A retrospective investigation on clinical and radiographic outcomes of distal tibial fractures after intramedullary nailing using the lateral parapatellar extra-articular approach.

INTRODUCTION: According to reports, the modified extra-articular parapatellar approach allows the performance of tibial nailing in the semi-extended position without the concern of joint violation. However, there remains no special study that has provided a detailed assessment of the benefits and risks of this approach for treating distal tibial fractures (DTFs). The aim of this retrospective study was to investigate the clinical and radiological outcomes of patients with DTFs after intramedullary nailing using a lateral parapatellar extra-articular (LPE) approach in comparison to using the suprapatellar (SP) and transpatellar (TP) approaches. METHODS: Data were collected from 99 patients with a minimum follow-up period of 12 months. Comparisons were conducted between the groups regarding the number of intraoperative fluoroscopies, complications, knee pain, knee range of motion (ROM), the Lysholm Knee Scale (LKS), the Olerud-Molander Ankle Score (OMAS) and radiological findings. RESULTS: The demographic characteristics were comparable between the groups. Fewer intraoperative fluoroscopies were performed in the LPE (27.47 ± 4.98) and SP (26.03 ± 5.12) groups than in the TP group (30.20 ± 7.42; P<0.001). When compared with the other two approaches, the LPE approach was associated with less knee pain (P<0.001) and better knee ROM (P<0.001) at one week postoperative. No significant intergroup differences were detected in the incidence of complications, LKS scores (P = 0.687) and OMAS (P = 0.926). Radiological findings demonstrated that postoperative tibial alignment (P = 0.853), the time of bony union and rate of non-union were similar between the groups. CONCLUSION: The LPE approach can serve as a safe and effective option for tibial nailing, as it offers favourable outcomes in knee pain relief and knee ROM in the early postoperative period and is equivalent to the other two approaches in terms of the incidence of complications, fracture healing, functional recovery and postoperative alignment for patients with DTFs.

Intramedullary Nail or Primary Arthroplasty? A System Review and Meta-Analysis on the Prognosis of Intertrochanteric Femoral Fractures Based on Randomized Controlled Trials.

Introduction: There is no consensus regarding the superiority between intramedullary nailing and primary arthroplasty in the management of intertrochanteric femoral fractures. This systematic review was performed to investigate and compare the clinical efficacy of intertrochanteric femoral fractures treated with these 2 methods. Materials and methods: We systematically searched PubMed, Embase, Cochrane, Web of science core collection and ClinicalTrials.gov for randomized controlled trials which compared the clinical outcomes of intertrochanteric fractures treated with either intramedullary nails or primary arthroplasty. Relevant data of the postoperative complications, reoperations, mortality and functional assessment, were pooled and presented graphically. Results: A total of 6 trials with 427 participants were identified and included in the analyses. The pooled estimates suggested these 2 techniques have comparable risks in terms of overall complications (pooled risk ratio [RR] .80; 95% confidence interval [CI] .43 to 1.43; I2 = 79.94%), the rate of patients with orthopedic complications (RR .71, 95% CI .40 to 1.27; I2 = .00%), reoperations (RR 1.33, 95% CI .48 to 3.71; I2 = .00%), the overall mortality (RR .52; 95%CI .26 to 1.02; I2 = 31.35%) and 1-year mortality (RR .67; 95%CI .38 to 1.19; I2 = .00%). Primary arthroplasty associated with higher HHS at 3 months postoperatively (MD -21.95, 95% CI -28.29 to -15.60; I2 = 70.44%). While the difference was not significant at 6 months (MD 2.32, 95% CI -1.55 to 6.18; I2 = .00%), and even reversed at 12 months postoperatively (MD 13.02, 95% CI 8.14 to 17.90; I2 = 73.42%). Conclusions: Meta-analytic pooling of current evidences demonstrated that primary arthroplasty is related to a better early functional recovery at the early stage postoperatively, but the long-term result tends to favor to intramedullary nailing. The differences in overall complications, the rate of patients with orthopedic complications, reoperations, overall and 1-year mortality did not reach a significant level.

Effects of fibular strut augmentation for the open reduction and internal fixation of proximal humeral fractures: a systematic review and meta-analysis.

BACKGROUND: There is still a lack of remarkable consensus regarding the clinical efficacy of the application of fibular strut augmentation (FSA) combined with a locking plate for proximal humeral fractures. A systematic review and meta-analysis to assess the effect of the use of FSAs in open reduction and internal fixation of proximal humeral fractures was conducted. METHODS: A literature search was conducted in PubMed, Embase, Cochrane, Web of Science Core Collection, and ClinicalTrials.gov to identify trials that compared the clinical outcomes of proximal humeral fractures treated using a locking plate with or without FSA. The primary outcome measures were postoperative complications, radiographical findings, functional recovery scores, and postoperative range of motion (ROM). Data were pooled and analysed using a random-effects model based on the Der Simonian and Laird method. RESULTS: Eight studies involving 596 participants were included for further analysis. Compared with using a locking plate independently, the additional application of FSA was associated with the likelihood of lower risk of overall complications (OR 0.37; 95% CI 0.22-0.65; I2 = 12.22%; 95% PI 0.14-0.98) and the rate of patients with orthopaedic complications (OR 0.48; 95% CI 0.25-0.92; I2 = 7.52%; 95% PI 0.16-1.45), less changes in postoperative humeral head height (MD - 2.40; 95% CI - 2.49 to - 2.31; I2 = 0.00%; 95% PI - 2.61 to - 2.20) and the neck-shaft angle (MD - 6.30; 95% CI - 7.23 to - 5.36; I2 = 79.32%; 95% PI - 10.06 to - 2.53), superior functional outcomes (Constant-Murley score: MD 5.07; 95% CI 3.40 to 6.74; I2 = 0.00%; 95% PI 2.361-7.78; American Shoulder and Elbow Surgeons Score: MD 5.08; 95% CI 3.67 to 6.49; I2 = 0.00%; 95% PI 1.98-8.18), and better postoperative ROM in terms of forward elevation and external rotation. However, the evidence regarding postoperative abduction was insufficient. CONCLUSION: Meta-analytic pooling of current evidence showed a significant association between the application of FSAs and favourable clinical outcomes in terms of postoperative complications, radiographical findings, functional recovery, and postoperative elevation and external rotation.

miR-455-3p enhances chondrocytes apoptosis and inflammation by targeting COL2A1 in the in vitro osteoarthritis model.

Emerging evidence has shown that microRNAs are important regulators in osteoarthritis (OA). Here, we investigated the function role of miR-455-3p in the pathogenesis of OA and the underlying molecular mechanisms. We first established the in vitro OA model using IL-1ß treated human chondrocyte cell line CHON-001. Using quantitative real time PCR, we observed the expression of miR-455-3p expression was up-regulated in the OA cartilage tissues and IL-1ß-treated chondrocytes. A series of function assays, including CCK-8 assay, flow cytometry, and ELISA assay showed that miR-455-3p contributed to IL-1ß-induced apoptosis and inflammation. Moreover, COL2A1 was confirmed as a target of miR-455-3p by luciferase reporter assay. Furthermore, COL2A1 knockdown reversed the effects of miR-455-3p inhibition, and aggravated the effects of miR-455-3p overexpression on IL-1ß-induced OA-like phenomenon. Taken together, these results revealed that miR-455-3p/COL2A1 axis might provide a novel molecular target for the treatment of OA.

Dexmedetomidine inhibits the NF-κB pathway and NLRP3 inflammasome to attenuate papain-induced osteoarthritis in rats.

Context: Dexmedetomidine (Dex) has been reported to have an anti-inflammatory effect. However, its role on osteoarthritis (OA) has not been explored. Objective: This study investigates the effect of Dex on OA rat model induced by papain. Materials and methods: The OA Wistar rat model was induced by intraluminal injection of 20 mL of papain mixed solution (4% papain 0.2 mL mixed with 0.03 mol L-1 l-cysteine 0.1 mL) into the right knee joint. Two weeks after papain injection, OA rats were treated by intra-articular injection of Dex (5, 10, or 20 µg kg-1) into the right knee (once a day, continuously for 4 weeks). Articular cartilage tissue was obtained after Dex treatment was completed. Results: The gait behavior scores (2.83 ± 0.49), PWMT (15.2 ± 1.78) and PTWL (14.81 ± 0.92) in H-DEX group were higher than that of OA group, while Mankin score (5.5 ± 0.81) was decreased (p < 0.05). Compared with the OA group, the IL-1ß (153.11 ± 16.05 pg mg-1), IL-18 (3.71 ± 0.7 pg mg-1), IL-6 (14.15 ± 1.94 pg/mg) and TNF-α (40.45 ± 10.28 pg mg-1) levels in H-DEX group were decreased (p < 0.05). MMP-13, NLRP3, and caspase-1 p10 expression in Dex groups were significantly lower than that of OA group (p < 0.05), while collagen II was increased (p < 0.05). p65 in the nucleus of Dex groups was significantly down-regulated than that of OA group (p < 0.05). Discussion and Conclusions: Dex can improve pain symptoms and cartilage tissue damage of OA rats, which may be related to its inhibition of the activation of NF-κB and NLRP3 inflammasome.

Electrical peripheral nerve stimulation relieves bone cancer pain by inducing Arc protein expression in the spinal cord dorsal horn.

OBJECTIVE: The analgesic effect on chronic pain of peripheral nerve stimulation (PNS) has been proven, but its underlying mechanism remains unknown. Therefore, this study aimed to assess the analgesic effect of PNS on bone cancer pain in a rat model and to explore the underlying mechanism. MATERIALS AND METHODS: PNS on sciatic nerves with bipolar electrode was performed in both naïve and bone cancer pain model rats. Then, the protein levels of activity-regulated cytoskeleton-associated protein (Arc), α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid-type glutamate receptor 1 (GluA1), and phosphate N-methyl-d-aspartic acid-type glutamate receptor subunit 2B (pGluNR2B) in spinal cord were evaluated by immunohistochemistry and Western blotting. Thermal paw withdraw latency and mechanical paw withdraw threshold were used to estimate the analgesic effect of PNS on bone cancer pain. Intrathecal administration of Arc shRNA was used to inhibit Arc expression in the spinal cord. RESULTS: PNS at 60 and 120 Hz for 20 min overtly induced Arc expression in the spinal cord, increased thermal pain thresholds in naïve rats, and relieved bone cancer pain; meanwhile, 10 Hz PNS did not achieve those results. In addition, PNS at 60 and 120 Hz also reduced the expression of GluA1, but not pGluNR2B, in the spinal cord. Finally, the anti-nociceptive effect and GluA1 downregulation induced by PNS were inhibited by intrathecal administration of Arc shRNA. CONCLUSION: PNS (60 Hz, 0.3 mA) can relieve bone-cancer-induced allodynia and hyperalgesia by upregulating Arc protein expression and then by decreasing GluA1 transcription in the spinal cord dorsal horn.

A Traditional Chinese Medicine Xiao-Ai-Tong Suppresses Pain through Modulation of Cytokines and Prevents Adverse Reactions of Morphine Treatment in Bone Cancer Pain Patients.

Treating cancer pain continues to possess a major challenge. Here, we report that a traditional Chinese medicine Xiao-Ai-Tong (XAT) can effectively suppress pain and adverse reactions following morphine treatment in patients with bone cancer pain. Visual Analogue Scale (VAS) and Quality of Life Questionnaire (EORTC QLQ-C30) were used for patient's self-evaluation of pain intensity and evaluating changes of adverse reactions including constipation, nausea, fatigue, and anorexia, respectively, before and after treatment prescriptions. The clinical trials showed that repetitive oral administration of XAT (200 mL, bid, for 7 consecutive days) alone greatly reduced cancer pain. Repetitive treatment with a combination of XAT and morphine (20 mg and 30 mg, resp.) produced significant synergistic analgesic effects. Meanwhile, XAT greatly reduced the adverse reactions associated with cancer and/or morphine treatment. In addition, XAT treatment significantly reduced the proinflammatory cytokines interleukin-1ß and tumor necrosis factor-α and increased the endogenous anti-inflammatory cytokine interleukin-10 in blood. These findings demonstrate that XAT can effectively reduce bone cancer pain probably mediated by the cytokine mechanisms, facilitate analgesic effect of morphine, and prevent or reduce the associated adverse reactions, supporting a use of XAT, alone or with morphine, in treating bone cancer pain in clinic.

A reversed-flow differential flow modulator for comprehensive two-dimensional gas chromatography.

A simple and reliable differential flow modulator has been demonstrated which reverses the flow during the flush step. The modulator is constructed with commercially available capillary flow technology tees which simplifies the apparatus and permits wide range of column dimensions to be used because the modulator volume is adjustable. Using a reverse flush arrangement the tailing of the peak at the base (baseline rise between modulations) is reduced 10-20 fold as compared to forward flush modulation. This is most easily observed for peaks overloaded in the first dimension. Excellent reproducibility (<2% RSD) of area measurements has been demonstrated with a complex fragrance sample as well as the capacity to handle significant overloading without loss of resolution in the second dimension. Further demonstrating the flexibility of this modulator, separation of C1-6 alkanes and olefins are demonstrated with two porous layer open tubular columns.

Determination of short-chain branching content in polyethylene by pyrolysis comprehensive multidimensional gas chromatography using low thermal mass column technology.

A research effort was undertaken to utilize the pyrolysis process to create fragments of polyethylene that could be indicative of branching, and allow quantitiation of said short-chain branches by pyrolysis comprehensive 2-D GC (Py-GC x GC). Several strategies for sample introduction and pyrolysis such as the in-column pyrolysis device and the programmed temperature vaporizer (PTV) were studied. The chromatographic separations were executed using low-thermal mass (LTM) comprehensive 2-D GC (GC x GC). A series of polyethylene-co-hexene samples were analyzed and a linear correlation of 1-hexene content with branching peak ratio was found. Correlation coefficients were determined as 0.97 for the measurements performed.

Universal and discriminative detection using a miniaturized pulsed discharge detector in comprehensive two-dimensional GC.

A miniaturized pulsed discharge detector (Mini-PDD) has been successfully demonstrated for comprehensive 2-D GC (GC x GC) analysis of pyrolysis gasoline and the pyrolysis GC x GC analysis of a polyethylene copolymer. The detector cell volume of the Mini-PDD is reduced to 25% of the Valco plug-in PDD D-3. An n-C11 peak width at base is 96 ms for the Mini-PDD, about 23% larger than a peak width of 78 ms detected by a flame ionization detector (FID). The Mini-PDD has sufficient response time for most GC x GC applications. When Mini-PDD is operated in helium photoionization mode (Mini He-PDD), it is a universal detector for both inorganic and organic compounds. This is especially useful when detection of water is needed in GC x GC applications. When krypton is doped in the helium discharge gas (Mini Kr-PDD), it can suppress signals of compounds having higher ionization potentials and enhance relative signal intensities of aromatic compounds. The determination of aliphatic to aromatic hydrocarbon ratios is essential to the operation of petroleum crackers. Comparison of the signal from two modes of the Mini-PDD is a simple and fast way to verify the location of aromatics in comprehensive 2-D gas chromatograms.

Comprehensive two-dimensional gas chromatography using liquid nitrogen modulation: set-up and applications.

An improved modulation system for comprehensive two-dimensional gas chromatography (GC x GC) is presented. It is based on two-jet modulation with liquid nitrogen as cryogen. A valve system was designed to include subsequent re-heating of cooled capillary segments after modulation. It is demonstrated that even volatile components, such as propane or butane, are easily modulated with this system. Thus, the temperature range for GC x GC operation compared to diaphragm valve or liquid CO2 modulation is extended. The system allows highly efficient analysis of volatile and non-volatile components. Applications include separations of alkenes and gasoline samples. Also sulfur-containing hydrocarbon samples were compared via GC x GC and differences among samples of different producers were observed. Finally, headspace GC x GC investigations of volatiles found in polymer latex-coated papers round out the increasing portfolio of valuable applications.

Analysis of low levels of oxygen, carbon monoxide, and carbon dioxide in polyolefin feed streams using a pulsed discharge detector and two PLOT columns.

A gas chromatography (GC) method is developed for rapid analysis of polyolefin feed streams for the catalyst poisons CO, CO(2), and O(2). The method uses an HP MoleSieve column in parallel with a CP-PoraPLOT Q column and a pulsed discharge detector (PDD). Detection limits for each of the potential poisons are between 50 and 250 ppb. For a 10-ppm standard, the precision of the method was +/- 4.2% for oxygen, +/- 7.8% for carbon dioxide, and +/- 2.0% for carbon monoxide. In addition to the polyolefin feed stream, nitrogen and hydrogen feed streams are also analyzed. In each case, sampling is observed to be a critical issue, with air contamination of the sample cylinder often the limiting step in determining the true level of oxygen. It is also noted that large amounts of argon are present in the standards when nitrogen is used as a balance gas. Because the trace oxygen peak partly coelutes with the larger argon peak, it is suggested that helium be used as the balance gas for all standards. This general experimental arrangement should be effective when applied to feed streams for other polymers as well.

Direct injection GC method for measuring light hydrocarbon emissions from cooling-tower water.

A Direct Injection GC method for quantifying low levels of light hydrocarbons (C6 and below) in cooling water has been developed. It is intended to overcome the limitations of the currently available technology. The principle of this method is to use a stripper column in a GC to strip waterfrom the hydrocarbons prior to entering the separation column. No sample preparation is required since the water sample is introduced directly into the GC. Method validation indicates that the Direct Injection GC method offers approximately 15 min analysis time with excellent precision and recovery. The calibration studies with ethylene and propylene show that both liquid and gas standards are suitable for routine calibration and calibration verification. The sampling method using zero headspace traditional VOA (Volatile Organic Analysis) vials and a sample chiller has also been validated. It is apparent that the sampling method is sufficient to minimize the potential for losses of light hydrocarbons, and samples can be held at 4 degrees C for up to 7 days with more than 93% recovery. The Direct Injection GC method also offers <1 ppb (w/v) level method detection limits for ethylene, propylene, and benzene. It is superior to the existing El Paso stripper method. In addition to lower detection limits for ethylene and propylene, the Direct Injection GC method quantifies individual light hydrocarbons in cooling water, provides better recoveries, and requires less maintenance and setup costs. Since the instrumentation and supplies are readily available, this technique could easily be established as a standard or alternative method for routine emission monitoring and leak detection of light hydrocarbons in cooling-tower water.

Modulation techniques and applications in comprehensive two-dimensional gas chromatography (GC x GC).

More than a decade after Phillips' first published work this article reviews recent developments in comprehensive two-dimensional gas chromatography (GC x GC). Special attention is devoted to the further development and diversity of modulation devices. These include heated sweepers, cryofocused modulators, and a variety of diaphragm valve-switching strategies. It is demonstrated that all modulation approaches can be very well suited to GC x GC, depending on the particular application. Diaphragm-valve modulation is very powerful for volatile organic compounds. Slotted heater and cryofocused modulation are preferred for samples that contain non-volatile components. Applications ranging from petroleum to environmental and biological samples are illustrated. Extension of the technique to GC x GC-mass spectrometry (MS) is also discussed and trends for future research activity are pointed out.