. We also found that the downregulation of SOX3 decreased the expression of Snail, Twist and matrix metalloproteinase-9 (MMP-9), and increased E-cadherin expression, resulting in the inhibition of cell migration and invasion. Taken together, our data indicate that SOX3 may serve as an oncogene in osteosarcoma, and SOX3 downregulation may prove to be a novel approach for the inhibition of osteosarcoma progression.

A figure-eight suture loop with Kirschner wires for fixation of anteromedial coronoid process fractures: A case series.

PURPOSE: Sufficient fixation of an anterior or anteromedial facet fracture of the coronoid process in fracture-dislocation of elbow is important to maintain joint stability. The purpose of this study was to report our experience with 11 patients who were managed with an original fixation technique using a "figure-eight" suture loop. METHODS: From February 2010 to March 2011, 11 cases with a fracture of the anterior or anteromedial facet of the coronoid process were treated by coronoid fixation using a figure-eight suture loop. For cases with comminuted fractures, to prevent a suture from sliding into the fracture line, a 3- or 4-hole phalanx plate was enclosed in the suture loop to compress multiple fragments. Accompanying injuries, such as a radial head fracture or olecranon fracture, were fixed with repair of lateral collateral ligament injuries. RESULTS: On final evaluations at an average of 18 months after injury, the mean elbow arc of motion was 125.5° and the mean forearm rotation arc of 124.1°. All fractures were united with an average postoperative score according to the Mayo Elbow Performance Index of 91 points. All patients achieved satisfactory scores (seven excellent, four good). All 11 fractures were united at final follow-up with no joint incongruity, dislocation, or subluxation of the injured elbow. CONCLUSIONS: The figure-eight suture loop technique is an easy and effective technique to fix anterior or anteromedial facet fractures of the coronoid process.

Prokaryotic Expression of α-13 Giardin Gene and Its Intracellular Localization in Giardia lamblia.

To study prokaryotic expression and subcellular localization of α-13 giardin in Giardia lamblia trophozoites, α-13 giardin gene was amplified and cloned into prokaryotic expression vector pET-28a(+). The positive recombinant plasmid was transformed into E. coli BL21(DE3) for expression by using IPTG and autoinduction expression system (ZYM-5052). The target protein was validated by SDS-PAGE and Western blotting and purified by Ni-NTA Resin. Rabbits were immunized with purified fusion proteins for preparation of polyclonal antibody; then the intracellular location of α-13 giardin was determined by fluorescence immunoassay. The results showed that the length of α-13 giardin gene was 1038 bp, encoding a polypeptide of 345 amino acids. The expressed product was a fusion protein with about 40 kDa largely present in soluble form. The target protein accounted for 21.0% of total proteins after being induced with IPTG, while it accounted for 28.8% with ZYM-5052. The anti-α13-giardin polyclonal antibody possessed good antigenic specificity as well as excellent binding activity with recombinant α-13 giardin. Immunofluorescence assays revealed that α-13 giardin was localized in the cytoplasm of G. lamblia trophozoite, suggesting that it is a cytoplasm-associated protein. The present study may lay a foundation for further functional research on α-13 giardin of G. lamblia.

Rapamycin inhibits tumor growth of human osteosarcomas.

PURPOSE: Treatment options for osteosarcoma are limited due to its resistance to chemotherapy and radiotherapy. Signaling through the mammalian target of rapamycin (mTOR) pathway contributes to cell proliferation and chemoresistance of many cancers. Rapamycin, as an inhibitor of mTOR, has been developed as potentially valuable therapeutic agent. In this report, we evaluated the effects of rapamycin on human osteosarcoma cells' growth in vitro and in vivo. METHODS: Proliferation of osteosarcoma cells treated with rapamycin at different time periods was detected and changes in the cell cycle were measured by MTS and flow cytometry, respectively. Autophagy induced by rapamycin in osteosarcoma cells and the expression of cell cycle regulating proteins were detected by Western blotting. The effect of rapamycin on tumor growth in vivo was detected using mice xenograph models. RESULTS: The proliferation of osteosarcoma cells was signif- icantly inhibited by rapamycin treatment in a concentration-dependent manner and the cell cycle progression was impaired with G1 arrest. Rapamycin induced autophagy, increased the expression of p27 and decreased the expression of Cyclin D1. In addition, rapamycin suppressed the tumor growth in mice xenograph models. CONCLUSIONS: The potent antiproliferative activities of mTOR inhibitor rapamycin has been proven. Theses results strongly indicate that rapamycin may be a promising agent against osteosarcomas.

[Expression of transforming growth factor beta1 and insulin-like growth factor I in the regenerated bones after low frequency micro movement].

OBJECTIVE: To investigate the expression of transforming growth factor beta1 (TGF-beta1) and insulin-like growth factor I (IGF-I) in new bone after low frequency micro movement. METHODS: Fifteen female sheep from Shandong province were involved in the study and their bilateral tibias transversely osteotomized in the middle shafts with a defect of 2 mm. The hind limbs were fixed with unilateral external fixators connected to a controlled micro movement device. Ten days after osteotomy, one hind limb of each sheep randomly was selected to perform micro movement at an amplitude of 0. 25 mm and a frequency of 1 Hertz, 30 min a day for 4 weeks (micro movement group). The other hind limb served as the control group. Five sheep were sacrificed at 3, 4 and 6 weeks after osteotomy, respectively, and specimens were harvested for detecting the expression of TGF-beta1 and IGF-I by immunohistochemistry and RT-PCR. RESULTS: Immunohistochemistry: In the third postoperative week in the micro movement group, the expression of TGF-beta1 was detected in different areas of new chondrocytes at the margin of callus, mainly in proliferating area, and IGF-I expressed in osteoblasts at the margin of endochondral ossification area, calcified and mature chondrocytes and osteocytes. There was seldom expression of IGF-I and little expression of TGF-beta1 in the corresponding area in the control one. In the 4th postoperative week in the micro movement group, the expression of TGF-beta1 diminished gradually with the mature of new bone and be located in extracellular matrix and osteoblasts around ossified areas; The expression of IGF-I reached the peak and be located mainly in osteoblasts of new bone surface, maturing osteocytes and calcifying osteoid. But there was little expression of them in the control group. In the sixth postoperative week in the micro movement group, there was a little expression of IGF-I expression but little expression of TGF-beta1; there was nearly no expression of them in the control group. In the micro movement group, the absorbance values of TGF-beta1 at 3 and 4 weeks and of IGF-I at 3, 4 and 6 weeks were significantly higher than those in control group (P<0. 05). RT-PCR: In the third and fourth postoperative weeks in the micro movement group, there was higher expression of mRNA of TGF-beta1 and TGF-I than those in control group; in the sixth postoperative week, the expression diminished gradually, but was higher than that in control group. The absorbance values of TGF-beta1 at 3 and 4 weeks and IGF-I at 3, 4 and 6 weeks were significantly higher than those of control group (P<0. 05). CONCLUSION: Low frequency and controlled micro movement in the early stage of the fracture healing can promote the expression of TGF-beta1 and IGF-I. They worked together to regulate the process of the endochondral ossification, while in the late stage the differentiation of osteocytes and mineralization of osteoid were regulated mainly by IGF-I, which played an important role in regulating the cell biological behavior during micro movement.