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Background Forearm crisscross injury is rare in children; there is no relevant literature so far. Surgeons lack experience and knowledge in treating this type of crisscross injury. We report a case of forearm crisscross injury in a child for the first time and analyze its mechanism. Case summary An 8-year-old boy experienced pain in his left forearm when he accidentally fell while skateboarding. Physical examination revealed swelling and deformity of the left forearm. We performed imaging and the results revealed left radial head dislocation, left distal radial epiphyseal separation from the shaft, and interruption of the continuity of the dorsal cortex of the left distal ulna. Anteroposterior and lateral X-ray films showed that the radius and ulna were crisscrossed. A diagnosis of superior radioulnar joint dislocation, left distal radial epiphyseal injury, and left distal ulnar fracture was made. After unsuccessful manual reduction, we adopted a minimally invasive procedure and succeeded. After a 14-wk period of follow-up, the patient had good left upper limb function, no complaints of pain or limited range of motion, and good follow-up results. Conclusion This is the first report of a child with a forearm crisscross injury in which the mechanism and the differences from adult crisscross injury are analyzed. Minimally invasive surgery with intramedullary fixation can achieve a good therapeutic effect. This case provides a reference for the treatment of similar patients in the future.

Anterior pelvic ring injuries can be treated via Pfannenstiel, modified Stoppa, or ilioinguinal approaches, but these require exposing the abdominal soft tissues and may damage pelvic organs. The scar on the abdominal wall is also unacceptable for some patients. The minimally invasive anterior pelvic ring internal fixator (INFIX) is not ideal for thin patients with easily irritated skin, and it is associated with complications such as femoral nerve palsy, vascular occlusion, and lateral femoral cutaneous nerve injury. In this study, we designed a new external pelvic approach for the treatment of an anterior pelvic ring fracture.We retrospectively reviewed 28 patients with 36 pubic ramus fractures that had been treated via the covert-inferior pelvic approach. All patients underwent a surgical procedure between August 2019 and January 2021. According to the Nakatani classification, there were 6 cases of type-I fracture, 25 cases of type-II fracture, and 5 cases of type-III fracture. Operative time, blood loss, and postoperative radiographic and computed tomographic (CT) findings were recorded. Patients were followed for fracture healing time, functional status, esthetic satisfaction, and complications.A total of 27 patients had follow-up for at least 12 months (range, 12 to 29 months). Postoperative radiographs and CT scans showed well-positioned plates and screws. The mean preoperative time was 9.4 ± 3.8 days, the mean operative time was 61.3 ± 22.67 minutes, the mean intraoperative blood loss was 63.6 ± 42.62 mL, the mean fracture healing time was 4.1 ± 1.6 months, and the mean Majeed score was 89.74 ± 8.07. There were no complications of nonunion, internal fixation failure, vascular injury, nerve palsy, or hernia. All of the patients were esthetically satisfied with the scar.The covert-inferior pelvic approach combined with a subpubic plate effectively fixed Nakatani type-I, II, and III fractures. The advantages of this method include rapid recovery after the surgical procedure, safety, simplicity, a short learning curve, no damage to abdominal soft tissue, no effect on pubic symphysis micromotion, and esthetic benefits. It may be another option for anterior pelvic ring fractures and can supplement other approaches.Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

BACKGROUND: Percutaneous sacroiliac screw fixation is the standard treatment for sacroiliac joint (SIJ) dislocation. In most hospitals, the procedure is guided by a C-arm X-ray fluoroscopy system, which must be repeatedly repositioned during surgery. In this study, we investigated the feasibility of using 2 fluoroscopes simultaneously. METHODS: A total of 28 consecutive patients with SIJ dislocation were included in this study. The patients were randomly allocated to groups and underwent percutaneous sacroiliac screw fixation using either 1 or 2 fluoroscopes. Total radiation exposure frequency, radiation dose, and operation time were recorded and compared. Dislocation reduction quality was assessed using the Tornetta and Matta standard, and the Majeed functional score was used to evaluate clinical, imaging, and social function following pelvic injury. Complications were also recorded. RESULTS: The results showed that the radiation exposure frequency was significantly less with 2 fluoroscopes than with a single fluoroscope (21.5±8.6 and 42.6±18.3 times, respectively; P0.05) between the 2 groups was not significantly different. The total operation time was also significantly shorter with 2 fluoroscopic devices than with a single device (35.8±12.9 and 65.5±19.7 minutes, respectively; P0.05) did not differ significantly between the 2 groups at the final follow-up. Complications, such as pain, superficial infection, restricted squatting, limp, and screw failure, were rarely recorded in either group. CONCLUSIONS: The simultaneous application of 2 fluoroscopes is highly appropriate during percutaneous sacroiliac screw fixation to treat SIJ dislocation, and can significantly reduce radiation exposure frequency and operation time.

Osteomyelitis is a difficult-to-treat infectious disease. Treatment, which includes controlling the infection and removing necrotic tissues, is challenging. Considering the side effects and drug resistance of systemic antibiotics, local drug delivery systems are being explored. Antibiotic-loaded bone cement is the main treatment strategy; however, it has several disadvantages. Thus, based on its thermosensitive gelation properties, poly(D, L-lactide-co-glycolide)-poly(ethylene glycol)-poly(D, L-lactide-co-glycolide) (PLGA-PEG-PLGA) copolymer was used as a sustained-release drug carrier by calibrating its synthesis parameters. We prepared and characterized vancomycin@PLGA-PEG-PLGA/hydroxyapatite (HA) thermosensitive hydrogel with an LA/GA ratio of 15:1. The rheological characteristics, sol-gel phase-transition properties, and critical micelle concentration value of the PLGA-PEG-PLGA/HA complex confirmed that it undergoes a temperature-sensitive sol-gel phase transition. Furthermore, the HA in the composite increased the storage modulus of the system. FT-IR, XRD, and TEM findings showed that HA could be dispersed uniformly in the PLGA-PEG-PLGA polymer. Moreover, HA neutralized acidity during polymer degradation, improving in vitro cytocompatibility. In vitro and in vivo antibacterial experiments showed that the composite sustained-release system exhibited good bone repair characteristics owing to its efficacy in infection treatment. Therefore, vancomycin@PLGA-PEG-PLGA/HA allows sustained release of antibiotics and promotes bone tissue repair, showing potential for wide clinical applicability.

The tension in the skin margin of a wound is the major determinant for wound healing. The difficulty of primary closure for large skin defects due to excessive wound tension has long been a clinical challenge. In this study, we designed and fabricated a reverse-traction skin-stretching device (RT-SSD) to relieve the skin tension of a large skin defect and thereby allow primary wound closure. The novel RT-SSD designed in this study drives the fixing device fixed on the skin edge of the wound by rotating the pulling device, thus exerting a reverse tensile force on both sides of the wound, causing creep and stress relaxation, thus reducing the skin tension. Through the tension analyses; microcirculation detection; clinical scores; and a series of histological staining in vivo, it is verified that intraoperative application of RT-SSD can stretch and straighten collagen and fragment elastin, thus effectively reducing skin tension of large skin defect of miniature pigs. In addition, its special linear and planar traction protects the subcutaneous microcirculation of the wound site. The evaluation of wound healing confirmed that RT-SSD had negligible negative impact on wounds, reduced the incidence of complications, and promoted the healing of large skin defects. Therefore, this study provides a new safe and effective device for the primary closure of large skin defects.

In view of the problems in hip replacement, a new gel material is developed and incorporated into cemented femoral prosthesis. The material precipitates hydroxyapatite (HA) onto silk fibroin (SF) by biomimetic method, namely silk fibroin hydroxyapatite (SF–HA). Through X-ray diffraction (XRD) and scanning electron microscope (SEM) analysis, HA precipitates on SF. Taking the gel time as the standard, 5 groups of gel materials are selected. Through in vitro degradation experiments, the degradation rate of these materials is 45%∼55%. Cell experiments (mouse L929 cells, osteoblasts HO-F) show that these cells have no cytotoxicity and support the growth of osteoblasts. In addition, in the vivo experiment (two groups), one group was treated with gelatin materials and the other group is treated with bone cement prosthesis transplantation directly. Comparing the indexes before and after operation, it proves that the new gel material has great application value in hip replacement surgery.

Background: Calcaneal fractures are the most common tarsal bone fracture, and are often accompanied by heel pain, local swelling, tenderness, and inability to walk or stand. Surgical intervention results in better reconstruction of the calcaneal anatomy and reduces future complications; however, the optimal incision approach is still controversial. The incision is exposed better with extensile lateral approach (ELA), while the sinus tarsi approach (STA) causes fewer complications. The purpose of this meta-analysis is to compare the outcomes of STA and ELA. Materials and methods: Published trials comparing ELA and STA in calcaneal fractures were included in our analysis. The quality of each study was assessed using the revised Jadad scale and the Newcastle–Ottawa scale. Two researchers (CP and BY) independently extracted data from all selected studies. Fixed- or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine the heterogeneity of the included studies. Results: Calcaneal height and calcaneal width had high heterogeneity. Results showed that the incidence of incision complications in STA was lower than that in ELA (P

Osteoporosis leads to various complications, such as prosthesis loosening and periprosthetic fracture, after joint replacement. This is mainly due to the impaired osteogenesis and excessive osteoclastic activity in osteoporotic microenvironment, which leads to insufficient osseointegration between prostheses and host bone. In this study, a functional drug-releasing inorganic-organic bioactive interface was constructed, comprising inorganic three-dimensional (3D) printed porous titanium alloy interface and organic poloxamer 407 temperature-sensitive hydrogel loaded with a novel anti-osteoporosis drug (technetium methylenediphosphonate, 99Tc-MDP). The inorganic-organic bioactive interface showed good biocompatibility and exhibited a sustained release profile. This performance enhanced osteogenic differentiation, inhibited the expression of osteoclast-related genes and inhibited the osteoclastogenesis, as compared with traditional bisphosphonates (alendronate) in vitro. When implanted into the distal femoral defect using an osteoporotic rabbit model, the 99Tc-MDP-loaded bioactive interface exhibited the most stable osseointegration with native bone. Furthermore, the drug delivery system inhibited osteoclastic activity via regulation of the osteoprotegerin/receptor activator of NF-κB ligand (OPG/RANKL) signaling pathway, which significantly ameliorated the osteoporosis status to effectively prevent continuous bone destruction around the interface. This study has clinical significance, as it demonstrates that the 99Tc-MDP modified inorganic-organic interface serve as a novel artificial prosthetic interface for patients with poor osteogenesis.

BACKGROUND Established tibial nonunions rarely heal without secondary intervention; revision surgery is the most common intervention. Herein, we evaluated the clinical outcomes of patients with tibial nonunion treated with a new technique - minimally invasive percutaneous plate osteosynthesis (MIPPO) - combined with a new onionskin-like autologous bone grafting method. MATERIAL AND METHODS From 2010 to 2013, 18 patients with tibial nonunions (average bone defect: 9.5 mm) were treated with MIPPO technology combined with onionskin-like autologous bone grafting. Indices for clinical evaluation included operative time, fluoroscopy time, blood loss, hospital stay, healing time, postoperative complaints, radiographic performances, the Short Musculoskeletal Function Assessment (SMFA) questionnaire, and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. RESULTS The average operation and fluoroscopy times for tibial nonunion were 65 min and 15.5 s, respectively, with a total blood loss of 107.7 mL. The mean duration of hospital stay was 12.8 days. The mean follow-up time was 11.9 months, and all patients achieved radiologically confirmed bony healing in an average time of 13.1 weeks. No lower-leg deformity, fixation failure, infection, and vascular, or nerve injuries were recorded in any patient, and only 4 patients complained of slight limb pain upon total weight-bearing at the end of follow-up. The SMFA and AOFAS ankle-hindfoot scores of patients were graded excellent in 14 (77.8%) and good in 4 (22.2%), indicating high functional recovery. CONCLUSIONS MIPPO technology combined with onionskin bone grafting is an efficient method to treat patients with tibial nonunion, especially for patients with poor soft tissue condition.

This study was aimed to identify hub genes associated with the development of glioblastoma (GBM) by conducting a bioinformatic analysis. The raw gene expression data were downloaded from the Gene Expression Omnibus database and The Cancer Genome Atlas project. After the differentially expressed genes (DEGs) were identified, the functional enrichment analysis of DEGs was conducted. Subsequently, the protein-protein interaction (PPI) network, molecular complex detection clusters, and transcriptional factor (TF)-miRNA-target regulatory network were constructed, respectively. Furthermore, the survival analysis of prognostic outcomes and genes was analyzed. In addition, the expression of key genes was validated by quantitative real-time PCR (qRT-PCR) analysis. A total of 884 DEGs, including 418 upregulated and downregulated genes, were identified between GBM and normal samples. The PPI network comprised a set of 3418 pairs involving 751 nodes, and AKT1 and CDK2 were the critical genes in the network. A total of seven clusters were identified, the genes in which were intensively associated with cell cycle, cholinergic synapse, and extracellular matrix (ECM)-receptor interaction. qRT-PCR analysis indicated that AKT1 and CDK2 were significantly upregulated, and NRXN3 and NPTX2 were significantly downregulated in GBM samples. The TF-miRNA-target regulatory networks were built, in which CCNB1, RFC5, microRNA524, and microRNA34b were key regulators. There were 43 genes, including NPTX2 and NRXN3, significantly related to the prognostic outcomes of GBM patients. These crucial genes might be promising options for GBM treatment.

In vitro and vivo studies indicate that oxidative stress contributes to bone loss. Fluorescent oxidation products (FlOPs) are novel biomarkers of oxidative stress; they reflect global oxidative damage of lipids, proteins, carbohydrates, and DNA. However, whether FlOPs are associated with bone mineral density (BMD) is still unclear. In the present study, we examined the association between FlOPs and BMD among male veterans. This cross-sectional study was conducted among participants recruited from the Department of Medical Examination, The Second Hospital of Jilin University in Jilin, China. We identified male veterans who were at least 50 y old between June and October of 2019. Plasma FlOPs were measured with a fluorescent microplate reader (excitation/emission wavelength: 320/420 nm). BMD were measured by dual-energy X-ray absorptiometry (DXA). The association between FlOPs and BMD was tested by multivariable linear regression models. A total of 164 male veterans were enrolled in the study, the average age was 56.6 y. After adjusting for covariates, veterans who had FlOP levels in the highest tertile had a statistically significant lower femoral neck (β = -0.044; p = 0.007) and total hip BMD (β = -0.045; p = 0.020) as compared to those with FlOP levels in the lowest tertile. Similar results were found when FlOPs were treated as a continuous variable (per 1-SD increase, β = -0.014 and p = 0.033 for femoral neck BMD; β = -0.016 and p = 0.047 for total hip BMD). Higher FlOP levels were associated with lower BMD among male veterans.

Electrospun fibrous scaffolds combined with bioactive factors can display impressive performance as an ideal wound dressing, since they can mimic the composition and physicochemical properties of the extracellular matrix (ECM). The aim of this study was to fabricate a new composite biomaterial (IGF1-DA and Os-DA-modified PLGA electrospun fibrous scaffold) for wound healing, using a rat model for experimental evaluation. A small pentapeptide tag composed of DA–Lys–DA–Lys–DA residues was introduced into insulin-like growth factor 1 (IGF1) and the antimicrobial peptide Os to prepare IGF1 and Os modified with 3,4-dihydroxyphenylalanine (DA) (IGF1-DA and Os-DA). The designed chimeric growth factor and antimicrobial peptide could successfully anchor to PLGA electrospun fibrous scaffolds, and the growth factor and antimicrobial peptide could be controllably released from the electrospun fibrous scaffolds. The results showed that the IGF1-DA and Os-DA-modified PLGA electrospun fibrous scaffolds (PLGA/Os-DA/IGF1-DA) exhibited high hydrophilicity and antimicrobial activity; moreover, the porous network of the scaffolds was similar to that of the natural ECM, which can provide a favourable environment for BALB/C 3T3 cells growth. The in vivo application of PLGA/Os-DA/IGF1-DA electrospun fibrous scaffolds in rat skin wounds resulted in improved wound recovery and tissue regeneration rate. The experimental results indicated that the IGF1-DA and Os-DA could effectively bind to PLGA electrospun fibrous scaffolds, promote wound healing and prevent infection in rats, thereby suggesting that PLGA/Os-DA/IGF1-DA electrospun fibrous scaffolds have a wide application value in the field of skin wound repair.

Fixation of a comminuted mid-distal femur fracture is challenging in clinical practice due to a high degree of comminution and malformation. Here we describe a procedure involving a series of steps for accurate fracture fixation in a patient diagnosed with comminuted mid-distal femur fracture. Emergency traction of the tibia tubercle was initially performed using a large distractor for temporary external fixation to maintain the femoral force line and to reduce intraoperative fractures. A three-dimensional printed model was then used as a preoperative simulation tool to preshape the customized locking plate, reducing the operation difficulty and improving surgical accuracy. Finally, the comminuted femur fracture was treated with the minimally invasive percutaneous plate osteosynthesis technique for maximum protection of bone fracture fragments and the surrounding blood supply. No postoperative complications were observed at the 3-year follow-up when the plate was removed. This procedure offers new possibilities for orthopedic surgeries and should be considered as an option for accurate fixation of comminuted mid-distal femur fractures.

Backgrounds Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. Methods Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient’s ankle pain, and related complications were also recorded. Results The mean time for fracture healing was 3.6 months (range: 3–6 months). According to Mazur’s criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up. Conclusions This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.

Background Exosomal miRNAs have attracted increasing interest as potential biomarkers and treatment targets for cancers, however, glioblastoma (GBM)-related exosomal miRNAs remain rarely reported. The study aimed to screen crucial serum exosomal miRNAs in GBM patients and explored their possible mechanisms. Methods Serum exosomal miRNA profile datasets of GBM patients and normal controls were downloaded from the Gene Expression Omnibus database (GSE112462 and GSE122488). The differentially expressed miRNAs (DEMs) were identified using the limma method. Their diagnostic values were assessed by receiver operating characteristic (ROC) curve analysis. The target genes of DEMs were predicted by the miRwalk 2.0 database. Function enrichment analysis was performed using the DAVID database. The expression and prognosis of target genes were validated using TCGA sequencing data and immunohistochemistry. Results Seven DEMs were shared in two datasets, among which hsa-miR-183-5p and hsa-miR-98-5p as well as has-miR-323-3p or has-miR-19b-3p constituted a diagnostic signature to distinguish GBM from controls, with the area under the ROC curve nearly approximate to 1. MAPK8IP1/FAM175B, OSMR/CASP3, PTPN2 and FBXO32 may be underlying targets for hsa-miR-183-5p, hsa-miR-98-5p, has-miR-323-3p and has-miR-19b-3p, respectively. Function analysis showed all of these target genes were involved in cell proliferation and related signaling pathways [positive regulation of cell proliferation (OSMR), negative regulation of transcription from RNA polymerase II promoter (PTPN2), cell division (FAM175B), regulation of transcription, DNA-templated (MAPK8IP1), hsa05200:Pathways in cancer (CASP3) and hsa04068:FoxO signaling pathway (FBXO32)]. The protein and (or mRNA) expression levels of OSMR, CASP3, PTPN2 and FBXO32 were validated to be upregulated, while MAPK8IP1 and FAM175B were downregulated in GBM tissues. Also, OSMR, CASP3, PTPN2 and FBXO32 were associated with patients' prognosis. Conclusion These findings suggest these four exosomal miRNAs may represent potential diagnostic biomarkers and therapeutic targets for GBM.

To reveal the potential molecular mechanism of glioblastoma multiforme (GBM) and provide the candidate biomarkers for GBM gene therapy. Microarray dataset GSE50161 was obtained from GEO database. The differentially expressed genes (DEGs) were identified between GBM samples and control samples, followed by the module partition analysis based on WGCNA. Then, the pathway and functional enrichment analyses of DEGs were performed. The hub genes were further investigated, followed by the survival analysis and data validation. A total of 1913 DEGs were investigated between two groups, followed by analysis of 5 modules using WGCNA. These DEGs were mainly enriched in functions like inflammatory response. The hub genes including upregulated N-Myc and STAT Interactor (NMI), Capping Actin Protein-Gelsolin Like (CAPG), and Proteasome Subunit Beta 8 (PSMB8) were revealed as potential liquid biopsy molecules for GBM diagnose. Moreover, Nucleolar and Spindle Associated Protein 1 (NUSAP1) and G Protein-Coupled Receptor 65 (GPR65) were outstanding genes in survival analysis. Our results suggested that CPNE6, HAPLN2, CMTM3, NMI, CAPG, and PSMB8 might be used as potential molecules for liquid biopsy of GBM. NUSAP1 and GPR65 might be novel prognostic targets for GBM gene therapy. Furthermore, the upregulated NMI might play an important role in GBM progression via inflammatory response.

Bone nonunion has become one of the most severe sequelae of fractures, infections, bone tumors, or revision arthroplasty owing to its high morbidity and disability rate. Recently, bone nonunion has received considerable attention from plastic surgeons. There are different treatment methods for nonunion depending on its classification according to the etiology and pathological types. Bone tissue engineering provides advanced platforms for the treatment of bone nonunion via the use of material scaffolds with sufficient mechanical strength. Meanwhile, it promotes bone regeneration and osseointegration by the addition of various growth factors or drugs. This review describes in detail the classification and leading causes of nonunion, as well as the clinical treatment methods and basic research progress, including the design of metal and bioactive material scaffolds. Future challenges in engineering, material science, and three-dimensional printing are also summarized. This article may provide new perspectives of the clinical translation for the treatment of bone nonunion by understanding the pathogenic mechanism and the rational application of bioactive scaffolds. Keywords: Material, Bone nonunion, Classification, Pathological feature, Treatment progress

Glial fibrillary acidic protein (GFAP) is one of the best markers for the activation of astrocytes (AS) following injury or stress in the central nervous system (CNS). The purpose of this study was to examine the expression of GFAP and 14-3-3ε in rat AS subjected to hypoxia. We established primary cultures of AS from cerebral cortex of neonatal Sprague-Dawley rats as a model of glucose deficiency and hypoxia/ischemia-reperfusion. We analyzed the activated astrocyte markers GFAP and 14-3-3ε by western blot analysis and found that both increased over time, starting at 4 h and reaching the highest level at 72 h, at the end of the experiment. GFAP and 14-3-3ε protein localization by double-labeling immunofluorescence showed elevated expression and co-localization in the cytoplasm of AS. GFAP and 14-3-3ε expression remained elevated in AS 72 h after stress conditions, which is possibly related to the excessive activation and dysfunction of the CNS in chronic injuries.

Background The aim was to research the molecular changes of bone cells induced by excessive dose of vitamin A, and analyze molecular mechanism underlying spontaneous fracture. Methods The gene expression profile of GSE29859, including 4 cortical bone marrow samples with excessive doses of Vitamin A and 4 control cortical bone marrow samples, was obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DGEs) between cortical bone marrow samples and control samples were screened out and pathway enrichment analysis was undertaken. Based on the MSigDB database, the potential regulatory transcription factors (TFs) were identified. Results A total of 373 DEGs including 342 up- and 31 down-regulated genes were identified. These DEGs were significantly enriched in pathways of protein processing in endoplasmic reticulum, ubiquitin mediated proteolysis and glycerophospholipid metabolism. Finally, the most significant regulatory TFs were obtained, including E2F Transcription Factor 1 (E2F1), GA Binding Protein Transcription Factor (GABP), Nuclear Factor, Erythroid 2-Like 2 (NRF2) and ELK1, Member of ETS Oncogene Family (ELK1). Conclusion Key TFs including E2F1, GABP, NRF2 and ELK1 and their targets genes such as Ube2d3, Uba1 , Phb2 and Tomm22 may play potential key roles in spontaneous fracture induced by hypervitaminosis A. The pathways of protein processing in endoplasmic reticulum, ubiquitin mediated proteolysis and glycerophospholipid metabolism may be key mechanisms involved in spontaneous fracture induced by hypervitaminosis A. Our findings will provide new insights for the target selection in clinical application to prevent spontaneous fracture induced by hypervitaminosis A.

The present study aimed to screen potential genes associated with conventional osteosarcoma (OS) and obtain further information on the pathogenesis of this disease. The microarray dataset GSE14359 was downloaded from the Gene Expression Omnibus. A total of 10 conventional OS samples and two non‑neoplastic primary osteoblast samples in the dataset were selected to identify the differentially expressed genes (DEGs) using the Linear Models for Microarray Data package. The potential functions of the DEGs were predicted using Gene Ontology (GO) and pathway enrichment analyses. Protein‑protein interaction (PPI) data were also obtained using the Search Tool for the Retrieval of Interacting Genes database, and the PPI network was visualized using Cytoscape. Module analysis was then performed using the Molecular Complex Detection module. Additionally, the potential microRNAs (miRNAs) for the upregulated DEGs in the most significant pathway were predicted using the miRDB database, and the regulatory network for the miRNAs‑DEGs was visualized in Cytoscape. In total, 317 upregulated and 670 downregulated DEGs were screened. Certain DEGs, including cyclin‑dependent kinase 1 (CDK1), mitotic arrest deficient 2 like 1 (MAD2L1) and BUB1 mitotic checkpoint serine/threonine‑protein kinase (BUB1), were significantly enriched in the cell cycle phase and oocyte meiosis pathway. DEGs, including replication factor C subunit 2 (RFC2), RFC3, RFC4 and RFC5, were significantly enriched in DNA replication and interacted with each other. RFC4 also interacted with other DEGs, including CDK1, MAD2L1, NDC80 kinetochore complex and BUB1. In addition, RFC4, RFC3 and RFC5 were targeted by miRNA (miR)‑802, miR‑224‑3p and miR‑522‑3p. The DEGs encoding RFC may be important for the development of conventional OS, and their expression may be regulated by a number of miRNAs, including miR‑802, miR‑224‑3p and miR‑522‑3p.

Patients suffering from extremely medial clavicle fractures combined with distinct displacement generally need surgical intervention. Double-plate fixation is a widely applied technique in the treatment of distal radius fracture, which has been reported to fix lateral clavicle fracture as well. This study reveals the effect of double-plate fixation as an innovative procedure in the treatment of extremely medial clavicle fractures for the first time.Nine patients complaint of extremely medial clavicle fracture were enrolled in this research from May 2017 to March 2019. Patients were operated with an open reduction and internal fixation using the double-plate technique. Postoperative x-ray was taken regularly to observe the fracture healing at each visit, and the related complications were also recorded. The rating score systems of Constant Murley score of treated shoulder and contralateral shoulder, ROWE score as well as American Shoulder and Elbow Surgeons (ASES) were evaluated to comment on the postoperative shoulder joint function.All patients achieved postoperative fracture healing with no complications. Only 1 patient complained of slight restriction, 2 patients complained of pain during overhead work, and another patient was found with plate breakage. Meanwhile, the Constant Murley scores of treated and contralateral shoulder were 94.1 and 98.5 points, respectively, indicating the similar shoulder function. Furthermore, the ROWE and ASES scores of the involved shoulder were 96.7 and 96.3 points at average, respectively.It is the first time to introduce the surgical technique of vertical double-plate fixation implied in stable fixation of extremely medial clavicle fractures, which could provide the surgeons with an alternative method for this type of fracture.

Background Bone defects represent a common orthopedic condition. With its vast array of donor sources, xenogeneic bone shows considerable potential as a bone defect repair material but may also be associated with immune rejection and reduced osteogenic capacity. Thus, reducing the risks for immune rejection of xenogeneic bone, while improving its osseointegration, are key technical challenges. Methods Decellularized bone matrix scaffolds (DBMs) were fabricated by thorough ultrasonic vibration and subjection to chemical biological agents to remove cells and proteins. The DBMs were then mixed with platelet-rich plasma (PRP) under negative pressure. Growth factor concentrations of PRP, as well as the microstructures and biomechanical properties of the system, were examined. Furthermore, osseointegration capacities in the critical-size radial defect rabbit model were verified. Results Complete decellularization of the scaffold and limited reductions in mechanical strength were observed. Moreover, the obtained PRP demonstrated various growth factors. Radiographic evaluation and histological analysis verified that more new bone formation occurred in the DBM mixed with PRP group at 6 and 12 weeks after implantation compared with both the blank group and the DBM without PRP group. Conclusions Thorough physical and chemical treatments can reduce the probability of immune rejection of DBMs. The novel composite of DBMs mixed with PRP can serve as a promising bone regeneration material.

Effect and related mechanisms of miR-101 on the chondrogenic differentiation of rat bone marrow mesenchymal stem cells (MSCs) were investigated. The expression level of miR-101 was detected during chondrogenic differentiation. Three groups were established to study the potential function between miR-101 and chondrogenic differentiation: miR-NC group (negative control), miR-101 mimics (BMSCs transfected by miR-101 mimics) and mimics + inhibitor (BMSCs transfected by miR-101 mimics and inhibitor), after the induction of chondrogenic differentiation, the cell viability of MSCs and chondrogenic markers were determined, further, the expression level of Sox9 and Runx2 were detected. In our present research, miR-101 was found upregulated during chondrogenic differentiation of MSCs. Compared with the miR-NC group, the cell viability of MSCs was enhanced and the expression level of chondrogenic markers were respectively gained. The expression level of Sox9 was increased but the expression level of Runx2 was decreased by treatment of miR-101 mimics after induction of chondrogenic differentiation. However, these variations of the indicators were reversed by the intervention using the miR-101 inhibitor. Collectively, our research revealed promotion function of miR-101 on chondrogenic differentiation of MSCs, indicating that miR-101 could be a potential therapeutic strategy for the treatment of osteoarthritis (OA).

This study explored the method of imaging diagnosis of primary spinal osseous tumors and the application value of imaging in clinical diagnosis. Sixty-nine patients with primary spinal osseous tumors who received treatment in Nankai Hospital from July 2016 to June 2017 were selected. All of them received X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) examinations to analyze the imaging features of the three examination methods. Sensitivity (Sen), specificity (Spe), positive predictive value (PV+), negative predictive value (PV−) and accuracy (Acc) were compared. The consistency of the three examination methods in diagnosing primary spinal osseous tumors was analyzed. Sen, Acc and PV− of the three examination methods in diagnosing spinal osseous tumors had obvious differences. MRI showed the highest Sen (P

Long noncoding RNAs (lncRNAs) are recognized as a class of critical regulators in various tumors. Recently, lncRNA LSINCT5 has been reported to promote the progression of bladder cancer, ovarian cancer, gastric cancer, and breast cancer. However, the biological function of LSINCT5 remains elusive in osteosarcoma (OS). In our study, we found that LSINCT5 was significantly upregulated in OS tissues than in adjacent normal tissues. Additionally, the expression of LSINCT5 was inversely associated with the prognosis of patients with OS. LSINCT5 knockdown dramatically inhibited OS cell proliferation in vitro and tumor growth in vivo. Mechanistic exploration revealed that LSINCT5 interacted with EZH2 to suppress the expression of APC, a negative regulator of the Wnt/β-catenin pathway. Moreover, rescue assays suggested that LSINCT5 exerted oncogenic roles by partially inhibiting APC expression in OS. In summary, our study demonstrated that LSINCT5 was a promising candidate for OS prognosis and therapy.

Schwann cell transplantation and hyperbaric oxygen therapy each promote recovery from spinal cord injury, but it remains unclear whether their combination improves therapeutic results more than monotherapy. To investigate this, we used Schwann cell transplantation via the tail vein, hyperbaric oxygen therapy, or their combination, in rat models of spinal cord contusion injury. The combined treatment was more effective in improving hindlimb motor function than either treatment alone; injured spinal tissue showed a greater number of neurite-like structures in the injured spinal tissue, somatosensory and motor evoked potential latencies were notably shorter, and their amplitudes greater, after combination therapy than after monotherapy. These findings indicate that Schwann cell transplantation combined with hyperbaric oxygen therapy is more effective than either treatment alone in promoting the recovery of spinal cord in rats after injury.

The aim of the study was to compare the protein expression of MMP-9 and p53 and examine their correlation with prognosis in lung cancer metastatic spinal tumor. Tissue samples were obtained from 30 cases of para-cancerous tissue (group I), 75 cases of non-metastatic lung cancer tissue (group II) and 100 cases of metastatic spinal tumor tissue of lung cancer (group III). The protein expression of MMP-9 and p53 was detected by immunohistochemistry and was present in all three groups. The positive rate for MMP-9 was 20, 67 and 83%, respectively. There was a significant difference among the three groups (p

The aim of the present study was to investigate the risk factors for postoperative recurrence of spinal tumors by logistic regression analysis and analysis of prognostic factors. In total, 77 male and 48 female patients with spinal tumor were selected in our hospital from January, 2010 to December, 2015 and divided into the benign (n=76) and malignant groups (n=49). All the patients underwent microsurgical resection of spinal tumors and were reviewed regularly 3 months after operation. The McCormick grading system was used to evaluate the postoperative spinal cord function. Data were subjected to statistical analysis. Of the 125 cases, 63 cases showed improvement after operation, 50 cases were stable, and deterioration was found in 12 cases. The improvement rate of patients with cervical spine tumor, which reached 56.3%, was the highest. Fifty-two cases of sensory disturbance, 34 cases of pain, 30 cases of inability to exercise, 26 cases of ataxia, and 12 cases of sphincter disorders were found after operation. Seventy-two cases (57.6%) underwent total resection, 18 cases (14.4%) received subtotal resection, 23 cases (18.4%) received partial resection, and 12 cases (9.6%) were only treated with biopsy/decompression. Postoperative recurrence was found in 57 cases (45.6%). The mean recurrence time of patients in the malignant group was 27.49±6.09 months, and the mean recurrence time of patients in the benign group was 40.62±4.34. The results were significantly different (P

The expression and correlation analysis of the regenerating gene family member 4 (RegIV) and vascular endothelial growth factors (VEGF-A and VEGF-C) in metastatic spinal tumors were studied. Fifteen patients with metastatic spinal tumors who underwent operation in our hospital from January 2011 to January 2013 were selected into this study. The expression level of tumor tissues in patients with spinal metastasis and RegIV, VEGF-A and VEGF-C of the corresponding paracancer normal tissue samples were evaluated by immunohistochemical staining method and the correlation between the expression of RegIV, VEGF-A and VEGF-C was analyzed. qRT-PCR results showed that the expression of RegIV was increased (P

Relatively few studies have addressed surgical strategy for complex proximal tibial fractures by now. The purpose of this study was to assess the results of a single lateral locking plate using minimally invasive plate osteosynthesis (MIPO) for proximal tibia fractures (AO/OTA type 41-C) with diaphyseal involvement. From Jun 2009 to Jun 2014, 20 patients (fifteen women and five men, mean age 35.8 years) were managed for proximal tibial fractures which extend into the diaphyseal region of the bone, including three 41-C1, eleven 41-C2, and six 41-C3. Twelve patients were open fractures. A single lateral locking plate characterized by percutaneous technology was used with or without additional lag screws. Mobilization was started immediately after the procedure, and non-weight-bearing was maintained for at least 6 weeks, then progressively weight bearing depends on both clinical and x-ray findings. Primary union was achieved by 16 of the 20 study subjects. Early bone grafting was performed in 4 cases with a massive initial bone defect and staged bone grafting was used in one to treat nonunion. The mean articular step off was 1.0 mm (range, 0-3 mm). No patient had misalignment greater than 10°. Acceptable range of knee motion of ≥120° was achieved in sixteen, and the mean knee Hass score was 87.4 at final follow-up visits. The complications included superficial infection in one patient. In conclusion, the surgical strategy can provide favorable results in the treatment of proximal tibial fractures (AO/OTA type 41-C) with diaphyseal involvement.