Heterotopic ossification(HO)is a pathological process resulting in aberrant bone formation and often involves synovial lined tissues.During this process,mesenchymal progenitor cells undergo endochondral ossification.N...Heterotopic ossification(HO)is a pathological process resulting in aberrant bone formation and often involves synovial lined tissues.During this process,mesenchymal progenitor cells undergo endochondral ossification.Nonetheless,the specific cell phenotypes and mechanisms driving this process are not well understood,in part due to the high degree of heterogeneity of the progenitor cells involved.Here,using a combination of lineage tracing and single-cell RNA sequencing(sc RNA-seq),we investigated the extent to which synovial/tendon sheath progenitor cells contribute to heterotopic bone formation.For this purpose,Tppp3(tubulin polymerization-promoting protein family member 3)-inducible reporter mice were used in combination with either Scx(Scleraxis)or Pdgfra(platelet derived growth factor receptor alpha)reporter mice.Both tendon injury-and arthroplasty-induced mouse experimental HO models were utilized.Sc RNA-seq of tendon-associated traumatic HO suggested that Tppp3 is an early progenitor cell marker for either tendon or osteochondral cells.Upon HO induction,Tppp3 reporter^(+)cells expanded in number and partially contributed to cartilage and bone formation in either tendon-or joint-associated HO.In double reporter animals,both Pdgfra^(+)Tppp3^(+)and Pdgfra^(+)Tppp3^(-) progenitor cells gave rise to HO-associated cartilage.Finally,analysis of human samples showed a substantial population of TPPP3^(-) expressing cells overlapping with osteogenic markers in areas of heterotopic bone.Overall,these data demonstrate that synovial/tendon sheath progenitor cells undergo aberrant osteochondral differentiation and contribute to HO after trauma.展开更多
The functional interdependence of nerves and blood vessels is a well-established concept during tissue morphogenesis, yet the role of neurovascular coupling in proper and aberrant tissue repair is an emerging field of...The functional interdependence of nerves and blood vessels is a well-established concept during tissue morphogenesis, yet the role of neurovascular coupling in proper and aberrant tissue repair is an emerging field of interest. Here, we sought to define the regulatory relationship of peripheral nerves on vasculature in a severe extremity trauma model in mice, which results in aberrant cell fate and heterotopic ossification(HO). First, a high spatial degree of neurovascular congruency was observed to exist within extremity injury associated heterotopic ossification. Vascular and perivascular cells demonstrate characteristic responses to injury,as assessed by single cell RNA sequencing. This vascular response to injury was blunted in neurectomized mice, including a decrease in endothelial proliferation and type H vessel formation, and a downregulation of key transcriptional networks associated with angiogenesis. Independent mechanisms to chemically or genetically inhibit axonal ingrowth led to similar deficits in HO site angiogenesis, a reduction in type H vessels, and heterotopic bone formation. Finally, a combination of single cell transcriptomic approaches within the dorsal root ganglia identified key neural-derived angiogenic paracrine factors that may mediate neuron-to-vascular signaling in HO. These data provide further understanding of nerve-to-vessel crosstalk in traumatized soft tissues, which may reflect a key determinant of mesenchymal progenitor cell fate after injury.展开更多
Tears of peroneus brevis tendon represent a cause of underdiagnosed lateral ankle pain and instability.The typical clinical presentation is retro-malleolar pain,in some cases associated with palpable swelling around t...Tears of peroneus brevis tendon represent a cause of underdiagnosed lateral ankle pain and instability.The typical clinical presentation is retro-malleolar pain,in some cases associated with palpable swelling around the fibular malleolus,pain during activities and difficulty in walking.We present a case of peroneus brevis split lesion with superior peroneal retinaculum avulsion in a young athlete who referred to the emergency ward of our hospital for left ankle pain after an inversion injury.An early diagnosis allowed treating the injury and promptly resuming sport activity,after rehabilitation training.Surgical reconstruction key-points and postsurgical follow-up were also discussed.A late diagnosis would have caused a symptomatology worsening and an increased recovery time.展开更多
BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be consid...BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be considered for these cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.CASE SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h ago.He had no medical history.Radiological investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.展开更多
BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction w...BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography(ERCP).CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior.Four days prior to presentation,the patient had slipped,fallen and struck his abdomen on a motorcycle handle.His initial vital signs were stable.On physical examination,he showed right upper quadrant pain and Murphy’s sign,with decreased bowel sounds.Additionally,he had had a poor appetite for 4 d.He had been on aspirin for 2 years due to underlying hypertension.Initial simple radiography revealed a slight ileus.The laboratory findings were as follows:white blood cell count,15.5×103/µL(normal range 4.8×10^(3)–10.8×10^(3));hemoglobin,9.4 g/dL;aspartate aminotransferase/alanine transferase,423/348 U/L;total bilirubin/direct bilirubin,4.45/3.26 mg/dL;-GTP,639 U/L(normal range 5–61 U/L);and C-reactive protein,12.32 mg/dL(0–0.3).Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm×40 mm hematoma.Dilatation was observed in both the intrahepatic and common bile duct areas.Antibiotic treatment was initiated,and ERCP was performed,with hemobilia found during treatment.After cannulation,the patient’s symptoms were relieved,and after conservative management,the patient was discharged with no further complications.After 1-month follow-up,the gallbladder hematoma was completely resolved.CONCLUSION In the case of traumatic injury to the gallbladder,conservative treatment is feasible even in the presence of hematoma.展开更多
To theeditor:Post-traumatic stress disorder(PTSD)arises after traumatic experiences,presenting with symptoms like reliving trauma,avoidance of reminders,mood changes and increased arousal,significantly affecting life ...To theeditor:Post-traumatic stress disorder(PTSD)arises after traumatic experiences,presenting with symptoms like reliving trauma,avoidance of reminders,mood changes and increased arousal,significantly affecting life quality and daily functioning.1 A severe complication of PTSD is suicidality,notably contributing to the higher mortality among PTSD sufferers.展开更多
Objective: To study the trauma and stress level of the pelvic fracture treated by 3D printing combined with lateral rectus abdominis approach surgery. Methods: A total of 50 patients with pelvic fractures who were tre...Objective: To study the trauma and stress level of the pelvic fracture treated by 3D printing combined with lateral rectus abdominis approach surgery. Methods: A total of 50 patients with pelvic fractures who were treated in the hospital between July 2015 and Jun 2017 were collected anddivided into control group (n=25) and observation group (n=25) by random number table method. Control group underwent lateral rectus abdominis approach surgery, and the observation group received 3D printingcombined with lateral rectus abdominis approach surgery. The differences in perioperative inflammatory response, coagulation function and stress degree were compared between the two groups. Results: 24 h before surgery, the differences in inflammatory response, coagulation function and stress degree were not statistically significant between the two groups. 24 h after surgery, serum IL-1, TNF-α, CRP, FIB, D-D, Cor, AngⅡ and NE levels of both groups of patients were higher than those 24h before surgery, and serum IL-1, TNF-α, CRP, FIB, D-D, Cor, AngⅡ and NE levels of observation group were lower than those of control group. Conclusion: 3D printing combined with lateral rectus abdominis approach surgery can effectively reduce the degree of surgical trauma and reduce the systemic stress response in patients with pelvic fracture.展开更多
The rapid corrosion rate and limited biological functionality still pose challenges for magnesium(Mg)-based implants in the treatment of complicated bone-related diseases in clinic.Herein,a multifunctional biodegradab...The rapid corrosion rate and limited biological functionality still pose challenges for magnesium(Mg)-based implants in the treatment of complicated bone-related diseases in clinic.Herein,a multifunctional biodegradable curcumin(herbal medicine)-ferrum(Cur-Fe)nanoflower was self-assembled on plasma electrolytic oxidation(PEO)-treated Mg alloy via a facile immersion process to realize differential biological function for anti-bacteria/tumor and bone regeneration.The results indicated that Cur-Fe nanoflower coating can promote protein adsorption,cell adhesion and proliferation,exhibiting excellent biocompatibility.The Cur-Fe nanoflower coating exhibits unique degradation characteristics,as curcumin gradually decomposes into ferulic acid,aromatic aldehyde and other antibacterial substances,and the coating spontaneously converts into FeOOH nanosheets,ensuring the corrosion resistance of Mg-based implants.Moreover,Cur-Fe coating exhibits remarkable narrow gap semiconductor characteristics,which can generate reactive oxygen species(ROS)and demonstrated excellent antibacterial effect under simulated sunlight(SSL)irradiation.Meanwhile,under NIR irradiation,Cur-Fe coating showed excellent chemotherapy/photodynamic/photothermal synergetic antitumor properties in vitro and in vivo due to the introduction of curcumin,and photocatalysis and photothermal conversion properties of coating.Furthermore,Cur-Fe nanoflower coating demonstrated great osteogenesis activity in vitro and in vivo due to unique micro/nano structure,surface chemical bond,and the release of Mg and Fe ions.展开更多
Osteoporotic fractures often exhibit delayed healing and repair difficulties in which the bone immune microenvironment may play a critical role,but direct evidence remains elusive.Recently,magnesium(Mg)-based alloys h...Osteoporotic fractures often exhibit delayed healing and repair difficulties in which the bone immune microenvironment may play a critical role,but direct evidence remains elusive.Recently,magnesium(Mg)-based alloys have emerged as promising biodegradable materials capable of promoting fracture healing.Herein,we performed internal fixation of high-purity Mg implants for osteoporotic fractures and used single-cell studies to investigate and elucidate the cellular heterogeneity and dynamic changes that occurred during osteoporotic fracture repair.We observed an early increase in immature neutrophil numbers,together with anti-inflammatory changes in lymphocytes and macrophages.A cluster of macrophages exhibited pro-angiogenic capabilities activated via the TRPM7/S100A4 pathway.These findings provide new theoretical insights into the biological effects of Mg-based materials on the healing of osteoporotic fractures.展开更多
AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHO...AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHODS: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intraand perioperative complications increased for such patients. We evaluated all patients with body mass index(BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty(THA) or total knee arthroplasty(TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score(HHS), Hospital for Special Surgery score(HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated.RESULTS: Six thousand and seventy-eight patients with a BMI ≥ 25 were treated with a primary THA or TKA. Age decreased significantly(P < 0.001) by increasing obesity in both the THA and TKA. HHS and HSS were at significantly lower levels at the time of treatment in the super-obese population(P < 0.001). Distribution patterns of the type of endoprostheses used changed with an increasing BMI. Peri- and postoperative complications were similar in form and quantity to those of the normal population. CONCLUSION: Higher BMI leads to endoprosthetic treatment in younger age, which is carried out at significantly lower levels of preoperative joint function.展开更多
Spinal cord ischemia/reperfusion injury is a stress injury to the spinal cord. Our previous studies using differential proteomics identified 21 differentially expressed proteins （n 〉 2） in rabbits with spinal cord ...Spinal cord ischemia/reperfusion injury is a stress injury to the spinal cord. Our previous studies using differential proteomics identified 21 differentially expressed proteins （n 〉 2） in rabbits with spinal cord ischemia/reperfusion injury. Of these proteins, stress-related proteins included protein disulfide isomerase A3, stress-induced-phosphoprotein 1 and heat shock cognate protein 70. In this study, we established New Zealand rabbit models of spinal cord ischemia/reperfusion injury by abdominal aorta occlusion. Results demonstrated that hind limb function initially improved after spinal cord ischemia/reperfusion injury, but then deteriorated. The pathological morphology of the spinal cord became aggravated, but lessened 24 hours after reperfusion. However, the numbers of motor neurons and interneurons in the spinal cord gradually decreased. The expression of protein disulfide isomerase A3, stress-induced-phosphoprotein 1 and heat shock cognate protein 70 was induced by ischemia/reperfusion injury. The expression of these proteins increased within 12 hours after reperfusion, and then decreased, reached a minimum at 24 hours, but subsequently increased again to similar levels seen at 6-12 hours, showing a characterization of induction-inhibition-induc- tion. These three proteins were expressed only in cytoplasm but not in the nuclei. Moreover, the expression was higher in interneurons than in motor neurons, and the survival rate of interneurons was greater than that of motor neurons. It is assumed that the expression of stress-related proteins exhibited a protective effect on neurons.展开更多
AIM:To investigate the actual injury situation of seniors in traffic accidents and to evaluate the different injury patterns.METHODS:Injury data,environmental circumstances and crash circumstances of accidents were co...AIM:To investigate the actual injury situation of seniors in traffic accidents and to evaluate the different injury patterns.METHODS:Injury data,environmental circumstances and crash circumstances of accidents were collected shortly after the accident event at the scene.With these data,a technical and medical analysis was performed,including Injury Severity Score,Abbreviated Injury Scale and Maximum Abbreviated Injury Scale.The method of data collection is named the German InDepth Accident Study and can be seen as representative.RESULTS:A total of 4430 injured seniors in traffic accidents were evaluated.The incidence of sustaining severe injuries to extremities,head and maxillofacial region was significantly higher in the group of elderly people compared to a younger age(P<0.05).The number of accident-related injuries was higher in the group of seniors compared to other groups.CONCLUSION:Seniors are more likely to be involved in traffic injuries and to sustain serious to severe injuries compared to other groups.展开更多
Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists ...Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists of surgical resection. We describe a case of perforated jejunoileal diverticulum with localized abscess and highlight the merits of surgical vs medical management. The patient is a 77-year-old male who presented with sharp, constant abdominal pain just inferior to the umbilicus. Administration of intravenous antibiotics results in complete and long-term resolution of the patient’s symptoms. In this report, we establish a framework for safely treating perforated small bowel diverticulum without surgical exploration.展开更多
AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were...AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controllingthe source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.展开更多
BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients.Early postoperative portal vein thrombosis(PVT,inciden...BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients.Early postoperative portal vein thrombosis(PVT,incidence 2%-2.6%)and early hepatic artery thrombosis(HAT,incidence 3%-5%)have a poor prognosis in transplant patients,having impacts on graft and patient survival.In the present study,we attempted to identify the predictive factors of these complications for early detection and therefore monitor more closely the patients most at risk of thrombotic complications.AIM To investigate whether intraoperative thromboelastography(TEG)is useful in detecting the risk of early postoperative HAT and PVT in patients undergoing liver transplantation(LT).METHODS We retrospectively collected thromboelastographic traces,in addition to known risk factors(cold ischemic time,intraoperative requirement for red blood cells and fresh-frozen plasma transfusion,prolonged operating time),in 27 patients,selected among 530 patients(≥18 years old),who underwent their first LT from January 2002 to January 2015 at the Liver University Transplant Center and developed an early PVT or HAT(case group).Analyses of the TEG traces were performed before anesthesia and 120 min after reperfusion.We retrospectively compared these patients with the same number of nonconsecutive control patients who underwent LT in the same study period without developing these complications(1:1 match)(control group).The chosen matching parameters were:Patient graft and donor characteristics[age,sex,body mass index(BMI)],indication for transplantation,procedure details,United Network for Organ Sharing classification,BMI,warm ischemia time(WIT),cold ischemia time(CIT),the volume of blood products transfused,and conventional laboratory coagulation analysis.Normally distributed continuous data are reported as the mean±SD and compared using one-way Analysis of Variance(ANOVA).Nonnormally distributed continuous data are reported as the median(interquartile range)and compared using the Mann-Whitney test.Categorical variables were analyzed with Chi-square tests with Yates correction or Fisher’s exact test depending on best applicability.IBM SPSS Statistics version 24(SPSS Inc.,Chicago,IL,United States)was employed for statistical analysis.Statistical significance was set at P<0.05.RESULTS Postoperative thrombotic events were identified as early if they occurred within 21 d postoperatively.The incidence of early hepatic artery occlusion was 3.02%,whereas the incidence of PVT was 2.07%.A comparison between the case and control groups showed some differences in the duration of surgery,which was longer in the case group(P=0.032),whereas transfusion of blood products,red blood cells,fresh frozen plasma,and platelets,was similar between the two study groups.Thromboelastographic parameters did not show any statistically significant difference between the two groups,except for the G value measured at basal and 120’postreperfusion time.It was higher,although within the reference range,in the case group than in the control group(P=0.001 and P<0.001,respectively).In addition,clot lysis at 60 min(LY60)measured at 120’postreperfusion time was lower in the case group than in the control group(P=0.035).This parameter is representative of a fibrinolysis shutdown(LY60=0%-0.80%)in 85%of patients who experienced a thrombotic complication,resulting in a statistical correlation with HAT and PVT.CONCLUSION The end of surgery LY60 and G value may identify those recipients at greater risk of developing early HAT or PVT,suggesting that they may benefit from intense surveillance and eventually anticoagulation prophylaxis in order to prevent these serious complications after LT.展开更多
BACKGROUND Schwannomas are rare,often benign,tumors deriving from Schwann cells that have low incidence in the retroperitoneal region(0.5%to 5%).Their diagnosis is hardly confirmed at early stage due to lack of specif...BACKGROUND Schwannomas are rare,often benign,tumors deriving from Schwann cells that have low incidence in the retroperitoneal region(0.5%to 5%).Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs,symptoms and imaging tests.Thus,it is necessary performing guided punch biopsy in order to identify it.Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy.CASE SUMMARY Forty-seven years old female patient who was hospitalized for elective orthopedic procedure,without complications,evolved with severe pain in the lower limbs,thigh and gluteal region associated with neurogenic claudication.Persistent pain required magnetic resonance imaging(MRI)of the lumbar spine,which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion.The surgical team opted for draining the collection,as well as requested an MRI of the abdomen and pelvis,whose analysis showed expansive lesion in the retroperitoneum,in close contact with the inferior vena cava and with the right renal vein.A guided puncture was performed for diagnostic clarification,which showed immunohistochemical profile compatible with schwannoma.The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy.The patient was discharged and remained stable after 4-mo follow-up;she remains under followup to check the need of cancer investigations.CONCLUSION Schwannoma features requires surgical treatment based on laparoscopic resection,which often presents low relapse rates and optimistic prognosis.展开更多
Post-traumatic peritendinous adhesion presents a significant challenge in clinical medicine.This study proposes the use of diamond-like carbon(DLC)deposited on polylactic acid(PLA)membranes as a biophysical mechanism ...Post-traumatic peritendinous adhesion presents a significant challenge in clinical medicine.This study proposes the use of diamond-like carbon(DLC)deposited on polylactic acid(PLA)membranes as a biophysical mechanism for anti-adhesion barrier to encase ruptured tendons in tendon-injured rats.The results indicate that PLA/DLC composite membrane exhibits more efficient anti-adhesion effect than PLA membrane,with histological score decreasing from 3.12±0.27 to 2.20±0.22 and anti-adhesion effectiveness increasing from 21.61%to 44.72%.Mechanistically,the abundant C=O bond functional groups on the surface of DLC can reduce reactive oxygen species level effectively;thus,the phosphorylation of NF-κB and M1 polarization of macrophages are inhibited.Consequently,excessive inflammatory response augmented by M1 macrophage-originated cytokines including interleukin-6(IL-6),interleukin-1β(IL-1β),and tumor necrosis factor-α(TNF-α)is largely reduced.For biocompatibility evaluation,PLA/DLC membrane is slowly absorbed within tissue and displays prolonged barrier effects compared to traditional PLA membranes.Further studies show the DLC depositing decelerates the release of degradation product lactic acid and its induction of macrophage M2 polarization by interfering esterase and PLA ester bonds,which further delays the fibrosis process.It was found that the PLA/DLC membrane possess an efficient biophysical mechanism for treatment of peritendinous adhesion.展开更多
Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobilit...Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.展开更多
We present a case of a 33-year-old female who sustained multiple injuries of her spine, including spinous process fractures of C5 to C7 and a lamina fracture of C6 and C7. Her thoracic spine showed transverse process ...We present a case of a 33-year-old female who sustained multiple injuries of her spine, including spinous process fractures of C5 to C7 and a lamina fracture of C6 and C7. Her thoracic spine showed transverse process fractures of T4 to T10, a compression fracture and lamina fracture of T3, spinous process and transverse process fractures of T4 and T5, a rotation injury of T6, as well as a compression fracture of L1. Thirteen months after posterior thoracic spinal instrumentation, a pedicle screw was suspected to be in contact with the aorta, which was proved by computed tomography angiograms. Consequently, implant removal was planned with direct exposure of the aorta in order to allow for immediate repair if needed. So far, studies that compare different techniques to remove pedicle screws that are suspected to penetrate the aorta are missing. However, different techniques have been described in case reports, mainly minimally invasive endovascular techniques vs open techniques such as thoracotomy.展开更多
Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament（ACL）reconstruction.Interference screw,as a surgical implant in ACL reconstruction,may influence natural loading transmis...Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament（ACL）reconstruction.Interference screw,as a surgical implant in ACL reconstruction,may influence natural loading transmission and contribute to tunnel enlargement.The aims of this study are（1）to quantify the alteration of strain energy density（SED）distribution after the anatomic single-bundle ACL reconstruction;and（2）to characterize the influence of screw length and diameter on the degree of the SED alteration.A validated finite element model of human knee joint was used.The screw length ranging from 20 to 30 mm with screw diameter ranging from 7 to 9 mm were investigated.In the post-operative knee,the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings,whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture.Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel;whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel.Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw.In consideration of both graft stability and SED alteration,a biodegradable interference screw with a long length is recommended,which could provide a beneficial mechanical environment at the distal part of the tunnel,and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel.These findings together with the clinical and histological factors could help to improve surgical outcome,and serve as a preliminary knowledge for the following study of biodegradable interference screw.展开更多
基金funded by the NIH/NIAMS (R01 AR070773,R01 AR068316,R01 DE031028,R21 AR078919)USAMRAA through the Peer Reviewed Medical Research Program (W81XWH-18-1-0121,W81XWH-18-1-0336)+4 种基金the Peer Reviewed Orthopaedic Research Program (W81XWH-20-10795)Broad Agency Announcement (W81XWH-1810613)the American Cancer Society (Research Scholar Grant,RSG-18-027-01-CSM)the Maryland Stem Cell Research Foundationfunded by the NIH (R01 AR079171,R01 AR078324,and R01 AR071379)。
文摘Heterotopic ossification(HO)is a pathological process resulting in aberrant bone formation and often involves synovial lined tissues.During this process,mesenchymal progenitor cells undergo endochondral ossification.Nonetheless,the specific cell phenotypes and mechanisms driving this process are not well understood,in part due to the high degree of heterogeneity of the progenitor cells involved.Here,using a combination of lineage tracing and single-cell RNA sequencing(sc RNA-seq),we investigated the extent to which synovial/tendon sheath progenitor cells contribute to heterotopic bone formation.For this purpose,Tppp3(tubulin polymerization-promoting protein family member 3)-inducible reporter mice were used in combination with either Scx(Scleraxis)or Pdgfra(platelet derived growth factor receptor alpha)reporter mice.Both tendon injury-and arthroplasty-induced mouse experimental HO models were utilized.Sc RNA-seq of tendon-associated traumatic HO suggested that Tppp3 is an early progenitor cell marker for either tendon or osteochondral cells.Upon HO induction,Tppp3 reporter^(+)cells expanded in number and partially contributed to cartilage and bone formation in either tendon-or joint-associated HO.In double reporter animals,both Pdgfra^(+)Tppp3^(+)and Pdgfra^(+)Tppp3^(-) progenitor cells gave rise to HO-associated cartilage.Finally,analysis of human samples showed a substantial population of TPPP3^(-) expressing cells overlapping with osteogenic markers in areas of heterotopic bone.Overall,these data demonstrate that synovial/tendon sheath progenitor cells undergo aberrant osteochondral differentiation and contribute to HO after trauma.
基金JHU microscopy facility.A.W.J.was funded by NIH/NIAMS(R01 AR070773),NIH/NIDCR(R21 DE027922)USAMRAA through the Peer-Reviewed Medical Research Program(W81XWH-18–1–0121,W81XWH-18–1–0336)+7 种基金Broad Agency Announcement(W81XWH-18–10613)American Cancer Society(Research Scholar Grant,RSG-18–027–01-CSM)the Maryland Stem Cell Research Foundation.B.L.funded by the NIH(1R01 AR071379)funded by NIH(R01 AR079171)Do D(W81XWH-20–1–0795)supported by the NIH/NIAMS(R01 AR068934)NIH/NIDCR(R21 DE027922)the VA(Merit Award and Senior Research Career Scientist Award)。
文摘The functional interdependence of nerves and blood vessels is a well-established concept during tissue morphogenesis, yet the role of neurovascular coupling in proper and aberrant tissue repair is an emerging field of interest. Here, we sought to define the regulatory relationship of peripheral nerves on vasculature in a severe extremity trauma model in mice, which results in aberrant cell fate and heterotopic ossification(HO). First, a high spatial degree of neurovascular congruency was observed to exist within extremity injury associated heterotopic ossification. Vascular and perivascular cells demonstrate characteristic responses to injury,as assessed by single cell RNA sequencing. This vascular response to injury was blunted in neurectomized mice, including a decrease in endothelial proliferation and type H vessel formation, and a downregulation of key transcriptional networks associated with angiogenesis. Independent mechanisms to chemically or genetically inhibit axonal ingrowth led to similar deficits in HO site angiogenesis, a reduction in type H vessels, and heterotopic bone formation. Finally, a combination of single cell transcriptomic approaches within the dorsal root ganglia identified key neural-derived angiogenic paracrine factors that may mediate neuron-to-vascular signaling in HO. These data provide further understanding of nerve-to-vessel crosstalk in traumatized soft tissues, which may reflect a key determinant of mesenchymal progenitor cell fate after injury.
文摘Tears of peroneus brevis tendon represent a cause of underdiagnosed lateral ankle pain and instability.The typical clinical presentation is retro-malleolar pain,in some cases associated with palpable swelling around the fibular malleolus,pain during activities and difficulty in walking.We present a case of peroneus brevis split lesion with superior peroneal retinaculum avulsion in a young athlete who referred to the emergency ward of our hospital for left ankle pain after an inversion injury.An early diagnosis allowed treating the injury and promptly resuming sport activity,after rehabilitation training.Surgical reconstruction key-points and postsurgical follow-up were also discussed.A late diagnosis would have caused a symptomatology worsening and an increased recovery time.
文摘BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be considered for these cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.CASE SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h ago.He had no medical history.Radiological investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.
文摘BACKGROUND We report a case of intragallbladder hematoma and biliary tract obstruction caused by blunt gallbladder injury.We report that the patient was safely treated by conservative treatment after the obstruction was resolved by endoscopic retrograde cholangiopancreatography(ERCP).CASE SUMMARY A 67-year-old man was admitted via the emergency department due to complaints of right-sided abdominal pain that started 2 d prior.Four days prior to presentation,the patient had slipped,fallen and struck his abdomen on a motorcycle handle.His initial vital signs were stable.On physical examination,he showed right upper quadrant pain and Murphy’s sign,with decreased bowel sounds.Additionally,he had had a poor appetite for 4 d.He had been on aspirin for 2 years due to underlying hypertension.Initial simple radiography revealed a slight ileus.The laboratory findings were as follows:white blood cell count,15.5×103/µL(normal range 4.8×10^(3)–10.8×10^(3));hemoglobin,9.4 g/dL;aspartate aminotransferase/alanine transferase,423/348 U/L;total bilirubin/direct bilirubin,4.45/3.26 mg/dL;-GTP,639 U/L(normal range 5–61 U/L);and C-reactive protein,12.32 mg/dL(0–0.3).Abdominal computed tomography showed a distended gallbladder with edematous wall change and a 55 mm×40 mm hematoma.Dilatation was observed in both the intrahepatic and common bile duct areas.Antibiotic treatment was initiated,and ERCP was performed,with hemobilia found during treatment.After cannulation,the patient’s symptoms were relieved,and after conservative management,the patient was discharged with no further complications.After 1-month follow-up,the gallbladder hematoma was completely resolved.CONCLUSION In the case of traumatic injury to the gallbladder,conservative treatment is feasible even in the presence of hematoma.
基金funded by a grant of the National Research Foundation of Korea Grant(NRF-2020M3E5D9080733)and(NRF-2020R1A2C2003472)to J-MK。
文摘To theeditor:Post-traumatic stress disorder(PTSD)arises after traumatic experiences,presenting with symptoms like reliving trauma,avoidance of reminders,mood changes and increased arousal,significantly affecting life quality and daily functioning.1 A severe complication of PTSD is suicidality,notably contributing to the higher mortality among PTSD sufferers.
文摘Objective: To study the trauma and stress level of the pelvic fracture treated by 3D printing combined with lateral rectus abdominis approach surgery. Methods: A total of 50 patients with pelvic fractures who were treated in the hospital between July 2015 and Jun 2017 were collected anddivided into control group (n=25) and observation group (n=25) by random number table method. Control group underwent lateral rectus abdominis approach surgery, and the observation group received 3D printingcombined with lateral rectus abdominis approach surgery. The differences in perioperative inflammatory response, coagulation function and stress degree were compared between the two groups. Results: 24 h before surgery, the differences in inflammatory response, coagulation function and stress degree were not statistically significant between the two groups. 24 h after surgery, serum IL-1, TNF-α, CRP, FIB, D-D, Cor, AngⅡ and NE levels of both groups of patients were higher than those 24h before surgery, and serum IL-1, TNF-α, CRP, FIB, D-D, Cor, AngⅡ and NE levels of observation group were lower than those of control group. Conclusion: 3D printing combined with lateral rectus abdominis approach surgery can effectively reduce the degree of surgical trauma and reduce the systemic stress response in patients with pelvic fracture.
基金supported by the National Key R&D Program of China(2021YFC2400500)Shanghai Committee of Science and Technology,China(20S31901200)+2 种基金the Fundamental Research Funds for the Central Universities(2022ZYGXZR042)Postdoctoral Science Foundation of China(2022M723288)GDPH Supporting Fund for Talent Program(KY0120220137).
文摘The rapid corrosion rate and limited biological functionality still pose challenges for magnesium(Mg)-based implants in the treatment of complicated bone-related diseases in clinic.Herein,a multifunctional biodegradable curcumin(herbal medicine)-ferrum(Cur-Fe)nanoflower was self-assembled on plasma electrolytic oxidation(PEO)-treated Mg alloy via a facile immersion process to realize differential biological function for anti-bacteria/tumor and bone regeneration.The results indicated that Cur-Fe nanoflower coating can promote protein adsorption,cell adhesion and proliferation,exhibiting excellent biocompatibility.The Cur-Fe nanoflower coating exhibits unique degradation characteristics,as curcumin gradually decomposes into ferulic acid,aromatic aldehyde and other antibacterial substances,and the coating spontaneously converts into FeOOH nanosheets,ensuring the corrosion resistance of Mg-based implants.Moreover,Cur-Fe coating exhibits remarkable narrow gap semiconductor characteristics,which can generate reactive oxygen species(ROS)and demonstrated excellent antibacterial effect under simulated sunlight(SSL)irradiation.Meanwhile,under NIR irradiation,Cur-Fe coating showed excellent chemotherapy/photodynamic/photothermal synergetic antitumor properties in vitro and in vivo due to the introduction of curcumin,and photocatalysis and photothermal conversion properties of coating.Furthermore,Cur-Fe nanoflower coating demonstrated great osteogenesis activity in vitro and in vivo due to unique micro/nano structure,surface chemical bond,and the release of Mg and Fe ions.
基金financially supported by the National Natural Science Foundation of China(Nos.81871742 and 82102538)Shanghai Sailing Program(No.21YF1405800)+2 种基金Shanghai Pudong Science and Technology Development Funding(No.PKJ2020-Y44)the Featured Clinical Discipline Project of Shanghai Pudong New District(No.Pwyts2021-03)the support of the National Engineering Research Center of Light Alloy Net Forming,Shanghai Jiao Tong University
文摘Osteoporotic fractures often exhibit delayed healing and repair difficulties in which the bone immune microenvironment may play a critical role,but direct evidence remains elusive.Recently,magnesium(Mg)-based alloys have emerged as promising biodegradable materials capable of promoting fracture healing.Herein,we performed internal fixation of high-purity Mg implants for osteoporotic fractures and used single-cell studies to investigate and elucidate the cellular heterogeneity and dynamic changes that occurred during osteoporotic fracture repair.We observed an early increase in immature neutrophil numbers,together with anti-inflammatory changes in lymphocytes and macrophages.A cluster of macrophages exhibited pro-angiogenic capabilities activated via the TRPM7/S100A4 pathway.These findings provide new theoretical insights into the biological effects of Mg-based materials on the healing of osteoporotic fractures.
文摘AIM: To evaluate a possible association between thevarious levels of obesity and peri-operative characteristics of the procedure in patients who underwent endoprosthetic joint replacement in hip and knee joints. METHODS: We hypothesized that obese patients were treated for later stage of osteoarthritis, that more conservative implants were used, and the intraand perioperative complications increased for such patients. We evaluated all patients with body mass index(BMI) ≥ 25 who were treated in our institution from January 2011 to September 2013 for a primary total hip arthroplasty(THA) or total knee arthroplasty(TKA). Patients were split up by the levels of obesity according to the classification of the World Health Organization. Average age at the time of primary arthroplasty, preoperative Harris Hip Score(HHS), Hospital for Special Surgery score(HSS), gender, type of implanted prosthesis, and intra-and postoperative complications were evaluated.RESULTS: Six thousand and seventy-eight patients with a BMI ≥ 25 were treated with a primary THA or TKA. Age decreased significantly(P < 0.001) by increasing obesity in both the THA and TKA. HHS and HSS were at significantly lower levels at the time of treatment in the super-obese population(P < 0.001). Distribution patterns of the type of endoprostheses used changed with an increasing BMI. Peri- and postoperative complications were similar in form and quantity to those of the normal population. CONCLUSION: Higher BMI leads to endoprosthetic treatment in younger age, which is carried out at significantly lower levels of preoperative joint function.
基金supported by the National Natural Science Foundation of China, No. 30872609
文摘Spinal cord ischemia/reperfusion injury is a stress injury to the spinal cord. Our previous studies using differential proteomics identified 21 differentially expressed proteins （n 〉 2） in rabbits with spinal cord ischemia/reperfusion injury. Of these proteins, stress-related proteins included protein disulfide isomerase A3, stress-induced-phosphoprotein 1 and heat shock cognate protein 70. In this study, we established New Zealand rabbit models of spinal cord ischemia/reperfusion injury by abdominal aorta occlusion. Results demonstrated that hind limb function initially improved after spinal cord ischemia/reperfusion injury, but then deteriorated. The pathological morphology of the spinal cord became aggravated, but lessened 24 hours after reperfusion. However, the numbers of motor neurons and interneurons in the spinal cord gradually decreased. The expression of protein disulfide isomerase A3, stress-induced-phosphoprotein 1 and heat shock cognate protein 70 was induced by ischemia/reperfusion injury. The expression of these proteins increased within 12 hours after reperfusion, and then decreased, reached a minimum at 24 hours, but subsequently increased again to similar levels seen at 6-12 hours, showing a characterization of induction-inhibition-induc- tion. These three proteins were expressed only in cytoplasm but not in the nuclei. Moreover, the expression was higher in interneurons than in motor neurons, and the survival rate of interneurons was greater than that of motor neurons. It is assumed that the expression of stress-related proteins exhibited a protective effect on neurons.
基金Supported by Federal Highway Research Institute(BASt)the German Research Association of the Automotive Technology,a department of the VDA(German Association of the Automotive Industry)
文摘AIM:To investigate the actual injury situation of seniors in traffic accidents and to evaluate the different injury patterns.METHODS:Injury data,environmental circumstances and crash circumstances of accidents were collected shortly after the accident event at the scene.With these data,a technical and medical analysis was performed,including Injury Severity Score,Abbreviated Injury Scale and Maximum Abbreviated Injury Scale.The method of data collection is named the German InDepth Accident Study and can be seen as representative.RESULTS:A total of 4430 injured seniors in traffic accidents were evaluated.The incidence of sustaining severe injuries to extremities,head and maxillofacial region was significantly higher in the group of elderly people compared to a younger age(P<0.05).The number of accident-related injuries was higher in the group of seniors compared to other groups.CONCLUSION:Seniors are more likely to be involved in traffic injuries and to sustain serious to severe injuries compared to other groups.
文摘Jejunoileal diverticula are rare and generally asymptomatic. In the few cases of patients who develop complications such as diverticulitis, perforation, obstruction, and/or hemorrhage, conventional treatment consists of surgical resection. We describe a case of perforated jejunoileal diverticulum with localized abscess and highlight the merits of surgical vs medical management. The patient is a 77-year-old male who presented with sharp, constant abdominal pain just inferior to the umbilicus. Administration of intravenous antibiotics results in complete and long-term resolution of the patient’s symptoms. In this report, we establish a framework for safely treating perforated small bowel diverticulum without surgical exploration.
文摘AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controllingthe source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.
文摘BACKGROUND Thromboembolic complications are relatively common causes of increased morbidity and mortality in the perioperative period in liver transplant patients.Early postoperative portal vein thrombosis(PVT,incidence 2%-2.6%)and early hepatic artery thrombosis(HAT,incidence 3%-5%)have a poor prognosis in transplant patients,having impacts on graft and patient survival.In the present study,we attempted to identify the predictive factors of these complications for early detection and therefore monitor more closely the patients most at risk of thrombotic complications.AIM To investigate whether intraoperative thromboelastography(TEG)is useful in detecting the risk of early postoperative HAT and PVT in patients undergoing liver transplantation(LT).METHODS We retrospectively collected thromboelastographic traces,in addition to known risk factors(cold ischemic time,intraoperative requirement for red blood cells and fresh-frozen plasma transfusion,prolonged operating time),in 27 patients,selected among 530 patients(≥18 years old),who underwent their first LT from January 2002 to January 2015 at the Liver University Transplant Center and developed an early PVT or HAT(case group).Analyses of the TEG traces were performed before anesthesia and 120 min after reperfusion.We retrospectively compared these patients with the same number of nonconsecutive control patients who underwent LT in the same study period without developing these complications(1:1 match)(control group).The chosen matching parameters were:Patient graft and donor characteristics[age,sex,body mass index(BMI)],indication for transplantation,procedure details,United Network for Organ Sharing classification,BMI,warm ischemia time(WIT),cold ischemia time(CIT),the volume of blood products transfused,and conventional laboratory coagulation analysis.Normally distributed continuous data are reported as the mean±SD and compared using one-way Analysis of Variance(ANOVA).Nonnormally distributed continuous data are reported as the median(interquartile range)and compared using the Mann-Whitney test.Categorical variables were analyzed with Chi-square tests with Yates correction or Fisher’s exact test depending on best applicability.IBM SPSS Statistics version 24(SPSS Inc.,Chicago,IL,United States)was employed for statistical analysis.Statistical significance was set at P<0.05.RESULTS Postoperative thrombotic events were identified as early if they occurred within 21 d postoperatively.The incidence of early hepatic artery occlusion was 3.02%,whereas the incidence of PVT was 2.07%.A comparison between the case and control groups showed some differences in the duration of surgery,which was longer in the case group(P=0.032),whereas transfusion of blood products,red blood cells,fresh frozen plasma,and platelets,was similar between the two study groups.Thromboelastographic parameters did not show any statistically significant difference between the two groups,except for the G value measured at basal and 120’postreperfusion time.It was higher,although within the reference range,in the case group than in the control group(P=0.001 and P<0.001,respectively).In addition,clot lysis at 60 min(LY60)measured at 120’postreperfusion time was lower in the case group than in the control group(P=0.035).This parameter is representative of a fibrinolysis shutdown(LY60=0%-0.80%)in 85%of patients who experienced a thrombotic complication,resulting in a statistical correlation with HAT and PVT.CONCLUSION The end of surgery LY60 and G value may identify those recipients at greater risk of developing early HAT or PVT,suggesting that they may benefit from intense surveillance and eventually anticoagulation prophylaxis in order to prevent these serious complications after LT.
文摘BACKGROUND Schwannomas are rare,often benign,tumors deriving from Schwann cells that have low incidence in the retroperitoneal region(0.5%to 5%).Their diagnosis is hardly confirmed at early stage due to lack of specific features in signs,symptoms and imaging tests.Thus,it is necessary performing guided punch biopsy in order to identify it.Tumor removal is the treatment of choice due to its low sensitivity to radiation and chemotherapy.CASE SUMMARY Forty-seven years old female patient who was hospitalized for elective orthopedic procedure,without complications,evolved with severe pain in the lower limbs,thigh and gluteal region associated with neurogenic claudication.Persistent pain required magnetic resonance imaging(MRI)of the lumbar spine,which showed epidural collection with dural compression and massive heterogeneous perihepatic nodular lesion.The surgical team opted for draining the collection,as well as requested an MRI of the abdomen and pelvis,whose analysis showed expansive lesion in the retroperitoneum,in close contact with the inferior vena cava and with the right renal vein.A guided puncture was performed for diagnostic clarification,which showed immunohistochemical profile compatible with schwannoma.The selected treatment comprised retroperitoneum tumor resection in association with laparoscopic cholecystectomy.The patient was discharged and remained stable after 4-mo follow-up;she remains under followup to check the need of cancer investigations.CONCLUSION Schwannoma features requires surgical treatment based on laparoscopic resection,which often presents low relapse rates and optimistic prognosis.
基金supported by the National Natural Science Foundation of China(No.82172408,81772314,and 81922045)the Original Exploration project(22ZR1480300)+5 种基金Outstanding Academic Leaders(Youth)project(21XD1422900)of Shanghai Science and Technology Innovation Action PlanPrinciple Investigator Innovation Team of Both Shanghai Sixth People’s Hospital and Shanghai Institute of Nutrition and Health,Shanghai Jiao Tong University Medical College“Two-hundred Talent”Program(No.20191829)The Second Three-Year Action Plan for Promoting Clinical Skills and Clinical Innovation in Municipal Hospitals of Shanghai Shenkang(No.SHDC2020CR4032)Shanghai Excellent Academic Leader ProgramShanghai Engineering Research Center for Orthopaedic Material Innovation and Tissue Regeneration(No.20DZ2254100)China Postdoctoral Science Foundation(2023M742347).
文摘Post-traumatic peritendinous adhesion presents a significant challenge in clinical medicine.This study proposes the use of diamond-like carbon(DLC)deposited on polylactic acid(PLA)membranes as a biophysical mechanism for anti-adhesion barrier to encase ruptured tendons in tendon-injured rats.The results indicate that PLA/DLC composite membrane exhibits more efficient anti-adhesion effect than PLA membrane,with histological score decreasing from 3.12±0.27 to 2.20±0.22 and anti-adhesion effectiveness increasing from 21.61%to 44.72%.Mechanistically,the abundant C=O bond functional groups on the surface of DLC can reduce reactive oxygen species level effectively;thus,the phosphorylation of NF-κB and M1 polarization of macrophages are inhibited.Consequently,excessive inflammatory response augmented by M1 macrophage-originated cytokines including interleukin-6(IL-6),interleukin-1β(IL-1β),and tumor necrosis factor-α(TNF-α)is largely reduced.For biocompatibility evaluation,PLA/DLC membrane is slowly absorbed within tissue and displays prolonged barrier effects compared to traditional PLA membranes.Further studies show the DLC depositing decelerates the release of degradation product lactic acid and its induction of macrophage M2 polarization by interfering esterase and PLA ester bonds,which further delays the fibrosis process.It was found that the PLA/DLC membrane possess an efficient biophysical mechanism for treatment of peritendinous adhesion.
文摘Introduction: Tibial plateau fractures are solutions of continuity of the epiphyseal-metaphyseal block of the upper end of the tibia of which at least one line enters the joint. They threaten the stability and mobility of the knee and can compromise walking and standing. These fractures are on the increase, especially affecting young and active subjects. Orthopedic treatment is a rare indication apart from non-displaced or slightly displaced forms. Surgical treatment is required in displaced forms, particularly in depression fractures. The aim of this work was to report the lesional and therapeutic aspects of tibial plateau fractures in our department. Patients and Method: Patients and method: This was a retrospective study over 36 months from January 2019 to December 2021. Included in this study were patients treated for a tibial plateau fracture in our department and followed up for at least 10 months. The epidemiological and clinical data analyzed were age, sex, affected side, etiology, mechanism of injury, pathological anatomy and associated lesions. The fractures were classified according to the classification of Duparc and Ficat. The slightly or non-displaced forms were treated orthopedically while the displaced forms were treated surgically. The minimum follow-up was 10 months. The results were evaluated by the anatomical criteria according to Mazas and Duparc and functional according to Merle d’Aubigné. Results: The authors collected 71 cases of tibial plateau fractures. They accounted for 4.0% of all limb fractures, 5.8% of lower limb fractures and 33.8% of knee fractures in our service. The male sex was the most represented at 78.9% with a sex ratio of 3.7. The age group of [20 - 40] years was the most affected, i.e., 53.5%. The average age was 41 years with extremes of 17 and 82 years. The left side was affected (n = 47) and the right side (n = 24). Road traffic accident was the main cause. The mechanism of injury was mainly represented by lateral and sagittal compressions. Lateral unituberosity and bi-tuberosity fractures were the most frequent pathological types in our series, respectively 42.2% and 28.2%. The associated lesions were mainly represented by bone, ligament, skin and neurological lesions. The treatment was orthopedic in 52.1% and surgical in 47.9%. According to the functional criteria of PMA, our results were very good and good at 77.4%, Average at 14.1% and poor at 8.5%. Conclusion: It appears in this study that fractures of the tibial plateaus are frequent and serious because of their articular nature. Lateral and sagittal compressions are the most evoked injury mechanisms. Lateral unituberosity and bituberosity fractures are the most frequent pathological types. Functional and anatomical results are significantly better with surgical treatment.
文摘We present a case of a 33-year-old female who sustained multiple injuries of her spine, including spinous process fractures of C5 to C7 and a lamina fracture of C6 and C7. Her thoracic spine showed transverse process fractures of T4 to T10, a compression fracture and lamina fracture of T3, spinous process and transverse process fractures of T4 and T5, a rotation injury of T6, as well as a compression fracture of L1. Thirteen months after posterior thoracic spinal instrumentation, a pedicle screw was suspected to be in contact with the aorta, which was proved by computed tomography angiograms. Consequently, implant removal was planned with direct exposure of the aorta in order to allow for immediate repair if needed. So far, studies that compare different techniques to remove pedicle screws that are suspected to penetrate the aorta are missing. However, different techniques have been described in case reports, mainly minimally invasive endovascular techniques vs open techniques such as thoracotomy.
基金supported by the National Science & Technology Pillar Program of China(2012BAI18B07 and 2012BAI22B02)the National Natural Science Foundation of China(10925208 and 11120101001)the National Key Lab of Virtual Reality Technology
文摘Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament（ACL）reconstruction.Interference screw,as a surgical implant in ACL reconstruction,may influence natural loading transmission and contribute to tunnel enlargement.The aims of this study are（1）to quantify the alteration of strain energy density（SED）distribution after the anatomic single-bundle ACL reconstruction;and（2）to characterize the influence of screw length and diameter on the degree of the SED alteration.A validated finite element model of human knee joint was used.The screw length ranging from 20 to 30 mm with screw diameter ranging from 7 to 9 mm were investigated.In the post-operative knee,the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings,whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture.Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel;whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel.Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw.In consideration of both graft stability and SED alteration,a biodegradable interference screw with a long length is recommended,which could provide a beneficial mechanical environment at the distal part of the tunnel,and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel.These findings together with the clinical and histological factors could help to improve surgical outcome,and serve as a preliminary knowledge for the following study of biodegradable interference screw.
