Outcomes of Anterior Lateral Approach and Gerdy's Tubercle Osteotomy for Tibial Plateau Fractures Involving the Posterior Lateral Condyle: A Retrospective Study of 20 Patients.

BACKGROUND The objective of this investigation was to assess the effectiveness of using T-shaped steel plates through the anterior lateral approach and Gerdy's tubercle osteotomy for treating posterior lateral tibial plateau fractures. MATERIAL AND METHODS A retrospective analysis was conducted on clinical data from 20 patients, aged on average 53.9±10.36 years, who were admitted for tibial plateau fractures involving the posterior lateral condyle between January 2019 and October 2022. The fixation and reduction of the posterior lateral bone block were performed using the anterior lateral approach combined with Gerdy's tubercle osteotomy to address the posterior lateral tibial plateau fracture. Post-surgery assessment was conducted using the Hospital for Special Surgery (HSS) knee combined score. RESULTS During the 12-24 (14.2±1.7) month postoperative period, we conducted 20 surgeries. Within 9 to 12 weeks, fracture healing transpired without any complications such as incision infection, nerve injury, or fracture displacement being detected. Assessment of knee joint function at the final follow-up was conducted using the HSS knee combined score, with results indicating 16 cases rated as excellent, 3 cases as good, and 1 case as fair. CONCLUSIONS In tibial plateau fractures impacting the posterior lateral condyle, the anterior lateral approach, combined with Gerdy's tubercle osteotomy, allows for direct exposure and manipulation of the posterior lateral bone block fracture. Using a T-shaped support plate and a lateral locking plate provides a reliable method for fracture fixation, aiding in convenient surgical positioning and intraoperative fluoroscopy. The treatment approach effectively manages fractures located on the posterior lateral aspect of the tibial plateau.

Clinical Study of Volar Median Approach Combined with Lateral Radial Auxiliary Approach in Treatment of C-Type Distal Radius Fractures: Our Clinical and Radiological Results.

BACKGROUND The aim of the study was to explore the clinical implications of median approach combined with radial auxiliary plate in the treatment of C-type distal radius fractures. MATERIAL AND METHODS From January 2017 to January 2022, a total of 20 cases were collected, including 6 male and 14 female patients with closed fresh distal radius fractures. All patients received volar medium approach T-shaped locking plate treatment, as well as radial auxiliary plate open reduction and internal fixation. We recorded the incidence of median nerve injury, incidence of radial artery and vein or their branches injury, postoperative X-ray measurement of radial styloid process height, ulnar declination, palmar inclination, and Gartland-Werley score. RESULTS All surgical procedures were successful, and all patients were monitored for 3 to 12 months after the procedure. In the postoperative follow-up, there was no obvious loss of reduction. At the last follow-up, all patients' articular surface flatness was less than 2 mm, and the mean values for palmar inclination and ulnar declination were (14.36°±3.55°) and (19.79°±2.57°), respectively. The average height of a radial styloid was 117±2.42 mm; functional evaluation: excellent in 12 (60%), good in 6 (30%), and fair in 2 cases (10%) cases. Five patients showed slight nerve injury, but all recovered quickly within 6 months. CONCLUSIONS The volar median approach, which combines a T-locking plate with a radial auxiliary plate for open reduction and internal fixation, is an effective treatment for unstable distal radius fractures.

Modified Posterolateral Approach for the Treatment of 2-Part Fractures of the Posterior Malleolus Associated with Medial and Lateral Malleolar Fractures: 1 Incision, 2 Windows, 3 Steel Plates.

BACKGROUND The aim of this study was to investigate the effect of the modified posterolateral approach using 1 incision, 2 windows, and 3 plates in the treatment of 2-part posterior malleolus fractures complicated with medial and lateral malleolus fractures. MATERIAL AND METHODS Twelve patients with 2-part fractures of the posterior malleolus complicated with medial and lateral malleolar fractures and treated by the modified posterolateral approach from January 2018 to January 2021 were studied retrospectively. After surgery, the ankle hindfoot score and visual analog scale (VAS) of the American Orthopedic Foot and Ankle Society (AOFAS) were used for evaluation. RESULTS The average follow-up time of the 12 patients was 18 months (7-30 months). All patients had no infection, and their incisions healed in the first stage. Postoperative radiography showed that the average fracture healing time was 12.5 weeks (10-15 weeks). The average time for patients to walk weight bearing was 13 weeks (11-16 weeks), and there was no obvious pain or discomfort. At the last follow-up, the average AOFAS ankle hindfoot score of the 12 patients was 87.5 (77-95), with 7 excellent and 5 good scores. The VAS score improved from before surgery (average 8.25 points) to after surgery (average 1 point). The curative effect was satisfactory. CONCLUSIONS The posterolateral approach using 1 incision, 2 windows, and 3 steel plates was effective in the treatment of 2-part posterior malleolus fractures complicated with medial and lateral malleolus fractures.

Interaction of High-Sugar Diet and History of Stroke with Risk of Cognitive Decline in Older Adults.

BACKGROUND Cognitive decline has become a public health concern as it causes adverse economic and socio-psychological outcomes. Studies have assessed the effects of history of stroke or high-sugar diet on cognitive decline of older adults, but whether there was interaction between high-sugar diet and history of stroke in affecting cognitive decline was still unclear. The present study explored the interaction between high-sugar diet and history of stroke in affecting the risk of cognitive decline in older adults. MATERIAL AND METHODS This cross-sectional study included 2710 subjects. Univariate analysis was applied to explore the associations of high-sugar diet or history of stroke in affecting cognitive decline. The relative excess risk of interaction (RERI), synergy index (SI), and attributable proportion of interaction (API) were used to assess the interaction of high-sugar diet and history of stroke in risk of cognitive decline. RESULTS An increased risk of cognitive decline was observed in people with history of stroke [odds ratio (OR)=1.826, 95% confidence interval (CI): 1.124-2.968] and high-sugar diet (OR=1.509, 95% CI: 1.109-2.052). The confidence intervals of interaction indicators RERI=1.257 (95% CI: 0.188-2.326) and API=0.386 (95% CI: 0.135-0.638) did not contain 0 and were both >0; the confidence interval of SI=2.261 (95% CI: 1.063-4.809) did not contain 1 and were >1. CONCLUSIONS A high-sugar diet and history of stroke interacted synergically in association with cognitive decline in older adults, which might provide a reference for management of cognition in older adults.

Posteroanterior Lag Screws Versus Posterior Buttress Plate Fixation of Posterior Malleolar Fragments in Spiral Tibial Shaft Fracture.

The aim of this study is to compare the clinical outcomes of posteroanterior (PA) lag screws versus posterior buttress plate fixation in treatment of posterior malleolar fragments (PMFs) in spiral tibial shaft fracture, and provide guidance for surgeons selecting a treatment strategy. A total of 48 eligible patients with PMFs associated with spiral tibial shaft fracture surgically treated from March 2009 to January 2016 were included in the study. They were divided into the screw group (n = 24) and the plate group (n = 24). All operations were performed via a posterolateral approach by a senior orthopedic surgeon. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS), and assessment of ankle range of motion (ROM) were used for clinical evaluation. The radiographic evaluation of posttraumatic arthritis scale was determined by Bargon reference criteria. At the mean follow-up period of 29.5 ± 4.3 and 30.4 ± 4.1 months, respectively (p > .05), all patients in both groups had bone union without severe wound problems or complications. There were no significant differences in AOFAS (92.5 ± 5.3 vs 94.7 ± 5.6, p = .129) and VAS (2.4 ± 0.8 vs 2.2 ± 0.9, p = .196) scores between the groups at final follow-up. No significant differences were found between the groups in injured/contralateral ankle ROM or posttraumatic ankle arthritis scale postoperatively (p > .05). For PMFs in spiral tibial shaft fracture, PA lag screws or posterior buttress plate fixation via a posterolateral approach can achieve good and equivalent clinical and radiological outcomes with minimal complications.

Periodic Mechanical Stress Stimulates GIT1-Dependent Mitogenic Signals in Rat Chondrocytes Through ERK1/2 Activity.

BACKGROUND/AIMS: The mitogenic effects of periodic mechanical stress on chondrocytes have been studied extensively, but the mechanisms whereby chondrocytes sense and respond to mechanical stimuli remain to be determined. We explored the question and verified the key role of G protein coupled receptor kinase interacting protein 1 (GIT1) signaling in periodic mechanical stress-induced chondrocyte proliferation. METHODS: Two steps were undertaken in the experiment. In the first step, the cells were maintained under non-pressure conditions or periodic mechanical stress for 1 h prior to Western blot analysis. In the second step, the cells were pretreated with short hairpin RNA (shRNA) targeted to GIT1 or Src or control scrambled shRNA, or transfected with GIT1 wild-type or GIT1 mutant Y321F, or focal adhesion kinase (FAK) wild-type or FAK mutants Y397F or Y576F/Y577, respectively. Moreover, the cells were pretreated with blocking antibody against integrin ß1 or PP2. Then the cells were maintained under non-pressure conditions or periodic mechanical stress for 1 h prior to Western blot analysis, and for 3 days, 8 h per day, prior to direct cell counting and CCK-8 assay, respectively. RESULTS: Periodic mechanical stress significantly induced sustained phosphorylation of GIT1 at Tyr321. Reduction of GIT1 with shRNA targeted to GIT1 and GIT1 mutant Y321F inhibited periodic mechanical stress-promoted chondrocyte proliferation, accompanied by attenuated extracellular signal-regulated kinase (ERK)1/2 and FAK phosphorylation at Tyr576/577. However, activation of Src and FAK-Tyr397 was not prevented upon GIT1 suppression. Furthermore, pretreatment with blocking antibody against integrin ß1, Src-selective inhibitor, PP2, and shRNA targeted to Src blocked GIT1 activation under periodic mechanical stress. In addition, GIT1 phosphorylation at Tyr321 was not reduced upon pretreatment with FAK mutants Y397F or Y576F/Y577 under conditions of periodic mechanical stress. CONCLUSION: These findings collectively suggested that periodic mechanical stress promoted chondrocyte proliferation through at least two separate pathways, integrin ß1-Src-GIT1-FAK(Tyr576/577)-ERK1/2, and the other parallel GIT1-independent integrin ß1-FAK(Tyr397)-ERK1/2.

Periodic Mechanical Stress Stimulates Cav-1-Dependent IGF-1R Mitogenic Signals in Rat Chondrocytes Through ERK1/2.

BACKGROUND/AIMS: The biological effects of periodic mechanical stress on the mitogenesis of chondrocytes have been studied extensively over the past few years. However, the mechanisms underlying the ability of chondrocytes to sense and respond to mechanical stimuli remain to be determined. In the current study, we analyzed the mechanisms by which periodic mechanical stress is translated into biochemical signals and verified the key role of non-integrin mechanosensors including Caveolin-1 (Cav-1), and insulin-like growth factor-1 receptor (IGF-1R) in chondrocyte proliferation. METHODS: Two steps were undertaken in the experiment. In the first step, the cells were maintained under static conditions or periodic mechanical stress for 0 h and 1 h prior to Western blot analysis. In the second step, the cells were pretreated with short hairpin RNA (shRNA) targeted to Cav-1 or IGF-1R or control scrambled shRNA. Moreover, they were pretreated with their selective inhibitors methyl ß-cyclodextrin (MCD) or Linsitinib (OSI-906). They were maintained under static conditions or periodic mechanical stress for 1 h prior to Western blot analysis, and for 3 days, 8 h per day, prior to direct cell counting and CCK-8 assay, respectively. RESULTS: Periodic mechanical stress significantly induced sustained phosphorylation of Cav-1 at Tyr14 and IGF-1R at Tyr1135/1136. Proliferation was inhibited by pretreatment with Cav-1 inhibitor MCD and by shRNA targeted to Cav-1 in chondrocytes in response to periodic mechanical stress. Meantime, MCD and shRNA targeted to Cav-1 also attenuated IGF-1R, and extracellular signal-regulated kinase (ERK)1/2 activation. In addition, inhibiting IGF-1R activity by Linsitinib and shRNA targeted to IGF-1R abrogated chondrocyte proliferation and phosphorylation level of ERK1/2 subjected to periodic mechanical stress, while the phosphorylation site of Cav-1 was not affected. CONCLUSION: These findings collectively suggested that periodic mechanical stress promoted chondrocyte proliferation through Cav-1-IGF-1R-ERK1/2.

Globular Adiponectin Attenuated H2O2-Induced Apoptosis in Rat Chondrocytes by Inducing Autophagy Through the AMPK/ mTOR Pathway.

BACKGROUND/AIMS: Chondrocyte apoptosis is closely related to the development and progression of osteoarthritis. Global adiponectin (gAPN), secreted from adipose tissue, possesses potent anti-inflammatory and antiapoptotic properties in various cell types. This study aimed to investigate the role of autophagy induced by gAPN in the suppression of H2O2-induced apoptosis and the potential mechanism of gAPN-induced autophagy in chondrocytes. METHODS: H2O2 was used to induce apoptotic injury in rat chondrocytes. CCK-8 assay was performed to determine the viability of cells treated with different concentrations of gAPN with or without H2O2. Cell apoptosis was detected by flow cytometry and TUNEL staining. Mitochondrial membrane potential was examined using JC-1 fluorescence staining assay. The autophagy inhibitors 3-MA and Bafilomycin A1 were used to treat cells and then evaluate the effect of gAPN-induced autophagy. To determine the downstream pathway, chondrocytes were preincubated with the AMPK inhibitor Compound C. Beclin-1, LC3B, P62 and apoptosis-related proteins were identified by Western blot analysis. RESULTS: H2O2 (400 µM)-induced chondrocytes apoptosis and caspase-3 activation were attenuated by gAPN (0.5 µg/mL). gAPN increased Bcl-2 expression and decreased Bax expression. The loss of mitochondrial membrane potential induced by H2O2 was also abolished by gAPN. Furthermore, the antiapoptotic effect of gAPN was related to gAPN-induced autophagy by increased formation of Beclin-1 and LC3B and P62 degradation. In particular, the inhibition of gAPN-induced autophagy by 3-MA prevented the protective effect of gAPN on apoptosis induced by H2O2. Moreover, gAPN increased p-AMPK expression and decreased p-mTOR expression. Compound C partly suppressed the expression of autophagy-related proteins and restored the expression of p-mTOR suppressed by gAPN. Thus, the AMPK/mTOR pathway played an important role in the induction of autophagy and protection of H2O2-induced chondrocytes apoptosis by gAPN. CONCLUSIONS: gAPN protected chondrocytes from H2O2-induced apoptosis by inducing autophagy possibly associated with AMPK/mTOR signal-pathway activation.

The study of mechanisms of protective effect of Rg1 against arthritis by inhibiting osteoclast differentiation and maturation in CIA mice.

Ginsenoside Rg1 is a natural product extracted from Panax ginseng C.A. Although Rg1 protects tissue structure and functions by inhibiting local inflammatory reaction, the mechanism remains poorly understood. In vitro, Rg1 dose-dependently inhibited TRAP activity in receptor activator of nuclear factor-κB ligand- (RANKL-) induced osteoclasts and decreased the number of osteoclasts and osteoclast resorption area. Rg1 also significantly inhibited the RANK signaling pathway, including suppressing the expression of Trap, cathepsin K, matrix metalloproteinase 9 (MMP9), and calcitonin receptor (CTR). In vivo, Rg1 dramatically decreased arthritis scores in CIA mice and effectively controlled symptoms of inflammatory arthritis. Pathologic analysis demonstrated that Rg1 significantly attenuated pathological changes in CIA mice. Pronounced reduction in synovial hyperplasia and inflammatory cell invasion were observed in CIA mice after Rg1 therapy. Alcian blue staining results illustrated that mice treated with Rg1 had significantly reduced destruction in the articular cartilage. TRAP and cathepsin K staining results demonstrated a significant reduction of numbers of OCs in the articular cartilage in proximal interphalangeal joints and ankle joints in Rg1-treated mice. In summary, this study revealed that Rg1 reduced the inflammatory destruction of periarticular bone by inhibiting differentiation and maturation of osteoclasts in CIA mice.

Cost-effectiveness analysis of neonatal hearing screening program in China: should universal screening be prioritized?

BACKGROUND: Neonatal hearing screening (NHS) has been routinely offered as a vital component of early childhood care in developed countries, whereas such a screening program is still at the pilot or preliminary stage as regards its nationwide implementation in developing countries. To provide significant evidence for health policy making in China, this study aims to determine the cost-effectiveness of NHS program implementation in case of eight provinces of China. METHODS: A cost-effectiveness model was conducted and all neonates annually born from 2007 to 2009 in eight provinces of China were simulated in this model. The model parameters were estimated from the established databases in the general hospitals or maternal and child health hospitals of these eight provinces, supplemented from the published literature. The model estimated changes in program implementation costs, disability-adjusted life years (DALYs), average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER) for universal screening compared to targeted screening in eight provinces. RESULTS AND DISCUSSION: A multivariate sensitivity analysis was performed to determine uncertainty in health effect estimates and cost-effectiveness ratios using a probabilistic modeling technique. Targeted strategy trended to be cost-effective in Guangxi, Jiangxi, Henan, Guangdong, Zhejiang, Hebei, Shandong, and Beijing from the level of 9%, 9%, 8%, 4%, 3%, 7%, 5%, and 2%, respectively; while universal strategy trended to be cost-effective in those provinces from the level of 70%, 70%, 48%, 10%, 8%, 28%, 15%, 4%, respectively. This study showed although there was a huge disparity in the implementation of the NHS program in the surveyed provinces, both universal strategy and targeted strategy showed cost-effectiveness in those relatively developed provinces, while neither of the screening strategy showed cost-effectiveness in those relatively developing provinces. This study also showed that both strategies especially universal strategy achieve a good economic effect in the long term costs. CONCLUSIONS: Universal screening might be considered as the prioritized implementation goal especially in those relatively developed provinces of China as it provides the best health and economic effects, while targeted screening might be temporarily more realistic than universal screening in those relatively developing provinces of China.

High TRB3 expression induces chondrocyte autophagy and senescence in osteoarthritis cartilage.

OBJECTIVE: Osteoarthritis is closely related to aging. Tribbles homologue 3 (TRB3) is found to display age-related expression and contributes to the regulation of cell proliferation, differentiation and fibrosis. In this study, we aimed to investigate the potential involvement of TRB3 in cartilage autophagy and aging in osteoarthritis. METHODS: Cartilage tissue samples were collected from osteoarthritis patients who received joint replacement and cadaveric donors. In osteoarthritis cartilage tissue, we analyzed autophagy- and senescence-associated proteins using immunohistochemistry and western blot (WB), in vitro, to confirm the role played by TRB3 in the process of autophagy, cell senescence, and inflammation, small interfering RNA (siRNA) was used for TRB3 knockdown in cells. RESULTS: We found increased level of p62, decreased level of microtubule-associated protein 1A/1B-light chain 3 (LC3) and beclin-1 in cartilage, and increased level of p16 and p21 in tissue samples collected from osteoarthritis patients, indicating decreased autophagy and increased cell senescence. TRB3 knockdown significantly rescued, in vitro, the reduced autophagy and elevated cell senescence in human chondrocyte. CONCLUSIONS: Interfering with TRB3 expression in cartilage may serve as a target in the prevention and treatment of age-related osteoarthritis.

Dual Rate-Modulation Approach for the Preparation of Crystalline Covalent Triazine Frameworks Displaying Efficient Sodium Storage.

A dual rate-modulation approach was implemented for the first time to create crystalline covalent triazine frameworks. Based on a new polycondensation approach, regulating the condensation rate via the exploitation of a modulated aldehyde monomer and addition of an extrinsic inhibitor affords inherent control over the polymer growth and therefore provides tunable crystallinities and porosities for the resulting triazine frameworks. The existence of rich redox-active triazine linkages gives rise to obtaining exceptional sodium storage, where 239 mAh g-1 at 1.0 A g-1 is obtained after 200 cycles. We anticipate this new protocol based on the dynamic imine metathesis will facilitate new possibilities for the construction of crystalline covalent triazine frameworks and promote their energy-related applications.

A new flexible pressure sensor contributes to the early diagnosis of acute compartment syndrome.

Acute compartment syndrome (ACS) is a surgical emergency, caused by the sharp increase of interstitial pressure within a closed osteofascial compartment, which can impair local circulation and functions. A non-invasive sensor is needed of satisfactory sensitivity to continuously monitor the alterations of the ACS pressure, which could be used as a supplementary means in the early diagnosis of ACS. A prepared "pasting-type" flexible pressure sensor was used to establish an extracorporeal pig-skin model with a soft-tissue expander device to simulate compartment syndrome conditions. An acrylic panel was inserted into the pig skin, allowing the soft-tissue expander to expand in one direction, which is similar to the movements of a patient's bones in real life. The touch spot of the flexible pressure sensor was attached to the rind by medical tape, to record the internal and external pressure data. Relationships between the internal and external pressures at different thickness (0.87 mm, 3.53 mm and 3.97 mm), as well as that of the 3.97 mm thickness under various initial internal pressures (0.5 mmHg, 25 mmHg and 44 mmHg) were measured. Significant differences were observed in the range of internal pressures at various pig-skin thickness. After adding the acrylic panel, the measured ranges were significantly increased, with the lowest measurable internal pressure being 5 mmHg. Moreover, alterations in external pressure were also greater than in models without acrylic panels. The external pressure measured by the sensor was able to reflect an increase in intra-organizational pressure. This may be a new non-invasive and sustainable method for early diagnosis of ACS.

Experimental Wear Behavior Analysis of Coated Spindle Hook Teeth under Real Harvesting Work Conditions.

This study aimed to investigate the wear failure changes of spindle hook teeth and the reasons for such failure during field work. Spindle samples were obtained from a fixed position of the spindle bar under different field picking area conditions and combined with the spatial distribution characteristics of cotton bolls in Xinjiang. After cutting a spindle sample, a scanning electron microscope and an energy spectrum analyzer were used to characterize the micromorphology and element composition of the hook tooth surface and cross section under different working area conditions. The wear parameters of the hook teeth were then extracted. The results showed that the thickness of the coating on the surface of the hook tooth used in this study was between 66.1 µm and 74.4 µm. The major chemical element was chromium, with a small amount of nickel. During the field picking process, failure of the coating on the surface of the hook teeth initially appeared on the tooth tip and tooth edge, and then spread to the entire hook tooth surface. The wear failure of the hook teeth resulted from abrasive wear, oxidative wear, and fatigue peeling. As the picking area increased, the wear area of the hook teeth increased exponentially, while the wear width increased linearly. When the field picking area reached 533.33 ha, the maximum change rate of the wear area was 2.33 × 103 µm2/ha, and the wear width was 1.84 µm/ha. During field work, the thickness of the coating decreased from the cutting surface to the tooth edge, and the wear rate gradually increased. The wear rate at Position 1 was the slowest, at 0.01 µm/ha, and the wear rate at Position 5 was the fastest, at 0.25 µm/ha.

Rg1 in combination with mannitol protects neurons against glutamate-induced ER stress via the PERK-eIF2 α-ATF4 signaling pathway.

AIMS: Ginseng and ginsenosides are known for their remarkable effects on the central nervous system. However, pharmacokinetic studies have suggested that the Ginsenoside Rg1 (Rg1) cannot be efficiently transported through the blood-brain barrier. To investigate the effects of Rg1 in combination with mannitol protects neurons against glutamate-induced ER stress via the PERK-eIF2 -ATF4 signaling pathway. MAIN METHODS: Rg1, along with the BBB permeabilizer mannitol, exhibited a potent neuroprotective effect by significantly reducing the neurological scores and infarct volume in rats exposed to middle cerebral artery occlusion. We evaluated the effect of Rg1 on neuroprotection after MCAO, and also explored its potential mechanism of action. KEY FINDINGS: Our results show that Rg1 reduced the number of terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL)-positive neurons. This neuroprotection may be dependent, at least in part, on the preservation of the endoplasmic reticulum and mitochondrial function. Ischemia-induced brain injury is largely caused by the excessive release of glutamate, which results in excitotoxicity and cell death. Neurons were pretreated with Rg1 before inducing endoplasmic reticulum stress with glutamate. A reduction in the expression of Bax and a concomitant increase in Bcl2 expression prevented the induction of apoptosis. Furthermore, Rg1 downregulated the expression of endoplasmic reticulum stress genes. SIGNIFICANCE: Our results indicate that Rg1 modulation of stress-responsive genes helps prevent glutamate-induced endoplasmic reticulum stress in neurons through the PERK-eIF2-α-ATF4 signaling pathway.

Use of Mechanical Stretching to Treat Skin Graft Contracture.

After transplantation, skin grafts contract to different degrees, thus affecting the appearance and function of the skin graft sites. The exact mechanism of contracture after skin grafting remains unclear, and reliable treatment measures are lacking; therefore, new treatment methods must be identified. Many types of centripetal contraction forces affect skin graft operation, thus leading to centripetal contracture. Therefore, antagonizing the centripetal contraction of skin grafts may be a feasible method to intervene in skin contracture. Here, the authors propose the first reported mechanical stretching method to address contracture after skin grafting. A full-thickness skin graft model was established on the backs of SD rats. The skin in the experimental group was stretched unilaterally or bidirectionally with a self-made elastic stretching device, whereas the skin was non-stretched in the control group. The rats were sacrificed 2 weeks after stretching. The area, length, and width of the skin were measured. The grafts were cut and fixed with formalin. Routine paraffin sections were stained with hematoxylin-eosin, picric acid-Sirius red, Victoria blue, and anti-alpha-smooth muscle actin (SMA). Mechanical stretching made the graft lengthen in the direction of the stress and had an important influence on collagen deposition and alpha-SMA expression in the graft. This method warrants further in-depth study to provide a basis for clinical application.

A Modified Direct Posterior Midline Approach for the Treatment of Posterior Column Tibial Plateau Fractures.

The purpose of this study was to introduce a modified surgical approach for the treatment of posterior column tibial plateau fractures. Fifteen patients with posterior column fractures with or without other column fractures were included and treated with this approach between July 2015 and June 2016. The patients were followed up for 18 to 24 months (20.9 ± 1.8 months). Outcomes included neural or vascular injuries, wound complications, nonunion, plate loosening or breakage, and Hospital for Special Surgery (HSS) scores. Bone union was observed in all cases, and the average time for bone union was 13.5 ± 1.4 weeks (11-16 weeks). No neurovascular injuries, malunion, nonunions, or plate loosening or breakages were observed. The average HSS score was 94.7 ± 4.1 (range: 84-100). The modified direct posterior midline approach can provide excellent exposure and facilitate reduction and internal fixation of posterior column fractures of the tibial plateau, including split and depressed fractures. We expect that this approach can be used as a new effective method for managing complex posterior tibial fractures.

Loss of Klotho contributes to cartilage damage by derepression of canonical Wnt/ß-catenin signaling in osteoarthritis mice.

Caducity is known to be an independent risk factor in osteoarthritis (OA), yet the molecular basis behind caducity and OA remains unclear. Klotho, an anti-caducity protein, is an endogenous antagonist of the transduction of Wnt/ß-catenin signal which can stimulate the articular cartilage degradation, indicating that deficiency in Klotho may increase Wnt/ß-catenin activity and consequently accelerate the development of OA. We found that expression of Klotho was markedly higher in normal mouse cartilage than in the OA model, and in this model the activity of Wnt/ß-catenin and its target gene was up-regulated. Decrease in Klotho expression was closely associated with the increase of ß-catenin in OA, indicating that there was a negative correlation between Klotho and Wnt signal transduction. In the vitro and in vivo experiments, Klotho was found to bind to multiple Wnt, including Wnt1, Wnt4 and Wnt7a. It was additionally found that cyclic tenisle strain (CTS) inhibited the expression of Klotho and activated ß-catenin. On the contrary, over-expression of Klotho would reduce the degradation of articular cartilage induced by CTS. These results suggest that Klotho is an antagonist of endogenous Wnt/ß-catenin activity. In OA cartilage, decrease in expression of Klotho can activate Wnt/ß-catenin signal transduction and consequently induce cartilage injury.

Regulation of cartilage damage caused by lack of Klotho with thioredoxin/peroxiredoxin (Trx/Prx) system and succedent NLRP3 activation in osteoarthritis mice.

This present study aims to verify the underlying mechanism that anti-aging protein Klotho protects cartilages against the damage induced by oxidative stress. The Klotho expression level in the articular cartilages of mice with osteoarthritis (OA) was measured by using western blotting and quantitative real-time PCR. This work also investigated the effects of Klotho on chondrocyte functions, such as PI3K/Akt pathway, apoptosis and reactive oxygen species (ROS) production, through overexpressing Klotho in chondrocytes by transfecting with the plasmid encoding Klotho. The results showed that Klotho expression level obviously decreased in the articular cartilages of OA mice. It was also found that mechanical loading significantly reduced the expression and activity of Klotho in chondrocytes. In addition, the overexpression of Klotho suppressed chondrocyte apoptosis through thioredoxin/peroxiredoxin (Trx/Prx) family and ROS/TXNIP/NLRP3 signaling pathways. All these above findings suggest that Klotho is essential in OA progression, and may be a good target for the research and development of the drugs for OA treatment.

Therapeutic effect of MIPPSO in the thoracolumbar vertebra fracture.

The purpose of this study was to compare the efficacy of minimally invasive percutaneous pedicle screw osteosynthesis (MIPPSO) and traditional open pedicle screw osteosynthesis (TOPSO) in the treatment of thoracolumbar vertebra fracture. A retrospective case-control study was conducted in 120 patients with thoracolumbar vertebral fractures treated in the Affiliated Jiangyin Hospital of Southeast University Medical School (Jiangyin, China) from January 2013 to September 2014. They were randomly divided into two groups: MIPPSO and TOPSO groups with 60 cases in each group. The operation time, blood loss, incision length, post-operative bed rest time, hospital stay, visual analogue scale (VAS) pain scores and Oswestry disability index (ODI) scores before and after operation were recorded and analyzed. Inflammatory indexes including serum C-reactive protein (CRP) and creatine kinase (CK), the anterior vertebral height ratio and kyphosis Cobb's angle changes were also observed. The basic data of the two groups were similar, and there was no significant difference in the operation time between the two groups. The perioperative blood loss, length of incision, bed rest time and total hospital stay in the minimally invasive group were less than those in the open group. Levels of post-operative inflammation indicators such as CRP and CK were significantly higher than those of pre-operative (P<0.05), which was more obvious in the TOPSO group (P<0.05). VAS, ODI scores, anterior vertebral height and Cobb's angle were significantly improved at three days, one and 12 months after surgery compared with those before operation. MIPPSO for the treatment of thoracolumbar fractures can achieve similar clinical effects with traditional incision surgery. In addition, it has the advantages of less trauma, less bleeding and shorter post-operative bed rest time and hospital stay.