Using External Joint Stabilizer - Elbow (EJS-E) for treating elbow instability-biomechanical assessment and clinical outcomes.

BACKGROUND: This study aimed to evaluate the outcome of using an External Joint Stabilizer - Elbow (EJS-E) for persistent elbow instability based on biomechanical experiments and analysis of clinical results. METHODS: An EJS-E was used in 17 elbow instability patients. The median follow-up was 26 months (range, 12-42 months). We evaluated the flexion-extension and pronation-supination movement arcs, visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), Broberg and Morrey classification system, and occurrence of complications in these patients. Moreover, construct stiffness and maximum strength tests were performed to evaluate the strength of the fixation techniques. RESULTS: The final median range of the extension-to-flexion and pronation-to-supination arc of the elbow was 135° (range, 110°-150°) and 165° (range, 125°-180°), respectively. The VAS pain scores were > 3 in two patients. The median MEPS was 90 (range, 80-100 points). Five patients showed signs of grade I post-traumatic osteoarthritis according to the Broberg and Morrey radiographic classification system, while grade II changes were observed in three patients. Complications included axis pin loosening with pin-tract infection in two patients, transient ulnar nerve symptoms in two patients, heterotopic ossification in two patients, and suture anchors infection in one patient. Based on the biomechanical testing results, the EJS-E exhibited higher stiffness and resisting force in varus loading. It was 0.5 (N/mm) stiffer and 1.8 (N·m) stronger than the internal joint stabilizer (IJS) by difference of medians (p < 0.05). CONCLUSIONS: Biomechanical and clinical outcomes show that EJS-E via the posterior approach can restore mobility and stability in all patients, thus serving as a valuable alternative option for the treatment of persistent instability of the elbow.

Down-regulation of ATF1 leads to early neuroectoderm differentiation of human embryonic stem cells by increasing the expression level of SOX2.

We reveal by high-throughput screening that activating transcription factor 1 (ATF1) is a novel pluripotent regulator in human embryonic stem cells (hESCs). The knockdown of ATF1 expression significantly up-regulated neuroectoderm (NE) genes but not mesoderm, endoderm, and trophectoderm genes. Of note, down-regulation or knockout of ATF1 with short hairpin RNA (shRNA), small interfering RNA (siRNA), or clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9) was sufficient to up-regulate sex-determining region Y-box (SOX)2 and paired box 6 (PAX6) expression under the undifferentiated or differentiated conditions, whereas overexpression of ATF1 suppressed NE differentiation. Endogenous ATF1 was spontaneously down-regulated after d 1-3 of neural induction. By double-knockdown experiments, up-regulation of SOX2 was critical for the increase of PAX6 and SOX1 expression in shRNA targeting Atf1 hESCs. Using the luciferase reporter assay, we identified ATF1 as a negative transcriptional regulator of Sox2 gene expression. A novel function of ATF1 was discovered, and these findings contribute to a broader understanding of the very first steps in regulating NE differentiation in hESCs.-Yang, S.-C., Liu, J.-J., Wang, C.-K., Lin, Y.-T., Tsai, S.-Y., Chen, W.-J., Huang, W.-K., Tu, P.-W. A., Lin, Y.-C., Chang, C.-F., Cheng, C.-L., Lin, H., Lai, C.-Y., Lin, C.-Y., Lee, Y.-H., Chiu, Y.-C., Hsu, C.-C., Hsu, S.-C., Hsiao, M., Schuyler, S. C., Lu, F. L., Lu, J. Down-regulation of ATF1 leads to early neuroectoderm differentiation of human embryonic stem cells by increasing the expression level of SOX2.

Plate-on-plate technique for treating peri-implant fractures of distal femoral locking plate: a retrospective study of 11 patients.

INTRODUCTION: In this study, we aimed to ascertain the feasibility and reliability of the plate-on-plate technique for peri-implant fractures of the distal femoral locking plate when the distal femoral fracture is still unhealed. MATERIALS AND METHODS: From January 2007 to December 2016, we enrolled 11 patients who received treatment at our institution. All patients underwent at least 1 year of follow-up. Their medical records, imaging studies, visual analogue scores, walking ability, complications, and functional outcomes at 1 year postoperative based on the Short Form (36) Health Survey (SF-36) scores were retrospectively evaluated. RESULTS: The average follow-up duration was 20.5 (range 15-30) months. All fractures united with satisfactory alignment, and the average time for union was 27.5 (range 16-40) weeks. The average SF-36 scores at 1 year postoperative was 79.2 (range 72-90). Regarding ambulatory status, all patients could perform unrestricted outdoor ambulation. CONCLUSION: In our case series, the plate-on-plate technique achieved a good bone union rate and functional outcomes with low complication rates and thus may be a good alternative for managing this difficult type of fracture.

Arthroscopic excision of wrist ganglions: does trans-cystic or cystic-sparing portal technique affect clinical outcomes?

INTRODUCTION: The preliminary results of arthroscopic wrist ganglionectomy were contradictory. The approach used for the arthroscopic excision of wrist ganglions may play an important role. We analyzed two surgical approaches for arthroscopic excision of wrist ganglions. MATERIALS AND METHODS: Between April 2009 and October 2014, 49 patients with wrist ganglions who underwent arthroscopic excision in our institute were retrospectively classified into two treatment groups, namely the trans-cystic portal technique (TCP) and cyst-sparing portal technique (CSP). The visual analog scale (VAS), Mayo wrist scores, and disabilities of the arm, shoulder, and hand (DASH) scores were measured for clinical assessment. Recurrence, residual pain, and complications were evaluated at follow-up. RESULTS: No significant differences were found between the groups in terms of demographic data, and preoperative clinical assessment, as well as with regard to postoperative VAS score (p = 0.898), Mayo wrist score (p = 0.526), DASH score (p = 0.870), recurrence (p = 0.491), residual pain (p = 0.690), and complications (p = 0.352). Recurrence was found in 2 of the 47 patients and they were both in the CSP group. At the final follow-up, residual pain was found in four patients in the TCP group and three in the CSP group. CONCLUSIONS: For performing arthroscopic resection of wrist ganglions, both techniques are safe regarding the complication rates. In recurrence rate, no significant difference was found between the two groups, but no recurrence was observed when the TCP technique was used.

Three-stage treatment protocol for recalcitrant distal femoral nonunion.

INTRODUCTION: In this study, we proposed a three-stage treatment protocol for recalcitrant distal femoral nonunion and aimed to analyze the clinical results. MATERIALS AND METHODS: We retrospective reviewed 12 consecutive patients with recalcitrant distal femoral nonunion undergoing our three-stage treatment protocol from January 2010 to December 2014 in our institute. The three-stage treatment protocol comprised debridement of the nonunion site, lengthening to eliminate leg length discrepancy, deformity correction, stabilization with a locked plate, filling of the defect with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique) or free vascularized fibular bone graft. The bone union time, wound complication, lower limbs alignment, amount of lengthening, knee range of motion, and functional outcomes were evaluated. RESULTS: Osseous union with angular deformity <5° and leg length discrepancy <1 cm were achieved in all the patients. The average amount of lengthening was 5.88 cm (range 3.5-12 cm). Excellent or good outcomes were obtained in 9 patients. CONCLUSIONS: Although the current study involved only a small number of patients and the intervention comprised three stages, we believe that such a protocol may be a valuable alternative for the treatment of recalcitrant distal femoral nonunion.

Single posterior approach for circumferential decompression and anterior reconstruction using cervical trabecular metal mesh cage in patients with metastatic spinal tumour.

BACKGROUND: The goal of surgical management of metastatic spinal tumours is to remove the tumour mass, restore spinal stability and alignment, and provide a better quality of life. A single posterior transpedicular approach, with circumferential decompression, for anterior reconstruction has been advocated to reduce the risk of complication and morbidity associated with a combined anterior-posterior approach. The purpose of our study was to evaluate the clinical outcomes of patients who underwent a single posterior approach for anterior reconstruction at our institution to determine the feasibility and effectiveness of the approach, including the use of a cervical trabecular metal (TM) mesh cage as a vertebral body replacer. As a secondary aim, we evaluated the effect of accumulated experience with the surgical approach on clinical outcomes. METHODS: Twenty consecutive cases of single posterior approach were identified from a retrospective review of spinal surgeries performed at our institution between January 2009 and December 2012. Information on the following clinical outcomes was retrieved from the medical charts for analysis: visual analogue pain score (VAS); neurological status, classified on the Frankel scale; vertebral body reconstruction; spinal alignment, using Cobb's angle; operative time; volume of blood loss; complications; and the modified Brodsky criteria score, which was used to classify functional recovery as excellent, good, fair, or poor. RESULTS: Pre- to post-surgical evaluation of outcomes demonstrated a significant decrease in pain (p < 0.001), improved spinal alignment, with a mean correction angle of 12° (range, 3°-29°), and higher Frankel score (p < 0.001). No severe complications were identified, including deep surgical infection or neurologic deterioration. Eighteen patients achieved good to excellent outcomes, based on the modified Brodsky criteria (p < 0.001), with two patients dying within 9 and 11 months of their surgery. Accumulated surgical experience reduced operative time and intraoperative blood loss (p ≤ 0.007). CONCLUSIONS: A single posterior approach provided good to excellent clinical and functional outcomes. Based on this evidence, we propose that a posterior approach provides a feasible alternative to the combined posterior-anterior approach for managing patients with metastatic spinal tumours.

Interim Use of Antibiotic-Loaded Cement Spacer for Patients with Infected Cervical Fusion.

OBJECTIVE: The management of postoperative deep infection after anterior cervical discectomy and fusion (ACDF) remains challenging for spine surgeons. Our institution uses handmade antibiotic-loaded cement spacers to treat these complex cases. This study aimed to determine the efficacy and feasibility of this treatment. METHODS: This study included 4 patients with deep cervical spine infections after ACDF who underwent our treatment between March 2012 and January 2022. Patients' laboratory data, visual analog scale scores, comorbidities, complications, and neurological status were recorded. Their clinical conditions were also evaluated based on the Neck Disability Index, Japanese Orthopaedic Association score, and Odom criteria. RESULTS: Infection eradication was achieved in all patients after treatment. The average preoperative visual analog scale score was 7.5 (range: 7-8); this decreased to 1.25 (range: 1-2) at 1 year postoperatively. None of the patients experienced severe complications, such as neurological deterioration or bone graft dislodgement. The Neck Disability Index improved from a preoperative value of 54% (range: 48-60%) to 6% (range: 4-8%) at 1 year postoperatively. The Japanese Orthopaedic Association score improved from a preoperative score of 10.25 (range: 10-11)-14.75 (range: 14-16) at 1 year postoperatively. All patients achieved excellent outcomes based on Odom criteria at 1 year postoperatively. CONCLUSIONS: Good clinical outcomes were achieved in this study. Although 2-stage surgery is required, this technique could be an alternative for patients with postoperative deep infection after ACDF.

Percutaneous Sacroplasty for Symptomatic Sacral Pedicle Screw Loosening.

Background: This study aimed to evaluate the efficacy of fluoroscopy-guided percutaneous sacroplasty in patients with sacral pedicle screws loosening after instrumented spinal fusion. Methods: We retrospectively reviewed the medical records of 18 patients who underwent percutaneous sacroplasty to treat sacral pedicle screws loosening from January 2016 to December 2019. Imaging studies, visual analog scale (VAS), length of hospital stay, and complications were recorded. The clinical outcomes based on the Oswestry disability index (ODI) and the modified Brodsky's criteria (MBC) were also evaluated to determine the efficacy of percutaneous sacroplasty. Results: All patients had undergone at least 1 year of follow-up in our institute (range, 12-24 months). The average VAS score was 5.6 (range, 4-7) before surgery and decreased to 1.7 (range, 1-3) at the final visit. All patients were discharged on the next day after surgery. No patients experienced complications, such as cement leakage, deep infection, or neurologic deterioration. All patients achieved good or excellent outcomes based on the MBC. The ODI scores improved from 51.8 preoperatively to 25.6 postoperatively. Conclusion: Percutaneous sacroplasty was an effective treatment approach for relieving the patient's symptoms caused by sacral pedicle screws loosening and could be a valuable treatment alternative to extensive revision surgery. Level of clinical evidence: IV.

Single Posterior Approach for Circumferential Debridement and Anterior Reconstruction Using Fibular Allograft in Patients With Skipped Multifocal Pyogenic Spondylodiscitis.

OBJECTIVE: Skipped multifocal pyogenic spondylodiscitis is a rare presentation of spinal infection. In our institution, we used the single posterior approach for circumferential debridement and anterior reconstruction with fibular allograft for treatment. This study aimed to ascertain the viability and reliability of this technique for these difficult cases. METHODS: Nine patients with skipped pyogenic spondylodiscitis who received our treatment method from January 2012 to December 2019 were enrolled in this study. Visual analog scale scores, causative agents, laboratory data, comorbidities, and complications were recorded. The patients' clinical conditions were evaluated based on modified Brodsky's criteria, visual analogue scale, and Oswestry Disability Index. RESULTS: All the patients achieved infection eradication without repeat surgical treatment. The average visual analog scale score was 8.4 (range, 8-9) before operation, which decreased to 1.9 (range, 1-3) 1 year after the surgery. No patient experienced severe complications such as neurologic deterioration or fixation failure. All patients achieved a good or excellent outcome based on modified Brodsky's criteria. The Oswestry Disability Index improved from 80.4 (range, 70-86) preoperatively to 25.1 (range, 20-32) 1 year after the surgery. CONCLUSIONS: In our case series, good clinical outcomes and high successful rates could be achieved through the single-stage posterior-only approach. This could be considered an alternative method to manage patients with skipped pyogenic spondylodiscitis.

Using an Internal Joint Stabilizer Through a Single Posterior Approach for Elderly Patients With Terrible Triad Injury.

Introduction: Treating a terrible triad injury of the elbow remains a challenge for orthopedic surgeons, especially in elderly patients due to the poor quality of the surrounding soft tissue and bony structures. In the present study, we propose a treatment protocol using an internal joint stabilizer through a single posterior approach and analyze the clinical results. Materials and Methods: We retrospectively reviewed 15 elderly patients with terrible triad injuries of the elbow who underwent our treatment protocol from January 2015 to December 2020. The surgery involved a posterior approach, identification of the ulnar nerve, bone and ligament reconstruction, and the application of the internal joint stabilizer. A rehabilitation program was initiated immediately after the operation. Surgery-related complications, elbow range of motion (ROM), and functional outcomes were evaluated. Results: The mean follow-up period was 21.7 months (range, 16-36 months). ROM at the final follow-up was 130° in extension to flexion and 164° in pronation to supination. The mean Mayo Elbow Performance Score was 94 at the final follow-up. Major complications included breaking of the internal joint stabilizer in 2 patients, transient numbness over the ulnar nerve territory in one, and local infection due to irritation of the internal joint stabilizer in one. Conclusions: Although the current study involved only a small number of patients and the protocol comprised two stages of operation, we believe that such a technique may be a valuable alternative for the treatment of these difficult cases. Level of Clinical Evidence: 4.

Comparison of intra-articular injection of ArtiAid®-Mini with Ostenil®-Mini for trapeziometacarpal osteoarthritis: A double-blind, prospective, randomized, non-inferiority trial.

OBJECTIVES: This study aims to compare the effectiveness and safety of intra-articular hyaluronic acid (HA) injections of ArtiAid®-Mini (AAM) and Ostenil®-Mini (OM) for the treatment of trapeziometacarpal joint osteoarthritis. PATIENTS AND METHODS: Between February 2018 and April 2020, this 24-week, double-blind, prospective, randomized, non-inferiority trial included a total of 17 patients (8 males, 9 females; mean age: 60.3±9.5 years; range, 42 to 76 years) who were treated with either intra-articular AAM (n=8) or OM (n=9). The primary outcome was pain according to a change in Visual Analog Scale (VAS) at 12 weeks after the last injection. The secondary outcomes included the change of VAS at Weeks 2, 4, and 24 after the injection, satisfaction, range of motion (ROM) of trapeziometacarpal joint, pinch strength, grip strength, and adverse events at Weeks 2, 4, 12, and 24 after the injection. RESULTS: Eight patients with AAM and eight patients with OM completed the follow-up. No significant differences in primary and secondary outcomes were observed between the two groups at baseline and each time point (p>0.05). The intra-group differences were significant in each time point. CONCLUSION: The intra-articular injection of either AAM or OM is effective and safe for patients with trapeziometacarpal osteoarthritis up to 24 weeks.

The Impact of Exercise Training on Physical Activity among Elderly Women in the Community: A Pilot Study.

According to a survey conducted by the Taiwanese government, the elderly spend most of their time watching TV for their daily leisure activities, and most do not pant or sweat during exercise. Relevant studies have shown that physical activity has benefits and importance for the physical functions of the elderly. The objective of this study was to investigate the effects of exercise training on the functional fitness of elderly females in the community. The women subjects were from the community of Kaohsiung City, Taiwan. In total, 34 females were randomly divided into an intervention group and a control group. The ages of the subjects ranged from 65 to 80 years old, with an average age of 75.13. The experimental group continued their physical activity intervention for 20 weeks. The control group had no training plan. The results of the study showed that after 20 weeks of intervention, participants in the intervention group experienced improvements in back grasping, right-hand grip strength, sitting to standing, right hip flexion, right knee extension, right ankle dorsiflexion, right sitting forward extension balance, and sitting back around objects. Six-minute walking distances also showed a significant difference in all cases. The results demonstrated that the 20-week physical activity program intervention used in this study can assist in improving back grasping, right-hand grip strength, sitting to standing, right-hand sitting posture, forward balance, sitting back around objects, and six-minute walking distance among older women in the community. In summary, we recommend a moderate-intensity physical activity exercise program for older women in the community.

Clinical evaluation of repeat percutaneous vertebroplasty for symptomatic cemented vertebrae.

BACKGROUND: Percutaneous vertebroplasty (PV) with polymethylmethacrylate is widely used to treat osteoporotic vertebral compression fracture and satisfactory clinical outcomes have been reported in the literature. However, recurrent or persistent back pain after PV is not uncommon. Sometimes, the pain may result from pathogenesis within the previously treated vertebra. In this study, we evaluated the efficacy and safety of repeat PV for treating patients with recurrent back pain caused by the previously cemented vertebrae. METHODS: We retrospectively reviewed the medical records of 18 patients who underwent repeat PV to treat symptomatic cemented vertebrae. Patients were categorized into 3 groups based on clinical presentation and imaging studies: those with refracture (RF), residual vacuum (RV), and osteonecrosis (ON) along the bone-cement interface. A bipedicle approach was used for repeat PV in all patients. The visual analogue scale (VAS) and modified Brodsky criteria were used to evaluate clinical outcomes before and after surgery. The Kruskal-Wallis test, Wilcoxon signed-rank test, and Spearman correlation analyses were used to analyze patient surgical prognosis and radiologic findings. RESULTS: Nine patients were diagnosed with RF, 5 with RV, and 4 with ON. The average VAS score was 77.1 (range, 62-90) before repeat PV (80.1, 72.4, and 76.3 for the RF, RV, and ON groups, respectively) and 34.4 (range, 25-45) after repeat PV treatment (33.1, 36.8, and 34.3 for the RF, RV, and ON groups, respectively). The VAS score significantly decreased in all 3 groups. The vertebral body height was significantly restored by a mean of 13.9% across all groups (17.8%, 12.7%, and 6.8% in the RF, RV, and ON groups, respectively). Fifteen patients recovered from vertebral compression fracture and regained their preinjury activities of daily living. No surgery-related complications occurred except asymptomatic cement leakage in 5 patients. CONCLUSIONS: The results of this research demonstrate that repeat PV may be an effective method for relieving recurrent or persistent pain in patients with symptomatic cemented vertebrae, allowing them to regain functional activity.

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis.

BACKGROUND: Skipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique. METHODS: Twelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients' clinical conditions were evaluated based on modified Brodsky's criteria and Oswestry Disability Index (ODI). RESULTS: All the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7-8) before surgery and decreased to 2.1 (range, 1-3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70-84) preoperatively to 25.5 (range, 22-28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky's criteria one year postoperatively. CONCLUSIONS: In our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.

A new mouse model of ankle instability induced by multiple mechanical sprains with controlled inversion angle and speed.

Ankle sprain occurs by a sudden and extreme inversion and plantarflexion at the ankle joint to cause ligamentous injuries. A portion of ankle sprain patients experience recurrent ankle sprains and develop chronic ankle instability (CAI). The present CAI animal models are single events with severe ligamentous injury using surgical transection of ligaments or manually overextending the ankle. Purpose: To simulate the mechanical and recurrent sprain injuries in CAI patients, we established a new ankle instability model with multiple ankle injuries using a self-designed machine to sprain the ankle with a controlled inversion angle and speed. Methods: Male C57BL/6J mice were used and respectively subjected to a sham operation, calcaneofibular ligament (CFL) transection, and mechanical ankle sprains. Three mechanical sprains were performed on the 13th and 185th day after the initial mechanical ankle sprain. Results: The first mechanical sprain and CFL transection induced ankle injury as indicated by an average of a 62% decrease in ankle pressure pain threshold and a 114% increase in the ankle thickness compared with the contralateral untreated ankle. The second and third mechanical sprains induced recurrent ankle injuries. The foot slips during beam tests were increased after mechanical ankle sprains but not after CFL transection, indicating the induction of motor balance deficits. Multiple mechanical ankle sprains induced significant gait changes in longer duration of stance (an average of 194% increase), swing (134%), and step cycle (147%) compared with CFL transection or sham operation, and slower walking speed (78% reduction) and shorter step distance (91%) after the third sprain. Conclusion: These results elucidate that multiple mechanical sprains, which induce recurrent ankle injuries, balance deficits, and gait changes, are a good model for investigating the mechanisms of CAI induced by recurrent sprain injuries.

Body Weight Gain Status during the Incubator Weaning Process in Very Low Birth Weight Premature Infants.

Incubator care is essential for premature infants during early hospitalization. As the infants' conditions improve, incubator weaning becomes necessary. This retrospective study aimed to evaluate the effect of body weight gain and status of intake-calorie gain on the incubator weaning process for very low birth weight (VLBW) premature infants. The study included 127 VLBW premature neonates. We analyzed data on clinical characteristics potentially associated with the weaning period and the end-weaning body weight (EWBW), including body weight gain status, intake-calorie gain status, and disease conditions. The neonates were weaned from the incubators at a mean postmenstrual age (PMA) of 35.1 ± 1.3 weeks; postnatal days, 37.7 ± 18.2 days; and body weight, 1882.8 ± 157.1 g. The total weaning period was 3.5 ± 3.1 days. Regarding the weaning period, there was a strong positive relationship only in the end-weaning PMA and the daily body weight within 3 days before incubator weaning. Further, regarding the factors associated with EWBW, only the end-weaning PMA and necrotizing enterocolitis had a significant positive impact. Body weight gain and the status of intake-calorie gain showed no association with either the weaning period or the EWBW and, thus, were not related to the incubator weaning process.

External Locking Plate Fixation for Femoral Subtrochanteric Fractures.

Introduction: Internal fixation is the treatment of choice for subtrochanteric fractures in most conditions. However, it may be an unsuitable procedure for patients with poor health status, osteomyelitis, and surrounding soft tissue compromise. This study aimed to ascertain the viability and reliability of using external locking plate fixation for these difficult cases. Methods: Eleven patients with femoral subtrochanteric fractures who received external locking plate fixation in our institute from January 2014 to December 2019 were enrolled in our study. The bone union time, wound complication, alignment, and necessity for narcotic agents were evaluated. Results: The average length of follow-up was 17.5 months (range, 14-26 months). The mean time for bone union was 17.7 weeks (range, 15-21 weeks). The indications included poor health condition, soft tissue compromise, and post-operative osteomyelitis. Pin tract infection was noted in two patients who were treated successfully with oral antibiotics administration and removal of the involved screws. Osseous union with varus deformity <10° was achieved in all patients except one. Three patients required an orally administered pain killer at the final visit. The average Harris Hip Score at one year post-operatively was 66.6 (range, 49-80). Conclusions: Although the current study only involved 11 patients, we believe that our method may serve as a valuable alternative for the treatment of a femoral subtrochanteric fracture in selected cases. Level of Evidence: Level IV, retrospective case series.

Lonicerae Japonicae Flos Attenuates Neutrophilic Inflammation by Inhibiting Oxidative Stress.

Lonicerae japonicae flos (LJ) is an Asian traditional herb that is used as a dietary supplement, tea, and beverage to clear heat and quench thirst. However, no studies investigated its effect on activated human neutrophils, which played a crucial role in the bad prognosis of coronavirus disease of 2019 (COVID-19) patients by aggravating lung inflammation and respiratory failure. Herein, we evaluated the anti-inflammatory effect of LJ ethanol extract (LJEE) on human neutrophils activated by N-formyl-methionyl-leucyl-phenylalanine (fMLF). Our experimental results indicated that LJEE suppressed fMLF-activated superoxide anion (O2•-) generation, the expression of CD11b, and cell adhesion and migration, as well as the formation of neutrophil extracellular traps in human neutrophils. Further in-depth mechanical investigation revealed that pretreatment with LJEE accelerated the Ca2+ clearance, but did not affect the phosphorylation of mitogen-activated protein kinases (MAPKs) and protein kinase B (Akt) in activated human neutrophils. In addition, LJEE displayed a dose-dependent reactive oxygen species (ROS) scavenger activity, which assisted its anti-inflammatory activity. From the bioassay-coupled chromatographic profile, chlorogenic acids were found to dominate the anti-inflammatory effects of LJEE. Moreover, LJ water extract (LJWE) demonstrated an interrupting effect on the severe acute respiratory syndrome coronavirus-2 spike protein (SARS-CoV-2-Spike)/angiotensin-converting enzyme 2 (ACE2) binding. In conclusion, the obtained results not only supported the traditional use of LJ for heat-clearance, but also suggested its potential application in daily health care during the COVID-19 pandemic.

Ipsilateral vascularised fibula with external locking plate for treatment of massive tibial bone defects.

INTRODUCTION: Management of massive tibial bone defects remains challenging for orthopaedic doctors. This study aimed to ascertain the viability and reliability of utilising an ipsilateral vascularised fibula with an external locking plate for the difficult situation. MATERIALS AND METHODS: Between January 2012 and December 2017, eight patients (7 men) with a mean age of 32.3 (19-54) years who presented with massive tibial bone defects were treated using the described technique. The mean length of the bone defect was 12.4 (8-20) cm. The patients were assessed for clinical and radiographic results, hypertrophy of the fibular graft with DeBoer and Wood's method, and SF-36 functional score. RESULTS: The mean follow-up period was 40.3 (26-60) months. The average time for union was 5.6 (3-8) months. At the final follow-up, all patients had fully united grafts and walked without restriction. The mean graft hypertrophy index was 98.2 %. The SF-36 score was > 75 % in five patients, and 50-75 % in three. Three patients had a leg length discrepancy of > 1.5 cm. Two patients with equinus foot were treated using tibiotalocalcaneal fusion. Three patients had pin-tract infections. Four screws were broken in two cases. CONCLUSION: Ipsilateral vascularised fibular transfer combined with an external locking plate as a definitive external fixator provides a simple and comfortable treatment, and appropriate mechanical loading and vascularisation of the graft site to achieve hypertrophy of the fibular graft. Hence, our technique can serve as a valuable alternative for the treatment of massive tibial bone defects.

Influence of quantified dry cupping on soft tissue compliance in athletes with myofascial pain syndrome.

PURPOSE: This study aimed to develop a quantitative dry cupping system that can monitor negative pressure attenuation and soft tissue pull-up during cupping to quantify soft tissue compliance. METHODS: Baseball players with myofascial pain syndrome were recruited to validate the benefits of cupping therapy. Nine of 40 baseball players on the same team were diagnosed with trapezius myofascial pain syndrome; another nine players from the same team were recruited as controls. All participants received cupping with a negative pressure of 400 mmHg for 15 minutes each time, twice a week, for 4 weeks. Subjective perception was investigated using upper extremity function questionnaires, and soft tissue compliance was quantified objectively by the system. RESULTS: During the 15-minute cupping procedure, pressure attenuation in the normal group was significantly greater than that in the myofascial group (p = 0.017). The soft tissue compliance in the normal group was significantly higher than that in the myofascial group (p = 0.050). Moreover, a 4-week cupping intervention resulted in an obvious increase in soft tissue lift in the myofascial pain group (p = 0.027), although there was no statistical difference in the improvement of soft tissue compliance. Shoulder (p = 0.023) and upper extremity function (p = 0.008) were significantly improved in both groups, but there was no significant difference between the two groups. CONCLUSION: This quantitative cupping monitoring system could immediately assess tissue compliance and facilitate the improvement of soft tissues after cupping therapy. Hence, it can be used in athletes to improve their functional recovery and maintain soft tissues health during the off-season period.