[Open reduction and internal fixation in treatment of four cases of bipolar clavicle dislocations].

Objective: To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Methods: Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. Results: All operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. Conclusion: For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.

[Effects of glutamine induced heat shock protein 70 overexpression on atrial fibrosis and connexin 43 remodeling in isoprenaline-treated rats].

OBJECTIVE: To explore the effects of glutamine (Gln) induced heat shock protein 70(Hsp70) overexpression on atrial fibrosis and connexin 43 remodeling in isoprenaline(ISO)treated rats and related mechanisms. METHODS: Forty male SD rats were randomly divided into five groups (n = 8 each group): control group, DMSO group, ISO 5 mg×kg(-1)×d(-1) group (Fibrosis group), ISO 5 mg×kg(-1)×d(-1) + Ala-Gln 0.75 mg×kg(-1)×d(-1) group (Intervention group) and ISO 5 mg×kg(-1)×d(-1) + QUE 100 mg× kg(-1)×d(-1) + Ala-Gln 0.75 mg×kg(-1)×d(-1) + DMSO group (QUE group).Rats were killed after 7 d. The AngII expression in myocardial tissue was detected by radioimmunoassay; myocardial fibrosis was observed by HE staining.Collagen volume fractions were quantified by Masson staining and as the indicators of atrial fibrosis. The expressions of Hsp70, p-JNK1/2/3, c-Jun and Cx43 were determined with immunohistochemical method. RESULTS: AngII content was similar between the control group [(68.51 ± 10.76) pg/L] and DMSO [(71.47 ± 11.49) pg/L] group (P > 0.05), and significantly increased in fibrosis group [(211.25 ± 49.49) pg/L], intervention group [(185.32 ± 54.85) pg/L] and QUE [(189.90 ± 42.12) pg/L] group (P < 0.01 vs. control group). Atrial fibrosis was significantly higher in the fibrosis group [(29.485 ± 9.966)%] and QUE group [(25.060 ± 8.581)%] but not in the intervention group [(7.861 ± 1.867)%] compared to control group [(6.842 ± 1.674)%] and DMSO group [(7.108 ± 1.343)%]. The expression of Hsp70 was similar among the control group (0.160 ± 0.023), DMSO group (0.163 ± 0.022), fibrosis group (0.166 ± 0.028) and QUE (0.168 ± 0.027) group (P > 0.05) while significantly upregulated in the intervention group (0.215 ± 0.018) (P < 0.01 vs. control group). The expressions of p-JNK1/2/3 and c-Jun were similar between control group (0.151 ± 0.016;0.163 ± 0.022) and DMSO group (0.154 ± 0.021;0.164 ± 0.024)(P > 0.05), while significantly upregulated in fibrosis group (0.202 ± 0.025; 0.254 ± 0.044) and QUE group (0.196 ± 0.024; 0.251 ± 0.027) (P < 0.01 vs. control group) but not in intervention group (0.160 ± 0.025; 0.168 ± 0.024)were not changed obviously (P > 0.05 vs. control group). The content of Cx43 was similar between control group and DMSO group (0.231 ± 0.035 vs. 0.220 ± 0.032, P > 0.05), and was linearly distributed in intercalated disc of the cardiomyocytes, however, the content of Cx43 was significantly reduced (P < 0.01) and the Cx43 distribution was disordered in fibrosis group (0.163 ± 0.013) and QUE group (0.165 ± 0.024), while these changes were not found in intervention group. CONCLUSION: Glutamine could reduce the atrial fibrosis and Cx43 remodeling in isoprenaline-treated rats by up-regulating Hsp70 and inhibiting JNK signaling pathway activation through down-regulating p-JNK1/2/3 and c-Jun expression.