Common types and treatment of elbow injuries in skiing or snowboarding / 中华创伤骨科杂志

Objective:To investigate the common types of elbow joint injuries in skiing or snowboarding and their treatment.Methods:A retrospective study was conducted to analyze the data of 90 patients with elbow injury caused by skiing or snowboarding who had been admitted to Department of Upper Limbs, Sichuan Orthopaedic Hospital from February, 2015 to February, 2022. There were 53 males and 37 females with an age of (31.8±8.4) years. The types of elbow injury, visual analogue scale (VAS), range of motion (ROM) of the elbow and Mayo elbow performance score (MEPS) of the patients were recorded before treatment and at the last follow-up.Results:Of the patients, 18 were treated conservatively (3 simple Mason type I radial head fractures and 15 O'Driscoll type I coronal process fractures) and 72 surgically. Their follow-up time was (31.3±18.7) months. The fractures all healed by the time of the last follow-up. Simple elbow fracture was observed in 63 patients, simple elbow dislocation in 2 patients, fracture plus dislocation in 25 patients. The posterior dislocation was the most common (22 cases). Among the elbow fractures, radial head fracture occurred in 27 patients, ulnar coronoid process fracture in 41 patients, proximal ulnar fracture in 13 patients, and distal humeral fracture in 28 patients. Collateral ligament injuries were complicated in 65 cases. In the patients undergoing conservative treatment, their VAS, elbow ROM, and MEPS were all improved significantly from 4.7±1.4, 92.2°±14.4° and 63.9±6.5 before treatment to 0.4 (0,1.0), 110.6°±0.6°, and 92.2±3.9 at the last follow-up ( P<0.05); in the patients undergoing surgical treatment, their VAS, elbow ROM, and MEPS were also all improved significantly from 5.6±1.7, 24.3°±18.4°, and 26.9±12.2 before surgery to 0.6 (0,1.0), 97.4°±14.0° and 86.6±7.1 at the last follow-up ( P<0.05). After surgery, 8 patients presented with neurological symptoms and 7 patients developed heterotopic ossification. Conclusions:In skiing or snowboarding, the coronoid process of the ulna is the most vulnerable to fracture. In the elbow injuries due to skiing or snowboarding, posterior dislocation is the most common type which is often accompanied by injuries to the medial and lateral collateral ligaments. For simple Mason type Ⅰ radial head fractures and O'-Driscoll type Ⅰ coronoid process fractures in which the elbow is stable, conservative treatment can be adopted; surgical treatment is indicated for the other injuries.

The effect of medial calcar screws on the treatment of Neer type Ⅲ proximal humeral fracture with Multiloc intramedullary nailing / 中华创伤骨科杂志

Objective:To investigate the effect of the use of medial calcar screws on the treatment of Neer type Ⅲ proximal humeral fracture with Multiloc intramedullary nailing.Methods:A retrospective study was conducted to analyze the data of 36 patients with Near type Ⅲ fracture of the proximal humerus who had received Multiloc intramedullary nailing at Department of Upper Limbs, Sichuan Orthopedic Hospital from January 2016 to December 2021. There were 6 males and 30 females with an age of (63.9±5.3) years. They were divided into 2 groups according to whether medial calcar screws had been used or not. There were 17 cases in the group without medial calcar screws and 19 cases in the group with medial calcar screws. The 2 groups were compared in terms of flexion and lifting, external rotation, internal rotation and back touch, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score for shoulder function (Constant score), neck shaft angle, and incidence of complications at the last follow-up.Results:There were no statistically significant significances in the preoperative general data between the 2 groups, indicating comparability between the groups ( P>0.05). The 36 patients were followed up for 13.5(12.0,19.8) months after surgery. The flexion and lifting, external rotation, internal rotation and back touch, VAS, ASES score, Constant score, neck shaft angle at the last follow-up in the group without medial calcar screws were, respectively, 134.1°±8.4°, 32.1°±5.3°, 14.0 (13.0, 15.5) , 0.0 (0.0, 1.0), 78.2±5.2, 78.0±5.8, and 137.6°±8.1°, insignificantly different from those in the group with medial calcar screws [134.7°±6.1°, 35.0(30.0, 35.0)°, 14.0(13.0, 15.0), 1.0 (0.0, 1.0), 78.2±5.4, 76.7±4.5, and 136.9°±6.4°] ( P>0.05). Postoperative complications occurred in 6 patients in each group, showing no statistically significant difference between the 2 groups ( P=1.000). Conclusion:The use of medial calcar screws has no significant impact on the postoperative shoulder function and incidence of complications in the treatment of Neer type Ⅲ fractures of the proximal humerus with Multiloc intramedullary nailing.

Clinical effect of arthroscopic combined with open release in the treatment of severe and extremely severe post-traumatic elbow stiffness / 中华骨科杂志

Objective:To investigate the therapeutic effect of arthroscopic combined with open release in the treatment of severe post-traumatic elbow stiffness.Methods:Data of 32 patients with severe post-traumatic elbow stiffness treated by arthroscopy combined with open release from January 2016 to September 2019 were retrospectively analyzed, including 13 males and 19 females. Age: 38.5±15.6 years (range, 17-66 years). For the original trauma, there were 12 cases of distal humeral fractures, 8 cases of radial head fractures, 8 cases of horrible triad of elbow, 2 cases of anterior dislocation of elbow through olecranon fracture, 1 case of Monteggia fracture, and 1 case of olecranon fracture. The range of motion (ROM), Mayo elbow performance score (MEPS) and visual analogue scale (VAS) of elbow joint at pre-operation, 6 months post-operation and the last follow-up were recorded and compared to evaluate the clinical effect of this operation on severe post-traumatic elbow stiffness.Results:The average operation time was 114.1±27.5 min (range, 70-170 min). Two patients developed mild ulnar nerve symptoms after operation, which were relieved after oral mecobalamin. The follow-up time was 38.5±14.4 months (range, 25-69 months). For elbow extension to flexion ROM, it was 47.66°±12.05° at pre-operation, 93.75°±12.89° at 6 months post-operation, and 106.88°±17.68° at the last follow-up, the differences were statistically significant ( F=148.87, P<0.001). For elbow rotation ROM, it was 132.19°±22.68° at pre-operation, 141.88°±21.91° at 6 months post-operation and 149.38°±23.27° at the last follow-up, and the differences were statistically significant ( F=4.64, P=0.012). At 6 months post-operative, the extension to flexion ROM of the elbow was significantly higher than that of pre-operation ( P<0.05); The rotation ROM was higher than that of pre-operation, but the difference was not statistically significant. At the last follow-up, the extentsion to flexion ROM and the rotation ROM were both significantly higher than those of pre-operation ( P<0.05). At the last follow-up, the VAS and MEPS were 1.38±0.94 and 93.44±5.15 respectively, which were significantly improved compared with those of pre-operation 3.91±1.09 and 37.97±7.71 ( P <0.001). Conclusion:Arthroscopic combined with open release in the treatment of severe post-traumatic elbow stiffness can significantly increase the elbow ROM and functional score as well as significantly relieve the pain of the elbow. It can effectively release the elbow while keeping it minimal invasive, and maintain the stability of the elbow to the maximum, with reliable efficacy.

Comparison of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of three- or four-part fractures of proximal humeral in the elderly / 中华骨科杂志

Objective:To compare the clinical effects of reverse shoulder arthroplasty and hemiarthroplasty in the treatment of three- or four-part proximal humeral fractures in the elderly.Methods:The clinical data of 58 elderly patients with three- or four-part proximal humeral fractures treated with hemiarthroplasty or reverse shoulder arthroplasty from June 2014 to June 2020 were retrospectively analyzed. Among them, 46 cases were from Sichuan Provincial Orthopaedic Hospital (22 cases of hemiarthroplasty and 24 cases of reverse shoulder arthroplasty), and 12 cases were from Tianjin Hospital (5 cases of hemiarthroplasty and 7 cases of reverse shoulder arthroplasty). In the hemiarthroplasty group, there were 27 patients, including 7 males and 20 females, with an average age of 70.29±6.81 years (range, 61-87 years), and there were 10 cases of 3-part fractures and 17 cases of 4-part fractures. In the reverse shoulder arthroplasty group, including 9 males and 22 females, with an average age of 75.06 ±4.25 years (range, 67-86 years), and there were 9 cases of 3-part fractures and 22 cases of 4-part fractures. The postoperative efficacy evaluation indexes included visual analogue scale (VAS), range of motion (ROM), prosthesis upward displacement, healing of greater tuberosity, scapular glenoid notch, American Shoulder and Elbow Surgeons (ASES) and Constant-Murley score.Results:The average follow-up was 50.63±16.02 months (range, 24-75 months) in the hemiarthroplasty group and 28.32±11.93 months (range, 14-56 months) in the reverse shoulder arthroplasty group. The anterior elevation in the reverse shoulder arthroplasty group was 118.22°±27.22°, and those in the hemiarthroplasty group was 102.77°±25.88°, which was significant difference ( t=2.21, P=0.032); the results of external rotation (ER) and internal rotation (IR) in two groups were similar, and no significant difference (ER: t=0.57, P=0.616; IR: χ 2=2.61, P=0.273); the average Constant-Murley and ASES in the reverse shoulder arthroplasty group were significantly better than those in the hemiarthroplasty group ( P=0.019 and 0.018); the complication rates of hemiarthroplasty group and reverse shoulder arthroplasty group were 37% (10/27) and 13% (4/31), respectively (χ 2=4.59, P=0.032). In the hemiarthroplasty group, 6 patients had upward movements of the prosthesis and 2 patients had wear of the glenoid side; notching (sirveaux grade 1) was noted in 1 patient in the reverse shoulder arthroplasty group. Conclusion:In the treatment of three- or four-part proximal humeral fractures in the elderly, reverse shoulder arthroplasty achieves significantly better functional results compared to hemiarthroplasty.

Clinical and radiological effects of arthroscopic biceps reroutingin treating large to massive rotator cuff tears / 中华骨科杂志

Objective:To evaluate the short-term effects of arthroscopic biceps rerouting along with rotator cuff repair in treating large to massive rotator cuff tears.Methods:Retrospective evaluation of patients with large to massive rotator cuff tears who were treated with arthroscopic biceps rerouting along with rotator cuff repair was conducted from May 2017 to September 2020. There were 48 patients with average age 58.7±18.4 years (range from 45-72 years), of which 19 cases were males and 29 cases were females. The following outcomes, range of motion, functional outcomes, pain and radiological outcomes, were assessed perioperatively. Pain symptom was assessed according to visual analogue scale (VAS). The functional outcomes were assessed according to American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score. MRI was used to evaluate radiological outcomes preoperatively and at 3, 6, 12 months postoperatively.Results:All forty-eight patients were followed-up. The mean duration of follow-up was 24.2±33.5 months (range from 13-53 months) after surgery. The average VAS of the patients decreased from 6.4±1.8 before surgery to 4.6±2.2 at 6 months after surgery, to 1.9±2.1 at 12 month after surgery, and to 1.7±2.0 at the last follow-up with significant difference ( F=4.47, P<0.001) . ASES score decreased from 56.4±20.9 before surgery to 48.3±29.1 at 6 months after surgery, and increased to 77.2±18.2 at one year after surgery, and to 82.3±13.8 at the last follow-up with statistically significant difference ( F=36.34, P<0.001). The Constant-Murley decreased from 52.7±17.5 before surgery to 49.4±27.5 at 6 months after surgery, and increased to 80.1±20.1 at one year after surgery and to 87.4±11.9 at the last follow-up, respectively. The difference between the preoperative and the last follow-up was statistically significant ( F=52.68, P<0.001). The forward flexion increased from 102°±24° preoperatively to 121°±33° at 6 months, to 140°±17° at 12 months, and to 148°±15° at the last follow-up ( F=34.24, P<0.001). External rotation decreased from 57°±32° before surgery to 45°±37° at 6 months, and increased to 70°±31° at 12 months after surgery and to 75°±30° at the last follow-up with significant difference ( F=19.68, P=0.042). Internal rotation decreased from 8±3 before surgery to 7±4 at 6 months, and increased to 9±3 at 12 months after surgery and to 10±2 at the last follow-up with significant difference ( F=11.86, P=0.015). Six patients (12.5%) underwent retear of the repaired rotator cuff on the postoperative MRI, of which 4 cases were confirmed at 3 months after surgery and 2 cases at 6 months after surgery. Conclusion:Arthroscopic biceps rerouting along with rotator cuff repair for the treatment of large to massive rotator cuff injuries could significantly relieve pain symptoms and improve shoulder joint function without the help of scaffold. The present technique has lower retear rate.

Expression and clinical significance of interleukin-2/Janus kinase 3/signal transduction and transcriptional activator 5 in peripheral blood of patients with ankylosing spondylitis / 中华风湿病学杂志

Objective:To detect the expression of interleukin 2 (IL-2)/Janus kinase 3/signal transduction and transcriptional activator 5 (JAK3/STAT5) signaling pathway in peripheral blood of patients with ankylosing spondylitis (AS) and explore its mechanism in the development and progression of AS.Methods:Clinical data, peripheral blood and laboratory tests of 30 patients with active AS (ASA), 30 patients with stable AS (ASS) and 50 healthy subjects (HC) were collected. The mRNA expression levels of JAK3, signal transduction and transcription activator 5a (STAT5a) and signal transduction and transcription activator 5b (STAT5b) were detected by quantitative real-time-polymerase chain reaction (RT-qPCR). The expression levels of JAK3, STAT5a and STAT5b proteins and phosphorylated proteins were detected by Western-blot. Plasma IL-2 concentration was determined by enzyme-linked immunosorbent assay (ELISA). Two independent samples t-test or one-way analysis of variance were used for measurement data consistent with normal distribution, LSD- t test was used for pairwise comparison between the three groups, Mann-Whitney U test or Kruskal-Wallis H test was used for non-normal distribution, χ2 test was used for correlation analysis of categorical variables. Spearman correlation analysis was used for correlation analysis between variables, and receiver operating characteristic (ROC) curve was used to evaluate the value of JAK3, STAT5a and STAT5b mRNA expression levels in monitoring AS activity. Results:① The mRNA expression levels of JAK3, STAT5a and STAT5b were significantly different among the three groups ( F=65.98, P<0.001; F=21.15, P<0.001; F=13.67, P<0.001). JAK3 mRNA expression in ASA group (2.5±0.9) was significantly higher than that in ASS group (1.1±0.4) and healthy subjects (1.0±0.5), the difference was statistically significant (both P<0.001). The mRNA expression level of STAT5a in ASA group (1.4±0.3) was significantly higher than that in ASS group (0.9±0.3) and healthy subjects group (1.0±0.3), the difference was statistically significant (both P<0.001). STAT5b mRNA expression level in ASA group (1.5±0.6) was significantly higher than that in ASS group (1.0±0.4) and healthy subjects (1.0±0.4), the difference was statistically significant (both P<0.001). The expression level of JAK3 mRNA in HLA-B27 positive group (1.9±1.0) was higher than that in HLA-B27 negative group (1.4±0.6), and the difference was statistically significant ( t=-2.22, P=0.032). The phosphorylation levels of JAK3, STAT5a and STAT5b showed statistically significant differences among the three groups ( F=91.56, P<0.001; F=25.15, P< 0.001; F=178.59, P<0.001). The phosphorylation level of JAK3 protein in ASA group (1.04±0.08) was significantly higher than that in ASS group (0.568±0.019) and healthy subjects (0.536±0.064), the difference was statistically significant (both P<0.001). The phosphorylation level of STAT5a protein in ASA group (1.166±0.096) was significantly higher than that in ASS group (0.923±0.018) and healthy subjects (0.911±0.017), the difference was statistically significant (both P<0.001). The phosphorylation level of STAT5b protein in ASA group (0.81±0.05) was significantly higher than that in ASS group (0.21±0.03) and healthy subjects (0.24± 0.07), the difference was statistically significant (both P<0.001). The difference of plasma IL-2 concentration among the three groups was statistically significant ( F=3.32, P=0.040). The IL-2 concentration in the ASA group [(110±40) pg/ml] was significantly higher than that in the ASS group [(89±40) pg/ml] and the healthy group [(88±39) pg/ml], the difference was statistically significant ( P=0.044, P=0.016). ② Spearman correlation analysis showed that STAT5a mRNA expression level was positively correlated with platelets in AS patients ( r=0.353, P=0.006). JAK3 mRNA expression level in ASA group was positively correlated with IL-2 concentration ( r=0.766, P<0.001), and negatively correlated with estimated glomerular filtration rate ( r=-0.485, P=0.007). STAT5a mRNA expression level was positively correlated with erythrocyte sedimentation rate ( r= 0.680, P<0.001), and STAT5b mRNA expression level was positively correlated with hypersensitive C-reactive protein (CRP) ( r=0.823, P<0.001). ③ The ROC curve showed that JAK3 mRNA expression level predicted the area under ROC curve (AUC) of ASA with a 95% CI of 0.920 (0.853, 0.987), sensitivity and specificity of 86.7% and 90.0%, respectively. STAT5a mRNA expression level predicted the AUC 95% CI of ASA was 0.874 (0.787, 0.961), and the sensitivity and specificity were 96.7% and 66.7%, respectively. STAT5b mRNA expression level predicted the AUC 95% CI of ASA was 0.749 (0.617, 0.881), and the sensitivity and specificity were 73.3% and 80.0%, respectively. Conclusion:This study suggests that IL-2/JAK3/STAT5 may be involved in the pathogenesis of AS, and JAK3 mRNA can be used as a biological indicator to monitor the activity of AS disease.

Effect of rhTPO and rhIL-11 on Thrombocytopenia after Chemotherapy in Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze and compare the efficacy of recombinant human thrombopoietin (rhTPO) and recombinant human interleukin-11 (rhIL-11) in the treatment of thrombocytopenia after chemotherapy in acute leukemia patients.@*METHODS@#180 patients with acute leukemia complicated with thrombocytopenia after chemotherapy in the First Affiliated Hospital of Anhui Medical University were analyzed retrospectively. Among them, 50 patients who treated with rhTPO and did not receive platelet transfusion were set as group A, 50 patients treated with rhTPO and receive platelet transfusion were set as group B, Forty patients treated with rhIL-11 without platelet transfusion were set as group C, Forty patients who treated with rhIL-11 and received platelet transfusion were set as group D. The duration of PLT below 20×109/L, the days it takes for PLT to recover to more than 100×109/L, and the incidence of different bleeding degrees were compared among several groups.@*RESULTS@#The duration of PLT<20×109/L in group A(3.72±1.14 d) was significantly shorter than that in group C(4.93±1.33 d) (P<0.001), and there was no significant difference from group B (P>0.05). The duration of PLT<20×109/L in group B(3.06±0.91 d) was significantly shorter than that in group D(4.65±0.98 d) (P<0.001), while the difference in duration of days between group C and D was not statistically significant (P>0.05). The times for PLT to recover to 100×109/L in group A(13.46±1.67 d) were significantly shorter than that in group C(16.85±2.13 d) (P<0.05), but there was no significant difference from group B (P>0.05). The time required for PLT to recover to 100×109/L in group B(13.36±1.49 d) were significantly shorter than that in group D(16.18±1.78 d) (P<0.05), while the difference in the days required for group C and group D was not statistically significant (P>0.05). The incidence of high bleeding risk in group B was significantly lower than that in group A (22% vs 44%, P<0.05), the incidence of high bleeding risk in group D was significantly lower than that in group C (32% vs 65%, P<0.05), and the incidence of high bleeding risk in group A was significantly lower than that in group C (44% vs 65%, P<0.05). The incidence of high bleeding risk in group B(22%) was lower than that in group D(32.5%), and the difference was not statistically significant (P>0.05).@*CONCLUSION@#In the treatment of acute leukemia patients with thrombocytopenia after chemotherapy, compared with rhIL-11, rhTPO can significantly shorten the duration for patients in a status with extremely low levels of PLT and the recovery time of PLT to normal range. In addition, PLT transfusion cannot speed up the time for patients to raise platelets to a safe range, nor can it shorten the duration of low PLT levels, but it can reduce the incidence of high bleeding risk events.

Study on the expression profile of circular RNA in patients with ankylosing spondylitis / 中华风湿病学杂志

Objective:To screen for circle RNA (circRNA) differentially expressed in peripheral blood mononuclear cells (PBMCs) of patients with ankylosing spondylitis (AS), and to analyze its expression profile to explore the role of circRNAs in the pathogenesis of AS.Methods:CircRNA microarray chip technology was used to detect the expression of circRNAs in PBMCs of 3 patients with active AS, 3 patients with stable AS and 3 healthy controls (HC), and then screening for differentially expressed circRNAs by fold change (FC) and P value. Then differentially expressed circRNAs among the circRNAs with the highest differential expression were selected randomly to verify the chip results by real-time fluorescence quantitative polymerase chain reaction (qPCR); Differentially expressed circRNAs were subjected to Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and microRNA (miRNA) target prediction software was used to predict the circRNA/miRNA interaction relationship. Finally, the data were statistically analyzed by t test and Mann-Whitney U test. Results:① Chip text results showed that there were 800 circRNAs with significantly different expression (FC>1.5, P<0.05) in active AS than HC, of which 466 were up-regulated and 334 were down-regulated; the stable AS had a total of 1 149 significantly differentially expressed when compared with the HC (FC>1.5, P<0.05) circRNAs, of which 589 were up-regulated and 560 were down-regulated. 233 circRNAs were significantly differentially expressed (FC>1.5, P<0.05) between active AS and stable AS, of which 145 were up-regulated and 88 were down-regulated. ②The RT-qPCR verification results suggested that the expression trends of the four differentially expressed circRNAs were consistent with the results of the chip. ③ GO analysis results suggested that these differentially expressed circRNAs were mainly involved in nonsense-mediated mRNA decay, Rho GTPase binding and other processes. The analysis showed that the KEGG pathway were enriched in Th17 cell differentiation and chemokine signaling pathways. The results of miRNA target prediction software analysis suggested that differentially expressed circRNAs might play a role by targeting miR-650, let-7b-5p and other miRNAs. Conclusion:Compared with HC group, there were differentially expressed circRNAs in Peripheral Blood Mononuclear Cells (PBMCs) of AS patients, The results of this study suggest that these circRNAs may be involved in the pathogenesis of AS.

Circular RNA expression profiles of peripheral blood mononuclear cells by microarray analysis in gout patients / 中华风湿病学杂志

Objective:To analyze the expression of circular RNA (circRNA) in peripheral blood mononuclear cells (PBMCs) of patients with gout and to explore the possible mechanism of circRNA in the pathogenesis of gout.Methods:Peripheral blood samples of 24 patients with acute gout (AG), 24 patients with intermittent gout (IG) and 24 healthy control subjects (HC) were collected. Three cases of AG, IG, and HC were randomly selected, and the differentially expressed circRNA in PBMCs was screened by human circNA microarrays. The 6 circRNAs with large differences between the two comparison groups were selected, and the relative expression levels of 6 circRNAs in all the collected 72 PBMCs of the study subjects were detected by real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). The significantly differentially ex-pressed circRNA (fold change>1.5, P<0.05) was analyzed by GO analysis, Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis, and its interaction with microRNA (miRNA) was predicted. The median (interquartile range) was used to describe the data, and the Mann-Whitney U test was used for comparison between groups. Results:(1) The microarray analysis results showed that compared with the HC group, the AG group and the IG group had 116 and 41 significantly differently expressed circRNAs, respectively; com-pared with the IG group, the AG group had 105 significantly differently expressed circRNAs. (2) Among the 6 circRNAs verified by PT-qPCR, the expression trends of 5 were consistent with the microarray results. The expression of hsa_circRNA_105034 in the AG group [5.17(4.60)] was statistically significantly different com-pared to the IG [1.68(2.39)] and HC [0.90(0.73)] groups (AG vs IG: Z=-4.413, P<0.01; AG vs HC Z=-5.052, P<0.01). (3) Bioinformatics analysis: ① GO analysis found that differential circRNA swere mainly involved in DNA transcriptional regulation, positive cell regulation and protein modification, etc. ② KEGG pathway analysis revealed that differential circRNA might be involved in the immune response mediated by the mitogen-activated protein kinase signaling pathway. ③ CircRNA might affect its inflammatory response by targeting molecules such as miRNA-146a, miRNA-302b and miRNA-23a. Conclusion:There are differentially expressed circRNAs in PBMCs of patients with gout, which may be closely related to the occurrence and development of gout.

Circular RNAs in peripheral blood mononuclear cells from ankylosing spondylitis / 中华医学杂志(英文版)

BACKGROUND@#Circular RNA (circRNA) is a type of closed circular noncoding RNA (ncRNA), mostly formed by back-splicing or alternative splicing of pre-messenger RNA (mRNA). The aim of this study was to explore the expression profile of circRNA in peripheral blood mononuclear cells (PBMCs) of patients with ankylosing spondylitis (AS) and discover potential molecular markers of AS.@*METHODS@#The circRNA microarray technology was used to detect the expression of circRNAs in the peripheral blood of 6 patients with AS and 6 healthy controls (HC). To screen the differentially expressed circRNAs by fold change (FC) and P value, these differentially expressed circRNAs were analyzed by bioinformatics. In 60 cases of AS and 30 cases of HC, 4 circRNAs were subjected to real-time fluorescence quantitative polymerase chain reaction (RT-qPCR), and their correlation with various clinical indicators was analyzed. Finally, the receiver operating characteristic (ROC) curve was used to analyze their potential as AS diagnostic markers.@*RESULTS@#The microarray results showed that there were 1369 significantly differently expressed (P  1.5) circRNAs between the AS and HC groups (675 upregulated and 694 downregulated). The results of bioinformatics analysis suggested that they were mainly involved in "enzyme binding," "adenosine ribonucleotide binding," "MAPK signaling pathway", etc. The RT-qPCR results showed that the expressions of hsa_circRNA_001544 (U = 486.5, P < 0.05) and hsa_circRNA_102532 (U = 645, P < 0.05) were significantly different between the AS group and the HC group. The AS group was further divided into two subgroups: active AS (ASA) and stable AS (ASS). After analysis, it was found that compared with the HC group, hsa_circRNA_001544 was significantly increased in both ASA (U = 214, P < 0.05) and ASS groups (U = 273, P < 0.05), while hsa_circRNA_008961 (U = 250, P < 0.05) and hsa_circRNA_102532 (U = 295, P < 0.05) were only significantly increased in the ASA group. Furthermore, hsa_circRNA_012732 was significantly different between the ASA and ASS groups (U = 194, P < 0.05), and there was no statistical significance among the remaining groups. Correlation analysis results showed that hsa_circRNA_012732 was negatively correlated with Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), high-sensitivity C-reactive protein (hsCRP), and globulin (GLOB) and positively correlated with lymphocyte count (LY), mean corpusular volume, and albumin (ALB), and hsa_circRNA_008961 was negatively correlated with platelet (PLT) count. ROC curve analysis showed that hsa_circRNA_001544 (95% CI = 0.610-0.831, P < 0.05) and hsa_circRNA_102532 (95% CI = 0.521-0.762, P < 0.05) were statistically significant, and their area under curve (AUC) values were 0.720 and 0.642, respectively.@*CONCLUSIONS@#There are differentially expressed circRNAs in PBMCs of AS patients, and they may be involved in the occurrence and development of AS. Among these differentially expressed circRNAs, hsa_circRNA_012732 has the potential to become an indicator of disease activity, and hsa_circRNA_001544 has the potential to become a molecular marker for AS diagnosis.

Reliability of three dimensional CT measurement of glenoid track in patients with recurrent anterior dislocation of shoulder / 中国骨伤

OBJECTIVE@#To evaluate the reliability and repeatability of three-dimensional (3D)-CT measurement of glenoid track.@*METHODS@#Glenoid and Hill-Sachs bone defects in 60 patients with recurrent anterior dislocation of the unilateral shoulder were evaluated by 3D-CT and analyzed by three independent observers(shoulder orthopedists) according to the Di Giacomo method. These injuries were classified to formulate a surgical protocol. All the patients were repeatedly measured 1 week later. Intraclass correlation coefficient (ICC) and coefficient of variation (COV) were used for reliability analysis.@*RESULTS@#Interobserver reliability was "very good" for both measurements of glenoid diameter and glenoid bone defects, and "good" for measurements of Hill-Sachs interval. Interobserver agreement was high on the assessment of the extent of the glenoid defect, and poor on track/off track assessment of the Hill-Sachs lesion. Intraobserver reliability for measurements of glenoid diameter, glenoid defect, and Hill-Sachs interval was "very good". The COV was 4.1% for glenoid diameter, 4.4% for glenoid defect, and 21.1% for Hill-Sachs interval.@*CONCLUSION@#The reliability and reproducibility of 3D-CT measurements of glenoid bone defects are good, but the assessment of humeral head bone defects shows large variability with poor reliability.

Assessment of Benchmark Dose in BEAS-2B Cells by Evaluating the Cell Relative Viability with Particulates in Motorcycle Exhaust / 生物医学与环境科学（英文）

Objective@#This study aimed to use an air-liquid interface (ALI) exposure system to simulate the inhalation exposure of motorcycle exhaust particulates (MEPs) and then investigate the benchmark dose (BMD) of MEPs by evaluating cell relative viability (CRV) in lung epithelial BEAS-2B cells.@*Methods@#The MEPs dose was characterized by measuring the number concentration (NC), surface area concentration (SAC), and mass concentration (MC). BEAS-2B cells were exposed to MEPs at different concentrations @*Results@#Our results reveal that BMD of NC and SAC were estimated by the best-fitting Hill model, while MC was estimated by Polynomial model. The BMDL for CRV following ALI exposure to MEPs were as follows: 364.2#/cm @*Conclusion@#These results indicate that MEPs exposure

Clinical features and treatment of anterior shoulder dislocation complicated with fractures of glenoid and greater tuberosity / 中华创伤骨科杂志

Objective:To explore the clinical features and treatment of anterior shoulder dislocation complicated with fractures of glenoid and greater tuberosity (GT).Methods:From December 2013 to October 2019, 26 patients (27 shoulders) were treated at Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital by arthroscopy or open reduction and internal fixation (ORIF). They were 13 males and 13 females with a mean age of 49.1 years (range, from 22 to 71 years). By the Goss-Ideberg classification for glenoid fractures, there were 21 cases of type Ⅰa and 6 cases of type Ⅱ; by the Mutch classification for GT fractures, there were 3 cases of depression type, 6 cases of avulsion type and 18 cases of split type. At the last follow-up, visual analogue scale (VAS), Constant-Murley and American Shoulder & Elbow Surgeons (ASES) scores were used to evaluate the pain and function of the shoulder and the Rowe scores to assess shoulder stability.Results:In this cohort, the avulsion type accounted for 66.7% (18/27) of the GT fractures and the type of anterior glenoid rim for 77.8% (21/27) of the glenoid fractures. All the 26 patients (27 shoulders) were followed up for a mean period of 18.3 months (range, from 12 to 47 months). All fractures united after 6 to 17 weeks (mean, 11.6 weeks). At the last follow-up, anterior flexion and lifting averaged 155.6°, lateral external rotation 43.6°, and the internal rotation thumb touching the spinous process levels from L4 to T8. At the last follow-up, the Constant-Murley scores averaged 89.2, the ASES scores 88.9, the Rowe scores 94.5, and the VAS scores 0.3.Conclusions:In anterior shoulder dislocation complicated with fractures of glenoid and GT, the GT fractures are mainly the split type and the glenoid fractures mainly the type of anterior glenoid rim. Arthroscopy or ORIF can be used to repair rotator cuff tears and restore shoulder stability, leading to significantly improved shoulder function and satisfactory therapeutic outcomes.

Effect of sublingual immunotherapy on functions of effector T cells and regulatory T cells / 上海交通大学学报（医学版）

Objective • To investigate the effect of sublingual immunotherapy (SLIT) on the functions of effector T cells (Teff) and regulatory T cells (Treg) under allergic rhinitis (AR) condition. Methods • Peripheral blood mononuclear cells (PBMC) were obtained from 20 AR patients who were recruited from Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital North of Fudan University before and after the 24-and 30-month treatments of SLIT. The percentages of Teff and Treg in CD4+ T cells in PBMC were examined and the contents of calcium release-activated calcium channel modulator 1(ORAI1) protein and Ca2+ mean fluorescence intensity (MFI) in PBMC were measured. Then, Teff and Treg after the 30-month treatment were cultured in vitro, and were evaluated for the expression of ORAI1 protein and concentrations of interleukin-4(IL-4) and IL-10 in the cultures. Lentivirus vector (lenti) that encoded short hairpin RNA against ORAI1(lenti-ORAI1) was prepared and transfected into Teff and Treg, and then Ca2+ MFI in Teff and Treg and concentrations of IL-4 and IL-10 in the cultures were assessed again. Results • The percentage of Teff in CD4+ T cells in PBMC reduced gradually after the 24-and 30-month treatments (P=0.000, P=0.027); however, the percentage of Treg was increased (P=0.000, P=0.008). The expression of ORAI1 protein (P=0.000, P=0.003) and Ca2+ MFI (P=0.000, P=0.000) in Teff were also decreased gradually after the 24-and 30-month treatments; however, the expression of ORAI1 protein (P=0.000, P=0.007) and Ca2+ MFI in Treg were enhanced (P=0.000, P=0.000). ORAI1 protein was expressed in these two types of cells cultured in vitro. Furthermore, Ca2+ MFI in them (P=0.004, P=0.000) and IL-4(P=0.009) and IL-10(P=0.000) in the cultures were all decreased after the transfection of lenti-ORAI1. Conclusion • SLIT can control functions of Teff and Treg through regulating the expression of ORAI1 protein.

Effect of L-cysteine on colonic motility and the underlying mechanism / 生理学报

The purpose of the present study is to investigate the effect of L-cysteine on colonic motility and the underlying mechanism. Immunohistochemical staining and Western blot were used to detect the localization of the HS-generating enzymes cystathionine-β-synthase (CBS) and cystathionine-γ-lyase (CSE). Organ bath system was used to observe the muscle contractile activities. Whole-cell patch-clamp technique was applied to record ionic channels currents in colonic smooth muscle cells. The results showed that both CBS and CSE were localized in mucosa, longitudinal and circular muscle and enteric neurons. L-cysteine had a dual effect on colonic contraction, and the excitatory effect was blocked by pretreatment with CBS inhibitor aminooxyacetate acid (AOAA) and CSE inhibitor propargylglycine (PAG); L-cysteine concentration-dependently inhibited L-type calcium channel current (I) without changing the characteristic of L-type calcium channel (P < 0.01); In contrast, the exogenous HS donor NaHS increased I at concentration of 100 μmol/L, but inhibited I and modified the channel characteristics at concentration of 300 μmol/L (P < 0.05); Furthermore, L-cysteine had no effect on large conductance calcium channel current (I), but NaHS significantly inhibited I (P < 0.05). These results suggest that L-cysteine has a potential dual effect on colonic smooth muscle and the inhibitory effect might be directly mediated by L-type calcium channel while the excitatory effect might be mediated by endogenous HS.

Clinical characteristics and risk factors of systemic sclerosis with hematologic system damages / 中华风湿病学杂志

Objective:To investigate the clinical features, laboratory characteristics and risk factors of systemic sclerosis (SSc) patients with hematologic damages.Methods:The clinical data of 180 SSc patients were collected from January 2010 to April 2020, at the Affiliated Hospital of North Sichuan Medical College. The demographic information, laboratory tests, and clinical symptoms were analyzed retrospectively. Statistical Product and Service Solutions (SPSS) 19.0 was used for t-test, non-parametric Mann-Whitney U test, Chi-squared test, Logistics regression analysis. Results:① Among 180 SSc patients, 70(38.9%) cases were complicated with hematologic damages. Fifty-one (72.9%) cases had anemia, 24 cases (34.3%) had leukopenia, 24 cases (34.3%) had thrombocytopenia, and 22 cases had hematologic damages associated with more than two cell line involvement. ② Clinical symptoms: arthritis was significantly higher in the hematologic damage group than patients without( χ2=4.815, P=0.028), however, there was no significant difference in gender, age, disease course, respiratory symptoms, gastrointestinal symptoms, Raynaud's phenomenon, interstitial lung disease and pulmonary hypertension ( P>0.05). ③ Laboratory tests: erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were increased in the hematologic damage group, while the albumin decreased ( Z=-2.448, P=0.014; Z=-2.450, P=0.014; Z=-4.773, P<0.01). The positive rates of anti-dsDNA antibody and anti-ribosomal P protein anti-body was higher in the hematologic damage group ( χ2=5.428, P=0.020; χ2=8.169, P=0.004). ④ Prognosis: during follow-up, leukopenia was more likely to recover, while the thrombocytopenia was more difficult to recover. ⑤ Logistics regression analysis showed that positive of anti-ribosomal P protein antibody might bea risk factor for SSc complicated with hematologic damages [ OR=3.930, 95% CI(1.130, 13.666, P=0.031)]. Conclusion:SSc complicated with hematologic damages is common, and patients with hematological damage have more serious clinical symptoms, some of whom have difficulty in recovery. Anti-ribosomal P protein anti-body may be a risk factor for SSc hematologic damages.

Identification of Volatile Organic Compounds Used to Diagnose and Evaluate Acute Promyelocyte Leukemia / 中国实验血液学杂志

OBJECTIVE@#To analyze the characteristics of volatile organic compounds (VOCs) in expiratory air components of patients with acute promyelocytic leukemia (APL), and assess the feasibility of VOCs for the diagnosis and prognostic evaluation of APL.@*METHODS@#The VOCs exhaled from the patients with APL and healthy volunteers should be analyzed with SPME-GC/MS, and compared between newly-diagnosed group, relapse group, remission group, and healthy group with Wilcoxon/Kruskal-Wallis one-way analysis of variance and Dunn-Bonferroni test.@*RESULTS@#Dimethyl sulfide, toluene, and dodecane obtained of newly-diagnosed APL patients were significantly higher, while ethanol, n-hexanal, and benzaldehyde were significantly lower than those of healthy people (P<0.05). Compared with the newly-diagnosed group, dimethylsulfide, toluene, and dodecane of the remission group significantly decreased, while ethanol, n-hexanal, and benzaldehyde significantly increased (P<0.05), which was just opposite from the relapse group.@*CONCLUSION@#Dimethyl sulfide, toluene, dodecane, ethanol, n-hexanal, and benzaldehyde can be used as biomarkers for the diagnosis and prognosis assessment of APL patients.

Efficacy comparison of intense pulsed light combined with meibomian gland massage and eyelid fumigation massage in the treatment of MGD-related dry eyes / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe and compare the therapeutic effects of intense pulsed light(IPL)combined with meibomian gland massage and eyelid fumigation massage on dry eyes associated with meibomian gland dysfunction(MGD).<p>METHODS: This study was a prospective randomized controlled clinical trial. Totally 73(146 eyes)outpatients with MGD-related dry eyes were selected from March 2018 to August 2018 at Xi'an No.4 Hospital. 38 patients(76 eyes)in the experimental group were given IPL combined meibomian gland massage treatment(once every three weeks, three times in all), and 35 patients(70 eyes)in the control group were given eyelid fumigation combined meibomian gland massage treatment(fumigating and cleaning the eyelid margin every day for 5d, massaging the tarsal gland on the fifth day, repeating treatment after 2wk, totally 3 times). The study lasted 12wk. The ocular surface disease index(OSDI), standard dry eye assessment questionnaire(SPEED), non-invasive tear film rupture time(NITBUT), non-invasive lacrimal river height measurement(NITMH), meibomian gland loss score(MGS), meibomian gland secretion assessment(MGYSS)before and after the first treatment, the first week, the fourth week, the seventh week and the twelfth week were recorded to evaluate the curative effect of the two treatments.<p>RESULTS: There was no significant difference in gender and age between the two groups(<i>P</i>>0.05).There was no significant difference in data between the two groups before treatment(<i>P</i>>0.05). Indexes except NITMH and MGS each time point after treatment in the two groups were significantly improved compared with those before treatment, and the difference was statistically significant(<i>P</i><0.05). There was no significant difference in each index between the experimental group and the control group at 1wk after treatment(<i>P</i>>0.05); at 4, 7 and 12wk after treatment, the experimental group was superior to the control group except for NITMH and MGS, and the difference was statistically significant(<i>P</i><0.05). From the change trend of the indicators, the therapeutic effect of the experimental group continued to improve after the first treatment, and was the best at the 12th week, while that of the control group was the best at the 7th week after the first treatment, and then the curative effect was weakened. There were no obvious complications in both groups after treatment.<p>CONCLUSION: Both intense pulsed light combined with palpebral gland massage and eyelid fumigation massage are convenient, safe and effective for MGD-related dry eyes, and the curative effect and maintenance time of intense pulsed light combined with palpebral gland massage are better than that of eyelid fumigation massage.

Efficacy of 23G intra-infusion-assisted scleral buckling on spherical retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the treatment effect and discuss availability of spherical retinal detachment by 23G intra-infusion-assisted scleral buckling. <p>METHODS: Twenty-one eyes were randomly selected from in-patients with rhegmatogenous retinal detachment with much subretinal fluid and spherical appearance between February 2017 and February 2018, which were suitable for scleral buckling. The 23G intra-infusion was placed in the pars plana of ciliary body before the surgery. Retinal hole was not solidified during operation. Laser photocoagulation was performed around the retinal hole after surgery. Retinal reattachment state and the complications were evaluated by 3 to 10mo follow up. <p>RESULTS: All patients have undergone operations smoothly. Subretinal fluid was drainage, chroidal bleeding and retinal incarceration did not appear during the operation. Eighteen eyes achieved retinal reattachment on the first postoperative day; Subretinal fluid of two eyes was asorbed fully; One eyes achieved retinal reattachment after the adjustment by the external pressure block. One eyes with recurrence achieved retinal reattachment after vitreoretinal surgery. One eye developed complication with subretinal hemorrhage and the range of bleeding was less than 1PD, which was absorbed after 3mo. There were no eyes found abnormal intraocular pressure, anterior segment ischemia or other sever complications.<p>CONCLUSION: The 23G intra-infusion was pre-placed before relieving fluid in the scleral buckling of retinal detachment, which can effective keep intraocular pressure stably and reduce the possibilities of explosive suprachoroidal hemorrhage and postoperative choroidal amotio triggered by fast decrease of intraocular pressure. The retina is flat basically and the hole location is relatively accurate, which improve the success of the surgery.

Effect of Ultrashort Wave on Macrophage Polarization and Inflammatory Response after Spinal Cord Injury in Rats / 中国康复理论与实践

Objective To explore the effect of ultrashort wave on macrophage polarization and inflammation response after spinal cord injury in rats. Methods A total of 96 Sprague-Dawley rats were randomly divided into sham group, model group and ultrashort wave group, with 32 rats in each group. The spinal cord injury model was established by modified Allen's method in the model group and the ultrashort wave group. The ultrashort wave group received ultrashort wave since the first day after modeling. BBB score was applied to evaluate the locomotion recovery. HE staining was used to as-sess the injury area, while immunochemistry, real-time PCR and Western blotting were applied to measure the mRNA and protein expression of inducible nitric oxide synthase (iNOS), arginase-1 (Arg-1) and tumor necrosis factor-α (TNF-α). Results Compared with the model group, the BBB score increased (P<0.05), the expression of iNOS and TNF-α de-creased, and the expression of Arg-1 increased (P<0.05). Conclusion Ultrashort wave therapy may promote macrophage polarization from M1 to M2, inhibit inflammatory re-sponse and promote recovery after spinal cord injury in rats.