Icariin alleviates the apoptosis of chondrocytes in osteoarthritis through regulating SIRT-1-Nrf2-HO-1 signaling.

Icariin has shown the potential to treat osteoarthritis (OA), but the specific mechanism still needs further exploration. Therefore, this study attempted to reveal the effect and mechanism of icariin on OA based on in vitro and in vivo experiments. In vivo, a mouse model of OA was established by cutting the anterior cruciate ligament, and 10 mg/kg icariin was given to mice orally. Then, the OA injury and pathological changes of cartilage tissue in mice were identified by OA index and hematoxylin and eosin staining. In vitro, the viability of C28/I2 cells incubated with different concentrations of icariin was detected by 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di- phenytetrazoliumromide assay. Subsequently, C28/I2 cells induced by IL-1ß were used as the cell model of OA, the expression of Sirtuin (SIRT)-1 in cells was knocked down, and icariin was added for intervention. Next, western blot was used to observe the expression level of sirtuin 1 (SIRT-1)-Nrf2-heme oxygenase 1 (HO-1) signaling pathway-related proteins in cells of each group. Besides, cell viability and apoptosis were detected by MTT and apoptosis assay, and DNA damage was observed by comet assay. In vivo experiments, intragastric administration of icariin could effectively reduce the OA index of mice, improve the pathological changes of cartilage tissue, and obviously activated the SIRT-1-Nrf2-HO-1 signaling pathway. In vitro experiments, icariin did not exhibit toxic effect on C28/I2 cells, but could activate the SIRT-1-Nrf2-HO-1 signaling pathway, improve the viability, reduce the level of apoptosis and relieve the DNA damage in OA cells; however, these effects were inhibited by si- SIRT-1. Icariin can improve the symptoms of OA by activating the SIRT-1-Nrf2-HO-1 signaling pathway.

Surgical Treatment of Vertical Shear Pelvic Fracture Associated with a Lumbosacral Plexus Injury through the Lateral-Rectus Approach: Surgical Techniques and Preliminary Outcomes.

OBJECTIVE: To examine the surgical techniques and preliminary outcomes of the lateral rectus approach (LRA) for treating vertical shear (VS) pelvic fracture associated with lumbosacral plexus (LSP) injury. METHODS: This study was a retrospective trial. From August 2010 to October 2017, 29 patients with VS pelvic fractures involving LSP injury who were treated with the LRA were included in this study. The patients were 18-61 years old, with a mean age of 36.2 years. All patients underwent neurolysis, open reduction, and internal fixation (ORIF) through the LRA. The fracture reduction was evaluated using the Matta criteria, and the neural recovery was evaluated by muscle strength grading proposed by the British Medical Research Council (BMRC). RESULTS: All 29 patients underwent the surgery successfully. The mean operating time was 155.2 ± 32.1 min (range: 105-220 min). The mean operative blood loss was 1021.4 ± 363.4 mL (range: 400-2000 mL). All patients were followed-up for at least 24 months (mean, 32.8 ± 13.5 months; range: 24-96 months). According to the Matta criteria, there were 17 excellent cases, nine good cases, and three fair cases in 29 patients. The ratio of excellent-to-good cases was 89.66%. According to the criteria of the Nerve Injuries Committee of the British Medical Research Council (BMRC), the recovery of nerve and muscle strength achieved to M5 (full recovery of neurological symptoms) was 14 cases, M4 (fine recovery of neurological symptoms), seven cases; M1, M2, and M3 (partial recovery of neurological symptoms), five cases, and M0 (no recovery of neurological symptoms), three cases. CONCLUSIONS: LRA is a safe and feasible surgical approach for treating VS pelvic fractures with LSP injury, which can be used to perform nerve exploration and release from the front, reduce the fracture, and fix it with the anterior iliac plates and/or sacroiliac screws.

The application of lateral-rectus approach on toddlers' unstable pelvic fractures.

BACKGROUND: Pelvic fractures are rare in toddlers but are often associated with other injuries that make treatment difficult. Conservative treatment has been used with moderate success, but it is unclear if surgical correction could confer additional benefits and improve patient outcomes. The purpose of this study was to report authors' experience using the lateral-rectus approach (LRA) for surgical correction of unstable pelvic fractures in two toddlers. METHODS: We retrospectively analyzed the cases of two toddlers with unstable pelvic fractures who underwent surgery through the LRA between April 2016 and October 2018. Patients' characteristics, fracture type, mechanism of injury, Injury Severity Score (ISS), operative time, intra-operative blood loss, and post-operative complications were assessed. Pelvic asymmetry, degree of deformity, Cole scoring criteria and modified Barthel Index (MBI) were used to evaluate radiographic and functional outcomes. RESULTS: Successful surgical treatment was performed using the LRA, external fixation, and sacroiliac screw fixation. Surgery duration was 180 min on average, with an average intra-operative bleeding of 250 ml. There were no iatrogenic nerve injuries or infections. Pelvic asymmetry a week after surgery was 0.5 cm on average and dropped to 0.3 cm on average at the end of the follow-up period. The deformity index of the pelvis dropped from an average of 0.035 a week after surgery to 0.02 at the end of the follow-up period. The mean MBI was 100 in the last follow-up, and Cole scoring criteria categorized both patients as being in excellent condition. All patients achieved radiological bone union without discrepancy in length of the lower limbs. Neither patient had loss of reduction nor evidence of low back pain during the mean follow-up period of 22 months. CONCLUSIONS: Pelvic fracture in toddlers is rare, and surgical treatment requires careful consideration. The lateral-rectus approach was proven as a viable alternative for managing unstable pelvic fractures in toddlers, with minimal blood loss and risk of nerve injury. Furthermore, anterior external fixation and posterior sacroiliac screw fixation would be adequate for this population, with excellent final outcome.