Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly (version 2023) / 中华创伤杂志

Periarticular fracture of the shoulder is a common type of fractures in the elderly. Postoperative adverse events such as internal fixation failure, humeral head ischemic necrosis and upper limb dysfunction occur frequently, which seriously endangers the exercise and health of the elderly. Compared with the fracture with normal bone mass, the osteoporotic periarticular fracture of the shoulder is complicated with slow healing and poor rehabilitation, so the clinical management becomes more difficult. At present, there is no targeted guideline or consensus for this type of fracture in China. In such context, experts from Youth Osteoporosis Group of Chinese Orthopedic Association, Orthopedic Expert Committee of Geriatrics Branch of Chinese Association of Gerontology and Geriatrics, Osteoporosis Group of Youth Committee of Chinese Association of Orthopedic Surgeons and Osteoporosis Committee of Shanghai Association of Chinese Integrative Medicine developed the Chinese expert consensus on the diagnosis and treatment of osteoporotic periarticular fracture of the shoulder in the elderly ( version 2023). Nine recommendations were put forward from the aspects of diagnosis, treatment strategies and rehabilitation of osteoporotic periarticular fracture of the shoulder, hoping to promote the standardized, systematic and personalized diagnosis and treatment concept and improve functional outcomes and quality of life in elderly patients with osteoporotic periarticular fracture of the shoulder.

Research progress of research on the effect of quorum-sensing system on periodontal pathogens / 口腔医学

@#Periodontitis is one of the most common oral diseases in humans. As the initiating factor of periodontitis, dental plaque bacteria, is the primary factor leading to periodontitis. Quorum-sensing system relies on quorum-sensing signaling molecules to regulate and strengthenthe communication between different kinds of bacteria, strengthen the communication between bacteria, and promote the occurrence and development of diseases. Quorum-sensing system also plays an important role in promoting the formation of dental plaque biofilm by dental plaque bacteria. In recent years, many studies have shown that quorum-sensing inhibitors can effectively attenuate quorum sensing between bacteria and inhibit and reduce the formation of plaque biofilms between bacteria and the expression of their virulence factors. In this paper, we will review the progress of research on the effects of quorum-sensing signaling molecules on periodontitis pathogens.

Expert consensus on rehabilitation strategies for traumatic spinal cord injury / 中华创伤杂志

TSCI have dyskinesia and sensory disturbance that can cause various life-threaten complications. The patients with traumatic spinal cord injury (TSCI), seriously affecting the quality of life of patients. Based on the epidemiology of TSCI and domestic and foreign literatures as well as expert investigations, this expert consensus reviews the definition, injury classification, rehabilitation assessment, rehabilitation strategies and rehabilitation measures of TSCI so as to provide early standardized rehabilitation treatment methods for TSCI.

Lineage conversion of mouse fibroblasts to pancreatic α-cells

α-cells, which synthesize glucagon, also support β-cell survival and have the capacity to transdifferentiate into β-cells. However, the role of α-cells in pathological conditions and their putative clinical applications remain elusive due in large part to the lack of mature α-cells. Here, we present a new technique to generate functional α-like cells. α-like cells (iAlpha cells) were generated from mouse fibroblasts by transduction of transcription factors, including Hhex, Foxa3, Gata4, Pdx1 and Pax4, which induce α-cell-specific gene expression and glucagon secretion in response to KCl and Arg stimulation. The cell functions in vivo and in vitro were evaluated. Lineage-specific and functional-related gene expression was tested by realtime PCR, insulin tolerance test (ITT), glucose tolerance test (GTT), Ki67 and glucagon immunohistochemistry analysis were done in iAlpha cells transplanted nude mice. iAlpha cells possess α-cell function in vitro and alter blood glucose levels in vivo. Transplantation of iAlpha cells into nude mice resulted in insulin resistance and increased β-cell proliferation. Taken together, we present a novel strategy to generate functional α-like cells for the purposes of disease modeling and regenerative medicine.

Delta12-prostaglandinJ2-nano capsule up-regulates growth factor expression and enhances bone regeneration in rats / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of local delivery of delta12-prostaglandinJ2-loaded poly (lactic-co-glycolic acid) (Δ(12)-PGJ2-NC) on growth factors expression and bone formation.</p><p><b>METHODS</b>Δ(12)-PGJ2-NC was prepared by the emulsion solvent diffusion method. The physical and chemical properties of the nanoparticles were evaluated by particle size analysis, transmission electron microscopy, drug-loading ratio and the in vitro release study. Then standardized transcortical defect (5.0 mm × 1.5 mm) was conducted in the femur of 48 male Wistar rats which were randomly divided into four groups (n = 12), S, K, F, and N. Thirty microliter of saline (S), unloaded nanoparticles (K), Δ(12)-PGJ2 (F) and Δ(12)-PGJ2-NC(N) in a collagen vehicle were delivered inside a titanium chamber fixed over the defect. Then, four subgroups were randomly divided in each group named as D3, D7, D14, and D28 (n = 3) according to the days 3, 7, 14, and 28 after the surgery. At days 3, 7, 14, and 28, the mRNA expression of the bone morphogenetic protein-6 (BMP-6), platelet-derived growth factor-B (PDGF-B) in defect aera was analyzed by real time quantitive-polymerase blotting. HE staining was employed to reveal new bone formation in weeks 2 and 4.</p><p><b>RESULTS</b>Δ(12)-PGJ2-NC appeared opalescent white and remained relatively stable, with an average particle size of (135.2 ± 0.85) nm. The images from transmission electron microscopy showed that Δ(12)-PGJ2-NC was spherical in shape and homogeneously distributed. The encapsulation efficiency of Δ(12)-PGJ2 with the poly (lactic-co-glycolic acid) (PLGA) nanocapsules was about 92%. The in vitro release of Δ(12)-PGJ2-NC at 37 °C showed a sustained fashion and the average accumulated amount was 30%, 52%, 77%, 91%, and 98% respectively, at 0.5, 1, 2, 4 and 6 h. Compared with the animals treated with saline, after dose of 100 mg/L Δ(12)-PGJ2 and Δ(12)-PGJ2-NC apllication, the mRNA expression level of BMP-6, PDGF-B increased significantly (P < 0.05, P < 0.001). The protein expression of BMP-6, Ephrin-B2 also was up-regulated. Histomorphometry revealed that new bone formation increased at the same dose of 100 mg/L. But the unloaded nanoparticles did not have the same effect (P > 0.05).</p><p><b>CONCLUSIONS</b>A stable Δ(12)-PGJ2 loaded nanoparticle was successfully prepared. Δ(12)-PGJ2-NC may upregulate the expression of BMP-6, PDGF-B and Ephrin-B2, and promote new bone formation in bone defect area.</p>

Minimally invasive transforaminal lumbar interbody fusion:characteristics of screw malposition and cage displacement / 中国组织工程研究

BACKGROUND:Traditional open surgical transforaminal lumbar interbody fusion often needs a broader dissection of the paraspinal soft tissue and longer stretch time of soft tissue, induces greater surgical trauma and more blood loss. Minimal y invasive transforaminal lumbar interbody fusion (MIS-TLIF) may reduce or avoid these shortcomings. However, MIS-TLIF technique needs a process of learning curve. Correctly understanding the MIS-TLIF technique and dealing with their associated complications, have an important clinical significance. OBJECTIVE:To summarize the MIS-TLIF complications for treatment of lumbar disease, and explore the prevention and treatment strategies. METHODS:Between May 2008 and May 2012, 100 patients with lumbar disease were treated using MIS-TLIF. Al of patients had typical low back pain combined with leg pain, and were ineffective by conservative treatment for 6 months. There were lumbar spinal stenosis syndrome in 42 cases, lumbar spondylolisthesis in 31 cases, and lumbar disc herniation with lateral recess stenosis in 27 cases. The operative levels included L 3/4 in 2 patients, L 4/5 in 28 patients, L 5/S 1 in 50 patients, L 3-L 5 in 2 patients, and L 4-S 1 in 18 patients. The intraoperative and postoperative complications were recorded. RESULTS AND CONCLUSION:One patient appeared extradural hemorrhage 1 000 mL and was given blood transfusion, no complications were found. Pedicle screw malposition was found in 11 pedicle screws (11/435, 2.5%). Only one patient had new L 5 radicular pain due to impingement by the tip of a bicortical S 1 screw upon the lumbosacral trunk anterior to the sacrum. This screw was re-positioned at a subsequent procedure, with resolution of the radicular pain. Interbody cage malposition was found in 2 patients with 2 cages (2/120, 1.7%) after operations, they showed no clinical symptoms and were not treated. One patient with one cage (1/120, 0.8%) appeared cage displacement during fol ow-up, which required twice revision surgeries, one is cage re-position and the other is posterior interbody fusion. Within one month after operations, two patients had poor visualization in the right pulmonary arteriography, which was diagnosed as pulmonary embolism and was treated with thrombectomy and thrombolysis. No death and other consequence were found. Experimental findings indicate hat, MIS-TLIF is a safe, reliable and effective surgery for treating lumbar diseases, with few complications.