Long non-coding RNA PMS2L2 is down-regulated in osteoarthritis and inhibits chondrocyte proliferation by up-regulating miR-34a.

Long non-coding RNA (lncRNA) PMS2L2 has been reported to participate in endotoxin-induced inflammatory responses. As these types of responses can promote osteoarthritis (OA), it was of interest to ascertain if PMS2L2 may be involved in OA. To explore any potential participation of PMS2L2 in OA, synovial fluid was extracted from both OA patients and healthy controls (n = 62 each) and PMS2L2 expression of each sample determined by RT-qPCR. In addition, as miR-34a has a potential binding site on PMS2L2, hypothetical interactions between PMS2L2 and miR-34a in chondrocytes were analyzed by performing over-expression experiments. Furthermore, the role of PMS2L2 and miR-34a in the regulation of chondrocyte proliferation was analyzed using CCK-8 and BrdU assays. The results showed that PMS2L2 expression in OA patient synovial fluid was lower compared to that in control group fluid, and the extent of this reduction was related to disease stage. In in vitro studies, it was seen that endotoxin treatment of chondrocytes led to decreased PMS2L2 expression. It was found that PMS2L2 over-expression caused increased miR-34a expression in OA patient chondrocytes but not in cells from healthy controls. In contrast, miR-34a over-expression in either cell population did not affect PMS2L2 expression. Lastly, over-expression of both PMS2L2 and miR-34a led to inhibited chondrocyte proliferation. Of note, a combined over-expression of PMS2L2 and miR-34a resulted in stronger effects on proliferation compared to that from either single over-expression. Based on the findings that PMS2L2 is down-regulated during ongoing states of OA, and that changes in PMS2L2 expression can lead to increases in chondrocyte expression of miR-34a - resulting in inhibition of chondrocyte proliferation in OA. From these findings, one may conclude that finding means to regulate PMS2L2 could be a promising new target in the development of regimens for the treatment of OA.

[Treatment of calcaneal fracture by closed reduction and minimally invasive plate fixation assisted with bidirectional distractor distraction].

OBJECTIVE: To investigate clinical effects of calcaneal fracture with closed reduction and minimally invasive plate fixation assisted with bidirectional distractor distraction. METHODS: From September 2015 to October 2016, 11 male patients(13 feet) with calcaneal fractures treated with bidirectional distractor distraction assisted with minimally invasive plate fixation were retrospectively studied. They were aged from 24 to 57 years old with an average of 36.4 years old;8 feet were type IIand 5 feet were type III according to Sanders classification. Postoperative incision, fracture healing, Böhler angle, Gissane angle were observed and Maryland scoring system was used to evaluate clinical effects. RESULTS: All fractures healed well without incision inflammation and incision disunion. All patients were followed up from 12 to 15 months with an average of 13.5 months. Böhler angle were improved from (9.6±7.3)° before operation to (20.2±4.6) ° at 1 year after operation, and had statistical meaning; Gissane angle increased from (92.7 ±8.5)° before operation to (121.7 ±7.6) ° at 1 year after operation. Maryland score at 1 year after operation was 88.79±8.25, and 11 feet got excellent results and 2 feet moderate. CONCLUSIONS: Bidirectional distractor distraction assisted with minimally invasive plate fixation could effectively fix calcaneal fractures, reduce postoperative complications, and get satisfied results of postoperative images and functional recovery. It is one of effective methods for treating Sanders II and III calcaneal fractures.

miR-214 suppresses the osteogenic differentiation of bone marrow-derived mesenchymal stem cells and these effects are mediated through the inhibition of the JNK and p38 pathways.

In this study, we sought to investigate the expression of microRNA (miR)-214 on the osteogenic differentiation of bone marrow­derived mesenchymal stem cells (BMSCs) and explore the possible underlying mechanisms. We found that the overexpression of miR­214 effectively promoted the adipocyte differentiation of BMSCs in vitro, reduced alkaline phosphatase (ALP) activity and the gene expression of collagen type I (Col I), osteocalcin (OCN) and osteopontin (OPN) in the BMSCs. We further found that the overexpression of miR­214 suppressed the protein expression of fibroblast growth factor (FGF), phosphorylated c­Jun N-terminal kinase (p-JNK) and phosphorylated p38 (p-p38) in the BMSCs. The downregulation of miR­214 promoted the osteogenic differentiation of BMSCs, and increased ALP activity and Col I, OCN and OPN gene expression in the BMSCs. It also increased FGF p-JNK and p-p38 protein expression in the BMSCs. The use of JNK inhibitor (SP600125) enhanced the inhibitory effects of miR­214 overexpression on osteogenic differentiation, ALP activity, and Col I, OCN and OPN gene expression in the BMSCs. Lastly, the use of p38 inhibitor (SB202190) also enhanced the inhibitory effects of miR­214 overexpression on ALP activity, and Col I, OCN and OPN gene expression in the BMSCs. These results provide a mechanism responsible for the suppressive effects of miR­214 on the osteogenic differentiation of BMSCs involving the inhibition of the JNK and p38 pathways.

Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture: A randomized clinical trial in 64 patients.

BACKGROUND: We conducted a prospective randomized clinical trial to compare the clinical and radiological outcomes of the sinus tarsi and extended lateral approaches for the surgical treatment of displaced intraarticular calcaneal fractures. METHODS: Between January 2009 and January 2014, patients with displaced intraarticular calcaneal fracture were randomly assigned to receive surgical treatment by the sinus tarsi approach or the extended lateral approach using block randomization. We recorded and analyzed data on demographics, time to surgery, wound complications, Böhler angles pre- and postoperatively, and American Orthopedic Foot & Ankle Society score. RESULTS: Sixty-four patients met the inclusion criteria and were randomly assigned to the 2 groups: 32 patients underwent sinus tarsi approach, and 32 patients the extended lateral approach. Baseline characteristics of both groups were similar. The time to surgery in the sinus tarsi approach group was significantly shorter than in the extended lateral approach group (P = 0.04). The wound complication rates were 6.3% and 31.2% in the sinus tarsi approach and extended lateral approach groups, respectively, which was significantly different (P = 0.01). Regarding the clinical outcomes, the groups did not differ significantly on walking visual analogue scale or American Orthopedic Foot & Ankle Society scores at 6 months and 1 year postoperatively. No significant differences existed between groups regarding the Böhler angle at different times and reduction quality of the articular surface and the medial wall. CONCLUSION: Compared with the extended lateral approach, the sinus tarsi approach decreased wound complications and preoperative waiting time, and achieved similar functional and radiological outcomes for displaced intraarticular calcaneal fractures.

What Are the Risk Factors for Dislocation of Hip Bipolar Hemiarthroplasty Through the Anterolateral Approach? A Nested Case-control Study.

BACKGROUND: Hip dislocation after treatment of a femoral neck fracture with a hemiarthroplasty remains an important problem in the treatment of hip fractures, but the associations between patient factors and surgical factors, and how these factors contribute to dislocation in patients who have undergone bipolar hemiarthroplasty through an anterolateral approach for femoral neck fracture currently are only poorly characterized. QUESTIONS/PURPOSES: We evaluated patients with bipolar hemiarthroplasty dislocation after surgery for femoral neck fracture treated through an anterolateral approach and asked: (1) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dislocations? (2) What are the frequency, characteristics, and risk factors of bipolar hemiarthroplasty dissociations? METHODS: A review of hospital records for patients who underwent bipolar hip hemiarthroplasty for femoral neck fracture at one hospital between July 2004 and August 2014 was conducted. During that time, 1428 patients were admitted with a diagnosis of femoral neck fracture; 508 of these patients underwent bipolar hip hemiarthroplasty, of whom 61 died and 23 were lost to followup during the first year, leaving 424 (83%) available for analysis. The remainder of the patients during that time were treated with internal fixation (512), unipoloar hip arthroplasty (17), or THA (391). For each patient with dislocation, we selected five control patients from the cohort according to sex, age (± 3 years), and year of entry in the study to eliminate some confounding factors. We recorded patient characteristics regarding demographics, medical comorbidities, Katz score, American Society of Anesthesiologists score, Mini-Mental State Examination (MMSE) score, and anesthesia type. Medical comorbidities included diabetes, chronic pulmonary disease, heart disease, neuromuscular diseases, and dementia. Univariate analyses were used to search for possible risk factors. Conditional logistic regression analyses on dislocation or dissociation were performed to estimate hazard rates (HRs) and corresponding 95% CIs with covariates of a probability less than 0.1 in univariate analysis. RESULTS: In this cohort, there were 26 dislocations including four that were also dissociations. The proportion of patients experiencing a dislocation was 6% (26 of 424). The mean interval from surgery to dislocation was 56 weeks (range, 0-433 weeks), and 18 dislocations (69%) occurred within 3 months after surgery. Three variables were independently associated with an increased risk of hip dislocation: dementia (HR, 3.51; 95% CI, 1.19-10.38; p = 0.02), discrepancy of offset (HR, 1.72; 95% CI, 1.15-2.58; p = 0.008), and lower MMSE score (HR, 0.93; 95% CI, 0.88-0.98; p = 0.007). The proportion of patients experiencing a dissociation was 0.9% (four of 424). The result of conditional logistic regression for dissociation showed that cup size smaller than 43 mm was the risk factor (HR = 513.05). However, there was no statistical difference with the probability equaling 0.47. CONCLUSIONS: After the anterolateral approach for treatment of femoral neck fracture using bipolar hemiarthroplasty, 6% of hips dislocated and 0.9% experienced dissociation. Cognitive dysfunction and discrepancy of offset were independent risk factors associated with an increased risk of prosthetic dislocation. The small cup without a safety ring may be the risk factor of dissociation. Discrepancy of offset should be avoided during the operation by performing an accurate femoral osteotomy and choosing an adequate femoral stem neck length. For patients with cognitive dysfunction and a small cup, suturing the joint capsule during the operation and reinforcing protective measures after surgery might reduce the occurrence of dislocation and dissociation, however a study addressing this is necessary to confirm this. LEVEL OF EVIDENCE: Level III, therapeutic study.

The Treatment of Mid-shaft Clavicle Fractures.

OBJECTIVE: Through reviewing the relevant literature from the past decades, to summarize the assessment and management of fractures of the clavicle, and provide an overview of the clinical results of a range of treatment options. DATA SOURCES: The data analyzed in this review are mainly from articles included in PubMed and EMBASE, published from 1960 to 2015. STUDY SELECTION: Studies involving assessment of fractures of the clavicle were reviewed. Further literatures were gathered regarding the conservative and surgical treatment of these fractures, including the methods of fixation and the surgical approaches used. Both conservative and surgical treatments were then compared and contrasted. RESULTS: Through retrieving and reading the abstract, a total of 42 representative articles were selected, which covered all aspects of the conservative treatment and surgical treatment, and compared the advantages and disadvantages of different treatment options. CONCLUSIONS: Although the majority of recent data suggest that surgery may be more appropriate as it improves functional outcome and reduces the risk of complications, we recommend that the treatment should be individually assessed.