Repairing of recurrent leg ulcer induced by hydroxyurea with posterior tibial artery perforator propeller flap: Case report.

INTRODUCTION AND IMPORTANCE: Hydroxyurea is a cytotoxic drug commonly used to treat various myeloproliferative disorders. However, prolonged oral administration of this drug may trigger skin side effects and ulcers. There are few clinical reports on treating leg ulcers caused by hydroxyurea and even fewer clinical reports on managing recurrent ulcers after treatment. CASE PRESENTATION: An 87-year-old woman with essential thrombocythemia presented with a painful skin ulcer on her left calf. After failed outpatient treatment, she opted for hospitalisation for free skin grafting. Four months later, ulcers reappeared at the transplant site, leading to her readmission to the hospital. The diagnosis revealed that the leg ulcers were caused by hydroxyurea. Despite this, she persisted with hydroxyurea treatment and subsequently underwent posterior tibial artery perforator flap surgery. During the two-year follow-up, a new ulcer developed on the medial condyle of her other calf. However, no new ulcers or local pain were observed in the area where perforator flap grafting was performed. CLINICAL DISCUSSION: Leg ulcers caused by hydroxyurea are rare clinically and can easily be misdiagnosed. There is currently minimal research on ulcer recurrence after treatment. Posterior tibial perforator flaps may more effectively promote the healing of recurrent ulcers. CONCLUSION: Compared to conservative treatment and skin grafting surgery, the posterior tibial artery perforator flap offers a dependable blood supply and enhances the likelihood of wound healing. It can be considered an option, particularly for recurrent and refractory ulcers, even without discontinuing medication.

Estimating intrafraction tumor motion during fiducial-based liver stereotactic radiotherapy via an iterative closest point (ICP) algorithm.

BACKGROUND: Tumor motion may compromise the accuracy of liver stereotactic radiotherapy. In order to carry out a precise planning, estimating liver tumor motion during radiotherapy has received a lot of attention. Previous approach may have difficult to deal with image data corrupted by noise. The iterative closest point (ICP) algorithm is widely used for estimating the rigid registration of three-dimensional point sets when these data were dense or corrupted. In the light of this, our study estimated the three-dimensional (3D) rigid motion of liver tumors during stereotactic liver radiotherapy using reconstructed 3D coordinates of fiducials based on the ICP algorithm. METHODS: Four hundred ninety-five pairs of orthogonal kilovoltage (KV) images from the CyberKnife stereo imaging system for 12 patients were used in this study. For each pair of images, the 3D coordinates of fiducial markers inside the liver were calculated via geometric derivations. The 3D coordinates were used to calculate the real-time translational and rotational motion of liver tumors around three axes via an ICP algorithm. The residual error was also investigated both with and without rotational correction. RESULTS: The translational shifts of liver tumors in left-right (LR), anterior-posterior (AP),and superior-inferior (SI) directions were 2.92 ± 1.98 mm, 5.54 ± 3.12 mm, and 16.22 ± 5.86 mm, respectively; the rotational angles in left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were 3.95° ± 3.08°, 4.93° ± 2.90°, and 4.09° ± 1.99°, respectively. Rotational correction decreased 3D fiducial displacement from 1.19 ± 0.35 mm to 0.65 ± 0.24 mm (P<0.001). CONCLUSIONS: The maximum translational movement occurred in the SI direction. Rotational correction decreased fiducial displacements and increased tumor tracking accuracy.

The therapeutic effect between metal augment and impacted bone grafting in the hip revision of acetabular bone defect / 医学研究生学报

Objective The application of metal augments in the revision of total hip arthroplasty(THA)has achieved re-markable results in the treatment of bone defects.However,there are limited studies compared this effective method with the traditional treatment.The purpose of this article is to investigate the curative effect of both metal augmentation and impacted bone grafting in the revision of acetabular bone defect. Methods We retrospectively analyzed 20 patients(20 hips)with bone defects after THA in Au-thority of Nanjing General Hospital of Nanjing Military Region from August 2010 to February 2017.These 20 patients were allocated into 2 groups:impacted bone grafting group(n=11,filling acetabular bone defect with autogenous iliac bone and artificial bone)and metal aug-mentation group(n=9,filling acetabular bone defect with metal aug-ment).The duration of surgery,blood loss and the hospital for special surgery knee score(HSS)were compared between these two groups and the Harris score was applied to evaluate the hip function and full weight bearing. Results The surgery duration and blood loss of impacted bone grafting group were significantly increased when compared with the metal augmentation group(44.5±7.82 min vs 36.22±5.19 min and 431.82±57.76 mL vs 333.33±72.80 mL respec-tively).there were 3 cases showed mild bone resorption in the I regions in the impacted bone grafting group, while only one case showed mild bone resorption in the II region in the metal augmentation group.The HSS scores in the metal augmentation group were higher than those in the impacted bone grafting group at the time of postoperative 2 weeks(43.89±2.76 vs 40.82±4.42), 3 months (49.89±2.03 vs 45.27±3.90)and 6 months(53.44±2.46 vs 50.55±3.67), the differences were statistically significant(P<0.001). The Harris scores in the metal augmentation group were higher than those in the impacted bone grafting group(P<0.01).The metal augmentation group had a shorter time of getting out of bed compared with the impacted bone grafting group(P<0.01). Conclusion For those patients with upper acetabular bone defect,revision surgery using metal augments can save the operation time.Meanwhile, it is also superior to the impacted bone grafting in the early prosthesis stability and bone ingrowth,and thus enables to shorten the time on getting out of bed and promote functional.

Roles of microRNA-206 in osteosarcoma pathogenesis and progression.

BACKGROUND AND AIMS: MicroRNA-206 has proven to be down-regulated in many human malignancies in correlation with tumour progression. Our study aimed to characterize miR-206 contributions to initiation and malignant progression of human osteosarcoma. METHODS: MiR-206 expression was detected in human osteosarcoma cell line MG63, human normal osteoblastic cell line hFOB 1.19, and paired osteosarcoma and normal adjacent tissues from 65 patients using quantitative RT-PCR. Relationships of miR-206 levels to clinicopathological characteristics were also investigated. Moreover, miR-206 mimics and negative control siRNA were transfected into MG63 cells to observe effects on cell viability, apoptosis, invasion and migration. RESULTS: We found that miR-206 was down-regulated in the osteosarcoma cell line MG63 and primary tumor samples, and decreased miR-206 expression was significantly associated with advanced clinical stage, T classification, metastasis and poor histological differentiation. Additionally, transfection of miR-206 mimics could reduce MG- 63 cell viability, promote cell apoptosis, and inhibit cell invasion and migration. CONCLUSIONS: These findings indicate that miR-206 may have a key role in osteosarcoma pathogenesis and development. It could serve as a useful biomarker for prediction of osteosarcoma progression, and provide a potential target for gene therapy.

Early clinical research of total hip arthroplasty for the treatment of old acetabular fractures / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the early clinical effects of total hip arthroplasty(THA) for the treatment of old acetabular fractures.</p><p><b>METHODS</b>From January 2007 to June 2010, thirteen patients with old acetabular fractures were reviewed, including 10 males and 3 females. Ten patients were treated with internal fixation and conservative treatment had been used in three patients. The average Harris Hip Score was used to evaluate therapeutic effects.</p><p><b>RESULTS</b>After operation, all thirteen patients were followed up for one year. Hip X-ray films were taken and prosthesis loosening was not seen on any of the films at the 1st year after operation. The Harris Hip Score improved from preoperative (37.19 +/- 20.12) to postoperative (83.38 +/- 3.33), there was statistically significant difference.</p><p><b>CONCLUSION</b>For reasons of malunion or failure of internal fixation, large and various bone defect, it's difficult to reach the anatomical reduction. THA is a good treatment method, but it needs rich skills and experience compared with ordinary operation.</p>

Early rehabilitation after simultaneously bilateral total knee arthroplasty / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the principle and methods of preoperative and postoperative rehabilitation for simultaneous bilateral total knee arthroplasty.</p><p><b>METHODS</b>From January 2005 to June 2008, 72 patients (144 knees) were reviewed in the study, including 33 males and 39 females, ranging in age from 46 to 78 years, with an average age of 69 years. There were 54 patients with osteoarthritis, 17 patients with RA, and 1 patient with traumatic osteoarthritis, including 10 cases (15 knees) of fixed varus deformity more than 30 degree and 6 cases (8 knees) of fixed vagus deformity more than 15 degree. Rehabilitation protocol was made for preoperative, early postoperative and late postoperative stages. Patients were encouraged to initiate the exercises at the early postoperative stage on the premise of multimodal analgesia. Knee function and pain were evaluated using WOMAC and VAS pain scores. Lower limb embolism was determined by ultrasonic scan and pulmonary embolism was diagnosed by clinical manifestation and D-dimer level.</p><p><b>RESULTS</b>Sixty-nine patiets (138 knees) were followed up at 2 d preoperatively and the second day, 1, 2, 8 and 24 weeks postoperatively. The average postoperative WOMAC and VAS score were significantly lower than preoperative levels,while the postoperative knee ROM and 6 min walking distance were evidently higher than the preoperative ones, respectively. One hundred and twenty-eight knees achieved full extension and flexion more than 90 degree at 2 weeks postoperatively, and 135 knees reached 110 degree in flexion. Unilateral lower limb embolism was found in 2 cases (2 knees) and bilateral ones were found in 1 case (2 knees). No pulmonary embolism was confirmed.</p><p><b>CONCLUSION</b>Rehabilitation protocols should be made for preoperative, early postoperative and late postoperative stages of simultaneous bilateral knee arthroplasty. Patients should be encouraged to exercise at the early postoperative stage on the premise of multimodal analgesia, in order to improve knee function and reduce edema.</p>

Prognostic significance of hidden blood loss in total hip arthroplasty (THA) / 中国骨伤

<p><b>OBJECTIVE</b>To explore the prognostic significance of hidden blood loss in total hip arthroplasty.</p><p><b>METHODS</b>From May 2008 to July 2009, Harris hip score was used to evaluate the functions of 71 patients undergoing single side total hip arthroplasty (including 47 males and 24 females with a mean age of 68.3 years, ranged from 48 to 75 years). The blood loss in the operation was analyzed to study the correlation between hidden blood loss and the functional rehabilitation.</p><p><b>RESULTS</b>All 71 patients undergoing THA were involved in the result analysis. The mean total blood loss was 1473 ml and the hidden blood loss was 545 ml (37%). Hidden blood loss significantly correlated with functional rehabilitation (P = 0.001), but there were no correlations between functional rehabilitation and age, gender, operative limb of patients (P = 0.067, 0.527, 0.926, 0.072).</p><p><b>CONCLUSION</b>Hidden blood loss maybe a useful prognostic information contributing to the functional rehabilitation of total hip arthroplasty.</p>

Concentration measurement of the OPG and sRANKL of peripheral blood among normal healthy people / 中国骨伤

<p><b>OBJECTIVE</b>To measure the concentration of osteoprotegerin (OPG) and receptor activator of NF-kappaB ligand (sRANKL) in peripheral blood among normal healthy people and investigate the relationship pf the concentration with age and sex.</p><p><b>METHODS</b>The peripheral blood samples of 220 normal healthy people (included 108 males and 112 females, aged from 35 to 70) were collected in the morning. The OPG and sRANKL concentration of blood serum were measured by ELISA.</p><p><b>RESULTS</b>The concentrations in female peripheral blood were: OPG 21.95 to 315.47 pg/ml, sRANKL 10.25 to 370.20 pmol/L; while in male were: OPG 14.78 to 192.55 pg/ml, sRANKL 9.22 to 300.32 pmol/L. There was positive correlation between the OPG concentration and age in the females older than 46 years. And for female older than 57, the sRANKL concentration of peripheral blood increases obviously.</p><p><b>CONCLUSION</b>Age and sex are the elements that affect the OPG and sRANKL concentration in peripheral blood. For female older than 46, the OPG concentration of peripheral blood increases with age, while the sRANKL concentration of peripheral blood increases for females older than 57.</p>

Complications of bipolar hemiarthroplasty for the treatment of unstable intertrochanteric fractures in the elderly / 中国骨伤

<p><b>OBJECTIVE</b>To analyze the complications of bipolar hemiarthroplasty for the treatment of intertrochanteric fractures.</p><p><b>METHODS</b>From Jan. 2004 to Dec. 2007, 62 patients over 80 years old with unstable interthochanteric fracture were treated with bipolar hemiarthroplasty, included 34 males and 28 females with an average age of 86.3 years ranging from 81 to 97 years. According to the Evans classification, there were 29 cases of Evans III, 26 of Evans IV and 7 of Evans V. The systemic and operation related complications were investigated.</p><p><b>RESULTS</b>Among all the cases, 59 were followed up in outpatient department for 24 to 70 months (33 months on average). Systemic complications were found in 19 cases with no death during preoperative period and 5 deaths after leaving hospital. Operation related complications were found in 9 cases, included 3 cases of thigh pain, 1 iatrogenic fracture of proximal femur, 2 hip dislocations, 2 delayed union of fractures and 1 superficial infection. There were no aseptic loosening, peri-prosthetic infections,ectopic ossification or injuries of nerves and vessels.</p><p><b>CONCLUSION</b>Bipolar hemiarthroplasty is indicated for patients over 80 years old with intertrochanteric fracture, thus the organic or systemic malfunctions should be corrected during perioperative period. Meanwhile, retaining of lesser trochanter and reconstruction of calcar femorale are important for improving periprosthetic biomechanics and reducing local complications.</p>

Improved citation status of World Journal Gastroenterology in 2004: Analysis of all reference citations by WJG and citations of WJG articles by other SCI journals during 1998-2004.

AIM: To determine the citation status in 2004 and the citation trend of WJG by analyzing all articles cited by WJG and all WJG articles cited by SCI journals during 1998-2004. METHODS: The total number of published articles and reference citations in WJG, authors' self-citations, WJG's self-citations, citations of WJG articles by SCI journals and inappropriate citations in WJG during 1998-2004 were statistically analyzed. Data on self-citations of the articles published between 1998 and August 2004 (Issues 1-16) were from ISI SCI-E, and data on self-citations of articles published after August 2004 (Issues 17-24) were from the WJG Editorial Office. Data on citations of WJG articles by other journals between 1998 and August 2004 were from ISI SCI-E. RESULTS: Annual number of published articles: WJG published 179, 144, 211, 174, 236, 634 and 830 articles, respectively, in 1998, 1999, 2000, 2001, 2002, 2003 and 2004. The number in 2004 increased by 594, compared to that in 2002, giving an increased rate of 251.7%. Annual references cited by WJG were 2 123, 2 125, 6 244, 8 883, 11 442, 23 218 and 25 971, respectively, in 1998-2004. The average number was 31.3 per WJG article in 2004, which was less than that (48.5) in 2002, giving a reduction rate of 35.5%. Authors of WJG cited 125, 126, 343, 210, 354, 310 and 470 of their own published articles, respectively, in 1998-2004. The average number of authors' self-citations was 0.57 per WJG article in 2004, which was decreased by 0.93 or 62.0%, compared with that in 2002. Annual numbers of journal's self-citations: Authors of WJG articles cited 5, 7, 373, 733, 1474, 1947 and 1412 of WJG articles, respectively, in 1998-2004. The average number of journal's self-citations was 1.70 per WJG article in 2004, which decreased by 4.55 or 72.8%. No WJG article was cited in 1998 by other SCI journals. However, the number of citations steadily increased afterwards, with 16, 18, 39, 85, 372 and 580, respectively, in 1999-2004. The average number of citations by other SCI journals was 0.11, 0.09, 0.22, 0.36, 0.59 and 1.06 per WJG article, respectively, 1999-2004 (January-August). There was an increase by 582%, when comparing the citation numbers between 2004 and 2002. Annual WJG self-citation rates and citation rates of WJG articles by other SCI journals: WJG self-citation rates were 30.43%, 95.40%, 95.07%, 94.55%, 83.96% and 67.47%, respectively, in 1999-2004 (January-August). Compared with 2002, the self-citation rate in 2004 decreased by 26.87%. The citation rates of WJG articles by other SCI journals were 69.57%, 4.60%, 4.93%, 5.45%, 16.04%, and 32.53%, respectively, in 1999-2004 (January-August). Compared with 2002, the citation rate in 2004 decreased by 26.87%. There were 8, 19, 218, 274, 461, 698 and 574 inappropriate citations, respectively, in 1998-2004. The average inappropriate citation in 2004 was 0.69 per article, which represents a decrease of 1.26, compared with that in 2002. Inappropriate citations were mostly those with the differences between the two sides of the hyphens of 5-9, and the proportions of inappropriate citations within the three subsections of the differences between the two sides of the hyphens (5-9, 10-19, and >=20) were approximately 7:2:1. In addition, inappropriate citations mostly occurred with frequencies of 1-3 in the articles, and the proportion of inappropriate citations within the two frequency subsections (1-3 and >3) have been approximately 4:1 since 1999. CONCLUSIONS: In 2004, the average number of reference citations, authors' self-citations and journal's self-citations were 31.3, 0.57 and 1.70 per article, respectively, which represents a decrease in the numbers by 35.5%. 62.0%, and 72.8% respectively compared to the corresponding numbers in 2002. WJG self-citation rate was 67.47% in 2004 (January-August), which was a decrease by 26.87%, compared with 2002. The citation rate of WJG articles by other SCI journals was 32.53% in 2004 (January-August), an increase of 26.87%, compared to 2002. There were 574 inappropriate citations in 2004, with an average of 0.69 per article, which represents a decrease of 1.26, compared with that in 2002. These figures demonstrate that the overall citation status of WJG is improving.