The Characteristics and Influencing Factors of Nonsuicidal Self-Injury of Adolescents With Depressive Disorder in China: A Meta-analysis.

ABSTRACT: This study is a systematic review of characteristics and influencing factors of nonsuicidal self-injury behavior among adolescents with depressive disorder in China. PubMed, CNKI, WanFang Database, and VIP were searched for studies. Meta-analysis was performed using RevMan 5.1 software. Nineteen studies involving 707 subjects were included in the meta-analysis. Age, gender, only child or not, and residence were included in the analysis, of which age ( I2 = 0%, p = 0.42) and residence ( I2 = 0%, p = 0.84) were analyzed by fixed-effects model; gender ( I2 = 75%, p = 0.003) and only child or not ( I2 = 50%, p = 0.140) were analyzed by random-effects model. The evidence shows that, according to the common self-injury mode and location, the nonsuicidal self-injury behavior of young people with depressive disorder aged 15-18 years is paid attention to and guided, so as to achieve early detection and early diagnosis and treatment, and reduce the occurrence of serious harm.

Arthroscopic retrieval of knee foreign bodies in pediatric: a single-centre experience.

PURPOSE: The present study was to investigate the clinical features of foreign body (FB) residues in children's knee joints, surgical retrieval, and postoperative function of knee joints. METHODS: This retrospective study included a total of 13 children (8 boys and 5 girls; the mean age is 6.69 years old, range from 2 to 16 years old) who underwent retrieval surgery of knee FBs in our hospital. Related clinical factors were recorded and analyzed to find the influence factors of surgical methods and FBs' location change. RESULTS: The FBs in 11 cases were removed completely by arthroscopy, two cases by open surgery changed from arthroscopy. Besides glass pieces (n = 4, 31%) and wooden splinter (n = 1, 7%), sewing needle fragments were the most common type of knee foreign body (n = 8, 62%). There were two patients with FBs whom open surgery changed from arthroscopy was performed. The FBs of patients with open surgery changed from arthroscopy were more likely to locate in the posterior compartment (p = 0.04), and had a higher interval between injury and surgery than that in patients with arthroscopy (p = 0.01). The location of FBs (all were needle fragments) had changed intra-operatively in three patients, whose mean weight was lower than patients with fixed FBs (p = 0.04). The FB (small glass piece) of one patient was flushed out of the joint during arthroscopy. CONCLUSION: Arthroscopic retrieval surgery was an effective procedure to remove the FBs of the children's knee joint. The earlier it is detected, the easier it is to be treated. The location change of FBs should be cautioned in arthroscopic surgery and they are more likely to migrate into the posterior compartment of the knee joint.

Temporary hemiepiphysiodesis using an eight-plate implant for coronal angular deformity around the knee in children aged less than 10 years: efficacy, complications, occurrence of rebound and risk factors.

BACKGROUND: Temporary hemiepiphysiodesis (TH) using an eight-Plate implant is one of the most common surgeries used for the correction of coronal angular deformities around the knee in adolescents. However, few studies have focused on children aged less than 10 years treated with TH using an eight-Plate implant. The purpose of this study was to investigate the efficacy, correction velocity, and complications of TH with an eight-Plate implant as well as the occurrence of rebound and risk factors in this population. METHODS: This retrospective study included a total of 135 physes (101 knees) from 66 children (mean age of 4.69 years old, range from 1 to 10 years old) who underwent TH with an eight-Plate implant to correct coronal genu angular deformities in our hospital. Related clinical factors were recorded and analysed by multivariable linear and logistic regression models. RESULTS: The mean deformity correction period was 13.26 months, and the mean follow-up after eight-Plate removal was 12.71 months. In all, 94.06% (95/101 knees) of the genu angular deformities were completely corrected. Non-idiopathic genu angular deformity was found to be an independent risk factor for deformity correction failure (odds ratio (OR) = 2.47). The femoral correction velocity was significantly higher than the tibial correction velocity (1.28° vs. 0.83° per month, p < 0.001). After adjustment for other factors, younger children had higher correction velocities in the distal femur; however, genu valgum and idiopathic deformities were associated with higher correction velocities in the proximal tibia. In addition, we found three (3/101, 2.97%) knees with genu valgum that experienced rebound after removal of the eight-Plate, while five (5/101, 4.95%) knees with non-idiopathic genu angular deformity experienced screw loosening. No other complications were found, and non-idiopathic deformity was the only risk factor for complications (OR = 3.96). No risk factor was found for rebound in our study. CONCLUSIONS: TH using an eight-Plate implant is an effective procedure for coronal genu angular deformities with a low incidence of complications and rebound in patients younger than 10 years old. For this population, TH using an eight-Plate should be considered as soon as the deformity stops responding to conservative treatments. The parents of children younger than 10 years of age with non-idiopathic deformities should be informed preoperatively that the deformity may be prone to correction failure or screw loosening after eight-Plate implantation.

Risk factors for implant-related fractures after proximal femoral osteotomy in children with developmental dysplasia of the hip: a case-control study.

Background and purpose - Proximal femoral osteotomy (PFO) is commonly performed to treat children with developmental dysplasia of the hip (DDH). Implant-related femoral fractures after osteotomy are sometimes reported, but the potential risk factors for these fractures remain unclear. We investigated the association of implant-related fractures with PFO and potential risk factors for these fractures.Patients and methods - We retrospectively reviewed 1,385 children undergoing PFO for DDH in our institution from 2009 to 2016 after obtaining institutional review board (IRB) approval and identified 27 children (28 hips, fracture group) with implant-related femoral fractures after PFO. We selected 137 children (218 hips, control group) without fractures who matched the children in the fracture group by age, weight, surgeon, and surgical period. Relevant clinical data were collected and compared between the 2 groups. Multiple analyses of risk factors for implant-related fractures were conducted by logistic regression with the stepwise regression method.Results - The occurrence rate of implant-related fractures was 1.9% (27/1,385). Compared with the control group, the fracture group more commonly exhibited bilateral involvement (74% vs. 53%, p = 0.04), used a spica orthosis for immobilization after osteotomy (43% vs 21%, p = 0.01) and exhibited mild remodeling at the osteotomy site (46% vs. 19%, p = 0.003), and less commonly required capsulotomy during osteotomy (61% vs. 79%, p = 0.03). According to the multiple regression analysis, the only factor identified as an independent risk factor for implant-related fractures was mild remodeling at the osteotomy site (OR = 3.2, 95% CI 1.4-7.5). Remodeling at the osteotomy site was significantly associated with varus osteotomy (coefficient = 1.4, CI 1.03-1.8). The fracture occurred at a mean of 12 months (2.2-25) after osteotomy or 3.3 months (0-12) after implant removal. In children undergoing implant removal, the fractures mostly occurred at the osteotomy site (n = 13/15), while in those with the implant remaining, the fractures mostly occurred in the screw hole (n = 8/13).Interpretation - The type of PFO performed is not associated with implant-related fractures in children with DDH. Children with mild remodeling at the osteotomy site should be closely followed up, regardless of whether the hardware is removed, and high-intensity activity should not be permitted until moderate or extensive remodeling is confirmed. After PFO, the implants should be removed when solid union is achieved at the osteotomy site.

Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children.

OBJECTIVE: Although most of nerve injuries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the involved nerve is always required in the cases with the entrapment of posterior interosseous nerve (PIN). However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. The aim of the report is to observe and understand the pathology of PIN injury associated with Monteggia fracture-dislocation in children, and to propose the possible indication for the exploration of nerve. METHODS: Eight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors?Hospital from 2007 to 2008 were retrospectively reviewed. All the patients underwent the attempted closed reduction before they received exploration of PIN, with open reduction and internal fixation or successful closed reduction. RESULTS: The PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type III Bado's Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of radial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up. CONCLUSION: The findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by PIN and an irreducible radial head in children should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment.

[Study on the relationship between structure and spectroscopy of two compounds containing 2,2'-bipy and [MoO3] cluster skeletons].

Two compounds of molybdate with 2, 2'-bipy and [MoO3]: [(2, 2'-bipy)2 (MoO3)3]n (I) and [(2, 2'-bipy) (MoO3)]n (II) were successfully synthesized by hydrothermal synthesis method with programmable temperature control. In order to clarify the relationship between the structure and spectroscopy of these two compounds, both of them were characterized by means of X-ray powder diffraction (XRD), Fourier transform infrared spectra(FTIR), thermal perturbation 2D-IR correlation spectrum (2D-IR COS), thermogravimetric analysis(TGA), scanning electron microscopy(SEM), High temperature infrared analysis, UV-Vis DRS adsorption spectra and solid fluorescence spectrum to investigate the relationship between structure and properties of the title compounds. The powder XRD patterns of the complexes are well matched with the simulation based on single-crystal analysis, which indicate that compound I and II are in a pure phase. The characteristics of vibration frequency of FTIR and thermal perturbation relative spectral response of 2D-IR peak is consistent with thecompound I and II structure analysis. The synchronous and asynchronous correlation 2D-IR spectra of compounds also identified the compounds I and II molybdenum-oxygen cluster skeletons sequencing of vibration intensity change with temperature consistent with the high temperature infrared analysis. Through the TGA and high temperature infrared analysis it was found that the decomposition temperature was more than 300 degrees C and maximum weight losses rates above 800 degrees C, which suggest that they have good thermal stability. According to the UV-Vis DRS spectrum of the compound I and II there exists a wide ultraviolet absorption band in a range of 225 to 350 nm. The compound I and II steady-state fluorescence spectrum under the excitation of 277 and 295 nm respectively revealed compound I and II have the strongest emission peak at 460 and 480 nm respectively. This paper illustrates the coordination situation of these two compounds, and reveals the inherent law of valence electrons in molecule energy level transition. In the meantime it was verified that the weak interaction not only plays a role of stability in the frame of the structure of the complexes, but also plays an important role in heat resistance.

Finite Element Analysis of Mechanical Characteristics of Internal Fixation for Treatment of Proximal Femoral Osteolytic Lesions in Children.

OBJECTIVES: Clinically, it is very difficult to prevent pathological fracture caused by high recurrence rate of osteolytic disease of proximal femur in children. At present, there is no consensus in clinical studies of which internal fixation method can significantly reduce the probability of recurrence of pathological fracture. The study aims to research the mechanical properties of different internal fixations in the treatment of osteolytic lesions of proximal femur in children by finite element analysis, and to find out the optimal treatment. METHODS: Based on finite element analysis, the osteolytic disease models of the femoral neck and intertrochanter in a child (8-year-old, boy) were established respectively, and different internal fixation models (plate and titanium elastic intramedullary nails, TENs) were assembled. For the osteolytic lesion of the femoral neck: model A1 was assembled with a plate; model A2 with two TENs crossing the physis; model A3 with two TENs without crossing the physis. And for pertrochanteric osteolytic lesion: model B1 was assembled with a plate, model B2 with two TENs crossing the physis and model B3 with two TENs without crossing the physis. The Eccentric bearing load, torsional restraintal restraint of calcar femorale and composite load were analyzed for each models. RESULTS: When the yield strain of each model is reached, the stress concentration points are located in the proximal and distal femoral calcar. In the model of femoral neck lesions, the failure load of model A1 and model A2 are the same (1250 N), and the failure load of model A3 (980 N) is significantly lower than that of the former two; in the model of intertrochanteric lesions, the failure load of model B2 is the largest (1350 N), and the failure load of model B1 (1220 N) is lower than that of model B3 (1260 N), but both are smaller than that of model B2. CONCLUSION: Through finite element analysis, TENs through the epiphyseal plate, is found to be the better internal fixation method for femoral neck lesions and intertrochanteric lesions under two different working conditions. The results of clinical correlation study provide new biomechanical information for orthopedic doctors to consider different treatment options for osteolytic lesions of proximal femur.

Diagnostic Performance of MRI Versus CT in the Evaluation of Intra-articular Osteochondral Fracture in Pediatric Patients With Acute Traumatic Lateral Patellar Dislocation.

Background: Evaluation of intra-articular osteochondral fractures in children with acute traumatic lateral patellar dislocation (LPD) is important for determining treatment options. Purpose: To (1) compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) for evaluating intra-articular osteochondral fractures; (2) compare the interpretation of CT and MRI images between radiologists and pediatric orthopaedic surgeons (POS); and (3) investigate any clinical factors influencing the accuracy of CT and MRI evaluations. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We reviewed 35 knees in 35 patients (mean age, 12.2 ± 1.2 years; 12 boys and 23 girls) who were treated arthroscopically for acute traumatic LPD; 71% of the patients had patellar fractures, 54% had femoral fractures, and 60% had free osteochondral fracture fragments. All presurgical MRI and CT images were reviewed by POS who were blinded to both the reports of the radiologists and surgical records. We compared the accuracy of CT and MRI in diagnosing intra-articular osteochondral fractures against the arthroscopic findings and compared the interpretation of the images by the POS (MRI-O, CT-O) with those of the radiologists (MRI-R, CT-R). Results: There was no significant difference in diagnostic accuracy between CT and MRI for overall intra-articular osteochondral fractures by the POS or the radiologists; however, the CT-O images had a higher diagnostic specificity (84.2% vs 69.6%; P < .001) and sensitivity (88.1% vs 70.1%; P < .001) versus the MRI-R images. Regarding free fracture fragments, the CT-R images had a higher diagnostic accuracy than the MRI-R images (73.5% vs 47.1%; P = .026). When backed by clinical data, the MRI-O images had greater diagnostic accuracy (78.7% vs 60.3%; P = .001) and sensitivity (88.1% vs 30.7%; P = .021) but lower specificity compared with the MRI-R images, and the CT-O images had similar diagnostic accuracy but greater sensitivity than the CT-R images (70.1% vs 52.2%; P < .001). The diagnostic accuracy of MRI-O images was lower for children under 12 years versus children 12 years and over (67.5% vs 83.3%; P = .040). Conclusion: Compared with MRI, CT scans had better diagnostic performance in the evaluation of intra-articular osteochondral fractures in pediatric patients with acute traumatic LPD. Clinical data enhanced the diagnostic sensitivity of MRI and CT but decreased the specificity of MRI. MRI evaluations remain challenging for both POS and radiologists.

Comparing the Tibial Tuberosity-Trochlear Groove Distance Between CT and MRI in Skeletally Immature Patients With and Without Patellar Instability.

BACKGROUND: The tibial tubercle-trochlear groove (TT-TG) distance was originally described for computed tomography (CT), but it has been measured on magnetic resonance imaging (MRI) in patients with patellar instability (PI). Whether the TT-TG measured on CT versus MRI can be considered equivalent in skeletally immature children remains unclear. PURPOSE: To investigate in skeletally immature patients (1) the effects of CT versus MRI imaging modality and cartilage versus bony landmarks on consistency of TT-TG measurement, (2) the difference between CT and MRI measurements of the TT-TG, and (3) the difference in TT-TG between patients with and without PI. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We retrospectively identified 24 skeletally immature patients with PI and 24 patients with other knee disorders or injury but without PI. The bony and cartilaginous TT-TG distances on CT and MRI were measured by 2 researchers, and related clinical data were collected. The interrater, interperiod (bony vs cartilaginous), and intermethod (CT vs MRI) reliabilities of TT-TG measurement were assessed with intraclass correlation coefficients. RESULTS: The 48 study patients (19 boys, 29 girls) had a mean age of 11.3 years (range, 7-14 years). TT-TG measurements had excellent interrater reliability and good or excellent interperiod reliability but fair or poor intermethod reliability. TT-TG distance was greater on CT versus MRI (mean difference, 4.07 mm; 95% CI, 2.6-5.5 mm), and cartilaginous distance was greater than bony distance (mean difference, 2.3 mm; 95% CI, 0.79-3.8 mm). The TT-TG measured on CT was found to increase with the femoral width. Patients in the PI group had increased TT-TG distance compared with those in the control group, regardless of landmarks or modality used (P > .05 for all). CONCLUSION: For skeletally immature patients, the TT-TG distance could be evaluated on MRI, regardless of whether cartilage or bony landmarks were used. Its value could not be interchanged with CT according to our results; however, further research on this topic is needed.

[Investigation on anxiety state of NICU newborn babies' family members].

OBJECTIVE: To study the anxiety state of family members of newborns admitted to the neonatal intensive care unit (NICU) and investigate the influencing factors of their anxiety state. METHODS: The self-designed questionnaire was used to collect the associated family information of 200 newborns who were admitted to the NICU. A self-rating anxiety scale was applied to investigate the anxiety state of the newborns' family members. RESULTS: The anxiety score of the newborns' family members averaged 44.86+/-7.59, which was significantly higher than that of domestic norm of adult (37.23+/-0.58; P<0.05). The differences of the family members' anxiety score were related to the severity of baby's diseases, their educational level and family's economic condition as well as the locality of the family (countryside or city). The more severe the baby's illness, the higher anxiety score of the family members had. The family members with higher educational levels or poorer economic conditions had higher anxiety scores. The anxiety score of the family members from the countryside was higher than that of the family members from city. CONCLUSIONS: The family members of NICU newborns have obvious anxiety. The degree of anxiety is associated with the severity of baby's illness, educational level of the family member, family's economic condition and the family locality (countryside or city). These results remind the medical staff working in the NICU should pay more attention to communicating with the family members in a compassionate way and help them to cope with this stressful situation.

Analysis of risk factors for complications after femoral neck fracture in pediatric patients.

BACKGROUND: Pediatric femoral neck fracture is a rare injury but yields frequent complications. However, there is a paucity of data regarding the risk factors for these complications. PURPOSE: The present article reports the rate of complications after femoral neck fracture in pediatric patients and investigates the possible risk factors. METHODS: We retrospectively reviewed 44 children (mean age of 9.0 years, range from 2 to 14 years) who were surgically treated for femoral neck fracture in a single trauma center with a mean follow-up of 57.75 months (range from 11 to 224 months). Related clinical factors were recorded and analyzed by multivariable logistic regression. RESULTS: Fracture displacement or Delbet-type fracture had no relation to the injury mechanism. However, younger children experienced severe trauma, combined injury, and low fracture location more than older individuals did. Children with combined injuries were more likely to have a longer waiting time for surgical reduction. Common complications included avascular necrosis (AVN) in 14 cases, nonunion of fracture in 2 cases, coxa vara in 4 cases, and premature physeal closure (PPC) in 7 cases. Only the Delbet type was an independent predictor of AVN (OR = 0.14, p = 0.030). Inadequate reduction was associated with higher rates of coxa vara (OR = 33.19, p = 0.032). Epiphysis penetration in children younger than 10 years old increased the rate of PPC (p = 0.032). No significant risk factor was found for fracture nonunion. CONCLUSION: For femoral neck fracture in pediatric patients, both the injury mechanism and fracture characteristics have age-related distributions. Early reduction should be carried out as early as possible based on the safe condition of the child, but for younger children, transepiphyseal fixation should be avoided. AVN may be intrinsic to injury characteristics rather than resulting from the choice of treatment mode.

Postmenopausal women with osteoarthritis and osteoporosis show different ultrastructural characteristics of trabecular bone of the femoral head.

BACKGROUND: Osteoporosis (OP) and osteoarthritis (OA) are public health diseases affecting the quality of life of the elderly, and bring about a heavy burden to the society and family of patients. It has been debated whether or not there is an inverse relationship between these two disorders. METHODS: To compare the exact difference in bone tissue structure between osteoporosis and osteoarthritis, we observed the ultrastructure of trabecular bone from the femoral heads using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). A total of 15 femoral head specimens from postmenopausal women were collected during the procedures of total or hemi hip replacement (OP, n = 8; OA, n = 7). The morphologic structure of the trabecular bone, collagen fibers, resorption lacuna and osteoblasts were observed. RESULTS: Under SEM, osteoporotic trabeculae appeared to be thinning, tapering, breaking and perforating. A number of resorption lacunae of various shapes were seen on the surface of the trabeculum. The collagen fibers of lacuna were resorbed. On occasion, naked granular bone crystals could be found. In the OA group, the trabecular bone looked thick with integrated structure. Reticular and granular new bone could be found. The trabeculum was covered by well-arranged collagen fibers around the resorption lacuna. In the OP group, under TEM, marginal collagen fibers were observed to be aligned loosely with enlarged spaces. A few inactive osteoblasts and no inflammatory cells were seen. In the OA group, the collagen fibers inside the trabeculum were arranged in a dense manner with many active osteoblasts and inflammatory cells infiltrating the matrix. CONCLUSION: We found significant differences in the trabecular bone, collagen fibers, lacunae and osteoblasts between postmenopausal women with OP and OA. These findings support the hypothesis that there is an inverse relationship between OP and OA.

Leptin induces the apoptosis of chondrocytes in an in vitro model of osteoarthritis via the JAK2­STAT3 signaling pathway.

Emerging data has suggested a high prevalence of osteoarthritis (OA) among obese people. As an important adipokine secreted by white adipose tissue, leptin may be a key mediator in the progression of OA. Leptin exerts a catabolic effect on OA cartilage by increasing the production of metalloproteinase (MMP) enzymes, and contributes to apoptosis in chondrocytes. The current study aimed to explore the role of leptin on the apoptosis of chondrocytes in OA, and its underlying mechanisms. In the in vitro model of OA used in the present study, administration of exogenous leptin induced the generation of reactive oxygen species (ROS) and apoptosis in chondrocytes. It has been demonstrated that leptin is associated with the pathogenesis of OA via the Janus kinase 2 (JAK2)­signal transducer and activator of transcription 3 (STAT3) signaling pathway, and data gathered in the present study demonstrated that suppression of this signaling pathway using a JAK2 inhibitor, AG490, significantly ameliorated leptin­induced apoptosis in damaged chondrocytes in vitro, and reduced the generation of ROS. Furthermore, the protein expression levels of MMP­13 and B­cell lymphoma 2­associated X protein were downregulated in the AG490­treated group. The results of the present study may provide insight into the underlying molecular mechanism by which leptin induces apoptosis in chondrocytes. These findings indicated the importance of leptin as a therapeutic target for the treatment of OA in the overweight population.

Echocardiographic evaluation of cardiac dyssynchrony in patients with congestive heart failure.

The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure (CHF). A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization (CRT) and presented with low ejection fraction (EF) and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio (FT/RR), left ventricular pre-ejection delay (PED), interventricular mechanical delay (IVMD), longitudinal opposing wall delay (LOWD) and radial septal to posterior wall delay (RSPWD). Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group (P<0.01). In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter (LVESd), LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) (P<0.01), but positively with the LVEF (P<0.01). Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV (P<0.01), but negatively with the LVEF (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order (P<0.01). Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group (78% sensitivity, 83% specificity), those in QRS-2 group (83% sensitivity, 77% specificity) and in QRS-3 group (89% sensitivity, 79% specificity). In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.

Changes of substance P during fracture healing in ovariectomized mice.

Neuropeptides may play an important role in the healing process of osteoporotic fractures. The objective of this study was to determine the role of substance P during osteoporotic fracture healing. One hundred ninety-two mice were randomized into ovariectomy (OVX) and control (CON) group (n=96, respectively). Femoral shaft fracture was created 3 weeks after OVX. Bone mineral density (BMD), micro-CT (microCT) analysis of fracture callus formation and mineralization, microCT analysis of fracture site neovascularization and biomechanical property as well as substance P levels were evaluated 1, 2, 4, and 8 weeks after fracture and compared with CON group. Following OVX-induced bone loss, fracture healing in OVX mice was significantly poorer than that in CON mice, with a significant decrease of substance P at the fracture site at all time points and with the level at early stage (1 and 2 weeks) higher than later stage (4 and 8 weeks). Impaired angiogenesis was also noted in OVX mice. No significant change of substance P level in serum was found between different groups or time points. In conclusion, fracture healing is inferior in OVX-induced bone loss and associated with a significant decrease of substance P. Substance P may play an important role during osteoporotic fracture healing.

Osteogenic potential and responsiveness to leptin of mesenchymal stem cells between postmenopausal women with osteoarthritis and osteoporosis.

The aim of this study was to compare the osteogenic potential and responsiveness to leptin of mesenchymal stem cells (MSCs) from bone marrow between postmenopausal women with osteoarthritis (OA) and osteoporosis (OP). MSCs of the proximal femur from OA and OP donors were cultured under control and different experimental mediums. After verifying the availability of primary cells, their osteogenic potential and responsiveness to leptin were compared between two groups. Similar patterns of cell growth were shown in both OA and OP groups. However, after the sixth passage, the viability of undifferentiated cells decreased more in OP than in OA donors. Under the same osteogenic supplements condition, the mRNA expression of osteogenesis-specific genes, osteocalcin (OC) and alkaline phosphatase (ALP) were higher in OA group. Comparison of bone matrix mineralization was parallel to that of mRNA expression. The level of bone-specific ALP (BAP) was higher in cells from donors with OA, whereas osteoprotegerin (OPG) was higher in OP group. This difference in BAP expression proved to be insignificant after the administration of leptin. Although leptin upregulated the expression of OPG, a significant difference still existed between OA and OP. In conclusion, differential osteogenic potential and responsiveness to leptin of MSCs were noted between postmenopausal women with OA and OP. Differential biological behavior of MSCs seems to be partly related to the different distribution of bone mass between OA and OP populations.

Differential articular calcified cartilage and subchondral bone in postmenopausal women with osteoarthritis and osteoporosis: two-dimensional analysis.

OBJECTIVES: Osteoarthritis (OA) and osteoporosis (OP) are both common problems that affect life quality in aging society. It has been for decades of years to debate an inverse relationship between OA and OP. The objective of this paper was to compare structural properties of the articular calcified cartilage (ACC) and subchondral bone between postmenopausal women with OA and OP. METHODS: Eight femoral heads were taken from postmenopausal women during total hip replacement surgery due to primary OA. They were compared with nine femoral heads obtained from age-matched women with OP during hemi-hip arthroplasty surgery due to osteoporotic fracture of the proximal femur. Two-dimensional histomorphometric sections were prepared to measure the thickness of ACC and bone histomorphometric parameters. The ratio of ACC to the total articular cartilage (TAC) was also calculated in all bone specimens. RESULTS: Osteoarthritic donors had higher ACC and the ratio of ACC to TAC (ACC: 117.69+/-28.16 microm vs. 97.88+/-16.79 microm, P=0.041; the ratio of ACC to TAC: 15.74% vs. 10.51%, P=0.023). Lower bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N) and the ratio of nodes to termini (Nd/Tm) were demonstrated in donors with OP (BV/TV: 21.55+/-3.41% vs. 16.64+/-2.26%, P=0.003; Tb.Th: 121.33+/-16.11 microm vs. 98.59+/-18.56 microm, P=0.017; Tb.N: 2.41+/-0.73 mm(-1) vs. 1.37+/-0.31 mm(-1), P=0.001; Nd/Tm: 0.78+/-0.22 vs. 0.50+/-0.14, P=0.007). However, trabecular space (Tb.Sp) increased in these osteoporotic patients (Tb.Sp: 345.49+/-106.18 microm vs. 652.09+/-159.71 microm, P=0.0004). CONCLUSIONS: The pathogenesis of OA and OP were influenced by differential properties of ACC and subchondral bone microstructure. Structural properties of the subchondral mineralized tissue supported that an inverse relationship existed between postmenopausal women with OA and OP.

Differential bone metabolism between postmenopausal women with osteoarthritis and osteoporosis.

UNLABELLED: A comparative study of bone metabolism between postmenopausal women with osteoarthritis and osteoporosis showed that differential levels of bone remodeling markers, leptin, free leptin index, and osteoprotegerin might partly contribute to the proposed inverse relationship in bone mass between postmenopausal women with osteoarthritis and osteoporosis. INTRODUCTION: Osteoarthritis (OA) and osteoporosis (OP) are two common disorders affecting the quality of life in the elderly. The association between OA and OP has always been debated. The objective of this study was to compare bone metabolism between postmenopausal women with OA and OP. MATERIALS AND METHODS: A total of 120 postmenopausal women with OA and OP (n = 60, respectively) were included in this comparative study. Anthropometric parameters and BMD at the spine and the proximal femur were measured. Serum leptin, soluble leptin receptor (sLR), osteoprotegerin (OPG), and bone remodeling markers, including bone-specific alkaline phosphatase (BALP), osteocalcin (OC), deoxypyridinoline cross-links (DPD), and cross-linked N-telopeptides of type I collagen (NTX), were quantified with commercial ELISA or EIA kits. Free leptin index (FLI) was also calculated by the ratio between serum leptin and sLR levels. RESULTS: Postmenopausal women with OA had higher body weight, body mass index, fat mass, and percentage of fat than those suffered from OP. Compared with the patients in OP group, the patients in OA group had significantly higher BMD values at all sites measured. Higher serum leptin and FLI and lower OPG levels were shown in the OA group (leptin: 31.22 +/- 6.4 versus 26.50 +/- 9.27 ng/ml, p < 0.001; FLI: 3.20 +/- 1.02 versus 2.50 +/- 0.95, p < 0.05; OPG: 4.75 +/- 1.97 versus 6.96 +/- 2.75 pM, p < 0.001), whereas lower serum OC and higher urine DPD were noted in the OP group (OC: 16.45 +/- 8.45 versus 13.06 +/- 6.25 ng/ml, p < 0.05; DPD: 10.83 +/- 7.12 versus 15.29 +/- 6.65 nM BCE/mM Cr, p < 0.001). Serum OPG levels negatively correlated with BMD at all sites assessed. However, no correlation was found between leptin and BMD. Only in the OA group di positive correlations exist between FLI and Z-score at the femoral neck and Ward's triangle region. After stepwise regression analysis, it was found that differential factors were able to predict the variance of BMD at different sites to a certain extent. CONCLUSIONS: Our study suggests that there are significant differences in bone metabolism between postmenopausal women with OA and OP and provides evidence for the inverse relationship between OA and OP. Differential levels of bone remodeling markers, leptin, FLI, and OPG may partly contribute to the proposed inverse relationship. Roles of leptin and its soluble receptor in bone metabolism regulation should be explored further.

Partial scapulectomy for congenital elevation of the scapula.

We treated 26 patients with congenital elevation of the scapula by excising the superomedial part of the scapula. We also simultaneously resected the omovertebral bone when present. A modified inverted L-shape incision was used to release the contracted tissue around the medial edge of the scapula. We evaluated 28 shoulders (26 patients) at a minimum of 10 months followup (mean, 3.9 years; range, 10 months-7 years). The improvement rate for range of shoulder abduction was 59.11%. Eighteen shoulders with preoperative abduction less than 120 degrees achieved an average improvement of 52 degrees, whereas 10 shoulders with a preoperative abduction range greater than 120 degrees achieved an average improvement of 19 degrees. However, there was no difference in the improvement rate of the range of shoulder abduction between the two groups (60.94% versus 56%). Twenty-three shoulders (82.24%) attained various degrees of cosmetic improvement after the operation. There were no neurologic complications during or after surgery. No patients complained of scar problems. Excising the superomedial part of the scapula is a safe, simple operation for treating congenital elevation of the scapula.