Long noncoding RNA HOTAIR promotes the proliferation and metastasis of osteosarcoma cells through the AKT/mTOR signaling pathway.

It has been proven that long non-coding (lnc)RNAs serve an important role in the tumorigenesis and development of several types of human malignancy. Previous studies have demonstrated that the lncRNA Hox transcript antisense intergenic RNA (HOTAIR) is involved in the development various types of cancer, including osteosarcoma (OS). However, the underlying mechanisms by which it has an affect are still largely unknown. In the present study, it was observed that the expression of HOTAIR was significantly upregulated in OS tissues compared to matched adjacent normal tissues, using reverse transcription-quantitative polymerase chain reaction analysis. HOTAIR was silenced using specific small interfering RNA (siRNA/siR), siR-HOTAIR, in order to investigate its role in regulating OS cell proliferation, apoptosis, migration and invasion. siR-HOTAIR inhibited the proliferation of MG-63 cells due to the induction of G1 phase arrest. In addition, the results of in vitro assays demonstrated that the suppression of HOTAIR in MG-63 OS cells significantly reduced migration and invasion. The silencing of HOTAIR also significantly decreased the expression of matrix metalloproteinase (MMP) 2 and MMP9, but increased E-cadherin expression through regulating the RAC α serine/threonine protein kinase-mammalian target of rapamycin signaling pathway. The results indicated that siR-HOTAIR may be a potential OS therapy.

Femoral neck shortening in adult patients under the age of 55 years is associated with worse functional outcomes: Analysis of the prospective multi-center study of hip fracture outcomes in China (SHOC).

INTRODUCTION: Young femoral neck fracture patients require surgical fixation to preserve the native hip joint and accommodate increased functional demands. Recent reports have identified a high incidence of fracture shortening and this may have negative functional consequences. We sought to determine if fracture shortening is associated with poor functional outcome in young femoral neck fracture patients. PATIENTS AND METHODS: One hundred and forty-two patients with femoral neck fractures age 18-55 were recruited in this prospective cohort study across three Level 1 trauma hospitals in Mainland China. Patient-reported and objective functional outcomes were measured with the Harris Hip Score (HHS), Timed Up and Go (TUG), and SF-36 Physical Component Summary (SF-36 PCS) at 12 months. Radiographic fracture shortening was measured along the long axis of the femoral neck and corrected for magnification. Severe shortening was defined as ≥10mm. The primary analysis measured associations between severe radiographic shortening and HHS at one-year post-fixation. RESULTS: One hundred and two patients had complete radiographic and functional outcomes available for analysis at one year. The mean age of participants was 43.7±10.8years and 53% were male. Fifty-five percent of fractures were displaced and 37% were vertically orientated (Pauwels Type 3). The mean functional outcome scores were: HHS 90.0±10.8, TUG 12.0±5.1s, and PCS 48.5±8.6. Severe shortening occurred in 13% of patients and was associated with worse functional outcome scores: HHS mean difference 9.9 (p=0.025), TUG mean difference 3.2s (p=0.082), and PCS mean difference 5.4 (p=0.055). CONCLUSIONS: Severe shortening is associated with clinically important decreases in functional outcome as measured by HHS following fixation of young femoral neck fractures, occurring in 13% of patients in this population. The principle of fracture site compression utilized by modern constructs may promote healing; however, excessive shortening is associated with worse patient-reported outcomes and objective functional measures.

Femoral Neck Fractures in Adults Treated With Internal Fixation: A Prospective Multicenter Chinese Cohort.

INTRODUCTION: Although femoral neck fractures in young patients are rare and their complications are well-documented, there is a paucity of data on patient-reported outcomes for this population. The purpose of this study was to describe the quality of life and the effect of clinical complications on the outcomes of young patients with femoral neck fractures in a Chinese cohort. METHODS: In this prospective observational cohort study, patients aged 18 to 55 years admitted to one of three participating trauma hospitals in China for treatment of a femoral neck fracture were recruited. The primary outcome was the patient's health-related quality of life using the Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey at 1 year after injury. Associations between the primary outcome and potential predictors were explored with univariate and multivariate regression analysis. RESULTS: One hundred seven patients (mean age, 44 years) completed 1-year follow-up. Nearly all patients were treated with closed reduction and screw fixation. Nine cases of nonunion, 7 cases of malunion, and 11 cases of osteonecrosis were identified. The mean SF-36 Physical Component Score was 48.6 ± 8.5, and the mean Mental Component Score was 51.0 ± 7.4. Fracture displacement, quality of reduction, and nonunion were associated with a poor Physical Component Score outcome. DISCUSSION: Our results demonstrate that the quality of life for patients after closed reduction and screw fixation of femoral neck fractures is similar to that of the general population, particularly when complications of nonunion and malunion are avoided. LEVEL OF EVIDENCE: Level I.

[Case-control study on two suturing methods for the repairing of complete rupture of the deltoid ligament].

OBJECTIVE: To compare clinical outcomes between two suturing methods using non absorbable materials through drilling the bone and suturing anchors for the treatment of complete rupture of the deltoid ligament. METHODS: From January 2009 to January 2013, 58 hospitalized patients with ankle fracture combined with complete rupture of the deltoid ligament were treated with suturing using non absorbable materials through drilling the bone or suturing anchors. There were 29 patients who received suturing treatments using non absorbable materials through drilling the bone (Group A), including 18 males and 11 females, with an average age of (39.76 +/- 11.81) years old. According to the Lauge-Hansen classification, 12 patients had supination external rotation (SER) injuries with IV degree, 5 patients had pronation external rotation (PER) injuries with III degree, 10 patients had PER injuries with IV degrss, and 2 patients had pronation abduction injuries with III degree. There were 29 patients who received treatments with suturing using anchors (Group B), including 14 males and 15 females, with an average age of (41.79 +/- 13.28) years old. According to the Lauge-Hansen classification,9 patients had SER injuries with IV degree, 6 patients had PER injuries with III degree,13 patients had PER injuries with IV degree, and 1 patient had pronation abduction injuries with III degree. All the patients were treated with open reduction and internal fixation, as well as reconstruction of deltoid ligaments to restore the stability of the medial ankle structures. The clinical examination, imaging evaluation, American society for ankle surgery (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the clinical results after operation, and the results of the two groups were compared and analyzed statistically. RESULTS: The follow-up duration of the 58 patients ranged from 23 to 40 months,with an average of 27.3 months. All the patients had fracture union, and the mean healing time was 12.3 weeks (ranged, 10 to 17 weeks). There were no incision complications and ankle instability. There were no significant differences between two groups in AOFAS (P=0.666) and the VAS (P=0.905). CONCLUSION: Treatments of complete rupture of the deltiod ligaments with the two suturing methods get similar good clinical effects, but the suturing using non absorbable materials through drilling the bone has several advantages such as reducing the financial burden of patients, saving social medical resources and avoiding the shortcoming in difficult removal of anchor suture.

Endothelin-1 concentrations are correlated with the severity of knee osteoarthritis.

Endothelin-1, a potent vasoconstrictor regulator, contributes to articular cartilage destruction. Therefore, we aim to assess the correlation of endothelin-1 concentrations with the development and severity of knee osteoarthritis (OA). This study included a population of 209 patients with knee OA. Kellgren-Lawrence (KL) grading was utilized to score the severity of OA. The case group had higher serum endothelin-1 concentrations than controls. Patients with knee OA with a relatively higher grade showed significantly elevated serum and synovial fluid (SF) endothelin-1 concentrations compared with those with lower KL grades. A significant correlation was found between serum and SF endothelin-1 concentrations and KL grades. Serum and SF endothelin-1 concentrations are correlated with the development and progression of knee OA.

Analysis of complications of intertrochanteric fracture treated with Gamma 3 intramedullary nail.

UNLABELLED: Whether Gamma 3 fixation system is suitable for all intertrochanteric fractures is inconclusive. This paper analyzed the surgical complications of Gamma 3 intramedullary nail in the treatment of intertrochanteric fractures. METHODS: A total of 186 cases were enrolled in the study including 115 males and 71 females. The surgical operations were performed in all cases and Gamma 3 intramedullary nail was inserted in medullary cavity. RESULTS: Anti-rotation screw displacement into the intermuscular space of inner thigh occurred in 1 case, lateral femoral wall defect in 3 cases; refracture of proximal femur shaft during the Gamma 3 nail inserting into the medullary cavity occurred in 5 cases and fractures with a gap or malalignment in closed reduction of A3 type in occurred 6 cases. Fracture union occurred in 3-4 months postoperative. Recovery situations of all patients were evaluated based on Harris scoring system 6 with an average of 87 points. There are indications and shortcomings in the treatment of intertrochanteric fracture with Gamma 3 intramedullary nail. CONCLUSION: Understanding the surgical indications, standardizing the operation and upgrading skills are the key points to ensure operation successful, reduce complications and improve clinical outcomes.

MiR-145 inhibits osteosarcoma cells proliferation and invasion by targeting ROCK1.

MicroRNAs (miRNAs) contribute to the development and progression of various types of human cancers. The aim of this study was to study the role of miR-145 and to identify its functional target gene in osteosarcoma (OS) cells. We found that miR-145 was reduced in OS tissues and cell lines. Enforced expression of miR-145 inhibited cell proliferation, migration, and invasion abilities of MG-63 cells. Furthermore, we revealed that Rho-associated protein kinase 1 (ROCK1) was a target of miR-145 in OS. Finally, we found that silencing of ROCK1 performed similar effects with miR-145 in MG-63 cells, and ROCK1 was inversely correlated with miR-145 in OS tissues. Collectively, these data indicate that miR-145 may act as a tumor suppressor and contributes to the progression of OS through targeting ROCK1.

Evaluation and clinical application of sacral s1 vestibule measurements in chinese adults / Evaluación y aplicación clínica de las mediciones del vestíbulo sacral s1 en adultos chinos

This study aims to measure the anatomic parameters of the sacral 1 (S1) vestibule in Chinese adults and to discuss their clinical application during iliosacral screw fixation for pelvic posterior ring injury. Three-dimensional computed tomography (CT) reconstructions were performed on 36 individuals, and the parameters of their S1 vestibules were measured. Vestibular width (VW) was 25.15±2.91 mm, vestibular height (VH) was 20.94±3.03 mm, and mean vestibular size (VS) was 400.23±85.11 mm2. The mean angle of superior inclination was 30.85°±9.22°, and the mean anterior inclination (AI) was 13.91°±6.25°. VW and VS were significantly smaller in females than in males (p<0.05), but no statistical differences were found between the left and right sides. The S1 vestibules of Chinese patients are smaller than those reported for Caucasians. Therefore, the placement of iliosacral screws should be considered carefully based on the size, gender, and ethnicity of the patient. The anatomic parameters of females were much smaller than those of males and close to the minimum requirement for fracture fixation. Therefore, female Chinese patients who need iliosacral screws should undergo preoperative CT scans to measure S1 vestibule parameters to make individual operational plans.

El estudio tuvo como objetivo medir los parámetros anatómicos del vestíbulo sacral 1 (S1) en individuos adultos chinos y discutir su aplicación clínica durante la fijación de tornillo iliosacral por lesiones del anillo pélvico posterior. Se realizaron reconstrucciones de tomografía computarizada tridimensional (TC) en 36 individuos y se midieron los parámetros de sus vestíbulos S1. El ancho vestibular (AV) fue 25,15±2,91 mm, la altura vestibular fue 20,94±3,03 mm y el tamaño medio vestibular (TV) fue 400,23±85,11 mm2. El ángulo medio de inclinación superior fue 30,85°±9,22° e inclinación anterior media fue 13,91°±6,25°. AV y TV fueron significativamente menores en las mujeres que en los hombres (p<0,05), sin embargo no se encontraron diferencias estadísticas entre los lados izquierdo y derecho. Los vestíbulos S1 de pacientes chinos son más pequeños que los reportados para los caucásicos. Por lo tanto, la colocación de tornillos iliosacros debe ser considerada cuidadosamente basada en el tamaño, el sexo y origen étnico del paciente. Los parámetros anatómicos de las mujeres eran significativamente más pequeños que los de los hombres y cercanos al requerimiento mínimo para la fijación de fracturas. Por lo tanto, pacientes de sexo femenino chino que requieren tornillos iliosacros deben ser sometidos a tomografías computarizadas preoperatorias para medir los parámetros del vestíbulo S1 a con el objetivo de programar un plan operativo individual.

MiR-143 suppresses osteogenic differentiation by targeting Osterix.

Osterix (Osx) is an essential transcription factor for osteoblast differentiation and bone formation. However, the knowledge of the regulation of Osx expression is poor. MicroRNAs (miRNAs), a class of small non-coding RNAs, play critical roles in numerous biological processes, including the proliferation, differentiation, and survival of cells and organisms. Herein, we aimed to explore the effect of miR-143 on Osx expression and osteogenic differentiation. miR-143, which was suppressor of the osteogenic differentiation of MC3T3-E1 cells, had decreased levels of expression during osteogenic differentiation. Moreover, Osx was identified to be a direct target of miR-143. Inhibition of Osx performed similar effect with miR-143 on osteogenic differentiation, while overexpression of Osx could partially reverse the suppressive effect of miR-143. Collectively, these data indicate that miR-143 is a novel regulator of Osx, and it might play an essential role in the regulation of osteogenic differentiation.

Stress-induced hyperglycemia after hip fracture and the increased risk of acute myocardial infarction in nondiabetic patients.

OBJECTIVE: To investigate the risk of acute myocardial infarction (AMI) following stress hyperglycemia after hip fracture. RESEARCH DESIGN AND METHODS: From February 2007 to February 2012, we carried out a prospective observational analysis of 1,257 consecutive patients with no history of diabetes who suffered hip fractures. Fasting blood glucose (FBG) and glycosylated hemoglobin tests as well as electrocardiography, ultrasonic cardiography, and chest X-ray examinations were performed after admission. All selected hip fracture patients were divided into stress hyperglycemia and non-hyperglycemia groups according to their FBG, and the incidence of AMI was monitored. RESULTS: Among the patients enrolled, the frequency of stress hyperglycemia was 47.89% (602/1,257) and that of AMI was 9.31% (117/1,257), and the occurrence of AMI in the stress hyperglycemia group was higher than in the non-hyperglycemia group (12.46 vs. 6.41%, P<0.05). In the stress hyperglycemia patients, FBG reached maximum levels at 2-3 days after hip fractures and then decreased gradually. The AMI incidence (62.67% [47/75]) of the stress hyperglycemia group was highest in the initial 3 days after hip fracture, significantly coinciding with the FBG peak time (P<0.05). In all patients with AMI, non-ST-segment elevation myocardial infarction occurred more often than ST-segment elevation myocardial infarction (62.39% [73/117] vs. 37.61% [44/117]). CONCLUSIONS: Stress-induced hyperglycemia after hip fracture increased the risk of AMI.

Treatment of posttraumatic equinus deformity and concomitant soft tissue defects of the heel.

BACKGROUND: To evaluate the operative method and clinical outcome for the treatment of posttraumatic equinus deformity and concomitant soft tissue defect of the heel. METHODS: Between June 2006 and May 2010, seven cases of posttraumatic equinus deformity and concomitant unstable scar or ulcer of the heels were treated by using a hinged Ilizarov apparatus and reversed sural fasciocutaneous island flap transfer. Achilles tendon lengthening was also done in all patients. The average duration of follow-up was 21 months. The sizes of sural flaps were from 7 cm × 6 cm to 10 cm × 9 cm. Two weeks after the flap transfer, distraction of the Ilizarov fixator was initiated to gradually correct the equinus position of the foot. RESULTS: Results were evaluated by using the following criteria: (1) the degree of active dorsiflexion of the ankle, (2) the total active range of motion of the ankle, and (3) walking ability and flap durability. For active dorsiflexion of the ankle, the results were good in three patients and fair in four patients. For range of active motion of the ankle, the results were good in five patients and fair in two patients. For walking ability and flap durability, the results were good in six patients and fair in one patient. CONCLUSION: This study showed that posttraumatic equinus deformity accompanied by soft tissue defect of the heel can be treated effectively with Achilles tendon lengthening, reversed sural fasciocutaneous island flap transfer, and a hinged Ilizarov technique.

Surgical treatment of open pilon fractures.

OBJECTIVE: To discuss the methods, timing and clinical outcomes of surgical treatment for open pilon fractures. METHODS: From April 2003 to July 2008, 28 patients with open pilon fractures were treated. All had type C fractures according to the Arbeitsgemeinschaft für osteosynthesefragen-Association for the Study of Internal Fixation (AO/ASIF) classification. Three operative methods were applied, the methods being determined by the types of fracture, soft tissue damage and time interval after injury. Seven cases were treated by debridement and internal fixation with plate; 19 by limited internal fixation combined with external fixation; and 2 by delayed surgery. The clinical outcomes were evaluated by the Burwell-Charnley score. RESULTS: All cases were followed up for from 6 to 48 months (average 24 months). The Burwell-Charnley score of clinical outcomes: anatomic reduction achieved in 12 cases, functional reduction in 15, and unsatisfactory reduction in 1. The healing time was from 2.5 to 11 months (average 4.7 months). Two cases had delayed union. According to the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle joint, there were excellent results in 8 cases, good in 14, fair in 5 and poor in 1. Complications included four cases of skin superficial sloughing, two of superficial infection, one of deep infection, two of delayed fracture union and ten of post-traumatic arthritis. CONCLUSION: It is important to perform appropriate surgeries for open pilon fracture according to fracture classification, different damage to skin and tissue and time interval after injury. Thorough debridement, proper use of anti-infective medication, appropriate bone grafting, and postoperative ankle function exercise can reduce the occurrence of complications.

Prophylaxis against venous thromboembolism in orthopedic surgery.

Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. They are frequent complications of various surgical procedures. The aging population and the survival of more severely injured patients may suggest an increasing risk of thromboembolism in the trauma patients. Expanded understanding of the population at risk challenges physicians to carefully examine risk factors for VTE to identify high-risk patients who can benefit from prophylaxis. An accurate knowledge of evidence-based risk factors is important in predicting and preventing postoperative DVT, and can be incorporated into a decision support system for appropriate thromboprophylaxis use. Standard use of DVT prophylaxis in a high-risk trauma population leads to a low incidence of DVT. The incidence of VTE is common in Asia. The evaluation includes laboratory tests, Doppler test and phlebography. Screening Doppler sonography should be performed for surveillance on all critically injured patients to identify DVT. D-Dimer is a useful marker to monitor prophylaxis in trauma surgery patients. The optimal time to start prophylaxis is between 2 hours before and 10 hours after surgery, but the risk of PE continues for several weeks. Thromboprophylaxis includes graduated compression stockings and anticoagulants for prophylaxis. Anticoagulants include Warfarin, which belongs to Vitamin K antagonists, unfractionated heparin, low molecular weight heparins, factor Xa indirect inhibitor Fondaparinux, and the oral IIa inhibitor Melagatran and ximelagatran. Recombinant human soluble thrombomodulin is a new and highly effective antithrombotic agent. Prophylactic placement of vena caval filters in selected trauma patients may decrease the incidence of PE. The indications for prophylactic inferior vena cava filter insertion include prolonged immobilization with multiple injuries, closed head injury, pelvic fracture, spine fracture, multiple long bone fracture, and attending discretion. Multiple-trauma patients are at increased risk for DVT but are also at increased risk of bleeding, and the use of heparin may be contraindicated. Serial compression devices (SCDs) are an alternative for DVT prophylaxis. Compression devices provide adequate DVT prophylaxis with a low failure rate and no device-related complications. Immobilization is one of important reasons of VTE. The ambulant patient is far less likely to develop complications of inactivity, not only venous thrombosis, but also contractures, decubitus ulcers, or osteoporosis (with its associated fatigue fractures), as well as bowel or bladder complications.