[Limited internal fixation combined with a hinged external fixator in treatment of peri-elbow bone infection].

Objective: To evaluate the effectiveness of limited internal fixation combined with a hinged external fixator in the treatment of peri-elbow bone infection. Methods: The clinical data of 19 patients with peri-elbow bone infection treated with limited internal fixation combined with a hinged external fixator between May 2018 and May 2021 were retrospectively analyzed. There were 15 males and 4 females with an average age of 44.6 years (range, 28-61 years). There were 13 cases of distal humerus fractures and 6 cases of proximal ulna fractures. All the 19 cases were infected after internal fixation of fracture, and 2 cases were complicated with radial nerve injury. According to Cierny-Mader anatomical classification, 11 cases were type Ⅱ, 6 cases were type Ⅲ, and 2 cases were type Ⅳ. The duration of bone infection was 1-3 years. After primary debridement, the bone defect was (3.04±0.28) cm, and the antibiotic bone cement was implanted into the defect area, and the external fixator was installed; 3 cases were repaired with latissimus dorsi myocutaneous flap, and 2 cases were repaired with lateral brachial fascial flap. Bone defects repair and reconstruction were performed after 6-8 weeks of infection control. The wound healing was observed, and white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reaction protein (CRP) were reexamined regularly after operation to evaluate the infection control. X-ray films of the affected limb were taken regularly after operation to observe the bone healing in the defect area. At last follow-up, the flexion and extension range of motion and the total range of motion of the elbow joint were observed and recorded, and compared with those before operation, and the function of the elbow joint was evaluated by Mayo score. Results: All patients were followed up 12-34 months (mean, 26.2 months). The wounds healed in 5 cases after skin flap repair. Two cases of recurrent infection were effectively controlled by debridement again and replacement of antibiotic bone cement. The infection control rate was 89.47% (17/19) in the first stage. Two patients with radial nerve injury had poor muscle strength of the affected limb, and the muscle strength of the affected limb recovered from grade Ⅲ to about grade Ⅳ after rehabilitation exercise. During the follow-up period, there was no complication such as incision ulceration, exudation, bone nonunion, infection recurrence, or infection in the bone harvesting area. Bone healing time ranged from 16 to 37 weeks, with an average of 24.2 weeks. WBC, ESR, CRP, PCT, and elbow flexion, extension, and total range of motions significantly improved at last follow-up ( P<0.05). According to Mayo elbow scoring system, the results were excellent in 14 cases, good in 3 cases, and fair in 2 cases, and the excellent and good rate was 89.47%. Conclusion: Limited internal fixation combined with a hinged external fixator in the treatment of the peri-elbow bone infection can effectively control infection and restore the function of the elbow joint.

[Effect of dimethyloxalylglycine on angiogenesis in Choke â ¡ zone of cross-zone perforator flap and its mechanism].

OBJECTIVE: To study the effect of dimethyloxalylglycine (DMOG) on angiogenesis in Choke Ⅱ zone of rats cross-zone perforator flaps and its mechanism. METHODS: One hundred and twenty-six adult male Sprague Dawley rats were randomly divided into DMOG group, YC-1 group, and control group, with 42 rats in each group. Cross-zone perforator flap model with size of 12 cm×3 cm was made on the back of rats in the three groups. DMOG group was intraperitoneally injected with DMOG (40 mg/kg) at 1 day before operation, 2 hours before operation, and 1, 2, and 3 days after operation; YC-1 group and control group were intraperitoneally injected with YC-1 (10 mg/kg) and the same amount of normal saline at the same time points, respectively. The survival of flap was observed after operation. At 7 days after operation, the survival area of flap in each group was measured and the survival rate of flap was calculated. Flap transmittance test, gelatin-lead oxide angiography, and HE staining were used to observed the angiogenesis in the Choke Ⅱ zone of flaps in each group. Immunohistochemical staining and Western blot were used to detect the expressions of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor 1α (HIF-1α) in Choke Ⅱ zone of flaps in each group. The expressions of VEGF and HIF-1α were also determined by ELISA at 3, 5, and 7 days. RESULTS: At 7 days after operation, there was no obvious necrosis at the distal end of the flap in DMOG group, while necrosis occurred in both the control group and YC-1 group, mainly located at the distal end. The flap survival rate of DMOG group was 90.28%±1.37%, which was significantly higher than that of YC-1 group (84.28%±1.45%) and control group (85.83%±1.60%) ( P<0.05). DMOG group had more angiogenesis in Choke Ⅱ zone and the vascular structure was clear and complete. In YC-1 group and control group, the vessels in Choke Ⅱ zone was less and the vascular structure was disordered. The number of vessels was (25.56±1.29)/field in the DMOG group, which was significantly higher than that in the YC-1 group [(7.38±0.54)/field] and the control group [(14.48±0.91)/field] ( P<0.05). At 3, 5, and 7 days after operation, HIF-1α and VEGF expressions in ChokeⅡzone of DMOG group were significantly higher than those in YC-1 group and control group ( P<0.05). CONCLUSION: DMOG can promote angiogenesis in Choke Ⅱ zone, accelerate the early angiogenesis of the flap, improve the microcirculation and blood supply in the potential zone of the flap, reduce the injury of flap ischemia and hypoxia, and increase the survival rate of the flap.

A comparative study protocol of external fixation versus volar plate in treating distal radius fracture.

BACKGROUND: The superiority of the open reduction and internal fixation (ORIF) and external fixation remains uncertain owing to the limited sample size involved in the literature. This retrospective cohort research was implemented for the comparison of the efficiency of ORIF and external fixation utilizing the locked volar plating in treating the intra-articular fractures of distal radius. We hypothesized that compared with the external fixation, ORIF can improve the functional scores and reduce complications. METHODS: We conducted a retrospective and single-center cohort trial that was approved by institutional review committee of Gansu Provincial Hospital. From June 2016 to July 2018, in our experiment, 178 patients with intra-articular fractures of the distal radius were recruited. Inclusion criteria in this cohort study were designed as follows: the age of patients is between 18 and 65 years, the patients with American Society of Anesthesiologists level I-III, and with the AO-type C3 or C2 fractures of distal radius confirmed by computed tomography scans, the patients with radiographic clinical follow-up for 1 year or >1 year. The patients participating in the trial would be divided into 2 groups: the patients treated via the external fixation and the patients treated by the ORIF utilizing volar plate. The main functional results were the grip strength and the range of motion of wrist. Radiographic measurement and complications were also evaluated in our study. RESULTS: This study protocol will guide and clarify our assignments, and the final outcomes and conclusion will further enrich the clinical knowledge in the literature. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6116).

Skin Closure Tape and Surgical Staples in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: Staples closure technology has been widely used in total knee arthroplasty (TKA) and achieved good results. In recent years, a new type of material called skin closure tape (SCT) has been applied to TKA which also showed good treatment results. However, since it is still not clear yet which one is better, this paper collects literatures for statistical analysis so as to provide evidence for the use of SCT in TKA. METHODS: The comparative study on effects between SCT and staples is reviewed after the primary release of TKA in PubMed, the Cochrane library, and the EMBASE database up to March 2019. The two researchers independently screened the literature and evaluated the quality of the literature using bias risk tools. RESULTS: A total of four studies (3330 knees) have been included in our meta-analysis. For the main point, the results show that the SCT can reduce readmission rates compared to staples (RR 0.68, 95% CI 0.49-0.95, P=0.03), with no significant difference in complications (RR 0.85, 95% CI 0.27-2.64, P=0.77). Secondly, the results suggest that although there is no significant difference in removal time between the two groups, the SCT can reduce pains, save time and costs, and have a better cosmetic effect. CONCLUSIONS: Our study indicates SCT as a closure method with fewer complications and faster speed compared with staples. Nevertheless, the cost and pain need to be further confirmed because of the small sample size included in this study.

The efficacy of fascia iliaca compartment block for pain control after hip arthroplasty: A meta-analysis.

PURPOSE: To assess the effect of fascia iliaca compartment block (FICB) on pain control and morphine consumption in patients with total hip arthroplasty (THA). METHODS: We searched databases (PubMed, Embase, Cochrane Library) for eligible randomized controlled trials (RCTs) published prior to September 12, 2018. We only included THA patients who received FICB versus placebo for pain control. Risk ratios (RRs), standard mean differences (SMD) and 95% confidence intervals (CI) were determined. Stata 12.0 was used for the meta-analysis. RESULTS: A total of 326 THA patients from 7 RCTs were subjected to meta-analysis. Overall, FICB was associated with lower VAS scores at 1-8 h and 12 h compared with placebo (P < 0.05). However, there was no significant difference between VAS at 24 h (SMD = -0.56, 95% CI [-1.42, 0.31], P = 0.206) and 48 h after THA (SMD = -0.82, 95% CI [-2.07, 0.44], P = 0.204). Compared with the control group, FICB significantly decreased the occurrence of nausea (RR = 0.41, 95% CI 0.25 to 0.69, P = 0.010; I2 = 0.0%). There was no significant difference in the risk of falls between the FICB and control groups (P > 0.05). CONCLUSIONS: FICB has a beneficial role in reducing pain intensity and morphine consumption after THA. Moreover, FICB has morphine-sparing effects when compared with a control group. More high-quality RCTs are needed to identify the optimal technique and volume of injectate for FICB.

Optimal strategies for the prevention of heterotopic ossification after total hip arthroplasty: A network meta-analysis.

BACKGROUND: Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs), selective NSAIDs, and radiation are widely used for the prevention of heterotopic ossification (HO) after total hip arthroplasty (THA). Previous studies have suggested that nonselective NSAIDs, selective NSAIDs and radiation can prevent HO after THA, though the results are conflicting. In this network meta-analysis, we aimed to comprehensively analyze the efficacy and safety of three strategies for preventing HO after THA compared to a placebo. PATIENTS AND METHODS: Relevant studies about nonselective NSAIDs, selective NSAIDs, radiation and controls that were used to prevent HO after THA were collected. Data were extracted independently by two reviewers. Network meta-analysis was applied to assess treatment efficacy and safety. The surface under the cumulative ranking curve (SUCRA) method was used to assess which treatment was ranked the highest. The node-splitting method was used to calculate inconsistency. RESULTS: Radiation was found to be the most efficient option for preventing overall incidence of HO and Brooker IV, I, II and III HO after THA. Selective NSAIDs were the safest option, and radiation was ranked second for preventing HO after THA, as the treatments were ranked taking discontinuation caused by nongastrointestinal side effects (DNGSE) and the incidence of complications into consideration. CONCLUSIONS: A network meta-analysis concluded that radiation is the most efficacious method for preventing HO after THA.

Is opening-wedge high tibial osteotomy superior to closing-wedge high tibial osteotomy in treatment of unicompartmental osteoarthritis? A meta-analysis of randomized controlled trials.

BACKGROUND: High tibial osteotomy (HTO) is an effective surgical technique that can stop or inhibit progression of knee osteoarthritis (OA) and avoid or postpone the need for knee arthroplasty. This meta-analysis determined whether opening-wedge high tibial osteotomy (OWHTO) was superior to closing-wedge high tibial osteotomy (CWHTO) in treatment of unicompartmental OA. METHODS: Databases (PubMed, Embase, Web of Science, Cochrane Library and Google) were searched from the time of their establishment to 1st August 2018 for randomized controlled trials (RCTs) comparing OWHTO and CWHTO in patients with unicompartmental OA. The Cochrane risk of bias tool was used to assess methodological quality. Statistical analysis was performed with Stata 12.0. RESULTS: Nine RCTs (599 participants) were included in this meta-analysis. The pooled results showed that there were no significant differences between OWHTO and CWHTO VAS knee pain scores, HSS knee scores, walking distances or hip-knee-ankle (HKA) angles (P > 0.05). Furthermore, there were no significant differences between the two groups in complication and survival rates (p > 0.05). Nevertheless, there was a significantly greater tibial slope angle in OWHTO patients (P < 0.00001). CONCLUSION: CWHTO reduced the inclination of the tibial plateau, whereas OWHTO increased the posterior tilt, and these factors should be considered in the specific need of an individual patient when choosing the type of osteotomy. Therefore, we are unable to conclude which method is superior.

[Research on characteristics of soil clay mineral evolution in paddy field and dry land by XRD spectrum].

The present paper took the typical saline-alkali soil in Jilin province as study object, and determinated the soil clay mineral composition characteristics of soil in paddy field and dry land. Then XRD spectrum was used to analyze the evolutionary mechanism of clay mineral in the two kinds of soil. The results showed that the physical and chemical properties of soil in paddy field were better than those in dry land, and paddy field would promote the weathering of mineral particles in saline-alkali soil and enhance the silt content. Paddy field soil showed a strong potassium-removal process, with a higher degree of clay mineral hydration and lower degree of illite crystallinity. Analysis of XRD spectrum showed that the clay mineral composition was similar in two kinds of soil, while the intensity and position of diffraction peak showed difference. The evolution process of clay mineral in dry land was S/I mixture-->vermiculite, while in paddy field it was S/I mixture-->vermiculite-->kaolinite. One kind of hydroxylated 'chlorite' mineral would appear in saline-alkali soil in long-term cultivated paddy field. Taking into account that the physical and chemical properties of soil in paddy field were better then those in dry land, we could know that paddy field could help much improve soil structure, cultivate high-fertility soil and improve saline-alkali soil. This paper used XRD spectrum to determine the characteristics of clay minerals comprehensively, and analyzed two'kinds of land use comparatively, and was a new perspective of soil minerals study.

[Analysis of XRD spectral characteristics of soil clay mineral in two typical cultivated soils].

The present paper took black soil and chernozem, the typical cultivated soil in major grain producing area of Northeast, as the study object, and determinated the soil particle composition characteristics of two cultivated soils under the same climate and location. Then XRD was used to study the composition and difference of clay mineral in two kinds of soil and the evolutionary mechanism was explored. The results showed that the two kinds of soil particles were composed mainly of the sand, followed by clay and silt. When the particle accumulation rate reached 50%, the central particle size was in the 15-130 microm interval. Except for black soil profile of Shengli Xiang, the content of clay showed converse sequence to the central particle in two soils. Clay accumulated under upper layer (18.82%) in black soil profile while under caliche layer (17.41%) in chernozem profile. Clay content was the least in parent material horizon except in black profile of Quanyanling. Analysis of clay XRD atlas showed that the difference lied in not only the strength of diffraction peak, but also in the mineral composition. The main contents of black soil and chernozem were both 2 : 1 clay, the composition of black soil was smectite/illite mixed layer-illite-vermiculite and that of chernozem was S/I mixture-illite-montmorillonite, and both of them contained little kaolinite, chlorite, quartz and other primary mineral. This paper used XRD to determine the characteristics of clay minerals comprehensively, and analyzed two kinds of typical cultivated soil comparatively, and it was a new perspective of soil minerals study.

Clinical significance of protocadherin-8 (PCDH8) promoter methylation in bladder cancer.

OBJECTIVE: To investigate the clinical significance of protocadherin-8 (PCDH8) promoter methylation in bladder cancer. METHODS: Methylation-specific polymerase chain reaction was used to examine the promoter methylation status of PCDH8 in tumour tissue samples obtained from patients with bladder cancer, and in normal bladder epithelial tissue samples obtained from age- and sex-matched control subjects. Methylation status was correlated with demographic, clinical and pathological parameters and disease outcome. RESULTS: PCDH8 promoter methylation was detected in 76/135 (56.3%) patients with bladder cancer and none of 34 (0%) control subjects. Methylation was significantly associated with advanced stage (T2-T4), high grade (G3), tumour recurrence, larger tumour diameter (>3 cm) and nonpapillary morphology. In addition, methylation was associated with significantly shorter survival time and was an independent predictor of overall survival. CONCLUSIONS: PCDH8 promoter methylation is a common occurrence in bladder cancer, and is associated with malignant behaviour and poor prognosis. Determination of PCDH8 promoter methylation status in tumour tissue may assist in the identification of patients who require aggressive postoperative intervention in order to improve prognosis.