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Background Intraarticular impacted fragment (IAIF) of posterior malleolar fractures has been reported by a few studies. However its location, morphology, and the correlation of posterior malleolar fractures have not been described in detail. The aim of this study was to describe the morphology of IAIF in posterior malleolar fractures, to analyze the related factors between IAIF and posterior malleolar fragments, and explore the treatment of IAIF. Materials and methods Between January 2013 and December 2018, 108 consecutive patients with unilateral posterior malleolar fractures were managed in our hospital. Basic demographic and computed tomography (CT) data were collected and classified by Lauge–Hansen, OTA/AO, Haraguchi, and Mason classification. Additional radiographic data, including the length and area of posterior malleolar fragment, IAIF, and stable tibial plafond were measured. The location of IAIF was described, and involvement of the fibular notch and medial malleolus was also observed. Statistics were analyzed based on univariate analysis (Chi-square test, t-test, Mann–Whitney U test, Fisher’s test) and Spearman’s correlation test. Results Among the 108 cases of posterior malleolar fractures, 75 (69.4%) were with IAIF and 33 (30.6%) cases were without. There were 74 (68.5%) females and 34 (31.5%) males, and the average age of the patients was 49 years (18–89 years). The average LIFN/(LIFN + LSFN) [length of involving fibular notch/(length of involving fibular + length of stable notch fibular notch)] was 32.9% (11.6–64.9%). The APMF/(APMF + ASTP + AIAIF) [area of posterior malleolar fragment/(area of posterior malleolar fragment + area of IAIF + area of stable tibial plafond)] and AIAIF/APMF (area of IAIF/area of posterior malleolar fragment) were 13.1% (0.8–39.7%) and 52.6% (1.2–235.4%), respectively. Involvement of medial malleolus (fracture line extended to medial malleolus, P = 0.022), involvement of fibular notch (P = 0.021), LIFN/(LIFN + LSFN) (P = 0.037), LMPMF (P = 0.004), and APMF were significantly related to the occurrence of IAIF. Conclusion Our research indicates a high incidence of IAIF in posterior malleolar fractures. All IAIFs were found in posterior malleolar, and the most common location was within the lateral area A. Posterior malleolar fracture lines that extend to medial malleolus or fibular notch herald the incidence of IAIF. LIFN/(LIFN + LSFN), LMPMF and APMF are also associated with the incidence of IAIF. CT scans are useful for posterior malleolar fractures to determine the occurrence of IAIF and make operational plans. Operation approach selection should be based on the morphology of posterior malleolar fragments and the location of IAIF. Level of evidence Level III, retrospective case analysis.

The morphology of medial malleolar fracture is highly variable and difficult to characterize without 3D reconstruction. There is also no universally accepeted classification system. Thus, we aimed to characterize fracture patterns of the medial malleolus and propose a classification scheme based on 3D CT reconstruction.We retrospectively reviewed 537 consecutive cases of ankle fractures involving the medial malleolus treated in our institution. 3D fracture maps were produced by superimposing all the fracture lines onto a standard template. We sliced fracture fragments and the standard template based on selected sagittal and coronal planes to create 2D fracture maps, where angles α and β were measured. Angles α and β were defined as the acute angles formed by the fracture line and the horizontal line on the selected planes.A total of 121 ankle fractures were included. We revealed several important fracture features, such as a high correlation between posterior collicular fractures and posteromedial fragments. Moreover, we generalized the fracture geometry into three recurrent patterns on the coronal view of 3D maps (transverse, vertical, and irregular) and five recurrent patterns on the lateral view (transverse, oblique, vertical, Y-shaped, and irregular). According to the fracture geometry on the coronal and lateral view of 3D maps, we subsequently categorized medial malleolar fractures into six types based on the recurrent patterns: anterior collicular fracture (27 type I, 22.3%), posterior collicular fracture (12 type II, 9.9%), concurrent fracture of anterior and posterior colliculus (16 type III, 13.2%), and supra-intercollicular groove fracture (66 type IV, 54.5%). Therewere three variants of type IV fractures: transverse (type IVa), vertical (type IVb), and comminuted fracture (type IVc). The angles α and β varied accordingly.Our findings yield insight into the characteristics and recurrent patterns of medial malleolar fractures. The proposed classification system is helpful in understanding injury mechanisms and guiding diagnosis, as well as surgical strategies. Cite this article

BACKGROUND Osteoarthritis (OA) is a degenerative joint disease often present on the surface and edge of the joint and beneath cartilage forming new bone. Arthroscopy had been used for the treatment of knee OA. This study aimed to measure the expression of miR-22, miR-140, and BMP-2 in patients with OA before and after arthroscopy operation. MATERIAL AND METHODS The synovial fluid of 80 patients and 60 healthy volunteers were aspirated using a syringe before OA operation and again six months post-operation in patients with OA. The total RNA was extracted and analyzed by quantitative PCR. RESULTS The level of miR-22 was elevated in the progression of OA. The expression of miR-140 level in the synovial fluid was significantly reduced in the patients with OA and was negatively correlated with OA severity compared to controls. Expression of miR-22 and miR-120 returned to normal levels post-operatively. BMP-2 expression was reduced in patients with OA, and returned to normal levels post-operatively. Bioinformatics analysis showed that miR-22 and miR-140 closely target with 3'-UTR of BMP-2 in different positions. The correlation between BMP-2 and miR-22 was negative. The correlation between BMP-2 and miR-140 was positive. CONCLUSIONS The present study identified a change in miR-22, miR-140, and BMP-2 expression in the synovial fluid of patients with OA before and after arthroscopic debridement. Results provide a novel characterization of the pathogenesis and therefore underlying therapeutic target for OA.

Osteosarcoma stem cells are able to escape treatment with conventional chemotherapeutic drugs, as the majority of them are in a quiescent state. Recent reports have suggested that small ubiquitin‑like modifiers (SUMOs) serve important roles in the maintenance of cancer stem cell stemness. Therefore, a potential strategy to increase the effectiveness of chemotherapeutic agents is to interfere with SUMO modification of proteins associated with the maintenance of stemness in osteosarcoma stem cells. The present study revealed a significant decrease in the expression of SUMO1 specific peptidase 1 (SENP1) in osteosarcoma tissues and osteosarcoma cell lines, and SENP1 expression was much lower in osteosarcoma stem cells than in non‑cancer stem cells. Further experiments indicated that the low levels of SENP1 were essential for maintenance of stemness in osteosarcoma stem cells. Overexpression of SENP1 resulted in a marked decrease in the maintenance of stemness, but only slightly induced apoptosis of osteosarcoma cells, which is crucial to reduce the side effects of drugs on normal precursor cells. Finally, SENP1 overexpression led to a significant increase in the sensitivity of osteosarcoma stem cells to the herpes simplex virus 1 thymidine kinase gene in combination with ganciclovir in vitro and in vivo. In conclusion, the present study described a novel method to increase the sensitivity of osteosarcoma stem cells to chemotherapeutic drugs. Notably, this approach may significantly reduce the required dose of conventional chemotherapeutic drugs and reduce side effects.

Connexin 43 (Cx43) can be modified and regulated by small ubiquitin-like modifier (SUMO)1; however, its role in liver cancer stem cells is poorly understood. In this study, we found a significant difference in the expression of Cx43 and SUMO1 between cancer stem cells and non-cancer stem cells in liver cancer. In liver cancer stem cells, Cx43 was almost absent, although the level of SUMO1 was significantly higher than that in non-cancer stem cells. Further experiments confirmed that the conjugated site of Cx43 by SUMO1 was located in Lys-144 and Lys-237, both of which are highly conserved among species. By the co-expression of Cx43 and SUMO1 in cancer stem cells, the gap junction intercellular communication (GJIC) of liver cancer stem cells was obviously improved. Using this feature, we verified whether it could effectively increase the sensitivity of cancer stem cells to the herpes simplex virus 1 thymidine kinase (HSVtk) gene in combination with ganciclovir (GCV), a conventional chemotherapeutic drug, in vitro and in vivo. As expected, increasing the expression of Cx43 SUMOylation in liver cancer stem cells effectively enhanced their sensitivity to HSVtk/GCV. On the whole, this study revealed a novel method which may be used to effectively restore GJIC in cancer stem cells in liver cancer, which enhances their sensitivity to conventional chemotherapeutic drugs.

To investigate the operative method and clinical results of arthroscopic assisted treatment of shoulder dislocation combined with fracture of greater tuberosity of humerus.From February 2006 to June 2008, 12 cases of shoulder dislocation (6 left, 6 right) combined with greater tuberosity fractures were treated. There were 4 males and 8 females with an average of 58.5 years (range 34-79 years). Eleven cases fall down and one was crushed. The time from injury to hospital averaged 2.1 hours (range 30 minutes-24 hours). X-ray films revealed greater tuberosity fractures with average 5.8 mm (range 5-12 mm) displacement, and MRI showed Bankart lesion in 2 cases. Arthroscopic examination taken 3-14 days after reduction revealed 3 cases of Bankart lesion and 1 case of SLAP lesion. Three cases of great tuberosity fractures were fixed with cannulated screws, 2 cases with absorbable screws, 7 cases with titanium suture anchor. Three cases were repaired under arthroscopy, and 9 cases were repaired under arthroscopic assistance mini-incision.All the incisions were healed at first intention without infection. All patients were followed up for 6-32 months (average 16 months). The shoulder joints were fixed stably without redislocation. Six months after operation, there were 3 cases with mild limitation of abduction and 1 case with pain in flexion related with impingement. The X-ray films showed all fractures healed 2-6 months after operation (average 3.2 months). The American Shoulder and Elbow Surgeons and University of California at Los Angeles scores were 16.03 +/- 1.03 and 32.65 +/- 4.83, respectively. Eight cases were excellent, 3 were good, 1 were fair and the excellent and good rate was 91.7%.For shoulder dislocation combined with fracture of greater tuberosity of humerus, the treatment by shoulder arthroscopy is a safe and mini-invasive operative method with comprehensively accurate intraoperative diagnosis, satisfying therapeutic effect, good functional recovery, as well as obvious relief of pain.

To study the effect of compound injection of Radix Hedysari on peripheral nerve regeneration in rats.Seventy-five healthy adult SD male rats, weighing 150 g, were randomized into 5 groups (15 rats in each group). The bilateral sciatic nerves of the rats were exposed and clamped with a smooth clamp to make an injury area of 2 mm. After clamp operation Group 1 was injected with compound injection of radix Hedysari (CIRH) 1.5 ml/day, Group 2 with CIRH 1.0 ml/day, Group 3 with CIRH 0.5 ml/day, Group 4 with nerve growth factor (NGF) 50 U/day, and Group 5 was taken as the control group without any management. The bilateral sciatic nerve was taken out at 3 days, 1, 2 and 4 weeks after clamping, stained with osmic acid and observed microscopically. The myelinated nerve fibers were counted. The nerve conduction velocity was determined 2 and and 4 weeks before sample taking the sciatic nerve function index was measured 4 weeks before sample taking.The results of nerve conduction velocity, the myelinated nerve fiber count and the sciatic functuion index in the CIRH treated groups were better than those in the control group. The results of the nerve conduction velocity and the myelinated nerve fiber count at 2 weeks and the nerve conduction velocity at 4 weeks in Group 1 were better than those of Group 4. Biological observation showed that degenerated and necrotic myelin sheath in CIRH treated Groups at 2 and 4 weeks decreased remarkably compared to the NGF treated group.CIRH can promote regeneration of peripheral nerves and absorption of degenerated and necrotic injured nerves. It has the same effect as NGF.