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Subscapular tendon plays an important role in shoulder joint function. With the advance of magnetic resonance imaging technology and the popularization of arthroscopic shoulder surgery, subscapularis tears have been increasingly detected. However, reduction and fixation of subscapular tendon tears appears to be technically challenging. This study aims to describe an arthroscopic intra‐articular X‐shaped fixation technique: a procedure of subscapularis tendon repair performed with the aid of a suture passer using only a single anterior portal and a single suture anchor. By incorporating the advantages of a single anterior working portal for anchor placement and tear repair, this technique provides an easier way to use suture lasso and make knots in a limited working space, and the whole procedure is minimally invasive with a short learning curve. This technique has been applied in patients with subscapularis tears involving no intraoperative or postoperative complications. Our technology offers a valuable new treatment option for subscapularis tears. [ABSTRACT FROM AUTHOR]

Background: During the current COVID-19 pandemic, offline clinical education was mandated to suspend at the neurology department of many teaching hospitals globally, yet there is insufficient evidence regarding the preferred practice and methods for online neurology intern training course. Objective: The investigation aimed to examine whether the online neurology training course based on Small Private Online Course (SPOC) and blending learning mode can achieve a good effect and cater for interns from different medical programs and whether the learning group size affects the teaching effect. Design: The subjects were 92 students enrolled in the neurology internship at the Second Xiangya Hospital of China from 9 March to 9 August 2020. After completing the online course, the final scores and evaluation results were compared among different groups of interns, and their preference to distinct contents of the course was analyzed. Statistical analysis was performed using the SPSS program (version 22.0). Results: Our online course received consistent positive recognition from the interns. Ninety-nine percent of the interns recommended incorporating the online course into the conventional offline training program after the pandemic. There was no significant difference between interns from different programs concerning the final scores and course evaluation. A smaller learning group size (<15 students) could achieve a better teaching effect than a larger group size (p < 0.05). The interns preferred interactive discussions, and course contents that they can get practice and feedback from, rather than video watching and didactic lectures. Conclusions: The online neurology intern training course based on SPOC and blending learning mode is worthy of popularization in a large student base. The teaching effect of an online intern training program may be improved by limiting the group size to less than 15 students and encouraging more interactive discussion, more practice and feedback. [ABSTRACT FROM AUTHOR]

Abstract Background Epimedii herba is one of the most frequently used herbs in formulas that are prescribed for the treatment of osteoporosis in China and its main constituent is Epimedium pubescen flavonoid (EPF). However, it is unclear whether EPF during chronic exposure to cigarette smoke may have a protective influence on the skeleton. The present study investigated the effect of EPF on bone mineral status and bone turnover in a rat model of human relatively high exposure to cigarette smoke. Methods Fifty male Wistar rats were randomized into five groups: controls, passive smoking groups and passive smoking rats administered EPF at three dosage levels (75, 150 or 300 mg/kg/day) in drinking water for 4 months. A rat model of passive smoking was prepared by breeding male rats in a cigarette-smoking box. Bone mineral content (BMC), bone mineral density (BMD), bone turnover markers, bone histomorphometric parameters and biomechanical properties were examined. Results Smoke exposure decreased BMC and BMD, increased bone turnover (inhibited bone formation and stimulated its resorption), affected bone histomorphometry (increased trabecular separation and osteoclast surface per bone surface; decreased trabecular bone volume, trabecular thickness, trabecular number, cortical thickness, bone formation rate and osteoblast surface per bone surface), and reduced mechanical properties. EPF supplementation during cigarette smoke exposure prevented smoke-induced changes in bone mineral status and bone turnover. Conclusion The results suggest that EPF can prevent the adverse effects of smoke exposure on bone by stimulating bone formation and inhibiting bone turnover and bone resorption.

Abstract Background Many studies have identified smoking as a risk factor for osteoporosis, but it is unclear whether passive smoking has an effect on bone mineral density and bone turnover and if such an effect could cause osteoporosis.The purpose of the study was to investigate the effect of passive smoking on bone mineral density (BMD) and bone turnover and the relationship between BMD and bone turnover in female rat. Methods Forty-eight female Wistar rats were randomized into six groups: 2-month, 3-month,4-month smoke-exposed rats and their controls. A rat model of passive cigarette smoking was prepared by breeding female rats in a cigarette-smoking box for 2, 3 or 4 months. Serums were analyzed for levels of osteocalcin, bone-specific alkaline phosphatase (b-ALP) and Tartrate-resistant acid phosphatase 5b (TRACP 5b). BMD was assessed at lumbar vertebrae and femur by dual energy X-ray absorptiometry in passive smoking rats and in control rats. Results BMD of lumbar spine and femur was lower in 4-month smoke-exposed female rats than that in controls. However, there was no significant difference in serum osteocalcin levels between smoke-exposed rats and controls. Significantly lower b-ALP and higher TRACP 5b were found in the 3-month or 4-month smoke-exposed rats compared to controls. Subsequent analysis showed that b-ALP positively correlated with BMD of the lumbar vertebrae(r = 0.764, P = 0.027) and femur(r = 0.899, P = 0.002) in 4-month smoke-exposed female rats. Furthermore, TRACP 5b levels negatively correlated with BMD of lumbar vertebrae (r = -0.871, P = 0.005) and femur (r = -0.715, P = 0.046) in 4-month smoke-exposed female rats. Conclusion Our data suggest that smoke exposure can inhibit bone formation and increase bone resorption. The hazardous effects of passive smoking on bone status are associated with increased bone turnover in female rat.

Objective: To assess the clinical results of the remnant‐preserving and I.D.E.A.L. femoral tunnel technique in the arthroscopic treatment of anterior cruciate ligament (ACL) injuries. Methods: This was a retrospective single‐center, single‐surgeon study reviewing data from November 2016 to March 2019. Based on our inclusion/exclusion criteria, a total of 31 patients (18 males, 13 females; mean age, 23.6 years) who underwent arthroscopic ACL reconstruction with the remnant preservation and I.D.E.A.L. femoral tunnel technique were recruited and had a minimum follow‐up of 12 months. Clinical data and status of knee stability were recorded. The International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale were collected both preoperatively and at a minimum of 1‐year follow‐up. Results: Statistically significant differences were detected between the preoperative and postoperative values for Lachman test and pivot‐shift test (P < 0.01). The mean postoperative Lysholm score was 89.6 ± 9.4, whereas the mean preoperative Lysholm score was 47.3 ± 12.8 (P < 0.01). The mean Tegner activity score was significantly higher at postoperative evaluation than at preoperative evaluation (6.5 ± 2.1 vs 2.6 ± 1.8; P < 0.01). The mean IKDC score was significantly improved from 49.5 ± 10.6 preoperatively to 88.2 ± 10.7 postoperatively (P < 0.01). No case of infection was reported. No radiograph showed any joint space narrowing or degenerative change at the last postsurgical follow‐up. Conclusion: The anatomical remnant‐preserving and I.D.E.A.L. femoral tunnel technique achieves a satisfactory clinical outcome and provides an effective option for the treatment of ACL injuries. [ABSTRACT FROM AUTHOR]

Anatomic tunnel formation and remnant preservation are the recent trends in posterior cruciate ligament (PCL) reconstruction. However, it is difficult to observe the anatomical PCL footprint and perform the operation in the process of remnant‐preserving PCL reconstruction. This study describes a single‐bundle, transtibial PCL reconstruction technique with anatomic graft passage over the remnant PCL fibers. A femoral tunnel of PCL is created at 2 mm medial to the roof of the intercondylar notch and 3 mm proximal to the margin of the articular cartilage. The tibial insertion of PCL is observed using a figure‐of‐four position through a posterior trans‐septal portal. A tibial bone tunnel is made below the distal center portion of the tibial insertion of residual PCL fibers. The graft is passed over the PCL through the tibial bone tunnel, the space between the anterior cruciate ligament (ACL) and the residual PCL fibers, to the femoral socket and is fixed by the EndoButton and screw. This technique is able to ensure a reasonable intra‐articular length and optimal isometry. It has been applied in patients with PCL rupture and posterior instability of the knee joint, and no intraoperative or postoperative complications occurred. Our technology provides a valuable new treatment option for PCL rupture. Future comparative studies are needed to further clarify its beneficial effect. [ABSTRACT FROM AUTHOR]