[Cystic fibrosis primarily presenting with pseudo-Bartter syndrome: a report of three cases and literature review]. / 以假性Bartter综合征为主要表现的囊性纤维化患儿3ä¾‹å¹¶æ–‡çŒ®å¤ä¹ .

OBJECTIVES: To summarize the clinical characteristics and genetic variations in children with cystic fibrosis (CF) primarily presenting with pseudo-Bartter syndrome (CF-PBS), with the aim to enhance understanding of this disorder. METHODS: A retrospective analysis was performed on the clinical data of three children who were diagnosed with CF-PBS in Hunan Children's Hospital from January 2018 to August 2023, and a literature review was performed. RESULTS: All three children had the onset of the disease in infancy. Tests after admission showed hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis, and genetic testing showed the presence of compound heterozygous mutation in the CFTR gene. All three children were diagnosed with CF. Literature review obtained 33 Chinese children with CF-PBS, with an age of onset of 1-36 months and an age of diagnosis of 3-144 months. Among these children, there were 29 children with recurrent respiratory infection or persistent pneumonia (88%), 26 with malnutrition (79%), 23 with developmental retardation (70%), and 18 with pancreatitis or extrapancreatic insufficiency (55%). Genetic testing showed that c.2909G>A was the most common mutation site of the CFTR gene, with a frequency of allelic variation of 23% (15/66). CONCLUSIONS: CF may have no typical respiratory symptoms in the early stage. The possibility of CF-PBS should be considered for infants with recurrent hyponatremia, hypokalemia, hypochloremia, and metabolic alkalosis, especially those with malnutrition and developmental retardation. CFTR genetic testing should be performed as soon as possible to help with the diagnosis of CF.

Arthroscopic treatment of ankle impingement syndrome.

Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.

MiR-200a and miR-200b restrain inflammation by targeting ORMDL3 to regulate the ERK/MMP-9 pathway in asthma.

BACKGROUND: Asthma is one of the most frequent and serious diseases worldwide. Inflammation has been reported to correlate with airway remodeling, which is critical for the progression of asthma. Better understanding of novel molecules modulating asthma and the underlying mechanism will benefit explorations of new treatments. Method: To explore the role of miR-200a and miR-200b in asthma, miR-200a mimics/inhibitor and miR-200b mimics/inhibitor were employed in A549 cells, respectively. Expression levels of inflammatory cytokines, including TNF-α, IL-4, IL-5, IL-13 and IL-1ß, were measured by quantitative real time polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA). A dual luciferase reporter assay was performed to identify whether miR-200a/200b directly bound to Orosomucoid 1-like 3 (ORMDL3). ERK, p-ERK and MMP-9, involved in downstream pathways of ORMDL3, were detected using qRT-PCR and western blotting. Results: MiR-200a/200b silencing significantly increased the expression of inflammatory cytokines, including TNF-α, IL-4, IL-5, IL-13 and IL-1ß, in A549 cells. ORMDL3 was the target gene of miR-200a/200b, with high expression levels in miR-200a inhibitor and miR-200b inhibitor groups. MiR-200a and miR-200b played synergistic roles in the regulation of the inflammatory effect in A549 cells. Expression levels of p-ERK and MMP-9 were significantly increased in miR-200a inhibitor and miR-200b inhibitor groups and were rescued by ERK inhibitor and MMP-9 inhibitor, respectively. Conclusion: These findings suggest that miR-200a and miR-200b are required to regulate asthma inflammation. Reduction in miR-200a/200b promotes the development of asthma inflammation by targeting ORMDL3 to activate the ERK/MMP-9 pathway. Therefore, elevating miR-200a and miR-200b and decreasing ORMDL3 might be potential strategies for inhibition of the asthma process.

Hemi-arthroplasty performed in a 109-year-old patient with intertrochanteric fracture: A case report.

The mortality of conservative treatment and the risk resulting from operation for elderly patients with femoral intertrochanteric fractures are high. Safety in the perioperative period and quicker recovery should be placed at the top priority for elderly patients with hip fractures. We reported a case of 109-year-old female patient with intertrochanteric fracture who has undergone the hemiarthroplasty in our center recently. With sciatic nerve and lateral cutaneous nerve block anesthesia, she was offered the artificial femoral head replacement in the lumbar plexus block after sufficient preoperative preparation. The surgery went well with minimally invasive cut, and the patient's recovery was satisfactory.

[Clinical features of tracheobronchial foreign bodies in children].

OBJECTIVE: To investigate the clinical features of tracheobronchial foreign bodies in children and to provide a basis for feasible preventive measures. METHODS: A retrospective analysis was performed on the clinical data of 114 children with tracheobronchial foreign bodies confirmed by fiberoptic bronchoscopy between February 2012 and February 2013. RESULTS: The majority (71.9%) of children with tracheobronchial foreign bodies were younger than three years old, and the male-to-female ratio was 2:l. The proportion of cases in winter was higher than that in summer. The incidence of tracheobronchial foreign bodies was significantly higher among rural children than among urban children. The positive rate of CT varied significantly for tracheobronchial foreign bodies at different sites, and the patients with tracheal foreign bodies had a significantly lower positive rate of chest CT than patients with foreign bodies in the left and right main bronchi (P<0.01). The misdiagnosis rate in children with a history of aspiration of foreign bodies was significantly lower than in children without one (P<0.01). CONCLUSIONS: Health education related to the prevention of tracheobronchial foreign bodies in children should be conducted primarily in rural areas. Tracheobronchial foreign bodies are common in children younger than three years old. Bronchoscopy should be performed early for suspected cases of tracheobronchial foreign bodies.

[Knee arthroscopic resection of articular capsule valvular treat popliteal cysts].

OBJECTIVE: To retrospective study the results of arthroscopic resection of articular capsule valvular treated popliteal cysts and examined the incidence of complication. METHODS: From July 2007 to July 2010, 45 patients with symptomatic popliteal cysts such as knee pain and limitation of motion were treated with arthroscopic technique to resect the connecting valvular mechanism at posteromedial compartment of articular capsule. Through the posteromedial viewing portal and cyst resection working portal, resected the valvular mechanism by shaver and plasma cutter, associated intra-articular pathology was treated simultaneously. The functional outcome was evaluated by employed Rauschning and Lindgren score before the surgery and the last follow-up. By using of Wilcoxon rank sum test to statistics analyze the clinic outcome. RESULT: In all cases, 40 patients were found the associated intra-articular pathology, the incidence was 88.9%.The intra-articular pathology was medial meniscus tear (27 cases, 60.0%), lateral meniscus tear (20 cases, 44.4%), cartilage lesion (28 cases, 62.2%), which composed with patellofemoral joint (12 cases, 26.7%),medial condyles of femur (10 cases, 22.2%),lateral condyles of femur (6 cases, 13.3%). The anterior cruciate ligment injury was found in 2 cases, the incidence was 4.4%. All the patients achieved symptoms relief postoperative, such as posterior knee discomfort and swelling after activities.The Rauschning and Lindgren score was improved 1-2 grade in average (Z = -6.092, P = 0.00). The recurrence rate was 2.2%. All the incision healed good. No major complications were encountered such as saphenous nerve, great saphenous vein, blood vessel in popliteal injury. CONCLUSIONS: Arthroscopic resection of articular capsule valvular treatment of popliteal cyst and treatment of associated intra-articular pathology are effective and safe. This surgery technique has more minimally trauma and lower recurrence rate.The clinic results in short term are excellent.

Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: comparison of autograft, fresh-frozen allograft, and γ-irradiated allograft.

PURPOSE: To compare clinical follow-up results of anterior cruciate ligament (ACL) reconstruction using (1) autologous, (2) fresh-frozen allogeneic, and (3) γ-irradiated allogeneic bone-patellar tendon-bone (BPTB). METHODS: From February 2002 to January 2006, 187 patients received BPTB ACL reconstruction at our center. One hundred forty-two consecutive patients who had received single-bundle BPTB ACL reconstruction were included in this study. Of these patients, 41 had autografts, 33 had fresh-frozen allografts, and 68 had γ-irradiated allografts. Clinical results were evaluated with the KT-1000 maximum displacement test (MEDmetric, San Diego, CA), Lachman test, and Lysholm, Irrgang, and Larson activity scales. RESULTS: The mean duration of follow-up was 6.7 ± 1.5 years (range, 4.2 to 8.2 years). There were 3 cases of acute synovitis due to immunologic rejection (fresh-frozen allografts) and 6 cases of failure (γ-irradiated allografts). KT-1000 examination showed more anterior laxity in the γ-irradiated allograft group compared with the autograft and fresh-frozen allograft groups (P < .05). The Lysholm, Irrgang, and Larson activity scales showed no difference among the 3 groups (P > .05). CONCLUSIONS: The study showed a statistically poorer KT-1000 result and higher failure rate in the γ-irradiated allograft group compared with the autograft and fresh-frozen allograft groups. This may suggest that γ-irradiated allograft is not a good candidate graft for ACL reconstruction. Power analysis showed that the study was underpowered, so further research and longer follow-up study are needed to make this point clearer. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Long-term survival analysis of posterior cruciate-retaining total knee arthroplasty.

PURPOSE: Clinical factors related to cruciate-retaining knee arthroplasty failure in a long-term follow-up are yet unclear. The study was designed to evaluate the long-term survival rate of cruciate-retaining arthroplasty and clinical factors that may contribute to its failure. METHODS: A total of 162 patients (188 knees) who received cruciate-retaining press-fit condylar arthroplasty from June 1993 to May 1994 were followed up. All patients were assessed clinically and radiographically. Revision for any reason was regarded as failure of arthroplasty. RESULTS: A total of 120 patients (138 knees) were successfully followed up. Survivorship over 17 years was 92.5%. Fourteen knees were revised. Tibial varus angle of the operated knee in the unrevised patient group was greater than in revised group. There was statistical difference between these two groups (P < 0.05). CONCLUSION: Long-term survivorship of cruciate-retaining arthroplasty was fair. Varus and valgus deformity of the unoperated contralateral knee and tibial varus deformity of the operated knee could be important factors related to arthroplasty failure. CLINICAL RELEVANCE: This long-term follow-up result of Press-Fit Condylar cruciate-retaining arthroplasty was good considering it was an old design. The alignment of the operated knee and deformity of the unoperated contralateral knee are important clinical factors that should be paid attention to avoid unexpected arthroplasty failure. LEVEL OF EVIDENCE: IV.

lncRNA NEAT1 promotes hypoxia-induced inflammation and fibrosis of alveolar epithelial cells via targeting miR-29a/NFATc3 axis.

The objective of the present study was to explore the function and mechanism of long noncoding RNA (lncRNA) nuclear paraspeckle assembly transcript 1 (NEAT1) in pulmonary fibrosis (PF) progression. HPAEpic cells and A549 cells were exposed to hypoxic conditions to establish an in vitro model. Cell apoptosis was detected by TUNEL assay, and inflammatory cytokine levels were detected by ELISA. Gene and protein expression levels were identified by qRT-PCR and Western blot assays, respectively. The interaction among NEAT1, miR-29a, and NFATc3 was identified by dual-luciferase reporter and RNA pull-down assays. In hypoxia-treated cells, hypoxia markers (HIF-1α and HIF-2α), cytokines (TNF-α, IL-1ß, and IL-6) and fibrotic markers (α-SMA, collagen I and collagen III) were significantly enhanced. Consistently, the expression levels of NEAT1 and NFATc3 were increased, but miR-29a was decreased in hypoxia-stimulated cells. Knockdown of NEAT1 significantly decreased cell apoptosis and the releases of TNF-α, IL-1ß, and IL-6 as well as reduced the levels of α-SMA, collagen I, and collagen III. Moreover, NEAT1 positively regulated NFATc3 expression by directly targeting miR-29a. Functional experiments showed that the anti-apoptotic, anti-inflammatory, and anti-fibrotic effects mediated by NETA1 silencing were impeded by miR-29a inhibition or NFATc3 overexpression in hypoxia-stimulated HPAEpic and A549 cells. Collectively, these data demonstrated that NEAT1 knockdown inhibited hypoxia-induced cell apoptosis, inflammation, and fibrosis by targeting the miR-29a/NFATc3 axis in PF, suggesting that NEAT1 might be a potential therapeutic target for relieving PF progression.

LncRNA NEAT1 regulates MMP-16 by targeting miR-200a/b to aggravate inflammation in asthma.

Asthma is a common respiratory disease which is characterized by persistent airway inflammation. Abnormal expression of long non-coding RNAs (lncRNAs) is observed in asthma. However, whether lncRNA nuclear-enriched abundant transcript 1 (NEAT1) regulates asthmatic inflammation and its mechanism still needs to be further investigated. The expression levels of inflammatory factors (tumour necrosis factor (TNF)-α, interleukin (IL)-4, IL-13, and IL-10) were detected using reverse transcription quantitative real-time PCR (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA). MTT and flow cytometry assays were employed to determine cell proliferation and apoptosis, respectively. Dual luciferase reporter assay was performed to verify the relationship between miR-200a/b and MMP-16 or NEAT1. NEAT1 silencing markedly reduced TNF-α, IL-4, and IL-13 levels, while elevated IL-10 expression, suppressed cell proliferation, and promoted cell apoptosis. However, NEAT1 overexpression elicited the opposite effects on cell proliferation and inflammation cytokines secretion. What is more, NEAT1 negatively regulated miR-200a/b expression, and MMP16 was a target gene of miR-200a/b. miR-200a/b overexpression suppressed inflammation, cell proliferation, and enhanced cell apoptosis through regulation of MMP16. Moreover, MMP-16 overexpression or miR-200a/b inhibition abolished the regulatory effect of sh-NEAT1 on cell inflammation and apoptosis in BEAS-2B cells. NEAT1 acted as the role of sponge for miR-200a/b to regulate MMP-16 expression, thereby promoting asthma progression, suggesting that NEAT1 might have great potential as therapeutic target for asthma.

Triple Hemisection Percutaneous Achilles Tendon Lengthening for Severe Ankle Joint Deformity.

OBJECTIVE: To investigate the efficacy of modified percutaneous Achilles tendon lengthening for severe ankle joint deformity. METHODS: This retrospective case series study included 33 patients with an average age of 25.2 years who underwent surgery in our hospital from April 1, 2010 to March 1, 2018. Triple hemisection percutaneous Achilles tendon lengthening was performed. One stage surgery, other soft tissue surgery or bone correction surgery could be performed. After surgery, a plaster cast was used to fix the functional position, and rehabilitation training was carried out as planned. Complications during the perioperative period were recorded. Statistical analysis of the patients' visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score before and at the last follow-up was performed. The recurrence rate of Achilles tendon contracture at the last follow-up and the patients' satisfaction rate were investigated. RESULTS: All patients were followed up, with an average follow-up period of 56.31 months (8-104 months). All achieved good ankle joint function and appearance improvement And there were no infection or skin necrosis complications. In two cases, the incision was poorly healed at non-Achilles tendon site and was cured by change of dressing. The average VAS score at the last follow-up was reduced from (2 ± 1.48) points before surgery to (0.26 ± 0.51) points (P = 0.001), and the average AOFAS score was increased from (64.97 ± 13.56) points before surgery to (90.06 ± 10.06) points (P = 0.001). During the follow-up period, there was no chronic rupture of Achilles tendon. There were two cases of recurrence of foot drop (5.7%), and the patients' satisfaction rate was 93.9%. CONCLUSION: In the surgical treatment of severe ankle joint deformity, the application of triple hemisection percutaneous Achilles tendon lengthening for Achilles tendon contracture has the advantages of less trauma, beautiful incision, and reliable efficacy. The satisfaction rate of patients with this treatment is high, and it is worth promoting in the clinic.

Disruption of the chitin synthase gene CHS1 from Fusarium asiaticum results in an altered structure of cell walls and reduced virulence.

Natural resistance of wheat against Fusarium head blight (FHB) is inadequate and new strategies for controlling the disease are required. Chitin synthases that catalyze chitin biosynthesis would be an ideal target for antifungal agents. In this study, a class I chitin synthase gene (CHS1) from Fusarium asiaticum, the predominant species of FHB pathogens on wheat in China, was functionally disrupted via Agrobacterium tumefaciens-mediated transformation. Specific disruption of the CHS1 gene resulted in a 58% reduction of chitin synthase activity, accompanied by decreases of 35% in chitin content, 22% in conidiation, and 16% in macroconidium length. The Deltachs1 mutant strain had a growth rate comparable to that of the wild-type on PDA medium but had a 35% increase in the number of nuclear cellulae and exhibited a remarkably increased sensitivity to osmosis stresses. Electron microscopy revealed substantial changes occurring in cell wall structures of the macroconidium, ascospore, and mycelium, with the most profound changes in the mycelium. Furthermore, the Deltachs1 mutant displayed significantly reduced pathogenicity on wheat spikes and seedlings. Re-introduction of a functional CHS1 gene into the Deltachs1 mutant strain restored the wild-type phenotype. These results reveal an important in vivo role played by a CHS1 gene in a FHB pathogen whose mycelial chitin could serve as a target for controlling the disease.

[Treatment of elbow dysfunction under elbow arthroscopy].

OBJECTIVE: To evaluate early clinical outcome after arthroscopic treatment of elbow dysfunction. METHODS: From September 2007 to December 2009, 21 patients with elbow dysfunction were treated with an arthroscopic procedure. All patients had chronic history of elbow dysfunction. Extension lag was 18.2° (10° - 25°) combined with pain. All patients underwent five-portals arthroscopic release and debridement. Postoperative care including anti-infection, rehabilitation and prophylaxis of myositis ossificans were prescribed. All elbows were assessed for increase in ROM and Mayo assessment before and after surgery. Mayo score assessment: ≥ 90 points, excellent; 75 - 89 points, good; 60 - 74 points, common; < 60, bad. Complications were evaluated. RESULTS: At an average follow-up of 19.7 months (6 - 29 months), all patients had improvement of extension and relief of pain. The average lag of extension was 2.4° (0° - 5°). Pre-operative Mayo assessment: good, 13 patients; common, 5 patients; bad, 3 patients. Post-operation Mayo assessment: excellent, 17 patients; good, 4 patients; common, 0 patients; bad, 0 patient. There was no complication in this case serial. CONCLUSIONS: Arthroscopic surgery can minimize trauma and bleeding, and reduce complications. Combined with reasonable rehabilitation, arthroscopic surgery can improve elbow function and appears to be satisfactory management.

Bone regeneration using an acellular extracellular matrix and bone marrow mesenchymal stem cells expressing Cbfa1.

To treat bone defects, tissue-engineering methods combine an appropriate scaffold with cells and osteogenic signals to stimulate bone repair. Mesenchymal stem cells (MSCs) derived from adult bone marrow are an ideal source of cells for tissue engineering, in particular for applications in skeletal and hard tissue repair. Core binding factor alpha1 (Cbfa1) is an essential transcription factor for osteoblast differentiation. However, the effects of Cbfa1 on MSCs in vitro and in vivo have not been well characterized. In this study, we found that MSCs modified genetically to express Cbfa1 promoted the healing of segmental defects of the radius in rabbits. First, osteogenic differentiation of MSCs transfected with an adenovirus encoding Cbfa1 was demonstrated. Expression of mRNA from a number of osteoblastic marker genes, including osteocalcin, osteopontin, and type I collagen, was detected. In addition, alkaline phosphatase activity and increased osteocalcin content were observed. The cells expressing the Cbfa1 gene were then combined with acellular bone extracellular matrix in a flow perfusion culture system. Finally, the cell-matrix constructs were implanted into radius defects in the rabbit model. After 12 weeks, radiographic, histological, and biomechanical analyses showed that MSCs modified with the Cbfa1 gene resulted in a significantly higher amount of newly-formed bone and rebuilding of the marrow cavity than control cell-matrix constructs. This study indicates that MSCs modified with the Cbfa1 gene can act as suitable seed cells for the regeneration of bone defects.

[Second-look arthroscopy study after anterior cruciate ligament reconstruction: effect of residual anterior cruciate ligament tissue upon accelerating revascularization of allologous bone-patellar tendon-bone grafting].

OBJECTIVE: To explore via an arthroscopic second-look the effect of preserved residual anterior cruciate ligament (ACL) tissue upon revascularization of allologous bone-patellar tendon-bone (B-PT-B) grafting. METHODS: Twenty-eight patients with allologous B-PT-B ACL reconstruction were recruited. Patients were divided into 2 groups according to the amount of residual ACL tissue. Group A: ACL residual tissue was cleared; Group B: ACL residual tissue was preserved. Patients were advised to undergo arthroscopic second-look at 6 months after ACL reconstruction. During second surgery, ACL photos were taken during 10 minutes after tourniquet was released. Photoshop was used to analyze red chroma of ACL tissue. The percentage area of three degrees of red chroma was calculated and a standard curve plotted. RESULTS: Fourteen cases in group A and 13 cases in group B were examined by second-look arthroscopy. According to Photoshop analysis, ACL graft in group B had better red chroma appearance than group A. Two peaks were observed on grade three red chroma curve. CONCLUSION: Residual ACL tissue can be preserved during allologous B-PB-B reconstruction of ACL At 6 months post-reconstruction, the revascularization of graft with preserved residual ACL tissue was much better than the other grafts. Small vessels were found on surface of all ACL grafts at 6 months post-reconstruction.

V-Y Tendon Plasty for Reconstruction of Chronic Achilles Tendon Rupture: A Medium-term and Long-term Follow-up.

OBJECTIVE: To evaluate the surgical results of V-Y tendon plasty in the treatment of chronic Achilles tendon rupture during medium and long-term follow-up. METHODS: Between June 2005 and September 2017, 20 patients with chronic Achilles tendon rupture underwent V-Y tendon plasty in our hospital. The mean injury-to-surgery time was 20.4 weeks (range, 4-96 weeks). The Matles test and an improved Thompson test was used to examine Achilles tendon rupture. These patients were not able to stand on the tiptoes of the injured lower extremity. X-ray tests ruled out the chance of fracture and were used to examine the Kager triangle. MRI was used to confirm the final diagnosis. The function of the ankle and the foot was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Achilles Tendon Total Rupture Score (ATRS). V-Y tendon plasty for Achilles tendon reconstruction was performed. A below-knee cast was used to keep the ankle in plantar flexion (up to 20°) for 4 weeks. Non-weight-bearing exercise was allowed with crutches. After 4 weeks, partial weight-bearing was allowed. Physical exercises were performed under rehabilitation guidelines. At 10-12 weeks postoperation, patients began to return to daily life activity levels without restrictions. Preoperative and postoperative MRI was obtained. RESULTS: The mean follow-up period was 32.8 months. The mean operative gap of the Achilles tendon after debridement was 5 cm (range, 4-9 cm), with 85% of the gap less than or equal to 6 cm. The mean AOFAS score increased from 59.25 ± 12.28 preoperatively to 96.55 ± 3.75 at final follow-up (P < 0.05). The mean ATRS score increased from 39.55 ± 14.21 preoperatively to 94.05 ± 4.89 at final follow-up (P < 0.05). All patients had no recurrent Achilles tendon rupture during the follow up. No patient had developed serious complications, such as sural nerve injury or deep vein thrombosis. Patients were able to return to daily life activity levels without restrictions. At the latest follow-up, all patients were able to perform repetitive single heel rise on the involved limb, and to walk without a visible limp. All of the postoperative MRI showed the continuity of the Achilles tendon with no signs of cysts or inflammation, indicating perfect healing at the final follow-up. CONCLUSIONS: V-Y tendon plasty can be used in most cases of chronic Achilles tendon rupture. It yields satisfactory functional results and low complication rates. The advantage of this procedure is that it is an easy and economic method without the need for expensive synthetic implants. V-Y tendon plasty should be considered an acceptable first-choice treatment.

Application of 3D-printed Customized Guides in Subtalar Joint Arthrodesis.

OBJECTIVE: To explore the feasibility of 3D printed customized guides assisting the precise drilling of Kirschner wires in subtalar joint arthrodesis. METHODS: We retrospectively reviewed the data of 29 patients (30 subtalar joints) who underwent subtalar joint arthrodesis between 1 July 2013 and 31 December 2017. The customized guides were designed on a full-scale 3D polylactic acid model made from computed tomography (CT) data of patients by Model Intestinal Microflora in Computer Simulation (MIMICS) software, which were manufactured by 3D printing technology. A total of 14 joints used customized guides (experimental group); the remained 16 joints used the traditional method (control group). The time of drilling the Kirschner wires to the correct position, the time of subtalar fusion, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and complications were evaluated in both groups. RESULTS: All customized guides were successfully manufactured. In the experimental group, it took 2.1 ± 0.7 min to drill the Kirschner wire to the satisfactory position, and 2 cases needed to be re-drilled; in the control group, it took 4.6 ± 1.9 min to drill the Kirschner wire to the satisfactory position (P < 0.05), and 8 cases needed to be re-drilled. No serious complications occurred in both groups during and after the surgery. Postoperative radiographic fusion was confirmed in all cases. No significant difference was observed in the fusion time and AOFAS scores 1 year postoperatively between the two groups (P > 0.05). CONCLUSION: It is safe to apply 3D-printed customized guides for subtalar joint arthrodesis, which can assist the accurate drilling of Kirschner wires into the appropriate position according to the preoperative plan, and reduce the operation time as well as intraoperative radiation.

Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures.

OBJECTIVE: To report the clinical outcome of arthroscopically assisted treatment for tibial plateau fractures. METHODS: A total of 39 patients with tibial plateau fractures were treated by arthroscopic fixation from February 2002 to December 2005, including 11 patients with bony avulsion of the anterior cruciate ligament and 19 with meniscal injury. There were 4 cases of type I fracture, 12 type II, 9 type III, 12 type IV and 2 type V according to Schatzker criteria. Firstly, the combined injuries were treated. Then the plateau fractures with the displacement over 3 mm or more were reduced and fixed. Finally, the internal fixation was observed by X-ray equipment. Postoperative management was early motion and delayed weight bearing. RESULTS: All the fractures healed in 3 or 4 months. All patients were followed up for 1 to 5 years after operation. No case had severe complications, such as poor wound healing, infection, osteofascial compartment syndrome and osteoarthritis. According to the Rasmussen scoring system, 36 cases obtained excellent or good results and the other 3 cases had moderate clinical results. The average score was 26+/-3. CONCLUSIONS: As an adjuvant treatment of intraarticular fractures such as tibial plateau fracture, arthroscopy has many advantages. It can treat associated intraarticular soft tissue components, visualize the chondral surface reduction, lavage the hematoma and smaller loose fragments, decrease soft tissue dissection, reduce the risk of scarring and promote rapid recovery.

[In vivo MR imaging tracking of supermagnetic iron-oxide nanoparticle-labeled bone marrow mesenchymal stem cells injected into intra-articular space of knee joints: experiment with rabbit].

OBJECTIVE: To evaluate the feasibility of in vivo magnetic resonance imaging (MRI) with 1.5T system tracking of the survival, migration and differentiation of magnetically labeled seed cells-bone marrow-derived mesenchymal stem cells (MSCs) injected into the articular cavity. METHODS: Rabbit MSCs were isolated, purified, expanded, and then coincubated in vitro with supermagnetic iron oxide particles (SPIO) and 5-bromo-2-deoxyuridine (BrdU). Prussian blue staining and transmission electron microscopy were performed to observe the intracellular iron. Some labeled MSCs were subjected to chondrogenic differentiation and the phenotype was examined to assess their chondrogenic differentiation capacity. MSCs colabeled with SPIO nanoparticles and (BrdU were suspended in chitosan and glycerophosphate (C-GP) gel. Eighteen rabbits underwent damage to the femoral trochlea to create cartilage defect models, and randomly divided into 3 groups 1 week later: Group A (n=6) undergoing injection of the MSC suspension in C-GP gel into the intra-articular space of knee joints, Group B (n=6), injected with un-labeled MSC suspension in C-GP gel, and Group C (n=6), without injection. MRI of the knee was performed 1, 4, 8, and 12 weeks after the injection respectively on a certain numbers of rabbits. and then the rabbits were killed with their knee joints taken out to undergo immunohistochemistry. The MR imaging findings were compared with the histological findings. RESULTS: Prussian blue staining and transmission electron microscopy showed intracytoplasmic nanoparticles in the SPIO-labeled cells. Safranin-O staining showed deposition of proteoglycan and type II collagen outside both the labeled and unlabeled MSCs, showing chondrogenesis. GRE T2-weighted MR image showed marked hypointense signal void areas, representing the implanted MSCs, in the intra-articular space after the MSC injection in Group A that persisted for 12 weeks at least; 2 week after the MSC injection hypointense signal could be seen in the defect, which peaked in the signal intensity about 4 weeks later, and then gradually decreased in the signal intensity; and 12 weeks after the injection no recognizable hypointense signal in the defect was detected. Immunohistochemical staining demonstrated the presence of Prussian blue-positive cells and BrdU-positive cells in the tissue sections in the areas corresponding well to the signal intensity loss regions in the MRI images. Group B and Group C showed no signal intensity loss in the intra-articular spaces by GRE T2-weighted MR imaging. Histological observation showed that the defects were repaired with fibrocartilage in Groups A and B, and with fiber tissue in Group C. CONCLUSION: Labeled with SPIO, the MSCs remains their ability of chondrogenic differentiation. It is feasible to track the fate and dynamic redistribution of magnetically labeled MSCs, the seed cells, injected into the articular cavity by 1.5T MRI, an efficient noninvasive technique.

[Bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction: allograft versus autograft].

OBJECTIVE: To evaluate the clinical result of arthroscopic anterior cruciate ligament (ACL) reconstruction with either allo- or auto- bone-patellar tendon-bone (B-PT-B) grafts. METHODS: From February 2002 to January 2006, 142 of 187 cases of ACL ruptures who received ACL reconstruction with B-PT-B grafts were studied retrospectively. There were 93 male and 49 female whose age was from 15 to 57 years (mean 26 years). Patients were divided into 2 groups by graft selection: 38 patients with autograft and 104 with allograft. Clinical results were evaluated according to IKDC, Lysholm, Irgang and Larson scales. Sub-items of scales such as pain, swelling and laxity were specifically evaluated. RESULTS: All of the patients were followed up with an average of 24 months (range from 6 to 43 months). All grafts were radiographically in good position at the time of follow-up. KT-1000 examination of affected knee showed less than 3 mm anterior translation difference compared with contralateral one's. Allograft group: 85 patients got normal IKDC score (81.7%). Lysholm score 82.8 +/- 8.5, Irgang score 79.2 +/- 7.3, Larson score 86.7 +/- 3.1. Autograft group: 29 patients got normal IKDC score (76.3%). Lysholm score 84.6 +/- 9.5, Irgang score 79.5 +/- 7.6, Larson score 88.9 +/- 6.8. No significant statistical difference was found between the 2 groups in the comprehend scale (P>0.05). CONCLUSIONS: Both autograft and allograft group achieve good results, and the allograft B-PT-B could provide the similar clinical result as autograft, the preliminary result of allograft reconstruction might indicate predictable result in the future.